Permit INCITY OF TIGARD BUILDING PERMIT
COMMUNITY DEVELOPMENT Permit#: BUP2018-00016
-l-[GAR.D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/06/2018
Parcel: 1 S135BD00300
Site address: 9735 SW SHADY LN 201 Jurisdiction: Tigard
Project: Renew Sleep Solutions Subdivision: None
Project Description: TI for new tenant:Demolition and adding new walls. Lot: None
Contractor: ROBERT TODD CONSTRUCTION INC
Owner: TIGARD MEDICAL MALL LLC
4080 SE INTERNATIONAL WAY B113 PO BOX 98
MILWAUKIE, OR 97222 POULSBO, WA 98370
PHONE: 503-653-5704 PHONE:
FAX: 503-653-5729
Specifics:, FEES
Type of Use: COM Description Date Amount
DC Provision Review,COM TI-Ping 02/06/2018 $91.00
Class of Work: ALT Type of Const: IIIB
Permit Fee-Additions,Alterations, 02/06/2018 $619.25
Occupancy Grp: B Occupancy Load: 25
Dwelling Units: 0 Demolition
Stories: 3 12%State Surcharge-Building 02/06/2018 $74.31
Height: 0 ft Plan Review
Bedrooms: 0 Bathrooms: 0 02/06/2018 $402.51
Plan Review-Fire Life Safety 02/06/2018 $247.70
Value: $40,000
Info Process/Archiving-Lg$2.00(over 02/06/2018 $4.00
11x17)
Address Fee 02/06/2018 $50.00
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $1,488.77
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 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 Notifipation -nter. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. Yo. ••_ .'n a copy of the rules or direct questions to OUNC by calling 5, . r
I •8 o 1.800.332.2344.
Issued By: ��---L .c—
Permittee Signature: i
I II
C. •03..A.4175 by 7:00 a.m.for the next available inspection d.te.
This permit card shall be kept in a conspicuous place on the job site until completion of t e proj: t.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
CQnf�ercial FOR OFFICE USE ONLY
City Of Tigard ' - A e ., Received �+t�' Permit No.: / y f
VI I-1% �t I Date/By: I a 1'r/y/ Ut 0 Cr 4�
lig
e 13125 SW Hall Blvd.,Tigard,OR 97225, rF' .1 3 " Plan Review
Phone: 503.718.2439 Fax: 503.598.1966' '` Date/By: a- ' ' Other Permit:
TIGARD Inspection Line: 503.639.4175 Date Ready/By: tuns: ® See Page 2 for
Internet: www.tigard-or.gov FEB' s 2 i Notified/Method:e/ /'
I r / 7/ Supplemental Information
TYPE OF %Y / ( k J . REQUIRED DATA:1-AND I"AMI ,Y DWELLING
❑New construction ID'M Oji1 exin b',' , #'rri; Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
ddition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
-- ..�; ' . workindicated on this p application.
CATEGORY F CONSTRUCTION a pl'
. . . ,• Valuation: $
❑ 1-and 2-family dwelling ommeretal/industrial
—
❑Accessory building 111Multi-familyNumber of bedrooms:
❑ Master builder ❑Other: Number of bathrooms:
—
;;IOB SITE INFORMATION';AND LOCATION Total number of floors:
Job site address: -�C � G New dwelling area: - square feet
City/State/ZIP: Lf Garage/carport area: square feet
uite dg./apt.no.: t Project name: g ., -_Covered porch area: square feet
Cross street/directions to job site: - — Deck area: square feet
Other structure area: square feet
REQUIRED DATA:CO11MMERCIAL-JSE 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
y DESCRIPTION OF WORK -work indicated on this application. _ —_
, Valuation: $
te*--
Existing building area: square feet
titer 0--0 4 ' .i.: _ i .--41._ �- —
---------
New building area: square feet
1'I*O'ERTI WNER �- 6.7 1ANT Number of stories: _ _ ___
Name: _ _ iLV/12 ��— 4__ Type YPe of construction: —
Address: 1 "'.Arthet•Ide.- l l Occupancy groups: ___—
City/Staff% �� 3j-7
��� ��^ � Existing:
�-� -,moi- _ 91 -
-- ---- -- —
Phone: i Fax:( 22- .,I New:
iPkLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
Structural plan review' (flea.serefer 10 ee-sckedWWl ,,. -
�yj"
Business name: ' 1 - -"•� ? p
- fee(or deposit):
Contact name:
--- — FLS plan review fee(if applicable):
Address: PO• ''� �
------------------ Total fees due upon application:
City/State/ZIP: c 9`7� _—�_— —_ -
' -t`-- Amount received:
Phone:(Sl 2..-7_,.t, Fax: :( )
PHOTOVOLTAIC SOLAR PANEI.SSfSTEM FEES*
E-mail: d AO I i' I ‘ ,4 . ('.L".tivt,
Commercial and residential prescriptive installation of
CoNTRAC'TOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name: , c j 1 r ect i! :2 _ Submit two(2)sets of roof plan with connection details
- and fire department access,along with the 2010 Oregon
Address: '" ,e7;31f2- � a� � \14 .4 '_ Solar Installation Ssecialt Code checklist.
Cit /State/ZIP: e-\--7z, .:2. �__('?J Permit fee(includes plan review $180.00
Y v� — and administrative fees):
Phone:( a) 6,5.3-�'`-y Fax:(. ) (jj - 7,*?-`] _ State surcharge(12%of permit fee): $21.60
CCB lie.: 117 -----
,.4------,_ —_ Total fee due upon application: $201.60- This permit application expires if a permit is not obtained
Authorized signature: `' r
within 180 days after it has been accepted as complete.
Print name: \ I ! /4"-NDate: r3. ti * Fee methodology set by Tri-County Building Industry
Ot l 401_ _ Service Board.
l:ABuilding\Permits\BUP-COM PermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Building Division
Accessibility: Barrier Removal Improvement Plan
T I GARD
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] $ ,gtrx.
MULTIPLIER(25%barrier removal requirement): x .25
TOTAL BUDGET FOR BARRIER REMOVAL: [2] $ (0(Cen
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)✓A accessibl
jojte to the altered area: 16X' AP,4 , $
(d),7At least one accessible restroo or each sex or a sing e unisex
restroom: $
(e)vAccessible telephones: $
(f),G-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
City of Tigard • BUILDING DIVISION
Over-The-Counter (OTC) Building & Fire Protection System Pe
Appointment Checklist Y rmit
Permit Record#: h', • ,..
N ' 'Contact Name: ,t;� �
Phone #: 3-,;...9- '20_3'20_3-as�-
Business Name: p c ccf119�? __c z e, Appt• Date/Time: 44/'
�y Site Address: 35' SLc/ Bldg/Suite #: „,2c,fProject Name: �� `S1 c
i-twotjs' New Tenant? l'EP Yes 0 No
Project Description: /4/7z72/02. .,, ,,s7`7D
Existing Use: Af fP �. ��,E----
MMD Required: 0 Yes New Use: 047 -25/ ,c" e.g-
_._.__..____________
No Related Record #:
APPLICATION SPECIFIC INFORMATION
GENERAL INFORMATION
Class of Work: ►�� Occu.anc Grou.:
Tie of Use: TA.e of Construction: fliQg�
SPECIFICS 11111 Occu.an Load: � �, Ore on S.ecial Code:
Number of Stories: Ore:
�I•'
Number of Dw Units: �' Buildin. Hei:ht: -
- Mixed Use:
BUILDING SQ FT-SCHOOL Number of Bathrooms: —, Number of Bedrooms:OTHER SQUARE FOOTAGES
Sto S.uare Foota•e:
Access() Structure: _
Basement: Covered Porch:
Total S.uare Foota.e: IEEMIIIIIIIIIIIIIIIezz:
SETBACKS C °rt: MMezzanine: —
Side and Setback–Left Side arc!Setback–Front
Side and Setback– :ht , Side and Setback–Back =,—�-�_
CONSTRUCTION _
Exterior Walls: 0.enin• Protected:
S: N: Firewall Se.aration:
N: W: E: S: Occu.an Se•aration:
REQUIRED ITEMS W` Access.Parkin• S•aces:
Fire S.rinklers: r 7 Fire Alarms: .
S•rinkler TA.e: Smoke Detectors:
Stand.i.e Re.uired: �� Protected Corridors:
Hazard Grou•: Pull Stations Re.uired: liMallillilin
—
Densi : Batte Calcs Provided: --
Cut Sheets Provided: IIIIIIIIII
Desi: Area:
K Factor:
Total Project Valuation: $_=� t _ t
4o, o o o $ • • . DC Prov Rvw,COM TI–Ping
DC Provision Review Fee for COM TI(effective 7/1/2017) $ 'E Mr Permit Fee–Add,Alt,Demo
Project Valuation 7 �� 12%State Surcharge
$0.00 $4 0c • 4 Plan Review,Structural
Up to - 99 999 $$0 00 $ Plan Review,Fire Life Safety
$5, 000- 74,$149,999 $226.001 $ Info Proc/Arch,Lg(over 11x17$2.00)
$150,000,0and r $361.00 Info Proc/Arch,Sm(up to 11x17$0.50)
$ Metro Construction Excise Tax
$ School Construction Excise Tax
$ Hourly Rate Fee
11-------- Hourly Rate State Surcharge
T----- Misc.Admin Fee
Building Staff $ Other:
$ Other:
Date/Time:
..1U___4:31:22. TOTAL FEES DUE
I:\Building\Forms\OTC_BUP_FPS_070117.docx •- /- -
94
t 1 rfr,'an
Frontl DSTS
Subject: Dan Young, Oregon Business Arch - 503-708-2555, 9735 SW Shady Ln, Suite 201 -
Renew Sleep Solutions
Location: CR_-_3_Permit_Center
Start: Tue 2/6/2018 10:00 AM
End: Tue 2/6/2018 11:00 AM
Recurrence: Weekly
Recurrence Pattern: every Tuesday, Wednesday, and Thursday from 10:00 AM to 11:00 AM
Organizer: -Building_OTC
Call Handling Mode 2: 2
New Tenant= Renew Sleep Solutions
Project valuation=$30,000
Scope of work=interior demolition of walls, add new walls and finishes
Existing use= medical office
New use= medical office
1
1114 City of Tigard
■ r COMMUNITY DEVELOPMENT DEPARTMENT
T 1 cA RD Building Permit Review — Commercial - No Land Use
Building Permit #: j r cr—
Site Address: 173 Sw �,1 �n
y Suite/Bldg#: Z01
Project Name: S t
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
P P )
Planning Review
Proposal:
Existing Business Activity: 6J.,( OF-F4
Proposed Business Activity: l'IA;.LZ.ii a m',L
Verify site address/suite#exists and active iner
p trot s�ys�t
reg diver Terrace Neighborhood: CI Yes Lei No
E oning: C
IV/Permitted Use: l] Yes ❑ No
CI Spec Space
IV Confirm no land use required.
[0/Business License:
Exists: ❑ Yes V17-No,applicant notified to obtain business license
Notes: KN c,L sot oti plaA
Approved by Planning: 1.44.,,,,,At /
Date: 2-6-1
Revisions (after Building Submittal only)
Revision 1: ❑ A Reviewer Date
pproved ❑ Not Approved
Revision 2: ❑ Approved El Not Approved
Revision 3: ❑ Approved El Not Approved
Building Permit Submittal
Original Submittal Date: a/a, t(�
Site Plans: # Ni 0
Building Plans: # 3
Building Permit#: ®�rater building permit#above.
Workflow Routing: , ❑ Permit Coordinator
Planning e' wilding
Workflow Sign-off: off for Planning(include notes from planning review)
Route Application Documents: ding. original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes: )7.--e--
By Permit Technician:
-3-` Date: -76/ii
`2.
1:\Building\Forms\B1dgPermitRvw COM_NoLandUse_060116.docx
Permit Coordinator Review
El Conditions "Met"prior to issuance of building permit
Date:
IDApproved,NOT Released:
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: El Yes ❑ N/A
❑ OK to Issue Permit
Date:
Approved by Permit Coordinator:
I:\Building\Forms\B1dgPermitRvw_COM_NoLandUse_070915.docx
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
9735 SW SHADY LN 201 , TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Building BUP2018-00016
Inspection Type: Inspector:
299 Final inspection Jeff Grove
Result:
PASS - CofO
Comments:
Violation Summary:
Inspector Contractor