Permit 1111 CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
• COMMUNITY DEVELOPMENT Permit #: ELR2009 -00285
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/03/2009
Parcel: 2S112DC01400
Jurisdiction: Tigard
Site address: 15865 SW 74TH AVE 105
Subdivision: CREEKVIEW INDUSTRIAL PARK Lot: 4
Project: Cognex Corporation
Project Description: Install camera on SE corner of building.
FEES
Owner:
JDS LLC & Description • Date Amount
CRITERION CREEKVIEW LLC, PO BOX 6525 Restricted Energy Permit 09/03/2009 $75.00
BEAVERTON, OR 97007 12% State Surcharge - Electrical 09/03/2009 $9.00
PHONE:
Contractor:
ARONSON SECURITY GROUP
8089 SW CIRRUS DR
BEAVERTON, OR 97008
PHONE: 503 - 639 -9988
FAX: 503 - 684 -4357
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
Required Items and Reports (Conditions)
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: y
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 OAR 952 - 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 5 03.246.6699or 1.800.332.2344. / Issued By: Permittee Signature: e>. " 1p PL ' /
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.
Cali 503.639.4176 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.
i. Electrical Permit Application . ' `. F OFFICE USE ONLY • .. •
City Of Tigard RECEIVE} Received 9 .J j Permit No. i / _ 81.6". Y g Date /By: G d V 7 b" , 0, • " 13125 SW Hall Blvd., Tigard, OR 97223 q
' Phone: 503.639.4171 Fax: 503.598.190E p 01 2009 Other Pernutt Qi / _
T Inspection Line: 503.639.4175 Date Ready /By: El See Page 2 for
Internet: www.tigard- or.gov CITY OF TIGARD Notified/Method: Supplemental Information
TYPE OFI IJING DIVISION - , , PLAN REVIEW
❑ New construction N Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1 - and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of75 KVA or
JOB SITE INFORMATION AND LOCATION • ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "B ", "l -2 ", "I -3 ",
�I 74 Job no.: I Job site address: 15865 SW 74 AVE 100HP or more. occupancy.
❑ Six or more residential units. 0 Recreational vehicle parks.
City /State /ZIP: TIGARD, OR 97224 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: 105 Project name: COGNEX CORPORATION ❑ Service or feeder 600 amps or more.
. FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. 1 Fee. 1 Total 1
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Tax map /parcel no.: Ea. add') 500 sq. ft. or portion 33.40 1
Limited energy, residential
DESCRIPTION OF WORK (with above sq. R.) 75.00 2
Limited energy, multi - family
C.i'MNe alid OA SE abr11e. - t t l_ i rt residential (with above sq. ft.) 75.00 2
Q Services or feeders installation, alteration, and/or relocation
• 200 amps or less 80.30 2
❑' PROPERTY OWNER . _❑ TENANT 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City /State /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that 1 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 599 amps 133.75 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date:
A. Fee for branch circuits with
El APPLICANT ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 6.65 2
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee,
_ first branch circuit 46.85 2
Address: Each add'l branch circuit 6.65 2
_ Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular
dwelling, service and /or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR • Sign or outline lighting 53.40 2
Signal panel, or limited -
Business name: ARONSON SECURITY GROUP
energy panel, alteration, or
Address: 8089 SW CIRRUS DR extension. Describe: 1 Page 2 75.00 2
City /State /ZIP: BEAVRTON OR 97008 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (503) 639 -9988 Fax: (503) 684 - 4357 Investigation per hour (1 hr min) 62.50
CCB Lic.: 185024 Electrical Lic.: 26 - 497CL Suprv. Lic.: 974LEA Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES •
Suprv. Electrician signature, required: Subtotal: 75.00
Print name: JIM LEPPER Date: 8/25/09 Plan review (25% of permit fee):
State surcharge (12% of permit fee): 9.00 t./.'-
Authorized signature: TOTAL PERMIT FEE: 84.00
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
I: \Building \Permits \ELC- PermitApp.doc 05/23/06 440- 4615T( l l /05 /COM /WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK "ONLY:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
n Audio and Stereo Systems*
n Burglar Alarm
n Garage Door Opener*
n Ieating, Ventilation and Air Conditioning System*
n Vacuum Systems*
II Other:
CQMMERCIAL_WORK`ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918 309 - 0000)
Check Type of Work Involved:
n Audio and Stereo Systems
n Boiler Controls
n Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
n I-IVAC
I I Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control*
n Medical
n Nurse Calls
n Outdoor Landscape Lighting*
n Protective Signaling
M Other Intrusion Alarm Systerm
Total number of commercial systems: 1
*No licenses are required. Licenses are required
for all other installations
I: \Building \Permits \ELC- PeimitApp.doc 03/23/06