Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00038
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Da te Issued: 01/25/2011
Parcel: 2S102AB00912
Jurisdiction: Tigard
Site address: 12125 SW 92ND AVE
Project: LAWSON Subdivision: KIMBERLY ADDITION Lot: 12
Project Description: Photovoltaic system.
Contractor: SOLARCITY CORPORATION Owner: LAWSON, KAREN L
6132 NE 112TH AVE 12125 SW 92ND AVE
PORTLAND, OR 97220 TIGARD, OR 97223
PHONE: 503 - 964 -0489 PHONE:
FAX: 503 - 926 -9101
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 01/25/2011 $100.70
Specifics: amps or less
1 crt Branch Circuits w /Purchase 01/25/2011 $7.42
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 01/25/2011 $12.97
Electrical
Type of Const:
Occupancy Grp:
Total $121.09
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 acc r 1anr,- 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. ATT TION: Orego law - uires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules ace set forth in OAR
952 -001 -0 10 thro gh OAR 952 -� :1 -00 ou may obtain a copy of the rules or direct questions to OUNC by callin 3.2 2.1987 or 1.800.332.2344.
Issue By: / i Permittee Signature: 3t `l' �� � •
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
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
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.
Electrical Permit Apjilieation ', Fc>a ��rrici Lsr ONLY
I City of Tigard C�� Datei I I' II en-- PennitNo.: OUai ,.��? p�
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review �
' 1 Other Permit: [��
Phone: 50 3.639.4171 Fax: 503.598.1960 1 �� Date :By: � �( f� j1 f �' V 914 "�iJ�'�'� 0
6
TO c A I: f) Inspection Line: 503.639.4175 P` ' 1 to Ready /By: 1 I ® See Page 2 for
Internet: www.tigard- or.gov J o �, C �l: ∎ fi4d.-Method: Supplemental Information
/ I TYPE OF WORK CO 1 \sr1� I1 . PL
° � y
' PLAN .> `CIE .
❑ New construction Addition /alteration /1-40 Please check all that apply (submit 2 sets of plans w /items checked below)'
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY CECORf OF •C:CP1gST>>t<)C 1 J N exceeds 10,000 amps at 15D volts or ❑ Floating buildings.
less to ground. or exceeds 14,000 ❑ Commercial -use agricultural
and 2- family dwelling ❑ Commercial /industrial ❑Accessory building amps for all other installations. buildings.
❑ M ulti- family ❑ Master builder ❑ Other: 0 Fire pump. ❑ installation of 75 KVA or
❑ Emergency system. larger separately derived system
. JOB SITE INFORMATION AND : LOCATION ❑ Addition of new motor load of ❑ "A" "E" "1 -2" "1 -
Job no.. Job site address: �f !- / /vim occupancy.
��� _rte /� /G� �VV �� �C i 100HP or more.
0 Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: 094RD � / y 2� ❑ Health -care facilities. ❑ Supply voltage for more than
' 7 ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: I Project name: /4% �SOA/ ❑ Service or feeder 600 amps or more.
/ �' FE)E. - SCHEDULE
Cross street /directions to job site: Description l Qtr. I Fee. I Total I *
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'1500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
75.00 2
DESCRIPTION OF W6kk (with above sq. It.)
Limited energy, multi- family
-. -7 ,& / j} e� y � T J y1v� j ?V a' YS� '/vl residential (with abovesq. ft.)
75.00 2
•
(((///��/// / � "e� �/ � — U , L -1 �, Services or feeders installation, alteration, and/or relocation
200 amps or less ( 100.70 400,7'" 2
. , ❑ PROP;E%T il' ' OW1 ER - 0. TENANT ' 201 amps to 400 amps 133.56 p 2
401 amps to 600 amps 200.34 2
Name:
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and /or
City /State/ZIP: relocation
Phone: ( ) . I Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: • A. Fee for branch circuits with
above service or feeder fee 2
❑ h1?�'[:[C NT El GONLV -T P€119,N 7.42
.1 each branch circuit r� "
Business name: B. Fee for branch circuits without
service on feeder fee, first 56.18 2
Contact name: branch circuit
• Each add'l branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
Cit / State/ZIP: o • Each manufactured or modular 67.84 2
Y dwelling, service and/or feeder
Phone: ( ) I Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2 ,
E - mail:
Sign or outline lighting 67.84 2
.i 2ONTRA COR Signal circuit(s) or limited - energy
Business name: . RC1r' nc� a ATt Q,/ panel, alteration, or extension. Page 2 2
` O 4/4"//27// �� � [� Each additional inspection over allowable in any of the above
Address: 6 f 3 Additional inspection (1 hr min) 66.25/ hr
City / State/ZIP: 7� f' A(1 7 ??O
Investigation p (1 (1 mm) 66.25/ hr
/' r°"`, Industrial plant (1 hr min) 78.18/hr
Phone: 103) T6 0/ Fax: ( ) ?zc, -9/0/ Inspections for which no fee is 90.00/ hr
specifically listed (A hr lnin)
CCB Lie.: /$ 047/9 ft Electrical Lic.: CZC Suprv. Lic.: 520 LS • ELECTI ECAI. PERMIT •)1 E4
Suprv. Electrician signature, required: o Subtotal: 1O ().
• Plan review (25 /o of pemsit fee):
Print name: b ‹ & Date: / / I State surcharge (12% of permit fee): 1 1, 617
TOTAL PERMIT FEE: d / (S c- (
Authorized signature:
1 This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: /r / ..„.... T'�N� Date: 17/ L I * Number of inspections allowed per permit.
1: Building Permits ELC- PennitApp.doc 07'01 10 440 -4uCOM WEB