Permit IL CITY OF TIGARD REROOF PERMIT
44
I. ' COMMUNITY DEVELOPMENT Permit#: RER2019-00031
T t c,A R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/12/2019
Parcel: 1 S134BC00401
Jurisdiction: Tigard
Site address: 12442 SW SCHOLLS FERRY RD
Project: Providence Subdivision: None Lot: None
Project Description: Reroof.
Contractor: JIM FISHER ROOFING&CONST INC Owner: PROVIDENCE HEALTH&SERVICES-ORE
13580 SW GALBREATH DR ATTN: REAL ESTATE&CONSTRUCTION
SHERWOOD, OR 97140 4400 NE HALSEY BLDG 2 STE 190
PORTLAND, OR 97213
PHONE: 503-625-2586 PHONE: 971-291-5578
FAX:
FEES
Description Date Amount
Permit Fee 11/12/2019 $1,444.19
Specifics: 12%State Surcharge-Building 11/12/2019 $173.30
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Load:
Stories: Height: 0 ft
Project Valuation: $156,000.00
General Information
Building Area: 0
Re-Roof Area: 0
Roof Class:
Tear Off:
Overlay:
Existing Roof Layers:
Parapets:
Total $1,617.49
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 btain a co oft rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available ins Lion date.
,,i
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.
Buildini Permit Application
Re-Roof , _ i tliz Ohrlcl-: 1 sl',t)\l l
City of Tigard Received / 4/A !/ ' p/<.L g l�y�
N O V 1 2 2019 Date/By: `/ I 110t 5 "{ :l
II
a 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
C Phone: 503.718.2439 Fax: 503.598.1960 -r�,. Date/By: Other Permit:
Ins ection Line: 503.639.4175 ' ` s.ama� �
T 1 G A R U p U'LD d E / Daze Ready/By: Juris: See Page 2 for
Internet: www.tigard-or.gov �` DIVISION Notified/Method: Supplemental Information
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
0 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
❑Addition/alteration/replacement 521 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ 1-and 2-family dwelling [ICommercial/industrial Valuation: $
❑Accessory building 0 Multi-family Number of bedrooms:
0 Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 12414-2._ e S�btxS -. "4 (~z New dwelling area: square feet
City/State/ZIP: "("i 4„.AAA), 0t2.f E-,0t'...1 9-7 raS Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: Covered porch area: square feet
Cross street/directions to job site: SW koYL�tE �RkL!';,..IA cs, 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./�
gef2wr . F=t.vr1 R.. -- �4 e.c, 1 L.S-q-‘4 /hit PaercrCro4 Valuation: $ 1 G Y' GiC�.d
v Ae-cD, 0 V all.. fa a 5�t N4!� i LA Y cY2 /2cx, SYS-7C 14X7, 4.
Existing building area: (S/(7C, square feet
/47/I ld,,, Mfu iY4./IG.4-ei_Ni 4--i-1Aztkc3 '(irk> 2,0kI'e,sysic4.4 zit CGAz New building area: square feet
(, PROPERTY OWNER 0 TENANT 1,A 9 Number of stories:
Name: fPov,t n�-4.t c_s 14466.7rot. Type of construction:
Address: 40G I sS.`( S'f t g,,E1 13L. Z. Occupancy groups:
City/State/ZIP: ?D p,2, CI-7 ZI 3 p
t `�l7G ��/ Existing:
Phone:(97I ) ZqI -�57$ Fax:( ) New:
0 APPLICANT 0 CONTACT PERSON
NOTICE
Business name: e /si,i Z /2c>,/4/6 All contractors and subcontractors are required to be
Contact name: /24-ve C 6=ArZ(2 ^,/-7 licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: /C�5. lac) c ,,,. (,44-G F32 6,974 Lei i✓V jurisdiction in which work is being performed.If the
City/State/ZIP:'5! �' / Z ,,Z, /7/4D applicant is exempt from licensing,the following reasons
apply:
Phone:(5,.3) ZZ! -71.•4'-2,, Fax::(t) ZeD --ey 520
E-mail: pee-L/c2--( t S k e,t•/ cos-,4-7. e 0&11
CONTRACTOR
Business name: r`=is/./..'� / c )i l A/4 BUILDING PERMIT FEES*
Address: /3 5 0, see,,,.. & 4 ,, :•• t / 1 V� (Please refer fee schedule)
City/State/ZIPH6,i J h 1/r 6)a r 0
Structural plan review fee(or deposit):
/ FLS plan review fee(if applicable):
Phone:(, ) 227 _7( 3 Fax:(s p3) C,,2 -ci��2-5
CCB lic.: 1.1-Sel Total fees due upon application:
74�..,-,•....- Amount received:
Authorized signat e: ,+ .,
r` / This permit application expires if a permit is not obtained
Print name: /�
�®� ,,� ^ within 180 days after it has been accepted as complete.
Ili, of+e+i/W! Date:/l /`! 70/42 * Fee methodology set by Tri-County Building Industry
Service Board.
1.03uirding\Permits ROOF-PermitApp.doc 10/01/09 440-4613T(11/02/COM/WEB)