Permit CITY OF TIGARD PERMIT
PERMIT #: BUP2000 -00075
aye DEVELOPMENT SERVICES DATE ISSUED: 03/07/2000
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S110CD 07000
SITE ADDRESS: 12010 SW QUEEN ELIZABETH ST
SUBDIVISION: KING CITY NO. 2 ZONING:
BLOCK: LOT: 040 JURISDICTION: KIN
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: OTR FIRST: sf N: S: E: W:
TYPE OF USE: SF SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: 5N : sf N: S: • E: W:
OCCUPANCY GRP: R3 TOTAL AREA: 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: $ 6,000.00
Remarks: Tear off existing roofing and replace sheathing, install 25 yr arch Owens Corning roofing material.
Owner: Contractor:
MIKE KELL ROBBY L. CHASTAIN
12010 SW QUEEN ELIZABETH ROB'S GUTTER SERVICE
KING CITY, OR 97224 PO BOX 8
Phone: L Phone: 503 R -4 34 = 5 76f35�2
7
Reg #: LIC 124973
FEES REQUIRED INSPECTIONS
Type By Date Amount Receipt Dryrot After Tear -Off Insp
PRMT GEO 03/07/200C $87.00 0000496 Final Inspection
5PCT GEO 03/07/200C $6.96 0000496
' Total $93.96
ORIGINAL
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 -1987. You may obtain a copy of these rules or direct questions to OUNC by
calling (503) 246 -1987.
--
Perrnitee -
Signature: I A
Issued By: /11/ A'
Call 639 -4175 by 7 p.m. for an inspection the next business day
ilk
, ^°
CI OF TI GARD Plan Check #:
13125 SW HALL BLVD. Rec'd By:
RE -ROOFING PERMIT APPLICATION Date TIGARD OR 97223 n�u—~x��,��x nx��� o �~n�xwun n ��o n u—n���nx o��x� Rec'd: .
V- 503-639-4171 X304 Date to PE :
Data - DST:
F-503-598- 1960 Permit #: ��173
�
1 | illegible appO will Called:
applications
not
# Please fill out applicable sectioplIci attach copy of roofing
Job Site / � 'u/« -'') OwI^/c./'
Bldg # Zip
tA,/�
L�� A.
•
Name", ' � 1.SpaoiUoohon#:
�~ ��� � --._ Zs y Po
Applicant Mailing Address 2. Manufacturer: 0 u^ ��u'nm^^�
1/1-1.0 5,---I -7-n�^�4~°°^o Sr-
City/State Zip Phone *3a UL Classification:
�
-r f" � ?��-�� ���_�/ 4� •
Roofing Nap / � Li�odUL Building Materials Dim��oryPage #:
Contractor /, ���c- c�csw�p ���� (OR)
(Prior to issuance mamno*duvavv °3b Wamock
onpxoantmuvt / //7 5°" /- ^u,/-''� 5 7 -� �
provide a copy of City/State Zip Lia1odVVarnookHomayDim�oryPago#�
. � � �
all contractor ^��� "��L 5 7. *COPY OF � ASSEMBLY REQUIRED
'. /
licenses n Bmnm� Fax #
expimumCOT 5 /m - 0/ 1 -1 8 B. ICBO Research #:
database) State Congr.Csntr. eourd #
����'��^i�� DATED:
C. SPECIAL PURPOSE ROOFING WOOD SHAKES
Building - Type Of Use: '(circle one) (review required by plans examiner)
SF SFA COM MF
Building - Type of Construction: VALUATION OF PROJECT $ �
�
sq. ft.z�no ofmofarea ��c���7��
Existing Deck Type: , Permit fee based on valuation*
Combustible ( ) Non-Combustible ( ) * see chart on back $
~ '
'^'~-~~'^/ required ~y~'~''`~^~''''~'/ 4 :` pam� ,�: I ' x^ � ,14~, ' ^r~w wkW``W4n60°f4Me, •
� i D ermit required ONLY when spaced shea is covered by ~`
solid sheathing. Changes to roof line require Building Permit 8% State Surcharge $ '
Application.
SUBMIT WJO (2) SETS OF PLANS SPECIFYING �v4I,ii
A. Roof area & nearest street. ` *Required for major repairs of
Residential / � "y�
B. A�nvo�o'Pmxide1 sq. ft. for each 150 sq. ft. cfo�ic or^(�^above ° 6S�� Plan U�mviReview $ (� - • *~
space. Vents shall be located in the upper 1/3 of the roof
pnmido1 uq���foremnh3OOuq���whonouve&a#io ����@EBJp��N)��� Poim4 , :: 0���������*�:k�
vonUngiopmvided. e�� �� ��''
. TOTAL $ �� �^ ^°~
I acknowledge that I have read this application and that the
in formation given iocorrect that |amlhe owner orauthorized
n������ bm� agent of the owner, and that the plans (if applicable) are in
[J RE (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/A t Date
B. Existing built-up note � REMAIN: � —� J� ���
muntsubmitononginee/o ^ �
elements. Review uhuUbear the seal (or stamp) nfthe A - /
ovohihedorengineer|ioennodin0mgon. Contact Person Name Telephone .
C. Asphalt or > � ^� �� �� �
'
� L���' �m^~ �� � �� ---
• (PROCEED 7D �7�P�� �-,` "�
ldxtsdonos\mo[m,x.doc
8/26/99
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-= - KING CITY
i 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 peunit, 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: \--1-eaci
� —/���
located at: /g017) Af 4 , ' t
1
King City Representative
I: DSTS\KCINST DOC
8/17/00 Activities for Case #: BUP2000 -00075 •
1:54:59 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
BUPA005 Application received 3/7/00 GEO RECD No Hold GEO 3/7/00
BUPA010 Permit created 3/7/00 GEO DONE No Hold GEO 3/7/00
BUPA830 Dryrot After Tear -Off lnsp No Hold GEO 3/7/00
BUPA870 Final Inspection No Hold GEO 3/7/00
BUPA085 (F) Issue building permit 3/7/00 GEO DONE No Hold GEO 3/7/00
BUPA090 (F) Reprint Permit 8/9/00 ZZZ DONE No Hold ZZZ 8/9/00
Page 1 of 1
CITY, OF TIGARD BUILDING INSPECTION DIVIS • 'O)0 �/'a5
24 -Hour Inspection Line: 639 -4175 Business Line' 639 -417 ' MST
Ci):igiri
Date Requested - 2 ( AM PM L) lj - 000 2
Location / 2 /U.S. t- g 14P� a a..( s �n EC
Contact Person 4/7 Ph 3 W - 0° l i 'LM
Contractor it Ph ."SWR
0 21Z' Tenant/Ater •P-c* cl 1 1 ,1 / _vc/i,. . - ELC
Retaining Wall ELR
Footing Acces
Foundation / J n 4/5/v FPS
Ftg Drain l� �f
Crawl Drain Inspection Notes: qz _ 00 3 / SGN
Slab ( SIT
Post &Beam L / , g C 1 9- � _ 0 -S `Lads
Ext Sheath /Shear �y�-� '�-�/`
Int Sheath /Shear
Framing G", ,� 5 - / Ao / iNG4o l7 �l
Insulation a�
Drywall Nailing �/ �^/
Firewall o ) A,0� -0 r QV ®�J l e - � �)
Fire Sprinkler v� �0 U nrU
Fire Alarm /9 "1/\-5 �\ �J
Susp'd Ceiling f V v U J� —ei�1
Roof , ,_ , e , 6 `�� : rot' c../ -
Misc: ° �� p � Y
in Lid' c..,... 4
1 PART FAIL
'.7 BING ` � '
Post & Beam
Under Slab Ar , ∎ rte < s :2 5)LiEt/L
To Out
Water Service 1 3. I 1A.) i• l
Sanitary Sewer
Rain Drains j 1 z /
Final
PASS PART F L y ..4-40, L..a. 0 r
MECHANICAL', ' e= I „
Post & Beam
Rough In /1 3 ` 3 /� 3 • • I ` l�V-'e.-i ,
Gas Line
Smoke Dampers t Z \
Final (�
PASS PART ' IL
ELECTRICAL, o , MEW
Service L
Rough In _ ∎ — =� mir
UG /Slab
Low Voltage nArifULC 3 — ~
Fire Alarm
Final
PASS PART FAIL .
SITE ,' '.: . • U A C —
Backfill /Grading / t
Sanitary Sewer 0> u -e v 'AC
Storm Drain [ ] Reinspection fee of $ required before next in ■ection. Pay at C Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: ' [ ] Unable to inspect - no access
ADA 1 l9
Approach /Sidewalk W7 Other Date ( Inspector l s
/ `
Final
PASS PART . FAIL DO NOT REMOVE this inspecti . record from the job site.