Permit CITY OF TIGARD
,<<�� DEVELOPMENT SERVICES BUILDING PERMIT
i( PERMIT # : BUP97 -0467
�!+ -- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639.4171 DATE ISSUED: 10 / 14 / 97
PARCEL: 1S126DC -04800
SITE ADDRESS...: 09495 SW LOCUST ST #E
SUBDIVISION • LEHMANN ACRE TRACT ZONING:C —P
BLOCK LOT •004 JURISDICTION:TIG
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION —
CLASS OF WORK.:ALT FIRST • 0 sf N: S: E: W:
TYPE OF USE...:COM SECOND...: 1080 sf PROTECT OPENINGS?
TYPE OF CONST.:5N .... 0 sf N: S: E: W:
OCCUPANCY GRP.:8 TOTAL 1080 sf ROOF CONST: FIRE RET ?:
OCCUPANCY LOAD: 15 BASEMENT.: 0 sf AREA SEP. RATED:
STOR.: 0 HT: 0 ft GARAGE...: 0 sf OCCU SEP. RATED:
BSMT ?: MEZZ ?: REQD SETBACKS REQUIRED
FLOOR LOAD • 0 psf LEFT: 0 ft RGHT: 0 ft FIR SPKL: SMOK DET..:
DWELLING UNITS: 0 FRNT: 0 ft REAR: 0 ft FIR ALRM: HNDICP ACC:
BEDRMS: 0 BATHS: 0 IMP SURFACE: 0 PRO CORR: PARKING: 0
VALUE. $ : 35000
Remarks : Tenant improvement
Owner: FEES
MBM MEDICAL CENTER type amount by date recpt
9495 SW LOCUST PRMT $ 215.50 DRA 10/14/97 97- 300045
TIGARD OR 97223 SPCT $ 10.78 DRA 10/14/97 97- 300045
PLCK $ 140.08 DRA 10/14/97 97- 300045
Phone #: 245 -2415 FIRE $ 86.20 DRA 10/14/97 97- 300045
Contractor:
BNK CONSTRUCTION INC
PO BOX 66
CLACKAMAS OR 97015
Phone #: 503 - 557 -0866 $ 452.56 TOTAL
Reg #..: 001075
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Framing Insp
Tigard Municipal Code, State of Ore. Specialty Codes and all other Gyp Board Insp
applicable laws. All work will be done in accordance with r) 1►3
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 - 00101987.
You many obtain a copy of these rules or direct questions to OUNC
by calling (503)246 -1987.
1 ,
Permittee Signature. 40_, / %' Issue By: Q/
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Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
• Commercial Building Permit Application
City of Tigard \
13125 SW Hall Blvd. �6
Tigard, OR 97223
(503) 639 -4171
Jobsite Address: 1495 S_W_ T.ncust
Office. Use Only
Tenant: Clincal Research Suite # I /
Valuation: 35,000
Planck/Rec # /61
Pemiit # ( D91
Owner: MBM MEDICAL CENTER Map & TL #
Address: 9495 S.W. Locust Approvals Required
Planning
Phone: 245 -24154
Engineering
. Other
Contractor: BnR Construction
Address: 10730 S.E. Hwy. 212
Type of const: S■
Clackamas, OR
Occupancy class: B2
Phone: 557 -0866
Sprinklered? Yes No
Contractor's License # I 07555
(attach copy of current Oregon license) Sq. ft. of project: 1080
Contact name & phone: Bill Ludwig - 557 -0866 Story (1st, 2nd, etc.) 2nd
Proposed use: Medical Office
Architect/Engineer: Jon R. Jurgens & Assoc. , Inc.
Previous use: Medical Office
Address: 15455 N.W. Greenbrier Pkwy. Suite 260
Note: Plumbing & mechanical plans
Beaverton, OR 97006 must be submitted at time of
Phone:
(503) 690 -1779 building permit application.
JOB DESCRIPTION: Tenant Improvement (Non - Structural)
�M.i.v.. Ryt...q 690. 117 9 --
pplicant Sir ature Phone number
Receive by: , - _ Date Received:
Permit # Account Description Amount Amt. Pd. Bal. Due ..
Bldg. Permit (BUILD)
Plumb. Permit (PLUMB)
Mech. Permit (MECH)
State Tax (TAX)
Bldg:
Plumb:
Mech:
Plan Check (PLANCK)
Bldg:
Plumb:
Mech:
Sewer Connection (SWUSA)
Sewer Inspection (SWINSP)
Parks Dev Charge (PKSDC)
Residential TIF (TIF -R)
Mass Transit TIF (TIF -MT)
Commercial TIF (TIF -C)
Industrial TIF (T1F-1)
Institutional TIF (TIF -IS)
Office T1F (TIF -0)
Water Quality (WQUAL) •
Water Quantity (WQUANT)
Fire Life Safety (FLS)
Erosion Cntri Permit (ERPRMT)
Erosion Planck/USA (ERPLAN)
Erosion Planck/COT (EROSN)
TOTALS:
- OVER - THE - COUNTER (OTC) PERMIT
• COMMERCIAL ( STRUCTURAL) BUILDING PERMIT CHECKLIST
DESCRIPTION OF PROJECT: -r-/
CLASS OF WORK: 4-1 FLOOR AREAS: EXTERIOR WALL CONSTRUCTION
TYPE OF USE: COQ FIRST SQ. FT. i N: S: E: W:
TYPE OF
CONSTR: SECOND La° SQ FT PROTECT OP NGS ?:
OCCUPANCY GRP: Ig THIRD SQ. FT. N: S: E: W:
OCCUPANCY LOAD: 1 TOTAL SQ. FT. I ROOF CONS FIRE RET:
I I
STOR: HT: FT: BSMNT: SQ. FT. AREA :EP. RATED:
BSMNT?: MEZZ ?: GARAGE: SQ. FT. OCCU.SEP.RATED:
FIRE FIRE SMOKE HANDICAP
SPRINKLER: ALARM: ' ETE TOR: ACCESS:
I COMMERCIAL INSPECTION ACTIONS . FEE MENU
L g tp
Foot/Found Post/Beam 5 a — Permit Fee
Masonry Framing $ 14 °S Plan Review
Insulation Shear Wall • • t�(0 �$ 5% State Surcharge
Firewall Gyp Board ly� FLS Plan Review
Suspended Ceiling Sprinkler Rough -in 5 Add'I Permit Fee
Sprinkler Final Fire Alarm $ Add'I FLS Pln
Smoke Detector Approach /Sidewalk $ Inspection
Miscellaneous Final $ MIS Fee
FOR OFFICE USE ONLY:
TYPE OS USE OPTIONS (COM= commercial; CMS = commercial manufactured structure)
CLASS OF WORK OPTIONS FOR ALL PERMITS (NEW =new; Add = addition; ALT = alteration; ACS = accessory;FND- foundation;
OTR= other; DEM= demolition; REP= repair; FPS =fire protection system, NOTE: USE OTR FOR FENCES, RETAINING
WALLS, DETACHED DECKS, SIGNS, AWNINGS, CANOPIES)
I:\ovrcntr2.doc (DST) 4/97
•
OVER THE COUNTER (OTC) •
(attachment to Submittal Criteria)
SUBJECT: ACCESSIBILITY
• BARRIER REMOVAL IMPROVEMENT PLAN
REQUIREMENT: OREGON REVISED STATUTE (ORS) 447.241.
(1) Every project for renovation, alteration or modification to affected buildings and related
facilities shall be made to insurehhat the path of travel to the altered area and the restroom,
telephones and drinking fountains are readily accessible to individuals with disabilities, unless
such alterations are disproportionate to the overall alterations in terms of cost and scope
(2) Alterations made to the path of travel to an altered area may be deemed disproportionate to
the overall alteration when the cost exceeds twenty-five per -cent (25 %).
THEREFORE; Each submittal for a building permit shall include this form providing the following
information. [Excluding re- roofing, mechanical and electrical permit applications]
VALUATION of all renovation, alteration or modification being done
excluding painting, wallpapering. [1] $ .2.5 � 000
multiply: 25% Barrier removal requirement _ .25
BUDGET FOR BARRIER REMOVAL [ $ 6 , 2 50
The dollar amount of the BUDGET established on line (2) in the computation above shall be spent
providing the accessible elements in the following order.
1. An accessible route connecting the building to accessible pedestrian
walkways, and the public way. $
(including but not limited to curb ramps, detectable warnings,
marked crossings, ramps handrails and landings).
2. Not less than one accessible parking space. $
(including but not limited to adjacent access aisle, signs and curb ramp
connecting with the accessible route).
3. Accessible entry or entries. $ 8 5 0
(including but not limited to ramps, handrails, landings,
door sill height, door width and door hardware).
4. An accessible interior route to the altered area. $
(including but not limited to door -ways, maneuvering •
clearances, door hardware and stairways).
5. At least one accessible restroom for each sex. $ 7 , 6 50
6. At least one accessible telephone where public phones
are provided. $
7. When drinking fountains are required, fifty per -cent but
not less than one shall be accessible. $
8. Additional accessible elements such as storage, reach ranges,
alarms, etc.. $
TOTAL` Shall equal line 2 of Value Computation $ . 8,500
is /otc4.doc(DST)
2/10/00 Activities for Case #: BUP97 -00467
4:16:53 PM •
• Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
BUPC005 Application received 10/9/97 DRA RECD BON 10/9/97
BUPC008 Permit created 10/9/97 • B • DONE BON 10/9/97
BUPC010 Check for prd. restrict. 10/9/97 DRA DONE BON 10/9/97
BUPC012 Plans routed to Plans Examiner - 10/9/97 DRA DONE BON 10/9/97
BUPCO26 Approved Plans routed to DSTs 10/9/97 RDP APPR BON 10/9/97 .
BUPC740 Framing Insp 11/3/97 GS PASS GES 2/19/98
BUPC760 Gyp Board Insp 11/10/97 GS PASS GES 2/19/98
BUPC802 Final Inspection 1/26/00 RB PASS AKJ 1/26/00
BUPCO29 DST Post Review Completed 10/14/97 B DONE BON 10/14/97
BUPC090 (F) Ready to issue 10/14/97 B PASS BON 10/14/97
BUPC100 (F) Issue permit 10/14/97 DRA PASS DRA 10/14/97
BUPC762 Susp Ceilng Insp 11/24/97 GS FAIL J *H 11/24/97 1. Electrical inspection required
. for low voltage; permit and
inspection. 2. Need ladder on
site for electrical inspector and
ceiling cover
inspection /approval.
BUPA865 Request inspection research 1/24/00 JMT DONE No Hold JMT 1/24/00
BUPC960 Case Finaled 1/26/00 AKJ DONE No Hold AKJ 1/26/00
Page 1 of 1
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639-4171 9 _7 d o v �o
Date Requested // ,m,, pg/C50 AM PM BLD
Location qy CXJ Suit f 9 7'CO
Contact Person Ph PLM
Contractor Ph SWR
(UILDIN5 Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes
Slab SIT
Post Beam �I n ..�,�� _ , „ ,411/
Ext Sheath/Shear (� �
Int Sheath /Shear
Framing INA — 00 A / 6 YsA-
Insulation
Drywall Nailing V (- _ 1 . 0
Firewall /`
Fire Sprinkler i 9 (7_ QU �q
Fire Alarm
Susp'd Ceiling
Roof
Misc: � 1
- ART FAIL
- ING '
Post & Beam
Under Slab
Top Out �
Water Service
Sanitary Sewer
Rain Drains
Final
RT FAIL
CA
M ANICAr
Post 8 Be �
Rough
Li I
Gas Line
\
Smoke Dampers
na
PART FAIL
TRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA f
Approach /Sidewalk Date U Inspector Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.