Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00218
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/06/2011
Parcel: 1 S133DC14700
Jurisdiction: Tigard
Site address: 13269 SW TAMERA LN
Project: Pederson Subdivision: VILLAGE AT SUMMER LAKE NO. 1 Lot: 2
Project Description: Installation of solar photovoltaic system.
Contractor: SOLARCITY CORPORATION Owner: PEDERSON, RICHARD D & FLORENCE J
6132 NE 112TH AVE 13269 SW TAMERA LANE
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 05/06/2011 $100.70
Specifics: amps or less
1 crt Branch Circuits w /Purchase 05/06/2011 $7.42
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 05/06/2011 $12.97
Electrical
Type of Const:
Occupancy Grp:
Total $121.09
Required Items and Reports (Conditions)
This permit is iss. - • b'ect to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other applicable law. All work will
be done i - ccordance with - • •rove• • an Ti' •ermit will expire if work is not started within 180 days of issuance, or if work is s - . • - • for ii •re the 180
days. - ENTION: Oregon law -quires y- to follow the rules adopted by the Oregon Utility Notification Cent / -- - . •AR
952 -00 -0010 through OAR 952 -011 -i090.# may o •stain a copy of the rule r direct questions to OUNC by calling 03 • .il
Iss ed By: , _ Permittee Signature: : � ■C 1• _
NW
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 Application FOR OFFICE USE ONLY
Received of Tigard E DateiB : S Permit No• 13125 SW Hall Blvd., Tigard, OR 972.2 RE CEIVE , - I:Plan Review
' � = Phone: 503.639.4171 Fax: 503.598.1960 Date.'B : Other Permit: £ 4 M 1_, oak
T I G A R D Inspection Line: 503.639.4175 APR 2 7 2011 p Date R eady /B y: L ® See Page 2 for
Internet: www.tigard- or.gov Notified'Method: , J/ A U SI Supplemental Information
. 3c 1,:L4 iz,,
❑ New construction C Addition/alter!' f .S a!�i 1'. : VISIC;r,. Please check all that apply (submit 2 sets of plans wtitems checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
C:ATECORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural .
n i - and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
El Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
Illl3 SITE INFORMATION TIOV AND LOCATION ❑ Emergency system. larger separately derived system
❑ Addition of new motor load of ❑ "A ", "E ", "1 - ". "1 - ",
Job site address: / I OOHP or more. occupancy.
II / / _ff I ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: .
I , / / ❑ Health facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: / - 0 ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street /directions to job site: Description I Qty. I Fee. I Total I
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. II. or less 168.54 4
Ea. add'l 500 sq. tt. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
75.00 2
DESCRIPTiON OF WORK (with above sq. fl.)
Limited energy, multi- family
.00 p I / / residential (with above sq. ft.) 75.00 V `', „et or feeders installation, alteration, and/or relocation
200 amps or loss j 100.70 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 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: ( ) Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that 1 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
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
APPLICANT C CON' ' t OWN
' above service or feeder fee, I 7.42 2
each branch circuit
Business name: p/ 1 " i i A 014-1 B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: �. ` ✓ branch circuit
Each add'l branch circuit 7.42 2
Address: , 2 ' e Miscellaneous (service or feeder not included)
tate /ZIP: / r - `L • , = q a - dwelling, service and/or feeder Each manufactured or modular
Cit /S 67.84 2
y �
Phone: ( 0 ) q$1 - ` r !Q Fax: : ( 5 ) , - 2 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
-� Sign or outline lighting 67.84 2
t ONTR,t. L Signal circuit(s) or limited-energy
Business name: Q r ` ` -` �- panel, alteration, or extension. Page 2 2
a Each additional inspection over allowable in any of the above
Address: • , r Additional inspection (1 hr min) 66.25/ hr
• City /State /ZIP: •,,��� �� , i O Investigation (1 hr min) 66.25/ hr
�� Industrial plant (1 hr min) 78.18/ hr
Phone: (603) 90_ QL, O I Fax: (503) 026 - / /D/ Inspections for which no fee is 90.00/ hr
specifically listed ('N hr min)
CCB Lie.: ; 0 '' sv Electrical Lie.: e.56, , Suprv. Lie.: 5 Q 5 ELECTRICAL PERMIT FEES r _
Suprv. Electrician signature, required. �`� � G — Subtotal: w •- J
�c Plan review (25% of pemut fee):
- IiI. a, / ' 1 . P Date: i Mal State surcharge (12% of permit fee): 0_1
` TOTAL PERMIT FEE:
Authorized signature:- �� / `n�
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
■= Date: / iffilIMI * Number of inspections allowed per permit.
I: Building Permits ELC- PennitApp.doc 07 01 10 440 -16 I5Tt 1 105 COM9 WEB