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Permit Y „ CITY OF TIGARD MASTER PERMIT 1111 COMMUNITY DEVELOPMENT Permit #: MST2011 -00193 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/16/2011 , CAR:I 9 g Parcel: 2S104CD04700 Jurisdiction: Tigard Site address: 13867 SW BENCHVIEW TER Subdivision: HILLSHIRE ESTATES Lot: 47 Project: ARMELI Project Description: Wine cellar addition in crawl space. BUILDING Floor Areas Required Setbacks Required Stories: 0 Bedrooms: 0 First: 0 sf Basement: 407 sf Left: 0 Parking Spaces: 0 Height: 0 Bathrooms: 0 Second: 0 sf Garage: 0 sf Front: 0 Smoke Dwelling Units: 0 Third: 0 sf Right: 0 Detectors: Yes Total: 407 sf Value: $41,473.30 Rear: 0 PLUMBING Sinks: 1 Water Closets: 0 Washing Mach: 0 Laundry Trays: 0 Rain Drain: 0 Urinals. 0 Lavatories: 0 Dishwashers: 0 Floor Drains: 0 Sewer Lines: 0 SF Rain Storm Sewer: 0 Drains: 0 Tubs /Showers: 0 Garbage Disp: 0 Water Heaters: 0 Water Lines: 0 Catch Basins: 0 Bckflw Prevntr: 0 Footing Drain: 0 Ice Maker: 0 Hose Bib: 0 Backwater Value: 0 Other Fixtures: 0 Drywell- Trench Drain: 0 Other Fixture Units: MECHANICAL Fuel Types Air Conditioning: N Vent Fans: 0 Clothes Dryers: 0 Heat Pump: N Hoods: 0 Other Units: 1 Furn <100K: 0 Vents: 0 Woodstoves: 0 Gas Outlets: 0 Furn > =100K: 0 ELECTRICAL Residential Unit Service Feeder Temp Srvc /Feeders Branch Circuits 1000 sf or less: 0 0 -200 amp: 0 0 -200 amp: 0 W/ Svc or Fdr: 0 Ea add, 500 sf: 0 201 -400 amp: 0 201 -400 amp: 0 W/O Svc/Fdr: 1 Mfd Home /Feeder /Svc: 0 401 -600 amp: 0 401 -600 amp: 0 601 -1000 amp: 0 601 +amp -1000v 0 1000 +amp /volt: 0 ELECTRICAL - RESTRICTED ENERGY SF Residential Audio & Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All Other: N Other Description: Ecompasing: N BUILDING INFO Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet: ALT SF VB R -3 407 Owner: Contractor: ARMELI, THOMAS F & TERRI F CREATIVE HOME REMODELING CO Required Items and Reports (Conditions) 13867 SW BENCHVIEW TER 7350 SW LANDMARK LN TIGARD, OR 97223 TIGARD, OR 97224 PHONE: PHONE: 503- 639 -2411 FAX: 503- 639 -0950 Total Fees: $1,577.07 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 ado•ted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through O:' 952- 001 -0090. You may obtain a copy o - rules or direc • uestions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued B ' —� ___ _ � Permittee Signature: a A LL► "2"" Ca t ^ w by 7:00 a.m. for the next available inspection date. This permit card s • • • ept 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. 11/08/2011 10:55 5035981960 CITY OF TIGARD PAGE 01/02 Building Permit Application _ Residential r•Oit it a: tit:caNJ1 -. C ity of T igard $4C) :eat:mind; el ; 13125 S W Halt Blvd, 7igard,OR 97223 "ro ; Q r �� Permit No,: . 7 � , a Ravic -� hall Other Permit: rd i [� ' Phone: 503.718.2439 Fax; 503.598.196�� ,� s/G,Ij . , Inspection Line: 503.639.4175 ok �� c1 Data Roadyf . y; � ® See Page 2 for Internet: www.tigard- ir,gov ) Notified/Method: . - J Supplemental lnibnnadon 4.4�'�s5,�,yi > >4 - of °jkGfi ��' Y . • 'c'•c:.,:; ;a;1,�riritkfn + ?i!;TniSri , „(;{'.'i�`l':r = 'I' �. .�Ij ,•i � .'�Y:an> 1 Ihlfi,,:. '.. (� r.F.i •'- r�l �.':.1y ,.. ... .` d�.K I . � . �I V�. , , ❑ New construction ❑ Dem,(rl> , Permit fees' arc based on the value of the work performed. ��, Indicate the value (rounded to the nearest . dollar) of all ID et, Addition/alteration/replacement ❑ OthS equipment, materials, labor, overhead, and the profit for the `~d' , •: eja Gijjrot: : :dr RU k6 • - : .,.... . work indicated on this application. I- and 2- family dwelling ❑ Com mercial/industrial Valuation: $• I ) -” ❑ Accessory building ❑ Multi - family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms; ti ;:. OD Eli LA Total number of floors: ,41.l�11i�9: �i�OC : SGiI _ lob site addrese ' ? (3� S IGN V I -- /— New dwelling area: - rt square feet City /State /ZIP: - 7 19/2 9 7Z Z 3 Garage/carport arca; ' square feet Suite/bldg. /apt no.: Project name: 4/ (-L / Covered porch arca square feet Cross street/directions to job site; Deck area: . square feet Other structure area: square feet Subdivision: Lot no.; Perrni fees"' are based on the value of the work performed. t indicae he value rourdd c to the nearest dollar) map /parcel no.; ( ) of all equipmen materials, labor, overhead, and the profit for the °' '''' . • DES4 IUIP',k'T4*,arf-WORii: _ work indicakd on this application. i z'A AAI I S�Qt?� tilt , l c J /e%1 r . Valuation: $ / C Existing buildin area ' square feet New building arca: / square feet rd PROPERTY: OWl in,.T i * Number of stories: Name: RO n/ 6- I2a? -t/ l Aryhezt l • Type of constru zt • Address: 6 5 54, 7 , .., j3Nc —f7 V I ew / �6E P./ C.t� Occupancy groups; City /State /ZIP: I 4 E D rte-- 9 4`223 Existing: •Phone: (5D3) 3 • ef / $s 3 Fax: ( ) New: ` [' iti ttlICAINT- 11,.:`, ; -'; q -: CONTACT :,Y!Ef.SOft :::. ::. ,�:B D)INPR ? •� :: Rug -, L,:.-.. Incas name: GI- EATIImo- Nom �64`tvDE� lN . , . rev rdeil; .: . Contactnarne: 6 e4 6 H4 'VA F L1' Structural plan rev iew f ee (o deposit): 5• ^ �� i1 S plan review fee (if applicable): �- Address: � c - p 5 � L A ND M/� City / State/ZIP: PO �7 L D il 0 e. ly 2-2 -L/ Total fees due upon application: Phone; (5 Co 39 ' 2 he Fax; ; (co!) 6037- T t� "7950 Amount received: •- / — Q � ;• ;M : E�"i 1 L . t I l.. E-mail; CI C" r ear Gb erno d �i ill , ca n ;;:;' •.:‘ .... ' � Commercial nd residential prescriptive f cscriptive installation o' : �� • " • .• • ,• - • • . ; , •.• �••••� mounted.PhotoVoltatc Solar Panel System. Business name: C 4 Tf v t_to 1'r� w i � M a p 4. L / A16— Submit two (2) sets of roof plan with connection details 4 �! and fire deportment access, along with the 2010 Oregon Address 3 4-® _5 L 4 ! e Di-IAA/4, LN Solar lnstallotion Specialty Code checklist. City / State/ZIP: PO g "7 Am D O 12 1'4 2-2.6 -/ Permit Fcc (includes plan review $180.00 and administrative fees); Phone: 5 3) G 3 it. / ` Fax; (5o3) 6 ? - ogco State surcharge (12% of permit fee); $21.60 CCB tic.: 135 7 06, s--- / 19 11 Total fee due upon application: $201.60 Authorized signature: /', This permit application expires it a permit is not obtained ��_ , � 616 � t , b '- ' r � C4-1- 4 1 t R within ISO days after it has been accepted as complete. �I(� Print name: ' - t A Da te: F) - q- — 1 /// ' Fee methodology set by Tri County Building Industry �`{ Service Aoard, I: \Building \Permits \BUP- RESPcrmitApp.doc 02/24/2011 440 4613T(11 /02/COM/VVEI3) photo.JPG 107 KB Part 1.3 25 bytes 2 of 2 11/8/2011 8:29 AM . his -, - Mechanical Permit Application , V T__ __ _,HOR OFFICE USE ONLY _ _ - 9 City of Tigard �� G Date/By: /� / f/ PermitNo.S7O / /_QO`52 13125 SW Hall Blvd., Tigard, OR 9 2 ,,, !!! -a . Plan Review C : - Phone: 503.718.2439 Fax: 503.598. f ` r L� Date/By: Other Permit: iv ' TI G A R D Inspection Line: 503.639.4175 `, ' J Date Ready/By: Iuris See Page 2 for Internet: www.tigard- or.gov �\OV { r ` Y : ' , - ' Notified/Method: ,l s uppleme n tal Information \v '0 ` f\` t t U/ TYPE OF WORK C , , 41 w COMMERCIAL FEE* SCHEDULE - USE CHECKLIST Q \v- Mechanical permit fees* are based on the value of the work [New construction ❑ Addition /alteration/reacement performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. Value: $ CATEGORY OF CONSTRUCTION RESIDENTIAL EQUIPMENT / SYSTEMS FEES* W I - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building For special information use checklist. ❑ Multi - family ❑ Master builder ❑ Other: Description Qty. Ea. Total JOB SITE INFORMATION AND LOCATION Heating/cooling: Air conditioning Job site address: i 3 *O 7 5t,,J &,u" 1 I . 6 - - t��2AC� (requires site plan showing placement) 46.75 ` / I Furnace 100,000 BTU (ducts /vents) 46.75 City /State /ZIP: i ��.1i lc D (9le_ c 7- 22,3 Furnace 100,000+ BTU (ducts /vents) 54.91 Suite/bldg. /apt. no.: Project name: l R me L f Heat pump (requires site plan showing placement) 61.06 Cross street/directions to job site: Duct work 1 23.32 Z3 • / gUij Ott t t red Flydronic hot water system 23.32 Residential boiler (radiator or hydronic) 23.32 Unit heaters (fuel -type, not electric), in -wall, in -duct, suspended, etc. 46.75 Subdivision: Lot no.: Flue /vent for any of above 23.32 Other: 23.32 Tax map /parcel no.: Other fuel appliances: DESCRIPTION OF WORK Water heater 23.32 n Gas fireplace 33.39 W741 0 CP.P(6.4- Flue vent for water heater or gas fireplace 23.32 Log lighter (gas) 23.32 Wood/pellet stove 33.39 Wood fireplace /insert 23.32 1E1 PROPERTY OWNER ❑ TENANT Chimney /liner /flue /vent 23.32 Other: 23.32 Name: ram 1 ' j er - r, A r � � / Environmental exhaust and ventilation: Address? • 3 r/_ "J ! 5 & � c A v Thy y y .� �1 � Range hood /other kitchen C�' equipment 33.39 City /State /ZIP: QJ tom- q 72-2 3 Clothes dryer exhaust 33.39 (9 5 �y Single -duct exhaust (bathrooms, Phone: 5 F ax: ( ) toilet compartments, utility rooms) 23.32 [APPLICANT ❑ CONTACT PERSON Attic /crawlspace fans 23.32 Other: 23.32 Business name: /I r D� (. ✓, o ,� rn 0 � � l� G Fuel piping: Contact name: - ��„L - , / t!1.�4 ' • $14.15 for first four; $4.03 for each additional - .- ?� Address: Li Furnace, etc. Gas heat pump City /State /ZIP: /1-- r( - q-02_/./ Wall /suspended/unit heater Phone: ( 60 (34f 0,L.0/ Fax:: ) WC/ 05 7) Water heater 1 /� ( Fireplace E -mail: (�. 5 0 Cre4t -h 1 b IMeroi 1 � I , (. Range e u CONTRACTOR ' Barbecue Business name: b. eiL f i A, 14 - ke deli V1-‘ G Clothes dryer (gas) Address: q0 31,t) k a.44 /vim, k_ MECHANICAL PERMIT FEES* City /State /ZIP: - Pe -± aAld 01- .g-iZ, y Subtotal ' Z Phone: b3) f� ' j �- Fax: � Z� �^b Minimum permit fee ($90.00) (?. lP 7i ` ( 3‘i �J P lan review (25% of permit fee) CCB lic.: ( 5 0 State surcharge (12% of permit fee) '(C t Rt',, I/l TOTAL PERMIT FEE l co , N:3 Authorized signature: n/ l This permit ap expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: Aci v, e.i,i ii e. Met ff- i p `( Date: it / 15I (1 * Fee methodology set by Tri- County Building Industry Service Board I:\ Building \Permits \MEC- PermitApp.doc 09/09/10 440 -46177 (I1 /02 /COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial & Multi- Family Fee Schedule: Total Valuation: Permit Fee: $0.00 to $500.00 Minimum fee $69.06 $500.01 to $5,000.00 $69.06 for the first $500.00 and $3.07 for each additional $100.00 or fraction thereof, to and including $5,000.00. $5,000.01 to $10,000.00 $207.21 for the first $5,000.00 and $2.81 for each additional $100.00 or fraction thereof, to and including $10,000.00. $10,000.01 to $50,000.00 $347.71 for the first $10,000.00 and $2.54 for each additional $100.00 or fraction thereof, to and including $50,000.00. $50,000.01 to $100,000.00 $1,363.71 for the first $50,000.00 and $2.49 for each additional $100.00 or fraction thereof, to and including $100,000.00. $100,000.01 and up $2,608.71 for the first $100,000.00 and $2.92 for each additional $100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. I:\ Building \Permits\MEC - PermitApp.doc 09/09/10 2 11/16/2011 17:00 FAX 360 576 7422 Prairie Electric Inc. EJ001. /001 FROM Creative Home Remodeling 503 - 639 - 0950 (WED)NOV 16 2011 15:13/3T. 15:12/No. 6807758448 P 1 • Electrical .Permit Application,] 1, .,"'I; t tl )' l ; •, (?6 City of Tigard Racivcd" Pcrmil.N,i' /� �),. SI �� Date/my; J ' ' S u QLU 13125 SW Hall Blvd., Tigard,OR 9 r`Q Plan Review ether Penult: 503,718 ::439 Tax: 50 1r ' •0 ® Date/By: inspection Line: 503.639.417 1 � Dole Acidly/fir Luria: la $4.* Pier: 2 for Internet: www.til;ard- or.gov aV O ,4��' Notifiod(MothO4 YJW^ !Supplemental torornr.tton • ,: ;1 ;'; i'., '..'r',1, , -. � ©]I Y,N • , ! : :'. ''l.Y -A " ' : (. j P 'Ol,W4 ' eW construction AQdIt10n /altefati •'r. �r meet Mew chock all that apply (submit a Sets of plans Wilms chex ked below): re, � ❑ Service or feeder 400 amps or more ❑ Building over ihrcc stories, ❑ Demolition El Other: .Q Whore the available fault current ❑ Mannar; and hoalyank. c� :r.. /r� �a p.�{y��j/y�r S ..',, . , exceeds 10,000 amps at 150 voltx ' r El Floating buildings. .;4`:: ':" C �. i' r, ':X: 1�: ? A,:%=' y- �7C�A1�F '!"A�'„°`- 1!'�,:�!/_el�Cr.. il' -M.� . �!t•� r. ): '.: r - t eas a 10 ground- amps ps at l I o voli 0 C eating fa use agricultural I and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building ramps for all other installations buildings, ❑ Other: F ire pump. 1 ❑ nsialla of 7 KVA vy m ❑ Multi - family ❑ Master builder Cl 1 or �;'�a�a gW�Ld�,U��,�/i ❑ Emergency system_ larger ep d . vt U ..;,�," ��.:: ,. ' Addition ofacwmotor load of ❑ "A ", "2 " "1.2 " "1•' , .. ]OdHP Ur mp,t, occupancy, Job no.: Job site address: 13 6 7' .505 .ee. J ❑ Six or more residential in Recreational vpFl°le park. ❑Hu+lth.ca El Hazardous locations. rc facilities 1::) SUVUIY voltage For more than City/State /ZIP: 7 600 volts nominal, 2' Suite/bldg: /aptno,: Project name: 4. P ❑ Service or feeder 600 ampsormore. t u Cross street/directions to job site: , .. ,., OM Vac Total • New residential single- or m ultt• family dwelling unit. . Includes attached garage. Subdivision: - ." Lot. no.: 1,000 sq. ft. or!pl - 168.54 4 - Ba, add'I 500 sq. (L or portion 33.92 I Tax map /parcel no.: Limited energy, residential 75,00 � - : ,D$Se* ' $ ,O ic, ;. 5: g (with above : +: t ' �dK:�� ,�� y�� t i . �_'sn y ,., . � .r•Vft�>,i!y0{, t ith b ( �' ft. Limited energy, multi- family 75,00 2 (*,144/4.)-( . )� r , i,. _ C" ! /w residential it) abovesy. i t N / J L/" V 1 ` U�'�`�► Services or feeders installation, alteration, and/or relocation • 200 amps or less 100.70 2 • ,�.,p1 w ,: 1 , ! 1,, ; '1::',..:- . ... .: 201 amps to 400 amps 133.56 2 ::'. "' 401 amps to 600 amps 200,34 2 Name: I i. t 7 r -' - -.___L____ 6(►1 amps to 1,000 amps 301.04 2 Address: r S I/ /• 4 -LCC Y Over 1.000 amps or volts 552.26 , 2 - . T>� Temporary services or feeders installation, alteration, and/or City/Statc/ZiP: ! _ 1 2-7_3 relocation _ t 200 amps or less 59.36 i Phone: (e O � Fax: ( ) 201 amps to 400 amps 125,08 2 Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Rrontb circuits- new, alteration or extension, ter - panel Owner signature: Date: A. Fee for branch circuits with • •, a�A .._:." above service or feeder foe, 7.42 i ja41. ,, ��o i *. ',&1 :e,- ;: -: 7 : .il)1 �;�, :t�,��atii % 5!v, ![ +.a�.y,'.- n..:.. w. r- v each trench circuit Business name; (1� 4 2 ` i • ,- / B. Fee for branch circuits without ti.�d ! k service or feeder fee, first 56.18 5G, l j Contact name; z l� , l�l i1�'L L y l branch circuit , ,/ Each odd'I branch evait 7.42 2 • Address: C , 4 / nv T 44 /V' A / ee L Miscellane•oua service or feeder not included � �� Each manufactured or modular 0 2 CCity/State '�d [ T �T /f � ¢ r je % dwelli g, service and/or feeder " ... Cy'" Phone; c ReLoruloctonly 67,84 2 5 & 9 Z>� I/ Fax: (�3) L D 67 "84 2 Pump n it only on circle E -mail: 4/ h) C' r c€9,--, , Sign outline lighting 67.84 - ::7b l' ;N, ., : ' 1J ( ;,��, il' ;' ;Ui ”D ,ra 6,.:' 5 -!•t.: ",. .0,:2A.n , gigrml circuit0i) or limited - energy : I alteatlo. orestension. 11.1 Pa :e _ 2 Business name: / t v , �" C �G r �r/ Each additional Inspeedon over allowable in an of the above Address: 6d d , 6 Additional inspection (1 hr min) 66.25/ hr — Investigation (I hr.•min) 66.25/ hr Ci ty/$tatc✓Z1P: '4 12 . � . � Industrial plant (1 hr min) 78.18 / hr Phone: ( ) 7 3 — ,.L'? P (3eD4 57 \ S —Ct a c" Inapeciwns for which no fcc is 9000/ hr s. Mead Listed % hr min CC13 Lic.: 0 , Electrical Lic,: Il ( Supry, Lie.: 5� E5r' ,6 f it 1 ' r r., i„ 14 , 1 '1 t t 1 i; :11 Subtotal! s t e , • _, prv. Electrician signature, required: Plan review (2S °6 n emit fee]'. r , t r Q S tor e ue,rcha rae (12't(. of permit foe) ; -t4 , • 'tint name: � V� t OC Darer (( I �Q — TOTAL PERMIT FEB: • 1 �i P r` t Authorized signaw „If 'Phis p ermit a pplication expires if a permit is not obtained *Milo 180 _, - ._ days days aRcr it her been accepted as complete, Print narnc: t. Date: • Number of inspections allowed per permit. ,.m..., �,__,°___._��. .,_._:, •., -�,,.. mrr u,n 140- 4413T(1 I/U5 /COM/'ED I IV, iU 1_c.i I. e_II_ • ../t!1 I I\UI I • ,• I.J1 I I I I- • I I_lJI I.L I YI 1 ..JC1U )J7O 3J._ _' I U. J r . l FROM Creative Home Remodeling 503 - 639 - 0950 (WED)NOV 16 2011 15:31/ST.15:31/No.6807758 1 1 Plumbing Permit Application -. ntinafleng Fixtures n.e+•.e Permit Noy il City of Turd Ph o„,: 13125 SW Hal! Ellvd„ Tigard, OR Plan Review P A : 4 ellnaars ..-0013. Phone: 503.718 2439 Pax 503 . afar Ps rmlt No.: Internet www tl Line: 503.639.4f 75 \ '� `wD9ne�i3alylBy: ate:: ®9m ea errr�ar .1 .. , Jt �d.or �,. I , � '• ' Vii✓ v` "..^ 1 � I q;.4,-1 •� , rat �. 7y !� �� I •. t` 1 ��. 1 . � �. �, �.:,+. •.fir : »-41!' ". 11 ,Y yJ[n/�`r 4AX n r' F ll P�. b4 11`' �'!• K • :fi. � nb r .Yr. � - (3'}1 w construction 0 D � e.. tiA � 'rti0n FiArr�odri6slbr o 1 Total ( `AdditiwJoltortionheplaceroent 0 Other Now 1 24321il ydwdli 1(n) ft. forbid= ert5i utirs�comaouae) .I a - 4 •• ' ; s : • SFR 16Wb 312- 4 . r w yr., r l . ^ , c 3, .:- ..L . • E, ' 49t'Y SFR (2) bath 437.74 P. .:fled 2-family dwelling ❑ CommerciAl/mdwlri$) sip (3) bath 50032 ❑ Ulm bry building • ❑ Multi - family Bach addition) bath/kitchen 25.02 ❑ Mincer buUder 0 Other: Pk sprinkler (__.__ sq. ft) Page 2 1 it ,) w.r t>,n , .-r 1t� .• Rn*11� q/FtR She edltid: ., r�. h . • 1� des, r ro� Y17 . . r. tip e' Ouch baths or area drain 18.76 lob site address: � �jed tC.+'6 dfeti✓ J Drywdl, kaab lim or mmeli drain 13.76 _ City/State/Zit' / JY it/) F C ' ' - 1-z -z _Footing . linear 11.: Page 2 Suite/bldg. /wt. no.: Project name: , f+f A../ / Manufactured horns utilities 50.03 Cross street/directions to job site: Manholes • 18,76 Rain drain Connector 18.76 - --- Sanitary sewer (no. linear ft.: ___) Page 2 Swam reuses (no. linear ft.: _J Page 2 Weer service (no. linear is .) Pic 2 _ , Subdivision: f Lot no.: Fixture or Way + '' $addiuw presenter 31.27 tax ►naP /pared no.: 12.51 Backwater va C.I�tsa�d ��_Go-is .2.. -- -r - /'- biome', 25.02 Drinking fountain _ 25.02 FFaecleaSt unnp 7.5.02 ! ?acpansioo tint 12 Y- :` . '. ' . .01%,„, '. .i:..' 25.2 - - - Fixtund ewer cap , Nome: 6,.. r ., i . n-r re 11 . Floor drain/Rom aittc/bub 23.02 Addtrsa: ' .4 � ' l' - ,_ii. . Garbagedtspool - 25.02 __.__....,,.... -. City/State/ZIP ' :: / p le �"p '/ F2-73 . Note bib 25.02 Phone ((O2) 4 nrcl. Fax: ( ) Inc makes 1241 ,nt t i , . 1, ' : A ; - 0.';t _i 4atuccptDdtrta m II" 2302 / Medical gas (vr1uc S ) Page 2 ausineas norm: ..air..... eat - t1 o i 4,1 CGG l ' Primer . 1151 Contact /vr . .c/•f4,V4 p -L..r Roof drain (commercial) 1231 T L iIV SinkibaakYtavatory l 25. s02- city /SI.tctZlP: p /l ( r err-. / f 2.-2.(1 r� Seim units , _ Phono: (.�-D3) & I g nc I Flue : ( Ir 3 �r 0 T p Tub/drowcddlowa pan 1231 Urinal 25.02 Frtnail: ' /• / : r. . ' _ 'J.. • '.a. ■ 4 . . " .r ' ?5.02 d .t �n».r -1-7'..' 37.52 edam , . _.. S t...... � � •.�� Waaerera9aer 37.52 ii Business name; / p r 4 , i , a • .A. / r 1. Wier PiPinB/DW 56.29 Address: 7z._ . I IZ `aT- ()tote 25.02 C:ld /State/z1e: 116 mzt 1 0 R . '11 213 Sabtooal 26 ' F ax: ( ! 5-' 8 "' 3 5� Minimum permit r , s72.i0 7 Ram ( ,Z - 7 , - 2 - Firm review (25% of p tee_ • CCB Lie,: k -1 Gq ij 3 Plumbing Lie. no.: Ai Refs surcharge (17.% of permit tee) di0 , . tailwind signature: : 0 r j a. / /L. . f TOTAL PERMrT r 75, �� /� 7b1s perms application mires Icaarmires rte psi met s m!n>oias/ widths in dsy+ ,: d i r .. .G9ia ( iL� OW it bas boss areNtad oar ems• "Faro teeiadoloyy set by Tri-Coenty (laildina Industry Service Pasant. , 10- 1J &._.a._I..Ia •If r a.. ...I. • ... J.-.. tn..onn IATUNI•IM1.IViaS