Permit ■
CITY OF TIGARD BUILDING PERMIT
COMMUNITY DEVELOPMENT Permit#: BUP2016-00018
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/19/2016
Parcel: 2S102AC00700
Jurisdiction: TIGARD
Site address: 12540 SW MAIN ST 202
Project: RecoveryWorks Subdivision: BURNHAM TRACT Lot: 1
Project Description: TI-Improvements for private clinic. New partition walls to form exam rooms and other associated areas.Other
revisions to second floor area,including door addition/removal.
Contractor: SUMMIT CONSTRUCTION Owner: DOLAN&CO LLC
PO BOX 10345 BY FLORENCE T DOLAN
PORTLAND, OR 97296 4523 NE DAVIS ST
PORTLAND, OR 97213
PHONE: 503-223-9703 PHONE: 503-225-9009
FAX: 503-242-3841
Specifics: FEES
Description Dale Amount
Type of Use: COM
Class of Work: ALT Type of Const: VB DC Provision Review,COM TI-Ping 01/19/2016 $220.00
Permit Fee-Additions,Alterations, 01/14/2016 $1,030.65
Occupancy Grp: Occupancy Load: Demolition
Dwelling Units: 0 12%State Surcharge-Building 01/14/2016 $123.68
Stories: 2 Height: 0 ft Plan Review 01/14/2016 $669.92
Bedrooms: 0 Bathrooms: 0 Plan Review-Fire Life Safety 01/14/2016 $412.26
Value: $90,000 Info Process/Archiving-Lg$2.00(over 01/19/2016 $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 $2,464.51
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. Specially 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 ATTENTIONOregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those miss are set forth in OAR
952-OC 1-0010 through OAR 952-0011--000090. You may obtain a copy of the rules or direct questions to OUNC by wiling 503.232.1987 or 1.800.332.2344.
Issued By: C. Permittee Signa ura: (�
109.4178 by 7:00 a.m.for the next available inspection de.
This permit card shall be kept in a conspicuous place on thajob site until comp) tion of the project.
Approved plans are required on thejob site at the time of each Inspection.
Buildim Permit Application
Commercial RECEIVEDFOR OFFICE USE ONLY
MECity of Tigard D'atc B"ed Permit No.: as
13125 SW Hall Blvd.,Tigard,OR 97223 JAN 14 Plan Re k
Phone: 503.718.2439 Fax: 503.598.1960 2016 Date/B Other Permit:
Inspection lane: 503.639.4175 CITY OF rl Date R J.,v, ® See page 2 for
Internet: www.tigmd-or.gov GARD Notified/Method. Supplemental Information
BUILDING DIVISION
TYPE OF WORK REQUIRED DATA:I-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 ®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:12540 SW Main St. New dwelling area: square feet
City/Stale/ZIP:Tigard,OR 97223 Garage/carport area: square feet
Suite(bldglapt.no.:202 Project name:Dolan Tigard— P-ecov tr u)e S 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.:700 Permit fees*are based on the value of the work performed.
Tax map/parcel no.:21-2-AC 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.
Tenant improvement project for private clinic.New partition walls to form Valuation: $$90,000.00
private exam rooms and other associated areas along with associated ceiling Existing building area: 14115 square feet
revisions.Other revisions to second floor area,incl.door addition/removal. New building area: 14115 square feet
® PROPERTY OWNER ❑ TENANT Number of stories: 2
Name:Dolan Type of construction: V-B
Address: 1919 NW 19's Street Occupancy groups:
City/State/ZIP:Portland,OR 97209 Existing: M,B
Phone:(503)22.5-9009 Faz:( )
New: M,B
❑ APPLICANT ® CONTACT PERSON BUILDING PERMIT FEES*
Business name:CmA,Inc. Please refer to fee schedule
Structural plan review fee(or deposit):
Contact name:Sander Kohler
Address: 15895 SW 72ee Ave. FLS plan review fee(if applicable):
City/State/ZIP:Portland,OR 97224 Total fees due upon application:
Phone:(503)226-1285 Fax::( )
Amount received:
E-mail:sanderk@cidainc.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CONTRACTOR Commercial and residential prescriptive installatio
roof-top mount photoVoltaic Solar Panel em.
Business name:Summit Construction Submit two(2)se of roof plan with CPH6,ction details
and fire department Ness,along the 2010 Oregon
Address:1335 NW 20's Ave. Solar Installation S ecr C e checklist.
City/Slate/ZIP:Portland,OR 972% Permit fee(include an review $18000
and admiffistrXive fees):
Phone:(503)742-3841 Fax:( )
State surcharg 2ek of pe fee): $21.60
CCB lic.:63249 To ee due upon applicati $201.60
Authorized signature: This permit application expires if a rmit is not obtained
within 180 days after it has been accepted as complete.
Print name: V Date: ' ( • Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building ermits\BUP-COM PermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Building Division
Over-The-Counter (OTC) Building Permit
Check List
Project Description:
APPLICATION SPECIFIC INFORMATION.,QL
GENERAL INFORMATION
Class of Work*: Occu Gm : T of Construction:
Type of Use**: OccupancyLoad: Ore n S al Code:
SPECIFICS
Number of Stories: Building .H i Mixed Use:
Number of Dw Units: Number of Bathrooms: Number of Bedrooms:
BUILDING SQ PT-SCHOOL CET OTHER SQUARE FOOTAGES
Story Square Foo Accessory Structure: Covered Porcb:
Basement: Deck:
Total Square Foo Carport Mezzanine:
SETBACES
Sideyard Setback—Left Skkyw Setback—Front
Side and Setback—Right Sid and Setback—Back
CONSTRUCTION
Exterior Walls: Protected: Firewall S ration:
N: S: N: S: Occu an Se aration:
E: W: E: W: Access.Parking Spaces:
REQUIRED ITEMS
Fire Sprinklers: Fire Alums: Smoke Detectors:
Sprinkler T Alarm T Protected Corridors:
StandpipeRequired: Pull Stations Required: Para
Flazard Group: Battery Cales Provided:
Density: Cut Sheets Provided:
Design Area:
K Factor.
Total Project Valuation: $ FEES DUE
$ `Z -C)DC Prov Rvw,CONI TI—Ping
$ )Permit Fee—Add,Alt,Demo
DC Provision Review Fee for COM n(effective 7/l/2015) $ 12a/6 State Surcharge
Project Valuation $ Ian Review,Structural
Up to$4,999 $0.00 $ Plan Review,Fire Life Safety
$5,000-$74,999 $98.00 $ Info Proc/Arch,Lg(over 11x17$2.00)
$75,000-$149,999 $220.00 $ Info Proc/Arch,Sm(up to l lx17$0.50)
$150,000 and over $351.00 $ Metro Construction Excise Tax
$ School Construction Excise Tax
$ Hourly Rate Fee
$ Hourly Rate State Surcharge
$ Misc.Admin Fee
$ Other
$ Other
-
$ Othee
Building Staff $ Other
Date/Time: $ TOTAL FEES DUE
*TYPE OF USE: COM=commercial;CMS=commercial manufactured structure
*+`CLASS p • ACS=, e o • .— Aon•ADU=accessory dwelling unit;ALT=alteration;DEM=demo;NEW=new;
0TR=o or caro'Pi .
1:\Building\Forme\OrC—BUP =115.do
City of Tigard
COMMUNITY DEVELOPMENT DEPARTMENT
Building Permit Review — Commercial - No Land Use
Building Permit #:
Site Address: 12 Sy o Svc/ MUN'N St. Suite/Bldg#: W-2
Project Name: DolOI✓) TiG)GIrZ( 12Qco� WO✓lr A
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Planning Review
Proposal: Te, 1 1(/117 t" (M r r-OVY.� t3 r PYNJc-1 -C C li n t L.
Existing Business Activity: Q A'Lt-
Proposed Business Activity: 0 t (r Le--
X,Verify site address/suite# exists and active in permit system.
River Terrace NeighborhoodU
: /� 1:1 Yes -&--No
/ Zoning: M U - La
Permitted Use: tX Yes ❑ No ❑ Spec Space
VConfirm no land use required.
—4� $IIsiness License:
Exists: ❑ Yes ❑ No, applicant notified to obtain business license
Notes: /f
Approved by Planning: �J (r77ZGL /�I�od-g-r� Date:
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
Building Permit Submittal
Original Submittal Date:
Site Plans: #
Building Plans:
Building Permit#: Enter building permit#above.
Workflow Routing. E-'Planning ❑ 12enei r- Building
Workflow Sign-off: �gn-off for Planning(include notes from planning review)
Route Application Documents: ;1-1�u-ilding: original permit application,site plans,building plans,engineer and
�beam calculations and trust details,if applicable,etc.
Notes: ! l�
By Permit Technician: d �YLt�-n_/ Date: / lq
I:\Building\Forms\BldgPe itRvw_COM_NotandUse_070915.dmx
Permit Coordinator Review
❑ Conditions "Met"prior to issuance of building permit
❑ Approved,NOT Released: Date:
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:
❑ SDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes ❑ N/A
Tigard Trans SDC: ❑ Yes ❑ N/A
Parks SDC: ❑ Yes ❑ N/A
❑ OK to Issue Permit
Approved by Permit Coordinator: Date:
I:\Building\Forms\BldgPe itRvw COM_NolendUse_070915.dmx
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
12540 SW MAIN ST 202, TIGARD, OR, 97223
Commercial - Building
299 Final inspection
PASS - C of O
BUP2016-00018
Chip Barnett
Violation Summary:
Inspector Contractor