Case File 4 V .
I
H
Ul
H
W
E
3
U1
H
r
z
to
I
r-
ao
c
m
r'
rn
c�
11513 SW BAMBI LANE --
CIT' OF TIGARD
DEVELOPMENT SERVICES
13125 SW Hall Blvd., Tigard,OR 97223 (503)6394171
CERTIFICATE OF
OCCUPANCY
PERMIT #. . . . . . . : M5T96 -.0481.)
DATE ISSUED: 03/ 14/97
PARCELs 2S103BD-HG04,"`
I TTE ADDRESS— : 11513 SW BAMBI LN
�3UBD 11.11 S I ON. . . . 3 HUNTER15 GLEN ZONING-R--4. 5 PD
)LOCK. . . . . . . . . . t LOT. . . . . . . . . . . . . 1042
'LAS
3 OF WORK. eNEW
TYPE OF USE. . . :SF
TYPE OF CONSTR35N
OCCUPANCY GRP. tR3
OCCUPANCY I-OAL-12
Remarks : Path I
1)wneri
I-EGEND HOMES
6900 SW HAINES ST
TIGARD OR 9721(".13
Phone #S 620-8080
Contractors ..___......__.____-
L_EUEND HOMN."73 CORPORATION
71671 SW HAZELFERN RD.
311I*i*E 1 N
TIGARD OR 97a:L'4
1--'hone #1 620-8080
Req #. . : 60563
This Certificate
grants, Occupancy of the above referenced building or portion
theroof And zonfirms that the building has been inspected for compliance with
tj-je State of Cjt-tgon Specialty Colts for the group, 0c , .1 ancy, and ose under
which the referon(Amd permitwas issued.
A�
A
PECTF
SUILDINr
POST IN CONSPICUOUS PLACL
CITY OF TIGARD
DEVELOPMENT SERVICES ►•_1nSTCR r-'ERMIT
13125 SW Hall Bivd., Tigard,OR 97223 (503)639.4171 PERMIT #. . . . . . . MST96 -04(3,
DATE: ISSUED: 10/22/96
F'ARCLL_: �:S 1�,?�ND._hiG►Lt4�'
'a 11'6 AI)DRE '3a. . . �: 11513 5W 'DFYMIa T LN
GLNADIr)ISTON. . . . : HUNTER' S) GLEN ZONING: R--4. 5 F,D
BLOCK. . . . . . . . . . . I.,L7 .. . . . . . . . . . . . . r 04
Remarks: Path 1
---------------------------------------------------------------- BUILDIN5 ------------- -------•--
REISSUE: STORIES.......: 2 FLOOR AREAS---------- BASEMENT...: 0 sf REQUIRED SETBACKS----- REDUIRED---------
CLASS ;.r WORK.-.NEW HEIGHT........: 27 FIRST....: 1047 5f GARAGE.....: 440 sf LEFT..........: 5 SMOKE DETECTRS: Y
TYPE OF USE...:SF FLOOR LOAD....: 40 SECOND...: 967 sf FRONT.......... 26 PARKING SPACES: 1
TYPE OF UNST.:5N DWELLING UNITS: 1 FINBSMENT: 0 sf RIGHT.........: 5
OCCUPANCY GRP.:R3 BD!ft 4 BATH: 3 TOTAL------: 2014 st VALUE—$: 142516 REAR..........: 1.6
----.... _..--------------------------------------•----- -- PLUMBING --------------—--------------------------
SIWS.........: I WATER CLOSETS. , 3 WASHING MACH..: 1 LAUNDRY TRAYS.: 0 RAIN DRAIN f°: 0 TRAPS.........: 0
..AVATORIES....: '+ DISHWASHERF...: 1 FLOOR DRAINS..: 0 SEWER LINE ft: 0 SF RAIN DRAINS: 1 CATCH BASINS..: 0
UB/SHOWERS...: 3 GARBAGE DISP..: I WATER HEATERS. : I WATER LINE ft: 100 BCKFLW PREVNTR: ? GREASE TRAPS..: 0
OTHER FIXTURES. 0
--------------------------------------------------- -- - ---- MECHANICAL --------------------------------------------------------
FUEL TYPES----------- FJRN l 188N ,.: 0 BOIL/CMP ( 3rh'! 0 VENT FAN&.....; 4 CLOTHES DRYERS: 1
/GAS/ / / FURN )=188K ..: 1 UNIT HEATERS..: 0 HOODS......... : I OTHER UNITS...: 1
MAX INP.: 0 BTU FLOOR FURNACES: 8 VENTS.........: 0 WOODSTOVES....: 0 GAS OUTLEi3...: 1
---------------------------------------------•----------------- ELECTRICAL --- --- ------- - __... -------------------------------.-
--RESIDENTIAL UNIT-- ---SERVICE/FEEDER---- --TEMP SRVC/-EEDCRS— ---BRANCH CIRCUITS--- ----MISCELLANEOUS---- --•ADD'L INSPECTIONS--
1000 SF OR LESS: 1 0 - M amp..: 0 0 - 200 amp..: 0 W/SVC OR FDR.. : 0 PLIMP/IRRIGATION: 0 PER INSPECTION: 0
EA ADD'L 51MSF.: 3 201 - '>00 amp..: 0 201 - 400 asp..: N lst W/D SVC/FDR: 0 SIGN/OUT LIN LT: 0 PER HOUR......: 0
iMITF•T ENERGY. : 0 401 - 660 amp..: 0 401 - 600 amp_ : 0 E� ADDL. BR CIR: 0 SIGNAL/PANEL...: 0 IN PLANT...... : 0
MANF HMISVC/FDR: 0 601 - 1000 amp.: 0 681+asps-1000 v: 0 MINOR LABEL -10: 0
1000+ amp volt.: 0 -----------------•---------------- PLAN REVIEW SECTION ----------------------------
Reconnect only.: 0 )=4 RES UNITS..: SVC/FAR)=225 A.: ) 600 V NOMINAL: CLS AREA/SPC OCC:
----------------------------------- -----— ELECTRICAL - RESTRICTED ENERGY --•----.----
A. SF RESIDENTIAL------------------------- B. COMMERCIAL- --------------- - ---------------------- -------------------------------
OUDIO I STEREO.: VACUUM SYSTEM..: AUDIO I STERE'].: FIRE ALARM.....: INTERCOM%PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM..: 0TH: :: X Bf1ILER.........: HVAC...........: LANDSCAPE/IRRIG: PROTECTIVE S16NL:
GARAGE OPENER..: :.LOCK..........: INSTRLWNTATION: MEDICAL........: OTHR:
!1VAC............ ROTA/TELE COMM.: NURSE CALLS....: TOTAL SYSTEMS; 0
Owner: ,[,��/ —�-"�=tontractor: ------ ___—___—_—.—___� TOTAL FEES:f 4435.46
JGE fiU -S LEGEND HOMES CORPORATION
5980 SW HAINES ST 7160 SW HAZELFERN RD.
SUITE 100
T'GARD OR 97223 TIGARD OR 97224
Rhone N: 620-8890 Phone M: 620-•8080
Reg M..: 60563
This permit :s issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This pervit will expire if work is not Started withir, 1B0
days of issuance, or if work is suspended for more than 180 days.
--.------------.-_ REOUIRED INSPECTIONS --------------
rooting Insp PLM/Underfloor Framing Insp Gas Fireplace Water Service In Building Final
Fourdation Insp Mechanical Insp Shear Wall Insp Insulation Insp Appr/Sdwlk Insp Erosion Control
Post/Beam Struct Plumb Top Out Low Voltage Gyp Board Insp Electrical Final
east/Beam Mechan Electrical Servi Fireplace Insp Rain drain Insp Mechanical Final
.ravel Drain Electrical Rough G s Line Insp Water Line Insp Plumb Final
iF',L-i-mittee Si gnatIar•ei --t55lted By :
+! f 639- 4175
CITY OF TIGARD SEWER CONNECTION
I
DEVELOPMENT SERVICES PERMIT
13125 SW Hall Blvd., ilgard,OR 97223 (503)639.4171 PERMIT #. . . . . . . : S�:i;9r✓ -��+F3�
DATE. ISSUED: 1.0/22/96
PARCEL: _S 1071BD-HG04
SITE ADDRESS. . . : 1. 151.3 SW BAMBI LN
SUBDIVISION. . . . : HUNTER' S GIL.F N ZONING: R-4. 5 PD
BLOCK. . . . . . . . . . . I_I_lT. . . . . . . .. . . . . . :042
TENANT NAME. . . . . :L_EGEND HOMES
USA NO. . . . . . . . . . . FIXTURF UNITS. . . . 0
i;l_ASS OF WORK. „ . :NEW DWFL'_I NG UN I TS. . : 1
TYPE OF USE. . . . . :9F NO. OF BUILDINGS: 1
INSTALL._ TYPE. . ., . :111.ISWR IMPERV SURFACE: 0 sf
Remarks : Path 1
Owner-: ----_________.____._.___.__.___.__..__.___._...___..-.---_-----.__.__-___..._.. FEES
LEGEND HOMES type amount by date i^ecpt
6900 SW HAINES ST PRMT $ 2200. 00 JSD 10/22/96 96-285514
INSP $ 35. 00 JSD 10/22/96 9E:,--2S'5514
TIGARD OR '37e-'23
K>h o n e #: 6210-8080
i:,rrntractoi. ; _____....____. -
---
.-.
CONTRACTOR NOT ON FILE:
Phone #: 4 2235. 00 TOTAL
--- - ---
REQUIRED INSPECTIONS
-This Applicant agrees to comply with all the rules and regulations Sewer Inspection
of the Unified Sewage Agency, The permit expires 18e days from _
the date issued. rhe total mount paid will be forfeited if the
permit expires. the Agency does not guarantee the accuracy of the
side sewer laterals. ?f the ,ewer is not located at the measurement
given, the installer shall prospect 3 feet in all directions from y
the distance given. If not so located, the installer shall purchase
a "Tap and Side Sewer" permit and the Agency will install a lateral, �-
e r m i t t e e S i y n a t Ur•e : 1-211)"
' ✓ ,�
r Ir -q
I PIP'
I s s r.t e d By
Call for inspection - 639-4175
Plan Check # �(
:ITY OF TIGARD Residential Building Permit Application Rec'dBy ka,r>✓
3125 SW HALL BLVD. New Construction Additions or Alterations Date Recd
IGARD, OF. 97223 Single Family Detachec or Attached Date to P E. O-11-I
303) 639-4171 Date to DST t)
Print or Type Permit#im
��a
Incomplete or illegible applications will not be accepted Called 10-11-11(s
Name of Subdivision Lot 0 Name
JobHUNTER ' S GLEN 42 LEGEND HOMES
Address SdeAddreS �T Architect Mailing Address
h � 6900 SW Haines St .
1].5].3 S Wefra a City/State Zip Phone
Name
LEGEND HOMES Tigard , OR 97225 620-80BO
Owner Mailing Address NameF R O E L:t-.�
6900 i W Haines St . pp En ine3r Mailing Address
iigatrd, OR 223 6 �e8080 g 6969 SW Hampton St .
Name City/State Zi Phon
LEGEND HOMES Tigard , OR 9723 62 -7005
General describe work new6k, addition O alteration O repair O
Contractor Mailing Address to be done:
6900 S W Haines St . Additional Description of Work:
City/State ZIP Phone
Tigard , OR 97223 620-8080
Oregon Const.Cont. Board Lic.# Exp.Date
Attach Copy of 060563 6/19/97 Project
Current COT Business Tax or Metro Exp Date Valuation ��,,
Licenses 437 r 5 � 6/1/` 7___
Name NEW CONSTRUCTION ONLY: _
.
Mechanical SUNGL OW INC . I J Sq.Ft. Hou e: Sq.Ft.G r e:
Sub- Mailing Address -- G' 1' X17
Contractor , 24--B S E 105th Corner Lot Yes No Flag Lot Yes No,.
City/State Zip Phone -- (check one) )�__- (check one)
i_P o r t l a n d , _ O R 97216 253-7789 Restricted Audio/Stereo -'Burglar
Oregon Const.C.rit. Board I.ic.# Exp. DatQ. l Energy System Alarm
Attach Copy of , 48131 t
Current COT Business Tax or Metro# Exp Dat Installation 0 f440+ s' Garage Door HVAC
Licenses 1276 l* x Opener Systems
Name _ (check all that Other:
Plumbing ; WOLCOTT PLUMBItNIG app!z)
Sub- •'alling Address —_---- Will the electrical subcontractor wire for all Yes No
Contractor PO Box 2007 restricted energy installations?
City/State Zip Phone --- Has the Subdivision Plat recorded? N/A Yes No
Gresham r
OR 97030 667-9891 ,
Oregon Const.Cont.Board Lic.# Expp. Date Reissue of MST# Solar Compliance
Attach Copy of 10/19/97 t f ; C rY' ' (Calculation Attached)
Current Plumbing Lic.# Exo. Date I Kereby acknowledge that I have read this application,that the
Licenses 2 6-2 0 8 P B 8/31197 L information given is correct, that I am the owner or authorized agent of
COT Business Tax or Metro# Exp.Date the owner, and that plans submitted are in compliance with Oregon
96-4281 12/96 t State laws.
Name Signpture of Ow r/Agero Date
Electrical GARNER ELECTRIC �� - ' '4 y
114
Contarst Perso N Ph n
Sub- Mailing Address
Contractor 21785 SW TV Highway FOR _OFFICE USE ONLY:
Cityo h a Zi Phone Plat# MaplrL#:
Aloha , OR 9706 591-1320
Oregon Const. Cont. Board Lic.# E . Date _ Tl'' f 1 L.�j I
attach copy of �74,�� � / L Setbacks Zone: Solar
Current Electrical Lic.# Exo, t f 7 / `�l
Licenses 34-305C 7 L' A E ,'� FU
COTe sy mess Tax or Metro n Exp Qa Engineering Appr al• Planning Approval: TIF:
r-1 115110
sts\mstapp.doc q 7w CJ
'7
l
Permit AccoslplDgrrptLu AMQI nA Am' P aw Due
-0-'I MST. Permit (BUILD) 2/0-:)-v 5C/a,w
Plumb. Permit (PLUMES) 2,)", 2 2 S
Mech. Permit (MECH)
ELC/EI_R Permit (ELPRMT) 2 ).-*0 p 2�
State Tax (TAX) S), 7
Bldg:
Plumb:
Mech: : L
ELC/ELR:
Plan Check
MST: (BUPPLN) 4�CJ/• =s .?` '�� �U/
Plumb: (PLMPLN)
Mech: (MECPLN) _ //• z �'r
CDC Review (LANDUS) b•
A. s' � .,�s ,� Sewer Connection (SWUSA) �-a o1) o2;1 61,J
Sewer lnsperti -n (SWINSP) 3- 3- 3y —'•
Parks Dev Charge (PKSDC) 16)-5 0 l05�
Residential TIF (TIF-R) 1571)
Mass Transit TIF (TIF-MT) 2 D /,20
Water Quality (WQUAL)
Water Quantity (WO 1IANT) /UJ --
Erosion Control Permit (ERPRMT)
Erosion Planrk/USA (r-RPLAN) �� J r�D•�
Erosion Planck!COT (EROSN) •t •�'U
Fire Life Safety (FLS)
TOTALS:
\dVcWstapp doc C4 F-
R•sv. 7/913
I
Box B. continued Box B:
2. Measure change in elevation Isom front property line to finished floor elevation. If
the lot slopes up from the front lot line to the foundation, the figure is positive. If
the lot slopes down from the front lot line to the foundation, the figure is negative. — It
3. Measure distance from finished floor elevation to the affected peak/eave. + _ ft
4. If the roof line runs North-South, deduct three feet. If the roof line runs East-West, ft
deduct nothing.
5. Subtract one foot for each footw of difference ire elevation from the front property
line to the rear property line, if the lot slopes up from the front to the rear. If the
lot has no slope or slopes up From the rear to the front, deduct nothing - _ ft
6. Total figure for box B: ft
Box C. Distance to the shade reduction line. Box C:
1. Measure the distance from the North property line to the foundation near the ft
affected peaWeave.
2. Measure the distance from the foundation to the affected peak or eave. + ft
3 Total figure for box C: _ ft
It is most useful to draw a vertical line to represent the appropriate figure found in box 'A"drid a horizontal line to represent the
appropriate figure found in box "C". The intersection of the vertical and horizontal lines determines the value found in box"D". The v;'lue
;n box "D"should be compared to the value in box"B"; if the value in box"B"is less than or equal to the value found in box "D", then
the building ii in compliance with the solar balance code. If you have any questions, please contact us at 639-4171, x304 or at the
Community Development Counter.
MAXIMUM PERMITTED SHADE PAINT HEIGHT (In Feet)
Distance to North south lot dirnens;on(in fee')
shade '10+ 95 90 85 80 75 70 65 60 55 50 45 40
reduction line
from northern
lot line(in feet)
70 40 40 40 41 42 43 44
65 38 38 38 39 40 41 42 43
60 36 36 .36 37 38 39 40 41 42
55 34 34 34 35 36 37 38 39 40 41
50 32 32 32 33 34 35 36 37 38 39 40
45 30 30 30 31 32 33 34 35 36 37 38 39
40 28 28 28 29 30 31 32 33 34 35 36 37 38
35 26 26 26 27 28 29 30 31 32 33 34 35 36
30 24 24 24 25 26 2' 28 29 30 31 32 33 34
25 22 22 22 23 24 25 26 27 28 29 30 .31 32
20 20 20 20 21 22 23 24 25 26 27 28 29 30
15 18 1E 18 19 20 21 22 23 24 2526 27 28
10 16 16 16 17 18 19 20 21 22 23 24 25 26
5 14 14 14 15 16 17 18 19 20 2'' 22 23 24
Box D. Maximum allowed shade point height:
h Wcxs�nancyWenturalsolar chp
Revised 2/26/96
5blar Balance Point Standard Worksheet
Address
Box A calculations: North-South dirnniihmon for the lot. Box A:
This dimension is determined by finding the midpoint of the North lot line and drawing
an intersecting line perpendicular to that point. :5O
First, determine which property line is the North let line. The North lot line is the line
with the smallest angle from a line drawn east-west and intersecting the northern most
point of the lot.
ata
�\ LLItiE A
NORI/ERN NORRkRN ) t� 1 f-ET-0
lOT UNE LOT UNE
-- N �� // North-South
/ Dimension for Lot.
Measure the distance from the midpoint of the North lot line to the South lot line along
the described line.
feet
_�_ N
NORTWSM1N o�+Eraw,N
L__ _j
Box B calculations. Shade point height for your residence. Box B:
1. Determine whether measurements will be based on the peak or cave of your Which describes
structure. The orientat,on of the ridge is also important. your residence?
I a: If the roof line runs North-South, measurements will (circle one)
be based on the peak of the roof. TO-T37770
"V""—+ �� 1A. 1B 1C
1 b: If the roof line runs East-W est and the roof pitch is \'
less than 5/12, measurements will be based on the
cave.
9WX POINT tA�4
Ic If the roof line runs East-West and the roof pitch is
5,12 or steeper, measurements will be based on the RM
PMDY
peak.
p..aE PC"oou
PLOT PLAN
LOT *142 , �4UNTER' 5 GLEN
11513 5W 5AM51 LAN3
MAi= M 261035G), TAX LOT " 0600 • �.a ..�„
N.E. 1/4 OF 5EOTION 3, T.25, R.IW, W.M. -
GIT1' OF TIGARD
W,45I41NGT,DN COUNT)', OREGON
WATER 'lETER
( LEGEND HOMES W------�"- WATER LINE
Srj--—--— SANITARY AEWER
6900 s.�. a�uaEe srREEr TIGARD, OREGON S[,7— -- — STORM DRAIN
PW�ZA 2. SUITE 200 97229-2a 14 OF STREET
omcE (009) e20-6060 rax (509) age-e9oo _-�
MANHOLE
1 I r ®
CATCH BASIN
11 PROPOSED
11 I 2040 STREET TREES
STREET LIGHT
h
FIRE "yC RANT
1
1`I •• N
L-07 41
r
�� 'v
lip
/'� 1• I 4e
1 202.4'21'
LOT 42
\ U
LUINU5OR 'F--3' '
W d1 // 111 - FIN. FLR. • 21�?�fD' 2120 \
11 I 1 CaARAGE FLR 2m9 5' I ^y 112 ' \
1 1 ;Zi16�S' �� ��/I 11 � I � R•43Ida' \
(� I L-29.,1' \
212.0' �\ 1
/ 1 _ LU _
Z--
<1
--
Lot
TRACT $' \� ` \� \• `\\i r d
I r
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97213
IMPORTANT PERMIT NOTICE:
WOLCOTT PLUMBING CONT. INC
P O BOX 2007
GRESHAM OR 97030
Plumbing Signature Form
Permit ff . . . . : MST96-0489
Date Issued . : 10/22/96
Parcel . . . . . . : 2S103BD-HG042
Site Address : 11513 SW BAMBI LN
Subdivision. : HUNTER' S GLEN
Block. . . . . . . . Lot . 042
Zoning. . . . . . : R-4 . 5 PD
Remarks :
Path 1
Your company has been indicated as the plumbing contractor for the permit indicated above. In order
for the plumbing permit to be valid, please have the appropriate individual from your company sign
below and return this Plumbing Signature Form prior to the start of work. No plumbing inspections
will be authorized until this completed form is received.
AN INK SIGNATURE IS REQUIRED ON THIS FORM
)WNI-;P : I'1-IJMR1NG CONTRACTOR :
LEGEND HOMES WOLCOTT PLUMBING CONT. INC
6900 SW HAINES ST P O BOX 2007
TIGARD OR 97223 GRESHAM OR 97030
Pfic)nr, # : 620-8080 Phone # :
Reg # . . : 23847
Signature of Authorized PlumbLr
Please return this completed form to the address above.
ATTN: Building Dept.
If you have any questions, please cal' 639-071 , ext. #31C
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
GARNER ELECTRIC
21785 SW TV HWY
#L
PLOHA OR 97006
Electrical Signature Form
Permit # • • • • : MST96-0489
Date Issued . : 10/22/96
Parcel . . . . . . : 2S103BD-HG042
Site Address : 11513 SW BAMBI LN
Subdivision. : HUNTER' S GLEN
Block. . . . . . . . Lot . 042
Zoning. . . . . . : R-4 . 5 PD
Remarks :
Path 1
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 work. No electrical inspections will be authorized until
this completed form is received.
AN INK SIGNATURE IS REQUIRED ON THIS FORM
WNF'k : ELECTRICAL CONTRACTOR:
LEGEND HOMES GARNER ELECTRIC
6900 SW HAINES ST 21785 SW TV HWY
#L
TIGARD OR 97223 ALOHA OR 97006
Phone # : 620-8080 Phone # :
Reg # . . • - i_up ,
721
X
S i g Electrician
Please return this completed form to the address above.
ATTN. Euilding Dept.
If you have any questions please call 639-4171 , ext. #310
r
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639-4175 Business Phone: 639-4171
Footing Rain Drain Cover/Service IN :
Foundation Water Line Ceiling -Plumb.
Post/Beam Mech. Shear/Sheath Framing eC
Plbg,Und/Flr/Slab Plbg. Top Out Insulation -Elect. t
Post/Beam Struct. Mech. Rough-in Gyp. Bd.
San. Sewer Gas Line Appr/Sdwlk Reins.
Other: _
Date: e_7__ A.M. kf'P.M. Entry:_.
Address
Tenant: Ste:_—_ MST:
MEC:
PLM:
ELC:
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
Inspector — - -----. Date:
000
ROVED DISAPPROVED/CALL FOR REINSP. CF CO
CITY OF TIGARD BUILDINGIN E TION NOTICE
Inspection Line: 639-4175 Business Phone:639-4171
Footing
Cover/Service Foundation Rain Drain CFINAL:
Water Line
Post/Beam Mech. ShCeiling
ear/Sheath7U-�
Plbg,Und/Fir/Slab Framing
Plbg. Top Out -Mech.
PosVMe
Beam Struct. Insulation
Mech. Rough-in -Elect.
San, Sewer GYP• Bd. -Bldg,
Gas Line
4ppr/Sdwlk Reins,
eins.
Date:
—'`---L---�__ —
Address: A.M. �_— 5 Entry:
Tenant: —_"��—=s�-
Con/Own: -------- ----- Ste:_--_ MST �� c
MEC:
THE FOLLOWING CORRECTIONS ARE REQUIRED PLM: —
ELC: `----
/nspecto,:/_
OVEG- Date
DISAPPROVED/CALL FOR REINSP —i
_ CF CO