Permit n
CITY OF TIGARD BUILDING PERMIT
s COMMUNITY DEVELOPMENT Permit#: BUP2015-00235
T WARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/05/2015
Parcel: 1S134BC00401
Jurisdiction: Tigard
Site address: 12442 SW SCHOLLS FERRY RD 100
Project: Providence Medical Group Subdivision: GREENWOOD TERRACE CONDO Lot: 17
Project Description: TI for existing tenant:Wall construction for a 2,000 sq.ft.remodel.
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: IIB DC Provision Review.COM TI-Ping 08/05/2015 $351.00
Occupancy Grp: B Occupancy Load: 21 Permit Fee-Additions,Alterations, 08/05/2015 $1,836.79
Demolition
Dwelling Units: 0 12%State Surcharge-Building 08/05/2015 $220.41
Stories: 3 Height: 0 ft Plan Review 08/05/2015 $1,193.91
Bedrooms: 0 Bathrooms: 0 Plan Review-Fire Life Safety 08/05/2015 $734.72
Value: $220,951 Info Process/Archiving-Lg$2.00(over 08/05/2015 $28.00
11x17)
Metro Const.Excise Tax 08/05/2015 $265.14
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $4,629.97
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 oth-`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 uspended for more the 180
days. ATTENTI• . -•n law requires you to follow the rules adopted by the Oregon Utility Notification Center. Thos rules a e set forth in OAR
952-001-01 •through OAR 9 •-00 -**90. You may obtain a copy of the rules or direct questions to OUNC by c- • =•r .2344.'
.PAL WIMP`
Issu=• By: _��, Permittee Signature:
Call 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 101t OFF I( l: I til:()NIA
City of Tigard I:� Received S- ; Permit No.: �. •
• 13125 SW Hall Blvd.,Tigard,OR 972 ___ Plan Review i,� ��IN S • •
= Phone: 503.718.2439 Fax: 503.598.160 5 205 Date/B : ]`ell Other Permit:
lit. A R D Inspection Line: 503.639.4175 Date Ready':' RI See Page 2 for RN Internet: www.tigard-or.gov o`I4�(\BO Notified/Method: if/BM Supplemental Information
G 5 � Si ,
TYPE OF WQI {Ow.— ,v, 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.
12 1-and 2-family dwelling ®Commercial/industrial Valuation: $
❑Accessory building ❑Multi-family Number of bedrooms:
❑Master builder El 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.:100 Project name:Medical Home Remodel 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 2,026 SF+/-of interior non-structural remodel Valuation: $220,951
on the 1st Floor of an existing Medical Office Building. Existing building area: 25817 square feet
New building area: none square feet
® PROPERTY OWNER I ❑ TENANT Number of stories: 2
Name:Providence Health&Services Type of construction: Ill-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
® APPLICANT ® CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name:JRJ architects,Ilc 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 Photo Voltaic Solar Panel System.
Submit two(2)sets of roof plan with connection details
Business name:In Line Commercial Construction,INC. 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 lic.:51880 Total fee due upon application: $201.60
All , , This permit application expires if a permit is not obtained
Authorized signatu -• _„ 0ft irmi:S within 180 days after it has been accepted as complete.
r * Fee methodology set by Tri-County Building Industry
Print name:Thomas A.Wesel Date:
�/7 J j tj Service Board.
I:\Building\Permits\BUP-COM PermitApp.doc 02/24/2011 440-4613T(I 1/02/COM/WEB)
City of Tigard
III • COMMUNITY DEVELOPMENT DEPARTMENT
•
TIG u n Building Permit Review — Commercial - No Land Use
Building Permit #: if 40,0 70/5 35
Site Address: /Q4'/Q ,S1c) .aiipits. 7 is cite/Bldg#: /CD
Project Name: rrr vi �'1- s' I/ /0/ ■■# idle . •a
(Name of commercial business occupying the space. If vacant,enter f ec Space.)
Planning Review
Proposal: 77 /. r4 ,--,7, /g d o ,ce.:7 . 74. t.0?„hc
.e
Existing Business Activity: • '02_
Proposed Business Activity: /'."f 'Lk_I1d Verify site address/suite#exists and active in permit syysst .
'lam' ver Terrace Neighborhood: 1=1 Yes L1J'No
e-f
Vmitted ning. Use: LJd' Yes ❑ No ❑ Spec Space
I nfirm no land use required.
Business License:
Exists: Yes ❑ No,applicant notified to obtain business license
Notes:
Approved by Planning: L . Date: Of I/S-
Revisions (after Building Submittal only) Reviewer bate
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Building Permit Submittal
Original Submittal Date: Nis-
Site Plans: # 4//4-
Building Plans: # - ?
Building Permit#: nter building permit#above.
Workflow Routing: arlianning ❑ Permit Coordinator I - t l"dtng
Workflow Sign-off: [a�S' -off for Planning(include notes from planning review)
Route Application Documents: BI- uilding. original permit application,site plans,building plans,engineer and
n beam calculations and trust details,if applicable,etc.
Notes: Olt-
By Permit Technician: ''' _ _ Date: g`/5-1/
i/
1:\Building\Forms\BldgPermitRvw_COM_No LandUse_070915.docx
r
Permit Coordinator Review
❑ Conditions "Met"prior to issuance of building permit
❑ Approved, NOT Released: Date:
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:
❑ SDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes ❑ N/A
Tigard Trans SDC: ❑ Yes ❑ N/A
Parks SDC: ❑ Yes ❑ N/A
❑ OK to Issue Permit
Approved by Permit Coordinator: Date:
I:\Building\Forms\BldgPennitRvw_COM_NoLandUse_070915.docx
4
IBuilding Division
T I G A RD Over-The-Counter (OTC) Building Permit
Check List
Project Description: l
APPLICATION SPECIFIC INFORMATION
GENERAL INFORMATION
Class of Work*: Occupancy Group _Type of Construction: 7
Type of Use**: (, Occupancy Load: ( Oregon Specialty Code: AO y
SPECIFICS .
Number of Stories: '-j 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: te/2"/> 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: $ 2-720;?'51.O0 FEES DUE
$ ":3 -1,CC DC Prov Rvw,COM TI—Ping
$ (1l;, Permit Fee—Add,Alt,Demo
DC Provision Review Fee for COM TI(effective 7/1/2015) $ 12%State Surcharge
Project Valuation Planning $ 1/`",:?,—I Plan Review,Structural
Up to$4,999 $0.00 $ `z j.&" Plan Review,Fire Life Safety
$5,000-$74,999 $88.00 $ '.LX') Info Proc/Arch,Lg(over 11x17$2.00)
$75,000-$149,999 $220.00 $ Info Proc/Arch,Sm(up to 11x17$0.50)
$150,000 and over $351.00 $ '2(0'5,14- Metro Construction Excise Tax
$ School Construction Excise Tax
$ _ Hourly Rate Fee
$ Hourly Rate State Surcharge
$ Misc.Admin Fee
$ Other:
$ Other:
$ Other:
Building Staff: $ Other:
Date/Time: $ A(2q,617I10TAL 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(se for fences,deckssretaining walls,signs,awnings or canopies).
I:\Building\Forms\OTC_BUP_070115.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 100, TIGARD,
OR, 97223
Commercial - Building
299 Final inspection
PASS - No C of O
BUP2015-00235
Jeff Grove
Violation Summary:
Inspector Contractor