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14555 SW 128TH PLACE a N s V d n CD 14555 SW 128"' Place fir, �7.a CITY OF T11GARD RIALDING INSPECTION '-"."^"NN 24-Knur It spection Line. 9-4175 Business line: 63 .171 MST 2-e-4'ey U BLIP Gate Requested S- C _ —_AM PM -- BLD Location /�/s�s�5 �✓ / 2 �' /.l • Suite _ MEC Contact Person _ —� Ph c'G -A43 rr u PLM Contractor _ _ -- Ph SWR BUILDING Tenant/Owner ELC: Reiaininq Wall - — ELR -�-- �----- Foot'�ng ACCCSS: k�� YV—N �! -i( -- - ---. ---- Foundation // FPS Fig Drain e-f, 2 ('i• �. — ------ - Crawl Lrain Inspection Notes: SGN Slab _ - ------- Sr. Post a oadm -- —__-_.._-------_. Ext Sheafh/Shear Int Sheth/Shear -" - - -- ---- --- Framir!g —— ---------------- InaU131ion —--------- - --- Drywai!Nailing irewall -- Fire Sprinklai Fire Alarm - -- - --- - - Susp'd Ceiling — Roof - Misc: Fina. — — ----- P ---RART FAILPost& Beam -- -- -- ----- -- ----- - --- - ��`P uflAwN Under Slab Top Out - ----- — Water Service Sanitary Sewer �'� - ----- -- Rain Drains .�� _-- ASS PART FAIL MECHANICAL -- -- - '- Post'& Beam Rough In Gas Line: Smoke Dampers Final PASS PART FAIL. ELECTRICAL scivice Rougt.In UG/Slab — --- ---_— Low Voltage — - Fire Al-arm Final -- .--- -- - _ ---- PASS PART FAIL SITE Backfill/Grading --- - -- ------ — Sanitary Sewer Stomi Drain [ J Relnspect!on fee of required before next Inspection. Pay at City 11811, 1:l1..P 5W Nell Blvd Catch Basin ,'ire Supply Line [ J Please call for reinspection RE:_._ —__ ( J Unable to inspect. no access ADA ✓ �.'� L Approach/Sidewalk Other Date .�' o `� °' Inspector Vii" . _� - -- ext Final ----- - ----- PASS PART FAIL 00 NOT REMO:r0 this inspection record from the job site. � ti CITY OF TIGARD BUILDING INSPECTION DIVISIr`N MST zed 24-Hour Inspection Line: ;9-4175 Business Line: 6� .171 BUF Date Requested.__-3 / �—_AM 4----pm UP ,.ocation_ f .� ��' f 2��`'n` FL —V_ Suite Col„qct Person �:_.��_N —�_ Ph , /(�– 1 U�/J PLM _ Contracty Ph SWR BUILDING Tenant/Owner __ ELS Retaining Wall ELR Footing Access: Fnundation 3 L� y� FPS FtS Drain / SGN Crawl Drain Inspection Notes: - - -------- -- Slab Post&Beam SIT -------q--- Ext Sheath/Shear Int Sheath/Shear Framing Insulation - - Drywall Nailing Firewall Fire Sprinkler Fire Alarm ' / Susp'd Ceiling -- l - i — �--�-- --- Roof Misc: - - ---- - -- Final PASS PART FAIL PLUMBING Post& Beam Under Slab Top Out ------- _ - ---- Water Service - Sanitary Sewer Rain Drains Final -- PASS PART FAIL. -�- --- ANECHANICAL - -' Post&Beam -- - -- --- ---- - - - Rough In Ges Line - Smoke Dampers Final -- -- PASS PART FAIL ELECTRICAL I Service Rough In - - - --------- ---- - UG/Siab Low Voltage CPASS` ARTFAIL Backfill/Grading __._ _-_- __ -- _-_--- Sanitary Sewer Storm Drain (�Jivispection fee of$ required before next inspection. Pay at City Hell, 13125 SW Hall Blvd Catch Basin _ le �e call for reins ection RE: Fire Supply Line p I I Unable to inspect-nn acca�s ADA el Approach/uidevfalt; --Date _'�� G/ Inspector �:)V� A Other . � ✓�.� Ext Final PASS PART_ FAIL J 00 NOT REMOVE this Inspection rczord from the job tilt!. C7Y OF TIGARD BUILDING INSPECTION DIVISION MST '24,-Hour Inspection Line: 639-4175 Business Line: 639-4171 BUP --Date Requested_ /-/ —,-30 AM PM — BLD Location TS Z Suite _ MEC ._ Contact Person 'h . f PLM n f�' -_-_ Contractor Ph :"NR Ei ----- ---- BUILDING Te nanUOwner (Retaining- Wall— --- ELR _--_-- - Footing ccg eS,Si . ,i�`-� s ^( FPS _- - Foundation Fig Drain ` - -- SGN Crawl Drain Inspection Notes: Slab --- - SIT ------_ Post&Ream _ Ext Sheath/Shear - - -- -- - Int Sheath/Shear Framing - Insulation Drywall Nailing Firewall Fire Sprinkler __--- ---_---- -- ___ __-_ Fire Alarm _ Susp'd Ceiling - -- - - _-- Roof - M - - F - — PASS ART FAIL_ -- _ ----- -- __�_ _ NG Fust 8 Beam- -- —_ _-- -_-- ---- Under Slab _-- Top Out ----- - .-� Water Service Sanitary Sewer Rain Drains _ - ---.__ __.---------------___.------_ Final PASS PART FAIL _ MECHANICAL Post&Beam _. -------- Rough In Gas 1 ine Smoke Dampers --- ------- .�-_ -- -- Final PASS PART FAIL ---- ELEGTRIGaL --------- -------- _ - Service Rough In UG/Slab Low Voltage Fire Alarm Final -- PASS PART FAIL ------ ------ — SITE Backfill/Grading - -- Sanitary Sewer required before next inspection. Pay at City Hall. 13125 SW Nall 81 (4, Storm Drain [ j Reinspection fee cf$ ^atrh Basin ( ]please call for eI ipection RE: [ ]Unable to inspect-no access ire Supply Line ADAr r--- Approach/Sidewalk Date I ��__Insspoctor y,..,��-_� ____—� Ext -� Other _ —T Final PASS PART FAIL DO NOT REMOVE. this ainspectlo + rer:ord from the jAh 31t0. kAA AAAI►AAAA►�AAAA6AAAAA�►AI►AAAAAi,�AAAAASAA/►A/R P I I 1 P ► � � P 4 T t-. I. M ► 4 z r Q ► 4 1 ►� d. ;�' t3 � ► 4 o" P p„ w v 4 LO) .-r, OIQ ► i b a 1 p o 0%- i i L ! 7 �' '► v 1 YO ] o 0 4 p �' ► ` eoil d ► i111. i I ; r � �r � i I i I► TT Apr 7rT�iT�rTTVa OFT T T v T T TTTT7/TTT�'iTTr�►TT� \ -„ �, tav��1 ao ,r i nAateecco4 ar u�.,i taxa nn. tt KIM tern a t7 b y 0 r . nc `t1 n o EL y � h S � R o C. � a o (� o Qo] y o Q NrR` a ^ a .P y vi r1 1 S n z s` Ry C •ti C x sem. / CITY OF T I G A RD ___—_ MASTER PERMIT PL RMIT#: MST2000-00280 DEVELOPMENT SERVICES DATE ISSUED: 9/18/00 13125 SV!/ Hall Blvd.,Tigard, OR 97221 '503) 639-4171 SITE ADDRESS: 14555 SSV 128TH PL PARCEL: 2S109AD-07600 SUBDIVISION: FI_K HORN MIDGE ESTATES ZONING: R-7 BLOCK: LOT:002 JURISDICTION: TIG REMARKS: S/F PATH I BUILD NG REISSUE. STORIES- 2 FLOOR AREAS _ REOUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 27 FIRST: 1,827 s BASEMENT: at I-EFT: 12 SMOKE DETECTORS. TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,536 si GARAGE: 599 ct FRONT: 2n PARKING SPACES TYPE OF CONST: 5N DWELLING UNITS: 1 FINE'MENT: sl RIGHT: 6 VALUE: S 238,527.59 OCCUPANCY GRP: R3 BDRM: 4 BATH: 3 TOTAL: 3.183.00 s1 REAR: 21 PLUMEING SINKS: I WATER CLOSETS: 3 WASHING MACH: 1 LA 1NDRY TRAYS: RAIN DRAIN inn TRAPS: LAVATORIES: 5 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 101, SF RAIN D^41N5. 1 CATCH BASINS: TUB/SHOWERS: 3 GARBAGE DISP: 1 WATER HEATERS: I NATER LINES: 100 BCKFLW PREVN'R. I GRr nSE 1 RAPS: OTHER FIXTURES: MECHANICA_ FUEI.TYPES FL'RN<100K: BOILICMP<3HP VFNT FANS: 5 CLOTHES DRYER: 1 GAS FURN—100K: UNIT HEATERS: HOODS: 1 OTHER UNITS- z MAX INP: btu FLUOR FURNANCES: VENTS. 1 WOODSTOVES: GAS OUTLETS: 1 ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 1 U 200 amp: U 200 amp: WISVC OR FOR: 1 PUMPIIRRIGATION: PER INSPECTION: EA ADD'L 500SF: 6 201 400 amp: 201 400 amp: Is WIG SVC/FDR: 00 SIGNIOUT LIN LT: PER HOUR: LIMITED ENERGY: 401 600 amp: 401 600 amp: EX ADDL SR CIR: SIGNAL/PANEL: IN PLANT: MANU HMISVCIFDR: 601 - 1000 amp: 601•amps-t000v: MINOR LABEL* -1000♦amplvolt PLAN REVIEW SECTION Reconnect only: -- >•4 RES UNITS: SVC/FDR>-225 4.: >600 V NOMINAL: CLS AREA/SPC OCC ELECTRICAL•RESTRICTED ENERGY SF RESIDENTIAL S.COMMERCIAL AUDIO a STEREO: VACUUM SYSTEM: AUDIO&STEREO: FIRE ALARM: INTERCOMIPAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPFARRIG: PROTECTIVF SIGNL: GARAGE OPENER CLOCK: INSTRUMENI►TION: MEDICAL: OTHR: MVAC DATA(TELE COMM: NURSE CALLS: TOTAL 0 SYSTEMS: Owner: Contractor: TOTAL FEES: $ 6,606.33 WESTLAKE HOMES IN(: WESTLAKE HOMES This permit is subject to the regulations contained In the PCE BOX 69326 PO BOX 69326 Tigard Municipal Code,State of OR. Specialty Codes and PORTLAND,OR 97201 PORTLAND,OR 97201 ell other ce with a laws All work well be done it accordance with approved plana. This permit will expired work Is not started within 180 days of Issuance,or If the Work Is suspended for more than 18U days ATTENTION. Phone: Phone- Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center Those rules are set Regal: LIC 00065324 forth In OAR 952-001-0010 through 952-001-0080 You may obtain copies of these rules or direct questir.ns to OI1NC by calling(5U3)246-1987 REQUIRED INSPECTIONS Erosion 844-8444 Post/Beam Structural PLM/Underfloor Electrical Rough In G83 Fireplace Electrical Final Grading Inspection Post/Beam Mechanical Mechanical'asp Framing Insp Insulation Insp Mechanical Final Sewer Inspection Underfloor Insulation Mechanical Insp Shear Wall Ir sp Rain drain Insp Plumb Final Footing Ins ._ Crawl Drain/Backwater Plumb Top Out Exterior Sheathing Insl Water Line Insp Final inapeetdon Foun on Insp Footing/Foundation Dr; Electrical Service Low Voltage Appr/Sd Ik 14p Building Final Issued I UL 1�— Permittee Signature Call (503)639-4175 by 7:00 p.m.for an Inspection needed the next business day CITYOF TIGARD SEWER CONNECTION PERI111T DEVELOPMENT SERVICES PERMIT'$: SWR2000-00223 13125 SW Hall Blvd., Tigard, OR 972.23 (503) 639-4"'i DATE ISSUED: 9/18/00 SITE ADDRESS; 14555 SW 128TH PL PARCEL: 2S 109AD-07600 S11BDIVIS:0t4: ELK HORN RIDGE ESTATES ZONING: R-7 _ BLOCK: _ LOT: 002 —__—T JURISDICTION: TIG TENANT NAME: USA NO: FIXTURE UNITS: CLASS OF WORK: NEW DWELLING UNITS- 1 TYPF. OF USE: SF NO. OF BUILDINGS: 1 INSTALL TYPE: L.FPSWR IMPERV SURFACE: Rem.3rks• S/i= PATH I Owner: -- ------ - __ _ FEES WESTLAKE HOMFS INC Type By Date Amount Receipt PO BOX 69326 _ _ PORTLAND, OR X7201 ( PRMT CTR 9/18/00 $2 300.00 27200000000 I INSP CTR 9/18/00 $35.00 27200000000 Phone: 675-0495 Total 42,335 00 Contractor: Phone: Rea #: R3quired Inspoctions Sewer Inspection I I This Applicant agrees to comply with all the rules and regulations of the Unified Se-Nage Agency. The permit expires 180 days from the date issued. The total amount paid will be forfeited if the permit expires. The Agency does not guarantee the accuracy of the side sewer laterals If the sewer is not located at the measurement given,the installer shall prospect 3 feet in all directions from the distance given. If not so located, the installer shall purchase a"1'ap:?nd Side Sewer" Permit and the Agency will install a lateral. ATTENTION: Oregon law requires you to follow rules adUAed by the Oregon utility Notification Center. Those i ulec are set forth in OAR 952--001-0010 through OAR 952-001-0080. You rn�(y obtain copies of these rules or iirect questions to OUNC by calling (503) 246-1,97. i �' td IssuL by: '�—j . Signature;(- - -- Call (503) 639-4175 by 7:00 P.M. fnr an inspection needed the next business day CITY OF TIGARD Residential Building Permit Application Planch �7�,�.,3? 13125 SW HALL BLVD. /ii tiiti sir pdtet ions Recd�,�;c;� Date Recd—7- TIGARD, OR 97223 Single Family Detached or Attache (Duplex) �� rate to P.E. V 50;S-63q-4171 , / Date to DST - F 503-684-7297 Print or Type Called,[ A •- Incomplete or illegible applications will not ueadcopted N arae of�Proie�ct ,(� T Z Name Job n -' , dL ,�) �' C'r, D Address i e.44dre�s Architect Mailing Address C' lSta e ZipName I Phone o s Owner Mailing Ad ss a EU L 6 V. _ I �t/ CEt/nG Zip Phone 9 -- Ea ineer (ailing Address ciI N� C y/Stat,e Zip- Phone General Name - Contractor S�� en7 �� Describe work NewAddition O Alteration O Repair O M ilingAddri6ss .- to be done: Prior to permitLi'tAdditional Desc.iption of Work: <. Issuance,a copy City/State Zip Phone D,� of all licenses are required if Oregon Const Cont Board Exp.Date PROJECT 2 expired in COT Lic#D a 3(��/ i database VALUAI'I,')N Mechanical Name NEW CONSTRUCTION ONLY: Sub- /n/o - Sq. Ft. House: Sq. Ft. Garage Contractor Mailing Address 72142-3"— �_c-,27`t— Prior to permit -q- Indicate Indicate the resit cted energy installation by the electrical issuance,a copy Cit /Staff to Z:p Phone subcontractor in the following areas - ofalllicenses ' 64na SLY 7,a Restricted Audio/Stereo are required if Cregun Const.Cont.Boa ` Exp.Date Energy System Alarms expired In COT Lic.# � t u(L-f/O c' Installations Vacuum - Irrigation _database -At-TL System System Plumbing Name (:heck all that Other: Sub- / / / y7p Corner Lot =YESINO Flap Lot YES NO Contractor Melling Address /r check one check one 4 Qn�'-��_ _ Has the Subdivision Plat recorded? N/A YES NO Prior to permit Cit /State y r17tPhone issuance,a copy /_ O vof all licenses are Oregon ons Cont B ar Exp.Date required if Lic.# j / 6- �W c o/ b f expired in COTo I hearby acknowledge that I have read this application,that the � `--� information given Is conect,that I am the owner or authorized agent database Plumbing Lic.# Ex Date g 9 3 Ze O/ of the owner,and that plans submitfad are in compliance with - 'P j3 Oregon State laws. _ Name �.n_a._tu,_re_o�ner/A Dat Electrical �. �r --- _ 7 2? a Stlb- Mailing Address Con ac Person Nam one Contractor ')'o? /�'I S -M.F_ �� ,. N R. . CitylState Zip Phone Prior to permit p issuance,a copy 1 '�� FOR OFFICE USE OALY: of all licenses are Oregon Co�L�on and Exp Date''��'' 1, Plat#: required if Lic# 7 �t �? t expired In COT S 0D C 4'^--A_ I '1101 database Electrical Lic # Exp. Date r l) Setbacks Zone: / Solar. VA41 - (A lb - 0-I. - Electrical Supervisor Lic Exp. Date Engineering Approval: Planning Approval: TIF. r\dsts\forms\sfaddalt doc 11120/98 00 Jur,15 08,31:54 R,11112wo dwg MAR S.W. GREENFIELD DRIVE yoh - _ -. _ o, _L 141' S 0',s-,e• W y 79 65' cJU 7.7"• / 24 0 I i MAIN FLOOR 1 (' EL ,500.0' I 1 I Iae I I ' wIL.1 � �) I GARAGE I EL :497 5' I I I 1 1 1 • I c Iqg I N' CONC j DRIVEWAY 1 13500 P S I I f s N i O o N 0',5'30" E .. ..�J r age wErE� Iq6 s e 00 I INVF.Rf I INVEAt EL 4880 EI ANS0 S.W. GREENPARK PLACE 5t[I rfNCf . RCIAINM+G wut 06/,5/00 MRR _�T ZLJ -- SCA t L 1 2 0 ALAN YAlCOND a1aN At wen Not CITY OF TIGARp 2201A IusAt r0a r�AccWAc+Or N11 rorooNAla. ELKHORN RIDGE ESTATES OONtlAIgl it ro 144 l0LE ptNNQN�roA"I 0 1N! T / euNnla ro veNs.All sunt cow11 r oNt wc1 AN0 LOT 2 AN.tAl IKActO ON TNt>u11 ANO Npi�+iw1 OMN1Ns Or AM Not1NnA1 rt10 YOOt10ArIOlp BY KEN NE N AI Aw WAltcOwO Otf10M ASSOCIAtII.Nc 6,948 S0. F1. "' CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE TIMBER VALLEY PLUMBING PO BOX 34 CANBY, OR 97013 Plumbing Signature Form Permit #: MST2000-IJ0280 Date Issued: 9118100 Parcel: 2 S109AD-07600 Site Address: 14555 SW 128TH PL Subdivision: ELK HORN FJDGE ESTATES Block: I_ct: 002 Jurisdiction: "IG Zoning: 14-7 Remarks: SIF PATI Your company has been ine --ited as the plumbing contracto-for the permit indicated above. In order for the plumbing permit to be valid, please hav-� the appropriate individual from your company sign below and return this Plumbing Signature form prior ane start of the work to the address above, ATTN. Building Dent. No plumbing inspections viii! be authorized until this cornpleted form is received OWNER: P�UMBING CONTRACTOR WESTLAKE HOMES INC TIMBER VALLEY PLUMBING PO BOX 693A:6 PO BOX 34 PORTLAND, OR 97201 CANBY, OR 97013 Phone #. 675-0495 Phone #: 266-4300 Reg #: I I(: 42.031 PI M 3-166PB AN INK SIGNATURE IS REQUIRED ON THIS FORM Signature of Authorized Plumber If you have any questions, please call (503) 639-4171, ext. # 310 CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE LITE-RITE ELECTRICAL 28820 SW BURKHALTER RD HILLSP-.RO, OR 97123 Electrical Signature Form Permit #: MST2000-00280 Date Issued: 9/18/00 Parcel: 2S109AD-07600 Site Address: 14555 SW 128TH PL Subdivision: ELK HORN RIDGE ESTATES Bleck: Lot: 002 Jurisdiction: TIG Zoning: R-7 Remarks: S/F PATH Your company has been indicated as the electrical ccotractor for the permit indicated ghove. In order for the electrical permit to he valid, the signature of the supervising electrician is required. Please have the appropriate individual from your company sign b0ow arid return this Electrical Signature Form prior to the start of the work to the address above, ATTN- Building Dept. No electrical inspections will be authorized until this completed form is received OWNER: ELECTRICAL CONTRACTOR: WESTLAKE HOMES INC LITE-RITE ELECTRICAL PO BOX 69326 28820 SW '3URKHALTER RD PORTLAND, ON 97201 HILL SBORO, OR 97123 Phone #: 675-04915 Phone #: 503-593-9775 Req #- LIC 00089854 SUP 40415 FLE 14-356C AN INK SIGNATURE IS REQUeRED ON THIS FORM igna re ofSupervising I an If you have any questions. rlcosp fall (503) 639-4171, ext. # 310 ELECTRICAL PERMIT- / �\ CITY OF TIGARD _ RES TRICTEDENERGY DEVELOPMENT SERVICES PERMIT ELR2000-00305 13125 SW HPII Blvd , Ticiard, OR 9722.3 (503) 639-4171 DATE ISSUED: 12/18/00 PARCEL: 2S109AD-07600 SITE ADDRESS. 14555 SW 128TH PL SUBDIVISION: ELK HORN RIDGE ESTATES ZONING: R-7 BLOCK: LOT: 002 JURISDICTION: TIG Protect Description: A. PESIDFNTIAL _ _ B.COMMERCIAL -- AUDIO K STEREO: AUDIO & STEREO: INTERCOM & PAGING: BURGLAR At-ARM: BOILER: LANDSCAPEhRRIGAT: SARAGE OPENER: CLOCK: MEDICAL. HVAC: DATA/-CELE COMM: NURSE CALLS: VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE: OTHER: ALL ENCOM X HVAC: PROTECTIVE SIGNAL: INSTRUMENTATION: OTHER: _ TOTAL # OF SYSTFMS• Owner: Contractor: WESTLAKE HOME=S INC GARY'S VACUFLO INC PC BOY.69326 9015 SE FL.AVEL PORTLAND, OR 972.01 PORTLAND, OR 97266 Phone: 675-0495 Phone: 775-2042 Reg #: LIC 69047 ELE 26.728CLE _ FEES — Required Inspections - _Type By Date Amount Receipt Low Voltage Inspection PRMT CTR 12118100 $75.00 2720000000 5PC1 CTR 12/18100 $6.00 2720000000 Total $81.00 This Permit is issued subject to the regulations containPJ in the Tigard Nlunicipal Cade, State of OR. Specialty Landes and all other applicable laws All work will be done in accordance with approved plans. This parmit will expire if work is not started within 180 drays of issuance, or if work is suspended for more than 180 day-, ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952.-001-0080. You may obtain copies of these rules or direct questions to rUNC at (503) 248-1987 Issued by m Q R--` Permittee S;jnature_�" C1 k'a•';,.L__�.—__. OWNER INSTALLATION ONLY The installation is beir g made on property I rwn which is not Intended for sale. loase, or rent. OWNER'S SIGNATUR'.= - — _ --- - DATE:---- CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR ELEC'N s _-__ _�—___..—_ DATE:__ LICENSE NO: -- --- Call 639-4175 by 7:00 P.M. for an inspection needy:d the next business day Electrlcsl PlerntitAppUcatlon Datcrereiycd: Permitzrro�'Z., p Cite of Tigard F'rojrVVappl. Expire date: t iy fTigurd Address: 13125 SW Hall Blvd.Tigard,OR 97223 natoissued: By: Recelp:no.: Phone- (503) 439-4171 -----.. Fax: (50's) 598-1960 t^asetilcno.: Payment type Laud usfi,approval: 771 &2 tarnily dwelling or accessory Cl Commercial/industlial D Multi-farnily J Tcna it improvement ' XNew r:onscruetion U Addition/alteration/replacement U Wier: lob,.ddtess: {` 'L,U i:n ( , Bldg•no,' Suite no.: Tax maFftax lotlaccount no.: LUF 1 ock. Subdivision: - Prq;cet name: _ _ Description 811ui locatlon of work on premises: Espmated date of compledorthws tion: KIM 0[&1 111101 W I'll III KILIN Joh ba: _ Fm "tnc CENTRAL VAC INS'fALLA'1'lU>y �— �i wan To no.huip Nonrritlrlriulal-sirglo nr tntdti fattrly per GARY ' S VACUF'LO, INC 775-2042 9015 a1 FLAVEL, 97268 CCB: 890'17 Serrkelnrlrrted CLE: 26728 � 1lflneq.ft.orlrsv +-- J law� Q e J G;rch ads+lanai SGOsq.:•.+r Donlon therc,.f q Lrlrlwienerpy,radenual Clly/mciff iKL uo.: I irnitcdri,crEy,nrn•rraidenGal F uch manafwtured'.imine ar modular a,-tilling SI nature of supervising oleeltidin(required) W Date 1,crvicu mnVur feeder 2 Sup oieet.nlune(print): 1Joerlsono! Senlersurfoedeta-htuallallon, altrntinn or 1-010crtion. IN amp Ur lett 2 3111-lit. ,,400 amps 2 MaiL'ng&ddr�gs 401 amps to 69lutrps 2 ou 1 craps'n 1 Kin amps 2 City: _ istat.,: 271': Over loon amps orvnits l_— . Phone:^ — Fu: E-mail: Rtoconnewtunly - - -- �`—` 'i�rnponry serrlasr ur frnienr• w Owner installation;'I he ihstallnb'un is he tip made on pmperty I own which Is net intended for We,lease,rant,or exchange according toNX)lrutalhrdort aherDtluo,orrdoeatluu: i 0(,'i 447.455,479,570.701 neaps ur Jr 201 amps to 40o ung:, -1- .- Ow,ier'; sigttadnt: Ur.n: a01ia WC0 017108 Drurehcrealu-nen,alteraHnn, O: or exatusloo per ptwel: Name: A. Fcc for branch cin•uiie wish purchioc of r►dtiae: _ service or fet>drr fee,ri"tuanJr circuit City _ _ $ate; 7ZIf': _ Fee m forbrch theatre withum pumhnse plione' PLAT of service ar tir�lcr fm,flrt+r brooch r.ircuit' ___ �_ I rah: Loch nd�llUunal branch crcuii: Mie.(5nrde+or(orderrtof Irclydort): - U Service ave 225 rim, ,Q,rtunerclyd U Hculth•aur ho:dity Each purt�t or Irt- atrt drole U Serviicr aver 320 amps-rutiny of i A 2 U Harwdo,:•.bcadau finch signor ouiltne tl htin talell,dwellings 0 Building aver 10MV Aquare 1irl roar or Signal cimuh(a)or a lin,iled rncgv pnnel, U syr,temove 60n volts I:olrumd mute rr.Aidendnl units in nnr ruruetun: _dtere{IOn,oYNtfetttlun• -�.. -�.-_ 2 U Auilriing o,,ry three etoNc U pr2dtmc,dao wnps or more , 'cri �� l.1 J,t:upant load avor'09 pirnmu a F1nnoWured cUvuuitx or P pfach adalllole ork 17trd _ ^ . U fprearJhghdngpldn U Jder. — nal Inspr.tlon ore,the allowabW III cry lrF y of tslrore: pari"eptttion Submit,_.. .eeb of Phos with any of foe a4ote. InvesttdaUor.foe ,_ IMe above We not applicable to teaaporary cnastructRoa serrice. NM all}rtlwik,dnw racpt erer aYt r'ud\pMcall puLdirtimw mare Infum rnllon Molise:'('tile permit appNocilon Partnl l foe... .. .... 0Visa O M.actarcam expires ii a permit is not obWticd Plan review(at �) S odh ca .wrraly: - ---� �� within ISn days alter it has been iLatr surchop(d9b)....S . --- �f accepted&-I campleir. TOTAL S �. Name ara,�"iit3:i r'�,e�s erre 'it nom+ -�" � • .•o.•.'••••....... -:7j 401015 IrIROMMI Z Z 'd 090'(IN WdSO:b 0002'E1'Aa