Permit CITY OF TIGARD MASTER PERMIT
o" COMMUNITY DEVELOPMENT Permit#: MST2022-00138
Date Issued: 06/13/2022
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S104DC04800
Jurisdiction: Tigard
Site address: 13372 SW CLEARVIEW WAY
Subdivision: BENCHVIEW ESTATES Lot: 48
Project: Pribyl
Project Description: Solar photovoltaic system 4 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: $3,608.80 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
Bcktlw Prevntr: 0
Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0
Drywall-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 SrvclFeeders Branch Circuits
1000 sf or less: 0 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add!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: Y Other Description: Roof top solar array 4 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:
PRIBYL FAMILY LIVING TRUST ION DEVELOPER LLC Required Items and Reports(Conditions)
13372 SW CLEARVIEW WAY 3214 NORTH UNIVERSITY AVE
TIGARD,OR 97223 503
PROVO,UT 84604
PHONE: PHONE: (888)781-7074
FAX:
Total Fees: $319.88
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: �lir AV/ n Permittee Signature: ir.U(�C.f/// �C.!/U(N
GG6 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.
4
B;xikling Permit Application
Residential +�E C E I V E FOR OFFICE USE ONLY
11 Cityof Tigard Received U,?„2— 3�
1312 SW Hall Blvd.,Tigard,OR 97223 �� '/ 2022 Date/By:ReviwyIP1 �Z �' y "_ /
g Plan Review3 ! 1 ether Pe m e
Phone: 503.718.2439 Fax: 503.598.1 Date/By:
Inspection Line: 503.639.4175 CITY OF TICaHHIJ DateReady/By. q Jura: ® SeePage2for
Internet: www.tigard-or.gov BUILDING DIVISION, ' fied/Method: /' /'St Supplemental Information
- vL_...../
TYPE OF WORK ' QUIRED 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 ❑Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation: $ 3608.80
❑ 1-and 2-family dwelling ❑Commercial/industrial
ElAccessory building El Multi-familyNumber of bedrooms:
❑Master builder 0 Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 13372 SW Clearview Way,Tigard,Oregon,97223 New dwelling area: square feet
City/State/ZIP: Garage/carport area: square feet
Suite/bidg./apt.no.: Project name: Karel Pribyl 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*arc 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.
Rooftop Solar PV
Valuation: $
Existing building area: square feet
New building area: square feet
® PROPERTY OWNER ❑ TENANT Number of stories:
Name: Karel Pribyl Type of construction:
Address: 13372 SW Clearview Way,Tigard,Oregon,97223 Occupancy groups:
City/State/ZIP: Existing:
Phone:( ) Fax:( ) New:
❑ APPLICANT ® CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name: BRS Field Ops, LLC
Structural plan review fee(or deposit):
Contact name: Spencer Fong
FLS plan review fee(if applicable):
Address: 1403 N Research Way
Total fees due upon application:
City/State/ZIP: Orem, UT 84097
Amount received:
Phone:( 385)482-0045 Fax: :( )
E-mail: permitting.deparment@blueravensolar.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name: BRS Field Ops,LLC Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: 1403 N Research Way Solar Installation Specialty Code checklist.
City/State/ZIP: Orem, UT 84097 Permit Fee(includes plan review $180.00
and administrative fees):
Phone:( 385)482-0045 Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lic.: 2271135 Total fee due upon application: $201.60
Authorized signature: This permit application expires if a permit is not obtained
Cy/���p�r�,. Fj}f�y, Permitting Coordinator within 180 days after it has been accepted as complete.
Print name: Spencer Fon �if�6�A V(R Date: OS/11 12022 x Fee methodology set by Tri-County Building Industry
Service Board.
1:\Building\Pennits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Electrical Permit Application E C . "Zeived J
pp ■ FOR OFFICE USE ONLY
City of Tigard Date/B : Permit#:
`
13125 SW Hall Blvd.,Tigard,OR 97223 MAY 1 Hr 7O2
o Plan Review Related Permit#:
' Phone: 503.718.2439 Fax: 503.598.1960 Date/B
l 1 t i E l Inspection Line: 503.639.4175 C STY OF TI(,,f1 N Ready Date/By: Jura: LESee Page 2 for
Internet: www.tigard-or.gov -Notificd/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑New construction ❑.i Addition/alteration/replacement Please check all that apply(submit 2 sets of plans wiitems checked):
0 Service or feeder 400 amps or more 0 Building over three stories
❑Demolition ❑Other:
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
O 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑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: 13372 SW Clearview Way,Tigard, Oregor, 9HP or more. ❑"A","E "1-2","1-3",
City/State/ZIP: 0 Six or more residential units. occupancy.
❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name: Karel Pribyl ❑Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: ITh 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'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential 75.00 2
Rooftop Solar PV (with above sq.ft.)
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
til PROPERTY OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: Karel Pribyl 200 amps or less 100.70 2
Address: 13372 SW Clearview Way,Tigard,Oregon,97223 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) Fax: ( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email:
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
EaAPPLICANT 0 CONTACT PERSON Branch circuits—new,alteration,or extension, • r panel
A.Fee for branch circuits with
Business name: BRS Field Ops, LLC above service or feeder fee, 7.42 2
each branch circuit
Contact name: Spencer Fong B.Fee for branch circuits without
Address: 1403 N Research Way ran service or feeder fee,first 56.18 2
bran circuit
City/State/ZIP: Orem, UT 84097 Each add'l branch circuit 7.42 2
Phone: 385)482-0045Miscellaneous(service or feeder not included)
( Fax: :( ) Each manufactured or modular
Email: permitting.department@blueravensolar.com
dwelling,service and/or feeder 67.84 2
Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: BRS Field Ops, LLC Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address: 1403 N Research Way panel,alteration,or extension. 0 See Page 2 2
City/State/ZIP: Orem, UT 84097 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( 385) 482-0045 Fax:( ) Investigation(I hr min) 90.00/hr
Email: permitting.department@blueravensolar.com lndustnal plant(1 hr mm ) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: 227185 Electrical L'c.: C1493 Suprv.Lic.: 6394S specifically listed(Si hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal:
Print name: Shan Whittaker Date: 05/11 /2022 ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: TOTAL PERMIT FEE:
gn �!(,(((`!,/' F)z?9. Permitting Coordinator
77 This permit application expires if a permit is not obtained within 180
Print name: Spencer Fong Date: 05/11 /2022 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I1Building5PermitsB:I.0 PermitApp_ELR_ERE.dac Rev 06/17/2015 440-4615T(l 1105/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 Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 1 100.70 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
❑ 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
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(h hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 Subtotal(Enter on Page l):
*
(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
❑ 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:113uilding\Pcrmits ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015