Permit 41,
y `CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2003-00164
"Pit DEVELOPMENT SERVICES DATE ISSUED: 5/29/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 12385 SW ASPEN RIDGE DR PARCEL: 2S110BC - TS034
SUBDIVISION: THORNWOOD ZONING: R -7
BLOCK: LOT: 034 JURISDICTION: TIG
REMARKS: New SF detached, Path 1.
BUILDING
REISSUE: DM172 STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 25 FIRST: 1,910 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 675 sf GARAGE: 400 sf FRONT: 15 PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD. 2,588 sf RIGHT: 5
VALUE: 250,345.20
OCCUPANCY GRP: R3 BDRM: 3 BATH: 2 TOTAL: 5,173 sf REAR: 15
PLUMBING
SINKS: 1 WATER CLOSETS: 2 WASHING MACH: 1 LAUNDRY TRAYS: 1 RAIN DRAIN: 100 TRAPS: ,.
LAVATORIES: 3 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS:
TUB /SHOWERS: 3 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIL /CMP < 3HP: VENT FANS: 2 CLOTHES DRYER: 1
GAS FURN > =100K: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: 1
MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 4
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 1 0 - 200 amp: 0 - 200 amp: W /SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 4 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/FDR: SIGN /OUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EAADDL BR CIR: SIGNAL/PANEL: IN PLANT:
MANU HM/SVC /FDR: 601 • 1000 amp: 601 +amps- 1000v: MINOR LABEL:
1000+ amp /volt :
PLAN REVIEW SECTION
Reconnect only:
> =4 RES UNITS: SVC /FDR > =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC:
ELECTRICAL - RESTRICTED ENERGY
A. SF RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 5,337.15
This permit
DON MORISSETTE HOMES DON MORISSETTE HOMES INC Mu is a l Code, e, State OR. Specialty the regulations contained Co i ode s and
the
4230 GALEWOOD STE #100 4230 GALEWOOD ST, STE 100 all other applicable Municipal law . All w
l Cod work will be done ialty Ce
LAKE OSWEGO, OR 97035 LAKE OSWEGO, OR 97035 all applic i
accordance with approved plans. This permit will expire if
work is not started within 180 days of issuance, or if the
work is suspended for more than 180 days. ATTENTION:
Oregon law requires you to follow rules adopted by the
Phone: 503 - 387 - 7538 Phone: Oregon Utility Notification Center. Those rules are set
5p � forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You
LI
Reg #: 387 may obtain copies of these rules or direct questions to
L1 5 $3 OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Erosion Control Insp 8 Post/Beam Structural Plumb Top Out Exterior Sheathing Ins F Rain drain Insp Electrical Final
Grading Inspection Post/Beam Mechanical Electrical Service Low Voltage Roof Nailing Mechanical Final
Sewer Inspection Underfloor insulation Electrical Rough In Gas Line Insp Water Line Insp Plumb Final
Footing Insp Crawl Drain /Backwater Framing Insp Gas Fireplace Water Service Insp Building Final
Foundation Insp Mechanical Insp Shear Wall Insp Insulation Insp Appr /Sdwlk Insp
Issued By . N _ A / !J // s Permittee Signature :,t
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day
. e • O • • O r x+54• - u t i. x c. y �, i co 3V,
A ,,
molding Permit Application 't- u-, . - x r - ' ;, ,,. } ' - d '
- Date received: X 2 9 45 Permit n o . : ct
. / e'
I Cit of Tigard� , 11 .. ; , i )
__s:, rr•; 1 ', Project/appl. no.: Expire date:
Ciry - igard Address: 13125 SW Halt Blvd; Ti gard, OR 97223
Phone: (503) 639 - 4171 ,
C)g Date issued: By: I Receipt no.:
Fax: (503) 598 -1960 ' p 2 9 �[�31,i i ase file no.: Payment type:
Land use approval: CITY OF TIGAr D_ k ,T i &2 family: Simple Complex:
cot lll. ill' G UlVZ)'' -
i' '',.. 1r s s K s..w. 3 . (t-- , w. i, ly l.- : r Q j , '%` f' a :. r n ; e.... :
A 4 - i t.21 k N _ 4` f . � IATIVa ... T1 PE llT tz`°" x „ `,` &Ifq�;. "" .4 5� ' .'
0 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family „ New construction 0 Demolition
0 Addition/alteration /replacement 0 Tenant improvement 0 Fire sprinkler /alarm 0 Other:
--4 '?'' '`s 4 •' 7. - JOB SITE INFORIIIATIOIY :'-7: f ¢ � -�
i r r r �.
Job address: 1,_ -1A1 ' 1 ' n Mg , j ) y. Bldg. no.: Suite no.:
Lot: 7-2/4 I Block: ISubdi ision: — 1 '' j ,) - I Tax map /tax lot/account no.:
Project name: k.,
Description and location of work on premises/special conditions:
1:141 1r'a ry `fit � � .4 �S�,.t�� L�R4`Nt�: ��.s � e.. F ,. a r r �. �.
1 1/ ;�'°" , 4 > „F _ - r t' ' r���04'SP CIALMINI.OII<MATION,� N67€ 4tetilIST 1 �'
� �i. I s i _ r - '; awr e ` , , ....,4 I etc -.t � '',,
�-�� �� 'T��a� i� 0 - : „. p l a) scpttccapacttY ;solar,c c ) ,-` :
Mailing address: ' ' , ) -L ,(, j - , ' + T 1 & 2 family dwelling:
City: 1 ; 0 . I Stater, ZIP: q'1). Valuation of work $
Phone: 7.. Fax: , -mail: No. of bedrooms/baths 6
Owner's representative: , A' ;♦ t i I C (i '_ Total number of floors v'
Phone: Fax: E -mail: New dwelling area (sq. ft.)
r ' APPLICANT Garage/carport area (sq. ft.)
Name: \ C \ i j 2 f .; , Covered porch area (sq. ft.)
Mailing address: 'i'Yle_- 0,6 0, ie., Deck area (sq. ft.)
City: I State: I ZIP: Other structure area (sq. ft.)
Phone: Fax: E -mail: Commercial/industriallmulti- family:
CONTRACTOR i-` V a l ua ti on o wor $
Existing bldg. area (sq. ft.)
t r � "� . 1=�= 1•� New bldg. area (sq. ft.)
Address: _ � �� Ini Number a stories
City: State: Type of construction
Phone: J Fax: 1E-mail:
CCB no.: 7) S Occupancy group(s): Existing:
New:
City/metro lic no.: Notice: All contractors and subcontractors are required to be
`- ARG IITE,,_ I�ESIGNER,` ,�`1 licensed with the Oregon Construction Contractors Board under
EIMSIMORMAritMTIMMIIIIMI provisions of ORS 701 and may be required to be licensed in the
Address: _ ,. • C I�� S w jurisdiction where work is being performed. If the applicant licant is
City: State: ZIP:
exempt from licensing, the following reason applies:
Contact person: Plan no.:
Phone: Fax: E -mail:
, f [ . ;- s, _, .ENGINEER . - j v m • - ' ' : -
Name: Contact person: Fees due upon application $
Address: Date received:
City: (State: VIP: Amount received $ _
Phone: I Fax: I E -mail: Please refer to fee schedule.
I hereby certify I have read and examined this application and the Not all jurisdictions accept credit cards, please call jurisdiction for more information.
attached checklist. A i rovisions of 1 ws and oidinances governing this o Visa 0 MasterCard
work will be complie0 wr , r, whether cified Herein rtro zj Credit card number: / /
Expires
� i
Authorized si atu _� ° A (1 �-� .[e: I � V /� Name of cardholder as shown on credit card
Print name: •� 4 �' .� Cardholder signature 1' I ( $
Amount
Notice: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440 -4613 (M)0/COM)
•,
One- and Two-Family Dwelling FVO.,. PriV :
= s ,,, . Building Permit Application Checklist Reference no.:
City of Tigard Associated permits:
City of Tigard ❑ Electrical 0 Plumbing 0 Mechanical
Address: 13125 SW Hall Blvd, Tigard, OR 97223 0 Other:
Phone: (503) 639 -4171
Fax: (503) 598 -1960
- TIIEFOLLOWING ITEMS ARE - REQUIRED FOR. REVIEW _Yes. NO N/A
1 Land use actions completed. See jurisdiction criteria for concurrent reviews. V
2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc.
3 Verification of approved plat/lot.
4 Fire district approval required.
5 Septic system permit or authorization for remodel. Existing system capacity
6 Sewer permit.
7 Water district approval. �(
8 Soils report. Must carry original applicable stamp and signature on file or with application.
9 Erosion control 0 plan 0 permit required. Include drainage -way protection, silt fence design and location of t /
catch -basin protection, etc. J�
10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state
building codes. Lateral design details and connections must be incorporated into the plans or on a separate full -size
sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed r/
if copyright violations exist. J�
11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if
there is more than a 4-ft. elevation differential, plan must show contour lines at 2-ft. intervals); location of easements and
driveway; footprint of structure (including decks); location of wells/septic systems; utility locations; direction indicator, lot x
area; building coverage area; percentage of coverage; impervious area; existing structures on site; and surface drainage.
12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent
size and location.
13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater,
furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc.
14 Cross section(s) and details. Show all framing- member sizes and spacing such as floor beams, headers, joists, sub -floor, •
wall construction, roof construction. More than one cross section may be required to clearly portray construction. Show
details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings and foundation, stairs,
fireplace construction, thermal insulation, etc. J�
15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels.
• Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope.
Full -size sheet addendums showing foundation elevations with cross references are acceptable.
16 Wall bracing (prescriptive path) and/or lateral analysis plans. Must indicate details and locations; for
non - prescriptive path analysis provide specifications and calculations to engineering standards.
17 Floor /roof framing. Provide plans for all floors/roof assemblies, indicating member sizing, spacing, and bearing
locations. Show attic ventilation. /�C\
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered
systems, see item 22, "Engineer's calculations."
19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists
over 10 feet long and/or any beam/joist carrying a non - uniform load.
20 Manufactured floor /roof truss design details. • �(
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas - piping schematic is required
for four or more appliances.
22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or
architect licensed in Oregon and shall be shown to be applicable to the project under review.
JURISDICTIONAL
23 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ".
24 Two (2) sets each are required for Items 16, 19, 20 & 22 above.
25 Building plans shall not contain red lines or tape -ons.
26 No rolled, reversed or mirrored building plans will be accepted.
27
28 •
Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black ink.
Red ink is reserved for department use only. 440-4614 (6A0/COM)
•
Mechanical Permit Application
• A , Date received: 03 Permit noi'1 , .,,,,5
h � t 1 City of Tigard .4.4. -...1. Y b Projecdappl.no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: Building permit no.:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ Tenant improvement , •
XIew construction ❑ Addition/alteration/replacement ❑ Other:
• JOB SITE INFORMATION ' COMMERCIAL VALUATION SCHEDULE - -
. Job address: 15 ' , / f DC Indicate equipment quantities in boxes below. Indicate the dollar
•
Bldg. no.: I Suite no.: value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: profit. Value $ .
Lot: IBlock: I Subdivision:` NA/a: *See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
City/county: I ZIP: 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE' •
Description and location of work on premises: AND COMMERICALIINDUSTRIAL EQUIPMENTSCHEDULE
. Fee(ea.) Total
Est. date of completion/inspection: Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC:
Air handling unit CFM
Is existing space heated or conditioned? ❑ Yes ❑ No
Is existing space insulated? ❑ Yes ❑ No Air conditioning tif xi existing plan required)
g P _ _ _ Alteration of existing HVAC system
' MECHAN CONTRACTOR Boiler /compressors
f ` State boiler permit no.:
Business name:
X1.1 HP Tons BTU/H
Address: llN Fire/smoke dampers/duct smoke detectors
EIB��j�i• ���M ZIP: '111,16.1 Heat pump (site plan required) ,
Phone ."7-52-)D Fax: E -mail: InstalUreplace furnace/burner BTU /H
Including ductwork/vent liner 0 Yes U No
CCB no.: '?)�r = 3(" Install/replace/relocate heaters- suspended,
City/metro lic. no.: N/A wall, or floor mounted
Name (please print): • gp t 1 *AM' 1�R _t___ Vent for appliance other than furnace
CONTACT PERSON Refrigeration:
Absorption units BTU/H
Name: °I E32-1—
111 t`�C�.t --� Chillers HP
11 Address: ' mil'✓ c - alxvto • Compressors HP
Environmental exhaust and ventilation:
City: I State: rZIP: Appliance vent
i Phone: Fax: E - mail: Dryer exhaust
O � 1' N E R Hoods, Type U 11/res. kitchen/hazmat
hood fire suppression system
Milti t Ba'ta�� Exhaust fan with single duct (bath fans) .
Mailing address: IF � �� ar S>� - AIll Exhaust system apart from heating or AC
��.�� Fuel piping and distribution (up to 4 outlets)
�� CiLSZ�•irw�� ��� Type: LPG NG Oil
Phone: asa2 Fax: E -mail: Fuel piping each additional over 4 outlets
. _ .. ENGINEER Process piping (schematicrequired)
Name: Number of outlets •
Other listed appliance or equipment:
Address: Decorative fireplace
City: I State: [ZIP: Insert - type
Phone: Fax: E -mail: Woodstove/pelletstove , Other:
Applicant's signatu ��, ' ' ; Date: Aill 0537 i 5 Other:
Name (print): (- J ) .r ' ► ri - nc /1
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $
r
❑ Visa ❑ MasterCard Notice: This permit application Minimum fee $
Credit card number: / / expires if a permit is not obtained Plan review (at _ %) $
Expires within 180 days after it has been State surcharge (8 %) .... $
Name of cardholder as shown on credit card accepted as complete.
S TOTAL $
Cardholder signature Amount 440 -4617 (6N0/COM)
• Plumbing Permit Application . .., yk ` - .
Datereceived: f 03 Permit no.:1156 , 1205-€90/e/
: City of Tigard
Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd, Tigard, OR 97223 projecUappl no.: Expire date:
CiryofTigard Phone: (503) 639 -4171
Fax: (503) 598 -1960 Date issued: By: Receipt no.:
Land use approval: Case file no.: Payment type:
TYPE OF PERMIT •
O 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family 0 Tenant improvement
b7. ew construction O Addition/alteration/replacement 0 Food service 0 Other
- JOB SITE INFORMATION FEE SCHEDULE (for speci inf use checklist)
A, / Description Qty. Fee(ea.) Total
Job address' :� nee, . New 1- and 2-family dwellings only:
Bldg. no.: Suite o.: (includes 100 ft. for each utility connection)
Tax map /tax_lot/account no.: SFR (1) bath
Lot: Block: Subdivision: V * W SFR (2) bath
• Project name: SFR (3) bath
City /county: I ZIP: Each additional bath/kitchen
_ Description and location of work on premises: Site utilities: .
Catch basin/area drain
Esi date of completion/inspection: Drywells/leach line/trench drain
—_ Footing drain (no. lin. ft.)
PLUMBING . CONTRACTOR Manufactured home utilities
Business name: TN p 1. v Manholes
Address: k_��gg • Rain drain connector
� ,��, / ft.
i!),�t -�. �'� ZIP: Sanitary sewer no. lin. Storm sewer (no. lin. ft.) ft.)
Phone: E -mail:
M 1 Fax: _ !well Water service (no. lin. ft.)
CCB no.: t. ar. - 7 L Plumb. bus. reg. no:
� � Fixture or item:
City/metro lie. no.: N/A Absorption valve
Contractor's representative signature `�.� — Back flow preventer
• 1 • / i ' I Backwater valve
CONTACT PERSON Basins/lavatory Clothes washer
Name: P.\\--t . SPc��I Dishwasher
Address: ., 'AL , I b V, ,V Drinking fountain(s)
City: State: ZIP: Ejectors/sump
Phone: Fax: E -mail: Expansion tank
y "_: OWNER Fixture/sewer cap
Fl oor drains/floor sinks/hub
Name (print): !�( [;'� �1�` 'j �r� t �" , G arbage d isposal
Mailing address: � • 'If .. lab • , • A Hose bibb
City: _ () State , ZIP:q Ice maker __
. I Phone: , f , - /a [ Fax: •,7-70 . E -mail: Interceptor /grease trap
Owner instal lation /residential maintenance only: The actual installation Primer(s) _
will be made by me or the maintenance and repair made by my regular Roof drain (commercial)
employee on the property I own as per ORS Chapter 447. Sink(s), basin(s), lays(s) _
Owner's signature: Date: Sump _
ENGINEER - Tubs/shower /shower pan
Urinal _
Name: Water closet
Address: Water heater
City: I State: I ZIP: Other.
Phone: Fax: E -mail: Total
Minimum fee $
N« all Jurisdictions p
accept credit cards, please call iunsd eumore on for more information. Notice: This permit application Plan review (at %) $
l_' Visa 0 MasterCard expires if a permit is not obtained
Credit card number. / / within 180 days after it has been State surcharge (8 %) .••• $ Expires TOTAL $ -_—.—__-
accepted as complete.
Name of cardholder as shown on credit card
S
Cardholder signature Amount 430.4616 (600■COM)
Electrical Per Application -
. Ai k . :. Date received: I O " Permit no.: yj .40/6 A
4 741 'Jyl` City of Tigard Project/appl. no.: Expire date:
City ofTigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By: Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
TYPE OF PERMIT "
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement
I' New construction ❑ Addition/alteration/replacement ❑ Other. ❑ Partial
JOB SITE INFORMATION
Job address: t( - SO) 11. " - • ' ' . e 'D Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: Block: Subdivision: 'l(rAN jd •
Project name: I Description and location of work on premises:
Estimated date of completion/inspection: •
"p CONTRACTOR APPLICATION . • - FEE SCHEDIILE. .. -
Job no: Fee • Max
Business name: CAC1t - [X -‘ Description Qty. (ea.) Total no. Irtsp
� `� New residential -single or multi-family per
Address: ) 69,0 , -) 4,, 4,, 2 T,� - -t. S' -- (---r 7 dwelling unit. Includes attached garage.
City: 'TA 1,1\--12___V? Stater ZIP: c 3 Service included:
� > 1000 sq. ft... or less • 4
PhOne:L 7j ° IC I3) Fax: E Each additional 500 sq. ft or portion thereof
CCB no.: / f o}. Elec. bus. lid. no: 01 C Lmi energy, residential 2
C Limited energy, non - residential 2
�� Each manufactured home or modular dwelling
mature of supervising electrician (required) Date �d3 Service and/or feeder 2
Sup. elect. name (print): ..... 9 , ef_ A1 ' License no: l �5 Sernces orfeeders- installation,
alteration or relocation:
. . PROPERTY OWNER 200 amps or less 2
• Name (print): l� >S" `9 • JC_.i t G 1(,` �7- ? 201 amps to 400 amps 2
-�- �}{ r , 401 amps to 600 amps 2
Mailing address: 33 )0 ti 5a . 'Ti , a . 601 amps to 1000 amps 2
City: L., Q, State 703 Over 1000 amps or volts 2
Phone:? } Fax : 7b(,E -mail: ' Reconnect only 1
Owner installation: The installation is being made on property I own Temporary servicesorfeeders -
which is not intended for sale, lease, rent, or exchange according to installation, alteration, orrelocation:
200 amps or less 2
ORS 447, 455, 479, 670, 701. 201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 amps 2
— ° ' " 'ENGINEER • -' Branch circuits - new, alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: I State: I ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: 2
Phone: Fax: E-mail: Each additional branch circuit:
PLAN REVIEW (Please check all that apply) . ' Misc. (Service or feeder not included):
❑ Service over 225 amps - commercial O Health -care facility Each pump or irrigation circle 2
❑ Service over 320 amps- rating of 1 &2 ❑ Hn7ardous location Each sign or outline lighting 2
family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
o System over 600 volts nominal more residential units in one structure alteration, or extension* 2
❑ Building over three stories ❑ Feeders, 400 amps or more *Description:
O Occupant load over 99 persons O Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
O Egress/lighting plan ❑ Other Per inspection 1
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Permit fee $
N04 all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application $
❑ Visa O MasterCard expires if a permit is not obtained Plan review (at _ %)
Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $
Expires accepted as complete. TOTAL $
Name of cardholder as shown on credit card
Cardholder signature Amount 410 1615 (6d10/COM)