Permit CITY OF TIGARD MASTER PERMIT
'III ■ , Permit#: MST2022-00015
COMMUNITY DEVELOPMENT
T 1 G A lip 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/27/2022
Parcel: 1 S133DC09100
Jurisdiction: Tigard
Site address: 13215 SW SHORE DR
Subdivision: WINTER LAKE Lot: 20
Project: Roberts
Project Description: Rooftop Solar PV 4.35 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: $4,350.00 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<10OK: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0
Fum>=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
Other: Y Other Description: Roof Top Solar PV System 4.35 kW Ecompasing: N
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
OTR SF VB R-3 0
Owner: Contractor:
ROBERTS,DALE V ELEMENTAL ENERGY LLC Required Items and Reports(Conditions)
13215 SW SHORE DR 1339 SE 8TH AVE#B
PORTLAND,OR 97223 PORTLAND,OR 97214
PHONE: PHONE: 503-967-5786
FAX.
Total Fees: $431.17
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: Hod(y Va" De- Permittee Signature: OwAh1 Qt^
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.
Building Permit Application
Residential RECEIVED FOR OFFICE USE ONLYReceiv {�/ /y� f
City of Tigard t ^Pry 7
Date/By: 2 20� Permit No.:/tiSrf.t/22"µ)0i
ill c
' 13125 SW Hall Blvd.,Tigard,OR 97223 `I!-'t'' A 1 L.I K Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 .X• Plan : I i3 Zv �'
Other Permit:
T 1 C A R D Inspection Line: 503.639.4175 LA TV (/1 TI GARD Date ReadyBy: lads: ® See Page 2 for
Internet: www.tigard-or.gov L 1..11LP`i1'3 3 OlVIS!CA\I �letlfied/Method: a'/ ,Z 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
I❑Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION t Ala work indicated on this application.
in 1-and 2-family dwelling ❑Commercial/industrial Valuation: $ 4350
0 Accessory building ❑Multi-family Number of bedrooms:
❑Master builder ❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 13215 SW Shore Dr New dwelling area: square feet
City/State/ZIP: Tigard OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: Roberts Pv Solar Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Cb
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.
4.35 kWAC, roof mount, prescriptive, grid tied, pv, solar Valuation: $
system Existing building area: square feet
New building area: square feet
J PROPERTY OWNER 0 TENANT Number of stories:
Name: Dale Roberts Type of construction:
Address: 13215 SW Shore Dr Occupancy groups:
City/State/ZIP: Tigard, OR 97223 Existing:
Phone:(503) 270.7433 Fax:( ) New:
0 APPLICANT ® CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name: Elemental Energy LLC
Structural plan review fee(or deposit):
Contact name: Molly Beckel
FLS plan review fee(if applicable):
Address: 1339 SE 8th Ave Suite B
Total fees due upon application:
City/State/ZIP: Portland OR 97214
( 503 9675786 ( ) Amount received:
Phone: Fax: :
E-mail: permits@elementalenergy.net PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted Photovoltaic Solar Panel System.
Submit two(2)sets of roof plan with connection details Business name: Elemental Energy LLC
and fire department access,along with the 2010 Oregon
Address: 1339 SE 8th Ave Suite B Solar Installation Specialty Code checklist.
City/State/ZIP: Portland OR 97214 Permit Fee(includes plan review $180.00
and administrative fees):
Phone:( 503 9675786 Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lie.: 195141 Total fee due upon application: $201.60
Authorized signaturg: t'Q�. _ This permit application expires if a permit is not obtained
-�fC7 within 180 days after it has been accepted as complete.
Print name: Molly Beckel Date: 1/11/22 *Fee methodology set by Tri-County Building Industry
Service Board.
1:1Building\Pennits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Building Permit Application Checklist '
One- and Two-Family Dwelling FOR OFFICE USE ONLY
City of Tigard Received
Date/By, Permit No.:
13125 SW Hall Blvd.,Tigard,OR 97223 Associated penults:
Phone: 503.718.2439 Fax: 503.598.1960
24-Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing 0 Mechanical
ic'ARD Internet: www.tigard-or.gov ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW 'cs No N/A
I Land use actions completed. See jurisdiction criteria for concurrent reviews. ■ ❑ ❑
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. 0 0 0
3 Verification of approved plat/lot. ❑ ❑ ❑
4 Fire district approval required. Name of district: 0 ❑ ❑
5 Septic system permit or authorization for remodel. Existing system capacity 0 0 ❑
6 Sewer permit. ❑ 0 ❑
7 Water district approval. ❑ ❑ ❑
8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ❑ ❑
9 Erosion control ❑plan ❑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 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
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, ❑ 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
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,roofmg,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 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 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. ❑ ❑ ❑
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required 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 ❑
architect licensed in Ore:on and shall be shown to be applicable to the . o'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". 0 0 0
24 Two(2)sets each are required for Items 16,19,20 and 22 above. ❑ 0 0
25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. ❑ ❑ ❑
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, ❑ ❑ ❑
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
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.
1:1Building\Permits\BUP-RESPennitApp.doe 02/24/2011 440-4613T(11/02/COM/WEB)
ElectricarPermit Applicatio>11-yE FOR OFFICE USE ONLY
City o Tigard 1� Received
g DafeB : Permit a,
III • 13125 SW Hall Blvd.,Tigard,OR 97223 �� t.' Q%'
3 ;-1_:.. Plan Review
0 Phone: 503.718.2439 Fax: 503.598.1960'' l Date/B Related Permit ri:
Inspection Line: 503.639.4175 „ Ready Date/By: Juris: Pi See Page 2 for
TIGAR D Internet: www.tlgard-or.gov t''gv y t I]p,.RD Notified/Method. Supplemental Information
TYPE OF WORK PLAN REVIEW
❑New construction E Addition/alteration/replacement Please check all that apply(submit 2 sets of plans whims checked).
❑Demolition ❑Other: 0 Service or feeder 400 amps or more 0 Building over three stories.
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
E 1-and 2-family dwelling ❑Commercial/industrial El Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 4-'.' 0 Emergency system. larger separately derived
Job#:21-2391 Job site address: 13215 SW Shore Dr ❑Addition of new motor load of system.
100HP or more. ❑"A" "E"
City/State/ZIP: Tigrad, OR 97223 ❑Six or more residential units. occupancy.
❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: Roberts PV Solar ❑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.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'I 500 sq.ft or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
4.35 kWAC roof mount, prescriptive, grid tied, pv, solar
(with above sq.ft.) 75.00 2
Limited energy,multi-family 75.00 2
system and a 200A main service panel residential(with above sq.ft.)
Renewable Energy 0 See Page 2
M PROPERTY,OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: Dale Roberts 200 amps or less X 100.70 2
201 amps to 400 amps 133.56 z Address: 13215 SW Shore Dr
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) 270 7433 Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: Dalevirginia808@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
El APPLICANT ® CONTACT PERSON Branch circuits—new,alteration,or extension, , r panel
A.Fee for branch circuits with
Business name: Elemental Energy LLC above service or feeder fee, 7.42 2
each branch circuit
Contact name: Molly Beckel B.Fee for branch circuits without
service or feeder fee,first
Address: 1339 SE 8th Ave Suite B branch circuit 56.18 2
City/State/ZIP: Portland OR 97214 Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( 503)9675786 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 LLC Sign or outline lighting 67.84 2
Address: 1339 SE 8th Ave Suite B Signal,alteration,
or extension. ❑ See Page 2 2
panel,altemtioq or extension.
City/State/ZIP: Portland OR 97214 Each additional inspection over allowable in any of the above
Additional inspection(I hr min) 66.25/hr
Phone:( 503 9675786 Fax:( ) Investigation(1 hr min) 90.00/hr
Email:permits@elementalenergy.net Industrial plant(Ihrmin) 78.18/hr
Inspections for which no fee is
CCB Lie.: 195141 Electrical Lie.: C1228 .,Suprv.Lie.: 4894S specifically listed(//hr min) 90.00/hr
r, ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: a >t\ Subtotal:
Print name: David Gerke Date: 1/1 1/22 ❑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: Molly Beckel Date: 1/11/22 days after it has been accepted as complete.
* Number of inspections allowed per permit.
1'.1➢adding\Permits\ELC_PernitApp_ELR EREdoc Rev 06/17/2015 440-4615T(I1/05/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 Qtr. I Each I Total
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
5 kva or less 1 100.70 2
Check Type of Work Involved:
501 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to25 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
[1 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('h hi min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Subtotal(Enter on Page 1):
Fee for each commercial system: $75.00 • Number of inspections allowed per penml.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
n Clock Systems
n Data Telecommunication Installation
❑ Fire Alarm Installation
n HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
n Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
n Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
1:1Building\Pernuls'ELf PermitApp_ELR_ERE.doc Rev 06/17/2015