Permit CITY OF TIGARD ELECTRICAL PERMIT
a, ( v
COMMUNITY DEVELOPMENT Permit #: ELC2010 -00055
T [ GARL? 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 02/16/2010
Parcel: 2S 111 AD10900
Jurisdiction: Tigard
Site address: 15145 SW 88TH AVE
Subdivision: SCHECKLA PARK ESTATES Lot: 50
Project: Mitchell
Project Description: Installation of 3220 watt solar array system (PV).
Owner: FEES
MITCHELL, BARRY 0 Quantity Description Date Amount
15145 SW 88TH AVE
TIGARD, OR 97224 1 ea Services or Feeders - 200 02/16/2010 $100.70
amps or less
PHONE: 503 - 713 -3585 2 crt Branch Circuits w /Purchase 02/16/2010 $14.84
Service or Feeder
1 ea 12% State Surcharge - 02/16/2010 $13.86
Contractor: Electrical
STAPLETON ELECTRIC & SOLAR LLC
2314 SE 12TH AVE
PORTLAND, OR 97214
PHONE: 503 - 970 -2976
FAX: 503- 236 -0410
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $129.40
Required Items and Reports (Conditions)
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
952- 001 -0010 through 0 R 952-001-0100. You may obtain ►(a a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: . 5 t l A `�1 Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
j
SIGNATURE OF SUPR. ELEC' Date: 2//0
LICENSE NO.
Caii 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
Electrical Permit Applicatio® RECEIVED n• EO R OF F I CE_ 1—'0_ (;_\ I.
; City of Tigard FEB 02 p eB _�� P— itNo.: FA/ ('.„10/0- 00CS,t
• 13125 SW Hall Blvd., Tigard, OR 97223 pi Review 503.639.4171 Fax: 503.598.1r an Y OF TIGARD Date/By: Other permit'
•,. , Inspection Line: 503.639.4175 BUILDING DIVISION DateReadyB - 1 la See Page 2 for
I Internet: www.tigard- or.gov Notified/M ' • I • T 61 'I , t. Supplemental Information
Go- TYPE OF WORK W
• v W. fr PLAN REVIEW
❑ New construction ® Addition/alteration/replacement Phase check all that apply (submit 2 sets of plans w/items checked below):
❑ Senice or feeder 400 amps or more ❑ Building o%er three stories.
❑ Demolition ❑ Other: where the mailable fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
0 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fiee pomp. ❑ Installation of 75 K VA or
❑ Emergency system larger separately derived system.
JOB SITE INFORMATION AND LOCATION _ ❑ Addition of new motor load of ❑ "A "E', "1.2 ", - 1 -3 ",
lob no.: I Job site address: 15145 SW 88 Ave, looms °r more. more Re
❑ six or e residential gaits. ❑Recreation al vehicle parks.
City / State/ZIP: Tigard, Oregon 97224 ❑ Health -ere facilities ❑ Supply vvhage for more than
❑ Hazardous locations. 600 %ohs nominal.
Suite/bldgJapt no.: I Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: erstriotkro 1 Ow. I Fee. 1 Total 1 •
New residential side- or multi- family dwelling unit.
Includes attached garage.
Subdivision: 1 Lot no.: 1,000 sq. It or less 168.54 4
Ea. add'1500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
67.84 2
DESCRIPTION OF WORK (with above sq. ft.)
ES
Limited
3220 Watt solar array (PV) reside with above sq. ft.) - 67.84 2
Services or feeders installation, alteration, and/or relocation
200 amps or less I 100.70 /ekl•.7o 2
® PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
Name: Barry Mithchell 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: 15145 SW 88 Ave. Over 1,000 amps or volts 552.26 2
City/State/ZIP: Tigard, Or. 97224 Temporary services or feeders Installation, alteration, and/or
relocation
Phone: (503)713 -3585 I Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent or exchange. according to ORS 447, 449, 670, and 701. 401 amps to 599 amps - 168.54 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel _
> A. Fee for branch circuits with
❑ APPLICANT 1 ❑ CONTACT PERSON above service or feeder fee. Z 7.42 / $f< 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, 56.18 2
first branch circuit
Address: Each add'! branch circuit 7.42 2
Miscellaneous (service or feeder not Included)
City /State/ZIP: Each manufactured or modular 67.84 2
• dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
E -mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name: Stapleton Electric & Solar LLC S�,�y � al orb oy
Address: 2314 SE 12 Ave. extension. Describe Page 2 2
City/State/ZIP: Portland, Oregon 97214 Each addidonal lltsmeedon over allowable in any of the above
Per inspection 66.25
Phone: (503) 970 -2976 I Fax: ( ) Investigation per hour (1 tr min) 66.25
V I Electrical Lic.: C -166 .1 Suprv. Lic.: 4848S industrial plant per h�
CCB Lic.: 169059 78.18
�-- E LECTRICAL PERMIT FEES
Suprv. Electrician signature, required: p y ,' wl _ Subtotal: f9@:T //5 Scj
Print name: Patrick Stapleton I pate: Plan re 25% of permit fa ):
l State study (12% of permit fee): /5. 8
Authorized signature: TOTAL PERMIT FEE: /,Q !• go
Print name: I Date: This permit da after It expires accepted is c obtained k thin 180
• Number of inspections allowed per permil.
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