12215 SW JAMES COURT I
N
N
Cd1
A
rn
cn
cn
f
__ 12215 SW JAMES ST.
/ MECHANICAL PERMIT
CITY OF TIGARD -- PERMIT#: M
DEVELOPMENT SERVICES PE18/0
3
00330
13125 SNI Hall Blvd., 1 igard, OR C-17223 (503) 639-4171 Dl,TE ISSUED:
PARCEL 2510 3
2S103C13-00600
SITE ADDRESS: 12215 S'dV JAMES ST
SUBDIVISION: ZONING: R-4.5
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS.
'TYPE OF USE: 3F UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O AP?L: VENT SYSTEMS:
STORIES: _ BOILERS/COMPRESSORS_ HOODS:
_ FUEL TYPES 0 3 HP: 1 DOMES. INCIN:
ELF J 3 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS?: 30 -50 Hr: WOODSTOVES:
GAS PRESSURE: 50 + HP: CLO DRYERS:
FURN < 100K BTU: AIR HANDLING UNITS OTHER UNITS:
FURN >=100K BTU: <= 10000 cfrn:
GAS OUTLETS:
> 10000 cfm:
Remarks: i -,call exterior AC.
Owner: _ _�. -- -- FEES
—SCHMIDTMANN, BRANDT + KAREN K Description Date Amount
12215 SW ,TAMES ST �ti11;('ll� Pcrnul I cc 6/18/03 $72.50
TIGARD, OR 9722.3
I'I.�\� K°�,�tatr I u� 6/18103 $5.80
—
Phone: 503-524-744: Total $78,30. --�
Contractor:
A-TEMP HEATING& COOLING
16000 SF EVELY q ST
CLACKAMAS, OR 97015 REQUIRED INSPECTIONS J
Cooling Unt Insp
Phone: 503-650-9002 t-Inal Inspection
Reg #: LIC 71878
This permit is issued subject to the regulations contained in the Tigard Municipal Code. State of Ore
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans. 1 his 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 in ;he Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR
952-001-0100. You may obtain copies of these rules or direct questions to OUNC by calling
(503)246-6699. /
Issued By: �' __ / ! '� ( Permittee Signature:
Call (503) 639-4175 by 7:00 P.M. for inspections needed the next business day
JUN-113-2663 09:19 H TEMP HEATING 5035572 90 P.02"o-';
Mcea'A]LaCation Received Mechanical C n.,
P/ PcrmilNa I
Pl■nninaApprovtd Building
patdB , Permit 1,10.: _
City of 'figar d Plan Revirw-- other
13125 SW iia': Bl_lvd. Datc�BPandit st
Tigard,Oregon 97223 Post-Review and
Phone: 503-639.4171 Fax: 503-598-1960 Datci" By;_ Case No.:
.:
Cunlact Juris,: See Page 2 for
InW
temel: wW.ciA&ard,or,u5 N■mc/Mclhnd. Su lemenlallnformallonim .
24-hour Inspection Request: 503-6394175 - -�
TYPF.OF WORK
COMMERCIAL FEE'SCHEDULE USE CHECKLIST.
Demolition Mechanical permit fees"are based on the total value of the work
New construction - - perfamied. Indicate the value(rounded to the nearest dollar)of all
ddition/alteration/re lacement Other: mechanical materials,equipment,labor,overhead and profit.
"r CATEGORY OF CONSTRUCTION See Page 2 for Fee Schedule
& 2- amil dw cllin Commercial/lndustria' Vatu RESIDENTIAL E MENT/SYSTEMS FEEL.SCHEDULE,
Accessory Building Multi-gamily i u_e,�_rl�uot t Pee ce. Total
- �--`- - oUn Conlin 11
Master Builder Other: e 14.00
INFOR A TION and LOCATION _ Furnace-add n air conditionin 14.00
S \ 0-
(3113 eat It
Job Site address= `3-� Duel work _ -
Suite#: �,./AnI4, H dronic hot waters stent 14.00 _
Pro"ect Nam-�I Residential boiler
for radiator or h dronic s attm 14,00
Cross streCGDirecli0ns to job site: Unit heaters(fuel,not electric)
(in wall,in-duct,suspended,ctc. (4.00
Flue/vent(for any of above 10.00
_ --- Repair units 11.15
Subdivision: RucI A nanca
Water heater r— 'r 10.00
Tax mg / arcel_#`-ON OF WORK Oils rife)ace 10.00
DESCRIP I
-� Flue vent(wotcr hcala 10.00
/gas lira I■ee) 10
.00
Low li htcr as 10.00
Wood/Pcllet stove 10.00 --
Wood flit lace/insen _ 10.00 �-
y Chlnutc Hiner/flue/vent 10.00
TETo
T
other,
RO T1t'OW 1fjR Envronntene
Range hood/other- kitchen equipment 10.00
Name. a ,�
1.1 _,.l• Clothes dryer exhaust 10.00
Address: 'a'��-•l 6!� a_--�- '
City/State/ZilY - _ �'1�� �' `� Single duct exhaust
Fax: _ (bathrooms,toilet compartments, 61
80
plione:S��L CONTACT t'ERSON utlli� ly ruonts)APP IC 7' Attivcrawl space fans 10.00
Name:_ i ----- -- other: )nano
_-bier Plplaa Address: -- °�(SS./o ror mitt 1,St.00 each addlflonal
Cit /Statt'./Zi : —-- Furnace,ctc. er
Phone: F$x;_�.—- (3as helm
E-mail __. Wall/sus cnded/unit healer 04
Water heater °.
�I Fire lett
Business Name: - Ran e
..
Address:\
Cit /state/Li : a r 1L -.0 �s.� Glothca dr cr as °°
�ax:s /J - Tal
011ie ot :
Phone: r*f 9J
CCB Lie. #: --7- _7- Mechanical Permit tees"
�, Subtotal; $LS Authorized pale. ?J I Minim irn Permit Fee 572,50
Signature' --
Plan R�Fe,' 25 A of Permit Fee
�`2_�-. - -- State Surchar,c B°Ja of Hermit F•_� $ '
---' (Please print name) -_^UTAL PERMIT PEE S _
Notice: This permit application r spit is!f a Permit Iv net nht°ined"Ithin ,•,Fe t{ p u drequiredtfn'I itr f�uMCB eltsln6 Ind Service Board.
180 days after It has peen accepted or O'Plr e
1:1I)%s\l mini,Forrnq\htecPrrmtlAt1
503S572990 P.03/03
JIJN-16-2003 09:20
A TEMP HEATING
A-Teaup fleating dand Cooling
Site plfall
I v llomid;iry Linc
Ll
S11-ccl
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business Line: 639-4171
BUf'
—_—Date Requester (' ��_ Am PM — BLD
Location 11-2-1<� IC�.rwL2/� + Suite MEC _
Contact Person r-YYA Ph �' " 2o PLM
Cortractor Ph SWR
BUILDING - — Tenant/Owner ELC
Retaining Wall ELR
Footing Access: ------ -
Foundation FPS
Ftg Drain —
Crawl Drain Inspection Notes SIGN
Slab -- ----- - ------ -- SIT
Post 8 Beam
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final ---�---.
PASS PART FAIL
11M
Post R Beam - -
Under Slab
Top Out - - - -
Water Service --
Sanitary S ewer
Rgiaprains _ _----- ---- -- -- - —
IJ
AS PART FAIL
CHANICAL
Post& Heap —,. ._ -.---- -- ----------- _- --- --- - ---
Rough In
GasLine ---- ----- ------ ..- - - --- - - - - __---.-
Smoke Dampers
Final -__ - - --------------- - — - -
PASS PART FAIL
ELECTRICAL — ---- ----- --- _�.�__ —
Service
Rough In
UG/Slab
Low Voltage
Fire Alarm _-- -- -- —
Final
PASS PART FAIL -_ -- —SITE
Backfill/Grading —`---"—
fSanitary Sewer
�Storm Drain ( J Reinspection fee of$_ _required before next Inspection. Pe y at City Hall, 13125 SW Hall Blvd
Catch Basin rUnable to ins
Fire Supply Line )Please call for reinspection RE.. - _ ( ) pact no access
ADA
Approach/Sidewalk Date `� Y Inspector / i '" '� Ext._�'k
Other _
Final
PASS PART FAIL DO NOT REMOWE tI!vrs iRrspection record f*om the job site.
CI 1 Y OF TIGARD MASTER PERMIT
PERMIT 11: MST1999-00334
DEVELOPMENT SERVICES DATE ISSUED: '11/12/1999
13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4
SITE ADDRESS: 12215 SW JAMES ST / PARCEL: 2S103CB-00600
SUBDIVISION: /�/ ZONING: R-4.5
BLOCK: LOT: " N e
ISDICTION: URB
REMARKS: Single family addition
BUILDING
REISSUE: STORIES: I FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ADD HEIGHT: 10 FIRST: 240 of BASEMENT: at LEFT: 7 SMOKE DETECTORS.
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: of GARAGE: of FRONT: PARKING SPACES
TYPE OF CONST: 5N DWELLING UNITS: FINSSMENT: of RIGHT:
VALUE: $17,032 80
OCCUPANCY GRP: R3 BORM: 1 BATH: 1 TOTAL: of REAR:
PLUMBING
SINKS: WATER CLOSETS: 1 WASHING MACH, LAUNDRY TRAYS: RAIN DRAIN: TRAPS:
LAVATORIES: 1 DISHWASHERS: FLOOR DRAINS: SEWER LINES: Sr RAIN DRAINS: 1 CATCH BASINS:
TUBISHOWERS: + GARDAGF UISP. WATER HEATERS: WATER LINES: BCKFLW PREVN rR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN c 100K: BOIUCMP 3HP: VENT FANS: 1 CLOTHES DRYER:
GAS FURN>•100K: UNIT HEATERS: HOODS: OTHER UNITS:
MAX INP: btu FLOOR FURNANCES: VENTS: 2 WOODSTOVES: GAS OUTLETS:
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS 0 200 amp: 0 200 amp: WISVC OR FDR: 1 PUMP:iRRIGATION: PER INSPECTION:
FA ADO'L 500SF: 201 400 amp: 201 400 amp: tat W/O SVC/FDR: SIGNIOUT LIN LT: PER HOUR:
LIMITED ENERGY: 401 800 amp: 401 600 amp: EA ADDL BR CIR: SIGNALIPANEL: IN PLANT:
MANU HMISVCIFDR: 801 • 1000 amp: bG'+ampo•1000v: MINOR LABEL:
1000+amplvolt:
PLAN REVIEW SECTION
Reconnect only:
>•4 RES UNITS: SVC/FDR»223 A.: >800 V NOMINAL. CLS AREA/SPC OCC:
ELECTRICAL•RESTRICTED ENERGY _
A.SF RESIDENTIAL B.COMMERCIAL
AUDIO&STEREO: VACUUM SYSTEM: AUDIO&STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNOSC LT.
BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPEARRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: C 'HR:
HVAC: DATAITELE COMM: NURSE CALLS: TOT L M SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 524.98
This permit is subject to the regulations contained in the
SCHMIDTMANN, BRANDT+KAREN K CROUCH CUSTOM CONSTRUCTIONTgard Municipal Code,State of OR Specialty Codes and
12215.3W JAMES ST 12220 SW JAMES ST all other applicable laws All work will be done in
TIGARD,OR 97223 TIGARD,OR 97223
accordance with approved plans. This permit will expire rf
work is not started within 180 days of issuance,or if the
work is suspended for more than 180 days ATTENTION
Phone: Phone: Oregon law requires you to follow rules adopted by the
Orogon Utility Notification Center Those rules are set
Rep N: LIC 104297 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
Erosion 844-8444 Underfloor insulation Plumb Top Out Insulation Insp Final Inspection
Footing Insp Crawl Drain/Backwater Electrical Service Rain drain Insp Building Final
Foundation Insp Footing/Foundation Dr; Electrical Rough In Electrical Final
PosVBeam Strncturat PLM/Underfloor Framing Insp Mechanical Final
POSVBe�A Mechanical Mechanical Insp I Low Voltage Plumb Final
Issued By : _ 1� 1�� � � Permittee Signatllre
Call (503) 639-4175 by 7:00 p.m. for an inspection needed the n xt bUsineas day
CITY OF TIGARD k.sidential Building Permit Application Plan Check# --772r—
Recd Bye
13125 SW HALL BLVD. Additions or Alterations
Date Recd MIJ
TIGARD, OR 97223 Single Family Detached or Attached (Duplex) Date to P E z
V 503-639-4171 Date,o DST k:^!'9
F 503-684-7297 PO_ Permit# '/15T710M 7733'-
Print
33'Print or Type Called
Incomplete or illegible applications will not be accepted
Nan...^!^ruled — -� � Name
Job ,/d!
� �!0!V Architect Mailing Address
Address ite Address -t-
S �. W J AM C`S J City/State Zip 7one
Name
Name e -
� � r
Owner Mailing Address
IS^ '''('LlSte' Engineer Mailing Address
City/State ZipPhone
.) -7YVa City/State Zip Phone
General Nofie _ _
Contractor Describe work New O Addition Alteration O Repair O
Mailing Add sa __ �, to be done:
Prior to permit AdditionalDesciriplion of Work-
issuance,a copy City/Slee Zip Phon ij ., �✓ ncler r?)IJ 5.f f t
of all licenses
are required if Ore k,,tomnst.Cont.Board Exp, Date PROJECT
expired indatabaGOT Lic# / 7 07102 a O VALUATION
Mechanical Name NEW CONSTRUCTION ONLY:
Sub- A TPx{p he9 tl Sq. Ft House: Sq. Ft. Garage
Contractor Mailinn Address V —
p ��,CV U �L, Sf. Indica he restricted energy installation by the electrical
Prior to ermit
issuance,a copy C /State Zip one subcontractor In the followin areas
Of all licenses ''fit1-$ ,��.- 186 Restricted Audio/Stereo
are required if Oregon Const.Cont.Board Exp.Date Energy System Alarms
expired in COT Lic# Ins!allations Vacuum Irrigation
database -7 System System
Plumbing Name (check all that Other-
Sub-
therSub- X55oe--t/In (70?S rU(4b.N apply)
Contractor Mailing Address Corner Lot YES NO Flag Lot YES NO
< '_ 4r check one check one
A) �, 05 r Q1Vj1#N-)N• I 6 Has the Subdivision Plat recorded? N/A I YES NO
Prior to permitity/Slate Zip Phone
Issuance,a copy D
of all licenses are Oregon Const Cont Board Exp Date
required If Lic.# -Wo
�"l I hearby acknowledge that I have read this application,that the
expired in COT //0 e/yam
database Plumbing Lic.# Exp.Date information given is correct,that I am the owner or authorized agent
��13 __ ;A 0 of the owner,and that plans submitted are in compliance with
Oregon State laws.
Name /-/ Sign wner e Aa� i
Electrical77
����°�rI b, Contact P-rson N me '/ `Phone#
Sub- Mailing Address _� �'0ug:l l
Contractor
City/State Zip Phone
Prior to permit
issuance,a copy FOR OFFICE USE ONLY:
of all licenses are Oregon Const.Cont.Board Exp.Date Plat# 1 MrrL#-
t� '
required if Lic.# �, A t �
expired In COT �'
ii
database Electrical Lic.# Exp.Date Setbacks: Zone: / S012L.
Electrical Supervisor Llc.# Exp.Date Engineering Approval. Plan�nln�Approval: TIF•
LigvP�N �� 1 Wststforms\sfaddelt doc 9/8/99
11 10 99 WED 10.06 FAX 5096931490 WASH CO HAS i�llttl
WASHINGTON COUNTY DFPART'. ENT OF HEALTH AND HUMAN SERVII'US
IrNVIRONMENTAL NEALT11 AND SANITATION
�
tt AUTiIORIZATION NUYIC'F. REPORT
CR 4.: L.C_� DAtt(s)of inspection: 1_��5—.•C��—._._.
Date Rev'd: ------ ---
Map and Tax lot number:ToKnship A) — Range _ S.ctiion,-3C b T.L.
Road Name: l 7 ?_)5 SIO ;1 ern►r..� ; f-r ------- --------
Proptrty Owner: t!l 3A "I:j
Changes to use with no increase in sewage flow or design llow is not exceeded.
Ch:utpcs in use where sewage flow is increased by not more than 3(10 gallotts beyond design capacity
or by not more than 50°'n of design capacilN (whicltevci iz le5sy.
Personal Hardship C ounel.lion
Renewal of Hardship Connection
'Temporary Placement
i)ENIED
- If Authonzation Notice is denied, it mai be re%,tewed by the Department of
Environmental Quality upon i-Nuesc An applictitiun must be submitted for review
within 30 days. A denial fee is charged
APPROVED
"I his notice authorizes the usu of the on site sewage disposal
system located on the property identified above to serve a
with a sewage flout up to
— ►�—__ �"_ .._-- gallons per day.
REMARKS: �' ;/r7r,2c
��►► r
9'7
SANITARIAN: �G�, l _ �� � �* � —-®t,.5__ DAI!✓:
I 'in,ia'�r rcpnr bl "`K
r
v�
r-
�s' I a s
S.w , TA
i
72.2-3
(,vile << n, e�e Pf a,
I
� as►�3 c,g onti�n
I
590 -- 7a1 �
7 1
I
i I -
' 110
a 70
1 �Iv�nrrl
� r�xao JIa�►rl�or� � ��\�- -
i
Is i
Ci
Q �a�
Svi SAAr: ST .
/ CITY OF T I G A R D ELECTRICAL PERMIT
PERMIT#: ELC2003 00377
DEVELOPMENT SERVICES DATE ISSUED: 6/23/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 PARCEL: 2S103CB-00600
SITE ADDRES'`: 12215 SW JAMES ST'
SUBDIVISION:
ZONING: R45
BLOCK: LOT : JURISDICTION: TIG
Project Description. Wire for AC unit
F `___ _i 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 arnp: SIGNAL/PANEL:
MANF HM/SVC/FDR: 601+arrrps - 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: IN PLANT:
601 - 1000 amp: _ _ _ _PLAN REVIEW SECTION
1000+ amp/voit: %=4 RES UNITS: >600 VOLT NOMINI,L:
Reconnect only: _ — —SVC/FDR >=225 AMPS:_— CL4SS AREA/SPEC OCC_
Owner: Contractor:
SCHMIDTMANN, BRANDT +KAREN K EVERGREEN ELECTRICAL CONTRACTO
12215 SW JAMES ST 23861 SE 442ND
TIGARD,OR 97223 SANDY,OR 97055
Phone: 503-524-7442 Ph,lne: 503-638-4608
Ree#: LIC 136311
I.I.I: 3.472c
_ FEES -- ---- S1,1' 15r;1 ti
Description Date Amount
Required Inspections
$46.85 ^ l
$3.75 Rough-in
— Elect'I Final
Total $50.60
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 plans. This permit will expire if work is not started within 180 day:,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 952-001-0100. You may obtain copies of these rules or direct ques�ions to OUNC at(503)
246-6699 , 1-8 00-332-2144.
Issued By: � r_ �� , ,�c i � Permit Signature:
_ OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: _ DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: _ DATE:
LICENSE NO: ---- --L 4 > ----- ---- ---- --- — -----
Call 639-4175 by 7.00pm for an inspection the next business d,-y
04:23/2002 15:21 PX 5035981960 CITY OF TIGARD l�0it2
Electrical PermuitApplicaboo
rDatctxeived' Pcm,;t nn. :L}CCity of Tigard t/aPPI.n0`� Expire date:
City 7186,d Addmas: 13125 SW Hull Blvd,Tigard,OR 97223
PDatmeissucd:Phone: (503) 639-4171Pax; (503) 598.1960 se file no — Payment type:y-
Land use. approval: . -- -_-
e
^ dlt.2 family dwelling or act Ssory U Con•merciaUtndustrial !-7 Multi-family U Tenan(irnprovcrncnt
V New comtrltctiun J Other- U Panial
)gib address' r Bldg. no Si ltitr no, Tax map/Lax lot/account no..
Lo(; B1ocM: Subdivision: Ca✓ --__ __. _
pro1eet Warne: scriptior+and locution
of work wt txmisot
Dt
Estimated data of co
e
Fa Maa
,lob no: L' ) L1 I ---- — tr,cscr( .t. Qty (�a l total I no.Insp
Business panne: E v r,Xer a rnrsl�h 1111W
Address: �, 11 dwel(treX,mit.Irsrhrdra attadeni Rxa.�.
city: 4 State;L-l_ ZIP; C{ r-r liervieenrehl,se�:
c a
E-mail: 1000 s .h.orlon _
phpt;r.; L
Fax:t Faith addldonal 300 sq•ft or portion thereof
CCB nu 1 3A. 1 $lite.bus.lie.no: -•}1 Uniitcd cn ,restdcoual 2
City/metro tic.no.: o L+mnedenar y,norr-rwidaneisl 2
itch manufactured honx or modular dwellin0
Servlecan
S rti of wpavisittC eleurictan(required) ,� _arc Norfrredcr
Servicrs or feeintc--Wal lotion,
Sop,aisret.name(prinr).C- iZl A,e a Iteration orratieWdaa:
200 amps or leas
r-• , � 201 e s to X00 are '-
Name(pnnll: ) ` 401 am n to 6W - 1
Mailin address: _ _,— bpi am_r:to 100 mops 1
city state: Over 11100 a s or volt.;
Photo: . L`t-k4� Fax E mut Rrconttectonl� - 1
Owner lna0alladi3n:The inuallation is being made on property 1 own Tempnryeary +o►irrrkn-
which is not lntendtd for sale,, Itasr,rent I"itatioa,alurution,or rrla-b rte or exchange according to 100 amp<or Less 2
ORS 447,455,419,610. 701. r 201 amt-'io 400 mrri
owner's Si nature: Date: 4p I to 600 aT s - 1
111rseb retks sew,aheradar,
er clOrmlon per peel:
Netnc: a Fax frit hrrnrh chcoiu with ru,clmse or
---
Addtegs: of vie or render fee,each brun:h circuit 1
- �- service bench circulu r+i• ut puttfiuc
_rily; �sl„te� _
! FeeloticeorfeedcrtealirstMerteheireuie I! 2
?Mont: �P;tx E.nail -
Eac_h�io diuo�al circeti
Fsc.(Sa*vfee orfeeder not Included): -
U Serviw over ll(arrpc�r,t nK.r,�l l Hralrh:;am farihty
Each pump or Irrigation eitelr
D Srtvi,e over 310 ampFr+ung of 1 k: U Haxard,rvs h cation Each sign or audirm b
Sf rte!cireultf c)cr a Itmite,enrrgv Ps
Llfamilvdv,ellings U buildingovet 1U.0tiouivarrlcatou,cr 9
❑System over60U volu nominsl more residential units to one etnmurr alteration,orcirr:sten' ��_ _ —7- -1 _,I
C3 Building"ver avec stnMrr O Feeders,400 scope or rmre
O Occupant load over 99 pentons 0 Manufactured structures of RV park FAtrh erMtlfaa'Ihsprrlion oyer 1161 allun+ble In any of tie above:
❑E.prens/lighdnEpion J other .-_-._ Ver uispeul;o
5utwnk___
at';of Pit"with 111117 of tune above- —! Ir•icu"igauoa
The abrin are etiee applleabie to temps ary collatrnctioo aervke' _—M
—
_-- -- --
^`rsart arils pMiar NI pvt.stmm rite mere iNaerWka NMi+ •This Permit arpllustion Permit fee.....................$
Naeu�trtadinlasm,we Plan tcvicw(at _ %) S
O Vis* O MastatCud e..pb es tf a permit;c not o4buned •,
_ _ J ranthin 110 dtrys after it run heen Stare surehar>Se(951r)....S .? L
Credit,+rd ftv tber _ _ (:
�.— tea accepted A,complete TOTAL .................... S
i
Narita aTcirdbuidr_i w, 7w'on arwi-NEM 3 -
--CwdboNv N� -_ ASN BApdal!l6t�[OM7