Permit q CITY OF TIGARD BUILDING PERMIT
` ". 1 ,.' COMMUNITY DEVELOPMENT Permit #: BUP2011 -00129
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/30!2011
Parcel: 1S136AD01700
Jurisdiction: Tigard
Site address: 6875 SW PINE ST
Project: Blume Subdivision: VILLA RIDGE Lot: 2
Project Description: Photovoltaic system.
Contractor: SOLARCITY CORPORATION Owner: BLUME, JULIE E & HENDRIK A
6132 NE 112TH AVE 6875 SW PINE 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 06/22/2011 $180.00
Class of Work: ALT 12% State Surcharge - Building 06/22/2011 $21.60
Dwelling Units: 0 Info Process /Archiving - Sm Sheet (up to 06/22/2011 $14.00
Stories: 2 Height: 0 ft 11x17)
Bedrooms: 0 Bathrooms: 0
Value: $0
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $215.60
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 in OAR
952- 001 -0010 through OAR 952- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1 *:7 or 1.800.332.2344.
'/
Issued By: „/.0°'� Permittee Signature:
Call 0 ' .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 t: y L sir ;,s . FOR OFFICE USE: ONLY
City of Tigard 2 - Date /B :
O �
Received Q 1 M Permit No : / PAO / �lpZ
JUN 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review ._ , 11 503.718.2439 Fax: 503.598.1960 Date : �/ Other Permit:
C
Line: 503.639.4175
Inspection Ins TIGARD Date Ready/ t ®
:' lurs: See Page 2 for
;,A p CITY OF
Internet: www.tigard - or.gov BUILDING DIVISION Notified/Method: Supplemental Information
' • . ' `. TYPE` OF. WORK ' : , 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
' CATEGOR_ Y_ ..OF CONSTRUCTION. ,
• , ,, - work indicated on this application.
pl tcatton.
® I - and 2- family dwelling ❑ Commercial /industrial Valuation: $ : 362 5
❑ Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB number of floors:
JOB -SITE. INFORMATION ANTE LOCATION,,
to sw phi Sf.
Job site address: J /� n New dwelling area: square feet
City/State /ZIP: Pori- I an , O i . , 9722 i Garage /carport area: square feet
Suite/bldg. /apt. no.: Project name: f3/� � j r LeJ 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 indicated on this application.
Roof Mount PV System Valuation: $
Existing building area: square feet
New building area: square feet
IJ PROPERTY OWNER ❑ TENANT Number of stories:
Name: I " t e/ Type of construction:
Address: v
Occupancy groups:
City/State /ZIP: 51114 E Existing:
Phone: ( ) Fax: ( ) New:
, - ❑-. APPLICANT l ® CONTACT PERSON *
. • � _ ._ .. ' ' �� •. . ;. BUILDING PERMIT.FEES ' : ,
Business name: SolarCity Corporation (Pleaseiejeriof . _'
Structural plan review fee (or deposit):
Contact name: Caitlin Horsley
m FLS plan review fee (if applicable):
Address: 6132 NE 112 Ave
City/State /ZIP: Portland
Total fees due upon application:
Phone: (503) 9560610 Fax: : (503) 5366513 Amount received: c*A /' T '
E -mail: chorsley @solarcity.com PHOTOVOLTAIC SOLAR PANEL SYSTE *'
- - _• c . Commercial and residential prescriptive installation of
' . '
CONTRACTOR
" • - roof -top mounted Photovoltaic Solar Panel System.
Business name: SolarCity Corporation Submit two (2) sets of roof plan with connection details
and fire department access, along with the 2010 Oregon
Address: 6132 NE 112` Ave Solar Installation Specialty Code checklist.
City/State /ZIP: Portland, Oregon 97220 Permit Fee (includes plan revie $180.00
and administrative fees):
Phone: (503) 9560610 Fax: (503) 4366513 State surcharge (12% of permit fee): $21.60
CCB lie.: 180498
Total fee due upon application: $201.60
Authorized signature: — / //, This permit application expires if a permit is not obtained
w ithin 180 days after it has been accepted as complete.
* Fee methodology set by Tri Building Industry
Print name: Caitlin Ho ey Date: /2Z�� Service Board.
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