Permit CITY OF TIGARD REROOF PERMIT
e COMMUNITY DEVELOPMENT Permit #: RER2010 -00017
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/22/2010
Parcel: 1S135DD01800
Jurisdiction: Tigard
Site address: 11565 SW HALL BLVD
Subdivision: Lot: 0
Project: Columbia Dental Arts
Project Description: Reroof - remove and replace.
Owner: FEES
PANG, KEIKO TR Description Date Amount
46 -442 HOLOLIO ST Permit Fee 09/22/2010 $789.69
KANEOHE, HI 96744 12% State Surcharge - Building 09/22/2010 $94.76
PHONE:
Contractor:
COLUMBIA RIVER ROOFING INC
2951 NW DIVISION ST #150
GRESHAM, OR 97030
PHONE: 503 -684 -8754
FAX: 503- 674 -8347
Specifics:
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Load:
Stories: Height: 0 ft
General Information
Building Area: 0
Re -Roof Area: 0
Roof Class:
Tear Off:
Overlay:
Existing Roof Layers:
Parapets:
Total $884.45
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 -0100. Yo •• - • • = or direct questions to OUNC by calling ' .3.•46.6699 or 1.800.332. 344.
Issued By: / � ` _ Permittee Signature: A y /IL�
t /� _
�.��k�•
39.4176 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.
Building Permit Application
Re -Roof FOK OFFICE USI: ONLY
City of Tigard IN ® Received Permit No.: r
`J g Date/13 : fi F' L , 10-
11 q 13125 SW Hall Blvd., Tigard, OR 9722 S 2 Q
\ Q Plan Review
Phone: 503.639.4171 Fax: 503.598.1 C` Q Date./13 : Other Permit: r 1 G n it D Inspection Line: 503.639 S` �0 Date Ready/By: See Page 2 for
Internet: www.tigard '` \G1 v C Notified/Method: Supplemental Information
Cs\ GON \ S \0
TYPE OF WORia0 REQUIRED DATA: 1- AND 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
V(Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
❑ 1- and 2- family dwelling g&Commercial/industrial Valuation: $
❑ Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 11 5(.0c. Sty) 4i < U (vd New dwelling area: square feet
City/ State/ZIP: P / c . c n 213 Garage/carport area: square feet
Suite/bldg. /apt. no.: Project name: Cdr ■ ;0 lOciutti ( 4 14 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
DESCRIPTION OF WORK work indicated on this application.
F--e-- rno Valuation: $ S- 7 q !.r 3 . °
�" Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER I ❑ TENANT Number of stories: 2
Name: N C- 4fr '- Type of construction:
Address: (.K 2,1 (3 Y l G a y\ 100 Occupancy groups:
City/ State/ZIP: f rk-t cola (T- 017 20 5 Existing:
Phone: (56 22?) '741-7 1 Fax: ( ) New:
14 APPLICANT ❑ CONTACT PERSON NOTICE
Business name: \ikt/Nel bt LL— ewe( 1Zociyt a 1 VL� All contractors and subcontractors are required to be
Contact name: ` ,1 �( �.(, /
c
J licensed with the Oregon Construction Contractors Board
G'1 Y �, 7 under ORS 701 and may be required to be licensed in the
Address: let s-' ! `\ it) t U GU ( CV jurisdiction in which work is being performed. if the
Ci City/State/ZIP: / (/t�l Q ��'� applicant is exempt from licensing, the following reasons
ty (7VecI/fr'.t. 0 apply:
Phone: (S'a3) in L(" g s LI Fax:: ( �� t0 4 ^ 9,-.51.-r-7
E-mail: Er1V1 e. c rroo - coo . ?
CONTRACTOR ( le i ( Business name: Colt Vvv? lQj,o r`- ` (. W 12.„,h
J BUILDING PERMIT FEES*
Address: (Please refer to fee schedule)
S,lC Structural plan review fee (or deposit):
City/State/ZIP: cJ
FLS plan review fee (if applicable):
Phone: ( ) Fax: ( )
Total fees due upon application:
CCB lic.: Amount received:
Authorized signature: r' _ This permit application expires if a permit is not obtained ,62
if within 180 days after it has been accepted as complete.
Print name:
1 (��� f � Date: Z Z n 0 • Fee methodology set by Tri -County Building Industry
Service Board.
1: 1Buildigg \Permits1R00E- PermitApp.doc 10/ 01/09 440- 4613T(11 /09/COM/WEB)
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