Permit CITY OF TIGARD MASTER PERMIT
IN cli
!a COMMUNITY DEVELOPMENT Permit #: MST2012 -00084
T I GA RD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/09/2012
Parcel: 1S134ACO2650
Jurisdiction: Tigard
Site address: 11080 SW COTTONWOOD LN
Subdivision: ENGLEWOOD NO.3 Lot: 216
Project: Haynes
Project Description: Installation of photovoltaic system.
BUILDING
Floor Areas Required Setbacks Required
Stories: 0 Bedrooms: 0 First: 0 sf Basement: 0 sf Left: 0 Parking Spaces: 0
Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 0 Smoke
Dwelling Units: 0 Third: 0 sf Right: 0 Detectors:
Total: 0 sf Value: $0.00 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 Storm Sewer: 0
Tubs /Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: 0 Catch Basins: 0
Bckflw Prevntr. 0
Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0
Drywell -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: 1 0-200 amp: 0 W/ Svc or Fdr: 1
Ea add'I 500 sf: 0 201 -400 amp: 0 201 -400 amp: 0 W/O Svc/Fdr: 0
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 Security Alarm: N Vaccuum System: N Garage Opener: N All
Other: N Other Description: Ecompasing: N
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
ALT SF VB R - 3 0
Owner: Contractor:
HAYNES, KENNETH R & KELLY D SOLARCITY CORPORATION Required Items and Reports (Conditions)
11080 SW COTTONWOOD LANE 6132 NE 112TH AVE
TIGARD, OR 97223 PORTLAND, OR 97220
PHONE: PHONE: 503- 964 -0489
FAX: 503- 926 -9101
Total Fees: $328.19
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. AT • • . Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 1010 rough • • R • • -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued = -�0 " —"' /' Permittee Signature: er►1, -7 1
Call 603.839.4175 by 7:00 a.m. for the next available inspecti
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.
Building Permit Application
Residential r , --
- - p /:i c i FOR 01-1-1c1: I: sl: o\l.V
City of Tigard ', c' ' Received �A N
D : y Permit No.:
III • 13125 SW Hall Blvd., Tigard, OR 97223 '�� "{ '
C Plan Review WERE Phone: 503.7182439 Fax: 503.598.1961 PR 9 2 pang •
: Other Permit:
1" I u A It':1 Inspection line: 503.639.4175 _ / OF Date Ready/By: Jura: ® See Page 2 for
���
Internet: www.tigard- or.gov Notified/Me
� ��° r ;� � , ��� '� �� Supplemental Information
r : Oi
TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed.
® Addition/alteration/replacement ❑Other: Indicate the value (rounded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application. ,
® 1- and 2- family dwelling ❑ Commercial/industrial Valuation: $ G t �
❑ Accessory building ❑ Multi- family Number of bedrooms: J
❑ Master builder ❑ Other: Number of bathrooms:
• JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 1 1 ORO c )U`) Cotton wood L an eJ New dwelling area: square feet
City/ State/ZIP: l'io jrd 0Q, ' 1Z2? Garage/carport area: square feet
Suite/bldg. /apt. no.: J 11 Project name: } `r t InPG Covered porch area: square feet
Cross street/directions to job site: ` 'v` Deck area: square feet
Other structure area: square feet
REQUIRED DATA: COMMERCIAL -USE CHECKLIST
Subdivision: Lot no.: Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
Tax map /parcel no.: equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application. .
Roof Mount PV System Valuation: $
Existing building area: square feet
1 New building area: square feet
(✓J PROPERTY OWNER I 0 TENANT Number of stories: `
Name: , Type of construction:
Address: Occupancy groups:
City/State/ZIP: Existing:
Phone: ( ) Fax: ( )
New:
❑ APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
Business name: SolarCity Corporation (Please refer to fee r`k)
Structural plan review fee (or deposit):
Contact name: Caitlin Horsley
,� FLS plan review fee (if applicable):
Address: 6132 NE 112 Ave
City/State/ZIP: Portland
Total fees due upon application:
Phone: (503) 9560610 Fax: : (503) 5366513
Amount received: tr , !'°
E -mail: chorsley @solarcity.com PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
CONTRACTOR Commercial and residential prescriptive installation of
roof -top mounted Photo Voltaic Solar Panel System.
Business name: SolarCity Corporation • Submit two (2) sets of roof plan with connection details
1e and fire department access, along with the 2010 Oregon
Address: 6132 NE 112 Ave Solar Installation Specialty Code checklist.
City/State/ZIP: Portland, Oregon 97220 Permit Fee (includes plan review
and administrative fees): $180.00
Phone: (503) 9560610 Fax: (503) 4366513 State surcharge (12% of permit fee): $21.60
CCB lic.: 180498
Total fee due upon application: $201.60
Authorized signature: — I ti This permit application expires if a permit is not obtained
/ t••• - j , within 180 days after it has been accepted as complete.
Print name: Caitlin Ho ey / Date: 4 I i q 1' *Fee methodology set by Tri- County Building Industry
Z Service Board.
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•
Electrical Permit Applicati( ' ,? ''. FOR OFFICE USE ONLY
�
����
City of Tigard Date :
. 13125 SW Hall Blvd., Tigard, OR 9722 R R 2 i 2 Received Plan Review Permit No.: 5% -fit' $
Phone: 503.718.2439 Fax: 503.598.1 f0 Date /B : / Other Permit:
I I c : � R I Inspection Line: 503.639.4175 i -4.. .7 '. - • - 6 ^ f) Date Ready/By: tom: M See Page 2 for
Internet: www.tigard - or.gov O. 1 ' L1. .1' . 1.� .. •:L5 Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ® Addition /alteration/replacement 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 OF CONSTRUCTION exceeds 10.000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14.000 ❑ Commercial -use agricultural
® 1 - and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ 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 ", "I - ", "I - ",
Job no. Job site address: , /, ,, 1 , ,
IOOHP or more. occupancy.
�, 2sgu 1 1102 0 5 W on W oocl 0 Six or more residential units.
0 Recreational vehicle parks.
City/ State/ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than
`/1 [ �,r [� I l J KJ �, L 3 0 Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: J Project name: H 1 ' r� e S ❑ Service or feeder 600 amps or more.
M , J FEE SCHEDULE
Cross street/directions to job site: Description I Qtv. I Fee. I Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
. Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family 75.00 2
Roof Mount PV System residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less f 100.70 2
is PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2 •
Name: (U I M J� , 601 amps to 1,000 amps 301.04 2
Address: - I V - -� 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
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. -
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
® APPLICANT I 0 CONTACT PERSON above service or feeder fee, ' 7 42 2
each branch circuit
Business name: SolarCity Corporation B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: Caitlin Horsley branch circuit
Each add'I branch circuit 7.42 2
Address: 6132 NE 112 Ave Miscellaneous (service or feeder not included)
Each City/ State/ZIP: Portland, Oregon 97220 dwelling, service and/or or r modular 67.84 2
� dwelling, service and/or Ceeder
Phone: (503) 9560610 Fax: : (503) 5366513 Reconnect only 67.84 2 '
Pump or irrigation circle 67.84 2
E - mail: chorsley @solarcity.com Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited -energy
Business name: SolarCity Corporation panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 6132 NE 112th Ave Additional inspection (I hr min) 66.25/ hr
Investigation (I hr min) 66.25/ hr
City/State/ZIP: Portland, Oregon 9722
Industrial plant (I hr min) 78.18/ hr
Phone: (503) 9560610 Fax: (503) 5366513 Inspections for which no fee is 90.00/ hr
specifically listed ('h hr min)
CCB Lic.: 180498 Electrical Lic.: C562 Suprv. Lic.: 5201S ELECTRICAL PERMIT FEES
Subtotal:
Suprv. Electrician signature, required 4....4:::::Cdr Plan review (25% of permit fee):
Print name: Derek Cropp Date: ' /l _ I i a Z (t State surcharge (12% of permit fee):
T t TOTAL PERMIT FEE:
Authorized si nature:
g - T his permit application expires if a permit is not obtained within 180
� ( 4 I i ` days after it has been accepted as complete.
ct 12 • Number of
Print name: Caitlin Horsley U Date: inspections allowed per permit.
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