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12030 SW 135TH AVENUE ADDRESS., 030 IN /35 Ay �u a �n ti —' is records\rtnicrotim\;argets\buildinct,doc L LU J CITY OF TIG,A►RD BUILDING INSPECTION DIVISION MST 24-Hour Inspection Line: 539-4175 Business Line: 639-4171 -- RUP . y I Date Requested �� ' 3Ci �� AM PM BLD Location �.�-L' �� SW «A�r 9�/-�_' Suite / MEC Con!act Person (/f'1 S ���i.�( �'(C c ,� Ph -2 Cry '1 y PLM Contractor_ CT- Ph _ X �, SWR G — BUILDING Tenant/Owner � ELC Retaining Wall I ELR _ Footing Access: Foundation FPS Fig Drain SGN Crawl Drain Inspection Notes: — Slab -_-� SIT Post& Be,im Ext Sheath'Shear _ Int Sheath/';Bear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling - --- --- ---- -- - Roof Misc Final PASS PART FAIL --- PLUMBING Post 8 Beam �— Under Slab Top Out l'� -- Water Service Sanitary Sewer l — - Rain Drains Final PASS PART FAIL MECHANICAL 1 �) Post&Beam Rough - -- — --- - --- -- --- -- Rough In Gas Line -- Smoke Dampers Final — --------- -- -- ---- PASS PART FAIL Service Rough In a UG/Slab -- CC Low Volt2ge Fir larm wwsw PART FAIL — ---- ---- ------ -- J r Backfill/Grading -- --_�--------- ------ -- Sanitary Sewer Storm Drain [ ]Reinspection fee of$ _required before next inspection. Pay at City Nall, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ ]Please call fe. reinspection RF _ [ ]Unable to inspect-no access 1 ADA Approach/Sidewalk Date /�e -Inspector � �j � Ext Other -- *--- Final PASS PART FAIL_ DO NOT REMOVE this inspection record from the job site. CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24-Hour Inspection Line: 639-4175 Business Line: 639-4171 BUP �ZDate Requested_� �_ �aAl� PM _ gLD n Location ��- _�c..J / 3 3 .--_'' // MEC Contact Person ti r�L-�_>�� Ph 3 'i`� `t ! PI_M Contractor �G�t,�- Z5 Ph > SWR _ BUILDING Tenant/Owner ELC —_-- Retaining Wall _ ELR Footing Access: Foundation FPS Ftg Drain SCN 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 PART FAIL — -- PLUMBING Post& Beam v V -- --- - Under Slab Top Out ----- - —------- ------- '✓Vater Service Sanitary Sewer -- Rain Drains Final — PASS PART FAIL NEE HANICAL Post --- Rough In Gas Line - ---- — - —v -- - Sm ke Dampers SAS PARTFAIL VEEFIRICAL Service - _ --- - —_� ------ — Rough In UG/Slab --- -- — ----- — ---- - -- - c Low Voltage Fire Alarm ----- ---- - Lr Final f PASS PART FAIL - -� SITE r. Elackfill/Grading Sanitary Sewer w Storm Drain ( ]Reinspection fee of III required efore next inspection °'y at City Hall, 13125 SW Hall Blvd Catch Basin ease Fire Supply Line call kr r spedio _ �_ ( ]Unable to inspect-no access �- _ - - ADA Approach/Sidewalk ( r Date — " _—_- Inspector Ext Other _ Final PASS PART FAIL DO .SOT REMOVE this inspection record from the job site. CITY OF TIGARD ELECTRICAL PERMIT DEVELOPMENT SERVICES PERMIT #: E'LC98-.02B6 ATIMUM 13125 SW Hall Blvd., Tigard,OR 97223 (501639-4171 DATE 1,1:':iSUED: 05/2-18/98 PARCEL: 2S104AB-00100 SITE ADDRESS. . . : 12030 SW 135TH AVE SUBDIVISION. . . . : Z ON 1 NG: R-4. 5 BL.00V. . . . . . . . . . : LOT. . . . . . . . . . . . . JURISDICTION: TIG Project Description: Electrical addition -------------------------------------------------------... _--..RESIDENTIAL UNIT----- 5RVC/FEEDERS-.--.- ------MISCEl_LANEOUS------ - 1000 SF OR LESS. . . . : 0 0 - 200 amp. . . . . . . : 0 PUMP'/IRRIGATION....: @ EACH ADDIL 500SF. . . : 0 201 - 400 amp. . . . . . . : 0 SIGN/OUT LINE L.TG. . : 0 LIMITED ENERGY. . . . . : 0 401 - 600 amp. . . . . . . : 0 SIGNAL./PANEL.......: 0 MANF. HM/ SVC/FDR. . : 0 601+amps-1.000 volts. .. 0 MINOR LABEL ( 10,' . . - : 0 ----SERVICE/FEEDER---- ----BRANCH CIRCL117S----- --.--ADD' L INSPECI IONS--,--- e 200 ainp. . . . . . : 0 W/SERVICE OR Ft"l-EDER: 0 PE'"R INSPECTION. . . . . . 0 201 400 amp. . . . . . : 0 1st W/O SRVC OR FDR. : 1 PER HOUR. . . . . . . . . . . : 0 401 600 amp. . . . . . : 0 EA ADD' l_ BRNCH CIRC: 0 IN PLANT. . . . . . . . . . . : 0 601 1000 amp. . . . . : 0 ­---------------PLAN REVIEW SECTION----------------- 1000+ 6mplvolt. . . . . : 0 > =4 RES UNITS. . . . . . . . : ) 600 VOLT NOMINAL. . : Reconnect only. . . . . : 0 SVC/FDR ) = 225 AMPS— : CLASS AREA/SPEC OCC. : Owner- F 7 EEG --._____---------__ SUNAMOTO, ROPERT & TOMO type Amount by date recpt 12030 SW 135TH AVE PRMT $ 35. 00 B 05/28/98 9B- 7IGARD OR 972123 5PC7 $ 1. 75 B 05/28/98 98-3 1 1,_11 I Phone #: Contractor-: ----------------------------- GRF ELECTRIC $ 36. 75 TOTAL 15460 SE PIARADIESE LN REQUIRED INSPECTIONS IYIULINO OR 97042 Rough-in Flect' l Final Phonc, #: 503-829-4146 Elect' l Service Reg tz. . : 001015 This permit is issued subjtct to the regulations contained in the Tigard Municipal Code, State of Oregon Specialty Codes and all other applicable laws. All work will he dine 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 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 OAR 952-001-0010 through OAR 952-001-1987. You may nbtain a copy of these rules or direct questions to OUNC by calling (503)246-1987. r--,p rm i t t e P Si gnat 1-tre- Issued By:..6, CL INSTALLATION ONLY-._----_--.__.------------------ V) - The installation is being made on property I own which is not intended for sale, lease, or rent. OWNER' S SIGNATURE: DATE: __-----_----------------._-CONTRACTOR INSTALLATION Uj S13NATURE OF SLIF-R. ELECIN: &VV eA_j /1 DATE- LICENSE NO: .......4•.........4•........................4.................4.4.................... Call 639-4175 by 7:00 p. m. for an inspection needed the next business day 4..........L....................................4.........................++++4 05/28/1998 13:07 5038295747 GRF ELECTRIC PAGE 01 CITY OF TIGARD Electrical Permit Application Plane _ 13125 SW HALL BLVD. Reed By TIGARD OR 97223 Date Rev'd-_2T• "f Phone (503)639-4171, x304 Cate to P.E. Inspection (303)639-4175 Print or Type oats to D&T Incomplete or Illegible will not be accepted Permit M ^� Fax(503) 684-7297 9 Called 1. Job Address: w. Complete Fee Schedule Below: IName of Development Oa S Number of Inspections per permit allowed Name(or name of business)__ lir9eA�1' LAV)A Service Included: Items Cost Sum Address_ 44. Rssldentlal-per unit 1000 eq,h.or Ieea __ 5110,Op __ 4 City/Slate/Zlp Eech additional 500 sq,IL o► Commercial❑ Re9idential portion thereof $25.00 1 Limited Energy _ $25.00 _ Each Manuf'd Home or Modular Dwelling Service or Feeder $68,00 2 2a. Contr-actof Installation only: - (Anach cope of all current licenses) 4b.Services or Feeders Electrical Contra,Aor _�` ���� Installatlon,anershon,or rsiocetion Add ress-�-4;�I-�-�-. 200 amp4 or lees -- srso 00 2 201 amps to 400 amps $140.00 2 t A4,� Stat rP__ 401 amps to 600 amps 5120.00 PhOAn rvo._._ �� � �� �� _ 901 amps to 1000 amps - $1140.00 � Job No. Reconnect only or volts $340.00 2 Elec. Cont. Lice No p.Date_ Y - $5000 _ 2 OR State CCB Reg, No,� Exp.Date� 4c.Temporary Services or Feeders COT Business Tex or Metro No. `i ,Exp.Date___4 i a or Installation,.alteration or relocation 200 amps or less $50.00 2 Signature of S ipr. Elec'n L� 201 amps to 400 amps $75.00 2 ----- -- 401 amps to 600 amps $100.00 2 l� Over 400 amps to 10rin volts, License No, Exp.Dare see^b"above. Phone NO 4d.Branch Circuits -_-� 2b. For owner;nstallatlons: New,alteration or extension per par of ��. r� 9.)a�'�I a)The fee for branch circuits with purchase of service or Pnnt Owner's Name rower ler Address Each branch circuit $5.00 _ 2 City._______-_____.� State_-_- Zip_ b)The fee for branch circuits without purchase o/ Phone No _ - service or("der fee. / 2 First branch circuit ( $35.00 2 The Instnllntion Is being made on property I own which is not Each arldlfinnal branch circuit $500 _- 2 intended for sale. 'onse or rent. 4s.Miscellaneous Owner's na SI ture (3ervlos or feeder not Included) Signature_ _ Each pump or Irrigation circle 640 00 2 Each sign nr outline lighting $40,00 2 3. Plan Review section (if required):* Signal clrcult(s)or a limited energy panel,alteration or extension $40.00 is Minor Labels(10) - $100.00 _ please check appropriate Item and enter fee In sectlon 59. V) _ 4 or more residential units In one structure 41.Each additional Inspection over T `Service and fowler 225 amps or more the allowable In any of the above System over W)vohs nominal Par Inspection _ $35.00 _ Classllled anon of structure containing special occupancy Per hour $55.00 L as described In N.E.C.Ctwoor 5 In Plant $55.00 w 'Submit 2 sets of plana with application Visits any of the above apply. S. Feer: 7 J Net required for amiportary construction services. 98.Enter total of above.093 544 Sorcnarge(.05 x total leer;i N!)_ICF suAMtal t _ 515 Enter 25%of line 6a for PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Rewew If r9gYIL (Sec.a) >> NOT COMMENCED WITHIN 190 DAYS,OR IF CONSTRUCTION OR WORK Subtow i IS SUSPENDED OR ABANDONFO FOR A PERIOD OF 190 DAYS AT ANY TIME AFTC-R WORK IS COMMENCED. r-->~^nz AcL�unr Tobi belanco r)tH PlraSe, -6A.� or C�.�.� CITY OF T I C A R D MECHANICAL DEVELOPMENT SERVICES PIERMIT ilk 13125 SW Hall Blvd., Tigard,OR 97223 (503)639.4171 DATE ERMIT #. . .ISSUED: . . . : MEC97-OWI 10/16/97 PARCEL: 2SI04AB-00100 SITE ADDRESS. . . : 12030 SW 135TH AVE SUBDIVISION. . . . : ZONING: R--4. 5 BLOCK. . . . . . . . . . : LOT. . . . . . . . . . . . . JURISDICTION: TIG CLASS OF WORV,. . :ALT FLOOR FURN. . . . : 0 EVAP, COOLERS- 0 -i"YPIE OF USE. . . . :SF UNIT HEATERS. , : 0 VENT Ff)NS. . . : 0 OCCUPIANCY GRP,. , : R3 VENTS W/O AFFIL: 0 VENT SYSTEMS: 0 STORIES. . . . . . . . : 0 BOILERS/CO;YIPIRESSORS HOODS. . . . . . . : 0 FUEL TYRES------------- 0-3 Hr,. . . . o DOMES. INCIN: 17, :GAS 3-15 Hr.,. . . . 0 COMML. TNCIN: 0 MAX INr,UT: 0 BTU 15-30 HP,. . . . . 0 REP,AIR UNITS: 17.1 FIRE DAMF,ERS'?. , : 30-50 HF,. . . . : 0 WOODSTOVES. . : 0 GAS P,RESSURE. . . 504- Hp. . . . - 0 CLD DRYERS. . : 0 NO. OF AIR HANDLING UNITS OTHER UNITS. : 0 T=URN ( 100K BTU: 0 10000 cfm : I GAS OUTLETS. : 1 FURN > =1001( BTU: 0 > 10000 cfm: 0 Remar-ks : Installing exterior A/C unit. A/C unit must not encroach into 5' side or rear yard setbacks. Owner: FEES SUNAMOTO, ROBERT & TOMO type amot.int by date r-VCpt SW 135TH AVE P,RMT $ 125. 00 B 10/16/97 97--300t15 TTGARD OR 97223 !t,P-C T $ 1. :=5 B 1.0/16/97 97-3001. 1''p r-1hune #: Cont tact or-: FIRST CALL MCCALL HEATING & COOLING .1.650 NE LOMBARD $ 26. 25) TOTAL P,0RTLAND OR 97211-4798 P I h o n e # C'--'3 1.-,'3 3 11. Reg #. . . 001020 REOUIRED INSP,ECTT(1Nr) This permit is issued subject to the regulations contained in the Gas Line Insp Tigard Municipal Code, State of Ore. Specialty Codes ana ?11 other Meehan ical Ins applicable laws. All work will be done in accordance with Final Inspection approved plans. This permit will expire if work is not started -—------ within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon (Jtility Notification Center, Those rules are set forth i )AR 952-001-0010 through OAR 952-01-0080. You may V) obtain copies of these rules or direct questions to OUNC by calling (503)246-9187. % r ;s Ij e B y Pler-mittpe Si gnat i-ir-P 4-.++++++4............4-1-4+++++4+4-+++4...4.......................................... Call 639-41-75 by 7.00 p. m. for inspections needed the next 'CIUSiness day t V4 4-#-+++-+-4......F++++++4..........................I....... .......4+4+++4..........4 Plan Check M CITY OF TIGARD Mechanical Permit Application Rec'd By 13125 SW HALL BLVD. Commercial and Residentiz•1 Date Recd TIGARD, OR 97223 Date to P.E. (503) 639-4171, x304 Date to DST 7n Print or Type Permit Called Incomplete or illegible applications will not be accepted Name of DeveiopmoimProtect Description Table 1A Mechanical Code aTy PRICE AMr Job Street Address Stings A) Permit Fee -0- -0- 10.D0 Address ZC>>o _ Bldg# Cityfstate Zip 1.) Furnace to 100,000 BTU 6.00 in uding duds&vents Name for name of business) 2.) Furnace 100,000 BTU+ 7.50 Owner 1 t�! } it 4 ,n J S��;1 �LrYI o p including duds&vents Mailing Address 3.) Floor Furnace 6.00 1 1 c) U r� f\- Q including vent Cay/state Zip Phone 4) Suspended heater,wall heater 6.00 A \< « r e C `1 '?Z,' Inii 2,4- or floor mounted heater Name name of bus nsu) 5.) Vent not included in appliance perme, 3.00 Occupant "cling oddness 6) Boiler or tomo.heat pump,air Gond. 6.00 _ to 3 HP;absorb unit to 100K_BU- CnPhone--Lp Boiler or comp,heat pump,air Gond. 11.00 1 7,) 3-15 HN;absorb un't to 500K BTU" Contractor tName 8.) Boiler or comp,heat pump,air Gond. 15.00 (Prior n r 1 r A O CYC r << 1 I 15-30 HP;absorb und.5-1 and BTI.1" issuance Mailing Address 9) Boiler or comp,heat pump,air Gond. 22.50 applicant 1,lo -ILD N1✓ I ��`'�b� rz t 30-50 HP;absorb unit 1-1.75mil BTU" must provide all Zip Fhone 10.; Boiler or comp,heat pump,air Gond. 37.50 17 t i 5 ?_ `1_'%2c, _ >50 HP;absorb unit 1.75 mil BTU" license Oregon Const.Cant.Board Lic M Exp.Date 11.) Air handling unit to 10 000 CFM 4.50 information if expired in Cj 2 U 3 _-3C, CO; Cor Business Tax or Mena x Exp Date 12.) Air handling unit 10,000 CFM 7.50 database). L Architect Name 13) Non-portable evaporate cooler 4.50 Or Mailing Address 14.) Vent fan connected to a s ngle dud 3.00 Engineer City/State zp Prone 15) Ventilation system not inc ded in 4.50 appliance permit Descmbe work New O Aldition AlterM.on O Repair O 16) Hood served by mechanical exhaust 4.50 to be done Residential O Non-residential O Additional Description of work 17) Domestic inanerators 7.50 1 H) Commercial or m 1ustnal type 30.00 Incinerator - Existing use of 19) Repair units 459 titl td-ng or property _ 20) Wood stove 4.50 Proposed use of 21 ) Clothes dryer,etc. 450 building or property 22) Other units 450 ► Type of fuel-oil O natural gasLPG O electric O :'3) Gas piping one to four outlets 2.00 F' I hereby acknowledge that I have read this application,that the 24) More than 4-per outlets(each) .50 information given is coned,'.hat I am the owner or authorized agent of .J the owner,that plans submitted are in compliance with Oregon State QTY.SUBTOTAL laws _ �✓rC Signature of Owner/Agent Date 'SUBTOTAL c�5 V-3->'C 7 - 5%SURCHARGE � �, �l « � �• � �� zs� inti y _ _ I.ZS Contact Person Name Phone PLAN REVIEW 25%01-SUBTOTAL `'C C TOTAL i AstVrtechpmt doc (rev 9 'Minimum permit fee is S25+5%surcharge "Residential A/C requires site plan showing placement,)(unit. Q, Q) Cl) &OFT Li LL 30 ILJ CITY OF TIGARD ELECTRICAL PERMIT DEVELOPMENT SERVICES PERMIT #: El-C97-0688 13125 SIN Hall Blvd., Tiy;rd,OR97223 (503)639.4171 DATE ISSUED: 10/16/97 PARCEL.: L=S1O4AB---001OO SITE ADDRESS. . . : 11:_030 SW 135TH AVE SUBDIVISION. . . . : 7.0NTNG:R--4. 5 BLOCK. . . . . . . . . . . L..OT_. . . . . . . . . . . .. JURISDICTION: TIG Pt-�o.j ect De scr,i.pt i on : Installing exterior A/C uni.t. A/C unit oust not encroach into 5' side or rear yard setbacks. - - RESIDENTIAL UNIT----- ---TEMP ERVC/FEEDERS------- -----MISCELL.ANEOUS•-------- 1000 SF OR LESS. . . . : 0 0 — �'00 amp. . . . . . . : 0 PUMP/I RR I CTAT I ON. . . . : Vj E.ACH ADD' L 500SF. . . : 0 2'01 — 400 amp. . . . . . . : 0 SIGN/OUT LINE LTG. . : '?i LIMITED ENERGY. . . . . . 0 401 _.. 61'o amp. . . . . . . : 0 SIGNAL/PANEL. . . . . . . : 0 MANF. HIh/ SVC/FDR. . : 0 6O1+amps--1000 volts. : 0 MINOR LABEL ( 10) . . . : 0 ----SERV ICE/FEF_DFR--__..- --- 13RAN,',H CIRCUITS------ ---ADD' L INSPECTIONS—_- 0 — 200 amp. . . . . . : 0 W/SEF.VICE OR FEEDER: 01 PER INSPECTION. . . . . : V, 201 — L�00 amp. . . . . . : 0 1st W/O SRVC OR FDR. : 1 PER HOUR. . . . . . . . . . . : 0 401 — 600 amp. . . . . . : 0 EA ADD' L BRNCH CIRC: 0 IN PI-ANT. . . . . . . . . . . . i) 601 -- 1000 camp. . . . . : 0 --------------------PLAN REVIEW SECTION—____.____—___.___.__... _ 1000+ amp/volt. . . . . : 0 11 =4 RFS UNITS. . . . . . . . : ) 600 VOL-T NOMINAL. . : Reconnect only. . . . . : 0 SVC/FDR > _ 225 AMPS. . : CUASS AREn/SPEC OCC. : Owner: - -- _..._.__.....___.-__.___________...._-_ ..___....._._.._.._—______.-_—_-_ .______._.____.._ FEES SUNAMc; fO, ROBERT & TOMO type amor-tnt by date recpt 12030 SW 135TH AVE PRMT $ 35. 00 R 1171,'1619'7 97-3001 15 TIGARD OR 97223 SPCT $ 1. 75 B 10/16/97 97--3O0115 Phone #: Cont:r,act or,: F I RST COL.L MCCALL HEATING $ 36. 75 TOTAL. If-.50 NE LOMBARD REDUIRE:D iNSPErTIONS _.____......_.. PORTLAND OR 97211 Ror.rgh--in Elect' l Final Phone #: 2,31--3311 Elect' l Service Req ff. . : 001.020 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Oregon Specialty Codes and all other applicable laws. All work will be done in accordance with approved piens. This permit ,ill expire if work is not started within 180 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 DAR 952-001-0010 through OAR 952-001-1987. You may obtain a copy of these rules or, direct question! to OUNC by calling (503)245-1987. 1-1ermitt;ee Siynati_rre : Issr_red Sy -,i�. INSTALLATION The installation is being made on pr-aper'ty I own which is not intended for- sale, orsale, lease, or, rent. OWNER' S SIGNATURE: DATE: LO INSTALLATION ONLY---------------------------- SIGNATURE OF SUFIR. ELEC' N: _� (l1 Ii OI�' YN _ DATE I_I CENSE NO: _. _ ++++► +++++++++ +++ f++++++ ++++++++++++++++++++++++++++++++++++,+-r-+-f++++++--r ++++++ __Call 639-_4175 by 7:0@ n. m. far an inseectinn npeded the +++++++++++•+++++++++ #-+++•f•h++++++++++++ ;-+++++++++++++++++++++++-f,+++++++-+++++++++ 09,130/97 TUE 14:1.4 FAX 503 598 1960 CITY OF TIGARD Z002 CITY OF TIGARD Electrical Permit Application Plan Check 4 13125 SW HALL BLVD. nec'd By TIGARD OR 97223 Dale need Phone(503)639-4171,x304 Date to P-E- Print or Type. Date to DST Inspection(503)639-4175 Incomplete or illegible will not be accepted Perrna :N_ _ _ � 1''? Fax (503)6H4-7297 Called 1. Job Address. 4. Complete Fee Schedule Below: Name of Development Number of Inspection per permit nllowed Name(or name of business) FII C bei L 'i' o,n c, —"\kn C..M Service Included: Items Cast Sum Address I Z.0:5y 5 03 I 5+11 4a. Residential-per unit L /State/Z T-1 a 7 -7 2- - 1000&q-ft'or less $110-00 Ity P----� 3 Each additiurat 500 bq_rt-or GUfNnerCial ❑ Residential® portion thereof _ $25.00 Limited Energy $25.00 Each Manut'd Homo or Modular 2a. Contractor installation only: Dwelling Service or Foodor $68.00 -------- _ 2 (A88oh copy of all current Ilcr:nsor.) 4b-Services or Feeders Llecbical Contractor f `' ' ' r_, l( I Inslullawn,alteration,or rcloralion Addrenss �L i ,L 11 200 amps or less $00.00 2 Ci Fk k �u State 2�1 201 amps to 400 armp6 $0000 2 ty _-- ap 401 amps to IS00 a mrz $12000 -_--- 2 Phone No..!2:U- � K u°I e f��� col:imps to l000 amps -- $160.00 2 Job No. I I ' \ Over 1000 amps or volts _ $340.00 2 Elea Cont.Lice.No. `I U) t ''t EXp.Deto_ICS- I - Reconnect only _-„ $50,00 2 OR State CGB Rog.No. I u'I, Exp.Date S-30 't 4c Tempomiy Service.or Feeders CC)i Business Tax or Metro No.' t Exp.Date Installallrm,alteratlon,nr relori lion 200 amps or las. 2 Signature of Supr. Elee'n —� 201 401 amps to 406 s to 000 a rip`s .____ $100.00 _ v 2 License No. ( ' s e N v_ .� P,Date f o- I- Y Cwweer 600"b" bove.to 1000 volts. Phone No. '.V, 1 CA L i rA + Ad.Ranch Circultr. 2b. For owner installations: Vieane ion or extension per panel a))The lee for branch circuits with purchase of rmervice or Print Owner's Narne larder fee. Each branch circr�it $5.(X) Atftftess. - T — b)'rhe tee for branch circuits city Strite _ IJP- _ wiBwuf pwchave of Phone No.— service or trader too. -�-- I irsl branch cueun ( SM-00 2 The installation is being made cin orophrty I own whieh is not l a.;h additional branch clrcult -. $5.00 2 intended for sale,lease or`Frit. 40.Visrnllannous (Sorvir a or feeder not included) OwnerS 6ignature� I oris pump or irrigation circle $40.00 1 Each sign or outline lighting - _ $40.00 2 Signal rirhril(e)or a limited rirrorgy 3. Plan Review seer'ion (if required): panel,aneration or onnonaion $40.00 __ -_ 2 — Please check appropriate item and enter fee in w.ction Se. Minor t shins(to) $100.00 4 or more residential units in one 61nfctute 4f 'ach additional inspection over CL Service and fonder 225 amps er more the alluwabie in any of the nbuve -" Systa n twar(3100 wits nominal Prr Inspe-tion S'�5 nU Cktasifted area or shucbire containing spectral occupancy Per hour ,F5 cx1 as described In N E.0 Chapter 5 In Plant $511 tN1 - - Submit 2"M M plans;with application wham any of the ahnvo npply. S. Fee \ -� Nnt required for temporary construction services. 6a.Enter total of above few S � 5%AUMJ%Wgo((5 X totoi fees) I jI'r NOTICE Subtotal •2{;—97 to U.t 5b.Fntor 25%of lino 5a for -u PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED IS Plan Review f)Muirerl(5tic.3) $ NOT COMMENCED WITHIN 160 DAYS,OR IF CONSTnUr-rION On WORK Subretal $ IS SUSPCNDED OR ABANDONED FOR A PERIOD OF 1P',DAYS AT ANY TIME AFTER WORK IS COMMENCED. ❑ llusl amount N— 8 1' I Total halanre Ohre