Loading...
14803 SW 106TH AVENUE ADDRESS: 141?os -jo&� AvAvuR CL' I- N H J G:] C7 J i:\records\microflm\tergels\buildieg. a•.c Page No. 1 CASE HISTORY FOR CASE NO- ELC96-031) GLEN WHITMORE 14803 SW 1061H AVE 12/14/98 Action Description Req/ Schd/ End/ ACLion Notes Disp By Update Upd Code Sent Done Done Date By RLCA001 Application received / / / / 05/17/96 RECD CJS 05/17/96 CJS ELCA003 Permit created / / / / 05/17/96 PEND CJS 05/17/96 CJS ELCA500 ;F? Issue permit / / / / 05/17/96 PASS CJS O5/17/96 COS ELCA799 Elect'l Final 05/17/96 / / 06/17/96 PASS TLP 06/18/96 'PLP ELCA800 Case finaled / / / / 06/17/96 PASS TLP 06/18/96 TLP r� v, F=. c.J Page No. 1 CASE HISTORY FOR CASE NO.: MEC96-0137 i3LEN WHITMORE 14803 SW 106TH AVE 12/14!98 Action Description Req/ Schd/ End/ Action Notes Lisp By Update Upd Code Sent Done Done Date By ------- ------------------------------ -------- ---•---- -------- --------------------------------------- ---- --- -------- --- MECA007 Application received / / / % 05/17/96 RECD CJS 05/17/96 CJS MECA060 (F) Issue permit / / / j 05/17/96 PASS CJS 05/17/96 CJS MECA705 Gas Line Insp 05/17/96 / j 06/17/96 PASS TLP 06/18/96 TLP MECA715 Mechanical Insp 05/17/96 / / 06/13/96 no air pressure on gas line FAIL TLP 06/14/96 TLP MECA799 Final Inspection / / / / 06/17/96 PASS TLP 06/18/95 TLP MECA800 Case Finaled / / / / 06/17/96 PASS TLP 06/18/96 TLP a F— N t 1— J o-r G7 CD W J CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24-Hour Inspection Line: 639-4175 Business Line: 639-4171 I i �9 _ �_ BUP _ J Date Requested �- AM PM BLD Location V ' / r! Suite,/ MEC �c-- Contact Person , Ph Z`r 7 7 T PL Contractor Ph SWR BUILDING Tenant/OwnerELC Retaining Wall — _ ELR Footing Access: Foundation n �, ,/ Ftg Drain FRS �.AQ� _ Crawl Drain Inspection `:es: L�7LS> SGN Slab __ �n-- S Post Beam �� a� _ Ext Sheath/Shear eath/Shear ��*4 Int Sheath/Shear � Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ce";ng n Roof Misc: �-__-- Final i-- P SS----RARE FAIL -------- -- __ Post&Beam —`- Under Slab Top Out -- -- Water Service Sanitary Sewer, -- R ' prains incl ' ---__-�- - --- ---- --- ART FAIL Post& Beam --------- -- - ------- — — Rough In GasLine ----------- --------------- --- - - Smoke Dampers Final -- ---- --- --- -- -------- - PASS PART FAIL ELECTRICAL -- - -- ---- ----- - ------ -- 1 Service _ ' Rounh In C" UGISIab �- Low Voltage Fire Alarm Final --- - ----------- - -- - PASS PART FAIL_ J SITE Backfill/Grading - `-�-- -- - - - -- - Sanitary Sewer Storm Drain [ ]Rainspection fee of$ _-_ required before next inspection. Pay at r;ty Hall, 13125 SW Hall Blvd Catch Basin Fire F opply Line [ J Please rail for reinspection RE:- _ [ ]Uneble to inspect- no access ADA Approach/Sidewalk Other Date 1 _ - — inspector- Y - - ExtDl Final PASS PART- FAIL DO NOT REMOVE this Inspection record from the jobs site. CITY OF TIGARD DEVELOPMENT SERVICES P'111MPTNG PERMIT FIFRMI-i #. . . . . . . : PILM97-02,17jr15 13125 SW Hall Blvd., Tigard,OR 97223 (503)639-4171 DATE ISSUED: 07/2'41-/97 PARCEL: SITE nDDRESS. . . : 1/1803 SW 106TH AVE SUBDIVISION. . . . . LANG HILL N0. =' ZONING: R-11 ' D 1.-0 C K. . . . . . . . 1, . : 1-01.. . . . . . . . . . . . . :77 JURISDICTION: TIG ------------------------------------- CLAS7) OF WORK%. . :ALT GARBAGE DTSF-,OSnL-S. : 0 MOBILE HOME SPACES. : V, TYPE OF USE. . . . :SF WASHING MACH. . . . . . : 0 BACKFLOW r,REVI\ITRS. . : I OCCUPANCY GRF'. . : R3 FLnnR DPr"1NEi. . . . . . : 0 TRAPS. . . . . . . . . . . . . . . 0 STORIES. . . . . . . . : 0 WATER HEATERS. . . . . : 0 CATCH BASINS. . . . . . . : 0 F T XTURES- LAUNDRY TRAYS. . . . . : 0 SF RAIN DRAINS. . . . . : 'A SINKS. . . . . . . . . : 0 URINALS. . . . . . . . . . . . 0 GREASE TRAPS. . . . . . . . 0 LAVATORIES. . . . : 0 OTHER FIXTURES. . . . : 0 THB/SHOWERS. . . : 0 SEWER LINE (ft) . . . : 0 WATER CLOSETS. : 0 WATER LINE (ft ) — 0 DISHWASHERS. . . . : 0 RAIN DRAIN (ft ) . . . : 0 Remzav-ks : Install. ing backflow prevention deice. Owner-: FEES 01 EN WHITMORE type amoi-trit by date r-ecpt 14803 SW 1.06TH AVE PRNT $ 15. 00 DRA 07/2'4/97 97-297546 7 1! TIGARD OR 97;2L24 5PCT $ 0. 75 DRn 07/24/3'7 '37--' 97546 Phone #: F 0 . nt r-ac't OMS MAINTENANCE '560 SW MANDAN DRIVE TUALATIN OR 970622 Phone #: $ 15. 7,-1 TOTAL Reg It. . : 690(: REQUIRFD INSPECTIONS This permit is issued subject to the regulations contained in the RF'/Backflow Pv,ey I igard Municipal Code, State of Ore. Specialty Codes and all other Final Inspection anolicable laws. All work will be done in accordance with appy-yed plans. This permit will expire if work s not started within 180 days of issuance, or if work is susrended for more V) 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 952-000I-0010 through OAR You may ;7-1 obtain copies of these rules or direct questions to OUNC by calling (4- 3)246 1987. C-M ISSI-Ir-d By : Pet-mittee Si9nat'-1r-e :-S-/'L0J �CA +-++++++++4 I I +4 F-+4++++ +4--+-+.......4++4-+++++++++++4......►+++4-4.4-+++++++++++++4+++++++++-I////// ++A-4-4-+++++++++4-+++4...........If I Cal 1. 6.39--41'75 by 6:00 p. m. foran inspect ion needed the np)(t bosinegs day +++++++++4.4+++++4+4++4.++++4•+++++++++++++++++... .........4......4.......4-+++4++I -ITY OF "i'fGARDcd By Plumbing Application Re 3125 SW HALL BLVD. Commercial and Residential Date Recd IGARD, OR 97223 Dan to P.E. 503) 639.4171 Date to DST Permit A f-11, . L Print or Type Related SWR to Incomplete or illegible applications will not be accepted caned_ Name of oevolopmenvprtr - QT-i ` 1p p rAli1T� Job sink "_'` 9.00 Address Street Address Suite lavatory 9.00 ` V®3 5L) 10 L Tub or Tub/Shower Comb. 9.00 Bldg a City/State ZIP Shower Onty 9 00 i o r 7 Z�l V/SW Closet 9.00 - rliftle-�-y s f:+� C1uJ�it ��. mhw D.00 Owner MWWV Address Suite Garbage Disposal 9.00 4 0'3 sw (Ot: aj i_ Was"Mum" 9.00 citylstate Zip Phots Floor Drain 2- 9.00 to!MLt 7 /i 'Gr f 3- -' 9.00 Name 4. 9.00 ~- Occupant me"Address, Suite water Heater 9.012 _ Laundry Room Tray 0.00 Gly/State Zlp Phone Urinal- 9.00 Name OtMr Fixturn(Specify) -� W Contractor Willing Address sure 9,00 II1?b SLID l�s.bw 0.00 (prior to isswrtm Gtyo'S1lte ZIP phone -- -• applicant must &tt-;i,, - 9.00 ��i1 Ztiy -"-r+i1'l provide all Oregon Const.Cunt.Board t-ic ill Exp.Date 9•01.' contractors q/G 4 S 4 -9(4- 9.00 kense Plumbing tic.0 Exp.Date Sewer-tat 100' 10.00 Information 1340(o i Sewer-esm add"M tar 25.00 for COT COT Business Tax or Metro! Exp.Date yya -tat 100 database). 30.00 Name Water Sarvim-each additlonal 200' 23.00 Architect Ston"6 Rain Drain-tat 100' 30.00 or Mailing Address - Suite Storm&Rare Oran-each adddlonaf IW 25.00 Mobd -H.ne Spam �- 23.00 -- Engineer Gtylslare --Zip Phone Contmer.iii Back Flow rvenbori Dev+m or Anti- 2500 PofkMkm Devin e=ibe work New O Addition O Alteration 0 Ri-par U RasidantW Baddlow Preventlon Device' I 15.00 o be done: Residential O Non-msidendal O Any Trap or Waste Nut Connected to a Fixture 9.D0 dditional descripbon of wax Catch Basin 9.00 Insp.of Dusting pun" 40.00 N _ Waw P4141,.r.• - -- penhr Ing use of Specialty Requested Inspecbons 40.00 ..ny or I> b ---- - -- ,� -- Rin Oran.sagM family dwearxj pwft 30.00 -000sed use of Grease Traps 9.00 kiildin9 o,property__ QUANTITY TOTAL ., re you capping. moving or repiaeing any nxh"s1i Yes❑ NO(V loo+Mfc or raw dtairsm is rapirrrao if ouerwy Tarr is >9 if yM see back of form) 'SUBTOTAL _7_ Nen-by acknowledge that I have read the application.that the information - ,en is corr!d dtat I am the owner or authorized agent of the owner.and 5%SURCHARGE at plans submitted are in Compliance with Oregon State Laws. gnature of Owrier/Agent Date PLAN REVIM 7.5'X.OF SUBTOTAL , Rrrpinae arMy if fhem/'rfy total is>Y - TOTAL I , enact Person Name Phone _ 'Minimum permit fee rs$25•5%surcharge.axcept Residennal Bacltfirrw Z`/Y-e-1}f Preventhn Device.which is SIS -5%ststharge 1:1p1mapu.doc 11196 (dst) 'LEASE COMPLETE AS APPROPRIATE TO PROJEC Fixtures to be capped, moved or replaced Qty . Sink Lavatory Tub or Tub/Shower Combination Shower Only Water Closet Dishwasher Garbage Disposal Washing Machine _ Floor Drain 2" 3" 4" Water Heater Laundry Room Tray Urinal Other Fixtures (Specify) ,OMMENTS REGARDING ABOVE: r� w RECEIVED CUMMUNIIV D[YELOPMFNI I:\plmapp.doc 12/96 (dst) MECHANICAL. CITY ®F T i GARS► F'c. . I T F'E:RMIT #. . . . . . . MEC96--•0137 COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 05/17/96 13125 SW Hall Blvd.Tigard,Or*pon 07223.8129 (503)83A-4171 PARCEL: 2S 1 1:graJ--085 I0 SITE ADDRESS. . . : 14803 SW 106TH AVE �3UBDIVISION. . . . : LANG HILL NO. 2 'ZONING: R-12 BLOCK. . . . . . . . . . . 1-.OT. . . . . . . . . . . . . : 77 (.,I-ASS OF WORK. . :ALT FLOOR T=URN. . . . : 0 F_VAP COOL-ERS: 0 TYPE OF USE. . . . :SF UNIT HEATERS. . : 0 VENT FANS. . . : 0 OCCUPANCY GRI•'. . :A1 VENTS W/O APDL: 0 VENT SYSTEW-3: 0 GTO RIES. . . . . . . . : 0 BOILERS/COMPRESSORS HOODS. . . . . . . : 0 1=UEL 7YF'ES -_-._.______.__ 0- HP. . . . : 0 DEMES. INCIN: 0 : /GAS! / / 3-15 HP. . . . : 0 COMML. INCIN: 0 MAX INPUT : 0 BTU 15-30 HP. . . . : 0 REPAIR UNITS: 0 I'-I RE DAMPERS '. . 30-50 HF'. . . . : 0 WOODSTOVES. . : 0 GAS PRE=SSURE. . . : 50+ 1.11-1. . . . : 0 CLO DRYERS. . : 0 NO. OF' UNITS---------- AIR HANDLING UNITS OTHER UNITS. : 0 F�URN ( 100K ?BTU: 1 (= 10000 c•-fm : 0 GAS OU"I-L.ETS. : 3 FURN ) ==100K EATU: 0 ) 1000'•h cfm : 0 Remarks : Installing a residential fl-trnace ' o 100K BTU and gas piping. Owner,: --- -______ .._.__________.__...._.__._.__„___._._______.____._______ FEES GLEN WHI TMORE type amol.tnt by date r^ecpt: 14803 SW 106TF•I AVE: PRMT $ 25. 00 CJS 05/17/96 96-279576 5PC r s 1. 25 CTS 05/17/9S 96--279576 TIGARD OR 972x4 PLCK f 6. 25 CJS 05/17/96 96--279576 1='hone #: C:ontractor: ------- ------ --______________ A-TEMP HEATING & COOLING 1b000 SE EVELYN 91'. (::LACKAMAS OR 97015 _.__----.-......-•-•-•--------____---•-------•---.__._.....__._ _ Phone #: 650--5014 f &.2. 50 TOTAL. Hey #. . : 71878 ------- REQUIRED INSPECTIONS This permit is issued subject to the regulations contained in the Gas Line Insp Tigard Municipal Code, State of (Ire. Specialty Codes ar.d all other ME Chal-).i Ca l Insp applicable laws. All work will to done in accordance with F i nay l Inspection _ approved plans. This permit will expire if work is not started within 180 days of issuanc?, or if work is suspended for @ore _Y .____._• W-- M—` _ __�.. than 1,80 days. - I'e:•m i t t e e S i g n a t i_t r-e : I s s i_t e d B y C Call for inspection - 639-4175 City of Tigard MECHANICAL PERMIT Planck/Rec. # 79.S7/ 13125 SW Han Blvd. APPLICATION Permit # /A Fr 9(-L)137 Tigard, OR 97223 (503) 639-4171 `scnption Ta►,le 3A Mechanical Coda QTY PRICE AMT Job 't"4 1) Permit Fee -0- -0- 10.00 Address I CA-.rd 72 2-q- 2) Supplemental Permit 3.00 Furnace to 100,000 1:3 1 U 1) Ind.ducts&vents 1 6.00 kumv AM— Fumacs 100,000 13 FU -t Owner 2) incl.ducts b vents 7.50 Hcor Furnarice 3) incl.vent 6.00 • ---Sunondedheater.waJI heater 4) or floor mounted heater 6.00 vent not i in Occupant 5) appliance permit 3.00 Repair of ting,reng. 6) cooling,r,bsorpdon unit 6.00 boiler or comp,heat pump, air cond. !) to 3 HP;absorp unit to 100K BTU 6.00 8oiler or comp,heat pump,air cond. �, { 8) 3-15 lip;absorp unit to 500K BTU 11.00 Contractor .i er or comp,real Pump,air co 15 9) 15-30 HP;absorp unit.5.1 r••' BTU 15.00 r r tnas .Q „ sem+�9•�M^ � Boiler OY comp,heat p�.imp,au co t 1R 10) 30-50 HP;nbsorp unk 1.1.75 mil BTU 22.50 hereby acknowledge th-aTTFaive road triis app ice on, e— - Boilar or comp,heat pump, air cond. _ information given is correct,that I am the owner or author zed agent 11) >50 HP;absorp unit 1.75 mil BTU _ 37.50 of the owner, that plans submitted are in compliance with State r handing unit to laws, that 1 am registered with the Construction Contractor's 9oard, 12) 10,000 CFM 4.50 that the number given is corroct. (If exempt from State registration, — it an-a6ng-uni please give reason below.) 13) 10,000 CTM+ 7.50 Non portable 14) evaporate cooler 4.50 Vent tan connected 15) to a single duct 3.00 ern anon system not 16) included in appliance permit 4.50 -- Hood served V, I b I I� 17) mechanical exhaust 450 U.IsMbe woo new addition alteration repair i-) --70-mmercial or industrial to be done residential non-residential J 18) type incinerator 30 00 Existing use o , l I — ter i.e.,wo stove,water building or property Y� �-k� J u �X _ 19) heater, soiar, clothes dryers,etc. 4.50 M' N Proposed use ofOo���� f' 20) Gas piping one to four outlets -3 2.00 2 . 00 building or property P-� ►- 21) More than 4-per nutlet Type of fuel -oil Q natural gas LPG Q electric Q - -- 1n L!3 NOTICE U) Minimum Fee$25.00 SUBTOTAL J (o -j PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR S%SURCHARGE ) 2-E) IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME PLAN REVIEW 25%OF SUBTOTAL 2- AFTER AFTER WORK IS COMMENCED TOTAL 3- -2- ��� Special Condibons Date issued .S / ; ��� by r4r(5AlT --- -- CITY OF Ti RD BUILDING INSPECTION NOV 1E Inspection Line. G39-4175 Business Phone: 639-4171 Footing Rain Drain �over/_Se INFoundation Water Line Ceiling -Plumb. Post/Beam Mech. Shear/Sheath Framing -Mech. Plbg.Und/Fir/Slab Plbg.Top Out Insulation -Elect. Post/Bearn Struct. c . ou h-' Gyp. Bd. -Bldg. San. Sewer asyL�ine, _ ppr/Sdwlk Reins. Other: ^y► �J lk — _. Date: �� A.M. 4 P.M. Entry: Address: 3 /,0 (,. Tenant: Ste: MST: BUP: Con/Own: _ MEC: PLM: ELC: THE FOLLJWING CORRECTIONS ARE REQUIRED: ELR: do #441 �yE'E-ss4" T�"Si 6�vde� �Yrvpu/> Gv�fi M( C /Cl of-- G� 4qWeF/ �s'��.rUr/�h� LY '- 3 / iu '00 C.�rsy f ��'► Fri?�2� U�`. �p1�1t Sif/a�✓ �Ncr � J .-w 03 - W .J Inspector: _ 'T — Date: �3 _APPROVED DISAPPROVED/CALL FOR REINSR CF CO CITY OF TIGARD BUILDING INSPECTION NOTICE Inspection Line: G39-4175 Business Phone- 639-4171 I` Footing Rain Drain Cover/Service F Foundation Water Line Ceiling -Plum . Post/Beam Mech. Shear/Sheath Framing -Mech. Plbg.Und/Flr/Slab Plbg Top Out Insulation d � Post/Beam Struct. Mec Rough-in Gyp. Bd. -Bldg. San. Sewer Appr/Sdwlk �Reins. Other: — —rVl�h .� 1.C��—'� Date: 7 _ A.M. P.M, Entry:_ — Address: 1 Lt(O Y' � Tenant:f — _�. Ste: _ MST: BJP: _ Con/Own:_ MEC: /e U PLM: ELC: THE FOLLOWING CORRECTIONS ARE RE:OUII IED: ELR: Ye ctor: Date:PPROVED —DISAPPROVE D/CALL FOR REINSP. CF CO ELECTRICAL PERMIT CITY OF TIGARD FERMI #: ELC96-0319 COMMONITY DEVELOPMENT DEPARTMENT DATE ISSUED: 05/17/96 13125 SW i1all Blvd.Tigard,Oregon 97223.8199 ('03)839-4171 PARCEL.: 2s 1 10AD-Or3500 SITE ADDRLSS. . . : 14803 SW 106TH AVE SUBDIVISIOII. . . . : _ANG HILL NO. 2 LONING: R•- !2 BLOCK. . . . . . . . . . . I_OT. . . . . . . . . . . . : 77 Project Description : Installing twc branch cir,cLlits. IAL UNIT-.---- ----TEMP SRVC/FEEDERS----- -•-.---M I SCE I-LANEOUS----- 1000 SF OR LESS. . . . : 0 0 - 200 amp. . . . . . . : 0 PUMP/IFRIGATION. . . . : 0 EACH ADD' L 500SF. . . : 0 201 - 400 amp. . . . . . . : 0 SIGN/OUT LINE LTG. . : 0 I_IMI T'ED ENERGY. . . . . : 0 4.01 - 600 amp. . . . . . . : 0 SIGNAL/PANEL. . . . . . . : 0 MANF. HM/ SVC/FDR. . : 0 601.+amps-1000 volts. : 0 MINOR LABEL_ ( 10) . . . : 0 ---SERVICE/F•EEDER-___. ___.__...._1 RAIVCH CIRCUITS------ ---ADD' L ANSPECTIONS--- 0 200 amp. . . . . . : 0 W/SE:RVICE OR FEEDER: 0 PER INSPECTION. . . . . : 0 201 - 400 amp. . . . . . : 0 1st W/O SRVC OR FDR. : 1 PER HOUR. . . . . . . . . . . : 0 .401 - 600 camp. . . . . . : 0 EA ADD' L BRNCH CIRC: 1 IN PL.ANT. . . . . . . . . . . . 0 601 - 1000 amp. . . . . : 0 - -.__.__._._________...--1 'LAN REV IL_W SECTION— 1000+ amp/volt. . . . . : 0 ) =4 RES LIN17S. . . . . . . . : > 600 VOL [ NOMINAL. . : Reconnect only. . . . . : 0 SVC/FDR > = 225 AMP'S. . : CLASS AR&A/SPEC OCC. : Owner: __._._--_-_-. __._____.______._____._.__--------_--_.__--_______-• FEES ----------------- GI-E:N WHIT14ORE type amol_rnt by date r-ecpt 14803 SW 106TH AVE P'RMT $ 40. 00 CJS 4'5/17/96 96- '79576 5PCT $ 2. 00 CjS 05/17/96 96-279576 T I CARD OR 9721::14 Phone #: Contractor: AC ELECTRIC INC 42. 00 Ti,TAL 1.8520 SHENANDOWA DR REQUIRED INSPECTIONS ---.__...__. .. OREGON CITY OR 97045 Wall. Cover^ Elect" 1 Final Phone #: 503-L32--8656 Elect' 1 Service lie #. . : 55615 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other P',7. mittee Signator^e applicable laws. All work will be done in accordance with approved plans. This permit will empire if work is not started / within 180 days of issuance, or if work is suspended fo more than 180 days. I s s�r ed By OWNI.R INSTNLLATION The installation is being made on property I own which is not intended for sale, lease, or rent. OWNER' S S't GNATURE: __. ____..__._.__.__........ DW --._._.------------------CONTRACTOR INSTf+ ' ION ONLY-----____--_--.-_---__-__._-__. jIGNATURE OF SLrPR. ELIC' N: yin c. �", ;/��-�; y,.,,, � DATEo S - r 96 s LICENSE NO: Call for, inspection - 639-4175 117 213 95 111: 116 23`5117 6,94 7297 CI Y OF TIGARD 4b11111 0112 Community Development ELECTRICAL PERMIT APPLICATION 13125 SW Mall Blvd. Tigard, OR 97223 Planck/Rec. #� ,-�-7 q yF A ;k P`rine (503) 639 4171 Permit # _E1L 9K Gaalg FAX (503) 664-7297 Date Issued S -�7. CITY OF TIGA12D TDD No. (503) 684-27 72 Issued by _r ter rlirr,�/f -- Inspection (503) 639.4175 1. Job Address- Complete Fee Schedule Below: Narne of L)Pvelopment �� Number of Ins Ione oet P� permit allowed Address SarviJe included ^Ti1-�1-� —1'L--I -11�� 1�1 --- Itama Cast(ea) Sur" City/State2ip��Q - J� vl I L,C4 - 4n Rl"Idenlial• - wVi pE+r unit d 1000 W h or Itt" (110.00 NAITIe (Or name of t)ll$Iness EAdr ndA4lenel non ea II or portion ihereol t Commercial i] f�r•_sidenlial umMod F,,A gy FACh MArnrr d Ilom�or MnealAr _-- 2a. Contractor installation only: D -n-9 4ernr,or roo,%, r 4b.9ervimit or Feeders Elecbical Contractor InUggat+on,sherAlloh.or mincailon Address �— - aoo ampo qr lea. sen cc {y 201 a-pe 10 400/rr+nq No 00 —`------- � �I1r _ State ]rpl � 4O1 ampa 1e N00 Amry: _�_-.–' 912000 7 601 ampq In icon o,ope ('(lone N0. ? _41.cr_ _ - +<te000 7 - f?r.r 1000 amps or vohr. — Contraclor's Llrnenonnetl ard ense No. a4oco ___ 1�.. y ss0 ao Contractor's Board Reg No. Gl5 ------ de. Temporary 9wrvices or Feeders nipllnlion.AI'grAllnn Si1jnAtUrc Of Supr. rlec'n LA' Al L or rglorAllnn 4'1 2' 200 Amp- pyp15000 License No_ PhonA No, 23Q $ srC�l� 201 ampq to 400 amps '" -- f�9 ? ._ 401 pmpe to 6110_pp 2V. ForW Q-600 mnpll In 1000 Vol" v ner Inst,111et1o.r1s: it"W ALVVI Print (_tiwnP.l Name 4d. aranrh Circuits AddrnSs – P1ew.e4e1016on el e„englon Mf pnnel -- _ _ a)Th*too I—b_,Wh orndeM le ll+ (�Ity--- _ �_ Slate__ zip - PtOrhava o/wr.ra or Mdar n►o Phone No. Each bra.-ch r»eull fS.pQ bI TT,w(ole Inc hrarr_h d,cvhq wrrhnrn 7 he inctRllntlort is being melte on propr.•rly I own which IS rIlmhah or/NVICA hr rNdor PM, —• not Intended for Sale, lensC or rP.nt. _ $0500 3E; 7 FAr:I,hAAdinngl pr�nnh rylryli, _l. $ADO "►'-- l Owner's 9igndlturA ii 4e. Miscellaneous 3, Plan Review sectlorl (if required): (Service or faller net included) a I rqM p.m,p pr iniAAlinn rn,cla 1~t0 00 Each sign or oijorw Iighlh,g rlorse check appropriala 1114111 rind aular lea in seclion 5R 9,014 r'Tve(q)or s limned wwvy — - 4 M lura,r"gldanN:tl units III one tmictutaroll'"I 0arnllon elf gHor"lun 14000 I -- 7-ArvVe and staler 225 amps or more ti+nn,lalrla(tri) -- (loon By9tam near 1300 wllq nominal 41. Fneh adoltional Inypeelion over ClasriFed etaA or slnlCilltP canialning Aper-ial occu�flnry the ollowahla In any or Iha oboes As described In N.F C, Clinpter 5 r.r v14pM,n„ sas(ro Per hour US on SutAnil 2 sale of plans with oppiicalion whoa any of the above In Plant "5.00 !poly. Nei rogn'rod lot farnpotary consirnellon servlcaa S. Fees: H97 97ICE 5s. Fnnir total of Alxlva 1"qs _ 40.LO I",7UICh+1rg0(OS X Ivtal feeF) 'A PFnmirs 817GO F. vplD it wooly,OR t✓Ot anUCTION Subrolaf E AU rHonttED IS NOT r 0MMENCF0 INIT14IN Iso tnAYs, OR Ir 5h. EntAr 25%nr Ilne A for CONITRI If.110N On W(_)FiK. 113 91.19PENVFf on ARANDOWD Fon PIAn naNQw it required tSec.3) S - A PFrT1oD Or IRO DAYS AT ANY TIME APTFR wonK IS SubfoleJ s -- COMMENCED --- Dhaat Accounl M S _ Balance Due $