12449 SW 116TH AVENUE ti{
ADDRESS,
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lNecords\microfInAtargels\building.doc
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.Page No. 1 CASE HISTORY FOR CASE WO.: MST96-0502
LEGEND HOMES
12449 SW 116TH AVE
08/01/97
Action Description Reqj Schd/ End/ A( J on Notes Disp By Update Upd
Coda Sent Done Done Date By
MSTA005 Application received / / / / 10/22/96 RECD DRA 10/24/96 BON
MSTA008 Permit Lreated / / / / 10/24/96 PEND B 10/24/?6 BON
MSTA010 Check for pr i. restrict. / / / / 10/22/96 10/24/96 BON
MSiAO12 Plans routed to Plans Examiner / / / / 10/24/96 PEND B 10/24/96 BON
MSTA026 Plans approved by Plans Exmr / / / / 10/29/96 PASS RT 10/29/96 BT2
MSTA030 Reviewed plans routed to DSTS / / / / 10/29/96 PASS RT 10/29/96 BT2
MSTAO80 (F) Ready to issue / / / / 10/30/96 PASS B 10/30/96 BON
MSTA092 (F) Issue combination permit / / / / 11/06/96 PASS JDA 11/06/96 JDA
MSTA097 issue plumbing signature form / / / / 11/06/96 OK JDA 12/02/96 JT
MSTA098 Issue electric signature form / / / / 12/0,.'96 OK JDA 12/02/96 KAS
MSTA705 Footing Insp / / / / 11/15/96 APP KS 11/18/96 KBS
MSTA706 Foundation Insp / / / / 11/19/96 APPR GS 11/19/96 GES
MSTA710 Post/Beam Structural / / / / 12/05/96 APP KS 1!./05/96 KBS
MSTA711 Post/Beam Mechanical / / / / 12/05/96 AFP KS 12/05/96 KBS
MSTA717 PLM/Underfloor / / / / 12/03/96 PASS MS 12/04/96 MRS
MSTAT20 Mechanical Insp / / / / 01/31/97 APP GS 01/31/97 GES
MSTA722 Plumb Top Out / / / / 01/28/97 PASS MS 01/28/97 MRS
MSTA723 Electrical Service / / / / 01/27/96 PASS MJR 01/27/97 MJR
MSTA724 Electrical Rough In / / 01/27/96 fan box, family, entry, & m. bed PASS MJR 01/27/97 MJR
MSTA725 Framing nsp / / / 01/30/97 #-1- strap each cide cf glu/lam at DIS KS 01/30/97 KBS
garage
#-2- firestop mechanical chase at upper
level
1-3- secure fs paper at fireplace; ok to
insotate reinspect
MSTA725 Framing Insp / / / / 02/03/97 #-1- mechanical soffits not built at DIS KS 02/04/97 KBS
garage
MSTA726 Shear Wall Insp / / / / 01/31/97 APP GS 01/31/97 GES
MSTA735 Gas Line Insp / / / / 01/30/97 #-1- no pressure DIS KS 01/30/97 KBS
n MSTA735 Gas Line Insp / / / 01/31/97 APO GS 01/31/97 GES
MS'%'36 Gas Fireplace / / / / 02/03/97 #-1- gas piping app by GS, 01/31/97 APP KS 02/04/97 KBS
} MSTA745 >yp Board Insp / / / / 02/11/97 #-1• adjust B vent at garage ceiling to DIS KS 02/1./97 KBS
maintain clearance
—� #•2- seal joint above furnace at ceiling
#-3- nail shear wail between fam/din rm
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Page No. 2 CASE HISTORY FOR CASE i7.: MST96-0502
LEGEND HOMES
12449 SW 116TH AVE
08/01/97
Action Description Req/ Schd/ End/ Action Notes Disp By Update Upd
Code Sent Done Done Date By
------- ------------------------------ -------- -------- -------- --------------------------------------- ---- --- -------- ---
MSTA745 Gyp Board Insp / / / / 02/18/97 #-1- adjust B ven: at garage ceiling DIS KS 02/26/97 KBS
horizontal secctioi to maintain
clearance alta ve,•tical
#-2- seal joint behiid furnace at
ceiling with gypsua, or
26 gauge sheet metal
MSTA745 Gyp Board Insp / / / / 02/18/97 #-1- adjust B vent at horizontal to A/N KS 04/0707 KBS
provide min;
clearances seal joint at ceiling line
either with
gypsm or metal
MSTA755 Rain drain Insp / / / / 11/21/96 PASS MS 11/22/96 MRS
MSTA760 Water Line Insp / / / / 11/21/96 PASS MS 11/22/96 MRS
MSTA765 Appr/Sdwlk Insp / / / / 03/05/97 NOT READY. DIS PI 03/10/97 RB
MSTA765 Appr/Sdwlk Insp 03/12/97 / / 03/10/97 1. BF PREPARED TO PROTECT FINISH. OK PASS PI 03/12/97 RB
M�JA790 Electrical Final / 1 / / 03/26/97 APP GS 03/31/97 GES
MSTA795 Mechanical Final / / / / 03/26/97 net readyl N/R RB 03/31/97 RB
no record of insulation/ failed gypsum
inspection
no inspection made
MSTA795 Mechanical Final / / / / 04/04/97 #-1- see bldg final this date NOTD KS 04/08/97 KOS
MSTA795 Mechanical Final / / / / 04/24/97 APP KS 04/25/97 KBS
MSTA797 Plumb Final / / / / 03/26/97 APP GS 03/31/97 GES
MSTA799 Building Final / / / / 03/26/97 see meth final N/R RB 03/31/97 RB
MSTA799 Building Final / / / / 04/04/97 #-1-provide handrail each side of stairs DIS KS 04/08/97 KBS
at man door
a #-2- provide lending at ext man door
'- garage
ct
f- 0-3- seal all penetrations at garage
�n
#-4- ander dryer vent at ext
�- #-5- sent door jambs at storage
-i #-6- insulate exposed section of heat
_r duc t
w
0-7- remove wood / debris at crawl
-� #-8- need to locate low point drain
MSTA799 Bu°lding Final / / / / 04/24/97 APP KS 04/25/97 KBS
MSTA960 (F) Issue Cert. of Occupancy / / / / 04/24/97 mailed 8-1-97 08/01/97 S*W
Page No. 3 CASC HISTORY FOR CASE NO.: MST96-0502
LEGEND HOMES
12449 SW 116TH AVE
08/01/97
Action Description Req/ Schu/ End/ Action Notes Disp By Update UId
Code Sent Done Done Date By
-- ---- -------------------- ---- -------- ------- -------- --------------------••- ------ ---- --- -------- ---
MSTA970 Case Finaled / / / / 04/24/97 APP KS 04/25/97 KBS
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From: "Jeanne Temple"<TIG3/JEANNE>
Organization. city of Tigard
To: Susan
Date sent: Thu, 28 Aug 1997 14:18:15 PST
Subject: Project-12449 116th
Please fax a copy of the 0/0 to: Terry Stenberg, 645-6351. In case
you need to call her; 645-0320.
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Susan Weber - 1 -- Thu, 28 Aug 1997 15:54:33
.09/02/97 08:28 0&503 684 7297 CITY OF TIGARD 000
ACTIVITY Rl,'i,oR,r
TRANSMISSION OK
TX/RX NO. 3377
CONNECTION TEL 503 645 6351
CONNECTION ID
START TIME 09/02 0%:27
USAGE TIME 00'49
PAGES 2
RESULT OK
SEZZLY-C rLM 2VQA W FOR sER Erg F lrcFLLELv
_CE
J."i'acsimile
To: TEegy
Company:
Phone.
Fax: 46-
From:
Company: City of Tigard
Phone: (503)639-4171
FLX: (503)684-7297
ul Date:
Pages including this paec-,
COMMENTS.,
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CITY OF TIGARD BUILDING iNSPECTION NOTICE
Inspection. Line- 639-4175 3usiness Phone: 639-4171
Footing Rain Drain Cover/Service FINAL:
Foundation Water Line Ceiling -PIurr..o.
Post/&ni Mech. Shear/Sheath Framingech.
Plbg.Und/Flr/Slab Plbg.Top Out Insulation ,1 Elect.
Post/Bearr Struct, Mech. Rough-in Gyp. Bd.
San. SewQr Gas Line Appr/Sdwlk '1 Reins.
Other:
Date: A.M. xP.M, En ry:
Address: 1?+41�ea�
Pit-
Tenant: Ste: MST:
BUPCon/Own:_� L — 5MEC ppf.�
MEC:
PLM:
i.LC: —THE FOLLOWING CORRECTIONS ARE REOUIRED: ELR:
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Inspector: _� _ _ Data:
_i APPROVED _DISAPPROVED/CALL FORREINSP. vF CO
CITY OF TIGARD
DEVELOPMENT SERVICES
13125 SW Hall Blvd.,Tigard,OR 97223 (503)639.4171
CERTIFICATE_ OF
OCCUPANCY
PERMIT #. . . . . . . : MST96-030F
DATE I'SS'_IED: 04/24/97
PARCEL : 26103RD-FtG001
ITE ADDRESS. . . ; 12/144 :3W 116-1-1-1 ►4VE
'JBD I V I S Y ON. . . . : HUNTER' S GLEN Z ON I N0 FI-4. 5 PD
BLOCK. . . . . . . . . . ; LOT. . & V10I JURISDICTION:
r'LA5 S OF WQf,".C. -NEW
YPE OF USEc`. . SF"
TYPE OF CONST;/:5N
OCCUPANCY GRP. :R3
OCCUPANCY LOAD;,::
Rpm<av k : Path I
Owner:
BEND HOMES
c..900 SW HAI NES ST
TIGARD OR 9722:3
F''horle #; 6PO--8000
Contrar_tor-.
L ZGEND HOMES CORPORATION.
7160 S4 HAZE"LFE RN RD.
STE too
T I C3F RV, OR 97224
Phone #: 6e:0-0080
Pop #— : 000605
This Certificate grants ocr.4.lpancy of the above referenced building or portion
thereof and conf r^me that the building hay, been inspected For r_ompli.ance with
' 'lc State of Oregon Specia;ty Codes for the group, occupan y, .and use under
,hich the referenced permit was issued. �-�
8 DI is INSPECTOR BUILDING OFFICIAL
V1
POST IN CONSPICUOUS PLACE
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CITY OF TIGARD
,A DEVELOPMENT SE;?VICES MASTER F'E:RMIT
13125 SW Hall Blvd., Tigard,OR 97223 (503)639.4171 DATE I SSUE . . ; . : MST9F,-0502
DATE ISSUED:
FA RCE!-: 23103BD--HGOO I
SITE ADDRESS. . . : 1',2'44q SW 116T1-I AVE:
SUBDIVISION. . . . : HUNT ..R' S GLEN ZONING: R--4. 5 I-11)
CLOCK. . . . . . . . . . . LOT. . . . . . . . . . . . . :001
Remarks: Path 1
-------------------------------------- BUILDING ----•--------------------------- -------------------------------
REISSUE: STORIES....,..: 2 FLOOR AREAS----------- BASEMENT...: 0 sf REQUIRED SETBACKS---- REQUIRED--------•-----
CLASS OF WORK.:NEW HEIGHT........: 20 FIRS....: 1020 sf GARAGE.....: 527 sf LEFT..........: 5 SMOKE DETECTRS: Y
TYPE OF USE...:SF FLOOR LOAD....: 40 SECOND...: 1280 sf FRONT.........: 20 PARKING SPACES: 1
TYPE OF CONST.:5N DWELLING UNITS: 1 FINBSMENT: 0 sf RIGHT.........: 23
OCCUPANCY GRP.:R3 BDRM: 3 BATH: 3 TOTAL------: 2300 sf VALUE..$: 163187 REAR..........: 30
----------------------------------------------------------------- PLUMBING ----------------------- ---------------------------------------
SINKS.........: 1 WATER OLOSETS.: 3 WASHING MACH..: I LAUNDRY TRAYS.: 1 RAIN DRAIN ft: 0 TRAPS........ .: a
LAVATORIES....: 4 DISHWASHERS...: 1 FLOOR DRAINS..: 0 SEWER LINE ft: 0 SF RAIN DRAINS: 1 CATCH BASINS.•: 0
TUB/SHOWFRS...: 3 GARBAGE DISP..: 1 WATER HEATERS.: 1 WATER LINE ft: 100 BCKFLW FREVNTR: 1 GREASE TRAPS..: 0
OTHER FIXTURES: 0
---------------------------- MECIIANICAL ----------------- --------------------------
FUEL TYPES---------- FURN ( 100K ..: 0 BOIL/CMP ( 3HP: 0 VENT FANS.....: 4 CLOTHES DRYERS: 1
/GAS/ / / FURN )=,,W,, ..: 1 UNIT 4EATERS..: 0 HOODS.........: 1 OTHER UNITS...: 1
MAX INP.: 0 BTU FLOOR FURNACES: 0 VENTS.........: 0 WOODSTOVES....: 0 GAS OUTLETS...: 1
----------------------------------------------•--------- ELECTRICAL -------------------------------------------------------------
--RESIDENTIAL UNIT-- ---SERVICFr'EEDER---- --TEMP SRVC/FEEDERS-- ---BRANCH CIRCUITS--- ----MISCELLANEOUS---- --RDD'L INSPFCTIONS--
1000 SF OR LESS: 1 0 - 200 dip..: 0 0 - 2'a0 amp..: 0 W/SVC OR FDR..: 0 PUMP/IRRIGATION: 0 PER INSPECTION: 0
EA ADD'L 500SF.: 4 201 - 400 amp..: 0 201 - 400 amp..: 0 ist W0 SVCIFDR: a SIGN/OUT LIN LT: 0 PER HOUR......: 0
LIMITED ENERGY.: 0 401 - 600 amp..: 0 401 - 600 amp..: 0 EA AIDnl BR CIR: 0 SIGNAL/PANEL...: 0 IN PLANT......; 0
MANF :4M/SVC/FDR: 3 601 - 1000 amp.: 0 601+amps-1000 v: 0 MINOR LABEL -10: d
1100+ amp/volt.: P. ----------------------------------- PLAN REVIEW SECTION ---------------------------------.—.
Reconnect only.: 0 )=4 RES UNITS..: SVC/FDR)=225 q.: r 602 V NOMINAL: CLS AREA/SPC OCC:
----------------------------------------------------- ELECTRICAL - RESTRICTED ENFP. Y --------------------I----------------
A. SF RESIDENTI/!L------------------------- B. COMMERCIAL------------------------------------- ------- ----------------------------------
AUDIO 6 STEREO.: VACUUM SYSTEM..: AUDIO G STEREO.: FIRE ALAEM.....: INTERCOM/PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM..: 0TH: :: X B91LER.........: HVAC...........: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER..: CLOCK..........: INSTRUMENTATION: MEDICAL........: OTHR:
HVAC...........: Dk.n/TELE COMM.: NURSE CALLS....: TOTAL N SYSTEMS: 0
Owner: ---------------------------------Contractor: ----------------------------- TOTAL FEES:s 4600.95
LEGEND HOMES LEGEND HOMES CORPORATION
6900 SW HAINES ST 7160 SW HAZELFERN RD.
SUITE 100
TIGARD OR 97223 TIGARD OR 97224
Phone #: 628-8080 Phone A: 620-8080
Reg C.: 60%33
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V1 This permit is 1ss1jp1 subject to the regulations contained in the Tigard Municipal Code, State of Ore. SPacialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work i� not started within 180
days of issuance, or i. work is suspended for more than 180 days.
~ --------------------------------------------------------- REQUIRED INSPECTIONS ---------------------------------------------------
Footing Insp PLM/Underfloor Framing Insp Gas Fireplace Water Service In Building Final
Foundation Insp Mechanical Insp Shear Wall Insp Insulation Insp Appr!Sdwlk Insp Erosion Control
Post/Beam Struct Plumb Top Out Low Voltage Gyp Board Insp Electrical Final
Post/Beam Mechan Electrical Servi Fireplace Insp Rain drain Insp Mechanical Final
Crawl Drain Flectrical Rough Gas Line Insp Water Line Insp Plumb Final _
F'er,mittee Signat 1-Pre : Issi,ied Bv :
CA 11 for insper_t .ion -- 639---4175
CITY O F T104 A R D SEWER CONNECTION
DEVELOPMENT SERVICES PE r1m IT
13125 SW Hall Blvd.,Tigard,OR 97223 (503)639-4171 PERMIT #. . ". . . . : SWR96-0504
DATE ISSUED: 11/06/96
PARCEL: 25103BD--HGOO1.
SITE ADDRESS. . . : 124.4 SW 116TH AVE
SUBDIVISION. . . . : HUNT R' GLEN ZONING: R-4. 5 PD
13LOCK. . . . . . . . . . : LOT. . . . .. . . . . . . . . :001
TENANT' NAME. . . . . :LEGEND H014ES
USA 1\10. . . . . . . . . . : F I XTURE UN I TS. . . 0
CLASS OF WORI�. . . :NEW DWELL_IN3 UNITS. . : I
TYPE OF USE. . . . . :SF NO. OF BUILDINGS: I
INSTALL TYPE. . . . :8USWR IMPERV SURFACE: 0 Sf
Remarks : Path I
Owner-: FEES
LEGEND HOMES type amal.krit by date recpt
6900 SW HAINES ST PRMT $ 2200. 00 JDA 11/06/96 96-286183
INSP $ 35. 00 JDA 11 /06/9C, 96-2,96183
TIGORD OR 97223
Picone #-. 620—RO80
Cent r-Actat-.
CONTRACTOR NOT ON FILE
$ 2235. 00 TO-`Al—
Reg #. . -
REQJIRFi. -NSFIECTTONS
This Applicant agrees to c,,mply with all the rules and regulations Sewer, InspeTttin
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 accuracy of the
side sewer laterals. It the sewer is not located at the measurement
given, the installer shall prospect 3 feet :n all directions from
the distance given. If not so located, the installer shall purchase
a "Tap ind Side Sewer" Permit and the Agency will install a lateral.
1--ler-mittee Signattir,e
T i 9 1-1 e d B y Ld
Call for inspection F:3^-4175
I Li
r Plan Chec /
IT' - OF T10,41RD Residential Building Permit Application Recd By
31f25 SW HALL BLVD. New Construction Additions or Alterations Date Recd
IGARD, OR 97223 Single Family Detached or Attach - Date to P.E. - IV
-
03) 639-4171 Date to DLgE4�*
T /0
Print or Type �� Permit# `)IO-
Yp I / Called
Incomplete or illegible applicAtions will not be accepted_
IT
Name of Subdivision Lot# Nam,n
JobHl)i NTER ' S t_..EN 01 LESEND HOMES
Architect Mailing Address
Address Site A ess 6900 SW Haines St .
1 2 4 4rl SW I to t-h A v e.n u P City/State Zip Phone
LEGEND HOMES1 i ard , OR 97223 620-8080
I
Name
Owner Mailing Address E R O E L I C f l
16900 S W Haines St Engineer Mailing Address
City/State Zi ph ne g 6969 S W Ham ton SL .
Tigard , OR 922.3 G2�-8080 —P
City/State Zip 7 Phone
Name Tigard , OR 97223 1 624-7005
General LEGEND HOMES Describe wor< new W addition O alteration O repair O
Contractor Mailing Address to be done:
6900 S W Haines S t . Additional Descrip,ion of Work:
City/State Zip Phone
ITi ard OR 97223 620-8080 I
Oregon Cons;.Cont. Board Lic.# 7xp. Date
Attach Copy of 060563 6/19/97 Project /
Current COT Busine s Tax or Metro# Exp.DLa ' ValuatiCn _
Licenses CZ ' 7 NEW CONSTRUCTION ONLY:
Name /i4/:3/ l
Mechanical SUNGLOW INC . Sq.Ft. House: Sq.Ft.Ga)rag_7e:
Sub_ Mailing Address 3M
Contractor 2428 S E 105th Corner Lot Ye- No Flag Lot Yes Nq
City/State Zip Phone (cheCK one) (check one) X
I P o r t.1.a n . _OR 97216 253-7789 Restricted Audio/Stereo /, t - Burglar
Oregon Co•,st. Cont.. Board Lic.# Ex Energy >< System Alarm
Attach Copy of It 8131- J,° Garage Coor !-,VAC
Installation g
Current CCT Business Tax or Metry# Exp. Date t Opener Systems
Licenses 112 7 6
�l Name (check all that Otoer:
Plumbing WOLCOTT 'LUMBING apr-y) -
.1ailing Addrec.s — Will the electriczl subcontractor wire for all Yes No
Contractor PO Box 2007 restricted energy installations?
Has the Subdivision Plat recorded? N/A Y�s No
city/state zip Phone
Gresham OR 97030 667-9891 — --
Oregon Const. Cont. Board Lic.# Exp. Date Reissue of MST# Solar Compliance
Attach copy of L 10/19/97 �� (Calculation Attache6)
Current Plu mg Lic. is Exo. Date I hereby acknowl;dge that I have read this application, that the
Licnnses 2 6-2 0 8 P B B/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 rubmittod are in compliance with Oregon
CC N 96-4281 _ 12/96 State laws. _
Name signatpre of w t/Av;ir, Date
�- Fleutricail GARNER ELECTRIC con Perso�j e P ones
Sub- Mailing Address /"�'' /� I -q/ CSU- o � �
L Contractor 21785 SW TV Highway FOR OFFI'..:E USE ONLY:
CZ City/State Zi e Phone Plat# MaplrL#:
-� Aloha OR 97006 591-1320
I , v
Oregon Const.Conjl. Board L-c.# EXp Date
Attach Copy of 4'' A) v� �I W Setbacks Zone: Solar
Current Electrical Lic.# (-p. Dal
Licenses 3 4-3 0 5 0 r
C_7iT Business Tax or Metro p Up.Yale Engineering Approval: Planning Approval. TIF:
{hob
sts\mstapp.eoc r� �� .mss / --
Rer—mill Account Qnscription DescriptionAmount Amt. Pd. Bal. Due
MST. Permit (BUILD) 5 2 _ y3
Plumb. Permit (PLUMB) �� 1
Mech. Permit (MECH)
ELC/ELR Permit (ELPRMT) d 7�
U U-
State Tax (TAX) S S
Bldg:
Plumb: j1
Mech:
ELC/ELR: 7)
Plan Check V
i vi ✓ ✓ q'� dJ
MST: (BUPPLN) -= � _ �50 8S(4 ,
Plumb: (PLMPLN)
Mech: (MECPLN) j/ ? 1
CDC Review (LANDUS) �- p•,,,,
+ ; (Sewer Conr;ection (SWUSA) 2;),l _ r22 to u
Sewer Inspection (SWINSP)
Parks E ev Chargr (PKSDC) 10 SV
Residential TIF (TIF-R) /S 7 U C
Mass Transit TIF (TIF-MT)
Water Quality (WQUAL)
Water Quantity (WQUANT) l J
Erosion Control Permit RPRMT)
Erosion Planck/USA (ERPLAN)
O
Erosion Planck/COT (EROSN) th �>
J
Fire Life Safety (FLS)
TOTALS:
OdstaWstapp doc
1�6R@V.7/98
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 Form
Permit # . . . . ti MST96-0502
Date Issued. : 11/06/96
Parcel . . . . . . : 2S103BD-HG001
Site Address : 12441 SW 116TH AVE
Subdivision. : HUNTER' S GLEN
Block. . . . . . . . Lot : 001
Zoning. . . . . . . R-4 .5 PD
Remarks :
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 electrician
is required.
Please have the appropriate individual from your company sign below and return this Electrical
Signature Form prior to the start of work. No electrical inspections will be authorized until
this completed form ice. received.
AN INF SIGNATURE IS REQUIRED ON THIS FORM
OWNER: ELECTRICAL CONTRACTOR:
LEGEND HOMES GA<NER ELECTRIC
6900 SW HAINES ST 21785 SW TV HWY
#I,
TIGARD OR 97223 ALOHA OR 97006
n phone # : 620-8080 Phone # :
Ln
RAS # . . . 11 721
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Signature o �upervisin lectrician
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
P10LCOTT PLUMBING CONT. INC
P 0 BOX 2007
GRESHAM OR 97030
Plumbing Signature Form
Permit # . . . . : MST96-0502
Date Issued. : 11/06/96
Parcel . . . . . . : 1S103BD-HG001
Site Address : 12441 SW 116TH AVE
Subdivision. : HUNTER'S GLEN
Block. . . . . . . . Lot__ : 001
Zon.ing. . . . . . 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
OWNER : PLUMBING CONTRACTOR:
LEGEND HOMES WOLCOTT PLUMBING CONT. INC
6900 SW HAINES ST P 0 BOX 2007
TIGARD OR 97223 GRESHAM OR 97030
Phone # : 620-8080 Phone # :
Reg # . . : 23847
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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
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