Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
11111 COMMUNITY DEVELOPMENT Permit#: ELR2013 00255
T[CARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/15/2013
Parcel: 151260000300
Jurisdiction: Tigard
Site address: 9585 SW WASHINGTON SQUARE RD OFFICE
Project: Microsoft Kiosk Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: S
Project Description: Low voltage for data for kiosk located in main hallway near the Anne Taylor and Bath&Body Works stores.
Contractor: STALEY INC Owner: PPR WASHINGTON SQUARE LLC
3400 JE DAVIS DRIVE PO BOX 847
LITTLE ROCK,AK 72209 CARLSBAD,CA 92018
PHONE: 720-259-4667 PHONE:
FAX: 303-779-4501
FEES
Description Date Amount
Specifics:, Restricted Energy Permit 10/15/2013 $75.00
12%State Surcharge-Electrical 10/15/2013 $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: 1 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: 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 rdance wi -pproved 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. AT NTION: Oregon I. requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-00 010 through OAR 952-00 •-190. Y•u may obtain a copy of the rules or direct questions to OUNC by callingbua.132. •7 or 1.800.332.2344.
Iss d By: / / I /4 A—A Permittee Signature: - , i-!;11 ■
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.
10/10/2013 THU 11112 FAX 3037794501 $• a1ey Inc 2002/004
-Electrical Permit Application � 'J 4.'if_ FOR OF1 ICI, ELSE.ONLY
• Received Pcmdl Nn,:
City of Tigard OCT Il ARM"' f4,�
Y 13125 SW Hall Blvd.,Tigard,OR 97223 ® Z��� Dims : r,,,e,_.6,0
l � , 8 Plan Review Other Permit:
Phone; 503.718.2439 Fax: 503.598.1960 f J. s, ; DmdB :
li$pectirnl Line: 503.639.4175 ��° il VI'S 11 00h.1�N Dere Ready/t!y' ludic ® See Peg 2 for
I'IC,/ RI.) Internet: www.tigad•or.gov 3 (oL.nG•A± �'P, ^e tl 'N0lifed/Melhod: Supplemental Information
l _ I l.ku_, �, „.,�ot;;a. a�i ,:;s '6.,;.....: f1le1: i•t .. -(t� 7iAT,„I.I t.rHt ;',7 ttif'g i -i SAVA t
0 .-;i.
1
❑Ncw construction ®Addition/alteration/replacement Please check all Ilwt apply(submit 2 sale of pions whims checked below):
❑Scrvicc or feeder 400 maps or more ❑Building over duce stories.
❑Demolition ❑Other: where the available fhtilt cumenl El Mm•iooa and banlyo111s
1 Id , f I eta tu' `l r t I . r '� 017. µle 5 i ' ,lfr1 `,' cacc.4 10,010 mama at 150 vo113 or ❑Flooring Loadings.
k{ ,.rl, k1)!' ia� :?i '' t A ' fi�l,tl"L',:'. � less to ground,or exceeds 14,000 ❑Canmrercinl•usc agrientwraI
❑ 1-and 2-family dwelling ®Commercial/industrial 0 Accessory building amps for all odlerinstaNmions. buildings.
❑Multi family ❑ Master builder ❑Other ❑Flit pump. []lusialletto i of 150 KVA or
- 7 r r . A . A 1 i ❑Emergency system, Imp.'sepornlely derive
d system,
J,.: ;r C d,a h ..$,T I f 44...} �.,, .J., • � yL -_ it.t723 l 1111:0 5 wF1 ❑Addition of now motor load of ❑-A.,.E l_2• ..I-3'.
Job no.:8014 Job site address:9585 SW Washington Square Rd 100HP or moos. OCcupancy
❑Six or more Iesidenlinl units, ❑Reecetional vehicle perils,
City/Siatc/ZIP:Tigard,WA 97223 - ❑I'lealllrenre fncilitioe. ❑Supply voltage Ibr mole Ihnn
❑Hn7e.dous locations, 600 volts nominal.
Suite/bldg./apt.no.:1-C I Project name:Microsoft Kiosk.I-C ❑Service or feeder 000 amps ormore.
41'14 ;,i'H I{i.4,t.;.ii;`!ii"rlg,Cil d. 0,"31 ifi�; a V nl
Cross street/directions to job site:Washington Square Mali Description I qy. Pee. I Total
n New residential single-or multi-family dwelling unit.
A iv 0 t 2 7? .'th`• 1 0427 (-30) Includes attached garage.
—
Subdivision: I Lot no.; 11 1,000 so.R,or leas 168.54 4
En,adtl'I 500 sq.0.or portion 33,92 1
Tax map/parcel no.: Limited energy,residential
n ,l t+yr iii 1 I��F/T S'SILT; 1, ' z n 12 r, • �i >r,'.T y"n;rte gin w" 75,00 2
i4,sli ly,r11,,,,..et,1.t.§�YidlilLII-.. l�'���,.?tg):j:�fi,� 9 n �2r t,,ally.. ckilr.�P_r••,(s'..i ulvo ::,t,tl,r (wlthabovesq.R.) _
Limited encr67,mulls-(Molly 75.00 2
Extend one 6-strand armored fiber LEA) o LTA&ce. 027"!9-' residential(with above sq.I1)
Renewable Energy l'Sce Page 2
From Telecom Room to Microsoft Kiosk _Services or feeders Inelnllatlon,alteration,Hnd/Qr relocation
f,11 5 1.7r t 114 ESI V7 Ma g °0.1 . a l e 200 "1113S aps 100.7 0 2
201 amps to 400 amps 133,56 2
Name; Microsoft 401 amps l0 600 amps 200.34 2
Address:9585 SW Waslrinton Square Rd 1-C 601 onipa to 1,000 amps 301.04 2
- Over 1,000 amps or volts 552.26 2
City/Statc/ZIP:Tigard,OR 97223 Temporary services or feeders Installation,alteration,and/or
Phone:(855)270-6581 Fox:( ) relorntlon _ - - ,_
200 amps or less 59.36 1
Owner installation:This installation is being made on property Ihnn 1 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 maps to 599 amps 168,34 2
Owner signature: Date: Branch circuits-new,alteration,or extension,per panel _
r 'r't; n v 1;1• I,,,t 7,Iftj .:::" ,':•h.,v i• • .glw, •A.Fee lOr branch circuits wish f
1 r ���sf• M; 1 % •i, �,; :' lc ,,a .'/ t CONT C7:P .e ,i 1 c+ l•�' . .:,1' a .I, .. .1.• ..:A,i ,,I.B�r•.�5.2'• �': ..,'.,r,,.,,.�— 11.,. ...jt,„,• '�,4TY'�.,y above service or feeder fee, •
Business name: S '. / each branch CRGIiI 7,42 2
�.. B.Fee for brnnch circuits rvrrfrord
Contact name:Rhonda MI or sarico or feeder fee.ftrsl 56.18 2
blanch circuit
Address:3400 JE DavIs Drive Each add'l branch circuit 7.42 2
City/State/ZIP:little Rock,AR 72209 W Miscellaneous(service or feeder;not Included)
Each manufactured or modular 67414 2
Phone:(720)259-4667 I Pax::(303)779-4501 dwcmn�,service and/or fe der
�•__
Reconnect only 67.84 2
Email:Imfiler.rnstnleyinc.eorn Pump or irrigation circle 67.14 2
C NTRACTOR ;, , . Signor outline lighting 67.84 2
Business name: V ♦'/n ,�. —Signal citcuit(s)or limited energy Sec 7 SOD
mM.niternuon.or exteinim1. Page 2 S 2
Address:3400.1E Davis Drive Each additional Insecctlon over allowable In any of the above
- Additional inspection(I hr min) 66.25/hr
City/State/Z1 P;Little Rock,A It 72209 investigation(I hr min) 66,25/hr
Phone:(720)259-4667 11 AS/13 % Pax:(303)779-4501 /c//it Industrial plan(I hr nun) 78,18/hr
Inspections for which no fee is 9t).1 1f1/hr
CCi3 Lic.; • Eieetricii ,)e•: ,14 ill.rv. Lic.: 5/'I� ,,sporaacally listed(A hr main)
` *`” :ELECTRICAL PERMIT,.I EES
5uprv.Electrician signature,rr u(I;. _v Subtotal: _ —7*
1
Print name: Gary Ferrell Dale. 10/10/13 Plan rcvicw(25%of permit lee):
Stoic surcharge(12%4 of permit fee): 9 o0
Authorized signature: I , TOTAL PERMIT FEE:; g`T -Oo
I • This permit applientiun expires if H permit is not uhlaivad wilhin 1811
Print name: Rhonda Miller I Date: 10/10/13 days nftvr it has been accepted a,enIn dale.
-- - - - • Number of InspeClruns allowed per permit.
I llluildinetuennilxtaLC Pu liMil_F.I,R l RI:duc Key'm sinoi.o aan.aal vr(I Igo/COMM!)
10/10/2013 THU 11: 12 Fax 3037794501 Staley Inc 0003/
Electrical Permit Application—City of Tigard
Page 2--Supplemental Information
Limited Energy Permit Fees: +� Renewable Energy Permit Fees: g1
kj�U D1 D tt�I?t1�1 i tz r I� r� J 111 ��:�;d r '.) :;. 1 {s?:' r it"'L?v 'a?y �u� �1<<l'<"I T„1�{N��'L':Fx�l �/,�.tA.. ;',4:k G.SCGtt� °_ , 51,�+
Y.�.•'{1.. ��tt�..��..1h.t :�. J. ..I\,1i1 vti�I. tT.��11.�,... li:w:...,n..,..>.1. .I,rt ti�i+.)_4.'..ri�,!t?, a,r_Y+�i
Fee for residential systems combined........ $75.00 oetertptlon .
Renewable electrical energy systems;
Check Type of Work Involved: 5 kva or less 100.70 2
5,01 to 15Icva 133.56 2
❑ Audio and Stereo Systems* -
toes kva 200. 4 0 2
❑ Burglar Alarm Wind gettart111on.extetns In excess of 9 kva;
25,01 to 50 kva 301.04 2
❑ Garage Door Opener* 50,01 to 100 kva 552.26 2
>100 kva(lee In accordance with 55226 2
n 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 0.0 3
Each additional Inspection over allowable In any of the above:
❑ Other; Each additional inspection it 66.25/hr 1
charted at an hourly(1 hr min)
inspections for which no tee is
90.00/hr
cikical listed 14 hr min
,T o f �� • a �" J .'l{ � iii S s T V I ti 1 �r fY r.r 7 �'f
.l}:�i.l.]f,�/...,,.�.. �' ..Il.t�..,r.11.3L.L���_J.��I' 7..�,.lv.,.....�.. ' 1+.i�1.. ..)...f 1.., .ri,{�.1171.'.. ...., .��1J...IF�'.a•L.��:.]nr±����.ra!��1C1., )��. I
Fee for gash commercial system .... $75.00 Subtotal:
(SEE OAR 918-309-0000) _ Plan review,if required(25%of permit foe):
Stele surcharge(12%of permit fee):
Check Type of Work Involved: TOTAL.PERMIT PEE;
'I'IIIe;.permit application expires If o permit Is Rol obtained within 180
❑ Audio and Stereo Systems days after It has been accepted ea complete.
• Number of inepcctiona allowed per pcnnit.
❑ Boiler Controls
n Clock Systems
El Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
n Landscape Irrigation Control*
❑ Medical
O Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I:\aulldlnpu ermit&ua.C.rennhnpp_ELR CRe dot Rev OS/21/2013
10/10/2013 THU 11: 12 FAX 3037794501 Staley Inc la001/004
® STALEY
TECHNOLOGIES, LW
A SWAY MCMINN 07Aptar Solutions at work.
FAX
SUBJECT: P1-1-'
DATE: 10110113
NO. OF PAGES: 4 () c1-. at Co R)
RECIPIENT: 3 O,
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TELEPHONE: s0 3♦ 7/ a- 2.44-19
4 FAX: S , s9 8 , J 9 `2 0
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SENDER: ZA-F�bbl�C M 1 L
TELEPHONE: W. v-S 9 • L(.0 G27
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FAX: 3 d 3' 1-11 - �-t So
425 W 115th Ave d. 303.779.4600 vamstaleylnc,can
Unit 2 f. 303.779.4501
No►thglenn,CO 80234