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9894 SW KIMBERLY DRIVE to 00 to A N 3� c� v 9894 SW Kimberly Drive CITY `)F TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT#: PLM2001-00020 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DACE ISSUED: 1/25/01 SITE ADDRESS: r 1k94 SW KIMBERLY DR PARCEL. 2S111CD-09500 SUBDIVISION: KERW0011 ESTATES ZONING: R-4.5 BLOCK: LOT: 031 JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: YPE OF USE: SF WASH114G MACH: BACKFLOW PREVNTRS: .SCC 1PANCY GRP: FLOOR DRAINS: TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES _ LAUNDF (TRAYS: SF RAIN DRAINS: SINKS: � URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: 0 TUB/SHOWERS: 1 SEWER LINE; ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: 17AIN DRAIN: ft Remarks: Jac w/i Tub Owner: [�Type FEES By _— DatP� Amount Receipt ;=nRtiES, ROGER M + PATRI-.IA," — — -- j894 SVV KIMBERLY DR PRMT CTR 1/2.3/01 $72.50 2720u'00000— TIGA.RID, OF, 97224 5PCT — CTR— 1/23/01 $5.80 27200100000 Total $78.30 Phone 1: Contractor: RANGER RUO--ER PLUMBING INC 605 NE 22ND STREET BATTLEGROUND WA 98604 REQUIRED INSPECTIONS Phone 1: 503-274-9367 Rough-in Insp Reg#: LIC 131969 Final Inspection PLM 3-413PB This permit is issued Subject to the regulations cont.,ined in the Tigard l Municipal Code. State of OR. Specialty Codas 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 fcr more than 180 days. ATTENTION: Oregon law requires you to foilow rules adopted by the Oregon Utilitv Notification Center. Those rules are set forth in OAR 952.0001-0010 thr9Ugh OAR 952-0001-0080 You may obtain copies of these rules or direct questions to OUNC by calling (503) 46-1; 87 Issued By . Permittee Signature: A Call (503) 639.4175 by 7:00 P.M. for an inspection needed the next business day Plumbcog Permit Applicatioin R City of Tigard Date recerved: . rermitno.L _ r ALJ_ ✓l ('01 t r L Address: 13125 SW Hall 131vd,"Tigard,OR 9722 Sever permit no. Building permit no.:- -- --------. City ofTigerd Phone: (503)639-4171 Project/appl.no.: Expire date: Fax: (503) 598-960 Date issued: By: Receipt no.: Laid use approval: _ Case file no.: Payment type: U I &2 family dwelling or accessory U Commercial/industrial U Multi-Gundy U"tenant improvement U New construction U Midition/alteration/rcplaceuicnt 1 Fo()d ~..vice U Other: Job address_ �s rL Descriiption - (tty. Fee(t:a.) Total Bldg. no.: Suite no.: -- New I-and 2-family dwelling�only: Tax map/tax lot/account no.: (includes I00 It.for Tach ut f Ih y connection) - _ SH?(I)bash Lot: Block: Subdivision: - SFR(2)bath -___ --_ --- -- Project name: pr �, _ SFR(3)bath - City/county: T'l 66k-42 - IZIP: -f Each additional bath/kitchen - Description and location of work on pren,lscs: Shemilitles: _ rwy /10L\ Catch basin/area drain Fist.dale of completion/inspection:�- Drywells/leach line/trench drain Footing drain(no. lin. ft.) Manufactured home utilities Business name:_ rtq�� Manholes Address: 32 l0 1 ft, Rain drain connector City: (Y%;It.,. , r'le I Statc: r I Z111:9 71 ZZ-. Sanitary sewer(no,lin-.ft.) - - Phone: 3 Z Fax: �p 19 Y i I: Storm sewer(no. lin.ft.) CCB no.: .1 = SP Plumta!bm.rig. nn• Water service � (no,lin.ft.) - City/metro lic.no.: Fixture or item: Contractor's representative 9Jg nature: lbso tion valve t Print "a - 11u�, - -- - t _ .r • BaL',flow preventer Uale: ! 2 / c Backwater valve Basins/lava gory -- h Clothes washer .�..., Narrte: _ - _ ishwasher Address: Drinkingfountain(") - -- City: State: 71 P: - -- -- - - -- Ejcaors/surnr Phone: I Lyat sion tank -- ixtuir/sewer cap - g Name(print): Floor diains/floor sinks/hub - Moiling address: Garbage dissal_ - .�--�----_ City: _ State TZIP: — Hone Bibb - -, t _ Ice maker -i- Phone: I ax: -- E-mail: — Interco tar/grease trap - —- d Owner installation/residential mainte rance only: The actual installation Primer(s) will be made by rile or the maintenance and repair made by my reguh; Roof drain(commercial) - erviloyce on the property I own as per ORS Chapter 447. Sink(s),basin(s), ays(s) - - t:wner's signature: Date: Sump Cnkmin IVI I I Tubs/shower;shewer pati Name: Urinal - - --- --- -- _— .�.-- Water closet — Address: - - -- � Add —_ Water heater 0.-j City: _ Sta�.e: ZIP:_ _ Other: —�- R' io-nc: Fax: E-mail: Total `CNot all hutsdictions ao-ept ctedb card.,please call Jurisdiction For mre h odormrr m: . ,. t,1 inimum fee................$ �• �Z -t O vita U Master^ard Noire: p:rmut arp.�cation Ilan review(at _ %) $ expires if a permit is not obtained --~- Credit card number:�— —.—._ State surcharge(8%)....$ � :Z - et within 180 days after it has been g accepted as complete. TOTAL .......................S Name of c..clholckr ns shown on credit card p p t ardholdcr silmature, s Amotaa T X a IR Ez n --- • �eF II0-4616 tdIXe'rM� PLUMBING PERMIT FEES: PRICE TOTAL New 1 and 2-family dwellings only: _ FIXTURES (individual) QTY ea AMOUNT (includes all plumbing fixtures in PRICE TOTAL Sink 16 60 !_ the dwelling and the first100 ft. QTY (ea) AMOUNT _ for each utility connection 1660 Lavatory One 1 bath _ $249.20 -1�---- Tub or TublShower Crriu. 16.60 _Two(2)bath _. $350.00 _ �^ 16.60 Three 3 bath _ _$399.00 Shower Only _— Water Closet 1660 — SUBTOTAL Urinal — 16.60 8%STATE SURCHARGE Dishwasher — 16.60 PLAN REVIEW 25%OF SUBTOTAL _ TOTAL Garbage Disposal lb 60 _-_ - - - ----� _--- - - -- Laundry Tray m 16,60 i fishing Machine 16.60 >r Drain/I icor Sing— 2" — 16 60 PLEASE COMPLETE: 3" 1660 4" An — uante b Work Performed Water Heater Oconversion O like"nd 1660Gas piping requires a separate mechanical Fixture Typiew Nloved Replaced P.emovedl Cap�ed_ermit. _MFG Home New Water Service 46.40 Sink46.40 Lavatory_MFG Home New San/Storm Sewer Tub or Tub/Hoae Bibs 16.60 Combinatio _ __Roof Drains 16.60 Shower On — 18.60 Water Closet _ .. Drinking Fountain — Urinal _ --_ Other Fixtures(Specify) _ 15•°0 EGa�rba washer --- a Dis osal -- - _Laun�Room Try__ Washing Machine —, _ Floor Drain/Sink — Sewei •1sr 100' 5b.0U I i 3" _ -- Sewer-each additional 10U' 46.40 j 4 — Water Service at 100' 55.00 Water Heater Other Fixtures Water Service•each additional 200' 4640 _- r!!eci - Storm&Rale Drain•1st 100' 55.00 Storm R Rain Drain•each additional 100' 46.40 _— -- Commercial Back Flow Prevention Device 46.40 — Residential Backflow Prevention Device' 27.55 ^� Catch Basin 16.GC Inspection of Existing Plumbing or Specially 72.50 Re uested Ins ertions _per/hr COMMENTS REGARDING ABOVE: Rain Drain,single family dwelling b.i 25 -- —- — Grease Traps -- 1660 ;;jtrANTITY TOTAL —_----- Isometric or riser diagram Is required If -- Quantity Total is >9 "SUBTOTAL _ - 8%STATE SURCHARGE - — "PLA N REVIEW 25%OF SUBTOTAL Required GnLIf fixture qty total Is>9 TOTAL : "Minimum permit fee Is$72 50+a%stale surcharge,except Residential F ackllow, Prevention Device,which Is$se 25+8%state surcharge "All Now Commercial Buildings require plant wHh I sometric or riser diag'am and plan review I:\dstsVonna\pim-fees.doc 10/10/00 i, CELECTRICAL PERMIT CITY OF TIGARD PERMIT#: ELC2001-00052 DEVELOPMENT SERVICES PATE ISSUED: 1/2.5/01 13125 SW Hall Blvd.. Tinard, OR 97223 (503) 639-4171 PARCEL: 2S111CD-09500 SITE ADDRESS: 09894 SW KIMBERLY DR SUBDIVISION: KERWOOD ESTATES ZONING: R-4.5 BLOCK: LOT : 031 JURISDICTION: TIG Proipct Description. Jacuzzi Tub RESIDENTIAL UNIT -� _ - TEMP SRVC/FEEDERS — MISCEI_LAN_EuUS 1000 SF OR LESS: 0 -200 amp: PUMP/IRRIGATION: EACH ADD'L 500SF: 201 400 amp: SIGN/OUT LINE LTG: LIMITED ENERGY: 401 600 amp: SIGNAL/PANEL: MANE HMI SVC/ FDR: 601+amps - 1000 volts' MINOR LABEL (10): i SERVICE/FEEDER - — BRANCH CIRCUITS V ADD'L INSPECTIONS 0 200 amp: W/SERVIC - OR FEEDER: PER INSPECTION: 201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR: l 401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT: 601 - 1000 amp. _ _ PLAN REVIEW SECTION 1000+ amp/volt: >=4 RES UNITS: i > 600 VOLT NOMIN,' Reconnect only: _ SVC/FDR >= 225 AMPS: ---CLASS AREA/SPEC Owner: Contractor: FORBES, ROGER M + PATRICIA A CORPORATE ELECTRIC 9894 SW KIMBERLY DR 8040 SW BONITA RD TIGARD, OR 972.24 TIGARD, OR 97224 Phone: Phone: 503-997-2081 Reg#: LIC 143114 ELE 34-541 C SUP 40755 _ FEES J�= Raquired Inspec,:lons Type By _ Date Amount Receipt Rough-in PRMT CTR 1/25/01 $46.85 2720010000( Elect'I Final 5PCT CTR 1/25/01 $3.75 2720010000( Total $50.60 This Permit is issued subject to the regulatir,ns contains:in the Tigard Municipal Code,State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with Fpproved plans. 1 his permit will expire if work is not started within 180 days of issuance,or I work is suspended for more than 180 days. AT"ENTION: Oregon raw requires you to follow rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR 952-001-001 G through OAR 952.001-0080 You may obtain copies of these rules or direct questions to OUNC at(503) 246-1987. _- - PERMITTEE'S SIGNATUPE % r ISSUED BY: v � OWNER INSTALLATION ONLY The Installation is being made on property I own which is not intended for gale, lease, or rent. OWNER'S SIGNATURE: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELFC'N: DATE:______ I_ICENEE NO: _� ----- - -- - -- -----_-- -. - Call 639-4175 by 7:00pm for an inspection the next business d iy Electrical Permit Ap,Nlication "Dateere=ceivedj :,� p �Permit no.:fLc�,er�r•�G:r6" City of Tigard Project/appl.no.: Expire date: Ci(vof7►narJ Address: 13125 SW Hall Blvd,Tigard,OR 9722.: Date issued: By: Rc..ciptno.: Phone- (503) 539-4171 Fax: (503) 598-1960Case lite no.: Payment type: kind ind Lice approval: -- -- &2 family dwelling or accessory U Commercial/industrial U Multi-family U Tenant improvement U New constriction U Addition/affcration/replm_ement U Odier. U Partial 11 ' 1 J Idres;: ' �� l�Lr^3L� (�,1" Bldg.no.: ITax map/tax lot/account no.: _ Lot: BIoc4`� IS ►d+rixietr� ! --- -- _ _— _ _ Project name: I Description and location of work on premises: t � - Estimated date of coin letion/ins ertion: t Job no: �L—l4 r�� Max Business name: ,� E�-[ G T t G rL• .L ticscrlplinn (lty.I (ea.� I'olal no.lns Newresidential singkor:nuh rndlf per Address;: pery rV t,o-,i it dwellingumil.Inon(imanaovedgarage. City: X16 ?�_ Stale: LIP: Serviceincluded: K:onr! 1 mail_ Itxx)cq,ft.or less -- 4 - / y --— Each additional 500 sq.ft.or portion thereof CCR I Elcc.bus.tic.no: Limited energy.residential 2 City/metro lic.no.: Limited energy,non•residenlial 2 -s' - _ Er.h manufactured home or modular dwelling t nature of supervlsing electrician(required) _ Dale Service and/or feeder 2 Sup.elect.name(print): — ; �, L l.icciiseno: Services or feeder Installation, alteration or relocation: Li! t 200 snips or less 2 Name(print): �j �� 201 amps to 400 amps _ �/f ' -� - 401 amps to 600 amps 2 Mailing address: Ad42k�_ 601 amps to 1000 amps 2 City: I State: ZIP: Over 1000 amps or vol Is _ 2 Phone: r-,aI E-mail Reconnectnnl _� I Owner installation.`i he installation is being made on property 1 own Temporary senlm or feeder. which is not i;ttended for sale,lease„rent,or exchange according to Installdlon,altentlon,urrelncaHon: 20(1 amps or ORS 447,4 i5,479,670,701. less 2 201 motops l0 4(1(1 amps _ Owner's sl n,ture: Dale: 1 401 to 000 ams 2 grarch circuits-new,allerallon, or exlension per panel: Nam C: A. Fee for hianch circuits with purchase of Address: service or feeder fee,each branch circuit 2 Slate: ZIP: H. Fee for branch circuits witnout purchase 15 Ir --- of s•_rvice or feeder fee,first branch circuit: ` b S 2 Phone: 1:+� I:-Mail: larch additional branch circuit: Misc.(Service or feeder not included): ❑Service over 225 mops-commercial 0 r iealth-care facility Foch pump or irrigation tittle z U Servlccovcr120nmps-ratingof 1&2 U llnrardouslocation Each signor outlinelighlin,; - family dwellings U Building over IOAK)square feet four c Signal circuits)or a limited energypanel. U System over 600 volts nominal more residential units in one structure alteration,or extension' 2. U Building over three stories U Feeders,010 snips or more •Destl1non:. — U Occupant load over 99 persons U Manufactured structures or RV park Each additional Inspectlon ov.r the allowable In any of the above: U Egresit/Ilghtirippla o U tNher __------_-__-_.. __ Perinspectinn --- — Suhmll __ -et of plans with any of the above. Investigation fee The above gyre not applicable ru temporary cunstructionserviee. Other -— — Permit fee..................... . w $ Not all jurisdictions sept credit mis,please call juriufiction Orn mom informinion. Notice:This permit application — U Visa U MasterCard expires if a permit is not obtained Plan review(at , %) $Credit card rumba: _ within 180 days after it has been State surcharge(896)....$ 'Mfe' accepted as completr TOTAL . $ ,S—O.9_ --dame of c r u shown on c t card $ /�'� ,- — older denature -— -- Amount 4404613(t)roatcoMl cudh E!etrtricai Permit Fees: Limited Energy Fees: ---- ––-- –" - — __ TYPE Or WORK INVOLVED-RESIDENTIAL ONLY Complete Fee Schedule Below: Restricted Energy Fee.......................... ..................I........ $75.00 Number of Ins coons er =1 ailowEd (FOR ALL SYSTEMS) Seriice included: Items Cost "total I Check Type of Work Involved: Residential-per unit 1000 sq n.or less $145 15 4 0 Audio and Stereo Systems Each additional 500 sqhor portion thereof i $3340 1 Burglar Alarm Limited Energy $75.00 Each Manufd I tome or Mudule, Garage Door Opener' Dwelling Ser-Ice or Feeder $9090 2 SE*vices or Feeders F-1 Heating,Ventilation and Air Conditioning Syslen' Installation,alteration,or relocation 201 amps or less $80.30 _ 2Vacuum Fystems' 2,,l amps to 400 amps $106.85 2 401 amps to 600 amps $160.60_ 2 Other 601 amps to 1000 amps $240.60 2 u Over 1000 amps or volts i $454.652 Reconnect only $6695� 2 Temporary Services or Feeders TYPE`OF WORK INVOLVED -COMMERCIP.L ONLY Fee for each system.......................................................... $75.00 installation,alteration,or relocationder 200 amps or less $86.85_ _ ! (SEE OAR 916-280-280) 201 amps to 400 anips _ $100.30 z Check Type of Work Involved: 401 amps!o 600 amps _ $133.75 2 Over 600 amps to 1000 volts, F-� Audio and Stereo Systems see"b"above. Branch Circuits E] Boller Controls New,alteration or extension per panel a)The fee for branch circuits Clock Systems with purchase of service or feeder fee. Each branch circuit _ $6.65 _ _ 2 Data Telecommunication Installation b)The fee for branch circuits without pttrrhase of service ❑ Fire Alarm Installation or feedor fee. First branch circuit �_ $46.85 ( HVAC Each additional branch circuit 56.65 Miscellaneous Instrumentation (Service or feeder not Included) Each i ump or irrigation circle $53.40 F-1 Intercom and Paging Systems Each sign or outline lighting _ $53.40 Signal circult(s)or a limited energy Landscape Irrigation Control' panel,atterauun or extension _ $75.00 Minor Labals(10) $125.00 ❑ Medical Each addih,)nal inspection over the aliowabla In any of the above Nurse Calls Per inspection $62.50 Per hour _ $62.50 In Plant 3.73.75 _ Outdoor Landscape Lighting' Fees: Protective Signaling F.0or+.otnt of above fees $ l J Other _ W/6 State.Surcharge $ �_. ^Number of Systerr s 25%Plan Review Fee No licenses are required. Licenses are required for all other Installations See"Plan Review"section o 1 $ front of application ______. - Fees: Total Balance Due $ ___ Enter total of above fees $ ._ U Trust Account# _ 8%State Surcharge = — --- -- Total Balance Duty $ — 0dstslformslcic-fees.doc 10/09/00 CITY OF TIGARD 24-Hour SUIS-LING Inspection Line: (503) 335-4175 MST _--- --- INSPECTION DIVISION Business Line: (503) 635.4171 — BUP ----- --Received ---_ __ Date Reue:,led > � AM _ _ _____--_- PM� — BUP d Location --- -_ � - �� -_Suite--_. _-- Contact Person V Ph( -_._) LMS :;lZ)4 OL Contrartui -----�__._---- - _-- Ph(--_ __-) _ SWR _. BUILDING Tenant/Owner -______ -_ _.. _ EL Footing ELC Foundation Access: Ftg Drain k ELF! Crawl Drain — Slab Inspection Notes: SIT -_- Post& Beam -_- -- - Shear Anchors Ext Sheath/Shear Int Sheath/Shear - Framing - — —_—, Insulation — ._""--- Drywall Nailing -- Firewall Fire Sprinkler - Fire Alarm Susp'd Ceiling -- - Roof Other — — — Final PASS PART FAIL r Post& Beam Under Slab --- -- ---- - Rough In �1� • 7 / �G Water Service -�,--� — -- -- Sanitary Sewer Rain Drains Catrh Basin/Manhole Storm Drain Shower Pan Other: - — PART FAIL — CHAN- I L Hough-In --- Gas Line S_-o Dampers -- -- �� Fina C S^ PART_ FAIL — - - ---- --- — --EtEtTRICAL Service Rough-In UG/Slab Low Voltage Fire Alarm i Final ❑ Reinspection fee of$� required before next inspection. Pay at City Hall, 13125&A Hall Blvd. PASS PART FAIL SITE �- [� Please call for rein pection RE: — _ Unable to inspect- ro acrep Fire Supply Line 1 ADA Date _�._ Inspiectnr --� f EKt� Approach/Sidewalk I Other:_ Finer DO NOT REMOVE this Inspection record from the job site. PASS-" PART FAIL J eta• �A', CITY O F TI��RD ___ PLUMBINGLUMBING PERMIT , PERMIT #: PLM2002-00063 DEVELOPMENT SERVICES DATC ISSUED: 2/25/02 13125 SW Hall Blvd., Tigard, OR 17223 (503) 639-4171 PARCEL: 2S111 CD-09500 SITE ADDRESS: 09894 SW KIMBERLY DR SUBDIVISION: KERWOOD ESTATES ZONING: IG _BLOCK: LOT: 031 JURISDICTION: TIG TIG JCLASS O'F WORK: AI r GARBAGE DISPOSALS: MOBILE. HOME SPACES: TYPE OF USE: `I- WASHING MACH. BACKFLOW PREVNTRS: OCCUPANCY GRP. P:i FLOOR DRAINS: TRAPS: STORIES: WATER HEATERS: CA)CH BASINS: FIXTURES_ LAUNDRY TRAYS: 3: RAIN DRAINS: — `—JSINKS: ` — — URINALS: GPEASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB/SHOWER-;: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Relocate existing water heater -- __ _ FEES Owner:_, Type By Date Amount Receipt FORBES, ROGER M +PATRICIA A I�— PRMT CTR 2l25IO2 $ 2.50 7.7200200000 9894 SW KIMBERLY DR 5PCT CTR 2125/02 $5.80 27200200000 TIGARD, OR 97224 Total $78.30 Phone 1: Contractor: _ — RHINO PLUMBING INC 13811 SE RAMONA ST PORTLAND, OR 97236 REQUIRED INSPECTIONS Final Inspection Phone 1: 777-8946 Req #: LIC 128026 PLM 26-640PB This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all othe, applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-0001-0010 through OAR 952-0001-0080. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-1987. ' Issued By: _ Permittee Signature: o' � �.�1s.� -�-- r. Call (503) 639-4175 by 7:00 P.M. for an inspection needed the,OL,xt business day 1 Plumbing Permit Applicata n City of Tigard 7 /C,t "tereceived: y e L777 ' —6,061 to 3 ty g `Sewer permit no.: g _Addren:13125 S., "all Blvi,Tigard,OR 9 23 C'irynf"figard Phone: (503) 639-4171 ProjecUappl.na:Fax: (503) 598-1960 bate issued: By . : Land use approval: _ _ Case file no.: Payment type: &2 family dwelling or accessory U�C inmercial/industrial U Muiti-family U Tenant improvement U New construction I�Jdition/alteration/replacement LJ Food service X01her: 1 101)CTION FEV SCHEDULE(for special information use cliccillis Job ad('- _ `�jj`�`� 5(L) /I' Ucxcripli rn Oty. hce(ea.) '1'Witl New 1-and 1-family dwellings ooly: [Fid-9.no.: Suite no.: (includes 1000.17nreachutilityc(lnnection) Tax map/lax lot/account no.: SFR (1)bath Block: Subdivision: SFR(2)bath _ Project name: SFR(3)bath City/county: \ C);L ZIP: A L J Each additional bath/kitchcn Description and 141atiot of work on premises: Siteutilitters — Catch basin/area drain _ Est.date of corn -tion/inspect n: t .2- Drywells/leach line/trench drain Footing drain(no.lin.ft., L11;0 0 Manufactured home utilities Business name: (��}�(, ? l'LU Manholes Address: \'2b\\ 5 f_ rL A IA ")` Rain drain connector City: �. State: 7,IP: q—j C Sanitary sewer(no.lin.ft.) — Phone• Fa 1 E-mail: ti Storm sewer(no.lin,ft.) CCB no.: 2AQA� Plumb.bus.rcg.no:26 -6-10 Water service lin.ft.) Fixture or Item: City/metro lic,no.: rv}(' y�,_t?1 Absorption valve ac Contractor's mpresentative signature: _ Bk flow reventer Print came: Date: U 3ackwater valve — Basins/Iavatory _ Clothes washer Name: re �wzt� .c v _ — Uishwnsher ___ Address: y N14 5L Drinking fountain(s) City: �, Stalc:C Ejectors/sump Phon ;� T1_'"X;07R 11-10 E, mail: AjlExpansion tank Fixture/sewer cap Floor drains/floor sinks/huh Nvnc(print): L-I \a-'—51 -- Cnrba a disposal Mailing address: _ _- / r rile Hose bibb City: ", State: P: cr'),1� ' Ice maker Phone: Fax: E-mail: Interceptor/grease trap Owner installation/residential maintenance only: The actual installation Primer(s) will be.made by me or the maintenance and repair made by my regular Roof drain(commercial) employee on the prop--tty I own as per ORS Chapter 447. Sink(s),basin(s),lays(s) Owner's signature:— __ Date: - Sum Tubs/shower/shower pan Urinal _ �— Nttme: Water closet Address: Water heater City: State: ZIP: Phone: Faxes -___mai!• l'utal Minimum fee S Not all Jutioctiau accep credit cords,please call jurisdiction fr:morc Inform all Notice:This permit application Flan review(at 96) U Visa U MosterCerd expires if a permit is not obtained Cmdit c,rd number —_.—__ within 180 days after it has been State surcharge(896)....$ _ Ospirea accepted as complete. 'TOTAL .......................$ -- Name of cardholder as shown on neila card S t Cardholder signal urt Amount 440-4616(6MCOM) PLUMBING PERMIT FEES: PRICE TOTAL New 1-and 2-famlly dwellings only: FIXTURES (individual) QTY ea AMOUNT (includes all plumbing fixtures In PRICE TOTAL Sink --'-�-" -- 1660 the dwelling and the f rst100 ft. QTY fea) AMOUNT - for each utility connecticn)_ Lavatory _ t880 One 1 bath - - $249.20 Tnb or Tub/Shower Comb 16.60 Two 2 bath $350.00 Shower Only 16.60 Three 3 bath - $399.00 Water Closet 16.60 _ SUBTOTAL Urinal J� 16.60 8%STATE SURCHARGE _ Dishwasher _ - 16.60 PLAN REVIEW 25%OF SUBTOTAL_ ,. Garbage Disposal 16.60 TOTAL Laundry Tray 16.60 Washing Machine 16.60 Floor Drain/Floor Sink 2" 16.60 PLEASE COMPLETE: 3" 16.60 4^ 16.60 Water Heater G coi,version O like kind 16.60 Quantic b ir Work Performed Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removed/ Capped permit. MFG Horne Naw Water Service 46.40 Sink _ MFG Home New San/Storm Sewer 46.40 Lavatory _ _ Tub or Tub/Shower Hose Bibs 16.60 Combination - Roof Drains i 16,60 Shower Only _ Drinking Fountain 16.60 Water Closet --- b-Inal other Fixtures(Specify) 16.60 Dishwasher Garbage Dis osal - Laundry Room Tray _ Washing Machine Floor Drain/Sink: 2" Sewer-1 at 100' 55.00 - 3„ _ Sewer-each additional 100' 4640 4" Water Se,vice-fat 100' 55.00 Water Heater _ Other Fixtures vah,r Service each additional 200' 46.40 S ecif St,rm 8 Rain Drain-1 st 100' 55.00 _ - Slorra R Rain Drain-each additional 100' 46.40 Commercial Back Flow Prevention Device 46.40 --- _ Residential Backflow Prevention Device' 27.55 - Catch'Easin 16.60 --� -�- Inspection of Existing Plumbing or Specially 52.50 _ Requested Inspections _ er/hr COMMENTS REGARDING ABOVE Rain Drain,single family dwelling 65.25 - Grease Traps td.60 ---- - -- QUANTITY TO't AL Isometric or riser diagram Is required If Quantity Total is >9 -_ "SUBTOTAL - -- -y8%STATE SURCHARGE -- --�- ""PLAN REVIEW 25%OF SUBTOTAL Required only if fixture gly total is>9 - TOTAL S "Minimum permit fee is$72.5x1+e%state surcharge,except 7esidential Backflow Prevention Device,which Is$,M 25+9%state surcharge ""All New Commercial Buildings require 2 ser-of plans with Isometric or nser dlagran.for$plan review. I:\.dsts\forms\plm-fees.doc 12/26/01 CITY OF TIGARD - MECHANICAL PERMIT DEVELOPMENT SERVICES PERMIT#: MEC2002-00078 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 2/22/02 PARCEL: 2S111 GD-09500 SITE ADDRESS: 09894 SW KIMBERLY UR SUBDIVISION: KERWOOD ESTATES ZONING: R45 BLOCK: LOT: 031 JURISDICTION: TIG CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS: TYPE 01' USE: SF UNI r HEATERS: VENT FANS: OCCUPANCY GRP: R3 VENTS W/O ,XPPL: VENT SYSTEMS: STORIES. BOILERS/COMPRESSORS HOODS: FUEL TYPES 0 - 3 HP: DOMES. INCIN: I PG _ 3 15 HP: COMML. INC1N: MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS: r-IRE DAMPERS?: 30 - 50 HP: GAS PRESSURE: 50 + HP: COU DYERS: FURN 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS. FURN >=100K BTU: <= 10000 cfm: OTHER UNITS: > CAS OUTLETS: 10000 cfm: 3 iemarks: Installation of gas furnace and air conditioner, fuel piping and 3 outlets. A/C cannot be placed within required setback. Owner: FEES—— ---- FORBES. ROGER M + PATRICIA A Type By Date Amount Receipt 9894 SW KIMBERLY DR PRMT CTR 2/22/02 $72 50 2720020000 TIGARD, OR 97224 5PCT CTR 2122/02 $5.80 2720020000 Phone: Total $78.30 - -- Contractor: SUNSET FUEL CO PO BOX 422.87 2944 SE POWELL BLVD REQUIRED INSPECTIONS PORTLAND, OR 97242 Mechanical Insp Phone:503-254-0611 Heating UO Insp Reg#:LIC 00002374 Cooling Unt Insp ELE 26-113C -This permit is issued subject to the regulations contained in the Tigard Municipal Coda, State of Ore. Specialty Codes and all other �pplicable 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 foilow rules adopted in the Oregon Utility Notification Ce.Aer. those rales are set forth in OAR 952-001-0010 through OAR 952-001-0080 You may obtain copier, of these rules or direct questions to OUNC by calling (503)246-9189. Issue By: _ Permittee Signature: Call (503) 639-4175 by 7:00 P.M. for inspections needed the next business day 02/15/2002 10:04 2340380 SUNSET-fYEL CO PAGE 01/02 Mechanical Permit Application •t `� nue teweived� (.,] ©f �j4fI�R1"(� ���'�..x�' P Ai �� Rrinit no,:�I ('ity;¢77g.irA Addrrss: 1.1125 SW hall blvd,•l'igaul,OR 97223 PIroJ.cdappl.no" �pvedare: MIMIC: (50.1) 639.4171 Date issued: 13y 1�' Roceiptno. ~- Fax: (501) 5911.1901) Catsefile no'; I'alid use applu,a;& _ Lll Y ur !Jt(.irAAU tyment type; Bulldin g pemtit no:: WINITRIM yl &2.family dwelliuk or accessory U(:umrncrCialfindustiml Cl Mu11i fc amily U Tenant improvemenl U N,-,w c�lrrsttuctiorl ))>r<Additir�rU hcrdion(mptucrnlety L1 00)er: Job address; i {'v .Ja iyt hErmmmm _�: Irtdic3te ecimpmrrlt quantities in boxes below. IndiL•ate the doitar Bldg.no.: _ Suite no.: value or 311 mcrhanical materials,equiprrlent,lal,or,overhead, Tax map/tax lol/account no.. _ profit. Value S _ LOC name. Block: - Subdivision: *See checklist for important application information and r orbes _ _ jurisdictions fee..schedult for residential permit fee. City/counry:�grd __ Zl! —q7A _ Descripti.,n and location of work on premise qq s ..gift : sad we trondr'>rianer _ -� Frr(ell) 7 stall Fiat date of com IetioMnspection: 1> ptinn r1r Ret. RnL 'Tenant irnprovement or change of use: - Ft,existing space heated or conditioned?CJ Yes ❑NoAir handlin unit _ t;17►1 _ is exit '.I,.space inaulatecll U Ye, U Not A tconr stoning sitr.Ti rrgiirii)~ - 2F— 77- Altera onto existing luv C y11,5Xi '- o er co� - - 111IMMIsS name; hut/ State boilerpernnit nn.. Addresa_�„7gty� S� Powe// Yd Hp^ -Tons_ BTU/" - v Sit c am ters/duct rmoke ctcetorr Ct_ • �rtJgtxi Srate. o Z r� o I [P': Aiae� eat ump(sue an rtqui� Phone: .!,�4.OG// Fax�DU3y H mail: tneta repToTivna're CCB no.: 417q Including ductwortc/vew liner 5il Yee 0 No /yiC ft City/mento lic.soli _ e �; nsta Vi�rp ac re oc ate caters-suxpen J wall,or(loot m„unted Name(please print): cnt or-a-lin-til one,u ter th�n�mace Ahsurpiinto units f B•[U/y t•hillrrs _- s_ HP Addms: -- __ t_,un neasors - tip � Tn.�rattebw4 Qn a y oes _ _ Z�. Ap liancevent ��+'�Ypeiu-`ETtc`hrrt�iir�tut hood fur.9upprrasion eystcm Kxhaus(fan with Bingle duct 013th fans) Mailing adtirrss: 9® 4nLvrl c br. il`euet eyatern i tart rim eai rT lg or/►�� C 1y., 'ard State:o ItP 97a.�y sup to ou ets Ptlont�"'V'la t>E:td P - �— T K: 11-1 � NO (lit 9 ax: &mail: ucl t r earTi di,, aT<iver ileii _ t►lYexl kACCIC� Nam.c: Number of outlets Address: �TirraIGieeor -—- Uocotative _ r�laee ZIP: nun-i . Phone: Fax; 1:-stall• nurv��e - -� Ap licant'+ aiytnaturti;- bat -� l4) 1_meq e_ _,i nq -Naux (Fsrint): l S_ Nrt Ihr a��uMN d1�6Aadoa� ty 1!nn1.1�MrM i�tine �Idx�Y��.�- __.__.-.-� _.�— F'ennit - +.�•� +1ti Y4. U M 1 ,Nica This perxrut rtl�licstian 1a S y _, I Minimum fee................ A n pptn:it Is nootkaned s i xirea It a PC mut rlt cr,�c 5 _ ([_f t l Ilan rrview(al _r 114" within IRU days tiler h has bads state rurrh 8'16 ''+rk :ri♦f�._ ac+n�M as oumpl.-ee. �( )....$ 7�=_ 4404617(60003M 02/15/2002 10:04 2340380 SUNSET FUEL W PAGE 02/02 00 7j �; !' -- CITY OF T!'GARL' SUILMNG INSPECTION DIVISIDN MST 24-Hour Inspection Line: 639-4175 Business Line: 63S-4171 --- / BJP _Dale Requested—�?I _AM �M BLD L-ocation /0 210,25 w C~- Suite T MEC _ Contact Person Ph PLM _ Contractor �1-„-�;r,'I ., f=& Ott_ Ph SWR BUILDING-v_— Tenant/Owner ELC '7 Retaining Detaining Wall ELR Footing Access: Foundati(ri FPS _-- — Fig Drain SrN Crawl Drain Inspection Nctes: ----- -- Slab ---- ----- —— — ----__---- SIT Post&Beam -- --_- Ext Sheath/Shear _ Int Sheath/Shear Framing --- —_-- -�--- - ------ —____ Insulation Drywall Nailing _-- -----.-- Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling —��_ _ ----- --- Roof Mise: Final PASS PART FAIL PL UMBING Post& Beam -------� — -----__�-------- -- ----__----__.—__.._-------- Under Slab fop Out --------------- Water Service Sar.!::.,-) sewer --- Rain Drains Final PASS PART TAIL MECHANICAL F'osf&Beam - - ---------- — —_--- - - Rough In Gas Line — Smoke Da npers Final --- - --- ------- - __ ---- — ---- - _.._..- PASS PART FAIL Service UG/Slab Lowa�e -----� Fire Al,nrm _--.---_.-- Final PART FAIL _-- — ----SITE Backfill/Grading ----_- Sanitary Sewer Storm Drain I ]Reinspection fee of$ —�- •equ:red before next inspection Pay?t City Hall, 13125 SW Hall Blvd Catch Basin I ]Please call for reinspection RE _ --__ ( ]Unable to inspect-no access Fire Supply Line ADA Approach/Sidewalk Other I Date I/ "` ��__Inspector —Ext Final r' PASS PART — FAIL Do NOT REMOVE this Inspection record from the job site. CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24-Hour Inspection Line: 639-4175 Business Line: 639-4171 — BUP Date Requested_ �� �� AM—_ PM --- BLD Location_ ` /(�L Suite _ MEC �� _ Contact Persor, �" Ph PLM Contractors '�!'n"_L.�/��- Ph 7_ SWR BUILDING i enant/Owner ;_ ELC -Bh/ G`�✓ S i � Retaining Wall ELR Footing Access Foundation FPS Fig Grain Crawl Drain Inspection Notes SGN Slab -- --.�_---- ----- — ��- SIT Post& Beam —` F xt Sheath/Shear Int Sheath/Shear I naming Insulation ----------------- ------- Drywall Nailing ---- _-- --- - - - Firewall / 1 Fire Sprinklor Fire Alarm 'SACC -F"l�n Susp'd Ceiling Roof ' �. _ sl Final PASS PART FA, -_-- "� a PLUMBING Post&Beam -- Under Slab Top Out Water Service ' +j C, �_ 7 Sanitary Sewer Rain Drains Final - - PASS PART F-AII. I _ MECHANICAL -_- Post&Beam Rough In Gas Line - - - -- - --- --- - -- Smoke Dampers Final - PASS PART FAIL < ELECTRICAL - - -- Service Rough In UG/Slab Low Voltage Fire-Alarm PART FAIL SITE r Backfill/Grading - — - Sanitary Sewer Storm Drain ( 1 Reinspection fee of$ required before next 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 Approach/Sidewalk -.,C)/inspector )OtherDate Ls:.�4 Ext Final �— PASS PART FAIL 00 NO't REMOVE this inspection record from the lob site• CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24-4, our Inspection Line: 639-4175 Business Line: 639-4171 --- BUP _ Date Requested 2- 6, AM _PM BLD Location y8> q ,3 w /</m 49-4,1 l!j '9✓ Suite MEC Gj Contact Person Ph ��/ 7 PLM Contractor C< U/Z e�'oI'4- . �4 ��7 << _ Fah / SWR _ BUILDING Tenant/Owner R/*4ZC Ck iY �v S-ell _ ELC u 0Y 2— Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain I SGN Crawl Drain Inspection Notes — Slab _ — SIT Post& Beam Ext Sheath/Shear Int Sheath/Shear Framing ------ --- --- ------ - �, —� _ _ Insulation Drywall Nailing - -----------------------------—_-_ Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling ___"_ __._.___,!� _.__._---------_- Roof ------ Roof - ._� Misc: - - --- - - Final PASS PART FAIL ' PLUMBING Post& Beam ( _ Under Slab Top Out JVater Service Sanitary Sewer Rain Drains ----- __ _ Final PASS PART FAIL - -- - MECHANICAL Post& Bearn -- --- - ---- - --- Rough In Gas Line - _ _ _. -- - ------- --- _. Smoke Dampers Final PASS PART FAIL Se ice Rough In UG/Slab Low Voltage Fire Alarm - PASS P RT FAIL ST rE— BackfllrGiading - - - - - Sanitary Sewer Stora Drain [ J Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ )Please call for reinspection RE - [ J Unable to inspAct-no access ADA Approach/Sidewalk Other Dated/" -D -_ - Inspector .� Ext Other - Final PASS PART FAIL_j DO NOT REMOVE this Inspection record from the job site. CELECTRICAL PERMIT CITY O F T I GA R D / PERMIT#: ELC2001-00559 DEVELOPMENT SERVICES DATE ISSUED: 11/8/01 ' 13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 PARCEL: 2S111CD-09500 SITE ADDRESS: 09894 SW KIMBERLY DR SUBDIVISION: KERWOOD ESTATES ZONING: R 4.5 BLOCK: LOT : 031 JURISDICTION: TIG Proiect Descriodon: Service change. _ RESIDENTIAL UNIT TEMP SRVC/FEEDERS _ AAISCELLANEOUS 1000 SF OR LESS: 0 - 200 amp: p'jMPIIRRIGATION: EACH ADD'L 500SF: 201 - 400 amp: SIGN/OUT LINE LTG: LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL: MANF HMI SVC/ FDR: 601+amps 1000 volts: MINOR LABEL (10): SERVICE/FEEDER _ BRANCH CIRCUITS_ ADD'L INSPECTIONS 0 - 200 amp. 1 W/SERVICE OR FEEDER: PER INSPECTION: 201 - 400 amp: 1st W/O SRVC OR FDR: PEE', HOUR: 401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT: 601 - 1000 amp: _ PLAN REVIEW SECTION '000+ amplvolt: >=4 RES UNITS: > 600 VOLT NOMINAL: Reconnect only: SVC/FDR >=225 AMPS: _ CLASS AREA/SPEC OCC: Owner: Contractor: FORBES, ROGER M +PATRICIA A GARNER ELECTRIC 9894 SW KIMBERLY DR 21785 SW TUALATIN VLY HWY #C TIGARD, OR 97224 ALOHA, OR 97006-1249 Phone: Phone: Reg #: W-64fPOW SUP 3707S ELE 34-305C FEES Required Inspections _ Type By Date Amount Receipt Elect'I Service Elect'I Final PRMT CTR 11/8/01 $80.30 2720010000( 5PCT CTR 11/8/01 $6.42 2720010000( Total $86.72 TI-is Penn t is ia.ued subject to the regulations contained rn the'figard Municipal Code, State of OR Specialty Codes and dil other applicable ws 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 wL'*is suspended fir more thin 18'1 days ATTENTION Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR 95;1-001-0010 through OAR 352-001-0080 You may obtain ropies of these rules or direct questions to OUNC at(503) 246-6699 or 1-800.332-2344 Permit Signature: 17_. . 4 � Issued By: - O_)A_NER INSTALLATION ONLY _ The installation is being made on prnperty I own which is not intended for sale, lease, or rent. OWNER'S SIGNATURE: — — — DATE:— CONTRACTOR hISTALLATION ONLY SIGNATURE. OF SUPR. ELEC'N: _ —. --_ DI-TE:_—_ LICENSE 110 Call 639-4175 by 7:00pm for an inspection the next business day FROM : GARNER b_ECTR 1 C: FAX NO. Nov. 07 2001 04:05PM P1 electrical.permit Application Daterecelyed,i i 1 I 7007 o.: City of Tigard ->�— .�s' - Address: 13125 SW Hail blvd,Tigard,OR 97221 I't")ecv—�tt`� teCiryuJ7ignrd I'llune; (503) 639-4171 Uute issued_ fly Fax: (503) 598-1960Case file no.. f'aynlcnt rypc Land use Approval: 1 I &2 family dwelling or accessory Q Cumnlercial/industrial -1 Will Ian+ik U New conslnlction 0 Addition/altetition/rt-rl:u•enicnt 1 t�it1 Tenant irnpowcment Q Partial 1 1 Bldg,no.: tiuite, o.: Tax map/tax lot/account no.: I�tt. Block. Subdivisi n, Irro act name: _ Description and location of work on(+remises: Ear' E,stimlted date of cont letlon/inspection: 1 Job no; t Max Business flame: '-- --- Clrscrq+Ilan GT I G may. (ez) ,aryl Ira.incl. Address: Zl �. J W Newrrshleatlial-airtgkmnru 1-familyprr `�'C `j da+JUnituniLInclndcsart2rhnikarAge. City: i . State: _ ZIP 9'7 0D — Ser.imincluded. Phone: (p _45 Fax: cl Z E. M17-- IUW sq it or Icss 1 CC o.� 1 � Elec,bus. lic.no: _ O`aCi Bach additiondl 5fx)sy.fl.or portion thereof' _ Limited energy,residential �._ Cil y afro tr o.; v 1 p _- _ z Limited energy,rKin.realtictititil / _- 7-�� Fach manufactured home or mndulnrdwelling Sign arc of nu ry s n(fele ricion(required Vale Serv+re and/or seeder Sup.Cleo.name(pdnt): ntpt'I icea� arno U _ Sanies-o'r�ecden-irsstallaUon, 1 alteration or relocation: I 200 amps or less 2 Name(pnnt} pv l_ �C 201an+pato4Warpps 2 - �- 401 amps to 6110 amp.-- —In "'T Mailing address: — —' 2 60psto1000 amp+ 2 City: State: ZIP. over 1000 amps of volts2Phone: Fax &mail: Rerntmectont --- I Owner installation:The Installation is being made on property I own emib�hse,vlce+arreedewhich is trot intended for sale,lease,rent,or exchange according to hsslallanon,alleratlon.orrelocatioORS 447,455,479,670,701. 200 am s or less 2 201 amps to 400 amps 2 nolle 401 to 6W amps 2 Btameh circtl is-now,alieratlnn, Namc: or ralrnslon per panel: - - --- -- — A. Fu fnr'ranch circuits with purrl,tsr, of Address: service or feeder fee,each branch circuit 2 Cit _ State: ZIP; n Fee for branch circuits without purchase Phone: Fax: E mail: of cervica or feeder fee,first branch circuit: 2 Each additional branch circuit MM W11 ' ' Misc.(Sen ice or feeder not—Included): 7f3t'rdlv -225amps-colturiuctill ❑Ilralth-•arefacility Errhpumporirrigauoncircle 2 ver t 0 mnps•ratind of Ikl U Havudous location t3ach`ijtn c+r oudinr lighting 2 ellings O Building over 10.00(1 syrate feet four or Signal circult(s)ar n limited energy panel, er600voltsnontinal trn,reres�dcntialunitsinone srructum alteration.orextenaiun' 2 U Building liver three storici U Feeders,400 amps or more •t)ess an: n b - _ U Occupatn load over 91)persona U Manufactured souctures or R park FDeh n d on,llo irupecftoe the allowable hi rul over e of lire abnr O F tess/liphungplen 1)Other _ Pot inspection Submit—sets or plate with any of the stare. invratlgalion fee The above are not applicable to temporary condruction servke. Omer — Ned Allludadktiau weept ctnLt cads,plc,•-call lutidicuon fa tm,rs inkymanon. Notice:This permit application Permit fee.....................$ O Viaa to MmierCaid expires 11'a permit is not obtained Plan review(at -� ,) $ Cada card numbs. _ / within 180 days atter it has been State surcharge accepted s complete. TOTAL •.. ••••••••••••.Namr own on a it car( (o r 2 Cr � der a E IR -- s-Ammit r ' j 4"13(lYaAt..l)11)