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Permit " !"i'.— ✓ Iito g G ® f�G� , /7 �/' ( - /; C., , ✓�(4, J i OF �I�/`�1�® ELECTRICAL PERMIT II PERMIT #: ELC2008 00175 ° COMMUNITY DEVELOPMENT DATE ISSUED: 3/28/2008 • 11GAI2D' 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 - PARCEL: 25101 BD -00300 SITE ADDRESS: 08015 SW HUNZIKER RD ZONING: I -L SUBDIVISION: LOT : JURISDICTION: TIG PROJECT: PERFORMANCE CONTRACTING Project Description: TI - (1) panel and low voltage for fire alarm. Job No. 73129. 4/17/08 ADDED (17) branch circuits. RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS 1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION: EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG: LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL: 1 MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10): SERVICE/FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS 0 - 200 amp: 1 WISERVICE OR FEEDER: 17 PER INSPECTION: 201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR: 401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT: 601 - 1000 amp: PLAN REVIEW SECTION 1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL: Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC: Owner: Contractor: LOSLI E HOWARD TRUSTEE AND E C COMPANY SEABROOKE, CAROL ET AL PO BOX 10286 BY PERFORMANCE CONTRACTING, IN PORTLAND, OR 97296 CHARLOTTE, NC 28217 Phone: Contact #: PRI 503 - 220 -5377 FAX 503 - 295 -3012 FEES Description Date Amount Reg #: ELE 26 -45C [ELPRMT] ELC Permit 3/28/2008 $155.30 LIC 49737 [TAX] 12% State Surchar 3/28/2008 $18.64 SUP 3924S Total $173.94 REQUIRED ITEMS AND REPORTS 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 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344. Issued By: ������ Permittee Signature: / Uii OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale, lease, or rent. OWNER'S SIGNATURE: DATE: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N: DATE: LICENSE NO: 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. 04/16/2008 00:44 5032205347 ,1 i i . l , ' . 1 ' ;', 5 PAGE 01 �n 8 1tiJ Electrical Permit A pplicatioln i " ; ' ?w i` 4447 � x } ()K (( 1'rli +ti} it .,1 5.4a� y 2.11°8 x.:.dl�-y .r . ,4 s� i . f _ ".rsaiw >: a .'7OL _. M .t ".f. _ ,:j. I ,. . '+4 A sT':i ., Y t A .�tk'. ;5� i City of Tigard APR p clued J g (37 Permit No.: 0LC�)8i - 7 r 13125 SW Hall Blvd., Tigard, OR 97223 p t � /! " ✓�� s • :i Phone: 503.639.4171 Fax 503.598 1960..: : .s' 71 -J Other Permit: Inspection Line 503.639.4175 r iM " 1 Date fB : Jun ,',-:',-14 � , : h� i d T + " - �Y Y FR See Page 2 for Internet: www.tigard- or.gov ,., Notified/Method: , Supplemental Information I TYPE OF WOIU% PLAN REVIEW ❑ New construction R Addition/alteration /repiaccment Please check all that apply (submit i sets of plans w /items checked below): CI Dettl4lition El Other ❑ Service or feeder 400 amps or more ❑ Building over three stories. where the available fault current ❑ Marinas and boatyards. T CATEGORY OF CONSTRUE exceeds 10,000 amps at 150 volts or ❑ Floating buildings. less to ground, or exceeds 14,000 ❑ Commercial -use agricultural 1- and 2- family dwelling tx Commercial /industrial ❑ Accessory building amps for all other installations. buildings ❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. Cl Installation of 75 KVA or I. JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. ❑ Addition of new motor toad of ❑ se atel derived Job no.: Job site address: / �, ,/� �I� IOQHP or more. occupancy. !�� , `S �� , f vc { ,H a ❑ six or more residential units. ❑ Recreational vehicle parks. C rty /State /ZIP: . Q Health •care (tic m cihties. ❑ Supply voltage for ore than ^4' '' Fr, / I - " p ❑ Hazardou_s locations. 600 volts nominal. Suite/bldg. /apt. no.; Project name: YC� ❑ Service tar feeder 600 amps or more. - Cross street/directions to job site: FEE SGYI>EAULS IkrctrEtioo 1 Qty. 1 Fee. 1 Total 1 - New residential single- or multi- family dwelling unit. — Includes attached garage. Subdivision: Lot no.: _1,000 sq. ti, or less 145.15 4 Tax map/parcel Ea. add'l 500 sq. ft. or portion 33,40 I ap/parcel n0 -: Limited energy, residential $ DESCRIPTION OF WORK -Limited abov aq. ft.) 75.00 2 Limited energy, multi - family ikkidiVri. I t �� ?� residential (with above sq. ft.) 75.00 2 / V Services or feeders installahon and/or relocation 200 amps to less 80.30 2 PROPERTY OWNER I © TENANT 201 amps to 400 amps 106.85 2 Name: 401 amps to 600 amps 160.60 2 Address: 601 amps to 1,000 amps 240.60 2 Over 1,000 amps or volts 454.65 2 City/State/ZIP: Temporary services or feeders Installation, alteration, and/or relocation Phone: ( ) t Fax: ( ) 200 amps or less 66.85 1 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2 intended for salt, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 turps to 599 amps 133.75 Owner signature: Date: Branch circuits - new, alters ion, or extension, per panel A. Fee for branch circuits with I 0 APPLICANT © CONTACT PERSON above service or feeder fee, 11 6.65 1/1. es 2 each branch circuit Business name: " B. Fee for branch circuits Contact name: without service or feeder fee, 46.85 2 first branch circuit Address: Each add'l branch circuit 6.65 2 -•— Miscellaneous (service or feeder not included) City /StatdZlP: Each manufactured or modular Phone: dwelling, service and/or feeder 90,90 2 ( ) --1 Fa ' ( ) Reconnect only 66.85 2 E -mail: Pump or irrigation circle 53,40 2 CONTRACTOR Sign or outline lighting 53.40 - 2 Business name rr - Signal circuit(s) or limited - r iA 41 I . . ' -' .I/ .. 1 J// A■ ,/ /A energy panel, alteration, or Address: Lj, i extension. Describe: Page 2 2 City/State/ZIP; p��„I.tli iv__ `77 g / - Each additional inspection over allowable In any of the above Phone: + e) / / � /!/� /•( F ax: , ,� Per inspection 62.50 �-�: a/ ) /r Investigation per hour (1 hr min) 62.50 CCB Lie.; d ElectricalLic. . - Suprv. Lie.: industrial plant per hour 7175 ELECTRICAL PERMIT FEE$ Suprv. Electrician signature, required:r.ogi .101'4. � _ 4 Subtotal: fig, $ = Plan review (25% P fee): , Print name: Date: (5 /° of trait "�J " JL � � � / ! State surcharge (12 °6 of permit fee): 13 57 Authorized signature: TOTAL PERMIT FEE: gh 42 Tbls permit application expires if a permit is not obtains w tbin I90 Print name: Date: days after it bas been accepted as complete. • Number of inspections allowed per permit. i:+ Buildirilpermit8 1ELC- PermitApp.doc 05123/06 440.4615T(11/05/COM/waa TY OF TIGARD ELECTRICAL PERMIT I N V PERMIT #: ELC2008 -00175 ° COMMUNITY DEVELOPMENT DATE ISSUED: 3/28/2008 TIGARD, 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S101BD 00300 VIE ADDRESS: 08015 SW HUNZIKER RD ZONING: I - SUBDIVISION: LOT : JURISDICTION: TIG PROJECT: PERFORMANCE CONTRACTING Project Description: TI - (1) panel and low voltage for fire alarm. Job No. 73129 RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS 1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION: EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG: LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL: 1 MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10): SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS 0 - 200 amp: 1 W /SERVICE OR FEEDER: PER INSPECTION: 201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR: 401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT: 601 - 1000 amp: PLAN REVIEW SECTION 1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL: Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA /SPEC OCC: Owner: Contractor: LOSLI E HOWARD TRUSTEE AND E C COMPANY SEABROOKE, CAROL ET AL PO BOX 10286 BY PERFORMANCE CONTRACTING, IN PORTLAND, OR 97296 CHARLOTTE, NC 28217 Phone: Contact #: PRI 503- 220 -5377 FAX 503 - 295 -3012 FEES Description Date Amount Reg #: ELE 26 -45C [ELPRMT] ELC Permit 3/28/2008 $155.30 LIC 49737 [TAX] 12% State 3/28/2008 $18.64 SUP 3924S Total $173.94 REQUIRED ITEMS AND REPORTS 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 f. • _ - • 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those ru -s are set forth in .. • ' 5 901 -0010 through OAR 952 -001 -0100. You may obtain copi -. - ese rules or direct questions to OUNC at 503.24..6699 or 1.800.332. , • Issue• By: k_ ' / 4 / • I Permittee Signatur- • ♦) de il s OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale, lease, or rent. OWNER'S SIGNATURE: DATE: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N: ( • _,� %!llf_ J i DATE: I r LICENSE NO: 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. _ 1i 03/27/2' 02:01 5032205347 PAGE 01 e 1 Permit .Application Y -, d , Yi "i�. �', ,� � �,`�,� � I t�l I C I j . ��1� ti I ('t \ I \ -�s ^ t $� M 1 ? 1 r' •s City of '$'igard . , .; r te e ;.t . ., i r — ' Receive ¢ n 3 _ ' ., 13125 SW Ifall Blvd., Tigard, .5' 0'� x C J E DatolB ; ,s02 J Of 7 Q I Permit No.;12ae4g. 6V! 7 F„ Phone: 503.639.4171 Fax; 50 ` :.` :. t ' Review ,' � ,, Inspection Line: 503.639 A175 „Date/By Re Other Permit: ;,, Date :;Pl Internet: www.tigard- or.gov MAR 2 7 200 D Read - , Notified/Method: / Ca $ap lnformadoq T OF '. r !G ;,4r _ RE TYPE VIEW r New construction ddition/ � @� �� l S! O �] Please check all that apply (submit cats of Demolition Oiler: O Service or feeder 400 plans Building three t below): U r more 0 Ma Mari ap over roe stories, - i CATEGORY OF CONSTRUCTION _ where the available fault curnmt as and boatyards. axceed 0 1 0,000 amps at 150 volts or 0 Floating buildings, © 1- and 2- family dwelling j5kCommerciallindusttial [] Accessory building less t o erne , or exceeds 14,000 Ci Commercial -use agricultural ❑ Multi-family Other: 0 a pump. other installations. buildings. 0 Master builder ■ JOB SITE INFORM ATTON A > im LOCATION O Emery system 0 Installation of 75 cn or separately derived ayetdn. JOb no ` ❑ Addition of new motor load of 0 "A” "•g•' "1 - 2" "1 - 3•', `1 ale A, Jo site a (go 1 S `S( Or t,,,, 7 , Fe loam or more. oocutpancy City /State /ZIP: Cl six co mere residential units. []Recreational vehicle panes. Il ° 1 - 1 a a 3 ❑ Health-care facilities. 0 supply voltage for more than ❑ Suite/bldg /apt. no.: pro's name: dous locations. 600 volts nominal. J p CT 0 Service or feeder 600 amps or more. Cross street/directions to job site: """ FEE BCEfEDIJI.>E Ikat K Toth - New residential tingle- or multi- family dwelling unit. Includes attached garage, Subdivision: Lot no.: 1,000 sq. ft or less 145.15 0 Tax map/farccl no.: La. iced addi energy, y, s e portion 33.40 1 Limited energy residential D ON OF WORK (with above set. ft.) 75.00 2 � - 1 Q, 1 U d ::€ th nily (�t/J //' v e sq. ft.) 2 stallation alteration, and/or relocation 200 amps or less % 80.30 _ , • 2 'g PROPERTY OWNER ❑ TENS 201 turps to 400 amps 106.85 Name: 401 amps to 600 amps III 160,60 601 sus to 1,000 amps 240.60 Address: Over 1,000 amps or volts 11111 454,65 City/ State/ZIP: Temporary services or feeders installation, alteration, and/or relocation Phone: ( ) Fax: ( ) 200 amps OK Ices _ 66.85 1 Owner installation: This installation is being made on property that I own which is not 4 01 amps to 400 turp 100.30 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 to 599 amps 133,75 2 Branch circuits - new, alteration, or extension, r panel Owner signature: Date: A. Fee for branch circuits with 1 0 APPLICANT 1 0 CONTACT PERSON above service or feeder fee, each branch circuit 6.65 2 Business name: B. Fee for branch circuits Contact name: - without service or feeder fee, 46.85 2 first branch circuit Address: Each Will branch circuit 6.65 2 Miscellaneous (service or feeder not included) City/ State/Z1P: Each manufactured or modular 90.90 2 dwelling, service and/or feeder Phone: ( ) I Fax:: ( ) Reconnect only 66.85 2 E -mail: Pump or irrigation circle 53.40 2 Sign or lighting 53.40 2 1 CONTRACTOR Business name: �� ignal circuit(s) or limited- Cr,... " ft r,..1 energy panel. ahctution, or Address: p o t, e k 4 0 a g G extension. Describe Page 2 1& Ai 2 City /State/ZIP: P 4 a r --))1.--) Each additional inspection over allowable Ina of the above Per ins .ection 62.50 Phone: (S0 ) 0 0 - S 'N11 ` Fax: (54 3) aq Z S . 10 \ Invcstigution per hour (t hr min) 62.50 CCB Lie.: L k e N " ) n I Electrical Lic -: C „.. 1 S C L Suprv. Lie.: 691g/5 Industrial plant per hour 73.75 7 ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: yjill$W4 Subtotal: 155 Print name: / Date: Plan review (25% of permit fee); / t lG .ct l 'r tA 1S 14 J!” State sureharg IT 6 of permit fee): ■ . t� Authorized signature: TOTAL PERMIT FEE: vrv qy Print name: I Date: Thb permit application coins if a permit Is not obtained within 160 days after it has been accepted its complete • - • Number of iospe:chops allowed per permit. +eo wlsr(ttros�coDVivt�l a uildingTonnfl(ILC,PenaitApy.aoc 05/23/06 : CITY OF TIGARD r, BUILDING DIVISION PERMIT #: ELC2008 -00175 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/2812110[) Phone: (503) 639-4171 Inspection Requests (24 Hrs.): (503) 639 -4175 .�' INSPECTION WORKSHEET FOR DATE: 6/13/2008 TIME: 7:01AM PAGE: 33 SITE ADDRESS: 080Th SW HUNZIKER RD CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: PERFORMANCE CONTRACTING DESCRIPTION: 11 - (1) panel and low voltage for tire alarm. Job No. 73129. 4/17/08 ADDED (17) branch circuits. OWNER: E HOWARD TRUSTEE AND, LOSLI PHONE #: CONTRACTOR: E: C COMPANY PHONE #: 503.220 - 5377 Inspection Request Scheduled For: Date: U13/2008 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Electrical final 071344 503 -867 -4559 N Corrections /Comments / Instructions: X PASS PARTIAL APPROVAL ❑ CANCEL n NO ACCESS FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: G N66 LE Date: 6 / O`S Phone #: (503) 718- V1 1eL CITY OF TIGARD BUILDING DIVISION ri PERMIT #: ELC20013 Q0175 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/28/2000 Phone: (503) 639 -4171 Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: G/4 /2008 TIME: 7 :01AM PAGE: 38 SITE ADDRESS: 08015 SW HUNZIKER RD CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: PERFORMANCE CONTRACTING DESCRIPTION: TI - (1) panel and low voltage for fire alarm. Job No. 73129. 4/17/08 ADDED (17) branch circuits. OWNER: E HOWARD TRUSTEE AND, LOSLI PHONE #: CONTRACTOR: E C. COMPANY f\A\ PHONE #: 503- 220 -5377 Inspection Request Scheduled For: Date: 6/412008 Pour Time: Code # Inspection Description CConfir. # Contact # Message 199 Electrical final 070804 -01 503-867-4559 Y Corrections/Comments/Instructions: �� - n"\ P IU cf• ` 5�3 67) tZv.s S(tLE kiJ w∎I i1J �,T lk c bt 6c6N6 - eJ _ M . 2 O .Oka -) Kt1 rA I.,d CZ Ot4 b of esN Re. N•I,,E 6F C:AR, (14% *64. . 10 6 0 \--CO FAR &Ally e ms . The electrical installation defects noted on this report shall be corrected and an inspection request made within 20 c AR a18 -£11 -0030 n PASS ❑ PARTIAL APPROVAL ❑ CANCEL I I NO ACCESS X44 - FAIL U CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED e Inspector: � 11v Date: L' v1) Phone #: (503) 718- 0 - /r! CITY OF TIGARD BUILDING DIVISION r PERMIT #: ELC2008.00175 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3:28 /2008 Phone: (503) 639 - 4171 °` 11 A, Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 674/2008 TIME: 7:01AM PAGE: 37 SITE ADDRESS: O13016 SW HUNZIKER RC) CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: PERFORMANCE CONTRACTING DESCRIPTION: TI - (1) panel and Iow voltage for fire alarm. Job No. 73129. 4/17/08 ADDED (1 7) branch circuits. OWNER: E HOWARD TRUSTEE AND, LOSLI PHONE #: CONTRACTOR: E C COMPANY PHONE #: 503-220-6377 Inspection Request Scheduled For: Date: 6/4/2008 Pour Time: Code # Inspection Description ' onfirm # Contact # Message 135 Low voltage 070804 -02 603 867 -4653 N Corrections /Comments/ Instructions: F-Aqt c:ict,t5tv Pass)Q +C{, ell. ❑ PASS ❑ PARTIAL APPROVAL n CANCEL 1 NO ACCESS FAIL n CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED Inspector: — � Date: OLb Phone #: (503) 718 - 0' CITY OF TIGARD BUILDING DIVISION ' PERMIT #: ELC200€ -00175 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/28/200 Phone: (503) 639 -4171 pL� Inspection Requests (24 Hrs.): (503) 639-4175 /11+ 39 -4175 s °'I � INSPECTION WORKSHEET FOR DATE: 6/3/2008 TIME: 7:00AM PAGE: 21 SITE ADDRESS: 08015 SW HUNZIKER RD CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: PERFORMANCE CONTRACTING DESCRIPTION: TI - (1) parcel and kw voltage for fire alarm. Job No. 73129. 4/17/08 ADDED (17) branch circuits. OWNER: E HOWARD TRUSTEE AND, LOSLI • PHONE #: CONTRACTOR: E C COMPANY PHONE #: 503 220.5377 Inspection Request Scheduled For: Date: 6/3/2008 Pour Time: Code # Inspection Description Confirm Contact # Message 195 Mil inspection 070714 -01 503-867 -4553 N Corrections /Comments /Instructions: ❑ PASS PARTIAL APPROVAL ❑ CANCEL n NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ADDITIONAL FEES ASSESSED Inspector: 3 NC Date: 6• 3 0N Phone #: (503) 718- 2°T y� CITY OF TIGARD _ BUILDING DIVISION PERMIT #: ELC20O8 -00175 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/28! 00(3 Phone: (503) 639 -4171 �° �� Inspection Requests (24 Hrs.): (503) 639 -4175 ...': 1L - INSPECTION WORKSHEET FOR DATE: 4//642008 TIME: 7:OOAM PAGE: 32 SITE ADDRESS: 080Th SW HUNZIKER RC) CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: PERFORMANCE COItlTRACTING DESCRIPTION: TI - (1) panel and loge voltage for fire alarm. ,lob No. 73129 OWNER: F HOWARD TRUSTEE AND, LOSLI PHONE #: CONTRACTOR: E C COMPANY PHONE #: 503 220 - 5377 Inspection Request Scheduled For: Date: 4/1612008 Pour Time: Code # Inspection Description / Confirm,# Contact # Message 126 Wall cover p A 6 S. 063453 -01 5o:3-B67-4559 N Corrections /Comments /Instructions: A,1 • rI F. c_ .. • - ■ i S CA" .. Q, v . • v t AT '&1343 nr\._ . 7 c Rit_.lrTs A Nit. 156 v, : - s 9 N ► -- r -- 31; ∎15 ec= c)t 0 G A k.1 o -e- . 200 - 2°4731 e, , \s c (Vac. L., I 133A 1 PASS APARTIAL APPROVAL 7 CANCEL n NO ACCESS n FAIL ❑ CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED Inspector: Gm U v L Date: M f 1 'R J V Phone #: (503) 718 - VtitlY CITY OF TIGARD BUILDING DIVISION • PERMIT #:2UGZSXt 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: Phone: (503) 639- 4171 '„ • Inspection Requests (24 Hrs.): (503) 639 -4175 IL. INSPECTION WORKSHEET FOR DATE: 1 .1 . TIME: PAGE: ..11 A� SITE ADDRESS: ')015 6 W �tV IQ 7...111:M. 1� • CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: 'PeR.0 c CE (_ I • DESCRIPTION: -T 1 OWNER: PHONE #: CONTRACTOR:' G A 14 V • PHONE #: Inspection Request Scheduled For: Date: Li' 1 Pour Time: Code # Inspection Description Confirm # Contact # Message 1 g 45C_, Corrections/Comments/Instructions: n PASS Iti PARTIAL APPROVAL ❑ CANCEL n NO ACCESS n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Cr 1" ( i ( e4 Date: liI 1 ` 1 V Phone #: (503) 718 -1"v