Permit CITY OF TIGARD BUILDING PERMIT
1 . : COMMUNITY DEVELOPMENT Permit #: BUP2013 00160
T [ GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/27/2013
Parcel: 1 S 126 DC80001
Jurisdiction: Tigard
Site address: 9385 SW LOCUST ST
Project: Family Practice Clinic Subdivision: LOCUST OFFICE PARK CONDO Lot: 1
Project Description: New ADA toilet room for new tenant in a medical office.
Contractor: NORWEST CONTRACTORS INC Owner: TSE INVESTMENTS LLC
PO BOX 25305 PO BOX 1754
PORTLAND, OR 97298 -0305 LAKE OSWEGO, OR 97035
PHONE 503 - 291 -6986 PHONE:
FAX 503 - 291 -7036
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: VB DC Provision Review, COM TI - Ping 06/27/2013 $67.00
Occupancy Grp: B Occupancy Load: 11 DC Provision Review, COM TI - LRP 06/27/2013 $10.00
Dwelling Units: 0 Permit Fee - Additions, Alterations, 06/27/2013 $597 21
Demolition
Stories: 0 Height: 0 ft 12% State Surcharge - Building 06/27/2013 $71.67
Bedrooms: 0 Bathrooms: 0 Plan Review 06/27/2013 $388 19
Value: $37,850 Plan Review - Fire Life Safety 06/27/2013 $238.88
Info Process /Archiving - Lg $2 00 (over 06/27/2013 $6 00
11x17)
Floor Areas:
Total Area: 0
Accessory Struct 0
Basement 0
Carport. 0
Covered Porch: 0
Deck: 0
Garage 0
Mezzanine: 0
Total $1,378.95
Required: Required Items and Reports (Conditions)
Fire Sprinkler. Yes 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 -0010 through OAR 952 - 001 -0090 You may obtain a copy of the rules or direct questions to OUNC by calls 232.1987 or 1 800 332.2344.
Issued By: �/ � Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for the next available inspectio 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 FOR OFFICE USE ONE) .
• City of Tigard Received Permit No.: i
1 q
h' g DateB . _ u c —0# 4
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review �]
0 Phone: 503.718.2439 Fax: 503.598.1960 Daz�g Rev. � G Other Permit
TI G n R D Inspection Line: 503.639.4175 Date R t Juns ® 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.
❑ 1- and 2- family dwelling N Commercial/industrial Valuation: $
❑ 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: 9385 SW Locust Street New dwelling area: square feet
City/State/ZIP: Tigard, OR 97223 Garage /carport area: square feet
Suite/bldg. /apt. no.: I Project name: Family Practice Clinic Covered porch area: square feet
Cross street/directions to job site: 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.
New ADA Toilet Room, plumbing and electrical for Medical Office Valuation: $$37,850.00
Existing building area: square feet
New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories: 1
Name: TSE INVESTMENTS LLC Type of construction: VB
Address: PO Box 1754 Occupancy groups:
City /State /ZIP: Lake Oswego, OR 97035 Existing: B
Phone: ( ) Fax: ( ) New: N/C
® APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
Business name: NW Precision Design (Please refer to fee schedule)
Structural plan review fee (or deposit):
Contact name: Darin Bouska
FLS plan review fee (if applicable):
Address: 22605 SW Pinehurst Ct
City /State/ZIP: Sherwood, OR 97140 Total fees due upon application:
Amount received:
Phone: (503) 680 -6444 Fax:: ( )
E -mail: Dario @NW- Precisioo.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
• - CONTRACTOR roof -top mounted PhotoVoltaic Solar Panel System.
Business name: Norwest Contractor's, Inc. Submit two (2) sets of roof plan with connection details
and fire department access, along with the 2010 Oregon
Address: PO Box 25305 Solar Installation Specialty Code checklist.
City/State/ZIP: Portland, OR 97298 Permit fee (includes plan review $180.00
and administrative fees):
Phone: (503) 291 -6986 Fax: ( ) State surcharge (12% of permit fee): $21.60
CCB lic.: 89425
Total fee due upon application: $201.60
Authorized signature: 1 This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Darin Bouska Date: 6/26/13 1 * Fcc methodology set by Tn- County Building Industry
Service Board
I•\Building\Permits \BUP -COM PermitApp.doc 02/24/2011 440- 4613T(11 /02 /CO M/WEB)
71
a Building Division
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] $ 37,850
MULTIPLIER (25% barrier removal requirement): x .25
TOTAL BUDGET FOR BARRIER REMOVAL: [2] $ 9,462.50
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 $ 475
(b) An accessible entrance: $ Compliant
(c) An accessible route to the altered area: $ 1,800
(d) At least one accessible restroom for each sex or a single unisex
restroom: $ 7,400
(e) Accessible telephones: $ None
(f) Accessible drinking fountains: and, $ None
(g) When possible, additional accessible elements such as storage and
alarms: $
TOTAL (shall equal line [2] of Valuation Computation): $ 9,675
I: \Building \Permits \BUP -COM PermitApp.doc 03/03/2011
114 a Building Division
Development Code Provision Review
TIGARD Commercial Projects - No Associated Land Use Case
Building Permit No: ,QuPa. — OD to 0 xpedited Review Q7C
Project Narne 9'3 PS SA) LA C a S T
Site Address: /L e C C i t.. , Suite /Bldg #:
Plans Routed: ���
Original Plan Submittal Date: v /..1.7/3 Routed By:
1st 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 o ly if approved.
Planning Review (contact at (503) 718-g Liao or 1.4 @tigard- or.gov)
Proposal: A r / ^ 1 4 0 /6 "t - .41(4,0e
Zoning AI U 1; i
Permitted Use Yes [5 No ❑
Land Use Required: Yes ❑ No 2
Notes:
Itr ❑ Not Approved ❑ DCPR Not Required — No DCPR Fees Due
Date Routed to Building: L ,. �7 - /
1: \CURPLN\Masters\Development Code Provision RevimkDCPR_COM NoLandUse.doc Rev. 01/16/13
11111 2 Building Division
Over - The - Counter (OTC) Building Permit
TIGARD
Check List
Project Description: 1 1
APPLICATION SPECIFIC INFORMATION
GENERAL INFORMATION
*Class of Work: Lt Occupancy Group: Type of Construction: ]
*Type of Use: CO(Ak Occupancy Load: Oregon Specialty Code: 201l)
SPECIFICS
Number of Stones: 1 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: $ 3 7) 6S0.00 FEES DUE
$ ro 7, CO DC Prov Rvw, COM TI — Ping
$ _` g DC Prov Rvw, COM TI — LRP
DC Provision Review Fee for COM TI $ a Permit Fee — Add, Alt, Demo
Project Valuation Planning LRP $ (s 7( 12% State Surcharge
Up to $4,999 $0.00 $0.00 $ ''.p ,t' Plan Review, Structural
$5,000 - $74,999 $67.00 $10.00 $ 2 I • (. Plan Review, Fire Life Safety
$75,000 - $149,999 $167.00 $25.00 $ , , I 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
$ A/Iise. Admin Fee
Permit Coordinator: $ Other:
$ Other:
Building Staff: Other: 1. /.
Date/Time: Date
/ $ (p5 , Q3 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: \Budding \Forms \OTC - BUP.docx 07/01/2012