HomeMy WebLinkAboutRES2025-0005 SZAPUCKI BUILDING PERMIT APPLICATIONr
Buildin Permit Apilication
Residential FOR OFFICE USE ONLY
City of Tigard R Permit
No
i C 4 111225 S11 Hall Blvd,Tigard.OR 97221 I)�ir A.
Plan Rr Ito/ titter Pemut
Phone 503 718 2439 Fax 503 598 1960 Pile H
inspection Line 503 639 4175 two 0 Ser Page I for
T 1 II Rb Date Ready Ry Supplemental Iaformatis■
Internet wuu tigard-or goi Notified Method
TYPE OF WORKREQUIRED DATA:1-AND 2-FA.MILY DWELLING
0 New construction Pemiii fees`are based on the value of the work performed
0 Demolition Indicate the value(rounded to the nearest dollar)of all
Addition alteration replacement r equipment,materials.labor,overhead,and the profit for the
❑Other
work indicated on this application.
CATEGORY OF CONSTRUCTION S
Valuation
0 1-and.-family dwelling 0 Commercialhndustnal
Number of bedrooms
0 Accessory building ❑Multi-family
❑ Master builder Number of bathrooms
❑Other
JOB SITE INFORMATION AND LOCATION Total number of floors
lob site address I SOS S 0 -72 New dwelling area: square feet
City'State/ZIP: ` 'i �4r ! �Q // 3 Garagercarport area square feet
Suite'bld ;apt no; 9 V Corned porch area square feet
g P Project name
Cross street:directions to job site. Deck area square feet
72 4 ' T— Other structure area square feet
_ REQL1RED DATA:COMMERCIAL-USE CHECKLIST
`Subdivision I 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.
1-n S -// / g r x 30 / Valuation S
i iO/ Existing building area square feet
j New building area square feet
a
._):1 PROPERTY OWNER 0 TENANT Number of stones
Name ,/3„-/ t. /2A46 14 s 2t �k✓G '' Type of construction
Address _11Le . __ (J •1-1-4 Occupancy groups:
Ciry'State'ZIP: -Tt „,/ / O/? 9 7 3 Existing:
Phone: (g 7() g7 Fax ( ) New
15 APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
1 '_/ f 2 (Mow refer tofu uledi19
i„
Business name c,4 v� /`70avtas (� C,
Structural plan review fee tor deposit)
Contact name CO3/s r,is1
FLS plan review fee(if applicable)
Address g95C1/c7 Su/ e✓.{'„*Ie/0- s'f" Total fees due upon application.
City•State ZIP: W lso ria,//r` 6,4 g070
Phone:( 97/) ,, 7/ - 90 6.6 I Fax::( ) Amount received ,
�r / PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES`
F-maiI. C.�A/'rs � 4,,tiii,04 CO,,i ,
Commercial and residential pre'cnpine installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System
Business name ( .i 0.S nw f�- Submit two(2)sets of roof plan with Conn;-ction details
Q� � and fire department access,along with the 2010 Oregon
Address. g O cici s W �`Mt'!_f S'/L Solar Installation Spt'rialti ('ode checklist
City State.ZIP 4 f 0°L O '7` Permit Fee(includes plan review $180 00
and administrative fees)
Phone:197i/) 7 f - /10g Fax ( ) State surcharge 112°.of permit fee): S21 60
CCB tic: —
Total fee due upon application S201 60
This permit application rspirrs if a permit is not obtained
Authorized signature 1 within 180 days after it has been accepted as complete.
,�Print name��j,s �j/,Y / D itc / 'Fee methodology set by Tn-County Building Industry
f'! �b ;� Service Board.
\BuildingWermits\BUP-RESPcrmitApp doe 01i25'2023 4404613T(11 02.COM WEB)