Report PROJECT SUBSTANTIAL COMPLETION NOTICE
Hospitals, Ambulatory Surgical Centers, Psychiatric Hospitals and
Special Inpatient Care Facilities
Instructions: Complete and forward this report approximately three weeks prior to taking occupancy of
a facility or major project area which has received a plan review through the Licensing
Plans Review Program. A Site Inspection date should be coordinated with staff at
Facilities Planning and Safety to confirm the actual Inspection date and time.
Patient /Resident occupancy is a building should not take place until the Site Inspection
has been done, all Inspection items resolved, a Project Building Approval is issued from
Facilities Planning and Safety, and appropriate documents are completed from the
Licensing Program. For further information, please call (503) 373 -7201. Copies
should be provided and forwarded as follows:
FORWARD ONE COPY TO FORWARD ONE COPY TO
Pam Triplett — Staff Architect Rick Bolen
Facilities Planning & Safety Senior Building / Mechanical Inspector
Oregon Health Services City of Tigard
880 Winter Street NE 13125 SW Hall Boulevard
Salem OR 97301 pamela .r.triplettcnr.state.or.us Tigard OR 97223 ricktigard-or.gov
FORWARD ONE COPY TO FORWARD ONE COPY TO
Sanya Rusynyk — Licensure & Certification Gayle Johnson
Health Care Regulation & Quality Improvement Bureau of Institutions / Codes
Oregon Health Authority — Public Health Office of State Fire Marshal
800 NE Oregon Street — Suite 640, #21 4760 Portland Road NE
Portland OR 97232 sanya.m.rusynykstate.or.us Salem OR 97305 gayle.johnson@,state.or.us
Plans Review No.: PR # 10 -155
Facility Name: Scholls Ferry Medical Office Building S ChOL,1-,s,.,e7 /eE7,t.g
Project Description Expansion of existing Rehab Department
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Address: SW Scholls Ferry Road — Tigard OR 97223
Facility Contact Person: Richard Scogin
Address: 4400 NE Halsey Street — Suite 160 — Providence Office Park — Bldg. #1 — Portland OR 97213
Telephone No.: (503) 215 -2692 Email Address: richard.scooin(a�providence.org
Desired Inspection Date: February 22, 2011
Expected Occupancy Date: February 28, 2011