Permit i Y
CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2003 -00462
11i DEVELOPMENT SERVICES DATE ISSUED: 7/29/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 16485 SW PACIFIC HWY PARCEL: 2S115BD -02800
SUBDIVISION: ZONING:
BLOCK: LOT: JURISDICTION: KIN
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK:,Al 1 6'rr< FIRST: sf N: S: E: W:
TYPE OF USE: COM 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: $ 153,180.00
Remarks: Re -roof
Owner: Contractor:
HEALTH RESOURCES, INC COLUMBIA CONSTRUCTION SERVICE
PO BOX 987 28395 SW BOBERG RD
TUALATIN, OR 97062 WILSONVILL, OR 97070 -6769
Phone:
Phone: 503 - 684 -9123
Reg #: LIC 116607
FEES REQUIRED INSPECTIONS
Description Date Amount Misc. Inspection A- - r' mE o F F1--�..IC MOW
[BUILD] Permit Fee 7/29/03 $954.90 Final Inspection
[TAX] 8% State Tax 7/29/03 $76.39
Total $1,031.29
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: _ ..�a�.1_. :�,
Permittee
Signature: zei (? 1 ,e 7 0
Call 639 -4175 by 7 p.m. for an inspection the next business day
JD Ul U U 'I. G1 LUL h tau
ii •L NN ii aLlll
Received 1 ., Building
Date/By: / aV - 03 ' Permit No.: &) i 3 Q .7C) l 2--
Cl of Ti and Planning Approval Other
�J g
13125 SW Hall Blvd. C/ ► Plan Plan Review : Re Permit No.: Other
Tigard, Oregon 97223 � !, Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 50341 -1 6� /�"s'j'F'hIrk�lIl Post view Case L N e
In www.ci.tigard.or.us 1 2".4--111'' e__. Contact . C ® See Page 2 for -
24 - hour Inspection Request: 69>r Name/Method: Supplemental Information
TYPE OF WORK . 'REQUIRED DATA: - -
❑ New construction Demolition 1 & 2 FAMILY DWELLING
0 Addition/alteration/replacement I El [] Other: (iZoOP CATEGORY OF CONSTRUCTION Note: Permit fees* are based on the total value of the work performed. Indicate
❑ I & 2- Family dwelling M 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 $
' JOB SITE INFORMATION and LOCATION- No. of bedrooms: No. of baths: -
Job site address: 1(p 4 $ S S.W. pAC 1 rl G NW Total number of floors
New dwelling area (sq. ft.)
. Suite #: ) Bldg. /Apt. #: Garage/carport area (sq. ft.)
Project Name: ILuJ4 G1-1`I 1 Hv4re,. Covered porch area (sq. ft.)
Cross street/Directions to job site: Deck area (sq. ft.)
•q. A A-C..F- t NI- -e Other structure area (sq. ft.)
C,-04.9S S-111-0621 - Fi s G i2- PAD REQUIRED DATA:
COMMERCIAL - USE CHECKLIST
_ Subdivision: I Lot #:
Tax map /parcel #: Note: Permit fees* are based on the total value of the work performed. Indicate
DESCRIPTION OF WORK the value (rounded to the nearest dollar) of all equipment, materials, labor,
_ overhead and profit for the work indicated on this application.
4.1 -0> ,C 1 k,e-- 7 ,q - Ll N C w Valuation $ ( I$°.
S 1 n.1 Cs L4 9W 1= �yg1aM Existing building area (sq. ft.) SO c caO St=
New building area (sq. ft.) -6. 144.
S-5 A T7 A-wc- ?ik S t' - * Number of stories i
IN PROPERTY OWNER . 1 ❑ TENANT Type of construction Woof ,
Name: AVAM NeAL j 1AC. Occupancy group(s):
New:
Address: Z S 11 .1.A.). ;AA-V.w 1 Sulrc i
City /State /Zip: kid t 1,Onl v 1 try R icri D
Phone(60 -) 570 - silos Fax: '(5 ) S7 — 3315 NOTICE: All contractors and subcontractors are required to be
licensed with the Oregon Construction Contractors Board under
APPLICANT e} CONTACT PERSON provisions of ORS 701 and may be required to be licensed in the
Business Namel .uM6q , (0AISI, v .ion/ SG_Nc.i. ' qurisdiction where work is being performed. If the applicant is exempt
Contact Name: A, -ct S. CA4>2 •17E - from licensing, the following reason applies:
Address: 2 33 5.14? /3„,p, go S, 7c 6
City /State /Zip:Wlt- Sorlwu.o, Olt el /670
Phone (50),) 6, 34- 4 11Z3 I Fax: (so5) („B4 - -(4`S$
00 YFRMrrF- s * "
E-mail: l l' e r o oc� o cv Co 1 . 'Please rekr to' fee. schedule.
CONTRACTOR • 1
Business Name: CoLLM '5,4 C�ntsz�nioA/ S Ii.lc
ees due upon application $
Address:MS9 S Ste. gog L► ,2c 507c — s5
City /State /Zip:iv/ of 4 ti 'LW Qt2 ej7 o70 _ Amount received $
Phone: j, . $ 4 -1 z-3 I Fa :(9 3) (p8 4 Se Date received:
CCB Lic. a , / (, - •
Authorized , rar Notice: This permit application expires if a permit is not obtained within
Signature: , , ■ ` / A, A Date: O 3 180 days after it has been accepted as complete.
\ / 5 • C I ., & t 7 6 - 1 1 .-- *Fee methodology set by Tri- County Building Industry Service Board.
(Please print name) (� ,
is \Dsts\Permit Forms\BldgPermitApp.doc 01/03 ?rid �6 `-'" f ,
1,1' 76.
07/29/2003 10 :27 5036393771 CITY OF KING CITY PAGE 03/03
G �
` 'eco
KING CITY ve 1 03
1111461
c10
16300 SW, 116th Avenue, King City, Oregon 9724.2692 �U� 2 0
�,,,� Phone: (503) sag - 082 -FAX (503) 639.877 G, .O G 1
•
BV11- \N
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. : .
f •
If your permit application DOES NOT REQUIRE PLAN REVIEW, sij,nply complete the
appropriate application legibly and submit it to the King City staff. The ggging City staff will
collect all fees and fax the application to the City of Tigard. City of Tigaird 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 reE dy 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 proce will occur until a
complete, legible application is received.
i
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 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 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: • '
located at: , .
•
King Ci Representative :.
1 DSTSKCIXS DOC ! •
•
.
City of Tigard Building Department
V 13125 SW Hall Blvd., Tigard, OR 97223 Phone: (503) 639 -4171
Re -Roof Pre - Inspection Report Form _11.1: �, 1 i
t.i'i Requested by Q....8 < < - t L ....O &s j • Telephone ( 3 ) ef ( 2 J
Job Address I '(p q C � 11v fit. c). L Permit #:
Roof Access Location Wre . - - r 12-0'`( 4> \ A_c. -
Date Requested "2/2--5 Time Requested
Type of Existing Roof - LA..+. VP —.__4 ∎,•(Z-.
1. Slope of roof deck Xefr R F C F I V E D
2. Roof/Penetrations /General Conditions Krrair ❑ Poor .
3. Are there blisters? Ei<s ❑ No JUL 2 9 2003
4. Are there cracks? 2<es ❑ No CITY OF TIGARD
5. Is there evidence of water ponding? 1:1 N BUILDING DIVISION
6. Is moisture present under roofing (leak)? ❑ Yes • No 7
7. Is roof insulation existing? ❑ Yes . ❑ No 3 ".J=t 1 -,.)6 % ev..l �ck-
8. Is roof insulation wet? ❑ Yes [✓] No
9. Property line setbacks on all sides > 10 feet ❑ Yes ❑ No
10. Building size ❑ < 3000 sq. ft. ❑ < 6000 sq. ft 000 sq. ft.
11. Building height [1 2 Stories ❑ > 2 Stories
12. Class of roof required ❑ N n -rated ❑ A. lEr3. ❑ C.
13. Type roof deck mbustible ❑ Non - Combustible
14. Roof drains ❑ Provided L quired. ❑ Adequata. 12.x..4 -.4-s. ,--
15. Overflow drains . ❑ Provided E ❑ Adequate
16. Attic ventilation c--1, ‘ reA kz .j. Provided ❑ Required ❑ Adequate •
17. Roof listing • ❑ Provided ❑ Required $, p
18. Installation Instructions Rvided ❑ Required
To re -toof this structure the following conditions must be met:
v •
Alm! I . _ 111K
. 4 S,.•., Vj v■,...:.. 9-/11 C e_ o ..,:,�5 • S
5
The re -roof proposal is L!‘proved for permit issuance if the conditions listed above are met. After obtaining your permit you must contact the
Building Division for an inspection when the roof deck is ready for the first inspection : The first inspection for a complete tear off is the deck
inspection. For a built -up roofing system (overlay), the first inspection is at the start of the job. After the re-roof is complete, a final inspection is
required.
Inspector -.(.. - kt-t\ Ext. 7 -`f Date 7 / 2 �d 3
,la,icE„o,Ruoor won resat Porn
CITY OF TIGARD 24 -Hour
!'BUILDING Inspection Line: (503) 639 -4175
INSPECTION DRIVISION Business Line: (503) 639 -4171 MST orp z
Received L t. 3 0 Pm Date Re ested tO/ / / 7 AM PM BUP
Location 16'�BS /a•E -F n� t•+l4- Suite MEC •
Contact Person l•= PAnA Ph ,A -' / ?S' PLM
Contractor ./ . •. Ll-[\ • s Ph ( SWR
BUILDING Tenant/Owner at:k /G2i Q.fO � -�` ELC
Footing r
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'51Seiling
RootIlIPP
Other:
•
tidies` PART FAIL
=NG
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 EI Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date 10 1( 3 Inspector 4. Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL