HomeMy WebLinkAboutRES2025-0022 APPLICATION Building Permit Application
Residential 10k OI FIc'F t:tih:()Nix
City of Tigard Date/B d
Permit No.:
III 4 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
e Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Other Permit:
Inspection Line: 503.639.4175 Date Ready/By: Juris: BI See Page 4 for
i �' i2 D p Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
0 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 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation: $ R e,boo
❑ 1-and 2-family dwelling ElCommerciaVindustrial
Number of bedrooms:
ElAccessory building El Multi-family❑Master builder Other: D /.., ',`!pia Number of bathrooms:
JOB SITE INFORMATION AND LOCATION ` Total number of floors:
Job site address: \L\15 Z S ln3 7/ 0-0 t , New dwelling area: square feet
City/State/ZIP: T ciao q 7 as 4 Garage/carport area: square feet
Suite/bldg./apt.no.: 4 Project name: —1(aM-- e.41l4. '..?.�/.. Covered porch area: 3ai.i square feet
Cross street/directions to job site: 1 Deck area: square feet
_� CD r n .� .t-fee{ Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision:Tr-6 S {Li- I l L, ,d rn s Lot no.: Permit fees*are based on the value of the work performed.
t_ Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: to Dd0 2S\\2 G equipment,materials,labor,overhead,and the profit for the
1,'�i/ c DESCRIPTION� OF WORK work indicated on this application.
rLp}}ICU t y..1s'1 Lt ' to al) ne4ti dedb Valuation: $
✓l11° c.) ?lv )U ` „6�L ,1Y) Existing building area: square feet
L �/[ New building area: square feet
0 PROPERTY OWNER 0 TENANT Number of stories:
Name: Type of construction:
Address: I y 7 5 2 Sc..)LJ '7 6-t put, Occupancy groups:
City/State/ZIP: -7-; n�ro/ D,a n-7„)a[-/ Existing:
Phone:( ) `l Fax:( ) New:
A APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name: ?ed .s i' h 41 IStructural plan review fee(or deposit):
Contact name: 1 �. S .1Yt-f'Y)
7'I S 2�, FLS plan review fee(if applicable):
Address: c,9nr�c� 51 . L�2c2 livrCLc) � Total fees due upon application:
c
City/State/ZIP: / s La dla- 0 2 of Q 2 2)
Amount received:
Phone:(5A )6) .) (G 714, Fax::( )
E-mail: PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
�JPcr»Z-Z• . ZedClzsi r) Fl. ynrlf .0 Cem
�J Commercial and residential prescriptive installation of
CONTRACTOR' roof-top mounted PhotoVoltaic Solar Panel System.
Business name: /Vi - L-Gvt/ / e(p i Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: ,?J-5 �G con �L.( �p Solar Installation Specialty Code checklist.
City/State/ZIP: C� QPermit Fee(includes plan review $180.00
�1S 4 L .- 2. 7b 2.3 and administrative fees):
Phone:(0(3 I )5 bp-- 1 S y Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lic.: 7 .5Q gg� Total fee due upon application: $201.60
Authorized signature: 04 ! i/Y/ This permit application expires if a permit is not obtained
JL/:/ i L, within 180 days after it has been accepted as complete.
Print name: Date: / *Fee methodology set by Tri-County Building Industry
&4/�/-y) 1 1 I 425 Service Board.
I:\Building\Petmits\BUP-RESPermitApp.doc 01/25/2023 440-4613T(11/02/COM/WEB)