Permit y,. 1..- 1k 1 M1-- r
Electrical Permit Appl �a� '' • S 4-- ' FOR Ofrl(l: I SE ONLY
City of Tigard Received
�� 7 SF P 3 2020 Date/B : / / /
1111 i-41 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
' Phone: 503.718.2439 Faxy 5 5,98 r .1= D Date/B.. Related Permit#:
Inspection Line: 503 639 41'35!` f t ( ,(S,,1 Ready Date/By: El See Page 2 for
1 I '?.It D Internet: www_tigard or cW,.'' . 1 ` '`' J Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
0 New construction K1 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
O Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition ❑Other:
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
In 1-and 2-familyless to ground,or exceeds 14,000 El Commercial-useagricultural
dwelling 0Commercial/industrial ❑Accessory building amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: Job site address: 13740 Sw Liden Drive 100HP or more. ❑"A "E","l-z","1-3
City/State/ZIP: ❑Six or more residential units. occupancy.
Tigard. OR 97223 0 Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name: Reyes Solar ❑Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. I Each I Total I "
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
6.00kW AC Solar Photovoltaic Prescriptive Roof Mount install, (with above sq.ft.) 75.00 2
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
® PROPERTY OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: Gabriel Reyes 200 amps or less 100.70 2
Address: 13740 Sw Liden Drive 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: Tigard, OR 97223 601 amps to 1,000 amps 301.04 2
Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email:
relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
APPLICANT CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: ET,EMENTAL ENERGY above service or feeder fee, 7.42 2
each branch circuit
Contact name: CHRISTINE STAMPER, 503-522-9190 (CELL) B.Fee for branch circuits without
service or feeder fee,first
AVEAddress: 1339 SF 8TH SIT. R branch circuit 56.18 2
City/State/ZIP: Each add'l branch circuit 7.42 2
PORTLAND OR 97214 Miscellaneous(service or feeder not included)
Phone:(503)967-57R6 Fax: :( ) Each manufactured or modular 67.84 2
sery
Email: er PERMITS ELEMENTALENERGY-NET a coin ect only ica and/or feeder 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: ELEMENTAL ENERGY Sign or outline lighting 67.84 2
•
Address: 1339 SE 8TH AVE STE B Signal aclteration,
n or limited-energy ❑ See Page 2 2
panel,alteration,or extension. g
Each additional inspection over allowable in any of the above •
City/State/ZIP: PORTLAND OR 97214 Additional inspection(1 hr min) 66,25/hr
Phone:( 5031 967-5786 fl Fax:( ) Investigation(1 hr min) 90.00/hr I
Industrial plant(1 hr min) 78.18/hr
Email: PERMITSna ELEMENTALENERGY.NET Inspections for which no fee is
CCB Lie.: "Electrical Lie.: C 1228 suprv.Lie.: 4894S specifically listed('/hr min) 90.00/hr
195141 ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: _,Pd-;/ffii„,- Subtotal:
Print name: David Gehrke Date: 09/30/2020 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature:
TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 190
Print name: CHRISTINE STAMPER Date09/30/2020 days after it has been accepted as complete.
* Number of inspections allowed per permit.
1:\Building\Pemtits\ELC_PermitApp_ELR ERE doe Rev 06/17/2015 440-4615TO 1/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Description I Qty. 1 Each Total I
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 00.70 2
5.01 to 15 kva 1 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
❑ Garage Door Opener*
>100 kva(fee in accordance
•
with OAR 918-309-0040) 552.26 2
❑ Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over 25 7.42 3
•
❑ Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ Other: Each additional inspection is 66.25/hr
charged at an hourly(1 hr min)
Inspections for which no fee is 90 00/hr
specifically listed('/,hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 Subtotal(enter on Page l):
y . Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
n Boiler Controls
•
n Clock Systems
❑ Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
1.r3uilding Permirs\ELC_PermitApp_ELR_ERE.doc Rev06/17/2015