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16725 SW MATADOR LANE I 3NVI voavivW MS su% t i L'J g a � a o o a a 3 7.tJ N N ti r 16725 SW MATADOR LN CITY OF TIGARD BUILDING INSPECTION 0XISION MST 24-Hour Inspection Line: 639-4175 Business Line: 639-4171 I BUP _ Date Requested L'4 I / 3 9 AM PM BLD Location 7��.S_ �- Q Suite MEC _ Contact Person Ph PLM Contractor tW C kt,tU� Ph -�`� s0-0-t� SWR BUILMV5 Tenant/Owner ELC Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: Slab SIT Post&Beam Ext Sheath/Shear Int Sheath/Shear Framing — Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm J ' Susp'd Ceiling --_ — — Roof Misc: -- Final PASS __PART FAIL — — LUMBING -�r-13€am Under Slab Top Out Water Service _ Sanitary Sewer EWU Drains in S PART FAIL _ — ANICAL Post&Beam — Rough In Gas Line -- -- Smoke Dampers Final — — -- PASS PART FAIL ELECTRICAL _ d Service —_ — -- Rough In rn UG/Slab C Low Voltage — J Fire Alarm m Final PASS PART FAIL � SITE Backfill/Grading Sanitary Sewer Storm Drain [ ]Reinspection fee of$ — required before next inspeclion. Pay at City Hall, 13125 SW Hall Blvd Catch Basin [ ]Please call for reinspection RE: — [ ]Unable to inspect-no access Fire Supply Line — ADA Approach/Sidewalk Date InspectorExt 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: 639-4176 Business Line: 6394171 - BUD Date Requested /.,�// 3 9 AM PM BLD _ Location_ I �� 7 .5" �cy A�O 6�&Y,-' Suite MEC ( q 9-00 3� Contact Person Ph PLM Contractor lug A CO6Ls Ph SWR BUILDING Tenant/Owner ELC Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain Crawl Drain Inspection Notes: SGN Slab SIT Post&Beam -- Ext Sheath/Shear Int Sheath/Shear Framing Insulation r' Drywall Nailing Firewall - -- Fire Sprinkler Fire Alarm r-}, C7 - � Susp'd Ceiling _ _ l..0 0 Roof -� Misc: Final PASS PART FAIL PLUMBING Post&Beam -- Under Slab Top Out Water Service Sanitary Sewer -- Rain Drains Final - IPA" -PART FAIL _ MECHANICAL Rough In Gas Line Sm a Dampers S PART FAIL \ 15 LECTRICAL ���-- L Service C Rough In UG/Slab _ Low Voltage Fire Alarm j Final "p PASS PART FAIL _ SITE j Backfill/Grading - --- Sanitary Sewer Storm Drain [ )Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin [ Please call reinspection RE: Unable to Fire Supply Line ll fiiInspect-no access[ 1 ADA Approach/Sidewalk -2 pproach/Sidewalk9 Other Date Y_ 2 +hispector Ext Final _._ PASS FART FAIL DO NOT REMOVE this Inspection record from the job *It*. CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24-Hour Inspection Line: 639-4175 Business Line: 639-4171 Date Requested AM PM BUP BLD _ Location �J� Z S 02� , LG:L[lJC Suite _ MEC _ Conact Person Ph PLM Contractor Q0J?KAPh SWR _ �I BUILDING Tenant/Owner EL.. Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: — Slab _— SIT Post&Beam Ext Sheath/Shear _ Int Sheath/Shear Framing _— Insulation Drywall Nailing — _ Ale- Firewall Firewall - Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc: Final PASS PART FAIL --- PLUMBING Post&Beam -- — -- Under Slab Top Out Water Service Sanitary Sewer -- Rain Drains Final PASS PART FAIL MECHANICAL Post& Bearn Rough In Gas Line — Smoke Dampers Final -------- --- �_ —�_ --- PASS PART FAIL fv� a Sery 'I, .-_.. t` Rough In -— — -- -- CO) UG/Slab LLow Voltage L Fire Alarm m PART FAIL W Backfill/Grading — - Sanitary Sewer Storm Drain ( ]Reinspection fee of$._ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin ( ] Please call for reinspection RE:_ ]Unable to inspect no access Fire Supply Line ADA Approach/Sidewalk Date Inspector --��_EXt Other Final PASS PART FAIL I DO NOT REMOVE this Inspection record from the job 90te. CELECTRICAL PERMIT CITY O F T I G A R D PERMIT M ''LC1999-00543 ,., DEVELOPMENT SERVICES DATE ISSUED: 09/08/1999 13125 SW Hall Blvd..Tigard, OR 97223 (503)F39-4171 PARCEL: 2S 116AD-11000 SITE ADDRESS: 16725 SW MATADOR LN SUBDIVISION: KING CITY NO.13 ZONING: BLOCK: 210 LOT : 006 JURISDICTION: KIN Prosect Description: Ad,; two(2)branch circuits to an existing dwelling. RESIDENTIAL UNIT _ TEMP SRVC/FEEDERS MISCELLANEOUS 1000 SF OR LESS: 0 - 200 amp: PUMPIIRRIGATION: EACH ADD'L 500SF: 201 - 400 amp: SIGN/OUT LINE LTG: LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL: MANF HMI SVC/FDR: 601+amps-1000 volts: MINOR LABEL (10): SERVICE/FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS 0 - 200 amp: W/SERVICE OR FEEDER: PER INSPECTION: 201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR: 401 - 600 amp: EA ADD'L BRNCH CIRC: 1 IN PLANT: 601 - 1000 amp: _ PLAN REVIEW SECTION 1000+ amp/volt: _ >=4 RES UNITS: >600 VOLT NOMINAL: Reconnect only: _ SVC/FDR>=225 AMPS: CLASS AREA/SPEC OCC:__ Owner: Contractor: RICHARD MURPHY (GARY) COOPER ELECTRIC 16725 SW MATADOR 11845 SE 34TH ST KING CITY, OR 97224 MILWAUKIE, OR 97222 Phone: 503-603-0725 Phone: 653-8803 Reg#: SUP 2965S LIC 00042918 ELE 3-191C _M FEES Required Inspections Type By Date Amount Receipt Wall Cover PRMT GEO 09/08/199E $42.85 99-318169 Elect'I Final _SPOT GEO 09/08/1999 $2.99 99-318169 ORIGINAL Total $45.84 This Permit is issued subject to the regulations contained in the Tigard Municipal Code,Stale of OR. Specialty Codes and all other applicable laws. 0. All 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 more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0080. You may obtain copies of these rules ordirect questions to OUNC at(503) 246-1987. i PERMITTEE'S SIGNATURE ISSUED BY: m t3 _ OWNER INSTALLATION ONLY W The installation is being made on property I own which is not intended for sale, lease, or rent. OWNER'S SIGNATURE: _ DATE: _ _ CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N: -1 L�_ DATE:—2 LICENSE NO: C51- Call 639-4175 by 7:00pm for an Inspection the next business day U9-"UY'H0 SUN Ud. W MA OUJ aero LeoU BILI ur Liv.%nu CITY OF TIOARD RECEWF ectrlcal Permit Application Plan Cho&0 13126=W HALL BLVD. p"'d By TIGARD OR 99223Date Radt1 SEP (111999 tri DOW to pi Phone(603)030.4171,x3134 Inspeftm(503)638.417 MMUNITY DEVELOPMENT Dab b D1T �0 Print of Type r mu# E`Ll 14�4Y-c7d SU3 Wax(502)59111-41060 11 of of ftbb vm not b0 atZCwIlA1 a`. I. Job Adlwdra": A CftV*t4 F"Schede Bob w: Name ofWvelopment Aqlfivyf I It ghm Name(or name of buelneb) *WI"Ifleluded: "W" CA a cum IM ay.I.W we „>'., cnpr6eaiviJp A'7n�t2�,t/jQ3-� a.a,addlnlon.l W.a.n.or LlyperNen Commerdal ❑ Rala)denfW t� auront s 2a�1 dMd aitaryy Sash Maeurd Hone or m"dular Zi*. ConillarBlotlor 1nsU1le0on only: DAI&V OWN or Fasdar I►tlor Is po nrlt Issu mos,appsearbM must provide Osrre*oler Ibarlt:a 4&am"oss or Radars lmkm~for COT dlMe r NOWT MN AOR.W M a6ftOn ®ol.'IrlOel COrthaabr m Mlp a Mrs a 64.21 2 .ip 261 am"M 400 amps 1 am i It L.��✓ � y 400 amps b N0 on" �� �i1 tfa a0 2 City Alf! .l l►�t able JdY. ___ lap„ +7 101 dips to 1000 amps a ptwo No. - /d0 _,_ OW 1000 ulpa OF VOW "1 21!.76 — 7 Job No 1 10.10 t vw:.cont-666—No - d 6Xp.0ah !C—~ 4a Twrow"MrI orpwdem OR$tete CCB Rep No. ____Exp.Dub Itrtalaaon,aararen.or tMeealen CCT Business Tax or Mdm No. Ems, 1oo M"p'or a e140 2 201 rnpe to 400 amps 1 K21 2 &Ipnature M 6upr. Eleo'n _ 401 amps to 100 amp. On,100 amps to 1000 VOW LldMta No. Ev Oct wa mob"abew. Phone No. �—$ d 3 / �r 4d. ,a ftre en.or to �+.--� Now,11Mn1on,o•trtanalen per panel 1)TM Na for brfnaP*wb 2b. FOr owner/nSftllaftni: OM purehas of Iw*o or IYu1ar Abe. Prnt Owner's Name _ Iaah brand+dr.,rt a 1.11 _ 2 Address _ �_� b)Tta be kr brar4 oYoub "am OWWhaeo ofawyme City Phone No. 9" IJp RkM bo nd etadr 1 17.60 $70 KOM aedrseml bnnah drug► �1 1.21 The IraullMon Is being made on property I own wNch Is not 44.Mlueltanaaua Inbnded for sails, lease or rent rube or tbedar not a dxbL) ash pump or Woom okeM 1 42.71 OW!Mr'e SgMtUle +�! Each sign vou0 ms Ahem/ —1 42.11 Ivw corn aw or s kr Md anergy 3. Plain Review section(M rwW1r*W: War ubstltai(0) er axMnaln;r i 107,001000 pINM check approprlabs hm and airier Nae In awboa Bs. 4L Bash oddlaansl Inep"dw WW 4 or nwm reekNntlal unb In one ohuoturo the alkm bM In any of the above Sahaper and Warr 226 amps or more PW a"�1°s'" 8 6000 CL PW NOW �1 /000 ..Squsm ever ago volts nominal b1 plant { 1100 U) C us"area or atrudtwe COMMIrft 6"601 occupancy as dea0r2rsd N N.[.G.Ci+aplar a FW: t!r W legal M above tau e ' Wbmlt 2 vab or plarr wtet spollaWOn whom any e11na anew apply. 7 vuraruae(0/X tests teoq e m Not requhad for WWIM M aonatnatlon earvkraa. smmsw aA anal r W%of M M for STN plan Rayless Loom(am 3 e J pERMTS BECOME VVID IF t+ M OR CO"TRUCT10N AUTMORIUD d1bI101M _----- 16 NOT COMM6r10ED WTHM 180 GAYS,OR IF CONSTRUCTION 0R WORK It!9USMNDEd OR ABANOONBD FOR A PERIOD OF 160 DAYS ❑ Treat Amew is� 8 AT ANY T"AFTER WORK M OOMMONCED, T OIlti1 Dila ; i.`dw1(btmMleotrlc.doc SEP-08-99 WEU 09:35 AM City of v' Zg City FAX:503 639 3771 PAGE 2 KING CITY 1NWO S.W. l lfith Avenue,King City,Oregon MYA-2693 Phone (iA)3)ti I)A(M•FAX(W3)Pr99 3771 Notice To Contractors Working In King City Due to an intergovernmental agreement with the City of Tigard, many building related permits for projects in Kinn City are issued and inspected by the Cite of Tigard. If your permit application DOES No'r REQUIRE PLAN REVIEW, simply complete the appropriate application legibly and submit it to the King City staff. The Kine City staff will collect all fees and fa:;the application to the City-of Tigard. City of Tigard staff wilt then create the permit, issue the permit, and perform inspectior_s. Please indicate on the permit application wh,-cher you would like the Tigard staff to call you when the permit is ready for issuance or %�hether you prefer it to be mailed without any notification. Any incomplete or illegible application will be returned to King City staff for correction and no processing will occur until a complete, legible application is received. If your permit application DOES REQUIRE PLAN REVIEW, this form must be signed by a King City staff person. King City staff will simple sign this form indicating land use approval. Take this signed form to the City-of Tigard Development Services Counter located at 131.25 SW Hall Blvd, Tigard, to submit applications and plans. Development Services Technicians are available at 639-4171 Fxt. 304 should you have any questions concerning submittal requirements. All permit fees will be assessed and collected at the City of Tigard. n' The City of King City hereby authorizes ipplicant to pursue permits at the City of Tigard OC t- rn Building Department for the follovying project: _iu� 7 m located atA us_�I,y �G�dir O W King City Representative t AST%h'(1-,JT MW O MECHANICAL PERMIT CITY OF TIGARD DEVELOPMENT SERVICES PERMITM MEC1999-00339 13125 SW Hall Blvd.,Tigard,OR 97223 (503)63 DATE ISSUED: 8/12/99 PARCEL: 2S 116AD-11000 SITE ADDRESS: 16725 SW MATADOR LN SUBDIVISION: KING CITY NO.13 ZONING: BLOCK: 20 LOT:006 JURISDICTION: KIN CLASS OF WC`^K: OTR FLOOR FURN: EVAP COOLERS: TYPE OF USE: SF UNIT HEATERS: VENT FANS: OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS: STORIES: BOILERS/COMPRESSORS HOODS: FUEL TYPES 0 - 3 HP: 1 DOMES. INCIN: LPG 3 - 15 HP: COMML. INCIN: MAX INPUT: BTU 15-30 HP: REPAIR UNITS: FIRE DAMPERS?: 30-50 HP: WOODSTOVES: GAS PRESSURE: 50+ HP: CLO DRYERS: FURN < 100K BTU: 1 AIR HANDLING UNITS OTHER UNITS: FURN >=100K BTU: <= 10000 cfm: GAS OUTLETS: 1 > 10000 cfm: Remarks: Installation of one furnace, one a/c unit and associated gas piping. Owner: FEES _ MURPHY, RICHARD& BETTY Type By Date Amount Receipt 16725 SW MATADOR PRMT DEB 8/12/99 $50.00 KING CITY KING CITY, OR 97224 5PCT DEB 8/12/99 $3.50 KING CITY Phone:603-0725 Total $53.50 Contractor: PIONEER FURNACE 3615 NE BROADWAY PORTLAND, OR 97232 REQUIRED INSPECTIONS Heating Unt Insp Phone:249-5000 Cooling Unt Insp Reg#:LIC 36102 Final Inspection IL a _J This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other applicable laws. All 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 more than 180 days. ATTENTION: Oregon law requires you to follow ruleG adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through CAR 952-001-0080. You may obtain copies of these rules or direct questions to OUNC by calling (593)7-4'6,,9189. ,c1 �� �� Issue B • ��. GLA{ .�Ltsl(�Y12� Permittee Signature:J., Aa it Call (503) 6394175 by 7:00 P.M.for Inspections needed the nefxt business day wg► AUC-10-99 TUE 10.04 AM City of Kine City FAX:503 6'19 X771 PAGE 2 GI1Y OF TIGARD Mechanical (Permit Application Plan`h"a0 Red By_jE 13125 SW HALL BLVD. Commercial and Residential Date Reed >z- io -9'r TIGARD, OR 97223 Qac to Re. (503)639-4171, x304 Date w wTS 49 Print or Type permi1a tif-et?99-00339 Incomplete or illegible applications will not be accepted CAM aruvetopmeraNnise a;� n _ _� Table to Medtanksl Code QlY Pdo I AN Job gr.►,aaar"S— Per.�It ee 16.00 �0 7 G� 11 1) Fumace to 100,000 6TU Address ek+q Chrr3r L � •� Irld4ror ducts a venom —" Mn!!!e,to1,2 0.65 2) Furnace 100,00:BTU* 7 including duels A vents e41 foomob 1,2 12.00 Nametatimedt%xIneaa) 3) MwFumaoe Ownerro ` t) includingvent, see footnolt u a.W Suspends heeler,wall Mater 11 11Q or door mounted healer • see footnote 1,2 9.65 I U-7 � FA7Ada)Y 5 Vemtc not inted i,sppilarim pemid 4.741 qo Check all that appy: "Boller Heat 0n1(4 C [ i� (� �,�.D�' For Itemon s 6.10,see or Pump Cd Cb Prleo Mit kwm— M f) footnotes'1,2 6)cW;absolb unit to 100(t3TU 9.66 r. occupant Mi��n�wares:—T 7)Sas HP;eaaorb unk look to Wei BTU 17.66 CkWSUfe - --- Paami )1530 P;absorb unit.31 mit OTU _ 24.15 Name _-_ 1i)350 HP;absorb contractor unit 1-1.75 mil BTU 1 �` 19.00 01D ` C Ira OL V-" 4 YI_L r_t-, 10):BWHP:absorb kern — Prior b pramit Address --_— >1.75 mol BTU 60.15 imuanae,a appy _ / dt 11 Air handrmg�to 10,000 CPM of OR faenses 910suss M 7,00 aro 1 12)Air handing unit 10,000 CFM+ argued it COT Orovw canal caul_eoartt LJ . 1175 dotnnasc 2 f. 10 13)Non-portable evaporate cooler Architect No" N 7.00 114)Vent fan connectod to a soVli duct or Ma9h41A44rnat d.7S IS)Ventilation systtm not Ina in 010118mce permit _ _7,00 Englneer 1 Hood served by mechaniralexhaust 7.00 I)oacxihe work b be done: — 17)Domesfk indnerafors __ 12,00 New O Repair O Replace with Ake kind- Ye9�No O 10)Commercial or industrial type indnsrator Residential O commercial d __,--�- 40.2.5 19) pair units additional infornrafion or deu;afpaort Of work: MO 20)Wood stovelpas Mother unNa/clothe dryer/etc. ' 7.00 NOTE: For Commercial prokM only Unita ever 4001641,require 21)Gas'piping one to lour autiets StRMW pas wine. 8M footnote 1 3.75 ,7 Type of suet of O re[ural gee LPG O electric O 22) ae t an 4 oar outlet 418th 75 _ Minimum Permit Fen$50.00 • >t NOTAL I hereby admowledge that 1 have read this application,that the inf m+atlon Tib SURCHARO . given k correct that I em the owner or authorized agent.of PLAN R"EW 25 OF USTOTAL thn owner,that plans euhrnhted are in ourVance with Oregon Stab laws. Required for ALL eontmarclal rmils on — OT i Th } Signature or OwnerlAgont Other Inspectionsr:and Fee 1• Insipecflons outside cl normal btrnlnesa hours(mWrium chaigrtwo Contact Penton Name Phots hour's) 0tf0A0 per hour _/ 2- Imspeedons for which no flee to eptelAeatty Indlentod (minimum t (� p Aid— �a=-�� chargo-half hour) 250.00 per hour Foenotes lot cnmmarc projocts only: 3. Additional plan review required by changes:,addlMons or Wtions to t. Ftovoo tug schemadc of existing and proposed gas line and prewwre plans(minimum chat"ono-half hour SS0.00 per hour 2. Provide drawings to scab showing axkdng and proposed Mechanical units. i 'State Contradw Boger GertMndon required ~Residential AIC lequirai alterplan showing placement of unit I.tmeeh6erm.doe rev tit 4199 CITY OF T I CSA R D PLUMBING PERMIT DEVELOPMENT SERVICES PERMITM PLM1999-00260 13125 SW Hall Blvd.,Tigard,OR 97223 (503) 639-4171 DATE ISSUED: 8/12/99 SITE ADDRESS: 16725 SV'J MATADOR LN PARCEL: 2S116AD-11000 SUBDIVISION: KING CITY NO.13 ZONING: BLOCK: 20 LOT: 006 JURISDICTION: KIN CLASS OF WORK: OTR GARBAGE DISPOSALS: / MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: K4` BACKFLOW PREVNTRS: OCCUPANCY GRP: R3 FLOOR DRAINS. TRAPS: STORIES: WATER HEATERS: 1 CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB/SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Replacement of water with like kind. FEES Owner: _ "— Type By Date Amount Receipt MURPHY, RICHARD& BETTY PRMT DEB 8/12/99 $50.00 KING CITY 16725 SW MATADOR 5PCT DEB 8/12/99 $3.50 KING CITY KING CITY, OR 97224 _^ _ Total $53.50 Phone 1: 603-0725 Contractor: PIONEER GAS FURNACE 3615 NE BROADWAY PORTLAND, OR 97232 REQUIRED INSPECTIONS Phone 1: 249-5000 Final Inspection Reg #: LIC 003610 PLM 26-621 PB a oc ca This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. m Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. LU 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 Utility Notification Center. Those rules are set forth in OAR 952-0001-0010 through OAR 952-0001-0080. You mit o tabrFopies of these rules or direct questions to OUNC by calling (503) 246-1987. Issu By: _ Permittee Signature: -- Call (503) 634-4175 by 7:00 P.M.for an Inspection needed the next 14ness day A11G-1i!-99 TUE 10:05 AM City of King Ci+.y FAX:503 639 3771 PAGE 3 CITY OF TIGARD Plumbing Permit AppIIC8l110171 Plan Check0 _ 1.3125 SW HALL BLVD, Commercial and Residential Rec'dBy��QI.1__� TIGARD, OR 97223 DatR ROLA (503) 639-4171 Dale toP,E• _ Print or Type Dale to DST--11 /j 0 —t - Incomplete or illegible applications will not be accepted Panh'�e /'�11 /3.Y�h Related SWR! tte�r� Caped___ --- Named vcbtxrheni/PrrJae t7l' ,�-;? y Job Sink A Ii.W Address Street Address Su11e 1-evatory 11.50 jd� Tub or Tub/Shower Comb 11.50 6Mp s Glyr51e a Zipa Shower Only 11.50 Water Closet N 7Q 1 f 1 Y"w� hwasher 11.50 Owner Malling^A� rewi Sidle Garbage Disposal 11fo - 3. C/�5w-� WashingMacrAneCity/State ti Phone�7 `� o�a Floor Drain ooiSitk 2" „;- __ 4' 11.50 Occupant Mailing Address _ Suite Wsler Heider O convet>W O We kind 11.50 I I Gasp requires a separate mechanical permit.City/Stele tip one — Laundry Room Tray e N 5A Umal - 11.50 1T1sQ Other Fndures(Specify) - 15,00 Contractor b�S dress Suite Fria to permit Why/Shale I tip Acne "— issuance,atopy of all licenses are regen Cons.t;.onL Board Lic 0f�rp-pattee �p _ (epuirgd if / `7 expired In COT Plumbing Uc.0 Earp.021e database 1) 9�] $wver-1st 100 38.00 Nertre Sewer-each additional 100' 32.00 Architect Water Service-1x1100' 38.00 Or Mailing Address suite Wader Service.-each additional 200' 32.00 Engineer Gty/5tate� lip Phone steno Rain Drain.lgl100' 38-00 Storm A Rain Drain-each adrlil;onal 100' 32.00 Describe work M be done: T Mobile Home Space �^ 32.00 New O Repair O Replace with like kind: res No 0 Commerdal Sack Fbw Prevention Device 32.00 Residential 0 Commemial O —� Ra0dentlal Be-Wir-sPmven'on Device' 19.00 Additioal Aensai0on o_1w ork: - -- C tohBasin 1150 l t6,_a LqA ^ Insp.of Uoting Plumbing 50.00 n, Are you capping,movin§or replacing any fixtures? PKAY .— Yes)§. No O specially Requested Inspection- 50,00 If yes,see back of form to Indicate work performed by per/hr N fixture. FAILURE TO ACCURATELY REPORT FIXTURE ^Dra�h,:Ingle family dwelling 45-Do _ - — _ / -- WORK COULD RESULT_IN INCREASED SEWER FEES. Grease Irapa 111,50 -� I hereby acknowtodga that I hove read this application.that information QUAINTITY TOTAL m given is torted,that I am the owner or aulhorked agent of Use owner,s,wf I that fans Submitted are in co kenos WiIA Ore on Stats Laws. sameFtc or riaei diagram t reQukep M t]uentay TOtsi isl- W s t or Onun r Agent - TIM?? *SUBTOTAL jS ?? 7%9URCHARGE <:f C t Prson roma Ph nc / 71 Ql�� /' 102147- "PLAN REVIEW 27%OF SUBTOTAL rPOKS A' ti � J? r ;_ RIred onl i off o ary,Wi Yah)r� YOTAL K p n +0�13 Z+LEs f,,(p.uQ n µDi •( ! "" nr} •Meninlunr permh fee is 35n+7%tvrchupe.w=FA Resider,141 eatkaavr Proavklbn DeA m,w"beh b$25 v rA eurenarge '"An NewCommertelal Buildings ropunre pl rm wM leomcer dte etric or ritran►ane pion rttikr 1dfl�NbnNdlmapp.dnc 71aAa