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Permit
• 11( a CITY OF TIGARD BUILDING PERMIT PERMIT #: BUP2007 -00386 : COMMUNITY DEVELOPMENT DATE ISSUED: 7/24/2007 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 1S134BC-00401 SITE ADDRESS: 12442 SW SCHOLLS FERRY RD 101 ZONING: C - N SUBDIVISION: LOT: JURISDICTION: TIG PROJECT: PROVIDENCE Project Description: TI - Tech /Draw area remodel. 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 - 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: N SMOK DET: DWELLING UNITS: FRNT: ft - REAR: ft FIR ALRM : HNDICP ACC: BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING: VALUE: $ 28,000.00 • Owner: Contractor: PROVIDENCE HEALTH SYSTEM IN LINE COMMERCIAL CONSTRUCTION 4607 NE GLISAN 18880 SW SHAW ST PORTLAND, OR 97213 ALOHA, OR 97006 Phone: 503- 215 -6282 Contact #: PRI 503 - 642 -5117 FAX 503- 649 -3301 Reg #: LIC 51880 FEES Description Date Amount REQUIRED ITEMS AND REPORTS [BUILD] Permit Fee 7/24/2007 $243.72 [TAX] 8% State Surcha 7/24/2007 $19.50 [BUPPLN] Pln Rv 7/24/2007 $158.42 [FLS] FLS Pin Rv 7/24/2007 $97.49 Total $519.13 • 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 t• - rules adopted by the Oregon Uti ity otification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 -00 V You may obtain a copy oft rules or • -ct • - stions to OUNC by calling 503.246.6699 or 1.800.332.2344. /,. I sued By: - "S ,/ ., iA / 1) . Permittee Signature .#ii ■ 7 r J Call 503.639.4175 by 7:00 a.m. for an inspectio at b in - ss day. This permit card shall be kept in a conspicuous place on the job site 0 til ompletion of the project. Approved plans are required on the job site at the time , f e. ch inspection. ® Building Permit App1; :?'ri_ a iC FOR OFFICE USE ONLY lig City of Tigard l � D 7 e fei eg ME Permit No.: /g407--403e. 1 ° 13125 SW Hall Blvd., Tigard, OR 9J) � 2 ! 1007 k �� Phone: 503.639.4171 Fax 503.598.1960 Daarte/RBe .• AWE Other Permit: T I G A R D Inspection Line: 503.639.4 �'�1 (, �Q Y Q Date Ready : 1 See Attached Checklist for Internet: www.tigard -or. ov v vx a Notified/Method: / 6 Supplemental Information v7 1,DIIVG DIVISION TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING ❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all ® Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. ❑ I- and 2- family dwelling ® Commercial /industrial Valuation: $ ID Accessory building ❑ Multi - family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: 12442 SW Scholls Ferry Road New dwelling area: square feet City /State /ZIP: Tigard, Oregon 97223 Garage /carport area: square feet Suite/bldg. /apt. no.: 101 Project name: Tech/Draw Area Remodel Covered porch area: square feet Cross street/directions to job site: SW Scholls Ferry and SW North Dakota St. Deck area: square feet Other structure area: square feet REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: Lot no.: Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all Tax map /parcel no.: equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF WORK work indicated on this application. Non - structural remodel to an existing Tech and Blood Draw area. All MEP to be Valuation: $28,000 completed on a design -build basis. Existing building area: square feet New building area: square feet ❑ PROPERTY OWNER ❑ TENANT Number of stories: 2 Name: Providence Health System - Oregon Type of construction: 3 -A Address: 4706 NE Glisan Occupancy groups: City /State /ZIP: Portland, Oregon 97213 Existing: B Phone: (503)215 -6282 Fax: (503)215 -6802 New: B ❑ APPLICANT ❑ CONTACT PERSON NOTICE Business name: Jon R Jurgens and Associates, Inc. All contractors and subcontractors are required to be Contact name: Paul Borowick licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: 15455 Nw Greenbrier Parkway - Suite 260 jurisdiction in which work is being performed. If the City /State /ZIP: Beaverton, OR 97006 applicant is exempt from licensing, the following reasons apply: Phone: (503) 690 -1779 Fax: : (503) 690 -0913 E -mail: pborowick @jrjarch.com CONTRACTOR Business name: In -Line Commercial Construction BUILDING PERMIT FEES* Address: 18880 SW Shaw Street (Please rejerro fee schedule) Structural plan review fee (or deposit): City /State /ZIP: Aloha, Oregon 97006 Phone: (503) 642 -5117 Fax: (503) 649 -3301 FLS plan review fee (if applicable): CCB lie.: 51880 Total fees due upon application: � Amount received: Authorized signature: This permit application expires if a permit is not obtained � within 180 days after It has been accepted as complete. Print name: .7 . , / r0 /ti/ L f Date: 7427/ * Fee methodology set by Tri- County Building Industry Service Board. I:\Building\Permits'BUP- PermitApp.doc 03/21/06 440- 4613T(I I /02/COM/WEB) CITY OF TIGARD . I. BUILDING DIVISION , I 7 MM PERMIT #• BUP2007 -00386 13125 SW Hall Blvd., Tigard, OR 97223 [J A TE IS - D: 7/24/2007 2 Phone: (503) 639 -4171' Inspection Requests (24 Hrs.): (503) 639- 4175III I I/ INSPECTION WORKSHEET FOR DATE: 10/10/2007 TIME: 7:01AM PAGE: 45 SITE ADDRESS: 12442 SW SCHOLLS FERRY RD 101 CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: PROVIDENCE DESCRIPTION: TI - Tech /Draw area remodel. OWNER: PROVIDENCE HEALTH SYSTEM, PHONE #: 503 -21 &6203 CONTRACTOR: IN LINE COMMERCIAL CONSTRUCTION PHONE #: 503.642 -511 Inspection Request Scheduled For: Date: 10/10/2007 3 Pour Time: 1 Code # Inspection Description Confirm # Contact # Me .age d✓ is, , 299 Final inspection 057292 -01 503 519 -3965 Y A Corre ions /Comments /Instructions: (/" A t. Cs): Pb i ci lb X1.1 ti Eaz a - oo 2M -7 C Xr w`* p i t o 65 1 � 7 0 0 o 03 `r 3 C z.v,, tc.A.Q.re 5 c l g PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL . ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED ` 0 0 l Ins ector: Date: b / ( C Phone #: 503 2.V2)1 P ( ) 718 - CITY OF TIGARD , : , BUILDING DIVISION PERMIT #: B11p20t17 -00386 13125 SW Hall Blvd., Tigard, OR 97223 ilitYlit DATE ISSUED: 7/24/21107 Phone: (503) 639 -4171 Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 10/9/2007 TIME: 7:00AM PAGE: 35 SITE ADDRESS: 12442 SW SCHOLLS FERRY RD 101 CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: PROVIDENCE DESCRIPTION: TI - Tech /Draw area remodel. OWNER: PROVIDENCE HEALTH SYSTEM, PHONE #: 593- 215.6282 CONTRACTOR: IN LINE COMMERCIAL CONSTRUCTION • PHONE #: 503 - 642.5117 Inspection Request Scheduled For: Date: 10/912007 Pour Time: Code # Inspection Description Confirm # Contact # Message 299 Final inspection 057201 -01 503519-3966 N Corr ctions /Comments /Instructions: 107,0 (5) : E- uo - 1-bo(2.o'k ( ()CSC (- l/i ..\ le /loyal% eli.- 00-l- oo'ofS CTI (4)8c) ovi a l . 151---1-4007- vZ &o' - C tea../ - rats. ) .... 1- LLi -7_00 00 2-' 7 cL+vprc, r ) pil, VL/t a Zoo's - Q'b 1-tS( c t i SQ t A-iSV. rwv(94 r71L P Lt'1 Zcs o'-) - 063 2J.; c T1- 5 r 9 +- LA Swz In 200/ - 00 't3 (401. L) IBS. 4- ?L. s' . , _ ' di ._ elx P i 1 ..... (N 47....-A-- le- - C-A,tj, \ ----- d je j 0 ❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS X FAIL k CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: It (,' ✓ Date: 1t1 A J vA o ' 7 Phone #: (503) 718- � CITY OF TIGARD 4 ` BUILDING DIVISION PERMIT #: BUP2001 -00386 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/24/2007 503 Phone: A ( ) 639 -417 1 � I Inspection Requests (24 Hrs.): (503) 639 -4175 J INSPECTION WORKSHEET FOR DATE: 9/17/2007 TIME: 7 :00AM PAGE: 44 SITE ADDRESS: 12442 SW SCHOLLS FERRY RD 101 CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: PROVIDENCE DESCRIPTION: TI - Tech/Draw area remodel. OWNER: PROVIDENCE HEALTH SYSTEM. PHONE #: 503- 215 -6282 CONTRACTOR: IN UNE COMMERCIAL CONSTRUCTION PHONE #: 503 -642 -5117 Inspection Request Scheduled For: Date: 9/17/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 275 Framing 055776 -01 503- 519 -3965 N Corrections /Comments /Instructions: © - _ u :C — c s\ [11 PASS v :1 •ARTIAL APPROVAL El CANCEL El NO ACCESS Alr ❑ FAIL �► 47 _ - 1 PECTION ❑ADDITIONAL FEES ASSESSED 7 Inspector: ■ Date: 1 ) / V Phone #: (503) 718- zA q ._____