Permit CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT Permit#: MST2020-00097
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/09/2020
Parcel: 1 S134AC03300
Jurisdiction: Tigard
Site address: 11049 SW BLACK DIAMOND WAY
Subdivision: HARTS LANDING Lot: 4
Project: Gibbs
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: $6,670.00 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
Drains: 0
Tubs/Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 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
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Tamp Srvc/Feeders Branch Circuits
1000 sf or less: 0 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add'I 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
801-1000 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 6.67 kW Ecompasing. N
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
OTR SF VB R-3 0
Owner: Contractor:
GIBBS,WILLIAM R&KATHRYN A ELEMENTAL ENERGY LLC Required Items and Reports(Conditions)
11049 SW BLACK DIAMOND WAY 1339 SE 8TH AVE#B
TIGARD,OR 97223 PORTLAND,OR 97214
PHONE: 503-713-7989 PHONE: 503-967-5786
FAX:
Total Fees: $355.69
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 0 952-001-00 . You may o in a y of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.��yF r
Issued By: i / Permittee Signature: c. A /1
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.
4
Builling Permit Applicat�e ..CFI D
Residential II���� FOR OFFICE 1 SF ()NI 1.
City Of Tigard MAR 2 '; 2020 Received -2,
7 J / ,tyy _ J 7
Date/By: ` XV6017A0
13125 SW Hall Blvd.,Tigard,OR Qp _ 2
Phone: 503.718.2439 Fax: 503 `9�t I IGARD Date/By:Review 7I ZbZ-O + I Other Permit:
fIGARD Inspection Line: 503.639.4175 t llll LDING DIVISION DateReady/ey: / l /� / seera�ezfor
Internet: www.tigard-or.gov tskAined/Meth/o., ��) ! � U Supplemental laformallon
r- ((/J - -41 r
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
D' Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
CATEGORY OF CONSTRUCTION work indicated on this application.
1-and 2-family dwelling 0 Commercial/industrial
Valuation: $ 6670
Number of bedrooms:
❑Accessory building CIMulti-family
❑Master builder
❑Other: Number of bathrooms:
JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 11049 SW BLACK DIAMOND WAY, New dwelling area: square feet
City/State/ZIP: TIGARD, OR 97223 Garage/carport area: square feet
Suite/bldg./apt.no.: Project name: GIBBS SOLAR Covered porch area: square feet
Cross street/directions to job site: 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.
6.67 kW AC Solar Photovoltaic Prescriptive Roof mount Valuation: $
Existing building area: square feet
New building area: square feet
® PROPERTY OWNER 0 TENANT Number of stories:
Name: KATHRYN GIBBS Type of construction:
Address: 11049 SW BLACK DIAMOND WAY Occupancy groups:
City/State/zIPTIGARD, OR 97223 Existing:
Phone:( (503) 713-7989 Fax:( ) New:
eil APPLICANT a CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule)
Business name: ELEMENTAL ENERGY Structural plan review fee(or deposit):
Contact name: CHRISTINE STAMPER 503-522-9190(CELL)
FLS plan review fee(if applicable):
Address: 1339 SE 8TH AVE STE B
Total fees due upon application:
City/State/ZIP: PORTLAND, OR 97214
Phone:( ) 503-967-5786 Fax::( ) Amount received:
E-mail: PERMITS@ELEMENTALENERGY.NET PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Submit two(2)sets of roof plan with connection details
Business name: ELEMENTAL ENERGY
and fire department access,along with the 2010 Oregon
Address: 1339 SE 8TH AVE STE B Solar Installation Specialty Code checklist.
City/State/ZIP: PORTLAND OR 97214 Permit Fee(includes plan review $180 00
Phone: and administrative fees):
( ) 503-967-5786 Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lic.: 195141
Total fee due upon application: $201.60
Authorized signature: This permit application expires if a permit is not obtained
,,t„x oxye 3..rl within 180 days after it has been accepted as complete.
Print name: CHRISTINE STAMPER Date: *Fee methodology set by Tri-County Building Industry
Service Board.
I:1Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(I1/02/COM/WEB)
:Electrical Permit Application FOR OFFICE USE ONI.1
•
City of Tigard ReceivedDate B Permh t:
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
■ Phone: 503.718.2439 Fax: 503.598.1960 Date B ; Related Perm t#:
Inspection Line: 503.639.4175 Ready Date/By: nos: M See Page 2 for
I:luARI] Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK 'IAN REVIEW
❑New construction $)Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition D Other:
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10.000 amps at 150 volts or 0 Floating buildings.
IV 1-and 2-familyless to ground,or exceeds 14,000 0 Commercial_ se agricultural
dwelling ❑Commercia/industrial ❑Accessory building amps for all other installations. buildings.
❑Multi-family 0 Master builder ❑Other: ❑Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION El Emergency system. larger separately derived
te
Job ft: Job site address: 11049 SW BLACK DIAMOND AV ioor°o°Rwre motor load of ❑SA E
City/State/ZIP: TIGARD, OR 97223 0 Six or more residential units. occupancy.
❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: GIBBS SOLAR ❑Hazardous locations. 0 Supply voltage for more than
0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description i efts. I Each I Total i *
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#: Ea add'l 500 sq.ft.or portion 33.92 I
DESCRIPTION OF WORK Limited energy,residential
75.00 2
(with above sq.ft.)
6.67 kW AC Solar Photovoltaic Prescriptive Roof mount Limited energ
y,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
IR PROPERTY OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: KATHRYN GIBBS 200 amps or less 100.70 2
Address: 11049 SW BLACK DIAMOND WAY 201 amps to 400 amps 133.56 2
City/State/ZIP: TIGARD OR 97223 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Phone:( )503-713-7989 Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: kathrynanngibbs@gmail.com relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 I
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
APPLICANT CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: ELEMENTAL ENERGY above service or feeder fee, 7.42 2
eacch
Contact name: CHRISTINE STAMPER, 503-522-9190 (CEL ) B.Fee for branch circuits without
service or feeder fee,first
Address: 1339 SR RTH AVE STF, R branch circuit 56.18 2
City/State/ZIP: PORTLAND OR 97214 Each add'l blanch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(503)967-57g6I Fax::( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: PERMITS(a,ELEMENTALENERGY.NET Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: ELEMENTAL ENERGY Sign or outline lighting 67.84 2
Address: Signal circuit(s)or limited-energy 0 See Page 2 2
1339 SE 8TH AVE STE B panel,alteration,or extension.
City/State/ZIP: Each additional inspection over allowable in any of the above
PORTLAND OR1 97214 Additional inspection(1 hr min) 66.25/hr
Phone:(503 967-5786 Fax:( ) Investigation(1 hr min) 90.00/hr
IndustEmail: PERMITS(a,ELEMENTALENERGY.NET Inspetionsfoal r(hich1 hr no) 9000'78 18/ r
Inspections for which no fee is 90.00/hr
CCB Lie.: Electrical Lic. Su rv.Lic.: specifically listed(Vs hrmin)
195141 aC1228 p 59255
Suprv.Electrician signature,required: —/ ✓ � "� ELECTRICAL PERMIT FEES
7�
Subtotal:
Print name: NA'!HAN MILLER Date: 03/25/2020 0 Plan Review Required(25%of permit fee):
'- c State surcharge(12%of permit fee):
Authorized signature: r;:'r- TOTAL PERMIT FEE:
..—_.., .
03/25/2020 This permit application expires if a permit is not obtained within 180
Print name: CHRISTINE STAMPER Date days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:\BuildingWamils\ELC_PermitApp_ELR_ERE.doe Rev 06/17/2015 440-615T(11/05/COM/WEB
',Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Fee for all residential systems combined: $75.00 Description pry. Each Total
y Renewable electrical energy systems:
Check Type of Work Involved: s kva or less 100.70 2
5.01 to 15 kva 1 133.56 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
552.26 2
with OAR 918-309-0040)
❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 lava:
System*
Each additional kva over 25 7.42 3
C 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 90A0/hr
specifically listed(Y2 hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
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:
El Audio and Stereo Systems
El Boiler Controls
•
n Clock Systems
❑ Data Telecommunication Installation
n Fire Alarm Installation
El HVAC
❑ Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
El Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
n Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
1:\Building\Permits 1 EEC_PermitApp_ELR_ERE.doc Rev 06/17/2015