Permit ,, CITY OF TIGARD BUILDING PERMIT
11111 `' COMMUNITY DEVELOPMENT Permit#: BUP2014 00250
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/28/2014
Parcel: 2S 101 AA08700
Jurisdiction: Tigard
Site address: 12511 SW 68TH AVE
Project: Kassay Clinic Subdivision: WEST PORTLAND HEIGHTS Lot: 34
Project Description: Interior TI for new tenant,some demolition,new walls,ceiling,casework&finishes
Contractor: NORWEST CONTRACTORS INC Owner: BEVELAND BUILDING LLC
PO BOX 25305 12511 SW 68TH AVE
PORTLAND,OR 97298-0305 PORTLAND,OR 97223
PHONE: 503-291-6986 PHONE:
FAX: 503-291-7036
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: VB Permit Fee-Additions,Alterations, 10/28/2014 $1,558.95
Demolition
Occupancy Grp: B Occupancy Load: 28 12%State Surcharge-Building 10/28/2014 $187.07
Dwelling Units: 0 Plan Review 10/28/2014 $1,013.32
Stories: 2 Height: 0 ft Plan Review-Fire Life Safety 10/28/2014 $623.58
Bedrooms: 0 Bathrooms: 0 Info Process/Archiving-Lg$2.00(over 10/28/2014 $20.00
Value: $175,000 11x17)
Metro Const.Excise Tax-Commercial 10/28/2014 $210.00
Use
Floor Areas: DC Provision Review,COM TI-Ping 10/28/2014 $299.00
DC Provision Review,COM TI-LRP 10/28/2014 $44.00
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $3,955.92
Required: Required Items and Reports(Conditions)
Fire Sprinkler: No 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 Code nd all other a••licable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issu- ce, o if work is -pended for more the 180
days. ATTENT1QN Oregon law requires you to follow the rules adopted by the Oregon Utility Notificati• Center. Those rules , e set forth in OAR
952-0 010 through O' '52-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 50.P32.1987• 1.80 . 3 . - 4.
sued By: 1 Permittee Signature: /
Call 503.639.4175 by 7:00 a.m.for the next available inspec In 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.
,, CITY OF TIGARD BUILDING PERMIT
11111 `' COMMUNITY DEVELOPMENT Permit#: BUP2014 00250
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/28/2014
Parcel: 2S 101 AA08700
Jurisdiction: Tigard
Site address: 12511 SW 68TH AVE
Project: Kassay Clinic Subdivision: WEST PORTLAND HEIGHTS Lot: 34
Project Description: Interior TI for new tenant,some demolition,new walls,ceiling,casework&finishes
Contractor: NORWEST CONTRACTORS INC Owner: BEVELAND BUILDING LLC
PO BOX 25305 12511 SW 68TH AVE
PORTLAND,OR 97298-0305 PORTLAND,OR 97223
PHONE: 503-291-6986 PHONE:
FAX: 503-291-7036
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: VB Permit Fee-Additions,Alterations, 10/28/2014 $1,558.95
Demolition
Occupancy Grp: B Occupancy Load: 28 12%State Surcharge-Building 10/28/2014 $187.07
Dwelling Units: 0 Plan Review 10/28/2014 $1,013.32
Stories: 2 Height: 0 ft Plan Review-Fire Life Safety 10/28/2014 $623.58
Bedrooms: 0 Bathrooms: 0 Info Process/Archiving-Lg$2.00(over 10/28/2014 $20.00
Value: $175,000 11x17)
Metro Const.Excise Tax-Commercial 10/28/2014 $210.00
Use
Floor Areas: DC Provision Review,COM TI-Ping 10/28/2014 $299.00
DC Provision Review,COM TI-LRP 10/28/2014 $44.00
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $3,955.92
Required: Required Items and Reports(Conditions)
Fire Sprinkler: No 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 Code nd all other a••licable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issu- ce, o if work is -pended for more the 180
days. ATTENT1QN Oregon law requires you to follow the rules adopted by the Oregon Utility Notificati• Center. Those rules , e set forth in OAR
952-0 010 through O' '52-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 50.P32.1987• 1.80 . 3 . - 4.
sued By: 1 Permittee Signature: /
Call 503.639.4175 by 7:00 a.m.for the next available inspec In 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 ► O►Z (i► l►( 1 ► �► (1v► 1
City of Tigard
Received l0 / 7 PermitNo.: -ea�*
13125 SW Hall Blvd.,Tigard,O' Cy .
�► � o�
Pan Review tom*
: I Phone: 503.718.2439 Fax: 503. V: ,1 bt Date/g 4'S _•y4 Other Permit:
i_ `�,t� Inspection Line: 503.639.4175 O(''` 2 L Date Ready/13y: f id See Page 2 for
Internet: www.tigard-or.gov
�+ �� ��� Notified/Method: Supplemental Information
TYPE OF • s �,1 `�,� REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑ Permit fees*are based on the value of the work performed.
New construction • ition
l
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.
❑ 1-and 2-family dwelling ErCommercial/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: I 2_5 I 1 S,ti(.4 (o$i-2,2 AVet....se_. New dwelling area: square feet
City/State/ZIP: �AVtl 012s. 1/u Garage/carport area: square feet
Suite/bldg./apt.no.: X2410 Project name: / !A;64 c-7:I. Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
NW. GOro--.l..v 42.11./• Gs MI' Cj■iJ. btattou.,d 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.: 2G) p k.A.O8 QQ 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.
ltni I �f ,��I1,' Valuation: S t Y� t'JO6 00
-LJAbe 1-PJtuktn4- I v0V0.4N"¢ir 5 41 4141.4.- 4t olt1►o.n.l //
I ! 5 Existing building area: �.(s+( square feet
v�tn/ t�GUyl ��1't�t; �tset/ark ►�.►s
New building area: 7.1!+40 square feet
(PROPERTY OWNER ❑ TENANT Number of stories: 2
Name: t,„ te.,Ahd (I b 1[^r r.-444417 Type of construction: a.ib
� r `�'i 4 11�
Address: 2. . j . 1 r-wmv.4. Occupancy groups:
City/State/ZIP: f 44 O1N`1'� ?� Existing: jj
Phone:( ) t Fax:( ) New: e, (O4.l-'PA'r1 1-
0 APPLICANT (CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule)
t�
Business name: `a`'t 1 V-4 ia,:l is/Ar t Structural plan review fee(or deposit):
Contact name: PA i„1 K( 1t 2lrn
FLS plan review fee(if applicable):
Address: 16602 r7.E... 5441% h,.vQ-v,b•G
Total fees due upon application:
City/State/ZIP: i l tac,tAkl E o_ 111.2.2,
Phone:( ,o',)4,52_•88ct I Fax: :( ) Amount received:
E-mail: q r .4 h�1 4 1 np ViiW e_y31,r\�� PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
l l Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted Photo Voltaic Solar Panel System.
Business name: No > - Gov‘g.1vw 1,}�vt,-.., Iv\` Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: P.c. pos. Z9yfDS Solar installation Specialty Code checklist.
City/State/ZIP: r - d o� 4 q 29$ Permit fee(includes plan review $180.00
and administrative fees):
Phone:( c ,) Zpi(—49• .(A Fax ( )
State surcharge(12%of permit fee): $21.60
CCB ltc.. $$ek 4 ` Total fee due upon application: $201.60
Authorized signature: j ` This permit application expires if a permit is not obtained
4/1/ �ti� i within 180 days after it has been accepted as complete.
Print name: ,{emu tA' `Q 1 Date: ZYjv(,T �+ _ * Fee
Bcxitology set by Tri County Building Industry
Service
I:\Building\Permits\BUP-COM PermitApp.doc 02/24/2011 4404613T(l 1/02/COM/WEB)
City of Tigard
71 r COMMUNITY DEVELOPMENT DEPARTMENT
T 1 G A li D Building Permit Review — Commercial - No Land Use
Building Permit #: I' c2ael-eogso
Site Address: /0Z.5/f S ‘6.-7 Suite/Bldg#: pV
Project Name: dr 4J.s eAil1 7.7-
(Name of commercilI business occupying the space. If vacant,enter Spec Space.)
Planning Review
Proposal: 0/4‘4. 4 ,44,./ D cc1 0L'`' 1-l' only.
Existing Business Activity: dike,
Proposed Business Activity: 14 1 C//•,'
1 erify site address '#exists and active in permit system.
❑ Zoning: /VC--
-
❑ P fitted Use: L'�' Yes ❑ No ❑ Spec Space
Lam'Confirm no land use required.
Notes: A hArig k7 &ei S141-3 pwAt 4444 Pb & add
me/0aq Li
Approved by Planning: /g Date: 10,,i%
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: �� > �4
Site Plans: # '
Building Plans: # 3
Building Permit#: rater building permit#above.
Workflow Routing: [—Pta'nning - Permit Coordinator wilding
Workflow Sign-off: gn-off for Planning(include notes from planning review)
Route Application Documents: J ilding: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technicia
( --'\ ,
/ _ Date: /c /c,‘'
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:
❑ OK to Issue Permit
Approved by Permit Coordinator: Date:
I:\Building Worms\BldgPerm itRvw_COM_NoLandUse_071514.docx
11114 I Building Division
Over-The-Counter (OTC) Building Permit
T I G A R D Check List
Project Description:
APPLICATION SPECIFIC INFORMATION
GENERAL INFORMATION
Class of Work*: Occupancy Group: Type of Construction:
Type of Use**: Occupancy Load: 77 _ Oregon Specialty Code: (�
SPECIFICS
Number of Stories: 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 1 �
Fire Sprinklers: Cam) 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:
Total Project Valuation: $ t75)Ct) FEES DUE
$ • "Eltria, DC Prov Rvw,COM TI—Ping
$ ' A CO DC Prov Rvw,COM TI—LRP
DC Provision Review Fee for COM TI(effective 7/1/2014) $ — s Permit Fee—Add,Alt,Demo
Project Valuation Planning LRP $ - ,Q 12%State Surcharge
Up to$4,999 $0.00 $0.00 $ Ell Plan Review,Structural
$5,000-$74,999 $75.00 $11.00 $ .I74;Plan Review,Fire Life Safety
$75,000-$149,999 $187.00 $28.00 $ 1O I ar 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)
$ "2-(0.415:, Metro Construction Excise Tax
$ School Construction Excise Tax
$ Hourly Rate Fee
$ Hourly Rate State Surcharge
$ Misc.Admire Fee
$ Other:
$ Other:
Building Staff: $ Other:
Date/Time:
;/. TOTAL FEES DUE
l
*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;
O'R=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
12511 SW 68TH AVE, TIGARD, OR, 97223
Commercial - Building
299 Final inspection
PASS - C of O
BUP2014-00250
Chip Barnett
Violation Summary:
Inspector Contractor