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CITY OF TIGARD ELECTRICAL PERMIT
11111 ' COMMUNITY DEVELOPMENT Permit#: ELC2021-00544
Date Issued: 10/27/2021
T f G A R E) 13125 SW Hall Blvd.,Tigard OR 97223 503 718.2439
Parcel: 2S 102C B02300
Jurisdiction: Tigard
Site address: 13240 SW PACIFIC HWY
Project: Westside Surgery Center Subdivision: FREWING'S ORCHARD TRACTS Lot: 8
Project Description: Electrical for TI:(4)200 amp feeders with(77)branch circuits for expansion of eye surgery center.
Contractor: ALCO ELECTRIC Owner: WESTSIDE BUILDING PROPERTIES LLC
5724 NW 144TH CIRCLE BY VALLABHANATH, PRASHANTH
VANCOUVER.WA 98685 11086 SE OAK ST
MILWAUKIE, OR 97222
PHONE:
PHONE: 360-946-1307
FAX:
FEES
Quantity Description Date Amount
4 ea Services or Feeders-200 10/26/2021 $402.80
Specifics: amps or less
77 crt Branch Circuits w/Purchase 10/26/2021 $571 34
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 10/26/2021 $116.90
Type of Const: Electrical
Occupancy Grp: 1 ea Plan Review Electricial 10/26/2021 $243.54
Total $1,334.58
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 cony of the rules or direct ouestions to OUNC by callina 503.232.1987 or 1.800.332.2344.
Issued By: F-jo{a.y Vaw De-Wege Permittee Signature: Qvn A 11r.p4-tn-vi-
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
RECEIV � lC)k01 1 I( I Itil t1,1 ,
City of Tigard ived
101
Date/By: 'emit#: L.C. J'l 11J�f'`�
14 13125 SW Hall Blvd.,Tigard,OR 97223
Plan Review p�"
■ Phone: 503.718.2439 Fax: 503.598.1960 Q g Ag,f Related Permit#: G(CJ
SEP 2 7 2021 Date/By: Z 14,(2 1 J C7 1 r'u/
Inspection Line: 503.639.4175 Ready Date/By: t _ ® See Page 2 for
I I(i./a E l) Internet: www.tigard-or.gov � �r n� i Notified/Method: '`
�ITII I I�ft d ii ♦ 1 IG Supplemental Information
TYPE OF WORK BUILDING nIVISIOPt .b` afitNi PLAN REVIEW
❑New construction ►1 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
❑Demolition ID Other: 0 Service or feeder 400 amps or more ElBuilding over three stories.
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 ►�4 Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
0 Multi-family 0 Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: Job site address:
13240 SW Pacific Hwy 100HPormore. ❑"A","E","l-r','l-3",
0 Six or more residential units. occupancy.
City/State/ZIP: Tigard 97223
Recreational vehicle a
0 Health-care facilities. ❑ parks.
Suite/bldg./apt.#: Project name:Westside Surgery Center°Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. I Each I Total
New residential single-or multi-family dwelling unit.
Subdivision:Frewing' s Orchard Tracks Lot#: 8 Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential 75.00 2
(with above sq.ft.)
Alteration of existing building expansion of Limited energy,multi-family
residential with above s ft.) 75.00 2
existing eye surgery center ( ��
Renewable Energy 0 See Page 2
PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: Westside Building Properties LLC 200 amps or less 4 100.70 ;402 . 3f)
201 amps to 400 amps 133.56 2
Address: 11086 SE OAK ST
401 amps to 600 amps 200.34 2
City/State/ZIP: Mi lwauk i e, OR 97222 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 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
ri
APPLICANT ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name:ALC O ELECTRIC LLC above service or feeder fee,
42
each branch circuit 7 7 7.42 5 71 . 3
Contact name: Brian Alexander B.Fee for branch circuits without
service or feeder fee,first
Address: SAME INFORMATION AS CONTRACTOR branch circuit 56.18 2
City/State/ZIP: Each add'!branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name:ALCO ELECTRIC LLC Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address: 5724 NW 14 4 t h CIRCLE panel,alteration,or extension. 0 See Page 2 2
Each additional inspection over allowable in any of the above
City/State/ZIP: Vancouver WA 98685 Additional inspection(1 hr min) 66.25/hr
Phone:(3 6 0) 9 4 6-1 3 0 7 Fax:( ) Investigation(1 hr min) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
brian@alco-electric. com Inspections for which no fee is 90.00/hr
CCB Lie.: 2 3 313 6 Electrical Lie.:C 1575 Suprv.Lie.: 64 31 S specifically listed('/2 hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: 6 G �1 `�` Subtotal: $974 . 14
Print name:Brian Alexander + Date: 9/24/2021 ='" Plan Review Required(25%of permit fee): $243 . 5
State surcharge(12%of permit fee):
TOTAL PERMIT FEE:
Authorized signature: Siitz;;_,
m. $1, 3 3 4 . 5 er
This permit application expires if a permit is not obtained within 180
Print name: Brian Alexander Date: 9/24/2021 days after it has been accepted as complete.
* Number of inspections allowed per permit.
1:1Building\Permits 1ELC_PermitApp_F,LR_ERE.doc Rev 06/17/2015 440-46 I 5T(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Fee for all residential systems combined: $75.00 Description I Qty. I Each I Total 1
�' Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
I I Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
n Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
n Garage Door Opener*
>100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
I I Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* 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:
n Other Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(%hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):
y ' Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
n Audio and Stereo Systems
n Boiler Controls
n C• lock Systems
• Data Telecommunication Installation
h Fire Alarm Installation
I I HVAC
n Instrumentation
Intercom and Paging Systems
n L• andscape Irrigation Control*
P Medical
Nurse Calls
n O• utdoor Landscape Lighting*
I I Protective Signaling
Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015