Permit (164) CITY OF TIGARDlig
BUILDING PERMIT
It`; '' COMMUNITY DEVELOPMENT Permit#: BUP2019 00023
!GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/29/2019
T-
Parcel: 2S102AA00906
Jurisdiction: Tigard
Site address: 12084 SW MAIN ST
Project: Kimberly Berg's Rebel Fit Subdivision: Lot: 4
Project Description: Installing(1)office,(2)treatment rooms,janitor room, break room, men's/women's toilet,exercise room,exit door
for TI.
Contractor: SUMMIT PROPERTIES AND DEVELOPMENT CO INC Owner: BSM REALTY LLC
6445 CITATION DR SUITE G BY RITE AID
CLARKSTON, MI 48346 PO BOX 3165
HARRISBURG, PA 17105
PHONE: 248-625-4711 PHONE:
FAX:
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: VB Permit Fee-Additions,Alterations, 04/29/2019 $842.40
Demolition
Occupancy Grp: A-3 Occupancy Load: 225 12%State Surcharge-Building 04/29/2019 $101.09
Dwelling Units: 0 Plan Review 01/31/2019 $547.56
Stories: 0 Height: 0 ft Address Fee-per lot/suite(up to first 20) 04/29/2019 $50.00
Bedrooms: 0 Bathrooms: 0 DC Provision Review, COM TI-Ping 04/29/2019 $98.00
Value: $65,000 Plan Review-Fire Life Safety 04/29/2019 $336.96
Info Process/Archiving-Lg$2.00(over 04/29/2019 $20.00
11x17)
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $1,996.01
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 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332. .
����
Issued By: � )y' Permittee Signature:
�l 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 of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
l Itis �Ifr FOR()1 1 1(1. t SF()NI.)
City of Tigard + Receivedt ]
11 II 13125 SW Hall Blvd.,Tigard,OR 97223 �r�r� 2a L Plan Review �� a/� 14 �� 1�lr O�{/� '� ��`3
Phone: 503.718.2439 Fax: 503.598.196 Q�— 6- 1 Other Permit:
Da[eBy:
T I C,A R D Inspection Line: 503.639.4175 D Date Ready/By: Jetts: ® See Page 2 for
Internet www.tigard-or.gov 24 t,31V�, otified/Metho :
�{ Supplemental Information
.. _ . �.w, •d mss.-,ia x s
as .
❑New construction
❑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 ®Other:Tenant Impr equipment,materials,labor,overhead,and the profit for the
x - work indicated on this application.
ID1-and 2-family dwelling ®Commercial/industrial Valuation: $0
0 Accessory building ElMulti-familyNumber of bedrooms: 0
0 Master builder 0 Other: Number of bathrooms: 0
X s s Total number of floors: 0
Job site address:1208' SW Main Street New dwelling area: 0 square feet
City/State/ZIP:Tigard,OR 97223 Garage/carport area: 0 square feet
Suite/bldg./apt.no.:B Project name:Kimberly Berg's Rebel Fit Covered porch area: 00 square feet
Cross street/directions to job site:SW Main St&SW Scofffins St Deck area: 0 square feet
(t) td [) KG �tc �JLc-1 c� �,X33 Other structure area: 0 square feet
Subdivision: Lot no.: Permit fees*are based on the value of the work performed.
Tax map/parcel no.:2S102AA00906 Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
work indicated on this al s lication.
Instsall 1 office,2 treatment rms,janitor rm,break rm,mens/women's toilet Valuation: $$65,000.00
exercise rm,exit door Existing building area: 11235 square feet
New building area: 0 square feet
.; t � Number_.... be of stories: 1
Name:BSM Realty LLC By Rite Aid Type of construction: IIIB
Address:PO Box 3165 Occupancy groups:
City/State/ZIP:Harrisburg,PA 17105 Existing: M
Phone:( ) Fax:( ) New: A3
Business name:HG Kimura Architect,PLLC
Structural plan review fee(or deposit):
Contact name:Howard Kimura
Address:PO Box 59415
FLS plan review fee(if applicable):
City/State/ZIP:Renton,WA 98058 Total fees due upon application:
Phone:(425)271-1875Amount received:
Fax::(425)271-1875
E-mail:hgkimura@comcast.net 1 =` t;
Commercial and residential prescriptive installation of
roof-top mounted Photovoltaic Solar Panel System.
Business name:TBD „,�,�, ro c)‹...0 4 ct Submit two(2)sets of roof plan with connection details
Address: rr ` and fire department access,along with the 2010 Oregon
l f S` C c Gt, iv, Solar Installation S•ecial Code checklist.
City/State/ZIP: L( /I 54. ! n/(1 L1 v 2 /_ Permit fee(includes plan review
V t!� and administrative fees):
Phone:(Z'44?) 6,Z5 ,y7 Fax:( ) State surcharge(12%of permit fee):
CCB lic.: >21 JC.�' lt
t/� Total fee due upon application:
Authorized signature: ` -y This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:Howard Date:1-16-2019 * 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)
INI
_,
■ Building Division
Accessibility: Barrier Removal Improvement Plan
TIGARI)
REQUIREMENT: OREGON REVISED STATUTE (ORS) 447.241.
(1) Every project for renovation,alteration or modification to affected buildings and related
facilities shall be made to insure that the path of travel to the altered area and the restroom,
telephones and drinking fountains are readily accessible to individuals with disabilities unless
such alterations are disproportionate to the overall alterations in terms of cost and scope.
(2) Alterations made to the path of travel to an altered area may be deemed disproportionate to
the overall alteration when the cost exceeds twenty-five per-cent(25%).
VALUATION: Total of all renovation,alteration or modification being done,
excluding painting and wallpapering. [1] $ 61000
MULTIPLIER(25%barrier removal requirement): x .25
TOTAL BUDGET FOR BARRIER REMOVAL: [2] $ 15,250
ELEMENTS: In choosing which accessible elements to provide under this section,priority shall be given
to those elements that will provide the greatest access. Elements shall be provided in the
following order.
(a) Parking $ 750
(b) An accessible entrance: $
(c) An accessible route to the altered area: $ 1200
(d) At least one accessible restroom for each sex or a single unisex
restroom: $ 15000
(e) Accessible telephones: $
(f) Accessible drinking fountains:and, $ 1200
(g) When possible,additional accessible elements such as storage and
alarms: $
TOTAL(shall equal line [2] of Valuation Computation): $ 18150
I:\Building\Pemuts\BUP-COM PermitApp.doc 03/03/2011
Building Division
Plan Submittal Requirements
!CARD Commercial& Multi-Family-New,Additions or Alterations
1. SITE PLAN (fully dimensional,drawn to scale) labeled with:
A. ® map &tax lot# ® project name ® site address ® suite number
® zoning ® applicant name ® phone number
B. North arrow.
C Scale (architectural or engineering only).
D. Street names.
E. Setbacks.
F. Parking, including disabled access.
G. Finished floor elevations.
2. EROSION CONTROL PLANS AND DETAILS.
3. BUILDING PLANS: See the "Plan Submittal Requirement Matrix" for the number of
plans required based on submittal type (no redlines or tape-ons accepted).
All details listed below shall be incorporated into the plans:
A. Scale (architectural or engineering onl)).
B. Foundation plan.
C Floor plan(s).
D. Cross sections.
E. Reflective ceiling plan.
F. Seismic bracing detail for suspended ceiling.
G. Roof plan.
H. Exterior elevations.
I. Structural calculations,plans,details and specifications.
J. Accessibility barrier removal worksheet.
K. Deposit- based on valuation of project.
4. EXTRA SET OF THE FOLLOWING:
A. Two (2) copies of site plan to include vicinity map.
B. One (1) copy of erosion control plan with details.
C Fire Department Building Survey, and full set of architecture drawings.
I:\Building\Permits\BUP-COM PermitApp.doc 03/03/2011
.11111
Building Division
Plan Submittal Requirement Matrix
T I G A R C) Commercial& Multi-Family-New,Additions or Alterations
Demolition Permit 2
(site plan required showing location and square
footage of all buildings to be demolished)
Site Work 3
(must include location of all accessible parking)
Plumbing (site utilities) 2
Building 3
Fire Protection System 3
Mechanical 2
Plumbing(building fixtures) 2
Electrical 2
Plan review is dependent upon submittal of a completed application and plans.
After plan review approval, the Plans Examiner will contact the applicant to request
additional sets of plans for distribution purposes (for contractor,City of Tigard,Washington
County, and Tualatin Valley Fire &Rescue), if applicable.
I:\Building\Petnits\BUP-COM PermitApp.doc 03/03/2011
Julie Drinkwater
From: Julie Drinkwater
Sent: Monday,January 28, 2019 11:56 AM
To: fkimura@comcast.net
Cc: #Building Permit Technicians
Subject: FW: Kimberly Berg's Rebel Fit Club at 12080 SW Main Street, Suite B
Good morning Florence
Below is an email sent from Sam Copelan, from our planning division. The planning division will complete the review
process once they receive notification of the new address from Oscar Contreras. At that point,the submittal will be
forwarded to the building division,the permits will be created,the plan review fee will be applied to the building permit,
and per your request we will email the receipt to you.
Thank you and please contact us if you have any questions.
Julie Drinkwater
Permit Technician
City of Tigard I Building Department
13125 SW Hall Blvd
Tigard, OR 97223
503-718-2804
From:Samuel Copelan
Sent:Thursday,January 24, 2019 2:57 PM
To: hgkimura@comcast.net
Cc:Oscar Contreras<OscarC@tigard-or.gov>; #Building Permit Technicians<TigardBuildingPermits@tigard-or.gov>
•Subject: RE: Kimberly Berg's Rebel Fit Club at 12080 SW Main Street,Suite B
Hello Howard,
Minor Modifications for a "Change of Use" are not required for properties located within the MU-CBD Zone. If you were
installing any new windows or making any facade changes,then a Type 1 Downtown Design Review would be required.
Since the only marked facade change is an exterior door to meet ADA requirements, no Downtown Design Review(DDR)
is required per 18.650.020.C.3.
Your cover sheet mentions that you will restripe parking spaces in the parking lot. Please contact the Building Division to
determine if your work will require a Sitework Permit.
Once Oscar notifies Planning that the address has been created, Planning will finish the review and then route the
application to Building.
Sincerely,
Sam Copelan
Assistant Planner
1
City of Tigard; Community Development
13125 SW Hall Boulevard
Phone: (503)-718-2450
Email: Samuelca,tigard-or.gov
From: hgkimura@comcast.net<hgkimura@comcast.net>
Sent:Thursday,January 24, 2019 12:52 PM
To:Samuel Copelan<samuelc@tigard-or.gov>
Subject: RE: Kimberly Berg's Rebel Fit Club at 12080 SW Main Street, Suite B
Hi Samuel,
Due to the orientation of the space,this will be an exit only door.
See below in red.
From:Samuel Copelan<samuelc@tigard-or.gov>
Sent:Thursday,January 24, 2019 12:07 PM
To: hgkimura@comcast.net
Subject: RE: Kimberly Berg's Rebel Fit Club at 12080 SW Main Street,Suite B
Hello Howard,
Thank you for your response;would you please answer the following questions about your proposed door that faces SW
Scoffins?
1. Is the door required for ADA upgrades? Yes it is an ADA and IBC Exiting requirement to have this door due to
the orientation of the space and distances.
2. Will this be an exit only door?Yes, exit only.
3. Are you proposing any weather protection for the exit, such as an awning? Will flash the head, but no
awning. Trying not to draw any attention to this side of the building as we want them to enter from the parking
lot.
Thank you for your time.
Sincerely,
Sam Copelan
Assistant Planner
City of Tigard;Community Development
13125 SW Hall Boulevard
Phone: (503)-718-2450
Email: Samuelc(i tigard-or.gov
From: hgkimura@comcast.net<hgkimura@comcast.net>
Sent:Thursday,January 24, 2019 10:55 AM
To:Samuel Copelan<samuelc@tigard-or.gov>
2
Cc:#Building Permit Technicians<TigardBuildingPermits(c@tigard-or.gov>; Oscar Contreras<OscarC@tigard-or.gov>
Subject:RE: Kimberly Berg's Rebel Fit Club at 12080 SW Main Street,Suite B
Samuel and Oscar,
Please find attached the Address Commercial Suite Application Form. Also, see the attached cover sheet of our drawing
set,also clarifies the location of the Rite Aid Building and the suite B location proposed.
Samuel: we were also notified by a previous designer from the Rebel Fit club that we may need to apply for a Minor
Modification Application for the change of occupancy from M Retail to A3. If this is true,can you forward an application
form and we will get this back to you asap.
Please let us know if you have any further questions.
Sincerely,
Howard G. Kimura I Principal
HG Kimura Architect PLLC
18012 W. Lake Desire Dr SE
PO box 59415
Renton, WA 98058
Office 425-271-1875
Cell: 425-766-5000
Fax: 425-271-2383
From:Samuel Copelan <samuelc@tigard-or.gov>
Sent:Wednesday,January 23, 2019 6:06 PM
To: hgkimura@comcast.net
Cc:#Building Permit Technicians<TigardBuildingPermits@tigard-or.gov>;Oscar Contreras<OscarC@tigard-or.gov>
Subject: Kimberly Berg's Rebel Fit Club at 12080 SW Main Street, Suite B
Good evening Howard,
Planning has received your plans for Kimberly Berg's Rebel Fit Club at 12080 SW Main Street,Suite B. Unfortunately,we
will not be able to route your plans to the Building Division until after your new address has been created. Please
complete the following form and send to Oscar, who I have included into this conversation: http://www.tigard-
or.gov/document center/Building/address application.pdf
Once Planning has been notified that this address is active,we will be able to route your application to the Building
Division. Please let me know if you have any questions,thank you!
Sincerely,
Sam Copelan
Assistant Planner
City of Tigard; Community Development
13125 SW Hall Boulevard
Phone: (503)-718-2450
Email: Samuelc(a�tigard-or.gov
3
DISCLAIMER: E-mails sent or received by City of Tigard employees are subject to public record laws. If requested, e-mail
may be disclosed to another party unless exempt from disclosure under Oregon Public Records Law. E-mails are retained
by the City of Tigard in compliance with the Oregon Administrative Rules "City General Records Retention Schedule."
4
I 114 City of Tigard
~ COMMUNITY DEVELOPMENT DEPARTMENT
T I G A R D Building Permit Review — Commercial - No Land Use
Building Permit #: U J t jR) /7 --(aVaz i
Site Address: '12-00
2_0 1 '‘n/ F'lai, S--. Suite/Bldg#: `_
Project Name: Kip,W7 ),,,z-f, '1 ,4 1 H- C11b-
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Planning Review
Proposal: 1,\A 1 0 iu.� Z rc,;\—..,v� nid fr S to r Mal) (rc,L / fa,It�� 2 rt�
f A �. r1� 1,✓c/1tn S � k
r%N)vAl ZX;\-K6 ,- TO tllit )j 1r retAilft"In
Existing Business Activity: Sh Gj 0,ti's ,-it4
Proposed Business Activity: ,3,ri a sc C n.,7ip,h vi 1-
( erify� site address/suite# exists and active in permit system.
vEl River Terrace Neighborhood: ❑ Yes Vi No
12/Zoning: h w—C Cp
permitted Use: [ les ❑ No ❑ Spec Space
Confirm no land use required.
Lid' Business License: �/
Exists: El Yes [ No,applicant notified to obtain business license
Notes: 'Tv..i- P r• T{Lt eAu-i'rr- -exit �Lsr is rot rtr vi td r,r C, x 15, 6 SO.O LO C.3,b
Lk. _
„ I 0
Approved by Planning: ) Ltri--- Date: F 3k ci
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: r /A)Il
Site Plans: # i
Building Plans: #
Building Permit#: R► nter building permit#above.
Workflow Routing: IPJ PlanningPlanPermit Coordinator 7M Building
Workflow Sign-off PI"Sign-off for ning(include notes from planning review)
Route Application Documents: P Building: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: /1/7e7‘2, / /- .7/ Date: - / .4 '
I:\Building\Forms\BldgPermitRvw_COM_NoLandUse_060116.docx
Permit Coordinator Review
❑ Conditions "Met"prior to issuance of building permit
0 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:
94DC Fees Entered: Wash Co Trans Dev Tax: 0 Yes //A
Tigard Trans SDC: ❑ Yes ❑ N)/
Parks SDC: ❑ Yes L6'N/A
OK to Issue Permit
Approved by Permit Coordinator: Date:5..„)?3 !(/ s
02 1
A/4
/ I7
I:\Building\Forms\BldgPermitRvw_COM NoLandUse_070915.docx