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16090 SW KING CHARLES AVENUE
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CITY OF T I G A R D MASTER PERMIT
DEVELOPMENT SERN.ACES DATEEIS
ISSUED: 7/24/03 3 00392
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171
SITE ADDRESS: 160,0 SW KING CHARLES AVE PARCEL. 2S1 15BB-04100
SUBDIVISION: ZONING:
BLOCK: LOT: JURISDICTION: KIN'
REMARKS: Encicso existing front porch with new bay window and relocate front door.
BUILDING
REISSUE CUSTOM STORIES, I FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ALT HEIGHT, FIRST: sr BASEMENT: sf� LEFT: SMOKE DETECTORS:`
TYPE OF USE: SF FLOOR LOAD: .t0 SECOND- sl GARAGE.: 9 FRONT: PARKING SPACES
TYPE OF CONST: 5N nl"TELL%IG UNITS: t TORO sr RIGHT:
00
.
OCCUPANCY GRP: R3 BDRM: OATH: 1 OTAL: 0 er VALUE: 4 620 REAR:
PLUMBING
SINKS: WATER CLOSETS. WASHING MACH: LAUNDRY TRAYS: RAIN OR,i.r TnAoS:
LAVATORIES. DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS
1 UBISHOWERS: GARBA IE DISP: WATER HEATERS. WATER LINES: BCKFLW PREVNTR: CREASE TRAPS
OTHER FIXTURES:
MECHANICAL
FJEL TYPES FURN c 100K. BOIL!(-,MI'c OHP, VEN I FAN is CLOTHES DRYER
FURN>=100K: UNIT HEATERS: HOOD': OTHER UNITS:
MAX INP. btu FLOOR FURNANCES: VENTS: WOODST04FE GAS OUTLETS:
ELE,'TRICAt
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIFEEDERS BRAI4CH CIRCUITS MISCELLANEOUS l,DD'L INSPECTIONS
1000 SF OR LESS: 0 -200 amp 0 -200 amp- W,SVC OR FDR. PUMPIIRRIGATION. PER INSPECTION.
EA ADD'L 500SF: 101 - 400 amp 201 400 amp 1st N'IQ SVCIFDR: lye SIGNIOUT LIN LT: PER HOUR
LIMITED ENERGY: 401 - 600 amp-. 401 - 000 w•p LA AL'DL OR CIR: SIGNALIPANEL. IN PLANT
-
MANU HMISVCIFDR: 601 - 1000 amp ool amr:I Mov MINOR I-ABEL.
1000.ampWplt
PLANRK`.1r-W SEC,,'TN
1 Reconnect only:
—4 RES UNIT i SVCIFDR-225 A •600 V NOMi,'AL: CLS AREAISPC OCC
ELECTRICAL-RESTRICTED ENERGY
A.SF RESIDENTIA- B.CUMMERCIAL
AUD;Q R STEREO: 1ACUUM SYS rErA: AUDIO 8 STEREO: FIRE ALARM: INTERCOM/PAGING. OUTDOOR LNDSC LT
BURGl-AR ALARM OTH: BOILER: HVAC: LANDSCAPFIIRRIG PROTEC NVE SIGNL.
CARAGE OPF.IFR CLOCK: INSTRUME.NTATIOP MEDICAL: OTHR.
dVAC: DATA/TELE COMM: NURSE CALLS: TOTAL 0 SYSTEMS:
Owner: Contractor: TOTAL FEES: $ .215.'13
U CHENF OWNER A DThis permit is subject to the regulations contained In the
1_YNU
YND D KING CHARLES Tigard Municipal Code,State ) OR. Specialty Codes and
KING CITY,OR 97224 all other applicable laws. All He-k will be done in
accordance with approved plFn.. This permit will expi-e If
work is not started within 180 1 iy,of issuance;,or if th,�
work Is suspended for more than 180 days. ATTENTION:
Oregon law requires you to{,)II)wrules adopted by thr;
Phone: 503.639-7877 Phone: Oregon Utility Notification C'en =,r. Those r..Ies are SO
forth in OAR 952-001-OC10 thrr.ugh 952-001-0080. `ou
Reg N: may obtain copies of the9L rules or direct questions',o
OUNC by calling(503)246-1987.
REQUIRED INSPECTIONS
Footing Insp Frp— g Insp
Foundation Insp Extenor Sheathing Inst
Underfl-�or insulation Insulation Insp
Crawl Drain/Backwater Electrical Final
Electrical Rough In Final inspection
1 1 >
Issued R I " Ct I `''�/; PeI mittee Signature
Call (503) 639-4175 yy 7:00 p.m. for an inspection needed the next business day
Building Pern-At Ap lication FOR OFFICE USE ONLt
----— Received Building n
Date/By: //1'i C;_ Permit No._:_ �Tj ' -Cr✓J��i�
CityCit of Tigard Planning Approval Other
g Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard,Oregon 47223 Date/By: — Permit No.:
Phone: 5113-639-4171 Fax: 503-598-1960 Post-Review Land Use
Internet: www.ci.tigard.or.0Date/Dy: Case No.s Contact Julia.: 0 ser Page 1 for
24-hour Inspection Request: 503-639-4175 Name/k uthod: supplemental Information
_ TYPE OF WORK REQUIRED DATA:
New construction ❑ Demolition 1 &2 FAMILY DWELLING
Add Ition/alteration/re lacement ❑Other:
_ CATEGOR'f1F CONSTRUCTION Note: Permit fees'are based on the total value of the work performed. Indicate
1 &2-Family dwelling ❑Commercial/Industrial the value(rounded to the nearest dollar)of all equipment,materials,labor,
Accessory Buildingamid
overhaad and profit for the work indicated on this application.
Multi-[' �
Master BuilderOther: Valuation............................................ $ ` �0
JOB SITE INFORMATION and LOCATION No.of bedrooms:-_ No.of bath,--
Job site address: p Total number of floors.................... ...............
Suite#: Bld ritlew dwelling irea(sq.fl.)..............................
./A ti�_17 Garage/carport area(sq. R.)..........
Project Name: Covered porch area(sq.R.1...... ` �Js, _ A,2 t7
Deck arca f, R.
Cross street/Directions to job site: . q•fl.)...........................................
QG� - ) 6z )CI ?-4h�,� R Other structure area(sq.R.)............................
/cid /� J�-� r ,
42� ` R}��� REQUIRED DATA. —
COMMERCIAL-USE CHECKLIST
Subdivision: sr I,ot#: _I --
Tax map/par Note: Permit fees•are based on the total value of the work performed. Indicate
DESC TION_ F WOR C the value(rounded to the nearest dollar)of all equipment,materials,labor,
-` — overhead and profit for the work indicated on this application.
C 'ov a c
aation•.....................•.................................. S
/ xisting building area(sq.R.).........................
�- -- -
- -i'Qew building area(sq.R.)...............................
Number of stories............................................ ---------
AN Type of construction..••..................•.........•......
PROPERTY OWNER-_ T
Ndtrte: y - Occupancy group(s): Existing:
Address: Ncw:
Cit /Sy tate/7.i ' C/t
Phone�`p,�2w , _ _7 NOTICE: All contractors and subcontractors are required to be
APPLICAlicensed with the Oregon Construction Contractors Board under
NT CONTACT PERSON
-- provisions of ORS 701 and may be r-quired to be licensed in the
Business Name: _ - _ jurisdiction where work is being per lormed. If the applicant is exempt
Contact Name: � —� from licensing,the followinh reason applies:
Address: --_.__._-�----
Cit /State/Zi - _- _ --—•— I --- — --- -- —
'hone: Fax: ------__--- _ —
E-mail: — --- --- -�- BUILDING PERMIT FEES"
-- Please refer to fee schedule.
CONTRACTOR
Business Name:
.Address: Fees e upon application.................•............ $
— —--- j8�- -- —-
f ,�i` d!r
Cit '/Stale/71 jam- Amount r,ccived..........................................
...
--Z----p- — - - —
Phone: Fax: Crate received:
CCB Lic. #:
Authorized Nnllce: I'his permit application expires it a pencil is not obtained is itltin
Signature: IRJ dans afret it has been accepted as complete.
Z' � u L K r e jf xl' *1:
ec metbndalop� set he Tri-('ounl� R tNdinp Industry Service Board,
�/� (Please print name)
i:\Data\PermitFolmcmnldgPermitApp.doc Qi/n3
9ne-and Two-Family Dwelling -
� � � � � � � - � Reference no.: +
Building Permit Application Checklist
Cirvoffigai(l City of Tigard � Associaie,fnctmiIs:
Address: 13 125 S W hU Electrical U Plumbing U Mechanicalall Blvd,Tigard,OR 97223 U Other:
Phone: (503) 639-4171
Fax: (503) 598-1960
11 IN t
1 Land use actions completed.Sct,jurisdiction critcr❑r for concurrent reviews.
2 Zoning.Flood plain,solar balance points,seismic soils designation,historic district,etc. --
3 Verification of approved plat/lot. _
4 Fire district approval required. —"
SepUe system permit or authorization for remodel. Existing s)stem capacity
6 Sewer permit. --
7 Water district approval.
8 Soils report.Must catty original applicable stamp and signature on file or with application.
9 Erosion control U plan U permit required.Include drainage-way protection,silt fence design and location of
catch-hasin protection,etc.
10
-3 Complete sets of legible plans.Must be drawn to scale,showing conformance to applicable local and state
building codes. Lateral design details and connections must be incorp-orated int(,the plans or on a separate full-si;:c
sheet attached to the plans with cross references between plan location and dt sails. plan . view cannot he completed
if copyright violations exist.
I 1 Site/plot plan drawn to scale.The plan must show lot and building setback dimensions;pmperty comer clevatiora(if _
there is more than a 4-ft.elevation differential,plan must show contour lines at 2-ft,intervals);location ofcasements and \
driveway;footprint of structure(including decks);location of wells/septic systems;utility to atiot s;direction indicator;lot
area;building coverage area;percentage of coverage;impervious arca;existing structures an site;and surface drainage.
12 Foundation pian.Show dimensions,anchor bolLs,any;cold-downs and reinforcing pads,cot,nection details,vent
size and location.
13 Moor plans.Show all dimensions,room identiftc tion,window size,location of smoke detectors,water heater,
furnace,ventilation fans,plumbing Fixtures.balconies and decks 30 inches above g:adc,etc.
14 Cross section(s)and details.Show all framing-rnemher sizes and spacing such as floor beams,hcaders,,I oi,t.,sub-floor,
wall construction,roof constmrtion.More than one cross section may he required to clearly portray construction.Show
details of all wall and roof sheathing,roofing,roof slope,ceiling height,siding material,footings and foundation,stairs,
fireplace construction, thermal insulation,etc.
15 Elevation views.Provide elevations for new conRtntrtion:minimum of two elev^,ions for additions and remodels.
Exterior elevations must reflect the a,;tual grade if the(hangs in grade is grew r than four foot at buildinf en,elope. x
Full-size sheet addendums showing foundation elevation,with cross references are acceptable. ( \
I Wall bracing(prescriptive path)and/or lateral analysls plans.Must indicate details and locations;for
non-prescriptive path analysis provide specifications and calculations to engineering standards.
17 Floor/roof framing,Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and bearing
locations.Show attic ventilation.
18 Basement and retaining walls.Provide cross sections and d ails showing placement Of rebar. For engineered
systems,see item 22,"Engineer's calculations."
19 Beam calculations, Provide two sets of calculations using current code design values for all beams and multiple joists
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor/roof truss design details. —
21 Energy Code compliance.Identify the press;.'plive path or provide calculations.A gas-piping schematic is required
for four or more appliances.
22 Engineer's calculations.When re. rind or provided,(i.e.,shear wall,roof truss)shall he stamped by an engineer or
architect licensed in Oregon and shall he shown to he apphrihle to the project under rry iea.
23 Five(5)site plans are required for hent 1 I above. Site plans must he 5-12"x I I"or I I" x 17".
24 Two(2)sets each are required for Items 16, 19,20&22 above. _
25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will he not accepted.
26 "Reversed"building plans must meet criteria outlined in(he Permit&System Development Fees document.
27 "Drawn to scale"indicates standard architect or engineer scale.
28 Site plan to include tree size,type&location per approved project street tree plan(if applicable),and COT Street Tree List.
Checklist trust be completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black ink,
Red ink is reserved for department use only. 4404614((dW'0M)
Electrical Permit Application 'NLY
----- --- ----
Received Glcctrical
Date/B : Permit No.: f
CityCit Of Tigard Planning Approval Sign
g Date/By: Permit No.: _
13125 SW Hall Blvd. Plan Review Other -
Tigard.Oregon 97223 Date/By: Pemba:4o.:
Phone: 503-639-4171 Fax: 503-598-1960 Post-Rei iew Land Use
Date/By: Case No.:
Internet: www.ci.tigard.or.us Contact JJE See Page 2 for
24-hour Inspection Request: 503-639-4175 Name/Method: Supplemental Information.
TYPE OF F`FORK � PLAN REVIEW Please check rll that apply) _
❑ New construction Demolition Service over 225 amps- 0 1lealth-care facility
❑ Addition/alteration/replaceme:rtther: commercial ❑Hazardous location
_ ❑Service over 320 amps-rating of C3 Building over 10,000 square feet,
t:A7 EGORY OF CONSTRUCTION i &2 family dwellings four or more residential units in
I_&24 amily dwelling El Commercial/Industrial ❑System over 600 volts nominal one structure
]:]'Accessory Buildin Multi Family [I Building over three stones ❑Feeders,400 amps or more
_�' — _ ❑Occupant load over 99 persons ❑Manufactured structures or RV park
Master Builder Othe:: ❑Ggress/lighting plan ❑Other:
JOB SITE INFORMATION and LOCATION submit.—sets of plans with any of the above.
The above are not applicable to temporary construction scrvlcr.
Job site address: _ FEES SCHEDULE
--------
Suite#: Bld ./A t.#: - ---- Nit nber of Ins Ilections per permit allowed
------------- -- - --- ---- -
Project Name: t_ Description Qty Fee f_^.j Tatst
New residculial-single or multi-family per
Cross street/Directions to Job site: dwelling unit.Includes attached.,rage.
Service Included:
1000 sq.ti,or less 145.15 4
Each additional$00 sq,nor portion thereof33.40 _ 1
Subdivision: Y Lot#: _ Limited energy,residential 75.00 2
Limited energy,non residential 75.00 ___ 2
Tay,ma / arcel #: Fach manufactured home or modular dwelling
DESCRIPTION OF WORK service and/or feeder 90.90 2
Services or feeders-Installation,
alteration or relocation:
—--- __-__ —-----__-. 200 amps or less 80.30 2
201 am s to 400 ams 106.85 2
401 amps to 600 amps 160.60 _ 2
/ PROPERTY OWNER 'CIENANT 601 amps to 1000 am 240.60 _z
f — Over I IAIU amps or volts 454.65 2
sale: '- e-- Reconnect only66.85 _ 2
Aress' (�J� .� Temporary services or feeders-installation,
dd
/ 7 alteration,or relocation:
l/
City/State/Zip::`s'�f2 / ��-� 200 amps or less 66.85 I
Fhone:�3 _��'>' '� 9�vZ 201 amps to 400 am 100.30 ------ 2-
APPLICANT ONTACT PERSON 401 to OWLamps 133.75 2
--: - Branch Orculls-new,alteration.or
Name: extension per panel:
— -- — A.Fee for branch circuits with;archase of
Address: _ _6 try 2
—_ service or feeder fee,each branch circuit
Cit r/State/Zip: v B.Fee for branch circuits without purchase of
service or feeder fee first branch circuit 41,9L
Phone: � Fax: _ Each additional branch circuit 2
E-mail- � �— Misc(Service or feeder not included)
Each pump or irrigation circle 53.40 1
___CONTRACTOR-ACTOR --- Each sign or outline lighting _53.40 2
Job NO: ` Signal circuit(s)or a limited energy panel,
BU31neS5 Name: Y``- alteration Paz
or --' e2 1
_ Description
Address: _
City/State/Zip: �i F.ach aldilional inspection over thr allowable In an of the tll sve:
_Per inspection pct hour Aron-I h(ur)-- 62.50
Phone: Fax: _investi
CCB Lie. #: Lie. #: Other -
►;lectrlcal Permit Ffts4
Supervising electrician _ -- r Subtotal
signature rear aired: _ Plan Review(25%of Permit Pec S
Print Name: Lie.#: State Surcher a 8%of Permit Fee $ 'Y �,3r
_ TOTAL PERMIT FEE _s J 7 "1
XAuthorized -P �'�,, � Notice: Thh pet ml(application expires if a permit Is not obtained within
Signature rLe�'A.- l �-+D IE!"` ��T7 I80 days after it has been accepted as complPfc.
*Fee methor'uloRv set by TO-County Bullding Industry Service Board.
--(Please print name)
i•\Dsts\Permit Forms\ElcPermitApp.doc 01/03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RES-110."I"TIAL WORK ONLY:
Fee fo-all sy.it,,ms............................................................ $75.00
Clter!,Type of Work ln%rolved:
Audio and Stcreo,.;vstcrns*
!ui glar Alarm
Garage Door Opcner*
I leafing,Ventilation and Air Conditioiling System*
Vacuum Systems*
Other
Ctm,01ERCIAL WORK ONLY:
Feefor each system......................................................... $75.00
(SEE OAR 11;m-260-2601
Check Ty,,je of Work Involved:
[7 Audio and Stereu Systems
Roilcr Contiols
Clock Systems
F-1
Data Telecommunication Installation
Dire Alarm Installation
IIIA(
hrstrwncntamm
Intercom and Paging Systems
I andscupc Irrigation Control*
E] Medical
ElNurse Calls
Outdoor landscape Lighting*
Protective Signaling
Other
Number of'Systems
No licenses are required. Lirl.111se, are required for all
When installations
i:\Dsti\Pe*rmitFomls\ElcPmmi,P,ppPg2.doc 01/03
11crm►t#
Address: qo GC.I oe C mtgg LAS
I suedby: a""
Date: 71-.21/ G>_-
Statement: Information Notice to Property Owners
About Construction Responsibilities
Note: Oregon Lauv, 016 ,01.055(4), requires residential construction permit appli-
cants who are not registered with the Construction Contractors Board to sign the
followingstatement before a building permit can he issued. This statement is required
for resiaential building, electrical, mechanical, and plumbing permits. Licensed
architect and engineer applicants, exempt from registration under ORS 701,010('7),
need not submit this strrtempnt. This statement will he filed with the permit,
I-III in the appropriate blanks and initial h, .es i and 2, and either box 3A or 313:
I � I own, reside in, or will reside in t,:e completed structure.
1 understand that I must register as a construction contractor if the structure is sold or offered for sale
before or upon completion.
l 3A. My general contractor is
U (Name) Contractor regis. #
i will instruct my general contractor that all subcontractors who work on the structure must be
registered N�ith the Construction Contractors Board.
OR
0*3 B. I will be my own general contractor.
Vs
if I hire subcontractors, i will hire only subcontractors registered with the Construction Contractors
Board if I change my mind and hire a general contractor, I will contract %%ith a contractor who is
rq,iswred with the CCB and will immediately notify the office issuing this building permit of the
nainc of the contractor.
herehy certify that the above information is correct and that I has a read anal do under stand the Information
Notice to Properh, 0svners about Construction Responsibilities on lite rei erre side of this form.
(Signature of permit applicant) (Date)
(White copy to issuing agency permit file,
pink copy to applicant)
Information Notice to Property Owners
,About Construction Responsibilities
% N,,l icv to I'l'i1ft('r'li1/11711"t� 'thoia( UI s[I'la li011 k('ti,onsibdi11es
I'll-Hic['opistlucti n otiltrtlt'tors Roel d tll wilth ORS"Of 05.5(3).
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If voii art:aci 1119 ClS vI 1_r)itttj(,t1 It to(,tlrlstruct a nc:1it I'it)nic or make?1 tiUhstand aI improvement to an existing Structure.
you cars prew�" It fnanw to jk>leuls f?y, l)c ink;aiw rt 4t4c 7,o ` jjt1$Mspy!> (,t'c,q�� Kitt
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EMPLOYER RESPONSIBILITIES.,
II'%III) IIIrt l"'er+Un$ Ilul rl�l•f1 tt:r.l \All 1111 l'L1114LrI1�tJth11 t (?111r1iCit11", Bowl 11.1 do liabol III L:(lIIAI'1tU1lIW t'lr W',S t'7 In ill,-
L:1111"I I'll,
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vnu hires Dill tW .;111 mua 001111k (+ith the ftlill,M il;L,
4..)radi*n's�tiithliultlint�t:r►4)ev: :ulemploNer. titlIII kl-.f withhold income tstxesfconi empl(,vrewager atthrtill lCI-nipla\,el:,
aec-paid. Yon\\Ill t)C haWc 11:r the ili.x pIi.vinrtit"evol if Voll dol'I't tactually%a irhhold the t;)x from your ornplovec,, Vor more
inIormation,call the()r•etttin I)ent.ot'R v€nuetit94' -11O91
Unemplovnient instiran a tail: A,,an cniplo�er.woo,ire rcriuircd to pay a tax I'ar uneniploynie,lt insurance plu p(lsex tit the
wa es cel (all enlplllw(:c,. Far mare ill forinatitm.Call'the-Ure,gon bilpluyvicat L)e{iartitlentttt,:31i5-:i7�-t,
Workvrs'coitilie n4aaIion insurance: As tan cin plover.you clre stlbjc�et W the WI W orkcrs'(1:)ul1"COS lt101I lWit" ;inti Illus(
(7h1;1III ,, '=C1,r.r�. (,llrl(�t`il'�,il11111Inslarflnt�t tl'1' 4(,Ilr(.'lllpl+, wC�;, i1lntllaIiIoAlit: Ill (1orker,'omipell";1111111Ill ti1If:111C, wN,1n1aA
br .1III 1--willik"'Ind ,wIll ht:llabIl.1t11;1t1(.1,1lit'le;;.t",i(I,I1e(if inlulvd(iI,thcjob. I1_,iinort:1111+11,111atlill),
call l'i '1Voi1, I','('('tltllcnsEatHIll Ii', 1111(11 ill all~` i1CI?al'1iYlt`nl t1{�( (,Iltiill'11eJ �llld 14+I,In('S.y�1G1'\Ie19�;11 q•I;� '�{ �.
li.'~`.im�.a, ul ite►`nut tier►uc: A;art L nlplo�o. uu must%%ithht)ld t„tiL . l in(41111e tax til Ill( nlllltryt rti'1�111yec 1(rn ill hL
lint>f4 ter tilt tax p,I�rnL ntet'en it y Liu didn't urtu,lll) ►vithhald the tax. For inorc inlurrrintion,ct,lI the IwerhrtAItevelow lstxv il�C
,1t I tttli)_R�ti.,rbit),
OTHER RESPONSIBILITIES AND AREAS OF CONCERN:
C'odceowpliaance: Asthepeimit holdl�ril'l 1his,1)r(1it:o.w tlarewsp,msilok:[Ur lin,!twj\ lmlmi,lloincetcode recyilirenients
that illnl ol:ht1)ught t(1 votirallCntl(ltl Illr( lwh 111',pe'4tions.
Ilihllltl'ttnriIlrllpt'I'tVdilnlat!einlitil-ante: I ,,nl'rict.�nlil'imlinilice'10ellit ,1.t'(:ilwilIl:”,L'll(""1111,14' In,t'tm,k' I%(-r.v-,cfrlr
act pleat, uud L,I,III,:.n1nti such rig,fulling t(1t 1i.)IIint cl�er,praw. I,%wcr d;tmap., trtltn pipe punk:,ino, fire,ur►►t1rk that Itw t he
rime to snper►ise emplorce.: %til.t ,urL:%ou lim v:ni'l lellt Will:if,supw,Ise",tlr e111111 Nous
pe'rliiv: Ni,iki., )it h,llr,III;:CAIWOlw*oactatiVcult;;l\tlt_'LIIC;itICtllnl'3CI0I'.i, oidin,iteiIickkork;ltl','1)1�)i'1 ;Ti:lti(!floial'I
tlt di f and it)rn,tA t,, t l:, +,. • I,.11 the ihe> c-an perfwnt) the r(.gttir!-(l 1w,ji l
If Nolo llaLi�adi.luional t.1ueIA1011 1.1 itc or Cali the Construction Ctintra(:It)ry hi);ird 11'1?lloA I-1 I M. `�nlcnl,OR
503,979-,1621). 'I he Hoti,.1 is located 7t 7100 Stimnaer St. Nh, Suit,` 300, in Salem,
191
KIN(-
; CITY
15300 S.W.116th.avenue,King City,Oregon 972-94•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«ill 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 simple 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 sho ild you have anyquestions concerning submittal
requirements. All permit fees will be assessed and collected at the Civ of Tigard.
The City of king City hereby authorizes applicant to pursue permits at the City of Tigard
Building Department for the following project:
G
located at:
King City Representative
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CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175 MST _q
INSPECTION DIVISION Business Line: (503)639-4171 -- -
/� SUP _
Received Date Requested— `�(� AM PM BLIP
LocationD_ /Kr- _Suite MEC
Contact Person __�.i r1 _ Pn(— (p-��L-�8 �J PLM —--_
Ph ( ) _ — SWR _ T
BUILDING Tenant/Owner ___- ELC —
Foundation ELC
Ftg Dram Access: r- ---— ---
Crawl Drain ELR —_--
PostInspection Nates; �� � � SIT
Post 8 Beam S y ��ee .4 -�—
.hear Anchors - \ '"—�
Ext Sheath/Shear
Int Sheath/Shear - -
Framing _
Insulation _ r,� 0
_
Drywall Nailing
Firewall ,
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Root 1
O ier: -
Fit t
ASS PART FAIL t\t -
PLUMBING
Post -
Under Slab
Water Service _
Water _Sanitary Sewer
Sewer -
Rain Drains -"---- ___
Catch Basin/Manhole
Storm Drain - -- -----
Shower Pan
Other: ----_ --
Final ------- --------- -PASS PART--
FAIL ---
MECHANICAL
Post 8 Beam —
Rough-In
Gas Line
Smoke Dampers
Final —
P __ FAIL
ECTRICAL o V\G
Rough-In
UG/Slab —`— -- --
Low Voltage _
F' larm
s11m
Reinspection fee of$ —_required before next inspec'ion. Pay at City Hall, 13125 SW Hall Blvd.
S PART FAIL
SITE -- r� Please call forte HE-
Fire
Unable to inspect-no access
Fire Supply Line
ADA
Approach/Sidewalk Datl �_; InsapsatW 4 �,_4?i
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL