Permit CITY OF TIGARD ELECTRICAL PERMIT
l COMMUNITY DEVELOPMENT Permit #: ELC2013 -00042
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/17/2013
Parcel: 2S102DCO3900
Jurisdiction: Tigard
Site address: 13895 SW ANDREW TER
Project: Tran Subdivision: MCDONALD WOODS Lot: 12
Project Description: Installation of (1) branch circuit for electric car.
Contractor: SOLARCITY CORPORATION Owner: TRAN, BRUCE NGOC QUANG
6132 NE 112TH AVE 13895 SW ANDREW TER
PORTLAND, OR 97220 TIGARD, OR 97223
PHONE: 971 - 279 -9655 PHONE:
FAX: 866 - 810 -7656
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 01/17/2013 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 01/17/2013 $6.74
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
Required Items and Reports (Conditions)
This permit i i sued -ct to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done ' accordance with - pproved 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. TTENTION: Oregon l -w -q es you to follow the rules adopted by the Oregon Utility Notif . • Center. Those rules are set forth in OAR
952- 1 -0010 thro gh OAR 952-s11-0091. may obtain a copy f the rules or direct questions to O , 1 C by calli ` r ''44 1987 or 1.800.33A'3
Is- ed By: / / Permittee Sign: ` Ailm.111.16WAir •
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' M . ��1 - 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.
To' Pogo 2 or 3 2013- 0 -16 2253:29 O IIT 18668107856 Fr ore • Joel Peterson
,
I pp '
Electrical Permit Application CEIVE I FOR OFFICE USE ONLY
City of Tigard JAN i 6 Received ' : iff �J Permit No': Eh.Gap /3 DD - f i >
13125 SW Had Blvd., Tigard, OR 97223 ? O i 3 Plan Review
' • Phone: 503.718.2439 Fax: 503 I}atr 1i . Other Permit
hob: ( {
1 I c..■ RI) tv inspeetion Lane: 503.639.4175 1._I OF TT Date Read)'°BX : H See Page 2 for
lnttaaet www.tigard-or.gov B r r i d D I CARD Dale R d/Metbod Supplemental information NGDIVISI4N
TO AF WORK PRAT) REVI1 Y .
❑ New construction ® Addition /alteration/replacement Please check all (hat apply (submit a sets ofplans wlitems checked below):
❑ Service or feeder 400 angss or mare ❑ Building over three stories.
❑ Demolition ❑ Other: whom the available fault current ❑ Marines and boatyards.
CA TEGORY 'O G OIvSTR13CT10N exceeds 10.000 amps et 150 volts or ❑ Floating buildings.
" less to ground, or exceeds 14.000 ❑ Commercial -use agriculmal
® 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps lbr all ether inn, lbtions. buildings.
❑ Multi - family ❑ Master builder ❑ Other, ❑ Fire pump. ❑ Installation of75 KVA or
• ❑ Emergency system. brgerseparatelyderivedsyetem-
JOB ' SITE INFORMATION AND i:OCATiQFI, . _ _ • ❑ Addition of new motor load of ❑ "A" "E ", "1 -2 ", ••1 -3 ",
^7 \ Job site address 'y/ 1
Job no.: L L � 1 - I n1 (�� {}'r� 1001IP or occupancy. r�. �� U 1 J 7 t/V �I V �1 V .� l l-K ❑ Six or more residential units. ❑ Recreational vehicle pules.
City'State21F: orZl LIB ) ( 2 c L. ❑ Health -an ficiGllrs. ❑Supply voltage for more than
❑ Hazardous location. 600 volts nominal
Suite/bldg. /apt. no.: Project name: T(J Q K ❑ Service or feeder 600 amps or more.
Cross street/directions to job site: 1 " 1 FEE 3CSEDOI e `
] nererlptlon I Qtr. I Fee, 1 - 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
Tax map/parcel no.: Ea add•1500sq. ft. or portion 33.92 1
Limited energy, residential 75.00 2
DESCRIPTION OE WORK — (with above sq. ft.)
Limited energy, multi - family
So A N C.K<i R N 1 n J OUT LET residential (with above sq. I) 75.00 2
rr /� Services nr feeders installation, alteration, and/or relocation
]rt ]r • l 1Q�,� 200 amps or leas 100.70 2
® PROPERTY .OWNER < ! (] TENANT 201 amps to 400 amps 133.56 2
(�h T tS. f� /� 401 amps to 600 amps 200.34 2
Name: L)1`v -L n � i -tp r 601 amps to 1,000 amps 301.04 2 •
M
Address: SA ► 1 s :Tog v l> S 1TE Over 1,000 amps or volts 552.26 2
Temporary ser or feeders installation, alteration, and /or
City/State/ZIP:
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
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 16834 2
Branch circuits -new, alteration, or extension, per panel
Owner signature: Date: _ A. Fee for branch circuits with
..... AEPLICAN above service or feedea Port, *,
I; i. CONTAGC` PERSON __.. _ - 7.42 2
tec b ranc h circuit
Business name: SolarCity Corporation B. Fee for branch circuits without
service or feeder fee, fist ` 56.1s S(y , I% 2
Contact name: Joel Peterson branch circuit
Each WW1 branch circuit 7.42 2
Address: 6132 NE 112 Ave Miscellaneous (service or feeder not Included)
City /State/ZIP: Portland, OR 97220 Each manufactured a or r Header 6784 2
dwelling, stsrvlee tixder
Phone: (971) 279 -9655 Fax: : (866) 810 -7656 Reconaect only 67.84 2
E -mail: jpetersonCsolercity.com Pump or irrigation circle 67.114 2
_ S! or outline li ghting 67. 2
Sign
- ... 'CON? ►_070.— .. . : Signal circuit(s) or limited - clergy
Business name: SolarCity Corporation panel, alteration, or extension. Pale 2 2
. -_ Each additional Inspection over allowable in any of the above
Address: 6132 NE 112 Ave Additional inspection (1 hr min) 66.25/ hr
City/State/ZIP: Portland, OR 97220 Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (971) 279 -9655 Fax: (866) 810 -7656 Inspections for which no fee Is 90.001 hr
specifically listed (Ile hr min)
CCB Lic.: 180498 Electrical Li • C562 Suprv. Lic. 52015 ;,, , . - - . E L ..;ELECTRiCA1 PERMIT •FEES ,
Suprv_ Electrician signature, required: Subtotal:�o.)
2 Plan review (25% of permit fee):
-
Print name: Derek Cropp Date: 16 I State surcharge (12% of permit fee): Cv , - 7
TOTAL PERMIT FEE: 6 1 r 0
Authorized signature:
This permit application expires if a permit It not obtained within 180
Print name; Joel P on Date: 1/ (,/ • days after it has been accepted as complete.
Number of inspections allowed per permit. 6 41-'
J
1: Building Permit ELC- PermiApp.doe 0 41 10 440.461511)103.COM WEB
To Peon 1 of Z1 16060107656 From Joel loptnroon
FAX COVER SHEET
TO
COMPANY
FAX NUMBER 15035981960
FROM Joel Peterson
DATE 2013 -01 -16 22:53:09 GMT+00:00
RE 13895 SW Andrew Terr Electrical App & CC
COVER MESSAGE
Joel Peterson
Office Admin
Solar City
Phone: (971) 279 -9655
Fax (866) 810 -7656
jpeterson@solarcity.com <mailto: jeterson@solarcity. com>
WWW.EFAX.COM