12450 SW 115TH AVENUE I
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_� 12450 SW 115TH AVENUE _
I' CITY OF TIGARD
DEVELOPMENT SERVICES
13125 SW Hall Blvd., Tigard,OR 97223 (503)639-4171
CERTIFICATE OF
OCCUPANCY
PERMIT #. . . . . . . : MST96-0,i
DPTE ISSUM 02/24/17
P040'EL ; j-.S.1 0--1`bD-HG0C-*7
I TE ADDRESS. 124' SW I 15TH AVE
4JEAD I V I S I ON. . . . c HUNTERS ULEN ZONING a R-4. r1D
,LOCK. . . . . . . . . . :* L.CIT. . . . . . . . . . . . . 02 7
t-LPSS OF WORK. :NEW
! YPE OF' USE. . . t9F
IYPE OF CONSTP.5N
1CCUF,ANCY GRP. ;R3
1CC1.PANCY UJAD:,:..'
Remarkes Path I
EGEND HOME G
-100 SW HAINES £i,r
TOARD OR 9,7223
,hori p #s 620-8080
ontractort -
I JEND HOMES CORPORATION
'1160 13W HAZELFERN RD.
1'.;Lj 17 E 100
I MARD OR 972Z�4
Phone #: 6c-10-8080
Peg #. . s 60563
This Cortific-atr gran-ta occuPll
au'Y of the oboyp rvferencpd boilding or portion
e
"hroof and k:cwfil mri thatthe building hall been insperted for~ compli ncv witi,
the State of Oregon Sper.-IrAity Codes fortFje I.P't"UPs ,; !V, And Under
,�<"kz�
V f,
whicl-) the t fprenced porteit was isft,ter.J.
/07
TOR )INC; OFFICIAL
it,
f)(11737 IN UOMFPTCLJO(�r, F,1 ACE
CITY CSF TIGARD S
IPERMIT
DEVELOPMENT F"ERVSCES PERMIT #. . . . .
. . ;, MST96--046`
13125 SW Hall Blvd., Tigan:+, ;rt 97223 (503)639.4171 DATE. I S SLJE:D. 10/14 /96
PARCEI_.: 2 S 103,I3D--HGN0�7
SITE ADDRESS. . . : i2450 SW 115T'ii AVE.
SLJBD I V IS I 0 1. . . . : HLINTER' S GI.-EN ZiJN I NC : R---4. 5 PID
. . . . . . . . . . . I.-OT. . . . . . .. . . . . . . 0;_'7
Remarks: Path 1
BUILDING ------------------------------------------
REISSUE: STORIES.......: 2' FLOOR AREAS--------- BASEMIENT... 0 sf REQUIRED SETBACKS---- REQUIRED----------
CLASS OF iZRK,:NEW HEIGHT........: 22 FIRST....: 1107 sf GARAGE.....: 755 sf LEFT..........: 5 SMOKE DETECTRS: V
Ifp', nF USE...:SF' FLOOR LOAD....: 40 SECOND....: 1283 sf FRONT.........: 24 PARKING SPACES: 1
TYPE OF CONST,:5N DWELLING UNITS: I FINBSMENT: 0 sf RIGHT.........: 21
OCr.UPPACY GRP.:R3 BDRM: 3 BATH: 3 TOTAL-------: 2390 sf VALL''L••. S: 173239 NEAR..........: 19
- -
---------------------------------------------------------------- PLUMBING -------------------- ..____-----_------------------------
SINKS.........: 1 WATER CLOSETS.: 3 WASHING MRH..: 1 LAUNDRY TRAYS.: 1 RPIN DRAIN ft: 0 TRAPS.........: 0
LAVATORIES....: 4 DISHWASHERS...: 1 FLOOR DRAINS... 0 SEWER LINE ft: 0 SF RAIN DRAINS: 1 CATCH BASINS..: 0
IUB/SHOWERS...: 3 GARBAGE DiS."..; 1 WATE9 HEATERS.: 1 WFTEP LINE ft: 100 BCKFLW PREVNTR: 1 GREASE TRAPS... 0
OTHER FIXTURES: 0
-- MECHANICAL -----------------------•---------— .-..-----------
FUEL TYPES------------ FURN ( 1081: ..: 0 BOIL/CMP 3HP: 0 VENT FANS.....: 4 CLOTHES DRYERS: 1
/GAS/ / / FURN 1,=100K ..: I UNIT HEATERS..: 0 HOODS.........: 1 OTHER UNITS...: 1
MAX INP.: 8 BTU FLOOR FURNACES: 8 VENTS.......,.: 0 AOODSTOVES....: 0 GAS OUTLETS...: 1
EL.ELT iCAL ---- ------------ ----- ---------------------------------
--RESIDENTIAL UNIT--- ---SERVICE/FEEDER---- --TEMP SRVC/FEEDERS-- ----BRANCH CIRCUI7r -- ----MISCELLANEOUS---- --ADD'L INSPECTIONS--
1800 SF OR LESS: 1 0 - 200 amp... 0 0 .?00 amp., : 0 W/SVC OR FDR..: 0 PUMP/IRRIGATION: 0 1•ER INSPECTION: 0
EA ADDIL SIOSF,: 5 It - 400 amp... 0 281 - 400 amn„: 0 1st W/O SVC/FDR: 0 SIGN/OUT LIN ILT: 0 PER HOUR......: 0
LIMITED ENERGi.- 0 401 - 600 amp..: 0 401 600 asap,.. - CM ADDL BR CIR: 0 SIGNAL/Pi NEL...: 0 IN PLANT......: 0
MANF HM/SVC/FDR: 0 601 - 1000 amp.: 0 681+amps-1080 v: 0 MINOR LABEL -16: R
1808+ ampiVolt 0 ..---.----- -- I-•----- ------ .- PLAN REVTEW SECTION -----------••---------------
Reconnect only.: 0 )=4 RES UNITS..: SVC/FDA)=225 A.: 1600 V NOMINAL: CLS AREA/SPC OCC:
ELECTRICAL • RESTRICTED ENERGY ----------------------------__--------------------
A. SF RESIDENTIAL----------- - ---------- B. COMMERCIAL-------------------------------------•-----------------------------------------
AUDIO k STEREO,: YKUJN SYSTEM..: AIJC19 & STEREO.: FIRE ALARM.....: INTERCOM/PAGING: OUTDOOR LNDSC LT:
BURGLAR ALAPM..: DTH: +t X BOILER.........: HVAC...........: LANDSCAPE/IRRIG: PROTECTIVE SIGNI:
GARAGE OPENER.,: CLOCK..........: INSTRUM1ENTATION: MEDICAL........: OTHR: :.
HVAC........,..: DATA/TELE C9HM.: NUP5E CALLS....: TOTAL N SvSTFMS: 0
Owner: --------------------`--------------Contractor: ------------------------ -`- TOTAL FEES:$ 4619.70
LEGEND HM LEGEND HOMES CORPORATION
6900 SW HAINES ST 7160 SW HAiELFERN RD.
SUITE 100
1IGFRD OR 97223 TIGARD OR 97224
Phone M: 620.8080 Phone 11: 6241-8080
Reg N. : 60563
This pprmit is issued subject to the regulation, contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other•
app'ticable laws. All work will be done is accordance with approved plans. This permit will expire :f work is not started within IBP
days of issuance, or if work is suspended for more than 160 dads.
--- PEQU!RED INSPECTIONS - _._..__..--___--------------------_..._-_-_---------.__--
Footing Insp PLM/Underfloor Framing Insp Gas Fireplace Water Service In Building Fina
Foundation Insp Mechanical Insp Shear Wall Insp Ins'A ation Insp Appr/Sdwlk Insp Erosion Contror
Post/Beam Struct Plumb Top nt Low Voltage Gyp Board Insp Electrical Final
P3st!Bpam Mechan Electrical vi Fireplace Insp Rain drain Insp Mechanical Final
Crawl Drain Electrrc31 Rough) Gas/tinrAnsp /Water Line Insp Plumb Final
I'P I m i i;L G� S i.y n 1 t r �� � �.d .:�I l'wL�_�,n.r .- 1 5 5�.r C✓r i 8�.�-5 + , ( {..
+. 1 1 ian �_._J
CITY O F T i G A R D SEWER CONNECT T ON
DEVELOPMENT SERVICES PERMIT
PERMIT #. . . . . . . : SWR96-0467
1312SSWHan 8lvd., Tigard,ORI*,223 (507)639-4171 DATE ISSUED: 11211ILil')03
Pf^,-XLLL: -'S10:-,BD--HG0C..7
SITE ADDRESS. . . : 12450 SW 1. 15TH AVE
SUBD I V 15 1 ON. . . . : HUNTER' S GLEN ZONING: R-4. 5 1-,[,
BLOCV.. . . . . . . . . . . LOT. . . . . . . . . . . . . :027
TFNANI NAME. . . . . :LEGEND HOMES
LISA NO. . . . . . . . . . : F1XTLJRF UN1Tb- . . 0
CLASS OF WORK. . . :NEW DWELI—Ir,,16 UNITS. . I
TYPE OF USE. . . . . :SF NO. OF BUILDINGS: j
INSTALL TYPE. . . . :BUSWR IMPERY SUPFACE: 0 sif
Reniat-ks : Path 1
Owner,. FEES
LEGEND HOMES type a M 0 lill t by date r-pcpt
(,900 9W HAINES ar PRMT $ 2200. 00 JSD 10/14/96 96-285150
1 35. 00 .JSD 10/14/96 96-285150
TIGARD OR
r,tiarie #: 620-8080
CONTRACTOR NOT ON FILE
Phone #: $ 22 35. 00 TOTAL
Ree] REQUIRED I NGPECT I ONS
This Applicant agrees to comply with all the rules ana regulations Sewer" Inspect ion
of the Uni"ied Sewage Agency. The permit expires 0 days from
the date issued. The total amount paid will he forfeited if the
permit expires. The Agency does not guarantee the accuracy of the
side sewer laterals. If the sewer is not located at the measurepent
given, the installer shall, prospect 3 feet in all directions frog
the distance given. if not so located, the installer s7all purchase
a "Tap and Side Sewer" Permit and the Ag e 7 y wi)11 J, mitall a latprdl.
Per,mittee Signato-we: 1-;:6111441
1
-7-
Call for, inspect ion 639--4175
Plan Check# (gyp
:ITY OF TIGARD Residential Building Permit Application Rec'deya_t-
3125 SW FIAT',- BLVD. New Construction Additions or Alterations Date Recd
]GARD, OR 97223 Single Family Detached or Attached Date tc P.E. l�
503) 639-4171 Date to DST a- —F
Permit
Print or Type Called #rl�Iol
Incomplete or illegible applications will not be accepted 1 '
Name of Subdivision Lot# Name
Job HUNTER ' S GLEN 27 LEGEND HOMES
Site Address Architect Mailing Address
Address 6900 SW Haines St .
12450 ")VI 115Lh Avenue
Name City/State Zip Phone
LEGEND HOMES Ti a r d OR 97223 1620-8080
Name
Owner Mailing Address F R 0 E L I C H
6900 SW Haines St . Engineer Mailing Address
City/State ziph ne g
Tigard , OR 97223 LlU080 6969 SW Hampton St .
CitylState Zip Phone
Name Tigard , OR 97223 624-7005
General LEGEND HOMES Describe work new fi ' addition O alteration O repair O
Contractor Mailing Address to be done:
6900 S W Haines St . Additional Description of Work:
City/State ZIP Phore
Tigard , OR 97223 620-8080
Oregon Const.Cont. Board Lic.# Exp. Date
Attach Copy of 060563 6/19/97 t, Project
current COT Business Tax or Metro# Exp.Date Valuation ¢
_Licenses 4371 CoT:']E,- _703 6/1
/9 7 1.Name 1,Z-31-1(c NEW CONSTRUCTION ONLY:
_�
Mechanical SUNGLOW INC . Sq.Ft. House: ��;�,��j, ,� Sq.rt.Garage: 2 �' 7
Sub- Mailing Address
Contractor 2428 S C 105th Corner Lot Yes No Flag Lot Yes No
^ityJState Zip Phone (check one) (check one)
P o r L 1 a n d, 0 R 97218 253-7789 Restricted Audio/Stereo Burglar
Oregon Const.Cent. Board Lic.# Exp. Date Energy . System Alarm
Attach Copy of 48131 "-or,7 a; hr' `� f
Current C'aT--ausiress Tax pr Metro 4Exp.Date Installation Garage Door HVAC
Licenses 12 7 6—,_12r,-• _ tJ .g Opener Systems
Name (check all that Other:
Plumbing !_JOLCOTT PLUMBING apr,y)
Sub- .!ailing Address Will the electrical subcontractor wire for all Yes No
'i restricted energy installations?
Contractor PO Box 2007 Has the Subdivision Plat recorded? NIA Ye No
�i,;'State Zip Phone
Gresham OR 97030 667-9891.
Oregon Coria.Cont.Board Lic.# Exp. Date Reissue of'AST# Solar Compliance
g /� Calculation Attached)
Attach Copy ofL. 10/19/97 L
Current Plum mg Lic.# Exo. Dat-i I t ereby acknowledSs that I have read this application,that the
Licenses 2 6-2 08 P B 8/31/97 information given is correct. that I am the owner or authorized agent of
COT Business Tax or Metro# Exp.Date the owner, and that plans submitted are in compliance with Oregon
_
96-4281 1.2/96 V State laws.
Name Signature of OwnPrpgent of Date, 4
Electrical GARNER CLEC TRIC
C3ntac--0rrson Narile P WOne t
Sub- Mailing Address !� 'Y.•t�
Contractor 21785 SW TV Highway FOR OFFICE USE ONLY:
City/State Zi Phone Plat# Map/TL#:
Aloha , OR 91006 591-1320
Oregon Const.Cont.Board Liao Exp.Date L��� , _ I �"�1
Attach Copy of I`i 9 Setbacks -7 Solar-
Current Ele.'rlcal Lic.# Exp.Date f! I 1 r �> '��
Licenses 3 .�-•3 0 S C _ s
C. T Business Tax or Metro# Exp. Date Engineering Approval. Planning Approval: TIF:
SIMmstapp.doc M r f k11,, X 'f"fin I , t
Permi # Acco,ant Oescri t� AD4uos Amt -Ed,
"" MST. Permit (BUILD)SiC. —
Flumb. Permit (PL UMB)
Mech. Permit (MECH) —
ELC/ELR Permit (ELPRMT)
State Tax (TAX)
Bldg: _ -
Plumb.
Mech:
ELC/ELR:
Plan Check
MST: (BIJFPLN)
Plumb: (PL_MPLN)
h.�ech: (MECPLN)
CDC Review (LANDUS)
i�•U�G;Sewer Connection (SWUSA)
Sewer Inspection (SWINSP)
Parks Dev Charge (PKSDC)
Residential TIF (TIF.-R)
Mass Transit TIF (TIF-MT)
Water Quality (WQUAL)
Water Quantity (WQUANT)
Erosion Control Permit (ERPRMT)
Erosion Planck/USA (ERPLAN)
Erosion Planck/COT (EROSN)
Fire Life Safety (FLS) ,�
TOTALS: (� .'.aZL�'.. ae�up
i:Wrlllmttapp.doc
R.V.rroe
-SbIar Balance Point Standard Worksheet
Address
Box A calculations: North-South dimension for the lot. Box A:
This dimension is determined by finding the midpoint of the North lot line and drawing
an intersecting line perpendicular to that point.
First, determine which property line is the North lot line. The North lot line is the line
with the smallest angle from a line drawn east-west and intersecting the northern most
point of the lot.
4,50-0-
1 �
1g1�tNf
LOT L"
N Norf h-South
Dimension for Lot:
Measure the distance from the midpoint of the North lot line to the South lot line along, y
the described line.
�.p feet
t ^�
NOR41•SOUIN DOANWN \\,
Box B calculations: Shade point height for your residence. Rox B:
1 Determine whether measurements will be based on the peak or eave of your Whic!i describes
structure. The orientation of the ridge is also importai it. yc,ur residence?
1 a: If the roof line runs North-South, measurements will ...""�`; (circa; one)
be based on the peak of the roof. `,;o U)U
1A 1B� 1%
1 b: If the roof line runs East-West and the roof pitch is
less than 5/12, measurements will be based on the
eave.
r"M ,I
1 c: If the roof line runs East-West arid the roof pitch is
5,12 or sleeper, measurements will be based on the
peak.
vWX nw+u[xe
Box B. continued Box B.
2. Measure change in elevation from front property line to finished flour elevation. If
the lot slopes up from the front lot line to the fount anon, the figure is positive. If
the lot slopes down from the front lot line to the foundation, the figure is negative. Ift
1. Measure ,distance from tit ished floor elevat;on to the affected peak eave. + , ft
4. If the roof line runs North-South, deduct three feet. If the roof line runs East-West,
deduct nothing.
S. Subtract one foot for each foot ol difference in elevation from the front property
line to the rear property line, if the lot slopes up from the front to the rear. If the
lot has no slope or slopes up from the rear to the front, deduct nothing. - ft
6. Total figure for box B: ,,/
ft
Box C. Distance to th(t shade reduction line.
Box C:
1. Measure the distance from the North property line to the foundation near ther
affected peak/eave. _ ft
2. Measure the distance from the foundation to the affected peak or eave. + R
ft
3. Total figure for box C: ,�
� ft
It is most useful to draw a vertical line to represent the appropriate figure found in box"A"and a horizontal line to represent the
appropriate figure found in box "C". The intersection of the vertical and horizontal lines determines the value found in box "D". The value
in box "D"should be compared to the value in bo:"B"; if the value in box"B"is less than or equal to the value found in box*!D-. then
the building is in compliance with the solar balance code. If you have ar. ,4uestiorts, please contact us at 639-4171,x304 or at the
Community Developmert Counter,
7shadMAXI,AUM PERMITTED SHADE POINT HEIGHT (In feet)
e
ce to North-south lot di erasion(in feeU
100+ 95 90 85 80 7P 70 65 60 55 50 45 40
ion lineorthern
70 40 40 40 41 42 43 44
65 38 38 38 39 40 4' 42 43
60 36 36 36 37 38 3 40 41 42 1
55 34 34 34 35 36 3 38 39 40 41
50 32 32 32 33 34 36 37 38 39 40
45 30 30 30 31 32 34 35 36 ,7 38 39
40 28 28 28 29 30 32 33 34 35 36 37 :8
35 26 `26 26 27 _28 30 31 32 33 34 35 36
30 24 24 24 25 26 28 29 30 31 32 33 ;14
25 2 22 22 23 24 5 26 ? 28 29 30 31 3.2
20 20 20 20 21 22 3 24 25 26 27 28 29 30
15 18 18 18 19 20 1 22 23 24 25 26 27 28
10 16 16 16 17 18 9 10 21 22 23 24 25 26
5 14 14 14 15 16 17 18 14 29 21 22 23 24
Box D. Mai imtrtn allowed shade point height: _ feet
I,kda:s\nancy\ventura�solai;fip
Revised 2/26/116
FLOT FLAN
Lo,r *,z/ ,i, �4UNTE R' S GLEN
12450 SCJ 115th AVENUE �
R-4.5f [)
1"1,4f= M 2ro1035D, TAX L-OT # -1100
N.E. 1/4 OF SE:TION 3, T.26, RJW, W.1°'1, WATER I'IETER
C I I OF TI .r4RI� W-------• WATER L-NE
►,U,c,���;-�iNC�TON CCS ITT , OREGON So+NITARY SEWER
SD-- - - — STORM DRAIN
jj ( r�T 2 OF STREET
UEGE1V U HOMES "�ANNOLE
alloo S.W. HAMS sTressr nGARD. OREGON � C.ATCN BASIN
PLAZA 2, SUM 200- 97223-2614 � PROPOSED
(603) 620-6000 IAY (603) 690-6900 �( STREET TREES
® STREET LIGHT
FIRE HYDRANT
s;i 115th AVE.
-------1--------------------W—_.._ --- -------
—,
'_" I I /I /�'/ •LI■Z,��'1% !Q 215I8' — �--�—�--,h -^_/� ��-46lr -lU�•_
CURB
SIDEWALK B
SIDEWALK
P.
-------- . —
--
--{------------- . L07 2�
I I �
L OT 127/ ku
6,364 SO, FT
1 ft INFIFL 0 'B'
•f 1 1 fl �. FIN FLP = 2
� 205 /
GARAGE FL R 2IS&
I
3ETE3Ar:K. l iIJE
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CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
WOLCOTT PLUMBING CONT. INC
P O BOX 2007
GRESHAM OR 97030
Plumbing Signature Form
Permit # . . . . : MS' 16-0465
Date Issued. : 101.4/96
Parcel . . . . . . : 2S103BD-HG02'7
Site Address : 12450 SW 115TH AVE
Subdivisic:;. : HUNTER' S GLEN
Block. . . . . . . . Lot : 027
Zoning. . . . . . : R-4 . 5 PD
Remarks :
Path 1
Your company has been indicated as the plumbing contractor 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 Form prior to the start of work. No plumbing inspections
will be authorized until this completed form is received.
AN INK SIGNATURE IS REQUIRED ON THIS FORM
;wrJl,Ir : PLTJMBTNG CONTRACTOR :
LEGEND HOMES WOLCOTT PLUM:31NG COPT. INC
6900 SW RAINES ST P O BOX 2007
TIGARD OR 97223 GRESHAM OR 97030
Phony # : 62.0--8080 Phone # :
Reg # . . : 23847
Signature of Authorized Plumber
Please return this completed form to the address above.
ATTN: Building Dept.
If you have any questions, please call 639-4171 , ext. #310
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
GARNER ELECTRIC
21785 SW TV HWY
#L
ALOHA OR 97006
Electrical Signature Forrn
Permit. # . . . . : MST96-0465
Date Issued. : 10/14/96
Parcel . . . . . . : 2S103BD-1IG027
Site Address : 12450 SW 115TH AVE
Subdivision.. : HUNTER' S GLEN
Block. . . . . . . L _,t : 027
Zoning. . . . . . : R-4 . 5 PD
Remarks :
Path 1
Your company has been indicated as the electrical naturetractor for the of the supervising electricianermit d above. In
oraer for the electrical permit to be valid, 9
is required.
Please have the appropriate in&iidual from No elect r calrinspect oris will rberauthorized eturn this Euntilrical
Signature Form prior to the start of work.
this completed form is received.
AN INK SIGNATURE IS REQUIRED ON THIS FORM
ELECTRICAL, CONTRACTOR.:
OWNER : GARNER ELECTRIC
LEGEND HOMES 21.785 SW TV HWY
6900 SW RAINES ST #L
ALOHA OR 97006
TIGARD OR 97223 Phone # :
Phone if : 620-8080 Reg # . : 11672
ctrlclar
Signatu a of 0 vising ETe-
Please return this' ni?mp!eted form to the address above.
ATTN- Building Dept.
If you have any questions, please call 639-4171 , ext. #310
CITY OF TIGARD BUILDING :NSPECTION NOTICE e�
Inspection Line: 639-4175 Business Phone: 639-4171
Footing Rain Drain Cover/Service FINAL:
Foundation Water Line Ceiling -Plumb.
Post/Beam Mech. Shear/Sheath Framing -Meeh.
Plbg.Und/Fir/Slab Plbg.Top Out Insulation Ete
Post/Beam Struct. Mech. Rough-in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr/Sdwik Reins.
Other.-
Date:
ther:Date: A.M. P.M.
Entry:
Address: ___
Tenant: ----- —� - Ste: MST:
BLIP:
Ifoj /Own: :1.4_7��_._-_.`�, - MEC:
PLM:
ELC; ..
THE FOLLOWING CORRECTIONS ARE REQUIRED ELR: ._
co od
00,
Inspector: 11t�__�Ct► orl�` Date:..
APPROVED _—DISAPPROVED/CALL FOR REINSP
.IX CO
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639-4175 Business Phone: 639-4171
Footing Rain Drain Cover/Service FINAL:
Foundation Water Line Ceiling -Plumb.
Post/Beam Mach. Shear/Sheath Framing - ec
Plbg.Und/Flr/Slap Plbg.Top Out Insulation -Elect,
Post/Beam Struct. Mach. Rough-in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr/Sdwlk Reins.
Other:
Date: 1_ A.M.�P.Me,� Entry
Address: �O'- �+ / tl'�
Tenant:.___ _-� _ Ste:___ MST:
��� —S BUG:
Con/Own: .�_.^ MEG:
PLM:
ELC:
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
/ow
I Date:PROVED
DISAPPROVED/CALL FOR REINSP. CF- CO
LJ