Permit „ CITY OF TIGARD MASTER PERMIT
'”! Y COMMUNITY DEVELOPMENT Permit#: MST2021-00478
Date Issued: 11/18/2021
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S 109DA00800
Jurisdiction: Tigard
Site address: 12574 SW AUTUMNVIEW ST
Subdivision: ARLINGTON HEIGHTS NO.2 Lot: 43
Project: Pond
Project Description: Rooftop Solar PV 7.92 kW
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: $28,100.00 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: 0
Ea add'I 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 V Other Description: Roof Top Solar PV System 7.92 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:
POND,PETER PREMIER SOLAR NW Required Items and Reports(Conditions)
CROSS,ROBIN 12399 NW WAKER DR
12574 SW AUTUMNVIEW ST PORTLAND,OR 97229
TIGARD,OR 97224
PHONE: PHONE: 503-799-9042
FAX:
Total Fees: $474.97
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
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Issued By: F-jo-Wj VcuA.,Di.Wcge- Permittee Signature: 0Itt'Ap-p-tic.a4iavv
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 job site at the time of each inspection.
r
Building Permit Application j— II Al
Residential -ECEIVEC I t�>►z()l l:l( L USE
City of Tigard NOV Date/By,/hi
Li �' Permit No. TZQy-66 4 Ts)
13125 SW Nall Blvd.,Tigard,OR 97223 Plan Review 1
' Phone: 503.718.2439 Fax: 503.598.i �,'TYOFTIGARG Date By: i Other Permit:
t 1 t A.,1 t Inspection Line: 503.639.4175 Date Ready/By: ® see Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION Notified/, thrall//� / 7!/�' / 1 ( Supplemental Information
• /.�.L .� �• (lir a
Permit fees*arc based on the value of the work performed.
DI New construction ❑Demolition
Indicate the value(rounded to the nearest dollar)of all
®Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
work indicated on this application.
1-3 1-and 2-family dwelling 0 Commercial/industrial Valuation: $$28,100.00
Number of bedrooms:
❑Accessory building ❑Multi-family
0 Master builder 0 Other: Number of bathrooms:
Total number of floors:
Job site address: 12574 SW Autumn View Street New dwelling area: square feet
27. City/State/ZIP: Portland OR.97224 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: Pond Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
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
work indicated on this application.
Adding 7.92 kW Roof Top solar PV sytem to home Valuation: $
Existing building area: square feet
New building area: square feet
Number of stories:
Name: Peter Pond Type of construction:
Address: 12574 SW Autumn View Street Occupancy groups:
City/State/ZIP: Portland OR.97224 Existing:
Phone:(206 941-0087 Fax:( ) New:
v,� y�
Business name: Premier Solar NW
Structural plan review fee(or deposit):
Contact name: Robert M. Rathbone
FLS plan review fee(if applicable):
Address: 12399 NW Waker Dr.
Total fees due upon application:
City/State/ZIP: Portland,OR 97229
Phone:( 503-$28-9500 I Fax::( ) Amount received:
E-mail: rrathbone@premiersolarnw.com
.
s Commercial
iland residential prescriptive
a tivinlaion of
roof-top mountedPhdttialtr Sr System.
Business name: Premier Solar NW Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: 12399 NW Waker Dr. Solar Installation Specialty code checklist.
City/State/ZIP: Portland,OR 07229 Permit Fee(includes plan review $180.00
and administrative fees):
Phone:( 503-$28-9500 Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lie.: 218826 Total fee due upon application: $201.60
Authorized signature: 6 This permit application expires if a permit is not obtained
'z ,, within 180 days after it has been accepted as complete.
Print name: Clifford Barry Date: 11/4/21 *Fee methodology set by Tri-County Building Industry
Service Board.
1:\Building\Pcrmits\BUP-RESPemritApp.doc 02/24/2011 440-4613T(1 l/02/COM/WEB)
v
5-
,
Building Permit Application Checklist
I> IIl,,.'' FOR OUT ICI' 1'SI 011.A
}�, Tigard Received
bilt `, Date/By:
No.:
13125 SW Ball Blvd.,Tigard,OR 97223 Associated permits:
Phone: 503.718.2439 Fax:'503.598.1960
24-Hour Inspection Line: 503.639.4175 0 Electrical 0 Plumbing 0 Mechanical
. %pi)
Internet: wwwrigard-or.gov 0 Other:
1.111': FOLt.OW'ING I-I-L\IS .kRE REQUIRED FOR PLAN REV'I FAN 'I" No v`k
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ■ • IN
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. ❑ 0 0
3 Verification of approved plat/lot. 0 0 0
4 Fire district approval required. Name of district: • 0 0 0
5 Septic system permit or authorization for remodel. Existing system capacity 0 0 0
6 Sewer permit. 0 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 ❑permit required. Include drainage-way protection,silt fence design and location of catch- ❑ 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 ❑
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 ❑ ❑
and location.
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, ❑ 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 0 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 ❑
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 0 0 0
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 a licable to the ro'ect under review.
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 0E El
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. El 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 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
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 0 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.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
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Electrical Permit Ao licatiliECEIVED l.olt t)l.l lt'l.: t Sl f)\1.1
SiReceived '^ '/ p
City ofTigard i'j`aa!"d Date/B : Penxutis. Sr 2o21-00"1'76
13125 SW tall 814,Tigard,OR 97223 N� - �°� Plan Review
Phone: 503,716,2439 Fax: 503.598 Date/B : Related Permit q:
tnspt etion IJne: 503.639.417$ OF TIGARD Ready Date/By: Inns: ® See Page 2 for
Internet wwwi rd-otgov _ , _ e L Notified/Method: Supplemental Information
❑New construction 1, Addition/attention/replacement Please check all that apply(submit 2 sets of plans w/items checked)
❑Service or feeder 400 amps or more ❑Building over three stones.
❑Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
exceeds 10,000 amps at 150 volts or ❑Floating buildings.
N Yoe „<. .ci^,.-.
® 1 and 2-family dwelling ❑Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. 0 Installation of 150 KVA or
0 Emergency system. larger separately derived
'
.--. -l' - s x # ❑Addition of new motor load of system
Job#: Job site address:12574 SW Autumn View Street 100HP or more. ❑"A","E","1-T',"i-3
❑Six or more residential units. occupancy.
City/State/ZIP: Portland OR.97224 ❑Health-care facilities. 0 Recreational vehicle parks.
SuitC/bldg./apt.#: I Project name: Pond 0 Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 gums or mom. 600 volts nominal.
Cross street/directions to job site:
Description Qty. Each Total •
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
Syr,
„ � Limited energy,residential 75.00 2
Adding 7.92 kW Roof Top solar PV System (with above sq.ft.)
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
Services or feeders installation,alteration,and/or relocation
Name: Peter Pond 200 amps or less 1 100.70 2
Address: 12574 SW Autumn View Street 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: Portland OR.97224 601 amps to 1,000 amps 301.04 2
Phone:(206 941-0087 Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: pepond@msn.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
,, ,r y� � v �f,� 7 � Branch circuits—new,alteration,or extension,per panel
5 . L „ �,k /x�r �� ,i,;�.r� � A.Fee for branch circuits:lit:
Business name: Premier Solar NW above service or feeder fee, 7.42 2
each branch circuit
Contact name: Robert M. Rathbone B.Fee for branch circuits without
service or feeder fee,first 56.18 2
Address: 12399 NW Waker Dr. branch circuit
City/State/ZIP: Portland, OR 97229 Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( 503-028-9500 I Fax: :( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: rrathbone@premiersolarnw.com Reconnect only 67.84 2
ragti ea 113M EZIME` ,,, Pump or irrigation circle 67.84 2
Business name: Premier Solar Nw Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy ❑ See Page 2 2
Address: 12399 NW Waker Dr. panel,alteration,or extension.
Each additional inspection over allowable in any of the above
City/State/Z1P: Portland, OR 97229 Additional inspection(I hr min) 66.25/hr
Phone:( 5034828-9500 Fax:( ) Investigation(1 hr min) 90.00/hr
Industrial plant(t hr min) 78.18/hr
Email: cbarry@premiersolarnw.com Inspections for which no fee is
90.00/hr
CCB Lie.:218826 Electrical Lie.:C1540 Suprv.Lie.:6533S
s cificall listed 'h hr min
Suprv.Electrician signature,required: V Subtotal:
Print name: Tim Oliver Date: 11/4/21 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
TOTAL PERMIT FEE:
Authorized signature:
This permit application expires if a permit is not obtained within 190
Print name: Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
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Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
Description Qty. Each Total .
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less i tw.7o 2
5.01 to 15 kva 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
❑ G• arage Door Opener* >100 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
n H• eating, 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:
n O• ther Each additional inspection is 66.25/hr 1
charged at an hourly(1 hrmin)
Inspections for which no fee is 90.00/hr
s.- ificall listed(54 hr min
Fee for each commercial system: $75.00 Subtotalllowed (Enter t.o Page l>:
y' • Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
7 Audio and Stereo Systems
n Boiler Controls
7 C• lock Systems
❑ Data Telecommunication Installation
(— Fire Alarm Installation
HVAC
- Instrumentation
n Intercom and Paging Systems
n L• andscape Irrigation Control*
- M• edical
Nurse Calls
Outdoor Landscape Lighting*
n P• rotective Signaling
n O• ther:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
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