10145 SW VIEW COURT ADDRESS:
iArec )rds\microflm\targets\building.doc
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business Line: 639-4171 --
BUP _
Date Requested ���' I AM��� - BLD
LocationLU S,^te MEC
Contact Person , L Ph Z �� _ PLM/y=
Contractor Ph
113UILDING Tenant/Owner _ -_ -_ ELC _
VRetainmg Wa!I y ELR
Footing Access: FPS
Foundation ---
Ftg Drain SIGN -
Crawl Drain Inspection Notes.
Slab -- -- SIT �_--
Post& Beam -
Ext Sheath/Shear - - - - —
Int Sheath/Shear
Framing _ -------- — ---- -- .._ -
Insulation
Drywall Nailing — --
Firewall
Fire Sprinkler -- - - - - - -
Fire Alarm
Susp'd Ceiling ------— - ---
Roof
Misc: -----
Final
PASS PART FAIL- -
PLUMBING
Post&Beam
Under Slab - -
Top Out
Water Service -- -- ---
Sa ' Sewer
ins -- -
F'
P SS RT FAIL
MECHANICAL
Post& Beam
RoughIn
---------------
Gas Line
- ------------------------- --
Smoke Dampers
Final
PASS SART FAIL
ELECTRICAL -- --
Service - ---- - - --
Rough In
UG/Slab -
Low biz: ;gL
Fire Alarm - -- _ -- -------- ------
Final
PASS PART FAiL --- ----- -- --- —-
SITE _
Backfill/Grading - -- ------- ------------ ------ --
Sanitary Sewer
Storm Drain [ ]Reinspection fee of$ required before next inspection. Pay:at City Hall, 13125 SW Hall Blvd
Catch Basin [ ]Please call for reinspection RE _—_ _ [ ]Unat.le to inspect• no access
Fire Supply Lire
ADA O, _
Approach/Sidewalk Date `. i'` ✓ _,Inspector _ Ext
Other -
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the ,job site.
CITY OF TIGARD
DEVELOPMEN I SERVICES F' 11NG PERMIT F'E RM I-1 T ##.. . . . . . . : F'LM'a8-0c'18
13125 SW Hall Blvd., Tigard,OR 97223 (503)639.4171 DATE ISSUED: "t-18111198
PARCEL: 251 1 1 BC-01400
SITE ADDRESS. . . : 101.45 SW VIEW TERR
SUBDIVISION. . . . : GREENBRIER ZONING: R-3. 5
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . .. . :004 JURISDICTION: TICS
CL ASS OF WORE',. . :QTR GARBAGE DISPOSALS. : 0 MOBILE HOME SPACES. : 0
TYPE OF USE. . . . :SF WASHING; MACH. . . . . . : 0 BAC KFr.C1W PREVNTRS. . : 0
LCCUPr4r•ICY Gp.p. . :R;3 FLOOR DRAINS. . . . . . . 0 TRAPS. . . . . . . . . . . . . . . 0
STORIES. . . . . . . . 0 WATER HEATERS. . . . . : 0 CATCH BASINS. . . . . . . : 0
FI X T'JRES _._________._.__ LAUNDRY TRAYS. . . . . : 0 SF RAIN DRAINS. . . . . : 0
SINKS. . . „ _ . . . . . 0 URINALS. . . . . . . . . . . . 0 GREASE. TRIPS. . . . . . . . 0
LAVA''OR r :.5. . . . : 0 OTHER FIXTURES. . . . : 0
TUB/SH'; JA=RS. . . : 0 SEWER LINE (ft ) . . . : 0
WATER 1,L-OSE1 S. : 0 WATER LINE (ft ) . . . : 175
DISHWASHE'RS. . . . : 0 RAIN DRRIN (ft ) . . . : 0
RFinar-l• s : 175' of rai.n drain
Owner.: __________________.__.____.__.__----___________.__._.__._---.__.. FEES -.—__-----__._-
GRE=GORY BUE:HLER type amor_rnt by date recpt
10145 SW VIEW TER PRMT $ ti`.i. 00 B 09/ 11/98 98-308192
T IGARD OR 97224 SPCT t 7':, B 0y/1 1 /98 98—�-:08192
Phone #: 684-0754
Contract-.
OL.ESON EXCAVATION CO
15405 SW PLEP;3ANT VALLEY RD
BEAVERTON OR 97007 ---. --•--____._..-_._.__._.._____.._____________.__.._
Phone #- 628-563' s 57. 75 TOTAL.
Reg #. . : 206266
REOU1RED INSPECTIONS
This pvrei: is issued subject to the regulations contained in the Rain Drain Insp
Tigard Municipal Code, State of Ore. Special`, Codes and all other Final 'Inspection
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 18P days. ATTENTION: Oregon law requires you to follow rules
adopted by the Oregon Utility Notification Center. Those r;125 are
set forth in OAR 952-MI-NIO through DAR 952-Mi-W. You may
obtain copies of these riles , direct questions to LAW. by calling
(S8:i12Mb-1987.
Issr_rea BY -/ 04LjQ�VW�---_ Permittee Signature :
++++++++4•+++++++++++++-+++++++++++++•++++++++++-+++++4-+++++++.+•+++++++++++++++++++
Call 639-4175 by 7:00 p. m. for an inspection needed next br;siness day
+++++. -~•.++++.+++++++++-�-+++++++++++++++++++++++++++++++J ++++++++++++++++++4-++++++
CITY OF TIGARD Plumbing Permit Application Plan Check#
13125 SW HALL BLVD. Commercial and Residential Reca By1.ca�r—
TIGARD, OR 972?3 Dale Recd el
(503) 639-4171 D
Print or Type -
Permit
ate to DL T v
S
Incomplete jr illegible applications will not he accepted Related SWR
Called
Name o1 Development/Project FIXTURES (Individual) 6lTYzV',°PRICE)S
Jab / n /ti S .S !^�. ra.d.0.c f Sink -- s.00
Address Seet A
trddress Suite Lavatory 9,00
Tub or Tub/Shower Comb 9.00
Bldg# rr,Xl%lGGa1n� 4P-7Z7 Shower Only 9.00
�_A. I Water Closet 9.00
Name9.00
� �h ��,(L i�C Dishwasher _
Owner Mailing Address _r/ Suite Garbage Disposal _ 9.00
/0/yS S.W. 11���'a�`�' Washing Machine 900
Ci Y.
Stat Zip 2� ( Phone Floor Drain/Floor Slnk ?." 9.00
�� 3" a.00
Name <^ 2 I N - -
q" 9.00
Occupant Mailing Address uite Water Heater O conversion O like kind~ 9.00
C-CO-, ��p Gas i Ing requires a separate mechanir�. mit.
City/State Zip Phone Laundry Room Tray 9.00
Urinal 9.00
ni Other Fixtures(Specify) 9.00
9.00
Contractor Mailing Addres. Suite
1S.1oSSw, Ira,l 30
Prior to permit (-,I late Zip�r+�f Pboneg Q 0 Sewer-tat 100 30.J0
issuance,a copy 7 / Fj Z / _ Sewer-each eddllinnal 100' 25.00
of all licenses are Oregon Const,C9nt.BLic.# xp 3 to Water Service-1 st 100' 30.00
required I1 2- V ��
expired In COT Plumbing Lic.# Exp.Date
Water Service-each additional 200' 25.00
database Storm&Rain Drain-1st 100' 30.70 -
Name Storm&Rain Drain-each additional 100' 25.00 '
Architect Mobile Home Space _ 25.00
Or Mailing Address Suite Commercial Back Flow Prevention Device or Anti- 25.00
Pollution Device
Engineer
City/State Z.Ip Phone Residential Backflow Prevention Device' 15.00
(Irrigation timing devices require a separate
Describe work to be do0e: restricted ener ermlt)
New O Repair r3''Replace with like kind: Yes O No O Any Trap or Waste Not Connected to a Fixture 9.U0
Residential (V-Commercial O _ — _ Catch Basin 9.00
Additional description of work. Insp.of Existing Plumbing 40.00
rthr _
Specialty Requested Inspections 40.00
perthr
_ —.- -— Rain Drain,single family dwelling 30.00
Are you capping,moving or replacing any fixtures Grease Traps 9.00
Yes O No
If yes,see back of form to indicate work performed by QUANTITY TOTAL
fixture. FAILURE 10 ACCURATELY REPORT FIXTURE Isometric or riser diagram is required If )uantny Total Is >9
WORK COULD RESULT IN INCREASED SEWER FEES. "SUBTOTAL
I herehy acknowledge that l have read this application,that the Information --
given is correct,that I am the owner or authorized agent of the owner,and 5%SURCHARGE a
that plans submitted are i m Ifance with Ore on Stale Laws —
SI;jnsture,aftPwner en Date "PLAN REVIEW 25%OF SUBTOTAL
Required only H fixture qty total is>9
TOTAL
Co—ntacctPerson—Name Phone —
/ O I r2S v e 6ZS—g Pa J 'Minimum permit toe Is$25+5%surcharge,excevt Residential Backflo
+".Q 4 fL�f _ _ Preventinn Device,which is$15+5%surcharge
-- -All New Commercial Buildings require plans with isometric or riser diagram
and plan review
I wsls%plurn.op doe 712198
PLEASE COMPLETE:
Fixture Type " — Quantity by Work Performed _
Newer—Moved Replaced Removed/Capped
Sink
Lavatory
Tub or Tub/Shower Combination
Shower Only _ - I - -- _ _ - --_-----
Water Closet
Dishwashe_r ----_.._____-__
Garhage Disposal
_Washing Machine_
Floor Drain/Floor Sink 2" _ ~
._Water Heater --- ----------_.Laundry Room Room Tray —
Urinal
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
+ WASHINGTON COON 1 V DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL HEALTH AND SANITATION
15b N. First Avenge
Hillsboro,Oregon 97174
(503) 648-8722
CR. #: e—��� , _
Tax Map #: _ l 1180
Road Name: >f,.� U ✓✓���
PERMIT
New Construction
Ful
Repair %1`Iajo�, Minor)
Alteratio "
An On-Site Sewage Disposal Permit is issued to : 6" rata-...._- _
for a period of one year from the date issued.
(This Permit is NOT transferable)
All septic systems n ust be installed as indicated on the approved plot plan. If any changes are
anticipated, d revised plot plan must be submitted to the Washington County Department of
Health and Human Services for approval. The plot plan is part of the permit.
Before a drainfield can be backfilled, a pre-cover inspection must be made. The inspection will
be made within 7 working days after it is requested.
Date %sued: -
-- Environmental Yealth Specialist
7H-W (T
CITY OF TIGARD BUILDING INSPECTION DIVISION �) �- /zI7�
24-Hour hispcetion Linc: 6394175 Business Phonc: 6394171
Date Requested: t`� A.tvl. RM. MST:
1
Location: BUR
I�. — •----
Tenant: Suite: Bldg: — MEC-
Contractor: Phone: PLM:
Owner: __
V Phone: ELC:
- Lj
rn- ati tiy T ELR:
_ SIT:
BUILDING BLDG(can't) PLUMBING ECHANIC ELECTRICAL SITE
Site Post/Beam Post/Beam os cam Cover/Service Sewer/Ston
Footing Roof UndFI/Slab Rough-In Ceiling Water Line
Slab Framing Top Out Gas Line Rough-In UC,Sprinkler
Foundation Insulation Sewer Ilooa/Duct Reconnect Vault
Bsmt Damp Drywall Ston Furnace Temp Service MISC.
Masonry Ceiling Rain Chain A/C UG Slab
Shear/Sheath Fire S;k1r/Alm Crawl/Found Dr I{eat Pump Low Volt
Approved Approved 4Z&rovcd Approved Approved
Appr/Sdwlk Not Approved Not Approved Not Anproved Not Approved Not Approved
FINAL FINAL (-F—[NA-I-,--, FINAL FINAL
CI Call foO Reinspection fee of S —required bbccforee nexttiinspection C1 Unable to inspect
Inspector: /C7 �— Date _ ...z L_ -- --- Page--of—
_�—
CITY OF TIGARD ME CHAN I CAL.
PERMIT
DEVELOPMENT SERVICES PERMIT #. . . . . .
. MEC97-0166
13125 SW Hall Blvd., Tigard, OR 97223 (503)639.4171 DATE ISSUED: OG/02/97
PARCEL: c5111BC-01400
SITE ADD.'.-SS. . . , 10145 SW VIEW TERR
SUBDIVISION. . . . : GREENBRIER ZONING: R-3. 5
BLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :4 JURISDICTION: TIG
CLASS OF WORK. . :NEW FL_JOR FURN. . . . : 0 EVAP COOLERS: 0
?YPE OF USE. . . . :SF U'JIT HEATERS. . : 0 VENT FANS. . . : 0
OCCUPANCY GRP. . :H2, r ENTS W/0 APPI_: 0 VENT SYSTEMS: 0
STi RIES. . . . . . . . . 0 1AOILERS/COMPRESSORS HOGD3. . . . . . . . 0
FUEL TYPES------ --- --- 0-3 HP. . . . : 0 D'JMES. INC 1 N: 0
:GAS 3-15 HP. . . . : 0 COMML.. I NC I N: 0
MAX INPUT- 0 BTU 15_.30 HP. . . . : 0 REPAIR UNITS: 0
FIRE DAMPERS')_ : 30-50 HP. . . . : 0 WOOD STOVES. . : 0
GAS PRESSURE. . . : 50+ HP. . . . 0 CLO DRYERS. . -. 0
IVO. OF Ut 1 i TS—._._—___--.__— AIR HANDLING UNITS OTHER UNITS. : 1
FURN ( 1.00K BTU: 1 (=1 10000 cfm: 0 GAS OUTLETS. : 0
FURN ) =100K BTU: 0 ) 1100 cfm : 0
Pemar-4(s : instl furnance ducts/vents 6 water heat et. . ural gas
flainer': _____________________...___.________._.___......_____..____.__.__—_— f F_ES
SARA BUEHL.ER type amoUnt by date r^ecpt
1.0145 SW VIEW TER PIRMT $ 25. 00 TAT 06/02/97 97-29534:-"
TIGARD OR '37224 5PCT $ 1. L`_S TAT 06/02/97 37-295343
Phone #: 684-0754
Cont-actor.. --____._.____.___.._.—_--•_---____—_
GAROKEN ENERGY COMPANY
3975 SW 113TH
UEAVF_RTON OR 97005 -----------
f-'hone #: f 216. 25 TOTAL
Reg #. . 0004:31
----- -- REQUIRED INSPECTIONS
This peroit is issued subject to the regulations cantained in the Gas Line Insp
Tigard Municipal Code, State of Ore. Specialty Codes and all other Mechanical Insp
I applicable laws. P11 work will be done in accordance with Heating Unt Insp
approved plans. This oerrit will expire if work is not started Cooling Unt Insp
within 189 days of issua,•ce, or if work is suspended for sore Final I n s pect i ar, _
than 199 days. --------
r'e r m i t t e e Sig Pit e : -
- --
T s s l.r e d B y : _
i
l Call for inspection -- 639-4175
l:i i Y Vf 11UAHU MtGHANICAL NEHMIT Permit #
Description
Table 3A Mechanical Code ale PRICE AMT
City of Tigard - ,-
13125 S.W Hall Blvd. 1) Permit Fee -0. -0 0.00
P.O. Box 23397 —� --
Tigard, OR 97223 2) Sjpplemental Permit 3.00
639-4175 Furnace to 100,000 BTU
1) Incl.ducts A vents 8.00
Furnace 100,000 BTU + ^-
2) incl.ducts&vents 7.50 76-
Name of tlnvelopmenl �) Floor Furnace ti
incl.vent
00
Job Address -- 4) Suspended heater,wall heater s 00
Address _ t d �� r or floor mounted heater
ly5 �w tow. e_-. _ _ _ -- ---
tax Lot Map No ) Vent not incl.in 3
00
Lot mock Subdrvtsrun 5) appliance permit -, -
Name(or name of business) 6) Repair of healing,refrig., 600
C::; O.r Q _ cooling.absorption unit -� -
Malting Address Phone Boiler or comp to 3 HP 00
Owner 1 U 1�S ` UelL �rr�«� (�G C'7 5y �) absorp.unit to 100,000 BTU - ('
City/Slate zip Boiler or comp to 3 HP-15 HP
O 9) 00
absor unit to 500,000 BTU 1 t
2 4a`4
---- p' -- - - -- --
Name _ r Boiler or comp 15-30 HP
,�^ c� (� �) absorp.unit 1/2-1 million 15,00
l -TC.1cca cMPr �
Mailing Address hone 10) Boiler or comp to 30-50 HP 2250
(IIS t yl, � �� e absorp.unit i -1.75 million
Contractor ` ' at�.r �� Se_�i� Boiler or coin to
citylstale Zip 11 p 50 HP 31 50
1 . ��•�� , ) absorp,unit 1,750,000 BTU
Air handling unit to
Stale Registration No City Bus lax No 12) 4 50
G� f C,� _ t0,000CFM
/"� ( ' Air handling unit
I hereby acknowledge that I have read this application that the information given is t 3) 10,000 CFM + 7 50
oorrect,that I am the owner or authorized agent of the owner,that plans submitted ere in — -- --------- �_-___
compliance with Stale Isws,that I am registered with the Stele Builders'Board,that the 14 Non portable I
number given is correct (it exempt from Stale registration please give reason below) ) evaporate cooler 450
_ 15) Vent fan connected 300
to a single duct
16) Ventilation system not 450
included in appliance permit
17) Hood served by 450
mechanical exhaust
Signature(owner or epsnf) -- Date ) Domestic type
Describe work I I additl n C I alleratiof I-] repair I I 19 incinerator 7 SU
to be done V resider non-reside itial I I - 19) Commercial or industrial
Existing use of r incinerator 3000 �-
building or properly �) Other I.e.,woodstovel water 4 r�
Proposed use of
heater,solar,clothes dryers,etc
building or property __-_
21) Gas piping one to four outlets 200
Type of fuel• oil f I natural gas�.V) LPG f 1 electric t_]
22) More hen 4-per outlet
Q1t7TICE - _ �_
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CON SUS-TOTAL I/.GC
STRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 SURCHARGE d�,
DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR PLAN REVIEW 25%OF SUN-TOTAL
ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER — -- -- - - --
WORK IS COMMENCED. TOTAL
Special Conditions
Date iatrred .- ---,_-- - by
CITY OF TIGARD
DEVELOPMENT SERVICES PLUMBING PERMIT
PERMIT #. . . . . . . : PLM97019 i
13125 SW Hall Blvd., Tigard,OR 97223 (503)639 4171 DATE ISSUED: 06/02/97
PARCEL: 2S111DC--01400
SITE ADDRESS. . . : 10145 SW viEw TERR
SUBDIVISION. . . . : GREENBRIER ZONING: R-3. 5
BLOCK. . . . . . . . .. . : LOT. . . . . . . . . . . . . ..4 JURISDICTION: TIG
CLASS OF WORK. . :NE(-, GARBAGE DISPOSALS. : 0 MOBILE HOME SPACES. : 0
TYPE OF USE. . . . :SF WASHING MACH. . . . . . : 0 BACXFLOW PREVNTRS. . : 0
OCCUPANCY GRPI. . :H2 FLOOR DRAINS. . . . . . . 0 TRAPS. . . . . . . . . . . . . . 0
STORIES. . . . . . . . : 0 WATER HEATERS. . . . . : I CATCH BASINS. . . . . . . : 0
FIXTURES--------------- I AUNDRY TRAYS. . . . . : 0 SF RAIN DRAINS. . . . . : 0
SINKS. . . . . . . . . : 0 URINALS. . . . . . . . . . . . 0 GREASE TRAP'S. . . . . . . . 0
LAVATORIES. . . . : 0 OTHER FIXTURES. . . . : 0
TUB/SHOWERS. . . : 0 SEWER LINE ( ft ) . . . : 0
WATER CLOSETS. : 0 WATER LINL (ft ) . . . : 0
DISHWASHERS. . . . : 0 RAIN DRAIN (ft ) . . . : 0
Remarks : instl I t-jatpt- he-Ater,
Owner-: FEES
SARA BUEHLER type amol.knt by date r-eept
10145 SW VIEW TER PRMT $ 25. 00 TAT 06/02/97 97-295343
TIGARD OR 97224 5PCT $ 1 . 12'5 TAT 0(5/02/97 97—,:_-_*95343
Phone #:
Contr-actat----------------------------------
Phone #: $ 26. 25 TOTAL
Reg
---- REDUIRED INSPECTIONS
This pereit is issued subject to the regulations contained in the Water- Line Insp
Tigard Municipal Code, State of Ore. Specialty Codes and all other Water Set-vice In
applicable laws. All work will bf done in accordance with Rof_(ghin Insp
approved plans. This pervit will expire if work is not started FILM/Underfloor __ _
within
ILM/Undpt-fIoor-
within 180 days of issuance, or if work is suspended for sore Top—oi.it Insp
than 188 days, Final Inspection
Signatl.t I
Issi.tpd By :
11 fat-, inspection 639-4175
A
City of Tigard PLUMBING PERMIT APPLICATION Planck/Rec. # r�
13125 SW Hall Blvd. Permit #
Tigard, OR 97223
(503) 639-4171
MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE
New Single Family Residences Only
- ❑ 1 BATH HOUSE$140.00 0 2 BATH HOUSE$195.00
Job 0 3 (BATH HOUSE$225.00
Address n. Fee includes all plumbinq fixtures it' the dwelling and the first 100 feet
of water service, sanitary sewer and stom. sewer. See fees below._
gl1ex�,,gl1eglei,,1eeer FIXTURES _ CITY PRICE AMT
ClY r� 1J llC' -Ae Y" Sink 9.00
y.�y.dfw
Lavatory 9.00
/ o ����L Tub or TubyShower Comb. 9.00
r
Owner " - 9.00
uMar. tr Shower Onty _•_
Nater Closet _ 9.00
Dishwasher 9.00
Garbage Disposal 9.00
occupant 4e„e ,,;,. 1001- Washing Machine 9.00
Floor Drain 9.00
J Water Heater 9.00 ZJ
Laundry Room Tray 9.00
NOW _ Urinal 9.00
14 _0-3� `( Other Fixtures (Specify) 9.00
We"sae Phu" 9.00
Contractor 9.00
ap 900
s Sewer 1st 100' 30.00
ON"
s as ea TO W Sewer-ea. Addd. 100' _ 25.00
3 -Il3P/S __30- ,
y .00 I
1 C_ 1 ��� Water Service 1st 100'
25.00
I hereby acknowledge that I have read this application, that the Water Service ea_Addil. 200'
nformation given is :onect, that 1 am the owner or authorized agent of Storm 8 Rain Drain 1st 100' 30.00
the owner, that plans submitted are in compliance with State laws, that 20.00
I am registered with the Conr.niction Contractors Board, that the Storm &Rain Drain Addit. 100'
number given is correc'. (If exempt from State registration, please Mobile Homs Space _'5.00
give reason below,l
Back Flow Prevention
Device or Anti-Pollution Device 9.00
Ogle Any Trap or Waste Not
-q' Connected to a Fixture
Catch Basin 9.00
Describe work new addition alteration repair 40.00/hr
to be done residential 0 non-residential Q Insp. of Exist. Plumbing
Specialty Requested Inspections 40 00/hr
Existing use of t Rein Dram, single family dwelling 3G 00
building or property Residential backflow prevention
devices 15.00
Proposed use of _
building or property •(Except residential backflow
prevention devices)
NOTICE 'Minimum Fee !25.00 SJBTOTALj,(�
PERMITS BECCME VOID IF WORK OR CONSTRUCTION SURCHARGE �'d
AUTHORIZED IS NOT C':MMENCED WITHIN 180 DAYS OR IF
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED
- FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS PIAN REVIEW 25% OF SUBTOTAL
CCMMENCED - - /
TOTAL
Seecial Conditions -- -
Date tssued _ _ by -
!1w