Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00911
ri DEVELOPMENT SERVICES DATE ISSUED: 12/30/2005
67 I I° 13125 SW Hall Blvd., Tigard, OR 97223 503- 639 -4171
PARCEL: 1S12600-00300
SITE ADDRESS: 09393 SW WASHINGTON SQUARE RD ZONING: C -G
SUBDIVISION: WASHINGTON SQUARE LOT : JURISDICTION: TIG
Project Description: TI electrical. Job #106002. (kids)
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: 1 PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG: 1
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL: 4
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: 33 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > = RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
WASHINGTON SQUARE LLC DYNALECTRIC
BY THE MACERICH COMPANY • 2901 SW FIRST AVE.
9585 SW WASHINGTON SQUARE RD PORTLAND, OR 97201
TIGARD, OR 97223
Phone: Contact #: PRI 503 - 226 - 6771
FAX 503 - 226 -7720
FEES
Description Date Amount Reg #: LIC 066793
[ELPRMT] ELC Permit 12/30/200: $800.03 SUP 4653S
[TAX] 8% State Surcharge 12/30/200: $64.00 ELE 26 -59C
Total $864.03 REQUIRED ITEMS AND REPORTS
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All
work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set
forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503 - 246 -6699 or
1- 800 - 332 -2344.
Issued By: j),"7.4,2 Permittee Signature: S.A. %\c,
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
A
*
._ r
Electrical Pern#1 ilo D FOR OFFICE USE ONLY
City f Tigard �� n " /B " y : f� "'. G �� 2 0(1 009
ty a
g -1\ P errrtitNo.
13125 SW Hall Blvd., Tigard, og 7 223: . � Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 4 -�"a �' I� Daffy: Other Permit:
Inspection Line: 503 639.4175 OF TIGAFID 1!,, Date Ready/By: J /' 65 See Page 2 for
Internet: www.ci.tigard.or.us Ol f ' l Notified/Method: fI V Supplemental Information
tfr iI
FT' " ..� t, oF l' M. i . . -T71 'J , �'! ' �" 1' 1 f !1 •t 1' 1 :I ,�- I' • l' - u1 ,
' }rati e, : i rift , 1 , , . , 7 yyp� t 7 - S.o'R,T. . .i, ...�-, r; ' .C 2 k i `V'�'' E IV V lly' , „ i - p , , G, ' t J :
S�S��i�';$,+N'+wi`a'A,t�A%r � #.' ., t -'t { {: .t`;'• •'t�_,. Cti i �i - rani ���i.t.;,fo.,�}�`(� { ",f� i'tlTili�,i,•�}`4: ''!e7ta�';i , cf:, :i'lY„"`Y'. +nI...�_' { : ;s4:= rF!'
® New construction ❑ Addition/alteration/replacement Please check all t hat apply:
❑ Demolition ❑Other' ['Service over 225 amps comm'I ['Hazardous location
e £ _ Y ,
['Service over 320 amps — rating Buildng over
� � , � � ❑ 10,000 sq. ft.,
nip _ L � + ri Mt `� � N t �'' �,�� i : V;; ie fi E of 1- and 2- family dwellings 4 or more new residential r ,
' ,,,c, 1
- 6 44 : � i ,',*L',. G . 41. ' i'I,, ,y, I * L al 41 4 'Vii, ," _t " - 9 , i', i bh 4'
❑ 1- and 2- family dwelling ® Commercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
['Building over three stories ['Feeders, 400 amps or more
❑ Multi- family 0 Master builder ❑Other:
# § 1 [Occupant load over 99 persons ['Manufactured structures or
Aga M ._ ,s . ? ° 'I U t 7V 5=1 - # ` � , h .! p l a c r'llf ® E t tin plan RV park
x ,- .. . - w�Kr�;.. r' -�rc..- 4 � a .r, Sn�'8 h 8 P
❑Health -care facility ['Other:
Job no.: Job site address:-.958 Washington Square Rd Submit 2 sets of plans with any of the above.
p
City/State/ZIP: Tigard, Oregon 97223 / 3 q3 _ The above are not applicable to temporary construction service.
Suite/bldg. /apt no.: 5 -208 Project name: Abercrombie * ` r Y'' { ' ` k � ; . a i` *TIP* .j ''
Description Qty. Pee. Total ,
Cross street/directions to job site: Washington Square Mall 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'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
1,• , e' t1 r < . '<t x . Ti - ` _I, i , 'r y >r, .., - - Each manufactured or modular
Tenant Build Out. First and partial second floor. dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less p. 80.30 60,60 2
; s ,_ OP O _ rN - .,. - . ' -'3" ” '. '' E " ' 1 A - - = ', 't? 401 amps to 600 amps 160.60 2
Name: Abercrombie & Fitch - Store Planning 601 amps to 1,000 amps 240.60 2
Address: 6301 Fitch Path Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State/ZIP: New Albany, Ohio 43054 Temporary services or feeders installation, alteration, and/or
Phone: (614)283 -6541 I Fax: (614)283 -8541 relocation
200 amps or less I 66.85 ( 54 5 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
S I I " � � t i r , , , ! ° ' d 3l`' A. Fee for branch circuits with
service or feeder fee, each 3 6.65 aI ys 2
Business name: Thorson Baker & Associates branch circuit
B. Fee for branch circuits
Contact name: Jeff Miterko without service or feeder fee,
Address: 3030 West Streetsboro Rd (S.R 303) each branch circuit 46.85 2
Each add'l branch circuit 6.65 2
City/State/ZIP: Richfield, Ohio 44286 Miscellaneous (service or feeder not Included)
Phone: (330) 659 -6688 I Fax: : (330) 659 -6675 Pump or irrigation circle 53.40 2
Sign or outline lighting I 53.40 53.40 2
E -mail: jmiterko@thorsonbaker.com Signal circuit(s) or limited -
nr tyu = , rp � t srt ° ag ;rtr 1_ > 11 ^ h ;- ,e „ >r ;� n�-K panel, alteration, or
1s a : - e.:,.. ' ?'i�fi:?' ,, t . `t$is P , ... ,tlt i?t�• lJt `b i fI x.17, - u.Pt�': r jt ,.ts+�, a energy ll
P
extension. Describe: y Page 2 �n
�/00OD 2
- - -- - Business name: TBD . . _ - _- - _ .
Address: `e- ` V'� Each additional inspection over allowable In any of the above
...vvv Q/A - -- Per inspection 62.50
City /State/ZIP: Investigation per hour (1 hr min) 62.50
_ _ _ _Phone-_(_ ) _ I Fax' (_ ) Industrial plant per hour 73.75
;I r ff1 16.gae:7I1R1CAL''PfRMPfidf ES `; !r4,,;.Yy.=?'-
CCB Lie.: Electrical Lie.: Suprv. Lie.: Subtotal i y � � 3 r
Suprv. Electrician signature, required: Plan review (25% of permit fee)
State surcharge (8% of permit fee) Co 4, 00 i
Print name: Date: /
TOTAL PERMIT FEE g(„4, o 3
Authorized signature: This permit appllcatlon expires If a permit la not obta with / in 180
days aRer it has been a as compl
Print name: - Date: * Fee methodology set by Tri- County Bedding Industry Service Board
** Number of inspections per permit allowed.
I lauilding\Pernuts\ELC- PtmtitApp doe 11103 440-4615T(10/02/COM/WEB
12- 30 -05; 8 :O5AM;Dynalectrlc service ;503 226 7720 # 5/ 7
. Electrical Permit Application . FOR OFFICE USE ONLY
City of Tigard .f' .. .5- -CGy // Received
Date/By: Permit No .
I3125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 4r + ;s• O.
r l�' IIf Date/By: Other Permit:
Inspection Line: 503.639.4175 ao . n` -, Date Ready/By: hut Si See Page 2 for •
Internet' www.ci.tigard.or us Notified/Method: Supplemental information
.r t•.'•.:; c;: rxi :tr { ' 41! :''� : ' -•*s•.r, zl;: � uu;m, ; =use ,u: • . e ,,� ,.�,.. - ri• °�: •, eW,,. ,•
_ i . qr...- t t� � �, ' , � t � :� � 7�,�? r�i4'. • . � 91:..ir u 7 p,4.� . �� _ __ ■ New construction ❑ Addition /alteration/replacement Please check all that apply:
❑ Demolition Other: ❑Service over 225 amps, comm'1
Demolition t ` J: ,,,0, ,- Z __ _
mP ❑Hazardous location
t. i :� " ':•: _ , y i ?. _ xp � i ' I {�� (►r�r � , ❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. R.,
'.- :`- '=:_
' - 7 'sr4 1 ' t..' •eg ir4WY e' . „ `. :r i�".1''''' - �.t. :y .: ! r:
• . 111 . ?.4. ' . " . w_rr. ;w_'rr i41 aza of 1 -end 2- family dwellings 4 or more new residential
❑ 1 - and 2- family dwelling A /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi- family ❑Master builder ❑ g ❑ Feeders, 4
Other: -- O Buildin ove three stories 400 amps or more - -
r. :r :cc•d :na- , _.�. « •n :x :.{vc� r•n:' 4 aY ✓. w•'
ff }r ; n ; :_ d._I :�:; ',:46/ 1.1••031;.. 0110 O 4 " t �� " " "'' '° �0 = <t '~ i ; :4 ti )r;4 ' ( Occupant load over 99 persons ❑Manufactured structures or
xti ,��- �- �� i +al�c:t,t, .z•�:!"- :(„•,,_a,!iIl : ,t-,,,, ❑ Egress lighting plan RV park
Job no ��� Job site address: ❑Health -care facility ❑Other:
/ � t yr- - Submit 2 sets of plans with any of the above.
City /State/ZIP: 7- ..e2/ Q. ' The above are not applicable to temporary PP construction P �Y on service.
Suite/bldg./apt. ame: y� r t.. �- OW'- .Dg �� r.:
g. apt. no.: Project n /J � L - �� �- -tee + _ �;�1..; *.. _ •,-," _.. ,
Description I Qty. I Fee. I Taal I
CI oss street/directions to job site: /4445'h,:e...,6...rJ (^,� �?� // New residential single - or multi - family dwelling unit.
�� Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: I Lot no.: Ea. add') 500 sq. ft. or portion 33.40 (
Tax map /parcel no.. Limited energy, residential 75.00 2
.;i : 5,', > :a,[ ` %a :f.: i i t it `! .ito a o' �' • t L.' u?f p Limited energy, non-residential
4:•,y ��a t,� _
" P ug gy on- reside 75.00 2
7
�•� "x�•`� Each manufactured or modular
�� .001a27 dwelling, service and/or feeder _ 90.90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
, xr }R-. : •�, 6 , iffiI it 6-6- , o �:. '"i _•".: ; ;, . a , , . a. �r i h, Ri. r 0 s to 400 amps
L . ma r z i t- . i • w, amps P 106.85 2
».IJh.�• a!4�i'��a !� ~ . ,i ����' s• ;.,;i', 0415." � 0415."
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2 '
Address: Over 1,000 amps or volts 454.65 2
City /State/ZIP: Reconnect only 66.85 2
Temporary services or feeders installation, alteration, and/or
Phone: ( ) Fax: ( ) relocation
or Owner installation: This installation is being made on property that I own which is not 20 amps to less 00.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 201 amps to 400 amps 100.30 2
401 amps to 600 amps 133.75 2
Owner signature:
Date: Branch circuits - new, alteration, �� :., �,r ' " f � y �` �' 1 -.U`I6 t r: p,�. .� : : ., , . : �t, *•,��,: r_•, , teratlon, or extension, per panel
..... :;•k�t� - r4. 1P : O g t : ` n
: Ti .Iii ' i } i'tO t7; r' `_ � , .�H.;?;:�� pf u i� ; A. Fee for branch circuits with • . _ ' ` °' ''" service or feeder fee, each
Business name: ������` branch circuit 6.65 2
Bus
Fee for branch circuits
B
Contact name:
B.
/240....,.. �� '+',.1 without service or feeder fee,
Address: "4...9 r Cam/ / •sT each branch circuit 46.85 2
Each add'l branch circuit 6.65 2
City /State/ZIP:, fr.7 Q/L,A 9 7 , ; 7 0 / Miscellaneous (service or feeder not included)
Phone: (9,i.) ) Z �� ,�77/ Fax:: (..<63 ) Pump or irrigation circle 53.40 2
Z Z • -7 z„,,,,2, Si or outline lighting
E -mail: g g 53.40 2
... -¢: ty" �y1' �a!' ��r ;jly'x'i ~'.'. .��.i4�;- 1t�N�GS l � • "09f�` ( �s � • Signal circuit(s) or limited-
.. �n ,°� ign gg .H ,: k --,; , energy anel, alteration, or
Business name: 7 / ; e).c..sion. Describe: Page 2 2
Address: ,..0 SGV ` �,���� Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State/ZIP: i, ,,
"°°" ,,,,se. 7 - , investigation per hour (I hr min) 62.50
Phone: (5y'5 .,;,,2•6 -Sd 77/ Fax: �3) 72,7e3 Industrial plant per hour 73.75
CCB Lic.: I t ':ig; ':'4.r " S i ( (?45 s• 0`- g.: _ .
E lec trical Lic. Suprv. Lic. : ^'Y ' = ' u ' -
4,4 � � : �'% •C ' p 4 S Subtotal
Suprv. Electrician signature, required: _..."" I Plan review (25% of permit fee)
' -_...._.4" „ re. A. _ . ,al i .1.
Print name: f� � / Dat : ' State surcharge (8% of permit fee)
4uthorized signatur / .� TOTAL PERMIT FEE err
Gy.
• / `� /♦�_ ..... J Thls permit application expires if a permit is not obtained within 180
'i int name: ,'
Date: after It hos been accepted as complete
i ate: _ , 4,5 - • Fee methodology set by Tri- County Building Industry Service Board
iu ;ld;ng\permite \ELC- PermnApp 12/03
- •• Numberofinspections
440 ST(10/02/COM/WBB
•
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2005 -00911
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1:.130/200
Phone: (503) 639 -4171 1,r1 l.
Inspection Requests (24 Hrs.): (503) 639 -4175 _2 .. "'I I..
INSPECTION WORKSHEET FOR DATE: 5/1/2006 TIME: 7:00AM PAGE: 7
SITE ADDRESS: 09393 SW WA SHINGTON SQUARE RD CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE:
PROJECT NAME: ABERCROMBIE KIDS
DESCRIPTION: TI electrical. Job #106002. (kids)
OWNER: WASHINGTON SQUARE LLC, PHONE #:
CONTRACTOR: DYNALECTRIC PHONE #: 503•226E771
Inspection Request Scheduled For: Date: 5/1 /2006 Pour Time:
• e Inspection Description Confirm # Contact # Message
199 Electrical final 029045 -01 503-849 286E N
Corrections /Comments /Instructions:
4 v.QD 35 1(.1 c.
A)
•
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: GA
0 -A - )--- 1'V Dat e: I 1 vv Phone #: (503) 718 - 1015
CITY OF TIGARD
BUILDING DIVISION PERMIT #: El_C2005- O0911
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/3012005
Phone: (503) 639 -4171 1
Inspection Requests (24 Hrs.): (503) 639 -4175 ..:'III..
INSPECTION WORKSHEET FOR DATE: 4/28/2006 TIME: 7:02AM PAGE: 102
SITE ADDRESS: 09393 SW WASHINGTON SQUARE RD CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE:
PROJECT NAME: ABERCROMBIE KIDS
DESCRIPTION: TI electrical. Job #106002. (kids)
OWNER: WASHINGTON SQUARE LLC, PHONE #:
CONTRACTOR: DYNALECTRIC PHONE #: 503 226 - 6171
Inspection Request Scheduled For: Date: 4/28/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 028870 -01 503849 -2866 N
Corrections /Comments /Instructions:
5 v06t IM C- c,j CE A 0 3 16
Z s vpPoti17 I . Pte'. 36 . � 4 _L'�n ,,, , 1 \ /___Q
\r_ ____Q
06
❑ PASS CK PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL IX1 CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 1' V`►-. Date: 4 / 2 tiO 6 Phone #: (503) 718- 21 4
CITY OF TIGARD - .•
BUILDING DIVISION PERMIT #: ELC2005 -00911
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/30/7005
Phone: (503) 639 -4171 y " j 1
Inspection Requests (24 Hrs.): (503) 639 -4175 �amv
INSPECTION WORKSHEET FOR DATE: 1/30 /2006 TIME: 7 : 01AM PAGE: 16
SITE ADDRESS: 09393 SW WASHINGTON SQUARE RD CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE:
PROJECT NAME: AI3ERCROMBIE KIDS
DESCRIPTION: Ti electrical. Job #105002. (lady:)
OWNER: WASHINGTON SQUARE LLC, PHONE #:
CONTRACTOR: DYNALECTRIC PHONE #: 503 - 226 -6/71 1
Inspection Request Scheduled For: Date: 1/30/2000 Pour Time:
Code # • - • ' escription Confirm # Contact # Message 1
130 Ceiling cover 025957 -01 503 -849 2866 N
Corrections /Comments / Instructions:
S v Ho Ca nA C. & 6' cAsbt.,
- k...4V E KT ok, fkamrk,
4.1.1
_____i
Vii[ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ' v oa LJr Date: I 10 Phone #: (503) 7181,0 t
CITY OF TIGARD • _ ll
BUILDING DIVISION 1 Y PERMIT #: ELC200&•0()911
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/300005
Phone: (503) 639 -4171 Av< rI
Inspection Requests (24 Hrs.): (503) 639 -4175 ill..
INSPECTION WORKSHEET FOR DATE: 1/20/2006 TIME: 7:00AM PAGE: r)6
SITE ADDRESS: 09393 SW WASHINGTON SQUARE RD CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE:
PROJECT NAME: ABERCROMBIE KIDS
DESCRIPTION: II electrical. Job #106002. (kids)
OWNER: WASHINGTON SQUARE LLC, PHONE #:
CONTRACTOR: DYNALECTRIC PHONE #: 503-226-6771
Inspection Request Scheduled For: Date: 1/20/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
130 Ceiling cover 025337 -01 503 - 8492866 N
Corrections /Comments/ Instructions:
M R.- L6 -
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n, FAIL Ac. LL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
/
V 0 6 Phone #: (503) 718- 2 �1 4C�
Inspector: D ate:
CITY OF TIGARD
BUILDING DIVISION PERMIT #: EI-C201M0911
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/30/2105
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639- 4175IIL.
INSPECTION WORKSHEET FOR DATE: 1/6/2006 TIME: 7: 00AM PAGE: 51
SITE ADDRESS: 09393 SW WASHINGTON SQUARE RD CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE:
PROJECT NAME: ABERCROMBIE KIDS
DESCRIPTION: TI electrical. Job #106002. (kids)
OWNER: WASHINGTON SQUARE LLG, PHONE #:
CONTRACTOR: DYNALECTRIC PHONE #: 503.22G
Inspection Request Scheduled For: Date: 1/6/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
125 Wall cover 024495 -01 503. 849.2966 Y
Corrections /Comments/ Instructions:
Ro tiNgAtt 1 s a a L.L41, NAL AM
, t ..,_ .. >� v as �.j! ;,
13 41 '1 N N It s LL, 4
'e .�tis ^LL Q -'
1\40 psoL- fuk. L.t3 wiak. to
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ ALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: LP / iii Date: �� (‘-o Phone #: (503) 718- 2111/A"