Permit (6) CITY OF TIGARD ELECTRICAL PERMIT
q COMMUNITY DEVELOPMENT Permit#: ELC2023-00410
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 7/26/2023
Parcel: 1S135AC03800
Jurisdiction: Tigard
Site address: 9244 SW OAK ST
Project: Steadfast Senior Living Subdivision: Lot: 16
Project Description: Temporary power for residential care facility.
Contractor: PRAIRIE ELECTRIC INC Owner: ACOYA TIGARD LLC
6000 NE 88TH ST 4275 EXECUTIVE SQUARE STE 370
VANCOUVER, WA 98665 LA JOLLA, CA 92037
PHONE: 360-573-2750 PHONE:
FAX: 503-576-7422
FEES
Quantity Description Date Amount
1 ea Plan Review Electricial 07/25/2023 $209.62
Specifics:
1 ea 12%State Surcharge- 07/25/2023 $100.62
Type of Use: MF Electrical
7 ea Services or Feeders-200 07/25/2023 $704.90
Class of Work: NEW
amps or less
Type of Const: 1 ea Services or Feeders-201 to 07/25/2023 $133.56
Occupancy Grp: 400 amps
Total $1,148.70
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for mare the
180 days. ATTENTION:
Oregon law requires allow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 throua '6 952-001-00 ,gypo m v o n a coov.of the rules or direct Questions to OUNC by callina 503.232.1987 or 1.880 332.2344.
Issued By: f/f //�� Permittee Signature: '8" -/�'
L.
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale,lease or rent.
OWNER'S SIGNATURE: Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC'N Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Application
. , n a ;City of Tigard Received d: ,7 3. r Perm":E l(.'r,61 'QO{V
1111 • 13125 SW hall Blvd.,Tigard,OR 97223 g Phone: v f 503.718.2439 Fax: 503.598.1960 Of- i K3A J J) Plan Rav Datellily: 1 Related Porn*4:
T 1 G A It D Inspection Line: 503.639A175 '\J(' DIVISION Ready Date/B ' ram: El See Page 2 for
Internet: www.tigard-or.gov Notided/Method: Supplemental lafornadon
TYPE OF WORK " 1 n 1.$LAN REVIEW
®New construction 0 Addition/alteration/replacement Please check all that apply(submit 2 ads of plans w/items checked):
O Service or feeder 400 amps or mom 0 Building over three stones.
0 Demolition 0(met;
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ I-and 2-family dwelling 0 CommerciaVindustrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
s.
®Multi-family El Master builder El Other. El Fire�for all other installations. tafa
pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergmrcy system. larger separately derived
Job#: Job site address: ❑Addition of new motor load of system.
200557 9244 SW Oak Street [OOHP or more. ❑'A","B",n 2", la
City/State/ZIP: Tigard, OR 97223 Ir7'sp.or morc residential unity. occupancy.
motional vehicle❑Health-care facilities. 0 parks.
Suite/bldg./apt.#: Project name: Ac o y a Tigard ❑Hazardous locations. 0 Sup Supply
v page ,o more than
❑Service or feeder 600 amps or more.
Cross street/directionstojobsite: Steadfast Senior Living FEE SCHEDULE
Ianarlpnea ) 91.. I ram I Total I t
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.R or less 168.54 4
Tax map/parcel#: Es.add'1500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
)
Temporary Power Servicepanels and feeders (with nergy,mulbove sq. ti 75.00 2
P Y Limited ener
gy, 75.00 ._. 2
for new construction MF facility residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
0 PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: 200 amps or leas 100.70 2
Address: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 7 5936 415 . 5:1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 1 125.08 125 . 0 82
Owner signature: Date: 401 amps to 599 amps 168.54 2
_--.—__ Brunch circuits-new,alteration,or extension,per panel
El APPLICANT a CONTACT PERSON A.Fee for branch circuits with
Business name: prairie Electric, Inc above service or feeder fee, 742 2
each branch circuit
Contact name: Anita Paso B.Fee for branch circuits without
Address: serce eder
27050 NE 10th Ave branchcircuit fee,first 56.18
City/State/ZIP: Ridgefield, WA 98642 Each add'l branch circuit 7.42 2
Phone:(503) 286-9209 Fax::( ) Eauh�n�tu�or�ulaeedernotmelnded)
dwelling,service and/or feeder 67.84 2
Email anitap@prairielectric. com Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: Prairie Electric, Inc Sign oroutlinelighting 67.84 2
Signal circuit(s)or limited-energy 0 See Page 2 2
Address: 27050 NE 10th Ave panel,alteration,or extension.
Each additional Inspection over allowable in an)of the above
City/State/ZIP: Ridgefield, WA 98642 Additional ins petxion(1 hr min) 66.25/hr
Phone:(5 0 3) 2 8 6-92 0 9 Fax:( ) Investigation(I hr min) 90.00/hr
Email: Industrial plant(l hr min) 78.18/hr
anitap@prairielectric.corn Inspections for which no fee is
90'00/hr
CCB Lic.: 60178 Electrical Lic.: 3 7-4 91 C I Suprv.Lic.: 5 9 8 6 5 specifically listed 111,hr min,
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: ,,4 vl. - _.:�
._,� Subtotal: 540 . 60
Print name: Rod Ha lb e r g Date: 5 . 22 . 23 ❑Plan Review Required(25%of permit fee): 13 5 . 15
State surcharge(12%of permit fec): 64 . 87
Authorized signature: TOTAL PERMIT FEE: 7 4 0 . 62
/ This permit application expires if a permit is not obtained within 180
Print name: ",,;;' % cif/f%-" Date: days after It has been accepted as complete.
E'— -- • Number of inspections allowed per permit
I'usrdmnMermitriEt.C_PermidApp_ELg ERE.doc Rev 06/11/2015 44046157(11N5/COM/WED