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12562 SW 116TH AVENUE ADDRESS: Sw Wo!"AW 1 E a un J rfl - � !:v -Wrdslmicto�lm\targetslbuildir.�!.doc; w J Page No. 1 CASE HISTORY FOR CASE NO.: MST97-0082 LEGEND HOMES 12562 SW 116TH AVE 12/03/97 Action Description Req/ Schd/ End/ Action Notes Dinp By Update Upd `ode Sent Done Done Date F31; MSTA005 Application received 03/26/97 / / 03/21/97 PASS JOA 03/26/97 JD MSTA008 Permit _rented 03/26/9' / / 03/26/97 PASS JSD ..3/26/97 JD MS'rA010 Check for prcl. restrict. 03/26/97 / / 03/26/97 PASS TSD 03/26/97 JD MSTA012 Plane routed to Plans Examiner 03/26/97 / / 03/26/97 PASS JSD 03/26/97 JD MSTA026 Plans approved by RPE 03/31/97 / / 03/31/97 APPR RDP 03/31/97 RDP MSTA030 Reviewed plans routed to DSTS 03/31/97 / / 03/31/97 RDP 03/31/9'1 RDP MS1'A032 DST Poo,,Review Completed / / / % 04/01/97 PASS JDA 04/01/97 JDA MSTA080 (F) Ready to issue / / / / 04/01/97 PASS JDA 04/01/97 JDA MSTA092 (F) Issue combinat.on permit / / / / ^4/03/97 PASS JMH 04/03/97 DST MSTA095 Issue plumbing signature form / / / / 04/20/97 RECD JM 08/18/97 JT MSTA097 Issue electric signature form / / / / 04/11/97 RECD JT 04/21/97 JT MSTA700 Erosion Contol 03/31/97 / / / / 03/31/97 RDP MSTA705 Footing Insp 03/31/97 / / 04/10/?7 APP KS 04/11/97 KBS MSTA706 Foundation Insp 03/37./97 / / 04/11/97 APP Ks 04/11/97 KBS MSTA710 Post/Beam Structural 03/31/97 / / 04/21/9'7 APP KS 04/22/97 KBS MSTA711 Post/Beam Mechanical 03/31/97 / / 04/21/97 AFP KS 04/22/97 KBS MSTA712 Underfloor insulation 03/31/97 / / / / 03/31/97 RDP MSTA717 PLM/Underfloor 03/31/97 / / 04/18/97 PASS MS 04/21/97 MP. MSTA720 Mechanical Insp 06/19/97 / / 06/17/97 PASS TLP 06/19/97 J•H MSTA72.2 Plumb Top Out 04/01/5' / / 06/02/97 PASS MS 06/01/97 J' MSTA723 Electrical Service 04/01/97 / / 06/06/97 AFB;Entry - check panel being flush with FAIL BPP 06/06/97 ' it finish surface at final (384-7) stair light box not firmly mounted to building c'_ructure 110-13(a), 410-15(a)1!EC. Load wire, in meter base not fully inserted into lug. Sect. 110-14(a)NEC. Lin" wire at main circuit breaker is not fully inserted into lug. Lug appears to be deformed Sect. 110-14(a) NEC. MSTA723 Electrical Service 06/12/97 / / 06/10/97 FAIL BRP 06/12/97 J*H MSTA724 Electrical Rough In 0./31/97 / / 08/06/97 PASS HRP 08/18/97 l•P 6.. ce N Y H J C,7 W ..1 Page No. 2 CASE HISTORY FOR CASE NO.: MST97-0082 LEGEND HOMES 12562 SW 116TH AVE 12%03/97 Actico Description Req/ Schd/ End/ Action Notes Disp By Update Upd Code Sent Done Done Date By ---' -----`------------------------ -------- -------- -------- ------------•--------------------------- ---- --- -------- MSTA725 Framing Insp 03/31/97 / / 06/11/97 1. 2^ concrete r�q'd around plenum - FAIL GL 06/16/97 J+H garage flror and 3rotective barrier req'd. 2. Add support under notched glu-lam hips above stairway or provide engineering. 3. Gas line pressure below 1Opsi 4. Lateral brace trusses per trnse details. 5. completely firentop lid of gas vent and ductwork upstairs. 6. Fireblock dropped ceiling at master shower. 7. Connect exhaust duct to £ar, lowar bath. S. No listing labels ott fireplace vent. 9. Tv & cable wires require whatever clearance is req'd from fireplace tent Please provide venting information. MSTA725 Framinq Insp / / / / 06/17/97 PASS TLP 06/19/97 J-11 MSTA726 Shear Wall Insp 03/31/97 / / 05/20/97 no plans on site- unable to inspect FAIL RB 05/21/97 RB MSTA726 Shear Wall Insp 05/21/97 / / 65/21/97 PASS DD 05/21/97 JT MSTA726 Shear wall Insp / / / / 07/03/97 Approved subject to corrections: PASS RS 07/10/97 RB 1. Shear nailing not applicable at gypsum. 2. Wonder board at stall shower. MSTA735 Gas Lino Insp 03/31/97 / / 06/11/97 Gas line pressure below 10 psi FAIL GL 06/16/97 J-H MSTA735 Gas Line Insp 06/19/97 / / 06/17/97 PASS TLP 06/19/97 J-H MSTA74o Insulation lne,) 03/31/97 / / 06/23/97 1. gave baffle missed at master bath. PAIL RS 06/25/97 J•H 2. Extend batt insulation at vaultod LL ceiling above blown insulation or CL provide batts. f— vl } MSTA740 Insulation Insp / / / 06/20/97 Do not drywall, contact inspector to FAIL RB 08/27/97 .T•H provide jobsite inspection reports. Reinspection fees waived. Unable to ilc inspect without electrical service; W roughin; framing and insulation reports. J MSTA745 Gyp Board Irep 03/31/97 / / 07/03/97 PASS RS 08/28/97 J+H MSTA751 Rain drain Insp 04/01/97 / / 04/14/97 PASS MS 04/15/97 MRS MSTA760 Water Line Insp 03/31/97 / / 04/14/91 PASS MS 04/19/97 l9LS MSTA765 Appr/Sdwlk Insp 04/01/97 / / 06/25/97 PASS PI 06/27/97 B'W Page No. 3 CASE HIS'rORY FOR CASE NO.: MST97-0082 LEGEND HOMES 1.2562 SW 116TH AVE 12/03/97 Action Description Req/ Schd/ End/ Action Notes Limp By Update Upd Code Sent Done Done Date By ---- --------------—'---------—-- ----- -- -------- -------- --------------------------------------- ---- --- -------- --- MSTA790 Electrical Final 03/31/97 / / 08/15/97 Master bathroom recept. plate not flat FAIL HRP 08/18/97 B•P 'Al wall surface. Art.410-56. Switch plate at entry not flat on wall. Sheetrock gap exceeds allowed minimum.Art.370-20,21.and 410-56. cut in box, over mantle not approved on new constructicn.Art.370-23. MSTA790 Electrical Final / / / / 08/19/97 PASS BRP 08/19/97 B•P MSTA795 Mechanical Final 03/31/97 / / 08/25/97 PASS KS 08/25/97 J•H MBTA797 Plumb Final 03/31/97 / / 08/15/97 PASS MS 08/18/97 MRS MSTA799 Building Final 03/31/97 / / CB/25/97 Gypsum inspection approved on 070397 b,, PASS KS 08/25/97 J+H KS (Finals plumbing, electrical and erosion control appr,rved.) 1. —:i unused opening at rear of structure. 2. Vertical bare missed at rear deck. 3. Clean all loose wood/debris from crawl 6 recover vapor barrier an needed 4. Seal around electrical cable at furnace/ceiling, also spot nails at garage. MSTA799 Building Final / / / / 08/27/97 PASS KS 08/28/97 J+H MSTA960 (F) Issue Cert. of Occupancy / / / / 09/26/97 mailed 12-3-97 JT 12/03/97 S+W CL CC F— tn T rl .f] CJ W J I CITY CIF TIGARD �. DEVEL.OPME14T SERVICES 13125 SW Hall B!vd., Tigard,OR 97221 (503)639.4171 CERTIFICATE OF OCCUPANCY PERMIT #. . . . . . . M5"T G'7 rl►IZrCr, DATE T SUED: 013/,:6/97 PARCEL: :'_Si 1 O3BD--HG023 SITE ADDRESS. . . t 12562 SW 110TH AVE SUBDIVISION. . . . : HUNTER' S GLEN ZONING- R--4. 5 PD BLOCK. . . . . . . . . . LOT. . . . . . . . . . . . . 1@23 JURISDICTION:TIG CLASS OF WO1W. :NEW TYRO' Fan USE. . . :GF TYPE OF CONSTR:5N OCCUPANCY GRP. r R3 OCCUPANCY LOAD-,!: Hemarks : New SFU Owner a I_F:QEND HOMES 6900 SW HAINES ST TIGARD OR 97223 Phone #: 6i:-.'0—k3080 Contractor: L_LGEND HOMES CORPORATICIN 7160 SW HAZELFERN RD. STL 100 'TIGARD OR 97224 Phone #- 6,20-8080 Reg N. . : 000006 7hi4. Certificate grantA oCM(penry of thi. ibovr t- eferenced bUilding or portion thereof and confirms that the britlding has been inspected for compliance with the Statue of Oregon Specialty Codes for the yt'OLA rcc.upancy, and use under which the �eef'evenced per,prlt was issued. Ln BUILDING, INSPECTOR BUILDTNt, 01'F ICIAL J POST IN CION 3P I C:UOUS PLACE J 1 CITY OF TIGARD BUILDING INSPECTION DIVISION 24-Hour Inspection Linc: 6394175 Business Phone: 6394171 Date Requested: �U M.M. v— P.M. — MST: / L/ / — Location: _ �2,, o z{—S. L�L_�� L 072,3 BUR Tenant:_ _ Suite:__ —Bldg:— NEC: r— Contractor: Phone: PLM: Z�C��) ��� PLM: Owner: — _ __._- _ Phone: _ --— ELC:— —_ -- --- -- — — ELR:� — _ SIT: BUILDING LD n'q PLUMBING '1tNF H lmr ELECTRICAL SITE Site ost/I3eam Post/Ilcam Post/Beatn Cover/Service Sewer/Stonn Footing Roof UndFl/Slab Rough-1n Ceiling Water Line Slab Framing Tcp Out Gas Line Rough-in UG Sprinkler Foundation Insulation Sewer Ilood/Duct Reconnect Vault Bsmt Damp D"all Stonn Furnace Tmy Service misc. Mr.sonry Cciling Rain Drain A/C / I IG Slab Shear/Sheath Fire Spklr/Alm Crawl/Pound I h I lent Pump Ale Low Voll 6kppruvc Approved Approved Approved Appr/Sdwlk Not A-r:a-,ed Not Approved Not Approved Not Approved AL FINAL FINAL FINAL FINAL im a r h :A CJ W 17 Call for reinspectio C7 Reinspection Ice of 3r —required before next inspection C7 Unable to inspect 9 G --, Insp-dor: �___ Date:_ o Z 7 Pap. of CITY OF TIGARD MVELOPMENT SERVICES MAS7EP PERMIT PERMTT #. . . . . . . : M'7Tq7l-oop-, 13125 SW Hall Blvd,,Tigard,OR 97223 (503)b39.4171 PATE T'751.1ED: 04/01/c37 12S-67— PARr7F-1. : 2q- 10113171 -FIG@23 r,1,F M 7ONTNr: R - 4, - PT) ;17 ncK. . . . . . . . . i rl Ir. . . . . . . . . . . . . .07,-� 7L1R7,7,r)j(-TT0T: TTr:, '-arks: New SFD ----------------- -------------------------------- pull ----------------- ---------------------------- REISFUE: 7.....1. : 2 FLOOR AREAS---------- BASEMENT...: 0 sf REQUIRED SMACKS---- PcQ'—:' CLASS OF WORK.-NEW . .... . 7 26 FIRST—.- 1026 sf GARAGE...... 79of TYPE OF �!q—:SF FLOOR LOAD.... - 9e SECOND—- 1026 sf CRORT..,...... 16 FAF""' TYPE OF COKST. :SN DWELLING UNITS: 1 FTRISMT: 0 sf RMPT......... . 9 �CrUpAqry rlRp,.Rl BORF: 3 9TH: I TOTAI-------: 2052 of VALUE„5: 152197 REAR....,...... 21 ------ ------------------- ------ -------------------------- PLUMBING ------------------------------------------------------------ SINKS... ..... . I WATER CLOSETS.: WASHING MACH— : t LAUNDRY TRAYS.: 0 PATH DRAIN ft: IN LAVATORIES..., : 1 DISHWASHERS.., : I FLOOR DRAINS—! 0 SEVER LIRE ft: 1.00 SF PATH DRAINS: 0 ;AslMS.. Mtr t"MWrt(z.,. I 7 r3AR?AGF n7sp.. : I WATER FEA',14FPS, WATER LINE ft: IN 9rMW PREM, Ok ------------------ ------------------ ------------- MECRAVICAl.- ------------------ - ----------------------- - -- - ----- 7UETPES I" ........... — riryF 1 FURN < 1M I POLL/CMP < 3HP! "N' FANS....,: 4 Rq. I CAS FURN ):INK 0 1,,NTT YEAITPS.. : 0 ...... 0 to rIMP FURNACES: 0 VENTS,.....,.. 0 GA," ------------ ------- ELECTRICAL ------------- ------ - ------ -.71FEEDEP—, --TEMP qPVCIFFEDEPS— --PPANCP CIRCUITS--- --- -4-7'-:.ANEDUS---- --ADP'!. !q5PFrTTnN 0 200 f 0 , 200 )mp..- 0 W/SVr OR MR..- 0 PM ':RIGATION! 0 PER INSPECTION! 201 400 amp.. : t~ 201 - 400 9mr, 0 lot V/0 SVC/FDR: 0 SIGN/OUT LIN LT- 0 PER ROUP,...., : 0 qrF5v- 0 401 600 imp..: 0 401 - 600 0 EA AM RR fIR: 0 SIGNALMIFI—,- 0 IN PLANT....... /FDR P 601 10,00 amp' ! 0 501#81ps-I0Pe V: 0 MINOR LABEL -10: 0 1POO4 app/volt.: 0 - ------- PLAN REVIEW SErTION ------ --------- --------------- 6@0 V NOMINAL: CLS AREA/SPC Or ------------------------------------- FNERGY --------- ------- ......-------------- ..................... ...... --------------- VrIJUF c,Mr" AMIn 1, STEREO, - A!,M.... LRDFr OM HVAC.,...,.. APA21E ^FFNFF,- X MF;)Trk VAC.,..,,.,,.. . A-A v f 5YsTrns! W, tart. P HOMES CDR -!0 N WtLFERN Fr -oivl;tif�ns io0iinel in t�v 'rij4rd rode, State if Ore. Spee!f,!+v Codes one all other 'lye, i—rdsncp vith qv--Pe plons. This reriP0 will P�:pire if v10, is not stirff.0 within 180 j, rlt•fj thjr, f!? ------------ ---------- ------------------------------ ---------- Servi Apprtsd0 �p Final inspection Building Final CITY O F TO GAR D SFI-'r' CONNECTTON DEVELOPMENT SERVICES PFRMT PERMIT _T 0. . . . . . . . q - JIM 13125 SW Hall Blvd., Tigard,OR 97223 (503)639-4171 SWR PATE. TSSIJFD: 04/02/97 r'AR(-FL: 'JPDTVTq-Tr**. WUNNTER (')I-T'.N 70f1TNGt R-4. 5 Pn '.Orl<. . . . . . . . . . . . . t021,t JURTSDICTTON : TTCt, 7NANT NAME. . . . . .LEGEND HOMES '-A N fl. . . . . . . . , - F7TYT1JRF UNTTS. . . 0 '.A`'t= C,r WORE, . - NFW DWPI-A.TNG UNTTS75, , I `,'PF r)r I-1133F. , , . -c-,F NO, nr P1JTI,DTNCi5;: 1. 1,JqTA1J, TYPE. . . . - LTP7WP TMPFRV SURFACE! 0 Sf —�,i r k r., New 57P w n y r --_____ - ----- - F E P 53 17 ;1 m o u n t by datp r r-p '?GENT? P9MF17 IMM SW flATNEF, ST p RMT 2200, 00 YMH 04 /01/97 97 -29,','6qr Tr,ARD riR 97221 T14SP 15. 00 IMM 04,01/97 97-292r,9(.:. t rnQ`i TnTAT. REG!.j'TRFT) TN9PErTT0Nr-' Applirant agrepe tv ^.ovply vtth all the rvlPF and regulatlons Tnqp,---+.inri ,',- 11, I iflad 59vage Agency, The pervit expiree IPA days from ,'pit �,,td. ThL The total amovot paid will he forfeited if the "lie Agency drriq not quaraitpL, the scrurmay rf lihp !L- 5evo., If the sever is not located at ihi,, opsPurp"_0 sten, the InetaPer snal! prr±gDP& 3 fpof In 911 dirprtionp from a distance 90pn, Tf ns' Fo Iora>pd, the Jre+.qllpr she'] purehRsp 'Top and Side Serer" Perm!I 'lip Agency vi l install a litpre* T Plan Check# 3 .ITY OF TIGAR.D Residentia! Building Permit Applicatior: R,,,;'d"' � 3125 SW HALL BLVD. ew Construction Additions or Alterations Date Recd 3 IGARD, OR 97223 ( '� Single Family Detached or Attached Gate to P ' _ 503) 639-4171 Date to DeT Permit# TNA%T n� L ► Print or Type Called ! mplete or illegible applications will not be accepted ----- Name of Subdivision LotName LEGEND HOMES JobHU I' T Fl? ' S GLEN Z Sb L�_ ; Architct-.t Mailing Address Addres to ddreAs 6000 SW Plaines St . II 116th Ave nuc — Ci://State Zip Phone cName LEGEND HOMES _ Ti ard , OR 97223 1620-BOPn Name Owner MLuling Address F R O L L ICH _ 6900 S W Haines St . Engineer ineer Mailing Address City/State 7i Ph ne 6969 S W Hampton 5t . Tigard , OR 9'223 62c0-8080 — _ _ City/State Zip Phonu Name _ Tigard , OR 97223 624-, 005 General I_L G E N D HOMES Uescrlbe work new O' addition O alteration O repair u Contra.cte k:.,mg,>ddre5s tc he dune: 6900 S W Haines St . Additional Description of Work: City/State Zip Ph.me Tigard OR 97223 620-8080 Oregon Const,Cont. Board Lic.# Exp.Date — AttachCopyof 060563 6/19/97 Project �(�J�) Current COT Business Tax o, ".ict(o" Exp.Date Valuation T Licenses 4371 6-11fi97 NEW CONSTR- IJ�ION ONLY: Y Name / S/-! _�. "Mechanical SUNGL.OW INC . _ _ Sq.Ft. Hos Sq �G. ge: Sub- Mailing Address 7 t,ontractor , 2428 S E 105th Corner Lot Yes N� F!ag Lot Yes N citylS.ate Zip Phone (check one) L(check one) 1 Portland ---OR 9721 253-7789 Restricted Audio/Stereo Burglar Oregon Conct. C:;nt. Board Lic.# Exp. Date ` Energy System Alarm Attach Copy of 48131 7 — A Current COT Business Tax or Metro# Exp.Date Installation Op a Opener Doer HVAC _Licenses 1 J-c�/ /—/ -�� Opener Systems Name (check all that Other. Plumbing WOLCOTT PLUMBING aFP:,/). _ Sub- -'ailing Address Will the electrical subcontractor wire for all 'fes No PO Box 2007 restricted energy inst0lations? Contractor CitylStat� Zip Phone Has the Subdivision Plat recorded, N/A I Yes No Gresham OR 97030 667-9891 Oregon Const.Cont. Board Lic.# Exp. Date Reissue of MST# Solar Compliance Attach Copy of 2 33 n 7 10/19/97 _ _ (Calculation, Attached) Current Plumbing Lic # Exo Date I hereby acknowledge that I have read this application, that the Licenses Z 6-2 08 1'B 8/31/97 information given is correct, that I am tFR owner or authorized agent of C07 Business Tax or Metro# Exp. Date the owner, and that plans submitted are in compliance with Oregon 96-4281 12/96 State laws. — Name Sign re of Own /Ageni Date - Electrical GARNET' ELECTRIC Contac rson Na'90on J Sub- Mailing Address 21785 SW I V Highway Contractor FOR_U FILE U, E ONLY: _ Cl /State Zi - ty e Phone Plat# Map(TL#: ' Aloha , OR 97006 591-1320 G �I Oregon Const.Te.onE Board Lic.# Exp,Date Attach Copy of 1/ A /,/ � Sethacks Zone:. Solar* Current Electrical Lic.# Exp.Date ,�. , "�'' Licenses 34-305C /�� 1;J I 4 ��V„// COT Business Tax or Met[o# P.Date Engineering Approval: Planning Approval: TIF: stsvnsi app.doc ._c � `� _ r i # Account Description ril &jnLF_L Bal. Due c Permit i + ``'` MST. (BUILD) aU •�D Pl-jmb. Permit (PLUMB) 60 > ' : 0 Meeh. Permit (MECH) �`'� '' v ELC/ELR Permit "-� t}� 0- (ELPRMT.) _ �� m _ a �5. po State Tax (TAX) ��- Bldg.- Plumb: ldg:Plumb: Mech- x. 73 ELC/ELR: ��,c_ 5 1�•as Plan Check MST: (BUPPLN) �� o I �• 58 Plumb: (PLMPLN) A iN _ Mech: (MECPLN) j k', 6 -3 CDC Review Sewer Connection (SWUSA) Sewer Inspection (SWINSF) Parks Dev Charge (PKSDC) �0�0 - oo JA Residential TIF (TIF-R) o — fy ✓ Mass Transit TIF (TIF-M� ) Water Quality if a Qo�1� eK����s (WQU,NL) NA ISA no VJ u l-u s Water Quantity (WOUANT) ! '' 10(j �- Erosion Control Psrmit (ERPRMT)7. erosion Planck/USA (ERPLAN) YJ } Erosion Planck/COT (EROSN) � Fire Life Safety (FLS) _I,I 1 TOTALS: (;(� `147�1.yo2- \q�f I JAI) i:W4t9lm9tapp.dUr. Rev. 7/96 PLOT LOT #23, HUNTEfi;R 'S GLEN 12555 SW 11et1 , AVENUE M,4P 0 251035D, TAX LOT M ol00 N.E. 1/4 OF SECTION 3, T.25, R.IUJ, W,.-j. C I T1' OF T IGAf;Rr:) El WATER METER W,45HIN(srON COUNT T , OREGON WATER LINE 55———-- SANITARY SEWER LEGEND (�`� STORM DRAIN (1E —"----- OF STREET `✓ 690 9.11. HAINE9 STREET TIGARD, OREGON MANHOLE Pune 2, SUM 200 97229-2814 ® CATCH BASIN 0MCX (003) 620-0000 r,Lz (603) 698-8900 PROPOSED STREET TREES ® STREET LIGHT - F;RE HYDRANT Lor 29 LOT 30 f 3mm'46'm4 _ _77­ m"UJ���'' ••��. 76.00, 223.4' <1Q �v SETS-ACK-LINE n / cv e L OT 23 / w ©;- 5,432 SCI. FT, BUCKINrSPAtl 2268'� � •►' GAr"CsE FLR. . 2.263' tla0. LOT L_ L07" 22 24 ___ ------ _—`- r --_ .l 8 G4P'46 0 ^' uj UTILITY • EASMENT SIDEWALK w aP 22-g'_ � ------�ry.:_� � `11• 9 I CURB CITY OF TIGARD 13125 S.W. iiALL BLVD. TIGARD, OR 972.23 IMPORTANT PERMIT NOTICE WOLCOTT PLUMBING CONT. INC P O BOX 2007 GRESHAM OR 97030 Plumbing Signature Form Permit # . . . . : MST97-0082 Date Issued. : 04/11/97 Parcel . . . . . . : 2S103BD-HGO23 Site Address : 1356$, SW : 16TH AVE Subdivision. - HUNTER' S GLEN B]-ock. . . . . . . . Lot . 023 Zoning. . . . . . . R-4 . 5 PD Remarks : New SFD 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 F;ombing Signature Form prior to the start of work. No plumbing inspections will be authorized until this completed form is received. AN K SIGNATURE IS REQUIRED ON THIS FORM UWNFR: PLUMBING CONTRACTOR: LEGEND HOMES WOLCOTT PLUMBING CONI'. INC 6900 SW HAINES ST P O BOX 2007 TIGARD OR 97223 GRESHAM OR 97030 Phone # : 620-8080 Phone # : o Reg # . . : 23847 h- Signature of Authorized Plumber Please return this completed form to the address above. ATTN: Building Dept. If you have any questions, please call 639-4171 , ext. #310 (a) CITY OF TIGARD 13125 S.W. HALL BLVD. TIGARD, CR 97223 IMPORTANT PERMIT NOTICE GARNER ELECTRIC 870 SE WALNUT HILLSBORO OR 97123 Electrical Signature Form Permit # . . • . : MST97-0082 Date Issued. : 04/11/97 Parcel . . . . . . : 2S193BD-HG023 Site Address : 1258ILSW 116TH AVE Subdivision. : HUNTERS GLEN Block . . . . . . . . i )t : 023 Jar_isdiction: TIG Zoning. . . . . . . R-4 . 5 PD Remarks : New SFD 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 REO.UIRED ON THIS FORM OWNER : '�L,EC`T`RICAL CUP'TRACTOR: LEGEND HOMES GARNER ELECTRIC 6900 SW HAINES ST 870 SE WALNUT TIGARD OR 97223 a: HILLSBORO OR 97123 Phone # : Phone 4 : T eg # • • : 001167 c X �- -� Si a ure o S Ing Electrician Please return this completed form to the address above. Al TN: Building Dept. If you have any questions, please call 639 4171 , ext. #310