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12160 SW MAIN ST
CITY OF TIGARD
BUILDING DIVISION PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: TIME: Any 1w PAGE: -
SITE ADDRESS: I e11 I (OD GJUS Ole vt `_-4. CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
vi-� r S�eyL
OWNER: v�j �j�h k PHONE #: 5n—fo35-
CONTRACTOR: 1 r_1 _ , n C PHONE #:L �3 —23 Vito
Inspection Request Scheduled Four: Date: Pour'Time:
Code # Inspection Description Confirm # Contact # Message
Corrections/Comments/Instructions:
a
U)
_J
m
W
J
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
[ � FAIL [ ] CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspe:Ror: _.__�T r _V_t-e (� _ Date:12-- 1101 Phone #: (503) 718•
ELECTRICAL -
ERMIT
CITY OF TIGARD RESTRIC DPENERGY
DEVELOPMENT SERVICES PERMIT#: ELR2004-00330
13125 SW Hall Blvd..TIQard. OR Q7223,, ;503)639-4171 DATE ISSUED: 10/21/2004
SITE ADDRESS: 12160 SW MAIN ST PARCEL: 25102AA-02301
SUBDIVISION:TIGARD HIGHWAY TRACTS ZONING: CBD
BLOCK: LOT: 004 JURISDICTION: TIG
Protect Description:f'.ARM REWIRING.
A. RESIr)r:NTIAL B.COMMERCIAL _
AUDIO& STEREO: AUDIO&STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE/IRRIGAT:
GARAGE OPENER: CI-OCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: HVAC: PROTECTIVE SIGNAL: X
INSTRUMENTATION: OTHER:
TOTAL# F 1
Owner: Contractor:
HOYT CORPORATION DIEBOLD, INC
BY U S BANK 15100 SW KOLL PKWY
REAL ESTATE MGMT DIV T-3 BEAVERTON, OR 97006
PORTLAND, OR 97208
Phone: Phone: 503-469-1700
Reg#: LIC 994493
FEES R Required Inspections
Descriptiun _ Date Amount Low Voltage Inspection
1t L.PItMTj C:LR Pcrmit 10/21/2004 $75.00 Elect1 Final
ITAX1 K",t,State Surcharl 10/21/2004 $6.00
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, 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. ATTENTION: Oregon law requires
you to follow rules adopted by the Oregon Utility Notification Center. Those ales are set forth in OAR 952-001-0010
4. through OAR 952-001-0100. You may obtain copies of these rules or direct questions to OUNC at 503)246-6699.
N Issued by Permittee Signature
OWNER INSTALLATION ONLY
m The Installation Is being made on property I own which Is not Intended for sale, lease, or rent.
t7
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N DATE:
LICENSE NO:
Call 639-4175 by 7:00 P.M.for an Inspection needed the next business day
Electrical Permit Application Itait
owl
City Of ilgard Date/8, Permit No. .
13125 SW Hall Blvd.,Tigard,OR 97223 Plam Review -
Ph,,re 503.639.4171 Fax: 503.506.1960 DatelB : Other Permit:
Inspection Line: 503.639.4175 I :fe Ready/By: lung, ® See Page 2 for
Intemet: www ci.tigard.or.us Notified/Method Supplemental Information
TYPE OF WORK PLAN REVIEW -
�❑New construction Addition/alteration/re»lacement Please check all that apply:
❑Demolition ❑Other. ❑Service over 225 amps,comm'I ❑Hazardous location
_— -- ❑Service over 320 amps-rating ❑Buildng over 10,fm sq.ft.,
CATEG'ORY OF CONSTRUCTION of]-and 2-family dwellings 4 or more new residential
❑ I-and 2-family dwelling Ci Commercial/industrial ❑Accessory building L1System over 600 volts nominal units;n one structure
❑Multi-family ❑Master builder ❑Othtr: ❑Building over three stories ❑Feeders,400 amps or more
❑Occi,pant load over 99 persons ❑Manuft.ctured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park
Job `S, ❑Health-care facility (]Other:
Jot,no.: site address: t7A� tw7� �j�- `-�
Submit 2 sets of plans with any of the above.
tv- .Ite/ZIP• `+-1 The above are not applicable to temporary construction service.
Sunubidg./apt.no.: Project name: US � �� __ FEE* SCHEDULE .•
Dneripttoe Qty. Fee. Tohl
Cross street/directions to job site: New residential single-or multi-family dwelling unit.
Includes attached garage.
i,5U0 sq.fI or less 145.15 4
Subdivision: Lot no.: Ea.add']500 sq.ft.or portion _33.40 I
:
Tax snap/parcel no. Limited energy,residential 75.00 2
.: _ Limited energy,non-residential 75.00 _ 2
DESCRIPTION OF WORK Each manufactured or modular
,ry"' �� dwelling,service and/or feeder 90.90 2
�+_ _ E a Services or feeders Installation,alteration,and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
-- 401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps~ 240.60 2
Address: Over 1,000 amps or volts 454.65 2
— -- Reconnect only 1 66.85 2
City/State/ZIP: Temporary services or feeders Installation,alteration,and/or
`— relocation _
Phone:( ) Fax:( ) 200 amps or less 66.85 1
Owner Installation:This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 600 amps_ 133.75 2
Owner signature: _ Date: _ Branch circuits-new,alteratlen,or extension,per panel
❑ APPLICANT ❑ CONTACT PERSON A.Fee for branch circuits with
-- - -- service ur feeder fee,each
Business name: U1G�1> I N(_ branch circuit 6.65 2
- �—- B.Fee for branch circuits
Contact name:_ N(tom_ without service or feeder fee, 46.85 2
Address: _each branch circuit
5C — �-�-- Each add'i branch circuit _ 6.65 2
d' City/State/Z[P: Me�y UTA, oR q 7 c(, Miscellaneous(service or feeder not included)
R __ _ -
�_/� Fump or irrigation circle 53.40 2
Phone
Sign or outline lighting 53.40 2
E-mail: Signal circuit(s)or limited
CONTRACTOR energy panel,alteration,or 1
extension.Describe: Page 2 2
m Business name:
(� r Each additional Inspection over allowable In any of the above
W Address: CJ ccD sk,..) L�
J _ —___�. _- _ ._- Per inspection` 62.50
4 City/State/ZIP: '��� R, Investigation per hour(t hr min) 62.50
1;4 11 r Phone: ) -� cc> �- Fax:(spa)w - 17 Industrial plant pe:hoar 73.75
- ELECTRICAL PERMIT FEES
4. CCB Lic.: LAElectrical Lic.;wb�(� Suprv.Lig, 2.LQl Subtotal
Suprv. Electrician signature,required: _ Plan review(25%of permit fee)
State surcharge(8%of permit fee;
Print name: � Date: „ �- i TOTAL PERMIT FEE
Authorized signature: This permit application expires If a permit Is not obtained within IND
days after It has been accepted as complete
Print name: Date: • Fee methodology set by Tri-County Building Industry Service Board
••Number of inspections per permit Allowed.
i�BuildingNPertnitrrELC.PemitAppdoe 12103 440.4611T(10/02/C0M/WP8
FPaElan
Electrical Permit Alication - City of Tigard
ge 4' - Supplemental Information '
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY: _
Fee for all residential systems combined. .... $75.00
t 'heck'fype of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY: _
Fee for each commercial system...................... $75.00
(SEE OAR 918-260-260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication installation
❑ Fire Alarm Installation
❑ I-IVAC
❑ Instrumentation
❑
6 Intercom and Paging Systems
2 ❑ Landscape irrigation Control*
❑ Medical
3
'p ❑ Nurse Calls
9
j ❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other Installations
is�Building\Pemits\ELC-PmnitApp d,x OM01
CITY OF TIGARD 24-Hour
BUILDING Inspection Une: (.403)639-4175
INSPECTION DIVISION Business Line: (503)639-4171 MST _ —
BUP
Received _ Date Requested_,�G� _ �5�—AMPM BUP
Location _ �,� I Cl l /NJ suite MEC
Contact Person - i 1�' _- Ph(� ) !1 � PLM �_�__
Contractor Ph( ) — SWR
WiLDING_ Tenant/Owner — ELC
Footing ____
Foundation --------
FI Drain AC`%e3S: ELC
Fig ELR
Crawl Drain
Slab Inspection Notes: SIT
Post&Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear ---
Framing
Insulation
Drywall Nailing --- --- _
Firewall
Fire Sprinkle- - ---
Fire Alarm
Susp'd Ceiling —
Roof
Other: --
Final -
PASS PART FAIL -�--
PLUMBING _
Post& Beam-- i
Under Slab —
Rough-In
Water Service -- _
Sanitary Sewer
Rain Drains
Catch Basin/Manhole
Storm Drain -- ---
Shower Pan
Other:
Final
PASS PART_ FAIL —
MECHANICAL
Post&Beam -
d Hough-In
Gas U, a
F� Smoke Dampers -------- --
N Final
PASS PART FAIL -- - - — -- —
ELECTRICAL_
m Service .`- --` ------__--- _. _
Rough-In _-� -- - - --- -
� ura/fat,
L
FiT r, Reinspection fee of$ required before next Ina
PART FAIL lJ Inspection. Pay et City Nail, 13125 SW Hall Blvd.
$ E Please call for reinspection RE: _.- _ Unable to inspect- no accass
Fire Supply Line / �/
ADA
Approach/Sidewalk Date
Other:
Final _ DOR T REIUBOV5 thle inspection meoord from the 1 site,
PASS PART FAIL
�4.R D ELECTRICAL PERMIT
CITY OF T I G
PERMIT#: ELC2.000-00420
DEVELOPMENT SERVICES DATE ISSUED: 7/25/00
13125 SW Hall Blvd.,Tigard,OR 97223 (503)6:.9-4171 PARCEL: 2S102AA-02301
SITE ADDRESS: 12160 SW MAIN ST
SUBDIVISION: TIGARD HIGHWAY TRACTS ZONING: CBL)
BLOCK: LOT • 004 JURISDICTION: TIG
Prosect Description: Sign or outline lighting.
RESIDENTIAL UNIT _ TEMP SRVC/FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP/I ZRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN/OUT LINE LTG: 1
LIMITED ENERGY: 401 - 600 amp: SIGNALIPANEL:
WANF 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 SR'1C OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION _
1000+amp/volt: >=4 RES UNITS: >600 VOLT NOMINAL:
Reconnect only: SVC/FDR>=225 AMPS: CLASS AREA/SPEG OCC:
Owner: Contractor:
HOYT CORPORATION BLAZE SIGNS OF OREGON
BY U S BANK PO BOX 23910
REAL. ESTATE MGMT DIV T-3 PORTLAND, OR 97281-3910
PORTLAND, OR 97208
Phone: Phone:
639-3262
Reg#: SUP 524SIG
LIC 64325
ELE 26380CLS
_ FEES Required Inspections
Type By Date Amount Receipt Elect'I Final
PRMT BLD 7/25/00 $42.75 0003962
5PCT BLD 7/25/00 $3.42 0003962
Total $46.17
This Permit is issued subject to the regulations oontained in the Tigard Municipal Cede,State of OR. Specialti 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
a suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notificatio, L,enter. Those
rules are set forth ri OAR 952-001-0010 through OAR 952-001-0080. You may obtain copies of these;ules orftect qu':,(ions to OUNC at(503)
U) 246-1987.
l�. QERMIT r EE'S SIGNATURES ' ISSUED BY: ��Z3
m OWNER INSTALLATION ONLY
WThe installation is being rnade on property I own which is not intended for sale, lease, or rent,
OWNER'S SIGNATURE: DATE:.
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:—
LICENSE NO: — --
Call 639-4175 by 7:OOpm for an Inspection the next business day
CITY OF TIGARD Electrical Permit Application Plan Check*
13125 SW HALL BLVD. Recd By
TIGARD OR 97223 Date Recd-
Date to P.E. _
Phone(503)639-4171, x304 Date to DST
Inspection (503)639-4175 Print of Type Permit# E1-e-2 p --401/.?o
Fax (503) 598-1960 Incomplete or illegible will not be accepted called_-
1. Job Address: 4. Complete Fee Schedule Below:
Name of Develor .ant �( �� 4 Number of Ins -dons per permit allowed
Name for nam r business) u %��n�,�_ ATM-- Service included: Items Cost Sum
Address 1 n S LL ) YY1 c.-•w, 4a. Residential-per unit
Ci /State/Zip
tY � - /� ! 1000 sq or less f 117.75 __ 4
� _G. �' Each additional 500 sq fl or
rr��11 portion thereof $ 26.75 _ 1
Commercial ,l Residential❑ Limited Energy $ 60.00
Each Manuf d Iinme or Modular
2a. Contractor Installation only: towelling Service or Feeder f 72.75 2
(Prior to permit Issuance,applicants must provide contractor license 4b.Services or Feeders
Information for COT data e. _ Installation,alteration,ar relocation
Electrical Contractor 200 amps or less -_ $ 6495 _ 2
Adar 201 amps to 400 amps - f 115.50 2
�1� 401 amps to 600 amps 1, 1211.50 2
City _Stat@�-Zip_,5'1&R /- 601 amps to 1000 amps - $ 192.50 - 2
Phone No. (�a-U q$) Over 1000 amps or volts $ 363.75 2
Job No. p tb 7 -i Reconnect only _-_ $ 53.50 - 2
Elec. Cont. Lice. No. ,i(_ <.I.5 Exp.Date ,)-•a 1-0 / 4c.Temporary Services or Feeders
OR State CCB Reg. No.( `-� 4 S ___Exp.Date, Installation,alteration,or relocation
COT Business Tax or Metro Nada'3 Exp.Date 1 1- 01 200 amps or less _ $ 53.50 2
201 amps to 400 amps $ 80.25 _ _ 2
Signature of Supr. Elec'n _ 401 amps to 600 amps Y _ f 107.00 2
Over 600 amus to 1000 volts,
see"b"above.
License No. 7 s(� Exp.D
Phone NO
New,
Branch Circuits
- New,alterationon or or extension per penal
a)The fee for branch circuits
2b. For owner installations: with purchase of service or
feeder fee.
Print Owner's Name Each branch circuit $ 5.35 2
Addressb)The fee for branch circuits
- ---- - without purchase of service
City State Zip or feeder fee.
Phone No First branch circuit $ 37.50
-� Each additional branch circuit _ _ _ $ 5.35
The installation is beirr,made on property I awn which is not 4e.Miscellaneous -
intended for sale. lease or rent. (Service or feeder not Included;
Each pump or irrigation circle $ 42.75 _
Owner's Signature Each sigr or outline lighting -1- S 42.75 y i, 7 5-
Signal
Signal cir uit(s)or a limited energy
panel, Iteration or extension S 60.00 -
L 3. Plan Review section (if required):* Minor Let els(10) $ 10e.00
Ption over lease check appropriate item and enter fee in section 5B. 4f.Each a.fdltlonal Inspec
n 4 or more residential units in one structure the allowable In any of the above
Service and feeder 225 amps or more Per inspection S 50.00
our
Per hour $ 50.00
J System over 600 volts nominal In Plant $ 59.00
Classified area or structure containing specie!occupancy as
descried in N E C Chapter 5 5. Fees:
U 8e.Enter total of above fees
U " Submit 2 sets of plans with application where any of the above apply. -Surcharge�►Surcharge(� total fees► $ 3.4 Z
Not required for temporary construction services. Subtotal $ _
5b.Enter 25%of line 8a for
NOTICE Plan Review if required(Sec 3) $
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED Subtotal S -
IS NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR r
WOPK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS u Trust Account 0
AT ANY TIME AFTER WORK IS COMMENCED Total balance Due s7
_ J
i:\dsts\fbrms\cicctric.doc
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business Line: 639-4171 —'—
BUP
Date requested —AM PM BLD
Location T 2_16L,5w Lal. - f us e ��_ Suite MEC _
Contact Person Ph (o Z r V P )� PLM
Contractor Ph SWR _
BUILDING Tenant/OwnerELC 1�____V 41 ZQ
Retaining Wall _ ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab _ SIT
Post&Beam
Ext Sheath/Shear —
Int Sheeth/Shear
Framing -
InFulation
Drywall Mailing
Firewall
Fire Sprinkler _—
Fire Alarm
Susp'd Ceiling _ _ —
Roof
Misc: - - - --
Final _
PASS PART FAIL ---
PLUMBING
Post&Beam �- -
Under Slab _
Top Out
Water Service
Sanitary Sewer
Rain Drains.
Final
PASS PART FAIL
MECHANICAL
Post& Bearn
Rough In
Gas Line ------ - -.-__ _- ��—
Smoke Dampers
Final -
PASS PART- FAIL
ELECTRICAL __-- ✓- - �~
Service __—
Rough In
UG/Slab
Low Voltage s�G
F'[p_Alarm _-
Fii
PART FAIL
ITE
BackflliGrading -
t Sanitary Sewer
Storm Drain f I Reinspection fee of$ required before next inspection. Pay at City Hall, Ak 3125 SW Hall Blvd
Catch Basin I ]Please call for reinspection RE: _ I I Unable to Inspect-no accP-,s
Fire Supply Line
ADA
Approach/Sidewalk Date - �, Inspector ,,I� -r EXt
Ott1P,f
Final
PASS PART FAIL DO NOT REMOVE this Inspection record from the job site.
(A rY OF TIGARD BUILDING INSPECTION DIVISION MST
74-Hour Inspection Line: 639-4175 Business Line: 639.4171
BUP
Date Requeste:l_, AM PM _ BLD
Location l G Ci Suite MEC
Contact Person — Ph _,�1!7- 74// PLM
Contractor Ph SWR _
BUILDING enant/ wnar _U s �A�,o � ELC _
Retaining Wall V ELR
Fooling
Foundation Access: FPS
Fig Drain ` ' ���/� _ —
SGN
Crawl Drain Inspection Notes: —
Slab _ SIT
Post$Beam `_---
Ext Sheath/Shear I
Int Sheath/Shear
Framing
Insulation
Drywall Nailing __—
Firewall
Fire Sprinkler
Fire Alarm
Sgsjo Ceiling
OF
in
ASS RT FAIL - ----
PL NO
Post&Beam --—�-
Under Slab
Top Out
Water Service
Sanitary Sewer s
Rain Drains
Final
PASS PART FAIL
MECHANICAL.
Post& Beam
Rough Rough In
Gas Line — -- — --
Smoke Dampers
Final -- ---� _
PASS PART FAIL
ELECTRICAL
L Service
C Rough In
UG/Slab
Low Voltage
Fire Alarm
3 Final
0 PAS`3 PART FAIL
9 SITE
U Backfill/Grading
J
Sa•iitary Sewer
Storm Drain [ ]Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin [ ]Please call for reinspection RE: _ [ ]Unable to inspect-no access
r""ire Supply Line
ADA
Approach/Sidewalk /
Other Date 7- Z 2z _Inspector—� r Ext
Final
PASS PART FAIL DO NOT REMOVE this Inspection record from the job site.
CITY' OF TIGARD -- BUILDING PERMIT
PERMIT M BUP1999-00145
DEVELOPMENT SERVICES DATE ISSUED: 4/19/99
13125 SW Hall Blvd.,TIQard, OR 97223 (503)639-4171 PARCEL: 2S102AA-02301
SITE ADDRESS: 12160 SW MAIN ST
SUBDIVISION: TIGARD HIGHWAY TRACTS ZONING: CBD
BLOCK: LOT: 004 JURISDICTION: TIG
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: OTR FIRST: sf N: S: E: W:
TYPE OF USE: COM SECOND: sf PROJECT OPENINGS-6—
TYPE
6TYPE OF CONST: 5N sf N: S: E: W:
OCCUPANCY GRP: B TOTAL AREA: sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: BASEMENT: sf AREA SEP. RATED:
STOR: HT: ft GARAGE: sf OCCU SEP. RATED:
BSMT?: MEZZ?: READ SETBACKS REQUIRED
FLOOR LOAD: psf LEFT: ft RGHT: ft FIR SPKL: SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALAM : HNDiCP ACC:
BEDRMS9: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALDE:
Remarks: Re-roof.
Owner: Contractor:
US BANK T D NORTHWEST
12160 SW MAIN S 15245 SW 74TH
TIGARD, OR 97223 TIGARD, OR 97224
Phone: 639-7611 Phone: 624-1590
Reg#: LIC 00078466
_ FEES REQUIRED INSPECTIONS
Type Py Date Amount Receipt Pre-roofing inspection
PRMT tXH 4/19/99 $146.50 99-314660 /NSf 9'(_TiOA/
5PCT DI-H 4/19/99 $7.33 99-314660
Total $153.83
This permit is issued su!�,Pct to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable law. All work will be done in accordance with approved plans.
'This permit will expire ii work is not started within 180 days of issuance, or if wor'< is suspended for more
than 180 days. ATTENTION: Oregon law requires you to follow the rules adoped by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952-001-0010 through OA'R 952-001-1987. You
may obtain a copy of these rules or direct questions to OUNC by calling (503) 246-i'B7.
Permitee �
Signaturo:
Issued By:
Call 639-4175 by 7 p.m.for an inspection the next business day
CITY OF TIGARD Plan Check#:
- 413125 SW BALL BLVD. Recd By: T—
TIGARD OR 97223 RE-ROOFING PERMIT APPLICATION Date Recd: �
7-503-639A171 X304 immercial and Residential Date to PE------
F-503-598-1960
_-F-503-598-1960 , Date to DST:
l i Permit#: d LJ
Incomplete or Illegible applications LI not be accertcdi Called:
Name of Development/BuCriess
Street Address Ste k Please fill out applicable section and attach cap of roofing
Job Site 1 Z t(,--" S w Icy",, specifications.
Bldg N City/State Zip Nt1
FTn.
Name! 1. Specification M N -l Z -_T
Applicant Mailing Address 2. Manufacturer: � A F
City/Slate Zip Phone '3a UL.Classification:
_ it c-'et 1 O_2 (,1'i I ?
Roofing Na _ Listed UL B�ilNnkg Materials Directory Page
Contnctor —1 IJ (OR)
(Prior to Issuance Mailing Address ^ '3b Warnock Hersey:
applicant must -t S +`-
provide a copy of City/State Zip Listed Wamcck Hersey Directory Page M
all contractor —` C'X G I Lzq "COPY OF ASSEMBLY REQUIRED
--- ----- ---- --------- - ----------�--------------
licenses H Phone#-
Fax 8
expired In COT ("Z A 1 a ' a tSek3 B. ICBO Research#:
database) State Constr C ontr.Board R Exp.Pate
,I$`i k, l 1 cf DATED:
C.
SPECIAL PURPOSE ROOFING: WOOD SNAKES
Building-Type Of Use: (circle (review required by plans examiner)
SF SFA COM MF
Building- Type}f construct* n: VALUATION OF PROJECT
- 0�(� , c�� s .ft. of roof ares _ 4 0 3
Existing Deck Type: Permit fee based on valuation'
Combustible ( ) Non Combustible ( ) "see chart on back
S
City use ahly: V/ACO: ;
0 REPAIR(MAJOR)(review required by Alar;examiner) BUILD � UBUIL4?�
Permit required ONLY when spaced she;ithing Is covered by -a
solid sheathing. Changes to roof line require Building Permit 6%State-Surcharge s
Application. t
SUBM17_TWO!2)SETS OF PLANS SPECIFYING. W C UT
A. Roof area '%nearest street. 'Required for major repairs
B. Attic vents-Provide 1 sq. ft.for each 150 sq.ft.of attic or'C'above '65%Plan Review $
space. Vents shall be located In the upper 1/3 of the roof. City Use only: WACO
Provide 1 sq.ft,for each 300 sq,ft.when eave&attic $UPPLN)' $UPL.N
venting is provided
_ TOTAL $
.i I acknowledge that I have read this application and that the
';leas or Work: Oi information given is correct; that I am the owner or authorized
Dpscribe work to be done:(check appropriate box) agent of the owner, and that the plans(if applicable)are in
❑ RE ROOF (circle A,13 or C) d rnnh,er compliance with Oregon State law.
Existing built-up roof covering to be RE=MOVED andAlisek
repaind- Signature of Owner/Agent �!' Date
B. Existing built-up roof covering to REMAIN:note applicant
must submit an engineer's review of the roof strucAural
elements. Review shall bear the seal(or stamp)of the C rt to
architect or engineer licensed In Oregon. Contact Person Name Tele
C. Asphalt or wood shingle/shake
(PROCEED TO STEP
BdstsVormsiroof.doc ___
CITY OF T!.ARD
BUILDING P€RMIT FESS
TOTAL.
PLAN STATE BUILDING
VALUATION OF PERMIT REVIEW TAX PERMIT
PROJECT FEES (65%) 6% FEES
1-1500 25.00 16.25 1.25 42.50
1,501-1600 26.50 17.2_'. 1.33 45.06
1,601-1,700 28.00 14.20 1.40 47.60
1,701-1,800 29.50 19.18 1.48 50.16
1801-1,900 31.00 20.15 1.55 52.70
1,901-2,000 32.50 21.13 1.63 55.26
2,001-3,000 38.50 25.03 1.93 65.46
3,001-4,000 44.50 28.93 2.23 75.66
4,001-5,000 50.50 32.83 2.53 85.86
5,001-6,000 56.50 36.73 2.83 96.06
6,001-7,000 62.50 40.63 3.i 3 106.25
7,001-8,000 68.50 44.53 3.43 116,46
8,001-9,000 74.50 48.43 3.73 126.66
9,001-10,000 80.50 52.33 4.03 136.86
10,001-11,000 86.50 56.23 4.33 147.06
11,001-12,000 92.50 60.13 4.63 157.26
12,001-13,000 98.50 64.03 4.93 167.46
13,001-14,000 104.50 67.93 177.66
14,001-15,000 110.50 71.63 5.53 187.86
15,001-16,000 116.50 75.73 5.83 198.06
16,001-17,000 122.50.. 79.63 6.13 208.26
17,001-18,000 128.50'' 83.53 6.43 218,46
18,001-19,000 134.50 87.43 6.73 228.66,'
19,001-20,000 140.50 91.33 7.03 t 6'.38.86
20,001-21;000 146.50 '.' 95.23 7.33 249.06
21,001-22,000 152.50 - 99.13 7.63 259:26 , x )
22,001-23,000 158.50 103.03 7.93 269.46
23,001=24,000 164.50 106.93 8.23 279.66
24,001-25,000 170.50 110.83 8.53 189.86 f r,
25,001-26,000 175.00 113.75 8.75 297.50 `' =
26,001-27,000 179.50 116.68 8.98 305.16 '
27,001-28,000 184.00 119,60 9.20 312.80
28,001-29,000 188.50 122.53 9.43 320.46
29,001-30,000 193.00 125.45 9.65 . 328.10 -
30,001-31,000 197.50 128.38 9.88 335.76 -
31,001-32,000 202.00 131.30 10.10 343.40
32,001.33,000 206.50 134.23 10.33 351.06
33,001-34,000 211.00 137.15 10.55 358.70
34,001-35,000 215.50 140.08 10.78 366.36
35,001-36,000 220.00 143.00 11.00 374.04
36,001-37,000 224.50 145.93 11.23 391.66
37,001-38,000 229.00 148.85 1145 389.30
1:ldsbdormsVnM.doc
1
C11Y OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business Line: 635-4171
1 '-o�3 Date Requested 7-,-;k- BUP- 7 /U AM `QM __ BLD
Location ll,�.Q co 'I &' rb Suite MEC
Contact PersonCjg Ph5� PLEA _
Contractor r,,Aa.0 rel 1 l Ph 607Ljr n c__. SVMR
BUILDING nant/Owner ELC � -
Retaining Wall ELR �C//✓�"'
Footing —
Foundation Access: 1 ' FPS —
Ftg Drain1. RIUKA
$GN
Crawl Drain Ins coon Notes:
Slab SIT
Post Beam CC, 7-V —
Ext Sheath/Shear
eath/Shear _
Int Sheath/Shear
Framinp _
Insulation
Drywall Nailing
Firewall
Fire Sprinkler _
Fire Alarm
Susp'd Ceiling _—
Roof
Misc:
Final
PASS PART FA,L --- �_
PLUMBING
Post&Beam —
Under Slab
Top Out — —�
Water Service
Sanitary Sewer —
Rain Drains _
Final
PASS PART FAIL i_
--
MECHANICAL
Post&Beam --
Rough In
Gas Line — —
Smoke Dampers
Final — —
P T FAIL
LECTRICA
Servrce _
Rough In —
w�VoltageF' ---------- -- --
PART FAIL
Backfill/Grading
Sanitary Sewer
Storm Drain [ ]Reinspection fee of$_ required before, .(inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin [ j Please call for reinspection RE: _ [ j Unable to inspect-no access
Fire Supply Line
ADA /
AOtheoach/Sidewalk Date �_ L7/. �' Inspector l'�,' Ext
Final
PASS PART FAIL DO NOT REMOVE this Inspection record from the job ,site.
r
CITY OF TIGARD
DEVELOPMENT SERVICES
13125 SW HaN Blvd.,Tlp rd,OR 97223 (503)W4171 EL E C T R T'"AL PERMIT -
RFrTPTCT1=D ENE=RGY
PERMIT #: ELR98-0152
DATE ISSUEDs 06/18/98
PARCEL : 29102AA-02301
("ITE" ADDRESS. . . : 12160 5W MAIN OT
nimniVTSION. . . . :TIGARD HIOHWnY TRACTS ZONTMG:CRD
DLOCI:. a . . . . . . . . : LOT. . . . . . » . . . . . . :004 J1JRI'.''7TCTN: TTG
Pr•njert Desrriptions Acc CCTV for an e4isting bank.
^a. RFSIDENTIAL---------- R, CCIMMFRCIAL-------------------------------------------
AUDIO
------------______________-_______.__---._.,.AUDiO i1 STFREO. . . : AI IU I i? & STEREO. . .- INTERCOM & PAGING
BURGL qR ALARM. . . . : ROTI-ER. . . . . . . . . . : 1_ANDSCAPE/IRRICAT. . ,
GARAGE OPENER. . » . . CLOCK. . . . . » . . . . . Mr7r,I C01.. . . . . . . . . . . . .
HVAC. . . . . . . . . . . . . : DATA/TELE COMM. . : NURSE CALLS. . . . . . . . »
VACUUM SYSTEM. . FIRE ALARM. . . . . . : OUTDnOR L ANDSC I_.I TE s
OTHER: : s MVAC. . . . . . . . . . . . : PROTECTIVE 7GNAL. . :
TN;TRUMFNTATION. : 0THER. . :CCTV : : X
TOTAL # OF SYSTEMS: 1
Owners
US SANK type amount by date recpt
121.60 SW MAIN STREET PRM-1, $ 410. 00 r.iF(3 06/18/98 98- 30GE,75
TIGARD OR 9722:% 5PCT # 8. 00 CEO 06/18/98 98-30665P
Phone #: 275•-7393
Contractor:
DATA CABL 1 NG A- FNG I NEER I NG INC 42. 00 TOTAL.
3930 SW 30TH
.------ RFOU T RFD INSPECTIONS
ORr-111AM OR 970130 Low Voltage Insp
P -tone #t: 8,74-85"1":' Elect' I Final
Peg #. . : 0009011
Ttiis perait 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 it accordance with approked plans. This perait Nil? expire if work is not started within 18@
days of issuance, or if work is suspended for rare than 18@ nays. ATTENTION: Oregon law requires you to follow rule adapted by the
"regon Utility Notifiration re,ta.. Thane pules a,e set forth in OAR S 8P1-Q'Pt@ threogh OAR T2 411-009, You ray obtain ropies of
these rules or dire-` ;testi IN (431246-1987.
n
'S sIIE'd r,,. Pet-mittee Fign,ature
I
-OWNER INSTAL-LATION ONLY-__.-_�_-____
Thr- installation is being made on property I own which is not intended for
�l eleaseq or rent.
')WNER1 S SIGNATURE: DATE:
i
' __ _....-.---. ._._......_.__._... ..__........_CCNTRArTOR
INSTALLATION
� r?NnTURF nF SUPR. E'LMI Ns ,CI _...__--• DATr ° y'
I.;GNSE: NO:
F-4-•1 -+-F-I-..++++++.+++++4-+++.+++i+f-++++++++++++t+'++-4••4•+++++-F++++++•F+++.++1-+++++.1.4.4.4
r al l 639-4175 by 7:00 P. M. for an i.nspert i on opedod the next brrs;i ness da-y
. +++4+4++++.+.+-F++.4.4.+-F+++....h++++++t•4•+++++++'&+.++i••++++++++++++++4 -++++++f•+++4•++
CITY OF TIGARD RESTRICTED ENERGY ELECTRICAL APPLICATION Recd by:
13125 SW HALL BLVD Date Recd:
TIGARD OR 97223 PRINT OR TYPE 4,,-4
V-503-639-4171 X304 Permit#:
F -503-684-7297 INCOMPLETE OR ILLEGIBLE APPLl-ATIONS Cust.Call'd:
WILL NOT BE ACCEPTED
Name of Development Project TYPE OF WORK INVOLVED-RESIDENTIAL ONLY
Restricted Energy Fes........................................ $40.00
(FOR ALL SYSTEMS)
JOB Street Address Ste 8
Check Type of Work Involved:
ADDRESS 194 0 c
,Cfity/State ZipOR Phone 093
❑ Audio and Stereo Systems
] 73
N ❑ Burglar Alarm
t ❑
OWNER Mailing Address Garage Door Opener'
L�City/State Zip —Thone 0Heating,Ventilation and Air Conditioning System•
-�
Name ❑ Vacuum systems'
❑ Other _
CONTRACTOR Mailing Addrtss
3630 n5"J 304k S7 TYPE OF WORK INVOLVED-COMMERCIAL ONLY
(Prior to issuance aity/State Zip Phone N Fes for each system.............................................. $40.00
copy of all licenses &_eAelY 19 1't 0 2 6 (SEE OAR 918-260-260)
are required if Oregon Contr.Bid Lic.S Exp.Date
expired in C.O.T. 170-?0,6 Check Type of Work Involved:
data base). Electrical Contr Lic.k Exp.Date
CL ❑ Audio and Stereo Systems
C O.T or Metro L ic.0 Exp.Dale
❑ Boiler Controls
Owner's Name
❑ Clock Systems
OWNER- Mailing Address
APPLICANT ❑ Data Telecommunication Installation
City/Slate Zip Phone X ❑
Fire Alarm Installation
This permit is issued under LX-E-918-320-370.This applicant agrees to ❑
make only restricted energy installations(100 volt amps or(ass)under this HVAC
permit and to do the following:
❑ instrumentation
1 Only use electrical licensed persons to do installations where required.
Certain residential and other transactions are exempt from licensing. ❑ Intercom and Paging Systems
'hese have asterisks('). All others need licensing;
❑ Landscape Irrigation Control*
2 Call for inspections wf do installation under this permit are ready for
inspection at 503-639-4175; ❑ Medical
3 Purchase separate permits for all installations that are not ready for an ❑ Nurse Calls
inspection when the inspector is out to inspect under this permit;
IL4. Assume responsibility for assuring that all corrections required by the ❑ Outdoor Landscape Lighting*
N inspector are done,and; ❑
Protective Signaling
5 Assume responsibility for calling for a final inspection when all of the
corrections are completed. ® Other CC T V
_J
m Permits are non transferable and non refundable and expire if work is not
O started within 180 days of issuance or if work is suspended for 180 days. _.Number of Systems
W
-� 1 he person signing for this;permit must be the applican'or a person No licenses are required Licenses are r-qu!red for all other installations
authorized to bind the applicant.
l Fes' _�/r► •�—
ENTER FEES $
5%SURCHARGE(.05 X TOTAL ABOVE) 5 OST
Authority if other than Applicant TOTAL $
i1dstsvesele doc 7197 -
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business Line: 639-4171
BUP _
Date Requested AM_ PM BLD
Location at-Ad 179"t Suite MEC
Contact Person _ Ph PLM `
Contractor 'M RPh SWR
BUILDINt3� Tenant/Ownervt � ,��G/� ELC — ��--
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes: --
Slab SIT
Post&Beam //,, /
Ext Sheath/Shear �� 3 J bn! IA r� .fir C7+y5
Int Sheath/Shear I
Framing
Insulation
Drywali Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof l
Misc: - -/
Final
PASS PART FAIL — -
PLUMBING
Post&Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post&Beam - - -
Rough In
Gas Line —
Smoke Dampers
Final -
PASS PART FAIL
ELECTRICAL
n, Service
Rough In
N UG/Slab
Low Voltage �—
Fire Alarm
m PASS PART FAIL
5
J Backfill/Grading
Sanitary Sewer
Storm Drain [ ]Reinspection fee of$ required before next inspection. Pay at CRy Hall, 13125 SW Hall Blvd
Catch Basin [ ]Please call for reinspection RE: _ [ ]Unable to inspect-no access
Fire Supply Line
ADA
Approach/Sidewalk
Other
Date15�Y _Inspector (� ��_�! Ext
Final
PASS PART FAIL DO NOT REMOVE this inspectlon rllit+cotrd from the job alto.
CITY OF TIGARD PERMIT #: EPERMIT
LC98 0425
DEVELOPMENT SERVICES DATE ISSUED: 07/29/98
13125 SW Hall Blvd.,77gard,OR 97223 (503)&V4111
PARCEL: 2S1O2AA-02301
SITE ADDRESS. . . : 1216O SW MAIN ST
SUBDIVISION. . . . :TIGARD HIGKWAY TRACTS ZONINGsCBD
BLOCK. . . . . . . . . . . LO-i.. . . . . . . . . . . . . :004 JURISDICTION: TIG
Flro j ect De scr i pt i on: Electrical service for installation of 3 permanent mall
signs.
-----------------------------------------------------------------------------------
-- -RESIDENTIAL UNIT---- ---TEMP SRVC/FEEDERS---- -----MISCELLANEOUS-----
1000 SF OR LESS. . . . : 0 0 — 200 amp. . . . . . . : 0 PUMP/IRRIGATION. . . . : 0
EACH ADD' L 5O0SF. . . : 0 201 — 400 amp. . . . . . . : 0 SIGN/OUT LINE LTG. . : 3
LIMITED ENERGY. . . . . : 0 401 — 600 amp. . . . . . . : 0 SIGNAL/PANEL. . . . . . . : 0
MANF. HM/ SVC/FDR. . : 0 601+amps-1000 volts. : 0 MINOR LABEL ( 10) . . . : 0
----SERVICE/FEEDER---- ----BRANCH CIRCUITS----- ---ADD' L INSPECTIONS---
0 — 20u amp. . . . . . : 0 W/SERVICE OR FEEDER: 0 PER INSPECTION. . . . . : 0
201 — 400 amp. . . . . . : 0 1st W/O SRVC OR FDR. : 0 PER HOUR. . . . . . . . . . . : 0
401 — 600 amp. . . . . . : 0 EA ADD' I BRNCH CIRCs 0 IN PLANT. . . . . . . . . . . : 0
601 — 1000 amo. . . . . : 0 ------ ------------PLAN REVIEW SECTION----------------
1000+ amp/volt. . . . : 0 )=4 RES UNITS. . . . . . . . s ) 600 VOLT NOMINAL. . :
Reconnect only. . . . . : 0 SVC/FDR ) = 225 AMPS. . : CLASS AREA/SPEC OCC. :
Owner: --------------------------------------------------------- FEES ------------------
US BANK type amount by date recpt
1.2160 SW MAIN STREET PRMT $ 120. 00 DEB 07/24/98 98-307672
TIGARD OR 97223 SPCT $ 6. 00 DEB 07/24/98 98-307672
Phone M:
Contractor: ---------- ------------------
CLARK SIGNS $ 126. 00 TOTAL
PO BOX 1113
------- REQUIRED INSPECTION, -----
ST_ HELENS OR 97051 Ceiling Cover Elect' 1 Service
Phone s`: 781-6081 Wall Cover Elect' 1 Final
Reg #. . : 000649
This permit is issued subject to the regulations contained in the Tigard Municipal Code, Btate tf Oregon Specialty Codes and all other
applicable lams. All work mill be done in accordance mith approved plan;. This permit mill expi,v if murk is not started within 181
days of issuance, or if work is suspended for more than 189 days. ATTENTION: Oregon law requires V,iu to follow the rules udopted by
the Oregon Utility Notification Center. Those es are set forth in OAR 952-0111 through OAR 9%-Ml-lgd7. u may obtain a copy
of these rules or direct questions to OUNC c ling 1 1 - 7.
a Permittee Signature: Issued Bya01 246,"eZt
a
N -------------------------•----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::
W
J ------------- -------------CONTRACTOR INSTALLATION ONLY-----------------------------
SIGNATURE
---------------•------------SIGNATURE OF SUPR. ELEC' N: C - DATE:
LICENSE N0: $
++f++++-+-+-V.....4...........V.............;-4........................................++f++++-+-+-f+++++++++++++++-f++++++++++++,-i.+++++++++++++++++++++++++++++++++++++++
Call 639-4175 by 7:00 p. m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
CITY OF TIGARD Electrical Permit Application Pia^c ..tJ
13125 SW HALL BLVD. Recd B
TIGARD OR 97223 Date Recd � -
Phone (503)639-x171, x304 Date to P.E.
Print or Type Date to DST
Inspection (503)639-4175 Incomplete or illegible will not be accepted Permit It 5
Fax (503)684-7297 Called
r--
1. Job Address: / J C /��,,� 4. Complete Fee Schedule Below:
Name of Development_ v's/ 6 7- � Number of Inspections par permit allowed
Name(or name of businesses)^ '�/ S 6 AW Service Include. Items Cost Sum
Adui ess /-Z-/ G J W ) S 4a. Residential-per unit
1000 sq.tt.or less $110.00 4
City/State/Zip tr e-V_ Each additional 500 sq.ft.or
Commercial Residential❑ portion thereof $25.00 1
Limited Energy i $25.00 _
Each Manuf'd Home or Modular
dwelling Service or Feeder $89.00 2
2a. Contractor Installation only:
(Attach copy of ell H/ent�ce�s ) C 4b.Services or Feeders
Electrical C tractor L"T7 ' t V f A) Installation,alteration,or relocation
200 amps or less $60.00 2
AddreSS -TA201 amps to 400 amps $90.00 2
City State Zip�/ yS 77- 401 amps to 600 amps $120.00 2
Phone Ne. ofy 601 amps to 1000 amps $190.00 _ 2
.lob No. Z- Over 1000 amps or volts $340.00 _ 2
Dec.Cont. Lice. No. � Exp.Date 0 Reconnect only $50.00 2� --'
OR State CCB Reg. No._ Z Exp.Date 4c.Temporary Services or Feeders
(,o,r Business Tax or Metro No OQ2S6 Exp.Date Installation,alteration,or relocation
200 amps or less $50.00 _ 2
Signature of Supr. I-lec'n � 201 amps to 400 amps $75.Q0 - 2
401 amps to 600 amps $100.70 2
Over 600 amps to 1000 volts,
License No. -2-1:3 s l x .Date l(�� a""b"above.
Phone No. 27 71 oy j
4d.Branch Circuits
New,alteration or extension per panel
2b. For owner installations: I a)The fee for branch circuits with
purchase of service or
Print Owner's Name_ 11"cler fee.
Address Each branch circuit $5.00 2
Cit State Zi b)The fee for branch circuits
y _ _ P without purchase of
Phone No. servlre or feeder les.
Fir;t branch circuit $35.00 2
The installation is being made on property I own which is not Each additional branch circuit_ $5.00 _ 2
intended for sale,lease or rent. 4e.Miscellaneous
(Service or feeder not Included)
OwnP,i'S Signature _ Each pump ar hrtgation circle $40.00 2
Each sign or outline lighting $40.00 �� 2
3. Flan Review sec:ior (if required):* Signal circuits)or a limited energy
L panel,alteration or extension. $40.00 p
Minor labels(10) $100.00
r Please check approprsate Item and er:ter fee In section 58. -�
4 or more residemial units In one structure 4f.Each additional Inspection over
Service and feeder 225 amps or more the allowable In any of the above
System over 600 volts nominal Per inspection $35.00 _
Classified area or structure containing special occupan„y Per hour - $55.00
O as described in N.E.C.Chapter 5 In Plant $55.00 _
U *Submit 2 sets of plans with application where any of the above apply. S. Fees: U 0O
JNot required for temporary construction services. 5e.Enter total of above fees $
5%Surcharge(.05 X total foes) $ �
NOTICE Subtotal $ 406
5h.Enter 25%of line 5s for
PFRMiTS RFCOMF VOID IF WORK OR CONSTRUCTION AUTHORIZED Is Plan Review If M%jlro(Ser.3) $
NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK Subtotal $ ---
IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY
TIME AFTER WORK IS COMMENCED ❑ Trust Account M_
Total balance Due $
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