12210 SW PAR 4 DRIVE ADDRESS:
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iArecords\microflmMt rgets\building.doc
INSPECTION N(XfICE
City of Tign M Building Department
13125 SH "all blvd. Tigard. Oregon 97223
Inspection Line (Rec-O-VkLre): 639-4175 Business Phone: 639-41.71
Inspection:__ S /_0,'7 e --
Footing Plbg. Underelab Mech. Rough-in Appr/Sdwlk
Found. Plbg. Top Out Gas Line FINALS `
Poet/Beam Struct. San. Sewer Framing -Bldg.
Poet./Beam Mach. Rales Drain Innulation -Plumb.
11bg. Underfiojr Water Line�i Gyp. Bd. -Mech.
Date Requeetc:.a.._ `�` / Times AM PN
hddress: I L) C Permit 6zl iO
Builder:/�_ 2oU` T"l')�]qr
THE FOLLOFIING 0ORREc7TIONS ARE B.EQUIRM '7'7 7 7- / C, S J
- o c-0 h 1�Ol c S e S
At —
/ 7
Inspector: ! Date:
_APPROVED
DISAPPROVED APPROVED SUBJECT TO ABOVE
-__—Call For Reinsp.
KING (.CITY
15300 S.W. I kith Avenue,Bing City,0,ey;on 97224 Ph ane:6:39-4082
COMMUNITY DEVELOPMENT
APPLICATION FOR BUILDING PERMIT
(Instructions on reverse)
DATE_ 4--
1.
-1. NAME OF APPL I CANT: V6"(& C- %y `; / w Phone No.
ADDRESS: /Z c�,Z— 5, W. A;E Y 651 C — —
ADDRESS OF PROPOSED IMPROVEME14T_Z,2
TYPE OF MANGE, IMPROvTT- ENT OF. CONSTRUCTICN FOR WHICH PERMIT IS REQUESTED.
DE:CRIBE BRIEFLY - ATTACH 'IWO COPIES OF PLANS OR. DRAWINGS OF
PROPOSED PROJECT: 2 E Q(_4c C--
3.
--3. NAME MMD ADDRESS OF CONTRACTOR 2A r r<r el"7/15 jl iZ Pa
_— PHONE NO.Z2 Z. 7�. 7 ,c_ _L i CENSENei 9 5
4. NEIGHBORS WHO MAY BE AFFECTED BY THIS PROJECT WILL BE NOTIFIED BY THE CITY.
S. APPLICANT OR HER/HTS REPFVSE4TATIVE MUST BE PRESENT AT THE PLANNING COMMISStON
MF-FrING NEXT HELD ON_ _
REPRESS TATIVES NAME— PHONE NO._
(The King City Planning C(mmission will consider only those applications received at least five (5) days
prior to a meeting.)
SIGNATURE
APPLICATION RECEIVED BY. c DATE-
APPLICABLE FEE r ECE1VE7 L�
PLANNING CCMMISSION DECISION: Apptoved. Df-nled
CONDITIONS
Approved applications are valid for sii months �cly
Signature.._ Date
f' Date
NOTE, Oregon oo uilders Law requires that all persons who contract for work an their re_A ence be
registered with the Builders Board which means the contractor is banded and insured o3 the job site
For your protection, be certain your contractor is registered by calling City Ball Ph; 639-4081.
NOTE: A permit trust also be obtained from the City of Tigard Department of
Comrimity Develoyirne-lit Yes _ No_
*********'�:it***�f�t7t*'!F*�C*k71r****/t*****�r*At*�I'*A'�t*A*/(**yr*A*A7k9r7k*k**•k 7k�I/C 7I IY�IA kA�'***/c**JIB****
CITY OF TIGARDINSPEC'PION REP,.:T
The above listed project has been inspected and Aporoved_ ✓ Denied
Gate_( - /-—2Y-- Connent.s -- -
Signatui!eF-`� —_���_2���-3--r—✓ .��_�.r� _ �.-----•
�din9 4-rv5pect0n Pte&Ae. r AuAm one. ( 1 J copy to King City i
TNSPE("'ION NOTICE
City of Tigard Building Departaent
13125 ON Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O-Phone)s 639-4175 Business Phone: 1,39-4171
Inspection: 1
F-,otinq Plbg. Underslab Mech. t4/'h-in Appr/Sdwlk
Found. Plbq. Top Out Can Line FINAL:
Post/Beam Struct. San. Sewer Framing -Bldg.
Post/Beim Mech. train Drain Insulation -Plumb.
Plbg. Underfloor Nater Line Gyp. Bd. -Mech.
Date Requested: :) —Timet AM PN
-170
Address:�L� Permit t:
Buiider: deeftl
THE FOLLOWING CORRECTIONS ARE REQUIRED:
Inspector:__4/�1./I _ Date: p
��APPROVED DISAPPROVED APPRIVRD SU&IECT TO ABMIX
call For Reinep.
CHN OF TIGARD
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd.Tigard,Oregon 97223.8199 (503)839-4171
i..i 1. ... .. ., _. .
(� j� 13175 SW HsU Blvd. PLNCK/RECTCITY OF TIGA D PERMIT
COMMUNITY DEVELOPMENT DEPARTMENT T,prd.O,e6on,9?W
(503)b394171 DATE ISSUED
�CraCo �� l
JOB ADDRESS: 12210 _ IzZ9G 5•w • Paz V TAX MAP/LOT %II L,rZ1%6•s
SUB: LOT: LAND USE:
/ �ALUAT I JN: `fS
DOWNER
KESPECIAL NOTES
N` C�iY FAX �` TowaN�•as�$ �flss�v
NAME: REISSUE OF: _
ADDRESS: iz' �� 5. w. eArz. y Dz,.�F_ LAST REISSUE: —
-- orZ q�zz.yt
/C -3G �,,j J _ FLOOD PLAIN/
PHONE: Z - lSENSITIVE LAND:
CONTRACTOR APPROVALS REQUIRED
NAME: 24), Ke - nlq-STEm5 L..• PLANNING:
ADDRESS: ' • gsn ENGINEERING: _
�oZ (,9wp 'Z 9.7-24 FIRE DEPT. _
PHONE: -7.r""1 C('3 _ OTHER: _
_ CONTR. BOARS 0: 31115 EXP DATE: _
ITEMS REQUIRED
SUBCONTRACTORS: PLUMB: _ LIST/SUBCONTRACTORS: _
MECH: _ BUS TAX: —
ARCH ENGINEER CALCULATIOMS:
NAME: TRUSS DETAILS: _
ADDRESS: OTHER:
PHONE:
PROPOSED BLDG. USE:COMMENTS:
v
APPLICANT SIGNATURE
Received By: Date Received:
PERMIT # ACCT # DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE
10-432 00 Building Permit Fees
10-431 00 Plumbing Permit Fees _
10-431 01 Mechanical Permit Fees _
10-230 01 State Building Tax (5%)
Building
Plumbing _
Mechanical
10-433 00 Plans Check Fee / 3
Building
Plumbing
Mechanical
10-230 06 Fire
30-202 00 Sewer Connection
30-444 00 Sewer Inspection
25-448-02 Commercial TIF Fees
25-448-04 Industrial TIF Fees
25-448-06 Institutional TIF Fees
25-448-03 Office TIF Fees
25-448-01 Residential Traffic Fees
25-448-05 Mass Transit TIF Fees
52-449 00 Parks System Oev Charge (PDC) —
31-450 00 Storm Drainage Syst Oev Chrg
(SSDC)
24-445-01 Water Quality (Fee in lieu of)
24-445-02 Water Quantity (Fee in lieu of)
TOTAL
nm/3587P.WPf=
r ,
CITY OF I'MARD FECT I PT OF P'AYME'NT PECE'IPT No.
CHLCK AMOUNV 21.�J,71
OPME o KING CITY TOWNHOUSFS CASH AMOUNT 0. 00
fJ.)DRr-..SS SVC':!; ASSN. PAYMPNT OAT'- V 14 0 2;
SjUSD I V I S I ON
[A)PPOSE OF PlMilf-J41' Alin-UNT PAID PUPPIOSU-7. OF V-lr4YMFN. l" AmflUlA I P01:V?
U- D-—I G- E-('?*M- 50 PLAN PF
CO. BUILD PUP
1 i
li-.*?'W SM PAR 4 DR, C) flp'
RE...HOOF I NG PERMIT
VIVIL flt4CJL)rJ,r r-',n i r) 04,4'
----APR-20-'93 93 TUE 0858 I U:C I T'' 1_F t'I tC -I T',' Fk' 111--1:503 639-3771 4693 Pt71
Post-It'brand tax transmittal memo 7671 N of pages►
fh / Prom
r',"Tir%1Z / 2c_'/iSS�
KING CITY T,2 arl rre. # /r c, 4
Dept. Pews r 7L j Phnr,e N G7.3�
15300 W 1 tfith Avenue,}sing City,Oregon 97224 Phunr Fs■N l^ — Fax a r- 7 ��
COMMUNITY ---
APPLICATION FOR
(Instructioos on reverse)
DAr!'E cr[_ 19 1 3 N c C +Y Pa z y
Phone No. 5`
. T,r{�r� 1�o..,�S ��u .As��
1. NAME OF APPLICAN`I' h�2 � 1 _Rr v� ![, C.i i y --
ADDRFSS: t Z u - P A(C 4 n,2 r 4 , ,G C
ADDRESS OF PROPOSED IMM:)VEMMiT_12 I- 11-1
2. TYPE 4F MANGE It4FROVPMPN'P OR CW 5'TRUGT T ON FOR WH I Chi PERMIT IS REQUFSIM:).
L'E:CRIAF BRIEFLY - ATTAac�� 'IWO COP1F.& OF P S QR j)RAWINGS OF
PROpcMM PKUJECT: -----
2Hrnr _ InAti,T fL �� �F' �� r1r4
3. NAME AND ADL*ESS OF CONTRACTOR-- 3 l 19
Iz,(�1 N➢ ,lz f 1?HONE N). 2 7-1_-I�_LICENSE NO.
4. NE I uEWpO s WHO MAY BE AFFECTED ED BY THIS PROJECT WILL hE NOTIFIED ii`l THE C:I TY-
5. APPLICANT OR HER/HIS
REPRES'ENTAT I VE MUST BF PRESENT AT THE PLANNING O("I SS I ON
MEETING NEXT HELD ON_ — -- '—- -
REPRFSENTA.TIVES PHONE ------
(The King City Planning Coemission Bill consider only those applications received At least five (5) days
prior to a meeting.)
_.-----------_---
r*******�r,r****�****x�srx*t**********,r�**#************vc*******:t*******�x**vr****i�it***
-- -- DATE LL - -
APFLICATION RECEIVED BY—J-"!
APPLICABLE FEE RDCTTVED —
PLANNING CEMISSIM T) SIO[Vi—0=pv-
GOND
ITIONS-- Qa
' plical' n lid jot sit 11tos only
`- ''
Signatt.tre_ % � Date L.,�.1..---------•-
NOTB: a mebuilders Lar requires that all persons who contract for wor oa their residence be
registered with the Buildirs Hoard vhicb m�aos the contractor is banded And insured on the job site.
Per your protection, be eertain your contractor is registered by calling City Hall Ph: C9 4082,
NVid: A permit rraast naso be obtaina
F-d fru the City of Tigard Department of
Cam mi t y Devel opmit ----
CITY OF TIGARD_INS_ppt;T ON REPORT
The abpVP_ listed project oj ect has beets inspected and Approved_.—__—pesiied ._.
r
Dale c1cffn ►nts —
Signature _._ --- o►ut (11 copytokui9 Ci4)
PR-20-'93 TUE 0$: ID:CITY CiF KING CITY FAX Nb:503 639-3771 #693 P02
000765
L .. Date_ 1?
EXCI LLENCE IN ROOFING
� Sourc9
F�J J7,& Grid
1RAIN•MAmit ROOFING CO., INC. . FAX 15031775-3670
8315 S.E.82nd Ave.,Portland,OR 97188 - Mailing Address:P.O.BOA 1§ 39.P.rtlsrrd,OR 97216 (503) 777-7663
t
_11lru v C iTV 11''AM 11
NAME N .r l+� IA�..w N�-•t t adv_ 'J R 5,PHONE
BTREET �Z(O - I��-9>IZ�r••?pd r Four' �r. _ BUS.PHONE
CITY Ki•yr e;' ' )r- - -- STATE L�i'• �.ZIP —
JOB ADDRESS " COMMENTS —
Oregon License*31195 ROOF DESCRIPTION Washington License x RAI—NM/RC117NT
�o c� exrs��"7 u ..lit 5 ---AGE . PITCH _ �'Z' —
SQS..MORE OR LES.SJ69y MATERIA- --- --
Fl. VALLEY FT. ROOF DEG y ... DROP BbX �7� U YUS.
HIPS — �"
STYLE: GABLE V DUTCH HIP ❑ CONTEMPORARY ❑ HEIGHT-1—STORY , COLOR �HIP C1❑ MANSARD U OTHER--_ NEW MATERIA
S S
HEIPONSI•ILITY:The following responsibilities will be assumed by you or us as Indicated.
UsYou Us You Us You
Uf ❑ ❑
Delivery..................................... (a O Drip Edge............,.,,.,.....,...,..,... Debris Removal........................ �
Roof Pre 0 U Flashing.......... ... ❑ Clean rip Job Site., .... .. 0 ❑ • A
Prop .............. Permit..........................r.......
Roel RamovaL.......................... rd C] Counter Flash.......,.....,.N1A... ❑ I=)
11 Iff
Roof Material........................... 0 U Sheathing Removal... ...., O ❑ Gutter Removal.. .......... O ❑
Roof Installation...................... 0 ❑ Sheathlno Ine111111 ............ ,..... O ❑ Gutter Material............... ........ CJ ❑
Ridge Ca _.-.......1. YI ❑ Gutter installation........ ❑ ❑
RootVents............................ 7 ❑ p.. ...........
We propose to furnish and Inslall the Items below In accordanee with the following conditions wid specifications:
ae wOu�'r g .-A- 5 L kALC —41 roo!i-...y I iL''d I
Ort t Ll N � ...�_�j_,•-G�� "►1 /r )'
�,, �r l.�.�-- ��'11 J►� ��9 �il'Y G./-�7 _�.Q � X41: ' Mit r.rft <.IV," .7 CXfMri- eteot r
f�eui'er.ely
4. i"
•DL( .jr - r-c a,'r' rIL4- Aide. f
AST "SO 5(,q T \
w1o�r�� " COI�k t Sew s
�464 Kaw1i �I�G.yes-y� Irl Rr.r �� -
Vrtrn�+VE (TJf_l Yi5 r~ G -�iinm Ar�K�. rrti. Ara i)6ILA�t
t. Our work will be parlor-rppd by skilled tradeernon and will comply with presently eAlsting codes and regulations.
2.All labor furnish by uV A beer s.t year warranty from the date of installation against defects in workmanship.If a roof Installed by
us leaks within t�yea+al and labor furnished by us will a one
I of completion duo to labor furnished by us,we will repair such looks without charge to the customer All putter
metal materiill hear warranty from date of Installation against defects in workman•
and sheet
ship and met leis. (II pA,./ 'n6 '
` i Z`fEEouLA '
e
3, Servlce under Ihls warranty will only be provided during normal working hours. Lu�.•r-?"AWT,?"AWT, f�r•1a'
4.Ourinp Installatlen we shall lake all ressonebie precautions In avoid Injury to persons and damagn to properly. *etE'r ZS'93�
�hrifrs 3r o 0
Title to the material will remain with us until all sums due us have been paid. 7/1097 3 •�"
q3
b. Any materiel or labor In addition to that required by this proposal will be paid for by you as an extra at our normal rotas. o
7. 11 is understood that this proposal sets forth our entire agreement.
S. This proposal will become a contract between us If accepted by Vnu and approved in writing by our duly oulirvriied representative
aterial or
ll
ly be exouutod
written
g alteration
same,and andiwill bscomen from han extra cve harpeentions over the sumsng^xtro costs of mentioned to this rc contract Allarsalmenls must be made nnwriting.
10. All materials deliverer' to job site remain the property of Rain-Master Roofing Co., Inc.until actual application/attachment to
subject structure,
11.The Contractor agrees to carry Workman's Compensation and Public Llablilly Insurance,also to pay all ;ales Taxes,Old Age Benelit,
and Unemployment Compensation taxes upon the materlal and labor furnished under this contrast as i tquirod by the United Slates
r,._er..r.t+._hlrh MI•omits �- na/IAfined.
VUVtl1111,ItlIR r,W u.e Vw•o. . ......... ...... ..�... � _ ^-_
JOB DESCRIPTION
PRICE
ADDITIONAL CHARGE. ITEMS:Optional
_
are_ I
1 rq M.
W
2. air a.� r Si.. 7' _. r --
3.
3.
3. L—..__._ -- -Pry—ry
4.
Commanla ,�t1J�1 ir.s �wl(1rf,a+1 wry,f or pp Tax --' ---.._
--�� — F.1CrfCni.! n+¢• ore g ,/t�eJ C�A.t,— Total --
r ou, the Buyer, may cancel this transaction at any time poor to midnight of the third business day after the date of acceptance.
RAIN STER UFI,(NG CO., INC.
TERMS OF PAYMENT;
_upon af:ceptance of agreement. _ .:.__-_!!___ -_—_ ----
(t)
NOTE:This proposal may he withdrawn if not occupied withirC10
L100
xgj am— -- --- n completion.
Balance of upo
days.
ACCEPTANCE
The above prices and eoneltlons are satlslactory and are hereby ac
Cepled. You are authorl7,.A to do the work staled. Payment will he 6lpnalureX
made as outlined above.
Date olAr.ceplence -r -_--- !------- -- - — 94 r•.trr9
„ . ., , , wrap}' f7FfIPF r,ii. ,,i_. -t n •: i