Permit - CITY OF TIGARD MASTER PERMIT
• a V COMMUNITY DEVELOPMENT P ermit #: MST2013 -00133
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/01/2013
TIGARD Parcel: 2S 103DA04600
Jurisdiction: Tigard
Site address: 10570 SW PARK ST
Subdivision: FANTASY HILL Lot: 1
Project: Pugsley
Project Description: Installation of solar photovoltaic system.
BUILDING
Floor Areas Requlred 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 0 Storm Sewer: 0
__ — __ Tubs/Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Drains: Catch Basins: 0 _
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0
Other Fixtures: 0
Drywell- Trench Drain: 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: 1 0 -200 amp: 0 W/ Svc or Fdr: 0
Ea add 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:
PUGSLEY, CLAYTON A & SOLARCITY CORPORATION Required Items and Reports (Conditions)
FREEMAN - PUGSLEY, CAMIE 6132 NE 112TH AVE
10570 SW PARK ST PORTLAND, OR 97220
TIGARD, OR 97223
PHONE: 503 - 705 -6619 PHONE: 971 - 279 -9655
FAX: 866 - 810 -7656
Total Fees: $329.88
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 OAR 95 - 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. 6 `
Issued By: ,� Permittee Signature: Q� ��/ G / f!'.�T7d /�.l
Call 503.639.4176 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.
,RECEIVED
Buildini Permit Application :?
in 1 0 2013
Residential o)1t ouri c u_ i,sr ONi.
City of Tigard CITYOFTIGARD y �
ea � i3 CD4,02 PermitNo.: , , . 5,e0/33
4 13125 SW Hall Blvd., Tigard, ORB9 Plan Revi ` ��
; 1 Phone: 503.718.2439 Fax: 503.598.1960 D ♦' Other Permit:
I'I'G I: Il Inspec. Date Ready. r i luris: la See Paget for
Internet: tion www Line: 503 or 639.4175 Notified/Method: Supplemental Information
TYPE OF WORK REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
® Addition/alteration/replacement ❑ Other. equipment, materials, labor, overhead, and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
Valuation:
® $ , ' - ./O
I. 2- family dwelling 0 Co O 9
❑ Accessory building ❑ Multi- family Number of bedrooms:
es
❑ Master builder ❑ Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: (c).57t S t� Sr New dwelling area: square feet
City /State ZIP: 1 ' (,q,,e 0 c Q„ Q Garage/carport area: square feet !II
Suite/bldg./apt. no.: ' I Project name: !) � e � a m � e Covered porch area: square feet
Cross street/directions to job site: , j Deck area: square feet
• Other structure area: square feet
REQUIRED DATA: COMMERCIAL - USE CHECKLIST
Subdivision: I 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
New building area: square feet
® PROPERTY OWNER I ❑ TENANT Number of stories:
Name: [, t / , Cj� u , c `c Type of construction:
Address:\ �-J 1057 p SA y (L 4 Occupancy u
, `."` P Y Bro s: P
City /State/ZIP: T,„3 Cie, 7,93 Existing:
Phone: (503) 76 C°(e( I Fax: ( ) New:
® APPLICANT ® CONTACT PERSON BUILDING PERMIT FEES*
Business name: SolarCity Corporation (Please refer wife schedule)
Structural plan review fee (or deposit):
Contact name: Joel Peterson
1h FLS plan review fee (if applicable):
Address: 6132 NE 112 Ave
City /State/ZIP: Portland, OR 97220
Total fees due upon application:
Phone: (971) 279-9655 I Fax: : (866) 810-7656
Amount received:
E -mail: jpeteraon@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
and fire department access, along with the 2010 Oregon
Address: 6132 NE 112 Ave Solar Installation Specialty Code checklist.
City/State/ZIP: Portland, OR 97220 Permit Fee (includes plan review $180.00
Phone: (971) 279 -9655 I Fax: (866) 810 -7656 and administrative fees):
State surcharge (12% of permit fee): $21.60
CCB lic.: 180498
r A Total fee due upon application: $201.60
Authorized signatur° %' / This permit application expires if a permit is not obtained
4 ditK within 180 days after it has been accepted as complete.
Print name: Joel P ou Date: h.) t * Fee methodology set by Tri- County Building Industry
Service Board.
1: ;Building 02/24/2011 440 -4613T(11 /02 /COM /WEB)
Electrical Permit Applica CElVED Fok OFFICE JSE ON L..1'
Cl Of Tl and Received i P ermit No.:
h' il �f 1 0 X013 Date : , ft 0 /5 X43,.3
13125 SW Hall Blvd., Tigard, OR 9'7233 Plan Review
" • ' Phone: 503.718.2439 Fax: 50 .ip$. h 1111U1�1U1 rt,p D : Other Permit:
T I . R,I, Inspection Line: 503.639.4175 . 1 I V Date Ready/By: kr la See Page 2 for
Internet: www.tigard- or.gov BUILDING DIVISION Notified/Method: Supplemental Information
-- -- TYP ,(OF� WORK_ - — _ __ 'PI- REVIEW - 1
❑ New construction ®Addition/alteretion / replacement
Please check all that apply (submit 2 sets of plans w /items checked below):
Other: ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑
_ where the available fault current ❑ Marinas and boatyards.
L - _ toxi _c -oily OF' Qg(NSfRU . F1UNI exceeds 10.000 amps at 150 volts or ❑ Floating buildings. .
® 1 - and 2-family dwelling Commercial/industrial less to ground, or exceeds 14.000 ❑ Commercial -use agricultural
y g ❑ ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
I - -- == - -- =_- _ - . — -- -- _ - - ❑ Emergency system. larger separately derived system.
-
1dQBa SITE INFQRMiA7l0N AND- LOCATIO motor bad of I
-- = - - - - _ = _ --- - - � ❑ Addition of new m ❑ "A" "E" "1.2" •• - 3"
Job no.: Job site address: r 100HP or more. occupancy.
UJ 7V 50 U J ❑ Six or more residentia units. ❑ Recreational vehicle parks.
City/State/ZIP: `! ....z..73 ❑ Health -care facilities. ❑ Supply voltage for more than
� L) 0Q.. 1 ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name:
V ❑ Service or feeder 600 amps or more.
S t- �
_ _FSE, +SCHEDULE-
Cross street/directions to job site: Description 1 Qty. I Fee. I Twat 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. fl.) 75.00 2
;DE
Limited energy, multi - family 7500 2
Roof Mount PV System residential (with above sq. ft.)
Services or feeders installation, al:7, and/or relocation
200 amps or less 100.70 fCrj'7° 2
®; i'ROPERT OWNER ; 9 :'•TEN 201 amps to 400 amps 133.56 2
Name: �‘1� 2 — • _
401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: 1 0 ✓7 G>)(,---) - � Ls1.. ` Over 1,000 amps or volts 552.26 2
�� �' - � Temporary services or feeders installation, alteration, and/or
City/State/ZIP:- TI'4(G( �Z et 7'9 .93 relocation
Phone: ()1 t v _/( j e L c ' Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I 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
APpL1CA1V rt I above service or feeder fee,
i_ _ ®69111A '1ERSONI___� 7.42 2
- -
each branch circuit
Business name: SolarCity Corporation B. Fee for branch circuits without
service or feeder fee, first 56.18 2
p ��
Contact name:. I r V 6\d U t \INI( k, branch circuit
Each add'I branch circuit 7.42 2
Address: 6132 NE 112 Ave Miscellaneous (service or feeder not included)
Each manufactured or modular
City/ State/ZIP: Portland, OR 97220 dwelling, service and/or feeder 67.84 2
Phone: (971r ( 77( I Fax: : (866) 5G a aa({S Reconnect only 67.84 2
E -mail: ,'f 1
Pump or irrigation circle 67.84 2 • 1 ' �� .i _oV, C L � _ _ Signor outline lighting 67.84 2
Cb . N9�RA :U — __ _ _ _ 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 112 Ave Additional inspection (I hr min) 66.25/ hr
City/State/ZIP: Portland, OR 97220 Investigation (1 hr min) 6625 / hr
^ Industrial plant (1 hr min) 78.18/ hr
(
, o(
Phone: 971 3t\ - 5 Fax: 86 - oa l.� q Inspectio for which no fee is 90,00 / hr
7 ( 7/.9 ` specifically listed (1/2 hr min)
-- - -- - -- - - -
CCB Lic.: 180498 Electrical Li • C562 Suprv. Lic.: 5201S , �ELECDRIC'A`I5, PERMIT FEES
Subtotal:
Suprv. Electrician signature, required: �/
X � H of permit fee):
Print name: Derck Cropp Date: State Plan surcharge review (12% (25% of permit fee):
Authorized signature: '/
r i _ TOTAL PERMIT FEE:
y (/ o„� ■ This permit application expires a permit Is not obtained within 180
ll days after it has been accepted as complete.
Print name. - _ -. ,- ..,,,.1(� 01„ \114\ I Date: • Number of inspections allowed per permit.
i:' Building'PermaiEt.C.Pena'App.doc 0 1 70 1 , 10 440.4615T(II.05 COM-WEB
T0: Pogo 1 or 2 2013 -00 -27 17:52:28 OMIT 6665922249 From: IV10II KrBll
RECEIVED
JUN 2 7 2013
CITY OF TIGARD
FAX COVER SHEET BUILDING DIVISION
TO
COMPANY
FAX NUMBER 15035981960
FROM Mollie Krell
DATE 2013-06 -27 17:48:17 GMT+00:00
RE MST2013-00133- Pugsely Cammie_ CC auth
COVER MESSAGE
Please fax me back a receipt or invoice of this payment today!!! Thx
Sincerely,
Mollie
Mollie Krell I Permit & Inspections Coordinator I SolarCity I T: 971-201-52781
mkrell@ solarcity. com<mailto:mkrell@solarcity.com> I www.solarcity.com
WWW.EFAX.COM