Permit •, CITY OF TIGARD BUILDING PERMIT
-
1 .; !:'. COMMUNITY DEVELOPMENT Permit #: BUP2010 -00252
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/16/2010
Parcel: 1S134BC00401
Jurisdiction: Tigard
Site address: 12442 SW SCHOLLS FERRY RD 202
Project: Scholls Ferry Rehab Subdivision: Lot: 0
Project Description: TI 12/8/10, phasing occupancy, 2 phases.
Contractor: ANDERSEN CONSTRUCTION CO Owner: PROVIDENCE HEALTH SYSTEM
6712 N. CUTTER CIRCLE 4400 NE HALSEY BLDG 1 SUITE 160
PORTLAND, OR 97217 PORTLAND, OR 97213
PHONE: 503 - 519 -5949 PHONE: 503 - 215 -6282
FAX: 503 - 283 -4393
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee - Additions, Alterations, 11/16/2010 $1,498.55
Class of Work: ALT Demolition
Dwelling Units: 0 12% State Surcharge - Building 11/16/2010 $179.83
Stories: 0 Height: 0 ft Plan Review 11/16/2010 $974.06
Bedrooms: 0 Bathrooms: 0 Plan Review - Fire Life Safety 11/16/2010 $599.42
Value: $165,000 Metro Const. Excise Tax - Commercial 11/16/2010 $198.00
Use
Additional Permit 12/08/2010 $200.00
Floor Areas: Phased Plan Review 12/08/2010 $149.86
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $3,799.72
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 - ordance • - 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: Oregon la requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -141 -0010 through OAR 952 - 001 -0.9P. ' •u • •btain a copy of the rules or direct questions to OUNC by calling 503. .: 1987 or 1.800.332 '44.
Issued By: 401 // Permittee Signature: I
CaII 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.
r
CITY OF TIGARD
BUILDING PERMIT
II '`- COMMUNITY DEVELOPMENT Permit #: BUP201000252
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/16/2010
T tom Parcel: 1 S 134 BC00401
Jurisdiction: Tigard
Site address: 12442 SW SCHOLLS FERRY RD 202
Project: Scholls Ferry Rehab Subdivision: Lot: 0
Project Description: TI
Contractor: ANDERSEN CONSTRUCTION CO Owner: PROVIDENCE HEALTH SYSTEM
6712 N. CUTTER CIRCLE 4400 NE HALSEY BLDG 1 SUITE 160
PORTLAND, OR 97217 PORTLAND, OR 97213
PHONE: 503 - 519 -5949 PHONE: 503 - 215 -6282
FAX: 503 - 283 -4393
FEES
Specifics: Description Date Amount
Type of Use: COM Permit Fee - Additions, Alterations, 11/16/2010 $1,498.55
Class of Work: ALT Demolition
Dwelling Units: 0 12% State Surcharge - Building 11/16/2010 $179.83
Stories: 0 Height: 0 ft Plan Review 11/16/2010 $974.06
Bedrooms: 0 Bathrooms: 0 Plan Review - Fire Life Safety 11/16/2010 $599.42
Value: $165,000 Metro Const. Excise Tax - Commercial 11/16/2010 $198.00
Use
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $3,449.86
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. ATTE e 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 • • R 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 _ ( Permittee Signature: ��/ , /G' /
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
RECEIVEn
Commercial FOR OFFICE USE ONLY
City of Tigard NOV 12 2010 Received
Date /B f/ ` 7 //& /U / / /Jt Permit No. : D°��.' 10 2.
C_L
rit - 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 OF TIGARD Date /B • �� l�i � Other Permit.
T i G A t2 D Inspection Line: 503.639.4175 BUILDING DIVISION Date Read : : Juris: 9J See Page 2 for
Internet: www.tigard- or.gov Notified /Method: Supplemental Information
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
® Addition/alteration/replacement 111 Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ 1- and 2- family dwelling Z Commercial /industrial Valuation: $
❑ Accessory building ❑ Multi - family Number of bedrooms:
1:1 Master builder ❑ Other: Number of bathrooms:
/ 4/ JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: .2d22'SW Scholls Ferry Road New dwelling area: square feet
City/State /ZIP: Tigard, OR 97223 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: Scholls Ferry Rehab Remod Covered porch area: square feet
Cross street/directions to job site: Scholls Ferry Road and North Dakota Deck area: square feet
Street, Second Floor next to McDonalds Other structure area: square feet
REQUIRED 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 OF WORK work indicated on this application.
Remodel and expansion of the existing rehab clinic into the adjacent vacant Valuation: $ 1 000
space. Area to be remodeled is approx. 1,800SF and the expansion area is approx Existing building area: 1,800 square feet
1,100SF. New building area: 2,920 square feet
® PROPERTY OWNER ❑ TENANT Number of stories: 2
Name: Providence Health Systems Type of construction: Remodel
Address: 4400 NE Halsey Bldg 1, Suite 160 Occupancy groups:
City/State /ZIP: Portland, OR 97213 Existing:
Phone: (503)215 - 6282 Fax: ( ) New:
® APPLICANT ❑ CONTACT PERSON
NOTICE
Business name: Andersen Construction All contractors and subcontractors are required to be
Contact name: Libby Metz licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 6712 North Cutter Circle jurisdiction in which work is being performed. If the
City /State /Z1P: Portland, OR 97217 applicant is exempt from licensing, the following reasons
apply:
Phone: (503) 519 -5949 Fax: : (503) 283-4393
E - mail: Imetz @andersen - const.com
CONTRACTOR
Business name: Andersen Construction BUILDING'PERMIT FEES*
(Please fee schedule)
Address: 6712 North Cutter Circle
Structural plan review fee (or deposit):
City/State /ZIP: Portland, OR 97217
FLS plan review fee (if applicable):
Phone: (503) 519 - 5949 Fax: (503) 283 - 4393
CCB lic.: 63053 Total fees due upon application:
Amount received:
Authorized signature: This permit application expires if a permit is not obtained
f within 180 days after it has been accepted as complete.
Print name: Libby etz Date: 11 - 04 - 10 * Fee methodology set by Tri-County Building Industry
Service Board.
L \Building\Permits\BUP -COM PermitApp.doc 10/01/09 440- 4613T(11/02/COM /WEB)
Building Division
a
Accessibility: Barrier Removal Improvement Plan
TIGARD
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] $
MULTIPLIER (25% barrier removal requirement): x .25
TOTAL BUDGET FOR BARRIER REMOVAL: [2] $
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 $
(b) An accessible entrance: $
(c) An accessible route to the altered area: $
(d) At least one accessible restroom for each sex or a single unisex
restroom: $
(e) Accessible telephones:
(f) Accessible drinking fountains: and,
(g) When possible, additional accessible elements such as storage and
alarms: $
TOTAL (shall equal line [2] of Valuation Computation):
L.L
I: \Building \Permits \BUP -COM PermitApp.doc 06/25/08
111 Ili
1 1.1 Building Division
Over- The - Counter (OTC) Building Permit
TIGARD Check List
Description of Project: 1 I
GENERAL INFORMATION
Class of Work:* Floor Areas (sq. ft.): Exterior Wall Construction:
Type of Use:* &NOTi First floor: N: S:
Type of Construction: Second floor: E: W:
Occupancy Group: Third floor: Openings Protected Y /N ?:
Occupancy Load: — Total sq ft.: N: S:
Stories: -Z Note: Combine total floor area for E: E:
Height: all floors above third floor and Roof Construction: _
Floor Load: add to the third floor sq. ft. Fire Retardant:
Basement: Basement: Area Separation Rated:
Mezzanine: Garage: Occu. Separation Rated:
� REQUIRED ITEMS
Fire sprinkler: ) V 7 Handicap access:
Smoke detector: Protected corridors: i
Fire alarm: (.(16'� Parking spaces ( #):
Notes:
Total Valuation: $ l' 65
INSPECTIONS ' FEES DUE
Footing /foundation Firewall $ I 1 - ,5 Permit Fee
Post /beam structural Smoke detector $ g, e3 State Surcharge
Shear wall Misc. inspection $ ° KW .. Plan Review Fee
Masonry Approach /sidewalk $ Fj ' , 4 . 2....... FLS Plan Review Fee
Framing $ Additional Permit Fee
Insulation Sprinkler rough -in $ Additional Plan Review Fee
_ Gyp board Fire alarm $ ! ` c ‘ ! .., Metro Construction Excise Tax
Suspended ceiling Sprinkler final $ School Construction Excise Tax
Final inspection $ Misc. Fee
$ Hourly Rate Fee
$ Hourly Rate State Surcharge
$ Other:
$ 34f , jj Total Fees Due
*OPTIONS:
TYPE OF USE: COM = commercial; CMS = commercial manufactured structure.
CLASS OF WORK: ACS = accessory; ADD = addition; ALT = alteration; FND = foundation; DEM = demo;
FND = foundation; FPS = fire protection system; NEW = new; OTR = other (use for fences, decks, retaining walls, signs, awnings
or canopies); REP = repair.
I: \Building \Forms \OTC - BUP.doc 08 /19/08