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9335 SW LEHMAN STREET r 40 �D w w V r ac tzz N H M C�7 H f I I� i #9335 SW LEHMAN STREET "L A CITY OF TIGARD BUILDING INSPECTION DIVISION MST ,-IL,)/_u 24-Hour InipecfBcn Line: 6: 9-4175 Business Line: 639-4171 BUFF Date Requested— „� ! AM— _PM — — BLD Location � LC rnR. __ Suite — MEC — Contact Person _ _ Ph _,,2 3L-/ V _ PLM — Contractor Ph SWR BUILDING Tenant/OwnerELC Retaining Wall - ELR FouU^j Foundation A�rp''S CPS _ F=ig Drain _ SGN Crawl Drain Inspection Notes: / // ------ Slab - C-VYeokt-] c'C�di /Cv7 SIT Post& Beam -_--- -- Fxt Sheath/Shear Int Sheath/Shear - Framing Insulation Drywall Nailing Firewall --- ^;re Sprinkler vire Alarm Susp'd ;Piling Roof Misc. Fina _ ---- - -------------___.__ PA . ; PART FAIL PLUMBING Post& Beam __--- Under Slab Top Out -- -- Water Service Sanitary Sewn - - -- -T ---- Rain Drains Final _..---------- -- ----- - �PASS PART FAIL - �M,ECHANICAL I Post& Beam _.__-__-_�---_------- --•- - Rough In G,as Line ---------- _ -_- Smoke Dampers Final --�--------- __ - _ PASS PART FAIL fiervice Rough In ---- ---- -- -- --- UG/Slab Low VoFtage - PASS ' f ART FAIL - - - ---- ---- ----- --- Backfill/Grading --- ----- - -- ---- -- -�- --- Sanitary Sewei Storm Dmin I J Reinspection fee of$-__ -requh cd before next inspection. Pay at Cita Hall, 13125 SW Hall Blvd Catch Bann Fie Supply LinE t J Please call for reinspection RE _ _ _ J Unable to inspect-no access ADA Approach/Sidewalk _ Date( fL � Inspectoroter ' Ext Final PASS PAJRT FAIL DO NOT REMOVE this Inspection record from the jots site. CITY OF TIGARD BUILDING INSPECTION DIVISION �` 2.voj,ov6l7U 24-Hour Inspection Line: 635-4175 Business Line-:'639-417 +i 13UP _ Date Requested Z 3 —AM 7 V PM — BLD _ Location 3 S�Sw �>'�irri o„� ;,.2 _ Suite MEr. Contact Person _ _ Ph y _ PLM — Contractor Ph SWR --_ — ILDA ELC' FtS'i Wall ----— ------- ------ ELR _ Footing Access' - Foundation VL�w , G 74? FPS ------- - Ftg Drain aw brat Inspection Nctes SGN —_— — —_ SIT Post& Beam `, i S, ` - --- Ext Sheath/Shear Lti b Int Sheath/Shear - - Framing Insulation — — Drywell Nailing _-- ' j �Ai - Firewall J Fire Spriikler - Fire Alarm Susp'd Ceiling -__-- --- ___---_— _- - -_ Roof Misc: _--. ----�- — ------- --- ----- FineJ�� ---------- A S- PART FAIL_ C ��Y Post R Beam �._.�----- ------------ - --------- ---- Under Siab Top Out _-- Water Service Sanitary Sewy r Rain Drain xXry1 ��--------------- - -- --- ' RFART FAIL _-- ANICAL Post& Be -- --- - -------------__...�__.-- Ue A4 ' Gas tine __- �Smoke DampE:9-'L-%-A Final - --- - -- ---- PASS ?ART FAIL ELECTRICAL --- `-- —�— Service Rough In UG/Slab - --- --- --- ---- -- Low Voltage Fire Alarm ---- - ------- - — -- -- - ------- Final PASS PART FAILSITE _ Backfill/Gradinu Sanitary Sewer Stot.-i Drain [ ;Reinb,ection fee of$ _ _ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply L ine [ J Please call for reinspection RE:�..__ __— -_- [ Unable;o inspect-no access ADA f Approach/Sidewalk - Other Date v O 1 _ Inspector �Jl�� � _ -Ext'�� Final PASS PART FAIL J DO NOT REMOVE this inspection —mord from the job site. 2 CITY OF TIGARD BUILDING INSPECTION DIVISION 2,e o1_G U o 7U 24-Hour Inspection Line: 639-4175 Business Line: 639-4171 MST _ BLIPDate Requested S— Z- _ AMPM BLD --_—_ ---_-- Location _ 3 S ..e" Suite MEC +;ontact Person -- y Ph L S' Y 7 7 v PLM — ----_— — -- Contractor _ Phi 3� SWR UILDIN Tenant/Owner ELC Retaining Wall ~— _ ELR - `-- Footing -- Foundation ACC83S / _ l Ftg Drain (�( �C 6c�t �Gv✓ ( S�l ��•� C4 e,, J FPS S / ---- ------._.. Crawl Drain Inspection Notes. SGN Slab --------.-._-- Post&Beam - -.�--- --- - ---- --- SIT ----- -- — Ext Sheath/Shear Int Sheat:r/Shear - ----- -------- Framing ----------- Insulation - -- -----— ------ Drywall Nailing - - _- Firewall ---- - --- -- -- ---------- - -- - - -- Fire Sprinklr.r - Fire Alarm Susp'(+Ceiling ---__ --_----- _— Roof - —__-_ ----- —- ----- -- ------ .-- Mise ---- -- - --- PART FAIL - -- - -------- -- ------.....----- ------- - --- ---- -- ..._�_ hVMBING Post& Beam - -- ..._. ---- ----- -- -- ------ - - ----- --------- - - ---- .._. Under Slab TopOut -- --- --- ---- - -- - -- -------- Water Service Sanitary Sewer -------_._--___-_- - --_-- Rain Drains Final PASS PART FAIL Post& Beam -- ---- -.._ ---- -- ---- - Rough In --- - -------- -- Ga, Line -- - --------- . Smoke Dampers --- -------------_-_�_._��_ GA8-ECTRICAL � PART NAIL - - - - - --- -- - ----....-------- --- ---- - — Service Rough In UG/Slab Low Voltage --- --- — Fire Alarm -----------____-- Final ..__----- ------ - PASS PART FAIL SITE Backfill/Grading ---- ---- - ----_---_-- --- ---__--- ---- Sanitary Sewer Storm Drain ( ]Reinspection fee of$ ^-_ required before next inspection. Pay at City Hall, 13125 SW Hall Blw, Catch Basin -- Fire Supply Line ( ] Please call for reinspection RE:______ - _ ( ] Unable to inspect-no access ADA Approach/Sidewalk Other Date --�_1`'Z _--- Inspector E)a Final - -PASS PART FAIL 00 NOT REMOVE this inspection record from the job site. mow. CITY O F T I G A R D MASTER PERMIT PERMIT#: MST2001-00070 DEVELOPMENT SERVICES DATE ISSU=D: 2/26/01 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 SITE ADDRESS: 09335 SW LEHMAN ST PARCCL: 1S126DC-01001 SUBDIVISION: LEHMANN ACRE TRACT ZONING: R-4.5 BLOCK: LOT: 002 JURISDICTION- 'FIG REMAP.KS: 10' x 16' hedroorn addition BUILDING REISSUE: STORIES 1 FLOOR AREAS 141.(JOIRED SETBACKS REQUIRED CLASS OF WORK: ADD HEIGHT 1 i FIRST: 1HO at BASEMENT: at LEFT: 24 SMOKE DETECTORS: Y — TYPE OF USE: Sr FL OOR LOAD I, SECOND: at GARAGE of FRONT: PARKING SPACES TYPE OF CONST: 5N DWELL ING UNITS: FINBSMENT: of RIGHT: VALUE.: S 15,534 00 OCCUPANCY GRP: R3 BDRM. t RATH: 1 TOTAL: 1or)00 It REAR: PLUMBING SINKS: WATER CLOSETS: t WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN TRAPS. LAVATORIES: 1 DISHWASHERS: FLOOR DRAINS: SEWER LINES SF RAIN DRAINS: I CATCH BASINS: TUBISHOWERS. 1 GAFBAGE DISP. WATER HEATE IS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN<10OK: BOILICMP<AHP: VENT FANS: 1 CLOTHES DRYER: FURN—100K: UNIT HEATERS: HOODS: OTHER UNITS: MAXINP: btu rLOORFURNANCES: VENTS: 2 WOODSTOVES. GAS OUTLETS. ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS MISCELLANEOUS AUD'L INSPECTIONS 1000 SF OR LESS: 0 200 amp'. 1 0 - 200 amp WISVC OR FDR: I PJMPlIRRIGATION: PER INSPEC71ON. EA ADD'L 500SF: 201 400 amp. 201 400 amplot W/O SVCIFDR: SIGNIOUT LIM LT: PER HOUR: LIMITED ENERGY: 401 600 amp 401 600 amp' EA ADDL SR CIR: SIGNAUPANEL: IN PLANT VIAND HM/SVC/FDR: 601 - 1000 amu: 601.ampe•1000v: MINOR LABEL: 1000.amp/volt PLAN REVIEW SECTION Reconnect only: — —'--- >=4 RES UNITS: SVCIFOR>=225 A >600 V NOMI JAL: CLS A.REAISPG OCC: ELECTRICAL-RESTRICTED ENERG _ A.SF RESIDENTIAL _ B.COMMERCIAL _ AL'010&STEREO: VACUUM SYSTEM: AUDIO B STEREO: FIRE ALARM: INTERr'OMIPAGING. OUTDOOR LNDSC LT: BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPFIIRRIG: PROTECTIVE SIGNL- GARAGE OPENER: CLOCK: INSTRUMENTATION. MEDICAL: OTHR: HVAC: DATAITELF COMM. NURSE CALLS: TnTAL 0 SYSTEMS: Owner; Contractor: TOTAL, FEES: $ 655.33 TOBThis permit is subject to the regulations contained In the 9335 S MARSHAL BOB SW LEHMUELSAN INC Tigard Municipal Coda, State of OR Specialty Cn:'ds and 9335 SW LEHMAN ST 8735 SW LEHMAN ST all other applicable laws. All wol:,will hp.done 1n TIG^RD,OR 97223 PORTLAND,OR 97223 accordance with aF proved plans. This pert;+it will expire H work is not started within 180 days of issuance,or if the work is suspended for more then 180 days. ATTENTION' Phone: Phone. Oreg.ln law requires you to follow rules adopted by the Oreo,,o Utility Notification Center, Those rule,are set Reg#: 11c for'n in OAR 952-001-0010 ihrough 952-001-0080. You m Ay obtain copies of these rules or direct questions to C UNC by calling(503)246-1997. REQUIRED INSPECTIONS Footing Insp Crawl Drain.dackwater Electrical Service Low Voltage Plumb Final Foundation Insp Footing/Foundation Dr; Electrical Rough In Insulation Insp. Final inspection Post/Beam Structural PLM/Underfloor Framing Insp Rain drain insp Building Final Post/Seam Mechanica Mechanical Insp Shear Wall Insp Electrical Final Underfloor Insulation Plumb Top Out Exterior Sheathing Ins; MechaniLal Final Issued By : AL _ Permittee Signature Call (56) by 7:00 p.m. for an inspection needed the next business day 02 16 2001 10:23 FAX 50368472.97 Cita' of Tigard '4-P o0,. Buileing Permit Application -- - Dam recnved: City of Tigard Projeetlappl.no.. Expireda.e: CryoJTga.J Addmss13125 SW Fla-11 Blvd,Tigard,OR 97225 Phone: (503) 630-4171 Date,ssued: By: PLc _ tno.: Fax: (103) 598-1960 Care file no.: PaYmenttype- Land use approval: - 1 k2 fam ty simple eo,nulex. J 1 &2 family dwelling nr accessory O Commercial/industnal ❑Matti-family J Ncw constmctio r O Demolition O Addition/alteration/replaccmrnt la Tenant Itttpro.emcut ❑Pre sprvildcr/alarm 0 Other: �- - Job address: Bldg,no,: Surla no— 1 Lot: Block- Subdivision: L_,S:4.4 Tax mapllax Jot/account no: rProjact name: 'ZZ�Y ''r+--�� ------------� fh•scnpuon and loc:trion of work on premise slspccinl conditions:__A Name 66A06WA -- i Mai}, addmss g _ ,A��" f &z family dwelling; state LIP: $_ Valuation of work........................................ $ s G _ ' Phone: Fax.— -jE-mail: No of tledrvvms/baths................................. �.•-4_�- Owner's reptesentntivc; -- Total number of floors................................. -- F1 E-mail. New dwelling area ,;q.ft.) - Phone: .. Garage/carport are- (sq. ft.)......................... _ 1 r et.� Covered porch area(sq. ft.) ......................... Name: �1� `l .ire —- Dec}:arta(sq ft.) ..._ •-• Marling addrus,, �� -�• . . ............ ........... --- City: 5ta_c: ZII � Otho:structure area(sq ft' ......... ---- - CommerciaVinduitrlal/muni-[amilr: Phone: - Fax E•mail Valuation of work........................................ x �`�� Existing bldg.area(sq.ft.) ......................... -- Business mime -- J - New bldg.arca(sq ft) .............................. --- ddress GZ�„ a3_-• Numbcr of stories . .... ................................. ---- CiTy: State: Z1Pr�12;M_ Type of consuiretion - t'lione Occupancy group(s): Exisrinp CCB no.: I t3o 1 ----- - _ New: City/metro lic.no.: a Notice:All cuatncic:,and subcordrnctors arc required to be licensed with the Oregon Ccinstn,ction Contractors Bonrd under provisions of ORS 701 rind may be required to be licensed in the Address - / �. •__ �-_ - exem t 3onfrc where work-)s being ing reason If the applicnit is _ --4�--- exempt from licensing,the following reason oppGcs: City - State i ZIP: - ---- " - --- —_ _ Contact person: (,� �Iq Flan no -- Phcne: Fa�:•o E-mail: A — -- Name: iContacr person: Fccs due upon applic:ttiun ................... .. ... S _ -------- --- - Date rcocivcd: —_ Address: --- -- --- om_ State: l-LIT p:- Amount received ..... . .. .............................. C ---- _ � itync: -mall- -_ Pleare refer to fee scheduleFho - I hereby certify I have read and exmruned Ihjs application and the Not all ju ird.ct-on.acceri credit cards Flo di ^e call jun. rnon Pot mere iaArata:ea attached checklist. All provisions of laws and ordinances govcming this O visa J WizierCard en.d.i cwd npataC--- -- --J work will he compiled th, whc ei�fsg�ec�i�_f�_edj�hJe�_re,�in or not. F�1,r-.+ Authorized si�aeturc: .II1S +✓,1G JZA N-ft rn—to r caraholde.u.no.n an uedtt cord —� S Print name: Cudboldu el�aruce �mcan� N:mcc Tnis permit applicatinn cxpires if 3 permit is not obtained within I QO days after it has been accepted as complete. •14C•d6:3 r6fl'(W) t, I `/ " /,'A d' . tcb 09 01 04 : 10P Rayborn' s Plumbing , Inc . 15036912328 P .02 PIUCYIti1nE PCIIIIIt APCAt10' Date received Permit no City of T iga rd Sewer Permit No Building Permit No. 13125 sW hall Ql,i 'r,gard.OR 97223 ProtccVAp2No_ --_ Expire Date —, Mone 503 634•117 i,Fax 503 598-1960 Date issuod Qy Roeeipt No. band 11sc Aprtoval Case File No. Payment TyDe - J 1 ' +milv dNelling or accessory U Commexcial/industrial U Multi-farruly U'fenanl improvement U Nw,,constniclu,ri Ll Addibm/alteration/replacementU Food service U Other. _ Job address 9335 SW Lehman St Descnption Qty Fee Total New 1 de 2 family dwelling only: /+ 100 ft Bldg. No —� Suite no ` SFR(1,Hath $24920 0 'I ax map/tax lot/account no.: SFR(2)Bath __ —� 5350 0 SFR(3)Hath 5399 0 Lot Block. Subdivision — Each additional bath/kitchen S Project name Tobe} Site Utilities: Catch basin/_area drain S1660 (I City/County — — —_— lip — _ Dra}•wells/leach line/trench drian S --- Footing drain(no Lin. it $ 0 Descnptron and Location of work. Remodel Manufactured Home utilities-each $4040 0 Date of Completion/inspection Manholes — $ 11 Rain drain connector _ S (1 Sanitnry Scwcr(no.of linear feet)1U(1' $55 00 0 Business name : RAYBORN" PLUMBING Storm Sewer (nu of linear feet) IUD' _ _ S55 00 0 Address P U BOX 0 — Water Service (no of linear feet)1()()' _ $55 00 0 Fixture or Item City : TUALATIN — State OR 7.ip 97062 Absorption valve _— $16 60 0 Phone - 501 652-4119 Fax 503 691-231.8 Hack Ilow prevcriter S27 55 U E Mail Address WaynerrrRayborns.com Hackvvatet valve _ S1660 U _ Basins/Lavatory 1 $1660 16 6 CCD nu 87852 _�— Plu nb. Bus, No. 34-166PB Clothes Washer_ _ —_ $1620 0 City/Metro Li( No 001806 Dishwasher _ S1660 0 -- --- Drinking Fountain(s) 516.60 U Contractor's signature yks t --_—__ F.�mtui/sump Sly,ti0 0 Print name. Wayne Siebold Date :2/9/01 Expansion lank_ -- _ S 16 60 0 Fixtuie/sewer wp 116(,o 0 Floor drains!1]oor sinks/Ilnb S1G 6l1 0 Nsune Garbage Disposal $1660 0 Address '—— I lose Bibb _ $1660 _ (1 --— — — Ice:maker $16.60 (1 Cite State —_�- Intercel.lor/Grease trap — $16.60 0 Phone Fax PrimerY 316 60 0 Rmf drain (comniarical) S 16 60 0- -Sink,(s),Basin(s),Lav 's) S1660 0 Notice . This permit app),cation expires if a permit is not obtained Sump _ __ S11',60 0 within 180 days after it nas been accepted as complete. Tuhs/show.t/shover pan _ I 516.60 166 -- — Urinal 316.60 0 Notes Supplv STUPID S,.cond Fixture Form tWater Close 1 $1660 166 Water beaten Y S 16 60 0 Other — $1660 0-- 49.8_49.8 Minimum 4,;e > Visa Card 0 48'43 4900 0291 004 Expire Date -09/01 Plan M,icw r(P10'1/0 Cardholder name- Howard L Ravbom State charge 08°%, SIGNATURE Y -- _ _ _ Amount$— _ --- — — Total Feb-09 01 04 : 10P Raybor n' s Plumbing , Inc . 1 503691 2328 P . 03 10/13/00 FRI 10' 48 FAC 503 59' 960 CI'f!' 01, i'1CARD 2001 PLUMBING PERMIT FEES: �— --- — PRICE TOTAL. New 1 and 2-family dwellings only _ FIXTURESindividual _ 4TY ea AMOUNT (includes all plumbing fixtures In PRICE TOTAL ---� 1660 the dwelling and the firstlL- 1 UTY (ell) AMOUNT Sink far each utlll connection 18.60 t ----� --- -- - Lavatory _ _ $249.20 Tub or Tub/Shower Comb r 16.80 Two 2 bath _ $35_0.00 Shower Only — 18.60 Tf Threes ath =399.00 Water Glocnt 1660 _SUBTOTAL - Urinal -_ - — — -1660 _ 6%STATE SURCHARGE Dishwasher _ 16.60 PLAN REVIEW 25%OF SUBTOTAL _ _ _ _— - ------- TOTAL Garbage Disposal 18(ID --- - — Leundry Washing Machine FloorDraln/Floor Sink 2'. 1860 PLEASE COMPLETE: 3" 18,60 4• 18.60 ---- ---- __------- -- Quantl!X h P Work Performed Weler hlealer U conversion O like tend 18.60 Fixture Type: New Moved Replaced Removedl Gas piping requires a separate mechanlul Caped errnit. - - -- - - MVO Home New Water Service 40.40 Sink MFG Home New SarUStorm Sewer 86.40 Lavatory _- _ _— Tub or Tub/Shower Ilose Bibs 1660 _ Combination __- Hoof Orairis 18.80 Shower Only Drinking Fountain 1660 Wa'er Closet 16 80 - Urinal _ Uhler Fixtures(Specify) Dishwasher Laund RanmTray_ -- Washing Machine Floor DrainlSlnk. r _ Sewer tat 100' --- 550 3- - Sewer earh additional 100' 46.40 4 ---.--- Water Service-1st 100' S5 OD Water Netter 46.40 Other Fixtures Water Service-each addillonel 200' Sclfy Storm 6Rain Drat; 1st 100' 55.00 --- Storm b Rein Drain•eech additional 100' 48.40 ---- Cornmarrial Flack Flow Preventlon Device 46.40 - ---�- Residnnlial Backflow Prevention Device' 27.55 — Catch Basin _ 1660 -- - _. Inspecllon Exiating Plumbing or Specialty 72.50 of Ra ueeled Inspections or/hr COMMENTS REGARDING ABOVE Rain Drain,single farnitydwelling 65.25 ---- Grease Traps QUANTITY TOTAL Isometric or nser diagram Is required if Quantity Total Is 29 - �— 'SUBTOTAL Aa/a STA''E SURCHARGE — +— "PLAN REVIEW 25%OF SUBTOTAL Required only Itflxlur�Ml totalIs�'e TOTAL *Minlmum prrrr+ll fee Is$72 50•a%stole surcharge,except Realdentlei Backflow prnvenhon Device,which Is 139 25•a%state surcharge **Ali New Commerclal tlulldinas require piens with Iaormtrlc or Hier diegrem and hlnn rlVICW TO P.0 ,22 i6 20P,'. t1 : F1� FPOM BOB SPMUEIS INC. �',lcctrical Permit a.ppllicatlon _ 1 -.^ Mk recttir'+d 77- A . a L ]DCity of Tigard Rg�.-�'•p('lrr' _ c: -C-"!of IRndNJdrttt: 1317,E SOR 97220 L14;u•ard; __ Racctptuu.I'I)rnlr: (3031 63'}4I i Cttc 6:e*n.. type: r.kx: (505) SDR 1900 L"Ild use appro"al: -- f 2("il),a'sall Los CK ACeeescny J Cumrne+caiV�rdulritd �.1 Mtt1u tumtly O'I'eonnt LWOVtrr,elll ;�, •conalvclSt>, AAJItioUthec�tira'r:Flxcm^rrc UOther _ .._.__ UPartial loLe rrv: ,167 L�.v� ____.. ptdg—nu! ;uite no.: Tu rri*Aaktt _IOVA44CUn BIt-C►: Cubrl'i0lrm: Prr}e nnroe ��� ,,.�►,��4• i�"'�fiP iia znd Io.-Ltiun of N•vrlt Vae,� mixt: 1✓.,.' rt ,_jjn1 ed dein l`f�tisrn clw>�ia� '�lixl - A1a Area fob DNcr tt4K •a.� Tuvl e�. gu6ti ssnarne: c �•'"����1ee�-�±�c fr°��— Ne—n r oam� •�r+u�►r+ •r.._-- Add1. • fvrclGrr(Iralr.lntAlAt•artachalyst'ret• City: f4 pF_- --'�`_ -` .�t�', (a00 I ur-� t- Pltcn^ �'2 1. r „n j�ix�• ) ' r, ni:u1 �e��rt Pachati;uora!wgQ n '-Pu_'lo^t1t^eof ALL fi1ec. r•r bus.lie. ' ,)(p CCR I ,.t \L�C� -- rt rdrw res:lrntiJ - - _ I�ti•1 1tnv6trc„rc3A!0litf I 2 I Cl,,ti "IrC - 2�G D, C..G r.nrad>aad hcvc o,moddtd d-cll.,ra ,trY 1 in•icc+rd'o fry 4 e rl It,ytv;Vu el•eoic ' ua N'r It l _ —�-� 6erNta rs fKert�-IatiUllrtlen - — n 1!:r:r.ne ��� aiheelfanxtebeatlelt: ap cl n•r',rlp^I 7 w•r� I NO M .w kr ! 401 J lh_-�/9. rpi arnr:,; 17t'o tngr 1 Medi y ed2t°sr. R -- 1 — Sate. ��1} -77? _ rher104nt ru�nly _ — Clry: E,tu. OlYLK10r1 ,_ Piro0 Tus(waq M vrtra N N (Tw, .InSfalii'.,('i1: rht:I.ntli-Iet:trn ii('CIOs f11J(k jn )rt,4lrl[y 1 Ow0 y.��.wyH•f{.wl,ur relncatioa: whit is no t�trlKled for dale,;eaiA.,r.'ut,ur Cl(Jangl CCcefdil)g to 7MauV at Inn - - - 7 UPS 7 q}S,�7v.070.701. ;01 eetouu Sol:am _ _— _ �77 .C: 1 1 o u OK 7 real%rt �a���.r••w,all•r.11ra, ar••r•e•low per p14 A lr.la sr+utt,citc,iu w,h r.utl,ru;or ac. a.•rfaferru,c•cL�:ridlcirc•it 7 Addr u: _- - ------- - --t-- — szwe: 71P: ). tee Im!roil cllry n•Ilb x+t rerc)ucr Ci : - �=� -- o(kr l:ewlttJ•rfec.lUtIbI01Rh." vlt I PAtrn ►.ht' � R-+toll: kr:hednwn •I•thorcvlt IMt- ,w• K d•roartalthld•�p tach a IT neonrirei• q tan stir alt angrcomr»nia! ;1 11rr)ll+ca:.r,•cl'+r' (yld,r�n M ota1M Ilthiltyc_ --- --Z - O hs+ is me*12n anp,tay of l t2 7 FI,._)dov r ncy ro 51 a]cr^�ub)utI06'eJcutryrp�ltl, t)dwe.y as•.a,rr er10:Ol�tgiat'ratrvra t I :Jfyr nrVtr6t�7vah nn,llh]I re rci'•Imud uru4 in enc RWt4JK ilta+UGrr or eztacdvtl' J_ �ltk•• a,reo.C1t11R<f4,rb Cf'ealaJ'GfllOan•;tr•fiw2 •rht�Uplon ___ y U(> .t.�!e•1 a•cr 7S^a+�n J rllt�Idon:r tJ.ut wtY m R�pmt t�c/dfUarpf�t]acllel(M alluhabhN and of the sUcm �rutretM Ma of t1e114 w11h so)of Ike abt•e. n. Not y_ j►tt nett ase*at arpiltaf,}t lu Icroptt>itt coavtro:tlaa rcnlet. Ot1wr _ T— _ _ Prrrtlt fen.._...............b Ko r a•M Rr9"'� v6m1 a'o' Notice 'bta writ a(�?Ifcotiort r P11111 RV1ew(et Q vt• U MutcrCare e.�'drea i(t prrmil Is not OW 11wu rt- ---• »IUrin 1t0 tlfXl aft 1,btu been SroU Cutch:rat,(Rrb) S _ IK'cepttd of CdriQl1>r 7 U7AI. ....,,. ........_. _._ acr.,er • r•rrvn.nv..ere� � ? `--�� ccato►rrJ Ww'+aa ____.. — rninii•� a�101'.ia�r'YCUMI s Post-ir Fax Note 7671 Date To Comept. — Co Phoner' ri0�i 2V 5. 'tlt+o Phoner 1413o �_ — CCf3 � 13306 FATa Fat a 5e3.24S '1710 Sc3. 2-4Co. o93tp F eh 09 (11 1)4 : W) Spec i a i t�j Heat t nr. 503 598 071B p. P Mechanical Permit Application Datereceivcd Pernutno.I 00_ o City of Tigard Pro)ecdappl.no.: _ E,tpire date: City oJTigard Address: 13125 SW Mall Blvd,Tigard,OR y71'.3 Date issued: By. Receiptno.: Phone: (503) 639-4171 Fax: (503) `>8 1960 Case Mr no.: Payment type: ^ Land use approval: Building permit no.: TYPE OF PERMIT )KI At 2 family dwelling or accessory 0 Commer:ial/industrial U Multi-family U Tenunt improvement U New construction ddition/alteration/replacement U U'tier:NOMMITUM13CA I Job address: 335 5 rYJ S t Indicate equipment quantities in boxes below. Indicate the dollar Bldg.no.: Suite no.: — value of all mechanical materials,equiprtetit,iabor,overhead, Tax ma /tax lot/account no.: profit.Value$ Lot; Block: Subdivision: 'See checklist for important applicatio:t information and Project name: t) jurisdiction's fee schedule for residential permit fee. City/county: '7/W (,(/� ZIP: 3 r ) Descriptio an 1 cation of k on premises.��C -S= r r t r l s uiY► I/l � Fee(ea.) Total Est.date of ompletionJinspection: Descri Non__ Qty. Res.only Res-only Tenant improvement or change of use: VAC: Air handling unit Is existi,g space heated or conditioned?0 Yes 0 No Airconditioning(sitep su require Is existing space insulated?0 Yes 'J No _Alteration of existing IT C system MECHANICAL CONTRACTOR of er compressors State boiler permit no.. Business nam >d L ' ` !I��/ HP 'Cons__BTU/H Address: 5 ' 61 LJ EV Ut 1 '9-r- `7 smoke ampers duct smoke electors 1 CityI State.p,Q ZIP:q 79';L 3 Hent Pum (site plan re9uire ) Phone' Fax;69� �7/ E-mail: Instal rep�cefurnnce/burner G ES/ — - Including ouctwork/vent liner O Yes 0 No CCB no.: `J T Instal rep acelrelocuteticaton-sus,...,id , City/metro lit:,no.: ! ,,_ wall,or floor mounted Natne(please print) r.;j4- IS Vent ora lance other an furnace R►fri);erahon: Absorptiununits_ BTUM Narne: -r-•J L-!e rf —?t��,�+) ►7-P-lei ,. Chillers HP Address: q s a"I^ $' S L� / / 2ZZi1 c{ S i Compressors HP n ronncota exhou't oni,ventilation: City: �ye/ SIR *'--I?ZIP: y 7oLa-� APPliancevent _ Phone•r 3 GAO Fax:rj9f*0719' Email: Dryer exhaust oods,Typc 1 res.kite a azmat h-ud fire suppression system Namv_: �+ _ Exhaust fan with single duct(hath tans) Malting address: 33 S S4­e,641441 r- -Exhaust system art from calla or AC Cllr j State: L7--TP: Ty7��.� ypl piping andistribution up to outlets) — - Type: LPG .A... NO Oil I'llotic I E-mail: del pipin cnrh- additional oven out rocesspiping(sc r—f ematicrequired) Name: Number of outlets iffifier UsteA appliance or equipment: Address: Decorgtivefireplace City: _ State 7,IP _ Insert-type Phone: Fax. E-mail- Woo stov pe etssiove Other: .13 Applicant's sib.:ature �C1ti Date: oZ �� Ot er: Name(print): r14 Not all tunsdicvons accept cntdn L40%.pleme call jurisdiction for more into—rn� Permit fee.....................$ U visa Q MasterCard Notice This permit application Minimum fee................$ Credit cord number / expires if a permit is not obtained plan rrsview(at _ 9b) $ iivires - within 180 days after it has been State surcharge(8%)....$ atilt o cudholdcr as Mo.,n on credit card accepted as complete. Cmdhol er Nancure Amount 4n4817(ala0/COM) Apr-03- 01 03 : 05P R.a�brn s Plumbing , Inc . 15036912328 P -01 04/113/111 11 C 1. v a�� CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE RAYBOR N'S PLUMBING INC PO BOX 69 TUALATIN, OR 97062 Plurbing Signature Form Permit #: MST2001-00070 Date issued: 2126101 Parcel: 1 S126DC-01001 Site Address: 04335 SW LEHMAN ST Subdivision' LEHMANN ACRE TRUICT Black !ot: 002 Jurisdretir;: TIG 7oningJ 1145 Remarks: 10' x 18' bedroom addition Your company has been indicated as the p umbing contractor for the permit indicated above. In order for the plumbing permit to be valid, please have the appropriate individual from your company sign below and return this Plumbing Signature Form prior to the start of the work to the address above, ATTN Building Dept. No plumbing Inspections will be authorized until this completed form is received OWNER: PLUMBING CONTRACTOR. TOBEY, MARSHA L RAYBORN'S PLUMBING INC 9335 SW LEHMAN ST PO BOX 69 TIGARD, OR 97223 TUALATIN, OR 97062 Phone #: Phone #; 503-692.4139 Reg * t_tC 00087852 PI M 34-166PB AN INK SIGNATURE IS REQUIRED ON THIS FORM X �'t.' l� .' Q -- Signator f Authorized Plumber If you have any questions, please call (502) 639-4171, ext. # 310 CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE WEST SIDE ELECTRIC CO INC 1834 SE 8TH AVE PORTLAND, OR 97214 Electrical Signature Form Permit #: MST2001-00070 Date Issued: 2126101 Parcel: 1 S126DC-01001 Site ,\ddress: 09335 SW LEHMAN ST Subdivis'", LEI IMANN ACRE TRACT Block: Lot: 002 Jurisdiction: TIG Zoning: R-4.5 Remarks: 10' x 18' bedroom addition 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-. Budding Dept. No electrical inspections will be authorized until this completed form is received OWNER- ELECTRICAL CONTRACTOR: TOBEY, MARSHA L WEST SIDE ELECTRIC CO INC 9335 SW LEHMAN ST 1834 SE 8TH AVE TIGARD, OR 9722:: PORTLAND, OR 97214 Phone #: Phone #: 231-1548 Req #: LIC 13306 SUP 1556s ELE 26.115c AN INK SIGNATURE IS REQUIRED ON THIS FORM Signature-of'Supervising Electrician If you have any questions, please call (503) 639-4171, ext. # 310 i CITY OF TIGARD ILDING INSPECTIOP'NOTICE Inspection Line: 639-4175 Business Phone 639-4171 Footing Rain Drain Co%er/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. Other: ;2 Date: _ A.M. Entry: Address: Tenant: Ste- _ MST: .____ /Own: .. _.77 �,f- 04; BLIP: , — THE FOLLOWING CORRECTIONS ARE REQUIRED: EI-R: Inspector: 7 –tom Date:, 7 APPROVED _DISAPPROVED/CALL FOR REINSP. n��CF rrMUMMA CITY OF TIGARD BUILDING INSPECTION DIVISION 24-Hour Inspection Line: 639-4175 Business Line: 639-4171 TMST BUP _Date Requested AM PM _ BLD Location % i .>�� f Suite . MEC Contact Person )/ Ph PLM 97-DDjy Contrr-tor X)/k-/7J )mac.?��)/ — Ph (1Y,=? SWR BUILDING Tenant/Owner —�'<<�; ,�� %�/,. — ELC Retaining Wall y -- ELR Footing --- -- Foundation Acc NOT REQUESTED '�/'�/" � '��'' FPS Ftg Drain FO Crawl Drain Ins UND DURING RESEARCH SGN Slah NO INSPECTION(S) IN FILE SIT Post& 133am 7 ---- 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 ----- --_ Under Slab �0 I op Out Water Service \-� Sanitary Sewed V� — -- ------ -- — — - RairjDrains S PART FAIL AWOHANICAL Post& Beam Rough In Gas Line ------- -- -------- — —_Smoke Dampers Dampers Final —_ _—�___-- -- - ------- ------- PASS PART FAIL ELECTRICAL -- - -- ----- -- -- -- --- Service Dough In ------------------------- --------- ---------I1(3/Slab I ow Voltage ------- —�._---- ------•---- ---- ---- ------- I ire Alarm F rnal PASS PART FAIL SITE Backfill/Gracing - -- _.—__--_—_ ------- _ Sanitary Sewer Storm Drain [ ]Reinspection fee of$--_--_required before next iospection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line ( ] PI"ase call for reinspection RE'_ --- [ ]Unable to inspect-no access ADA ,7 Gy lam, Approach/Sidewalk Other Date � / —_ Inspector /, j —_�Ext yZ Final PASS PART FAIL _j DO NOT REMOVE this inspection record from the job site. CITY OF TIGARD LNEVELOPMENT SERVICES PLUMBING PERMIT PERMIT #. . . . . . . : PI-1197-0029 1305 SW Hall Blvd.,Tigard,OR 97223 (503)639-4171 DATE ISSUED: 02/10/97 PARCEL: 1S1c6DC 01001 SITE ADDRESS. . . : 0937-5 13W LEHMANN ciT SUBDIVISION. . . . t LEHMANN ACRE TR(4(-'*IZONING: R--4. 5 BLOCK. . . . . . . . . . .* LOT. . . . . . . . .. . . . . -------------------------------------------- ----------------------------------------- CLASS OF WORV,. . :AI-T GAPBAGE DISPOSALS. : 0 MOBILE HOME SPACES. : 0 TYPE OF USE. . . . :SF WASHING MACH. . . . . . : 0 BACKFLOW PREVNTRS. . : 0 OCCUPANCY GRP. . :R3 FLOOR DRAINS. . . . . . : 0 TRAPS. . . . . . . . . . . . . . 9TORIES. . . . . . . . : 0 WATER HEATERS. . . . . c 0 CATCH BASINS. . . . . . . : FIXTURES LAUNDRY TRAYS. . . . . : 0 SF RAIN DRAINS,. . . . . : ;INKS. . . . . . . . . . : 0 URINALS. . . . . . . . . . . i e GREASE TRAPS. . . . . . . : I-AVATORIE573. . . . . 0 OTHEP FIXTURES. . . . : TUB/SHOWERS. . . . 0 SEWEI LINE (ft) . . . WATER CLOSETS—* 0 WPTEP 1-TNC- (ft ) . . . DISHWASHERS. . . . : I RAIN DRAIN (ft ) . . . ; Remarks : Inst4ll dishwasher, Owner: ------------------------ FEES -----__-______-.. !hARCIA TOBEY J. "ype amni.int by date t,ecpt '9335 SW LEHMANN ST PRMT $ 25. 00 JSD 02/10/97 97-290154 9!'�CT 1.. 25 J91; 02/10/97 97-2901.511 TIGARD OR 972'23 Ohone aNCI'11_ PI...UMBING INC 1.6900 SW MERLO RD 8F.AVERTON OR 97008 1)�ionoe #.- $ .:6. 25 TOTAL Reg #. . : 241.84 REQUIRED INSPECTIONS This permit is issuer' subject to the regulations contained i,i the Misc. Inspection Tigard Noricipal Code, State of Ore. Specialty Codes 0--d all nther Final Inspection applicable laws. All work will he done in accordance with ipproved plans. This permit will expire if work is not started Kithin IN days of issuance, or if work is suspended for ove than 18@ days. Permittee 13 9 M Issi.ted BY9 Call f,,r ;.aspect ion 639-4175 CITY OF TIGARD Plumbing Application Recd eye--� L _ Date Recd r� C. loci 13125 SW HALL BLVD. Commercial and Residential Date to P.E. C"C TIGARb, OR 97223 Date to DST (503) 639-4171 Permit 0('L `+ / 3'1 Print or Type Related SWR e _ Incomplete or illegible applications will not be accepted Called _ Name of Devlopment/projectJob Ir et Addrr;ss Suite �E) I BATH HOUSE 140PR''`n Z bt2 BATH CiOUSE� 1 !f W r' ' Address j BATH�ioises2 0 .5i,j r Fee es kq s M the dwltililtip'iina IQs t 1 ise } Bldg• City/State • Zip wate aeMce esnilar� ewer a..-none sewer See ides}wow j�' "1'• _ Name K FIXTURES(individual) QTY PRICE AMT Sink 9.00 Owner Mailing Address its Lavatory 9.00 78771 E Tub or Tub/Shower Comb. 9.00 City/State Zip Phone Shower Only 3.00 Name Water Closet 9.00 Dishwater 9.00 Occupant Mailing Address Suite Garbage Disposal 900 Washing Machine 9.00 Clly/State Zip Phone Floor Drain 2" 9.00 3" 9.00 Name /k-X-'1l L L c% �//� Z 4" 9.00 Contractor Mpi my Address. Suitfif Water He>rer 9.00 Laundry R,^c'i Tray 9.00 City/Slate Zip / Phone -] Urinal 9.00 V �� Z T�13 Other Fixtures(Specify) 9.00 Oregon_.Const.Cont. Llc.0 Exp.Date _ Attach Copy of 9.00 J Current Plumbi Lic.0 Exp Date 9.00 License 76, /�'L 0� Sew^r 1a 100" 9.00 C07 Business Tax or Metro a Exp.Date Viewer-each additional 100' 30.00 Name Water Sr,rvice-1 at 100' 25.00 Water Sarvice-each additional 200' 30.00 Mailing Address Suite ,form d Rain Drain-1st 100' 25.00 Architect - Storm 3 Rain Drain-each additional 100' 30.00 Mobile Home Space 25.00 Engineer City/State Zip Phone Commercial Back Flow Prevention Device or Anti- 25.00 Desciihe work New O Addition O Alteration Repair O Pollution Device to be done: Residenti Non-residential Residential Backflow Prevention Device' 1500 Additionat descnpt,on of workf Any Trap or Waste Not Connected to a Fixture 9.00 Catch Basin 9.00 G 7 L P"� _ �X` / ��f' �� 5 ��,t. Insp.of Existing Plumbing 40.00 per hr Existing use of Specially Requested Inspections v 40.00 building or property _ per hr Rain Drain,single family dwelling 3000 Proposed use of - Grease Traps 9.00 building or property -� Are you capping any fixtures? Yes p No(] QUANTITY TOTAL ..,, .. Isometnc or riser diagram is required M Quanity Total is >9 I hereby acknowledge that I have read this application,that the information 'SUBTOTAL - given i correct,that I am the 1wnFir or authorized agent of the owner,and that plpfis submitted are in coiqp lance with Oregon Slate Laws. 5/e e SURCHARGE Sign ure of Own Aigen 9 Date PLAN REVIEW 25%OF SUBTOTAL Required only 4 fixture qty total is>9 Contact Berson Name Phone TOTAL t c- 'Minimum permit fees 325+5%surcharc e,except Residential Backflow Prevention Device,which Is S15+5%surcharge i Ndsts\plmapp.doc TIGARD CITY OF DEVELOPMENT SERVICES ELECTRICAL PERMIT PERMIT #: cLc97-0070 13125 SW Hall Blvd.,Tigard,OR 97223 (503)639.4171 DATE ISSUED: 02/10/1-1 PARCEL: 1 51.26DC-01001 TE ADDRESS. . . : 09335 SW LEHMANN ST BDIVISION. . . . : LEHMANN ACRE TRACT ZONING;R•-4. 15 BLOCK. . . . . . . . . . ; LOT. . . , - ., , . . . . . :2 Project Descr-i pt ion: i.nstl branch circuits ---RESTDENTIALwUNIT--- ---TEMP SRVC/FEEDERS---- -----MISCELLANEOUS---------• 1000 SF OR LESS. . . . : 0 0 - P-00 amp. . . . . . . : 0 PUMP/IRRIGATION. . . . : 0 EACH ADD' L 500SF. . . : 0 P01 - 400 amp. . . . . . . : 0 SIGN/OUT LINE LTG. . : 0 1_.IMITED E'NERGY. . . . . 0 401. - 600 amp. . . . . . . : 0 SIGNAL./PANEL.. . . . . . . : 0 MANE. HM/ SVC/FDR. . : 0 601.+amps-1'.00 volts. : 0 MINOR LABEL ( 10) . . . : 0 - ----SERVICE/FEEDER------- -------BRANCH 1r I RGU T 1!; __._.__ ------ADD' L INSPECT T ONS'-._-. 0 .- 200 amp. . . . . . : 0 W/SERVICE OR FEEDER: 0 PER INSPECTION. . . . . : ih 201. - 400 amp. . . . . . : 0 1st W/O SRVC OR FDR. : 1. PER HOUR. . . . . . . . . . . : 0 401 - 600 amp. . . . . . : 0 EA ADD' L BRNCH CIRC: 1 IN PLANT. . . . . . . . . . . : ra01 1000 amp. . . . . : 0 _.___.._.._ .-._____....._ .__..-PLAN REVIEW 1000+ amp/volt. . . . . : 0 ) =4 RES UNITS. . . . . . . . : ) 600 VOLT NOMINAL. . : Reconnect only. . . . . : 0 SVC/FDR ) = 225 AMPS. . : CLASS AREA/SPEC OCC. : Owner: ---------------------------------------------------------- FEES --- _-__-- -•---.____. MARC:IA TOBEY type Amo1_in t by cute r e c p t 9335 SW LEHMANN 5T PRMT f 40. 00 TAY 0=/05/97 97-289969 5P'CT $ P. 00 TPT 01,/05/97 97--289969 T I CARD OR 97223 Phone #: Contractor; CHANDLER F'L_.ECTRIC INC $ 42. 00 TOTAL 3521 SW CARSON ST --------- REQUIRED INSPECTIONS --- - ---- PORTLAND OR 97219 Ceiling Cover Underrgrol.rnd Cove Phone #: 245-7774 Wall Cover Elect' l Service Reg #. . : 000949 This per•eit is issued subject to the regulatigns contained in the Tigard Municipal Code, State of Ore. Specialty Codes and nil other Perim#tt' Signatu applicable laws. All work will be donr in accordance with ( r/ approved plans. This pereit will exp4.re if work is not started within 1N@ days of issuMce, or if work is suspended for sore than 18@ days. I s sited By INSTAL_LATTON CINI-Y--__ __.__..._...__.__....__......__-.w-.-____.. The installation is being made on property I own which is not intended for Sale, lease, or rent. OWNER' S STGNATURE: DATE: INSTALLATION SIGNATURE OF SUPR. ELEC' N: DATE 1. I CENSE NO: __._. _.._......_ __.__..___.......__.____. .._..____._.._____._-_._....._.__ __..._...._..._._.__.__._—-----......___ Call for inspection - 639 -4175 Community Development ELECTRICAL PERMIT APPLICATION 13125 SVV Nall Blvd. Tigard, OR 97223 Planck/Rec. # _ Permit # ' , -7 > Phone (503) 639-4171 Date Issued _ u' 1r,I a CITY OF TIGARDFAX (503) 684-7297 Issued by _ TDD No. (503) 684-2772 Inspection (503) 639.4175 1. Job Address: 4. Complete Fee Schedule Below: Name of Development 12 Number of Inspections per permit allowed Address q�'�-+ ,? -�� Lor �-,VV1l'}rL Service included Items Cost(ea) Sum City/State/Zip 1�..(�l9z-L -� 4a. Residential-per unit 4 1000 sci It or less $1 to 00 Name (or name of business)MD rc-'t o"(sr'T'Q _ Each e there)f sq It or 1 pportionn(hereof $2500 1 Gornmercial ❑ Residential©� Limited Energy $2500 Each Manurd Horne or Modular 2 Dwelling 39rvine or reader _ $M 00 2a. Contractor Installation only: 4b.Services or Feeders ( '-"allatmn allocation,or ralocaUon 2 Electrical Contractor w1� /E;�^ ria L.l _ 200 omp�6 or lens $0000 2 Address15' / n 201 amps to 400 amps $8000 2 401 amps to WO amps $12000 _ 2 ' Clty_[ -0 State zip9'74 15 601 amps 10 1000 amps $18000 2 Phone No. 7 '$ — Char 1000 amps or vola $34000 2 Contractor's License No. Z 241 C'- Roconned only $5000 Contractor's Board Reg. No 1-/ L 4c. Temporary Services or Feeders Installation allerobon or relrication 2 Signature ofS r. Elec' ?► F/-- ,� 200 amps or less $50 00 2 License No. — Phone NoG�7 77 te 201 amps to 400 amps $7500 2 101 amps to fp00 amps $100 00 Over 600 amps to 1000 volts 2b. For owner Installations: sea'b'above 4d. Branch Circuits Print Owners Mame_ Now alteration or extension per panel Address n)The fee for branch circuits with City_ State Zip v purchase of sarvke or leader 1". 2 Phone No. Fach branrh circuit $500 _ b)The lee for branch circuits wffhouf T he installation is being made on property I own which is purchase of ssirvke or leader fee. / 2 �j not intended for sale, lease or rent First branch sant $3500 2Each adde,onal branch crrp,l x500 Goner's Signature _ 4e. Miscellaneous (Service or feeder not included) 2 3. Plan Review section (if required). Each pum0 or irrigation Circle $4000 2 Each sign or oulli s lighting S4000 Signal circus(s)or a Ilmled energy 2 Please check appropriate item and enter fee lit section 5B. panel,aleration or extension $4000 4 or more residenhai tinits in one structure Minor Labels(101 $10000 Service and feeder 225 amps or more _System over 1500 volts nominal 41. Each ad6iinnal inepe;tion over Classified area or structure containing special occupancy the allowable In aly of the above as described in N E C Chapter 5 it.,n;trctio" $3500 _ Per hou' $55 00 Submit 2 sets of plann with application where any of the above it,Plant $550o apply. Not required for temporary construction services. 5. Fees: 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. Fnter 25%of line A for CONSTRUCTION OR WORK IS SUSPt:NDED OR ABANDONED FOR Plan Review if required(Sec 31 $ A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $ COMMENCED ❑ Trust Account 0 $ Balance Due $ wcwl.vvnMVWc pm■c'•