Permit Support Document VO
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City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT g/6/21 ,4f2d
i III al
'Pi Request for Permit Action
T i t i A R Il 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) ION DEVELOPER LLC
Mailing Address: 4801 N University Ave#900
City/State/Zip: Provo, UT 84604
Phone No.: (801)326-0959
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
X❑ CANCEL/VOID PERMIT APPLICATION.
X❑ REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
Permit#: MST2021-00171
Site Address or Parcel#: 12470 SW 128 Ave,Tigard, Oregon,97223
Project Name: Allison Solar Install
Subdivision Name: Lot#:
EXPLANATION: Customer cancelled project.A permit is no longer required.
Signature: BO1't414.&Leisliz Date: 05/04/2021
Print Name: Bonnie Leslie
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• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort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.
FOR OFFICE USE ONLY
Route to Sys Admin: Date By Route to Records: Date //e/Zir By 42O
Refund Processed: Date 0/2.,/ By 1 Invoice Processed: Date By
Permit Canceled: Date g�cs/j y By dil Parcel Tag Added: Date By
I:\Building\Forms\RegPermitAction_12 51ll doc
'I - ,.
V II I .
Building Permit Applicat><o r ECElVED , 2: ,0 ' - i 2 2
Residential APR 21 2021 FOR OFFICE USE ON I 1
Received I Permit Na.:
City of Tigard Date/By: 0�ZS 202/ 14ST20Ll-00171
IIN 13125 SW Hall Blvd.,Tigard,OR 9722CIN OF TIGARD /74/v
r� g Plan Review / Met Phone: 503.718.2439 Fax: 503.598 DING DIVISION Date/By: Other Permit:
T I G A R D Inspection Line: 503.639.4175 Date Ready/By. lug . H See Page 2 for
Internet: www.tigard-or.gov ified/Method: Supplemental Information
TYPE OF WORK REQUIRED DATA:1-AND 2-FAMILY DWELLING
❑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
❑Addition/alteration/replacement 1.7 Other: PV Solar equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
IN1-and 2-family dwelling 0 Commercial/industrial Valuation: $9367
❑Accessory building 0 Multi-family Number of bedrooms:
❑Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 12470 SW 128 Ave New dwelling area: square feet
City/State/ZIP: Tigard,Oregon,97223 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: Allison Solar Install 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.
Installation of solar panels on existing residential roof. 6.46kW Valuation: $
Existing building area: square feet
New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories:
Name:Timothy Allison Type of construction:
Address: 12470 SW 128 Ave Occupancy groups:
City/State/ZIP: Tigard,Oregon,97223 Existing:
Phone:( 971 ) 280-1114 Fax:( ) New:
® APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name: ION DEVELOPER LLC
Structural plan review fee(or deposit):
Contact name:Bonnie Leslie
FLS plan review fee(if applicable):
Address:4801 N University Ave#900
Total fees due upon application:
City/State/ZIP: Provo, UT 84604
Amount received:
Phone:( 888) 781-7074 x8530 Fax::( )
PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
E-mail: permits@ionsolar.com
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted Photo Voltaic Solar Panel System.
Business name: ION DEVELOPER LLC Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: 4801 N University Ave#900 Solar Installation Specialty Code checklist.
City/State/ZIP: Provo, UT 84604 Permit Fee(includes plan review S180.00
and administrative fees):
Phone:( $$$) 781-7074 Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lic.: 230394 Total fee due upon application: $201.60
Authorized signature: 13Q'yi si,(,e./Le.sUe This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Bonnie Leslie Date: 04/20/2021 *Fee methodology set by Tri-County Building Industry
Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(1 I/02/COM/WEB)
Building Permit Application Checklist
One- and Two-Family Dwelling FOR OFFICE I Sl Ovl.1
City of Tigard Received Permit No.:
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 0 Electrical 0 Plumbing 0 Mechanical
IIGARD
Internet: www.tigard-or.gov ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes \o N k
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. 0 0 ■
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. 0 0 0
3 Verification of approved plat/lot. 0 0 0
4 Fire district approval required. Name of district: • 0 ❑ 0
5 Septic system permit or authorization for remodel. Existing system capacity . 0 0 ❑
6 Sewer permit. ❑ 0 0
7 Water district approval. 0 0 0
8 Soils report. Must carry original applicable stamp and signature on file or with application. 0 ❑ 0
9 Erosion control 0 plan 0 permit required. Include drainage-way protection,silt fence design and location of catch- 0 0 0
basin protection,etc.
10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state 0 0 0
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 0 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 0 0 0
and location.
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, 0 0 0
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 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 0 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 0 ❑
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered 0 0 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 0 0
architect licensed in Ore.on and shall be shown to be applicable 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. 0 0 0
25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. 0 0 0
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. 0 0 0
27 "Drawn to scale"indicates standard architect or engineer scale. ❑ 0 ❑
28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard 0 0 0
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, 0 0 0
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, 0 ❑ ❑
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.
1:\Building\Permits\BUP-RESPerrnitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
•
Electrical Permit Application FOR OFFICE 1 SL Oy1.1
City of Tigard Received
Permit#:
DateB :
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
s Phone: 503.718.2439 Fax: 503.598.1960 DateB : Related Permit#:
Inspection Line: 503.639.4175 Ready Date/By: Juris: ® See Page 2 for
11( A R Il Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑New construction 0 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 El
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 ❑Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: Job site address:12470 SW 128 Ave I00HP or more. ❑"A","E","l-2","1-3",
City/State/ZIP:Tigard,Oregon,97223 ❑Six or more residential units. occupancy.
ty g g 0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: Allison 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 l Qty. 1 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
(with above sq.ft.) 75.00 2
Installation of solar panels on existing residential roof. 6.46kW Limited energy,above
multi-family 75.00 2
Addition of(2)0-30A circuit(s) residential(with above sq.ft.)
Renewable Energy rza See Page 2
® PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: Timothy Allison 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Address: 12470 SW 128 Ave
401 amps to 600 amps 200.34 2
City/State/ZIP: Tigard,Oregon,97223 601 amps to 1,000 amps 301.04 2
Phone:( 971 ) 280-1114 Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: allisontimI95@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
[Xi APPLICANT ❑ 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 feeAddress: 4801 N University Ave#900 branch c rcuit der fee,first
5618 1 . $56.18 2
City/State/ZIP:Provo, UT 84604 Each add'l branch circuit 1 7.42 $7.42 2
Miscellaneous(service or feeder not included)
Phone:( 888) 781-7074 x8530 Fax: :( ) 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
Address: 4801 N UniversityAve#900 Signaln circuit(s)or extension. 0 See Page 2 2
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:( ) Investigation(1 hr min) 90.00/hr
Email: Industrial plant(I hr min) 78.18/ht
permits@ionsolar.com Inspections for which no fee is
CCB Lie.: 230394 Electrical Lie.: C 1524 Suprv.Lie.: 6098S specifically listed(/2 hr min) 90.00/hr
(j ELECTRICAL PERMIT FEES
/y�
Suprv.Electrician signature,required: 46e.s,(1irf Subtotal: $197.16
Print name: David S Conrad Date: 04/20/2021 0 Plan Review Required(25%of permit fee):
_ State surcharge(12%of permit fee): $23.66
Authorized signature: "V1 ao n e/Le.i l�t.(� TOTAL PERMIT FEE: $220.82
This permit application expires if a permit is not obtained within 180
Print name:Bonnie Leslie Date:04/20/2021 days after it has been accepted as complete.
* Number of inspections allowed per permit.
1:\Building\Permits\ELC_PcrmitApp ELR_ERE.doc Rev 06/17/2015 440-4615T(l1/05/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. I Each I Total I *
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 $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 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:
El Other: Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed('/2 hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
SubFee for each commercial system: $75.00 Number of inspections allow d pertalEpnet ton Page 1): $133.56
t.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
El Audio and Stereo Systems
❑ Boiler Controls
Clock Systems
El Data Telecommunication Installation
❑ Fire Alarm Installation
El HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
El Medical
Nurse Calls
El Outdoor Landscape Lighting*
❑ Protective Signaling
• Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
1:\Building\l'crmits\ELC_PcrmitApp_ELR_ERE.doc Rev 06/17/2015
u
III
TIGARD
City of Tigard
September 10,2021
ION Developer LLC
4801 N University Ave #900
Provo, UT 84604
Re: Permit No. MST2021-00171
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 12470 SW 128th Ave
Project Name: Allison
Job No.: N/A
Refund Method: ® Check#240483 in the amount of$337.93.
❑ Credit card "return"receipt in the amount of$
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 customer cancelled job. 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
liGA}t 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: ION Developer TLC DATE: 9/6/2021
4801 N University Ave #900
Provo, UT 84604 REQUESTED BY: Dianna Ornelas
TRANSACTION INFORMATION:
Receipt#: 434107 Case#: MST2021-00171
Date: 5/4/2021 Address/Parcel: 12470 SW 128th Ave
Pay Method: CreditCard Project Name: Allison
EXPLANATION: Per applicant's request as customer cancelled job. Refund 80%of permit fees.
REFUND INFORMATION:
Fee Description From Receipt Revenue Account No. R.
.�.Li.i,41,1
Example: Building Permit Fee Example: 2300000-43104 ? $Amount
Building Permit Fee 230-0000-43104 $144.00
Electrical Permit Fee 220-0000-43103 157.73
12%State Surcharge 100-0000-24001 36.20
TOTAL REFUND: $337.93
APPROVALS: SIGNATURES/DATE:
If under$5,000 Professional Staff
If under$12,500 Division Manager
If under$25,000 er Department Manager
g
If under$100,000 City Manager
If over$50,000 Local Contract Review Board
� < FQRACCELA SYSTEM ADMINISTRATION USE ONLY
Case Refund Processed: Date: t�"rr ,t : -/ By: a{
I:\Building\Refunds\RefundRequest.doc x 09/01/2010
CITY OF TIGARD RECEIPT
71 ram-
■ ' 13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
Ti .iA11
Project Name: Allison
Site Address: 12470 SW 128TH AVE
Receipt Number: 436385 - 09/10/2021
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
MST2021-00171 $-337.93
Total: $-337.93
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Check 240483 DHOWSE 09/10/2021 $-337.93
Payor: ION Developer LLC
Total Payments: $-337.93
Balance Due: $337.93
Page
g of 1
CITY OF TIGARD RECEIPT
13125 SW Hall Blvd.,Tigard OR 97223
503.639.4171
TI[ AT 1
Project Name: Allison
Site Address: 12470 SW 128TH AVE /2-(6
Receipt Number: 434107 - 05/04/2021 /�e �
n ''Ie
CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID
MST2021-00171 Solar Photovoltaic System 230-0000-43104 /4/Yr't) $180.00
MST2021-00171 Info Process/Archiving-Sm$0.50(up to 230-0000-43135 $3.50
11x17)
MST2021-00171 12%State Surcharge-Building 100-0000-24001 /7,Zf $21.60
MST2021-00171 Branch Circuits wo/Purchase Service or 220-0000-43103 ,`2®.tf $63.60
Feeder
MST2021-00171 12%State Surcharge-Electrical 100-0000-24001 SFr 77:Z $23.66
MST2021-00171 5.01 to 15 kva 220-0000-43103 704r 4- $133.56
Total:
® 3 37. 913$425.92
PAYMENT METHOD CHECK# AUTH CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT
Credit Card 7696116 PUBLICUSER389 05/04/2021 $425.92
Payor:
Total Payments: $425.92
Balance Due: $0.00
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