Permit CITY TIGARD BUILDING PERMIT
COMMUNITY DEVELOPMENT DATE ISSUED: 6/6/2008 -00194
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 104AA -90281
SITE ADDRESS: 12646 SW KAREN ST 28 ZONING: R -12
SUBDIVISION: BELLWOOD TERRACE CONDOMINIUMS LOT: 028 JURISDICTION: TIG
PROJECT: BELLWOOD TERRACE
Project Description: Reroof, remove and replace. Units: 28 -33.
REISSUE: tt i FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: PiT FIRST: sf N: S: E: W:
TYPE OF USE: COM SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: : sf N: S: E: W:
OCCUPANCY GRP: R3 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: $ 12,903.00
Owner: Contractor:
STEVEN MOZINSKI INTERSTATE ROOFING
ZAKOCS, EDWARD JR 15065 SW 74TH AVE
PO BOX 189 TIGARD, OR 97223
YAMHILL, OR 97148
Contact #: PRI 503 - 684 -5611
Phone: FAX 503 - 639 -3056
Reg #: LIC 55485
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[BUILD] Permit Fee 6/6/2008 $118.06
[TAX] 12% State Surch 6/6/2008 $21.80
Total $139.86
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 B . , . �� Permittee Signature: ,/ .... 4
qprAP-
•
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 -1 of f
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Building Permit Application , f OR OFF ICL I JSE ONLY ; 1 ":04 0 ,7
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131 Of Tigard � � yi/ Permit No.: '✓ i XI' (Zit if
13125 25 SW Hall all Blvd., Tigard, OR 97223 Y 9,1%.,,,, E !ew giro; sr -
pp 6 � "�, "(I �, Date /By:
Phone: 503.639.4171 Fax: 503.598.1960 1" Other Penult:
Inspection Line: 503.639.4175 \\\\ V '_ Date Ready/By: El See Page 2 for
Internet: www.ci. tigard.or.us Jv (: Notified/Method: M Supplemental Information
� " Ti'PE,jO 0 .q ' * '` h REQUIRED=DATA I= :AND';2= FAMILY DWELLING
❑ New construction S6 r 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
'' '%''' < . _ ST work indicated on this application.
• : " '= CATE G ,._,
❑ 1 - and 2- family dwelling ❑ Commercial /industrial Valuation: S
El Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder 0 Other: Number of bathrooms:
JOB,SITE; INFORMATION A Total number of floors:
Job site address: / 26 5 5 W A R E-A) S l New dwelling area: square feet
City /State /ZIP: • -7 0 .q) ,- 0 ! 0 ?7 2,2,3 Garage /carport area: square feet
Suite/bldg. /apt. no.: A,.. . 3 3 Project name: E J bap � C e Covered porch area: square feet
• Cross street /directions to job site: Deck area square feet
,2,T(.)'(, ,;251 Other structure area: square feet
T G V f iVat ' t REQUIRED DATA C0MMERe- AL- USECHECKLIST
Subdivision: Lot no.: Permit fees* are based on the value of the work performed.
Tax map /parcel no.: a(.Y r Indicate the value (rounded to the nearest dollar) of all
OcT (Yr!1 v..e I re-P - (4∎05 • equipment, materials, labor, overhead, and the profit for the
,DESCRIPTION OFt WORK' < r;_ work indicated on this application.
Valuation: $
�ZEM 0‘./L5 b q LC. QGo RazF/NG TG D ec4 3o a ! J g
M. . FE L 7' /' 1 U Sc , /7■1 �1 A�- L- �4N e i 2/4 /%6 ALS . Existing building area: square feet
fq_ A- 514!x/ 6-S t)eAirs• 0 G e,,4,2 ee - z4, JTeel New building area: square feet
PROPERTY'OWNER V,z' ® ii.NAN t Number of stories:
Name:864 -i. CAS c)6.0 762,2 4G G' ND (� /L1 / /JJ u )-15 Type of constructon:
Address: Occupancy groups:
City /State /ZIP: Existing:
Phone: ( ) . Fax: ( ) New:
[ APPLICANT ,`W ® CONTACT PERSON + - - , NOTICE
Business name://U 7 -6-Rs 7 e. R0 -6,.� /✓ G All contractors and subcontractors are required to be
Contact name: , C (A_ d 2 N E- 4 A S ( sl3 _ 82 O - / (,, ) licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: /6.0 . d (n 5 5 l.� 7 6/ / A 1 /E - .' . jurisdiction in which work is being performed. If the
applicant is exempt from licensing, the following reasons
City /State /ZIP:
// Poz/L4 i 1Q Q2 t 2 Z y app
Phone: 0503) co gq 5 , l f Fax:: sti3) 6. 9 365 5 to
E-mail:
' ;,R.,,,,,,:,,,,,'„1,' `' . . ..� CONTRACTOR
. • ' . ..
Business name: / iJ re: 7: 7 re, f Aj G °' :5,4 LDIV
I•G 1.0.1viiti FEES *' / �(
/6 46 rS 74/77...7 �'a �. ��ro, :. .�. .,., ( �/`�t
Address: l
Li e Please refer to fee sch ule. cL.l ,
City /State /ZIP: i a c , s z L,4 NQ v 2. 1 3-7.2. Y J 3 ( �/_
Phone: / Fees due upon application (yn
(503) (o �'�-5 , (/ Fax: (,543 L37_3 O 5 6 R►�
Amount received
CCB lie.: 5 5 4' e'
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: 44L /.5 6i? All..-74 / &5 Date: C ^ 6 -etf * Fee methodology set by Tri- County Building Industry
Service Board.
i. \ Building \Peimits \ROOF- PermitApp doc 12/03 440 -46I 3 T(1 I /OJCOM/WEB)
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CITY OF TIGARD
BUILDING DIVISION ‘, . , PERMIT #: BUP2008-00194
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 616/2008
/ / A
Phone: (503) 639-4171 rill)
Inspection Requests (24 Hrs.): (503) 639-4175 .4-:- a"' '--...
INSPECTION WORKSHEET FOR DATE: 612/ 008 TIME: 7:03AM PAGE: 46
SITE ADDRESS: 12646 SW KAREN ST 28 CLASS OF WORK:
SUBDIVISION: BELLWOOD TERRACE CONDOMINIUM LOT #: 028 TYPE OF USE:
PROJECT NAME: BELLWOOD TERRACE
DESCRIPTION: Reroof, remove and replace. Units: 28-33.
OWNER: M0.7INSKI, STEVEN PHONE #:
CONTRACTOR: INTERSTATE ROOFING PHONE #: 503-684-5611
Inspection Request Scheduled For: Date: 612412008 Pour Time:
Code # Inspection Description Confirm # Contact # Messa e
299 Final inspection 071752-01 503-481-8256
Corrections/Comments/Instructions:
Q ..... 11" ... l af PARTIAL APPROVAL 0 CANCEL I I NO ACCESS
I I FAIL !' ALL FOR INSPECTION
■11,„- ADDITIONAL FEES ASSESSED
/._
Inspector: IMBII11111■_ - - Date: 6 4 -4 /7 1 `e.) Phone #: (503) 718-
_ .., _• „ , _
' ..
CITY OF ��m u w n�po TIGARD
BUILDING DIVISION ' PERMIT #: BUp200E-00194
1312SSVV Hall Blvd.. Tigard, OR07223 \ DATE ISSUED: 0/6/2008
Phone: (503) 639-4171
Inspection Requests (24Hs.):(503)63O'4175 ^ed41 A.1!.
INSPECTION WORKSHEET FOR DATE: 6/18K2008 TIME: 7:02Ak8 PAGE: 60
SITE ADDRESS: 12646 SW KAREN ST 28 CLASS OF WORK:
SUBDIVISION: BELLWOOD TERRACE CONDOMIMUM LOT #: 028 TYPE OF USE:
PROJECT NAME: BELLVOOQ
DESCRIPTION: Reroof, remwe and re Units: 28-33.
OWNER: K4OANSK|.8TEYEN PHONE #:
CONTRACTOR: INTERSTATE ROOFING PHONE #: 503
Inspection Request Scheduled For: Date: 5/18/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
740 Exterior sheathing 071520-01 503-481-8256 N
Corrections/Comments/Instructions:
�~
��_
.
PARTIAL APPROVAL El CANCEL fl NO ACCESS
n FAIL i r CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
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Inspector: Date: '�' Phone #: (503) 718- c-_-*� '
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