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10554 SW NAEVE STREET S 3AWN MS VGSU t Z cn w � J Ln O 10554 SW NAEVE ST CITY OF TIGARD CERTIFICATE OF OCCUPANC Y COMMUNITY DEVELOPMENT DEPARTMENT PERMIT M. . . . . . . I MST95--91393 13125 sw Hd Wvd. 0giard,Orson 97229.8199 (M)GU-4171 DATE I SSUED i 04/05/96 SITE AUDRESS. ., . I 19154 SW NAFVE ST PARCELt aS110DA- 0100 SUBDIVISION. . „ . e RENAISSANCE SUMMIT Z©NINGeR-3. 3 BLOCK. . . . . . . . .. . I LOT. . . . . . . . . . . . . 1012 CLAft-UF-WORK. eNfwW------�______._.__________..----_.__. TYPE OF USE. . . I SF OCCUPANCY GRP. :"!,I* 913 OCCUPANCY LOAD42 Remairks I PATH I Owner --_--_____________ -_-.-_____-____----- RENAISSANCE CUSTOM HOMES 1672 WILLAMETTE FALLS DR WEST I_INN OR 97066 Phone #9 557--6000 Cont ract or I -.______...___ - .-.___._ ___.___._,_-_-__ RENAISSANCE CUSTOM HOMES INC 1672 SW WILLAMETTF FALLS DR WE ST L INN OR 97068 Phone MI Reg M. . : 97599 This Cer-tificmte grants occupancy of the obove referenced building or portion thereof and confirms that the building has been inspert9d fo compliance with *he State of Oregon Specialty Codes for the grokrp, ace )ancy, and use �rrrder which the referen ed permit was issued. A1_1L_ . ING IN ECTOR BUILDING OFFICIAL POST' IN CONSPICUOUS PLACF CL r� m 0 w a 04 R PERMI CITY OF TIGARD PERMITS#ER. . . . . .. MST95-0393 COMMUNITY DEVELOPMENT d&A* I!NT DATE ISSUED: 11/01/95 13176 8'N HaN Blvd.Tigard,Orpon 9722398199 (503)639-4171 PARCEL: 2S110DA--0 '100 SITE ADDRESS. . . : 10554 SW NAEVE ST SUBDIVISION. . . . : RENAISSANCE SUMMIT ZONING: R-3. 5 BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :012 --- —_--------------- ------------ BUILDING ----------------------------------------- REISSUE: DWELLING UNITS: 1 BASEMENT. . . . . . . . :0 sf CLASS OF WORK. :NEW BEDRMS:4 BATHS:3 GARAGE. . . . . . . . . . :670 sf T' -r- OF USE. . . :SF FLOOR AREAS---------- REQUIRED SETBACKS—­­­­ T1,PE OF CONST. .-SN FIRST. . . . - 1215 s f LEFT. . :5 ft R I GH-T. :5 ft OCCUPANCY GRP. :R3 SECOND. . : 1325 sf FRONT. :20 ft REAR. . : 15 ft STOR I ES. . . . . . . :2 F I NBSMENT:0 o f REQUIRED---------------------- 1E EQUIRED---------------------- IE I GHT. . . . . . . . : 'h f t TOTAL-------:2540 ,f SMOKE DETECTORS. :Y F OOR LOAD. . . . :40 psf VALUE. . . . . f : 175157 PARKING SPACES. . : 1 13e parks : PATH I ---------------------------------- PLUMBING --------- ----- ----- _--- ------ --- SINKS. . . . . . . . . . .. I FLOOk DRAINS. . . . :0 BACKFLOW PREVNTRS. . : 1 LAVATORIES. . . . . :5 WATER HEATERS. . . : 1 TRAPS. . . . . . . . . . . . . . :0 TUB/SHOWERS. . . . :3 LAUNDRY TRAYS. . . .- 1 CATCH BASINS. . . . . . . :0 WATER CLOSETS. . :3 SEWER LINE (ft ) . :0 GREASE TRAVIS. . . . . . . :0 DISHWASHERS. . . . : 1 WATER LINE (ft ) . : 100 OTHER FIXTURES. . . . . :0 GARBAGE DISP. . . : I RAIN DRAIN (ft ) . :0 WASHING MACH. . . : 1 SF RAIN DRAINS. . : 1 MECHANICAL --------------------------------- FEES - ---_—_----__---- FUEL TYPES-- ---------- UNI- HTRS. . -0 type amol.tnt by date recpt /GAS/ / / VENTS . . . . . :0 TIF f 1590. 00 .B 11/01/95 95-272342 MAX INPUT:0 BTU VENT FANS. . :4 SWM f 180. 00 B 11/01/95 95-•-272342 TURN ( 100K . . :0 HOODS. . . . . . : 1 SWM t 100. 00 B 11/01/95 '15-272342 TURN ) =100K . . .- I WOODSTOVES. :0 BPRT $ 623. 00 B 11/01,195 : .5---272 342 FLOOR FURN. . . . :0 CLU DRYERS. : 1 BPLC f 404. 95 BON 10/19/95 95-271889 BOIL/CMP ( 3HP:0 OTHER UNITS: - R5PC $ 31. 15 B 11/01/95 95--272342 GAS OUTLETS: 1 PARK $ 500. 00 B 11/01/95 95-2723422 Owner-: ------- ----------------------------MPRT $ 45. 00 B 11!01/95 95-272342 RENAISSANCE CUSTOM HOMES MPLC f 11. 25 B 11/01/95 95-272342 1672 WILLAMETTE FALLS DR M5PC $ 2. 25 B 11/01/95 95-272342 38TH f 225. 00 B 11/01/95 95-272342 WEST LINN OR 97068 P5PC $ 11. 23 B 11/01/95 95-272342 Phone #: 557-8000 EROS $ 64. 00 B 11/01/95 95-272.342 Contrar..tar-: -----._._______.____.__----___-.. _-._-.--.ERPC $ 20. 80 S 11./01/95 95- 272342 RENAISSANCE CUSTOM HOMES INC ERPC f 120. 80 B 11/0J /95 95--272342 1672 43W WILLAMETTE FALLS DR IL WEST LINN OR 97068 I F- F"hone #: CO) Req_ #. . : 97599 ---------------------------------------•--- —__$-—3829. 45 TOTAL --- -- This permit is issued ;uhject to the regulations contained in the — REQUIRED INSPECTIONS — m Tigard Municipal Code, State of Ore. Specialty Codes anJ all other Footing Insp P1 1_tmb Top Out Yapplicable law3. All stork will be done in accordance with approved FoI_tndat ion Insp Electr-ical Servi Plans. This permit will eeoire if work is not stsrted within 180 Post/Beam S•,, •uet Electrical Rough days of i«liance, or if stork is suspended for more than 180 days. Post/Sep.m Mechan Framing Insp Crawl Drain Low Voltage Plm/undslah Insp Fireplace Insp PLM/Underfloor Gats Line Insp iss".1eli Bv : Mechanical Insp Insi_tlation Insp Call for inspection — 639--4175 SEWER Z0NNECT7MT— PERMITCI1Y OFTPERMIT #. . . . . . . s SWR95--@445 COMMUNITY DEVE_OPMEN9TtMWPNT DATE i SSI;ED s 11/01/95 13125 8W Hall Blvd.Tigard,Oregon 972230109 (503)039-4171 PARCEL: 2S 1 10DA-0c 100 13TTE ADDRESS. . . : 10554 SW NAEVE ST SUBDIVISION. . . . : RENAISSANCE SUMMIT ZONING: R-3. 5 BLOCK. . . . . . . . . . . LOT. s 012 TENANT NAME. . . . . : USA NO. . . . . . . . . . s FIXTURE UNITS. . . : CLASS OF WORK. . . :NEW DWELLING UNITS. . : 1 TYPE OF USE. . . . . sSF NO. OF BUILDINGS: 1 INSTALL TYPE. . . . :OUSWR IMPERV SURFACE. . : : sf Remarks : MATH I Owner: -------------------------------------------------- FEES __----_—_—_ RENAISSANCE CUSTOM HOMES type amo:ant by date recpt 1.672 WILLAMETTE FALLS DR PRMT t 2200. 00 B 11/01/95 95-272342 INSP $ 35. 00 A 11/01/95 95-272342 WEST LINN OR 91066 Phone #: 557-9000 Contractor: CONTRACTOR NOT ON FILE --------------- Phone #: $ 2233. 00 TOTAL Reu #. , ------- REGUIRED INSPECTIONS -------- This Applicant agrees to comply with all the rules and regulations Sewer- Inspect i of the Unified Sewage Agency. The permit expires 189 days from the date issued. The total amotint paid will be forfeited if the pereit expires. The Agency does not guarantee the accuracy of the _ side sewer laterals. if the sewer is not located at the measurement given, the installer shall prospect 3 feet in all directions from the distance given. 1f not so located, the installer shall purchase a "Tap and Side Sewer" permit and the will instal _ Permittee SiynatL.ir-N: IL p� Call for inspection — 639-4175 H rn J W J 1� • Residential Building Permit Application City of Tigard ti 3125 SW Hall Blvd. Tigard, OR 97223 k (543) 639-4171 Z Jubsite Address: `�5 y L) I�)L��V� .��f _ Subdivlsionk m1.e;(L1 (/ 4 LUl)uj a 1- Lot aIR Use Qn '� Planck/Rec 10-W q f- Valuation• "' G permit# n S f`�i] d ✓ j Corner Lot? Y CN -- Flag Lot? Y N Reissue of Mop & TL Owner: AgprQvsls 604164 } Address: �- Fat L M Planning' z Engineering _-- n..Ad—IiC. Phone: 5c; 7 - 7CC-2O• Other Contractor•. �� ( �,,, l ,()tea YYI YY� kms Rq"jMdd Address: �(0 1: ��I (��))�-Uta 1 aL e Subcontractors L 4 �i) if). (� (I��", —I I Truss Details Phone: J_.�_1- G Other 1+ P1f Qum Contractor's License # t; , V`C (attach copy of current Oregon license) Ire •5 k-�. Contact Name & Phone: d IL Subcontractors: Archltect/Engineer. � ,LL(j, rn Plumbing: IL ) Address: 1,3- 7 A I 3 III .� Mechanical: - (+ 1 _ � lOv m (attach copy of current OR ntractoes License) Phone: W JOB DESCRIPTION: jj]�J�L r(arkil" �A �021,1 0_( Applicant Signature & Phone number ^ / Received by: - I°I " Date Received: ►/- ���yQLt-1' �_ N WA)RMCOMDF"F_$APP Permit* Acc,►unt Description Amount Amt. Pd. Sao. Duo q( Bldg. Permit (BUILD) fp . k �3► �'"� Plumb. Permit (PLUMB) Zj v� 2 i►�� Mech Permit (MECH) -iLj.�.-• State Tax (TAX) Bldg: ��i s� .��.ij Plumb: _ /, L �� �►L t Mach: ,L •�'L ( / .2 Z, Plan Chec (PLANCK) Bldg: r Plumb: Mach: L, Sewer Connection (S SA) .Z!'� Sewer Inspection (SWINS 3 ) 3 �' Parks Dev Charge (PKSDC) SCiIJv r Storm Drainege Chg (SDSDC) Residential TIF (T'F-l2) U d �-- Mass Transit TIF (TIF-MTL� Commercial TIF �JAK;C) Industrial TIF (TIF-1) Institution IF (TIF-IS) Q. r. OTge TIF (TIF-0) N '�Uater Quality (WQUAL) m �/ Wnter Quantity (WQUANT) 0 Fire District (FIRE) Erosion Cntrl Permit fERPRMT) Erosion Planck/USA (ERPLAN) ;2v,*v „ y Erosion Planck/COT (EROSN) CPR.Sy TOTALS: ldl�G�- Y ..,.. _Solar Balance 'Worksheet Address f��Sl �jlt NAII`1e Box A calculations: North-South dimension for the lot. Box A: This dimension is determined by finding the midpoint of the North lot line ar.d dr,;-Ning Pn intersecting line perpendicular to that point. Measure the distance from the midpoint of ;he North lot line to the South lot line along the described line. tt Box B calculations: Shade point height from your structure. Box B: 1. Determine whether measurements will be based on the peak or eave of your structure. The or'enta•ion of the ridge is also important. Which describes your lot? 1 a: If the roof lino runs North-South, measurements will be based on the peak of the (Circle anal roof. 18 1b(1c 1 b: If the roof line runs East-West and the roof pitch is less than 5/12, measurements will be based on the eave. 1 c: If the roof line runs East-West and the roof pitch is 5/12 or steeper, measurements will be based on the peak. ft 2. Measure change in elevation from front property line to finished floor elevation. ft 3. Measure distance from finished floor elevation to the affected peak/gave. V)_ ft 4. If the roof line runs North-South, deduct three feet. If the roof line n,ns East-West, deduct nothing. 5. Subtract one foot for each foot of difference in elevation from the front property ft line to the rear property line, if the lot slopes up from the front to the rear. If the lot has no slope or slopes up from the rear to the front, deduct nothing. _? CL 6. Total figure for box B: - -"4 " W I rN Box C. Distance to the shade reduction line. Box C: ED J 1. Measure the distance from the North property line to the foundation. ft LU J 2. Measure the distance from the foundation to the affected peak or eave. + ft 3. Total figure for box C: Sa ,.ogin��im •o erc - — Solar Balance Point Standard Boat A. North-South dimension for the lot sox s. shade point height from your structures measured through the middle of the house change in elevation from north property line to the finished floor elevation added to the height 1 � of the building from finished floor elevation to feet the affected peakleays. ':f the roof line runs MIS, subtract 3 feet f the figure. f*at Sm C. Distance to the shade reduction line Distance fros North property line to foundation Added tc the distance from the foundation to the ffected roof peak. ^)� feet The following helps explain the graph below: The horisontal anis (rows) represents bca "C" figures. The vertical axis (columns) represents bbx "A" figures. It is most useful to draw a vertical '.ine to represent the appropriate figure found in box "A" and. a horizontal line to represent the appropriate figure found in box "C" . The intersection of the vertical and horizontal lines detecmines the value found in. box "D" . The value in box "D" should be compared to thkt value in box "B"; if the value in box "B" is less than or equal to the value found in box "D", the building is in compliance with the solar balance code. Distance to shade 100+ 95 90 851 80 75 70 65 5o .5 50 45 40 reduction line from northern lot line in. feet 70 40 40 40 41 42 43 44 65 38 38 38 39 40 41 42 43 60 36 36 �6 37 38 39 40 41 42 55 34 34 34 351 36 37 38 39 40 41 50 32 32 32 33 34 35 36 37 38 39 40 41 42 45 30 30 30 31 32 33 34 35 36 37 38 39 40 40 28 28 28 29 30 31 32 33 34 35 36 37 38 L 35 26 26 26 27 28 29 30 31 32 33 34 35 36 p� 30 _24 24 74 25 _26 27 28 29 30 31 32 33 34 25 22 22 22 23 24 25 26 27 28 29 30 31 32 20 20 20 20 21 22 23 24 25 26 27 28 29 30 15 18 18 18 19 20 21 22 23 24 25 26 27 28 _ 10 16 16 16 17 18 19 20 21 22 23 24 25 26 _m 5 14 14 14 15 . 16 17 18 19 20 21 22 23 24 I9 W J Box 'D" Maximum allowed shade point height T L� T feet 0 b. b�A�� - 989 • �9ss• �_ a \ S 9-4513 W 58.80, / C L p `. I O . I pz CS cF e, `� 8 4 u by `b. do GI 1 ti0• � `'' it .p �1 R 1 OD I ✓ X47. 16 '/ '.,' /. _ �, .. " r p l ' --CHANGED FOOTPRINT PER RANDY, N10-16-95, 8TA —REMOVED PORCH, MOVED ..OUSE PER SCOTT, 10-13-95, BTA 1 I N --CHANG, FOOTPRINT PER SCOTT, MOVED U PRIVATE STORM DRAINAGE EASEMENT HOUSE, 10-10-95, BTA. ---NEW HOUSE PER SCOTT, f j _ 10-10-95, BTA. S 89'52.07" W 93.37' OD SCALE DRAWING LOT 12 RENAISSANCE SUMMIT F9 _ All --EIGHT FOOT PUBLIC A14D PRIVATE UTILITY S.E.1�4 SEC.10,T.2S.,R.1W.,W.M. EASEMENT ALONG ALL FRONT AND REAR LOT LINES CITY OF TIGARD - WASHINGTOM COUNTY, OREGON SEPTEMBER 27, 1995 Centerline Concepts Inc. DRAWN BY: BTA r.HECKED BY: WGD111 640 82nd Drive Gladstone, Oregon 9-'�_ SCALE 1"=20' ACCOUNT _# 115 503 650-0189 fax 503 650-0189 J PLUMBING PERMIT CITY OF TIGARD DATE I ISSUED: . 11/01/955-0393 1/01/955-0393 COMMUNITY DEVELOPMENT DEPARTMENT 131'25 SW Hall Blvd.Tigard,Oregon 97223.8199 (503)030-4171 PARCEL: 2S 1 10DA-02100 SITE ADDRESS. . . . 10'554 SW NAEVE: aT SUBDIVISION. . . . : RENAISSANCE SUMMIT ZONING: R--3. 5 BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :012 C1.-.ASS OF WORK. . :NEW GARBAGE DISPOSALS. . : 1 TYPE OF USE. . . . :SF WASHING MACH. . . . . . . : 1 BACKFLOW PREVNTRS. . : 1 OCCUPANCY GRF'. . :R3 FLOOR DRAINS. . . . . . . :0 TRAPS. . . . . . . . . . . . . . :0 STORIES. . . . . . . . s2 WATER HEATERS. . . . . . : 1 CATCH BASINS. . . . . . . :0 FIXTURES-•-----.------- LAUNDRY TRAYS. . . . . . : 1 SF RAIN DRAINS. . . . . ! I SINKS. . . . . . . . . . : 1 GREASE TRAPS. . . . . . . :0 LAVATORIES. . . . . :5 OTHER FIXTURES. . . . . :0 TI_IS/SHOWERS. . . . : SEWER LINE (ft ) . . . . :0 WATER CLOSETS. . :3 WATER LINE (ft ) . . . . : 100 DISHWASHERS. . . . : 1 RAIN DRAIN (ft) . . . . :0 Remarks : PATH I OWNER: ------•-----•------------------- -----------------FEES----- --_---•----- RENAISSANCE CUSTOM HOMES TIF t 1590. 00 B 11/01/95 95-272342 1672 WILLAMETTE: FALLS DR SWM $ 180. 00 B 11/01 /95 95-272342 SWM $ 100. 00 A 11/01/99, 95-27234: WEST LINN OR 9706P BPRT E 6cP..3. 00 B 11/01/95 95-272342 Phone #: 557--8000 BPLC $ 404. 95 BON 10/19/35 95-2271889 BSPC f 31. 15 B 11/01/95 95-272342 Plumbing Contractor:------------------- PARK t 500. 00 B 11/01/95 95-272342 MPRT f 45. 00 B 11/01/95 95-272342 Name :_.___... GC1%A;,,gr_,e � .__. MPLC f 11. 25 B 11/0t/95 95-272342 Address :.-_jWAw&_ 1d 1mla.*iO4r .__.� MSPC $ 2. 25 B 11/01/95 95-272342 C i t y :_ LLQ_._._ St at e : _ O� 3ST14 $ 225. 00 S 11/01/95 95--272342 Z i p: - -Q�j,�.�_ Phone#: _ a, �"._._._�_.._ V'SPC $ 11. 25 B 1 1101/95 95-272342 Reg #:_.._....-. Q.�_ _......____-- -•_-_- __-�- Additional fees not shown here. . . . . . . . . --- ---- REQUIRED INSPECTIONS - ---This permit is ssued subject to the reg- ulations contained in the Tigard Municipal Footing Insp Low Voltage Code, State of Ore. Specialty Codes and all Founoation Insp Fireplace Insp other applicable laws. All work will be done Post/Heim Struct Gas Line Insp in accordance with approved plans. This Post/Beam Mechan Insulation Insp permit will expire if work is not started Crawl Drain Gyp Board Insp within 180 days of issrcanr_e, or, if work is Plm/Undslab Insp Rain drain Insp IL suspended for more than 180 days. PLM/Underfloor Wzter Line Insp Mechanical Insp Water Service In N Plumb Top Out Appr/Sdwlk Insp Electrical Servi Electrical Finial Electrical Rough Mechanical Final J X. % __ _ ___ �� Framing Insp Additional. . . . . . AithorizeT Plumbing ontractor Signature W Call for inspection - 639-4175 J Contractor Notes :__ ELECTRICAL PERMIT CHY GF TIGARD DATElISSUED: 12/09395 COMMUNITY DEVELOPMENT DEPARTMENT PARCEL: 2S 1 10DA-02100 ITE31IrDTVe5" .T 1� 4T Wim E� 5T:71 SUBDIVISION. . . . : RENAISSANCE SUMMIT ZONING:R-3. 5 I3LOCK. . . . . . . . . . : LOT. . . . . . . . . . . . . :(Al2 I,ro,ject Description : Residential 3, 500 sq ft. _.. --------------- --RESIDENTIAL UNIT---- ---TEMP SRVC/FEEDERS----- -----MISCELLANEOUS----- 1000 5F OR LESS. . . . : 1 0 - 200 amp. . . . . . . : 0 PUMP/IRRIGATION. . . . : 0 E_ACH ADD' L 500SF. . . : 5 201 - 400 amp. . . . . . . : 0 SIGN/OUT LINE LTG. . : 0 LIMITF_L ENERGY. . . . . : 0 401 - 600 .amp. . . . . . . : 0 SIGNAL/PANEL. . . . . . . : 0 MANE. HM/ SVC/FDR. . : 0 601+zmps- 1000 volts. .' P MIN©R l_ASEL. ( 10) . . . : 0 -----SERV I CE/FEEDER---_- -----BRANCH CIRCUITS-------- ---ADD' L INSPECTIONS—- 0 NSPECTIONS--- 0 - 200 amp. . . . . . : 0 W/SERVICE OR FEEDER: 0 PER INSPEC•rION. . . . . : 0 x_01 - 400 ramp. . . . . . .. 0 1st W/O SRVC OR FDR. s 0 PER HOUR. . . . . . . . . . . . 0 401 - 600 amp. . . . . . : 0 EA ADD' L BRNCH CIRCr 0 IN PLANT. . . . . . . . . . . 1 0 601 - 1000 ..amp. . . . . : 0 -------------------PLAN REVIEW SECTION-----------------_ 1000+ amp/volt. . . . . : 0 ) =4 RES UMTS. . . . . . . . : ) 600 VOLT NOMINAL. . : Reconnect only. . . . . . 0 SVC/FDR ) = 225 AMPS--. I CLASS AREA/SPEC OCC. : Owner s -------------.._. .._ -_-____-____---- -----_-- --------- FEES ---------------- GAGE ELECTRIC type amot+nt by date recpt PO BOX 1429 PRMT f : 35. 00 CJS 12/19/95 95-274101 5PCT f 11. 75 CJS 12,, 19/95 99-274101 CLACKAMAS OR 97015 Phone #: 503-657-0142 Contractor: --•-_-_---•---------------------•--------•--------------•---•------•------- GAGE ELECTRIC INC f 246. 75 TOTAL PO BOX 1429 ------ RE9UTRFD INSPECTIONS - -- --- CLACKAMAS OR 97015 Ceiling Cover Elect' l Service Phone #: Wall Cover Elect' l Final Req #. . I This permit is issued subject to the regulations contained in the - Tioard Municipal Code. State of Ore. Specialty Codes and all other F'erm i t t ee Signature applicable laws. All work will be done in accordance with aooroved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 188 days. Issued By INSTALLATION ONLY-------------------------------- IL the installation is being made on property I own which is not intended for 7,ale, lease, Or rent. N f1WAIER9S SIGNAT1JRE: DATF_s INSTALLATION ONLY-------- ---- - ----- -__..._._- W ,TGNATURE OF SUPR. ELEC' Ns d��rp!. DATE 5 W J L.I CENSE NO: Call for inspection - 639-4175 ' s f Community Development ELECTRICAL PERMIT Air-PLICATION 13125 SW Hall Blvd. Tigard, OR 972.23 PlancklReC. # 9S-.2 AYP/ Pern,it # E-Lf9.S'-Qr537 _ Phone (503) 639-4171 Late 'issued Z,2_ /9-y,-_ _ CITY OF TIGARD FAX (503) 684-7297 Issued by TDD No. (503) 684-2772 Inspection (503) 639-4175 f. Job Address: 4. Complete Fee Schedule Below: Name of Development Number of Inspections par permit allowed Address_I V S'!e&4 S c,&.J- N w.e:1" S'C Service included: Items Gost(pa) Sum City/State/Zip AN a 4a. Residential-par unit4 1000 sq It or less $11000 ��i Name (or name of business). Each arfirikk rel 500 so If or Q 1 ---- porton thereof $26 oo rJ commercial❑ Residential o — Limited Energy 82600 Each Manul'd Home or Modular 2 Dwslinrr Service or Feeder we 00 2a. Contractor Installation only: 4b.Services or Feeders Inalallatron,alteration,or relocation 2 Elec,rical Contractor ,� 200 amps or lase $6000 22 Address P•0. t 1 201 amps to 400 amps x8000 _ Yom- 401 amps 10 80o amps $12000 2 City Ct is rima,rtr�t Stated Zip q 20 L r Bot amps to 1000 amps 1116000 — 2 Phone No._�i ��! Over 1000 amps or volts _— $940 n0 2 Contractor's License o. -3 _1�—-C. RetO/1A"U o* -- �F0°° -- Contractor's Board Reg. No. !i a::44"d _ 4s.Temporary Services or Feeders Installation,alteration,or relocation 2 Signature of Supr. Elec'n_0, . --6 20°amps or Was s6°on 2 amps to 400 amps $75 00 2 License No._f Phone N( . .z A�� 4pt amps M Boo ampa 610000 — Over Bran wraps to 1000 volle 2b. For owner Installations: see'b'above 4d. Branch Circuits Print Owners Name — New,allwaticn or extension per panel Address a)The tee for branch drains with Ci Statep---- _ Zi purvlwas of sovrlee or miter 1".. 2 city___ Each branch drain $630 _ Phone. N0. __ b)The fee for branch circuits 8400err The installation is being made on property I own which is prwehase or e1^'lve or'realer Am 2 Firnt hranrh circud $3500 2 not intended for sale, lease or rent. Fart,AMilional Manch circuit Owner's Signature_ 4e. Miscellaneous (Service or feoder not included) 2 3. Plan Review section (if required): Each pump or irrigation arch $4000 p—_ 2 Each sign or molina ligating S4000 Signal circut(s)or a limited energy 2 Please check appropriate item and enter%a M section 58. panel,alteration or axlens-on $40 0n — IL 4 or more residential units in one structure Minor$abets(10) $10000 _ _ Service and feeder 225 amps or more f" System over 600 volts nominal 4f. Fatch additional inspection over N -- he allowable in any of the above Classified area or structure containing special occupancy the –�as described in N.E.0 Chapter 5 Par inspection $9500 Per hour $6500 � !n Plant $9600 m Submit 2 sole of plans with application where any of the above --- apply. Not ropuired for temporary construction services. 5. Fees: LU NOTICE Se. Enter total of above fees 5%Surcharge(05 X total fees) $ PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $ AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF Sb. Enter 25%of lino A for CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Plan Peview If required(Sec 3) $ A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $ _ COMMENCED. ❑ Trust Account 4 $ Balenre Due $