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16800 SW QUEEN MARY AVENUE ._ ....... ..�w..:... � .. .. ..... . .<•..... _ .. .. . ....... . .. _..,�..n _..... .r .... .v .. .... a.. .w...-. ...,w• «.a..o...a+s.r.r•rw�,....,r_�.w. ...ww.....n-r.•«.a .. ... .r ... r..�. .. � .. _ .... •r. .. ... -.«.+.... .. .. ... • .... ..,.. w. ... . . . r� ..r.n......„....., ..�.. . 2- ti c � . 10 v k a- 14 i I , 1TY OF TIGARD D► re�fi" ► .......... .................... Approved. �...... . ... c p,+. I ! Conditionally Approved................................ . ). For only the Work as described in: PERMIT N6.1 75 UP •�- f,kle P�a. c.e , See Letter to Follow............................ ............( ): I ...........c Attach ..................... .. Job Address: 0 � �--- I Date: gh BSP: r 4�;ell x F0 to� Kdol, (,j i,-, JOB Chim - Pro CO. SHEET NO. _ OF I 18430 SE Burnside Portland, OR 97233 CALCULATED BY DATE CHECKED BY � DATE SCALE NOTICE: IF THE PRINT OR TYPE ON I ANY -r��llr Ili iii iii ll � ill lli , 1 , . �-11- 1 � � qT r ._111 .1-1TT _ 11 _1 111 .111 T 111 rli ilr 11 � 111 ` 111 r� r 111 rll 1.� i i 1 111 r 1 r i i iii i i i i l i 1 i i i i i l i � � l i l l! ! 1 I Til l l I I I I I � I l i � l � ► � I r 111 1 1 III I 1 I IMAGE IS NOT AS CLEAR AS THIS NOTICE, Z 2 3I ___— -- - -- — — - ---1—---- - 4 _--- 5 �,2OL IT IS DUE TO THE QUALITY OF THE No.36r- ORIGINAL DOCUMENT s g L s � Ili11111IlII1111lIllIIIllIIIIIII I �� IIII ILII Ilii 1111lllilllllll IIII IIIIillllllllllilllllll:rllilllllllllllllllllllllllll1111ILIIiII� lli� llllf�lllllllllllllllllLl IilllL11.11111ILIIIIi1t11 111[ LIIII �I, Qs 00 O O N A c c� d 16800 SW Queen Mary Ave CITY OF TIGARD BUILDING INSPECTION DIVISION MST a _ 24-Hour Inspection Line: 639-4175 Business Line: 639-4171 BLIP ___ Date Requested &7 --// —AM__ PM __ BLD Location 1Z41 Suite MEC �i Contact Person �� " -ct _— Ph(SZ'-3� (�'� 'T-�T�L�� PLM Contractor _ Ph — _ SWR BUILDING Tenant/Owner ELC RElaining Wall ELR --_- _-------.--_.--_ Footing Access FPS Foundation Fig Drain SGIJ Crawl Drain Inspection Notes SIT Slab - - – Post& Beam Ext Sheath/Shear -- - - "- Int Sheath/Shear Framing -- Insulation Drywall Nailing Firewall Fire Sprinkler - - Fire Alarm Susp'd Ceiling - Roof Misc: - Final PASS PART FAIL - -- PLUMBING Post&Beam Under Slab - Top Out Water Service - Sanitary Sewer Rain Drains ----- Final - -- -' PASS PART FAIL - - ANI - _ - I ost S Beam Rough In Gas Line - — S e Dampers S _ PART FAIL —_ - ELECTRICAL - Service — — - --- --------- - Rough In UG/Slab - --- ---- Low Voltage Fire Alarm - -- ---- - Final PASS PART FAIL — — SITE BackfilllGra �J ding --- Sanitary Sewer Storm Drain ( ] Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin ( ] Please call for reinspection RE: j Unable to inspect- no access Fire Supply Line ADA Approach/SidewalkDat@ C —/ — r Inspector _ Ext Other Final PASS PART FAIL , DO NOT REMOVE this Inspection record frorn the job site. CBUILDING PERMIT CITY OF TIGARD PERMIT #: BUP2001-00331 DEVELOPMENT SERVICES DATE ISSUED: 9/13/01 ' 13125 SW Hall Blvd.. Tiqard, OR 97223 (503) 639-4171 PARCEL: 2S115BC 07000 SITE ADDRESS: 16800 SW QUEEN MARY AVE SUBDIVISION: ZONING: BLOCK: LOT: JURISDICTION: KIN REISSUE: _FLOOR AREAS EXTERIOR WALL CONSTRUCTION CLASS OF WORK: ALT FIRST: sf N: S: E: W: TYPE OF USE: SF SECOND: sf PROJECT OPENINGS? TYPE OF CONST: 5N sf N: S: E:y W: OCCUPANCY GRP: R3 TOTAL AREA: 0.00 sf ROOF CONST: FIRE RET? OCCUPANCY LOAD: BASEMENT: sf AREA SEP. RATED: STOR: HT: ft GARAGE: sf OCCU SEP. RATED: BSMT?: MEZZ?: R_EQD_S_ETBACKS _ _ _ REQUIRED _ FLOOR LOAD: psf LEFT: ft RGHT. ft FIR SPKL: SMOK DET:_ DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC: BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING. VALUE: $ 3,500.00 Remarks: Construction of chase enclosure for fire place installation. To be constructed under existing eaves. Owner: Contractor: RFNGO, ARTHUR C TRUSTEE CHIM-PRO BY DEBORAH BOONE + DIANE WEINE 18430 SE BURNSIDE HAMLET RT BOX 933580 PORTLAND, OR 97223 SYhonDe: '1 -2"174 O60 Phone: 503-669-9301 Reg #: FEES REQUIRED INSPECTIONS Type By Date Amount Receipt Framing Insp PRMT CTR _ 9/12/01 $81.70 27200100000 Final Inspection `)PCT CTR 9/12/01 $6.54 27200100000 PLCK CTR 9/12/01 $53.10 27200100000 Total — $141.34 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire 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 the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-1987. You may obtain a copy of these rules or direct questions to OUNC by calling (503) 246-6699 or 1-800-332-2344. Pe nn ittee J' Signature: �) "' Issued By: _ � � �"t-i --- --- Call 639-4175 by 7 p.m. for an inspection the next business day Building Permit Application iG1 1 r Date received / Permit no.: �;(� City of Tigard 1= ProjecUappl.no.: Expire date: Address: 13125 SW Hail Blvd.Tigard,OR.�72231 JJgJ -- �'irvnf7it;nrd Date issued: ey-' Receiptno.: Phone: (503) 639-4171 ',i'k. _ Fax: (503) 598-1960 rase file no.: Payment type: Land use approval: — CITY — 1&2 family:Simple Complex: Al &2 fvnily dwelling or accessory U Commercial/industrial U Multi-fatnily U New construction U Demolition i'Addition/alteration/repiacemcnt U Tenant improvement U fire sprinkler/alarm U Other: INFORMATION Job address: 1&)0C)0 S o-) i4fa. /r I/r IBldg. no.: Suite no.: I.ot: Block: Subdivision: �ax map/tax lot/account no.: _- 11mlect name: t I r t4 ; t•'/R<<.? — Descnpuon and location of work on premiscs/speeial conditions: d e d t�r �) , solar, Name � It�� MaiIin dress: 10R1_0 S w Lro' r'", / 4� fi t'�' 1 & 2 family dwelling: City: l�, rr- C . State:�) LIP: Z r' 4 Valuation of work........................................ S 3-SX). 4 ) E,/ Fax: E-mail: No.of hedroorns/baths 'J Z Phone: - Owner's representative: Total number of floors................................. / i one F.tx: E-mail: New dwelling area(sq.ft.) .......................... Gamge/carport area(sq.ft.)......................... _Nance: Covered porch area(sq.ft.) ......................... _ Mailing address: Teck area(sq. ft.) ........................................ Pity: __ State: _ ZIP: Other stnicture aro-a(sq. IL)......................... Phone: Fax: E-mail: ComoerciaUlndustrial/multi-family: MUM Valuation of work........................................ $ Existing bldg.area(sq. ft.) .......................... Business name: ('Lr,/,0, i ( c _ New bldg.arta(sq. ft.) ................................ Address: 3 t, S c r.t S Number of stones........................................ City: PO1-9 14,-v/ I State:h%2 ZIP: 97Zjj •rvpc of construction Phone: ,tr," i/a I Fax:66/'' l i H E-mail: Occupancy group(s): Existing' CCD no.: f S R 5 -- New: City/metm lic. no.: t'. ')/ Notice:All contractors and subcontractors are required to be iicensed with ace Ortgon Cunsua--.ion Cu,iLmc..or Huard under Nance: provisions of ORS 701 and may he required to be licensed in the Address: jurisdiction where work is being performed. If the applicant is _ zIl. exempt from licensing,the following reason applies: Citv: State Contact person: — Phone: Fax: I:-mat l: -- Name: Contact person: Fees due upon application ........................... S_ Address: Date received: City: State: ~ZIP: Amount received ......................................... S Phone: Fax: E-mail: Please refer to fee schedule. I hereby certify I have read and examined this application and the Na W1 iunWiruau Apr efeiit earth.ptraw c.Wt iunsibman to tn(ve in(a rukUM attached checklist. All provisions of laws and ordinances governing this Uvisa o MasterCard f ctd;t card tsaattiv —_ __._/ / work will be complied wiU echoy'spe i herein or not. Audconzed signature:-- ignatureDate: � � Nam d anmohin u�t n tri rd ' / S Ptint name: ,t�!' ✓r,G�'• ---- — c,rtlM�ldC 11Ruuurc �owmt Notice:This permit application expires if a permit is not obtained within 180 days atter it ha,been accepted as complete. 440-4613(&UWOM) Ale Ad KING CITY 15300 S.W. 119th Avenue.King Cit;:,Oregon 9=24-2693 Phone:1503)639-4082•FAX 1503)639-3-.71 Notice To Contractors Working In King City Due to an intergovernmental agreement with the City of Tigard. mar,% building related permits for projects in King Cit.: are issued and inspected by the City of Tigard. If your permit application DOES NOT REQUIRE PLAN REVIEW, simply complete the appropriate application legibly and submit it to the King Cit,- staff. The King City staff will collect all fees and fax the application to the City of Tigard. City of Tigard staff will then create the permit, issue the permit. and perform inspections. Please indicate on the permit application whether you would like the Tigard staff to call you when the permit is ready for issuance or whether you prefer it to be mailed without any notification. .'arty incomplete or illegible application will be returned to King City staff for correction and no processing vyiil occur until a complete, legible application is received. If your permit applicatlo,. DOES REQUIRE PLAN RE`'IEW. this form must be signed by a King City staff person. King City staff will simple sign this form indicating land use approval. Take this signed form to the City of Tigard Development Sen-ices Counter located at 13 125 SW Hall Blvd. Tigard, to submit applications and plans. Development Sen ices Technicians are available at 639-4171 Ext. 304 should you have any questions concerning submittal requirements. All permit fees will be assessed and collected at the City of Tigard. The City of King City hereby authorizes applicant to pursue permits at the City of Tigard Building Department for the followingproject: ' tc fit, <<< <L'F.�t<<z . Kind_ City Represent ti%e 1 DSTS KCMT DOC SEE 35MM ROLL # 20 FOR OVERSIZED DOC UMENT CITYOF T I GA R D MECHANICAL PERMIT DEVELOPMENT SERVICES PERMIT#: ME1/0OU322 1 13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 2511 1 PARCEL: 2S 15BC-07000 SITE ADDRESS: 16800 SW QUEEN MARY AVE SUBDIVISION: ZONING: BLOCK: LOT: JURISDICTION: KIN CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS: TYPE OF USE: S,f= UNIT HEATERS: VENT FANS: OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS: STORIES: _ BOILERS/COMPRESSORS HOODS: _ FUEL TYPES_ 0 3 HP: DOMES. INCIW LPG 3 15 HP: COMML. INCIN: MAX INPUT: BTU 15 -30 HP: REPAIR UNITS: FIRE DAMPERS? 30 - 50 HP. WOODSTOVES: GAS PRESSURE: 50 + HP: CLO DRYERS: FURN < 100K BTU: _ AIR HANDLING UNITSOTHER UNITS: FURN >=100K BTU: <= 10000 cfm: GAS OUTLETS: 1 > 10000 cfm: Remarks: Installation of factory built fire place and vent. Owner: _ FEES RENGO, ARTHUR C TRUSTEE Type By Date Amount Receipt BY DEBORAH BOONE + DIANE WEINE PRMT BB 9/11/01 $72.50 KING CITY HAMLET RT BOX 950 5PCT BB 9/11/01 $5.80 KING CITY SEASIDE, OR 97138 - — — - Total $78.30 Phone: Contractor: CHIM-PRO CO. CLASSIC HEAT SOURCE, INC. 18430 SE BURNSIDE REQUIRED INSPECTIONS__ PORTLAND, OR 97233 Gas Line Insp Phone:669-9301 Final Inspection Reg #:LIC 00084985 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other applicable laws. All work will be done ii accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952_-001-0010 through OAR 952-001-0080. You may obtain copies of these rules or direct questions to OUNC by calling Issue By: <<, ���, f� Permittee Signature: }; /ale �.� Call (503) 639-4175 by 7:00 P.M. for inspections needed the next business day m— -_ I - X01 10:47 5Ft'�F,?q'1771 CITY nF KING CITY PAGE 02/02 Mechanical Permit Application ^ � Date received: Permit no.: Ti City of l gard V Ir/ED PLANNING I�lN Project/appl.no.: � Bxpiredate: City of Tigal d Address: 13125 SW Hall I iIvd,Tigard,OR 97223 — Phone: (503) 639-4171 AUG 2 8 2001 Date issued: _ By: kecciptno.: Fax: (503) 598-1961) Case tile.no Payment type: Land use approval: , CIT�I ' OF TIGARD Building permu nn — AI do zfamily dwelling oraecessoiy U Coin ntcreial/industriill U Multi-family U Tenant improvement U New construction Addidon/altemtion/replaeement U Other: Jolt address: 1 G gp p S w Indicate equipment quantities in boxes heiow.Indicate the dollar Bldg.no.; Suite no.: value of all met himical materials,equipment,labor.overhead, Tax ffiaphax lot/account no.: profit. Value$ Lot: ` Block: Subdivision: "See checklist for important application information and Project name: rj a�,I ,' i v e rr+(ac E jurisdiction's fee schedule for residential permit fet, City/county: .� !�!r( c_ ZIP: c Z low Description and location o work un premises: a y0e_o F I,-CjD/QGe- � QMG/O5 r✓o e _- Fee(ea.) Troll Eat.date of completiott/inspecuon: c,e tl if _�v rl'�C __ Lleacri on (at . lirv_ordv It�w.nnly Tenant improvement or change of use: Is existing space heated or conditioned?99Yes C! Air handling unit CPM No -- rcan(u unin r(sitr plan require IS existing 9pa(•(•insulated?U Yea U Nu Alteration elation of existing HVAC system _ fll ledcompresotrs State ttoiler permit no.: Business name: C►.11 I'w) _ !'0,r, C'G� ' HP Tons 6TUM Addtrs_a: / [! ,/3 e- S f. n d v hS r.e__ ��'__ ire�srnuke dame u_ct smoke detectors City: Foo—t IAA- ' •.gid _ State:v a DP: y 7ZT 3 Heat pump(site p an t u' ) Phone; 6 o Fax:6 h7- -F F.-mail: nstRivreplace turnnee urner BTU/11— CCB no.: & ��j Includingduetwork/vent liner U_Yes U No nsta lep nC relocnlP eaters�9ll.SPen e City/metro lic.no.: /b wall,or flcx)I mounted Name( lease Tint): '. a �✓ a ,�K _ semi ora Bance other thin mace e ertrt n. INN Adsorption units. _. BTUR 1 Name: SG!*t e, '13- f4"Y!f. - Cltinero . . --- HP Address: (`rml11mssnrs _. Hp rTroii ental ex—Tuurt�it r tet on! — -('tty - ----T ---1 State. ZIP: Appliance vent — - I'llone: Fax- E-mail: ore laud t Ilood%,Type l/11 A.-kitchtnAiRzinat hood fire suppression sysrrm Nair _7 1 A rt �� e , r/ - Lithaust(in with single duct(hath Isnsl Mailutg nrlilnsst t?xFiau81 s stemma,Ian trorn heaungur AC City: Stair: Lll' ue pl-prng anA d rt vi on(up to 4 outlets) - — _ T ____l P0 _ NG ___Oil Phone: �� Fax: E mail: Tuc n nn each a(duionol over 4 ouTIAS - ltaI.p nR(sc temanciequi ) Name; Nulntmr of outlets t, rl aiurre orrqulpmenl: Address: Urxotntrveltrr111n�.r %Orae City: 5tate: ZlI': insert__i.— Phone: -' Ftu:� mail: _ o, tovepe eistov,. — Applicant's signature: Date:d•t;-o Name (print): �P ri/ .�' 1/r.i A, -- --- New VI iuri r1ini(xu aeepl ctatlt cattle.rt"M emit iuridiceon far ran(tdarmrim Pemlit fee.....................s ❑V;sx q Maslet('ur1 NoticeThis permit application Minimum fee................$ 7 Z r 50 i ir&Card rmadrcr. ! expires if n permit is not obtained Flan review(at _ %) $ J�� within 180 da i after it hap horn xpim y State.sutrharge(8%) $ 1Tirne ;,n Tan u rhmni on credit card accepted m o anplete. TOTAL .... 40417 417(6KAMM) 09/06/2001 10:47 5036393771 CIT`/ OF KING CITY PAGE 01/02 KING CITY t 15100 SIN 116th Avenue. King Cit.,,Oregon 97=4 Phone:-0.4082 F'AX COVER SHEET DA,rE TO : FROM : Mi S S c•1G�' . ^� This transmittal contains _ :.pages , including this Cover Shpet . if you experience any Arobler19 , bloase contact : City of King City ( 503 ) ,39-4082 Fax Number ( 503 ) 639-3771 CELECTRICAL PERMIT CITY OF TiGARD PERMIT#: ELC2001-00482 DEVELOPMENT SERVICES DATE ISSUED: 9/28/01 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 PARCEL: 2S115BC-07000 SITE ADDRESS: 16800 SW QUEEN MARY AVE SUBDIVISION: ZONING: BLOCK: LOT : -JURISDICTION: KIN Proiect Description: Installation of(1) branch circuit. RESIDENTIAL UNIT TEMP SR_VC/FEEDERS _ MISCELLANEOUS _ 1000 SF OR LESS: 0^ 200 amp PUMP/IRRIGATION: EACH ADD'L 500SF: 201 - 400 amp: SIGN/OUT LINE. L'fG: LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL: MANF HM/ SVC/ FDR: 601+amus - 1000 volts: MINOR LABEL (10): SERVICE/FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS 0 - 200 amp: W/SERVICE OR FEEDER: PER INSPECTION: 201 - 400 amp: 1st WIO SRVC OR FDR: 1 PER HOUR: 401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT: 601 - 1000 amp: _ PLAN REVIEW SECTION _ 1000+ amp/volt: >=4 RES UNITS: > 600 \f)LT NOMINAL: Reconnect only: _ _ SVC/FDR — 225 AMPS: CLASS AREA/SPEC OCC: Owner: Contractor: ,JOHN/DENNA HEWITT OWNER 16800 SW QUEEMN MARY AVE. KING CITY, OR 97224 Phone: 503624-9616 Phone: Reg#: FEES Required Inspections Type By Date Amount Receipt Wall Cover _ Elect'/ Final 5PCT CTR 9/28101 $3.75 2720010000( PRMT CTR 9/28101 $46.85 2720010000( Total $50.60 This Permit is issued subject to the regulations contained in the Tigard Municipal Code,State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire K 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 952-001-0010 through OAR 952-001-0080. You may obtain copies of these rules or direct questions to Issued By: l�ti� Fermit Signature: OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale, lease, or rent. OWNER'S SIGNATURE: DATE: CONTRACTOR INSTALLATION ONLY _ SIGNATURE OF SUPR. EI_EC'N: DATE: LICENSE NO: — — - Call 639-4175 by 7:00pm for an inspection the next busine3s day Electrical Permit Application Date received: I Permit no.: / -LZ,y =- City of Tigard Project/appl.no.: Expire date: City(!f Tigard Address: 13125 SW Nall Blvd,Tigard,OR 97221 Date issued: By: Receipt no.: Phone: (503) 639-4171 Case rile no.: Payment type: Fax: (503) 598-1960 Land use approval: - t T/?N 2 family dwelling or accessory U C'ornmercuil/nnluyu lel U Multi-fancily U Tenant improvement w coconstruction Add ` ition/alter;dion/replacement U Other: _ U Partial Joh address: l Q �(l) Bldg,no.: Suite no.: Tax map/tax lottaccount no.: Lot: IZlock: ivision: Project name: _ Description and location of work on premises' {3L 7 U {islim;ncll dlalc of cons lotion/inspecliun ?; L Pee Max Job no: _ ----- — - Description Vl). (ea.) Total no.insp Business dame: —� --- — Nrw residential-singe or multi famih ne, Address: -- dsselling,uni1 .6uludk.Winchedgarage. City: State: ZIP: %erilecincluded: IINN)xl i or less 4 Phone: Fax: E mall' — - Each additional 9(x1 sq,ft.or portion thereof CCB no.: Elec.bus.lic.no: Limited energy.residential City/ncetru lic.no.: Limited energy.non-residential 2 Bach manufactured home or modular dwelling 2 Date Service and/or feeder Si nature of sit rvisin electrician(requited Serrlceaorfeeders-Installation, Sup Acct mune(prino I,icensenu ■lleratlonorrelocation: PROPERTI OWNER 200 amps or less 2 201 amps to 41)0 amps 2 Nano•(print): e witt 401 amps to 600 amps 2 Mailing address: pU lAJ_ N 601 amps to 1000 amps 2 State:p ZIP:Ll 2 over llxxlamps orvnits 2 City: — I Phone: C Fux: Email' - Reconnect only L — Temporary senlces or feeders- Owner installation:The installation is axing made on property I own einstallation,oaryvererptiorfee elocplinn: which is not intended for sale,leaser,rens,or exchange according to 2txl amps or less ORS 447,455,479,670,701. yCV 201 amps to 41x1 amps _ _ 2 Owner's si nature: c L ale: �6 401 to 600 nm s — 2 h $ Bnnchcircuits nen,aBrration. or extenslop per panel: Nance: I A. Fee for branch circuits with purchase of 2 - service or feeder fee,each branch circuit Slate: %1P: N. Fee for branch circuits without porch Se j City: of service or feeder fee,first branch circuit: ( � 2 Phone: f$tr F.-nail: Each additional branch circuit Mhc.(Serrlce or kedet not lncludrd l: Each purr or irrigation ctrcic 2 U Service over 225 antps.eonuu ,, .! 1lrnith•cae facility Bach signor outline lighting 2 U Service over 320 anips-raring of I A 2 U I lazardous location Si nal circuH(s)or a limited energy panel. family dwellings U Building over 100x)square feet four m g r 2 U System over 6(x)volts nominal more residential units in one structure alteration,or extension• O Building over three shxies U Feeders,41x1 amps or mote •hey:nation: -___— _.._-- O occupant load over qy persons U Manufactured structures or RV park fAt'II additional inspection tiler torr pltaNplrle In any of the allort: U Egress/lightingplau J Ocher'. _----- ----_ I'ennsprcuun F—�--� submit sifts of pians with any of the above. Investigation fee 7 he alloy are not applicable to temporary construction service. , — -- ----- Permit fee.....................$ Not all)urisdictinn,accept credit cards.plena 0111 jurisdiction fa more in6xnwlinn Notice:This permit application Plan review(at — %) $ �- U Visa U Mastercard expires if a perncit is not obtained State surcharge(8%) ....$ Credit cud number. _L—l.___ within ISO days ager it has been --a- _-_- Expired TOTAL .......................$ accepted ry complete. - — Name of cardholder Y wn ilei c it card S C,vdholdkr Itgnature Amount 4104615 16/(xl/t't)M