Permit CITY OF TIGARD MASTER PERMIT
I COMMUNITY DEVELOPMENT Permit#: MST2021-00446
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/16/2021
Parcel: 1 S134CA00708
Jurisdiction: Tigard
Site address: 11945 SW SUMMER CREST DR
Subdivision: BURLWOOD NO.3 Lot: 43
Project: Fort
Project Description: Rooftop Solar PV 6.48 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: $19,970.00 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: 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
Roof TopSolar PV System 6.48 kW N
Other: Y Other Description: Y Ecompasing:
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
OTR SF VB R-3 0
Owner: Contractor:
FORT,GAVIN 8 REBECCA PREMIER SOLAR NW Required Items and Reports(Conditions)
11945 SW SUMMER CREST DR 12399 NW WAKER DR
TIGARD,OR 97223 PORTLAND,OR 97229
PHONE: PHONE: 503-799-9042
FAX:
Total Fees: $362.69
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
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Issued By: HertLJ Vavt,De,Wey2 Permittee Signature: Ofry Ap-p-tizzolio-vt,
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.
Building Permit Application A / •
Residential RECEIVED FOR OFFICE ('SF()`I.,
City of Tigard Received
Date/B % Permit No.: MS1 2021.-004firto
II 13125 SW Hall Blvd..Tigard,OR 97223 OCT 1 2021 Plan Review ✓J
Phone: 503.713.2439 fax: 503.598.1960 Date/By: IP p ✓I Other Permit:
T i G A 1,n Inspection Line: 503.639.4175 CITY OF TIGARL Date Ready/By: z ( )uris: H See Page 2 For
Internet: www.tigard-or.gov Not' ;Method:
BUILDING DIVISION Z1 Supplemental Information
TYPE OF WORK REQUIRE DATA:1-AND 2-FAMILY DWELLING
0 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
❑X Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
® I-and 2-family dwelling 0 Commercial/industrial Valuation: $ $19,970.00
❑Accessory building 0 Multi-family Number of bedrooms:
❑Master builder 0 Other: Number of bathrooms:
(P JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 11945 SW Summer Crest Drive New dwelling area: square feet
City/State/ZIP: Tigard OR 97223 Garage/catport area: square feet
Suite/bldg./apt.no.: Project name: Fort 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: Lot no.: Permit fees*are based on the value of the work performed.
Tax map/parcel no.: Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Adding 6.48 kW Roof top Solar PV System Valuation: $ $19,970.00
Existing building area: square feet
New building area: square feet
0 PROPERTY OWNER 0 TENANT Number of stories:
Name: Gavin Fort Type of construction:
Address: 11945 SW Summer Crest Drive Occupancy groups:
City/State/ZIP: Tigard OR 97223 Existing:
Phone:(716-550-3750 Fax:( )
New:
® APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
Business name: Premier Solar NW
(Please refer to fee schedule)
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 Fax: :( )
Amount received:
E-mail: rrathbone@premiersolarnw.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel 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
and administrative fees): S 180.00
Phone:( 503 828 9500 Fax:( ) State surcharge(12%of permit fee): S21.60
CCB lie.: 218826
Total tee due upon application: S201.60
Authorized signature: ;f✓l .-a., This permit application expires if a permit is not obtained
G G r within 180 days after it has been accepted as complete.
,G•" *Fee methodology set by-Fri-County Building Industry
7t name: Clifford Barry Date: 10/7/21
Service Board.
ding\Pennits'BUP-RESPermitApp.doc 02/24/201 1 440-4613T(I I/02/COM/WEB)
,„
Elfectrical Permit Application RECEIVEroam: ICI" t SF O\I IN
City offigard OCT 1 2 LUL B Received Permit -w 4�
Date/By: it#:N`Sr
It • I tl'S SW Hall Blvd..l itmrd,OR `)''?3 Plan Review
a Phone: 503 718.2439 Fax: 5t13.59S,1961) T�/ T n ' Related Permit#:
CITY t OF I�Gt1�L Dare/By:
Inspection Line: 5(13 6.9,4175 Ready Date/By: furls: ® See Page 2 for
TIGAKD Internet: wµ�e ugatd oructy BUILDING DIVISIG Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ®Additistn tlteration'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.
0 Demolition ❑Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,001)amps at 150 volts or 0 Floating buildings.
® 1-and 2-family dwelling 0 Commercial/industrial ❑Accessory building less to ground.or exceeds 14.000 ❑Commercial-use agricultural
amps for all other installations. buildings.
❑ Multi-family 0 Master builder 0 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: 11945 SW Summer Crest Drive I00HP or more. ❑"A","E",'i-2",'I-3".
❑Six or more residential units. occupancy.
City/State/ZIP: Tigard OR 97223 ❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: Fort 0 Hazardous locations. 0 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 Qtv. F.ach 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 I
DESCRIPTION OF WORK Limited energy,residential
75.00 2
Adding 6.48 kW Roof Top Solar PV System (with above sq.tt.)Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Renewable Energy 0 See Page 2
® PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: Gavin Fort 200 amps or less 4 100.70 2
Address: 11945 SW Summer Crest Drive
201 amps to 400 amps 133.56 2
401 amps to 600 amps 20().34 2
City/State/ZIP: Tigard OR 97223 601 amps to 1,000 amps 301.04 2
Phone:( 714-§18-7601 Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: gavin.fort@gmail.com 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
® APPLICANT ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: Premier Solar NW above service or feeder fee,
each branch circuit 7.42 2
Contact name: Robert M.Rathbone B.Fee for branch circuits without
serAddress: 12399 NW Waker Dr. branchce i feederitfee,first
branch circuit 56.18 2
City/State/ZIP: Portland,OR 97229 Each add'!branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( 503-)828-9500 Fax: :( ) Each manufactured or modular 67.84
dwelling,service and/or feeder
Email: rrathbone@premiersolarnw.com Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: Premier Solar NW Sign or outline lighting 67.84 2
Signal circuit(s)cr limited-energy 0 See Page 2 2
Address: 12399 NW Waker Dr. panel,alteration,or extension.
City/State/ZIP: Portland, OR 97229 Each additional inspection over allowable in any of the above
_ Additional inspection(I hr min) 66.25;hr
Phone:( 503-828-9500 Fax:( ) Investigation(1 hr min) 90.00 hr
Email: cbarry@premiersolarnw.com Industrial plant(I hr min) 78.18 hr
Inspections for which no fee is 90.00'hr
CCB Lic.: 218826 Electrical Lie.: C1540 Suprv.Lie.:6533 specifically listed('/-hrmin)
r � y ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: t9--/ Subtotal:
Print name: Tim Oliver Date: 10/8/21 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: � '� Date: 10/8/21 days after it has been accepted as complete.
* Number of inspections allowed per pennit.
is Building\Permits\ELC_Permit App_ELR_ERE.doc ev 06/17/2015 d40-4615T(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: $75.00 Description Qty. I Ench I Total I *
Renewable electrical energy systems:
Check Type of Work involved: 5 kva or less 100.70 2
5.01 to 15 kva j 133.56 1 2
El Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ B• urglar 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
❑ 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 1
charged at an hourly(1 hr min)
Inspections for which no fee is
specifically listed(V2 hr min) 90.00/hr
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):
(SEE OAR 918-309-0000) * Number of inspections allowed per permit.
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ F• ire 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
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