Permit q CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
11 COMMUNITY DEVELOPMENT Permit#: ELR2013-00207
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/19/2013
Parcel: 251 12DA01 000
Jurisdiction: Tigard
Site address: 6610 SW CARDINAL LN
Project: Umpqua Bank Subdivision: 1995-098 PARTITION PLAT Lot: 1
Project Description: Access control system
Contractor: COOK SECURITY GROUP INC Owner: PACIFIC REALTY ASSOCIATES
5841 SE INTERNATIONAL WAY ATTN: N PIVEN
MILWAUKIE, OR 97222 15350 SW SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-786-5173 PHONE:
FAX: 503-786-3792
FEES
Description Date Amount
Specifics: Restricted Energy Permit 08/19/2013 $75.00
12%State Surcharge-Electrical 08/19/2013 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio&Stereo: 0 Boiler Controls: 0
CCTV: 0 Clock Systems: 0
Data&Telecommunications: 0 Fire Alarm: 0
HVAC: 0 Instrumentation: 0
Intercom/Paging: 0 Landscape/Irrigation: 0
Landscape Lighting: 0 Medical: 0
Nurse Calls: 0 Protective Signal: 0
Security Alarm: 0 Other: 1 Total $84.00
Other Desc: 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 952-0 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: O�° 15 ��/` 4-77e41
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 603.639.4175 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.
From: 08/14/2013 15:02 #971 P.002/003
Electrical Permit Applicatio FOR OH IC L USE:O\l\ .. 'w
1.11,1
City of Tigard "� E '� a te/B`a t�i9® :c IA PermitNo.:6 01 �0a0
• 13125 SW Hall Blvd.,Tigard,OR 9 Plan Review
C ' Phone: 503.718.2439 Fax: 503.598.1960 Other Permit:
T 1 C A 1;11
Inspection Line: 503.639.4175 AUG 1 4 2013 Date Date/B Ready/By: lan 65 See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
�_,_ . -- --_ - -_;_TYPE• ..FL W. ,0-Ma':-- - _
-"-- '- :" :,_ ',c ,.9. �- ,,. i'='r�� ;�_.. ::e:;PLAN;�VIEW_ � - �. ,5-1:--,-;,s
❑New construction ®Addition/alt it el't1dP+N 1SION Please check all that apply(submit 2 sets of plans w/items checked below):
❑Demolition ❑Other: ❑Service or feeder 400 amps or more ❑Building over three stories.
where the available fault current ❑Marinas and boatyards.
j CATEGORY.;QE:•CONSTRUCTION: "-``' ' r-<:':, 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 of 150 KVA or
.- - _ ❑Emergency system. larger separately derived system.
-^ JOB SITE'INFQRMATTUIV``AND'L'OCAT[ON';.-,:_;;,- :;-''•,;�,;„'
. Addition of new motor load of ❑"A",
Job no.:.103209 Job site address:6610 SW Cardinal Lane Pac.Ln. I00HP or more. occreattcy.
❑Six or more residential units. ❑Recreational vehicle parks.
try/State/ZIP:Tigard,OR 97224 ❑Health-care facilities. ❑Supply voltage for more than
tkr ❑Hazardous locations. 600 volts nominaL
A.
Suite/bldg./apt.no.: Project name:Umpqua Bank
10 Service or feeder 600
amps or more.
`FEE-SCHEDULE - -
Cross street/directions to job site: Description I Qty. I Fee. I Total I •
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq.ft.or less 168.54 4
Ea.add'I 500 sq.ft.or portion 33.92 1
Tax map/parcel no.:
Limited ever residential
gy 75.00 2
.DESCRiP......OF._;W,ORK. _ -- - -- (with above sq.ft)
Limited energy,multi-family 75.00 2
Low voltage go<ccess control residential(with above sq.ft.)
-.Ren'evable Energy. :--:. >. :0'See Page 2 = - . .,_.-
Services or feeders installation,alteration,and/or relocation
PRQ . .; . 100.70 2
.f::-."-- I'ERTY;OWNEItr:<" -_:-,'-�: ;..:. ;;; ;,-�= 200 amps or less
Name:Same as above 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Address: 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation,alteration,and/or
Phone:( ) Fax:( ) relocation
200 amps or less 59.36 I
Owner installation:This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 599 amps 1 68.54 2
Owner signature: Date: Branch circuits—new,alteration,or extension,per panel
APPLICANT.: .;-:;`'-- ' .PERSON'%. A.Fee for branch circuits with
®',CONTACT? above service to feeder fee,
Business name:Cook Security Group,Inc. each branch circuit 7.42 2
B.Fee for branch circuits without
Contact name:Sharon Provost service or feeder fee,first
branch circuit 56.18 2
Address:5841 SE International Way Each add'l branch circuit 7.42 2
City/State/ZIP:Milwaukee,OR 97222 Miscellaneous(service or feeder not included)
Each manufactured or modular 6784 2
Phone:(503)786-5173 x139 Fax::(503)786-3792 dwelling,service and/or feeder
■ Reconnect only 67.84 2
E-mail:sharon.provost @cooksecurltygroup.com Pump or irrigation circle 67.84 2-
�; 67.84 9C� 2
Business name:Cook Security Group,Inc. Signal circuit(s)or limited-energy 1 See 7 rte
panel,alteration,or extension. Page 2 J"" 2
Address:5841 SE International Way Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
City/State/ZIP:Milwaukee,OR 97222 Investigation(I hr min) 66.25/hr
hone:(503)786-5173 Fax:(503)786-3792 Industrial plant(1 hr min) 76.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: 151552 Electrical Lic.: 3-541 CLE Suprv.Lic.: 4233LEA specifically listed(h hr min)
Suprv. Electrician signature,required: �� ELECTRICAI:.;PERMIT FEES. �__�" =
Subtotal: Jam•/u T5;07)
Print name: Brian Cook Date: 08/14/13 Plan review(25%of permit fee):
State surcharge(12%of permit fee): I r A
Authorized signature: _ ' ' TOTAL PERMIT FEE:
d This permit a pp lication expires if a permit B not obtained 180+ r
Print name: Brian Cook Date: 08/14/13 days after It has been accepted as complete.
• Number of inspections allowed per permit.
I:+Building'Permits\ELC PermitApp_ELR ERE.doc Rev 05212013 440.4615111i/05/COM•WES
From: 08/14/2013 15:02 #971 P.001/003
C O O K S E C U R I T Y G R O U P
Cook Security Group Inc.
5841 SE International Way
Milwaukie,Oregon 97222
503-786-5173
503=786-3792
FAX
To: ?e,r 4 �- From: %moo x� •c)n0 0��
Company: C�{t� o-c �tc,o,n� Phone: 503-- ,.. 5t13
Fax: 503- 911c- L g Le 0 Pages: 3
Subject: E-teekrlcli RANA: kee Date: 51-
0