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Permit • A ll? CITY OF TIGARD - MASTER PERMIT PERMIT #: MST2004 -00365 " DEVELOPMENT SERVICES DATE ISSUED: 3/24/2005 r 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 1 PARCEL: 2S112BA -11400 SITE ADDRESS: 07905 SW PICKLEWEED LN ZONING: R -12 SUBDIVISION: BONITA TOWNHOMES LOT: 050 JURISDICTION: TIG Project Description: New SFA. BUILDING REISSUE: STORIES: 3 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: NEW HEIGHT: 32 FIRST: 77 sf BASEMENT: sf LEFT: SMOKE DETECTORS: Y TYPE OF USE: SFA FLOOR LOAD: 50 SECOND: 585 sf GARAGE: 470 sf FRONT: PARKING SPACES : TYPE OF CONST: 5N DWELLING UNITS: 1 THROE 633 sf RIGHT: VALUE: 133 OCCUPANCY GRP: R3 BDRM: 2 BATH: 3 TOTAL: 1.295 sf REAR: PLUMBING SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: 100 TRAPS: LAVATORIES: 4 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS: TUB /SHOWERS: 2 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: 1 BOIL/CMP < 3HP: VENT FANS: 3 CLOTHES DRYER: 1 GAS FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS: MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 3 ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 1 0 - 200 amp: 0 • 200 amp: W/SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 2 201 - 400 amp: 201 - 400 amp: 1st W/O SVC!FDR: SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 • 600 amp: 401 - 600 amp: EA ADDL BR CIR: SIGNAL/PANEL: IN PLANT: MANU HM/SVC /FDR: 601 - 1000 amp: 601 +amps- 1000v: MINOR LABEL: 1000+ amp /volt : PLAN REVIEW SECTION Reconnect only: > =4 RES UNITS: SVC /FDR > =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC: ELECTRICAL • RESTRICTED ENERGY A. SF RESIDENTIAL B. COMMERCIAL AUDIO E. STEREO: VACUUM SYSTEM: AUDIO 8 STEREO: FIRE ALARM: INTERCOM/PAGING: OUTDOOR LNDSC LT: BURGLAR ALARM: OTH: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS: This permit is subject to the regulations contained in the Owner: Contractor: Tigard Municipal Code, State of OR. Specialty Codes JLS CUSTOM HOMES JLS CUSTOM HOMES and all other applicable laws. All work will be done in 16280 NW BETHANY 16280 NW BETHANY accordance with approved plans. This permit will expire BEAVERTON, OR 97006 BEAVERTON, OR 97006 if work is not started within 180 days of issuance, or if the work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules Phone: 503 - 533 - 4006 Phone: 503 - 533 - 4006 adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You may obtain copies of these rules or Reg #: LIC 139970 direct questions to OUNC by calling 503 - 246 -6699 or TOTAL FEES: $ 6,536.77 1 -800- 332 -2344. REQUIRED ITEMS AND REPORTS Ersn Cntrl 681 -4444 High- strength bolts Structural welding Issued By : Permittee Signature • 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. ` Building Permit Application : FOR OFFICE USE ONLY �` J' `,r ✓ City 01 Tigard �.. �I C� Received O �r Permit No. 13125 SW HallBlvd , Tigard, OR 9s/ . K Date By: f/ r l/ Permit f 7 O y�� �� Plan Revr rr � _ Phone 503.6:9.4171 Fax: 503 598.1960 ` t + � e Date/ 1 �S �f S O th er Pe mut. �) i/ I W 1 �V 1� Inspection Line: 503.639 4175 DEC 0 2 2 004 d• Daze Ready/By: lures See Attached Checklist for Internet ww'N.ci.tigard or us � ' 7 CI Attached Notified/Method / ir Supplemental Information CITY OFF TIIG t- Uri r.}- "st IBliE l®n REQUIRE D D.'T,1: 1 -AND 2-FAMILY DWELLING • KNew construction ❑ Demolition Permit fees' are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all ❑ Addition alteration'replacement ❑ Other: equipment. materials, labor, overhead, and the profit for the • • CATEGORY OF CONSTRUCTION work indicated on this application. 33 / 5 9 Valuation. � X I- and 2- family dwelling XCommercial,industrial ❑ Accessory bolding ❑ Multi-family Number of bedrooms 5 ❑ Master builder ❑Other Number of bathrooms • JOB SITE INFORMATION AND LOCATION — //I Total number of floors Job site address: //[.i ���7/� New dwelling area_) "295 square feet City /State /ZI.P:T y _ - c � Garage'rport a �� rea V square feet • Suite/bldg./apt. no.: Project name: CW - _ Co\ered porch alea.L square feet Cross street'directions to job site: !.‘ [ 'r Deck area. / A 6 square feet 1 ¢� re Other structure area. square feet 1 REQUIRED DATA: COMMERCIAL -USE CIIFCKLIS'r Subdivision: v1,i-� hu,_, • • ' [� Permit fees' are based on the flue of the +v performed 11iJ���- ��� l s - 1.Y ` a � 1 g� Lot no �' I Indicate the +clue ied in the nearest dollar) of all i; Ta maliparcel no.: equipment. maten als. als. labor. Overhead. :rd the profit for the DESCRIPTION OF WORK rock indicated on this application. • Valuation S Existing burldnrg area square feet Nos burldtn: area' square feet . A PROPERTY OWNER - ❑ TENANT Number of stones Name: C Type of construction • Address: 1 Dago no Q - 1 --/1/1 Vl Occupancy groups. — -- 2 w !Awn Exisun��. Phone: (rjb ) 5z3' /10 Fax: (503) J Nen: ❑ APPLI X PERSON NOTICE -- Business name: SAS All contractors and subcontractors are required to he Contact name: _.( p licensed null the Oregon Construction Contractors Board —4 . tinder ORS 701 and may be required to be licensed in the Address: a t- jurisdiction in which is or k is being performed. If the City /State /7_IP'. �./ applicant is exempt from licensing. the following reasons • appl,, . Phone: (SOS) ° t (o9 I 3 Fax: : ( ) 'icime E -mail: • •••CONTRACTOR • • Business frame: 5pl m E BUILDING mom FEES` Address: C Plrnae refer ru fee " . itviState /ZIP: Phone: Fees due upon applicati ( ) Fax: ( ) 1 Amount received CCB lic.: 139 9 -Th Date received: Authorized sienattC �r�, e }4 : � r ' \� this permit application expires if a permit is not obtained `` / J`� �' (/� -� �J �1� n ithin 180 days after it has been accepted as complete. 1 Print name: N (0k f-eye 5 Date: • Fee methodology act by Tn- Count Building Industry Service Board r , Bertding\PerrrdauUP- Permit App doe 12 440.4613tii1r02COM ;WLB) 11,1Ch.t111`.n1 .1 01 11111 /A 1.11/11lLnuv11 . City of Tigard Received DatuDy: Permit No . 13125 SW Hall Blvd.. Tigard, OR 97223 • Plan Review hone: 503 639.4171 Fax: 503 593.1960 g fk Other Permit Inspection Line: 503 639 a175 ye Date Ready /By: Rum El See Page 2 for Internet: www.ci.tigard.or us Notifed,T.lerhod I Supplemental Information . • T YPE' OF WORK PLAN REVIEW ❑ New construction ❑ Addition/alteration/replacement Please check all that apply ❑ Demolition ❑ Other: ❑Service over 225 amps. comm'I ❑Hazardous location ❑Service over 320 amps - rating ❑Bulldog over 10,000 sq ft CATEGORY OF .CONSTRUCTION. of I. and 2-family dwellings 4 or snore new residential ❑ I - and 2-family dwelling ❑ Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure ❑ Multi-family ❑ Master builder ❑Other: ❑Building over three stones ❑Ireedc,s. 400 amps or mot ❑Occupant load over 99 persons ❑. tanrifactured sanctities c JOB SITE INFORMATION AND LOCATION ❑Egress %lighting plan R\' park • Job no: Job site address:iq� + � e 1 J'/ I ❑l!ealth -tare facility ❑O(!,cr 1:)-----1 L1�� C� Submit 2 sets of plans with any of the above City/State/ZIP: T ^` p '( The above are not applicable to Icmporar. constiucllon service ! 1 1` . r— / FEE' SCHEDULE Suite,blde.!a it. no.: V Project name: ' Descnprion I Q I Fee. J TOO! I Cross street directions to job site: v L �� New residential single - or multi-family dwelling unit. "� " Includes attached Karate. •• — 11 1,000 sq. ft or less l 4 14515 r Subd1yrston : c s t . ` ��, - „ L � 4 ` I Lot no: Ea. add . I 500 sq It or poluon Z ! - = 40 — �_�_ __1 - 1V► Y_V Limited energy, residential 75 00 Tax map /parcel no.: � S' 1 k.+V 1 a g` Limited energy. non - residential - , - . 5 00 DESCRIPTION OF WORK — Each manufactured or mod ular dwelling, service and /or feeder 1 - -- 90 90 Services or feeders installation. alteration, antl'or relocation • 200 amps or less I SO 30 PROPERTY' OWNER 201 amps to 400 amps + j 160 S5 121 �� '^ . _ ` -10! amps to 000 amps H R Nmae: 11 L c � - �Y V�R� .[� ' 6 240 60 �� � � [�� Address: c lJ:23V -mom � • Che I.C'f�fl amps Or s " pliti .l I._. — Reconnect only 66 CityiState:lIP: t QC ' ]Y ' c Lf: �l Temporary services or feeders installation. alteration. author Phone: ( p Fax: ) relocation 3 ) c,7- �W S 53 - OHO 2(i0 amps or less I I 66 35 T Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps Iti( ''li intended for sale, lease. rent, or exchange, according to ORS 447, 449. 670 and 701 401 amps to 600 amps 1 I _: -. Owner signature: Date: Branch circuits - nest'. alter ath, o. or extension. per panel ❑ APPLICANT I CONT.ACP PERSON A Fee for branch circuits nail I service or feeder fee. each t . 65 Business name \ _ � branch circuit — Contact name: Al f (Ole B Fee for branch circuits without service or feeder fee. 16 85 Address: m `� each branch circuit C ,' E ach add'I branch circuit I 6 65 City /State /ZIP: Miscellaneous (service or (ceder nut included) C�(,, (y (� Pump or irrigation circle 53. 10 Phone. (t)3) { `r I ! �3 Fax: ( ) �� c Sign or outline lighting 5= 40 E -mail: Signal circuit(s) or limited- . _ ' CONTRACTOR energy panel, alteration, or extension Describe Page 2 Business name: 6 C l Address: `O L n 1 _ Each additional inspection over altos +able in any of the e above l l J p`� 1�� Per Inspection I I C C Citv;State/ZI R�5�c [� ct-1 173 —1 Investigation per hour (I In nun) 62 50 Phone: (503) W 4 2 _ ,3S C' 1 Fax. ‘16- (t' - 1�,e lndustnal plain per hour - 73 75 a `.# ELECfRICA.L PERMIT FEES' CCB Lic.: l ($R Electrical 1 -.c.: q -- Suprv. Lic.: Subtotal Supn•. Electrician signature. required: �I j Plan review (25% of permit fee) dalliEll Print name: D ater - State surcharge (3%.-o of permit fee) 5� � � � TOTAL PER%llT FEE Authorized sif?tlature: NIC This permit application expires if a permit is not obtained within 1st / VVV ��— ��1... — days after it has been accepted as complete Print name: NI _ ev1.� R p A e5 0 Date: • Fee methodology set by Tri Count.; Building Industry Service Board - - I �` "' • • Number of inspections per permit allowed i.\ Building 'Permins+.ELC.PerrrutApp doc 12'03 4a0.4615T110:O2;CD.•.1/WEB iviecuaulc ii rerulil f WIJIIIcaluuu . City of Tigard Received Date/13v: Permit No.: 13125 SW Nall Blvd . Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598 1960 Date/By: Other Permit Inspection Line: 503.6:9.4175 , X em Rz ' �� Date Readv:By: ruin El See Page 2 for Internet w•ww.ci.tigard.or.us Notified/Method: Supplemental Information • TYYE OF WORK. "' COMMERCIAL FEE' SCHEDULE - USE CHECKLIST New construction ❑ Additioaalteration %replacement Mechanical permit fees' are based on the value of the '.cork performed. Indicate the value (rounded to the nearest dollar) of a: ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit CA7 OF CONSTRUCTION Value S RESIDENTIAL EQUIPMENT / SYSTE\1S FEES' ISCI- and 2- family dwelling X Commetcial /industrial ❑ Accessory building .. — " For special rnfcrntr,rton use crec.:rs! ❑ Multi- family ❑ Master builder ❑ Other: Description I Qty I Ea Total . JOB SITE INFORMATION AND LOCATION Heating /cooling Job site address: Air conditioning or heat pump �/ � (requires site plan shms•m= placement) it 00 City. /State /`LIP: ii QC-. Furnace 100,000 BTU (duets vents) 1.1 00 I Furnace 100.000+ BTU (ducts:veins) I? 90 Suite /hldg.:apt. no.: Project name -- Gas heat pump 1.1 00 ( • , •s---. . Cross street/directions to job site: Duct • s ort I 4 00 Itydronte hot water system _ _ 14 00 �� Residential boiler (radiator or hvdronic) 14.00 Unit heaters (fuel-type, not electric), n•■■•all, in -duct. suspended, etc 10 00 n: Lot no.: Flue vent for any of abo%e 10 00 Sul ?divisio ��‘� ►r +� — 3-1 sD Ol her • 10 00 Tax map /parcel no.: J 3 (/& I /••�� I Other fuel auiliances ( ` D DE ESCRRI I PTION OF WORK Water heater i 10 i''' Gas fireplace — �_ /J 10 00 Flue vent for svatei heater or teas fireplace i 10 (.ii 1 1_og lighter (gas) - l_ICi 00 Wood pellet stove _ I 10 00 _ Wood fireplacennsctt 10 00 PROPERTY OWNEK Chunnc-.:liner.flue'• city IC 00 . �. ❑ TENANT Other • _l 1_10 .,'. I Name: SLS C tW iaes Environmental exhaust and sentilation Address: { 9O , 1 .\ C Ranee hood:othei kitchen Lll1LJC('] I�J,� f t equipment 10 00 Cit yiSt a 1 e/Z. li 2 ri c:11 \ Q I . er /e a v_ J Clothes dryer exhaust / I'? 00 1JK-► v U_ � Single -duct exhaust (bathrooms, Phone: (53 )533_ (-`O _ Fax: (563 ) 533- y366 toilet compartments, utility rooms) L t 6 80 . ❑- APPLIC.aNT ; , . , Z, CONTACT PERSON Antcicrasvtspace fans 10 "0 Business name: Other: 10.00 Fuel piping Contact name: ' ' 55.40 for first four: 51.00 for each additional / Address: • M e Furnace, etc. ` , \��— Gas heat pump City/State/ZIP: - \Vail: suspended /unit heater Phone: (563 ) 969_ 1L5 Fax: : ( ) 51� Water heater /— E -mail: + 1 `- ` Piieplace / Range CONTRACTOR.: • ' Bat becue Business name: , `,_ Clothes dryer (gas) v-� _ �l .Llt/ Other: Address: . ••, (S b3 • f l \JI . MECHANICAL PERMIT FEES' City /State /ZI.P: 1,^��. O V_ . _ 1 t- 1- L-�-� t —L_u1Y LL Subtotal q �/ Q Mini mu:m permit fee (572 50) Phone: (5::;,) q I 1 a 2 `i F ax: (563) gq@1- 0� Plan review (25% of permit fee) CCI3 lie.: 1 14 I 31 LJ State surcharge (3% of permit fee) • ....-----7- ,- TOTAL PERMIT FEE Authorized si nature: This permit application expires if a permit is not obtained "it hin ISO / ` — dais after it has been accepted a$ complete. Print name: - f `� Q R n r `� - .------- I — I Date.: i 1(] lee methodology set by I'n- Count; Building Indu n'. Service Board �n0 - 46r iI )t t,O /CO'.V+ F3) r : Building +Permits \MEC- ` PPermitA pp pp l doe 12/03 Dunning r'mutes Plumbing Permit Application " FOR OF ONLY d , l ' City or Tigard Received Date/By: Pemut No . 13125 SW Hall Blvd., Tigard, OR 97223 — Phone: 503 639.4171 Fax: 503.598.1960 � `y )j t DateBy: Plan Review 0 ' Other Permit No 24- Hour Inspection Line: 503 - 639.41 75 � ' r ,,,, s Date Ready.By: o See Page 2 for Internet: , .. , ww.ci.tigard or us Nolified/Method l Supplemental Information = : , - .:.`fYPE • OF .1 F EE ' S • IIED 1 : gNew construction E1 Demolition For special information use chet/(lisr. Descnption I Qty. Ea total ❑ Addition /alteration /replacement El Other: New 1- 2- family dwellings (includes 100 ft for each utility connect ot "' C: TECORY. OF`'C'ONST'RUCTION, :' SFR (1) bath 249 20 K1- and 2- family dwelling _ XCommcrciaUindustrial SFR (2) bath 350 00 111 Accessory building ❑Multi- family SFR (3) bath .. ),C 399 00 -- Each additional batlukitchen 45 00 ❑ Master builder ❑ Other: f Fire n ( 9 ft.) g • sprinkler s 1. Page - , J 0 ; SI' rE'•�i \ 1 ?I�IL�71 "I'1()N''A1VD': I,OC:1`i;ION` _1= "'-=-- `�'`` "� ... .. .':-" ;, - - 1 tie tilt Ares Job site address: Vie M' / / / / I Catch basin or area drain 16 60 CityiState! "I_II 1 — di r q DIywell, leach line, or trench drain 16 60 Suite/bldg./apt. no.: li k Project name: (^� Footing drain (no linear ft.. ) Page 2 '��"�`'. Manufactured home utilities 110 00 Cross street'tlireelions to job site ri, _C- e-tZ__ Manholes 16 60 Rain drain connector 16.60 Sanitary sewer (no. linear ft : ) Page Storm. sewer (no. linear ft : ) Pace 2 Subdivision c Lot no.: 'rater scr:uc (no linear 0 • ) _ Page 2 VT `• ������ > Fixture or item Tax maplparcel no.: . .....,..• ! .-' - w - Absorption o 60 ion al c DESCRik'TION - OF WORK :.. B:tckflo3� prcyertler Page 2 Backwater valve 16 60 Clothes washer 16 60 Dishwasher _ ` 16 60 ;- : - r ;. r_' t_r-->�<,: Vir. . _- - Drinking fountain 16 60 PROPERTY OWNJ.R . ; = ❑' %TEiy�iNr;`'�`:.;'::::; :` :.....::. ..:.:. K I:jcctorsisurrrp 16 60 Name: BS I-• -Sl. S_ S Expansion tank 16.60 Address: I (0 a s — c ., . (5 ^' � � _ Fixture /sewer cap 16 60 • Cits %Statcr7_I.P: �n]r- -r y.J;l � N ^� 1 ` 1=1001drain %floorsinkhub _ 1660 Phone: _ 55 ._ q � - T -` ,C42,. Fax: ( 563 ) 533_ O[ I0/ / O Garbage disposal L _ 1660 : - " ' : a w:/-s,:,;,, c-; -;; :.: _ 7� <-fi', =;'�_ . . ier: :r,;"; aI Hose bib I 16 60 is - - ", _ :5 •�'C.'.3•: ..:.,..;� ?.t = •y'a j' = i., -. _. .: ?:t, u.. �. .••. r'!;. 1 ;3.;. -:,E 1 s:>XY Ice maker 16 60 Business name: RI (at Q Interceptor /grease trap 16 60 Contact name: Medical gas (value: $ ) Page 2 Address: 3�E Primer 16.60 City/State/ZIP: Roof drain (commercial) 16.60 Phone: (563) d9- 11153 Fax: : ( ) Sinkrbasin/layatory 16 60 �� 'limb /shower /shower pan 16 60 E -mail: Urinal 16.60 .. eori H cci - ater close! I • .. 5 660 Business name: Water heater 16 60 Address: a (._(! i./1 Other. � Subtotal City /Slat /ZIP: \_ \ � h..fY+� _ /�\ u �J V � 9.1122 Minimum permit fee. $72.50 Phone: (56 (02 3 - I 103a_.___ F (5 3) 10 3 _ Residential backflow minimum permit fee: $36 25 CCB Lie.: Dcia to K9 _ Plumbing Lic. no.:3q a /_/A) Plan review (25% of permit fee) _ —/ f � • ) tom State surcharge (8% of permit fee) Authorized signature < �- f/ 1 ; TOTAL PERMIT FEE Print • name - `- / --r -0 � Jc- Q C n � ,, • I D ate: This permit application expires if a permit is not obtained withir /r f�' 180 days after it has been accepted as complete. • Fee methodology set by Tn- County Building Industry Service Boar( Building \Prrmits \PLMF• PrrmitA pp doe 12/03 440.46167( 0 /OZ/COM/WE.B) CITY OF TIGARD BUILDING DIVISION PERMIT #. ?.0tH • 003 `� 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: Phone: (503) 639 -4171 Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: TIME: PAGE: SITE ADDRESS: CIOT r I w CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: DESCRIPTION: OWNER: PHONE #: CONTRACTOR: PHONE #: Inspection Request Scheduled For: Date: Pour Time: Code # Inspection Description Confirm # Contact # Message 3`\ iN4�- PL v•■ . OISSIA GI Corrections/Comments/Instructions: A PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: C V ' 1 v Date: 10 11 Phone #: (503) 718 - 2-6b L k • CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2004 -00365 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/24/2005 • Phone: (503) 639 -4171 I C I Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 10/7/2005 TIME: 7:05AM PAGE: 26 SITE ADDRESS: 07905 SW PICKLEWEED LN CLASS OF WORK: SUBDIVISION: BONITA TOWNHOMES LOT #: 050 TYPE OF USE: PROJECT NAME: BONITA TOWNHOMES DESCRIPTION: New SFA. OWNER: LS CUSTOM HOMES, PHONE #: 503- 533 -4006 CONTRACTOR: .ILS CUSTOM HOMES PHONE #: 503-533-4006 • Inspection Request Scheduled For: Date: 10/7/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 1994 Electrical final 017748 -01 503-642 -2800 N Corrections/Comments/Instructions: ' P � ROv\ w 4 \CUs 1. ?K` • PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: (< �7 Date: / / `S Phone #: (503) 718- CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2004 -00365 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/24/2005 Phone: (503) 639 -4171 ICI Inspection Requests (24 Hrs.): (503) 639 -4175 .� &- �__.. INSPECTION WORKSHEET FOR DATE: 10/10/2005 TIME: 7:04AM PAGE: 87 SITE ADDRESS: 07905 SW PICKLEWEED LN CLASS OF WORK: SUBDIVISION: BONITA TOWNHOMES LOT #: 050 TYPE OF USE: PROJECT NAME: BONITA TOWNHOMES DESCRIPTION: New SFA. OWNER: JLS CUSTOM HOMES, PHONE #: 503 -533 -4006 CONTRACTOR: JLS CUSTOM HOMES PHONE #: 503-533-4006 Inspection Request Scheduled For: Date: 10/10/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 699 Mechanical final 017863-01 503-209-6038 N Corrections /Comments /Instructions: �:�&V4 mw p ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: 410 NI Date: I V ( D U ✓ Phone #: (503) 718 - � CITY OF TIGARD BUILDING DIVISION PERMIT #:44 -S z —COWS' 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: Phone: (503) 639 -4171 , t Inspection Requests (24 Hrs.): (503) 639 -4175 '!!. 'I t .. INSPECTION WORKSHEET FOR DATE: (D (7 /0s- TIME: PAGE: SITE ADDRESS: 71 Oc5 CLASS OF WORK: SUBDIVISION: #: TYPE OF USE: PROJECT NAME: DESCRIPTION: OWNER: - PHONE #: CONTRACTOR: � LS PHONE #: Inspection Request Scheduled For: Date: Pour Time: Code # Inspection Description Confirm # Contact # Message 618544' Oz- Corrections/Comments/Instructions: 1 Pi-0 I 13 �'A PP Q___ Alf AMY irtr ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL F ES ASSESSED Inspector: D ate: (o (l Phone #: p glir (503) 718 - Building Permit Application ' FOR OFFICE USE ONLY ', `. City of Tigard EC EIVED Received 416) -ay 'l Permit No.V_ t, 2/;'dV//)3� 13125 SW Hall Blvd , Tigard, OR P at vt / \'v x� tip+ Phone- 503 - 639 -4171 Fax: 503 598.1960 ', '+r� 'o, /J J Other Permn m z9e � v Od36,4 Ins echon Line. 503.639 75 DEC 0 2 20U4 } 1 �1 Date Ready/By n tus 2 See Attached Checklist for p Internet www.ci.tigard.or us VotifiediMethod: f 1 (r Supplemental Information CITY OF TIGARD E U riri- ,. tatital l', fa,1i .,1-' -, • - EQUIRD DAT RE 1- AND 2- FAMILY DWELLING New construction ❑Demolition Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all ❑ Addition'alleration'replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. 33 / 5 � Valuation- S r I / I- and 2- family dwelling 'Commercial /industrial . - 7 111 Accessory building ❑ Multi- family Number of bedrooms. El Master builder ❑ Other Number of bathrooms 5 JOB SITE INFORMATION AND LOCATION Total number of floors 3 Job site address: Jg1)5 G, 0(,) P I Y / `-�- -� , p R. mid J li d f ,j New dwelling area 2�''� square feet City /State /ZIP:T((�� ✓ ✓ C� l` Garagecarport area. 7 ? square feet Suit no.: `'jv(�' Project name {'��� v \-.0 i ,... , Covered porch area. - b square feet Cross street/directions to job site �J CkiNn___e_VRpC Deck area , 6 square feet Other structure area square feet _ REQUIRED DATA: COMMERCIAL -USE CIIECKLIST Subdivision: - Mtai_ • � w`,A . Lot no Pert fees' are based on the + clue of the work performed — _� Permit Tax map /parcel no,: a� `N�Y'� t Y) Indicate the value (rounded to the nearest d of all equipment, materials, labor. . oveerhead , and the he profit for the DESCRIPTION - OF WORK xvork indicated on this application_ Valuation: 5 Existing building area: square feet Nev building area square feet . A PROPERTY OWNER-- - -. ❑ TENANT Number of stones. Name: OS C u5' VlomPS T,.peofconstruction Address: (Dl"$0 1u) r -- Occupanc} groups - City /State /ZIP: A� (�� L 9 - � l Existing. � h 1 Phone: (S83) S33- LIVI ) ( r) Fax: ( S ,3) 3 ' Li3OW New: ❑ APPLICANT . . - - XCONTACT PERSON NOTICE Business name: SWV I All contractors and subcontractors are required to be Contact name: Aj (cQve_ licensed +vith the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address ' 3 jurisdiction in which ++ork is being performed. ]f the City/State/ZIP: applicant is exempt from licensing. the following reasons • t apply- Phone: (SOS) or c.9- `- i L 3 Fax:: ( ) �p r7 1 01 e E -mail: TRACTOR ON • 5 Business name: R m G L Fees due BUILDING PERMIT FEES* Address: Ple ase refer ro fee schedule. City /State /ZIP: upon app lic ation Phone: ( ) 'Jr Fax: ( ) Amount received CCB Iic.: , t c 9 Bch / /J I Date received: Authorized signattrfe: /(/ r }-4 I % • � This permit application expires if a permit is not obtained ! �•(/ J �a l � U within 180 days after it has been accepted as complete. Print name: N1 Coif i-eye 5 �' Date: * fee methodology set by Tn- Count: Building Industry Sen•1ce Board 1 \BmldingTerrniu BLrP -Perms App doc 1203 440 4613T(1I102'COt`4,WEB) L' 1GL.L1 IL ai 1 CI hill tip? Jill4 Lloll ' ■ ' ■ ' ■ ■ City of Tigard Received Permit No Date/By: 1 1.3125 SW Hall Blvd., Tigard, OR 97223 . Plan Review Phone: 503.639.4171 Fax 503 593.1960 t t Date /By: Other Pe Inspection Line: 503.639.41 75 `/ I� Permit: Date Ready/By. Juru 0 See Page 2 for Internet www.ci tigard or - Notified/Method' Supplemental Information . . - TYPE` -OF WORK PLAN REVIEW ❑ New construction ❑ Addition'alteration/replacement Please check all that apply ❑ Demolition ❑Other: ❑Service over 225 amps. comm'1 ❑Hazardous location ❑Service over 320 amps — rating ❑Butldng over 10,000 sq ft CATEGORY . CONSTRUCTION of 1- and 2- farvh dwelhnes 4 or more new residential 11' 1- and 2- family dwelling El Commercial /industrial ❑ Accessory building ['System over 600 volts nominal rails in one structure ❑Building over three stones ❑Feeders. 400 amps or mgr ❑ Multi family ❑ 1'lasier builder 111 Other: ❑Occupant load over 99 persons ❑Manufactured structures c _JOB SITE INFORMATION AND LOCATION . I R \' park ❑Egress;hehting plan P• ��yy �/� �� ) � • /'� I ❑Health -care facility ❑Other: Job no.. Job site address:'�q � 0 p l a L( l tJ(/l.; ` Submit 2 sets of plans ',with any of the above City /State, ZIP: r c��. n ' 0 The above are not applicable to tempora- construction service - � . Suite /bldg /apt. no.: i Project name � c. Description FEE* SCHEDULE Qty 1 Descption I Qty I pre. Tutor Cross street/directions to job s � � 1 T vac) C cia o__ New residential single- or multi - family dwelling unit. l Includes attached garage•• 1 sq. ft- or less / I 145.15 Subdivision. L � ,�, _1 Q � Lot no.: Ea. add SOU sq ft. or portion Z I 33_40 � ' �, & 4 i.: 1 1 �; Limited energy, residential %5 00 Tax map /parcel no.: a Limited enerz. non- residential I �S 00 DESCRIPTION OF WORK Each manufactured or modular dwelling, service and/or feeder I 90 -90 _ Services or feeders installation. alteration. andfor relocation • . 200 amps or less I SO 30 201 amps to 400 amps 1 106 85 PROPERTY OWNER 11 TENANT �� 401 amps to 600 amps 160 60 Name. C t 601 amps to 1,000 amps 240 60 i Address: 1 �7 r li 111 tr \ di, • Over 1.000 amps or oils i 4S' -6S 1 . Reconnect only 66 55 City /State /ZIP : 1 I �� —�Q-� � � � � I ! .\(,(13 Temporary services or feeders Installation. alteration. and /or � relocation [(/�/'� e� 5 Phone ( ) aQ O_ s'` t 6 Fax: (�J�.�e�) :- - 43 i 66.85 J �+cac� c �l 200 raps or less Owner installation: This installation is being made on property that I own which is not I 201 amps to 400 amps 1 100'0 intended for sale, lease. rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps 10600 amps p p 1 1'' c 1 Owner signature: Date: Branch circuits — new. alteration. or extension. per panel . ❑ APPLICANT $,CONTACT PERSON' • A Fee for branch circuits I, uh 1 1 , 66 service or feeder fee. each �' n om^ Business name: (, , l I branch circuit Contact name: B Fee for branch circuits ! N (�O J . wirhour service or feeder fee. 46.85 • Address: } each branch circuit �/ '' `� Each add'l branch circuit 6.65 City /State /ZIP: Miscellaneous (service or feeder not included) Phone: ( Q9� (, 1 g3-3 Fax:: ( ) F)n NIB Pump or irrigation circle 53 40 ! ( Sigr or outline liehhng 5. 40 E - mail: Signal circuits) or limited- CONTR ACTOR enerey panel, alteration or r extension Describe: Page 2 Business name: K ��� F I q a C I Address: an 1 C c �� , � Each additional inspection over allowable in any of the above 1 i!(� ti —1 Per inspection I 62_50 City/State/ZIP: 4i `f�� \^ et t 2 O e CP 173 Investigation per hour (1 he nun) 1 62 -50 , Phone: (S53) (p _a F �1 oc, Fax: r , (w2_ 5(,1 t� industrial plant per hour I 73.:5 �t� ••—) G [ l ELECTRICAL PERMIT FEES * CCB Lic. • (r r Electrical ,-c.: q — Supry Lie.: 1 I Subtotal 0 111/1/1 / 1 Suprv. Electrician signature, required: —Marl Plan review (25 °-0 of permit ire) sr Print name: 3-v G 1 D -�^z Da — State surcharee (8°'6 of permit fee) i l A C TOTAL PERMIT FEE I Authorized si>?Iiature: c • /v This permit application expires if a permitis not obtained within lit �— days alter it has been accepted as complete R e , Print name: N I cat Le5 0 J Date: • * Fee methodology set by Tn- Count; Building industry Ser ice Board f—` '• Number of inspections per permit allowed. i .\Building'Pernits'ELC- PcmdtApp deg 12.'03 000461 5T(10 /02 /COM WEB ivieclllauical retina pippiICallulll ::. • ' 1 I ' '; City of Tigard Received Date/By: Fermi :moo. 13125 SW flail Blvd., Tigard, OR 97223 e P1an.Rv Phone: 503 639 -4171 Fax: 503.598 1960 Other Permit s ' + Inspection Line: 503.639 4175 e l �1 jn Date/By: 1 B • Date Readvy: lures. El See Page 2 for - o r.us � Internet: www.ci.tigard.or.us �� g Notified/lvlethod: Supplemental Information • • TYPE OF WORK - -- CO14'MIERCIAL FEE* SCHEDULE - USE CHECKLIST Mechanical permit fees' are based on the value of the v,ork New construction ❑ Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of a: ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit- - == : CATEGORY, OF 'CONSTRUCTION Value: $ ' RESIDENTIAL EQUIPMENT / SYSTEMS FEES* [1 and 2 family dwelling Commercial /industrial ❑ Accessory building For special information use checklist ❑ Multi family ❑ Master builder ❑ Other Descnpnon Qty Ea Total • - ',JOB SITE INFORMATION .AND' LOCATION Heating /cooling � � ' /� /� ��� ( I e , � � n � I Air conditioning or heat P amp ) 1 4 _ 0 0 (requires plan placement) 0 City/State/ZIP: Furnace 100 BTU (ducts.'‘ ems) / 14.00 1 ��Q� 1 4 � Furnace Furnace 100.000+ BTU (ducts: vents) 17 90 Suite/bldg./apt. no-: Project name ��//�� v 1711 Gas heat pump 14 00 Cross street/directions to job site: t ` 2 � Duct work I 00 �� Hldronic hot . +atersystem 14.00 �EVi Residential boiler (radiator or hydronic) 14 -00 Unit heaters (fuel -type, not electric), in-wall, in -duct, suspended, etc 10_00 : ��`t�,,��, Lot no - Flue-vent for any of above 10 00 Subdivision �hI��t �•r S Other 10 00 Tax map /parcel no : O R 5 1 1 r1 ceis 1 Other fuel appliances . ' - DESCRIPTION. OF WORK \Water heater / 10 00 i Gas fireplace / l0 00 F lue v ent for water heater or gas fireplace 10 ('0 I Leg lighter (gas) 10 00 Wood. pellet stove 10.00 Wood fireplace/insert 10 00 ` �, PROPERTY OWNER - _ Chimnclr,'liner, (lug' cent I 0 00 I ❑ T Other' I 10 00 1 Name: V 1 ,�'�/' ' • ‘fie Environmental exhaust and ventilation Address: � .` Range hood /other kitchen �a8o � i w 1• t CA_ Range 10 00 Cih' /State /Z 1' : Clothes dryer exhaust / 10 00 �! ; a% ` I �`� ` Single -duct exhaust (bathrooms, Phone: ( )513- LION,-, Fax: (56s ) 533 _ 4/366 toilet compartments, utility rooms) 6.80 _:. ❑`APPLCA INTr - ' K CONTACT PERSON" attic%Cra\vlspace fans 10.00 Business name: Other 10 00 k sR� Fue pipi Contact name: , f ��� $5.40 for first four: $1.00 for each additional Address: `�� c M E, Furnace, ace etc. / Gas heat pump City/State /ZIP: - Wall /suspended /unit heater Phone: (5c 3) 9 (09. 14`53 Fax: ( ) 5 (�(� ` F J Water heater i ` Fireplace / E -mail: Range CONTRACTOR Barbecue ' Business name: 0 Clothes dryer (gas) �� ii, - ; t1 •:r ; Other: Address: l4 5 53 , MECHANICAL PERMIT FEES* City/State/ZIP: ‘ 1 0 * O rV Subtotal � Minimum permit fee ($72 50) Phone: (5 591 -9 ( Fax: (5 3) g'{ii_ U-} 8e Plan review (25% of permit fee) CCB ]ic.: J (.4 1 31 L I State surcharge (8% of permit fee) - - TOTAL PERMIT FEE Authorized si attire: i /�/"y�� �y//J( This permit application expires if a permit is not obtained .\i1hin 130 f�"y h - days after it has been accepted as complete. Print name: �]IC " Date: 1 ' Fee methodology set by Tn- County Building Indust Service Board ■ `. Building \ME _ Pe l mtitApp doe 12/03 440 -461 7T (1 I/02 /COr1/\\ EB) tsunuing rlsiures Plumbing Permit Application FOR OFFICE USE ONLY J. City of Tigard Received Date/By Permit No.: 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503 639.4171 Fax: 503 - 598.1960 lGxrmAitw; �r, Date/By: Other Permit No — 24- Hour Inspection Line: 503.639.4175 �( a! ' F_ ,11... . Date Ready/By Io RI See Page 2 for Internet: www.ct.tigard - us Notified/Method• Supplemental Information ..a ' _ ,...' •TYPE •OF N ORK x y -FEE* SCNEDULE . , ' ANew construction III Demolition For spe information use checAfisL _ Description I Qty. I Ea Total ❑ Addition/alteration/replacement ❑ Other: New 1- 2- fami}v dwellings (includes 100 ft for each utility connecuor CATEGORY OF CONSTRUCTION _ SFR (1) bath 249 20 IRT1- and 2- family dwelling XCommercial/industrial SFR (2) bath 350.00 1:1 Accessory building ❑ Multi- family SFR (3) bath 399 QO Each additional bath/kitchen 45 00 ❑ Master builder ❑ Other: _ Fire sprinkler ( sq ft -) Page 2 =Fa _ - - .t' 5 ,':•; ,, ;. = rJUB, "�F'ORIVIATION' A1�I) L_OC�#TION � y ; - - -- - Site utiliti Job site address: es �r/L =1f I �/-/ /III, Catch basin or area dram 16 -60 City / State/ZIP: ` i ' 16 I q — Dry leach line, or trench dram 16 60 Suite/bldg -iapt. no.: v Project name Footing dram (no. linear ft.: ) Page 2 ��jj Manufactured home utilities 11000 Cross street/directions to job site: ey 1 Manholes 16 60 Rain dram connector 16.60 Sanitary sewer (no. linear ft. ) Page rs 2 ,�• _ Storm sewer (no- linear ft : ) Page 2 Subdivision 1l l l - 6AXI� 1K 1 �P S Lot no. Water service (no. linear f] : ) Page 2 ^ o i ^ C711 Fixture sor t or item Tax map /parcel no.: t'� �, valve •� .. -. . -.... Absorption erpt ton � va 16 60 DESCRIPTION -OF �yORK Backflow preventer Page 2 Backwater valve 16.60 Clothes washer 16.60 Dishwasher i 1 60 r - W - - Drinking fountain 16 60 : PROPERTY OW NER ❑ TENANTS r, ' r Ejectors/sump 16.60 Name: B LS _ it. V a li • s & Expansion tank 16.60 Address: 1 lD a BC S ' AY\ ('.k- City /State /ZIP: r k 1 (1Q, el � . Fixture /sewer cap 16 60 t _ Floor drain/floor sink'hub 16.60 Phone: 1503) 5 . tbOu • Fax: (5 )533_ Garbage disposal 16,60 � ,,,,,'r'" : - 'r ✓ ;a :`i - 4',W � , <'; - n ir_ � w � � Hose bib 1 16 -60 y Y'_: -- ;a r 't .A.RY r -l:l Kv ;, . -1; . . �,, : ,FONT. : . ! P EIb 4*,.,i N •, .._ s.. :...zr nF: Y r ^. z k I I ce maker Business name: 5A 6.60 C Int erceptor /grease trap 16,60 Contact name: N wit Medical gas (value: S ) Page 2 Address: 3AYAE Primer 16.60 City /State/ZIP: Roof drain (commercial) 16.60 Phone: (50S) 4 Q 11153 Fax: : ( ) ML u / sin/lavatory 16.60 T ,' i Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 '- j EONTRAICTR . - ..... , -. . '.: ; ca :c -.� _ .. _r.;, k. -. +�h ... Water closet 16 60 Business name: l �j \1 �r � „,,,,,\,....; t � Water heater 16,60 Address: a q'S / t 5 l � ` J Q ` �t�\ Q ` l S Other - 1 � 7 v�+v '7 Subtotal Cih' /State /ZIP: L�, �<<Sb0 �(-C' \� 9 T' !3 / Minimum permit fee: $72.50 Phone: (56 1021 — ) 10 3a_ Fax: (6153) 6 a _ tt Residential backflow minimum permit fee: 536.25 CCB Lic.: pciat Plumbing Lic. no.:3q a60 Plan review (25% of permit fee) - - � - f � ) State surcharge (8% of permit fee) Authorized signature: p . /� J/ / 0 . TOTAL PERMIT FEE Print name: /dlf / az e f . . Q / i 4 1 Date: This permit application expires if a permit is not obtained withir -� ° 1 I � y 180 days after it has been accepted as complete. *Fee methodology set by Tri -County Building Industry Service Boar( Building \Permits \PLMF- Pern pp doe 12/03 440- 4616T(10/02/COM/WEB) _ _. 1 CITY OF TIGARD BUILDING DIVISIONV PERMIT #: MST2004 -00365 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/24 /2005 Phone: (503) 639 -4171 k"°"r Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 10/7/2005 TIME: 7 :05AM PAGE: 26 SITE ADDRESS: 07906 SW PICKLEWEED LN CLASS OF WORK: SUBDIVISION: ESONITA TOWNHOMES LOT #: 050 TYPE OF USE: PROJECT NAME: BONITA TOWNHOMES DESCRIPTION: New SFA, OWNER: JLS CUSTOM HOMES, PHONE #: 503.533 -4006 1 CONTRACTOR: JLS CUSTOM HOMES PHONE #: 503-533-4006 Inspection Request Scheduled For: Date: 10/7/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Electrical final 017748 -01 503-642 -2800 N Corrections /Comments /Instructions: ) - J tc,\A RO■wn 9L-k %4 \i\\15 1 .? 0 . • \] PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL El CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: ,- (,/ Date: . Phone #: (503) 718 - CITY OF TIGARD • BUILDING DIVISION PERMIT #: MST2004 -00365 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/24/2005 Phone: (503) 639 -4171 �omvmdOiln�Mlhj�l Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 10/14/2005 TIME: 7:04AM PAGE: 87 SITE ADDRESS: 07905 SW PICKLEWEED LN CLASS OF WORK: SUBDIVISION: BONITA TOWNHOMES LOT #: 050 TYPE OF USE: PROJECT NAME: BONITA TOWNHOMES DESCRIPTION: New SFA. OWNER: JLS CUSTOM HOMES, PHONE #: 503-533 -4006 CONTRACTOR: JLS CUSTOM HOMES PHONE #: 503-533-4006 Inspection Request Scheduled For: Date: 10/1012005 Pour Time: Code # Inspection Description Confirm # Contact # Message 699 Mechanical final 017863-01 503-209-6038 N Corrections/Comments/Instructions: 4 1 0 5 / MEMeMin/ u ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED 1 Inspector: • 1 Date: I U ( D S Phone #: (503) 718- CITY OF TIGARD . BUILDING DIVISION PERMIT #:/1 ,Sr zZo,4— S- 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: Phone: (503) 639 -4171 a/1 °� Inspection Requests (24 Hrs.): (503) 639 -4175 . ' -- INSPECTION WORKSHEET FOR DATE: ('O (7 fOT TIME: PAGE: SITE ADDRESS: 7 0' {--' C--(_, t_ ` — °(� CLASS OF WORK: SUBDIVISION: 19'f #: TYPE OF USE: PROJECT NAME: DESCRIPTION: OWNER: PHONE #: CONTRACTOR: LS PHONE #: Inspection Request Scheduled For: Date: Pour Time: Code # Inspection Description Confirm # Contact # Message 6163. -©2- Corrections /Comments /Instructions: ` - . ,,, mairar- M I 111 V I V ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAS ASSESSED Or . i Date: (o/ Inspector: p Phone #: (503) 718-