Permit VOID
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT 'Vk/7'/ OIII il
Request for Permit Action
T I G A R D 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
FROM: ❑ Owner X❑ Applicant ❑ Contractor ❑ City Staff
Check(✓)one
REFUND OR Name:
INVOICE TO: (Business or Individual) TESLA
6132 NE 112TH AVE,
Mailing Address:
PORTLAND OR 97220
City/State/Zip:
Phone No.: 5035605583
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
RI CANCEL/VOID PERMIT APPLICATION.
n REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
LI REMOVE/REPLACE CONTRACTOR ON PERMIT(do not cancel permit).
Permit#: MST2020 324
Site Address or Parcel#: 13058 SW BLACK WALNUT
Project Name: LEE MCPHERSON
Subdivision Name: Lot#:
EXPLANATION: CUSTOMER CANCELLED
Signature: A M E L I S SA FARIW Date: 4.18.21
Print Name:
Refund Policy
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• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort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. ififeg 07 _ ,yy p- 3(o .o e
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FOR OFFICE USE ONLY
Route to Svs Admin: Date B, Route to Records: Date - /0 By '
Refund Processed: Date 9 6`,'.-/ B /0 Invoice Processed: Date By
Permit Canceled: Date -76//� B . D Parcel Tag Added: Date By
I:ABuilding\Forms\RegPermitAction_ 9231 doc
I
II a
TIGARD
City of Tigard
September 10,2021
Tesla Energy
6132 NE 112th Ave
Portland, OR 97220
Re: Permit No. MST2020-00324
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 13058 SW Black Walnut St
Project Name: McHugh
Job No.: N/A
Refund Method: ® Check#240519 in the amount of$280.95.
❑ Credit card"return"receipt in the amount of$
Note: Please allow 2-5 days for this refund transaction to be
credited to your account by the company that issued your card.
❑ Trust account"deposit" receipt in the amount of$
Comment(s): Per applicant's request as job was cancelled. Refund 80% of permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
Dianna Ornelas
Building Division Services Supervisor
Enc.
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171
TTY Relay: 503.684.2772 • www.tigard-or.gov
City of Tigard
l c k Accela Refund Request
TThis 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: Tesla Energy DATE: 9/6/2021
6132 NE 112th Ave
Portland, OR 97220 REQUESTED BY: Dianna Ornelas
TRANSACTION INFORMATION:
Receipt#: 432222 Case#: MST2020-00324
Date: 12/20/2020 Address/Parcel: 13058 SW Black Walnut St
Pay Method: CreditCard Project Name: McHugh
EXPLANATION: Per applicant's request as job was cancelled. Refund 80% of permit fees.
REFUND INFORMATION.
Fee Description From Receipt Revenue Account No. R.4.f+.,041
Example: Building Permit Fee Example: 2300000-43104 s Amount .„
Building Permit Fcc 230-0000-43104 $144.00
Electrical Permit Fee 220-0000-43103 106.85
12%State Surcharge 100-0000-24001 30.10
TOTAL REFUND: $280.95
APPROVALS: SIGNATURES/DATE:
If under$5,000 Professional Staff
If under$12,500 Division Manager Ci'►�e2%L2���..,�
If under$25,000 Department Manager
If under$100,000 City Manager
If over$50,000 Local Contract Review Board
Case Refund Processed: Date: /cf By:
I:\Building\Refunds\RefundRequest.doc x 09/01/2010
CITY OF TIGARD RECEIPT
IIII • 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
'TIGARD
Project Name: McPherson
Site Address: 13058 SW BLACK WALNUT ST Acht,dzs
Receipt Number: 436383 - 09/10/2021
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
MST2020-00324 $-280.95
Total: $-280.95
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 240519 DHOWSE 09/10/2021 $-280.95
Payor: Tesla Energy
Total Payments: $-280.95
Balance Due: $280.95
Page 1 of 1
CITY OF TIGARD RECEIPT
I 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TIGARD
Project Name: McPherson
Site Address: 13058 SW BLACK WALNUT ST T1 6-` f
Receipt Number: 432222 - 12/20/2020 P® Td
/LET�c•v_IN
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
MST2020-00324 Solar Photovoltaic System 230-0000-43104 /yy UUtj $180.00
MST2020-00324 Info Process/Archiving-Sm$0.50(up to 230-0000-43135 $4.50
11x17)
MST2020-00324 12%State Surcharge-Building 100-0000-24001 /?' $21.60
MST2020-00324 5.01 to 15 kva 220-0000-43103 /04,,"6- $133.56
MST2020-00324 12% State Surcharge-Electrical 100-0000-24001 /.`�Z $16.03
MST2020-00324 Misc Administration Fee 230-0000-45319 $5.00
Total: 1r,zpo 1s $360.69
/ t•/L)
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 7160370 PUBLICUSER107 12/20/2020 $360.69
Payor:
Total Payments: $360.69
Balance Due: $0.00
/2 ere) 5 --ht
/7.
3 ) . / 0 To fY—
Page 1 of 1
_III CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT Permit#: MST2020-00324
T I C,A R I-) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/12/2021
Parcel: 2S109DB09100
Jurisdiction: Tigard
Site address: 13058 SW BLACK WALNUT ST
Subdivision: SUMMIT RIDGE NO.5 Lot: 159
Project: McPherson
Project Description: Solar photovoltaic system.
BUILDING
Floor Areas Required Setbacks Required
Stories: Bedrooms: First: sf Basement: sf Left Parking Spaces:
Height: Bathrooms: Second: sf Garage: sf Front: Smoke
Dwelling Units: Third: sf Right: Detectors:
Total: sf Value: $9,000.00 Rear:
PLUMBING
Sinks: Water Closets: Washing Mach: Laundry Trays: Rain Drain: Urinals:
Lavatories: Dishwashers: Floor Drains: Sewer Lines: SF Rain Storm Sewer:
Tubs/Showers: Garbage Disp: Water Heaters: Water Lines: Drains: Catch Basins:
Bckflw Prevntr:
Footing Drain: Ice Maker: Hose Bib: Backwater Value:
Other Fixtures:
Drywell-Trench Drain:
Other Fixture Units:
MECHANICAL
Fuel Types Air Conditioning: N Vent Fans: Clothes Dryers:
Heat Pump: N Hoods: Other Units:
Furn<100K: Vents: Woodstoves: Gas Outlets:
Furn>=100K:
ELECTRICAL
Residential Unit Service Feeder Temp SrvclFeeders Branch Circuits
1000 sf or less: 0 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add'l 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 14.28 kW Ecompasing: N
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
OTR SF VB R-3
Owner: Contractor:
MCPHERSON,AMBER M&LEE TESLA ENERGY Required Items and Reports(Conditions)
13058 SW BLACK WALNUT ST 6132 NE 112TH AVE
TIGARD,OR 97224 PORTLAND,OR 97220
PHONE; PHONE: 503-894-6903
FAX: 866-445-7459
Total Fees: $360.69
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: b .) e\ .AK o Permittee Signature: C (\ C1,)��l�C(\�c�-,.
Call 50$.639.4175 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.
*
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
I t
DexuiPlim I Q.,- I Fee I fatal "
Fee for all residential systems combined........ $75.00 Renewable electrical energy systems:
5 kva or less 100.70 2
Check Type of Work Involved: 1 501 to 15 kva 133.56 133.56 2
n Audio and Stereo Systems* 15.01 to 25 kva 200 34 2
Wind generation systems in excess of 25 kva:
n 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 552 26
2
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
n 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 9000,hr
specifically listed t'-5 hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Subtotal •
Fee for each commercial system $75.00 Plan review,if required(25%of permit fee).
(SEE OAR 918 309 0000) State surcharge(12%of permit fee)'.
Check Type of Work Involved: TOTAL PERMIT FEE.
This permit application expires if a permit is not obtained within 180
❑ Audio and Stereo Systems days after it has been accepted as complete.
* Number of inspections allowed per permit.
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
n Instrumentation
❑ Intercom and Paging Systems
n Landscape Irrigation Control*
n M• edical
n N• urse Calls
Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1:\Building\Permits\ELC_PermiIAPP_ELR_ERE.doc Rev 0521/2013
City of Tigard
Building Division
13125 SW Hall Blvd,Tigard,OR 97223 RECEIVED
Phone: 503.718.2439 Fax: 503.598.1960
TIGARD Inspection Line: 503.639.4175 DEC 1 A 2Q20
www.tigard-or.gov
CITY OF TIGARD
BUILDING DIVISION
2010 Oregon Solar Installation Specialty Code
Check List for Prescriptive Installation of Roof-Mounted
Photo Voltaic Solar Panel System
Property Information
Installation Address: 13058 SW Black Walnut St,
City: Tigard, OR 97224, US Zip: 97224
Owner's Name: Lee McPherson Date:
Contractor's Name: TESLA CCB #: 180498
Design Parameters of the Property/Structure
If"Yes", does not
Flood Hazard Is the installation ❑ Yes qualify for the
Area Located in a flood prescriptive path, follow
plain/flood way? ® No OSSC or ORSC for
design requirements.
Wind Exposure Is the wind exposure El Yes If"Yes", qualifies for
"C"or less? ❑ No the prescriptive path.
Installations on detached Is the Ground Snow
single/two-family Load 70 psf or less?
dwelling/single/two- If"Yes",qualifies for
family townhomes ® Yes the prescriptive path.
and/or their accessory
Ground structures. ❑ No
Snow Load Is the Ground Snow
Installations on all Load 50 psf or less?
structures other than El Yes
"Yes", qualifies for
Yes the prescriptive path.
above
❑ No
1
I:Buil ding/Form s/PhotoVoltaic-Checklist.docx
I
Is the construction
Type of material wood and does El Yes If"Yes", qualifies for
the construction qualify ❑ No the prescriptive path.
Construction as "conventional light
frame"construction?
Is the spacing 24 inches
or less?
Pre-engineered trusses. ® Yes If"Yes", qualifies for
the prescriptive path.
❑ No
Roof framing
members Is the spacing 24 inches
or less?
Nominal lumber. ® Yes If"Yes", qualifies for
the prescriptive path.
❑ No
Is the combined weight ® Yes
of the PV modules and If"Yes", qualifies for
racking less than or ❑ No the prescriptive path.
Solar equal to 4.5 psf?
installation Is the solar installation
El
layout in accordance Yes If"Yes", qualifies for
with Section 305.4(3) of
n No the prescriptive path.
the 2010 Oregon Solar
Code?
❑ Metal
Single layer If roofing material is
Roofing Check the type of ❑ of wood one of the three types
material roofing material shingle/shake checked, qualifies for
Max. two layers the prescriptive path.
® of composition
shingle.
Is the roof mounted ® Yes
Connections of solar assembly
the solar assembly connected to roof No If"Yes",prescriptiveqptifies for
framingor blockin ❑ the path.
to the roof g
directly?
2
1'/Building/Forms/PhataV ullaic-Checklisl.docx
El Yes If"Yes", qualifies for
Is the gauge 26 or less?
❑ No the prescriptive path.
115 lbs for 60 inch
spacing or less?
El Yes
"Yes", qualifies for
Yes the prescriptive path.
❑ No
Minimum Uplift rating
of Clamps? 75 lbs for 48 inches
spacing or less?
If"Yes", qualifies for
❑ Yes the prescriptive path.
❑ No
Attachment of
roof mounted Minimum 24 inches If the spacing falls
solar systems Spacing of clamps? within 24 inches and 60
dlrectl to inches inches, qualifies for the
Y Maximum 60 inches prescriptive path.
standing seam
metal panels Width of roofing If the width of the panel
panels? 18 inches or less is less than 18 inches,
inches qualifies for the
prescriptive path.
Minimum#10 at 24
inches o/c?
Size and spacing of El Yes If"Yes", qualifies for
fastener? the prescriptive path.
❑ No
Is the roof decking of
WSP min. Y2"thickness, n Yes
decking connected to If"Yes",qualifies for
framing members ❑ No the prescriptive path.
w/min. 8d nails @
6"/12" o/c?
Is the height less than or
Maximum 18 inches equal to 18 inches?
Height of the from the top of the If"Yes", qualifies for
solar modules module to the roof ® Yes the prescriptive path.
surface. ❑ No
3
C/Building/Forms/PhotoVoltaic-Checklist.docx
- .
Submittal Documents required for Prescriptive Installations
Show the location of the PV system in relation to buildings, structures,
property lines, and, as applicable,flood hazard areas.
Site Plan Details must be clear and easy to read.
Minimum size of the plan is 8.5 x 1 I inches.
Attach a simple structural plan showing the roof framing(rafter size,type, and
spacing) and PV module system racking attachment.
System must be shown in sufficient detail and clarity to assess whether it
Structural Plan meets the prescriptive construction requirements as listed earlier above in the
matrix.
Minimum size of the plan is 8.5 x 11 inches.
PV Modules
Manufacturer: REC
Model Number: 260
Listing Agency: UL1703
4
I:/Buil ding/Forms/Photo V oltaic-Checkl ist.docx
Branden Taggart
From: Branden Taggart
Sent: Friday, December 18, 2020 1:05 PM
To: Melissa Farias
Subject: Solar Permit for Lee McPherson: MST2020-00324 - 13058 SW Black Walnut St.
Attachments: Invoice.pdf
Hi Melissa,
The solar Building permit for Lee McPherson is ready to issue now. The balance due is$360.69, and I have attached an
invoice above for you to reference. The permit fees can be paid online through our
website: https://aca.accela.com/tigard/Default.aspx. From there,click on the Building tab, enter the permit number
(MST2020-00324) in the Record Number field, and click Search. Once paid, please notify us at
TigardBuildingPermits@tigard-or.gov, and we will mail this permit to you.
Thanks,
Branden Taggart
a City of Tigard
I t rs.t`i Senior Permit Technician
i Community Development
IIT o
13125 SW Hall Blvd
Tigard, OR 97223
(503)718-2449
brandent@tigard-or.gov
1