Permit CITY OF TI GARD BUILDING PERMIT
PERMIT #: BUP2004 -00380
Ail DEVELOPMENT SERVICES DATE ISSUED: 8/6/2004
t_ 13125 SW Hall B lvd.. Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 09020 SW WASHINGTON SQUARE RD 570 PARCEL: 1S126BC -01506
SUBDIVISION: ZONING: C -G
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: 2FR sf N: S: E: W:
OCCUPANCY GRP: B TOTAL AREA: 0 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: 21 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: $ 78,200.00
Remarks: TI: new dental office.
Owner: Contractor:
WISCO INVESTMENT SERVICES CO NORWEST GENERAL CONTRACTORS INC
111 SW FIFTH AVE # 1100 PO BOX 25305
PORTLAND, OR 97204 PORTLAND, OR 97298 -0305
Phone: 503 - 222 -4375
Phone: 503 - 291 -6986
Reg #: LIC 89425
FEES REQUIRED INSPECTIONS
•
Description Date Amount Mechanical Permit Require
[BUILD] Permit Fee 8/6/2004 $629.43 Electrical Permit Required
[TAX] 8% State Surchari 8/6/2004 $50.35 P Plumbing Permit Required
[BUPPLN] Pln Rv 8/6/2004 $409.13 Framing lnsp
[FLS] FLS Pin Rv 8/6/2004 $251.77 Gyp Board lnsp
Susp Ceilng Insp
Total
$1,340.68 Final Inspection
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes
and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of these rules or direct questions to OUNC by
calling (503) 246 -6699 or 1- 800 - 332 -2344.
Issued B y: , ' , 17
Permittee
Signatur : `
Call 639 -4175 by 7 p.m. for an inspection the next business day
`i®
- Building Permit Appli t :.a:.,, l:oli OVHCi USE ON 1.1
City of Tigard t� AO. DateB ( I Permit No.: , ` 0 0 1� 1
13125 SW Hall Blvd., Tigard, OR `` c O Plan Review
Phone: 503.639.4171 Fax: 503.598.196 V f.,4431) /I " ' "? e I '` Date/By. Other Permit.
l Inspection Line: 503.639.4175 .c�G ;, � l ' Date Ready/By tuns B See Attached Checklist for
r
Inteet: www.ci.tigard.or.us G` ,� Cr � \'' Notified/Method- 5 \O Supplemental Information
- , TYPI F WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑ New construction Demolition Permit fees* are based on the value of the work performed.
- Indicate the value (rounded to the nearest dollar) of all
❑ Addition/alteration/replacement R Other. T l equipment, materials, labor, overhead, and the profit for the
'CATEGORY OF CONSTRUCTION • work indicated on this application.
❑ 1- and 2- family dwelling F3 Commercial mdustrial Valuation --.$.—
❑ Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder ❑ Other. Number of bathrooms:
r JOB SITE INFORMATION AND , LOCATION - Total number of floors:
Job site address: oI a 2 0 5 tn) (,t,JA S N tJ 4 ro,J 5 R b . Su l re. 570 New dwelling area: square feet
City/State/ZIP: ' A ;7_ 0,2 q 7 I. Z 4 Garage/carport area: square feet
4.42.. IdgJapt. no.: 5 - 7 c.) I Project name: b 2 . 5 cc, ; r '3A 2,2y Covered porch area: square feet
Cross street/directions to job site: 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.
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 work indicated on this application.
j J 1D N7A L c�'Fr, C,C
Valuation: $ _ 7� j ' ZQ O • -- / Existing building area: square feet
New building area: square feet .
JA. PROPERTY OWNER ; ❑ TENANT Number of stories: 5
o •
0 Name: IA) y 56 IN✓Ls- ren t..Jy San.. r c.G COW, 1'gN1 Type of construction: --I-t i ca...
Address: III 5 r- . F rH AV E. Sv t r e 1100 Occupancy groups:
.3 City/State/ZIP: p ty7 i_ .J. O(Z... rl 7 Z o d Existing JA C oO
Phone: (5o3) 222 - X43 7 Fax: ( ) New: 3
JR APPLICANT (-- ❑ CONTACT PERSON NOTICE
Business name: 1j c,J P2 6 L, C r n ,J J 1 G n� All contactors and subcontractors are required to be
Contact name: !L r O � 1 r licensed with the Oregon Construction Contractors Board
D
under ORS 701 and maybe required to be licensed in the
Address: 5 0 o N tai } d 4 "`"' AL/6, S tJ t TC / D Z jurisdiction in which work is being performed. If the
City/State/ZIP: applicant is exempt from licensing, the, following reasons
i 0 ( LA, 0 o rL ct 7 2.0 9 apply:
Phone: (So3) 969 - .4 849 I F a x : 23 3 - -1l0 5
E -mail: 1)30 to 5' it A e_ 14 E u A 13 v T. 'CD wl. _
CONTRACTOR '4.
Business name: DJar2wt -5 7 Gn)72A 5 /pJG • , - - BUILDING PERMIT FEES* _ '
Address: Po gD A 2-53 0 5 Please refer to fee schedule.
City/State/ZIP: e0 2 7 L A„, D 0 2 9 7 Z `j F� Fees due upon application
Phone: (503) 2q ( - (v 9 2 4' I Fax: (5 0 7) Zq i - 70 3 c.
Amount received
CCBlie.: S 3/5/0
Date received:
Authorized s 1 .., . ill / This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: ' . Date: gc. le 04 * Fee methodology set by Tri- County Building Industry
Air:
Service Board.
we y6 �v Ofi S0.- x1 d
FROM : TIMBERLINE FAX NO. : 5032544227 Aug. 03 2004 09:46AM P2
Fans Se Project Name pr Scott Barry I Pa ae' I r
LIGHTING - GENERAL
1. Interior Exceptions (Section 1313.1)
Exceptions Ei No Interior Lighting. The building plans and specifications do not call for new or
of altered interior lighting. Skip to item 5, Exterior building Lighting - General, below.
Discuence exec On* tnin tumors ra Exceptions. 1. The building or part of the building qualifies for an exception from
code fighting requirements. Applicable code exception is number
2_ Lighting equipment that qualities for an exception - in addition to general lighting and is
separately controlled. Applicable code exception is number: 2.41
Areas of the building and equipment that qualify for any exceptions:
Task lighting for medical and dental purposes
Pima /specs 'als. •
show wrongs tir Inaluthe 2. Local Shut -off controls (Section 1313.3.1.1)
dfeMAat. GRO¢ flower.
etw nq Wh speemowtmzamon Ed Compiles. At least one local shut-off righting control for every 2,000 square feet of
1 tli 0 wooswerni lighted floor area and for all spaces enclosed by walls or ceiling height partitions.
This control(s) is detailed in the building plans on drawing number.
O Exception. The building or part of the building qualifies for an exception.
Applicable code exception is Section 1313.3.1.1, Exception:
Portions of the building that qualify:
' 3. Automatic Shutoff Controls (Section 1313.3.1.2)
GB Not Applicable- Office floor area is not over 2,000 square feet of contiguous office
floor area or permitted space is not over 5.000 square feet. No offices less than 300 square feet, meeting or
conference rooms, or school classrooms.
O Compiles. All interior lighting systems are equipped with a separate automatic
control to shut off the fighting during unoccupied periods. Offices less than 300 square feet,
meeting and conference rooms, and school classrooms shall be equipped with
occupancy sensors that comply with Section 1313.3.1.2.1,
Compliance details in plans/specs:
O Exception. The building or part of the building qualifies for an exception. The
applicable code exception is Section 1313 3.1,2, Exception:
Portions of the building that qualify:
4. Daylighting Controls (1313.3.1.3)
O No classrooms or atriums with skylights or window to wall ratio greater than SO%.
❑ Complies_ All classrooms and atriums with window to wall ratio greater than 50% and/or
Exterior ' skyights are equipped with automatic daylight sensing controls, as required by Section
Building 1313.3.1.3.1 and Section 1313.3.1.3.2. The daylight sensors specified comply with
Lighting &Wed t Section 1313,3.1.33.
wnrme the e>aenar Compliance details in plans/specs: I
calm Wen; one
Knoche ene eysettd ■+
India nen *eh or
5. Exterior Lighting (Section 1313.5)
�
When =open. .
C Complies. The plans do not call for incandescent or mercury vapor lamps for use
on building exterior.
Clock O Exception. The building plans indicate luminaires with incandescent or mercury vapor
Switches O lamps, but they are specified for use in or around swimming pools, water features, or other
be w°trorow ` locations subject to the requirements of Article 680 of the 2002 National Electrical Code.
eaesotvd r ql
type with sepvece
yogurts for cell day
On* weekend noel 6. Exterior and Canopy Lighting Controls (Section 1313.3.2)
SW! Imlay to
marten drop eepfy El Complies. The building plans and specifications include photoelectric and/or clock
dung pewee lramek
0da switches on all exterior lighting systems which are designed and programmed to
extinguish fights when daylight is present, as required by Section 1313.3.2.
7. Interior Connected Lighting Power (Section 1313.4)
Y ES1Complles. The interior lighting power does not exceed the interior power allowance established
in either the Tenant Space Method (Form 5b) or the Space- by
Method (Form 5c).
Tenant Space Method (Form 5b) ' Space - - Space Method (Form 5c)
s-I
Lighting 2004 Forms Live Vi.2-040104
4 -.
Q
FROM : TIMBERLINE FAX NO. : 5032544227 Aug. 03 2004 09:46AM P3
Form 5d Project Name: Dr. Scott Barry Pagel g-
INTERIOR LIGHTING POWER - 'Tenant Space Method
Lighting (a) (0) (c) (
Budget
Tenant or SuHoing Type Floor Area (sci ft) Max Power Li
lrcapmmy/ (Table -133) L Power
Ulw 'PAM
Density (wit Buaaet (W )
See butnic lore _ --
w description of . Healttcarc - clinic .., 2,066 1 0 2,066
ro.r+rn erase .
Lighting L Total tntedor Lig1Trrg Power Budget (Watts) for Building. w
Poorer - ■tom.
Budget -
2. Total length of track lighting (R)
3 Lute 2 multpfiad by 37.5 Wattsat
Track
Lighting A Total amperage of circuit breaker(s) serving track lighting (amps)
Power 5. Voltage of circuit breaker serving track ligtmng (volts) _ -
6. Maximum wattage of track lighting (multiply line 4 by line 5) _
I 7. Track Lighting Power (lesser value of line 3 or line 6 )
Building's 8. Track Lighting Power (line 7)
Lighting 9 Total Interior Lighting Power from Wortaheet Sb-1 (Sum of Column (m)) _ + 1,863
Power 10. Total Adjusted fighting Power (line 8 + line 9) = 1,863
11. toes design meet budget? Line 10 must be no greater then line 1 YES
5.2
Lighting 2004 Forms Livc V1.2-040104
FROM : TIMBERLINE FAX NO. : 5032544227 Aug. 03 2004 09:47AM P4
worksheet Sb-1 Pro)ctName: Or Scott BallY • e 3 I
INTERIOR LIGHTING POWER
Spaee•bySpace Method Only
Slop to column 0) a using the Tenant Space Method 6)
(a) (b) (c) (d) (e) 0) 0) (0
La's Quantity of (h)
Room IO (do Space Type Spice U9n0n9 Power Workkhket Luminaires (or Lurmnwre Lighting Room
net leave any Area (Table 13-1-1) Type Budget 5e Column lineal ft. for track Power Exempt Power Total 1.18.
blanks) (ft) (enter space type only once per room) (PD (b) x (co fal lahling) - (Woos) Fddures (S) x (N Power „
Each roam must - - A -1 2 93 El 186 -
30 1340101ed. - - 10 93 v 980 -
Describe - _ 4 28 O 112
hrndnaites for .. _ 2 0 56 -
each undividu I - -
room In plains. _ - 17 u Set .-
- I , 79 r7 474 _
- H 1 54 t] 54
awerenrll eta ' y
- edMIIn dam • - +e E .I 6 17 p 102 .
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0
aare(a.wea .i _ .--
oavaa ®tra . exwem _ . .� - - p - -
wyaK. rdet�my'
grew room.Yi� - . • - e .
"mein is lisettudiMIL .
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o
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• • Warksheet56 -1 Total Budget • - >nrlmm:5b.1 Total Llgttorg POI er (= lwim9 axemplArack Mures) • 1,963 '
ammrr�emlm� . • _ '
'rmrtbe�maeraaalm
rrrgr a w8 total Number of Addabenal Worlsheet5E, 0 .i .
aaam
CA Ma
Mg tame P.). aae l Mang; urg r«
vrensraeex Ramer, way Nem ( at* Moorm =bag Tenet Mated)
e,.ti
5b•1 - - 1,963 - ,
5b.2
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a . - Satan olaaid aOnel Sb worlcvheels
4 f Total '
Bu7gBt(ot ara �o xk51fee7) -
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Lighting 2004 Forms Live V1 1-040104sls
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Worksheet . = _ - - . ` - project Nairie::Dr. Soon t3erry = - page Y
- LIGHTING SCHE - - - = - . ' - . - -
(a) (b)
L H xi
(c) (d) (e) - j+} 3
uml Lurnlnaire Is Luminalre m
- Luminaire ' Lemp ballasts From
- .Tvaa - . • - . . • Descrlation - No. Descriallon No, Description (watts) , Table Sc z •
A Fluorescent T8 -4foot 3- F3218- ELECTNO.93W • -3 F32TB 1 Electronic Normal Output. RS 93 YES m
[3 12 Volt Tungsten Halogen Lamps ^! 1 -25 watt lamp -EPS 28W _ I 25 watt lamp 1 Electronic Power Supply 28 YES
C Compact Fluorescent'Rein . 1 -CFT13WKaX23MAGSTD -17W . _ 1 CFT13WIGX23 1 Magnetic Standard 17 -
YES
D 12 Volt Tungsten HalogenLampa •] t-60 watt lamp -MT-65W - 1 -
re 50 watt lamp 1 Megnetlo Transformer 56 YES
E CompactFluoscertlWn : 1-C FTf3WVGX23�41AGSTO -17W j — 1 CFTI3W1GX23 I Magnetic Standard 17 YES
F Compact Fluoresced fl 2- CFC1311 J
VZOX7- ELECT-34W
r(1 2 CFT13W+2GX7 2 Electronic 34 YES
G Fluorescent -4 foot 3- F32T8130ES•ELECT 1JO.79W • - 3 F32T81341ES 1 Electronic Normal Output. 19 79 YES
H FlOoresaertt18 - 4 foot 2- F3278/30ES -ELECT NO-64W • 2 F32TS13OES 1 Electronic Normal Output. IS 54 YES
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Lighting 2004 Forms 1.hre V1.2-040104
HUU Ub - CUU4 1 K 1 Uy 5U Hll \ MX NO. P. 01/01
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( , t ) A- - s F-. D.
City of Tigard
Attention: Brian Blalock
Building Department
13125 SW Hall Blvd.
Tigard, OR 97223
Tel; 503/639 -4171
Fax: 503/684 -7297
•
Doctors/Dentists Questionnaire June 08, 2004
As part of the building permit review for your proposed tenant space; the following
information is requested.
Please answer the following questions and return to us a signed copy. Please also
provide a copy to the building owner or their agent:
1. Yes o Will there be use of procedures that render a patient incapable
of unassisted self- preservation? (This would include any use of
general anesthesia, as well as any procedures that would result
in a patient becoming incapable of recognizing a fire
emergency, or of immediately leaving the building without
assistance.)
2. If your answer to Question 1 was "yes ", what is the maximum
number of patients who could possibly be incapacitated at any
one time? (This would include all patients meeting the
description above, whether they are being prepped, undergoing
a procedure, or in your recovery area).
3. If you answer to question #1 was "yes" would you normally
transfer patients in an emergency in a gurney or a wheelchair
(please underline)?
Signature• Building Name /Address:
Name: r"'�.{ (cal-SP-At-5W LOIS i t furl 56 4(
Date: 706/o 4 Stia irr 6
fA.14(.01, art 1 7��3
This information is intended solely for the purpose of determining construction standards
for the building and for your space in it. There is no correlation with the procedure lists
used by the State Health Division in its licensing process, nor with any lists that may be
used by any insurance carrier, etc.
Thank you for filling out this questionnaire and returning it to the architect or space
planner responsible for obtaining your building permit.
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION9IVISION Business Line: (503) 639 -4171 MST
BUP Z - -mo o
CC4
•
J
Received Date Requested t 7 ( 66-- AM PM BUP
Location qZ() CUAS SC, Suite 570 MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner - j 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
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Ot
44) PART FAIL s —
- ING ' v
Post & 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 E Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE El Please cal or reins •ection RE: .twit . El Unable to inspect — no access
Fire Supply Line II'
ADA Date Air Ins ecto /11 Ext
Approach/Sidewalk P
Other:
Final DO OT REMOVE this inspection record from the Job site.
PASS PART FAIL