Permit K CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2005 -00079
j i b DEVELOPMENT SERVICES DATE ISSUED: 4/7/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S112CD RM005
SITE ADDRESS: 07952 SW CAROL ANN CT ZONING: R -12
SUBDIVISION: REBECCA MEADOWS LOT: 005 JURISDICTION: TIG
Project Description: New SF detached
BUILDING
REISSUE: PH24 -030 STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 23 FIRST: 666 sf BASEMENT: sf LEFT: 4 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,024 sf GARAGE: 231 sf FRONT: 15 PARKING SPACES : 2
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: 5
VALUE: 162,577.70
OCCUPANCY GRP: R3 BDRM: 3 BATH: 3 TOTAL: 1,693 sf REAR: 15
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: 4 CLOTHES DRYER: 1
GAS FURN > =100K: UNIT HEATERS: HOODS: 1 OTHER UNITS: 1
MAX INP: btu FLOOR FURNANCES: VENTS: 1 W00DSTOVES: GAS OUTLETS: 4
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 & STEREO: VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM /PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: ALL - ENCOMP 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 Tigard
Owner: Contractor: Municipal Code, State of OR. Specialty Codes and all other
KEYSTONE DEVELOPMENT INC KEYSTONE DEVELOPMENT INC. applicable laws. All work will be done in accordance with approved
PO BOX 476 PO BOX 476 plans. This permit will expire if work is not started within 180 days
LAKE OSWEGO, OR 97034 LAKE OSWEGO, OR 97034 of issuance, or 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 questions to OUNC by calling 503 - 246 -6699
Phone: 503- 635 -4736 Phone: 503- 635 -4736 or 1 -800- 332 -2344.
Reg #: LIC 71135
TOTAL FEES: $ 8,826.12
REQUIRED ITEMS AND REPORTS
Ersn Cntrl 681 -4444
�– ,
Issued By : Permittee Signature : / Gam' ` 17
� � f.�L�:�Cif.� g
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that b siness d -, .
This permit card shall be kept in a conspicuous place on the job site u om •) • tion of the project.
Approved plans are required on the job site at the time of each inspection.
RECEIVED �;
Buildin Permit Application ��- PU n , :� TOR OFFICE USEONLY ,.'
City Of Tigard B 102005 Received., / � _ �j
Date/BY: ,) / 0 0 L J g PermitNo :9 „....00674/
13125 SW Hall Blvd., Tigard OR '97223 Plan Revie � p�`r
Phone: 501639.4171 Fai:: 503598.l9$Q,TY it*i s`�'fl' Date/BY: 7 — Q} 1 I. V/ Other PermieW -005 74-
Inspection Line: 503.639.4175 BUILDING DIVISIOF' ILL, Date Ready /By: 7 Jr See Attached Checklist tin www.ci.tigard.or.us Notified/Method: ` Q�' I ( Supplemental Information
J
PI 4-Z� W�� \\\,-, . TYPE OF • WORK ' . - REQUIRED .DATA: 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/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
" - CATEGORY CONSTRUCTION work indicated on this application.
f( I- and 2- family dwelling ❑ Commercial /industrial
Valuation: $
❑ Accessory building ❑ Multi- family Number of bedrooms: 3
❑ Master builder ❑ Other: Number of bathrooms: 2 111,
- .JOB SITE INFORMATION AND LOCATION Total number of floors: 2
Job site address: 7q5 �— 5(0 GA ?DI- .ANN G I • New dwelling area: I ( /5 square feet
City / State/ZIP: TIC 9 t OP- 617223 Garage /carport area: 2Q) ( square feet
Suite/bldg. /apt. no.: Project name: Covered porch area: /� square feet
Cross street/directions to job site: M CO- N f.,?.... Clf w 141M 11 P) glioltA Deck area: square feet
Other structure area: square feet
,...• REQUIRED DATA COMMERCIAL -USE CHECKLIST
Subdivision: g ofAccw5 i Lot no.: Permit fees* are based on the value of the work performed.
5 j� y ,�� �� Indicate the value (rounded to the nearest dollar) of all
Tax map /parcel no.: 2 � (2CP / e Lo I _ equipment, materials, labor, overhead, and the profit for the
DESCRIPTION OF WORK work indicated on this application.
N 1 ?:11.1 s FP- ORTAC; eP Valuation: $
Existing building area: square feet
New building area: • square feet
. PR OPERT OWNER ` 0 TENANT:: Number of stories:
Name: ST'O N E r-) NI 1r1 1 NG Type of construction:
Address: PQiOX zr �D Occupancy groups:
City/State/ZIP: - ( ! OSVJ .6'O 0 - 91
Existing:
Phone: (Gb3) (,33 S -Qi' (p Fax: ( ) &Tq — 17 k ,
1 New:
3 "CONTACT PERSON -
NOT ..
Business name: 1/.4} c 0 pe_ ()esU p
i M t All contractors and subcontractors are required to be
Contact name: Po 60 WANKS ?L'- licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: LAM (x WT I Of- 91 D4 jurisdiction in which work is being performed. If the
City/ State/ZIP: applicant is exempt from licensing, the following reasons
apply:
Phone: ( ) 4MR-- Fax: : ( ) Sj .R-
E -mail: J ?D1.Y =-3 ( Co( ST. On
. � • CONTRACTOR;:: .
Business name: V.-P{ (JE, D vV.4.O M i C BUILDING PERMIT FEES *
Address: r C Ac / °' 1 ' l IN
City/State/ZIP: Please refer to fee schedule.
Phone: ( ) Fax: Fees due upon application
( )
CCB Iic.: 1( (� Amount received
Date 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: - g N ?OtM - Date: 3 1,01 D * Fee methodology set by Tri- County Building Industry
Service Board.
ILIFcPR/Fr)
Mechanical PermitA nlication -, , • . , .
• Toil OFFICEISE °ONLY
- . , . .
City Of Tigard e Received
Date/By: Permit Nofk5^ - 0
1 0 062/Y
13125 SW Hall Blvd., Tigard, OR MR 20U5 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Azt, titho I A Date/13y: Other Permit:
Inspection Line 503 CITY OF TIGARD 411 Date Ready/By: Juris: 121 See Page 2 for
'nternet: www.ci.tigard.or.us BUILDING DIVISION Notified/Method: Supplemental Inform n atio
•
-• COMMERCIAL .FEE* SCHEDULE - USE CHECKLIST
. , .
Mechanical permit fees* are based on the value of the work
O.:New construction 0 Addition/alteration/replacement
performed. Indicate the value (rounded to the nearest dollar) of all
0 Demolition 0 Other: mechanical materials, equipment, labor, overhead, and profit.
' : '.., • . '•:., . :,„_: :: : -, CATEGORY: OF CONSTRUCTION :, : : _ - :- : : , Value: $
RESIDENTIAE.EQUIPMENT / SYSTEMS FEES*
* - and 2-family dwelling 0 Commercial/industrial 0 Accessory building
For special information use checklist.
0 Multi-family 0 Master builder 0 Other:
Description I Qty. I Ea. I Total
- • -.
JOB SITE . INFORMATION • AND LOCATION . . Heating/cooling
Job site addresi:71 g.-- . c-Ap-o I,- AO t4 cj• Air conditioning or heat pump
(requires site plan showing placement) 14.00
City/State/ZIP: T1 &4 2 -0 1 e* 11 /1-11, Furnace 100,000 BTU (ducts/vents) 14.00
Furnace 100,000+ BTU (ducts/vents) 17.90
Suite/bldg./apt. no.: Project name: g.55ECCA KS S
Gas heat pump 14.00
Cross street/directions to job site: (),) D 1 1 111)0 Duct work 14.00
Hydronic hot water system 14.00
00 S u-3 CA1-0 1, A 13 CT-, Residential boiler (radiator or
.
hydronic) 14.00
Unit heaters (fuel-type, not electric),
in-wall, in-duct, suspended, etc. 10.00
Subdivision: fLebf...C-e--'A A/FACWS Lot no.:
L
Flue/vent for any of above
10.00
Other: 10.00 1
Tax map/parcel no.: Other fuel appliances
Water heater 10.00
;:::':::: : - :: ':!' - •=-:.,-'' ' : :7 :i` ,. .•.: '
DESCRIPTION OF WORK: : . :' " - . • '' '' ' ''
Gas fireplace
N eA)) S 1 - P eerACk‘e,11) Flue vent for water heater or gas 10.00
fireplace 10.00
Log lighter (gas) 10_00
Wood/pellet stove 10.00
Wood fireplace/insert 10.00
..-- - Chimney/liner/flue/vent 10.00
IEPTOrgkij :::;. : :::::::;';',- - •:: 0' TENANT ' ::: 2 ..:7 . .. Other: 10.00
Name: K E. IDOAIRWelv)s IN1C, Environmental exhaust and ventilation
Address: PO 602 1 4=1 to Range hood/other kitchen
equipment 10.00
A _.
City/State/ZIP: Lity_.€, osvie.50 I OF- 11 Obi' Clothes dryer exhaust 10.00
Single-duct exhaust (bathrooms,
Phone: (.9)5 ) (03 6 - unu, Fax: ( 51'6 ) ( I --11 LH toilet compartments, utility rooms) 6.80
II: •/..,'''" $1.: i ';'; :11 --. 0 CONTACT PERSON - •.:.: . Attic/crawlspace fans 10.00
Other: 10.00
Business name: K 13 E., pF, E of:0T 1 . 1\)
‘ C.
Fuel piping
Contact name: I 1'0 WW-- $5.40 for first four; $1.00 for each additional
Furnace etc.
Address: ,e,(\ne, As "(6N ,F...
Gas heat pump
City/State/ZIP: I' 11 Wall/suspended/unit heater
Phone: ( ) I\ II Fax: : ( ) Water heater
Fireplace
E-mail: i Po AK3 @, tovv-Ascr . NV"" Range
CONTRACTOR Barbecue
Clothes dryer (gas)
Business name: 77J 6. ch..a-y -.7
Other:
Address:
.• . -:. '!, .MECHANICAL PERMIT FEES*
‘ . ..,
City/State/ZIP: ahet_ ( G 2_ . .: , Subtotal
_
Minimum permit fee ($72.50)
''one: (S) ,c5 22.20 Fax: ( )
Plan review (25% of permit fee)
...213 lic.: State surcharge (8% of permit fee)
TOTAL PERMIT FEE
if a permit is not obtained within 180 has been accepted as complete.
Authorized ' a :
Print name
...-{ _29 I Date:, e -7-0...,r- This permit application e
days after it
• Fee methodology set by Tri-County Building Industry Service Board
R lo EOVE
Pl> robin Permit Apphca n FOR OFFICE USE` ONLY `
MAR _
ye . _
City of Tigard MAR 1 0 2005 Received Permit N
13125 SW Hall Blvd., Tigard, OR 97223
Date/13y: rm No.: 5 1 °OC75
Plan Review
Phone: 503.639.4171 Fax: 503.598.19 /tika Date/By: Other Permit No.:
ITY OF TIGAR
24- Flour Inspection Line: 503.639.4175 s ( c.. W Date Ready /By: Jura: See Page 2 for
Internet: www.ct.tigard.or.us BUILDING DIVISI - Ready/By: ®
Notified/Method: Supplemental Information
TYPE OF -WORK FEE* SCHEDULE
For special information use checklist.
I:New construction ❑ Demolition
Description I Qty. I Ea. I Total
❑ Addition/alteration/replacement ❑ Other: New I- 2- family dwellings (includes 100 ft. for each utility connection
.CATEGORY OF CONSTRUCTION: SFR (1) bath 249.20
01- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other:
Fire sprinkler ( sq. ft.) Page 2
°.JOB SITE' INFORMATION AND; LOCATION. Site utilities
Job site address ---n5y 5 co cm-DL.... A C"r. Catch basin or area drain 16.60
City/ State/ZIP: -1- A. I (7.. cvl ')-23 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: Footing drain (no. linear ft.: ) Page 2
P J ` Manufactured home utilities 110.00
Cross street/directions to job site: S N'�� ` 1 r Manholes 16.60
dJJ S 0L ,P NN CT. . Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: p_.0.15 a M ot} ',S Lot no.: 6) Water service (no. linear ft.: ) Page 2 •
Fixture or item
Tax map /parcel no.:
valve
Absorption 16 GO
DESCRIPTION OF` WORK Backflow preventer Page 2
Neo3 SfF- - f)1 7'1 e-2 Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
16.60
`. ' 'i. : -, ; f PROPERTY ' p� , ,l r
OCtlE''�E v E&;OPT. • E /sump 16.60
Name: p 0. Box 476 Expansion tank 16.60
Address: Lake Oswegg, OR 97034 Fixture/sewer cap 16.60
City/ State/ZIP: Floor drain /floor sink/hub 16.60
Phone: ( ) &5 - 1 Fax: (5 99 _ -' - t..} I Garbage disposal 16.60
° 7*APPLICANT' ; 0. CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: KEYSTONE DEVELOPMENT Interceptor /grease trap 16.60
Contact name: P. Box 476 Medical gas (value: $ ) Page 2
Address: Lake Oswego, OR 97034 Primer
16.60
City/State/ZIP: Roof drain (commercial) 16.60
Phone: Sink/basin/lavatory 16.60
( ) ./(W%-lt.. Fax: ( ) Ste- Tub /shower /shower pan 16.60
E -mail: .S lot-A1-3 Q 'r+ Nel" Urinal 16.60
CONTRACTOR , : ; Water closet 16.60 •
Business name: /0r. we /Q'P.J mer P /vr►m bl Water heater 16.60
Address: p0 i_W x333 Other:
City/ State/ZIP: p apps o k q lag j Subtotal
�J � Minimum permit fee: $72.50
Phone: (5a3) 47,22 L1 - 0.5-62 Fax: (3 3) a7,2-05 b 2- Residential backflow minimum permit fee: $36.25
'CB Lic.: / 35 o , Plumbing Lic. no.: 3.9-35/643 Plan review (25% of permit fee)
� State surcharge (8% of permit fee)
Authorized signature: /� TOTAL PERMIT FEE
Print name: in, C h P Ma A 4' //p �- Date:48765 This permit application expires if a permit is not obtained within
C 180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
mil vire:uob kYJ: i biLIJIS2bypre rff L1C11-1 [HOUSE ELECTRIC PAGE 01
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......-----.. . ...—...........-..____,.....__ . --...,._
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— . - - - " [ Miaow to 400 4r4n
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; riteadec foi sole. teats, rant, et excharip, ttecordln to ORS 447, 4.0, el°, rald 10) 41 am t 600
_
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i ,-..,,,•str.r,ZIP: lijaS it.2e,, ; Iti‘esttotasn ;Jet hoc. •Ti Iv Oilki , 62 .5.3
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- --, . , - fiLiCTIUCAL PERMIT MS* • I
::E 1. • ' Blact. . • • S IT ic - )---........
:-.-------..1-5-4-17-9.1---- ' - ..3 i Sv'ototai :
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—...............----...----.1
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TOTAL FERMIT i r , ICE I i
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land use and development standards for street tree installation.
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CITY OF TIGARD
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BUILDING DIVISION .
PERMIT #: Kim
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/7/2005
Phone: (503) 639-4171 40 /01iiitt
Inspection Requests (24 Hrs.): (503) 639-4175 „-.41P' '-‘—
INSPECTION WORKSHEET FOR DATE: a(12/2005 TIME: 7:06AM PAGE: 71
SITE ADDRESS: 07952 SW CAROL ANN CT CLASS OF WORK:
SUBDIVISION: REBECCA MEADOW, LOT #: 005 TYPE OF USE:
PROJECT NAME: REBECCA MEADOWS
DESCRIPTION: New SF detached
OWNER: KEYSTONE DEVELOPMENT INC, PHONE #: 503-635-4736
CONTRACTOR: KEYSTONE DEVELOPMENT INC. PHONE #: 503.635-4736
Inspection Request Scheduled For: Date: fill 212006 Pour Time:
Code # Inspection Description • Confirm # Contact # Message
299 Final inspection 013396-01 603-704-9506 N
Corrections/Comments/Instructions:
EIZOS/01V
117 1 - - , ( 71. '1 --- - Ma: 3
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p*ASS m PARTIAL APPROVAL El CANCEL 0 NO ACCESS
lAzr-A-I.L-- II ''ALL FOR INSPECTION
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' -411111gillabo 111 ADDITIONAL FEES ASSESSED
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Inspector: ■ Date: 8 iz ' (-- Phone #: (503) 718-
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CITY OF TIGARD
BUILDING DIVISION PERMIT #: MST2005 -00079
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/7/2005
Phone: (503) 639 -4171 iA gH�b�iullN���'�
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 9/12/2005 TIME: 7 :06AM PAGE: 72
SITE ADDRESS: 07952 SW CAROL ANN CT CLASS OF WORK:
SUBDIVISION: REBECCA MEADOWS LOT #: 005 TYPE OF USE:
PROJECT NAME: REBECCA MEADOWS
DESCRIPTION: New SF detached
OWNER: KEYSTONE DEVELOPMENT INC, PHONE #: 503 - 6354736
CONTRACTOR: KEYSTONE DEVELOPMENT INC. PHONE #: 503 -- 635.4736
Inspection Request Scheduled For: Date: 8/12/20055 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 013936 -05 503.704 - 9505 N
Corrections /Comments /Instructions:
ASS "ARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
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Inspector Date: /Z� .� Phone #: (503) 718 -
CITY OF TIGARD. P _
BUILDING DIVISION PERMIT #: MST2005 -00079
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 4/7/2005
Phone: (503) 639 -4171 11 � 1 ?�
Inspection Requests (24 Hrs.): (503) 639 - 4175!.1
INSPECTION WORKSHEET FOR DATE: 8/9/2005 TIME: 7 :05AM PAGE: 87
SITE ADDRESS: 07952 SW CAROL ANN CT CLASS OF WORK:
SUBDIVISION: REBECCA MEADOWS LOT #: 005 TYPE OF USE:
PROJECT NAME: REBECCA MEADOWS
DESCRIPTION: New SF d
OWNER: KEYSTONE DEVELOPMENT INC, PHONE #: 503.635 -4730
CONTRACTOR: KEYSTONE DEVELOPMENT INC. PHONE #: 503-635-4736
Inspection Request Scheduled For: Date: 8/9/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 013114 -01 503 - 704 -9505 N
Corrections /Comments /Instructions: •
•
<PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED i
Inspector: it71., Date: / Phone #: (503) 718- {
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CITY OF TIGARD .
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BUILDING DIVISION
DATEPEISRSMUITED#:: 4177/1-220°0°55-00°79
13125 SW Hall Blvd., Tigard, OR 97223
Phone: (503) 639-4171 J.
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Inspection Requests (24 Hrs.): (503) 639-4175 --_-_-0- ----.
INSPECTION WORKSHEET FOR DATE: 13/3/2005 TIME: 7:06AM PAGE: 29
SITE ADDRESS: 07962 SW CAROL ANN CT CLASS OF WORK:
SUBDIVISION: REBECCA MEADOWS LOT #: 005 TYPE OF USE:
PROJECT NAME: REBECCA MEADOWS
DESCRIPTION: New SF detached
OWNER: KEYSTONE DEVELOPMENT INC, PHONE #: 503_6364736
CONTRACTOR: KEYSTONE DEVELOPMENT INC. PHONE #: 503-635-4736
Inspection Request Scheduled For: Date: 8/3/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 012714-02 503-698-9600 N
Corrections/Comments/Instructions:
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ASS pi PA •TIAL APPROVAL Ej CANCEL fl NO ACCESS
E FAIL 0 '.ALL FOR INP!,;:. CTION D ADDITIONAL FEES ASSESSED
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Date:
Inspector: i , 31 6 Phone #: (503) 71