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.93
Community Development ELECTRICAL PERMIT APPLICATION
13125 SW Hall Blvd.
Tigard, OR 97223 Planck/Rec. #
Permit ,At !ELC 9S- aZn 1
Phone (503) 639-4171 Date Issued
CITY OF TIGARD FAX (503) 684-7297 Issued by
TDD No. (503) 684-21'72 —
Inspection (503) 636-4175
1. Job Address: /�{{ 4. Complete Fee Schedule Below:
Name of Development /Mae-yu_t�,� &ns Number of Inspections per permit allowed
Address / y 1 j'�:} ,mss j�'t� � Service included Items Cost(ea) Sum
City/State/Zip nG,,,,,��� 4a. Residential-per unit
4
1000 sq It or less $11000
Each additional 500 sct f; or i
Name (or name of business)_--__ portion thereof $2500 1
Commercial, Residential a Limited Energy $2500
Each ManAd Home or Modular 2
Dwelling Service or Feeder __ SM 00 _
2a. Contractor installation only:
4b.Services or Feeders
Installation,alteration,or relaxation 2
Electrical Contractor�l r a i.1 41 u i. exttL&zi- 200 amps or less $Ot7 Co 2
Address_�i:. a 4,s 201 amps to 400 amps $8000 _ 2
401 einpe to 1300 amps $12000 2
Cit r s, �.,.av,. State l �' .1" - z
Y L— �_ I._1 801 amps to 1000 amps $18000
Phone No.__ �"• j 5 - _-- Over 1000 amps or volts $.'140 0o 2
Contractor's License No. 3 ) Reconnect only _ $S000
Contractor's Board Reg. No. 4c.Temporary Services or Feeders
Installation,alteration,or relocation
Signature of pr. Elec'n -fl / 200 amps or less $5000 2
201 amps to 400 amps $75 00
License No. Phos 0. Q T• S 5 7 401 amps to floe amps $too 00
Over 800 amps to 1000 volts
2b. FO* owner installations: see'W above
4d. Branch Circuits
Print Owner's Name New,alteration or extension per panel
Address a)The fee for branch drculte with
City •_ State _ Zip_ purchase of ewvlce or Nader Ase.
Phone N0. Each brnnch circuit $500
b)The Ion for branch circuits without
The installation is being made on property I own which is purchase of service or Nader be. _
—1 $3500
not intended for sale, lease or rent. First hranch circuit Fant,aridlional branch circuit $500
Owner's Signature _ 4a. Mi,cellansous
(Service or feeder not included)
3. Plan Review section (if required): Fach primp or irrigation orcie $4000
Fach sign or outline lighting $4000
Signal clrcud(s)or a limited anergy
Please check appropriate Item and enter fee in sOclior. J8. panel,alteration or extension $4000
a. 4 or more residential units in one structure Minor Lahals(1u) $10000
R Service and food& 225 amps or more
System over 600 volts nomir,al 41. Each additional inspec:lion over
Classified area or structure containing snecial occupancy the allowable in any of the ob-ve
inspas described in N E C Chapter 5 per Per hour hour on $35 00 -
r--r $55 00
J In Plant $55 00
., Submit 2 sets of plans with %pplication where any of the above - —
°� apply. Not required for temporary cr:;fstruction services. Jr. Fees:
c�
-j NOTICE 5a. Enter total of abcve fees $
5%Surcharge 105 X total fees) $
PERMITS BECOME VOID IF WORK OR CONSTRUCTION Subtotal $
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF 5b. Enter 25910 of line A for
CONSTRUC rION OR WORK IS SUSPENDED OR ABANDONED FOR Plan Review if required(Ser,J) $
A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS Subtotal $ !_`
COMMENCED. ❑ Trust Accnunt N
$
Balance Due
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CITYOF TIGARD CERTIFICATE OF
A
7CMo, RD OCCUPANCY
COMMUNITY DEVELOPMENT DEPARTMENT iT-PMIT #. . . . . . . : SUP91
13126 SW HWI Blvd. P.O.Bei 23397,TlgaM,Oregon gf22
7-17—Tr ISSUE!?- 10,1411/91
SITE ADDPESS. . . : SW 11219TH AVE PARCEL.:
SUBDIVISION. . . . : ISATTLER PARK Z ON 1 WG:
BLOCK. . . . . . . . . . .. I.OT. . . . . . . . . . . . . 110
CLACS OF WORK. :ADD
TYPE OF USE. . . :MFS
OCCUPANCY GRP. :M1
OCLUPANC Y LOAF,-.
TENANT AAMC. . . :
RtAl.u.iwks . Add .- carport struc-,turev w/33 stalls.
Dwneru
Hli'L.M137
t)821 MIMI MAP IMODI UITC. L2,00
':)AN 0117130 CA 921r:'1
Phone #:
BAJA CONSTRUCTION CO. INC.
2'x3 FOSTFR STREET BOX 3080
MARTINEZ CA 94353
Phem., iP 415-0`9-0732
reg
Occupancy of the &bove referenced building is her t-by given, kw)d ceirtifies
the --ompliAnce with the .State Of Oregon G)pecijklty Codes for the group,
0CLktp*ncy, aTI ' Lt cve,,-unrTey which the referenced permit wAF, isnxuprj.
IRE DEPORT011"NT N.i. INO CTO
6ni:! OFFICIAL
P0S7 IN CONSPICUOUS PLACE
u-
uj
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line ,'Rac-O-Phone): 639-417") Business Phone: 639.4171
n
Inspection:
Footing Susp. Ceiling Spnnk. Rough-in Appr/Sdwlk
Foundation Plbg. Undemlab Mech. Rough-in Fireplace
Post/Beam Struct. Plbg. Top Out Elec. Rough-in FINAL:
Post/Beam Mech. San. Sewer Gas Line -Bldg.
PIbg. U,iderfloo, Rain Drain Framing -Plumb.
Alarm Water Line Insulation -Mech.
Underflr. Insul. Shear Wal: Gyp. Bd. -Elect.
Date Re;l.ested _ `J T me: AM PM
Address:
3-5 G �
Builder. �� i l �t Exe s35 3 Permit #:
?�y_c3g3
THE FOLLOWING CORRECTIONS ARE REOUIRE'D.
rX
h-
Un —- -- --
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Ill ------
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Inspector: _04,
PPROVED _DISAPPROVED _-APPROVED SUBJECT TO ABOVE
Call For Roinsp.
INSPECT19N—!LOT—ME
City of Tigard Building Department
1317.5 Sw Hall Blvd. Tigard, Oregon 97223
Inspection Line (Rec O-Phone): 639-4175 Business Phone: 639-4171
Inspection:—_ (.ZL , --
Footing Plbg. Underslab Hech. hough-in Appr/5dwlk
Found. Plby. Top Out Gas Line FINAL:
Poet/Beam Struct. San. Sower Framing /� -Bldg.
Post/Beam Hoch. Rain Drain Insulation l -Plumb.
Plbq. Underfloor Water
^�Line •yp. Bd. -Hoch.
Date> Requeetedi �� �V `��
Er�milt-- r
�r
_"AMC�
PH
Address: Z22 #1 elf—
e
Build
�L THE FOLLOWING CORRECTIONS ARE RENUIREDi
F-
N
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CA
V.)
J
Inspector/: _�__ Date:
APPROVED DISAPPROVED APPROVED SUBJECT TO ABOVE
Call For Reinsp.
INSPECTION NOTIrl:
^.ity of Tigard Building Depart.—nt f
13125 SW Hall Blvd_ Tigard, Oregon 97223
laspectLon Line (Rec-O-Phcne;: 639-417,5]Bit e8i Zhone: W-4171
i:.upec.tiont
Footing~ Plbg. Oncsersiub Mech. Rough--in Appr/Sdwlk
Found. Pabg. Top Out Gas Line FINAL:
Pont/Beam Struct. San. Sewer Framing -Bldg.
Post/Beam Mock.. Rain Drain Insulation. -Plumb.
Plbg. Underfloor Water Line Gyp. Bd. -Koch.
Date hequosted:� 1 1 Tij - AM
Addreee:_— , Permit it
THE FOLLOWING CORRE(MONS ARE REQUIRED:
f
F-
i
?nopnrtn V --Date:_
APPROVED DISAPPROVED APPROVED SUBJECT TO ASJVE
Call For Relnep.
INSPECTION NOTICE
City of Tigard Building Department L�17-21 ee
P.O. Box 23397
Tigard, Oregon 97223
Phone: 639-417':
Type of Inspection _ 7 __��
Date Requested� Time_ A.M.--P.M.
iy79 sw i G� g�;oG�06
Address _i !C_ �� Cly T' —_. Permit #.$f f,,L)
Owner Lot #
BuilderThe following Building Code deficiencies are required to be corrected:
Presented to A–Approved
Inspector –_L� U Disapproved
Date
CALL FOR REINSPECTION
❑ YES 0 NO
C17YOFT167ARD
t'YOFTMR' BUILDING PERMIT
COMMUNITY DEVELOPMENT DEPARTMENT ��+ 171E RM IT #. . . . . . . .. BU17191-019j�
13126 SW Fhll Blvd. P.O.Bon 23397,rgajr,Or"m 97223(SW)6344174
639-4171 DATE ISSUED 06/109/91
/z/179 y AC. .sc�
SITE ADDRESS. . . : 4-+47t�' ;.iW 109TH AVE PARCEL. 25110pe----m4so
SUBDIVISION. . . . : ....�;= .E i._F+A�?K ZONING:
LLOCV.. . . . . . . . . . .I I LOT. . . . . . . . . . . . . : 10
REISSUE: FLOOR AREAS--------- EXTERIOR WALL CONSTRUCTION -
CLASS OF WORM. :ADD F I RST. . . . : s f N: S: E» W:
TYPE OF USC„ . . :MF SECOND. . . : sf PROTECT OPENINGS?-__.___.__.-__
TYPE OF CONST. :2N TH I kD. . . . : S f N.- S: E:: W
OCCUP;NCY GRP. :M i TC'', AL ---- : 0 s F ROOF CONST:C FIRE RET? :Y
0C'(' .,r-'ANCY LOAD: BASEMENT. : sf AREA SEP. RATED:
STOR. : 1 HT. :9 ft GARAGE. . . :5346 Sf OCCU SEP. RATED.
BSM7').N MEZZ7:N READ SETBACKS------
FLOOR
FLOOR LO(�D. . . . : 1 25 ps f LEFT. ft RGHT: ft F I R SPIKL :N SMOK DET. . :N
DWELLING UNITS: FRNT : ft REAR: ft FIR ALRM:N HNDICP ACC:N
BEDRM ; . BATHS: IMF' SURFACE: PRO CORK:N Pf RK T NG:
VALUE. $ r 14025
Remarks : Add 6 carport str1.Icti-,res w/33 sails.
Owner: __._______..____._.____________-..__.__.__. . FEES
HELMUT KIr=F=MAN +.ype amo(_int by date r ecpt.
5C3?1 MIRA MAR ROAD, SUITE x.'00 PRIeT t 110. 50 ,JLH OB/09/91 - I
PLCK $ 71. 83 JLH 07/12/91 215303
FIRE r 44„ 6-20 JLH 07/12/91 2153017
Phr,ne #: 5PC:T 5. 53 JLH 08/09/91 -•
Contractor:
BAJA CONSTRUCTION CO. INC.
12&':3 FOSTER STREET' BOX 3080
MARTINEZ CH 94553
Phone #: 415-229-0732 f 232. 06 TOTAL
Req #. . . 46.1 &2
REQUIRED T"It;PE:CTIONS - _._----_
This perait is issued subject io the regulations contained in the Fool:/FoLlnd lnsp
Tigard Municipal Code, State of Ore. Specialty Codes and all other S 1 a b I n s p
applicable laws. All work will be done in accordance with Framing Insp --
approved plans. This permit will expire if work is not started Final Insper_tion
within 180 days of issuance, or if cork is suspended for sore
n thl.n 180 days.
J i 'e r m i t t e e S i g n a t u r e»
J
Call for inspection. - 639-6175
I
1
CITY OF T I AF'IRD _ RECE V'T 1.1F F''FIYME:N1 RECEIPT NO. :9 1— '16182'
CHECK Ah:91-INT a 1 16. 03
NAME s USA WEST Ar-If-1R*l"llI N'T FUND CASH AMOUNT s 0. QZ�
ADD:)REI')::i s 5820 ML i RAMAP RD r AYMENT DATE
W I TES '--- SUBD I V 151 ON
:SAN D I E:1.471, (J) 92121 -
'JRf-,OSE (]F F,AYME'NT AMOUNT FSP I D PURPOSE OF PAYMENT AMOUNT_�A I D
lit_DINr PERM 11121. 50 ST. BUILD PIER 5. a3
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147 9 SW tQ.',)Tll f1VVF ll
VCITAL 11MOUNT 1='i�T U - > 1 1.h. 03
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BUT I DINC; PEPKET
CITY OF TIGA RD I'E-'RMT'T' NO . : MA390606
Cr:�rff—OF�W�A RD
CONjMUNITY DEVELOPMENT DEPARTMENT ORFOON
13125 S.W.Hall Blvd..P.O.Box 23397,Tigard,Oregon 97713,(503)639-4175 1.)A*1'1: T S!:)I I Fi.1) ZI/.1 09
1 117-WT� 144.1.. 10 611W)WAZ
1-'IfY9 t,.iw 10')TH .,)Vl:.
-1AX MAP/11-01' 42 S1 :I.Oo(:, 500 F:I
LAND
I.A.T11 SIZE : W.M...UATION : $ 9 F3,!•JSETBACKS
FIRKINT : PEWI:
WORK (:'I ASS . NE'U UW I T
L . UNIT'S d1l LET'T : RUA-IT:
USE TYPE : el 1::'AMT I Y NO. DEDPOOMS: a EXT.WAI L. CUNTT' :
CONS T* . TYPE ; VN NO. 113ATHS : ll:
N:NP S) I'--" N 1.1 W:Nk,
00010P .(aPP . : P1. PROT . (:)PEN:1:N(.-,[5 :
CHICUIZI .1...0A1) 1.el, N:NP S : NI? N 1-4 W:NP
'TO TAI... APEYO 391%)
N(3. 51T)i 1E.G : P 15;'T' : 1970 ROOF (U)NST: C F*]:PI:-*.* Pli T? NO
111:::1:(::1•:1, : N D J.97 0 AREA SEPAP'? NO PATEM:
- 20 o
BA GE-11"ll'."NT? NO
.1E.PAP'? NO DA'11-:1) .
Ml-::ZZAN:i:Nl:::*? NO D05UM—11'
1%I-X.1101:1 I OAD: 100 P'lPE. S11:111(1 1"V? NO (.411-ARM'? NO
FLOW((.'.)F)M) DE-A'EX-V? Yl
117;,AX .WIPW - 611-6,11" 113 8 H H Y NE)
I AN (:,I-4l::XK PY : JI-ij
i-4-MARKS :
P1EEISSU11ii.: OF NO.
L.AS'T' PrEISSUE'.
0
W PE'11MIT 41/130 . 00
SE PL.AN RIEVIEW 14279 . 50
A F,c) 1.1:1.1-1(1 014 97F-216 V IPIE DETIT '11:1.'7X)..
(503) STA(EK 'TAX 1121 . 150
('11 Y'l.-IF.174
C "I I III'MIENT CHAAUE5 :
0
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R C U 1.1 CUMI: ANY 1')(:,(Si T REEE."T 11111 440 . 00
A 031 15 Sr STAI1K S T* t I f.;1 11, 1 n1F,0a
T
o PHON11' 11503) 2132-41'78
Lf -1 .: t.
L�1-11 I�Lil I'll�11 UN�N" 1111f.? '91e13 . 00
This permit is issued subject to the regulations contained In Title 14 PECE-K I PT NO . /0,33
nt the TMC, State of Oregon Specialty Codes,zoning regulations ——
and all other applicable codes and ordinances, and It is hereby f&:.Q0*lJ1E:D 1:N5 PVX,11:ONS
agreed that the work will be done in accordance with the plans and li;'00T.1 NC,
specifications and In compliance with all applicable codes and
ordinances. The issuance of this permit does not waive restrictive FT)UNDATION WALI
covenants, Contractor and subcontractors shall have current [J(7SI & 01EAM
ri hUsiness tax permits. This permit will expire.and berorn, ;;,,Il i,! V'PAMT W.,
void if work is not started within 180 days,or If work Is suspei 'c,i of NATE 1...1:NG
abandoned for a period of 180 days any time after work, has
commenced. It shall be the responsibility of the permittee to assure INGULoT.11:ON
all required Inspections are requested and approved. G,11'P 00API)
F,T N1.)1,
iferr m I t Wt . S�i
Issued By
I L 1:4)W INSPI. 110N 639 /1.1'75
SEPARATE PERMITS REQUIRFD FOR WORK OTHER THAN DESCRIBED A30VE
SEKWEP PEAMIA*
PEPM11' NO. : 1:
• CITY OF T IGA�
CITYOFTWA
COMMUNITY DEVELOPMENT DEPARTMENT 01110<W
13125 S.W.Hall Blvd.,P.O.Box 23397,Tigard,Oregon 97223,(503)6394175 DA*Tl': ISSUEA)
13014 1el*199 SW 10911-1 AVE.' I. a21 USA N U M 1 1: 037'e1'TO
IAX MAP/1 01' 2 51, 10AC, .500 SUN: 1-11*111.`* R(.1LA M*T' PAWK API'S UK :
I AND USE : i R
L CYT S 1:71
�!')PK 01-ASS : Nl*-"W
USE 'T*YI:',E: el FAM11-Y
aq:)1:)JA. 1,11, ata.:I. iikricl r4:1S;It.I:Latt,a.tari9i tai' tura l.lrla.i°a.4a ca
Fiew(,;+I-akge Ageriic�y I'lle? pel-Ini't. 120 cIa.w!i -:'i-(3nI the Llilktel e f,11 t AI
'11.1110t.11-11, 1319J.d l41,11 be Tc)r,feitecl JAI I,he ex(:)ir•e% . 'The Ac -icy -icI t
Met , c1cieu; I rl m in.r--
m.1-It.ee t'he (:).r 1oc�mIlticil-I cif thfi... 15:kic.l Iwwtiw If t'hr t;eWc.�l- iti;
rlml. Tcx:41ilted att the giverl , t.he irisutin.A.].er- sihat:ll ;)r,ci%;)eo.t '3 -fliv.?et iri
is.3.3 dir.c.1c.-tJol-lin --1--c)III t'he uiverl . If 1*1(3-t. lt;(3 1.43ci9'te(j , the? :11.11tawa11er, mhal.l.
m. "Tatp mricl Sidl-ii Sepwetr-" Pe)i-1JtIJ.t .1111CI tI'Je (-)gerICq Wi.I.A. :1.1-If3tal,11 In. TiAte1"R&1 .
AREA:
.,'I I I I!V UNI I'S 1./1 '1'1:..N(-)N'I' IMP,11:40VIEME.N'T : NO
UNII:T'S : ,.I
W C, 9 11 G.a lit p lit I-I y 1.)E'.P M:I:,Y* 41/15 . 00
4
'(: ('3:31.5 !11:: St'ati-It St, GONNIECTAX)IN CHAPGE- $,e4 .100 . 0
r- P c)I` t.3.at I-1 cI (:IP 97P1.6 I-INE '11AP INST(1I L.
1:1-IONIE' 150*311 1,el IF)
0*11-1EA
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C P C1 r 6 I.in.I-I cI 014 91P16
T
0 11-40M*. (503) 1,41,78
R ION NO I",Lill-1 Y'(-Xrot $1,AlA5 . 00
This permit is Issuec subject to the regulations contained in Title 14 NO. 7
..........
of the TMC, State of Oregon Specialty Codes,zoning regulations
and all other applicable codes and ordinances, and it is hereby
agreed that the work will'3e done in accordance with the plans and S EK W E t 4
specifications vid In compliance with all applicable codes and
FJ.NAL.
ordinances The issuance of this permit does-lot waive restrictive
covenants Contractor and subcontractors shall have current city
business tax permits. This permit will expire Find become null and
void it work is not started within 180 days.or it work is suspended or
abandoned for a period of 180 days any time after work has
commenced. It shall be the responsibility of the permittee to assure
all required inspections are requested and approved
IP e'r;r Z t It�Pi 9 n a*tur a
Issued By _ , il 1- 1 11.111 1 1 11N 639-4117.13
SEPARATE PERMi i S REOUIRED FOR WORK OTHER 'THAN DESCRIBED ABOVE
V-1 UMBIAG PE'RMI-T
IDERIM:11"T' NO. ; -
CITY OF T167A RD M� 1.)LIB90643
C17YOT WARD
ORIG
COMMUNITY DEVELOPMENT DEPAR-. 41ENT ON
13125 S.W.Hall Blvd.,P.O.Box 23397,Tigard,Oregon 97223.(503)63941175 17A111, T!:i5t.JE;;I*-) I/ J.0/L39
JOB AL)IDPEGS : 71--el'/Y9 SW 1091 11 AVL
'T'AX MAI--,/I (.)T P. 50. :I.OA(:, 500 SUB: 1-111'LE BULL MT' A.VYI-S L.T : HK
L-ANU USE* : P1.2
I-OT 51ZE' :
.1.TEEM: NO: NO
Wt: PK GLASS : NEW WYNER C'L.OSET a TPAP
U15E FYPIE: el FAMIA y 1. RJ:N0I
C(:)NF-.i*f* , TYPI: VN 'I PAP PRTMI:A
("PP . P1. jPEASE'. *T'I;',',,.)I*)':')
D.l.'514WASHEN:4
(-',ARPAGA:: 01Si;1-"OSAI
NO. S'T ORT I: W051-41W, MACA-1.1NE: ZI
0W.A.A.. .UNITS : 'e.1 1. AUND14y VkAy DI 13G. DPATN ( IXIA
14-1 00P I:~1N
lli:[NK A Gr'WEP
wA*rr.:r:l 5'T0PM/PA1N (FT
0TIA1-":A
P 1;-:,.M f)P K 51
W "I*Z.550 . 00
N U3.1 r,It G t
E
R PCs r-I"I rIIcI Op 97Z-21. 1: T
1:4-IONE 50,311 E!52 1,-e1 18 5 I'AX $3.7 . 5
1107 . "1 10
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01
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0
R '101*61 11A,1155 00
This permit is Issued subject to the regulations contained in Tire 14 NO. '102
of the TMC. State of Oregon Specialty Codes,zoning rc!gulations
and all other applicable codes and ordinances, ane It ;s hereby lKA41A] PEA) 1INSPEC'TJONS
agreed that the work will be done in accordance with ti%t plans and
11-0 . UNIHKASI AR
specifications and In compliance with all applicable codes and POI.A.-A4 I N
ordinances. The issuance of this permit does not waive restrictive
C13 covenants Contractor and subcontractors shall have current city
business tax permits. This permit will expire and become null and EWEN UWAXINIS
void if work is not started within 180 days.or If work 19 SUSpeodedo. PI F.4 . TOI7'(.X.J11*
abandoned for a period of 180 days any time after work has I.:. N A 11—
commenced It shall be the rerponsibll:.) of the permittee to assure
all required Inspections are requested w J approved
ar
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mitt S Si tu
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Issued 93V: 11:111111 INSPI, i I TON 6,39 (117
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE
CITY OF TI6A RDLi1,� J.CAl
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COMMUNITY DEVELOPMENT DEPARTMENT OREGON
13125 S.W.Halt Blvd.,P.O.Box 23397,Tigard,Oregon 97223.(503)639-4175 /1/ 10/819
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AUDPIEKSS : 14799 tiw 1.09TI.-I U .
MAP,/I ITT is 5:1. :1.0f)(:' 300 LITTI E 1'-:-(.Jl L. 1`11' PAPK APITS I
6ND USE :
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USE TYPE : Al AIA HANDI R 3.01<
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NO. �31'151111 OR(DOM
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2� This permit is issued subject to the regulations contained In Title 14 P ET',F*:I PT N 0
of the TMC, State of Oregon Specialty Codes.zoning regulations "»"""""""•'"""'...... /03,397
CA and all other applicable codes and ordinances, and It is hereby :I:Nl:iPl:.::(:',TA:(INS
agreed that the work will be done in accordance with the plans and Ml::*(*'I-I()N(:,L . riY!i'TLM
specifications and In compliance with all applicable codes and
1 I'NAL
ordinances. The issuance of this permit does not waive restrictive
ro covenants. Contractor and subcontractors shall have current city
business tax permits. This permit will expire and become null and
IJ void if work is not started within 180 days,or If work Is suspended or
abandoned for a period of 180 days any time after work has
commenced. It shall be the responsibility of the permittee to assure
all required Inspections are requo:;ied and approved,
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Permit /7 - 6W
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Permit � gnp�.re
Issued By
FOP 1.Ws P I—(:,1 .1 L)N 631i'zlj. jr5
SEPARATE PERMITS REOUIRED FOR WORK OTHER THAN DESCRIBED ABOVE