Permit r
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OF T'IGARD .,,� -r, �,�,,.,.
4, ,.7. r DEVELOPMENT SERVICES ^FRMT— a • ..• , .... MRT9g— L7i',717
r , X91 I'l nr T c c;! PD . ^'3: ViE� / 9A
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639.417
4 A ' f't1RCEL : -'cam 1 1 ` pR— . / ! FF : _;a21
OITE ADDRESS. ..:lE4C RO
SW YR!..`Y PKWY
SI.JBDIVTSTOhI. , . „ :F' -INE fTT1` F® 7nh.!IhJf�.
'3LDOK.... , ... ,, . '_CT............ .JURISDICTION: KIN
Remarws: Reracf an existing single family dwell_no. Tear off ex;stino and reclacA with n:vwood and coop.
- - -- — - - --
BUILDING --
REISSUE: STORIES • 0 FLOOR AREAS - - - - -- BASEMENT... 2 sf REQUIRED SETBACKS - -- REQUIRED
CLASS OF WORK. :ALT HEIGHT • 0 FIRST 0 sf SARAGE • 0 sf LEFT • 0 SMOKE DETECTRS:
TYPE OF USE... :SF FLOOR LOAD : ? SECOND...: 0 sf FRONT • 0 PARKING SPACES: i?
TYPE OF CONST.:SN DWELLING UNITS: 0 FINBSMENT: 2 sf RIGHT • 0
OCCUPANCY GRP.:R3 BDRM: 0 BATu: 0 TOTAL - - - - -: 0 sf VALUE..$: E500 REAR • 0
— ------------- ---- -- PLUMBING
SINKS • 0 WATER CLOSETS.: 0 WASHING '+EACH..: 0 LAUNDRY TRAYS.: 0 RAIN ^RAIN ft: 0 TRAPS • 0
LAVATORIES • 0 DISHWASHERS...: 0 FLOOR DRAINS..: 0 SEWER LINE ft: 0 SF RAIN DRAINS: 0 CATCH BASINS..: 0
TUB!SHOWERS...: 0 GARBAGE DISP..: 0 WATER ' 0 WATER LINE ft: 0 BCKFLW PREUNTR: 0 GREASE TRAPS..: 0
OTHER FIXTURES: 0
- ------ - - ---- - MECHANICAL - -- ---- -- - - - --
FUEL TYPES - -- FURN ( 100K ..: 0 BOIL/CMP ( 3HP: 0 VENT FANS • 0 CLOTHES DRYERS: 0
FURN ) =120K ..: 2 UNIT HEATERS..: 0 HOODS • 0 OTHER 'UNITS...: 0
MAX INP.: 0 BTU FLOOR FURNACES: 0 VENTS • 0 WOODSTOVES • 0 GAS OUTLETS,..: 0
--------------------------- - - - - -- ELECTRICAL ------------- --- - --
-
-- RESIDENTIAL UNIT - -- - -- SERVICE /FEEDER - --- —TEMP SRVC /FEEDERS— - -- BRANCH CIRCUITS -- - - -- MISCELLANEOUS- - -- —ADD': INSPECTIONS -
1000 SF OR LESS: 0 0 - 200 alp..: 0 0 - 200 amp..: 0 W /SVC OR FDR..: 0 A'UMP /IRRIGATION: 0 PER INSPECTION: 0
EA ADD'L 500SF.: 0 201 - 402 amp..: 0 201 - 400 amp..: 0 1st W/G SVC /FDR: 0 SIGN /OUT LIN LT: 0 PER HOUR • 0
LIMITED ENERGY.: 0 421 - 600 amp..: 0 401 - 500 amp..: 0 EA ADDL ?R CIR: 0 SIGNAL /PANEL...: 0 IN PLANT....,.: T
MANE HM /SVC /FDR: 0 601 - 1%% amp.: 0 601 +asps -1000 v: 0 MINOR LABEL -10: 0
1000+ asp /volt.: 0 - - - - -- PLAN REVIEW SECTION - - --
Reconnect only.: 0 ) =4 RES UNITS..: SVC /FDR) =225 A.: ) 600 V NOMINAL: CLS AREA /SPC OCC:
--- - -- — ELECTRICAL - RESTRICTED ENERGY ------- - - - - --
A. SF RESIDENTIAL------- - - ---- B. COMMERCIAL - - -- — - - --
pUCIO & STEREO.: VACUUM SYSTEM..: AUDIO & STEREO.: FIRE ALARM • INTERCOM /PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM..: CTH: :: BOILER HNC LANDSCAPE /IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER..: CLOCK INSTRUMENTATION: MEDICAL DTHR: ..
HVAC DATA /TELE COMM.: NURSE CALLS • TOTAL * SYSTEMS: 0
Owner: Contractor: TOTAL FEES :$ 65.63
FRANCES RAGOZZINO GREG'S DUALITY ROOFINhG This permit is subject to the regulations contained in the
16465 SW ROYALTY PARKWAY 12245 SW PIONEER LN Tigard Municipal Code, State of Ore. Specialty Codes and all
'ING CITY OR 97224 # D -119 other applicable laws. All work will be done in accordance
BEAVERTON OR 97008 with approved plans. This permit will expire if work is
Phone *: Phone ##: 590 -6148 not started within 180 days of issuance, or if the work is
Reg *..: m958 suspended for more than 180 days. ATTENTION: Oregon law
— - - - -- requires you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952 -001 -0010 through CAR 952 -001 -0080. You may obtain copies of these rules or
direct questions to OUNC by calling (5033)246 -1987.
---- _--- - - - - -- - - - - - -- -- REQUIRED INSPECTION5 - - ---- - - - -- - - - --
Misc. Inspection
Final inspection
issued y��_ / // / = Permittee Signature. 0 -
-1--1-+4-1--1-+) '. r-r 1 Fi - 1 - - - + 1 ! ,- . -I ' - 'I - 1 - -^ 1 -I - +-1 - -+ I- 4 -'- +-1 -F.I -1- + 4-1- r++.! 4-1- +.1 +++-!•-1.4-4 - 1 -.1..
Call. 639 - 4175 by 7 :0121 p.m. For an inspection needed the n xt business day
CITY OF TIGARD Recd By:
13125 SW HALL BLVD. Date Rec'd:
TIGARD OR 97223 RE- ROOFING PERMIT APPLICATION Date to PE:
V - 503 - 630 - 4171 X304 Incomplete or illegible applications will not be accepted Date to DST:
F- 503 - 598 -1960 Permit #:�,5r 9
Called:
I
Nana of Developm usiness
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Street Address 2�2,,,,,,(4 Ste # Please fill out applicable section and attach copy of roofing
Job Site 1(0 Goc SEA Kw' specifications.
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Bldg , te , ` ( �+ _ Zi p d:: .b1 blit :::GC
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Name n n 1. Specification #:
F cigct.2tL3
Owner Mailing Address J 2. Manufacturer:
IL9 5., Roywc Pr k..Orny
City/State., Zip P 12 r 3a UL Classification:
5 Ci '
Roofing rvy3 s
nn (� Listed UL Building Materials Directory Page #:
Contractor re's OvaiLL 1 Z (NL. (OR)
(Prior to issuance Mailing Address —. p 2 L 't 3b Warnock Hersey :
applicant must 1 ) 1 s w f --M
provide a copy of C• /State Zip Listed Wamock Hersey Directory Page #:
all contractor [ , 9 5•"4 I> C),(2- 9 -1Z 25 (PROVIDE COPY OF ASSEMBLY)
licenses if Phone # Fax # -
expired in COT - 0 _ (O / (4 g- B. ICBO Research #:
database) S - e Constr Board # Exp. Date
'
_ `J i 9 0 3 3o 9V DATED:
::i�.l.1.1 . :4 iii: Y /r :::iL:}':•''.•'i g:: isi }: ti ::' si i:: }>.:.i:.i %Y:.: FINS: ..r— _ r i — r
.. E�I t�''` a:. �1! IE �� R�I�FI�. i:�;•.::' is� ;:.;:.;:; : :.:.:::..:::::i:.: C. SPECIAL PURPOSE ROOFING: :....:.. 00 NG: WOOD SHAKES*
Buildin e Of Use: (circle one) (* review required by plans examiner)
,SF SFA COM MF
Building - Type of Construction: VALUATION OE PROJECT
$ & SO0
Existing Deck Type: Permit fee based on valuation*
Combustible ( ) Non - Combustible ( ) * see chart on back $
':1; SIDE ALi :;;: :OI! 3f::::Cla s::ol;:.. , 1.: >.M.. .
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... . �o: rl�.. AFt�ratl�rt :.:::::.:::::::::,::.:<:..::.. CI . :.
.
RC (MAJOR) a ` ' ..
Permit required ONLY when spaced sheathing is covered by
solid sheathing. 5% State Surcharge $ 3. /_
. ity:use only: ;::i< :'. . WACO::.:: > <: >: >'::'i:;:!. >;.: ;;:;:::`:::::;::.... -
SUBMIT THREE (3.) SETS OF PLANS SPECIFYING.
A. Roof area & nearest street.
65% Plan Review $
B. Attic vents - Providel sq. ft for each 150 sq. ft of attic City use only::: WACOr• :: >::•: :
space & vents shall be located in the upper 1/3 of the roof. :(BUPPLN): < °;`;:<`::> :;:: (UBUPLN) :::: >. : `: :.::..: ••-
Provide 1 sq. ft. for each 300 sq. ft. when eaves & attic _
.......... IVIERC :: >::: >:: >:::: >:; � 1 :... . ;;;;;: . i: . i i:,;::. i:. i .::;: >:;:.iai:.iii: : I acknowledge _ $ G ` , l r
.:: a that I have read this application
and
9 tha� th
the
:: .......... .....: p�.::::. :
::.::::: ::::::::::::::. i:.
:. ;:. :i
. ;:;.;:. :.>:.;:.;; ii ;:.;:.:.:. >:.:.:.;: information Informs
ton 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 applicabel) are in
J RE -ROOF (circle A ,B or C) compliance with Oregon State law.
I A. Existing built -up roof covering to be REMOVED and deck
repaired - Signet re of Owner /Agent Date
B. Existing built -up roof covering to REMAIN: note applicant
I must submit an engineer's review of the roof structural 3 l
elements. Review shall bear the seal (or stamp) of the /
architect or engineer licensed in Oregon. Contact Person Name Telephone
C. Asphalt or wood shingle /shake
(PROCEED TO STEP 2) GY� Lei SD _ (o / r } ( ik
I:ROOF1.DOC (dsts)
CITY OF TIGARD
BUILDING PERMIT FEES
TOTAL
PLAN STATE BUILDING
VALUATION OF PERMIT F.L.S. REVIEW TAX PERMIT
PROJECT FEES (40 %) (65 %) (5 %) FEES
1 -1500 25.00 10.00 16.25 1.25 52.50
1,501-1600 26.50 10.60 17.23 1.33 55.66
1,601 -1,700 28.00 11.20 18.20 1.40 58.80
1,701 -1,800 29.50 11.80 19.18 1.48 61.96
1,801-1,900 31.00 12.40 20.15 1.55 65.10
1,901-2,000 32.50 13.00 21.13 1.63 68.26
2,001-3,000 38.50 15.40 25.03 1.93 80.86
3,001 - 4,000 44.50 17.80 28.93 2.23 93.46
4,001-5,000 50.50 20.20 32.83 2.53 106.06
5,001 -6,000 56.50 22.60 36.73 2.83 118.66
6,001-7,000 62.50 25.00 40.63 3.13 131.25
7,001 -8,000 68.50 27.40 44.53 3.43 143.86
8,001-9,000 74.50 29.80 48.43 3.73 156.46
9,001 - 10,000 80.50 32.20 52.33 4.03 169.06
10,001- 11,000 86.50 34.60 56.23 4.33 181.66
11,001-12,000 92.50 37.00 60.13 4.63 194.26
12,001- 13,000 98.50 39.40 64.03 4.93 206.86
13,001- 14,000 104.50 41.80 67.93 5.23 219.46
14,001- 15,000 110.50 44.20 71.83 5.53 232.06
15,001-16,000 116.50 46.60 75.73 5.83 244.66
16,001- 17,000 122.50 49.00 79.63 6.13 257.26
17,001- 18,000 128.50 51.40 83.53 6.43 269.86
18,001- 19,000 134.50 53.80 87.43 6.73 282.46
19,001-20,000 140.50 56.20 91.33 7.03 295.06
20,001- 21,000 146.50 58.60 95.23 7.33 307.66
21,001-22,000 152.50 61.00 99.13 7.63 320.26
22,001-23,000 158.50 63.40 103.03 7.93 332.86
23,001- 24,000 164.50 65.80 106.93 8.23 345.46
24,001- 25,000 170.50 68.20 110.83 8.53 358.06
25,001-26,000 175.00 70.00 113.75 8.75 367.50
26,001-27,000 179.50 71.80 116.68 8.98 376.96
27,001-28,000 184.00 73.60 119.60 9.20 386.40
28,001- 29,000 188.50 75.40 122.53 9.43 395.86
29,001- 30,000 193.00 77.20 125.45 9.65 405.30
30,001-31,000 197.50 79.00 128.38 9.88 414.76
31,001- 32,000 202.00 80.80 131.30 10.10 424.20
32,001- 33,000 206.50 82.60 134.23 10.33 433.66
33,001- 34,000 211.00 84.40 137.15 10.55 443.10
34,001- 35,000 215.50 86.20 140.08 10.78 452.56
35,001-36,000 220.00 88.00 143.00 11.00 462.00
36,001- 37,000 224.50 89.80 145.93 11.23 471.46
37,001- 38,000 229.00 91.60 148.85 11.45 480.90
I:ROOF1.DOC (dsts)
.
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 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:
located at:
•
, • King City Representative
IADSTS000INST.DOC
•
6/13/00 Activities for Case #: MST98 -00053
2:19:17 PM d •
Assigned Hold Updated ��
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
MSTA005 Application received 3/6/98 GEO RECD DST 3/6/98
MSTA008 Permit Created 3/6/98 GEO DONE DST 3/6/98
MSTA770 Misc. Inspection 3/6/98 DST 3/6/98
MSTA798 Final inspection 3/6/98 DST 3/6/98
MSTA092 (F) Issue combination permit 3/6/98 GEO PASS DST 3/6/98
MSTA945 Request inspection research 5/22/00 ST ' DONE No Hold ST 5/22/00
MSTA153 Expired by limitation 6/7/00 HAP DONE No Hold AKJ 6/7/00
•
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• Page 1 of.1
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