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13700 SW 118TH COURT i ADDRESS: ) no—o II& CwRoor" CY H V) f-- J - - i:\rec)ords\microtlm\targetslbuilding.doc w .J CITY OF T'IGARD DEVELOPMENT SERVICES 13125 SIN Hall Blvd, Tigard,OR 97223 (503)639.4171 P'LUMBING PIERMIT PERMIT #. . . . . . . : F-11-1196-0322 DATE'. ISSUED: 10/23/96 FIARCEL: 2SI.03CD-07600 SITE ADDRESS. . . 13700 SW 118TH CT SUBDIVISION. . . . : CRFL-VSiDE NARK ZONING: R-4. 5 BLOCK. . . . . . . . „ . I-01.. . . . . . . . . . . . . :6 CLASS OF WORK. . :OTR GARBAGE DISP,OSALS. : 0 MOBILE HOME SPACE=S. : 0 TYRE OF USE. . . . :SF WASHING MACH. . . . . . : 0 BACKFLOW PREVNTRS. . : 1 OCCUPANCY GRP,. . :R3 FLOOR DRAINS. . . . . . : 0 TRAPS. . . . . . . . . . . . . . . 0 STORIES. . . . . . . . : 0 WATER HEATERS. : 0 CATCH BAFINS. . . . . . . : 0 FI X TURES------------- LAUNDRV 'TRAYS. . . . . : 0 SF RAI 61 DRAINS. . . . . : 0 SINKS. 0 URINALS. . . . . . . . . . . . 0 GREASE TRAPIS. . . . . . . : 0 L A'.'A T 0��,TE* S, ka OTHER FIXTURES. . . . : 0 TUB/SHOWERS....: 0 SEWER LINE (ft ) — . s 0 WATER CLOSETS. . 0 WATER LINE (ft ) . . . : 0 DISHWASHERS— . : 0 RAIN DRAIN (ft ) . . . : 0 Rpniar-14.s : Installing residential bac:l�flow Prevention devi(.:e Owner: FEES WILLIAM STEWART type arroi.Ant by date r,e;_Pt t3700 SW 118TH CT P,RMT $ 15. 00 B 10/23/96 96-285559 5 P,CT $ 0. 75 B 10-1/23/96 96- 85559 TIGARD OR 97r--'.23 Plhor)e ft: 620-6122 Cuntt�actrjt,: -------------------------------- OWNER F-11-ione #: $ 15. 75 'TOTAL Reg 99999 -------- REQUIRED INSPECTIONS rhis permit is issued subject to the regulations contained in the RP/Bac-kf I ow P't-ev Tigard Municipal Code, State of Ore. Specialty Codes and all other Final. TilspPeti.rin applicable laws. nil 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 sore than 180 days. CL: Perm ittee Si n u� �[Sslled BV : C3 Call for inspecti.an 639--4175 CITY OF TIGARD BUILDING INSPECTION NOTICE Inspection Line: 639-4175 Business Phone: 639.4171 Footing Rain Drain Cover/Service FINAL: Foundation Water Line Ceiling -Plumb. Post/Beam Mech. Shear/Sheath Framing -Mech. Plbg.Und/Flr/Slab Plbg. Top Out Insulation -Elect. Post/Beam Struct. Mech. Rough-In Gyp. Bd. -Bldg. San. Sewer Gas Line Appr/Sdwlk Reins, ---7) Other: O-f�C O Date: A,M. M f Address: 12 7 U U Sw -.1 --- �- --,;e Tenant:_. _ Ste: MST: BUP: Co wn. MEC: PLM: -03Z ELC: _ 1"HE FOLLWWG CORREC' ONS ARE REQUIRED: ELR: — CIL F- C3 Insp cta — -— Date:/#C ROVED DISAPPROVED/CALL FOR REINSP. CO v r.t fY OV T1�:!F11711 '" f?F'LE' �.1, �.�� �'OYME.N7 R1:C:E1F-IT 1" O. 344., . FI�.74.�r. 'd CHN.CK AMOUN r r 1.:-;. 7';`• NOME e S f w.WAR I', I_.O RR NA CW114 WMOUN f r 0. 00 4"7 'r'3 PUrZV 06 . L& F-A'04P N1 NMOUNI P(11 D I-'URPUbf,. Ur P(lYML N'1 AMUl1N"f 011D 1). 00 w i DU I L V F-lf P. 0. 11ti a Ln > J L` W J 700 �.iw I I CAI 1.4 1.�1 TO roil_ AMULINI PAID _ lb. i b ,ITY OF TIGARD Plumbing Application Recd By 13125 SW HALL BLVD. Commercial and Residential Date Recd0- 3- Date to P E. TIGARD, OR 97223 Date to DST_ (503) 639-4171 Permit# L-I'l11(0- D:� Print or Type Related SWR# Incomplete or illegible applications will not be accepted Called_ Name of Development/Project - --- FIXTURES (Individual) QTY PRICE AMT Job �_ / c'_fG Sink 9.00 u r 'e_ Lavatory 900 Address Street Address_ ;uite _ 1> // WA C e"c y 7" Tub or Tub/Shower Comb 900 Bldg# City/Stale Zip Shower Only 9.00 7 1 1 3 Water Closet 9-00 Name 11 '4L�, .f.� 1ICciz,yt- Dishwasher 900 Owner Mailing Address Suite Garbage Disposal 9.00 i 7C'(1 t4 1 /4li i alt Washing Machine 9.00 City/State Zip Phone Floor Drain 2' 9.00 9 7 2 z 3 (c1 CJ /1 L. 3' 9.0C Name '37 4_ 900 Occupant Mailing Address Suite Water Heater 9.00 Laundry Room Tray 9.00 City/Stale Zip Phone Unnal 9.00 Other Fixtures(Specify) 9.00 Name r )i v Yul'f----_ 9.00 - Contractor Mailing Address Suite — 9.00 _ — 9.00 City/State Zip Phone 9.00 Oregon Const.Cont.Board Lic.# Exp. gate 9.00 4ttach Copy of 900 Current Plumbing Lic.# Exp. Date Sewer- 1 st 100" 3000 Licenses Sewer-each additional 100' 2500 COT Business Tax or Melro# Exp. Date Water Service- 1st 100' 30.00 Name Water Service-each additional 200' 25.01 Architect i-r >L—�— Storm&Rain Drain- 1 st 100' 30.00 or Mailing Address Suite Storm&Rain Drain-each additional 100' 25.00 Mobile Home Space 2500 Engineer City/Slate Zip Phone Commercial Back Flow Prevention Device or Anti- 25.00 Pollution Device _ Describe work New O Ado-lion O Alteration Repair O Residential Backflow Prevention Device' 15.00 J�_ to be done. Residential e Non-residential O Any Trap or Waste Not Connected to a Fixture 900 Additional description of wot* Catch Basin 900 Insp.of Existing Plumb ng 40.00 per/hr h- -- Specially Requested Inspections 4000 N Existing use of I) thr >_ building or property Yi[ZL i U)LI f"yf 1 r�1cI61 c('t( m � Rain Drain,single(airily Only dwelling JO OD J Proposed use of Grease Traps 900 building or property QUANTITY TOTAL WAre you capping , moving or replacing any fixtures? Yes Q No Cl Isometric or riser diagram is required if Ouandy Total is >9 —r (If yes see back of form) _ 'SUBTOTAL 1 I hereby acknowledge that I have read this application,that the information ^_s given is correct.that I am the owner or authonzed agent of the owner,and 5% SURCHARGE that plans submitted are in compliance with Oregon Slate Laws. Signature of Owner/Agent Date PLAN REVIEW 25%OF SUBTOTAL Required only d Nduro city !oral is>9 TOTAL /,- Contact Person Name Phone *Minimum permit fee is 525-596 surcharge.except Residential Backflow Prevention Device,which is$15+5%surcharge ildsts\plriapp doc 8/98 PLEASE COMPLETE AS RIATE TO PROJECT: Fixtures to be capped, moved or replaced Qtv Sink _ Lavatory Tub or Tub/Shower Combination Shower Onlv Water Closet Dishwasher GarbaS. Disposal Washing Mach;,,-,--, Floor Drain _2" 3" 4" _ Water Heater Laundry Room Tray Urinal Other Fixtures (Specify) _ - COMMENTS REGARDING ABOVE: C7 41 --- CITY OF T I GARD PER PERMIT EIRMIT MASTIt. . . . . . . : MST95-03LO COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 08/30/95 13125 SW Hall Blvd.Tigard,Oregon 97223.8199 (503)639-4171 PARCEL: i:-R'S105CD--07600 SITE ADDRESS. . . : 13700 SW 118TH CT SUBDIVISION. . . . : CREEKSIDE PARK Z D 1\1 111\1 G: R-4. 5 BLOCK�. . . . .. . . . . . .. LOT. . . . . . . . . . . . . C- PUILDING REISSUE: DWELLING UNITS-.0 BASEMENT. . . . . . . . .0 s f CLASS OF WORK. :ADD BEDRMS:O BATHS:@ GARAGE . . . . . . . . :0 sf TYPE OF USE. . . :SF FLOOR AREAS-..-.._.....__-.- - REQUIRED TYPE OF CONST. : N FTRST. . . . ..0 sf LEFT. . : 11 ft R10HT. : 1l ft OCCUPANCY GRP. :R3 SECOND. . . :0 sf FRONT. :21 ft REAR- 08 ft STORIES. . . . . . . : 1 FINDSMENT:O sf HE I GI-AT. . . . . . . . : 10 -Ft TOTAL - '0 .-,f SMOKE DETECTORS. :Y rLOOR LOAD. . . . :0 psi' VALUE. . . . .. 0 517 PARKING SPACES. Remarks : adding alcove for natural gas fireplace --------------------------------- PLUMBING -------------------------------- S I NKS. . . . . . . . . . :0 FLOOR DRAINS. . . . :0 BACKFLOW PREYNTRS. . .0 LAVATORIES. . . . . :0 WATER HEATERS. . . :0 TRAPS. . . . . . . . . . . . . . :0 TUB/SHOWERS. . . . :0 LOUNDRY TRAYS. . . :0 CATCH BASINS. . . . . . . zO WATER CLOSETS. . :O SEWER LINE (ft ) . :0 GREASE -TpArns. . . . . . . :o DISHWASHERS. . . . :0 WATER LINE (ft ) . nl?i OTHER FIXTURES. . .. . . :0 GARBAGE DISP. . . :0 RAIN DRAIN (ft ) . :O WASHING MACH- 0 SF RAIN DRAIN 5. . :O --------------- MECHANICAL -------------------------------- FEES .-_.--_.-_.___.-__-.._._ FUEL TYPES----------- UNIT HTRS. . :O type amount by (late reapt /GAS/ VENTS . . . . . :0 BPRT $ 25. 00 B 08/30/95 95-269970 MAX INPUT:@ BTU VE HT FANS. . :0 BPLC $ 16- 25 JA 06/21/95 95-269613 rURN ( 100K . . :0 HOODS. . . . . . :0 BSPC $ 1. 25 B 08/30/95 95-269170 FUPN > =100K . . :0 WOODSTOYES. 0 MPRT 1 25. 00 D 06/30/11 11-0699717.1 FLOOR FURN. . . . -0 CLO DRYERS. : 0 M5PC $ 1. 85 B 08/30/05 95-269970 BOIL/CMP ( 3HP:O CnHER UNITSK GAS OUTLETS: 1 Owner; WTLLIAM STEWART 11745 SW 95TIl TIGARD OR 97223 Ph une 4: Contractors OWNER Phone Reg 4. 000000 $ 68. 75 TOTAL >- This persit is issued subject to the rpgdatitns contained in the REQUIRED INSPECTION�) Tigard Municipal Code, State of Ore. Specialty Codes and all other Footing Insp Gyp Board Insp applicable laws. AN wvk All be doe in accordance with approved Foundation Insp Mechanical Final G plans. This pereit will expire if work is not started wit�,in 180 Post/Seam Meehan Building Final UJ days of issuances or if work it suspended or sore than0 _ d a,, Mechanical Insp KrusControl-' Contol Framing Insp Permitter Swrii-:.Ature ' Fireplace Insp ___ �-M-___ ...____ Gas Line Insp issued By : pevlvv� Tnsulation Insp Call (or inspection 639-4175 Permit #: -- Addre-,.,: 1 �Z00 6\N ( R C ISSUM hy: ���� Date: -- i 3 . Statement: Information Notice to Property Owners About Construction (Responsibilities Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli- cants who are not registered with the Construction Contractors Board to sign the following statement before a building permit caa be issued. This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt from registration under ORS 701.010(7), need not submit this statement. This statement will be filed with the permit. Fill in the appropriate blanks and initial boxes I and 2, and either box 3A or 3B: 1. I own, reside in, or will reside in the completed structure. 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion. a 3A. My general contractor is (Name) Contractor regis. # I will instruct my general contractor that all subcontractors who work on the structure must be registered with the Construction Contractors Board. OR B. I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors 1 Board. If I change my mind and hire a general contractor, I will contract with a contractor who is registered with the CCB and will immediately notify the office issuing this building permit of the G name of the contractor. I hereby certify that the above information is correct and that I have read and do understand the Information , Notice to Property Owners about Cons ruction Responsibilities on the reverse side of this term. Uj J - -- (Signature of permit applicant) (bate) (White copy to issuing agency permit file, pink copy to applicant) CITY OF TIGARD BUILDING INSPECTION NOTICE Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171 Inspection: �. -- 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 Mech. San. Sewer Gas Line -Bldg. Plbg. Underfloor Rain Drain Framing -Plumb. Alarm Water Line Insulation -Mech. Underflr. Insul. Shear Wall Gyp. Bd. CE R` Date Requested: f� (���� S Time: AM PM Address: Builder: .ZO C-J Z Permit u: rn 6 a 30 THE FOLLOWING CORRECTIONS ARE REOUIRED: Cb LoC7Z,J LL r J 'J W _J Inspector_ ��� Date: <'__'APPROVED —DISAPPROVED APPROVED SUBJECT TO ABOVE __Call For Reinsp. CITY OF TIGARD BUILDING INSPECTION NOTICE I Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171 �J Inspection: C n Footing Susp. t iling Sprink. Rough-in Appr/Sdwlk Foundation Plbg Underslab Mech. Rough-ir�! Fireplace Post/Beam Struct. Plbg. Top Out Elec. Rough-in FINAL: Post/Beam Mech. San. Sewer Gas Line Bldg, % Plbg. Underfloor Rain Drain Framing -Plumb. Alarm Water Line Insulation - ec Underflr. Insul. Shear Wall Gyp. 8d. -Elect. Date Requested: lU Time: AM PM Address:_ -76/0 Z/ L'_JC ' ���'lil� ' �C `�' ( � Z�Permit THE FOLLOWING CORREC I NS AR�REOUIRED: Ins ector _ __ Date: drPPROVED DISAPPROVED APPROVED SUBJEC TO ABOVE 10Q, Call For Reinsp. CITY OF TIGARD BUILDING INSPECTION NOTICE � Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171 j Inspection 0—,C Footing Susp. Ceiling Sprink. Hough-in Appr/Sdwlk Foundation Plbg. Underslabttiq Fireplace Post/Beam Struct. Plbg. Top Out Elec. Rough-in FINAL: Past/Beam Mech. San. Sewer SCGas1J s—=� -Bldg. Plbg. Underfloor Rain Draint; r"F`m ng) -Plumb. Alarm Water Line Insulation -Mech. UnderfIr. Insul. Shear Wall Gyp. Bd. -Elect. Date Requested:_ -7 _Time:__—AM PM Address: l L ' -1-- — c> 1Sy C--) Permit a; Z .3 THE FOLLOWING CORRECTIONS ARE REQUIRED: _ /S' �s• �- �,�z �,SJ !sr.�.�rte=s Ln h :a W J Inspector: �� Dater�y 5 APPROVED DISAPPROVEDPROVED SUBJECT TO ABOVE Call For Reinsp. CITY OF TIGARD BUILDING.; INSPECTION NOTICE Inspection Line (Rec-0-Phone): 639-4175 Business Phone: 639-4171 Inspection:_ Footing Susp. Ceiling Sprink. Rough-in Appr/Sdwlk Foundation Plbg. Underslab Mech. Rough in Fireplace Post/Beam Struct. Plbg. Top OutAlec. 03 uyhj FINAL: Post/Beam Mech. San, Sewer Gas Line -Bldg. Plbg. Underfloor Rain Drain Framing -Plumb. Alarm Water Line Insulation -Mech. UnderfIr. Insui. Shear Wall Gyp. Rd. -Elect. Date Requested: `7- Time:—AM PM Address:_ 13 CDG �Buii ��t 1j2 C' G� Z Z- Permit # THE FOLLOWING CORRECTIONS ARE REQUIRED: E O 15':-- D(lC& _.1/ /1-,,{c-,fit C r" - tr r� 2 7 4 i� ti V7 E- L7 W YJ --- n ..1 Inspector: Date: !2-2- APPROVED -2-APPROVED _DISAPPROVED APPROVED SUBJECT TO ABOVE _Call For Reirtsp. ' CITY OF TIGARD BUILDING INSPECTION NOTICE Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171 . t Inspection: Footing Susp. Ceiling Sprink. Rough-in Appr/SdwlN Foundation Plbg. Underslab Mech. Rough-in Fireplace ost/Bea- m S tt-u�L� Pibg. Top Out E(ec. Rough-in FINAL: Post/Beam Mech. San. Sewer Gas Line -Bldg. Plbg. Underfloor Rain Drain Framing -Plumb. Alarm Water Line Insulation -Mech. Underflr. Insul. Shear Wall Gyp. Bd. -Elect. Date Requested. J' q Time: AAM PM Address: Builder. Permit #:_` Z U THE FOLLOWING CORRECTIONS ARE REQUIRED: v. c� w Inspector: Date: ..__ PROVED DISAPPROVED —APPROVED SUBJECT TO ABOVE —Call For Reinsp. CITY OF TIGARD BUILDING INSPECTION NOTICE Inspection Line (Rec-O-Phone): 639-4175 Business Phone: 639-4171 Inspection: 0o i Susp. Ceiling Sprink. Rough-in Appr/Sdwlk oundatio Plbg. Underslab Mech. Rough-in Fireplace Pos earn Struct. Plbg. 'Top Out Elec. Rough-in FINAL: Post/Beam Mech. San. Sewer Gas Line -Bldg. Plbg. Underfloor Rain Drain Framing -Plumb. Alarm Water Line Insulation -Mech. Underfir. Insul. Shear Wall Gyp. Bd. -Elect. Cl Date Requested: / / ,j , Time:,ZAM PM Address: i '2 G ( Z Z T Permit#: THE FOLLOWING CORRECTIONS ARE REQUIRED: r� ti c c� w Inspector: Date: S� S ""APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE Call For Reinsp. t I I I Cfl- 1 14 1.-1 11-114 1r I T U 1 1 )RD Ok 9 P014-4*:,1 11 I'll ;-1A N ON WIN I 1•'1-11 1.1 1 It.)f%,t,t IIA. 1-11 Pi-I Y,MI N I 3!-f. IAO IIT„ tit.)I 1 1) 1 IV P rs LLJ j I ' Illit. Ol I 1 1 IN I 4 I y I If- I J,oHRl PLO,. J I I 111 PI:y I"I f rd 1 10 1,f-, I P I Nt 1, •9 t7s W I L A . I I.IM P I-0110.11,11 1 0. OV) I 10 1 I'l 1;1. 1.11,4YOW141 0141K r om/ow/ Uk I-AIM) IM INI't 1,-il l It- 141 Y M N I 14MION1 Pi).10 Pt 1•t P'{ Q3 III "1. 140,1111,11 PH 1 11 d Residential Building Permit Application City of Tigard 13125 SW Hall Blvd. Tigard, OR 9722: (503) 639-4171 Jobsite Address: 1-a 700, jc•J I I`S tL- CT Subdivision: `12EEK-51I- Pi�C_K Lot# w Office Use Only Valuation: S i f• Z$ 03 a:2dAR-E Fir;--r i_ Contact Date / ! Initials Result New Construction Only: (Square Footage) Planck/Rec # t -�4 Permi # --i= O . ,=2 House: Garage: Reissue of � Map & L#� - 7l Corner Lot? Y Flag Lot? CD N Zone Owner: ILL- I ,Vejt ,;A �TLcWAl?T Plat # ;r, - D ( Address: � 3'4 o o Sin I l"'O CT A royals Required -1 2) Planning Setbacks (�- Solar 6 A P-D C7 k ► 1) Engineering _ Other Phone: ( 0 3 ) Co20 Lp i2 Contractor; 131LL �TEUJ (�T �NOr�E�l1)nJ(✓k� items Required Address: 1�� D O S� �$ ' C`i _ Subcontractors _ Truss Details 1411 Other Phone: 6-10 ` (D l Z I Notes _ Contractor's License # (attach copy of current Oregon license) Contact Name: Contact Phone: ) E _it _ 0 Subcontractors: Architect/Engineer: Plumbing: _ �- Address: CL LL Mechanical: v~i (attach copy of current OR Contractor's License) >- Phone: ( L� JOB DESCRIP ION: A �� A - 4 ' - A LCnVL COP A_ NATAPP tyA S Fi��f'iRt't. -C 1 '-' Applicant Signature Applicant Phone number C �I Received by� Date Received: w wyndnvwa . 4 Permit# Account Description Amount Amt. Pd. Bal.-Duo 0 Bldg. Permit (BUILD)„`_ Plumb. Permit (PLUMB) Mech. Permit (MECH) State Tax (TAX) �, �� 1;2 Bldg: --,�-� Plumb: Mech: Plan Check (PLANCK) Bldg: �'• Z �� Plumb: Mech: ^_ Sewer Connection (SV%'USA) Sewer Inspection (SWINSP) Parks Dev Charge (PKSDC) Residential TIF (TIF-R) Mass Transit TIF (TIF-MT) _ Commercial TIF (TIF-C) Industrial TIF (TIF-1) Institutional TIF (TIF-IS) Office TIF (TIF-0) Water Quality (WQUAL) CL Water Quantity (WQUANT) Of "' Fire Life Safety (FLS) r Erosion Cntrl Permit (ERPRMT) L Erosion Planck/USA (ERPLAN) w J Erosion Planck/COT (EROSN) TOTALS: tjc'-,V THt S Afk i Cavo/J APPLIES To4d,41ZD PFR M tT # Community Development ELECTRICAL PERMIT APPLICATION M5795"` r,?0 13125 SW Halt Blvd. Tigard, OR 97223 Planck/Rec. # Permit # �)-C - L40- 0 Phone (503) 639-4171 Date Issued el-I C) `' 1 CITY OF TIOARDFAX (503) 684-7297 Issued by TDD No. (503) 684-2772 Inspection (503) 639-4175 9, Job Address: 4. Complete Fee Schedule Below: Name of Development 1!131 DiE Number of Inspections per permit allowed Address Service included. Items Cost(ea) Sum City/State/Zip t �(Z� ,(� = r.1 4a. Residential• per unit 4 1000 at( It or lees $11000 r Name (or name of business) 0,yuCj.- Ry.ILXft Each additional 500 aQ If or I portion thereof $2500 Commercial❑ Residential❑ limned Energy $2500 Each Manul'd Home or Modular 2 Dwelling Service or Feeder $6800 2a. Contractor installation only: 4b.Services or Feeders Innlninhon,allarntion,or ralocntion 2 Electrical Contractor 200 amps or leas $6000 _ 2 Address 201 amps to 400 amps $8000 _ 2 401 amps to 600 amps $12000 CityState Zip 601 amps to 1000 amps $18000 2 Phone No. Over 1000 amps or Vona $34000 2 Contractor's License No. Reconnect only $5000 Contractor's Board Reg. No. 4c.Temporary Services or Feeders Installation,ntteration,of relocation 2 Signature of Supr. Elec'n 200 amps lir lase $5000 2 201 amps to 400 amps $7500 I icense No. Phone No. 401 amps,to 600 amps $10000 Over 600 amps 10 1000 Vona 2b. For owner installations: Sae W above 1 r 4d. Branch Circuits Print Owner's Name / r� New alteration orexlension per panel Address_ ' ) c L n)The lee for branch circuits with City G State__-Q,__ Zips purchase ssrvke a feeds be. 2 Each branr_h circuit $500 Phone No. 1`912, b)The lee for branch ara,dn without ~� The installation is being made on property I own which is purchase of sinks or feeder Fast branch orcial LL $35 00 2 fes. r ria 2 not intended for sale, Ivase or rent. i Each adddional branch Grt,7i:l $500 _ i Owner's Signature 1./ / 4e. Miscellaneous (Service or feeder not included) 2 3. Plan Review section (if required): Ench pump or irrigation circle $4000 2 Each sign or outline lighting $4000 Signal cir uit(&)or a limned energy Please check a 2 ppropriate item and enter fee in section 5B. panel,nnerntion or extension $4000 _ 4 or more residential units in one structure Minor labels(10) $10000 _ Service and feeder 225 amps or more _System over 600 volts nominal 41. Each additional inspection over i bl ll he allowable n an .� _Classified area or structure containing special occupancy ty of the above cc as described in N E C Chapter 5 p"r 11B1ion $3500 _ N Psi hour f55 00 In Plant $5500 >- Submit 2 sets of plans with application where any of the above apply. Not requited for temporary construction services. 5. Fees: J So. Enter total of above fees $ NOTICE 5%Surcharge(05 X total fops) T r� Subtotal PERMITS BECOME VOID IF WORK OR CONSTRUCTION � 5b. Enter 25%of line A for AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF Plan Review it required(Sec 3) $ CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Subtotal A PERIOD OF 180 DAYS!. ANY TIME AFTER WORK IS COMMENCED ❑ Trust Account# Balance Due $ -� r _ 12 Il,Z . r cxvrER Y ��rSL.1 {�L TIDN 6#16 04- k. N� • cov*?., _. l; — —_ hey '''�"+„-.,x•`S-.�. 2'OCbNCRETE 1 l�PPpOVED FOR QONStRUCTION --�.:_,_.:_ _ �'C�'` � .._ _ - �c��►�� �dc�:msfss �3Z0_,:,;_ . __,. ;. .�.�-�J7o�-sw11..� �� _ DIA STEEL QE.-9AR I,` LOOG — UIUL)� AWLD SET 34'• IaM EX►SnO fr FIREPLACE PAD _ _.__....... LoGATED E,)tR VMC BLACK PLASTIC. FEOCE PERIMETEk . . ''' 1 v 1 I . n LAJ I I '•1' I� '• .�, • ,y ,�1 ., ..• .I v, \.y ,jai I I I .I..yrJ .. .'4.7�9 1 , • i I r e 4 vi Li re- 06 O LAII A v, s oo J D i.l J IN. -- 00 1 • ✓� N N Q � M r LLJ ovi �, ,�► i o rev 98 • ^� ry w . tt1 10 .0 / o too 0 Q oLOW t1� 1 •�.. �� �'�0 88 s P �►� • Q 0 Oo '.�.. 8 E' , ��'0 88 • 0 ry to - Ar _"1 r �.: