Permit (159) CITY OF TIGARD MASTER PERMIT
N -. COMMUNITY DEVELOPMENT Permit#: MST2019-00059
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/12/2019
T I(..�I<.D9 Parcel: 2S103BA00110
Jurisdiction: Tigard
Site address: 12055 SW ANN ST
Subdivision: LERON HEIGHTS Lot: 10
Project: Prague
Project Description: 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:
Total: 0 sf Value: $21,000.00 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 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: NI 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: Y Other Description: Roof top PV system 13.23 kW 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:
PRAGUE,RONALD ANTHONY&LISA TESLA ENERGY Required Items and Reports(Conditions)
12055 SW ANN ST 6132 NE 112TH AVE
TIGARD,OR 97223 PORTLAND,OR 97220
PHONE: 503-201-6242 PHONE: 503-894-6903
FAX: 866-445-7459
Total Fees: $363.19
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 thro�•'R 95-01-009* You may obtain. copy of the rule or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
•
Issued `! LI `.LLAl/ �� Permittee Signature: Z `w-di(4
-717
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.
R
Building Permit Application i�x• '
Residential s FOR OFFICE ( SI.ONE)
City of Tigard ° `� 2 x 1(11(:' Received
13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: �, p2- �� ' 'J �)��—�O(� j
g +�� } � e elanReview l/"�
' Phone: 503.718.2439 Fax: 503.598.1960 1,. - -V /By a 9-c- / M- other Permit:
" a
Inspection Line: 503.639.4175 yp ` ,-.)11\.!;,--".. 't fiate Ready/By: lulls: ® See Page2 for
I EGARD +
InteCnet: www.tigard-or.gov Notified/Method:J /4 Supplemental Information!
A, . ai
1, rif , 121f,1(egi:- a v�-, �, ,.
Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
El Addition/alteration/replacement 0 Other:
AccessoryValuation: $ 21,000
1-and 2-family dwelling 0 Commercial/industrial
Number of bedrooms:
El Master builder 0 • bathrooms:
,fitAWAILERIMMie: rui,' 'r&TWiro;;-16111"7,1rMfirrallirlirtio,,,j1E1111111,21111r"r; ,I" Total number of floors:
Job site address: 12055 SW Ann St, New dwelling area: square feet
City/State/ZIP: Tigard, • ' ' Garage/carport
Suite/bldg./apt.no.: Project name: Ronald A Prague Covered.
Cross street/directions to job site: Darea:ecksquare
Other
Subdivision: Lot no.: Permit fees*are based on the value of the work performed.
Tax map/parcel no.: Indicate the value(rounded to the nearest dollar)of all
ro,
equipment,materials,labor,overhead,and the profit for the
'11117,7:1:.;
R<1 100 - work indicated on this a.plication.
PV ROOF MOUNT 13.23 KWValuation:
+ENERGY STORAGE SYSTEM Existing buildingsquare
New building area: square feet
Name: Ronald A Prague Type of construction:
Address: 12055 SW Ann St, Occupancy
City/State/ZIP: Tigard,OR 97223
Phone:( 503) 201 6242 Fax:( )
e E
Business name: TESLA
Structural plan review fee(or deposit):
Contact name: Melissa Farias
FLS plan review fee(if applicable):
Address: 6132 NE 112th Ave,
• 97220
Total fees due upon application:
City/State/ZIP: Portlandl ) 8946903
I ;'' Amount received:
i • t 445 7459 , w'orrowgplgqt d i3, 4I LI1
Commercial and residential prescriptive installation of
" ".��, .,
,.. . ,_ s ) .i� ,.I ' ""1� roof-top mounted Photovoltaic Solar Panel System.
Business name: TESLA Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: 6132 NE 112th Ave, Solar Installation Specialty Code checklist.
City/State/ZIP: Permit Fee(includes plan review
t3 Portland OR 97220 and administrative fees): $180.00
Phone:( 503 ) 894 6903 Fax:( 1866) 445 7459 State surcharge(12%of permit fee): $21.60
CCB lic.: 180498 Total fee due upon application: $201.60
jo
Authorized signature: This permit application expires if a permit is not obtained
1' t within 180 days after it has been accepted as complete.
2.10.19 *Fee methodology set by Tri-County Building Industry
Print name: A. Meliss. arias Date: Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
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Building Permit Application Checklist
One- and Two-Family Dwelling FOR OFFICE FSI. ON Ll
City of T1gaCTigardg Date/B PermitNo.:
U 13125 SW Hall Blvd.,Tig223 OR 97223 Y
Associated permits:
114
I Phone: 503.718.2439 Fax: 503.598.1960 Received
24-Hour Inspection Line: 503.639.4175 ❑ Electrical ❑ Plumbing 0 Mechanical
TIGARI)
Internet: www.tigard-or.gov ❑ Other:
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW hes No V'k
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ 0 0
2 Zoning. Flood plain,solar balance points,seismic soils designation,historic district,etc. ❑ 0 0
3 Verification of approved plat/lot. ❑ 0 0
4 Fire district approval required. Name of district: CI CI ❑
5 Septic system permit or authorization for remodel. Existing system capacity . 0 0 ❑
6 Sewer permit. ❑ ❑ ❑
7 Water district approval. 0 0 ❑
8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ❑ El
9 Erosion control El plan ❑permit required. Include drainage-way protection,silt fence design and location of catch- El ❑ ❑
basin protection,etc.
10 3 Complete sets of legible plans. Must be drawn to scale,showing conformance to applicable local and state ❑ ❑ ❑
building codes. Lateral design details and connections must be incorporated into the plans or on a separate full-size
1 sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if
copyright violations exist.
11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions;property corner elevations(if ❑ ❑ 0
there is more than a 4-ft.elevation differential,plan must show contour lines at 2-ft.intervals);location of easements
and driveway;footprint of structure(including decks);location of wells/septic systems;utility locations;direction
indicator;lot area;building coverage area;percentage of coverage;impervious area;existing structures on site;and
surface drainage.
12 Foundation plan. Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent size ❑ ❑ 0
and location.
13 Floor plans. Show all dimensions,room identification,window size,location of smoke detectors,water heater, ❑ ❑ ❑
furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,etc.
14 Cross section(s)and details. Show all framing-member sizes and spacing such as floor beams,headers,joists,sub- 0 ❑ ❑
floor,wall construction,roof construction. More than one cross section may be required to clearly portray
construction. Show details of all wall and roof sheathing,roofing,roof slope,ceiling height,siding material,footings
and foundation,stairs,fireplace construction,thermal insulation,etc.
15 Elevation views. Provide elevations for new construction;minimum of two elevations for additions and remodels. ❑ ❑ ❑
Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope.
Full-size sheet addendums showing foundation elevations with cross references are acceptable.
16 Wall bracing(prescriptive path)and/or lateral analysis plans. Must indicate details and locations;for non- ❑ ❑ ❑
prescriptive path analysis provide specifications and calculations to engineering standards.
17 Floor/roof framing. Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and bearing ❑ ❑ ❑
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ ❑
systems,see item 22,"Engineer's calculations."
19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists ❑ ❑ ❑
over 10 feet long and/or any beam/joist carrying a non-uniform load.
20 Manufactured floor/roof truss design details. ❑ ❑ ❑
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required ❑ 0 0
for four or more appliances.
22 Engineer's calculations. When required or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or ❑ ❑ ❑
architect licensed in Ore.on and shall be shown to be a.ilicable to the .ro'ect under review.
JURISDICTIONAL SPECIFICS
23 Three(3)site plans are required for Item 11 above. Site plans must be 8-1/2"x 11"or 11"x 17". ❑ ❑ ❑
24 Two(2)sets each are required for Items 16, 19,20 and 22 above. 0 ❑ ❑
25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will not be accepted. ❑ ❑ ❑
26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. ❑ ❑ ❑
27 "Drawn to scale"indicates standard architect or engineer scale. ❑ ❑ ❑
28 Site plan to include tree size,type and location per approved project street tree plan(if applicable),and City of Tigard ❑ ❑ ❑
Street Tree List.
29 Site plan to include trees and tree protection measures as required by conditions of approval. Tree locations,driplines, ❑ ❑ ❑
and protection measures must be drawn to scale and must include the project arborist's signature of approval.
30 A Clean Water Services'Sensitive Area Pre-Screening Site Assessment form is required for all building additions, ❑ ❑ ❑
including decks,patio covers(over non-impervious surface)and accessory structures to existing residential dwellings
on a lot of record approved prior to September 9,1995.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
1.
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Electrical Permit Application- " -' FOR OFFICE FSF.0NL1'
r�.! 2 ' (
City of Tigard ` I21 C. Received{ Date/B : Permit No.:
IN 11 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.54i)4'0 '.' ` Date/B : Other Permit:
T 1 G A R D Inspection Line: 503.639.4175 't a ..° g \ ` Date Ready/By: lulls' ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
NewconstructionAddition/alteration/replacement P 1 � Iy Please check all that a1 submit 2 s is of ins w + t J
0 ® PP y( p /items checked below).
❑Service or feeder 400 amps or more ❑Building over three stones.
❑Demolition ❑Other: where the available fault current 0 Marinas and boatyards.
r ,�°'` af' 4i: r , "'r exceeds 10,000 amps at 150 volts or 0 Floating buildings.
.r n '` "`°° % .;,, �. - �, O •`- . al�' " less to ground,or exceeds 14,000 0 Commercial-use agricultural
® 1-and 2-family dwelling 0 Commercial/industrial ❑Accessory building amps for all other installations. buildings.
❑Multi-family 0 Master builder 0 Other: ❑Fire pump. ❑Installation of 150 KVA or
+ l.iI ,iA i i ❑Emergency system. larger separately derived system.
„ lupi E .. nusuut ❑Addition of new motor load of ❑"A","E","l-2","l-3",
Job no.: Job site address: 12055 SW Ann St, Six or or more. occupancy.
❑Six or more residential amts. ❑Recreational vehicle pazks.
City/State/ZIP: Tigard,OR 97223 ❑Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations 600 volts nominal.
Suite/bldg./apt.no.: I Project name: Ronald A Prague ❑Service or feeder 600 amps or more.
'I' tt ,
Cross street/directions to job site: 'Description Qty. Fee. Total
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq.ft.or less 168.54 4
Ea.add'l 500 sq.ft.or portion 33.92 I
Tax map/parcel no.: Limited energy,residential
€ s ', _-44'54'4"'"'"P!'''1 ,''''."41,7
".. '1 ,7 t (with above sq.ft.) 75.00
��,... �. �gb
Limited energy,multi-family 75.00 2
PV ROOF MOUNT 13 KW residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
+ENERGY STORAGE SYSTEM Services or feeders installation,alteration,and/or relocation
ovvismr4:.,tg ` O, ,,,,i;:. imitit '.s, .', .._ " .,.;., s 200 amps or less 100.70 2
ram`"" "" '"" 201 amps to 400 amps 133.56 2
Name: Ronald A Prague 401 amps to 600 amps 200.34 , 2
Address: 12055 SW Ann St, 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP: Tigard,OR 97223 Temporary services or feeders installation,alteration,and/or
Phone:( 503) 201 6242 I Fax:( ) relocation
200 amps or less 59.36 1
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
Owner signature: Date: Branch circuits—new,alteration,or extension, er panel
l+ A.Fee for branch circuits wit
,. 4: ::s '' .:-.'i.ia,.,, ..ORVAI ) � ,t .T.:.':,.-, above service or feeder fee,
Business name: each branch circuit 7.42 2
TESLA B.Fee for branch circuits without
Contact name: MELISSA FARIAS service or feeder fee,first 56.18 2
branch circuit
Address: 6132 NE 112TH AVE, Each add'I branch circuit 7.42 2
City/State/ZIP: PORTLAND OR 97220 Miscellaneous(service or feeder not included)
Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Phone:(503 ) 894 6903 I Fax: :(1866) 445 7459
Reconnect only 67.84 2
E-mail: AFARIAS i TESLA.COM Pump or irrigation circle 67.84 2
r:-:'0 ,5,At t t ,I ":+1) Sign or outline fighting 67.84 2
Business name: Signal circuit(s)or limited-energy See
TESLA panel,alteration,or extension. Page 2 2
Address: 6132 NE 112TH AVE, Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
City/State/ZIP: PORTLAND OR 97220 Investigation(1 hr min) 66.25/hr
Phone:( 503 ) 894 6903 Fax:(1866)445 7459 Industrial plant(1 hr min) 78.18/hr.
Inspections for which no fee is 90.00/hr
CCB Lic.: 180498 Electrical Lic.: C562 Suprv.Lic.: 5873S s.ecificall listed('%hr min)
Suprv.Electrician signature,required: Nr.,..15, Subtotal:
Print name: NICK ARMSTRONG Date: 2.10.19 Plan review(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: t '0 TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: A.MELISSA FARIAS I Date: 2.10.19 days after it has been accepted as complete.
s Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013 440-4615T(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
Fee for all residential systems combined ... $75.00 Description Qty. Fee Total
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 1 133.56 133.56 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 with 552.26 2
❑ Heating, Ventilation and Air Conditioning OAR918-309-0040)
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
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
specificall listed(Vs hr min)
Fee for each commercial system $75.00 Subtotal:
(SEE OAR 918-309-0000) Plan review,if required(25%of permit fee):
State surcharge(12%of permit fee):
Check Type of Work Involved: TOTAL,PERMIT FEE:
This permit application expires if a permit is not obtained within 180
❑ Audio and Stereo Systems days after it has been accepted as complete.
• Number of inspections allowed per permit.
❑ 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.doe Rev 05/21/2013
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
12055 SW ANN ST, TIGARD, OR, 97223 July 31 , 2019 at 2:07:51 PM
Record Type: Record ID:
Residential - Master Permit MST2019-00059
Inspection Type: Inspector:
299 Final inspection Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor