Permit CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT Permit#: MST2022-00478
T WARD D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/22/2022
Parcel: 1S134DC07200
Jurisdiction: Tigard
Site address: 11695 SW GALLO AVE
Subdivision: GALLO'S VINEYARD Lot: 3
Project: Carrier
Project Description: Rooftop Solar PV System 6.16 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: $2,000.00 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
Fum<100K: 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: 0 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 SvdFdr. 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 Vaccuurn System: N Garage Opener: N All
N
Other: N Other Description: Ecompasing:
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
OTR SF VB R-3 0
Owner: Contractor:
CARRIER,TIMOTHY S&SHANNON PRO STAT SERVICES LLC Required Items and Reports(Conditions)
11695 SW GALLO AVE 1721 NE 64TH AVE STE 120
TIGARD,OR 97223 VANCOUVER,WA 98661
PHONE: PHONE: (360)859-3749
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 yo to_follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
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Issued By: Permittee Signature:
gte ,tPr I '`�� . 0
Call 503.639.4175 by 7:0 a.m.for the next available inspection date.
This permit card shall be kept In a c picuous place on the job site until completion of the project.
Approved plans are required on the lob site at the time of each inspection.
• Building Permit Application // 1"3 17,
Residential
City of Tigard �7 Received ga
Ili i 13125 SW Hall Blvd.,Tigard,OR. 97223 p gate/By..
Penult No.:[V S1 t0Z'Z�QS��
Phone: 503.718.2439 Fax: 503.598.196 � ' _! �a lae/By:n Review
'r Dare/By: I I ill,' 2✓ Pri6r Other Permit:
T 1 c,4 R 1, Inspection Line: 503.639.4175 Date Ready/By: I runs: 63 See Page 2 for
Internet: www.tigard-or.gov NOV 1 ?Tit Notified/Metlwd: I I V il" j(/"I Supplemental Information
TYPE OF WORiU'DING nivlS1 t' REQUIRED 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
®Addition/alteration/replacement ®Other:SOLAR equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
ElI-and 2-family dwelling ❑Commercial/industrial Valuation: $2,000
❑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: 11695 SW Gallo Ave Tigard,OR 97223 New dwelling area: square feet
City/State/ZIP: Tigard,OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name:CARRIER,TIM 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.
SOLAR PV INSTALLATION Valuation: S
6.16 kW Existing building area: square feet
New building area: square feet
EI PROPERTY OWNER 0 TENANT Number of stories:
Name:CARRIER,TIM Type of construction:
Address:11695 SW Gallo Ave Tigard,OR 97223 Occupancy groups:
City/State/ZIP:Tigard,OR 97223 Existing:
Phone:(503)639-7173 Fax:( ) New:
® APPLICANT ® CONTACT PERSON BUILDING PERMIT FEES*
Business name:PROSTAT ELECTRIC (Please refer le fee schedule)
Structural plan review fee(or deposit):
Contact name:DALE KRUEGER
FLSplan review fee(ifapplicable):
Address:1721 NE 64Tn AVE
Total fees due upon application:
City/State/ZIP:VANCOUVER,WA 98661
Amount received:
Phone:(503)539-7772 Fax::( )
E-mail:date.krueger@comcast.net PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CONTRACTOR Commercial and residential prescriptive installation of
roof-top mounted PhotoVoltaic Solar Panel System.
Business name:PROSTAT ELECTRIC Submit two(2)sets of roof plan with connection details
Address:1721 NE 64Tn AVE and fire department access,along with the 2010 Oregon
Solar Installation Specialty Code checklist.
City/State/ZIP:VANCOUVER,WA 98661 Permit Fee(includes plan review
and administrative fees): $180.00
Phone:(503)539-7772 Fax:( )
State surcharge(12%of permit fee): $21.60
CCB lie.:189902
Total fee due upon application: $201.60
Authorized signature: Dah, A.--- tz4_ This permit application expires if a permit is not obtained
a __ within 180 days after it has been accepted as complete.
Print name:DALE KRUEGER Date:11/7/22 *Fee methodology set by Tel-County Building Industry
Service Board.
I:1Building\Permits\BUP-RESPermitApp.doe 02/24/2011 440-4613T(I I/02/COM/WEB)
Electrical Permit Application FoR f)rrlcl: I'`F 1iC11
Rai M512o�.2—00147 IIII City of Tigard •� may, zit*=
a 13125 SW Hall Blvd,Tigard,OR 972F1E'CE [ Plan Review
II: Phone; 503.718.2439 Fax: 503.598. 9 Date/By: Related Permit it:
r - Inspection Line: 503.639.4175 \O V 1 J 2022. Ready Date/Hy: furls: t3 See Page 2 for
I i;•1'.L IntemM: wwn.tigard ar.gov Notified/Method: Supplemental Information
TYPE OF wok tTY OF TIGAfIL PLAN REVIEW
�. ❑New construction alAddition/alteratit701tWA'Y�S1�e n Please cheek all that apply(submit 2 sets of plans w/items checked):
❑Service or feeder 400 amps or more ❑Building over three stories.
ElDemolition ❑Other. where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
® I-and 2-family dwelling 0 Commercial/industrial ❑Accessory building less to proved,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
11695 SW Gallo Ave Tigard,OR 97223 ❑Addition of new motor load of system
Job#: Job site address: 9 10014P or more. ❑`A","E•`I-2"•"I-3".
Ci tate/ZIP: Tigard,OR 97223 0 Six or more residential units. occupancy.
❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg• PProject t.#: name: CARRIER,TIM 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 SCRFdDI1[
Description I Qty. I Each I Tonal i •
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.ft.or less I 168.54 4
Tax map/parcel#: Ea.add'1500 sq.ft.or portion 33.92 I
DESCRIPT[ON OF�WORRKK j� Limited energy,residential
eV t .L� W"1 1��•' (with above sq.m multi
75.00 2
Limited energy,multi-family 75.00 2
6.16kW residential(with above sq.ft.)
IN PROPERTY OWNER I TENANT Renewable Energy ❑ See Page 2
I ❑ Services or feeders installation,alteration,and/or relocation
Name: CARRIER,TIM 200 amps or In.Ss 100.70 2
Address: 11695 SW Gallo Ave Tigard,OR 97223 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: Tigard,OR 97223 601 amps to 1.000 amps 301.04 2
Phone:( 503439-7173 Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: tim carriertvahoo.com relocation
I Owner installation:This installation is being made on property that I own which is not 200 amps or less 5936 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 16R.54 2
AP CANT CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
i l ! 1jjk. t' A.Fee
bo for branch circuits with
Business name: 7 l 1 i� r• above service or feeder fee, 7.42 0
��( each branch circuit
Contact name: �1� t Vme t B.Fee for branch Circuits without
-y v'�! J s�[ ` -+ service or feeder fee,first
, Address: F' AAS il4t-lW e_ branch circuit 56./8 2
City/State/ZIP: Vr C6 t.a{'�__ ty Each addr branch circuit 7.42 2
4 ! t+c� Miscellaneous(service or feeder not included)
Phone:( 3) s�Ns 2 21 7 .. Fax::( ) Each manufactured or modular 67.84 2
dwelEmail: dole .'t"uj4'rt . Ger ":i t„CilLi Ota..k Reconnect
l service and/or feeder
67.84 2
_JCONTRACIOR - Pump or irrigation circle 67.84 2
I Business name: .. [. ,j t'��Z„t(�,,,r. Sign or outline lighting 67.84 2
/ (ii `k Signal lierait(s)or extension.
❑ See Page 2 2
, Address: 1 Yt�r".-r. panel.alteration.,or extensiert.
City/State/ZIP: tl (jlOtt..j4..� W N R+ tO`C Each additional inspection over allowable is any Mlle above
' �j Additional inspection(I hr min) 66.25/lir
Phone:(13 53 177 � Fax:( ) Investigation(1 hr min) 90.00/in
`/�,1 � a a.yt. ' /�� '' Industrial plant(1 hr min) 78.18/hr
Email: . ,'w�`•",14� ` �/'" • �"`• Inspections for which no fce is I ,
CCB Lie.: r��Z Electricalit./...gsnpN.Lie.: 5specifically listed(Yes hr min) 90.00 hr
•, ELECTRICAL PERMIT FEES1 Suprv.Electric signature,ream 9 Subtotal:
I Print name: ex-
w f. O Date: 11/7/22 ❑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 UM
Print name: Date: 11/7/22 days after it has been accepted as complete.
" Number of inspections allowed per permit.
rltoildnig.PermasiELQ cronApp_EIR_ERE.doc Rev 06'17/2015 b40-4615T(I t/OSRAaUWER