Permit C ITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2006 -00277
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 11/15/2006
PARCEL: 1 S 134AD -06201
SITE ADDRESS: 10450 SW NIMBUS AVE RC ZONING: I - P
SUBDIVISION: SCHOLLS BUSINESS CENTER LOT: JURISDICTION: TIG
Project Description: T -stats
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: HVAC: X PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
KG INVESTMENTS GOHMAN MECHANICAL
KYLE LATTA 412 S BEAVERCREEK RD #602
10240 SW NIMBUS SUITE L3 OREGON CITY, OR 97045
PORTLAND, OR 97223
Phone: 503 -598 -9980 Contact #: PRI 503- 650 -1588
FAX 503- 655 -0514
FEES Reg #: ELE 3- 495CLE
LIC 119952
Description Date Amount
[ELPRMT] ELR Permit 11/15/200E $75.00
[TAX] 8% State Surcha 11/15/200E $6.00 REQUIRED ITEMS AND REPORTS
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and al ,ether
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started with ; 180 d. s
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires y'• to follow Ili es - •opte• • e Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 -01 -0100 •u inay o• ,:pies of these
rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By: 16a#0114 4yZA, Permittee Signature: 4 i,
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 an inspection that business day.
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 /f� FOR OFFICE 1 SF 01.1 V
City of Tigard RECEIVE 11 We 1 /� J Pmt No.: ° - , • _ o 77
I I • 1312 SW Hall Blvd., Tigard, OR 97223 Plan Re v i e w
C . Phone: 503.639.4171 Fax: 503.598.1960 Nov 1 5 2006 Date/B : Other Permit: I' I G n R D Inspection Line: 503.639 Date Ready/By: E1 See Page 2 for
Internet: www.tigard -or.gov �C� CITY OF i ;GARD No[ifed/Method: Supplemental Information
TYPE OF WOIt DIVISION PLAN REVIEW
❑ New construction ® Addition/alteration/replacement Please check all that apply (submit Z 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
❑ 1- and 2- family dwelling ® Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pwnp. ❑ Installation of 7s KVA or
JOB SITE INFORMATION AND LOCATION ❑ ❑Addition of new motor larger separately derived system.
otor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: I Job site address: 10450 SW Nimbus Ave 100H or or more. trey.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: Portland Or ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: { I Project name: Software solutions ❑ 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 145.15 4
Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
Modify existing ducting and grills to accommodate new wall layout, Relocate 6 the residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City/State /ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less '66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits - new, alteration, or extension, r panel
Owner signature: Date: A. Fee for branch circuits with
® APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: Gohman Mechaniocal Inc. B. Fee for branch circuits
Contact name: Mark Gohman
without service or feeder fee, 46.85 2
first branch circuit
Address: 412 S Beavercreek Rd # 602 Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Oregon City Each manufactured or modular 90.90 2
Phone: (503-) 650 -1588 Fax: (503-) 655 -051 Reconnect t on y and/or feeder
503
( ) ( ) 4 Reconnect only 66.85 2
E -mail: mark @gohmanmechanical.com Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Signal circuit(s) or limited -
Business name: energy panel, alteration, or
Address: extension. Describe: / Page 2 2
"
City/State/ZIP: ✓1 / • 5( 2 "t ` `q CiL' Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( ) Fax: ( ) p Investigation per hour (1 hr min) 62.50
CCB Lic.: 119952 Electrical Lic.: 3592CRE Suprv. Lic.: 4037LEB Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, require : ``�_ Subtotal: "G7 '-
Print name: Mark Gohman Date: 11/15/06
Plan review (25% of permit fee):
- State surcharge (8% of permit fee):
Authorized signature: U I'�� TOTAL PERMIT FEE: SI
Print name: Mark Gohman Date: 11/15/06 This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:\ Building \Pemtits \ELC- PernitApp.doc 05/23/06 4104615T(I1 /05 /COM/WEB
CITY OF TIGARD
BUILDING DIVISION - PERMIT #: ELR2006 -00277
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/1512006
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639 -4175 .- F. 1 -
INSPECTION WORKSHEET FOR DATE: 12113/2005 TIME: 7 PAGE: 30
SITE ADDRESS: 10450 SW NIMBUS AVE RC CLASS OF WORK:
SUBDIVISION: SCHOLLS BUSINESS CENTER LOT #: TYPE OF USE:
PROJECT NAME: SOFTWARE PROFESSIONALS
DESCRIPTION: T -stats
OWNER: KG INVESTMENTS, PHONE #:
503-59B-9990
CONTRACTOR: GOHMAN MECHANICAL PHONE #: 503 - 650 - 158B
Inspection Request Scheduled For: Date: _ 12/13/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 041034 -01 503-650 -1566 N
Corrections /Comments / Instructions:
c - )
X PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: tr b Date: lqi 31 0 b Phone #: (503) 718 - 2. {b