Permit 4. CITY OF TIGARD MASTER PERMIT
^ l ,t��i i �N DEV R SERVI DATE ISSUED: ��- M -0272 Hall Blvd., Tigard,
PARCEL: 2S115BC- 15900
SITE ADDRESS••.:12415 SW KING RICHARD DR
SUBDIVISION • ZONING:
BLOCK LOT - JURISDICTION: KIN
Remarks: Reroof existing single family dwelling. Tear off replace with 27Y, sq.ft of malarkey 3 tab 20 year.
- -------------------- --------- - - - -- BUILDING - -- - -- ------ - - - - --
REISSUE: OR STORIES • 0 FLOOR AREAS-- - - - - -- BASEMENT...: 0 sf REQUIRED SETBACKS - --- REQUIRED - - -__r
CLASS OF WORK.3 'f HEIGHT • 0 FIRST • 0 sf GARAGE • 0 sf LEFT • 0 SMOKE DETECTRS:
TYPE OF USE...:SF FLOOR LOAD : 0 SECOND...:, 0 sf FRONT • 0 PARKING SPACES: 0
TYPE OF CONST.:5N DWELLING UNITS: 0 FINBSMENT: 0 sf RIGHT • 0
OCCUPANCY GRP.:R3 BDRM: 0 BATH: 0 TOTAL- ---- -: 0 sf VALUE..$: 5810 REAR • 0
_____ —_ _- - - - -_— _________ — PLUMBING - - - - -- ---- ---- _ — --------- __ --- _ — ---- —
SINKS • 0 WATER CLOSETS.: 0 WASHING MACH..: 0 LAUNDRY TRAYS.: 0 RAIN DRAIN ft: 0 TRAPS • 0
LAVATORIES • 0 DISHWASHERS...: 0 FLOOR DRAINS..: 0 SEWER LINE ft: 0 SF RAIN DRAINS: 0 CATCH BASINS.•: 0
TUB /SHOWERS...: 0 GARBAGE DISP..: 0 WATER HEATERS.: 0 WATER LINE ft: 0 BCKFLW PREVNTR: 0 GREASE TRAPS..: 0
OTHER FIXTURES: 0
- ---------------- _--- ---- -- - - MECHANICAL - -------------- __— ----- ---w — ------ _-
FUEL TYPES---- ---- -- FURN ( 1'41( ..: 0 BOIL /CMP ( 3HP: 0 VENT FANS • 0 CLOTHES DRYERS: 0
FURN ) =100K ..: 0 UNIT HEATERS..: 0 HOODS • 0 OTHER UNITS...: 0
MAX INP.: 0 BTU FLOOR FURNACES: 0 VENTS 0 WOODSTOVES • 0 GAS OUTLETS...: B
_ ---- — __---- w —____ - ---- - -- ELECTRICAL --- - ----- ---- -- -------------------
-- RESIDENTIAL UNIT --- -- SERVICE /FEEDER -- —TEMP SRVC /FEEDERS — --- BRANCH CIRCUITS --- -- -- MISCELLANEOUS- --- --ADD'L INSPECTIONS--
lm SF OR LESS: 0 0 - 200 amp..: 0 0 - 200 amp..: 0 W /SVC OR FDR..: 0, PUMP /IRRIGATION: 0 PER INSPECTION: 0
EA ADD'L 500SF.: 0 201 - 400 amp..: 0 201 - 4;v, amp..: 0 1st W/O SVC /FDR: 0 SIGN /OUT LIN LT: 0 PER HOUR : 0
LIMITED ENERGY.: 0 401 - 600 amp..: 0 401 - 600 amp.:: 0 EA ADDL BR CIR: @ SIGNAL /PANEL...: 0 IN PLANT : 0
MANF HM /SVC /FDR: 0 601 - 1.' amp.: 0 6014-amps-IC' v: 0 MINOR LABEL -10: 0
1m+ amp /volt.: 0 --- - - ---- --- - - ---- PLAN REVIEW SECTION - ----- --- — ------- -- ___ ----- --- _
Reconnect only.: 0 )=4 RES UNITS..: SVC /FDR) =225 A.: ) 600 V NOMINAL: CLS AREA /SPC OCC:
- -------------------------------------------------- ELECTRICAL - RESTRICTED ENERGY -
A. SF RESIDENTIAL - -- — B. COMMERCIAL ---- - - ---- -- - -- -
AUDIO & STEREO.: VACUUM SYSTEM..: AUDIO & STEREO.: FIRE ALARM • INTERCOM /PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM..: 0TH: :: BOILER.........: HVAC • LANDSCAPE /IRRI6: PROTECTIVE SIDNL:
GARAGE OPENER..: CLOCK INSTRUMENTATION: MEDICAL • OTHR: ..
HVAC • DATA /TELE COMM.: NURSE CALLS....: TOTAL II SYSTEMS: 0
Owner: -- _w-- _- _ --- —___w Contractor: ----------- — TOTAL FEES:$ 59.33
LEWIS HILTON HERMAN ROYBAL This permit is subject to the regulations contained in the
12415 SW KING RICHARD AVE 6288 SW SEVILLE•AVE Tigard Municipal Code, State of Ore. Specialty Codes and all
KING CITY OR 97224 LAKE OSWEGO OR 97035 other applicable laws. All work will be done in accordance
with approved plans. This permit will expire if work is
Phone 0: 639 -0782 Phone 0: 697 -6916 not started within 180 days of issuance, or if the work is
Reg 0..: 123001 suspended for more than 180 days. ATTENTION: Oregon law ,
- - ---------------------- -- requires you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952 - 001-%40 through OAR 952- 001 - You may obtain copies of these rules or
direct questions to OUNC by calling (503)246 -1987.
- ---- ---- -- - - - - -- REQUIRED INSPECTION5------------- ------ --- --- ___ --------- ----- _ _w
Misc. Inspection
Building Final •
Issued — By: - 4/`7 ' Rer�mittee S gnat ur^e: Vii/'._ _ _�sL /i
+ + + + + + + + + + + + + ++ + ++ + + + +++ + + + + + + + + + + + + + + + + + + + + + + + ++ 4- + ++ + r + + ++
Call 639 -4175 by 7.00 p.m. for an inspection nee '� de ne ■u- nes: day
CITY OF TIGARD Plan Check #:
13125 SW HALL BLVD. Rec'd'By:
TIGARD OR 97223 RE- ROOFING PERMIT APPLICATION Date Recd:
- - V - 503 639 - 4171 X304 • - 'Incomplete or illegible applications will not be accepted ,. Date DS:
:
F- 503 - 598 -1960 Date to DST:
Permit #: //Pey - 7,:
Called:
Name fDevelopment/Business
a eo
; ..�15`x >; NirwR.o4l± INGAS3gMpt .;::.;::>>:;; :.;.;:.;
:;:;:.; :.:: . :.:. : ::.;;
:. :::
::
: <MaterraI:DO'4uiillehtation :..' 8C Atiip o i eiix 15 .:::::< :: » : : : : ; :: >::.:: >:::: >::>.: >: >< >:::: : : : : : :<::::: >:::::
Street Address Ste # Please fill out applicable section and attach copy of roofing
Job Site /2, y j S, l/, Ka b , 4, ri-,1-s? 4 A specifications.
Bldg li City/State Zip ListeitAssembiy:::: >::: (::Circle:: &::Coen.plete::A;::B orC}<< >« >> >s i : <: _ <;
k')Ni's £l7 `l 972.` A.
Name 1. Specification #:
L e._Lvls Hi L7 - 0 iy
N � - NK E i 5 T A/3 20
Applicant Mailing Address 2. Manufacturer:. U ,
rz.'fi 5, lo, / {),Y ( tic/1f-AQ /3-' -. 7
City/State I Zip f Phone 3a UL Classification:
• 07-o 70 - 2
Roofing Name Listed UL Building Materials Directory Page #:
Contractor F out A F/Nish/ iNc : ;A 1,, (OR)
(Prior to issuance Mailing Address ,.., 3b Warnock Hersey :
applicant must (L $, . / 1'
provide a copy of City/State Zip _ Listed Warnock Hersey Directory Page #:
all contractor 4f�K,_r�S tv047b 9'70 3 S (PROVIDE COPY OF ASSEMBLY) _
licenses if Phone # Fax #
expired in COT 0 7...._,6f/6 B. ICBO Research #:
database) State Constr.Contr. Board # Exp Date
14.5(2(?( , z ,zi co DATED:
C. SPECIAL PURPOSE ROOFING: WOOD SHAKES
Lfl G. W O
t EH�::It�€1=t�
Building - Type Of Use: (circle one) (review required by plans examiner)
SFA COM MF
Buildin - Ty of Construction: VALUATION OF PROJECT $
sq. ft. 2 7i7O of roof area 53 70
Existing Deck Type: Permit fee based on valuation*
Combustible ( ) Non - Combustible ( ) * see chart on back $
:::..:.:..:p;..::::.:_:::..:::::::9...:....490s4::.:::: cfrk,AfteratokR:::.::::::::::::.:..Ci ::use:on :::.::.;::;.>;>;: WACO...::::.:.::..:.,.:::. .. : .. ..: :::...,::.:::.. _.:. ..
REPAIR (MAJOR) (review required O rev ew u ed b I
ans exam
7
iner)
e am r
B ILD
Permit required ONLY when spaced sheathing is covered by
solid sheathing or roof line is changed. 5% State Surcharge $
Ci : ..,o..:,.: :: W . ; > ; :: ` >: > : >: :: .` : ;::a > > >:;::: :
!�Y : . : a ;only::.: >`::::::. ACq: .., ;<;: :;,::: :.:.:: : : ::<: ><; :::<. >:, ;;: ;:;�� >::::::<;
SUBMIT THREE OF PLANS REE SETS O LAN S SPE
3 S S SPECIFYING. C NG
:TA'X
TAX '
A. Roof area & nearest street.
B. Attic vents - Provide 1 sq. ft. for each 150 sq. ft. of attic 65% Plan Review $
space. Vents
h II located in
shall be the upper of the roof. : : .... .. , ... ., ;:,, ::> • :. ... ., ...,.. , : ...:::...� .�:
P Peer 1!3 0 00 . :. CI : -= : >:::: > : ::: WACO;:;:: :, .::::.,;:. >:<: ::<:::::_<:: >;; :>»<;;.:.>;.::; ::::::: >: >::<: >; .;_: .<:::: ><<:::
Provide e1s for or ea h300s .w
c ft hen v attic
ea e&
venting is provided.
TOTAL $
> STEP >'l >: <: >: > >« :>? COMMERCIAL < >: aONL : > < >::!$ig ::: m$ :: ir!ii ::::
I acknowledge that I have read this application and that the
9 pP
nformation given is correct that I am the owner or authorized
Describe work to be done: (check appropriate box) .,.... .. 9
agent of the owner, and that the plans (if applicable) are in
❑ RE - ROOF (circle A ,B or C) compliance with Oregon State law.
A. Existing built -up roof covering to be REMOVED and deck
repaired - Signature of Owner /Agen Date
B. Existing built -up roof covering to REMAIN: note applicant _- . /p�
must submit an engineers review of the roof structural f /"
elements. Review shall bear the seal (or stamp) of the �
architect or engineer licensed in Oregon. t'a
6nct Pers. ame Telephone
- - - -C: Asphalt —or -wood- shingle /shake -- l��/// ( i / 2 /,, q 697.-6--
(PROCEED TO STEP 2) 1 i E - - DY w / 7
I:ROOF1.DOC (dsts) REV 4/98
u
CITY OF TIGARD
BUILDING PERMIT FEES
TOTAL -
PLAN STATE BUILDING
VALUATION OF PERMIT REVIEW TAX PERMIT
PROJECT FEES (65 %) (5 %) FEES
1 -1500 25.00 16.25 1.25 42.50
1,501-1600 26.50 17.23 1.33 45.06
1,601-1,700 28.00 18.20 1.40 47.60
1,701 -1,800 29.50 19.18 1.48 50.16
1,801-1,900 31.00 20.15 1.55 52.70
1,901-2,000 32.50 21.13 1.63 55.26
2,001 -3,000 38.50 25.03 1.93 65.46
3,001-4,000 44.50 28.93 2.23 75.66 .
4,001-5,000 50.50 32.83 2.53 85.86
c5-001-6,000 56.50 36.73 2.83 96.06
6,001 -7,000 62.50 40.63 3.13 106.25
7,001 -8,000 68.50 44.53 3.43 116.46
8,001-9,000 74.50 48.43 3.73 126.66
9,001- 10,000 80.50 52.33 4.03 136.86
10,001-11,000 86.50 56.23 4.33 147.06
11,001-12,000 92.50 60.13 4.63 157.26
12,001- 13,000 98.50 64.03 4.93 167.46
13,001- 14,000 104.50 67.93 5.23 177.66
14,001-15,000 110.50 71.83 5.53 187.86
15,001-16,000 116.50 75.73 5.83 198.06
16,001- 17,000 122.50 79.63 6.13 208.26
17,001- 18,000 128.50 83.53 6.43 218.46
18,001- 19,000 134.50 87.43 6.73 228.66
19,001-20,000 140.50 91.33 7.03 238.86
20,001- 21,000 146.50 95.23 7.33 249.06
21,001- 22,000 152.50 99.13 7.63 259.26
22,001- 23,000 158.50 103.03 7.93 269.46
23,001-24,000 164.50 106.93 8.23 279.66
24,001- 25,000 170.50 110.83 8.53 289.86
25,001 - 26,000 175.00 113.75 8.75 297.50
26,001- 27,000 179.50 116.68 8.98 305.16
27,001- 28,000 184.00 119.60 9.20 312.80
28,001- 29,000 188.50 122.53 9.43 320.46
29,001- 30,000 193.00 125.45 9.65 328.10
30,001- 31,000 197.50 128.38 9.88 335.76
31,001-32,000 202.00 131.30 10.10 343.40
32,001- 33,000 206.50 134.23 10.33 351.06
33,001 - 34,000 211.00 137.15 10.55 358.70
34,001-35,000 215.50 140.08 10.78 366.36
35,001-36,000 220.00 143.00 11.00 374.00
36,001-37,000 224.50 145.93 11.23 381.66
37,001- 38,000 229.00 148.85 11.45 389.30
I:ROOF1.DOC (dsts) REV 4/98
. . .
IA/ KING CITY
15300 S.W. 116th Avenue, King City, Oregon 97224 -2693
■ Phone: (503) 639 -4082 • FAX (503) 639 -3771
Notice To Contractors Working In King City
Due to an intergovernmental agreement with the City of Tigard, many building 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, simply 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 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 ready for issuance or
whether you prefer it to be mailed without any notification. Any incomplete or illegible
application will be returned to King City staff for correction and no processing 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 indicating 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 Services Technicians are
available at 639 -4171 Ext. 304 should you have any questions concerning submittal
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: ■' TIZ 4 i1
located at: /14/5 $'JA/ ki ft
19 Rt-e-h-O-td
gaiii,- \::h 0
King City Representative
___ _ I9DSTSUCCINST DOC
•
CITY OF TIGARD BUILDING INSPECTION DIVISION MST cfR- 17J-
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
,2, , BUP
1� � e )) Date Requested ' // " j `t q(', AM PM BLD
Location l 2 15 �(A) K- 41 \ 't MEC
Contact Person Ph t'O 7- 690- PLM
Contractor Ph SWR
Tenant/Owner ELC
Retaining Wall ELR
Footing Access: -
Foundation /6; /� FPS
Ftg Drain t SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
is :
10 PART FAIL
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICALg
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL x x ,
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
[ ] Please call for reinspection RE: [ ] Unable to inspect.- no access
Fire Supply Line
ADA — / Lf 6r24 Approach /Sidewalk Date �7 — / (. /'63 Inspector l� Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.