Permit CITY OF TIGARD BUILDING PERMIT
s: 1 COMMUNITY DEVELOPMENT Permit #: BUP2010 -00242
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/19/2010
Parcel: 25111 BB00300
Jurisdiction: Tigard
Site address: 14085 SW 100TH AVE
Project: Peterson Subdivision: TIGARDVILLE HEIGHTS Lot: 11
Project Description: Installation of solar voltaic system.
Contractor: RS ENERGY LLC Owner: PETERSEN, DAVE & DENA
20915 SW 105TH AVE 14085 SW 100TH AVE
TUALATIN, OR 97062 TIGARD, OR 97224
PHONE: 503 - 752 -2885 PHONE: 503 - 998 -2105
FAX: 503 - 228 -2770
FEES
Specifics: Description Date Amount
Type of Use: SF Solar Photovoltaic System 11/04/2010 $180.00
Class of Work: ALT 12% State Surcharge - Building 11/04/2010 $21.60
Dwelling Units: 0
Stories: 0 Height: 0 ft
Bedrooms: 0 Bathrooms: 0
Value: $4,000
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $201.60
Required: Required Items and Reports (Conditions)
Fire Sprinkler: Parapet:
Fire Alarm: Protected Corridors:
Smoke Detectors: Manual Pull Stations:
Accessible Parking: 0
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 the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth 'n OAR
952- 001 -0010 through OAR 952 -001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503. 987 or 1.800.332.234.
Issued
ItZ
�+ Permittee Signature: _, __.
Call 503.6' ,A 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 Application
Residential
REC FOR OFFICE USE City of Tigard Received �,i n
° 13125 SW Hall Blvd., Tigard, OR 97223 Nov 4 2010 Plan R : //' p ermit No.: , �
Plan Review��� Other Permit:
Phone: 503.639.4171 Fax: 503.598.1960 Date/B ■
T I GARD Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready /By: ® See Page for
- Internet: www.tigard- or.gov Notified/Method: ' iifil Supplemental Information
BUILDING DIVISION 590 ,-,„ c2.,
• TYPE OF WORK • REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑ 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.
Q'1- and 2- family dwelling ❑ Commercial /industrial Valuation: $ A-000
El Accessory building El Multi-family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: % 4 d as 3 0 loom A✓t. New dwelling area: square feet
City /State /ZIP: i 79 `, e 1 D re C� 04 4 . 1- - 2 - L. 4 Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: / c.4_ « &t ,, -I$ 18 v Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL - 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
DESCRIPTION OF WORK . work indicated on this application.
C IS o Valuation: $
Existing building area: square feet
2`r C 4 �0 Sa (a. / 74-E14-1 d /j Poo-P. // New building area: square feet
❑ PROPERTY OWNER ❑ TENANT Number of stories:
Name: pc.,. Jt T f � �� 4 ers Type of construction:
Address: L .4 o 6 f ,S (,J / O 0 24 J�, Occupancy groups:
City/State /ZIP: / -� ,J , O 1 .. 82.4 Existing:
Phone: ( Sol) y H 6) - - V 5 Fax: ( ) New:
❑ APPLICANT ❑ CONTACT PERSON NOTICE
Business name: ' Ev'e�y t LL_C. All contractors and subcontractors are required to be
Contact name: J licensed with the Oregon Construction Contractors Board
�V a 11 ∎ L -r6 S under ORS 701 and may be required to be licensed in the
Address: ' Lo c i lc .G1)) ( Sth ihG jurisdiction in which work is being performed. If the
applicant is exempt from licensing, the following reasons
City/State/ZIP:
TU 0, c.'.i n O2 qi •fO G 2- apply:
Phone: ( 3) Z_ 2.8 65 Fax: :(5 l7 - 2 , 1 . 1 .. 0
E -mail: at..0;c\ a rS' SZS. co.-,
CONTRACTOR
Business name: '-9....S Irte_c ` Luc_ BUILDING PERMIT FEES*
Address: -Lock t 5 6 �v S - A' :�� (Please refer to fee schedule)
1� Structural plan review fee (or deposit):
City/State/ZIP: t V k" ` �' � - i l 2 oroZ FLS plan review fee (if applicable):
Phone: ( cas) '}S ' g '
s
fiax: (� 2 - � U / // i Z Total fees due upon application: °AO/ • (
CCB lie.: 2$ , j
Amount received: ,X 701 `, GO
"( t I permit expires a permit is n ot obtained
Authorized signature:
1 � / C k� 1
This within 180 days application after it has been if accepted as co mplete.
Print name: Dv V t J �/`p Date: U y/ / v * Fee methodology set by Tri- County Building Industry
Service Board.
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