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Permit ,,,, AN CITY OF TIGARD MASTER PERMIT PERMIT #: MST2006 -00007 °r'r DEVELOPMENT SERVICES DATE ISSUED: 1/5/2006 "�� II 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S103CB -09300 SITE ADDRESS: 12398 SW QUAIL CREEK LN ZONING: R -4.5 SUBDIVISION: QUAIL HOLLOW - EAST LOT: 051 JURISDICTION: TIG . Project Description: Add 2nd story floor over vaulted area, remodel to office space. BUILDING REISSUE: CUSTOM STORIES: FLOOR AREAS REQUIRED SETBACKS REQUIRED CLASS OF WORK: ALT HEIGHT: FIRST: sf BASEMENT: at LEFT: SMOKE DETECTORS: Y TYPE OF USE: SF FLOOR LOAD: 50 SECOND: 220 sf GARAGE: sf FRONT: PARKING SPACES : TYPE OF CONST: 5N DWELLING UNITS: THRD: sf RIGHT: VALUE: 16.500.00 OCCUPANCY GRP: R3 BDRM: BATH: TOTAL: 220 sf REAR: PLUMBING SINKS: WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS: RAIN DRAIN: TRAPS: LAVATORIES: DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: CATCH BASINS: TUB /SHOWERS: GARBAGE DISP: WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS: OTHER FIXTURES: MECHANICAL FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS: CLOTHES DRYER: FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS: MAX INP: btu FLOOR FURNANCES: VENTS: 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/FDR: 1 SIGN /OUT LIN LT: PER HOUR: LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: 2 SIGNAL/PANEL: IN PLANT: MANU HM/SVC /FDR: 601 - 1000 amp: 601 +amps - 1000x. 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/1RRIG: PROTECTIVE SIGNL: GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR: HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL 6 SYSTEMS: This permit is subject to the regulations contained in the Owner: Contractor: Tigard Municipal Code, State of OR. Specialty Codes MIKE & MEL HILTS BOXWELL GENERAL CONTRACTING and all other applicable laws. All work will be done in . 12398 SW QUAIL CREEK LN LLC accordance with approved plans. This permit will expire TIGARD, OR 97223 10940 SW BARNES RD SUITE 232 if work is not started within 180 days of issuance, or if the PORTLAND, OR 97225 work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules Phone: Contact #: PRI 503- 807 -6479 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 TOTAL FEES: $ 422.21 Reg #: LIC 158946 direct questions to OUNC by calling 503 -246 -6699 or 1- 800 - 332 -2344. . REQUIRED ITEMS AND REPORTS . n Issued y : _ �/ // 1 ./ - -�1 = Permittee Signature %L - Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. 1 1 Building Permit Application FOR OFFICE USE ONLY City Tigard Dat of Date BV 1/ �// Received Q D 1�i 1%'��� n'�� ' 13125 SW Hall Blvd., Tigard, OR 97223 Plan Rev iel Phone: 503.639.4171 Fax: 503.598.1960 � "r ?I,'� Date•Ev Other Permit Inspection Line: 503.639.4175 ^ 'I r Se Attached Checldisl for Internet: www.ci.tigard.or.us / � � Supp lemental 0 Info TYPE OF WORT. REQUIRED DATA: 1- AND 2- FAMILY DWELLING El New construction ❑Demolition Permit fees* are based on the value of the work performed. Indicate the value (rounded to the nearest dollar) of all IA Addition /alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the CATEGORY OF CONSTRUCTION work indicated on this application. JZ1- and 2 -famil dwellin Valuation: $ /67 y g ❑ CommerciaUindustrial ❑ Accessory building ❑ Multi - family Number of bedrooms: ❑ Master builder ❑ Other: Number of bathrooms: JOB SITE INFORMATION AND LOCATION Total number of floors: - Job site address: ► 2)C s LS-1 New dwelling area: 22 square feet Izo 0 - City /State/ZIP: -n b A-4 -a I O & 1 3 Z.2) Garage /carport area: square feet Suite/bldg. /apt. no.: Project name: Covered porch area: square feet Cross street/directions to job site: Deck area: square feet T . 'Z1 .. Other structure area: square feet REQUIRED DATA: COM1%IERC14L -USE CHECKLIST Subdivision: Lot no.: Permit fees* are based on the value of the work performed. Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all equipment, materials, labor, overhead, and the profit for the DESCRIPTION OF WORK work indicated on this application. I N T& �, A t T1 ot.� D 1 - 0 rr't�)c Valuation: $ Existing building area: square feet New building area: square feet jerl'ROPERTY OWNER ❑ TENANT Number of stories: Name: l7/l I i / P^ L TL� syt- ri t i._ Type of construction: Address: T 8 •-•• Q✓ t-t. _ C. i 1e— ( Occupancy groups: City/ State/ZIP: et-4-1) / 0 tZ �'�-2 ?- Existing: Phone: ( ) Fax: ( ) New: .Z .PPLICANT 0 CONTACT PERSON NOTICE Business name: ' o 6 .. IE NA-L. toft - 1 NV ) LLC. All contractors and subcontractors are required to be Contact name: licensed with the Oregon Construction Contractors Board under ORS 701 and may be required to be licensed in the Address: I 0 9 c{ a Cy-) 3 4 _ 3 £-O s'i) t'i E--+# Z3 2. jurisdiction in which work is being performed. If the City/State/ZIP: N 0 X 0 )2 . G 2tf applicant is exempt from licensing, the following reasons i apply: Phone: (f ,) g o - 4-- 6,41 I Fax:: ( ) E -mail: CONTRACTOR Business name: BUILDING PERMIT FEES* Address: Please refer to fee schedule City / State/ZIP: Fees due upon application Phone: ( ) I Fax: ( ) CCB lic.: 9 `f ` I ' 049 Amount received 1 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: Co C 0 2t; KSk I Date: ' LI 211 l e r I * Fee methodology set by Tri- County Building Industry Service Board. i :U3irildvigiPexmits 1BUP- Pec®tApp.doc 12/03 440- 46131(11/02/COM/WEB) Electrical Permit Application FOR OFFICE USE ONLY City of Tigard Receive ,� / Agrd (o _R Permit No 5 „e ,.. 13125 SW Hall Blvd., Tigard, OR 9 Plan Review 4" Phone: 503.639.4171 Fax: 503.598.1960 Date By Other Permit 1 2 T Inspection Line: 503.639.4175 "' .l _ I I i , Date ReadrBy hJ See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: Mill Supplemental Information TYPE OF WORK PLAN REVIEW ❑ New construction Addition/alteration/replacement Please check all that apply: El Demolition ❑Other: 0 Service over 225 amps, comm'l 0 Hazardous location ❑ Service over 320 amps – rating ❑ Buildng over 10,000 sq. ft., CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential 2K- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building 0 System over 600 volts nominal units in one structure ❑Building over three stories ['Feeders, 400 amps or more ❑ Multi - family ❑ Master builder ❑ Other: ❑Occupant load over 99 persons 0 Manufactured structures or JOB SITE INFORI•LATION AND LOCATION 0 Egress/lighting plan RV park Job no.: Job site address: 1 2.1,'1% sc., v i< C 's t_ CAC.* G. i∎Ii:I -care facility ❑other: Submit 2 sets of plans with any of the above. City / State/ZIP: T 6 A -i 0 ef-4 - 2 23 The above are not applicable to temporary construction service. Suite/bldg./apt no.: Project name: FEE* SCIIEDULE Des Qiy. tion I Qq. I Fee. I Total I "` Cross street/directions to job site: New [residential single- or multi- family dwelling unit. Includes attached garage. % 2 L ST 1,000 sq. ft. or less 145.15 4 Subdivision: I Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 1 Limited energy, residential 75.00 2 Tax map /parcel no.: Limited energy, non - residential 75.00 2 DESCRIPTION OF WORK Each manufactured or modular dwelling, service and/or feeder 90.90 2 ice" t C R- Services or feeders installation, alteration, and/or relocation � 200 amps or less 80.30 2 2 'ROPERTV OWNER • I ❑ TENANT 201 amps to 400 amps 106.85 2 401 amps to 600 amps 160.60 2 Name: µ 1 K,.s.-- - t t t.ar'S 601 amps to 1,000 amps 240.60 2 Address: . 1 ' ' e t S t.J Qv/} -. L C 4e_ (�.-1 Over 1,000 amps or volts 454.65 2 Reconnect only 66.85 2 City /State/ZIP: ' fl 6 eN. A....v, O tip-- 9 1- Li. 3 Temporary services or feeders installation, alteration, and/or relocation Phone: ( ) I Fax: ( ) 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 d J .- 1.PPLICANT I ❑ CONTACT PERSON A. Fee tiv branch circuits truth service or feeder fee, each 6.65 2 Business name: k w eZ.c.. C a>i T t c c branch circuit ' B. Fee for branch circuits Contact name: ( S X - L.4.► without service or feeder fee, t )/ S 2 fast branch circuit 46 -85 `� Address: ) oq ti 9w • 4,rers L 3 Z Each add'l branch circuit_ - a' 6.65 - / 5, V 2 City / State/ZIP: 'P p )4- p (L � '7- s Miscellaneous (service or feeder not included) / Phone: ) Col. - (a 4 I Fax:: ( ) Pump r urination ti I I 53.40 I 12 � / Sign or outline lighting 53.40 2 E -mail: Signal circuit(s) or limited - CONTRACTOR energy panel, alteration, or extension. Describe: Page 2 2 Business name: ' 4 4 - ' - I G Address: ^— Each additional inspection over allowable in any of the above W - Per inspection 62.50 City / State/ZIP: Investigation per hour (1 hr min) 62.50 Phone: ( ) F es; ( ) Industrial plant per hour 73.75 l4, k � � /0Ve ELECTRIC U PERM b total • � CCB Lic.: [- Electrical Lic.: Su p rv. Lic.: /05 (o / ' Suprv. Electrician signature, requited Plan review (25% of permit fee) Print Warne: Date: State surcharge (8% of permit fee) 4. 8 TOTAL PERMIT FEE / / Authorized signature: This permit application expires if a permit is not ob wwithin 180 days otter it has been accepted as complete Print name: I Date: • Fee methodology set by Tri- County Building Industry Service Board •• Number of inspections per permit allowed i:\Bui ing\Pennits \ELC- PermitApp.doc 12/03 440- 461ST(ta0vcoM/WEB , CITY OF TIGARD 13125 S.W. HALL TIGARD OR 9 226LVD. RECEI�Ep IMPORTANT PERMIT NOTICE JAN 1 r i 2006 CITY OF TIGARD VANGARD ELECTRIC INC. BUILD DIVISION 3800 MORRIS ST NEWBERG, OR 97132 Electrical Signature Form Permit #: MST2006 -00007 - -Date- Issucd: 11512006 Parcel: 2S103CB -09300 Site Address: 12398 SW QUAIL CREEK LN Subdivision: QUAIL HOLLOW - EAST Block: Lot: 051 Jurisdiction: TIG Zoning: R-4.5 Remarks: Add 2nd story floor over vaulted area, remodel to office space. Your company has been indicated as the electrical contractor for the permit indicated above. I n 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: MIKE & MEL HILTS VANGARD ELECTRIC INC. 12398 SW QUAIL CREEK LN 3800 MORRIS ST TIGARD, OR - 97.223_._ NEWBERG, OR 97132 Phone #: Phone #: 503 - 537 -5006 Reg #: LiC 164865 ELE 36 -104C SUP 4880S AN INK SIGNATURE IS REQUIRED ON THIS FORM � Signature • Si- ' ing Electrician If you have any questions, please call 503.718.2433. • CITY OF TIGARD BUILDING DIVISION PERMIT #: MST 006 ��ti0i)7 • 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/5/2006 (503) 639 -4171 v „ y; I i l fh\ Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 2/31200; TIME: 7 :02AM PAGE: 10 SITE ADDRESS: 12396 SW QUAIL CREEK LN CLASS OF WORK: SUBDIVISION: QUAIL HOLLOW EAST LOT #: 051 TYPE OF USE: PROJECT NAME: HILTS DESCRIPTION: Add 2nd story floor over vaulted area, remodel to office space. OWNER: HILTS, MIKE & MELISSA PHONE #: CONTRACTOR: BOLL GENERAL CONTRACTING LLC PHONE #: 503- 807 -E179 Inspection Request Scheduled For: Date: 2/3/2006 Pour Time: Code # Inspection Description Confirm # Contact # M; - :e 299 Final inspection 026259-02 503- 807 -6479 411. Corrections /Comments /Instructions: ., 1 1 - 00 /-rill gil \ \ PASS PA' AL APPROVAL ❑ CANCEL 111 NO ACCESS vv ❑FAIL 1 ' L FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date: Z - 0 6 Phone #: (503) 718- _ CITY OF TIGARD BUILDING DIVISION PERMIT #: MST20t:G -00007 13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 1/5/2006 Phone: (503) 639 -4171 Awdfo li Inspection Requests (24 Hrs.): (503) 639 -4175 "'I !.. INSPECTION WORKSHEET FOR DATE: 2/3/2006 TIME: 7:02AM PAGE: i'l SITE ADDRESS: 12398 SW QUAIL CREEK LN CLASS OF WORK: SUBDIVISION: QUAIL HOLLOW- EAST LOT #: 051 TYPE OF USE: PROJECT NAME: HILTS DESCRIPTION: Add 2nd story floor over vaulted area, remodel to office space. OWNER: HILTS, MIKE & MELISSA PHONE #: CONTRACTOR: BOXWELL GENERAL CONTRACTING LLC PHONE #: 503 - 007 -€479 Inspection Request Scheduled For: Date: 2/3/2006 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Electrical final 026259-01 503- 807 -6479 N Corrections /Comments /Instructions: r SS MI r' R ' APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL VA • , L FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Dater - 3 6316 Phone #: (503) 718- CITY OF TIGARD MY157 1 BUILDING DIVISION PERMIT # 2oot — 0.000 7 1 13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: Phone: (503) 639 -4171 a Illi Inspection Requests (24 Hrs.): (503) 639 -4175 P__.. INSPECTION WORKSHEET FOR DATE: TIME: PAGE: SITE ADDRESS: / a e:1 g a U4 e v- -e-- CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: DESCRIPTION: OWNER: PHONE #: CONTRACTOR: PHONE #: Inspection Request Scheduled For: Date: / - 3 - C,. Pour Time: Code # Inspection Description Confirm # Contact # Message P. t 7,5 -- ) 2.e,9 t�.f S I y��- v s1 ?-- 6 o r ctions Comments /Instructions: UAL q a :3 0 - //: iizzA/Inti :moo ,ir1. Cm- rL__--C� Z')s - A+-t &/ G k - �� 5 /ZO C .(C_'fC------_ - KO c11 - - ?tq '3 PASS ❑ P' 'TI' APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL / t ' . • R INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date: 723 6) ‘le #: (503) 718- CITY OF TIGARD BUILDING DIVISION PERMIT #: triST20i)�Gt,t,t17 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/f /2006 4o Phone: (503) 639 -4171 , ,�,, liil Inspection Requests (24 Hrs.): (503) 639 -4175 --. INSPECTION WORKSHEET FOR DATE: 1/1812008 TIME: 7:01AM PAGE: 15 SITE ADDRESS: 12398 SW QUAIL CREEK LN CLASS OF WORK: SUBDIVISION: QUAIL HOLLOW - EAST LOT #: Q51 TYPE OF USE: PROJECT NAME: HILTS DESCRIPTION: Add 2nd story floor over vaulted area, remodel to office space. OWNER: HILTS, MIKE & MELISSA PHONE #: CONTRACTOR: BOXVVELL GENERAL CONTRACTING LLC d 0x v oj( PHONE #: 103.00/- (3,479 Inspection Request Scheduled For: Date: 1/18/2006 Pour Time: • Code # Inspection Description Confirm # Contact # Message 120 Electrical rough -in 025185 -01 503-807 -6479 Y Pi" file• -- - 40"` "5 1 Corrections /Comments /Instructions: K / ►17�o ( ) car:2c;Lc ,vS ❑ PASS I - ARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS IL % , L FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date: /88 Phone #: (503) 718 -2 r/ CITY OF TIGARD BUILDING DIVISION _ PERMIT #: MST200Er00007 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/5/200 Phone: (503) 639- 4171 Inspection Requests (24 Hrs.): (503) 639 -4175 . -' - J. INSPECTION WORKSHEET FOR DATE: 1/17/2006 TIME: g: 36AM PAGE: '10 SITE ADDRESS: 12398 SW QUAIL CREEK IA CLASS OF WORK: 4 SUBDIVISION: QUAIL HOLLOW - EMI LOT #: 051 TYPE OF USE: PROJECT NAME: HILTS DESCRIPTION: Add 2nd story floor over vaulted area, remodel to office space. OWNER: HILTS, MIKE & tdELIS SA PHONE #: CONTRACTOR: BOXWELL GENERAL CONTRACTING LLC PHONE #: 503.607 -6479 Inspection Request Scheduled For: Date: 1/16/2006 Pour Time: /DU) s3 r w. Code # Inspection Description Confirm # Contact # Message 120 Electrical rough -in 025031 -01 503807 -6479 V i z o Corrections /Comments /Instructions: P i Y U I , ' � / � Ye _//) � , � Lam, � ko W U zi I 1-01-f- I . I i ' 6 9 U , a ' a M V I W /'t1 12i 1 ) l I hipPe< 47) . 2 1 o , ;.)-- (A- ❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS X FAIL ❑ CALL F R INSPECTION ❑ ADDITIONAL FEES ASSESSED / I -.‘ i 6 Inspector: Date: Phone #: (503) 71 CITY OF TIG,ARD BUILDING DIVISION PERMIT #: MST)006- 00007 13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 1/W7006 Phone: (503) 639 - 417119 ^ Inspection Requests (24 Hrs.): (503) 639 -4175 .- '� L. INSPECTION WORKSHEET FOR DATE: 1/10/2006 TIME: 7 :01AIvi PAGE: 14 SITE ADDRESS: 12398 SW QUAIL CREEK LW CLASS OF WORK: SUBDIVISION: QUAIL HOLLOW EAST LOT #: 051 TYPE OF USE: PROJECT NAME: HILTS DESCRIPTION: Add 2nd stony floor over vaulted area, remodel to office space. OWNER: HILTS, MIKE & MELISSA PHONE #: CONTRACTOR: BOXWELL GENERAL CONTRACTING LLC PHONE #: 503-807-6479 Inspection Request Scheduled For: Date: 1/10/2006 Pour Time: Code # Inspection Description Confirm # Contact # Message 275 Framing 025186 -02 503807 -6419 N Corrections/Comments/Instructions: +� 4 ✓Q r.:1 Jr /9. 0 6 c_it, �ik_�G , k/ S Ate, CP>r- _P c_ ❑ PASS / ' • "TIAL APPROVAL ❑ CANCEL ❑ NO ACCESS FAIL I ' OR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: — _ —� Date: ` 8- Phone #: (503) 718- CITY OF TIGARD BUILDING DIVISION PERMIT #: MSj "20U6- 5 0007 13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 1/(/2006 Phone: (503) 639 -4171 .. �tt 1 Inspection Requests (24 Hrs.): (503) 639 -4175 �� J4 '' I INSPECTION WORKSHEET FOR DATE: 1/1712006 TIME: G:36AM PAGE: 9 SITE ADDRESS: 12390 SW QUAIL CREEK LN CLASS OF WORK: SUBDIVISION: QUAIL HOLLOW - EAST LOT #: 061 TYPE OF USE: PROJECT NAME: HILTS DESCRIPTION: Add 2nd story floor over vaulted area, remodel to office space. OWNER: HILTS. MIKE & MELISSA PHONE #: CONTRACTOR: BOXWELL GENERAL CONTRACTING LLC PHONE #: 503- 1307 -€479 Inspection Request Scheduled For: Date: 1/16f 2006 Pour Time: Code # Inspection Description Confirm # Contact # Message 275 f=raming V 025031 -02 503 - 807.6479 N Corrections /Comments/ Instructions: D Providi 'tji, 1' 2tc,w174) L Ox I p /4 cs a Pa 1432 tti4 � `� I CO �c s R t lieti-e4 © i k " b l oll a m i V " bbytai A l b 6" 4 i Ail-4 Olt4e4Apillois) �P 0 �, / _ /. 1 41 Pw} Irma t - R.k. it ' / r Q,.4 5 �,#, 4. /4, FI, 5 l 6''oi 1LX di /dive$ de's R I4 %J. U *' - 1).Z, � Ph) �a �g �- �n�dg 12 3i v 00501 A-0,4 41 S _ ll V 1+.4U /4/15'/A1 El ❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS X FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: , I , Date: / r 11-06 06 Phone #: (503) 718 -' 7 I