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-- 12490 SW KING RICHARD DRIVE �.
CITY OF TIGARD
- DEVELOPMENT SERVICES BUILDING PERMIT
13125 SW Hall Blvd., Tigard,OR 97223 (503)639.4171 PERMIT #. . . . . . . : BUP97—O213
DATE ISSUED: 04/29/97
S I Tr .!DRESS. . . : 12490 SW KING RICHARD DR PARCEL-: 28115BC-14400
�.0IVISION. . . . : ZONING:
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . a .JURISDTCTION:KIN
____=_---------------------------_—___._
REISSUE: FLOOR AREAS--------- EXTERIOR WALL CONSTRUCTION--
CLASS OF WORK. :ALT FIRST. . . . : 0 sf N: S: E: W:
TYPE OF USF. . . -SF SFCCIND. . . : 0 s f PROTECT OPEN INGS?-----�--_..___..
TYPE OF CONST. :5N 0 sf N: S: E: W:
OCCUPANCY GRP. : R?. TOTAL--------•: 0 s f POOF CONST: FIRE RET? :
OCCUPANCY LOAD: 0 BASEMENT. : 0 sf AREA SEP. RATED:
STOR. : 0 HT: 0 ft GARAGE. . . : 0 s f OCCU SEP. RATED:
DSMT?: MEZZ?: REDD SETBACKS--------- REQUIRED--------------------
FLOOR LOAD. . . . : 0 psf !_EFT: 0 ft RGHT: 0 ft FIR SPKL: SMOK DET. . :
DWELLING UNITS: 0 FRNT: 0 ft REAR: 0 ft FIR Al_RM: HNDICP ACC:
BEDRMS: 0 MATHS: 0 IMP SURFACE: 0 PRO CORR,. PARKING:
VALUE. $: F1100
RP;,farks: Residential roof
IOwner: -.._.—.-__.___.------.-----_______-_.___—_________.___—_.__—_— _.--- FEES
WALT FORMAN type amoi_int by date recpt
!.2'490 SW KING RICHARD PRMT $ 38. 50 B 04/29/97 97-293864
KING CITY OR 97224 PLCK $ 25. 03 B 04/29/97 97-293864
Phone #: 624-9541 SPCT $ 1. 93 B 04/29/97 97-293:364
Contractor: — —________—.•-•-------•---______
MAXIMUM ROOFING
GARY D MARQUEZ
9055 SW BLAKE
TUALATIN OR 97O62
Phone #: 692-6726 $ 65. 46 TOTAL.
Rep #. . : 011527
---- — REDUIRED TNSPECTIONr, —_-This permit is issued subject to the regulations contained in the _
Tigard Municipal Code, State of Ore. Specialty Codes and all other
applicable laws. All work will he done in accordance with
approved plans. This permit will expire if work is not started
within 198 days of issuance, or if work is suspended for more
than 198 days.
Permittee Si at fa r e :
Ts s IA e d By: �'..' i•L� jo.,�r_ . _ __ _ -._._ __ __ _ _ y___Y r_ _._.__..__ __�_.___.�.__.
Call for inspection — 639-4175
-7
CITY OF TIGARQ '� Q,�p
� �'
( ' �)
Permit#:]N f
13125 SW HAI.L BLVD. Date Recd: -�5 -r
TIGARD OR 97223 RE-ROOFING PERMIT Bldg: $ uV-503-639-4171 ,
F-503-5647297 x3oa APPLICATION P!an Chk: $ 5 6
St Sur. Chrg:$ .k-a:t.t- e,3
Incomplete or illegible applications will not be accepted
Name 1 Development/Business
12��1 O L'� �� p I Date work is to begin: ' � l bate Completed�:__y'j
JOB Addr ss `. i, NEW ROOFING ASSEMBLY
SITE ct .
Building Us
STEP 2
Na New Roofing Material Documentation (UBC Appendix 15)
"0 ° Please Fill Out Applicable Sections 8.
OWNER Mailing t, dress Attach Copy Of Roofing Specifications
I„21 qo
Cl 5t eCZ1 Phone -
l L c I del, 2
Name j
JOAO,, Listed Assembly:
X(u'UI
ROOFING Mailing Address 1. Specification#
CONTRACTOR
(All licenses .,Cl to Zi Phone Manufacturer: 611)_av�5
have to be 1u, (� plj��)6 7
current at St�te�o�tr.Contr. Board# p ate UL Classification: IqQ Ftye.
time of -77
Issuance) rc
OT Sus. Tax or Metro LIc M Exp.Date (or)'Vlamock Hersey:
C, -L_, �� `i J i`t 7
STEP 1 Listed UL Building Materials Directory Page#:
Describe work to be done; (circle one) Listed Warnock Hersey Directory Page#;
RE-ROOF
(JExisting (PROVIDE COPY OF ASSEMBLY-
roof covering to be REMOVED and deck ( OR )-
4paired -PROCEED to STEP M 2.
2. IC80 Research#:
S. Existing roof covering to REMAIN: NOTE;APPLICANT Dated:
MUST SUBMIT AN ENGINEER'S REVIEW OF THE ROOF STRUCTURAL ( PROVIDE COPY OF ASSEMBLY)
ELEMENTS. REVIEW SHALL BEAR THE SEAUSTAMP OF THE
ARCHIT,cT OR ENGINEER LICENSED IN OREGON 3.SPECIAL PURPOSE ROOFING: WOOD SHAKES'
(PROCEED TO STEP 4 2)
"REVIEW REQUIRED BY PLANS EXAMINER
•
EpAIR MAJO_R�._.....-i
'WH1 . UC LHMFNTS OTHER THAN SHEATHING IS TO BE
REPLACED A PLAN REVIEW 1;4 REOUIREO. ,15 78 OF PLANS MUSt C �VC>
Ij, elf MIT[ED VALUATION OF PROJECT:
Existing Deck Type:
I HEREBY STATE THAT THE BOVE INFORMATION IS
TRUE AND A� CURATE _
Combustible ( l/ I /
SIGNED: �
Non-Corrlbustible '75":,
DATE:
l;Vvof cod V97 (D:;"r)
KING CI'T'Y
16300 S.W 116th Avenue,King City,Oregon 97224.2693
Phoae:(503)639.4082•FAX(603)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 perform inspections. Please indicate on the permit application
whether you would like the Tigard staff to call you when the permit is ready .:or issuance or
whether you prefer it to be mailed without any notification. Any incomplete or illegible
application %kill 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: ), fI.6D1 pClth. "tiJ& r —
located at: 1-!�A0 wKnq LG hCLc
King City Representative
I LATS KC11ST DOC
c ccs,
I _ Ah.
. . ' • 1 . .- - . . ..
Submitted .
'Name: Mr Forman ..
•• SW King Richard A:
City; Kin City . -
Home Phone: • Phonel Fax: (503)692-6726
Phone: . .
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CITY OF TIGARD BUILDING INSPECTION NOTICE'
Inspection Line: 639-4175 Business Phone: 639-4171
Footing Rain Drain Cover/Service FIN
Foundation Water Line Ceiling -Plumb.
Post/Beam Mach, Shear/Sheath Framing Mach.
Plbg.Und/Fir/Slab Plbg.Top Out Insulation -Elect.
Post/Beam Struct. Mach, Rough-in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr/Sdwlk Reins.
Other: —
Date:
__. A.M. — P.M. nt
Address:
Tenant: S '_--- MST: •�.•e�1,�
Con/Own: BUP:MEC:
PLM: _THE FOLLOWING CORRECTIONS ARE REQUIRED. ELR:
i
Inspector:�_�
Date. t-1�
AAPPROVED DISAPPROVED/CALL FOR REINSP. CF CO