Permit CITY OF TIGARD MASTER PERMIT
/44 "° � DEVELOPMENT SERVICES PERMIT # • MST98 -0024
'j' DATE ISSUED: 02 /05/98
!+a I I- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 29115BC -11600
SITE ADDRESS...:16760 SW QUEEN ANNE AVE
SUBDIVISION • ZONING:
BLOCK LOT • JURISDICTION: KIN
Remarks: Re -roof an existing single family dwelling. Tear off and replace.
BUILDING
REISSUE: STORIES • 0 FLOOR AREAS BASEMENT...: 0 sf REQUIRED SETBACKS - REQUIRED
:j
CLASS OF WORK.f — IGHT • 0 FIRST • 0 sf GARAGE • 0 sf LEFT • 0 SMOKE DETECTRS:
TYPE OF USE.. SF FLOOR LOAD : 0 SECOND...: 0 sf FRONT • 0 PARKING SPACES: 0
TYPE OF CONST. :5N DWELLING UNITS: 0 FINBSMENf: 0 sf RIGHT • 0
OCCUPANCY GRP.:R3 BORN: 0 BATH: 0 TOTAL 0 sf VALUE..$: 7200 REAR • 0
PLUMBING
SINKS • 0 WATER CLOSETS.: 0 WASHING MACH..: 0 LAUNDRY TRAYS.: 0 RAIN DRAIN ft: 0 TRAPS • 0
LAVATORIES • 0 DISHWASHERS...: 0 FLOOR DRAINS..: 0 SEWER LINE ft: 0 SF RAIN DRAINS: 0 CATCH BASINS..: 0
TUB /SHOWERS...: 0 GARBAGE DISP..: 0 WATER HEATERS.: 0 WATER LINE ft: 0 BCKFLW PREVNTR: 0 GREASE TRAPS..: 0
OTHER FIXTURES: 0
MECHANICAL
FUEL TYPES FURN ( 100K ..: 0 BOIL /CMP ( 3HP: 0 VENT FANS : 0 CLOTHES DRYERS: 0
FURN ) =100K ..: 0 UNIT HEATERS..: 0 HOODS • 0 OTHER UNITS...: 0
MAX INP.: 0 BTU FLOOR FURNACES: 0 VENTS • 0 WOODSTOVES : 0 GAS OUTLETS...: 0
ELECTRICAL
— RESIDENTIAL UNIT— — SERVICE /FEEDER --- —TEMP SRVC /FEEDERS— — BRANCH CIRCUITS — — MISCELLANEA— - -ADD'L INSPECTIONS--
l' SF OR LESS: 0 0 - 200 alp..: 0 0 - 200 alp..: 0 W /SVC OR FOR..: 0 PUMP /IRRIGATION: 0 PER INSPECTION: 0
EA ADD'L 500SF.: 0 201 - 400 alp..: 0 201 - 400 alp..: 0 1st W/O SVC /FDR: 0 SIGN /OUT LIN LT: 0 PER HOUR • 0
LIMITED ENERGY.: 0 401 - 600 alp..: 0 401 - alp..: 0 EA ADDL BR CIR: 0 SIGNAL /PANEL...: 0 IN PLANT • 0
MANF HM/SVC/FDR: 0 601 - 1'.':' amp.: 0 601+amps- 1''.' v: 0 MINOR LABEL -10: 0
1000+ amp /volt.: 0 PLAN REVIEW SECTION
Reconnect only.: 0 )=4 RES UNITS..: SVC /FDR) =225 A.: ) V NOMINAL: CLS AREA /SPC OCC:
ELECTRICAL - RESTRICTED ENERGY
A. SF RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO.: VACUUM SYSTEM..: AUDIO & STEREO.: FIRE ALARM INTERCOM /PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM..: 0TH: .. BOILER HVAC LANDSCAPE /IRRIG: PROTECTIVE SIB:
GARAGE OPENER..: CLOCK • INSTRUMENTATION: MEDICAL OTHR: ..
HVAC • DATA/TELECOM.: NURSE CALLS • TOTAL # SYSTEMS: 0
Owner: -- -- Contractor: TOTAL FEES:$ 71.93
E. WAYNE MILLER HERMAN ROYBAL This permit is subject to the regulations contained in the
16760 SW QUEEN ANNE 1982 NE HYDE ST Tigard Municipal Code, State of Ore. Specialty Codes and all
KING CITY OR 97224 HILLSBORO OR 97124 other applicable laws. All work will be done in accordance
with approved plans. This permit will expire if work is
Phone #: Phone #: 681 -8933 not started within 180 days of issuance, or if the work is
Reg #..: 123001 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 OAR 952- 001 -0080. You may obtain copies of these rules or
direct questions to OUNC by calling (503)246 -1987.
REQUIRED INSPECTIONS
Building Final
A.
/'
Y
Issued By: / /iK_ /_ /.. Permittee Signature•'_ /_
+ + + + ++ ++ ++++++++++++ + +.' + + + + + + + + + + + + + + + + + + + + + ++ + + ++ - + + +f e1 ++ + + ++
Call 639 -4175 by 7:0" p.m. for an inspection neede- he nex /b,O"nes day
:ITY OF TIGARD Recd By:
13125 SW HALL BLVD. Date Recd:
TIGARD OR 97223 RE- ROOFING PERMIT APPLICATION Date to PE:
V- 503 684..7 171 X304 • Incomplete or illegible applications will not be accepted Date to DST:
F- 503 -684 -7297 Permit # /'/15 v- q g oh - o 5/
Called:
Name of Development/Rusin . v STEP 2:: •NEW ROOFING ASSEMBLY,::::` 0 : :
:_ •% ?. • : `:;> ;: <':><:: ;;; :: ? ;: ;:::: :.
r / ." i Materiel Docum nt tton..(tJBC�Appendlx 15t <> ` ? ,•\
Street Address I Ste* Please fill out applicable section and attach copy of roofing
Job Site /b 77•C 5 ' (, .en k specifications.
Bldg It I City State Zip Listed Assembly • . ( Circle• &Complete A; B or C) :.> : s. . : : :. :> : > : :: s::.:
/r/y7/ 972Z/ A.
C
Name /. l��., A ./ 1. Specification #
Owner Mailing AAddre /// 2. Manufacturer.
� /jam '7,0 . 4.,,, 4 . e
// City State Zip / Phone 3a UL Classification:
Al l't 9 7 22' 3y'3
Nine / /, � // Listed UL Building Materials Directory Page #:
/ 1 (OR)
Roofing Ma 'ng Address 3b Wamock Hersey :
Contractor ,,, fSS>' ,c Sp / 4
(Prior to issuance C Zip _ Listed Warnock Hersey Directory Page #:
applicant must ,,/
tire _ 6 7
r 9'.3 S (PROVIDE COPY OF ASSEMBLY)
a
provide a copy of hone 2ti
all contractor ( -- 41/ 6 �ax s
B. ICBO Research #:
licenses if State Constr.Contr. Board it E Da
expired in COT , i' j? 'j Z300 ( /j_ 9,K DATED:
database) COT Bus. Tax or Metro tic a [ Ec .Dte (PROVIDE COPY OF ASSEMBLY)
3U!LDING•!NFORMATWK'�• `:::`:•; >< >: :;�e;�< >:s<>> ?::>:: >r::: C. SPECIAL PURPOSE ROOFING: -
�� � �\� G: WOOD SHAKES' ................ .. . .....\. v \ \���: \ \`.��n \`) \ \ \ \b \C \ \�. �vbv: �h \ +`.v:.vv`iv�.:v \c.ijii`u`s'S3b v:• _
Building - Type Of Use: (circle one) e review required by plans examiner)
SF SFA COM MF
: uilding - Type of Construction: VALUATION OF PROJECT $
76.0 `V
•
xisting Deck Type: Permit fee based on valuation' �/
Combustible ( ) Non - Combustible ( ) • see chart on back $ `b . sd
_ : RESt ::.ON <:::<°» »: >;:<::; : >::< >::� ; .;.
OEIt}TtAE:: >:. LX::�< <�= <:;.:.::� :..,.::. City use on
0 REPAIR (MAJOR) (BUILD) 1 (UBUILD)
Permit required ONLY when spaced sheathing is covered by
solid sheathing. 5% State Surcharge $ 3 ' 4 3
City use only: . : WACO:
UBMIT THREE (31 SETS OF PLANS SPECIFYING. (TAX) - • I (UTgX)
L A , ' Roof area & nearest street
65% Plan Review $
B)Attic vents - Providel sq. ft. for each 150 sq. ft of attic City use only: WACO:
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
TOTAL S
. COlitllif£ RCtAE<«` �Ot► if_= T:<:><:>:<>:>:>>'> <';�<- >? >�` > ? »� >::'z: >:�:: ><':
.:..::;:; �::;.>; :.:,: ,.: .::.:....:.,..,.;...,.:<;:>:: � :....:.:::..::.;;:.>;::;.:::::. �>:;;<;>:;.;;::. :.;;;:.;;:.;:�;;:- :' ><:.�:<.�:= I acknowledge that I have read this application and that the
Describe work to be done: (check appropriate box) information given is correct; that I am the owner or authorized
3 RE -ROOF (circle A ,B or C) agent of the owner, and that the plans (if applicable) are in
A. Existing built -up roof covering to be REMOVED and deck compliance with Oregon State law.
repaired - Signature of OwnerlAgent Date
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 ct Person ame Telephone
C. Asphalt or wood shingle/shake
(PROCEED TO STEP 2) J — 2 "/ �1 t'
/ 5
I :ROOFI.DOC (fists) `
CITY OF TIGARD
BUILDING PERMIT FEES b
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)
liAld KING C ITY
15300 S.W. 116th Avenue, King City, Oregon 97224 -2693
Phone: (503) 639 -4082 • FAX (503) 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 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: �1�./IA/ O — h1.. -
located at: # 7 -b _AA /.r
il
/e-67 [� V_Day
King City Representative
I:'DSTSUCC INST. DOC
02 —I I
1 . 47
CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171 dill'
Date Requested: A
e9 \`� � —/ °� � � � P.M. MST: /
Location: /6P 7. ) A) I / ,my. BUP:
Tenant: Suite: Bld g: MEC:
Contractor: % /,j ! ` _ . L � , /
/ Phone: ( /' 79-67/6 PLM:
Owner: VOA- Phone: ‘.3c7-3473 ELC:
X POi-t F D ROOF" THEY / / 4_e - ELR:
GILL TA-RP FEn R YOU— ; SIT:
BUILDING BLDG (con't) - l UMBING MECHANICAL ' CAL SITE
Site Post/Beam h di! . st/Beam Post/Beam Cover /Service Sewer /Storm
Footing ' oo _, 1,L,4,44/W4 ndFl/Slab Rough -In Ceiling Water Line
Slab raining Top Out Gas Line Rough -In UG Sprinlder
Foundation Insulation Sewer Hood/Duct Reconnect Vault
Bsmt Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Drain A/C UG Slab
Shear /Sheath Fire Spklr /AIm Crawl/Found Dr Heat Pump Low Volt
Appr Approved Approved Approved Approved
Appr /Sdwlk -- o pproved Not Approved Not Approved Not Approved Not Approved
FINAL FINAL FINAL FINAL FINAL
0 Call for reinspection O Reinspection fee of $ required before next inspection O Unable to inspect
Inspector: 1P- �- V Date: 1 r 1/ — - V Page of
•
/144-7 g--azra 2
CITY OF TIGARD BUILDING INSPECTION DIVISION RAO—t1-5------
24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
Date Requested: l ( `_ A.M. P.M. MST:
Location: - , - _ . i A. 1 i 4 % QMPp:
Tenant: Suite: Bldg: MEC:
Contractor: Phone: PLM:
Owner: Phone: _ 7 — (, 76 ELC:
X Li / ELR:
SIT:
BUILD (con't) PLUMBING MECHANICAL ELECTRICAL SITE
Site ostBeam Post/Beam Post/Beam Cover /Service Sewer /Storm
Footing Roof UndFl/Slab Rough -In Ceiling Water Line
Slab Framing Top Out Gas Line Rough -In UG Sprinkler ,
Foundation Insulation Sewer Hood/Duct Reconnect Vault
Bsmt Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Drain A/C UG Slab
Shear /Sheath Fire Spklr /Alm Crawl/Found Dr Heat Pump Low Volt
Approved Approved Approved Approved Approved
Appr /Sdwlk ' of • :,. oved Not Approved Not Approved Not Approved Not Approved
tffIr FINAL FINAL FINAL FINAL
/ g
•
•
O Call for reinspection /� O Reinspection fee of $ / Ot- required before next inspection O Unable to inspect
g e:n4 Inspector: - L,c Date: I / e89 Page of
06 35 r
/am CITY OF TIGARD BUI I CTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
Date Requested: // d 1 ) c) -- ( 1 9 - 9S A.M. P.M. MST: 9g-(112/
Location: ! e; 766 (i/..//�J/f'L /177/1/e., I — BUP:
Tenant: // S -- uit g e: // Bldg: MEC:
Contractor/e,42 , / )} one: (D / 7 t 0 �� PLM:
Owner. P // Phone: ELC:
ELR:
SIT:
BUILDING cli LDG n't) PLUMBING MECHANICAL ELECTRICAL SITE
Site Post/Beam v Post/Beam Post/Beam Cover /Service Sewer /Storm
Footing aof . . UndFUSlab Rough -In Ceiling Water Line
Slab raining Top Out Gas Line Rough -In UG Sprinkler
Foundation Insulation Sewer Hood/Duct Reconnect Vault
Bsmt Damp Drywall Storm Furnace • Temp Service MISC.
Masonry Ceiling Rain Drain A/C UG Slab
Shear /Sheath Crawl/Found Dr Heat Pump Low Volt
Approved Approved Approved Approved Approved
Appr /Sdwlk .. , , . , Not Approved Not Approved Not Approved Not Approved
f` FINAL FINAL FINAL FINAL
•
O Call for reinspection ' O Reinspection fee of $ required before next inspection O Unable to inspect
Inspector: v Date: — 1 1 — Page of