Permit L:= .CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2008 -00422
COMMUNITY DEVELOPMENT DATE ISSUED: 7/23/2008
,TiGARD' 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S110AA -01200
SITE ADDRESS: 14300 SW PACIFIC HWY ZONING: C -G
SUBDIVISION: CANTERBURY PLACE LOT : 008 JURISDICTION: TIG
PROJECT: DR DAVID WILSON
Project Description: TI
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/ SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10):
SERVICE/FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 5 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:
STEPHEN & JODETTE BATES TIMBERLINE ELECTRICAL CONTRACTORS
10430 SW VIEW TERRACE PO BOX 918
TIGARD, OR 97224 LAKE OSWEGO, OR 97034
Phone: Contact #: PRI 503 - 459 -4089
FAX 503 - 254 -4227
FEES
Description Date Amount Reg #: ELE 26 -121 IC
[ELPRMTI ELC Permit 7/23/2008 $80.10 LIC 160037
[TAX] 12% State Surchar 7/23/2008 $9.61 SUP 4957S
Total $89.71 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: Permittee Signature: •' s
y' g /�/ Grp e ' - - ,k
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:
CaII 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.
07/21/2008 19:01 FAX 2 002/002
Electrical Permit Application r■ llz (* l: b s• r. oN I A
A► w•
City of Tigard RELIVE V Permit No.: ELL a ao0 p
-GO 2 - Z
111
13125 SW Hail Blvd., Tigard, OR 97223 Plan Review
• I Phone: 503.639.4171 Fax 503.598.1960 r,tdgy: Other P81ID1c EL2 ac)C OC> 2 2 - 3
, i c ,., t t ) Inspection Line: 503.639.4175 `I I L 22 20 ' Ready/By: runs. ® See Page 2 for
Internet: www_tigard- or,gov J V rt t �� Supplemental information
1 YA OF. `WORKC p Y ►GN"' j�[ P1i KDI REYiEW
❑ New construction ® Addition/alteratio 0 DIVISIO • Please check all that apply (submit 2 sets of plans w /ttcros checked below):
�� ❑ Service or feeder 400 amps m more ❑ Building over three stones.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
. : ' . CATEGORY OF .CONSTRUCTION. - exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
Q I - and 2 � dWellin leas to ground, or exceeds 14,000 ❑ Commercial -use agricultural
y g ® Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi-family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 K VA or
. . ['Emergency system. larger separately derived system.
,.: } :r dOB SCI 1PrtYFOR1riAT1ON :AN
- ...: `, - .... ❑ Addition of new molar toad of ❑ °A" "E », "1 -2" "I -3'•
Job no.: Job site address: 14300 SW Pacific Hwy 1 ooHP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City / State/ZIP: Tigard, Oregon 97224 ❑ Health -care facilities. ❑ Supply voltage for more than
['Hazardous locations. 600 volts nominal.
Suite/bldg. /apt no.: Project name: Dr Wilson ❑ Service or feeder 600 amps or more.
FEE SCUEDUJLE,
Cross street/directions to job site: Descrtptioo I Qty. I Fee. T T.r.t I
' New residential single- or multi-family dwelling unit
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
lia. Will 500 sq. ft. or portion 33.40 I
Tax map /parcel no.: Limited energy, residential
DESCR�IlON OF .Wt)RK
(with above sq. f.) 75.00 2
New lighting Limited energy, multi - family 75 00 , , 2
residential (with above sq. S.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
. t.: PROPERTY OWNER • 1 . 0 TENANT - 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 alnps 160.60 2
•
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City /State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) l Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that 1 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 extension, per panel
Owner signature. Date: A. Fee for branch circuits with
' - : g APPLICANT- ' • 1 ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 6.65 2
Business name: -7-1 i.Q,, -F7.acV -4. (_. 13. Fee for branch circuits
circuit
Contact name:tAL r'cr -e� \ fast brand without service or feeder fee, 1 46.85 46.branch 2
Address: Po Spy 7/, add'I branch circuit 5 6.65 33.25 2
Miscellaneous (service or feeder not included)
City/ State/ZIP: � .3 Each manufactured or modular 90 2 J
r dwelling, service and/or feeder
Phone: (523) yJr dgq � F , ax: at ( n j'd3)�j1 `�(
Reconnect 66.85 2
E C LtL Q `f-1 fM b441-1. . p„ C.tt -iL. Cay1/N . Pump or irrigation circle 53.40 2
CONTRACTOR - Sign or outline lighting 53.40 2
Business name: Timberline Electrical Contractors, Inc. Signal circuit(s) or limited -
energy panel, alteration, or
Address: Po Box 918 extension. Describe: Page 2 2
City / State/ZIP: Lake Oswego, Oregon, 97034 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (503) 459 -4089 .1 Fax: (503) 2544227
Investigation per hour (t hr min) 62.50
CCB Lic.: 160037 I Electrical Lic 1 C uprv. Lic.: i( q S? $' Industrial plant per hour 73.75
�� ELECIRI PERMIT' FENS •,
Suprv. Electrician signature, required: /4 11`y'{ p
�/"�� l Subtotal: 80.10
Print name: Patrick Ai • Ile. , • n Date: 7/22/20 Plan review (25% of permit fee):
d Ii State surcharge (12% of permit fee): 9.61
Authorized signature: ` TOTAL PERMIT FEE: 89.71
This permit application expires if a permit is not obtained within 180
Print name: Dom: days after it has been accepted as complete.
*No licensee are required. Licenses are required for all other installations
CITY OF TIGARD ELECTRICAL PERMIT
° PERMIT #: ELC2008 -00422
COMMUNITY DEVELOPMENT DATE ISSUED: 7/23/2008
T1cARq 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S110AA 01200
SITE ADDRESS: 14300 SW PACIFIC HWY ZONING: C -G
SUBDIVISION: CANTERBURY PLACE LOT : 008 JURISDICTION: TIG
PROJECT: DR DAVID WILSON
Project Description: TI - 9/3/08, ADDING LOW VOLTAGE FOR X -RAY CONTROL.
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: 1
MANF HM/ SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 5 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:
STEPHEN & JODETTE BATES TIMBERLINE ELECTRICAL CONTRACTORS
10430 SW VIEW TERRACE PO BOX 918
TIGARD, OR 97224 LAKE OSWEGO, OR 97034
Phone: Contact #: PRI 503 - 459 - 4089
FAX 503 - 254 - 4227
FEES
Description Date Amount Reg #: ELE 26 -121 IC
[ELPRMT] ELC Permit 7/23/2008 $80.10 LIC 160037
[TAX] 12% State 7/23/2008 $9.61 SUP 4957S
[ELPRMT] ELC Permit 9/3/2008 $75.00
(additional fees not listed here) REQUIRED ITEMS AND REPORTS
Total $173.71
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 ar t forth •■ OA: - 52- 001 -0010 through OAR 952 -001 -0100. You may obtain copies ese rules or direct questions to OUNC at
503.246.6699 or 1.800.332. , • , 4.�
Issued By: - �� 4 Permittee Signatur %Jae__ /7
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.
l ••�•q � Permit ♦ � •,,•�{., � s �"e. :5., i,�'�'' `A'S.«7 p t�,7r�., (P ,5 it
E �' 7�.aApplication , 1. C , t,1 } �s ,;..., i , l 1" r ∎, { r 1 i s { i 5 i = r , t o t ,,, ,,,.,
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iii; , ..... , ,,,,.,,, City of Tigard , ' C9, R e c eive d / f ! Dg jJ Permit No.: deg-
13125 SW Hall Blvd., Tigard, OR ' v
a • • 1. �, ' Phone: 503.639.4171 Fax 503.598. 960 „flak %J ' Plan ig Other Permit: ,
Line: 503.639.4175
.,, l SEQ
- - t , ; Internet www.tigard- or.gov G . -.
See Page 2 for
�! pkmentslInformation
❑ New construction 1 _ Addition/ • «� : 1 c : l ,, ;!• t t r . Please limit all that apply (submit Mb of plans w /items checked below):
D Service ex feeder 400 amps or more 13 Boildmg over throe stories.
❑ Demolition ■Other
where the available fault =rent ❑ Marinas and boatyards.
A exceeds 10,000
J n A
} t -, at 150 volts or ❑ Floating buildings
❑ 1- and 2- family dwelling 7 Commercial/industrial ❑ Accessory building lap g rO1 o � ezcoeas la.000 ❑ din g&
❑ M lase agienkmal
ulti - famil • M aster builder F ettier insteusz[om b
. Inst d;aga
Y ❑ Other: ❑F� P�p ❑ Inarallation of 75 KVA or
larger sepandely
-` r - _ h tiy k5 l7Additionof new motor load ". � ved
Job no.: (915 Job site addtrss: ii i366 366 •AGh7 L. t 10011) or more. oa m.y.
�,/�^ co). (�j - L (7 � D Six or more res dential units. ❑ Reaeatiaaal vehicle packs.
City/State/ZIP: `77 r _ [ 72 ! . ❑ Health facilities. ❑ Supply voltage for more than
❑ Hazardous locations 600 volts nominal.
Suite/bidgJapt no.: I Project name: 01. to i L .5 on ❑ Service or feeder 600 amps or mom
Cross street/directions to job site: x '" . is ''• _ . 't'::::.:17`.1.`".., • car. Fes. Teti] -
New residential single- or multi- family dwelling unit.
Inctndes attached garage.
Subdivision: I Lot no.: 1,000 scl ft. or less 145.15 4
Tax map/parcel no.:
Ea. add'l 500 sq. ft. or portion 33.40 1
S ; s Limited energy, residential
75.00 2
' / , Limited', mufti- family
/ `r'+" ! " titi 40- residential (with above sq f3.) 75.00 2
/1
1/6-6171- �-, 6 b� - l � e _ 0 0 ./ 2 2 Services or feeders installat on and/or relocation
200 apm�p,s, of less
l 2 V h. '•• � � 800 � 2
_ . F _ r..........ty.. ' . _
. 7_$ ...' , 201 am to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
Address: _ 601 amps to 1,000 amps 240.60 2
Over 1,000 amps or volts 454.65 2
City /State/ZIP: Temporary services or feeders installation, alteration, and/or
1 relocation
Phone: ( ) Fax: ( ) 200 amps or Tess 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 10 400 am P s ' • 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 .
Owner signature: Branch circuits - new, alteration, or extension, per panel
re A. Fee for branch circuits with
,- t a above 8 Ot f Cd fCC
Business name: u. , �, _ 6.65 2
each circuit
B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
first branch circuit
Address: Each add'I branch circuit 6.65 _ 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Each manufactured or modular ` 90
Phone: .90 2
dwelling, service and/or feeder
( ) , Fax: )
E -mail: Reconnect only 66.85 2
Pump or irrigation circle 53.40 2
. , , . -, . . ?�,:. L, °s r .:x g; <. y `5 Sign or outline lightzng . 53.40 2
Bu titmess name: T j r o�-�� 4.0- ,,c ' ` , mfr. Si circuit(s) or limited-
Addcess: O r boy 9C Des Ow Or OF Page 2 1 25 2
City/State/ZIP: . J e90 r 0 a a /> / Each additional Inspection over allowable in :. of the above
Phone: ( 5 J 3 ) o 7 ! 4 108, J 1 ( ) ji - 4 [ 1 � Per inspection 62.50
CC9 I.ic.:� Per hour (i hr min) 62.50
16 06 3 Electrical Lic.: • - I Lic. u Iadnsaial Plant hoar
•;■ A • ` Su ., • pier. 'l 7J` p Per 73 7s
Suprv. Electrician s' Jr .,, • requitdl' r/11 /1,/h / 3
A : f /' Subtotal:
Print name: ' ' 4 i -- '' j FTo., ; 2 Date: 94710 Plan review (2596 of permit fee): i 'JS
t State surcharge (12% ofper permit fee): 7_
Authorized signature: . I /5 ; 4�r,
r' I •TOTAL PERMIT FEB: b c9 ,
Print naive: Pea S tiirctri I Date: . L D ( TAP Permit aPPileation elPh'es bra permit la not obtained Maio 180
days alter it has been accepted as complete
E00 /Z00E Xtid EZ :OZ 800Z/Z0/60
Electrical Permit "Application - City of Tigard
Page 2 - Supplemental Information
LEVII'rED ENERGY PERAIIT FEES:
Fee for a residential systems combined $75.00
Check Type of Work Involved:
❑" Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener's
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other.
Fee for gad commercial $75.00
system]
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ ` Fire Alarm Installation
❑. HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling rr
Other X -gt ebit&I
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
E00 /EOOIJ XVd EZ :OZ 800Z /ZO /60
CITY OF � - '
��um w ��n� TIGARD . �
' ~��-
BUILDING DIVISION . ~°~°"~~~�",°~~ ~°,°,~°,~,"" PERW1|T ELC2008.0(
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/23/200
Phone: (503) 639-4171
Inspection Reque�o(24Hrnj:(SO3)830'4175 "�0�-.�
I
INSPECTION WORKSHEET FOR DATE: 9/19/20013 TIME: 7:0OAM PAGE: 37 1
SITE ADDRESS: 143UO3W PACIFIC MVVY CLASS OF WORK:
SUBDIVISION: CANTERBURY PLACE LOT #: 008 TYPE OF USE:
PROJECT NAME: DR DAVID WLSON
DESCRIPTION: T| - 9V3/08. ADDING LOW VOLTAGE FOR X-RAY CONTROL,
OWNER: BATES, STEPHEN &.|DDETTE PHONE #:
CONTRACTOR: TIML3ERLINE ELECTRICAL CONTRACTORS ' PHONE #: 503416941009 0�
Inspection Request Scheduled For: [}ate: 8/19$2008 Pour Time:
_
Code # Inspection Description Contact # Message
199 Electrical final 076533-01 603-209-9192 ~~ Y
Corrections/Comments/Instructions: ./
----- 8'
�
ilk
`
71\ PA SS fl PARTIAL APPROVAL CANCEL ri NO ACCESS
��
FAIL �� �ALLFOR|NSPE�T|[]N fl ADDITIONAL FEES ASSESSED
�
�' - Nr � �� �� � � /
Inspector: �� L�� Date: ~8 iii �� Phone #: (503) 718- �-~�~i6
\
�
CITY OF TIGARD
BUILDING DIVISION 1. PERMIT #: EI_C200l 00422
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/2312000
Phone: (503) 639 -4171 r
Inspection Requests (24 Hrs.): (503) 639 -4175 -�++
INSPECTION WORKSHEET FOR DATE: 9/12/2008 TIME: 7:00A.M PAGE: 23
SITE ADDRESS: 14300 SW PACIFIC H1.NY CLASS OF WORK:
SUBDIVISION: CANTERBURY PLACE LOT #: 008 TYPE OF USE:
PROJECT NAME: DR DAVID WILSON
DESCRIPTION: 11 - 913/00, ADDING LOW VOLTAGE FOR X -RAY CONTROL.
OWNER: • E3ATES, STEPHEN & JODETTE PHONE #:
CONTRACTOR: TIMBERLINE ELECTRICAL CONTRACTORS PHONE #: 503. 459.4009
Inspection Request Scheduled For: Date: 9/12/2008 Pour Time:
Code # Inspection Description jnfir-m_# Contact # Message
199 Electrical final '\\ 07EA13 -01 503.209 -9132 Y
Corrections /Comments /Instructions: 1 OM \'oMEs
Aill
\ -- 6 c (Tb u L.> F 'hi\ to wbp0 3) 9° lo
?► .. - a . t - .1 : [. = AO■
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
0 - FAIL X CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: N(161.-E
Date: 91 1 'i Phone #: (503) 718- vi r,-
CITY ��8�~�� ������N��������
n v�wm� u wn�N�mnp��
BUILDING DIVISION ' ' , ' `
PERMIT #: ELC2008'0(422
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/33/200R
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 939,12008 TIME: 7:00AkA PAGE: 17
SITE ADDRESS: 143UU PACIFIC |'0«NY CLASS OF WORK:
SUBDIVISION: CANTERBURY PLACE LOT #: 008 TYPE OF USE:
PROJECT NAME: DR DAVID W LSON
DESCRIPTION: TI y/]/DD. ADDING LOW VOLTAGE FOR X CONTROL.
OWNER: BATES, STEPHEN & JODETTE PHONE #:
CONTRACTOR: TIMBERLINE ELECTRICAL CONTRACTORS PHONE #: 503
Inspection Request Scheduled For: Date: 9/9/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
130 Ceiling cover 0762%-01 603-209-9132 N
Corrections/Comments/Instructions:
ri PARTIAL APPROVAL 0 CANCEL | | NO ACCESS
FAIL ri CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector: ll-c-416d Date: 9 Y]
.
CITY OF TIGARD
BUILDING DIVISION 1 PERMIT #: ELC2008 -()0122
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: . 7/2.3/2.1)08
Phone: (503) 639 -4171 1'+�
Inspection Requests (24 Hrs.): (503) 639 -417.4.4 ..
INSPECTION WORKSHEET FOR DATE: 9/3/2008 TIME: i:01 AM PAGE: 11
SITE ADDRESS: 14300 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: CANTERBURY PLACE LOT #: 008 _ TYPE OF USE: '
PROJECT NAME: [)R DAVID WILSON
DESCRIPTION: TI
OWNER: BATES, STEPHEN a JODETTE PHONE #:
CONTRACTOR: TIME3ERl_INE ELECTRICAL CONTRACTORS PHONE #: 503•4594009
Inspection Request Scheduled For: Date: 9/3/2008 Pour Time:
Code # Inspection Description onfirm # Contact # Message
173 Wall cover 075011-01 503-209-9132 ,Y.
Corrections /Comments /Instructions: 10 NI
1
1
/
i PASS n PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
U FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED •
Inspector: 0 6t61 Date: cl• 3 4, Phone #: (503) 718 - 2--1yc
2000 07:31 5036395400 PC G E 01
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Portlmtd OR 97209
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