Permit • r "
CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2001 -00237
A i t DEVELOPMENT SERVICES DATE ISSUED: 6/22/01
�--' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 11830 SW KING GEORGE DR PARCEL: 2S110CA 02200
SUBDIVISION: ZONING:
BLOCK: LOT: 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: R3 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: $ 3,980.00
Remarks: Replace shingle roof with architectural composite.
Owner: - Contractor:
BLACKLEY, KATHERINE I EXTERIORS INC
11830 SW KING GEORGE DR 1516 SE 120TH AVE
KING' CITY, OR 97224 VANCOUVER, WA 98683
Phone: - Phone: 360- 260 -1311
Reg #: LIC 126986
FEES REQUIRED INSPECTIONS
Type By Date Amount Receipt Roof Nailing Insp
PRMT CTR 6/22/01 $81.70 27200100000 Final Inspection
5PCT CTR 6/22/01 $6.54 27200100000
Total $88.24
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes
and alI,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 -6699 or 1- 800 - 332 -2344.
Permitt- - / /
Sign. ure: w��j��
Iss ed By: r f�
Call 639 -4175 by 7 p.m. for an inspection the next business day
, el .. Building Permit Application
,, Date received: 6 O( Permit no.: R-
1 1 fir City of Tigard A' � `
_ . Project/appl. no.: Expire date:
City ofTigard 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: l &2 family: Simple Complex:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ New construction ❑ Demolition
❑ Addition/alteration/replacement ❑ Tenant improvement ❑ Fire sprinkler /alarm ❑ Other:
JOB SITE INFORMATION • - -
Job address: J/33 57147 - k',' aq y Bldg. no.: Suite no.:
Lot: I Block: ISubdivision: / I Tax map /tax lot/account no.:
Project name: / ,
Description and location of work on premises/special conditions: -'et_ — — f ff) � Di7t 7 54.ye.�6 YG cf
OWNER FOR SPECIAL INFORMATION, USE CHECKLIST
Name: . 4 /� (Floodplain, septic capacity, etc.)
Mailing address: / f 23 . 5. L. . ) 4c,, d y 1 & 2 family dwelling: G� p
City: y � / �j IState:p 1/ I P: 9'7L Valuation of work $ .3 /D�
Phone: a I E -mail: No. of bedrooms/baths
Owner's representative: Total number of floors
Phone: Fax: E -mail: New dwelling area (sq. ft.)
APPLICANT •Garage/carport area (sq. ft.)
Name: Covered porch area (sq. ft.)
Mailing address: - Deck area (sq. ft.)
City: State: ZIP: Other structure area (sq. ft.)
Phone: Fax: E -mail: Commercial/industrial/multi-family:
CONTRACTOR Valuation of work $
Business name: Existing bldg. area (sq. ft.)
y 2i 1 Di <, ^-- e New bldg. area (sq. ft.)
Address: ) COQ S . / ZD Number of stories
City: L% z I State:42AI ZIP: 7f_ 1� Type of construction •
Phone: .14.4 � p �Iax: I E -mail: / Occupancy group(s): Existing:
CCB no.: J2-4 �i S' 4. New:
City /metro lic. no.: J 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
City: State: ZIP: exempt from licensing, the following reason applies:
Contact person: • I Plan no.:
Phone: Fax: E -mail:
ENGINEER
Name: Contact person: Fees due upon application $
Address: • Date received:
City: IState: IZIP:. Amount received $
Phone: I Fax: 1E-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 ❑ Visa ❑ MasterCard
work will be complied with whethe s. • '.'/.` hey. , or not. Credit card number exp'irs
Authorized signature: A „ , . * / j , . ' Date: ' 2-2, - Name of cardholder as shown on credit card.
Print name: tfi%' ' ' /.07. c ardholder s ignature $ Amount
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 446-0613 (600/COM)
a :•ai /'
RE- ROOFING PERMIT CHECK LIST ,
RESIDENTIAL; ONLY"'- '.ClassrofWork". Alteration$ ,
❑ REPAIR (MAJOR) (plan review required by plans examiner)
Building permit is required when spaced sheathing is covered by solid sheathing and /or
changes are made to roof line.
SUBMIT TWO (2) SETS OF PLANS SPECIFYING:
A. Roof area and nearest street.
B. Attic vents: Provide 1 sq. ft. for each 150 sq. ft. of attic space. Vents shall be located in
the upper 1/3 of the roof. Provide 1 sq. ft. for each 300 sq. ft. when eave and attic
venting is provided.
Note: No permit is required for residential re -roof if, (1) not more than three layers of
roofing will exist upon completion of the re- roofing or, (2) sheathing is not being applied over •
spaced sheathing (spaced sheathing usually exists when wood shingles were initially
applied).
COMMERCIAL ONLY; - Class of Work: 'Repair " `' 1
❑ RE -ROOF (circle A, B or C):
A. Existing built -up roof covering to be REMOVED and deck repaired.
B. Existing built -up roof covering to REMAIN. Note: Applicant must submit an engineer's
review of the roof structural elements. Review shall bear the seal (or stamp) of the
architect or engineer licensed in Oregon.
C. Asphalt or wood shingle /shake. (PROCEED TO STEP 2)
COMMERCIAL ONLY -Class of Work' Repairx . s " ". `°
STEP 2 NEW RQOFING AS
Material Documentation, ;(UBC,,.Appendix 15)
Please fill out applicable section and attach copy of roofing specifications.
Listed 'AAssernbly e (Circle and, c omplete A,: B`;o r.'C); . S
A. 1. Specification #: •
2. Manufacturer:
3a. UL Classification:
Listed UL Building Materials Directory Page #:
OR
3b. Warnock Hersey:
Listed Warnock Hersey Directory Page #:
*COPY OF ASSEMBLY REQUIRED
B. ICBO Research #:
Dated:
C. SPECIAL PURPOSE ROOFING: WOOD SHAKES
(Review required by plans examiner.)
VALUATION OF PROJECT:
sq. ft. of roof area
Permit Fee based on valuation:
(see Building Permit Fees chart) •
8% State Surcharge:
65% Plan Review Fee:
(Required for major repairs of Residential or
Assembly item "C" above.
TOTAL: $ J
•
•
i:dsts \forms \roofchecklist.doc 10/05/00
KING Y A 7 .44,4
' - — -
01' t
03 �
x • � 16300 S.W. 116th Avenue, Avenue, King City. Oregon 97224-2693
Phone: (603) 639 -4082 • FAX (503) 639 -3771
• Notice To Contractors Working In Ding 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 :•ill then create
the permit, issue the permit, and perfoim 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: / */(.17. der
King City/ epresentati\e
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;:i'Y OF TIGARD BUILDING INSPECTION DIVISION
`24 -Hour Inspection Line: 639 -4175 Business Line: 639 - 4171.. MST
0
Date Requested ' AM PM BUP 2oG / 2 3 7 BLD
Location /((30 „le,/ K/ r) 67-'6 v q..t 17 Suite MEC
Contact Person Ph . ,0-26- /3/ ( PLM
Cas /Sib - _coy?
Contractor Ph SWR
Tenant/Owner P /.e &. C ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation /
�i /
Drywall Nailing CPC �r/4 , 4 . A- / 1 - Ce
Firewall
Fire Sprinkler
Fire Alarm
Sus 'd Ceiling ar' 2O co a �
Roof nql f,.-,
Misc:
Final
PASS PART FAIL
PLUMBING -,, %e w .a° t;
Post & Beam
Under Slab •
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final 1�
PASS PART FAIL •
• ;MECHANICAL` '`.: ;
Post & Beam
Rough In
Gas Line
Smoke Dampers
• Final
PASS PART FAIL
•
P.
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection.fee of $ required before next inspection: Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk Date ` 7'�/ Inspector / o���`""i E x t
Other p
Final •
PASS PART' FAIL DO NOT REMOVE this inspection record from the job site. •