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6777 SW BONITA ROAD BLDG D STE 100 d � e � L r-. w H O H 2' [TJ H H N ;Tr O ;77 � C7 I I I. I I� r 6777 SW BONITA RD. BLDG D SUITE. 100 ........,.........�.....,...�.._ .�... ...-- ......., CITY OF T I GIRD CERTIFICATE OF COMMUNITY DEVELOPMENT DEPARTMENT OCCUPANCY 13125 SW Hall Blvd.Tigard,Oregin 97223*8199 (503)839-4171 PERMIT #. ., . . . . , : BUP96.-.0105 DATE ISSUED: 06/20/96 PARCEL : JPS I I.:!AA. 00(0 SITE ADDRESS. . . 1 06777 SW BONITA RD #100 SUBDIVISION. . . . I ZONING: BLOCK. . . . . . . . . . s LOT. . . . . . . . . . . . . . CLASS OF WORK. cALI TYPE OF' USE. . . sCOM TYPE OF CONSTR:3N OCCUPANCY GRP. :Br-I OCCUPANCY LOAD- 120 TENANT NAME-". . � :ROTH D I STR I BUT NG Pf?mat-ks : TOnent Improvement : WAIII fOr- Cabiriet display Owner. SPIEKER PROPERTIES 4830 SW MACADAM STE 100 PORTLAND OR Phone #: 2'21 -5700 C. 'SCHIEWE & ASSOCIATES ILA24 NE DAVIS PORII.AND OR 97232. t--Ihune #: J.'3A-4,617 Reg #. . : 9410,15 This Certificate grants occUrlancy Of the above referenced building or, portion thereof and c.onfirmA that the building has been inspected for compliance with the State of OlrQOr, Specialty Cod&s for t h e group, occupancy, and use kinder- which the referenced ppr-mit, was itSfAed. > P E E OR RUILDING OFFICIAL"' IN CON5'PICU001-3 PLACE CITY OF TIGARD BUILDING INSPECTION NOTICE Inspection Line: 639-4175 Business Phone: 639-4171 Footing Rain Drain Cover/Service FINAL: Foundation Water Line Ceiling lum Post/Beam Mach, Shear/Sheath Framing Plbg.Und/Flr/Slab Plbg.Top Out Insulation ETi#i<f. Post/Beam Struct. Mech. Rough-in Gyp. Bd. Bldg. San. Sewer Gas Line Appr/Sdwlk Other: Dater 9� A.M. _P,M. Entry: Address: _ Tenant: u _ Ste:.---.---- MST: BUP: Con/Own: _ MEC: ----- -- - PLM: O�5 ELC: THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR: In ector: ---- --- Date: . L`f _APPROVED DISAPPROVED/CALL FOR REINSP. CF CO 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 Mach. Shear/Sheath Framing -Mach. Plbg.Und/Flr/Slab Plbg, Top Out Insulation (:II Post/Beam Struct. Mach. Rough-in Gyp. Bd. -Bldg, San. Sewer Gas Line Appr/Sdwlk Reins. Other: Date: _ A.M. P.M. Entry:— Address: � Tenant: Ste:-ICAMST Con/Own:l� n `O BLIP: -� •- _-- - MEC: PLM: THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR: LInspector �P Date. APPROVED _DISAPPROVED/CALL FOR REINSP. CF CO CITYO F T I GA R D BUILDING PERMIT PERMIT#: BUP2000-00080 DEVELOPMENT SERVICES DATE ISSUED: 3/16/00 " 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 PARCEL: 2S112AA U060G SITE ADDRESS: 067"7 SW BONITA RD 100 SUBDIVISION: NELSON BUSINESS CENTER ZONING: I-L. F—C BLOCK. LOT�C-D JURISDICTION: TIG REISSUE: FLOOR AREAS RIOR WALL CONSTRUCTION _] LASS OF WORK: AL i FIRST: sf N: S: E: W. TYPE OF USE: COM SECOND: sf _ JECT OPENINGS? TYPE OF CONST: 3N sf N:—� E: W: OCCUPANCY GRP: S2 TOTAL AREA: sf ROOF CO ST: FIRE. RET? OCCUPANCY LOAD: BASEMENT: sf AREA SEP. RATED: STOR- HT: ft GARAGE: sf OCCU SEP. RATED: BSMT?: MEZZ?: REQD SETBACKS REQUIRED FLOOR LOAD: psf LEFT: ft RGHT: ft FIR SPKL: Y� SMOK DET DWELLING UNITS: FRNT: ft REAR: ft FIR ALRV : HNDICP ACC: BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING: VALUE: $ 14,900.00 Remarks: Tenant improvement- install new wall. Owner: Contractor: SPIEKER PROPERTIES LP M STEARNS CONSTRUCTION CO 4380 SW MACADAM AVE S7 F 100 8030 NE CLACKAMAS ST PORTLAND, OR 97201 PORTLAND, OR 97213 Phone: Phone: 256-55C2 Reg #: LIC 44616 REQUIRED INSPECTIONS _ Type By Date Amount Receipt Framing Insp PRMT DEB 3/16/00 $170.25 0000742 Insulation Insp Gyp Board Insp 5PCT DEB 3/16/00 $13.62 0000742 Final Inspection PLCK GEO 3/14/00 $110.66 0000603 FIRE GEO 3/14/00 $68.10 0000603 _ -- Total $362.63 V�------ I This uermit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Spe(Jelty Codes and all other applicable law. All work will be done in accordance wile approved plans. Thi3 permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 190 days. ATTENTION. Oregon law requires you to follow the rules adopted by the Oregon Utility N:,irfication Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-1987. You may obtain a copy of these rules or direct questions to OUNC by calling (503) 246-1987. Penn!lee \ \ Signaturg. �— Issued �( Call 639-4175 by 7 p.m. for an inspection the next business day 1 CITY OF TIGARD Commercial Building Permit Application RPlan ec'dBy c_ 13125 SW'HALL BLVD. New Construction and Additions e�'drJ Dare Recd_7 -14,)0 TIGARD, OR 97223 Date to P E. t:03) 639-4171 c'Tz-- Date to DST 3'io 90&70-40 Print or Type Imo, RW'F'w Permit# oo -0C'0?N6 Incomplete or illegible applications will not be accepted Related SWR# _ Calledd Name of Development/Pro)ect Job Lei nl't R _ Existing Building New Building ❑ Address Street Address Suite (,-1-1-) I co ___ Building Bldg# City/State Zip Data Existing Use of Building or Property: Name L-. N Property 7QIfKsG{2, ` "(f_S Owner Mailing Addresssuite Proposed Use of Building or Property: cAj,, M1M1 City/Stale Zip Phone --- LA�t 5�� No. Of Stories: Occupant Name _ Sq. Ft. Of Project: VaTH 1.4 -6 _ Name -- Occupancy Classes) Contractor �4 A.YnS QPy"I , Prior to permit �Mailirg Address Suite T S ype( )of Construction 4n�1C T•t X Issuance,a copy „�(ptp K lEy Rno� of all licenses S03o (4L- �C.k UmA are required if Clty/Stale Zip Phone Will this project have a Fire Suppression System? expired In C.O.T database --,,7 ��►tf 111 Z(� Z Yes N_o ❑ Oregon Const.Cont.Board Lic.# Exp.Date Americans with Disabilities Act(ADA) L,r (�� 3I i Valuation X25% = $_ Participation "TT Complete Accessibility Form Name Project $ Architect "/A Valuation 00 Meiling Address Suite I Plans Required: See Matrix for number of sets to submit CltylSlate Zip Phone on back Engi leer Nam;t I hereby acknowledge that 1 have read this application,that the information I given is correct,that 1 am the owner or authorized agent of the owner,and Mailing Address Suite— that plans submitted are in compliance with Oregon State Laws. Signature oferftent Dat City/State Zip Phone V� � r Cont P rs Namq Phone Indicate type of work New O Addition O Demolition A Accessory Structure O Foundation Only O Alteration O Repair 0 Other. T2 -1`0p,,LJ_ - FOR OFFICE USE ONLY Description of work: Map/TL# Land Use. �rlti(I�L il,-If i ��M t5th L-4% t. 1! CLL--, 1) Notes --- Parks. Estimated#of Employees 10 - - — --- TIF If the above figure Is not supplied at the time of application,the city will calculate the fee based upon the number of parking spaces` Note Site Work Permit Application must precede or accompany Building Permit Application i tdsts\forms\comnew doc 10/8199 COMMERCIAL PLAN SUBMITTAL REQUIREMENT MATRIX Flan Review is dr-pendent upon submittal of B0'1-F1 la's, A D a C bMPI ETEO bpplication. For an electrical submittal, the application must contain the, ignature of the supervising electrician before plan review will be conduct� ter plan review approval, Plans Examiner will contact the applicant to reque < additional plan sets for distribution purposes. (Copy for Contractor, City, ilashington County, Tualatin Valley Fire & fescue) ------------ ,I YPE OF SUBMITTAL plans KEY: Submitted S (Private) 1 S = Site Work B (New or Add) 1 B = Building F (New or Add or Alt) 3 F = Fire Protection Systern M (New or Add or Alt) 1 M = Mechanical B & M (New or Add) 1 P = Plumbing P (New, Add, or Alt) 2 E = Electrical B & M & P (New or Add) 2 New = New Building E (New, Add, or Alt) 2 Add = Addition B & F & M & P & E 3 Alt = Alternation to Existing (New , Add) Building *6 or Ci & M (Alt) .----------- --- 1 "B�M & F' (Alts.�.......... � ............ ._�....�............ -- 'B & M & P & F & F{A!t) 3 NOTES: h"did are"s'd`esignale*''A"tT 6ub:i is only 1 1dsNVorttts\mattxcom.doc 10/30/98 i 02/17/00 10:10 FAX Z003 Exhibit B \tZ CG 14 F d v i I f 1 ~� I - - If -n-a H=--- i 0- .., I . i I � i/VE)V d2F.M15/��4Jci ccGL 4 t CITY TIAARU EllC 4lr� ForMI N v PERMIT NO. See Le;tor to: Follow........................[ Attach ........... Job Address: --p-mel,—W By: __ WIG. �o • r.i �-IN — 1 1/2" Deep Top Track To Beam - No Screws 0 Channel Legs- U.O.N. 20 GA. Metal Studs 0 '24 o.c. �i _ 5/8" Gyp.Bd. B.S. �Typa "X" Gyp.' Bd. 0 emisfng Walla t7pC Bottom Track To Fin. Floor W/ Power Driven Anchors 0 24" O.C. �1 � F u_l_l_ Hqt, Wall __ CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24-Hour Inspection Line: 639-4175 Business Line: 639-4171 BUP Date Requested d —AM_ �PMMBLD Location Suite 1[.tom MEC Contact Person J91i1 AJ^'z Ph 1 C� "��yy PLM Contractor Ph SWR UILD G Tenant/Owner ELC - Retalnf g Wall ELR Footing Access: Foundation �v\AAAk 0-%Ud � Nl q '� FPS Ftg Drain C 0," Crawl Drain Inspection Notes: SGN Slab �y I� - _--._ --��G �A.�v,1 1.._ ----- SIT Post 8 Beam --- Ext SheathlShear ��` Int Sheath/Shear Framing Insulation Drywall Nailing __ Firewall Fire Sprinkler _- Fire Alarm Susp'd CeilingRoof mal ) ASS PART FAIL -- PLUMBING Post&Beam Under Slab Top Out -- ---.-,------- - Water Service Sanitary Sewer - -- -- - --- - -_----T- Rain Drains Final ------__-- -- PASS PART FAIL MECHANICAL - - - - Post& Beam — -- — - -- Rough In Gas Line - -- - ---..-- --- ------- --- Smoke Dampers Final -- -- ---- --- -- - ----- PASS PART FAIL ELECTRICAL -- -` --- -- Service Rough In UG/Slab Low Voltage Fire Alarm -_-- Final PASS PART FAILSITE Backtill/Grading - -- Sanitary Sewer Storm Drain ( ]Reinspef tion fee f,f$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line ( ]Please can foi rernsf,ect nn r:F — _ ( J Unable to inspect-no access ADA Approach/Sidewalk Other Date - / Inspector ! - Ext Final PASS - PART FAIL DO NOT REMOVE this inspection record from the job site. 7 7 r m I #. . . . . . . CITY OF TIGARD ',".Tt'7 ISSUED. 03/14/9 COMMUNITY DEVELOPMENT DEPARTMENT 13125 SW Hall Blvd.Tigord,Oregon 97223*8199 (503)639-4171 2S 11 LAP ZONING; 1EI FLOOR AREAS - CV-ZRIOR WALL CONSTRUCT! L(1', -1 1. , r� . . FIRST— . ; 2028 sf IN: S. EC T Y r,c - '_'73 17-. . ,C,-,J0, SECOINn. . , . C, S f 7 r C-7 r-C T 0 P C I 17 NGC" TYPE 07 CCNC')T. .3."1 . . . 4 ;,,, of N. C. C. W CrP, ;U2 TOTAL — - 2003 of ;7007 CONST: r1RE RrT7 . OCCUPANCY LOW: 20 DPEEMENT. t 0 s PP70 1EP. RATED: 0 f 0 Sf CCCU 'X-P. RATIA). MEZ77. =0 SETBncw ....... REOU T RED---- - -- --- . . . . ... ?� p LE�, T: 0 ft RIGHT: 0 f t r I R UPKL;%` SMOK DLT, OWLLL INC UNITS; 0 FRNT: 0 ft REAR: 0 ft FIR ALRM:Y HINDICP .1CQY imp ouRrAcc , 0 PRO COR17;N PARI"ING; Q. emcnt : Walls for cabinet disp1w, . I-Er-13 t , pc zmu ,nt by date rez : ' 013/11,/iG os SO JM1.11 C-3/111/96 If.1- L '7114. 170 JM1 1 0"1/14 2. "121 JMH 0s/1 ' Car ZLKIEWL AGSOCIATES OR 4 0': TUTOL. REQUIRED IN31--'ECTIONS 'his Pe11-t ii issued subject to the regAitions contained in the ~r^ zraing I n 6 P ilard State of 01-1. Specialty Co-dis aA all ether Invulat, iars -ppl;cstif laws. All w4 will be done it accordance with 0yjj Puard ; , FVcved Plari- T!•,is Permit otil, expire J work is lit started Su6p Ceilng :f isi;ance, jr if work i; susiprde,, for sort "'ipr,inkler f inj�j Fire Alat,ij Inrp Cm0te dptoctc, C j 1� Misc. Inspeut , 1 V Inapeut Commercial Building Permit Application City of Tigard 4 "1 13125 SW Hall Blvd. Tigard, OR 97223 (503) 639-4171 3 Jobsite Address:Cg 7 Imo✓ Cs'Gir/Ti`I Office Use O� Tenant: 2 . Mtn.. Suite# ��c�,-T_ j'2 Valuation: z4UO ` Planck/Rec # `a '"Z`i! Permit # a(-(�tp(oU ICES Owner. -' -`�/�/�/�F,>� f',rUF' 7/ES Map & TL # Address. �O Is"I /Oo ApprqNq4is Re aired Planning _ Phone � �"�76U Engineering Other Contractor. .� — Address: _ Type of const: t = Occupancy class: z Phone Sprinklered� i'Yes J No Contractors License # _ _ `- e (attach copy of current Oregon license) Sq. ft, of project: (, Contact name & phone _ Story (1st, 2nd, etc.) Architect/Engineer: Proposed use _I� r, Previous use: Address �`� 4 SI, 1��2 14;41 S � Note. Plumbing & mechanical plans must be submitted at time of Phone. � _v>57 building permit application JOB DESCRIPTION _ t /rL / lj l: c/'i�+ 71ia r_ r/i 4,42 1A �./ . ��lJ e��6��tV`_'6 t r r�r l t l � ��. r✓ !� f �Ap Ont Signature & Phone number Received by 1 '�;� .V�1,2�� Date Received: l i Permit 0 Account Description Amount Amt. Pd. Bal. Duu fv�. n1 Bldg. Permit (BUILD) Plumb. Permit (PLUMB) ate_, Mech. Permit (MECH) State Tax (TAX) —� Bldg: Plumb: Mech: _ Plan Check (I LA14CK) Eldg: _ Plumb: Mech: Sewer Connection (SWUSA) Sewer Inspection (SWINSP) _ Parks Dev Charge Residential TIF (TIF-R) Mass Transit TIF (TIF-MT) Commercial TIF (TIF-C) Industrial TIF (TIF-1) Institutional TIF (TIF-IS) Office TIF (TIF-0) '^_--- Water Quality (WQUAL) Watei Quantity (WQUAN'f) Fire Life Safety (FLS) Erosion Cntrl Permit (ERPRMT) Erosion Planck/USA (ERPLAN) Erosion Planck/COT (EROSN) n ?3 TOTALS: 7� L l I M H NI .AAl. PERMIT CITY OF TIGARD DATE PERMIT I:i#. . . :. .. ; MEC96--0100 COMMUNITY DEVELOPMENT DEPARTMENT 13126 SW Hall Blvd.Tigard,Oregon 972,!3.8199 (503)830.4171 PARCEL: 2G 1 1 c AA--00600 SITE ADDRESS. . . : 06777 SW BONITA RD #100 SUBDIVISION— . : ZONING: BLOCK. . . . . . . . . . . LOT. . . . . . . . . ., . . . . CLAS.'. OF WORK. . :ALT F=LOOR FURN. . . . : 0 EVAP COOLERS: 0 TYPE OF USE. . . . :COM UNIT' HEATERS. . : 0 VENT FANS. . . : 0 OCCUPANCY GRP. . :B2 VENTS W/O APDL: 0 VENT SYSTEMS: 3 STORIES. . . . . . . . : 0 BOILERS/COMPRESSORS HOODS. . . . . . . : 0 FUEL TYPES--_____-.---_._ 0--3 HP. . . . : 0 DOMES. INCIN: 0 : /GAS/ / / 3-•15 HP. . . . : 0 COWL.. INCIN: 0 MAX INPUT: 0 BTU 15--30 HP. . . . : 0 REPAIR UNITS: 0 F=I RE DAMPERS?. . : 30--50 HP. . . . : 0 WOODSTOVES. . : 0 GAS PRESSURE. . . : 50+ HP. . . . a 0 CLO DRYERS. . : 0 NO. OF UNITS------------ AIR HANnL I NG UNITS OTHER UNITS. : 0 F"URN ( 100K BTU: 0 (= 10000 cfm : 0 GAS OUTLETS. : 1 FURN ) =100K BTU: 0 > 10000 cfm: 0 Remarks : Tenant Improvement ..)wner: ___...---.__.__._.._____ FEES I PIEKER PROPERTIES type amount by date r^ecpt 4830 SW MACADAM PRMT f 25. 50 JSD 04/16/96 96-278262 ISTE 100 PLCK f 6. 38 JSD 04/16/96 96-27826x' PORTLAND OR 5PCT $ 1. 28 JSD 04/16/96 96-278262 1-hone #: 221--5700 Lontractora AMERICAN HEATING INC t339 SE G I DEON 6'ORTLAND OR 97202 ------------------------------------- [,hone --------------------------------.-_.T,hone #: 503-2:39-4600 t 33. 16 TOTAL 33135 REQUIRED INSPECTIONS ------ This permit is issued subject to the regulations contained in the Gas Line Insp Tigard Municipa'. Code, State of Ore. Specialty Codes and all other Mechanical Insp applicable laws. All work will be done in accordance with Mi sc. Inspection approved plans. This permit will expire if work is not started Final Inspection within 14 days of issuance, or if wcvk is suspended for more than lbi days. k=,er-mittee Signatures le Call for inspection - 639-4175 • City of Tigard MECHANICAL PERMIT Planck/Rec. # Oaf -5Z C_ 13125 SW H;111 Blvd, APPLICATION Permit K _MF' 1H -- Tigard, OR 97223 i (503) 639-4171 Liesciipton Table 3A Mechanical Code 07Y PRICE AMT Job 4,777 L. h^r 1) Permit Fee -0 0 10.00 Address -- ,, 2) Supplemental Permit 3 CO ""•" -- Furnace to 100.GW 1) incl. duds A vents 6.00 "` umace100,000 EITU « Owner 2) incl. duds 8 vents 750 _Floor urce -- 3) incl. vent t 00 � -- - -^-�- .,uspen afar,wail heater 4) or floor mounted heater 600 � - en not incl in OCCU�ant 5) appliance permit 300 Repair o eaung, ie ng. 6) cooling,absorption unit 600 gofer or comp,hieat pump,air conn J+. 71 to 3 HP;absorp unit to 100K BTU I 600 t3oiler or comp,Tleat pump, air cora] Contractor 4- deo 8) 3.15 HP absorp unit to 500K BTU 1 100 quer or comp, eat pump,air comic lR 4 (,i2 C , 9) 1530 HP;absorp unit 5-1 mil BTU 15 CO ""^�•," "'� ; eTr or comp, a- eaatpump, air comma 10! 3050 HP;absorp unit 1-1,75 mil BTU , 22,50 oreby ac iowi ge triatT I havo react Vs appi"tion, that the - t3oi er or comp, ea pump, air cone - information given is correct, that I am the owner or audhonZed agent 11) > 50 HP;absorp unit 1 75(nil BTU 3 57 of the owner, that plans submitted are in compliance with State Air handling unit to laws, that 1 am registered with the Construction Contractors Board, 12) 10,000 CFM I 4 50 that the number given is correct (If exempt from State registration, Air handling unit please give reason below } 13) 10,000 CTM . I 7 50 Non porvio�[e 14) evaporate cooler Tent tan coinne-ted 15) to a single duct ` 3 A --venTon system not 16) included in appliance permit 50 •' Hood served y ter, ✓/ r� V-9 17) mechanical exhaust 450 esrn wo new acidition a teration repair Commercia or(n ustnai to be done residential Q non-residential Q 18) type incinerator _ 3000 Existing USB of (_Aher 1'0 wu StovP,water building or property- -i - 19) heater,solo, doilies dryers,etc. 450 Proposed use of 201 Gas piping one to four oudets 200 1 building or property - A- - 21) More than 4 ar outlet I �701 fuel -oil Q natural gas LPC Q otnc-trc -T - - - - Minimum Fee$25 OO SUBTOTAL y' PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS.OR 5%SURCHARGE 3 IF CONSTRUCTION OR WORK IS SUSPENDED OR -- ----- ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME PLAN REVIEW 25`+6 OF SUBTOTAL AFTER WORK IS COM!'JENCED -- r :. TOTAL Special Conditions --- --- _ Date +ssu ._ - by •.V EGMYV t CERTIFICATE OF CANCY CITY OF T'OARD PERMIT #. .O. . . .CUP. . P COMMUNITY DEVELOPMENT DEPARTMENT DOTE 15SUED: 07/31 /95 13125 SW Hall Blvd.Tigard,Oregon 97223*8199 (503)639-4171 PARCEI-; 25112AA OOGOO ITE ADDRESS. 06 777 SW BON I TA PD #S. 1110 .iUBDIVISION. . . . I ZONING: ItLOCK. . . . . . . . . . LOT. . . . . . . . . . . . . . 1','LASS OF WORK. GALT IYPE OF USE. . . .-CC.M ,)CCUPANCY ORP. :B2 OCCUPANCY LOAD-.2 rC:NANT NAME. . . - ROT H D I STR I Bur I NG INC 1'enant Improvement Owners 3PIEKER PROPERTIES LP A SANDHILI_ RD. *u'1210 4ENL0 PARK CA c)402Fj pl-lone #: Contractors RUSSELL CONSTRUCTION 2211 N. W. F'RONT AVENUL PORTLAND OR 972-09 I'-,hone #* Req #. . : 8'41.a chis Lertific-ate certifies that the above rpfei-enred buildlLnp ov- portion thereof has been J,rigperted for compliance with the Tigard Building Code for- Cha gr-oup and division of ocetipancy RnH use for which the above , ofet-enced permit: w,is isciued, and occupancy is hereby gr-anted. BUILDING INSPECTOR IN OFFICIAL POST 114 CONt5PICUOUS PLACE CITY OF TIGARD BUILDING INSPECTION NOTICE Inspection tine iRec-O-Phone): 639.4175 Business Pcon�' 63 171 Inspection: Footing Susp, Ceiling Sprink. Rough-in /Sdwlk Foundation Plbg Underslab Mech. Rough-in Fireplace Post/Beam Struct. Plbg. Top Out Elegy. Rough-in FINAL: Post/Beam Meeh, San Sewer Gas Line --grf9;j(ti . Plhg. Underfloor Rain Drain Framing -Plumb. Alarm Water Line Insulation -Mech. Underflr. Insul. Shear Wall Gyp, Bd. -Elect. Date Requested: _ ^ Time: AM PM Address: Builder: _Permit THE FOLLOWING CORRECTIONS ARE REQUIRED: Inspector y Date—zzaL �PfjDVED — DISAPPROVED !APPROVED SUBJECT TO ABOVE __Call For Reinsp. CITY OF TIGAR,p B IU L-DING INSPECTION NOTICE Inspection Line (Ree-O-Phone): 639.4175 Business Phone: 6394171 Inspection: Footing Susp. Ceiling Sprink, Rough-in Appr/Sdwlk Foundation Plbg. Underslab Mech. Rough-in Fireplace Post/Beam Struct. Plbg. Top Out Elec. Rough-in FINAL: Post/Beam Mech. San. Sewer Gas Linedg, Plbg. Underfloor Rain Drain Framing -Plumb. Alarm Water Line Insulation Underflr. Insul. Shear Wall Gyp. Bd. -Elect. Date Requested: S --Time: AM PM Address: Builder: Permit THE FOLLOWING CORRECTIONS ARE REQUIRED: Inspector: _ Date: Z-00ROVEU DISAPPROVED APPROVED SUBJECT TO ABOVE Call For Reinsp. CITY OF TIGARDlitillPERMT7 COMMUNITY DEVELOPMENT DEPARTMENT PnTU 1SCUED; 04/03/96 13125 SW Hall Blvd.Tigard,Orogon 9722398109 (503)630-4171 PARCEL: Mum" i, 1 =R:71. 7w mman Rc ZONING : LCT. . . . . . . . . .. . . . . jout Doscription; Ll-ay,ch REMDENTIAL UNIT-- - - - -TEMP ERVEWEEDER& - - vis sr OR WIS. . . . : " 20e . . . . . . . . 0 r',]Mr,'I R R I T 1 Ot 1. AAD' L SONS`. . . : 0 2,01 400 . . . . . . . . 0 Slmvou"r LINE '1.TG, . -IMITC1.) MERCY. . . . . : W! - Sol amp. . . . . . . 1 0 GIGNAL/PnNM.. . . . . . . r. HM/ CVC/FDR. 0 ''.'01+0MPS 1220 volts. 0 MINOP LABEL CC.'r,V I CE.171EELIM", TN.s7T.-% Tj - -T,P. 0 W/rERVICE On rECDER; 0 PCR INSPECTION. h0.':'. a rr.p 11;t W/O -R%fc n, 110,Ur. . . . . . . .. . . . . r01 600 amp. 0 Ep"t ADC'' L 'RZNCH ^r P C 9 18 IN PLnNT. ;101 112100 amp. . . . . : 0 7'LFiN r-C". IC!,4 SECT I ON 0OW amp/volt. . . . . . 0 4 RES UNITS. . . . . . . : ) 600 VOL : Qeccnnect only. . . . . ; C cvc/FDR rmrc. . , CLASS AW :wnur: 1 .11 1- 1- 1 1-IL Tr! E'03 71711 n!7TP ,:7'TNr, t j i� M u I.L')t" by -,'at,- .5'.: PIT) T $ 125. 00 CIS) 04107-11-1c, `3 Pf 7 T I G. TE cis 21 J.-CTITC ccrr. %-LINOVSWW711 55_018= Wall it 1 ijbjett to the regulations contained in t`re State of Ore. spezialty Codes and all :`.her I'p—rittep Sign. %III be dcr,, r. accurdzr:: hi"h I'le: 7;',.5 ervit All expii-E if wcfk is not itartc :77 2E,y. isuvv, or if wa6 is susptrde.' for o;r _61ce de-f. &)"dt_ I ad by OWNER, JNLY, We an property I own whicA 1 : t irt , du� cc'� D A TL c' I Community Development ELECTRICAL PERMIT APPLICATION 13125 SW Hall Blvd Tigard, OR 97223 Permit # Date Issued ___1 3yE Phone (503) 639-4171 CITY OF TIGARD FAX (503) 684-7297 TDD No. (503) 684-2772 Inspection (503) 639-4175 1. Job Address: 4. Complete Fee Schedule Below: Narrle of Development Number of Inspections per permit allowed Address �T`j S 001-,TPF C V is r-) `service included Items Cost(ea) Sum City/State/Zip l-c-gt"�_IJI<- 91 Z-2-`- 4a. Residential -per unit 1000 sq ft or less $.110 00 _ 4 Name (or name Ot businesS)�-MLD J�_____ Each additional 500 sq It or portion thereof $2500 Commercial Residential Limited Energy $25 on =___ 1 Each Manufd Home or Modular Dwelling Service or Feeder $6800 2a. Contractor installation only: 4b. Services or Feeders Electrical Contractor COM ENCIAL FT,FY'TRICI-L CORP Installation.alteration or relocation 200 amps or less $6000 2 Address 10928 N.E. KILLINGSWORTH 201 amps to 400 amps E6000 City PORTLAND State OR __ Zip 97220 401 amps to 6Do amps $12000 _ a 601 amps to 1000 amps $18000 2 Phone No. 255-9822 — Over 1000 amps or volts $340.00 Job NO. Reconnect only $5000 contractor's license NO. 26-33C 4c. Temporary Services or Feeders Contractor's Board Reg. No. 7� Installation,alteration,or relocation Signature of Supr Elec'n 200 amps or less - - 1 201 amps l0 400 amps $5000 License No_ 1 Z Ph ne No 255-4R27 _ 401 empe to eDo amps $75 00 Over 6DO amps to 1000 volts $10000 - 2b. For owner installations: see"b"above 4d. Branch Circuits Print Owner's Name_ _ New.alteration or extension per pane Address a)The fee for branch circuits With City State Zippurchase of service or leader fee. - - - Each branch circuit __ $5.00 _ Phone No. b)The fee for branch circuits without -+ The Installation is being made on property I own which is purchase of service or feeder fee. a First branch circuit $3500 �' r T riot intended for sale, lease or rent. Each additional branch circult $500 Owner's Signature— 4e. Miscellaneous (Service or feeder not included) .3. Plan Review section (if required): Each pump or irrigation circle $4000 Each sign or outline lighting $4000 Signal circullls)or a limited energy Please check appropriate item and enter fee in section 5B panel,alteration or extension $4000 4 or more Iesldentlal units In one structure Minor Labels(tn) $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 as described In N E C Chapter 5 Perinspection $3500 _Y Per hour $5500 In Plant $55 DO Submit 2 sets of plans with application where any of the above apply. Not required for temporary construction services. 5. Fees: .--00 NOTICE 5a. Enter total of above fees $ Z " 5%Surcharge (05 X ,utal fees) $ PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $ - - - AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5b. Enter 25%of line 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 F] Trust Account # y Balance Due I I --- L CITY OF TIGARD ELECTRICAL PERMIT DEVELOPMENT SERVICES PERMIT #: ELC98-052=5 13125 SW Hall Blvd., Tigard,OR 97223(503)6394171 DATE ISSUED: 09/02/98 PARCEL: `S I l EPA-00600 SITE ADDRESS. . . :06777 SW BUN I TA RD #100 SUBDIVISION. . . . :NELSON BUSINESS CENTER ZONI•NG: I--L. BLOCK.. . . . . . . . . . . LOT. . . . . . . . . . . . . :C-D JURISD:iCTION: TIG Project Description : Roth Distributing TI - - RESIDENTIAL. UNIT---- -._--.TEMP SRVC/FEEDERS----_-- -----MI SCEI._LANEOUS-._.____. 100x: SF OR LESS. . . . : 0 0 -• 200 amp. . . . . . . : 0 PUMP/IRRIGATION. . . . : 0 EACH AD1>' L 500SF. . . : 0 201 - 400 amp. . . . . . . : 0 SIGN/OUT LINE LTG. . : 0 LIMITED ENERGY. . . . . : 0 401. -- 600 amp. . . . . . . : 0 SIGNAL-/PANEL.. . . . . . . : 0 MANE. HM/ SVC/F'DR. . : 0 601 +amp_=,-1000 volts. : 0 MINOR LAPEL_ ( 10) . . . : 0 ----SERVICE/FEEDER---- -----BRANCH CIRCUITS.---.----• ----ADD' L. INSPECTIONS-- 0 - 200 amp. . . . . . : 0 W/SERVICE OR FEEDER: 0 PER INSPECTION. . . . . : o 201 - 400 amp. . . . . . : 0 1st W/O SRVC OR FDR. : 1 Pf'R HOUR. . . . . . . . . . . : Vi 401 - 600 amp. . . . . . : 0 EA ADD' L BRNCH CIRC: 3 III PLANT. . . . . . . . . . . : 0 601 - 1000 amp. . . . . : 0 -----------------PLAN REVIEW SECTION----------------- 1000+ amp/volt. . . . . : 0 ) =4 RES UNITS. . . . . . . . : > 600 VOLT NOMINAL. . : Reconnect only. . . . . : 0 SVC/FPR > = 225 AMPS. . : CLASS AREA/SPEC OCC. : Owner: ----- - --- -____.___..___-__.-.---•------------_________..____.___.___ FEE'S _.._._.-•-- ------____-- SPIEKER P'ROP'ERTIES type amount by date recpt PO BOX 5909 P'RMT E 50. 00 .JSD 09/02/98 98-308790 PORTLAND OR 97228 5P'CT $ 2. 50 .TSD 09/02/98 98-308790 Phone #: Contractor: OREGON ELECTRIC CONST/GROUP $ 5);?. 50 T0TA1_ 1010 SE 11TH AVE -----•-- REQUIRED INSPECTIONS) - - PORTLAND OR 972'14 Ceiling Cover Elect' ] Service Phone #: 234--9900 Wall Cover Fl ect' 1 Final Reg #. . . 203 This permit is issued vibject to the regulations contained in the Tigard Municipal Code, State of Oregon Specialty Codes and all other applicable laws. All Mork will be done in accordance,Mith appy ed plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for sore than IAB day . ATTE ON: Oregon law requires you to followr rules adopted by the Oregon Utility Notification Center. Those ru s are set forth in R g52-001-0010 through OAR 952-801-1967 you may obtain a copy of these rules or direct questions to ODIC by lin (73)246- L - / - Permittee Si nat e : _____-•----------------..._.__-C11INER INSTALLATION Che installation is being made on property I own which is not intended for •:,ale, lease, or rent. OWNER' S SIGNATURE: DATE: _____-_•_---__._.__... ......,____------ CONTRACTOR IN5TAI_ 1. ATION GNI._Y---- ---------_...---_---_-_.-__-_._ SIGNATURE OF l-iHF'R. ELEC ' N: DATE: LICENSE NO: +++++•+++i•i• r+++++++++++++++++++++++++•++++++++4.++++++++++++++.4-++•4++++++++++++++44 Call 639-4175 by 7:00 p. m. for an inspection needed the next business day +++++++++++4 +++++++++++-F+++++++++++++++++++++++++++++++++++++++++++-M++++.++.++++ Community Development '_CEIVMLECTRICAL PERMIT APPLICATION 13125 SW Hall Blvd , �� r ._, Tigard, OR 97223 -Rermit # L �. /C-)(-,\ n ate Issued Phone (503) 639-4171 i CITY OF TIOARD FAX (503) 684-7297 I�7 TDO No. (503) 684-2772 ?` ��p, P Inspection (503) 639-4175 -' 1. Job Address: 4. Complete Fee Schedule Below: Name of Development. Roth Distributing Number of Inspections per permit allowed Address 6777 S W Bonita Rd. #D1100 _ Service Included Items Cost(ea) Sum City/State/Zip Z'i g a rdi—O r. 97224 4a. Residential - per unit 1000 sq It or less $11000 4 Name (or name of business) Roth_ Di S t. Each adddional 500 sq If of --- -- --- porbun thereof $2500 Commercial Residential ❑ Limited Energy $2500 _V 1 Each Manurd Home or Modular Dwelling Service or Feeder S68 00 2 2a. Contractor installation only: ---- --- 4b. Services or Feeders Installation,alteration,or relocation Electrical Contractor Oregon Electric: Group 200 amps or less $6000 2 Address_ 1010 S E 11th 201 amps to 400 amps $00 00 —_ 2 City Portland State Or Zipg721 4 401 amps to 600 amps +_ $12000 _ 2 Phone No 601 amps to 1000 amps $19000 2 2 34=9 9 0 0 -- Over 1000 amps or volts $34000 2 Job NO _ 7 7 3 31 Reconnect only $50 00 -- 2 contractor's license NO. 26-95 _ 4c. Temporary Services or Feeders Contractor's Board Reg. No 2 Installation,alteration,or relocalion Signature of Supr Elec'n ! _ 200 amps or less 11 License No �g 41 S O 201 amps to 400 amps $5000 2 --- --- 401 amps to 600 amps $7500 2 Over 600 amps to 1000 volts $10000 -- ---.- 2b. For tlwner installations: see"b"above 4d. Branch Circuits Print Owner's Name _ Newalteration or extension per cane Address _ _ a)The fee for branch carulls with purchase or service or feeder fee 2 CIfV State_ Zip, Fach branch circuit $500 Phone NO ^� b)The fee for branch circuits without The Installation is being made on property I own which is purchase of service or feeder es. 22 not intended for sale, lease or rent. first branch rirrult L` $35 00 3 _ Q n Each additional branch circuit .1500 (-)wner s Signature ____ _T 4e. Miscellaneous (Service or feeder riot included) 2 3. Plan Review section (if required): Each pump nr Irrigation circle S4000 Each sign of outline lighting $4000 Signal circuit(s)or a Ilmlted energy 2 Please check appropriate Item and enter fee in section 5E, panel alteration or extension $4000 4 or more residential units in one stricture Minor Labels(to) $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 as described in N E C Chapter 5 ter inspertion -'35 00 hour _ $5500 -- SuIn Flanl $55 00bmit 2 sets of plans with application wh:,re arty of the above -- apply Not required for temporary construction services 5. Fees: NOTICE 5a. Enter tutui of above fees S 50. 00 5%Surcharge (05 X total fees) $ 2 Tu J PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal S =0 AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5b. Enter 25% of line A for CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Plan Review •'required (Sec 3) $ A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal S COMMENCEL. ..m omn.rw �_� Trust Account p �/ —G L Halance Due Ste. LQ BUILDING PERMITCITY OF TIGARD PERMIT #. . . . . . . : S UP,P, COMMUNITY DEVELOPMENT DEPARTMENT , DATE ISSUED: 06/26/95 6 131201 SW Hall Blvd.Tigard,Oregon 9722398199 (503)039-4171 P,ARCEL: ESI12AA-00600 S 7 SW BONI ; - #S. 1001 SUBDIVISION. . . . : ZONING: DLOCK. . . . . . . . . . : LOT. . . . . . . . . .. . . . . RI 1:3a UE: F'LOOR AREAS--------------- EXTERIOR WAL'. CONSTtaic-rim CLASS OF WORK. :ALT FIRST., . . . : 14,+ 5f N: S: E.. W: OF USE. . . :COM IS ECOND. . . : s PROTECT OP,EtqINGS?-----.-.. TYPE OF CONST. :3N TIAIRD. . . . : s N: S; E: W: t'-C(JPANCY GRP,.. :B2 TOTAL--_ 144 .5f ROOF CONST:B FT RE RE 1i . ;GLJPIANCY LOAD:2 BASEMENT. : sf ARE"A SEP. RATED: IOR. ; l I-IT. :2 E, ft GARAGE. . . : 5 f OCC"U SEP,. RATE.D. .iMT?:N MEZZ'?:N REOD SE*TBACKS------------ REUU I - --- _OOR LOiAl). . . . : 125 psf LAIFT: ft RGHT: ft FIR '::`PKL:Y SMOK DET. . :N .JELLING UNITS: FRNT: ft REAR: ft FIR ALRM:Y HNDICP, ACC:Y -DR115. PATHS: IMP, SURFACE: PRO CORR.-N PARKING: ILUE. $ : 2400 marks, : Tenant Mode partitions, window, cokintei, No electrical or- mechaniLEII ridefined variable : open to roof above, no ceiling ***required to be open for .)t-inkler- pi,otect ion. ,,neo: FEES - IEKER PROP,rRTIES LP type amal-trit by date r,ecpt 1130 SANDHILL RD. 02'00 P,LCK $ 25. 03 JHF 06/20/95 rIRE 111 15. 40 J1AF 06/,20/95 !,1ENLO PARK CA 1)4025 SECT $ 1. 93 JHF 06/1-20/05 Phone #: PIRM T $ 38. 50 JHF 06/20/95 Cont ract al., : RUSSELL. CONSTRUCTION C_ "`-Al N. W. FROHT AVENLJE PORTLAND OR 971209 1-T)one 0 ; It ao. ac, TOTAL Hey 513918 REOUIRED INSF,ECTIONS 'his piroit is issied subJert to the regulations contained iri the Framing I n s F.) igard Municipal Code, State of Ore, Specialty Codes and all other Gyp Boav-d I n s p applicable laws. All work will be done in accordance wit' Final Inspectiun approved plans. This persit will expire if work is not started sith;n 180 nays of issuance, or if work is suspended fcr more than IN days. 17'e I m ; t t. e ci -3 i L41 A t 1-1 i.,e . I R,J B y Cal 1 for- inspect ion 639 417-5) \ o `J�� CN Commercial Building Permit Applicat o � City of Tigard 13125 SW Mall Blvd. l Tigard, OR 97223 (503) 639-4171 Jogsite Address: G- �� •,� �r 9 D Tenant: Office use on $IIIb Valuation: Plandc/Rec 1 Permit # ' t' 1 — Owner: (,.s C, is js (.C-UR1Z Map &Tt# Address: n t V-,Cyt P P,(, crovals Reoulred Planning Phone: kA — Engineering w Other Contractor: I A 'T 44— Address: f:1 ) 1.1�f l-��c. .,� ucZ� '.. Cmt \. Type of const: j Occupancy class: j' , Phone: ` �' ��' ' - Sprinklered? Yes' No Contractor's License # S �(affach copy of currant Oregon license) Sq. ft. of project: Contact name & Phone: tc �'J~� ' 1t "' 1,ov` rr 3?s v.( '. Story (1st, 2nd, etc.) _ Proposed use: `'A`� IA-1, ' ArchltecVEngineer. r�r a ^ s P� rl ( rr 5� � tilr r,2 „-f ` �L r Previous use: Address: c I �� , ' -" Note: Plumbing & mechanical plans must be submitted at time of Phone: Sl; .� nt. �� building permit application. JOB DESCRIPTION: /'�(�� T\ Applicant Signature R Phone number Received b c1� ~� L-6Y ,��.��- Date Received: .� � 1 Permit tf Account Description Amount Amt. Pd. Bal. Due Bldg. Permit (BUILD) Plumb. Permit (PLUMB) Mach. Permit (MECH) State-i ax (TAX) Bldg: Plumb: Mach: Pian Check (PLANCK) 12 Bldg: Plumb: I Mach: Sewer Connection (SWUSA) Sewer Inspection (SWINSP) Parks Dev Charge (PKSDC) Residential TIF (TIF.•R) Mass T ransit TIF (TIF-MT) Commercial TIF (TIF-C) _ Industrial TIF (TIF-1) Institutional TIF (TIF-IS) Office TIF (TIF-0) Water Quality (WQUAL) Water Quantity (WQUANT) i — i Fire Life Safety (FLS) r/ 5 Frosion Cntrl Permit (ERPRMT) Erosion Planck/USA (ERPLAN) Erosion Planck/COT (EROSN) TOTALS: P1 UMRING PERMIT i CITY OF TIGARD DATE,ISSUED:•03/12/9EG4@@jn COMMUNITY DEVELOPMENT DEPARTMENT 13125 SW Hall Blvd.Tigard,Oregon 97223.8199 (503)839.4171 PARCEL; Irl I2AA--OO600 . :ADD GARBAGE DISPOSAL'-'!—: 0 MOBILE HOME SPACES. : 0 ^E. . . . :COM WASHING MACH. . . . . . : 0 PACKFLOW PREVNTRS. . : @ LOOR DPPINS. . . . . . . 0 TRAPS. . . . . . . . . . . . . . . 0 l . . . . . . . . 7 @ WATZR HEATERS. . . . . . 1 CATCH BASINS. . . . .. . s (� nr __ �_AUIZRY TRAYS. . . . . e Sp RAIN DRAINS. . . . . . 0 . . . . . . . . . . . URINALS. . . . . . . . . . . . 0 GREASE TRAPS. . . . . . . . @ T:c�/541►7WER5. . . . : @ SEWER LINE (ft). . . -. @ WATER CLCr:, . . : @ tdATf_A LINE (ft) . . . : @ DISHW'I::!(ER'_'. . 0 RAIN DRAIN (ft). . . : 0 RJmar ks.- Tenant impr•ovemer,t ------------- rEE5 IEKER PROPERTIES type amount bl/ date r•ecpt 4330 SW MACADAM PRMT $ 27. 0121 JDA 031,12196 9b--r'_'7,1,843 ,UITE 100 sr,r.T .,�� t 7r 7 1. ..DA 0.,, �::!9 )ORTLAND OR 97203 ne i!: i?iJWLAND r LUMB I NG ``4 N LOMBARD -_,RTLANC OR 97203 ___..._. . 1 23. ` TOTAL _.__ . .. REQUIRED INSPECTIONS ' s ptroit is issued subject to the rtgulations contained in the PLM/Under-f I oo� ,prd l(uri,,pal Cafe, State sf Ire. Specialty Codes and all other Top-out Insp _ pplicable 1atis. All work will be done in accordant with Misc. In6pect itrr; -pproved pians. This pertit pill expire if mri, is not started F-inal Ir;;pe=tion _ yIthin IN days of issuance, or if work is sisperdt.' fcr tore :hin loll Mays. pity & Tigard PLUMBING PERMIT APPLICATION Planck/Rec. # 20111 b- 00571 1312'5 SW Hall Blvd. Permit # Tigard, OR 97223 (503) 639-4171 MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE New Single Family Residences PUI �►»• f 0 1 BATH HOUSE$140.00 ❑ 2 BATH HOUSE$195.00 Job r }� 0 3 BATH HOUSE $225.00 Address raw>a. ze Fee includes all plumbing fixtures in the dwelling and the first 100 feet % of water service, sanitary sewer and storm sewer. See fees below. Nrfr to now"of boom) _-_ FIXTURES QTY PRICE AMT L_� ��, �'� �5 �/ Sink 900 (. - M.A,a MOO" Lavatory 9,00 Owner Tub or Tub/Shower Comb 9.00 urian. Shower Only 9.00 Water Closet 9.00 N•m•�a n•nw 0 eu.nwqDishwasher 9.00 5-1wuz U11 ( Garbage Disposal 9.00 Occupant M•rq ••• PR_ Washing Machine 9.00 F - C:�t�� Floor Drain 900 awrw IJAA Water Heater 900 jp Laundry Room Tray 9.00 Nin• Unnnl 9.00 - AJ&-i Other Fixtures 1Speafy) 900 Mull"Ars"s vn«�,,.� - - 930 Contractor 11512-4 �1 25--, 900 crwaua _ri 9.00 LI- 0 V L17a' Sewer 1st 100' 30.00 xn.R.aw.m,No C41 s.ra.No. Sewer-ea. Addit 100' 25.00 1 Water Service 1st 100' 3000 I hereby acknowledge that I havr! read this application, .hat the Water Service ea Addit. 200' 25.00 information given is correct. 'hat I am the owner or authorized agent of the owner that plans submitted are in compliance with State laws, that Storm &Rain Drain 1st 100' 3000 1 am registered with the Construction Contractor's Board, that the Storm &Rain Drain Addit, 100' 2500 number given is correct. (if exempt from State registration, please -- give reason below) Mobile Home Space 25.00 Rack Flow Prevention Device or Anti-Pollution Device 900 rvn.n..,�« .�"Mn • Any Trap or'Waste Not Connected to a Fixture 900 Describe work new (D addition v alteration W repair O Catch Basin 9.00 to be done residential Q non-residential �\ Insp. of Exist. Plumbing 40 001hi Specially Requested Inspections 40 00/hr Existing use of Rain Dram, single family dwelling 3 000 building or property l -�/ ,F L �� -- Residential backflow prevention devices 1500 Proposed use of ��, `�� budding or pioperty � '(Except residential hackflow prevention devices) NOTICE 'Minimum Fee $25.00 SUBT07AL PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5% SURCHARGE CONSTRUCTinN OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT Af4Y TIME AFTER WORK IS PMN REVIEW 25"" OF SUBTOTAL COMMENCED TOTAL Soec al Conditions Date ssued by