Permit r'
• CITY OF TIGARD BUILDING PERMIT
• PERMIT #: BUP2004 -00464
X41 DEVELOPMENT SERVICES DATE ISSUED: 11/24/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 16215 SW 108TH AVE BLDG D PARCEL: 2S115AA -OTOOA
SUBDIVISION: OAK TREE APARTMENTS ZONING: R -25
BLOCK: LOT: OOA JURISDICTION: TIG
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: NEW FIRST: 8,032 sf N: 1HR S: 1HR E: 1HR W: 1HR
TYPE OF USE: MF SECOND: 7,651 sf PROJECT OPENINGS?
TYPE OF CONST: 5-1HR : 7,285 sf N: N S: N E: N W: N
OCCUPANCY GRP: R1 TOTAL AREA: 22,968 sf ROOF CONST: C FIRE RET?
OCCUPANCY LOAD: 93 BASEMENT: sf AREA SEP. RATED:
STOR: 3 HT: 32 ft GARAGE: 787 sf OCCU SEP. RATED: 1HR
BSMT ?: MEZZ ?: REQD SETBACKS REQUIRED
FLOOR LOAD: 50 psf LEFT: ft RGHT: ft FIR SPKL: Y SMOK DET:Y
DWELLING UNITS: 18 FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:Y
BEDRMS: 39 BATHS: 24 IMP SURFACE: PRO CORR: Y PARKING:
VALUE: $ 19,124.10
Remarks: Building D - 18 units with 3 attached garages.
Owner: Contractor:
OT2 LLC KEYWAY CORP
5437 ROSALIA WAY SUITE 100 7275 SW HERMOSO WAY
LAKE OSWEGO, OR 97035 PORTLAND, OR 97223
Phone: 503 - 620 -4373
Phone: 503 - 684 -5100
Reg #: LIC 127522
FEES REQUIRED INSPECTIONS
Description Date Amount Mechanical Permit Require Shear Wall Insp
[BUPPLN] Pln Rv 9/29/2004 $4,352.61 Electrical Permit Required Exterior Sheathing lnsp
[FLS] FLS Pin Rv 9/29/2004 $2,678.53 Sprinkler Permit Required Firewall Insp
Plumbing Permit Required Drywall nail /screw
[TAX] 8% State Surchari 11/24/2004 $536.16 Ersn Cntrl 681 -4444 Gyp Board Insp
[CDCBLD] CDC Bld Re 11/24/2004 $132.00 Footing Insp Smoke Detector
(additional fees not listed here) Foundation Insp Bolts in concrete final repo
Slab lnsp Structural welding final rep
Total $29,058.53 Framing Insp Final Inspection
Insulation Insp
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes
and all other applicable law. 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 the 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 a copy of these rules or direct questions to OUNC by
calling (503) 246 -6699 or 1- 800 - 332 -2344.
Issued By: • , .1'1 C
Permittee
Signature: - —
Call 639 -4175 by p.m. f r an inspection the next business day
' Building Permit A lh.Gati FOR OFFICE USE ONLY
E`(�,®,f ,
City of Tigard Received 9 ,rye r
Permit r • ((f
13125 SW Hall Blvd., Tigard, OR 97223 Date/By: OC j !/ 7 �7 �J�i,L ®V y — 0 O I
g Plan Review, ���LLL �[
Phone: 503.639.4171 Fax: 503.598.1969EP 2 9 2004 j II Ij Date/By: � � � J / 1„ )15 Other Permit:
Inspection Line: 503.639.4175 J a �� W Date Ready /By: /y1 y A [r- Juris ® See Attached Checklist for
Internet: www.ci.tigard.or.us CITY OF YIGARD' ^n ^^ Notified/Method Z �f + V Supplemental Information
id
:.. _.,
Y ,1
•- �•;-•, :"._. -,. � „•” „ .,`~ �� � °RE UIRED "DATA. 1- .:AND,2- FAMILY:`DWELliIN
E OF
it
® New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
❑ Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
s3;; „1':• � °'�;' rl;. 3 ';
work indicated on this application.
,,�CAT.:EGORY UE',GOI\STRUCTION. = <: ','.
❑ 1- and 2- family dwelling ❑ Commercial /industrial Valuation: $
❑ Accessory building ® Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
:`' ". ` `- ;` `; ~', , "JOB•,;SITE INFORMATION AND Total number of floors:
., �w�� ..�.._" ,», .� __ , . , �?•` _ ,,�.
Job site address: t LA1 5 �L•0 1 ' ? /.Tv New dwelling area: square feet
City /State /ZIP: 97224 Garage /carport area: square feet
Suite/bldg. /apt. no.: BLDG D Project name: OAK TREE II APARTMENTS Covered porch area: square feet
Cross street/directions to job site: SW 108 Ave. & SW Durham Road Deck area: square feet
Other structure area: square feet
` REQUIRED` <D :kCOMME U S E ' CH ECK L IST
Subdivision: Lot no.: Permit fees* are based on the value of the work performed
Tax map /parcel no.: 2S115AA 00700, 01000, 01100, 01200 Indicate the value (rounded to the nearest dollar) of all
,.,,- ::.'...,.:,;, ,:.,,�.,<,,.;.,.,;: overhead, and the profit for the
equipment, materials, s, a or, a e o
r
,
%; °�k`'' '' °'- `- work indicated on this application.
.; 't
New construction Valuation: s]' ‘70-2-. 560.
Existing building area: square feet
New building area: 23755 square feet
1.1.1 Number Number of stories: 3
Name: OT2 LLC Type of construction: V -1 hour
Address: 5437 Rosalia Way, Suite 100 Occupancy groups:
City/State /ZIP: Lake Oswego, Oregon 97035 Existing:
Phone: (503)620 -4373 Fax: (503)620 -1243 New: R1 & U1
, ;. ..APP ' NT' � •, "„ •,, . ,:, -.: `" CONTACT ;PERSON °� � �;,,;', y �:". <,
. ",•.�.,�:,: ".,.,,:_' °` - �,.,."- N .,..... 4 ' rf,?NO ICE':::,.;.
Business name: Ossey Development Corporation All contractors and subcontractors are required to be
Contact name: Dick Ossey licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 5437 Rosalia Way, Suite 100 jurisdiction in which work is being performed. If the
City/State /ZIP: Lake Oswego, Oregon 97035 applicant is exempt from licensing, the following reasons
apply:
Phone: (503) 620 -4373 Fax: : (503) 620 -1243
E -mail: richard.ossey @verizon.net
U'CONTRA ` "TOR °g z RI
Business name: Keyway Corp ,
BUILDCNG:.PERMIT;';FEES* •_.`
Address: 7275 SW Hermoso Way
Please refer to fee schedule.
City/State /ZIP: 97223
Fees due upon application
Phone: (503) 684 -5100 Fax: (503) 684 -5500
Amount received
CCB lic.: 127522
� Date received:
Authorized signature: // // This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Richard B. 0- ey r . u x/24/04 * Fee methodology set by Tri- County Building Industry
Service Board.
is \ Building \ Permits \BUP- PermitApp doc 12/03 440- 4613'r(11/02/COM /WEB)
RECEIVED
COUNTYWIDE Nov 2001
CITY OF TICARD
TRAFFIC IMPACT FEE BUILDING' G' DIVISION
•
PAYMENT OPTION FORM
4‘v...stLr gA( /64
Date Site Address
•
- 7(ip26)074 exi/
Project Name Plan Check #
I realize that I must make a decision on payment of the Traffic Impact Fee (TIF) at this
time. Therefore, I request the following (choose whichever option or options are
• applicable):
•
❑ Cash or Check
•
❑ Credit Voucher
Ti Bancroft or Installment Payments
or
The Ordinance allows for deferral of payment of the TIF until issuance of the
occupancy permit if the TIF is greater than $5,000. If the TIF meets this
requirement, I also request this option. I understand the TIF must be paid prior to
issuance of an occupancy permit. I also understand that the TIF will be
recalculated based on the prevailing rates at the time of payment. Please be
advised that TIF rates may increase up to six percent each July 1st. This rate
increase is not subject to appeal.
•
0 ER/APPLICANT OWNER/APPLICANT
cc: Building Permit File
Payment Option Notebook
is \dstsltif\TIF- PayOption.doc 03/28/02
r Astkplit
November 18, 2004
CITY OF TIGARD
O REGON
Dick Ossey
Ossey Development Corporation
5437 Rosalia Way, Suite 100
Lake Oswego, OR 97035
RE: NEW APARTMENT, BUILDING D and 3 ATTACHED GARAGES
Project Information
Building Permit: BUP2004 -00464 Occupancy Type: R1 /U 1
Tenant Name: Oak Tree II Construction Type: V/1 HR
Address: 16215 SW 108 Avenue Occupant Load: 93
Area: 23,755 Sq Ft Stories: 3
The plan review was performed under the State of Oregon Structural Specialty Code (OSSC)
1998 edition; and the Tualatin Valley Fire & Rescue Ordinance 99 -01 (TVFR99 -01) 1999
edition. The submitted plans are approved subject to the following conditions.
• The deferred submittals listed on sheet A1.0 may be charged a deferred submittal fee
based on the valuation of the portion of the work being deferred. The minimum fee
shall be $200.00.
Special Inspection: Special inspection is required for items listed on sheet S101.1. The
special inspection agency of record, shall furnish inspection reports to the Engineer of
Record, Conlee Engineers, Inc. the General Contractor, Keyway Corp and the City of
Tigard, Building Division, attention Hap Watkins. All discrepancies shall be brought to the
immediate attention of the general contractor for correction. The special inspector shall
submit a final signed report stating whether the work requiring special inspection was, to the
best of the inspector's knowledge, in conformance with the approved plans and specifications
and the applicable workmanship provisions of the code. 1701.3 OSSC
American with Disabilities Act (ADA): It shall be the responsibility of the Architect,
Engineer, Designer, Contractor, Owner and Lessee to research the applicability of the ADA
requirements for the structure. The City of Tigard reviews the plans and inspects the structure
only for compliance with Chapter 11 of the OSSC which may not include all of the
requirements of the ADA.
Approved Plans: 1 set of approved plans, be. ring the City of Tigard approval stamp, shall
be maintained on the jobsite. The plans shall.be,available to the Building Division inspectors
throughout all phases of construction. 106.4 ?. ()SSC
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 TDD (503) 684 -2772
S Jun 01 05 08:06a Hydro Tech y�, 3 60 256 2817 p_2
" f 4; a �.5 /O $' ea ,D
VOP 2004- 005 4 A--
WASHINGTON STATE FIRE MARSHAL'S OFFICE FIRE SPRINKLER ADVISORY BOARD
CONTRACTORS MATERIAL & TEST REPORT FOR ABOVEGROUND PIPING HYDRO TECH FIRE PROTECTION !NC
P.O. 80X 40
BRUSH PRAIRIE, WA 98606
PROCEDURE _. . ....... ........=.....-.
....._. .
Upon completion of work, Inspection and teats shalt be made by the contractor's representative and witnessed by an owner's representative. All defects
shall be corrected and iystem lett in service before contractor's personnel finally leave the Job.
A certlfrcate shall be filled out and signed by both nspresentatives. Copies shall be prepared for approving authorities, owners, and contractor. tt Is under-
stood the owner's representative's signature In no way prejudices any claim against contractor for faulty material, poor workmanship. or failure to comply
with approving authority's requirements or local ordinances.
PROPERTY NAME A ✓ T .ntSL 4TS z 4 T
O�h :Toni.
PROPERTY ADDRESS
1(c0:65 -° ‘ r ► A„,„1 . iz.. Ti � � 1(7 o C` gErlOf i
ACCEPTED BY APPROVING AUTHOR IES (NAME)
ADDRESS CJ y C)1 ----.
) r GAK.�
•
INSTALLATION CONFORMS TO ACCEPTED PLANS OYES LINO
PLANS EQUIPMENT USED IS APPROVED YES ❑ NO
IF NO, EXPLAIN DEVIATIONS
HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS TO LOCATION jesIZES U NO
OF CONTROL VALVE AND CARE AND MAINTENANCE OF THIS NEW EQUIPMENT?
IF NO, EXPLAIN
HAVE COPIES OF THE FOLLOWING SEEN LEFT ON THE PREMISES: YES NO
INSTRUCTIONS
1. SAND MAINT ICE INSTRUCTTIONS. ES ONO
3. NFPA 13A .YES 0 NO
LOCATION }
OF SYSTEM SUPPLIES BUILDINGS 1 CS 3 a��Tt4 6`-o t
•
YEAR OF ORIFICE TEMPERATURE
MAKE MODEL MANUFACTURE SIZE QUANTITY RATING
SPRINKLERS _
•
•
I
PIPE AND TYPE OF PIPE /0" _
FITTINGS TYPE OF FITTINGS c fil‹..�
ALARM ALARM DEVICE MAXIMUM TIME TO OPERATE • --
VALVE THROUGH TEST CONNECTION
OR FLOW TYPE MAKE 1 MODEL MIN SEC.
INDICATOR Fl ,-,% Cj:...:.visrC -ty t'cyT+ ; ii`jie -<j-f- .
DRY VALVE Q.OD.
MAKE �
MODEL SERIAL NO. MAKE MODEL SERIAL NO.
t I
• TIME TO TRIP - TIME WATER ALARM
DRY PIPE THRU TEST WATER AIR TRIP POINT REACHED OPERATED
OPERATING CONNECTION _ PRESSURE PRESSURE _ AIR PRESSURE TEST OUTLET PROPERLY
TEST MIN. SEC. PSI PSI PSI MIN. SEC. YES NO
WITHOUT
Ails, 0.0.D.
WITH
Q.O.D.
IF NO. EXPLAIN
• B MEASURED FROM TIME INSPECTORS TEST CONNECTION IS OPENED
(OVER)
S
•
Jun 01 05 08:06a H Tech 360 256 2817 p.3
•
f M
•PERATION'
PIPING SUPERVISED MAT]C ELECTRIC DETECTING MEDL0. SUPERVISED • YES • NO
DELUGE DOES VALVE OPERATE FROM THE MANUAL TRIP AND /OR REMOTE CONTROL STATIONS
P REACTION
IS THERE AN ACCESSIBLE FACILliY IN EACH GJRCUIT FOR TESTING IF NO, EXPLAIN YES Np
VALVES
❑YES 0 N
t� I t MAKE MODEL DO PERVIS ONR SS ALARM TE OPERATE VALVE RELEASE MAXIMUM TIME TO
OPERATE RELEASE
•
•• ••
TEST IQ wo .~, 011ssra W term shall dd be made 4 hol {ea* than aoo pd (12.4 eery br h o ha,n or 60 pd 17 4 beta/ stow pommy' moms ISO A! (102
DESCRIPTION rr p. wt.. ct.p0•rs ehail b. tan cpen d.innp l.4 b pr.wnl damage. An .sw
oprourst plpiny l.altap. owl b• rlltpod.
�• , • • ElaMLah 40 pd g2.7 bars' .1r proms'. and measure e
was and .h • and nwaur. eh drop exceed 1 112 ps 1 bent In 2 4 p hours
(r1.1 eery N 2. Mt's. Teat Fr..ayr0 ler,b d rorrnat wales
p drop whirl, shall not a.ca.d 1 f!d rs In l ours.
W PIPIN HYDROSTATIC-ALLY TESTED AT C . PSI FOR HRS. IF NO, STATE REA O
DRY PIPING PNEUMATICALLY TESTEDIYgA Y� ES — ONO
EQUIPMENT OPERATES PROPERLY 1Z' YES ❑ NO
• • YOU CERTIFY AS THE SPRINKLER SYSTEM CONTRACTOR THAT ADENINES AND CORROSIVE CHEMICALS, SODIUM
SIUCATE OR DERIVATIVES OF SODIUM SILICATE, BRINE, OR OTHER CORROSIVE CHEMICALS WERE NOT USED FOR TEST-
ING SYSTEMS OR STOPPING LEAKS? OYES 0 N
TESTS DRAIN RE VALVE 1`
READING OF GAGE LOCATED NEAR WATER RESIDUAL PRESSURE WITH VA
!
ST SUPPLY TEST CONNECTION: PSI CONNECTION OPEN WIDE
NDERGROUND MAINS AND LEAD IN CONNECTIONS TO SYSTEM RISERS FLUSHED BEFORE CONNECTION MADE TO PSI
SPRINKLER PIPING.
RIFTED BY COPY OF THE U FORM NO. 858 OYES ❑ NO OTHER
FLUSHED BY INSTALLER OF UNDER - EXPLAIN
c ROUND SPRINKLER PIPING NVES ❑ NO
BLANK TESTING NUMBER i LOCATIONS
KET$ NUMBER REMOVED
GAS
I ED PIPING DYES eCINO
00 YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING PROCEDURES COMPLY
H THE REQUIREMENTS OF AT LEAST AWS 010.9. LEVEL AR-3 ®YES 0 N
. • YOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS QUALIFIED IN
WELDING COMPUANCE WITH THE REQUIREMENTS OF AT LEAST AWS 010.9, LEVEL AR-3
❑YES ONO
/�
• • YOU CERTIFY THAT WELDING WAS CARRIED OUT IN COMPLIANCE WITH A
Milk DOCUMENTED QUALITY CONTROL PROCEDURE TO INSURE THAT ALL DISCS ARE
• RIEVED, THAT OPENINGS IN PIPING ARE SMOOTH, THAT SLAG AND OTHER
: • ING RESIDUE ARE REMOVED. AND THAT THE INTERNAL DIAMETERS OF
PIPING ARE NOT PENETRATED
i / A CUTOUTS DO YOU CERTIFY THAT YOU HAVE A CONTROL FEATURE TO ENSURE THAT ALL AYES NO
I T / fl (DISCS) r OUTS (DISCS) ARE RETRIEVED? ❑ YES ❑ NO
FUNCTIONAL DOES AHJ REQUIRE A FUNCTIONAL FLOW TEST OF RESIDENTIAL SPRINKLERS?
FLOWTEST RE FUNCTIONAL FLOW TEST RESULTS SATISFACTORY? OYES LINO _
HYU AUUC NAME PLATE PROVIDED f YES ❑ NO
iF NO, EXPLAIN
DATA NAMEPLATE
* I
DATE LEFT IN SERVICE WITH ALL CCONTROL VALVES OPEN:
REMARKS
NAME QF SPRINKLE ,CONTRACTOR CONTRAC OR UCENSE #
a-C k r,C. 'Dg :1 ZZa z Z
FOR PROPERTY OWNER (SIGNED} TESTS WITNESSED BY
SIGNATURES TITLE DATE
` ma y 1 7 - CO Ra a w a r ► W`t ' TITLE D A T ROVi•?f\�� I �7' _ a c B
11, I, TITLE DA E
CERTIFY � T THE F•RMATI• � �!' INSTAU_ED IN ACCORD-
CE WITH RCW 18-160 AND THE RULES ADOPTED BY THE WASHINGTON ADMINISTRATIVE CODE AS ADMINISTERED BY
CERTIFICATION HE STATE FIRE MARSHAL
•
NAME CF CERTIFICATE OF CCIAPETENCY HOWER (PRINT CE) TYPE)
•
EATIFlCATE REGISTRATION SIONATVJE OF CERTIFICATE C COMPETENCY HOLDER
DATE
MTprat •EXPI ANAPON MO NOTES
a6A BACK
.-F TIGARD
BUILDING DIVISION PERMIT #: BUP2004- 00464
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/24/2004
Phone: (503) 639 -4171 a h�R Ai.
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 10/26/2005 TIME: 7:07AM PAGE: 32
SITE ADDRESS: 16215 SW 1013TH AVE BLDG D CLASS OF WORK:
SUBDIVISION: OAK TREE NO. 2 APARTMENTS LOT #: 00A TYPE OF USE:
PROJECT NAME: OAK TREE!! APARTMENTS
DESCRIPTION: Building D - 18 units with 3 attached garages. TIF Deferred
OWNER: 0T2 LLC, PHONE #: 503-620-4373
CONTRACTOR: KEYWAY CORP PHONE #: 503 -684 -5100
Inspection Request Scheduled For: Date: 10/26/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
299 Final inspection 019397 -01 503. 888-2082 Y
Corrections /Comments /Instructions:
rA55 I PARTIAL APPROVAL CANCEL 1 NO ACCESS
1 FAIL CALL FOR NSPECTION 1 1 ADDITI• AL F ES ASSESSED
Inspector: / . . Date: _a Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION
PERMIT #: BUP2004-00464
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/24/2004
Phone: (503) 639-4171 iithiliti 11
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 10/25/2005 TIME: 7:10AM PAGE: 14
SITE ADDRESS: 16215 SW 108TH AVE BLDG D CLASS OF WORK:
SUBDIVISION: OAK TREE NO. 2 APARTMENTS LOT #: 00A TYPE OF USE:
PROJECT NAME: OAK TREE II APARTMENTS
DESCRIPTION: Building D - 18 units with 3 attached garages. TIF Deferred
OWNER: OT2 LLC, • PHONE #: 503-620-4373
CONTRACTOR: KEYWAY CORP PHONE #: 503-6845100
Inspection Request Scheduled For: Date: 10/25/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
998 Alarm final 019277-01 503-888-2082 N
a rrec ons/ o men s/Inst .
- C eu ta
• •:,24,,f os-- C) 061 ,
■ _
•
()
- _
1] PASS pi PARTIAL APPROVAL V CANCEL NO ACCESS
El FAIL 1 CALL FOR INSPECTION 1 1 ADDITIONAL FEES ASSESSED
Inspector: Date: Phone #: (503) 718-
CITY-OF F lt TIGARD
BUILDING DIVISION PERMIT #: P2 00464
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11124!20&4
Phone: (503) 639 -4171 u �ph f3U
n ;
Inspection Requests (24 Hrs.): (503) 639 -4175 -�! AL _�.. �i
-_ _INSPECTION WORKSHEET FOR DATE: iQ/25/20O& TIME: 7:10AM PAGE: 14
SITE ADDRESS: 16216 SW 1Oi3l H AVE BLDG D CLASS OF WORK:
SUBDIVISION: OAK TREE NO. 2 APARTME TS 1/4 LOT #: OOA TYPE OF USE:
PROJECT NAME: OAK TREE Il APARTMENTS
DESCRIPTION: Budding D 13 units with 3, attached Owes. 'f 1F Deferred
OWNER: 012 LL..C, PHONE #: 503 - 6 2 &43 73
CONTRACTOR: KEYWAY CORP PHONE #: 603-684.510O
Inspection Request Scheduled For: Date: 10/25/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
998 Alarm final , ± 'i 2s 7 D1 !w�:�rlf38-20F32 N
^^�� „.' t - ¢ 4
-orre I ' ons/ n o ,me s /Inst uoti
0..., 3C -- \,
C tc j' & ° 2.-0 0 -- OO / )
1
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i p
----"- - I P\ {1/4 *---t II A `, t, \-.; t \".""- \
I
la PASS 1 1 PARTIAL APPROVAL ] CANCEL ❑ NO ACCESS
n FAIL 7 CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
r ,
Inspector: ' c >' ' Date: • I ' r " - Phone #: (503) 718