Permit Support Document 111111 - CITY OF TIGARD BUILDING PERMIT
COMMUNITY DEVELOPMENT Permit#: BUP2018-00139
13125 SW Hall Blvd.,Ti and OR 97223 503.718.2439 Date Issued: 05/02/2018
TtCa7�E4.L 9
Parcel: 2S113AB00500
Jurisdiction: Tigard
Site address: 16083 SW UPPER BOONES FERRY RD
Project: Bridgeport Family Medicine Subdivision: FANNO CREEK ACRE TRACTS Lot: PT 37
Project Description: TI for new tenant:Demolition and office reconfiguration for outpatient clinic and bathroom improvements.
Contractor: BARTEL CONTRACTING INC Owner: G&S FC LLC
PO BOX 160 16083 SW UPPER BOONES FERRY RD,
GLADSTONE, OR 97027 STE
TIGARD, OR 97224
PHONE: 503-650-4084 PHONE:
FAX: 503-650-4104
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: IIB DC Provision Review,COM TI-Ping 05/02/2018 $226.00
Occupancy Grp: B Occupancy Load: 160 Permit Fee-Additions,Alterations, 05/02/2018 $1,256.95
Demolition
Dwelling Units: 0 12%State Surcharge-Building 05/02/2018 $150.83
Stories: 5160 Height: 0 ft Plan Review 05/02/2018 $817.02
Bedrooms: 0 Bathrooms: 0 Plan Review-Fire Life Safety 05/02/2018 $502.78
Value: $125,000 Metro Const.Excise Tax 05/02/2018 $150.00
Info Process/Archiving-Lg$2.00(over 05/02/2018 $22.00
11x17)
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $3,125.58
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 copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: �gnature: ! —.maw _-
��—rte —
C39.4175 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 oft project.
Approved plans are required on the job site at the time of each inspection.
Building Permit Application
Commercial FOR OFFICE USE()NEI
City of Tigard ReceivedDate/B : 1, lAli Permit No.:e.A ; ,. 1
II . 13125 SW Hall Blvd.,Tigard,OR 97223 MAY 2 201;Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/Be: ^• �; Other Permit:
TI G A R D Inspection Line: 503.639.4175 -tiirk yr�q1,Yy,IG Rady/By: See Page 2 for
Internet: www.tigard-or.gov ; A 1 V j ed/Method:, f , J. FrIM Supplemental Information
LIQ*,
..xx `OF RK' . RE+ .I ' DA F (t
❑New construction ❑Demolition Permit fees*are basedl.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
rlAter: AT) + ,`� i F COiST 174..i7ON etiwork indicated on this application.
0 1-and 2-family dwelling ®Commercial/industrial Valuation: $
0 Accessory building ❑Multi-family Number of bedrooms:
❑Master builder 0Other: Number of bathrooms:
t. OB i'i'F,- ; 'RMA1 LOCA v+ Total number of floors:
Job site address: 16083 SW Upper Boones Ferry RD. New dwelling area: square feet
City/State/ZIP: Tigard, Oregon 97224 Garage/carport area: square feet
Suite/bldg./apt.no.:Suite 130 I Project name: Bridgeport Family Medicine T.I. Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
SW Upper Boones Ferry Rd & SW 72nd Ave. Other structure area: square feet
e A s,•..,''i w kg.,-US ` 1 }®
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
i P C ON ' i �' work indicated on this application.
Interior tenant improvement with a minor exterior modifications: Valuation: $125,000.00
partial demo of interior walls and add new offices, exam rooms and Existing building area: 49,963 square feet
central nurse station. Add 2 ADA restroom within suite. New building area: 49,963 square feet
17,. PRO R C ; , : , 3
x P O ,� Number of stories:
Name: Parkland Development, LLC (Su Moran) Type of construction: I I-B
Address: 16083 SW Upper Boones Ferry RD., Suite 130 Occupancy groups:
City/State/ZIP: Tigard, Oregon 97224 Existing: B
Phone:(503)639-0108 Fax:(47 )61,er _r /
New: B
, dNT ' NI : B 1 t e i ES*
LRS Architects
Structural Business name: „AZ),
'��
Structural plan review fee(or deposit):
Contact name: Peter Kim
FLS plan review fee(if applicable):
Address: 720 NW Davis, Suite 300
Total fees due upon application:
City/State/ZIP: Portland, Oregon 97209
Amount received
Phone:(503)221-1121 Fax::573 ),..�( . 2477 i y s
E-mail: PKim@Irsarchitects.com
P) € OVOL �EOtAR1 1 a l"EES*`,"
Commercial and residential prescriptive installation of
tsiness'njaM:'
a ® ' . t roof-top mounted PhotoVoltaic Solar Panel System.
e: Built Environments Northwest Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: 135 E Hereford St Solar Installation Specialty Code checklist.
City/State/ZIP: Gladstone, Oregon 97027 Permit fee(includes plan review $180.00
and administrative fees):
Phone:(503)650-44086 Fax:(503)650-4104 State surcharge(12%of permit fee): $21.60
CCB lic.: 79970 Total fee due upon application: $201.60
Authorized signaierr This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:Peter Kim Date: 05.02.2018 * Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\BUP-COM PermitApp.doc 02/24/2011 440-46131(11/02/COM/WEB)
1111Building Division
Accessibility: Barrier Removal Improvement Plan
TIGARD
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] $ 125,000.00
MULTIPLIER(25%barrier removal requirement): x .25
TOTAL BUDGET FOR BARRIER REMOVAL: [2] $ 31,250.00
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: $
(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): $
The building is fully accessible.
No further ADA upgrade is required.
I:\Building\Permits\BUP-COM PermitApp.doc 03/03/2011
g
City of Tigard • BUILDING DIVISION
III ' 4 Over-The-Counter (OTC) Building & Fire Protection System Permit
T 1(,A It r) Appointment Checklist
Permit Record#: b/ it- X)i 31
Contact Name: - r j, , Phone#: 17 1- f)74
Business Name: L Lt ZA, Appt. Date/Time: 0,2//y
Site Address: /6,0I3 me6y �t ,,,y Ae Bldg/Suite#: 13i)
Project Name: ,Bn� �y- q' t- ` ly A tir-1^-c_ New Tenant? A Yes 0 No
Project Description: )/i'fi?yv e er rQ_ „ �t.t74,,,- p1—u-ilv,'�
G4.401t. v,zi.i.n i - 7/021 f74ucv
ur J1- 'y
rnot,, .z, * 71 kA -
Existing Use: ` New Use: „a
MMD Required: 0 Yes 0 No Related Record#:
PLI TI .SPECIFIC INFORMATION
GENERAL INFORMATION
Class of Work: A)T Occupancy Group: Type of Construction: j)–
'r"
Type of Use: D Occupancy Load: I rt p Oregon Specialty Code: 2d 3
SPECIFICS
Number of Stories: ,,S-) 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: Ve`iFire 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:
Total Project Valuation: $ I akc O O 0 I 1EES DUE
$ aa.6 DC Prov Rvw,COM TI–Ping
$ 1 a,cg. 9s Permit Fee–Add,Alt,Demo
DC Provision Review Fee for COM TI(effective 7/1/2017) $ • , ! 12%State Surcharge
Project Valuation $ ! .. . Plan Review,Structural
Up to$4,999 $0.00 $ a_ , ; Plan Review,Fire Life Safety
$5,000-$74,999 $91.00 $ ,ia— Info Proc/Arch,Lg(over 11x17$2.00)
$75,000-$149,999 $226.00 $ Info Proc/Arch,Sm(up to 11x17$0.50)
$150,000 and over $361.00 $ I S p Metro Construction Excise Tax
$ School Construction Excise Tax
$ Hourly Rate Fee
$ Hourly Rate State Surcharge
$ Misc.Admin Fee
$ Other:
Building Staff: $ i Other:
Date/Time: 31 as . CeI'OT FEES DUE
I:\Building\Forms\OTC_BUP_FPS_070117.docx
■ City of Tigard
a COMMUNITY DEVELOPMENT DEPARTMENT
T1cARD Building Permit Review — Commercial - With Land Use
Building Permit #: f'3APac r-c'D i 39'
Site Address: 16083 S' U fr' Qod,e, F«7 Z4 Suite/Bldg#: I)'O
Project Name: Qr411,0y,.}- F-4,.117 hid«;^G
(Name of commercial business occupying the space. If vacant,enter Spec Space.)
Planning Review r^��
Proposal: 7ktr( Veer ' , - ?\ ,. �vt t i 4- claw : Ot.-,4(�k% j 64_ ritAv ural-roi a4 LA atih
{"`fri h � aUtr4iiy, ctr4ic.
LSV rift' •site address/suite# exists and active in permit systteemy
l 'Liver Terrace Neighborhood: ❑ Yes (d No
[ ,and Use Case#: h hp Loy-00DNI
L,d'Plaans/Match Approved Land Use:
Di Site Plan Vi, Landscape Plan ❑ Other:
+
CI Urban Forestry Plan ❑ Elevation Plan
W Building Height: Maximum Height Actual Height V) CLtut't
Conditions Met: ❑ Prior to Submittal ❑ Prior to Permit Issuance
Ly' Business Liceens�.
Exists: Ll' Yes ❑ No,applicant notified to obtain business license
Ly' Public Facilities Improvement(PFI) Permit:
Required: ❑ Yes,applicant was notified L9No Applied For: ❑ Yes ❑ No,stop intake
Notes:
Approved by Planning: )il `"TAIL Date: S Z-IJ
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: 's', / ,
Site Plans: # N 4
Building Plans: #
Building Permit#: nter building permit#above. ,,__,��--
Workflow Routing: ,_ ning ❑ Engineering ❑ Permit Coordinator L`i'"tiullding
Workflow Sign-off: L�7,.� �St °ff for Planning(include notes from planning review)
Route Application Documents: LJ�Building: original permit application,site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes: 65'f
4111111 ,
By Permit Technician: s .---- ---......„.z, Date:
I:\Building\Fonns\BldgPermitRvwCOM WithLandUse 060116.docx
Engineering Review
❑ Slope at building pad:
❑ PFI Permit#:
❑ Conditions "Met"prior to issuance of building permit
❑ Easements (encroachments)per engineering conditions of approval and plat (not typical on SDR/CUP)
❑ Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes ❑ No
Assess Water Quantity Fee in-lieu: ❑ Yes ❑ No
LIDA Facility on lot: E Yes ❑ No
❑ NOT Approved by Engineering: 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:
❑ 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\B1dgPennitRvw_COM_WithLandUse 070915.docx
CITY OF TIGARD BUILDING PERMIT
COMMUNITY DEVELOPMENT f ' Permit#: BUP2018 00139
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 FON r 4:7) Date Issued: 05/02/2018
T t g=''"jt O g Parcel: 2S113AB00500
Jurisdiction: Tigard
Site address: 16083 SW UPPER BOONES FERRY RD 130
Project: Bridgeport Family Medicine Subdivision: FANNO CREEK ACRE TRACTS Lot: PT 37
Project Description: TI for new tenant:Demolition and office reconfiguration for outpatient clinic and bathroom improvements.
Contractor: BARTEL CONTRACTING INC Owner: G&S FC LLC
PO BOX 160 16083 SW UPPER BOONES FERRY RD,
GLADSTONE, OR 97027 STE
TIGARD, OR 97224
PHONE: 503-650-4084 PHONE:
FAX: 503-650-4104
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: ALT Type of Const: IIB DC Provision Review,COM TI-Ping 05/02/2018 $226.00
Occupancy Grp: B Occupancy Load: 160 Permit Fee-Additions,Alterations, 05/02/2018 $1,256.95
Demolition
Dwelling Units: 0 12%State Surcharge-Building 05/02/2018 $150.83
Stories: 5160 Height: 0 ft Plan Review 05/02/2018 $817.02
Bedrooms: 0 Bathrooms: 0 Plan Review-Fire Life Safety 05/02/2018 $502.78
Value: $125,000 Metro Const.Excise Tax 05/02/2018 $150.00
Info Process/Archiving-Lg$2.00(over 05/02/2018 $22.00
11x17)
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $3,125.58
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 copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344,
,1111,
Issued By: Permittee Signature: a-711—i42
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 project.
Approved plans are required on the job site at the time of each Inspection.
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
16083 SW UPPER BOONES FERRY RD 130,
TIGARD, OR, 97224
Record Type: Record ID:
Commercial - Building BUP2018-00139
Inspection Type: Inspector:
299 Final inspection Jeff Grove
Result:
PASS - CofO
Comments:
Violation Summary:
Inspector Contractor