Permit Support Document (15) City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
1111
e
Request for Permit Action
TI G A R ID 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov
TO: CITY OF TIGARD
Building Division
13125 SW Hall Blvd.,Tigard, OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov
FROM: ❑ Owner ❑ Applicant ❑ Contractor vr City Staff
Check(✓)one
REFUND OR Name:
INVOICE TO: (Business or Individual)
Mailing Address:
City/State/Zip:
Phone No.:
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
CANCEL/VOID PERMIT APPLICATION.
REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
❑ INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit#: H4DT" o2D!? -00 a.97
Site Address or Parcel#: 15 3 5 L„., opt 1-S !i224FC.L.
Project Name: N e U-y f i
Subdivision Name: Lot#:
EXPLANATION: L-c P 1✓t C E r) '-• C(LEAT-E
Co N lb re Ps Lsr'09_01 tT—on ?ic to. . i-- wets l 46 0-E-b .
4,2..t-ter 11,-Tv 1 iot bc1).
Signature: C Ci-X) Date: cd/ /17
Print Name: `-p E gg is 4-1> H
Refund Policy
1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of:
• Any fee which was erroneously paid or collected.
• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort
has been expended.
• Not more than 80%of the application or permit fee for issued permits prior to any inspection requests.
2. All refunds will be returned to the original payer in the form of a check via US postal service.
3. Please allow 3-4 weeks for processing refund requests.
FOR OFFICE USE ONLY
Route to Sys Admin: Date g 1,4 i i B Route to Records: Date 9/4.- i!/2 By
Refund Processed: Date /1//,t- Bic-0744.> Invoice Processed: Date/ By
Permit Canceled: Date 9//V/j7 By arcel Tag Added: Date By
I:\Building\Forms\RegPernutAction_t4 2314.doc
fng Permit Applicatio V/67
FOR OFFICE USE ONLY
sidential
Received V t 7 Permit No.: M 11 ci, 41 T
City of Tigard Date/By: I /• L
. n 13125 SW Hall Blvd.,Tigard,OR 9 Plan Review - �.�) Other Permit
Date/By:503.718.2439 439 Fax: 503.598.1960 1 e loris: 10 See Page 2 for
Inspection Line: 503.639.4175 t� Date q /
T1GARI) p \} Noti ed/Method: ` i,j / 1 ' Supplemental Information
Internet: www.tigard-or.gov
TYPE OF V1 [`1C�ly ' QUIRED DATA:1-AND 2-FAMILY DWELLING
147
0 New construction Allan Permit
Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
0 Addition/alteration/replacement ❑Other: equipment,materials,labor,overhead,and the profit for the
work indicated on this application.
CATEGORY OF CONSTRUCTION Valuation: $
14.,1-and 2-family dwelling Eil Commercial/industrial
Number of bedrooms:
❑Accessory building 0 Multi-family
Number of bathrooms:
❑Master builder ❑Other:
JOB SITE INFORMATION AND LOCATION
Total number of floors:
New dwelling area: square feet
Job site address: 15356 Sw Oak Valley Terrace
Garage/carport area: square feet
City/State/ZIP: Tigard, OR 97224
Suite/bldg./apt.no.: Project name:
Covered porch area: square feet
Cross street/directions to job site:
Deck area: square feet
Other structure area: square feet
REQUIRED DATA:COMMERCIAL-USE CHECKLIST
Lot no.: Permit fees*are based on the value of the work performed.
Subdivision: Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the
DESCRIPTION OF WORK work indicated on this application.
Valuation: $
5.590 kW Prescriptive Roof-Mounted Solar PV Installation
Existing building area: square feet
New building area: square feet
❑ PROPERTY OWNER 1
TENANT Number of stories:
Type of construction:
Name: Hung Nguyen
Address: 15356 Sw Oak Valley Terrace Occupancy groups:
City/State/ZIP: Tigard, OR 97224 Existing:
Phone:(504) 905-8488 Fax:( ) New:
0 APPLICANT 0 CONTACT PERSON BUILDING PERMIT FEES*
(Please refer to fee schedule
Business name: Elemental Energy Structural plan review fee(or deposit):
Contact name: John Grieser FLS plan review fee(if applicable):
Address: 3123 SE Belmont St Total fees due upon application:
City/State/ZIP: Portland, OR 97214 Amount received:
Phone:(503 )967-5786 I Fax::( )
PHOTOVOLTAIC SOLAR PANEL SYSTEM FEES*
E-mail: john@elementalenergy.net Commercial and residential prescriptive installation of
CONTRACTOR roof-top mounted PhotoVoltaic Solar Panel System.
Submit two(2)sets of roof plan with connection details
Business name: Elemental Energy, LLC and fire department access,along with the 2010 Oregon
Solar Installation Specialty Code checklist.
Address: 3123 SE Belmont St Permit Fee(includes plan review
$180.00
City/State/ZIP: Portland,OR 97214 and administrative fees):
Phone:(503 )967-5786 I Fax:( ) State surcharge(12%of permit fee): $21.60
CCB lic.: 195141 Total fee due upon application: $201.60
This permit application expires if a permit is not obtained
Authorized signature: /QAT-- within 180 days after it has been accepted as complete.
I
*Fee methodology set by Tri-County Building Industry
Print name: John Grieser I Date: 7/13/2017 Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011
440-4613T(11/02/COM/WEB)
Electrical Permit Application
PP n FOR OFFICE USE ONLY
City of Tigard 0 Received ���7) ,/p
IIIDate/By: Permit No.: moi/`Y!/'t//> L(/A'7
. -41 13125 SW Hall Blvd.,Tigard,OR 2223 ` 1 Plan Review ��v
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
1 1(0A RD Inspection Line: 503.639.4175 Date Ready/By: I Juris: ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
ID New construction ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked below):
❑ 0 Service or feeder 400 amps or more 0 Building over three stories.
1:1 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
❑1-and 2-family dwelling ❑Commercial/industrial 0 Accessory building amps for all other installations. buildings.
Multi-family ❑Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived system.
❑Addition of new motor load of ❑"A","E","1-2",'l-3",
Job no.: Job site address: 15356 Sw Oak Valley Terrace10bHP or more. occupancy.
0 Six or more residential units. 0 Recreational vehicle parks.
City/State/ZIP:Tigard, OR 97224 0 Health-care facilities. 0 Supply voltage for more than
0 Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name: 0 Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: _Description I Qty..I Fee. I Total L
*
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq.ft.or less I 168.54 I 4
Ea.add'I 500 sq.ft.or portion I 33.92 I 1
Tax map/parcel no.: Limited energy,residential
DESCRIPTION OF WORK (with above sq.ft.) 75.00 2
Limited energy,multi-family 75.00 2
5.590 kW Prescriptive Roof-Mounted Solar PV Installation residential(with above sq.ft.)
Renewable Energy 0 See Page 2
Services or feeders installation,alteration,and/or relocation
0 PROPERTY OWNER 0 TENANT 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Name: Hung Nguyen
401 amps to 600 amps 200.34 2
Address: 15356 Sw Oak Valley Terrace 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP: Tigard, OR 97224 Temporary services or feeders installation,alteration,and/or
Phone:x(504) 905-8488 Fax:( ) relocation
200 amps or less 11111 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701.
401 amps to 599 amps I 168.54 2
Owner signature: Date: Branch circuits—new,alteration,or extension, •er •anel
❑ APPLICANT 0 CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee,
7.42 2
Business name: Elemental Energy each branch circuit
B.Fee for branch circuits without
Contact name:John Grieser service or feeder fee,first 56.18 2
branch circuit
Address: 3123 SE Belmont St Each add'l branch circuit 7.42 I 2
City/State/ZIP: Portland, OR 97214 Miscellaneous(service or feeder not included)
Each manufactured or modular
Phone: (503 )967-5786 Fax: : ( ) dwelling,service and/or feeder 67.84 2
Reconnect only 67.84 2
E-mail: john@elemetalenergy.net Pump or irrigation circle I 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name: Elemental Energy Signal circuit(s)or limited-energy I See
panel,alteration,or extension. Page 2 2
Address: 3123 SE Belmont St 1 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
City/State/ZIP:Portland, OR 97214 Investigation(1 hr min) 66.25/hr
Phone:(503 )967-5786 Fax:( ) Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: 195141 Electrical Lic.: C1228 Suprv.Lic.: 4786S specifically listed(A hr min)
/ ELECTRICAL PERMIT FEES I
Suprv.Electrician signature,required: (2 E_____,„0 J 7
rrr Subtotal:
Print name: Charles Harry e: 7/13/2017 Plan review(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: TOTAL PERMIT FEE:
7/13/2017 f(715--
This permit application expires if a permit is not obtained within 180
Print name: John Grieser Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
C\BuildingAPermits\ELC_PermitApp_ELR ERE.due Rev 05/21/2013 440-461 5T(I 1/05/COM/WEB
Electrical Permit Application-City of Tigard
Page 2-Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY, sentTLE
Fee for all residential systems combined ... $75.00 Description I Qty. I Fee I Total ._.I *
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 1 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Burglar Alarm
Wind generation systems in excess of 25 kva:
25.01 to 50 kva 301.04 2
❑ Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance with 552.26 2
11] Heating, Ventilation and Air Conditioning OAR 918-309-0040)
System* Solar generation systems in excess of 25 kva:
Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva-no additional charge 0.0 3
111Other:
additional inspection over allowable in any of the above:
Other: Each additional inspection is
charged at an hourly(1 hr min) 66.25/hr 1
Inspections for which no fee is 90.00/hr
specifically listed(1/2 hr min)
COMMERCIAL WORK ONLY: ELECTR16L l ERM
Fee for each commercial system $75.00 Subtotal:
(SEE OAR 918-309-0000) Plan review,if required(25%of permit fee):
State surcharge(12%of permit fee):
Check Type of Work Involved: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
❑ Audio and Stereo Systems days after it has been accepted as complete.
* Number of inspections allowed per permit.
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
n Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
C\Building\Permits\ELC_PermitApp_ELR_IERI..doc Rev 05/21/2013
City of Tigard
III '' Building Division
2 13125 SW Hall Blvd,Tigard, OR 97223
Phone: 503.718.2439 Fax: 503.598.1960
TI G A R D Inspection Line: 503.639.4175
www.tigard-or.gov
2010 Oregon Solar Installation Specialty Code
Check List for Prescriptive Installation of Roof-Mounted
PhotoVoltaic Solar Panel System
Property Information
Installation Address: 15356 Sw Oak Valley Terrace
City: Tigard, OR 97224 Zip:
Owner's Name: Hung Nguyen Date: 7/13/2017
Contractor's Name: Elemental Energy CCB #: 195141
Design Parameters of the Property/Structure
If"Yes", does not
Flood Hazard Is the installation ❑ Yes qualify for the
Area Located in a flood prescriptive path, follow
plain/flood way? ❑ No OSSC or ORSC for
design requirements.
Wind Exposure
Is the wind exposure ❑ Yes If"Yes", qualifies for
"C" or less? 0 No the prescriptive path.
Installations on detached Is the Ground Snow
single/two-family Load 70 psf or less?
dwelling/single/two- If"Yes", qualifies for
family townhomes 0 Yes the prescriptive path.
and/or their accessory
Ground structures. ❑ No
Snow Load Is the Ground Snow
Installations on all Load 50 psf or less?
structures other than El
If"Yes", qualifies for
above Yes the prescriptive path.
❑ No
1
1:/Building/Forms/Photovoltaic-Checklist.docx
Is the construction
material wood and does 0 Yes "Yes",of If Yes , qualifies for
the construction qualifyEl the prescriptive path.
Construction as "conventional light p p
frame" construction?
Is the spacing 24 inches
or less?
Pre-engineered trusses. Q Yes If"Yes", qualifies for
the prescriptive path.
❑ No
Roof framing
members Is the spacing 24 inches
or less?
If"Yes", qualifies for
Nominal lumber. ❑✓ Yes the prescriptive path.
❑ No
Is the combined weight p Yes
of the PV modules and If"Yes", qualifies for
racking less than or ❑ No the prescriptive path.
Solar equal to 4.5 psf?
installation Is the solar installation
Ei
layout in accordance Yes «
with Section 305.4(3) of If Yes , qualifies for
the 2010 Oregon Solar ❑ No the prescriptive path.
Code?
❑ Metal
Single layer If roofing material is
Roofing Check the type of ❑ of wood one of the three types
material roofing material shingle/shake checked, qualifies for
Max. two layers the prescriptive path.
❑✓ of composition
shingle.
Is the roof mounted p Yes
Connections of solar assembly
the solar assembly connected to roof No If"Yes",pqrescriptive
for
framingor blockin D the prescriptive path.
to the roof g
directly?
2
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❑✓ Yes
Is the gauge 26 or less? If"Yes", qualifies for
0 No the prescriptive path.
115 lbs for 60 inch
spacing or less?
If"Yes", qualifies for
ElYes the prescriptive path.
❑ No
Minimum Uplift rating
of Clamps? 75 lbs for 48 inches
spacing or less?
If"Yes", qualifies for
❑✓ Yes the prescriptive path.
❑ No
Attachment of
roof mounted Minimum 24 inches If the spacing falls
solar systems Spacing of clamps? within 24 inches and 60
directly to inches Maximum 60 inches inches, qualifies for the
prescriptive path.
standing seam
metal panels Width of roofing If the width of the panel
panels? 18 inches or less
is less than 18 inches,
inches qualifies for the
prescriptive path.
Minimum#10 at 24
inches o/c?
Size and spacing of If"Yes", qualifies for
fastener? Yes the prescriptive path.
❑ No
Is the roof decking of
WSP min. t/z" thickness, 0 Yes
decking connected to If"Yes", qualifies for
framing members ❑ No the prescriptive path.
w/min. 8d nails @
6"/12" o/c?
Is the height less than or
Maximum 18 inches equal to 18 inches?
Height of the from the top of the If"Yes", qualifies for
solar modules module to the roof ❑� Yes the prescriptive path.
surface. 0 No
3
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Submittal Documents required for Prescriptive Installations
Show the location of the PV system in relation to buildings, structures,
property lines, and, as applicable, flood hazard areas.
Site Plan Details must be clear and easy to read.
Minimum size of the plan is 8.5 x 11 inches.
Attach a simple structural plan showing the roof framing (rafter size, type, and
spacing) and PV module system racking attachment.
System must be shown in sufficient detail and clarity to assess whether it
Structural Plan meets the prescriptive construction requirements as listed earlier above in the
matrix.
Minimum size of the plan is 8.5 x 11 inches.
PV Modules
Manufacturer: Hyundai
Model Number: HiS-S29ORG
Listing Agency: UL
4
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