Permit T�/ �f
CITY 1 ® GARb * ELECTRICAL PERMIT
° • PERMIT #: ELC2008 -00514
COMMUNITY DEVELOPMENT DATE ISSUED: 9/5/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 104AD -03401
SITE ADDRESS: 12828 SW WALNUT ST ZONING: R -4.5
SUBDIVISION: LOT : JURISDICTION: TIG
PROJECT: LEWIS
Project Description: (1) feeder and (2) branch circuits for solar power system.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HM/ SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: 1 W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 1 IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
BRIAN & CHRISTINE LEWIS SOLAR ENERGY SOLUTIONS INC
12828 SW WALNUT ST 3730 SE LAFAYETTE CT
TIGARD, OR 97223 PORTLAND, OR 97202
Phone: 503 - 590 -5890 Contact #: PRI 503 - 238 - 4502
FEES
Description Date Amount Reg #: LIC 170635
[ELPRMT] ELC Permit 9/5/2008 $113.80
[TAX] 12% State Surchar 9/5/2008 $16.06
Total $129.86 REQUIRED ITEMS AND REPORTS
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other applicable laws 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 sus • - • • - . . r
more than 180 days ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those r : - - re set forth in
OAR 952 - 001 -0010 through OAR 952 - 001001 -0�_o •• - = - • •f these rules or direct questions to OUNC at 503.24 •r 1 800.332 2344
Issued =, �� d ` I� - ermittee ignature:
4111111111.21/ 411111111.
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'N: 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.
E LC. ao $- cr5 I
Electrical Permit Application FOR OFFICE USE ONLY
Jr Received
City of Tigard Date/By
No
1 3125 SW Hall Blvd , Tigard, OR 97223 Plan Review
` 0 Phone 503 639 4171 Fax 503 598 1960 Date/By Other Permit
TI G A IZ D Inspection Line 503 639 4175 Date Ready /By lures ® See Page 2 for
Internet. www tigard -or gov Notified/Method Supplemental Information
TYPE 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
❑ 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 ❑ Emergency system larger separately derived system A
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: 1ooHPormore occupancy
❑ 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: ❑ Service or feeder 600 amps or more
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. 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 145 15 4
Ea add] 500 sq ft or portion 33 40 1
Tax map /parcel no.: Limited energy, residential 75 00 2
DESCRIP'T'ION OF W (with above sq 0 )
/^/ 9� 1)1- / p� // � Limited energy, multi- family 75 00 2
�t% / t A� /eL K [�P ' R- i / // . , / / residential (with above sq ft )
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER ❑ TEN 201 amps to 400 amps 106 85 2
Name: 401 amps to 600 amps 160 60 2
601 amps to 1,000 amps 240 60 2
Address: Over 1,000 amps or volts 454 65 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 66 85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100 30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133 75 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
A Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee, 6 65 2
each branch circuit
Business name: B Fee for branch circuits
without service or feeder fee,
Contact name: 46 85 2
first branch circuit
Address: Each add'l branch circuit 6 65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular
dwelling, service and/or feeder 90 90 2
Phone: ( ) Fax: : ( ) Reconnect only 66 85 2
E -mail: Pump or irrigation circle 53 40 2
CONTRACTOR Sign or outline lighting 53 40 2
// „fi ,/ Signal circuit(s) or limited -
Business name:
/ 9 c N GJ✓Y/ i 1 / /4/S5 • 0 energy panel, alteration, or
Address: / c 5 S /r extension Describe Page 2 2
City/State /ZIP: k,t !,y O f f 7/ � 6 Each additional inspection over allowable in any of the above
' / ' ` Per inspection 62 50
Phone: (�7j3) - r Fax: ( ) Investigation per hour (1 hr min) 62.50
CCB Lie.: 30 , / ( Electrical Lie.: V-1 Suprv. Lie.: LI 5 Industrial plant per hour 73 75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal
Plan review (25% of permit fee)
Print name: G 7 r Date: State surcharge (12% of permit fee)
Authorized signature: TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
” Number of inspections allowed per permit
1 \Building\Permits\ELC- PermiApp doc 05/23/06 440- 46I5T(I I /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
(' RESIDE■TIAL WORK ONLY: E-
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
•COMMERCIAL WORK-ONLY:' ' '�f
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting* •
•
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I \Bwldmg\Permns\ELC- PermnApp doc 03/23/06
SEP -16 -2008 12:55 PM CHRIS LEWIS 5035905890 P.01
CITY OF TIGARD
' COMMUNITY DEVELOPMENT
I I t Al '`' 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
Electrical Signature Form
IMPORTANT PERMIT NOTICE
ELECTRIC NORM INC
1385 SE 10TH ST
WARRENTON, OR 97146
Permit* ELC2008 -00614
Date Issued:
Parcel: 28104AD -03401
Site Address: 12828 SW WALNUT ST
Subdivision:
Lot:
Jurisdiction: TIG
Zoning: R-4.6
Project Name: LEWIS
Description: (1) feeder and (2) branch circuits for solar power system.
Your company has been indicated as the electrical contractor for the permit referenced above. In order for the electrical
permit to be valid, the signature of the supervising electrician is required. Please have the appropriate individual from
your company sign below and return this Electrical Signature Form prior to the start of the work. Please mail the form to:
City of Tigard, Building Division, 13125 SW Hall Blvd., Tigard, OR 97223, or you may fax the form to: 503.624.3681.
If you have any questions please call 503.718.2433.
No electrical inspections will be authorized until this completed form is received
OWNER: ELECTRICAL CONTRACTOR:
BRIAN & CHRISTINE LEWIS ELECTRIC NORM INC
1252$ SW WALNUT ST 1365 SE 10TH ST
TIGARD, OR 97223 WARRENTON, OR 97146
Phone #: 503 - 590 -5890 Phone #: 503 - 238 -4502
503 -861 -1688
Reg #: LIC 170635
LIC 30615
AN INK SIGNATURE IS REQUIRED ON THIS FORM
x
Signa ure of Supervigmg
Electrician Name (printed) SUP LIC #
CITY OF TIGARD , .
BUILDING DIVISION v PERMIT #: Ft G2008 G0514
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/5/2008
Phone: (503) 639 -4171 3111
Inspection Requests (24 Hrs.): (503) 639 -4175 'I I..
INSPECTION WORKSHEET FOR DATE: 10/8/2008 TIME: 7:00AM PAGE: 17
SITE ADDRESS: 12828 SW WALNUT ST CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
, PROJECT NAME: LEWIS
DESCRIPTION: (1) feeder and (2) branch circuits for solar power system.
OWNER: LEWIS BRIAN & CHRISTINE
PHONE #: 503 - 6190.5890
CONTRACTOR: SOLAR ENERGY SOLUTIONS INC PHONE #: 503 - 238 -41502
Inspection Request Scheduled For: Date: : : Pour Time:
10/8/2008
Code # Inspection Description Co • . # Contact # • Message
.199 Electrical final 07€419.01 503 -238 -4 Y
Corrections /Comments /Instructions:
P 01 Piq (Z• 3
\\ .
- \
\ •,,
•
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL . ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: •Cr ooe•Le Date: 1 1 Phone #: (503) 718- 1 4 .