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Permit
/ ,, A,..._ CITY OF TIGARD MASTER PERMIT PERMIT #: MST2004 -00271 i DEVELOPMENT SERVICES DATE ISSUED: 9/27/2004 � �� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 11825 SW KATHERINE ST PARCEL: 1S134CD -00700 SUBDIVISION: LERON HEIGHTS NO.3 ZONING: R - 4.5 BLOCK: LOT: 077 JURISDICTION: TIG REMARKS: Addition of (3) bedrooms, (1) bath & computer room. Other mechanical is duct work. BUILDING REISSUE: CUSTOM STORIES: 3 FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ADD HEIGHT: 30 FIRST: sf BASEMENT: sf LEFT: 5 SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 40 SECOND: sf GARAGE: sf FRONT: ,20 PARKING SPACES : 2 TYPE OF CONST: 5N DWELLING UNITS: THRD: 675 sf RIGHT: 5 VALUE: 62,370.00 OCCUPANCY GRP: R3 BDRM: 3 BATH: 1 TOTAL: 675 sf REAR: 15 PLUMBING SINKS: WATER CLOSETS: 1 WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: 2 DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS: TUB /SHOWERS: 1 GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIUCMP < 3HP: VENT FANS: 1 CLOTHES DRYER: FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS: 1 MAX INP: btu FLOOR FURNANCES: VENTS: 0 WOODSTOVES: GAS OUTLETS: ELECTRICAL RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS 1000 SF OR LESS: 0 - 200 amp: 0 • 200 amp: W /SVC OR FDR: PUMP /IRRIGATION: PER INSPECTION: EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVC/FCR: oo SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: 2.00 SIGNAUPANEL: 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: BOILER: HVAC: LANDSCAPE/IRRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL # SYSTEMS: Owner: Contractor: TOTAL FEES: $ 1,159.06 This permit is subject to the regulations contained in the KILLION, RANDALL L + JUI -MEI H FULLY RESTORED INC Tigard other Code, laws. All l work kwil Specialty done 11825 SW KATHERINE ST 11825 NW TUALATION AVE in TIGARD, OR 97223 PORTLAND; OR 97229 and all other applicable laws. All workwill be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if the work is suspended for more than 180 days. Phone: Phone: 503 - 816 - 8881 ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those Reg #: LIC 156048 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 -1987. REQUIRED INSPECTIONS Footing lnsp Framing Insp Mechanical Final Foundation lnsp Shear Wall lnsp Plumb Final Mechanical lnsp Special insp. required Final inspection Plumb Top Out Insulation Insp Electrical Rou h In Electrical Final Issued By : 4 ' Permittee Signature ! ...'.> i % it ,/' Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next business day I i _ 1 RECEIVED Buildi> g Permit Application 10 L Received 4 FOR OFFICE USE ONLY City of Tigard P 1 Date/By: ! / / Perna No.:'•: r.,3 "7 id i J 13125 SW Hall Blvd., Tigard, OR 97223 V i Y OF TIGA Plan Review v Phone: 503.639.4171 Fax: 503.598.1960 1 . - 1.t o- "'' Date/By N,�.. AA BUILD{ � n - < Date/B _ C� ' Other Permit: Inspection Line: 503.639.4175 ,�,���� � ' ` i► t 4 � � Date Ready /By: Juris:J O See Attached Checklist for Internet: www.ci.tigard.or.us �'L(r(l/Ynli,n ' A ,. Notified/Method: 1 Supplemental Information — Ga�s' iii b' CQ. , �- 7 7 d " .- f .. '.eT Vic• ox.. 7ti.'i. ,^�:5:':izls. 'S ",: `-`,. -:'. ., ;, „,J " T . W®IZK fi n ,,. ¢ ' „ • • - ; , RE ,D, DATA . l �, N,ND 2= `i,a pWE , E =;- ^.z , - .� � '.`.;',Y.Sb,., a'�cs ..��±:,...s :. :�'�..v.,s;.',"��ta, ^+Yr' v ....�i,i.., ., :si� s4. � ..<? „f ^.�,s�`�.:$at a"�",. ^: "`r -a.. �:4::.'a- ��:rz -.,..: �_ & .:^.. ,s ., ... . ... ❑ 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 v; . `` . ,ate CA ,"a G - ,, ^ �" , '.;•,.r $ __ work indicated on this application. u TE . GONST UC ICI ©� .., tern : : u , - 2'1- and 2- family dwelling ❑ Commercial/industrial Valuation: $ (0 ❑ Accessory building ❑ Multi - family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: ! t ” k'AOB SITE INF+OR VIATION AND' ATION ' ?; Total number of floors: 5, 3 Y• e- i(" fia �r, -__ � -F:i' ,^;?:u?''Aaq`, x,wn /. ..+« .5 . . '� .. , -� .3:?;<. 5 ..4Z . ,.. `.: ` = / 1 S oL j �� N ew dwelling area: 'l Job site address: t L..i � - G •e,�, ' � S .t I..P� 6 'D square feet City/State /ZIP: -- ri � O ec,IrD O2 ' 7d --a-3 Garage /carport area: square feet Suite/bldg. /apt. no.: Project name: Ko k 1P es ',ye., ce Rude I Covered porch area: square feet Cross street/directions to job site: titi,t / 91,4-- $ 1 all J 4vC vi ue Deck area: square feet Other structure area: square feet s i2�EQUI2 , IT :4614V ifit CHECKLIST - Subdivision: Le yo pf e, 1A9 ° 3 Lot no.: 7 ermit fees* are based on the value of the work pe ormed. Tax map /parcel no.: v Innl cate the value (rounded to the nearest dolla of all equip ent, materials, labor, overhead, and e profit for the li _ . DES "CR rON of Wo ` �fiE .s ' work in ated on this application. u•ps�4 U-��1 f- ,� .of 3 bPd1 ac c7 ✓� Valuation: $ a v e b a `H ir 0 o 4 b 4 c— p (A y a, V QR Existing building. ar a: square feet New building area: square feet � RO, ERT ©WNEIbh /t i- .; ': ialL k , S . • Number of stone Name: i et-M41&, 1 l "- T.A. , _ nte- i k,-11%.5- Type of con uction: Address: / I 5 f W te 4 e -- • ,..,e S -1-4 PeC Occup�ncy groups: \ City/State /ZIP: ` A 6 v 4 2 , // Q k ¶ 7 ' 2 2-3 / �/ / Existing: N .S Phone: (303) 5 t b 4 7 9 Fax: ( �U,7) S?- 4--m b 7 b New: / f;, _ ; APPIICANT s CONTACT PEER SO , ::s .i' »�5; x , • 4 _:; - rn. a: i. , , . ?:�.;.:�c,zavx ^..�..N::�,.., ' .,ti ... .:�<e:(;,4'.'� -," ��., r•�- �:e> :r?,.�, .... .,�•xz• �. ,.., ^ ^«W ". y<t. air .�a .•,�. � '�R'I��;I`I� »i•q ` •; �.. ,. .r�.iei,:c. w a :n. Y. e.:' �w,., �.,:a, - ,.• Business name: F / i ��e.Sto i.e Q. , I .tc , All contractors and subcontractors are required to be Contact name: j It p k e- licensed with the Oregon Construction Contractors Board �` under ORS 701 and may be required to be licensed in the Address: 1 1 0-5 NUJ 74a. I.,fi k liver/ t• e jurisdiction in which work is being performed. If the applicant is exempt from licensing, the following reasons City/State /ZIP: r �pOrt( �c.w A O( ei 7 9_2_4 apply: Phone: ( •j O D I F - 'O1g tl j ,183 'S a.s.1 Fax:: ( ) E -mail: r rgrFqr *'° � ;C i 1 Business name: (..„ i( r - f - d tr sZ� r v.-4 �, _ ( f' e' ( ,,4-!' i r le.,4INGIN, RM IZ FE S* . Address: / / 7c a_ � Al k �c_e . o - a, I Gt ue .�5, r. a A- n efe Please refer to fee schedule. City /State /ZIP: PO 1- `I- k ,,._0 , U 9 7a -a.-? - ' Fees due upon application Phone: (S( ) V r^,- $a' - ) Fa • ( ) 004 Amount received CCB lic.: / 5 _ &0 CC �' Date received: Authorized signature: ` t This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: QA_, tYn4 I ( L , l e it , - 4.3 to Date: y. 6-2-04 `f * Fee methodology set by Tri- County Building Industry Service Board. t:\ Building \Pernuts \BUP- PermitApp.doc 12/03 440- 4613T(11 /02/COM/WEB) One- and Two - Family Dwelling Building Permit Application Checklist FOR OFFICE USE ONLY Received City of Tigard Asss permits: Permit No.. 13125 SW Hall Blvd., Tigard, OR 97223 DaBy: Phone: 503.639.4171 Fax: 503.598.1960 / / *4 6 1 �v A 24- Hour Inspection Line: 503.639.4175 cal,. -A I ❑ Electrical .• ❑ Plumbing ❑ Mechanical Internet: www.ci.tigard.or.us -"— ❑ Other: THE FOLLOWING ITEMS ARE REQUIRED FOR PLAN REVIEW Yes No N/A 1 Land use actions completed. See jurisdiction criteria for concurrent reviews. ❑ ,- ❑ ❑ 2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc. ❑ ❑ - ❑ 3 Verification of approved plat/lot. ❑ ❑ ❑ 4 Fire district approval required. Name of district: . ❑ ❑ ❑ 5 Septic system permit or authorization for remodel. Existing system capacity ❑ ❑ ❑ 6 Sewer permit. ❑ ❑ ❑ 7 Water district approval. ❑ ❑ ❑ 8 Soils report. Must carry original applicable stamp and signature on file or with application. ❑ ❑ ❑ 9 Erosion control ❑ plan ❑ permit required. Include drainage -way protection, silt fence design and location of catch- ❑ ❑ ❑ basin protection, etc. 10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state ❑ ❑ ❑ building codes. Lateral design details and connections must be incorporated into the plans or on a separate full -size sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed if copyright violations exist. 11 Site /plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if ❑ ❑ ❑ there is more than a 4 -ft. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements and driveway; footprint of structure (including decks); location of wells /septic systems; utility locations; direction indicator; lot area; building coverage area; percentage of coverage; impervious area; existing structures on site; and surface drainage. 12 Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent size ❑ ❑ ❑ and location. 13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater, ❑ ❑ ❑ furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc. 14 Cross section(s) and details. Show all framing- member sizes and spacing such as floor beams, headers, joists, sub- ❑ ❑ ❑ floor, wall construction, roof construction. More than one cross section may be required to clearly portray construction. Show details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings and foundation, stairs, fireplace construction, thermal insulation, etc. 15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels. ❑ ❑ ❑ Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope. Full -size sheet addendums showing fouhdation elevations with cross references are acceptable. 16 Wall bracing (prescriptive path) and /or lateral analysis plans. Must indicate details and locations; for non- ❑ ❑ ❑ prescriptive path analysis provide specifications and calculations to engineering standards. 17 Floor /roof framing. Provide plans for all floors /roof assemblies, indicating member sizing, spacing, and bearing ❑ ❑ ❑ locations. Show attic ventilation. 18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered ❑ ❑ ❑ systems, see item 22, "Engineer's calculations." 19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists ❑ ❑ ❑ over 10 feet long and/or any beam/joist carrying a non - uniform load. 20 Manufactured floor /roof truss design details. ❑ ❑ ❑ 21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas - piping schematic is required ❑ ❑ ❑ for four or more appliances. 22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or ❑ ❑ ❑ architect licensed in Oregon and shall be shown to be applicable to the project under review. JURISDICTIONAL SPECIFICS . 23 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1 /2" x 11" or 11" x'17". ❑ ❑ ❑ 24 Two (2) sets each are required for Items 16, 19, 20 and 22 above. ❑ ❑ ❑ 25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will not be accepted. ❑ ❑ ❑ 26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document. ❑ ❑ ❑ 27 "Drawn to scale" indicates standard architect or engineer scale. ❑ ❑ ❑ 28 Site plan to include tree size, type and location per approved project street tree plan (if applicable), and City of Tigard ❑ ❑ ❑ Street Tree List. 29 Site plan to include tree protection measures as required by conditions of approval. ❑ ❑ ❑ 30 A Clean Water Services' Sensitive Area Pre - Screening Site Assessment form is required for all building additions, ❑ ❑ ❑ including decks, patio covers (over non - impervious surface) and accessory structures to existing residential dwellings on a lot of record approved prior to September 9, 1995. SEE 'AMS A/2o di A EA . i:\Building\Permits \One - Two- FamilyChecklist.doc 12/03 Mechanical Permit Application FOR OFFICE USE ONL �. Received City of flgard Date/By: Permit N oftJ5T p 7 e 3-z/ y d j 7) 13125 SW Hall Blvd., Tigard, OR 97,d ��� Plan Review Other Permit:: Phone: 503.639.4171 Fax: 503.59:. • .E �ta11/11 . l I� Juns. t I ,A\ Date /By: Inspection Line: 503.639.4175 r �7 . A Date Ready /By: See Page 2 for 6 iwler. �.. Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information SEP .. 0 700 04,, ' ` � ', ,a ., ,. .., 4 , , . �` .:,:, . , „` .. ,.; ,COMI FEE * ` ?USE.CHE'._ , . ` Mechanical permit fees* are based on the value of the work ❑ New construction 4NHd>iatt. I t ou - - 9 a ement performed. Indicate the value (rounded to the nearest dollar) of all ❑ Demolition ❑ Other: mechanical materials, equipment, labor, overhead, and profit. 1' ' 1 J " € , C - ATEGORYr OF CONRUCTIS ;5 Value. $ • ia�t., .xf >� �� i .,:>�. a...> E,,...- ...s. _%u a,1i1,., _St ST >., - xi0..t ON : "'v_... -%', .-:� ,°,s,.'. .�P 2 , ;5 ,13.E &t ' "' - - • z . ..m • - • * RESIDE NTIALEQUH'ME NT' /SYSTE]VIS:FEES 04 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 - ! u "'c�i- Yt:`�3ay. � ��.. ,:; :.�.;- � t `u°,F' ")= ° J k.:, JOB FSTTEINFORMATIONAND, LOCATION i Heating/cooling Air conditioning or heat pump r.,�r z- .w�&�a�k. «'� .�_3 �-.. o,er�.�.. .c$ -_.r .� c >.. � ";�s,�c - tea__ ,�. ..a- / Job site address: j)g 5 St.✓ eu el- r r,,,e St PQe (requires site plan showing placement) 14.00 City/State /ZIP: 1.i 9, e, r - (9 QK `Z 7� a Furnace 100,000 BTU (ducts /vents) 14.00 t, p p Furnace 100,000+ BTU (ducts /vents) 1 7.90 Suite/bldg. /apt. no.: I Project name:'; // - .. /t f',31 ' L( eirc2 4Cwx.rk( Gas heat pump 14.00 Cross street/directions to job site: 1441.1 u f .- / 2 / S 4 - 4 v t° K ue Duct work t 14.00 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 Flue /vent for any of above 10.00 Subdivision: Le ro 11 ht..i s IF 3 1 Lot no.: 7 7 Other: 10.00 Tax map /parcel no.: Other fuel appliances .,. - :. ` �. .. `> ' n" < ' t: Water heater 10.00 Gas fireplace 10.00 4 -P.3 1 t IQ 6,-...11.0e.• e 0e. f-'..-D.^ e'F '3 b Fcy' r u c'''' S, Flue vent for water heater or gas I b ��t k Go rufv tt to V 1r e a fireplace 10.00 u Yv�✓t.v cwt Log lighter (gas) 10.00 Wood /pellet stove 10.00 . Wood fireplace /insert 10.00 "a i '� ®TNANT r - . .. -,-. Chimney /liner /flue /vent 10.00 PROPERTY- OWNER E Other: 10.00 ice. db, a. • a w. a 'a ?c*4,. _erc -s :..- _......-k -> 4 x. ,. - . -. Name: keA,,, cK i ( 4- 'f.,,; - -i K1 i,'vt.t Environmental exhaust and ventilation � Range hood /other kitchen Address: 118�s ,SW / 6 / e i - rime S T -I-e,..4)- equipment 10.00 City/State /ZIP: 5 i Y .,J) r o q 7.2a-3 Clothes dryer exhaust 10.00 Single -duct exhaust (bathrooms, Phone: ( s03) ,5 4 q Y G Fax: (503) 6 (, 7 ( toilet compartments, utility rooms) ( 6.80 • Wit+ :;_• L4 t- •, "r "Aa: +: ':': >+,fg,- ., •, ,,„ Wif fi Attic/crawlspace fans 10.00 r g tb i ® I : .0, :v o mo Inc .., .® NT CO RE AS O N ' .. P Other: 10.00 Business name: 51...1 Re h9, S Fuel piping Contact name: gilt P c k etf " $5.40 for first four; $1.00 for each additional `' / Furnace, etc. Address: t i a I / t,,,/ Ti„ 6 - l 4-tt ot A Ve t'' Gas heat pump City/State /ZIP: Pb ¥ t1 G K , 9 d R 9 7 Za q Wall /suspended /unit heater _ Phone: (j o 3 ) 1 ) ( X64131 -:),1 2 - , j 3t 21 Fax: : ( ) Water heater Fireplace E -mail: Range ,., ..es. . n -r.- sx-' .z' ni� s-.i :; - ..vs.:.-;:a;` r..yxatT-"a .. .:1 'E ;?iu " s .'e;.. '�? c �2 ,.a� k '." > ,,? i:4,Tii : ^' '-"'; I" J tial t A: ., «: ` C ONTRAC; T OR a r i. 5 . ., . . i? ... >, _ . : ; Barbecue Business name: I ,\,,,i s g, o ' - as / ._v G v , Ntev j 1ec' c4, Clothes dryer (gas) Address: p a / V 4 (.c r h ,{vevt u a3 is AA.,.. .21? E `` ``„ : q'i y : ' °3.. ,, _ .: . .. l I g j ':MECHAIVICAL , PERIVITI�REES* , . City/State /ZIP: po A'-- s i .. 1 . 7 62 ( 9_1' . Y v e, t o/ Subtotal Phone: Minimum permit fee ($72.50) Phone: (5O ) .c g d2�Z j a (.. Fax: ( ) .; -( -� 7� Plan review (25% of permit fee) CCB lie.: 1 • Q L(---:6 1 3;g -2 7 State surcharge (8% of permit fee) ..e" TOTAL PERMIT FEE V10'5 This permit application expires if a permit is not obtained within 180 Authorized signature: days after it has been accepted as complete. Print name: 1?,e.r r /► 4 ( ( L • �i Ili J v� Date: 6 v * Fee methodology set by Tri County Building Industry Service Board � i:\Building \Permits \MEC- PerrnitApp.doc 12/03 440 -4617T (I I /02 /COM/WEB) Mechanical Permit Application - City of Tigard Page 2 - Supplemental Information Commercial Fee Schedule: . . a."te a, `�r'� "'AO . ^��5i�, +k�.° a� .;. ;,� °% :.�.."..z ,_, r,)r,`���� dr;; ,p ?3: u ro 194 Valu4 ® „ Peru t 1, , .° w .. ,. a: ^ c+c $1.00 to $2,000.00 Minimum fee $72.50 $2,001.00 to $5,000.00 $72.50 for the first $2,000.00 and $2.30 for each additional $100.00 or fraction , , . +, thereof, to and including $5,000.00. $5,001.00 to $10,000.00 $141.50 for the first $5,000.00 and $1.80 for each additional $100.00 or fraction thereof, to and including $10,000.00. $10,001.00 to $50,000.00 $231.50 for the first $10,000.00 and $1.35 for each additional $100.00 or fraction thereof, to and including $50,000.00. $50,001.00 to $100,000.00 $771.50 for the first $50,000.00 and $1.25 for each additional $100.00 or fraction thereof, to and including $100,000.00. $100,000.01 and up $1,396.50 for the first $100,000.00 and $1.10 for each additional $100.00 or fraction thereof. Note: All new commercial buildings require 2 sets of plans. i:\ Building \Permits\MEC- PermitAPP.doc 12/03 2 . . Electrical Application , • .F012 OFFICE USE City of-Tigard RECEIVED A Received Date/By: ' Permit NA/ _ 0147 13125 SW Hall Blvd., Tigard, OR. 9,223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 Other Permit: Inspection Line: 503.639.4175 Date Ready/By: Juris IEI See Page 2 for Internet: www.ci.tigard.or.us SEP 10 2004 i4.777,4.1i Date/B : Notified/Method. Supplemental Information gt;i7W .:4:t::::"*.4":"N MW.6191t W MA El New construction As itiordalterationireplacement Please check all that apply. ['Service over 225 amps, comm'l ID Hazardous location Ei Demolition 0 Other: _ , 0Service over 320 amps - rating 0Buildng over 10,000 sq. ft., IIIES,2147",,VW.05410,040#0,101111,a-MS122.Z of 1- and 2-family dwellings 4 or more new residential i and 2 dwelling 1:1 Commercial/industrial 0 Accessory building ['System over 600 volts nominal units in one structure ['Building over three stories 0Feeders, 400 amps or more D Multi 0 Master builder 0 Other: 00ccupant load over 99 persons 0Manufactured structures or tih'qtelliiiif Si eilikA P Egress/lighting plan RV park ,,....-• ., -, $.,,,,,4-,,,, ,,, ,,,-..^: iW, Job no.: Job site address: / / g (^ 0Health-care facility 00ther: - — 1 • A ' e 5.-- Subrnit 2 sets of plans with any of the above. City/State/ZIP: - ,- oq 5-1:12--<7 The above are not applicable to temporary construction service. A i,::.;'', Suite/bldg./apt. no.: 1 Project name: C 7/ I :,,„ e,,, 4,,,,, • •-• • • • • • . Description 1 Qty. I Fee. 1 Total I ** Cross street/directions to job site: [ cx a ÷ / ..4- f j t---- New residential single- or multi-family dwelling unit. Includes attached garage. 1,000 sq. ft. or less 145.15 4 Subdivision: , ,e, 1 r <3 t.A frft l'IA no Lot no.: .." 0 Ea. add'l 500 sq. ft. or portion 33.40 I Limited energy, residential / 75.00 2 Tax map/parcel no.: . Limited energy, non-residential Ilk 75.00 • 2 LSNgfihM4Ritk'aTik0:*otqigoy Each manufactured or modular dwelling, service and/or feeder 90.90 2 e _ ( d - I .-c,.... ( L"' 8.- C 4- s9 ; R. 0.,51_,Z1,-.. ,,, csF Services or feeders installation, alteration, and/or relocation 3 /9-e_4 44 ';" I b 0-1-1,,----u,A.-- 200 amps or less 80.30 2 V„:1414keyaff'4 = ,:%:"WIEVAMTIFili4ii4Wenof,;' 201 amps to 400 amps 106.85 2 160.60 2 Name: g ct IA ega- I ( t 7 „.q i' - met K11 ).-441'... 601 amps to 1,000 amps 240.60 2 Address: I 1 9, , 2, 5 — j (..4- jealetri/L..e. 5 fl..,e.e.4)- Over 1,000 amps or volts 454.65 2 Reconnect only 66.85 2 City/State/ZIP: T( e.or V , 0 (2 9 7 7-21 Temporary services or feeders installation, alteration, and/or Phone: (c4s 3 ) 5),1-....- Z 4 Fax: (Soy) 5 - ; - 4 7 L — 6 relocation 200 amps or less 66.85 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 sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2 Owner signature: Date: Branch circuits - new, alteration, or extension, per panel A. Fee for branch circuits with 6.65 2 Business name: branch circuit B. Fee for branch circuits Contact name: without service or feeder fee, each branch circuit / 4 6.85 2 Address: Each add'I branch circuit 2 6.65 2 City/State/ZIP: Miscellaneous (service or feeder not included) Pump or irrigation circle 53.40 2 Phone: ( ) Fax: :•( ) Sign or outline lighting 53.40 2 E • Signal circuit(s) or limited- ROV-EieaiiWgfgrzm energy panel alteration or ex Describe: Page 2 2 Business name: j - 0 M dic.Y- C (=WV tke.‹ 6 (4 Each additional inspection over allowable in any of the above Address: : i (.16, 51/1/ i t tie i ” 6 , ) ,„0, ?___, 0 g A ii ; k j .)2,..4-y.,- c Per inspection 62.50 City/State/ZIP: 5 e ,,,,,t v ,,,,.? ? -700 Investigation per hour (1 hr mm) 62,50 Phone: (56 3) 6,1. -. by 1 / Fax: ( ) Industrial plant per hour 73.75 aiVa7RILIMilitattf-CW,Min3rTifTte-; CCB Lic.: St3 L0'1 Electrical Lic.: Suprv. Lic.: Subtotal Suprv. Electrician signature, required: Plan review (25% of permit fee) State surcharge (8% of permit fee) Print name: Date: g 47j-- TOTAL PERMIT FEE Authorized signature: • / /7 This permit application expires if a permit is not obtained within 180 , days after it has been accepted as complete Print name: Ra_,..9, k 2.— r, Id 14 Date: '1, I 'L k<1 * Fee methodology set by Tri-County Building Industry Service Board ** Number of inspections per permit allowed. i \Building TermitsELC-PermitApp.doc 12/03 440 5T(10/02/COM/WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information " LIMITED ENERGY PERMIT FEES: I; t SIDENT W M O.y, =. t o ' X11 h,, �� � �. ,_.._ � _....�.:.��. .._..� ateM , Fee for all residential systems combined ... $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: ° C ® ..R.CIAL WORK 4NLI' E' W Zi Fee for each commercial system $75.00 (SEE OAR 918 - 260 -260) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations i:\ Building \Permits\ELC- PermitApp.doc 04/03 Building ; Fi xtures Plumbing Permit A t EEI VED FOR OFFICE USE ONLY City of Tigard Received Permit N94,1•6 a6 Y _ 7/ 13125 SW Hall Blvd., Tigard, OR 97223 SEP 10 2004 Date/By: Plan Review Phone: 503.639.4171 Fax: 503.598.1960 E „ Date/By: Other Permit No.: 24- Hour Inspection Line: 503.639.417CITY OF TIGAR P el 1 I Date Ready/By: Juris: 0 See Page 2 for Internet: www.ci.tt ard.or.us fied/Method: Supplemental Information g BU LIP' nI! No ti LI �B: _ ...�.�" ? 4,��: „ '4•.c . 'fi':w s SY�?ka";�r ""'w.�V' ^; a.. - .,+ `�"R,'_ - ;�'", . n - v ,. �. w . e. �,yi. {.. g' "c , �» � ; �sY:`, N' .. � Xv' � .av:,. ._¢�`Y�X��e't;4'AS - s i: <. - Cie !."�1?T- �iv; : ).: " »:�' , - .N 11 g.� Y ^'.24' .^.' - ' e'Wj .s y �. G &:•'^ R. SeLY4.' J . V:.. l •:y':` ' K ., °' . fsi a.;• • YrPE.• WOK - Ar,i, , rai,' _ ^ , F, .SCHEDULE _ _$ ; k� ��' �h` cm,'. �P. :z�.S.��.�aa�'E a.'� > ��v� rLK. • �• ,+ T'` ;r.'ca'' ... _- ,_..., .. . `:> ,��» -� i�., C *1 -sc.. x ^::�:E�or;s ;. ;.ns� =,� .,mr;«..v . , .. ❑ New construction ❑ Demolition For special information use checklist. Description Qty. Ea. Total Ij . Addition/alteration/replacement ❑ Other: New 1-2-family dwellings (includes 100 ft. for each utility connection) rpm-Tv rgi .* CATeE . 04708 COP[STRrgro ,``:, v�T «,,, � �=, sii SFR (1) bath 249.20 u •�`�d�5»-4 .$`:. �% th. ��` C3'a'�'r�..`Y4>.[P.°.�;itS b:rt;Y""'3„si w^ a�.. kD�� •a. d "i+...:�R'.atF� 21 and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 ❑ Accessory building ❑ Multi - family SFR (3) bath 399.00 Each additional bath/kitchen 45.00 ❑ Master builder ❑ Other: " r sans nY � = rnr frdi -° Y a Fire sprinkler ( sq. ft.) Page 2 tii : ,- I4E WFORMATrION - LO ATIUN 11 Site utilities Job site address: / / 3 (,✓ rle P,' v, e Si_ Catch basin or area drain 16.60 City/State /ZIP: -['t'G ac y� � a Q 770 73 Drywell, leach line, or trench drain 16.60 �J p ,,/ Suite/bldg. /apt. no.: Project name: K,� s - iPIe � dd Footing drain (no. linear ft.: ) Page 2 r i' �� A Manufactured home utilities 110.00 Cross street/directions to job site: //t/ / n -'- f ;/ s t 4 h u e /`T Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Subdivision: Lot no.: Water service (no. linear ft.: ) Page 2 Fixture or item Tax map /parcel no.: s " .,. ;, -,.,., :3 a ° =ss _... ,rr •,.:. x Absorption valve 16.60 , . 414 5 :e '`it DESCRIPTION ^i:OF , WORK , : a � a w U , h. 4 `� $ ", . m &..,_. ; .,, g,A,id. : �, - A , :z -,v,, `WI :kgAt ,5" t Backflow preventer Page 2 •e - y rs �� "�j`.� 0E - 7 , (7 v 6 0 s Backwater valve 16.60 C.) ( . e (J, 6-4-CI rpO m e. <--..44-10.<- , I Clothes washer 16.60 Dishwasher 16.60 4 ,. . x w. =. m:,,.� , ... ril . t :stn rs:r,. ° 4, Drinking fountain 16.60 , id ol.:.. - .. ,. R OPER T;Y OlV "WV- � r TENANT , 3 ��3�mI ;��.. «,�w�'�va,- u� >��s ��,;; .... � d4, .,.* °�. ,�,,M_ �:.;���. .;.4�, Ejectors /sump 16.60 Name: ' , re o E y 4 ( ( r Z3 e- /t(/.'ca' Expansion tank 16.60 Address: h. g ski t!c L, ev, xx S-f I ( -- Fixture /sewer cap 16.60 City/State/ZIP: - 1 ( - 5 ,, . 9 , v g ./ 7 . 02 Floor drain/floor sink/hub 16.60 Phone: ( , 2) ,g 4. _ [1 -q76, Fax: (Seg) ,_Q-(4-. 6 g 76 Garbage disposal 16.60 :aa ') € a-I �.5 ,1 ^c; xk ,,,�, s°, ,,w ',�s tzcztr, . , .a Hose bib 16.60 2' a AP ® , +CONTA ' ` P E RSO : "' . �. �:Ifis 1 : EA,E ;', •E , .r,' " ? 5= `,,,,,,;:: Ya sz => 'i' a,; •"' a s .. " Ice maker 16.60 Business name: Interceptor /grease trap 16.60 Contact name: Medical gas (value: $ ) Page 2 Address: Primer 16.60 City/State /ZIP: Roof drain (commercial) . 16.60 Phone: ( ) Fax: : ( ) Sink/basin/lavatory 16.60 Tub /shower /shower pan I 16.60 E -mail: Urinal 16.60 .r` ;l t"`"q.,i ,.. ;: - : :' i2^ ' i b;: : `;a.::<.N, x: s�,�• 6 � ._ :i ii .r.`<fir..., ;s�'�"` ' o;: � , rw w j '«�y` `` ':i 6l i Y, _u`' '';" ., .., a- h,'#': r i €rod 4 #t s y CON w ` r r , ri , P r �s : "g ac.�r � a� .srvw ,ss _sc.... sir 4, i 31. al i ;?g u 1 Water closet i 16.60 Business name: t.,, K`te y , + _Water heater 16.60 / - J Address: 1 e ,a �, : f ,,� e /� 5 Ph,4rv•- b % „Ct - O ther: Subtotal City/State/ZIP: e 0 13 L k 15 014. S.0 K ,P V l 6 -7 0.5,5 - - 1 / / Minimum permit fee: $72.50 Phone: (st:.) ( "7 I 014- LI ! I Fax: ( ) Residential backflow minimum permit fee: $36.25 CCB Li - ■ r '- �� 155' $ 35 � / /Sto luummbi�ng Lic. no -410- 4159, Plan review (25% of permit fee) Authorized signature: j / /)._ ' J / / 31105- State surcharge (8% of permit fee) TOTAL PERMIT FEE Print name: Q 4 „` J ( 0• " L, I/( 0 v v Date:/, \1 7 )10(f This permit application expires if a permit is not obtained within i` `l 180 days after it has been accepted as+ complete. *Fee methodology set by Tri -County Building Industry Service Board i:\ Building \Pemuts\PLMF- PermitApp.doc 12103 440- 4616T(10/02/COM/WEB) . Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: ResidentiaitFire Suppression Systems: Site Utthties^ '�.. ��' . �aF y ee(ea) t Square Foiotage . � ex Fees$,.= : Footing drain - l 100' 55.00 0 to 2,000 ' $115.00 Footing drain - each additional 100' 46.40 2,001 to 3,600 ' $160.00 3,601 to 7,200 $220.00 Sewer - 1st 100' 55.00 7,201 and greater $309.00 Sewer - each additional 100' 46.40 Water Service - 1st 100' 55.00 Medical Gas Systems: Water Service - each additional 100' 46.40 permlf Fee -4> x= °- ° ° ~ ' Storm & Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each Qfgi Fee(ea)Potai = additional $100.00 or fraction thereof, to and �Fl, 0C...�OT t -9n1 %a: _..1:4'°x.' s :41.4 4 x. including $10,000.00. Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $ 1.54 for Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to (minimum permit fee $36.25) 27.55 and including $25,000.00. Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for each additional $100.00 or fraction thereof, to Inspection of existing plumbing or and including $50,000.00. specially requested inspections - per hour 72.50 Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for each additional $100.00 or fraction thereof. • Fixture Work: Are you capping, moving or replacing existing fixtures? If "yes ", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees * . o-, �QuantttyYjy (xturo)orlPerfoYmed Fixture -Type � nr aYea Exis $ �eappea Comments regarding fixture work: Baptistry/Font Bath - Tub /Shower - Jacuzzi/Whirlpool Car Wash -Each Stall -Drive Thru Cuspidor /Water Aspirator Dishwasher - Commercial - Domestic Drinking Fountain Eye Wash Floor Drain /sink - 2" -3" -4" Car Wash Drain Garbage - Domestic Disposal - Commercial *Note: If the fixture work under this permit results in an Industrial increase of sewer EDUs, a sewer permit will be issued and Ice Mach. /Refrig. Drains Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the - Rec. Vehicle Dump Station plumbing permit can be issued. Shower -Gang -Stall Sink - Bar/Lavatory Quantity Total - Bradley Commercial Isometric or riser diagram is required if fixture quantity Service total is >9. Swimming Pool Filter Washer - Clothes Water Extractor Plan Review Water Closet - Toilet Plan review is required if fixture quantity total is >9. Urinal Other Fixtures: is\Building\Permits\PLM- PermitApp.doc 3/03 , CITY OF 13125 S.W. HALL BLVD. TIGARD, OR 97223 IMPORTANT PERMIT NOTICE MIKE'S ELECTRIC 11070 SW ALLEN BLVD BEAVERTON, OR 97005 Electrical Signature Form Permit #: MST2004 -00271 Date Issued: 9/27/2004 Parcel: 1 S134CD -00700 Site Address: 11825 SW KATHERINE ST Subdivision: LERON HEIGHTS NO.3 Block: Lot: 077 Jurisdiction: TIG Zoning: R -4.5 Remarks: Addition of (3) bedrooms, (1) bath & computer room. Other mechanical is duct work. 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 the work to the address above, ATTN: Building Division. No electrical inspections will be authorized until this completed form is received OWNER: ELECTRICAL CONTRACTOR: KILLION, RANDALL L + JUI -MEI H MIKE'S ELECTRIC 11825 SW KATHERINE ST 11070 SW ALLEN BLVD TIGARD, OR 97223 BEAVERTON, OR 97005 Phone #: Phone #: 503 - 649 -6991 Reg #: MET 00003623 LIC 50209 SUP 4230S ELE 34 -18c AN INK SIGNATURE IS REQUIRED ON THIS FORM X ALA L. ignaturr of Supervt ing Electrician If you have any questions, please call_ 503.718.2433. _ CITY OF TIGARD BUILDING DIVISION PERMIT #: MST2004- 0027 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/27/2004 Phone: (503) 639-4171 i Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 4/14/2005 TIME: 7 :10AM PAGE: 5 SITE ADDRESS: 11825 SW KATHERINE ST CLASS OF WORK: SUBDIVISION: LERON HEIGHTS NO.3 LOT #: 077 TYPE OF USE: PROJECT NAME: KILLION DESCRIPTION: Addition of (3) bedrooms, (1) bath & computer room. Other mechanical is duct work OWNER: KILLION, RANDALL L + JUI -MEI H, PHONE #: CONTRACTOR: FULLY RESTORED INC PHONE #: 503-816-8881 Inspection Request Scheduled For: Date: 4/14/2006 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Electrical final 004542 -01 503- 816.8881 N Corrections /Comments/ Instructions: i / i X PASS -- - ❑ PARTIAL APPROVAL - -- ❑ CANCEL El NO ACCESS - - - - - -- AIL $ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED . Inspector :. 11 . Date: 7 l / v Phone #: 503 ( ) 718- • CITY OF TIGARD , BUILDING DIVISION #: MST2004 -00271 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/27/2004 Phone: (503) 639 -4171 / iii j Insp Requests (24 Hrs.): (503) 639 -4175 ...':� -_— INSPECTION WORKSHEET FOR DATE: 4/13/2006 TIME: 7:10AM PAGE: 12 SITE ADDRESS: 11825 SW KATHERINE ST CLASS OF WORK: SUBDIVISION: LERON HEIGHTS NO.3 LOT #: 077 TYPE OF USE: PROJECT NAME: KILLION DESCRIPTION: Addition of (3) bedrooms, (1) bath & computer room. Other mechanical is duct work. OWNER: KILLION, RANDALL L . JUI -MEI H, PHONE #: CONTRACTOR: FULLY RESTORED INC PHONE #: 503-816-8881 Inspection Request Scheduled For: Date: 4/13/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 699 Mechanical final 004423 -02 603-816.8881 N Corrections/Comments/Instructions: b _ PASS ---- _ PARTIAL APPROVAL - - ❑ CANCEL ❑ NO- ACCESS - -- n FAIL n CALL FOR INSPECTION E ADDITIONAL FEES ASSESSED /J ,,1 Inspector: t .A Date: / l �/� Phone #: (503) 718- CITY Of TIGARD _- BUILDING DIVISION PERMIT #: MST2004 -00271 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/27/2004 Phone: (503) 639 -4171 : A �� „ Inspection Requests (24 Hrs.): (503) 639 -4175 . ���. ”? ,,f l INSPECTION WORKSHEET FOR DATE: 4/13/2005 TIME: 7:10AM PAGE: 13 SITE ADDRESS: 11825 SW KATHERINE ST CLASS OF WORK: SUBDIVISION: LERON HEIGHTS NO.3 LOT #: 077 TYPE OF USE: PROJECT NAME: KILLION DESCRIPTION: Addition of (3) bedrooms, (1) bath & computer room. Other mechanical is duct work. OWNER: KILLION, RANDALL L + JUl -MEI H, PHONE #: CONTRACTOR: FULLY RESTORED INC PHONE #: 503 -816 -8881 Inspection Request Scheduled For: Date: 4/13/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 Plumbing final 004423 -01 503 -816 -8881 N Corrections /Comments /Instructions: d AM-4-7( e -PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION y ❑ ADDITIONAL FEES ASSESSED /13/° 5� Inspector: Date: Phone #: (503) 718- CITY OF TIGARD / BUILDING DIVISION PERMIT #:;„ lib cf, av d 2 -1 , 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 0 Phone: (503) 639 -4171 Am ��� j b , Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 3 --67 TIME: PAGE: SITE ADDRESS: / / S a 5 K CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: DESCRIPTION: OWNER: PHONE #: CONTRACTOR: PHONE #: / ( - 8:.?? Inspection Request Scheduled For: Date: Pour Time: Code # Inspection Description Confirm # Contact # Message Corrections /Comments/ Instructions: /7 „-i4./ 0 r _ �/ � Or `� 1 , I ���� t 4/ Z 2-- . - • SS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ - NO ACCESS __ ❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date: ( Phone #: (503) 718 - CITY OF TIGARD 24 -Hour BUILDING, Inspection Line: (503) 639 -4175 MST ,66( — ° )- INSPECTION DIVISION Business Line: (503) 639 -4171 BUP Received Date Requested AM PM BUP Location si . lI uite MEC Contact Persona 0 i f, Ph ( y ) / 4 ' g o 8 ( PLM Contractor Ph ( ) SWR • BUILDING Tenant/Owner ELC Footing ELC Foundation Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath /Shear Int Sheath /Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final P RT FAIL LUM „x Post & Beam Under ough -In Waler Service • Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: F i`� •ART FAIL 'tl ; AL Post& Beam (ugh -In ) Gas Line Smoke Dampers Fin AS PART FAIL CTRICAL Service • Rough -In UG /Slab Low Voltage Fire Alarm Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE 0 Please call for reinspection RE: 0 Unable to inspect – no access Fire Supply Line T ADA Approach /Sidewalk Date S Inspector Ext Other: Final DO NOT REMOVE this inspection re rd from the job site. PASS PART FAIL