Case File a w - • e _ \
x•
•
•
I
n`
Y
� •i
r,
d
•.a
• R
»' 1
t
/ \ CITY OF TMASTER PIERMI T
\ DEVELOPMENT SERVICES F'ERMIT #. . . . . . . : MSTOB-
04'35
13125 SW Hall Blvd., Tigard,OR 97223(503)639.4171 DATE ISSUED: 03/16/57
F,A R(-.FI : I S 134DA--07 400
SITE. ADDRESS. . . : 112 0 SW BUFFAL.O PL.
CSUDD I V I S I ON. . . . :DAKOTA MEADOWS ZONING: R-- 12 F'D
BL-GCK. . . . . . . . . . [_OT. . . . . . . . . . . . . .Onlr 7 JURISDICTION: T I G
Remar!s: New single family attached, path 1.
---------- ------------------------------------------- ------ BUILDING ------------------------------- ----------------------------
REISSUE: gTORIES.......: 3 FLOOR AREAS---_------ BASEMENT...: 0 sf REQUIRED SETBACKS---- REQUIRED-------------
CLASS OF WORK.:NEW H'IGHT........: 26 V RST....: 743 sf GPDgGE..... : 560 sf LEFT.......... : 0 SMOKE DETECTRS:
TYPE OF USE... :SFA FLOOR LOAD....: 40 SECOND...: 742 sf FRO':i.........: B PARR INC, 1'WS: 2
TYPE OF CONST.:75N DWELLING �_"!rTS: 1 FINBSMENT: 0 sf R.6HT.........: 0
OCCUPANCY GRP..R-, BDRM: BAN. 3 TOTAL------: i485 sf VALUE..S: 250000 REAR..........: 0
----------------____— ----------------------------------- PLUMBING ----------------------------------------------
SINKS.........: 1 WATI_R CLOSETS.: 3 WISHING MACH..: 1 LAUNDRY TRAYS.: 0 RAIN DRAIN ft: 100 TRADE .........: 0
LAVATORIES....: 3 DISI ASHERS... : I FLOOR DRAii).. : 0 SEWER LINE ft: 100 SF RNIN DRAINS: 2 CATrh BASINS..: 0
TUB/SHOWERS...: 2 C^PRAGE DISP .: 1 WATER HEATERS.: 1 WATER LINE ft: 100 LCKFLW PREVNTR: 1 GREPgc TRAPS..: 0
OTHER FIXTURES: 0
-------------------------------------------------------------- MECHANICAL ------------------------------------------------------_.----------
FUEL TYPES------------- FURN i IM ..: 1 BOIL/CMF ( 3HP: 0 VENT FANS.....: 3 CLOTHES DRYERS: 1
GAS FURN )=100K ..: 0 UNIT HEATERS..: 0 HOODS.,.......: 0 CTHER UNITS...: I
MAX INP.: 0 BTU FLOOR FURNACEO: 0 VENTS.........: 0 WOODSTUVES....: a GAS OUTLETS...: 1
---------------------- - -------------------------- -------------- ELECTRICAL - -------------------•------------------------------------------
--RESIDENTIAL. UNIT--- ---SERVICE/FEEDER---- --TEMP SRVC/FEEDERS-- ----.BRANCH CIRLI.IIT5--- ----M15CELLANEDIJS---- --ADD°L INSPECTICMS--
1000 SF OR LESS: 1 0 - 200 amp..: 0 0 - 200 amp..: 0 W/9V[; OR FDR..: 0 WW/iRRIGATION; 0 PER INSPECTION: 0
EA ADD'L 5005F.: '_ 201 - 490 amp..: 0 2@1 - 400 amp..: 0 1st W/O SVC/FDR: 0 SIGN/OUT LIN LT: 0 PER HOAR......: 0
LIMITED ENERGY.: 0 401 600 amp..: 0 401 - 500 amp..: 0 EA ADDL BR CIR: 0 SIGNAL/PANEL...: 0 IN PLANT......: 0
MR:f HM/qjVr,'rDR: 0 601 - 1300 amp.: 0 601+amps-1000 v. 0 MINOR LABEL -10: 0
10P,0+ amp/volt.: 0 -------------------------------•----- PLAN REVIEW SECTION ---------------------------------
Reconnect only.: 0 )=4 RES UNITS..: SVC/FDR)=cM A.: ) 600 V NOMINAL: CLS AREA/SPC OCC:
----------------------------------------------------- ELECTRICAL - RESTRICTED ENERGY --------------------------------------------- ------
A. SF RESIDENTIAL--- --------- ---------- B. COMMERCIAL------------------- ------------------------------------------------------
AUDIO 6 STEREO.: VACUUM SYSTEM..: AUDIO F SIFREO.: FIRE ALARM....: INITFPCOM/PAGING: OUTDOOR LNDSC LT:
BURGI.AR ALARM..: 01P. :: BOILER.........: HVAC...........: LANDSCAFr/IRRIG: PROTECT?VE 51 X
G^RAGE OPENER„; C.LOCK........... INSTRUMENTATION: MEDIr,AL......... OTHR:
KIC...........t DATA/TELE r,9MM.: NURSE CALLS....: TOTAL 0 SYSTEM✓: 0
---....-----------------------------Contractor: --- •--- iITPL FEEF A 5101) tiu
CFAL(.0 HMS Pte. BEACON HOMES, INC This nernt is subject to the egul,tions contained in the
95N SW 125TH AVE 9500 SW 1125TH AVE Tigard Municipa' Lode, State if Ore. .:iecialty Codes and all
BEAVERTON 9R 97008 BEAVERTON OR 97068 other applicable laws. All r,ork will be done in accordance
with approved plans. This permit will expire if work is
Phone A: 524-1999 Phone A: 524-1999 not ,tarted r.ithin 180 days of issuance, or if the work is
Reg t..: W707 suspended for more than 1,'0 days. ATTENTION: Oregon lav,
--____—..----------------------w____ requires you to rullow rulas adopted by the Oregon Utility
Notification Center. Those rules are set forth in DAR 952-Oel-0010 through OW,' 952-001-0080. You may obtain copies of these rules or
I irect questions to OLW by calling (503)246-1987.
--- --__ --- ------- ---------------------------------- REOUIREU INSPECTIONS --- -- - --------- ----------------- -- -- -- -
!Erosion Control electrical Rough Gas Fireplace Water Line Insp Plumb Final
'Footing ]nsp Mechanical Insp Insulation Insp Water Service In Mechanical Final
'lab Insp Plumbl-i Top Out Shear Wall Insp Appr/5dwlk Insp Buildiig Final _-
P, /undslb Insp Framing Insp Firewall Insp Smoke Detector
Elen. ical Servi Gas Line ?nsp Rain Drain Insp Electrical Final
I iSl12d Ry : I L _ F�ermittee 5i gnatr.rr e: \J� 1 _
++t++-++++++4-++4444 ++++++4 + ++4++++++•44 1 +4+++++44+4++++++++++•F.++4+ +44 ++++t+++
Call 637-4175 by 7:00 p. m. for an inspection needed the next bit iness day
I
CITY O TIGARD SEWER CONNECTION
DEVELOPMENT SERVICES PERMIT
13125 SW Hall Blvd„Tigard,OR 97223(503)639-4171 'PERMIT C#�. . . . . .07/16/ 99
. .. SWR98-0340
D;RCEL:
TF T gc31-1FD: Y'7/1.6/99
ft%111 1 S 134DA--rr7400
SITE ADDRESS. . . * 11220 SW BUFFALO Pt.
SUBDIVISION. . . . :DAKOTA MEADOWS ZONING: R-12 PD
IBL.00K. . . . . . . . . . LOT. . . . . . . . . . . . . :007 JURISDICTION: TIS
(TENANT NAMF. . . . . :DAKOTA MEADOWS LOT 7
(USA IVO. . . . . . . . . . . FIXTURE UNITS. . . . 0
CLASS OF WC,RK. . . :NEW DWFI_L..I NG UNITS. . : 1
TYF"'E OF USE. . . . . :SFA NO. OF BUILDINGS: 0
INSTALL TYPE— . . :[-TPSWR IMPERV SURFACE: 0 sf
Remarks : New single family attached, Path 1.
Owne,•. ____________..____________._______. ----___.___— -----__._._._ FEES _.----_•--__—_—_—
BEACON HOMES INC type aMOIAnt by eat a recpt
9500 5W 117,51-H AVE PRM'i $ 2300. 00 B 03/16/99 99-313'747
BE't71VERTON OR 97008 1NSP $ 35. 00 B 0:;/16/99 99--313747
Phone #:
Cont--ac t or: ---•---_—•----______________________.
OWNER
Phone #: $ 2335. 00 TOTAL_
Reg #. .
-- _ -- REQUIRED J NSPECT I ON ,
This Applicant agrees to comply with all the rules and regulations Sewer, Inspection
of i,he Unified Sewage Agency, The permit expires 189 days from
the date issued. The total amount paid will be forfeited if the
permit expires. T',.p Agency does not guarantee the accuracy of the
side sewer laterals. If the srwer is not located at the meas�-Pment _
given, the installer shall prospect 3 feet in all directions from
the distance given, If not so located, the installer shall purchase
a "Tap and Side Sewer" permit and the Agency will install a lateral.
ATTENTION: Oregon law requires you to follow rules adopted by the _
Oregon Utility Notification Center. Those rules are set forth in OAR
952 P01 001 through OAR 952-MI-MO. You may obtain copies of
these rules or direct questions to OUNC by calling 15@31246-1987. _
n ' I
L 1.i e C' b v : �'�y ✓(� � �" F'e r m i t t e e S i r,n o t i_i r e:._
h++....+++++++++++++•F+++4-+4-+++-1•++.+++i++++ :.+.A-+++4++++++++++-++ r-++++++•h-.+.++++++++
Call 633-4175 by 7:20 p. m. for• an insp•_ction needed the next bl..tsiness day
+-F•1 +++++4++++++.++++++++++++•4•++++++++++ ++•F++++++++++++++.....f.+++++++++++++.++++
(;,'TXA,F TIGARD Residential Building Permit Application Plan Check Ar . � • ' -
13125 SW HALL BLVD. New Construction '\dditions or Alterations Recd By__/_r1�
Date Recd
TIGA RD, OR 97223 Single Family Detached or Attached (Duplex) Harr to P E y iv
V 503-639-4171 Date to DST f
F 503-684-7297 Permit#
Print or Type Called O 1 lye z�d
Incomplete or illegible applications will not be accepted
Name of Pruiect Name
DAY �----------
Job OTA MEADOWS PETER_MAGARO ARCHITECHTUk
Architect Mailing Address
Address Site -Address � ���� 1_0570 SW Citation Dr.
--- - I I ���) f: q i=ce—i=------ City/Stale Zip Phone ~ —
Name Beaverton 97008 579-2421
BEACON �ION:ES, INC. -------- ----
Owner li��d5' S 125th Avenue NRFF DOVE ENGINEERING
�,t ZZ Phone _ Engineer Mafl. P.ddress
Beaverton 6 (,08 4914 Oakridge Rd .
_- 5 2 4-19 9 9 /State Zie Phone
General Name Lae Oswego 9703 697;-5926
Contractor BEACON HOMES, INC. Dc .gibe work New Addition n Alteratior O Repair O
Mailing Address to tx done:
Prior to permit 9500 SW 125th A V e n u a Ad A lional Description of worm;:
issuance,a copy City/State Zi Phone attached single family dwellings
of all licenses Beaverton 9/008 524-1999 —� -are required if Oregon Const.Cont.Board Exp. Date PROJECT
expired in COT Lica 7 0 7 8 2 12/17/9 8 ��
database _ l VALUATION i$ G .Do
Mechanical Name NEW CONSTRUCTION ONLY: _
Sub- MUEHE QUALITY HEATING - Sq. Ft. House: I �q. Ft. Garage gu
Contractor Mailing Address
Prior to permit PO BOX 9 Indicate the restricted energy installation by the electrical
----- areas
issuance,a copy CRY/State Zip Phone- subcontractor in the follow' 1
of all licenses - West Linn 97068 _598-0966 Restricted Audio/Stereo
are required if Oregon Const.Cont Board Exp Date Energy _ System Alarms
expired in COT- Lic.# 50096 3/5/99 Installations VaCULin _ Irrigation
__ database-� _ ----System System
Plumbing Nar*.e (check all that Other:
Sub- J & R PLUMBING ap�_L_-_ _
Contractor Mailing Address —Y— Comer Lot YES NO Flag Lot YES NO
3430E SW 209th Avenue (check one X (check one) X
---
_ Has the Subdivision Plat recorded? N/A YES NO
Prior to permit City/State Zip Phone X
issuance,a copy Aloha , 97007_ 647.-7776 SolarCcmpliance
of all licenses are Oregon Const.Cont.Board Exp.Date calculation Attached)_ _
require:dif Lick 72680 3/28/99
expired in COT I hearby acknowledge that I have read this application, that the
database Plumbing Lic.k Exp.Date information given is correct,that I am the owner or authorized agent
34 214 PB 4/30/99 of the owner,and that plans submitted are in compliance with
Ore_qon State laws.
Name SigofKUSE
Date
Electrical BEAR ELECTRIC, INC. ((II\\Sub- Mailing Address roapct PersPhone#
ContractorPO BOX 389 FOR OFFY: _
CRY/State Zip Phone plat#: - Mapfft
Prior top•mmit Donald, OR 9702 678-1355
-7G,,
issuance a copy _ _ Solar:
rtrZone:
:Setbacksli,
of all lia.nses are Or+_�gon Const.Cont.Board- Exp.Date / �, ,/
diredif Lir-.# 20919 2/20/00
exp red in COT _ Engineering Approval: Planning Approval: TIF:
database I Electrical Lic # Ex ale
24-107C 1/1/98
I SFREM2.DOC(D3T)8/11198
r<
CITY
w � �I���� CERTIFICATE OF OCCUPANCY
;�]
PERMIT#: MST98-00495
DEVELOPMENT SERVICES DATE ISSUED: 03/16/1999
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 PARCEL: IS134DA.-07400
ZONING: R-12
JURISDICTION: TIG
SITE ADDRESS: 11220 SW BUFFALO PL
SUBDIVISION: DAKOTA MEADOWS
BLOCK: LOT:007
CLASS OF WORK: NEW
TYPE OF USE: SFA
TYPE OF CONSTR: 5N
OCCUPANCY GRP: R3
TENANT NAME:
REMARKS: New single family attached, Path 1.
Owner: _
Phone:
Contractor:
BEAC'U'N HOMES, INC
9500 SW 125TH A\'=
BEAVERTON, OR 97008
Phone: 524-1999
Reg #:
This Certificate isL ued 08/23/2111111 grants occupiincy of the above referenced building or
portion thereof and confirms that the building has been inspected for compliance with the
State of Or gon Specialty Codes for the grcoup, occupancy, and use under which the
referenced permit was issued.
BUILDING INSPECTOR BUILDIN3 8FFICIAL
POST IN CONSPICUOUS PLACE
CITY OF TIGARD BUILDING INSPECTION DIVISION
24-Hour Inspection Line: 639-4175 Business Line: 639-4171
E3UP _
--- ----_Gate Requested "nJ �' d� -----A'VI --PM ------ BLD
Location_�12 i� -�` �� Suite MEC —
Contact PersonPh Gp PLM
Contractir — GIf M �( Ph SWR
BUILDING��— Tenant/Owner ELC
Retaining Wall ELR
Footing Access-
Foundation
Foundation / (.�t,� , FPS _
Ftg Drain SGN
Crawl Drain Inspection Notes: /,J �✓� - -----
Slab �" '"'�- SIT
Post&Beam
,�1
Ext Sheath/Shear 1✓
Int Sheath/Shear W
Framing
Insulation
Drywall Nailnig /��`�5�,�Q_
Firewall
Fire Sprinkler CA �S"1 _
Fire Alarm
Susp'd Ceiling
Roof i
MISQ.
iy
t1PASS,J PART FAIL.-OrM
BING
Post&Beam T --"--- — --
Under Slab -
Top Out -- - -
Water Service
Sanitary Sewer — -
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post& Beam --
Rough In
Gas Line
Smoke Dampers
Final - --- - ----
PASS PART FAII-
ELECTRICAL __�_
Seivice _
Rough In
UG/Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill/Grading - _ _. .-_--.
Sanitary Sewer
Storm Drain [ J Reinspection fee of$ —required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ]Please call for reinspection RE:• [ ]Unable to Inspect-no access
ADA
Approach/Sidewalk Date `�' Q� Inspector /� Ly Ext-�
Other - -- --- P —
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD bUILDING INSPECTION DIVISION MST qg-ncl9S
24-Hour Inspection Line: 639-4175 Business Line: 639-4171
f BUP
_ — —Date Requested _ 1�( _AM__ PM _ BLD
I_acation__ Suite —_ _ 1 MEC
Contact Person — U) 1✓1 _ Ph �, r, t� P4Nt'--
Contrar,for Ph $WR
+tJ1LDiTl6 Tenar,`/OweELC
elaining Wall — ELF:
Footing ---�
Access:
Foundation < /1 �..}� tn j FPS _
Ftg Drain
Crawl Drain Inspection Notes: SGN ,
Slab SIT
Post& Beam ��'---
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing _.� Vo
IL tf
Firewall
Fire Sprinkler
Fire Alarm
3usp'd Ceiling _
Roof
blisc:
_ PART FAIL _
BING
Post&Beam —--'—
Under Slab
Top Out —
Water Servirc
SPnitary Sewer
Rain Drams
Final
I PASS PART FAIL
MECHANIC _
Post Beam -- --- -- .. —
Rough In
Gas Line
Smoke Dampers
?PXSS'SJ PART FAIL.
ttlICTRICAL
Service
Rough In - - - _—
UG/Slab
Lin
tagelarmS PART FAIL
ITE
Ba, fill/Grading
Sanitary Sewer
Storm Drain 1 [ Reinsp,1ion fee of$ required bef;.,re next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ]Please call for reinspection RF ( Unable to Inspect-no access
ADA (�
A ro h/ i calk �
�
tl, Date " - �— Inspector -� V� Ext
PA PART_ FAIL 00 NOT REMOVE this inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business Line: 635-4171
Date Requested �L�-�sj- AM--,y rm BLD
Location �L�} c� Suite MEC
Contact Person —_� r�1 ) I/� Ph ,;2G- y PLM
Contractor Ph SWR
BUILDING - Tenant/Owner ELC _
Retaii,,ng Wall ELR _
Footing Access; -
Foundation �1 \fZ_,? C� _ n� > FPS _
Fig Drain
Crawl Drain Inspection Notes: ��,ln SGN
Slab - ----� /AALy ' l- -- SIT
Poe:} 3 Beam
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation - ---- -- -
Drywall Nailing
Firewall -
Fire Sprinkler _
Fire Alarm
Susp d Ceiling
Poof
N.isr.. _
F,nal -
PAbS PART FAIL. -
40, UMBING `
Post& Beam - - - -- - - - _ -
Under Slab
1 op Out - -- --- ----_
Water Service
-
Sanitary Sewer --
Rain Drains
Fines
PART FAIL
CHANICAL _
Post& [leans --
Rough In
Gas Line - --
Smoke Dampers
Final - _- - --- - ----- — ... --
PASS i 4RT FAIL
ELECTRIChL - --- - - --- . _
Service.
RoughIn --- ---------------__------- ----- ---
UG/Slab _
Low Voltage --
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill/Grading --- _-- ---
Sanitary Sewer
Storm Drain [ J Reinspection fee of$ required before next inspection Pay at City Mall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ }PIPase call for reinspectii n RE: _— �__ ( j Unable io inspect-no access
ADA
Approach/Sidewalk - `
Other _ Date — Inspector �r — Ext -
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CITY OF TIG RD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business Line: 639-4171 —
Qi C� C BUP
---_--Date Requested_ _I 'G/ l AM, .PM _ BI_D
Location— 1220 1GaU _L� Suite _ — MEC
Contact Person r-jp L7/- Ph PLM
Contractor Ph SWR –
BUILDING Tenant/Owner ELC ---- ---_
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain -- SGN
Crawl Drain Inspection Notes:
SlabSIT
Post&BeF m "—
Ext Sheath/Shear I
Int Sheath/Shear —
Framing
Insulation �f--"
Drywall Nailing � � - -
----- -- _-_._ _ __ ------
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling -
Roof
Misc: __ - - - ---- -- -- -
Final
PASS PART rAll. -- -
PLUMBING
Post& Beam
Under Slab
Top out - -
Water Service
Sanitary Sewer
Rain Drains
---------- -----
Final
PASS PART FAIL
MECHANICAL
Post& Beam
Rough 'n
Gas Line ---- - - -- -
Smoke Dampers
Final - - - - -- - ------- -- ----
P PART FAIL
Service
Rough In ------ -----_-------- -- -- ---- ----
UG/Slab
Low Voltage f
Fire Alarm
ri
ASS PART FAIL
Backfill/Grading --
Sanitary Sewer
:storm Drain ( J Reinspection fee of$_ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin ( J Please call for reinspection RE: ( J Unable to inspect-no access
Fire Supply Line
ADA / /
ApproachiSidewaik
Other Date /.,Z9 _Inspector — I �1� C� _Ext
Final
PASS PART FAIL j a NOT REMOVE this inspection record from the job site.
CITY OF TIGARD
1312.5 S.W. HALL FILVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
BEAR ELECTRIC
PO BOX 389
28085 BLTTEVILLE RD NE
DONALD OR 97020
Electrical Signature Form
Permit # . . . . : MST98-0495
Date Issued. : 03/16/99
Parcel . . . . . . : 1S134DA- 07400
Site Address : 11220 SW BUFFALO PL
Subdivision. : DAKOTA MEADOWS
Block. . . . . . . . Lot. : 007
Jurisdiction : TIG
Zoning. . . . . . : R-12 PD
Remarks :
New single family attached, Path 1 .
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 electrici-in
is required.
Please have the appropriate individual from your company sign below and return this Electrical
Signature Form prior to the start of work to the address above, ATTN: Building Dept.
No electrical inspections will be authorized until this completed form is received.
AN INK SIGNATURE IS REQUIRED ON THIS FORM
WNE;k : ELECTRICAL CONTRACTOR:
BEACON HOMES INC BEAR ELEC'T'RIC
9500 SW 125TH AVE PO BOX 389
BEAVERTON OR 97008 28085 BUTTEVILLE RD NE
DONALD OR 97020
Phone # : Phone It : F-678-1108
Reg # . . : 000209
moo-,-�
Signature o upervisingTE ecfncian
/czS
If you have any questions, please call 6394171 , ext. #310
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
MT TABOR PLUMBING
13324 NW GLENRIDGE DR
PORTLAND OR 97229
Plumbing Signature Form
Permit # . . . . : M'iT98-0495
Date Issued. : 03/24/99
Parcel . . . . . . : 1S134DA-07400
Site Address : 11220 SW BUFFALO PL
Subdivision. : DAKOTA MEADOWS
Block . . . . . . . . 1,()t . 007
Zoning. . . . . . . R-12 PD
Remarks :
New single family attached, Path 1 .
Your company has been indicated as the plumbing, contactor for the permit indicated above. In order
for the plumbing permit to be valid, please have the appropriate individual from your company sign
below and return this Plumbing Signature Farm prior to the start of work.
No plumbing inspections will be authorized until this completed form is received.
AIV ;NK SIGNATURE IS REQUIRED ON THIS FORM ,
(?WNFR : PLUMBTNG C(-)NTPACTOR :
BEACON HOMES INC MT TABOR PLUMBING
9500 SW 125TH AVE 13324 NW GLENRIDGE DR
BEAVERTON OR 97008 PORTLAND OR 97229
Phone # : 24-1999 Phone # :
Req # . . : 000110
x-- -, �-�-i-
Signature o. Authorized Plumber
Please return this completed form to the address abo—
ATTN: Building Dept.
If YOU have any questions, please call 639-4171 , ext. #310