Permit ., , CITY OF TIGARD BUILDING PERMIT
COMMUNITY DEVELOPMENT
PERMIT D : 8 6/2008 -00195
DATE ISSUED: 6/6/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 104AA -90011
SITE ADDRESS: 12666 SW KAREN ST 1 ZONING: R -12
SUBDIVISION: BELLWOOD TERRACE CONDOMINIUMS LOT: 001 JURISDICTION: TIG
PROJECT: BELLWOOD TERRACE
Project Description: Reeroof, remove and replace. Units 1 -6.
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION ,.
CLASS OF WORK: / FIRST: sf N: S: E: W:
TYPE OF USE: COM SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: : sf N: S: E: W:
OCCUPANCY GRP: R3 TOTAL AREA: 0 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: BASEMENT: sf AREA SEP. RATED:
STOR: HT: ft GARAGE: sf OCCU SEP. RATED:
BSMT ?: MEZZ ?: REQD SETBACKS REQUIRED
FLOOR LOAD: psf LEFT: ft RGHT: ft FIR SPKL: SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 12,903.00
Owner: - Contractor:
STEVEN MOZINSKI INTERSTATE ROOFING
ZAKOCS, EDWARD JR 15065 SW 74TH AVE
PO BOX 189 TIGARD, OR 97223
YAMHILL, OR 97148
Contact #: PRI 503 - 684 -5611
Phone: FAX 503 - 639 -3056
Reg #: LIC 55485
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[BUILD] Permit Fee 6/6/2008 $118.06
[TAX] 12% State Surch 6/6/2008 $21.80
Total $139.86
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 than 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. You may obtain a copy
of these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
i ( / .C4 4
Issued By ` : _� Permittee Signature:
Call 503.639.4175 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.
•
Re -Roof
Building Permit A [icatiO FUR OFFICE US[ ONL1
Clt ' Of Tigard Received Jr
3 ° Date/By. / 4 ,. Permit No / ✓ aeV r .... / , .
13125 SW Hall Blvd., Tieard, OR !;A3�
Plan Review
Phone: 503.639.4171 Fax. 51 �t • .0 �00� ��� / �i °hlk l i Date /By: Other Permit:
Inspection Line: 503.639 4175 . 1.� `:� ,, Date Ready /By turns El See Page 2 for
Internet: \aw,w.ci.tigard. onus � � \`/% � � O ^• Notified/Method t9 Supplemental Information 1
`WORK • - REQUIRED =DATA: • I - AND •2- FAMILI' DWELLIN
❑ 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 Other: equipment, materials, labor. overhead, and the profit for the
.:CATEGORY =OF - CONSTRUCTION - - work indicated on this application.
[3 1- and 2- family dwelling ❑ Commercialiindustrial Valuation: S
❑ Accessory building ❑ Multi - family Number of bedrooms
•
El Master builder Other: Number of bathrooms
JOB 'SITE INFORMATION AND 'LOCATION Total number of floors:
Job site address' / •°' 6 6 6 $ A L _ A ,/ j New dwelling area: square feet
City /State /ZIP: • i7 g>* 0 r 0 ` - 7 :C?, 3 Garage /carport area: square feet
Suite/bldg. /apt. no.. l i' n Project name i6eL4 G c c s 0 ,,._- ; C e Covered porch area. square feet
• Cross street /directions to job site: Deck area: ' square feet
Other structure area: square feet
. ,REQUIRED DATA :; 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
DESCRIETIOIV- 'OF.>WORK," work indicated on this application.
r = r Valuation: S
REM vim. A Lc. 044D eta //u . Te, ® ' .3C `�/ d 0 ,3
!I3 F L • /� 5' / /v II , L ` ' p e 772.4 Z2v ALL Existing building area: square feet
New building area: square feet
PROP•ERT.Y OW
1. �,' ' ,. _, „ ,. ,, Q TENANT ; -. Number of stories:
Name:8eLL t, ^3 c,:: c, 0 7E/Z/ 46 tit=: AU'f} n 19 //11/ a J j 5 Type of construction:
Address: Occupancy groups:
City /State /ZIP: Existing:
Phone: ( ) . Fax: ( ) New:
', . a''APPtiICANT ,
®1 C ONTACT PERSON 'NOTIC) ` , ";
Business name: _ _ _ .
1 t ! L i5 77) 7 - 6 l�C'Zl! 4! 6 All contractors and subcontractors are required to be
Contact name: h Ci (A_ (F) j'Z L .44 (5t3 - Y-Z Q - / `/ C',2) licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: /6-0 6 S 5 Lsi 7 4'7.V A / 1 jurisdiction in which work is being performed. if the
City /State /ZIP: P,..,,, 4 .4 ,A./ G 12 t?7 �� applicant is exempt from licensing, the following reasons
/ y apply:
Phone: (,563) 6s7 /( Fax: : ( :3) t!.3 J 3 c., S 4
E-mail:
CONTRACTOR ;
Business name: ,l ' z leS %.9 7-4f. 7ec- '�/e //V 6_ ...
. .:BUILDING PERMIT 'FEES* ./` �". O(p
Address: 45 —4) CS ,$ r.:J 746—‘.../ 0I e
Please refer to fee schedule.
City /State /ZIP: ci a 7 : ,®. 6.Q 9-7 x Z Se' 0 )4. ,, 131.____F
Phone: (5E, 3) e S 6, / Fax: 6. 63 � el- 3 C 5- Fees due upon application
Amount received
CCB lic.: 5 5' Y d'
(..:0,./24,--Le____-6 D ate received:
Authorized signature: j
This permit litii if
a obtained
within per i80 days app after caon it has e xp res been accepted permit is as not complete.
Print name: 1. / 5 i R /lf L= L, 4_5 Date: 6 – 6 — * Fee methodology set by Tri- County Building Industry
Service Board.
is \rsuilding \Permits \ROOF- PemiutApp doc 12/03 440- 4513T(11/02 /CUM /WEI)
CITY OF TIGARD
BUILDING DIVISION PERMIT #: t3UP2!O08
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/6/2008
Phone: (503) 639 -4171 �uNl���tp��� �1i�'
.
Inspection Requests (24 Hrs.): (503) 639 -4175 °`..?�
INSPECTION WORKSHEET FOR DATE: 6/24/2008 TIME: 7:03AM PAGE: 45
SITE ADDRESS: 12666 SW KAREN ST 1 CLASS OF WORK:
SUBDIVISION: BELLWOOD TERRACE CONDOMINIUM LOT #: 001 TYPE OF USE:
PROJECT NAME: BELLWOOD TERRACE
DESCRIPTION: Reeroof, remove and replace. Units 1 -6.
OWNER: MOZINSKI, STEVEN PHONE #:
CONTRACTOR: INTERSTATE ROOFING PHONE #: 503 - 6B4 - 5611
Inspection Request Scheduled For: Date: 6/24/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
299 Final inspection 071753 -01 5034181 -8256 N
Corrections /Comments /Instructions:
�. ''�►r %PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
❑ FAIL IN CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: _._ _ Date: P-- - elE Phone #: (503) 718- T
CITY OF TIGARD
BUILDING DIVISION PERMIT #: 13
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/6/2008
Phone: (503) 639-4171 - e
Inspection Requests (24 Hrs.): (503) 639-4175 _T44- IL.
INSPECTION WORKSHEET FOR DATE: U12/2008 TIME: 7:02AM PAGE: 54
fe?
SITE ADDRESS: 12666 SW KAREN l.3T 1 CLASS OF WORK:
SUBDIVISION: BELLWOOD TERRACE CONDOMINIUM LOT #: 001 TYPE OF USE:
PROJECT NAME: BELLWOOD TERRACE
DESCRIPTION: Reeroof, remove and replace. Units 1-6.
OWNER: 1ViOZI NSW , STEVEN PHONE #:
CONTRACTOR: INTERSTATE ROOFING PHONE #: 503-684-5611
Inspection Request Scheduled For: Date: 6112J2008 Pour Time:
Code # Inspection Description Confirm # Contact # Messa • e
250 Roof nailing 071252-01 503453-6938
o rE
Corrections/Comments/Instructions:
4.• c) 44(
; PAS IN PARTIAL APPROVAL LII CANCEL fl NO ACCESS
FAIL r CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
c'
Inspector: Date: j___4/ a egPhone #: (503) 718- Coo