Loading...
10580 SW HIGHLAND DRIVE c , cu a E M p . � � oO (n w I -1 E C: CD h m 13 cirl W 7 (D W M U i- rt (D F+ O O X m 7 rty r` W " N O C H N• N H O C) �] H 7 fD rt J -ry ry C 7 0' r* W \ F, 11 H N• (i) CJI C. '" N In N• C H ., ❑D < 1r T1 NC-r" u O N —1 C_ (D S D Q) F-' m C H O rl• ,-4 m F-+ W Lo H r) m P. i 3 W F• (n N H. O rt O O' X17 11 O ri (1) n LO H O O rr CJ) H ci• cn O N O. M rt CL t- . (D (D W F N m c+ M !r rl iI Cr < 3 -� r*) —1 n r) a r i 0 r'1 n r i sa �) '*7 •O Ln Ln J L-) -*1 _=i (n C I� (x" • � C N• N W rt M 'iN N• W (A P. 7 0 H O E N• M H N H O +-' 27�� c � rJ n 7 H (D < W :0 O N• rt 71 F--+ M 3 H rt) O U O N r) �7 � • O C (D CL H 77 F ' U n H ') O M rr CL -� 0 (D O N (D J O C O O T ti• r•. .1 M (D (D r O Tt x N OP. rpl rt @ J O 3 Lo i �A `fJ � I � 1c; l SAIVO CIW4111DIH MS 0"1 CITY OF TIGARD BUILDING INSPGC"FION DIVISION 24-Hour Inspection Line: 639-4175 Business Line: 639-4174 MST _�-- ElUP LJH Date Requested__ ��� �/ er�f' M PrA �_— V / a — �. _ BLD Location g < L ) .1� E��l/IT Gc� \�(.� Suite MEC _ Contact Person --_ Ph PI-M _ Contractor :.�Ph ✓ _ (c �L= � � �7 SWR BUILDING Tenant/Owner L ' C Retaining Wall ELR Fuoting Access: _ Foundation 1 FPS Ftg Drain Crawl Drain Inspection Notes: SGN _ Post& Beam /-C -- SIT _ Ext Sheath/Shear Int Sheath/Shear Framing Insulation - ---- -- -- ---V---Drywall Nailing __.._ _- --- _ ____-----.-----..-.-----� f Firewall Fire Sprinkler -- Fire Alarm --- Susp'd Ceiling Roof Misc --- Final PASS PART 1-A;L 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►---•PAR-T.- FAIL ELEC7RICAL -- _.�__ --- -- ----- -- Service Rough In 1 J -- -- -- ----- -----— — - ---—— --- UG/Slab Low Voltage ( � - F' nm I S BART � FAIL' Backfill/Grading - -- -- - -...--- ------- --- ------- - __ .....-_ Sanitary Sewer Storm Drain ( ]Reinspecton fee of$ required before next inspectiao Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line ( ]Please call for reinspection RE: llnable to inspect no access ADA Approach/Sidewalk Date l ' v Inspector V ' '� '' Ext Other Final PASS PART FAIL_ 00 NOT REMOVE this inspection record frorn the job site. CITY OF TIGARD PI-AIMBING PERMIT DEVELOPMEN7 SERVICES PERMIT #. . . . . . . : PLM913­0401 13125 SW Hall Blvd,, Tigard,OR 97223(50x)639-4171 DATE ISSt 'D: 10/29/98 SITE ADDRESS. . . : 10580 SW FI (GHL..AND DR PARCEL.-: ;R'3+ i ODD-05,3100 SUBDIVISION. . . . : SUMMERFIEI_D NO. 4 ZONING: K-7 DI-OCK. . . . . . . . . . : I—OT. . . . . . . . . . . . . : 153 JURISDICTION: TIG ------------------------------------------------------------------ - CI—ASS OF WORK. . :AL.T GARBAGE DISPOSALS. : 0 MOBILE HOME 'SPACES. 0 TYPE OF USE. . . . :SF WASHING MACH. . . . . . : 0 BACI;FL.OW PREVNTRR. . 0 OCCUPANCY GRP. . FI-OOR DRAINS. . . . . . . 0 TRA'S. . . . . . . . . . . . . . 0 13TORIES. . . . . . . . WATER HEATERS. . . . . . I CATCO SA31NS. . . . . . . 0 L-.AIJNDRY TRAYS. . . .. . : 0 13F RAIN DI-0I NS. . . . . 0 SINKS. . . . . . . . . . 0 URINAt..S. . . . . . . . . . . : 0 GREASE TRAPS. . . . . . . . Vi 1_nVATORIES. . - . . 0 OTHER F I XTURES. . . . - TUB/SHOWERS. . . : 0 SEWER L.INE (ft ) . . . WATER CL-OSETS. . 0 WATER LINE (ft ) _ . DISHWASHERS. . . . ; 0 RAIN DRAIN (f t ) . . . Remarks : Removing ele,.7tric water heater and replacing witt-i 50 gal. gas watpj- v1pater. Owner: FEES COPOi... KRONEWEITTER type amok.int by date rerpt 1.05130 SW HIGHLAND DR PRMT $ E'5. 00 B 10/29/98 98-310397 'TIGARD OR 97224 5P(__T $ 1. 2"5 B 10/29/58 98-310697 Pl-lone COLUMBIA HEATING & COOL IN13 INC r,,o sox 230397 8900 SW BURNHAM ST STE E-110 TIGARD OR 97281-0397 r1hone #: 624-2704 >i 26. 25 TOTAL REQUIRED INSPECTIONS This permit is issued subject to the regulations contained in the Misr. Inspection Tigard Municipal Code, State of Ore. Specialty Codes and all other Final Inspection applicable laws. All work will be done in accordance with approved plans. This permit will expiry if work is not started within 180 days of issuance, or if work is suspended for more than :30 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. rose rules are set forth in OAR, 952-001-0010 through OAR 952O.-000I-0080. yoe may obtain copies of these rules or direct questions to OLWt' by calling (503) T s s�i e d By:__- Permittee Siqnat - 1) +4•+++++.++++++++++++.. +++++++++++++++++•++-+++++++++++++4-+4-4+ ++++++++++++++•++++i- Call ...44.......4-++++.4- Call 639-4175 by 7:00 p. m. for an inspection needed the next business day .........4•.......4.++++-4...4....... ..............................4-++++4, CITY OF TIGARD Plumbing Permit Application Plan Check# 13125 SW HALL BLVD. Commercial and Residential Rec'd By TIGARC, OR 97223 Date Recd (503) 039 4171 Date to P.F. _ Print or Tvpe Dale to DST Incomplete or illegible applications will not be accepted Permit# pc/- Related SWR Called N me of Development/Project � ——1 FIXTURES (individual' QTY PRICE AMT Job N7 L) f"1)H I IL)J l Jic -. Sink - --- — --- 900 Address Street Address Suitr>---� Lavatory 9.00 o'!;"yo 5L L) �Z L _ Tub or Tub/Shower Comb. 9.00 Bldg# City/St to Zi J Shower Only 9.00 - �( Water Closet 9.00 { ('I roncw I ►f K Dishwashers _ 900 Owner Mailing Address Suite Garbage Disposal 9.00 I Washing Machine "-� 9,00— CI /Stale z1b Phone - I / O C r_23 1 Floor Drain/Floor Sink 2' _ W 900 - -v� -- Na_e I 3" 9 00 O J)I r- _ 4 -`---- 9.00 Occupant Mailing AddressSuile Water Heater fYconversion O like kind 9.00 — _ Gasp ing requires a separate mechanical permit I _ L (��• City/Stale 711 Phone Laundry Room Tray — 900 /7 - ----__---. Urinal 9.Go l_( (2 1(1 C -- Other Fixtures(Spc_iff) 00 -- Contractor ailing_Address Suite — 9.00 ~<. h'a __ 9.00 Prior to permit Cit/State 21 Phone Sewer- 1 at 100' 3000 issuance,a ropy 2 C �Ut. — Sewer•each additional 100' 25.00 of all licenses are Oreg/nJ CoConst.Cont.Board Lic.#I Exp.Date __-- required if 1-7 61 G� Were Service• Est 100' 30.00 expired in COT Plumbin Lic.# Exp.Date Water Service-each additional 200 25.00 database 3��/ 7_7� j/-� Storm&Rain Drain-1 at 100' V 30.00 Name Storm&Rain Drain-each additionai 100— 25.1,o Architect _ _ Mobile Home Space — 25.00 Or Mailing Address Suite Commercial Back Flow Prevention Device or Anti- 25.00 Pollution Device _ Engineer City/State Zip Phone Residen!ial Gackflow Prevention Device* s 1500 (Irrigation timing devices require a separate Describe work to be done: -� restricted_energy permit.) New O Repair O Replace with like kind: Yes 0'No ©" Any Trash or Waste Not Connected to a Fixture 9.00 Residential 0-' Commercial O _ Catch Basin 9.00 Additional description of work: II Insp.of Existing Plumbing 40.0 , *J)I oe Oe4r,c cc.+cl et- lllh!a.AQr+ — Ler/hr Specially Requested Inspections -- 40.00 per/hr Are you capping, moving or replacing ary fixtures? Rain Drain,single family dwelling - 30.00 Yes O No O Grease Traps 9.00 If yes,see back of forrrt to indicate work performed by QUANTITY TOTAL fixtwi. FAILURE TO ACCURATELY REPORT FIXTURE Isometric orriser diagram lerequired nQuenTotal ia�s _WORK COULD RESULT IN INCREASED SEWER FEES. 'SUBTOTAL I here__by acknowledge that I have:ead this application,that the information given is correct,that I am the owner or authorized agent of the owner,and 5%SURCHARGE that plans submitted are in compliance with Oregon State Laws L7 8lgnat R dwnerlAge Date ""PLAN REVIEW 25%OF SUBTOTAL Required only K fixture qt .Notal is�9v-`— 's �G TOTAL - -- Contict Person Name Phone 'Minimum permit fee is$25+5%surcharge,except Residential Backflow Prevention Device,which is$15+ 5%surcharge "All New Commercial Buildings require plans with isometric or riser diagram and Plan review I Vistshplumapp dm 7f AM PLEASE COMPLETE: Fixture Type -- Quantity by Work Performed _ Sink New Moved Replaced Removed/Capped _ -- — ---I ----- — - - Lavatory --_-^--- --- --- — -- _- —_ — i ub or Tub/Shower_ Combination Shower Only — — Waler Closet — ---- -- -_— - -- --- ____ - Dishwasher Garbage Disposal _ — -- Washing Machine Floor Drain/Floor Sink 2" -- 411 _Water Heater - _ -- ---- - _ Laundry Room Tray — - Urinal Other Fixtures (Specify) COMMENTS REGARDING ABOVE: d^,Isy.h una,,dor.-;rrCu, CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24-Hour Inspection Line: 639-4175 Business Line: 63 4�1 Date Requested � _ .-\ AM _�/PM BLIP BLD Location 6 tC'�� Suite P- MI: Contact Person Ph - .� / --� � Contractor / - _ Ph SWR -- BUILDING Tenant/Owner 4 - y�— ELC -_�- Retaining Wall ELIR Footing ACrr;ss: Foundation ,�- /f) FPS Ftg Drain �:°-!.� ,l•�1 ...�.� (.0 - V T� l� �0,�] �-- Crawl Drain inspection Noes: SGN Slab -}-� SIT Post& Beam AM ------- Ext Sheath/Shear Int Sheath/ShearFraming Insulation Insulation '- --------- Drywall Nailinq _ Firewall --_---- Fire Sprinkler - Fire Alarm - - -- - - - Susp'd Ceiling Roof 1 Misc: �• lV--� �C�✓b�2-t1.J �'L� Final _ ------ PA RT FAIL - UMBIN Post R Beam - --------- - - ___-__N__ Under Slab Top Out _-.-- Water Service Sanitary Sewer Rain-,"Trains Fin 1pARTrAIL a—• -- __._.—_� _------` �_ Post& Beam Rough In 11 Gas Line �(,Lik Sm ke Dampers in -- - -- - -- -- -- - - ----- -- ----- ------ �SS DART FAIL FtICAL -- - — Service Rough In _---- --- UG/Slab I --- - -- - -- --------- _- - -- — Low Voltage Fire Alarm Final `J`- PASS FART FAIL SITE ---.._...----------- Backfill/Grading ---- - --- -- -- -- - ----— Sanitary Sewer Storm Drain [ J Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SVS!hall Blvd Catch Basin Fire Supply Line [ ]Please call for reinspection RE: - v ____ ( J Unable to inspect no access ADA _ Approach/Sidewalk l C C ► �/ ` I L Other Date -- ------- Inspector V(it Ext Final PASS PART__ FAIL- DO NOT REMOVE this inspection record from the job site. /� CITY' C F TI G A R D MCCPEARN RM IT ICAl. DEVELOPMENT SERVICES PERMIT ##. . . . . . . : MEC98-0484 13125 SW Hall Blvd,, Tigard,OR 97223(503)639.4 i 71 DATE ISSUED. 10/29/98 PARCEL: 2SIIODD-05300 SITE ADDRESS. . . - 10580 FW HTr3HI.._(1Nl.) DR SUBDIVISION— , - qUMMERFTELD NO. 4 ZONING: R-7 BLOCK. . . . . . . . . . .. LOT. . . . . . . . . . . . . : 153 JURISDIrTTON: TIG ------------------ CLASS OF WORK. . :ALT FL.O'-' FURN. . . . : 0 EVAP COOLERS: 0 TYPE OF USE. . . . :SF UNI . ~:EATER9. . -. 0 VENT FANS. . . : 0 OCCUPANCY GRP. . : R3 VENIS W10 APPL: 0 VENT SYSTEMS: 0 STORIES.. . . . . . . . : 0 B 0 1 L E R 9/C,0 M P R E S S 0 R 5 HOODS. . . . . . . : 0 FUEL TYPES- .---.- _------ 0-'3 HP. . . . : 0 DOMES. INCIN: 0 GAI .5 3-15 HP. . . . . 0 COMML. TNCIN: 0 MAX INPUT: 0 RTLI 15-30 HP. . . . : 0 REPAIR UNITS: 0 F IRE DAMPERS?. . : 30-50 HP. . . . : 0 WOODSTOVES. . : 0 GAS PRESSURE. . . : 504. HP. . . . - 0 CI_.O DRYERS. . : 0 NO. OF UNITS----- ­­­ ­.- AIR HANDI.. ING UNIT5 OTHER UNITS. : 0 rURN ( 10VIK BTU: 1 10000, cfM: 0 GAS OUTLETS. : I F*J.JRN ) =100F, B*TU: 0 10000 rfm: 0 Pe;rarks: Removing gas furnace and replacing with %,NO BTU gas furnace. Owner: FEES CAROL KRONEIIEITTFR type amount by date reept 10580 SW HIGHLAND DR PRMT $ 25. 00 B 10/29/98 98--310397 TIGARD OR 97224 5FPCT $ 1. 25 B 10/29/98 98-310397 Phone #: Contractor: ------------------------------ -- COLUMBIA HEATING & COOLING INC PO BOX 230397 26. 25 TOTAL. TIGARD OR 97223 Phone #: 624-2704 Reg #. 000763 REQUIRED INSPECTIONS 'This permit is iss,,FH subject to th4 regulations contained in the Goo Line nsp Tigard Municipal Code, State of Ore. Specialty Codes and all other Mechanical I n s p applicable laws. All work will be done in ac_ordance 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 tho Oregon Utility Notification Crnter, Those rules are set forth in OAR 952-001-0010 through OAR 952.441-0080 You may obtain copies of these rules questions to OW by cail;ng I S S Ue By Permittee Signati. . ...... . ............4................ ........4•........4-+f.............................4-+ ,- Call 639-4175 by 7:00 p. m. For inspections needed the next bi.tsiness day . ..................4-4++4,++++.i ..............++4................................... L Plan Chet,I CITY QF TIGARD Mechanical Permit Application Rer,'d By 13125 SW HALL BLVD. Commercial and Residential Date Recd I 2 TIGARD, OR 97223 Date to P E. (503) 639-4171, x304 Date to DST Print or Type Permit#_� Incomplete or illegible applica`ions will not be accepted Called _ -- — 147e of 0evelnpne roject J r,escription --- —Y- -C_�'LY7 AGI�f�(XL/1 r Table 1A Mechanical Code Ot Price Amt Job Street Address 8We# A) Permit Fee —_—_ 10.00 / 1) Furnaces to 100,000 BTU Address -J` � lL/�f/1Q includin�ucts&vents _ 6.00 �11v Bldgk /stile Zip 2.) Furnace 100,000 BTU+ !J eye ��7.�, / includingducts&vents 7.50 i Ng(11e(or�•an of b slness)` 3) Flocr Furnace, / includin vent 6.00 Owner l GLJ '! �/ — — Mailing Address 4) Suspended heater,wall heater � _or floor mounted heater _ _ 6.00 _ l U/1�! /l 5) Vent not included in appliance permit C!Y/state Z p Phone 3,00- _ CHECK ALL 'Boiler Heat Air ----- ------- Na a(or name of business) THAT APPLY: or Puma Cond Qty Price Amt �mF 6)<3HP,absorb unit tc _ — -- Occupant Mailing Address 100K.BTU _ _600 71 3-15 HP;absorb unit CMy/state 'IpPte—none 1_001k to 500k BTU 8)15-30 HP,absorb unit.5-1 mil BTU _ _ I 15.00 _ Contractor NB f S)30-50 HP;absorb unit 1-1.75 mil BTU 22.,50 Prior to permit ailing firebs 10)>50HP,absorb unit issuance,a copy I 1 "...75 mil BTU ^_ __ 37.50 of all licenses c"y'state ZIP Phone 11)Air handlin nit to 10,000 CFM are required if Ir 1. q 7G _ _ 4 50 expired in COT Oreg n Const ..mt. eard L1c* Exp Date 12)Air hanWmg unit 10,000 CFM+ da'3base Arch;!ect I Na ne 13)Non-portable evaporate cooler _ _4,50 �Mi IIIng Addroas 14)Vent fanconnected to r,si,rle ductOr ___ ___ 3.0.0 _ 15)Ventilation system not included in Engineer Clty/Firr;: zip Phone appliance permit _ 4.50 16)Rood served by mechanical e.,haust Describe work to be done — v 4.50 17)Domestic incinerators New C` Repair O Replace with like kind Yeto-1Vo O — 7.50 _ Resid,ntia, Commercial r; 18)Commercial or industrial tyre incinerator v _ _ 30.00 Add•ional information or descripPon of work 19)Repair units 4.50 —_ 20)Wood stcve -- ------ 4.50 v ` 2.1)Clothdr,etc. Clothes d 50 Type of fuer oil O natural gavV LPG O electric O 22)Other units _ 4.50 I herebyacknowledge that I have read this a lication,that the information 23)Gas pining one to four outlets 9 PP J12 00 /?�J given is correct,that I a„1 the owner or authorized agent of __ the owner,that plans submitted are in compliance with Oregon State lav,s 24)More than 4-per outlet(each)— 0 5 Signa v of Owner/In Date � — z,_ I Minimum Permit Fee 625.00 SUBTOTAL > L 5%SURCHARGE 5 Cfin t Person a Pham _ PLAN REVIEW 25%OF Sl18TOTAI Required for ALL commercial permits only CJ���-- L TOTAL— - �) 'State Contractor Bo°nr Certification required "Residential A/C requires site plan showing placement of unit I\mechperm dor. rev 07/20/98 CITY OF TIGARD ELECTRICAL PERMIT DEVELOPMENT SERVICES PERMIT #: ELC98--0648 13125 SW Hall Blvd., hgatd,OR 97223(503)639-4171 DATE ISSUED: 10/27/9E-1 PARCEL: 2S110DD-05300 F31TE ADDRESS. . . .- 10580 SW HIGHLAND DR SUBDIVISION. . . . :SUMME'RF I ELD N0. 4 ZONING!,R---7 BLOCK. . . . . . . . . . : LOT. . . . . . . . . . . . . : 1.53 JURISDICTION: TIG Project Description: JC111641 UNII------ --------T*Fiv1P SRVC/FEEDERS-.--..--- -------M I 9CELLANEOt.JS------ 1.000 SF OR LESS. . . . : 0 0 7=00 amp. . . . . . . : 0 F01P/IRRIGATION. . . . 0 EACH ADDIL 500SF. . . : 0 20I 400 amp. . . . . . . : 0 SIGN/OUT LINE LTG. ., 0 LIMITED ENERGY. . . . . : 0 401 600 amp. . . . . . . : 0 SIGNAL/PANE1.. . . . . . . 0 MANF. HM/ SVC/FDR. . 0 601+Amps--1000 volts, : 0 MINOR LABEL ( 1,'r) . . . Q) ----BRANCH CIRCUITS------- --.-.-ADD9L INSF',7_CT1ONS—-- 0 200 amp. . . . . . : 0 W/SERVICE OR FEEDER: 0 PER INSPECTION. . . . . : 0 C'01 400 ramp. . . . . . : 0 1st W10 jRVC OR FDR. : I PER HOUR. . . . . . . . . . . : Q) 401 6011 amp. . . . . . . 0 EA ADD' L_ BRNCH CIRC: 3 IN PLANT. .. . . . . . . . . . : 0 601 1000 amp. . . . . : 0 REVIEW SECT I loc.rb+ amp/volt. . ., . . : 0 ) =4 RES UNITS. . . . . . . . : ) 600 VOLT NOMINAL. . : Reconnect only. . . . . . 0 SVC/FDR ) = 225 AMPS- - CLASS AREA/SPEC OCC. : Owner: FEES OWNER type amol-int by date reept 10580 SW HIGHLAND DR PRMT $ 50. 00 JSD t0127138 98-310312 TIGARD OR 97224 5PCT $ J-'. 50 JSD 10/27/98 98-310312 Phone #: Contractor: ----------------------------- JPC ELECTRICAL SERVICES INC $ `;2. 50 TO TAI_ 4120 13E INTERNATIONAL. WY STE A-107 REPUTRED INSPECTIONS 11ILWAUKIE OR 97222 RoI.Agh--iTi Elect' l Final Phone #: 654-3325 Elect' l Service Reg #. . .- 001255 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Oregon Specialty Codes and all other apolicable laws. All wnrk will be lone in accordance with approved plans. This permit will expire if work is not started within 130 days of issuance, or if work is suspended for more than 180 days, AITENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Centtr. Thos, rules arset forth in DAR 952-0014010 through DAR 9521-001-1987. You @a "*'tip a copy of these rules or direct questions to OUNC,#y calliny((993 {,`1987. /4 Pprmittee 5ir g na t 1-t rc_ e SSI.Aed B --------_--------------------OWNER INSTALLATION ONLY----------------------------- The installation is being made an property I own which is not intended for sale, lease, or r,?-rt. OWNER' S SIGNATURE: DATE: --------------------------CONTPPrTOR I NSTALLAT ION ONLY— SIGNATURE OF SUPR. ELECI N. DATE: LICENSE NO: +++++++•++++++++++++++-++-+-4•+++++; I i-+++++++++++++++++++++++++++4-+++++++++•+++++++++ Call 639-4175 by 7:00 p. m. for- an inspection needed 'the next bt-Isiness day ++++++++++•+-++-+++-+-++•+++++++++++++++++++++•++-+++++++++++++•++++++++++++++++++++ JC Comn-unay Development ELECTRICAL PERMIT APPLICATION 13125 SW Han Blvd. RECEIV Tigard, OR 97223 Planck/Rec. # � ��q ermit # Phone (503) 639-4171 ate Issued FAX (503) 6£34-7297, .,,r 1 CITY OF TIGARD TUD No (503) 684 ��'UulTY DEviLa GIBeued by Inspection (503) 639-4175 1. Job .Address: 4. Complete Fee Schedule Below: Name of Development �,{ Number of Inspections per permit allowed Address y�) Su f Iltahlong ,fir, - Service Included Isms Cost(ea) Sum City/State/Zip Ctitcd 0 c 4s. Residential-per unit 1000 aq ft of lens $110.00 Each adell,onal 500 no 11 or -� -- Name (or name of business) �� portion thereof $2600 + Commercial❑ Residential LimdadEnergy -�� Mon F- wwt'd Home or Modular Dwelling Senses or Feeder $6800 2a. Contractor Installation Only: 4b.Services or Feeders / I 'Wallation,alteration.ur reloralion 2 Electrical Contractor �Ct Ct l �Ir i c``• ' I 200 amps or less $6000 2 Address j` f 1 pc t t a t71 0 201 amps to 400 amps �- $8000 2 City_ d L1 t,t_ r State Zip_ 401 amps to 1500 amps $12000 2 601 amps to 1000 amps $18000 2 Phone No. 4-, ��.� Y Over 1000 amps or volts $34000 2 Contractor's License No. 4 C= Reconnedonly _— $5000 Contractor's Board Reg. No. / 5-5 ,q ZZ 4c.Temporary Services or Feeders /r Installation,alteration or rni��nl on ? Signature of Supr. Eleic'n / 200 amps of lone S5000 7 License No. S e No. S 201 amps to 400 amps $7500 — 2 „- 401 ampa to 600 amps $10000 over 600 amne to 1000 volts — 2b. For owner lnstullat/ons: see•h•nbx e 4d. Branch Circuits Print Owner's Namf, _ New alteration or extension per panel Address_ a)The lee for brooch nrcurts with City Stat@ Zip purchase of eeryice or$leader Ase, 2 - Each branch circuit $1,100 Phone N0. b)The tea for branch circuits wllhorrt The installation is being made on property I own which is purchase or service or bodw Ase, f Od 2 S. not intended for sale, lease Or rent. Fvst bunch circuit $3500 2Each r.ddnronal branch circuit 00 Owner's Signature - _ `- 4a. Miscellaneous (Service or feeder not included) 2 J. Plan Review section (i1 required): Each pump or Irrigation pme $40 00 2 Each sign or outline lighting $4000 Signal cirruit(s)or a limited energy 2 Please check appro,rriate item and enter fee in section 5B. panel,alteration or exleneton $4000 4 or more residential units in one structure Minor Labels(10) st0o 0n Service and feeder 225 amps or more _System over 600 volts nominal 4f. Each additional inspection over Classified area or structure containing special occupancy the allowable in any of the above as described in N.E.C. Chapter 5 '"'""r°" " $1�on 11 $56 oo Subryit 2 sets of plans with application where a^ 1'1;v1! $55 00y of the above -- apply Not required for temporary construction, services. $. Fees: i NOTICE 5a. Enter total of above fees $ 5%Surcharge(.05 X total fees) $ PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $ AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF 5b. Enter 25"/.of line A for CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR Plan Review it required(Sec 3) $ A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $ COMMENCED C� Trust Account M $ ' C7 Balance Due $ .amm,ne.,n.w�am.ao