Permit CITY OF TIGARD ELECTRICAL PERMIT
' s COMMUNITY DEVELOPMENT Permit #: ELC2010 00570
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/29/2010
Parcel: 2S110BA05300
Jurisdiction: Tigard
Site address: 11815 SW WILDWOOD ST
Subdivision: SHADOW HILLS Lot: 11
Project: Johnson
Project Description: (1) service and (3) branch circuits for photovoltaic system.
Owner: FEES
JOHNSON, GARY E & Quantity Description Date Amount
SIBLEY, BARBARA D, 11815 SW WILDWOOD
ST 1 ea Services or Feeders - 200 10/15/2010 $100.70
amps or less
PHONE: 3 crt Branch Circuits w /Purchase 10/15/2010 $22.26
Service or Feeder
1 ea 12% State Surcharge - 10/15/2010 $14.76
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 $137.72
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 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 suspen. • for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. = -e ru -re set forth in OAR
952- 001 -0010 through OAR 952 - 001 -0100. You may obtain a co. of the rules or direct questions to OUNC by calling 503.246.6699 ..4.0r710.3,..0--"4.
Issued = .. J Permittee Signature:
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 Application FOR (I•FICII 1`SI: o\I.V
City of Tigard c.. Received �
lC
I I •
13125 SW Hall Blvd., Tigard, 0 L �c Plan Review
Phone: 503.639.4171 Fax: 5033 J `96t ` e t,� \ Date-By: f d i (p, { •Q ( /l
J/ Other Perm ��Q QQa
Inspection Line: 503.639.4175 4 ty Q Date Rea /By: � � /� Juris:
T 1 c ; : 1: D ®See Page 2 for
Internet: www.tigard- or.gov O C,\ � 1 1 :Por ` OCi Notified/Method: �U 15) / Tr-Lo
Supplemental information
TYPE OF WORK � ' � O 1 (...SV J c »POW' Iv t /Vick PLAN REVIEW
❑ New construction 13 Addition /alterati tit Please check ell that apply (submit sets of plans w /items checked below):
® ['Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10.000 amps at 150 volts or ❑ Floating buildings.
less to ground. or exceeds 14,000 ❑ Commercial -use agricultural •
el 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi-family ❑ Master builder ❑ Other: ❑ Fire pump. • ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ION ❑ Emergency system. larger separately derived system
`vt ` ' ❑ Addition of new motor load of ❑ "A ", "E ". "1 -2 ", "1 -3 ".
Job no.:01j" S I Job site address: 1In 1S W � `ac n... \ ��,` 100HPormore. occupancy.
vvv"'666XXX
\ 1 )1 0t. (10U ❑ Six or more residential units. Recreational vehicle parks.
City / State/ZIP: ❑ Health - care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no Project name: e 3� n^ ['Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Otv, I Fee. 1 Total 1 •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. fi. or less 168.54 4
Tax map/parcel no.: Ea. add'I 500 sq. ft. or portion 33.92 1
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ti.)
W, Limited energy, multi - family 75.00 I 2
Q�^SII^ �tA \ Zt. residential (with above sq. ft.) _
S (� � L �� \ �� / 1 \1 Services or feeders installation, alteration, and/or relocation
�' \ ) �\ Mp�� C V S S � 200 amps or less ' 100.70 1 76 2
PROPERTY' OWNER I ❑ TIEN,4N'F 201 amps to 400 amps 133.56 2
/� \ 401 amps to 600 amps 200.34 2
Name: T
lAllf �1 U min \ 601 amps to 1,000 amps 301.04 2
Address: \`, \ S \ \; - ic \ St Over 1,000 amps or volts 552.26 2 ,
� ( """""" Temporary services or feeders installation, alteration, and/or
City/State/ZIP: ` � 0 r \ .14 relocation
Phone: (563 ) 3 y1 oZZ,( I Fax: ( ) 200 amps or less 59.36 t
201 amps to 400 amps 125.08 Owner installation: This installation is being made on property that 1 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
Branch circuits – new, alteration, or extension, er panel
Owner signature: Date: A. Fee for branch circuits with 222(9 above service or feeder fee I
❑ APPLF( ANT 1 ❑ CONTACT Pft2d0N 7.42
each branch circuit
Business name: B. Fee for branch circuit withou
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'l branch circuit 7.42 f 2
Address: Miscellaneous (service or feeder not included)
Cit / State/ZIP: Each manufactured or modular 67 84 2
Y dwelling, service and/or feeder
Phone: ( ) I 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: �Q� q� n� R e7Q�
panel, Each additional inspection Paget 2
M ]]] ��/ t Each additional inspection over allowable in any of the above
Address: l0 r Z iV 7f2 Additional inspection (I hr min) 66.25/ hr
City /State/ZIP: �7 i � 9 "Zo Industr p plant (1 (1 hr m) 78.8/ hr
Industrial p lant (1 hr min) 78.1 1 B/ hr
Phone: 103) vf_ 04139 Fax: (53) ?26, - 9/0/ Inspections for which no fee is 90.00 / hr
specifically listed (% hr min)
CCB Lic. :�$O g I Electrical Lic.: e_5( Suprv. Lic.: 520 tS EL,ECI'RI('.1 PERMIT F Subtotal FEES LZZ - �� _
t 1-, -1 II
Suprv. Electr required: 11 11 �� I - —
_
l�< Plan review (25% of permit fee): _ •
Print name: bER C ).�orp Date: State surcharge (12% of pennit fee): _ (' H t -1Q, TOTAL PERMIT FEE: I j 7 . 7
Authorized signature: /�=
This permit application expires if a permit is not ob nett nttn,u ,d0
Print name: jCkl 5-rRoA Date: \( \� \� •
days
after it has been accepted as complete.
t� Number of inspe pectio per pemtit 9,13 77 I: Building Permits ELC- PennitApp.doc 07 01 10 440- 415Tt 11 •5 COM WEB �/Ci '