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Permit u CITY OF TIGARD ELECTRICAL PERMIT • _ COMMUNITY DEVELOPMENT ' Permit #: ELC2013 00136 2 Date Issued: 02/25/2013 TIGARD O 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 AM" Parcel: 1S136CC00100 Jurisdiction: Tigard Site address: 8200 SW PFAFFLE ST Project: Westside Christian High School Subdivision: 2006 -016 PARTITION PLAT Lot: 3 Project Description: (4) temporary services for (4) trailers. 3/11/13 REPRINT Add (1) feeder 200 amps or less. 3/14/13 REPRINT to replace the (4) temporary services with (4) feeders 200 amps or less, as trailers will be in use more than 90 days. Contractor: JOHANSEN ELECTRIC INC Owner: CITY BIBLE CHURCH 10948 SE VALLEY VIEW TERR 9200 NE FREMONT ST HAPPY VALLEY, OR 97086 PORTLAND, OR 97220 PHONE: 503 - 698 -3417 PHONE: FAX: 503 - 698 -2486 FEES Quantity Description Date Amount 5 ea Services or Feeders - 200 03/14/2013 $503.50 Specifics: amps or less 60 12% State Surcharge - 03/14/2013 $60.42 Type of Use: COM Electrical (manual) Class of Work: ALT Type of Const: Occupancy Grp: Total $563.92 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 a . • - 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. A NTION: Oreg• • requires you to follow the rules adopted by the Oregon Utility Notificat • • Center. Those rules are set forth in OAR 952 -Or -0010 through OAR 9; 001 r r ou may obtain a copy of the rules or direct questions to OUN .232.1987 or 1.800.332.2344. I / Iss ed By: i //� �� Permittee Si • • • . — r /� 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' e c."1/4-4 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. CITY OF TIGARD ELECTRICAL PERMIT 1111 q COMMUNITY DEVELOPMENT 3 !' 13 ' Permit #: ELC2013 -00136 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503 718.2439 Date Issued: 02/25/2013 Parcel: 1 S136CC00100 Jurisdiction: Tigard Site address: 8200 SW PFAFFLE ST Project: Westside Christian High School Subdivision: 2006 -016 PARTITION PLAT Lot: 3 Project Description: (4) temporary services for (4) trailers. 3/11/13 REPRINT Add (1) 200 amps or less Contractor: JOHANSEN ELECTRIC INC Owner: CITY BIBLE CHURCH 10948 SE VALLEY VIEW TERR 9200 NE FREMONT ST HAPPY VALLEY, OR 97086 PORTLAND, OR 97220 PHONE: 503 - 698 -3417 PHONE: FAX: 503 - 698 -2486 FEES Quantity Description Date Amount 4 ea Temp Services or Feeders - 02/25/2013 $237 44 Specifics: 200 amps or less 1 ea 12% State Surcharge - 02/25/2013 $28.49 Type of Use: COM Electrical Class of Work: ALT 1 ea Services or Feeders - 200 03/11/2013 $100.70 amps or less Type of Const: 0 ea 12% State Surcharge - 03/11/2013 $12.09 Occupancy Grp: Electrical Total $378.72 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 rf 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 OA 9 - 001 -00 0, You may obtain as co y of the rules or direct questions to OUNC by calling 503 232.1987 or 1 800 3332 �7/ ` Issued By: V�(�-f�/t Permittee Signature: t „ A PPr--/ c, ' r okI 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' 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. n CITY OF TIGARD ELECTRICAL PERMIT ''1 I COMMUNITY DEVELOPMENT Permit #: ELC2013 -00136 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/25/2013 Parcel: 1 S136CC00100 Jurisdiction: Tigard Site address: 8200 SW PFAFFLE ST Project: Westside Christian High School Subdivision: 2006 -016 PARTITION PLAT Lot: 3 Project Description: (4) temporary services for (4) trailers. Contractor: JOHANSEN ELECTRIC INC Owner: CITY BIBLE CHURCH 10948 SE VALLEY VIEW TERR 9200 NE FREMONT ST HAPPY VALLEY, OR 97086 PORTLAND, OR 97220 PHONE: 503 - 698 -3417 PHONE: FAX: 503 - 698 -2486 FEES Quantity Description Date Amount Specifics: 4 ea Temp Services or Feeders - 02/25/2013 $237.44 200 amps or less 1 ea 12% State Surcharge - 02/25/2013 $28.49 Type of Use: COM Electrical Class of Work: ALT Type of Const: • Occupancy Grp: Total $265.93 Required Items and Reports (Conditions) This permit ' • - • - •'ect to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be do in accordance with : •proved 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 la. - •uires you to follow the rules adopted by the Oregon • • ifi - • • Center. Those rules are set forth in OAR 952 101- 0010 th •ugh OAR 95 ' • 1-; • = • You may obtain a copy of the rules or direct questions to % NC by •- , . 0 :1 1 b 4 +. 32.1987 or 1.800.33 '344. Iss • =d By: _ �t ►��� d Permittee 's nature: • , -•<:',4•: "? °i lr 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' 411111111W , .4 1 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 ApplicatioRECEIVED FOIL OFFICE USE ONLY ► Cit y of Tigard Received E ° Datelt,. _�► f�aoi3 oa43 - t 5 .ro t 3 Pcm»t .n. v r- P = C ` L 13125 SW lien Blvd., Tigard, OR 97224 = - Plan Review ����/l! n Phone 503.639.4171 Fax. 501.598.1960 Date/iv. Other Penn it: ehti eya / T 1 G A Kll Inspection Line' 503.639.4175 CITY OF TIGARD Date Rcadatl■ ) e„ D See Page 2 for Internet: H,vy+.ltpatd- or.go, BUILDING DIVISION N itilied'Melhod: Supplemental Information I TYPE OF WORK PLAN REVIEW ❑ New construction ® Addition /alteration /replacement Please e check all that apply (submit 2 sets of plans mutants checked below): ❑ Service or feeder 401) amps or more ❑ building over three stones ❑ Demolition ❑ Other: ,shell the available fault current ❑ Marinas and boatyards. CATEGORY OF CONSTRUCTION exemils 111.000 rungs at 150 volts in ❑ Floating buildings, less to ground. or exceeds 14,000 ❑ Commercial -use agricultural ❑ l- and 2- family dwelling El Commercial /industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi - family ❑ Master builder ❑ Other. ❑ Fire pump. ❑ Installation of 75 KV;l or JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. ❑ Addition of new motor loud of ❑ "A" "f" "I 7 "'I.3 ". Job no.: Job site address: 1 i 9 - _g,w F ; ur nr 100111' or more occupancy. ���—�+ ❑ Six or more residential units. ❑ Recreational vehicle parks City /State /ZIP: boo 1.4.) — i - 5 Ct ❑ tlealth -care facilities. 0 Supply voltage fin more Ihun !/r ❑Hazardous locations. 601) volts minimal. Suite /bldg. /apt no.: Project name: C S ❑ Service or feeder 600 amps or more FEE SCHEDULE Cross street/directions to job site: -LA)E 9 Cia.677 q43 14 .5 • i Description I DIY. I Fee. I total I • New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: I Lot no.: 1,000 sq. ft or less 161154 4 En. add'1 501) sq. 0. in portion .13.92 I Tax map /parcel no.: I umlel cnclgy. residerrtral DESCRIPTION OF WORK i (with above sq n.) 75 Uu 2 I.irniled energy. multi - family 75 On 2 4 temporary feeders v., residential (,yid, above sq ft.) Services or feeders installation, alteration, and /or relocation 20(1 snips or les 1(10 70 2 56 2 201 limn to 400 amps - .._ 3 ❑ PROPERTY OWNER ❑TENANT r l s 13 Name: I 4(11 amps to 600 amps 200.34 2 [„ 60I amps to 1.000 amps 301.04 2 Address: ; Over 1.000 amps or volts 552 26 2 I Temporary services or feeders installation, alteration, and/or City /Slate /ZIP: relocation Phone:( ) Fax: ( ) 200 amps or ICS, 4 59,36 237.44 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2 intended for sale, lease, re, or exchange, according to ORS 447, 449. and 71)1. 401 amps to 599 amps 168.54 2 rem, Branch circuits - new, alteration, or extension, er panel Owner signature: ,,______ __ __ Date: A. Fee for branch circuits with ® APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7 4� each branch circuit Business name: Johansen Electric N.Pccforbrmnchcircuits -- 1 service or feeder fee, first Contact name: Charlynn Leifsen blanch circuit 56.18 2 Each udd'I branch circuit 7 42 1 2 Address: 10 94 8 SE Valley View Terr Miscellaneous (service ur feeder not included) _ Each manufactured or modular City /State /ZIP: Happy Valley, OR 97086 1 dwelling. service and/or feeder 67. 2 Phone: (503) 698 -3417 Fax:: (503) 698 -2486 Reconnecl 67.84 2 Pump or irrigation circle 67.84 2 E -mail: Sign or Outline lighting 67.84 2 CONTRACTOR Signal circuit(s) or limited - energy Business name: Electric panel, alteration, or extension. Page 2 2 Johansen Each additional inspection over allowable in any of the above Address: 10948 SE Valley View Te rr Additional inspection II hr min) 66.25. hr City /State /ZIP: Happy Valley, OR 97086 Investigation (Ibrmm) 6r;.zs hr _..._.. __ . _, Industrial plum (I hi min) 78.18' hr Phone: ( 5 0 3) 698-3417 I Fax: ( 503) 698-2486 Inspections for which no feu is 9)0 00' It specilical listed ('i hr min) i CCB Lie.: 515 3 9 I Electrical Lie.: 3-243C I Suprv. Lie.: 2053S ELECTRICAL PERMIT FEES Subtotal: 237.44 Suprv. Electrician signature, required: f}'*r' e A .- 4... Plan review (25% of permit feel: Print Hama Car 1 ansen Dale: 2/25/13 sally surcharge (I 2% of permit tee): 28.49 •l OTAL PI•atM T Fl•a ?: 265.93 Authorized signahtre:l 4 nab permit applieatlnn expiry If a permit Is not obtained within 1811 y r days alter It has been accepted as complete. Print name: Charlynn Leifsen Dale. 2/25/13 • Number of inspections allowed per permit I tlm dnc 0701.40 4- ar- 4r.1sF)l!- uc »2Os,Yehn „,k A 4 .,,, pexiv i.L.L._20 3 - 00 13 Co - 0 ( Electrical Permit Applicft I OR lil'I I(, 1 51.11\1., City of Tigard Permit No.: 13125 SW /tall 13lvd.,Tigard, OR 97223 hear Pnrmil. Phone: 503.639.4171 Fax: 503.5 1i l 1 2013 Inspection Line: 503,639.4175 i imp El See Page 2 for Internet: www.tigard- nr.gov /l T SSupplomnitol lnPo w'sUmi e � 1 �► (^ I V ,..1',.:,W-.,,A. heat ell that apply (submit j sets of plans wlitems checked below)' ❑ New construction El Addr , : , •- V , VI Please ❑ Service or &odor 400 amps or more ❑ Building over three dories. ❑ Demolition ❑ Other. wtcre the available fault currant ❑ Manilas and boatyards, ,% , .. y f, . . ,�. •Y :i"1 ' r1 5.� ) ' y Y `U Iii J ” fir^ ih .. y ; x "ir :y. ° : e ? i`. •`lid,'.;' , - „ b ; we ;. I, ,. • .. : '• n; °` . ., r, ^t 1 ' : - r'.t exceeds 10,000 amps al 150 volts or 0 Molting buildings. lass to ground, or exaods 14,000 ❑ Commercial -use agricultural ❑ 1- and 2- family dwelling ® Cotnmeroial/industrial ❑ Accessory building amps for all other installations buildings. ❑ F ie pump. ❑ Installation of 75 KVA or ❑ Multi - family ❑ Master builder ©0►her' larger separately derived system. k , ; ' k ' �� f. yl -,�,,, �Y ‘1,. . �Y�r : � �� � Frnergntoyeyatom, + ; r � y o ; i • y : s, ❑ Addition anew motor toad of In "A", "h ", "1 -2", "1-3", lob no.: Job site address: �. ' �t S t LOONY or more. ocoupanoy- 5l/t J 1 Z �' ❑ Six or more residential mute. ❑ Recreational vehicle parks. [] m allll.care facilities. 0 supply voltage for more than City/State/ZIP: ❑ Hazardous locations, 600 volts nominal. Suitc/bldg. /apt. no., I Project name: D Service or feeder 600 mem or More. ') : ;:, : S he. ` Y` , : :i.1 . , ` . ";g `, y, j Cross street/directions to job site: Da ariatloe Pea ( Tol I r • New residential single- or multi- family dwelling unit. includes attached garage. Subdivision: I Lot no.: 1,000 sq. ft. or loss 16R 54 4 En, add'I 500 sq. ft or portion 33.92 1 Tax map/pineal no.. T,imited energy. residential 75 00 2 cny,f ... •;r ;At',, .4^p ' :y .r., � . r n ? . '' ; .'6 �/ t. " :;, .-, '' �'""55,^ (with nho e'sq. 04 .. 1,imitdergy en, mulu- family 75.00 2 l :' , w•; r � / J e a's ) r pe residential (with above se, ft) Servteea or feeders Installa auoration, and/or relocation Los. 200 amps or 1 F 100.7C . - Tt , 2 . ' . T�_. 7"v t " -^ ' " , 201 amps to .5 •� ,. r, '.''Y � : ��aia�r�.7fbN�N! - ' � ' S's �r, A'�, - , - 'q '�.r- .� :<. M amps 133 ,v. 2 401 wupa to 600 amps 200.34 2 Name: 601 amps to 1,000 amps 301.04 2 Address: Over 1.000 amps or volts 552.2G 2 Caty/State/ZIP. Temporary services or feeders Installation, alteration, and/or _ relocation Phone: ( ) 7 Fax: ( ) 200 amps or less 59.36 1 Owner installation: This installation is 201 amps to coo amps l2s Olt 2 being made on property that l 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. . Branch circuits — new. alteration, or extension, per panel Owner signature: Date: A. Foe for branch circuits with ,"',...:?./.,.., ° ^ :' err a !.7; above service or feeder fee, 7A2 2 % i't' `t, i' ?r',` " . each branch circuit . Business name: Johansen Electric B. F00 (Or branch circuit& service or feeder fee, first 56,18 2 Contactnama Charlynn Leifsen branch circuit , Each add'I branch circuit 7.42 2 Address: 10948 SE Valley View Tarr ' Miscellaneous (service or reader not included) __ Happy Valley, OR 9 7 0 8 6 Each ea a la' modular 67 -s4 2 h' r dwelling, service and/or foxier Phone; (503) 698 -3417 I Fax: :(503) 698 --2486 . 2486 Reconnect 67.84 w. Pump or irrigation circle 67,84 2 E- !118111 ;' "'' ;'''' r I Sign or outline y l ig h ting 67.84 2 ,. n ; ; . rlq _ Signal Jt?hansen El panel, alteration, or extension. _ Pane 2 Each additional Inspection over allowable In any of the above Address: 10948 SE Valley View Terr Additional inspection (lhrmin) 66.25/hr Val 1 e , OR 9 7 0 8 6 Investigation (t hr min) 78 66.25/ hr City/State/ZIP: Happy Y Industrial plant (1 hr mini) 78 1 1u Phone: (503) 698-3417 Pax: ( 503) 698 -2486 inspections fur which no feu la 90,00 /hr .ecificall listed 'h hr mm CCB Lic,: 51539 I Electncal Lic.: 3-243C Suprv. Lic.. 20535 ., . ,' ' , 1F,' r: .' 4 -''R„ '' " Subtotal: • . ]0 Suprv. Electrician signature, required' e k rTtAf► J Plan review (25% of permit fee): Print name. Carl hansen 4Drac; /11/13 Slate sun lmrge (12% of pemiit fee): /2. $ TOTAL PERM!' Authorized signature: ernd t f not o I//2^ , 7 Thy want appoeadon expires a Ir permit m not btan ied within 150 dare after " has 1accepted as complete. Print name: Charlynn Leifsen Date' 3/11/13 • Number of Inspections allowed per permit. ' I oZ - / Cl 1.1auitdh WPermds\ELC-PametlApp doe 07/01/10 440.46151(11/05/e014/W61t Z /T - HYti:a 9817Z869CO9 986Z869E0S ID3ZJ NaSN HOf wit 9Z:E0 EIOZ•II'^iew t WEK ED Electrical Permit Applica f(,lt (>F FR I: l'tii: 0\1 .1 City of Tigard MAR 1 4 2013 r iBed s®�o r ,rx /, • 1312 S W h al l Blvd Tigard. OR 97223 N AQj) ' Phone: 503.639.4171 Fax: 503.5 O. _ _ r SG •, all" Fatah; , , , f _ I , Inspection Lino: 503.639,417 GrDNlsl Ditto Rantyn . ly: ®see Page 2 for Internet: www.tigard.or.gov u1D1N Notified/Method: supplementallnfornwtion Q New construction E Addition/alteratioii/repiaconlcnt Plan ate all that apply (submit 2 u of elms w/itenna checked below): 0 Servieo nr lamer 400 amps or more ❑ Building over three stories, © Demolition 0 Other: where the available fault current ❑ Marinas and boatyards. :.r•° `r.fi1. -'g sCA1 Cl1�91 "O i'. y t:,a : v sop Floating buildin gs, �:.r_ <.'`• : n:,;: r �;'r ,,� .E .!4aF . 5�'tt�l!1Y���S: moods 10,000 amps al 150 Ole ❑ 8 i'... to l ortl exceeds ,, �__ _ . __ - , - , ..... ., - lass o gro m0, tosls 14,000 [] Crnnmeroial�ne agricultural El and 2- family dwelling ® Comtnereial /industrial ❑ Accessory building amps fer ell other installations. buildings. ti -fam M ulil Master builder ❑ Piro pump, 0 Installation of 75 KVA or rl � .__...__ ❑ _ C1 . •- — 77, — — - .� . _ .._. - F:tttcrgeney' dyetietti larger separately derived system. . `'.� : .a , .. : , .... ATip(+T.:... . , ❑ IarK Q �:' ;;': • � . • - � : ��� ' .'' " !' ,:;:: 5� • . ,• •::::.: ' y - : ❑ Addition of now motor bad of 'A ", "ti" "1 - 2 ". "1 Job no. ' Job site address: ?2,4)0 ) V f � II 5t wily or Mira. occupancy, ❑ Six ur morn rostdantial units. ❑ Recreational vehicle parks. City/State/ZIP: ❑ lioallhwore facilities. ❑ Supply voltage for more than ❑ Flazardolls locations. 600 volt. nominal. Suitc/bldgfapt. no.: l Project name: W e 5 � JD SorviGO or feeder 600 amps or more. ,�t Cross atreel/direotions to job site: Deur r Qty. I Poo. 1 Total :" New residential single- or multi - family dwelling unit. includes attached garage. Subdivision: ( l ot no.: 1,000 sq. 0. or Ices 168,54 4 tin, midi 500 sq. 0. or portion 33.92 I Tax trap /parcel no,: - Limited energy. rcaidontiel °r; ^�l� ":'"' p (with above ft. 75.00 2 /� /► � r /� .��� /� ' •'` I.imiledonerBY,multi- family 75. r S // � i1 e b / ae M 1 / ' / G a it ras 00 2 attial with above t) _s - -. it. d $T / fie4es 200 amps or low nxaera Instillation 100.70nr rc � uh' 2 w a onlalteration F r hoc � l` `: ,,i :,+ i /0 iinii ' w !t`'! a 'j ,'7,; 201 amps to 400 amps 133.56 2 Name: 401 amps 4.600 sunps 200.34 2 601 amps to 1,000 amps 301.04 2 Address: Over 1.000 amps or volts 552.26 2 City/State/ZIP: Temporary service or feeders installation, alteration, and/or relocation Phone: ( ) — 1 Fax: ( ) 200 amps or less I 5936 I I 201 amps to 400 amps I 125,08 I 1 2 Owner installation: This installation is being made on property that I own which is not 401 amps to $92 amps I 168.54 I r 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. ' 401 amps Branch circuits- new, alteration, or extension, bier panel Owner signature: Date: A. Fee for branch circuits with , 4; . , r::: ���rr :: ll t - t T^ boio err faodor foe, 7,42 2 ' ti 416 ° i'd." `.. , ... ',. Cl i C,6i0l�r v C $• l: : :. : c;W auaeh ve br aery t m eh circuit e - Business name: B. Poo for branch circuits wnhoui Johansen Electric sarvieo or feeder fee, first 56.18 2 Contact value: Charlynn Le i f sea brooch circuit - Rw:h udd'I branch circuit 7,42 2 Address: 10948 SE Valley View Terr Miscellaneous (service or feeder not Included) Each manufactured or modular City/State/ZIP: Happy Valley, OR 97086 dwelling, service undhwfeeder 67 84 2 Phone: (5 0 3) 6 9 8- 3 417 1 ( 5 0 3 ) 6 9 8 - 2 4 8 6 Rocnmtcct only 67.84 2 Pomp or irrigation circle 67.84 2 E -mail: ,`•, _ sign or outline lighting 67.84 2 .h..,;vP' `: i � ~'':,: y: . » . _ - - Signal — gt circuit(e)orlimitcd- onorgv Business name: Johansen Electric panel. alteration, orexte:mien, Paget 2 Each additional Inspection over allowable in any of the abov Address: 10948 SE Valley View Terr Additional inspection (1 hr min) 66.25/hr la vestigation (I hr min) 66,25/hr City /Statc/ZIP: Happy Valley, OR 97086 industrial plant ( hr min) 78.18/hr Phone: (5 0 3) 698-3417 1 Fax: (5 0 3) 6 9 8 - 24 8 6 Inspections for which no fco is r ificall listed ,h ht min 90.00/ hr CCB Lie,: 5153 9 J Electrical Lic,: 3 - 2 4 3 C 1 Suprv, Lic.: 2053$ ., • ..r : •::(' ,.'. (x ' "N ?= .'r: Suprv. Electrician signature, required: e yc Q k Subtotal; r evc- Plan review (25% of permit fee): Print name: Carl Jo nsen pate: 3/14/13 State surcharge (12%o permit fee): W. (/ Authorised signature: TOTAL PERMIT FEE: t 2. This permit application expire Ira pone la not a within 180 Print name: Chart nn Leifsen t sen Date; 3 / 14 / 13 days After It has been accepted as complete y • Number of inapeetions allowed Per Pernik <13.7 / ig ) r: U u lf ruildinglpermiLC•rbtmitApp.duc 07/01 /10 4404d15T(I1/0S /C0M/WEB I SIG -20 Z /T •aDva 9817Z869CO5 986Z869C0S ID3'I3 NaSMVHOf Wd 9P :Z0 £TOZ•rT•xElni