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7065 SW BEVELAND ROAD 0 rn Ln uj t� r 1 7065 SW BEVELAND .:iTR:I T _-ter - MECHANICAL CITY OF TIGARD PERMIT #. PERMIT.. MEC95-0354 COMMUNITY DEVELOPMENT 0EPAF"MtNT DATE ISSUED: 10/10/95 13125 SW Hall Blvd.Tigard,Oregon 07223.9199 (503)039.4171 PARCEL : 2S101A@-02300 SITE ADDRESS. . . : 07065 SW BEVELAND ST SUBDIVISION. . . . : BEVELAND ZONING: C-P BLOCK. . . . . . . . LOT. . sl __-_-_--__-_-.-------------------- --------------------------------------------- CLASS OF WORK. . :ALT FLOOR FURN. . . . .. EVAP COOLERS: TYPE OF' USE. . . . :SF UNIT HEATERS. . : VENT FANS. . . : OCCUPANCY GRP. - :R3 VENTS W/O APDL: VENT SYSTEMS: STORIES. . . . . . . . : 1 BOILERS/COMPRESSORS HOODS. . . . . . . : FUEL_ TYPES------------ 0-3 HP. . . . : DOMES. INCIN: : /GAS/ / / 3-15 HP. . . . : COMML. INCIN: MAX INPUT: 100 BTU 15-30 HP. . . . : REPAIR UNITS: FIRE DAMPERS?. . : 30-50 HP. . . . : WCODSTOVES. . : GAS PRESSURE. . . : 50+ HP. . . . : CLO DRYERS. . : NO. OF UNITS----------- AIR HANDLING UNITS OTHER UNITS. : FURN ( 100K BTU: l (= 10000 cfm: GAS OUTLETS. : 1 FURN ) =100K BTU: ) 10000 cfm: Remarks : One furrarca to 100k BTU and gas piping one to four outlets. Owner: -----------------------------7------------._-_-_------ FEES, --------------- DEr;\I BOLANtype amount bpi date recpt 7065 SW 9EVELAND PRMT f 25. 00 CS 10/10/95 95-271460 5PCT t 1. 25 CS 10/10/95 95—L71460 TIGARD OR 97223 Phone #: Contractor: -------•—_--__---_-------__.--_— A—ACCURATE nIL CO 67;32 NE 4.7TH PORTLAND OR 97218 _.____..-----------------------...—.--.__-- Phone #: 281-6212 26. 25 TOTAL Reg #. . : 53391 �—--_- - REQUIRED INSFEGTIONS This permit is issued subject to the regulations contained in the Gas Line Insp Tigard Municipal Code, State of Ore. Specialty Codes and all other Mechanical Ins p applicable laws, All work will: be done in accordance with Final inspection approved plans. This permit will expire if work is not started within 188 days of issuance, or if work is suspended for more -- i than 188 d,- Permittee oPermittee Signature : Issued B y : Call for inspection — 639--4175 City of Tigard MECHANICAL PERMIT Planck/Rec. # a5-- 13125 SW Han Blvd. APPLICATION Permit # 171,ocC95-"D754/ )'U Box 2' '-- , Tigard, Oh, �j i 223 (503) 639-4171 •� —i—— — scnphon Table 3A Mechanical Code OTY PRICE AM1 JOU OG LJ L yl. L - ti 1) Permit Fee -0- -0- 100 Address _ --- tJ 6) _ '77,9,)=,? 2) Supplemental Permit 3.00 -- -- •^� Furnace to 100,000 t,) 60C• 1) ind.duds 6 vents 6.00 A «� umace 100,000 r Owner 1-u 'C"VY'AE- 2) incl.duds 6 vents 7.50 umance 3) Ind.vont 6.00 Suspended healw.wall heau.4 4) or Moor mounted heater 6.00 ind.to — Occtl7ant 5) appliance permit 3.00 pRepair of seating.refrig. — 6) cooling,absorption unit 6.00 ----- -- a�compto Slip - --- r rir;'!1"i G 1�4'rin 1.�+ 7) absorp.unit to 100,000 BTU 6.00 R� Mier or comp to 3 HP- 15 TT Contractor (a 7.3d, /VC, y 7,tt 1 X81 8) absorp.unit to 500,000 BTU 11.00 Wap Bodet or comp to 15 30 RFF - �� 9) absorp.unit.5 - 1 million BTU 15.00 •'• •••••" p a miler or comp to 30--� '� -- 10) absorp.unit 1 - 1.75 million BTU 22.50 sere y at I have read this appficalanthat the Boiler or comp to 50 HP -� information given is correct,that I am the owner or authorized agent 11) absorp.unit 1,750,000 BTU 31.50 of the owner,that plans submitted are in compliance with State Air handing unrt to laws,that I am registered with the State Builders' Board,that the 12) 10,000 CFM 4 50 number given is correcL (if exempt from State registration, please Air handling unit give reason below.) - 13) 10,000 CTM 4 -- — 7.50 - on portable 14) evaporate cooler 4.50 Vent fan connected 15) to a single dud 3.00 - - en7 abon system not 16) in luded in appliance permit 4.50 7.. .. Hoods IT) median"exhaust 4.5U scn new 0 additicri alteration repair --rbc type to be done msidantial non-residential O 1e) incinerator 7.50 E)asbng use --v-- Commercial or iridu sbra —- - building or property —— — 19) type incinerator ?0.00 Tier rye,w stove,water - Proposed use of 20) heater,solar,clothes dryers,etc 4.50 buildiing or property — r7U 21) Gas piping one to lour outlets 2.00 Type of fuel-of Q natural ga!:0 LPG Q electric r j -- 224 Mors than 4 per outlet O • -C - � -;�-S " `r Minimum Fee SUBTOTAL PERMfTS BECOME NULL AND VOID IF WORK OR -- CONSTRUCTION AUTHORIZED IS NOT COMMENCED 5%SURCHARGE / WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK IS - SUSPENDED OR ABANDONED FOR A PERIOD OF 180 PLAN REVIEW 25%OF SUBTOTAL DAYS AT ANY TIME AFTER WORK IS COMMENCED. - TOTAL Speaal Conditions — — —_ Date issued___ --by �.�caaRrr l CITY OF TIGARD _ A COMMUNITY DEVELOPMENT DEPARTMENT litI. . . . . . . 13125 SW Hall Blvd.Tigard,Oregon 9722398199 (503)639.4171 ".A-1` , '. 121 Z JN. 4J NU C- . ....... ..... i OLA' 1-L-12;� I U I�14 EUt r7 f:A N S. . . j, S f UNI 0 T S. VEN'T VL�i'v I y 1,1 lyl L'.') L 0 M 0 D 1—i LUMML. EV i u WLAA)�41L' ."Sez su"'Jezi, t. "`f Uri t',; i r,e I n c•dl mn I '-2 1 n7' iA Hot,k W, .1 Ila 1 11s p e r'- City of Tigard MECHANICAL PERMIT Planck/Rec. # 13125,SW Hall Blvd. APPLICATION Permit # Tigard, OR 97223 (503) 639-4171 74— Descnption Table 3A Mechanical Code QTY PRICE AMT A.xk - ] Job `t•» 1) Permit Fee -0- 10.00 Address CYC 2) Supplemontal Permit 3.00 ^•^° Furnace to 100,000 1) incl. ducts S vents 6.00 ) �`•_ Furnace 100,000 + Owner /f �. J �-�/�� 2) Ficl.duds d vents —! 7.50 -- Floor Furnance 3) incl. vent 6.0,0 °'•^�°� Suspended eater,wall heater 4) or floor mounted heater 6.00 •• — Vent not incl.in Occupant 5) appliance permit 300 Repair of heating,re ng. 6) cooling,absorption unit 6.00 Boiler or comp,heat pump,au con — �� C' 4)LP0 7) to 3 HP absorp unit to LOOK ETU 600 Bo,ler or camp, eat pump, air Gond. 8) 3.15 HP absorp unit to 500K BTU 11.00 Contractor --9671er or comp,heat pump,air cond. 9) 15.30 HP absorp unit.5.1 mil BTU 15.00 Wall L� � 2-370 � boiler H comp,heat pump,air cond. 10) 30-50 HP absorp unit 1.1.75 mil BTU 2 .50 hereby ac low ge at ve rea is application,that the Boiler or comp,heat pump, air cond. information given is correct,that I ata the owner or authorized agent 11) >50 HP absorp unit 1.75 mil BTU 31.50 of the owner,that plans submitted are in compliance with State Air handling unit to �— laws.that I am registered with the Construction Contractors Board, 12) 10,000 CFM 4.50 that the number given is correct (If exempt from State registration, Air handing unit please give reason below.) 13) 10,000 CTM. 7 50 Non portable 14) evaporate cooler 450 Vent fan connect 15) to a single dud 3.00 Twlq-� enh ation system not S2 16) Included in appliance permit 4.50 •• HoR served by — 17) mechanical exhaust 4.50 srnbe work new addition 0 a teraConrepair mmeraal or m stnal to be done residential Xnon-residonrial OAR, 18) type incinerator 30.00 Existing use of Other i.e.,w stove,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 21) More than 4-per outlet Type of fuel-of O natural g- LPG Q electric O r OTIC Minimum Fee$25.00 SUBTOTAL PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR 5%SURCHARGE IF CONSTRUCTION OR WORK IS SUSPENDED OR -- ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME PLAN RE"IEW 25%OF SUBTOTAL AFTZR WORK IS C0.IMENCED. — - j TOTAL L Special Coneitions 71 _� — -- ------_,_ /11i<-) fl l 1 ac( Date issued by V 4H7/A(i T� wrdm.�lw CITY OF TIGARD IT #. . . . PERMIT PERMIT #. . . . . . . : F'LM95•--034�/ DATE ISSUED: 11/16/95 i:OMMUNITY DEVELOPMENT DEPARTMENT 13125 SW Hall Blvd.Tigard,Oregon 97223*8199 (503)939.4171 PARCEL: 2S 101 AS-02300 SITE IaD1JRESb. . . : 070(_,`j SW Br_VELAND ST SUBDIVISION. . . . : BEVELAND ZONING: C-P BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . : 1 _____.__---------•------------- CLASS OF WORK. . -.ALT GARBAGE DISPrSALS. : 0 MOBILE HOME SPACES. : 0 TYPL', OF USE. . . . :SF WASHING MACH. . . . . . : 0 BACKFLOW PREVNTRS. . : 0 OCCUPANCY GRP. . :R3 FLOOR DRAINS. . . . . . e 0 TRAPS. . . . . . . . . . . . . . : 0 STORIES. . . . . . . . : 1 WATER HEATERS. . . . . : 1 CA1CI4 BASINS. . . . . . . : 0 FIX1'URES-_._._ __-..____..____ LAUNDRY TRAYS. . . . . : 0 SF RAIN DRAINS. . . . . : 0 SINKS. . . . . . . . . . 1 URINALS. . . . . . . . . . : 0 CREASE TRAPS. . . . . . . . 0 LAVATORIES. . . . . 1 OTHER FIXTURES. . . . : 0 . TUB/SHOWERS. . . . : 1 SEWER LINE (ft ) . . . : 0 WATER CLOSETS. . : 1 WATER LINE (ft ) . . . : 0 DISHWASHERS. . . . : 1 RAIN DRAIN (ft) . . . : 0 Remarks : Owner,: --__.______.________________________._---••-----.- ---__._____.-- FEES ---------•----- DEAN BOLAN type amol_Int by date recpt 7065 SW REVEL-AND PRMT $ 54. 00 B 11/16/95 95-272988 5PCT E ;-. 70 S 11 /16/95 95-272988 TIGARD OR 97222 Phone #: Lontractor: --- ---.•-__________________.-_--- RAYBORN' S PLUMBING, INC. 19990 SW CIPOLE ROAD 1-UAL.AT I N OR 9706 _____________---__.--•--.-________..__.__ Phone #: 692-•4139 f 56. 70 TOTAL. Req #. . 1 87852 - -- --- REQUIRED INSPECTIONS This permit is issued subject to the regulations contained in the PL.M/UnderFlaor•• Tigard Municipal Code, State of Ore, Specialty Codes and all oth;r Tap-out I n s p - V - applicable laws. All work wi be done in accordance with Mi -,c--. Inspert i on approved plans. This permit will expire if work is not started Final Inspection _ within 188 days of issuance, or if work is suspended for more than iBf, days. .__..__.__.__._.__ -.F._._-•��_._.-_._. 'far"m],F1-pf? it lit llr'P. : Casll for inspection - 639-4175 City of Tigard PLUMBING PERMIT APPLICATION Planck/Rec. # 13125 SVV Hall Blvd. Permit # Z1.;A ,j D--0'7,y'5 Tigard, OR 97223 (503) 639-4171 MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE wU .W D..Www New Single Family Residancea Only - Job A°"— ❑ 1 BATH HOUSE$140.00 ❑ 2 BATH HOUSE $195 00 0 3 BATH HOUSE $225.00 Address carleul. zo Fee includes all plumbing fixtures in the dwelling and the first 100 feet of water service. sanitary sewer and storm Sewer See fees below. "•"• ° "•°• 9—... FIXTURES QTY 1 RICE AMT L �� Sink L 9.00 QS: M.rlp A."... °hLavatory _ 9.00 Owl ier Tub or Tub/Shower Comb — 900 °p Shower Only I 900 •• Water Closet 9.00 9 _ Dishwasher 9.00 y Garbage Disposal 900 — C c cupant M, Q A"..,. i Washing -- Machine 900 Floor Drain 900 Water Heater ry 9 00 n_ Laundry Room Tray 9 00 Urinal 900 N^Ir(Q„ Other Fixtures (Specify) 900 Contractor 9,00 9.00 1 U K1 114 11 LJ � —_ ` _ Sewer 1st 100' - 3000 �"'B" '""" Sewer -ea. Addit 100' 25.00 / Water Service 1st 100' 30.00 1 hereby acknowledge that I have read this application, that theWater Seryce ea Addit. 200' 25.00 information g!ven is correct, that I am the owner or authorized agent of _ the owner, that plans submitted are in compliance with Stale laws, that Storm & Ra,n Drain 1st 100' 30.00 1 am registered with the Construction Contractor's SOL d, that the ---Storm 8 Rain Drain Addit. 100' 25.00 number given s correct. (If exempt from State registration please give reas,m below) Mobile Home Space 2500 Back Flow Prevention Device or Anti-Pollution Device 900 Any Trap or Waste Not — Connected to a Fixture 900 Describe work new 0 addition alteration repair Q Catch Basin 9.00 to be done residential O non-residential (_ insp of Exist. Plumbing 40 00/hr Existing use of Specially Requested Inspections 40,00/hr _ budding or property — Rain Drain. single family dwelling 30 00 Residential backflow prevention devices 1500 Proposed use of — — building or propertv _ (Except residential backflow pre�•ent/on devices) NOTICE 'Minimum Fee $25.00 SUBTOTAL � PERMITS BECOME VOID IF WORK OR CONSTRUCTION 1 AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS. OR IF 5`6 SURCHARGE CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED PLAN R2vIEW 73% OF SUBTOTAL _ Special Conditions — TOTAL— — Date issued _ by Community Development ELECTRICAL PERMIT APPLICATION 13125 SW Hall Blvd. \ Tigard, OR 97223 Planck/Rec. # 9,S — � Permit # CL/-g5 Phone (503) 639-4171 Date Issued lo7 95 Ci TY OFTIGARD FAX (503) 684 4-27 Issued by TDD No. (503) 684-2772 Inspection (503) 639.4175 1. Job Address: 4. Complele Fee Schedule Below Name of Development (-Won O I L Number of Inspections per permit allowed - Address_ ()b S S W �� VC CSM Service Included Items Cost(ea) Sum City/State/Zip-11.,(.1 J V 1\ 4a. Residential-per unit 4 1000 eq II or Isere $11000 Name (or name of business)_ Each additional 500 eq If or —- portion thereof 3125 Do Commercial® Residential❑ Limited Energy $2500 Each Manut'd Home or Modular 2 Dwelling Service or Feeder tFiH 00 2a. Contractor installation only: — 4b.Services or Feeders Electrical Contractor ' c -�rr Installation,alteration,or relocatior 2 F I?�,c r y" C 200 amps or lose �_ $8000 (4 C 2 Addresses rlA Ibl 201 amps to 400 amps $8000 2 CI C 401 amps to 90o amps $12000 2 City � a y-\d Staie Q�� Zip 5 1 g01 amps to 1000 amps $190 00 - Phone No. ,�.cC - IQ is_ Over 1000 amps or volte $34000 Contractor's License No. D6 Raconnad only $5000 Contractor's Board Reg. No. b- VbgJ _ 4c. Temporary Services or Feeders (` installation,alteration.or reloca,on Signature of Supr. Elec'n ��. iZ -v „ � ,'00 amps or Isle $50 on License No. O S_ ne No. -_ 5 2',1 amps to 400 amps $7500 --- 401 amps to BOn amps $100 DO le t I Over(100 amps to 1000 volts 2b. For owner installations: an•h•above Print Owner's Name 4d. Branch Circuits New,alteration or extension per panel Address a)The fee for branch crcuits with City State Zip -- Purchs”of Service or feeder An. I�� 2 Phone No. — Each branch circuit r[.5, II-Soo i b)The fee for branch circuits wffhrwf The installation is being made on property I own which is Purchase,or swvko or baawr Ivo. not intended for sale, lease or rent. rest branch cirmid $35 DO Each additional branch circuit $500 Owner's Signature _ 4e. Miscellaneous ,Service or feedrr not included) 3. Plan Review section (if required): I Each pump cr iurgatron code $40 DO _ Each sign or outline lighting $4000 Please check appropriate item and enter fee in section SA. S gnat circult(s)or a limited energy p panel,alteration or extension $4000 4 or more residential units in one structure Minor l abets(10) 3110000 Service and feeder 225 amps or more — System over 600 volts nominal 4f. Each additional inspecti,,n over Classified area or structure containing special occttpagcy the allowable in any of the above as described in N E.C. Chapter 5 Per inspection _ vl1 nc Per hour $55 m Submit 2 sets of plans with application where any of the above In Plant $5500 apply. Not required for temporary construction services. 5. Fees: 5o. Enter total of above fees NOTICE $ 5%Surcharge(.05 X total tees) $ 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 Subtotal $ COMMENCED. ❑ Trust Account N $ _ Balance Due $ MECHANICAL CITY OF TIGARD PERMIT F�ERMIT #. . . . . . . MEC96--I1`b.:i (COMMUNITY DEVELOPMENT DEPARTMENT DATE I,SUED: 0B/02/96 13125 SW Nall Blvd.Tigard,Oregon 07223.8109 (503)830.4171 F'faRC:EL_: 2S 101 AB--02300 S111_ I-�DDRESS. . . : 0'i0E:5 SW BEVELAND S1- SUBI)IVISION. . . . : BEVELAND ZONING: C--P BL.00I-1. . . . . . . . . . . LOT. . . . . . . . . . . . . 1 i ------------------------------------------------------------------------------ CLASS OF WORK. . :ALT FLOOR FURN. . . . : 0 EVAP, COOLERS: 0 TYPE OF USE. . . . :SF UNIT HEATERS. . : 0 VENT FANS. . . : 0 OCCUF'ANC:Y GRP,. . : R3 VENTS W/O AFFIL: 0 VENT SYSTEMS: 0 STORIES. . . . . . . . : 0 BOILERS/COMFIRESSOR5 HOODS. . . . . . . : 0 FUEL TYF,ES-------------- 0-3 HP. . . . : 0 DOMES. INC 1 N: 0 : /E.LE/ / / 3-15 HFI. . . . : 0 COMML.. I NC I N: 0 MAX INPUT: 0 BTIS 1,5- 30 HP. . . . : 0 RE.F'A I R UNITS): Vi FIRE DAMF,ERS?. . : 30-50 HF'. . . . : 0 WOODSTOVES. . : 0 GAS F'RrSSURE. . . : 50+ HP. . . . s 0 CLO DRYERS. . : 0 NO. OF UNITS------------ AIR HANDLING UNITS OTHER UNITS. : 0 FURN ( 100K STU: 0 ( 10000 cfm : 1 GAS OUTLETS. : 0 FURN ) =100K BTU: 0 > 10000 c..fm : 0 Remarks : Installing one air- handling unit to 10K CFM. Owner-. -- _._.---______._-------___________._______.________.._— FEES ---------------- DEAN BOLCIN tycie amount by date rrecpt 7065 SW BEVELAND FIRMT $ 25. 00 CJS 08/02/96 96-262438 5PCT $ 1. 25 CJS 08/02/96 96-282436 TIGARD OR 972:23 Phone #: Contractor: ----_._____._ __.____..-.--•—.---_.--_ ._.._.___ MCCALL HEATING & COOLING CO 1650 NE LOMBARD PORTLAND OR 97211 Phone #: 503-231-3311 $ 26. 25 TOTAL Rey it. . 1020.30 __.__._.. REQUIRED INSPECTIONS This permit is issued subject to the regulations contained in the Merhan:ical Insp figara Municipal Code, State of Ore. Specialty Codes and all other Misc. Intpection applicable laws. All work will be done in accordance with Final Inspection 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. P e r m i t t e e S i y n at u r•e : Call for inspection - 639-4175 City of Tigard MECHANICAL PERMIT Planck/Rec. # ')c -)QaN3,9 13125 sw Hall Blvd. APPLICATION Permit # rY1Et_'96 f�a63 Tigard, OR 97223 (503) 639-4171 F � — escnption Table 3A Mechanical Code OTY PRICE AMT Job -")�i ( v w 11 Permit Fee 0 -0- 10.00 Address •. -- ,� 2) Supplemental Permit 3.00 ^• '^•""^ urnace tom= U.'-A Il ( 1) incl ducts &vents 6.00 Furnace I — �1- Owner q >r 2) incl. ducts R lents 7 50 oorurF—nance 3) incl. vent 600 ^ "' ""•" Suspended heater, wall eater 4) or floor mounted heater 600 Occupant • Vent not enc. in 1 5) appliance permit 300 6) cooling, absorption unit 6.00 Boiler comp, heat pump, air can 7) to 3 HP; absorp unit to 100K BTU 600 MO.a — t Boiler or com—p—Treat pump, air cond. c ;ontractor - d 11 8) 3-15 HP; absorp unit to 500K BTU 11 00 1 .over or comp, heat pump, air con r Q n (�� ,�,_ 9) 15-30 HP; absorp unit 5-1 mil BTU 1500 ' Boiler or comp, heat pump, air con . (' YCJ 10) 30-50 HP. absorp unit 1-1 75 and BTU 22.50 ore y acknowledge a ave read tis application, that the Boiler or comp, eat pump, air�— information given is correct, that I am the owner or authorized I 11) > 50 HP; absorp unit 1.75 and BTU 3750 agent of the owner, that plans submitted are in compliance with Air handring unit to State laws, that I am registered with the Construction Contractors 12) 10,000 CFM 450 I, Board, that the number given is correct. (if exempt from State Air handling urn registration, please give reason below.) 13) 10,000 CTM + 7 50 Non portable _ 14) evaporate cooler 450 Vent fan connecteeT— -- — 15) to a single duct 300 Ventilation system not 16; included in appliance permit 450 •^'•'°'^""' oo served—F 17) mechanical exhaust 4 50 escn a wo new addition i, alteration repay t,ommeraa or in us3iriaT-- to be done residential 0 non-residential lJ 191 type incinerator 30 00 Existing use o _ ter ie, woo stove, water building or property _ _ 19) heater, solar, clothes dryers, etc. 4 50 Proposed use of 20) Gas piping one to four outlets 200 budding o, property _ _ L 1) More than 4-per outlet (each) 2 00 Type of fuel •oil Q natural q LPG 0electric Q — C I , Minimum Fee 525,00 SUBTOTAL PERMITS BECOME VOID IF WORK OR CONSTRUCTION — AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR 571. SURCHARGE IF CONSTRUCTION OR WORK IS SUSPENDED OR -- ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME PLAN REVIEW 25% OF SURT,OTAL AFTER WORK IS COMMENCED. TOTAL Special Coniiitions — -- Date issued _ by n1L0OIM09TMMM*W'