Permit c
n CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
!; 13 COMMUNITY DEVELOPMENT Permit #: ELR2009 -00287
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/08/2009
.TIGARD, Parcel: 1 S 136DD03800
Jurisdiction: Tigard
Site address: 11675 SW 66TH AVE
Subdivision: WEST PORTLAND HEIGHTS Lot: 7
Project: City County Insurance Services
Project Description: Installation of security system.
FEES
Owner:
CITY COUNTY INSURANCE Description Date Amount
1313 COURT ST Restricted Energy Permit 09/08/2009 $75.00
SALEM, OR 97303 12% State Surcharge - Electrical 09/08/2009 $9.00
PHONE:
Contractor:
COOK SECURITY GROUP
5841 SE INTERNATIONAL WAY
MILWAUKIER, OR 97222
PHONE: 503- 786 -5173
FAX: 503 - 786 -3792
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: N Fire Alarm: N
HVAC: N Instrumentation: N Total $84.00
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N Required Items and Reports (Conditions)
Nurse Calls: N Protective Signal: N
Security Alarm: Y Other: N
Other, Desc:
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 0 952-001-0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: G% r `` ~ _ Permittee Signature: D/l /WL /e�% /dN /
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 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.
■
Electrical Permit App >< RECE Foli OFFICE USE oNl
City of Tigard S E P 0 8 2009 Received C / ., DateB : ! - Q9 liktr Permit No.: i —oO 0
13125 SW Hall Blvd., Tigard, OR 97223 Plan Revie •
Phone: 503.639.4171 Fax: 503.598.196 OF TIGAR / h
t ITY ther PermittA644109 — OdArO
V Date/By: ate/By: `� //
Inspection Line: 503.639.4175 - ■ I I � Date Ready/By: Juris• ® See Page 2 for
Internet: www.ci.tigard.or.us BUILDING DIVISI r t Notified/Method: 71 C Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ❑ Addition/alteration /replacement Please check all that apply:
❑ Demolition Other: 1 �I ❑Service over 225 amps, comm'l ['Hazardous location
['Service Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CON of 1- and 2- family dwellings 4 or more new residential
❑ 1 - and 2 family dwelling Commercial /industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
El Multi - family Master builder ❑Other: El Building over three stories ❑Feeders, 400 amps or more
DOccupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress /lighting plan RV park
Job no.�08B� l Job site address: ' � (o
75 5 54). (o (o It. ❑Health -care facility ['Other:
Submit 2 sets of plans with any of the above.
City /State /ZIP: • 3a ,#-d . O it , 9' 2 2 3 The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: FEE* SCHEDULE
. ei� Description I Qty. I Fee. I Total [ *'
Cross street/directions to job site: New residential single- or multi- family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 _ 1
Tax map/parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential I ' 75.00 /5.00 2
DESCRIPTION OF WORK Each manufactured or modular
5 65e_ 1�'
dwelling,
er ic service rs installation, feeder 90.90 2
t7 ls� � Services or feeders instaallation, alteration, and/or relocation
200 amps or less 80.30 2
B PROPERTY OWNER , ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: C ' 5 601 amps to 1,000 amps 240.60 2
Address: / / w 1-7 5 5 /„ eo Over 1,000 amps or volts 454.65 2
rf/ 1Y Reconnect only 66.85 2
City /State /ZIP: 1 a .�� O . et-7 2.2 3 Temporary services or feeders installation, alteration, and/or
relocation
Phone: (505 — Up • 3 Sq 5 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 600 amps 133.75 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
RI APPLICANT I ❑ CONTACT PERSON A. Fee for branch circuits with
(� r service or feeder fee, each 6.65 2
Business name: C 00 R- secu.-1 f.. • �' �! ) up branch circuit
B. Fee for branch circuits
Contact name: �J�(
8 y ' i '� i Coo without service or feeder fee, 46.85 2
Address: C 1� each branch circuit
5 9 a.l'E • TG i?Q ono `i✓d1 Each add'l branch circuit 6.65 2
City/State/ZIP: Misc ellaneous (service or feeder not included
y I v1 � WLc•GC.l2r '� D �. • � ? 2 2 2 ( included)
Phone: ( 0 ) Fax:: ( �f p
Pump or irrigation circle 53.40 2
3 ZP (o ' 6 I 1 50,3 7 9 ' 3 ! `.� Sign or outline lighting 53.40 2
E -mail: f <f�l.Nrl hu n r 4O k Aecu.nt L � NO c -tp.C. -) Signal circuit(s) or limited-
) CQNTRACTOR J �+ energy panel, alteration, or
_ -'n extension. Describe: Page 2 2
^
Business name: loo► - Seett_ it h f GroLt
Address: 6 8' - 11 6 _ . � k t / .�1A , , Each additional inspection over allowable in any of the above
A - ' /A' i e € n a Q17Q. t/Vw \x•J( Per inspection 62.50
City /State /ZiP:_ /t 1 u)a.t ..1 , l (y ? 2 2 Investigation per hour (1 hr min) 62.50
Phone: (50& 3 I I n, , 5 )7 Fax: (5031 ?8' .3 79 !L Industrial plant per hour 73.75
/ ELECTRICAL PERMIT FEES*
`� CCB • Lic.: J CC,2 Electrical Li - Sy�C�E� Suprv. Lic.: 72s Subtotal 75.00
Suprv. Electrician signature, required: Plan review (25% of permit fee) -
Print name: I Date: / 2 "6 State surcharge_StiWof permit fee)
TOTAL PERMIT FEE QUO
Authorized signature: JV�
lin T his permit application expires if a permit is not o within 180
p days after it has been accepted as complete .' CV Print name: t t 1 `� p , Date: • Fee methodology set by Tri- County Building Industry Se and
�` '• Number of inspections per permit allowed.
C \ Building \ Permits \ELC- PermitApp doc 12/03 440- 4615T(10 /02 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL W.ORK:ONLY:
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 ONLY
Fee for each commercial system $75.00
(SEE OAR 918 - 260 -260)
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
74 Other IN, ,,t6
Total number of commercial systems: t
*No licenses are required. Licenses are required
for all other installations
i:\ Building \Permits \ELC- PermitApp.doc 04/03