Permit CITY OF TIGARD ELECTRICAL PERMIT -.,
I' I' COMMUNITY DEVELOPMENT Permit #: ELC2011 -00183
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/12/2011
Parcel: 2S103ACO3700
Jurisdiction: Tigard
Site address: 12532 SW 114TH TER
Project: Borok Subdivision: WALNUT GROVE Lot: 6
Project Description: Installation of solar photovoltaic system.
Contractor: SOLARCITY CORPORATION Owner: BOROK, DAVID AND JULIE JANET
6132 NE 112TH AVE 12532 SW 114TH TERRACE
PORTLAND, OR 97220 TIGARD, OR 97223
PHONE: 503 - 964 -0489 PHONE:
FAX: 503 - 926 -9101
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 04/07/2011 $100.70
Specifics: amps or less
1 crt Branch Circuits w /Purchase 04/07/2011 $7.42
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 04/07/2011 $12.97
Electrical
Type of Const:
Occupancy Grp:
Total $121.09
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 a • • - c= • 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. A NTION: Oregon la re• •ir= y• to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -00 0010 thro • h OAR 952 -00 A 1, 090. • =y obtain a copy •f the rules or direct questions to OUNC by cal '• •2.1987 or 1.800.332. ' 4.
if
Issu d By: i , — /`I� ►iir( . Permittee Signatu M.' _A --
1
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 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.
Electrical Permit Application I (IR ()I 11( I I •I O'I Y
IIIII City of Tigard Received
DateiB `
�
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1 960 Date g �� Permit No.: �( Other Permit. • . (� ire
I I , , , i li inspection Line: 503.639.4175 Date Ready /By: See Page 2 for
Internet: www.tigard or.gov Notified /Method: r` Supplemental Information
�
YPE OF WORK PLAN REVIEW
❑ New construction Addition /alteration /replacement Please check all that apply (submit 2 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 .
I. 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 ;RII LOCATION d ❑ Emergency system. larger separately derived system
❑ Addition of new motor load of
Job no.: q72574, Job site address: 12632 51N WO' Tex. 100HP or more. occupancy.
❑ ❑ Six or more residential units Recreational vehicle parks.
City/State/ZIP: Y or��lt.Yl 012.- 7'� 2 ❑ Health -care facilities. ❑ Supply voltage for more than
1 ❑Hazardous locations. 600 volts nominal
Suite/bldg. /apt. no.: Project name: s0 ro IC.J ❑ Service or feeder 600 amps or more.
FEE. SCHEDULE
Cross street/directions to job site: Description P 1 01•' I Fee. I Total I
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map /parcel no.: Ea. add'l 500 sq. ft. or portion 33.92 1
Limited energy, residential 75.00 2
DESCRIPTION OF VI ORK (with above sq. ft.)
y �
� D `, Limited energy, multi - family 75.00 2
5.4lp kW P.00-t 1� o1k P �( ( 5up(/ /] residential (with above sq. ft.) _
U A 1 � f Services or feeders installation alteration, and /or relocation
200 amps or less I 100.70 2
❑ PROPER TY OW NER I ❑ TEN 41 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name:
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and /or
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, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ k.PPL11C t.NI I E CONTACT PERSON above service or feeder fee, 1 7.42 2
each branch circuit
Business name: ( Solar - CI • h , r c p Or t 0 B . Fee for branch circuits without
J service or feeder fee, first 56.18 2
Contact name: r ant c n I 5' C branch circuit
Each add'1 branch circuit 7.42 2
� Address: i . ' NE 1/2 -n. Ay{ , Miscellaneous (service or feeder not included)
City /State/ZIP: J0r'/i( -1 �( { . '9 '7 1 2 " .) Each manufactured and/or d/ r modular 67.84 7
u / �.i l sC dwelling, service andJor feeder
Phone: (03) 9 � _0( Fax: (503 ) ,"!, 3 to .. u 5/3 Reconnect only 67.84 2
r 7 p� sot C /,� . (Orn J Pump irrigation t in g e 67.84
E -mail: o 2
V ! �7 �f^ J am / / 6 cJ
Sign or outline lighting 67.84 2
CONTRACTO Signal circuit(s) or limited- energy
Business name: Q `R��. n,. R t�?'iQ� panel, ao n, i s e - Page 2 2
^ rC ` Each addditdit l inspection over allowable in any of the above
Address: 6,t t / ]7- y �Yt i Additional inspection (] hr min) 66.25/ hr
City /State/ZIP: .ti 9 1 0 Investigation {] hr min) 66.25/ hr .
Industrial plant (1 hr min) 78.18 / hr
Phone: (503) 7 (Oy O1..1 get Fax: (53) ii.26 -9/01 inspections for which no fee is
specifically listed (' /•_ hr min) 90.00 / hr
CCB Lic.:/a010 e I Electrical Lic.: C Suprv. L 5 ( 5 E LECTRICAL PERMIT FEES
C Subtotal:
Suptv. Electrician signature, required: Plan review (25% of permit fee):
• Print name: b .< eg sp Date: State surcharge (12% of permit fee):
TOTAL PERMIT FEE: ��l,
Authorized signature:
/f/ This permit application expires it a permit is not obtained within 180
Print name: `/ sIA �-' N(p Date: 4/4 x Number o in after ii has been accepted as complete.
���sss f inspections allowed per permit.
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