Permit Electrical Permit Application RECEI /EI FOR OFFICE USE ONLY'
City of Tigard Received
Petmu#:Hsi-mu"W�f3z •
�p�� Date/B :
a 13125 SW Hall Blvd.,Tigard,OR 97223 MUG 1 G:_., Plan Review
• - Related Permit II:
Phone: 503.718.2439 Fax: 503.598.1960 DateB
Inspection Line: 503.639.4175 CITY OF TIGARL, Ready Date/By: ruris RI See Page 2 for
TIGARI) Internet: www.tigard-or.gov NotifiedMethod. Supplemental Information
UILDIAIr. UIVI510N
TYPE OF WORK PLAN REVIEW
❑New construction ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
❑ Demolition ®Other: PV Solar
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
® 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
❑ Multi-family ❑Master builder 0 Other: 0
amps for other installations. Inbustaings.
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: 13355 SW 110th Ave 100HP or more. ❑"A","E","1-z","t-3",
City/State/ZIP:Tigard, OR,97223 ElSix or more residential units. occupancy.
❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: Savage Solar Install 0 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.
Tax map/parcel#: 1,000 sq.ft.or less 168.54 4
Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
(with sq.ft.) 75.00 2 I
Installation of solar panels on existing residential roof. 4.07kW Limitedwith abovesq.gy, .)family
residential(with above sq.ft.) 75.00 2
Addition of(1) 0-30A circuit(s) Renewable Energy 0 See Page 2
® PROPERTY OWNER I ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name:Karen Savage 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Address: 13355 SW 110th Ave
401 amps to 600 amps 200.34 2
City/State/ZIP: Tigard, OR,97223 601 amps to 1,000 amps 301.04 2
Phone:( 503)310-8692 Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: ksavagel@yahoo.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
Igi APPLICANT 0 CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: ION DEVELOPER LLC above service or feeder fee, 7.42 2
each branch circuit
Contact name: Bonnie Leslie B.Fee for branch circuits without
service or feeder fee,first 1 56.18 $56.18 2
Address: 4801 N University Ave#900 branch circuit
City/State/ZIP: Provo, UT 84604 Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( 801 ) 326-0959 x8530 Fax: :(801 )607-6826 Each manufactured or modular 67.84 2
Email: dwelling,service and/or feeder
permits@ionsolar.com Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: ION DEVELOPER LLC Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy 0 See Page 2 2
Address: 4801 N University Ave#900 panel,alteration,or extension.
City/State/ZIP: Provo, UT 84604 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(888) 781-7074 Fax:(801 )607-6826 Investigation(1 hr min) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
permits@ionsolar.com Inspections for which no fee is
hr min) 90.00/hr
specifically listed
CCB Lic.: 230394 Electrical Lic.: C1524 Suprv.Lic.: 6098S
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: .ate Subtotal: $156.18
Print name: David S Conrad Date: 08/09/2021 ❑Plan Review Required(25%of permit fee):
a 7I� State surcharge(12%of permit fee): $18.74
Authorized signature: an ie.LG.`LG TOTAL PERMIT FEE: $174.92
L7
This permit application expires if a permit is not obtained within 180
Print name:Bonnie Leslie Date:08/09/2021 days after it has been accepted as complete.
" Number of inspections allowed per permit.
tlBuildinglPermits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440.4615T(11/05/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.
Fee for all residential systems combined: S75.00 Description I Qty. Each Total
•
3 Renewable electrical energy systems:
Check Type of Work Involved: 5 kvaorless 1 100.70 $100.70 2
5.01 to 15 kva 133.56 2
El 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 I
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(V hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Subtotal(Enter on Page 1): $100.70
Fee for each commercial system: $75.00 • Number of inspections allowed per permit.
(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
❑ 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
I:\Building\Permits/ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015