Permit `id f BUILDING PERMIT
CITY OF T I G A R D PERMIT #: BUP2002 -00519
,icAtilp DEVELOPMENT SERVICES DATE ISSUED: 12/6/02
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 1S134BC -00401
SITE ADDRESS: 12442 SW SCHOLLS FERRY RD
SUBDIVISION: ZONING: C -N
BLOCK: LOT: JURISDICTION: TIG
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: ALT FIRST: sf N: S: E: W:
TYPE OF USE: COM SECOND: 1,779 sf PROJECT OPENINGS?
TYPE OF CONST: : sf N: S: E: W:
OCCUPANCY GRP: B TOTAL AREA: 1,779 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: 17 BASEMENT: sf AREA SEP. RATED:
STOR: 2 HT: ft GARAGE: sf OCCU SEP. RATED:
BSMT ?: N MEZZ ?: N REQD SETBACKS REQUIRED
FLOOR LOAD: psf LEFT: ft RGHT: ft FIR SPKL: Y SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: Y PARKING:
VALUE: $ 96,000.00
Remarks: Tenant Improvement ment 2nd floor & Conference room on 1st floor
- IRE-Axe-1-
Owner: Contractor:
SISTERS OF PROVIDENCE IN OR BNK CONSTRUCTION INC
BY STEVE FOSTER 10730 SE HWY 212
PO BOX 13993 PO BOX 66
PORTLAND, OR 97213 CLACKAMAS, OR 97015
Phone:
Phone: 690 -1779
Reg #: 1563i1085 80070033S
941
FEES 651-Q.856. EQ
Description Date Amount Mechanical Permit Require
[BUPPLN] Pin Rv 12/4/02 $469.57 Electrical Permit Required
FLS F LS Pln Rv 1 2/4/02 $288.97 Sprinkler Permit Required
[FLS] Plumbing Permit Required
[BUILD] Permit Fee 12/6/02 $722.42 Framing Insp
[TAX] 8% State Tax 12/6/02 $57.79 Gyp Board Insp
Total Susp Ceilng Insp
otal $1,538.75
Final Inspection
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 than 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- 001•01 lough OAR 952 - 001 -0100. You may obtain a copy of these rules or direct questions to OUNC by
calling 503) 246- 6699or 1- 800 -332- • 4
■ )i Issued - P \, y i - =� /
Perm ittee �� ��
Signature: �'�/ �i
Call 639 -4175 by 7 p.m. for an inspection the next business day
III
ti,
Building Pe (( pplication OFFICE USE ONLY
Ti E N E Date received: pZ— OFFICE US mit N _ �j f /�
A n' City of igard `'� U t� °2 D�
Project/appl. no.: Expire date: •
City of Tigard Address: 13125 SW Hall Blvd, uL l. V ,6) 9� N�JJ a
Phone: (503) 639 -4171 Date issued: B Receipt no.:
Fax: (503) 598 -1960 CITY OF TIGAFID Case file no.: Payment type:
Land use approval: BUILDING DIVISION I &2 family: Simple Complex:
TYPE OF PERMIT
0 I & 2 family dwelling or accessory 0 Commercial /industrial 0 Multi- family 0 New construction 0 Demolition
0 Addition /alteration/replacement JtirTenant improvement 0 Fire sprinkler /alarm 0 Other:
JOB SITE INFORMATION .
Job address: 12442 SW Scholls Ferry Road Bldg. no.: Suite no.:' •
Lot: Block: Subdivision: Tax map /tax lot/account no.:
Project name: Scholls Rehab & Conference Room
Description and location of work on premises/special conditions: Tenant inf ill of existing unfinished space,
physical therapy treatment booths., infill of existing lobby to become a conference room.
OWNER FOR SPECIAL INFORMATION, USE CHECKLIST
Name: Providence Health S stem (Floodplain, septic capacity, solar, etc.)
Mailing address: 4706 NE Glisan St. 1 & 2 family dwelling:
City: Portland State: OR ZIP: 97213 Valuation of work $
Phone: 215 -2692 Fax: 21 -68021 U L�.a., Vlidelet ai m /baths
Owner's representative: Mr. W arren g • i•Son Total number of floors
Phone: 215 -2692 Fax: 215 -6802 E -mail: ws ,•son • or. vlfd ljo gea (sq. ft.)
APPLICANT Garage /carport area (sq. ft.)
• _ - Covered porch area (sq. ft.)
Mailing address: c _ Deck area (sq. ft.)
�' ZIP: Other structure area (sq. ft.)
•I •; 11
Phone: I Fax: E- ma il: mercial/industrial /multi - family:
690 -1779 6 90 - 091 d' oh11S011 l ' Valuation of work S 96 `b00
1 CONTRACTOR r
Business name: Existing bldg. area (sq. ft.) 24, 000
BnK Construction Inc New bldg. area (sq. ft.) 24,000 0 00 •
Address: 10730 SE HI/ . 212 Number of stories 2
City: Clackamas State: Q. ZIP: 97015 Type of construction B
Phone: 557 -0866 Fax: 557--108 E- mail:ludwi•@bnk B
Occupancy group(s): Existing:
CCB no.: construction ca n New: R
City/metro lie. no.: Notice: All contractors and subcontractors are required to be
ARCHITECT /DESIGNER licensed with the Oregon Construction Contractors Board under
Name: Jon R. Jur.ens & Assoc. Inc. provisions of ORS 701 and may be required to be licensed in the
Address: 15455 NW Greenbrier Pkwy. #260 jurisdiction where work is being performed. If the applicant is
City: Beaverton State: OR ZIP: 97006
exempt from licensing, the following reason applies:
Contact person: Dave Johnson Plan no.: 87133 -19 20
Phone: 690 -1779 Fax: 690 -091 ' E -mail: djohnson @j .can
ENGINEER OFFICE USE ONLY
Name: Contact person: Fees due upon application $
Address: Date received:
City: State: ZIP: Amount received $
Phone: Fax: E -mail: Please refer to fee schedule.
I hereby certify I have read and examined this application and the Not all jurisdictions accept credit cards, please call jurisdiction for more information.
attached checklist. A • • • • - • • f I ws •. nd ordinances governing this CI visa D MasterCard
work will be comp ie • , • 4' fed herein or not. Credit card number: / /
, 1 IP r r //y '] AA Expires
Authorized sit ature: m ' ' Date: � �l . fr W e, Name of cardholder as shown on credit card
Print name: 1Ie t .. . 71 • - Cardholder signature $ Amount
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440 -4613 (6 /00 /COM)
CITY OF TIGARD • 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 T
Received Date Requested �` " AM q/C1 PM �BUP
Location �' !� . � � � i' .1�. Suite e N ° 1 1 / MEC -
Contact Person -ICY Ph ( f ) ST $ d D' PLM
Contractor Ph ( SWR
CBUILDI Tenant/Owner .• // NIL % ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear H 2 6O Z - 6 Q SO (-� / 2 V+ —
Framing \ l
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
AS - PART FAIL
BING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In -
UG/Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE 1 Please call for reinspection RE: ❑ Unable to inspect – no access
Fire Supply Line /�
ADA z-7 (0
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL