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12550 SW EDGEWATER COURT N lJ1 V1 O V� M a w m E a rt m h n rt r Y i I I i 12330 SW EDGEWATER CT _� CITY OF TIGARD DATi'lE r SUED . . . . : M/T95Iii,+,7; DATE ISSUED: i 1/20i 9c., COMMUNITY DEVELOPMENT DEPARTMENT I-'flRCEL ; 1 c 134�E{-1:%I 1 V)►Z� 13125 SW Hall Blvd Tigard,Orspoi 97223-8199 (503)839.4171 SI Ti ; 1::1: CT SUHii I V 1 �1(JN. . . . : M i L.l_V I LW i QIV I NG: R-4. 5 SL.Clt' 1K. . . . . . . •. . . . I_0T. . . . . . . . . . . . . . i. Remarks: room addition to existing house PATH 133650 FT .---••-----------------••--------- _ ---- ------------------- BUILDING ---------------•- REISSUE: STORIES.......: I FLOUR AREAS---------- BASEMENT...: 0 sf REQUIRED cETBACXS---- REQUIRED--------- CLASS OF WORK.:ADD HEIGHT....,...: 19 FIRST....: 336 sf GARAGE.....: 0 sf LEFT....... ... 10 SMOKE DETECTRS: r TYPE OF USE...:5F FLOOR LOAD....: 40 SECOND...: 0 sf FRONT.........: 0 PARkING SPACES: 0 TYPE OF CONST.:SN DWELLING UNITS: I FINBSMENT: 0 sf RIGHi.........: 6 OCCUPANCY GRP.:R3 BDRM: I PATH: I TOTAL------: 0 sf VALUE.-4: 21726 REAR..........: 25 ------ PLUMBING -••---------------------------------------------•---------------- SINI(S.........: 0 WATER CLO:ETS.: i WASHING MACH..: 0 LAUNDRY TRAYS.: 0 RAIN DRAIN ft: 0 TRPPS.........: 0 LAVATORIES....: 1 DIR WEIS)IERS...: 0 FLOOR DRAINS..: 0 SEWER LINE ft: 0 SF RAIN DRAINS: 0 CATCH BASINS..: 0 TUB/SHOWERS...: 1 GARBAGE DISP..: 0 WATER HEATERS.: 0 WATER LINE ft: 0 BCKFLW PREVNTR: 0 GREASE TRAPS..: 0 OTHER FIXTURES: 0 -- -------------------------------------------_-_.__---------- MECHANICAL --------------------------------------------------------------- FUEL TYPES----------- FURN ( 100H ..: 0 BOIL/CMP ( 3HP: 0 VENT FANS.....: 1 .LOTHES DRYERS: 0 /GAS/ / / FURN )=100K ..: 0 UNIT HEATERS..: 0 1@ODS.........: 0 OTHER UNITS...: 0 fAX INP.. 0 BTU FLOOR FURNACES: 0 VENTS.........: c WWDSrOVES....: 0 GAS OUTLETS..,: 0 ---- ELECTRICAL -------------------------------------•------------------------- --RESIDENTIAL WIT--- ---SERVICE/FEEDER---- --TEMP SRVC/FEEDERS-- ---BRANCH CIRCI)ITS--- -----MISCELLANEOUS---- --ADD'L INSPECTIONS-- 1000 5F OR LESS: 0 0 - 200 amp..: 0 0 - 200 amp.. : 0 W/SVC OR FDR..: 0 PUMP/IRnIGATION: 0 PER INSPEC"ON: 0 EA ADD'L 500SF. : 0 201 - 400 amp..: 0 201 - 400 amp..: 0 Ist W/O SVC/FDA: 0 SIGN/OUT LIN LT: 0 PER HOUR...... : 0 LIMITED ENERGY.: 0 401 - 600 amp..: 0 401 - 600 amp..: 0 EA ADDL OR CIA: 0 51GNAL/PANEL...: 0 IN PLANT......: R MANF HMiSVC/FDR: 0 601 - 1000 amp.: 0 601+amps-1000 v: 0 MINOR LAPFL -10: 0 low# amp/volt.: 0 ----------------------- ------ PLAN REVIEW SECTION --------------------------------- Reconnect only.: 0 )=4 RES UNITS..: SVC/FDR)-225 A.: ) 600 V NOMINAL: CLS AREA/SDC OCC: ---------------------------------------------------- ELECTRICAL - RESTRICTED ENERGY ------------•-------------------------------------- A. SF RESIDENTIAL-------------------------- B. COMMERCIAL-----------------------------•--------------------------------------------- AUN0 6 SIEREC.: VAQIUM SYSTEM..: AUDIO I STEREO.: FIRE ALARM.....: INTERCOM/PAGING: OUTDOQF; LNDSC LT: BURGLAR ALARM..: 0TH: :: BOILER.........: HVAC............ LANDSCAPE/1RR1G: PROTECTIVE SIGNL: GARAGE OPENER,.: CLOCK..........: INSTRUMENTATION: MEDICAL........: OTHR: HVAC...........: DATA/TELE COMM.s NURSE CALLS...... TOTAL RI SYSTEMS: 0 Owner: -------------------------•------- --Contractor: --- ----- --- - --- - --•. TGTA� 320.11 HIEU PHAM OWNER IES50 SW FDGEWATEF CT TIGARD OR 972 3 Phone N: 620-#051 Phone Its Reg N..: 00ABA0 This uormit is Issued subject to the renulatsons contained in the Tigard Municipal Code, State of Ore. Specialty Cades and all other applicable lives. All work will be done in accordance with approved plans. This permit will expire if work is not started within 160 days of :ssuan_e, or if work is suspended for more than 160 dans. ------------------------------------------------------- REQUIRED INSPECTIONS Footing Insp PLM/Underfloor Framing Insp Rain drain Im p Erosion Control _ Foundation Insp Mechanical Insp Low Voltage Electrical Final NostiNea, S1- :ct Plumb Top Out Gas Line Insp Mechanical Final Post/Beat Mechai Electrical Servi Insulation Insp Plumb 1"i nal Crawl Drai•i Electrical Rough, Gvp Board Irsp Building Final Permittee Signatcrrr. ---- �Q1:ys _red Py : CalI for- inspection - C, 4175 Residential Building Permit Application City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 (503) 639-4171 .t Jobsite Addres3. _ iL 5 S 4 S 'w Subdsvision: _ M i 1(\/I��) Lot # Office Use Only Valuation: �f�� 'I �'��-'�(- — Contact Date / / Initials -- Result New Construction Only: (Square Footage) PlancklRec # J�- P v 0 0 H�Sa: 3 �(� _ Garage: _ Permit # M_S YS ' U>,�/ Reissue of_ Corner got? N Flag Lot? Map & TL # � Y N Zone -- Owner: A%;i U P N ANA Plat # r�:r l�.• , <<, i — C — A rovals Required ,-3 Address: _ ;2.C;-U 0 �. ) _ - - _ G�'a Planning Setbacks Y-� ___ Solari Zo��Iry ,,-[ �-� -i��--- 7 Engineering _ 7 Phone: ( 5 UPJ ) C,-L�� ' U S"�(�� .S', jE �J Other Contractor: Items Required �k -- Subcontractors � Address: Truss Details - Other Phonu: L_ ) Notes - -- -- Contractors license # _ -------- - (atfach copy of current Oregon license) Contact Narne: Contact Phone Subcontractors: ArchitectJEngmeer: CIIP.-1t S •c j�j (_ht Plurnbrng: `-- -- — Ad,�,ess .2 ] 11 ( ,Kt✓Iztu g)v[� Mechanical: (attach copy of current OR Contractor's LicefMe) Phcne: 2- -70 JOB DESCIPTION — (ZGC M /kt)ID;�T 01J __ _ Applicant Si nature � ��� AFpiica t Phone number / ' 6 �� ~ S A T Received by _ Date Rece ved: ISS '+'MP`Mb+111+p K-C r VA Ilk- 9S_ - oo! Permit At Account Description Amount Amt. Pd. Bai. Due Bldg. Permit (BUILD) 5 a -/-52 Plumb. Permit (PLUMB) 7 vG . Mech. Permit (MECN) r -v State Tax (TAX) 7-3 /U. 7j Bldg: _ Plumb: Mech: 1_ Plan Check (PLANCK) J `� Plumb: _ Mech: !. c�, z 1� �• ZS Sevver Connection (SWUSA) Sewer Inspectijo (SWINSP) Parks Dev Charge (PKSDC) 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) Water Quantity (,:.QUANT) Fire Life Safety (FLS) Erosion Cntrl Permit (ERPRMT) Erosion Planck/USA (ERPLAN) Erosion Planck/COT ;EROSN) TOTALS: l� K= Permit #: -- / .6 F Address: IZ475 Issued by: P, Q w Date. -- Statement: Information Notice to Property owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli- cants who are not registered with the Construction Contractors Board to sign ti►e following statement before a building permit can be issued. This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt from registration under ORS 701.010(7), need not submit this statement. This statement will befiled with the permit. Fill in the appropriate blanks and initial boxes I and 2, and either box 3A or 313: El1. I own, reside in, or will reside in the completed structure. (� 2. 1 understand that I must register as a construction contractor 'if the structure is sold or offered for sale u before or upon completion. ❑ 3A. My general contractor is (Name) Contractor regis. # I will instruct my general contractor that all subcontractors who work on the structure must be registered with the Construction Contractors Board. OR u 3B. I will be my own general contractor. If 1 hire subcontractors, I will hire only subcontractors registered with the Construction Contractors Board. If I change my mind and hire a general contractor, I will contract with a contractor who is registered with the CCB and will immediately notify the office issuing this building permit of the name of the contractor. I hereby certify that the above information is correct and that I have read and do understand the Information Notice to Property (owners about Construction Responsibilities on the reverse side of this form. (Signature of perr.-A applicant) (Date) (Whiten copy to issuing agency permitfile, pink copy to applicant) Information Notice to Properly Owners About Construction Responsibilities Noir: Iho lnfr,rimm'On Noti, r to 1'ropfrt.�•Owners al„•tt Constit tion Responsibilities was de'i•r oiled,»Y rhf, Consfrurtion Con1r,1-fors Board in acco►-dance with ORS 7L L055(5). If you are acting as your own contractor to construct a new home or make at substantial improvement to an existing structure, i you can prevent many emblems by being aware of the i,,Iluwing responsibilities and areas of cotx:ern. • EMPLOYER RESPONSIBILITIES: If you hire persons not registered with the Construction Contractors Board to do labor in constructink or assisting in the constructior.or improvement of a residential structure,you will, in most instances,be -led to be an employer and the people you hire will he employees. As the employer, you must comply with the following: Oregon's withholding tax law: As an employer,you nwst withhold income taxes from employee wages at the time employees are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. i-or mon information,call the Oregbtt Dept. of Revenue at 945-8091. Unemployment insurance tax: As an employer,you are,required to pay a tax for unemployment insurance purposes on the wages of all employees. For more information,call the Orcron Employment Division at the Department oi'Humm)Resourceta at 378-3524. Workers'compensation insurance: As an employer.you are subject to the Oregon Workers'Compensation Law,and must obtain workers'compensation insurance for your employees. If you fail to obtain workers'compensation insurance,you may be subject to penalties and will be liable for all claim cost`if one of your employees is injured on the job. Fur more information. call the Workers'Compensation Division at the Department of Consumer and Business Services at 945-7888. U.S.Internal Revenue Service: As an employer,you must withhold federal income tax from employees'wages. You will be liable for the tax payment even if you didn't actually withhold the tax. f-or more information,call the Internal Revenue Service at 1-8(N)-929-1040. OTHER RESPONSIBILiTiES AND AREAS OF CONCERN: Code compliance: As the pernut holder fur this project,you ate responsible for resolving any failure to meet axle requirernent� that may be brought to your attention through inspections. Liability and property damage insurance: Contac!Your insurance agent to see if you have adequate insurance coverage for accidents and omissions such as falling tools,paint overspray, water damage from pipe punctures,fire,or work that must K re-done. Time to supervise employes: Make sure you have sufficient time to supervise your employees. Expertise: Make sure you have the expertise to act as your own general contractor,to coordinate the work of rough-in and finish trades, and to notify building officials at the appropriate times so they can perform the required inspections. If you have additional questions, write or call the Construction Contractors Board(PO Box 14140,Salern.OR 97309-5052. 503/379-4621). The Board is located at 7tl(t Summer tit. NF Suite 31111, in Salem. prop-own.pm4 1/94 i � I 1�1 ' � ! N p �r V � Z � sw �ur<nn,1�r�cr�3T' ca. A.Dr IT 10 N � CITY OF TIGARD BUILDING INSPECTION NOTICE Inspection Line: 639-4175 Business Phone: 639-4171 Footing Rain Drain Cover/Service FINAL, f Foundation Water Line `C_eiI!N__ Plumb. Post/Beam Mach. �TopOut Framing ec / Plbg.Und/Flr/Sla Insulation -Elect. 9 L i Post/Beam Struct. Mech. Rough-in Gyp. Bd. fdg San. Sewer Gas Line Appr/Sdwlk Reins. Other: — Date: L'C___ A.M. P.M.__ Entry: Address: _—[ U_ �—' Tenant: -- __�-- te:_—_ MST BLIP: Con/Own:_�_ _ MEC:_ PLM: _— ELC: THE FOLLOWING COPRECTIONS ARE REQUIRED: ELR: i Ly Inspector: — -- Date: ROVED DISAPPROVED/CALL FOR REINSP. CF CO RTRITDRCIN OF TIGARD ESCEPERMIT COMMUNITY DEVELOPMENT DEPARTMENT PERMIT #: ELRn 6�- 01� 4 3126 SW Hall Blvd.Tigard,Oregon 97223.6199 (503)639-4171 DA i E I CCI ; : i��+;'4�1 i'y PARCEL: 1233 1-14CP 101 TC i? 7,'2G -WrC?C -4tt?TIwR l�T gDIiJ1; .lu. . . . : MILL'."iCIJ 'ZONING; R- 4. cS CC6<. . . . . . . . . . . _GT. . . . . . . . . . . . . . 1 OieC.'. DeoUr_il:tiVn-' 'Restr_iCtad ener-'gy far a 3'c,:.ide ;tzal haue.i RE'"IDC.NTIA;.-_._._..._ .... ...._ B. COMMERCIAL— .. . ....__... . .... _ ._...._...__._... _._.. _�_ wTFrEC,. . . nUDTO & STE:Rf-70. ,• INTERCCM & E''f1CIt:7. . , E1. PO—' AP nL()!*M. . . . . BOILER. . . . . . . . . . . LANDSCAPE/IRRIGAT. . . r{~DRi^C1` nrCT1Cr. . . . . CLOCI:. . . . . . . . . . . . "C.DICr4L. . . . . . . . . . . . . . , . . . . . . DATA/TELE COMM1. . . NURSE: CALLS. . . . . . . . . rYCTCM. .. . . . rT.RC ALAPM. . . . . . . OUTDOOP I_AtSL�'3_ LI" E VOLT : :X I IVAC. . . . . . . . . . . . ~'RvTF_CT I ti C C S G VAi... . t� t INGTRUi'•",CNTAT I w';. : OTI ICr. . : . . T:ITAL # Or YS" EMIL V :. :. _ __ rCf _ _. . . ie1 L' "'Ii(af' typQ at otant 'ay date r er:r,t 1.«CC14� •Jyv r_DCEWAT~r ET PRMT 1 40. 00 CTS 04/01/16 S 5PCT t 2. 00 CJS 04/411/116 n6 .: TICArC OR 97=3 r1l.)O n ! It. E�'20 E'051 /► ham' C ti t ? e_. 00 TOT(1L C_ RE•QUI RE D I NSPEwCT I Cei I i ray Ca-4e; E"ler_A, 1 rr_' e fit Wall 7LI)VQ1` ;ervit is issued subject to the regulations contained in the N,.Acipal "Dde, JtitE of Etre. Sapicialt) Udis and ill other �'C't rl: t fi n r 7.�Y!•�t _tr'r� 1Lable laws, All work hill he dine in 3_cerdance with ,."o►ed plans. This pereit will aspire if work is not started .`.Nin 180 days of issuar:e, or if wcrk is suspended for tore (cI_. .�e11�t_G�t tear, r"W ER IN sTAI..I..ATION ONLY C- :ns�tallet; i_• ur+'=.�'g .made c ,; V -:Peaty I Gwr which -,-)c;t int tr,:;cd rrI`;Tf"C'irYnr• "''I!"Tfa1.i..AT2�l!" '�`IIY ... .. . TI or I zcD 5 I Cii' n I.i'7 r a ._.___. _ _ _ _w ._ ._ _...__._ VATC: 7aO 1 'rot- irispi..Ctiart Community Development RESTRICTED ENERGY ELECTRICAL APPLICATION 13125 SW Hall Blvd. Tigard,OR 97223 PERMIT# ELR 96 -0/0 4/ Phone(503)639-4171 FAX(503)684-7297 DATE ISSUED. y- q6 TDD No. (503)684-2772 CITY OF TIGARD Inspection (503) 639-4175 ISSUED BY czr/e r PLEASE COMPLETE ALL SECTIONS 1. LOCATION OF INSTALLATION 4. TYPE OF WORK. /.2SSD SW 6AI.-ew"frEe C1: Address RESIDENTIAL—Restricted Ener Fee . . . . . 940.00 7T/;6 g) , �� 9 7Zz= (FOR ALL SYSTEMS) City State Zip Check Type of Work Involved: PERMITS ARE NON-TRANSFEhABLE AND NON-REFUNDABLE AND EXPIRE IF WORK ❑ Audio and Stereo Systems IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF WORK IS 5USPENDED FOR y 1130 DAYS. ❑ Burglar Alarm 2. CONTRACTOR APPLICATION ❑ Garage Door Opener' ❑ I seating,Ventilation and Air Conditioning System' Contractor _ 1YPe 11 V cuum Sy tems" Address Ovther COMMERCIAL—Fee for each system . . . . . . . . . S4o,QQ (SEE OAR 91A-260-260) Property Owner Check Type of Work Involved: Contractor's Board Reg. No. _ ❑ Audio and Stereo Systems ❑ Boiler Controls Phone# ❑ Clock Systems 3. OWNER APPLICATION ❑ Data Telecommunication Installations II►C!J ( J ❑ Fire Alarm Installation A5 eftw —= ❑ HVAC Print Owner's Name Phone No ❑ Instrumentation Address ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control' City Stale Zip ❑ Medical 1 his permit Is Issued under OAR 91 B-320.370.This applicant agrees or,make only ❑ Nurse Calls rmtrirled energy installations(100 volt amps or less)under this permit and to do the ❑ Outdoor Landscape Lighting• faflawing: Protective Signaling 1. Only use elect+ai ucensed persons to do installations where required.(Certain ❑ residential arts other transactions are exempt from licensing.These have ❑ Other asterisks(•)All others need licensing). ` 2. Call for an inspection when all of the installations under this permit are ready for Inspection at 503-639-4175. ❑ Number of Systems 1 Purchase separate permits for all Installations that are not ready for inspection when the inspector is nut to inspect under this permit •No licenses are required. Licenses are required for all other installations. 4. Assume rr+on sihility for assuring that all corrections required by the inspector Are done,and 5. Assume responsibility for calling fora final inspection when all of the S. FEES corrections are crunpleterl. The person signing for this permit must be the applicant or person AG P g g P PP P a. Enter Fees $ y� authorized to hind the applicant. b. 5%Surcharge(.OS x total above) $ °O _ Signature TOTAL $ Authority if other than applicant ENERGAP.CHP ELEC-I-R I CAL PERM I T 51 CITY OF TIGARD DAREIISSUEDI:C11/1.?/95 L COMMU14ITY DEVELOPMENT DEPARTMENT 1312"BW Hall Blvd.Tigard,Oregon 97223.8199 (503)839-4171 PARL:EL : 1 S 134CS-1010 + SITE ADDRESS. . . 125'950 'SW FDGI_.WA'fER CT SUBDIVISION. . . . MILL.VIF."W ZONING: R-4. 5 Lal__OC:I:. . . . . . . . . . . I._01.. . . . . . . . . . . . . . 1 Project Descr-iption: Install two branch circuits -RESIDENTIAL UNIT---- ---TEMP' rRVC/FEEDERS---- - -- --MISCEI_LAI�IEQUS-- --- 1.000 SF OR LESS. . . . 0 0 -- POO ramp. . . . . . . . 0 PUMP/IRRIGATION. . . , 0 EACH ADD' L. 500SF. . . : 0 :.01. - 400 ,amp. . . . . . . : 0 SIGN/OUT LINE LTCB. . : 0 l_.IM1TED ENERGY. . : 0 401 -- 600 amp. . „ . . . . : +�+ STGNAL/PANEL.. . . . . . . .. 0 MANE. HM/ 9)VC/FDR. . : 0 6.0.1+amps-1 +00 volts. : j+ MINOR LABEL ( 10) . . . : 0 __-._SERVICE/FEEDER_._..._ --.-._BRANCH CIRCUITS------ --ADDr L INSF FCTIOtIS --- 0 - 600 amp. . . . . . : 0 W/SE:RVIC:E OR FEEDER: 0 F'ER INSPECTION. . . . . : 0 c:IrJ 4+1+O a+np. . . . . .. : +t1 1st W/O SFRVC OR FDR. : 1 PF_R HOOP. . . . . . . . . . . : 0 401 - 600 amp. . . . . . : 0 EA ADD' L BRNCH CIRC: 1 IN PL.ANT. . . . . . . . . . . 0 71REVIEW SECTION------- ("i IOV- _ _ _ _ _(> 77 � 1001+ • amp/volt. . . . . : 0 ) =4 RES UNITS. . . . . . . . : > 600 DOLT NOMINAI— s Reconnect only. . . . . . 0 SVC/FDR 1 = 22,5 NMPS. . s CLAS.: AREA/SPEC OCC. : Owners ----.____.___..___..____._._.____ ___-___._._..___.....___._.._____---____. FEES HIEU PlAAhI type amolint by date t�ecpt 1,2550 SW EDGE::WATER CT PRMT s 40. 00 JD 11/1-3/95 95•-272790 5 P C T $ -:. 00 JD 1 1/13/95 95--276:790 TIGARD OR 970::1:3 r'hone #: 62:10-6051 Lontr-ar_tor•: OWNER 421. 00 TOTAL REGU I RED INSPECTIONS -- - - - Wall lover Phone #: I:: leci:' 1 Vinal Ren #. . : +I+000012) This pereit is Issued subject to the regulations contained in the Tlnard Municipal Coce. State of Ore. Specialty Codes and all other F'er,m i t t ee Si gnat ore applicable laws. All work will to done in accordance with approved plans. This permit will expire if wn-k is not started within 180 days of issuance, or if wirk is suspended for more than 188 days. I Is s 1. d _.____---_._____--_-•--___-__nWNER IN TALI.-ATION Oie installation is beim made on roperty I own which is not intended for- sale, lease. or i, - f OWNER' S S 1[GNAT URE-r -�-_1 .�_ _.._ DATE: __�_ 1l.9. INSSTAL_L_ATION cIGNA1URE: OF SUPR. ELEC' N: DATE: L_i CEN SE: NO: Call for inspection 639-4175 Community Development ELECTRICAL PERMIT APPLICATION 13125 SW Hall Blvd. _ Tigard, OR 97223 F'lanck/Rec. # ...t,t Permit # _ L c_q4 Of; Phone (503) 639-4171 Date ISSu9d / /jj.Li 1 FAX (503) 684-7297 Issued by i CITY OF !!GARD TDD No. (503) 684-2772 l Inspection (503) 639-4175 l 1. Job Address: 4. Complete Fee Schedule Below: Name of Development_ R Q U M AV V llyb b) Number of Inspections per permit allowed Address 1,2 5 S L} G-4Ahl i1tc'Y Cl . Srlrvicy includFd Itams Cost(ea) Sum Ciiy/State/Zip T, C, f DK 7.12 4a. Residential-per unit 4 1000^Q It or lase $11000 Name (or name of business) fl i E 1.1 F WAMI r Fah ion thereof �, a or "--` 1 portion Ihereul $25 00 Commercial[l Residential 0' Limited Energy $2500 Y M Each Manul'd Home or Modular 2 Dwelhng Service or Feeder W 00 2a. Contractor installation only: 4b.Services or Feeders installation.allerationor relocation 2 Eiectrlcai Contractor _ _ 200 ampa or lose $80002 2 Address 201 amps to 400 amps $8000 2 City State Zi 401 amps to 600 amps $12000 _ 2 '/ _. p 601 amps to 1000 amps $18000 2 Phone No. Over 1000 amps or volts $,34000 2 Contractor's License No Reronned only $5000 Contractor's Board Reg No. 4c. Temporary Services or Feeders Installation,alteration,or relocation 2 Signature of Supr. Elec'n� _ 200 amps or leas $5000 2 .icense N0. Phone No. 201 amps to 400 amps s75 0o 2 • -- -- 401 amps to 600 amps $10000 Over 600 amps to 1000 volts -- 2b. For owner Installations. sea'b'above l /� 4d. Branch Circuits Print Owner's Name- 141 E U �r�/-(� Nmv egrnation or extension per pinnal Address�2 SC S- 5.%,V, /4 ly aAyf. a)The lee for brnrk:h circuits with City_ '—(� t Stat Zip_44;. Each branch o/servke a hMer hw. Phone No. -0- _ r{ Each branch arcuit $5 00 �_,(�L°S I f �Q_� ��E+{�—_�_ h)The lee for branch circuits without / The installation is being made on property I own which is purchase of service or fouler fee. / � �< V not intended for dale lease Or rent. L ns1 branch afam $3sno additional branch circuit $5 00 fl Owner's Sgpptuw:.—- a'r r-1----_- -T - 4e. Miscellaneous (Service or feeder not included) 2 3. Plan Review section (i required): Fach pump or irrigation circle $4000 Fach sign or outline lighting $4000 Signal circuit(s)of a limited energy ? Please check appropriate ilorrl and enter tee in section 50. panel alteration or extension S4000 _ 4 or more residential units In one structure Minos I atnit)131 _ $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 �, $3500 I'-ho,�� s55 n0 _ Submit 2 sets of plane with application where any of the above -- apply. Not required for temporary construction services. l 5. Fees: NOTICE 5a. Enter total of above fees $ 5'%Surcharge(05 X total fees) $ PERMITS BECOME VOID IF WCRK 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 requircki(Sec 3) $ A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK. IS Subtotal $ COMMENCED [__t Trust Account# g Balance Due $ I wocammf�NMecpm qr