Permit CITY OF TIGARD BUILDING PERMIT
COMMUNITY DEVELOPMENT Permit#: BUP2016-00044
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/10/2016
Parcel: 1 S134AA01900
Jurisdiction: Tigard
Site address: 10115 SW NIMBUS AVE 200
Project: I Love Kick Boxing Subdivision: IKOLL BUSINESS CENTER,TIGARD Lot: B
Project Description: TI for new tenant:ADA restrooms,break room floor covering,paint&ceiling work.
Contractor: CPS CONSTRUCTION INC Owner: ROBINSON, CONSTANCE A
9825 SW DAY ST BY KILLIAN PACIFIC LLC
SHERWOOD, OR 97140 500 EAST BROADWAY, STE 110
VANCOUVER,WA 98660
PHONE: 503-320-0918 PHONE:
FAX: 503-570-8713
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of work: ALT Type of Const: Vg DC Provision Review,COM TI-Ping 02/09/2016 $220.00
Occupancy Grp: A-3 Occupancy Load: 49 Permit Fee-Additions,Alterations, 02/09/2016 $1,090.89
Demolition
Dwelling Units: 0 12%State Surcharge-Building 02/09/2016 $130.91
Stories: 1 Height: 0 ft Plan Review 02/09/2016 $709.08
Bedrooms: 0 Bathrooms: 0 Plan Review-Fire Life Safety 02/09/2016 $436.36
Value: $98,000 Info Process/Archiving-Lg$2.00(over 02/09/2016 $16.00
11x17)
Info Process/Archiving-Sm$0.50(up to 02/09/2016 $2.50
Floor Areas: 11x17)
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $2,605.74
Required: Required Items and Reports(Conditions)
Fire Sprinkler: No 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 do=By:
oved 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. requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001- 090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.2 .1987 or 1.800.332.2344.
IssuePermittee Signature:
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 p ect.
Approved plans are required,on the job site at the time of each inspection.
13uilding Permit Application
Commercial RECEIVE! r
City of Tigard FRecei,v!y: Permit No.:
13125 SW Hall Blvd.,Tigard.OR 97223Plan ev Other Permit:
Phone: 503.718.2439 Fax: 503.5FTW 9 /"q, Dat.
Inspection Line: 503.639.4175 Date Rea y: Juris ® See Page 2 for
Internet: www.tigard-or.gov i . •�. 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 Valuation: $
g ®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: 10115 SW Nimbus Ave New dwelling area: square feet
City/State/ZIP:Tigard,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.:250 Project name:I LOVE KICK BOXING Covered porch area: square feet
Cross street/directions to job site:SW Scholls-Ferry 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.
ADA Restrooms,Break Room,floor covering,paint,ductwork,Ceiling work Valuation: S$98,000.00
Existing building area: square feet
New building area: Same square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories: 1
Name: Type of construction: V-B
Address: Occupancy groups:
City/State/ZIP: Existing: B
Phone:( ) Fax:( ) New: A-3
® APPLICANT ® CONTACT PERSON BUILDING PERMIT FEES*
Business name:Day Road Design Please refer to feeschedule _
Structural plan review fee(or deposit):
Contact name: Ron Kief
Address:9825 SW Day Road FLS plan review fee(if applicable):
City/State/ZIP:Sherwood,OR 97140 Total fees due upon application:
Phone:(503)320-0918 Fax::(503)972-1848 Amount received:
E-mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name:CPS Construction,Inc. Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address:9825 SW Day Road Solar Installation Specialty Code checklist.
City/State/ZIP:Sherwood,OR 97140 Permit fee(includes plan review $180.00
and administrative fees):
Phone:(503)320-0918 Fax:(503)972-1848 State surcharge(12%of permit fee): $21.60
CCB lic.: 102248 t�' Total fee due upon application: $201.60
Authorized signature: This permit application expires if a permit is not obtained
x within 180 days after it has been accepted as complete.
Print name:Ron Kief jfi� :02-04-16 * Fee methodology set by Tri-County Building Industry
Service Board.
[:\Building\Permits\BUP-COM PennitApp.doc 02/24/2011 440-4613T(I1/02/COM/WEB)
_ Building Division
Accessibility: Barrier Removal Improvement Plan
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] $ 98,000
MULTIPLIER(25%barrier removal requirement): x .25
TOTAL BUDGET FOR BARRIER REMOVAL: [2] $ 24,500
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 $
(b) An accessible entrance: $
(c) An accessible route to the altered area: $
(d) At least one accessible restroom for each sex or a single unisex
restroom: $ 24,500
(e) Accessible telephones: $
(f) Accessible drinking fountains:and, $
(g) When possible,additional accessible elements such as storage and
alarms: $
TOTAL(shall equal line [2] of Valuation Computation): $
I:\Building\Permits\BUP-COM PermitApp.doc 03/03/2011
7
_ Building Division
Plan Submittal Requirements
Commercial&Multi-Family-New,Additions or Alterations
1. SITE PLAN (fully dimensional,drawn to scale) labeled with:
A. ❑ map& tax lot# ® project name ® site address ❑ suite number
❑ zoning ® applicant name ❑ phone number
B. North arrow.
C. Scale (architectural or engineering only).
D. Street names.
E. Setbacks.
F. Parking,including disabled access.
G. Finished floor elevations.
2. EROSION CONTROL PLANS AND DETAILS.
3. BUILDING PLANS: See the"Plan Submittal Requirement Matrix" for the number of
plans required based on submittal type (no redlines or tape-ons accepted).
All details listed below shall be incorporated into the plans:
A. Scale (architectural or engineering only).
B. Foundation plan.
C. Floor plan(s).
D. Cross sections.
E. Reflective ceiling plan.
F. Seismic bracing detail for suspended ceiling.
G. Roof plan.
H. Exterior elevations.
I. Structural calculations,plans, details and specifications.
J. Accessibility barrier removal worksheet.
K. Deposit - based on valuation of project.
4. EXTRA SET OF THE FOLLOWING:
A. Two (2) copies of site plan to include vicinity map.
B. One (1) copy of erosion control plan with details.
C. Fire Department Building Survey, and full set of architecture drawings.
1:\Bui1ding\11emuts\BUP-00M PermitApp.doc 03/03/2011
Building Division
Plan Submittal Requirement Matrix
Commercial&Multi-Family- New,Additions or Alterations
Type of Submittal # of Plans
(Includes new, additions and alterations.) Required at
Submittal
Demolition Permit 2
(site plan required showing location and square
footage of all buildings to be demolished)
Site Work 3
(must include location of all accessible parking)
Plumbing (site utilities) 2
Building 3
Fire Protection System 3
Mechanical 2
Plumbing (building fixtures) 2
Electrical 2
Plan review is dependent upon submittal of a completed application and plans.
After plan review approval, the Plans Examiner will contact the applicant to request
additional sets of plans for distribution purposes (for contractor, City of Tigard,Washington
County, and Tualatin Valley Fire&Rescue),if applicable.
l:\Building\Permits\BUP-COM PermitApp.doc 03/03/2011
Debbie Adamski
From: Albert Shields
Sent: Wednesday, February 10, 2016 11:05 AM
To: Debbie Adamski
Subject: RE: I Love Kickboxing, 10115 SW Nimbus #200,
MMD2016-00007/BUP2016-00044
Restaurant would have a much higher TDT than kickboxing and Cleaners probably similar to kickboxing, therefore I
figure that there will be no TDT due on the Change of Use. Similarly for Parks, restaurant would have more employees,
so no Parks will be due.
Thanks, Albert.
From: Debbie Adamski
Sent: Wednesday, February 10, 2016 11:00 AM
To: Albert Shields
Subject: RE: I Love Kickboxing, 10115 SW Nimbus #200, MMD2016-00007/BUP2016-00044
Per the contractor, they are combining spaces that were previously restaurant and cleaners. Not sure the square
footages for each.
Debbie Adamski
Senior Building Permit Technician
City of Tigard I Community Development
13125 SW Hall Blvd.,Tigard, OR 97223
503-718-2450
From: Albert Shields
Sent: Wednesday, February 10, 2016 10:54 AM
To: Debbie Adamski
Subject: RE: I Love Kickboxing, 10115 SW Nimbus #200, MMD2016-00007/13UP2016-00044
Thanks, Debbie. What was the previous use of the space? Albert.
From: Debbie Adamski
Sent: Tuesday, February 09, 2016 3:57 PM
To: Albert Shields
Subject: I Love Kickboxing, 10115 SW Nimbus #200, MMD2016-00007/BUP2016-00044
Albert,
I did not realize that this project had a minor modification when I scheduled the OTC. We went ahead and did the
review but I will need to have you check to see if additional SDC's are due for this change of use prior to issuance. I have
the plans at my desk and I have attached a copy of the application. Let me know if we need add SDC fees to this
permit. ThanksW
Debbie Adamski
Senior Building Permit Technician
City of Tigard I Community Development
1
UPI
Building Division
Over-The-Counter (OTC) Building Permit
Check List
Project Description: �
APPLICATION SPECIFIC INFORMATION
GENERAL INFORMATION
Class of Work*: Occupancy GrType of Construction:
Type of Use**: Occupancy Oregon Specialty Cod
e:
SPECIFICS
Number of Stories: 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
Side and Setback—Left Side and Setback—Front
Side and Setback—Right Side and 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:
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: I T�� I
Total Project Valuation: $ 6tf FEES DUE
$ DC Prov Rvw,COM TI—Ping
$ Permit Fee—Add,Alt,Demo
DC Provision Review Fee for COM TI(effective 7/1/2015) $ 12%State Surcharge
Project Valuation $ —709,0; Plan Review,Structural
Up to$4,999 $0.00 $ Review,Fire Life Safety
$5,000-$74,999 $88.00 $ - Info Proc/Arch,Lg(over 11x17$2.00)
$75,000-$149,999 $220.00 $ Info Proc/Arch,Sm(up to 11x17$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:
$ Other:
Building Staff: $ Other:
Date/Time: $ L, TOTAL 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_070115.docx
mCity of Tigard
COMMUNITY DEVELOPMENT DEPARTMENT
Building Permit Review — Commercial - With Land Use
Building Permit #: 6-40
Site Address: to 1 IS -SW N imbun Ave Suite/Bldg#:
Project Name: 4 V e, Vi r k Box i
(Name of commercial business occupy' g the space. If vacant,enter Spec Space.)
Planning Review
Proposal: �.lC b�Jtt v� fnOcanefs anA
f'e
Verify site address/suite#exists and active in permit sstem.
"X River Terrace Neighborhood: El Yes No
E/Land Use Case#: MIAN014— OM077
WT9d Plans Match Approved Land Use:
Site Plan $Landscape Plan ❑ Other:
49- Urban Forestry Plan -D—Elevation Plan
F-::3—Building Height: Maximum Height Actual Height
—B—Conditions Met: ❑ Prior to Submittal ❑ Prior to Permit Issuance
Business License:
Exists: ❑ Yes ❑ No,applicant notified to obtain business license
'$—Public Facilities Improvement(PFI)Permit:
Required: ❑ Yes,applicant was notified XNo Applied For. ❑ Yes ❑ No,stop intake
Notes:
Approved by Planning: T Date: Z 9 '
I
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: Q
Site Plans: #
Building Plans: # J�
Building Permit#: ElEnter building permit#above.
Workflow Routing. 12—Planning E;—Enginreriog ator wilding
Workflow Sign-off E- Sign-off for Planning(include notes from planning review)
Route Application Documents: O'Building: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes:
By Permit Technician: Date:
I:\Building\Forms\B1dgPermitRvw_COM_W ith LandUse_070915.docx
Engineering Review
❑ Slope at building pad:
❑ PFI Permit#:
❑ Conditions "Met"prior to issuance of buildin en-nit
❑ Easements (encroachments)per engineering condi of approval and plat(not typical on SDR/CUP)
El Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: [3 es 13 No
Assess Water Quantity Fee in-lieu: Yes El No
LIDA Facility on lot: ❑ Yes ❑ No
❑ NOT Approved by Enginee ' Date
Notes:
Approved by Engineering: Date:
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
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:
rDC Fees Entered: Wash Co Trans Dev Tax: ❑ Yes )i4 N/A
Tigard Trans SDC: ❑ Yes N/A
Parks SDC: ❑ Yes �°N/A
OK to Issue Permit
Approved by Permit Coordinator: A60LZDate:
I:\Building\Forms\BldgPermitRvw_COM_WithLandUse_070915.docx