Permit (36) CITY OF TIGARD BUILDING PERMIT
COMMUNITY DEVELOPMENT Permit#: BUP2019-00026
Date Issued: 02/05/2019
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S112DC00701
Jurisdiction: Tigard
Site address: 15965 SW 72ND AVE
Project: Gym Habit Subdivision: FANNO CREEK ACRE TRACTS Lot: 39
Project Description: TI for new tenant:(2)new rooms and finishes.
Contractor: BLUE INSTALLATION Owner: PACIFIC REALTY ASSOCIATES
9270 SW OMARA ST ATTN: N PIVEN
TIGARD, OR 97223 15350 SE SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-863-1030 PHONE:
FAX:
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: VBDC Provision Review,COM TI-Ping 02/05/2019 $98.00
Occupancy Grp: B Occupancy Load: 31 Permit Fee-Additions,Alterations, 02/05/2019 $271.43
Demolition
Dwelling Units: 0 12%State Surcharge-Building 02/05/2019 $32.57
Stories: 0 Height: 0 ft Plan Review 02/05/2019 $176.43
Bedrooms: 0 Bathrooms: 0 Plan Review-Fire Life Safety 02/05/2019 $108.57
Value: $13,000 Info Process/Archiving-Lg$2.00(over 02/05/2019 $6.00
11x17)
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $693.00
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 O'. Speciale, 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 :' days of i•suance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon tilit Notifica ion 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 OU C b ca og -18:232.1987 or .800.332.2344.
eie
Issued By: Permittee Signature: r .
all 513.63 9.4175 by 7:00 a.m.for the next available inspect 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 LASE ONLY
City of Tigard RECEIVE I Received
Date/I3 : �,r Permit No.:7 '��sJt7tJ�
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
C Phone: 503.718.2439 Fax: 503.598.1960 FEB 5 2019 Date/B : _ -• * Other Permit:
T 1( ,R I) Inspection Line: 503.639.4175 Date Ready/By =I ® lil See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method:� 4' t= iv1/ r �� Supplemental Information
- BUILDING DIVISION 11012-7---'
TYPE i OF:WORK REQI)IRED DATA:-1-ANI)2-FAMILY D YELLING
0 New construction 0 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 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OE CONSTRUCTION work indicated on this application.
❑ 1-and 2-family dwelling ®Commercial/industrial Valuation: $
Accessory buildingNumber of bedrooms:
❑ ry 0 Multi-family
❑Master builder 0 Other: Number of bathrooms:
jo$"sITE INFORMATION"AND LOCATION Total number of floors:
Job site address:15965 SW 72nd Ave New dwelling area: square feet
City/State/ZIP:Tigard,OR 97224 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:Gym Habit Covered porch area: square feet
Cross street/directions to job site:Carmen/72nd Deck area: square feet
Other structure area: square feet
REQUIRE')DATA:COMMERCIAL-USE CHECKLIST
Subdivision: 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 OR WORK work indicated on this application.
Build two 9x10 foot rooms(non load bearing walls) Valuation: $$13,000.00
Add Finishes Existing building area: 1530 square feet
Minor electrical/HVAC New building area: 1530 square feet
C] PROPERTY OWNER .4 TENANT" Number of stories: 1
Name:Lisa Rhoades&Jordon Hice Type of construction: V-B
Address:1185 SW Stephenson Court Occupancy groups:
City/State/ZIP:Portland,OR 97219 Existing: None
Phone:(503)908-3290 Fax:( ) New: B
El APPLICANT CI CONTACT PERSON BUILDING PERMIT FEES*
Business name:Gym Habit
rofer tafee hcl
Structural plan review fee(or deposit):
Contact name:Lisa Rhoades
FLS plan review fee(if applicable):
Address:1185 SW Stephenson Court
Total fees due upon application:
City/State/ZIP:Portland,OR 97219
Amount received:
Phone:(503)961-4968 Fax::( )
PHt-1!TOVOLTAIC SOLAR PANEL SYSTEM FEES*
E-mail:gymhabit365@gmail.com
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name:Blue Installation Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: Solar Installation Specialty Code checklist.
Permit fee(includes plan review $180.00
City/State/ZIP: and administrative fees):
Phone:(503)863-1030 Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lic.:131708. b ` / Total fee due upon application: $201.60
Authorized sign. re: i� / �-- This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
k t' * Fee methodology set by Tri-County Building Industry
Print name: Lisa Rhoa i Date:1/17/19 Service Board.
I:\Building\Permits\BUP-COM PermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
City of Tigard • BUILDING DIVISION
IN ■ .1 Over-The-Counter (OTC) Building & Fire Protection System Permit
TR,n p p Appointment Checklist
Permit Record#:
Contact Name: c e_ Phone#: ( $) 7e3--311
Business Name: /Y) Appt. Date/Time: /2 clic) ( fv x7-
Site Address: f 5,6 S.—J J 7o2 j-C, Bldg/Suite #:
Project Name: Gyp,,, /-Jb New Tenant? EYes 0 No
Project Description: iiJ _ a(,4 T -� /vow yin LA) t _
Existing Use: New Use: 743(.64,y)(.64,y)\�
MMD Required: Ei—Ter El-f0 No Related Record#: "7,142.ig!`aw I
APPICATIO .SPE..CIFIC INFORMATION
GENERAL INFORMATION
Class of Work: Occupancy Group: 3Type of Construction: ?– y– 1)
Type of Use: Occupancy Load: 3 �) Oregon Specialty Code: r)...4�.4.
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 FOOT_ AGES
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: 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: $ f 3, 000
$ • --- DC Prov Rvw,COM TI–Ping
$ _ - _ Permit Fee–Add,Alt,Demo
DC Provision Review Fee for COM TI(effective 7/1/2018) $ • _ . 12%State Surcharge
Project Valuation $ !nsk Plan Review,Structural
Up to$4,999 $0.00 $ , y Plan Review,Fire Life Safety
$5,000-$74,999 $98.00 $ — Info Proc/Arch,Lg(over 11x17$2.00)
$75,000-$149,999 $243.00 $ Info Proc/Arch,Sm(up to 11x17$0.50)
$150,000 and over $388.00 $ Metro Construction Excise Tax
$ School Construction Excise Tax
$ Hourly Rate Fee
$ Hourly Rate State Surcharge
$ Misc.Admin Fee
$ Other:
Building Staff: $ Other:
Date/Time: $ 6 93 TOTAL FEES DUE
I:\Building\Forms\OTC_BUP_FPS_070118.docx
City of Tigard
COMMUNITY DEVELOPMENT DEPARTMENT
T1cAlzo Building Permit Review — Commercial - With Land Use
Building Permit #: a41/2pa)/ _ C24-4))-(t"
Site Address: i Sq (o S S W 1 - n ase Suite/Bldg#:
Project Name: (V m H C b i f
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Planning Review
Proposal: In+e/i10 r 171--
Verify site address/suite#exists and active in permit system.
River Terrace Neighborhood: ❑ Yes No
gi Land Use Case#: M (v) D 20) c 0 000
VPlans Match Approved Land Use:
Site Plan ❑ Landscape Plan ❑ Other:
❑ Urban Forestry Plan ❑ Elevation Plan
p Building Height: N/( t Maximum Height Actual Height
yConditions Met: ❑ Prior to Submittal ❑ Prior to Permit Issuance
VBusiness License:
Exists: ❑ Yes )2(No,applicant notified to obtain business license
p' Public Facilities Improvement (PFI) Permit:
Required: ❑ Yes,applicant was notified No Applied For: ❑ Yes ❑ No,stop intake
Notes:
Approved by Planning: (V) V\ice Date: Z/ S I t (:))
Revisions (after Building Submittal only) Reviewer Date
Revision 1: El Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Building Permit Submittal
Original Submittal Date: d-A/�w
Site Plans: # /
Building Plans: #
Building Permit#: ter building permit#above.
Workflow Routing: ming ❑ Engineering ❑ Permit Coordinator ®'"8 i'tding
Workflow Sign-off: sfn r Planning(include notes from planning review)
Route Application Documents: wilding: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: 'r--- Date: 431iii
I:\Building\Fonns\BldgPermitRvw_COM_WithLandUse_060116.docx
Engineering Review
❑ Slope at building pad:
❑ PFI Permit#:
❑ Conditions "Met"prior to issuance of building permit
❑ Easements (encroachments)per engineering conditions of approval and plat(not typical on SDR/CUP)
❑ Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes ❑ No
Assess Water Quantity Fee in-lieu: ❑ Yes ❑ No
LIDA Facility on lot: ❑ Yes ❑ No
0 NOT Approved by Engineering: "` Date
Notes:
Approved by Engineering: Date:
Revisions (after Building Submittal only) Reviewer Date
Revision 1: 0 Approved ❑ No•Approved
Revision 2: ❑ Approved ❑ r of Approved
Revision 3: ❑ Approved E Not Approved
Permit Coordinator Re '-w
❑ Conditions "Met"prior to .ssuance of building permit
❑ Approved,NOT R; eased: Date:
Notes:
Revisions (afte :uilding Submittal only)
Revision .tice 1: Date Sent to Applicant:
Revision otice 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\BldgPemiitRvw_COM_WithLandUse_070915.docx
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
15965 SW 72ND AVE, TIGARD, OR, 97224
Record Type: Record ID:
Commercial - Building BUP2019-00026
Inspection Type: Inspector:
299 Final inspection Jeff Grove
Result:
PASS - CofO
Comments:
Violation Summary:
Inspector Contractor