Loading...
Permit City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT 2 . a Request Permit Action _l. c n It D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard- or.gov TO: CITY OF TIGARD v 0 1 0 Building Division Services Supervisor 13125 SW Hall Blvd., Tigard, OR 97223 /0/ //L At Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov FROM: ❑ Owner ❑ Applicant ❑ Contractor N City Staff (check one) REFUND OR Name: INVOICE TO: (Business or Individual) / f.. Mailing Address: City/State/Zip: Phone No.: PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED ( M CANCEL /VOID PERMIT APPLICATION. REFUND PERMIT FEES (attach copy of original receipt and provide explanation below). ❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below). ❑ REMOVE /REPLACE CONTRACTOR ON PERMIT (do not cancel permit). Permit #: �ue oZ c;.1 — OO 145 4 Site Address or Parcel #: I-5(Q(p 0 ` ole.0 I' o c i - e..1 C. 1-1 Wy A-/ Project Name: P 4....- r CZ) Subdivision Name: lit ii Lot #: N/// EXPLANATION: 5e_cP €- O F ta I R wl .k Celli' / E T l Signature: . C . 1 4 0 4 A - - • Date: q 1/9 ii 9 - P r i n t Name: � f ) tl1 _ . N'pt Refund Policy 1 The Director or Building Official may authorize the refund of: a) any fee which was erroneously paid or collected. b) not more than 80% of the land use application fee when an apphcation is withdrawn or canceled before any review effort has been expended. c) not more than 80% of the land use application fee for issued permits. d) not more than 80% of the building plan review fee when an application is canceled before any plan review effort has been expended. c) not more than 80% of the building permit fee for issued permits pnor to any inspection requests. 2. Refunds will be returned to the ongmal Payer in the same method in which payment was received. Please allow 2 -4 weeks for processing refunds. FOR OFFICE USE ONLY Rte to S s Admin: Date • m ®L 1 J ,,, / m Rte to Bld• Admin: Date , ©em B ./, Refund Processed: Date 09. By ar nvoice Processed: Date By Permit Canceled: Date /0 2// Z B -.0 Parcel Tag Added: Date By Receipt # Date Method Amount $ I:\ Building \forms \RegPemtitAction.doc Rev 05/25/2012 Buildin Permit A lication �p� V 0 I 0 /0N"- Aer' Commercial EIVED FOR OFFICE USE ONLY D ate /B T. �� —.4 P?� City of Tigard AUG 2 0 2012 „; 11 -v 13125 SW Hall Blvd , Tigard, OR 97223 PI. R ' 0 Phone: 503.718 2439 Fax: 503 $ ' TIGARD Date /B i 11 1AR a IZI TI G A R D Inspection Line. 503 639 4175 11��;;�1 Date Ready /By. � A � ® See Page 2 for Internet. www ugard- or.gov ( UILDINGDIVISION N j p d/Me hod t����� �Supp mental Information TYPE OF WORK REQUIRED DATA: 1- A' 'D 2- FAMILY DWELLING ❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed. Inch. to the value (rounded to the nearest dollar) of all ® Addition/alteration/replacement ❑ Other: cquipm: t, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION work indre.ted on this application. ❑ 1- and 2- family dwelling ® Commercial /industrial Valuation: $ ❑ Accessory building ❑ Multi- family Number of . drooms: ❑ Master builder ❑ Other: Number of bat oom . JOB SITE INFORMATION AND LOCATION Total number of • tors: Job site address: /_54,6,0 ,SLJ e l - C/F /C ofit Nat New dwelli.: area: square feet Cit /State /ZIP: l61Ai O e vl 1- 2 24 Garage/ arport area: square feet Suite /bldg. /apt. no.: Project name:T ,:rofzE Sut%u/ 01 Cov red porch area: square feet Cross street/directions to job site: 5eck area• square feet Other structure area: se are feet REQUIRED DATA: COMMERCIAL -USE HECKLIST Subdivision: I Lot no.: Permit fees* are based on the value of the work aerformed. 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. Valuation: $ k5,000 5-roe€ 44 LV( r Existing building area: square feet New building area: square feet ❑ PROPERTY OWNER 0 TENANT Number of stories: t Name: 7E,'t 'e Type of construction: Address: rl Its L o g , Occupancy groups: City /State /ZIP: ' pt.,,) _Dt1^,FT0 t^_t4 °12.1 l Existing: ri_El 1 Phone: (to, 5e 433 -7p, 45 Fax ( ) New: C,T1AI V) 0-APPLICANT 'l. CONTACT PERSON BUILDING PERMIT FEES* � (Please refer to fee schedule) � - Business name: �l� I GAGE Structural plan review fee (or deposit): ,) Contact name: Ch /i3 / l'//�S �f FLS plan review fee (if applicable): 11 1"- Address: 13400 /"j l�Fi S /De .g. - +x,202 .1"N Address: fees due upon application: �. City /State /ZIP: 3 /i6e tR,si 0,4),( j, C/) 9/4V - �j' ) 8. p (0/b )454 _ ---5.5 Amount received: Phone: (bit � la� Fax. PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES* E -mail: b ig @ 76/eMi 7 --- p .Ace C,o.n Commercial and residential prescriptive installation of tii CONTRACTOR Cdr�i, roof -top mounted PhotoVoltaic Solar Panel System. Business name: T �A L O Submit two (2) sets of roof plan with connection details I � `�� and fire department access, along with the 2010 Oregon Address: 90/ N u a 54 z �- - Solar Installation Specialty Code checklist City /State /ZIP: L �� ca 97 a 5 �. Permit fee (includes plan review $180 00 "� �} and administrative fees): Phone: S 3) A 9 —q 7 `j/ Fax: ( ) State surcharge (12% of permit fec): $21 60 CCB lie.: / g 4 0 P application: fee due upon a lication: $201.60 Authorized signature: y. This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: Date: * Fee methodology set by Tri- County Building Industry Service Board. I• \Building \Permits \BUP -COM PermitApp.doc 02/24/2011 440- 4613T(I I /02 /COM /WEB)