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10512 SW NAEVE STREET REVISIONS TO SETBACKS, ?/10/01 MSG. REVISIONS TO HOUSE AND TRIED TO MAKE HOUSE FIT, 1/11/02 MSG. --REMOVFD DECK AND ROTATED HCUSE TO AN ANGLE. MPW 1/15/02 --CHANGE MIN. SETBACKS, 1/16/0;! M,;G. --SLICE WEST AND NORTH, 1118102 MSG. M , tel N 89 Ar,' ,-0 E 122.03' Z+ ...1 �' \!" (j) m 0) V 1 � i 4 . - l �. V '+ . ov .008 �/ I 0 ?' ' f � 3 s �fl Cu.� j • 2.02' I'. 8 k S 89' 9'54" W "rRE E T SCALE DSA WING LOT 11 1SRICKS4N KEIGH'TS S.E. 4C. 10, T.2S., R.1 W., W.M. CIr( OF TIGARD h WASHINUON COUNTY, OREGON ---A 2.5 FOOT LANDSCAPE EASEMENT SHALL ' JARY 7, 2002 EXIST ALONG ALL S"i-RET FRONTAGE. Centerline- Concepts Inc .DRAWN B Y': MSG CHECKED 8Y: --A 7.5 FOOT PUBLIC UTILITY EASEMENT y'*.- � SG CH WGDIII SHALL EXIST ALONG LANDSCAPE EASEMENT SCALE 1"=20' ACCOUNT_ 1 ,05 640 82nd Drive Gladstone, Oregon 97017 MAMLI\L1 I ERICK 503 650-0188 fox 503 650--0189 NOTICE: IF THE PRINT OR TYPE ON ANY Ip [ 111111111111111 11 ► � 111 ► 1 ( 1111 111111 r1TjT�1 ! (T 111 i-11 Ili ill III III 111 1111111 ► 11 111 ! 11 1111111 � 111111 Ir -r 1 I 1 1 ! II I I I I I -f- 1 ' I 1 1 I 1 -(IIJill I 1 I t 1 I 1 I > i I r 1 I 1 I I IMAGE IS NOT AS CLEAR AS THIS NOTICE, 1 2 3 I ( I � ! 1 -_------ -- ----- -_ -- -- - __ - _ _ _- S 1---- 10 11 17 IS DUE TO THE QUALITY OF THE -�- - —� ---- .W.": ... O R iG INAL DOCUMENT ---- - -- - --- _--- ----- -- ------ -- T ET-- -- F 6Z SZ` LZ 9Z SZI � Z EZ ZZ TZ OZ 61 Si LT 9T 5I � — 1 ' I � jgi, l - � 1111��111 .4 a o N z m m c� N E" r' 10512 SW Naeve Street CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)639-4175 MST2,662-001 a INSPECTION DIVISION Business Line: (503)639-4171 - BUP _ Received ____ Date Requested- 5 "" `f' AM _ PM BUP Location Z-- ..�'" Suite MEG Contact Person __` _.� � Ph I --31 0 2- PLM Contractor Ph( _) __— SWR BUILDING Tenant/Owner _ -_-_- ELC Footing ELC _ Foundation Access: Ptg Drain ELF! Crawl Drain Slab Inspection Notes: SIT Post&Bean; Shear Anchors Ext Sheath/Shear Int Sheath/Shear Frr.ninq - -- -- --- - -- Insulation Drywall Nailing Firewall Fire Sprinkler - - ----.- - Fire Alarm Susp'd Coiling _- Roof Other: - -- - -— Final ----- - PASS_ PART FAIL - _ - -- -- -- PLUMBING Post& Beam Under Slab M ' Hot; an j� �iC -- --- - - - ----- Cat Basin/Mar;tole Shower Pan Other:— -- - ART FAIL ,- �/0&aEeWNI__AL 1 - - - -- Post&Beam 1 Rough-In - r ~ ----- - - -- --- -- - Gab Line Smoke Datopers Final PASS PART FAIL - ELECTRICAL Service - - -- Rough-In LIG/Slab --- Low Voltage Fire Alarm Final Reinspect on fee of$__ required before next inspection. Pay at City Hall 13125 SW Hall Blvd. PASS PART FAIL SITE Please call!or reinspection RE: _ Unable to inspect-no access Fire Supply Line i ADA /� Approach/Sidewalk fiats - Inspector — Ext Other:_ Final 0 NOT REMOVE this Inspection record from the job site. PASS PART FAIL ELEVATION CERTIFICATION PER SECTION 710.l of the OSPSC CITY OF 11GAIW 3510.1 of the OTFDSC OREGON THE UPSTREAM MANHOLE RIM APPEARS TO BE ABOVE SOME OR ALL OF THE FIXTURE SPILL RIMS IN THIS STRUCTURE. INFORMATION IS NEEDED ON THE ELEVATION DIFFERENCE FROM THE MANHOLE TO THE LOWEST FLOOR CONTAINING PLUMBING FIXTURES TO ESTABLISH THE NEED FOR A BACKWA'I ER VALVE(S) AND TO DETERMINE WHICH FIXTURES NEED TO BE PROTECTED FROM BACKFLOW. OBTAIN AND SUBMIT WRITTE a DOCUMENTATION TO THE CITY OF TIGARD BUILDIN I DEPARTMENI WITH THE FOLLOWING INFORMATION: / LOT NUMBER SUBDIVISION _ ADDRESS �d /oZ tiAtvc�� PERMIT# A TRANSIT SHOT ON(DATE)6_3hIo-2— HA IED THAT THE I IRST UPSTREAM MANHOLE SPILLRIM IS HIGH OR LOWER(CIRCLE ONE)THAN THE i!�ff FINISH Ft""*ELEVATION. ,,//11;6 �i e- 4 Roo F ,L�OtiI lIG�'�-�' DATE Q312& �0 Z PLUMBER DATE JOB SUPERINTENDANT ABOVE INFORMATION ACCEPTED AND APPROVED BY: INSPECTOR'-, DATE� - 04 13125 SW Hall Blvd., Tigard, OR 97223 (503)639-4171 TDD(503)694-2772 03,-06,,021 WE11 14:29 FAT 503 671 9J 4i C'dRI.SON TESTIN, ; Ilical Jrte,n��� ftr•m t�enonmoe Carlson Geon PO i3ox 23814 40W Hudson Ave„NE ?.0 ®ox 7918 A nv)mion of Carlson Teating,Inc. Tigivd,Orepoi 97281 Sgiern, OR 9730' Renr1,OF 87708 Geoiecnrlcal Consuitlrg Phere:503)694.34x: �'Yone(i50 i 589.1252 Phone(5411 330-91 S6 Construution Inspection end'-delated Tests :AX '."J)870.9147 FAX(8(1°)389-13M WX;541)330-9183 CGT No. G010186?.A Permit No. Unavailable FIELD OBSERVATION RFPOkT DATES COVE-RED, March 6, 2002 PROJECT; Erickson 1-felghts Subdivision- Lot 11 ADDRESS: 10512 SW Naeve Street, Tigard, Oregon BY, Robert Russell WEATHER. Raining, —40°F PURPOSE OF VISIT: Construction Observation Garison Geotechnical ICGT) Ge;otechnicai Staff, Robert Russet, arrived on site at 1'1U hours as requested by Steve Hunt of Renaissanco Homes (RH) The purpose of my visit was to obeervo. footing subgrades conditions for lot number 11 of Erickson Heights Subdivision I net with Brian and Steve of RH on 61e, At the time of my observation, the footing forms were �n place and re-bar had been placed within the fors in the northwest of the proposrd building. The soils consisted of brown silt with trace sand. I observed that the I.,t slopes down hill from north to south at between 15 and 20 percent (less then 211: 1V)and the lot had been benched from north to south. I probed the footing sut�rades with a "'P." diameter steel foundation rod and in 99neral could ponetrato 0'e soils 4 to 8 Inches, indicating medium stiff soil conditions. Brian iriormed IT* that they would be pouring concrete for the footings at the end of the week. I recommended tc Brian to remove the upper 4 to 8 inches of soft soil anti all surface;water prior to pouring concroto. I alteo recommended if footings were going to be left exposed for more than a week, to place 1 to 2 irches or crushed aggregate int, the footings to help protect the subgrade. I left the sits at '1140 hours. Robert L. Russell, E.I.T. Niemer, N.L. Geotechnical Stat Ffriri pal Geotechnical Engineer Note, Our reports pertain to the lucabor,s observeC at the time of our visit only Irfurmation contained herein Is not to be reproduced, except in full, without prio authorl?ation from this office DISTRIBUTION: Stove Hunt, Renaissance Homes. Fax: 503 670.8663 CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)639-4175 MST INSPECTION DIVISION Business Line: (503) 639-4171 BLIP Received —T - --- -Date Requested----__ _-- � `.-- AM ---___ PM-_-- BLIP i Location ____ -- _1 p _Ss- -r_ Suite-- -l--- ----- MEc -- --- Contact Person -__--_-- -f'tf( --) -- Y9 3-40 -- PLM --_---- Contractor --- - - --- - ---- -- Ph(- ) ---- - - SWR BUILDING Tenant/Owner -- - -. -- Footing — FLC Foundation Access: Fig Drain 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 ---- - ---- -- - - Root Other: ------- -- ---- Final -------- --- PASS PART FAIL ------- - -- ----------- _- - - - ---- _ PLUMBING Post& Beam -- Under Slab Rough-In Watei Service ------ ---- ----- ---- - ----- ------ Sanitary Sewpi Rain Drains Cc:;h Basin/Manhole Storm Drain --— --- --- - --------Shower Pan Other:-----,- I -- - — -------- - - - - ------._--_ na PART FAIL -- - -- --- --- �_.--- ----..---- _ANICA_L_ Post& Beam T Rough-in — --_... - --- ---- -- — -- - - -- Gas Line Smoke Dampers — Final _PASS PART FAIL ---- ELECTRICAL Service Rough-In -- - ---- --- - - --- --- UG/Slab Low Voltage Fire Alarm Final C� Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE U Please call for reinspection RE: - __-_-_-__ -� Unable to inspect-no access Fire Supply Line AA Approach/Sidewalk Date v __ __C1� Inspector Ext Other:..--- Final ther:_Final DO NOT REMOVE this, Inspection record from the job site. PASS PART FAIL CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503) 639-4175 IV INSPECTION DIVISIu@4 Business Line: (503) 639-4171 I BUP Received __ -.-_ Date Requested -_ - AMPM - --_-_-. BUP I_oration Suite_ MEC — Contact Person �� _ -- Ph ( ) �- 3l Qo�� PLM Contractor— _ _-- Ph ( _--) -- ---.—... SWR BUILDING Tenant/Owner ELC _ - _— Footing ELC Foundation Acct:-s: - - Ftg Drain ELR 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 — PLUMBING Post&Beam - -- Under Slab - -- -- Sough-In Water Service -- --- Sanitary Sewer Rain Drains - - - - -- - Catch Basin/Manhole Storm Drain - Shower Pan Other: Final _ - PASS PART FAIL MECHANICAL Prst&Beam Rough-In Gas Line Smoke Dampers - -- - Final PA_SS PART FAIL ELECTRICAL Service Rough-In UG/Slab Low Voltage Fire Alarm -] Reinspection fee of$— - required before rext inspection. Pay at City Hall, 13125 SW Hall Blvd. c PART FAIL SITV Please call for reinspection RE:—_ __— F] Unable to inspect-no access Fire Supply Linp , ADA Approach/Sidewalk Date, -_ Insp�Ct ^� L - -Ext Other: Final DO NOT REMOVE this inspection record fr en the job site. PASS PART FAIL CITY OF TIGARD 24-Hour p� BUILDING Inspection Line: (503)639-4175 MST INSPECTION DIVISION Business"Line: (503) 639-4171 BLIP Received __ _Date Requested —AM r PM __ BUP Location �� �- e--��___ Suite MEC _ Contact Parson ? �-e--- _ Ph( ) 'L� PLM -- Co _ -- - Ph ( ---) SWR --- UILDING Tenant/Owner ELC __- _--------- -- -_-__ !" ng ELC --- Foundation Access: Ftg Drain ELR ------_----__--_. Crawl Drain _ _ - Slab Inspe.;tion Notes. SIT _ Post&Beam Shear Anchors Ext Sheath/Shear Int Sheath/Sheur Framing -- ------ - _ - -- - -- Insulation, Dryw,.i Nailing - -- - - - Firrwall ire Sprinkler - -- -- _- - Fire Alarm Susp'd Ceiling - Roof Other: - �risi SS PART FAIL - - _ Under Slab ---- - - - ---------- — -- Rough-In % Water Service - - -- - - --- - — Sanitary Sewer Rain Drains - Catch Basin/Manhole � Storm Drain - Shower Pan Other: - - - Final P 4- PA T FAIL ECN'4NICA ost&Bea r - Rgh-In ----- - ----.----------------------- --_._.. Gas Line Smoke Dampers ina PART FAIL - TRICAL r Service Rough-In _ UG/Slab _ Low Voltage Fire Alarm 11 Final lPART FAIL - I Reinspection fee of - required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PAss SITE Please call for reinspection RE:_._ ---_ __ Unable to inspect-no access Fire Supply Line ADA Approach/Sidewalk DAtr �����- - Inspector_ ____ Ext _- Other: Final DO NOT REMOVE this Inspection record from the job kite. PASS PART FAIL MASTER PERMIT CITY O F T I G A R D �- PERMIT#: MST2002-00124 DEVELOPMENT SERVICES DATE ISSUED: 2/28/02 13175 SW Hall Blvd., Tigard, OR 97223 (503) 6394171 SITE ADDRESS': 10512 SW NAEVE ST PARCEL: 2S11ODA-05000 SUBDIVISION: ERICKSON HEIGHTS ZONING: R-3.5 BLOCK: LOT: 011 JURISDICTION: TIG REMARKS. S/ F Path 1 BUILDING REISSUE: STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK. NFW HEIGHT: ?4 FIRST. 1,840 of BASEMtNf 71000 at LEFT: 5 SMOKE DETE.TORS: V TYPE OF USE: SF FLOOR LOAD: 4n SECOND: 1,880 at GARAGE: 786 of FRONT: 31 PARKING SPACES TYPE OF CONST: 5N DWELLING UNITS: FINBSMENT: at RIGHT: 18 VALUE: S 468.706.30 OCCUPANCY GRP: R l BDRM: 5 BATH: 4 TO"AL: 3,120.00 of REAR: 21 PLUMBING SINKS: 1 WATER CLOSE"rS. 4 WASHING MACH: I LAUNDRY TRAYS: 1 RAIN DRAIN: 100 TRAPS: LAVATORIES: 7 DISHWASHERS 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS. 1 CATCH BASINS: TUBISHOWERS: GARBAGE UISP 1 WATER HEATERS: I WATER LINES. RCKFLW PREVNTR i GREASE TRAPS: OTHER Fix"TURES: MECHANICAL FUEL TYPES FURN<10OK: BOIL1CMP<3HP: VENT FANS: 7 CLOTHES DRYER: 1 FURN>-1001(: 1 UNIT HEATER' HOODS: 1 OTHER UNITS: 1 MAX INP btu FLOOR FURNANCES: VENT.: 1 WOODSTOVES: GAS OUTLETS: I EL.F CTRICAL RESIDENTIAL UNIT _SERVICE FEEDER TEMP SRVC/FEEDE'IS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 10(10 SF OR LESS: 1 0 700 amp: 0 200 amp: WISVC OR FDR: 1 PUMPIIRRIGATIOW PER INSPECTION: EA ADWL 500SF: to 201 400 amp: 201 400 amp: 1st WIO SVCIFDR: 00 SIGNIOUT LIN LT: PER HOUR: LIMITED ENERGY: 401 •600 amp: 401 - 600 amp: EA ADOL OR CIR: SIGNALJPANEL: IN PLANT: MANU HM/SVC/FDR: 601 • 1000 Amp: 801+amps-1000v: MINOR LABEL: 1000+amp/volt PLAN REVIEW SECTION Reconnect only: >-4 RES UNITS: 9VCIFDR)•295 A.: 800 V NOMINAL: CLS AREA/SPC UCC ELECTRICAL•RESTRICTED ENERGY A.SF RESIDENTIAL B.COMMERCIAL AUDIO 6 STEREO VACUUM SYSTEM: AUDIO 6 STEREO: FIRE ALARM: INTERCOMIPAGING: OUTDOOR LNDSC LT BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE/]RRIG: PROTECTIVE SIONL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC DATA7TELE COMM: NURSE CALLS: TOTAL N SYSTEMS: Owner: Contractor: TOTAL FEES: $ 9,485.31 RENAISSANCE CUSTOM HOMES RENAISSANCE CUSTOM HOMES This permit is subject to the regulations contained in the Tigard Municipal Code,State of 1672 SW WILLAMETTE FALLS DR 1672 WILLAMETTE FALLS DR WEST LINN.OR 97062 WEST LINN.OR 97068 all other applicable laws. All woorkk will be done Specially Codes and it accordance with approved plans. This permit will expired work is not started within 180 days of issuance,or if the work is suspended for more than 180 days ATTENTION Phone. Phone: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set Reg N: LIC 04995' 'Orth in OAR 952-001.0010 through 952-001-0080. You may obtain copies of theIse rules or direct questions to OUNC by calling(503)246-1967. REQUIRED INSPECTION$ Erosion Control Insp 8, Wtr Prooflrg Bsm't We Footing/FOUndation Dr; Electrical Service Low Voltage Water Line Insp Grading Inspection Post/Beam Structural PLM/Underfloor Electrical Rough In Gas Line Insp Appr/Sdwlk Insp Sewer Inspection Post/Beam Nlechanlca Ing Drain Bsm't Wells Framing Insp Gas Fireplace Electrical Final Footing Insp Underfloor Insulation Mechanical Insp Shear Wall Insp Insulation Insp Mechanical Final Foundation Insp Crawl Draln/Backwate• Plumb Top Out Extorior Sheathing Insl Rain dr in Insp PIUrA Final Issued By : Iart-L.�� �..��/�tJ Permittee Sign.tore r� f7L--� Call (503) 639-4175 by 7:00 p.m. for an inspection needad thelhext busin RF , CITYOF TIGARD SEWER CONNECTION PERMIT DEVELOPMENT SERVICES PERMIT M SWR2002-00100 13125 SW Hall Blvd.,-igard, OR 97223 (503) 639-4171 DATE ISSUED: 2/28/02 PARCEL: 2S 110DA-05000 SITE ADDRESS; 10512 SW NAEVE ST SUBDIVISION: ERICKSON HEIGHTS ZONING: R-3.5 BLOCK: LOT: 011 _ JURISDICTION: TIG TENANT NAME: USA NO: FIXTURE UNITS: CLASS OF WORK: I\":W DWELLING UNITS: I TYPE OF USE: SF NO. OF BUILDINGS: 1 INSTALL TYPE: LTPSWR IMPERV SURFACE: Remarks: Sewer connection for new SF Owner: _ FEES_ �_ RENAISSANCE CUSTOM HOMES Type By Date Amount Receipt 1672 SW WILLAMETTE FALLS DR — - WEST LINN, OR 97062 PRMT CTR 2/28/02 $2,300.00 27200200000 INSP CTR 2/28/02 $35.00 27'-'002000no Phone: Total $2,335.00 Contractor: — Phone: Peg #: Required Inspections This Applicant agrees to comply with all the rules and regulations of the Unified Sewage Agency The permit expires 180 days from the date issued. The total amount paid will be forfeited if the permit expires. The Agency does not guarantee the accuracy of the side sewer laterals. If the sewer is not located at the measurement given, the installer shall prospect 3 feet in all directions from the distance given If not so located, the installer shall purchase a"Tap and Side Sewer' Permit and the Agency will instal! o laieral. ATTENTION Oregon law requires you to followA ules adopted by the Oregon Ut�llty Notification Center. Those rules are set forth in OAF+952-001-0010 through � R 9 2-001-0080. You may obtain copies of these rules or direct question*to OUNC by calling (503) 246- 87.. Issued by: ��� ��, ��.;" �ti Permittee Signature:_ Call (503) 639-4175 by 7:00 P.M. for an inspection needed the n rt busines ay / 1 / 7. �l� / sui�zoal-oD� db Building Permit Application 7D,a,teeceived: I �0 2- Permit no gd .pd ICity of Tigard t/appl.no.: Expire date: Cir n Ti mrd Address: 13125 SW Hall Blvd,'Tigard,UR 97223y f8 Phone: (503) 639-4171 ssued: By: Receipt no.: SS% •f'" ' Fax: (503) 598-1960 ,I / Case file no.: Payment type: �\ Land use approval: 1&2 family:Simple Complex: r r•. }x'1 &2 family dwelling or accessory U Commercial/industrial U Multi-family XNew construction U Demolition U Addition/alteration/replacement U Tenant improvement U Fire sprinkler/alarm U Other: .lob address: 140511. 5W ♦e vo- - Bldg.no.: Suite no.: � Lot: / Blrck: Subdivision: __-1>lr y�r -s Tax mapltrix lot/account no.: /30_j 3 S� 3 ` Project name: ,.re kf.„r f/trl,Tkff ---_ Description and location of work on premises/special conditions: �t /r1r�A�rr►>li 4� - Name: (1:10odillain.septic capaciii. .solar,etc.) Mailing address: 1672 SV t+/11"e a I-a//s I &2 family dwelling: 1l,G � City: ��/ rf 6:4#t State: ZIP: — Valuation of work........................................ $ _ --- Phone:S01 7 Twive Fax:S;MSVC E-mail: No.of bedrooms/baths................................. - Owner's representative: ,,,� '-_ Quo o t•1 Total number of floors................................. Phone: fare T'a c 1 mail New dwelling area(sq.ft.) ................... ...... 3� -- mom Garage/carport area(sq.ft.).............7.�.� Covered porch area(sq.ft.) ......................... SS Name: fah -- -. ^ Mailing address: ------- Deck area(sq. ft) ........................................ 150 --7- Other stnicture area(sq. ft.)......................... City: _�State. ZIP:_ - TI. mail Commercla I/industriallmulti-family: Phone: Fax: Valuationof work................................... ... $ Existing bldg.area(sq.�ft.) ............... ......... _ Business name: forte New bldg.area(sq.ft.)............... Address: Number of stories State: Zip ........ City: - - Type of construction...,.. . Phone: Fax: E-mail: Occupancy group(s), Existing: CCB no.: 9 130VV9 rN __- 7111 0Z New. — City/metro lic.no.: e,,_. /Z m 6 Notice:All contractors and subcontractors are required to be. licensed with the Oregon Construction Contractors Board under Name: sle /iN H j provisions of ORS 701 and may be required to be licensed in the Address: jurisdiction where work is being performed.if the applicant is /o�� nR ZIP: exempt from licensing,the following reason applies: Cit State: Contact person-_ _T. - Plan no.: ? ( Phone:so.3 799 7`96 Fax less: e: �;,,, (� , I Contact pars rn: Fees due upon application .......................... - - Date received: —_--_ _ r•ti•�/a�� J State.: aQ ZiP: Amount received ......................................... $ - - Phone:f 73-381-17 Fax: E-mail: Please refer to fee schedule. I hereby certify 1 have read and examined this application and the Not all jurisdictions accept credit tante,please cell jurisdiction for mote informatm. attached checklist.All provisions of laws and ordinances governing this U Visa U MasterCard work will be complied with,whether specified herein or not. ct:sit cera"omrrec _ `. /_ pile pe Expires ,•— ��. — Nims" — Authorized signature: /M�, _ AIC: — f ceidholder u ehmvn oncretlll cam-- s Print name:� �J _ ,--• Cardholder sipalure Amount Not; .This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Ou1-4611(OW One-and Two-Family Dwelling Building Permit Application Checklist Reference no.: ---- — Associated permits: Cityof'figard Lily of llgardB O Electrical U Plumbing LJ Mechanical Address: 13125 SW Hall Blvd,Tigard,OR 97223 U Other: Phone: (503) 6394171 — Fax: (503) 598-1960 THE FOLLOWING 1 1 FOR PLAN.RIEVIEW. Yes No NIA 1 Land use actions completed.See jurisdiction criteria for concurrent reviews. 2 Zoning.Flood plain,solar balance points,seismic soils designation,historic districi,etc. 3 Verification of approved platllot. - 4 Fire district approval required. 5 Septic system permit or authorization for remodel.Existing system capacity 6 Sewer permit. _ 7 Water district approval. 8 Soils report.Must carry original applicable stamp and signature on file or with application. 9 Erosion control U plan U permit required. Include drainage-way protection,silt fence design and location of I catch-basin protection,etc. _ 10 3 Complete sets of legible plans.Must be drawn to scale,showing conformance to applicable local and state building codes.Lateral design details and connections must be incorporated into the plans or on a separate full-size sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if copyright violations exist. 11 Sitelplot plan drawn to scale.The plan must show lot and building setback dimensions;property corner elevations(if there is more than a Oft.elevation differential,plan must show contour lines at 2-ft.intervals);location of easements and driveway;footprint of structure(including decks);location of wells/septic systems;utility locations;directon indicator,lot area;building coverage area;percentage of coverage;impervious area;existing structures on site;and surface drainage. 12 Foundation plan.Show dimensions,anchor bolts,any hold-downs and reinforcing pads,connection details,vent size and location. 13 Floor plans.Show all dimensions,room identification,window size,location of smoke detectors,water heater, furnace ventilation fans plumbing fixtures,balconies and decks 30 inches above grade,etc. 14 Cross section(@)and details.Show all framing-member sizes and spacing such as floor beams,headers,joists,sub-floor, wall construction,roof construction.More than one cross section may be required to clearly portray construction.Show details of all wall and roof sheathing,roofing,roof slope,ceiling height,siding material,faotings and foundation,stairs, _ fireplace construction, thermal insulation,etc. _ I Elevation views.Provide elevations for new construction;minimum of two elevations for additions and remodels. Exterior elevation must reflect the actual grade if the change in grade is greater than four foot at building envelope. Full-size sheet addendums showing foundation elevations with cross references are acceptable. 16 Wall bracing(prescriptive path)and/or lateral analysis plans.Must indicate details and locations;for nonprescriptive path analysis provide specifications and calculations to engineering standards. v 17 Floor/roof framing.Provide plans for all floors/roof assemblies,indicating member sizing,spacing,and bearing locations.Show attic ventilation. l8 Basement at:d retaining walls.Provide cross sections and details showing placement of rehar.For engineered systems,see itpin 22,"Engineer's calculations." 19 Beam calculations.Provide two sets of calculations using current code design values for ail beams and multiple joists over 10 feet long and/or any bepm/joist carrying a non-uniform load. 20 Manufactured floor/roof truss design details. _ 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas-piping schematic is required for four or more appliances. 22 Engineer's calculations.When 1,. wed or provided,(i.e.,shear wall,roof truss)shall be stamped by an engineer or architect licensed in Oregon and shall be shown to be applicable to the project under review, 23 Five(5)site plans are required for Item 11 above. Site plans must be 8-1/2_'x 11"or 11"x 17". _ 24 Two(2)sets each are required for Items 16, 19,20&22 above. 25 Building plans shall not contain red lines or tape-ons. 26 "Reversed"building plans must meet criteria outlined in the Permit&System Development Fees document. 27 No"mirrored"building plans will be accepted. 28 "Drawn to srale"indicates standard srchitect or engineer scale. Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black ink. Red ink is reserved for department use only. 440-4614(6roorcoM) A Plumbing Permit Application ` — - t)ate received: Permitno.:,,, QZ ;6City of Tigard Sewer permit no.: Building permit no.: Address: 13125 SW Ilall Blvd,Tigard,OR 9722 Pro ccVa 1 no.: Expire date: Cin ,/77g Mrd 1 phone: (503) 639-4171 pP - - Fax: (503) 598-1960 Date'-,sued: By: Receiptno.: Land use approval: _.._ case fife no.: Payment type: TVPE OF PERMIT mom �-1 &2 family dwelling or accessory ❑CommerciaUindustrial U Multi-family U Tenant improvement New co,tstniclion U Add ition/alterat ion/re fill ace ment U Food service U Other: t tLLUU=n1T1 t it, t t pescnpti Qty.7Feeea.) '1•otal Job address: c�S Z 51.i /t✓nr v� Ne", I-and 2-family r',wellirrgs only: Bldg.no.: Suite no.: — _ (includes too ft.for eacitutilit, connection) } 'Tax map/tax lotlaccount no.: SFR(1)bath Lot: it Block: Subdivision: E /c �, 6� SFR(2)bath Project name:-��,,, f•�,,-,- P_fhb- SFR(3)bath /coun :�' n l / rr . /� Each additional bath/kitchen Cit t ZIP: y y r r�t �� Siteutilit:-s: Description and location of work on premises: cL.- lle ,4+n*• /t'si�1/r•.+>';r% Catch basin/araa:;rain Drywells/leach line/trench drain Est.date of completion/inspection: Footing drain(no. lin.ft.) Manufactured home utilities _ Business name: C� �6 / 4,o Manholes Address: 77 Rain drain connector City: /jr.,,.,-f..• State: �� ZIP: 9 7��' Sanitary sewer(no.lin, ft.) Phone:S -6 =4 9 bl Fax: E-mail: Storm sewer(no. lin.ft.) Plumb.bus.re no: Water service(no.lin.ft.) CCB no.:_7 9�LG g' ° - -��°�' Fixture or Item: City/metro lic.no.: 2 5,f/ Absorption valve Contractor's representative signature ` ' _._. Back flow prev Print name: a //� Date: Backwater valve -� Basins/lavatory _ Clothes washer _ Name: Dishwasher Address: _ Drinking fountain(s) City: - Statc:i� ZIP: Ejectors/sumP _ ___ Phone: Fax: E-mail: Expansion tank MFixture/sewer cap Floor drains/floor sinks huh 1 Name(print): Ife,406-Ir-co C l:.s -*m /, Garbage disposal Mailing address: 16 77 Sri t //s _ Hose bibb _ City: (,/..J>'�,u�, State: ryf ZIP: 7A;`� Ice maker Phone: E-mail: Interce tor/ tense tra _ Owner installation/residential maintenance only: 'The actual installation Pnmer(s) will be made by me or the maintenance and repair made by my regular Roof drain(commercial) employee on the property 1 own as pe,,-ORS Chapter 447. Sink(s),hasin(s)_lays(s) Owner's signature: __ - Date: _ Sump --- Pubs/shower/shower pan lJfinal — Name: -- Water closet _ Address: _ Water heater _ City: State: ZIP: Other: Phone Fax: E-mail: Total Minimum fee................ Not all jurisdictions accept credit cards,please call jurisdiction for more information Notice:This permit application Plan review(at ^ %) $ _ U Visa U MasterCard expires if a permit is not obtained Credit card number. — / / within 180 days after it has been cardhdder u shown on credit card — State surcharge (8%)....$ _ Expires accepted as complete. TOTAL .......................$ -- — — Name of $ -�� Cardholder signature _- --__ Amount U)I 4616(WOOWOM) I PLUMBING PERMIT FEES: PRICE TOTAL New 1 and 2-family dwellings only: I FIXTURES (individual) CITY ea AMOUNT (includes all plumbing fixtures in PRICE TOTAL Sink 16.60 the dwelling and the first100 ft. CITY (ea) AMOUNT _ for each utility connection) _ Lavatory - - - 16.60 --_ One 1 bath -_ _ $249.20 Tub or Tub/Shower Comb 16.60 Two 2 hath $300.00 _ Shower Only 16.60 Three(3)bath $399.00 Water Closet - 1660 _SUBTOTAL Urinal 16.60 80/.STATE SURCHARGE Dishwasher 16.60 PLAN REVIEW 25%OF SUBTOTAL Garbage Disposal 16.60 TOTAL Laundry Tray 16 60 Washing Machine 16 Fc t=loot Drain/Floor Sink "216.60 2" - -- 16.660 - PLEASE COMPLETE: I - 4" 16.60 _ --- Water Heater O conversion O like kind 16.60 Quandt b Work Performed _ Gas piping requires a separate mechaniutl Fixture Type: New Moved Replaced Removed/ _permit. __ +_ _ Ca ed MFG Home New Water Service 4640 Sink - _ veto MFG Home New San/Storm Sewer- 46.40 I-a�-- -- Tub or Tub/Shower Hose Blbs — 1660 Combination Roof Grains 1b.bt1 Shower Only -_ r.nking Fountain 16.60 Water Closet Roof - [Olher Fixtures(Specify) 16 60 Urinal _ Dishwasher ;--3rbage Disposal _ Laundry Room Tray _ -- -- Washtn; MECHANICAL PERMIT FEES COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE: _ Price Total _ -- Description: Qty (Ea) Amt TOTAL VALUATION: PERMIT FEE: Table 1A Menllanical code — It to$5,000.00 Minimum fee$72.50 1) Furnace io 100,000 BTU _ 14 00 $5,001,00 to$10,000.00 $72.50 for the first$5,000.00 and including ducts&vents — 51.52 for ee.n additional$100.00 or I 2) Furnace 100,000 BTU+ 17 4u fraction thereof,to and including M-1 includin & ducts vents _ $10,000.00. - 3) Floor Fumace $10,001.00 t $$25,000.00 $148.10 for the frst$1$10,000.00 and — 1400 includin vent $1.54 for each additional$100.00 or 4) Suspended heater,wall heater fraction thereof,to and including 14.00 $25,000.00. or floor mounted heater _ 5) Vent not included in appliance permit 6.80 525,001.00 to 55(,000.00 a�745 for each addfirs itional$100.00 nor fraction thereof,to and including Et6,) Repair units 12.15 $50,000.00. _ - Bailer Heat Air —t-5-0,001---- and up $742.00 for the first$'.0,000.00 and Check all that apply: ur "111-1p,p C::d $1.20 for each additional$100.0(1 or For footinotes below.se Comp fraction thereof. - -- _--- 7)<3HP;absorb unit 1400 UBTOTAL: — -- Minimum Permit Fee$72.50 to 100K BTU -7::71 _ 8)3-15 HP;absorb 25.60 8%State Surcharge unit 100k to 500k BTU _ 9)15.30 HP;absorb 35 00 25°/.Plan Review Fee(of subtotal) unit.5-1 mil BTU — Required for ALL commercial permits_onil 10)30-50 HP;alsorb 5220 TOTAL COMMERCIAL.PERMIT FEE: unit 1-1.75 mil BTU 11)>SPHP;absorh 8720--.- unit 720unit>1.75 mil BTU _ -- - _ 12)"Air unit to 10,000 CFM 10.00 _ ASSUMED VALUATIONS PER APPLIA Value Total 13)Air handling unit 10,000 CFM+ [i-)escrintion, :_--__ Q Amount 1 20 - Furnace to 100,000 BTU,including 955 14)Non-portable evaporate cooler 10T00 [ducts 1,170&vents Furnace> 100,000 BTU Including 15)Vent fan connected to a single duct 6.60 ducts&vents - Floor furnace includirjvent 955—� --- 16)Ventilation system not Included in 1000 Suspended heater,wall heater or 955 a Ifan�etmit floor mounted heater __ -- 17)Hood served by mechanical exhaust 1000 Vent not Inducted In ap llicance 445 — ermit _-.._ — ------- 18)Domestic incinerators 17 40 805 Repair units _ __. — 955 <3 hp;absorb.unit, 19)Commercial or industrial type incinerator 6995 to 100k BTU — 1,700 3 15 hp;absorb unit, 20)Other units,including wood stoves 1000 — 101 k to 500k BTU — -- li 15-30 hp; 2 absorb.unit,501k to 1 310 21)Gas piping one to four outlets 5.40 V30-50 — 3,400 J ,?)More than 4-per outlet(each) 1 00 ;absorb.unit,dl.BTU8725absorb.unit, Minimum Permit Fee$72.50 SUBTOTAL: - >1.75 mil.BTU - -I Air han&ng unit to 10,000 cfm _ 856 — 8°/.State Surcharge - Air handl n un t-10,000 cfm— 1,170 __6E — { �—.�_ 858 Non- ortable eva orate cooler.— — 448 _----- TOTAL RESIDENTIAL. PERMIT FEE: Vent fan connected to a single=duct _ 856 Vent system not Included In dance permit Other Intgectione and es: Hand served b 858 mechanical exhaust 1 Inspections outside Feof normal business hours(minimum charge two hours) _Domestic incinerator 1,170 _ ns 50 per hour Commercial or industrial Indm�rator 4,590 2 inspections for which no fee is specifically indicated (minimum charge-half hour) 656 572.5E per hour Other unit,Including wood stoves, 3 Addlticnal plan review required by changes.additions or revisions to plans(minimum inserts.etc. 360 — charge-one-half hour)$72.50 per hour Gas i Ig 1-4 outlets - 63 Fach additional outlet *Stale Contractor Boller Certification required for units>200k©TU. - --' a "Re~idontial AIC requires site pian showing placement of unit. TA TOL COMMERCIAL VALUATION: All New commercial Buildings require 2 sets of plans. i\dsts\forms\mech-tees 00c 08/29/01 Mechanical Permit Application Date received: Permit no. City of Tigard ProjecVappl.no.: Expire date: City of fig ard Addre­.: 13125 SW Hall Blvd,Tigard,OR 97223 Date issued: By: Receipt no.: Phone: (503) 639-4171 Fax: (503) 598-1960 Case file no.: Payment type: Land use approval: Building permit no.: 1 =tNlew mily dwelling or accessory U C'onlmerclalhndustnal U MUlo-family U Tenant improvement struction U Addition/alteration/replacement U Other: I 11111111' 1", Job address: /Z Sh✓_ Nr�*vE Indicate equipment quantities in boxes below. Indicate the dollar Bldg.no.: _ Suite no.: _ value of all mechanical materials,equipment,labor,overhead, A map/tax-lot/account no.: profit. Value Lot: lT�— Block: Subdivision: � t/� r �, 'See checklist for important application information and Project name: ijurisdiction's fee schedule for residential permit fee. In,/,ts ,.,_ Cityicounty:'j;_1 • /,, ,,, ZIP: SCHEDULE Description ani location of work on premises: [ E�:.N•.�_ t g t g Fee(ea.) Total Est.date of completion/inspection: Description Qty. Res.only Res.only Tenant improvement or change of use: Air handling unit CFM Is existing space heated or conditioned?U Yes U No Aircon itioning(site plan requited) _ Is existing space insulated?U Yes U No Alteration of existing IVACsystem Boiler/compressors State holier permit no.: _Business nanm: ;'�,��,,,o ,, //Q.; ,,,, _ Hp __.Tons___RTU/H Address: `7 V f �t'�+a /.,•. ire smoke ampers/dusmoke detectors City: /� t;'llr -Y et State: � ZIP: ]/Z3 eat pump(site plan required) _ Phone:f'�? . Z7nZy2 I Fax: E-mail: Install/replace urnace/bums: BTU Including ductwork/vent liner U Yes O No _ CCB no.: /`j�_ c� Z' Dt nsta. replac re Weare eaters-suPen e City/metro lie.no.: fjS� wall,or floor mounted _ Name(please print): (�,,,/ , ant for app lienee other than furnace UK e gerat on: Ahsorptionunits_. _ BTU/rl Name: }'sv«t Chillers___ ___ HP _— Address: - — Com ressors HP -- ,nv ronmenta exhaust and ventilation: City: State: Z[P: _ Appliance,ent Phone: - Fax: E-mail: rycrex a, goo s, ype U 117!es.kitche-n a-zmat — hood fire suppression system -- -- Name: _/r e•.ra,fs�.+�C C.s7}�� A/ rf Exhaust fan with single duct(bath fans) Mailing address: /G Jj S li./° ' ':haust system a,att from heating or AC Cit 5tatc: n ZIP: Fuel piping an distribution(up to 4 outlets) Y i✓+s t �.'���� �� Type: ---I PG _ NG Oil _ Phone:jJ?S.S 7 j0 Cr Fax: ;ry.;t`,Sd iG 4-mail: Fuel ,i in each additions over 4 outlets rw:esspiping(sc ematicrequite ) Numher of outlets Name: _ Other listed appiTance or equ pment: Address: Decorative fireplace _ City: State: 1.I P. -- nsert -type - �- o�ocTorWr-_T1et stove Phone: Fax: Email: Ot ter: — Applicant's signature: /_ / �� Date: Name (print): Not all jurisdictions accept credit cards,plena call jurisdiction for more information. Pereiil fee.....................$ _.. U Visa U MasterCard Notice:This permit application Minimum fee................$ Credit card number expires if a permit is not obtained Plan review(at __, %) $ within 180 day`after it has been s - splrci State surcharge(8%n) ....$ _ Name of car hoWr as shown on credit card accepted a.,complete. $ TOTAL .......................$ --- Cadholder signature Amount 440-4617 1hrXW rI,Nt, Electrical Permit Application Date received: Permit no.: .-00 City of Tigard Projcct/appl.no.- Expire date: - City rrfTigard Address: 13125 SW Hall !Ivd,Tigard,OR 97223 Date issued: By: I Receiln no.: Phone: (503) 639-4171 Fax: (503) 598-1960 Case file no.: Payment type: Land use approval: _ _ — TYllsE 1 &2 family dwelling or accessory U Commercial/industrial J Multi-family U Tenant improvement New construction U Addition/al teration/replace meitt J 011•l _ U Partial JOS SITE INFORMATION Job address: 10 55 Sl,/ AlAevt Bldg. no.: tiuite no Tax map/tax lot/account no., -- Lot: IBlock: Subdivision: Project name: Description and location of work on premises__ Estimated date of complelion/inspection: �� 1 SCHEDULEFEE Job Dot I rc Max — _ _ Description Qty• Ira.) otn no. nsp Busines8 L7t me: (, � Gwx Tr,C._ _ New residential-sinRkormulti-family per Address: PO ^�� f 2 dwelling unit.Inc ludes attached garage. ( State: c< ZIP: 7©/S Serviceincluded: y: <,1-/ c u 4 I(1(N)sq.ft.or less _ Phone:SO%t37 I 01,'v 2 Fax: E-mail: - Each additional 500 sq.ft.or portion thereat CCB no.. Elec.bus. lic no: 3— /Z Te Limited energy.residential _ 2 City/metro lic.no.: /Zy3 Limitedenergy.non-residential 2 Each manufactured home or modular dwelling —� � _-- service an feeder Signature or supervising electr cion(required) Date T_$ S Services or feedero—inatallatlon, Sup.elect.name(print). ��!4 -; t License no: alteration or rdccaMon: 1 ' 200 amps or less _. '- _ 201 amps to 400 amps 2 Name(print): �p,1 CA,,5 c,nc e 6k a41 //m""o' 401 amps to 6l>D amps — 2 Mailing address: 1 G 7 t S' �,ur u� i� 601 amps to 1000 arras _ City: �,i /�,+�+ State: -W ZIP: j 7 ty fj Over 1000 amps or volts _ 2 _ Phonc.: Y.2, jr 7` ar0 Fax:sn% ® E-mail: Reconnector.l 1 Owner installation:The installation is being made on property I own 'temporary services or feeders- whichis not intended for sale, lease,rent Inrurllation,alteration,or relocation:or exchange according to ,00 amps or less _ 2 ORS 447,455,479,670,701. 201 amps to 400 amps _ 2 Owner's si nature: Date: 401 to 600 ams '- Branrh circuits-new,alteration, ore xtension per panel: Name: _— —_ A. Fee for branch circuits with purchase of Address: service or feeder fee,each branch circuit '- ZIP: B Fee for branch circuits without purchase City: Slate: of service or feeder fee,first branch circuit: 2 _ Phone: Fax: E-mail: F;ach additional branch circuit: Misc.(Service or feeder not included): Each pump or irrigation circle 2 Service over 223 amps-commercial 0 Heahh-care facility -- 2 Each signot outline lighting 7ifamily Service over 320 amps-rating of I&2 o Hazardous 1ocatinndwellings U BuildinP over 100)0 square feet four or Signal circuit(s)or a limited energy panel, i U System over 600 volts nominal more residential units in onesirv,rare alteration,or extension* 2_ U Building over three stories U Feeders,400 amps or more *Description: -- J Occupant load over 99 persons O Manufactured structures or RV park tach additional Inspection over the alloNable to anv of the ahrrve: U Ggress/lightingplan U Dtltec Perinspection Submit_,sets of plans with env of the above. Investigation fee The above are not applicable to temporary construction service. Other Permit fee.....................$ —-Not all juritdicttoru accept credit cant,please call judrdiction for more information. Notice:This permit application O Visa U MasterCard expires if a permit H not obtained Plan review(at _ '7n) Credit card number / / _ within 180 days after it has been State surcharge(8%) ....$ Expires accepted as complete. TOTAI. .......................$ Name of csi&older es shown on credit cord Cardholder tlansure s Amnuat 440-4615(6W/COM) ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT S=EES: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY Complete Fe? Schedule Below: — — —� Restricted Energy Fee...................................................... $75.00 Number of Inspections par permit allowed) (FOR ALL SYSTEMS) Service included: Items Cost Tot i1 L I Check Type of Work Involved: Residential-per unit 1000 sq ft or lens - $145 15 — 4 ❑ Audio and Stereo System Each additional 500 sq it or portion thereof _ $3340 1 ❑ Burglar Alarm Limited Energy $75.00 Each Manuf'd Home or Modular ❑ Garage Door Opener' Dwelling Service or Feeder _ X90 90 _ 2 Services or Feeders LJ Heating,Ventilation and Air Conditioning System' Installation,alteration,or relocation 200 amps or less __ $80.30 2 �❑ Vacuum Systems" 201 amps to 400 amps $106.85 2 401 amps to 600 amps $160.60 — 2 601 amps to 1000 amps $240.60 _ — 2 ❑� Other Over 1000 amps or volts _ $454.65 2 Reconnect only $66.85 2 Temporary Services or Feeders TYPE OF WORK INVOLVED -COMMERCIAL Or ILY Installation,alteration,or relocation Fee for each system......................................................... $75.00 200 amps or less —_— $6L.85_ 2 ;SEE OAR 918-260-260) 201 amps to 400 amps $10030 1 401 amps to 600 amps $133 Tri _ 2 Check Type of Work Invcdved: Over 600 amps to 1000 volts, see"b"aboi e. ❑ Audio and Stereo Systems Branch Circuits ❑ Boiler Control New,alteration or extension per panel a)The Ine for branch circuits ❑ with purchase of service or Clock Systems feeder fee. Each branch circuit $6.65 ❑ Data Telecommunication Installation b)The fee for bran.:h circuits without purchase of service �❑ Fire Alarm Installation or feeder fee. First branrh circuit $46.85 Each additional branch dreuit $6.65 ❑ HVAC Miscellaneous ❑ Instrumentation (Service or feeder not included) Each pump or irrigation circle _ $5340 _a u Intercom and Paging Systems Each sign or outline IlghtIng — $534(, Signal circuil(s)or a limited energy panel,alteration or extension $7500 _— ❑ Landscape Irrigation Control' Minor Labels(10) _ $125.00 Medical Each additional Inspection over ❑� the allowable in any of the above ❑ Per inspection $62,50 I Nurse Calls Per hour _ $62.50 _ In Plant ,_— $73.75 I ❑ Outdoor Landscape Lighting' Fees: [] Protect ve Signaling Enter total of above fees $ ❑ Other 8^i State Surcharge $ Number of Systeme 25%Plan Review Fee See"Plan Review"rection on ti No licenses are required. Licenses are required for all other installations front of application --- Fees: Total Balance Due — Enter total of above fees L._J Trust Account N 8'/e State Surcharge $ -- --�---� - -- _-- Total Balance Due S i:dsts\fortnsklc-fees.doc 06/07/01 SEF 35Mlvi ROLL # 20 FOR OVERS14...Jr7ED D Oc../U' -'NIENI, d p b f � M G w1 W O IS � n CD r. mp r, f jir M r?tOti, Ln T � n N A C' A