Permit CITY OF TIGARD ELECTRICAL PERMIT
° COMMUNITY DEVELOPMENT Permit #: ELC2010 -00571
T [ G A R O 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/29/2010
Parcel: 2S110BA05400
Jurisdiction: Tigard
Site address: 11825 SW WILDWOOD ST
Subdivision: SHADOW HILLS Lot: 12
Project: Troy
Project Description: (1) service and (2) branch circuits for photovoltaic system.
Owner: FEES
TROY, MATTHEW J Quantity Description Date Amount
11825 SW WILDWOOD ST
TIGARD, OR 97224 1 ea Services or Feeders - 200 10/15/2010 $100.70
amps or less
PHONE: 2 crt Branch Circuits w /Purchase 10/15/2010 $14.84
Service or Feeder
1 ea 12% State Surcharge - 10/15/2010 $13.86
Contractor: Electrical
SOLARCITY CORPORATION
6132 NE 112TH AVE
PORTLAND, OR 97220
PHONE: 503 - 964 -0489
FAX: 503 - 926 -9101
Type of Use: SF •
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $129.40
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applig •le 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 .Zpended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center, hos les are set forth in OAR
952 -001 -0010 through OAR 952- 001 -0100. You may a coo of es or direct questions to OUNC by calling 50 . or 1.:: r • .2344.
•
Issued By: / /_ / /L.` i Permittee Signature:
dieW _ .400/
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
Electrical Permit Applicatio FOR f l Sf ONLY
�' Tigard
of Ti alY r ` ' ece Jr `
� ECE\NI DateiB : (0 t � _ I
13125 SW Hall Blvd., Tigard, OR 9722 Plan Review
:111 4
Phone: 503.639.4171 Fax: 503.598.1960 0 , 2 010
C D at e,By: I D lit . (1) l4et► - Y Other Per e v
d2v /0 -oaa 9
I c I; i) Inspection Line: 503.639.4175 • 'ate Ready /By: a iuris: ® See Page 2 for
Internet: www.tigard- or.gov 1 1G� otified /Method: I 0 1 (c) �( AP Supplemental Information
• _ aw■lw _.U.N
TYPE OF WORK 1 \ G 1 t 4 ' !' PLAN REVIEW
❑ New construction g Addition /alteration /r '' cement Please check all that apply (submit sets of plans w /items checked below):
❑ Service or feeder 400 amps or more 0 Building over three stories.
❑ Demolition ❑ Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10.000 amps at 150 volts or 0 Floating buildings.
less to ground, or exceeds 14,000 0 Commercial -use agricultural .
lal 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family 0 Master builder 0 Other: ❑ Fire pump. 0 Installation of 75 KVA or
❑ Emergency system. larger separately derived system
JOB SITE iNFORMATIO AND LOCATION 0 Addition of new motor toad of ❑ "A ". °E". "I - 2". °1 - 3". '
Job no.:' 2_054c) I Job site address: \\'(L5 S \/J �\k „a 100HP or more rest occupanc
0 Six or more residential units. 0 Recreational vehicle parks.
City /State/ZIP: 7 d,14", fi �
O 6\1111 0 facilities. ❑ Supply voltage for more than
�' J � 1 ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt.no.: I Project name: al-('av ()Service or feeder 600 amps or more.
1 FEE SCHEDULE
Cross street/directions to job site: Description
1 Qtr. 1 Fee. 1 Total 1 •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. fl. or less 168.54 4
Tax map /parcel no.: Ea. add'l 500 sq. fl. or portion 33.92 1
Limited energy, residential 75.00 2
DESCRIPTION OF WORK with above s.. fi.
Limited energy, multi- family 75.00
T � t , t.. residential (with above s.. It) 75 —111
`' S e Services or feeders installation, alteration, and/or relocation
3 . ) �bv�� / V J t7 � 200 amps or less I 100.70 Inn, /0 2
201 amps to 400 amps 133.56 2
PROPERTY O�gNER � ■ TENANT 201 P
T ) - n 401 amps to 600 amps 200.34 2
«
Name: lV 601 amps to 1,000 amps - 301.04 _
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City/State/ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1 ]
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
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, er panel
Owner signature: Date: A. Fee for branch circuits with (�
❑ APPLFC.�NT 1 ❑ CONTACT PERSON above service or feeder fee, Z 7.42 1 s Oy 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 • 2
Contact name: branch circuit '
• Each add'l branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
Each City /State/ZIP: dwelling, s e d/or feeder 67.84 2
Phone: ( ) Fax: : ( ) Reconnect only • 67.84 2
Pump or irrigation circle 67.84 2
E-mail:
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy
Business name: Y _ - ` ` `-. O. •anel alteration, or extension. Pa:e 2 2
Each additional ins . ection over allowable in any of the above
Address: 6 rt ! /Y Hz ?"'"0240 Additional inspection (1 hr min) MI 66 25/ hr —■
City/State/ZIP: d
Investigation (1 (1 hr min) = 66.25/ hr =:
b/ � Industrial plant (1 hrmin) 78.18/hr
Phone: ( 503 ) I / oy $9 Fax: (53) 76 - /D/ inspections for which no fee is
s. cificall listed (h hr min) 90.00 / hr
CCB Lic.: /$'py9It I Electrical Lic.: C5( Suprv. Lic.: 52015 ELECTRICAL. PERMIT FEES
Suprv. Electrician signature, required: _ _ __
Illb o Subtotal: 1� ;S•
�aG .� Plan review (25% o perrnit fee): •
=R, a . 1 , Date: p AM State surcharge (12% of pennit fee): 13,
TOTAL PERMIT FEE: ti 04 a p Authorized signature: / +
This permit application expires i a permit is not ob aineo wttonn .e0
Print name: �eie ST� /V `b I ``\ \D
days after it has been accepted as complete.
t� Date: ` l Number of inspections allowed per permit. , , , A Q ,
/.
1: Building Permits ELC- PennitApp.doc 07 01 10 440- J6l5T(I 1 05 COM WEB