Permit CITY OF TIGARD BUILDING PERMIT
11111 COMMUNITY DEVELOPMENT Permit#: BUP2015-00163
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/22/2015
Parcel: 151260000300
Jurisdiction: TIGARD
Site address: 9618 SW WASHINGTON SQUARE RD GO5
Project: Helzberg Diamonds Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: S
Project Description: TI for existing tenant.
Contractor: TRI NORTH BUILDERS INC Owner: PPR WASHINGTON SQUARE LLC
PO BOX 259568 PO BOX 847
MADISON,WI 53725-9568 CARLSBAD,CA 92018
PHONE: 608-271-8717 PHONE:
FAX:
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: IIB Permit Fee-Additions,Alterations, 09/22/2015 $674.35
Demolition
Occupancy Grp: M Occupancy Load: 58 12%State Surcharge-Building 09/22/2015 $80.92
Dwelling Units: 0 Plan Review 06/09/2015 $438.33
Stories: 0 Height: 0 ft Plan Review-Fire Life Safety 06/09/2015 $269.74
Bedrooms: 0 Bathrooms: 0 DC Provision Review,COM TI-Ping 09/22/2015 $75.00
Value: $45,000 DC Provision Review,COM TI-LRP 09/22/2015 $11.00
Info Process/Archiving-Lg$2.00(over 09/22/2015 $16.00
11x17)
Floor Areas: Info Process/Archiving-Sm$0.50(up to 09/22/2015 $4.00
11x17)
Total Area: 2115
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $1,569.34
Required: Required Items and Reports(Conditions)
Fire Sprinkler: 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 ar€ 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 503.2 .1987 or . 0.332.2344.
Issued By: Permittee Signature:
Calf .639.4175 by 7:00 a.m.for the next available inspect: n date.
This permit card shall be kept in a conspicuous place on the job site until completion of the projoct.
Approved plans are required on the job site at the time of each inspection.
Irt CITY OF TIGARD BUILDING PERMIT
t s: COMMUNITY DEVELOPMENT Permit#: BUP2015-00163
TIGARD 13125 SW Hall Blvd..Tigard OR 97223 503.718.2439 Date Issued: 09/22/2015
Parcel: 151260000300
Jurisdiction: TIGARD
Site address: 9618 SW WASHINGTON SQUARE RD 005
Project: Helzberg Diamonds Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: S
Project Description: TI for existing tenant.
Contractor: TRI NORTH BUILDERS INC Owner: PPR WASHINGTON SQUARE LLC
PO BOX 259568 PO BOX 847
MADISON,WI 53725-9568 CARLSBAD, CA 92018
PHONE: 608-271-8717 PHONE.
FAX:
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: IIB Permit Fee-Additions,Alterations, 09/22/2015 $674.35
Demolition
Occupancy Grp: M Occupancy Load: 58 12%State Surcharge-Building 09/22/2015 $80.92
Dwelling Units: 0 Plan Review 06/09/2015 $438.33
Stories: 0 Height: 0 ft Plan Review-Fire Life Safety 06/09/2015 $269.74
Bedrooms: 0 Bathrooms: 0 DC Provision Review,COM TI-Ping 09/22/2015 $75.00
Value: $45,000 DC Provision Review,COM TI-LRP 09/22/2015 $11.00
Info Process/Archiving-Lg$2.00(over 09/22/2015 $16.00
11x17)
Floor Areas: Info Process/Archiving-Sm$0.50(up to 09/22/2015 $4.00
11x17)
Total Area: 2115
Accessory Struct: 0
Basement: 0
Carport 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $1,569.34
Required: Required Items and Reports(Conditions)
Fire Sprinkler: 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 503.2 .1987 or 0.332.2344.
Issued By: 7 Permittee Signature: L)
Cat .4175 by 7:00 a.m.for the next available inspecti n 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 1 SI:ON IA
Received
- City of Tigard Permit No.: Ai_ ,1/ _ a
• 13125 SW Hall Blvd.,Tigard,OR 97 R3t t p R `�i ,
Phone: 503.718.2439 Fax: 503.598.1960 Date/B : A 1.5._
Other Permit:
T I G A RD Inspection Line: 503.639.4175 Date Notified/Method:y: ' ��� ® See Page 2 for
Internet: www.tigard-or.gov :`, Ned/Meth / Supplemental Information
TYPE OF WORK' '. `s, REQUIRED DATA:I-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.
El 1-and 2-family dwelling ®Commercial/industrial Valuation: $
❑Accessory building ❑Multi-family Number of bedrooms:
El Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address:9618 S.W.Washington Square Road New dwelling area: square feet
City/State/ZIP:Tigard,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:Helzberg Diamonds Covered porch area: square feet
Cross street/directions to job site:Washington Square Mall 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.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application. _
Complete build out of jeweler room in back of house existing room. Valuation: $45,000 1
Install new mechanical,electrical,and plumbing fixture. Existing building area 2115 square feet
Install new finishes,casework,equipment,and replace door to jeweler room. New building area 0 square feet
❑ PROPERTY OWNER ® TENANT Number of stories: 1
Name:Helzberg Diamonds (Lesley Nasalroad,Design Mgr.) Type of construction: 2B
Address:1825 Swift Occupancy groups:
City/State/ZIP:North Kansas City,MO 64116
Existing: MERCANTILE
Phone:(816)627.1436 Fax:(816)627.1494 New: MERCANTILE
® APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name:H.C.Klover Architect Structural plan review fee(or deposit):
Contact name:Henry Klover FLS plan review fee(if applicable):
Address:10955 Lowell Ave.,Suite 700 Total fees due upon application:
City/State/ZIP:Overland Park,KS 66210 Amount received: 708.07
Phone:(913)649.8181 Fax: :(913)649.1275 PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
E-mail:hcpermitting @klover.net Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted Photo Voltaic Solar Panel System.
n y J Submit two(2)sets of roof plan with connection details
Business name:TBD / tR /1/(-44 czr/ {cc and fire department access,along with the 2010 Oregon
Address: �l r v C.- -jr y Solar Installation Specialty Code checklist.
City/State/ZIP: �lJ� J 7 Permit fee(includes plan review tap no
Y Ms�iel;. a h w 5-3 d`5--' f cG r and administrative fees):
Phone: ir Or 7/ '7(7 9 Fax:(C4° )Sf a 7/ 3 51-i State surcharge(12%of permit fee): 1-60-
CCB lic.: 1 yC �l /I Total fee due upon application: X91-60
Authorized signature::
� � :7 This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
, * Fee methodology set by Tri-County Building Industry
Print name:Henry C. Io' r Date:06.08.15 Service Board.
1:\Building\Permits\BUP-eI PermitApp.doc 02/24/2011 440-46l3T(Il/02/COM/WEB)
• •
City of Tigard
COMMUNITY DEVELOPMENT DEPARTMENT
Building Permit Review — Commercial - No Land Use
I I( , 1RI)
Building Permit #: 6t;I/°O/r= cjc(,3
Site Address: ckik Sc,/. //Jt,, 7' J ,, �/, Suite/Bldg#:
Project Name: /74 ]Z 0�, -
(Name of commerc4Vusiness occupying the space. If vacant,enter Spec Space.)
Planning Review / ,
Proposal: 7/s, - e'(/S?75 -7
Existing Business Activity: ,c b S- 00076 rz:27641
Pro osed Business Activity: ii n
Verify site address/suite#exists and active in permit sys m.
o' ver Terrace Plan District ❑ Yes No
IG/Zoning: M U
rmitted Use: Yes ❑ No ❑ Spec Space
Confirm no land use required.
usiness License:
Exists: I(d Yes ❑ No,applicant notified to obtain business license
Notes:
Approved by Planning: .- -----j-
At. %, Date: VCOS--""
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 (9/0--
Original Submittal Date:
Site Plans: # jt/0
Building Plans: L�I�r
Building Permit#: nter building permit#above.
Workflow Routing: [3—plan C-Permit Coordinator D2-Praildifik
Workflow Sign-off: ign-off for Planning(include notes from planning review)
Route Application Documents: - g original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: _i` Date: 6/4/4.5—
I:\Building\Forms\BldgPermitRvw_COM_NoLandUse 031015.docx
v
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:
to Issue Permit /
/Approved by Permit Coordinator: 4! ./..,-d4 c., Date: 6°/>%
1:\Building\Forms\BldgPermitRvw_COM_NoLandUse 03 1015.docx
RECEIVE)
lhckioverarc hitect
JUN - 9 2015
transmittal: CITY OF t'ii1ARD
NG n�ls�1C!(ltn,
date: 06.08.15 attention: Building- menf
job no: 15007.051 to: City of Tigard
bill group: 00001 prose code: 01 13125 SW Hall Blvd.
Tigard, OR 97223
reference: Helzberg Diamonds- Washington
Square- PermiSubmittal
phone: 503.718.2449
copy: File
File to: _ from: Jaclyn Shepherd
items transmitted are:
® attached ❑per your request ❑ for your files ❑ urgent
items transmitted for your:
❑ information
❑use ® approval El review
items transmitted via:
®federal express ®standard ❑priority ❑residential delivery I
❑ups ❑next day ❑2^d day
❑courier ❑ 1 hour ❑2 hour ❑4 hour ❑same day
❑us mail ❑pick up ❑ hand delivered
❑fax number:
description of items transmitted:
copies: date: description:
4 06.08.15 Permit set of drawings
1 06.08.15 Cut Sheets for Equipment (faucet, sink, and mitsubishi)
1 06.08.15 Plan Review fee $708.07; check number 2436
1 06.08.15 Building Permit Application
1 06.08.15 Building Permit Checklist
comments:
To Whom it may concern,
Please find the above referenced items attached for your review. If you have any
questions, please let me know.
Thank you,
Jaclyn Shepherd
)955 lowell ave ■ suite 700 • overland park, ks 66210 • t 913.649.8181 • f 913.649.1275 • www.klover.net
L
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
9618 SW WASHINGTON SQUARE RD G05,
TIGARD, OR, 97223
Commercial - Building
299 Final inspection
PASS - No C of O
BUP2015-00163
Jeff Grove
Violation Summary:
Inspector Contractor