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Case File Ul 0 N N cn A (D z r A n m 15025 SIN 1491" GLACE CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503) 639-4175 MST INSPECTION DIVISION Business Line: (503) 639-4171 BLIP Received __ _— Date r^^requested , S _ AM PM _ BLIP Location _ �–�_ = lad - �, Suite--- MEC ---- ---- ---__--- Contaci Person Ph PLM Cc; iiractur --------- --- Ph ( ) SWR BUILDING Tenant/Owner _— ELC Footing Foundation ELC - ---- - - --- - Ftg Drain Ac.eSs: Crawl Drain ELR Slab Inspection Notes: ) SIT Post&Beam � Shear Anchors -- Ext Sheath/Shp,.r Int Sheath/near Framing Insulation Drywall Nailing Flrewal! ..— Fire Sprinkler Rie Alarm Susp'd Coiling -- Roof `�-- Other- Final PASS PART FAIL PLUM8ING Post& Beam Under Slat --_ -__-- Rough-In Water Service - -- -- Sanitary Sewer Rain Drains - - Catch Basin/Manhole Storm Drain - - - -- .--------- - Shower Pan —— Oth r (r,n PART_ FAI_L CHANICAL _ Post& Beam Rough-In Gas Lino — Smoke Dampers Final PASS PART FML ELECTRICAL_ Service - -- Rough-In UG/Slab Low Voltage F re Alarm Ffinal Reinspection fee of$___________ ,equired before next inspection. Pay at City Hall. 13125 SW Hall Bivd. PASS PART FAIL _ SITE _— Please call for reinspection RE:. �] Unable to inspect-no access Rre Supply Line ADA I Approach/Sidewalk Data_. _� Inspactotr Other F nal DO NOT REMOVE this Inspection record `rom the Job site. SASS PART FAIL CITY OF TIGN'.ZU 24-Hour BUILDING Inspection Line: (503)639-4175 MST INSPECTION DIVISION Business Line: (503)639-4171 BUFF -- - — ---- Heceived Date Requested d ` S ' AM__..__-_-__ PM __ BLIP Location ) Suite MEC - -----_-_--_,__ Contact Person _ _._ Ph(_ ) ------ -._--- PIM - ---------- - Contractor Ph( ) -- —_ SWR BUILDING Tenant/Owner -_ �_ ELC Footing ELC Foundation Access: Ftg Drain ELR U U O _ Crawl Drain _— Slab Inspection Notes: SIT -- Post& Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing -- - - --------- - 1 Insulation Drywall Nailing - Firewall Fire Sprinkler - -- -- - -- -- -- — - --- Fire Alarm Susp'd Ceiiing Roof Other: _- -__ --------_�_— ,-. ----- — -__ - - Final PASS PART FAIL - - - -- --PASS Post&Bearn -- - Under Slab -- - Rough-In Water Service - - - --- Sanitary Sewer Rain Drains Catch Basin Basin/Manhole Storm Drain Shower Pan Other - Final _PASS PART FAIL MECHANICAL Post& Beam Rough-In ---- _. -- -- - Gas Line Smoke dampers --- -- - ----- --... Final ;serva_- FAIL i((j-p-- RICA� Rough-In UG/Slab o, ge �Fjre-farm �P PART FAIL Reinspection fee of$- required before next inspection. Pay at City Hall, 13125 SW Hall Blvd - - --- SITE _ J Ploase call for reinspection RE-_ __ _.._______._____�--__—� �_ Unable to inspect- no access Fire Supply Line ADA ApproachiS dewalk Datil �1'�__�`� 27!-� Inspecte► Other: -_ Final UG NOT REMOVE thV. Inspection record h7om the Job site. PASS PART FAIL CITY OF TIGARD 24-Hour BUILDING L ^pection Line: (503)639-4175 L`) INSPECTION DIVISION Business Lire: (503)639-4171 MST BUP Received Date RequestedAM _ PM_ BUP Location _— <'1) �am� � �Zi ' c _-1 y%� ,��" Suite MEC _ Contact Person _ -tL-r` i ct Ph(_ _ 7 PLM Contractor �._ Ph(—_—_) —___—___ SWR BUi LAIN Tenant/Owner _ ELC Foo in'g Foundation fInspection ccess: ELC Ftg Drain <-y.� I S S f1� �a ELR ----- --------- Crawl Drain Slab Notes: SIT Post&Beam _ Shear Anchors Ext Sheath/Shear Int Sheath/Shear - - - -- Framing __ --- ---------r Insulation Drywall Nailing -�-- -- Firewall Fire Sprinkler ----- --- - _ — __------_ _---_-. Fire Alarm Susp'd Ceiling — Roof Other: PASS,)PART FAIL - - - I TING Post& Beam - Under Slab - Rough-In Water Service - Sanitary Sewer Rain Drains - -- - Catch Basin/Manhole Storm Drain Shower Pan Other. - Final PASS AA I�_..,FAIL J&eHANICAj_,> — eam - Rough-In Gas Line S e Dampers m 1 33 PART FAIL E[WrRiCAL Service - - Rough-In UG/Slab __. _ -- ---------------_ Low Voltage Fire Alarm Final Reinspection fee of$_-. required before next ira ection. Pa at Cit Hall, 13125 SW Hall Blvd. PASS PART FAIL L_.l p ----- - 4 p 1' 1' SITE i Please call for rei spection FIE: _ _ —___ _._ _ rl Unable to inspect- no access Fire Supply Line I ADA I Approach/Sidewalk Dat,* Inspector Ext Other: Final DO NOT REMOVE this Inspection record from the job site. SS PART FAIL CITY OF TIGARD MASTER PERMIT PERMIT#: MS1'2002-00086 DEVELOP'ME14T SERVICES DATE ISSUED: 4/17/02 13125 SW Hall Blvd., Tigard, OR 97223 (503) 1539-4171 SITE ADDRESS: 15025 SW 149TH PL PARCEL: 2S108DA-DP001 SUBDIVISION: DAVIS PLACE ZONING: R•7 BLOCK: LOT: 001 JURISDICTION: URB REMARKS: Construction of new SF detached residence. Path 1 BUILDING REISSUE: S FOWES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NF W HEIGHT: 23 FIRST: 1.345 of BASEMENT. 17700 a} LEFT: 5 SMOKE OLTECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND, 1251 U GARAGE: 641 of FRONT: 22 PARKING SPACES: 2 TYPE OF CONST: 5H DWELLING UNITS: 1 FIN13SMENT: of RIGHT. 5 VALUE: S.123,378 00 OCCUPANCY GRP: R3 BORM: 4 BATH: 3 TOTAL: :.5,H 01) el REAR: 22 PLUMBINC SINKS I WATER Cl OSETS: 3 WASHING MACH. LAUNDRY TRAYS: 1 RAIN DRAIN 100 TRAPS: LAVATORIES: 5 DISHWASHERS' 1 FLOOR DRAINS. SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS. TUBISHOWERS: 3 GARBAGE DISP: I WATER HEATERS: I WATER LINES: 100 BCKFLW PREVNTR: I GREASE TRAPS: OTHER FIXTURES: MECHANICAL _ FUEL TYPES FURN<100W BOIL/CMP<3HP: VENT FANS. 5 CLOTHES DRYER: I GAS FURN>=100K: I UNIT HEATERS HOODS: 1 OTHER UNITS: I MAX INP: btu FLOOR FURNANCES: VEt-r^ I WOODSTOVES: GAS OUTLETS: 1 _ ELECTRICAL. PRESIDENTIAL.UNIT SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUIT:{ MISCELLANEOUS AUD't.INSPECTIONS, 1000 SF OR LESS. I 0 200 amp: 0 100 amt: W%SVC OR FDR: I PUMPPoIRRIGATION: PER INSPECTION: FA ADD1 5008F. 101 400 amp: 201 400 amu. 1e1WIO SVCIFl3R: 00 SIGNIOUT LIN LT: PER HOUR: LIMITED ENERGY 401 600 amp. 401 600 amp: EA ADDL BR CIR, SIGNAL/PANEL IN PLANT MANU HM/SVCIFDR Go 1000 amp. 601-amps-1000v: MINOR LABEL: 1000•amplvolt PLAN REVIEW SEC r10N Reconnect only. —4 RES UNITS: SVCIFDR-225 A.. >600 V NOMINAL: CLS AREA/SPC OCC ELECTRICAL-RESTRic rED ENERGY A.SF RESIDENTIAL _ W COMMERCIAL AUDIO 6 STEREO —_ VACUUM SYSTEM: AUDIO d STEREO. FIRE ALARM: INTERCOMPAGING: OUTDOOR LNDiC LT BURGLAR ALARM OTH BOILED. HVAC LANDSCAPEARRIG: PROTECTIVE SIGNL- GARAGE OPENER :LOCK. INSTRUMENTATION. MEDICAL- OTHR- HVAC DATA7TELE COMM NURSE CALLS TOTAL N SYSTEMS: Owner: Contractor: TOTAL FEES: $ 5,381.85 This permit is subject to the regulations contained In the RIVERSIDE HOMES RIVERSIDE HOMES Tigard Municipal Coals, State of OR Specialty Codes and 15455 NW GREENBRIER FKWY#140 15455 NW GREENBRIER PKWY all other applicable laws. All work will be done in BEAVERTON,OR 97006 SUITE 140 accordance with approved plans. This permit will expire R BEAVERTON,OR 97006.2115 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 at�,oted by the 'Iregon Utility Notification Center. Those rult-are set Reg N: LIC 70065 forth in OAR 95?.•001-0010 through 952-001-00:9, You may obtain copies of these rules or direct questioi ,,'o OUNC by calling(503)246-1987. REQUIRED INSPECTIONS Erosion Control Insp 8, Slab Insp Crawl Drain/Backwater Electrical Service Low Voltage Water Lina Insp Grading Inspection Wtr Proofing Bsn1't W2 Footing/Foundation Dri Electrical Rough In Gas Line Insp Appr/Sdwlk Insp Sewer Inspection Post/Beam Structural PLM/Underfloor Framing Insp Gas Fireplace Elec'.rlcal Final Footing Insp Post/Beam Mechanica Mechanical Insp Shear Wall Insp Insulation Insp Mechanical Final Foundation Insp Underfloor nsulation PWmb Top Out Exterior Sheathing Insl Rain drain Insp Plumc Final^—� Issued By : Permittee Signature Call (503) 639-4175 by 7:00 p.m. for an inspection needed the next business day y i CleanWater Services Our commitment is cleat. Pr_)SANITARY ° 155 N First Avenue,Suite 270 Q Hillsboro,(503)846-862197124 SURFACE WATER i . ISSUE DATE 041702 EXPIRATION DATE 101402 EC, EXP DATE: 041604 PERMIT RUCTURE ADDRESS 15025 PROJECT 8469 RUC T URE STREET SW 149TH P TACE: LOT 1 BLOCK PE CONNECTION- NEW PLACE PE INSTALLATION- 119 ? BLL) SWR/EPO CON/Sir PE OrCiJPAN(;Y-. ( 1 ) SINGLE: FAMILY PARCEL 251 SDA 5010 QTR SEC 461.4 MH 1594 ONNER RIVERSIDE HOMES, INC A'JDRESS 1545'.) NW GREENBRIER 4140 TRE:ATMEN`T PLANT DURHAM BEAVERTON OF 97006 P OhC 50:3-645-0986 WATEP DISTRICT "T'IGARD t XTURF EQUIVALENT DWELLING RESIDENTIAL Arris SERVICE UNITS 0 0 UNITS I SERVICE UNITS CONNECTION FEES .aURFACk WATER DEVELOPMENT FEES SEWER CONNECTION ::3010 . 00 WATER QUALITY 225.00 LESS CREVIT° c 225 . 00:+ WATER QUANTITY 275 . 00 LESS CR.EI.II`I' 0 . 00-, EROS ION CONTROL INSPECTION 64 , 00 PLAN CHECF 41 , 60+ SUBTOTAL 2300. 001 SUBTOTAL 380 . 60 TOTAL 2680. 60 A PI, KAME ROBERT PHONE ,"FILLIATION RFF ;MARKS DAVIS PLACE PROD 48469 LOT ] • . • r.anber f o r: t1 ,rT1C)N--84f-Lvde1 - • , • . 44 i j ieL_ / 7:y L? NY (;P035M Permit conditions The applicant agrees to comply with all the rules and regulatfbns of Clear, .Vater Servkes. When calling for an inspection,please refer to the Permit Number. The permit expires one hundred eighty(180)days from the date of.,suance. Th.District sloes not guarantee the a.curacy of the location of side sewer laterals Revised 6/01 White-USA, Blue,-Accounting, Green-Inspection, Yellow•customer Building Pet-, mit Applicati©n Date received: 7 2 Permit no.• 'A `\ City of Tigard - -- Project/appl.no.: Expire date: City njTignrd Address: 131251 IV hp;7 3/I �) -_- - U\ Phone: (503) E N�'���V ) Date issued: By:f - Receipt no.: Fax: (503) 598 1 �'J I Case file no.: Payment type: Land use approval: _ : 1&2 family:Simple C'a,nplex: �J r Ll I &2 rimiiy dwelling or ac meraaR dustrial U Multi-family New constriction U Demolition P„ddition/alteration/replaceinent U'renwit improvement 0 Fire sprinkler/alarm Ll Other: ,t -IOU NITL INFORMATION Job address: LL tai 1� Bldg.no.: Suite no.: Lot: -��Block: Subdivisio t: ' , / �/~ Tax ma /tax lot/account no.: k'rojrcl name.—yt 7 ' (�u z Description and location of work on premises/special conditions: 1 f Name: Mailing address:jf rrAJU G r- ' • - 1&2 family dwelling: „- City: State: ZIP: Valuation of work �.Z.:; 3 7f ............ $ Phone: Fax: - Z E-mail: Noof hrdrooms/baths................................. Owner's representative: (UJ"t _ Total number of floors................................. Phone: New dwelling arra(sq. ft.) .......................... Garage/carport area(sq.ft.)......................... 6- Name:az UA- Covered porch area(sq,ft.) ......................... Deck area Mailing address: (sq. ft.) ........................................ --- City: State: "!_IP: Other structure area(sq.ft.)......................... Phone: Fax: E-mail ('ommereial/industrial/inu11i-family: Valuation work....... ............................... - - Business name.: p� �} nt�rte_,r Existing Idg. rea( .R.) .......................... ------ Address: Nrw bid .area R.)...................y........... ---- City: State: ZIP: Number f sto •.. ........................................ --- Type of o tucti Phone: Fax: E-mail: ................'...... ........�; CCB no.: - - - Occup y group(s): Rkistin _ ---- New: City/metro tic.no.: Notice:All contractors and subcontractors are required to he t licensed with the Oregon Construction Contractors Board under Name: provisions of URS 701 and may he required to he licensed in the Address jurisdiction where work is being performed.if the applicant is Cit : A State: ZIP: exempt from licensing,the following reason applies: Contact person: M— Plan no.: --- Phone: I ax: E-mail: - — — - Name: Contact person: Fees due upon application ........................... Address: Dote received: _ City: State: ZIP: Amount received ...................................... $ Phone: 71Fax: I E-mail: Please refer to fee schedule. I hereby certify 1 have read and examined this application and the Not all iuriedlclions ercepl cr-dit cardr,pleue coil iuNadiclictl for nim.Inramation. attached checklist. All provisions of laws and ordinances governing this U Visa U MasletCard work will he complied with,whether specified h herein or not. ('r-dlt wd number Authorized signature: `� 'ri,'�N?�_ L "1 I)fltC: �C� �� NnnK rf:udholder u shown on crcdd cardT— tp Print name:— Y-!_mac'✓ J )eIC''(, ---o nit -----__�_----- s nmrwm Notice:Thfit permit applicr.tion expires if a permit is not obtained within 180 days alter it has been secrpted as complete. /161/513 ttuxv,r)Nt One- mid Tivo-1,'a1nily Divelling Building Permit Application Che�cltlist Reference ,__ - -- Associated permits: City(ooTigard Cit of Tigard Y g u Electrical V Plumbing U Mechanical Address: 13125 SW Hall Blvd,Tigard,OR 97221 U Other: Phone: (503) 639-4171 Fax: (503) 599-1900 1 1 Land use actions cot.gdeted.Sec jut Isdictian a•llcr1:1 f t t cunt anent IVViews 2 Zoning.Flood plain,,,alar bal;tnce points,seismic soils de,wilaoon,hislunc CIL, 7 T =1 - - -- - - - 3 Verification of approved plat/lot. 4 Fire district_ approval required. 5 Septic system pe At or authorization for remodel. Fxi lnnp ,ysIvol capaclk 6 Sewer permit. 7 Water district approval. 9 Soils report.Must carry original applicable stamp and signature on file or"1111a1111lication- -- - 9 Eroslon control U plan U permit required. Include drainage-way protection,silt fence design and lok an(lo of cruel hasin protection,etc. 167 3amplete sets of legible plans.Must he drawn to scale,showing conformance to applicable local and state frit ang codes. Lateral design details all([cmnitection:,must he incorporated into the plans ur on a separate full-size sheet attt+.hed to the plans with cross references helxveen plan 1'1e align and -iml•. 11,111 review cannot he completed ,'copyright violations exist. I Ite/plot plan drawn to scale.'I'hr plan must show lot and hill Ill uIII,wil1'.it k dunrm1,nig.pi 1X,I1x e purr rlevatiuns I If— - `_ there is more than a 4-11.elevation(IitIcreniia1,111;ut nuts[shoal cnnl(ill r lair`.1t 2 1! ultcI%.II I.I,M;Iu,m Fel ea'••Iit,lits and drivewav;fix)(pritit of slnlc•lIire(Includin)!decks);kk align 01 wells/se1111L syslr11 ".uulnl 14 auu11s;diIc anti Indicator;pot area;building coverage arra:percentage of cuvcrage;i11tpervious arra;existing soot ries on,Ile;and sutlace drainage. 12 Foundation plan.Show dimensions,anchor halts,any hold-downs and reinforcing pads,connection details,vent size and location. 11 Floor plans.Show all dimensions,room identification,window site,location of srnokc detectors, water healer,---- - -- furnace,ventilation fans,plumbing fixtures,balconies and decks 10 inches above grade,cic _ -- _ _ 14 Cross section(s)and details.Show all framing Wentz I sues and spacing such as floorf><an1s,headers, jrnsts,salt-Flour, wall cunstmction,roof construction. More than one crus.w,to a1 luny he n quin•d to clearly portray conslrurtion.Show details of all wall and roof sheathing,nxll-ing,ruin slope.tt•ilnlr' 11e1gllt,siding n+Mteria;,foKlliogs Mrd loLIII align,stalls, fireplace construction, thermal insulation.c1c____ - 15 Elevation views.Provide elevations for new cunstruclion,miminuin of two clevauons for additions and remodels. Exterior elevations n+ust r4lect the actual grade if file change in grade is grealet than four fool al building envelope hull-size sheet addendllniAhowing_ foundation elevations with cross references Mee acceptable _ 16 Wall bracing(prescriptive path)and/or lateral analysis plans. Must indicate details and locations; fill non-prescriptive path anal;;lsis provide specilicatiuns and calculations to engineering standards. _ 17 Floor/roof framing.Provide plans for all fluu►s/rool' indicating mcnther siiing,spacing.and hearing _ locations.Show attic t entilalion. 18 Basement and r^Isirtng walls.Provide crus%sections and delails snowing placement of rchar. War engineered systems,sec item 22,"lingincer's calculalions." 19 Resin calculations. Provide two set;of c:lle11136011s using current code design values fur all her its and multiple joists over 10 feel lung and/or any beam/joist cartxing_I nun-uniform load.- 20 Manufactured floor/roof trues design details. _ liance. Identify the prescriptive path or provide ralcadatiuns. A gas piping schematic is required 21 Energy('ode comp I'm four or more appliances. 22 Engineer's calculations.When required mr provided.(i r ,.',,-at%%all. I uusv shall he stamped by an engineer of :110111•t') IICCII';ed Irl OI'VgOo and 01311 he sJIWAIl 111 he;111 It- 1111; 1 '1u prlyetl undo rt•xit•w. V. 23 five(5)site platls ate required tut Iterll 11 ahelvr. title pl;n1` nur,l hr ri 1/2" x 11"of 11" x 17" _ _- 24 Two(2)sets each are required for Items 16, 1`),20& 22 allot e 25 Building plans shall not contain red lines or tale ons. 2( No rolled,reversed or mirrored building plans will b accepted. 27_ 28 -- ----- ----—— —- ---- --- --- ('hecklist must he completed before plan review start date. Minor changes or notes on submitted plans may he in blue or black Ink. Red ink is reserved for department use only. -1.114,1!(WA otitl U4/211it)I 12:51) FAX 1 360 254 7106 1 1?LfiCRIC, INC. IQ)oUl �Jectrical Fern itApplicatxoll __-- Ueh,received: Isetmltno,: City of Tigard lknjcct/appl.no -�` Iitpiredatc: Ciryn/lignrvf Address: 13125 SW hall nlvd,Tigard.OR 97721 Urn}srral: Phone: (303)639.41•/I _ __ .-_.__._..._.•- OY:_ _ Receipt no.; Fax!(503)596.1960 Cate fife-1): Payment typo Land use approval: r U I &2 family dwelling or accessory U Cornrnemial/industrial U Multi.family U Tenant irnprovcn)cnt YU New construction O Addition/aitele(lmvmplacernent U Other: U.Partial dub addles: �,� -- Bldg.nG' ti-IL" c t R Sui.c no,; Tax mep/tax lot/aecounl no.: Lot:: block:' Subdivision . , Jam,� _ `_--- Project name - Delen ti n and Illation of work on premises:�� Estimated date orclxn letion/inspection: "'"""" s----- -__.__._.__.-w-_.•-M.-_--. -In 1111FM Jobno- Mil-Will s?tr Business name: F e r w e s t 11 e c t r i c I u c: . 1►aGrintion no-IM Address: 7402 N l 1 99th A v t� �k"""�rW-si11Rk or liwth r.rnih pr; Y u ti c o u v e rsr."— City: A»enllla unk.lnchtdn eltacM 11 r/r apt. Slue: ZIP Aetekeinrlatled: Phone `. rax: •t t�_ 1naiL'� Y_~ 1000rq h 1.1 less CCD no,6 2 3 50 Blec.bus,lie.no: Y-3 7-2 7 7(; Eodl°ddluanal lW ;fi,or jtnnion rhtrccif_ - - Cityirnetro lie.no.: tJmlledenr° isrldenuo► n-�,-'�� ,,,,/�/q�_�, j jf���__ Llmitedener ,nrni-rrudrnud �� -• - �1-" _ ---+a•j�F�•fn.ri�G >r,(LStQSI,t__._ `_ �_' `y'�y�1 VachmmruraclurerlMmeolmafutarrlwrlllna SIgnN�",G a-t i°p�t►Vµl. clocuicon(I ulred _ _ t�,e! / crnico wwot(red" Sup.ekcc nrne tift.t);A! war H 2.52 S'` refers ar ke n—lmtellnl�irtl attention or Ietocarlor. 200 amps or tent 2 Ntune(paint) , t' �(C l t. � 201"Vito too on-In .____"""'r -_ 2 Mmlingalldliefs: 1'r r' /GL - '- v40tamptto600It s _ / 2-. r � SLI j4._ 601 In t Io!OW A� Cit r� i 7 Slate OZ11F ' C' -� Over I W0 ampsor mittfr ' maIkcemneetonly Owner installaUnn:•rhe installtuion is being made o,,property 1 ownTempenryaefetelaofi"den• which is not intended for sale,lease,rent,or ex0innpe according to °Ibtkah,eneretlee,arretoatlen URS 447,495,479,670,701. M0 smrt t„tut 2 I ompi to 10U errryrl �' --2 owner's signature; 70 Dare Msec clrttms Name: or or extension per pare+h• -^— -• -------- A. I'te fat btrh chevlu with port hne of Address: _ mservice o•A-tiler W.each branch cirevll ? City; 21P:_ __._..__... _n`.Ibr rot olinoh drrtliu trnnoot pwrLax itluxlr, rax: E-mail: _ nt ran me or loader toe.flrat Mauch circuit: 2 FFwch additional March circuit Mitt.(tutelar nr teed.,and taxi re ►: 0 5etvtoe over 223 bop/•ro Wr"1W U Flealth-cut facility Goch Itilornp up Inisailon circle 2 GSenlanver]2Usn>f+lraslnadlR7 L3HtuardouIit)estiat :khs!Annroyn%rM familydwelhn8t U Dowinxovri injodRome ter,Inulm Sign°lcircyigs)aalimiledawillypanel. -- U Syttn»ores(M wAu norrunal menti residential enlM In one suveture altreatiort,of estenrton4 y2 1.1 numolnirovnlh1rethnire U reedrn,tdt)amptv1naMr •tJetCn uu. ~ U Occupant)ned ovet 99 perntu W Manufactvntt auvnorts ry RV pall ttlWhbnet Ineprrtta,rivet she allewehle M tiny of the ehevr. U riirrtVlixhtle.qplan U this, —.___ hvrlMpr~ual !9nhesit 1.114 of theta"hh any of lbe ob". l tnwu rnbnlat hr atso�e�rr trot a lewbie to tew(terrtvy r _^ -" '""-_ `� t'N orwtrvdlob t►er+rtce. txttet Na Ni ye{►dkitaw adept atdu rwft,Mair:MI ja,wer,ifre ew.wdarnwr°. Nobre l lips patnit M>f,licatlon `Permit fee U Nn 1_I MarlerCad expires Ire trerntll Is not ohtalncil flan review fnl ',�) _ endo sem number vclthln IA,deyt aper it hat been State surcharxr(11%) ...S _. -�•-- K' arcepted et crnnplAr TOTAL .. ... . ........... .S -1b�r�y r�ewii en rwT�. �Yi/Xutl�l.�we1_�.._.^..►.__.�.___—�Alaounl_ 4Mt aFIS fM1rM('t1R1) Mechanical Permit Application - Datereceived. Permit no.: Cit of Tigard —� •� y t'J I'mjccb'aJill l.no.: Expire dart: ('if%41'ford Address: 13125 SW IlalI Blvd.Tigard,OR 9T',' -- Phone: (503) 6.9-4171 Dalt,issued: _ liy: Receipt no.: Fax: (501) 598-1960 Case file no.: Payment type: Land use approval: _—_ — _ -- Building permit no.: U I k 71amily dwelling or accessory U c' Inns I, MI/industrial U Multi-family U Tenant improvement WNowntclion 'J '„I IIII a .1111 talion/replacentrnl U Other: -- Joh address: c w-) _ 1.SOi,' 1. Indicate equipment quantities in hoxes below. Indicate the dollar Bldg.no.: _- Suite no.: value of all mechanical materials,equipment,lahor.o\clhr:nd. Tax map/tax 101/,ICerlltnt no.: -' 111`01111. Value f11lock: Sul)(IN ion: — -- 'See checklist for important application inlilrntation mrd Project name: S jurimIidi(l_'% fcc srhr,hllr lilt residcntiul prrnnit !'ee. City/county: 711': T7 2 2 I 1 Description and to alion of work 0n prernises: 1 ? 1 I t 1 -- —_ hce(ea.) 'Iolal Est.date of conq,iction/inspection: flr.rriplioll qly. Res.only Res.only • Tenant improvement or change of ua': All IIIIIIUIIIII;111111 __ _ _I I Is existing space healed n1`condi(: nrd' J 1'rS U No Air cont ilioning(sine p an n'qun --IS cxiSling Sparc insolmrd”U Yt`ti J No Alb rnil�,n nl cxisliry'.I I�'Ac'syslcw --- MECHANICAL CONTRACU0111 Ituilrl/cunlpresc„Iti --- -.__--- - - Slab hr,ilct Iu'nnll fill Business name: 3 Ali<rS ttq• "5 171 III' Ion• 1111 11/11 97Z n/C --- --— — — Ad'IreSS: n r l�7� f f I.1n/tion F.1`Janl�x l /11111 t•.nn ft 111111ItuS OY l�nA� 7 TP_i,? Ilr,lllnllul,l'IIr h Illlr,lllurll I11,1all/it Ill ire lural a lirl IT /II cil it, - -- - --��- — Int 111111,19 dod olk/\cot hall 'J)vs U No -- .- -- ---- _ InSln �/rtplarc/u Itu,11cht�ut•r; <ucl,cnl�t�t1.- ( It\/rttelro lie.no.: _ \vall,1`n tl„w n nu11cd Nanny(Itleaseclan) "i'llIL-1 111.111 Ininat:r -- e Krrat on: AbsorpUun unll CON-1-ACT PERSON It l 11/11 N,uor: � •� t'hlllrr. III' •- ___. �,IJIrSs St;ur: /II' 11111� m onrntn exhaust end srnl n al n: r I Appliance vent Phone: (nail IityetextT— -- If0cli s,' Y11cTITf7rrx. — n hood fire supprcasion syslcnl Name:L.. Vt P";�%(t-11'1"Lr Exhaust lan with single duct(11;1111 Pails) -�- -- Millhttg address: r ! 1 - I NIri1w sysicm amain floor livalin g of C - - -- -- _ _ 11.1` �Cyi s,/_�( i y / /•f=! l_C: ) , ,• ,. Tlci piping Ilnl 1 cit b1111011(ltp to outlets) C'ity:.1 ;q( t;l l l tate:( /� '1.11. c7 -'�_.__ ^ypcIl�ei Net 1thl dtUtte: I"ax' •, 11II1i111: Tuvilnlm'.l•at'11;4I IliunaTu,t'r• uulclti --- 'n,crecp p nRlxe'lcmaut Icrluuct 1 __ _ Name: Number tit outlets --- — - - --- --- -- --- I her liTlid arpTlanrr n1`equ pmcnti Address: __ I►ccoralive fireplace t_ily_--__. - --- -- St.nc: J.II': -- - 1nSiri lypr --------- I hone: i lilu�i 711c;ICS Signdulc: Dntc: Ill ter: Naar- tlninll: .9 p,�.1, n „ ••pl u'dn raub pr•r.•� dl pn wdu,o a,I,.1` inn•udnun,�li„❑ 'el rtlll h'1` ... ., Nullt t' t Illti I,t'I11111;Il,pllr;lllnll 'J\l i I K1 nl.it u I NI111111111111 tt't' ,I ilr',it a I,cnnu is nun ohlninrtl Ilan Ircu•t% 1;11 I n•.Ii1� u�l mnnb., I,p,,,., „illnn I Sn dm<;tltrr it hn';hrrn ---_---.__ Slant' tlllckltge (X%)....I; Nnmc nl r-mtTlujrh•r a.�h�n.n nn.n•�Ih i ani acct'I,Icrl a.t'rgtlptclr TO A1, t, t'na11lullik•,,n•nnu„' \nunrru _ I MECHANICAL PERMIT FEES COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE: TOTAL VALUATION. _ FEE: Description: - Price Total J-16-0 lrs$5 00q.00 _ Minimum fee$72.50 - -- Table 1A Mechanical Code Qly (Ea) Amt $5,001.00 to$10,000.00 _ $72.50 for the first$5,000.00 and 1) Furnace to 1n0,000 BTU $1.52 for each additional$100.00 or Including ducts 8 vents 14.00 - fraction thereof,to and including 2) Furnace 100,000 BTU+ _ _ $10,000.00. Includingducts&vents 17.40 $10,001.00 t $$25,0(30.00 $140.'n for the first$10,000.00 and 3) Floor Furnace $1.54 01 each additional$100,00 or Including vent 14.00 fraction thereof,to and including 4) Suspended heater,wall heater _$251000.00. or floor mounted healer _ 14.00 325,001.00 t $$50,000.00_ $379.50 for the first$25,000.00 and 5) Vent not included in appliance permit $1.46 for each additional$100.00 or 6.80 -- fraction thereof,to and including 6) Repair units $50, 12.15 U00.00._j5_0_,001 d0 and up - $742.00 for the first$50,000,00 and Check all that apply: Boiler Heat Air $1.20 for cacti additional$100,00 or For Items 7-11,see or Pump Cond fraction lhPrgot. footnotes below. Comp" -- _- _ 7)<3HF,gbsorb unit ASSUMED V�f,LUATIONS PER APPLIANCE: 8)3-15 B i U - _ - 14.00 B)3-15 Hr,absorb Value Total _ unit 100k to 500k BTU 25.60 Desert lion: _ QtY a Amount 9)15-30 H11;absorb Furnace to 100,000 BTU,Including 955 unit.5-1 mil BTU 35.00 _- ducts 6 vents 10)30-50 HP;absorb Furnace> 100,000 BTU including 1,170 J unit 1.1.75 mil BTU 52.20 - ducts&vents -- 11)>50HP:absorb Floor furnace Including vent �- 955 --_ _.._ unit>1.75 mil BTU 87.20 --A Suspended heater,wall heater or 955 12.)Air handling unit to 10,000 CFM floor mounted heater 10.00 _ Vent not Included In applicance 445 13)Air handling unit 10,000 CFM+ permit _ _ _ __ 11.20 Repair unite _ _ 805 _ _ _- 14)Non-portable evaporate cooler <3 hp;absorb. jnll, 955 _ 10.00 to 100k BTU --- 15)Vent Ian connected to a single duct 3.15 hp;absorb.unit -_--�- - 1,700 _ 6.80 _-_-- 101k to 500k BTU _ -- - 16)Ventilation system not Included In 15-30 hp;absorb.unit,5011 to 1 - 2,310 appliance perrnit 10.00 mil.BTU_ -- 17)Hood served by mechanical exhaust 30-50 tip;absorb unit,-i--- 3.400 1000 ` 1.1.75 mil.BTU -- ---- - 16)Domestic Incinerators >50 hp;absorb.unit, -- 5,725 1740 _ >1.75 mil.BTU --.- 19)Commercial or Industrial type incinerator Air handling unit to 10x000 cfnr Air handling unit>10,0000 cfm 1,110 20)Other units,Including wood stoves Nonyortable eve orale cooler 656 _ 1000 Vent ten connected to aside duct 446 21)Gas piping one to four outlets Vent system not Included In656 5.40 �pllance permit_- _ ._ 22)More than 4-pet outlet(each) Hood served by mechanical exhaust 656 1.00 - UomesOcindnerator 1,170 _ Minimum Permit Fee$72.50 SUBTOTAL: $ Commercial of industrial Incinerator 4,590 _ Other unit,Including wood stoves, 656 - 8%State Surcharge $ Inserts,etc. _p_ __ --- �. _.-- Gas Iping 1-4 oullels __._. 1116 285h Plan Ftevier•r Fee(of subtotal) Each additional outlet­_._ r;i Required for ALL commercial permits only ---TOTAL COMMERCIAL $ TOTAL RESIDENTIAL PERMIT FEE: $ VALUATION: �-�- OIMe►1rr�pecllonR pod Feer. Inspeclions oulsde nt normal business hours(minimum charge-Iwo hnurs) $12 50 pet hour 2 Inspeclions for which no tun is specifically indicalnd (minimum charge hall hour) $?2 gp pet hour 3 Additional plan review required by changns,eddittons or revisions to plans(Imminunl chartin One hall haul)$72511,nor hour 'State Contractor Boller Certification required for units 3,2001 BTU. "Residential AIC requlres site plan shnwing placement of unit. i\d319\frt11119trinP.Ch Ine.4 dor: 10/11/00 r Plulmbiiig- ermif Application Ih1, ! ':c\ccl II,nail w, Buildingperim!no.: Ad:11,•,,s; 13 125 51V Iiall Illtd,•figard•OR 97221 ('i!v.�lTi!;urrf Plimic: (503) 039-4171 Prt,ject/aIII to Expire dale: Pax: (503) 598-1960 I .L•i«m ; ---- liy: Receipt no.: Lund nsc approval: .-- I , I,i, 1� ---•----- I':lytnrm typr —______ 1 U I:&2 family dwelling or accessory U('t,nnnrrcillUtndutitti,l ^,lii{I. I .1„IVt uTenam improvementU Nonslnrclion U :1.1.1.1 ..n%III r,lunnh, hl,l„ In til I I 1 U(hlli 1 1 ' ► 1 1 t 1 , • Joh address: �tj0�� c:'�J i(� H� p� - -- ll\uviptiml (1tY. 1"Ce(ell.) 'olid -131dg.no.: _ Suite no, Nr^tt 1-and 2-fa mily dneliings only: Tax nlaphaz lul/nculunl no,: ^-- — -- (htcluilmtoo A.for ec,chatJill ycnnncclion) ----- SI'R 11)ualh Lot: Ilhlck: r tiuhtll\I,h,n:rC�{� ]� -- ftk�- Sl�lt(2)hath I'rnject name: j SIR(3)hath___ ---------__-- _ City/county: /,II'. < F.aclt addilioual b:ltldkilchrn — Description and localirnt of tvolk on taenia:., Site III ll1111cm ('arch basin/area ctr:lin list.date ofColl IpIvlion/insltcclit'll Itrywells/leach hildflench drain 1 1 Footin drain(ni,. Iln. Ii.► ^_ - �— — MENEM Manufaclured home•utilities `- Advanced Custom MCCIWIIICill Inr 5825 SE Foster Rd Bilin 11,1111�t,nllr�j - �� -- �iallll.Il\ tt't\xl (1µt :III II.I Portland OR 97206 503-774-4900 'Widrr tiervicc(nig. Int li.l — CCB: 15054 PLM: 26-723PB hlrture or Item: _ ('onu•:tl:alr's rcprlscnlat, AbNoi --- _.— - - - 11;1,k llrna l,lrtcni,•, I'Iiltl tlaltu Dille: / ` ( ISn,Ltt;txl t.11\r - 1 - h,lme✓�U 2{'/ 1 �I/c'Gi t' �'I+�jllx•, tta•,li,'I I I I ./s r urly Fax: ' 7 Sri is luail. I 'l+,ul i lalik — I Itltllrh.x\trt r;llt ("/o y ' Ilnul dl un^Jll , n '.nll'.!Inih - Mailing address:/rc Gathlgc dl>la, :,I — --- -. — -.. OW,-_f 1 <_> kc im%ker mail Intl irllHnr/prra.�c Irak— _—___.--- llttnl l alIll ion/resident ill I main(cnance unit Thr actual nINIAlatitnl I'lluu•11 ------`— --- tt III ,r malk.liv Illy 111 Illl`I11i11111CI1i111Ce{11111(x11,111 Illadr by 111_\'1 11111�It I•'.ul�l ,1•,1111 (r,llllltxfrull) rill lovre on Ihr ,n,mlty I own;IN v'I (IRS(•h.l,Irl •117. 1 1 1 i I tin,kl�l.l,o`un•,I, til\tlt) Ilttnrl ,ignalurc: Itale: Stilly, fabs/tihtntrl,'tihutvcl rill Iltin,ll 1�`inrl rlmct \�IIIr ,, �1;Ucr hrulrl t Il t ``I',IIt i II' 1 1111x1 ,,I,n•Jnmt ply r .Alpul.l,•t, til i, i. ullnw.u�"O •.1 ,IIr I!ih.l,t•IIt1tI:Ipl,hc:llit,ll Ntlllilinfill It•c.. I' I',1 �. i „�I 1'11111 Iv\-Ir\\ ,II I ,1 + h,•Imit i.ltd nhlainc+l ' / tllluu IHti In\t allot it h,1ti I+ rll S.aly ttn h.ltcr 1 S' ! I y,ur, a., ,It•d;,,clan,Irte TOTAL t nillhiiliN•1 +ign.nuh• lnumm PLUMBING PERMIT FEES: FIXTURES (individual) WQTyTAL Newt and 2-family dwellings only: UNT kt(h udes all plumbing fixtures in i PRICE TOTAL Sink dwcllinp and the firstt!0 ft. QTY Lavatory pch utility.connection (ea) AMOUNT 1 bath Tub orTub/Shower Comb $24920 ath Shower Only - -- _ - _ 5350.00 e 3 bath — �- ------- 5399.00 _ Wr;dr Clo,=elUlinal SUgTOTA1.DI:nwaslte87°STATE SURCHARGE PLAIT..^.EVIEW 2S°/.CF SUBTOTAL _ '- Garbage D sposal 16.60 _—__- - - TOTAL - i Laundry Tray 16.80 Washing Machine 16 60 — Floor Draln/Floor Sink 2" Fn - 5500 - 3" _ PLEASE COMPLETE: 4„Water Hater O conversion 0 like kind --- --j Quatic ork PerformedGas piping requires a separate mechanical Fixture Type: Now Moved Replaced Rerrinved/ ermit.FG I lome New Water Service Sink Ca ped- MFGHome New San/Slorm Sewer 46 40 LAvatorHose Bibs 1660 - Tub or Tub/ShowerRoof brains __ Combination 1b.bir _Drinking Fountain 16.60 Water ClosetOther f xtr,rrs(specify) Urinal16.60 --� _Dishwasher___- Garbo a Dis osal Laundr Room Tra Washln MachineSewer- Iat 100 _ _Floor Drain/Sink: 2" Sewer-each addillonal 100' 16.40 3a -- — _ - 4" - Water Service-1st 100' 55.00 — Water Healer Waley Servicn-ench addlllonal 7.00' -- 48 A0 Other Fixtures -- Slorm&Rain Drain 71st 100' — r ---- Specify __ 5.r 00 Slr;rm 3 Rain Drain-esch addtlk'181 160' 46,40 - -- ----- — Comrnercial l3ack Flow Prevention Device 46.40 - Resldenhal l3nckrlow Preventlen bovine' --- — 27.55 -- - -- Cnlch Basin - Inspoclion of Fxisling Plumbing or Speclally 72.50 _Requested Ins ectlans or/hr _ COMMEr1TS REGARDING ABOVE: Rel"Drain,single family dwelling 65.25 Greaso Traps' — -- 16 e0 --- — QUANTITY TOTAL — �— Isealelrlr.or riser diagrarn la required It Ouantgy total le g — •flUBTOTAL �— 8%STATE SURCHARGE - — - -- "PLAN REVIEW 28°/.OF SUBTOTAL ^ Rm alto onl�l(iAlurr qty lelat Is,D TOTAL 'Minimum permit len i4$12 50 r a^,'n slat"41rrCIIa,Qe,eMCer)1 ne41lICIlI 11 Uar.MMw r`,evenlimn tlr.vire,whirls Is}1a7,14 fl%41.110 surchargn 'All New Cemmerrial Rulldin94 trvpdre pines will,Iaomnlnr ni user dingram nod 111.111 review Ods lforntstplm fees der. 10/10/00 I 150TH A VE _ I� ---- - ------- 7 Z ` v 40 - b ._ /'� � - f ,� ._.--.r-..... ,•moo.. / /✓/ � �•� � �i h Sr,1 b XJ t� 11��1r 1 I ..................... Wit r.�n 1 �"RU►rC1 iDsfGN G)Nst�l."I hN1S [:? SITE PLAN Iii 1':rIf'1' 4\yM1'NWNIAI rrr,lll�.l,„•., ED/V1.41^N I4'M S 1t' I ilsl Avenue.Suilr I NOMFg I'Inllnnl, f)R u1211 ;, .1 CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOT'iCE ADVANCED CUSTOM MECHANICAL INC 5825 SE FOSTER RD PORTLAND, OR 97206 Plumbing Signature Form Permit #: MST2002-00086 Date Issued: 4/-i7/02 Parcel. 2S10LDA-DP001 Site Address: 15025 SW 149T4 PL Subdivisino: DAVIS PLACE Block: Lot: 01`11Jurisdiction: URB Zoning: R-7 Remarks: Construction of now SF deta,:hed residence. Path 1 Your compRny has been indicated .as the plumbing cor+tractor for the permit indicated above. In order for thy: plumbing permit to be valid, please have the appropriate individual from your company sign below and return this Plumbing Signature Form prior to the start of tl,a work to the address above, ATTN: Building Dept. N.a plumbing !nspactions will be authorized until this completed form is recei-fed OWNER: PLUMBING CONTRACTOR: RIVERSIDE HOMES ADVANCED CUSTOM MECHANICAL IN 15455 NW CREENBRIER PKWY #140 5825 SE FOSTER RD BEAVERTON. OR 97006 PORTLAND, OR �S'7206 Phone # 645-0986 Phone #: 503-774-4900 Reg #: I Ir 150540 PI M 26-723PB AN INK SIGNt.TURE IS REQUIRED ON THIS FORM Signatu e of Author .. .d Plumber It you have any questions, please call (503) 639-4171, ext. # 310 CITY OF TIGARD ELECTRICAL - ENER RESTRICTED ENEF'.GY DEVELOPMENT SERVICES PERMIT #: ELR2002-0009: 13125 SW Hall Blvd., Tigard. OR 97223 (5,331639-4171 DATE ISSUED: 5123102 SITE ADDRESS: 15025 SW 149TH PL PARCEL: 2S108DA-05700 SUBDIVISION: DAVIS PLACE ZONING: R-7 BLOCK: LOT: 001 JURISDICTION: IJR Proic:t Description: Installation of phone, data and cable TV systems. A. RESIDENTIAL B.COMMERCIAL AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING: BURGLAR ALARM: BOILER: LANDSCAPE/IRRIGAT: GARAGE OPENER: CLOCK: MEDICAL: HVAC: DATA/TELE COMM: NURSE CALLS: VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE: OTHER: PH/DATA/TV X HVAC: PROTJCTIVE SIGNAL.: INSTRUMENTATION: OTHER: TOTAI # OF SYSTEMS: Owner: Contractor: ^ RIVERSIDE HOMES GREENLINE INC 15455 NW GREENBRIER PKWY#140 PO BOX 230755 BEAVERTON, OR 97006 TIGARD, OR 97223 Phone: 645.0986 Phone: 968-1978 Reg #: LIC 103033 _LE 34.397CL SUP 3345JLE FEES _ Required Inspections Type By Date _Amount Receipt Low Voltage Inspection PRM3 CTR 5/23/02 $75.00 2720020000 Elect'I Final 5PC2 CTR 5/23/02 $6.00 2720020000 Total $81.00 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 '.80 days of issuance, or if work is suspended for more than 180 days. ATTENTIOt'- Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are:let forth in OAR 952-001-0010 thrcrigh OAR 952-001-0080. You may obtain copies of theGP rules or direct quwAons to OUNC at (503) 246-1987. ` Issued by Pern ' tr. Signature *?✓ OWNER INSTAI _A' ION (.ONLY' The installation is LrPing made on property I own which is riot intended foo sale. lease, or rent. OWNER'S SIGNATURE: DATE: CONT RACTOR !NSTALLATION ONLY SIGNATURE OF SUPR Ft.F_C N DATE: LICENSE NO Call 639 4175 by 7:00 P.M. for an inspection needed the next business day �1 05/22/2002 08:59 5039682058 GREENLINE PAGE r�" Electrical Permit Applic ation Datereceived: ;" d Permit nn.��I„r,��d ' City Of Tigard � Pto�est/appl.no. rxpiredate. Ci(Vo K jrd Address, 13125 SW Heli Alvd,Tig tru„OR 97273/- pre issued: Phone: (503) 639-4171 / n BY.;,� Receipt no.: Fax: (503)598-1960 % I` case file no.; Payment type; _ Land use approval: 7 1 &7.family dwelling or accessory U CommemWinduatlial (.]Mnatt family O Tenant improvement U New construction UAddition/alteration/replacement ..l r)cher _ p Partial r Job address: [ oa5 -i. Bldg.nn.: Suite no. Tax ma /tart lot/account no.: _ Lot: ( F31ak: Suttdivi ion: .11-.Project namef1r;rr rStio;t and locimion of work on premises: Dkjfvv _ el Estimated date of com letioNins tion: PU Job not .. �._ _ _ Business nan r tUar�rlprioa (Mi, (ncJ _Fi tel no.Imp V '-� tv'�w.�:idemw•skgk a•wale-anally per _ Address: P, ,li0 3,N MF dwemlft unit lneluda nttan"Ck'rR. City: —TinaAKX - ,ilAt[Q ZIP: �er.ioekrdtttted Phone: _ Fax: Esnail: 1000 sq.n_or lest — a Each additional 300 sq n.or portion Ihcmo CCB no.: 131ec,bus.tic.no:�tC_MI—LL—E-- Limited energy,rrsidential city/metrolic no.: ' UnrltedenerEynon-residern4d 2 Eich mnnufoctured home or modular dwelling Signa of isin rlitin(re ) Drte Service and/of feeder 2 skip.rlw-name(pr1nt), Ucevseno!'053 Servireeorfre4enr—lattaltatien, alteration or relociell" 2110 ump<or tete 2 N urn(print): _i:u r,mp,to 400 nips ---— Mailin( 401 imps to 600 amps 2 Got amps 10 1000 Amps 2 rity: State: ZIP: Over 1000 amps orvoltr —�— PhunaRrc.mneclonl Ownu installation-The insWlation is being made on property 1 own ICM7�"ratyaervkeeorfeeellen;- which Is not intended for sale,loose,rem or exchange according to issetallalha+,alferallon,orrekratletY f►RS 447,455,479,670,701. 2(Ht unpa nr lens 2 201 ampgin 400 amps _ 2 (11Vtler 9 sl Date: 401 to 600 nm s 2 ■vatic t cimiu•east,a1le�wlba, of extension per pastel' �lalneJ _ _ A Fee for branch circuits with purchase of Addi".as: service nr frrder fee,each branch circuit 2 City: State: �7•FF^ 6 Feeforb►anchcfrcuits thnutpurchase ..,... _.._ � � _ phop0: of service at feeder fee,first -snch circuit;circuit; 2 F x f?•utail pitch addicircuit: r "I" (Servl;r or freder not lac )t O Service over"M onvi r rwomereinl -1 lirallh car^farihty 13act2ump or Irrigation circle 2 ❑savloe Me,.120 anwa rating of 1&2 U Hazerdvur location Fnrh sign or outline lighting 2 frmilydwellings ❑gulldingover 111.000 square feet Imu or Signal clmuitla)or a limited antxgy panel. O System ov0600 N.,11,nown oil ru re rcaidentinl units in one structure alteration,rat eztensinn• :2 naildinR over threo stcnirs U Feeders.40n amps or more •(1�scrlptjon ____ _ _ Q orcupact lams ova 99 renonr 0 Manufactured onn.ru•rn or Rv park t rch adANioNI In►gestlatl over tlrw altar .hl In any sf abre: —� U Eattyr/lighun�nlan U 1.7thar __------- Pet Inspection Sahmir _aefs of plots•vrtth ant'of the a2'orr+ _ InvestiLadontce 11rr abr•c are pot aappUcible to temporary ennttro,flon arr►ice, other -� _ —� .c� Nor all Iart+dlnlanr rc.:pr;scalls cnida,ple�ese can patadlrlinn for stress iN�.,ar�an. Notice.'this pemlrt application Permit far.....................S '75 'j vml U Matrtrard expires if a permit is not obtained Plan review(at „_•— `b) S r'.red, cmd member _ ,r L, within I No days after It has been State surcharge(11%) ... S accepted as complete TOTAL., ............... •...$ ,— ala! _ a -- earafio►eer u�ttarae /cmamr — 44n.4615(6atlrenm) � f � 0 a C. a n ry ttA wl crF Fr rb o � 0