Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 00167
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/13/2011
Parcel: 1S136AB05400
Jurisdiction: Tigard
Site address: 10460 SW 72ND AVE
Project: Olney Subdivision: SKORO MLP93 -0008 Lot: 3
Project Description: Solar photovoltaic system.
Contractor: SOLARCITY CORPORATION Owner: OLNEY, JERRY A & BETTY L
6132 NE 112TH AVE PO BOX 231153
PORTLAND, OR 97220 PORTLAND, OR 97281
PHONE: 503 - 964 -0489 PHONE:
FAX: 503 - 926 -9101
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 04/13/2011 $100.70
Specifics: amps or less
1 crt Branch Circuits w /Purchase 04/13/2011 $7.42
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 04/13/2011 $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 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 forth in OAR
952- 001 -0010 through OAR 95 - 001 -0090. You may obtain a Ies or direct questions to OUNC by calling 503.232.1987 or 1.80
Waft
Issued By: _ _ i ■ Perm ittee 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 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 o u O I r 1( r l r O\ I V
City of Tigard RECEIVED Date /B o/ • Permit No.: Q ` COQ /,
1 1 '
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Ph one : 503.639.4171 Fax: 503.598.1960 MA 3 I 2,Q i Date' : Il a 111 Other Permit:
I c l? li Inspection Line: 503.639.4175 Date Ready /By: l�
Internet: www.tigard o luris: 0 See • for
r.gov
CITY !1F TIGARD Notified/Method: �a Supplemental Information
TYPE OF 'WIW( DING DIVISION 1- w 9"h (11 PLAN REVIEW
. Please check all that apply (submit sets of w /items checked below):
❑ New construction liAddition /alteration /
❑ Service or feeder 400 amps or more ❑ Building over three stories.
0 Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10.000 amps at 150 volts or ❑ Floating buildings.
12 /1- less to ground, or exceeds 14,000 ❑ Commercial -use agricultural .
and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: I3 Fire pump. ❑ installation Of 75 KVA or
❑ Emergency system. larger separately derived system
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A" "E" "1-2". "1-3".
Job no.. is 2 Job site address. 1�(¢� Q 5W 72 K CI 7 \w Six or oo more re s, occupancy.
7..• C 0 or more residential units. ❑ Recreational vehicle parks.
City / State/ZIP: pnrtk curl ci 7 2 2 2 f 2 ❑ Health -care facilities. ❑ Supply voltage for more than
• O� ) ❑ Hazardous locations. 600 volts nominal
Suite/bldg. /apt. no.: Project name: Oi ❑ Service or feeder 600 amps or more.
FEE. SCHEDULE
Cross street/directions to job site: Description I QA'. Fee.
I 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
Ea. add'l 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF Y ORK (with above sq. ft.)
A , Limited energy, multi- family
5.4u \NW Root l k , } \ f c' i /� i q ,^^ l residential (with above sq. ft.)
75.00 2
V W' ` V W '' /� - v Services or feeders installation, alteration, and/or relocation
200 amps or less / 100.70 I /Do.74 2
PROPER Z }' Od%NER I ❑ TEN %N'F 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/Z1P: 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, e er panel
Owner signature: Date: A. Fee for branch circuits with
0 APPLE( ANT I CON'F.4.0 I PERSON above service or feeder fee, 7.42 �• 2 2
each branch circuit
Business name: C r 1 4 Y (-Ai ( ■ service or feeder B. Fee for branch r f ee, ts without
V ` r fee, first 56.18 2
Contact name: CO�.i tla v branch circuit
� Each add'l branch circuit 7.42 I 2
Address: 10 ti) 2 1\ 1F 1 , 2 , e_ . Miscellaneous (service or feeder not included)
City /State/ZIP: ' 7oY4 . kcx el 4y_ a ` r - 2 1 . (Y
Each manufactured or modular 67.84 2
7 dwelling, service and/or feeder
Phone: (S03) ctsk . O1� 10 Fax:: ( 5 0 3 ) • 536 • Lo ve Reconnect only 67.84 2
`A j (p+ r ^ c J OI 0 �
Pump irrigation circle 67.84 2
E -mail: /fir l
`, • Sign or r outline e lighting 67.84 2
CONT RACTOR Signal circuit(s) or limited- energy
Business name: S oRCr1/4/ R � YO, r / panel, alteration, or extension. Page 2 _ ?
t� i ! V Each additional inspection over allowable in any of the abov
Address: 6, r �� ! (2 Additional inspection (1 hr min) 66.25/ hr
/ ? ?2 0 Investigation min) 66.25/ hr
City / State/Z]P: D 011. Industrial plant t (1 hr min) 78.18 / hr
Phone: (503) Vy 0LI 5 1 Fax: (503) 26 -9/0/ Inspections for which no fee is
90.00/ hr
specifically listed (A hr min)
CCB Lic.: /gag/ ( Electrical Lic.: c 6, Suprv. Lic.: 52 I s ELECTRICAL PERMIT FEES
Subtotal: I al, /2
Suprv. Electrician signature, required: Plan review (25% of permit fee): "—
Print name: , �. I . p Date: 3 30 G 1 State surcharge (12% of pennit fee): /2- 9 7
Ji ;1 , try
TOTAL PERMIT FEE:
Authorized signature:
This permit application expires if a permit is not o6ta ed within 180
,// !
days after it has been accepted as complete.
Print name: /l�t� y
/ � S T ' Ncr Date: 340 * Number of inspections allowed per permit.
1: Building Permits ELC- PennitApp.doc 0 �
1 100 440-4615T(11 05 WEB