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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