Permit CITY OF TIGARD PERMIT
PERMIT #: BUP2000 00068
,0� DEVELOPMENT SERVICES DATE ISSUED: 03/01/2000
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 15790 SW QUEEN VICTORIA PL PARCEL: 2S110CC -08700
SUBDIVISION: KING CITY NO. 3 ZONING:
BLOCK: LOT: 061 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: $ 3,800
Remarks: Re -roof
Owner: Contractor:
COOK, LUTHER MARBLE AND J VAUGHAN ROOFING INC
PHYLLIS E, TRUSTEE 2373 NW 185TH AVE
15790 SW QUEEN VICTORIA HILLSBORO, OR 97124
KrnoneTY, OR 97224 Phone: 503 - 645 -8923
Reg #: LIC 88412
FEES REQUIRED INSPECTIONS
Type By Date Amount Receipt Roof Nailing Insp
PRMT BON 03/01/200C $68.50 0000355 Final Inspection
5PCT BON 03/01/200C $5.48 0000355
Total $73.98 OR1GNA
L
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.
Permitee
Signature: CO P tk (J"Y\
Issued By: f • ( t& JA _.
Call 639 -4175 by 7 p.m. for an inspection the next business day
CITY OF TIGARD Plan Chec : A
13125 SW HALL BLVD. Rec'd By:
TIGARD OR 97223 RE- ROOFING PERMIT APPLICATION Date Rec'd: 3- t - 2cIPP
V- 503 - 639 -4171 X304 Date to PE:
Date to DST:
F- 503 - 598 -1960 Permit #: ar
Incomplete or illegible applications will not be accepted Called:
Name of Development/Business STEP 2. NEW ROOFING ASSEMBLY
Material Documentation (UBC Appendix 15) .
St5eet Address 4i, / 41 Ste # Please fill out applicable section and attach copy of roofing
Job Site 15. 790 S W 4a., .,•1. PI. specifications.
Bldg # City /State Zip Listed Assembly ( Circle & Complete A, B or C)
A.
Name n ) i /° 1. Specification #:
Y y i ss 6 L
Applicant Mailing Address 2. Manufacturer: a ve. p o T ra nia r 2.c-
5 fart i; bfic is 3.)
i 6 790 5" Q Age.. L2 J '1 P /
.9ty /State Zip Phone *3a UL Classification:
1C G/ G1
Roofing Na r ./ Listed UL Building Materials Directory Page #:
Contractor J. 1/clM.y 1 .l RooF,••5 , i2 c. (OR)
(Prior to issuance M lin Addl�ss *3b Wamock Hersey :
applicant must 7- 5. 3 A/ i%) / ' S � � L Air .
provide a copy of City /State Zip Listed Warnock Hersey Directory Page #:
all contractor 14 ,' 6 r,.J o 9Q 97/z Y *COPY OF ASSEMBLY REQUIRED
licenses if Phone # Fax #
expired in COT (p °/ 0 - l ?D 7 r, Vi 6 - 1 2 3 B. ICBO Research #: •
database) State Constr.Contr. Board # Exp. Date
gg t/l 2 r-2 /- 0 DATED:
BUILDING INFORMATION C. SPECIAL PURPOSE ROOFING: WOOD SHAKES
Building Of Use: (circle one) (review required by plans examiner)
F SFA COM MF
Building - Type of Construction: / .- 7 . 7 OF PROJECT $ t)) sq. ft. 2 »a of roof area `. ' O -
Existing Deck Type: Permit fee based on valuation*
Combustible ( ) Non - Combustible ( ) * see chart on back $
eRESSD 11AL T`ONCY = Class o n• _ _ City use only: WACO: 16
❑ REPAIR (MAJOR) (review required by plans examiner) (BUILD) (UBUILD)
Permit required ONLY when spaced sheathing is covered by
solid sheathing. Changes to roof line require Building Permit 8% State Surcharge $
Application. ity use only WACO:
SUBMIT TWO (2) SETS OF PLANS SPECIFYING. , (TAX) (UTAX) 6 •
A. Roof area & nearest street. r *Required for major repairs of
/ Residential
B. Attic vents - Provide 1 sq. ft. for each 150 sq. ft. of attic or "C" above * 65% Plan Review $
space. Vents shall be located in the upper 1/3 of the roof City use only: WACO:
Provide 1 sq. ft. for each 300 sq. ft. when eave & attic (BUPPLN) _ (UBUPLN)
venting is provided.
TOTAL $7 ; [
STEP 1. COMMERCIAL ONLY [ I acknowledge that I have read this application and that the
Class of Work: Repair • information given is correct; that I am the owner or authorized
Describe work to be done: (check appropriate box) 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 /Agent Date
B. Existing built -up roof covering to REMAIN: note applicant
must submit an engineer's review of the roof structural - o
elements. Review shall bear the seal (or stamp) of the
architect or engineer licensed in Oregon. Contact rson Name Telephone
C. Asphalt or wood shingle /shake . P- 6g - /8b7
(PROCEED TO STEP 2) ,.Joi s on a H ol I, 4
t :dsts\forms\roof. res. doc
8/26/99 - --
. . •
Vie KING CITY
15300 S.W. 116th Avenue, King City, Oregon 97224 -2693
IIMMINEMMINIII Phone: (503) 639-4082 • FAX (503) 639 -3771
Notice To Contractors Workin 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: ‘..1-e.,024.-/ v
located at: /5791 iLt. c ,l g,i LI & M
ie .-„,_-_,'Ag_i_.._
King City Represent v e
1:'DSTS\KCINST.DOC
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CITY OF TIGARD BUILDING INSPECTION DIVISION Ms
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
Date Requested 3 - 7 AM PM BLD
Location /5 Q .Q,1 ifisiccasuite MEC
Contact Person c&JOY) Ph g r v( - 21 3 PLM
Contractor Ph SWR
ILDI Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain 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
Roof
Misc:
i
PART FAIL
NG
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
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
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk
Other Date Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 (-018.
Date QOO C
Date Requested / . AM PM BLD
Location �] q ({� 1 V 1 c �U n Suite MEC
Contact Person 6 /kciA.../ Ph 3 / Z_/ 33 PLM
Contractor Ph SWR
UILDI enant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear /
Framing I tai Nee '•/ i A 770.1) Dd / iL/ - e ' !�
Insulation ,,//
Drywall Nailing f /e-
Firewall
Fire Sprinkler '■./ C4 /i� 4 L - 7A_l S / 0
Fire Alarm
Susp'd Ce''u •
Rs.q i
Misc:
Final
PASS PART FAIL
PLUMB!
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
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
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk
Other Date ��� Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.