Permit i/ (IP /06 CI Y I D
PERMIT #: ELC2005 -00147
DEVELOPMENT SERVICES DATE ISSUED: 6/8/2005
�--"' 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S114AA -00100
SITE ADDRESS: 09000 SW DURHAM RD ZONING: R -4.5
SUBDIVISION: LOT : JURISDICTION: TIG
Project Description: Girls locker room, CE2/Transitions TI. 7/13/2006 Added (6) Branch circuits and (2) amp feeders.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL /PANEL:
MANF HM/ SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: 2 W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 20 IN PLANT:
601 - 1000 amp: • • EVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
TIGARD - TUALATIN SCHOOL DISTRICT 23J COUGAR ENTERPRISES
6960 SW SANDBURG ST 1301 COOLEY RD.
TIGARD, OR 97223 WOODBURN, OR 97071
Phone: 503 -431 -4000 Contact #: FAX 503 - 256 -7679
PRI 503- 256 -7718
FEES
Description Date Amount Reg #: ELE 24 -400C
[ELPRMT] ELC Permit 5/27/2005 $139.95 LIC 132060
[ELPLCK] ELC Pln Rev 5/27/2005 $34.99 SUP 5028S
[FAX] 8% State Surcharge 5/27/2005 $11.20
(additional fees not listed here) REQUIRED ITEMS AND REPORTS
Total $402.68
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All
work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if 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 OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503 - 246 -6699 or
1- 800 - 332 -2344.
Issued By: , � ' , Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
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.
CITY OF TIGARD Li—q-0 ELECTRICAL PERMIT
PERMIT #: ELC2005 -00147
e' DEVELOPMENT SERVICES DATE ISSUED: 6/8/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S114AA - 00100
SITE ADDRESS: 09000 SW DURHAM RD ZONING: R - 4.5
SUBDIVISION: LOT : JURISDICTION: TIG
Project Description: Girls locker room, CE2/Transitions TI.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL /PANEL:
MANF HM/ SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 14 IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
TIGARD - TUALATIN SCHOOL DISTRICT 23J COUGAR ENTERPRISES
6960 SW SANDBURG ST 1301 COOLEY RD.
TIGARD, OR 97223 WOODBURN, OR 97071
Phone: 503 - 431 -4000 Contact #: FAX 503 - 256 -7679
PRI 503 - 256 -7718
FEES
Description Date Amount Reg #: ELE 24 -400C
LIC 132060
[ELPRMT] ELC Permit 5/27/2005 $139.95 SUP 24-12'5
[ELPLCK] ELC Pln Rev 5/27/2005 $34.99
[TAX] 8% State Surcharge 5/27/2005 $11.20
REQUIRED ITEMS AND REPORTS
Total $186.14
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All
work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if 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 OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503 - 246 -6699 or
1- 800 - 332 -2344. —
Issued By: f' 7 �� r �� Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
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.
11
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
COUGAR ENTERPRISES
1301 COOLEY RD.
WOODBURN, OR 97071
Electrical Signature Form
•
Permit #: ELC2005 -00147
Date Issued: 6/8/2005
Parcel: 2S 114AA -00100
Site Address: 09000 SW DURHAM RD
Subdivision:
Block: Lot:
Jurisdiction: TIG
Zoning: R - 4.5
Remarks: Girls locker room, CE2 /Transitions TI.
Your company has been indicated as the electrical contractor for the permit indicated above. In order for the electrical
permit to be valid, the signature of the supervising electrician is required. Please have the appropriate individual from
your company sign below and return this Electrical Signature Form prior to the start of the work to the address above,
ATTN: Building Division.
No electrical inspections will be authorized until this completed form is received
OWNER: ELECTRICAL CONTRACTOR:
TIGARD - TUALATIN SCHOOL DISTRICT 23J COUGAR ENTERPRISES
6960 SW SANDBURG ST 1301 COOLEY RD.
TIGARD, OR 97223 WOODBURN, OR 97071
Phone #: 503 - 431 -4000 Phone #: 503 - 256 -7718
Reg #: ELE 24 -400C
LIC 132060
SUP 2412S
AN INK SIGNATURE IS REQUIRED ON THIS FORM
X
Signature of Supervising lectrician
If you have any questions, please call 503.718.2433.
C ITY O F TIG A R® ELECTRICAL PERMIT
z H PERMIT #: ELC2005 -00147
DEVELOPMENT SERVICES DATE ISSUED: 6/8/2005
`-`-" 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2 S 114AA -00100
SITE ADDRESS: 09000 SW DURHAM RD ZONING: R -4.5
SUBDIVISION: LOT : JURISDICTION: TIG
Project Description: CE2/Transitions TI
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL /PANEL:
MANF HM/ SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 14 IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
TIGARD-TUALATIN SCHOOL DISTRICT 23J BROADWAY ELECTRIC - COCHRAN INC
6960 SW SANDBURG ST 626 SE MAIN
TIGARD, OR 97223 PORTLAND, OR 97214
Phone: 503 - 431 -4000 Phone: 503 - 234 -6564
FEES Reg #: LIC 72942
SUP 3447S
Description Date Amount ELE 37 - 546C
[ELPRMT] ELC Permit 5/27/2005 $139.95
[ELPLCK] ELC Pln Rev 5/27/2005 $34.99 REQUIRED ITEMS AND REPORTS
[TAX] 8% State Surcharge 5/27/2005 $11.20
Total $186.14
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other applicable laws
All work will be done in accordance with approved plans This permit will expire if work is not started within 180 days of issuance, or if work is
suspend for more an 180 days ATTENTION• Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules a set forth in OA' 95 01 10 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OU
503 -2 -6699 r 1 -800 -3 2
Issue By: g Permittee Signatur
OWNER INSTALLATION ONL
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INS ALLATION ONLY
SIGNATURE OF SUPR. ELEC' ft.' �� ��1�� DATE:
LICENSE NO: r`/ 75
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.
• 5035981960
• 06'07%•2005 1,2:38 FAX 5035981960 CITY OF TIGARD 001
Electrical Permit A lie ' EN. AI& : FoR o f 1 li "a.:, I tit: ()NIA , 1
City of Tigard ve d Pernritxo.: .. Does . 13125 SW Hall Blvd, Figard OR 97223 P n Review _ /I � t' Phone: 503.639.4171 Fax 503.598 1960 �A p (\ t ' r, . .': j, I ' Dale/By . 7 b All- Other Permit
Inspection Line: 503 - 639.4175 1Y11�R 1 `V Al 'I 1i DateReady/BY T H Sec for
Internet: www.ci.11gard.or_us Notified/Methods (O ,� ( Supplemental Information
,� +; a .�c ;tin ' F mr=•.∎ _ r
, �
,'''. . '` : h. t ''' ,.y s ' 1 •r n t l _ k4, l'•22 ,'. . . iii 0 _ •.'`."�'3�:: + j 7 . rit:="11
❑ New construction 174 • a :y :1 1; t+ !... ent P1. check all that apply.
❑ Demolition 1:1 Other: ❑Service over 225 amps, comet '1 ❑Hza
ardous location
z �r+ uvr waUw; r. , *,,pl t% w,' , ❑Service over 320 snips — rating ❑ Buildng over 10,000 sq_ R,
• ,:+ +r• W ;:ir : ' '' `✓;¢ c � , - , 017 Zs' ?' 1 1': ' y , ' - - of 1 and 2 family dwellings 4 or more new residential
❑ 1- and 2- family dwelling r, V. . ommereiai/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
LI Multi - tardily ❑ Master builder ❑ Other: OBuilding over three stories ❑Feeders, 400 amps or more
,t� t
In Occupant load over 99 persons ❑Manufactured structures or
` p t : ',: f. wh�°i 1., , . ,,. `• V : 4, : ',W .. ❑E plan RV pack
lob Jo b site addr dt .0`1,4.3 i�t�C�L2.iM ❑Health - care facility ❑Ot cr:
Submit 2 sets of plans with any of the above_
City /State/ZIP: P The above are not applicable to temporary construction service-
. - 2 c _ .rar —wtau 7:::: :1. 7�4 E. �i': 1 t
Suite /bldg. /apt. no.: Project name: r'eti f 7- ,AAA-S r� i ot.cs �rM b ,c _�.W" ,.�, . �
Q[Y• F es Td
TOW
Cross street/directions to job site: •' [ ik t - -' i -. t New residential single- or multi- family dwelling unit.
(J Jd - Includes attached garage.
1,000 sq. R or less 145.15 4
Subdivision: Lot no.: Ea. add') 500 sq. ft. or portion 33.40 1
Tax map/parcel no : Limited energy. residential 75.00 2
:1 , 7 ., ,B, b �, Limited energy, non-residential 75.00 2
n < 1 , F' etc manufactured or modular
l �` .. - dwelling. service and/or feeder 90.90 2
� ( � j t u , � b l f G ��� �C l U Services or feeders installation, alteration, and/or relocation
i 4_ ( , . 200 amps or less 80.30 2
201 amps to 400 amps 10 5
?�'�*. . ° ter '.r�.' ' "i,„�•, �,r:'L'�4�,'�' ,, �'! c��,n P ps 6.8 2
( ,w . 401 amps to 600 amps 160.60 2
Name ` c( ?\ C mot 601 amps to L000 amps 240 -60 2
Address 6, 'ti, ( l l•u G.,,,,,,,I Gu r5 Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City /State/ZIP: - b ► Temporary services or feeders Installation, alteration, and/or
Phone: ( D [ c - D „� relocation
cation
} ;t I Fax: ( ) 3 (` °� 200 amps of less 66.85 1
Owner installation: This in _ lation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange) according to ORS 447, 449, 670, and 701.
401 amps to 600 amps 133.75 2
Owner signature _ Date: Branch circuits - new, alteration, or extension, per panel
'`, q `` - -dG�- "•.i, trilil +, : I : 1 ,, , _' ;LYiftil*l? °P = ' - t, A. Fee for branch circuits with
y - — ;', service or feeder fee, each
Business name: '1-° `U 3 t ai l ip t l's l' 't branch circuit 6.65 2
Contact name: 'd B_ Fee for branch circuits
without service or feeder fee, Lyj ,
.. /
- _ each branch circuit G 46 -85 r (( Ltl 2
Address: =f Q i�) �j�,N t) Each add') branch circuit �
y 6.b5 ?A 2
City/State/ZIP: '—' ._ Zf
p{ Miscellaneous (service or feeder not included)
( t l` lb Pump or irrigation circle 53.40
Phone: (9 3) t +l i x, D Fax:: (50 3 ) t - t `f 7
II
Sign or outline lighting 53.40
E -mail: Signal circuit(s) or limited -
i is : 1, - :' ,1;: ; !/ ;°>t' r: R' '-' " , ' .•rr.: .,
,. ay,
n energy panel. alteration. or
- extension Describe: Page 2 2
Business name: C c '-- - B e c ct. J t,,.r Oak,
. z .1--
Address: 19 D-- S � Each additional inspection over allowable In any of the above
- - �Y 1(y_ c..� -� r Pa inspection 62.50
City /State/ZIP: , - ._ ci - ! a Investigation per hour (1 hr mio) 62.50
Phone: ( `col) ..74 & I Fax ( Industrial plant per hour 73.75
.
CCB Lie.: 7d_gf y I Electrical Lie.: 37-51./ c. Suprv. Lie.: 3''t 13 Subtotal
Suprv. Electrician signature, required: V • \ \ Plan review (25% ofpermit fee) %1�
^
_ state surcharge (8°h of permit fee)
Print name: � ��� u \ D at e: &O( -7 ( O �—
TOTAL PERMIT FEE in 1 11
Authorized signature: I - . This permit application expired if s permit is not obtained within 180
days after it has been aceeptod as complete
Print name: C-- : ".�„ V % 0 - -s . - f ate: 3q'1 J aS • Fee methodology set by Tri-Cowgy Building Industry Service Board
`'— ' ' 4 •• Number of inspections perpermitallowed.
i.lBuildine•enniti ].0 -Per itAre.doc 12/03 z 9-9 — 6 1 1}(6 440-4611 t(OaaliCOM/WE8
,,
, CITY ®F Ti °OAR® ELECTRICAL PERMIT
, PERMIT #: ELC2005 -00147
r k l DEVELOPMENT SERVICES DATE ISSUED: 6/8/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S114AA -00100
SITE ADDRESS: 09000 SW DURHAM RD ZONING: R -4.5
SUBDIVISION: LOT : JURISDICTION: TIG \
Project Description: CE2/Transitions TI
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HM/ SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 14 IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
TIGARD- TUALAIIN SCHOOL DISTRICT 23J BROADWAY ELECTRIC - COCHRAN INC
6960 SW SANDBURG ST 626 SE MAIN
TIGARD, OR 97223 PORTLAND, OR 97214
Phone: 503 - 431 -4000 Phone: 503 - 234 -6564
FEES Reg #: LIC 72942
SUP 3447S
Description Date Amount ELE 37 - 546C
[ELPRMT] ELC Permit 5/27/2005 $139.95
[ELPLCK] ELC Pln Rev 5/27/2005 $34.99 REQUIRED ITEMS AND REPORTS
[TAX] 8% State Surcharge 5/27/2005 $11.20
Total $186.14
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws
All work will be done in accordance with approved plans This permit will expire if work is not started within 180 days of issuance, or if work is
suspend • or more an 180 days ATTENTION. Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules a • set forth in ORE? 95 01 10 through OAR 952 - 001 -0100 You may obtain copies of these rules or direct questions to OU
503 -2 • •-6699 r 1 -800 -3 2 J
Issue • By: 4 ��� -� Permittee Signatury �1�-
G --
OWNER INSTALLATION ONL
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INS ALLATION ONLY
SIGNATURE OF SUPR. ELEC' 1� , I � �� � DATE:
LICENSE NO: r ' 75
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.
..
Ferni 16- £/C2ods -6o %9
' U, rye l 3 / / /05 124e /SSvcd
e e/C o20oS- 6o/y� 6 / o2o6S-6 &7
co q m • / _ go -30 Zo2oo rh p { = 8O.
6rx C1 rc , Is - 6,GS S7 / -,9 brdw..k 6r ( - S'(,
S h�l C�rcv,� 3 = •! 25, °o c�dd`/ br4hG� ►G. � (6.4s) y3./O
. = 2/'3o ' 3 V -
s� 7e et 1-1,20-
116,6k , p 6
�! /�
b- o
I, u Cl VtG 1 h ��" � -
A/ e Q
1 -au `
Coe c -r" f'
c, c� O —00 /V 7 '\
/✓ER/ FED
f�E2�i - /D/ 7 , /5" — / Jc 9s = 77, v2 a
E heal Permit Apal' cation FOR OFFICE ICE uSE ONLY
City of Tigard 9 Date /B Received 3 /6 D ,
Permit No. ( �5 _ QO /
13125 SW Hall Blvd., Tigard, OR 97223 (� Plan Revi
Phone: 503.639.4171 Fax: 503.598.1960 ON\ /',;,�rygr; i > Date/B . Other Permit. Inspection Line: 503.639.4175 NQ \s \1- �O ;- . „!.ii a`I_I . Date Ready /By 0 See Page 2 for
Internet. www.tigard- or.gov O�d° 1® Notified/Method: ., ,& , ,,,;(,d supplemental Information
TYPE OF W K O, , t on/re PLAN REVIEW
• El New construction ❑ Addition/alte��
{{��� Please check all that apply:
��(S,, -3-,) t.LJervice over 225 amps, comm'l ❑Hazardous location
El Demolition ❑ Other:
❑ Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF d4 Ii' ION of l- and 2- family dwellings 4 or more new residential
❑ 1 and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structurc
❑ Multi family ❑ Master builder ❑ Other: ❑Building over three stories ❑Feeders, 400 amps or more
DOccupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress /lighting plan RV park
Job no.: Job site address: ' ' 5 5( 'b p..1 , ❑Health - care facility ❑Other:
Submit 2 sets of plans with any of the above.
City /State /ZIP: ; l b - _l De_ q �f Z Z4 The above are not applicable to temporary construction service
Suite/bldg. /apt. no.: � f Project name: � � r / �g FEE* .SCH Qty.
Description Qty. Fee. I Total I **
/
Cross street/directions to job site: r , t New residential single- or multi - fancily dwelling unit.
' V \ \ Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'I 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 p dwelling, service and/or feeder 90.90 2
(ak, l,Y . ri U e\ ( '°Kiit.\ t_ ' 7673144-4 ' Services or feeders installation, alteration, and /or relocation
t-= — (e_ 04 e•( �� � S / J
C...- 200 amps or less f 80.30 if 2
� . ROPERTY OWNER, ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 ■ 2
Name: 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State /ZIP: 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 600 amps 133.75 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
0—APPLICANT ,
❑- CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each �C 6.65 s7/. 2
Business name: 1 --- ,, f. O .,4_ ,,. I T 4- s7/. / 7
branch circuit '
3
� B. Fee for branch circuits
Contact name:U l "Jv f h without service or feeder fee, 46 � rO 2
first branch circuit + i
Address: 6 Ct C 3a4.4_ CD-0?--. Each add'I branch circuit (q' 6.65 93.1 i 2
City /State /ZIP: i ,�N r 0C).__ Miscellaneous (service or feeder not included),, .'L F es:: l}
Pump or irrigation circle 53 40 2
Phone:
(�03) 5( — `C� > ( 4 ( v d Sign or outline lighting 53 40 2
E -mail: Signal circuit(s) or limited -
CONTRACTOR ' energy panel, alteration, or 3 r
extension Describe: Page 2 O 2
Business name:
Address: Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State /ZIP: Investigation per hour (I hr min) 62 50
Phone' ( ) Fax: ( ) Industrial plant per hour 73.75
ELECTRICAL PER MIT FEES*
CCB Lie.: Electrical Lie.: Suprv. Lie.: Subtotal /Q 0, /5
Suprv. Electrician signature, required: Plan review (25% of permit fee) 25y a 9
Print name: Date: State surcharge (8% of permit fee) -/ 3 7
4,__A,t6.,:;_lt3.. TOTAL PERMIT FEE' ' ,J3$ /-- Authorized signature: \ " Th is permit application expires if a permit is not obtained within 180 -
` days after it has been accepted as complete
Print name: j 3 f Fkl/(" Date: 1..3l * Fee methodology set by Tn- County Building Industry Service Board
** Number of inspections per permit allowed
I \BuildingWermits\ELC- PernutApp doc 12/30/05 440- 4615T(I0 /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
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System *
❑ Vacuum Systems*
n Other:
COMMERCIAL WORK ONLY:
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1 \Bu Idmg \Permits\ELC- PermitApp doc 12/30/05
CITY OF TIGARD
- BUILDING DIVISION PERMIT #: ELC2005 -00147 •
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/8/2001
Phone: (503) 639 -4171 ilii iV
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 9/1/2006 TIME: 7:01AM PAGE: 1
SITE ADDRESS: 09000 SW DURHAM RD CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: TIGARD HIGH SCHOOL
DESCRIPTION: Girls locker room, CE2/Transitions TI. 7/13/2006 Added (6) Branch circuits and (2) amp feeders.
OWNER: TIGARD- TUALATIN SCHOOL DISTRICT 23J, PHONE #: 503.43.1 -4000
CONTRACTOR: COUGAR ENTERPRISES PHONE #: 503 - 256 - 77113
Inspection Request Scheduled For: Date: 911 /2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 035969 -01 503 -932 -2741 N
Corrections /Comments /Instructions:
a6 ik ooF G -F-c._I `Th6T S - PR,av i®a Poval, Etze_. AU_
-F C t .
nli . i> s4 (• zsl 6E-
R.oize " tci Raa� `p •
c
►2. PASS I PARTIAL APPROVAL n CANCEL I NO ACCESS
n FAIL ❑ CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
Inspector: G lt- NU I-4 Date: � r - I . ' $3 k Phone #: (503) 718-2114L•
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2005-00147
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/812005
Phone: (503) 639-4171 ntoppli 0
Inspection Requests (24 Hrs.): (503) 639-4175 . It A r3 I 0 F. a = .= a •
INSPECTION WORKSHEET FOR DATE: 8/24/2006 TIME: 6:59AM PAGE: 16
SITE ADDRESS: 09000 SW DURHAM RD CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: TIGARD HIGH Sr .
DESCRIPTION: Girls locker roon CE2/Trarisitionsil. 7/13/2006 Added (6) Branch circuits and (2) amp feeders.
OWNER: TIGARD-TUALATIN SC )0L DISTRICT 23,I, PHONE #: 503-431-4000
CONTRACTOR: COUGAR ENTERPRISE CYV■ I Kr) PHONE #: 503-
Inspection Request Scheduled For: Date: 8/24/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final -- i t 035502-03 503-932-2741 Y
---_-.
Corrections/Comments/Instructi ifs.
PASS PARTIAL APPROVAL El CANCEL I I NO ACCESS
• FAIL 7 CALL FOR INSPECTION I ADDITIONAL FEES ASSESSED
I • Inspector: G--i () 6(2) Li - Date: C al -2_4„ - b Phone #: (503) 718- 24440
- ,
CITY OF TIGARD
BUILDING DIVISION
PERMIT #: ELC2005-00147
—
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/812005
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175 JLW IL.
INSPECTION WORKSHEET FOR DATE: 8/23/2006 TIME: 7 : 03 AM PAGE:
SITE ADDRESS: 09000 SW DURHAM RD CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: TIGARD HIGH SCHOOL
DESCRIPTION: Girls locker room, CE2/Transitions TI. 7/13/2006 Added (6) Branch circuits and (2) amp feeders.
..61•■•■■•••■•••■•■■■,
OWNER: TIGARD-TUALATIN SCHOOL DISTRICT 23J PHONE #: 503-431-4000
CONTRACTOR: COUGAR ENTERPRISES PHONE #: 503-26171B
Inspection Request Scheduled For: Date: 13/23/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 035449-02 503-932-2741
Corrections/Comments/Instructions: \(\i\
CD, k pck '
t-1 Fiut, &'■ R4 GZ
•
I PASS Pi, PARTIAL APPROVA 7 CANCEL 7 NO ACCESS
FAIL U • • INSPECTION ADDITIONAL FEES ASSESSED
Inspector: Date: 15 ' O Phone #: (503) 718- 1-446
•
CITY OF TIGARD ., .
BUILDING DIVISION
III* PERMIT #: ELC2006-00147
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 61812006
Phone: (503) 639-4171 Akopliki 1 i f
Inspection Requests (24 Hrs.): (503) 639-4175 All. ti.
INSPECTION WORKSHEET FOR DATE: 8/24/2006 TIME: 6:59Arvi PAGE: 11
SITE ADDRESS: 09000 SW DURHAM RD CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: TIGARD HIGH SCHOOL
DESCRIPTION: Girls locker room, CE2iTransitions TI. 7/13/2006 Added (6) Branch circuits and (2) amp feeders,
OWNER: TIGARD-TUALATIN SCHOOL DISTRICT 23J, 'PHONE #: 603-431-400
CONTRACTOR: COUGAR ENTERPRISES PHONE #: 503-266-7718
Inspection Request Scheduled For: Date: 8/24/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
116 Electrical service 035502-01 503-932-2741 N
Corrections/Comments/Instructions:
4i) Liet gS1— ALL PA 014.6 1 ONI tiASb; nit) yRts,e 61..m 0 1
tiaiNi1R04513- .
4) Pazsvtioc N v NNISSAS AT c_i tz,r_A;11 ik.1 '13-
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o j) V IT N _ 7 Y OW N MI
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iLL
1 I PASS 7 PARTIAL APPROVAL pi CANCEL fl NO ACCESS
, AIL ACALL FOR INSPECTION I ADDITIONAL FEES ASSESSED
Inspector: 0_ N ci.6 Lc Date: 4 i; 1 'lir 0 Phone #: (503) 718- 1414'
CITY OF TIGARD .,
BUILDING DIVISION
A PERMIT #: ELC2005-00147
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/8/2005
Phone: (503) 639-4171 , oyf
Inspection Requests (24 Hrs.): (503) 639-4175 ,„3,11" ' -I..
INSPECTION WORKSHEET FOR DATE: 8/24/2006 TIME: 6:59AM PAGE: 17
SITE ADDRESS: 09000 SW DURHAM RD CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: TIGARD HIGH SCHOOL
DESCRIPTION: Girls locker room, CE21Transitions TI. 7/13/2006 Added (6) Branch circuits and (2) amp feeders.
OWNER: TIGARD-TUALATIN SCHOOL DISTRICT 23J, PHONE #: 503-431-4000
CONTRACTOR: COUGAR ENTERPRISES PHONE #: 503-266-7718
Inspection Request Scheduled For: Date: 8/24/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
130 Ceiling cover 035502-02 503-932-2741 N
Corrections/Comments/Instructions:
a_fi...xbas; 6 .
UASS PARTIAL APPROVAL 0 CANCEL 1 I NO ACCESS
I FAIL pi CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED ,
Inspector: G 1NR-a Noe 1 --‘ Date: 2 141° 6 &- I Ji ll i t s
Phone #: (503) 718- I PT 7 Li
L _ '
CITY OF TIGARD . ‘
BUILDING DIVISION PERMIT #: ELC200G-00147
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/8/2005
Phone: (503) 639-4171 llil
Inspection Requests (24 Hrs.): (503) 639-4175
..;'
INSPECTION WORKSHEET FOR DATE: 8/23/2006 TIME: 7:03AM PAGE: 2
SITE ADDRESS: 09000 SW DURHAM RD CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: TIGARD HIGH SCHOOL
DESCRIPTION: Girls locker room, CE2/Transitions TI. 7/13/2006 Added (6) Branch circuits and (2) amp feeders.
.--..
OWNER: TIGARD SCHOOL DISTRICT 23J, PHONE #: 503-431-4000
CONTRACTOR: COUGAR ENTERPRISES PHONE #: 503-256-7718
Inspection Request Scheduled For: Date: 8/23/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
130 Ceiling cover 035449-01 503-932-2741 Y
Corrections/Comments/Instructions:
'1), S vise ItS(t3 AU- WP(Licsf% eka3v1
...
Nio• „ d
Lhrt Cr6a3 62, T I Le\ .0
f iNi C/L.
1 N\ (- - f7c .
J
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0 t116NraiL Pil..., ..., ... ■
"..
PASS I I PARTIAL APPROVAL fl CANCEL n NO ACCESS
,ISI FAIL n CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: , .. '"-'v I__‘: Date: 4 k "2-3- a Phone #: (503) 718-141-14.)
CITY OF TIGARD -
BUILDING DIVISION PERMIT #: ELC2005-00147
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/8/2005
Phone: (503) 639-4171 , tif 4 t
Inspection Requests (24 Hrs.): (503) 639-4175 ...Ali" '---.
INSPECTION WORKSHEET FOR DATE: 8/170006 TIME: 7:01AM PAGE: 8
SITE ADDRESS: 09000 SW DURHAM RD CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE: •---
PROJECT NAME: TIGARD HIGH SCHOOL
DESCRIPTION: Girls locker room, CE2fTransitions TI. 7/13/2006 Added (6) Branch circuits and (2) amp feeders.
OWNER: TIGARD-TUALATIN SCHOOL DISTRICT 23J, PHONE #: 503-431-4000
CONTRACTOR: COUGAR ENTERPRISES PHONE #: 503
Inspection Request Scheduled For: Date: 8/1712006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
130 Ceiling cover 035172-01 503-932-2741 N
Corrections/Comments/Instructions:
CI F - 1 al-. or-i-'1 e_E--, Ra 6F
&
PAS; P e, IAL APPROVAL n CANCEL NO ACCESS
• I I C' L FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: Gle 1\168 (..)/ Date: t n 0() Phone #: (503) 718- 14144)
_ .
-----...-
CITY OF TIGARD ., .
BUILDING DIVISION PERMIT #: ELC2005-00147
,
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 802005
Phone: (503) 639-4171 Ats/4111
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 8/16/2006 TIME: 7:05AM PAGE: 1)
SITE ADDRESS: 09000 SW DURHAM RD CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: TIGARD HIGH SCHOOL
DESCRIPTION: Girls locker room, CE2/Transitions TI. 7/13/2006 Added (6) Branch circuits and (2) amp feeders.
OWNER: TIGARD-TUALATIN SCHOOL DISTRICT 23J, PHONE #: 503-431-4000
CONTRACTOR: COUGAR ENTERPRISES PHONE #: 603-256.7718
Inspection Request Scheduled For: Date: 8/16/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
130 Ceiling cover 035066-01 503-932-2741 V
Corrections /Comments/ Instructions:
A c e(' 1 1 tit clA -*;- So 1 o 4'
, (44-1-/ es4 ;he- s z. e I(
0
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A Liu
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4 i., a i.e.1,,,, 0 i412..- 4e-t,4.../p tik 4-1 0 ti It & it
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I I PASS PARTIAL APPROVAL 7 CANCEL NO ACCESS
_ FAIL CALL FOR INSPECTION 7 ADDITIONAL FEES ASSESSED
Inspector:
Aaa
Date: J o6 Phone #: (503) 718-
_ . .
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2005-00147
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/8/2005
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 8/15/2006 TIME: 7:054A PAGE: 72
SITE ADDRESS: 09000 SW DURHAM RD CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: TIGARD HIGH SCHOOL
DESCRIPTION: Girls locker room, CE2fTransitions TI. 7/13/2006 Added (6) Branch circuits and (2) amp feeders.
OWNER: TIGARD-TUALATIN SCHOOL DISTRICT 23J, PHONE #: 503-431-4000
CONTRACTOR: COUGAR ENTERPRISES PHONE #: 503-256-7716
Inspection Request Scheduled For: Date: 8/15/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
130 Ceiling cover 034927-01 503-932-2741
Corrections/Comments/Instructions:
•
•
s 0 C.. k €21 t( t4 9
ox 41\
*ci re 11 0 ' 1 c - a
(1) // 1'4 14Al24-440 etc C4.1 io
V
Cit t"-e- s p er+4-e-Ci
C 0 62_ ce;•litfrils
•
PASS TIAL APPROVAL r7 CANCEL I I NO ACCESS
FAIL n CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
1
1 Inspector: Date: 4 '•-• 6 Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION . , .
, PERMIT #: ELC2006-00147
13125 SW Hall Blvd., Tigard, OR 97223 ' DATE ISSUED: 6/8/2006
Phone: (503) 639-4171 ,..... /asm i llit
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 8111/2006 TIME: 7:06AM PAGE: 64
SITE ADDRESS: 09000 SW DURHAM RD CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: TIGARD HIGH SCHOOL
DESCRIPTION: Girls locker room, CE2/Transitions TI. 7/13/2006 Added (6) Branch circuits and (2) amp feeders.
OWNER: TIGARD-TUALATIN SCHOOL DISTRICT 23J, PHONE #: 503-431-4000
CONTRACTOR: COUGAR ENTERPRISES PHONE #: 503-256-7718
Inspection Request Scheduled For: Date: 8/11/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
--free Efmtriral-firrat- 034818-01 603-932-2741 N
fl ---- r
Corrections/Comments/Inst ctions:
<i) S v e•ptia A 6 1., Piqz_c ALfro-ve• vii (lair i 0 Pep (tf:411 rA
O P a-0v vO'C Z 64 X) 6.-g■t*. citaag.6 ,
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1.161"
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1 I PASS PARTIAL APPROVAL 0 CANCEL fl NO ACCESS
FAIL 0 CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
Inspector: 1\1 L.. Date: ' 1 06 Phone #: (503) 718- Mitt'
CITY OF TIGARD . .. .
BUILDING DIVISION V PERMIT #: ELC2005-00147
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/1312005
Phone: (503) 639-4171 ,,..eitilli V\
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 7/11/2006 TIME: 7 : 1)0 AM PAGE: 62
SITE ADDRESS: 09000 SW DURHAM RD CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: TIGARD HIGH SCHOOL
DESCRIPTION: Girls locker room, CE2/Transitions TI.
OWNER: TIGARD-TUALATIN SCHOOL DISTRICT 23J, PHONE #: 503-431-4000
CONTRACTOR: COUGAR ENTERPRISES PHONE #: 503-256-7718
Inspection Request Scheduled For: Date: 7/11/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
125 Wall cover 0328137-01 503-932-2741 V
—
Corrections/Comments/I tructions:
its
‘1 1., \R.
3 'V-- cov wALL5 ,
— il" - PR.. , )‘Z. F - e -- Es F F'a-a Hz:poscu To,
6, --- t-,N5 .
I I PASS PARTIAL APPROVAL I CANCEL fl NO ACCESS
I I FAIL 1 CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector: .-- 1 S q---Q\-- , NJ q• C.Z Date: )-) 1/1 6 b Phone #: (503) 718-
, .
0
, .-'•• -W, ■, . ,
CITY OF TIGARD .
BUILDING DIVISION PERMIT #: ELC2005-00147
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 602006
Phone: (503) 639-4171 :NM t
Inspection Requests (24 Hrs.): (503) 639-4175 ....,._,W • - .....
INSPECTION WORKSHEET FOR DATE: 6/30/2006 TIME: 701A1v1 PAGE: 1
SITE ADDRESS: 09000 SW DURHAM RD CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: TIGARD HIGH SCHOOL
DESCRIPTION: Girls locker room, CE2fTransitions TI
OWNER: TIGARD-TUALATIN SCHOOL DISTRICT 23J, PHONE #: 503-431.4000
CONTRACTOR: COUGAR ENTERPRISES PHONE #: 5°3256
Inspection Request Scheduled For: Date: 6 Pour Time:
Code # Inspection Description Confirm # Contact # Message
120 Electrical rough-in 032521-01 503-983-2274 Y
32 27 y I
Corrections/Comments/Instructions: r
k PA )
MI K "C 1 R
Fik.o(y kockov b16)
fto Wil Go v e 1 • 4 c_.... -.1 . 4 -. 6 '
. 1
3o37 5
J
1 I
gl 1 i 5) A \ {) 511
M IL,1,,u c 7 : .
PASS XPARTIAL APPROVAL D CANCEL [ NO ACCESS
I I FAIL 0 CALL FOR INSPECTION 7 ADDITIONAL FEES ASSESSED
Inspector: G-tkati N6t Lie Date: 1 ' 30-64 Phone #: (503) 718- 244.
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2005-0(1147
. .
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 602006
Phone: (503) 639-4171
/"./
Inspection Requests (24 Hrs.): (503) 639-4175 g4.14. 111,
INSPECTION WORKSHEET FOR DATE: 5/24/2006 TIME: 7:12AM PAGE: fitt
SITE ADDRESS: 09000 SW DURHAM RD CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: TIGARD HIGH SCHOOL
DESCRIPTION: Girls locker room, CE2f IrmsItions
OWNER: TIGARD-TUALATIN SCHOOL. DISTRICT 23J, PHONE #: 503-431•4000
CONTRACTOR: COUGAR ENTERPRISES PHONE #: 503-25G 7718
Inspection Request Scheduled For: Date: 5/24/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
125 Wall cover 0:30489-01 503-932.2741
Corrections/Comments/Instructions:
— OA 'Is FM tr pLho .
it ct t -
AaN
•
•
I 1 PASS ' PARTIAL APPROVAL D CANCEL D NO ACCESS
i FAIL n CALL FOR INSPECTION D ADDITIONAL FEES ASSESSED
Inspector: C .-- • 6e Date: 24 C)6 Phone #: (503) 718-