Case File V'I
ADDRESS:
1,2149D `41
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CITY OF TIGARD
COMMUNITY DEVELOPMENT DEPARTMENT CERTIFICATE OF
131125 SW Hall Stvd.Tigard,Oregon 9722398199 (503)639-4171 OCCUPANCY
PERMIT #. . . . . . . : MST` 5-0090
DATE IC SUED; 06/PO/96
SITE ADDRESS. . . 12490 SW 141ST PL PARCEL: 2S104BA-04100
SUBDIVISION. . . . : CASTLE HILL 02 ZONINGiR-12-1 PIT)
BLOCK. . . . . . . . . . c LOT. . . . . . . . . . . . . :074
CLASS OF WORN.. :NEW
TYPE OF USE. . . •'7F
OCCUPANCY GRP. 05N
OCCUPANCY LOAD;0z'
Owner:
NORTHLAND 1-4014ES
1834 SW 58TH AVE
SUITE # 202
PORTLAND OR lj-;'0
Phone #u 923975
Contriiwtor:
IJlolle #.-
Reg #. . : 13727
This Certificate grants ocrupFAncy of the zAbove referenced building or- pot-tiol.,
thereof and confirms that the building has been inspected for compi.lan(-e wit-i,
t' P State of Oreqon 15peciawity Cocieg for the group, ocr-UPAI) V, and dse under
which the referenced permit was issl..ied.
id- ILDING I-N-----E" TQfi BUILDING OFFICI-A-ZL—
LL
POST IN CONSPICUOUS PLACE
ti
uj
CITY F TIGARD BUILDING INSPECTION NOXE
Inspection Line: 639-4175 Business Phone: 639-4171
Footing Rain Drain Cover/Service FINALl:):
Foundation Water Line Ceiling -Plumb.
Post/Beam Mech. Shear/Sheath Framing -Mec
Plbg.Und/Flr,'Slab Plbg. Top Out Insulation -Elect.
Post/Beam Struct. Mach. Rough-in Gyp. Bd. rl I g
San. Sewer Gas Line Appr/Sdwlk Reins.
Other: —
Date: to ( A.M. _P �� ntry:
Address: 1 Z C1 U 1 ��.M.�_L
Tenant: Ste:___ MST:
BUP:
Con/Own:--ug-1 SsZ) MEC:
PLM:
C �MJL-J ELC:
FOLLOWING CORRECT NS ARE REQUIRE _--�LR: _
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F-
L
C.D
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Ins ector: --- Date:
PPROVED _DISAPPROVED/CALL FOR REINSP. CF C
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171
Inspection.-
Footing
nspection:Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwlk
Foundation Plbg, Underslab Mech. Rough-in Fireplace
Post/Beam Struct. Plbg. Top Out Elec. Rough-in FINAL:
Post/Beam Me:- San. Sewer Gas Line -Bldg.
Plbg. Underfloor Rain Drain Framing -Plumb
Alarm Water Line Insulation -Mech.
Underth. Insul. Shear Wall Gyp. Bd. 0
Date Requested: / �/ Cl=� Time: AM PM
Address: 1 'U / /
Builder: -7 Pe�mTi F,
THE FOLLOWING CORRECTIONS ARE REQUIRED:
17)
L
Inspector:,,[ ,, 1 y, 4�1 . t
_APPROVED _DISAPPROVED ,APPROVED SUBJECT TO ABOVE
Call For Reinsp. �
CI1Y OF TIGARD PLUMB'.NG PERM I T
COMMUNITY DEVELOPMENT DEPARTMENT PERMIT #. . . . . . . . MST9 004,x,,
13126 SW Hall Blvd.Tigard,Oregon 97223.6199 (603)839-4171 DATE ISSUED: 013/20/95
PARCEL: `S 104BA-•041.00
S 1 TE ADDRE`3,13. . . : 12490 SW 141 ST P
SUBDIVISION. . . . : CASTLE:: HILL #2' "ZON1NGs R-12 PD
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :074
CLASS OF WORK. . :NEW GARBAGE DISPOSALS. . . 1
TYPE OF USE. . . . sSF WASHING MACH. . . . . . . : 1 BACvPLOW PREVNTRS. . : 1
OCCUPANCY GRID. . :R3 FI.._OOR DRAINS. . . . . . . :0 TRAPS. . . . . . . . . . . . . . .0
STORIES. . . . . . . . :2 WATER HEATERS. . , . . . : 1 CAfCH BASINS. . . . . . . :0
FIXTURES--------------- LAUNDRY TRAYS. . . . . . :0 SF RAIN DRAINS. . . . . : 1
SINKS. . . . . . . . . . : 1 GREASE: TRAPS. . . . . . . :0
LAVATORIES. . . . . :4 LITHE FIXTURES. . . . . :0
f UR/SHCIWERS. . . . : SEWER LINE (ft ) . . . . :0
WATER CLO13ETS. . WATER LINE_ ( ft) . . . . 7, 100
DISHWASHERS. . . . : 1 RAIN DRAIN (ft ) . . . . s0
PPMArks : PATH I
OWNER. ___________.______..__._.__.________ -----_____..__.___.______F'Et_.5--__-_______.__.
NORTHLAND HOMES SWM i 180. 00 JF 03/20/95 -
1E1,34 SW 58TH AVE. SWM $ 1010. 00 JF 03/&:0/95 -
E U1 1 E # 202 BPRT f• 48b. 50 JF 0:3/20/95 -
PUR I LAND OR 97221 BPL.0 $ 315. 58 SM 02/24/95 95-262176
Pho1-ie #: 292:3975 B5PC $ 24. 28 JF 03/20/95 -
PARK f• 500. 010 JF 03/20/95 -
Plumbing MPRT $ 4:3. 50 JF 0:1/:=:0/95
MPL.0 $ 101. 88 JF 013/20/95
Name : M15k1c $ 2. ilei JF 03/201195 -
. .
Address s /Zg wSG+LJ �� 1 �, 3BTH 4, 225. 0101 JE= 03/20/95 -
City : __StAte : �l�... P5PC $ 11. 23 JF 171;171;3/4111/9`J/9 -
Z i p a ___ EROS $ 64. 00 JF 03/20/95
# -
Req : --41r, ___ .. .._L. .� .�1�� Additional fees not shown here. . .. . .. . . , ..
REUU I RED I N bPE L,1 I UNE,
This permit is issued subject to the reg-
ulations contalnecl in the Tigard Municipal Footing Insp Insulation Insp
Code, estate of Ore. Specialty Codes and all Foundation Insp C,yp board Insp
other applicable laws. All work will be done Post/Beam Strt..wt Rain drain Insp
ir, accordance with approved plans. 'This Post/Bram Me(_han Water Line Insp
permit will expire if work is not started Crawl Drain Water Service In
within 180 days ni` issuance, or, if work is Plm/undslab In!:p Appr,/Sdwlk Insp
CL
sI_Ispended for more than 1130 days. VLM/Underfloor Mechanical Final
►� Mechanical Insp Plumb Final
N Plumb Top Out Building Final
Ln Framing Insp Erosion l.ontroi
�- Fireplace Insp
x_...�... . _ 00 _�� ___.. Gay, Line Insp _ __ �.__..._ ._._....
AI.It:hal .�eci P u bing Contract - �7.AgtUturrr
w Call for- inet;pecion - 639-4175
_j L;ontractor Notes : � ._ �_—
CITY CSF TIGARD
COMMUNITY DEVELOPMENT DEPARTMENT PERMIT
I1' #. . . . . .PERMIT:
. . : IhST135-009kti
13125 SW Hall Blvd.Tlpard,Onpon 97223*8'L",3c j503)039-4171 LATE ISSUED: 03/80/95
PARCE=L: 2S104BA---04100
:SITE ADDRESS. . . : 12490 SW 141ST PL
SUBDIVISION. . . . : CASTLE HILL *2 ZONING: R-12 PD
FLOCK. . . . . . . . . . . LOT. . . . . . . r . . . . . :IZ174
_______________.--__._-_____ -_ BUILDING
RE:I SSUE a DWELLING UN ITS: 1 BASEMENT. . . . . . . . :o n f
k._L(4SS OF WORK. :NEW BEDRMS:zf Br-rrHS:3 GARAGE. . . . . . . . . . .400 S
1'YPE OF USE. . . :SF FLOOR AREAS--------- REOU I F CD SET BOCKS-_________._._
TYPE OF CONST. :SN FIRST. . . . :644 s f LEF=T. . : 13 ft RI GHT. : 19 ft
JCC:UPANCY GRP. : R3 SECOND. . . :X313' s f FRONT. :210 Ft REFER. . :60 ft
:i'TURIES. . . . . . . :2 FINBSMENT:O sf
i 4E I GHT. . . . . . . . .*,25 ft TOTAL----.- 17l j/ 51- SMOKE DETECTORS. : Y
r LUUR LOAD. . . . :40 ps f VALUE. . . . . $ : 1 :01 16 PARK I NCS SPACES. . : 1
Remar){s : PArH I
PLUMBING
INKS. . . . . . . . . . : 1 FLOOR DRAINS. . . . :0 BACKFLOW PREVNTRS. . : i
:..AVHIURIES. . . . . t4 WATER HEATE.RS. . . : 1 TRAPS. . . . . . . . . . . . . . :0
i'UB/SHOWERS. . . . :2 LAUNDRY I RAY S. . . :V) CATCH BASINS. . . . . . . :0
A F ER GL.OS T'S. • :3 SEWER LINE (ft) . :VA GREASE. TRAPS)". . . . . . . :0
r)ISHWASHERS. . . . : 1 WATER LINE (ft ) . : 100 OTHER FIXTURES. . . . . :0
GARBAGE DISP. . . : 1 RAIN DRAIN (ft) . :0
14AGH I NU MACH. . . : 1 SF RAIN DRAINS. . : I
MECHANICAL -------- FEES
I UL•:L_ I"Yp'Ea-- _- --- -- - UNIT HTRS. . ;0 type amount by date recpt
/6"S/ / / VENTS . . . . . :0 SWM $ 180. 210 JF 03/20/95 -
NAX INPUTtO CITU VENT FANS. . .4 SWM E 100. 00 Jr 03/::'0/'35 -
F URN i 100K . . : I HOODS. . . . . . : 1 BPRT s 465. 50 JF 03/20/95 -
1' URN ) -1001A . . :0 WOCIDSTOVES. :0 BPLC $ 313. 58 LSM Od/ 4/95 95-26c.-1 ib
I-1_00R PURN. . . . :0 CLO DRYERS. : 1 B5PC $ "4. 28 JF 03 /95 -
DOIL/CMI=' ( 3HP:0 OTHEP UNITSt 1 PARK $ 500. 00 JF 03/2'0/1)Fj
CCAS OUTLET'S: I MPRT $ 43. 50 JF 03/20/95
Owner: $ 10. 88 JF- 01]1/2121/95 _
NUR IHLNND HOMES M5PC L 2. 18 JF 111:3/8:0/9:, -
18.�,4 bW 58TH AVN 1�Brt1 $ --*,-'b. 00 JF 0 /20/15 _
Sul I L t# -'02 P5PC $ 11. 25 JF 03/20/95 -
PORTLAND OR 1)'7881 EROS $ 64. 00 JF 0:3/80/95 -
Phone #: 892'3975 ERPC $ 20. 80 JF 03/20/95 -
Cant ract or: __... .____._.._., __ _____....._.________CRF'C s. ''Vl. 80 JF 03/20/95
NORTHLAND HOMES
11.3:34 SW 5671-1
E-UR I L►INV UR 97221
i-'h ozi a #: �9i? 3975
Reg #►. . : ISIE7 __.____-._-_._-______w..._____________-_. ---
E 804.'13. '7 7 TU rAL
This perait Is issued subject to the regulation: contained in the - - - REQUIRED INSPE::CTIONS - -
Tigard Municipal Code, State of Ore. Specialty Cedes and all ether Footing Inap Pll.lmb Top OUt
applicable laws. All work will be done in accordance with approved Foundation 1 n s p Framing Insp
pians. this permit will expire if work is not started within H4 PoSt/Beam Struct Fireplace Insp
may; ^f issuance, if wnr4 is Uspe for sore than 1 ys. Post/Beam Meehan Cas Line Insp
Crawl Drain InSI.ilation Tn,p
w,r i,it ;, ee t,iUI,a L 1,1 �. _ I Im/Undslab Insp byp l:Anard Insp
F'LM/Underfloor Rahn drain Insp
s��eU lav : _ IHec:haniral Insp Water Line. Insp
Call for inspection -- 639-4175
CITY OF T I GARD SEWER CONNECTION
- COMMUNITY DEVELOPMENT DEPARTMENT PERM I T
13126 SW Hall Blvd.Tigard,Oregon 97223*8199 (503)639-4171 PERMIT #. . . . . . . : SWR95-0054,t
639-4171 DATE ISSUED: 03/20/05
PARC'EL -
51TL ADDRESS. . . : 12490 SW 141SI PI_
SUBDIVISION. . . . : CASTLE HILL #2 ZONING: FZ-12 PID
BLOCK. . . . . . . . . . . L-07.. . . . . . . . . . . . . :074
TENANT NAME.. . . . .
USA NO. . . . . . . . . . : 'F, I XTURE UNI,rS.
CLPbS OF WORK. . . :NE W DWELLING UNTTS. . : l
l'Yk,F- OF USE:. . . . . :SF= NO. OF BUILDINGS: 1
INSTALL TYPE. . . . :BUSWP IMPERV SURFACE.
Hemarks: PATH I
Owner: FEES
NORTHLAND HOMES type amoutnt by date recpt
1634 SW 58TH AVE PRMT $ 2200. 00 JF 03/20/95
SUITE # 11-102 INSP $ 35. 00 JF 1?.1 P)
PORTLAND OR 972e1
Phone #: 2923975
Lontrartor:
CONTRACTOR NOT ON FILA.:
$ 2235. 00 TOTAL
Heq REOUIRED INSPECTIONS
'his Applicant agrees to comply with all the rules and regulation; Sewt-,r Inspection
of the Unified Sewage Agency. The permit expires 180 days frei
the date issued. The total amount paid will op forfeited it the
permit expires. The Agency does not guarantee the accuracy of the
side sewer laterals. If the sewer is not located at the measurement
giver., the installer shall prospect 3 feet in all directions from
the distance given. If not so located, the -iistaller shall purchast
a 'Tap and Side Sewer" permit a;d
�,rmittee Iii!gnattti,
lss!.ted By :
o Call for inspection 639-4175
Residential Build�n Permit Application
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223
(503) 639-4171
, I5;r9
/Jobsile Address: 12A <I i~1
_Office Use Only
Subdivision:_� � L /�iLL Lot # 7�f
-- Planck/Rec # "
Valuation:
Permit # }
Corner Lot? Y C�
Flag Lot? Y ) Reissue of
�
S
Map & TL # r �, �
Owner: R/[���riv����� �?U�'>Gs Approvals Required
r
Address: /;� 3 q `�. �� S 8 ri�dC ZUZ Planning_
1" N/-�.��tv >7l Z/ Enginee►ing --
Phone: J `7 Z — 7"J TS _ Other
/Contractor: /wit lift/�iv� Items Requlred
Address: S^d y t Subcontractors
�r �/✓O /_�il���_Y L ` 72Z Truss Details
Phone: 1 `j Z '- �'S Other�l '•�Jyr.t,6 W-15 P!' �
Contractor's License # O/ 3 7 7 7
(attach copy of current Oregon license) SSE A ,c�,xc}.1 eb iNl PtV�
rvaI►�l�,y�p�by Proprrk� M.L>�xS. �bo r� .
Contact Name & Phone: enc Z•9Z - X175 0�40L) 'Sp(ar- U�1eu� S OV �dt
Subcontractors: a Architect/Engineer:-_OL:LL/SY .-57j,—,1 rx-,
Plumbing: \ Address: G 1 ? !L/ MC-9Aisc"v
Mechanical: _ �._ •�
T (attach copy of current OR Cot►tractor':; rise)
�- Phone:
J
L
w JOB DESCRIPTION: h , A /✓ L S'rv�ti �' ' •s ?la✓�
J
Applicant Sigr4lure & Phone number
nuceived by: Date Received•
N 1WORMCOMDMRESAPP
Permit# Account Description Amount Amt. Pd. Dal. Due
u D Bid Permit (BUILD) 5, �1 U�
9. _
Plumb. Permit (PLUMB) 2 ,
Mech. Permit (MECH) J-V q3._---.--
State ax (TAX)
Bldg: �/- Z b
Plumb:
Mech:
Plan Check (PLANCK)
Bldg: 31
Plumb:
Mech:
5w/i yJ C Sewer Connection (SWUSA) 2_Zev
Sewer Inspection (SWINSP) .3 3
Parks Dev Charge (PKSDC) S
Residential TIF (TIF-R) 11FJ� �
Mass Transit TIF (TIF-MT) if % A
dW
Commercial TIF (TIF-C)
Industrial TIF (TIF-1)
Institutlonal TIF (TIF-IS)
Office TIF (TIF-O)
Water Quallty (WQUAL) ' �--
Water Quantity (WQUANT)
Fire Life Safety (FLS) ..-----
Erosion Cntrl Permit (ERPRMT)
Erosion Planck/USA (ERPLAN) •�li'•� _
Eroslon Planck/COT (EROSN) � ��
TOTALS:' 2 ��
P=PC-il ;FIFST PHLEOICAN TkNASSR.li Tu so; Z44 5777 Q$-:0 419= P.Zz- -)4
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DEPARTMENT OF LAND USE & TRANSPORTATION
WASHINGTON LAND DEVELOPMENT SERVICES DIVISION #350-12
155 NORTH FIRST, HILLSBORO, OR 97124
COUNTY, PHONE: 503/640-3470
OREGON INSPECTION REQUESTS (24 hours): 503/640-3561 or 693-4415
# 05065,807 isi.._,jest # ' P0048801 St" ,L— APPROVEi. of
•r1 03/31/95 Issue?d 03/31/95 Expires 09/27/95 07/06/95 US : !i'
RESELEC
Titles GFR -- NEW OTH
Lption 12490 SW 141ST PL Begun . 03/:31/ ''
ldresc- 'Ci
Name iNSF�:�w`l'IQN TIGARD Reyg�.c_n D
ant Name( WRIGHT i ELECTRIC
number 760-8522 Valuation: 0 Appruvo-
Approval# . APPR
t.or Comments Rejected___
IVR-kESULTS
REQUEST ERRCO
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DEPARTMENT OF LAND USE&TRANSPORTATION
A LAND DEVELOPMENT SERVICES WASHINGTON 55 NORTH FIRST,HILLSBORO,ORV97124
40;;ft;�
COUNTY, INSPECTION REQUESTS: 503/840-3561/693-4415
OREGON
XXXXXXXXX--> 640-3470
Mage : 1 of 1
Date : 04/03/95
Time : 10 : 23
Permit 'Type Residential Electrical Permit Permit # : 05065807
Permit Status APPROVED ,Applied : 03/31/95
Situs Address '1'1 issued : 03/31/95
Permit 'Title SF*k - NEW Completed :
Permit Uescr, 12490 SW 141ST PL To Expire : 09/27/95
vtoject 'Title SFR - NEW Project # : P0048801
Project Uescr . 12490 SW 141ST PL * EROSION
Parcel Number ZbITI - Land Use District
Vaivation U
Leyal Desci .
Uwner INSPECTION - TIGARD Construction OTH
Applicant Name WRiUH'T 1 E'LEC'TRIC Classification 900
A{_piicant Addr . 5618 SE 13b'TH Occupancy R3
P'OR'TLAND, OR 9'/236 Validated by LG
Eipp.iicant Phone: '/bO-8b22 Inspector Area
Fee description Units Fee/Unit Ext fee Data
-------------------------------------------------------------------- ------------
,quare Footage LEnter Sq, Ft. ] 'L000 160 . 00
z)ubtotal Electricai Fees : 160 . 00
tate Surcharge of b'16 0 . 00
otal Eiectri.c:al Fees : 168 . 00
> «* Fees Required *** *** Fees Collected & Credits ***
Method Check # Receipt No , Date Payment
CK U8bb 03/31/9b 168 . 00
k'e,es : 168 . U0
11(1]ustments : . U0 Total Credits : . 00
Total Fees : 1158 . 00 'Total Payments : 168 . 00
Balance Due : UU
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NOTICE: This permit becomes null and void If the work or construction for which It Is Issued Is riot commenced within 180 days. Once construction has started,
p the permit becomes null and void If conalructlon is interrupted for a period of 180 days. I certify that the Information presented by the applicant and
'—� his agent or agents In support of this permit Is true and correct to the best of our knowledge. I acknowledge that the Building Department's reliance
upon false and misleading Information may Invalidate this permit. All provisions of applicable laws and ordinances governing the construction and use
of this building or structure will be complied with whether or not specified on the plans or noted on the plans correction sheets. I acknowledge that
the granting of a permit does not grant authority to access private property or to use easements. I further acknowledge that the Use or occupancy of
the structure or building permitted depends upon my calling for Inspections at various times during the process of ronstructlon and the building
Inspection staff verifying compliance with the various codes. Use or occupancy of the building or structure permitted prior to approval by the
Building Department is solely at the risk of the applicant and such use or occupancy Is rsvocabie until all inspection requirements are satisfied ar,i
approval Is given by the Building Official I further acknowledge that a lien may be placed on the title of the property upon which the permit Is Issued
specifying that the use or occupancy of the building or structure Is provisional and revocable until the satisfaction of all Inspection requirements.
APPLICANT'S SIGNATURE
r
WASHINGTON COUNTY ELECTRICAL PERMIT
Department of Land Use & Transportation
Electrical Inspection Section APPLICATION
155 North First Avenue, #350-12
Hillsboro, Oregon 97124
Information: (503) 640-3470 Fax: (503) 693-4412Permit C__ ` i
Number ��^ Date
PLEASE PRINT
Please complete.all sections, 1 through 5. 4. Complete Fee Schedule below j
1. Location of installation Number of Inspections per permit allowed
Address ��-y �� ��� I LATS 21- - Service included: Items Cost(ea.) Sum
Building A. Residential-per unit
City-��y Suite No.
-�. -- 1000 sq.ft.or less �- $110.00 t til.06 4
Tenant Name Each additional 500 sq.ft
(if commercial) - or portion thereof $25.00
Limited Energy $25.00 1
Map No. Tax Lot _2�4 _ Each Manut'd Home or Modular
Dwelling Service or Feeder $68.00 2 ,
Thomas Map Book: Page: Section:
Directions _ B. Services or Feeders
Installation.alterations or relocation
200 amps or less $60.00 - 2
Commercial ❑ Residential k] 201 amps to 400 amps $80.00 - 2
401 amps to 600 amps $120.00 2
2a. Contractor installation only. sol amps to 1000 amps $140.00 - 2
Y Over 1000 amps or volts -_ $340.00 2
Electrical Contractor Reconnect only $50.00 - 2
Address c�hGAS I Services or Feeders
City PC�E2TlAtvu State ' ' ZIP-,�,�,1c, C. Temporary p Y
Date Z r1` b Number - Installation,alteration or relocation
Property Owner i1t G t t-t�Iv D UIYI EY- 200 amps or loss $50.00 -_ _ 2
Contractor's License No. �' < 201 amps to 400 amps $75.00 2
Contractor's Board Reg. No. ( � 401 amps to 600 amps __ $100.00 2
g / Over 600 amps to 1000 volts see'B'above
"or
Signature of Supr. Elec'n `��l�� - D. Branch Circuits
License Phone No. rl�(1 -55` 1: Now,alteration or extension per panel
a) The fee for branch circuits with
2b. For owner installations: purchase of service or leader lee.
Each branch circuit $5.00 2 !
Print Owner's Name Phone No. b) The foe for branch circuits without
purchase of service or feeder lee.
First branch circuit $35.00 2
Address Each add'nl branch circuit $5.00 _ 2
E. Miscellaneous (Service or Feeder not included)
Each pump or Irrigation circle $40.00 _- 2
The installation is being made on property I own Each sign or outline lighting $40.00 _ 2
which is not intended for sale, !ease or rent. signal circuit(s)or a limited
energy panel,alteration
Owner's Signature _ or extension $40.00 2
F. Each additional inspection over the allowable
in any of the above
3. Plan Review section (If required) Per inspection $35.00
_c Per hour $55.00
l-_ Please check appropriate hem and enter fee In section 5B. In Plant $55.00
> 4 or more residential units in one structure
~ 5. fees
_Service and feeder, 800 amps or more
J _^System over 600 volts nominal A. Enter total of above fees $ I(C-Q.(y)
-Classified area or structure containing special 5% Surcharge (.05 X total fees) $ yC)
w occupancy as described in N.E.C. Chapter 5 Subtotal $ -
B. Enter 25% of line A for
Submit 2 sets of plans with application where any of the Plan Review if required (Section 3) $
above apply. Not required for temporary ronstructlon Subtotal $
services. Ll Trust Account $
Balance Due $ .nom
For inspections call This permit becomes null and vold M the work authorized by the Permit la"commenced
640-3561 or 693-4415 within IN days from dale of issuance of such Permit or"the work authorized 1s
suspended or abandoned at any'Ime after work Is commenced for a Period of Ib days
24-hour recorder, one working day In advance of need tlerirlcal Permits are non-refundable and non transferable.
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