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11525 SW DURHAM ROAD STE D-3 r+ i V �i V 1 ,4 l a p 11525 SW DURI IAM RD 9-3 ITT OF TIGARD _ PLUMBING PERMIT (�+- PERMIT#: PLM2003-00104 DEVELOPMENT SERVICES DA'rE ISSUED: 3/26(03 13125 SW Hall Blvd., Tigard, OR 97223 (503) 631.0-4171 "ARCEL: 2S11ODC-02300 SITE ADDRESS: 11525 SW DURHAM RD D-3 ZONING: C-G SUBDIVISION: PARTITION PLAT 1998-128 JURISDICTION: TIG BLOCK: LOT: — CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 1 FLOOR DRAINS; TRAPS: OCCUPANCY GRP LINK CATCH BASINS: STORIES: WATER HEATERS: FIXTURES � LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB(SH01/dERS: SEWER LINE: ft WWATER LINE: ft ATER CLOSETS: DISHWASHERS: RAIN DRAIN: ft Reinorks: Installation of backflow prevenlor, -- FEES Owner: --- Description Date Amount DLIRHAM/99 ASSOCIATES LTD PTNSH ��,I I I+I Pcrmit f;cc 3/26(03 $72.50 BY CRIIMI MAE SERVICES LP L I �,, tiI'm 3126/n3 $5.80 ATTN: LOAN SERVICING Total $78.30 ROCkVILLE, MD 20852 �—Phone : Contractor: MID (MILWAUKIE) PLUMBING CO P.O. BOX 393 CLACKAMAS, OR 97015 REQUIRED INSPECTIONS — RP/Backflow Prevenler Phone : 303-655-0161 Final Inspection Reg #: LIC 5002 III Ni 3-17PB 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 %:xpire if work is not started within 180 days of issuance, or If work is suspended for more than 180 days. ATTENTION: Oregon luw requires you to follow rules 'ed by the Oregcn Issued BY: `� �� = -� —— Pei rnittee Signature: - Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day MAP-26-03 W 55AM FPOM-MP PLUMBING 5036u6IT26 T •781 P 02/02 F-753 Plumbing Permit Application Dawruccivcd: Petmitno,: Pa'. / Y• • _E G�_ ---- —� (City of Tagard Sewer period no.. Huildingpetmi{no.: Addresa: 13125 SW Hall Blvd,Tigar3,Op 97.223 City ofTigard Phone: (503) 639-4.171 MAR �Uu'' �ojacuappl nn- — - Hxpiredate: Fax. (503) 598-10"0 CITY OF TIGAR� Date issued: Peceiptno.; Land use approval: .,I oil ,.11610 DIVISION ca-sc filen (s. Payment type: 7IJ18r.2 imunl) dwelling or accessory Comm rciaUinJusaial O Multi family U Tenant improvement I 'J New construction li�'Additic n/alteracion/replacatneot U huocl setvico U t)ther: _ ____ I 11A 12,1161111 P 1 fru lobaddrees: is �_ siDLa t•/. y __ Description Qt . Fee(ca.) Total ids.no.: Sui'x no.: - New 1-mod 2-family divelWtga ort : —• (includes 100 fl.fortAchutilitr connestlon) rax map/ta)tloUaccount no.: SDR(1)bath Lot; Block: I Subdivi ion: SFR (2)bath Pro jeet name: SNR 3 bath --— ---- Oty/county: -';- Z1P: Sach addition bath/kitchen. _._._9 Vu- �..._._ esctipti d I lion of work on raises• _ sit-utllitles: li6 . ! - -- Catr?t bamn/area drain - ^ t bate of cowplc4mJrnapecdon: —� - I v,wells/leach line/trench drain - Mar.ufaeturt:d home utili:eli Business nntua: I LA A2 -- M•utholes Address; _ Tarn dram connector Qty: Stater 4IF: Sanitary sewer(no. ne: Fax: ./.131111 B•mail:_ Storm sewer(no.lin.ft. CCB no,: - Plumb.bus.reg.no: 3- n pB Water service(no,11n.h.) City/metro lie,no.: Fixture or Uottt: Contractor's re easentadve si ature: Absorption salvo p_ � �-�= liar pow Ieventer INintnarne: D'dr: Backwater valve —� liasins/lavatory Clothes washer ishwasher Addrus; Ihittlting fountuin(s) Ci _ Smote m p T Bjector avm Phone: tax; P'mails `----- Expansion tan xture/sewer ca Name(print): - Floor draim/floor sinks/hub Mailing addresa. t3�rb byis oaal Cit ' State: gJIP: mone: ' !'ax: B mail: — terra tor/ reasc trap Owner inst lation/residential inaimmnance only: The actual lnstalladon Primer(s) will Ix rnade by me or the maintenancn and repair mat it:by my:t gulsr Roof drain cotnmeccial) —_ employee on the property I own ws pet ORS Chapter a 47. Si (s), as n s ,lays(s) Owner's aignature -- -- _--_ O C, _-- 1'u s/shown/shower pan �-- _Urinal W aier closet TAdit—mu: ater eater -- - —— City; State; :3p: other. Phone: Fax: — &mail: _ -- Total a,tt)ww►uwu.cccptereo�a�-ptwae.uJ+metcNo�raemla'rnr►eo permit application Mittimumfee.•............. $ Notice:This pe CA vim, U Miutc.urd Ilan rrvirw(at— ' ) $:Rd expires if a pormu fa not obtained il,.rr�,.me<,. _ - L l_ State surchup(8%) ... $ within 180 days after b M�:,oen -- accepted as oomplete. TOTAL .•....................•$ Mhme of ur Oterl o�liown on cn:d�card .. _ Z - �anthald�r NaMttRs Am1tw 4404616(MICOM) CITY OF TIGARD 24-Hour BUILDING Inspection Line: X503)639-4175 NIST INSPECTION DIVISION Business Line: (503)639-4171 BUP - - Received _ Date Requested 3;2 _ _ AM----, I'M __ --_ BLIP Location _ � orl Suite -_ MEC Contact Person Ph 4__ PLM Contractor - ----------,__— _ Ph SWR BUILDING Tenant/Owner --_ -_ � ELC _ Footing ELC Foundation Access: Ftg Drain ELR _ Crawl Drain Slab Inspection Notts: SIT Post&Beam - - - - Shear Anchors Ext Sheath/Shear _ Int Sheath/Shear Framing -- — Insulation Diywall Nailing Firewall Fire Sprinkler Fire Alarm _ Susr'd Ceiling — Root Cther. - - Final - PASS PART FAIT_ - PLUM61NG1 Post&Beam Under Slab - Rough-In Water Service Sanitary Sewer Rain Drains Catch Basin/Manhole Storm Drain - Shower Pan Q Other: Y -- - nkdcm MM PART FAIL (AWHANICAL Post&Beam Rough-In - Gas Line Smoke Dampers - Final PASS PART Full_ ---- - - -- - — ELECTRICnL Service -. - ----- - - Rough-In UG/Slab Low Voltage Fire Alarm Final f Reinspection fee of$_ _required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE Please call for reinspection RE: Unable to Inspect-no access Fire Supply Line / e� ADA l c�� " f Approach/Sidewalk Date _,i-- - �•Z- Inspector _ - Ext- -- Other: I Final DO NOT REMOVE this Inspection kiacord from the Job site. PASS PART FAIL CITY OF T,'GARD BUILDING INSPECTION DIVISION 24-Hour Inspvction Line: 639-4175 Business Line: 639-4171 MST - - — BUP — Date Requested6- AM— PM BLD --T— LoraUon � Z j 5� urh�.r Suite _ Q MEC ------ Contact Person ph 6_2- V _.3G3/ ?LM —� Contractor vel t f�_ Ph SWR BUILDING Tenant/Owner ELC ��G �r Retaining Wall ELR Footing -- - ACCPSS: Foundation C / EPS Ftg Drain ----- - Crawl 'Drain Inspection Notes SGN Slab ---- ----------- SIT Post& Beam --'— Ext Sheath/Shear Int heath/Shear Framing -- -- Insulation Drywall Nailing — Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof -` Nlisc: — Final PASS PART FAIL ---- -- -------_--_ _ _ _ -�,� PLUMBING Post& Beam - - - - - --- Under Slab Top Out - Water Service Sanitary 5evrci Rain Brains Final - - PASS PART FAIL MECHANICAL Post& Beam - - - --- - - - --- ---- -- Rough In Gas Line Smoke Dampers — Final -- --- - ---,..-- PA RT FAIL ELECTRICAL Rough In UG/Slab Low Voltage �— -- - --" Fire Alnrm Fina _ ------- ----- - ---- -- _..__ _� crk�i ' RT FAIL SITE Backfill/Grading ------- -- - -• _- Sanitary Sewer Storm Drain ( J RemspecK.);i fee of$ _required before next inspection Pay at City Hall. 13125 SW He!!Blvd Catch Basin Fire Supply Line ( J Ploase cull for reinspection RF -- - - J Unable to inspect-no access ADA Approach/Sidewalk r, ";r- Other atc __Inspector..----=' = �� Ext Final _-- PASS PART FAIL 00 NOT (REMOVE this inspection record from the job site. ELECTRICAL PERMIT TY OF T I G A R D PERMIT#: ELC2000-00590 DEVELOPMENT SERVICES DATE ISSUED: 10/13/00 Pak 1.3125 SW Hall Blvd.,Tigard, OR 972".3 (503) 639-4171 PARCEL: 2S110DC-02300 SITE ADDRESS: 11525 SW DLJRHAM RD D-3 SUBDIVISION: PARTITION PLAT 1998-128 ZONING: C-G BLOCK: LOT : JURISDICTION: TIG Proiect Description: "Shell"work. No tenant space. RESIDENTIAL. UNIT TEMP SRVC/FEEDERS _ MISCELLANEOUS _ 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: MANF HMI SVC! FDR: 601+arnps - 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: 1,t W/O SRVC OR FDR: PER HOUR: 401 600 amp: EA ADD'L BRNCH CIRC: IN PLANT: 601 - 1000 amp: _ _ _ PLAN REVIEW SECTION 1000+ arnp/volt: - >=4 RES UNITS: > 600 VOLT NOMINAL: Reconnect ons.__ — SVC/FDR >= 225 AMPS: CLASS AREA/SPEC OCC: Owner: Contractor: DURHAM/99 ASSOCIATES LTD PTNSH WILLAMETTE ELECTRIC INC BY CRIIMI MAE SERVICES LP PO BOX 230547 ATTN: LOAN SERVICING TIGARD, OR 97281 ROCK.VILLE, MD 20852 Phone: Phone: 624-3631 Rey#: LIC 000750 SUP 1965S ELE 34-2830 ----�� FEES ------��_�_—_-� Required Inspections Type By Date Amount Receipt_ Elect'I Final PRMT CTR 10/13/00 $80.30 2.72 00(10000( 5PCT CTR 10/13/00 $6.42 2720000000( Total $86.72 This Permit is issued subject to the regulations contained in the Tigard Munidp ; . de, Statp of OR Spedalty Codes and all other applicable laws. All work will be done in accordance with approved plans This permit will expire if wo.,,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 OAN 0512-001-0080 You may obtain espies of these rules or direct questions to OUNC at(503) 246 1987 PERMITTEE'S SIGNATURE yj,1�J _ ISSUED BY: l ?7r �� —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. ELEC'N: DATE: �— LICENSE NO: —-- ------- -— ----- — _�_._�� Call 639-4171N by 7:00pm for an inspection the next business day rlTV OF TIGARD Plan Check#_ 13125 SW HALL BLVD. EI )Ctrical Permit �p;ilication Recd By TIGARD OR 97223 Rer"P-0 Date Recd Print of Type Date to P.E. Phone(503)639 4171, x304 200 yf' Date to DST_ Inspection (503)639A175 ��'1 Ircntnphjor illegible will not be accepted Permit# _ Fax(503) 598-1960 M�N�,V btJkvrj Called 1. Job Address: 4. Complete Fee Schedule Below: Number of Inspections per permit allowed Name of Development Name(or name of business)_S� I I Service included: Items Cost Total r 4a. Residential-per unit ,Address I �2 > >c-, O j t kc,,,,_ R ej 1) 1000.q.ft.or less _ $147.15 4 City/State/Zip� f_C, r �z Ch.- Each additional 500 sqftor portion thereof $33.40 _ t Commercial Residential ❑ Limned Energy $75 00 Each Manut 'Home or Modular Dwelling Service or Feeder $90.90 _ 2 2a. Contractor installation only: ��- (Prior to permit Issuance,applicants must proVde contractor license 4b.Services or Feeders Installation,alteration,or relocation x C Information for COT data base). 200 amps or less $80.30 C 2 Electrical Contractor_tel,4 ,, tf c� F/fe r•-ir c L 201 amps to 400 amps $106.85 2 Address t',-) Ac L 4): 401 amps to 600 amps $160.60 2 City f r c,A n r) State O.-1 Zip_9 7 2�L_ 601 amps to 1000 amps $240.60 _^ 2 Phone No.�5 Tom- Over 1000 amps or volts $454.65 2 a 3� i.Z y- $4'�i Reconnect only $68.85 2 Job No. S r R -- Elec.Cont. Lice. No. C4 • 2 tr? C_ Exp.Date /0 - i - i 4a.Temporary Services or Feeders OR State CCB Reg. No._Lso v'; Exp.Date - e ! Installation, n 200 gimps or less or relocation $66.65 2 COT Business Tax or Metro No. i 3-1 Exp.Date -!_6'/ 201 amps to 400 amps $100.30 2 /� 401 amps to 600 amps $133.75 2 Signature of Supr. Elec'n s--� Over 600 amps to 1000 volts, see"b"above. License Exp.Date,io- 4d.Branch Circuits Phone No. 5c3 1 L zv - f6!�f _ New,alteration or extension per panel a)The fee for branch circuits 2b. For owner installations: with purchase of service or feeder fee. Each branch circuit $6.65 2 Print Owner's Name _ _ b)The fee for branch circuits Address _ without purchase of service City State Zip_ or feeder fee. First ranch circuit $46.85 Phone No. - Each additional branch circuit $665 The installation is being made on property I own which is not 4e.Miscellaneous (Sorvice or feeder not included) intended for sale, lease Or rent. Each pump or irrigation circle $53.40 Each sign or outline lighting $53.40 Owner's Signature __ . Signal circuit(s)or a limited energy panel,alteration or extension $75 00 .1. Plan Review section (if required):* Minor Labels(10) $125 00 item and enter fee in section 5B. 4f.Each additional Inspection neer Please check appropriate the allowable In any of the above 4 or more residential units in one structure Per Inspection X62.50 Service and feeder 225 amps or more Per hour $6250 System over 600 volts nominal In Plant $73.75 Classified area or structure containing special occupancy as 5. Fees: s described in NE C.Chapter 5 ba.Enter total of above fees $ * Submit 2 sets of plans with application where any of the above apply. Subtotal $ Surcharge(.08 x total fees) $ -r, _ Not required for temporary construction services. Su bb.Enter 25%of line ba for NOTICE Plan Review if required(Sec 3) $ ` Subtotal $ PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR ❑ Trust Account# WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS 2_ Total balance Due $ AT ANY TIME AFTER WORK IS COMMENCED. I\dsts\forms\electric rev,doc-8/00 CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24-Hour Inspection Line: 639-4175 Businens Line: 639-4171 --- p BUP —_-- —Date Requested O AM_ PM ^ BLD _ Location I l '� S jn .m� — Suite D-3 MEC - Contact Person Ph _ '/ PLM Contractor Ph Z 24) ':3S!C, SWR ---�. BUILDING l-enant/Owner ti z lLJ ELC Retaining Wall ELR _ Footing Access:Foundation FPS _ Ftg Drain 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 Misc: Final �- PASS PARI' FAIL_ — ---- ------------.— PLUMBING Post&Beam "- Under Slab Top Out ---^ - -`�- --- Water Service Sanitary Sewer - ------ ----------- --- —..__-- Rain Drains Final — - -- ------ -- ----------- --- PASS PART FAIL - -------- -------------------- MECHANICAL — Post&Beam -- — ----- --- Rough In Gas Line ----- -- -- --- Smoke Dampers Final — - -- --- - ..- - PASS PART FAIL ELECTRICAL - - Service _ _ _ Rough In —u UG/Slab _ A 1h_ Low Voltage Fire Alarm ASS PART FAIL _ Backfill/Grading Sanitary Sewer Storm Dre:n [ ]Reinspection fee of$ required before ne,;J soection ay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ )Please call for reinspection RF - —/Z--.. -_ _ [ I Unable to inspect-no access ADA Approach/Sidewalk Other Date _ _ _ Inspector _ — _Ext Final PASS PART FAIL J DO NOT REMOVE this inspectir•r- record from the job site. CITYOF T I G A R D _ELECTRICAL PERMIT PERMIT#: ELG1999-00455 DEVELOPMENT SERVICES DATE ISSUED: 7/26/99 13125 SW Hall Blvd., Ticiard, OR 9722.3 (513) 639-4171 PARCEL: 2S110DC-00400 SITE ADDRESS: 11525 SW DURHAM RD D-3 (ORIGINAL ZONING: C G SUBDIVISION: WILLOW BROOK PARK BLOCK: LOT : 016 JURISDICTION: TIG Project Description: Install--o of two branch circuits. Job No. 7-88 RESIDENTIAL UNIT _ TEMP SRVC/FEEDER_ S MISCELLANEOUS 1000 SF OR LESS 0 - 200 amp: PUMP/IRRIGATION: EACH ADD'L 500SF: 201 - 400 amp: SIGN/OUT LINE LTG: LIMITED E VERGY: 401 - 600 amp: SIGNAL/PANEL: MANF HM, _✓C/ FUR: 601+amps - 1000 volts: MINOR LABEL (10): SERVICE/Fibre BRANCH CIRCUITS ADD'L iNSPECTIO_NS 0 200 amp: W/SERVICE OR FEEDER: PER INSPECTION: 201 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR: 401 - 600 amp: EA ADD'L BRNCH CIRC: 1 IN PLANT: 601 - 1000 amp: PLAN REVIEW SECTION ___ _ 1000+ amp/ N volt: >=4 RES UNITS: > 600 VOLT OMINAL: Reconnect only: SVC/FDR >= 225 AMPS: CLASS AREA/SPEC OCC: Owner: Contractor: DURHAM 99 ASSOCIATES ELECTRICAL CONTRUCTION CO 135 EAST 57TH S-rREET PO BOX 10286 NEW YORK, NY 10022 PORTLAND, OR 97296 Phone: Phone: 224-3511 Rag#. LIC 049737 SUP 29865 ELE 26-45C FEES —— �` _� Required Inspections _ Type By Date Amount Receipt Elect'I Service PRMT DEB 7/26/99 $42.85 99-317131 Elect'I Final SPCT DEB 7/2.6/99 $3.00 99-317131 Total $45,85 This Permit is issued subject to the regulations contained in the Tigard Munidpal Code. State of OR Sped3lty Codes and all other applicable lays All work will be done in accordance with approved plans This permit will expire if work is not started within 180 days of issuance,orf work is suspended for more than 180 days ATTENTION Oregon law requ,res 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 gft6se rules ordirect questions to OUNC at(503) 246-1987 i Permit Signature: } Issued Fay . tet _ : / WNER INSTAL_LATIO_N ONLY The installation is being made on property I own which is not intended for sale, lease, or rent. OWNER'S SIGNATURE: _ _ DATE:_._—._ CONTRAC AOR INSTALLATION ONLY SIGNATURE OF SUPR. -LEC'N: DATE:-_---.----_--- LICENSE NO: i Call 639-4175 by 7:00pm for an inspection the next business day 07/22/1,399 15:37 5032203537 EC COMPANY PAGE 02 U7'20,99 rug 11:00 FAX 503 598 1960 CITY OF TIGARD im60 CITY OF TIGARD Electrical Permit Application Plan check 0 13125 SW HALL BLVD. Reed By TIGARD OR 97223 `ab '6 CTO 712�qq Date Reed 7 � } --- PhorlC(503)6394171, Data io D.E.171,x304 Dade to DST Inspect on(503)8394175 Print of i y�• Permit Fax(503)598-19W Incomplete or Illegible.brill r it be accepted Called 1. Job Address: Ge v lt► 4. Complete Fee Schedule Below: Name of Development e2.� h 5 �bOf�Ua� Number d ns r rrntt auowsa Name(or name of business) Service included: Items Cost Sum Address 44. Resteendal-per unit Cltyistate/Zip `e'OL rd .8Q. C`12� 1'100 sa.n.or lam s 11775 4 lz�J .�— Fit addiHenai 5011 sq.It.or portion thereof S 26.25 1 Corrrrlf±rciel� Residential❑ Limned Energy s 60.00 Each Manufd Nome or Modular 2a. Contractor installation only: Owacing Service at seeder _ s 72 75 2 (drtor to permit issuance,sopllcanis must provide contractor ecense ab.Servicao or Feeders irdormatlon for COT data baser►. Installallorl,alteration,or reiccatlon clectn®i ontractor_ 01e4!vH 200 amps or Was S 114 28 Z Address ,Q . 60-y' _�rJ �>5�! 20: arnpsto490ampe 6 86,50 2 Cit+/'�'7.� a ,State Zip tj"L- (3 —amps!0 6G0 amps 2 _s 119,50 _ 801 amps(0 lnoo amps _ t 192.50 2 00 Phone NO 3 — I Over 10amps cr volts i 383,75 2 Job No pleconned only r 5 53.50 2 Elec. Cont, Lice No. 2&-4,15C- EXP,Date 0- - do.Temporary 8ervkes or Feeders DR state CC8 Reg.No.x'1-5? _Exo.Oate/-jS--2200 Installation,eurratlon,or raloaUian COT Susinese Tax or Metra No, 103-1 �E:pDete 200 amps or less f 53.60 z 201 amps to 400 amps J S 80.25 2 Signature of Supr Elec'n _ 401 smps is 000 amps s 107.110 2 Over 600 amps to h Duo volts, License No. !i o'm 5 Exp.Date one"b above. Ad.Branch Circuits Phone Na. _ — — New,sileratbn or eatanslon per penal a)The res tprbrarskl dreutta 2b, For owner installations: with Pwdlaser of service or rirehser roe. Print Cwnw's Name Each brarlct drrult Address 01 Tire Ise fara bndy drevlra srhhoutpuroNase araerwee City State Zip _ or Rawer ha. tj 0 Phone No. Fiat branch dreu,t ti 37.50 .. Each additional brsndl dreutl `� s 3.35 The inatallabon is being made an property I own which Is not as.Nisc illswus intended fcr safe,Hesse or rent (Seryins or kado na Inaueea'� Each puny or brlp?tion cirds f 12,75 Omer$signature_ ver+sign or euvir"Wong i az 75 Signal arcuus)or a Undies enerplr 3. plan Review section (if requir®cO;' pane!. PWl ( ien or eetanslon s 00.00 T__ Minor ulhrrls 10) >) 107.00 Please Check epproprriate hill"n and enter fee In Action 58. 4f,Each additional Inspection over a or mora meldenuen um? •n one strueture the alimeble to any of the above SoNic1 and leader 225 amps or more Par tnspedion 9 50W Per how 1 50.00 "System over 900 velli nominal In Plant 3 8900 —ClassilW area or d ittdhdre containing special occupancy as (fee a 1 in N E C Cflstbr 5 S. F'ws: Z k tows mW of above fees s e submit 2 asses or plsne wlth application•-tram any of Use chew apply. 14 IpA%staMarge(OS x rota)hssi s _ Not required fbf temporefy eonatruetldn OGM4—. Subrenal f �_ Ib.Enter 25%of Moa Is for L1OCF Flan Rseleur If Mored(Sec.31 8 PERMr"BECOME VCiD F WORK Cil CONSTRUCTION AUI:iORUED sueeoietl t 16 NOT COMMENCED VATKN 160 0AY9,11R K CONSTRUCTION OR WORK IS SUSPENDED OR AWIDONED FOP A PERIOD OF 100 OATS Trust Account A&9 AT AW TIME AFTP14 WORK R COMMENCED. Tota/bets Due :.k. i 1•tdmlfbmnldceWa.doo � ,' ._ �� CITY OF TIGARD DEVELOPMENT SERVICES PLUMBINP PERMIT 13125 SW Hall BP7RMIT #. . . . . . , : pl_M9flvd,,Tigard,OR 97223 (503)639-4171 PnTE ISSUED: 06/17/98 PARCEL: 2S I I ODC-0014 001 31TU ADI)PESS. I t325 S-W l)LJRHP.M RD 1UP ZM1 I Hr 3 -,DIVISION. . . . WILLOW BROOK PAPK 3- C-G 131..OCIJ. . . . . . . . . . . I OT. . . . . . . . . . . . :016 .!LJRTSDIr*rT0N. TTU Gpf�SpGr." DISPOSAL9. . 0 MOBILE HOME r3PACE-9). .,LA!:'3S OF WnRK. , ALT TYPE Or USE. . . . ..COM Wrc3HTN0 MAC:H. . . . . . 0 SnCKFLOW PREVNTRE. . . I .f. fICCUPANI:Y GRP. . :A_3 FLOOR DRAINS. . . . . . . I.- TPnPS. . . (3TnR I ES. . . . . . . . . 0 WATER HFnTERS. . . . . ; 0 CATCH BnS I NG. 0 r-TXTI-JRES--- LAUNDRY TRAYS,. . . . . : 0 '3F- RAIN DRAINS. . . . . .. 0 ;INKS. . . . . . . . . : I URINALS. . . . . . . . . : 485RFA5E TRAPS. . . . . . . : 0 �_.AVATOPI;71). . . . : 0 OTHF11 FIYWi REEL . . . * 21 TUB/SHnWERS. . . ; 0 SEWER LINE ( ft) . . . : 0 14ATF_'R CLOSETS. : 0 14ATFR LINE (ft ) _ 1� T)I SHWOSHFRS. . . . : I RAIN nR(-ilN (ft Romarks : r4ltpratinn to rommorri ,il tenani. cyr2rupanry. Pipe SWR96-0132 for additionek'! ch,Rrge/fees due before issuing this permit. Owner: FEES !1Yr-_RC3' & SONS PLUMBING type -Amoi..tnt by detp rer-pt IS0C!4 oc"W JEAN PRMT 1; 79. 00 J.131) 06/17/98 98-306F,10 -ORE nSWFGO OR 9. 70.* __ "ir.lcl' t '. 95 JSD I-)a.. 3 1z F-1 C (I n P # '01YEPS & sm:") PLUMP TN13 GO,P4 SW JEAN RD, HL r.)b U` '-.nKF OSWFrin OR 97035 ...... I-,Ihanr (,84 -6602 1; OF!. 149 TO Al RFOIJIRFD TN5r,F('TT0Nc_' This pewit is issued subject to the regulations contained in the Final ITISPeet.- inil Tigard Municipal Code, State of Ore. Specialty Codes and all other applicable laws. All woi-4 will be done in accordance with approved plans, This ptroit will expire if wor4 is not started within 180 days of issuance, or if woriii is suspended for tore "han J80 days. ATTENTION: Oregon low requires you to follow rules aftptF,14 by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-898I-Nif through OAR 9V-01-M. You say nbtain copies of these rules or direct questions to OX by calling MAW. 01 Permittee Sign, A-+++4-+++ 4-++++--+++4...........1-+++++-h-++4-,f-++++44.+++-+++-4 1 r-.: r4 4.175 by 7.00 1--. m. Fn i n s,pef t i or, m-edod t hip next hi i� i r,P s; Plumbing Application Recd By ;ITY ,GF TIGARD g pP Date Recd 13125 SW HALL BLVD. Commercial and Residential Date to P.E. _ TIGARD, OR 97223 Date to DST— (503) 639-4171 Permit# �.l`I -D/' Print or Type Related SWR# .SG) .. 1'2." Incomplete or illegible applications will not be accepted Called �i0f1�v /,LL �. Name of Development/Project On back Indicate Work Performed by fixture. FIXTURES (Indlvldual) QTY PRICE AMT Job j�aCLYS .t'.t .s T:_ — s.00 Address Street Address , Suite J Sink — �j L` m //3 Z"5 bLo?? mI'l 11 L Lavatory J_ 9.00 Bldg# City/State Zip Tub rn TublShower Comb. 9.00 C,2 7 Z t`It Shower Only 9.00 Water Closet A 9.00 Moiling Address Suit Dishwasher 9.0U Owner ,r nv`'k�, e� Garbage Disposal __ 9.00 _CI (Stale Zi Phone Washing Machine 9.00 Ci 1. n• Floor Drain 51 Al�- 2� � 'Z. 9.00 3. 9.00 ir 9.00Occupant res p��+ L� Suite 4' _ _ — 9N (r, Water Heater O conversion O like kind 9.00 I City/State � Zip Phone Laundry Room Tray 9.00 _ �— Urinal 9.00 F ��Name —�— — 1 t�.l_L� �' .�r(S ��.�1,1 M��I�l r Other Fixtures(Specify) 900 J Contract Mailing Address Suite _ 9 00 (,.•14 5l� ��A�� f,L j 9.00 Prior to permit City/Stat Y Zip Phone /� 9.00 issuance,a ropy itL ✓EL.Ii ?G 3 fj 'UV -- 9.00 of all licenses are Oregon Const./Cont.Board Lic.# Exp.Date required if S `7 %� /O Sewer-1 St 100" 30.00 expired in COT Plumbing Lic.0 �'� E p 3l e p Sewer-each addillonal 100' 2500 databcse :1 l'!"• I ,7 Water Service-1st 100' 30.00 Name -- 25.00 Water Service-each additional 200' A CI11teCt Storm&Rain Drain- 1st 100' 1030 Or Marling Address Suite Storm R Rain Drain-each additional 100' 25.00 City/State ZIP Phone Mobile Horne Space 25.00 Engineer Commercial Back Flow Prevention Device or Anti- 25.00 [—Describe work New O Addition O Alleratlpn, Repair O Pollution Device_ to be dune Residential O Nonresidential 61 Residential Bac,",iw Prevention Device' 1500 Additional description of work Any Trap or Waste Not Connected to a Fixture 900 Catch Basin ,_ 9.00 Insp.of Existing Plumbing 40.00 per/hr Specially Requested Inspections 40.00 'xisting use of perlhr udding or property------ Rain Drain,single family dwelling 3000 reposed use of Grease Traps 900 wilding or property ----- ___ _ QUANTITY TOTAL hereby acknowledge that i have read this application,that the information Isometric w riser diagram is required I Ouanrty Total Is >9 liven is correct,that I am the owner or authorized agent of the owner,and — 'SUBTOTAL j9 f,. that plans submitted are in compliance with Oregon State Laws. Signature of w erlAgent Dais — 5% SURCHARGE PLAN REVIEW 25%OF SUBTOTAL �ontact Pa on Nafn oneRegwred only d fixture qt toy tal is,9 - _ �— TOTAL A;� ray Minimum permit lee is 525+5%TtirchargW exrept Residential Backflow Prevention Device,which is S15+5%surcharge "?.P : V# v� sE /J Gi.� r�rL.�vT F�< s' �u��rc ¢ �,r i�� E c H 0 s P� lion/ G/i6 .'�A[.c. Ct/44 41� Or T� c c y_S t`'A ��7� 9S� 7 n/o?7PF� n,T dwtolm�oP c, _t^i. 7 D C�F 7*R I'Iwr -/k 714 a,c� �,�,?mac r' 116X",17--AvF-tin �9 N1, Gi�ir rrr F ('R/'/�c�j • s� SFc. N F j P N-$E C-Q-M PLEM -Fixture Type --T Quantity by Work Performed New Moved Replaced Removed/Capped Sink Lavatory Tub or Tub/Shower Combination Shower Only _Water Closet Dishwasher Garbage Disposal _W_ashing Machine Floor-Drain 2" 311 Water Heater Laundry Room Tray Urinal Other Fixtures (Specify) T COMMEVTS REGARDING ABOVE: 13I0z � 6ISi-I0WiNii1 PMrn.l I welor"Apo tloc 5197 m Accumulative Sewer Tally Tenant Name: C( � IS This SWR# Address: I / 5 .�- S41 r h u ►� Qom, D This PLM#: Fixture Value Previous Previous Credits Capped Fixtures Fixtures New total New — # alue Capped off value added# added #s total LL Count off As count value values Baptistry/Font 4 Bath-Tub/Shower 4 -Jacuzzi/Whirlpool 4 Car Wash-Each Stall 6 - -Drive Through 16 CuspidorNVater Aspirator 1 1 u Dishwasher-Commercial 4 � -Domestic 2 D'inking Fountain 1 _ ye Wasn 1 Hour Drain/sink-2 inch 2 -" -3 Inch 5 -' -4 inch g - -Car Wash Dm 6 Garbbge Disposal 16 Cumestic(to 3/4 HP) T Commercial(to 5 HP) 32 -Industrial(over 5 HP) _ 48 Ice Machine/Refrigerator Drains _ 1 I( Oil Sep(Gas Statlon) 6 Rec.Vehicle Dump Station 16 — Shower-Gang(Per Head) 1 -Stall 2 '� Sink- Bar/Uvatory 2 -Bradley 5 Commercial 3 7 Service 3 - Swimming Pool Filter 1 �— Washer-Clothes 6 Water Extractor 6 Water Closet-Toilet 6 Urinal g -- TOTALS x�j Total 5x-b re values: XS 9 divided by 16 = 91 9 —EDU /U Fn u -S — AJ I HISTORY PLM# ;?-d9f EDU't /p SWR# y7.-oaS>0 PLM# EDU# SWR# _ PLM# ?9-01-?6 EJU_#�Z) SWR# �Z��d PLM# L=DU# SWR# _ PLM# 1/� -p?�� ECU# SW_R# 96 PLM# EDU#� SWR# PLM# ys-0 2 3 ECU# ;� SWR# �5 _py; Pi-M# — _ EDU# SWR# -�-- I 4iatslswrtaty.doc _ dG?.c ,-)f �l��ts� /� c 2�ic� /hDl�G•r'�C.Lu Q/si (lZcdt s,t.sc. 7 �r S r P �- 140004 Infill 09:05 FAX 503 244 0417 MILDREN DESIGN GROUP PC �lykI gap ?cf— ��✓y� MECH. I ROAM 100 SO. F- \\ I TYLER EVANS i' STA7;-FARM r.S RANGE L �- u 700 SO. FT. �Ic ls'`1� o ' I i L li o +. i 3995 SQ 'T��✓ G Yi�� f -----._—_ CITY OF TIGAR ® BUILDING PERMIT DEVELOPMENT SERVICES PERMIT #. . . . . . . : BUF198-0149 13125 SW Hall Blvd., Tlyard,OR 97223 (503)639-4171 DATE ISSUED: 04/06/98 PARCEL: 2SI10DC-00400 511F_ ADDRESS. . . : 11525 SW DURHAM RD D- 3 SUBDIVISION. . . . : WILLOW BROOK PARK ZONING:C—G BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :0 16 JURISDICTION:TIG ------------------------------------------------------------------ REISSUE: FLOOR EXTERIOR WALL CONSTRUCTION— r1*1.._ASS OF WORK. -ALT FIRST. . . . : 0 sf N: S: E: W. TYPE OF USE. . . :COM SECOND. . . : 0 sf PROTECT TYPE OF CONST. :5N 0 sf N: S: E: W: OCCUPANCY GRP'. :A,3 TOTAL-------: 0 s ROOF CONST : FIRE RET? : OCCUPANCY LOAD: 0 BASEMENT. : 0 sf AREA SEP. RATED: STOR. : 0 HT: 0 ft GARAGE. . . : 0 sf OCCU SEP. RATED: BSMT" : MEZZ ) : REDD SETBACKS— REQU I RED---------------------- FLOOR LOAD. . . . : 0 psf LEFT: 0 Ft RGHT: 0 ft FIR SPIKL: SMOK DET. . : DWELLING UNITS: 0 FRNT: 0 ft REAR: 0 ft FIR ALRM: HNDICP ACC: BEDRMS: 0 BATHS- 0 IMP SURFACE: 0 PIRO CORR: PARKING: 0 VALUE. $ : 4551 Remarks : Construct interior wall, reducing sq ft. Work not affecting primary area. No ADA required. Owner: FEES -------------- DURHAM/99 ASSC. LTD type amot-int by date recpt 227 W TRADE STREET PRMT $ 50. 50 DLH 04/06/98 98304681 SUITE 400 5PICT $ 2. 53 DLH 04/06/98 98304681 CHARLOTTE NC 28202 PILCK $ 32. 133 DLH 04/06/98 98304681 Phone #: FIRE $ 20. 20 DLH 04/06/98 9R,'04681, Contractor: -------------------------- BLUEsrON & HOCKLEY REALTY INC 4445 SW BARBUR BLVD PORTLAND OR 97201. Phone #: 222-3807 $ 106. 06 DOTAL Reg 000630 —REQUIRED ACTIONS or I NSPIECT IONS----- This permit is issued subject to the rrgulatie,.t contained in the Frami.ng Insp Tigard Municipal Code, Stat! of Ore. Specialty Codes and all other Gyp Board Insp aF71icable laws. All work will be done in accordance with SLisp Ceilng Insp approved plane. This permit will expire if work is not started within tV days of issuance, or if work is suspended for more than 160 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in DAR 952401-M8 through DAR 952-VIO1987. You many obtain a copy of these rules or direct questions to OUNC by calling (503)246-1987. e Signatoire : By : .4...............4......4 �)-++++++4-++++++++- +++r++++++++++++4+++- +++++++++-++++++ Call 639-4175 by 7:00 p. m. for an inspection needed the neNt bi-tsiness, day ++4................................ .....................................4+++++-+- CITY OF TIGARD Commercial Building Permit Reid By _ 13125 SW HALL BLVD. New Construction and Additions oats Rer'd TIGARD', OR 97723 ` Date to P E. Date to DST (503) 639-4171 Permit# Print or Type Related SWR# Incomplete or illegible applications will not be accepted Called Name of Development/Project Existing Building,'®New Building O Job4J Address Stress Suite Building 1 5 5 Data _ Bldg# City/state Zip Existing Use of Building or Property: 13 _L Name ) Proposed Property Use of Building or Proper hi. �/C, �1"l �, ;,,�v ��-�� Owner Mailing Address Suite 22 10 i/D G� No. Of Stories: City/State Zip Phone i ,��T �! r ( ,� Sq. Ft. Of Project: ` Occupant Name `- Occupancy Class(es) 4Mai Contrector - Type(s) of Construction Prior to permit g Address Suite issuance.a ropy Will this project have a Fire Suppression SysterD? of all licenses . 835 Std Yes 0 No a•�'� are required if y15t le Zip Phone Americans with Disabilities Act ADA expired in C O T � r (ADA) database U� ]„�U 1 �a?� Bt' Valuation X 25% = $ Participation Ore/goon Const,Cont,Board Lic# �E/xpDate(�( Complete Accessibility Form k (11 9 _ _ 7 -1 Y / C1 Project $ -- Name Valuation 7 , 15-5 1 Architect ` Mailing Addr-,,s Suite Plans Required: See Matrix fcr number of sets to submit on back City/State Zip Phone —— ---- -- I hereby acknowledge that I have read this application that the information given is correct,that I am the owner or authorized agent of the owner, and Name Engineer that plans submitted are in compliance with Oregon State Laws Mailing Address5uwte Signature of Owner!Agent Date City/Stale Zip - --__ Phone r tad P~ n Name Phone Indicate type of work New O Addition V( Demolition FOI� FFICE USE ONLY _ Accessory Structure O Foundation Only G Alteration O MapfTse: ]� Land U Repair O _ Other O DescrlpV o or work: """��'��'�� J7 -- J iC Notes. TIF Pa^^rks:''Estimatedill of Employees Note: Site Work Permit Application must precede or accompany Building Permit Application IACOMNEW DOC (DST) 8/97 COMMERCIAL PLAN SUBMITTAL REQUIREMENT MATRIX DISTRIBUTION TO PLANS OUT TO DS EXAMINERS (Note a.) TYPE OF S[JBNtf Ff'AL TOTAL CPE PPE EPE CPE PPF SITE 1 1 -- -- 3 (.j.o.u) - B (New or Add) 1 1 -- -- 3 (j,o,w) -- F (New or Add or Alt.) 3 3 -- -- 3 (j,o.t) M (New or Add. or Alt) 1 1 -- -- 20,o) -- B & M ("New or Add) 1 I -- -- 3 (j,o,w) -- P (New, Add. or Alt) 2 -- ? -- -- ?(j of B & M & P (New or Add.) 2 1 1 - 3 (j,o,w) 20"o) E (New. Add, or Alt) 2 13 & M & P & E (New, Add) 3 1 1 1 3 (j.o,w) 2(j.o1 B or B & M (Alt) 1 I — -- 20,o) -- B & 1\1& P(Alt) 3 2 (j,o) 20,o) B & M & P& E (Alt) 3 - 1 1 1 20,o) 20,o) N—QI'Ll'i. h LA� t. Before returning to DST. Plans examiner gets appropriate j =Job B - BUP numbt.r of revised plans from aFnlicant, stamps and completes, o =Office M = L1F( updates and adds actions. f= Fire P = PL,tit u = USA E = ELC b. Shaded areas designate At7`submitfak otfty. w== Wash. County F = FPS c. FPS is a new permit category set aside for fire sprinklers and fire alarms. d. Effective AUNUst 15, 1997, Tualatin Valley Fire and Rescue no longer requires a set of approved plans to be forwarded to their office. Exception. continue to forward a copy of appro .ed fire sprinkler and fire alarm plans with calculations. h Unatnc Doc wiLunL.� ut D1v.� "XUUN K 0003 Q �y of t�GaR io ptwed. �` •APP�nved•S�nb��.n'• � � ��'`�' WA.t-� Gond�t,pna Y� Ot Qntiy theI "` 1 17� •moi F EAM�T No. ogoW r h ti Se a�ette� %0'. pt*h " 1.r✓_-. �.. I b y ob BI i i 8 VAC'A�JT 144rC Si:. Fr• e tj tzL.. _ 1r �cv CaA.AL Iti•.t , � w a LJ Civ 3� 1 � . . -....�......w•........ v/iY/d0... d:IJOMM.i...�.._. `w�CJ U-'Lti�"v•r....'- d THU 08:05 FAX 503 244 0417 MILDRGN DESIGN GROUP PC t¢J004 i MECH. 1 ROOM 100 S0. FT. I I TYLER EVANS STATE-FARM INSURANCE 700 SO. FT I c � I I !' I I I L F i 3995 w�r • r�r/�/ i i CITY OF TIGARD ELECTRICAL- PERMIT DEVELOPMENT SERVICES PERMIT #: ELC98-0181 13125 SW Hall Blvd., Tigard,OR 97223 (503)6394171 DATE ISSUED: 04/1.6/98 PARCEL: 2SIlODC-00400 Sl 1 E ADDRESS. . . : 11525 SW DURHAM RD #D-3 SUBD I V I S I ON. . . . :WILLOW BROOK PARK ZONING:C--G BLOCK. . . . . . . . . . : LOT. . . . . . . . . . . . . :0 16 JURISDICTIONTIG Project Deser-iption : Installing first branch circuit -RESIDENTIAL IJNIT------ ---TEMP SRVC/FEEDERS------ ------MISCELLANEOUS—— - 1000 SF OR LESS. . . . : 0 0 — 200 amp. . . . . . . : 0 PUMP(/IRRIGATION....: 0 EACH ADD' I_ 500SF. . . : 0 201 — 400 amp. . . . . . . : 0 SIGN/OUT LINE LTG.. : 0 LIMITED ENERGY. . . . . : 0 401 — 600 amp. . . . . . . : 0 SIGNAL/PANEL. . . . . . . : 0 MANE. HM/ SVC/FDR. . : 0 601+amps-1000 volts. : 0 MINOR LABEL ( 10) . . . : 0 ----SERV I CE./FEEDER---- ------BRANCH CIRCUITS------ ---ADD' L INSPECT IONS---- IZA — 200 amp. . . . . . : 0 W/SERVICE OR FEEDER: 0 PER INSPECTION. . . . . : 0 201 — 400 amp. . . . . . : 0 1st W/O SRVC OR FDR. : I PER HOUR. . . . . . . . . . . : 0 401 — 600 amp-- . : 0 EA ADDIL BRNCH CIRC: LA IN PLANT. . . . . . . . . . . : 0 601 — 1000 amp. . . . . : 0 REVIEW 1000+ amp/volt. . . . . : 0 ) =4 RES UNITS. . . . . . . . . ) 600 VOLT NOMINAL. . : Reconneut only. . . . . : 0 SVC/F'DR > = 225 AMP'S. . : CLASS AREA/SPEC OCC. .- Owner: FEES FARWELL PERRY type amol-Int by date recpt 4414 NE 21ST AVE PRMT $ 35. 00 B 04/13/98 98--304A69 PORTLAND OR 97211 5PCT $ 1. 75 B 04/13/98 98-304869 (Phone #: Contractor: ------------------------------- FARWELL. PERRY ELECTRIC $ 36. *75 TOTAL. 607 NE 32ND AVE ------- REQUIRED INSPECTIONS PORTLAND OR 97232 Ceiling Cover- Elect' ]. Service Phone #: 2139-0078 Wall Cover- Elect' I Final Reg #. . - 091733 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Oregon Specialty Codes and z'l other applicable laws. All work mill be done in accordance with appro�,ed plans. This permit will expire if work is not started within IN, days of issuance, or if work is suspended for sore 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 PAR 95i-01-010 through OAR W-*1-1987. You may obtain a copy of these rules or direct questions to OLW, by calling (503)246-1987. I Ppi,rrittee Signati-a-e : -_A S S u d By : INSTALLATION ONLY------------------------------ The i.nstallption is being made on property I own which is not intended for, sale, lease, or, rent. OWNER' S SIGNATURE: DATF: INSTALLATION SIGNATURE OF SUPIR. ELECIN06YA X DATE: LICENSE NO: +++++++++++++++++...++++++++++++++++++ ++++++++-f++++++++++++++++++++++++ Call 639-4175 by 7:00 p. m. for an inspection needed the next bi.tsiness day ............................................................................... CITY OF TIGARD Electrical Permit Application Plan Check a 13125 SW HALL BLVD. Recd By TIGARD OR 97223 Date Recd Date to P.E. _ Phone (503)639-4171, x304 C. Date to DS1T Inspection (503) 639-4175 Print or Type �/ _ Incomplete or illegible will not be accepted Permit a - Fax (503) 684-7297 called___ 1. Job Address: 4. Complete Fee Schedule Below: *me of QP�velopment_ - y� Number of Inspections per permit allowed rLtv K'1ar7p(or name 0%4"9t, Service Included: Items Cost Sum Address,_-// 5 z J �4� 4-1 /l`, ' 4a• Residential-per unit �. 1cw?o sq.ft or la..c $110.00 4 City/Slate/Zip,__,_ c AL C 0 C- I Each additional 500 sq.It.or // ( portion thoreof $25.00 __ 1 Commercial Residential❑ � k)2 r Limited Fnergy - $25.00 � Each ManuPd Home or Modular � 2a. Contractor installation - Dwelling Service or Feeder $68.00 2 only: (Attach copy of all current licenses) 4b.Services or Feeders Installation,alteration,or relocation Electrical Contractor ) �`R� - 200 amps or less $60.00 2 AddressAl-E 4 S' - 201 amps to 400 amps $80.00 2 City State. C1A Zip_ 9 FZ t I _ 401 amps to 600 amps $120.00 2 Phone No. ! 3 L!LZ:t __ 601 amps to 1000 amps $180.00 2 Over 1000 amps or volts $340.00 2 Job No. Reconnnct only $50.00 2 Elec. Cont. Lice. No. l6 9 rs'�-_Exp.Date 119 g OR State CCB Reg. No.____?(_L3 j__Exp.Date 4c.Temporary Services or Feeders COT Business Tax or Metro No. 53 ate 1 1V- Installation,alteration,or relocation �1 200 amps or less $50.00 2 Signature of Su r. Elec'n201 amps ii 400 amps $75.00 2 9 P r -- 401 amps to 600 amps $100.00 2 Over 600 amps to 1000 volts, License No._ xp.Dater see"b"above. Phone No._ � 1- ---- qd.Branch Circuits Now,alteration or extension per panel 2b. For owner installations: a)The fee for branch circuits with purchase of service or Print Owner's Name _ _ feeder too. AdAddress_ Each branch circuit State Zi b)The fee for branch circuits City_ - �_- P-- - without purchase of Phone NO. - __i service or feeder fee. s F curuit __ $35.00 2 The installation is being made on property I own which is not E h actrf� qa nch arcuit $50032 .2C intended for sale, lease or rent �"` (�� eAA �` e e.Miscellaneous (Se included) Owner's Signature Each pump or Irrigation circle -__ $40.00 Each sign or outline lighting $40.00 - 3. Plan Review section (if required):' Signal circuit(s)or a lirr,ted energy - panel,alteration or extension $40.00 Minor Labels(10) � $100.00 -- - Please check appropriate item and enter fee in section 59. _4 or more residential units in one structure 4f.Each additional Inspection over Service and feeder 225 amps or more the allowable in any of the above System over 600 volts nominal Per inspection $35.00 _ Classified area or structure containing special occupancy Per hour $55.00 _ as described In N.E.C.Chapter 5 in Plant $55.00 _ `Submit 2 sets of plans with application where any of the above apply. 5. Fees: Not required for temporary construction services. 5a.Enter total of above fees $ --- 5%Surcharge(.05 X total fees) $ --L--- NOTICE Subtotal $ -� 5b.Enter 251.6 of line Se for PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review it reauirro!Ser..3) $ NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK Subtotal $ - -IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY Y TIME AFTER WORK IS COMMENCED ❑ Trust Account M 6' Total balance Due r gesrqTLC96 APP RN 9'96