Permit BUILDING PERMIT
CITY T I G A R D PERMIT #: BUP2001 -00060
,y.;� DEVELOPMENT SERVICES Mow, DATE ISSUED: 2/13/01
=-- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 15375 SW ROYALTY PKWY PARCEL: 2S110CD -05800
SUBDIVISION: KING CITY NO. 2 ZONING:
BLOCK: LOT: 015 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: : sf N: S: E: W:
OCCUPANCY GRP: TOTAL AREA: 0.00 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: 1 1 1 6. OD. D O
Remarks: Re!roof -
Owner: Contractor: 41 " c��
SORUM, POMEROYG /DAROLEN D � .
18129 SW BELTON RD j 4° 3— S � / ` 44 kV
SHERWOOD, OR 97140 V ■L-✓Le- CQ-z44..0�it._: 'L) A ce6, 6f-
Phone: Phone: 36,0 -7'-i (4
Reg #:
FEES REQUIRED INSPECTIONS
Type By Date Amount Receipt 4944ee-trrspe
PRMT CTR 2/13/01 $91.30 27200100000
Final Inspection \
5PCT CTR 2/13/01 $7.30 27200100000 EXPIRED
Total $98.60 c/72-3
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 ki
may obtain a copy of these rules or direct questions to OUNC by calling (503) 246 -1987.
Pe mi itee . l ■
Signature: // &",
Issued By: ti, Call 639 -4175 by 7 p.m. for an inspection the next business day it'
BUP - Building Permit EL C - Electrical Permit
J Inspection Description Date Passed By 4 Inspection Description Date Passed By
Footing /Setback Underground cover
Foundation walls Wall cover
Footing drain Ceiling cover
Waterproof bsmt walls Electrical rough -in
Slab Electrical service
Crawl drain Electrical final
Underfloor insulation
Post/beam structural
Shear walls /anchors ELR - Restricted Energy Permit
Roof nailing 4 Inspection Description Date Passed By
Firewall Low voltage
Tilt -up panel Electrical final
Masonry/Reinforcement
Framing
MFG - Structure set -up MEC - Mechanical Permit
Insulation
Drywall nailing 4 Inspection Description Date Passed By • Post/beam mechanical
Suspended ceiling Gas line
Engineered soils Mechanical rough -in
Welding Lab Final Fire damper
Concrete Lab Final Duct work
Bolting Lab Final Smoke detector
Fireproofing Lab Final Mechanical final
Structural observation
Final inspection
PLM - Plumbing Permit
'I Inspection Description Date Passed By
BUP - Fire Protection System Permit Plumb underslab
Inspection Description Date Passed By Crawl drain
Sprinkler underfloor /slab Post/beam plumbing
Sprinkler rough -in Plumbing top -out
Sprinkler final RP /backflow preventer
Fire alarm final Rain drain
Storm drain
Water service
SIT - Site Permit Sanitary sewer
J Inspection Description Date Passed By Culvert/catch basin
Footings Pump /fill septic tank
Foundation walls Plumbing final
Sprinkler supply lines
Sprinkler underfloor /slab
Catch basin /Manhole SWR - Sewer Permit
Engineered soils -4 Inspection Description Date Passed By
Engineering acceptance Sanitary sewer
Final inspection Final inspection •
INSPECTION RECORD - BUP, PLM, SWR, ELC, ELR, MEC, SIT PERMITS
CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2001 -00060
A DEVELOPMENT SERVICES DATE ISSUED: 2/13/01
`' '�I �! 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 15375 SW ROYALTY PKWY PARCEL: 2S110CD -05800
SUBDIVISION: KING CITY NO. 2 ZONING:
BLOCK: LOT: 015 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: : sf N: S: E: W:
OCCUPANCY GRP: TOTAL AREA: 0.00 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: . IMP SURFACE: PRO CORR: PARKING:
VALUE: Ie 00,0 0
Remarks: Reproof
Owner: Contractor: p 1st_ 4 Q p
SORUM, POMEROY G /DAROLEN D b s se .,Q,0 / "1'a`-n r�
18129 SW BELTON RD "/-"
SHERWOOD, OR 97140 V dvVi- VC) lv¢
Phone: Phone: 36,0 -- q'7 q-2I (p(
Reg #:
FEES REQUIRED INSPECTIONS
Type By Date Amount Receipt Misc. Inspection
PRMT CTR 2/13/01 $91.30 27200100000 Final Inspection
5PCT CTR 2/13/01 $7.30 27200100000
Total $98.60
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 / oil Signature: / ) 7/146
Issued By:
Call 639 -4175 by 7 p.m. for an inspection the next business day
• A A Building Permit Application
Date received:' �? _, / 3--D/ Permit no. 442/- ck2e4p
1 City of Citf Tigard
' - Project/appl. no.: Expire date:
City ojTigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 '
Phone: (503) 639 -4171 Date issued: By: I Receipt no.:
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: 1 &2 family: Simple Complex:
TYPE OF PERMIT
El 1 & 2 family dwelling or accessory ❑ Commercial/industrial 0 Multi- family ❑ New construction 0 Demolition
❑ Addition/alteration/replacement LI Tenant improvement O Fire sprinkler /alarm ❑ Other:
JOB SITE INFORMATION
Job address: S' 3 7 5 tv ,� , i ot iv A L Bldg. no.: Suite no.:
Lot: Block: Subdivision: Tax map /tax lot/account no.:
Project name: p yi
Description and location of work on premises/special conditions:
OWNER FOR SPECIAL INFORMATION, USE CHECKLIST
Name: v o 1 - ?(.4 h'1 ( Floodplain ,septic capacity, solar, etc.)
Mailing address: / g/ 2 — $ CO ,irramilwa.18, 2 family dwelling: /
.1 State: 6 ZIP: - ' i Valuation of work $ /6 0 )
Phone: �, Z 35 j Fax: E -mail: No. of bedrooms/baths 1
Owner's representative: - e, JO -- 4 Total number of floors
Phone: Fax: E -mail: New dwelling area (sq. ft.)
APPLICANT Garage/carport area (sq. ft.)
EMESUPWI
Covered porch area (sq. ft.)
Mailing address: AVAIMIMI Deck area (sq. ft.)
City: State: ZIP: Other structure area (sq. ft.)
Phone: Fax: E -mail: CommerciaUindustriaUmulti- family:
CONTRACTOR Valuation of work $
Business name: C 6 a � ` �ljt/� Existing bldg. area (sq. ft.)
�jli New bldg. area (sq. ft.)
Address: , 11 ‘.e41.5" ..r6 ��
City: //AA/ v �U Sta .. A ZIP: '8' :4 Number of stories
Type of construction
Phone: 68 z,/ aZiRjriNMEE Occupancy group(s): Existing:
CCB no.: / New:
City/metro lic. no.: - Notice: All contractors and subcontractors are required to be
ARCHITECT /DESIGNER licensed with the Oregon Construction Contractors Board under
Name: provisions of ORS 701 and may be required to be licensed in the
Address: jurisdiction where work is being performed. If the applicant is
Ci State: ZIP: exempt from licensing, the following reason applies:
ty:
Contact person: Plan no.:
Phone: Fax: E -mail:
ENGINEER
Name: Contact person: Fees due upon application $
Address: Date received:
City: State: ZIP: Amount received $
Phone: Fax: E -mail: Please refer to fee schedule.
I hereby certify I have read and examined this application and the Not all jurisdictions accept credit cards, please call jurisdiction for more information.
attached checklist. All provisions of laws and ordinances governing this O Visa 0 MasterCard
work will be complied with, th / Si:. ified herein or not / Credit card number: Expi /
Authorized signature: �- .p' _I / Date: 0'4.7"- / Name of cardholder as shown on credit card
Print name: Z lsi a // Cardholder signature $ Amount
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440-4613 (6100/COM)
P ST qi
'T ?. 3 0
One- and Two - Family Dwelling
�• ' <<
Building Permit Application Checklist Reference no.:
' Associated permits:
City of Tigard City a Tigard ❑ Electrical 0 Plumbing O Mechanical
Address: 13125 SW Hall Blvd, Tigard, OR 97223 l] Other:
Phone: (503) 639 -4171
Fax: (503) 598 -1960
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A
1 Land use actions completed. See jurisdiction criteria for concurrent reviews.
2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc.
3 Verification of approved platllot.
4 Fire district approval required.
5 Septic system permit or authorization for remodel. Existing system capacity
6 Sewer permit.
7 Water district approval.
8 Soils report. Must carry original applicable stamp and signature on file or with application.
9 Erosion control O plan ❑ permit required. Include drainage -way protection, silt fence design and location of
catch -basin protection, etc.
10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state
building codes. Lateral design details and connections must be incorporated into the plans or on a separate full -size
sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed
if copyright violations exist.
11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if
there is more than a 4-ft. elevation differential, plan must show contour lines at 2 -ft intervals); location of easements and
driveway; footprint of structure (including decks); location of wells/septic systems; utility locations; direction indicator, lot
area; building coverage area; percentage of coverage; impervious area; existing structures on site; and surface drainage.
12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent
size and location.
13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater,
furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc.
14 Cross section(s) and details. Show all framing- member sizes and spacing such as floor beams, headers, joists, sub -floor,
wall construction, roof construction. More than one cross section may be required to clearly portray construction. Show
details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings and foundation, stairs,
fireplace construction, thermal insulation, etc.
15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels.
Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope.
Full -size sheet addendums showing foundation elevations with cross references are acceptable.
16 Wall bracing (prescriptive path) and/or lateral analysis plans. Must indicate details and locations; for
non - prescriptive path analysis provide specifications and calculations to engineering standards.
17 Floor /roof framing. Provide plans for all floors/roof assemblies, indicating member sizing, spacing, and bearing
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered
systems, see item 22, "Engineer's calculations."
19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists
over 10 feet long and/or any beam/joist carrying a non - uniform load.
20 Manufactured floor /roof truss design details.
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas- piping schematic is required
for four or more appliances.
22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or
architect licensed in Oregon and shall be shown to be applicable to the project under review. -
JURISDICTIONAL SPECIFICS
23 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ".
24 Two (2) are required for Items 16, 19, 20 & 22 above.
25 Building plans shall not contain red lines or tape -ons.
26 No rolled, reversed or mirrored building plans will be accepted.
27
28
Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black ink.
Red ink is reserved for department use only. 440 -4614 (6/00/COM)
•
, .. ,..,
;,. ...,y.!•_ -4. KING CITY
15300 S.W. 116th Avenue, King City, Oregon 97224 -2693
MICEmessmiNE 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 pe form 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: ■../o /.vim - 7e.- le
located at: OW /5375 5.4.5 e
C
• .
, , , 4,_
King City Representa� e e i el
2 - /3 -0i
! Dsrs 1 :c!N•sr coc
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