Permit Building Permit Application
Commercial FOR OFFICE USE ONLY
i�
City of Tigard Received Permit Na 1 1�t { �
DateBY' 1 (p/ N' - i'. -+ 0-Otp{ '�OI�L_�
13125 SW Hall Blvd.,Tigard,OR 97223 iH V i I ' Plan Review
Phone: 503-718-2439 Fax: 503-598-1960 pareiBy: ) l- ' ,,_ 2'l:71 Related Permit
TI GARD Inspection Line: 503 639-4175 '. ; , ;(late Ready/By' < hum
® See Page 2 for
x Internet: www.tigard-or.gov �1L.E - Notified/Method: t Cr> SuQplementat information
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TYPE OF WORK REQUIRED DATE,1-AND 2-FAMILY DWELLING
❑New construction 0 Demolition Permit fees*are based on the value of the work performed.
f, Indicate the value(rounded to the nearest dollar)of all
❑ Additionlalterationireplacement Other: St(a y 5 equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
0 I-and 2-family dwelling Commercial/industrial Valuation: $
ElAccessory building 0 Multi-family Number of bedrooms:
❑ Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 7 35b 5iv WeiS4,n /h (,/ are,. kot. New dwelling area: square feet
City/State/ZIP: f 63 ' P// Y�" et 97,1 ?�iuV Garage/carport area: square feet
Suiterbldg./apt.#: ( Project name: e I,�5 Covered porch area: square feet
Cross street/directions to job)site: ,�L /J ` /� j� Deck area: square feet
6"r 13`u`IR f? , �v/a ✓W (34Jn bled ?j Other structure area: square feet
r• REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Lot#: Permit fees*are based on the value of the work performed.
Tax map/parcel II 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.
Valuation: $
lv�S�G/ ;l � inc-f�/' GGIa�c�,n let{�rs moo
v O / i( / 41/O (1 41(yi {�-rP�i&5 Existing building area:'R's-�"square feet
`/ h 0 f' '�Gyhl[5 / ` • %' New building area: 7 5'62s—squarefeet
XPROPERTY OWNER 0 TENANT Number of stories:
Name: t Tph L�Pw►a4 Type of construction:
Address: i j, ,wy 99
�� Q jj 7 Occupancy groups:
City/State/ZIP: nn wood 1 W 9 9507 Existing:
Phone:079 7 ! ✓ 1 Lr/C/ llF�ax:( )
( New:
l APPLICANT ❑ CONTACT PERSON
BUILDING PERMIT FEES*
Business name: E� Co
U Meese referto fee schedule)
� Structural plan review fee(or deposit): j,� ) '
Contact name: t 11(m" ate. 4 ��
Address. 43ai FLS plan review fee(if applicable):
City/State/ZIP: 2 Total fees due upon application:
�` 5 f 1 4 J7/ Amount received:
Phone:90{- JS S : _ (57Fax::( )
E-mail: ejk �� �`� r PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
NTRACTOR roof-top mounted Photo Voltaic Solar Panel System.
Business name: y( see) Submit two(2)sets of roof plan with connection details
! and fire department access,along with the 2010 Oregon
Address: Solar Installation Specialty Code checklist.
City/State/ZIP: 4 e_____���Y' -———e Permit fee(includes plan review $180.00
and administrative fees):
Phone:( ) e et: ) State surcharge(12%of permit fee): $21.60
CCB Lie.:
Total fee due upon application: $201.60
Authorized signature: This permit application expires if a permit is not obtained///�(/ within 180 days after it has been accepted as complete.
Print nameTm� ,fir _"' 1 Dale:/�.. 4_. 9� * Fee methodology set by Tri-County Building Industry
�J �, f O' Service Board.
I:\Building\Permits\BUP_COM_PermitApp.doc Rev.04/21/2014 440-4613T(l1/02/COM/WEB)