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Permit
is Slt CITY TIGARD MASTER PERMIT PERMIT #: MST2005 -00210 _A,L 44. DEVELOPMENT SERVICES DATE ISSUED: 9/29/2005 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S111AD -07000 SITE ADDRESS: 08855 SW SCHECKLA DR ZONING: R -4.5 SUBDIVISION: SCHECKLA PARK ESTATES LOT: 020 JURISDICTION: TIG Project Description: 340sf garage addition. BUILDING REISSUE: CUSTOM -C 5 STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED '� CLASS OF WORK: °" ( HEIGHT: FIRST: sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: TYPE OF USE: SF FLOOR LOAD: SECOND: sf GARAGE: 340 sf FRONT: 20 PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: TRIM sf RIGHT: 5 VALUE: 8 OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 0 sf REAR: 15 PLUMBING SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS: TUB /SHOWERS: GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIUCMP < 3HP: VENT FANS: CLOTHES DRYER: 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: 1 0 - 200 amp: W/SVC OR FDR: 2 PUMP/IRRIGATION: PER INSPECTION: EAADD'L 500SF: 201 • 400 amp: 201 - 400 amp: 1st W/OSVC/FOR: SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 • 600 amp: EA ADDL BR CIR: SIGNAL/PANEL: IN PLANT: MANU HM/SVC /FDR: 601 • 1000 amp: 601 +amps- 1000v. MINOR LABEL: 1000+ ampNolt : 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 WILLEY, GARY MIDIANE A OWNER and all other applicable laws. All work will be done in 8855 SW SCHECKLA DR accordance with approved plans. This permit will expire TIGARD, OR 97224 if work is not started within 180 days of issuance, or if the work is suspended for more than 180 days. ATTENTION:. Oregon law requires you to follow rules Phone: 503 - 624 - 9687 Phone: 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 #: direct questions to OUNC by calling 503 -246 -6699 or TOTAL FEES: $ 380.66 1- 800 - 332 -2344. REQUIRED ITEMS AND REPORTS Issued By : . I _ 4! it , /t�:!.L/ Permittee Signature : 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. i Building Permit ArivInttE f \/E r roil _Hit( is ! si 0 N1_1 City of Tigard Received /I _ e, Permit No • a _ /.• 13125 SW Hall Blvd, Tigard, OR 97223 rr r Phone: 501639.4171 Fax: 503.598.1960 J 2 8 200 G'i,: i,` P l DatdB "4 ^ f� -,pt; ' Other Perma Inspection Line: 503.639.4175 '' 'ii i � Date y /g y: �) r t See p Internet www,ei.tigardor.us CITY et- I IIaA - Notif ied/Merho d ! 7 1r I / S� p p temeatat mfnrmallen BUILDING DIVISION ,S y O\c.-q- (-'/Z oti,.. ,-a- TYPE OF WORK REQUIRED DATA 1- AND 2- FAMILY DWELLING ❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed Addition/alterati lacement 0 Indicate the value (rounded to the nearest dollar) of all P equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. g 4 _ g 1- and 2- family dwelling ❑ Commercial/industrial Valuation: $ ❑ Accessory building ❑ Multi family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: Job site address: b $. SW 5 AeGkh0. I) r . New dwelling area: - square feet City/State/ZIP: 7 C, i 0 R, 9 7zz y- 5 773 / image carport area: 3 y 0 square feet Suite/bldg. /apt. no.: Project name: u/t Li, y� 10ONG °L Covered porch area: square feet Cross street/directions to job site: Deck area: square feet Other structure area: square feet REQUIRED DATA: COMMERCIAL -USE CHECKLIST Subdivision: I Lot no.: Zd Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all Tax map/parcel no.: 2 S / / 14b DO O equipment, materials, labor, overhead, and the profit for the DESCRIPTION �� WORK work indicated on this application. 31" A ✓ tL� ��!! l40 -v e era t Aos Valuation: $ Existing building area: square feet New building area: square feet kr.PROPERTY OWNER I ❑ TENANT Number of stories: Name: 6, 4 ,,,_ 9 , t.l ay. y Type of construction: Address: €70,S s'w Se- e-cK L Q. OeeuP�Y groups: City/State/ZIP: `7 I _ OA . f' `7 Z"L Existing: Phone: (503 en, s 7 Fax: ( ) New: ❑ APPLICANT 7 gir CONTACT PERSON NOTICE Business name: All contractors and subcontractors are required to be Contact name: 413444,4 licensed licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: i b fa) m� 4 (in t2 jurisdiction in which work is being performed. If the applicant is exempt from licensing, the following reasons City/State/ZIP: $ i , me. ? /S{a apply: ./.... TO to V9 Phone: (7 3 .S' 7=' Y 8 I Fax: : ( ) S VI.3/ E- mail: - /O • 38 CONTRACTOR Business name: cer i4'l B as 04 ex — BUILDING PERMIT FEES* Address: Please refer to fee schedule City/State/ZIP: Fees due upon application Phone: ( ) I Fax: ( ) Amount received CCB lic.: Date received: Authorized si (� / This permit applicadon expires if a permit Is not obtained within 180 days after It has been accepted as complete. Print name: (5 M Vc t 7 /E y I Date: (p -, Q. 5 • Fee methodology set by Tri- County Building Industry Electrical Permit Application FUR OFFICE USE ONLY Cif of Ti and Received Permit No , � Oa 13125 SW Hall Blvd., Tigard, OR 9722RECE i L�/ a�5- a�0 Plan Review � Review Other Pemut: Phone: 503.639.4171 Fax: 503.598.1960 ~ I Date1B . Inspection Line: 503.639.4175 JUN c 0 -1 _ _ 'I I.. Date Ready/By. 1�+; HI See Page 2 for w ' Internet: ww.ci.tigard.or.us ° (i 200 - Notified/Method: Supplemental Information TVI)D 9,1 PLAN REVIEW ❑ New construction ., a ,at o'otery ° cement Please check all that apply: ❑ Demolition ❑Other: I Jl ❑Service over 225 amps, comm'I ❑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 S E1 - and 2- family dwelling ❑ CommerciaUindustrial ❑ Accessory building ❑System over 600 volts nominal units in one structure ❑ Multi - family ❑Master builder ❑Other: OBuilding over three stories ❑Feeders, 400 amps or more ❑Occupant load over 99 persons ❑Manufactured structures or JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park Job no.: Job site address: $e ,5(, e. Ki d t ❑Health -care facility ❑ er Submit 2 sets of plans with any of the above. City/State/ZIP""�"', ` a o „I / o Q, v 7 7 The above are not applicable to temporary construction service. Suite/bldg. /apt. no.: Project name: 0, 1,4ie7 /t!cear4 CtQ FEE* SCHEDULE Description I Qty. I Fee. I Total I •• Cross street/directions to job site: New residential single- or multi- family dwelling unit. Includes attached garage. 1,000 sq. ft. or less 145.15 4 Subdivision: Lot no.: 2...z) Ea. add'1500 sq. ft or portion 33.40 I Tax map /parcel no.: Z5 t1/14 -7? 7 00 energy, non-residential 75.00 2 Limited energy, non - residential 75.00 2 DESCRIPTION OF WORK Each manufactured or modular 3 r-1 r av , « / U„ dwelling, service and/or feeder 90.90 - 2 • � Services or feeders installation, alteration, and/or relocation 200 amps or less ' 80.30 2 XPROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2 401 amps to 600 amps 160.60 2 Name: 6 ( . 1 gey /Zit ae 601 amps to 1,000 amps 240.60 2 j Address: S , . Sl c) Sc. k[ de. t Over 1,000 amps or volts 454.65 2 - Reconnect only 66.85 2 City/ State/ZIP: 7 j C allot e/‹, ? 722y Temporary services or feeders installation, alteration, and/or Phone: ( 9 `. Z LV - 9 (p 8 7 Fax: ( ) relocation 00 ams - 200 amps or less 66.85 I 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 jik APPLICANT I ❑ CONTACT PERSON A. Fee for branch circuits with service or feeder fee, each 6.65 2 Business name: branch circuit B. Fee for branch circuits Contact name: S4<t 4 5 Dw/t.e,r' without service or feeder fee, 46.85 2 Address: each branch circuit Each add'l branch circuit 6.65 2 City/ State/ZIP: Miscellaneous (service or feeder not included) Pump or irrigation circle 53.40 2 Phone: ( ) Fax: : ( ) Sign or outline lighting 53.40 2 E -mail: Signal circuit(s) or limited - CONTRACTOR energy panel, alteration, or t extension. Describe: Page 2 2 Business name: .r isattac i t te I G Address: i°,40 a � 3A p Each additional inspection over allowable in any of the above l Per inspection 62.50 City/State/ZIP: 0etta.t / O/ , i 702 Investigation per hour (I hr min) 62.50 Phone: ($b,3) 4, -T b — t 3 y ' S Fax :(St73) J B Industrial plant per hour 73.75 �7�� ELECTRICAL PERMIT FEES* CCB Lic.: A0C( ` q Electrical Lic.: Z ii -1p 76, Suprv. Lic.: 3/ b 2r Subtotal 4 1 3 , 4, ° Suprv. Electrician signature, required: Plan review (25% of permit fee) Print name: 0 at f� g en p, ei Date: We &Ajs State surcharge (8% of permit fee) 7 , V `� 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. is\ Building \Pennits\ELC- PermitApp.doc 12/03 440-4615T(10/02/COM/WEB r • `` 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* El Burglar Alarm El Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* El Vacuum Systems* El Other: COMMERCIAL WORK ONLY: v f Fee for each commercial system. $75.00 (SEE OAR 918 - 260 -260) Check Type of Work Involved: El Audio and Stereo Systems El Boiler Controls ❑ Clock Systems El Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC El Instrumentation ❑ Intercom and Paging Systems El Landscape Irrigation Control* El Medical El Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling • El Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations i:\ Building \Permin\ELC- PemitApp.doc 04/03 CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE BEAR ELECTRIC P.O. BOX 389 DONALD, OR 97020 Electrical Signature Form Permit #: MST2005 -00210 Date Issued: 9/29/2005 Parcel: 2S111 AD -07000 Site Address: 08855 SW SCHECKLA DR Subdivision: SCHECKLA PARK ESTATES Block: Lot: 020 Jurisdiction: TIG Zoning: R-4.5 Remarks: 340sf garage addition. Your company has been indicated as the electrical contractor for the permit indicated above. I n 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: WILLEY, GARY M/DIANE A BEAR ELECTRIC 8855 SW SCHECKLA DR P.O. BOX 389 TIGARD, OR 97224 DONALD, OR 97020 — Phone #: 503 - 624 -9687 Phone #: 503 - 678 -1355 Reg #: LIC 20919 ELE 24 -107C SUP 4902S AN INK SIGNATURE IS REQUIRED • THIS FORM x • A ANA Signature of Supervising Electrician If you have any questions, please call 503.718.2433. CleanWater Services Our _ in,ruitmenl is c leilr. September 08, 2005 Gary Willey 8855 SW Scheckla Dr Tigard, OR 97224 RE: Garage addition located at 8855 SW Scheckla Dr., Tigard, OR CWS file 05- 002908 (Tax map 2S111AD Tax lot 07000) Clean Water Services has received your Sensitive Area Certification for the above referenced site. District staff has reviewed the submitted materials including site conditions and the description of your project. Staff concurs that the above referenced project will not significantly impact the existing •Sendive Areas found near the site. In light of this result, this document will serve as your Service Provider letter as required by Resolution and Order 049, Section 3.02.1. All required permits and approvals must be obtained and completed under applicable local, state, and federal law. This letter does NOT eliminate the need to protect Sensitive Areas if they are subsequently identified on your site. If you have any questions, please feel free to call me at(503) 681 -3605. Sincerely, Chuck Buckallew Environmental Plan Review Site plan attached • 2550 SW Hillsboro Highway • Hillsboro, Oregon 97123 Phone: (503) 681 -3600 • Fax: (503) 681 -3603 • www.CleanWaterServices.org CITY OF TIGARD . BUILDING DIVISION PERMIT #: MST200.00210 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/29/2006 Phone: (503) 639 -4171 8 '�n �" L Inspection Requests (24 Hrs.): (503) 639 -4175 � INSPECTION WORKSHEET FOR DATE: 1/24/2006 TIME: 6 :58AM PAGE: 59 SITE ADDRESS: 08855 SW SCHECKLA DR CLASS OF WORK: SUBDIVISION: SCHECKLA PARK ESTATES LOT #: 020 TYPE OF USE: PROJECT NAME: VOLLEY DESCRIPTION: 340sf garage addition. OWNER: WILLEY, GARY M/DIANE A, PHONE #: 503-624-969/ CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 1/24/2006 Pour Time: Code # Inspection Description Confirm # Contact # Message 299 Final inspection 025563 -03 503- 624 -9687 N Corrections /Comments /Instructions: r ,ASS ❑ i - IAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL !' CAL ' OR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector. Date: / Z0thone #: 718 - p 503 �) CITY OF TIGARD . BUILDING DIVISION PERMIT #: IAST2005.00210 13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 9/23/7O05 Phone: (503) 639 -4171 A Inspection Requests (24 Hrs.): (503) 639 -4175 `'I I.. INSPECTION WORKSHEET FOR DATE: 1/24/2006 TIME: 6 :58AM PAGE: 60 SITE ADDRESS: 013855 SW SCHECKLA DR CLASS OF WORK: SUBDIVISION: SCHECKLA PARK ESTATES LOT #: 020 TYPE OF USE: PROJECT NAME: WILLFY DESCRIPTION: 3.10.4 garage addition. OWNER: VALLEY, GARY M /DIANE A, PHONE #: 503 - 624 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 1124/2006 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Electrical final 025563.02 503-6249687 N Corrections /Comments/ Instructions: PASS 'TIAL APPROVAL ❑CANCEL ❑ NO ACCESS FAIL FOR INSPECTION ADDITIONAL FEES ASSESSED 6 Ins ecto . Date: / '27 Phone #: (503) 718 - p Ilk � ) _ CITY OF TIGARD • BUILDING DIVISION PERMIT #: MST2005-0O210 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/29/200, Phone: (503) 639 -4171 4� 6j �n Inspection Requests (24 Hrs.): (503) 639 - 4175 "'f �i INSPECTION WORKSHEET FOR DATE: 1/9/2006 TIME: 7:01AM PAGE: 20 SITE ADDRESS: 08855 SW SCHECKLA DR CLASS OF WORK: SUBDIVISION: SCHECKLA PARK ESTATES LOT #: 020 TYPE OF USE: PROJECT NAME: WMI..LEY DESCRIPTION: 340sf garage addition. OWNER: WMI..LEY, GARY M /DIANE A, PHONE #: 503 62496,3/ CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 1/9/2006 Pour Time: Code # Inspection Description Confirm # Contact # Message 120 Electrical rough -in 02.4585 -01 503-M.1355 Y Corrections /Comments/ Instructions: PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: G-A N 68 Date: 1' ( - 64 Phone #: (503) 718- 2 % CITY OF TIGARD BUILDING DIVISION PERMIT #: MS12705.00210 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9 /29 /2t)C)', Phone: (503) 639 -4171 , ' � Inspection Requests (24 Hrs.): (503) 639 -4175 IL. • INSPECTION WORKSHEET FOR DATE: 1/11/2006 TIME: 7:01AM PAGE: 136 SITE ADDRESS: 08855 SW SCHECKLA DR CLASS OF WORK: SUBDIVISION: SCHECKLA PARK ESTATES LOT #: 020 TYPE OF USE: PROJECT NAME: W1LLEY DESCRIPTION: 340sf garage addition. OWNER: VVILLEY. GARY M /DIANE A, PHONE #: 503 - 9697 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 1/11/2006 Pour Time: Code # Inspection Description Confirm # Contact # Message 275 Framing 024706-01 503 - 624.9687 N ?15,6 i A/ 5(4.4i& Corrections /Comments /Instructions: et e] PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date: It 0 Phone #: (503) 718- z7©(6' Watt 54 CITY OF TIGARD , �� Re�tib Cc�� BUILDING DIVISION PERMIT #: MST2005 -00210 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/29/2005 Phone: (503) 639 -4171 /m�w1ji1l�' Inspection Requests (24 Hrs.): (503) 639 -4175 :..W "__.. INSPECTION WORKSHEET FOR DATE: 11/9/2005 TIME: 7:09AM PAGE: 54 SITE ADDRESS: 08855 SW SCHECKLA DR CLASS OF WORK: SUBDIVISION: SCHECKLA PARK ESTATES LOT #:: 020 TYPE OF USE: PROJECT NAME: W ILLEY DESCRIPTION: 340sf garage addition. OWNER: WILLEY, GARY M /DIANE A, PHONE #: 503 -624 -9687 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 11/9/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 235 Shear walls /anchors 020722 -01 503.572 -4708 N Corrections /Comments/ Instructions: • V PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: 7 /7 V Date: l/ %*----- Phone #: (503) 718- CITY OF TIGARD . BUILDING DIVISION PERMIT #: MST200S -00210 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/29/2005 Phone: (503) 639 -4171 At �+ Inspection Requests (24 Hrs.): (503) 639 -4175 I I.. INSPECTION WORKSHEET FOR DATE: 11/9/2005 TIME: 7:09AM PAGE: 53 SITE ADDRESS: 08855 SW SCHECKLA DR CLASS OF WORK: SUBDIVISION: SCHECKLA PARK ESTATES LOT #: 020 TYPE OF USE: PROJECT NAME: WILLEY DESCRIPTION: 340sf garage addition. OWNER: WMLLEY, GARY M /DIANE A, PHONE #: 503 -624 -9687 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 11/9/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 240 Exterior sheathing 020722 -02 503 - 572 -4708 N Corrections /Comments /Instructions: PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: ^ 2'l / Date: it 7 Oc Phone #: (503) 718- CITY OF TIGARD BUILDING DIVISION PERMIT #: 2110 C Qd L r A 13125 SW Hall Blvd., Tigard, OR 97223 d DATE ISSUED: Phone: (503) 639 -4171 - l ei Inspection Requests (24 Hrs.): (503) 639 -4175 F_ INSPECTION WORKSHEET FOR DATE: TIME: PAGE: SITE ADDRESS: 3 � cc,(,.. e & Lk 1)( CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: DESCRIPTION: OWNER: PHONE #: CONTRACTOR: PHONE #: Inspection Request Scheduled For: Date: Pour Time: ICJ Cm)-- Code # IIn Description Confirm # Contact # Message Z c, 5 t a'+,.n- 2' z _ cSUZ �s f Corrections /Comments/ Instructions: • IPM + V a.�4. C— L C,. C , (.;`. e_4 ��_ ----€._?_4_,„Q_ r "`_ ______ c i ___,( cy2„..d 4\.) 4 0---L !---o%*_-_- PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: \ZOC.D___--- Date: \ /* 0 > Phone #: (503) 718-