Permit CITY OF TIGARD REROOF PERMIT
• :. COMMUNITY DEVELOPMENT Permit#: RER2022-00005
Date Issued: 4/25/2022
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S110DC01000
Jurisdiction: Tigard
Site address: 11155 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 $423.53
Specifics: 12%State Surcharge-Building 03/01/2022 $50.82
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Load:
Stories: Height: 0 ft
Project Valuation: $22,586.00
i
General Information
Building Area: 0
i Re-Roof Area: 0
Roof Class:
Tear Off:
Overlay:
Existing Roof Layers:
Parapets:
Total $474.35
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',t,y Va-i'l"De-Wege, Permittee Signature:
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.
Building Permit ApplicationAECEIVED 0
Re-Roof t� �j FOR Orli( is I.SE ONIA'
DEC 2 a`
3 Rece
;1 City of Tigard Re�ivedv: \`\\\2._ ON) Permit No.:9 2O2Z—(D(
" 13125 SW Hall Blvd.,Tigard,OR 97223 '<CITY OF I IGAFiL Plan Review Other Permit:
I Phone: 503.718.2439 Fax: 503.598.19 Date/By:
on Line: 503.639.4175 �JILDING DIVISION Date ReadyBy 1 hJ See Page 2 for
T t.;:1 I:I) Internet: www.tigard-or.gov Notified/Method: 1�`,Z2 erra;\('... � Supplemental Information
TYPE OF WORK
REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑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
gAddition/alteration/replacement ❑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
r-- Number of bedrooms:
0 Accessory building I,Multi-family
❑Master builder ❑mar: Number of bathrooms:
\1\S--S JOB SITE INFORMATION AND LOCATION Total number of floors:
��� New dwelling area: square feet
Job site address: \ _ .r'. {
City/State/ZIP: ``Ct(6 D 1 ,L( Garage/carport area: square feet
Suite/bldg./apt.no.:)itg .i ip:7S`Prolect name:, tYS(v exct Q.x_c‘k . 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
+�� 1 DESCRIPTION OF(WORK \ work indicated on this applicationn..} �,7 /
14 Q.1(YJQ_ ' eLtit) VIA QJC�CeT p `� .A pi t9 S Valuation: • $ of ram/ 5 D G
k j t^ W ('\ (\\ ,' Existing building area:'6 00 square feet
� � �5 O o iy • New building area: square feet
{�'�
0 PROPERTY OWNER ❑ 'TENANT Number of stories:
Name: C'A.\'AL, ) c\t,*\\u iQ C. Type of construction: _.co .
Address: kl, i N 11"1 o tsk. t 1A e L1 Occupancy groups:
City/State/ZIP: %e c Q 912.0 CI Existing:
I"!C
Phone:( ) 1 —n q�f Fax:( ) New:
PI APPLICANT 0 CONTACT PERSON NOTICE
Business name: ., i k 01,C- All contractors and subcontractors are required to be
` �^ � licensed with the Oregon Construction Contractors Board
Contact name: L l 4 y t'">l1l,{. -ea0 4 under ORS 701 and may be required to be licensed in the
Address: ' c.1v3sc`e- . do 9j j^ t ( 95' jurisdiction in which work is being performed.If the
applicant is exempt from licensing,the following reasons
City/State/ZIP: t'<Nls bn 09,. 94 l a-� apply:
Phone:6474 siA( . 418 Fax::( )
E-mail: QAtk—e Q.,- \ Cttc ccO • r...c>crn.
CONTRACTOR
Business name: \SO(\ /C)T 4 (\ /Cc ptark\.I \AC.� BUILDING PERMIT FEES*
Address:
V V l' C R'e, SST. LL „,x ,[0ci, (Please r�jer p plow schedu/e1
�et� {} Structural plan review fee(or deposit):
City/State/ZIP: \ \\ ( V C19-12.3
FLS plan review fee(if applicable):
Phone:(` ) gi.G - 15-3 5- Fax:( )
Total fees due upon application:
CCB lic.: 6, Amount received:
Authorized signature: �'*►1/%�,t*% This permit application expires if a permit is not obtained
it. .r'"�f./� -�/t�
within 180 days after it has been accepted as complete.
Print name: a t 1 d ate: I a• t1a,~aW 21 * Fee methodology set by Tri-County Building Industry
" Service Board.
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