15530 SW OAKTREE LANE-1 N 33Zi1Hd0 MSS OC996
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15530 SW OAKTREE LN
CITY OF T!GAb?D ELECTRICAL PERMIT
PERMIT K: ELC2004-00390
DEVELOPMENT SERVICES DATE ISSUED: 7/15/2004
13125 SW[Mall Blvd..Tigard. OR 97223 (503) 639-4171 PARCEL: 2S111DB-09200
31TE ADDRESS: 15530 SW OAKTREE LN
SUBDIVISION: SUt,AMERF'ELD NO.10 ZONING: R-7
BLOCK: LOT: 553 JURISDICTION: TIG
Project Description: Branch circuit to AC.
1/15/04,addition of panel change.
__ RESIDENTIAL UNIT TEMP SRVC/FEEDERS _ MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: P51101PARRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGWOUT LINE'-TO:
LIMITED ENERGY: 401 - 600 amp: SIGNAUPANEL:
MANF HM/SVC/FDR: 601+amps-1000 volts: MINOR LABEL (10):
SERVICE'FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 20C amp: 1 WISERVICE OR FEEDER: PER INSPECTIr N:
201 - 4fju amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA AWL BRNCH CIRC: IN PLANT:
601 - 1000 amp: _ _PLAN REVIEW SECTION
1000+amp/volt: >=4 RES UNITS: >600 VOLT NOMINAL: _
Reconnect only SVC/FDR>-225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
RICHARD FL 94ING EVERGREEN ELECTRICAL CONTRACTOR
15oPA SW O,1KTREE LN 23861 SE 442ND
TIGARD,Or, 97223 SANDY,OR 97055
Phone: 503-655-3179 Phone: 503.66841608
Reg#: LIC 136311
ELE 3-4720
FEES SUP 4581S
Description Date Amount Required Inspections
fELPRMTj ELC Permit 6/28/2004 $46.85 —
(TAX]8%State Surcharge 6/28/2004 $3,75 Elect'I Final
(ELPRMT]ELC Permit 7/15/2004 $80.30
(additional fees not listed here)
Total $137.32
This Permit is issued subject to the regulations contained in the Tigad Municipal Code,State of OR.Specialty Codes and all other applicable laws
All work will be done in accordance with approved plans. This permit Nill 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 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 questions to OUNC at(503)
246-6699 or 1-800-332-2344.
aIssued B ���,�L Permit Signature:
vi
co _ 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:.
_..�
W
—i CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. El EC°N: DATE:
LICENSE NO: _
Call 6394175 by 7:01pm for ar, Inspection the next business day
Electric I Permit Application
,aceived 6loctrical
Datrhiy:1 �'tI U NJ_ f Permit No.:6LC."Dy IYJ J 9 0
Planning Approval Sipe
City of Tigard DoWD : Permit No.
13125 SW Hall Mvd. Plan Review Other
Tigard,Oregon 97223 uaoe/By: — — Permit No.:
st
Phone: 503-639-4171 Fax: 503-598-1960 goat-Re: CaseLaw o..-
� LDte/By: Cane No.: _
Internet: www.ci.tigard.or.us uct luris.: See lugs 2 for
24-hou. Impcction Request: 503-639-4175 'a me/Method: sr Ip emcual!.rormanon.
TYPOPWFDRK Re
New Construction Demolition Service over 225 amp- 'LJ'iealth-caro fhorility
commercial ❑liazardou s location
Addition/alteration/replace ent Othei: C1 Service over 320 amps-rating of ❑Building over 10,000 square feet,
TEGORY NS CT 1 dt 2 family dwellings four or more residential unto in
�1 &2-Famll dwellin Commercial/Industrial ❑System over 600 vola nominal out structure
—._� []Building over three stories ❑Feeders,400 amps or more
Aecessor�Building _ M1►lti-Family (]occupant load over 94 persons ❑Manufactured strueturcs or RV park
Master Builder ()T11Ci: C]Elpess/lighting plan []Ottw:r:
B i(Ni7 Q Submit sets of plans with any or the thieve.
Me above are not a Riletatelle to construction scales.
Job site address: 'j- .�O ` CX�kfi .. t�
Suite#: I BIdF./A t.#: _ �_Number of to nee per"rmit allow.J
Desert tlon Qty Foe(see.) I 'Teem
Pro set NsunC: -— Now Mideatlatalugle or weNt-fa-Illy per
Cross street/Directions to Job sit.: dwelNag■oN.Includes attaebed garage.
service Iacluded:
1000 s9:ft.or less _ _ 143.15
Each add4;-vis l 500 sq.R.or portion thereof 33.40 i
Limited energy,residential 75.00
Subdivision: Lot M Limited ems,sora residential 75.00
Tax ma / areel#: Each manufacttred home or modular dwelling
«.:.- s,rvia+ardor feeder 90.90
services or("den-losalle loo,
alteration or relocation:
` ,^ 200 arrips or less _ 80.30
to 400 aryps 106.85 —_
arnple to"^r►arnpo 160.60
x 601 amps to 1000 — 240.60
1 `,� Over 1000 amp or volts 434.65
Name: �L d tic 11 In mMdA Reconnect only 66.85
Address' J _ Temporary service`or feeder-Installation,
alteration,or relocation:
City/State,/Zip: 200 am or less 66.83 _
n 201 am to 400 an - I�-30
Phone: 7�J
` - ' I Fax: 401 to 600 _` _33.78
Branch elrerlts-r.ew,alteration,or
Name' extension per pr tel:
A.Fee for brain+circuits"'pan:r:x of 6 65
Address: ere Llce or VAder f each branch circuit
Clt /StatP./Zl — B.Fee for branch circuits without purchase of -
service or feeder to Mt branch cimuit 46.85
Phone: Fax: F,aeh addltioeal laturh etrcult 6.68
E-mail Misc.(Service or lades not inchru�:
Eachpuny orirti ,'heli 33.40
Each si a outline li b 83.40
Job No: - ��r� Signal cimuil(s)rr a Ihnited energy panel. 2
.Iteral a r stenaion
Bushiess IN atne: '(T ��E C. .�1 — Description:
rad ,
Address: Lneh additional la n over the allowable Ina of the above:
Ci /State/Zi : •l..�C U J Per irr eeper�min.i hour) 62.so
Phone: 1pin`36 _ rax: - other:
�., CCB Lic.#: i alp 1 Lic.#: -
W Su t +ig electrician Suhtehl S e'
J � /
si afore i�uired: Plan Review 25•/.of Ptxrtiit Feel S
Print Name: " t` Lie.#: �, 1 Slue Stvct+tr a 8%of Pennit Fa $
— r " — - TOTAL PERMIT FEZ I S- a 1
Authorized r� Notice: Tble pernit appileatfon expires N a permit'r not ttbhlaed wlthls
Signature: i "�.-� DateT tg9 days after it ha been accepted ere ee�tnplete.
•Fir.methodol%-y set by Tri-County Building Industry Srrvke Board.
�(Pk ere print name)
i:MDM\Permit Fom\ElePernitApp.doc 01/03
CITY OFTIGARD 24-Hour
BUI`.DING inspection Lire: (503)63175 MSl"
—
INSPECTION 010410-4010410-4Biminess Line: (503)639-4171
��
BUP
P.eceived _ ^y ¢ V Date Requested_ *7- L; _U AM-_��.__PM_ _ sup
Locaiion . __!2k)G� - L i" Suite__ _ _ MEC
Contact Person _.- � Ph(�) �sz' �`� _� PLM _
Contractor _ _- Ph SWR _
BUILDING Tenant/Owner -_ _ __ ELC
Footing ELC
Foundation
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT -
Post&Beam
Shear Anchors
Ext Sheath/Sheer
Int SheathtShor.r —� 6.1
Framing �`��_`-"- ��' --
Insulation
Drywall Nailing -- -----
Firewbil
Fire Sprinkler —- — -- ---
Fire Alarm
Susp'd Ceiling - ---- -- �✓`------------- -
Roof .Cf
(ther:
Final
PASS PART FAIL —�-
PLUMBING -
Post&Beam
Under Slat'
Rough-In
Water Service ---- ---
Sanitary Sewer
Rain Drains - — ---- ---- -
Catch Basin/Manhole
Storm Drain ---— -- ----
Shower Pan
Ott,,4r:
Final
PASS PART
MECHANICAL
Post Beam
Rough-in
Gas Line
r<
?AS%
RT_ FAIL --- -
rn
4L --
Service -�
m Rough-In
UG/Slab '
W Low Voltage
_j Fire Alarm
Final Rainspection fee of g.__. _ squired before next inspection. Pay at City Hall, 1312E SW Hall Blvd.
PASS PART FAIL
S - Please call for reinspecti-)n RE: Unable to Inspect-no access
Fire Supply Line
ADA
Approach/Sidewalk Dem -
Other: ____ _
Final DO NOT REMOVE this Inspection mord from the job*11W.
PASS PART FAIL
• i
' CITY OF TIGARD rLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLM2004-00282
13125 SW Hall Blvd., Tigard,OR 97223 (503)639-4171 DATE ISSUED: 6/21!2004
SITE ADDRESS: 15530 5W OAKTREE LN
PARCEL: 25111 D3-092 J0
SUBDIVISION: SUMMERFIELD NO.10 ZONING: P.-7
BLOCK: LOT: 553 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
-YPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
Ol.iPANCY GRP: R3 FLOOR DRAINS: TRAP*&
STORIES: WATER HEATERS: 1 CATCH BASINS:
_ FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB/SHOWERS- SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWA'sHERS: RAIN DRAIN: ft
Aemarks: Water heater install elec. to gas.
Owner: --- — --
Description nate Amount
RICHARD PEENING
15530 SW OAKTREE LN [PLUMB]Permit Fee 6/21/2004 $72.50
TIGARD, OR 97223 [TAX] Q%State Surcharl 6/21/2004 $5.80
Total_ $78.30
Phone: 503-655-3179
Conti ictoc
WORTHINGTON PLUMBING
3915 SE MONROE ST
MILWAUKIE, OR 97222 REQUIRED INSPECTIONS
Phone: 503-522-3908 Final inspection
Reg#: LIC 153975
PLM 3-489PB
a
a
�n
JThis permit is issued subject to the regulations contained in the Tigard Municipal Code, Sty:G of OR.
F3
0Specialty Codes and all other applicable laws. All work will be done in accordance with approved
uu plans. This 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 by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952.0001-0010 through OAR
952-0001-0100. You may obtain copies of these rules or direct questions to OUNC by calli!tg (503)
246-6699.
Issued By: QC X � Permittee Signature
Call(503)639-4i 75 by 7:00 P.M.for an Inspection needed the next bu
Building Fixtures
Plumbing Permit Application MWI
City of Tigard Received
ee 9 a Permit Nn.
13125 SW Hall Blvd.,TigarC,OR 97223 Plan 7evi
Phone: 503.639.4171 Fax: .-'03.598.i960 Datd9y Other Permit No —
24-Hour Inspection Line: 503.139.4175 Date Ready/By r ® See Page 2 for
Internet: www.ci.tigard.or.ud Notified/Method: f Supplemental Information
❑New construction ❑Demolition __—_ fors da/Ia1 a-motion use checklist
Descri tiptip or\ Ea. Total
ditioo/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
SFR(1)bath 249.20
and 2-family dwelling ❑Cotnfnercial/industrial SFR(2)bath — .150.00 4
❑Acceismy building ❑Multi-family 5FR(3)bath 399.00 _` 1
rsch additional bath/kitchen 45.00
❑Masi er builder ❑Other: — —
Fire sprinkler(__sq.ft.) Page 2
Site utttlttt:
Job site address: no k- Catch bum or r:ea drain I6.60
City/State/ZIP: i VDrywell,leach line,or trench drain 16.60
Suite/bldg./apt.no Project name: Footing drain(no linear it.._) Page 1 —
Manufactured home utilities 110.00
Cross street/directions to job site: ---
- M.nholes 16.60
Rain drain connector 16.60 —
Sanitary sewer(no.linear ft:_� — Fage 2
Storm sewer(no linear ft.:�) Page 2
Subdivision: Lot no.: Water smite(no.linear fl.:�) Page 2
Future or Item
Tax map/parcel no.: — --
Absorption valve 16.60
Backflow preventer Page 2
—�' 11) ,w —�'j�,Q - Backwater valve 16.60
'�U{ -- Clothes washer 16.60
Dishwaa'ter 16.60
Drinking fountain 16.60
Ejectors/surnp 16.60
Name: G Expansion tank 16.60
Address: t Fixture/sewer cap 16.60
City/State/ZIP: �L Floor drain/flo nt sink/hub 16.60
Phone:(5y ) �U — to I (, Fax:( ) Garbage disposal 16,60
Hose bib 16.60
® Ice maker 16.60
Business name: C n v h,terc-ptorlgri-ase nip — 16.60
Contact name: UiA. Medical gas(value:S ) Page 2
Address: 3n11,� yylynhLl� �M --- Primer — — Iu.60
0.
City/State/ZIP: r! v L 2 Z Roof dram(cottvnercul) 16.60
Sink/basir(lavatory 16.60
CO) Phone: ?_L3U Fax: :( )
Tubl•,nower/shower pan 16.60
E-mail: b `11,111LUrinal — 16.60
3* e'
Water closet 16.60
Business name: am L. 40- Water heater 16.60
J I Address �� ��G �� _ Other:
City/State/ZIP: Z Z'L J,— Subtotal �.
��! — Minimum permit fee: $72.50
Phone:(�� ) �'> Z-3 Fax:((�5a3) —77 Residential backflow minimum penult fee: $36,25
CCA Lic.: fe, 27 Plumbing Lic_no. y Plan review (25%of permit fee)
State surcharge(g%of permit fee)
Authorized signature: X. - TOTAL PERMIT FE! wy�
Print names , Date: (s 'Z Thls permit application expires If a permit Is not obtained within
• 180 days after It has been accepted as complete.
*Fee rn`v dology,;et by Tri-County Building Industry Service Board.
i\Building',Permite\PLMP.PertntAppdoc 12107 440-4616T(10ML-0 NBB)
•J
Plumbing )Permit Application - City of Tigard _
Page 2 - Supplemental information
Fee Schedule: Residential Fire S53appresslun S stems:
Footing drain-I'100' SS.00 0 W i,r.u__ S 115.00
Footing drain-each additional 100' 46.40 2,001 to 3,600 $160.00
3 601 to 7,200 $220.00
3eva-1st 100' 35.00 7,201_and greater $309.00
r Sever-each additional 1 10' 46.40
Water Service-1st 1w _ 55.00 Medical Gas S 'stems:
Water Service-each additional 100' 46.40
Storm&Rain Drain-I st 100' SS.OG S I.00 to SS 000.00 Mininvitin fee$77 5_0
Storm&Rain Drain-each additional 100' 46.40 55,001.00 to 510,000.00 $72.50 for the fits,S5,000.00 and S 1.52 for each
additional$100.00 or fraction thereof,to and
includin $10,000.00.
Cortttrrercial Back Flow Prevention Ek—ice 46.40 S10,OOI.00 to 525,000 00 $149.50 for the first 510,000.00 and$1.34 for
Residential flow Prevention Device each additional$100.00 or traction thereof,to
minimum�crr.li:;ce$36.25) 27.55 and including S25,000.00. _
Rain Drain,si,rgle family dwelling 65.25 $25,001.00 to$50,000.00 5379.50 for the first S25,000.00 and S1 45 for
Inspection of existing plumbing or each additional:100.00 or fraction thereof,to
specially uested inspections-per hour 72.50 _— and includin 550,000.00.
Subtotal: 550,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
each additional$100.00 or faction thereof
Fixture Work:
Are you cappim;,moving or replacing existing fixtures? If
"yes",please fnalcate work performed by fixture. Failure to
accurate) ii-zioort fixtures could result in Increased sewer fees*.
Comments regarding fixture work:
Baptistry/Font
Bath -TubiShower _
-lacuzai/Wltirl 1 _
Car Wash -Each Stall-
-Drive Tluv —
Cuspidor/Water Aspirator —
Dishwasher -Commercial
-Domestic —
Drinking Fountain _
Eye Wash _
Floor Drain/sink, -2"
Y –
4,. —
_ Car Wash Drain
Clarbage -Domestic —
a
Dlspmal -commercial *Note: If the fixture work under this permit results In an
Ice Mach./Refri .Drain, Increase of sewer F.DUs,a sewer permit will be Issued and
Oil Separator teas station fees assessed for the sewer Increase must be paid before the
Rec.vehicle Dump Station plumbing permit can be issued.
Shower -(fang _
-Stall
Sink
W Sink -Bar/Lavatory
avatory Ouantity Total
_il -BBr dlmmercial ey Isometric or riser diagram Is required if fixture quantity
-Service total is>9.
SwimminILPocl Filter
Washer-Clothes _
Water Extractor Plan Review
Water Closet-Toilet Plan review Is required if fixture quantity tottl is>9.
Urinal
Other Fixtures:
i-\Buildlrg\Perme+\PI,PI-PermaApp doc 3/01
a1�
CITY OF TIGeARDi 24-Hour
BUILDING ® Inspection Line: (503)639-4175
INSPVCTION DIVISION Businoss Line: (503)639-4171
SUP
Received Date R udated_ AM PM SUP v �—
Location _— ���?l"� I'� �W• Suite. MEC
Contact Person _— _ Ph( PO tG55r 3/?!I PLM
Contractor Ph( —) SWR
BUILDING Tenant/Owner ELC 7 UU '3 9FO
Footing
Foundation Access: ELC
Ftg Drain
ELR
Crawl Drain --
Slab Inspection Notes: --- SIT
Post R Beam Alf
Shear Anchors J
Ext Sheath/Shear
Int Sheath/Shear -----
Framing _ �—
;nsulation P --� —A—
Drywall Nailing — 1 S W�� 1 f— Z6 +
Firewall
Fire Sprinkler — -- _—
Fire Al_-r;n "V_
Susp'd Ceiling ------- —•— �''�- ,
Roof
Other: ----
Final
PASS PART FAIL — -"— — - ----
PLUMBING _
Post&Beam - - — — —
Under Slab
Rough-In
Water Service --•— �_ _
Sanitary Sewer -
Rain Drains --------" _
Catch Basin/Manhole
Storm Drain
Shower Pan
Other: --
Final
PASS PART rAIL ^_ -
MECHANICAL
Post 8 Beam ---- ---- - .__
Rough-In
Gas Line
4 Smoke Dampe►s
H Final
U) PASS PART FAIL ELECTRICAL—
Service
LECTRICA Service
Rough-In
(a UG/Slab --
W Low Voltage
F arm
E] Rein tion fee of$ — r ection.uired before next Ins
SS_ -ART FAIL u F Pay at City Hall, 13125 3W Hell Blvd.
Please call for reinspection RE: — Unable to Inspect no acoasa
Fire Supply Line
ADA97/
1010 (�� A��( j,�.
Approach/Sidewalk �� � [ 1~ �` >•__ E
Other.
Final -- — DO NOT REMOV72 thle Inspoe oM from Mile job>Iltft.
PASS PART FAIL
ME ANICAL PE MIT
CITY OF TIG l) -- -
DEVELOPMENT SERVICES PERMIT 0: MEC2004-00387
13125 SW Hall Blvd.,Tigard,OR 97223 (503)639-4171 DATE ISSUED: 6/18/2004PARCEL: 2S111DB-09200
SITE ADDRESS: 15530 SW OAKTREE LN
SUBDIVISION: SUMMERFIELD NO.10 ZONING: R-7
BLOCK: LOT:553 JURISDICTION: TIG
CLASS OF WORK: QTR FLOO t FURN: EVAP COOLERS:
TYPE OF USE: SF UNIT ".:ATERS: VENT FANS:
OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS/COMPRESSORS HOODS:
_ FUEL TYPES 0 - 3 HP: 1 - DOMES.INCIN:
3 - 15 HP: COMML.INCIN:
MAX INPUT: BTU 15-30 HP: REPAIR UNITS:
FIRE DAMPERS?: 30 -50 HP: WOODSTOVES:
GAS PRESSURE: 50+ HP: CLO DRYERS:
FUP',N < 100K BTU: 1 AIR HANDLING UNITS OTHER UNITS:
FURN >=100K BTU: <= 10000 cfm: GAS OUTLETS: 1
> 10000 cfm:
Remarks: Install a/c unit. 6/21/04,adding furna.:e& gas line.
Owner: _ �— FEES
RICHARD FLEMING Oescription Date Amount
15530 SW OAKTREE LN ( 1ECH1 Permit Fee 6/18/20N $72.50
TIC.;ARD, OR 97223 [TAX]84'r,State Surchart 6/18/200e $5.80
Phone: 503-655-3179 Total $78.30
Contractor:
A-TEMP HEATING& COOLING
16000 SE EVELYN ST
CIACKAMAS,OR 97015 REQUIRED INSPECITLINS
Phone: 503-650-9602 Gas Line Insp
Heating Unt Insp
Reg#: LIC 71878 Cooling Unt Insp
Final Inspection
4.
J
E
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes
.w-r and all other applicable laws. All worts will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010th_rough OAR 952-001-0100. You may obtain copies of these,.,yes or direct questions to OUNC by calling
(503)24
Issu d By: Permittee Signature:
Call(503)639-4175 by 7:00 P.M.for Inspections needed the next business dsy
JUN-16-2004 09:05 A TEPP HEATING 5035572990 p.02/0-3
11t',,,edhanical Permit A� licatioll ReCE1ved Mechanic.,
Downes �/ 0� Permit No.: df'c'000 '(•If7 3 a
�/ Manning Ap vel Building
City Of Tigard and t Dala/D : PamitNo.:
13125 SW Hall Blvd. Plan Review Other
'rigaid,Oregon 97223pa" Permit No.:
Phone: 503-639.4171 Fax: 503.54r,"0 PorlWDR<view Vnd Use _ y
Case No.:
Internet: www.ci.liRard.onus ` /� `'
Conucl 1 See Pat*2 for
24-hour Inspection Request: 503.6394175 Nomchicthad: Ira i SUPPIO aatd Informsllon,
TYPE OF WORK CO Ent-1AL BP B;SM DUl.1c*1t� i ST
ew1construction Demolition Mechanical permit fees*are based on the total value ofthe work
STItUCTIOtY
Additioaa/alteratlon/re iAcement Other: perfo.nied. Indicate the value(roundel to the nearest dollar)of all
"► °,_T ^ORY O CONmechanical materials,equipment,tabu:,o-orhead and profit
&2-Famil dwellin Commercial/industrial value: c See Fye 2 for Fee schedule �
Accesso
Building Multi-Family
--�slD$N'1'1Ai.)t; -MF.IVT/sYsrEMS.>F�t`�CI�U1:E'
_ --�' Dacrl don Fae a. Total
Matter Builder Other: _ a. n quite
's B I INFOR ATIO eat'.LOCATION _ Fumac�••add-o conditionin ' 14.00
Job site address: I �' SLie, Gn heat jRvmp 14.00
Suite#:- Bid ./A t.#: Duct work 14.00
Project Name- R runic hot wafer a tem 14.00
Residential bailer . 11
Cross street/Directions to job6- e: for radiator or hydronic Fvstem _ 14.0
Unit heiters(fuel not electric)
in wall,Induct,suspended,etc. 14.00
Fludvent(for any or above) 10-00
Subdivision: Lot#; Repair units '12.15
�. bitter FFuelApi illaricns _
Tax mea /Psrceell#: _ Water hater 10.00
DF.SCtIPTI0 ' WORK Gas flre Ince 10.00
- � _ Flue vent water healer/ flre lace) 10.00J-
-411
0.00-411 lighter a 10.00
Wood/Pellot save 10.00
Wood tiro lace/Insert 110.00
Chirute Ainer/Ilue/vent 10.00
PL20 , R :Q W�JER_ ' T AN—
other: 10.0'3
Emvlronmental Esharst V flatlo
Name: _�" _ Range hood/other kitchen equipment 10.00
Aadrws: Clothes dryer exhaust 10.00
Cit /.c'itStC/71 t Single duct exhaust
Phony Fax:s_...i _� FaX: (bathrooms,toilet compartments,
PPL•I T' OKTACT PER,SO utilityrooms)
—'— Attie/crit a e fans 10.00
Name: OW, 10.00
Address: IL7- 0— Fuel Met a --
Cit /State/ — "(SSA for Ont 4.SI-l)0 each additional
Furnace etc.
Phone' Fax Ou heat um •. __
E-mail: Wallfsua ndedtunil healer ••
CONTRA-.TOR
Water heater "Fireplace
•'
Businesc Nam - �� -- ---
Address � ltno=5 V b �- an ..
Cit /State/zi : r Q,e's'�4% _A Q�,`-1ZtO( Clothes dr er as ••
Phone:�Sd loos-- 03.5, E Other
CCB Lic. #: r� Total:
Mechanical Permit F tr'
Author, ,/,,/ Subtotal: S
Ci atu►e: •ter Minimum Permit Fee$72.50 S
I Plan Review Fee 25%of Permit tee f
(Please print name) Stale Surchar c CSt;of emr t Pee S
TOTAL PERMIT PLE S
Notice: This perrat application expires If a perndl Is mot obtained within `Fee methodology att by Tri-County Building InAvttry 84 to Beard
Iso dors atter h las be.n accepted a contplere. **Slip-tan required for exterior A/C units.
iADstsV1ermt1 FormAPAecPermhApp,doc 01ro3
I
JUN-16-2004 09:05 A TEMP HEATING SO35572990 P.03/03
i
jk- Iemp .Heating and Poin I
Site Plan
!UN 16 ltrd
cirY 4
Prepared h S _ Uatu. j j CITY
Customer Name,�� 00
Custon er Phone:. Os-
r
hollcoy 11ollmllry Linc
'r.
6
7
J
2 �r
S�IccI
TOTAL P.03