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CITY ®F TIGARD CERTIFICATE
ICAC OF
OCCUPANCY
COMMUNITY DEVELOPMENT DEPARTMENT PERMIT fit. . . . . . . :
13125 SW Hall 31vd.Tior.,,Oregon 97:23e8199 f5r,,;839-4171 DATE 1 SGULD: I 1/01/9 S
Fri 4[4 LL: 2SI14AD-0-+900
ITE ADDRES5— : 1664: S0 90TH PL
!JPDIVISICIN. . . . : WAVLRL..Y ESTATES �f.11NYNCi:F2 1u
'-OCK. . . . . . . . . . . LOT. . . . . . . . . . . . . e 03 8
LA55 OF WOR!-'. :NEW
YPE. UF" USE . . . QPF Q
iGCUPANCY LOAD:c'
(imarks : PATP I
,wn&r: ........... .............. ........
AM BOTTER
, 2090 SW ASPEN RIDGE CSR
IGARD OR 97224
hnnp #: 639-4B69
,nh mtor,t _....__,.,.._...,..__...._......_.w._._...._...._.....-_._•._,,--.-..
)YAL_ CARS DEVELOPMENT
2096 SW PGPE:N RIDGE« DFi VE
IGARD OR 97,-2,2:'4
hone #: C39-4869
,eg #. . : 67111.
his Certificate grants occupancy of the above refer 1wed building or F_Ini tioi
hereof and confirms that the bl-li.ldinlg has been inspr_•cted for c:om!alianc.e Witt,
he State of Oregon Specialty C.ociel for the gr u ;, occ-v' tanc.:y, ¢incl use under
re9�erem: mit Was issued. Y,
UILD1NG INSPECTOR BUILDING OFFICIAL
IAL
POST 114 CONSPICUOUS PLACE.
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MASTFR 'PERoMT,
CM( OFTIGARD PERMIT
C01AFAUNITY DEVELOPMENT DEPARTMENT DATE ISSUED, nom,. -7
13125 SW Hall Blvd.Tigard,Oreg--r. ):7223*8190 (503)639-41711
SW 90TI I InI.,
J31)I V 15 1 ON. WAVERLY ESTATC-S ZONING4 P-, .,2
LOT. . . . . . . . . . . . . .Q),
SU I LD I NO
5,'ELLING 121' IT'
-AGS Or WORK. :NEW BURMS:4A R A E. . . . . . . . . . ...16 1
REQUIPRE ) 5ETBAC1 3 �
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'ePE Or. N- I PST. . . - 1284 LEF". . -.5 ft
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IF t Tr"T ill. =
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CITY OF TIGAR®
COr4MUNITY DEVELOPMENT DEPARTMENT nATE ISMED:
11125 LW He;;Blvd.Tigard,Oregon 97223o8199 (503)639-4171
SUBUI V'ASION. W A V 1ER L Y E STAT. ZONING., r%—
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PR""'T .1 0 AD 01 1".".j
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%#u': Sowage PW�c,,, Tthk rerait c(WreS in days froa
the das .i�UEU�. The pa--" ,;I,, be forfeitcd if the
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Residential Building PermitApRlication_
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223
(503) 639-4171
Jobsite A:idress:
Office Use Only
Subdivision: ;,�,���'4'��l,�t ��Ni� Lot #���J__�_ c� 7
Valuation: �< < Flanck/Rec #
.- Permit #
Corner Lot? Y
Flag Lot? Y N Reissue of_
i+4ap & TL # "
Owner: Approvals Rgguired
Address: Planniri " A t
iI v e f IPF:.1�G�✓%C.J
Engineering r�►'�
Phone: _ _ Other 4 (i x4.� -
Contractor: �, Lai t� ; l)F c�, (_ U Items Required
Address: 11 C'7 6" ;-o ei-S i 2C r v dwci ��> _ Subcontractors
— Truss details
t I 1y�
Phone: >r� '� `% * _�" -`(�A Other
Contractor's license # MWAN
(attacn copy of current Oregon license) 1
Contact Name & Phone: SiO,
s
CL Subcontractors: Architect/Engineer: R ICA
N Plumbing: hi A;'t kn 1.,/�,''1 _ Address.
Mechanical: 1<E.",;'", cc_
attach copy of current OR Contractor's License)
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JOB DESCRIPTION: C LZ Fl*,., I . L-I
1 r -
_ ,iia__ k 3
Applicant Signature & Phone number
ReceivQd by: ? Mod lkt,&P _ Date Rece;.ad:
N MORMOMMAREPAPP
Permit# Account Description Amount Amt. Pd. Bat. Due
fyl5f1�-C'•� �� Bldg. Permit (BUILD) ,>ri v �S `'b
Plumb. Permit (PLUMB) .a- ✓
Mach. Permit (MFH) `' • W '�
State Tax
Bldg: 5 Z ✓
Plumb: f� ✓'
Mech: ? • �� �
I
Plan Check (PLANCK) o
Bldg: u V/-. 5
Plumb:
Mech: I�V V,
f Sewer Connection (SWUSA) �?�2Ull 2
(� 2 GJ
Sewer Inspection (S:'VINSP) 2
Parks Dev Charge (PKSDCI SC/C) Se,i)
Residential TIF (TIF-R)
Mass Transit TIF (TIF-MT)
Commercial TIF (TIF-0)
Industrial TIF (TIF-1)
Institutional TfF (TIF-IS)
Office TIF (TIF-C) _
Water Quality (WQUAL)
Water Quantity (WQUANT) D q ✓
v
Fire Life Safety (FLS)
J
Erosion Cntrl Permit (ERPRMT)
ca -
�' Eiosion Planck/USA (ERPLAN! p�Y• p
Erosion Planck/COT (EROSN) V'
TOTALS: G'il� '34
CITY OF TIGAR"UiLiMNG INSPECTION NOTICE
Inspection Line (Rec-O-Phone): 639 4175 Business Phone- u31
;nspection:_
Fcoting Susp, Ceiling Sprink. Rough-in Appr/Sdwlk
Frundation Plbg. Underslab Mech. Rough-in Fireplace
Post/team Struct. Plbg. Top Out Elec. Rough-in (-MI—AA ',
Post/Beam Mech. San. Sewer Gas Line Bldg.
Plbg. Underfloor fia Drain Framing -Plumb.
Alarm Water Line Insulation
Underflr. Insul, Shear Wall Gyp. Bd. Elect.
Date Requested::,/'"/ E5_ Time:_.eAM PM
Aodress: leeq
Builder: Permit a:/1,3/_
THE FOLLOWING CORRE,�TiONS ARE REQUIRED:
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Ins ctor
:: J _ Dater'- J �/
APPROVED _-DISAPPROVED APPROVED SUBJECT TO ABOVE
—Call For Reinsp.
CITY OF TIGARY08UILWNG INSPECTION NOTICE
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-41
Inspection:
Footinr, Susp. Ceiling Sprink. Rough-in Appr;Sdwlk
Foundation Plbg. Undarslah Mech, Rough-in Fireplace
Post/Beam Struct. Plbg. Top Out Elec. Rough-in FINAL:
Post/Beam Mech. San, Sewer Gas Line -Bldg.
Plbg. Underfloor Rain Drain Framing hu_m-1;'
Alarm Water Line Insulation -Mech.
Underfl . Insul. Shear Wa!I Gyp. Bd -Elect.
Date Requested:_ 6L�? l JAS Time: AM __PM
5�-- - '
Address: C
( j Q L-
Puilder: _ Permit
1 HE FOLLOWING CORRECTIONS ARE REQUIRED:
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F.
CD
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Inspector: �. Date��--< /
PROVED ____DISAPPROVED APPROVED SUBJECT TO ABOVE
Call Fr. Reinsp.
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 671
Inspection:
Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
Foundation Plbg. Urderslab Mech. Rough-in Fireplace
Pcst/Beam Struct. Plbg, Top Out Elec. Rough-in FINAL:
Post/Beam Mech. San. Sewer Gas Line Bldg.
Plbg. Underfloor Rain Drain rainin -Plumb.
Alarm Water Line nsulatio -Mech.
Underflr. Insul. Shear Wall Gyp. Bd. -Elect.
Date Requested: /� �f J �[,S Time: AM PM
Address: A" `� 1
Builder: Permit
THE FOLLOWING CORRECTIONS ARE REOUIRED:
t,Qs�f�e6,.u��
insp tor' Date:____ G
PPROVED DISAPPROVED APPROVED SUBJECT TO ABO-�V-E�- �
—Call For Reinsp.
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-O-Phuna): 639-4175 Business Phone: 639-4171
Inspectior,.
Footing Susp. Ceiling Sprink, Rough-in Appr/Sdwlk
Foundation Plbg. Unde-slab Mech. Rough-in Fireplace
Post/Beam Struct. Plbg. Top Out Elec. Rough-in FINAL:
Post/Beam Mech. San. Sewer Gas Line -Bldg.
Plbg. Underfloor Rain Drain Framing -Plumb.
Alarm Water Line Insulation -Mech.
Underflr. Insu'. Shear Wall G Gyp. Bd. C=
Cate Requested: 1 -7 Time: AM —PM
Address:- 61 T C� ~'
Builder: Lo �cj "i_ Permit #:f_-7 G 1__5
THE FOLLOWING CORRECTIONS ARE REQUIRED:
et
^' Q
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Inspector.L/ LL� Date:
_APPROVED _DISAPPROVED ,L�PPROVED SUBJECT TO ABOVE
Call For Reinsp. r
— c�
CITY OF TIGARD BUILDING INSPEC71ON NOTICE
Inspection Line (Rec-O-Phone): 639.4175 Bisiness Phone: 639-417(,J/// /
Inspection: !!!
Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
Foundation Plbg. Underslab Mech. Rough-in Fireplace
Post/Beam Struct. Plbq. Top Out Elec. Rough-in FINAL:
Post/Beam Mech. San. Sewer Gas Line cfd �
Plbg. Underfloor Rain Drain Framing -Plumb.
Alarm Water Line Insulation ec
Undertlr. Insul. Shear Wall Gyp. Bd. -Elect.
Date Requested. i C
,.,/ f� Time: AM PM
Address:_�'1
Builder: Permit #:
THE FOLLOWING CORRECTIONS ARE REQUIRED
J
LO
LU
J
Inspector: � Date:
`APPROVED -11-SA-PROVED —APPROVED SUBJECT TO ABOVE
Call nor Reinsp.
CITY OF TIGARD BUILDING INSPECTION NOTi^.E
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:
Footing Susp. Ceiling Sprink. Rnugh-in Appr Sdwlk
Foundation Plbg. Underslab Mech. Rougn-in Fire
Post/Beam Struct. Plbg. Tap Out Elec, Rough-in FINAL:
Post/Beam Much San. Sewer Gas Line -Bldg.
Plbg. Underfla>r Rain Drain Framing -Plumb.
Alarm Water Line Insulation -Mach.
Underflr. Insul. Shear Wall Gyp. Bd. -Elect.
Date Requested:_ Time:,^-AM PM
Address: U'41-41
Builder: _ Permit #: J
TH FOLLOWING CORRECTICNS AHE REQUIRED:
Inspector: G !2�^ Dats:
_APPROVED _.DISAPPROVED PPROVED-SU13 F BOVE
Call For Rernsp. —
CITY OF TIGARL, BUILDING INSPECTION NOTICE
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 631-4171
Inspection:
i
Feting Susp, Ceiling Sprnk, Hough-in pp wlk
Foundation Pfbg. Underslab Mech. Rough-in Fireplace
PostiBeam Struct. Plbg. Top Our Elec. Rough-in Fl"'AL:
Post/Beare Mech. San. Sewer Gas I ine -Bldg.
Pibg. Underfloor Rain Drain Framing -Plumb.
Alarm Water Line Insulation -Mech.
Undertlr. Insul. ShearWallC-Gyp. ; -Elect.
Date Requested: Q z g�Time: AM
w.w �_PM
Address: -
Builder: Permit #:
THE FOLLOWING CORRECTION" ARE REQUIRED:
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Ins;PROVED
tor: Dat <,
DISAPPROVED ` APPROVED SUBJECT TO ABOVE
____Call For Reinsp.
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639 117
Inspection:
Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
Foundation Plbg. Underslab <!do�Pe I. Rough-in Fireplace
C'Post/Be m Struc Plbg. Top Out Elec. Rough-in FINAL:
ost/Bee Mech. )San. SewerGas I.in -Bldg.
nd�erflool_.> Rain Drain r.:min -Plumb.
Alarm Water Line Inst lation -Mach.
Underflr, Insul, Shear Wp Gyp. Bd. EI t. ,
Date Requested:_ O /�S� Time: AMS PQM'`~
Address: p 61 �-
Builder: Permit #: �S- d-
THE FOLLOWING CORRECTIONS ARE REQUIRED:
S' eat a?- TGf
J
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16TId
Inspector' Date:_'
—APPROVED _DISAPPROVED 'PROVED SUBJECT TO ABOVE
Call For Reinsp.
CITY OF TIGARD BUILDIN,:, INSPECTION NOTICE
Inspection Line (Rec-O-Phone): 639-4,75 Business Phone: 6 4171
Insp-ction: _
Footing Susp. Ceiling Sprink. Rough-in !Sdwlk
Foundation Plbg. Underslab Mech. Rough-in Fireplace
Post'Beam Struct. Ibg. Top O ' �, Elec. Rc,igh-in FINAL:
Post/Beam Mech. San. Sewer Gas Line -Bldg.
Plbg. Underfloor Rain Drain Framing -Plumb.
Alarm Water Line Insulation -Mech.
UndedIr. Insul. Shear Wall Gyp. Bd. -Elect.
Date Requested: ( 5 Time: AM __PM
Address:�(Q(,
Builder: Permit k: 5 —6 `3 ( 1
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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u:
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F—
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t,7
11.1
Inspec r._ — Dater
APPROVED DISAPPROVED 'PROVED SUBJECT TO ABOVE
_Call For Reinsp.
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspect;on Line (Rec-O-Phone): 639-4175 Business Phone: 3 4171
Inspection:
Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
Foundation Plbg. Underslab Mech. Rough-in Fireplace
Post/Beam Struct, Plbg, Top Elec. Rough-in FINAL:
Post/Beam Mech. San. Sewer Gas Line -Bldg.
g. Underf r Rain Drain Framing -Plumb.
Alar Water Line Insulation -Meeh,
Underflr. Insul, Shear Wal Gyp. Bd. Elect.
Date Requested: G j Time: AM PM
Address: sl.
Builder: Permit
THE FOLLOWING CORKS O R � D:
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2
57-0
S�CJ� S✓��%QAC T1/+�j tL<��'i2 �/%•� P / �_
v.
J
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Inspector: Uate:_
_APPROVED A.DISAPPROVED APPROVED SUBJECT TO ABOVE
�aflFor Reinsp,
CITY OF TI3ARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection:
Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
Foundation Plbg. Underslab Mech. Rough-in Fireplace
Post/Beam Struct. Plbg. Top Out _ec. oR�ug fi� FINAL:
Post/Beam Mech. San. Sewer Gas Line -Bldg.
Plbg. Underfloor Rain Drain Framing -Plumb.
Alarm Water Line Insulation -Mech,
Underflr. Insul. Shear Wall Gyp. Bd. -Elect.
Date Requested: /�`j 16 o�! Time:XAM PM
Address:
Builder: Permit #: S Q 36(,
THE FOLLOWING CORRECTIONS ARE REQUIRED:
r
Inspector [ c Date:/
APPROVED —.DISAPPROVED &PPROVED SUBJECT TO ABOVE
`Call For Reinsp.
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-O-Phone): 639 4175 Business Phone: 639-4171
Inspection:_
Footing Susp. Ceiling Sprink. Rough-in AppiiSdwlk
Foundation Plbg. Undersiab Mech. Rough-in Fireplace
Post/Beam Struct. Plbg. Top Out Elec. Rough-in FINAL:
Post/Beam Mech. (Va_ . Sawar•' Gas Line -Bldg.
Plb Undeilloor
g. dam Drain Framing -Plumb
Alarm star Lim Insulation -Mech.
Underflr. Insul. Shear Wali Gyp. Bd -EI
. t
Date Requested: Time: AM � �M
AddreF,: 1 . qL 17(_1 l� !—
Builder: Permit
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspector: Date: _
-LPPROVEU ,DISAPPROVED _APPROVED SU T TO ABOVE
—Call For Reinsp.
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4
r,
Inspection:
Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
Foundation Plbg Underslsb Mech. Rough-in Fireplace
Post/Beam Struct. Plbg. Top Out Elec. Rough in FINAL:
Post/Beare Mech. San. Sewer Gas Ling, -Bldg.
Plbg. Underfloor Rain Drain Frnming -Plumb.
Alarm �l�la(er.a Insulation -Mach.
Undertlr. Insul. Shear Wall Gyp. Bd. -Elect.
1
Date Requested: � � Z ( ��� Time: AM PM
Address:
Builder: Permit N:
THE FOLLOWING CORRECTIONS ARE REQUIRFn.
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Inspector. _ Date 2 Z Tl
C4PPROVED DISAPPROVED APPROVED SUBJECT TO A130VF
`Call For Reinsp
CITY OF:TIGARD BUILDING INSPECTION NOT;CE
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection: P] /
FooPngL Susp. Ceiling Sprink. Rough-in Appr/Sd
Foundation Plbg. Underslab Mech. Rough in Fireplace
ost/ eam Struct. Plbg. Top Out Elec. Rough-in FINAL:
Post/Beam Mech. San. Sewer Gas Line -Bldg.
Plbg. Underfloor Rain Drain Framing -Plumb.
Alarm Water Line Insulation -Mech.
Undertlr. Insul. Shear Wall Gyp. Bd. -Elect.
Date Requested: (a —A0 -- `7_5 Time:—, -AAM PM
Address: ) (a(Q y
Builder&CjOt,�-yt r�,,]D Permit #:h15T�
THE FOLLOWING CORRECTIONS ARE REQUIRED: ,���_ ;1 ell
J
LD
W
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Inspector:_ Date:
PROVED DISAPPROVED —APPROVED SUBJECT TO ABOVE
____Call For RPinsp.
CITY OF TIGARD BUILDING INSPECTION NOTICE %
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-41
Inspection:
�oot nng Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
oundation Plbg. Underslab Mech. Rough-in Fireplace
Post/Beam Struct. Plbg. Top Out Elec. Dough-in FINAL.:
Post/Beam Mech. San. Sewer Gas Line -Bldg.
Plbg. Underfloor Rain Orain Framing -Plumb.
Alarm Water Lin Insulation -Mech.
Underflr. Insul. Shear Wall Gyp. Bd. -Elect.
Date Requested:�j " 7 Time:ZAM PM
S��Address:
Builder: &P Permit H:
THE FOLLOWING CORRECTIONS ARE REQUIRED:
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Inspe/r: — Date:
-PPROVED _DISAPPROVED .APPROVED SUBJECT TO ABOVE
`Call For Reinsp.
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CIT'Y OF TiGARD RFCFI(.','( OV PAYMENT RFC;F,'f PT NO. :95265s�.,.n
CHr=CV, AMOUNT 250. 00
AMC, ROYAL OAKS r)FVEL.OPMF-NT CAlil-i AMOUNT OV
_ �j
4)RESS 9855 SW PEPPERTREL LANE POYMENT DATE t Or)/17/95
TtGARD, ON SUSD I V I S I ON
,.v,
97 E.'4-
_Wi ,LjSE OF PAYMENT f)mrit.JNT PAID PURPOI�E OF. PAYWNT omnUNT PAID
i7,
lq 0. 00
I SW 101 H PL-
T J;'(14L AMOUNT PA I E) 250. 00
CITY OF' TTOARD - REGEIVIT OF' PAYMENT RECEIPT NO. 1.5-F 6 5 1)0
CHECK AMOUNT t 3930. 51
NIVIF ROYAL., nAK9 DEW-I.OPMENT CASH AMOUNT a 0. 00
ADDRESS a 9655 SW LN. PAYMENT DATE' 05/P5/95
rIGARD, OR SUBDIVIGtON
9 PP.4--
PURPOSP. f_'lF PAYMENT AMOUNT PAID PURPOSE OF PAYMCNT AMOUNT PAID
PUT I DING PF RM MST950211 685. 50 PLUMBING PERM 231. 00
MrrHANICAL PE 4191.00 ST. SUIL-D PER 48. 23
PIA144 CHECK FE P07.5A SEWER USA 2po0. 00
1 1 WVR INSPECT 35. 00 PARKS 90C 500. 00
H. -O QUALITY FAC;IL. ITY FFE 180. 00 REE1,1DENTIAL. TRAF'FIC FEES 1430. 00
rliV113 TRANSIT TIF FF�-.S 120. 00 HRO QUANTITY FACILITY FEE 100. 00
CnN,rRC,)L,. Pl-RMITFFLS sa. IAVI FROS ION CONTROL. PLAN rK i;la. 60
f'"POSION CONTROL 218. 60
16f.:-41 SW WTH PI...
TOTAL AMOUNT PAID !__930. 51
ci,ry (.)F "riCAPD REcr-,ir,T OF F.,f4YMFNT RECrIPT NO. t45-2689'71
CIARCK WOUNT 9 4. c,'j-
NAMEROY(:'._ CAKS, DEVELCIPMF-:NT CO CASH AMC)LINT 0.00
4DD .
f :55
s lJ'096 SW ArAPFN RTDGF DR PnYMENT DATF a Ott i 07 c45
T I G A W) P sum)i v i��;i nN
9 7 r1'2-'4-
PLIPPOI,f OF PAYMENT AMOUN'r r,Ati) VURPOISE OF POYMENT AMOUNT PAXT.)
IPII . ,I I E.'.PMIT 185. 00 ST. SUILD F 9. 25
FA-L.95-03-06
101'AL. AMOUNT PAID 19 4. 2 ri
Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd. L C_ -65l_306Tigard, OR 97223 Planck/Rec. #
Permit # "! C � .
Phone (503) 639-4171 Date Issued
FAX (503) 684-7297 Issued by
CITY OF TIGARD TDD No. (503) 684-2772 —�—
Inspection (503) 639-4175
1. Job Address: 4. Complete Fee Schedule Below:
Name of Development WAU7,R L,f i:-SNumber of Inspections per permit allowed
Address I L&L SIJJ 9 I)T-H Service included: Items Cost(ea) Sum i
City/State/Zi p TJ -.-r4 D } l�R Cl 7 Q; 4s. Residential-per unit 4
1000 eq ft or lane �_ $11000 LL _—
Each ad id.onal 500 sq fl or -7c
Name, (Of name Of bUSIneSS} portion thereof �_ $2500 1 '
Commercial❑ Residential Limited :Harpy $2500
Each Manurd Home or Modular 2
Dwelling Service or Feader $69 00
2a. Contractor installation only: 4b•Services or Feeders
2
installation,alteration,or relocation
Flertrical Contractor_ ��. Ly F'.�5'�; � 200 amps or less _! $8000 2
201 amps to 400 amps E90 00 2
Address_ �Q� 401 amps to 600 amps -- $120 00 2
GIty qwcb\t n,,a� _ State—_ Zip 601 amps 10 1000 amps $113000 i 2
Phone No. Over 1000 amts or volts $34000 T
2
Contractor's License No.` -c _ aao°^^a`+only $5o 00
Contractor's Board Reg. No.__ft4LV2% 4c.Temporary Services or Feeders
Installation,alteration,°r r°localion 2
n C4AFr C�rr.,1i: 200 amps or lase $5500 _ 2
Signature of Supr. Elec'
201 amps to aoo amps $7500 2
License No. N-1 h- Pfione N0. 401 amps to 600 amps $10000
ovar 600 amps to 1000 volts
2b. For owner instr,ilations: see W above
4d. Branch Circuits
Print Owner's Name _ New,alteralion or extension per panel
a)The fee for branch circum with
Address _�. 2
purchase or awyke or seha
der .
City Slate Zip Each brarvh circuit $500
Phone No. _ b)The fee for branch circuits without 1
The installation is being made on property I own which is purchase oAaervka or Aaader be. 2
Fust branch cnrnnt $3500
not intended for sale, lease or rent. Each adddional branch circuit $5 00
i
Owner's Signature 4e.Miscellaneous
(service or feeder not included) 2
3. Plan Review section (if required): Each pomr or irrigation circle �, $4000 2
Each sign„r outline lighting _ $4000
Signal CUCUIt(S)01 a limited energy 2
Please check appropriate item and enter fee in section 5B. panel,alteration or axtanslnn $4000 _
4 or more residential units in one structure Minot t nt%ls(10) $100 00 _
`-' Service and feeder 225 amps or more
System over Soo valts nominal 41.Each additional inspection over
cn Classified area or structure containing special occupancy the allowable in any of the above
> Pa,tnrpe<'lu>n $3500 _
F as described in N E.C. Chapter 5 P,.,hour ,_ $5500
In f'I:u'l E55 00
Submit 2 sets of plans with application where any of the above
apply. Not required for temporary construc'lon services. 5. Fees:
4i 5a. Fnter total of above fees $
NOTICE _
—+ 5%'Surcharge(05 X total fees) $
PERMITS BECOME VOID IF WORK OR CONSTRUCTIONsubtotal $ �
,AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF 5b. Enter 250 of line A for
CONSTRUCTIO14 OR WORK IS SUSPENDED OR ABANDONED FOR Plan Reviaw it required(Sec 3) $
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $
COMMENCED L! TRI St Account M $
Sal,trce Due $ L �/