Permit CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2003 -00182
*��i DEVELOPMENT SERVICES DATE ISSUED: 5/5/03
,.� I ° 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 17135 SW PACIFIC HWY PARCEL: 2S115CB -04200
SUBDIVISION: ZONING:
BLOCK: LOT: JURISDICTION: KIN
REMARKS: Setup of temporary manufactured dwelling. Electrical includes 200 amp service reconnect and (1)
new branch. Plumbing includes water line and building sewer.
BUILDING
REISSUE: STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: OTR HEIGHT: FIRST: 1,512 sf BASEMENT: sf LEFT: SMOKE DETECTORS:
TYPE OF USE: SFM FLOOR LOAD: SECOND: sf GARAGE: sf FRONT: PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: THIRD sf RIGHT:
VALUE: 0.00
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 1,512 sf REAR: '
PLUMBING
SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS:
TUB /SHOWERS: GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: CLOTHES DRYER:
FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS:
MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS:
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 0 - 200 amp: 0 - 200 amp: W/SVC OR FOR: PUMP/IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/FDR: 00 SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EAADDL BR CIR: SIGNAL/PANEL: IN PLANT:
MANU HM/SVC /FDR: 601 - 1000 amp: 601 +amps - 1000x. MINOR LABEL:
1000+ ampNolt : •
PLAN REVIEW SECTION
Reconnect only: 1 -
>=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: OTH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 485.34
TUALATIN VALLEY FIRE & RESCUE TRAPPER'S MOBILE HOME SERVIC This permit is subject to the regulations contained in the
20665 SW BLANTON 18126 S. PALMER RD ETigard Municipal Code, State of OR. Specialty Codes and
ALOHA, OR 97007 OREGON CITY, OR 97045 all other applicable laws. All work will be done i
accordance with approved plans. This permit will expire if
work is not started within 180 days of issuance, or if the
work is suspended for more than 180 days. ATTENTION:
Oregon law requires you to follow rules adopted by the
Phone: Phone: 503 631 - 7392 Oregon Utility Notification Center. Those rules are set
forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You
Reg #: LIC 122655 may obtain copies of these rules or direct questions to
OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
MFG Home Electrical
MFG Home Set -up rou
Water Line lnsp
MFG Home Set -Up Fin
Issued By : 6 i 1. ._ .. .. Permittee Signature : X / aJ 1-2--
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day
Manufactured Dwelling OFFICE USE ONLY
, �� \ i . rmit Application Date received: .57.2/43 Permit no./fSi zOO. t)OlF
R �ry j � ai 0 Projecdappl. no.: Expire date:
..1 of Tigard / h I rig C 'ii
City of Ti and 125 SW Hall Blvd., Tigard, OR 97 Date issued: By Receipt no.:
MAX U 4 2 O one: (503) 639 -4171, Fax: (503) 598 -1969 y 2303 Case file no.: Payment type:
rnet address: w ww.ci.tigard.or.us �"�i
CITY OF TIGAi Health dept.: DEQ:
B _DING DIVIglind use approval: UX i r %.,..r r _- ..
TY OF PERMIT
O Owner installed jik Contractor installed 0 Repair
❑ New 0 Addition/alteration 0 Replacement: Same location 0 Yes ❑ No
1.t,/ JOB SITE INFORMATION
==.5
Job address: i 7 i G • h a /• I-tX (: t
— i t r , S�'P�,'�' i O , 35 Space no.: A/14-4 Manufactured dwelling park: A/ /� I / Address: Ai
Aril y' C. i'f"yy / State: OR . ZIP: 9 7 cj
Tax map /tax'Ibt no. /account no.: S I j_ c 4.44 /1 0v Lot I Block: Subdivision:
Base flood elevation: Elevation certificate:
Description, of work on premises: i �m we 15. P v, : //%1 c.+ ()w P,.(i i'. N = /iv," ^ t 7 fl „p P AS d 4 f ° V
tt
�t r”
r J X Jr�'1 'rr� 1 r ( r 'e. j e :1 7 r1 c _ u . 1 n r�e'� a r1'� 1-i— 5tcc & '
. OWNER MANUFACTURED HOME INFORMATION
Name: - rur,. rt+if Vri 1it' Fl r, rxi RP_c_".r_iI P_
Address:,2p6,kr 5. W. 1, ora Concrete stringers /slab under home: ❑ Yes 0 No
City: A j o j^,,, I State: Q R I ZI 0f 7 00 7 0 Single ;Si Double 0 Triple
PhonQ/y4 c 7 Fa /�� ,y _104 E mail:wcity;{vre t -any Valuation $ ,2 . 77 r l Square feet ...s""6 S"f'
Owner representative: (., e..0 F erry
Phone , _ Fax: li r. .. r Ii E c _ - , r jo ,, ,_ r ( (dwelling and set up only, does not include other permits)
SET. UP /INSTALLATION CONTRACTOR ADDITIONAL PERMITS (if required) •
Name: � r c , p_y- 5 o f l � e, ,o rie Serv) cam, 7110 ❑ Mechanical Permit no.:
Address: /p/ s, PllcriFi RA
City: fin/ C/Ty � j I ? 7p y.5-- ❑ Plumbing Permit no.:
Cit Stat /L ZIP:
Phone S42 /, 7 5 ?? I Fax:b., J_73 7 I E -mail: ❑ Electrical Permit no.:
CCB license no. :,2„Z 66-5 (City /Metro license no.: - 0 Foundation Permit no.:
MDI license no.: 5 7 0 0 Garage Permit no.:
SKIRTING CONTRACTOR
❑ Carport Permit no.:
Name: (i i r, -v 1 0 c,--1-c,, I (r_ rl p'0't ❑ Cabana Permit no.:
Address: t
City: I State: I ZIP: ❑ Ramada Permit no.:
Contact person: I Phone: 0 Awning Permit no.:
CCB license no.: City/Metro license no.: 0 Alterations Permit no.:
Skirting license no.: MDULSI license no.:
APPLICANT 0 Other Permit no.:
Name: G r t? P(,, r r . . F or- 1V F R Notice: Manufactured dwelling installers must have an Oregon
Address: � ( 5 ,,e t, B 0 n to ri MDI and Construction Contractors Board license under provi-
City: /4 a k a _ State:❑ lq I ZIP: q 7 O sions of ORS 701 and . may be required to be licensed in the
Phone: J 9 -/ 7 ct I Fax: 9 f .1osl E- mail: :! ! "ere ►-
' re
jurisdiction where work is being performed, or the appliant is
I - . . I - . . _ r , c ' • exempt from licensing for the following reason:
I hereby certify I have read and examined this application and know the same
to be true and correct. All provisions of laws and ordinances governing this
type of work will be compl d with whether specified herein or not.
/` � ��� Q _- ` y -� 7 O , Set up fee $
Applicant's s Date State surcharge $
Notice: This permit application expires if a permit is not obtained within State fee $
180 days after it has been accepted as complete. ■ ∎ t. NA 4y.' i ' � 4. e , TOTAL $
�` � 440-4624 (8/00/COM) p.
Building Fixtures
Plumbin Perini FOR OFFICE USE ONLY
ti5 Rece ived Plumbing
DateBy ��/ 3 Permit No/JS jo 2 0a3 - 00 /cP4_,
City of Tigard Planning Ap rova Sewer
g MAY 0 2 Plan Review Permit No.:
13125 SW Hall Blvd. 200 Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
"
Phone: 503- 639 -4171 Fax: 5 ( Y TIG DIV ' � ` : :,, t�, . I Post - Review Land Use
Date/By: Case No.:
Internet: wv✓w.ci.tigard.or.us � cal I Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 " " Name/Method: Supplemental Information.
TYPE OF WORK FEE* SCHEDULE (for special information use checklist)
❑ New construction ❑ Demolition Description I Qty. I Fee(ea.) I Total
❑ Addition/alteration/replacement I Other: j rcr/ New 1- & 2 - family dwellings
CATEGORY OF CONSTRUCTION V ! (includes 100 ft. for each utility connection)
1 & 2-Family dwelling ommercia/Inustrial SFR (1) bath 249.20
❑ Y $ ❑ C l d SFR (2) bath 350.00
['Accessory Building ❑ Multi- Family ' SFR (3) bath 399.00
❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00
JOB SITE INFORMATION and LOCATION Fire sprinkler - sq. ft.: _ Page 2
Job site address: / 7/ 3,5J , b✓. Par, i }- I , MI Site Utilities
Suite #: I Bldg. /Apt #: Catch basin/area drain 16.60
Drywell/leach line/trench drain 16.60
Project Name: -j/,tr R, % W ovs/41
/ 4 Footing drain (no. linear-ft.) Page 2
Cross street/Directions , t to job site: Manufactured home utilities 110.00
Pat;.IYIG Nwy 464 of- 6s /' Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.) Page 2
Subdivision: I Lot #: / /0c7 Storm sewer (no. linear ft.) Page 2
Tax map /parcel #: Water service (no. linear ft.) /,S Page 2
Fixture or Item
DESCRIPTION OF WORK Absorption valve 16.60
TP.nn Wolfer e,.a s ewer- 00/0 tr ).04 Backflow preventer Page 2
TA 1 NIFI 4 u/P 1 / Backwater valve 16.60
/ Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
® PROPERTY OWNER I ❑ TENANT Ejectors/sump 16.60
Name: 7V F d' g. I Expansion tank 16.60
Address: go (, E, j S. In/. Q /cti`)o Fixture /sewer cap 16.60
City /State /Zip: i j /ti al 0 4 2, 70 07 Floor drain/floor sink/hub 16.60
Garbage disposal 16.60
Phone: b 9 9 4s- 7 7 Fax: (, 42 - t}$ 1 tt Hose bib 16.60
[oAPPLICANT 0 CONTACT PERSON Ice maker 16.60
Name: j)/r -4 Gr .p� Rol Interceptor /grease trap 16.60
Address: J UV , n Medical gas - value: $ Page 2
�O 66� S �a�
Primer 16.60
P
City /State /Zip � 4/O AC, 0R q 700 7 Roof drain (commercial) 16.60
Phone: e 2 j'C / -, 9 I Fax: 511 - / 9 35' Sink/basin/lavatory 16.60
E -mail: Tub /shower /shower. pan 16.60
CONTRACTOR Urinal 16.60
Business Name: A . (, S A ) Water closet 16.60
t Water heater 16.60
Address: mq.:70 _<A/ C'PPole. Rev Other:
City /State/Zip: / Ua ,, J o,, t ;, ',cote. 9 7 (D6...._ Other:
Phone: tya , 4 / 3°f Fax: el / wag Plumbing Per
Subtotal $
CCB Lic. #: ' 75; S 2 Plumb. Lic.#: 3cjC. f e • Minimum Permit Fee $72.50 $
Authorized Residential Backflow Minimum Fee $36.25
Signature: Date: S ..5 03 Plan Review (25% of Permit Fee) $
n r.e l ' Y'' r 71 /f 41<. State Surcharge (8% of Permit Fee) $
leas print name) TOTAL PERMIT FEE $
Notice: This permit application expires if a permit is not obtained within All new commercial buildings require 2 sets of plans with isometric or
180 days after it has been accepted as complete. riser diagram for plan review.
*Fee methodology set by Tri - County Building Industry Service Board.
i:\Dsts\Permit Forms\PlrnPermitApp.doc 01/03
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information •
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee:
Footing drain - 1 100' 55.00 0 to 2,000 $115.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00
3,601 to 7,200 $220.00
Sewer - 1st 100' 55.00 7,201 and greater $309.00
Sewer - each additional 100' 46.40
Water Service - 1st 100' • 55.00 Medical Gas Systems:
•
Water Service - each additional 100' 46.40 Valuation: Permit Fee:
Storm & Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
additional $100.00 or fraction thereof, to and
Fixture or Item Qty. Fee (ea) Total including $10,000.00.
Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
•
Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to
(minimum permit fee $36.25) 27.55 and including $25,000.00.
Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for
each additional $100.00 or fraction thereof, to
Inspection of existing plumbing or and including $50,000.00.
specially requested inspections - per hour 72.50 $50,001.00 and up • $742.00 for the first $50,000.00 and $1.20 for
Subtotal: each additional $100.00 or fraction thereof.
Fixture Work:
Are you capping, moving or replacing existing fixtures? If
"yes ", please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees *.
Quantity by (Fixture) Work Performed Comments regarding fixture work:
Fixture Type: Replace
New Moved Existing Capped
Baptistry/Font
Bath - Tub /Shower
- Jacuzzi/Whirlpool
Car Wash -Each Stall
-Drive Thru
Cuspidor/Water Aspirator
Dishwasher - Commercial
- Domestic
Drinking Fountain
Eye Wash
Floor Drain/sink - 2" -
-3"
-4"
Car Wash Drain *Note: If the fixture work under this permit results in an
Garbage - Domestic
Disposal Commercial increase of sewer EDUs, a sewer permit will be issued and
- Industrial fees assessed for the sewer increase must be paid before the
Ice Mach./Refrig. Drains plumbing permit can be issued.
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar /Lavatory
- Bradley
- Commercial
- Service -
Swimming Pool Filter
-
Washer - Clothes -
Water Extractor
Water Closet - Toilet
Urinal -
•
Other Fixtures: _
is \Dsts\Permit Forms\PlmPermitAppPg2.doc 01/03
Electrical Permit Application FOR OFFICE USE ONLY
Received
Date/By: Perm N /' lS1e2oe 3 UQ
RECEIVED Datel6y: Permit No . /��
City REC Planning Approval
of Ti and Sign
g Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 MAY 0 2 200 Date/By: Permit No.:
Phone: 503 -639 -4171 Fax: 503 - 598 -1960 Post - Review Land Use
CITY O F TIG ' ' °`"��'�' ' '{� Date/By: Case No.:
Internet: www.ci.tigard.or.us , eel 1 Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: Aft01115DIV - Name/Method: Supplemental Information.
TYPE OF WORK PLAN REVIEW (Plea se check all that apply)
❑ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
❑ Addition/alteration/replacement FJ Other: T p ❑ Service over 320 amps - rating of ❑ Building over 10,000 square feet,
CATEGORY OF CONSTRUCTION 1 & 2 family dwellings four or more residential units in
❑ 1 & 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
El Accessory Building ❑ Multi-Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
JOB SITE INFORMATION and LOCATION Submit _ sets of plans with any of the above.
_
The above are not applicable to temporary construction service.
Job site address: / 7/ 3 / � 'r
- L1.i fi c. /4W/ FEE* SCHEDULE
Suite #: I Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: )" j p ,., R TP.,n/ j'./o ei ; /,-: c Desorption Qty Fee (ea.) Total i
Cross street/Directions to ob site: New residential - single or multi - family per
l dwelling unit. Includes attached garage.
7i, ` L
G /�-/C' / W`�/ /s of Fail 4^ Service included: 1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 1
Limited energy, residential 75.00 2
Subdivision: Lot #: // 0 CI Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
DESCRIPTION OF WORK service and/or feeder 90.90 2
,jam Services or feeders - installation,
-rP�nnn . ,(e.r Gpn i� e io /1 to .nr el WP II1n5 alteration or relocation:
II 1 J —' 200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
❑ PROPERTY OWNER ❑ TENANT 601 amps to 1000 amps 240.60 , 2
`� Over 1000 amps or volts 454.65 2
Name: / VF» R Reconnect only / 66.85 44 ,K6 2
Address: a O 6 6.6 S fit/ el? r l I n Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zip: /J / A O -) o 0 200 amps or less 66.85 1
Phone: Fax: 201 amps to 400 amps 100.30 2
APPLICANT 401 to 600 amps 133.75 2
❑ CONTACT PERSON
❑ . V - Branch circuits - new, alteration, or
Name: -- z — V/= , ,/"" G -e. c rJ e extension per panel:
/� A. Fee for branch circuits with purchase of
Address: a 06 66' J t/ r J 1 I _ service or feeder fee, each branch circuit 6.65 2
City /State /Zip: , Gelb h, C ( 70 tyl B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit / 46.85 'f J
, . g7 2
Phone: I Fax: , Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not included):
CONTRACTOR Each pump or irrigation circle 53.40 2
A "),) 1 _ Each sign or outline lighting 53.40 2
Job No: g Cili Stith o 3 s 76,flp Se/UIr - Signal circuit(s) or a limited energy panel,
p alteration, or extension Page 2 2
Business Nude: l A ,,L. 41 ec. y-I C . Description:
Address: / 7 yi A/ s ze A
Each additional inspection over the allowable in any of the above:
City /State /Zip: /' n ®ANN , erie._. 97.2 / 7 Per inspection per hour (min. 1 hour) 62.50
Phone: / /Z' /0Y Fax: /o /a //o3 Investigation fee:
CCB Lic. #: �y7 y 9 Lic. #: ,..?V-.2.2"/C_. ,..?V-.2.2"/C_. Other: Electrical Permit Fees*
Supervising electrician /e %. /o y Subtotal $ 7/3 , 70
signature required: Plan Review (25% of Permit Fee) $
Print Name: I Lic. #: py l6.$' State Surcharge (8% of Permit Fee) $ 9. AO
TOTAL PERMIT FEE $ /.,2 , Pd
Authorized f� r �_ ^ Notice: This permit application expires if a permit is not obtained within
Signature: /fie Date: • �L5 180 days after it has been accepted as complete.
/ *Fee methodology set by Tri -County Building Industry Service Board.
i ` 1 � f/
J~
P q (Ple a print name)
\
i:\Dsts Permi Forms\ElcPermitApp.doc 01/03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00 •
Check Type of Work Involved:
0 Audio and Stereo Systems
El Burglar Alarm
❑ Garage Door Opener
El Heating, Ventilation and Air Conditioning System
11 Vacuum Systems
0 Other
COMMERCIAL WORK ONLY:
Fee for each system • $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
Ej Audio and Stereo Systems
0 Boiler Controls
0 Clock Systems
Data Telecommunication Installation
❑ Fire Alarm Installation
HVAC
El Instrumentation
Intercom and Paging Systems
Landscape Irrigation Control
Medical •
El Nurse Calls
Outdoor Landscape Lighting
Protective Signaling
n Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
•
i:\Dsts\Permit Forms\ElcPerrnitAppPg2.doc 01/03
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
RAYBORN'S PLUMBING INC
PO BOX 69
TUALATIN, OR 97062
Plumbing Signature Form
Permit #: MST2003 -00182
Date Issued: 5/5/03
Parcel: 2S115CB -04200
Site Address: 17135 SW PACIFIC HWY
Subdivision:
Block: Lot:
Jurisdiction: KIN
Zoning:
Remarks: Setup of temporary manufactured dwelling. Electrical includes 200 amp service
reconnect and (1) new branch. Plumbing includes water line and building sewer.
Your company has been indicated as the plumbing contractor for the permit indicated above. In order for the
plumbing permit to be valid, please have the appropriate individual from your company sign below and return
this Plumbing Signature Form prior to the start of the work to the address above, ATTN: Building Division.
No plumbing inspections will be authorized until this completed form is received
OWNER: PLUMBING CONTRACTOR:
TUALATIN VALLEY FIRE & RESCUE RAYBORN'S PLUMBING INC
20665 SW BLANTON PO BOX 69
ALOHA, OR 97007 TUALATIN, OR 97062
Phone #: Phone #: 503 - 692 -4139
Reg #: MET 00001806
LIC 87852
PLM 34 -166PB
AN INK SIGNATURE IS REQUIRED ON THIS FORM
X A. .�-
Sig -ture of Authorized Plumber
•
If you have any questions, please call 503 :718.2433.
• 04/29/2003 13:35 50) ;393771 CITY OF KING CITY PAGE 02/02
•
/1
KING CITY . •
15.310 SW 116th Avenue, King City, Oregon 97224 -2692 •
ormi■ Phde: (603) 639 -4082 • FAX (602) 639 -3771
RE CEIVE .
APR 2 9 2003
CIT OF TIGARD
Notice To Contractors Wohung City
Due to an intergovernmental agreement with the City of Tigard, many building related permits 4
for projects in King City are issued and inspected by the City of Tigard. •
If your permit application DOES NOT REQUIRE PLAN REVIEW, siinply complete the
appropriate application legibly and submit it to the King City staff. The ting City staff will
collect all fees and fax the application to the City of Tigard. City of Tig.•rd staff will then create
the permit, issue the permit, and perform inspections. Please indicate on dlhe permit application t
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 incomplt:te 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 `4k,.
King City staff person. Icing City staff will simply sign this form indicati hg 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 Servici:s 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: ;y
�I' c r Q ' ,
located at: ' I t ,/ . 41 2S
Wit
Icing City Representative
1 : DSTSKC(NST DOC •
•
4 T c f v 3 - G o / 'v
4 KING CITY
15300 SW. 116th Avenue, King City, Oregon 97224 -2693 V D
,....... Phone: (503) 639 -4082 • FAX (503) 639-3771
MAY 0 2 2003
LI I i ur 1 uul-61.)
PLANNINGIENCIII RING
April 24, 2003
Greg Perry
Tualatin Valley Fire and Rescue
20665 SW Blanton Street
Aloha, OR 97007
RE: TVFR Type I - Temporary Use Permit
17135 SW Pacific Hwy.
Dear Mr. Perry:
As the City Manager of King City, I hereby grant a Type I Temporary Use Permit for the
district's proposal to temporarily occupy a residential manufactured home on the Tualatin Valley
Fire and Rescue (TVFR) property located at 17135 SW Pacific Highway.
Application Description
The purpose of the manufactured home is to provide temporary housing for TVFR staff while
the permanent fire station, including its living quarters, are remodeled to meet current seismic
code requirements. As shown on the proposed site plan, the temporary manufactured home will
be located in the northwest corner of the property (Attachment A). The building will serve as
temporary residential quarters for the TVFR personnel during the renovation. Adequate parking
shall continue to be available for the staff, and the other operations on the site, including access •
to Pacific Highway, will not change.
Explanation of the Decision
The property, along with several others, was recently annexed into the city, but the Washington
County zoning has not been changed to King City designations. So although it is in the city, .
county land use designations and regulations continue to apply. The TVFR applied for a Type
I Temporary Use permit subject to Washington County zoning requirements.
a Two chapters of the Washington County Community Development Code apply in this .
application. The Institutional District (330), which currently applies to the property, allows
temporary uses through a Type I (administrative — no notice) review (Section 330 -3.6). The
Temporary Use (430- 135.1) provisions allow the use of a manufactured structure t� house
commercial, industrial, and institutional use for a period up to one year (430 -135.1 C).
Page - 1
i
Decision and Conditions of Approval
A Type I — Temporary Use Permit is granted subject to the following conditions:
1. The manufactured home shall receive all of the necessary building permit approvals prior
to occupancy.
2. The manufactured home shall meet the yard requirement of the Washington County
Institutional Zone (Section 330 -7.3), which is a 20 -foot setback to the side (north and
south) and rear (west).
3. The manufactured home shall be removed from the site and all utilities properly
disconnected by April 26, 2004.
Sincerely,
Q/X-e-s Lfei/
Jane Turner
City Manager
cc: Keith Liden, City Planner
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CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST 3 - / £OZ
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested — 0 I AM PM BUP
Location 171 3 Suite MEC
Contact Person Ph ( ) — 5 SD PLM
Contractor —� Ph l ( ) SWR
BUILDING Tenant/Owner ! V F Q 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
Susp'd Ceiling
Roof
O l er: ��E� t r viv h 4L,(2.
4) PART FAIL
"=1NG j
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 U Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach /Sidewalk Date < 47D/43 Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL