Permit F44/08- j r0vv C.Tv') : c rf - cc_
CITY OF TIGARD ELECTRICAL PERMIT
Il
PERMIT #: ELC2008 -00469
, :. COMMUNITY DEVELOPMENT DATE ISSUED: 8/13/2008
s
:TIGARD. 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1 S 133RD -03800
SITE ADDRESS: 12750 SW SPRINGWOOD DR ZONING: R -7
SUBDIVISION: AMART SUMMERLAKE LOT : 012 JURISDICTION: TIG
PROJECT: MITCHELL
Project Description: Installing (4) branch circuits for kitchen remodel. 8/28/2008 ADDED (1) service.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAUPANEL:
MANF HM/ SVCI FDR: 601 +amps -1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
_ 0 - 200 amp: 1 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: 3 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:
JOHN MITCHELL A & J ELECTRIC
KAREN KAY PO BOX 330
12750 SW SPRINGWOOD DR FOREST GROVE, OR 97116
TIGARD, OR 97223
Phone: Contact #: PRI 503 - 359 - 5891
FAX 503 - 359 -1981
FEES
Description Date Amount Reg #: ELE 34 -1C
[ELPRMT] ELC Permit 8/13/2008 $66.80 LIP 505
[TAX] 12% State Surchar 8/13/2008 $8.02 SUP 50555
[ELPRMT] ELC Permit 8/28/2008 $80.30
(additional fees not listed here) REQUIRED ITEMS AND REPORTS
Total $164.76
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 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By: Ui�i Permittee Signature: P ��o
OWNER INSTALLATION ONLY
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: DATE:
LICENSE NO:
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.
Aug 28 08 09:31a Leeann Greason 503-359-1981 p.2
' • Eietrical Permit Application 0 FOR OFFICE USE ONLY
Cit of Tigard CV) Received -
a Daie .. • Alf= Permit No.:
. Phone: 503.639.4171 Fax: 501598. 0 ci
. • 13125 y SW Hall Blvd.. Tigard, OR 9
I LI
% ri-1 Plan Review
Other Pennit:
' 2 . v Date/El :
T 1 GA R D
Inspection Line: 503.6394175 \,.) 14 pate Ready/By: la See Page 2 for
Internet: www.tigard-orgov GO cdifiediMethod:
A\ ik, ki' 111MI Supplemental Information
- 4
- : . -: :. • . .-".' '''' -:: 07 !...::::.;:::.:: .::::,-: .- ' `::::.-- `'.: 7r . : ":" f ":- '-: .:: REYIE*.::,.
Pkase cheek all that apply (submit 2 sets of plans wThems checked below): I
0 New construction D Addition/aheratio., t. , ment
1 0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition D Other. where the available fault current 0 Marinas and boatyards.
C:A7l ...:: : ' ';:.- '' -":' . '':•••• : exceeds 10.000 amps at 150 volts crr 0 Floating build ini
I ess to ground, ow exceeds 1 4,000 CI COMMENCL2i-LLSC agricultural
O 1 - and 2-family dwelling 0 Commercial/industrial 0 Accessory building amps for all other instal !glow. buildings.
O Multi-family Ei Master builder D Other: 0 Fire pump. ID installation of 75 KVA or
-.:. .....,.-...,. .,..„ . . .. ., ... _ , . larger 9eparately derived system.
' . ' ' • ,,.- JOEfkr;WF:l..- . : ..,-,--..: ,..:,:, . .,.: 0 Addition of new motor load of
occupancy.
Job no.: r Job site address: ',, s; ,. •,,,, 3001-IP or MOM.
__.) -__ ,;....) . ,.. • ,:, .... r .... :, ), 1 , t. ,,-, ['six or more residential units. a Itecreational vehicle parks.
City/State/ZIP: - ,.. ., .- 0 Health-care facilities. 0 Supply voltage for more titan
--,,-.&- ,, ■." \ .,
0 Hazardous locations. 600 volts nominal.
Suite/bldg../apt. no.: Project name: CI Service or feeder 600 amps or more.
'FEE SCHEDULE
Cross street/directions to job site: ' Description I Qty. 1 Fee. 1 Tetsl 1 •
New residential single or multi dwelling and.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or Iess 145.15 4
Fa. addi 500 sq. IL or portion 33.40 ., I
Tax map/parcel no.: .
Limited energy, residential
! 7500 2
,.._ ::: :,.- , : ,..1:; :':_,.: ;..; .
(with above sq. II.)
'----... r^......, Limited energy, multi-family
.
c •-••■ i 75.00 2
- -: - --J; --- ,..-, `,.. __ . -z_s_.. •,-..._ -,- j "-....-,?_ -s • -.. -- . :,) ``•:. -N -,--;' residential (with above sq. ft.)
. Services or feeders installation, alteration, and/or relocation
- --N, ...... „ 200 amps or less 80.30 7 -3...z. - - 74 . I 2
i : ., ... .._„....._ ,....
: ,:-. --• 0 '1 OWNCII.' : :I -: • , :: . . : , :: .7' 1 :1 - :.Ti°1 1. `ilr .: .;......; - . :.:- . 20] amps 10 400 amps 106.85 2
Name: 40] amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City/State/Z1P: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1 I
s
Owner installation: This installation is being made on property that 1 own which is not 201 amp 10 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75
1 ! 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date:
A_ Fee for branch circuits with
' - ..:-' ' •' , . ' ' . :' El APP146A14, .ti:- - 2 - ''-. .:, : f ::- ,--:;,.:apINFAcr-PERW,I.",:4•••., above service or feeder fee,
6.65 2
each branch circuit .
Business name: ' B. Fee for branch circuits
without service or feeder fee,
Cott= name: 4-6.85 2
first branch circuit
Address: Each addi branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular
r 90.90 2
dwelling. service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only i 66.85 2
E-mail: Pump or irrigation circle 1 53.40 . 2
• - • . .. coprraAcroa , '--.i ,::. -: •: -. - .:-:::;.::-, : -.:::.,.. ,....:. „ Sign Or outline lighting 1 53.40 2
Sign-al circuit(s) or limited- ,
Business name: A&J Electric energy panel, alteration, or
Address: PO Box 330 extension. Describe: Page 2 2
City/State/ZIP: Forest Grove, OR 97116 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (503) 359-5891 Fax: (503)359-1981
Investigation per hour (1 hr min) 62.50
CCB Lic.: 959 Electrical Lic.: 34-1c Suprv. Lic.: 5055S industrial plant per hour 73.75
ELE'CIRICAL PERMIT FEES ;
Suprv. Electrician signature, required: ------ / - ___,.... .da
4 / 7
--- c- ..../ . .. .: .. - :
Subtotal: -?-7 .,
Plan review (259/0 of permit foe):
Print name: Tony Wilson 7 Date:
State surcharge ( I 2% of permit fee): 1
Authorized signature: TOTAL PERMIT FEE: , '- -_.::, \
This permit application expires if a permit is not obtained with la 180
Print narne: Date: days after it has beta accepted 53 complete.
• • Number or inspections allowed per permit.
I: BuildineltrmitstEUC-PermitApp dos 05e23106 640.9615T(11/09COM)WED
v CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: E /200 00469
COMMUNITY DEVELOPMENT
DA TE ISSUED: 8/13/2008
T:I 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1 S 133RD -03800
SITE ADDRESS: 12750 SW SPRINGWOOD DR ZONING: R - 7
SUBDIVISION: AMART SUMMERLAKE LOT : 012 JURISDICTION: TIG
PROJECT: MITCHELL
Project Description: Installing (4) branch circuits for kitchen remodel.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HM/ SVCI 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: 3 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:
JOHN MITCHELL A & J ELECTRIC
KAREN KAY PO BOX 330
12750 SW SPRINGWOOD DR FOREST GROVE, OR 97116
TIGARD, OR 97223
Phone: Contact #: PRI 503- 359 -5891
FAX 503 - 359 -1981
FEES
Description Date Amount Reg #: ELE 34 -1C
[ELPRMT] ELC Permit 8/13/2008 $66.80 LIC 959
[TAX] 12% State Surchar 8/13/2008 $8.02 SUP 5055S
Total $74.82 REQUIRED ITEMS AND REPORTS
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 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By: I `� Permittee Signature: 'c�
' OWNER INSTALLATION ONLY
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: DATE:
LICENSE NO:
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.
Aug 13 08 01:59p Leeann Greason 503-359-1981 p.2
Elqctrical Permit Application FOR OFFICE LSE ONLY
' 't . City of Tigard Receiv ri ff/ A -7:-. .
13125 SW Hall Blvd., Tigard, OR 97223 .\<.45) Dateill : 70 permit No.: .., _
Plan Review
' II . Phone: 503.639.4171 Fax: 503.598.1960
11
<F , 11. Date/13y: Other Permit:
i t G A D Inspection Line: 503.639.4175 Dale ReadyfEty: AM .. El See Page 2 for
Internet: www.tigard Notifiedfivlethod: f Supplemental Information
oi r \- 4
7 - . -:- .. :.., _--.: • .•..=-.,-.: • : .', • ', f ..-.). ..;■,';';`, ''.'..:. \047 , .. '''. :'•‘' • :.' • 1 • '''... • 1 ::'''.. .' '.: PTAS( itElfit'W i . • ; , .
ts ,\‘‘ Please check all that apply (submit 2 sets of plans willems checked below):
9 New construction altdditionialtera on/re nler4 .:\
9 Demolition Ej Other: 0 ()NY ['Service or feeder 400 amps or more ID Building Over three StorieS•
where the available fault current El Marinas and boatyards.
CAT.gdo4ilDit:t6i01* - . ? c I g . - :.: .'': - r' '5'3t ' . : 1 : :7 : . ':.: exceeds 10,000 amps at 150 volts or 0 Ficotimg buildings .
less to ground, or exceeds 14,000 CI Commercial-use agricultural
ELI and 2-family dwelling 9 Commercial/industrial ,F\ccessory building amps for all other installations. buildings.
0 Multi-family 0 Master builder • Other: 0 Fire pump. 0 Installation of 75 KVA or
, ,, , ,4.e,..,, ,- , ..... , ; .1 .„.., ) , : .... 0 Emergency system. larger separately derived system.
ll 1);;11 tg`i 14 #0W 1 4 .1 1 514. T. t'll-0 ":-':::,:. - ''. El Addition of new motor load of
- 7
--.., 100HP er more. occupancy.
Job no.: Job site addre -
Sc Six or more residential units. 0 Recreational vehicle parks.
-.. ;
City/SlateiZIP7' , , Pee 4246 10/ 0 Health-care facilities. 0 Supply voltage for more than
ID Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: Project name:
6 -7- o Service or feuder 600 amps or more.
?:,-: .- l .--'---,-;-;:-. ': '. . -- - - FFS. SCHEDULE " • . '
, ,
Cross street/directions to job site:
Description 1 Qty. 1 wee Total 1 •
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 I
Tax map/parcel no.:
_ Limited energy. residential
DESCRIPTION W 75.00 2
(with above sq. ti.)
. : : -. • .: _ • ..,•••
,
Limited energy, multi-family
75.00 2
N ' ..-- •-•... - " , .--. N C"';' -- --.'..' - _ -- ■ ------- • -- --- , •----- -- --..d.S:=L N _. , .. . residential (with above sq. A.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
106.85 2
401 amps to 600 amps 160.60 2
Name: p‘ vv //1717` /1
601 amps to 1,000 amps 240.60 2 .
Address: / A -75 . . .,..,,_ L extvp ) cof f 1 bAck Over 1,000 amps or volts 454.65 2
City/State/ZIP:
-
Temporary services or feeders installation, alteration, and/or
7---,, c... g l (R4- f:y re is relocation
Phone: ( ) Fax: ( ) in 43 77. 200 amps or less 66.85 I
Owner installation: This installation is bein& made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits - new, alteration, or CN tension, per panel
Owner signature: Date:
A_ Fee for branch circuits with
t1 4rPLIPOr t a:co41*-osoois ,..,::......:. - above service or feeder fee,
? 6.65 2
each branch circuit
Business name:
•
• B. Fee for branch circuits
without service or feeder fee,
Contact name:
first branch circuit '\ 46.85 .Z%C 2
Address: Each addi branch circuit ''''" 6.65 -\•=•\ .5 2
Miscellaneous (service or feeder not included) _
City/State/ZIP:
Each manufactured or modular '
90.90 2
dwelling, service and/or feeder
Phone: ( ) - i Fax: : ( ) Reconnect only 66.85 2
.
E Pump or irrigation circle 53.40 2
CONTRACTOR .:.-- - '.- " L: :' '' L:. .: . L; . : :_. Sign or outline lighting - 53 40 . 2
Signal circuit(s) or limited-
Business name: A&J Electric
energy panel, alteration, or
Address: PO Box 330 extension. Describe: Page 2 2
City/State/Z1P: Forest Grove, OR 97116 Each additional inspection over:allowable in any of the above
Per inspection 62.50
Phone: (503) 359-5891 I Fax: (503) 359-1981
Investigation per hour (I hr min) 62.50
_
CCB Lic.: 959 Electrical Lic,: 34-1c Suprv. Lic.: 5055S Industrial plant per hour 73.75
7 • . , . : - ELECrIOCA1.-otoirr FEES:
Suprv. Electrician signature, required: ,,.---...------------ _ ,...... 1_ ... 1....../ Subtotal:
i
Print name: Tony Wilson - Date:. - s - c2._ Q•)--2.. • Plan review (25% of permit fee):
State surcharge (12% of permit fee): 0)-
Authorized signature:
TOTAL PERMIT FEE:
J This permit application expires if a permit is not obtained within 180
Print name: Date:
days after it has been accepted AS complete.
* Number of inspections allowed per pemiit.
1:113uildi1APcrnits 05/23/06 440-46 I 5T(11/0)C0WWF_B
CITY OF TIGARD
B JILbING DIVISION PERMIT #: ELC2008- O10469
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/13/2008
Phone: (503) 639 -4171 A
Inspection Requests (24 Hrs.): (503) 639 -4175 °T I lilt'
INSPECTION WORKSHEET FOR DATE: 1f16/noo9 TIME: 7: 01 AM PAGE: 26
SITE ADDRESS: 12750 SW SPRINGW'000 DR CLASS OF WORK:
SUBDIVISION: AMART SUMMERLAKE LOT #: 012 TYPE OF USE:
PROJECT NAME: MITCHELL._
DESCRIPTION: In tailing (4) branch cis cults for kitchen remodel. 0120/2008 ADDED (1) MYiCO.
OWNER: MITCHELL, JOHN PHONE #:
CONTRACTOR: A & J ELECTRIC PHONE #: ,[f 6.369.6891
Inspection Request Scheduled For: Date: 1/18:009 Pour Time:
Code # Inspection Description . ' - onf rm- Contact # Message
109 FIectiical final 079730 -01 503 - 5244058 N
Corrections /Comments /Instructions: .
\ N\J i ,
.
■■ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Th %, Nbg Date: 1 ' 14,1 Phone #: (503) 718- VIC
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC20013.00469
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/1 312008
Phone: (503) 639 -4171 ICI
Inspection Requests (24 Hrs.): (503) 639 -4175 ' :_..
INSPECTION WORKSHEET FOR DATE: 11/1312008 TIME: 7:00AM PAGE: 14
SITE ADDRESS: 12750 SW SPRINGWOOf) DR CLASS OF WORK:
SUBDIVISION: AMART SUMMERLAKE LOT #: 012 TYPE OF USE:
PROJECT NAME: MITCHELL
DESCRIPTION: Installing (4) branch circuits for Kitchen remodel. 8/28/2008 ADDED (1) service.
OWNER: MITCHELL, JOHN PHONE #:
CONTRACTOR: A & J ELECTRIC PHONE #: 503 - 359-5891
Inspection Request Scheduled For: Date: 11/13/2008 Pour Time:
Code # Inspection Description Confirm. #:- Contact # Message
199 Elect 'loaf final 078039 -01 503.616-6425 N
Corrections /Comments /Instructions: )
-* 1 o AA/4 c- , w S 3 0 AMes . IAti�. (P)
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL CALL FOR INSPECTION f l ADDITIONAL FEES ASSESSED
Inspector: G Date:1 f 1 0') 3 1 Phone #: (503) 718- PIA_
CITY OF TIGARD i i _ -
B UILDING DIVISION PERMIT #: r- LC2008- 004Ci9
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/13/2()00
Phone: (503) 639 -4171 -
Inspection Requests (24 Hrs.): (503) 639 -4175 . '� °1f I�
INSPECTION WORKSHEET FOR DATE: 8/2012008 TIME: 7.0 2AM PAGE: 11
SITE ADDRESS: 12760 SW SPRINGWOOD DR CLASS OF WORK:
SUBDIVISION: AMART St1MMERLAKE LOT #: 012 TYPE OF USE:
PROJECT NAME: MITCHELL
DESCRIPTION: Installing (4) branch circuits for kitchen remodel.
OWNER: MITCHELL, JOHN PHONE #:
CONTRACTOR: A & J ELECTRIC PHONE #: 503 - 359 -5R91
Inspection Request Scheduled For: Date: 8/20/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
120 Electrical rough -in 07M09-01 503 -341 -7133 Y
gam, i 91
Corrections /Comments /Instructions:
1-.13 a \� 'TVA ($.o LI 1x1 WI I■)1) w,5
? IZZAvc,v1 •5 I ► a.Z. L. %low f i Nt9‘1 --
•
A PASS n PARTIAL APPROVAL 111 CANCEL ❑ NO ACCESS
n FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: CY ` Date: 4.1 Phone #: (503) 718 - Z
CITY OF TIG�. RD
BUILINNG DIVISION PERMIT #: ELC2008 OCY169
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/1311008
Phone: (503) 639 -4171 roue di l , • Inspection Requests (24 Hrs.): (503) 639 -4175 . -- R__..
INSPECTION WORKSHEET FOR DATE: 811912008 TIME: 7:OOAM PAGE: 6
SITE ADDRESS: 12750 SPRINGWOOD DR CLASS OF WORK:
SUBDIVISION: AMART SUMMERLAKE LOT #: 012 TYPE OF USE:
PROJECT NAME: MITCHELL
DESCRIPTION: Installing (4) branch circuits for kitchen remodel.
OWNER: MITCHELL, JOHN PHONE #:
CONTRACTOR: A & J ELECTRIC " -_ stn PHONE #: 503 - 353.5891
Inspection Request Scheduled For: Date: 811 .008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
120 Electrical rough -in 074351 -01 501341 -7133 \ Y
503• (
Corrections /Comments /Instructions:
. 119 I
1R— DAvc
O ') \, ND 1- .:►cam! ; 5 0,► t 6 UT i 66 ' Arq . 310 . IS
5 fee Z': : N 1C ) cN) • ct.1 k SC `l
A (0 L .
— O (Z
Ira. -Ni cto by '6(t$ - 314. IS
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: �' N 1.-)a Date: I S ' 9 i Phone #: (503) 718 - ION