Permit CITY OF TIGARD BUILDING PERMIT
COMMUNITY DEVELOPMENT Permit #: BUP2011 -00052
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/24/2011
Parcel: 2S103BA00111
Jurisdiction: Tigard
Site address: 12005 SW ANN ST
Project: PUGH Subdivision: LERON HEIGHTS Lot: 11
Project Description: Solar photovoltaic system.
Contractor: SOLARCITY CORPORATION Owner: PUGH, THOMAS R AND BARBARA J
6132 NE 112TH AVE 12005 SW ANN ST
PORTLAND, OR 97220 TIGARD, OR 97223
PHONE: 503 - 964 -0489 PHONE:
FAX: 503 -926 -9101
FEES
Specifics: Description Date Amount
Type of Use: SF Solar Photovoltaic System 03/15/2011 $180.00
Class of Work: ALT 12% State Surcharge - Building 03/15/2011 $21.60
Dwelling Units: 0 Info Process /Archiving - Sm Sheet (up to 03/24/2011 $4.50
Stories: 0 Height: 0 ft 11x17)
Bedrooms: 0 Bathrooms: 0
Value: $2,000
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $206.10
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. A ' • a -.on law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -0' -0010 through OAR • •2 -0. e V 1. Y. may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issue. By: /JAI i Permittee Signa ure:
Call 503.639.4175 by 7:00 a.m. for the next available inspection te.
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 ��� l O IZ O I i 1, 1 I� I ,,\ I, Ar City of Tigard Q�`�� ^^ Received T /, —WO _
}" O �\ Datei : l J Permit No.: 1 /
13125 SW Hall Blvd., Tigard, OR 97223 P .1. • ew
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Phone: 503.639.4171 Fax: 503.598.1960 `AP� 1 ' R 9 Da :: ' / Other Permit:
I i I Inspection Line: 503.639.4175 r �` O�� .t Sly ti fie d/M t A !, a b Page 2 for
Internet: www.ti and d- 0or. ov 7 Supplemental ental Informa
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TYPE OF WO I% R` REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑ New construction ❑ 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.
2(1- and 2- family dwelling ❑ Commercial /industrial Valuation: $ 40 O
❑ Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: / 2 00 5 SIN V Ann J ` , New dwelling area: square feet
City/State /ZIP: )', C,rC/ , OP-1 q 7 2 3 Garage/catport area: square feet
Suite/bldg. /apt. no.: Project name: P Covered porch area: square feet
Cross street/directions to job site: J Deck area: square feet
Other structure area: square feet
REQUIRED 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.
4 .2 kW goof / oun t /' V Sy,s7 1 Valuation: $
J Existing building area: square feet
(� New building area: square feet
❑ PROPERTY OWNER ❑ TENANT ` ` ' ber of stories:
WI
Name: ,
• t 0 .e of construction:
Address: t 7' `` ' ,o
� , , '- Occupancy groups:
City/State/ZIP: ", � � ' Existing:
Phone: ( ) ax: ( ) -C-0 New:
❑ APPLICANT F*CT ERSON NOTICE
Business name: (Solar (1.1i (1 orpura /7 � All contractors and subcontractors are required to be
Contact name: � 1 L
C A . Il licensed with the Oregon Construction Contractors Board
tf YI 111 UU s / /. • under ORS 701 and may be required to be licensed in the
Address: lY / 3 2 NE- 112-e- jurisdiction in which work is being performed. If the
City/State/ZIP: "/ 0 p t L its N 1 O n 72 applicant is exempt from licensing, the following reasons
apply:
Phone: ( 503) q Si . OLc I 0 I Fax: : ( 503 ) 53 li • (I ti /3
E -mail: Chars ors kA ( 50/circil . C owl.
CONTRACT°
Business name: 50 L A / 7 y CoR Q TI 0A/ BUILDING PERMIT FEES*
Address: 6/../.. /1(4 /2 ' /chic lease re er to ee schedule
City/State/ZIP: 0 ��A N v 92..0 Structural plan review fee (or deposit):
( 5Q3 / -7 0/..,/ : ( ^ FLS plan review fee (if applicable):
Phone: / Fax: 3) 92 W 9t o 1
/ � t / � Total fees due upon application: ' / l_ G c)
CCB lic.: Amount received: ■ O V CJ 9
Authorized signature — This permit application expires if a permit is not obtained
/ "�� within 180 days after it has been accepted as complete. Fee methodology set by Tri County Building Industry
Print name: 4 i - R.S �,V /s Date: *
'T Service Board.
I:\Building\Permits\BUP -RES PermitApp.doc 10 /01 /09 440- 4613T(I1/02 /COM/WEB)