Permit (185) 14 CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT Permit#: MST2016-00512
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/06/2016
Parcel: 1S 134DCO2200
Jurisdiction: Tigard
Site address: 11670 SW 114TH PL
Subdivision: 114TH PLACE Lot: 15
Project: Martin
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: $9,224.00 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 addl 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:
MARTIN,WILLIAM& BLUE RAVEN SOLAR LLC Required Items and Reports(Conditions)
OLSON,CINDY 1220 S 630 EAST,STE 430
11670 SW 114TH PL AMERICAN FORK,UT 84003
TIGARD,OR 97223
PHONE: PHONE: 385-498-4408
FAX:
Total Fees: $326.88
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 952-001-009 obtain- . •-.rules or direct questions to OUNC by calling 503 87.,• .800.332.2344.
Issued By:
•17
--
Permittee Signature:
.."503.639.4175 by 7:00 a.m.for the next available inspection dat
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 FOR OFFICE ISE 0\1.1'
'� '441 Received
illh 'I City of Tigard Permit No.:H racI6�_0057 l
13125 SW Hall Blvd.,Tigard,OR 97223 Plan
Review: 9 t �j
• Phone: 503.718.2439 Fax: 50Nf��1g(9 2 0 j 6 Date/B �
-30 .f - " Other Permit
f f c,ti.It I, Inspection Line: 503.639.4175 Date Ready/By: - Juris: 0 See Page 2 for
Internet: www.ti and-or. ov• a �'
g g � R 1 AJ ��4� a���� Notified/Method/- / / �� Supplemental Information
. --(47,//‘-• —1-'‘,
410.97,14URNSERNISREAMPZ:t;.i''' r,{"1'4':',11.tj'f.1,74 rz,j.,;VittiPP,flentill PFerrfnTrMjtfZtfr'RMMIV:Ar?Vr11;
0 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
Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
t • t e work indicated on this application.
.414itirlAirlik.4'4Moti*..r.Moht!tabligEffitai •.'1.
El 1-and 2-family dwelling 0 Commercial/industrial Valuation: $$9,224
❑Accessory building 0 Multi-family Number of bedrooms:
ElMaster builder 0 Other: Number of bathrooms:
Afierett
rAPPOIRNEE 1 'o ° t •ae y Total number of floors:
Job site address:11670 Southwest 114th Place New dwelling area: square feet
City/State/ZIP:Tigard , Oregon 97223 Garage/carport area: square feet
Suite/bldg./apt.no.: I Project name:William Martin Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet
Subdivision: I Lot no.: Permit fees*are based on the value of the work performed.
Tax map/parcel no.:1 S 134DCO2200 Indicate the value(rounded to the nearest dollar)of all
equipment,materials,labor,overhead,and the profit for the
,_ t t' t a ' work indicated on this application.
PV Solar Panels 4.06 kW Valuation: $
Existing building area: square feet
New building area: square feet
t Number of stories:
Name:William Martin Type of construction:
Address:11670 Southwest 114th Place Occupancy groups:
City/State/ZIP:Tigard ,Oregon 97223 Existing:
Phone:( ) Fax ( )
New:
4 1 y
Business name: Blue Raven SolarL4Nefi'IN I- .: 3U
Contact name: Brittany Gardner Structural plan review fee(or deposit):
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 I Fax::( ) Amount received: -
E-mail: Permitting@blueravensolar.com ® e ,. o r t .
"_ it '°: I .=' wt tore Commercial and residential prescriptive installation of
• f **•.- k roof-top mounted PhotoVoltaic Solar Panel Syste •
Business name: Blue Raven Solar Submit two(2)se oof plan with conne details
and fire department access, wi 2010 Oregon
Address: 1220 S 630 E Solar Installation Specialty Code 'st.
City/State/ZIP: American Fork,UT,84003 Permit Fee(includes review $180.00
and admi ' ative fees):
Phone:( ) Fax:( )
State surcharge(12 f permit fee): $21.60
CCB lic.: #210112
.yy� Total fee due upon application: $201.60
Authorized signature: S�w V This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry
Print name: Jeffery Lee Date:11/28/2016
Service Board.
I:\Building\Pennits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
Electrical Permit Application Folz 01 11( 1. t SI 0\1.1
City of Tigard Received
g r f-,11, 1 )) 5 'j j j fl DateB : Permit#:
411 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
I Phone: 503.718.2439 Fax: 503.598 1960 DateB : Related Permit#:
T I G n R D Inspection Line: 503.639.4175 ,, Ready Date/By: Theis: ® See Page 2 for
Internet: www.tigard-or.gov ,Notified/Method: Supplemental Information
TYPE OF W 1 'Aic,a1,.5 a' 1 ) i,c`.
PLAN REVIEW
❑New construction ®Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
❑Demolition 0 Other: 0 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 0 Master builder 0 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:11670 Southwest 114th Place 100HP or more. ❑"A","E","l-2","1-3",
City/State/ZIP:Tigard , Oregon 97223 ❑Six or more residential units. occupancy.
0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name:William Martin 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 *.r.
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#:1S134DCO2200 Ea add'I 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
PV Solar Panels 4.06 kW (with above sq.ft.) 75.00 2
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
® PROPERTY OWNER I 0 TENANT Services or feeders installation,alteration,and/or relocation
Name:William Martin 200 amps or less 100.70 2
Address:11670 Southwest 114th Place 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:Tigard , Oregon 97223 601 amps to 1,000 amps 301.04 2
Phone:( )5035987701 Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email:wpmartin60@comcast.net 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 N CONTACT PERSON Branch circuits-c 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
each branch circuit
Contact name: Brittany Gardner B.Fee for branch circuits without
service or feeder fee,first
1220 S 630 E STE 430
Address: branch circuit 56.18 2
City/State/ZIP: American Fork,UT,84003 Each add'I branch circuit 7.42 2
205-2530Miscellaneous(service or feeder not included)
Phone:(855 ) Fax::( ) Each manufactured or modular 67.84 2
lmittin dwelling,service and/or feeder
Email: Pe g�iblueravensolar.Com Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: AP Electric Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address: 1220 S 630 E STE 430 panel,alteration,or extension. 0 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
blueravensolar.com Industrial plant(1 hr min) 78.18/hr
Email: Permitting@blueravensolar.com
Inspections for which no fee is
CCB Lic.: 210112 J Electrical Lic.: C1214 I Suprv.Lic.: 6097S specifically listed(A 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: CifftrCkTOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Jeff Lee Date:11/228/2016 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WOON Y:
�,v J`1LE SCi EDULE
v _
:;
Description
� Qty. I Each I Total
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
❑ Garage Door Opener* >100 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over 25 7.42 3
El Vacuum Systems* >100 kva-no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ Other: Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
s ctficall listed('/z hr min)
t, NISICIA' WO$C(MN; `.. .
Fee for each commercial system: $75.00 Subtotal Enteron Page 1):
3' * Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015
13125 SW Hall Blvd.
Tigard, OR 97223
City of Tigard
Location:
11670 SW 114TH PL, TIGARD, OR, 97223
Record Type:
Residential - Master Permit
Inspection Type:
199 Electrical final
Result:
PASS
Comments:
Violation Summary:
Inspector
Tel: 503.718.2439
Inspection Date:
Record ID:
MST2016-00512
Inspector:
Jeff Grove
Contractor
,.
Electrical Permit Application—City of Tigard '/jam"`5 (7)-( 4%. -06/572._
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
!B * g ,,`'~•L 9 y .,Fri• s.y ��
- .. B @ rt$, :i..,^.` .n..,a 5. v..;,,y': 4: .»;e^S�c?•F ....s 6:. 2% 'c i "• a..-.f, . a
ewy„, 'l {ice 1 :;:1�, S�
Fee for all residential systems combined: _ 5• � :1` tlt��b
y Description
$75,00 Qty. Each Total.
Renewable 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
❑ Burglar Alarm Wind generation systems in excess of 25 kva:
25.01 to 50 kva 301.04 2
❑ Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance
LiHeating, Ventilation and Air Conditioning with OAR 918-309-0040) 552.26 2
System* Solar generation systems in excess of 25 kva:
Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva-no additional charge 0.0
3
ElEach additional inspection over allowable in any of the above:
Other: Each additional inspection is
charged at an hourly(1 hr min) 66.25/hr 1
Inspections for which no fee is
d° 1:11310011
a
�y specifically listed(%hr mm)
n... j �r tx 1 ,1It1' ,' � 1 •' tig1A3-1 ra3 . t 4.�4eStULIVP rg g*
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1).
(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
I:\BuildingWermits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015
13125 SW Hall Blvd.
Tigard, OR 97223
City of Tigard
Location:
11670 SW 114TH PL, TIGARD, OR, 97223
Record Type:
Residential - Master Permit
Inspection Type:
299 Final inspection
Result:
PASS- NoCofO
Comments:
Violation Summary:
Inspector
Tel: 503.718.2439
Inspection Date:
Record ID:
MST2016-00512
Inspector:
Jeff Grove
Contractor