14061 SW CHEHALEM COURT l
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14061 8W CHEMMEM COMT
CITY OF TIGARD
. .�.._ �. .. .. ,
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hell Blvd.Tigard,Oregon 07223.8180 (503)839-4171
111 accc"'d:7C?
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City of Tigard MECHANICAL PERMIT Planc!c/Rec. # ►��
13125 sw Hall Blvd. APPLICATION Permit # _.m6 -Dl''�
Tigard, OR 97223
(503) 639-4171
escription
Table 3A Mechanical Code a 0-re r;RICE AMT
JOb /1
Address C�.^h yL� ���e� c:1 t) PermitFee -0. -0- 10.00
2) Supplemental PeiTnd 300
Furnace t-100,07-717—
pie r 11 incl. ducts 3 vents 600
• ••• —�� �• urna t! +
Owner lem c- ) incl ducts &vents 7.50
• Floor Furnance
Z 2, 1 3) incl vent 6.00
•'"" ""•' """•
Scuspended heater, wall heater
4) or floor mounted heater 600
" ' — ^"• Vent not inc-17 in
Occupant 5) appliance permit 300
•" Repair of seating, re ng
8) coocng, absorption unit 6.00
of er or corn-, eat pump, air conn -{I---
�' C'c/ ,vol v SG S 71 to 3 HP. absorp unit to 100K BTU 600
"•
Boiler or comp, cheat pump. air con
Contractor 3) 3-15 HP, absorp unit to 500K BTU 11.00
�Mstaof er or comp, Real pump air con
�-�t►/ �M Z 'Z-3 (j) 15-30 Hh; absorp unit 5-1 mil BTU 15.00
of er or copump, air con
101 30-50 HP', absorp and 1-1 75 mil BTU 22.50
hereby acKnow a ge that I have read-Fs-rs app ication, a t eof cr or comp, heat pump, a rc� off- --
information given is correct, that I am the owr,er or authorized 11) >50 HP absorp unit 1.75 mil BTU 37.50
agent of the owner, that plans submitted are in compliance with Air handing unit to
State haws. that I am registered with the Construction Contractors 12) 10,000 CFM 4.50
Board, that the number given is correct. (If exempt from State it an ing and
registration, please give reason helow) 13) 10,000 CTM + 7 50
Non porta-5575 — -
14) evaporate cooler 4,50
ent an
connected
15) to a single duct 3.00
enu aticn system not
16) in.,luded in appliance permit 4 50
Hood served by
171 mechanical exhaust
450
Describe work new L agdition alteration repair ( T ommer,-ial or industrial
to be done resrcential non-residential Q 18) type ncinerator 3000
xisttng use of i er a woo stove, water
budding or property _ 19) heater. solar, clothes dryers, etc. 450
Proposed use of 201 Gas piping one to four outlets 1100
budding o•property
Type of fuel - oil Q natural gas Q LPG Q electrlr. Q 211 More than 4-per outlet (each) 2 00
NOTICE
Minimum Fee S2500 SUBTOTAL
PERMIT S BECOME VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMEN.ED WITHIN 180 DAYS, OR 501,, SURCHARGE r
IF CONSTRUCTION OR WORK IS SUSPENDED OR —
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME PLAN REVIEW 2511. OF St eOTAL r
AFTER WORK IS COMMENCED - —
I TOTAL
Special Conditions
Date Issued / by
�'Ln01M08T91MEC4PMT
"I IT
CITY OF TIGARD PERMi' �� :E L.C 0 i'� 17
COMMUNITY DEVELOPMENT DEPARTMENT DATE: ISCUED:
13125 SW Hall Blvd,Tigard,Oregon 97223.8198 (503)639-4171 101 Z L
2
TILL L
L I.. S 7 E Z 0 N 1 1\1 0
LCT.. . . . . . . . . . . . . .
I N SO 71 LL 'IMM AC UNIT 'W/ rREL,')T1:D MEC PERM—
SRVC/'--EDERS ' -
T U(IT I ON. lb
CIR amp. Pum;
Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Permit #
A, Date Issued
Phone (503) 639-4171
CITY OF TIOARD FAX (503) 684-7297
TDD No. 503) 684-2772
Inspection (503) 639-4175
1. Job Address: 4. Complete Fee Schedule Below:
Name of Developme it/��1 / �7< Number of Inspections per permit allowed
Address f��6_I ��/�-��� �t/e�'J L7 Service included Items Cost(ea) Sum
Cit /State/Zi // 4'4 LV✓- �7 2'Z",
City/State/zip p 4a. Residential -per unit
1000 sq. ft. or less $11000 4
Name (or name of business) Each additional 500 sq ft.or
portion thereof $2500
Commercial Ll Resident Limited Energy $25 00 - - 1
Each Manurd Home or Modular
Dwelling Service or Feedrnr SBr 00 2
2a. Contractor installation only: 4b. Services or Feeders
t
Installation, tion,or relocationElectrical Contractor ELG 200 amps or leas
SRO 00 2
Address 2Z-�� fj,a/ cf
201 amps to 400 amps $8000 2
City B� v<aj State�'r- Zips a} 401 amps to 000 amps $120 00 2
s $18000 2
Phone No. g2---]9.3 - Ove601 amtwotamppo I s oe oua $34000 _ 2
Job NO. Reconnect only $5000 _ 2
contractor's license NO. jY- 2
4c. Temporary Services or Feeders
Contractor's Board Req. No. 1. 1
_ Installation,a'terstlon,or relocation
Signature of Supr. Elec'n 200 amps or Mas 2
License NO.;� _ 6
- Z P One No. Ti— 201 amps b1 0amps 7 00 2
401 amps to 8000 $
amps __ S755 00
Over 600 amps to T A volts $10000 —
2b. For owner Installations: see"b"above.
Print Owner's Name 4d. Branch Cir-cuits
New,allerstion or extension per pane
Address a)The rec for branch circuits with
City. State__ Zip purchase of service or feeder fee. 2
Each branch circuit $5.00
Phone No. _ h The fee for branch circuits without
The installation is being made on property I own which is purchase of service or feeder fee. / �} 2
not Intended for sale, lease or rent. First branch circuit ! $75.00 �'� 2
Fach additional branch circuit $5.00
Owner's Signature __- 4e. Miscellaneous
(Service or fPr+Her not included) 2
3. Plan Review section (if required): Each pump or Irrigation circle $4000 2
Each sign or outline lighting $4000
Signal circuR(s)or a limited energy 2
Please check anpropriaie Item and enter fee In section 5B. panel,alteration or extension $4000
_4 or more res idential units in one structure Minor Label$(in) $10000
_Service anr; feeder 225 amps or more
System Iver 600 volts nominal 4f. Each additional Inspection over
Classified area or structure containing special r;cupancy the allowable in any of the above
as described in N E C Chapter 5 Per Inspection $3500
Pel hour $5500 _
In Plant 15500
Submit 2 sets of plans with application where any of the above `- --'
apply Not required for temporary construction services. 5. Fees:
NOTICE 5a. Enter total of above fees g
%�-. (� i
5%Surcharge (05 X total fees) g h— Y `
PERMITS BECOME VOID IF WORK OR CONE-.+ ICTION Subtotal
AUTHORIZED IS NOT COMMENCED WITHIN . DAYS, OR IF db. Enter 25% --f line A for
CONSTRUCTION OR WORK IS visru4DF_D OR ABANDONED FOR Plan Review It required (Sec.3) $
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $
COMMENCED. «.dcomennekc U Trust Account 0
Am/pp $
,
Balance Due $ �)�,
k, CITY CSF TIGARD `
1 COMMUNITY DEVELOPMENT DE OARTMENT CER1 I F I CA T'E GF
13125 SW Hell Blvd.Tigard,Oregon 97223.8199 (503)839.4171 OCCUPANCY
,,)<X A PU.RMI T #. . . . . . . . MST92--0-io
639 4171 DATE ISSUED: 07/20/93
PAR(;EI_: ,2S10s BS--05400
;ITC. ADDPCSS. . . : 14061 SW C;,-1Elif4LEM V,I
'iU81.)IVIEsION. . . . a L"AOTLL HILL. ZONINGa
11LOCK. . . . . . . . . . . I...ITT. . . . . . . . . . . . .
'(.ASS OV WORK. a NEW
1 YPL Or 1JSL. . . c SF
_1CCUPANCY Gm'. a R3
1CILL1F'ANCY LDA.Da 115 4
1 rl',IF N T NAME.. . . :
1"emarks : PATH to
''ORTLAND PAINTING DBA SIOME:RSET
zi9540 f.'& WOODED HIL_LIS L:1
"GRTI.-AND OR 97236
,hone #a 761-2000
►'OP T"LAND PAINTING DOi i
+540 5E. WOODED HILLS f"1
F'UR'T LAND OR 9723
Phone #9 761--122000
Eley #. . a 14949
'ICc:upaticy of t ' a above r•pf°ec'enc:ed building i !r heroby givre", and certtfies>
the compliaanup with the State (if Oregon Specialty Corips for the group,
'st)anc,y, and use under which the r'cefwr^encHci per-mit was insueci.
r'I RE DEPARTMENT idL!I I t46 �tF'E c,T"_i
r, 811 IL.tJ 4d-10EF I II-.
#SUS I IN CONGP I CUOUS PLACE
CITYOFTIOrARD -�
Cr1V L4OF TWA IRD MASTER PER11IT
COMMUNITY DEVELOPMENT DEPARTMENT PERMIT #. . . . . . . : MS T92-0308
13125 8W 11,11 BW, P.O.Box 23397,Tigard,Orepr, 07223 (663)&19-4175
SITE CIDDRESS. . . 1406i SW GH" 1ALEM CT PARCELs 2SiO4BB-05400
SUBD V)15 1 ON. . . . CkS I LE HILL. ZON I 1\16-
LALO('K. . . . . . . . . . L OT. . . . . . . . . . . . . : 1,3,
REISSUE: DWELLING UNIIEC3: 1 BASEMENT. . . . . . . . :0
CLASS OF WORK. :NEW BLDR1,11j.3 bATHS.-2 GARAGE:. . . . . . . . . . :473 S f
T YF 9E OF USE. . . -SF FLOOR AREAS—-----— REQUIRED SETBACKS—------
TYPE OF' CONST. :SN FIR51 . . . . : 1405 SF LEF T. . :5 ft RIGHT. :5 f.t
OCCUPANCY GRP. :R3 SECOND. . . 0 sf FRONT. 120 fit REAR. . :3i ft
S1 OR I E-5. . . . . . . . I 1HIRD. . . . 0 S f REUUI
HE 1 GH T. . . . . . . . : 15 ft TOTAL—--: .1405 S f SMOKE TNET EL TORS. : Y
FLUOR LOAD. . . . :40 psf VALUE. . . . . $ : 7*.;144 PAFRK1116 SPACES. . : I
Pc�marks : PATH 8
PLUMBING
bIqKb. . . . . . . . . . . I FLOOR DRAINS. :0 DN_KP LOW PREUN I RG. VA
LAVATORIES. . . . . C r?
WATER HEATERS. . . : 1 TRAPS. . . . . . . . . . . . . . :0
TUN/SHOWERS. . . :2 LAUNDRY TRAYS. . . :0 LA'rLFl BASINS. . . . . . . ..0
WATER CLOSE IF-x. . :E SLWER LINE (ft ) . :0 GREASE TRAPS. . . . . . . ..0
DISHWAS�HEIAZ_). . . . : I WATER LINE (ft ) . : 100 OTHER FIXTURES. . . . . ..0
UA RBAGE D I bP. . I RAIN DRAIN (f�t ) . :0
W()SH 1 NG NACI I. . . : I 15F RAIN DRAING. . I
MECHANICAL FEES
FULL TYI-T_.1� UNI r' H T RG. . :0 type amolant by date ret:pt
/GAS/ VENTS . . . . . .0 TIF 1, 1460. 00 P L L 01/07/93
11AX LA I U VENT FANS. . : 3 BP R 1 $ 355. 00 PLL 1.11/07/9's
FUR14 100K . . : j HOODS. . . . . . : 1 b F,L C, $ 230. 75 JLH 12/10/92 9, 34
FURN ) =100K . . :0 WOODGTOVLS. -.0 D5PC $ 17. 75 PLL 01/07/9;. —
F LOUR FURN. . . . :0 CLO DRYERS. : I SSDC.' $ 280. 0.0 FLL 01 /07/93
BUIL/C1,r1P ( 3HP:0 OTHER UNIT5: 1 PARK $ 500. 00 PLL 01/07/93
GAS OU1LETS: 1 MPRJ $ 40. 50 PLL 01/07/93
Owner; --.-- -- -- 11 10. 13 PLL 01/07/93
PORTLAND PAINTING DBA SOMERSET ITi5f.1c. $ 2. 03 F"L L 01 /07/9.3
09540 SE WOODED HILLS CT PPRI $ 117. 50 PLL 01/07/9::
P5PC1 $ 5. 88 PLL 01/07/93
OR 972,36
VItione #: 761--2000
PORJIJl1\11) PAINT' LNG DBA SUMS HSE T
9540 SE WOODED HILLS CJ
PORTLAND OR 97 36
ffione #.- 761-2000
Req #. . - 14949
t 301.9. 54 TOTAL
This permit is issued subji-' to the regulations contained in the REQUIRED INSPELT1ONS
Tigard 14unici,ml Code, State of Ore. Specialty Codes and all other
F-00t/fOUnd Insp Fireplace Insp
applicable laws. All work will be done in accordance with approved Post/Beam Strutt Gas Line Insp
plans. This permit will expire if work is not started within 189 Post/Beam Mectian InSLkla'tion Insp
days of issuance, or if work is suspended f"oreAihan 180 days. Plin/Lindslab Insp Gyp Board Insp
PLM/Underfloor Rain drain Ipsp
Permittee Sigyiato-tre : Mechanical Insp Water Line Insp
PILIMb 10P Out Appr/Sdwlk Insp
Issi.ted By : Framing Insp Mechanical Final
a1 .1 tot, inspection 639-4175
cin of TIGA RD
CffyOFTMIW SEWER CONNECTION
i i
COMMUNITY DEVELor.MENT DEPARTMENT 01110" PIE R lyl IT
12126 SW HWI OW. P.O.Ek*23397,TOW,OMPDn 97223(603)6394176 ;7-7 PERMIT #t:. . . . . . . : SWR92-0386
639-4171 DATE ISSUED: 01/07/93
SlIE ADDRESS. . . c 14QI61 .:)W CHEHAIJ.':11 CT PARCEL: 2S,1041313-05400
SUBDIVISION. . . . : (-PS I LE HILL ZONING:
BLULK. . . . . . . . . . LOT . . . . . . . . . . . .. . : 13
............-
TENANT NAME::. . . . .
USA NU. . . . . . . . . . : FIXTURE UNITS. . .
CLASS OF WORK. . . -NEW DWELL I NG UN 17 S. . - I
TYPE OF' USE:. . . . . :SF NO. OF BUILDINOS: 1
INSTALL T'YF-,E. . . . :BUSWR I1v1F-*,ERV SURFACE. .
Remarks: PATH 8
Owner FEES
PORTLAND FAINTING DBA SOMERSETtype aniol-trit by date t-ecpt
09540 SE WUGDED HILLS CT FIRMT 4, F'100. 00 PILL 01/07/93 -
INSP $ 35. 00 PLI- 01/07/93, -
PORTLAND OR 97236
14ione #-. 761-2000
Lunt ractor:
CONTRACTOR 1\101' ON FILE
p1tione k:
REQUIRED INSVIE-LTIONS
This 9pplicant agrees to comply with all the rules and regulations Sewer- Inspection
of the Unified Sewage Agency. The permit expires 180 days from
the date issued. The total amount paid will be forfeited if the
permit expires. The Agency does not guarantee the accuracy of the
side sewer laterals. If the sewer is not located at the measurement
given, the installs shall prospect 3 feet in all directions from
the distance given. If not so located, the installer shall purchase
a "Tap and Side Sewer" Permit and the Ancocy will install ; lateral.
Pei aiiLtep Sif
.4YIa'11 e
Issi.ted
Cali for inspection 639--4175
,
CITY OF TI GARD 13125 SW Hall BtW. PLNCK/RECT a �(
COMMUNITY DIyELOPMENT DEPARTMENT Tiprd,Orcgon97M PERMIT N
(503)639-4171 DATE ISSUED
,JDRESS: _ /�/l.% l '� (.�% L��� TAX MAP/Lor X2-6/
SUB: t 7 1S° LOT: 13 LAND USE:
VALUATION:
OWNER SPECIAL NOTES St4
NAME: CJ 0 w I REISSUE OF: _
ADDRESS: _ S F �ooc� /�� r� LAST REISSUE:
& A T i Vv W 6z P!!1 FLOOD PLAIN/
PHONE: 7L 2 D uG _ SENSITIVE LAND:
CONTRACTOR APPROVALS REQUIRED
NAME: SoflertrPT ��vP�PLANNING:
ADDRESS: 0 _EOO e f ENGINEERING: _
a P 9 -72 3 (, _ FIRE DEPT: _
PHONE: _ 7 .�G G� G OCHER: _[6EE
CONTR. BOARD #: ! EXP DATE: Z
ITEMS REQUIRED
SUBCONTRACTORS: PLUMB: G' LIST/SUBCONTRACTORS:
MECH: 'Jill eG A, P�' BUS TAX: _
RCH ENGINEER CALCULATIONS:
NAME: _ TRUSS DETAILS:
ADDRESS: OTHER:
1
PHONE: .
PROPOSED BLDG. USE:
COMMENTS.
A PLIC NT SIGNATURE
.Received By: __ /- Date Received: ,L�= �c y L
PERMIT # ACC"] # DESCRIPTION AMOUNT AMOUNT PD. BAL. DUE
Pi„ .�� 10-432 00 Building Permit Fees :7.f4 35`x,
10--431 00 Plumbing Permit. Fees /
10-431 01 Mechanical Permit Fees
10-230 01 State Building Tax (5%)
Building
Plumbing
Mechanical
10-433 00 Plans Check Fee ,
Building ,?o •
Plumbing
Mechanical
10-230 06 Fire
, � 30-202 00 Sewer Connection /'10
U V
30-444 00 Sewer ?nspection
2.5-448-02 Commercial TIF Fees
25-448-04 Industrial TIF Fees
25-448-06 Institutional TIF Fees
25-448-03 Office TIF Fees _
25-448-01 Residential Traffic Fees S U 3S u
25-448-05 Mass Transt TIF Fees
52-449 00 Parks System Dev Charge (PDC)
31-4 J0 00 Storm Drainage S.yst Dev Chrg
(SSDC) �/
24-445-01 Water Quality (Fee in lieu of)
24-445-02 Water Quantity (Fee in lieu of)
TOTAL v • Sy i
I
nm/3587P.WPF
— MECHANICAL
CITY OF TIGARD . . . . .
PE_RMIT� #. . . : MEC96-084
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 08/19/96
13125 SW Hall Blvd.Tigard,Oregon 97223.9199 (503)639-4171 PARCEL: 2S 104BB-05400
ITL ADDRESS... 14061 5W CHEI'AW-EM i_;l
SUBDIVISION. . . . : CASTLE•. HILL ZONING: R--25 PD
CLOCK. . . . . . . . . . : LOT.. . . . . . . . . . . . . : 1
t;l_ASS OF WORK. . :ALT FLOOR FURN. . . . : 0 EVAP COOLERS: 0
f YPE OF USE. . . . :SF UN IT HEATERS. . : 0 VENT' FANS. . . : 0
1CUPANCY GRP. . : R3 VENTS W/O APDL: 0 VENT SYSTEMS: 0
STORIES. . . . . . . . : 0 BOILERS/COMPRESSORS HOODS. . . . . . . : 0
I-UEL TYPE"5---_--- ----- 0--3 HP. . . - : 0 DOMES. INCIN: 0
: /GAS/ / / 3-15 HP. . . . : 0 COMML. INCIN: 0
MAX INPUT: 0 BTU 15-30 HIP. . . . : 0 REPAIR UNITS: 0
F IRE DAMPERS?. . : 30--50 HP. . . . : 0 WOODSTOVES. . : 0
i_iAS PRESSURE. . : 50+ HPI. . . . : 0 CLQ DRYERS. . : 0
NO. OF UNIT'S----------- AIR HANDLING UNITS OTHER UN I TS. s 0
F' URN l 100K BTU: 0 <- 10000 cfm : 0 GAS OUTLETS. : 1
URN > -100K B"fU: 0 > 10001A cfm : 0
Remar-ks : Gas piping to fo1_tr ot_ttlets.
_Owner –_ ___....__________________– FEES -----------------
MAZ Ike HERR t ype amol.tnt by ciat a r•ecpt
14061 SW CHEHAL.EM CT PRMT $ 25. 00 CTR 08/19/96 96-2630�L,
5PICT $ 1. E:5 CTR 08/19/96 96--711 ,17,
F IGARD OR 97223
Ffhone #-.
i:;ontr-:%ctor:
(iBLL MECHANICAL INC
PL) BOX 7176
BEAVERTON OR 97007 ___.__________________--•–_---_.____.---_.__._-
Ihone #: 640--4141 $ e:6. 25 TOTAL
Req #. . : 069114
-------- REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Gas Line I n s p
Tigard Municipal Code, State 1 ' Ore, Specia:`y Codes and all other Final Inspection
applicable laws. nl; work wil. be done in accordance with
approved plans. This permit will expire if work is not started
within 188 days of issuance, or if work is suspended for more
than 188 days.
o r•-m i t t e e S i g n a t It r-e: m i..(ec�..._.._
s l..1 e d B y .. �2..!_�_ __._.. ►n_�. _.
Call for inspectio•, – 639-4175
City of Tigard MECHANICAL PERMIT Planck/Rec. # 9F
131.25 sw Hall Blvd. APPLICATION Permit # m ori -C)�a
Tigard, OR 97223
(503) 639-4171
escnplion
Table 3A Mechanical Code QTY PRICE AMT
.lab �O��, )t�7lYl �.�. 1) Permit Fe.: -0- -0- 10.00
Address
--_ � ' a� / ��/ 2) Supplemental Permit 3.00^
Furnace o O�brBTU
r 1) Incl. ducts &vents 6.00
Zir--*
-1.Lq —.- urnace + -
�� :..� 2 incl. ducts &vents
Owner ryl M C ) -� 750
—Tr•" oor .,rnaoce
-- 3) incl. vent 6.00
Suspendied heater, wall eater
4.1 or Floor mounted healer 600
(iccupant Vent not me n —
5'I
appliance permit ?J0
Repair of heating, re ig. i
6) cooling, absorption unit 6.00
Boiler or comp, eat- t pump,air cond.
7) to 3 HP; absorp unit to 100K BTU 6.00
/- ) of er 57 .-nm-p,Meat pump, air con
-F.—
�5w h 8) 3-15 HP, absorp unit to 500K BTU 11 00
CCPtraCtOr ,,,"I" C o oiler ocomp, at pump, air con
I 7M S 9) 15-.;3 HP; absorp unit 5-1 mil BTU 15.00
oder or comp, e-at pump, air cond. -
•CQQ f 10) 30-50 HP; absorp unit 1-1 75 mil BTU 22.50
fere y
acKnowiefige that I have-read this application, at the Boiler or comp, heat pump, air con
information given is correct, that I am the owner or authorized 11) > 50 HP, absorp unit 1.75 mil BTU 37 50
agent of the owner, that plans submitted are in compliance with Xr handling unit to -
State laws, that I am registered with the Construction Contractor's 12) 10,000 CFM 4.50
Board, that the number given is correct. (If exempt from State - ihandling unit
registration, pie-,;e give reason belo% ) 13) 10,000 CTM + 750
Non poriz e
i4) evaporate Cooler 4 50
— ent an ronnecteT- —"
15) to a single duct 3.00
Ventilation system not
16) included in appliance permit 4 50
— —
0o sery IYY
1S 17) mechanical exhaust 4�0
�DescrrLe work Xw addition _� ation i'A Commeiaa or in ustria --
to ne done residential () nun-esi ial O 18) type incinerator 3000
Existing use o ^- —Other i.e., woodstove, water -
building or property FD 19) heater, solar, clothes dryers. etc 4.50
Proposed use of 7.0) Gas piping one to four outlets -� 2 00 .0 (�[�
building or property _ _ +++------
Type of fuel - oil na'Iiral as l)0 LPG 21) More than 4-per outlet (each) _ 2 00
Q g /� (� electric Q
Minimum Fee $25.00 SUBTOTAL 60
PERMITS BECOME VOID IF WORK OR CONSTRUCTION `- —"'-- --
L-:�I—
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR 5% SURCHARGE '
IF CONSTRUCTION OR WORK IS SUSPENDED OR ------ - --
ABANDONED FOR A PERIOD OF 180 DAPS AT ANY TIME PLAN REVIEW 25% OF SUBTOTAL
AFTER WORK IS COMMENCED. —
TOTAL
Special Conditions
Date ssued _V > >�. oY
w LLGDIMDSTSMECMOMT