Permit (243) CITY OF TIGARD BUILDING PERMIT
' ' - - CO MMUNITY DEVELOPMENT Permit #: BUP2012 -00273
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/30/2013
TIGARD: ' 9 Parcel: 2S 115AB01900
Jurisdiction: Tigard
Site address: 16200 SW PACIFIC HWY A ,
Project: Anytime Fitness Subdivision: 1994 -028 PARTITION PLAT Lot: 2
Project Description: Convert previous restaurant to 24 hour fitness health club.
Contractor: BEL SOUTHWEST INC Owner: SN PROPERTIES PARTNERSHIP
5186 E 16TH AVE 1121 SW SALMON ST
APACHE JUNCTION, AZ 85119 PORTLAND, OR 97205
PHONE: 480 - 232 -6242 PHONE:
FAX:
Specifics: FEES .
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: VB Permit Fee - Additions, Alterations, 01/30/2013 $1,256.95
Demolition
Occupancy Grp: A -3 Occupancy Load: 117 12% State Surcharge - Building 01/30/2013 $150.83
Dwelling Units: 0 Plan Review 12/26/2012 $817.02
Stories: 1 Height: 0 ft Plan Review - Fire Life Safety 12/26/2012 $502.78
Bedrooms: 0 Bathrooms: 0 Info Process /Archiving - Lg $2.00 (over 01/30/2013 $22.00
Value: $125,000 11x17)
Metro Const. Excise Tax - Commercial 01/30/2013 $150.00
. Use
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0 .
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $2,899.58
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. ENTION: . -•on law re.uires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
95 001 -0010 through OAR • 2 -00 .191. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Is ued By: , I / Permittee Signature:
. Call 503.639.4175 by 7:00 a.m. for the next available inspection d.
This permit card shall be kept in a conspicuous place on the job site until completion • = project.
roject.
Approved plans are required on the job site at the time of each inspec • n.
Buildin Permit A) 1' BE D
Commercial T,I'Z'2::.;':.r::`,::•:-1-:tmz:..ThimaiwtiAtigitptanili4V4V!.;
,5,r;lw,-,A4,-,
City of Tigard DEC 26 2012 Receiv,:d .
1 Datelle. 4 ERMitito , l '" it N u - . .4rd04,• eC, 73
fk ;* 13125 SW Hall Blvd., Tigard, OR 97223 phut Roiew
Phone: 503.718.2439 Fax: niyoFTIGARD
14
p. i . .
a 0 f4 ) 2„Z... I Other Pet mit: 11 HP 90 t I -cetz5"
-4i',7,- ,i, Inspection Line: 503.639.41.... .75` rmAi niuMintd : x ,,, t2 01 ■: .: I /5 010 , I ET See Page 2 far
Internet: www.tioard-or..ovidUILUM.1 LA V - ISITOMQ.1113111r&million
i / , , / i , t i 43'
TYPE OF WORK QUIRE[) DA 'A: 1- AND 2-FAMILY DWELT.liNC
, 0 New construction 1 0 Demolition 1 Permit fees* are based on the value of the work p;riiirmed.
— Indicate the value (minded to the nearest dollar) of all
I §L Addition/aherationireplaccmcnt 0 Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION , work indicated on this application.
1:1 1- and 2-family dwelling jaCommercial/industrial Valuation: S
Number of bedrooms:
0 Accessory building 0 Multi-family
_......_
0 Master builder j 0 Other: Number a bathrooms:
JOB SITE INFORMATION AND LOCATION 'total number of Boors:
site address: 16200 SW Pacific Highway New dwelling area: square feet
c4/slat d er7TP: Tigard, OR 97224 Garage/carport area: square feet
.. —
Suite/bldg./apt. no.: Ai 1 Project name: Anytime Fitness____ Covered porch area: square feet
______ _
Cross strcetidirections to job site: i
Deck area: square feet
_ . .. ... ___.„. . _..... .
Ti gard Towne Square Other structure area: square feet
— REQUIRED DATA: COMMERCIAL-USE CH ECK1,IST
Subdivision: 1 lot no.: Permit fees* are based on the value of the work performed.
. _ . - II —
_____
ui
----- Indicate the value (roded to the nearest dollar) of all
Ta;Mapipareel no.: _ _
equipment, mate, ials, labor, ovei head. and the profit for the
DESCRIPTION OF WORK
work indicated on this application.
luation: s 125 ._.
Interior Buildout Health Club Va / 000
____
_
Existing building area 6777 square feet
1 New building area: - square feet
0 PROPERTY OWNER 0 TENANT Number of stories: 1
. .
Name: Anytime Fitness Type of construction: 5B
AMress: 12181 Margo Avenue Occupancy groups: A3
... ........... ........ _
City/State/ZIP: Existing:
Hastings, MN 55033 . -
_ .. . ._ . ..
i Plme: 438-5069 Fax:( ) New: _
El :
us Architects
- APPLICANT 1
Wilk- g CONTACT PERSON
_ --
L BUILDING PERMIT FEES*
E . -
jiVayerefarofteschMM
Rosiness name
Structural plan review fee (or deposit): 1 ----1
Contact name: Kelly Buska
.. _ ELS plan review fee (if arplieable):
Address: 1 , .
i Valley Viw Road Total fees duc upon nprlicsition: $1,319.8
cityismtefim Eden Prairie MN 55344
_ -
Amount received:
Phone: (95 2 941-8660 Fav:(952 941-2755 — ...i._ _ _...
- . p TovorrA lc SOLAR PANEL SYSTEM : 'ES*
li-mail: kmb@wilkusarch.com
_ . COMMCICIL ' nd residential preseripti,Tjili's • atin of
CONTRACTOR roof-top mountx, 'hotoVoltaie Solar ' el System,
--- ___
Submit two (2) sets o - mf plan 'it connection details
Business name: TRD — and lire department access. : •ne with the 2010 Oregon
__ ....
Address: Solar Installation So!di . y Ci checklist.
Permit fcc '• udes plan reY
City/Stater/LP: S180.00
_ i administrative fees):
........._
Phone: ( ) Fax: ( ) ___ Stine • charg __
e (12% of permit fee): S21.60
_„.. . ._._.
CC13 lie.: • 1.
Total fee due upon appficat ion: S20 60 1
— --
- This permit application expires if a perinit is not obtained
Authorized signature: VA,NR9 within 180 days after it has been accepted as complete.
-- T - rce methodology set by Tri-County Building Industry
Print Michael Wilkus Date:. ,12/26/12_J slviceBoard
I' noildingWermas\BUP-COM PermitApp.doc 02/24/2011 440
7 Building Division
° . Development Code Provision Review
T I G A R D Commercial Projects - No Associated Land Use Case
Building Permit No: a_0"dl.c./ 0-- Co?? 3 ❑ Expedited Review
Plan Submittal Date: /A /f+G //
To the Applicant:
> If the proposed use is not permitted within the zone, please contact the Building Division to cancel
the permit application. Building Permit Technicians (503) 718 -2439.
> If a land use is required and for all other questions, please contact the staff person listed above the
Planning Review section.
Staff: please check items along left only if approved.
Planning Review (contact s r1CS {Loweu at 503-718-2427 or ol0 neS 1- @tigard - or.gov)
Proposal: MiG4Z OR ot.l ttf70n 'k0 Q CL2)W c.,dt-QG rtaockf1fl (It ;Jo
(Ind Cr:4Q en -4Zizl. AI Ynenf )
Zoning a "(.2
Permitted Use Yes Q" No ❑
Land Use Required: Yes V No ❑
Notes: P.MIA{r (m►noy. nrw4. \ \A 4 ufrG awl-pod -Pr ala o-(u -fzniA
reSVititreint -to X Approved .®'Not Approved Date: ill 3111'2-
'1 — . (MM o-oax) I
REVISE D 10/4/12
LETTER OF TRANSMITTAL
RECEIVED
December 21, 2012 DEC 2 6 2012
CITY OFTIGARD
To: Permit Center BUILDING
City of Tigard, OR DIVISION
13125 SW Hall Blvd.
Tigard, OR 97223
Project: Anytime Fitness — ATF7153 -12 Tigard, OR
Via: UPS — second day
From: Kelly M Buska
MICHAEL J. WILKUS ARCHITECT
11487 Valley View Road
Eden Prairie, MN 55344
QUANTITY DESCRIPTION
3 24x36 — Construction Documents - Bond — Permit Set —
Architectural only
1 Building Permit Application
1 Plan Review Fee check #29917 $1,319.80
COMMENTS
Michael J. Wilkus
A r c h i t e c t
If you have any questions please contact me at (952) 941 -8660.
11487 Valley View Road cc:
Eden Prairie, Minnesota 35314
ph. 952.941.8 h hO
I x .952.941.2755
Debbie Adamski
From: Debbie Adamski
Sent: Thursday, January 24, 2013 12:53 PM
To: kmb @wilkusarch.com
Subject: Anytime Fitness, 16200 SW Pacific Hwy, Ste A, Tigard, OR 97224
Attachments: CounterCopier@ tigard- or.gov_20130124_124755.pdf
Kelly,
Attached is a fee schedule for the building permit for Anytime Fitness. The permit number is BUP2012- 00273. It shows
the balance of the fees that are due. The contractor will also need to be identified prior to issuance. This permit is
ready to be issued. This can be done when they come in to pick up the permit.
Our office hours to pick up the permit are Monday through Thursday from 8:00 am to 4:30 pm. If you have any
questions please contact the building division at 503 - 718 -2439. Thank -you.
Debbie Adamski
Senior Permit Technician
City of Tigard I Community Development
13125 SW Hall Blvd., Tigard, OR 97223
503- 718 -2450
1
■
OF
F ` }, c C onstruction Contractors Board
"' =
Oregon www.oregon.2ov /ccb
' ED 9 John A. Kitzhaber, MD, Governor *CBI Mailing Address:
PO Box 14140
Salem, OR 97309 -5052
JAN 3 0 20\3 Street Address:
700 Summer St NE
CITY oFTIGkI Suite 300
BUILDING DIVI SIO N 503- 378 -4621
FAX 503 -373 -2007
CCB LICENSE DETAIL REPORT Oregon Relay 7 -1 -1
LICENSE: 198853
GENERAL INFORMATION
BEL SOUTHWEST INC LICENSE STATUS: Active
5186 E 16TH AVE FIRST LICENSED: 01/30/2013
APACHE JUNCTION AZ 85119 LICENSE EXPIRES: 01/30/2015
480- 232 -6242 ENTITY: Corporation
IND. CONT. STATUS: Exempt
ENDORSEMENTS ADDITIONAL CERTIFICATES / LICENSES
COMMERCIAL: CGC2 - General Contractor 2 CERTIFIED HOME INSPECTOR: NO
RESIDENTIAL: LICENSED LEAD BASED PAINT: NO
ASSOCIATED NAMES
ERIK LEE BRIGGS, Family Corporate Officer
TRACY LYN BRIGGS, Family Corporate Officer
RESIDENTIAL BOND INFORMATION
COMPANY:
AMOUNT
EFFECTIVE TO:
COMMERCIAL BOND INFORMATION
COMPANY: AMERICAN SAFETY CASUALTY INS CO
AMOUNT: $ 20,000
EFFECTIVE TO: 01/30/2015
INSURANCE INFORMATION
COMPANY: SL - COLONY INSURANCE COMPANY
OCCURANCE / AGGREGATE AMOUNT: $1,000,000 / $2,000,000
CANCELLATION DATE: 11/05/2013
OTHER LICENSE NUMBERS
This report was generated by the CCB on: January 30, 2013, 9:30 am