Permit CITY OF TIGARD2. MASTER PERMIT
' ,� COMMUNITY DEVELOPMENT Permit#: MST2022-00481
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/22/2022
Parcel: 2S 111 CA03700
Jurisdiction: Tigard
Site address: 9715 SW LAKESIDE DR
Subdivision: SUMMERFIELD NO.12 Lot: 657
Project: Peterson
Project Description: Rooftop solar PV system 6.08 kW.
BUILDING
Floor Areas Required Setbacks Required
Stories: 0 Bedrooms: 0 First: 0 sf Basement: 0
Height: 0 sf Left: 0 Parking Spaces: 0
g Bathrooms: 0 Second: 0
Dwelling Units: 0 Third: 0 sf Garage: 0 sf Front: 0 Smoke
sf Right: 0 Detectors:
Total: 0 sf Value: $4,256.00 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
FootingDrain: 0 Ice Maker: 0 Bckflw Prevntr: 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
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''500 sf: 0 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 2
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 SecurityN
Alarm: Vaccuum 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:
PETERSON,A PAUL&S DIANE ION DEVELOPER LLC Required Items and Reports(Conditions)
9715 SW LAKESIDE DR 3214 NORTH UNIVERSITY AVE
TIGARD,OR 97224 503
PROVO,UT 84604
PHONE: PHONE: (888)781-7074
FAX:
Total Fees: $457.42
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specially 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. ATTENTIO.• Oregon law equires 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: i A4•— ./i/�II/ �— Permittee Signature: �r ��jo i.[r„/l
Call 503.639.4175 by 7:00 a.m.for the next available inspection date. f/
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
Residential RECEIVE.,ecFOR OFFICE USE ONLY
City of Tigard Dateived Permit No.
■ 13125 SW HaI1 Blvd.,Tigard,OR 97223 NOV
Plan Review )Z4
rn S 12D 22—(����I
C Phone: 503.718.2439 Fax: 503.598.1960 'V + I I /ZZ AA Other Permit:
DateBy:
T I GA R D Inspection Line: 503.639.4175 I Date ReadyBy: 7 luris. ® See Page 2 for
Internet: www.tigard-or.gov CITY OF r6 „-\;"'�.r NotiSed/tvletlwd�I /� � I Supplemental Information
BUILDING DIVISr G„_ _ al DbSiri'VN
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
ElAddition/alteration/replacement ®Other: PV Solar equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
IN 1-and 2-family dwelling ElCommercial/industrial Valuation: $ 4,256
ElAccessory building El Multi-familyNumber of bedrooms:
ElMaster builder ElOther: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 9715 SW Lakeside Dr New dwelling area: square feet
City/State/Z1P: Portland,Oregon 97224 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: Peterson Solar Install Covered porch area: square feet
b Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Subdivision: Summerfield No 12 Lot no.: 267 Permit fees*are based on the value of the work performed.
Tax map/parcel no.: 2S 111 CA03700/R1006011 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.
Installation of solar panels on existing residential roof. Valuation: $
6.08 kW.Addition of 2 0-30A circuits. Existing building area: square feet
New building area: square feet
I PROPERTY OWNER ❑ TENANT Number of stories:
Name; Arthur Peterson Type of construction:
Address: 9715 SW Lakeside Dr Occupancy groups:
City/State/ZIP: Portland, Oregon 97224 Existing:
Phone:((503))310-0283 Fax:( ) New:
ICI APPLICANT ❑ CONTACT PERSON BUILDING PERMIT FEES*
Business name; ION Developer LLC (Please refer to fee schedule)
Structural plan review fee(or deposit):
Contact name: Dustin Davidson
FLS plan review fee(if applicable):
Address:4801 N University Ave#900
Total fees due upon application:
City/State/ZIP: Provo, UT 84604
Phone:( 888) 781-7074 Fax::( ) Amount received:
E-mail: permits@ionsolar.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Business name: ION Developer LLC Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: 4801 N University Ave#900 Solar Installation Specialty Code checklist.
City/State/ZIP: Permit Fee(includes plan review
Y Provo, UT 84604 and administrative fees): $180.00
Phone:( 888) 781-7074 Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lie.: 230394 Total fee due upon application: $201.60
Authorized signature: / This permit application expires if a permit is not obtained
�u p jam, / within 180 days after it has been accepted as complete.
Print name: *Fee methodology set by Tri-County Building Industry
Dustin Davidson Date: 11-16-2022 Service Board.
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Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard Received Permit#:
ll
13125 SW Hall Blvd.,Tigard,OR 97223
, Phone: 503.718.2439 Fax: 503.598.1960 PlDatan DateBe/Review Related Permit#:
Inspection Line: 503.639.4175 Ready Date/By: lads: la See Page 2 for
TIGAR D: Internet: www.tigard-or.gov Notified/Method:
S g Supplemental Information
TYPE OF WORK PLAN REVIEW
El New construction ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans wiitems checked):
0 Service or feeder 400 amps or more IDBuilding over three stories.
0 Demolition ®Other: PV Solar
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
El1-and 2-family dwellin less to ground,or exceeds 14,000 0 Commercial-use agricultural
g ❑Commercial/industrial ❑Accessory building
El Multi-family ❑Master builderamps for all other installations. buildings.
0 Other: 0 Fire pump. ❑Installation of 150 KVA or
JOB'BM.INFORMATION AND LOCATION 0 Emergency system, larger separately derived
Job#: Job site address: 9715 SW Lakeside Dr ❑100H ion of new motor load of system.
I OOHP or more. ❑"A" "E" ••1-2" "1-3"
City/State/ZIP: Portland,Oregon 97224 ❑Six or more residential units. occupancy.
cupancy.
❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: Peterson Solar Install 0 Hazardous locations. 0 Supply voltage for more than
0 Service or feeder 600 amps or more. 600 votte nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qrs. I Each I Total I *
New residential single-or multi-family dwelling unit.
Subdivision: Summerfield No 12 Lot#: 657 Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: 2S 111 CA03700 I R1006011 Ea.add'1500 sq.ft.or portion 33.92 I
DESCRIPTION OF WORK Limited energy,residential
(with above sq.ft.) 75.00 2
Installation of solar panels on existing residential roof. Limited energy,multi-family •
residential(with aboveft.) 75.00 2
6.08 kW.Addition of 2 0-30A circuits. sq.
Renewable Energy 0 See Page 2
0 TENANT® PROPERTY OWNERServices or feeders installation,alteration,and/or relocation
Name: Arthur Peterson 200 amps or less 100.70 2
Address: 9715 SW Lakeside Dr 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: Portland,Oregon 97224 601 amps to 1,000 amps . 301.04 2
Phone:((503))310-0283 Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: mrpau1503@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
® APPLICANT ID CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: ION Developer LLC above service or feeder fee, 7.42 2
each branch circuit
Contact name: Dustin Davidson B.Fee for branch circuits without
service or feeder fee,first
Address: 4801 N University Ave#900 branch circuit 1 56.1s 56.18 2
City/State/ZIP: Provo, UT 84604 Each add'l branch circuit ' 1 7.42 7.42 2
Miscellaneous(service or feeder not included)
Phone:(888) 781-7074 Fax: :( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: permits@ionsolar.corn Reconnect only 67.84 _ 2
•
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: ION Developer LLC Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address: 4801 N UniversityAve#900 0 See Page 2 2
panel,alteration,or extension.
Each additional inspection over allowable in any of the above
City/State/ZIP: Provo, UT 84604 Additional inspection(1 hr min) 66.25/hr
Phone:(888) 781-7074 Fax:( ) Investigation(1 hr min) 90.00/hr
Industrial plant(1 hr min) 78.18/hr
Email: permits@ionsolar.com Inspections for which no fee is
CCB Lie.: 230394 Electrical Lie.: C1524 Suprv.Lic.: 6098S specifically listed('A hr min) 90.00/hr
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: 14,464..yC ,,_Q Subtotal 197.16
Print name: David S Conrad Date: 11-16-2022 ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): 23.66
Authorized signature: Zssdl4x O� eM, TOTAL PERMIT FEE: 220.82
This permit application expires if a permit is not obtained within 180
Print name: Dustin Davidson Date: 11-16-2022 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:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Description Q
Fee for all residential systems combined: $75.00 . tam oral .
y Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 1 133.56 133.56 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
❑ 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:
El Other: Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed C/2 hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1): 133.56
(SEE OAR 918-309-0000) * Number of inspections allowed per permit.
Check Type of Work Involved:
❑ Audio and Stereo Systems
El Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
n 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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