Permit CITY OF TIGARD MASTER PERMIT
COMMUNITY DEVELOPMENT D T PERMIT # MST94 -0042
�M DATE ISSUED: 02/22/94
13125 SW Hell Blvd. Tigard. Oregon 97223.8199 (503) 639 -4171
PARCEL: 25114BB -16000
SITE ADDRESS...: 10241 SW PICK'S CT
SUBDIVISION • RIVERVIEW ESTATES ZONING: R -7 PD
BLOCK • LOT -6
BUILDING
REISSUE: DWELLING UNITS:1 BASEMENT •0 sf
CLASS OF WORK.:NEW BEDRMS:4 BATHS:3 GARAGE •760 sf
TYPE OF USE...:SF FLOOR AREAS REQUIRED SETBACKS
TYPE OF CONST.:5N FIRST •1250 sf LEFT..:16 ft RIGHT.:15 ft
OCCUPANCY GRP.:R3 SECOND...:1055 sf FRONT.:20 ft REAR..:25 ft
STORIES •2 THIRD •0 sf REQUIRED
HEIGHT •32 ft TOTAL :2305 sf SMOKE DETECTORS.:Y
FLOOR LOAD •40 psf VALUE $• 119710 PARKING SPACES..:1
Remarks: PATH I
PLUMBING
SINKS -1 FLOOR DRAINS •0 BACKFLOW PREVNTRS..:0
LAVATORIES •4 WATER HEATERS...:1 TRAPS :0
TUB /SHOWERS •3 LAUNDRY TRAYS...:0 CATCH BASINS -0
WATER CLOSETS..:3 SEWER LINE (ft).:0 GREASE TRAPS •0
DISHWASHERS •1 WATER LINE (ft).:100 OTHER FIXTURES •0
GARBAGE DISP...:1 RAIN DRAIN (ft).:0
WASHING MACH...:1 SF RAIN DRAINS..:1
MECHANICAL FEES
FUEL TYPES UNIT HTRS..:0 type amount by date recpt
/GAS/ / / VENTS •0 BPRT $ 483.00 JH 02/22/94 —
MAX INPUT:0 BTU VENT FANS..:4 BPLC $ 313.95 JLH 02/03/94 94—
FURN ( 100K ..:0 HOODS •1 B5PC $ 24.15 JH 02/22/94 —
FURN > =100K ..:1 WOODSTOVES.:0 SSDC $ 280.00 JH 02/22/94 —
FLOOR FURN •0 CLO DRYERS.: 1 PARK $ 500.00 JH 02/22/94 —
BOIL/CMP ( 3HP:0 OTHER UNITS:1 MPRT $ 45.00 JH 02/22/94 —
GAS OUTLETS:1 MPLC $ 11.25 JH 02/22/94 —
Owner: M5PC $ 2.25 JH 02/22/94 —
SKYLIGHT HOME BUILDERS CO PPRT $ 147.50 JH 02/22/94 —
P 0 BOX 2315 P5PC $ 7.38 JH 02/22/94 —
TIFF $ 1520.00 JH 02/22/94 —
LAKE OSWEGO OR
Phone #: 636 -2994.
Contractor:
SKYLIGHT HOME BUILDERS CO
P 0 BOX 2315
LAKE OSWEGO OR 97035
Phone #: 503 - 636 -2994
Reg #..: 34086
$ 3334.48 TOTAL
This permit is issued subject to the re . a ' ons contained in the REQU I RED I NSPECT I ONS
Tigard Municipal Code, State of Ore. S ecia y Codes and all other Foot /found Insp Fireplace Insp
applicable laws. All work will be doh i accordance with approved Post /Beam Struct Gas Line Insp
plans. This permit will expire if Oi not started within 180 Post /Beam Mechan Insulation Insp
days of issuance, or if work is cusp d- for more than 1 :)! days. Plm /undslab Insp Gyp Board Insp
PLM /Underfloor Rain drain Insp
Permittee Signature II, Mechanical Insp Water Line Insp
Plumb Top Out Appr /Sdwlk Insp
Issued By: Framing Insp Mechanical Final
Call for inspection — 639 -4175
Residential Building Permit Application
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223
(503) 639 -4171
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Jobsite Address: 7'-I S Pic Ns' co vR-T
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Subdivision: r,ve,rr t,,p AT rf Lot #
Valuation: aivat n• o
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Owner: S T �
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Address:
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Phone: 63 Z
<Approvals= Required; is :.:;,
PlanningtG!. .�i'I= ='
Contractor: tract r:
I
Address:
dd ess: -
Phone:
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# 3`)%
- -
Contractors Lice
- - --
of current Oregon license)
shoo ocuet - - - - --
(attach -- -
P e9
( copy -
<�Triss.. = . = ..
Subcontractors:
ntracto -
................ _
PI
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Plumbing: C �
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ng :
W
Mechanical: in L. e lit P 69
(attach copy of current OFi Contractor's License)
Architect/Engineer: Si( C' PT He h)e.1 1, 7/W o
Address: 5 .4rnc_ -e
Phone: 636 —2 .9 Y
COMMENTS: OAR S DE /1p 1.� .25 &At," Q�i.4./` 1r �-�t�p .lr.. -� I o I fl'F
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1 6 -?1'Y
: ignat
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Received by: Date Received: j "
Permit # Account Description Amount Amt. Pd. Bal. Due
r/ - ooIZ- Bldg. Permit (BUILD) VS -
Plumb. Permit (PLUMB) / / 7, so V / / 7 , 3 -7)
Mech. Permit (MECH) L7 } , 4 /5 — li d
State Tax (TAX) 33. 7! 3 3.7k
Bldg: //
Plumb: %• 3 ? •
Mech: _2 • L
Plan Check (PLANCK) / 75 20
Bldg: 3(3,97C /
Plumb:
Mech: - //, L 5
o u S/ Sewer Connection (SWUSA) ,� "
Sewer Inspection (SWINSP) 3� 3 ' J
Parks Dev Charge (PKSDC) S� U / 5 &O
Storm Drainage Chg (SDSDC) ,7 /
Residential TIF (TIF -R) / /
Mass Transit TIF (TIF -MT) / /
Commercial TIF (TIF -C)
•
Industrial TIF (TIF -1)
Institutional TIF (TIF -IS) -
Office TIF (TIF -0) -
Water Quality (WQUAL) --. -- . - - - . _ . _.
Water Quantity .(WQUANT) •
Fire District (FIRE) •
._.
C \
TOTALS: 3 e/If
TRAFFIC IMPACT FEE
Installment Payment Application and Disclosure Statement
In the Matter of the Traffic Impact Fee for Skylight Home Builders
Tax Map 2S114BB Lot Number(s) 6 Building Permit # MST94 -0042
Site Address 10241 SW Pick's Ct. Subdivision Riverview Estates
Case File # SUB90 -0014 TIF Land Use District R -7 PD
To Be Billed To: Skylight Home Builders Co.
Address: PO Box 2315, Lake Oswego, OR 97035 Phone #: 636 -2994
To the City of Tigard:
In accordance with the provision of Oregon Revised Statute 223.208 and Washington County Ordinance
No. 379 which relates to the imposition of a traffic impact fee for the financing of major collector roads and
arterials of Washington County, I/we HEREBY MAKE APPLICATION AND AGREE, JOINTLY AND
SEVERALLY, to pay my /our traffic impact fee, as has been determined by Washington County Ordinance
No. 379 in 10 semi - annual installments of the amount financed together with one -half of one year's
interest thereon at a rate of 7.5 annual percentage rate on the unpaid amount owed. The lien date is the
first day of the month following the date the application is signed. The first payment is due six months
thereafter and at six (6) month intervals thereafter for a period of 5 years. Each installment payment will
include principal and interest.
If I \we neglect or refuse to pay any part of the installments provided herein, including interest, within one
(1) year after the same shall have become due and payable, then the whole amount of the unpaid
assessment shall become due and payable at once and shall be collected in the manner provided by law
including foreclosure on the above - described real property.
The traffic impact fee, annual percentage rate of interest (7.5 %) and finance charges which I/we agree
to pay are as follows:
HIGHWAY TRANSIT
1) Amount of Traffic Impact Fee $ 1410.00 110.00 ¢
2) Amount Financed $ 1410.00 110.00 >
3) Equal Semi - Annual Principal Payments $ 141.00 11.00
4) Interest on Balance at Rate of 7.5 %
l\We understand that the amount owed, as stated above, shall be a lien on the above - described subject
prope y •ursuant to Washington County Ordinance No. 379 Section 6 (D) and ORS 223.230.
DATE. this 22nd day of February , 1994.
r .
Si', na r= of Property Owner(s) Signature of Property Owner(s)
STATE OF OREGON ) Name (Please Print): � iP. arfin
) Address: .:31.25 SW g al ; vC _ avol_ 7225
County of Washington ) ' /
SUBSCRIBED AND SWORN TO BEFORE me this ( ma day of ktaka , 19 ?7 .
Iopin\viol OFFICIAL SEAL
J
Notary Public for Oregon
e i NOTARY PUBLIC 0 OREGON
�.
/ COMMISSION No. 015877 ` '/ /
MY COMMISSION EXPIRES JUNE 4, 1996 My Commission Expires: l /'t 9h
a n
P
CITY OF T I GARD LUMBING PERMIT
# MST94 -0042
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 02/22/94
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 839 -4171
PARCEL: 2S114BB -16000
SITE ADDRESS...: 10241 SW PICK'S CT
SUBDIVISION • RIVERVIEW ESTATES ZONING: R -7 PD
BLOCK LOT -6
CLASS OF WORK..:NEW GARBAGE DISPOSALS..:1
TYPE OF USE •SF WASHING MACH •1 BACKFLOW PREVNTRS..:0
OCCUPANCY GRP..:R3 FLOOR DRAINS •0 TRAPS °0
STORIES °2 WATER HEATERS •1 CATCH BASINS •0
FIXTURES LAUNDRY TRAYS -0 SF RAIN DRAINS -1
SINKS •1 GREASE TRAPS •0
LAVATORIES •4 OTHER FIXTURES •0
TUB /SHOWERS SEWER LINE (ft) :0
WATER CLOSETS..:3 WATER LINE (ft) °100
DISHWASHERS °1 RAIN DRAIN (ft) •0
Remarks: PATH I
OWNER: FEES
SKYLIGHT HOME BUILDERS CO BPRT $ 483.00 JH 02/22/94 -
P 0 BOX 2315 BPLC $ 313.95 JLH 02/03/94 94-
B5PC $ 24.15 JH 02/22/94 -
LAKE OSWEGO OR SSDC $ 280.00 JH 02/22/94 -
Phone #: 636 -2994. PARK $ 500.00 JH 02/22/94 -
MPRT $ 45.00 JH 02/22/94 -
Plumbing Contractor: MPLC $ 11.25 JH 02/22/94 -
�/ M5PC $ 2.25 JH 02/22/94 -
Name: PPRT $ 147.50 JH 02/22/94 -
Address: PSPC $ 7.38 JH 02/22/94 -
City: State: TIFF $ 1520.00 JH 02/22/94 -
Zip: Phone #:
Reg #:
REQUIRED INSPECTIONS
This permit is issued subject to the reg-
ulations contained in the Tigard Municipal Foot /found Insp Rain drain Insp
Code, State of Ore. Specialty Codes and all Post /Beam Struct Water Line Insp
other applicable laws. All work will be done Post /Beam Mechan Appr /Sdwlk Insp
in accordance with approved plans. This Plm /undslab Insp Mechanical Final
permit will expire if work is not started PLM /Underfloor Plumb Final
within 180 days of issuance, or if work is Mechanical Insp Building Final
suspended for more than 180 days. Plumb Top Out Erosion Control
Framing Insp Crawl Drain
Fireplace Insp
Gas Line Insp
Insulation Insp
x .�, L �� / %., AL/ 41 Gyp Board Insp
Au horized Plumbing Contractor Signature
Call for inspection - 639 -4175
Contractor Notes:
MT7Y -5 y z
•
DEPARTMENT OF LAND USE & TRANSPORTATION
AIN WASHINGTON 155 NORTH FIRST, H DEVELOPMENT
O OR 97124
COUNTY, INSPECTION REQUESTS: 503/840- 3561/693 -4415
OREGON xXXXXxXXx - -> 640 -3470
Page : 1 of 1
Date : 05/15/95
Time : 09:39
Permit Type : Residential Electrical Permit Permit # : 05067684
Permit Status : APPROVED - Applied : 05/12/95
Situs Address : 10241 SW PICKS CT Ti. Issued : 05/12/95
Permit Title : SFR - BURGLAR ALARM L . V . Completed :
Permit Descr. : To
•
Expire : 11/08/95
Project Title : SFR - BURGLAR ALARM L.V. Project # : P0049955
Project Descr. : * EROSION *
Parcel Number : 251'1'1 - Land Use District :
Valuation 0
•
Legal Descr. •
Owner : INSPECTION - '1'1GARD Construction : O'TH
Applicant Name : AD'1' Classification : 900
Applicant Ad. : '703 NE HANCOCK Occupancy : R3
PORTLAND, OR 97212 Validated by : LG
Applicant Prone: 284 -3265 X35 Inspector Area :
Fee description Units Fee /Unit Ext fee Data
•
Limited Energy /Alter. /Extension 1 40.00 40.00
Subtotal Electrical Fees: 40.00
State Surcharge of 5% 2.00
Total Electrical Fees: 42.00
* ** Fees Required * ** * ** Fees Collected & Credits * **
Method Check # Receipt No. Date Payment
'DEP' OS/12/95 42.00
Fees: 42.00
Adjustments: .00 Total Credits: .00
Total Fees: 42.00 Total Payments: 42.00
Balance Due: .00
NOTICE: This permit becomes null and void N the work or construction for which it Is issued is not commenced within 180 days. Once construction has started,
the permit becomes null and void if construction Is interrupted for a period of 180 days. I certify that the Information presented by the applicant and
his agent or agents in support of this permit Is true and correct to the best of our knowledge. I acknowledge that the Building Department's reliance
upon false and misleading Information may Invalidate this permit. All provisions of applicable laws and ordinances governing the construction and use
of this building or structure will be compiled with whether or not specified on the plans or noted on the plans correction sheets. I acknowledge that
the granting of a permit does not grant authority to access private property or to use easements. I further acknowledge that the use or occupancy of
the structure or building permitted depends upon my calling for Inspections at various times during the process of construction and the building
inspection staff verifying compliance with the various codes. Use or occupancy of the building or structure permitted prior to approval by the
Building Department is solely at the risk of the applicant and such use or occupancy Is revocable until all inspection requirements are satisfied and
approval is given by the Building Official. I further acknowledge that a lien may be placed on the title of the property upon which the permit Is issued r
specifying that the use or occupancy of the building or structure is provisional and revocable until the satisfaction of all inspection requirements.
APPLICANT'S SIGNATURE
allk WASHINGTON COUNTY w . " RESTRICTED
Department of Land Use & Transportatio
iblp Electrical Inspection Section ELECTRICAL ENERGY
155 North First Avenue, #350 -12
H) 640-3470 Oregon 97124 APPLICATION
Information: (503) 640 -34Or70 g Fax: (503) 6934412
PLEASE PRINT ���
Please complete all sections, 1 through 5. Permit No.
/ 1. Location of ins A N t Date c 1�
Address c) 4 1/ LC/ l.0 j er
City 0_,Loe Zip Code •,,Z.Z -y 4. Type of work:
Map No. §5 `–R Tax Lot RESIDENTIAL Restricted Energy Fee $40.00 ■
Thomas Map Book: Page (o ' s Secti l� — / (for all systems)
i Check type of work involved:
Directions !L _ 1. ... /e -h _ ,
l)-71.,b) l e - ( _ Audio and Stereo Systems*
Commercial ❑ Residential 2'....--. $ Burglar Alarm
Telephone Systems*
Tenant Name _ - Garage Door Opener*
(if commercial) _Fire Alarm
H eating, Ventilation and Air Conditioning Systems*
2. Contractor application: _ Vacuum Systems*
_ Other
Electrical Contractor .41_=
Address 0 Al 9 .4 0 ,■_ COMMERCIAL Fee for each system $40.00
City is X State (l Zip 9 7,a /2- (see OAR 918 - 260-280)
Date 0 - Job Number Check type of work involved:
Property Owner ) 4i rx l• b . S fip a p, itt
Contractor's License No. _ai .ZO 9
•
Contractor's Board Reg. No. ,S q 9 Sty: _ B oiler Controls
Phone No. C lock Systems
Data Telecommunications Installations
- Fire Alarm Installation
3. Owner application: - HVAC
6 7-0 - 66p - Instrumentation
Print Owner's Name Phone No. • — Intercom and Paging System
- Landscape Irrigation Control*
Address — Medical
' — Nurse Calls
City State Zp — Outdoor Landscape Lighting*
This permit is issued under OAR 918 -320 -370. The applicant agrees - Protective Signaling
to make only restricted energy installations (100 volt amps or less) Other
under this permit and to do the following: -'
1. Only use electrical licensed persons to do installations where
required. (Certain residential and other transactions are exempt Number of Systems
from licensing. These have asterisks ("). All others need licens-
2. Call for an inspection when all the installations under this permit * No licenses are required. Licenses are required for all other installations.
are ready for inspection.
3. Purchase separate permits for all installations that are not ready 5. Fees
for inspection when the inspector is out to inspect under this
permit. Enter fees $ Q
4. Assume responsibility for assuming that all corrections required
. by the inspector are done, and 5 Surcharge (.05 X total above
5. Assume responsibility for calling for a final Inspection when all of 9 ( above) $
the corrections are completed.
The person signln is permit mus a the 0-p in • • ca or a person Trust Account $ y2 --
authorized to bin /e applica -
•
Signature 1/ . /' �/ /� � � Total $
Authority if other than applicant This permit becomes null and void if the work authorized by the
permit is not commenced within 180 days from date of issuance
For inspections call of such permit or if the work authorized Is suspended or abandoned
640 -3561 or 693 -4415 at any time after work is commenced for a period of 180 days.
Electrical Permits are non - refundable and non - transferable.
24-hour recorder, one working day in advance of need BL24 - 114
6/1/99 Activities for Case #: MST94 -00042
2:39:26 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
MSTA007 Application received 2/3/94 JLH PASS BLT 2/7/94
MSTA010 Plan check deposit paid 2/3/94 JLH PASS BLT 2/7/94
MSTA020 Plan check by 2/7/94 2/7/94 RT PASS BLT 2/7/94
MSTA030 Check for prd. restrict. 2/7/94 2/7/94 VG PASS BLT 2/7/94
MSTA705 Foot/found Insp 2/24/94 TLP PASS TLP 3/1/94
MSTA710 Post/Beam Structural 3/8/94 TLP PASS TLP 3/8/94
MSTA711 Post/Beam Mechanical 3/8/94 TLP PASS TLP 3/8/94
MSTA717 PLM /Underfloor 3/7/94 MS PASS MRS 3/8/94 need to insulate infront of
house vents
MSTA720 Mechanical Insp 4/21/94 RB FAIL RB 4/22/94 see building final
MSTA722 Plumb Top Out 4/15/94 MS FAIL MRS 4/18/94 water ok need tpo re -test waste
MSTA725 Framing Insp 4/21/94 • RB FAIL RB 4/22/94 ELECTRICAL COVER REQ'D;
SUPPORT 4- LAMINATED
FLOOR JOIST- ; FIRESPACER
REQ'D TO BE PLACED AT
TOP OF FIREPLACE CHASE.;
CHASE DUCTWORK IN N.
BEDROOM CLOSET; SINGLE
PLATE SUPPORT REQ'D FOR
RAFTERS BEARING ON
WALL- MIDDLE BEDROOM;
MASTER BEDROOM- CEILING
JOIST SUPPORT; POSITIVE
CONNECTIONS
THROUGHOUT; NOTCHED
FLOOR/CEILING JOIST IN
CORNER NE; EXHAUST
VENTING- SEAL FAN
HOUSING TO VENT.
MSTA735 Gas Line Insp 4/21/94 RB PASS RB 4/22/94 #116529
MSTA740 Insulation Insp 4/26/94 WEW PASS RB 4/26/94 PENDING FIRESTOPPING
REQ'D AT PENETRATIONS
TO TOP AND BOTTOM
PLATES EAST WALL IN
BATHROOM (EAST)
MSTA745 Gyp Board Insp 5/2/94 TLP PASS TLP 5/3/94
MSTA755 Rain drain Insp 3/10/94 TLP PASS TLP 3/10/94
MSTA760 Water Line Insp 3/10/94 TLP PASS TLP 3/10/94
MSTA795 Mechanical Final 6/16/94 RB FAIL RB 6/17/94 see building final this date
MSTA797 Plumb Final 6/13/94 MS PART MRS 6/14/94 sewer dean -out? dean -out ok
Page 1 of 2
6/1/99 Activities for Case #: MST94 -00042
2:39:26 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
MSTA799 Building Final 6/16/94 RB FAIL • RB 6/17/94 b -vent termination; front steps;
bonus room- attic door jams
need to be insulated.
MSTA097 Issue plumbing signature form 2/22/94 JH 2/22/94
MSTA092 (F) Issue combination permit 2/22/94 JLH PASS JH 2/22/94
MSTA705 Foot/found Insp 2/28/94 RB PASS RB 3/2/94 MAINTAIN SEISMIC
RESTRAINT; STUB -OUT FOR
CONTINUOUS FOOTING.
MSTA095 (F) Reprint Permit 3/25/94 JG 3/25/94
•
MSTA007 APPlication received 4/21/94 MRS 4/21/94
•
MSTA722 Plumb Top Out 4/21/94 MS PASS MRS 4/21/94
MSTA726 Framing <REINSP> 4/22/94 WEW PASS RB 4/25/94 EXHAUST FANS TO BE
CONNECTED. TWO 1/4 " X 2
1/2" LAGS AT NOTCH UNDER
TUB.
MSTA765 APPr /Sdwlk Insp 5/12/94 LT PEND KE 6/6/94 1) Remove drain line in
sidewalk. 2) Move drain line to
location marked - core
sidewalk. 3) Leave panel until
• new drain line is place. 4) Install
drain line to existing curb weep
hole to north of approach. 5)
Remove driveway from right of
way - either move back of
approach to go all the way
across and form new wing or
use bender board as marked.
MSTA720 Mechanical Insp 4/22/94 WEW PASS RB 6/16/94
MSTA799 Building Final 6/17/94 TLP FAIL TLP 6/17/94 HANDRAILS MISSING FRONT
STEPS
MSTA795 Mechanical Final 6/20/94 RB PASS RB 6/20/94
MSTA799 Building Final 6/20/94 RB PASS RB 6/20/94 pending- steps w/ handrail
handrail on order - Argo Safety
Railings Inc., Portland ) - to be
placed as soon as possible and
to be picked up this date.
Temp C of 0 asked for in the
. meantime.
MSTA970 Case Finaled 6/20/94 RB PASS RB 6/20/94 see building final this date
MSTA975 (F) Issue Temp Cert. of Occ 6/20/94 RB PASS RB 6/20/94 see building final this date.
MSTA795 Mechanical Final 6/20/94 RB PASS RB 6/20/94
MSTA799 Building Final 6/20/94 RB PASS RB 10/11/94 pending installation of
handrails. handrail installed- ok
MSTA960 (F) Issue Cert. of Occupancy 6/20/94 SKW PASS SW 6/23/94
Page 2 of 2
INSPECTION NOTICE
R.-...
City of Tigard Building Department
13125 SW Ball Blvd. Tigard, Oregon 97223
Inspection Line (Rec-O- Phone): 639 -4175 Business Phone: 639 -4171
Inspection:
Footing Plbg. Underslab Mech. Rough -in Appr /Sdwlk
Found. Plbg. Top Out Gas Line FIN -
Post /Beam Struct. San. Sewer Framing -Bldg.
Post /Beam Mech. Rain Drain Insulation - Plumb.
Plbg. Underfloor Water Line Gyp. Bd.
Date Requested: !ice[ W - G — ` _ 4- Time: AM M /� > PM
Address: ‘024 1 �W Q1 \( Permit #:4' 1 d - l7Q"1 L
Builder:
THE FOLLOWING CORRECTIONS ARE REQUIRED: Q
p .....e.9.....„.„..._....,, • _ - . - 6. _ 1
u� f r _ _ `•-•e l .. it ,
1 t�--� 1 7 y_l�� 1. c ���1L. ��
lit\(,)
.....- j
kvt (c
p) ,-(-7/ -
c}i/
Inspector: i Date: tp-'2. V -
APPROVED DISAPPROVED V APPROVED SUBJECT TO ABOVE
( , /Z Call For Reinep.