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CI"OF TIOARD
j Residential f O of C'erti
,f c..upancy
Permit No.: ,r UO2 Address: 2
Owner/Contractor:
Date of Final Inspection: 3 �l Inspector:
This structure has been found in he in substantial Compliance with the provisions of the State of Oregon One& Two Family Dwelling
Specialty Code and is hereby approved for occupancy. J
CITY OF TIGARD 24-Hour
BUILDING Inspe& -n Line: (503)639-417`;
MST
INSPECTION DIVISION .s202_�- •_
B��sin!as Line: (503)539-4171
2BLIP
Received Date Re uested___._. J -/ AM__ - _ PM _ BLIP _ --
Location
- - e-L -. suite � MEC
Contact Person - _-___----____--- _ Ph(--) PLM ---- --------
Contractor--- - -- -- --------- Ph(--) - _-- - -.- o;NH ----
-- -
BUILDING Teriant/Owner -__
--- LC
Footing -
Foundation Access: -- ELC
Ftg Drain ----`
Crawl Drain ELR --_.___---__---.-_--
Slab 111spection Notes: SIT
Post&Beam --
Shear Anchors -- -- - ---
xt Shnath/Shear
Int^heath/Shear --- ---- .._-- _
Framing - - -
Insulation --- - -
Dr)wall Nailing
--Firewall
Fire
- -
Fire Sprinkler
Fire Alarm
Susp'd Ceiling - ------ --
Roof - -- --- -
Other: -
PART FAIL - ---" — - _--
NQ
Post R Beam - -- -- --
Under Slab
Rough-In - - - - ---_
Water Se rvice
Sanitary Sewer -
Rain Drains
('etch Basin/Manhole
Ston.;r)rain
Shower Pan - - -
Other: -PASin
PART PART FAIL
ANICAL
Post&Beam - ---- - -------__--
Rough-In
Gas Line -- ----- - - -
Smoke Dampers
ASS PART FAIL
tervice
AL-
Rough-In
UG'Slab - - -._ -.--�-- -g
�PAF.T FAIL IJ r1einspection fee of i;_ required bofore next inspection. Pay at City Hall, 13125 SW Hall Blvd.
L Please call for reinspect!nn
Fire Supply Line _._____ __ Unable to insper;--no access
---
,IDA � ) ' _1 I J •�._•-
/�pproach/Sidewalk af+� - _.�. llnspectc�r _ -_ _ Ext-_
Other: �_-
Final - DO NOT REMOVE this inspeetion carordf Fr*M the Job site.
PASS PART FAIL
CITY O F TIGARD _-- MASTER PERMIT
PERMIT#: MST2002-00292
DEVELOPMENT SERVI(_'ES DATE ISSUED: 8/21/02
13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171
SITE ADDRESS: 12765 SW BLUE HERON PL PARCEL: 25103BC-BHP18
SUBDIVISION: BLUE HERON PARK ZONING: R-?.5
BLOCK: LOT: 018 JURISDICTION: TIG
REMARKS: New SF Path 1.
BUILDING
REISSUE: V STORIr.S: FLOOR AREAS _ RFQUIRED SETBACKS _REQUIRED__
CLASS OF WORK. NEW HEIGHT: 23 FIRST 1.157 of BASEMENT: of LEFT: 5 SMOKE DETECTORS. Y
TYPE OF USE: SFA FLOOR LOAD: 40 SECOND: 944 at GARAGE: 745 of FRONT: I'D PARKING SPACES
TYPE OF CONST: 5N DWELLING UNI'S: 1 FINSSMENT: of RIGHT: 5
VALUE: 5,190.565 40
OCCUPANCY GRP: R3 BDRM. 3 BA1H: 3 70TAL: 2.10100 of REAR: 25
PLUMBING
SINKS: 1 WATER CLOSETS, 3 WASHING MACH: 1 LAUNDRY TRAYS PAIN DRAIN: 150 TRAPS:
LAVATORIES. 4 DISHWASHERS: I FLOOn DRAINS: SEWER LINES: Ica SF RAIN DRAINS + CATCH BASINS:
TUBISHOWERS GARBAGE DISP 1 WATER HEATERS: I WATER LINES: tan BCKFLW PREVNT... I GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPCC_ FURN<10OK: BOIUCMP<3HP: VENT FANS: 4 CL;ITHES DR1 ER: 1
,;AS FURN>=100K: I UNIT HEATERS. HOODS: 1 OTHER UNITS: I
MAX INP. htu FLOOR FURNANCES: VENTS: 1 WOODSTOVES. GAS OUTLETS: 1
ELECTRICAL
RESIDENTIAL UNIT SFAVICE FEEDER TEMP SRVCIFEEDERS BRANCH CIRCUITS _ MISCELLANEOUS ADD'L INSPECTIONS_
1000 SF OP LESS: 1 J - 200 amp- 0 - 200 amp: WISVC OR FDR: I PUMPIIRRIGATION: PLR INSPECTION:
EA ADD'L 5UOSF: 3 201 - 400 amp: 201 400 amp: 1o1 W/O SVCIFDR: on SIGNIOUILINIJ, PER HOUR:
LIMITEu ENERGY: 40 t - 600 amp: 401 600 amp: EA ADDL 9R CIR, SIGNALIPANEL: IN PLANT
MANU HMISVCIFDR: 601 • 1000 amp: 601-amps-1000v. MINOR LABEL:
1000-amplvoll
PLAN REVIEW StCTIOP'
Reconnect only:
>-4 RES UNITS: 9VCIFDR-225 A.: >8UO V NOMINAL: CLS AREAISPC OCC:
ELECTRICAL•RESTRICTED ENERGY_ _
A.SF RESIDENTIAL B.COMMERCIAL
AUDIO R STEREO: VACUUM 5'STEM AUDIO&STEREO °IRE ALARM INTERC.OMIPAGING: OUTDOOR LNOSC LT:�
BURGLAR ALARM OTH: BOILER: HVA';: LAN+l4CAPEIIRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATAITELE COMM: NURSE CALLS. TOTAL 0 SYSTEMS:
Owne.. Contractor: TOTAL FEES: $ 6,811.38
This permit is subject to the regulations contained In the
WINDWOOD HOMES WINDWOOD HOMES INC Tigard Municipal Code,State of OR Specialty Codes and
12655 SW NORTH DAKOTA 12655 SW NORTH DAKOTA all other applicable laws All work will be done in
TIGARD,OR 97223 TIGARD,OR 97223 accordance Aith approved plans. This permit will expire if
work is not started within 180 days of issuance,or if the
work is suspended for more than 180 days ATTENTION
Phone: Phone: 7804375(M) Oregon law requires you to follow ru!c�adopted by the
Oregon Utility Notification Centel Those rules are set
Rag M: LIC sa196 forth in OAR 952-001-0010 through 952-001-0080 You
may obtair,copies of these rules or direct questions to
OLIN:'by zalln.q(503)246-1987
REQUIRED INSPECTIONS
Erosion Contrnl Insp 8• Post/Beam Mechanica Mechanical Insp Shear Wall Insp Insul3!Ion Insp Appr/Sdwik Insp
Sewer Inspection Underfioat insulation Plumb Top Out Exterior Sheathing Inst Gyp Board Insp Electrical Final
Footing Insp Crawl Drain/Backwater Electrical Service Low Voltage Firewall il,sp Mechanical Finai
Foundation Insp Footing/Foundation Dr: Flectrical Rough In Gar;Line Insp Ram drain Insp Plumb Final
Post/Beam Structural PLM/tJn ienloor Framing Insp Gat Firep!ace Water Line Insp Final Inspection
1> ued By : :.�Xt1 1�' ✓� Per.nitiee Signaturo y _
Call (503) 639-4175 by 7:00 p.m. for an inspection needed the next bu,iness day
CITYOF TIGA,R® SEWER CONNECTION PERMIT
�r DEVELOPMENT SERVICES PERMIT#: s00, 7
13125 SW H,-,Il Blvd.,Tigard, OR 97223 (503) 6:<a 4171 DATE ISSUED: 8/2211021/02
PARCEL: 2S103BC-3HP18
SITE ADDRESS; 12765 S4v BLUE HERON PL
SUBDIVISiON: BLUE HERON PARK ZONING: R-3 5
BLOCK: LOT: 018 _ _ JURISDICTION: TIG_____
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SFA NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE=:
Remarks: Sewer connection permit for new SFA residence.
Owner: -- � FEES
WINDWOOD HOMES Type By Date Amount Receipt
12655 SW NORTH DAKOTA — ---
TIGARD, OR 97223 PRMT CTR 8/21/02 $2,300.00 27200200000
INSP CTR 8/21/02 $35.00 27200200000
Phone: 590-4700 Total $2.,335.10
Contractor:
Phone:
Reg #:
Ii
I
_-Required Inspectwns _
This Applicant agrees to comply with all the rules and regulations of the Unified Sewage Agency The permit expires
180 days from the date issued The total amount paid will be forfeited if the permit expires The Agency does not
guarantee the acrura y of the side sewer laterals. If the sewer is not located at the measurement given, the installer
shall prospect 3 feet in all directions from the distance given, if riot so located, the installer shall purchase a"Tap and
Side Sewer" Perr., t and the Agency will install a lateral. ATTENI ION' Oregon law requires you to follcm rules adopted
by the Oregon 'Jtility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAF 952-001-0080.
You may obtain a)pies Qf these rules or direct questions to OUNC by calling (503) 246-1987.
Issued by: 1 Permittee Signature:
- Call (503)630-4175 by 7:00 P.M. for an Inspection needed the next business day
i
I�
-40 ,o Z' 13 r
Building'.Flermit Application
Date received:, -/(-t>'� Permit no.:
City of Tigard
Address: 13125 SW Hall Blvd,Tigard,OR 97223 Project/appl.no.: Expire date:
City of Tigard —"—
Phone: (503) 639-4171 L Date issued: By: Receipt no.:
Fax: (503) 598-1960 /1 ' In �� Case riileno.: Paymenttype:
1&2 family:Simple Complex: 77
Land use approval: r p p
�T$2 family dwelling or accessory 0 Coin mercial/industrial 0 Multi-family 0 New construction 0 Demolition
0 Addition/alteration/replacement (.:1 Tenant improvement ❑Fire sprinkler/alarm ❑Other: _
Job address: /a r y J e fa.I It Bldg. no.: Suite no.:
Lot: Block: Subdivision: of ray fti mapitax lot/account no.:
Project name: blk
Description and location of work on premises/special conditions:
OWNER [Olt SMIAL 1 1
Name: ..} �� ►t!S � � �� , ,
Mailing address: Q Awx W7OX: 1 &2 family dwelling-
City: (a Stat ZIP: 4?7,2,1�_ Valuation of work................................. ..... $
Phone G F G E-mail: Nc.of bedrooms/baths.....................;?.
Owner's representative: ( ,t Iota]wimber of floors...................... :......
Phone: 11-ax: F'. mail New dwelling area(sq. ft.) ............, 0 /
Garage/carport area(sq.ft.)...........AP.&..i..
Name Covered porch area(sq.ft.) .........................
Mailing address: _ Deck.area(sq.ft.) .......................................
City: _ _ _ State: ZIP: Other structure area(sq.ft.).................. ......
Phone` Fax E-mail Commerciallindustrial/multi-family:
Valuation of work....... ......................... ..... $—
7ms
,M
Existing bldg.area(s 4.R.) ...... ................
-- New bldg.area(sq.ft.) ................. ............
Number of stories....................... ..... .........
State: ZIP: Y
Type of construction............... _
Phone: Fax: E-mail:
L.CCB P. Occupancy group(s): Existing:
New:
Ci►y!:netro lie.no.:
Notice:All contractors and subcontractors ar- required to be
licensed with the Oregon Constriction Commetc rs Board under
Name: Q provisions of ORS 701 and may be required to b-licensed in the
Address: At-W / Q t.N ;•trisdiction where work is being performed. If the applicant is
Ci !- StateO-Y ZIP: Qa.�Uy exempt from licensing,the following reason applies:
Contact perso : fijq Plan no.: --
Phone: 4'/O Fax],x' E-mail:
Nam.: Contact person: .6 Fees due upon anplication ........................... $
— ---
Address: _ ) Date received:
City: jStateJZIP:,V2d_/4 Amount received ......................................... $
Phone: ) Fax: / E-mail: Please refer to fee schedule.
1 hereby certify I have read and examined this application and the naw jurirlictiam asepr cred t euds,plme call iurisdction for nwre intbrrru hna.
attached checklist.All provisions of laws and ordinances governing this Q Visa ❑MssterCard
work will be compiled with,whether specified herein or not. Credrr end mrnber:
�.., _ Expires
Authorized signature• _-�—"-'Date:_ Ww_w_R „ .m_ t cud
Print name nl /�Cc��'.�3 •- t-
so.nre amount
Notice:This permit sppkr--atior,expires if a permit is not obtained within 180 dr•s after it has been s xi-pted as complete. 4144613(ttroacoM)
Plumbing Permit Application
City of Tigard
rDateremce�ived: Permit no.: 1/ t)
Address: 13125 SW Hall Blvd,Tigard,OR 97223 Sewer permit no.: Building perm;t no.:
City of Tigard :'hone: (503) 639-4171 troJect/aPPI.no.:
C:xpire date:
Fax: (503) 598-1960 Date issued: -
gY Receipt no.:
Land use approval: _ Case file no.: Payment type:
�l $t 2 family, .fling or accessory U Commercial/indusuial 0 Multi-family U Tenant improvement
U New construct. n U Addition/altetatie (replacement U Food service U Otlier
Job address: `a 1. a��-2 �a� _ Dsc
eriptionI'ee(ea.) Total
Bldg.no.: Suite no.: New 1-and 2-family dwellings only:
Tax map/tax lot/account no.: / �eL, C 3 O (iat:ludn,!00 R.for each utility connection)
Lot: Block: Subdivision: -- SFR(1)baw
krOA SFR(2)bath — -- ----
Project name: _ _ �. SFR(3)bath
City/county: _ IP: ,� Each additional bath/kitchen "—
Description and 1 tion o work on premi� Sheudlldes:
Catch bmin/area drain
Est.date of completion✓inspection: Drywellslleach line/trench drain -
�'1 Footin drain(no. lin. ft.)
Business name: Manufactured home utilities
r-0 Manholes —
Address: Rain drain connector
City: State-0 ZIP: 976107— Sanitary sewer(no, —
Phone: y u y Fax• - u31 Email: Storm sewer(no.lin.ft.) _
CCB nr'.: �/9 p _ Plumb.bus.re .no: Water service No.lin. .) -
City/metro lic.no.: gam/b� Fixture or Neth:
Contractor's representative signature: ///��_ Absorption valve -
Print name: /�, I�,.f Date: Back flow reventer
Backwater varve --
Basins/lavatory
Name: m c Clothes washer —
Address: Dis washer —
CityState: ZIP: Drinkingfountain(s)
Phone: Fax: E-mail: Ejectorsisum
Expansion tank
Fixture/sewer cap
Name(print): _ {}.�t.yc4O ('G4t/$)' C_ Flair drains/floor s-nks/hub
Mailing address: S, j Nw^.ei, 7 Garbage disposal
City: Hose bibb
Y 2. Statete''/-C Z,IP_�_aA� Ice maker
Phone: Fa,,:G> E-mail: Interne tor/ reale tra --
Owner instal lotion/residential maintenatl�p only: The actual installation Primer(s)
will t„made by me or the maintenance and repair made by my regular Roof drain(cotttmercial)
employee on the property I own as per ORS Chapter 447. in (s),basm(s),lays(s)
Owner's signatu • aie: _ um �—
Tubsishower/shower pan -
Name: Urinal _
Address: T— ater closet
City: -- —_ tate: ZIP:
ater eater —
Phone: ----— —— 10ther
—•_._—_ Fax: _�m Tttbl
No all lmim'ktlmt ac eq aedt code,pkaae call luisdicticn fes noire iul xmutim. Minimum fee... ............S
U Mo,r O MastetCanl Notice:11tis permit of plication
expires if a-a;,mt is not obtained Pla i review(at _— %) g _
cteah oatd mmher --- ---..��_— xpuL within 110 days after it has been Slate surcharge(13%) ....E
Name nr x u drown,,,� ,card accepted as complete. 7i(11"AL .......................$
Cadhoideriiputtre— —A,mom�i-
440-4616(64MCQM)
1
i
Mechanical Permit Application
t .1 Date received: Permit no.:
City Qf Tigard lg8lru Project/appl.no.: Expiredate:
City ofTigard Addreft: 13125 W Hall Blvd,Tigard,OR 97223 Date issued: By: Receipt no.:
Phone: (503) 639-4171
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval _ Building permit no.:
"Ul c 2 family dwelling or accessory U Commercial/industrial U Multi-family U Tenant improvement
Cl New construction U Add ition/al teration/replacernent L.Utlie c.1011 SITE INFORNMIAXION
COMMYRCIAL
SCHEDULE
Job address: /tC �q/ Indicate equipmentquantities in boxes below. Indicate the dollar
Bldg.no.:
Suite no.: value of all mechanical materials,equipment,labor,overhead,
Tax map/tax lot/account no.: $/ !j G J L 3x'00 profit, Value$ .
Lot: Block: Subdivision: (/ 'See checklist for important application information and
Project name: aek-rv, At^t --- jurisdiction's fee schedule for residential permit fee.
City/county: �l fl / t• ZIP: �/77.1
Description and location/of work on premises:— 1 e
_ Fee(ea.) Total
Est.date of completion/inspection: Description Qty. Res.only Res.only
Tcnant improvement or change of use: �0
Air handling unit CFM
Is existing space heated or conditioned?0 Yes U No _—�
irconditioning(site plan required)
Is existing space insulated?U Yes U No Alteration of existing A system
Boiler/compressors
Bu:mess name: A / State hailer permit no.:
HP ---Tons BTIJ/H
Address: 7�, Fir;/smoke dampers/duct smoke detectors
Cit f I.ct M State: FP: Q�/3 eat pump(site p an required)
Phone: _ Fax: Email: :isle rep ace urnac urner
Including ductwork/vent liner U Yes(]No
CCB no.:
//1 yl y nsta rep ac re locateheifers-suspencneed
City/metro lic.no.: S a wall,or floor mounted
Nae(please print): Vent or a mance other than furnace
emri
Absorption snits BTU/FI
Name: -5Ct <1Chillers- HP
Address: - - — Compress" HP
-- ----
Environmental ronmenta eximint and vent oo:
City: State: ZIP• �— Appliancevent
Phono: Fax: E-mail: ryerexhaust
Hoods, ype res. itc eo7�azmat
hood fire suppression system
Name: U_ 1y,,0s wt�� �(�►tJ �- .j'1'l e- _ Exhaust fan with single duct(bath fans)
Mailing address: — I( �(ip f)q �st systema art from heating or AC—
-1sZ --'S-- v�- Fuelpiping an distribution(up to out ets)
City: j-/ /42/0 Stater/` ZIP: 7 3 Type: -
—_LPG _ NO Oil
Phone: Fax: E-mail: additional over ou ts
Processp (schematic requireT)
Name: Number of outlets
_ ter st appDame or equipment:
Address: Decorative fireplace
City: --— _—- Swtet IZ P nsert-t pc
Phone: Fax: E-mail: oo tov pe et stove
-mier:
Applicant's signature:----- Date t
Nance (print): -- — _ --�- -
c
Not tit jtriYdtcNro atzept omat cants.clean call Jurisdiction fur mae ii..,winatiun. Permit fee.....................$
❑visa t]M,ucer Notice:Thi-permit application Minimum fee.................S
expircr if a permit is not obtained plan review(at _ %) $
Expire; within Igo days after it has been State surcharge(8%)....$
-------------
---famed du of dwrwn on credit card accepted as complete. ')TOTAL
— _ Cardtw[der sipature -- A moumat 4104617 tMOICOMI
1
Electrical Per snit Application
Datereceived: Permitna.,4j�SAEY�Z �(JL
project/appl.no.: &r plmdate:
City of Tigard By. Receipt no.:
Address: 13125 SW Hall Blvd,Tigard.OR 97223 Date issued: —
City of Tigard lone: (503)639 4171 Pa inert type:
Case file no.: y
Fax: (503)598-1960
Land use approval: —
' I
❑Multi-family ❑Tenant im(,rc,v cnu�nt
U 1 &2 family dwelling or accessary U Commercialcratio /rcl U;partial
❑New construction U Addition/alteration/replacement U Other: _
11
e`- Bldg.no.: I Suite no.: Tax map/tax lot/account no.:
Job address-
Lot, Block: Subdivision: -
Project name: Description and location of work on premises:
Estimated date of compiction/inspection: l
Fe. MAX
job no:
Desai lion Qty. (en.) Total no.Inst,
Business came: ALT1LL New residential-single or multi-family per
F dwellir+gunit.lncludeaattachedgeragge•
Address: M ZIP:Q7'Xa3 Service included. 4
City: (('aq SLate:D --
I0(p aq.(t.or leas
Phone: p;'S Fax: E-mail: Fikch additiona1500 sq.ft.or ortion thereof
z
r EIcc.bits.lic.n0: I.rmitedenergy,residenual 2
CCB no.: `� l.imitedenergy,non-residential
City/metro lie.no.: Each manufactured home or modular dwelling 2
-- Uat--- Service and/or feeder
Signature n{supervisin�electricien(rec�ulred) S Services orfeeden-Installation,
l.icensena alteration or relocation: 2
Sup.elect.name(print): 200 amps or less
_ 2
201 amps to 400 amps2
Natttnt)-� t �.�J 401 amps to�00 amps 2—
Mailing address: QTN— rt�Of 601 amps to 1000 amps 2
Stated ZIP_ -7&gj Over 1000 amps or volts
Cit;+: -('(( `IQ - Rcco_nne-tonl __
E-mail: Temporary
Ph Fax. services or feeders-
Owner installation:The nstullation in,being mI own made on property 1",unation,alteration,orrehation: t
which is not intended for sale,lease,rent,or exchange according tc 200 amps or less --
ORS 447,455,479,670,701. 201 amps to 400 amps -- ?
Date-. 401 to 603 am s
Owner's si nature: Bench circuits-new.alteration,
or extension per panel:
_ A. Fee for branch circuits with purchase of
Name: — service or feeder fee,each branch circuit _
Address: B. Fee for branch circuits without pumh•se 2
City: Sta.... ZIP. of service or feeder fee,firat branch circuit: _ -
I ax. E-mail: Poch additional branch circuit:
Phone: Mbe,(Servlceorfeederar�tincluded):
2
U Health care facility Each ump or htillation cin:le 2
U Service over 225 amps-conurr-rcial Poch signor outline lighting
U Service over 320 turps-mting of 1&2 U Harirdous location square feet four or Signet circus';)or 1.1imitr�ener gy panel• 2
familydwellings U Building over 1o,00osq dteration,�rextension$
O System over 600 volts nominal more residential units in one structure
U Feeders,400 amps a more •Descri tiot:.
O Bonding ovur three stories Each addNlon ,►apection over the allowable In any of the above:
r3 occupant load over 99 persons U Manufactured structure or P.V path �--T_
❑Outer. ._ .— _----- per insQcction —1
Egress/lighungpisn Invests auonlee
Submit sets of plain With any of the above. Outer g —
bk to tttmspt>�rary conmvetbo @"Ace.
TiK above are mot applla Permit fee....................$
sNedoa for more I,do<,,,aua,.l Notice:This permit application Plan review(at — %) $
Not an Jrrlraeaan..pt.dt eardr,P call J� I expires if a permit is not obtained
O MasterCard within 180 days atter it has been State surcharge(8%)....$
Creditew number. — -- — L Umpted as Complete. TOTAL .......................$ —
dim►d c u s "T m t�edit card S 4404615(6011Ar'OM)
A I. A
DESIGN ASSOCIATES, INC.
Date:5/21.02
To wham it may concern:
With this letter Alan Mascord Design Associates,Inc. gives permission for the Buyer:
Name: Windwood homes,Inc.
Address: 12655 SW North Dakota
Tigard.OR.91273
Phone: (503)625-6526
To make revisions to,and additional copies of:
Plan No. 4026A
For the construction of a single project located at:
City or County City of Tigard
Lot No. Lot 17& 18
Subdivision Blue Heron Park
This permission is granted for the specific project and design listed above.This document is valid only
in original form,with an original signature in ink. Any modifications to,or copies of,this letter will
void the permission granted herein.
Alan Mascord
JUN t
0) x
Ts1n�=
1105 NW I R'"AvMw
thxtlaixt thegm 97209
s031225-9161 FAX 5031225-1933
www.ma�acnrd com
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CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPCrRTANT PERVIT NOTICE
METZGER ELECTRIC INC
8780 SW LEHMAN ST
TI BARD, OR 97223
Electrical Signature Form
f Permit #: MST2002-00292
Date I suet'.: 8/21/02
r'arcel: 2S103BC-BHP18
Site Address. 12765 SW BLUE HERON PL
Subdivision: BLUE HERON PARK
Block: Lot: 018
Jurisdiction: TIG
Zoning: R-3.5
Remarks: New SF Path 1.
Your company has z!�en 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
steal of the work to the address above, ATTN: Building Dept.
No electrical inspections will be authorized until this completed form is received
OVVNER: ELECTRICAL CONTRACTOR:
WINDWOOD HOMES METZGER ELECTRIC INC
12655 SW NORTH DAKOTA 8780 SW LEHMAN ST
TIGARD, OR 97223 TIGAP.D, OR 97223
Phone #: 590-4700 Phone #: 244-9025
Req #: uc 96805
SUP 3130S
ELE 34-167C
AN INK SIGNATURE IS REQU!RED ON THIS FORM
Signature of Supervising Electrician
RECEIVED
If you have any questions, please call (503) 639-4171, ext. # 310
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