Permit ,, CITY OF TIGARD ELECTRICAL PERMIT
° - , :' COMMUNITY DEVELOPMENT Permit #: ELC2011 -00483
1 3125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/06/2011
TIGARD g
�., Parcel: 1 S134CD00800
Jurisdiction: Tigard
Site address: 11795 SW KATHERINE ST
Project: Henderson Subdivision: LERON HEIGHTS NO.3 Lot: 78
Project Description: Solar photovoltaic system.
Contractor: WEST SIDE ELECTRIC CO INC Owner: HENDERSON, MARLAND
1834 SE 8TH AVE 11795 SW KATHERINE COURT
PORTLAND, OR 97214 TIGARD, OR 97223
PHONE: 503 - 231 -1548 PHONE:
FAX: 503 - 736 -0677
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 09/06/2011 $100.70
Specifics: amps or less
1 crt Branch Circuits w /Purchase 09/06/2011 $7.42
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 09/06/2011 $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 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 O 52 -! i,c•090. •u may obtain a copy of the rules or direct questions to OUNC by calling 503 232.1987 or 1.800 332 2344.
i
Issued By: • j%/t Permittee Signature:
i
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 . • .
City of Tigard 13125 SW Hall Blvd , Tigard, Dat /B d 010 0 � Permit No.: e /sc,2 �� / g 3
ard, OR 97223 R
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eview
Plan Review
Phone. 503.718.2439 Pax: 503.598.1960 Date /By: Other Permit:
T[G.ARD Inspection Line: 503.639 4175 Date Ready /By: 9 / 0 4( suds, 6J See Page 2 for
Internet' www.tigard -or gov Noufied /M Supplemental Information
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❑ New construction ❑ Addition /alteration /replacement ✓�
❑ Demolition ❑ Other: Solar Install
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_ Please check all that apply (submit 2. sets of plans w /items checked below):
ttg'iEGOi 1 OFraAgTRUCTION y
�> • � a3 �� -^ ❑ Service or feeder 400 amps or more ❑ Building over three
U 1- and 2- family dwelling ❑ Commercial /industrial U Accessory building where the available fault current stories.
exceeds 10,000 amps at 150 volts or ❑ Marinas and boatyards.
❑ Multi-family ❑Master builder ❑ Other:
,�, .�,-, - „,.�, _u less to ground or exceeds 14
”' y
Mar,:` r ; �'dQ13� N ORMA3TI0N�`iVD�I,O�C'ATIN ,71 , �; amps for all other installations.
❑ Floating buildings.
Commercial -use
Job no.: Job site address: 11795 SW Katherine Court ❑Fire pump. agricultural
Emergency system. buildings
City /State /ZIP: Tigard /OR/97223 addition of new motor load of ❑ Installation of 75 KVA
10oHP or more. or
Suite/bldg. /apt. no.: Project name: Henderson
- nix or more residential units. larger separately derived system.
Cross street/directions to ob site: ❑
J ❑ Health -care facilities
❑ occupancy.
❑ Hazardous locations.
Recreational vehicle
❑ Service or feeder 600 parks.
Subdivision: Lot no.: amps or more.
❑ Supply voltage for
more than
Tax map /parcel no.: 600 volts nominal
P >: a ." �,�.., r tuna.
r :°` o- 0=0 ` a & Eit:SCRiP.TIQN ON WQRKWE r irEN t�, t . ,
2 kW solar electric install on roof
. �',` '( :, ti:FEE'SGHEDUM7 ° " IMO
Description 1 Qty. 1 Fee, 1 Total 1*
New residential single- or multi - family dwelling unit.
' �� Includes attached garage.
PROPERTy &trWN'ER r „ 4II IO TENAN1F 1,000 sq: ft. or less 168.54 4
Name: Marland Henderson Ea. add'l 500 sq. ft. or portion 33.92 1
Limited energy, residential 75.00 2
Address: 11795 SW Katherine Court (with above sq. ft.)
Limited energy, multi- family 75.00 2
City /State /ZIP: Tigard /OR/97223 residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
Phone: ( ) Fax: ( ) 200 amps or less / 100.70 /' - 70 2
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 133.56 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 200.34 2
Owner signature: Date: 601 amps to 1,000 amps 301.04 2
' _ �>APfroc T) �: �' ;I 0 CONTACT ON , x . 1, amps i t volts r feeders installation, alteration, 55a26 2
T Over emporary 000 services o and /or
Business name: Future City Solar relocation
200 amps or less 59.36 1
Contact name: Jordan Weisman 201 amps to 400 amps 125.08 2
Address: 1631 NE Broadway #320 401 amps to 599 amps 168.54 2
Branch circuits new, alteration, or extension, per panel
City /State /ZIP: Portland /OR/97232 A Fee for branch circuits with [
above service or feeder fee,
7.42 7. 2
Phone: (503) 407 -6820 Fax: : ( ) each branch circuit
E-mail: ordann futurecit solar.com B. Fee service branch r circuits rstthout
J Y service or feeder fee, first
to i COt,:rrW T'OR '': �� ? sot z` branch circuit 56 18 2
Each add'l branch circuit 7.42 2
Business name: Westside Electric Miscellaneous (service or feeder not included)
Address: 1834 SE 8th Ave Each manufactured or modular 67.84 2
dwelling, service and /or feeder
City /State /ZIP: Portland, OR 97214 Reconnect only 67.84 2
Phone: (503- 231 -1548 Fax: (503 )-231 -9987 Pum e cin 67.84 2
Sign or outline lighting 67 84 2
CCB Lic.:
13306 Electrical Lic.:26 - 135C suprv. Lie.: 4654 -S Signal circuit(s) or limited- energy
. panel, alteration, or extension. Page 2 2
Suprv. Electrician signature, required: / Each additional inspection over allowable in any of the above
-( Additional inspection (1 hr nun) 66.25/ hr
Print name: Randall F Roberts Date: Sep 02, 2011 Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Authorized signature: Inspections for which no fee is
- specifically listed ('/ hr min) 90.00/ In / n
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