Permit , ..CITY OF TIGARD BUILDING PERMIT
Pi ;: PERMIT #: BUP2007 -00297
COMMUNITY DEVELOPMENT DATE ISSUED: 6/7/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 104AA -90131
SITE ADDRESS: 12658 SW KAREN ST 13 ZONING: R -12
SUBDIVISION: BELLWOOD TERRACE CONDOMINIUMS LOT: 013 JURISDICTION: TIG
PROJECT: BELLWOOD TERR.
Project Description: Re -roof apt. and club house.
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: OTR FIRST: sf N: S: E: W:
TYPE OF USE: MF SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: UNK sf N: S: E: W:
OCCUPANCY GRP: R1 TOTAL AREA: 0 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 LEFT: ft RGHT: ft FIR SPKL: SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: /3 g39. l.�d
Owner: / / Contractor:
MOZINSKI, STEVEN P INTERSTATE ROOFING
ZAKOCS, EDWARD JR 15065 SW 74TH AVE
PO BOX 189 TIGARD, OR 97223
YAMHILL, OR 97148
Phone: 503-487-0240 Contact #: PRI 503 - 684 -5611
FAX 503 - 639 -3056
Reg #: LIC 55485
FEES
REQUIRED ITEMS AND REPORTS
Description Date Amount
[BUILD] Permit Fee 6/7/2007 $177.70
[TAX] 8% State Surcha 6/7/2007 $14.22
Total $191.92
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 Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy
of these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: � % Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
Re- R oof / = ;�'' + '
t�¢ii i ,'' t
Building Permit Applic n W �. FO OFFICE USE ON LY
City of Tigard :UN 0 7 2007 Received ' Ct
Date /B, / / /� 'D ,J/ ‘90
13125 SW Hall Blvd., Tigard, OR 97223 Plan Re "-w
Phone: 503.639.4171 Fax: 503..598 ;1960 , i Y'lL..j ,Ay /.' B'l� i ;t Date /By. Other Permit:
• Inspection Line: 503.639.4175 -„ii &J. 411 Date Ready/By: Juris: El See Page 2 for
Internet: www.ci.tigard.or.us p T r " , r r. � L . '"c d • y • • '
t $ Notified/Method: Supplemental Information
TYPE OF WORK ' - REQUIRED DATA: 1 - 2- FAMILY DWELLING
❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
• ❑ Addition /alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
El 1- and 2- family dwelling ❑ Commercial /industrial Valuation: S
❑ Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder •Other:
Number of bathrooms:
. • JOB SITE INFORMATION AND 'LOCATION r Total number of floors:
Job site address: l £ S 8 5 (,ut I k N sr New dwelling area: square feet
City /State /ZIP: 77 G 4j7 OR, 9,72 a 3 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name:96'44 WO 60 Covered porch area: square feet
. Cross street /directions to job site: Deck area: square feet
Other structure area: square feet
. REQUIRED DATA COMMERCIAL CHECKLIST
Subdivision: Lot no.: Permit fees* are based on the value of the work performed.
Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Valuation: $
�?CMn1 AGL t s4� 2c saFi�lG ra Ec _ dra4 y 3 /Q / 8 _59
Existing building area: square feet
3 o y 6'42 d- MA • New building area: square feet
514PROPERTY OWNER - 0 TENANT : . Number of stories:
Name: 0 Z K O C , Type of construction:
Address: P 4 /3 e x / 6 9 Occupancy groups:
City /State /ZIP: 091o/4 C„ 6 i, 7 Jd Existing:
Phone: (563) 1/47 d 2 V 0 Fax: ( ) New:
ZAPPLICANt ❑ CONTACT PERSON ' - . ' NOTICE'
Business name: / NT(- Ate-/ 4 / C R evsi c hi i G All contractors and subcontractors are required to be
Contact name: / 6, 5 W /� C licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: / 6 L(./ S 6 lZ J .--L.../4 jurisdiction in which work is being performed. If the
. City /State /ZIP: /7, /L N t R., 97 a 2 4( applicant is exempt from licensing, the following reasons
apply:
Phone: (5 G3) (v 8 5/- 56 /7 Fax: : (5 6 3 r- 3 p.6:4 (77.
E -mail: III
' CONTRACTOR
Business name: ho T c �, I �S T. 9 ! C (�G�bF4 �sr s "
BUILDING PERMIT TEES*
Address: i s- 6 4 , S 7 i, v
Please refer to fee schedule.
City /State /ZIP: Pv 2 7� AA/ 6 OR, , 7 2 2 C(
Fees due upon application
Phone: (563) C. f y 5l it Fax: (5' 63 t / O 3 5 — 3 0 '
C Amount received
CB lic.: 5-
Date 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: 4,6 (',, / 'S pj,d EL 45' Date: * Fee methodology set by Tri- County Building Industry
Service Board.
i:\ Building \Pennits\ROOF- PermitApp.doc 12/03 440 -4613T(11 /O2/COM /WEB)
City of Tigard: Re- Roofing Permit Checklist
Page 2 - Supplemental Information
RESIDENTIAL (One- & Two - Family Dwelling)
❑ REPAIR (major) plan review required by plans examiner:
building permit is required when structural changes are made or the space sheathing is
removed or replaced.
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 not more than two (2) layers of
roofing will exist upon completion of the re- roofing.
COMMERCIAL (includes multi- family and condominiums)
❑ RE -ROOF: Pre - inspection is required for all roofs sloped 2:12 and less. Please make
an appointment by calling the inspection line at (503) 639 -4175.
El PLAN REVIEW:
Note: Depending on the conditions noted at the pre - inspection, plans may be required
to address any non - conforming items.
VALUATION OF PROJECT: $
sq. ft. of roof area -
Permit Fee based on valuation: $
(see Building Permit Fees chart)
8% State Surcharge: $
65% Plan Review Fee: $
(Required for major repairs of residential and
special purpose roofing of commercial projects.)
TOTAL: $ •
I:\Building\Permits\ROOF- PermitApp.doc 2
{ y ( 'y lt •
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CITY OF TIGARD
BUILDING DIVISION PERMIT #: BUP2007 -00 7
i 13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 6/7/2007
Phone: (503) 639 -4171 / A y uit611i
Inspection Requests (24 Hrs.): (503) 639 -4175 eh..
INSPECTION WORKSHEET FOR DATE: 7/16/2007 TIME: 7:04AM PAGE: 51
iZ(1 K -714— L5, K -
SITE ADDRESS: 12658 SW KAREN ST 13 CLASS OF WORK:
SUBDIVISION: BELLWOOD TERRACE CONDOMINIUM LOT #: 013 TYPE OF USE:
PROJECT NAME: BELLWOOD TERR.
DESCRIPTION: Re -roof apt. and club house.
OWNER: MOZINSKI, STEVEN P, PHONE #: 503407 -0240
CONTRACTOR: INTERSTATE ROOFING PHONE #: 503 -604 -5611
Inspection Request Scheduled For: Date: 1 /16/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Messa• - -I
299 Final inspection 0519883 - 01 503=401 -B256
Corrections/Comments/Instructions:
-
9 PASS PARTIAL APPROVAL CANCEL I NO ACCESS
FAIL / CALL FOR INSPECTION I ADDITIO AL FEES ASSESSED
Inspect. Date: / l °� Phone #: 503 718- L -C