Permit (9) CITY OF TIGARD ELECTRICAL PERMIT
1114
I COMMUNITY DEVELOPMENT •
Permit#: ELC2021-00682
T j C-,;�[r.T1 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 IDate Issued: 3/11/2022
Parcel: 2S1016601300
y ' e 4• Jurisdiction: Tigard
Site address: 11956 SW GARDEN PL
Project: Zoom+Care Lab&Pharmacy Subdivision: CROW PARK 217 Lot: 1
Project Description: Electrical for lab and pharmacy TI:4/8/22:REPRINTED permit to include(3)feeders and(150)branch circuits.
**WALL COVER AND UNDERGROUND/SLAB COVER INSPECTIONS COMPLETED UNDER ELC2022-00030**
Contractor: TIMBERLINE ELECTRICAL CONTRACTORS Owner: BKM PARK BC 252 LLC
PO BOX 918 BY SLK GLOBAL SOLUTIONS AMERICA
LAKE OSWEGO, OR 97035 2727 LBJ FREEWAY STE 806
DALLAS, TX 75234
PHONE: 503-459-4089 PHONE:
FAX: 503-254-4227
FEES
Quantity Description Date Amount
4 ea Services or Feeders-200 03/04/2022 $402.80
Specifics:
amps or less
1 ea Services or Feeders-201 to 03/04/2022 $133.56
Type of Use: COM 400 amps
Class of Work: ALT 29 crt Branch Circuits w/Purchase 03/04/2022 $215.18
Type of Const: Service or Feeder
Occupancy Grp: 1 ea Plan Review Electricial 03/04/2022 $187.89
1 ea 12%State Surcharge- 03/04/2022 $90.18
Electrical
2 ea Services or Feeders-200 04/11/2022 $201.40
amps or less
1 ea Services or Feeders-201 to 04/11/2022 $133.56
400 amps
Total $3,013.32
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 •- rules adopted by the Oregon Utility Notification C r. T e rules are set forth in OAR
952-001-00101hrouah OAR 952-001-0090. in, cony of the rules or direct ouestions to OUNC by callina 503.23 7 or 1. .332.2344.
Issued By: it-se - Permittee Signature: 2 -
OWNER INSTALLATION ONLY2,
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.
! t
Electrical Permit Application FOR OFFICE USE ONLY
- City of'Tigard Received i/f/ QX Permit x: � _]Oa1 —o.J_
w Date/By: L6, L4 Uui
13125 S W Hall Blvd.,Tigard,OR Plan Review '
Phone: 503.718.2439 Fax: 503.5RECEIVED Date/By: �+,i' 1 Related Permit d:
Inspection Line: 503.639.4175 Ready Date/By:' Juris: ® See Page 2 for
TIGARD Internet: wwu li and-ot'. ov Notitied/Me[hod: � �� Su lemenml Information
g g LIAR 7 2D27 PP
TYPE OF WORK f Eptlral ( )E.rot,;APLAN REVIEW
❑ New construction X Addition/rlteuttytlit/i4llfbeftfl l-< Please check all that apply(submit 2 sets of plans w/items checked):
❑ Demolition E Other: 111_ 71PR(i 10 're 4 r ''
®Service or feeder 400 amps or more ❑Building over three stories.
a�'•`�,�'��,'r n where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION r'k ' t, exceeds 10,000 amps at 150 volts or ❑Floating buildings.
❑ 1-and 2-family dwelling Commercial/industrial ❑ A c 5 y to �n� less to ground,or exceeds 14,000 0 Commercial-use agricultural
i amps for all other installations. buildings.
❑ Multi-family ❑ Master builder ❑ Other:
❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ®Emergency system.(Gen Docking St) larger separately derived
Job# Job site address: 11956 SW Garden Place ❑100H Addition mf oew motor load of system.
BUP2021-00267 IooHPormore. ❑`.A,.,"E,,,"1-z","1-3",
City/. ELC2021-00682 Tigard, OR 97223 ❑Six or snore residential units. occupancy.
0 Health-care facilities. ❑Recreational vehicle parks.
❑Hazardous locations. 0 Supply voltage for more than
sulterolag✓apt.#: Project name:Zoom+Care Lab&Pharmacy600 volts nominal_
0 Service or feeder 600 amps or more.
Cross street/directions to job site: FEE SCHEDULE
Off SW Hall Blvd at HWY 217&HWY 99W, SW Garden Place Description
I Qty. I Each I Total I
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: 2S1 01 BB01300 Ea.add'(500 sq.ft.or portion 33.92 I
DESCRIPTION OF WORK Limited energy,residential 75.00 2
This revision includes new emergency circuits to be powered by a mobile generator that (with above sq.a.)
Limited energy,multi-family hooks up to a exterior docking station to be engaged by an interior manual transfer switch. residential(with above sq.it) 75.00 2
0 PROPERTY OWNERTENANT Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
Name: Zoom+Care Contact: Kiley Gilchrist 200 amps or less 2 100.70 201.4 2
Address:1455 NW(riving St#600 201 amps to400 amps 1 133.56 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: Portland, OR 97209 601 amps to 1,000 amps 301.04 2
Phone:( 503)928-0189 Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: kgilchrist@zoomcare.com _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
X,1PPLICANT CONTACT PERSON Branch circuits—new,alteration,or extension, er panel
A.Fee for branch circuits with
Business name: Scott I Edwards Architecture LLC shove service or feeder fee, ISO 7.42 1113 2
each branch circuit
Contact name: Mark Steinhardt B.Fee for branch circuits without
service or feeder fee,first Address: 2525 E Burnside St branch circuit 56.18 2
City/State/ZIP: Portland, OR 97214 Each add')branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( 503) 896-5385 Fax: :( ) Each manufactured or modular
67.84 2
dwelling,service and/or feeder
Email: mstelnhardt@Seallp.com Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: / Sign or outline lighting 67.84 2
c c irSe Klber /7 _.''�,� C�Gr- 'c
Signal circuit(s)or limited-energy ❑ See Page 2 2
Address: � � ft S+ �(�4)1 ir�3 C. `r.�1,t panel,alteration,or extension. g
City/State/ZIP: Portland, OR-97225 1�/Sete— rl Each additional inspection over allowable in any of the above
77If ijr....Aj-j .we/ S;�.ewelVt7ldditional inspection(I hr min) 66.25/hr
Phone:( 503) 291 B Fax:( ) ..v , f/.--''7 Investigation O bruin) 90.00/hr
•� Indushialplant(1 hr min) 78.18/hr
Email: .Sli#14114013.11LeataUCIM Inspections for which no fee is
90.00/hr
CCB Lie.: OR 89425 Electrical Lie.: T.B.D. Suprv.Lie.: T,B,D, specifically listed('/hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: T.B.D. Subtotal: 1447.96
Print name: T.B.D. Date: ❑Plan Review Required(25%of permit fee):
.,� State surcharge(12%of permit fee):
Authorized signature: M ,y� '��- - `r /I TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Mark Steinhardt Date: 02/24/22 days after it has been accepted as complete.
* Number of inspections allowed per permit.
L'Building\Permits\ELC_PermitApp_ELR_ERE.doe Rev06/17/2015 440-4615T(I I/05/COM/VEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
... Desn iption Qty. Each I -rand
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: s kva or less 00.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
n Garage Door Opener* 50.01 l0 100 kva ssz 26 2
>100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
❑ 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:
❑ Other: Each additional inspection is 66.25/hr
charged at an hourly(1 hr min)
Inspections for which no fcc is 90.00/hr
specifically listed('IX hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Subtotal(Enter on Page I)
$.75 00
Fee for each commercial system: Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
Boiler Controls
(l Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
I I Outdoor Landscape Lighting*
n Protective Signaling
❑ Other:
Total number of commercial systems: _
*No licenses are required. Licenses are required for all
other installations
l:lBuilding\DermasAELC PermirApp_ELR ERE.doc Rev 06/17/2015
Branden Taggart
From: Mark Steinhardt <msteinhardt@seallp.com>
Sent: Wednesday, March 2, 2022 10:22 AM
To: Branden Taggart
Cc: Jeff Hammond; Darren Placek;Julie Drinkwater;Jeff Grove
Subject: RE: Revised drawings for issued building permit BUP2021-00267 (11956 SW Garden
Place -ZoomCare Central Lab & Pharmacy)
Caution!This message was sent from outside your organization. Allow sender I Block sender
Hi Branden,
We are preparing today to submit our revisions with the items that you have outlined below.The plumbing scope/
fixtures have not changed since the original submittal so we will not be submitting anything related to plumbing.
But we do have structural drawings and calcs confirming that the existing roof structure is adequate for the proposed
new units.Shall we submit this structural package as well? If so, do we need an application and/or transmittal letter to
submit this structural package?
Thanks
Mark Steinhardt
Designer
SEA
SCOTT I EDWARDS ARCHITECTURE LLP
2525 E Burnside St. Portland, OR 97214
0: 503.226.3617 I D:503.896.5385 I www.seallp.com
From: Branden Taggart <brandent@tigard-or.gov>
Sent:Tuesday, February 22, 2022 3:33 PM
To: Mark Steinhardt<msteinhardt@seallp.com>
Cc:Jeff Hammond <Jeff@seallp.com>; Darren Placek<dplumbingguy@gmail.com>;Julie Drinkwater<JulieD@tigard-
or.gov>;Jeff Grove<1effG@tigard-or.gov>
Subject: RE: Revised drawings for issued building permit BUP2021-00267 (11956 SW Garden Place -ZoomCare Central
Lab & Pharmacy)
Hi Mark,
I have attached our Transmittal Letter above for revisions. We will need to receive a separate Transmittal Letter for
each permit with the following:
• Mechanical permit revisions: (2) sets of revised mechanical plans, (2) sets of cut sheets for each unit, and (2)
aerial shots showing the locations of a rooftop or exterior unit(s)—if applicable.
• Electrical permit revisions: (2) sets of revised electrical plans for the emergency power system and (1) completed
Electrical Permit Application. With regard to a mobile generator on a truck, our Senior Inspector,Jeff Grove, will
likely need to review the plans and he will get back to you.
• Plumbing permit revisions: Plumbing plan review was not required for this permit. We need to receive (1)
completed Plumbing Permit Application to tell us what needs to be added or removed from the scope of
1
work. Please complete the Commercial Fixture Work section on the second page if plumbing fixtures are being
added or removed. I have attached the application above for you.
• Building permit: (3) sets of revised floor plans will need to be reviewed for egress. We will also need to know
the type of door and door closer.
Also, I have attached a PDF file of all of the associated Mechanical, Electrical, Plumbing, and Building permits that we
have on file for 11956 and 11958 SW Garden Place. Please let me know if you have questions.
Thank you,
Branden Taggart
y a City of Tigard
I ■ Senior Permit Technician
IIIII
Community Development
TUDAika
13125 SW Hall Blvd
Tigard, OR 97223
(503)718-2449
brande ntctigard-or,gov
From: Mark Steinhardt<msteinhardt@seallp.com>
Sent: Monday, February 21, 2022 1:16 PM
To: Branden Taggart<brandent@tigard-or.gov>
Cc:Jeff Hammond <Jeff@seallp.com>
Subject: Revised drawings for issued building permit BUP2021-00267 (11956 SW Garden Place -Zoomcare Central Lab &
Pharmacy)
Hi Brandon,
This project is under construction, but some revisions have come up, and we would like to know what the process is for
submitting revisions to an approved permit.
There have been some mechanical revisions due to discoveries made regarding existing HVAC units and associated
ducting.These HVAC revisions have associated electrical and plumbing revisions.
Also, there have been electrical revisions due to the addition of an emergency power system (mobile generator on a
truck, powering emergency circuits)
Finally, there are two new doors in the demising wall between 11956 SW Garden Place (Zoomcare Central Lab &
Pharmacy) and 11958 (Zoomcare Billing).
Please let us know how best to proceed.
Thanks
Mark Steinhardt
Designer
SCOTT I EDWARDS ARCHITECTURE LLP
2525 E Burnside St. Portland, OR 97214
0: 503 226 3617 I D: 503.896.5385 I www.seallp.com
DISCLAIMER: E-mails sent or received by City of Tigard employees are subject to public record laws. If requested, e-mail
2
CITY OF TIGARD ELECTRICAL PERMIT
;111a COMMUNITY DEVELOPMENT Permit#: ELC2021-00682
Date Issued: 3/11/2022
T I G AR I"1 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S101 BBO1300
Jurisdiction: Tigard
Site address: 11956 SW GARDEN PL
Project: Zoom+Care Lab&Pharmacy Subdivision: CROW PARK 217 Lot: 1
Project Description: Relocate existing panel B . (4)new breakers at existing Dist. Bd SDP-AC serving(3)new RTU's and new panel
"B2"(existing feeder remain unchanged)New circuits serving new receptacles, lighting and equipment.**WALL
COVER AND UNDERGROUND/SLAB COVER INSPECTIONS COMPLETED UNDER ELC2022-00030**
Contractor: TIMBERLINE ELECTRICAL CONTRACTORS Owner: BKM PARK BC 252 LLC
PO BOX 918 BY SLK GLOBAL SOLUTIONS AMERICA
LAKE OSWEGO, OR 97035 2727 LBJ FREEWAY STE 806
DALLAS,TX 75234
PHONE:
PHONE: 503-459-4089
FAX: 503-254-4227
FEES
Quantity Description Date Amount
4 ea Services or Feeders-200 03/04/2022 $402.80
Specifics: amps or less
1 ea Services or Feeders-201 to 03/04/2022 $133.56
Type of Use: COM 400 amps
Class of Work: ALT 29 crt Branch Circuits w/Purchase 03/04/2022 $215.18
Type of Const: Service or Feeder
1 ea Plan Review Electricial 03/04/2022 $187.89
Occupancy Grp:
1 ea 12%State Surcharge- 03/04/2022 $90.18
Electrical
Total $1,029.61
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 throuah OAR 952-001-0090. Youu my' f the rules or direct questions to OUNC by calling 503.232.1987 or 1.8 �j00.332.2344. _
Issued By: Permittee Signature:
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 RECEIVE ! FOR OFFICE USE ONLY
City of a1"(1 �etl� '�21 Nra,i,Y E4L, ez/. ( 2
• 13125 S 0 Blvd.,Tigard,OR 97223 NOV 1 5 2021 0'°�:e z �.Y . . - -..
II g Phone: 303.718.2439 Pax: 503.598.'960 . P�..-jt.I-- IC ' - r t SticrodPmadta:
Inspection Lino: 503.639.4175 CITY OF TIGARD `Reedy Jlmt. r I a i tern ,,. m Sterols 7 for
I i G A ii.D -N°""Nadmd: ( 4meenl inf«mation
,, r.. wow.tigard-0r.gav *�UiLDlNGD1VISIOP,,_ ,� � � � _ Supp
4 - -
TYPE___.. TYPE, OF WORK C.nr aa•'f`,i .. I I AN REVIEW
Plea =kali leo apply 2 sea or ohms w/items checked).
❑New construction [AdcilieNaltera[imilrepiacemeM v- s F.....1.,Pin....,cnr room ❑dui Wog over three viatica.
❑Demolition ❑Other: __-_ allele the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
.. -. __- -_ _—._ --__ less to pound,or exceeds 14,000 0 Commerciol-use egriadmN
❑ l-end 2-family dwelling l Comtnerceai/induatris1 ❑Accessory building amps for all ode insaillatio a. bui teliogs.
❑Multi-family ❑Master builder 0 Other: ❑Fire pump. ❑rnetsllatioe of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system larger separately derived
-_- _.. - _.-- -_. 0 Add Mon of ner motor load of s)13:mn.
Job#BUP2021-00267 Job site address: 11956SW Garden Place 100NPormore. 0°A",-r•,"I.2"•la',
❑sla or more recidehnial units. an/pricy.
Ciry/StaWZIP:Tigard.OR 97223 p Recreadonsl vehicle narks
tlerebh ore facilities.�. O
__ -_ otu r«urn than
Suite/bldg./apt.#: Project name:Zoom+Care Lab&Pharmac D Rawness ioc uox �F !
('' Y D set+•ice or feeder coo soma ce more. 500 robs eomiael.
4i Cross street/duections to job site: FEE SCHEDULE
. _.. -- _— N. aRa Turd _...e
Off SW Hall Blvd at HWY 217&HWY 99W,SW Garden Place Pa-id ilea
New residential skeet-or ee dli-faulty duetting atilt
Subdivision: Lot#; Includes attached garage. ...
..� ._.. _ - 1,000 W.O.or less -T 168.54 4
ry' Tax map/parcel 0:2S101 B1301300 Fa.edit 1500aq.n.or ponim 33.9z • 1
DESCRIPTION OF WORK ' l.imitad enngy,residential 75.nn 2
eli _ _— :with above s 8
Relocate eldsting panel"B'. 4 new breakers at IrldaBrlg Dial Bit.SOP AC servklp 3 new Imbed anew,muhi.mody 7s 00 2
s an I new pane ens mg'ee ors ro tamer unc.arge i 'Jew eaanls serving new residemml(with shoves.II.)
;t I I te- 'a... - I.- -..-- --- -.. ..- Renewable Ene ivy -.. 0 See Pa,.e 2
-._- �1.7•Rt ART 1;""(SWNER T'tNANT _ _ Services or leaden Wtatistion alteration,and/or relocatloe
4 Name:Zoom+Care Contact Jeffrey Schoenberg 200 amps or less + 100.70 ._ , 2
— 201 amps toall0amps / 133.56 2
i•i Addmsa:1455 NW hiving St#600 __—. _- 401 amps to 600 amps zuo 34 2
City/State/ZIP:Portland,OR 97209 601 amps to i,000amps 301.04 z
Phone:( 206)852-8751 Fox:( 1 Over 1,000 amps or volts 552,26 2
Temporary services or fenders iastollntlon,alteration,and/or
Email: jschoenberg§zoorricare.com relocation
Owner installation:This installation is being made on property that!own which is not 200 amps or less 59.36
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps es40oaolps i25.08 2
Owner signature: Date: as I Bags to599 amps 168.Sa 7
�._. _-_..-.- _. _ Branch circuits-new,alteration,ak esmeen,tier panel
= APPLICANT CONTACT PERSON _._. A.Fce for branch circuits with
."; Business name: Scott j Edwards Architecture LLC above service or feeder fee. ),,r 7.42 i 5;i i 2
_ each branch circuit .)
Contact name: Mark Steinhardt ` B.Fee for branch cirrttiis without
._ service or feeder fee,fin:
ia Address: 2525 E Burnside St Mauncrewit 5618 2
'
City/State/ZWP: Portland,OR 97214 Each midi]brands art 7.42 2
Miscellaneous servke or feeder not,ududed
bli
( 503)896.5385 Fes:: Each maro:facrured rsr modune
PhLlne: ( ) 6tsa 2
dwelling,service and/or feeder _
Email: mstelnhardt@sealp,com Reconnect only 67.84
_..__ CONTRACTOR Pump or irrigation circle 6714 2
Business name: -7' Sign or outline lighting 67.84 2
-. c Signet outli e l or limited-energy 0 See Page 2 2
Address: / 0 Balk anet,alteration.or extension. __
_ Each additional iaf,cettoa over allawabk in soy of the above
Cloy/Sea ICIZIP_ l �ht t Q • c7 i _ Addniaml in:p:coon(1 hr mint 6625/h:
Phone:(,') ) 7 5� 1 i ( )
Fax: Invertigmion(I ter min) 90.iNVte
_._ Industrial plant(Ibloin) iR-I8/hr
Email: / -
12,'.,{y_.±„L„.1'#cf i _ fi-,7,1_, ,G t_k'!? • ]mpenetons for which ao fee is 90.00/be
ein
CCBLic.: lG, ? Electri�q:-2•,_ 4•rv.[tie.: �5 - a,eciflrau, bs<t ('h hr t _
___-_ a�V'VYigg1'�w�,AtiVV,, ELECTRICAL PERMIT PAS
h �„y„- rt„tc.tRtirltr.. 1 7 , -_ Subtotal
D} `iti JAB ,I/t D 3— Q-zz D Plan Review Required(25%ofpenmtfee):
„ rrr 7Lt• IK^' J" ,\t�Ya�`. ''�t4e 0 State surcharge(1235 of permit fee): •i -
M df �' /. TOTAL PERMITFEE1 '
Authorized signature: a'e�`� '4 a'tA +'s
____-. _ --___. . . This permit applindon expires If■permit 1s not oh/ilea wk6io lEa
Print name: Mark Steinhardt We:11/11/21 days afkr it has been accepted as corepINS.
__ —.-... _ --i... __—._.._. _-_. • Number of inspecriom allowed per permit
TreyoMinyQYrmWiELC-Pnaw.xpp-ELR_ERE.d«ear 08.11Rat5 44144111[I INS.CO WEB