Permit CITY OF TIGARD BUILDING PERMIT
IN COMMUNITY DEVELOPMENT Permit#: BUP2016-00273
'1-EGA.R 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/13/2016
Parcel: 1 S 136DD05300
Jurisdiction: Tigard
Site address: 11850 SW 67TH AVE, STE#150
Project: American Family Insurance Subdivision: WEST PORTLAND HEIGHTS Lot: 9
Project Description: TI for existing tenant. Tenant is downsizing from second floor to first floor,and reconfiguring offices.
Contractor: VANOSDEL CONSTRUCTION Owner: PNWP LLC#2
PO BOX 1057 PNWP LLC
BATTLEGROUND,WA 98604 6600 SW 105TH AVE#175
BEAVERTON, OR 97008
PHONE: 360-600-9916 PHONE:
FAX: 360-687-7677
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: IIIB Permit Fee-Additions,Alterations, 09/13/2016 $1,008.06
Occupancy Grp: B Occupancy Load: 129 Demolition
12/o State Surcharge-Building 09/13/2016 $120.97
Dwelling Units: 0 Plan Review 09/13/2016 $655.24
Stories: 0 Height: 0 ft Plan Review-Fire Life Safety 09/13/2016 $403.22
Bedrooms: 0 Bathrooms: 0 Info Process/Archiving-Lg$2.00(over 09/13/2016 $8.00
Value: $87,000 11x17)
DC Provision Review,COM TI-Ping 09/13/2016 $224.00
Floor Areas:
Total Area: 12837
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $2,419.49
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. -- . direct questions to OUNC by calling 503.232197 or 1.800.332.2344.
Issued By: 7' -e ignature:
f'.39.4175 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.
•
City of Tigard • BUILDING DIVISION
Over-The-Counter (OTC) Building & Fire Protection System Permit
Appointment Checklist
Permit Record#: Gi/'o20/{o 00):73
Contact Name: grit. ,/I Phone #: (55v3 to _oy-S-,),
Business Name: t 1 ,„,_, Appt. Date/Time: ' /3 f(v 0 , 0
Site Address: //15-o EW 6'722-/¢vr Bldg/Suite #: -
Project Name: 41-e4,2 Fege, fy _724).,,,,cm
Project Description: Ae J),sv o ; c .,n
(ot / s z j,v5- , Vit 7`tr,-c 1S 1 ( c vtc,I.v. .,�75
Existing Use: ' •0-C New Use:
MMD Required: 0 Yes E I<fo- Related Record#:
GENERAL INFORMATION
Class of Work: 1&C-C- Occupancy Group: Type of Construction: 3
Type of Use: (', /tk, Occupancy Load: tOregon Specialty Code: 7„�
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: t -57 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:
Total Project Valuation: $ f57 MA er) MiliffillINIMMIIIMMI
$ C Prov Rvw,COM TI-Ping
I DC Provision Review Fee for COM TI(effective 7/1/2016) $ j 12%S Fee-Add,Alt,Demo
$ r 7.0 , 7 12%State Surcharge
Project Valuation $ =-, A 'lan Review,Structural
Up to$4,999 $0.00 $ ,c 'ZZPlan Review,Fire Life Safety
$5,000-$74,999 $90.00 $ g,01. Info Proc/Arch,Lg(over 11x17$2.00)
$75,000-$149,999 $224.00 $ Info Proc/Arch,Sm(up to 11x17$0.50)
$150,000 and over $357.00 $ Metro Construction Excise Tax
$ School Construction Excise Tax
$ Hourly Rate Fee
$ Hourly Rate State Surcharge
$ Misc.Admin Fee
$ Other:
Building Staff: $ - •-4�.� Other:
Date/Time: $ Z fAdAtTOT FEES DUE
I:\Building\Forms\OTC_BUP_FPS_070116.docx
.------- -
City of Tigard
p COMMUNITY DEVELOPMENT DEPARTMENT
r 1 c A R o Building Permit Review — Commercial - No Land Use
Building Permit #: 674,A,IO/6,- QD 73
Site Address: /f g ,�. ) 6 . ni,e Suite/Bldg#: ,i;
Project Name: /53,,u,ryceaft. .1.,",/fr��i>Cy Its c�.�rvoic.�
(Name of commercial business occupylspace. If vacant,enter Spec Space.)
Planning Review
Proposal: 7'l e;rokAi y -f-1
eAai!i—
Existing Business Activity: O
Proposed_opBusiness Activity: //
Verify site address/suite# exists and active inpermit s
yst
101 A .ver Terrace Nei hborhood: ❑ Yes No
IP/Zoning: /V1t-/E
trnitted Use: Yes 0 No 0 Spec Space
'Firp p
Confirm no land use required.
0 Business License:
Exists: Yes 0 No,applicant notified to obtain business license
Notes:
Approved by Planning: r
/'
.1Date:
Revisions (after Building Submittal only) Reviewer
Revision 1: 0 Approved 0 Not Approved Date
Revision 2: 0 Approved 0 Not Approved
Revision 3: 0 Approved 0 Not Approved
Building Permit Submittal
Original Submittal Date: w
Site Plans: #
Building Plans: #
Building Permit#: 0--rn'ter building permit#above.
Workflow Routing: ming 0 Permit Coordinator
Workflow Sign-off: ["'�Si °ff for Planning(include notes from planning review)
Route Application Documents: L`_i'Building: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes: CST
By Permit Technician:
Date: cv, -4k,�
I:\Building\Forms\BldgpermitRvw_COM_NoLandUse 060116.docx
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\B1dgPermitRvw_COM_NoL.andUse_070915.docx
Building Permit Application
Commercial
�- .� .. FOR OFFICE USE ONLY
City of Tigard HE . ; - - Received 9
IIII 13125 SW Hall Blvd.,Tigard,OR 97223 Date/B : f lannin. Permit No.: , /. , ;
= Phone: 503.718.2439 Fax: 503.598.1960 C.„'SEP 1 3 2 U 16 Plan Revie
Inspection Line: 503.639.4175 Date/I3 Other Permit:
TIGARD p Date Rea
Internet: www.tigard-or.gov 'o See Page 2 for
1, *'•-‘;
"` t Notified/Method:'T
s ii) Supplemental Information
TYPEOFW I ,.DIi'i t4...4 . .
REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑New construction ❑Demolition Permit fees*are based on the value of the work performed.
®Addition/alteration/replacement Indicate the value(rounded to the nearest dollar)of all
❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ 1-and 2-family dwelling ►,1 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:11850 SW 67th Ave
New dwelling area: square feet
City/State/ZIP:Tigard,Oregon 97223
Garage/carport area: square feet
Suite/bldg./apt.no.:150 I Project name:American Family Insurance
Covered porch area: square feet
Cross street/directions to job site:
Deck area: square feet
Other structure area: square feet
Subdivision: REQUIRED DATA:COMMERCIAL-USE CHECKLIST
I Lot no.: Permit fees*are based on the value of the work performed.
Tax map/parcel no.: 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.
Modify existing training room,offices,conference rooms and open office areas. Valuation:
$$87,000.00
Remove walls,doors and relites. Provide new walls,doors and relites per Existing building area: 12837 square feet
revised layout.
New building area: - square feet
.. PROPERTY OWNER I 0 TENANT
Number of stories: 2
Name:Pacific NW Properties
Type of construction: III-B
Address:6600 SW 105th Ave,Ste 175
Occupancy groups:
City/State/ZIP:Beaverton,Oregon 97008
Phone:( ) Existing: B/A3
Fax:( )
® APPLICANT New: B/A3
CONTACT PERSON BUILDING PERMIT FEES*
Business name:Mildren Design Group,PC (Please refer to fee schedule)
Contact name:Curt Trolan Structural plan review fee(or deposit):
Address:7650 SW Beveland St,Ste 120 FLS plan review fee(if applicable):
City/State/ZIP:Tigard,Oregon 76223 Total fees due upon application:
Phone:(503)244-0552 I Fax::(503)244-0417 Amount received:
E-mail:curt@mdgpc.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CONTRACTOR Commercial and residential prescriptive installation of
roof-top mounted PhotoVoltaic Solar Panel System.
Business name:VanOsdel Construction Submit two(2)sets of roof plan with connection details
Address:PO Box 1057 and fire department access,along with the 2010 Oregon
City/State/ZIP:Battle Ground,WA 98604 Solar Installation Specialty Code checklist.
Permit fee(includes plan review
Phone:(360)687-8636 and administrative fees): $180.00
Fax:(360)687-7677
CCB lie.:164073 State surcharge(12%of permit fee): $21.60
7�`- /� Total fee due upon application: $201.60
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:Curt Trolan I Date:9/13/2016 1 * Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\BUP-COM PermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
13125 SW Hall Blvd.
Tigard, OR 97223
City of Tigard
Location:
11850 SW 67TH AVE STE 150, TIGARD, OR,
97223
Record Type:
Commercial - Building
Inspection Type:
299 Final inspection
Result:
PASS -CofO
Comments:
Violation Summary:
Inspector
Tel: 503.718.2439
Inspection Date:
February 9, 2017 at 10:33:48
AM
Record ID:
B U P2016-00273
Inspector:
Chip Barnett
Contractor