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Permit p r t me . )r new � \xcfUe r r w� G� CITY OF TI A D PLUMBING PERMIT COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00148 x�;.I DATE ISSUED: 4/18/2007 TIGARD! 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S102CB - 03200 SITE ADDRESS: 09975 SW FREWING ST ZONING: C - SUBDIVISION: MASSIH OFFICE BLDG LOT: 021 JURISDICTION: TIG PROJECT: MASSIH OFFICE BUILDING Project Description: Hook up water service and RPBD, and 4 rain drains on roof. 5/1/07 ADD EJECTOR PUMP. CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 1 OCCUPANCY GRP: B FLOOR DRAINS; TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: 1 TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: 10 ft DISHWASHERS: RAIN DRAIN: ft Owner: FEES KAMELIA MASSIH 1831 SW DICKINSON LANE Description Date Amount PORTLAND, OR 97219 [PLUMB] Permit Fee 4/18/2007 $159.20 [TAX] 8% State Surcha 4/18/2007 $12.74 Phone : Total $171.94 Contractor: POWER PLUMBING CO PO BOX 19418 PORTLAND, OR 97280 REQUIRED ITEMS AND REPORTS Contact # : PRI 503 - 244 -1900 FAX 503- 244 -8825 Reg #: LIC 52378 PLM 34 -150PB This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other 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 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. // / Issued By: J // / ,� `� Permittee Signature: // ca. f /»1 Call 503.639.4175 by 7:00 a.m. for an inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. 1 -;.', , w , ,..,, ; ,,,, ' , CITY � F T GAR® r ,,, PLUMBING PERMIT : �.� ; ` PERMIT #: PLM2007 -00148 ,,� COMMUNITY DEVELOPMENT TI GARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 4/18/2007 A .. g PARCEL: 2S102CB - 03200 SITE ADDRESS: 09975 SW FREWING ST ZONING: C -G SUBDIVISION: MASSIH OFFICE BLDG LOT: 021 JURISDICTION: TIG PROJECT: MASSIH OFFICE BUILDING Project Description: Hook up water service and RPBD, and 4 rain drains on roof. CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 1 OCCUPANCY GRP: FLOOR DRAINS; TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: 10 ft DISHWASHERS: RAIN DRAIN: ft Owner: FEES KAMELIA MASSIH 1831 SW DICKINSON LANE Description Date Amount PORTLAND, OR 97219 [PLUMB] Permit Fee 4/18/2007 $159.20 [TAX] 8% State Surcha 4/18/2007 $12.74 Phone : Total $171.94 Contractor: POWER PLUMBING CO PO BOX 19418 PORTLAND, OR 97280 REQUIRED ITEMS AND REPORTS Contact # : PRI 503 -244 -1900 FAX 503- 244 -8825 Reg #: LIC 52378 PLM 34 -150PB This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By: �Jj�/�J7 //.Lr /�;� Permittee Signature: `l . iL2 p / 7/, Call 503.639.4175 by 7:00 a.m. for an inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. 1:20AM POWER PLUMBING CO. 503 244 8825 p.1 �, - Plumbing Permit App1• t • 1 y r , i .,. Sr'T YM C +, l r t)l 1 „, t F" a ,+ b1 / *,b . ,, A (�I ' 6: f 4.% X 0 dw , r i • "t a M 1t h. � H % 6 City of Tigard 1 1 It I /'1 Received Permit No. - 13125 SW Hall Blvd., Tigard, OR 97223 P a n Re Zo 60148 Phone: 503.639.4171 Fax: 503.598.1960 AP Plan Review p C {w a OL? er Permit NO.: 24 Hour Inspection Line: 503,639.4175 8 201 < i t il' Date/By: 24 Hour www.ci.tigard.or.us -�' ia Date Ready/By. la See Page 2 for g CITYi�FT _ a Notifed:Method: Supplemental Information i t --a 1 � 4 t rt _..irhf } J '...+ r R t$'w (' � P ,.�f L s f.. i _ �- .a ",. ' I %.--4 ,- L ,1.. 1, fi V e'< Mme] m m ii- , JL' Rrrtj is .. t' t� I a . 1 g F i 6•_2,1, irnik J Y { a" ,.3t a,i<3; `S- a es..•x4111 , . .. ... `k .ii _.n P?. xy (Sul:��l `�.a•• = ¢A � S L •,. + -. y,r -. � f ; pyid �ld 13 L-.:�� -..._ r �J � -. � .. �t.,..t°�aa ,is 1 :1- �� { � E..,�. r =tn �.. :. e31t�v+ -, � .. ❑ New construction ❑ Demolition For special information use checklist Description 1 Qty. 1 Ea. I Total ❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) 9 > 1 i�Ny 6 ai t s t ? c . , 11 a d 11 + ltii '1. e t'' " : R(1)bath 249.20 x .1t ' t SF ❑ 1- and 2- family dwelling Commercial /industrial SFR (2) bath 350.00 El Accessory building 0 Multi - family SFR (3) bath 399.00 El Master builder Each additional bath /kitchen 45.00 ❑ Other t����.,;�.... Fire sprinkler ( sq. ft.) Page 2 .: . ipR'R- ": ( . a _ I Ill t 1 " ,r L • t - , _ - a .e 0> .: - I^ ua.r c_.. h, r l. _li; -_.. 'o" - ' -.. ..�-. �;_. 11. . 2.. 1i7:'t :t-A '=-= .- Site utilities Job site address: 13 o s p �i f , Catch basin or area drain 16.60 City /3tatdZlP: ! 4 /] /" J Qy' f l - 3 Drywall, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: '"' `+ I Project name: i • r y Footing drain (no. linear ft.: ) Page 2 " � Manufactured home utilities 110.00 Cross street/directions to job sitc: I PIA 3 Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Water service (no. linear ft.: t D ) 1, Page 2 `v' W N 6 Subdivision: 1 Lot no.: Fixture or item Tax map/parcel no f) e ` s U ; yrhi h�^+f* a +w �.?. .. �„y..yT3. +11 AbsO tion valve 16.60 `: ....' .....i::..,'`.a�tt.,r -.., _ _.. art... f ,- +.c. c .� .�.=..I!��t'tet ..- ?,.a�, Backflowpreventer I Page , � �i7 i b (,1) E -t gyp .- ' kite. 4.t Backwater valve 16.60 �P ii, I 1� i4 I: _ - v`l.. - Clothes washer 16.60 Dishwasher 16.60 _:�yt j�,,',� "/a a + t i "'�•s`s: n��..CC Drinkin fountain 16.60 r .•, + 1.1[ :1...19 '' + :L i� Iiiilfiri E it { I a -stn ' Ip r lk ' . + .' ;, a.,,t&^�,it Ejectors/sump 16.60 M i g I .....�_. ._� t= „•:W ;...- ..- --''��>< Name: ,r Q VJ LLC Expansion tank 16.60 Address: Fixture/sewer cap 16.60 City/State/ZIP: Floor drain/floor sink/hub 16.60 Phone: ( ) Fax: ( ) Garbage disposal 16.60 Hose bib 16.60 Business name: y w �1 0 1 y Ice maker 16.60 Interceptor /grease trap 16.60 Contact name: ' D C)15p/1J, Medical gas (value: S ) Page 2 Address: p 84/-K. )t l ` C f Primer 16.6D City/State/ZIP: � �(+ OY 61 ..� 7� Roof drain(commercial) q 16.60 • (14,9140 Phone: ( ) Z44L# _I' 6 0 1 I Fax: : ( ) ! Sink/basinnavatory 16.60 Tub/shower /shower pan 16.60 E -mail: Urinal 16.60 13 '^ " }i< ,1i}t "• a: +gig .IC,�Sr - el' + } + ,.. i 4 •r , m.. d hl . , °. s , i t •1 ,:ki iU!3t of �.s Water closet 16.60 __.... - i ....., 514. � l II :ia..s .�,::: ! Business name: ' a,t/ nrf • Q 1 Water heater 16.60 W Address: V 14 Sty A�� P k 81 V) Other: City /State/ZIP: p iV -1 3 Subtotal 151 (�': Minimum permit fee: $72.50 Phone: ( ) )I q, 1110® Fax: ( )),4y. $lr Residential backflow minimum permit fee: $36.25 CCB Lic.: 42 i Plumbing Lic. no.: 34- 15DT 6 Plan review (25% of permit fee) Authorized signature: State surcharge (8% of permit fee) 12.744 �� '�+� TOTAL PERMIT FEE ill 9y Print name: �� Date: • I This permit application expires if a permit Is not obtained w hin 180 days after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. i.\ Building\ PerrnilsWPLM- PennitApp.doe 06/07 4404616T(10/02/COM/WEB) } 11:20RM POWER PLUMBING CO. 503 244 8825 p.2 Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Su. t resslon S stews: r . $: 1. i fjl.�• i Y�•� „y , AFC z r i Footing drain - I° 100' 55.00 O to 2,000 $115.00 Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00 3,601 10 7 $220.00 Sewer - l st 100' 55.00 . - 7,201 and greater 3309.00 Sewer - each additional 100' 46.40 Water Service - 1st 100' S5 Medical Gas S stems: Water Service each additional 100 J 46.40 4l 4b Storm & Rain [ram - ,st 100' 55.00 rl ' 1 " 0 0 t 5 " W" $1.DO to 55,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' 46.40 55,001.00 to 510,000.00 $72.50 for the first 55,000.00 and 51.52 for each t t r s, r - ' r_ , ; rr I r` ��T , r additional 5100.00 or fraction thereof, to and -'.. s ': rA u r t.Z *: .....' including $I0,000.00. Commercial Back Flow Prevention Device 46.40 4 t $10,001.00 to $25,000.00 $148.50 for the first 510,000.00 and 51.54 for Residentiel Baekflow Prevention Device each additional $100.00 or fraction thereof, to (minimum permit fee 536.25) 27.55 and including 525,000.00. Rain Drain, single family dwelling 65.25 525,001.00 to $50,000.00 5379.50 for the first 525,000.00 and $1.45 for inspection of existing plumbing or each additional $100.00 or fraction thereof, to and including 550,000.00. specialty requested inspections - per hour 72.50 $50,001.00 and up $742.00 for the first 550,000.00 and $1.20 for Subtotal: each additional $100.00 or fraction thereof. Fixture Work:t;l Are you capping, adding or replacing fixtures? If "yes ", A "complex structure" is defined as an installation of a plumbing please indicate work performed by fixture. Failure to system that meets any of the following criteria. accurately re • ort Ilstures could result In Increased sewer fees. Please check all that apply. ❑ An new commercial building. r , ,, , ` �! ..t�� l:i -;,_ :.j.., � ' s, t.Ji.0 . t Y g ` l a 31 ° 1 „) r , , ❑ Any new exterior plumbing site utilities. . t a � °r � � ate' n ` '-•"' ❑ A commercial building with installation, alteration or addition Baptistry/Font of nine (9) or more new or relocated plumbing fixtures. Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities .Jacuzzi/Whirlpool providing services 10 human beings. Car Wash - Each Stall ❑ Plumbing installations, alterations er additions to food service - Drive Thru facilities where new plumbing fixtures, including interceptors, Cuspidor /water Aspirator are being installed for the foul service area. Dishwasher - Commercial ❑ Any new residential building containing three (3) or more - Domestic dwelling units. Dnnking Fountain ❑ Any NFPA 13 -D multipurpose fire sprinkler system. Eye Wash Floor Drain /sink 2" , Subtndt 2 sets of plans wtth any of the above. .j��l�r � �s titer: Car wash orain r ..: °,!�': : 1; a], :Ili ,p .. to Garbage - Domestic • Isometric or riser diagram is required for new buildings Disposal - Commercial three (3) or more stories in height. - Industrial Ice Mach. /Refrig. Drains Oil Separator(Gaa Station) Comments regarding fixture work: Rec. Vehicle Dump Station Shower -Gang -Stall Sink - Bar/Lavatory - Bradley - Commercial - Service Swimming Pool Filter Washer - Clothes *Note: If the fixture work under this ermf results in an Water Extractor P Water Closet - Toilet increase of sewer EDUs, a sewer permit will be issued and Urinal fees assessed for the sewer increase must be paid before the Other Fixtures: plumbing permit can be issued. is Bui %ding \Pnmiu \Pt.M.PtrmiAPp.doc 07106/05 . /" � | ��8~��� OF /.� /" CITY ��n- TIGARD �. - ^ | BUILDING DIVISION PERMIT #: Pi `207-(014B 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4K181237 Phone: (503) 639-4171 Inspection Roquo�a(24Hm�:(S03)83A'4175 � INSPECTION WORKSHEET FOR DATE: E125/2008 TIME: 7:00AM PAGE: 21 SITE ADDRESS: 09975 SW FREWING ST CLASS OF WORK SUBDIVISION: &4MSS1H0FF|CE I3LOG LOT #: 021 TYPE OF USE: , PROJECT NAME: NU\SS|H()FF|CE'BU|LD}NG DESCRIPTION: Hook' up water nwniueandRP0[. and 4 rain drains onroof. 5/1/07 ADD EJECTOR PUMP. OWNER: k0ASSiM.KAMB]A PHONE #: CONTRACTOR: POWER PLUMBING CO PHONE #: 603244'1900 Inspection Request Scheduled For: Date: 6/25/2008 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 Plumbing final 071821-01 503.986-0610 Y Corrections/Comments/Instructions: — �_' �~ � / • a^ 'r�. r " ^~n"~�—_� yi..-.../ E "c c\m�., at .,; (..c. (A) 4.- 1-1,- 4me. - p^~ ~r- 4 S e e_ Pi--Ac ( 1 . | | __ �� ��FASS __ RART|ALAPPRO\�`L El NO ACCESS | | FAIL n CALL FOR INSPECTION Ej ADDITIONAL FEES ASSESSED Inspector: V 11- Date: ^' 2'r1 Phone #: (503) 718- CITY OF TIGARD BUILDING DIVISION PERMIT #: PLM2007- 00148 13125 SW Hall Blvd., Tigard, OR 97223 s DATE ISSUED: 4/113/2007 Phone: (503) 639 -4171 Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 5113/2008 TIME: 7:02AM PAGE: 22 SITE ADDRESS: 09975 SW FREWING ST CLASS OF WORK: SUBDIVISION: MAS SIH OFFICE BLDG LOT #: 021 TYPE OF USE: PROJECT NAME: hhA S 311-i OFFICE BUILDING DESCRIPTION: Hook up water service and RPBD, and 4 rain drains on roof. 5/1/07 ADD EJECTOR PUMP. OWNER: MASSIH, KAME.LIA PHONE #: CONTRACTOR: POWER PLUMBING CO PHONE #: 603 -241 -1000 Inspection Request Scheduled For: Date: 1/.13/20013 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 Plumbing final 069796-01 603-936-0610 Y Corrections/Comments/Instructions: ii � ( �^ p e `er r Z I P s • 0-tv v C t/J a tc✓ �-C /✓ d- 1 V 4 C3 e✓1 r 4.�Jr -e t J ✓7 1 wt,., ► Pe cx r `Te -1 c °cur Ut t o (9Q,,,A Je c c 974\ ►5cAR Coln j .e Ree,✓'C A.-"T 'Y Si4:€ /✓d' - T — a l l S i r w10 P 1,1 L V O a vc J st 1 a ( t.� ►-�eA ✓cit-,J A n ehi v Loc. i0 �. P 0+ir 1- ►1 lA .0 40 �'� rV fr . ✓.e e Z 2 r � uc 4 Z,. Kr c e ✓. • I PASS ❑ PARTIAL APPROVAL ❑ CANCEL I I NO ACCESS "K FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: ab)\1\I°- Date: S1 11 w $1 Phone #: (503) 718- CITY OF TIGAR® 4 , BUILDING DIVISION PERMIT #: PLM2007 -00 M8 13125 SW. Hall Blvd., Tigard, OR 97223 r DATE ISSUED: 4/18/7007 Phone: (503) 639-4171 °' ^� +i: Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 10/24/200 TIME: 7 :00AM PAGE: 57 SITE ADDRESS: 09976 SW FREW WIG ST CLASS OF WORK: SUBDIVISION: MASSIH OFFICE BLDG LOT #: 021 TYPE OF USE: PROJECT NAME: MASSIH OFFICE BUILDING DESCRIPTION: Hook up water service and i2PBD, and 4 rain drains on roof. 511/07 ADD EJECTOR PUMP. OWNER: MASSIH, KAMELIA PHONE #: CONTRACTOR: POWER PLUMBING CO PHONE #: 503-2441900 Inspection Request Scheduled For: Date: 10/24/20A7 Pour Time: Code # Inspection Description Confirm # Contact # Message 330 Water service 068237-01 971 -998 -5474 N Corrections /Comments /Instructions: PASS n PARTIAL APPROVAL ❑ CANCEL I NO ACCESS ❑ FAIL n CALL FOR INSPECTION ADDITIONAL FEES ASSESSED Inspector: Date: L(. I2 ©� Phone #: (503) 718- CITY OF TIGARD BUILDING DIVISION PERMIT #: PLM2007 -00148 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/1012007 • Phone: (503) 639 -4171 '' diti +� Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 5/3/2007 TIME: 7:OOAM PAGE: 24 SITE ADDRESS: 09975 SW FREWNG ST CLASS OF WORK: SUBDIVISION: MASSIH OFFICE BLDG LOT #: 021 TYPE OF USE: PROJECT NAME: MASSIH OFFICE BUILDING DESCRIPTION: Hook up water service and RPBD, and 4 rain drains on roof. 511/07 ADD EJECTOR PUMP. OWNER: MASSIH, KAMELIA PHONE #: CONTRACTOR: POWER PLUMBING CO . PHONE #: 503 2441900 Inspection Request Scheduled For: Date: 513 /2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 395 Misc. inspection 047585 -01 503-730-3017 Y Corrections /Comments /Instructions: C° iPvo d'‘-111 D ■rc gal ,c 14W T T5 (ti I PASS 1 1 PARTIAL APPROVAL 1 1 CANCEL ❑ NO ACCESS n FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: (N. ; \'\"—""� Date: 5- J O Phone #: (503) 718- CITY OF TIGARD BUILDING DIVISION PERMIT #: PLM2007 -00148 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/1180007 Phone: (503) 639 - 4171 Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 4/25/2007 TIME: 7:00AM PAGE: 69 SITE ADDRESS: 09975 SW FREIMNG ST CLASS OF WORK: SUBDIVISION: MASSIH OFFICE BLDG LOT #: 021 TYPE OF USE: PROJECT NAME: MASSIH OFFICE BUILDING DESCRIPTION: Hook up water service and RPBD, and 4 rain drains on roof. OWNER: MASSIH, KAMELIA PHONE #: CONTRACTOR: POWER PLUMBING CO PHONE #: 503 -244 -1900 Inspection Request Scheduled For: Date: 4/25/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 335 Rail! drain 047060 -01 503-244 -1900 Y Corrections /Comments/ Instructions: 7 r S 11241,r7 aa,�6t l a✓4 , 216 � ► - 2 6 �c. o , 4 F ✓o �'I� Cvti� .,l-u- i.� j` I 1 A-.14( S'u - �, � i..s( � ✓ r.j' wG.,. LV � L e✓ r n.. T6 �� : T jdQ ri.y.`:'1 (o..l.. ,. �. >. w e i � �,.w C. H. r ow,ci i - 7 -G if �, I d„ C��,, �-�— 4 g1/ /6-7 44.,. i I PASS PARTIAL APPROVAL n CANCEL n NO ACCESS FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: al Date: y f 2 C» -7 Phone #: (503) 718 - CITY OF TIGARD .: - BUILDING DIVISION PERMIT #: 13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: Phone: (503) 639 -4171 Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: WAyi TIME: PAGE: SITE ADDRESS: G C I 75S P'm'∎. to-5, CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: DESCRIPTION: Va. OWNER: ' L d M AC') PHONE #: CONTRACTOR: po �� `�• -. PHONE #: Inspection Request Scheduled For: Date: Pour Time: Code ` # Inspection Description Confirm # Contact # Message a 3 33 R , t. 0 /ca.) PLM 2- o ? . 001q Corrections /Comments /Instructions: S C ov ` Ottlatn P60{ A-1 Co A't, Je- 1, r ✓w s't�.�4'au+ e 1 �..,.i 1� P-e f—o v P n PASS KPARTIAL APPROVAL ❑ CANCEL n NO ACCESS FAIL 1 I CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: 1 v,-4w A\-N-,-- Date: 112-q 67 Phone #: (503) 718- CITY OF TIGARD k, i 2� 5` ,. • BUILDING DIVISION P PERMIT #: 13125 SW Hall Blvd., Tigard, OR 97223 - � DATE ISSUED: Phone:.(503) 639 -4171 I, ,�(6 Inspection Requests (24 Hrs.): (503) 639-4175 WORKSHEET FOR DATE: 1 /a7 TIME: PAGE: SITE ADDRESS: CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: DESCRIPTION: '' // OWNER: V\G a / /16 " ...-r; PHONE #: CONTRACTOR: PoL,,,t, ����y;� PHONE #: Inspection Request Scheduled For: Date: Pour Time: Code # Inspection Description Confirm # Contact # Message 33S Pal L. O 10 PL A4 Zoo 7- 6o /v Corrections /Comments/ Instructions: S ew` ✓a, r.a1 Qa yh; 60 AT �� T'GN�:� W.r�'�b.. ale P;'+•+f . -�!` �.'A `_•� 1 C)�J ��f%�t't ✓M1 D ✓ �' uF:. 6Y+"; (� � "" � _ J ! -Q If M I T U•✓ 0 • • PASS 1 KC PARTIAL APPROVAL ❑ CANCEL n NO ACCESS ❑ FAIL CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED • Inspector: 1 �� �"^��- Date: L i 12 9 I■Y) Phone #: (503) 718-