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Permit li .1 n CITY OF TIGARD,: MASTER PERMIT PERMIT #: MST2007 -00195 COMMUNITY DEVELOPMENT DATE ISSUED: 10/29/2007 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S 104BC -04400 SITE ADDRESS: 12610 SW ASCENSION DR ZONING: R -7 SUBDIVISION: HILLSHIRE WOODS LOT: 055 JURISDICTION: T1G PROJECT: OLVERA Project Description: Repair fire damage to residence and rear deck. BUILDING REISSUE: CUSTOM STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ALT HEIGHT: FIRST: sf BASEMENT: sf LEFT: SMOKE DETECTORS: y TYPE OF USE: SF FLOOR LOAD: 50 SECOND: sf GARAGE: sf FRONT: PARKING SPACES : TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: VALUE: OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 0 sf •8143e--- REAR: PLUMBING SINKS: WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: 5 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS: TUB /SHOWERS: 2 GARBAGE DISP: 1 WATER HEATERS: 0 WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: 1 MECHANICAL FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: 4 CLOTHES DRYER: 1 NAT FURN > =100K: 1 UNIT HEATERS: HOODS: 1 OTHER UNITS: 1 MAX INP: btu FLOOR FURNANCES: VENTS: 1 WOODSTOVES: GAS OUTLETS: 1 ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 0 - 200 amp: 0 - 200 amp: WSVC OR FDR: PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 201 • 400 amp 201 - 400 amp: 1st W,O SVC/FOR: 1 SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 am p EA AD DL BR CR: 15 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 & 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 0 SYSTEMS: This permit is subject to the regulations contained in the Tigard Owner: Contractor: Municipal Code, State of OR. Specialty Codes and all other applicable LETICA OLVERA OHICO CONSTRUCTION laws. All work will be done in accordance with approved plans. This 12610 SW ASCENSION DR 17255 PI LKI NGTON permit will expire if work is not started within 180 days of issuance, or TIGARD, OR 97224 LAKE OSWEGO, OR 97035 if the 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 952 - 001 -0080. You may obtain copies of these rules or direct Phone: 971 227 - 4254 Contact #: PRI 503 635 - 6248 questions to OU NC by calling 503.246.6699 or 1.800.332.2344. FAX 503- 636 -7183 Reg #: LIC 34908 TOTAL FEES: $ 2,544.52 REQUIRED ITEMS AND REPORTS 1 , 62,.............\____ Issued Permittee Signature : r 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. t ,. . ,. Buildin l Permit A 1 1 licatio Q0. ECE FOR OFFICE USE ONLY City of Tigard Received /v' S 0 CCCJJJ ✓ r Permit No.: frj577� vl .-bo`t 13125 SW Hall Blvd., Tigard, OR 972230 CT 5 2007 Date/ By: g Plan Review ,O1 ,, Phone: 503.639.4171 Fax Other Permit: Inspection Line: ax: 503.598.1 a Q � Y O C 11 (� Date/B : t` . e • V ,,,,e 503.639.4175 ` r � s® Date Ready /By: RI See Attached Checklist for TIGARD Internet: www.tigard - or.gov BUILD1NODIV1SION Notified/Method: / , a / 4i , Q F Supplemental Information .,' ' . ., �l �fTYRE OF WORK" --. Imo. i ..� 6 / d 7 I Psl ;i 2 " °FAM iTti E `� :�' <r � . c�-�u fir . D �fa�ra� �,..::at r5 �ek^ L �,- ��nr ❑ New construction ❑ Demolition Permit fees* a .aced on the value of the work performed. /� Indicate the value (rounded to the nearest dollar) of all 1=1 Addition/alteration/replacement Other: FI d ,6_ ,f2.6 P4 , equipment, materials, labor, overhead, and the profit for the r CATEGORY OF CONS R CT t ,r' Al - work indicated on this application. it )41- and 2- family dwelling 12 Commercial /industrial Valuation: $ f b O 0 0 Q 1=1 Accessory building 1=1 Multi-family Number of bedrooms: 1=1 Master builder 1=1 Other: Number of bathrooms:) d p - , - ` :;i ,-, JOB , ili INFOR =AN ifiro ATION .ra * Total mber of floors: G 2 , -,_ _,,,".,. `4g. �s Y,,, _,,« 3 ...,::;i}i`r. sc»f +" !d":: „...ksa�=:. ,,,, s^'.$=•£?t�... -:v 3tr3;,e..„. r.��.4.'. 'I Ab„,, Job site address: % Z ev( 0 .51/0 f S C_i6. / Sl o /3 S 1 New dwell] , area: square feet City /State /ZIP: 1\ (7 ►al\ o ! v r1 5.. & 0 Garage /carport ar square feet Suite /bldg. /apt. no.: Project name: Covered .: ch area: square feet Cross street/directions to job site: De area: square feet Other structure area: ! uare feet Y5• `H':.L_�..��:TR. , : d�Ah ?Y SgYsti:: "`�fi..c5+,�- `�:i�. iSi3'.li{b..:G:v�,rfcK.3 "'•:c'°�.+T. ^ >; �' 4 e-'e * A COM MER atEl GFIEGIO IST `, Subdivision: Lot no.: Permit fees* are based on the value of the work performed. In. 'cate the value (rounded to the nearest dollar of all Tax map /parcel no.: equip • -nt, materials, labor, overhead, and - e profit for the Valuation: $ : °, - . i rte ° t$ s, r-,. ,ha:ertxt_ivrt+�_x:�n:.At,:0.5.s 'x;.s4� .;•�,,;�,- -.,i :. ° e',.'- �e - ..�;:, s'G;�r"' �_ �"` � -& r � .,� - ` �r °�` � „� ��, r�,:. �” �- -� work inch •don this a 'DESCRIPTION OF OfORK _ ;;$ • PP lication. .. �s�,.:^ �;•:_ w�^'. �''_'' �ai�>=: x �.: u�� h�uv�al �. � � I, � y, � s. ��. -��>:v� - :,��.�.a.�a�'t±�ir� 12,IZM //L- !" t �-2 'J /" "" � 4... Tv. e .1 Z / 0 A) ., E � I (3 - p (_, Existing building area: _ square feet v +vr New building area: square feet !rJ +Y;.3 ".c�x�Gida*a'1A- I �F".�' _- - R: - - - �,.,�•�t�- t _._ L} � a I ts',Y: `JO „, ,� * �* �.R;? int. :; . -gli f ..� p.. � r PROP. -)CRTY OWNER t-° ®� 1 )ANT Number of stor s: i.- ke`gAt ,.,, .: -4,, ^x, - i,Av..:.,...w..,, :. e ?4- ¢ r.; 3,., ` eaS. .. o-r -a "x� ;., . :4 :1 :,:., _.G ,--,. , :; Name: L� 71 Gtf C L < Fr4 Type of struction: Address: 5G(_ . 013 s yr- Oce sancy groups: City /State /ZIP: Existing: Phone: (q 4-') 2..7- " 4 z6 ii. Fax: ( ) New: p=•. S:S:fla.:RG iY3)R3eri�;r fl ` j; �i�, T.! c�. �tn '5.= 3.�5':.1.�'in5�'���a±i' -X• «° , : - APPLICANT- # :> .al : t ' n. CONTACT PT;RSON ,N -,- :;.:: Ti, " of �" x-+ „ . 4. :���� �, 3` x�t 'a : >x:�:�: ��.,ri'•,tA€:x � �.� .:.:�.:xs:::a.s> apse. ku,n,'w.rzaw„e'�:�R;�.s+t "- ma ;� x. � rte � �� � � ^ T F '�. v . £1^ C� " ' 'sS� o�..04 �' �'�I Business name: ,,J�f C l 3 iJs /�i All contractors and subcontractors are required to be Contact name: v F r-`' G—i 1 s licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to he licensed in the Address: i? Z44 S (2 t VI" *L �{ 00 jurisdiction in which work is being performed. If the City /State /ZIP: v e . s . ` TL. A- p C) p f . 4 . 0 a applicant is exempt from licensing, the following reasons !1 5-3 apply: Phone:,3) 2-3 Z - 5-1.-1.1.9. Fax:: (rb 3) Z3 Z Z - E -mail ' \ 6.R 0 (,�„(( , (�„...„ . . _ , s , e CO `. -. _ . ..-. - ' , ° - a . .�s, • 5+�,s„` ...,L*.k3 eiY:.rze'. - �3 . � - yr*s �,+. Business name: p� s :z (/ / C o BUILDING PERMIT' S ' r ` , �iiRt eascse ree fer t of f a sch e dufe)lw , . ,1 . F d Address: 1 - 4 - Z � � -f I�- /" 7q7� r� -�` ,� . . City /State/ZIP: (Alai 0 h 4 0 � b i2 9 3-o 3's Structural plan review fee (or deposit): �� ,r 0 _ FLS plan review fee (if applicable): - Phone: (y j) 6 / /} � G J — 2C4 Fax: (503 (p 3 b - �/ g 3 Total fees due upon application: CCB lie.: 3 t s r / ,. / Amount received: Authorized signature: This permit application expires if a permit is not obtained /' � within 180 days after it has been accepted as complete. Print name: ` ` tJGw IS Date: qz * Fee methodology set by Tri- County Building Industry Service Board. I: \Building\ Permits \BUP- PermitApp.doe 03/21/06 440.46 13T( I UO2/COM/WEB) 10/04/2007 11:53 FAX 5036367183 OHI Construction R] 0004/0004 ,t Mechanical Permit Applicat' FOR OFFICE USE ONLY City of Tigard � t�IV Received DateB Permit No.: 13125 SW Hall Blvd., Tigard, OR 97223 �+ y v D �� V�� - 0 ' • ' Phone: 503.639.4171 Fax: 503.598.196 T 5 200 / Plan Review Other Permit: i 1 c .\ i , t� Inspection Line: 503.639.4175 �i Date/B Re ethod > Internet: www.tigard- or.gov • g CITY O .I jni�® Notif DZReeadyBy: fa See Page 2 for �F���Al1V� ®lUISI ®� a/M 6 Supplemental Information EEfi �?� fi s,�>-.. , �. � .'9s x c"yS'"� .5' '� ' '."e'., 7 . .�'_ "'. �i4. -z. B,� , rte 1 "' 1 t e- � n 'Ig d__t•g =. g:i:.:.. ,. •f. �° ,A�w r.tr .4 t _- l .Qia / J� , ,i�' y ,719r ~' � . 1 18 1 •Fr . • 'X i t QEt �: ; .. . � .. � s:a._.,v.. s.z,. sw:� E�e. .•.a_a._ rn» f it-. � �� • .:_... .......;_ ,� � .s.:., � , ..; Mechanical permit fees* are based on the value of the work ❑ New construction .0 Addition/alteration/replacement performed. Indicate the value (rounded to the nearest dollar) of all �� ❑ Demolition Other: \� r �r! \/ mechanical materials, equipment, labor, overhead, and profit. EX i i 1 i4. 01 Val $ Q 1 -and 2- family dwelling ❑ Commercial/industrial w � li V a�w o sli" t ap k �� ai y jY l ❑ Accessory building For special information use checklist. ❑ Multi family ❑ Master builder ❑ Other: r� v Description I Qty. I Ea. I Total �'T f.. . i � t .- t, t� fttr . !' sz 1 { M � 5 Yt k i hleating/eooling Job site address: C A Air conditioning or heat pump • �\ 0 t `S�eh� ' (requires site plan showing placement) 14.00 City/State/ZIP"- r Q .✓ ."4( .. '3 . Furnace 100,000 BTU (ducts/vents) . ( 14.00 1-{ Furnace 100,000+ BTU (ducts/vents) 17.90 Suite/bldg. /apt. no.: Project name: ( ■\ v��/4 Gas heat pump 14.00 Cross street/directions to job site: �Q„ v o ls . %I. a •Ntt, Duct work \ 10.00 1 p \\ Hydronic hot water system 14.00 -'b \ - - It. ._ Q - ' 0 `^ Residential boiler (radiator or hydronic) 14.00 Unit heaters (fuel -type, not electric), • in -wall, in -duct, suspended, etc. 14.00 Subdivision: Lot no.: Flue/vent for any of above 6.80 Other: 10.00 Tax map /parcel no.: Other fuel appliances l 3k `E'.a" C: f' ,r s"+i7.'3i s, a �. °yew pR.�.x,. Water heater 10.00 w Gas fireplace 1, 10.00 \`D - t - - Flue vent for water heater or gas fireplace 10.00 Log lighter (gas) 10.00 Wood/pellet stove 10.00 Wood fireplace/insert 10.00 z "r t . v Chimney/liner /flue/vent 10.00 i,- Y .e ,. a .'i 4 :1: _.,..,, :xl hl.�k , ._._ 6..9 v.. :i � u:^�.r. ;,4',w _.o....>_ 5, � other: 10.00 Name: se_ ■ © � • v •• �� Environmental exhaust and ventilation Address: Range hood/other kitchen - .4 _ • equipment , 10.00 k_� Clothes dryer exhaust • \ 10.00 (� - Single- duct exhaust (bathrooms, Z o Phone: ( ) Fax ( ) toilet compartments, utility rooms) y '6.80 �� ` 4 • ' s Y -''' 1 � z . ?. iti .. m r , '* '^zs Y Attic/crawls ace fans 10 00 `C ` \ ��.... Other: 10.00 Business name: C'� Fuel r t PPnR Contact name: a\--(\cp,,,V Se- ..._ $5.40 for first four; $1.00 for each additional t` Furnace, etc. Address: ° Z � S �, , R. -\�,-.- .� ^ �ci t Gas heat pump City /State /ZIP: . \_a_ �` ..12 .a ft 03 Wall/suspended/unit heater Phone: (53) cc. - ('4"% Fax:: .. ) L \'-� Water heater ©� Range E -mail: ge �`� �� \C.� -•- Ran • ge p;.,. Ti7°' � ; � x rF�i is � s 3."�">F Q?r> � tl 1I �, r ° ^x� � �i "�.'^ -., • a 7Y. `� BaIBarbecue kr.... ..........s ...,.x^.,i'..:C.`"x"i..S by x �.,.x..> i-`ve:'x.'' � ri C.:E?.;:`_. `s.'t ,:..s,��2"- ems....- �:.�...I,.x...w« .`.�.5 Business name: 1" (- -4 t. Q (_(; t/ I 4-71 • / Clothes dryer (gas) Address: Y a � ,� �. Other t ° ;, i , a _ j . LL%L. N V Pl E - N c ��. � i' �a il°t a i d..-,E 1- i' -� .._..._i �"�-yF City /State/ZIP: re-r, o l7 14�`'t Su btotal Minimum permit fee ($72.50) Phone: (5 ) 598 - o F4' . Fax: ( ) Plan review (25% of permit fee) GCB lie.: 5b0 ! „ . State surcharge (8% of permit fee) . TOTAL PERMIT FEE Authorized signature: This permit application expires if a permit is not obtained within 180 days after It has been accepted as complete. Print name: I Date: • Fee methodology set by Tri -County Building Industry Service Board 1:'Building\Permiu4MEC- PermiiApp doe 01/19/07 440 -4617T (11 /02/COM/WEB) 10/04/2007 THU 11:42 [TX /RX NO 53441 10/04/2007 11:52 FAX 5036367183 OHI Construction 00003/0004 4 Plumbing Permit Applicatia,, E CEIV ® . . Building Fixtures • FOR OFFICE tat. ONLY City of Tigard O C T 5 207 Received / D. Review S J Permit No.: l • 4 C ,� 13125' SW Hall Blvd., Tigard, OR 972 Y �¢ `((� Plan Renew � J • � � Phone: 503.639.4171 Fax: 503.59 ,�+. A Date/By: Other Permit No.: • 1 t c \ R 1) Internet: e Inspection Line: 503.639.4175 W l � ®fi 7� ®� www tigard -or gov Date Ready/By: Juris: B See Page 2 for Notified/Method: _ _ • Sbpplementallnformatton -_. �.:i1.... :: 71..., '"L7" d V V � L' {. Alf. 1.4 4:; 4 , ' R a . .r y -. ,, c.,¢R:L49 7 `' r -*�. .. +i - :,b, •fsi, .: s...tt,..� -. " . '' .c .t.. `' y.....3' x a ..'c _ f,-, E `,�, --•.. ` ,.�;;- ......i -:.'.� _._... .? iu Ir .e,, s .:+i is .a'�;..wa.i: ,'ii • ❑ New construction • ❑ Demolition Foe s pec zal i„formasoa use checklist - Description I ❑ Addition/alteration/replacement ❑ Other: -\ C aS •�,/ New 1- 2 famil dwellings (includes 100 ft. or l each utility I cconnection) iZR ai ..�� r ` , L SFR (1) bath 249.20 IC 1- and 2- family dwelling �w. ❑ Commercial/industrial SFR (2) bath • 350.00 ❑ Accessory building ❑ Multi- family SFR (3) bath 1 399.00 ' • ❑Master builder Each additional bath/kitchen V. • 45.00 • y ❑ Other: I xw " + 1 t �1 s p t ,, j °' g `�- Fire sprinkler ( sq. ft.) Page 2 ....... ' ... 7;', ... . ..r,.. '- " >.. -Az. fi x..,ZL . .i,, ,,s,. ., .e u tllltl es Job site address: \�\_..,„. \C3 5 A«se-,S,, , .•.'S.) , / Catch basin or area drain 16.60 City/State/ZIP: - ;Q} . t qZ�� �- Drywell, leach line, or trench drain 16:60 Suite/bldg. /apt. no.: , Project name: k J _r_..,,/ �Q.....„ Footing drain (no. linear ft.: _) Page 2 © Cross street/directions to job site: \ - _ Manufactured home utilities 110.00 V vv S �o Manholes 16.60 -t` " S« `�',„%!\C\ Rain drain connector 16.60 • Sanitary sewer (no. linear ft.: _) Page 2 Storm sewer (no. linear ft.: _, Page 2 Subdivision: I Lot no.: _ Water service (no. linear ft.: ) Page 2 Tax map /parcel no.: Fixture or item " .' �, 7•..,,7 , Absorption valve 16.60 •.. , , = .. � , ' - _ . 1 w . .. � e ^ y a ; _ Backflow preventer P e 2 ��� E Ni ■✓ Backwater valve 16.60 . • Clothes washer I 16.60 . lk VR� '`� Dishwasher t 16.60 �� r .... W . aF ..,: " WNE. t;" r i y <" g r 4 ► - • . ,c ::::tatn ` 16.60 Name: \_....,e. Cq � I �.% , c),_ Expansion tank 16.60 Address: � t r9` Fixture/sewer cap 16.60 City/State/ZIP:'�� �� �+ Floor drain/floor sink/hub 16:60 Phone: ( ) Fax: ( ) Garbage disposal .60 `t ° x .i i t! a x ��c [irk' a, ` 21 .a Hose bib 1b . .__. . � �. .., , � ., � � _ _� Ice maker ` 16.60 `L, Leg....' Business name: p"\, C,o.. -.�� Interceptor /grease trap 16.60 Contact name: ` - D . SS `\33 R' \ ∎ -r-,* •--: & • Medical gas (value: $ ) Page 2 Address: Primer 16.60 City /State /ZIP: ���„ ��) Roof drain (commercial) 16.60 Phone: (3, � z Lo-Z�{ ax; ; ( O -1 Sink/basin/lavatory 16.60 •ga 5 � �� T� s,3 Tub/shower/shower pan 16.60 "a"-P.-.. E -mail: , i S 7 a•\ t..-`i r C� "---� -•-� Urinal 16.60 I, 3 _ _ - _ r " ,r_ , 5 Water closet `-- 16.60 ki Business name: A - i \ (1 Water heater 16.60 Address: d6,9- • 61,A.) 1OQ14 -t� i- -/ ` - Other: City /State/ZIP: L 'L'1• l.L!•� -p.X�� t O/L ?7.19,3 Subtotal Minimum permit fee: $72.50 Phone:•(53 5( 0 9 l .- L a s7 "- Fax: ( ) • Residential backflow minimum permit fee: $36.25 CCB Lie.: it../t1 ? '7 Plumbing Lie. no.: ? t f -4 g? /6 Platy review (25% of permit fee) Authorized signature: State surcharge (8% of permit fee) TOTAL PERMIT FEE Print name: Date: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tri- County Building Industry Service Board. I: U3uilding\Pennus\PLMF- PermitApp doc I2/27/06 440- 46[6T(lo /OZ/COM \ r5 ) 10/04/2007 THU 11:42 [TX /RX NO 5344] 10/04/2007 11:52 FAX 5036367183 OHI Construction [70002 /0004 Electrical Permit Application ` j .; FOR OFFICE SE ONLY -ii , City of Tigard 3 - , ? r °`• Received IN Date/B : - U Permit No.: :� 13125 SW Hall Blvd., Tigard OR 97223 �" 5 1 OU Plan Review • ' y -it — I. Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit: I i ( \ 11,) Inspection Line: 503.639.4175 _I` ii;41- 4 F nail- up.. Ready/By: 0 See Page 2 for Internet www.tigard-or.gov �• ed/Method. I ) b Supplemental B ■• � i�G ®IVISIt� Information ;t_ _ : :z2,... - t ... ..�, ".! .,s..`.,...:...c^a.v..Z:i: a ,us. n ,rl7 . ..- r ; - �: ... i i tk Ja l f 1e � s � j j� .. . .1 �, _ - - .._ ...-t y:e ..: .,.. -w. .:u ... ..z._.w . "' G,. _ :. . ,.s..r .., .:.tx ..._ � ..:a . .. ❑ New construction • ❑ Addition/alteration /replacement Please check all that apply (submit 3 sets of plans iv/items checked below) ❑ Demolition t11er 4 ��� .,- where Service or feeder 400 amps or more ❑ Building over three stories where the available fault current ❑ Marinas and boatyards. ` .ate C' Art w• a C 1 gi £ exceeds 10,000 amps at 150 volts or Cl Floating buildings. � �• .< . , s less to ground or exceeds 14,000 ❑ Commercial - use a G - and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings. agricultural 0 Multi-family ❑ Master builder Fire um ❑Oth ❑ pump. • ❑ Installation of 75 KVA or ,t :l r "'-` ° � _ r 1 s , , . ` i ,r. r i ,} i 1:1 Emergency system- larger separately derived system. ,...z-_ U r, _.L__...,...,,, a.... ._ _ . ,.,• . : _� _._ .:: 3 a . ❑ Addition of new motor load of ❑ "A» "F', `1 -2" "1 -3" Job no.: Job site address: , a �-Q `c .,,,,.s _ 100EP or more. occupancy. la Cs ❑ Six or more residential units. ❑ Recreational vehicle parks. City / State/ZIP: ` . ■,/ , c ( — ❑ Health -care facilities. ❑ Supply voltage for more than C••• ID Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: •© \v�v ■ ❑ Service or feeder 600 amps or more. Cross street/directions to job site: ! - ifi ,: - ''- .� QQ � �� � Ilaatptioa � Qty. Fee. Total New residential single- or multi- family dwelling unit. . \ Or, . • 5��'e.' O t- Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less ......_v 115.15 4 1 F 4 Ea. add'l 500 sq. ft. or portion t 40 — � 1 Tax map /parcel no �U — �+r • +, u. -c,� a �, - - -,r, �, ,� Limited energy, residential' - 7 z 3, , l a - 7 4.4 U iSt. r i k �i ( with above s ft.) 75.00 2 Limited energy, multi - family 7500 2 gion.... residential.(with above sq. ft) • • Services or feeders installation, alteration, and/or relocation 200 amps or less 80:30 2 .. °' t• xx. ' i x . f r 1 r , ` ' 201 amps to 400 amps 106.85 2 MMEIMI■ ‘- ,.. ;^ r.....__ ::, , 7,2::: tl.t4.«.1 . :. .s..r. .4. r ° °'tom . r. �.v... .., _, _ C .w ■ 401 amps to 600 amps 160.60 2 601 amps to 1,000 amps 240.60 2 Address: Over 1,000 amps or volts 454.65 2 City/State/ZIP: —`r`^� "ft " ' Temporary services or feeders installation, alteration, and/or relocation Phone: ( ) • • Fax: ( ) 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 599 amps 133.75 2 O signature: Date: Branch circuits — new, alteration, or extension, per panel R Owner A. Fee for branch.circuits with r. ,,._..: FI c a i � , r5 M .. is t . ..._r � a R k-� _ x, .. N ._..�r., above service or feeder fee, . • 6.65 2 each branch circuit Business name: © , ' • B. Fee for branch circuits • without service or feeder fee, 46.85 <45??X 2 Contact name: \ .-‘3 • first branch circuit Address: \\/..._' _ a., ‘"R-4 1 Each add'l branch circuit Vc 6.65 , 2 q -J) Miscellaneous manufactured r er o r or feeder not included) 0 City / State/ZIP: 9 ��� S�� �� .� ` ` Each manufactured or modular p � dwelling, service and /or feeder 90.90 2 Phone: (S1:2;"3„ —�, —L.02---k c% Fax :: Lc, _ ` % Reconnect only 66.85 2 E -mail: Pump or irrigation circle 53.40 2 u ; , _.. „TV ,. ; , .r C0_! ®3 O ' Iq rte. 1 7E z n Sign or outline lighting 53.40 2 Business name: LAG trig / Signal panel, or limited - energy panel, alteration, or Address: 1 94e5 7 e. 61.-et-ci `✓ C• extension. Describe: Page 2 2 City /State /ZIP: i - ).-1 Od2_. 97 4. Each additional inspection over allowable in any of the above Per Phone: (6)$) 51p 4' -. 777 Fax: (& ) 6e d� Investig ation - $q inspection tig ation on 62.50 per hour (1 hr min) 62.50 CCB Lic.:, 1755 ) Electrical Lie.: f ..• Suprv. Lic.: 6(660 S Industrial plant per hhoour 73.75 r... rrnc _i..._ :_...4. a` .,L -.. -. . ,s!6'awti"` 6 • Suprv. Electrician signature, required: Subtotal: Print name: Da Plan review (25% of permit fee): State surcharge (8% of permit fee): Authorized signature: TOTAL PERMIT, FEE: This permit application expires if a permit is not obtained within 180 Print name: Date: days after it has been accepted as complete. • Number of inspections allowed per permit. I Dui1ding \Permits\ELC- PermitApp.doc 05/23/06 440-4615T01Po5/COM/WEB 10/04/2007 THU 11:42 [TX /RX NO 5344] Er ! CITY OF TIGARD COMMUNITY DEVELOPMENT TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 Plumbing Signature Form RECEIVED IMPORTANT PERMIT NOTIC 0 2001 GITY OF TIGARD REA MECH INC BUILDING DIVISION 30330 SW GRABEL RD. HILLSBORO, OR 97124 Permit #: MST2007 -00195 Date Issued: 10/29/2007 Parcel: 2S104BC-04400 Site Address: 12610 SW ASCENSION DR Subdivision: HILLSHIRE WOODS Lot: 055 Jurisdiction: R -7 Zoning: TIG Project Name: OLVERA Description: Repair fire damage to residence and rear deck. Your company has been indicated as the plumbing contractor for the permit referenced above. In order for the plumbing permit to be valid, please have the appropriate individual from your company sign below and return this Plumbing Signature Form prior to the start of the work. Please mail the form to: City of Tigard, Building Division, 13125 SW Hall Blvd., Tigard, OR 97223, or you may fax the form to: 503.624.3681. If you have any questions please call 503.718.2433. No plumbing inspections will be authorized until this completed form is received OWNER: PLUMBING CONTRACTOR: LETICA OLVERA REA MECH INC 12610 SW ASCENSION DR 30330 SW GRABEL RD. TIGARD, OR 97224 HILLSBORO, OR 97124 Phone #: 971 - 227 -4254 Phone #: 503 - 969 -6252 Reg #: LIC 34908 LIC 148437 PLM 34 -389PB LIC 175531 LIC 50096 AN INK SIGNATURE IS REQUIRED ON THIS FORM X % ,tc2 /e \rY + c 1 .c k I K- Signature of Authorized Plumber Name (printed) CITY OF TIGARD r BUILDING DIVISION PERMIT #: MST2007- OO1t)5 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10129/2007 Phone: (503) 639 -4171 44110 Inspection Requests (24 Hrs.): (503) 639 -4175 :_.. INSPECTION WORKSHEET FOR DATE: 312812008 TIME: 7:01AM PAGE: 16 SITE ADDRESS: 12810 SW ASCENSION DR CLASS OF WORK: SUBDIVISION: HILLSHIRE WOODS LOT #: 065 TYPE OF USE: PROJECT NAME: OLVERA DESCRIPTION: Repair fire damage to residence and rear deck. OWNER: OL.VERA, LETICA PHONE #: 971-227-4254 CONTRACTOR: OREGON HOME IMPROVEMENT CO PHONE #: 5036355248 Inspection Request Scheduled For: Date: 3128/2008 Pour Time: Code # Inspection Description Confirm # Contact # Message 2 9 Final inspection 067600 -02 971..218- 1857 N Corrections/Comments/Instructions: PASS ❑ PARTIAL APPROVAL CANCEL _ ❑ n NO ACCESS FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date: .?-2g-- O a Phone #: (503) 718- . ._, . . CITY OF TIGARD . .. . • , .. BUILDING DIVISION PERMIT #: MST2007-00196 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/29/2007 Phone: (503) 639-4171 hohimpOi & Inspection Requests (24 Hrs.): (503) 639-4175 AJJ. oill. INSPECTION WORKSHEET FOR DATE: 3/27/2008 TIME: 7:03AM PAGE: 16 SITE ADDRESS: 12610 SW ASCENSION DR CLASS OF WORK: SUBDIVISION: HILLSHIRE WOODS LOT #: 055 TYPE OF USE: PROJECT NAME: OLVERA DESCRIPTION: Repair fire damage to residence and rear deck. OWNER: OLVERA, LETICA PHONE #: 971-227-4254 CONTRACTOR: OREGON HOME IMPROVEMENT CO PHONE #: 503 Inspection Request Scheduled For: Date: 3/27/2008 Pour Time: Code # Inspection Description Confirm # Contact # Message . 699 Mechanical final 067439-01 971..219-1867 N Corrections /Comments/ Instructions: X PASS 0 * PARTIAL APPROVAL 0 CANCEL 0 NO ACCESS fl FAIL fl CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED ____ Inspector: Date/ f . • j4 A . Phone #: (503) 718- , ,. ,,. '. � CITY OF TIGARD - �*nm m ��n mn���mnn�� ' '- BUILDING DIVISION PERMIT #: MST2007-00195 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1U/29/2007 Phone: (6O3)633-4171 Inspection Requests (24 Hrs.): (503) 639-4175 -��� " ��� INSPECTION WORKSHEET FOR DATE: 3/27/2008 TIME: 7:03AhA PAGE: 14 SITE ADDRESS: 12610 SW ASCENSION DR CLASS OF WORK: SUBDIVISION: HILLSHIRE WOODS LOT #: 056 TYPE OF USE: PROJECT NAME: OLVERA DESCRIPTION: Repair tire damage to residence and rear deck. OWNER: OLVERA, LETICA PHONE #: 971-227-4254 CONTRACTOR: OREGON HOME IMPROVEMENT CO PHONE #: 6O3'635-6248 Inspection Request Scheduled For: Date: 9/27/2008 Pour Time: . I Code # Inspection Description Confirm # Contact # Message v ~* 153 Electrical U6T4�:/D1 �O�7���b�7 Y l ' -'J � ' '� ' h, Corrections/Comments/Instructions: �� � . ° 1 . V I \ PASS [1 rl PARTIAL APPROVAL CANCEL n NO ACCESS FAIL CALL FOR INSPECTION __ AOO|TiONALFEE8ASSESSEO *~r' � v Inspector: ' ' u� Phone #: (503) 718- ._ ' , . . .. . . • . CITY OF TIGARD . .. , . BUILDING DIVISION PERMIT #: MST2007-00 195 13125 SW Hall Blvd., Tigard, OR 97223 • • DATE ISSUED: 10/29/201)7 Phone: (503) 639-4171 4 /41041111 1 ` Inspection Requests (24 Hrs.): (503) 639-4175 - U.. INSPECTION WORKSHEET FOR DATE: 1/15/2008 TIME: 7:02AM PAGE: 16 --__ • ...,,,t,--..._ SITE ADDRESS: 12610 SW ASCENSION DR CLASS OF WORK: SUBDIVISION: HILLSHIRE WOODS LOT #: 055 TYPE OF USE: PROJECT NAME: OLVERA DESCRIPTION: Repair hie damage to residence and rear deck. OWNER: OLVERA, I..ETICA PHONE #: 971-227-4254 CONTRACTOR: OREGON HOME IMPROVEMENT CO PHONE #: 503-635-248 Inspection Request Scheduled For: " Date: 1/15/2008 Pour Time: Code # Inspection Description Confirm # (--- • . Contact # Message 120 Electrical rough-in L- 063248-01 503-780-8597 N y Corrections/Comments/Instructions: o •-- j ' \ - Q. - 2 (3- 6u 6 'Mk F Nkl s. j:ZIPASS 7 PARTIAL APPROVAL n CANCEL ET NO ACCESS ThF 7 CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED Inspector: .--- 1081.-6" Date: 1-16 01. Phone #: (503) 718- 2.4%. CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2007- 0(}195 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/29/2007 Phone: (503) 639- 4171�m +� Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 1/14/2008 TIME: 7:04AM PAGE: 20 SITE ADDRESS: 12610 SW ASCENSION DR CLASS OF WORK: SUBDIVISION: HILLSHIRE WOODS LOT #: 055 TYPE OF USE: PROJECT NAME: OLVERA DESCRIPTION: Repair fire damage to residence and rear deck. OWNER: OLVERA, LETICA PHONE #: 971- 727 -4254 CONTRACTOR: OREGON HOME IMRROVEMEW CO PHONE #: 503.635-6248 Inspection Request Scheduled For: Date: 1/14/2008 Pour Time: •ode # Inspection De . ••tion C f rm Contact # Message 120 Electrical rough -in 063158-01 503. 780.8597 Y Correc • - _ - - s •ons: 4 ..o c i o 8 A PASS ❑ PARTIAL APPROVAL ❑ CANCEL NO ACCESS FAIL CALL FOR INSPECTION fl ADDITIONAL FEES ASSESSED Inspector: Gm N 6 6 L E Date: "1 Phone #: (503) 718- 1j41# ; LN 141 0 \ ' , \ 111111 / ,i ' ' \ \ / hi / / 1 Ha ill ON Pil 1 0 .1 1 i ll 1 \ 0 \ \ I i II li Dr il II _ \ oil 1 HO \ r --,-, 7 — ; ---- r l'I 1111 0 ...x,0 HI I I , Iii mi •4110" . 1 - xi - ,..,_ m 1 4- - ------. 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BUILDING DIVISION 406110 , PERMIT #: MST2007-00i95 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1W29/2007 Phone: (503) 639-4171 i ihnsiim il lit- Inspection Requests (24 Hrs.): (503) 639-4175 l ‘ ,.,_,W0- ' - ..... INSPECTION WORKSHEET FOR DATE: 1/23/2008 TIME: 7:QOAM PAGE: 25 SITE ADDRESS: i 2810 SW ASCENSION DR CLASS OF WORK: SUBDIVISION: HILLSHIRE WOODS LOT #: Q TYPE OF USE: PROJECT NAME: OLVERA DESCRIPTION: Repair fire, damage to residence and rear deck OWNER: OLVERA, LETICA PHONE #: 971-227-4254 CONTRACTOR: OREGON HOME IMPROVEMENT CO PHONE #: 503-635-6248 Inspection Request Scheduled For: Date: 10312008 Pour. Time: Code # Inspection Description Confirm # Contact # Message 260 Insulation 063710-01 971-219-1657 N Corrections/Comments/Instructions: „dip ,,w7444,1„ , \—,,,,..... ..... ,‹. - ra,252e— - 11 743 - )7" . <= 1 44 _, ---.__ _ -.- ,- _.....,-:-.-- - _---- --1 S ' PARTIAL APPROVAL 0 CANCEL I I NO ACCESS I I FAIL CALL FOR INSPECTION / I I ADDITIONAL FEES ASSESSED , / / Inspector: / -.7 Date: / t..,Y--C7 e.„ Phone #: (503) 718- CITY OF TIGARD . , . BUILDING DIVISION PERMIT #: IvI5T2007-00195 D ATE 13125 SW Hall Blvd., Tigard, OR 97223 E ISSUED: 10/29/2007 Phone: (503) 639-4171 . a &v , 411101 A Inspection Requests (24 Hrs.): (503) 639-4175 :.,g,JJ.- 111. INSPECTION WORKSHEET FOR DATE: •/10/2008 TIME: 7:02AM PAGE: 64 SITE ADDRESS: 12610 SW ASCENSION DR CLASS OF WORK: SUBDIVISION: HILLSHIRE WOODS LOT #: 055 TYPE OF USE: PROJECT NAME: OLVERA DESCRIPTION: Repair fire damage to residence and rear deck. OWNER: OLVERA, LETICA PHONE #: 971-227-4254 CONTRACTOR: OREGON HOME IMPROVEMENT CO PHONE #: 503-635-6248 Inspection Request Scheduled For: Date: 1/1812008 Pour Time: Code # Inspection Description onfirm # Contact # Message 275 Framing 063487-01 971..219-1857 N Corrections /Comments/ Instructions: . • • ASS E PARTI A,' APPR•r• 440 0 CANCEL fl NO ACCESS FAIL I liC,' O " ' 4 ,:: i ri ADDIT NAL FE ASSESSED (503) 71: -l i g.- Inspector: . Arj ' j ' Date: Phone #: . CITY �����~��������� , . ' �wmm n *.�n mo�m�mom�� � • BUILDING DIVISION ` PERMIT #: AHST2007 0Ul8G | 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/39/2007 Phone: (503) 639-4171 4 Inspection Requests (24 Hrs.): (503) 639-4175 .4191 112. INSPECTION WORKSHEET FOR DATE: 1/11/2008 TIME: 7:01AkA PAGE: 63 SITE ADDRESS: 13G10SVY ASCENSION DR CLASS OF WORK: SUBDIVISION: H|LLSHIREWAACS LOT #: 055 TYPE OF USE: PROJECT NAME: ()LVERA DESCRIPTION: Repair tire damage to recidnce and rear deck. OWNER: OLVERA.LEDCA PHONE #: 971-227'4254 CONTRACTOR: OREGON HOME IMPROVEMENT CO PHONE #: 503-635-6348 / Inspection Request Scheduled For: Date: 1/11/2'Q08 Pour Time: Code # Inspection Description Confirm # Contact # Message 610 Gas line 063011'01 971'219-1867 N Corrections/Comments/Instructions: ^ I I PARTIAL APPROVAL El CANCEL ri NO ACCESS 7 FAIL 0 CALL FOR INSPECTION | | ADDITIONAL FEES ASSESSED Inspector: ^ �i~� l Date: /-17--4,g, Phone #: (503) 718- ?-9-46 CITY OF TIGARD . BUILDING DIVISION PERMIT #: MST2007- 0019& 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/230007 Phone: (503) 639 -4171 irtli i l ' Inspection Requests (24 Hrs.): (503) 639 -4175 __,. INSPECTION WORKSHEET FOR DATE: 1/11/2008 TIME: 7:01AM PAGE: 62 SITE ADDRESS: 12610 SW ASCENSION DR CLASS OF WORK: SUBDIVISION: HIL SHIRF WOODS LOT #: 065 TYPE OF USE: PROJECT NAME: OLVERA DESCRIPTION: Repair fire damage to residence and rear deck. OWNER: OLVERA, LETICA PHONE #: 871- 227 -4251 CONTRACTOR: OREGON HOME IMPROVEMENT CO PHONE #: x,03 -$35-6248 Inspection Request Scheduled For: Date: 1/11/2008 Pour Time: Code # Inspection Description Confirm # Contact # Message Cis Mechanical rough-in 063011 -02 871 -219. 1857 N Corrections/Comments/Instructions: �� _ftr"�i nl� /110 " !"E -S -LLc/9 � 10/ -4 �l'Gi l L - 4 ' PASS I I PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS FAIL ,/j CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED Al Inspector: 4/ Date:/--//— d2, Phone #: (503) 718 - <'" - CITY OF TIGARD • .. BUILDING DIVISION PERMIT #: MST2007-00195 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/29/2007 Phone: (503) 639-4171 A. Inspection Requests (24 Hrs.): (503) 639-4175 INSPECTION WORKSHEET WORKSHEET FOR DATE: 1/9/2008 TIME: 701A1v1 PAGE: 46 SITE ADDRESS: 12610 SW ASCENSION DR CLASS OF WORK: SUBDIVISION: HILLSHIRE WOODS LOT #: 056 TYPE OF USE: PROJECT NAME: OLVERA DESCRIPTION: Repair fire damage to residence and rear deck. - OWNER: OLVERA, LETICA PHONE #: 971-227-42fA CONTRACTOR: oRFGON HOME IMPROVEMENT CO PHONE #: 503-635-6248 Inspection Request Scheduled For: Date: 1/9/2008 Pour Time: Code # Inspection Description Confirm # Contact # Message 615 Mechanical rough-in 062790-02 971-219-1857 Y Corrections/Comments/Instructions: - AP "tiestz— 0 PASS n PARTIAL APPROVAL 0 CANCEL 0 NO ACCESS I CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED Inspector: ..94 Date: /— '-' 41 2 % . Phone #: (503) 718- . .... , . . ' CITY ������N�������� ��n n n OF mm���mnm�� ' '' . . ' BUILDING DIVISION PERMIT #: MST200cO0188 13125SVV Hall 8|vd.. Tigard, ORO7223 DATE ISSUED: 10/29/2007 Phone: (503) 639-4171 AM Inspection Requests (24 Hrs.): (503) 639-4175 .,.„...I. IL. INSPECTION WORKSHEET FOR DATE: 1/6y2OO8 TIME: 7:01AK8 PAGE: 47 SITE ADDRESS: 12610 SW ASCENSION DR CLASS OF WORK: SUBDIVISION: M|LLSM|RE LOT #: 056 TYPE OF USE: PROJECT NAME: OLVERA DESCRIPTION: Repair tire damage iooeid*noe and rear deck. OWNER: OLVERA, LETICA PHONE #: 971-227-4251 CONTRACTOR: OREGON HOME IMPROVEMENT CO PHONE #: 503-635-6248 Inspection Request Scheduled For: Date: 1/902008 Pour Time: Code # Inspection Description Confirm # Contact # Message 610 Gas line 082790'01 971'219'1867 N Corrections/Comments/Instructions: Al _^ _ El PASS.—fl PARTIAL APPROVAL 0 CANCEL LIII NO ACCESS | 'CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED Inspector: /' 0�0,1 \ Date: ----9---C: Phone #: (503) 718- CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2007-00196 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/29/2007 Phone: (503) 639-4171 /A 7/pittili?' Inspection Requests (24 Hrs.): (503) 639-4175 INSPECTION WORKSHEET FOR DATE: 3/28/2008 TIME: 7:01AM PAGE: 17 SITE ADDRESS: 12610 SW ASCENSION DR CLASS OF WORK: SUBDIVISION: HILLSHIRE WOODS LOT #: 056 TYPE OF USE: PROJECT NAME: OLVERA DESCRIPTION: Repair the damage to residence and rear deck. OWNER: OLVERA, LETICA PHONE #: 971-227-4254 CONTRACTOR: OREGON HOME IMPROVEMENT CO PHONE #: 503-635-6248 Inspection Request Scheduled For: Date: 3/28/2008 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 Plumbing final 067500-01 971-219-1867 N Corrections /Comments/ Instructions: • . X PASS El PARTIAL APPROVAL 0 CANCEL n NO ACCESS I I FAIL 0 CALL FOR INSPECTION ID ADDITIONAL FEES ASSESSED Inspector: 06144 Date: _3_12r/ OT Phone #: (503) 718- - - • CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2007-00 195 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1W29/2007 Phone: (503) 639-4171 Inspection Requests (24 Hrs.): (503) 639-4175 INSPECTION WORKSHEET FOR DATE: 12128/2007 TIME: 7:00AM PAGE: 68 SITE ADDRESS: 12610 SW ASCENSION DR CLASS OF WORK: SUBDIVISION: HILLSHIRF WOODS LOT #: 055 TYPE OF USE: PROJECT NAME: OLVERA DESCRIPTION: Repair fire damage to residence and rear deck. OWNER: OLVERA, LET1CA PHONE #: 971-227-4254 CONTRACTOR: OREGON HOME IMPROVEMENT CO PHONE #: 503-635-6248 Inspection Request Scheduled For: Date: 1212E0007 Pour Time: Code # Inspection Description Confirm # Contact # Message 320 Plumbing rough-in 062237-01 971-219-1857 Corrections/Comments/Instructions: to 6 LAJe.J-c/ Ct•o.r-A`. F ext,t/ L 4 -- \ ( 3 - C M\ L/\ " F - 1 1 1 L,-(41( • X PASS Li PARTIAL APPROVAL El CANCEL El NO ACCESS I FAIL Li CALL FOR INSPECTION LI ADDITIONAL FEES ASSESSED A Inspector: 07) '1 Date: 12zZ4z Phone #: (503) 718-