12880 SW BLUE HERON PLACE f
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12880 '3W Blue Heron Place
CITY O F TIGARD MASTER PERMIT
"-ERMIT#: MST2002-00365
QEVELOPMENY SERVICES DATE ISSUED: 10/3/02
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171
SITE ADDRESS: 12880 SW BLUE HERON PL PARCEL.: 2S103BC-BHP10
SUBDi'J!SION: ZONING:
BLGCK: LO.1-: JURISDICTICN:
REMARKS: New S/F attacned, Path I.
BUILDING
REISSUE: STORIES: 2 FLOOR AREAS REQUIRED SETBACKS _ REQUIRED _
L—ASS OF WORK: NEW HEIGHT. 24 FIRST: 739 of SASEM''NT: n1 LEFT: n SMOKE DETECTORS: Y
TYPE OF(ISE: SFA FLOOR LOAD: 40 SECOND: 951 of GARAGE: 400 of FRONT: 20 PARKING SPACES. 1
TYPE OF CONST: 5N DWELLING UNITS: 1 FINBSMENT: of RIGHT: fi
-
OCCUPANCY ORP: HJ BDRM: 3 SAYH: 3 TOTAL: tVALUE1t0,.97r(10fi9n of REAF. 17
PLUMBING
SINKS: I WATER CL1 ISFTS: 3 WASHING MACH: i LAUNDRY TRAYS: RAIN DRAIN: 100 TRAPS:
LAVATORIES 4 DISHWAS4FRN 1 FLOOR DRAINS: SEWER LINES: 100 SF RAIN DRAINS: 1 CATCH BASINS:
1 UR'SHOWERa: 3 GARBAGE DISP: 1 WATER HEATERS: 1 WATER LINES: 100 BCKFLW PREVNTR• 1 GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL 1 YP,?S FURN<100K•. 1 BOILICMP<3HP: VENT FANS: 5 CLOTHES DRYER: 1
rA; FURN>-100K: UNIT HEATERS: HOODS: 1 OTHER UNITS: 1
MAX INP: btu FLOOR FURNANCES: VE' 1 WOODSTOVES: GAP OUTLETS:
ELECTRICAL
ESIDFNTIAL UNIT SERVICE FEEDER TEMP SRVC/FEEDERS `PRANCH CIRCUITS MISCELLANEOUS ADD'L INSPFCTIONS
1000 SF OR LESS: 1 0 200 nmp: 0 - 200 amp W/SVC OR FUR: 1 PUMPIIRRIGATION: PER INSP,:CTION:
EA ADD'L 5009F: 3 201 -400 amp: 201 - 400 amp: tat WIO SVC/FDR: 00 SIGN/OUT LIN LT: PER HOUR:
1-:411'D ENERGY. 401 800 amp: 401 -800 amp: FA ADDL BP.CIR: SIGNAL/PANEL: IN PLANT:
MANU F.MISVC/FDR: 801 - 1000 n 1p: 801a8mos-1000v: MINOR LABEL.
1000*amp/vol
PLAN REVIEW SECTION
Reconnect only.
1-4 PcS UNITS: SVC/FDR-225 A.: >800 V NOMINAL: CLS AREAISPC OCC:
ELECTRICAL-kESTRICIEC ENERGY
A.SF RESIDENTIAL B.COMMERCIAL
AUDIO 6 STEREO: VACUUM SYSTEM: AUDIO&STEREO- FIRE ALARM: INTLRCOMIPAGING OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH. BOII-EH: HVAC: LANDSCAPEARRIGPROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION: MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS: TOTAL N 1.YSTEMS:
Owner: Contractor: TOTAL FEES: $ 6,116.07
This permit is subject to the regulations contained in the
WINDWOOD CONST RUCTION INC WINDWOOD HOMES INC Tigard Municipal Code,State of OR. Specialty Codes
12655 SW NORTH DAKOTA 12655 SW NORTH DAKOTA and all other applicable laws. All work will be done in
TIGARD,OR 97223 TIGARD,OR -n'223 accordance with approved pians. 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.
ATTENTION: Oregon law requires you to follow rules
Phone: 503-625-6526 Phone: 625-6526 adopted by the Oregon Utility Notification Certer. Those
rules are sAt forth in OAR 952-001-0010 through
Rog N, LIC 50190 952-001-0080. Ycli may obtain copies of these rules or Q
REQUIRED INSPECTIONS
Erosion Control Insp 8, POst/Bean1 Mechanical Mechanical Insp Shear Wall Insp Insulaticn Insp Mechanical Final
Sewer Inspection Underfloor insulation Plumb Top Out Exterior Sheathing Ino Rain drain Insp Plumb Final
Footing Insp Crawl Drain/Backwater Electrical Service Low'/oltage Water Line Insp nal I ec' n
Foundation Insp Footing/Foundation Dr, Elect{(ai Rough In Gas Line Insp Appr/Sdwlk Insp /
Post/Beam Structural PLM/Underfloor Frvming Insp Gas Fireplace Electrical F!Dal
Issued � �__ Permittee ,,ignature :
Call (503) 639 4175 by 7:00 p.n1. for an inspection needed t e next business day
C!!TY OF TIOARD SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT#: SWR2.002-00242
ze 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 10/3/02
SITE ADDRESS; 12880 SW BLUE HERON PL PARCEL: 2S103BC-BHP10
SUBDIVISION: BONING:
BLOCK: LOT: JURISDICTION:
TENANT NAME:
USA NO: FIXT62-1 UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SFA NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: New S/F attached, Path 1.
Owner: FEES
WINDWOOD CONSTRUCTION INC
12655 SW NORTH DAKOTA Description Date Amount
_
TIGARD, OR 97223 1SWUSAJ SwrCounect 10/3/02 $2,300.00
ISWINSPJ Swr Inspect 101!3/02 $35.00
Phone: 503-625-6526
Total $2,335.00
Contractor:
Phone:
Reg #:
Required Inspections
This Applicant agrees to comply with all the rules and regulations of the Clean Water Services. The pemdt expires 180
days from the date issued. The total amount paid will he forfeited if the permit expires. The Agency does not guarantee
the accuracy of the side sewer laterals. If the sewer is not located at the measurement given, the installF:y6hall pros t
:3 feet in all directions from the distance given. If not so located,the installer shall purchase a "Tap an Side S er" erm
Issu by: L...GI Permittee Signature:
Call (503)639-4175 by 7:00 P.M. for an Inspection needed the next business day
r
Building Permit Application
�Diitereceived: Q 7 Permit no.:/!',-,:.-,
CityCi of Tigard
b Projecdan�i.no.: Ex ire date: r
CiryofTigord Address: 13125 SW Hall Blvd,Tigurd,OR 97223
Phone: (503) 639-4171 Date issued: y:1 ,_ b' Receipt no.:
Fax: (503) 598-1960 Case file no.: Payment type: _ ("
Land use approval: I&z fatuity:simple Complex:
,.6T&2 family dwelling or arcessory U Commercial/industha.' U Multi-iWilily U New construction U Deni lition
U Addition/alteration/replacement U Tenant improvement U Fire sprinki-r/alarm Cl Other:_
t
Job address: W289 e�tU u C l' a� , Bldg.no.: Suite no.:
Lot: Block: Subdivision: ul tun - 1�� Tax map/tax lot/account no,.25 3S
Project name: ro,^_ --
Description and location of work on premises/special conditions:
Name:
Mailing address: 1 &2 family dwelling:
City: (CL istatZIP: Valuation of work........................................ $ I ry ri X t G
Phone: G F G E-mail: No.of bedroom:/baths..........3................... 3
Owner's representative: / R _ Total number of ours..........rad...................
Phone: Fax: E-mail: New dwelling area(sq.ft..) .....I,6r.ylJ.......... —
LDeck
e/ca port area(sq. ft.).....�j,0U.......... _
red porch area(sq.ft.) ......rYi4............
Name: /i't area(sq. ft.) ........................................
Mailing address:City: State: I ZIP: suucture area %sq.ft.)......................... _
Commerclal/indurtrial/multi-family:
Phone: Fax: E-mail:
Valuationofµork.............................. ........ $ _
Existing bldg.gree.,':y.ft.) ............. ............
Business name: New bldg.area(sq.ft.) .......... . ...............
Address: Number,,f stories
. ................... ... .............•
City: Sade: ZIP: Type of construction
Phone: Fax: E-mai!: Occupancy group(s): Existing: __--
CCB no.: 7!/ New: —
r !_Y/metro lic.no.: Notler.All contrdc 'ors and subcontractors are required to be
licensed with the Oregon Construction Contractors Boar.i under
provisions of ORS 701 and may be required to be licensed in the
Natne: AA -— jurisdiction where work is being performed. If the applicant is
AddAlw
exempt from licensing,the following reasor.applies:
city:.
City: N'e Statetj''t' ZIP: 477
Contact perst•n: 14A Plan no.:
Phane:V.15'`�!/ % Fax; ' Email:
Name: fit, Contact person:Q Fees due upon application ...................... .... $
Address: = Date received:
City: „tat ZIP: ,2/G
Amount received ...... ............I................. $
E-mail: Please refer to fee schedule.
Phone: . FAx: G� -
I herebv certify I have read and examined this application and the Not dl judd''.acm cadt aadb.sem can}uriodiction for more informubn.
attached checklist.All provisions of laws and ordinances go,,eraiag this o Visa o MutetCud
work will be complied with,whether s�tecifted herein or not. C"edtt"'d"1°'bm Expin—
Authorized sign -��Date' N One d u on ct"t card S
Print name:�� 'f - •t AMOW
Notice:This permit applir;ation expires if a permit Is not obtained within 180 days after it has been accepted as complete. 4104613 OMCOtrn
Plumbing-Permit Application
City of T galla
pDateTreceived: 5("14
Peimit no.:
Addres.,• 13125 SW Hall Blvd,Tigard,01' 97223 Sewer permit no.: Building pennitno.:
CirynjTigard phone: (503) 639-4171 Project/appl.no.: Expire date:
rax: (503) 598-1960 Date issued: By: Receipt no.:
Land use approval: case file no.: Paytr;,nt type:
t
fdI &2 family dwelling or accessory U Commercial/industrial U Muld-family U Tenant improvement
O New construction C]Addition/alteration/replacement U Food service ❑Other:
11 Jill
Job address: • J �� Description Qtv Fee(ea.) 'Total
Bldg.no.: i quite no.: New 1-Aad 2-family dwellings only:
Tax map/tax lot/account—no �S C39y o (tocludes l00 R.for eget utility connertlon)
Int: Block: Subdivision: SFR(l)bath
Z. SFR(2)bath -- — —
P,ojectname: c<r SFR(3)bath _—
Ciiy/c:,unty: IP: q Each additional bath/kitchen
Description and lo. tic"o work on premises: Sitentuftles:
Catch basin/area drain
Est.date of comole :onhnspection: wells/leach Iineltch d'aln
in ren
--
Foo drain(no.lin.ft.)
Business nae Manufactured h
mome utilities'
Manholes -'
Address: C) U Rain drain connector
City: St ate• /r ZIP: � 7 Sanitary sewer(no.lin.ft.)
Phone: �Y -4/6,?=YF'ax- 32 Email: Storm sewer(no. in.ft.)
CCA no.:_7/Slop Plumb.bus.reg.no: ;p _ �l4, Water.service no.lin.ft.)
City/metro0c.no.: 16 g�,' Fixture or item:
2onttactor's representative signature: Absorption valve
Print name: Back flow 7evcmer --
Date' Backwater valv=KIM KEE Slim MAIIIe
Basin0avatory
Name: /1!a Clothes washer
Address: - Dishwasher
City: State: Dunking fountain(s) _ —
Phone: Fax: E-mail: jectors/sum
Expansion tank
Fixture/sewer cap
Name(print): Floor dntins/floor sinks/hub
I tailing address: S,�j N_rv44,, A. Garbage tits sal
Hass BibbCit : T 2 States K ZIP:
3 Ice maker
Phone:FL Fax:(i' .- E-mail I
c tor/ ase trate_
Owner installation/residential maintenance only: The actual installation r(s)
will be made by me or the maintenance and repair made by my regular drain(commercial)
employee on the property I own rs per ORS Chapter 447. ---
s),hasin(s), lays(s)
Owner's si ale:
t:os/shower/shoer an
Name: _ Jn'nah w-
Address: — --- suer closet `
--r — suer eater -
City: _ tate: ZIP: er.
Phone: - ~�Fax: In
Not aU Juni Giber.cayt credit card.,please call jurisdiction for mere infornatlau. Minimum ice................$
❑viae ❑
Notice:Thu permit application Plan review(at %) S
coat card n°'n� —
ber: Card eypires if a Fermit is not obtained
within 180 hays after it has been State surcharge(W ...S
Expire; after
TOTAY,
N�a nrdlieidd as afio�:�u oo aedlt card-- accepted r complete. ............ .S
(.ardlwlder d�oadre___ � _Amoaol
4444616(64MCOM)
Mechanical Permit Application
Date received: 7p 9- Permit no.:
City of. Tigard Project/appl.no.: Expiredate:
CityujTigrrd Addmh: 13125 SW Hall Blvd,Tigard,OR 97223
Phone: (503) 639-4171 Date issued: By: Reco;at no.:
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval: Building permit no.:
U 1 &2 family dwelling or accessory O Commercial/indw in d 0 Multi-family 0 Tenant improvement.
O New construction 0 Addition/altcration/replaccmcnt U Other
Job address: _ /t� A Indicate equipment quantitic,in boxes below. Indicate the dollar
Bldg.no.: Suite no.: value of all mechanical materials,equipment,labor.overhead.
Tax map/tax lot/account no.: $/ a Lila G rc_ 3"o profit.Value$
Lot: Block: Subdivision: Blft *See checklist for important application information and
Project name: !te f(,D jurisdiction's fee schedule for residential permit fee.
City/county: bVaS )
Description and location/of work on premises: l
Fee(ea-) Total
Est.date of completionlinspection: Desai "y. Res.only Res.only
Tenant improvement or change of use: Air ban. unit _CFM
Is existing space heated or corlditioned'd 0 Yes 0 No it conditioning(site plan regwred)
Is existing space insulated ❑Yes 0 No ierauon oWexisting HVAC system
oiler compressors
Business name: PAke 71 State boiler permit no.:
-- HP Tons BTU/H
Address: d ' Fire/smoke dampers/duct smoke detectors
City: 4 e A girl State: IP: O-V30 Heat pump(site plan required)
PhoneFax: E-mall: .nsta rep ace urnre urner
/ yl Including ductwork/vent liner O Yes O No
CCB no.: L
Instalrep ac re ocate eaters-suspen e .
City/metro lic.no.: 4510.5wall,or floor mounted
Name( lease print): 11f k ,4 Sd,.I ant for lance other than furnace
e gena on:
Absorption units— BTU/H
Name: � � _ — Chillers _ HP
Address: Com ressors__ HP
T muent ex ust a vent on:
City: State: ZIP: 77Appliance vent
Phone: Fax: E-mail: ryerexhaust
oods,Type res. 'tc a azmat
hood fire suppression system
Name: IU 4lV Q Cum $ Exhaust fan with single duct(bath fans)
Mailing address: ,,Z 0 J �( Q�-�1�4 Exhaust system a art rom eaun or AC
Fuelpiping an st oo up to 4 outlets)
City: 7-1-54/16 State:(J/` ZIP: T LPG NO Oil
Phone: ��� bSr"ef: I a� (, = E•rnail: RN,
e i eacFia t�cditionalover4nut-_Rocess p p ttg(sc emat c requireea)
Name: mber of outlets
Address: --- ------ — ter st app a or equipment.,
_ _ _ Decorathefireplace
City: m — State: ZIP: nseit-_type_
Phone: _ _ �f:r.a-� F. mail:
oalstov pe et stove
Applicant's signature: Date: Other
Name(print): —
Na all furfadictions accr,a crcdn cents,plena call iurivlictAnn fnr mat information. Permit fee.....................$
❑vise Ll Mastercard Notice:This permit application Minimum fee................$
expires if a permit is not obtained
Cradle card number:- —_L,1Plan review(a[ __ %)- _ within Igo days after it has been State surcharge(8*)....$
—'--NomedfCardholciff u drawn.m,_rrvLt card -- accepted as complete.
Cadbol ler signature _— — Amount —
440-4617 tt;mCotin
_ L,4 y
Z 5 u SV Fr fur eo
�30
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CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4176 MSTs-
INSPECTION DIVISION Business Line: (503)639-4171 BUP
Received . ____-___Date Requested-_J 3 AM f;�1—__.�_ BUP
Location — - -� _Suite_ _--_.. MEC _--
Contact Person _-_-- ---.__-.----.--..._ _ Ph(� _—) _�L- �5� 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: --- _-- ----------- -- - --- ----
----
g
S PART FAIL
BING_ - ---..... - -- ----- ---- - -
Post&Beam
Under Slab ---- -- --- -
Rough-In
Water Service - -- - - - -
Sanitary Sewei
Rain Drains ----
Catci,Basin/Manhole
Storm Drain ---
Shower Pan
Other. --- -- - - - -- -- - --
in ----
ASS PART FAIL
ANICA_L ---- a^ _-- - — - - ---
Post& Beam -^
Rough-In -_�----- - - - -- - --- --
Gas Line
Smoke Dampers -----------_ _ -__- ----- - - --
AFART FAIL
-- --- --- �-- --
ASS)
Service
Rough-In
UG/Slab _)
----
rm
mal PART FAIL. EJ Reinspection fee of required before next Inspection. Pay at City Hell, 13125 SW Hall Blvd.
--SI -` ( j Please call for reinsfx mi fit- - Unable to inspect-no access
Fire Supply Line
ADA
Appioach/Sidewalk ppb-- Inspector Ext ----
Other:
Final DO NOT REMOVE this Inspection record from the Jab site.
I PASS PART FAIL-
NIA
Elcxtrical PermApp Received ' '
Date/By: _—
CitCit of Tigard Planning Approval Sign
y g Date/B : Permit No.:
13125 SW Ball Blvd. Plan Review Other
Tigard,Oregon 97223 Date/By: Permit No.:
Phone: 503-6394171 Fax: 503-598-1960 Post-Review Land Use
ard.or.us
Date/By: case No.:
Internet: www.ci.ti
8 Contact Juris.: 0 See Page 2 for
24-hour Inspection Request: 503-639-4175 Name/Method: _ Supplemental Information. I
TYPE OF WORK_ 1 PLAN REVIEW Please check all that apply) l
New construction,----- Demolition J Service ove 225 amps- Health-care facility
i commercial ❑Hazardous location
Addition/alteration/replacement Other: _ �j Service over 320 amps-rating of ❑Building over 10,000 square feet,
CATEGORY OF CONSTRUCTION I&2 family dwellings four or more residential units in
1 &2-Family dwellin Commercial/Industrial ❑System over 600 volts nominal one structure
['J Building over three stories [�Feeders,400 amps or more
Aceesso Building Multi-Famll� ❑Occupant load over 99 persons ❑Manufactured structures or RV park
�]Master Builder _ Other: ❑Egress/lighting plan ❑Other:
_ JOB SITE INFORMATION and LOCATION Submit__,.ie(-of plans with any of the above.
The above are not applicable to temporary construction service.
Job site address: I a ago 3(~) 13IJG PAu FEE*SCHEDULE
Suite#: I Bld ./A t.#: Number of Ins ections per permit allowed
Project Name: Rc„rl�r� c )) o Sw dive roo Description --- Qty Fee(ea.) Tsut
Cross sticet/Oirections t0 job site: New rng unit.In l Includes
or tachemultigars per
dwelling unit.Includes attached gauge.
Service Included: `ego ( „t r
1000 sq.ft.or less 145.15 1 i) 4
Each addttioral 500 sg.ft.or portion themor _ 33.40 0 6,00 I
Subdivision: _ Lot#: Limited enrr residential 75.00 2
Limited enema non residential __75.00 2
Tax map/parcel M Each mann actured home or modular dwelling
DESCRIPTION OF WORK service an&-ir feeder 90.90 2
Services or feeders-installation,
New ('C-►rtl eti+sC alteration or relocation:
-- — 200 amps or less 80.30 2
201 amps to 400 amy__— 106.85 2
401 amps to 600 amps 160.60 2
_PROPERTY OWNER TENANT 601 amps to 1000 am _ 240.60 2
- — —— --- -— Over 1000 amps or volts 454.65 2
Name: _ _ _ _ Reconnect only 66.85 2
Address: Temporary services or feeders-Installation.
- - - -- alteration,or relocation:
Cit /Stateqtp._ _ 200 ams or less 66.85 _ 1
Phone: Fax; 201 amps to 400 amps _ 100.30 2
APPLICANT CONTACT PERSON MI to 600 ams 133.75 2
_ Branch circults-new,alteration.or
Name: extension per panel:
-- — A.Fee for branch circuits with purchase of
Address: service or feeder fee each branch circuit 6.65 2
_City/State/Zip: -- B.Fee for branch circuits without purchase of
service or feeder fee first branch circuit 46.85 2
Phone: FSX: _ Each additional branch circuit 6.65 2
E-mai.
t Misc.(Service or feeder not included):
_
CONTRACTOR Each um or irrigation circle 53.40 2
Each sign or outline lighting 53.40 2
Job No' 10Z/ a Signal circuit(s)or a limited energy panel,-
- alteration or extension Pate 2 2
Business Name: CTre� �Wa V����.� ��. Description:
Address: )S-i y S z w_ rz 1 _
Each additional Inspection over the allowable In any of the above:
Cit /State/Zl a I, jO0-J O Z 9200,) Per inspection pet tour mh.. I hour 1 62.50
Phone: s 25• 0*s y Fax: s Investi tion fee:
CCB Lic. M Is3 'Iii Lic.#: 3 y -6/)e Other: --
v.•�.:pctrlcal Permit Fees*
Supervising electrician Subtotal S _
signature required: Plan Review(25%of Permit Fee S _
Print Name- 'p ,3 c. M q2 f Q w_ State Surcharge(8%of Permit Fee S
aclTO'T'AL PERMIT FEE S
Authorize Notice: This permit application expires If a permit is not obtained within
Signature: _ ate:_ 180 days after It has been accepted as complete.
*Fee methodology set by Tri-County Building industry Service Board.
(Please print )--- —
i:\Dsts\Permit Forrns\E1cPermitApp.dm 01103
Electrical Permit Application -City of Tigard
Page 2- Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY: _
Feefor all systems............................................................ $75.00
Check Type of Work Involved:
Audio and Stereo Systems*
Burglar Alarm
IJ Garage Door Opener*
DHeating,Ventilation and Air Conditioning System*
Vacuum Systems*
Other
_COMMERCIAL WORK ONLY:
Fee for each system.......................................................... $75.00
(SI:e OAR 418.260-260)
Check Type of Work Involved:
L_1 Audio and Stereo Systems
QBoiler Controls
Clock Systems
Data Telecommunication Installation
L7 Fire Alarm installation
HVAC
Instrumentsti4.n
Intercom and Paging Systems
0 Landscape Irrigation Control*
M Medical
Nurse Calls
Outdoor Landscape Lighting*
Protective Signaling
Other
Number of Systems
* No licenses are required. Licensee are required for all
other Installations
i:\Data\Permit Forms\FlcPemJtAPpP92.doc 01/03
I
CITY OV TIGARD
Residential Certificate of Occupancy
f,
Permit No.:'�'a�Z' �� Address: G�
Owner/Contractor: �t/,AmtI w "_J-_ _ -
bate of Final Inspection: Inspector: CI-1
This structure has been found to be in substantial compliance with the provisions of the State of Oregon One& Two Family Dwelling
Specialty Code and is hereby approved for occupancy. _ _-