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11770 SW MANZANITA STREET-1 IS VIINVZNdW MS OLL 6 L cn a z I z a 0 fl- 11770 SW MANZANITA ST a , CITY OF TIGARD MECHANICAL PERMIT DEVELOPMENT SERVICES PERMIT#: MEC2004-00782 13125 SW Hall Blvd., Tigard, OR 97223 (503)639-4171 DATE ISSUED: 1212/2004 PARCEL: 1 S 134CA-00516 SITE ADDRESS: 11770 SW MANZANITA ST SUBDIVISION: PANORAMA NO.2 ZONING: R-4.5 BLOCK: LOT:029 JURISDICTION: TIG CLASS OF WORK: OTR FLOOR FURN: EVAP COOLERS: TYPE OF USE: SF UNIT HEATERS: VENT FANS: OCCUPANCY GRP: R3 VENTS WIO APPL: VENT SYSTEMS: STORIES: BOILERS/COMPRESSORS HOODS: FUEL TYPES _ 0 - 3 HP: 1 DOMES. INCIN: 3 - 15 HP: COMML.INCIN: MAX INPUT: BTU 15-30 HP: REPAIR UNITS: FIRE DAMPERS?: 30-50 HP: WOODSTOVES: GAS PRESSURE: 50+ HP: FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS: OTHER UNITS: FURN >=100K BTU: <= 10000 cfm: 1 > GAS OUTLETS: 10000 cfm: Remarks: Install air ham'ier&heat pump. Owner: FEES PETERSOrv, KENNETH C Description Date _ Amount PETERSON, SHARON A INIFUll] Permit Fee 1212/200,e $72.50 11770 SW MAN7ANITA ST ITAg"„State Surchari 12121200L $5.80 TIGARD, OR 97223 Phone: 503-590-3531 Total $78.30 Contractor: SPECIALTY HEATING &COOLING 1601 SE RIVER RD HILLSBORO, OR 97123 REQUIRED INSPECTIONS Phone: 503-640-3607 Heating Unt Insp Misc. Inspection Reg#: LIC 66578 Final Inspection G. Ix H J_ m WThis permit is issued subject to the regulations contained in the Tigard Municipal Code, State.of Ore. Specialty Codes -� and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAF 952-001-0010 through OAR 952-001-0100. You may obtain copies of these rules or direct questions to OUNC by calling (503)246-6699. Issued By: Permittee Signature: t)'�� Call(503)639-4175 by 7:00 P.M. for Inspections needed the next buss nel ss day -Mechanical Permitpplic2tianIf 1H E q W Xg-4 City of Tigard r 1 A2'2z- PgroaltMi 13125 SW Rall Blvd.,TipH,OR 97223 Dan/my: ehona. 503639.4111 Fax: 503,599.1960Plan Review Inrptcrion Line: 503.639.4175 DEC Other Parrttl Internet, vvwwci.rIgard.or.uj Date Pmady/By: to up 2 for Supplent AtO Iftformseleft raY 0�i CoNwkkcrAL.Viet. *19LkLT -SCVkRDVtX — UWC8ft-RLEST 0 New construction El Addidon/altergifion/replItCerment Mclshlknicll Psrrnii fens*m based on the value of the worts 0 DemolitionOther: performed,indicate the value(rounded to the neatug dollar)of all rnechanical materials,eQUIIEMM labor.overhead,and profit. Value:$ I-and 2-family dwelling [:]Commercial/industrialE]Accessory building REM;P0747,9QM SYSTEMS nES* ❑Multi-family ❑ Master builder Other, )r0expecial lormauOR ture Checkhn. Qty I FA. HeadnWcooll Desenpdon Total — fir&- 'N' VPR'V T job Site address: Air condirlani a or es vtnp C) (require,pito 01 upff6t) 14.00 �,'&.,0.1=-tpvryv city/statelop: us Furnace;e 100,000 tal _,BTU(duavena) 4.00 Suitrinidg./apt. no,: Projec PuMlIC0 100 000+EITU Pducoi/vams) 17.90 1 name; � Cres hheatpurrip 14.00 Crussstreet/directions rojob tire: Duct work 1400 Hydronic hot water system 10.00 -Aesitifential boiler(nadiator or hydropic) 14.00 Unit heaters(fuel type,not electric), In-wall,in-duct,suspended,etc 10Z Subdivision: Lot no. Flue/vent Cor anyol, above Tax map/parcel no.: 10(o Oki y'. Water heater 1000 Gas circ lace 10.00 Flue vert(for ­ttcl hearer or gas aA-L10,DO 1_01K ha;hter(Itas) 10.00 Wood/Eallec stove 10.00 Wood f1rVIsce/insen ADO �hlrrincy/liner/Ouelven% 10.00 t Other: 10.00 Name: — Environmental exhaust and ventlIntion Addross: Rnngc hood/other kitchen city/statevzl]p: equipment 10.00 Sothes dryer wshaLst 10.00 Single-duct exhaust(bat! rn uoos, Phone: C'_IV?/ Fax: toilet coTpartm!nts ) utility roo I— 6.80 OR rlielorn±kpace fans 10.00 Business nerne: LOther. _=LO'O0 4— Fuel11 led Contact name I 19-40for(Irstfour; L99 breach■ddItIonq IL Address Furnace,SEc- R ..gas heat u. citylstatelzrp: J*Ll WxlGsuspendedlunic heaver _ -Phone:(SID 0 Water heater _tLLo Fax: Ringo Barbecue 0 Rusirlas name: LU _Cloches d Lvr(pfts) _j Address: Other: Cfrv/Statr)zlp: Subtotal Phone: Fax; fee(572,50) CCB fie.; Plan review(2514 of permit fie) State surcharge(891 of permit fee) Authorized si tur,e: \'r L' N–L-e t TOTAL PEPAUT Flit :1pplicarlan#xpIrm Ira 9*rlwtlm not nbfalnrd,. hin rb Print name! days cher It has NO"accepted at eempiate. C I Ditto: Fee rmt.N00101Y to,by Tri-County Building Industry Serviee boarn 12103 COO/7001pi XVJ 09:171. OOOZ/LZ/8O SITE. PLAN PL � y PL PL AO PL STREET C Specialty Heating & Cooling, Inc. 9528 SSV Tigard Street Tigard, OR 97223 Phone 503 .620.5643 Fax 503.598.0718 Hillsboro Phone 503.640-3607 Fax ,503.681 .0793 eoonoo @ xvj 09.0k 000ZA Z/eo CITY OF T I C A R D ELECTRICAL PERMIT PERMIT 0: ELC2 004-00808 DEVELOPMENT SERVICES DATE ISSUED: 12/17/2004 13125 SW Hall Blvd..Tigard,OR 97223 (503) 6394171 PARCEL: 1S134CA-00516 SITE ADDRESS: 11770 SW MANZANITA ST ZONING: R-4.5 !;r';1ASION: PANORAMA NO.2 BLOCK: LOT: 029 JURISDICTION: TIG Project Des,.ription: Heat pump&furnace. RESIDENTIAL UNIT TEMP SRVC/FEEDERS MISCELLANEOUS 1000 SF OR LESS: 0 - 200 amp: PUMP/IRRIGATION: EACH ADD'L 500SF: 201 - 400 amp: SIGN/OUT LINE LTG: LIMITED ENERGY: 401 - 600 amp: SIGNAUPANEL: MANF HMI SVC/FDR: 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 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+amplvolt: >=4 RES Utll'rS: �>600 VOLT NOMINAL: Reconnect only: SVC/FDR>=225 AMP1 _ CLASS AREA/SPEC OCC: Owner: Contractor: PETERSON,KENNETH C SOHLER ELECTRICAL CONSTRUCTION PETERSON,SHARON A 41131 SW BURGARSKY RD 11770 SW MANZANITA ST GASTON,OR 97119 TIGARD,OR 97223 Phone: 503-570-3531 Phone: 971-832-0807 Reg#: LIC 158285 I.LE 34-6670 FEES _ still 5945 Description Date Amount _ Required Inspections (FLPRM1'] EIX Permit 12/17/200, $5350 -- ITAX)8%State Surcharge 12/17/200, $4,28 Rough-in Elect'I Final Total $57.78 This Permit is issued subject to the regulations contained in the Tigard Municipal Code,State 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 more than 180 days 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 952-001-0100 You may obtain copies of these rules or direct questions to OUNC at(503) 14. 246"6699 or 1-800-332-2344 NIssued By: _ Permit Signature: �.�Q, OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale, lease, or rent. _W W OWNER'S SIGNATURE: —_ DATE: W — J CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. Et_EC'N: DATE: LICENSE NO: ^_— Call 639-4175 by 7:00pm for an inspection the next business day City of Tigard nen t,..rttf 1312.5 ser ern ehra.,rt�,ra,aR ` Phony. 503.639.4171 Fax: SOI. 6.1960 rt j\� FIRM pOer tem! LtePoction L tray. 503.639.4175 \" d t� � Dome at6„a�dt►1am11YYN, Infmet wwa.ci.bgadi.or.ua : � t IaaYrwrtlw ❑Now co;;ut ion �laonawt Pleaas ebeck an Ant appy: O Demolition OServioe aver 223 arrps,s-0111=1 OHaaadow kwalm OService over 320 wqm-rating O9ullft am lo,ow sq.l 7g �i ;;•�` ., air 1-and 2-famniy der WUW 4 or mag new residential 1-and 2-family dwelling ❑(-nmetciaVindwtrial ❑Accemory building; OSyatem over 600 volts nominal umhf in one wucwm multi-ramily ❑Masser builder O Othes- Mandbg ova three aoairs OFeeders,400 amps or rya �r- OOocmimm bad over 99 pumm Obismahamed ffb=tw t JAB s1Te'I1V Lac:A`!7 t>� Rv Park Job no_: Job site addiew. / 7 Sf� ll��ir tZ�,v, OHeale"we awc* 0Othw.. Subnoit X soft orpbaer with any of the abnve_ City/Satc/ZIP: T a `; 7203 TIM ar above enot Wpticable nn to tporwy conatruaian mvica. StutdbldVap, ���` - OrOw arroetMitections to job site: reaweftlml single-er..w-madly d.r.mmg mall. tad"m sttadlard empa. 1.000 aq.8 or lass 145.13 4 Subdivision: Lot no.: Fit.add'l 300 sq.ft.or 33.40 1 7Ls map/pwcei no.: ur'ited anergy,reddsM l 75.00 2 melte b1V1F. r-r- -,YAl .nmaAetWl 73.00 2 w� eachrtfermSdv Q or dwslllnL meylee artd/ar 11111110190.90 2 e E" Servt�.r feesters immumb l►..alhratteo.a.d/er relocation 200 agte ar Ira 1'ROr6tI_V_OVfRIillOt � �: wl!R 201 atlasID400 , arms_ 106.tS 2 401 atrge ro 600 160.60 2 Naate: �. -A/ I/'c I e r SI �% b01 amps b 1:000 wr 240.60 2 Address: l) 7 7(_Na r fS w M s /ol Over I AM or vdta 43x.63 2 x✓1 Z[ . ��- R � - 66.RS 2 City/SwdZ[P: (�!` �1 f a.�J Tempe p swvkm or reelere irstapatlast,slsaadoe.and/or Phone:(5 eJ)�i r Karr:( ) u radwmdm Owner Ittsta 0afian:This installation is being made on property that 1 osvn wrhich is not 200 alma or ba _ 66.85 1 intended fir-!ale,lease,rent,or rntchan 20i "`�argw 1111130 2 ge,scoording to ORS 447,449.670,and 701. 401 wqw a,600 _ 133.75 2 Owner signature Date Exam*e i eadla- aitiaeftloa,K eatatlaa. per paed ' APPUCANT �;! -. ti Fee fbr b ramit a b"M each / /� f sa<vioe or. w•fbe, &: ine&s ntsne %ad �f T branch eimuk - - 6.63 2 Contact num. H.Pee bms — ��a_3._-_�p main/Rados ar lballer fan. Address: �� �, �L__ e2 each bra!!b o,esit 46.85 y�.8 2 /' -- - F�WM I braeeh eittarit 6AS city/sraterzIp (rr �ra rte_ U a2 4 71_ — fe.r� .r t ta.r te.t i.ei.aM Plane:( 971) Far: p p or orale 33AQ 2 _-O . <!�- (sd3 ) �1LS _ U 7 i7 segs or a+dine Fidre6tt 33.40 2 IL &tttaiL ' - r-----�* Signal eircu6(a)or Hmiwr- x,: //�� EneW parrs,dtaation,or U) Brrsintss name L!----& a 0,s C-d N S i- Mention.Describe Page 2 2 Address: meeb mmitbaal 1a:pe,tgoa ever allowable to any of the above Per _ 62.30 J City/Statrl7lP: bis fiat pw bout(t br aiy 62,30 — — m phone.( ) Fag.IF ) - brdtatris)pka M bow 73.75 Ui CCB Lia: ! B.`28 S' Electrical Lief 7 -f, Sabftel J Suprv.Mactrictan signatnrr_required Pbn rsyfowr(23li of pertrit 1be) Print name: / Dom: Swse swdurge(11%orpmnit fee) t Authorized signantre: t►�r � �l'di'AL PlalpKl7'lIGR 5 aadroa K a pen.te r art aWWmed wilts■Ift Print nwm: M Date: . Pee days noer tit tis been j A=V N as tee ken _ amt>,edrttsry rat..:t>4 r�ors t.enrrr srr�iot ast„e .a.arlr .mmftO l.C-AawiMee dee tu» "Koerner of irrgaeaiera fw*p,atir sfawei 1 •d BLOi -S86-EUS JOTMOS nor waq :90 40 Li oaa CITY OF TIGARD BUILDING DIVISION o PERMIT#: MEC2004-00782 13125 SW Hall Blvd.,Tigard, OR 97223 DATE ISSUED: 1212/2004 Phone: (503) 639-4171 Inspection Requests (24 Hrs.): (503) 639-4175 INSPECTION WORKSHEET FOR DATE: 6/28/2005 TIME: 7.09AM PAGE: 5:1 SITE ADDRESS: 11770 SW MANZANITA ST CLASS OF WORK: SUBDIVISION: PANORAMA NO.2 LOT #: 029 TYPE OF USE: PROJECT NAME: PETERSON DESCRIPTION: Install air handler &he;# pump. OWNER: PETERSON, KENNETH C, PHONE#: 503590-3531 CONTRACTOR: SPECIALTY HE::A71NG &COOLING PHONE #: 503640.3607 Inspection Request Scheduled For: Date: 6/28/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 699 Mechanical final 010312-01 503640.3607 Y Corrections/Comments/Instructions: PASS [] PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: / �'�l/ _� Date: Phone #: (503) 718- . CITY OF TIGARD BUILDING DIVISION PERMIT#: ELC2004-00808 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/17/2004 Phone: (503) 639-4171 Inspection Requests (24 Hrs.): (503) 639-4175 INSPECTION WORKSHEET FOR DATE: 6/28/2005 TIME: 7:09AM PAGE: 47 SITE ADDRESS: 11770 SW MAN7_ANITA ST CLASS OF WORK: SUBDIVISION: PANORAMA NO.2 LOT#: 029 TYPE OF USE: PROJECT NAME: PETERSON DESCRIPTION: Heal pump&furnace. OWNER: PETERSON, KENNFTH C, PHONE #: 503570.3531 CONTRACTOR: SOHLER ELECTRICAL CONSTRUCTION PHONE #: 971-832-0807 Inspection Request Scheduled For: Date: 6/213/200!1 Pour Time: Code # Inspdction Description Confirm # Contact # Message 199 Elec.-trical final J 010319.01 971-632-0807 Y � I� D Corrections/Comments/Instructions: PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: _ Dete: � �� Phone #: (503) 718- • 5 c�, - G� lfo �oJIL CITY OF TIGARD BUILDING INSPECTION DIVISION G, /►� �" 24-Hour Inspection Line: 6394175 Business Phone: 639-4171 Date Requested: �� ' —_� A.M. P.M. MST. Location: :77 ------ BI1P: -- Tenant:_—_ _ Suite:_ —Bldg: _ MI:C: — — Contractor:_ ���( � '� _ —Phone: PLM: — Chvner._—(/ _ / Phone: -- — ELC:5 2—OJ$7 ELR: SIT: BUILDING BLDG(eon't) PLUMBING , MECHANICA.LJ �� SITE site Post/Beam Post/Beam Post/Beam Cover rvice Sewer/Storm Footing Roof I IndFI/Slab Rough-in Ceiling Water Line Slab Framing Top Chit Gas Line Rough-In UG Sprinkler Foundation Insulation Sewer I-lood/Duct Rearwuect Vault I3smi Damp I"ll Storm Furnace Temp Service MISC. Masonry Ceiling Rain Thain A/C UG Slab Shear/Sheath fire Spklr/Ahn G. .wI/Found Dr Heat Pump Low Volt _ Appy ,ved Approved Approved Approved �- Approved Appr/Sdwlk Not Approved Not Approved Not Approved ved Not Al proved FINAL FINAL FINAL FINAL FINAL 1 I 0 Call for reinspection J� ;qnspection fee of S r red before t in.4pectirm 0 Unable to inspect Inspector:__ �_ _—_-- Date: 91— Page__of _ CITY OF TIGARD ELECTRICAL PERMIT DEVELOPMENT SERVICES PERMIT #: ELC97-0387 13725 SW Hall Blvd.,Tigard,OR 97223 (503)6394171 DATE ISSUED: 06/19/97 PARCEL: 1S134CA-00516 SITE ADDRESS. . . : 11770 SW MANZANITA ST SUBDIVISION. . . . :PANORAMA N0. 2 ZONING:R--4. 5 BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . .29 JURISDICTION: TIG Flr^o.ject Descr-ipt ion: instl 1 branch circuit // jtb1 ? ------------------------------------------------------------------------------------- ---RESIDENTIAL UNIT---- ---TF-MP SRVC/FEEDERS----- •-----MISCELLANEOUS.----- 1000 SF OR LESS. . . . : 0 0 - 200 amp. . . . . . . : 0 PUMP/IRRIGATION. . . . : 0 EACH ADD' L_ 500SF. . . : 0 201 - 400 amp. . . . . . . : 0 SIGN/OUT LINE LTG. . : 0 LIMITED ENERGY. . . . . : 0 401 - 600 amp. . . . . . . : 0 SIGNAL/PANF_L.. . . . . . . : 0 MANE. HM/ SVC/FDR. . : 0 601+amps-1000 volts. : 0 MINOR LABEL ( 10) . . . : 0 -----SERVICE/FEEDER---- ----BRANCH CIRCUITS----- ---ADD' L INSPECTIONS--- 0 - 200 amp. . . . . . : 0 W/SERVIC:E OR FEEDER: 0 PER INSPECTION. . . . . : 0 c01. - 400 amp. . . . . . : 0 1st W/O SRVC OR FDR. : 1 PER HOUR. . . . . . . . . . . : 0 401 600 amp. . . . . . : 0 EA ADD' L BRNCH CIRC: 0 IN PLANT. . . . . . . . . . . : 0 601 1000 amp. . . . . : 0 -------------------PLAN REVIEW SECTION---------------- 1000+ amp/volt. . . . . : 0 ) =4 RES UNITS. . . . . . . . : ) 600 VOLT NOMINAL. . : Reconnect only. . . . . : 0 SVC/FDR ) = 225 AMPS. . : CLASS AREA/SPEC OCC. : Owner.: -----------------------•-------------------------------- FEES ------------------ KEN PETERSON type amount by date recpt 11770 SW MANZANITF, ST PRMT f 35. 00 TAT 06 /19/91 97-296192 TIGARD OR 97223 5PCT f 1. 75 TAT 06/19/97 97-296192 Phone #: Contractor: -- ---------•-----------------------.-------------------------------- JPC ELECTRICAL SERVICES INC f 36. 75 TOTAL 4120 SE INTERNATIONAL. WY rTE A--107 ------- REOUIRED INSPECTIONS ----- MILWAUKIE OR 97222 Ceiling Cover Elect' l Service 'hone #: 654--3325 Wall Cover Elect' l Final Reg #. . : 09:774 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Oregon Specialty Codes and all ether 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 188 days. ATTENTION: Oregon 1 , requires you to follow the rules adopted 'iy the Oregon Utility Notification Center. Those rules are set forth in OAR 952-01-8818 through OAR 952-801-1987. You nay obtain a :opy of these rules or direct questions to OUNC by calling (503)246-1987. Pvr-mi.ttee Signature : — Issued By - ----------------------------OWNER y :-------.--------------.-----OWNER INSTALLATION ONLY------------------------------ The installation is being made on proper-ty I own which i:, not intended for- sale, lease, or, rent. OWNER' S SIGNATURE: ff -`� — __ DATE: --V ----.------CONTRACTOR INSTALLATION , 9 T GNATURE OF SUPR. ELEC' N: O`7tiJ On--e — DATE: LICENSE NO: -7y� aS —_ --W-----------_---- --- -- +++4-+++++-1+++++.4-++++-4-+++++++++++++++++++++++++++•t++++++++++++++++++++++++++++t+ Call 639-4175 by 6:00 P. M. for, an inspection needed the next business day ++.++++++++++++++++++++++++++++++++ -+++++++.+++++++++++++++++++++++++++++++ is Community Development ELECTRICAL PERMIT APPLICATION 13125 SW Hall Blvd. Tigard, OR 97223 Planck/Rec. # Permit # - L Phone (503) 639-4171 Date Issued CITY OF TIC3ARD FAX (503) 684-7297 Issued by TDD No. (503) 684-2772 Inspi,xt)on (503) 639-4175 1. Job Address: 4. Complete Fee Schedule Below: Name of Development Number of Inspections per permit allowed Address >LL) Ma_n 7-4-n 1 54 Service included: Items Cost(ea) Sum City/State/zip'Tt CICt r`) 4s. Reeidential-per unit 4 e n 1000 aq 11 or less $11000 Name (or name of business) KE n _I'_P_ '>(E YS In n portE ionadditional W"' " °' $2600 1 Commercial❑ Residential Each Enefvlanul'd —_ Y25 W Each Noma or Modular 2 Diverting Service or Feeder $N W 2a. Contractor Installation only: 4b.services or Feeders ��� tr f� Ir>wtallation,aBsrMion,or rolocatron 2 Electrical Contractor 1• V 200 amps or leas $6000 Address 1 « 1 t _ /` 201 amps to 400 amps $80 W 2 401 amrm to 800 amps $120 W 2 City CwXt Ic _State c IL Zip q�� 1 801 amps to 1WO amps $180 W 2 Phone No. 7� - 33' Over 1000 amps or volts $34000 2 Contractor's License No,-3'1-3'71 Q Reconnect only -- $50 W G-4 _ Contractor's Board Reg. No. b "714 4c.Temporary services or Feeders Installation,alteration or relocation 2 Signature of Supr. Elgc'n ' 200 amps or lewa S6000) 2 License No. r�(�, ! One N0. r "� 201 amps to 4W ampe $7500 2 401 amps to 600 amps $10000 Over 80o amps to loon volts 2b. For owner installations: not'b'above 4d. Bunch Circuits Print Owner's Mame_ New,alteration or extension per pastel Address a)The fes for branch circuits with Ci State Zippurchase b eervk.or Meller Ape. 2 ry Each branch circuit $500 Phone No. b)The fee for branch circuts aAetwo The installation is being made on property I own which is pumha"of""'k'or bodw 1" ' $aW _ a C�f z not inte�rfed for sale, lease or rent. Feet branch drcuA 'Each addAionel branch drcult $500 Owner's Signature _ 4e, Miscellaneous (Service or feeder not included) 2 3. Plan Review section (i/required): Each pump or inigation 7rcle $4000 2 Each sign or outline lighting $4000 — Signal cimu4(s)or a limned energy 2 Please check appropriate Item and enter fee in section SB. panel,alteration or extension $4000 4 or more residential units in one structure Minor Labels(10) $10000 _Service and feeder 225 amps or more System over 600 volts nominal 4f.Each additional inspection over _Classified area or structure containing special occupancy the allowable in any of the above our as described in N E C Chapter 5 Per hn $3600 Per hour $6500 In Plant $55 W Submit 2 sets of plans with application where any of the above apply. Not required for temporary construction services. §. Fees: NOTICE 5a. Enter total of alio is fees $ 3 r �_ 5%Surcharge(.05 X total fees) $ /�-7 S5 PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $ AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF 5h. Enter 25%of line A for CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONEE FOR Plan Review if required(Sec.3) $ A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $ COMMENCED ❑ Trust Account fY $ Bolan"Dura $ 3 •,rticamisNMK Pm cur