Permit (154) CITY OF TIGARD:IN BUILDING PERMIT
I COMMUNITY DEVELOPMENT Permit#: BUP2019-00073
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/24/2019
T l i A R[, 9 Parcel: 1 S134BC00401
Jurisdiction: Tigard
Site address: 12442 SW SCHOLLS FERRY RD 100
Project: Providence Medical Group Subdivision: None Lot: None
Project Description: TI for existing tenant:Remodel of existing x-ray suite,new walls,and sound board upgrades.
Contractor: ANDERSEN CONSTRUCTION CO Owner: PROVIDENCE HEALTH&SERVICES-ORE
6712 N. CUTTER CIRCLE ATTN: REAL ESTATE&CONSTRUCTION
PORTLAND, OR 97217 4400 NE HALSEY BLDG 2 STE 190
PORTLAND, OR 97213
PHONE: 503-519-5949 PHONE:
FAX: 503-283-4393
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: VA Permit Fee-Additions,Alterations, 04/24/2019 $977.94
Demolition
Occupancy Grp: A-3 Occupancy Load: 300 12%State Surcharge-Building 04/24/2019 $117.35
Dwelling Units: 0 Plan Review 03/28/2019 $635.66
Stories: 0 Height: 0 ft DC Provision Review,COM TI-Ping 04/24/2019 $243.00
Bedrooms: 0 Bathrooms: 0 Plan Review-Fire Life Safety 04/24/2019 $391.18
Value: $82,800 Info Process/Archiving-Lg$2.00(over 04/24/2019 $24.00
11x17)
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $2,389.13
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 95 -001-0090. You may obtain a copy of the r t questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: w rmittee Signature: ' AR :Sktit;-"S1�
Call 503.639.4175 by 7:00 a.m.for the next available inspec n date. ' 1111
This permit card shall be kept in a conspicuous place on the job site unti ompletion of a roject.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
Commercial FOR OFFICE USE ONLY
Received ' � permit No.: C
1312Tigard EC3/x/1 7 /j" 66,'e2o 1_,..12,u,13
13125 5 SW Hall Blvd.,Tigard,OR RECEIVED EIVED Date/By:Plan Review
III - ,ey J Related Permit:
Phone: 503-71g-2439 Fax: 503-59g-1960 Date/By: y)0 .0. ) (1 .-
N I loris: I See Page 2 for
InspectionLine: 503-639-4175 MAR 2 8 2019 Date Ready/By: /.. /� p l
`1-l G A R D Notified/Method: Supplemental Information
Internet: www.tigard-or.gov
TY OF TIGARD ,� G _l'
GPM ���:;
RE LI D DATA,I-Ali' 'IF .MtL 'tort
TYPE����� � � � � � � fees*are of the work performed.
❑Demolition Permit based on the value
❑New construction Indicate the value(rounded to the nearest dollar)of all
L Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
work indicated on this application.
CATEGORY OF CONSTRUCTION ;; '
r .. . .. Valuation: $
❑ 1-and 2-family dwelling 0 Commercial/industrial
Number of bedrooms:
❑Accessory building ❑Multi-family
Number of bathrooms:
❑Master builder ❑Other:
�'�
,TOB SITE INFORMATION AND LOCATION t= Total number of floors:
Job site address:12442 SW Scholls Ferry Foad New dwelling area: square feet
City/State/ZIP:Tigard,Oregon,97223 Garage/carport area: square feet
area: square feet
Suite/bldg./apt.#:100 Project name:Diagnostic Imaging-X-ray Covered porch
Cross street/directions to job site: Deck area: square feet
From highway 217 take exit 4B to SW Cascade Ave,Turn right on SW Scholls Ferry Rd., Other structure area: square feet
turn right on SW North Dakota St.,turn left into parking lot REQU1([U D DATA:COMMERCIAL-USE CHECKLI I'
r.
Subdivision: I Lot#: Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel#:1 S134BC00401 equipment,materials,labor,overhead,and the profit for the
;DESCRIPTION pt-'wow work indicated on this application.
Valuation: $82,800
Remodel of existing X-ray suite,new walls,sound board upgrades
paint,mechanical,plumbing and electrical support systems
Existing building area: square feet
New building area: square feet
"II PROPERTY OWNER . I ` 0 ANT'' Number of stories:2
NXame:PROVIDENCE HEALTH&SERVICES-OREGON Type of construction:Ill-A
Address:4400 NE HALSEY STREET-BUILDING 2,Suite 190 Occupancy groups:B
City/State/ZIP:PORTLAND,OR 97213 Existing:B
Phone:( )(503)215-6282 Fax:( ) New:B
III APPLICANT I .1 CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule) r
Business name:JRJ Architects,Ile Structural plan review fee(or deposit):
Contact name:Scott Harris FLS plan review fee(if applicable): /
Address:15455 NW Greenbrier Parkway,Suite 260 Total fees due upon application:'P 3 (t
li r
City/State/ZIP:Beaverton,Oregon,97006 Amount received:
Phone:( )503.690.1779 I Fax::( )503.690.0913
PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
E-mail:shams@jrjarch.com Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Submit two(2)sets of roof plan with connection details
Business name:Andersen Construction Libby Metz Imetz@andersen-const.com and fire department access,along with the 2010 Oregon
Address:6712 North Cutter Circle Solar Installation Specialty Code checklist.
Permit fee(includes plan review $180.00
City/State/ZIP:PORTLAND,OR 97217 and administrative fees):
Phone:( )503-519-5949 I Fax:( ) State surcharge(12%of permit fee): $21.60
CCB Lic.:63053 Total fee due upon application: $201.60
This permit application expires if a permit is not obtained
Authorized signature: within 180 days after it has been accepted as complete.
Print namelj Cf3TT �' l S
I Date: �1 'v l j lei I * Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\BUP COM_PermitApp.doc Rev.04/21/2014 440-4613T(11/02/COM/WEB)
City of Tigard
UPIr COMMUNITY DEVELOPMENT DEPARTMENT
0
TIGARD Building Permit Review — Commercial - No Land Use
Building Permit #: /3 u ip,2p/9—000 73
Site Address: 12197- SW Q X15 Ftrrr LI Suite/Bldg#: i0
Project Name: P4-tr . E-(411-1. -' Crvi'CGi
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Planning Review
y
Proposal: t.1 ck., 64- -t ,fih, X rak 'S,./i NC4.! „„..th SI>r. �-d Up4r$414si 1041A', t.c n 4,�f OAv.,,kuj
e tc l s,,f f, k Tr.; -r.,q
Existing Business Activity: h 2,J•i L0,1 04e
ProposedroBusiness Activity: Ml, “:1 0.-C-CLt.
eLid erify site address/suite#exists and active in permit syst m.
ver Terrace Neighborhood: ❑ Yes VNo
/Poning: C
ermitted Use: F(Yes ❑ No ❑ Spec Space
El Confirm no land use required.
V.-Business License:
Exists: 0 Yes l}G No,applicant notified to obtain business license
Notes:
Approved by Planning: (4J .J - Date: 3 2 Y._I tI
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved 0 Not Approved
Revision 2: 0 Approved ❑ Not Approved
Revision 3: 0 Approved 0 Not Approved
Building Permit Submittal
Original Submittal Date: :2/2k//f
Site Plans: #
Building Plans: # .3
Building Permit#: [TEnter building permit#above.
Workflow Routing: Er Planning Er-Permit Coordinator EThuilding
Workflow Sign-off: 42- Sign-off for Planning(include notes from planning review)
Route Application Documents: Building: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes: e;67,47/777/ -
By Permit Technician: e''_f____e Date: z////1
I:\Building\Fonns\BldgPermitRvwCOM 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:
PDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes VN/A
Tigard Trans SDC: ❑ Yes E/N/A
Parks SDC: ❑ Yes 21/N/A
OK to Issue Permit Arg<ate:
Approved by Permit Coordinator: if l
I:\Building\Forms\B1dgPemutRvw_COM NoLandUse_070915.docx
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
12442 SW SCHOLLS FERRY RD 100, TIGARD,
OR, 97223
Record Type: Record ID:
Commercial - Building BUP2019-00073
Inspection Type: Inspector:
299 Final inspection Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor