Permit CITY OF TIGARD BUILDING PERMIT
'`1 ' ' COMMUNITY DEVELOPMENT Permit#: BUP2015-00018
Date Issued: 02/03/2015
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S135A601004
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 400
Project: Maxim Healthcare Subdivision: METZGER,TOWN OF Lot: 9
Project Description: TI for new existing tenant:New demising walls,secondary tenant entry,and walls.
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 02/03/2015 $75.00
Occupancy Grp: B Occupancy Load: 51 DC Provision Review,COM TI-LRP 02/03/2015 $11.00
Dwelling Units: 0 Permit Fee-Additions,Alterations, 02/03/2015 $834.87
Demolition
Stories: 6 Height: 0 ft 12%State Surcharge-Building 02/03/2015 $100.18
Bedrooms: 0 Bathrooms: 0 Plan Review 02/03/2015 $542.67
Value: $63,835 Info Process/Archiving-Lg$2.00(over 02/03/2015 $8.00
11x17)
Plan Review-Fire Life Safety 02/03/2015 $333.95
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $1,905.67
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 '• • - ules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: _ • ittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspe n 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 RECEIVED FOR OFFICE USE ONLY
City of Tigard
R "ed
Y g Date B : Permit No.. i
• 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review "VS I.
Iri
Phone: 503.718.2439 Fax: 503.598. 960.--r- patem : /,1Libm z'7 Other Permit:
TIGARD Inspection Line: 503.639.4175 ` 7.9 3 2015 Date Ready/By: 21 See Page 2 for
Internet: www.tigard-or.gov Notified/Method: HIM Supplemental Information
C1TYOF l'l(,AIW
TYPE ON"MING DIVISION REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑New construction ®Demolition ll 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.
El 1-and 2-family dwelling Valuation: $
®Commercial/industrial
El Accessory building ❑Multi-family Number of bedrooms:
El Master builder El Other:
Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address:2 Lincoln-10220 SW Greenburg Road New dwelling area: square feet
City/State/ZIP:Portland,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.:400 I Project name:Maxim Healthcare Covered porch area: square feet
Cross street/directions to job site:Project located north of SW oak street, Deck area: square feet
south of SW Locust Street and east of Greenburg Road Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot no.: Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Scope of work for the project includes interior tenant improvements for an Valuation: $$63,835.00
approx.5,016 sq ft tenant on the 4th of 6 floors.Work to include new demising Existing building area: 5016 square feet
walls,new secondary tenant entry,new walls,doors,relites and cabinetry New building area: 5016 square feet
® PROPERTY OWNER I ❑ TENANT Number of stories: 6
Name:Shorenstein Type of construction: I-B
Address:One SW Columbia Street Suite 500 Occupancy groups:
City/State/ZIP:Portland,OR 97258
Existing: B
Phone:(503)412-4902 Fax:(503)412-4903 New: B
® APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
Business name:Mackenzie (Please refer to fee schedule)
Structural plan review fee(or deposit):
Contact name:Lauren Rohde
FLS plan review fee(if applicable):
Address:1515 SE Water Ave Suite 100
City/State/ZIP:Portland,OR 97214
Total fees due upon application:
Phone:(503)224-9560 Fax::(503)228-1285 Amount received:
E-mail:h ohdef[4mcknze.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name:Russell Construction Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address:20915 SW 105th Ave Solar Installation Specialty Code checklist.
City/State/ZIP:Tualatin,OR 97062 Permit fee(includes plan review $180.00
and administrative fees):
Phone:(503)692-9002 Fax:(503)692-9008
State surcharge(12%of permit fee): $21.60
CCB lic.:58918 Total fee due upon application: $201.60
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:Lauren Rohde Date:02/03/2015 * Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\BUP-COM PermitApp.doc 02/24/2011 440-4613T(I 1/02/COM/WEB)
101 City of Tigard
•
COMMUNITY DEVELOPMENT DEPARTMENT
Building Permit Review — Commercial - No Land Use
TIGARD
Building Permit #: 61,,/ad)s---coo('
Site Address: 1022C) S1/\j Gfeenbul Rd , Suite/Bldg#: y(o
Project Name: MaYirn 1-1e6, core
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Planning Review
Proposal: new demisin waiIs for 2xIshn9 -I-enanr- new secondo.�,
2n+r\ -From/ i( -crib{ nortiel offdmYSy
Gahine,
Existing Business Activity: j cp
Proposed Business Activity: i Gpi
r Verify site address/suite #exists and active in permit system.
D0 Zoning: MUE-.,
Permitted Use: 'Yes El No ❑ Spec Space
Confirm no land use required.
Notes:
Approved by Planning: I / Date: 2.13115
PP Y g 7' frt V
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved El Not Approved
Building Permit Submittal
Original Submittal Date: of ,$
Site Plans: # � A
Building Plans:
Building Permit#: ter building permit# above. /
Workflow Routing: L 'Planning l���Perm Ls
it Coordinator <Building
Workflow Sign-off: "" off for Planning(include notes from planning review)
Route Application Documents: Building: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes: 0T(
By Permit Technician: _,t ` _ Date: a 3 IS—'
`/
1:1Bu ilding Worms l BldgPermitRvw_COM_NoLandUse_071514.docx
Permit Coordinator Review
❑ Conditions Met-Prior to Issuance of Building Permit
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant:
Revision Notice 3: Date Sent to Applicant:
❑ OK to Issue Permit
Approved by Permit Coordinator: Date:
I:\Building\Forms\BldgPermitRvw_COM_NoLandUse_071514.docx
IN Building Division
116AR1)
Over-The-Counter (OTC) Building Permit
Check List
Project Description: T (
APPLICATION SPECIFIC INFORMATION
GENERAL INFORMATION i
Class of Work*: Cr Occupancy Group: t----- Type of Construction: Zl`
Type of Use**: C�(A Occupancy Load: S _ Oregon Specialty Code: 20(4_
SPECIFICS
Number of Stories: /��(k, 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: tej Fire Alarms: Smoke Detectors:
Sprinkler Type: Alarm Type: Protected Corridors:
Standpipe Required: Pull Stations Required: Parapet:
Hazard Group: Battery Calcs Provided:
Density: Cut Sheets Provided:
Design Area:
K Factor: (::55) -5---(1f) _Total Project Valuation: $ _ FEES DUE
$ op DC Prov Rvw,COM TI—Ping
$ ,Ado . DC Prov Rvw,COM TI—LRP
DC Provision Review Fee for COM TI (effective 7/1/2014) $ fa r •ermit Fee—Add,Alt,Demo
Project Valuation Planning LRP $ rII 42%State Surcharge
Up to$4,999 $0.00 $0.00 $ Akigt lan Review,Structural
$5,000-$74,999 $75.00 $11.00 $ Plan Review,Fire Life Safety
$75,000-$149,999 $187.00 $28.00 $ s //► /Info Proc/Arch,Lg(over 11x17$2.00)
$150,000 and over $299.00 $44.00 $ Info Proc/Arch,Sm(up to 11x17$0.50)
$ Metro Construction Excise Tax
$ School Construction Excise Tax
$ Hourly Rate Fee 1
$ Hourly Rate State Surcharge
$ Misc.Admin Fee
$ Other:
$ Other:
Building Staff: $ Other:
Date/Time: $ 1lcPTOTAL FEES DUE
*TYPE OF USE: COM=commercial;CMS=commercial manufactured structure.
**CLASS OF WORK ACS=accessory;ADD=addition;ADU=accessory dwelling unit;ALT=alteration;DEM=demo;NEW=new;
OTR=other(use for fences,decks,retaining walls,signs,awnings or canopies).
I:\Building\Forms\OTC_BUP_070114.docx
1