Permit CITY OF TIGARD BUILDING PERMIT
s COMMUNITY DEVELOPMENT Permit#: BUP2014-00224
T t . A R O 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/01/2014
Parcel: 1S 134BC00401
Jurisdiction: Tigard
Site address: 12442 SW SCHOLLS FERRY RD 206
Project: Providence Medical Group Subdivision: GREENWOOD TERRACE CONDO Lot: 17
Project Description: TI for existing tenant. Minor demolition and creation of an exam room.
Contractor: IN LINE COMMERCIAL CONSTRUCTION Owner: PROVIDENCE HEALTH SYSTEM-OREGO
18880 SW SHAW ST ATTN: REAL ESTATE&CONSTRUCTION
ALOHA,OR 97006 4400 NE HALSEY BLDG 2 STE 190
PORTLAND,OR 97213
PHONE: 503-642-5117 PHONE:
FAX: 503-649-3301
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: IIIB DC Provision Review,COM TI-Ping 10/01/2014 $75.00
Occupancy Grp: B Occupancy Load: 20 DC Provision Review,COM TI-LRP 10/01/2014 $11.00
Dwelling Units: 0 Permit Fee-Additions,Alterations, 10/01/2014 $531.09
Demolition
Stories: 2 Height: 0 ft 12%State Surcharge-Building 10/01/2014 $63.73
Bedrooms: 0 Bathrooms: 0 Plan Review 10/01/2014 $345.21
Value: $32,000 Info Process/Archiving-Lg$2.00(over 10/01/2014 $18.00
11x17)
Plan Review-Fire Life Safety 10/01/2014 $212.44
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $1,256.47
Required: Required Items and Reports(Conditions)
Fire Sprinkler: Yes Parapet:
Fire Alarm: 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 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 the 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 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.33 344. .
Issued By: -:rmittee Signature:
503.639.4175 by 7:00 a.m.for the next available inspection 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
` ece III City of Tigard a4 ' f ate/iB ved: D f Permit No.:` / . /•f�,p 0 t L1
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review"
► l Other Permit:
2 Phone: 503.718.2439 Fax: 503.598.1960 �� Date/B : •
Ti G A R D Inspection Line: 503.639.4175 12014 Date Ready .y: tuns. ® See Page 2 for
Internet: www.tigard-or.gov OC1 Notified/Method: Supplemental Information
Cjt s• it
TYPE OF WORK nSit.p• REQUIRED DATA:1-AND 2-FAMILY DWELLING
x.911 Permit fees*are based on the value of the work performed.
❑New construction ❑ Dem P
Indicate the value(rounded to the nearest dollar)of all
0 Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
El 1-and 2-family dwelling ®Commercial/industrial
Valuation: $
❑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 OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.:206 I Project name:Scholls Ferry-Med.Home Covered porch area: square feet
Cross street/directions to job site:From Highway 217 take exit 4B to Deck area: square feet
SW Cascade Ave,Turn right on SW Scholls Ferry Road,turn right on Other structure area: square feet
SW North Dakota St,turn left into parking lot REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot no.: Permit fees*are based on the value of the work performed.
Tax map/parcel no.:1S134BC00401 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.
Approximately 1,931 SF+/-of interior non-structural remodel Valuation: $
on the tad Floor of an existing Medical Office Building. Existing building area: 25817 square feet 1/3
1
New building area: none square feet
® PROPERTY OWNER I ❑ TENANT Number of stories: 2
Name:Providence Health&Services-Rick Robinson Type of construction: 111-A
Address:4400 NE Halsey-Bldg.#2-Suite 190 Occupancy groups:
City/State/ZIP:Portland OR 97213 Existing: B
Phone:(503)893-6752 Fax:( ) New: B
0 APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name:JRJ architects,Ile Structural plan review fee(or deposit):
Contact name:Thomas A.Wesel AIA/Principal FLS plan review fee(if applicable):
Address:15455 NW Greenbrier Parkway-Suite 260 Total fees due upon application:
City/State/ZIP:Beaverton OR 97006 Amount received:
Phone:(503)690-1779 Fax::(503)690-0913 PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
E-mail:twesel @jrjarch.com Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Submit two(2)sets of roof plan with connection details
Business name:In Line Commercial Construction-Brian Grant and fire department access,along with the 2010 Oregon
Address:18880 SW Shaw Street Solar Installation Specialty Code checklist.
Permit fee(includes plan review $180.00
City/State/ZIP:Aloha OR 97006 and administrative fees):
Phone:(503)906-3976 Fax:(503)649-3301 State surcharge(12%of permit fee): $21.60
CCB lie.:51880 ■ , Total fee due upon application: $201.60
This permit application expires if a permit is not obtained
Authorized signature: ` - , 11/ This
180 days after it has been accepted as complete.
* Fee methodology set by Tri-County Building Industry
Print name:Thomas A.Wesel Da e:09-24-14 Service Board.
I:\Building\Pemiits\BUP-COM PermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
City of Tigard
III • COMMUNITY DEVELOPMENT DEPARTMENT
G R D Building Permit Review — Commercial - No Land Use
TIA
Building Permit #: 8/4,ea,0 j'—
(,0.)-1)-`I
Site Address: 19,44/ SV\J 6VID11 FOYY11 V4I. Suite/Bldg#: 210
Project Name: PrailatriCe real I'M 1 gav-ices
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Planning Review
l 7
Proposal: I for €)(�`1 I` - 1 nyik--.
Existing Business Activity: (\YAW 01
Proposed Business Activity: lYtiatCaj V (,Q
Z(Verify site address/suite #exists and active in permit system.
.12'Zoning: G—V>
.Permitted Use: ..Zr Yes ❑ No ❑ Spec Space
.2/Confirm no land use required.
Notes:
Approved by Planning: AlaltM gej%L(,(4 Date: to/p Jul
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Building Permit Submittal
Original Submittal Date: /O/01y
Site Plans: #
Building Plans: # —Aile --
Permit#: D ter building permit# above.
Workflow Routing: [2"-Pian ' g ❑ Permit Coordinator E' uilding
Workflow Sign-off: tg---n-off for Planning(include notes from planning review)
Route Application Documents: LCJBuilding: original permit application, site plans,building plans, engineer and
beam calculations and trust details,if applicable,etc.
Notes: art
By Permit Technician: `� __ �� Date: /6/1/y
%a
I:\Building\Forms\BldgpermitRvw COM_NoLandUse_071514.docx
Permit Coordinator Review
❑ Conditions Met-Prior to Issuance of Building Permit
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant:
Revision Notice 3: Date Sent to Applicant:
El OK to Issue Permit
Approved by Permit Coordinator: Date:
I:\Building\Forms\BI dgPermitRvw_COM_NoLandUse_071 5 14.docx
li . - Building Division
Over-The-Counter (OTC) Building Permit
C' li" Check List
Project Description:
APPLICATION SPECIFIC INFORMATION
GENERAL INFORMATION
Class of Work*: yitt47 Occupancy Group: Type of Construction:
Type of Use**: Occupancy Load: -j0 Oregon Specialty Code: 2...0
SPECIFICS
Number of Stories: ci Building Height: Mixed Use:
Number of Dw Units: Number of Bathrooms: Number of Bedrooms:
BUILDING SQ FT-SCHOOL CET OTHER SQUARE FOOTAGES
Story Square Footage: Accessory Structure: Covered Porch:
Basement: Garage: Deck:
Total Square Footage: _ Carport: Mezzanine:
SETBACKS
Sideyard Setback—Left Sideyard Setback—Front
Sideyard Setback—Right Sideyard Setback—Back
CONSTRUCTION
Exterior Walls: Openings Protected: Firewall Separation:
N: S: N: S: Occupancy Separation:
E: W: E: W: Access.Parking Spaces:
_REQUIRED ITEMS
Fire Sprinklers: ' Fire Alarms: Smoke Detectors:
Sprinkler Type: Alarm Type: Protected Corridors:
Standpipe Required: Pull Stations Required: Parapet:
Hazard Group: Battery Calcs Provided:
Density: Cut Sheets Provided:
Design Area: ,
K Factor: 2
Total Project Valuation: $ JZ-, con I FEES DUE
$ 5 iOD DC Prov Rvw,COM TI—Ping
$ 1 DC Prov Rvw,COM TI—LRP
DC Provision Review Fee for COM TI(effective 7/1/2014) $ fj �� Permit Fee—Add,Alt,Demo
Project Valuation Planning LRP $ to 12%State Surcharge
Up to$4,999 $0.00 $0.00 $ ,Z( Plan Review,Structural
$5,000 $74,999 $75.00 $11.00 $ G�( ' Plan Review,Fire Life Safety
$75,000-$149,999 $187.00 $28.00 $ ��r Info Proc/Arch,Lg(over 11x17$2.00)
$150,000 and over $299.00 $44.00 $ Info Proc/Arch,Sm(up to 11x17$0.50)
$ Metro Construction Excise Tax
$ School Construction Excise Tax
$ Hourly Rate Fee
$ Hourly Rate State Surcharge
$ Misc.Admin Fee
$ Other:
$ Other:
Building Staff: $ Other:
Date/Time: $ 125647 TOTAL FEES DUE
*TYPE OF USE: COM=commercial;CMS=commercial manufactured structure.
**CLASS OF WORK ACS=accessory;ADD=addition;ADU=accessory dwelling unit;ALT=alteration;DEM=demo;NEW=new;
OTR=other(use for fences,decks,retaining walls,signs,awnings or canopies).
I:\Building\Forms\OTC_BUP_070114.docx
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12442 SW SCHOLLS FERRY RD 206, TIGARD,
OR, 97223
Commercial - Building
299 Final inspection
PASS - No C of O
BUP2014-00224
Jeff Grove
Violation Summary:
Inspector Contractor