Permit (186) CITY OF TIGARD MASTER PERMIT
' COMMUNITY DEVELOPMENT Permit#: MST2016-00513
T I-GA R L 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/06/2016
Parcel: 2S 109 DA 15800
Jurisdiction: Tigard
Site address: 15410 SW SUMMERVIEW DR
Subdivision: ARLINGTON HEIGHTS NO.3 Lot: 77
Project: Nguyen
Project Description: Installation of solar 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: No
Total: 0 sf Value: $8,405.00 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
Bckflw Prevntr: 0 Catch Basins: 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
Furn>=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: 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: Roof top PV system Ecompasing: N
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group:Y Square Feet:
ALT SF VB
R-3 0
Owner: Contractor:
NGUYEN,COREY HOANG&LE CHAU TFBLUE RAVEN SOLAR LLC Required Items and Reports(Conditions)
15410 SW SUMMERVIEW DR 1220 S 630 EAST,STE 430
TIGARD,OR 97224 AMERICAN FORK,UT 84003
PHONE: 818-300-3184 PHONE: 385-498-4408
FAX:
Total Fees: $331.38
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 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 952-001-0090. You may obta' of the rules or direct questions to OUNC by calling 503. 32.19: :c0 2.2344.
Issued By:L � Permittee Signature: -
all 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.
' Building Permit Application
Residential k
FOR OFFICE USE ONLY
City of Tigard Received q ! /
�±g� Date/B : a i(9 �� �,� Permit No.: ��✓� 3
,, . 13125 SW Hall Blvd.,Tigard,OR �7V 2 9 ?0 i h Plan Review
Phone: 503.718.2439 Fax: 503.598.'1960 Date/B : / /' -J Other Permit:
I
�-,�1t[t Inspection Line: 503.639.4175 Date Ready/By: / { Juris: El See Page 2 for
Internet: •www.tigard-or.gov ,. �` Notified/Method: / Supplemental Information
e � t3
4 ' � 471.1 I. f t` ! • 1 t !
❑New construction 0 Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
0 Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
f f f work indicated on this application.
. • •t r
❑r 1-and 2-family dwelling ❑Commercial/industrial Valuation: $$8,405
ElAccessory building ❑Multi-family Number of bedrooms:
EI Master builder ❑Other: Number of bathrooms:
to : 1 •• lin,A.1-., . f f Total number of floors:
Job site address:15410 Southwest Summerview Drive New dwelling area: square feet
City/State/ZIP:Portland ,Oregon 97224 Garage/carport area: square feet
Suite/bldg./apt.no.: I Project name:Corey Nguyen Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
i 8'TE.,t t Oi'
Subdivision: I Lot no.: Permit fees*are based on the value of the work performed.
Tax map/parcel no.: 2S109DA15800 Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
' ifft
i•a . : 1 ®� ••• •� work indicated on this application.
PV Solar Panels 3.48 kW Valuation: $
Existing building area: square feet
New building area: square feet
ILLWAliWnrit Number of stories:
Name:Corey Nguyen Type of construction:
Address:15410 Southwest Summerview Drive Occupancy groups:
City/State/ZIP:Portland ,Oregon 97224 Existing:
Phone:( )8183003184 Fax:( ) New:
Business name: Blue Raven Solar1,..
Structural plan review fee(or deposit):
Contact name: Brittany Gardner
Address:
1220 S 630 E STE 430 FLS plan review fee(if applicable):
City/State/ZIP:
American Fork,UT 84003 Total fees due upon application:
Phone:( 855 ) 205-2530 Fax::( ) Amount received: --
T'
E-mail: Permitting@blueravensolar.com 'Ilei!)
, o o
11.
• „,, » ..� � s � _ #7,.,1.^;400,40§1,1. � � � • Commercial and residential prescriptive installati s• of ..
k r # f ` l„ ,_..„4 4 roof-top mounted PhotoVoltaic Solar Panel •'em.
•
Business name: Blue Raven Solar Submit two(2)sets of roof plan with c..action details
and fire department acce : •._ i the 2010 Oregon
Address: 1220 S 630 E Solar Installation Specialty Co,•c - t.
City/State/ZIP: American Fork,UT,84003 Permit Fee(include • an review $180.00
and as strative fees):
Phone:( ) Fax:( )
State surchar t 12%of permit fee): $21.60
CCB lic.: #210112
Ts .1 fee due upon application: $201.60
( ”
Authorized signature: Vy This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: JefferyLee *Fee methodology set by Tri-County Building Industry
Date:11/22/2016 Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Electrical Permit Application t C I OR 01:1:1( ,. 1 S,. ONI.v
City of Tigard ,1 C��l tJ t D l F Received
Date/B : Permit#:
r 13125 SW Hall Blvd.,Tigard,OR 97223r Plan Review
II g Phone: 503.718.2439 Fax: 503.598 1940 i . DateB : Related Permit#:
Inspection Line: 503.639.4175
,Ready Date/By: kris: ® See Page 2 for tCnZD Notifie /Method:Internet: www.ti azd-or. ov
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):
0 Demolition 0 Other: ❑Service or feeder 400 amps or more 0 Building over three stories.
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
® 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
0 Multi-family ❑Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND'LOCATION 0 Emergency system larger separately derived
❑Addition of new motor load of system.
Job#: Job site address:15410 Southwest Summerview Drive 100HP or more. ❑"A","E","I-2","1-3",
City/State/ZIP:Portland , Oregon 97224 ❑Six or more residential units. occupancy.
0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name:Corey Nguyen 0 Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. I Each I Total I *
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
Tax map/parcel#: 2S 109DA15800 1,000 sq.ft.or less 168.54 4
Eaadd'1500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
PV Solar Panels 3.48 kW
(with above sq.ft.) 75.00 2
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
®;PROPERTY OWNER Renewable Energy ❑ See 2
0 TENANT' Services or feeders installation,alteration,
Page and/or relocation
Name:Corey Nguyen 200 amps or less 100.70 2
Address:15410 Southwest Summerview Drive 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:Portland , Oregon 97224 601 amps to 1,000 amps 30L04 2
Phone:( )8183003184 Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: ricepwr@hotmail.com relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
0 APPLICANT I CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: Blue Raven Solar above service or feeder fee,
7.42 2
BrittanyGardner each branch circuit
Contact name: B.Fee for branch circuits without
Address: 1220 S 630 E STE 430 service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP: American Fork,UT,84003 Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not
Phone: 855 205-2530 included)
( ) Fax :( ) Each manufactured or modular 67.84 2
Email: permitting@blueravensolar.com dwelling,service and/or feeder
Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: AP Electric
Sign or outline lighting 67.84 2
Address: 1220 S 630 E STE 430 Signal circuit(s)or limited-energy
panel,alteration,or extension. ❑ See Page 2 2
City/State/ZIP: American Fork,UT.84003 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( 855 ) 205-2530 Fax:
( ) Investigation(1 hr min) 90.00/hr
Email: Permitting@blueravensolar.com Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
CCB Lic.: 210112 Electrical Lic.: C1214 Suprv.Lic.: 6097S specifically listed(%hr min) 90.00/hr
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: *.,.._
Subtotal:
Print name: Alex Petersen Date: 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: flitrC4TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Jeff Lee Date:11/22/2016 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PemitApp_ELR_ERE.doc Rev 06/17/2015 440-46151(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
pI # WORKONLYi v ":. 1" FEE=: CHP[Lrro>
Description 1 Qty. 1 Each 1 Total 1"e
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
5 kva or less 1 100.70 2
Check Type of Work Involved:
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
❑ Garage Door Opener* >100 kva(fee in accordance
55226 2
with OAR 918-309-0040)
❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva-no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ Other. Each additional inspection is 66.25/hr
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(%hr min)
t,.K
RICA Tglus'IkT
GOM1 IE iC wQ ' FEES
vfmi
Subtotal(Enter on Page 1):
Fee for each commercial system: $75.00 * Number of inspections allowed per permit.
(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*
El Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doe Rev 06/17/2015
' Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
, i. j 1 :::47 ' .,;.I .iti IL 4
Fee for all residential systems combined: $75.00 Description Qty. Each TotalRenewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 1 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
❑ Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
❑ Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva-no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ Other: Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
s.ecificall listed('/Z hr min)
. ... ....� ... n.
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1): I
(SEE OAR 918-309-0000) Number of inspections allowed per permit.
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*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
L\Building\Permits\ELC_PermitApp_ELR ERE.doc Rev 06/17/2015
13125 SW Hall Blvd.
Tigard, OR 97223
City of Tigard
Location:
15410 SW SUMMERVIEW DR, TIGARD, OR,
97224
Record Type:
Residential - Master Permit
Inspection Type:
299 Final inspection
Result:
PASS- NoCofO
Comments:
Violation Summary:
Inspector
Tel: 503.718.2439
Inspection Date:
February 2, 2017 at 9:01:18
AM
Record ID:
MST2016-00513
Inspector:
Chip Barnett
Contractor