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CITY OF TIGARD BUILDING INSPECTION DIVISION MST 7 ,
24-Hour Inspection Line: 639-4175 Bu4iness Line: 639.4171
BUP _
Date Requested AM PM BLD
Location �� S -Ax.7; xe Suite _ MEC
Contact Person Ph PLM
Contractor Ph SWR _
IFA-
BUILDING mer C" .L ELC _
Retaining Wall ELR
Footing Access:
Foundation FPS
Fig Drain _ 1
Crawl DrainSGN
Slab t itequested IT
Post& Beam hound Inuring Research
Ext Sheath/Shear No Insnectionts-i In File -
Int Sheath/Shear
Framina
Insulation — --
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susly'd Ceiling — -- -- -- —.__�_ - --
PART FAIL - --------------------
BING
Post& Beam ---- - -- -- -- ---------- -
Under Slab
Top Out --- -- — --- _ - -- -
Water Servi e
Sanitary Sev er —
Rain Drains
Final ------ ---T __ —
PASS PART FAIL
---------------
MECHANICAL
Post& Beam
Rough
-- --------- --- -- —,�— --
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
J
Backfill/Grading - - ----
Sanitary Sewer
1 Storm Drain ( ]Reinspection fee of$ requircd before nex'inspection. Pay at City Hall, 13125 SW Hall Blv:1
-'
Catch Basin
Fire Supply Line [ ]Please call for reinspection RE: _ [ ]Unable to inspect no access
ADA
Approach/Sidewalk Date JG' � I� � 9g Inspector ( t~�1 Ext
Other - --
Final -
PASS FART FAIL DO NOT REMOVE this inspection record from the job site.
CITY OF 1GARD ;MASTER PERMIT
. DEVELOPMENT SERVICES A'ERMIT #. . . . . . . . MST98-031.3
1 SW Hall Blvd., Tigard,OR 97223 (503)639.4171 C ATE I SSL.IED: 07/17/98
PARCEL.: c:S110CB•-01600
SITE ADDRESS. . . : 15475 SW 123RD AVE
S1JBD I V I S I ON. . . . : ZON 114(3:
BL_OCK. . . . . . . . . . 1-OT. . . . . . . . . . . . . . •JURISDICTION: KIN
Remarks: Installing sheathing dnl coop roof materia to •.-eplac_e .00d shame roof of existing single faaily dwelling.
-- - -------- --------------------- ------------------ BUILDING ---- -- ---_— ____------ _—____ —
REISSUE: STORIES.......: 0 FLOOR AREAS -- -- -- BASEMENT...: 0 sf REQUIRED SETBACKS---- REQUIRED-------------
CLASS OF WORK.:OTR HEIGHT........: 0 FIRST....: 0 sf GARAGE.....: 6 sf LEFT..........: 0 SMOKE DETECTRS:
TYPE OF USE...:SF FLOOR LOAD....: 0 SECOND...: 0 sf FRONT.........: 0 PARKING; SPACES: 0
TYPE OF CONST.:SN DWELLING UNITS: 1 FINBSMENT: 0 sf RIGHT.........: 0
OCCUPANCY GRP.:R3 BDPM: 0 BATH: 0 TOTAL-------: 0 sf VALUE..$: 5900 REAR..........: 0
----------------------------------------------------------- PLUMBING -------------------------------------------------------
SIrvs......... 0 WATER CLOSETS.: 0 WASHING MACH..: 0 LAUNDRY TRAYS.: 0 RAIN DRAIN ft: 0 TRAPS.......... J
LAVATORIES....: 0 DISHWASHERS...: 0 FLOUR DRAINS..: 0 SEWER LINE ft: 0 P,: RAIN DRAINS: 0 CATCH BASINS..' 0
TUB/SHOWERS.... 0 GARBAGE DISP..: 0 WATER HEATERS.: 0 WATFR LINE ft: 0 BCKFLW PREVNTR: 0 GREASE TRAPS..: 0
OTHER FIXTURES: 0
--------—------------—----------------------------------- MECHANICAL -- --------------- -- ------- ---------- -----------------
FUEL. TYPES--- ---- FURN ( 1001( ..: 0 BOIL/CMP ( 3HP: 0 VENT FANS.....: 0 CLOTHFS DRYERS: 0
FURN )�:100K ..: 0 JNIT MATERS..: 0 HOODS.........: 0 OTHER UNITS...: 0
MAX INP.: 0 BTU FLOOR FURNACES: 0 VENTS.........: 0 WOODSTOVES..... 0 GAS OUTLETS...: 0
------------------------------------------------------------ ELECTRICAL -------------- -------------------•---------------------------
--RESIDENIIAL UNIT-- ---SERVICE/FEEDER---- --TEMP SRVC/FEEDERS— ---BRANCH CIRCUITS--- ----MISCELLANEOUS-- -ADD'L INSPECTIONS—
1000 SF OR LESS: A 0 - 200 amp..: 0 0 - 200 amp..: 0 N/SVE OR FDR..: 0 PUMP/IRRIGATION: 0 PER IIV,;)ECTION: 0
EA ADD'L 5005F.: 0 201 - 400 amp..: 0 20i - 400 amp..: 0 1st W/O SVC/FDR: 0 SIGN/OUT LIN LT: 0 PER F21JR......: 0
LIMITED ENERGY.: 0 431 - 600 amp..: 0 401 - 600 amp..: 0 EA ADDL BR CIR: 0 SIGNAI_/PANEL...: 0 IN PLAN)......: 0
'ANF HM/SVC/FDR: 0 601 - 1000 amp.: 0 601+asps-1000 v: 0 MINOR LABEL -19: 0
1000+ alp/volt.- 0 ----------------------------------- PLAN REVIEW SECTION -__------------------------------.
Reconnect onl/.: 0 )-4 RES UNITS..: SVC/FDR)=225 A.: ) 600 V NOMINAL: CLS AREA/SPC OCC:
--------- ------------------------------------------- ELECTRICAL - RESTRICIEL ENERGY -- ------------------------------------------------
A. SF RESILrNTIAL---------------------------- B. COMMERCIAL------------------------ ----- ---------------_---__...-----
AUDIO I ]TEREI.: VACUUM SYSTEM..: AUDIO I STEREEO.: FIRE ALARM.....: INTEPCOM/PAGING: OUTDOOR LNDSC LT:
BUPGLPR ALARM. : OTH: :: BOILER.........: HVAC...........: LANDSCAPE/IRR1G: PROTECTIVE SiGNL:
GARAGE OPENER.. - CLOCK..........: INSTRUMENTATION: MEDICAL........: OTHR: ••
HVAC...........: DATA/TELE COMM.: NURSE CALLS....: TOTAL t SYSTEMS: 0
Owner: ------------------------------------Contractor: ----------------------------•- TOTAL FEES:s %.06
CONNIE SCHWARTZ CLOW ROOFING AND SIDING CO This permit is subject to the regulations contained in the
15475 SW 123RD AVE 434 N TILLAM001( Tigard Municipal Code, State of Ore. Specialty Codes and all
V ING CITY OR 97224 PORTLAND OR 97227 other applicable laws. All work will be done in accordance
with approved plans. This peroit will expire if work is
Rhone N: 230-3026 Phone A: 281-1756 not started within 180 days of issuance, or if the work is
Reg C.: 000403 suspended for sore than 180 days. ATTENTION: Oregon law
- -----••------------------• ------------ requires you to follow rules adopted by the Oregon Utility
n Notification Center. Those rules are set forth it DAR 952-001•-0010 through OAR 952-001 0080. You sail- obtain copies of these rules or
direct questions to OUNC by calling (503)[146-1987.
----------------------------------------------------- REQUIRED INSPECTIONS ---•--- ------------------------------------ ..-------------
> Final inspection
w
Issued By : -- Permittee Signao
++++++++++++++ +++++++++++++++++++++++++++++++++•++++++-F-+i+++++++t++++++++++++
Call 639--4175 by 7:00 p. m. for^ an inspection neeG•rd the next business day
07,'1.4 c` TCF. 11 : 19 FAX 503 5:3S 1960 Elie OF TIGAW) REROOF with cearoff , o o 2
CITY OF TIGARD Plan Check#:2 _2
13125,SW HALL BLVD. Rec'd By: -Z�
i1GARD OR 97223 RE-ROOFING PERMIT APPLICATION Date Recd: 4
V- 503-539-4171 X304 Commercial a,- J Residential Date to PE:
F-503-593-1960 KI� Date to DST:
Permi;#;�Si
Incomplete or illegible applications will not be accepted Called:
Name o°Devel:pment/Business STEP 2. NEW ROOFING ASSEMBLY _
Material Documentation(UBC Appendix 151
Street AadresP Ste# Please fill out applicable section and attach copy of roofing
Job Site 15475 SW 123rd A V specifications.
Blog# City;State Zip Usted Assembly (Circle& Complete A, B orC)
i KING CITY , OR 9_7224 A.
Name _ 1. Specification
CONNIE SCHWARTZ
Applicant Mailing Address I 2. Manufacturer:
15475 SW 123RD AVE i
lCity/StateI Zip I Prnone2 0- '3a UL Classification:
KING CpTY ,OR 97224 ! 3026 lW)
I )r fins Name Listed UL Building t✓aerials Diracto,ry Page#:
Cont�ac,or CLOW ROOFING &_ SIDING_ CO (OR)
(Prior to issuance Mailing Address '3b Warnock Hersey
applicant st 4 N TI L L A M O O K ---
provide a rod f City/State Zip Listed Warnock Hersey Directory Page#:
all contrac or PORTLAND-.,—OR 197227 - 1898 _ 'COPY CF ASSEMBLY REQUIRED _
licenses if Phone# Fax#
expired in COT 2 81 - 12 3 8 281 - 1 7 5 6 B. ICBG Research#:_
database; State Constr.Contr Boat# Exp. Date
_ 140364 Ilp/19� _ __DA_TE_D:
BUILnINGYNFORMAttON C, SPECIAL PURPOSE ROOFING WOOD SHAI:ES
Building-Type Of Use: (circle one) (review required by plans examiner)
SF SFA COM MF
Building - Type of Construction: VALUATION OF PROJECT $
_ sq ft.__of roof area _
Existing Deck Type: Permit fee based on valuation"
Combustible ( ) Non-Combustible ( ) _ 'see uha;;or, back S
RESIDENTIAL ONLY-Class of Work:Alteration I City use only: WACO:
REPAIR (MAJOR review required by plans examiner) ( (BUILD) (UBUILD)
Permit require ONL ,when spaced sheath;ng is covered by
solid sheathing )anges to roof line require Building Permit 5% State Surcharge S a hr
Application. City use only: WACO:
SUBMIT `1N0 12) SETS OF PLANS SPECIFYING. _(TAX) (UTAX)
A. Roof area & nearest street. 'Required for major repairs of Residential
B. Attic vents- Provide 1 sq. ft. forbach 150 sq. ft. of attic or'C" above ' 65% Plan_ Review $ 3,6 Z'Y
space. Vents shall be located in the upper 1/3 of the rorf. City use only: WAC0:
Provide I sq.ft, for each 300 sq. ft.when eave& attic (BUPPLN) _ (UBUPLN)
venting is provided.
TOTAL S ,p ,
STEP 1. COMMERCIAL ONLY I acknowledge that I have read this application and that the
Gess of Work: Repair information given is correct, that I am the owner or authorized
T 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
co B. Existing built-up roof covering to REMAIN: note applicant CLOW ROOFING & I D I N G C O
mus?submit an engmeer's review of the rcaf structural h
elements. Review shall bear the seal (or stamp) of the yam'"" f'1 fes„` 7 �/9i3
arch'tect or engineer licensed in Oregon. tact Person Name T�I9tph�ono
C. Asphalt or woodshingleishake Dennis M flaker 128111-11238
(PROCEED TO STEP 2)
I:ROOF'1 DOC(dsts) EV 8/1/98
]KING CITY
16300 S.W.116th Avenue,King City,Oregon 97224.2693
e� Phone:(.503)639.4082•FAX(503)639.3771
Notice To Contractors Workina In Kincr city
Due Lo 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 NO"r REQUIRE PLAN REVIEW, simply complete the
appropriate application legibly and submit it to the King City staff. The King Cite 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
a
Building Department for the following project: _ 9t.A- - '4ozy
G located at: 1-5Z7-S- Z 3-c i t
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H
I1J King City Representati0
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I DSTS XCIYST DOC
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