Permit - ,, CITY OF TIGARD BUILDING PERMIT
' x ' COMMUNITY DEVELOPMENT Permit#: BUP2015 00320
T[CARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/15/2015
Parcel: 1S135BC00202
Jurisdiction: TIGARD
Site address: 10763 SW GREENBURG RD 100
Project: Acadia Healthcare Subdivision: OAKBURG Lot: 27
Project Description: TI for a new medical clinic. Change of use from retail store to outpatient clinic.
Contractor: WHITE OAK CONSTRUCTION INC Owner: BELANICH, ROGER M
2455 RIVER RD S 22020 17TH AVE SE#200
SALEM, OR 97302 BOTHELL,WA 98021
PHONE: 503-588-3081 PHONE:
FAX:
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: VB Permit Fee-Additions,Alterations, 12/15/2015 $2,615.95
Demolition
Occupancy Grp: B Occupancy Load: 148 12%State Surcharge-Building 12/15/2015 $313.91
Dwelling Units: 0 Plan Review 11/10/2015 $1,700.37
Stories: 0 Height: 0 ft Plan Review-Fire Life Safety 11/10/2015 $1,046.38
Bedrooms: 0 Bathrooms: 0 Wash Co Trans Dev Tax 12/15/2015 $17,547.00
Value: $350,000 Parks SDC Improvement 12/15/2015 $1,427.00
Parks SDC Reimbursement 12/15/2015 $257.00
DC Provision Review,COM TI-Ping 12/15/2015 $351.00
Floor Areas: Info Process/Archiving-Lg$2.00(over 12/15/2015 $56.00
Total Area: 5832 11x17)
Info Process/Archiving-Sm$0.50(up to 12/15/2015 $57.50
Accessory Struct: 0 11x17)
Basement: 0 Metro Const.Excise Tax 12/15/2015 $420.00
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $25,792.11
Required: Required Items and Reports(Conditions)
Fire Sprinkler: No Parapet:
Fire Alarm: Protected Corridors: Yes
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 Co'-- and -II • er 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 iss -n--, o• if w•rk is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notificati--n en r. hose 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 calling 5.3. •2.1'.87 or .800.332.2344.
Issued By: Arerieet___ C/ a Signature: '1
503.639.4175 by 7:00 a.m.for the next available insp; tion date.
This permit card shall be kept in a conspicuous place on the job site un it completion of the project.
Approved plans are required on the job site at the time of each Inspection.
/i/'ths Ls
Building Permit Application
Commercial /,` f GO FOR OFFICE USE ONLY
{V V V Received
City of Tigard Date/B : i� ,moi, Permit No. ,12/1 i 5^/AI /LI
III13125 SW Hall Blvd.,Tigard,OR 972 4 V\S Plan Re L ether Permit:
Phone: 503.718.2439 Fax: 503.598.1960 Nw Date/B :
T I G AR D Inspection Line: 503.639.4175 \t GPO a ate Rea. ':-: El See Page 2 for
Internet: www.tigard-or.gov C� O'�11``I,S` ° otified/Method: EM Supplemental Information
TYPE OF WWu.— REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑New construction El 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.
El1-and 2-family dwelling ®Commercial/industrial Valuation: $
ElAccessory building ❑Multi-family Number of bedrooms:
El Master builder 11 Other:
Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 10763 SW Greenburg Road New dwelling area: square feet
City/State/ZIP:Tigard,OR 97223A- fa �T wryaln . Garage/carport area: square feet
Suite/bldg./apt.no.: 100 Project namef Covered porch area: square feet
Cross street/directions to job site:Cascade Avenue _` Deck area: square feet
, Other structure area: square feet
s .'\F��5 V REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: v" Lot no.:202 Permit fees*are based on the value of the work performed.
Tax map/parcel no.: 1S 1 35BC Indicate the value(rounded to the nearest dollar)of all
tit equipment,materials,labor,overhead,and the profit for the
DESCRIPT i OF ORK work indicated on this application.
Interior tenant improvements for a medical clinic. Gross floor area is 5,832 sq Valuation: $$350,000.00
ft. Exterior imprvements include a new concrete sidewalk and accessible parking Existing building area: 5,832 square feet
space. New building area: 0 square feet
—
❑ PROPERTY OWNER ® TENANT Number of stories: I
Name:Acadia Healthcare Type of construction: V-B
Address:4 Sourwood Ridge Road Occupancy groups:
City/State/ZIP: Black Mountain,NC 28711 Existing: NI
Phone:(408)688-8086 Fax:(877)303-8453 New: B
❑ APPLICANT ® CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name:Carlson Veit Architects P.C.
Structural plan review fee(or deposit):
Contact name:Craig Carlson
Address:3095 River Rd N FLS plan review fee(if applicable):
City/State/ZIP:Salem,OR 97303 Total fees due upon application:
Phone:(503)390-0281 Fax: :(503)390-2459 Amount received:
E-mail:ccarlson@carlsonveit.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted Photo Voltaic Solar Panel System.
Business name:White Oak Construction Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address:2455 River Road S Solar Installation Specialty Code checklist.
City/State/ZIP:Salem,OR 97302 Permit fee(includes plan review
$180.00
and administrative fees):
Phone:(503)588-3081 Fax:(503)588-3093 State surcharge(12%of permit fee): $21.60
CCB lic.: 111431
Total fee due upon application: $201.60
0L....Authorized signature: t This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:Craig D.Carlson Date: 10/30/15 * Fee methodology set by Tri-County Budding Industry
Service Board.
I:\Building\Permits\BUP-COM PermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
J - 'r
IFI City of Tigard
COMMUNITY DEVELOPMENT DEPARTMENT
T I G A lz[) Building Permit Review — Commercial - With Land Use
Building Permit #: L3//p ,5_C o.aao
Site Address: /0:?(() S �ll7r/..�fi j ` , ce Suite/Bldg#: /06 -,4//0
Project Name: / az-6a7 -M.(.�lre ,
(Name of commercial business occupying th.....4pace. If vacant,enter Spec Space.)
Planning Review "� /
Proposal: 7+/' nLe c •',c,e (�riCA of c i'1a/l S
/I&i 4 Ph..41. ,sdr2e2ce c>2...1 ./ /7:7)4 A ,:t- 47.4.)17_,
Lld' Verify site address/suite# exists and at6,3xlin permit syste .
U is 'ver Terrace Neighborhood: ❑ Yes IJeS No
11 jand Use Case#: kin cQO/S' c 36
Plan atch Approved Land Use:
Site Plan Landscape PlanAil/Other:
rban Forestry Plan / levation Plan
Building Height: Maximum Height Ile Actual Height a)::Sfry...,
*Conditions Met: ❑ Prior to Submittal 0 Prior to Permit Issuanc
[ Business Licen/:
Exists: ER41 Yes 0 No,applicant notified to obtain business license
XV 'ublic Facilities Improvement(PFI) Permit: 2(
Required: 0 Yes,applicant was notified la No Applied For: 0 Yes 0 No,stop intake
Notes:
Approved by Planning: F ,i/ Date: /if 5-
-----
Revisions
-
Revisions (after Building Submittal only) Reviewer Date
Revision 1: 0 Approved 0 Not Approved
Revision 2: 0 Approved 0 Not Approved
Revision 3: 0 Approved 0 Not Approved
Building Permit Submittal
Original Submittal Date: 1/ If1/$-
�j/
Site Plans: # f4
Building Plans: # 3
Building Permit#: IR-Enter building permit#above.
Workflow Routing. ffri tinning gineering EHt Coordinator EI—EtnittEng
Workflow Sign-off: E SIg--off for Planning(include notes from planning review)
Route Application Documents: [ -$u�ding: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc. ,p
Notes: J Q-�fi:r dy -/lre ,ifre� /AI/►'la./ ,e^/ /07A--- 8J-1
By Permit Technician: , — Date: ////D/} ---
Ara.
1:\Building\Fortes\BldgPermitRvw_COMOlise_0709I5.docx
r _ 1,
Engineering Review
Eope at building pad: V%
C-PFI Permit#: ;
2nditions "Met"prior t issuance of building permit
ZrEasements (encroachments) per engineering conditions of approval and plat(not typical on SDR/CUP)
Er-Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes 3'No
Assess Water Quantity Fee in-lieu: ❑ Yes grNo
LIDA Facility on lot: ❑ Yes [2(No
❑ NOT Approved by Engineering: Date
Notes: /Ja c 0.E4i,ji.«l
Approved by Engineering: 164.1 14141-“V--.. Date: /l—,g- i s
Revisions (after Building Submittal only) Reviewer Date
Revision 1: 0 Approved ❑ Not Approved
Revision 2: 0 Approved 0 Not Approved
Revision 3: 0 Approved 0 Not Approved
Permit Coordinator Review
0 Conditions "Met"prior to issuance of building permit
0 Approved,NOT Released: Date:
Notes:
Revisions (after Building Submittal only)
Revision Notice 1:
Revision Notice 2:
Revision Notice 3:
Date Sent to Applicant:
Date Sent to Applicant:
Date Sent to Applicant:
SDC Fees Entered: Wash Co Trans Dev Tax: X Yes 0 N/A
Tigard Trans SDC: ❑ Yes ' ' N/A
Parks SDC: "54 Yes ❑ N/A
OK to Issue Permit
Approved by Permit Coordinator: Ale(i Ccgz..---- Date: /1/j VI'S
1:\Building\Forms\B ldgPerm it Rvw_COM_W ith LandUse_0709 1 5.doc x
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
10763 SW GREENBURG RD 100, TIGARD, OR,
97223
Commercial - Building
299 Final inspection
PASS - C of O
BUP2015-00320
Jeff Grove
Violation Summary:
Inspector Contractor