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Permit CITY OF TIGARD MASTER PERMIT PERMIT #: MST2005 -00356 ,.1 DEVELOPMENT SERVICES DATE ISSUED: 11/9/2005 ai lijk ` 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S 115AD -04200 SITE ADDRESS: 10823 SW DOVER CT ZONING: R -2 SUBDIVISION: DOVER LANDING LOT: 025 JURISDICTION: TIG Project Description: Addition. C BUILDING REISSUE' CUSTOM / k)‘(9 STORIES• 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK:)Ir<\N HEIGHT: 11 FIRST: 154 sf BASEMENT' sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD' 40 SECOND: sf GARAGE. sf FRONT: PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS' TWO sf RIGHT. 5 VALUE: 14 60 OCCUPANCY GRP: R3 BDRM: BATH: TOTAL. 154 sf REAR: 15 PLUMBING SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS. RAIN DRAIN: 100 TRAPS LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: 1 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: UNK 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 SVC/FDR: 1 SIGN /OUT LIN LT: PER HOUR' LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp. EA ADDL BR CIR: I 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 # SYSTEMS: This permit is subject to the regulations contained in the Owner: Contractor: Tigard Municipal Code, State of OR Specialty Codes LIN DA & ARR FINTZY T & H CONSTRUCTION & and all other applicable laws All work will be done in 10823 SW DOVER CT DEVELOPMENT accordance with approved plans. This permit will expire TIGARD, OR 97224 SIMHONI COHEN if work is not started within 180 days of issuance, or if the 21611 S CLEARVIEW CT work is suspended for more than 180 days OREGON CITY, OR 97045 ATTENTION. Oregon law requires you to follow rules Phone: 503 684 - 6129 Phone: 503 309 - 1819 adopted by the Oregon Utility Notification Center Those rules are set forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You may obtain copies of these rules or Reg #: LIC 92846 direct questions to OUNC by calling 503 - 246 -6699 or TOTAL FEES: $ 493.13 1 - 800 - 332 - 2344. REQUIRED ITEMS AND REPORTS t / , Issued By : �� r >,e Permittee Signa j r : , .�.. L .�. 1—..r... Call 503 - 639 -4175 by 7:00 a.m. for an inspecti •n` at b iness day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Building Permit Application ' r F �\ , ° FOR OFFICE USE ONLY • City of Tigard ■ GO Received , _/ permit No. 13125 SW Hall Blvd, Tigard, OR 97223 t Date Revi/w� t 7 iip/ �� Phone: 503 639 4171 Fax 503.598.1960 QCi 200 ' Ir Date/By. MA r U- - �j Other Permit Inspection Line: 503.639.4175 ' " 1 Date Ready/By. i is 0 See Attached Checklist for Internet• www ci.tigard.or.us �� / Notified/Method ' i < io I Supplemental Information GM( OV TYPELB . k • ' K . -'i ,REQ ,f` 1 1 ATA: I- 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 O= Addition /alteration /replacement ❑ Other equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. • 01- and 2- family dwelling ID Commercial /industrial Valuation $ ? 5 j d o CD , ❑ Accessory building ❑ Multi - family Number of bedrooms: El Master builder ❑ Other. Number of bathrooms: . - ' JOB SITE INFORMATION AND LOCATION , . Total number of floors: Job site address: / 0 1 6x3 _5(...c.) 0 ve r New dwelling area. square feet • City /State /ZIP' t , d0/e 1 7aa Z/ Garage /carport area: square feet / Suite/bldg. /apt. no.. Project name: Covered porch area: square feet Cross street /directions to job site: _6 / 0 <r Deck area: square feet Other structure area: square feet REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: 1 Lot no.: Permit fees* are based on the value of the work performed. Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF ,WORK . ' work indicated on this application. 1., Valuation $ 6 5, 0 . c"-E7 Existing building area square feet 1,( . / New building area square feet r' ' ` XPROPERTY OWNER • ❑TENANT Number of stones 1 Name• 4G(D 11 �/ N ,/ a rl K 1.7 Type of construction: tO Address: /6c 51A) 6 m/'4,, ( Occupancy groups ` City /State /ZIP: 7 6 /el 1 04 /1 Existin g: �) / �J Phone: (-7::,) ) �7v ""�� 711 New: Q) _ . PLICAIYT ❑CONTACT PERSON - NOTICE - ` ' mess name: /'� 6.4y1/1 All contractors and subcontractors are required to be J co name VV "► licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the dress: jurisdiction in which work is being performed. If the City /State /ZIP applicant is exempt from licensing, the following reasons t J apply q�, Phone: ( ) Fax:. ( ) f 1 E - mail: t. CONTRACTOR Business name: % H s �r � D ao ¢, ( A� �6j BUILDING PERMIT FEES *" O Address # (jII A. C L i.t.0 0.-r-. Please refer to fee schedule. City /State /ZIP: (C CA pia 9 7e�c1� Fees due upon application Phone: ( S'j2) 301 - / s I -1 CCB lic.: �v��(0 Fax: ( ) Amount received Date received• Authorized signature: s � . „ This permit application expires if a permit is not obtained _ within 180 days after it has been accepted as complete. Print name: / 4 r b .� Date: /D -- / -Q S * Fee methodology set by Tn- County Building Industry Service Board. I \Building\Perm its\BUP- PemdApp doe 12/03 4404613T(I I /02/COM /WEB) One- and Two- Family Dwelling Building Permit Application Checklist FOR OFFICE 'USE ONLY City of Tigard Received Permit No. 13125 SW Hall Blvd., Tigard, OR 97223 Asse/By Associated permits Phone: 503.639.4171 Fax 503 598.1960 ^ /�x�, �; 24 - Hour Inspection Line: 503 639.4175 _,i I I ❑ Electncal ❑ Plumbing ❑ Mechanical Internet: www ci.tigard.or.us "� ' ❑ Other \ THE FOLLOWING ITEMS ARE REQUIRED FOR KLAN REVIEW Yes No N/A 1 Land use actions completed. See, jurisdiction criteria for concurrent reviews. I ❑ ❑ ❑ \ 2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. / ❑ ❑ ❑ \3 Verification of approved plat/lot. / ❑ ❑ ❑ 4, Fire district approval required. Name of district: . ❑ ❑ ❑ 5 \Septic system permit or authorization for remodel. Existing system capacity . ❑ ❑ ❑ 6 Sower permit. ❑ ❑ ❑ 7 W er district approval. ❑ ❑ ❑ 8 Soils eport. Must carry original applicable stamp and signature on file or with application. ❑ ❑ ❑ 9 Erosio control ❑ plan ❑ permit required. Include drainage -way protection, silt fence . - sign and location of catch- ❑ ❑ ❑ basin pro : ction, etc. 10 3 Compl • e sets of legible plans. Must be drawn to scale, showing conformance to . aplicable local and state ❑ ❑ ❑ building code . Lateral design details and connections must be incorporated into the p . s or on a separate full -size sheet attached to e plans with cross references between plan location and details. ' an review cannot be completed if copyright violatio • exist. 11 Site /plot plan drawn o scale. The plan must show lot and building setback di nsions; property corner elevations (if ❑ ❑ ❑ there is more than a 4 -ft. - levation differential, plan must show contour lines at -ft. intervals); location of easements and driveway; footprint o - ructure (including decks); location of wells /septi systems; utility locations; direction indicator; lot area; building . erage area; percentage of coverage; impervia s area; existing structures on site; and surface drainage. • 12 Foundation plan. Show dimensio . anchor bolts, any hold -downs an• einforcing pads, connection details, vent size ❑ ❑ ❑ . and location. 13 Floor plans. Show all dimensions, room ' . entification, window si location of smoke detectors, water heater, ❑ ❑ ❑ furnace, ventilation fans, plumbing fixtures, conies and decks 31 inches above grade, etc. 14 Cross section(s) and details. Show all framing • ember sizes . a spacing such as floor beams, headers, joists, sub- ❑ ❑ ❑ floor, wall construction, roof construction. More t' :n one Gros section may be required to clearly portray • construction. Show details of all wall and roof sheath ' I, roo g, roof slope, ceiling height, siding material, footings and foundation, stairs, fireplace construction, thermal ins . 'on, etc. 15 Elevation views. Provide elevations for new construction; ' imum of two elevations for additions and remodels. ❑ ❑ ❑ ` Exterior elevations must reflect the actual grade if the ch. ge in N ade is greater than four foot at building envelope. , Full -size sheet addendums showing foundation elevations with Gros' eferences are acceptable. 16 Wall bracing (prescriptive path) and /or lateral ana sis plans. Mu •ndicate details and locations; for non ❑ ❑ ❑ prescriptive path analysis provide specifications and alculations to engine: 'ng standards. 17 Floor /roof framing. Provide plans for all floors /r f assemblies, indicating - ber sizing, spacing, and bearing ❑ ❑ ❑ locations. Show attic ventilation. , . • _- . 18 Basement and retaining walls. Provide cross ections and details showing placeme . 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 a 'earns and multiple joists ❑ ❑ ❑ over 10 feet long and/or any beam /joist c/rying a non - uniform load. 20 Manufactured floor /roof truss design /details. ❑ ❑ ❑ 21 Energy Code compliance. Identify die prescriptive path or provide calculations. A gas - piping schema is is required ❑ ❑ ❑ for four or more appliances. / 22 Engineer's calculations. When /equired or provided, (i.e., shear wall, roof truss) shall be stamped by an en • • -er or ❑ ❑ ❑ architect licensed in Ore•on and shall be shown to be applicable to the .ro'ect under review. JURISDICTIONAL SPECIFICS 23 Five (5) site plans are rp4uired 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 and 22 above. ' ❑ ❑ ❑ 25 Building plans shall not contain red lines or tape -ons. "Mirrored'- ''building plans will not be accepted. ❑ ❑ ❑ 26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. -, • . ❑ ❑ ; ❑ 27 "Drawn to scale" indicates standard architect or engineer scale. -. ❑ ❑ ❑ • . 28 Site plan to include tree size, type and location per approved project street tree plan (if applicable), and City of Tigard ' ❑ ❑ ❑ Street Tree List. 29 Site plan to include tree protection measures as required by conditions of approval. ❑ ❑ ❑ 30 A Clean Water Services' Sensitive Area Pre - Screening Site Assessment form is required for all building additions, ❑ ❑ ❑ including decks, patio covers (over non - impervious surface) and accessory structures to existing residential dwellings on a lot of record approved prior to September 9, 1995. 1:\ Building \Permits\BUP- RES- PermitApp.doc 2 17O - 1497$ Ele ctrical Permit Application ,FOR OFFICE .USEONLY`. A City of Tigard Received Date/By. Permit No.: 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 /� "'"7� 1a' r . I` >'" D ate/By Other Permit: Inspection Line: 503.639.4175 '_' I Date Ready/By runs ® See Page 2 for Internet: www.ci.tigard or.us Notified/Method: Supplemental Information • TYPE OF WORK PLAN R EVIEW' ❑ New con Addition/alteration /replacement Please check all that apply ❑ Demolition ❑ Other: ❑Service over 225 amps, comm'l ['Hazardous location ❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft., � .CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential ' 1 - and 2 family dwelling ❑ CommerciaUindustrial ❑ Accessory building ❑S over 600 volts nominal units in one structure ❑ Multi- family ❑ Master builder ❑Other: ❑Building over three stories ['Feeders, 400 amps or more ❑Occupant load over 99 persons ❑Manufactured structures or JO,B, SITE INFORMATION AND LOCATION - ❑Egress/lighting plan RV park - Job no.: Job site address: / Dga3 �5� ) ❑Health - care facility ❑Other: ap� Submit 2 sets of plans with any of the above. City /State/ZIP: 7-464 - ox q .7a The above are not applicable to temporary construction service. i Suite/bldg. /apt. no.: Project name: FEE* SCHEDULE ' Description I Qty. I Fee. I Total I *` Cross street/directions to job site: S� l cfe 1 _ ( 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 Limited energy, residential 75 00 2 Tax map /parcel no.: Limited energy, non - residential 75 00 2 - DESCRIPTION OF WORK Each manufactured or modular /X t x /� et�n Iddui__?0-74 dwelling service and/or feeder 90.90 2 Services or feeders installation, alteration, and /or relocation 200 amps or less 80 30 2 ROPERTY OWNER . . ❑ TENANT 201 amps to 400 amps 106.85 2 401 amps to 600 amps 160.60 2 / / '' / Name: „C.l G4 ,1c' d 4 ci boll / H t X t / 601 amps to 1,000 amps 240.60 2 Address: / p to 3 (:; 4_ Over 1,000 amps or volts 454.65 2 Reconnect only 66.85 2 City/State/ZIP: / /VA , e )7( 9 7-.:2a( Temporary services or feeders installation, alteration, and /or i�aw i i _ , rr .rte 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, r t, r xchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2 Owner signature' .._ Date:/4 / 7 --- Sc; Branch circuits - new, alteration, or extension, per panel ' ❑ APPLIC T I ❑ CONTACT PERSON A. Fee for branch circuits with service or feeder fee, each 6.65 2 Business name: • branch circuit \ B. Fee for circuits Contact name: J l withoo service feeder service or feeder fee, I 46.85 2 Address: each branch circuit Each add'I branch circuit ) 6.65 2 City/State/ZIP: Miscellaneous (service or feeder not included) Phone: ( ) Fax :: ( ) Pump or irrigation circle 53.40 2 Sign or outline lighting 53.40 2 E - mail: Signal circuit(s) or limited- CONTRACTOR energy panel, alteration, or Business name: 'VQ,y f R 6.-/- / T{2, Q l � extension. Describe Page 2 2 Address: q' p ' ll) 9 C-01-- 4 >L ( Each additional inspection over allowable in any of the above - - Per inspection 62.50 City /State /ZIP: T ' � U j 4- q 7 a"a"o � Investigation per hour (I hr nun) 62.50 Phot, 53 - 7-7 I - s l le Fax: ( ) Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES* ' CCB Lic.: h3 (p Electrical Lic.: Suprv. Lic.: ,2g ?4 Subtotal Suprv. Electrician signature, required: 't'l 2 Plan review (25% of permit fee) Print name: Date: 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: Date: * Fee methodology set by Tri- County Building Industry Service Board '• Number of inspections per permit allowed I \Buildmg\Penmts\ELC- PermnApp.doc 12/03 440- 4615T(10/02/COM/WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all residential systems combined .. $75.00 \Check Type of Work Involved: \ ❑ Audio and Stereo Systems* Burglar Alarm ❑ k arage Door Opener* ❑ Hea.• g, Ventilation and Air Conditioning System* ❑ Vacuum stems* ❑ Other: COMMERCIAL WOR ~ _ONLY: -_ -w. _ w_ _. - _- - ._.__ - Fee for each commercial s $75.00 (SEE OAR 918- 260 -260) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunicati. Installation ❑ Fire Alarm Installati• ❑ HVAC ❑ Instrumentation ❑ Intercom and aging Systems ❑ Landscape 'rrigation Control* ❑ Medical . ❑ N urse ' ails Fl O ut,00r Landscape Lighting* ❑ P stective Signaling . ❑ • ther T •tal number of commercial systems: *No licenses are required. Licenses are required for all other installations i• \Bmlding \Permits \ELC- PermitApp doc 04/03 Building Fixtures Plumbing Permit Application ' " �, ■ FOR 01 ICE USX . °oNLY.". ,.. `, City of Tigard 4 Received N*T�as-oo 7�r Date/By No.: / V_� 7 Y ' /l 13125 SW Hall Blvd , Tigard, OR 97223 P lan Review Phone 503.639.4171 Fax: 503.598.1960 yNi I Date Other Permit No . Nl irrk 24- Hour Inspection Line: 503.639 4175 41 l Date Ready/By. Juns 0 See Page 2 for Internet: www.ci tigard.or.us Notified/Method. Supplemental Information TYPE OF WORK FEE* SCHEDULE '.t ❑ New construction ❑ Demolition For special information use checklist. Description I Qty. I Ea. I Total RI Addition /alteration/replacement ❑ Other New 1-2-family dwellings (includes 100 ft. for each utility connection) • . CATEGORY .OF CONSTRUCTION SFR (I) bath 249.20 ❑ 1- 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 / 1 3 .,- c A a Catch basin or area drain 16.60 City /State /ZIP: �' ' mi d ok Drywell, leach line, or trench drain 16.60 - Suite/bldg. /apt. no.: I Project name: Footing drain (no. linear ft. • ) Page 2 Manufactured home utilities 110.00 Cross street /directions to job site: Manholes 16.60 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 Fixture or item Tax map /parcel no.: Absorption valve 16.60 D SCRIPTION OF WO Back flow preventer Page 2 — ek i Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 Drinking fountain 16.60 ° ❑•PROPERTY OWNER ❑TENANT = Ejectors sump 16.60 Name: Qefride", Expansion tank 16.60 Address: 0 a 93 C am . ,� (/ � j , Fixture /sewer cap 16.60 City /State /ZIP: it % Floor drain /floor sink/hub 16.60 Phone' ( t 3) q r 5 - 5f' 4. Fax • ( ) Garbage disposal 16.60 T Hose bib 16.60 ❑ APPLICANT ❑ CONTACT' PERSON Ice maker 16.60 Business name' Interceptor /grease trap 16.60 Contact name: Medical gas (value: $ ) Page 2 Address Primer 16 60 City /State /ZIP: Roof drain (commercial) 16.60 Phone: ( ) Fax • ( ) Sink/basin/lavatory 16.60 Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 CONTRACTOR . Water closet 16.60 Business name: ��x Water heater 16.60 Address: /OS i9i zi. / 0o..tii.. Other Subtotal City /State /ZIP: �R Minimum permit fee: $72.50 Phone: ( 3) q 5 _ 5 7 Q 7 Fax: ( ) Residential backflow minimum permit fee: $36 25 CCB Lic.: Plumbing Lic no.: Plan review (25 % of permit fee) / (4470 State surcharge (8% of permit fee) Authorized signature: //Jv�' ft A.- TOTAL PERMIT FEE Print name: J, N i Date: f / - q-0 5 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. ■ \ Building\PennitsiPLMF- PennitApp doe 06/05 440-4616T(l0 /02JCOM/WEB) Plumbing Permit Application - City of Tigard • ; Page 2 - Supplemental Information . Fee Schedule: Residential Fire Suppression Systems: Site Utilities ' \ „ Qty. • Fee'(ea) 'Total Square Footage: . Permit Fee: - . • ' Footing drain - 1 100' \ 55.00 0 to 2,000 $115 00 Footing drain - each additional 100' \ 46.40 2,001 to 3,600 $160.00 3,601 to 7 $220.00 Sewer - 1st 100' 55.00 7,201 and greater $309.00/ Sewer - each additional 100' 46.40 Water Service - 1st 100' 55.00 Medical Gas Systems: Water Service - each additional 100' 46.40 Valuation: Pe it Fee• , ' • Storm & Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Mi 'mum fee $72.50 Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $ .50 for the first $5,000.00 and $1 52 for each Fixture or.Ite ' - ' - Qty. , Fee ( ea) Total : dditional $100.00 or fraction thereof to and including $10,000.00. Commercial Back Flow Prevention Device 1 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for Residential Backflow Prevention Device each additional $100 00 or fraction thereof, to (minimum permit fee $36.25) 27.55 and including $25,000.00 Rain Drain, single family dwelling 65.25 $25,001.00 to $50,0 0.00 $379.50 for the first $25,000.00 and $1.45 for each additional $100.00 or fraction thereof to Inspection of existing plumbing or and including $50,000.00. specially requested inspections - per hour 12 50 $50,001.00. up $742.00 for the first $50,000.00 and $1 20 for Subtotal: each additional $100.00 or fraction thereof. Fixture Work: Plan Review for Complex Structures , Are you capping, adding or replacing fixtures? If "yes ", A "complex structure" is defined as an installation of a plumbing please indicate work performed by fixture. Failure to system that meets any of the following criteria accurately report fixtures could result in increased sewer f• • *. Please check all that apply. Quantity by (Fixture) Work Perform • . . CI Any new commercial building. Fixtrire'Type: Re. ace ❑ Any new exterior plumbing site utilities. Previous Capped Added sting ❑ A commercial building with installation, alteration or addition Baptistry/Font of nine (9) or more new or relocated plumbing fixtures. Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities - Jacuzzi/Whirlpool providing services to human beings. Car Wash -Each Stall ■ Plumbing installations, alterations or additions to food service -Drive Thru ,- acilities where new plumbing fixtures, including interceptors, Cuspidor/Water Aspirator .. being installed for the food service area. Dishwasher - Commercial -MOM ❑ , new residential building containing three (3) or more - Domestic -A dwe 'ng units. Drinking Fountain —A ❑ Any ' PA 13 -D multipurpose fire sprinkler system. F r Drh V Floor Drain /sink 2" Sub it 2 sets of plans with any of the above. -3" 4" . Car Wash Drain ISO i i etriic or Riser Diagram - ' , - ; Garbage - Domestic ❑ Isometric or ri -r diagram is required for new buildings Disposal - Commercial three (3) or more tories in height. - Industrial Ice Mach./Refri •. Drains Oil Separator (Gas Station) Comments regarding xture work: Rec. Vehicle Dump Station Shower -Gang -Stall Sink - Bar /L. atory -- -Br.. ey r ommercial ` - Service Swimming Pool Filter . Washer - Clothes *Note: If the fixture work under this permit results in an Water Extractor Water Closet - Toilet increase of sewer EDUs, a sewer permit will be issued and Urinal fees assessed for the sewer increase must be paid before the Other Fixtures: plumbing permit can be issued. .. \Building\Permits\PLM- PermitApp doc 07/06/05 • . RFP:.- 22 -20D5 14:51 FROM:ENDPOINT DESIGN 5P 4F,DS317 1 i-i- -1S -2p J5 07 :58 FROM:ENDPOINT DESIGN 5 Ct 34689317 TO T1 F r P.1 :5 036814434 r.t \v APR 1 3 2005 �' FueNumber � � 3/ • CleanWater \ Servi � e� - ,i (8,05° Our commitment is clear. BY _�et3sitiv� tea Pre - Screening Site As s ' y b 1p � Jurisdiction J Q Map & Tax Lot Date Owner >FI A Contact j Site Address ®: „S W • 4 ■ irsA •Stt.4 <. ems t „ Company t�i�t zeil coo °}7774 Address Q pa • Proposed Activity sL.Pf t `j' _ City State Zip pa ��- Phone Fax ` g3t1` Official use onty below this line t Jl Y N NA Y N NA 11 I I Sensitive Area Composite Map Map# Stormwater infra iructure maps �`7!'� ❑ C [ ! i QS# t�31d Ej r } � , Specify adopted studies or maps ❑ U Other Specify r2y Based on a review of the above Information and the requirements of Clean Water Services Design and Construction Standards Resolution and Order No. 04.9: Sensitive areas potentially exist on site or within 200' of the site. THE APPLICANT MUST PERFORM A SITE CERTIFICATION PRIOR TO ISSUANCE OF A SERVICE PROVIDER. If Sensitive Areas exist on the site or within 200 feet on adjacent properties, a Natural Resources Assessment Report may also be required. Sensitive areas do not appear to exist on site or within 200' of the site. This pre- screening site assessment does NOT eliminate the need to evaluate and protect water quality sensitive areas if they are subsequently discovered. This document will serve as your Service Provider letter as required by Resolution and Order 04 -9, Section 3.02.1. All required permits and approvals must be obtained and completed under applicable local, state, and federal law. The proposed activity does not meet the definition of development_ NO SITE ASSESSMENT OR SERVICE PROVIDER LETTER IS REQUIRED. Comments: a —stoo l f.Kl YRt/1 • I i Q j ootyee , - r 9 N iC.rtf� T 4 le a �ou ad N ewr Reviewed By: Date: Returned to Applicant Mail X Fax Counter Dale_ N/z tlo5 B 2550 SW Hillsboro Highway • Hillsboro, Oregon 97123 Phone' (503) 681 -5100 • Fax: (503) 681 -4439 • www,e1minwa(erservjces.org APR 22,2005 16:32 5034609317 Page 1 CITY OF ��om m ��w mn��m~un�� BUILDING DIVISION ~~~°.~~~~""~~� ~~"°"~°"~=.~ . PERMIT #: kAST:K0600366 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/9r2005 Phone: (503) 639-4171 Inspection Requests (24 Hrs.): (503) 630'4175 .JyN i �� INSPECTION WORKSHEET FOR DATE: 1/26/2006 TIME: 7:03AN PAGE: 42 SITE ADDRESS: 10823 SW DOVER CT CLASS OF WORK: SUBDIVISION: DOVER LANDING LoT #: 025 TYPE OF USE: PROJECT NAME: FINTZY DESCRIPTION: Addition'. OWNER: F>NTZY. LINDA &ARR()N PHONE #: 603-684-6129 CONTRACTOR: , F & H CONSTRUCTION DEVELOPMENT PHONE #: 6OP-3091819 Inspection Request Scheduled For: Date: 1/26,12006 Pour Time: Code # Inspection Description Confirm # Contact # Message 299 Final inspection 026773.02 50:3-870 Y Corrections/Comments/Instructions: �� PA 0 APPROVAL CANCEL 0 N[) ACCESS ) | FAIL ALL FOR INSPECTION | | ADDITIONAL FEES ASSESSED �� • -�Ni� /y ' 'N U�� Inspector: [�m�m� ' ~° Phone #: (503) 718- ^-" . �� CITY ��U�� nn n OF nn��w�unn�� BUILDING DIVISION . PERMIT #: W�12.005.00358 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/S/2006 Phone: (503) 639-4171 Inspection Requests (24 Hrs.): (503) 639-4175 A- -IJI. INSPECTION WORKSHEET FOR DATE: 1/26/2006 TIME: 7:03AM PAGE: 43 SITE ADDRESS: 10823SW DOVER C7 CLASS OF WORK: SUBDIVISION: DOVER LANDING LOT #: 026 TYPE OF USE: PROJECT NAME: FINTZY DESCRIPTION: Addition. OWNER: FINTZY, LINDA & ARRON PHONE #: 6O34846129 CONTRACTOR: T&H CONSTRUCTION & DEVELOPMENT PHONE #: 603-309'1019 Inspection Request Scheduled For: Date: 1/2G/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Electrical final 025773-01 503-670-48J8 N Corrections/Comments/Instructions: PARTIAL APPROVAL 0 CANCEL O NO ACCESS 0 FAIL a C^ L FOR INSPECTION | | ADDITIONAL FEES ASSESSED ' /Z 6.106 Inspector: ~m�~.~~__ -~-�� Oa1e: Phone #: (503) 718- CITY OF TIGARD m S BUILDING DIVISION • 6 0 _ 5 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: Phone: (503) 639 -4171 u °�00q � Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: TIME: PAGE: 1-,u (1.1-bit-pLA ( o' , SITE ADDRESS: / d g 2 ? D CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: DESCRIPTION: OWNER: PHONE #: CONTRACTOR: PHONE #: Inspection Request Scheduled For: Date: / -a (404, Pou Time: r Code # Inspection Description Confirm # Contact # ssage g9q I99 ��- qq 3 97 v -a`{ 3330 - -► ' P Corrections /Comments /Instructions: / �g �� ----46)- - -- 1 ---e--- , il . OW —Sim Z. :7 7 riiii No. i 4c,„((----- I I PASS I • ' RTIAL APPROVAL ❑ CANCEL KNO ACCESS FAIL ri ALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED Y 1 0 6 I nspector: Date: _ Phone #: (503) 718 - M,6-- CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2005 -00355 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/9/2005 Phone: (503) 639 -4171 441,1 �, Inspection Requests (24 Hrs.): (503) 639 -4175 :. INSPECTION WORKSHEET FOR DATE: 12/6/2005 TIME: 7 :02AM PAGE: 50 SITE ADDRESS: 10823 SW DOVER CT CLASS OF WORK: SUBDIVISION: DOVER LANDING LOT #: 025 TYPE OF USE: PROJECT NAME: FINTZY DESCRIPTION: Addition. OWNER: FINTZY, LINDA & ARROW PHONE #: 503684 -61 � CONTRACTOR: T & H CONSTRUCTION & DEVELOPMENT PHONE #: 503 - 309 -1819 Inspection Request Scheduled For: Date: 121612005 Pour Time: Code # nspection Desc • ' Confirm # Contact # Message 120 Electrical rough -in 022992 -01 503 - 625 -M58 Y Corrections /Comments /Instructions: c e \L , A ASS n PARTIAL APPROVAL ❑ CANCEL NO ACCESS FAIL I I CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED Inspector: 6-'71 (1 Date: "4' Phone #: (503) 718- 2N-1/44o • CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2006-0.036(3 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/0006 Phone: (503) 639-4171 "MAI Inspection Requests (24 Hrs.): (503) 639-4175 INSPECTION WORKSHEET FOR DATE: 1/25/2006 TIME: 703Am PAGE: OE; SITE ADDRESS: 10823 SW DOVER CT CLASS OF WORK: SUBDIVISION: DOVER LANDING LOT #: 025 TYPE OF USE: PROJECT NAME: FINTZY DESCRIPTION: Addition. OWNER: FINTZY, LINDA & ARRON PHONE #: 503-6846129 CONTRACTOR: T & H CONSTRUCTION & DEVELOPMENT PHONE #: 503-309-18'19 Inspection Request Scheduled For: Date: 1/2612006 Pour Time: Code # Inspection Description Confirm # Contact # Message Final inspection 025637-01 503-830:4921 Corrections/Comments/Instru ions: U-44 1,A) VZLL' Ns c • - C L VLsLia— JzJ LQ I S ft L El PASS I I PARTIAL APPROVAL I I CANCEL r7 NO ACCESS WAIL fl CALL FOR INSPECTION ADDITIONAL FEES ASSESSED Inspector: Date: 1 / 2 C/ 6 / 6 Ph one #: (503) 718- . � CITY ��N�� n m n OF TIGARD BUILDING DIVISION ' PERMIT #: IN4BT2005-O0366 13125 SW Hall Blvd., Tigar . OR 97223 A 1 A E ISSUED: 11/8/2006 Phone: (503) 639-4171 Inspection Requeo��Hmj: (503) 639'4175 .4 I. INSPECTION VVORKGHEETFOR DATE: 1/25/2006 T|K4�� PAGE: 85 SITE ADDRESS: 10828SVV DOVER CT CLASS OF WORK: SUBDIVISION: DOVER LANDING LOT #: 025 TYPE OF USE: PROJECT NAME: Hk[[Z/ DESCRIPTION: Addition. OWNER: F|NTZY. LINDA &ARRQW • PHONE #: 503-694.6129 CONTRACTOR: TflA CONSTRUCTION � DEVELOPMENT PHONE #: 503 Inspection Request Scheduled For: Date: 1/26/2006 Pour Time: Code # Inspection Description Confirm # Contact # Message 389 Plumbing final 026637-02 W3'850^41821 N Corrections/Comments/Instructions: . 47ASS ^ . r] PARTIAL APPROVAL 0 CANCEL LI] NO ACCESS I I FAIL El INSPECTION ADDITIONAL 4 �� a / / v {� ^� �.�/ u�~ � Inspector: �� v� Date: / ~- ~� ` Phong#� (6O3)718' ' / CITY OF TIGARD BUILDING DIVISION • / PERMIT #: MST200&00356 13125 SW Hall Blvd., Tigard, OR 97223 A DATE ISSUED: 11/9/2006 Phone: (503) 639-4171 l 'olltmoiAl# Inspection Requests (24 Hrs.): (503) 639-4175 a g,91 111. INSPECTION WORKSHEET FOR DATE: 1/25/2006 TIME: 7:03AIVI PAGE: al SITE ADDRESS: 10023 SW DOVER CT CLASS OF WORK: SUBDIVISION: DOVER LANDING LOT #: 025 TYPE OF USE: PROJECT NAME: FINT7Y DESCRIPTION: Addition. OWNER: FINTZY, LINDA & ARRON PHONE #: 503-6346129 CONTRACTOR: 1' & H CONSTRUCTION & DEVELOPMENT PHONE #: 503-309-1019 • Inspection Request Scheduled For: Date: 1/25,0006 Pour Time: Code # Inspection Description Confirm # Contact # - ss 2 e � 699 Mechanical final 025637-03 503-830 v V ' Corrections/Comments/Instructions: l I I PARTIAL APPROVAL 0 CANCEL 0 NO ACCESS fl FAIL I I CALL FOR INSPECTION EI ADDITIONAL FEES ASSESSED . V4 } c... ' Inspector: Date: 1 - 7,t - 0 1%s Phone #: (503) 718- CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2005.00358 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/9/2005 Phone: (503) 639- 4171vnNpii�p�" I � Inspection Requests (24 Hrs.): (503) 639 -4175 J '' �.. INSPECTION WORKSHEET FOR DATE: 12/7/2005 TIME: 7:00AM PAGE: 30 SITE ADDRESS: 10823 SW DOVER CT CLASS OF WORK: SUBDIVISION: DOVER LANDING LOT #: 025 TYPE OF USE: PROJECT NAME: FINTZY DESCRIPTION: Addition. OWNER: FINTZY, LINDA & ARRON PHONE #: 503 -664 -6129 CONTRACTOR: T & H CONSTRUCTION & DEVELOPMENT PHONE #: 5033 - 309.1819 Inspection Request Scheduled For: Date: 12/7/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 230 Underfloor insulation 023098 -03 503- 309.1819 N Corrections /Comments /Instructions: PASS I PARTIAL APPROVAL n CANCEL I I NO ACCESS n FAIL I I CALL. FOR INSPECTION fl ADDITIONAL FEES ASSESSED Inspector: `� Date: 12 6 Phone #: (503) 718- • . ' . CITY OF ' . ��mn w n_�m TIGARD • ' BUILDING DIVISION ,. PERMIT #: N1ST2005-00356 13126SVV Hall B|vd.. Tigard, OR07223 DATE ISSUED: 11/9/2005 Phone: (503) 639-4171 Inspection Requests (24Hmj: (503) 639-4175 "J ��- 1 �� INSPECTION WORKSHEET FOR DATE: 1217y2005 TIME: 7 : 00 AM PAGE: 31 ./ SITE ADDRESS: 10823 SW DOVER CT CLASS OF WORK: SUBDIVISION: DOVER LANDING LOT #: 025 TYPE OF USE: PROJECT NAME: RNTJY DESCRIPTION: Addition. OWNER: FiNTZY.L|NDA & ARROW PHONE #: 503-6846129 CONTRACTOR: T&M CONSTRUCTION &DEVELOPMENT PHONE #: 503-309-1013 Inspection Request Scheduled For: Date: 12y712005 Pour Time: Code # Inspection Description - Confirm # Contact # Message 215 Footing drain 023098'02 503-309-1819 N Corrections/Comments/Instructions: PASS ri PARTIAL APPROVAL ri CANCEL NO ACCESS FA| 7 CALL FOR|NSPECT|(]N fl ADDITIONAL FEES ASSESSED _~ .^^6 / -- |napecto v~ `~ Date: / � 0 - Phone #� (5O3)718' �-«^^~7 /�� ` ' i CITY OF TIGARD • - BUILDING DIVISION „ PERMIT #: MST2005-00356 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/9/2005 Phone: (503) 639-4171 col ii 1 Inspection Requests (24 Hrs.): (503) 639-4175 J. IL INSPECTION WORKSHEET FOR DATE: 12/7/2005 TIME: 7:00AM PAGE: 32 / SITE ADDRESS: 10023 SW DOVER CT CLASS OF WORK: SUBDIVISION: DOVER LANDING LOT #: 0 25 TYPE OF USE: PROJECT NAME: FINTZY DESCRIPTION: Addition. OWNER: FINTZY, LINDA & ARRON PHONE #: 503 CONTRACTOR: T & H CONSTRUCTION & DEVELOPMENT PHONE #: 503 Inspection Request Scheduled For: Date: 12/7/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 280 Insulation 023098-01 503-309-1819 ,.. Y ?An Corrections/Comments/Instructions: ggo.x_dic 04 .779.,zeol ) deal-- , -t-tP 1,(wivtd_ocx,to____ g PASS El PARTIAL APPROVAL n CANCEL 0 NO ACCESS I I FAIL n CALL FOR INSPECTION I 1 ADDITIONAL FEES ASSESSED r --- Inspector: ( Date: 1 2 (l d'D Phone #: (503) 718- 2Z 0 6 CITY OF TIGARD BUILDING DIVISION PERMIT #: MMMST2005- 00356 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1119/2005 Phone: (503) 639 -4171 i i 6" �I Inspection Requests (24 Hrs.): (503) 639 -4175 W 'I �.. INSPECTION WORKSHEET FOR DATE: 12/5/2005 TIME: 7:00AM PAGE: 14 SITE ADDRESS: 108 23 SW DOVER CT CLASS OF WORK: SUBDIVISION: DOVER LANDING LOT #: 025 TYPE OF USE: PROJECT NAME: FINTZY DESCRIPTION: Addition. OWNER: FINTZY, LINDA & ARRON PHONE #: 503 -684 -5129 CONTRACTOR: T & H CONSTRUCTION & DEVELOPMENT PHONE #: 503 - 309-1819 1 00 6 *I c% t Inspection Request Scheduled For: Date: 12/5/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 275 Framing 022942 -01 03.309 -1819 Y Corrections /Comments /Instructions: 11 (AA r f PLIT1JS olk 47[1-F , .r r ; ' ( .:, , -- LIE-C-- - `� °v (� ‹_ l 1r--- u ki b R 6 `rte tikr c (cykt, T• (- _t om PS fli / -1-3 ( 1 r 1,__)----k- - ,(N--p er . `L C-- PASS ARTIAL APPROVAL El CANCEL NO ACCESS n FAIL CALL FOR INSPE TION ❑ ADDITIONAL FEES ASSESSED OY Inspector: Date: ( 5 Phone #: (503) 718- CITY OF TIGARD BUILDING DIVISION PERMIT #: MST200&-00366 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/9/2005 Phone: (503) 639-4171 At '1111\ Inspection Requests (24 Hrs.): (503) 639-4175 11... INSPECTION WORKSHEET FOR DATE: 11/22/2005 TIME: 7:02AM PAGE: 4 SITE ADDRESS: 10823 SW DOVER CT CLASS OF WORK: SUBDIVISION: DOVER LANDING LOT #: 025 TYPE OF USE: PROJECT NAME: FINTZY DESCRIPTION: (WIL9iiii OWNER: FINTZY, LINDA & ARRON PHONE #: 603-684-6129 CONTRACTOR: T & H CONSTRUCTION & DEVELOPMENT PHONE #: 503-309-1819 Inspection Request Scheduled For: Date: 11/22/2005 Pour Time: Code # Inspection Description Confirm # Contact # essage N 606 ?astibeam mechanical 022267-01 503-309-1819 Corrections/Comments/Instructions: *ASS I P 'TIAL APPROVAL 7 CANCEL El NO ACCESS FAIL r a ALL FOR INSPECTION ADDITIONAL FEES ASSESSED Inspecto All1111111 Date: //Z7 51 #: (503) 718- 4111 7 1 CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2005-00356 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/9/2005 Phone: (503) 639 -4171 � 4�'� p Inspection Requests (24 Hrs.): (503) 639 -4175 ., A 'e'I �.. INSPECTION WORKSHEET FOR DATE: 11/21/2005 TIME: 7:13AM PAGE: 19 SITE ADDRESS: 10823 SW DOVER CT CLASS OF WORK: SUBDIVISION: DOVER LANDING LOT #: 025 TYPE OF USE: PROJECT NAME: FINTZY f DESCRIPTION: dcfition. OWNER: FINTZY, LINDA & ARRON PHONE #: 503 -6M -6129 CONTRACTOR: T & H CONSTRUCTION & DEVELOPMENT PHONE #: 503-3091819 Inspection Request Scheduled For: Date: 11/21/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 225 Post/beam structural 022097 -01 503 - 309.1819 A -111 Corrections /Comments /Instructions: l ..tiff /e/- a /AUK •i - 11_' 174 ._-A ,L . 3l 4 X 2 x la/A/Lc 3 /.Gx2N' �r e -2..) tize)(ic 1 P ,mac> LAI ( «.1 s� L� 47,9-1 tja.1 11 7, l-e-ca-C A L, P, 401 : 4 € 6 ,,w -_,7z- ,,r, ,,, d ' /X PASS I I PARTIAL APPROVAL ❑ CANCEL I I NO ACCESS FAIL n CALL FOR INSPECTION ❑ ADDITIO L FEES ASSESSED Inspector: Ay Date: ('I Zi , OC Phone #: (503) 718- CITY OF TIGARD N57 BUILDING DIVISION PERMIT #:4Z06 Old 3S, 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: Phone: (503) 639 -4171 " �Iputij1l Inspection Requests (24 Hrs.): (503) 639 -4175 Asir 11. INSPECTION WORKSHEET FOR DATE: TIME: PAGE: SITE ADDRESS: /® 8 2, 3 1 V V. 4A, `± CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: DESCRIPTION: OWNER: PHONE #: CONTRACTOR: PHONE #: Inspection Request Scheduled For: Date: / (' ( - dJ Pour Time: ) C ode # Inspection Des '•tion Confirm # Contact # Message 4,,p c /0 c sz)q- -- o f s . 1 or - tions /Com�t nl stru •ns: /1,0fr/2d,,ei 7rnie, G - - fi t /� ., G� %4 {FYI " 4 1-4 d dl a G'-•0 c e/ 2 ,b, -a/4 Ce. 1--0 I V„0Qcli/' , -e-c;( tAiv ,./)e) .0 4 /(dyo i 1 .C/- A) Pd. 44 / .WA- 5 . - ,i_z__ 7 /Z Zia4 2-e- J s2L'* /1- i a,? tit � / pe---y,,14-7 por..eLe_h 4 z--)46:eAlda.;//0-77 ..ei•i,i • PASS H PARTIAL APPROVAL n CANCEL n NO ACCESS I !'FAIL CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED Inspector: / / r . Date: ( ( 7 ®5 Phone #: (503) 718- (/