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14351 SW 128TH PLACE w N N G N OD 0 �D 14351 SW 128"' Place CITY OF TIGARDt 24-Hour BUILDING Inspection Line: (503)639-4175 MST INSPECTION DIVISION Business Line: (503)639-4177 SUP Receivecl __ _Date Reque/st:d_ "Z- �_L/----- AN!------ PM--- --- BUP Locaticn � ,� � la � L --- suite MEC A MEC 73 _ --- Contact Person — Ph (------ ) L-- 3-$ PLM — ---------- Contractor____-- -- Ph ( _-----) - SW H BUILDING ELC --_—_--- Footing -— ELC _T--- Foundation Access: Fig Drain ELR Cr,wl Drain SIT' _ Slab !nom)ection Notes: Post&Beam - - - -------- Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing - - -- Insulatic.., - Drywall Nailing Firewall Fire Sprinkler - -- - Fire Alarm Susp'd Ceiling Roof Othgr: PASS . PART FAIL _ G Post 8 Beam Under Slab Rough-In Water Service Sanitary Sewer Rain Drains Catch Basin/Manhole Storm Drain Shower Pan - Olh ----- Fin S PARr_FAIL M C NNICAL -___- Post&Beam Rough-In - ---- Gas Line _ oke Dampers ASS PART FAIL - _ TRICAL Service Rough-In UG/Slab Low Voltage -- ------ - -- - _ —�---- ---- Fire Alarm F inal Reinspection fee of$__—__._—_--required before next inspection. Pay at City Hall, 13125 SW Hell Blvd. PASS PART FAIL SITE — — Please call for reinspection RE: Unable to Inspect-no access Fire Supply Line �— ADA DsftI — Ext Approach/Sidewalk - - �- nspector Other: Final OO NOT REMOVE this Inspection record from the doh site. PASS PART FAIL LAAAAAAAAA AAAAAAsj�AAAA AAAAAAAAAAAAAAAAAAAAA � r i o e ► i �' ► H No. a � V - a 4 14 N a d rD b y CL q > rl 44O o r A � C -4 �> CD A w !� M � lip- 10.N /♦CVVVVVVVVVVVVV Irkvvvvvvvvv®vvvvvvvv vvvTTV`as► b o n n n Z0 o o el w c C o C7 N% � CpL y ' b a a � y i 91 O a O o � x 1 0 CITY OF TIGARD 13125 S.W. (riALL BLVD. RECEIVED 'rIG� R.0. OR 97223 IMPORTANT PERMIT NOTICE JUT 1Vit?'1 Ci11 U e.0jil-k MALMEDAL PLUMBING INC 1BUI DYN0)W/11`1011 111 S 18TH AVE CORNELIUS, OR 97113 Plumbing Signature Form Permit #: MST2002-00300 Date issued 7/18;Q2 Parcel: 2S109AA-04400 Site Address: 14351 SW 128TH PL Subdivision: ELK HORN RIDGE ESTATES Block: Lot: 010 Jurisdiction: TIG Zoning: R-7 Remarks: New SF, Path 1.Geotech shall view and approve the dig-out and the slope set backs before calling for footing inspection Your company has aeer, indicated as the plumbing contractor for tl iermit indicated above. In order for the plumbing permit to w- valid, please have the appropriate individual from your company sign below and return ,his Plumbing Signature Form prior to the start of the work to the address above, MTTN: Building Dept. No plumbing inspections will be authoriz..d until this compl�:ted forrn is received OWNFR. PLUMBING CONTRACTOR: PAUL CARNEY INC MALMEDAL. PLUMBING INC 1480 NW 102ND AVE 111 S 18TH AVE r 0 R LAIVV, VI, JI 22 Phone #: 503-297-9406 Phone #: 503-310-9795 Reg #: 1 1c' 102535 PI M 34-276PB AN INK SIGNATURE IS REQUIRED ON THIS FORM X Signature of Authorized Plumber If you have any questions, please call (503) 639-4171, ext. # 310 CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 RECEIVED IMPORTANT PERMIT NOTICE FRANKL.!N ELECTRIC INC 1031 SE 22RD COURT GRESHAM, OR 97080 Electrical Signature Form Permit #: MST2002-00300 Date Issued: 7118/02 Parcel: 2S109AA-04400 Site Address: 14351 SW 128TH PL SUbdivisi'on: ELK HORN RIDGE ESTATES Block: Lot: 010 Jurisdiction: TIG Zoning: R-7 Remarks: New SF, Path '1.Geotech shall view and -approve the dig-out and the slope set backs before calling for footing inspection Your company has been indicated as the electrical contractor for the permit indicated above. In order for the electrical permit to be valid, the signature of the supervising electrician is required. Please have the appropriate individual from your company sign below and return this Electrical Signature Form prior to the start of the work to the address above, ATTN: Building Dept. No electrical inspections will be authorized until this completed form is receivcu OWNER: ELECTRICAL. CONTRACTOR: PAUL CARNE=Y ;NC FRANKLIN ELECTRIC INC 1480 NW 102ND AVE 1031 SE 23RD COURT PORI LAND, OR 97227 liRitti;1A1V11, c)K UIMSU Phone 11. 503-297-9406 Pho7e #: 492-4651 Req #: LIC 140110 ELE 26-I041C SUP 22GOS AN INK SIGNATURE IS REQUIRED ON THIS FORM x�- ---- Signatur o uoeriising Electrician If you have any questions, please call (503) 639-4171, ext. # 310 CITY OF �"IGARD � MASTER PERMIT PERMIT#: MST2002-00300 DEVELOPMENT SERVICES' DATE ISSUED: 7/18!02 13125 SW Hall Blvd., Tigard, OR 97223 1503) 639-4171 SITE ADDRESS: 14351 SW 128TH PL PARCEL: 2S109AA-04400 SIJBDIJISION: ELK HORN RIDGE ESTATES ZONING: R-7 BLOCK: LOT: 010 JURISDICTION: TIG REMARKS: New SF, Path 1.Geotech shall view and apprave the dig-out and the slope set backs before call -ig for footing inspection BUILDING REISSUr STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 21 FIRST: 1,745 of BASEMENT. of LEFT: 6 SMOKE DETECTORS: V TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,546 of GARAGE: 698 sf FRONT: 2n PARKING SPACES: 2 TYPE OF CONST: 5N DWELLING UNITS: I FINBSMENT: of RIGHT: 9 VALUE: $315,950.00 L.CCI'"ANCYGRP: R3 BERM: 4 BATH: .3 TOTAL: 3,291.00 of REAR 51 PLUMBING SINKS: 1 WATER CLOSETS: 3 WASHING MACH: I LAUNDRY TRAYS: 1 RAIN DRAIN: 100 TRAPS: LAVATORIES 4 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAI'I DRAINS: 1 CATCH BASINS: IUB/SHOWERS! 4 GARBAGE DISP: I WATER HEATERS I WATER LINES: 100 RCKFLW PREVNTR: 1 GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN�1UOK: BOILICMP<3HP: VENT FANS: 5 CLOTHES DRYER: 1 ,ns FURN>000K: I UNIT HEATERS: HOODS: I OTHER UNITS: I MAX INP: blu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 1 ELEC-,RICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC/FEEDERS SPANCH CIRCUITS MISC:LLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 1 0 200 amp: 0 - 200 amp: WISVC OR FDR: 1 PUMPARRIGATION: PER INSPECTION: EA ADD'L 50OBF: 6 201 400 amp: 201 • 400 amp: tat W/O SVCIFDR: 00 SIGN/OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 500 amp: 401 800 amp: EA ADOL BR CIR: SIGNALIPANEL: IN PLANT- MANU HMISVCIFDR: 601 - 1000 amp 601•amps-1000v: MINOR LABEL' 1000'-amplvpll. PLAN REVIEW SECTION Reconnect only: - >*4 RES UNITS: SVCIFOR>•225 A.: >600 V NUMINAL CLS AREA/SPC UCC: ELECTRICAL•RE9TRiCTEO ENERG. A.SF RESIDENTIAL B.COMMERCIAL AUDIO&STEREO• VACUUM SYSTEM: AUDIO A STEREO: FIRE ALARM: INTERCOMIPAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: 0TH: BOILER: HVAC: LANDSCA?EARRIG: PROTECTIVF SIGNL: GARAGE OPENER: CLOCK INSTRUMENTATION. MEDICAL: OTHR: HVAC: DATAr TELE COMM: NURSE CALLS: TOTAL N SYSTEMS: Owner: Contractor: TOTAL FEES: $ 8,083.28 This permit Is subject to the regulations contained in the PAUL CARNEY INC PAUL R CARNEY INC Tigard Niunicipal Code,State of OR. Specialty Codes and 1480 NW 102ND AVE 1480 NW 102ND AVENUE all other applicable laws. All work will be done In PORTLAND,OR 972.27 PORTLAND,OR 97229 accordance with approved plans. This permit will erpire K work Is not started within 180 days of Issuance,or if the r,ork Is suspended for more than 180 days. ATTENTION: Phone: Phone: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules art+set Reg N: LIC 56852 forth In CAR 952-001-0010 through 952-001-0080. You may obtain copies of these rules or direct questions to OUNC by calling(503)246-1987. REQUIRED INSPECTIONS Erosion Control Insp 8 Post/Beam Structural PLM/Underfloor Framing Insp Gas Fireplace Appr/Sdwlk Insp Grading Inspection Post/Beam Mechanlca Mechanical Insp Shear Wall Insp Insulation Insp Electrical Final Sewer Inspection Underfloor insulation Plumb Top Out Exterior Sheathing Inst Gyp Board Insp Merhanical Final Footing Insp Crawl Drain/Backwater Electrical Service Low Voltage Rain drain I .7 Plumb Final Foundattf h Insp Footing/Foundation Dr; Electrical Rough In Ga.,Line Insp Water LI �In Final inspection Li' l g Is ued gy : Permittee Signature : IV,-/,//_"Zj (( _ �----- Call (503) 639-4175 by 7:00 p.m. for an inspection needed the field business day CITYOF TIGARD SEWER CONNECTION PERMIT / UEVEI OI'MENT SERVICES E ISSUE#: s 18/02 -oo208 13125 SV,' hall '31vd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 7118/02 PARCEL: 2S1 U9AA-04400 SITE ADDRESS; 14351 SW 128TH PL SUBDIVISION: ELK HORN RIDGE ESTATES ZONING: R-7 BLOCK: LOTS 010 _ _ JURISDICTION: TIG TENANT NAME: USA NO: FIXTURE UNITS: CLASS OF WORK: NEW DWELLING UNITS: 1 TYPE OF USE: SF NO. OF BU!LD;NC-S: INSTALL TYPE: LTPSWR IMPERV SURFACE: Remarks: Sewer connection for new SF — �_— Owner: � FEES _ PAUL CARNEY INC Type By Date Amount Receipt 1480 NW 102ND AVE - PORTLAND, OR 97227 PRMT CTR 7/18/02 $2,300.00 27200200000 INSP CTR 7/18/02 $35.00 27200200000 Phone: 503-297-0406 Total $2,335.00 Contractor: Picone: Ren # Required Inspections This Applicant agrees to comply with all the rules and regulations of the Unified Sewage Agency. The permit expires 180 days from the date issued. The total amount paid will be forfeited If the permit expires. The Agency does not guarantee the accuracy of the side sewer laterals. If the sewer is not located at the measurement given, the installer shall prospect 3 feet in all directions from the distance given. If not so located,the installer shall purchase a"Tap and Side Sewer" Perm Is d by' Permittee Signature: Call(503) 639-4175 by 7:00 P.M. for an 'nspection needed the he uslness day 77) Building Permnit Application Datereceived: /, p,2 Permit no.: City of Tigard — Ci f v t,f/iga rd Address: 13125 SW 11• t'131vd,Tigard,OR 97223 Project/appl.no.: edate: Phune: (503) 639-41 Date issued: y Receipt no.: Fax: (503) 598-196 ! N Case file no.: Payment type: Land use appro L' 1&2 family:Simple Complex: f� I &2 family dwelling or accessory U Commercial/industrial U Multi-fancily U Ni w construction U Denwiitior U Addition/alteration/replacement U Tenant improvement ❑Fire sprinkler/alarm U Ottier:_— rLA 4 Job address:— :?-S-/ '$t v /2$r-\ j�/y c Bldg.no.: Suite no.: &7 Lot: Block: I.,uoatvision:'_//�" f/�,y Z, c/y1 - ax map/tax lot/account no.: p iJ - el Pr.iject name: Description and location of work on premises/special conditions: N i S'-xy 47 1 Name: rJ. Cd Mailingaddress: 1J AU1�. 02 c .•/ �. 1 A 2 family d++clliui,. City: -r-i q. State: jZ ZIP: y 7„2 Valuation of work................................. ...... $ Phunc:S%�3 7-`/ axsc 2yC,•fCtl R-niail: No.of bedrooms/baths................................. — Owner's representative: _ Total number of floors.................... _ Phone: , 7 7y0G Fax: 7q6 169t113-mall: New dwelling area(sq.ft. 32 9� Garage/carport area(sq. ft.)......................... _ L 73 f Name: Covered porch area(sq.ft.) ... ..................... -17- Mailing Mailing address: Deck area(sq. ft.) ................... ................... City: _ State: ZIP: Other stnicture area(sq.ft.)...... .................. Phone: I a r I'. rout: Commereiallindustrial/mult[-family: 010 RAN Vill Valuation of work $— Business names /I<� Existing bldg.area(sq.ft.) ..... ........ ......... Address: — New bldg.area(sq.ft.) .......... ....... ___ — Number of stories .................. ............... City: State: 'LIP: "' Phone: Fax: E-mail: Type of construction...................... ........... _ CCn no.: — -- Occupancy group(s): Ex ing: - - w: f i v/metro tic.no.: Notice:All contractors and subcontractors are required to he t licensed with the Oregon Construction Contractors Board under Name: provisions of ORS 701 and may be required to be,licensed in the Address: - jurisdiction where work is being performed. if the applicant is City: S.al re: LIP: -_ exempt from licensing,the following reason applies: Contact person: I Plan no.: - -- Phone: Fax. Name: Contact person: Fees due upon application .......................... $ Address: Date received: City: State: ZIP: Amount received ......................................... $ _ Phone: Fax: I E-mail: Please refer to fee schedule. I hereby certify I have read and examined this application and the Na VI juriidicuoru fircept ctedit clads,please call jurisdiction fa more infornwuon. attached checklist. All provisio5svf laws and ordinances governing thisra work will be B mpli t spec' �d herein or qnt. c"u _ Authorized si mato Date. - V? �L._ _ shown oo<< t�� is"pin' Print nam,!:-L G��i'� ts — .ol si Amount Notice:71.1s permit application expires if a permit Is not obtained within 180 days after it has leen sccrpted as complete. 4404613(MWOM) Plumbing Permit Application "Dateeived: / Permit no.: City of Tigard Sewer permit no.: Building permit no.: Address: 13125 SW Hall Blvd,Tigard,OR 97223 Ciry of Tigard phone: (503) 639-4171 ProjecUappt.no.: Expire date: Fax: (503) 598-1960 Date issued: By: Receipt no.: Land use approval: Case file no.: Payment type: ( R� I &2 family dwelling or accessory U Commercial/industrial U Multi-family U Tenant improvement ;J New construction U Adtlition/alteration/replacement U Food service O Other: jog StM INFORMATION alt r speclal Informadon ,/ Description Qt}. hce(ca.) lofal Job address: Suite nt, — - New I-and 2-family d"cllings only: - (includes 100 A.foreach utility connection) Tax map/tax lot/account w, SFR(1)bath tat: _Block: Subdivision: -------- ___ _.__-- SFR(2)bath Project name: SFR(3)bath City/county: ZIP: -_ Each additional bath/kitchcn Description and location of work on premises: — Siteutilities: _ Catch basin/area drain Est.date of completion/inspection Drywells/leach line/trench drain Footing drain(no.lin.ft.) PLUMBING CONTRAMOR 1 1111 Manufactured home utilities Business name: It�,l ./� _.,t 6, Manholes _ W Address: 9 71, // Rain drain connector City:qfq,q StateQP_ LIP: q 7//S San::ary sewer(no.lin.ft.) Phone. 5'0_?-3 to Y nFax: E-mail: Storm sewer(no.lin. ft.) CCB no.: OZ Plumb.bus.reg.no: 3 tfWater service(no.lin.ft.) City/metro lic.no.: Fixture or Item: Contractor's representative signature: Absorption valve Back flow preventer Print name: Date: Backwater valve IFAXER us 141,11110Basins/lavatory Name: Clotheswasher _ Dishwasher Address: Drinking fountain(s) City: State: 21P: Ejectors/sump Phone: Fax: E-mail: Ex ansion tank 'ixtu sewer cap Name(print): izioor drains/floor sinks/hub _ Mailing address1.: garbage disposal Husc bibb City: State: ZIP: Ice maker Phone: Fax: I E-mail: lnterce tor/ reale trap Owner installation/residential maintenance only: The actual installation Primer(s) will be made by me or the maintenance and repair made by my regular Roof drain(commercial) employee on the property I own as per ORS Chapter 447. Sin (s),basin(s), ays(s) Owner's signature. Date: Sum _ 011111010 a Tubs/shower/shower pan Urinal Name: — Water closet Address: Water heater City: _ _ Y_ State: ZIP: __---- OUt_r: Phone: Fnx: E-mail: Tota Nor dl Juridictim accept credit rant,,pdeam call Jurisdiction rex Mr"inrorinarion Minimum fee................ 7 Notice:This permi�.application Plan review(at _ 96) � U Visa U MasterCard 6// S� oa3 Z 6�u expires if a permit isnot obtained Credit card number within IRO days atter it has been State surcharge(R96) .... ---- � accepted as complete. TOTAL .......................$ udrnl won on c ural _ S Amount 40016(6r*WMM) Mechanical-Permit Application -- Date received:(,( Pcnnii no.: .- City of Tigard Project/appl.no.: Expire date: City Tigard Address: 13125 SW Hall Blvd,Tigard,OR 97223 Date issued: By: Receipt no.: Phone: (503) 639-4171 Fax: (503) 598-1960 Case ftie no.: Payment type: _ _ - Land use approval: - Building permit no.: 7'n�lq familydwelling or accessory U Commercial/industrial U Multi-family U•Tenant improvement construction U Addition/alteration/replacement U Other: Wilim It 1 1 1 1 1 Job address: Indicate equipment quantities in boxes below. Indicat, 'he dollar Job address: Suite no.: value of all mechanical materials,equipment,labor,overhead, Tax map/tax lot/account no.: profit.Value$ Lot: Block: Subdivision: 'Se checklist for important application information and Project name. — luri:,,;:,tion's foo schedule for residential permit fee. City/county: ZIP: Description and location ol'work on premises:_ __ I •a t�' I t a Ft•t•(t•a.} 'total East.date of completion/inspection: Dewription 1y. Itrs.unlr Itt�.onit Tenant improvement or change of ust:: C' Air handling unit CFM Is existing space heated or conditioned?U Yes U No ircon it on ng(site plan required) Is existing space insulated?U Yes U No Alteration of existing H VAC system Boiler/compressors State boiler permit no.: Business name: +� L >yf 1��.-1` HP Tons 11TU/H _ Address: ,7 v $w `e '' Fir smo a amper uct smo a detectors City: S G�1u w__7zW atc:Oty 7.1 P: /,Z eat ump(site plan required) _ Phone:,y�7-62r5-0ra Fax: E-mail: -N-stall/replace urnac urner - Including ductwork/vcnt liner U Yes U No CCB no.: /U Z/S-�f nsta rep ac rc ocate eaters-suspended, City/metro lic.no.: wall,or floor mounted - iii""iZ ant ora ianceother thanfurnnce - 1 1 efr goat on: Absorption units 11TU/H Name: Chillers _�_ Hf - Com ressors til' Address: F.nvironmental exhaust and ventilation: City: State: ZIP: Appliance vent Phone: Fax: E-mail: )rycrex taust 0o s,Type res. itc 1e tazmat momhood fire suppression system Name: Exhaust lon with single duct(bath fans) Mailing address: -Exhaust s-stem a art from heat City: State:_ ZIP: 'ur p p ng andistribution up to outlets) — Ty ___—LI'G __ NO _ Oil Phone; Fax: E-mail: ue ng each additional over out ets Process piling(sc emat c required) Number of o-«lets Name: OlherlLst :; arca or equipment: Address: Decorativeftre IOLc City: State: ZIP: Insert etstove Phone: E-mail: Date:App!icant's signature: Name (print): — C, _-._�_ J Nd all}uddictiunt creep credit cards,please reel Jutisdirtion fa man infnrnu0at Permit fee.....................$ )Wm,a U MmlerCard Notice:This permit application Minimum fee................$ Ordit card number y>;'r/ o nG(J�j expires ire permit is not obtained Plan review(at _ %) $ p �tgdet within 180 days eller it has been State surcharge(11%) ....$ T Nerect mod- - accepted as complete. $ TOTAL .......................$ -- -- unt - 4404617(60"M) Electrical Permit Application "Dateeceived: (C /7 p !Permit �)�r , 2, City of Tigard Project/appl.rto.: Expire date: CiryofTigard Address: 13125 SW Hall Blvd,Tigard,OR 97223 Date issued: By: Rcceiptno.: Phone: (503) 639-4i71 — Fax: (503) 598-1960 Case file no.: Payment type: Land use approval: .;;w' &2 family dwelling or accessory U Commercial/industrial U Multi-family U Tenant improvement New construction U Addition/altcration/replacentcnt U Other: U Partial 11 SITE INFOItMATION .lob address: / J � ) /a�- 131dg.no.: Suite no.: _ Tax map/tax Iot/accour,t no.: Lot: Block- Subdivision: Project name: _ _ Description and location of work on premises: Fstinlated date of cr)ntplcli)at/utspr cti)m: CONTRAICTOR APPLICATION Job rlo: _ Fee Max z step-7, e- Description dq. (es.) 'total no.lns Business name: �� _ P New reshkntial-single or multi-family per Address: 103 /_ - S r �T dwelling unit.Includes attachedgarage. City: A..,ti I Slatc:6a I ZIP: C jYv Serviccincluded: Phonc:s-3-L/97- 1 Fax: I E-mail: 1000 sq.ft.or less 4 Each additional 500 sq.ft.or portion thereof CCB nn.: rJ � Elec.huff.IIC,no: Limited rnrrpv,residential 2 City/metro I IC.n0.: Limited energy,non-residential 2 Each manufactured home or modular dwelling Signature ot'sury•rvising electrician(rc uired) Ua Service and/or feeder 2 Slip.elect I,ir,n,,.,,,, 5ervicetorfeeders-installation, ui alteration or relocation: PROPPROPERTV OWNER 200 amps or less 2 Name (print): 201 amptto400amps 2 -- - -- 401 amps to 600 amps 2 Mailing address: 601 amps to 1000 amps 2 City: ___4-�— State: ZIP: Over 1000 amps or volts 2 Phone: Fax: Ii-mail: Reconnect only ) Owner installation:The installation is being made on property I own Temporary services or feeders- which is not intended for sale,lease,rent,or exchange according to installation,alteration,or relocation: ORS 447,455,479,670,701. 200 amps or less 2 201 amps to 400 amps 2 Owner's si IlatUl C: Date: 401 to 600 ams 2 Branch circulls-new,alteration, or extension per panel: Name: A. Fee for branch circuits with purchase of Address: — service or fe^.der fee,each branch circuit 2 City: State: 'LIP: B. Fee for branch circuits without purchase of service or feeder fee,first branch circuit: 2 Phone: Fax: Email: Each addilionalbranch circuit, Misc.(Service or feeder not Included): O Service over 223 amps-commercial U Health-care facility Each pump or irrigation circle 2 U Service over 320antps•ratingof Idr2 U liazardouslocati.m Each sign or outline lighting 2— (anti ly dwell ings (antilydwellings UBuildingover10,000squarereetfouror Signal circuit(s)aralimited energy panel, I.ISystem over 600volts nominal more residential units in one structure alteration,orextemio-0 _ 2 U Building over three stories U Feeders,400 amps or more •Uescri flow: U Occupant load over 91 persons U Manrdac tired structures or RV pork Fitch additional Inspection over the allowable In any of the above: U Fitress/lightingplan U Other- _. _ -- Per inspection —r—�— %bnnit__sets or plans with any of the above. Investigation fee The above are not applicable to temporary construction service. Other Not all jurluli,u,xu ntcep credit cards,please call JaNrdieuon rax rmxe inrannstian. Notice:This permit application Permit fee.....................$ isa U MasterCard 63 expires fro permit is not obtained Plan review(at _ %) $ _ crcjt►tcud nuy*hec S/ 6c'S'2 G�yy d'�7-I within 180 days after it has been State surcharge(896) ....$ — =/- 4 '-^- c Expires accepted as complete. TOTAL $ d us c cord S _ - card r sipu Amount 440 4615 16AXWOM) 40 N. L. y7 57, � z a t�• � d Zr lu 1 f 1 Q � M�`•�t ` Ir�,, 4.� �a V - +� 4T T-TtJ w IL kv. / �, cl