Permit CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2003 -00219
4 DEVELOPMENT SERVICES DATE ISSUED: 7/9/03
' ---' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 10215 SW HALL BLVD PARCEL: 1S135AA-01400
SUBDIVISION: METZGER ACRE TRACTS ZONING: C - N
BLOCK: LOT: 037 JURISDICTION: TIG
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: NEW FIRST: 9.175 sf N: NR S: NR E: NR W: NR
TYPE OF USE: COM SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: 5N sf N: N S: N E: N W: N
OCCUPANCY GRP: B TOTAL AREA: 9,175 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: 48 BASEMENT: sf AREA SEP. RATED:
STOR: 1 HT: 31 ft GARAGE: sf OCCU SEP. RATED:
BSMT ?: MEZZ ?: Y REQD SETBACKS REQUIRED
FLOOR LOAD: psf LEFT: ft RGHT: ft FIR SPKL: Y SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:Y
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 798,225.00
Remarks: New 2 -story dermatology clinic.
Owner: Contractor:
INTEGUMEND LLC BY SCOTT COLLINS MD JOSEPH HUGHES CONSTRUCTION,INC
& MARIA ROSS MD 7035 SW HAMPTON
9495 SW LOCUST STREET TIGARD, OR 97223
PORTLAND, OR 97223
Phone:
Phone: 624 - 7100
Reg #: LIC 45645
FEES REQUIRED INSPECTIONS
Description Date Amount Erosion Control Insp 846 -8, Insulation Insp
[BUPPLN] Pln Rv 5/5/03 $1,734.92 Mechanical Permit Require Shear Wall Insp
[FLS] FLS Pln Rv 5/5/03 $1,067.64 Electrical Permit Required Gyp Board Insp
Sprinkler Permit Required Susp Ceilng Insp
[PKSDC] Parks SDC 7/9/03 $2,480.00 Plumbing Permit Required Appr /sdwlk Insp
[TIF - O] TIF Office 7/9/03 $33,330.00 Foot/Found Insp Final Inspection
(additional fees not listed here) Slab Insp
Masonry Insp
Total $46,562.29 Framing Insp
Roof nailng Insp
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes
and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of these rules or direct questions to OUNC by
calling (503) 246 -6699 or 1- 800 - 332 -2344.
Issued By: / i ZiA4_,...)
Pe rm ittee ` /
Signature: ( • ,,, „ 1 1
CaII 639 -4175 by 7 p.m. for an inspection the next business day
i 02.1S Stti aL-W
j� p + - - - FOR OFFICE USE ONLY
iB11fT1 °��'lrll ��er I!4 . . .. , 1° �•l�� Received n R Q Building , G
�` U a* Date/By: C 4- ' �; th Permit No.: bi (,t r Ap 4 5- Oei t /
Y�
City f Tigard Planning Approval Other
Y g MAY 0 5 2003 Date /By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 CITY OF TIGARD Date/By: Permit No.:
Phone: 503- 639 -4171 FaK)f f_031 8- MOVOSIO" 11 ''' 11t� Post - Review Land Use
• 1 bate/By: Case No. , v/2 6 000
Internet: www.ci.tigard.or.us . ^=^^ Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name/Method: Supplemental Information
.... _ _,.��.. � . _.r _,_.» ,_�, _w., ._..�...,_ ._ - -- A,.:., . „ ., .;.��.» -� ��. , �.- -tom: -:;� s _ M_�: y a� _ r��:t
r r M¢Z � : ��,�.� ` � 011i1 � � -... � . . r i � � � ".3 ��' � € 12Pj � UIR ED DA ' � < -af.
New construction ❑ Demolition R - -1` iii ,' &z2 F A yel , LLING � � . �_
❑ Addition/alteration/replacement ❑ Other:
I.. x,r fees* the work
��1�, .b- >y „' eCATEGbRX�bF'C®lY : T�RUCTIOIY�_ ;; , k',� +;. „;' Note: • �rmit fees are based on the total value of t performed. Indicate p
❑ 1 & 2- Family dwelling 1r, Commercial/Industrial the value (r. • • .ed to the nearest dollar) of all equipment, materials, labor,
overhead and pro or the work indicated on this application.
❑ Accessory Building • ulti- Family
❑ Master Builder 111 Other: Valuation $
',Sar t” - a . ,V A ve g . . x v t -1
No of bedrooms: o.. . at I s:
, a���� �. �J9B�5��E._� F012�TIQN�and�,® _ IQ � i `�,° �i�:
� , u X 1 ' 5l `/� Total number of floors
Job site address:. ® / 1 T/'�{ -4 �F-1( New dwelling area (sq. ft) .... •
Suite #: a -( , Bldg. /Apt. #: , / Garage /carport area (sq. ft.)
Project Name: 1 (J l j IN\ �I,v Covered porch area (sq. ft.)
Cross street/Directions t o job it e: . Deck area (sq. ft.)
t
` t - 1 1 B � V� G 4 , c , 0 Other structure area (sq. ft.)
b u� ��'• 4 8 - r Av - pit /� . - `
w #. -.ti �• ��o ff � „ a k- „
� temeir w fi
„ e � S 9ag ` ' m
Subdivision: Lot #:
Tax map /parcel #: "Ttdic 1F-"��T- OM Note: Permit fees* are based on the total value of the work performed. Indicate
my_ a'DS`C_$IPmTION�OTtWC)RIC 0 ,5 ;. the value (rounded to the nearest dollar) of all equipment, materials, labor,
overhead and profit for the work indicated on this application. �—�
t� .W & N r. I Srb M 2IGN ����p� . Valuation PeRTAt e ootTY z•9d � , _ .►�.• -�
6 L MG C� I o -- lhll 41 t";'tw - Existing building area (sq. ft.) �"
New building area (sq. ft.) al # 7`
Number of stories f
-�`' - --� - °� � � Type ✓� _
PI2 ®�1Z'r�'..Q�'1�R. � �:- : � �� TENANT �, _x :� . YP e of construction - I
Name: I t.fl 0 V Li... G Occupancy group(s): Existing: %- tg
New: 8
Address: 0 14 W LAGtrer Irr-
City /State /Zip: bRrILAN O Pte'.• ¶7 'L2�
P � ' � F � 2 NOTICE: All contractors and subcontractors are required to be
Oregon Construction Contractors Board under
. rie J CP licensed with the Ore
:.';, -- = - C c g
� � � L T�Q NT,. ` ..�. � � �- pro of ORS 701 and maybe required to be licensed in the
Business Name: v o l t ) t 4 iii • jurisdiction where work is being performed. If the applicant is exempt
Contact Name: NV t t7 Fo► ('' from licensing, the following reason applies:
Address: 2 N vk -r+ , # ao
City /State /Zip: Pig 1 15 91201
Phone: 5b3.2240'(pr 5 Fax: ,5∎) - ' 2?1) �3 } - r � IIYG 4 E µ I? E S * , A
E-mail: p� 6! (SS e, �Y�,G Y1 °�- C( ; eta a ref o re Y c el �; :-
c;+f�5 �, `;CC21`1„.:"'a,0 > - . , '{`� II 'Fa .: `°h... .a -
Business Name: c ysc-ierl-A c ki �� .2
'• Fees due upon application $ 3 2Z
Address: O�PM 6N .31 .
°" IN 3,Sy2 •ZZ
City /State /Zip :fl , • 9 Amount received $
Phone: St3.( I I op Fax: 505. • • r Date received: ,..2. ', / ,
• CCB ate: Lic. #:
Authorized // t , 5"... �
�i Notice: This permit application expires if a permit is not obtained within
Signature: / Ll�� � i , 180 d ays after it has been accepted as complete.
J P " /x *Fee methodology set by Tri -County Building Industry Service Board.
av (Please print name) .
i:\Dsts\Pemiit Forms \BldgPermitApp.doc 01/03
� A ,� Commercial Plan Submittal
I Requirement Matrix
City of Tigard
i TYP ioEisuBMIT • -, ' 4 #irof laps
g ` (Included New Addrtlons or Alterations: Required at
Site Work 4 •
(must include location of all accessible parking) .
i Plumbing - Site Utilities 2
Building 1*
Fire Protection System 3 ** . •
I
Mechanical 2
Plumbing - Building Fixtures • .2
•
Electrical 2
Plan review dependent upon submittal of a completed application and plans. After
plan review approval, the Plans Examiner will contact the applicant to request ,
additional sets of plans for distribution purposes (for Contractor, City of Tigard,
Washington County, and•Tualatin Valley Fire & Rescue).
*For over - the - counter commercial tenant improvements, submit 2 sets of plans.
** "New" fire protection systems require that plans bear the original seal of an
Oregon licensed fire suppression engineer, or NICET level "3" technicians.
r'
i:\dsts \forms \COM- matrix.doc 9/24/01
1 • DATE: NS CHECK
"a O- 0 3 c 9 .
PROJECT TITLE:
COUNTYWIDE 1- h '/ - eG,yum en c! GL
TRAFFIC IMPACT FEE 0
WORKSHEET APPLICANTi
u i i 55 -} 455 oc_,
(FOR NON - SINGLE FAMILY USES) MA UN a ADDRE W s _ A 30
CITY/ZIP /PHONE: ? 1 1 and 0 J /` 7 dv _/
TAX MAP NO.: '!
SITES NO.ADDRESS:
LAND USE CATEGORY RATE PER TRIP /0 a/5" / 11 Bic/J.
RESIDENTIAL $ 239.00
BUSINESS AND COMMERCIAL $ 60.00
OFFICE $ 220.00 •
INDUSTRIAL $ 230.00 4 'e V Is e d Ca /c la i 'a5
INSTITUTIONAL $ 99.00
PAYMENT METHOD:
CASH /CHECK
CREDIT
BANCROFT (PROMISSORY NOTE)
INSTITUTIONAL ONLY:
DEFER TO OCCUPANCY LAND / USE CATEGORY DE �IPTION OF USE WEEKDAY AVG. WEEKEND AVG. TRIP RATE
Cp 3 O
(--;// � f ` G I TRIP RATE x3.
BASIS:
J? pJrC4/!4 elf 05eS C 5 o-P 9000 s/ . - m
C /l'ii I' c . • C, lit f* G puY'n d N 0-F yhe, ht Id.' n ' s 9d 7 ¢
rn r citgil ( rook, i 5 App p ry x a o 0 0 O. i /F CA l - F - r d -
��r- �,• oh '/
CALCULATIONS:
TIP - 77 G. S. R av er 4 5 /y p ra 4 e X rCi-f e p.e --r i p.
6 . R a "7 x a 3. 7 `f x dc) = - �F
• PROJECT TRIP GENERATION:
/�f / /(a5"
/ r � Q = � � }'i � 5 )C ��� - 3V I 0 FEE: �} O
FOR ACCOUNTING PURPOSES ONLY
• ADDITIONAL NOTES:
RO D AMT
3 330. o0
TRAy,s IT no
PREPARE, Y:
•
i:\dsts\tinTIF- WkSht.doc 07/17/02 -
'"
Return Recorded Document to:
City Hall Records Department
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223
TRAFFIC IMPACT FEE
Installment Payment Application and Disclosure Statement
In the Matter of the Traffic Impact Fee for Intequmend LLC
Tax Map 1S135AA
Lot Number(s) 01400
and as further described in Deed #
Building Permit # BUP 2003 -00219
Site Address 10215 SW Hall Blvd.
Subdivision
Case File # SDR 2003 -00002
TIF Land Use District C -N
To Be Billed To: Intequmend LLC
Address: 9495 SW Locust St., Portland, OR 97223
To the City of Tigard:
In accordance with the provision of Oregon Revised Statute 223.208 and Washington County Code 3.17 which relates to the imposition of a traffic
impact fee for the financing of major collector roads and arterials of Washington County, I /we HEREBY MAKE APPLICATION AND AGREE,
JOINTLY AND SEVERALLY, to pay my /our traffic impact fee, as has been determined by Washington County Code 3.17 in 20 semi - annual
installments of the amount financed together with one -half of one year's interest thereon at a rate of 5.19 annual percentage rate on the unpaid
amount owed. The lien date is the first day of the month following the date the application is signed. The first payment is due six months thereafter
and at six (6) month intervals thereafter for a period of 10 years. Each installment payment will include principal and interest.
If I \we neglect or refuse to pay any part of the installments provided herein, including interest, within one (1) year after the same shall have become
due and payable, then the whole amount of the unpaid assessment shall become due and payable at once and shall be collected in the manner
provided by law including foreclosure on the above - described real property.
The traffic impact fee, annual percentage rate of interest ( 5.19 %) and finance charges which I /we agree to pay are as follows:
HIGHWAY TRANSIT
1) Amount of Traffic Impact Fee $ 33,330.00 $2,970.00
2) Amount Financed • $ 33,330.00 $2,970.00
3) Equal Semi-Annual Principal Payments $ 1.666.50 $148.50
4) Interest on Balance at Rate of 5.19 %
I \We understand that the amount owed, as stated above, shall be a lien on the above - described subject property pursuant to Washington County
Code 3.17 and ORS 223.230. \\
l
DATED this day of Jv _ , .
fir
(te(A.,4/ Oi./
Sig : ure of Property'Owner(s) • Signatur'of Property Owner(s)
STATE OF OREGON ) Name (Please Print): Et (c2(I( %�6, rr/ 2, SS
/Yud c Cte( O-' I 7Sf7 //lot /� (�e
County of Washington ) Address: . • 0 .. ( 7 3 . F
j2 ff n r
IP • • .r/r •
SUBSCRIBED AND SWORN TO BEFORE me this J day of c) Iti , 1' 20D 3 c_)/ c 03 i
Notary • ublic for Or -.on ('d7/ OFFICIAL SEAL
01 J BENGTSON
My Commission Expires: I J r NOTA PUBLIC - OREGON
COMMISSION NO. 368086
DOCUMENT1 I) MY COMMISSION EXPIRES APR. 27, 2007
CITY OF TIGARD 24 -Hour _ . .
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested /D c9`- AM PM) BUP — CO l
Location 1 O / S ,''h _- J A /vd • Suite MEC
Contact Person °T; "'t 76 '--0/ Ph ( ) a / — .S PLM
Contractor Ph ( ) SWR
(UILDIIV Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath /Shear // ���
Framing ■ i' ,Or / -- -fie C • • L. L%ti5, . ,
Insulation t OPP" r
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
•
"Final
AS$ PART FAIL --
BING
Post & Beam
71 -----9
Under Slab
Rough -In
\.../
Water Service \
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final G r ( gZ� l M a G/
PASS PART FAIL G0 S '1111111 k PP""
MECHANICAL -
Post & Beam ..
Rough -In 4 �•
Gas Line \
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL Q 5 li A -
Service
Rough -In •
UG /Slab
Low Voltage
Fire Alarm
Final E... Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE - < 0 Please call for reinspection E: ❑ Unable to inspect — no access
Fire Supply Line r°1 t Y - ,∎-
ADA
Approach/Sidewalk Date In pector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site. .
PASS PART FAIL