Permit W CITY OF TIGARD BUILDING PERMIT
COMMUNITY DEVELOPMENT Permit #: BUP2011 -00084
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/06/2011
Parcel: 1 S133DC14700
Jurisdiction: Tigard
Site address: 13269 SW TAMERA LN
Project: Pederson Subdivision: VILLAGE AT SUMMER LAKE NO. 1 Lot: 2
Project Description: Installation of a solar photovoltaic system.
Contractor: SOLARCITY CORPORATION Owner: PEDERSON, RICHARD D & FLORENCE J
6132 NE 112TH AVE 13269 SW TAMERA LANE
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 04/27/2011 $180.00
Class of Work: ALT 12% State Surcharge - Building 04/27/2011 $21.60
Dwelling Units: 0 Info Process /Archiving - Sm Sheet (up to 04/27/2011 $5.50
Stories: 0 Height: 0 ft 11x17)
Bedrooms: 0 Bathrooms: 0
Value: $2,500
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $207.10
Required: Required Items and Reports (Conditions)
Fire Sprinkler: Parapet:
Fire Alarm: Protected Corridors:
Smoke Detectors: Manual Pull Stations:
Accessible Parking: 0
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all of - - • • - • • All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or ' •pork is suspended for m• - the 180
days. ATTENT c .. . -.on law requires you to follow the rules adopted by the Oregon Utility Notification Cents-. Those rules are f• h OAR
952 - 001 -0010 rough OAR r52 -00 r 0. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.19$.23' •
Issued By: i OP� Permittee Signature. _ /1111161111r
Call 503.639.4175 by 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 l 14 i 1 1(1 1 r ()NI 1
City of Tigard RECEI "� Permit No.: P _
ipi,
13125 SW Hall Blvd., Tigard, OR 97223 Plan j� ; / ��
Phone: 503.639.4171 Fax: 503.598.1960 �t� /// C7/v Other Permit:
I 1 (, ,� I ; i
Internet: www.tiganl- or.gov Notified/MeInspection Line: 503.639.4175 APR 2 7 2 011 � � ay/By; N �� See page Z for
t�odO / it " Supplemental Information
CITY OF TIGARD 44 U'
TYPE OF "'WILDING DIVISION 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
13 ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
rii _ and 2- family dwelling ❑ Commercial /industrial Valuation: $ 2/ 40 0
❑ Accessory building ❑ Multi- family Number of bedrooms: V
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 132 4 9 U J T ani et. �i , J,n • New dwelling area: square feet
City/State /ZIP: 7i' ( O/ 9 72 f 3 Garage/carport area: square feet
Suite/bldg. /apt. no.: U Project name: / e <�CrS'.�/(J Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet k
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
I,,II-- II 11
DESCRIPTION OF WORK " work indicated on this application.
6 .OtY 1d ) .o j ' [ / owi Tv / s��'ii ,CA�, S ) Valuation: $
/ Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER I ❑ TENANT Number of stories:
Name: Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
g
Phone: ( ) Fax: ( ) New:
❑ APPLICANT ['CONTACT PERSON
NOTICE
Business name: Ql[/ C/ t J� r rf t4 (44..-1 All contractors and subcontractors are required to be
Contact name: /11 fU-n- I�V licensed with the Oregon Construction Contractors Board
^ r�l v under ORS 701 and may be required to be licensed in the
'
Address: W / 3 2 NE: 1 / jurisdiction in which work is being performed. If the
City/State/ZIP: Por_ lan c/ Qi' 9 72_2() applicant is exempt from licensing, the following reasons
/ 2 apply:
Phone: (O 3) /; 1s •6 � /0 I Fax: : (50 5.7 to - to 5/3
E -mail: C OYcs ley e (Wa r n/ 1- • (/4 )
CONTRACTOR
Business name: 30 LAtiR 7-y (R tg - 7 0rs BUILDING PERMIT FEES*
Address: �D /v / //���""(((///
/./2 , 1/2' " (Please refer to fee schedule)
Structural plan review fee (or deposit):
City/State/ZIP: An-LAND
96 "' „, / 9z� — n / 0 FLS plan review fee (if applicable):
(
Phone: 7 Fax: 3) 7 t V 71
CCB lic.: / $'0 // ?5 Total fees due upon application:
Amount received: S A to
Authorized signature This permit application expires if a permit is not obtained
`� J within 180 days after it has been accepted as complete.
Print name: ( , X�7Q,V/ I Date: Ld /2 770 * Fee methodology set by Tri- County Building Industry
// ,, � Service Board.
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