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Kainex Permanente Nortbiwest Division
ELEC: TRON ? C MEMORANDUM
Cre:ce d: 13-Oct-1998 05 :24pm PDT
From: Bruce Fong
PONGBR
Dept: Facilities cervices
Tel No: 813-468649 4686
110: Steven Kolberg f PKA.KOLBERGST )
�a
(Y': Janet O'Hollaren ( OHOLLAR%NJA )
Subject: Tigard Dental
Steve;
Enclosed .is the Tigard Dental plan .for your use. We will be using
Rooms 149 and 150 for vxal surgery. I have noted them with an arrow.
Our procedures call for only one patient will be sedated at a time.
Call ine if you need any other information or a 1/4" = 1' architectural
plan.
Please let me know whet ii•,terpretat.ion the code official makes on the I
occupancy requirements .
Thanks,
Bruce
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OCT, 19. 1998 2:09PM FACILITIES SERVICES N0, 7564 P. 1
Petersen Kolbe:q &Associates, RC. IuLmV AIA, Architects/Pianna�s
n!+r'1-IITMC T:o
Post-11'brand falx transmittal n.emo AMe+orps a ►!
f' J`
September 25, 1998 �-=C.—=� _ "` `���
l)ep% '— PRonir A 13
R
Mir. Jim �tarri
City r`Portland
r1ureau of Buildings
1120 SW 5"'Ave., Room 930
Portland, OR 97204-1992
RE: KAISER NORTH INTERSTATE DEN',.4L
CODE REVIEW
Mr. Harris-
This is a follow-up to our telephone conversation today with you, Steve Kolberg and
myself, regarding code requirements for Dental Faalities. We are remodeling an
existing Kaiser Dental Facility making minor modifications such as, removing casework.
The existing Clinic does sedate patients not capable of self preservation svith a total
maximum of five, which we would be classified as occupancy group 1 1 3 However,
since, we are only making minor modifications to this existing Clinic, we would not be.
rtNulred to upgrade the Clinic to current cede requirements such as. procedure room,
emergency electrical power, emergency power source for the fire alarms and exit lighting
and a minimum of 6' wide corridors. You did explain if we were expanding the Dental
O,R, area cr other major work in the tPnants, the Cif.y, could require upgrading of these
requirements.
We are proceeding as we discussed. Please let us know if you have any additional
comments.
Sincerely,
PETERSEN KOLBERG & ASSOCIATES, P.C.
Reg McDonald
Cc: Bruce Fong, Kaiser Permanente
Terry Greenman, Hrockamp & Jaeg«^r
RM/tm
6969 Southwest Hampton strfito Po,tlond. Oregon 97226 (503) 968-6800 FAX (503) 968-6860
d=.1,
Petersen Kolberg &Associates, P.C. AA.I.A. Architects/Planners
FIC-_VAf T! �'"'t r;
October 30, 1990
MI. Bob Poskin r
City of Tigard
13125 SW Hall Blvd. /
Tigard, OR 97223
RE, KA ISFR T!GARn !;17NTAL
7105 SW HAMPTON STREET
PORTLAND, OR 97223
Dear Mr. Poskin,
This is a follow-up letter to our telephone conversation today, concerning the
Tigard Kaiser Dental Clinic. The clinic: will begin doing procedures that rer,jer
patients incapable of self-preser.,Alion in two of the r-X;sting l-rcatn',ont rooms.
We have- confirmed with the Chief Practitioner, There wiil only be a maximum of
four patients at any one time lender incapabie of self-preservation. See the
attached signed form. Since .ve are under the code required five patients; this
clinic will remain as a 'B' Occupancy. Also, since we are not making any phyFical
changes to the clinic (except for casework within the Procedure room) no Lifa
Safety, ADA or other code required upgrades would be required of this clinic
If you have any further questions, please let me know.
Sincerely,
Reg McDonald
RM/tm
6969 SnnthWeSt rlampton Street Portland, Oregon 97223 (503) 968-6800 FAX (503) 968-6860
Petersen Kolberg & Associates, P.C. p1mm AIA. Architects/Planners
Anc>-4rrr_c rs
October ,'0, 1998
Mr. Bob Poskin
City of Tigard
13125 SW Hall Blvd,
Tigard, OR 97223
RE: KAISER TIGARD DENTAL CLINIC
7105 SW HAMPTON STREET
PORTLAND, OR 97223
Dear Mr. F'oskin,
I nis is a '_-Aow-up to our telephone conversation todav, concerning the Kaiser
Denial Clinic. We informed you that they will begin procedures that will render
patients incapable of self-preservation within two of the existing Procedure
Rooms. I have been informed from Kaiser that there will be fewer than five
patients incapable of self-preservation at any one time. With this confirmation,
you are he in agreement that the building would remain a 'B' Occupancy and
depending on what is necessary for these procedures to take place we have two
options:
1. If there are no physical changes to the Clinic (except casework changes):
we would submit a letter to you confirming the number of patients
incapable of self preservation with a signed letter from the Clinic's Chief
Practitioner as a record of this change.
2. 'f there are physical changes to the Clinic: we would submit the same
letter of documentation as noted in option #1 and apply for a building
permit. We would be required to upgrade the facility to ADA requirements
up to 25%t of the value of the project. Life Safety upgrades would only be
isolated to the area of remodel since there is no change in the occupancy
of the building.
If you have any further questions, please let me know.
Sincerely,
IYe-
Reg McDonald
RM/tm
6969 Southwest Hampton Street Portland, Oregon 97223 (503) W,8-6800 FAX (503) 968-6860
Doctors/Dentists Questionnaire
1�s part. of the building permit review for your proposed tenant
space, the following information is requested. Please see the back
.:,ide of this sheet for further explanation.
Pleasu answer the following questions and return to us a signed
copy. Please also provide n copy to the build] ng owner or their
agent
1 . Yes No Wil] there be use of procedures that render a
patient incapable of unassisted self-preservation?
(This would Include any use of general anesthesia,
as well as any procedures that would result in a
patient. heroming incapable of recognizing a fire
emergency, or of immediately leaving the building
without assistance . )
1
2 . If your answer to QUe.3tion 1 was "yes what is the
maximum number of patients who could possibly be
incapacitated at any one time? (1'hls would include
all patients meeting the description above, whether
they are being prepped, underguing a procedure, or
In your recovery area. )
signature Building Name/AddresG __ 1 _. _
Fame t�v%%) i JL V* V ,'A,) T�1� I_ r"fit- �-LA os-; e-
-
D a t e r c 9 k --t----- _y C VW
tf�ttt�' --
pa A-Tj,,A.- l, OIL
TtAs information Is i ntendec: soleay for the purpose of determining
c.onst.ruction standards for the building and for your space in it.
There is no correlation with the procedure lists used by the State
Hea].th Divisicn in its licensing process, nor with any lists that
may be used by any insurance carrier, etc .
'thank you for tilling out the attached questionnaire, and returning
it -o the architect or space planner responsible Lor obtaining your
building permit.
a ill
i
���� ®� �■���® ELECTRICAL PERMIT IR PERMIT#: ELC1999-00231
DEVELOPMENT SERVICES DATE ISSUED: 4/26/99
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 4171 PARCEL: 2S101AC-01300
SITE ADDRESS: 07105 SW HAMPTON ST
SUBDIVISION: 13EVELAND NO. 2 ZONING- MUE
BLOCK: LOT : 018 JURISt31CTION: TIG
Proiect Description: Add sign or outline lighting for .!•F;w monument sign
RESIDENTIAL UNIT TEMP SRVC/FEEDERS _ MISCELI-_ANEOUS _
1000 SF OR LESS: 0 - 200 amp: PUMP/IRRIGATION:
EACH ADD'L. 500SF: 201 - 400 amp: SIGN/OUT LINE LTG: 1
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HMI SVC/ FDR- 601+amps - 1000 volts: MINOR LABEL (10):
_
SERVICE/FEEDER_ _ _ _BRANCH CIRCUITSADD'L INSPECTIONS
— 0 200 amp: W/SERVICE. OR FEEDER:` PER INSPECTION:
20.1 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH C'RC: IN PLANT:
601 - 1000 amp: _ PLAN REVIEW SECTION _
1000+ amp/volt: >=4 RES UNITS: > 600 VOLT NOMINAL:
L—_Reconnect only. SVC/FDR >= 27.5 AMPS: — — CLASS AREA/SPEC UCC: _
Owner: Contractor:
KAISER PERMANENTE HEATH -r COMPANY LLC
822 NE HOYT STREE-r 4644 SE 17TH AVE:
PORTLAND. OR 97209 PORTLAND, OR 97202
Phone: Phone: 232-2620
Rey #: SUP 618sig
LIC 127870
ELE 26-998CLS
FEES Required Inspections
Type By Date AmountReceiptElect'I Service
Elect'I Final
PRMT GEO 4/16/99 $40.00 99-314466 EXPIRED
5PCT GEO 4/16/99 $2.00 99-314466
Total $42.00
_ L�This Permit is issued subject to the regulations contained in the Tigard Municipal Code,State of OR Speaalty Codes and all other applicable laws
All work wit be done in accordance with approved plans This permit will expi•e if work is not started within 180 days of issuance,or if work is
suspended for more than 180 days Al-r ENTION Oregon law requires you to follow rules adopted by the Oregon LltiIity Notification Center 1 hose
rules are set forth in OAR 952-001-0010 through OAR 952 001-0080 You may obtain oopies of these rules crdirect questions tc OUNC at(503)
246-1987
Permit Signature: { i! r;''{-� r L,\ Issued By:Cz
OWNER INSTALLATION ONLY ---
The installation is being made on property I own which is riot intended for sale, tease, or rent.
OWNER'S SIGNATURE: _ ---- DATE:
CO
NTRACTOR INSTALLATION
SIGNATURE OF SUPR. ELEC'N: y � -
LICENSE NO: --- – - — --- — -------- ---
Call 639-4175 by 7:00pm for an inspection the next business day
CITY OF TIGARD Electrical Permit Application Plan Check
Recd By
13125 SW HALL BLVD. Date Recd'Ll
TIGARD OR 97223 Date to P E.
Phone (503)639-4171, x304 Print or Type Date to DS
Inspection (503) 639-4175Permit a C�- 41"-Ma
Fax (503) 684-7297 Incomplete or illegible will not be accepted caned
4. Corn
1. Job Address: P
V
lete Fee Schedule Below:
Name of Development fS'.(s;J f'12 M A ti�r"Ny t _ Number of Inspections per permit allowed ---
Name(or name of businesss)�C� o}A�� Nt�� -r' Service included: Items Cost Sum
Address_ /c5�_,L r/A�►Id/O� -- __
4.1. Residenikil-per unit
1000sq.n.or loss � $110.00 ,
City/State/Zip 1 4�iC� �- __ Each additional ,0 sq.It.or
portion thereof ___ $25.00
Commercial Residential ❑ Limited Energy __ $25.00
Each Manurd Home or Modular
Dwelling Service or Feeder $68.00
2a, Contractor installation only: 4b.Services or Feeders
(Attach copy of all rrent I censes Installation,alteration,or relocation
Electrical Contractor- ra �' "'� L� �. - 200 amps or less $60.00
AddZ
/!�1 i�-- I A d2 X -- 201 amps to 400 amps �_ $80.00 _
City +fC�_r-.--State_C1j�e_Zip_ 7�_- 401 amps to 600 amps $120.00
s $180.00
Phona No. '7 Ll j (LLQ 's�/Q -- Over 10100tamps oo 1000 r outs $340.00 - 1
Job No. Reconnect only $50.00 __ 2
EIr c.Cont. Lice, No..2k. Cl.S Exp.Date_ 0 i 99
OR State CCB Reg. No.17 1 R 7L _Exp.Date -!-LW-- Cle'- 4c.Temporary Services or Feeders
COT Business Tax or Metro No. TaLcv: - Exp.Date X� Installation,alteration,or relocation
mo amps or less $50.00 r
?/ 7 201 amps to 400 amps $75.00 2
Signature of Supr. Eltac'n L� `"' 401 amps to fioo amps � $1tb.00 2
7
Over 600 amps to 1000 volts
License Nr / 3 1 oy _Exp.Date�4/ / 9 Q see"b"above.
Phone N _��� 4 44 5____1 51 --- 4d.Branch Circuits
rl(,,w,alteration w extension per panel
2b. For owner installations: ❑)The fee for branch circuits with
purchase or service or
Print Owner's Name__ ,,_ _ feeder fee.
$5.00
Each branch circuit
Address b)T'•Io fee for branch circuits
City State__ Zip wlthou,
purchase of
Phone No. _- __ service or feeder fee.
first branch circuit $35.00
The installation is being made on property I own which is not
Each additional branch circuit� $5.00 --
intended for sale,lease or rent. 4e.Miscellaneous
(Service or feeder not Included) $JO 00
Owner's Signature_---- Each pump or irrigation circle - `
Each sign or outline lighting $40.00 - 2
t Signal circuit(s)or a limited Energy
3. Plan Review section (if required)' panel,alteration or extension M $40.00
Minor Labels(10) $1 W.00
Please check appropriate Item and enter fee In section 5B. 411.Each additional Ins-ection over
4 or more residential units In one structure
Service and feeder 225 amps or more the allowable In any a no above $3500
System over 600 N,olts nominal Per Inspection -- V,5.00
Classified area or structure containing special occupancy Pet hour $5500
as described in N.E.0 Chapter.5 In Plant -
'Submit 2 sets of plans with application where any of the above apply. 5. Fees:
Not required for temporary construction services. 5a.Enter total of above fees $ - -
5%Surcharge(.05 X total fees) $
NOTICE Stobtotai $ -
5b.Enter 25%of line ba for $
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review if r it d(Sec.3) $ -
NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK Subfotot
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY El Trust Account k_- L`
TIME AFTER WORK IS COMMENCED. -�-
Total balance Due s
CU)STs1ELCgri APP nV.S W6
,A CITY Q F T I G A R DELECTRICAL PERMIT
PERMIT#: EI-2 01 006r 1
DEVELOPMENT SERVICES DATE ISSUED: 12/24/4/01
13125 SW Hall Blvd.. Tiqard, OR 97223 (503) 639-4171 PARCEL: 25101AC-01300
SITE ADDP.ESS: 07105 SW HAMPTON 51
SUBDIVISION: BEVELAND NO. 2 ZONING: MUE
BLOCK: LOT: 018 JURISDICTION: TIG
Pro,ect Description: Install one branch circuit, and modify two branch circuits for commercial TI
_ RESIDENTIAL UNIT _ TEMP SRV%/FEEDF.'1 _ MISCELLANEOUS --�
1000 SF OR LESS: 0 - 200 amp: —^ i PUMP/IRRIGATION:
EACH ADDT 500SF: 201 - 400 amp: SIGN/OUT LINE LTG:
LIMITED ENERGY: 401 600 amp: SIGNAL./PANEL:
MANE HM/ SVC/ FDR: 601+amts - 1000 volts: MINOR LABEL (10):
SERVICE/FEEDER _— BRANCH CIRCUITS
---- ----------- �. ._—�---__ ADD'I_ INSPECTIONS____
0 200 amp: WISERVICE OR FEEDER: PER INSPECTION:
201 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp' EA ADD'L BRNCH CIRC: 2 IN PLANT:
L601 - 1000 arnp: _PLA_ N REVIEW SECTION
1000+ amp/volt: >=4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect onlv: SVC/FDR >= 225 AMPS: _ CLASS AREA/SPEC UCC:
Owner: Contractor:
KAISER FOUNDATION HEALTH CHRISTENSON ELECTRIC INC
PLAN OF THE NORTHWEST#838 111 SW COLUMBIA
ATTN: PROPERTY ACCOUNTING STE 480
PORTLAND, OR 97227 PORTLAND, OR 97201
Phone: Phone: 241-4812
Reg #: LIC 458
SUP 3289S
ELE 2.6-34C
— FEES Required Inspections__
1= Y
Type By Date Amount Receipt Ceiling Cover
PRMT CTR 12/24/01 $60.15 2720010000( Wall Cover
Elect'I Final
5PCT CTR 12/24/01 $4.81 2720010000(
Total $64.96
This Permit is issued subject to the regulations contained in the Tigard Municipal Code,State of n'?. Specialty Codes and all other applicable laws
All work will b,done in accordance with approved plans. This permit will expire if wore-ip,got started with;n 180 days of issuanw,or if work is
suspended for more than 180 days. ATTENTION: Oregun law requires you to follow saes adopted by the Oregon Utility Notification Center. Those
rules are set forth in OAR 952-001-0010 through OAR 952-001.0080 You may obtain copies of these rules or direct questions to OUNC at(503)
246.6699 or 1.800-332-2344.
Permit Signature: Issued By, ,.
OWNER INSTALLATION ONLY _
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: _ DATE:
CONTRACTOR INSTALLATION ONLY_—
SIGNATURE OF SUPR. ELEC'N ______—�_� __� DATE: _
LICENSE hl O: —
Call 639-x175 by 7:00pm for an Inspection the next business day
Sent by: CHRISTENSON ELECTRIC 5032056721 ; 12/19/01 7:15PM;JQ1fX&_#30; Paye 1 /1
Electrical Permit Application
,r,4 Daterecelva& /,1. �/ / Pelfnit no.:
'&
City Of Tigard E Vrr'S■ Projecl/appl.no.: Expire date:
City o.f'rigdrd Address: 13125 SW Hall Blvd,Tigard,Oil 972.21 1 Dow issued: By: Receipt Do.,
Phonc: (503) 639-4171 �� �, L Ij 1 _ --
Fax: (503) 598-1960 Case file no. payment type:
Land use approve" CITY
y dwelling ur accessory XJ0 Commercial/industn4l O Multi-ram,ly U Tenant ialprovernent
uction U Addition/pltrration/r4rp!acxtnent U Othcr: U Pa,ltal
;Jo;baddress: 105 SW HVIPTON ST ilii). eo.! tinea n,. Tax map/rax lot/acro:nt no.:
Lot: Block: Subdivision:
Project name: IS9 DENTALL Description and location of work on its emises'TENANT IMPROVEMENT INSTALL"1
F_stimateddatenfcomplenon/ins .ction•Q .STTC-NS.MA T W.(503)936-2141 CIRCUIT, MODTFY (2)CTPCUITS
Joh not 83 0_3083 F« Matt
Business nanic:CHRISTENSON ELECfRlC INC. llcscrlPuou _ city. (tn.) Total no.ins
Address:111 SW COLUMBIA,SUITE 480 --" NrvvmJdmUal sin*,ornudti•tamllylrr
dwelluw.vosit twholes ottari.ed r�tryge,
—61 y: PORTLAND State: 0 ZIP: Ser.i"eincturlat
Phone51 E
03 2414812 Fax50324105mail. 100osq 1t,orteu 4
CCB neo t�8 C,bus.lie,no: 26-34C Each additional 50Dsq-n or ponio_n thereo
Limited enetgy,residential
Cit /rnetw_jom9no.. CJ 46 Umitedertergy,non•residentlel — 2
Each manufactured home or modular dwelling
Signal of supmisin a •ci r ucq ircC)^ Dare__ �9t0-1— Smice and/or&eder _ _ 2
Sup rJect rtarnc(print) B1?LAN CHRISTOPW--K Lltxusorw: 8735 S rvlmorfeeders-trwsllat
alteration or relocation:
200 amps ar less 2
Nance(print): 201 unpa to 400 apps 2
Mal llnz address: — — 4otamps0o
to6amps 2
__--- _ 61 amps to I00D am & 2
City. Stair.: ZIP: river 11X10 amps or vo V 2
Phone: - Fax: -- E-mail; Reconnectonl 1
owner installation:The installation is being made on property 1 own Trtnporar?savlotserreeders-
which is not Intended for sale,lease.,rent,or exchange according to iosulladott,alteration.orrelocations
ORS 447,455,479,670,701. 200 amps or It" -- 2
201 amps to 400 amps 2
Owner's sl nature: Date. 401w 6 amps - -- 2
¬ch elrcults-new,a tent ,
Vame. or extension per panel:
Fee fcr brmc't dreuits with ptu.:R-se of
Address: mrvice or feeder fee,each branch circuit 2
City: Stale: ZIP: B Fee for branch cucuits without purchase i 6. 2
Phone: Fax: F, mail of cervica or feeder fee.,first branch circuli 85 _
Bach additional branch circuit 2 13—.3-0
Misc.(Servleeorleederaot a ed):
❑Setv►ceova 225 amps commerold ❑ I Iralrh ties facility Each pump or irrigation inic 2
O Service over 320 amps rating of 1 A2 0 Haranlou&location Each signor outline lighdog 2
funilydrellings 0 Building over 10400 square feet foot or Signal circuit(&)or a limited energy panel
a System over5oo volts nominal nsore residential units to one structure utteration,or extension; 2
D Building ovrrthree stories 0 Feeden,400amps ormore •I1Cacti Um _
U(Wupani load aver 49 pemnm 0 Manulacturrct structuress or RV park Fjeh additional Inspection over the allowable in any at the above.
0 Nreadltghungplan 0 Other _- — Per inspection -
.Submit__sets of plans nlrh any of the above. nvuugsrtlonfre
_ liar above are not appticable_to ternprtrary cooctrudioo wit vice. Ocher __--
Na dl)uirdkuntn&accep.rtrdit reds,
plan Cali furisdw ti,Y-for mon ianxasmnn Notice:This permit application Permit fee............. ... S
pvtaa U Mastercard expires if permit is net nhlaired flan review(at __ %) $
Credit cmd ovmbea: __ �__����� within 180 days atter it 6u been State surcharge(8%)....$ ^�!
F P-aes atwepted as complete. TOTAL .......................5 _N T6
Nam ofof iZZo7dar as's=9 eo creldit ear = TRUST ACCOUNT DEDUCT****
1. caactiler daaaura -- --amount 14AJ6tS iMM1a-'UMI
OCT.2000 +FEES ON 'SACK OF FOKM
A - - m - - -
wel
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
j,24-hour Inspection Line: 639-4175 Business Line: 639-4171
BUP
Y'q ren—Date Requested —AM---,PM L31-D
Location
Suite MEC
��' r �� �-� - --
Contact Person Ph �1 ,�� 1 t _ PLM _
Contractor _� ���� t+� L l i'/rir--
Ph SWR
�_��. C"��/.iM iii,° Sv.>.�/ cLC
BUILDING Tenant/Owner /L'
Retaining Wall ELR
Footing Access: F=PS
Foundation
Fig Drain Drain SGN _
Crawl Drain Irspectior. Notes:
Slab --.r------- -- SIT
Post&Beam
Ext ;heath/Shear
Int Sheath/Shear
Framing - - - ---- -- -
Insulation
Drywall Nailing - - -- ------� ---
Firewall
Fire F prinkler -- ---- --- -
Fire Alarm
Susp'd Ceiling
Roof _
Misc: - -- - -- --
Final
PASS PART FAIL - -
PLUMBING
F'ost& Beam -,- --
Under Slab -- --- -- -- -- _ -
Top Out
Water Service ---
Sanitary Sewer
Rain Drains
Final
PASS
PASS PART FAIL - -- ---
M-- - ANICAL
F'ost& Beam - —
Faugh In
Gas Lire — -
Smoke Darnpers
Final
PAIS PAR r FAIL
ELECTRICAL
Service —.
Rough In
UG/Slab -
Low Voltage
Fite_Alarm
final
PART FAIL --_--
SITE
_
Backfill/Grading
Sanitary Sewer
Storm Drain ( ]Reinspection fee of$_ -required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin ]Please call for reinspection RE: ( ]Unable to inspect-no access
Fire Supply Line
I>,DA
Approach/Sidewalk Date- '`-- _Inspector_. — __ Ext �-
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the! job silte.
i
CITY
S '�,.��� _ BUILDING PERMIT
�/ O F T BPERMIT#: BUP1999-00144
DEVELOPMENT SERVICES DATE ISSUE;): 4/26/99
1312.5 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 PARCEL: 2S101AC-01300
SITE ADDRESS: 07105 SW HAMPTON ST
SUBDIVISION: BEVELAND NO. 2 ZONING: MUE
BLOCK- LOT: 01 P JURISDICTIOIJ: TIG
REISSUE: _ FLOOR AREAS_ _ EXTERIOR_WALL CONSTRUCTION
CLASS OF WORK: OTR FIRST: 54 sf N: S: E: W:
TYPE OF USE: COM SECOND: .f PROJECTOPENINGS?
TYPE OF CONST: 3N sf N: S: E: W:
OCCUPANCY GKIP: U2 TOTAL AREA: sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: 0 BASEMENT: sf AREA SEP. RATED:
STOR: HT: ft GARAGE: sf OCCU SEP. RATED:
BSM r?: MEZZ?: REQD SETBACKS REQUIRED
FLOOR LOAD: psf LEFT: ft RGHT: ft FIR SPKL. SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 7,500.00
Remarks: New monument sign.
Owner: Contractor:
KAISER PERMANENTS HEATH + COMPANY LLC
822 NE HOYT STREET 4644 SE 17TH AVE
PORTLAND, OP 97209 PORTLAND, OR 972.02
Phone: Phone: 232-2620
Reg #: LIC 127870
SUP 618sia
FEES REQUIRED INSPECTIONS
Type B Date Amount Receipt Electrical Permit Required _
YP Y _
FIRE GEO 4/16;99 $25.00 99-314466 _ Foot/Found Insp
FooUFound Insp
NLCK GEO 4/16/99 $40.63 99-314466 �������
PRMT GEO 4/16/99 $62.50 99-314466
- - — Total $12$.13
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 worl: will be done in accordance with approved plans. This permit will expire if work is
not starter within 180 days of issuance, or if work is suspended for more than 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 952 001-198 . You may obtain a copy of these rules or direct questions to OUNC by
calling (503), 246-1987.
Pe rm itee
Signature:
Issued By:
Call 639-4175 by 7 p.m. for an inspection the next business day
CITY OF TIGARD Commercial Building Permit Application Recd By � _
3125 S'W ,HALL BLVD. New Construction and additions Date to P Date to P
TIGARD OR 97'223 E.
fate to DST ��
(503) 639-417-1
f'ermit>rQ�t'��
Print or Type Related SWR/
Incomplete or illegible applications will not be accepted caked--
---
Name of Development/Project
Job0 Dra / „ j ,ti, �) ; e -- Existing Building ['] New 5uildinq []
Address Street Address Suite
r ; /0 5Lck!l —� Building
I Idg 0 City/State Zip Data
Existing Use of Building or Property:
Name (IL,
Property &/5en ,rM A'4 /C _
Owner Mailing Addross Suite Proposed Use of Building or Property:
J ,l NLL" f f.5 �
City/Slate Zip Phone
No. Of Stories:
Occupant Name Sq. Ft. Of Project
bell-440 C4
Nem - Occupancy Class(es)
Contractor ,e'R,/�j ,� INd1111,114,� �.� C
Prior to permit Mailing Address F Suite
issuance,a copy Type(s)of Construction
/
of all licenses r I;/ '.) fL'1 1qA"T
are required If City/State Zip Phnne Will this project have a Fire Suppression System?
expired In C T )
database ( f' / /` t �� 2 2 c, yc' `S 5/�' _ Yes_r- NO ❑ _ _
Oregon Const.Cont.Board Lir..# Exp.Date Americans with Disabilities Act(ADA)
/ 1 7 -70 )q elt, Valuation X 25% = $_ Participation
Name �— -- , Complete Accessibility Form
Project
Architect _ _ _ Valuation
Mailing Address— Suite
_ PlanSR §_WMatrix SMatrix for number cf sjF to bm
suit I
City/State Zlp —� Phone on back
Engineer Name I hPrebj acknowledge that I have read this appli,;ation,that the information i
2' Tegiven is correct,that I am the owner or authorized agent of the owner,and
Ma+++nq Address Suite -- that plans submitted are in compliance with Oregon State Laws
Signature of Owner/Agent ' Date
City l tate Zip — Phone - -- j PP �+A,7fq--k� ' L C,��/
L r `I_11 z- 235 b J -5 Contact Person Name Phone /
11 r
Indlrate type of work New tit' Addillon O Demolition O _�t'�-'�� t' LII f./r
Accessory Str1rh.re O Foundation Only O Alteration O
_ rtopair O other o FOk OFFICE USE ONLY _
Cescriphon of work: fOD_I+ y T. Map/7LiV Land Use ---
�_;5 -14�� l i'Jr�V4 AiM M I✓f S, ti Notes_ -- —
Parks: Fstimated N of Employees
TIF-
If
IF If the above figure Is not suppl:od at the time of application,the city will
calculate the fee based upon the number of parking s aces.
Note: Site Work Permit Application must precede or er,company Building r 7 fD EXPIRED
Permit Application U `f
I tCOMNFW DOC (DST) 5/98
Q�vPi9�tJ �o aJ�i
q 12
tht'V
COMMERCIAL PLAN SUBMITTAL
REQUIREMENT MATRIX
Plan Review is dependent upon submittal of BOTH plans AND a CC}WIPL F;ED
application. For an electrical submittal, the application must contain; the
signature of the supervising electrician before plan review will be conducted.
After plan review approval, Plans Examiner wil! uontac;t 'he applicant to request
additional plan -.ets for distribution purposes. !Copy for Contractor, City,
Washington County, Tualatin Valley Fire & Rescue)
Total # of
TYPE OF SUBMITTAL Plans KEY:
_ _ Submitted
S (Private) 1 S = Site Work
B (New or Add) 1 B = Building
F (New or Add or Alt) 3 F = Fire Protection Svstem
M (New or Add or Alt)_ 1 M = Mechanical
B & M (New or Add) _ 1 P = Plumbing
P (New. Add, or Alt) 2 E = Electrical
B & M & P (New or Add) �2 New = New Building
E (New, Add, or Alt) c Add = Addition
B & F & M & P & E 3 Alt = Alternation to Existing
(New , Add) Building
*B or B & M (Alt) 1�
*B & M & P (Alt) 3
[='(Alt) 3Y
NOTES:
*Shaded areas lesignate ALT submittals only.
I\dsts\forms\matrxc.-)m doe 10130/98