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MAY 282013
CITY OF TIGARD
BUILDING DIVISION
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1118 114Au,&v
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Building Permit Application
Residential �
REC ; FOR OFFICE usl. ONLY y: 'p Received � Permit City of 'igard DateB : — r:1"I _� P it N
Mr� -/ ' a l
11 • 13125 SW Hall Blvd., Tigard, OR 97223 MAY 2 8 2013 Plan Review Other Permit:
Phone: 503.718.2439 Fax: 503.598.1960 Date/By:
r ' Inspection 503.639.4175 p � / ± h Date Ready/By: Juris: El See Page 2 for
T I G A It OF T F O IGAR�
Internet: ,www.tigard or.gov Notified/Method: Supplemental Information
DI G D'1VIS OFF
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TYPE OF WO DUIL 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
❑ Addit lacement tl�:�_. -0 Other: equipment, materials, labor, overhead, and the profit for the
•
�"; - CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation: $ /O 0 OJ —
❑ 1- and 2- family dwelling ❑ Commercial/industrial /
❑ Accessotybuilding
❑ Multi - family Number of bedrooms:
a Number of bathrooms:
❑ Master buil�er , er: - , >,
JOB SITE INFORMA ON AND LOCATION Total number of floors:
Job site address: 10 C � c S lA/ f / / / v t) New dwelling area: square feet
City/State / : 0 0-7{-, p i U d vtf' Cy-) 3 Garage /carport area: square feet
Suite/blde,/apt. no.: Project name �, t t 6 , / ; Covered porch area square feet
Cross street/directions to job site: l Deck area: square feet
rr Other structure area: square feet
le= - + -.4 ., • REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: G C Lot no.: Permit fees* are based on the value of the work performed.
I . Indicate the value (rounded to the nearest dollar) of all
Tax !Ili/parcel i•: i •,, equipment, materials, labor, overhead, and the profit for the
r work indicated on this application.
DESCRIPTION Of WO
I , / I Valuation: $
j � �� ^� Y Existing building area square feet
11 ii.. .
1111C � 4 New building area: square feet
❑ PROP OWNER ❑ TENANT Number of stories:
Name: iWire Type of construction:
Address: ) .-i G 5 w 3 ,...y4 fl Occupancy groups:
City/State /ZIP: P„ -1 ( UI 9 > c2 / Existing:
Phon (5, '> 1 _. d l 9 . 3 Fax: (S a t( ( < J (0 9 New:
: i n APPLICANT 1 ❑ CONTACT PERSON BUILDING PERMIT FEES*
' f)
(Please refer to fee schedule)
Business nar[}ef Structural plan review fee (or deposit):
Contactn e:
+ FLS plan review fee (if applicable):
Address �;, �--
�°` .,.' - Total fees due upon application:
City/State /Z - - /� ' • 7 7 ,
7 `'
Phone: ( Fax: : ( ) Amount received:
.. PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
E -mail: y
Commercial and residential prescriptive installation of
CONTRACTOR roof -top mounted PhotoVoltaic Solar Panel System.
Business nJtii. ,� ) Submit two (2) sets of roof plan with connection details
`' and fire department access, along with the 2010 Oregon
t Address: 8 '. Y it Solar Installation Specialty Code checklist.
i • City /State /ZIP: `\ Permit Fee (includes plan review $180.00
` and administrative fees):
Phone: ( ) \ '••4 Fax: ( ) State surcharge (12% of permit fee): $21.60
CCB lic.: Total fee due upon appfication: $201.60
Authorized signature: This permit application expires if a permit is not obtained
Q within 180 days after it has been accepted as complete.
.......-1 * Fee methodology set by Tri- County Building Industry
• name: ( .- Date: S _ - Service Board
.ng\Permits\BUP-RESPermitApp.doc 02/24/2011 440 -4613T(11 /02 /COM/WEB)