Permit •
CITY OF TIGARD BUILDING PERMIT
PERMIT #: BUP2005 -00257
Ak DEVELOPMENT SERVICES DATE ISSUED: 8/10/2005
- 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1S12600-00300
SITE ADDRESS: 09329 SW WASHINGTON SQUARE RD ZONING: C -G
SUBDIVISION: WASHINGTON SQUARE LOT: JURISDICTION: TIG
Project Description: TI.
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: ALT FIRST: 5,397 sf N: S: E: W:
TYPE OF USE: COM SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: 2N : sf N: S: E: W:
OCCUPANCY GRP: M TOTAL AREA: 5,397 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: BASEMENT: sf AREA SEP. RATED:
STOR: 1 HT: ft GARAGE: sf OCCU SEP. RATED:
BSMT ?: MEZZ ?: REQD SETBACKS REQUIRED
FLOOR LOAD: psf LEFT: ft RGHT: ft FIR SPKL: Y SMOK DET:Y
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : Y HNDICP ACC:Y
BEDRMS: BATHS: IMP SURFACE: PRO CORR: N PARKING:
VALUE: $ 215,000.00
Owner: Contractor:
WASHINGTON SQUARE LLC GREENWOOD CONSTRUCTION
BY THE MACERICH COMPANY 12637 S. 265 WEST STE. 100
9585 SW WASHINGTON SQUARE RD DRAPER, UT 84020
TIGARD, OR 97223 .
one:
Phone:
FEES Reg #: LIC 162143
Description Date Amount REQUIRED ITEMS AND REPORTS
[TAX] 8% State Surcharl 8/10/2005 $95.42
[FLS] FLS Pln Rv 8/10/2005 $477.12
[PKSDC] COM & IND F 8/10/2005 $1,530.00
[BUPPLN] Pln Rv 6/15/2005 $775.32
Total $2,877.86
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 .'.99 or 800-332-2,24.
Issued By et_ .„ % Permittee Signature: , •
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.
Building Permit Application FOR OFFICE USE ONLY
City of Tigard Date /B , g 711 5 8 / Permit No - -r . O L 5
13125 SW Hall Blvd , Tigard, OR 9 7223 1 17 A.
Plan Review
Phone. 503 639 4171 Fax. 503 598 1960 Vi ( Date/By- r Other Permit
Inspection Line 503 639 4175 6' Date Ready/By ®See Attached Checklist for
Internet www.ci tigard or us - Notified/Method / 1 Supple mental Information
TYPE OF WORK • . ; REQUIRED DATA: 1- AND 2- FAMILY DWELLING
❑ New construction ❑ Demolition Permit fees* are based on the value of the work performed. U\
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
❑ 1- and 2- family dwelling ® Commercial /industrial Valuation: $
❑ Accessory building ❑ Multi - family Number of bedrooms:
❑ Master builder ❑ Other: Number of bathrooms:
43 JOB SITE INFORMATION AND LOCATION Total number of floors:
Job site address: 9389"WASHINGTON SQUARE ROAD New dwelling area: square feet
V)
City /State /ZIP: TIGARD, OR 97223 Garage /carport area: square feet
Suite/bldg. /apt. no.: T7 Project name: SEPHORA Covered porch area: square feet
Cross street/directions to job site: Deck area: square feet
Other structure area: square feet _
REQUIRED DATA: COMMERCIAL -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.
INTERIOR REMODEL OF EXISTING RETAIL TENANT SPACE FOR NEW Valuation: $$215,000.00
TENANT " SEPHORA" Existing building area: 5,397 square feet
New building area: 5,397 square feet
® PROPERTY OWNER ❑ TENANT Number of stories: 1
Name: WASHINGTON SQUARE MALL Type of construction: 1 -B
Address: 401 WILSHIRE BOULEVARD -SUITE 700 Occupancy groups: I f
City /State /ZIP: SANTA MONICA, CA 90401 Existing: MRCANTILE
Phone: (310)394 -6000 Fax: (310)434 -9810 New: MERCANTILE
® APPLICANT ❑ CONTACT PERSON
NOTICE
Business name: SEPHORA All contractors and subcontractors are required to be
Contact name: TIM SCILENK licensed with the Oregon Construction Contractors Board
under ORS 701 and may be required to be licensed in the
Address: 1120 EAST 80 STREET -SUITE 211 jurisdiction in which work is being performed. If the
City /State /ZIP: BLOOMINGTON, MN 55420 applicant is exempt Wing, ' ensing, the following reasons
apply:
Phone: (800) 541 -0821 Fax: : (952) 854-4909
$ - 7 75.3 '
E -mail: tims @elderjones.com � 47 7 .1
CONTRACTOR /�
Business name: T.B.D.
�r a1 ci � /, (C �— BUILDING PERMIT FEES*
Address: T l� S
��� � Bit ' / � � �4id
� � t° i.-(2 Please refer to fee schedule
City /State /ZIP: Lt a 0
Fees due upon application
Phone:
(go 1) 5-74:1-42; 4 SQ Fax: *al ) S 7co 0 7 3 3 Amount received
C CB lie.: / 2/f/3 1-3/°?
Date received:
Authorized signature: 1. S L A---.A..- This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: TIM SCHENK Date: * Fee methodology set by Tri -County Building Industry
Service Board
i \Butldtng\Permhs \BUP- PermitApp doc 12/03 440- 4613T(11 /02/COM/WEB)
L bO5 - 00 7
Form 52 _ Project Name. . e/h o(ci - � rI,
aS ✓� /�4 Si.,. r , , e. Page: I
LI YITING - GENERAL ri t u t 9 v t
1. Interior Exceptions (Section 1313.1) JUN 1 4 2005
❑ No Interior Lighting. The building plans and specifications do not call for new or altered interior lighting.
Skip to item 5. Exterior building Lighting - General;jbejow. TIGARD
Exceptions ❑ Ex ceptions. 1. Th e building or part of the building qualifies tor, eption from code lighting
p oLALuf VU u an a S�
Discussion of qualifying requirements. Applicable code exception is number.
exceptions in instructions
section 2. Lighting equipment that qualifies for an exception - in addition to general lighting and is separately
controlled. Applicable code exception is number: r
Areas of the building and equipment that qualify for any exceptions
Plans /Specs
Show compliance by including a
drawing sheet, detad number,
and/or specification section and
subparagraph 2. Local Shut -off controls (Section 1313.3.1.1)
Complies At least one local shut -otf lighting control for every 2,000 square feet of
lighted floor area and for all spaces enclosed by walls or ceiling height partitions.
This controls) is detailed in the building plans on drawing number
❑ Exception. The building or part of the building qualifies for an exception
Applicable code exception is Section 1313 3.1.1, Exception:
Portions of the building that qualify:
3. Automatic Shutoff Controls (Section 1313.3.1.2)
' 'Not Applicable. Office floor area is not over 2,000 square feet of contiguous office floor area or
permitted space is not over 5,000 square feet No offices less than 300 square feet, meeting
or conference rooms, or school classrooms.
❑ Complies. All interior lighting systems are equipped with a separate automatic control to shut off lighting
during unoccupied periods. Offices less than 300 square feet, meeting and conference rooms, and school
classrooms shall be equipped with occupancy sensors that comply with Section 1313.3.1.2 1.
Compliance details in plans/specs
❑ Exception. The building or part of the budding qualifies for an exception. The
applicable code exception is Section 1313 3.1,2, Exception:
Portions of the building that qualify.
4. Daylighting Controls (1313.3.1.3)
I3 classrooms or atriums with skylights or window to wall ratio greater than 50 %.
❑ Complies. All classrooms and atriums with window to wall ratio greater than 50% and/or skylights are
equipped with automatic daylight sensing controls, as required by Section 1313.3 1.3.1 and Section
1313 3.1.3.2. The daylight sensors specified comply with Section 1313.3 1.3.3.
Compliance details in plans /specs:
Exterior Build - ing 5�terior Lighting (Section 1313.5)
Lighting C omplies. The plans do not call for use of incandescent or mercury vapor lamps for use on building exterior.
is lighting directed to illuminate ❑ Exception. The building plans indicate luminaires with incandescent or mercury vapor lamps, but are
the exterior of the budding and specified for use in or around swimming pools, water features, or other locations subject to requirements
adjacent walkways and loading of Article 680 of the 2002 National Electrical Code.
areas with or without canopies
Clock Switches
shall be astronomic (seasonal 6. Exterior and Canopy Lighting Controls (Section 1313.3.2)
correcting) type with separate )(Complies. The building plans and specifications include photoelectric and /or clock switches on all exterior
programs for each day of the lighting systems which are designed and programmed to extinguish lights when daylight is present, as
week and shall store energy to required by Section 1313.3.2
maintain timekeeping during
power outages
7. Interior Connected Lighting Power (Section 1313.4)
I 'Complies The interior lighting power does not exceed the interior power allowance established
pr in either the Tenant Space Method (Form 5b) or the Space -by -Space Method (Form 5c)
- ,Tenant Space Method (Form 5b) C Space by -Space Method (Form 5c)
Compliance with OSSC elle( nvN o I:nt'y'i
Form 5b Project Name ge/ /" Nf •? J U� Page' p�
INTERIOR LIGHTING POWER - Tenant Space Method
Lighting (a) (b) (c) (d)
Budget
Occupancy/ Tenant or Building Type Floor Area Max Power Lighting Power
Use Types (Table-13G) (sq ft) Density (W /lt Budget (W)
See mstructions tor desc L ��''77� ) p�
nption d occupancy types V.e fu; L S r i ••-� O y9Q .r
Lighting Power 1. Total Interior Lighting Power Budget (Watts) for Building.
Budget
Track Lighting 2. Total length of track lighting (tt) G / -
Power
3 Line 2 multiplied by 37 5 Watts/It X7 7,s s
4. Total amperage of circuit breaker(s) serving track lighting (amps) .Pa10
5 Voltage of circuit breaker serving track lighting (volts) kW
6. Maximum wattage of track lighting (multiply line 4 by line 5) c9 ` Po
7. Track Lighting Power (lesser value of line 3 or line 6) c9,287-5—
8. Track Lighting Power (line 7) aag 7 r
9. Total Interior Lighting Power from Worksheet 5b-1 (Sum of Column (m)) + r 606
Buildings 1 0. Total Adjusted Lighting Power (line 8 + line 9) = JB ?jt 5
Lighting Power
11. Does design meet budget? Line 10 must be no greater than line 1 e)
3-t i ?"
L
'I7a 6
52
Gompiance w to OSSC S.liecovo 01 01 OS
r
Work: Project Name: °' — 4(h_ch .>. j.r 5;(,E Q Page: Z -
LIGHTING SCHEDULE "
(a) (b) (c) (d) (e) (I)
Is
Lum Luminaire Luminaire
ID Luminaire Lamp Ballasts Power From
Type Description No. Description No. Description (watts) Table 5c
I FA-1 1 C4 .,k W14..).r4e4' IP H • rmer 3o di, G y Ar _ J I C , -' / "'J t — 37, s
f U I I joolfsu✓l �•.'^ ~J.-iv/ J 3 3A1.4 t8 1 0,-(1 fc.R
ft [ <' a xM( 1rc � ] 3 3 w re t E fed-. 86
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LightingForms -V2.2 xls
Fo5t5 Project Name (/UCH rG S ^i G' r' /C? 5 -'2 Page
1 - INTERIOR LIGHTING V`� "^ OWER !!!
Space-by -Space Method Only
Skip to column (t) it using the Tenant Space Method
(a) (b) (C) (C) (a) Lum ID (g) (n) Cl U) (k)
ram Quantity of
Room ID (co Space Type Space Lighting Power worksheet Lurnnatres (or Lumnatre Lighting Room
not leave any Area (Table t3 -hi) Type Budget 5a Column lineal It for track Power Exempt Power Total Llg
Wanks) (11 (enter space :ype only once per room) LP() (b) x (d) (al ughhng) (Watts) Fixtures (g) x (h) Power
Each room - - FA`( - I (21 1 7f ❑ Al -
identified. -- -e f A! � p8 ' ❑ 14.�R .
Describe 9 ' ❑ I 7Q - - luminaires for each - - O -
individual room m _ __ _ ❑ _
pans
-- - : - _ ❑ - --
-- - - ❑ - - - 0 --
n
For track lighting -- ❑ - --
enter lineal feel in -- - - ❑ - .. --
corumn column (g) '
- ❑ -
- --
Column (h) enter -
_ . - ❑
sum of column (I) - ❑ - --
for each room only . _ -_
once al lest entry -. _, _ - ❑
Ica the room See - -- - ❑ - -
example in —
inslrucrnons - _ - ❑ -
_
-- .. ❑ ..
_ .. - ❑ .-
- -- - - ❑ - ••
- - - ❑ - -•
._ - ❑ - -•
-- -. ❑
-- - - ❑
- .. - ❑ _ __
__ • ❑
-. -- - ❑ --
-- _- ❑
— -- _ - ❑ • -- • -. -_ ❑ • --
_- .. - ❑ --
.- _ ❑ ..
-- -- - - ❑
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_ -- - . ❑ - __
_- - - - ❑ - ..
. Worksheet 5b -1 Total Budget - Wkshr 5b -1 Total Lighting Power (excluding exempt/track fixtures) -
Other Pages Total Number ol Additional Worksheet 5b I 0 J
List the additional
worksheets nece
scary to catalog as
luminaues in (I) (m) (n)
rwddnng Lighting Power Budget Proposed Buidng Lighting
Space -by -Space only (Taal Power (Total of column (k). Area Salt (not required
Worksheet Number of column (e)) excluding exempt/track) for Tenant Method)
E - 1 62 04
Sum of additional 5b worksheets 1 ( 0 06
er a -
_�;:�1, " l oral Bu 1(lel (or an worksheets) ! �0 DL
• r
Complanc• oorh OSSC e•Ileowe 0r or h-
-
n
ti
CITY OF TIGARD
BUILDING DIVISION PERMIT #: DI)P200�E
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/10/200 ;,
Phone: (503) 639 -4171 �
Inspection Requests (24 Hrs.): (503) 639 -4175 ...�' ` --.
INSPECTION WORKSHEET FOR DATE: 1/10/2006 TIME:' 7 :00AM PAGE: 77
SITE ADDRESS: 09329 SW WASHINGTON SQUARE RD CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE:
PROJECT NAME: SEPHORA .
DESCRIPTION: TI.
OWNER: WASHINGTON SQUARE LLC, PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 1/10/2006 Pour Time:
Code # Inspection Description • Confirm # Contact # Message
299 '/ Final inspection 024622 -01 801 - 520 -5734 N
Corre tions /Comments /Instructions:
A r Ara t ' f cm Jc co 1 \2_.e_ ' v,,,7\ — 0 C-CLK .
FLC,200 6 - 0 0 "-/-) 6 - . U4\j El
CAP 2�
o- 0 06,06-
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❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
t kIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: \� (t, • Date: `/� /° 7 Phone #: (503) 718- 2 y 2 _ 1
r' .
CITY , CTIGARD
BUILDING DIVISION PERMIT #: P2c - Ci 7
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: ( q / � TIME: PAGE:
SITE ADDRESS: ? ZCj ' ()1f CLASS OF WORK:
SUBDIVISION: _ LOT #: TYPE OF USE:
PROJECT NAME: • k 4 0
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code .# Inspection Description Confirm # Contact # Message
Corrections /Comments /Instructions:
— ( JSA L E/54p o- i ►J1C— c V( C 6 T REAP-_270
(�
27 6" ❑ PARTIAL APPROVAL El CANCEL El NO ACCESS
CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: ` ` Phone #: (503) 718-
ti
CITY OF TIGARD
BUILDING DIVISION PERMIT #: BUP2005 -00257
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/10/2005
Phone: (503) 639 -4171 -� h.
Inspection Requests (24 Hrs.): (503) 639 -4175 ! �.. •
INSPECTION WORKSHEET FOR DATE: 11/8/2005 TIME: 7:00AM PAGE: 1113
SITE ADDRESS: 09329 SW WASHINGTON SQUARE RD • CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE:
PROJECT NAME: SEPHORA 1
DESCRIPTION: TI.
OWNER: WASHINGTON SQUARE LLC, PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 11/8/2005 Pour Time:
Code # Inspection Description / Confirm # Contact # Message
299 Final inspection d 020512 -01 303 - 921 -4940 N
Corrections/Comments/Instructions:
% r b ( Fes - c-- Co rs iA- '06- v
•
n PA S' ❑ PARTIAL APPROVAL • ❑ CANCEL El NO ACCESS
IIEFAIL , ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
t
Inspector: f - fAlj Date: (C_ U _ Phone #: (503) 718-
'
1
CITY OF TIGARD • BUILDING DIVISION PERMIT #: BUP2005 00257
' 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8!1012005
Phone: (503) 639 -4171 t
Inspection Requests (24 Hrs.): (503) 639 -4175 ''' • ∎••• .
INSPECTION WORKSHEET FOR DATE: 26/2005 TIME: 7:12AM PAGE: 63
. SITE ADDRESS: CLASS OF WORK:
SUBDIVISION: 09329 SW WASHINGTON SQUARE RD LOT #: TYPE OF USE:
•
PROJECT NAME: WASHINGTON SQUARE
DESCRIPTION: SEPHORA
TI.
OWNER: WASHINGTON SQUARE LLC, PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 9/26!2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
287 Suspended ceiling 016560 -01 702 - 236 -9652 Y 40$2, - A/1-
Corrections /Comments /Instructions:
•
•
•
•
(PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL F R INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: . Date Phone #: (503) 718 - •
CITY .OF TIGARD •
BUILDING DIVISION PERMIT #: BUP2005 -00257
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/10/2005
Phone: (503) 639 -4171 1 t t
Inspection Requests (24 Hrs.): (503) 639 -4175 �' ^ '-1J
INSPECTION WORKSHEET FOR DATE: 9/12/2005 TIME: 7:04AM PAGE: 102
SITE ADDRESS: 09329 SW WASHINGTON SQUARE RD CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE:
PROJECT NAME: SEPHORA
DESCRIPTION: TI.
OWNER: WASHINGTON SQUARE LLC, PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 9/1212005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
285 Drywall nailing 015362 -02 702 -236 -9652 N
Corrections /Comments/ Instructions:
kl/J o
%PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
1 I
Inspector: 1 +T Date: q--1Z-- Phone #: (503) 718 -
CITY OF TIGARD
BUILDING DIVISION PERMIT #: BUP2005 -00257
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/10/2005
Phone: (503) 639-4171 11 '
Inspection Requests (24 Hrs.): (503) 639 -4175 y% °:_
INSPECTION WORKSHEET FOR DATE: 9/1212005 TIME: 7:04AM PAGE: 103
SITE ADDRESS: 09329 SW WASHINGTON SQUARE RD CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE:
PROJECT NAME: SEPHORA •
DESCRIPTION: TI.
OWNER: WASHINGTON SQUARE LLC, PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 9/12/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message •
280 Insulation
V 015362 -01 ' 702 -236 -9652 N
Corrections /Comments /Instructions: V
1 r
I A ill 414 A
•
I t(PA ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
' ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
ect r: Z� 0 5
Ins 718-
Inspector: �' Date: Phone #: (503) 718
CITY OF TIGARD
BUILDING DIVISION PERMIT #: BUP2005.00257
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/10/2005
Phone: (503) 639 -4171 ^r„ �
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 9/1/2005 TIME: 7:14AM PAGE: BB
SITE ADDRESS: 09329 SW WASHINGTON SQUARE RD CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE LOT #: TYPE OF USE:
PROJECT NAME: SEPHORA
DESCRIPTION: TI.
OWNER: WASHINGTON SQUARE LLC, PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 9/1/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
275 Framing 014725 -01 702 - 236 -9652 N
Corrections /Comments /Instructions:
/1/05Thr 5c.gF_a2s
•
•
B �
❑ PASS , PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAI ❑ CALL OR INSPECTION ❑ ADDITI AL FEES ASSESSED
Inspector: di Date: 1j ` v Phone #: (503) 718-
�, •
CITY OF TIGARD &AIP
BUILDING DIVISION PERMIT #: 7-O i — 00 6
7
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 • qt� I�I+�
Inspection Requests (24 Hrs.): (503) 639 -4175 '_ _.
INSPECTION WORKSHEET FOR DATE: A 3 /610 TIME: PAGE:
SITE ADDRESS: £ 1 324 \a4 h t/v SO • CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: 4 ,Q P tt 12-6.
DESCRIPTION:
OWNER:
CONTRACTOR: 1)6(1C-e PHONE #: - 1ib O - ' 415 — 7
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
26,6 C-DtAA I J ( n 4-(•/./16tJ rk .C 6 .
Corrections /Comments /Instructions: 'yJ f1 t r1. -)
, f _....,,,. ....:
'CI "
, .
. / .. ,
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T.
P1 ' ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: VIA Date: l J ( Phone #: (503) 718 - ?-. >
•