Permit CITY OF TIGARD BUILDING PERMIT
Ari
COMMUNITY DEVELOPMENT Permit#: BUP2019-00200
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/07/2019
T £"°'` Parcel: 1S134BC00300
Jurisdiction: Tigard
Site address: 12264 SW SCHOLLS FERRY RD
Project: Restore Cryotherapy Tigard Subdivision: None Lot: None
Project Description: Interior TI to replace existing Verizon retail store.
Contractor: DLP CONSTRUCTION COMPANY INC Owner: FW OR-GREENWAY TOWN CENTER LLC
5935 SHILOH RD E 200 PO BOX 790830
ALPHARETTA, GA 30005 SAN ANTONIO, TX 78279
PHONE: 770-887-3573
PHONE: 360-823-7223
FAX:
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: VB Permit Fee-Additions,Alterations, 10/07/2019 $1,256.95
Demolition
Occupancy Grp: B Occupancy Load: 23 12%State Surcharge-Building 10/07/2019 $150.83
Dwelling Units: Plan Review 08/12/2019 $817.02
Stories: Height: ft DC Provision Review,COM TI-Ping 10/07/2019 $254.00
Bedrooms: Bathrooms: Plan Review-Fire Life Safety 10/07/2019 $502.78
Value: $125,000 Info Process/Archiving-Lg$2.00(over 10/07/2019 $54.00
11x17)
Info Process/Archiving-Sm$0.50(up to 10/07/2019 $10.00
Floor Areas: 11x17)
Metro Const. Excise Tax 10/07/2019 $150.00
Total Area:
Accessory Struct:
Basement:
Carport:
Covered Porch:
Deck:
Garage:
Mezzanine:
Total $3,195.58
Required: Required Items and Reports(Conditions)
Fire Sprinkler: Parapet: 1 Special Inspection(see plans)
Fire Alarm: Protected Corridors:
Smoke Detectors: Manual Pull Stations:
Accessible Parking:
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 1.800.332.2344.
Issued By: r Permittee Signature: 4
•
"Call 503.639.4175 by 7:00 a.m.for the next available inspection 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
�p ''m FOR OFFICE USE ONLY
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City of Tigard REDate/By / 1L `�/ ' �, � �-
5 13125 SW Hall Blvd.,Tigard,OR 97223 f��6 8 2019 Plan Review ���h, /
Phone: 503-718-2439 Fax: 503-598-1960 pate By: �' ) ., ) ( / dt G1--a 5-
-FI CaARII Inspection Line: 503-639-4175 CITY Date Ready/By:/By: I . 6 int-1,, gi See Page 2 Tor
a 1'� Y icy 1 g
Internet: www.tigard-or.govI r rtled/Meth : r7; 7 %, Supplemental Information 1
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6UILDING DIV l;:.i ...�2�-�t'�/�l '
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑New construction ❑ Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
x❑Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
work indicated on this application.
C
CATEGORY OF ONSTRUCTION pp
Valuation: $
ElI-and 2-family dwelling pCommercial/industrial
❑Accessory building ❑Multi-family Number of bedrooms:
❑ Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 12264 SW Scholls Ferry Road New dwelling area: square feet
City/State/ZIP: Tigard,Oregon 97223 Garage/carport area: square feet
Suite/bldg./apt.4: Project name: Restore Cryotherapy Tigard Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet 1
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot 4: Permit fees*are based on the value of the work performed.
I map/parcel#: 1 S 134BC00300 Indicate the value(rounded to the nearest dollar)of all
equipment.materials,labor,overhead.and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Interior tenant improvement/construction to replace existing Verizon retail store. Valuation: $ 125,000.00
L.
Existing building area: 2,282 square feet
New building area: 2,282 square feet
0 PROPERTY OWNER 0 TENANT Number of stories: 1-story
Name: Nate Fennell Type of construction: VB
Address: 4871 Meadow Road, Suite 173 Occupancy groups:
City/State/ZIP: Lake Oswego,OR 97035 Existing: B-business
Phone:( 360 )823-7223
Fax:( ) New: B-business
0APPLICANT CONTACT PERSON BUILDING PERMIT FEES*
Business name: Order Architecture
Contact name: Paul Nielsen
(PleasereJertafeescGerlule)_
Structural plan review fee(or deposit):
Address: 541 W. 6570 S. FLS plan review fee(if applicable):
Total fees due upon application:
City/State/ZIP: Murray, Utah 84123
Phone: Amount received:
( 801 )597-764 1 Fax: :( )
_�; I-mail:paul@order-arch.com
PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
NI_ CONTRACTOR- TBD roof-top mounted Photo Voltaic Solar Panel System.
Business name: 01ii) Cd 6 O/r— Submit two(2)sets of roof plan with connection details
ti -♦r U. � and fire department access,along with the 2010 Oregon
Addy ess:(.5--q 36— --5-41.16L /V /a�7 16' Solar Installation Specialty Code checklist.
� Ob06 ,[� k Permit fee(includes plan review
City/State%LIP: �Tr-r $180.00
Phone:(7 pd) SS v7 ",3 5 � Fax:( ) )� and administrative fees):
State surcharge(12%of permit fee): $21.61-1
IN ,,..''TT C'C'B tic.: (/ a g.5 Til Total fee due upon application: $201.60
Authorized signature tet���"'''"'(/ This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
1----
Print name: A 1 , .PAtup Date:8747/7 * Fee methodology set by Tri-County Building Industry
(/ Service Board.
I.ABuilding\Permits\BUP_COMPermitApp.doc Rev.04/21/2014 440-4613T(II/02/COM/WEB)
City of Tigard
" COMMUNITY DEVELOPMENT DEPARTMENT
■
Building Permit Review — Commercial - No Land Use
TIGARD
Building Permit #:
Site Address: 122.(p4 x.11\/ 11s t,1 K4-1. Suite/Bldg#:
Project Name: Res rci C4i. 1 r ec (
(Name of commercial business occupying th space. If vacant,enter Spec Space.)
Planning Review
Proposal: , ( yle,t) �temovvvk-
Existing Business Activity: GA leg pirIchieoi r2*i
Proposed Business Activity: Fe,rsoryLl Genii V l c.eS
g Verify site address/suite# exists and active in permit system.
VI River Terrace Neighborhood: ❑ Yes kr No
21 Zoning: C.
Permitted Use: Yes ❑ No ❑ Spec Space
yConfirm no land use required.
Business License:
Exists: ❑ Yes rikNo,applicant notified to obtain business license
Notes: y rY. - SJC. iS /uD SZS at (S it ss 'fY>�s l r t 1
?C b�jrec� ► ' ho ytI ie4
Approved by Planning: Date: 13 fø t i
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Building Permit Submittal
Original Submittal Date: Tlg��
Site Plans: #
Building Plans: #
Building Permit#: Enter building permit#above.
Workflow Routing: Planning Permit Coordinator building
Workflow Sign-off: Sign-off for Planning(include notes fron/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: /ifWialE A /
By Permit Technician: ,�IDate: la (
I
I:\Building\Forms\B1dgPermitRvw_COM_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:
VDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes Q/N/A
Tigard Trans SDC: CIYes A
Parks SDC: ❑ Yes GA
OK to Issue Permit
Approved by Permit Coordinator: Date: t� / 3
1:\BuildingTorms\BldgPermitRvw_COM_NoL.andUse 070915.docx