Permit CITY O F TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2002 -00158
' DEVEL DEVELOPMENT Tigard, o
SERV SERVICES 639 -4171 DATE ISSUED: 4/9/02 13125 SW
PARCEL: 2S 103BC -03900
SITE ADDRESS: 12450 SW WALNUT ST
SUBDIVISION: ZONING: R -4.5
BLOCK: LOT : JURISDICTION: TIG
Project Description: Installation of service and 2 branch circuits for street light.
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: 2 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 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:
RAU, JULIE M R J ROUSE ELECTRIC INC
12430 SW WALNUT ST 19450 SW CIPOLE ROAD
TIGARD, OR 97223 SUITE 107
TUALATIN, OR 97062
Phone: Phone:
Reg #: 01:2-0 i L 54
SUP 661S
ELE 34 -359C
FEES Required Inspections
Type By Date Amount Receipt Rough -in
PRMT CTR 4/9/02 $93.60 2720020000( Elect'I Final
5PCT CTR 4/9/02 $7.49 2720020000(
Total $101.09
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
suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -6699 or 1 -800 -332 -2344.
Permit Signature: 1 �p Issued By:
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: 0)"1 G4 DATE:
]
LICENSE NO: (4 1
Call 639 -4175 by 7:00pm for an inspection the next business day
FROM :RJ Rouse Electric FAX NO. :503 612 - 0891 Apr. 09 2002 11:041:1M P2
Electrical Permit Application '
Ili* -•--^ Date t+eceived: g. Ferrari no.: , C ,.y _ -
4 ° '.n City of Tigard ') a(l p E D Projeet/appl. no.: Expire date:
Cityof77gard Address: 13125 SW Hall fly., Date issued: 9yi Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 APR - 9 7flfl? Case file no.: Paymonttype:
Land use approval: (i fl " t f •
. i i: j it T. IL :1.:1' tit & i
Il 1'Fl(\1I1
0 1 & 2 family dwelling or accessory ❑ Commercialtindustrial Q Multi - family Q Tenant improvement
New construction Addition/alteration/replacement , U Other. - LI Partial
J 51 11. 1N1 OR Ml.\ I ION
Job addres /a 1!!5D • s CL LA.)0An L..? -4 ' c-ih- _ _ .
Lot Block: Subdivision: ,, , A6 ,i)
Pro•ect name: •[� Descri • tion and location of work on ' - ' -es: '11._ ' , ` C, l si I R MI
Estimated date of corn • letion/ins • tion:
(c)N 1 R:\(1 It ,\1'1'1:1('. I ION 1.1.:1.: ,•c'1Il 1)111,l';
Job no:
Business name: Desch . iron [f Total
K. a . R� (4 F Fl F C T R 1 C 1 fl C New teddentw- sYtgleor -family pet III
Address: 19450 S, ' 1 •• I 1 #10,7 dwel ingmItdncludesattachedprice.
MY: T U A 1 1 State 1 ZIP; • s• Serdoelnchtded;
Phone :6 12 - 084 0 Fax: 612.0 8 9 1000 „ft. or tese 4
CCB no. : . 0 . . 1 1 ec. bus. lic. no , _ =NM
Limited - City /metro lic, no: 0 1 0 0 } �M - 2
/! � /,!� in r 111
,, . ■� 2
Sup. elect, name (., ' , r_ License no: r�[� Sento:d or feeders—Installation,
e 2ltetadoa or relocation:
t'!Z()1'I:It 1)11'NI:It 200 ,eor4ss R.
r ,' 2
Name (print): 201 amps to .. IIIII1• 2
401 am . tillilM=600 Mailing address:
MME 2
601 am.. to 1000 am- s 11.11__ 2
City: State: ZIP: Over 1000 .aorvolts _MEIN NEM
Phone: Fax: Email: Reconnectonl = l
Owner installation: The installation is being made on property I own Temporary services er feeders -
which is not intended for sale, lease, rent, or exchange according to Installation, alteration, or relocation:
ORS 447. 455, 479, 670, 701. 200 amps or less
O
II
wner's SI'• ature: Date: 401 to o600 400 amps
1.11\161N1.1- It Branch circuits- new, alteration,
or extension per panel:
A. Fee for branch circuits with purchase of ��,
• ' ' service or feeder fee, each brunch circuit f o
Ci : State; . ZIP: 8. Pee for branch circuits without purchase
of service or feeder fee, first brimch circuit: 2 .
Phone: Fax: E-mall:
Each additional branch circuit:
PLAN Ill ..Vl I•;\%' (I'lea.se cilcch all Hutt apple mire. (service orfeedernoth:eluded):
0 Service over 2.25 amps - commercial ' C Health -care facility Each pump or irrigation circle 2
0 Service over 320 amps - rating of 18z2 0 Hazardous location Each sign or outline llghdng 2
family dwellings 0 Building over 10,000 square feet four or Signal circuit(s)or a limited energy panel,
0 System over 600 volts nominal more residential units in one structure alteration. or extension* 2
Cl Building over three stories 0 Feeders. 100 amps or mote •Desert�tion: __
0 Occupant load over 99 persona O Manufactured structures or RV park Each additional Inspection over the allowable in any of the above:
0 Egress/lighting plan 0 Other. Per Inspection 1 I 1 J
Submit , sets of plans with any of the above. Invests . ation fee
The above are not applicable to temporary construction service. Other
Permit fee $ - V+ . •
Not all Jurtdkttmu accept credit raids. pirate roll Jurisdiction ter mere tofonnanon. Notice: This permit application r (at review W %) $ `�"'�
Cl Visa to MasterCard expires if a permit is not obtained Plan revtew a
credit card nbcn within 150 days after it has been State >3 (8%) ) $ ' 1-lGl amber plroe accepted as complete. TOTAL $ 10 Q 1. O9
Nam= der at ISOWO en t card
S
Cardholder aatute Amount 440-4615 (600ICOM)