Permit CITY OF TIGARD MASTER PERMIT
e COMMUNITY DEVELOPMENT Permit #: MST2012 -00281
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/26/2012
Parcel: 1S136CB09800
Jurisdiction: Tigard
Site address: 11312 SW 84TH AVE
Subdivision: ASH CREEK MEADOWS Lot: 2
Project: Koznek
Project Description: Add 5.28 kw PV 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' No
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
Drains: 0
Tubs /Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 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
Fum <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: 0 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:
KOZNEK, DANE PREMIER ENERGY INVC Required Items and Reports (Conditions)
11312 SW 84TH AVE 556 SOMMERSET RD
TIGARD, OR 97223 WOODLAND, WA 98674
PHONE: 971 - 404 -1236 PHONE: 503 -825 -9500
FAX:
Total Fees: $320.38
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 i - • • - - 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. . ENTION: Or- •on aw requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -r ∎ 1 -0010 t rough OAR 2 - +01 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issu d By: / //4-14/61--Li Permittee Signature: C
mow-
Call 503.639.4175 by 7:00 a.m. for the next available Inspection da e.
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
R ECEIVE !I -.,. _ . . - ...
- - FOR OF F ICE'USE ONLY
NOV 08 2012 -
/
Received �
City of Tigard Date/B : � � 1 a- Permit No.:, /�a,[ -r l,....., po
PI
° 13125 SW Hall Blvd., Tigard, OR 97223 CIT/�TIGARD plan Review `���a �
9 V �I 11 I�AAIl�J Other Permit:i `
Phone: 503.718.2439 Fax: 503 Date/B : � �!
T I G A ii D Inspection Line: 503.639.4175 BUILDING NISI • -1 Date Ready/By: , � ruris• ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: 14 I t (S h ` o{ Ill Supplemental Information
TYPE OF WORK REQUIRED DATA: I- AND 2- FAMILY DWELLING
❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rotnded to the nearest dollar) of all
Ad dition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
'and 2- family dwelling ❑ Commercial /industrial Valuation: $
❑ Accessory building ❑ Multi- family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 3 Z t,J If c/ 0 Ai ` New dwelling area: square feet
City /State /ZIP: 7 tog_ / 7 2 - 3 Garage /carport area: square feet
Suite/bldg. /apt- no.: Project name: kO Z11,� � 5 ., Covered porch area square feet
Cross street/diredions to job site: 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.
Tax map /parcel no.: Indicate the value (rotnded to the nearest dollar) of all
equipment, materials, labor, overhead, and the profit for the
DESCRIPT OF WORK work indicated on this application.
Ad el s- Z g /G ?(/ - 8_/ Si,,,,'r Valuation: S
Existing building area square feet
New building area: square feet
E 1 ROPERTY OWNER ❑ TENANT Number of stories:
Name: ' PG e k o z. n 4_ Type of construction:
Address: t / 3 / - g r / / - - Occupancy groups:
City /State /ZIP: ert. , 0 2 ?l 7 ZZ - 3' Existing:
Phone: (q-7() Lip c/ , / Z 3 c Fax: ( ) New:
I3 rxPPLICANT • ❑ CONTACT PERSON
NOTICE
Business name: / 414 ( a c cf1.e 0 All contractors and subcontractors are required to be
Contact name: '2 r te / licensed with the Oregon Construction Contractors Board
ekrt under ORS 701 and may be required to be lensed in the
Address: �—� / !/ P��P / ;i7 jurisdiction in which work is being performed. If the
Cit City/State/ZIP: n applicant is exempt from licensing, the following reasons
y &do � l „/Yld A 9 8 . 4. `7 apply:
Phone: (."03) ar Zs q -, 2_ Fax:: ( )
E -mail: 0 .S(cs)/et, U /Li V e.. - rig”, Yr'
CONTRACTOR BUILDING PERMIT FEES*
(Please refer to fee schedule
Business name:
rP,1v1 l - (iy n Permit fee:
Address: sS6 k}?P�o-S-47 State surcharge (12% of permit fee):
City /State /ZIP: t ) ,, ft pd/ J ,,J f q' 4; 7 z
FLS plan review (40% of permit fee):
Phone: (r -_" g ZS -- Fax: ( ) (Due upon application.)
CCB lic.: / 9ss c S- ! / y(q ( (,3 Total permit fees:
Authorized signature: L Amount received: 0 . (
G.( ��� This permit application expires if a permit is s no not obtained
Print name: ,� - / within 180 days after it has been accepted as complete.
1�'n / Date: // _ / 'Z * Fee methodology set by Tri -County Building Industry
Service Board.
I:\ Building \Permits\FPS- PermiWpp.doc Rev 01 /05/2012 440- 4613T(11 /02/COM/WEB)
City of Tigard: Fire Protection Permit Checklist
Page 2 - Supplemental Information
Describe work to be done:
1.) El New 2.) Modification to sprinkler heads only:
❑ Addition ❑ 1 -10 heads: No plan review required.
❑ Alteration ❑ 11+ heads: Plan review required.
❑ Repair
Number of sprinkler heads:
Additional description of work:
Type of S stem Complete A, B, C or D as ap i licable :
A.) Commercial Sprinkler
❑ Wet ❑ Dry
Additional Standpipes
Information: Hazard Group
Density
Design Area
K. Factor
Sprinkler Project Valuation: $
B.) Type I - Hood Fire Suppression System
Hood Project Valuation: $
C.) Fire Alarm
Submittal shall Battery Calculations ❑ Yes
include: Individual Component El Yes
Cut Sheets
Fire Alarm Project Valuation: $
D.) Residential Sprinkler (Stand Alone System)
Square Footage: Permit Fee:
0 to 2,000 $198.75
2,001 to 3,600 $246.45
3,601 to 7,200 $310.05
7,201 and greater $404.39
Sprinkler Project Square Footage: sq. ft.
Fire Protection Permit Fees
Project valuation subtotal (see A, B & C above): $
Permit fee based on project valuation (see fee schedule): $
Permit fee based on square footage (see D above): $
State Surcharge (12% of permit fee): $
FLS Plan Review (40% of permit fee): $
TOTAL: $
Plan review requires a completed application and three (3) sets of plans at submittal.
Plan review fees are required at submittal.
I: \Building \Permits \FPS - PermitApp.doc Rev 01 /05/2012 2
Electrical Permit Application RECE IV '\ . , . FO12 . 0l h ICE USt ..ONLY• ..
Received
City of Tigard NOV o 8 21 tateBy: (.d & (J.- PermitNc A �a U 1.1,, 190
Il
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
a Phone: 503.718.2439 Fax: 503.598.1960 T 'n 0. teBy: Other Permit:
T 1 G A It D. Inspection Line: 503.639.4175 CITY OF I , {! to Ready/By: tug / ® See Page 2 for
Internet: www.tigard- or.gov BI ILD*,IG DIVI r 11tC � l l Supplemental Information
TYPE OF WORK DIVI fJ 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
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
JOB SITE INFORMATION AND LOCATION ❑mergency system. larger separately derived system.
['Addition of new motor load of ❑ "A ", "E ", "I - ", "I - ",
Job no.: Job site address: ! g / / to Ave 1 Six or or more residential R occupancy.
,/ � Z 5 L✓ [ 0 or more residential amts. ❑Recreational vehicle 'parks.
City/State /ZIP: O f� 7 Z Z 3 ❑ Health -care facilities. ❑ Supply voltage for more than
r ,5W . f ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: k, Z n O L E S t j'iL, ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qtv. I Fee. I Total
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
�� L Limited energy, multi- family 75.00 2
Z g k_ � P V rte r P— residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
ErfROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
� 401 amps to 600 amps 200.34 2
Name: ' 'JGtrri KO Z ri_e_ 601 amps to 1,000 amps 301.04 2
Address: // — ! Z S �/ 2 c, , f 4„ Over 1,000 amps or volts 552.26 2
D Temporary services or feeders installation, alteration, and /or
City/State /ZIP: levrC (0 g 7 Z Z 3 relocation
Phone: (4 71 ) y o 4 / 7 L ( )
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
[APPLICANT ❑ CONTACT PERSON above service or feeder fee
7.42 2
each branch circuit
B. Fee for branch circuits without
Business name:
�P ✓►�' e / 6:7--
�! o S `� L r► ° service or feeder fee, first 56.18 2 .6 Contact name: '��,L� "Trot^ L / _ branch circuit
/ Each add'l branch circuit 7.42 2
Address: s-- a � �� d 2„e Miscellaneous (service or feeder not included)
City/State /ZIP: r Each manufactured or modular 67.84 2
e--Jo cco c _ A g 7 'y dwelling, service and/or feeder
Phone: (So M) g Z s_ Is-p Fax: : ( ) Reconnect only 67.84 2
` Pump or irrigation circle 67.84 2
r .
E -mail: d t �' Se (�Y� /t + i 1/� C w e . - ya, Signor outline lighting 67.84 2
7 CONTRACTOR Signal circuit(s) or limited - energy
Business name: / / panel, alteration, or extension. Page 2 2
//AT L /Pc / C� Each additional inspection over allowable in any of the above
Address: / cI 7 Z - A € ?orn I r 0 A� g } Additional inspection (I hr min) 66.25/ hr
5 Investigation (1 hr min) 66.25/ hr
City/State /ZIP: I r_,.,c �rR
�- ri , e " vJ"i 9i ®Lt
t� Industrial plant (1 hr min) 78.18/ hr
Phone: (3 6(3 4E c --- e7 _ .K. ! c Fax: ( ) F Ins for which no fee is
90.00/ hr
specifically listed (%a hr min)
CCB Lie.: / g -z 4 2 3 Electrical Lie G y 3 Suprv. Lic.: 5-3 - 7 S s ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: U Subtotal:
}yt Plan review (25% of permit fee):
Print name: N/ ! A e ; D'�te: / , S _ Z State surcharge (12% of permit fee):
TOTAL PERMIT FEE:
Authorized signature:
This permit application expires if a permit is not obtained within 180
1/
, it
Print name: AA days after it has been accepted as complete.
I l , k e_ L ye D at e : ii . $ — i Z Number of inspections allowed per permit.
I: \Building\Permits\ELC- PermitApp.doc 07/01/10 440- 4615T(I1/05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
p Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I:\ Building \Permits\ELC- PermitApp.doc 07/01/10