9900 SW CENTURY OAK DRIVE O
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"900 SW CENTt RY OAK DRIVE
CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour InspPction Line: 639-4175 Business Lige: 62°-41MST71 -- ---
BUP _
_ Date Reauested_ - '�f AM—� PM --- BUP
BILD
Location r i e,4) Sc✓ C--,--111(4 O 4 le ISA-- Suite — _ - ---
MEC
Contact Persui 1 422 6 __ P`t r f/-- (,6 PLM G6
Contractor Ph SWR
BUI—LV;NG - Ten6:nt/Owner ELC
Retaining Wall ELR
Footing Access: �_— •1 FPS
-.-
Foundation
Ftg Dain / � �'����?l�/1 -- -----__._-
Crawl Drain Inspection Notes SGN
Slab
__ ____----- --- ---- — SIT
Post u team --- ----- ------
Ext Shep.th/Shc ar
Int Sheatr•/Shear - --
Framing
Insulation
Drywall NeiHng -
Firewall
Fire Sprinkler
Fire Alarm - -- - -
Sus,-'d Ceiling
Roof
Misc: -
Final
JPI 1'JMr�;N—G�_
.sm.
arr - -- --
Under Slat ~
Top out -----
Water Service
Sanitary Sewer - �—
Rai c, ns
-- - - --- __ —�_- -. -
P7AS ``
31 PART FAIL
CKANICAL
Post& Beam -__.__._- -----------
Rough In
GasLine ------------------- -_�.—_� -__-- - - - - -- -
Smoke Dampers
Final ---------
PASS PART FAIL
ELECTRICAL -- -----____.- -__----
Service
Rough In ------•------_ -_— — -- ---�.- _---- -
UG/Slab -
Low Voltage
Fire Alarm
Final --------- ------_—. - --- ------ -
PASS PART FAIL -----_-----
$ITE
Backfill/Grading —_-.._.__-- -- -------- ---_--
Sanitary Sewer
Storm Drain [ j Reinspection fee of$ required before next inspe-tion. Pi- City Hall, 13125 SW Hall Blvd
das
Cetcir �n
Fire ii i3asy Line [ j Please call for reinspection RE. [ j Unable to inspo--t-no access
ADA G/
Approach/Sidewalk
Other _ Date I Insprctor1� _ _ Ext -y
Final
PASS PART FAIL 00 NOT REMOVE this inspection record from the job site.
CITYOF TIGAR D PLUMPING PERMIT
DEVELOPMENT SERVICES PERMIT#: PL M2000-00334
13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 9/8/00
SITE ADDRESS: 09900 SW CENTURY OAK DR
PARCEL: 2S1 ,1CC-06300
SUBDIVISION: SUMMERFIEI_D ZONING: R 12
BLOCK: LOT: 086 JURISDICTION: TIG
CLASS OF WOF.K: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: 1 BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES _ _ LAUNDRY TRAYS: SF RAIN GRAINS:
SINKS:�2 URINALS: GREASE TRAPS:
LAVATORIES: OTHL 1 FIXTURES:
TUBISHOWERS: 1 SEWER LINE: ft
WATER CLOSERS: 2 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of new plumbing fixtures.
FEES
Owner: -- � --
-���- Type By Date Amount Receipt
JOHN ----'—� --- —'
JOHN BARNESA HIGHLAND DR PRMT CTR 9/8/00 $99.60 272.00000000
NEWBERG, OR 97132 SPOT CTR 9/8100 $7.97 27200000000
Total $107.57 _J
Phone 1: 538-9666
Contractor:
MODERN PLUMEiNG
11120 SW INDUSTRIAL WbY
TUA' ATIN, OR 97062 REQUIRED INSPECTIONS
Phone 1: 691-6 i66 Top-out Insp
Reg #: LIC 87906 inal Inspcction
PLM 34-250PF
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved plan:;.
This permit will expire if wo,k is not started within 180 days of issuance, or if wore; is suspended fi)r marc;
than 180 days. A IFTFNTION, Oregon law requires you to folicw rules adopted by the Oregon Utility
Notification Center. Those rulr.s are ..et forth in OAR 952-0001-0010 through OAR 952-0001-0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-1987.
Issued By: 1; f Permittee Signature:
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day
J
CITY OF TIGARD Plumbing Permit Application Plan Cheek# _
13125 SW HALL BLVD. Commercial and Residential Recd By + r
T IGARD, OR 97223 Date Recd —e"
(503) 639-4171 Date to P.E.
Print or Type Date to DST
Incomplete or illegible applications will not be accepted Penult#_`U/:err-
Related S'V4#
Called
Name of Dm-olopment/Pro)ect FIXTURES (individual) QTY PRICE AMT
Job Sink 11
Address treat Address Suite Lavatory 11.50 v '
CJS ✓ Tub or Tub/Shower Comb
Bldg# City/51aid Zip , �'f/ Shower Only 11 50
Name Water Closet
ej/m Urinal -- -- 11.50
Owner Mailing Address Suite Dishwasher 11.50
Garbage Disposal 11.50
City/State Zip Phone Laundry Tray 11.50
aa, Or
Name Washing Machine/L Sundry Tray
Floor Drain/Floor Fink 2" 11,L0
OCCupant Mailing Address Siliie! 3" 11.50
City/Stale Zip Phone 4•, 11.50
Water Heater O conversion O like kind 11.50
Name Gas piping requires a separate mechanical permit.
MFG Home New Water Service 32.00
Contractor Mailing Address Suite MFG Tome New San/Storm Sewer 32.00
Hose Bibs 11.50
Prior to permit City/State ZipPho Roof Drains 11.50
issuance,a copy 1 J� ,C l�y y
Drinking Fountain 11.50
of all licenses are Orego Const.Cont Board Lic.# Exp.Data
required if 9 9, .Zl _O Other Fixtures(Specify) 15.00
expired in COT Plumbing Lic.# Exp.Date -
database i� _ �7-.00 — --
Name --—
Architect Sewer-1st 100' -- 38.00
or Mailing Address Suite Sewer-each additional 100' 32.00
E n i neer City/State Zip Phone Water Service-1 st 10f' 38.00
g Water Service-each additional 200' 32.00
Describe work to be done: — Storm&Rain Drain-1st 100' 38.00
New O Repair O Replace with like kind Yes O No O Storm&Rain Drain-each additional 100' 3200
Residential O Commercial O
Addlitional description of work — Commercial Back Flow Prevention Devi,* 32.01
Residential Backflow Prevention Device" 18.00
Catch Basin 11.50
Are you capping,moving or replacing any fixtures? Insp of Existing Plumbing or Specially Requezted 50.00
Yes O No O inspectionsper/hr
If yes, see hack of form to indicate work performed by Rain Drain,single family dwelling 4500
fixture. FAILURE TO ACCT,... -ELY REPORT FIXTURE Grease Traps 11.50
WORK COULD RESULT IN INCREASED SEWER FEES.
I hereby acknowledge that I have read this application,that the informatit.n QUANTITY TOTAL
given is correct,that I am the owner or,authorized agent of the owner,and Isometric or riser diagram is regulred if Quantity Total is >9 C�
thatla submitted are In com lienee ith Oregon State Laws. "SUBTOTAL (�
Slgn�r r of OwrarlAgent p
�, t 8%SURCHAk.:E
Contact Person Name -7Phone /
e' r' ' - '% - "'PLAN REVIEW 25%OF SUBTOTAL
-'"-- `�-c----'-- Required ont if fixture t total is 1 9
i 1 BATH HOUSE$178.00 - _
2 BATH HOUSE$250.00 TOTAL
3 BATH HOUSE$285.00
(This fee Includes all plumbing fixtures in the dwelling and the first
'Mcarrell tee n$50 B°Ft.surcharge.except Residential Backflow Prevention
100 feet of sanitary sewer storm sewer and water service) Device vroe which
hich is 1+25.8%surcharge
"Ali New Commercial Buildings require plans with isometric or riser diagram and
pian review
I Wsistformstpiunnapo doc 1111M9
PLEASE COMPLETE:
Fixture Type Quantity by 'llllork Performed
New Moved Replaced Removed/Capped
Sink - --
Lavatory --__---
Tub or_Tub/Shower Combination
Shower Only -
Water Closet - -
Urinal___
Dishwasher-� —_�_� _�—
Garbage_ Disposal — -- -
Laundry Roc;;, Tray �-
Washing Machine
Floor Drain/Floor Sink 2"
311
_Water Heater __ _ - __ — ---
Other Fixtures (Specify) -
COMMENTS REGARDING ABOVE:
I\ds`!1'orm!`plumap{o A<x 1 t11:'/qy
CITY OF TIGABD BUILDING ;NSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business Line: 639-4171 �—
BUP — -
-_ Date Requested � ` AM _PM -_— BLD
Location q7CC) W'-�k'LJD�d Suite -.. MEC
Contact Person _ _�^ Ph PLM —_ —
Contractor Ph SWR
BUILDING — Tenant/Owner _ ELC
Retaining Wall ELR
Footing / NOT REQUESTED FPS
Foundation --- --
Ftg Drain _ FOUND DURING RESEARCH SGN
Drawl Drain NO INSPECTION(S) FOUND IN FELE _ SIT
Slab _ --
Post&Beam
Ext Sheath/Shear 2 _ -
Int SheathiShear
Framing - -- - - - - --- ----
Insulation _
Drywall Nailing .. _ --- -------- -
Firewall --
Fire Sprinkles .-
Fire Alarm
Susp'd Ceiling
Roof
-
F incl
PASS PART FAIL -- ---- ---
PLUMBING
Post&Beam
Under Slab
Top Out -
Water Service
Sanitary Sewer
Rain Drains
Final -
PASS PART FAIL _._---_- -___-- -- --- -- —
I1NIC
Post& :-ieani — _.---------- ------ - --_-- -� -
Rough In
Gas Line -- -- -- - �-
Smoke Dampers
-in-al) - -_-- ----- ----FX-SS PART FAR
ELECTRICAL -----` ---- __---- ____ --Service --
Rough In
UG/Slab - - --
Low Voltage
Fire Alarm --- --- — - —
Final
PASS PART r AIL _ — _ --- -- ---SITE
Backfill/Grading - -`---- --- - -
Sanitary Sewer
Storm Drain [ J Reinspection fee of$-_-_—_required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ J Please call for reinspection RE: - [ J Unable to inspect-no access
ADA
Approach/Sidewalk DateInspector i Ext
Other -- -- —._ -__ -.
Final
PASS PART FAIL 00 NOT REMOVE this inspection record from the job site.
CITY OF TIGARD
DEVELOPMENT SERVICES ELECTRICAL. PE.RMT.T
PERMIT #- EL.C97-00131.
1312.5 SW Hall Blvd., Tigard,OR 97223 (503)639.4171 DATE ISSUED: 01/1.7/97
PARCEL: 2S11i.CC-06300
SITE ADDRESS_'. . . : 09900 SW CENTURY OAF', DR
SUBDIVISION. . . . a SUMMERFIELD Z0NING:R--12'-' r'D
ElL..00K, . . . . . . . . . . LOT. . . . . . . . . . . . . :136 rnVAAF �
F;'roject Description : instl 2 branch circl.tits
- --RESIDENTIAL UNIT---- ---TEMP SRVC/FE.EDERS---- ---- -MISCELLANEOUS-----
1.000 SF OR LESS. . . . : 0 0 - 200 amp. . . . . . . : 0 DUMP/TRRIGA'TION. . . . 0
"ACH AD►)' L 500SF. . . : 0 201. — 400 amp. . . . . . . : 0 SIGN/OU f LINE LYG. . : 0
I .iMITED ENERGY. . . . . : 0 401 -- 600 amp. . . . . . . : 0 SIGNAL./PANEL.. . . . . . . : 0
IhAN"z. HM/ SVC/FDR. . : 0 601.+amps-1000 volts. : 0 MINOR LABEL ( 10) . . . : 0
___.-SERVICE/FEEDER.._----- --_—BRaNC;FI CIRCUITS __-__rDD11_ INSPECTTON1
0 - 200 amp. . . . . . : 0 W/SERVICE OR FEEDER: 0 PER I.NSPE.CTION. . . . . : 0
'01 - 400 amp. . . . . . 0 1 s+ W/O ERVC (DR FDR. : L. PER HOUR. . . . . . . . . . . 0
401 — 600 amp. . . . . . : 0 EA ADD' L BRNCH CIRC: 0 IN PLANT. . . . . . . . . . . : 0
r-,1711 1000 amp. . . . . • 0 ----...___.__—_____._.______pl_AN R F VIEW SECT TON
1000+ amp/volt. . . . . s 0 ) =4 RES UNITS. . . . . . . . : > 600 VOLT NOMINAL. .
Rer,onnpr.t only. . . . . . 0 23VC/FDR ) -_ 225 AMPS. . . CLASS AREA/SPEC OCC.
Owners --------------------------------------------------- FEES
13HORON PETERSON type amol_mt by date recpt;
900 SW CENTURY OAR DR PRMT $ 35. 00 TAT 01/17/97 97-2:89076
5PCT $ 1. 75 7 A 01 /17/97 97 -2.89076
TJGAI3D OR 97223 PRMT $ 35. 00 l AT 01/1.7/97 97-289075
Phone ;+: 9PCT $ 1. 75 1 AT 01 / 17/97 97—IDS':)07E
ontractor•
WESTSIDE ELFt-TRIC: $ 73. 50 TOTAL_
7518 SW MACADAM AVE
—_-- REDUT.RFD INSPECTIONS --_.__....
t,OPJLAND OR 97219 Ceiling Cover IJndrr•oroi.tnd Cove
Phone #: 503-245-3385 Wall Cover Elect' ]. Service
Reg #. . : 0001;33
This pereit is issued subject to the regulations contained in the
Tigard Municipal Code, State of Ore. Specialty Codes and all other Perm ' t �e Si gnat l_(r e�
applicable laws. All work will be done in accordance with
approved plans. This pereit will expire if work is nut started
within 160 days of jance, or if work is suspended for sore _
than 184 days. I s s Li e d tiy_
_..._ .. . ..----.... __.__.. _._.....__..._ .. _ __.__ - OWNER INSTALLATION ONLY- - - _..... .. . .._.__._.____.....__......_.._
The installation is being made on property I own which is not intended far
,ale, lease, or- rant .
OWNER' S SIGNATURE: DATE:
TNSrAl_1_.PTION ONLY
S I C-,VATURE OF SUPR. F=L.EC,' N: _ DATE s _
I._T CENSE: NCi-
Call. for• inspection — 639--4175
Community Development ELECTRICAL PERMIT APPLICATION
13125 SIN Hall Blvd.
Tigard, OR 97223 Permit #
'-�
Phone (503) 639-4171 Date Issued
CITY OF TIC3A6tD
FAX (503) 684-7257
TDD No. (503) 6842772
Inspection (503) 639-4175
1. Job Address: 4. Complete Fee Schedule Below:
Name of Developp��men'_ Number of Inspectiont: per permit allowed
Address < < r/ •fl� ����rir 4-11 e9r T Servile included: Items Cost(ea) Sum
City/State/Zip /l <!!'L 4a. R-ealdential -per unit
// 1000 sq, ft. (i leas _ $11000 4
Name (or name of business) �'�/-10rt ( V Each additional 500 sq.It.or
r portion therec1 $2500
Commercial Residential Limned Energt $2500 1
Each Manufd itome or Modular
Dwelling Stivice or Feeder $6800 2
2a. Contractor in:tallation only:
4b. Servi,;es or Feeders
I � InstalleCon,alteration,or relocation
Electrical Contractor EtJP 200 amps oi less $6000 2
Address / r 201 amps to 40U wrips $8000 2
City G < State Zips 401 amps to 600 amp s $12000 2
Phone No. 'r - 601 amps to 1000 smp; $18000 _ 2
Over 1000 amps or volts $340 00 2
Job Nn. /L7 9- DU 2 Reconnect only -- $5000 2
contractor's license No. Z - L
. _ , ac. Temporary services or I es�lers
Contractor's Board Reg. No
-• Installation,alteration,or relocation
Signature of Supr. Elec'n u _ 200 amps or lase 2
License No. /S-f�.S Phone No. 7`1d -fS a .� 201 amps to 400 amps 150 00 -- 2
401 amps to Goo amps $75 L-0 2
Over 600 smpa to 1000 volts $too 00
2b. For owner installations: see"b°above
Print Owner's Name 4d. Branch Circuits
-- New,alteration or extension per pane
Address. e)The fee for branch circuits with
City State Zip purchase of service or reedier rye. 2
Phone No. Fach branch circuit $500
-- b)1 e fee for branch circuits without `
The installation is being made on property I own which is pL,.chos@ofservice orreederfee. 2
not intended for sale, lease or rent. First branch circuit $3500 l 2
Each additional branch circuit S500
Owner's Signature 4e. Miscellaneous —
(Service or feeder not included) 2
3. Plan Review section (if required): Each pump or irrigation circle __ S40 00 2
Each sign or outline lighting $4000
Signal.ircull(s)or a limited energy 2
Please check appropriate Item and enter fee In section 5B. renes,alteration or extension $4000
4 or more residential units in one structure M iior labels(10) $10000
Service and feeder 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.0 Chapter 5 Per inspection $3500
Per hour _ $5500
r � ---
Submit 2 sets o• pians with application where any of the above In Plant $55 00
apply. Not reojirad for temporary construction services. 5. Fees: _ 7S
NOTICE Be. Enter total of above fees $
5%Surcharge (05 X total fees) $
PERMITS 13ECOME VOID IF WORK OR CONSTRUCTION Subtotal $
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF Sb. Enter 25%of line A for
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOF' Plan Review if required (Sec.3) $
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal i $
COMMENCED. I LLd�Trust Account 4
$ 2l 7Sr—
nm.rn L
Balance Due s
_ � I
CITY OF TIGARD MECHANICAL
DEVELOPMENT i SEMCES
PERMIT #. PERMIT. MEC96-04 7
13!25 EW Hall 3ivd., Tigard.0►,97223 (503)639.4171 DATE ISSUED: 12/16/96
EAsv PIREORCEL: 2S111CC-O6300
S I TF At DRESS. . 00 9WI CENTURY OAK DR
SUBDIVISION. . . . &ERFIELD ZONING: R-12 PD
BLOCK. . . . . . . . . . LOT. . . , . . . . . . . . . :88
CLASS OF WORK. . :ALT FLOOR FURN. . . . : 0 F-.VAP COOLERS: 0
TYPE OF USE. . . . :SF UNIT HEATERS. . : 0 VENT FANS. . . : 0
OCCUPANCY GRP. . :A1 VENTS W/O APDL: 0 VENT SYSTEMS: 0
STORIES. . . . . . . . : 0 BOILERS/COMPRESSORS HOODS. . . . . . . : 0
f U17L.. TYPES.--- -. 0-3 HP. — : 0 DOMES. I NC I N: 0
: /L-,'AS/ / / 3-15 HP. . . . : 1 COMML. I NC I N: 0
MAX INPUT: 0 BTU 15-30 HP. . . . : 0 REPgIR UNITS: 0
FIRE DAMPERS?. . : 30-50 HP. . . . : 0 WOODSTOVES. . : 0
GAS PRESSURE.. . . : 50+ HP. . . . : 0 CLQ DRYERS. . : 0
NO. Ol UNITS- _•-------- AIR HANDLING UNITS OTHER UNITS. : 0
FURN ( 100K BTU: 1 <= 10000 cfm : 0 GAS OUTLETS. :
FURN )=100K PTU: 0 > 10000 cfm : 0
1 pmarl<s : .add fi.krnace, vents/dur-t s, heat Fit_imn, a/c;, R gas piping
Owner: -- -__..---___...___________.__-.-•.------ --________________ FEES --------- ---- -
'-.') IARON PETERSON type amount by date recpt
9900 SW CENTURY OAK DR PRMT $ 29. 00 TAT 12/16/96 96-287734
SPCT $ 1 . 45 TAT 12/16/96 96-287734
TICAPD OR 97224
Phone #:
Contractor-: ---------------------------------
C01._I'MP I A HEATING
PO BOX 43039'7
TIGARD OR 97281 ---------------------------._..____-___..
I'1h o n e #: 624-2704 4 30. 45 TOTAL_.
Reg #. . : 76359
REOU I RED INSPECTIONS
-----_
This permit is issued subject to the regulations contained in the Gas Line Ins p
Tigard Municipal Cude, 94te of G.s. Specialty Codes and all other Mechanical I n s p _
applicable laws. All Mork will be doi;� in accordance with Misc. Inspection
approved plans. This permit will expire 4f work is not started Final Inspection
within 104 days of issuance, or if work is suspended for more
than, 180 days.
Permittee Si At1.y�•e : � '
� I s s a e d By :
all for inspection - 639-4175
City of Tigard MECHANICAL PERMIT Planck/Rec. #
13125 sw Hail Blvd. APPLICATION Permit # r'1IC(A, - biV37
Tigard, OR 97223
(503) 639-4171
escripbon --
} 4� ' Table 3A Mechanical Code OTY PRICE AMT
Job
Adolf eSS -^- -z '. � 1) Pr,rmit Fee .0- -0- 1000
u -
1
Supplemental Porm;t 300
I- urnace o
C roo 'P;7 ^� 1) incl. ducts&vents 6.00
�umace 100. +
Owner r 2) incl. ducts d vents 7.50
' � --F1oorFumance --'—
____-�` 3) incl, vent 6.00
spcn-d5a-ieater, wa eater
f y 4) or floor mounted heater 600
Vent nincrin
Occupant V not —
5) appliance permit 300
Zip Repair o?�ieabng, re ng. - -- —
_ 6) cooling, absorption unit 600
nII I /}�� � Cotler or comp, ea plump,air con .
�(f)
r./LA _ 7) to 3 HP;absorp unit.o 'OOK BTU v� 6,00
/ —. boiler or comp, heat pump,—air con . -"
Contractor PC.6 � -IN63111( `/ ���'C- 8) 3-15 HP;absorp unit to 500K BTU / 11.00
13o er or comp, ea pump, air con . --
LY 4 9) 1530 HP;absorp unit 8-1 mil BTU 15.00
`
d
Boiler or comp, w� at pump, air con_-
7'�� 10) 3050 HP;absorp unit 1-1.75 mil BTU _ 22.50
hereby ac now ec ge that have road its
`application,ton, a e moi or or comp, ea pump, air con
information given is correct,that I am the o,vnar or authorized agent 11) > 50 HP,absorp unit 1 75 mil BTU 37.50
of the owner, that plans submitted are in co npliance with Sta a
- it ia�nnfing urni to ------
laws, that I am registered with the Construction Contractor's Board, 12) 10,000 CFM 450
that the number given is correct. (If axempt from State registration, "-_A-ir-fien ring unit - ~ -
ple ze give reason below.) 13) 10,000 CTM+ 7.50
—
14) e,.aporate cooler 4.50
Ven an cL„pec — -
_ < 151 to a single ducat
3.09
Venob aTbon ssystem not
16) included in appliance permit
450
-
�Hood served Fy—�
17) mecharrcal exhaust 4.50
Pscn a wor new U addirtton Tj_-iteration repair CT ommeraa-T or in ustnar—
to be done residontial Q nonresidential O 18) type incinerator 30.00
xisting usa-O — -- ier woo -love,water
building or property 19) heater, solar, clothes dryers,etc 4.50
Proposed use of 20) Gas piping one to four outlets 2.00
building or property
Type of fuel oil Q natural gas Q LPG 21) More than 4 per outlet -
(� electric�
Minimum Fee$25.00 SUBTOTAL
PERMITS BECOME VOID IF WORK OR CONSTRUCTION —
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR 511.SURCHARGE
IF CONSTRUCTION OR WORK IS SUSPENDED OR ---- -- - _��
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME PLAN REVIEW 25%OF SUBTOTAL.
AFTER WORK IS COMMENCED.
TOTAL
3�-r
Special Conditions
- — Date issued by
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