11075 SW COTTONWOOD LANE N
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110/5 SW CUPPONWOOD LANE
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CITY OF TIGARD BUILDING INSPECTION DIVISIO3N
24-Hour Inspection Line: 639-4175 Business Line: 639-4171 MST � �GG 2-U
BUP _
—Date Requested AM _PM BLD
Location l/D 7J -5 1-,,6G Ur wvu �^ Suite _ —
-• _ MEC _
Contact Person — _ �h r s �— _ Ph S�rG 67-;7-Z-- _ PLM
Contractor_ Ph -W4;!J Zq3 SWR —_-,
Tenant/Owner - ELC
Retaining Wall ELR —
Footing
Foundation Actress:
FPS
Ftg Drain - --
Crawl Drain Inspection Notes SGN
;lab -` "----
Post ti,Beam ---- — --- SIT
Ext Sheath/Shear -
In!Sheath/Shear / - --
Framing — --'el et
Insulation ------- --
Drywall Nailing
Firewall - ---- --- - --
Fire Sprinkler -_—
Fire Alarm -_.----- ..--_- --_-.
Susp'd Ceiling —_
Roof - ------
Fi
ASS PART FAIL '
PLUMBING
Post a Beam
Under Slab
Top Out - ---
Water Service
Sanitary Sewer
Rain Drains
Final -'
PASS PART FAIL
MECHANICAL -
Post& Beam
Rough In - -
(.;as Line
Smoke Dampers
f inal
PASS PART FAIL
ELECTRICAL --- -------- --- -
Service
- ------------------------------
Rough In - --- - - .
UG/Slab
I-ow Voltage -" -
Fire Alarm
Final
PASS PART FAIL
SITE -
Backfill/Grading - -- _------.`------_---— -
Sanitary Sewer
Storm Drain [ ] Reinspection fee of$ _ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin —
Fire Supply Line ( J Please call for reinspection RE: [ ]Unable to inspect-no access
ADA
Approach/Sidewalk �
Other _ -- - Date �� "�' Inspector Ext .s c
Final _--
PASS PART --FAIL DO NOT REMOVE this Inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Flour Inspection Line: 639-4175 Business Line: 639-4171 --
BUP
Date Requested ���� �AM_ PM Bt D
I-ocation7�f.✓ C vo �^- _ Suite MEC _—
Contact Person — Ph _fjD- `L7 Z-- _ PLM
Contractor _ Ph _ SWR
BUILDING Tenant/Owner — _ ELC �� 35
Retaining Wall _ ELR
Footing Access: —
Foundat on FPS
Ftg Drain SGN
Crawl Drain Inspection Notes / -
Slab _ _ Y. rlCYt C'ir-C, /t S" SIT
Post& Beam --
Ext Sheath/Shear
Int Sheath/Shear — ------
Framing ---- --- - ---- -__- - ----
Insulation
Drywall Nailing _
Firewall !-
Fire Sprinkler
Fire Alarm �� / C C '--- ,--- -`-
Susp'd Ceiling r � — (",
Roof
Misc _ ---�-� -- -_-
Final
PASS PART FAIL ------------ - - ___ ___--__
PLUM13ING
[lost& Beam —
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final __ _�_.__. �_r_-__--- •- --
PASS PART FAIL
MECHANICAL
Post& Beam __..----
Rough In
Gas Line --- - -- ------ ---
Smoke Dampers
Final - - -- -
PASS ART FAIL
erviee
[lough In ---- - - ---- --- -- -
UG/Slab
Low Voltage ------ -___.---------- ------- ----
larm
ASS ART FAIL
SI
Backfilurradiny -------------------- -- -- — --
Sanitary Sewer
Storm Drain ( ; Reinspection fee of$ required before next inspection. y at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ]Please call for reinspection RE. _______ [ ] Unable to inspect- no access
ADA /
Approach/Sidewalk
otherDate _ 7-e,,,VInspector _ Ext Y�
Final - -
PASS PART - FAIL DO NOT REMOVE this Inspection record from the job site.
CITY OF TIGARD MASTER PERMIT
PERMIT#: MST1999-00420
DEVELOPMENT SERVICES DATE ISSUED: 1/25/00
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171
SITE ADDRESS: 11075 SW COTTONWOOD LNPARCEL: 1S134AC-02634
0/?/
SUBDIVISION: ENGLEWOOD NO.3 wI ZONING: R-4.5
BLOCK: LOT: 191 V JURISDICTION: TIG
REMARKS: Patio room 4
BUILDING
I.FISSUE STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ADD HEIGHT: 35 FIRST: 190 at BASEMENT: at LEFT: SMOKE DETECTORS:
TYPE OF USE: 5F FLOOR LOAD: 4o SECOND: sf GARAGE- of FRONT: PARKING SPACES
TYPE OF CONST 5N DWELLING UNITS: FINBSMENT: of RIGHT.
VALUE: $12,85100
OCCUPANCY GRP: I43 BDRM: BATH: TOTAL: of REAR.
PLUMBING
SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES. DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS. CATCH BASINS:
TUB/SHOWERS. GARBAGE.DISP: WAIER HEATERS: WATER LINES: BCKFLW PREVNTW GREASE TRAPS.
OTHER FIXTURES:
MECHANICAL
FUEL TYPES _ FURN<100K: BOIIJCMP<3HP: VENT TANS: CLOTHES DRYER.
FURN r=100K: UNIT HEATERS: HOODS: OTHER UNITS,
MAX INP: blu FLOOR FURNANCES: VENTS: WOODSTOVES GAS OUTLETS:
ELECTRICAL
—RESIDENTIAL UNIT SERVICE FEEDER TCMP SRVC/FEEDERS BRANCH CIRCUITS _MISCELLANEOUS _ADD'L INSPECTIONS
1000 SF OR LESS: 0 - 200 amp: 0 - 200 amp: WISVC OR FDR: PUMP/IRRIGArION. PER INSPECTION:
EA ADD'L 500SF 201 - 400 amp: 201 - 4P^amp: 1st W/O SVCIFDR: SIGNIOUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 600 amp: EA ADDL SR CIR: SIGNAL/PANEL'. IN PLANT.
MANU HM/SVC/FDR: 601 - 1000 amp: 601.amps•1000vMINOR LABEL
1000.amp/volt:
PLAN REVIEW SECTION
Reconnect only: —-4 RES UNITS. SVCIFDR> 223 A. 600 V NOMINAL. CLS AREA/SPC OCC:
ELECTRICAL-RESTRiCTED ENERGY _
A.SF RESIDENTIAL _ B.COMMERCIAL _
AUDIO 8 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: DAl'A/TELE COMM: NURSE CALLS: TOTAL M SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 302.53
TRUNE, DENNIS R ANL TARA L APOLLO POOLS INC This permit is subject to the regulations contained in the
1107.5 SW COTTONWOOD LN 13306 NW CORNELL RD Tigard Municipal Code,Slate ,f OR Specialty Codes and
TIGARD,OR 97223 PORTLAND,OR 97299 all other applicable laws All work will be done in
accordance with approved plans This permit will expn'e If
work is not started within 180 days of issuance,or if the
work is suspended for more than 180 days ATTENTIGN
Phone: Phone: Oregon law requires you to follow rules aJopted by the
Oregon Utility Notification Center Those rules are set
Reg,A [I- P.1 forth in OAR 952-001-0010 through 952-001-0080. You
may obtain copies of these rules or direct questions to
OUNC by calling(503)246-1987
REQUIRED INSPECTIONS
Footing Insp
Slab Insp
Framing Insp
Final inspection
i
Issued By : y ���%) >c21 / Permittee Signature'11
Call (503) 639-4175 by 7:00 p.m. for an inspection needed the next business day
1
C: -r OF TIGARD Residential Building Permit Application Plan Addions or Alterations
Check#, —"—�—J
13125 SW HALL BLVD. li Recd ey` : _.-vl
.
TIGARD, OR 97223 Single Family Detached or Attached (Duplex) Date Reed
V 5v3-639-4171 � "1 Date to P E. I t L3
i� / Date to DST /Z ' e 114W
F 503-684-7297 /( Permit# > ' fl / ?c°j
Print or Type I / Called!
Incomplete or illegible applications will not be accepted
�v fJa a;fProject Name —'
Job , -�►�-'►x - -
Address Site Address Architect Mailing Address
N e City/State Zip Phone
Na
Cwner M 11inBA d S..5tt + aw✓ c'r r IL
4..i y/State 7 Zip F ne Engineer Mailing Add'r'e,��s —
General NarT'R ily tate Zi Phone /
Contractor 7 `i - ��`/V vv /ow/ '7( -s
Describe work New O Addition)a` Alteration O RP air O
Ma in Address ,y��q---`'— to be dune iL T 277
Prior to permit '_ck, K 4J_��t+�Q�[f /�C Additional escrl do )f Work: J!�
issuance,a copy C ty/State Zip Phone CL'—� *-O + &4-4
of all licenses 0'e are required if Oregon Const Cont Board Exp. Date PROJECT _ 6 b
expired in COT Lic# VALUATION �_ J
database (�/3 L �}•� QQ /
Mechanical Name NEW CONSTRUCTION ONLY:
Sub- _ --- Sq. Ft. House: Sq. Ft. Garage
Contractor Mailing Address —Y—
Prior to permit Indicate the restricted energy installation by the electrical
issuance,a copy City/State Zip Phonesubcontractor in the followingareas
of all licenses __ Restricted Audio/Stereo
are required if Oregon Const Cunt Board Exp. Date Energy — S�+stem _ Alarms _
expired in COT Lic.# Installations Vacuum Irrigation
_ database _ �_� _ S stem _ System
Plumbing Name (check all that Other:
Sub- awl )
Contractor Mailing Address Corner Lot YES NO Flag Lot YES NO
(check one) _ � (check one_T
Has the Subdivision Plat recorded? N/A YES NO
Prior to permit City/State ZIPPhonc
issuance,a copy
of all licenses are Oregon Const Cont. Board Exp. Date
required if Lic# _
expired in COT I hearby acknowledge that I have read this application,that the
database Plumbing Lic # Exp Date information given is correct, that I am the owner or authorized agent
r,f the owner, and that plans submitted are in compliance with
re on State laws
Name — —'V — �
OSi atur,ofwn r gent —���� � Dale
Electrical _�
Sub- Mailing Address -- Co act Person Naive Phone#
.bE'•�r
Contractor — ---
City/State Zip Phone
Prior to permit
issuance.a copy FOR OFFICE USE ONLY:
Y all licenses are Oregon Const Cont Board Exp Date
required if Lic# Plat#: rAI r ' MapfrL#: /
expired in COT __
database Electrical Lic # Exp Date Setbac s: Zone: Soler:
Electrical Supervisor Lic # Exp Date Engineering Approval- Planning Approval- TIF:
r fl r. _ Nr
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� ELECTRICAL PERMIT
CITY O F T I G�4 R D PERMIT#_ ELC2.001-00358
DEVELOPMENT SERVICES DATE ISSUED: 7/10/01
13125 SW Hall Blvd.,Tiaard, OR 972.23 (503) 639-4171 PARCEL: 1S134AC-02634
SITE ADDRESS: 11075 SW COTTONWOOD LN
SUBDIVISION: ENGLEWOOD NO.3 ZONING: R-4.5
BLOCK: LOT : 19" JURISDICTION: TIG
Proiect Description: Installation of t,.-;u branch circuits for new patio room.
RESIDENTIAL UNIT _ TEMP SRVC/FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP/IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN/OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HM/SVC/ FDR: 601+amps - 1000 volts: MINOR LABEL (10):
SERVICE/FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS _
0 - 200 amp: W/SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 1 IN PLANT:
601 - 1000 amp: _ _ PLAN REVIEW SECTION
1000+amp/volt: >=4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: _ SVC/FDR >=225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
TRUNE, DENNIS R AND TARA l- T ELECTRIC
11075 SW COTTONWOOD LN (BRUCE A TURNER)
TIGARD OR 97223 18300 NW ODELL CT
PORTLAND, OR 97229
Phone: Phone: 629-8664
Reg #: ELE 34-209C
LIC 525,
SUP 3342-S
FEES Required Inspections
Type By Date Amount Receipt Rough-in
PRMT CTR 7/10/01 $53.50 2720010000( Eh,,ct'I Final
5PC7 CTR 7/10/01 $4.28 2720010000(
Total � $57.78
This Permit is issued subject to the regulations cxntained in the Tigard Municipal Code, State of OR Specialf;Codes and all other applicarile latis
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 than 180 days ATTENTION Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center Those
rules are set forth in OAR 952-001-0010 through OAR 952-001-0080 You may obtain copies of these rules ordirect questions to OUNC at(503)
246-6699 or 1-800-332-2344
Permit Signature: z-���s� x�' Is ued By:
_ OWNER INSTALLATION ONLY _
The installation is being made on property I own which is not intende,: `--r sale, lease, or rent.
i
OWNER'S SIGNATURE: _.� DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 639-4175 by 7:00pm for an Inspection the next business day
Electrical Permit Application
Datereceived: /p O Permit no.: .1(*WaZ'/-r
City of Tigard Project/appl.no.._ Expire dale:
Ciryn(Tigard Address: 13125 SW Hall Blvd,Tigard,OR 97223 pate issued: Hy: Receipt no.:
Phone: (503) 639-4171 -- --
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval:
U 1 &2 family dwelling or accessory U Commercial industrial U Multi-family U Tcnant inlprovenlent
U New construction U Addition/alteration/replacenlent U(hher. U Partial
Job address: Ile 75 ,L) c,7720.AjWeW0 / Bldg. nu.: ITax map/tax lot/account no.:
Lot: I Block: Subdivision:
Project name: I Description and location of work on premises: /� /fes �Vz beAti�
Estimated date of completion/inspection: �`'w;. --
Job no: _ _ Pee MaxBusiness name: / r l r Description Qty. ler.) Total nc`Insp
2 New residential-single or mulli-family per
Address: /FLOG LLdwe.."iRunit.Includesanachedgarage.
City; L Staten ZIP: 7 Servicer.-luded
Phone: - Fax: E-mail: IWo sq.ft.or less
�+ Each additional 5011 s ft or portion thereof
CCB no.: ` 5 Elec.bus. Plc.no: J `r7L' C Limited energy,residential
City/metro lic.no.: Limited energy,non-residential 2 1
Each manufactured home or modular d wrllinti
Sign ure of supervising electrician(requited) _ Date Service and/or feeder
Sup.elect.name(print): License no: 5 Services or feeders•-Installation.
t1amps
on or relocation:
s or less 2
Name(print): / i �� C� s to 400 amps 2
to 600 amps 2
Mailing address: _ s to I OW amps 2
City: Slate: I ZIP: Over 1000arnpsorvolts 2
Phone: I E-mail: Reconnect only I
Owner installation:The installation is being made on property I own Temporary services or feederx- —
which is not intended for sale,lease,rent,or exchange according to Installation,alteration,or relocation:
ORS 447,455,479,670,701. 2W amps or less
21
201 amps to 400 amps _ 2 _
Owner's signature: Dale: _. 401 to 600 ams 2
Branch circuits-ne+ ,attention,
or extension per panel:
Name:: - —_ — ^— _ A. Fee for branch circuits with purchase of
Address:_ _ service or feeder fee,each branch circuit 2
Cilv:— State: ZIP: B. Fee for branch circuits without purchase
-` of service cr feeder fee,firs)branch circuit: 4 f ' 2
Phone: 1 ax E-mail: Each additional branch circuit:
91 M isc.(.Service or feeder not Included):
UService ma225snips-commercial -1llra0111 Each pump or irrigation circle 2
U Service over 320 amps rating of 1&2 U Hazardous location Each sign or outline lighting _ _ 2
family dwellings U Building over 10,000 square feet four or Signal circuit(s)or a limited energy panel.
L)System over 600 volts nominal rote residential units in one structure alteration,or extension*_ 2
U Building over three stories U Feeders.400 amps or more *Description: _
U Occupant load over 99 persons U Manufactured structures or RV park Loch additional Inspection over the allowable In any of the above:
U Egress/lightinl:plan j(1111(.[ Prinspection _ —
Submit - _ sei s of plans with an)of the above. Investigation fee
he alcove are not applicable to Irmliorary construction service. Other
------ ---- -
Neo all)udsdicUrats rapt credit card+,pkax call jurisdiction for nxsr information'. Notice:?'his permit epplicatlon PCI'Illtl fee.....................$
�>
U visa U MasterCard expires if a permit is not obtained Plan review(at _ %) $
Credit card number: — within 190 days after it has been State surcharge(896) $ —
Expires acceordpted as complete. TOTAL $ 67.76
.......................
IJame of arcOrolr�er u shown one t t
_ S
r'srdholder oijinature Amou
--- — 4104615(bOlYCOM)
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES:
Complete Fee Schedule Bolow: TYPE OF WORK INVOLVED - _ Y
_
p Restricted Energy Fee..................................................... s75.00
Number of lions per permit allowed) (FOR ALL SYSTEMS)
Service included: It, is Cost Total `t Check Type of Work Involved:
Residential-per unit
1000 sq ft.or less _ $145 15 _ _ 4 Audio and Stereo Systems'
Each additional 500 sq ft or
portion thereof $33.40 — 1 C] Burglar Alarm
Limited Energy $75.00
Each Manufd Home or Modular O
Dwelling Service or Feeder $9090 2 Garage Door Opener'
Services or Feeders Heating,Ventilation and Air Conditioning System'
Installation,alteratiorl,or relocation
200 amps or less __ $80.30 _ 2
a ❑
201 amps to 400 amps — $106.85 _ 2 Vacuum Systems'
401 amps to 600 amps $16060 — 2
601 amps to 1000 amps _ $240.60 —_ 2 C� Other
Over 1000 amps or volts $454.65 _ 2
Recon,ect only $66.85 2
Temporary Services or Feeders A TYPE OF WORK INVOLVED -COMMERCIAL ONLY
Installation,alteration,or relocation Fee for each system.......................................................... $75.00
200 amps or less $66.85 2 (SEE OAR 918-260-260)
201 amps to 400 amps $100.30 2
401 amps to 600 amps _ $133 75 ` — 2 Check Type of Work Involved:
Over 600 amps to 1000 volts,
see"b"above. Audio and Stereo Systems
Branch Circuits r,
New,alteration c-extension per panel LJ Boiler Controls
a)The fee for branch circuits
with purchase of service or Clock Systems
reeder fee.
Each branch circuit '— $6.65 2 ❑ Data Telecommunication Installation
bI The fee for branch circuits
without purchase of service
Fire Alums Installation
or feeder fen.
First branch circuit $46.85
Each additional branch circuit — $665 HVAC
Miscellaneous Instrumentation
(Service or feeder not included)
Each pump or irrigation circle _ $5340
Each sign or outline lighting _ $53.40 —__ LJ Intercom and Paging Systems
Signal circuit(s)or a limited energy
panel,alteration or extension $75.00 _ L Lands _pc..:igation Control'
Minor Labels(10) $125.00 _
Each additional Inspection over L� Medical
the allowable In any of the above ❑
Per Inspection $62 50 Nurse Calls
Per hour $6250
In Plan! $13 75 _ Outdoor Landscape Lighting'
Fees: Protective Signaling
Enter total of above fees $ L� Other
8%State Surcharge $
Number of Systems
25%Plan Review Fee
See"Plan Review"section on $ No licenses are required Licenses are required for all other installations
front of application _- ---- -- —
Fees:
Total Balance Due
--- Enter total of above fees S
❑ Trust Account# 8%State Surcharge
Total Balance Due s--
I:\dsts�forms\[Iofees.doc 06/07/01
Community Development ELECTRICAL PERMIT APPLICATION
13125 SW 11,1I Blvd.
Tigard, OR 97223 Planck/Rec. #
Permit # _
F hone (503) 639.4171 Date Issued
CITY OF TIGARD FAX (503) 684-7297 Issued by
TDD No. (503) 684-2772 —
Inspection (503) 639-4175
1. Job address: 4. Complete Fee Schedule. Below:
Name of Development / Number of Inspections per permit allowed
Address �.�e ff l N kA,104 L.t Service included Items Cost(ea) Sutn
City/State/Zip yc; —c 6 Ole Ct 7.e 2 7 4a. Residen A-per unit 4
1000 sq it or few: $11000
Name (or name of business)_aK h 13 r- Gti h Fac:h Additional 500 sq It or
portion thereof $)4 00 1
r'ommorcial❑ Residential® Limned Energy s2500
Each Manurd Home or Modular 2
lavellmg Serax or Feeder $166 00
2-a. Contractor installation only:
4b.Services or Feeders
CIn„iallation•alteration.or relocalron 2
Electrical Co�n/trra�ctor !r e / < _ 200 amps or less $W 00 2
Addres -JU/ iA" Ode 11 C 1 201 amps to 400 amps $8000 2
city • 401 amps to 600 amps $12000 2
r State D * P-22 601 amps to 1000 amps $18000 2
Phone No. 42? PT11 Over 1000 amps or volts $34000 2
Contractor's License No. ` - CC Reconnedonly — $6000
Contractor's Beard Rag. No. X5-1-2 4c.Temporary Services or Feeders
Installation,alteration,or relocation ?
Signature of Supr. Elee'n__ `1 200 amps or less $5000 2
License No.
2 J —No '�T ' 201 amps to 400 amps E/,00 2
Phone/ L t _ 401 amps to 600 amps _ $10000
60
Over o amps to t000 volts
2b. For owner installations: see W above
Print Owner's Name 4d, Branch Circuits
-- New,alteration or extension par panel
Address a)The lee for branch circuits with
City_ State Zip__ puroha«of*mks or tlneder be
Phone No. Each branch circuit —_ $',00
bn The fee for branch circuits without t
The installation is being made on property I own which is purlehses Of smite or boder lire. J
y
t
not intended for sale, lease Or rent. First branch circuit 0Each additional branch circuit
Owner s Signature � � 4e. Mi4cellarleous �rb
taervice of leader not Included) z
3. Plan Review section (it required): Each pump or irrigation ci•cle $4000
Lath sign or outline lighting $4000
Signal ctmuttprl or a limited energy 2
Please check appropriate item and enter fee in section 5B. panel,alteramn er extension _ $4000
_4 or more residential units in one structure Minor Labels(1u) —' $10000
_Service and leader 225 amps or more ---
System over 600 volts nominal 4f. Each additional inspection over
Classified area or structure containing special occupancy the allowable in any of the above
as described in N E C Chapter 5 F'e'"Cl—fir'" $3500
horn $55 00
5ubmrt 7 sets of plans with aµpiication when,any of the above "19.10 $5500
apply. Not requited for temporary construction services. 5- Fees:
NOTICE 5a. Enter total of above leasj 3 $ W w
5'11Surcharge(.05 X total fees) $
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF 5b. Enter 25%of line A for
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Plan Review if required(Sec 3) $
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS SSu-�bretaf $
COMMENCED El Trust Account N
$
Balance Due ✓7 '7g $ '