Permit . . .._. — _ . . .v;
CITY OF TIGARDII REROOF PERMIT
• COMMUNITY DEVELOPMENT Permit#: RER2022-00002
T 16 A II..D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 4/25/2022
Parcel: 2S110DC01000
Jurisdiction: Tigard
Site address: 11055 SW MEADOWBROOK DR 1
Project: Summerfield Re-roof Subdivision: WILLOW-BROOK-FARM Lot: 17
Project Description: Re-roof: remove and replace(2)layers of asphalt shingles and install new Certainleed Landmark asphalt
shingles roof system
Contractor: CARLSON ROOFING CO INC Owner: SUMMERFIELD ASSOCIATES LLC
PO BOX 1695 BY GREYSTAR RS NW LLC
HILLSBORO, OR 97123 1125 NHW COUCH ST STE 450
PORTLAND, OR 97209
PHONE: 503-846-1575 PHONE:
FAX: 503-640-2122
FEES
Description Date Amount
Permit Fee 03/01/2022 $464.97
Specifics: 12%State Surcharge-Building 03/01/2022 $55.80
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Load:
Stories: Height: 0 ft
Project Valuation: $25,041.00
I
General Information
Building Area: 0
Re-Roof Area: 0
Roof Class:
Tear Off:
Overlay:
Existing Roof Layers:
Parapets:
Total $520.77
Required Items and Reports(Conditions)
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
the 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 952-001-0090 You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Ho-wa va.. De. Wege Permittee Signature: Qvy A
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
. _ _ ._ W . , . .. ,.
Building Permit Application EC E I V E D 4
Re-Roof FOR OFFUt ('SF O\l.l
City of Tigard //�� Received
1 \\NV22 Permit No.:n1_q 2Q2Z-I �Z-
a 13125 SW Hall Blvd,,Tigard,OR 9722 ITY OF TIGANU Plan Review Other Permit:
0 Phone: 503.718.2439 Fax: 503.598. '.I n Date/By:
Inspection Line: 503.639.4175 WING DIVISION Date Ready/By: \` \\`- 1 0 See Page 2 for
T I u''''D Internet: www.tigard-or.gov Notified/Method: \ efetRt b Supplemental Information
TYPE OF WORK REQUIRED DATA:I-AND 2-FAMILY DWELLING
El New construction 0 Demolition Permit fees'are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
K.Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation: $
❑1-and 2-family dwelling aCommercial/industrial
Multi-familyNumber of bedrooms:
❑Accessory building
❑Master builder J 0 Other: Number of bathrooms:
duo s JOB SITE INFORMATION AND LOCATION Total number of floors:
-Job site address:_�L$$ Qr1 lilt���)r ( New dwelling area: square feet
City/State/ZIP: ` `C3r c ,;e-� o 9-} �� Garage/carport area: square feet
1 `"'
Suite/bldg./apt.no.:, -)l q ,project name: ttilf*�exck -.(• Covered porch area: square feet
Cross street/directions to job site:' �' Deck area: square feet
Other structure area: square feet
' REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot no.: Permit fees*are based on the value of the work performed.
' Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application. _ _
\ nO J►L 'Tlx3C) \C9 Q4_Oc aSONLN\- - 6 Valuation: $ Q u I
,n�i+e fi building 5(0(7
4 \ V` m e o � Existingarea: square feet
as..i U\l__` t \ L;e.-s , p(t S� �• New building area: square feet
❑ PROPERTY OWNER T ❑ TENANT Number of stories:
Name: ( RV �tlrl y \\ `_Q 1J �/� Type of construction: -.cQ c,
Address: N • 1N \ C 7 o ccn.})` &,1 .r,^� �e.. 1.150
VQ Occupancy groups:
I r ock ��a 't
City/State/ZIP: � � Existing:
Phone:( 3) 969 -6Ch(g Fax:( ) New:
iii,APPLICANT ❑ CONTACT PERSON NOTICE
Business name: ^ ', All contractors and subcontractors are required to be
Contact name: 'LA`-r 1 "` licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 6 kJ �.Q, cg C.L., CP♦ ,x ` C 96- jurisdiction in which work is being performed.If the
g\VS 0 _L t a
City/State/ZIP: apply:
Phone:(513.t 'ALA G — 15'98 , Fax::( )
E-mail: Q7,G/1 g. {}50 • C-oc11.
CONTRACTOR q
Business name: � `��,�y/��),c �c S {\ / COAP Cl eiN i 1A 'C-- BUILDING PERLNIIT FEES'
Address:beD v�,l t� CAP`e- 135• L1 C"1X �,(c (Please refer to or de ont):l
Clry Structural plan review fee(or deposit):
City/State/ZIP: E(\ C Q C) -1 1 or.
t FLS plan review fee(if applicable):
Phone: ) gii c - I5j-35- Fax:( )
�� ` Total fees due upon application:
CCB lic.: tc fv
Amount received:
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: it ate: ' �' li * Fee methodology set by Tri-County Building Industry
Service Board.
1:1BuiidmgTermits1ROOF-PermitApp.doc 10/01/D9 440-4613TO I/02/COM/WEB)