Permit ~ 0' 4e. CI +$ �� F TIGARD BUILDING PERMIT
CITY O PERMIT #: BUP2003 -00208
:4 , DEVELOPMENT SERVICES DATE ISSUED: 4/28/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S116AD - 16900
SITE ADDRESS: 16810 SW 129TH AVE
SUBDIVISION: KING CITY NO. 18 ZONING:
BLOCK: 19 LOT: 027 JURISDICTION: KIN
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: _ALIT CO' 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:
OWENS, WILLIAM V + CAROLYN K BOB CARLSON INC
16810 SW 129TH AVE PO BOX 63
KING CITY, OR 97224 HILLSBORO, OR 97123
Phone:
Phone: 640 - 3623
Reg #: LIC 5113 11 9g33
FEES M ET 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.
•
Issued By: / �� f ,,, ,
Permittee 4.
Signature: V Id - 14,4
Call 639 -4175 by 7 p.m. for an inspection the next business day
ti . FOR OFFICE USE ONLY
"Blinding Permit Application Received Building
Date/By: ,QS'-O Permit No.: � - c.' i(
• Planning Approval Other
City Of Tigard 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 °X ilellifr Post - Review Land Use
Date/By:
Case No.
Internet: www.ci.tigard.or.us �ti^-^ �'' Contact Juris.: Z See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name /Method: Supplemental Information
try 4' `�s?: � �,...
RK..
�''.?e: .., w?: "� v'= _ ., ....a. ... Z°Y. ... .- ,il.a .- ..'v^:- � » ?}, ` �� •?,3�j'F,� "a €UI R.,n :.t � �.t � �'» y . e
}t `? > ,
El New construction ❑ Demolition , ,, €I & 2 A DWEL ' z' x
.s. ��g:t �.r:
KAddition /alteration/replacement ❑ Other: {{F
: t ' t : ' r -j r.�:,.# ; :. . C K�; , '' Note: Permit fees* are based on the total value of the work performed. Indicate
, AT�EGORY, OF GONSTRUGTION ` �
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.
❑ Accessory Building ❑ Multi- Family
❑ Master Builder ❑ Other: Valuation $
? a it-4, %4JOJ SITE INFORMATION''and' LOCH =TION :: y .s :,. s. No of bedrooms: No of baths:
Job site address: I C.PM SW i.°14'-' Total number of floors
New dwelling area (sq. ft.)
Suite #: Bld /Apt. #: 33 � . Garage /carport area (sq: ft.)
Project Name:�j V ,II� R app.1671 4- - f ►x+2 Covered porch area (sq. ft.)
Cross street/Directions to job site: Deck area (sq. ft.) •
Other structure area (sq. ft.)
z.�: , Wi �3�zrxz« kik ?e. „, :a:w ^,, 0 �e, • ",4
4- COMME CI a` JSE CHECKLIST x N
Subdivision: Lot #:
Tax map /parcel #: Note: Permit fees* are based on the total value of the work performed. Indicate
W , x , f ._ ,, DE �._RIPTION �._.._.__.. _.,. F WORK __.._.... , „ . -
v,.. ; ..,,�, A;R - Z_ 1. the value (rounded to the nearest dollar) of all equipment, materials, labor,
�
�' � �f r �b k overhead and profit for the work indicated on this application.
7e-Ole" e.k,s _
Ct 0l 30 1 - m i et kAce 65 Valuation $ y ? �Cp
4 �4T "`T Existing building area (sq. ft.)
New building area (sq. ft.)
Number of stories
' ,PROP�ERTrYOWN e,T :_ ' . w_. 3 .^ ga$ Type of construction
� ; „TEL�tANT�'� ��„„�;,�;.:.., Existing:
Occupancy group(s): g:
Name:, C�.�, C 7 Q • c t ' o i , rt.i EQ rpm +, New:
Address:
City /State /Zip: K;i1 Cam, , oR er73 t
NOTICE: All contractors and subcontractors are required to be
Phone: Fax: licensed with the Oregon Construction Contractors Board under
iii * -- PLIICANT , ;M. W`;`> ':1 ^ CONTACT: PERSON provisions of ORS 701 and may be required to be licensed in the
Business Name: Bii, � i —r< jurisdiction where work is being performed. If the applicant is exempt • Contact Name: � • a_ WISc-, from licensing, the following reason applies:
Address: 5t�0 S., He k / Pro_ een. C3
City /State /Zip: 14;Ilsbc -e, It ? - 006-3 '`
Fax: (o` U— Llg - r', ,ar•;s ;^ . „'.s.: = .'a:;;w`';.. ' '+'a�. 5 'z, ;: ^.„ :ti:k -. .°,�tl, iag;�ng �;'
Phone: b03 ��v - 33 .-
(( �' ,�, , �' � ° � � � - °�$UILDING PER)lIIT x �� , �
E- mail: ,., .. r�d+7 Q -COY*, `` ' A `'� Pleasvefe to fe sched e: &tee ,:
' COI� , :.a.rr m _, . ._, � =
��s�- �e��»�- .,,�_� � � � ^.mac ' _ _
Business Name: E» C � r,{' , Fees due upon application $
Address: SC, j sw M L . / P -t . 461,,, 6 Amount received $
City /State /Zip: 1b'IWS(x� , OR t71D,.3- -DbC9
Phone: 503 C,z(0— 3c,j 3 Fax: 503 6%Z -40/6 Date received:
CCB Lic. #: /1 3
Authorized i / Notice: This permit application expires if a permit is not obtained within
Signature: Date: 4{o���d 180 days after it has been accepted as complete.
6 re5 C.--, *Fee methodology set by Tri -County Building Industry Service Board.
J (Please print name)
i:\Dsts\Permit Forms\BldgPermitApp.doc 01/03
04/28/2003 08:21 5036393771 CITY OF KING CITY PAGE 02/02
KING CITE
15300 SW 116th Avenue, King City, Oregon 97224.2693
mrssixorrog Phone: (503) 639.4022 • PAX (502) 639 -3771
Notice To Contractors Working In King City
Due to an intergovernmental agreement with the City of Tigard, many budding 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, si .ply complete the
appropriate application legibly and submit it to the King City staff. The ing City staff will
collect all fees and fax the application to the City of Tigard. City of Tigard 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 read v for issuance or
whether you prefer it to be mailed without any notification. Anyincompl-te or illegible
rn
application will be returned to King City staff for correction and no proses. ing will occur until a
complete, legible application is received.
If your permit application DOES REQUIRE PLAN REVIEW, this form !nest be signed by a
King City staff person. King City staff will simply sign this form indicatin R land use approval.
Take this signed form to the City of Tigard Development Services Counter located at 13125 SW
ITall Blvd, Tigard, to submit applications and plans. Development Service Technicians are
available at 639 -4171 Ext. 304 should you have any questions concerning s;ibmittal
requirements. All permit fees will be assessed and collected at the City of 7 "igard.
The City of King City hereby authorizes applicant to pursue permits at the City of Tigard
r
Building Department for the following project: ,- -- LA ^ 0 6--/../_
located at: _� -,t
•
� 1 C 4e
King City Representative i
1 DST5ECINST ooc
CITY OF TIGARD 24 -Hour -
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST 3 BUP J - o g
Received Date Requested , J AM PM - BUP
Location / � O v /v /.2-(41-t Suite ;.
Contact Person Ph ( )1 -54 3 -F3/8' PLM
Contractor Ph ( ) I l SWR
BUILDING Tenant/Owner "=-% • V ELC
Footing ELC
Foundation Access:
Ftg l Drain
Drain
('t ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear
Int Sheath/Shear
Framing
Insulation ! c "Pp 6417/74C
Drywall Nailing
Firewall / ck)) S / -`off- (" A
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
er:
4F' �
PART FAIL
P L MBING
Post & Beam
Under Slab
Rough -In
Water Service - 5_
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 E Please call for reinspection RE: E Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date C Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
CITY CTIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST {�
BUP 3 Oe:)( C)
Received Date Requested ( AM PM BUP
Location ( F/ l) /0._ 9 Suite MEC
Contact Person Ph ( ) 17f — s� 3 -5 g PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain
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
Sus •'d Ceiling •
Other:
PART FAIL
PL BING
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
Anal Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE El Please call for reinspection RE: Unable to inspect — no access
Fire
ADASupply Line � I i
Approach/Sidewalk Date Inspector , : Ext
•
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL