Permit CITY OF TIGARD BUILDING PERMIT
C COMMUNITY DEVELOPMENT Permit #: BUP2013 -00109
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/08/2013
Parcel: 1 S135AB04500
Jurisdiction: Tigard
Site address: 10250 SW GREENBURG RD 110
Project: Family Health Subdivision: 1991 -055 PARTITION PLAT Lot: 1
Project Description: TI
Contractor: RUSSELL CONSTRUCTION INC Owner: LINCOLN CENTER LLC
20915 SW 105TH AVE BY SHORENSTEIN PROPERTIES LLC
TUALATIN, OR 97062 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE. 503 - 692 -9002 PHONE
FAX: 503 - 692 -9008
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: IIB DC Provision Review, COM TI - Ping 05/08/2013 $67.00
Occupancy Grp: B Occupancy Load: 26 DC Provision Review, COM TI - LRP 05/08/2013 $10 00
Dwelling Units: 0 Permit Fee - Additions, Alterations, 05/08/2013 $707 41
Demolition
Stories: 3 Height: 0 ft 12% State Surcharge - Building 05/08/2013 $84 89
Bedrooms: 0 Bathrooms: 0 Plan Review 05/08/2013 $459 82
Value: $47,856 Plan Review - Fire Life Safety 05/08/2013 $282 96
Info Process /Archiving - Lg $2.00 (over 05/08/2013 $8 00
11x17)
Floor Areas:
Total Area 0
Accessory Struct. 0
Basement 0
Carport: 0
Covered Porch: 0
Deck' 0
Garage: 0
Mezzanine: 0
Total $1,620.08
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
952-001-0011 - gh OAR 952 - 001 -0090 You may obtain a copy of the rules or direct questions to OUNC by calling 503 3 987 or 1.800 332 2344
1
Issued By: (, .1��1 / Permittee Signature:
""��ll �X 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 Applicatio
Commercial FOR OFFICE USE ONLY
City of Tigard MAY 0 8 2013 DateB `� $AMOM Permit No : 1A)15-60/e1A)15-60/e,
13125 SW Hall Blvd., Tigard, OR 91-224—
P lan Review
Date/B 1 1 1 1 OF TIGARD (�
®� Other Permit:
503.639.4171 Fax. 503.59.
TIGARD
Inspection Line: 503.639.4175 BUILDING DIVISION Date Ready/By: Jug: ® 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 ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation: $
❑ 1- and 2- family dwelling ® Commercial/industrial
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: Four Lincoln -10250 SW Greenburg Road New dwelling area: square feet
City /State/ZIP: 97224 Garage/carport area: square feet
Suite/bldg. /apt. no.: 110 Project name: Family Health Covered porch area: square feet
Cross street/directions to job site: SW Locust Street Deck area: square feet
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.
Valuation: $$47,856.00
Existing building area: 2553 square feet
New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories: 3
Name: Shorenstein Realty Services Type of construction: 2 -B
Address: 5335 Meadows Road, Suite 300 Occupancy groups:
City /State/ZIP: Lake Oswego, Oregon 97035 Existing: B
Phone: (503)619 -3200 Fax: (503)619 -3210 New: B
® APPLICANT ❑ CONTACT PERSON
NOTICE
Business name: GBD ARCHITECTS All contractors and subcontractors are required to be
Contact name: Whit Middlecoff licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 1120 NW Couch Street, Suite 300 jurisdiction in which work is being performed. If the
City / State/ZIP: Portland, Oregon 97209 applicant is exempt from licensing, the following reasons
apply:
Phone: (503) 224 -9656 Fax: : (503) 299-6273
E -mail: whit @gbdarchitects.com
CONTRACTOR
Business name: Russell Construction BUILDING PERMIT FEES*
Address: 20915 SW 105 Avenue (Please refer to fee schedule)
City /State/ZIP: Tualatin, Oregon 97062 -9511 Structural plan review fee (or deposit):
Phone: (503) 692 -9002 Fax: (503) 692 -9008 FLS plan review fee (if applicable):
CCB lic.: 58918 Total fees d ue upo app lication:
Am ount r eceived: $
Authorized signature: This permit appli cation expire if a permit is not obtained
within 180 days after i t has bee accepted as complete.
Print name: Whit Middlecoff, AIA Date: 05/07/13 * Fee methodology set by Tri- County Building Industry
Service Board.
I:\BuildingWermits'BUP -COM PermitApp.doc 10/01/09 440- 4613T(11 /02/COM/WEB)
ilql Building Division
° Development Code Provision Review
TIGARD Commercial Projects - No Associated Land Use Case
Building Permit No: �c-u- Po97f 5_ -bG 1- 9 7 It Expedited Review
Project Name: - FA,xi I I 14 ca 1 --I"
Site Address: L O 2 -5 - 0 an e_c€) tL Q` , Suite /Bldg #: /1?)
Plans Routed:
Original Plan Submittal Date: 57//3 Routed By: CZ2____
1s Revision Submittal Date: Routed By:
2n Revision Submittal Date: Routed By:
To the Applicant:
> If the proposed use is not permitted within the zone, please contact the Building Division to cancel
the permit application. Building Permit Technicians (503) 718 -2439.
➢ If a land use is required and for all other questions, please contact the staff person listed above the
Planning Review section.
Staff: please check items along left only if approved.
Planning Review (contact c\ LA*, at (503) 718 - 1557 or iv i-iL @tigard- or.gov)
Proposal: I A A r wAIIs, 5fut.c... ree /yr* di't. 5.1-i al-ulic'.Q dcfi
& �er:d re exis{�'n door no cAowl 1 a i', opt J'ns .
- ,4dd,n an AWn,n5.
Zoning M U E - I
Permitted Use Yes L No ❑
Land Use Required: Yes ❑ No ❑ A
Notes: �'� / sr.►, .z; =.e�..ws..r :.a ---=- / Yt WA i n G 1c.c.Cf I n'T - s <ier 61
of4 .a Go I- pte�C. not virile(L -Fr9 St r4_41' or ofLe. pro 69.6i7i.(J .
b Approved ❑ Not Approved ❑ DCPR Not Required — No DCPR Fees Due
Date Routed to Building:
1: \CURPLN\Masters\Development Code Provision Review■DCPR_COM_NoLandUse.doc Rev 01/16/13
Building Division
Over- The - Counter (OTC) Building Permit
T[ G A R D Check List
Project Description: T
APPLICATION SPECIFIC INFORMATION
GENERAL INFORMATION
*Class of Work: Occupancy Group: Type of Construction:
*Type of Use: r. I Occupancy Load: Oregon Specialty Code: "Ze,(C)
SPECIFICS
Number of Stones: Building Height: Mixed Use:
Number of Dw Units: Number of Bathrooms: Number of Bedrooms:
BUILDING SQ FT - SCHOOL CET OTHER SQUARE FOOTAGES
Story Square Footage: Accessory Structure: Covered Porch:
Basement: Garage: Deck:
Total Square Footage: Carport: Mezzanine:
SETBACKS
Sideyard Setback — Left Sideyard Setback — Front
Sideyard Setback — Right Sideyard Setback — Back
CONSTRUCTION
Exterior Walls: Openings Protected: Firewall Separation:
N: S: N: S: Occupancy Separation:
E: W: E: W: Access. Parking Spaces:
REQUIRED ITEMS
Fire Sprinklers: Fire Alarms: Smoke Detectors:
Parapet: Manual Pull Stations: Protected Corridors:
Total Project Valuation: $ V7 0 . CO FEES DUE
$ (9'1 , GO DC Prov Rvw, COM TI — Ping
$ ( 0.60 DC Prov Rvw, COM TI — LRP
DC Provision Review Fee for COM TI $ 707 Al Permit Fee — Add, Alt, Demo
Project Valuation Planning LRP $ G� 12% State Surcharge
Up to $4,999 $0.00 $0.00 $-- Plan Review, Structural
$5,000 - $74,999 $67.00 $10.00 $ ` . c{,6, Plan Review, Fire Life Safety
$75,000 - $149,999 $167.00 $25.00 $ , (`�' Info Proc /Arch, Lg (over 11x17 $2.00)
$150,000 and over $268.00 $39.00 $ Info Proc /Arch, Sm (up to 11x17 $0.50)
$ Metro Construction Excise Tax
$ School Construction Excise Tax
$ Hourly Rate Fee
Planning Staff: $ Hourly Rate State Surcharge
$ Misc. Admen Fee
Permit Codrdinator: $ Other:
$ Other:
Building Staff: $ Other:
Date /Time: $ I (vZO,CS 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. \ Bwldmg \ Forms \OTC -BUP docx 07/01/2012
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
10250 SW GREENBURG RD 110, TIGARD, OR,
97223
Commercial - Building
299 Final inspection
2013-10-30 00:00:00
BUP2013-00109
PASS - C of O
Violation Summary:
Inspector Contractor