Permit CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2003 -00592
46 DEVELOPMENT SERVICES DATE ISSUED: 10/2/03
{--- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 12442 SW SCHOLLS FERRY RD 100 PARCEL: 1 S1346C -00401
SUBDIVISION: ZONING: C -N
BLOCK: LOT: JURISDICTION: TIG
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: ALT FIRST: sf N: S: E: W:
TYPE OF USE: COM SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: 3 -1 HR : sf N: S: E: W:
OCCUPANCY GRP: B TOTAL AREA: 0 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: BASEMENT: sf AREA SEP. RATED:
STOR: HT: ft GARAGE: sf OCCU SEP. RATED:
BSMT ?: MEZZ ?: REQD SETBACKS REQUIRED
FLOOR LOAD: psf LEFT: ft RGHT: ft FIR SPKL: SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 100,000.00
Remarks: Tenant improvement to remodel reception area, exam rooms & office space.
Owner: Contractor:
SISTERS OF PROVIDENCE IN OR BNK CONSTRUCTION INC
BY STEVE FOSTER 10730 SE HWY 212
PO BOX 13993 PO BOX 66
PORTLAND, OR 97213 CLACKAMAS, OR 97015
Phone:
Phone: 557 -1085 FAX
Reg #: 15ffif0866 00003941
FEES LIC REQUIRED INSPECTIONS
Description Date Amount Mechanical Permit Require
[BUILD] Permit Fee 9/25/03 $744.30 Electrical Permit Required
[TAX] 8% State Tax 9/25/03 $59.54 Sprinkler Permit Required
Plumbing Permit Required
[BUPPLN] Pln Rv 9/25/03 $483.80 Framing Insp
[FLS] FLS Pln Rv 9/25/03 $297.72 Gyp Board Insp
Total Susp Ceilng Insp
$1,585.36 Final Inspection
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 - 0 t0 fihr +ugh OAR 952 - 001 -0100. You may obtain a copy of these rules or direct questions to OUNC by
callin 503) 246 -66° • or 1- 800 - 332 -2344.
/ 1 `. v.- i i . /
Issue y: , i 4 , ' I
Permittee _ e-- �—
Signature:
Call 639 -4175 by 7 p.m. for an inspection the next business day •
Building Permit Application FOR OFFICE USE ONLY
Received Building /) _ cn
' Date/By: y: � &.-5 � � Permit No. /' C.V� J
Cit of Ti and Planning Approval Other
y g Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: /0 *7i"' � Permit No.:
Phone: 503- 639 -4171 Fax: 503 - 598 -1960 r N�i t Post - Review Land Use II
Internet: www.ci.tigard.or.us �• ∎ Date/By: Case No.
g Contact s • ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name/Method: / 1O Supplemental Information
TYPE OF WORK REQUIRED DATA:
❑ New construction ❑ Demolition 1 & 2 FAMILY DWELLING
® Addition/alteration/replacement ❑ Other:
CATEGORY OF CONSTRUCTION Note: Permit fees* are based on the total value of the work performed. Indicate
❑ 1 & 2- Family dwelling ® Commercial/Industrial the value (rounded to the nearest dollar) of all equipment, materials, labor,
overhead and profit for the work indicated on this application.
❑ Accessory Building ❑ Multi- Family
❑ Master Builder ❑ Other: Valuation $
JOB SITE INFORMATION and LOCATION No. of bedrooms: No. of baths:
Job site address: 12442 SW Scholls Ferry New New Road Total number dwelling a floors
area (sq. ft.)
Suite #: /CO Bldg. /Apt. #: Garage /carport area (sq. ft.)
Project Name: PMG Remodel Covered porch area (sq. ft.)
Cross street/Directions to job site: Deck area (sq. ft.)
Other structure area (sq. ft.)
Southeast corner of Scholls Ferry Road and
SW 125th Avenue REQUIRED DATA:
COMMERCIAL - USE CHECKLIST
Subdivision: Lot #:
Tax map /parcel #: Note: Permit fees* are based on the total value of the work performed. Indicate
DESCRIPTION OF WORK the value (rounded to the nearest dollar) of all equipment, materials, labor, •
overhead and profit for the work indicated on this application.
Remodel to the interior of an existing
Medical Office Building, consisting of new Valuation $ 100, 000.00
Waiting /Reception Area, exam rooms and Existing building area (sq. ft.) ___
New building area (sq. ft.)
off ice space. Number of stories 2
_ Ei PROPERTY OWNER I ❑ TENANT Type of construction III 1 -11R
Name: Providence Health System Occupancy grou Existing: - B -
New:
Address: 4706 NE Glisan Street
City /State /Zip: Portland OR 97213
Phone: 503 - 215 - 2692 Fax: 503 - 215 - 6802 NOTICE: All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board under
12 APPLICANT
❑ CONTACT PERSON provisions of ORS 701 and may be required to be licensed in the
Business Name: Jon R. Jurgens & Assoc., Inc. jurisdiction where work is being performed. If the applicant is exempt
Contact Name: Paul R. Borowick from licensing, the following reason applies:
Address: 15455 NW Greenbrier Pkwy. #260
City /State /Zip: Beaverton OR 97006
Phone: 503 - 690 -1779 Fax: 503 - 690 -0913
BUILDING PERMIT FEES*
E-mail:
poorowick@j rj .com Please refer to fee schedule.
CONTRACTOR
Business Name: BnX Construction Fees due upon application $
Address: 10730 SE Highway 212
City /State /Zip: Clackamas OR 97015 Amount received $
Phone: 503 - 557 - 0866 Fax: 503 - 557 - 1085 _ Date received:
CCB Lic. #: 107555 _
Authorized •
D ate: � V ?/ 2,i, Notice: This permit application expires if a permit is not obtained within
Signature: 180 days after it has been accepted as complete.
/ III / Vi robi L it *Fee methodology set by Tri -County Building Industry Service Board.
(Please print name)
is \Dsts\Permit Formms\BldgPermitApp.doc 01/03
AGxnnil�'d� I �A Z
Plan Submittal Requirement Matrix
Commercial & Multi- Family
City of Tigard New, Additions or Alterations
TYPE OF SUBMITTAL # of Plans
(Includes New, Additions Alterations) Required at .
Submittal
Site Work 4
(must include location of all accessible parking)
Plumbing - Site Utilities 2
Building 1
Fire Protection System 3 *
Mechanical 2
Plumbing - Building Fixtures 2
•
Electrical 2
•
Plan review is 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,.orNICET "3" technicians.
•
i:\dsts \forms \PlanSubMatrix.doc 2 /27/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
Received /f t 12 : r Date Requested a / � 5 AM PM BUP
Location / a q4 Z .d Suite n /t MEC
Contact Person -" d ?l Ph ( ) — i0 2. 3 c ' PL
Contractor e Ph ( ) SWR •
BUILDING Tenant/Owner ELC
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: ,, / �, SIT
Post & Beam a.":" 1l, 54)
Shear Anchors
Ext Sheath /Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
� PART FAIL
\�11•�i4 - ING
•ost & Beam •
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post" & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final ❑ Reinspection fee of $ • required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE El Please call for reinspection RE: • ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach /Sidewalk Date I Inspector Est
Other:
. Final DO NOT REMOVE this inspection record from the job site. •
PASS PART FAIL