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Permit CITY OF TIGARD ELECTRICAL PERMIT 11 1 : COMMUNITY DEVELOPMENT Permit #: ELC2012 -00247 T1GAR.D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/26/2012 . Parcel: 2S109DA06500 Jurisdiction: Tigard Site address: 14991 SW GREENFIELD DR Project: Worrell .Subdivision: SUMMIT RIDGE Lot: 42 Project Description: (1) branch circuit for heat pump Contractor: CLAPSHAW ELECTRIC Owner: WORRELL, BOBBY & STEVE 1722 17TH AVE 14991 SW GREENFIELD DR FOREST GROVE, OR 97116 TIGARD, OR 97224 PHONE: PHONE: 503 -201 -4506 FAX: • FEES Quantity Description Date Amount 1 crt Branch Circuits wo /Purchase 04/26/2012 $56.18 Specifics: Service or Feeder 1 ea 12% State Surcharge - 04/26/2012 $6.74 Type of Use: SF Electrical Class of Work: ALT Type of Const: Occupancy Grp: • Total $62.92 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 set forth in OAR 952- 001 -0010 through OA 5 090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.88000 ` Issued By: Permittee Signature: 1 /49"--e- /C09-770 ' ,� `r 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 603.639.4176 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. Apr 25 12 09:11a Doug Clapshaw 503 - 357 -4221 p.1 Electrical Permit Applicati s FOR OFFICE USE ONLY ° E� ` E Ilceeivtxl :_ City of Tigard Da ,„,,,, : , Z6 iZ o , Pen:dr No.: r1~rLe a0 /o2 00.2 `97 • • 13125 SW Hall Blvd., Tigard, Olt 97223 APR 2 5 2012 Plan Review t Phone: 5 03.718.2434 Fax; $U3,$98,19G0 Dateily; OtherPentl " " illalCC� /a- A. TIGARD Inspection line: 50.3 I /±� 1 p hale ice:Ay /0y: tutu: 4J fa S 1'nge 2 for Internet: www.tigard- or.gov CITY OF T1 .1. • Notified/Method: I v Supplemental Infurroation TYPE OF WILDING DiV SI PLAN REVIEW ❑ New construction rd' Addit ion/al tcration/replacement Please check all that apply (submit 2 sets of plans w /isms checked below); ❑ Scrviee or feeder 400 :naps or mum ❑ lluildirat over three stories. ❑ Demolition 0 Other: where the available halt current ❑ Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds If,onn amps al 150 volts or ❑ Floating buildings. less to ground. or exceeds 14.000 ❑ Cummnere agricultural I3-I- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building :imps for ;ill ocher iva:dlatiaac. hgil(linls, ❑ Mtilli Ihmily ❑ Master builder ❑ Other: Olrire 0 Installation of 7$ KVAmr JOB SITE INFORMATION AND LOCATION 0 Emergency system. Larger scaxaralely derived:ystern• /' ❑ Addition of new motor loud of ❑ "A" "li" "1.2", ' I.3-. Jab no.: .fob site address: /4 S &) yr .eenf 1 D, IOO ur wore. ❑ Nct n ra Nix n tional vehicle _ '❑ r inure residential units, parks. C.il.y /SL,te/ %I P• / 11 ' 0 fQ O 72 2 [/, 0 facilities. 0 voltage for mole titan ✓ Y I 7 T ❑ Haa nrdou� Math Incaliams. volts nominal, Suite/bldg./apt, Ito.: Project name: r . re 1 ❑ Service ur feeder 6110 amps or more. G FEE SCHEDULE Cross street /directions to job site; un..ipna. I try. I P«. l 'raw • - - New residential single- or multi - family dwelling unit. Includes attached garage. _ Subdivision: 1 Lol no.: 1 1 sq. 11. w less 168.54 4 Pa. add'i 500 sq. n• or portion 33.92 1 '1'az map /parcel no.; - Limited energy, residential DESCRIPTION OF WORK (with above sq. IL) 75.1)1) 2 Limited enemy, multi-family e �,(J r " '� ': '7 ' QQ „���' f /y►� residential (with above sq It.) 75.1)0 - _Services or feeders installation, alteration. prid/ur relocation 2 200 amps or lass 100.70 L=.. ❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps _ 133.56 2 Name: G 0 fin (,r )o rr» G! 401 amps to 60U amps 200 34 2 �,r _ 601 amps to I (1(14 amp 301.04 2 Address: ' c/ C I , S (i.) Cjr4o i 0 I 1 cD� Over 1.000 amps or VIALS ,i),.26 2 Temporary services or feeders installation, alteration, and /or City /State! %II': t• C 9 relocation Plano: ( ) 5 4 r � 7 ci Fax! ( ) 201) amps or less Ell 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 no intended for sale, [case, rent, or exchange, according to ORS 447, 449, 670, and 701, 401 amps to 599 amps 168.54 2 Branch circuits- new, a lteration, or extension, ier mud Owner signature: _ ....__..__ ^.....__..... ._....... — Date: A, Fee for branch circuits with • ❑ APPLICANT ❑ CONTACT PERSON above setvit C or limier I'tx;. . 7.42 2 cash hranch circuit • Business name: I3. FCC for branch circuits without service or feeder lee, first 56.18 I' Contact name: �— brunch circuit /. — Each udd't branch circuit _ _ 7.42 Address: Miscellaneous (service or feeder not included City /Slate /%I I': Each manufactured or modular - 67.144 © dwelling. service and/or feeder Phone: ( ) I Fax: ( ) - Ktxunntx only 67.84 B W ` Pump or irrigation circle = 67.84 E-mail: Sign or outline lighting 67.84 C NI'RACTOR _ Signal circuit(s) or limited- energy RIISIr1CSS mum: / ,.� , eiZ, 9Qut2 t�LL. L I _ Iach additionl inspection over allowahlc in an Of the abort Address; 1 7 u u Additional inspection (I hr min) _ 66.25/ hr City /SlttltJ /.,II >; 1/ /-� 4/2 �// r _ Investigation (I hr _min) 66.25/ hr f S f` � d�� {� lndusuialplant(I lirmin) U 78.18/ hr Pltnne: ) no toe is t "' +f `r l � / Fax: '/ ( ) fns slxpctions for which i ifiadly listed (' /, hr min) )0.W/ hr CB Lie.: /p7, Electrical Lic.: 3 ' &prv. I.ic,: .�{�� ELECTRICAL PERMIT FEES G� 0 / SubtoLtl: 0/ Suprv. Electrician sig re, required: 0 . / �� - -- -. �_� /- f� Plait review (2S''/ ol'pcmtit fee): Print n<ami 0 �fid rr State surcharge (12% of permit fcc); , il' lOi'A!. PERMIT FEE: Authorized sit'noture: 0 gig nature: permit applied' espiras if n permit is not obtaMed within urn i. i - Jays idler it has been neeeptcd as complete. . I I ll name: mile: • N of iaspect ins allowed per permit. / /may/ m: ltuilding8 haH: cnnLC•PrnnitApp.dnc n7 /u1/10 445461 T(II /ONCOWWL"U / / • r c, J /J� / / a/E..-�J `