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10200 SW GREENBURG ROAD STE 150-2 a' a 7 z a S 1 f i r 10200SNN' GriEENIIIiRGstn #150 CITY OF TIGARD ,ADEVELOPMENT SERVICES BUILDING PFRMIT 13125 SW Hall Blvd., Tioard,OR 97223 (503)639-4171 PERMIT #. . . . . . . : BUP97-020`"--, DATE ISSUED: 04/28/97 SITE ADDRESS. . . : 10200 SW GREENBIJR(; RL) #150 PARCEL: IS135AS-0090o SUBD T V I S ION. . . . : ZONING:C—P BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . JURISDICTION: T*IG REISSUE: FLOOR AREnS---------- EXTERIOR WALL CONSTRUCTION— ii CLASS OF WORK. :ALT FIRST— . : 0 s N.- 13: E: W: TYPE OF USE. . . :COM SECOND. . . 0 sf PROTECT OPENINGS?__ TYPE OF CONS1 . :2N 3811 s No. S: E: W: OCCUPANCY GRP. -.B Sell s ROOF CONST: FIRE RET?: OCCUPANCY LOAD: ei BASEMENT. - 0 s PREP SEP. RATED: STOR. : 0 HT: 0 ft GARAGE. . . .- 0 s OCCU SEP. RATED: BSMT? : MEZZ? : REDD SETBACKS---------- FLOOR 1..(JAn. . . . : 0 psf LEFT: 0 ft RGHT: 0 ft FIR SPKL- SMOK DET, . : DWFLl...TNG UNITS: 0 FRNT: 0 ft REAR: 0 f+ FIR ALRM: HNDTCP ACC: REDRMSo 0 BATHS: 0 IMP SURFACE: 0 PRO CORR: PARKING: 0 VAI-11F, $ . 0 1 Remarks e Add new partitioning and IDA casework. A sprinkler, vechanical, and fire alary pertit are required. Owner: ----------------------------------------------------- FEES NORRIS BEGGS & SIMPSON type amol.tnt by date ret:pt 10300 SW GREENBURG RD STE 200 PRMT $ 92. 50 DRA 04/28/'��7 972� 3807 TIGARD OR 97223 PLCK $ 60'. 13 DRP 04/28/,:it -j(c_'93807 Phone #: 452-5900 FIRE $ 37. ZO DRA 04/28/97 97293807 5PCT 4 4. 63 DRA 04/28/97 97293807 Contractnri --------------------------- MALIBU PACIFIC 735 NE JACKSON SCHOOL ROAD HILLSBORO OR 97124 Phone #: 693-9797 194. 26 TOTAL 000590 -------- REDUIRED INSPECTIONS -------- 11iis pervit is issued subject to the regulations contained in the Framinq Insp Tigard Municipal Code, State of Ore. Specialty Codes and all other GYP Board Insp applicable laws. All work will be done in accordance with Sl.tsp C e i l n q Tnip approved plans. This pervit will expire if woo i ted within !88 days of issuance, or if work is su ed for than 184 days. r f q e d 1?f or L PPv mitt P : s S 1.ted Call for- ifisPe(-tion 6319-14175 ama>nerJal Building Permit Apiplicatior� C ty of 'n)ard !31.,s sw hail nivd rigjro, OR?'.213 �- (501)b19 1'1 Jobsit': Address:l02M. J,IrI��'�lIL �U aG Q MICE WU ONLY TenantVll - X Suite # 1 � Planck/Rec. Valuation: !U_I _ Permit# b u� Map &TP.. # Owner: _ 1M�Q'(-r -r- IItt Address.- )0--6 -�-��5► � / /��t.�� planning - �e.�, Engineering Telephone: � Z�.�1..� Other Contractor. 1611 - � r7 ,address: =� CILIA Type of .nnstr:� Telephone: y `1 / Occupancy C:lass:_-13– Contractor's L.cense # � (' 5 Sprinkler? /Yes No (attach copy of current Qregon license) �•-- Sq. Ft. Of Project: � ontact name & telephone: SM)I�W`(�%Ca j. Story (est, 2nd, etc.) 7 ,rchitect & Engineer: ,yeicl� Proposed Used ` 5 Address: - Previous use: V 67 L A Note: Plumbing & mochanical plans must Telephone: �4-- _ be sularn;tted at time of building permit appli ration. OB DESCRIPTION:; ' KiEu .'T _(?AJ& (Applicant Signature & Telephone Number) Received by: _ Date Received: — C__%IPER rcc "CS". 'C:96 PERMIT# Account Oescription Amount Amt Pd. Balance Oue Budding Permit (BUILD) Plumbing Permit (PLUMS) Mechanical Permit (NIEC''10 State Tax (TAX) Bldo. Plumb. Mech. Plan Check (PLANCK) Bldg. Plumb. Meeh. Sewer Connection (SWIUSA) Sewer Inspection (SVViNGP) Parks Dev Charge (PKSDC) Residential TIF (TIF-R) Mass Transit TIF (TIF-IIAT) Commercial 17IF (TIF-C) Industrial TIF (TIF-1) Institutional TIF (TIF-IS) Office TIF (TIF,O) Water Quality (WQl1AL) Water Qu<anity (WQUANT) Fire life Safety (FLS) Erosion Cntrl Permit (ERPRMT) Erosion P!anck/USA (ERPLAN) Ero-ion Planck/COT (EROSN) TOTALS- 1__� _ -- — Cz.h1PER CCC ,DST) 10-a6 /` CITY OF TIGARD DEVELOPMENT SERVICES ELECTRICnI PERMIT PERMIT #: ELC97-0243 13125 SW Hall Blvd., Tigard,OR 97223 11503)639-4171 DATE ISSUED: 04/21/97 PARCEL-..- IS135AB-00900 SITE ADDRESS— : 10200 SW GREENBURG RD #150 SUBDIVISION. . . . : ZONING:C--P BLOCK. . . . . . . . . : LOT. . . . . . . . . . JURISDICTION: TIG Project D e s cr i pt ion: instl 12 branch circuits - job 8 222-2278 --------------------------------- ....._-RESIDENTIAL UNIT------ ---TEMP SRVC/FEEDERS---- .___MISCELLANEOUS_..-___ 1000 SF OR LESS. . . . : 0 0 - 200 amp. . . . . . . : 0 PUMP/IRRIGATION. . . . : 0 EACH ADD' l_ 500SF. . . V, 201 - 40e amp. . . . . . . : 0 SIGN/OUT LINE LTG. . : 0 LfMITED ENERGY— _ : 0 401. -- 600 amp. — . . : 0 SIGNAL/PANEL. . . . . . . : 0 MPNF. HM/ SVC/FDR. . : 0 601+amps-1000 'Volts. : 0 MINOR LABEL. ( 10) . . . : 0 R V I CE/FEEDE .__.- -BRANCH CIRI'UI*T(;------- ---PDD' L INSPECTIONS—- 0 200 airp. . . . . . . 0 W/SERVICE OR FEEDER: 0 PER INSPECTION. . . . . : 0 201 400 amp. . . , - . -, 0 Ist W/O SRVC OR FDR. : I PER HOUR. . . . . . . . . . . : 0 401 660 amp. . . . . . : 0 EA ADDIL BRNCH CIRC: it IN PLANT. . . . . . . . . . . : 0 601 1000 amp. . : 0 --------_________-PLAN REVIEW 1000+ amp/volt. . . . . % 0 ) =4 RES UNITS. .. . . . . . . : ) 600 VOLT NOMINAL. . : Pet-onnect 0 SVC/FDR > = 225 AMPS. . : CLASS AREA/SPEC OCC. : Owner: FEES US WEST DEX type amokint by date reept 10200 SW GREENSURG RD PRM,r $ 90. 00 TAT 04/r-1.1 /97 97-293509 STE 150 5PCT $ 4. 50 TAT 04/21/97 97-293508 TIGARD OR 97223 Phone Contractor: CHRISTENSON ELECTRIC INC 94. 50 TOTAL 1, 11 SW COLUMBIA STE 4aO RFOUIRED TNESPECTTON... PORTLAND OR 97201 Ceiling Cover Underground Cove Phone #s V-241-4812 Well Cover Elpet' l Servirr Reg #. . t 020004 This persit is issuet, subject to the regulations contained in the Tigard Municipal Code, State of Ore. Sperialty Codes and all other Perm itte Signat lAr applicable laws. All work will be done in accordance with approved plans. This persit will expire if work is not started within 180 Ways of issuance, or if work is suspended for sort than 180 days. s s did B y ---____---------_-_--______--___OWNER INSTALLATION ONLY-----_f__/!...... The installation is being mAdf, on property I own johich is not intended for sale, ].ease, or r1int. OWNER' S SIGNATURE- --------- DATE-. �.NSTRLLATION SIGNATURE OF SUPR. ELECIN: ATE: I- ICENSE NO: .ell for insper-tic.n 639-4175 CITY OF TIGARD Electrical Permit Application Plan Check a 13125 SW HALL BLVD. Recd By TIGARD OR 97223 Date RRc'd Phone (503)639-4171, x304 Date to P.E. Print or Type Date to os-i Inspection (503)639-4175 Fax (503)684-7297 Incomplete or illegible will not be accepted Permit f1__ Called 1. Job Address: 4. Complete Fee Schedule Below. Name of Development LINCOLN CENTER LINCOLN V Number of Inspections per permit allowed Name(r,name of business) US WEST DF.X SUITE 150 Service Included: Items Cost Sum Address._10200 SW GREENBURG RD 4a. Residontial-per unit City/State/Zip PORTLAND OR 1000 sq.n,or less $110 00 _ Each additional 500 sq.It.or Commercial Residential ❑ portion thereof $115 00 Limited Energy __ 7 5 nn ROSS CROSBY Each Manuf'd Home or Modular Dwelling Service or Feeder $sa or: 2a. Contractor installation only: --- -- (Attach copy of all current licenses) 4b.Services or Feeders Electrical Contractor CHRLSTENSON ELECTRIC, INC. Installation,alteration,or relocation Address. III S.W. COLUMBI , SUITE�4$U .-. 200 amps or less $60.00 City PORTLAND ---State OR. Zip 201 amps to 400 amps $8000 97201-5886 401 amps to 600 amps -- $120.00 ? Phone No. 503-241-4812 601 amps to 1000 amps $180.00 .lob N0. 222-7278 Over 1000 amps or volts $340.00 _ Elec.Cont. Lice. No._26-34C Exp.Date_ - Reconnect only $50.00 - OR State CCB Reg. No._ 0049 Exp.Date 4c.Temporary Services or Feeders COT Business Tax or Me'.ro No._5246 Exp Date Installation,aiteration,or relocation 200 amps or less $50.00 Signature of SUM Elec'n_ r7lf201 amps to 400 amps $75.00 _ -t"f Over 600 amps to 1000 volts,401 amps to 600 amps $100.00 License No. 873S _ Exp.Date Phone Nsee"b"abovF% No. 503-24 i_4�2 4/16/97 4d.Branch Circuits Now,alteration or extension per panel 2b. For owner%rstallatians: a)The foo for branch circuits with purchase of service or Print Owner's Nat feeder fee. Addrtss._ _ - Each branch circuit on City _ State Zip_ b)The fee for hran0 ;ircults without porch v"of Phone No._ service Qr feeder fee. First branch circuit 1 $35.00 35. The installation is being made on property I own which is not Each additional branch circuit $5.00 __ 2 intended for sa e, lease or rent 4e.Miscellaneous (Service or feeder not Included) Owner's Signature _ - Each pump or irrigation circle $40.00 Each sign or outline lighting ~- $40.00 _ ? 3. Plan Review soction (if required):' Signal ciicud(s)or a limited energy' panel,alteration or extension $40.Uu _ Please check appropriateMinor Labels(10) $100.00 item and enter fee ir,section.>B. 4 or more residential wilts In one structure 4f.Each additional inspection�ger Service and feeder 225 amps or more the allowable in any of the above System over 600 volts nominal Per Inspection $3500 Classified area or structure containing special occupancy Per hour _ $55.00 as described in N.E.C.Chapter 5 In Plant T1;5 00 *Submit 2 sets of plans with application where any of the above apply. 55. Fees: 90. Not required for temporary construction services. Sa.Enter total of above fees $ 5%Surcharge(.05 X total fees) $ -: � 50 1`IQTLSeE Subtotal $ 994 50 5b.Enter 25%of line Be for PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review if lea jd(Sec.3) NOT COMMENCED WITHIN 18U DAYS,OR IF CONSTRUCTION OR WORK Subtotal $ 0 IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. ❑ Trust Account N_ Total balance Due $ 94.50 I%DMIELC96 APP now w9R F-- CITY OF TIGARD DEVELOPoPv TIENT SERVICES 1.1125 SW Hall Blvd., Tigard,OR 97223 (503)639.4171 ELECT RiCAL_ r,[--,RtyilT RESTPICTED ENERGY PERMIT #- ELR97-0`94 c DATE ISSUED: 10/17/97 PARCEL: IS1335AS-00900 rTF nr)DRESS. . . : 1,02,00 SW r3REENSUP0 RD SUBD 1'.I I S I ON. . . . : ZONING:C--P PLOrK. . . . . . . . . . : LOT. . . . . . . . . . . . . jURTSDICTN: TIG Pt-ojec-t Desct-iption: Add protective signaling to an existing comperciai tenant ocrpy. n, RESIDENTIAL- -------..- B. AUDIO & STEREO. . . AUDIO & STEREO. . : INTERCOM & F-,AGINr;. . : SURGLAP ALARM. . . . : DOI LF R. . . . . . . . . . LANDSCAPE./TRRTGAT. , : GARAGE or.IEWER. . . . CLOCK. . . . . . . . . . . : MEDICAL. . . . . . . . . . . . HVAC . . . . . . . . . . . . . DnTP4/TEL.F COMM. . NURSE CALLS. . . . . . . . VnCUUP1 SYSTEM. . . . FIRE ALARM. . . . . . OUTDOOR LANDSC LITE: rTHL i7: HVAC. . . . . . . . . . . . .. PROTECT I VE SIGNAL._. . : Y INSTRUMENTATION. - OTHER. . : TOTAL.. # OF SYSTEMS: I FEES C 16 WEST DIRECTPANY type amol.tnt by date r-eept 1.0200 SW GRFENSURG ROAD PRMT $ 40. 00 GEO 10/17/97 TIGARD OR 97223 517,CT $ 22. 00 GEO 10/17/97 97-3001F, l r,h,onp #: 768 -1651 HONEYWELL INC $ 4_'. 00 TOT111_- 195495 sw sFoumn STE 100 RE QUI INSPECTIONS PORTLAND OR 97224 Low Voltage Insp r-Ylol�p 968-37,37, Elect' l Final J?Pq 4. 17.1410578 this pervit is issued subject to the regulations contained in the Tigard Municipal rode, State of Ore. Specialty "odes and all otrer applicable laws. All work will be done in accordance with approved plans. This persit will expire if work is not started within JR days of issuance, or if work is suspended for #are than 180 days, ATTENTION: Oregon law requires you to follow rule adopted by the Oregon Utility Notification Center. Those t,iles are set forth in OA', 9`2-001 010 through OAR 952-00I-0080. You iay obtain copies of these rules or direct q ti s 17,t (503)246-1987. TssLied b Per-mittee Signatr_it-e_ INSTALLATION ONLY- The installation is being made on property I own whic,t) is not intended fo. ';ale' ) eAsr-' or- r-Pni'-. nWNERI t, SIGNATURE: DATE ....--_--_..-__--___-_.--------CONTRACTOR INSTALLATION ONLY--- 9TONnTLIRE OF SLPR. ELECIN: DATE: ( ICENSE NO: 1 +-4,+++++++++...........4..........a"++4-++4-++++4-+4.............V++4-+4+++-+-+-+++4-+44-+4-4 Call 639--4179 by 7:00 P. M. for, an inspection needed the next business day + +4+-#...............++4......4++-f.................4...........f-+-f-+-f-+++4-+++ 1-4+-I-++++-1 CITY OF -IGARD RESTRICTED ENERGY ELECTRICAL APPLICATION Rac'd by:___ 1312 SW HALL BLVD Date Recd: TIGARD OR 9722:1 PRINT OR TYPE � �—�-0�� V-503-639-4171 X304 Permit#: G,e F- 503-684-7297 INCOMPLETE OR ILLEGIBLE APPLICATIONS CLISt.Call'd: WILL NOT BE ACCEPTED L Name of Develo mant Project TYPE OF WORK INVOLVED -RESIDENTIAL (J S 0e s DJ/'N_!°'t I Restricted Energy Fee........................................ 540.00 •'7 nCo (FOR ALL SYSTEMS) JOB Sheet Address Ste# �r Check Type of Work Involved ADDRESS 61 ' City/State Zip rPhone A ❑ Audio and Stereo Systems _ s Name I Burglar Alarm OWNER Mailing Address ❑ Garage Door Opener- City/Stele Zip Phone tt ❑ Heating,Ventilation and Air Conditioning System' ❑ Vacuum Systnrns' Name ❑ 011-r -------- — -- CONTRACTOR Mailing Add es /54/9,'. c N TYPE OF WORK !NVOLVED -COMMERCIAL (Prior to issuance a Clty/ tats Zip P one# Fee for each system.............................................. $40.00 copy of all licenses r t/crncL [�/� c 33oc, (SEE OAR 918.260-260) are required if Oregon Contr..Brd Lic.# Exp.Date expired in C.O T. 1 ? . 1-1131 Check Type of Work Involved: data base). Electrical Contr.Lic.# Exp. ate o /V / ❑ Audio and Stereo Systems C O.T.or Metro Lic.# Exp. ate `^ '. C,< r /-1- ❑ Boller Controls Owner's Name - ❑ Clock Systems OWNER - Mailing Address APPLICANT EJ Telecommunication In. .tion City/State Zip Phone# ❑ Fire Alarm Installation This permit is issued under CAE 918-320-370.This applicant agrees to make only restricted energy installations(100 volt amps or less)under this ❑ HVAC permit and to do the following: ❑ Instrumentation 1 Only use electrical r;t;ensed persons to do installations where required. Certain residential and other transactions are exempt from licensing. ❑ Intsrcom and Paging Systems These have asterisks(') All others need licensing; ❑ 2. Call for inspections when installation under this permit are ready for Landscape Irrigation Control' Inspection at 603.630-4175; ❑ Medical 3. Purchase separate permits for all installations that are not ready for an ❑ Nurse Calls inspection when the in:vpector is out to ins;;ect under this permit; 4 Assume responsibility fur assuring that all corrections required by the ❑ Outdoor Landscape Lighting' inspector are done,and' Protective Signaling 5. Assume responsibility for calling for a final inspection when all of the corrections are completed ❑ Other_ Permits are non-transferablet and non-refundable and expire if work Is not started within 180 dims of Issuance or If work is suspended for 180 days _Number of Systems The person signing for this permit must be the applicant or a person Nc licenses ere required Licenses are required for all other installations authorized to bind the applicant r D FEES• Sign tU ENTER FEES $ -a G 5%SURCHARGE(.05 X TOTAL ABOVE) s__ C'o Authority if other than Applicant TOTAL $ U U 4esele dor 12196 _ CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24-Hour Inspection Line: b39-4175 Business Line: 639-4171 ----------_— 3UP _ Date Requested_l,_�_ Z _^_AM _-PM BLD -----u-----�_` Location __--- Suite_-- _ MEC i Contact Person —� Ph PLM Co~ actor — -_ __ Ph ----_ - -------- SWR BUILDING -i enant/Owner --�-- ELC L2 -u v Retaining Wall F_LR Footing ACCESS: --— -----......---- -- Foundation FPS Ftg Drain ---'---- Crawl Drain Inspection Notes _--.- Slab SIT Post&Beam Ext Sheath/Shear d�� Int Sheath/Shear -- - -- Framing Insulation -------------_______-_ --_ Drywall Nailing _,____-._---- ---.-- -_- Firewall Fire Sprinkler Fire Alarm Sisp'd Ceiling Roof - - -- --- Misc: - _-- Final PASS PART FAIL PLUMBING �-7 e,- Post& Beam - `-�- - Under Slab Top Out Water Service Sanitary Sewer - Rain Drains Final - - -- -__--- ----- PASS PART FAIL MECHANICAL �- Post& Beam Rough In Gas Line --- - - - --- _ �- Smoke Dampers Final --- --- --- — PA5 RT FAIL Setvice Rough In - UG/Slab Low Voltage Fi rm SS PART FAIL Backfill/Grading -- - -- Sanitary Sewer Storm Drain [ )Reinspection fee of$ required beime 10inspection. y at City Hall, 13125 SW flail Blvd Catch Basin Fire Supply Line [ )Please call for reinspection RE: _- [ ]Unable to inspect-no access ADAAppr /l)f Otheoach/Sidewalk Dat (/ �(/ C� -- Inspector_ ��1 r7 _ Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. CITY OF TIGARD DEVELOPMENT SERVICES 13125 SW Hall Blvd., Tigard,OR 97223 (503)639.4171 [":ERTIFICATE OF' OCCUPANCY PERMIT #. . . . , . . I BUP9'7. 0..-Or' r' DATE ISSUFDe 08/05/s"a7 PARCEL s 1 S 135AB-00900 ITE ADDRESS. . . : 10200 SW GREENSURG RD #15 IUHDIVISION. . . . I ZONINGIC_P -.LOCK. . . . . . LOT. . . . . . . . . . . . . I JURISDICtIONe "VIG LASS OF WORK. IAI_T 11,1"L, OF' USE.. . . ICOM I YPE OF CONSTR:�2N OCE:UGANCY CRF'. a P OCCUPANCY LOAD a 0 T E."NON I NfIMF. . . .US WEST DEX I?emarks : Plid new partitionirry and ADA casework. ilwnl�r"a ....__.._. ....._._........_ __ __._..._......._..._�._ ._...... .,..,..,.._..._.._ NONR I S BE GGS & S I MPbON 1.0300 SW GREENSURG KD ;ATE 200 T I GARD OR 97223 PhonQ #. ('unt rar..t or I MAI_I SU PACIFIC 735 NE J')CKSON SCHPOL. ROAD I t I I_LSnORO OR 97124 Phone #e 693-9797 Peg #. . s 000590 ►hie: Certificate grantF occ.�upmncy of the above referenced building or portion thereof and confirms that the buildiigi has been inspected for compliance with ' tie State of Orgon Spec mIty Modes for the grauFr, ccupaRnryw and Lisp r.rnder hich the referenced permit was isss.rpci. OJT t4 I SrECTOR BUILDING OFFICIAL POST IN CONSPICUOUS PLACE CITY OF TIGARU Plan Check 9 1312 _ ; HALL BLVD.1W Electrical Permit Application r RecA By R�C��VFC TIGARD OR 97223 Date Ftec' Phone(503)8394171,x304 AUG 18 ZUOU uate to P E. _ Inspection 503)639-4175 Date to DST � P ( Print of Type MMUNIT" nEVEIOWNI Permit# r�C cpow--x Fax(503) 598-1960 Incomplete or illegible will not l��accer Called 1. Job Adt Ness: 4. Complete Fee Schedule Below: Name of DevelopmentLINCOLN CENTRE LINCOLN II Number of Inspections par permit allowed Name(or name of business) CHARLES SCHWAB Service included: Items Cast Sum Address 10200 SW GREENBURG RL SUITE 150 4a. Residentia -,3erunit Ci /State/Zi )'ORTLAND OR 1000 sq n or less s 117.75 _ 4 P- Each additional!w sq ft.or WALSH PAC-UTC portion thereof $ 2625 1 CommerciaQ Residential ❑ Limited Energy $ 00 0C -- QUESTIONS?CONTACT H0,',S CROSBY 936-6409 Each Manufd Home or Modular -� 2a. Contractor installation only: Dwc.Iing Service or Feeder $ 72 75 _! 2 (Prior to permit issuance,applicants must provide contractor license 4b.Servicea or Feeders information for COT data base). Installation,alteration,or relocation Electrical Contractor CHRISTENSON ELECTRIC, INC. 200 amps or less _ $ 64.25 2 Address 111 SW COLUMBIA.SU ITE 480 201 amps to 400 amps $ 85.50 -__ 2 401 amps to 600 amps 3 128.50 City PORTLAND State--OR Zip 97201-5886 601 amps to 1000 amps $ 192.50 - 2 Phone No. 241-4812 Over 1000 amps or volts i�- $ 103 65 2 Job No. 62-14374 Reconnect only _ $ 53.50 Elec. Cont. Lice. No. 26-31LC__Exp.Date 4c.Temporary Services or Feeders OR State CCB Reg.No. 458 Exp.Da 2- Installation,alteration,or relocation COT Business Tax or Metro No. E D 12/'31 / )t) 200 amps or Ius� s 53.50 _ 2 201 amps to 400 amps $ 80.25 2 401 amps to 600 amps $ 107.00 2 Signature of Supr. Elec n Over 600 amps to 1000 volts. V License No. � Exr,.Date 10/1/01 see'b"above. 4d.Branch Circuits Phone No. 241-4812 New,alteration or extension per penal a)The fee for branch circuits 2b. For owner installations: with purchase of service or /rider lee. Pnnt Owner's Name Each branch circuK _ $ 5.35 _ 2 Address _ _ I b)The fee for branch circuits ---- withoul purchase of service City_ -- :tate ____Z'P^.�_ I or feeder fee. Phone No. Fr;st branch circuit 1 $ 37 50 37.50 -- -- -v Each additional branch circuit _I ; $ 5.35 The installation is being made on property own which Is not 49.IlAlscsllan6ous intended for sale,lease or rent. (Servim or feeder not Included) Each pump or irrigetion circle $ 4275 _ Owner's Signature_-__ _ _ Each sign or outline lighting $ 4275 Signal circuit(s)or a Ilmilbu energy if required):* Mipanel,alteration or extension _-� $ 60.00 3. Plan Review section nor tat...'-1+0) � $ 10i.00 Please check appropriate item and enter fee in section 513. 4f.Each addlticioal Inspection over 4 or more residential units it one structure the allowable in any of the above Service and feeder 225 amps or more Pe,inspeche^ $ 50.00 - Per tun,/ $ 50.00 _ System over 600 volts n'Jminal n F'iant _- _^_ $ 59.00 - -Classified area or structure cont rining special occupancy as T- described In N E C Chaplet 5 5. Fees: 5a.Enter total of above fees $ 107.05 * Submit 2 sets of plans with application,where any of the above apply. 5%Surcharge(05 X total fees) 8% $ --8.56 Not required for temporary construction services. Subtotal $ 1 6b.Enter 25%of line 5a for NOTICE Flan Review if required(Sec.3) $ PERMIT:;BECOME VOID IF WORK OR CONS(RLICTION AUTHORIZED Subtoial $ 1 IS NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS ❑ Trust Account# ATA NY TIME AFTER WORK IS COMMENCED Total balance Due $ 115.61 Ptf 'forms%elcctric.doc