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N a. ❑ (j) 0 � 66 N a � . � } CL I� % % 5 2 £ o c r / o > 7) }k � (D (D C) f \ k 9 3 $ \ ƒ ± ƒ � � £ 3 5 5 M m m G - m 10 m �/ / � � \ m @ § § @ I k j ) \ Q K & $ / � 3 '> c / \ 2 Q)/ § { / E \ { ) ! \ 7 LLI6 rLl 0)q \ ƒ _ L) iL i / ] Cl $ k § ° $ / S 8 2 7 f ° 2 < § k Lr) k « a 2 Q. a 2 2 } v G g § g © G 5 § m m § _ = e P � 12 2-i LO � _ C 6 m = « o § & & c IL a _ � c 0 a CL 0.5 R r CLI �F U G G § ® § a) ¥ O 2 § 3 a @ CA @ 2 � 2 .� � § � ) 3 CL I.. t � � k / 0 ` K , u / k j _ \ CL L ) § \ / J $ o w o o § o 0 �?3 66 ti CITE( OF TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT #. . . . . . . : PLM99­006E, 0125 SW Hall Blvd., Tigard,OR 97223(503)639-4171 DATE ISSUED: 03/09/99 PARCEL: 2S104DD-01300 SITE ADDRESS. 1364/1 SW 130TH PI.._ SUBDIVISION. . . . : MOUNTAIN HIGHLANDS ZONING: R-4. 5 PD 'BLOCK. . . . . . . . . . : LOT. . . . . . . . . . . . . :O12 JURISDICTION: TIG —----------------------------------------------------------------------------------------- CLASS OF WORK. . :ALT GARBAGE DISPOSALS. : 0 MOBILE HOME SPACES. : 0 TYPE OF USE. . . . :SF WASHING MACH. . . . . . : 0 BACKFI-OW PREVNTRS. . : I OCCUPAN­Y GRP. . : R3 FLOOR DRAINS. . . . . . : 0 TRAPS . . . . . . . . . . . . . . 0 STORIES. . . . . . . . : 0 WATER HEATERS. . . . . : 0 CATCH BASINS. . . . . . . : 0 FIXTURES-------------__. LAUNDRY TRAYS. . . . . : 0 SF RAIN DRAINS. . . . . : 0 SINKS. . . . . . . . . : 0 URINALS. . . . . . . . . . . . 0 GREASE TRAPS. . . . . . . . 0 LAVATORIES. . . . : 0 OTHER FIXTURES. . . . : 0 TUB/SHOWERS. . . : 0 SEWER LINE (ft ) . . . : 121 WATER CLOSETS. : 0 WATER LINE (ft ) . . . : 0 DISHWASHERS. . . . : 0 RAIN DRAIN (ft ) . . . : 0 Rrmarl�s : Residential backflow prevention device Owner-: FEES AMOS, GARY—R DIXIE type amoi-int by date r-eept 13644 SW 130TH PL PRMT $ 15. 00 B 03/09/99 — TIGARD OR 97223 5PC­ $ 0. 75 B 03/09/99 — Phone #: 7RYON CREEK LANDSCAPE INC t1400 SW NORTH DAKOTA ST TIGARD OR 97223 Phone #: $ 15. 75 TOTAL Reg #. . : 00011.5 ------- REQUIRED INSPECTIONS ------- This permit is issued 5ubiect to the regulations contained in ftp 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 permit will expire if work is not started within lee days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are CL� set forth in OAR 952-000I-0010 through OAR 952-000I-080. you may obtain copies of these rules or direct questions to OUNC by calling (503)246-1987. 0 LLJ _j Issi-ted Permittee Signat-ttrt_ t,,�_� .............4........4................il.......4................................. 4 Cal 1 639-4175 by 7:00 p. m. for an inspect ion needed the next bi-ts iness day ..........................4-++++4-++++++_A_++++_*.................................4 CITY OF TIGARD Plumbing Permit Application Plan Chec # 13125 SW HALL BLVD. (:cmmercial and Residential Recd By TIGARD, OR 97223 Date Recd (503) 639-4171 • Date to P.E. Print or Type Date to U Incomplete or illegible applications will not be accepted Permit# VIIA0 Related SWR# Called Name of Development/Proiec�tl_� ( FIXTURES (individual) QTY PRICE AMT Job r IY�O�� 4�:C>�Ct \ r(��4 Sink 9.00 Address Street Address ulte Lavatory _ 9.00 1> Tub or Tub/Shower Comb. 900 Bldg# City/Stale Zip Shower Only 9.00 H Name Water Closet 9.00 �- 12 t Dishwasher 9.00 Owner Mailing Address Suite Garbage Disposal 9.00 - �yvtti r T`�b Washing Machine 9.00 City/State Zip Phone Floor Drain/Floor Sink 2" 9.00 Name 3" 9.00 i-� 4" 9.00 Occupant Mailing Address Suite Water Heater O conversion O like kind 0.00 _ Gas piping requires a separate mechanical permit. City/State Zip Phone Laundry Room Tray 9.00 Urinal 9.00 NameFECC�i i?t NEC Other Fixtures(Specify) 9.00 -TLzI CN tRtic- ��,N - Contractor Mailing Address Su!te - 9.00 1 l LAO o �.x iJ Ph Z-Ot A 5 9.00 Prior to permit Clty/State Zip Phone Sewer-1st 100' 30.00 issuance,a copy ,.;,,j,_,0. ZI `) Sewer-each additional 100' 25.00 of all licenses are Oregon Can,..Cont.Board LIc.# Exp.Date Water Service-1st 100' 30.00 required i1 expired In COT Plumbing Lic.# Exp.Date Water Service-each additional 200' 25.00 database _ Storm&Rain Drain-1st 100' 30.00 Name Storm&Rain Drain-each additional 100' 25.00 Architect Mobile Home Space 25.00 or Mailing Actdre: Sulle Commercial Back Flow Prevention Device or Anti- 25.00 Pollution Device _ Engineer City/State Zip Phone Residential Backflow Prevenllon Device' / 15.00 (Irrigation timing devices require a separate Describe work to be done: restricted energy permit.) New 9 Repair O Replace with like kind: Yes O No O Any Trap or Waste Net Connected to a Fixture- 9.00 Residential 0. Commercial O Catch Basin 0.00 Additional description of work; __ Insp.of Existing Plumbing 40.00 per/hr Specially Requested Inspections 40.00 f t�Sr t 1 _ _ per/hr _ Rain Drain,single famay dwelling 3000.00 Are you capping, moving or replacing any fixtures? -- - Yes O No ® Grease Traps 9.00 If yes,see back or form to indicate work performed by QUANTITY TOTAL un fixture. FAILURE TO ACCURATELY REPORT FIX'JRE Isometric or riser diagram is required NQuantity Total Is >9 fti WORK COULD RESULT IN INCREASED SEWER FEES. *SUBTOTAL r' V �- I hereby acknowledge that I have read this application,that the Information given is correct,that I am the wrier or authorized agent of the owner,and 6%SURCHARGE s that plans submitted are In compliance with Oregon State Laws _ Signature of Owner/Agent Date **PLAN REVIEW 25%OF SUBTOTAL C.DJ _ - �- 7J_ u _ �y(� Required only N nxture qty.total Is>9 TOTAL I 1 Contact Penton Name Phone l .Ll�,J 'Minimum permit fee Is$25+ 5%surcharge,except Residential Backflow LJ r Prevention Device,which Is$15 %surcharge "All Now Commercial Buildings requlre plans with Isometric jr riser diagram and plan review 1 ume"anapp doc 712M PLEASE COMPLETE: Fixture Type _ Ouantity by Work Performed New Moved Replaced Removed/Capped Sink - Lavatory Tub or Tub/Shower Combination Shower Only Water Closet Dishwasher Garbage Disposal Washing Machine Floor Drain/Floor Sink 2" 411 Water Heater Laundry Room Tray Urinal — -- Other Fixtures (Specify) - COMMENTS REGARDING A90VE: J W J CITY OF TIGARD CERTIFICATE Of gL:CUF'ANI,Y I T , . . . 9 ` -02 ?COMMUNITY DEVELOPMENT DEPARTMENT PERMIT' ATLISSUED: Q7i29/ 6 13125 SW Hall Blvd.Tigard,Oregon 07223.8100 (503)830-1171 PARCEL: 2S104DD-•01300 SITE ADDRESS. . . » ]. "644 SW 130TH GL SUBL)M S I UN. . . . ; MOUN T A I N f I GHLANDS Z ON I NG:R--4. PD BLOCK. . . . . . . . . . a LOT. . . . . . . . . . . . . CLASS OF WORK. -.NEW - •.--__.___._____.___.._.______.W.__._.___._.......-_-•- .- TYF'F.. OF USE. . . :SF- 011 OCCUPANCY GRP. :5N-1-% OCCUPANCY LOAD:2 Rema►rkss PATH I Owners CYRUS & LINDA SAURI 12515 SW G i wT PL, PORTLAND OR 9719 Phone ##: 246-1765 Cantr•actorc VISION HOMES NW IC515 SW G15T PL PORTLAND OR 97219 F-'hmie 4t; 246- 1765 Req #. . : 105506 This Certific_iAte c11-011tS arCUpanty of the Above referenced building or portion thereof and runfir•ms that the building has )Jaen inspected for romplicnae With the State of Oregon Specialty Codes for the grooccoipancy, anti Use Lrncier^ which t1--a rr�fervnced permit was i$tat.ipci. 43UIL6ING INSPECT "' BUILDING OFFICIAL_ FROST IN CONSPICUOUS PLACE c W J CITY OF TIGARD BUILDING INSPECTION NOTICE Inspection Line: 639-4175 Business Phone: 639-4171 Footing Rain Drain Cover/Service FINAL: Foundation Water Line Ceiling -Plumb. Post/Beam Mech. Shear/Sheath Framing -Mech. Plbg.Und/Fir/Slab Plbg. Top Out Insulation -Elect. Post/Beam Struct. Mech. Rough-in Gyp. Bd. Bldg.' San. Sewer Gas Line Appr/Sdwlk E1 . Other: Date: �J-t A.M. --P.M. Entry: Address: -3(1 Tenent: Ste: Con/Own: BUP. MEC:_ .T PLM: _ -7 '3ELC: THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR: --- ov A'il Insp or: _ Date: APPROVED i DISAPPROVED/CALL FOR REINSP. CF CO T r.1-RMIT it, 1f77n7- 0,707, OF T I GARD L_ J�TY "JE Isr,"Jim, COMMUNITY DEVELOPMENT DEPARTMENT 13125 SW Hall Blvd.Tigard,oregon 97223s8`199 (503)639-4171 P,A RC L. L-)1 714 F)D 4 G'W 0,4 1 V,4G R 4 PD ,Dr r j',*�r 14TIAIN HIGHLAND' IVISION. . . . MOU" . . . . . . . . . . . BUILDINI. M.,37:.L L I N G U N I T 3 . . . . . . .. . BATHS:3 GARPSE. . . . . . . . . . .700 f CL,"'tSS OF- WORK. NEW BEDRmst3 ` .'7,FrLOOR AREAS RECUTnrr GETDA(.F.r­ Ft RIGHT. ; 1 ' F I RST. sf LEFT. . I!2 . " G " CONST. 5 rQ rUip. . ' 7) 010111) .5 f F R 0 1,4 4. 1PO A., -NICY GM '. MENT.0 f PEOU I REL)-- F I N B S, �, -, I t- 1 ft TOTAL f M01-1E D—ECTOR'". :y . . . . .. . . . , :­Z b 1530 PARKING GPACES. - I MR L.010. . . . :40 Psf "O'PL UC- - PIUMPTAlp VNT RG- WrITER HEATE RS,- - - TRAPS. . . . . . . . . . . ... . SEWER LINE '(ft ) - R C A,Gj E TRAM Z;. . . . . . . .0 I'TER CLOSETS. . :., :,44TEr L I Nc (f t too nTHrR !1RDAGE DISE'. . » . 1 RPIN DRAIN (ft) - -0 or -AIN DRATN�!- MECI IAN IN"AL 4:i m VE.*NT S - 0 1 F f 1550. ,")o JD V!':1 -1 - 'I x111411 t I n-41. l3c JD HOODS. - Gwm 100. 00 JD 06/07195x 5­2 6 6 :0 SPP" 00 j!) 0 6 05 PPLC t 20 0595 L.'-j 0 R F I JR N- - "M 0 5 L 1 N't T5 A 6 0 AC U-r rIAM". $ !�-300. 00 JD C. ._'c' -MPnT $ mrllt_c 11n JD Q4 G V' m'i—c JD 0 .1/95 C. ERI-'C 30 TO 01, $ TOTPI.. INGP'�CTICNS REDUIRED i lr%c4 TI n s t, Plumb Top , rowvlatlon Ins'' Fr Insf p c.,4 11 c; t t/n 't m MD C.,tj jA T,, r s p T rt n _j .'T cod P! M/uinr!t-�� f loot al 1-1,�p W'A harA 175 .CITY OF71GARD Fl7rPrlT COMMUNITY DEVELOPMENT DEPARTMENT' A7 7I TC#). . 541F,3c, 0, 13126 SW Hail Blvd.Tigard,Oregon 97223#9199 (503)639-4171 n n C?il. „ . . MOUNTAIN HIGHLANDS ZONTNG: PT, LOT. 01 _rl NiC!. . . . . „ . . . 1 ?Y7UrE UNITS. . . . OF Lt3: . . . . , I J. OF L'UIL.DINGS: L .,(.1 ,,.,• T i�lfrr�r,'�' l�rf='Ai.��. . PATH I �,r, __ .. ..._.._. .. �.......__.._. .,.-__._..__. FU E 73 r .•� T 1 - •• i.d t Y 4=':', aim � Ly t: is IN �'' 1• ��. ?10 10 il()/Ili`.11 � ". ;':%f•. i , 0 1 lJ ---raul►rEn Ir���rcc;�rrr.+� E"Alai '�N din fi'31 _ Tf i�t� 4. .,F t ','fe.ii: if efc ....... r h— r1 hal .1Q C-9 W J (A6 2 l i City of Tigard Residential Building Permit Application G '` 1?125 SW Hall Blvd. Tigard, OR 97223 t 503) 639-4171 Jobsite Address: ���(, 13oTIC SGC r / ��C'U�7�[�rr )�-/ Office Use Only Subdivision: 1 / (G��f Lot# Valuation: / , .5. 0, ✓ Contact Date -- Result Planck/Rec # S" qg �- Nqw Construction Only: (Square Footage) Permit # l�Sf S a�� U. U_3 House: i f Garage: Reissue of Map & TL# i Grl nr) i,jC( Zone Coni: Y ► Lot? ( N- Plat # n , Flag Lot? Y �I � — Owner: l K _) ��n�� c'a� Approvals Required -/ �) % �( Planning Setbacks V c9V_- Solar VO� Address: 5 S Engineering yr tlGn� Cl j '1/ Other _ Phone: ( -� ) �'9'� -/7l0.S� Items Required Contractor: V J�l oll/t�0/yl.�J/L�. L / - �in�2 y j��r Subcontractors Truss Detaiis Address: �� S/ S /s 7' rC- Other— 17, / Notes, Phone Contractor's License # �G'S 5 d �� _VV YGCUYA 0 -- - / (attt copy of current Oregon license) Contact Name: ! l i� cc_. ��-I �' n Contact Phcne: Subcontractors: I %ku � rArchhecdEngineer: Plumbing: /i��' �/u A `r ^ 16 /7 58 Address: --,JI /� Mechanical: flh F3 or k r er (attach copy of current OR Cont actor's License) Phone: IL 9 LO JO SCRIPTION r ( �c> J l� So.S ) 4, - /71,S licant Signature Applicant Phone number Received by: =�, l K: y ^ermit# Account Description Amount Amt. Pd. Bal. Due .w -0 0 Bldg. Permit (BUILD) Plumb. Permit (PLUMB) 2 v,� _ Z S•vD �/ Mech. Permit (MECH) J •c- ,� State Tax (TAX) _ 2, LU L12 , Y d Bldg: 6 Plumb: Mech Pian Check (PLANCK) 5 3, 14 1 Bldg: ����• �� / Plumb: Mech: , Z, f. Sewer Connection (SWUS,4) _Ll . Sewer Inspection (SWINSP) Parks Dev Charge (PKSIiC) S UU Soo- c-� ✓ Residential TIF (-'F-R) Mass Transit TIF (TIF-MT) Commercial TIF (TIF-C) Industrial TIF (TIF-1) Institutional TIF (TIF-IS) I Office TIF (TIF-0) Water Quality (WOUAL) Water Quan!;iy (WOUANT) / ���� X00 4..� ✓' Fire Life Safety (FLS) r- Erosion Cntrl Permit (ERPRMT) =Y.,_ Erosion PiancklUSA (ERPLAN) f" Erosion Planck/COT (EROSN) e Y? TOTALS: Solar Balance Worksheet Address Box A calculations : North-South dimension for the lot . r Box A: Tris dimension is determined by finding the midpoint of the North lot line and drawing an intersecting line perpendicular to that point . Measure the distance from the midpoint of the North lot line to the South lot line along the described line . ft Box B calculations : Shade point height from your structure . Box B : 1 . Determine whether measurements will be based on the peak or eave of your structure . The orientation of the ridge is also important . Which la : Tf the roof line runs North-Soutn, measurements will be describes based on the peak of the roof . your lot? lb: If the roof line runs East-West and the roof pitch is less (Circle one) than 5/12 , measurements will be based on the eave . lc : If the roof line runs East-West and the roof pitch is 5/12 la lb lc�ll or steeper, measurements will be based on the peak. 2 . Measure change in elevation from front property line to finished floor elevation. ft 3 . Measure distance from finished floor elevation to the af:'zcted peak/eave . + 2( Lr ft 4 . If the roof line runs North-South, deduct three feet . If the roof line runs East-West, deduct nothing. � ft 5 . Subtract one foot for each foot of difference in elevation from the front property line to the rear property line, if the lot slopes up from the front to the rear. If. the lot X has no slope or slopes up from the rear to the front, ft deduct nothing. 6 . Total figure for box B : ft Lox C. Distance to the shade reduction line . Box C: LL J . Measure the distance from the North property line to the foundation . 2`j ft Un F 2 . Measure the distance from the foundation to the affected ft J peak or eave . 3 . Total figure for box C: w � Solar Balance Point Standard Box A. North-.South dimension for your lot Box B. Shade point height from your structure feet � �-.� � feet Box C. Distance to the shade reduction line (J Feet Distance to shade 100+ 95 90 85 80 75 70 65 60 55 50 45 40 reduction linin from northern lot line in feet 70 40 40 40 41 42 43 44 65 3j 38 38 39 X40 41 42 43 60 36 36 36 37 38 39 40 41 42 55 34 34 34 35 36 37 38 39 40 41 50 32 32 32 33 34 35 36 37 38 39 40 41 42 45 30 30 30 31 32 33 34 35 `36 37 38 34 40 - 40 ------ -8--_1 a - 2S 3 3 3 – 34-- --3.5_----3 6—-3-7 -- 38- 35 26 26 26 27 28 29 30 31 32 33 34 35 36 30 24 24 24 25 26 27 28 29 30 31 32 33 34 25 22 22 22 23 24 25 26 27 28 29 30 31 32 20 20 20 20 21 22 23 24 15 26 27 28 29 30 15 18 ifs 18 19 20 21 22 23 24 25 26 27 28 10 16 1.6 16 17 18 19 20 21 22 23 24 2., 26 5 14 14 14 15 16 17 18 19 20 21 22 23 24 Boy: "D" Maximum allowed shade point t,eight feet v; 1 i r (A 1o91n\viols\eolerh..I F— —1 (_T t.Ll .J CITY OF TIGARD DATE' �,�Tc ICUer7: 06l0""?5 COMMUNITY DEVELOPMENT DEPARTMENT 13125 SW He 11 Blvd.Tigard,Orspon 07223.8180 (503)830.4171 PARCEL: ;1474 Dl7- 4'�1 ti•454'� ;r-3');V I^ION. . . . . MOUNTAIN I-I I GIALANDS ZONING: R--4. 5 PT) I_C1T. .. . . . . . . . . .. . . 01 i '^r r1 r` 4�C I'^I',. ,. :t•iCW _•;9rA.'1-i'r�_i� r. 17/-1.1-AI..s. . 1 OF USE. . . z r r' WACHING MAC-4. . . . . . . : 1 DACKFLOW PRCVNTRa. . : 1 :CUP(INCY jr,% . FLOOR DRAINS. . . . . . . :0 Tr' S. I . . . . . . . . . . . . ;0 `ORIEG. . . . . . . . :.:: WATE': HCATER6. . . . . . . 1 CATCH IRA STNS. . . . . . . .0 URi: 73 LnUNDrY 7r.AY7. . . . . : 1 SF RAIN 1r'Rt;INS. . . . . : i. NNS. . . . . < . » . , GREASE TRAPS. . . . . . . .0 OTI iF'R FT XTURES. . . . , ;Q, "I/SHOWERS. . ,• . SEWER t_INr (ft ) . . . . :0 mn ' ' 'r`r LINE (ft ,' -- . 1 :� IWAr;rt' Tr'�. • . . ; , ?,"," ",� DRAIN (ft ) . . . . R 0 .l a,arks; PATH I :NERu __ ....... . _... . ..__.. .- _...._..._._ Pus a LINDA r:,flrl'!, "-T r t I""I" 1211r 515 SW 61ST PL SWM $ 180. 00 .;D 06./02/95 95--2661-- SWI --266SWM 3• 1410. 'i0 it) 266,1 _"LAND Or, 97LIc) 11PRT t 568. 00 JD of-1/02/gs C) 6c2' e #d , 24r 17rC 'j 71PI,C i :7102. "_:c", CW 05/1r,/)r" 1'i :irC BSAC 29. 40 JD 95-. ,":66J.,;:.C, is r) T) •) ConI r r c, 7,AF',;; 300. 00, JD �;;_/�'�!9 fir✓ / MF"F2T e 45. 00 JD 0G/0 :/95 9S k-a P�,wmw of ►� l �c�'rt,1 ��S Ii�t.c: 11 11. 5 Jr) 0C,/r4t�/'}s 'Y a(J95 / /(�o 015DC c. `5 JI3 r<6 f9°; ry5...; 01C ;11T)t 1; :.:': V)0 JD 0 6/0;:':f":)5 ');:> 2b r', 700 95 3 F'"5AC 11 15 in 06/02/95 95-266 D�Q/ 7j $ A,�r1ir: (anal fees not shown hero. . . . . REPU.1 RCD I N)PEC'T I ONS _OP; Mit is i ,sued :r�_,b.j(ar::t; {•c� Ll J, w� contained in the Ticlard Municipal Foot inp Inro 'ns,ulati en Int o ;.2. e, Pe}ciia l .y roes a n(1 ,gal Fo;.tndal: ion Irisin Cllr, rloat-d In_� hei c:iF)plicablfe laws. All wnr,k will t:;e dc,ne Post/Tleam Str,uct Rain dt-ain Insp �+C :Ui`,j��r".(: r� 4'Jith1 r:,Itwl"uVeC1 `^:.aal",h. Tli:i, 3 rid t. ret l� M(?(:han Water Line ln .ip bt - r;it will oxpire if wci-k is not star-tcdl Crawl M-ain Wate►- Gervice Ir, of . r Plm/1,Andalab Insp iQppv-/Sdwlk I;.,.p ra, more tpiato 160 ti,:ty 5. PLM/Un 0erfIc cr• Mech.'tnic-Al MP,AIAI:ical In�il2 Plumb r"inAl Oh / �/c. ��.� r �� . �''lu�li� Top nut Building Final t caminq lnsp Cra�� inn Cu;ltl rel v~i '''il eplae:e In5p 17:3 W J r Community Development ELECTRICAL PERMIT APPLICATION 131?5 SW Hall Blvd. Tigard, OR 97223 Planck/Rec. # Permit # '' _5.5—U AAq Phone (503) 639-4171 Date Issued CITY OF TIOARD FAX (503) 684-7297 TDD No. (503) 684-2772 Issued by clic.r1t+S Sc jl rrlydt Inspection (503) 639-4175 1. Job Address: 4. Complete Fee Schedule Below: Name of DevelopmentsiA� �--T^ C � Z Number of Inapectione per permit allowed Address k j- s(-f -,4 OL.AC-E- Service included: Items Cost(ea) Sum City/State/Zip-T, t V R OLD 4s. Residential-per unit 4 1000 sq it Orissa �— $11000 1 1 Q C,<i Name (or name of business)_ tC,nJ 11CV nc- (U t,t_) Each additional 500 eq It or portion thereof _ _ $2500 Commercial❑ Residential Limited Energy $2500 Each Manurd Nome or Modular 2 Dwelling Som oe or Fender $M 00 2a. Contractor Installation only: 4b.Services or Feeders . Installation,00mor+leaon,or relocallon 2 Electrical Contractor W I`Z l( Tt � F t����--�-�t- 200 amps or less $60.00 2 Address `F�)US_ E- 13 tom-,, A U L� 201 amps to 400 amps S8000 2 City ���RT L_F1!y Q State �'�t� ZI C^\t �,�_1j�, 401 amps to 600 amps -_ $120 DD 2 _S1Ya. p 1 601 amps l0 1000 amps $18000 2 Phone No. Over 1000 amps or volts $34000 2 Contractor's License No. Reconn"d only $5000 Contractor's Board Reg. No. f-1 4c. Temporary Services or Feeders Installation,alteration,or relocation 2 Signature Of Supr. EIeC'n G Q ✓ 200 amps or leas $5000 2 noata $ zLicense No. Phone No.'l� -5S`�ZZ— t mps o 600 amps Over 600 amps to 1000 volts 2b. For owner installations: see•h•above 4d. Branch Circuits Print Owner's Name New,alteration or extension per panel Address a)Tho fee for branch circuits with City State Zip purchase of service or bedor Are. 2 Each branch circuit f5 00 Phone N0. b)The lee for branch corcuds without I he installation is being made on property I own which is purchase of service or borer fee. 2 First branch circuit $3500 2 not intended for sale, lease or rent. Each additional brans,circuit $500 Owner's Signature 4e. Miscellaneous (Service or feeder not included) 2 3. Plan Review section (if required): Each pump or irrigation circle $4000 2 Each sign or outline lighting $4000 Signal cimus(s)or a limited energy 2 Please check appropriate item and enter tee in sect;m SB. panel,aherahon or exlension $4000 _ 4 or more residential units in one structure Minor Labels(10) $t0000 Service and feeder 225 amps or more h~ _System over 600 volts nominal 4f. Each additional inspection over 0- Classified area or structure containing special occupancy the allowable in any of the above as described in N E.0 Chapter 5 Per inspection $3500 Parhour WOO Submit 2 sets of plans with application where any of the above In Plant $5500-- �- apply. Not required for temporary construction services. 5. Fees: NOTICE 5a. Enter total of above fees $ 1 1`j DD 5%Surcharge(.05 X tote!tees) $ w PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $ AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF 5b. Enter 25%of lino A for CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Plan Review if required(Sec.3) $ A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $ COMMENCED L_1 Trus!Account 8 $ Balance Due $ ?� G errd`ogra am