Permit CITY OF TIGARD ,�, f BUILDING PERMIT
_ 4 .1 , ^ f. .
COMMUNITY DEVELOPMENT Permit #: BUP2011 -00271
T I G A RD D 1 3125 SW Hall Blvd., Tigard OR 97223 503.718.2439 �� ®® Date Issued: 03/23/2012
Parcel: 1S 136 DCO2504
Jurisdiction: Tigard
Site address: 7275 SW DARTMOUTH ST 180
Project: Tigard Triangle Smiles Subdivision: HUNTER POLLOCK NO.2 Lot: G
Project Description: TI. 4/19/12, reprinted to add suite number, 180.
Contractor: BNK CONSTRUCTION INC Owner: AMERICAN INDUSTRIES INC
45 82ND DR SUITE 53B 1750 NW FRONT AVE STE#106
GLADSTONE, OR 97027 PORTLAND, OR 97209
PHONE: 503- 557 -0866 PHONE:
FAX: 503 - 557 -1085
FEES'
Specifics: , Description Date Amount,
Type of Use: COM Permit Fee - Additions, Alterations; 03/23/2012 $1,371.71
Class of Work: ALT Demolition
Dwelling Units: 0 -12% State.Surcharge - Building 03/23/2012 $164.61
Stories: 1 Height: 0 ft Plan'Review _ 12/29/2011 $891.61
Bedrooms: 0 Bathrooms: 0 Plan, Review - Fire Life Safety 12/29/2011 $548:68 •
Value: $144,000 DC Provision Review, COM TI - Ping 03/23/2012 $160.00
DC Provision Review, COM TI - LRP 03/23/2012 $24.00
Info Process /Archiving - Lg $2.00 (over 03/23/2012 $24.00
Floor Areas: 11x17)
Info Process /Archiving - Sm $0.50 (up to 03/23/2012 $4.00
Total Area: 0 11x17)
. Accessory Struct: 0 Metro Const. Excise Tax - Commercial 03/23/2012 $172.80
Basement: 0 Use
Carport: 0
Covered Porch: 0
Deck: 0
- Garage: 0
Mezzanine: 0 •
Total $3,361:41
Required: Required Items and Reports (Conditions)
Fire Sprinkler: Yes Parapet:
Fire Alarm: Yes Protected Corridors:
Smoke Detectors: Manual Pull Stations:
Accessible Parking: 0
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. 'Specialty Codes and ell other applicable law. All work will
be done in actor a with approved plans. This permit will expire if work is not started within 180 days of ' issuance, or if work is suspended for more the 180
days. A ION: Orego aw requires you to follow the rules adopted by the Oregon Utility Notification Center, Those rules are set forth in OAR
952 -00 010 through OAR 952 -001 -• • • 1. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232. • ;7 or 1.800.332.2344.
Iss ed By: :///' . ` // ii Permittee Si • _\;; 4V �"`lCCaee��444 ///
_ _
Call 503.639.4175 by 7:00 a.m. for the next available ns • : solid
. This permit card shall be kept In a conspicuous place on the Job site until co pletion of the project
Approved plans are required on the job site at the time of each Inspection.
CITY OF TIGARD BUILDING PERMIT
III
$ • COMMUNITY DEVELOPMENT Permit #: BUP2011 -00271
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/23/2012
Parcel: 1 S136DCO2504
Jurisdiction: Tigard
Site address: 7275 SW DARTMOUTH ST
Project: Tigard Triangle Smiles Subdivision: HUNTER POLLOCK NO.2 Lot: G
Project Description: TI
Contractor: BNK CONSTRUCTION INC Owner: AMERICAN INDUSTRIES INC
45 82ND DR SUITE 53B 1750 NW FRONT AVE STE #106
GLADSTONE, OR 97027 PORTLAND, OR 97209
PHONE: 503 - 557 -0866 PHONE:
FAX: 503 - 557 -1085
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee - Additions, Alterations, 03/23/2012 $1,371.71
Class of Work: ALT Demolition
Dwelling Units: 0 12% State Surcharge - Building 03/23/2012 $164.61
Stories: 1 Height: 0 ft Plan Review 12/29/2011 $891.61
Bedrooms: 0 Bathrooms: 0 Plan Review - Fire Life Safety 12/29/2011 $548.68
Value: $144,000 DC Provision Review, COM TI - Ping 03/23/2012 $160.00
• DC Provision Review, COM TI - LRP 03/23/2012 $24.00
Info Process /Archiving - Lg $2.00 (over 03/23/2012 $24.00
Floor Areas: 11x17)
Info Process /Archiving - Sm $0.50 (up to 03/23/2012 $4.00
Total Area: 0 11x17)
Accessory Struct: 0 Metro Const. Excise Tax - Commercial 03/23/2012 $172.80
Basement: 0 Use
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $3,361.41
Required Required Items and Reports (Conditions)
Fire Sprinkler: Yes Parapet:
Fire Alarm: Yes Protected Corridors:
Smoke Detectors: Manual Pull Stations:
Accessible Parking: 0
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. 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 uance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notificati•i Cen�ter. Those rules are set forth in OAR
952- 001 -0010 through OAR 952- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503 ,r,w,; 87 or 1.800.332.2344.
Issued By: Permittee Signature: ��� i /2 4 5 :2 )4 . 7 - 4.e ......
,orr:(9P Call 503.639.4175 by 7:00 a.m. for the next available Inspe . • n date.
This permit card shall be kept In a conspicuous place on the Job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
Commercial �� FOR OFFICE USE ONLY
I N City SW of Tiga 4d fk Received permit No.:
Date /B n : Review -� p �J/ �G f f .
C ° 13125 Hall Blvd., Tigard, OR 9 3 �� a
Phone: 503.718.2439 Fax: 503.598.1961 �
, � G `S� O� Pla Date/B : /�e7JQo
TI G A R D Inspection Line: 503.639.4175 0`% 4 0 % ■ Date Ready ty: ® See Page 2 for
Internet: www.tigard or.gov G ` • Notified/Method: f- ? )II M Supplemental Information
\`
TYPE OF WO1Q REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑ New construction 0 Demolition ' Permit fees* are based on the value of tho vs.r( performed.
Indicate the value (rounded to the ne- .,filar) of all
❑ Addition/alteration/replacement 5TOther7, ' . ! equipment, materials, labor, over' ..id the profit for the
CATEGORY OF CONSTRUCTION work indicated on this applicr
❑ 1- and 2- family dwelling Commercial /industrial Valuation:
❑ Accessory building ❑ Multi- family Number of beds-
❑ Master builder ❑ Other: Number c ,oms:
JOB SITE INFORMATION AND LOCATION Totr .r of floors:
Job site address: `" )' ) l 4tj 040T 14 0;11-1 .F1.Vb .ellin area: square feet
City/State/ZIP: TV) 0 1 ; .age /carport area: square feet
Suite/bldg. /apt. no.: Project name: T / 1 , -.: j lc iSt L Covered porch area: square feet
Cross street/directions to job site: i Deck area: square feet
Other structure area: square feet
—
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: Lot n' Permit fees* are based on the value of the work performed.
Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK C / work indicated on this application.
Valuation: $ ILitl , GOD
?-- (t1-A ' cc) ar, 1 n1�1 'j'Vw'tvR�. f x2.34 ? 6'i , T 0744_
1 L b1 c -i-G45, � 9;411, \ / Existing building area: �� p square feet
l 6 J✓ New building area: 7 'L
, . Qi square feet
OPERTY OWNE j / t] TENANT Number of stories: '
Name: ✓ A.1 G
VA^ /d�yS.� � , - �L Type of construction: '27
Address: 1 -) 'c O p,., ju n; .. kk 60 , 1 _ _ -� 1 b c, ! Occupancy groups: '
City/State/ZIP: 'D4,1 LA>' OIL , a J D 1� ; Existing:
Phone: ( ) "L22 _ 0(1,00 Fax: (S(.) 2ZL - Dt.;) v l New:
APPLICANT ONTACT PERSON BUILDING PERMIT FEES*
Business name: 'C& 0 . A-44i_ ,e5/70\ (Please refer to fee schedule
Structural plan review fee (or deposit):
Contact name: -5,,A, r c 4 ,t
1,0%4 C 4 tai f AI FLS plan review fee (if applicable):
Address: _ l l
f �� Total fees due upon application:
City/ State/ZIP: CC)/ , A A CA ci 1 t
�� ( I (ju ) Amount received:
Phone: ( �) ' �j, Li . , Fax:: [ 3 T � G S'
�q PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
E-mail: I t e'- e-YI s e. ()}-L Ol �N . L 0 A
a Commercial and residential prescriptive installation of
CONTRACT R roof -top mounted Photo Voltaic Solar Panel System.
Business name: ,644/4. f $772 [ e . Aj Submit two (2) sets of roof plan with connection details
Address: y�' ca 41 and fire department access, along with the 2010 Oregon
.4 6 4 Sr a- Solar Installation Specialty Code checklist.
Permit fee (includes plan review
City/State/ZIP: -- ps'��e-. p 9 �O � and administrative fees): $ISO.00
,
Phone: /
(.�Q..1� �S7 —Q �(p 6, Fax: ( ) State surcharge (12% of permit fee): $21.60
CCB lic.: /e 7 4 ` S '
I____. Total fee due upon application: $201.60
Authorized signature:. This permit application expires if a permit is not obtained
. within 180 days after it has been accepted as complete.
Print name: S NP Date: 7;5 LA4P- i f� * S ervice B
I: \Building\Pennits\BUP -COM PennitApp.doc 02/24/2011 440- 4613T(1 1 /02 /COM/WEB)
1 o ° Building Division
Development Code Provision Review
TIGARD Commercial Projects - No Associated Land Use Case
Building Permit No: 01,1 P (' -tom ) ❑ Expedited Review
Plan Submittal Date: )d,/ iii .&.'7-
To the Applicant:
➢ If the proposed use is not permitted within the zone, please contact the Building Division to cancel
the permit application. Building Permit Technicians (503) 718 -2439.
• If a land use is required and for all other questions, please contact the staff person listed above the
Planning Review section.
Staff: please check items along left only if / approved.
Planning Review (contact 7 ,72 `1 i Rga.(`. at 503 - 718 -2 X13'( or @ ti gard- or.gov)
❑ Zoning C - & (P J Permitted Use Yes p No ❑
❑ Land Use Required: Yes X No ❑ (explain below)
Notes: /M /NW fk?c f ficA . 2 l/[ F -f c 5a-A - �iuc� del i el4.-t'
--r id a _ -_ : c t a....- . . lid , , o ' � 4, _ 0-� , ,g, b5:2:
Filorn 3.'7 1 xo . e to 3. ` I i 000 s K , /i /o.; 3hIG AeLL Jo (liar/did / pme « .
1,5 avecu,v% ti- u J2 ,w0 7Nr , tic e elia-kLC4"
. i 01' V+1 r, kJ ' L_ , U /2c°d/ /....?4,0. OS'o } .
Approved p ed Date: / Z - 3 1 )'// ( 'K&
*p( oLqJ' -/- a Q.i/
Permit Coordinator Review (contact Albert Shields at 503- 718 -2426 or albert @tigard - or.gov)
Notes:
Routed back to Building Division Date: •
•
•
I: \CURPLN
1111 _ ° Building Division
Accessibility: Barrier Removal Improvement Plan
TIGARD
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 insure that 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 %).
VALUATION: Total of all renovation, alteration or modification being done, 'k c ,, `` ,,
excluding painting and wallpapering: [1] $ I' 7
MULTIPLIER (25% barrier removal requirement): x .25
TOTAL BUDGET FOR BARRIER REMOVAL: [2] $ /2212 i 0 0
ELEMENTS: In choosing which accessible elements to provide under this section, priority shall be given
to those elements that will provide the greatest access. Elements shall be provided in the
following order.
(a) Parking $ ‘, d -C S
(b) An accessible entrance: $ CtDrylll s
(c) An accessible route to the altered area: $ Gvr(J[ i LS
(d) At least one accessible restroom for each sex or a single unisex
restroom: $ C DAVI t -4 3
(e) Accessible telephones: $ d`— in
(f) Accessible drinking fountains: and, $ tt l /1-
(g) When possible, additional accessible elements such as storage and ` � /
alarms: $ l7 (.--
TOTAL (shall equal line [2] of Valuation Computation): $
I:\ Building \Permics \BUP -OOM PemmitApp.doc 03/03/2011
Pacific Dental Services
December 27, 2011
To: City of Tigard
13125 SW hall Blvd,
Tigard Or 97223
503- 718 -2439
RE: Tigard Triangle Smiles
7275. SW Dartmouth Ave., Suite `TBD'
Tigard, OR
Description:
Enclosed please find for your use and review for our first submittal:
- One (1) Building permit application
- One (1) Electrical permit application with limited energy permit fee form
- One (1)Mechanical permit application
- One (1) Plumbing Permit application (both pages)
- One (1) commercial, application checklist
- One (1) payment authorization form
- Two (2) short circuit forms for panel A and Panel B
- Two (2) electrical corn check forms
- One (1)' set of electrical equipment cut sheets (per check off list)
- One (1) set of plumbing equipment cut sheets (per check off list)
- One (1) Accessibility barrier removal form completed (all shell work on this project is done
under separate permit, please let me know what I need to fill out in this form to comply)
- Three (3) wet signed sets
- Two (2) extra A -0 site plan sheets
If you have any questions please call me at (951) 582 -5745.
Sincerely,
Julie A. Margetich, NCARB, LEED Assoc.
Architect
2044 California Ave., Corona, CA 92881
Phone (951) 582 -5745 • Fax (714) 388 -3951
•
e -mail: margetichj @pacificdentalservices.com