Permit 1, CITY OF TIGARD REROOF PERMIT
t; • COMMUNITY DEVELOPMENT Permit# RER2012 -00025
Date Issued 09/17/2012
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 parcel 1 S135CA02600
Jurisdiction Tigard
Site address 11130 SW GREENBURG RD
Project Good Neighbor Center Subdivision HERS ADDITION TO GREENBURG HE Lot 3
Project Description Tear -off and replace existing roof, some flat and some pitched
Contractor GRIFFITH ROOFING Owner EAST WASHINGTON COUNTY SHELTER
6815 SW 111TH AVE PARTNERSHIP COUNCIL
BEAVERTON, OR 97005 DBA GOOD NEIGHBOR CENTER
11130 SW GREENBURG RD
TIGARD, OR 97223
PHONE 503 - 643 -1596 PHONE
FAX 503 - 644 -1529
FEES
Description Date Amount
Permit Fee 09/17/2012 $475 99
Specifics: 12% State Surcharge - Building 09/17/2012 $57 12
Type of Use COM
Class of Work ALT Type of Const
Occupancy Load
Stories Height 0 ft
Project Valuation $26,012 00
General Information
Building Area 0
Re -Roof Area 0
Roof Class
Tear Off
Overlay
Existing Roof Layers
Parapets
Total $533 11
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 do accordanc> th 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
day ATTENTION Oregon aw requires you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR
9 - 001 -0010 through OAR 952 -13 ' r • 0 ou may obtain a copy of the rules or direct questions to OUNC by calling 503 232 1987 or 1 800 332 2344
Issued By i / ,O) Permittee Signature e o,e ( A L ` r
Call 503 639 4175 by 7 00 a m for the next available inspe tb ion 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 A sr!' fi VED - OFFICE USE ONLY
C/ f r!°�'F2'b ../.• ,' Date received: Permit # &Ekc 2 0 /x' - 5 —
18880 SW Martinazzi Ave. q r ? 17 ?012 .. iti
Tualatin, OR 97062 t r
Phone 503- 691 -3044 Fax 503- 69201�ARDus '', Date Issued: By: Receipt:
IIU1 1 trO[v REQ DATA: 1 -A ND 2- F DW
_
❑ 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.
Valuation .(, 0 t Z O
❑ 1- and 2 -family dwelling Commercial/industrial [
❑ Accessory building ❑ Multi- family Number. of bedrooms
❑ Master builder ❑ Other. Number of bathrooms:
. 4 ,. JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address' ii .30 5 LA) Grr.e e -A ✓ ,e ,,. t ae) New dwelling area: square feet
City/State/ZIP. 7; ( ,,,y) ' & sell) Garage/carport area square feet
Suite/bldg /apt no : 8 O Project name G-c,a a Kt a )5 1 ocv ' " Covered porch area square feet
Cross street/directions to job site ! i j ✓pia v i Deck area. $, 300 ' Gc square feet
Other structure area square feet
RE .Y � .ate
QUIRED DATA: COMMERCIAL) -USE CHECKLIST
Subdivision I 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
„
%ea,. o ff Sa.- > -p" 30 Hjb.:�. IoGSe �.co ra.-( 4t a fli,`. j.:[ Valuation
f4... , � +r..cf / Existing budding area square feet
Cc...J k 3 a.- c4.Y.) aaa / s4.%i, /or, ,E ci, e V**. t , , � ,
C. a ,...f. t •+4'Jk�ty •T S r► p II .vj �co
, t . i J ^ J� e .". %1sna a[/ �m+ - ' "• a I , � � La 1V Zy/4 F; t, Ss�[tsr New building area square feet
,., ti ,,,
C
It
❑PROPERTY OWNER TEN ` ! C Number of stones
Name V Type of construction
Address' Occupancy groups
City/State/ZIP Existing'
Phone ( ) Fax ( ) New
Ig APPLICANT ❑ CONTACT PERSON ' BUILDING PERMIT FEES" „ ,
Business name
Please refer to fee schedule
Contact name. - , DATE
FEE TYPE AMOUNT PAID
Address '
City/ State/ZIP PERMIT FEE
PLAN CHECK FEE
Phone ( ) Fax ( )
(Due upon application)
E -mail: FIRE LIFE SAFETY FEE
(Due upon application)
CONTRACTOR STATE SURCHARGE
Business name ?? // - Cc, (12% of permit fee)
Address (De( s s w fike ,q,le OTHER
City/State/ZIP ige�v.gv ( OIQ 0., Q'f�1P�44.t'',i TOTAL FEES 3.«
Phone (j 5' ) (0q3 - l G Fax SCO) (o4'c- i S. .q NOTES•
CCB lic : q zs.. t /5/ 4,
Authorized signature. / (.n_R- ... This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name $4, .0 , ("4c, �i c.�.% e.■, Date Q — I q — )-c..) l Z,, * Fee methodology set by Tri-County Building
d Industry Service Board
•
,
FOR OFFICE USE ONLY
Back Page Information
For All l
Permit Applications
City of Tualatin
18880 SW Martinazzi Avenue
Tualatin, Oregon 97062 -7092 ,i,..i.,,r ,
Main: 503.692.2000
Fax: 503 -692 -0147 i
Web: www.atualatin.or.us
Permit Number:
Peceipt Number: _
Date Issued:
Permit Fee Type Fee Amount Date Paid
Building Permit
Plan Review (65 %)
Fire, Life, Safety (45 %)
State Surcharge (12 %) I
Plumbing Permit I
Plumbing Plan Review (25 %)
State Surcharge (12 %) ,
Mechanical Permit I ,
Mechanical Plan Review (65 %)
State Surcharge (12 %)
Erosion Control
Eros. Cont. Plan Review (65 %) I
Metro CET(.0012)or(.12 %)
School CET ($25000.00 Max)
TOTAL AMOUNT DUE
System Development Fees Fie An' iii tint Date Paid I 1
Sewer Connection
Sewer Inspection I
Water Connection
Water Installation
Storm Water Quality , I
1 Storm Water Quantity
i F
Traffic Impact Fee
Park Fee j
Other: I i '
TOTAL AMOUNT DUE ,�
Special Information and Conditions
i
I I I =
. ! ; F