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Permit CITY OF TIGARD MASTER PERMIT PERMIT #: MST2004 00235 0r � A DEVELOPMENT SERVICES DATE ISSUED: 8/27/2004 ��' �! 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 11946 SW 128TH AVE PARCEL: 1S133DD-17300 SUBDIVISION: VILLAGE AT SUMMER LAKE PARK 5 ZONING: R -4.5 BLOCK: LOT: 209 JURISDICTION: TIG REMARKS: 110sf. addition. BUILDING REISSUE: CUSTOM STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ADD HEIGHT: 14 FIRST: 110 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: sf GARAGE: sf FRONT: 20 PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: THRD: sf RIGHT: 5 VALUE: 4,200.00 OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 110 sf REAR: 15 PLUMBING SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS: TUB /SHOWERS: GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: CLOTHES DRYER: FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS: MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS: ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 0 - 200 amp: 0 - 200 amp: W /SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVCJFDR: 00 SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: 0.00 SIGNAL/PANEL: IN PLANT: MANU HM /SVC /FDR: 601 - 1000 amp: 601 +amps- 1000v: MINOR LABEL: - 1000+ amp /volt : PLAN REVIEWSECTION 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 & STEREO: VACUUM SYSTEM: AUDIO & 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: Owner Contractor: TOTAL FEES: $ 250.56 • This permit is subject to the regulations contained in the JOHNSON, JERALD E + PEGGY C OWNER SW 128TH Tigard Munidpal Code, State of OR. Specialty Codes 11946 11946 SW 1 TH AVE A 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 the work is suspended for more than 180 days. Phone: 503 - 590 - 96314 Phone: ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those Reg #: rules are set forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. REQUIRED INSPECTIONS Footing Insp Electrical Rough In Electrical Final Foundation Insp Framing Insp Final inspection Post/Beam Structural Shear Wall Insp Underfloor insulation Exterior Sheathing Insl Crawl Drain /Backwater Insulation Insp i Issued By • - / AO ' ,,�� // Permittee Signature • • 17 Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the xt business day t'. Building Permit Applic • I• � FOR OFFICE USE ONLY .i CEIVE P . City of Tigard Received / permit No.: 13125 SW Hall Blvd., Tigard, OR 97223 Plan Revie �V 16001/ _ ► Phone: 503.639.4171 Fax: 503.598.1960 AUG 1 3 20► , DateB : a 1 O`�T H 4 Other Permit: Inspection Line: 503.639.4175 MIL Date Ready/By: H See Attached Checklist for CA Internet: www.ci.tigard.or.us CITY OF TIG ' -D Notified/Method: Supplemental Information BUILDING DIVISION J r 3 °' t YPE,}O W < Q -' s» t; `! ss ' „ #;- . , s• " TA = p1�AND 2- FAMIL1r D,WLIilIi�.G, »; <4� � _�, :,,..�� ,lam �s � . ,. � `�� > >r a'� RE` Q,i,?IIiF3D DA , .� s<�ir...,"'8"o- .,' .. .z��' - .e.�,ds �. .k�..�,�r�..��- 4. °,�t�,'ma�: x�_rnF�=- ?,'�.. S ad. , �' w' .�a�.w�,,:r�..�s:�,�::,�;.c,<v •s:._ - . ❑ 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/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for ,,, x a' ' ' , ay — , �;:,:�, ��x .:�rv p, - - r work indicated on this application. w i , _ � x _, . � ` ` RC i E , :, O I T Rr Y Ce — ' 4 4 ` ` veto. E> j �` Q C1 / Valuation: $ / iftS1- and 2- family dwelling ❑ Commercial /industrial L Number of bedrooms: ❑ Accessory building ❑ Multi - family \ � ID Master builder ID Other: Number of bathrooms: v sr " -., " '';'ALL "aH t,.. ":M;z:;.:; t,?',tp. • {r..'a; . , a: ,> .., ,m ` � JOB S1± , I FQ AT ONa 'AND O , CATrIO �.� P , < Total number of floors: ' Job site address: WI q `7 & s GO I '.__4g,-- New dwelling area: square feet ) 1 City/State /ZIP: 11 9 In d ()K tt 7 - Garage /carport area: square feet l a Suite/bldg. /apt. no.: Project name: Covered porch area: square feet Cross street/directions to job site: 1 00N re ISM 4_ )2 8 Deck area: square feet • Other structure area: square feet 18 — i" 3°?�wet.s:; tx"`a :» ;.- ",° �.�" .. ,., r:.etif4A, ,?� ,w r_I fi;; va3..a; •.. ., `• .REQUIRED" DATA''• COMIVIERCrIAI -TISEiCH S a , e" Subdivision: Lot no.: Permit fees* are based on the value of the work performed. Tax map /parcel no.: 1f `1 0 1 ( C 9 9 Indicate the value (rounded to the nearest dollar) of all O � equipment, materials, labor, overhead, and the profit for the V, s %;.. r`v'',�'- :`�7x�`5)'�,i'�"^ � <`: ro ''•.�ii. K <w,:��;:: >^ ':'t i��' - � '�� ° a. �t „�,�.' h�;,,w;'r, �"i3,;' . `t 0 M raDESCRIP,TT01 ® 'oB x ' work indicated on this application. 4.. % �� t : > .,, _ � ..,g , A py?� 2 � d _ :: ` ; k (Nkt 6' , 1(5' 7c 11 WIC »t• Valuation: C Les L-- Existing building "area: 13 square feet 1 New building area: 1 1 0 square feet �� I PROPER , OWNER r 4, n M ' A , . $ ®`t- TENANT. e Number of stories: I Name: 4.) .. 1 0.) -I< d n Type of construction: Address: '1 k el 1. f t ( � 6 (10 12 K 1I Occupancy groups: City/State /ZIP: Il Q A"GJ G?',---e_ 97?- Existing: Phone: (c(2�l c'C., 0, q( Fax: ( ) New: � 'z�ra:4: M t .f a�:; t ;r,; �aE _ Awl .;° �,`,, 'd3, "r. r;?;c:.taf - ::€� °..;.�r: .",',. m �r °��;''''��• fl. '�. ,`� �'�" tr. „�`.�. �„ � �g ? a. "�r'�':,:1 r' :fr� ": .�-� ` .:t ,�; re:=»��' <„ �rt,� -�a x. �:�.�..�a.,s�s:; : . a CON.TAC P ,,.. — t ..,,.: �� "u�;,. l�APPL C�A�N'T���..., � ..� . '�. - z.�. �+ � � 'Y;� a �`� �^ � �.yr ";; �p,;,�,. 9.0" ...e='�..v..v's � =+s=: S .. �� ' ...,� . , ASr, aw S , ..,: c :, k I' S. "'.... n5 h� : ,�« _ _ : , , - �. � .. �"�'° � NOTICE ° .' , t � � -,;.. �'F S:h�liv4v:'x`iFSv:>W. {.�P�. [.. r .�TiP Business name: All contractors and subcontractors are required to be Contact name: licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: S 11Thri k jurisdiction in which work is being performed. If the City/State /ZIP: applicant is exempt from licensing, the following reasons apply: Phone: ( ) Fax:: ( ) E -mail 3 { Mli 'ti ` �c L iC 0�1� .IL'AGTiO�i Ih 1 - a t-A = J ` Business name: r _ n :nom ,�-^ „,�,,.' =,. ;: �BUILDIN,G»PE °RM�I zFEES* , Address:S' r l ry r Please refer to fee schedule. City/State /ZIP: Phone: ( ) Fax: Fees due upon application ( ) CCB lic.: / Amount received / Date received: Authorized sign. ure: / This permit application expires if a permit is not obtained ja td 4 A .,....... _ .--- within 180 days after it has been accepted as complete. Print name: Y`' .n C Lc r- ,s r) Date: ' (1 a 1 Q ({ * Fee methodology set by Tri- County Building Industry Service Board. i : \Buildmg\Pemiits\BUP- PernutApp doc 12/03 440- 4613T(I1 /02 /COM/WEB) . , ,. ii x: A l k Building Division /h.moti 6�ii Plan Submittal Requirement Matrix 1 . Commercial & Multi - Family - New, Additions or Alterations City of Tigard 1 3;l ey = pe of glubml ital r 4- f , r# o Plans , , , k f(Inc it de new, and afterations , 1 4Reginred a Demolition Permit 2 (site plan required showing location and square footage of all buildings to be demolished) Site Work 2 (must include location of all accessible parking) Plumbing (site utilities) 2 Building 1* Fire Protection System 3** Mechanical 2 Plumbing (building fixtures) 2 Electrical 2 Plan review is dependent upon submittal of a completed application and plans. After plan review approval, the Plans Examiner will contact the applicant to request additional sets of plans for distribution purposes (for contractor, City of Tigard, Washington County, and Tualatin Valley Fire & Rescue) * For over- the - counter commercial tenant improvements, submit 2 sets of plans. ** "New" fire protection systems require that plans bear the original seal of an Oregon licensed fire suppression engineer, or NICET level "3" technicians. i:\Building \Forms \COM- PlanSubReq.doc 12/24/03 Electrical Fermi � . 4..• !, -_. � _ 1,I. D FOROFFICE U SE ON , City of Tigard g Plan Re Received PeraritNo.: 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review : Phone: 503.639.4171 Fax: 503.1 %0601 3 2004. 0- �� d / ,1 Date/B : Other Permit Inspection Line: 503.639.4175 c � I ' `yaw Date Ready/By: Juris El See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information CIT ., . ._ .: , ,,.- -- r.--, - -s r .. , -, ;:..-- -.a �ar•..r.,".:r���,�� : �3Ul: a b?1 � = aa.:. >,� - � �' �` "��, � � :��a.,,taa . . �';: wRE�?IE�W _ El New construction Addition/alteration/replacement Please check all that apply: El Service over 225 amps, comm'l ❑Hazardous location ❑ Demolition ❑ Other: ttE _. e .. ❑ Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft., �. � "C OF�Cd1SSi RIJGLION r i s , t of 1 - and 2- family dwellings 4 or more new residential 1- and 2 family dwelling ❑ CommerciaUindustrial ❑ Accessory building ❑System over 600 volts nominal units in one structure ❑ Multi - family ❑Master builder ❑Other: ❑ Building over three stories ❑Feeders, 400 amps or more 12 Occupant load over 99 persons ['Manufactured structures or VII �i` 7. SIT F INO T ON� D O`GAITOl\ .;' s''`€ RV. ; �� ..��r.. N .. � r ...v - ��� �- nm�; _ ,,., � � .,�.„ e� ['Egress/lighting plan park P 1 I `T -1 S ❑Health -care facility ❑Other: Job no.: Job site address: t � ) I Submit 2 sets of plans with any of the above. City /State /ZIP: 1/ 4 0 q722 3 The above are not applicable to temporary construction service. Suite/bldg. /apt. no.: Project name: VIM s , CIr °E.`FrEE SCHEDUL -IK' Description Qty. Fee. Total Cross street/directions to job site: '-( COP) n 1, S (- 12-8- New residential single - or multi - family dwelling unit. Includes attached garage. 1,000 sq. ft. or less 145.15 4 Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1 map /parcel no.: Limited energy, residential 75.00 2 Tax m a . . ° _ - °�� r; r a _ ORK ��,�. r ,; rw + _ I ��,, Each Limited energy, non- residential 75.00 2 f r`� I , t DESCRI TION qF,, W " `„' :E;•,r a l manufactured or modular �.. ^ � ,, : �xs�a� �� _ _ .. ..> : �z -. dwelling, service and /or feeder 90.90 2 Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 % . mo w � ° blik -.xe �:� s,:; , ; . . s:.` ;-- 201 amps to 400 amps 106.85 2 a . ° f P R Q PERTT yOWNE, .§ f . 1.4 TEN �t � vow= ; P P 401 amps to 600 amps 160.60 2 Name: (- A- L A Jo h os e) n 601 amps to 1,000 amps 240.60 2 Address: 11 Cl 'L.( to' s w i Z� Over 1,000 amps or volts 454.65 2 �� o Reconnect only 66.85 2 City /State /ZIP: i l7 j 2 - Orr q 7 2 `3 Temporary services or feeders installation, alteration, and /or Phone: 'm 3) c _ o� 2) Fax: ( ) relocation 200 amps or less 66.85 1 Owner installation: This installation is being 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 600 amps 133.75 2 Owner signature: Date: Branch circuits - new, alteration, or extension, per panel ` 1 . / .APPI.I , ,,,,�... " ` yl+ K 1s -- ., ( bN TAotittRSO z -: ` A. Fee for branch circuits with � ,, " service or feeder fee, each Business name: S lit E. branch circuit 6.65 2 B. Fee for branch circuits Contact name: without service or feeder fee, / 46.85 �/� Cic Address: each branch circuit 7 d Each add'l branch circuit 6.65 2 City /State /ZIP: Miscellaneous (service or feeder not included) Pump or irrigation circle 53.40 2 Phone: ( ) Fax:: ( ) Sign or outline lighting 53.40 2 E - mail: ' Signal circuit(s) or limited- energy panel, alteration, or Business name: �7 extension. Describe: Page 2 2 Address: Each additional inspection over allowable in any of the above Per inspection 62.50 City /State /ZIP: Investigation per hour (I hr nun) 62.50 Phone: ( ) Fax: ( ) Industrial plant per hour 73.75 s_ i 4 ` ' I I •LIT6I?RIC EERIKUTT FEES „' ';9' CCB Lic.: Electrical Lic.: Suprv. Lic.: Subtotal • Suprv. Electrician signature, required: Plan review (25% of permit fee) 6 Print name: Date: State surcharge (8% of permit fee) 3 -2 'D TOTAL PERMIT FEE 4,, 49 Authorized signature: This permit application expires if a permit is not obtained within 180 , days after it has been accepted as complete Print name: A 1J' o s d 1 , Date: Siel I ., I e ti * Fee methodology set by Tri- County Building Industry Service Board '" Number of inspections per permit allowed. i: \Building\Permits\ELC- PermitApp.doc 12/03 440- 4615T(10/02/COM /WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: ,ut. bi g TI SITM M s t, Fee for all residential systems combined ... $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* • ❑ Heating, Ventilation and Air Conditioning System* n Vacuum Systems* ❑ Other: Ica xc .rig° CO Ot , y a _ 4 g. • Fee for each commercial system $75.00 (SEE OAR 918 - 260 -260) 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 ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations is\ Building \Pemuts\ELC- PermitApp.doc 04/03 • Permit #: IY,SS1 Ac96' - 0 ( ; - 2 s,____ f fi t' Address: I 19 $ w l le-r-4 :j, / ' Issued by: Date. 7 18 59 Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli- cants who are not registered with the Construction Contractors Board to sign the following statement before a building permit can be issued. This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt from registration under ORS 701.010(7), need not submit this statement. This statement will be filed with the permit. Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B: R 7 1. I own, reside in, or will reside in the completed structure. I 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion. ri 3A. My general contractor is (Name) Contractor regis. # I will instruct my general contractor that all subcontractors who work on the structure must be registered with the Construction Contractors Board. OR (/ 3B. I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors Board. If I change my mind and hire a general contractor, I will contract with a contractor who is registered with the CCB and will immediately notify the office issuing this building permit of the name of the contractor. I hereby certify that the above information is ; rrect and that I have read and do understand the Information Notice to Pro erty Owners ab ! ut - c str t' 1 n Responsibilities on the reverse side of this form. ,- / 41, � .�. /'7/ o / (Signature of / rmit applicant) (Date) (White copy to issuing agency permit file, pink copy to applicant) linortrnatjon ulate t© Propny Owners • Arcout ConsZocUon R(isponsiibMtles • Note: This Information Notice to Property Owners about Construction Responsibilities was developed by the Construction Contractors Board in accordance with ORS 701.055(5). If you are acting as your own contractor to construct a new home or make a substantial improvement to an existing structure, you can prevent many problems by being aware of the following responsibilities and area of concern. EMPLOVI.`M) RESPONISMLOTIES: IT you hire persons not regiscc with the Construction Contractors Board to do labor in constructing or assisting in the construction or improvement of a residential structure, you will, in most instances, be ruled to be an employer and the people you hire will be employees. As the employer, you must comply with the following: Oregon's vyl,thilaLiding tax iaw: As an employer, you must withhold income taxes from employee wages at the time employees are paid. You will be liable fo the tax payments even if you don't actually withhold the tax from your employees. For more information, call the Oregon Dept. of Revenue at 945-8091. Unemporine,T.qt 5nm:came tam As an employer, you are required to pay a tax for unemployment insurance purposes on the wages of al employees. For more information, call the Oregon Employment Division at the Department of Human Resources at 378-3524. Workers' compensation if:sr:Ter:Ice: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' cotiipeasation insurance for your employees. If you fail to obtain workers' compensation insurance, you may be subject to penalties and will e liable For all claim costs if one of your employees is injured on the job. For more information, call the Workers' Compensation Division at the Department of Consumer and Business Services at 945-7888. U,S,Intemali 12. Sc'..ir As an employer, you inusl withhold federal income tax from employees' wages. You will be liable for the tax payment even if you didn't actually withhold the tax. For more information, call the Internal Revenue Service at 1-800-829-1040. OTHER LIES!,' AMID AREAS OF CONCERIM: Code compliance: As the permit holder for this project, you are responsible. for resolving any failure to meet code requirements that may be brought to your attention through inspections. LiabinfIy and property elan insurance: Contact your insurance agent to see if you have adequate insurance coverage for accidents and omissions such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be re-done. Time to supervise employees Make sure you have sufficient time to supervise your employees. Expertise: Make sure you have the expertise to act as your own general contractor, to coordinate the work of rough-in and finish trades, and to notify building officials at the appropriate times so they can perform the required inspections. If you have additional questions, write or call the Construction Contractors Board (PO Box 14140, Salem, OR 97309-5052, 503/378-4621). The Board is iocated at 700 Summer St. NE Suite 300, in Salem. pro p-own.pm4 1 /94 CITY OF TIGARD C O TIG RD BUILDING DIVISION PERMIT #: MST2004 00235 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/27/2004 Phone: (503) 639 -4171 :ir 91n��m �' Inspection Requests (24 Hrs.): (503) 639 -4175 _� '__.. INSPECTION WORKSHEET FOR DATE: 6/21/2005 TIME: 7:11AM PAGE: 25 SITE ADDRESS: 11946 SW 128TH AVE CLASS OF WORK: SUBDIVISION: VILLAGE AT, SUMMER LAKE PARK 5 LOT #: 209 TYPE OF USE: PROJECT NAME: JOHNSON DESCRIPTION: 110sf. addition. OWNER: JOHNSON, JERALD E + PEGGY C, PHONE #: 503.590 -96314 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 6/21/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 299 Final inspection 009773 -01 503- 590 -9631 Y Corrections/Comments/Instructions: `i tiE,./7 &, 421 cs-c- ..-t,4)- L • PASS _ PARTIAL APPROVAL ❑ CANCEL _ NO ACCESS ❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: . , I Date: f — /' ES ' Phone #: (503) 718- CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2004 -00 35 13125 SW Hall Blvd., Tigard, OR 97223 N DATE ISSUED: 8/27/2084 Phone: (503) 639- 4171u Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 6/26/2005 TIME: 7:09AM PAGE: 16 SITE ADDRESS: 11946 SW 128TH AVE CLASS OF WORK: SUBDIVISION: VILLAGE AT SUMMER LAKE PARK 5 LOT #: 209 TYPE OF USE: PROJECT NAME: JOHNSON DESCRIPTION: 110sf. addition. OWNER: JOHNSON, JERALD E •H PEGGY C, PHONE #: 503 - 590.96314 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 6/28/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Electrical final 010331 -01 503 - 690.9631 N Corrections /Comments / Instructions: • ' PM.• Cq---CkZ\ \/*\ 5 Aa)Si L-O fa C IN ✓r9 I \ (D o I PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date: - � �`� Phone #: (503) 718 -