Permit (35) A CITY Y O TIGARD PLUMBING PERMIT
A DEVELOPMENT SERVICES PERMIT #: PLM2006 - 00412
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 9/25/2006
PARCEL: 1 S136DD -04100
SITE ADDRESS: 11850 SW 67TH AVE ZONING: MUE
SUBDIVISION: TIGARD TRIANGLE COMMONS LOT: 007 JURISDICTION: TIG
Project Description: Building 1. Interior Plumbing. Other fixtures: (2) drinking fountains, (1) ejector, (1) expansion tank,
(8) hose bibs.
CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: FLOOR DRAINS; 5 TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 1 URINALS: 4 GREASE TRAPS:
LAVATORIES: 8 OTHER FIXTURES:
TUB /SHOWERS: 1 SEWER LINE: ft
WATER CLOSETS: 10 WATER LINE: 100 ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
PACIFIC NW PROPERTIES
ATTN: PAUL GRAM Description Date Amount
P.O. BOX 2206 [PLUMB] Permit Fee 9/25/2006 $898.20
BEAVERTON, OR 97075 [PLMPLN] Plan Review 9/25/2006 $224.55
[TAX] 8% State Surcha 9/25/2006 $71.86
Phone: 503- 626 -3500
Total $1,194.61
Contractor:
WESTERN PLUMBING
9460 SW TIGARD STREET
TIGARD, OR 97223 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 639 -5296
FAX 503- 684 -9015
•
Reg #: LIC 2439
PLM 34 -29PB
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. 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 rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of
these rul r- direct questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344.
I sued By: • 6t(ev, Permittee Signature: f r
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
�► A
gull Fixtures ;‘, / \\I/16 tl tr Plumbing Permit Application rOR 011:1(: '. IJSE (NI.1
City of Tigard C L u .. Received /7 permit No.: ` f `'
v 13125 SW Hall Blvd., Tigard, OR 97223 JCr 2[106 Date/By. o �6 ' - uK ��a (7/62 (7/62 Plan Review - �, ,_.4",,, 1 �+ h
i g �11J� - ,) /
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: / Other Permit No. R;
Inspection Line: 503.639.4175 �. ,00"/ ) ur;g;
T I G A R D i.,��. i 1 l,01 1 rill Date Ready/By: V See Page 2 for
Internet www ttgard -or gov r Nob ;__T ,j�, 7(7(1: fied/Method J �I ( 1 - Supplemental Information t
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i .. : TYP O
RR 1 KK { _ , FE SCHEDULE
,'New construction ❑ Demolition For special information use checklist. ■
Description 1 Qty. 1 Ea. 1 To .
❑ Addition /alteration/replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection) '
f r CATEGORY, OF CONSTRUCTION ' SFR (Obeli 249.20
❑ 1- and 2 -family dwelling Commercial /industrial SFR (2) bath 3
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00 6
❑ Other:
Fire sprinkler ( sq. ft.) Page 2
; ;.w' , t4r -. JOB -SITE- INFORMATION : LOCATION :;
..... - Site utilities
Job site address: / /BSo S 6 ? /'.- ix /(G✓ -) y / Catch basin or area drain 16.60 A
City /State/ZIP: - 1 9 �`( Drywell leach line or trench drain 16.60 rk
Suite/610 /apt. no.: Project name: name: -774g/4/,y, G ' j 7�'is.J &A I Footing drain (no. linear ft.: Page 2
I Manufactured home utilities 110.00
Cross street /directions to job site: Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2 -
Subdivision: I Lot no.: Water service (no. linear ft.: ) - [ / Page 2s
Fixture or item
Tax map /parcel no
Absorption valve 16.60
r x z � ` i1ESCRIP'I'ION ,OF 'WORK _ '' / I'
Backflow preventer - / Paget �/ 'Tt�
�rF�1 /o2 f M47 &t4' Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
o Drinking fountain - 16.60 33 dP
x []$PROPERTY OWNER 1 . D TENANT, G,
Ejectors/sump _/ 16.60 /, ,
Name: /
Expansion tank / - 16.60 6
Address: Fixture/sewer cap 16.60
City /State/ZIP: Floor drain/floor sink/hub 2 to, 5 16.60 63,
Phone ( ) Fax ( ) Garbage disposal 16.60
Hose bib 8 16.60 /32 g o
z u . - $ 0 APPLICANT ❑ CONTACT ,PERSON
Ice maker 16.60
Business name:
Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City /State /ZIP: f' oof drain (co c ia 6 16.60 9, 6 - %
ink asi avat SU - 9 16.60 /7. t`"
Phone: ( ) Fax: : ( )
ub /shower /shower p / 16.60 U
//
g / '
C
E-mail. Urinal ra 16.60 /
x. . a Y - ,;CONTRACTOR`: , '-°,.- r > -
, . -'
- . Water closet 16.60 /f
Business name:/4/45T 1/ PL(r/P14',i //VG Water heater - / 16.60 /6,
Address:9 , O Sw - 77G/9 , !/ /4 lx 10/ Other:
Subtotal '/
City /State/ZIP: 776 4, 0 4 C) ,a 23
/ q�, Minimum permit fee: $72.50
Phone: ( .3 ) 63 9_5:x14 Fax: ( •SD )) (J ""9DIS Residential backflow minimum permit fee: $36.25
CCB Lic.: Plumbing Lic. no.:3% ?9 ,4d Plan review (25% of permit fee)
State surcharge (8% of permit fee) �
47,2i/.54, 47,2i/.54, , I .,
Authorized signature: �,,,s( TOTAL PERMIT FEE 1' CI {-/ b
Print name: a 7'7 10 ja "f/t,,r Date: ey7 fr This permit application expires if a permit is not obtained within
I 180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\ Building \Pamits\PLMF- PmnitApp.doc 04 /06/06 440- 4616T(10/02/COM/WEB)
CITY OF TIGARD
BUILDING DIVISION - PERMIT #: PLM200600412
13125 SW Hall Blvd., Tigard, OR 97223 - DATE ISSUED: 9/25/2006
Phone: (503) 639 -4171 r, KI � I I
Inspection Requests (24 Hrs.): (503) 639 -4175 - AIL L -
INSPECTION WORKSHEET FOR DATE: 10/20/2006 TIME: 7 :01AM PAGE: 63
SITE ADDRESS: 11850 SW 67TH AVE CLASS OF WORK:
'SUBDIVISION: Tit3ARDs TRIANGLE COMMONS LOT #: 007 TYPE OF USE:
PROJECT NAME: TIGARD. TRIANGLE .COMMONS
DESCRIPTION: Building 1. Interior Plumbing. Other fixtures: (2) drinking fountains, (1) ejector, (1) expansion tank, (8)
hose bibs.
OWNER: PACIFIC NW PROPERTIES, PHONE #: 503 - 626-3600
CONTRACTOR: WESTERN PLUMBING PHONE #: 503- 638-5285
•
Inspection Request Scheduled For: Date: 10/20/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
330 Water service 038563 -01 503- 730 -8325 'f
Corrections /Comments /Instructions: /
V
•
P ASS ❑ PARTIAL APPROVAL - ❑ CANCEL ❑ NO ACCESS
FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: /'' I, Date: ID l/ Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM7006-00412
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/76/2006
Phone: (503) 639-4171 -
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 10/19/2006 TIME: 7:02AM PAGE: 54
SITE ADDRESS: 11850 SW 67TH AVE CLASS OF WORK:
SUBDIVISION: TIGARD TRIANGLE COMMONS LOT #: 007 TYPE OF USE:
PROJECT NAME: TIGARD TRIANGLE COMMONS
DESCRIPTION: Building 1. Interior Plumbing. Other fixtures: (2) drinking fountains, (1) ejector, (1) expansion tank, (8) •
hose bibs.
OWNER: PACIFIC NW PROPERTIES, PHONE #: 503-626-3500
CONTRACTOR: WESTERN PLUMBING PHONE #: 503-539-5296
1 , • Inspection Request Scheduled For: Date: 10/19/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
330 Water service 038487-01 503-730-8325
Corrections/Comments/ Instructions:
AANPFINP=. -■_amm
Wir
PASS , ,r1 . ---PARTIAL APPROVAL 111 CANCEL. NO ACCESS
1 1 FAIL 1 1 CALL FOR INSPECTION 1 1 ADDITIONAL FEES ASSESSED
Inspector: 1 V/ Date: biT, V Phone #: (503) 718-
CITY OF TIGARD • i:
BUILDING DIVISION . ,, . PERMIT #: PLM2006-00412
_
13125 SW Hall Blvd., Tigard, OR 97223 - - '
. DATE ISSUED: 9f2&2006
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 11/1/2006 TIME: 7: 03Alvi PAGE: 30
SITE ADDRESS: 11860 SW 67TH AVE CLASS OF WORK:
SUBDIVISION: TIGARD TRIANGLE COMMONS LOT #: 007 TYPE OF USE:
PROJECT NAME: TIGARD TRIANGLE COMMONS
DESCRIPTION: Building 1. Interior Plumbing. Other fixtures: (2) drinking fountains, (1) ejector, (1) expansion tank, (6)
hose bibs.
OWNER: PACIFIC NW PROPERTIES, PHONE #: 503-626-3500 '
CONTRACTOR: WESTERN PLUMBING PHONE #: 503-639-5296
Inspection Request Scheduled For: Date: 11/1/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
330 Water service 039132-01 503-684-9015 Y
Correctioris/Comments/Instructions:
, AK _AMMO J(1 44111...dia ■1 -.._ P
. op-
/
..41'sr ,Aellr L_/■■ / -_- L
--
/
. '
]1__13ASS 0 PARTIAL APPROVAL 0 CANCEL El NO ACCESS
Ii FAIL 1 1 CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
,•
Inspector: 1\Ai
AV -ej Date: ti_q_b_C Phone #: (503) 718- 7 /)
. ,
•
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2006-00412
-
13125 SW Hall Blvd., Tigard, OR 97223 - DATE ISSUED: 9/25/2006
Phone: (503) 639-4171 AsIA, Olelk
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 11/3/2006 TIME: 5:07PM PAGE:. 2
SITE ADDRESS: 11850 SW 67TH AVE CLASS OF WORK:
SUBDIVISION: TIGARD TRIANGLE COMMONS LOT #: 007 TYPE OF USE:
PROJECT NAME: TIGARD TRIANGLE COMMONS
DESCRIPTION: Building 1. Interior Plumbing, Other fixtures: (2) drinking fountains, (1) ejector, (1) expansion tank, (8)
hose bibs.
OWNER: PACIFIC NW PROPERTIES, PHONE #: 503-626-3500
CONTRACTOR: WESTERN PLUMBING PHONE #: 503-639-5296
Inspection Request Scheduled For: Date: 11/6/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
330 Water service 039337-01 503-639-5296 N
Corrections /Comments / Instructions:
I .- r ■ai•
ilArW 4 1-)1 d
• SS 0 PARTIAL APPROVAL 0 CANCEL 1111 NO ACCESS
0 FAIL n CALL FOR INSPECTION ri ADDITIONAL FEES ASSESSED
Inspector: 1 Date: il Phone #: (503) 718-
•
CITY OF TIGARD •
BUILDING DIVISION PERMIT #: PLIN200& 00412
i
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/250006
Phone: (503) 639 -4171 �,P' 1
Inspection Requests (24 Hrs.): (503) 639 -4175 °'' �:. '.
INSPECTION WORKSHEET FOR DATE: 12/6/2006 TIME: 7 :01AM PAGE: 78 •
SITE ADDRESS: 11850 SW 67TH AVE CLASS OF WORK:
SUBDIVISION: TIGARD TRIANGLE COMMONS LOT #: 007 TYPE OF USE: •
PROJECT NAME: TIGARD TRIANGLE COMMONS •
DESCRIPTION: Building 1. Interior Plumbing. Other fixtures: (2) drinking fountains, (1) ejector, (1) expansion tank, (Et)
hose bibs.
OWNER: PACIFIC NW PROPERTIES, PHONE #: 503. 620.3500
CONTRACTOR: WESTERN PLUMBING PHONE #: 503.639x5296
Inspection Request Scheduled For: Date: 121€42006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
305 Plumbing underslab 040688 -01 503€- 6331,296 N
Corrections /Comments /Instructions:
�[J PASS ❑ PARTIAL APPROVAL n CANCEL n NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector:. Date: I d"/ 1/� Phone #: (503) 718 -
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2006-00412
•
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/25/2006
Phone: (503) 639 -4171 f' +
Inspection Requests (24 Hrs.): (503) 639 -4175 . '
INSPECTION WORKSHEET FOR DATE: 12/18/2008 TIME: 7 :05AM PAGE: 16
SITE ADDRESS: 11850 SW 67TH AVE CLASS OF WORK:
SUBDIVISION: TIGARD TRIANGLE COMMONS LOT #: 007 TYPE OF USE:
PROJECT NAME: TIGARD TRIANGLE COMMONS
DESCRIPTION: Building 1. Interior Plumbing. Other fixtures: (2) drinking fountain, (1) ejector, (1) expansion tank, (8)
hose bibs.
OWNER: PACIFIC NW PROPERTIES, PHONE #: 503. 626-3500
CONTRACTOR: WESTERN PLUMBING PHONE #: 503. 539.5296
Inspection Request Scheduled For: Date: 12118/200; Pour Time:
Code # Inspection Description Confirm # Contact # Message
305 Plumbing underslab 041217 -01 503 -639 -5258 Y
Corrections /Comments/ Instructions:
Vit41 *' v 1*• t. 6 (Ike a .
1 PASS PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION _ ADDITIONAL FEES ASSESSED
Inspector: V`-' % Date: \Z ti b$ Phone #: (503) 718 - V' 1 4
CITY OF TIGARD j : . ,. _
BUILDING DIVISION PERMIT #: PLI�2006 00'112
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/25/2006
Phone: (503) 639 -4171 �� a� l
Inspection Requests (24 Hrs.): (503) 639 -4175 .J—W "'I_I�
INSPECTION WORKSHEET FOR DATE: 1317012006 TIME: 7 :00AM PAGE: Q1
SITE ADDRESS: 11850 SW 67TH AVE • CLASS OF WORK:
SUBDIVISION: TIGARD TRIANGLE COMMONS LOT #: 007 TYPE OF USE:
PROJECT NAME: TIGARD TRIANGLE COMMONS
DESCRIPTION: Building 1. Interior Plumbing. Other fixtures: (2) drinking fountains, (1) ejector, (1) exparosion tank, (8)
he bobs.
OWNER: PACIFIC NW PROPERTIES, PHONE #: 503 - 626.3500
CONTRACTOR: WESTERN PLUMBING PHONE #: 503 -539 5296
Inspection Request Scheduled For: Date: 12/20/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Me a e
305 Plumbing underslab 0 41301 -01 503.464 -60$8 Y
Corrections/ ents /Instructions: , , 1..;_.,
e ill c - S"
2
n PASS si 'ARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED ,
Inspector:
VA, C /�" ''
Date: t /' I) /6(0 Phone #: (503) 718-
1
CITY OF TIGARD ,
BUILDING DIVISION PERMIT #: PLM2006-00412
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/25/2006
Phone: (503) 639 -4171 l illi ° n ' 1
Inspection Requests (24 Hrs.): (503) 639 -4175 . '`''
INSPECTION WORKSHEET FOR DATE: 5/11/2007 TIME: 7:01AM PAGE: 113 I
SITE ADDRESS: 11050 SW 67TH AVE CLASS OF WORK: 1
SUBDIVISION: TIGARD TRIANGLE COMMONS LOT #: 001 TYPE OF USE:
PROJECT NAME: TIGARD TRIANGLE COMMONS
DESCRIPTION: Building 1. Interior Plumbing. Other fixtures: (2) drinking fountains, (1) ejector, (1) expansion tank, (8)
hose bibs.
OWNER: PACIFIC NW PROPERTIES, PHONE #: 503 - 626.3500
CONTRACTOR: WESTERN PLUMBING PHONE #: 503-639-5296
Inspection Request Scheduled For: Date: 5/11 /2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
335 Rain drain 048056 -01 503-639-5296 N
Corrections /Comments/ Instructions:
_... k," -----
0 /1
•
PASS 4__ i - PARTIAL APPROVAL ,CANCEL U NO ACCESS
I
FAIL i
CALL FOR INSPECTION U ADDITIONAL FEES ASSESSED
Inspector: M ` - /`L V Dater lI / o ') Phone #: (503) 718 -
CITY OF TIGARD ..
A .
BUILDING DIVISION PERMIT #: PLM200(-00412
13125 SW Hall Blvd., Tigard, OR 97223
".
DATE ISSUED: 9/25/2006
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 5/30/2007 TIME: 7:00AM PAGE: 21
SITE ADDRESS: 11850 SW 67TH AVE CLASS OF WORK:
SUBDIVISION: TIGARD TRIANGLE COMMONS LOT #: 007 TYPE OF USE:
PROJECT NAME: TIGARD TRIANGLE COMMONS
DESCRIPTION: Building 1. Interior Plumbing. Other fixtures: (2) drinking fountains, (1) ejector, (1) expansion tank, (8)
hose bibs.
OWNER: PACIFIC NW PROPERTIES, PHONE #: 503-626-3500
CONTRACTOR: WESTERN PLUMBING PHONE #: 503-639-5296
Inspection Request Scheduled For: Date: 5/30/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
335 Rain drain 049250-01 503-639-5296 N
Corrections/Comments/Instructions: ,
al/
I /
Ass El PARTIAL APPROVAL l] CANCEL El NO ACCESS
n FAIL 0 CALL FOR INSPECTION I ADDITIONAL FEES ASSESSED
(,)
Inspector: 1 1% Date: --- 61 67 Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM200G -00412
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/25/2006
Phone: (503) 639 - 4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR • DATE: 6/1/2007 TIME: 7:O2AM PAGE: 38
SITE ADDRESS: 11850 SW 67TH AVE CLASS OF WORK:
SUBDIVISION: TIGARD TRIANGLE COMMONS LOT #: 007 TYPE OF USE:
PROJECT NAME: . TIGARD TRIANGLE COMMONS
DESCRIPTION: Building 1. Interior Plumbing. Other fixtures: (2) drinking fountains, (1) ejector, (1) expansion tank, (8)
hose bibs.
OWNER: PACIFIC NW PROPERTIES, PHONE #: 503 - 626.3500
CONTRACTOR: WESTERN PLUMBING PHONE #: 503. 639 -5296
Inspection Request Scheduled For: Date: 6/1/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 • Plumbing rough -in 049402 -01 503 - 639-5296 Y
Corrections /Comments /Instructions:
j..
r aiiritriurom
(9-0
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL I CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: / " Date: / 1 Phone #: (503) 718-
CITY OF TIGARD •• -
BUILDING DIVISION PERMIT #: PLM2006-00412
/„A 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/25/2006
Phone: (503) 639-4171
Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 8/24/2007 TIME: 7:00AM PAGE: 66
SITE ADDRESS: 11850 SW 67TH AVE CLASS OF WORK:
SUBDIVISION: TIGARD TRIANGLE COMMONS LOT #: 007 TYPE OF USE:
PROJECT NAME: TIGARD TRIANGLE COMMONS
DESCRIPTION: Building 1. Interior Plumbing. Other fixtures: (2) drinking fountains, (1) ejector, (1) expansion tank, (8)
hose bibs.
OWNER: PACIFIC NW PROPERTIES, PHONE #: 503 - 626.3500
CONTRACTOR: WESTERN PLUMBING PHONE #: 503 - 6335296
Inspection Request Scheduled For: Date: 8/24/2007 Pour Time:
Code # Inspection Description. Confirm # Contact # Message
399 Plumbing final 054584 -02 503 - 572 -7305 N
Corrections/Comments/Instructions:
CL„,,c,(L UwLV� w. ' �1 ✓w �aG✓ �io ✓T ar
et/vs- "o w..<.✓ co" A-1 " - Tzflo S t- - 7 CT O 2 ,,c'o PM-n ,. c dl e
Co >ob - r 1 ate✓ Pu vv t ✓►
Iyf PASS n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL CALL FOR INSPECTION 1 I ADDITIONAL FEES ASSESSED
Inspector: Cf1 14A...41/13 Date:,, 12 I- - 0- ) Phone #: (503) 718-