Permit City of Tigard • COMMUNITY DEVELOP MENT DEPARTMENT
i 1
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Request for Permit Action
T 1,,A R n 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 •www.tigard-or.gov
TO: CITY OF TIGARD
Building Division
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov
Applicant Contractor i Staff
Owner FROM: ,—, �./
❑ tY
Check(✓)one
REFUND OR Name:
INVOICE TO: (Business or Individual)
Mailing Address: _ 8313 4 ) djJ _ -
City/State/Zip: r AO' �'7i
Phone No.: (5a3) 3i2 .1.r5r
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
❑� ��CANCEL/VOID PERMIT APPLICATION.
K r,FUND PERMIT FEES (attach copy of original receipt and provide explanation below).
❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
Permit#: /1'S 7 9 --(X,3Qi
Site Address or Parcel#: / 3- '7ii 5t,,./ dt fly,f( 6, 4, - A.
Project Name: ?;�-0,,, r 0 e el 7,; 3
Subdivision Name: Lot #:
EXPLANATION: ,00/ y ),�, .) We..*-e. 1Mt))r 640.�j)12,,.t": �/
/)' r"ITt t4 /' ' C3 o it,✓ "".-., .+'�. are' . ' aGC_✓` i�y'r6 v!
Signature: Date: i/h?/#1.0
Print Name: 0 y?"V'.ylCf.i
Refund Policy U v
1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of:
• Any fee which was erroneously paid or collected.
• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort
has been expended.
• Not more than 80%of the application or permit fee for issued permits prior to any inspection requests.
2. All refunds will be returned to the original payer in the form of a check via US postal service.
3. Please allow 3-4 weeks for processing refund requests.
FOR OFFICE USE ONLY
Route to Sys Admin: Date I / � By Route to Records: Date , / 2-/ ' B, 'C
Refund Processed: Date /2f ByjJ Invoice Processed: Date / �/ By
Permit Canceled: Date it/..y- B 0 Parcel Tag Added: Date By
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TIGARD
City of Tigard
August 13,2021
Power Northwest
11393 NW Anderson St
Portland, OR 97229
Re:Permit No. MST2020-00306
Dear Applicant:
The City of Tigard has processed a refund for overpayment of permit fees on the above
referenced permit for the following:
Site Address: 13674 SW White Cedar P1
Project Name: Wanderscheid
Job No.: N/A
Refund: ® Check#240249 in the amount of$214.58.
❑ Credit card "return" receipt in the amount of$
❑ Trust account"deposit" receipt in the amount of$
Notes: Refund plan review fees collected in error.
If you have any questions please contact me at 503.718.2430.
Sincerely,62„
2<e:
Dianna Ornelas
Building Division Services Coordinator
Enc.
I:\Building\Refunds\1nii t nidaik erfaNigarg4faregon 97223 • 503.639.4171
TTY Relay! 503_F,R4.2772 • www_ticarrl-nr_cTnv
IIII p City of Tigard
r 1 c n R D Accela Refund Request
This form is used for refund requests of land use, development engineering and building permit
application fees. Receipts, documentation and the Request for Permit Action form (if applicable) must
be attached to this request form. Refund requests are due to Accela System Administrator by
each Wednesday at 5:00 PM. Please allow up to 3 weeks for processing of refunds. Accounts
Payable will route refund checks to Accela System Administrator for distribution to applicant.
PAYABLE TO: Power Northwest DATE: 8/10/2021
11393 NW Anderson St
Portland, OR 97229 REQUESTED BY: Dianna Ornelas
BT
TRANSACTION INFORMATION:
Receipt#: 431650 Case#: MST2020-00306
Date: 11/02/2020 Address/Parcel: 13674 SW White Cedar P1
Pay Method: Check Project Name: Wanderscheid
EXPLANATION: Refund 100%of plan review fee invoiced in error.
iREFUNIINM MATION:
Fee Description From Receipt Revenue Account No. Refund
Example: Building Permit Fee Example: 2300000-43104.. . $Amount
Cash Over 100-0000-48001 $214.58
TOTAL REFUND: $214.58
APPROVALS: SIGNATURES/DATE:
If under$5,000 Professional Staff
If under$12,500 Division Manager ,2 e„„e,.
..,
If under$25,000 Department Manager '"'�����
If under$100,000 City Manager
If over$50,000 Local Contract Review Board
FOR ACCELA SYSTEM ADMINISTRATION;USE ONLY
Case Refund Processed: Date: //y/� By: .ffej
I:\Building\Refunds\RefundRequest.doc x 09/01/2010
ipqCITY OF TIGARD RECEIPT
11; 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARD
Project Name: Wanderscheid
Site Address: 13674 SW WHITE CEDAR PL
Receipt Number: 435815 - 08/13/2021
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
MST2020-00306 $-214.58
Total: $-214.58
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 240249 DHOWSE 08/13/2021 $-214.58
Payor: Power Northwest
Total Payments: $-214.58
Balance Due: $214.58
Page 1 of 1
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71 CITY OF TIGARD RECEIPT
s 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
Tt GAR D
Project Name: Wanderscheid
Site Address: 13674 SW WHITE CEDAR PL
O/4 67 Af4-1---.-
Receipt Number: 431650 - 11/02/2020
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
MST2020-00306 Solar Photovoltaic System 230-0000-43104 $180.00
MST2020-00306 12%State Surcharge-Building 100-0000-24001 $21.60
MST2020-00306 15.01 to 25 kva 220-0000-43103 $200.34
MST2020-00306 12% State Surcharge-Electrical 100-0000-24001 $24.04
MST2020-00306 Cash Over 100-0000-48001 $214.58<-
Total: $640.56
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 57624167 HVANDEWEGE 11/02/2020 $640.56
Payor: Power Northwest
Total Payments: $640.56
Balance Due: $0.00
Page 1 of 1
CITY OF TIGARD MASTER PERMIT
111
' 'Y• COMMUNITY DEVELOPMENT Permit#: MST2020-00306
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/17/2020
T[6:,1AI i g Parcel: 2S104CD06600
Jurisdiction: Tigard
Site address: 13674 SW WHITE CEDAR PL
Subdivision: HILLSHIRE ESTATES Lot: 66
Project: Wanderscheid
Project Description: Solar photovoltaic system.
BUILDING
Floor Areas Required Setbacks Required
Stories: 0 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 0 Parking Spaces: 0
Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 0 Smoke
Dwelling Units: 0 Third: 0 sf Right: 0 Detectors:
Total: 0 sf Value: $83,303.00 Rear: 0
PLUMBING
Sinks: 0 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals: 0
Lavatories: 0 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0
Tubs/Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: 0 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0
Drywall-Trench Drain: 0 Other Fixtures: 0
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0
Heat Pump: N Hoods: 0 Other Units: 0
Furn<100K; 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 0 0-200 amp: 0 0-200 amp: 0 WI Svc or Fdr: 0
Ea add!500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0
Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0
601-1000 amp: 0 601+amp-1000v: 0
1000+amp/volt: 0
ELECTRICAL-RESTRICTED ENERGY
SF Residential
Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All
Other: Y Other Description: Roof Top Solar PV System 17.00 kW Ecompasing: N
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
ALT SF V8 R-3 0
Owner: Contractor:
WANDERSCHEID,ERIN&SEAN POWER NORTHWEST INCORPORATED Required Items and Reports(Conditions)
13674 SW WHITE CEDAR PL 11393 NW ANDERSON ST
TIGARD,OR 97223 PORTLAND,OR 97229
PHONE: PHONE: 503-348-2858
FAX:
Total Fees: $640.56
This permit is issued subject to the regulations contained in the Tigard Municipal Code, Stale 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 ules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: .�...�� Permittee Signature: a —raelY
.639.4175 by 7:00 a.m.for the next available inspection ate.
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 !.. - (0 OD 1 ao
Residential RECEIVED FOR OFFICE I NE 0.NI.1
City of Tigard Received
�� \I) 2 1 IA) ) permit No..MST 2020—00'500
i • 13125 SW Hall Blvd.,Tigard,OR 943T 2 2 20Z0 Pian Review (/ ^�
8 Phone: 503.718.2439 Fax: 5q0�+3.598.1960 p Date/By: 16 ?-�ZQZo !7g e'er fit:
TIGARI) Interment wine: aM or.go17CIT� OF TIGARD Date Ready/By: f y El See Page 2for
BUILDING DIVISION Notiifi,1ed/Method: lr-d?//�h� 1.77-- 11 Supplemental Information
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
0 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
0 Addition/alteration/replacement 0 Other equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
(11
lia 1-and 2-family dwelling 0 Commercial/industrial
Valuation: s 83303.00
❑Accessory building 0 Multi-family Number of bedrooms: 0
❑Master builder ❑Other: Number of bathrooms: 0
JOB SITE INFORMATION AND LOCATION Total number of floors: 0
Job site address: 13674 SW White Cedar Place New dwelling area: 0 square feet
City/State/ZIP: Tigard, OR 97223 Garage/carport area: 0 square feet
Suite/bldg.apt.no.: Project name: Erin Wanderscheid Covered porch area: 0 square feet
Cross street/directions to job site: NE on SW Benchview Terrace then right on Deck area: 0 square feet
SW Cedar Place Other structure area: 0 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 work indicated on this application.
17.00 kW DC Solar Array, s Valuation: $
14.75 kW AC Rating Max Peak Output Existing building area: square feet
New building area: square feet
IR PROPERTY OWNER ® TENANT Number of stories:
Name: Erin Wanderscheid Type of construction:
Address: 13674 SW White Cedar Place Occupancy groups:
City/State/ZIP: Tigard, OR 97223 Existing:
Phone:( ) 5032677316 Fax:( ) New:
® APPLICANT ® CONTACT PERSON BUILDING PERMIT FEES*
Business name: Power Northwest (Please refer ro fee scAed•Ae�
Structural plan review fee(or deposit):
Contact name: Garrett Hartwell
FLS plan review fee(if applicable):
Address: 11393 NW Anderson St
City/State/ZIP: Portland, Oregon 97229 Total fees due upon application:
Amount received:
Phone:( ) 50334.32858 Fax: :( )
E-mail: garrett@powernw.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name: Power Northwest Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: 11393 NW Anderson St Solar Installation Specialty Code checklist.
City/State/ZIP: Portland, Oregon 97229 Permit Fee(includes plan review $180.00
and administrative fees):
Phone:( ) 5033482858 Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lie.: 229987
Total fee due upon application: $201.60
Authorized signature: aeinl*/O171I0i9 This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry
Print name: Garrett Hartwell Date: 10/13/2020 service Board.
I.\Building\Pemtits\BUP-RISPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Document Ref:KNCCM-N2BOC-D3AHN-X72XW Page 1 of 2
1 Electrical Permit Apa1 E VED Fos OFFICE USE ONLY
+ Received
City of Tigard Re Rece Permit
4111 13125 SW Hall Blvd.,Tigard,oR � 2 2 2020 Plan Review MSs'Lc2�-oo'Sar.
II Phone: 503.718.2439 Fax: 503.59Related Permit 4:
Inspection Line: 503.639.41SSITv 8.1960 Date/B i OF TIGAR D Ready Date/By la See Paget for
I IIiAR1) Internet: www.tigard-or.ge.3'1 Ill r'.,r.9 � n1•,;1.q'Itr rN Notified/Melhod: NEM Supplemental Information
TYPE OF WORK PLAN REVIEW
❑New construction ®Addition/alteration/replaeement Please check all that apply(submit J sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
® 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job#: Job site address: 13674 SW White Cedar Place QAddinon of new motor load of system
I00HPormore. ❑"A" "E" "1.2" "I.3"
❑Six or more residential units. occupancy.
City/State/ZiP: Tigard, OR 97223 ['Health-care facilities. CI Recreational vehicle parks.
Suite/bldg./apt.#: Project name: Erin Wanderscheid ❑Hazardous locations. ®Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site; FEE SCHEDULE
NE on SW Benchview Terrace then right on SW Cedar Place Description I Qty. j 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'I 500 sq.ft or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
(with above sq.ft.) 75.00 2
17.00 kW DC Solar Array, New Roof& Gutters Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Renewable Energy ® See Page 2 133.56
® PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: Erin Wanderscheid 200 amps or less 100.70 2
Address: 13674 SW White Cedar Place 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:( ) 5032677316 Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: erinwanderscheid@gmail.com 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 ® CONTAC PERSON Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: Power Northwest above service or feeder fee, 7.42 2
each branch circuit
Contact name: Garrett Hartwell B.Fee for branch circuits without
Address: 11393 NW Anderson St service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP: Portland, Oregon 97229 Each add'1 branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) 5033482858 Fax: :( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: garrett@powernw.com Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: Power Northwest Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy See Page 2 2
Address: 11393 NW Anderson St panel,alteration,or extension.
City/State/ZIP: Portland,Oregon 97229 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) _66.25/hr
Phone:( ) 5033482858 Fax:( ) Investigation(1 hr min) 90.0D/hr
Email: arcett emW.COm Industrial plant(I hr min) 78.18/hr
g @pow . Inspections for which no fee is 90.00/hr
CCB Lic.: 229987 Electrical Lic.: CLR42 Suprv.Lic.: 94LRT specifically listed('A hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: DavidMaar Subtotal: 133.56
Print name: David Nicholls Date: 10/20/2020 ❑Plan Review Required(25%of permit fee): 33.39
State surcharge(12%of permit fee): 16.03
Authorized signature: G?Glt7'tff-fitl'hoe'll TOTAL PERMIT FEE: 182.98
This permit application expires if a permit is not obtained within 180
Print name: Garrett Hartwell Date: 10119/2020 days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:Mending\Permits1ELC_PermitAppER ERE.dac Rev 06/17/2015 440-4615T(11/05/COM/WEH
Document Ref:NQ5Q0-WXDWH-GFDHN-S4PBL Page t of 2
. Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
•
Fee for all residential systems combined: $75.00 Description ) Qty. I Each I Total I
3' Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva % 1 133.56 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva jidita/ `• 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
❑ Garage Door Opener* 50.01 to 100(fekva 552. 6 2
>100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
❑ 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:
Each additional inspection is
• Other: charged at an hourly(1 br min) 66.25/hr 1
Inspections for which no fee is 90.00/hr
specifically listed(%hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Subtotal(Enter on Page 1): 133.56
Fee for each commercial system: $75.00 • Number of inspections allowed per penait.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
• Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
HVAC
❑ Instrumentation
O Intercom and Paging Systems
O Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
0 Other:
Total number of commercial systems: _
*No licenses are required. Licenses are required for all
other installations
1:11luildmgiPermils'ELC_PermitApp_EIR_ERE.doe Rev O6/17/2015
Document Ref:NQ5Q0-WXDWH-GFDHN-S4PBL Page 2 of 2
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