Permit Q CITY OF TIGARD ELECTRICAL PERMIT
'`1 COMMUNITY DEVELOPMENT Permit #: ELC201300074
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/30/2013
Parcel: 2S112BA00800
Jurisdiction: Tigard
Site address: 14460 SW 80TH PL
Project: Hays Subdivision: WAVERLY MEADOWS Lot: 44
Project Description: (1) 200 amps or less for panel change
Contractor: CLAPSHAW ELECTRIC Owner: HAYS, JAMES E &
1722 17TH AVE SHELLEY P
FOREST GROVE, OR 97116 14460 SW 80TH PL
TIGARD, OR 97224
PHONE: 503 - 357 -4221 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 01/30/2013 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 01/30/2013 $12.08
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.78
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 OAR 952 01 -00 0. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
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Issued By: Permittee 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 FOR OFFICE USE ONLY
R ECEIVED Received e DaB: S 1 P ermit No.:
City of Tigard 130 13 ^ G�� .
-- 13125 SW Hall Blvd.. Tigard, OR 97223 Plan Review
k a Phone: 503,718 2439 Fax: 503.598 s _ )in lly: Other P rani:
Inspection Line: 503.639.4175 1I r-.:'l 2013 Date Ready /By: for
taro Sec Pale z
TIGARD Notified/Method: ( ] Supplemental Information
Interact: www.tieaM or.gov ,•�
TYPE � . - � a AR ij D *t PLAN REV
❑ New construction ® Addition ? % silt IOCO RON 1'le;uno check all that apply (submit 2 acts of plans whims checked below):
❑ Service ar feeder 400 x,11113 or men: ❑ Building over three stories.
❑ D*molitioll ❑ Other: where the available fault current ❑ Marinas and boalyardb.
CATEGORY OF CONSTRUCTION cxeecds 10,000 amps at 150 volts or ❑ floating buildings.
less to ground. or i xvectls 14,1100 ❑ Ci,mm: - use agricunm it
®1• and 2-fitmily dwelling ❑Commercial /industrial D Accessory building amps for all otherinstnllntions, Imihlinns.
❑ Multi- famil• ❑ Master builder ❑ Other: ❑ I +ire pump. ❑ Installation of 75 KVA or
❑
JOB SITE INFORMATION AND LOCATION Emergency n ew nl. larer - defined
g , "i:' , .yhlem.
❑ A�dilinu anew 'noun. 'noun. last a El "A'hI(" ^l 1 ", °{ ",
Job no. M Job site address: 14460 SW 80th I Six or or more. oc, hpanoy.
❑ Six or more residential units. ❑ Itecrealinnal vehicle parks.
v .,„
City/Stale/ZIP: Tigard, Oregon 97224 ❑ l lealilo-eare facilities. ❑ S upply voltage for more than
- ❑ Hazardous locutions, 600 volts nominal.
Suite/bldg. /apt, no.; Project name: ❑ Service or feeder 600 snips or more.
- FEE SCHEDULE
Cross street/directions to job situ: - Dacnpliaa I thy. l Fee. I Tamil I • ,
_ " ' New residential single- or multi - family dwelling unit.
_ Includes attached garage.
—
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 •I
.•- - - -- 1'a. udd'I 500 sq. 11. or portion 3332 I
• Lux map /parcel no.; - Limited _................ --
Lnniu�l enoigy, residcnlial 75.00 2
DESCRIPTION OF WORK with above sa. R,) ..- , ., ... , ,.,._
Limited energy, Inulti.laniily 75.00 • 2
panel change only residential (with above sq. R.)
Services nr feeders installation, alteration, and/or relocation
200 maps nr less I 100.70 100 70 2
❑ PROPERTY OWNER 1 ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name;
601 amps to 1,000 a mps 3010e 2
or volts 552.26 2
O ver 1,000 amps Address; P�
-" "' " -- Tempura servkeb or feeders installation, alteration. and /or
City /Stale /ZIP: rclocatirtn _
200 amps or leas 59.36 I
Phone: ( ) Pax; ( )
201 amps to 40 S.O
0 snips 12( 2
Owner installation: 'Phis installation is being made on property that I own which is not - - __— • — °• ._......._.... -'
intended for salt, 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, itcr panel
Owner signature: Dale: A. lee for branch circuits with
❑ APPLICANT 1 CONTACT PERSON above service or feeder fee, 7.42 2
cacti branch circuit _
Business name: - 11. :e for branch circuits wrrlr,ur
service or feeder fcc, first 56.IR 2
Contact name; branch circuit_ _
-r Each add') branch circuit�� - - 7.42 2
Address: Misccllancous (service or feeder nut included)
d ash manufactured or 'ba ler
City / Slate /ZIP: duelling, service and/or r 'baler 67.84 1 `
Reconnect only 67.84 2
Phone: ( ) Fax: ( ) y _.., —..... . - -- . --
- . _. Pump or irrigation circle 67.84 2
l' - mall: Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy
Business name: Clapshaw Electric Contracting • panol_altcratinn, orcxtcnsinn. Paget 2
, ._ Each additional inspection over allowable in any of the above
Address: 1722 17 Ave. Additional inspection (1 hr min) 6625 / hr
Cily /State /%ll': Forest Grove, Oregon 97116 Investigation (I hr min) 66.25/ hr
Industrial plant (1 hr min) 78, I R/ hr
Phone: (503) 357.4221 Fttx: (503) 357 - 4221 Inspections for which no fee is 90,00/ hr
-- specifically listed (14 hr min)
CCI3 Lie.: 107185 Electrical Lic.; 34 - 410C Stiprv, l.,ie.: 38705 ELECTRICAL PERMIT FEES
Subtotal: 100.70
Suprv. Electrician signature, required: a Al, ? (25% ' Plan review(25/oof gonna fee)'
Print name: Doug Clapshaw Date: 1/29/2013 State surcharge (12% ofpcm,)t fee): 12.08
L TOTAL PERMIT FEE: 112.78
Authorized signature; C� _.� This permit application expires if a permit in not obtained within 180
at4. days after it has been accepted as complete.
Print name: Doug Clapshaw % Date; 1/29/2013 • Number of innpectim allowed per permit.
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