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12440 SW 128TH AVENUE 12.440 SW -1 NO' Avenue i-- 09LVA CITY OF TIGiARD 24-Hour BUILDING Inspection Line: (503) 639-4175 --_- __ NIST _ 1'ISPECTION DIVISION Business Lino.- (503) 639-4171 ;> _ 7) BUP - --_- 7l Receive;a Date Requested v �— AM PM BUP Location _f Z L/ L/L _Suit�e u _ MEC Contact Person Ph :2)? ----_-�-- ---___--- n.+o'--' .--) :ui ? L 42 PLM ----- ---- -- ( Contr.,•,tor___-. -_ Ph(_ ) —.____— _ SWR BUILDING Tenant/Owner �� -- ELC - Footing ELC _ _ --- Foundation ACL9SS. ELR Ftg Drain - Crawl Drain - SIT Slab inspection Notes: - Post&Beam - - - Shear Anchors Ext Sheath/Shear -- -- Int Sheath/Shear — Framing — -- --- - l.sulation Drywall Nailing Firewall _ Fire Sprinkler Fire Alarm _ - Susp'd Ceiling Roof Other. --_- - 1nef - — - — SS PART FAIL BIND_ -- -- — Post&Beam ^- Under Slab - --- Rough-In Water Service —_. - - ---- -- ----- ------ - Sanitary Sewer _-- Rain Drains -------- _ Catch Basin/Manhole Storm Drain - - - - Shower Pan —_ Other:..-._--- -- - - F,nal _PASS PART FAIL MECHANICAL _ -_ ---- - --------- - - Post& Beam Rough-In - - Gas Line Smoke Dampers - Final _LEPA_SS PART FAIL - ECTRICAL Service Rough-In _ --- - -- UG/Slab Low Voltage --- Fire Alarm Final U Reinspectlon fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd _PASS PART FAIL. SITE —_— [� Please call fur reinspection PE: Unable to inspect-no access Fire Supply Line ADA - Ext Approach/Sidewalk Inapecftor - Other: Final DO NOT REMOVE this Inspection record from the Job sate. PASS PART FAIL CITY OF T�IGAR® - BUILDING PERMIT PERMIT#: BUP2002-00413 DEVELOPMENT SERVICES DATE= ISSUED: 9/19/02 13125 SW Hall Blvd.,Tigard. OR 97223 (503) 639-4171 PARCEL: 2S104AA-13300 SITE ADDRESS: 12440 SW 128TH AVE SUBDIVISION: BELLWOOD NO 3 ZONING: R-4.5 BLOCK: LOT: 152 JURISDICTION: TIG I REISSUE: _ FLOOR AREAS _ _ EXTERIOR WALL CONSTRUCTION__ CLASS OF WORK: ALT FIRST: sf N_ S: E: W: TYPE: OF USE: SF SECOND: sf _ _PROJECT OPENINGS? `— TYPE OF CONST: sf N: S: E: W: OCCUPANCY GRP: R3 TOTAL AREA: 0.00 sf ROOF CONST: FIRE RET? OCCUPANCY LOAD: BASEMENT: sf AREA SEP. RATED: GARAGE: sf OCCU SEP. RATED: STOR: HT: ft BSMT?: MEZZ?: REQD SETBACKS — REQUIRED FLOOR LOAD: psf LEFT: ft RGHT: ft FIR SPKL: SMOK DET: DWELLING UNITS: FP.NT: ft REAR: ft FIR ALRM : HNDICP ACC: BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING: VALUE:.ODPL' Remarks: Extending fire wall to attic. Owner: Contractor: COLLINS, J CAROL LIMITED EDITION 12440 SW 128TH AVE 17429 SW RIVERDELL TIGARD, OR 97223 DURHAM, OR 97224 Phone: Phone: 503-784-1882 Reg #: LIC 138890 FEES REQUIRED INSPECTIONS Type By Date Amount Receipt _ Framing Insp PRMT CTR 9/19/02 $72.10 27200200000 Final Inspection 51-CT CTR 9/19/02 $5.77 27200200000 Total $77.87 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or If work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow the rulus adopted by the Oregon JAllity Notification Center. Those rules are set forth In OAR 952-001-0010 through OAR 952-001-1987. You may o In a copy of these rules or direct questions to OUNC by calling (503)246.68 permittee Signature: Issued By: Z1 14 f. — Call 639-4175 by 7 p.m. for an inspection the next business day Building Permit Application City of Tigard �r Late received: � d"r Permit no.: Address: 13125 SW Hall BINd,Tigard,OR 47223 Project/appl.no.: Expire date: City u/l igard Phone: (503) 639-4171 Date issued; By: Receipt no.: Fax: (503) 598-1960 Case file no,: Payment type: Land use approval: 1&2 family:Simple Complex: U I &2 family dwelling or accessory U Commercial/industrial U Multi Gundy U New construction U Demolition U Addition/alteration/replacement U Tenant improvement U Fire sprinkler/alarm U Other: IN FOftATION Job address: FBldg.no.: Suite no.: Lot: Blork: Su ivision: I Tax map/tax lot/account no.: Project name; T — Description and location of work on premises/special conditions: 011 N1,11 FOR SPiCIAL t Name; JWMIPFAM _ . dplaKsep�i capachr,solar,etc.) Mailing address: ' I K 2 f^nil} dncllirtg: City: Stntc IP: - Vrt r work........................................ $-� �� Phone: rax: E-mail: Nu toms/baths................................ Owner's representative: _ Total nu,nher of floors................................. Phone: rax: E-mail: New dwelling area(sq.ft.) .......................... Garage/carport area(sq.ft.)......................... Name: Covered parch area(sq.ft.) ....................•.... Mailing address Deck area(sq.ft.) .......................•.............•.. City: State: ZIP: Other structure area(sq, ft.) — Phone. I , E-mail Commercial/industrlallmulti fr+milys t . Valuation of work....................................... $— — Business name: p� Existing bldg.area(sq.ft.) ..................•....... _Address: 6 v New bldg.area(sq.ft.)................................ City: at ZIP Number of stories........................................ -- ---- Phone: ' ax: L-rnail: Type of construction.................................... CCB n .: �' Occupancy group(s): Existing: New: City/metro lie. o.. ? -b Notice:All contractors and subcontractors are required to be r licensed with the Oregon Construction Contractors Board under Name: provisions of ORS 701 and may he required to be licensed in the Addrt s: jurisdiction where work is being performed. If the applicant is State: ZIP: exempt from licensing,the following reason applies: Contb^t person: Plan no.: -- - --- - Phone: Fax I F.-mail: - - -- -- Name: Contact person: Nees due upon application ........................... S Address: Dote received: _ Cil): state: ZIP; Amount received ......................................... $— Phone: 71--ax: I E-mail: 1 Please refer to fee schedule. I hereby certify I have read and examined this application and the NM all jurisdictions occepi creat cords,pleme call jmhdictaon rnr mos ini'mmation attached checklist, All pmxisjons a jaws and ordinances governing this U visa U MasterCard work will be complied w h'- he r, c i re�tt or not / Credit cord number --- - --- -- / / Expires Authorized sig re: Name-0Trnrdhulder u drown nn etedii cord Print name: -'Q��r�r �� Cudholdet dnature S Amount Notice:This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 4Q)1I i I uxxvMM) ')-. l C> One- and Two-Family Dwelling Building Permit Application Check list Refe rence no.: --- — Associated permits: City of Tigard city of regard ❑Electrical O Plumbing ❑Mechanical Address: 13125 SW Hall Blvd,Tigard,OR 9 711 ❑Other: Phone: (503) 639-4171 Fax: (503) 598-1960 1 1 1 ryr � I Land use actions completed.See jurisdiction criteria for concurrent reviews. 2 Zoning.Flood plain,solar balance points,seismic soils designation,historic district,etc. - 3 Verification of approved platllot. 4 Fire district __approval required. - 5 Septic system permit or authorization for remodel.Existing system capacity 6 Sewer permit. 7 Water district approval. 8 Soils report. Must carry original applicable stamp and signature on file or with application. 9 Erosion control ❑plan ❑permit required.Include drainage-way protection,silt fence design and location of catch-hasin protection,etc. _ I() 3 Complete sets of legible plans.Must be drawn to scale,showing conformance to applicable local and state building codes. Lateral design details and connections must be incorporated into the plans or on a separate full-size sheet attached to the plana with cross references between plan location and details.Plan review cannot be completed if copyright violations exist. I 1 Site/plot plan drawn to scale.The plan must show lot and building setback dimensions;property comer elevations(if there is morti than a 441.elevation differential,plan must show contour lines at 2 .intervals);location of easements and driveway;footprint of structure(including decks);location of wells/septic sysa ,utility locations;direction indicator;lot area;building coverage area;percentage of coverage;impervious arca;existing uctures on site;and surface drainage. 12 Foundation plan.Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent size and location. 13 Floor plans.Show all dimensions,room identification,window size,location of smoke detectors,water heater, furnace,ventilation fans,plumbing fixtures,balconies and decks 30 inches above grade,etc. 14 Cross section(s)and details.Show all framing-mcml>Lr sizes and spacing sr�h as floor beams,headers,joists,sub-floor, wall al.nstruction,roof construction.More than one cross section may be required to clearly portray construction.Show details of all wall and roof sheathing,roofing,roof slope,ceiling height,siding material,footings and foundation,stairs, fireplace construction, thermal insulation,etc. 1 Elevation views.Provide elevations for new construction;minimum of t'.vo elevations for additions and remodels. Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope. full-size sheet addendums showing foundation elevations with cross references are acceptable. In Wall bracing(prescriptive path)and/or lateral analysis plans.Must indicate details and locations;for _ non-prescriptive path analysis provide specifications and calculttions to engineering standards. 17 Floor/roof framing.Provide plans for till floors/root'assemblic,l,indicating member sizing,spacing,and bearing locations.Show attic ventilation. I8 Basement and retaining walls.Provide cross sections and details showing placement of rebar. For engineered systems,sec item 22,"Engineer's calculations." _ 1t Beam calculations.Provide two sets of calculation.:using current code design values for all beams and multiple joists over 10 feet long and/or any hcam/joist carrying a non-uniform load 20 Manufactured floor/roof truss design details. 21 Energy Code compliance.Identify the prescriptive path or provide calculations. A gas-piping schematic is required for four or more appliances. 22 Er;ineer's calculations.When required or provided,(i.e.,shear wall, roof tntesl Nhv)tl he stamped by an engineer or arclutcct licensers in Oregon and shall be shown to be applicable to 11 r „i. .1 til i1 1 -tew. JURISDICTIONALSPECIFI(S 23 Five(5)site plans are required for Item 1 I above. Site plans must he 8-1/2" x 11"ur I I"x I 24 Two(2) .lets each are required for Items 16, 19,20&22 above, 25 Building plans shall not contain red lines or tape-ons. "Mirrored"building plans will be not accepted. 26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. 27 "Drawn to scale"indicates standard architect or engineer scale. 28 Site plan to include tree!lite,type&location per approved proje'c't street tree plan(if applicable),and COT Street Tree I,ISI. Checklist must he completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black ink. Red ink is reserved for department use only. 440 4614 MAKWoM) CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)639-4175 INSPECTION MVISION Business Line: (503)639-4171 MST . BUP a Received _ Date Requbsted ( 1-:7 AM—__ PN BUP Location - '-4r) o� �`�'-' Suite-- MEC Contact Person Ph( -) PLM - Contractor Ph( ) > a q -3(,3 r SWR - BUIL^ING Tenant/Owner - ELC 4 U- Footing Foundation Access: ELC — Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post&Beam Shear Anchors - — Ext Sheath/Shear Int Sheath/Shear Framing — Insulation Drywall Nailing — --- — -- Firewall Fire Sprinkler — — -- -- — Fire Alarm Susp'd Ceiling — -- Roof Other. Final PASS PART FAIL ----- ------ --- - PLUMBING Post& Beam ---- ---------._� ._ .— _ Under Slab — ---- —._..----- ----- ---. Rough-In Water Service -------- — _� Sanitary Sewer Rain Drains —--- — -- --- —• — Catch Basin/Manhole Storm Drain — ---- --- Shower Pan Other: ------- ---- — Final ----------_ PASS PART FAIL MECHANICA_ L Post& Beam — ---- ---- ---- Rough-In Gas Line Smoke Dampers -------------._ _ — — —_-- -- rinal PASS_PART FAIL — ---- — ---- -- ELECTRICAL Service Rough-In 11(3/Slab 1 .w Voltage -- Fire Alarm �— a1:1Reinspection fee of$_ _ required before next inspection. Pay at City Hall. 13125 SW Hall Blvd. PAR_T FAIL SITS_ ❑ Please call for reinspection RE: �1 Unable to inspect—no access Fire Supply Line ADA Approach/Sidewalk Dawte �2_. Inspector- -- —L7 -� }- --- -- Other: Final - 00 NOT REMOVE this Inspection record from the job site. PASS PART FAIL CITYOF TI GA R D MECHANICAL PERMIT DEVELOPMENT SERVICES PERMIT#: MEC2002-00408 13125 :,W Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 9/13/02 SITE ADDRESS: 12.440 SW 128TH AVE FIARCEL: 23104AA-13300 SUBDIVISION: BELLWOOD NO. 3 ZONING: R-4.5 BLOCK LOT: 152 JURISDICTION: TIG CLASS OF WORK: ALT FLOOR FURN: — EVAP COOLERS: TYPE OF USE: SF UNIT HEATERS: VENT FANS: OCCUPANCY GRP: R3 VENTS WiO APPL: VENT SYSTEMS: 1 STORIES: _ BOILERS/COMPRESSORS HOODS: FUEL TYPES 0 - 3 HP. DOMES. INCIN: I F'C3 - 15 HP: MAX INPUT: BTU 15 -30 HP: COMML. INCIN: FIRE DAMPERS?: 30 - 50 HP: REPAIR UNITS: GAS PRESSURE. 50 + HP: WOODSTOVES: FURN < 100K BTU. _ _AIR HANDLING UNITS CLO DRYERS: FURN >=100K BTU: <= 1000G cfm: OTHER UNITS: > 10000 cfm: GAS OUTLETS: I Remarks: Gas piping and vent for Water Heater. Owner: FEES COLLINS, J CAROL Type By Date _ Amount Receipt 12440 SW 128TH AVE TIGARD, OR 97223 PRMT CTR 9/13/02 $72.50 2720020000 5PCT CTR 9/13/02 $5.80 2720020000 Phone: Total $78.30 Contractor: HONKE HEATING+ A/C 840 NE CLEVELAND AVE GRESHAM, OR 97030 REQUIRED INSPECTIONS _ Gas Line Insp Phone:666-3725 Mechanical Insp Reg#:LIC 71762 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other applicable laws. All work will be done. in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-Ont-0080. You may obtain copies of these rules or direct questions to OUNC by calling (503)246-9189. Issue By: �� ,' ,� i� � Permittee Signature: Call (503) 639-4175 by 7:00 P.M. for inspections needed the next business day r 4 09/11/2002 08:48 5036660589 HONKS HEATING PAGE 02/02 0 36 FAX 5039981060 CITY OF TTGARD 149003/00 t. pPCF Mi t n U.DameTromved: C City of Tigard 1ro t/appl.no.; Expiredale: 125 SW Nail blvd,T! a OR 97223 J)are.tsweA By: A�dmss; - Plume: (503) 619 4111 fMOM - - Fax:(50)598 1�4) 13 02 C��flk 0.:- PAYMMIM: i:2 no P -00_ _0 RmIdIrij permit no,: VoZ Land twe approvill. U Multi-family Q Tenant improvement7,iWdiN dw011ifig or aVAW)rY 13 Other. U Indicate equipment quantities in boxes helaw.Indicate care the the dol value of all mechanical materials,equipmaut,labor,uverhe4 I.Sulte no.: profit.Valuc$ 64,oc checklist fOf important application information and =qck- Subdivision: on'%ffr schedule for iesidential permit fee, tM Its 0 01106114 11 771F ind location of work on pr Ses: Fm(Z"Ll Desi era Res,oW Ra, AKF_ handling unit —.—,CFM -!t,e-;%hng space heated OF conditu"o C1 Yes sen efilFonq( tepwftqu, 9 tin irmnlatrA?U Yes Q No rM Stair,LoUlIP3 JW7 Mit nP.; INTUM 1le)ll) Ae e- H 7 _)0 RP —Tons _k d etectats uct "es(Iturnp(site 1pw Mq Alz J; ftx: -mail: nc w jin#dillAworklVout liner Cl y"0 NU __21 7 62;2 wall,of floor ni(xinted vats ft'll 11wwCUttK%tnwfU1n8(-C low 11TUM Chillm. pi ea taut and Tows a: C: A"liftAcievent Talc )a tnad. Hood&,1)�W V I jJW_.kMchr.&hazM_1lr__ %Wj)TV.3Slt"3"YWA. h stp,le Aunt(hath Can FiNviat fan with limust gVetap Rpsil fRn[I 110AUl !-r eA) ---Q,2wr1Sqw i _q: J a IV 40,0 w a r!V74 liutlels) 7 -4)e b T IX;—A- w ()It / -5.11( 1 16 tonal-ovel 4 tMdats 7AY/4, a 3 1 -MITll --TF, proem pildivr Nomhef of oinlris .1 jA T7 _hit-- r DftkW24vefireplaun Stdr. I ZTP. Inu,-"- type W et si—mm Paz It - - _,"00 pem%k fee..................S tia Z*�Oman,CA rat som kdwnmbm n "ViTAtku Notim.This pern2ft oppil-fint, Nunlinum _V?xsbrzwdrrltcw(21 ImpitrA Ira pri-ink i*will(rlhIjqitw,1 ful --I ,� - vAtfut,I so"after it Iwo;1-wn Swic $ weap"11 ox"Plev rm I.»..................-S CITY OF TIGA,RD 24-Hour BUILDING Inspection Line: (503)639-4175 INSPECTION DIVISION Business Line: (503)639-4171 MST BUP Received —___- �- Date Requested AM. PM BUP Location I - Ll L' - l —ti~< _SuiteMEC � Off' q d Contact Person Ph PLM Contractor — Ph(� ) SWR _ BUILDING TenanVQ"w er ° - 1a/ ELC _ _Footing �- Foundation Access: ELC Ftg Drain ELR Crawl Drain _ --- ----- --- Slab Inspection Notes: SIT Post&Beam _ - - Shear Anchors Ext Sheath/Shear Int SheattVShear - -- - - Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: - - - --- -... ---- ------ Final PASS PART FAIL — — PLUMBING Post& Beam Under Slab Rough-In Watr r Service Sanitary Sewer Rain Drains -- _ Catch Basin/Manhole Storm Drain -- --- _ Shower Pan Other — Final PASS fART FAIL imrr ANIC am Rou n Tm ke Dampers Stsj>ART FAIL - — ---- EL TRICAL Service - —� -- - --- Rough-In UG/Slab Low Voltage Fire Alarm '---- - Final FABS PART FAIL �, Reinspection fee of$,-_ requirod before next inspection. Pay at City Hall, 13125 SW Hall Blvd. Please call for reinspection RE: [] Unable to Inspect-no access Fire Supply Line ADA ApproPch/Sidewalk Date— Inspoctor - Ext Other: Final DO NOT REMOVE this Inspection record from the Job site. PASS PART FAIL ELECTRICAL PERMIT_ IT'S OF TIGARD PERMIT#. ELC2002-00420 DEVELOPMENT SERVICES DATE ISSUED: 8/28/02 13125 SW Hail Blvd., Tigard, OR 97223 (503) 639.4171 PARCEL: 2S104AA-13300 SITE ADDRESS: 12440 SW 128TH AVE SUBDIVISION: BELLWOOD NO. 3 ZONING: R-4.5 BLOCK: LOT : 152 JURISDICTION: 11G Proiect Description: Remodel, (4) branch circuits. Job No. 2663 RESIDENTIAL UNIT TEMP SR_VCIFEEDERS_ _ MISCELLANEOUS _ 1000 SF OR LESS: 0 206 amp PUMP/IRRIGATION: EACH ADD'L 500SF: 201 - 400 amp: SIGN/OUT LINE LTG: LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL: MANF HM/SVC/ FOR: 601+amps - 1000 volts: MINOR LABEL (10): _ SERVICE/FEEDER _ BRANCH CIRCUITS_ ADD'L INSPECTIONS 0 200 amp: W/SERVICE OR FEEDER: _ PER INSPECTION: 201 400 amr- 1st W/O SRVC OR FDR: 1 PER HOUR: 401 600 amp: EA ADD'L BRNCH CIRC: :3 IN PLANT: 601 - 1000 amp: _ _ _ PLAN REVIEW SECTION _ 1000+ amp/volt: >=4 RES UNITS: —> 600 VOLT NOMINAL: _ Reconnect only: VC/FDR >= 225 AMPS: CLASS AREA/SPEC OCC: Owner: Contractor: COLLINS,J CAROL WILLAMETTE ELECTRIC INC 12440 SW 128TH AVE PO BOX 230547 TIGARD, OR 97223 TIGARD, OR 97281 Phone: Phone: 624-3631 Reg#: LIC 75059 SUP 1965S ELE 34-283C FEES Required Inspections — Type By Date Amount Receipt Rough-in PRMT TR 8/28/02 $66.80 2720020000( Elecfl Final 1 `)PC I CTR 8/28,02 $5.34 2720020000( Total $72.14 This Permit is issued subject to the regulations contained in the Tigard Municipal Code,Stale of OR. Specially 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 180 days of issuance, or if work is suspended for pare than 180 days. ATTENTION- Oregon law requires you to folkw rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-901-0080. You may obtain copies of these rules or direct questions to •'l Permit Signature: Issued By: OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale, lease, or rent. OWNER'S SIGNATURE: _ DATE: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. FLFC'N: DATE: LICENSE NO: — Call 639-4175 by 7:00prn for an Inspection the next business day Electrical — hale received: f( 1P:'Di Permit no.: 10 ;1c, city of 'Figard Projectlappl,no.: _ date: GryefTi,,ard Address: 13125 SW liall BIv 1,'I•igard,OR 97223 hate issued: llyj_,_A Receipt no.: I'honc: (503) 639-4171 Fax: (503)598-1960 Cass tilt n,,.: Paynlcrsl lypc: Land use: approval: _ 04 i &2 familydw•cl�Acccssury U Cummcmial/induslrial U Multi-larnily U'I'cnnnt implovellieW U New cunsliuctiun U Addition/alleratiull/lepinccnlcnl U Other: _.- U I'artial Uld no.: Sufic no.: Tax neap/tax IoVacc.nn►l no.: Joh address: 1 2 `Id0 $t,� 1?b -- - LuC Block: Sulxlivisinn: --.--- Project naluc: (.0 !/, S bescription and location of work on premises: fislimMed rlalc of cum)Iclion/insl)ccliun: CON I It ACI Oft"APPLICAll I ON Fee Mu Iles r Ip11au Business name: w, ) wype - New re+Me,dLll-do k or mvhl famll r Address: l e)A,.,, 2 V T dwelllnannll.Includes pilot hrdgarage. Cir��fL�- SIa1c:C/ 'LIP: ZJ / Sereltelnelodedt ty: ls --;r 1(100 s n.or lets 4 Phone: L4-S ( hax: 6? .tq?-N-Mail: !—'1 — -- Poch addillonal 100 t(� fl.of purUnn Ihercuf CCU no.: 71-0 V-1 Islcr,bus.lic.no: 3 - Z.1 3 '-_ Limited energy,ie0denlial _ 2— Cil /m Iro lic.no.' /S'rt G tAmiledenergy,non lesidenlial _ 2 �j Poch manufacuned home or modular dwelling — Service and/or feetler _ 2 S nature of a ry eleclrlclen(red ulrtd Date -- Ilrrmrnrr /1/ )"- (Re►vhyerkeden-Im1a11Mllon, sap elect narne(rdllf) f),1 �, ( f allerallonarrelocellont l 200 em s or less 2 201 amps 10 400 amps _ _ 2 Name(print): C.- _J -- 401 am I to 6(10 ams �2 Mailing address: bol amps to IWuamp{., _ 2 Cq Slate: ZIP: Over 1(100 snipe ur votes 2` Phone: rex: E-mail: Reconnecto!lIy I Owner installnlion;'Ibe Installation Is being made on pmI)elty 1 own leaspen►yaenlceaarfeeden- which is nut intended for sale,Icnsc,n nl,(it exchange acconInslallatlon,aller allows,of relocallon:ling a) 200 amps or lett _ 2 URS 447,455,479,670,701. 2Jl amps Io 4W amps _ — 2— Ownet's si 1111mr•. hAlc' 401 to010Am s 2— - erMneh circuits.new,miler Milan, or ealerolon per ronel: Name: A, No row bialltll ritculls will,pdnchme tit Address: -- ^- servire or feeder fee,each bunch circuit - _ 7 City: --— Slate' ZIP: —� If. flee for branch circuits without rurchese ( S of service or Feeder fee,11141 blanch circuit: I 4 L 2 Phone: l'ax; E-mail: Pochadditional bunncchrnle � Mile.(Service or feeder not Incladed): U Serviex met 223 Mors-mmrriercld U Ilealth can(arilhy path romp or infgsllon_cht le UServiceovtvM)empt•ratingofl&L L1 lluardouslocs0an I?achsign orOutline lighting J� — 2 family dwellings U Ituilding over 10,M)square feel four M signal eirwit(s)or a Ihnlled energy panel, U System over 61111 volts r,nnunal none residential unlu In one structure slieulion,or extensions - 2 U Bvllding ovrr Ilvee shoirs U Feeders,400 amps of nom •Desats tion. U(rttipan11nr1 nvrt V9 pellaoc U Manufactured struclures or RV pack itch sddiltanal Impecllen over the allowable In any of the minor• U f41ressAilihtingplen U Other: __ Per lne Ilion — ._ I Submit—rets of plans"Ilk any of Ihc,above. Inve/Uptlon let int above are 1101 applicable to temponry eonhruclion service. Met Petnnil fee..................... eep Nnr an)rlsllcaar stcredit cards.please call lnitdictka for moat RW-;W.7 Nnliee:'ibis permit application flan review(al u vu. d MutetCud expires if a permit is not obtained ("I Crit M A,r: within 190 days after It has been State aulcholgc(R%) ....S �_ ares accepted as complete. 1'(YI'AI, ....................... W—iTima t7•irt�.-l:lrr wTicirn ee e" ear � Cr dies dgnslvre _ u ( 4 s0 4415(AWLOM) Electrical Permit Fees: Limited Lnetyy Fees: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY Complete Fee Schedule Below: Reslrlcled Eneruy rep....................................................... $75.00 Numbpr of his ecllons per lennll allowed (FOR ALL SYS ILMS) Service Included. Items Cost Total _ Check Type of Work;avolved. Hesidenllal-per unit 1000 so.8 or less S 145.15- 4 Audio and Stereo Systenns Fath additional 500 sq 11or porllon tiered $33.40 Jurular Almon Limited Energy ---_— $75.00 Each Menurd Ilorne o Modular 2 Garaye I kxn Upener� IhweNkig Servko or Feeder $90 90 Services or Feeders Ilealinu,Vanbilabun and Air Gondiliuniny Sy51-,nt' Instal allon,alteration.or relocalkm $80.J0 7 700 amps or less _ Vacuum Syslems, 7o 1 snips to 400 amps $106,85 2 401 amps to G00 amps MOM _ 2 l—) 011ier — G01 amps to 1000 angis _ 5740.60 2 — Uver 1000 arrgis or volls - $454.6,5 _— 2 _ $66.85 2 Reconnect orgy _ -- Temporary Services of Feeders TYPE OF WORK INVOLVED -COMMERCIAL ONLY Installation,anerallon.or rercx.eUcai roe for each xystem.......................................................... $75.00 700 amps or I've-) 388.85 --- _ 701 amps to 400 amps —_-- s 100 30 _-- 2 (SFE OAR e 111 2Gu-260) 401 snips to 800 anryrs _--_ $133 75 2 (hoer 6;610 amps to 10(x1 volls, Check Type nl Work Involved: see"b"■bove. U Audio and Stereo Systems 9ranch Circuits New,allwarkxi or exiensloo I'M 11-11101 Holler Controls 8)1be lee lot Itranch r:hculls with purchase or service or r—r (seder Fee. �J Clock Systems rads branch ckctill S8.G5 2 b)The lee to Ixarxai citrons - - - t)ala Telecanmunlcallon Irlelaitallull wtthorif prrrcha►e or service or roeder lee. Fire Alarm hislallallon rksl brand,c1moll --_ _ $40 85 _ Each addlllorial briar;;clicull - -_ $6.65 f IVAC Mlsceillanamus (Service or feederrtollocluded) El I1191tkill lM11,19/II Fach pump or Irrigation Orcin - _ SCJ 40 Fwh sign or rxilikne lighllnq _ Skil 40 _- _ -^_ ❑ l� Inlerunn and t'aulnu Systems Signal eirmill(s)or a Nmlled m1e19Y parcel,anerstino or etdenskxi $15.00 _ Landscape 1111011011Conhvl' MNttx Labels(10) - $175.00 - Each addilional hispocllrnt over Medical Ilia allowable In any of the above Per 4npecllon 517 50 --- ------ Nurse Calls Per hmff -- 567!i0 ------In Plant -- 573.75 _ �__�__ El Outdoor La11deG,.a Llylnlltlgr Fees: Protective 9lynallnu Enter total of above fees S —____ Other - 0%Slate Surcharge S _ _Number of Syslerne 25%Plan Review Fee See Tlau IlevMrv✓secikxi cxi 5 No licenses ere r0quhed. Licenses aro retpdted(W IN other hisisMNon9 Iron)d applkalkxt -- ro(al Balance Due $ -- Fees: Enter total of above lees ❑ Trust Account N,__-_._ _ - 8%state surcharge Total BNance Due S�- -- I ylkil,fornisklc fees(lo10111'1,114)