Permit o CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
114 8 ' COMMUNITY DEVELOPMENT Permit#: ELR2013-00261
Date Issued: 10/23/2013
T[G AR 13125 SW Hall Blvd,Tigard OR 97223 503.718.2439 Parcel: 1S136DD03800
Jurisdiction: Tigard
Site address: 11675 SW 66TH AVE
Project: City County Insurance Subdivision: WEST PORTLAND HEIGHTS Lot: 4-8&27
Project Description: CCTV system.
Contractor: COOK SECURITY GROUP INC Owner: CITY COUNTY INSURANCE SERVICES
5841 SE INTERNATIONAL WAY 1212 COURT ST NE
MILWAUKIE, OR 97222 SALEM,OR 97301
PHONE: 503-786-5173 PHONE'
FAX: 503-786-3792
FEES
Description Date Amount
Specifics: Restricted Energy Permit 10/23/2013 $75.00
12%State Surcharge-Electrical 10/23/2013 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio&Stereo 0 Boiler Controls: 0
CCTV: 1 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
Secunty Alarm: 0 Other: 0 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 952-001-0090 You may obtain a copy of the=rect questions to OUNC by calling 503 232 1987 or 1 800 332 2344
Issued By: — sz Permittee Signature: (F322 --
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.
IVE 10/21/2013 13:27 #068 P.002/004
RE4C7 11
Electrical Permit Application 2013 FOR OFFICE l jSF.0\1..1.
City of Tigard ��,1 2 Received/ a / ,
13125 SW Hall Blvd,Tigard,OR Mal) Plan Review e t
a Phone- 503.718 2439 Fax:l(543 78 0���tr p' DateJB : Other Permit.
TI GAR t Inspection Line: 503 639.41 li pp��G®IVIS1°N Date Ready/By H See Page 2 for
Internet: www.tigard-or.gs�ljlg�Dg1, Notified/Method. Supplemental Information
TYPE OF.WORK PLAN REVIEW
•®New construction ®Addition/alteration/replacement Please check all that apply(submit I 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
❑ i-and 2-family dwelling E Commercial/industrial ❑Accessory building amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency systcrn. larger separately system.
❑Addition of new motor load of ❑"A","E","1-2 "1-3",
Job no.:3356 Job site address:11675 SW 66th 100HP or more occupancy.
❑Six or more residential units. ❑Recreational vehicle perks
rl
City/State/ZIP•Tigard,OR 97223 ❑Health care facilities ❑Supply voltage for more than
❑Hazardous locations 600 volts nominal
Suite/bldg./apt no.: Project name:CIS l�i ;,,"„ , 1r�� ❑Sery or feeder 600 amps or more
/ ^'`^"'/r FEE SCHEDULE
Cross street/directions to job site: Desenptioo I Qty. I Fee. I Total I •
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq.R.or less 168.54 4
Ea add'l 500 sq.ft or portion 33.92 1
Tax map/parcel no.: Limited energy,residential 75.00 2
DESCRIPTION_ OF WORK- . . (with above sq.ft.) .
Limited energy,multi-family 75.00 2
CCTV,Low Voltage residential(with above sq.ft.)
— Renewable Energy Cl See Page 2
Services or feeders installation,alteration,and/or relocation
❑ PROPERTY OWNER-. I TENANT 200 amps or less 100 70 2
_ 201 amps to 400 amps 133.56 2
Name: Ct.�.% C u4-9 J_� , loo,nu LAS 401 amps to 600 amps 200.34 2
Address: t�� 601 amps[0 1,000 amps 301.04 2
V-)(9 0-Q Over 1,000 amps or volts 552.26 2
City/State/ZIP: S C-,S Temporary services or feeders installation,alteration,and/or
Phone:( ) 0'•' Fax:( ) relocation
200 amps or less 59.36 t
Owner installation:This installation is being made on property that 1 own which is not 201 amps to400 amps 125.08 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701.
401 amps to 599 amps 168.54 2
Owner signature: Date: Branch circuits-new,alteration,or extension,per panel _
0 APPLICANT -I ❑ CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee,
7.42 2
Business name: each branch circuit
B.Fee for branch circuits without
Contact name: service or feeder fee,first 56.18 2
branch circuit
Address: Each add'I branch circuit 7 42 2
Ci /StatelZlP: Miscellaneous(service or feeder not included)
ty Each manufactured or modular
Phone:( ) I Fax::( )
dwelling,service and/or feeder 67.84 2
Reconnect only 67 84 2
E-mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name:Cook Security Group,Inc Signal circuit(s)or limited-energy I See 75 00
panel,alteration,or extension Page 2 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:Milwaukie, OR 97222 investigation(1 hr min) 66.25/hr
Phone:(503)7865173 I Fax:(503)7863792 Industrial plant(I hr min) 78.18/hr
Inspections for which no fee is 90,00/hr
CCB Lic.: 151552 I Electrical Lie.: 3-54I CLW I Suprv.Lie.: 4233LEA specifically listed('G hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: 2______- _
Subtotal: 75 00
Print name: Brian Cook Date: 10/21/13 Plan review(25%of permit fee): —
State surcharge(12%of permit fee): q,.kg-
Authorized signature:,..0-----7-'7
_, TOTAL PERMIT FEE. vt.'�= r/
This permit application expires if a permit is not obtained within 180
Print name: Brian Cook Date: 10/21/13 days after it has been accepted as complete.
• Number of inspections allowed per permit
1\suddmg\Perants\ELC PernwApp_ELR_ERE dos Rev 05/21/2013 440-46151(11/OS/COM/WEB
From: 10/21/2013 13:28 #068 P.003/004
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
�.-i :'Vtia=0,WitiZIW>- '"=-��
Fee for all residential systems combined ... $75.00 Desaipsioa I Qty. ) Fa � Total ► •
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100 70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
El Burglar Alarm Wind generation systems in excess of 25 kva:
• 25.01 to 50 kva 301.04 2
❑ Garage Door Opener* 50.01 to 100 ha 552.26 2
>100 kva(fee in accordance with 552.26 2
❑ Heating,Ventilation and Air Conditioning OAR 918-309-0040)
System* Solar generation systems in excess of 25 kva:
Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva—no additional charge 00 3
IDOther: additional inspection over allowable in any of the above:
Other: Each additional inspection is
charged at an hourly(1 hr min) _ 66.25/hr 1
Inspections for which no fee is 90.00/hr
r _ specifically listed('h hr mint
r-'eiti2 "1VIEI.C1AI,�WORK-ON1LY: -- _
Fee for each commercial system $75.00 Subtotal: 75.00
(SEE OAR 918-309-0000) Plan review,if required(25%of permit fee):
State surcharge(12%of permit fee): 9.00
Check Type of Work Involved: TOTAL PERMIT FEE: 84.00
This permit application expires if a permit is not obtained within 180
❑ Audio and Stereo Systems days after It has been accepted as complete.
• Number of inspections allowed per permit.
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
El Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
® Other CCTV
Total number of commercial systems: 1
*No licenses are required. Licenses are required
for all other installations
I\Buildup'.Permits.ELC_Pe+mitApp_ELR_ERE doc Rev 05/21/2013