Permit CITY OF TIGARD MASTER PERMIT
111
COMMUNITY DEVELOPMENT Permit#: MST2021-00294
TI c A R I) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/29/2021
Parcel: 1 S 125DA00500
Jurisdiction: Tigard
Site address: 9955 SW 65TH AVE
Subdivision: None Lot: None
Project: Jordon
Project Description: 7.54 kW rooftop solar
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: $7,540.00 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 Drains: 0 Storm Sewer: 0
Tubs/Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Catch Basins: 0
Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0
Bckflw Prevntr: 0
Drywell-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: 1 0-200 amp: 0 W/Svc or Fdr: 2
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 N
Other: Y Other Description: Roof Top Solar PV System 7.54 kW Ecompasing:
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
OTR SF VB R-3 0
Owner: Contractor:
JORDAN,BERDINE L&BRIAN WC ELEMENTAL ENERGY LLC Required Items and Reports(Conditions)
9955 SW 65TH AVE 1339 SE 8TH AVE#B
PORTLAND,OR 97219 PORTLAND,OR 97214
PHONE: PHONE: 503-967-5786
FAX:
Total Fees: $493.59
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 requir s you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are+set forth in OAR
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Issued By: Permittee Signature: . [ Q'�
Call 503.639.4175 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 iob site at the time of each inspection.
Bvildin Permit Application
Residential RECEIVED FOR OFFICE USE ONLY
City of Tigard Received
Date/By: ,' Z� t►U Permit No.:(�(�STZVZ�'�ZQt�
14
. ` 13125 SW Hall Blvd.,Ti ard,OR 97223 JUL Z 0 EM
g ^,0
Phone: 503.718.2439 Fax: 503.598.19Plan Review /��
Date/By: rj YT Other Permit.
Inspection Line: 503.639.4175 `ulTY OF TIGARD Date Ready/By: J ® See Page 2 for
TIGAKD
Internet: www.tigard-or.gov BUILDING DIVISION '.i ed/Method: �� 2/ 4 Supplemental Information
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑New construction ❑ Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
N Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
work indicated on this application.
CATEGORY OF CONSTRUCTION
(51
IX
1-and 2-family dwelling ❑Commercial/industrial Valuation: $ 7540
ID Accessory building 0 Multi-family Number of bedrooms:
ID Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 9955 SW 65TH AVE, New dwelling area: square feet
City/State/ZIP: 775...a dot, a? 'au Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: Berdine ordon Solar Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: I Lot no.: Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
7.54kWAC Solar PV prescriptive roof mount install Valuation: $
Existing building area: square feet
New building area: square feet
NI PROPERTY OWNER 0 TENANT Number of stories:
Name: Berdine Jordan Type of construction:
Address: same as above Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( ) New:
NI APPLICANT [ CONTACT PERSON BUILDING PERMIT FEES*
Business name: ELEMENTAL ENERGY (Please refer deposit): tel
Structural plan review fee(or deposit):
Contact name: CHRISTINE STAMPER 503-522-9190 (CELL)
FLS plan review fee(if applicable):
Address: 1339 SE 8TH AVE STE B
City/State/ZIP: PORTLAND, OR 97214 Total fees due upon application:
Phone:( ) 503-967-5786 Fax::( ) Amount received:
F-mail: PERMITS@ELEMENTALENERGY.NET PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name: ELEMENTAL ENERGY Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: 1339 SE 8TH AVE STE B Solar Installation Specialty Code checklist.
City/State/ZIP: PORTLAND OR 97214 Permit Fee(includes plan review $180.00
and administrative fees):
Phone:( ) 503-967-5786 Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lie.: 195141
Total fee due upon application: $201.60
Authorized signature: This permit application expires if a permit is not obtained
� �"fy ' within 180 days after it has been accepted as complete.
Print name: CHRISTINE STAMPER Date: 07/21/2021 *Fee methodology set by Tri-County Building Industry
Service Board.
L\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-46I3T(11/02/COM/WEB)
Or NI.
Building Permit Application Checklist
One- and Two-Family Dwelling FOR OFFICE USE ONLI
City of Tigard Received Permit No.:
INii 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By.Phone: 503.718.2439 Fax: 503.598.1960 Associated permits:
24-Hour Inspection Line: 503.639.4175 El Electrical El Plumbing 0 Mechanical
TIGARD
Internet: www.tigard-or.gov 0 Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW l es No N/A
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ❑ ❑
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. ❑ ❑ ❑
3 Verification of approved plat/lot. ❑ ❑ ❑
4 Fire district approval required. Name of district: • ❑ ❑ ❑
5 Septic system permit or authorization for remodel. Existing system capacity . ❑ ❑ ❑
6 Sewer permit. ❑ ❑ ❑
7 Water district approval. ❑ ❑ ❑
8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ❑ ❑
9 Erosion control ❑plan 0 permit required. Include drainage-way protection,silt fence design and location of catch- ❑ ❑ ❑
basin protection,etc.
10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state ❑ ❑ ❑
building codes. Lateral design details and connections must be incorporated into the plans or on a separate full-size
sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if
copyright violations exist.
11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions;property corner elevations(if ❑ 0 ❑
there is more than a 4-ft.elevation differential,plan must show contour lines at 2-ft.intervals);location of easements
and driveway;footprint of structure(including decks);location of wells/septic systems;utility locations;direction
indicator;lot area;building coverage area;percentage of coverage;impervious area;existing structures on site;and
surface drainage.
12 Foundation plan. Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent size ❑ ❑ ❑
and location.
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, ❑ ❑ ❑
furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,etc.
14 Cross section(s)and details. Show all framing-member sizes and spacing such as floor beams,headers,joists,sub- ❑ ❑ 0
floor,wall construction,roof construction. More than one cross section may be required to clearly portray
construction. Show details of all wall and roof sheathing,roofing,roof slope,ceiling height,siding material,footings
and foundation,stairs,fireplace construction,thermal insulation,etc.
15 Elevation views. Provide elevations for new construction;minimum of two elevations for additions and remodels. ❑ ❑ 0
Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope.
Full-size sheet addendums showing foundation elevations with cross references are acceptable.
16 Wall bracing(prescriptive path)and/or lateral analysis plans. Must indicate details and locations;for non- ❑ ❑ 0
prescriptive path analysis provide specifications and calculations to engineering standards.
17 Floor/roof framing. Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and bearing ❑ ❑ 0
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ 0
systems,see item 22,"Engineer's calculations."
19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists ❑ ❑ ❑
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor/roof truss design details. 0 0 0
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required 0 0 0
for four or more appliances.
22 Engineer's calculations. When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or ❑ ❑ 0
architect licensed in Oregon and shall be shown to be ..ilicable to the .ro'ect under review.
JURISDICTIONAL SPECIFICS
23 Three(3)site plans are required for Item 11 above. Site plans must be 8-1/2"x 11"or 11"x 17". ❑ ❑ ❑
24 Two(2)sets each are required for Items 16, 19,20 and 22 above. ❑ ❑ ❑
25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. ❑ 0 0
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. ❑ ❑ ❑
27 "Drawn to scale"indicates standard architect or engineer scale. ❑ ❑ ❑
28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard ❑ ❑ ❑
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines. ❑ ❑ ❑
and protection measures must be drawn to scale and must include the project arborist's signature of approval.
30 A Clean Water Services'Sensitive Area Pre-Screening Site Assessment form is required for all building additions, ❑ ❑ ❑
including decks,patio covers(over non-impervious surface)and accessory structures to existing residential dwellings
on a lot of record approved prior to September 9,1995.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
1
Electrical Permit Applicatio FO12 OFhItl- 1 S1 O11.1
CityofTigard DECEIVED Received
g Date/B Permit#:
IN • 13125 SW Hall Blvd.,Tigard,OR 97223 0 s Plan Review
I Phone: 503.718.2439 Fax: 503.598.1960 JUL t" Date/B : Related Permit#:
Inspection Line: 503.639.4175 Ready Date/By: ® See Page 2 for
T iG A R D Internet: www.tigard-or.gov L I OF TiGARD Notified/Method: MEM Supplemental Information
TYPE OF Wo tDING DIVISION PLAN REVIEW
0 New construction J Addition/alteration/replacement Please check all that apply(submit 2 sets of plans us items checked):
0 Service or feeder 400 amps or more ❑Building over three stories.
0 Demolition 0 Other:
where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
1-and 2-familydwellingLI Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
❑ Commercial/industrialamps for all other installations. buildings.
El Multi-family 0 Master builder ❑Other: Elum Fire pump. 0 Installation of 150 KVA or
• JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
9955 S W 65 TH AVE ❑Addition of new motor load of system.
Job#: Job site address: I00HP or more. ❑"A","E",'l-2", °1-3",
City/State/ZIP: Portland, OR 97219 0 Six or more residential units. occupancy.
❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: Berdine Jordan Solar ID Hazardous locations. ❑Supply voltage for more than
0 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 1
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 75.00 2
7.54kW AC Solar Photovoltaic Install. (with above sq.ft.)
Limited energy,multi-family 75.00 2
Two Tesla Power Wall batteries- 1 service, 3 circuits residential(with above sq.ft.)
Renewable Energy 0 See Page 2
ID PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: Berdine Jordan 200 amps or less 1 100.70 2
Address: 201 amps to 400 amps 133.56 2
Same 401 amps to 600 amps 200.34 2
City/State/ZIP: 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 I
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
30
APPLICANT CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: ELEMENTAL ENERGY above service or feeder fee, 2 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
Address: 1339 SF. 8TH AVF. STF. R branch circuit 56.18 2
City/State/ZIP: Each add'I branch circuit 7.42 2
PORTLAND G 97214 Miscellaneous(service or feeder not included)
Phone:(503)967-5786 I Fax: :( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: PERMITS@ELEMENTALENERGY.NET Reconnect only 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 Signalnel, lte aiion(s)or extension. 0 See Page 2 2
panel,alteration,or extension. g
T�
Each additional inspection over allowable in any of the above
City/State/ZIP: PORTLAND OR 972 1 4 Additional inspection(1 hr min) 66.25/hr -
Phone:( 503) 967-5786 Fax:( ) Investigation(1 hr min) 90.00/hr
PERMITS ELEMENTALENERGY.NET Industrial planthr min) 78.18/hr
Email: Inspections forr which no fee is
specifically listed(1/2 hr min)
90.00/hr
CCB Lie.: 195141 Electrical Lic.: C 12281�1� prv. Lie.: 4894S
ELECTRICAL PERMIT FEES
Suprv.Electrician signature. ;{ctrequired: ',,- Subtotal:
Print name: David Gehrke Date: 07/21/2021 ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: ,, e�
TOTAL PERMIT FEE:
T� (� 07/21/2021 This permit application expires if a permit is not obtained within 180
Print name: CHRISTINE STAMPER Date; days after it has been accepted as complete.
* Number of inspections allowed per pennit.
I:\Building\Permits\ELC_PermitApp_ELRERE.doc Rev 06/17/2015 440-4615T(t I/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 Q* . 1 Each I Total
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 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
n Garage Door Opener*
>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:
❑ 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
SubtFee for each commercial system: $75.00 allowed
r permerit.
t.o Page 1):
3' * Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
n Audio and Stereo Systems
n Boiler Controls
❑ Clock Systems
Data Telecommunication Installation
❑ Fire Alarm Installation
n HVAC
n Instrumentation
Intercom and Paging Systems
n Landscape Irrigation Control*
❑ Medical
n Nurse Calls
r Outdoor Landscape Lighting*
n Protective Signaling
n Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015
Oregon Solar Installation Specialty Code
g p y RECEIVED
ii.442-74"I Checklist for Prescriptive Photovoltaic Installations in
accordance with Section 3111.5.3 JUL 0 2O2
Department of Consumer and Business Services CITY OF TIGARD
Building Codes Division BUILDING DIVISION
1535 Edgewater NW, Salem,Oregon
Mailing address: P.O. Box 14470, Salem,OR 97309-0404
Phone: 503-378-4133 •Fax: 503-378-2322
Web: bcd.oregon.gov
PROPERTY OWNER INFORMATION
Property owner name:Berdine Jordan
Installation address:9955 SW 65th Ave
City: Portland State: OR ZIP: 97219
Structure on which modules are to be installed:roof of house
Day phone: ( )971-284-4700 Evening phone: ( )
Email address:berdine.jordan@gmail.com
Contractor:Elemental Energy LLC CCB#: 195141
Day phone: ( )503-967-5786 Evening phone: ( )
Email address:permits@elementalenergy.net
SITE PLAN
• Attach a simple site plan showing the location of the PV system in relation to buildings,
structures, property lines, and, as applicable, flood hazard areas.
• System must be shown in sufficient detail to assess whether the requirements of Section 3111.4.8
or one of the exceptions have been met.
• The site plan must be on 8.5-inch x 11-inch or larger paper.
STRUCTURAL INFORMATION
All structures:
• Is this conventional light framed wood construction?
Yes ❑■ No ❑ (check one)
• Does the structure have pre-engineered trusses?
Yes ■❑ No ❑ (check one)
OR
• Does structure have roof framing members spaced at 24 inches on center maximum?
Yes ❑■ No ❑ (check one)
• Is the weight of the PV modules and racking less than 4.5 pounds per square foot?
Yes 111 No ❑ (check one)
• Is the roofing material metal, single layer wood shingle, or not more than two layers of
composition shingle?
Yes I] No ❑ (check one)
T MOW
F
440-4910(9/15/COM)
STRUCTURAL INFORMATION (continued)
Standing seam metal roofs:
• Is the metal gauge 26 or heavier?
Yes ❑ No ❑ (check one)
• Clamp design: Are clamps designed to withstand uplift of at least 115 pounds for clamps spaced at
60 inches on center or less or at least 75 pounds for clamps spaced at 48 inches on center or less?
Yes LI No ❑ (check one)
• Is the spacing of the clamps as measured along the seam less than or equal to 24 inches on center?
Yes ❑ No ❑ (check one)
• Is the roofing panel width 18 inches or less?
Yes ❑ No ❑ (check one)
• Will the roofia panel attachments be at least#10 screws at 24 inches on center?
Yes ❑ No [] (check one)
• Will the roofing panels be installed over minimum 'h-inch nominal wood structural panels
attached to framing with 8d nails at six inches on center at panel edges and 12 inches on center
field nailing?
Yes ❑ No ❑ (check one)
If no, on any of these requirements, the project may not be submitted using the prescriptive path.
ROOF DESIGN AND ATTACHMENT
• Attach a simple structural plan showing the roof framing(rafter size, type,and spacing) and PV
system racking attachment.
• System must be shown in sufficient detail to assess whether the requirements of Section 3111.5.3
have been met.
• The structural plan must be on 8.5-inch x 11-inch or larger paper.
WIND DESIGN
• Does the project site exceed 95 mph in exposure C or 105 mph in exposures A or B?
Yes ❑ No n (check one) If yes, the project may not be submitted using the prescriptive path.
• Is the module height less than 18 inches above the roof in accordance with section 3111.5.3?
Yes ❑i No ❑ (check one)
PV MODULES
Manufacturer: Solaria
Model number: Power XT-370R-PD
Listing agency: U L 1703
Christine Stamper Christine oa`ea'zOI;dOY1 12;,e0700' 07/21/2021
Applicant name(please print) Applicant signature Date
440-4910(9/15/COM)