Permit jilh„: CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2005 -00076
-,' i DEVELOPMENT SERVICES DATE ISSUED: 4/7/2005
F,' 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S112CD -RM002
SITE ADDRESS: 07925 SW CAROL ANN CT ZONING: R -12 •
SUBDIVISION: REBECCA MEADOWS LOT: 002 JURISDICTION: TIG
Project Description: New SF detached.
BUILDING
REISSUE: PH24 -030 STORIES: 2 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: NEW HEIGHT: 23 FIRST: 669 sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y
TYPE OF USE: SF FLOOR LOAD: 40 SECOND: 1,024 sf GARAGE: 231 sf FRONT: 15 PARKING SPACES : 2
TYPE OF CONST: 5N DWELLING UNITS: 1 THIRD: sf RIGHT: 5
VALUE:
OCCUPANCY GRP: R3 BDRM: 3 BATH: 3 TOTAL: 1,693 st 162,577.70 REAR: 15
PLUMBING
SINKS: 1 WATER CLOSETS: 3 WASHING MACH: 1 LAUNDRY TRAYS: RAIN DRAIN: 100 TRAPS:
LAVATORIES: 4 DISHWASHERS: 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS:
TUB /SHOWERS. 2 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
. FUEL TYPES FURN < 100K: 1 BOIL/CMP < 3HP: P VENT FANS: 4 CLOTHES DRYER: 1
GAS FURN > =100K: UNIT HEATERS: 0 HOODS: 1 OTHER UNITS: 1
MAX INP: btu FLOOR FURNANCES: VENTS: 1 W0ODSTOVES: GAS OUTLETS: 4
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 1 0 - 200 amp: 0 - 200 amp: W /SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 2 201 - 400 amp: 201 - 400 amp: 1st W/O SVC /FDR: SIGN /OUT LIN LT: PER HOUR:
n
LIMITED ENERGY: 401 • 600 amp: 401 • 600 amp: EA ADDL BR CIR: SIGNAL/PANEL: IN PLANT:
MANU HM /SVC /FDR: 601 • 1000 amp: 601 +amps- 1000v: MINOR LABEL:
1000+ amp /volt : -
PLAN REVIEW SECTION
Reconnect only:
>=4 RES UNITS: SVC /FDR> =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC:
ELECTRICAL - RESTRICTED ENERGY
A. SF RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: ' VACUUM SYSTEM: AUDIO & STEREO: FIRE ALARM: INTERCOM /PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: ALL- ENCOMP BOILER: HVAC: LANDSCAPEJIRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS:
This permit is subject to the regulations contained in the Tigard
Owner: Contractor: Municipal Code, State of OR. Specialty Codes and all other
KEYSTONE DEVELOPMENT INC KEYSTONE DEVELOPMENT INC. applicable laws. All work will be done in accordance with approved
PO BOX 476 PO BOX 476 plans. This permit will expire if work is not started within 180 days
LAKE OSWEGO, OR 97034 LAKE OSWEGO, OR 97034 of issuance, or if the 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 952 - 001 -0080. You may obtain copies
of these rules or direct questions to OUNC by calling 503 - 246 -6699
Phone: 503- 635 -4736 Phone: 503- 635 -4736 or 1- 800 -332 -2344.
Reg #: LIC 71135
TOTAL FEES: $ 8,826.12
REQUIRED ITEMS AND REPORTS
Ersn Cntrl 681 -4444
Issued By : ���C� � - Permittee Signature
/'' d/UV
I
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that busi ss day. /
This permit card shall be kept in a conspicuous place on the job site until co tibn of the project.
Approved plans are required on the job site at the time of each inspection.
Building Permit A� 3 li atIon r - < FOR'OFFICE USE.c NLY . .
a uL��rl�u v u L�)
/
/0
City of Tigard R eceived
Date/By :3Z/0/0 3Z I b � /315 Permit No. S —co' b
City �
13125 SW Hall Blvd., Tigard, OR 97223 Plan Revie
Phone: 503.639.4171 Fax: 503.598I1�96R J. 0 2005 � / � 4aa� ' ° +•Y'`
J b 1 Date/By: OtherPermit:5( � v
A06 o,, 1 I
Inspection Line: 503.639.4175 . . 1111 Date Ready/By: , ® See Attached Checklist for
Internet: www.ci.tigard.or.us CITY OF TIGARD Notifi y ed/Method: ` �1 - ).) 6 T ie` Supplemental Information
BUILDING DIVISION SQd� W�,) \�,
. - _ TYPE OF WORK:.' REQUIRED DATA: 1- AND'2- FAMILY DWELLING
y i 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
" CATEGORY OF CONSTRUCTION work indicated on this application.
0 I - and 2- family dwelling ❑ Commercial /industrial Valuation: $
❑ Accessory building ❑ Multi- family
Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms: 2 11
JOB SITE INFORMATION AND LOCATION . ' Total number of floors: --
Job site address: 7 0,5 Sw CA ?ix_ INN N G'1 • New dwelling area: • 1 1'i 7 square feet
City/ State/ZIP: T(4 Rp I DP- 117223 Garage/carport area: 9,...2) I square feet
Suite/bldg. /apt. no.: Project name: Covered porch area: 3/L square feet
Cross street/directions to job site: (( 444 G3 4'v) 741H li Pu gwo Deck area: square feet
Other structure area: square feet
.. REQUIRED DATA: COMMERCIAL- USE CHECKLIST_
Subdivision: 4 IAEDak.09 Lot no.: (P. Permit fees* are based on the value of the work performed.
Tax map /parcel no.: 25 �2GP /'� �,�' `Il� Indicate the value (rounded to the nearest dollar) of all
T a nd the profit fo
""WORK - work indicated this application.
materials,
on s app atione a
p r for e
DESCRIPTION
(�,.1/U � FP- --- oRrA� V aluation: $
Existing building area: square feet
New building area: - square feet
PROPERTY OWNER'. ❑ TENANT' • • - Number of stories:
Name: 11- -(ST'O N E C ) A 14 1 NG Type of construction:
1
Address: Po )C t1 (o Occupancy groups:
City/State/ZIP: "Litrv.g, Osw 4rO 0g_ 11o34 Existing: g:
Phone: ( ) t3 g — Q'13(O Fax: ( 3) (Aq _11.44
New:
APPLICANT .;_ _ _ " -' - •:: ,: :. ; : ; ;; `CONTACT`PERSON .
: -... NOTICE,
Business name: v_e Z') t p ap Q :Awl ( tNG • All contractors and subcontractors are required to be
Contact name: Po 60%4 416 jAN1es POti'K- licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: lAY ' ( W 4 I o� 91 p 34- jurisdiction in which work is being performed. If the
City/ State/ZIP: applicant is exempt from licensing, the following reasons
apply:
Phone: ( ) 4JJV1•e. Fax: : ( . ) Sy.JI-
E -mail: 3 ?ol c .2, e come ,. Nr
O
N
C TRACTOR; = r - _ - , •
Business name: ,S`�Ei � p \J - oeM \M -
��"" ( ` "BUILDING PERMIT FEES`.
Address: �` rr1 "
Please refer to fee schedule
City/State/ZIP:
Phone: ( ) Fax: Fees due upon application
( )
CCB lic.: 111 3 5 Amount received
Date received:
Authorized signature: This permit application expires if a permit is not obtained
/ t within 180 days after it has been accepted as complete.
: � r
Print name? Y ^ , Pouf- Date: '3 t 10.5 * Fee methodology set by Tri- County Building Industry
Service Board.
:. m.,: M :....10...,,:, n....,he,,,, n... torn 44O_4613T/11 /07/COM /WFR1
�C (IVED
r 1.�.
Mechanical Permit Applica ion FOR E:US.F.,. •-
City of Tigard MAR 1 G 2005 Received Permit No
v Date/By: v1}ST� 00 5 .- 6X06
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1-960 i0 , t= t)z D ate/B y : Other Permit:
inspection Line: 503.639.4175 I V OF TIGARD .i1
rt Date Ready /By: Juris: 0 See Page 2 for
tnternet: www.ci.tigard.or.us BUILDING DIVISION Notified/Method: Supplemental Information
. - • T_YPE. WORK_ COMMERCIAL FEE* SCHEDULE — USE CHECKLIST
New construction ❑ Addition /alteration /replacement Mechanical permit fees* are based on the value of the work
performed. Indicate the value (rounded to the nearest dollar) of all
❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit.
- ,CATEGORY - -OF CONSTRUCTION - . _ • � Value: $
RESIDENTIAL EQUIPMENT/ SYSTEMS FEES*
Dd and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building
For special information use checklist.
❑ Multi - family ❑ Master builder ❑ Other:
Description I Qty. i Ea. I Total
JOB SITE INFORMATION AND LOCATION • � .. Heating/cooling
Job site address: 1125 V3 6-A lap AO t CT- Air conditioning or heat pump
(requires site plan showing placement) 14.00
City/State/ZIP: Tl &4 w i of- `n2275 Furnace 100,000 BTU (ducts/vents) 14.00
Suite/bldg. /apt. no.: Project name: P ef4,0, Ne,ApbW 5 Furnace 100,000+ BTU (ducts/vents) 17.90
Gas heat pump 14.00
Cross street/directions to job site: 6W fV (2Ltc„n ofQ1 'T1(J Duct work 14.00
0 0 S w � 1-O L N 13 GT, Hydronic hot water system 14.00
Residential boiler (radiator or
hydronic) 14.00
Unit heaters (fuel -type, not electric),
in -wall, in -duct, suspended, etc. 10.00
Subdivision: p_sbe A o5 Lot no.: Other: for any of above 10.00
Other: 10.00
Tax map /parcel no.: Other fuel appliances
'DESCRIPTION OF WORK Water heater 10.00
Neu 5� _._..
QQ (� e / � p � ` • Gas fireplace 10.00
i� ' l� ``frIc leD Flue vent for water heater or gas
fireplace 10.00
Log lighter (gas) 10.00
Wood/pellet stove 10.00
•
Wood fireplace/insert 10.00
�: PROPERTY_ OWNER _ ,: • ❑ .TENANT t y tner /flue /vent
Chimne /li 10.00
I'` • : �� . • - Other: 10.00
Name: - K . '1 (STDO f/ DPI e4,0 lit") 1 iN V Environmental exhaust and ventilation
Address: P o 6 o 7 4 (4-1( Range hood/other kitchen
equipment 10.00
City/ State/ZIP: L Osyie,Gl0 i OF G� 4 c - Clothes dryer exhaust 10.00
�J Single -duct exhaust (bathrooms,
Phone: (a 6 - LEni Fax: (5) ,9 q —n t}-' toilet compartments, utility rooms) 6.80
,. .:: .,:. -- •_ .;:�,�..,. • .,::. : _ cra fans
APPLICANT - ❑ CONTACT" PERSON. Attic/crawlspace 10.00
Business name: K_ iJ P J a opo -r 1 ,NC. Fuel Other:
piping i0.00
Contact name: • S MAC— $5.40 for first four; $1.00 for each additional
Address: G Me As /. ,Dv V. Gas heat etc.
Gas heat pump
City/State/ZIP: I 11 Wall /suspended/unit heater
Phone: ( ) n II Fax: : ( ) Water heater
E -mail: J P0�4K3 CAS o Fireplace
�i �M � N� Range
..., :. ., -. .: CONTRACTOR,. .:; Barbecue
Business name: Z ())...a—t./ -! '�- / Clothes dryer (gas)
Other:
Address: ‘..' .
� y MECHANICAL' PERMTI F
City/ State/ZIP: /- a I Z Subtotal
Minimum permit fee ($72.50)
bone: (S'a ) SS-- 2220 Fax: ( ) Plan review (25% of permit fee)
t .13 lie.: State surcharge (8% of permit fee)
TOTAL PERMIT FEE
This permit application expires if a permit is not obtained within 180
Authorized -
days after it has been accepted as complete.
i Print name s F ee methodology Date: �/Q .� gy set by Tri- County Building Industry Service Board
f CEGyED
Plumbing Permit Applica Ion . - FOR,:OFFICE USE ; - • -
City of Tigard MAR 1 0 Received
2005 Date/By: PermitNo.:yVf, �5 -cwo
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.196t��T OF T� /da�''�i� Date/By: Other Permit No.:
24- Hour Inspection Line: 503.639.4175 GAR •Ls , ! • Date Ready /By: Juris: ® See Page 2 for
iVG ;
Internet: www.ci.tigard.or.us DIM � Notified/Method: Supplemental Information
` - TYPE :OF,_WORK. FEE* SCHEDULE
New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. I Total
❑ Addition/alteration/replacement 0 Other: New l- 2- family dwellings (includes 100 ft. for each utility connection
CATEGORY O F CONSTRUCTION,'.' SFR (1) bath 249.20
0 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB; SITE INFORMATION -:AND. LOCATION Site utilities
Job site address: 1 q Z 5 ij C /_p L /aN t.1 CT'. Catch basin or area drain 16.60
City/State/ZIP: - i OP- \1 e/A-3 Drywell, leach line, or trench drain 16.60
Footing drain (no. linear ft.: ) Page 2
Suite/bldg./apt. no.: I Project name:
Cross street/directions to job site: j 113 002 A PrAD Frof4 Manufactured home utilities 110.00
��.�opp r�te,, Manholes s 16.60
(})3 6 41 / PI NO cm Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: P- A" M MO at$ l Lot no.: Water service (no. linear ft.: ) Page 2
Tax map /parcel no.: Fixture or item
valve .
Absorption I l6 60
-�'- ` 'DESCRIPTIONN OF WORK` , Backflow preventer Page 2
NiW Sf - - Pt%fh e p Backwater valve 16.60 .
Clothes washer 16.60
Dishwasher 16.60
. �- G Drinking fountain 16.60
ROPERTY , m f 1 9 • P 9M_ 4NT -
J mP
E'ectors /su 16.60
Name:
P 0. Box 476 Expansion tank 16.60
Address: Lake Osweg0. OR 97034 Fixture/sewer cap 16.60
City/ State/ZIP: p Floor drain/floor sink/hub 16.60
Phone: ( Y3) (,35 - 1 Fax: ( 5 t,'11 _ 4 I Garbage disposal 16.60
'�} APPL . '0 CONTACT. PERSON Hose bib 16.60
Ice maker 1 6.60
Business name: KEYSTONE DEVELOPMENT
ELOPMENT Interceptor /grease trap 16.60
Contact name: P.O. Box 476
Medical gas (value: $ ) Page 2
Address: Lake Oswego, OR 97034 Primer
16.60
City/State/ZIP: Roof drain (commercial) 16.60
Phone: ( ) sf1w■& ( Fax: : ( ) Sf'l'W`2 -- Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail: J QO LAT-3 Q to
tn`rwt NeA" Urinal 16.60
=CONTRACTOR P/
vin ` -- .. / - Water closet 16.60
Business name:110(.4 / 45• - /Q !" v/n �f � ( Water heater 16.60
Address: Po 1X G3338. -/ Other:
City/ State/ZIP. j p ar� a q 7� 9-1 Subtotal
J � Minimum permit fee: $72.50
Phone: (5b3 ) b ? C1 _ 056a Fax: (.3) 62,2 ! -O5 Residential backflow minimum permit fee: $36.25
CCB Lic.: / 35- C " y 3 Plumbing Lie. no.: 5/6"e8 Plan review (25% of permit fee)
•
Authorized signature :` �� //�/� �/ `� State surcharge (8% of permit fee)
'>/� utIF TOTAL PERMIT FEE
Print name: ill , c ) Plat° /.177/ Z Date:4055 This permit application expires if a permit is not obtained within
/ ' t � C 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
;An..a.c....40......4.4m RI 0......:.A.....1...• In //17 ..An A <. L.,.n /n,.n�. -n.
ELI/ El I / '2t.1U 1:3`A :i bt1Jt:)b44bb L1(31 ELECTRIC PAGE 01
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® I O wner /A ent for 475, „,/e400.-ireiwt lnC,
(PLEASE PRINT) k (PERMIT HOLDER)
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Do hereby``'t.. y �
cerf th =at-the' foll`owmg location
meets Cit r .T
ofi and /Washington County
l and use and development standards for street tree installation.
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444 ADDRESS: 7q c"�0 C4 ,4,�d✓ Cr ��,C�iri�T�` ''�?
1
LOT: SUBDIVISION: X Zif-, 5
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BY: DATE: SPA/ 05
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RECEIVED BY: , DATE: - .3” 'Q,3--- 0.
VT V
CITY OF TIGARD �►
BUILDING DIVISION PERMIT #: MST2005- 00076
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/7/2005
Phone: (503) 639 -4171 /mn nIAlijgiypiqpti
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 8/9/2006 TIME: 7:05AM PAGE: 51
SITE ADDRESS: 07925 SW CAROL ANN CT CLASS OF WORK:
SUBDIVISION: REBECCA MEADOWS LOT #: 002 TYPE OF USE:
PROJECT NAME: REBECCA MEADOWS
DESCRIPTION: New SF detached.
OWNER: KEYSTONE DEVELOPMENT INC, PHONE #: 503 - 635.4736
CONTRACTOR: KEYSTONE DEVELOPMENT INC. PHONE #: 503 - 635 -4735
Inspection Request Scheduled For: Date: 8/912005 Pour Time:
Code # - Inspection Description Confirm # Contact # Message
299 Final inspection 013159.03 503 -704 -9505 • Y
Corrections /Comments /Instructions: •
•
•
fx . PASS - TIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ' ALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
,- �� - off
Inspector ,.N, Amor® Date: Phone #: (503) 718 -
•
CITY OF TIGARD ,
BUILDING DIVISION ' PERMIT #: MST2006-00076
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/7/2005
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 8/9/2006 TIME: 7:06AM PAGE: 52
SITE ADDRESS: 07925 SW CAROL ANN CT CLASS OF WORK:
SUBDIVISION: REBECCA MEADOWS LOT #: 002 TYPE OF USE:
PROJECT NAME: REBECCA MEADOWS
DESCRIPTION: New SF detached.
OWNER: KEYSTONE DEVELOPMENT INC, PHONE #: 503-635-4736
CONTRACTOR: KEYSTONE DEVELOPMENT INC. PHONE #: 503-635-4736
Inspection Request Scheduled For: Date: 8/9/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
699 Mechanical final 013169-02 503-704-9506
Corrections/Comments/Instructions:
N PASS ARTIAL APPROVAL E] CANCEL E NO ACCESS
n FAIL CL FOR INSPECTION El ADDITIONAL FEES ASSESSED
_
Inspector:
/ ' --- Date: Phone #: (503) 718-
)
. ,
•
CITY OF TIGARD
BUILDING DIVISION PERMIT #: M5T2005 -00076
I 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4!712005
Phone: (503) 639 - 4171 / ��iu > ✓�Nlolrymp�l'�lel
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 6/5/2005 TIME: 7 :02AM PAGE: 70
SITE ADDRESS: 07926 SW CAROL ANN CT CLASS OF WORK:
SUBDIVISION: REBECCA MEADOWS. LOT #: 002 TYPE OF USE:
PROJECT NAME: REBECCA MEADOWS
DESCRIPTION: New SF detached.
OWNER: KEYSTONE DEVELOPMENT INC, PHONE #: 503- 635.4735
CONTRACTOR: KEYSTONE DEVELOPMENT INC. PHONE #: 503 - 635.4736
Inspection Request Scheduled For: Date: 8/5/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 012861 -02 503.704 -9505 N
Corrections /Comments/ Instructions:
21 r /; T,J r /2
. / 11 /.i i APJ.P _
K PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: A Date: Phone #: (503) 718-
CITY OF TIGARD N ' .
BUILDING DIVISION PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: MST2005.00076
Phone: (503) 639 -4171 /fir >nglmyP�l�t i,) 4/7/2005
Inspection Requests (24 Hrs.): (503) 639 -4175 .J
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
7/27/2005 7 :15AM 4a
SITE ADDRESS: CLASS OF WORK:
SUBDIVISION: 07925 SW CAROL ANN CT LOT #: TYPE OF USE:
PROJECT NAME: REBECCA MEADOWS 002
DESCRIPTION: REBECCA MEADOWS
New SF detached.
OWNER: PHONE #:
CONTRACTOR: KEYSTONE DEVELOPMENT INC, PHONE #: 503.635.4736
KEYSTONE DEVELOPMENT I. 503 635 173E
Inspection Request Scheduled For: Date: Pour Time:
7/27/2005
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 012233 -02 50 -582 -9600 N
Corrections /Comments /Instructions:
I: PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
-a 7 Os r
Inspector: I 0 Date? Phone #: (503) 718-