Permit ap q CITY OF TIGARD REROOF PERMIT
°- COMMUNITY DEVELOPMENT Permit #: RER2011 -00005
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/02/2011
Parcel: 1 S135DC00400
Jurisdiction: Tigard
Site address: 11795 SW GREENBURG RD
Project: Dr. Steven Black Subdivision: TIGARDVILLE PARK Lot: 8
Project Description: Reroof, remove and replace.
Contractor: INTERSTATE ROOFING INC Owner: GREENBURG LLC
15065 SW 74TH AVE BY STEVEN & MELISSSA BLACK
PORTLAND, OR 97224 PO BOX 1891
LAKE OSWEGO, OR 97035
PHONE: 503 - 684 -5611 PHONE: 503 - 291 -6986
FAX: 503 - 639 -3056
FEES
Description Date Amount
Permit Fee 06/02/2011 $286.64
Specifics: 12% State Surcharge - Building 06/02/2011 $34.40
Info Process /Archiving - Sm Sheet (up to 06/02/2011 $10.00
Type of Use: COM 11x17)
Class of Work: ALT Type of Const: Hourly Building Rate 06/02/2011 $90.00
Occupancy Load: Hourly Building 12% State Surcharge 06/02/2011 $10.80
Stories: Height: 0 ft
Project Valuation: $13,301.00
General Information
Building Area: 0
Re -Roof Area: 0
Roof Class:
Tear Off:
Overlay:
Existing Roof Layers:
Parapets:
Total $431.84
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 '. - .. - -- 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. • TTENTION: Orego law re uires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
95 101 -0010 through OAR 952 -00 I. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Is ued By: ``" Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for the next available inspection 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 Applica .1 1. ,CEIVED
O I nierclal FOR OFFICE USE ONLY
City of Tigard JUN 2 2011 Received / �� Permit No.: f 'E ��i�•
Date /B : V
• 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
.1111 2 Phone: 503.639.4171 Fax: 505T'1 jF TIGARD Date /B : Other Permit:
t l Li A K 17 Inspection Line: 503.639 BUILDI G DIVISION Date Ready /By: tare ® See Page 2 for
Internet: www.tigard - or.gov Notified /Method: Supplemental Information
`i L11 _ R 4 r : -'' t 0\n". 18 SE r. Y�i.LI, - t3, -'"
,
I=1 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 t! Other: equipment, materials, labor, overhead, and the profit for the
—� — T -'•" — -- — work indicated on this application.
C EGO + � Lr .St olo
—�° - — — — — - - Valuation: $
❑ 1- and 2- family dwelling ❑ Commercial /industrial
❑ Accessory building ❑ Multi- family Number of bedrooms:
ID Master builder ► Other: Number of bathrooms:
c ..3 gillig r, 1 ?! a y y a t� , .. Total number of floors:
Job site address: s//72. S sL,u GR �E�B IA _ R R 0 s New dwelling area: square feet
City/State /ZIP: � e Ade 0 0,1Z ( a7 2 2 y' Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name:O' . S .. 7 - Ev f QL ,,+. Covered porch area: square feet
Cross street /directions to job site: Deck area: square feet
Other structure area: square feet
Cif 0, ; l R(37AL c HE a IS•
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
- ° ' D . MIRTH* " e7i CQ work indicated on this application.
Valuation: $ / 3 3 0 /
A'eet -'b ,ALL Agr°bfiAr 7 fleck /A- s%.fiL-c- `
4 / Existing building area: square feet
L f New building area: square feet
`' D: PROP • d']' O _ ,R - K ' >`'^� . D` ' -`'itt -: Number of stories:
Name: DR, _s J C 4i 44 L 4 ck Type of construction:
Address: 1/ 7 9 S W G R e Cnl a LA-i2 G /2 0, Occupancy groups:
City/State /ZIP: 777 e- ,r4/21? t R . 9.7 -2 V Existing:
Phone: (S.Q3 2,2 r 6 ? 84, Fax: ( )
New: •
APPLICANT ' u -?-TI , "' DrCOPiTAC .4ERSON - '' f .
NOTICE
Business name: /14/7 — , 4 , ec / , t t G All contractors and subcontractors are required to be
Contact name: 4 p L.4.., p j7. n! e° L 4- S - S'p 3 �� .6_ /d licensed with the Oregon Construction Contractors Board
under ORS 701 and maybe required to be licensed in the
Address: / 4"d S St.._) 7 /--7 - ( ,q. tJ e., jurisdiction in which work is being performed. If the
City/State/ZIP: applicant is exempt from licensing, the following reasons
Cit
Y P z,,2 , L.iN O . Og 9'7 Y apply.
Phone: (.6 !o eY- .5'44 Fax:: ( i)31 4 3 ?__ 3 O G s
E -mail:
CONTRACTOR,
Business name: / 7-e4,.. 7-G 1 Q 7- F G 'BUILDING`PERMIT'FEE5' -
Address: / 5' Q 5" ,3" /,..1 7y;:-.---6( eft % e, '_' % "' •' � (P,leasearefeeto%ee'schedulr� ; -, - ;_
�{ Structural plan review fee (or deposit):
Q
City /State /ZIP: ! e , - 4 4 ,, t , • 2 OR . ? 7 y
r FLS plan review fee (if applicable):
Phone: (5163) 6 5 f; 17 Fax: /503) 6 3 p_ 3 0 5.6
S 4./ Total fees due upon application:
CCB lic.:
Amount 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: 6 IA f.T 6) 2 A ) L= L .4 s Date: 6 .2 / j
Fee methodology set by Tri- County Building Industry
Service Board.
1: \Building \Permits \BUP -COM PennitApp.doc 10/01/09 440- 4613T(11/02/COM /WEB)