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9700 SW LAKESIDE DRIVE-1 A w m cn N- 0- co m 0 H C (D i 1 A I i I I MS 0015 I�IECHAN I CAL CITY OF TIGARD CHANI DEVELOPMENT SERVICES PERMIT #. . . . . . . : MEC99--0086 13125 SW Hall Blvd., Tigard,OF 97223(503)639.4171 MATE: ISSUED: 03/0t,/99 PARCEL: 2S 1. 1 1 CA-04400 SITE ADDRESS. . . : 09 700 SW L..W.L SIDE DR SUBDIVISION. . . . : SUMME-RF I E.LD NO. 12 ZONING: R--7 . . . . . . . . . . . t_r'T. . . . . . . . . . . . :GS4 JURISD?CTION: TIG CLASS iF WORT,. . :ALT F 'R FURN. . . . : 0 EVAP COOLERS: 0 T'YP'E L USE. . . . :SF UN i T HEATERS. . . 0 VENT FANS. . . : 0 OCCUPA 'CY GRP. . : R3 VENTS W/O ADPL: 0 VEN1 SYSTEh;S: 0 'TORIEL . . . . . . . .. 0 BOILERS/COMF'RESSIRS HOODS. . . . . . . : 0 FUEL TV. .S— -- -- --- 0--3 HP. . . . : 1 DOMES. INCTN: 0 3-15 HP. . . . 0 COMML. I Nr I N: 0 M'1 X INPUT: 0 BTU 1 5­30 HP. . . . : 0 ;E.PA I R Uh,I TS: 0 FIRE DAMPERS". . : 30-50 HP. . . . : 0 1,10:11)STOVES. . : 0 i.:qS PRESSURE. . . : 50+ 1(F'. . . . : 0 CLO DRYERS. . : 0 NO. OF UNITS-------­­ AIR HANDLING UNITS OTHER UNITS. : ,r FURN ( 100K BTU: 1 - 10000 cfm : 0 Gf,c; OUTLETS. 0 FURL. ) =10014 BTU: 0 > 10000 cfm : 0 R e m ar,l(s : Replace existing furnace and A/C writs. A/C unit cannot he placed within the required setback aree. Owner _---.—.----_________-----.._---__..-------.._____.______.__.___._.__ FEES WILLIAM SPEAR type amol--nt by date r,ecpt 9700 SW LAKE,IDE DR PRMT $ 25. 00 GE0 03/05/-­1 99-313456 TIGARD OR 97224 `;PCT $ 1. 25 GEO 03/05/ 19 99-31.3456 Phone #: 624­2122 Contractor,: -- -____-----------.----•--------- AAA HEATING R• COOLING 2'_315 NE MARTIN LUTHER KING P'-VD $ 26. 25 TOTAL PORTLAND OR 97L 1 E' Phone E14--•,_'173 Reg #. . : 000002 ____.-•-_—• RE(aUIRET) INSPECTIONS This pet-sit is issued subjert to the regulations contained in the Heating Unt Insp 1 Tigard Municipal Code, State of Ore. Specialty Codes and all other Cool i n g Unt I n s p applicable laws. All work will be done in accordance w?th Final Inspection approved plans. This permit will expire if work is not started wilhir. 180 days of issuance, or if work is suspended for more tha,, 180 days. ATTENTION: Oregon law requires you to follow rules Pdopted by the C,,egon utility Notification Center. Those rules are set forth in OAR 95F•001-0010 through OAR 952 W-0098. You may obtain Lopies of these rules or dirrct questions to OLK by calling (583)246-9187. Flermittee Signrti_tre: ++ ++++++4•++++++++ h+++•1-++++++++++++++++++++++++++++++++++++++++++++ + Call 6-,9—'' 175 by 7:00 p. m. for inspections needed t:hp next hi_tsiness day +++++•+4•++++++++++•+++•++++++++++++ • +++ F+++++.4-+-F+++4-++++++++++++++++++++++++++++++ 03/01/39 MON 10:33 FAX 503 598 1960 CITY OF TIGARD rj002 RECE Nl 1 Plan Check 0 CITY Ok TIGARD Mecha,iical Permit Application Recd By 13125 SW HALL BLVEMAR U 2 1599 Lommerr.ial and Residential [,ate R1cd— TIGARD, OR 97223 rate to P,E. (503) 639-41" x30AMMUNl1; DEVELUpMENi Date to DSS_ Print or Type � - Pt'""t�rNjy "��� Incomplete or illegible a plications ._ will not be accepted caned me rmneM/Pn>f m Description r' Table_1A Mechanical Code Qt P. Amt L -� _y -- A Permit Fee -_ — — 10.00 Job �trewi.:�reu _ _-- Adtlres'3 r r 1) Furnace to 100,000 4 t _ Including ducts Q ventssee footnote 1,2 6.00 LP BMpe citiiiiatme Zip 2: FUmarx►1100,000 BTU+ — ^-- �'' 1 _ including-cncts f1 vents-��sue footnote 1,2 7.50 — Namn(or nemeof business) 3) Floor Furnace — - - - Ovvner _ Includin vent age footnote 1,2_ --- 6.00 tdalllnp Addroas 4) Suspended heater,wall heater or floor mounted heater see footnote 1,2 6.00 5) Vent riot Included in appliance permit cityfshri p hone ?.00 y Check all that apply: 'BoNer Heat Air -�- -- acme(atM h,,.%Incas) ,$) -- - For items 6-10,see or Pump Cond Qty Price Amt footnotes 1,2 Com 6)<3HP,ah sorb unit o. Occupant ti' gA�"� �_— _— —---- 100K BTU 8.00 l -- 7)3-15 HP;shnorb unit cily/siate zip phone I00 to 500k BTU 11.00 8)15-30 HP;absorb i and.5-1 mil BI 15.00 contractor Na ° 9)30-50 PP;absorb -- 1-� �+_ ,y�� Lt, unit 1"1.75mil BTU 2250 _ Prior to permit Malang Addreeo 10)>50HP;absorb Unit issuance,atopy /j` �J{ . 1 �;" >1 75 mil STU _ - 37.50 of all licenses cityrSute p . oee-` , 11)Air handling unit to 10,000 CFM - are required if • i ��a% r r �� 4.50 expired In Cur orattnn Exp 12)Air handling unit 10,000 C.FM"r database 1 - l i ) j - - -- 7.FJ _ Architect rns 13)Non-portable evaporate cooler so ��Amu- - 14)Vent fan connected to a single duct or "�- 3.00 15)Ventilation sys"em not included in Engineer cxy/stete zip phmm appliance pen lit 4.50 16)Hood served 5y rpchanical exhaust Describe work to log done: - __ _ _ .-._ 4.5017)Domestic incinerates Newel Repair O Replace with like kind: Yes)0 No O Resldbntial p Corrwwrdal O 18)Commercial or h1Jr's'rul type Incinerator --- Additional infomutign or ascription of wgrk: 19)Repair uh,.- �>, 4.50 - 20)Wood stove NOTF: for Cori norciat projec`s only.Units over 400 lbs.require _ _ 4.50 structural gas calcs. 21)Clothes dryer,etc. - 1 ypo of fel: oil O—n—atura-1-p O LPO O eectrc O __- -_ 4.50 — 22)Other units 1 hereby acknowledge that!have read this appiktttbn,that the Information 450 , given is correct"that I am the owner or authorized agent of 2.3)Gas piping o,'te to four wtUets the owner,that plans submitted are In compliance with niegon State laws See footnote;1 - 2.00 _ 24)More than 4-per outlet(each) g1161 _re ofow-rwrIA9ent ---- ---^ Date _ _ __ tio _ Mlnlmum Perritt Fee$25.00 SUBTOTAL pZ d Petsort M to — 5%SURCHARGE >�� PLAN REVIEW 25%OF SUBTOTAL ---- Foonoten for cofnnr7fL�fiMI prt"M only:-- Required for ALL commercial permits oni 1 Provide full schematic of ex" and proposed gas line and pressure. M TOTAL 1 - 2 ProMe dnirWrige to scab showing existing and proposed rnechenicai - _units. _ — "late Contractor Boller Certification required - "Residential A/C requires site plan showing placement of unit I:Vrisc 1perm.doc rev 02/4/99 ''-�.•. .. -- — - _._,- _.•-�' 03/01/99 10:42 '1'X/RX N0.315H 1'.002 ■ AAA Heatinq and Cooling Air Conditioning Site Plan Customer C/�p ,� tq F dclres_ 9'1'U� � �-- Cit�i„�� _ � ,'1� ZiP 97-Z.LY C _ c T r Ul Ti n T-Ti �1 /� CITY OF TIGARD ELECTRICAL PERMIT DEVELOPMENT SERVICES PERMIT #: ELC99-0122 13125 SW Hall Blvd., Tigard,OR 97223(503)639-4171 DATE ISSUED: 03/03/99 P,ARCEI--: 2SIIICA--Q.4400 SITE ADDRESS. . . :09700 SW L.AKE SIDE DR, SUBDIVISION. . . . -.SUMMERFIELD NO. 12 ZONING: R-7 BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :664 JURiSDjr,TON: TIG Praj ect De scr i pt i on: Installation of I branch circuit. -----RESIDENTIAL UNIT---- ---TEMPI SRVC/FEE-DERS----- -----M.'SCEL.L.ANEOUS------ 1000 SF OR LESS. . . . : 0 0 — 200 amp. . . . . . . : 0 PUMP/IRRIGATION. . . . : 0 EACH ADD' L. 500SF. . . : 0 2.01 — 400 amp. . . . . , . : SIGN/OUT LINE LIG. - : 0 LIMITED ENERGY. . . . . : 0 401 — 600 amp. . . . . . . : 0 c3IGNA[_/F-',ANEl.. . . . . . . : 0 MANF. HM/ SVC/FDR. . : 0 601+amv-1000 "olts. : 0 MINOR LABEL ( 10) - - - : 0 GIRCUITS------ INSPECTIONS----- 0 NSPECTIONS——0 200 amp. . . . . . : 0 W/SEr0ICE OR FEEDER: 0 VIER INSPECTION. . . . . : 0 C_01 400 amp. . . . . . : 0 1st W/O SRVC OR FDR. : I PER HOUR. . . . . . . . . . . : 0 401 600 amp. . . . . . : 0 EA ADDIL BRNCH CIR(.-;: 0 IN PLANT. . . . . . . . . . 171 601 1000 amp. . . . . : 0 -------------------PL-AN REVIEW SECTION---- ---------- - 1000+ Amp/vol..t. . . . . .. 0 )=4 RES UNITS. . . . . . . . : ) 600 VOLT NOMINAL.. . : Reconnect only. . . . . .. 0 SVC/FDR ) = 225 AMPS. . -. CLASS AREA/SP-EC OCC. : I _)wn e r: FEES WILI-10M SPEAR type amol-Int by date reept 9700 L13W LAKFSIDE DR PRMT $ 35. 00 DEB o3, 03/911- 99-31.340:1 J (GARD OR 97224 5P-CT $ 1. 75 DEB 03/03/9 99--313401. Phone #% 624-2122 Contractor: ----------------------------- WEST SIDE ELECTRIC CO INC $ 36. 75 TOTOL !"234 SE STH AVE ------- RE,JIRED INSPECTIONS PORTLAND OR 97214 Elect' l Service Phone #.- 231--1540 Elect' l Final Reg #. . : 13306 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Oregoo Specialty Codes 00 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 foilnw the rules adopted by the Oregon Utility Notification Center, Those rules are set forth in OAR 952-00 1-Nl�through OAR 952-001-1987. You may obtain a copy of these rules or direct questions to OUNC by calling/5031246-1987. I PPI'm i tt ep S i.gnat I-o,e fT I S S 11 e d INSTALLATION The installation is being marl�- On property I own which is Ti intended f or, sale, IeaIse, or rent. DATE OWNER' S SIGNATURE: ---——————---——————--- ------CONTRACTOR INSTAI ATIO N -Y————————---—————————————-------- SIGNATURE OF SUP-R. ELECIN: DATE: LICENSE NO: +++-1•++++4+++-1-+.................j..............4++++++++-4.1-+++++++++++1-+++++++++++ Call ...........4Call 639-4175 by 7:00 p. m. for an inspection needed bhe next bmsiness day ++4........4+4.................................1-4............4-++-+................. MpR-02–'i9 04 :40 PM WEST SIDE ELECTRIC'_' 503 736 0677 P. 01 CITY OF TIDE RD Electrical Permit Application Plan Ch 13125 SW H; .L BLVD. R«'d 1 _ TIOARD OR 67223p Date Recd- ecd '�(�,� {tv Dots to P.E. Phone(503)639 4171, x304 Date to DST Inspection(503)639-4175 Print or 1;/pe k PermH to Fax(503)694-7297 Incomplete or Illegible, will not be accepted called _- 1. Job Address; 4. Complete Fee Schedule Below: Nome of Development_____ _^ , `cumber of Inspections per permit allowed Nor (or name of buslness) i//��i��. Service Included: Roma Coal Sum Address 70! S�✓ AQP iC� %o/ 4a. RosUlontlal per unit 1000 aq.M.or 1066 _ S110.00 4 City/State/7ip Fach arldhbnal 500 sq.II or Commercial El Residential 1 parlltxt thereof $25.00 Unfilled Energy SM 00 Each Manut'd Horne or Mndulnr pwe,li%Service or Feeder 960.00 ? 2e. Contractor Inatvllatlon only; (Anaah copy of ani cu ont�Ie a ab.Services or readers Electrical Cpn rtor / �/ Ins1e11nUon,nllerefion,at rolocehon Address �/ `� SZZ -- 200 caps at less $60.00 _ �— 2 �— 201 amps to a2mp9 __ $e0 00 2 Cllr r i State �_rp401 amps to 600 amps $120.00 2 Phone No.? /S��u _ eot amps to 1006 amps $I Flo 00 ___ 2 Job No.___Q[ Over 1000 amp%of volts $340.00 ? Elec.Cont.Lice.No, xp,L) rG Reconne:l only $5000 _. 2 OR State CCQ Reg, No._13 Exp.Daie_ __ ac.Tsmparary Servlcos or Feeders COT Businnsq Tax or Motto No_ � Exp.Date Inst,liatlan,atterntlon,or ralocatlon 200.^pn or leas $5n,00 Signature of Supr. Eloc'n -^-- I 201 amps l0 400 amps $7300 2 / ll 401 amps to Boo amps $100.00 _--- 2 LlcensA Nr b 1 Over 600 amps io 1000 vnlle, Exp.Date we"b"above, Phone Nr 4d,Branch Clrcults Now.sllnrstlon or•.tenslon per panel ' 2b. For owner Installations: e)The too for branct •rrcuils with purchase o/service or Print ewnor's Name feeder foo AddresEach hsrsnrh City _- F;tftteZi — h)The fart for Month clrruit% Zip wlthourpurrhase of Phone N0 _ _ � _ _ service or feeder fee. ^c First branch clrcult ` si5 0n —� — The installation is being mode on property I own which ie,not Each additional branch clrcult $6.00 intended for cele,lease or rent. 4e.Miscellaneous (Service or feeder not Included) (�Wflar 5 SiQnaTUfAFerh pump or litigation rrrcie f%0 or) 2 Each sign or outiina lighting 440D0 _ 3. Plan Review section (if required)-' Signal clrcWl(s)or a Ilmiled enaroy– $ .00 40 panel,Idlerstlon or aetenaInn ._ $100 00 Plane@ check appropriate Item and enter fee in section Fill, Minor LabNs(101 4 or more residential units In one structuro 41.Earh additional Inspocllon ever Service and fecdar 225 nrnpn or morn, the allowable In any of the above System over 1300 volts nominal Par In%pm-lion $35.00 Classified area or qm rturn contaInInp special occupancy Per hour _ $55'00 as degcrlbed In N.E.0 Chapter 5 In plant $55.00 - 'Submit 2 seta of pians with application where any of the above apply. 5. Fees; Not required for temporary construction services. so.Eider total of sbavu fnas $ 5%Surcharge(.U5 x total leas) $ M&E subtafal $ Sb.Entnr P-%aI Ilne Ra On! PFR6A(TS 9ECOMF VOID IF WORK OR CON91 RUC1 1014 AUTIIOn17FD IS Plan Raview II r 1id(6036.3) $ I,K)t rOIAMENr.FD WITHIN IBO DAYS,OR IF CONSTRUCTION GR WOrIK Sub areI $ IS;USPENDEO On ABANDONED FOR A PERIOD OF 160 DAYS AT ANY 1 ru91 Akox t s�,'7` j 16 1 TIME AFTER WORK 15 COMMENCED Tool ba/ipico Due CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24-Hour Inspection Line: 639-4175 Business Line: 639-4171 - ��// BUP _Date Requested , �r3'� � AM .!` PM BLD Location_! 1f_ CLiX.�s►�G _ � . Suite MEC 3 009(o Contact Person _ rh C L - L) 2Z PLM Contractor Ph SWR —�— BUILDING Tenant/Owner ELC Retaining Wall FLK Footing Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes ----- Slat, -- – - ----- - ------- SIT Post&Beam Ext Sheath/Shear _ Int Sheath/Shear / — Framing b/ 7-r- , ------ Insilation -� Drywall Nailing T._�.___ i�/�Lc�✓J Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling _- Roo! --- Final ------_---- PASS PART FAIL ----- -- - PLUMBING Post& Beam -- Under Slab Tip Out --_.---- --- Water Service ----------- -------- Sanitary Sewer -- --- --- _ - - Rain Drains _ Final PAS RT FAIL A (MECHANICAL) Post& : :am Rough In Gas Line — SmpLce Dampers -in all i-� ,PAS$' PART FAIL ELECTRICAL --- --`-�--- Service Rough In UG/Slab Low Voltage Fire Alarm Final PASS PART FAIL -.-.----_-- --- - _--SITE Backfill/Grading -- Sanitary Sewer Storm Drain ( i Reinspection fee of$_ required before next inspection. P 3y at City Flail, 13125 SW Hall Blvd Catch Basin I i Please call for reinspection RE _ —_ [ )Unable to inspect-no access Fire Supply Lins ADA A`,roach/SidewalkDate 4�' 7��7 Inspector Ext Other -._-_--___--- Final PASS PART FAIL 00 NOT REMOVE tt.i:: inspection record from the job site. CITY OF TIGARD BUILDING INSPECTION DIVISION 24-Hour Inspection Line: 6394175 Business Line: 639-4171 BUP _ _Date Requested__ �' i��'�C� AM_ _PM BLD Location -1 ltn Lc',L5,(c..Q 6r. — Suite MEC _ Contact Person Ph Ph PLM Contractor_ �✓! ,49 A 44-c-, Ph _ SWR // :�UILDIN. _ Tenant/C3W--' ? -f��i �1 1�`, ELCZl -o` Retaining Wall ELR _ Footing Access: Foundation FPS Ft t Drain SGN Uawl Drain Inspection Notes ------------ Slab ---- ----- — — — SIT Post&Beam -- — - --— Ext Sheath/Shear I Int Sheath/Shear Framing Insulation I)rywallNailing Firewall Fire Sprinkler Fire Alarm - Susp'd Ceiling — Roof Misc: _-- Final i PASS PART FAV ------ - LUMB , Post&beam Under Slab Trap Out Water Service Sanitary Sewer k ins PART FAIL_ Pos eam - Rough In Gas Line - - Smoke Dampers Final _--- ART FAIL LECTRIC —� - - --- - - -_ Se Rough In UG/Slah Low Voltage Filarm �,_.�_ ---- ---.---------__-----_—.�_._ _ S > PART FAIL __ - -------- ----_SITE _ Backfill/Grading - ----- ------ -.-_. __ — Sani+ary 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. ]Ui gable to Inspect-no access Fire Supply Line - ---- -- - ADA Approach/Sidewalk v[3 Other — Date 1 Inspector � _�� Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. CITY OF TIGARD PLUMBING PERMIT % DEVELOPMENT SERVICES 1�1!—Jngm 13125 SW Hall Blvd., Tigard,OR 97223(503)639-4171 PERMIT it. . . . . . . : PL.Mr-49-0070DATE ISSUED: 03/12/99 PARC'--L: 25111CA-04400 STTI.: ADDRESS. . . : 09700 SW I AKE STDE DR SUBDIVISION. . . . : SUMMERFIELD NO. IE' LONING: R--7 BLOCK. . . . . . . . . . . LOI.. . . . . . . . . . . . . :564 3URIF3DICTION: TIG CLASS Oma' WORK. . :AL.-T GARBAGE DISPOSALS. : 0 MOBILE HOME SPACES. : 0 TYPE OF USE. . . . :SF WASHING MACH. . . . . . : 0 BACKFLOW PRFVNT9S. . : 0 OCCUr,,"NCY GRP. . -.R3 FLOOR DRAINS. . . . . : fit TRAPS. . . . . . . . . . . . . . . Q) STO'lTES. . . . . . . : 0 WATER HEATERS. . . . . : 1 CATCH BASINS. . . . . . . : 0 LAUNDRY TRAYS. . . . . : 0 SF RAIN DRAINS. . . . . : 0 SINKS. . . . . . . . . . 0 URINALS. . . . . . . . . . . . 0 GREASE TRAVIS. . . . . . . . 0 LAVATORIES. . . . : 0 OTHER FIXTURES. . . . : 0 TUB/SHOWERS. . . : 0 SEWER LINE (ft ) . . . ; 0 WATER CLOSETS. : 0 WATER LTNE (ft ) . . . : 0 DISHWASHERS. . . . : 0 RAIN DRAIN ( ft ) . , . -. 0 Remarks : TnstallAtion of a new water heater-. Owner: -- FEES WILLIAM SPEAR type by date recpt 9*700 SW LAKESIDE DR PIRMT 10 25. 00 GEO 03/12/99 99--31"764t TIGARD OR 97224 5PCT 1. 25 GEO 03/12/99 99-313641 Phone #: 624-2122 Cont t-act o t---— AAA HEATING R. COOLING 2915 EN MARTIN LUTHER KING BLVD PORTLAND OR 97212 Flhone 0: 284--2173 26. 25 TOTAL, Reg 2P2 REQUIRED INSPECTIONS This permit ic i9slied subject to the regulations contained in th4 Final Inspection Tigard Muniripal Code, State of Ore.. Specialty Codes and all other applicable laws. All work will be done in accordance with approy j plans. This permit will expire if work is not started within 180 days of issuance, nr if work is suspended for more than 180 days. ATTENTION: Oregon law requires yon to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-MI-0010 through OAR 952-0001--0080. You may obtain copies of these rules or direct questions to UK by calling (503)246-1987. T i ss i-t e d F Xy 411�111'11 I' Permittee S i q,i a t 1.t t,e +4++++++++4-++++4.4-++A........4......4.++4.+++++++++i-+++++++++4 .......}•++++i+....... Call. 639-4175 by 7:00 p. m. for- an inspection needed the neAt bi-tsinRsis day 4.......4+ ;--4-++++4.................4-4-+++++++4-++++-I........4-++ ++++++++f RECEIVED :I"1 Y OF TIGARD MAR 12 1991" Plumbing Permit Application Plan I-,hcd*0 3125 SW HALL BLVD. Commercial and Residential —"- ---- IGARD, OR 97223 COMMUNIR DEVELOPMI r4, DatBy Datee r-'d Re 'd 503) 639-4171 Date to P.E Print or Type Date to DSI _ SWR- _ Incomplete or illegible applications will not be accepted Perme 71 Related SWR i__-__-_ Celled_ Nan'A of Develo ment/Pr P okm •d1�.,,�!f4 QTY:: Job sink e.00 Address sueet avatory Address-� Suite I.. �– — -- - _ 9.00 Tub ry 7uW5frowe Comb— B.00 Lldg• City/stabs Yip- ;.Hower C,ty - _ _ 91 Water Closet -- 9.00 -- y Dishwasher --- ------ 0.00 Owner MollUg Addmit au"s Garbage Disposal -- --- - 9.00 washing machine--- -- - ia;q q `� Floor Draln/Fbor Slnk T _ 0.00 OCGUpar1r Ake+ -— Witar Healer »nveroIon O Mke kind AAO 0V Gets piping requires a separate me,hsr&a_1 permit. - City/Stabs Ilp hone Laundry Room Tray F 9.00 - lh+rel ylame 9.130 \r \ , Otho,'-txhxes(Spec ty,- - 1 x -�.vr,. _ 9.DO Contractor -mailing AddrSAID — —_ 900 ,, IBJ JlJ - 9 00 Prior to permit rAy/State ZIP Sewrri-1at 100' Issuance,a r opy t f 7.3 __ _ 3000 -' of AN lir!nses are On tUt. Board LIc.9 E •Ds Smver-each ed.ldional 100' 25.00 required if ,;I- }- _/� - Water Service--1s1 1D0' 30.00 expired In COT Ing l IF.A _ [)ale Water Service-eaoh addRlonel 200' - 25.00 d:+tobase - .5 0 Storrn R Rak,fkaln 1st 100' - --- 30 00 lVeme Morro 6 Rain[ailn eadr eddMione1 1130' — - 25.00 Arr;hkert Mobile Fbme sp:c� --"----- ---- 26.00 pr Mawnp Address Sults Conimmulaf Back Ffow Preverrtlon f?Avkx er Antl- 28.00 _ Poliullon Devkx- En In@er Cfty/State - Zip Phone --- - 13.00 (Irm9ation Bing d9vi Prevention Devic�n• r (fmgatlon MmMq devices requirr o separate Describe work to be done - - restricted a rg)Pemi� Now 0 Repal O Replaoe r5in tike kind Yes b No O Any Trap of�Wastn Not Conlwted to a Fixture 9.00 Resid6ribal-0 Commercial a Catch Basin —"- --- --` 9A0 Addluone)description of work. -- Insp.of Existing Plumbing _-- — 40.00 -- _ rRx l Specda0y Roqueatad Inspnctlona - -- — 40.00 Rain L"In,singie famMy dwelling -- Are you capping,moving or replacing any fixtures 30.130^- _ Yoe O No-.O (Grease I7eps If yns.See back of form k. indicate work por.ormed L -- --- fixture. FAILURE rn ACCURATELY REPORT FIXTUREQUANTITY TOTAL. ler-.T!2c nr rani�-nrr;la required r ciugrdq Tara, WORK COULD RESULT IN INCREASED SEWER FEES. 'oUBTOTAL o I hereby acitnuwiedgc that 1 have read this spp iwii,that the oirneuon k gNen is Cdrect,that I em the owner or aulhdrized ---------.--------__ �� BOOM setae owrvr,and that lar*'jubrinded are in wn I5%SURCHARGElanoe with Orpon Stals Laws (> S:g. AOeM.�- �,`` @�,te - "PLJ►N REVIEW 25%or SUBTOTAL Require_only r lbr u- Iib foL,la>e �CaKieZ 1+eMlLory Mi Phone--- - - TOTAL c� 'Mlnlrvmm permit fee is i25 5!6 owttterge,except Reskfentlse Bxrkflote --. -----� _ --- - Prevention D"ce,which is f1F, 5%srrdrorge All Naw ConrmerrAd 11hilldings requke IdRns with rsometrlc of riser diagram and p+>•n review ldverlkm nswAm CD dao 216060 1 or. zoo 71 Q1( fL ;.f(1 1'LIJOgg' 969 COS M4 9t:80 RILL 88 go/CO PLEASE QQ_MPPLETE_: – Fixture TypE66161u Work 06if firmed New , Maven! Ft l>�j00 Romwmd)Cappad Lavatory Tub or Tu_b/Fhower Combination Shower Only _ Water_Clo_set Dishwasher _���rianallian�cal Wasting Machine Floor Drain/Floor Sink 2" 3" 419 Water Heater_ _ _ Laundry Room 'Tray Urinal –— - ---– --- Other Fixtures (Specify)_ COMMENTS REGARDING ABOVE. -- -- - - 14 Vj0hM—ff*.nWP&W Mm .2 OF r-AL D fCIO 71 am"f.L rf0 All 13 0961 9QS C0S rVJ Cf:60 HILL 66/60;"C0