Permit a CITY OF TIGARD REROOF PERMIT
.111 s COMMUNITY DEVELOPMENT Permit #: RER2010 00020
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/21/2010
Parcel: 1 S 135 BC00900
Jurisdiction: Tigard
Site address: 10855 SW CASCADE AVE
Subdivision: Lot: 0
Project: Paulson Carpet
Project Description: Reroof - remove and replace.
Owner: FEES
PAULSON LIMITED LIABILITY CO Description Date Amount
BY RICHARD G PAULSON SR, 10855 SW Permit Fee 10/21/2010 $256.22
CASCADE BLVD 12% State Surcharge - Building 10/21/2010 $30.75
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 $286.97
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. • os rules are set forth in OAR
952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling - 03.246.6699 or . • • 0. 2.
Issued By: / t
Permittee Signature: A . 1..1
Ca .lerirr4175 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 Folz OFFICE USE ONLY
City of Tigard D `t " DatReceived eB : 0 ® 711 Permit No.: e, ( „
° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
1111 C . Phone: 503.639.4171 Fax: 503.598.1960 DateB : Other Permit:
r I c. n R D CJ ,
Inspection Line: 503.639.4175 C 1 `tp10 Date Ready /By: Juris: 65 See Page 2 for
Internet: www.tigard - or.gov � 1 Notified/Method: 'f7 Jp Supplemental Information
�
TYPE OF WORK C c o INls REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑ New construction ❑ Detr W° 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.
❑ 1- and 2- family dwelling 1 Commercial/industrial Valuation: $
El 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: 1 1 0 $SS Ste) �.,� Avc New dwelling area: square feet
City /State/ZIP: - (gCli/�J 1 (') q 1 Z � 3 Garage/carport area: square feet
Suite/bldgiapt. no.: �} Project name: 13s eti.G( So vi 'S 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.
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.
SZ -e-r C ,_ " Valuation: $ I1 r y(D� OCR
� � Existing building area: 5 square feet
New building area: square feet
❑ PROPERTY OWNER I TENANT Number of stories:
Name: /JOLLA Sdh 5 Type of construction:
Address: 1 6 g55 S w CGtsaacdt 411/ G-. Occupancy groups:
f'
City /State/ZIP: - r Y J 1 v le_ G i23 3 Existing:
Phone: (�22) k97,0 — 10 Ov Fax: (5 (02C) — 3(415- New:
X
APPLICANT ❑ CONTACT PERSON NOTICE
Business name: (,o(U.W)) �C�.. K\ U PJ. I20nTI�i I vZC. All contractors and subcontractors are required to be
Contact name: ,t q ,,/ licensed with the Oregon Construction Contractors Board
Pay V '' l JV l(l .Y(}�y 1 under ORS 701 and may be required to be licensed in the
Address: 2Gi S 1 N IA) iJ 1 V(S 1 O � S+ i SO jurisdiction in which work is being performed. If the
City/State/ZIP: ei ves�1�.v► n� " Q t 763 0
applicant is exempt from licensing, he f ollowing reasons
/ 2
Phone: (Sd 3) U Ll - 51 s Fax:: ( 51 3) (0? 9 - p D 3 L11
E -mail: &Y( r1 edinrayf COYV7
, CONTRACTOR
Business name: C ( f ,,,, V (a Z i usev- 1 G, G I/l� ((/1 L BUILDING PERMIT FEES*
Address: �(', w S ot >° v- (Please refer w fee
Structural plan review fee (or deposit):
City /State/ZIP: -
Phone: ( ) Fax: ( ) FLS plan review fee (if applicable):
CCB lic.: (( b Total fees due upon application:
Amount received:
Authorized signature :42 - - _ This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: tav / f /uC,6Y(Sy∎ / Date: )) x2 • Fee methodology set by Tri-County Building Industry
/ ` Service Board.
I:' Building \Permiia\ROOF- PennitApp.doc 10/01/09 440- 4613T(11 /02/COM/WEB)