Permit CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2001 -00041
A' DEVELOPMENT SERVICES DATE ISSUED: 2/14/01
4-- 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 14916 SW 116TH PL PARCEL: 2S1106D -03200
SUBDIVISION: HELM HEIGHTS ZONING: R -4.5
BLOCK: LOT: 009 JURISDICTION: TIG
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: ADD FIRST: sf N: S: E: W:
TYPE OF USE: SF SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: 5N : sf N: S: E: W:
OCCUPANCY GRP: R3 TOTAL AREA: 0.00 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: BASEMENT: sf AREA SEP. RATED:
STOR: HT: ft GARAGE: sf OCCU SEP. RATED:
BSMT ?: MEZZ ?: REQD SETBACKS REQUIRED
FLOOR LOAD: psf LEFT: ft RGHT: ft FIR SPKL: SMOK DET:
DWELLING UNITS: FRNT: ft REAR: 16 ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 11,500.00
Remarks: Extension of, and installation of new decking and railing to existing deck.
Owner: Contractor:
GENE HOPKINS GEMINI GENERAL CONSTRUCTION
14916 SW 116TH PLACE 20623 SW GRACIE STREET
TIGARD, OR 97223 BEAVERTON, OR 97006
Phone: Phone: 503 - 649 -7597
Reg #: LIC 131611
FEES REQUIRED INSPECTIONS
Type By Date Amount Receipt Footing lnsp
PLCK CTR 1/30/01 $96.79 27200100000 Framing Insp
Final Inspection
PLC2 CTR 2/14/01 $6.24 27200100000
PRMT CTR 2/14/01 $158.50 27200100000
5PCT CTR 2/14/01 $12.68 27200100000
(additional fees not listed here)
Total $294.21
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable law. 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 the rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -1987. You
may obtain a copy of these rules or direct questions to OUNC by calling (503) 246 -1987.
Pe rm itee
Signature: ��
Issued By: • A - Mob a2/0_,//h_ts
Call 639 -4175 by 7 p.m. for an inspection the next business day
i
— vy i �J/ / L G of x.61
Building id
A :ceve: / 1? , // Permt no.: a, 0' 0 City of Tig o y/
l' �' ' Project/appl. no.: Expire date:
City ojTigard Address: 13125 SW Hall Blvd, Tigard, OR 97223
Phone: (503) 639 -4171 Date issued: By Receipt no.:
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: 1 &2 family: Simple Complex:
TYPE OF PERMIT
1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ New construction ❑ Demolition
Addition/alteration /replacement ❑ Tenant improvement ❑ Fire sprinkler /alarm `dOther: .2' ee,e.
JOB SITE INFORMATION
Job address: I y ) 6 S;,J j 1 6 Z ti, C e _ Bldg. no.: Suite no.:
Lot: Block: Subdivision: Tax map /tax lot/account no.:
Project name:
Description and location of work on premises/special conditions: 0 .<, — t 4J K 1 v, ,,^ c2t4 G -
OWNER FOR SPECIAL INFORMATION, USE CHECKLIST
IIME eve Pio a k', v. (Floodplain, septic capacity, solar, etc.)
Mailing address: 1 4 I E 5,.,.; 1 6 Q 9 1 & 2 family dwelling: -f)
State: 0 (. ZIP: `l) •23 Valuation of work $ I I i 5 00'
Phone: Fax: E -mail: No. of bedrooms/baths
Owner's representative: Total number of floors
Phone: 6 - 45 1 j Fax: E -mail: New dwelling area (sq. ft.)
APPLICANT Garage/carport area (sq. ft.)
L S Covered porch area (sq. ft.)
Name: � ctC � n� - Tv- � � : � K
Mailing address: i 1 e-b „ DA Ko r.i 5?. Deck area (sq. ft.)
City: Ti 4k'P•b State: O. ZIP: �� 2-?- Other structure area (sq. ft.)
Phone: o0- -Z1) t. Fax: E -mail: Commerciallindustriallmulti- family:
CONTRAChOR Valuation of work $
Existing bldg. area (sq. ft.)
Business name: 24.41.1.9. ; evt e ,r,,t, s tel 5 c 71 1v VN New bldg. area (sq. ft.)
Address: AAARK A ka-Sa,,,. Number of stories
City: State: ZIP:
Phone: Fax: ��Gil� IjaM Type of construction
CCB no.: Occupancy group(s): Existing:
� ° New:
City /metro lie. no.: Notice: All contractors and subcontractors are required to be
ARCIIITECI /DESIGNER licensed with the Oregon Construction Contractors Board under
Name: ' R l rs (Z 2 a il SC ,,� • provisions of ORS 701 and may be required to be licensed in the Mg Mr Address: i i 4 jurisdiction where work is being performed. If the applicant is
;;► State :0k ZIP: 2L
exempt from licensing, the following reason applies:
Contact person: _Sill Plan no.:
Phone: OEM ax: 6,.) _ '8;0 E -mail:
ENGINEER
Name: Contact person: Fees due upon application $ 9 , 7'
Address: Date received:
City: State: ZIP: Amount received $
Phone: Fax: E -mail: Please refer to fee schedule.
I hereby certify I have read and examined this application and the Not all jurisdictions accept credit cards, please call jurisdiction for more information.
attached checklist. All provisions of laws and ordinances governing this ❑ Visa ❑ MasterCard
work will be complied • whether specified herein or no . Credit card number: / /
igi` / Expires
Authorized signature: • .I. 1. Date: /4G/c.)1 Name of cardholder as shown on credit card $
Print name: ( J 0 - "k ` Cardholder signature Amount
Notice: This permit applicati in expires if a permit is not obtained within 180 days after it has been accepted as complete. 440-4613 (6a00/COM)
e- Pi 96 , 79
•
One- and Two - Family Dwelling
1;a Building Permit Application Checklist Reference no.:
Associated permits:
City of Tigard cit f Tigard y b ❑ Electrical ❑ Plumbing ❑ Mechanical
Address: 13125 SW Hall Blvd, Tigard, OR 97223 ❑ Other:
Phone: (503) 639 -4171
Fax: (503) 598 -1960
THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A
1 Land use actions completed. See jurisdiction criteria for concurrent reviews.
2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc.
3 Verification of approved plat/lot.
4 Fire district approval required.
5 Septic system permit or authorization for remodel. Existing system capacity
6 Sewer permit.
7 Water district approval.
8 Soils report. Must carry original applicable stamp and signature on file or with application.
9 Erosion control ❑ plan ❑ permit required. Include drainage -way protection, silt fence design and location of
catch -basin protection, etc.
10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state
building codes. Lateral design details and connections must be incorporated into the plans or on a separate full -size
sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed
if copyright violations exist.
11 Site/plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if
there is more than a 4-ft. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements and
driveway; footprint of structure (including decks); location of wells/septic systems; utility locations; direction indicator, lot
area; building coverage area; percentage of coverage; impervious area; existing structures on site; and surface drainage.
12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent
size and location.
13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater,
furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc.
14 Cross section(s) and details. Show all framing - member sizes and spacing such as floor beams, headers, joists, sub -floor,
wall construction, roof construction. More than one cross section may be required to clearly portray construction. Show
details of all wall and roof sheathing, roofmg, roof slope, ceiling height, siding material, footings and foundation, stairs,
fireplace construction, thermal insulation, etc.
15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels.
Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope.
Full -size sheet addendums showing foundation elevations with cross references are acceptable.
16 Wall bracing (prescriptive path) and/or lateral analysis plans. Must indicate details and locations; for
non - prescriptive path analysis provide specifications and calculations to engineering standards.
17 Floor /roof framing. Provide plans for all floors/roof assemblies, indicating member sizing, spacing, and bearing
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered
systems, see item 22, "Engineer's calculations."
19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists
over 10 feet long and/or any beam/joist carrying a non - uniform load.
20 Manufactured floor /roof truss design details.
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas - piping schematic is required
for four or more appliances.
22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or
architect licensed in Oregon and shall be shown to be applicable to the project under review.
JURISDICTIONAL SPECIFICS
23 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ".
24 Two (2) sets each are required for Items 16, 19, 20 & 22 above.
25 Building plans shall not contain red lines or tape -ons.
26 No rolled, reversed or mirrored building plans will be accepted.
27
28
Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black ink.
Red ink is reserved for department use only. 440 -4614 (6t00ICOM)
s - - -,. CITY OF TIGARD BUILDING INSPECTION DIVISION .‘
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
�� BUP p� uDfdUGC( / Date Requested G T AM PM BLD _
Location / Y �7 / / l -54.) //‘ 6t /i/ Suite MEC
Contact Person Ph 573 Z. f- ,96y PLM
Contractor Ph SWR
Tenant/Owner ELC
etaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
V"
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
ASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk 4.4 Other Date 2 Inspector ArC Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
- ,CITY OF TIGARD BUILDING INSPECTION DIVISION /, /r �
24 -Hour Inspection Line: 639 -4175 Business Line: 63 171
BUP d -coo q 1
Date Requested -` ' 5 AM PM BLD
Location / </ f /G SLJ 1/‘ t ,6j Suite MEC
Contact Person Ph 3Z Z- v '( 7/ PLM
Contractor Ph SWR
BUILDING j Tenant /Owner p/' $, (ey l( / I7 . ? J )4 n5A ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab
SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc: / //t-
Final
PASS PAR FAIL � j l�lS .� 1 � ap� l GTC U AN) 04L_
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk �
Other Date JJ Inspector 'r, Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION • "� • •
24 Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP 2 I — d'604
Date Requested 3— ?-- of AM PM BLD
Location (4°i j Co / /(o Suite MEC
Contact Person i.1,t A,Lic Ph C 2 2 - y / 7 7 PLM
•
Contractor Ph ),' SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing C/`.% /as:� � a� 1� � `���...� s dos -- ' -
Insulation
Drywall Nailing ' 2. •
Firewall
Fire Sprinkler A14/4- Jaw FSn -. v217A-,c S fvc c r
Fire Alarm
Susp'd Ceiling Aci3 i ?� vs�: ,� vc G �17'. l.1.�.� t��iz s �✓5�+.2 1 �;- �a`c.s
Roof e
Misc: �•ciEE ��
Final
PASS PART 6A7)- Sc 4 'r' 4 4. cc e
PLUMBING
6G 577,z+P 4�.v1 szL,
Post & Beam
Under Slab s S �,o v� TZ•..s
Top Out p J —
Water Service ,,— .2e} 4z-7 @ . GaLUrs� G�� C�
Sanitary Sewer �)
Rain Drains %
( ,c//i,c, r! -cdJ) crr7s."" - 7av Sla
Final
PASS PART FAIL e' Nr16 v .{�
MECHANICAL
Post & Beam %�lJo...,7 f os� �.� - rTzr�lc� /rLtcS�r 4
Rough In
Gas Line
47-Y-44-c4/ l�-z . � art- si= P ��2 co Srr7c, r--0.2zr
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk
Other Date 7 F e Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
4 .164 /
• `CITY OF TIGARD BUILDING INSPECTION DIVISION MST • `.
-
24:-Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP „.2.L0/ -' t q /
Date Requested Z-441 AM PM BLD
Location / 1f f /' 541 /Ll - Suite MEC
Contact Person n7 f kk Ph 51 Y/ 7 7 PLM
Contractor Phi �D y SWR
Tenant/0 er ��PG C� ELC
gETIM ELR
Footing Access: Access: FPS
-Ft rain
Crawl Drain Inspection Notes: SGN
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
ra P
I nsulation
Drywall Nailing
Firewall , S � r t " Q L�
Fire Sprinkler 'tfl pig S �v tZ
Fire Alarm
Susp'd Ceiling �� 'CN _ C' .O 1 .
Roof
Misc:
Final
PASS PART - 11I\ _` r Wti
PLUMBING �Q•N b it_ I j.'.
Post & Beam 1
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk
Other Date " Inspector E
Final
PASS PART FAIL DO NOT REMOVE this inspectio record from the job site.
0 6 7
CITY OF TIGARD BUILDING INSPECTION DIVISION . *. :'
• 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 MST
BUP ZGGJ -OUh (//
Date Requested 2- 2 -1 AM PM BLD
Location / q ,l 4' 514 f / ' Ae Suite MEC
Contact Person Ph 5 7)3 Ze f ° 04'9 PLM
Contractor Ph SWR
Tenant/Owner ELC
Re -' I'ng Wall ELR
ndation Access: FPS
Ftg Drain
Crawl Drain Inspection Notes: SGN
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath/Shear
� rami 0 / 04". s`7 sy ` jJUE_s"
TWA ation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART c211
2.
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk
Other Date 2 - 27—e/ Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
M
t �
•
•
BUP - Building Permit ELC - Electrical Permit
4 Inspection Description Date Passed By Inspection Description Date Passed By
Footing /Setback Underground cover
Foundation walls Wall cover
Footing drain Ceiling cover
Waterproof bsmt walls Electrical rough -in
Slab Electrical service
Crawl drain Electrical final
Underfloor insulation
Post/beam structural
Shear walls /anchors ELR - Restricted Energy Permit
Roof nailing J Inspection Description Date Passed By
Firewall Low voltage
Tilt -up panel Electrical final
Masonry /Reinforcement
Framing
MFG - Structure set -up MEC - Mechanical Permit
Insulation - 4 Inspection Description Date Passed By
Drywall nailing Post/beam mechanical
Suspended ceiling Gas line
Engineered soils Mechanical rough -in
Welding Lab Final Fire damper
Concrete Lab Final Duct work
Bolting Lab Final Smoke detector
Fireproofing Lab Final Mechanical final
Structural observation
Final inspection 11 al
PLM - Plumbing Permit
4 Inspection Description Date Passed By
BUP — Fire Protection System Permit Plumbing underslab
Inspection Description Date Passed By Crawl drain
Sprinkler underfloor /slab Post/beam plumbing
Sprinkler rough -in Plumbing top -out
Sprinkler final RP /backflow preventer
Fire alarm final Rain drain
Storm drain
Water service
SIT - Site Permit Sanitary sewer
4 Inspection Description Date Passed By Culvert/catch basin
Footings Pump /fill septic tank
Foundation walls Plumbing final
Sprinkler supply lines
Sprinkler underfloor /slab
Catch basin /Manhole SWR - Sewer Permit
Engineered soils 4 Inspection Description Date Passed By
Engineering acceptance Sanitary sewer
Final inspection Final inspection
INSPECTION RECORD - BUP, PLM, SWR ELC, ELR, MEC, SIT PERMITS
ti
w r
1 • *
CCITY F TIGARD BUILDING PERMIT
PERMIT #: BUP2001 00041
"'�' ii,, DEVELOPMENT i
L O ) 639 -4171 DATE ISSUED: 2/14/01
s
SITE ADDRESS: 14916 SW 116TH PL PARCEL: 2S1106D 03200
SUBDIVISION: HELM HEIGHTS ZONING: R -4.5
BLOCK: LOT: 009 JURISDICTION: TIG
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: ADD FIRST: sf N: S: E: W:
TYPE OF USE: SF SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: 5N : sf N: S: E: W:
OCCUPANCY GRP: R3 TOTAL AREA: 0.00 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: BASEMENT: sf AREA SEP. RATED:
STOR: HT: ft GARAGE: sf OCCU SEP. RATED:
BSMT ?: MEZZ ?: REQD SETBACKS REQUIRED
FLOOR LOAD: psf LEFT: ft RGHT: ft FIR SPKL: SMOK DET:
DWELLING UNITS: FRNT: ft REAR: 16 ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 11,500.00
Remarks: Extension of, and installation of new decking and railing to existing deck.
Owner: Contractor:
GENE HOPKINS GEMINI GENERAL CONSTRUCTION
14916 SW 116TH PLACE 20623 SW GRACIE STREET
TIGARD, OR 97223 BEAVERTON, OR 97006
Phone: Phone: 503 - 649 -7597
Reg #: LIC 131611
FEES REQUIRED INSPECTIONS
Type By Date Amount Receipt Footing Insp
PLCK CTR 1/30/01 $96.79 27200100000 Framing Insp
Final Inspection
PLC2 CTR 2/14/01 $6.24 27200100000
PRMT CTR 2/14/01 $158.50 27200100000
5PCT CTR 2/14/01 $12.68 27200100000
(additional fees not listed here)
Total $294.21
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. s t3t1
Specialty Codes and all other applicable law. 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 mor
than 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -1987. You
may obtain a copy of these rules or direct questions to OUNC by calling (503) 246 -1987.
Permitee '
SSignature: � - . •
Issued By: ,j � ! G2-6
1
Call 639 -4175 by 7 p.m. for an inspection the next business day