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10405 SW HIGHLAND DRIVE 0 A 0 LVIN C 2 (a Ai 7 L1 v 10405 SW Highland Drive CITY OF TIGARD BUILDING INSPECTION DIVISION 24-Hour Inspectior Line: 639-4176 Business Line: 639-4171 MST _-- --T G BIJP Date Requested. / ��/ AM !� PM Bl p Location_ J(-) Y0 5" �orl (j �r�c Suite MEC Concact Person Ph �S 5—I PLM Contractor / S Y Ph SWR BUILDING Tenant/Owner _- ki_V Uui nu Retaining Wall Footing ELR -.-- Foundation Access. FPS Ftg Drain Crawl Drain Inspection Notes: SGN _ Slab r' 71J .P� SIT Post 8 Beam _-- Ext Sheath/Shear Int Sheath/Shear - _ --------------._.__ Framing Insulation -- Drywall Nailing - Firewall _ - - Fire Sprinkler Fire Alarm -- Susp'd Ceiling _ Roof klisc: Final PASS PART FAIL PLUMBING Post&Beam -' — -- ---- Under Slab Top Out - trrater Service Sanitary Sewer -- Rain Drains Final - - PASS PART FAIL MECHANICAL Post&Beam — -— Rough In Cas Line - ,.�... Smoke Dampers Final ------- ---- - - — PARR PART FAIL cTRICAL "- Se — Ron h In 0.1 g UGISIab Low Voltage Fire Alarm PASS F,T FAIL Backfill/Grading _ Sanitary Sewer Storm Drain [ ]Re-spectionfee of$ required before next Inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin please call for reinspection RE:_,- Fire Supply Line [ ] p - [ ]Unable to inspect-no access ACA _ Approach/Sidewalk Date I nSpector 7 Ext Final �~ PASS PART FAIL DO NOT REMOVE this Inspection .record from the job site. CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24-Hour InsRiection Line: 639-4175 Business Line: 639-4171 -- - BLIP Date Requested 7- 0 _A M BLD Location C". go .'� �'V � Suite MEC e2 1 Go 3 ! r Contact Person ��'-Q� Ph "7 5-Z (o 5- C,, PLM Contractor Ph SWR BUILDING Tenant/Owner ELG --- - _ -- — - Retaining Wall ELR Footing .�.._._.�..�� Arcess: Foundation FPS Ftg Drain Crawl Drain SGN Slab Inspection Note ,, „ ��, __--- ------ Post BBeam SIT _-- --- - --- Ext Sheath/Shear int Sheath/Shear Framing C.'17, Z Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc. Final PASS PART FAIL _-_-__- _._----•------__.-------------._T_ PLUMBING Post 6 Beam - Unoer Slab Top Out Water Service Sanitary Sewer - - ---------- Rain Drains Final PASS PART FAIL CCHANICAL Post& Beam Rough In Smoke Dampers k na _ -- -- . -- - - - ASS PART FAIL. ELECTRICAL ---- Servire Rough In -_ UG/Slab Low Voltage Fire Alarm Final PASS PART FAIL LATE Backfill/Grading ----- Sanitary Sewer Storm Drain f j Reinspection fee of$ - required before next inspection. Pay at City Hail, 13120 SVV Hail Blvd Catch Basin Fire Supply Line [ ]Pleriae call for reinspection RF: [ j Unable to Inspect-no access ADA Approach/Sidewalk Other Date al `7/ T_ hisp..ctor x� Ext Final LPASS PART FAIL DO NOT REMOVE this, inspection record from the job site. CITY �0 F TI GA►!�D ELECTR!�,AL PERMIT ` PERMIT#: ii�LC2001-00448 DEVELOP. IEN i SERVICES DATE ISSUED: 9/6/01 13125 SW Hall Blvd., T;aard, OR 97223 (5031639-4171 PARCEL: 2S111CC-12200 SITE ADDRESS: 10405 SW ,41GHI-AND DR SUBOlViSiON: SUMMERFIELD NO.4 ZONING: R-7 BLOCK: LOT : 173 JURISDICTInN: TIG Project Description: Installation of(2} branch circuits for new furnace and a/c unit. RESIDENTIAL. UNIT TEMP SRVC/FEEDERS _MISCELLANEOUS 100(i SF OR LESS: 0 - 200 amp: PUMP/IKRIGATION: EACH ADD'L 500SF: 201 - 41)0 amp: SIGN/OUT LINE LTG: LIMITED ENERGY: 401 - 60)amp: SIGNAL/PANEL: MANF HM/SVC/FDR: 601+amps - 1000 volts: MINOR LABEL (10): ` ^3ERVICE/FEEDER _ _BRANCH CIRCUITS ADD'L INSPECTIONS 0 - 200 amp: W/SERVICE OR FEEDER: PER INSPECTION: - 201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR: 401 - 600 amp: EA ADD'L BRNCH CIRC: 1 IN PLANT: 601 - 1000 amp: _ _PLAN_ REVIEW SECTION 1000+amp/volt: >=4 RES UNITS: R > 600 VOLT NOMINAL.: Reconnect only._ SVC/FDR >=225 AMPS` CLASS AF'-:A/SPEC OCC: Owner: Contractor: HFRP, DONALD H -- PHIL'S ELECTRi HERR, MARTHA M 6600 SE CHARLES ST 1040.5 SW HIGHLAND OR MILWP,UKIE, OR 97222 TIGARD, OR 97224 Phone: Phone: 659-0303 Reg#: LIC 46126 ELE 3-217C SUP 3201S _ FEES Required Inspections Type By DateAmount Receipt Rough-in PRM2. T GTR 916101 $53.50 720010000( Elecl'I Fina( 5PCT CTR 9/6/01 $4.213 2720010000( -�-- Total $57.78 This Permit is issued subject to the regulations contained in the Tigard Iviunicipal Cade,State of OR. Specialty Codes and all other applicable laws. All work will be done In accordance with approved plans. This permit will expire If work is not started within 180 days of Issuance,or if work is suspended for more than 180 days. ATTEN I-ION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0080. You may obtain copies of these rules or direct questing to Per-nit Signature:: G `�J =- _ Issued By: OWNER INSTALLATION ONLY The installation is being made on property own which is not intended for sale, lease, or rent. OWNER'S SIGNATURE: DATE:_ CONTRACTOR INSTALLATIO► ONLY SIGNATURE OF SUPR. ELEC'N: r Z CG J fcl��^" __�_�_ DATE:_ LICENSE NO: --- Call 639-4175 by 7:00pin for an inspection the next businAss day Electrical Permit Application Datereceived, Permitno.: LC�eIo/ -cbyy$ City of Tigard Project/appl.no.: Expire date: Cifyn(Tigard Address: 13125 SW Hall niv(i,'I'ipar,l,lip 97223 Date issued: g -- Phone: (503) 639-4171 Y: Receipt no.: ` Fax: (503) 598-1960 Case file no.: Payment type. Land use approval: _-tl..... __ Jia I &2 family dwelling or accessory U('ununerrud/indu.tiUi:tl U Multi-larnily J Tenant improvement U New construction U Addilitrn/alleration/replacement U Other: J Partial JOB SITE INFORMATION Joh address: ,�. lll,�t tt, all Suite no.: Tax map/tax lot/account no.: Lot: Block: _ S_uhdivision: -- --name: --- Project mu J Description an 1 location of work on premises: 4r Estimated date of completion/inspection: ;:z APPLICATION I Job no- ____ fee Max Business name: y — - �� Uewriplimi 01,1. (Pa.) lural nn,imp - New re%iderdial-Angle or multi-famil;Irrr AddrCSS: ,,e divellingunil Inclmk,anaclKdgnnuge. City:Lai za"q 6A Slate: ZIP: Servk-included: Phone: Fnx: h-mail C. 1000 sq,Vit.orless 4 CCB no.: t �'r Hach additional SW s .ft or onion thcreur F:I:c.itus.tic.Ro:.3.:r � fn-1•C� q P -- I.fntftedcnergy,residential 2 City/metro lie.no.: Li mi led energy,non-residential 2 Each manufactured home or modular dwelling Signa ore n s! u 'rv{sing electrician(required) trate �.A Service and/orfeede, 2 Sup.elect,name flrint): License no:4,) r Services or feeders-Installation, dteratton 'r relocation: 21)0 amps or lnd ess 2 INme(print): 201 unips to 400 amps 2 iling address: 401 amps l0 600 amps r 2 _ 601 amps to I lxx)amps 2 City: StalC: ZIP: Over 1000 amps or volts 2 FaX: Ii-mail; Reconnect only Owner installation:The installation is being made on property I own Tempora, ervices or freden- which is not intended for sale,lease,rent,or exchange according to installation,alteration,or relocation: ORS 447.455,479,670,701. 2(x)amps or less 201 amps to 400 amps 2 hnlurr: hate: 40ttoW)amps --- -2 lot:15 Braneheircut!s-nery alteration, Nance: or extension per panel: - - -- A. Fee for branch circuits with;; •,;;a,c of Address: - _ service or feedrt fee,each bra v h circuit 2 City: StalC: ZIP:� d. Fee for branch circufts without i.•,rchme Phone: E-mail: -- of service or feeder fee,First branch cucult: / s" Each additional branch circuit Misc.(Service or feeder not included): U service over 225 amps-commercial U Health-care facility Fach pump or irrigation circle 2 U service over 320 amps-rating of 1&2 U Horordous location Each sign or outline lighting 2 familydweilings U Building over 10010 square feet four or Signal circuit(s)or a limited energy panel, U System over6(x)volts nominal more reAdential units in one structure alteration,or extension' 2 L.Building over three stories U Feeders.4W maps or more •Ikacti lion:__ _ J Occupant load over 99 persons U Manufactured structures or kV park Fatch ad.'ltional Inspection ov-.:the allowable In any of the alcove: J I.gress/lightingplan U Other -_ pernis ection _ %bntlt_vets of plans with any of the above. Investigation fee 71he above are not applicable to temporary construction service. other fee.....................$ Nor all)udsdicnona tlCCepr credit cards,pleasecall jurisdiction far more infnnnmirn. Notice:This permit application Perm U vis. U Mastercard expires if a permit is not obtained Plan review(at %) $ Credit card number.-_ // '' within ISO:sys alter it has been State surcharge(8%)....$ Y. Expires accepted as complete. TOTAL .......................$ — 7.7 t Name of cardholder as shown un ctedlt card CvTolder dgnature An.mal 440-4615 uSAX C'OM) Electrical Permit Fees: Limited Energy Fees: Complete Fee Sc'�edule Below: TYPE OF WORK INVOLVED -RESIDENTIAL ONLY Restricted Energy Fee..................................................... $75.00 _ qumber of Inspections per perrrtit allowed (FOR ALL SYSTEMS' Service included, Items Cost Total Check Type of Work Involved: Residential-per uni• 1000 sq ft.or less n I4� 15 4 ] Audio and Stereo Systems Lach additional 500 sq it of vortion thereof $3340 1 F-] Bt'rgiar Alarm L.'-ked Energy $75.00 Each Manurd Home or Modular Garage Door Opener' Dwelling Service or Feeder $90.90 2 Services or Feeders [] Heating,Ventilation and Air..onditioning System' Installation,alteration,or reloration 200 amps or less _ $80.30 2 Vacuum Systems' 201 amps to 400 amps _ $106.85 2 401 amps to 600 amps $160.60 2 b01 amps to 1000 amps $240.60 _ 2 Other Over 1000 amps or volts _ $454.65 _ 2 Reconnect only $6685 _ 2 -- Temporary Services or Feeders TYPE OF WORK INVOLVED -COMMERCIAL ONLY Installation,alteralion,or relocation Fee for each system......................... ................_......... .... $75.00 200 amps or less $66.85 2 (SEE OAR 918-260-260) 201 amps to 400 amps $100.30 2 401 amps to 600 amps _ $133.75_ 2 Check Type of Work Involved: Ovor 600 amps to 1 ono volts. ❑ see"b"above. Audio and Stereo Systems Branch Circuits Boller Controls New,alteration or extension per panel a)The foo lot branch circuits with purchase of service or Clock Systems feeder lee. Each branch circu 4 $665 ❑ Data Telecommunication Installation b)The fee for branch ct.suits without purchass '1 service Fire Alarm Installation or feeder fee. First branch circuit $46HVAC .85 _ ❑ Each additional branch circuit $6.65 Miscoilaneotis Instrumentation (Service or feeder not Included) Each pump or Irrigation circle $53.40 Intercom and Paging Systems Each sign or outline lighting _ $53.40 _ Signal circuits)or a limited energy panel,alteration or extension $75.00 _ El Landscape Irrigation Control, t4inor Labels(10) _ $125.00 Each additional inspection over ❑ Medical the allowable In any of the at)( re Nurse Calls I'er inspection $E2.50 ❑ Per hour $62,50 In Plant $73.75 Outdoor Landscape Lighting' Fees: [] Protective Signaling Enter total of above fees $ ❑ Jlher - 8%State Surcharge g _ - Number of Rystems 75%Plan Review Fee See"Plan Review"!;v�Ulu,o,i $ ` No licenses etc required Licenses are required for all other installations front of application _ _r Fees: Total Balance Due $ - — Enter total of above fees $- -El Trust Account#_ _ 8°/State Surcoarge s — Total Balance Due i:%Jstskfomuklafees.doc 10/09/00 CITYOF TIGARD _ MECHANICAL PERMIT PERMIT#: 9/6/01001-00316 DEVELOPMENT SERVICES DATE ISSUED: 9/6/U1 13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-41'1 PARCEL: 2)MCC-1200 SITE ADDRESS: 10405 SW HIGHLAND DR SUBDIVISION: SUMMERFIEI_D NCA ZOtLING: R-7 BLOCK: LOT: 173 JURISDICTION: TIG CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS: TYPE OF U,,E: SF UNIT HEATERS: VENT FANS: OCCUPANCY GRP: P.3 VENTS W/O APPL: VEN'7 SYSTEMS: STORIES. _ _BOILERS/COMPRESSCRS HOODS: FUEL TYPES _ 0 - 3 HP: 1 ~ DOMES. INC1N: 3 15 HP: COMML. INCIN: MAX INPUT: BTU 15 -30 HP: REPAIR UNITS: FIRE DAMPERS?: 30 - 50 HP: WOODSTOVES: GAS PRESSURE: 50 i HP: CLO DRYERS: FURN < 100K BTU: 1 _ AIR HANDLING tiNITS OTHER UNITS: FURN >=100K BTU: <= 10000 cfm: GAS OUTLETS: 1 > 10000 cfm: Remarks: Installation of A/C, gas furnace and gas pipin3. A/C cannot be placed within the required setbacks. Owner: FEES HERR, DONALD 11 + Type By � Date Amount Receipt FIERR, MARTHA M PRMT CTR 9/6/01 $72.50 2720010000 1(AO5SW HIGHLAND DR 5PCT CTR 9/6/01 $5.80 272001000E TIGARD, OR 97z, Total $78.30 Phone: Contractor: W ILI_AMETTE HEATING i- AIR COND DAILY, JOHN T. 4370 NE HALSEY STREET REQUIRED INSPECTIONS PORTLAND, OR 97213-1566 Gas Line Insp Phone:284-3740 Heating Unt Insp Reg#:LIC 79226 Cooling Unt Insp Final Inspection This p3rmit is issued subject to tie regulations contained in the"Tigard Municipal Code, State of Ore. Specialty Codes and all other appJcable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION-. Oregon law requites you to fellow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0080. You may obtain copies of these rules or direct questions to OUNC by calling (,,n-A)9AG-Q1 MI.., // ate'' /`. / ' Issue By: t �if ,� � Permittee Signature: Call (503) 639-4175 by 7:00 N.M. for inspections needed the next business day Mechanical Permit Application Uatercccived: Fcrmit no.��(' ,�,3/ City of Tigard Project/appl.no.: Expire date: Ci(vgffigard Address: 13125 SW Ifall Blvd,TiV,OR97223 Phone: (503) 639-4171 Dateissued: pt no.: _ By' Recei _ Fax: (503) 598.1960 Case file no.: Paymenttype: Land use approval: _ Building permit no.: TYPE OF PERMIT U 1 &2 family 6w,.;;ling or accessory U Comfnercial/industrial U Multi-family J Ten;nit improvement U New constructi in U Addition/alteration/replacerncnt Ll Other: JOB SITE INFORMATION tMMERCIAL VALUATION 1011 Job address: < <� ' G? icaw equipment quantities it fwxes below. :ndica(e the dollar Bldg,no,: Swte no.: value of all mechanical materials,equipment,labor,overhead, Tax map/tax lot/account no.: profit.Value$ , Lot: JBI(xk: Subdivision: *See checklist for important application information and Project name: _ jurisdiction's fee schedule lb, residential permit fee, City/county: Description and loQAuon of work on premises: ' t t --=� - lkw•ri lion 111►. Rtw.onl�' (tt+.rad� Est.date of complefion/inspection: P _— Tenani improvement or change of use: 11 Ac. Ao handling unit ._".._�___._CFM existing space heated or conditioned?U Yes U No Air con itioninI"(site plan require ) Is existing'sp;(CV insulated?U Yes LJ 'J" A terativnofexisting CsystemMECIIANICAL CONTRA( ioiler compressors State boiler permit no.: Business name: c1 HP Tons BTLI/H Address: `- -, ``` 'ir•smo c damper uct smo a etectors City: _ State: !P: seat pump(site plan required) _ Pt one: ax; Email: nstn rep ace furnace/burner urner i'fU IP Including ductwork/vent liner U Yes U No J C Cno.: � /� "c�;.' nsta 1 replac relocate eaters-suspen ed, 11 C'it /metro tic.no.: wall,yr floor mounted Narte(please print): Ant tornr lianceother Ihan I umac•e all all Refrigeration: Absorp(m„nunits�____,___.__ li'ht!IH Name: Chillers—___ til' Com remors IIP Address: snv ronmental exhamt and ventilation*. City: State: R ZIP: Appliance vent _ Phone: Fax: 1; nutil; )ryerexhaust _ Dods,Type res. lichen azmat hood fire suppression system Name: Exhaust fan with single duct(bath fans) Mailing address: iucaust sstern a ar from hearing o;AC State: Z,I!': piping an st at on(up tA�tl city: Z_ ,_:pe: LPC7 1�- NO Phone: i ax E-mail: Fki i in car a itioniiove: o MOM I Process piping(schematic required) _- Number of outlets _ P(atne: (mer listed appliance or erylTent: Address: _ Decorativefire lace` City: State: vp: ~ nsert type Phone: Fax: E-mail: Woodstove/pc et stove (hher. Applicant's signature:- Date: Name(print): Not ail lurisdictians accept•'redii cards,pka.e calf)owsdicilon for more informallon, 11c rmit fee..................... Notice:'fhis permit application Minimum fee................$ J Visa U MasterCard expires if a permit is not obtained 1ledncard number: _� �a._ _-- _ Plan review(fll �_ 96) $ -1;spir—eL'— within 190 days after it I,as been _____ State surcharge(896)....$ Nilo of iaAo der as s own rm credit card accepted as complete. [p(AI $ 5 . ....................... Crudholder signature ��mounl 440.4611(60W,0101) MECHANICAL PERMIT FEES C)MMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE: TOTAL VALUATION: PERMIT FEE: Descrip"rin: Price Total $1.00 to$5,000.00 Minimum fee$72.50 Table 1A Mc 1ianical Code Uty (Ea) Amt $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and 1) Furnace to 100,000 BTU $1.52 for each additional$100.00 or including ducts&vents _ 14.00 _ fraction thereof,to and Including 2) Fumace 100,000 BTU+ $10,000.00. including ducts&vents 17.40 $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and 3) Floor Furnace $1.54 for each additional$100.00 or Including vent 14.00 fraction thereof,to and including 4) Suspended heater,wall heater $2.5,000.00. _ or floor mounted heater 14.00 $25,001.00 to$50,000.00+ $379.50 for the first$25,000.00 and 5) Vent not included in appliance permit $1.45 for each additional$100.00 or 6.80 fraction thereof,to and including 6) Repair units I $50,000.00. t 12.15 $50,001.00 and up $742.00 for the first$50,000.00 and Check all that apply: Baiter Heat Air $1.20 for each additional$100.00 or For Items 7-11,see or Pump Cond fraction thereof. footnotes below. Comp"' _ 7)<3HP;absorb unit Minimum Permit Fee$72.80 SUBTOTAL: $ to 100K BTU 14.00 8)3.15 HP;absorb 8%State Surcharge $ unit 100k to 500k BTU 25.60 __ --.--_-__ T_e- _--.---.-----_ 9)15-30 HP;absorb 25%Plan Review Cee(of subtotal) $ unit.5-1 mil BTU 35.00 _ Required for ALL commercial permits only10)30-50 HP;absorb __ TOTAL COMMERCIAL PERMIT FEE: $ unit 1-1.75 mil BTU 52.20 11)>50HP:absorb unit>1.75 mil BTU 87.20 ASSUMED VALUATIONS PER APPLIANCE: 12)Air handling unit to 10,000 CFM 10.00 Value Total 13)Air handling unit 10,000 CFM+ Description: Q Ea Amount 17.20 Fumace to 100,000 BTU,including 955 14)Non-portable evaporate cooler ducts&vents 10.00 Fumace>100,000 BTU Including 1,170 15)Vent fan connected to a single duct ducts&vents _ 6.80 Floor furnace includin vent _ 955 16)Ventilation system not Included In Suspended heater,wall heater or 955 appliance permit 10.00 rroor mounted heater 17)Hood served by mechanical exhaust Vent not Included in appiicance 445 10.00 permit __ 18)Domestic Incinerators Repair.snits _ 805 17.40 <3 hp;absorb.unit, 955 19)Commercial or Industrial type incinerator to 100k BTU 69.95 3.15 hp;absorb.unit, 1,700 20)Other units,Including wood stoves 101k to 500k BTU _. 10.00 15-30 hp;absorb.unit,501k to 1 1,310 21)Gas piping one to four outlets mu.BTU __. 5.40 30-50 hp;absorb.unit, 3,400 22)More than 4-per outlet(each) 1-1.75 mil.BTU 1.00 >50 hp;absorb.unit, 5,725 Minimum Permit Fee$72.50 SUBTOTAL: $ >1.75 mil.BTU Air handling unit to 10,000 cfm _ 656 8%State Surcharge $ Air handling unit>10,000 cfm 1,170 _ Non-portable evaporate cooler 656 TOTAL RESIDENTIAL PERMIT FEE: $ Vent fan connected to a single duct 446 _ Vent system not Included in 656 appliance permit Other Inspections and Fees: Hood served b r mechanical exhaust 656 1 Inspections outside of normal business hours(minimum charge-two hours) Domestic Incinerator 11,170 $72 hour Commercial or industrial Incinerator 4 590 2 Inci. ;..,!is for which no fee is specifically Indicated (minimum charge-hall hour) Other unit,Including wood stoves, 656 $ 50 per hour (nSel-fS,etc. 3 AdAdditional plan review required by changes,additions or revlclons to plans(minimun charge-one-half hour)$72 50 per hour Gas I In 1-4 outlets _ _ 360 Each additional outlet 63 _ `State Contractor Boiler Certification required for units>200k BTU. __ "Residential AIC requires site pia- showing placement of unit. 1T01-AL COMMERCIAL $ VAL(JA_'r,iON:_. i:tdstslformstmech-fees.doc 08/06/01 : � t c� _ � Q �v .� �� Mechanical. Permit Application Date received: Permit no.: City of Portland By: 1900 SW 4th,Ste 5000,PO Box 8:20,Portland,OR 97201 Phone: (503)823-7363,Fax:(503)82}3018 ` TDD:;503)823-6868,Website:www wlidr.ci.portlund.or.us U 1 &2 family dwelling or accessory U ommercial/industrial U Multi-family 'U Tenant improvement U New construction Addition/alteration/replacement U Othcr. Job address: Indicate equipment quantities in boxes helow.Indicate the dollar Bldg.no.: Suite no.: _ value of all mechanical materials,equipment,labor,overhead, Tax map/tax lot/account no.: profit.Value$ _ Led; Block: ubdivision: — *See checklist for important application information and Project name: f uri diction's fee+scheJule for residential permit fee Cit;/county: ZIP: ' Description and location of ,ork on premises: ' Fee(ea.) Total Building Permit #,if app cable Desc tion t Res.onl Res.onl Est.date of completion/i spection: i Will you call for inspec on within 24 hours?U YesU No Air handling unit CFM ^. - _ $19 Air condinorin site p an required) 19 Tenant i, tprovement(J) change of use: Alteration of a sting A system _„ v$24 Is existing spaheated or conditioned?U Y 3 No - of er compr ssors Is existing spainsulated?U Yes 0 N�/ State boiler rmit no,: HP Tons _ BTU/H $24 ism a am ers uct smo a electors 1� eat mp(site an rc uirc - 8_ Business name: nst replace furnace/burner Address: Inc ding ductworldvent/liner U Yes U No $40 City: State: ZIP: in rep ace relocate heaters-suspended, Phone: Fax: E-mail: all,or boor mounted $19 CCB no.: ent ora Lance of erthan furnace __ __ _,._ Refrigeration- City/metro lie.no.: —�� Absorption units 8TU/H Name(please print): Chillers HPCONTAGI PERSON --- Com ressors HP Environmental ex oust and ventilation: Name: App iance vent _ $16 -- Dryer exhaust Address: Hoods,Type 1 /res. ite—Few mat City: -- _ _ State: ZIP: hood fire suppression system - Phone: Fax: E-mail: Exhaust fan with single duct(bath fans) $10 x gusts stem aart from eating or ACTS Fuel piping and distribution(up to 4 outlets; Name: Type: LPG NC Oil $11 -- -- - - I L piping each ad itiOr over outlets Mailing address: — --�---- Process piping(schematic required) City: State: ZIP: Number of oullets Phone: Fax: E-mail: Other listed appliance or equ pment: Decorative fireplace $19 nsert-ty _ 42 Name: -Woodstovyyellct stove Address: Other: (including oil tanks,gas and diesel 4 City; State: ZIP: generators,gas and el-r•rtc ceramic kilns,gas Phone: Fax: E-mail: fuel cells,jewelry torches crucibles and other appliance/equipment not included above) A licant'ssignature: Name(print): ---- Notice-?his permit application Permit fee......................$_ expires if a permit is not obtained Minimum fee ($50) ....$� within iRO days after it has been Commercial Plan review(at 60%) $ accepted as complete. State surcharge(8%).....$-- TOTALTOTAL.. .........................$ 440-4617(6/WCOM)