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12010 SW 119TH AVENUE ••S ADDRESS: � 01 0sw 11 04 J i:\records\mlcrolim\largets\lxdlding.doc w CITY OF TIGARD PLUMBING DEVELOPMENT SERVICES #.. . . PERMIT PERMIT . . . . . . , : F'I__M97-0 12',19 13125 SW Hall Blvd., Tigard,OR 97223 103)639-4171 DP"fE ISSLIFD: ih4/17/97 PARCEL_.: 19134CD-02900 S TE ADDRESS. . . : 12010 SW 119TH AVE SUED M S T ON. . . . : I_.ERON HE I GHTS 1\10. �, ZONING: R-4. 5 BLOCK. . . . . . . . . 1_..0T. . . . . . . . . . . . :59 JURISDICTION: TIG CLASS OF W.7RK. . :ALT GARBAGE DISPOSALS. : 0 MOBILE HOME SPgCES. : 0 TYPE OF USE. . . . :SF WASHING MACH. . . . . . : 0 BACKFLOW PREVNZRS. . : 1. OCCUPANCY GRP'. . : R3 1=1-OOR DRAINS. . . . . . : 0 TRAPS. . . . . . . . . . . . . . : 0 STORIES. . . . . . . . : 0 WATER HEATERS. . . . . : 0 CATCH BASINS. . . . . , . : 0 FIXTURES---------------- LAUNDRY TRAYS. . . . . : 0 SF RAIN DRAINS. . . . . : 0 S I NKS. . . . . . . . . . 0 URINALS. . . . . . . . . . . . 0 GREASE TRAPS. . . . . . . . 0 t.AVATORIES. . . . : 0 OTHER FIXTURES. . . . : N TUB/SHOWFRS. . . : 0 SEWF_.R LINE (ft ) . . . : 0 WATER CLOSETS. : 0 WhJER LINE (ft ) . . . - 0 DISHWASHERS. . . . : 0 RAIN DRAIN (ft ) . . . . 0 Remarks : INSTALLATION OF BACKFLOW PREVENTION DEVICE Owner --_ __ ___.__---•----------_..__-. FEES ------__-_—_-._-.- G1=0RGE BRIMHALI._ typr_ amnl_rnt by date r^pcpt 12010 SW 199TH PRMT $ 15. 00 DRA 04/17/97 97-•293448 TIGARD OR 97223 SPCT $ 0. 75 DRA 04/17/97 97-29344P Phone #: 590--8686 CantY"tiCt Or"--___---..__.__....----.-•--------__-___-...._.. F"NVTRnNMFNTAL- I..ANDSCAPING 14801. S GREENTREF=: DR, OREGON CITY OR 97045 _-.__-----_-----_----------------- Phone #: 65O-9539 $ 15. 75 TOTAL Req #. . 5042 ------ REOU I RED .NSPFCT I ONS - -----This persit is issued subject to the rtgulations contained in the RP/Backflow Prev Tigard Municipal Code, State of Ore. Specialty Codes and all other Final Inspection applicable laws. All work will be done in accordance with approved plans. This pvvit will expire if work is not started within 188 days of issnanre, or if work is suspended fqr sore than 18N days. CLf r r sr.re Py : J Call far inspection — 639-4175 (:��-Y OF TIGA.RD Plumbing Application Recd© 25 SW HAL! BLVD. Commercial and Residential Dale Recd 17-97 .1aRb, OR 97223 =ate oPE �.3) 639.-4,171 Cate to DST _ Print or Type Related SWR s Incomplete or illegible appti,:ations will not be accepted (:allea_� — i Name)t CeveloomentiProlect FIXTURE i (Individual) —QTy PRIG— E A'�jylT Job Sink - I 9 00 Lavatory i; -el Address Address �, Style _ 9Q0 � - (/�4 J ruo ar "UDI- a-m, :amto I— I 900 ��Ia�s jyrI to Q� Shower umv 9.00 - water �.,;oser V,t, r�e � , / I 9.00 II ��f�./� Clsnwa�,+er 9 00 Owner Mailing Addres •�� / Suite �-Garoaye Disposal I 9 00 Q __) _ I '/'Cashing Me,:nine I 9 00 I _�yiSlale -.a P One cl �-T'- _. / .,`� oor Drain I 000 ria ! 3' s 00 4- 9 ou Occupant Mailing Address Suite Nater Heateri r 00 Laundry Room rray 9.00 C ty S1ate Zi; Phone Urinal - 900 Name -- 1/ Clher Fix lures rSoecityl 9,00 9.00 Contractor bidding Address Suite 9 00 1P.or 10 ssuanceisiaie Zip Phone 9.00 JDFllctnt must 9.00 arovlae 3d c;;!gon�Cons).Ca t.Board Lrc a ExD Date _ 9.00 contractors r c , �l/- 9.� __-9,00 �' license Plumbing Lic,0 Exp.Date Sewer- 1 st 100' 00 00 nformau,n Sewer each additional 100' 2500 or COT �T 9usrness Tax or htetro t Cale4 —]at b. �� ��- I _I— t Water Service- +st tU0' 30.00 Name "rater Service-each liatim,mai Zoo' 25 00 Architect Storm d R,-,.n Dram• Ist loo' — ]0:00 Malin Address Srorm d Fain Drain-each additional 100' Or 9 I Suite 25.00 I Mobile Home Space I 25 00 ngineer CrtyrSlate CiD I Phone Commercial Baca F ow Prevention Device or Anti- 25 00 Pollution Device —� re,vorxNew _, Addition alteration Re--air C I �?sidentiat 3acx9cw evenhon_ence' S Qo C,f :one ResrCertiai J Nan-residential C any 'rap ;r:Vas:e'ict,annec*ea to 3=xture I 4 00 . 'anal descnotion of•xcrx Catch 3asm a 00 rnso of Existing=umorng —I OG— I Der/hr n s'rg use .f SDeci:•Ily Reduested Inspections 40.00 ,,c rg or oronerty L Der.hr Rain C in ,Ingle'at-,,"wedrrg I 30 ?0 CL :csea use of l Grease 'Car• I 9,.'0 �c rg or creeerty I ~ QU.`4TITY TCTAL re cu caoomg movirq x reDlac:ng any fixtures +es _ No I �^ x Iser:r s recurree r If ves see back of formic — I 'SUBTOTAL 1 p� ~e•eov ackncw,edge:ha: gave eaa;his appocation, :hat•he,nforriahcin /S w .er s correct :hat I am re owrer if authorized agent of•he owrer 3rii I 5:e SURCHARGE I 7 J -at=gar m submitted are - :cbllance vith Cregon Slate Laws. ;i hat a Of OwneriAgOati IfC PLAN REVIEW 25;e OF SUBTOTAL TOTAL 'orict a on am• phone h i ' 7� 'Alhrmum permit fee,s 525 - 5'6 surcharge except Reslaential Backflow Prevention Device, Nria',Is 515- 5'S surcharge Fasts olmano Loc&96 iLjE-A PLETE APPRO�'RIATE TO PROJECT; Fixtures to be capped, moved or replaced j Qty i Sink Lavatory Tub or Tub/Shower Combination j Shower Only Water Closet _ Dishwasher Garbage Disposal Washing Machine F Floor Drain 2" 7- 3" 3" 4' Water Heater _ Laundry Room Tray I _,,final Other Fixtures (Specify)- -- 1 ;OMMENTS REGARDING ABOVE: cc - --- — -- J W J CITY OF TICARD BUILDING INSPECTION NOTICE Inspection Line: 639-4175 Business Phone: 639-4171 Footing Rain Drain Cover/Service FINAL: Foundaticn Water Lire Ceiling lamb Post/Beam Mech. Shear/Sheath Framing -Meeh. Pibg.Und/l:lr/Slab Pibg. Top Out Insulation -Elect. Post/Beam Struct, Mech, Rough-in Gyp. Bd. -Bldg. San. Sewer Gas Line Appr/Sdwlk Reins. Other: Date: a' A.M. P.M.i_ Entry: Address: _�_�-O I U 9 Tenant: _C, Ste:_ ., MST. Con/Own: 5,37 MEC: — PLM.. ELC: THE FOLLOWING CORRECTIONS ARE REQUIRED ELR: r J W J Ins actor:"' Date: ROVED DISAPPROVED/CALL FOR REINSP. fAC FEB 13 '96 12:1NEIL I.YJPGN/RMDL P.1i1 DESIGNERS/i?EMODELERS 804 N. ALBERTA PORTLAND, OR (503)208-'7461 FA (MILE TRANSMITTAL SHEET TO: —r�1 Pipe � FROM: FAX #: L1 - -?-;� 91*) FAX #: (503)-288-7,164 COMPANY: O i7y OF 77CrlKD PHONE (503)-288-7461 JOB NAME:_ 601m1419 " PAGES (Including cover):_ DATE: SPECIAL INSTRUCTIONS:, � "��'''�� _— � -- — jy� tC � 3 (�sZy/ Ar / -IU S (,� , / (STH 6vt Of F- J w J I CITY OF TIGARD BUILDING INSPECTION NOTICE Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171 Inspection: Footing Susp. Ceiling Sprink. Rcugh-in Appr/Sdwlk Foundation Plbg. Undprslab 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 e�v Undertlr. Insul. Shear Wall Gyp. Bd. -Elect. Date Requested: < < G 1 Time: AM PM Address: Builder: Permit #:��> THE FOLLOWING CORRECTIONS ARE REQUIRED: 4a a Ln a7 t4J J In actor: Date: �-- FPROVED `DISAPPROVED —APPROVED SUBJECT TO ABOVE Call For Reinsp. CITY OF TIGARD BUILDING t PE T�-IOTICE Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171 Inspection: Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwlk Foundation Plbg. Underslab ech. Rough i / Fireplace Post/Beam Struct. Plbg. Top Out Elec. Rough-in FINAL: Post/Beam Mech. San. Sewer Gas Line -Bldg. Plthg. Underfloor Rain Drain r-raming lumb, Alarm Water Line Insulation Underflr. Insul. Shear Wall Gyp. Bd. -Elect. Date Requested: �' ? Ti>>me:4AM PM Address: / �� C� 1 C� `I t `1 /7C.i. Builder: Permit rHE FOLLOWING CORRECTIONS ARE REQUIRED: r77C r cr c �.Q 2 X, Inspector: _APPROVED ISAPPROVED APPROVED SUBJECT TO ABOVE �� [Call For Reinsp. July 7, 1994 CITY OF TIGAD McCall Heating Company OREGON 1650 NE Lombard Portland, OR 97211 12010 SW 119TH AVE, MECHANICAL PERMIT #MEC93-0241 On 9/14/93 we issued a permit for this project, however, we have no record of any inspection being completed. f Permits become void if there has not been an inspection performed or over 180 days. In that case, the Building Division may require a new application and fees to commence or continue work. A notice of non-compliance against the property may also be recorded by the City. Please advise the Buildilig .Division within 15 days from the date of this letter as to the status of this project. I Notice.b n _J a U J 43125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 TDD (.503) 684-2772 -J J INSPECTION NOTICE City of Tigard Brilding Depart3ment 13125 SW Ball Blvd. Tigard, Oregon 97223 Inspection Lt. * (Rec-O-Phone): 639-4175 Busineann Phone: 639-4171 Inspection: Footing Plbg. Unde,.slab Hoch. Rough-in Appr/Sdwlk Found. b�. Top Out Gas Line FINAL: Post/Bnam Strvct. San. ewe Framing -Bldg. Post/Beam Mech. Rain Drain Insulation -Plumb. Plhg. Underfloor Nater Line Gyp. Rd. -Meeh. �-��- —2L—AX _ Date Regvesteds / /Ti�met`"� PN P6rmiE I: el Builders. -i.� THE FOLLOWING CORRECTIONS ARE REQUIRED: CL .-r D: N J rr L7 W J Inepec AtIMOVrO DISAPPROVED APPROVED SUBJECT TO ABOVE ✓✓✓✓�������" Call For. Reinep. CITY 4F TIGARD COMMUNITY DEVELOPMENT DEPARTMENT 131'25 SW Hall Blvd.Tigard,Oregon 97223.8199 (503)839-4171 PLUMBING PERMIT PERMIT #. . . . . . . : PLM94 -0043 639-4171. DATE ISSUED: 0.3/18/94 PARCEL: 1S134CD-02900 SITE ADDRESS, . . : ; 010 SW 119TH AJE SUBDIVISION. . . . : LE RON HEIGHTS NO. 3 ZONING. R-4. 5 BLOCF . . . . . . . . . . : LOT. . . . . . . . . . . . . .59 CLASS OF WORK. . :AI—'T GARBAGE DISPOSALS. . : 1 MOBILE HOME SPACE=S. TYPE OF USE, . . . :SF WASHING MACH. . . . . . . : BACKFLOW PRE_VNTRS. . : OCCUPANCY GFRP. . :R.3 FLOOR DRAINS. . . . . . . . TRAPS. . . . . . . . . . . . . . . .STORIES. . . . . . . . : 1 WATER HEATERS. . . . . . : CATCH BASINS. . . , . . . . FIXTURES----- -------_ LAUNDRY TRAYS. . . . . . : SF RAIN DRAINS. . . . . SINKS. . . . . . . . . . : 1 URINALS. . . . . . . . . . . . . GREASE TRAP'S. . . . . . . . LAVATORIL�3. . . . . : OTHER FIXTURE=S. , . . . : TUB/SHOWS•2S. . . . : SEWER LINE (ft ) . . . . : WATER CLOSETS. . : WATER LINE: (ft ) . . . . : DISHWASHERS. . . . : 1 RAIN DRAIN ( ft ) . . . . : Remarks : Owner: —___.________.__. ____._._____.___.___________---__._____--_...__ FEES ---_---_.____. GEORGE BRIMHALL type amoi_rnt by date recpt 12010 SW 199TH PRMT $ 25. 00 JG 03/18/94 — 5F'CT $ 1. 25 JG 0:3/18/94 TIGARD OR 9722-1- Phone #: Contractor: --------------------_.—__---__. OREGON CITY PLMNG & HTNG 611 7TH STREET ORE(30N CITY OR 97045 Phone #: 656--8550 $ 26. 25 TOTAL Reg #. . : 02132 REQUIRED INSPECTIONS _ This permit is issued subject to the regulations contained in the Top•—ol.rt Insp Tigard Municipal Code, State of Ore. Specialty Codes and all other Final Inspection applicable laws. All work will be done in accordance with approved plans. This periit will expire if work is not started within 180 days of issuance, or if work is suspended for more a thar 168 days. I— �— 1 e r m i t t e n S i g n a t r.r r e t I _Ied Hy —� L Call for inspection — 639-4175 (AtY OF NVU,"[PI OF P0YI'WNl RF'CV .(P1 ND. 4--k 115 0 P 0 0 C.111L(:'K (11TIC)UH1 x 3i?.':0 ORF-MON C.T. TY P I.-(Jill Ef T NC.4 CASH 01101JISIT a 0. 00 SS 61.1 7 11.1 41 k I`F:'T P A Y ill EN 1 1)F•11 F: s 03/18/94 (MV.00bi CfTY, OR 4,*-, �IURPOSF OF PI)YIIIFN'i III(1t 114 1 P N't 1) PURPOSIP OF PAYMENT III U U N I P A.1 1) 0— ....................... ........ ILLIMPTNO PFAM (75. Wo PIAN CHV'CK I F Ce PFR t. 25 LAJ Id I I I., 114 '07AL AMOUNT PAIP 3( P. 50 CITY OF TIGARD PLUMBING PERMIT 13125 SW HALL BLVD. Applicants must hoW Oreguu Registration to c_oiAwi a plumbing TIGARD, OR 97223' `O business a must be property owner/operator not hiring outside help. -" Nm w of Deveioprrhent --- " (503)639-4175 y/7/ `> Z rJqPlumbing Permit No. O - _1 Description \ \ SVAV17 ORS 814-21-010 DUAN. PRICE AMT. Job Tax l.,oi � --'---�. Addnear _ FIXTURES _ Lot Block Sunni Mlon Srnk --� - 7.50 Na"(or namemess _ - -- Lavatory - -- - 7.50 Q`r r "\ Tub or Tub/Shower Comb. 7.50 Majitog Address -- ------ Shower Only Owner CRY/Slate ZIP Dishwasher --_ - - -7.50 Dishwasher _ 7.50 1 Phony Garbage Disposal �- �- 7.30 Name 11 Washing Madune 7.50 Floor Drain rr— _ 7.50 _ «. LFailo'ng Address Phone Water Heater 7.50 Occupant _ Laundry Roan Tray - - 7.50- P City/State Zip _Urinal 7.50 Name Other Futures(Specify) -_ -- 7.50 OREGON CITY PLUMBING 9 HEM CO. -- — 7.57 Address it 7111 sheat Phone Oregon City, Oregon 97045 -- -- 7.50-- CCn ontractor y/State Phone 656.855 Zip — — 750 Z (*I -V"O N MISCELLANEOUS City Bus. Tax No. Sewer 1 st 100' 3000 Deb a Sewer-ea.Addit.100' 15.00 (Residential) Water Service 1 st 100' - PA.00 I tweby w*nowtedge that 1 have read Ji-r"Alcatbn.that is kilor""000 Water Service ea.Addil h 15.00 given is con ed,that 1 am registered with the State Builders Board.and also Stone 8 Bain Drain 1 at.100' 30.00 have a Stale PkxnbkV kcense that the numbers♦;/Even are correct.that all Phrmbing wok will be done in arxordance with applicable provisions d Ore- Stam b Ptin Drain Addit.100* 15.00 - gon Revised Statutes C,WAws 417 and 693 and rghplladhb cedes and that Mobile Horne SPS 25.00 no help will be employed unless Nowteed under ORS 603 (11 exempt frcxn - - - —___ _- Stale registration.please give reason below). Baru Flow Prevention HOMEOWNERS-I hereby certify that I am the owner of the property de- Or-4ce or Anti-Pollution Device 7.50 acnbed above.at which location 1 propose to nuke a pkxnbinp Installation for Any Trap or W aslu Not my Awn roe ruxl th+h proPaty M not hftk`0 r nn-tn~for Salo.leave a reel ConnecW b S Fixture _ 7.50 - -- Cahri Basin 7.50 —---- ---- -- k".of Exist.Pkrnbinq 40.00 Per Hr. ---- -- ----- Spedsoy Requited inspections 10.00 Par Hr. -- - - -- - Rain Drain, 15.00 Single ram. Dwlg. _ AUTHORIZED SIO Tt/� ` Date _ -- � ��VCCC A Ueerc"ribe work new❑ addition(] alterstiotso repair F1 tip be clone reskterltie a� rlon-reeklential f xtsfkhp use of MINT.HUM PERMIT FEE 25.00 - txrtMV or prof—Ty -- -- _. - SUB-TOTAL INwoaed uaa of 5% SURCHARGE Ll I-*JkvorPoop"--- --- - - 25% PLAN REVIEW wrrlcf TOTAL Z. Thispen, b000m"nrtl aril vola 11 vwxk o ooneuuc do n authodied r nal com mSnaW nMtdn ISO d"xw it oendrvc lion or work is s spwwfed or abandoned kx a Pe.kuf rhl 180 days rd any en o~wgrh is oonwr4nood ttrMClAI-O0#M10N3 _ ------ -. 1 nate k1,cre•1 by .a+-+- CITY OF TIGARD11.;rlralvPERMIT COMMUNITY DEVELOPMENT DEPARTMENT P ER M I T . . . . . . . .. 13125 SW Hall Blvd.Tigard,Oregon 9722398199 (603)630-4171 DATE ISSUED- 09/ 14-/'33' PARCEL. 1S134GD-029&' SITE ADU'REGS. I'n,ijile SIA 119TH OVE ZONING: R-4. '---- SUBDIVISION. . . . : LERON HEIGHTS NO. 3 LO-1 . . . . . . . . . . . . . . OF WORK. FI-OOR FURN. . . . EVAP LOOLERIL): I YT`E' OF. USG. . . UNIT HEPTERS. . VENT FANS— : OCCUr2r)NCY ORP. . R3 VENTIS W/o APPI. YF-.'Nl' 5YS'1'*EMS- STQRJLG . . . . . . . . I 1301LERS/COMPRESSORS HOODS. . . . . . . : I FUEL 1 O 'L.:3•..... . . ..._... 0-3 HP. . . . : 1 DOMES. 1NCIN: O1L/E`LE/ 3-15 HP. . . . -. COMML. INCIN: : MAX INPUT: LATU 15-30 HP. - - - : REPAIR UNITS FIRE DAMPER67. - - 30-50 FIP- - - WOODSTUVES. . . - GA G P R L S 1L U R 5141-t. HI... . . CI-0 DRYERS. - NO. OF AIR HANDLING UNITS OTHER UNITS. FURN 4 100K UTL,- < 10000 cfm : GAS, OUTLE TS. FURN > =100K BT-U- 1 > 10000 cfm : REPLOGE WL FURNACE & ADD PIR CWID17IONER. Owner: FEES type amol.knt by date recp. I.L.010 SW 199141 PRMT $ 25. 00 JH 09/14/93 PL(-K $ Ei. 25 JH 09/14/0..3 I I G f 4 R D R `1 7 L, 5PC1' $ 1. 29 J11 09/ 14/9.3 Phone Cant _a Or: HV.AT'NC comtv,niy W50 N. E. LOMBARD PORTLOND OR WE'll If.)TAL REQUIr�Llj INSPECTIONO) porpit is issued subject to the regvlatiors contained in the Mechanical 1115P b;"c; Municipal Code, State of (h,e. Specialty Codes and all other F=ine +I Inspection ,clicatie laws. Ali work will be dait in accordance with projer plans, This pere.it will ex;ij-p if work is not started t,hir. jjq days of issuarcp or if work is suspended for ray ar lee days. un d T?v t Call f*L)I'-' itIS;ppi.tion 639--4175 c'o' CITY OF TIGARD -- RECL— T OF PAYMENT RECEIPT NO. s 93—,?441 7 1 CHECK AMOUNT s 32. 50 NAME a MCCALL. HEATING CO CASH AMOUNT s 0. 00 ADDRESS v 1650 NE LOMBARD PAYMENT DATE s 09/14/93 SUBDIVISION PORTLAND, OR 97211— PURPOSE OV PAYMENT AMOUNT PAID PURPOSE OF PAYMENT AMOUNT PAID E 25. 00 PLAN CHECK FE: E. 25 s,r. BUILD PER 1. cS 1,;-VIO f-3W 119TH PIE.CHAN I CAL PFRMTT 01, 1.- AMOUNT PA I D City of Tigard MECHANICAL PERMIT PlancWRec. # — _ 13125 sw Hall Blvd. APPLICATION! Permit # Tigard, OR 97223 (503) 639-4171 _ ^� "•"^�^M escriptron Table 3A Mechanical Code QTY PRICE AMT Job 12 010 SW 119th 1) Permit Fee -0- -0- 10.00 Address — '- Tigard, Or 97223 2) Supplemental Permit 3.00 umace to MUM UTIT— George Br imha l l 1) incl.ducts a vents 6.00 '''a A,"-. Furnace 100,000 + Owner 12010 SW 119th 590-8686 2) incl.ducts a vents, 1 7.50 7.50 oor umanoo - Tigard, Or 97223 3) incl.vent 6.00 '^ Suspe at(r,wa'',;.its; Sdille 4) or floor mounted heater 6.u0 en/r (not mrd,.in- - Occupant 5) appliance permit 3.00 - zw Repair of heatinp,rerig. 6) cooling,absorption unit 6.00 — -- — !es,or comp,1oat pump,air co . McColl Heating Co 7) to 3 HP absorp trod to 100K BTU 6.00 "n A.*— Boder or comp, !eat pump,air cond 1650 NE Lombard 231-333 00 8) 3-15 HP absorp unit to 5K BTU 11.00 Contractor ,.,. of er of caneat p, pump,air co �i Portland, Or 97211 s) 15-30 HPabsorliunit.5.1 mil BTU 15.00 15 s'u ••'°""° "i�Y" Boiler or comp, wat pump,air cond- 00140 3408 10) 305011P absoga unit 1-1.75 mil BTU 2250 hereby ac now ge that I have read this application,thatthe -- i err or comp,(heat pump,air cond. information given is correct,that I am the owner or audiodzed agent 11) >50 HP absorp unit 1.75 mil BTU 31.50 of the owner,that plans submitted are in compliance with State Air,an� w laws,that I am registered with the Construction Contractor's Gard, 12) 10,000 CFM 1 4.50 4 .50 that the number given is correct. (It exempt from State registration, ran ing unrt please give reason below.) 13) 10,000 CTM 4 7.50 _ --- Nin portal 14) evaporate cooler 4.50 ant-V—Voc«incx 6T --- 15) to a single duct 3.00 anti aeon system not 16) included in appliance permit 4.50 17) mechanical exluiust 4.50 Deldibe work n addition alteration repair Comma or uvdjstil to be done residential a non-residential Q 18) type incinerator 30.00 1seng use o lit / Other re., -love, building or property d-`.,!�ip/Jl' c' 19) heater,solar, -ithes dr)(ers,etc. 4.50 a Proposed use of 20) Gas piping one,o four cutlets 2.00 building or property. N `-� 21) More than 4-per outlet Typo of lunl -oil� natural gas Q LPG Q elect r NOTICE -- Minimum Fee$25.00 SUBTOTAL 25.00 PERMITS BECOME VOID IF WORK OR CONSTRUCT10N W AUTHORIZED IS NOT COMMENCED WITHIN 100 DAYS,OR 5%SURCHARGE 1.25 J IF CONSTRUCTION On WORK IS SUSPENDED OR — ABANDONED FOR A PERIOD OF 180 DAYS A T ANYTIME PLAN REVIEW 259 OF SUBTOTAL 6.251 AFTER WORK IS COMMENCED. . ""(, -( o t TOTAL 32.50 Special Contfitionsyvi L T(,-r 40-,e U'f �_�. -------- NPm L %�(I pjittl '. �Ty �/(T_ l`O Date issued by - — -- -