Permit i
.._._ .
...,.,",
,� BUILDING PERMIT
CITY OF TIGARD
P ERMIT #: BUP2003 -00207
�� DEVELOPMENT SERVICES DATE ISSUED: 4/28/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S116AD 17400
SITE ADDRESS: 16920 SW 129TH AVE
SUBDIVISION: KING CITY NO. 18 ZONING:
BLOCK: 19 LOT: 032 JURISDICTION: KIN
REISSUE: DO' FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: ,At- FIRST: sf N: S: E: W:
TYPE OF USE: MF SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: : sf N: S: E: W:
OCCUPANCY GRP: R1 TOTAL AREA: 0 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: BASEMENT: sf AREA SEP. RATED:
STOR: HT: ft GARAGE: sf OCCU SEP. RATED:
BSMT ?: MEZZ ?: REQD SETBACKS - REQUIRED
FLOOR LOAD: psf LEFT: ft RGHT: ft FIR SPKL: SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 47,096.00
Remarks: Reroof entire building. Tear off and replace.
Owner: Contractor:
GILMORE, BEVERLY C BOB CARLSON INC
16920 SW 129TH AVE PO BOX 63
KING CITY, OR 97224 HILLSBORO, OR 97123
Phone:
Phone: 640 -3623
Reg #: LIC 511 0o0 3 11 9g33
FEES MET REQUQRED6INSPECTIONS
Description Date Amount Dryrot after tear - off
[BUILD] Permit Fee 4/28/03 $125.00 Final Inspection
[TAX] 8% State Tax 4/28/03 $10.00
Total $135.00
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 than 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 -0100. You may obtain a copy of these rules or direct questions to OUNC by
calling (503) 246 -6699 or 1- 800 - 332 -2344.
By: (I
Issued B _�/
I��,����,i _ ■ � �
Penn ittee ! j %/�
Signature: *V i C�=i'`�
Call 639 -4175 by 7 p.m. for an inspection the next business day
, _ ( 9 -.90E KC
Building Permit Application . FOR OFFICE USE ONLY
S Received Building
Date/By: xl 23t -03 Permit No c Q3 — 00,4.Y7_
City f Tigard Planning Approval Other
y g an Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date /By: Permit No.:
;
Phone: 503- 639 -4171 Fax: 503 - 598 -1960 �a,,�M� Post Review Land Use
Date/By: Case No.
Internet: www.ci.tigard.or.us s. °' Contact Juris.:
See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name /Method: Supplemental Information
•
'A'. �„# ^>..., _ - , : ��.x'H ; :�.x: �Y ;may +:'� °:':�.. 'wt "::, ..c;?*::`w°w:. ."' :
�sc`. g ''::e' a ,
;.: , ; _ .t r , -' a r.. , TYPA.;OF ,QRK ' 4 " :.' t . 1 f _ ,; t � � r , i
-� - ';��`��a ,. M -. _„ � �� � � ��� � REQUIRED DATA � � �,
❑ New construction
In Demolition ' -, 1 & y 2 AMILY DWE MF V
Addition/alteration/replacement ❑ Other:
aCC ISTCATEGORY= 'QF<CONST?RU,CT,IQN a i`a tili__ ` Note: Permit fees are based on the total value of the work performed. Indicate
\ TO 1 & 2- Family dwelling ❑ Commercial/Industrial the value (rounded to the nearest dollar) of all equipment, materials, labor,
overhead and profit for the work indicated on this application.
t ❑ Accessory Building ❑ Multi- Family
❑ r Builder El Other: Valuation $ '17, Master
v '
Tin- Tin taltAISTMINFTI OMaad LOCATION " ; �t : No of bedrooms: No. of baths:
� � , d� Total number of floors
Job site address: (G4a0 New dwelling area (sq. ft.)
Suite #: Bld_. /Apt. #: 3' 1 Garage /carport area (sq. ft.)
Project Name:Go V,'I fc r.
' , ea, - I Covered porch area (sq. ft.)
Cross street/Directions to job site: Deck area (sq. ft.)
Other structure area (sq. ft.)
� . , � ` 4.11-4. REQUIRED DATA V
" , C v b'
USE CAACKLIST�
Subdivision: Lot #: 3s � _.. z �_ _ ., - _ M . ... =� ., l_ r v
Tax map /parcel #: Note: Permit fees* are based on the total value of the work performed. Indicate
r. =,4 =;kn. °`: "'�x DES »RI'P FWORK ^, r_, _.'�F ".�''i_' -A<:" , :� the value (rounded to the nearest dollar) of all equipment, materials, labor,
fi. <;;. a:.
- TeQY 0 ek 5 r - n 1l riot,/ Ye 4 overhead and profit for the work indicated on this application.
CIO � f ` r , , /44 �> Valuation $ L i 7 OICe
d ' 1 � Existing building area (sq. ft.)
New building area (sq. ft.)
Number of stories
' i E AMIMPWIWi080, ER*.* 4M EN`ANT t MM t 1 Type of construction
Name: ;,, C� Go., vi f -viE¢ l C;q Occupancy group(s): Existing:
New:
Address:
City /State /Zip: 1= Ir G4:i.., , OR R ?ac.
Phone:{: NOTICE: All contractors and subcontractors are required to be
a
„_,_ „ „ , j licensed with the Oregon Construction Contractors Board under
APPLICANTM "t.:.�'.;;,
_i44 EON TNOTIP7 1:800:::; ,''' g provisions of ORS 701 and may be required to be licensed in the
Business Name: Bm6 CA4 -- _. T j^C jurisdiction where work is being performed. If the applicant is exempt
Contact Name: a- CA, Isc^ from licensing, the following reason applies:
Address: 5 G SW lhp(e. I Pre)_ 63 ,
City /State /Zip: (;Its Os ?7 — &oC 3 .
Phone: 503 C/to- 3Coa3 Fax: 503 GLia-k8i10 xw 4 s4 z r _ m Y i 4
f r BUILD FEES' x � �” t+
E -mail: ' ,
, c i 5 , �
! dt"'� �” � Plea refe to fee schedule: � '�` � �°r � ` �`
��`�� "�.'� � �C�®NTRACTOR.�,��g �`�F:��E..� .=x >� AN
Business Name: 86 "X' , Fees due upon application $
Address: 5 S c ' i (,(_ / P• Ch, 8 6,3
971a3—00� Amount received $
City/State/Zip: M;I(,Gpro , 3
. Phone: 603 cm- 3 Fax: $03 640 elel Date received:
CCB Lic. #: 113
Authorized I Notice: This permit application expires if a permit is not obtained within
Signature: i Date: �1oZ�f1V 180 days after it has been accepted as complete.
6 1'z - Q M. £ .- &C'. --, *Fee methodology set by Tri -County Building Industry Service Board.
J (Please print name)
is \Dsts\Permit Forms \BldgPermitApp.doc 01/03
.
One- and Two - Family Dwelling
Building Permit Application Checklist Reference no.:
Associated permits:
City of Tigard City of Tigard 0 Electrical 0 Plumbing 0 Mechanical
Address: 13125 SW Hall Blvd, Tigard, OR 97223 Cl Other:
Phone: (503) 639 -4171
Fax: (503) 598 -1960
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A
1 Land use actions completed. See jurisdiction criteria for concurrent reviews.
2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc.
3 Verification of approved plat/lot.
4 Elie district apt.. ux s- q:+.r d.
5 Septic system permit or authorization for remodel. Existing system capacity •
6 Sewer permit.
7 Water district approval.
8 Soils report. Must carry original applicable stamp and signature on file or with application.
9 Erosion control 0 plan 0 permit required. Include drainage -way protection, silt fence design and location of
catch -basin protection, etc.
10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state
building codes. Lateral design details and connections must be incorporated into the plans or on a separate full -size
sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed
if copyright violations exist.
11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if
there is more than a 4 -ft. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements and
driveway; footprint of structure (including decks); location of wells/septic systems; utility locations; direction indicator; lot
area; building coverage area; percentage of coverage; impervious area; existing structures on site; and surface drainage.
12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent
size and location.
13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater,
•
furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc.
14 Cross section(s) and details. Show all framing - member sizes and spacing such as floor beams, headers, joists, sub -floor,
wall construction, roof construction. More than one cross section may be required to clearly portray construction. Show
details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings and foundation, stairs,
fireplace construction, thermal insulation, etc.
15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels.
Exterior elevations must reflect the actual ,grade if the change in grade is greater than four foot at building envelope.
Full -size sheet addendums showing foundation elevations with cross references are acceptable.
16 Wall bracing (prescriptive path) and /or lateral analysis plans. Must indicate details and locations; for
non - prescriptive path analysis provide specifications and calculations to engineering standards.
17 Floor /roof framing. Provide plans for all floors /roof assemblies, indicating member sizing, spacing, and bearing
locations. Show attic ventilation. -
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered
systems, see item 22, "Engineer's calculations."
19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists
over 10 feet long and/or any beam/joist carrying a non - uniform load.
20 Manufactured floor /roof truss design details.
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas - piping schematic is required
for four or more appliances.
22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or
architect licensed in Oregon and shall be shown to be applicable to the project under review.
• JURISDICTIONAL SPECIFICS
•
23 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ".
24 Two (2) sets each are required for Items 16, 19, 20 & 22 above.
25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will be not accepted.
26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document.
27 "Drawn to scale" indicates standard architect or engineer scale.
28 Site plan to include tree size, type & location per approved project street tree plan (if applicable), and COT Street Tree List.
Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black ink.
Red ink is reserved for department use only. 440 -4614 (6 /00 /COM)
04/28/2003 08:21 5036393771 CITY OF KING CITY PAGE 02/02
. KING CITE
15300 S.W. 116th Avenue, King City, Oregon 9724.2693
- Phone: (503) 639-4082 • FAX (502) 639 -3771
Notice To Contractors Working In ;King City
Due to an intergovernmental agreement with the City Of Tigard, many bu, gilding related permits
for projects in King City are issued and inspected by the City of Tigard.
If your permit application DOES NOT REQUIRE PLAN REVIEW, sin;tply complete the
appropriate application legibly and submit it to the King City staff The King City staff will
collect all fees and fax the application to the City of Tigard. City of Tigar ;l staff will then create
the permit, issue the permit, and perform inspections. Please indicate on the permit application
whether you would like the Tigard staff to call you when the permit is real v for issuance or
whether you prefer it to be mailed without any notification. Any incompl or illegible
application will be returned to King City staff for correction and no proces:i ;ing will occur until a
complete, legible application is received.
If your permit application DOES REQUIRE PLAN REVIEW, this form must be signed by a
King City staff person. King City staff will simply sign this form indicatin 13 land use approval.
Take this signed form to the City of Tigard Development Services Counter located at 13125 SW
Hall Blvd, Tigard, to submit applications and plans. Development Service Technicians are
available at 639 -4171 Ext. 304 should you have any questions concerning s abmittaI
requirements. All permit fees will be assessed and collected at the City of Tigard.
The City of King City hereby authorizes applicant to pursue permits at the City of Tigard
Building Department for the following project: � L:
Ors 6/4
•
located at: ±/ 0 U
I I
< i. .,
Awl, GYJ 4
King City Representative r,
f DSTS.f:cl\si aoc
CITY OF TIGARD . 24 -Hour
BUILDING �, Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST ,
Received 174 /7 e Date Requested s AM PM BUP
Location r %` -- 6 /4 a Suite MEC
Contact Person PRA7 Ph ( ) q7 53 45/? PLM
Contractor Ph ( ) SWR
UILDI Tenant/Owner ELC
Footing
ELC
Foundation
Access:
Ftg Drain e[ L,� `7 ELR
Crawl Drain
Slab Inspection Notes: ' � SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Ceiling
00
Other: "" U Air
- v
• S - PART FAIL
7" MBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post& Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
-
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line i
c� (> I
Approach/Sidewalk Date 5 j � ! 7 3 Inspector 7
ADA Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL