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16510 SW Monaco Lane
CITY O F T'G A R D _ BUILDING PERMIT
PERMIT#: BUP2002-00291
DEVELOPMENT SERVICES DATE ISSUED: 7/17/02
13125 SW Hall Bled., Tiqard, OR 97223 (503) 639-4171 PARCEL: 2S116AD-04600
SITE ADDRESS: 16510 SW N40NACO LN
SUBDIVISION: KING CITY NO. 11 ZONING:
BLOCK: 13 LOT: 109 JURISDICTION: KIN
REISSUE: _ FLOOR AREAS EXTERIOR WALL_CONSTRUCTION
CLASS OF WORK: GTR e FIRST: sf N: S: E: W
TYPE OF USE: MF SECOND: sf _ _PROJECT O_PE_N"'GS? _
TYPE OF CONST: sf N: S: E: W:
OCCUPANCY GRP: 1 OTAL AREA: 000 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 (_EFT: ft RGHT: � ft � FIR SPKL: SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACG:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 32,000.00
Remarks: Reroof entire building, tear-off and replace.
Owner: Contractor:
SIVERSON, ARNOLD S TRUSTEE BOB CARLSON INC
16510 SW MONACO LN PO BOX 63
KING CITY, OR 97224 HILLSBORO, OR 97123
Phone: Phone: 640-3623
Reg #: uc 5113
FEES _ REQUIRED INSPECTIONS
Type By Date Amount Receipt Dryrot After Tear-Off Insp
PRMT CTR 7/17/02 $62.50 27200200000 Final Inspection
5PCT CTR 7/17/07. $5.00 27200200000
--- Total $67.50
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes
and all 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 Notificatic-, 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 1-800-332-2.344.
Permittee nn
Signature: "
Issued B
Call 639-4175 by 7 p.m. for an inspection the next business day
Re-Roof f
Building Permit Application
� Dmti
Date � � Cry Petna,:
City of Tigard
Address: 13125 SW Hall Blvd,Tigard,OR 97223 I'rolwdappl.no.: �atr
Cay of%igard
Phone: (503) 639-4171 Date issued: BY" Receipt no.:
Tax: (503) 598-1960 Case file no.: Payment type:
Land use apPreval: 1&2 family:Sim,* Complex:
U I & 2 lanrily dwelling or accessory U Commercial/industrial 'I Multi-family 0 New construction Cl Demolition
U Addition/alu•ration/replacement U Tenant improvement 6..'ire sprinkler/alarm U Other:
Oi ON
Job address: 165 1pi..7 _ Bldg.no.: Suite no.:
Lot: Block: Subdivision; U I Tax map/tax lot/account no.:
Project name: oo �ifi�e w►t.i�t - aat.r___
Description and location of work on pro-mise.special conditions:
1
1 E' FOR SPECIAL INFORTUATION,
Name: (Floodplain I septic capaoty,solar,etc.)
Mailing add I & 2 family duelling:
City: — State: p ZIP: ,L� Valuation of work................................. .
Phone: Fax: &mail: No.of bedrooms/baths.............................. . _
Owner's representative: _ Total number of floors................
Phone: fax: 13-mail: New dwelling area(sq.ft.) ........ P11.1
Garage/carport area(sq.ft.)......................... �-
Name:
r. Covered porch area(sq.ft.) ......................... --
Mailing_ address: (� Deck area(sq.ft.) .......................................
City: State:
ZIP: �t Other structure area(sq. ft.)......................... _-- -_
Phone:(�qp_SlL L3 I Fax:&jo-4Tg1b I 1-mail: Commercial/industrialhnulti-family:
i ,. .:• i Valuation of work................................ .
Business name: b�4+�. �
Existingebid bldg.area(sq. ft.) .......................... _
Address: /Sp New bldg.arca(sq. ft.) .............................. .
City: �1a1 - -- State: R�'7.1P:S;'/1..3 Number of stories.................... .............. ....
Phone:(�•lO- l;.2 3 Fax: p.q�q E-mail: Tyle of construction....................................
- -- Occupancy group(s): Existing:
CCB no.: S 11 S New:
Cily/metrolic.no.: 16&015 Notice:All contractors and subcontractors are required to be�
ARCIPr licensed with the Oregon Construction Contractors Board under
Name: e,pp-_ _L�a�._ �r� provisions of ORS 701 and may he required to b.licensed in the
Address: p �J�_ S� w,� 2,p - jurisdiction where work is tieing performed.1[the applicant is
City: S ate:p 7.11' 0) exempt from licensing,the following reason applies:
Contact person:$}a,,c t$i�iJi Plan no.: - - �—
Phone:Z$D- 1$ Fax:Zlo-8lwo E-mail
Name: Contact person: Fees due upon application ........................... $
--------- --
Address: Date received:
City: _ State: ZIP: Amount received ......................................... $
Phone: _ Fax: _ G-mail: _ Please refer to fee schedule. 1
1 hereby unify I have read and examined this application ow,the Na all jurisdicrixu acceM credit cards,rteaw an jurisdiction r«nae lnran,.ui,x
attached checklist. All provisions of laws and ordinances governing this o visa t7 Mastercard
work will be complied with w t ified herein or not. Credit card number_— _ _ ____ / / -
Expires
Authorized signatr lrc:t _C m— Date: Name or cardholder as shown on credii card --
Print name: S o $
ai6natwe Amoaat
Notice:This permit application expims if a permit is not obtained within 180 days after it has been accepted as cumplele. 44c,46,3 ibR1Qi'Ot.t
RE-ROOFING PERMIT CHECK LIST
RESIDENTIAL ONLY - ClasE of Work: Alteration _
REPAIR(MA,iOR) (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)-1 --
COMMERCIAL
lied)»-COMMERCIAL ONLY - Class of Work: Repair
STEP 1:
Cly RE-ROOF (circle A, B or C):
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. Re,/iew shall bear the seal (or stamp)of the
architect or engineer licensed in Oregon.
C. s hp alt or wood shingle/shake. (PROCEED TO STEP ?J �—
CO _ CIAL ONLY - Class of Work: Repair
STEP 2: NEW ROOFING ASSEMBLY
Material Documentation (UBC_Appendix 1_5)_
Please fill out applicable section and attach copy of roofing specifications.
Listed_Assembly (Circle and complete A, B or C):
2. Manufacturer:
3a. UL Classification—4-- IV
Listed UL Building Materials Directory Page#: 5eea�lne.l+� Set+ 9t-+}�ecj
OF?
3b. Warnock Hersey: _
Listed Warnock Hersey Directory Page
_ `COPY OF ASSEMBLY REQUIRED_
B. ICBO Research#:E R-S o0 Z
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 Pel mit Fees chart
8% State Surcharge:
65% Plan Review Fee:
(Required for major repairs of Residential or
Assembly item"C"above.
TOTAL:
i:dsts\forms\roofcheddist.doc 10/05/00
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175
INSPECTION DIVISION Business Line: (503)639-4171 �^ MST r
BLIP 1_t1G 2-6 U ?1
Received __- Date Requested.. AM -_-_ PMBUP
� �� ` t - --------
Location _J�GL1� `"� Qr�i�CU --_ Suite --- -- - - _ _- MEC _
Contact Person __ _ _ _ Ph(_ ) _ _ PLM
Contractor -- Ph( __-) _-- SWR
Tenant/Owner -__ -�_ ELC -------- -
'-Fo m - -
ELC
Foundation Access: ,-" l-U�}.ila (�,c��� 4 /���
Ftg Drain <� g, ELF!
Crawl Drain 'T�^"� ��s!'
Slab Inspection Notes: SIT
Post&Beam ! i CO S
Shear Anchors
Ext Sheath/Shear _
Int Sheath/Shear
Framing _
Insulation
Drywall Nailing
Firewall
Fire Sprinkler --- --- - --
Fire Alarm
Susp'd Coiling ---- --
Other: 7 �
Final
PASSR FAIL
-- -
PLUMB- S
Post&Beam --- ---- ------..-.��`_
Under Slab
Rough-In
Water Service _ --
Sanitary Sewer
Rain Drains
Ca;ch Basin/Manhole
Storm Drain ——
Shower Pan
Other: ---
Final -
_--PASS PART--- FAIL ---- � -�----�---- --- -
MECHANICAL
Post&Beam
Rough-inGas Line
Line ---------- ----- ---__.�......_
Smoke Dampers -
Final ------
_PASS PARTFAIL - -- - - -- - - - - -- ----
ELECTRICAL
Service--__.- __ -- - ----
Rough-In
UG/Slab ---
Low Voltage
Fire Alarm
Final U Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
------- ---
SITE Please call for reinspection HE:. _ [1 Unable to inspect--no access
Fire Supply Line -
ADA
Approach/Sidewalk Date j` Inspector
Other: _
Final - DO NOT REMOVE this Inspection record from tho fob site.
PASS PART FAIL