12681 SW 116TH AVENUE A VENUE
o_
isirocordslmicro((m\targetsV)Lr,;.'irIfl.doc
w
r
Page No. 1 CASE HISTORY FOR CASE NO.: MST96-0515
LEGEND HOMES
12681 SW 116TH AVE
07/22/97
Action Description Req/ Schd/ End/ Action Notes Disp By Update Upd
Code Sent Done Done Date By
------- ------------------------------ -------- ------- -------- --------------•------------------------ ---- --- -----•-- ---
MSTA005 Applicrt.ion received / / / / 11/06/96 PASS DRA 11/07/96 PHN
MSTA008 Perm , 'rented / / / / 11/07/96 PASS DRA 11/07/96 PHN
MSTA010 Check for prcl, restrict. / / / / 11/13/96 PASS DRA 11/13/96 DRA
MSTA012 Plans routed to Plans Examiner / / / / 11/07/96 PASS DRA 11/07/96 PHN
MSTA026 Plans approved by Plans Exmr / / / / 11/12/96 PASS RT 11/12/96 BT2
MSTA030 Reviewed plans routed to DSTS / / / / 11/12/96 PASS RT 11/12/96 BT2
MSTA080 (F) Ready to issue / / / / 11/13/96 PASS DRA 11/13/96 DRA
MSTA092 (F) Issue combination permit / / / / 11/27/96 PASS DRA 11/27/96 DRA
MSTA097 Issue plumbing signature form / / / / 12/12/96 OK DRA 12/12/96 KAS
MSTA098 Issue o'.ectric signature form / / / / 11/27/96 PASS DRA 11/27/96 DRA
MSTA705 Footing Insp / / / / 12/04/96 APP KS 12/04/96 KBS
MSTA706 Foundation Insp / / / / 12/06/96 APP KS 12/06/96 KBS
MSTA710 Post/Beam Structural / / / / 12/13/96 N/R KS 12/13/96 KBS
MSTA710 Poet/Beam Structural / / / / 12/16/96 APP GS 12116/96 GES
MSTA711 post/Beam Mechanical / / / / 12/13/96 N/R KS 12/13/96 KBS
MSTA711 Post/Beam Mechanical / / / / 12/16/96 AFP GS 12/16/96 GES
MSTA717 PLM/Underfloor / / / / 12/13/96 PAS MS 12/16/96 MRS
MSTA720 Mechanical Insp / / / / 02/12/97 APP KS 02/13/97 KBS
MSTA722 Plumb Top Out / / / / 02/04/97 PASS TLP 02/05/97 UP
MSTA723 Electrical Service / / / / 02/07/^7 PASS MJR 02/07/97 RJR
MSTA724 Electrical Rough In / / / 02/07/97 PASS MJR 02/07/97 R
MSTA725 Framing Insp / / / / 02/11/97 #-1- truss clip missed at girder truss DIS KS 02/11/S7 KBS
#-2- adjust eave vent at closet
#-3- provide attic access
#-4- positive connection 6/8 beam above
entry
#-5- strap arross plate notched for
plumbing adjacent to kitchen
#-6- support fireplace vent at upper
level /' horizontal
MSTA725 Framing Insp / / / / 02/12/97 APP KS 02113/97 KBS
MSTA726 Shear Wall Insp / / / / 01/31/97 APP GS 01/31/97 GES
MSTA735 Gas Line Insp / / / / 02/11/97 #-1- gas piping pt test= 30 psi for 15 APP KS 02/11/97 YBS
CZ, minutes
y MSTA740 Insulation Insp / / / / 02/14/97 APP KB 02/18/97 KBS
�;— MSTA745 Gyp Board !nsp / / / / 02/21/97 #-1- seal joint above furnace either A/N Kf; 02/24/97 KBS
with gypsum or twenty gauge
L
sheet metol
rj #-2- remove mud/tape from B vent will
recheck at final
MSTA745 Gyp Board Insp / / / / 02/24/97 A/N KS 02/25/97 KBS
MSTA755 Rain drain Insp / / / / 12/10/96 PASS MS 12/11/96 MRS
MSTA760 Water Line Insp / / / / 12/10/96 PASS MS 12/11/96 MRS
Page No. 2 CASE HISTORY FOR CASE NO.: MST96-0515
LEGEND HOMES
12681 SW 116TH AVE
07/22/97
Art's: uescription Req/ Schd/ End/ Action Notes Disp By Update Upd
1:cvje Sent Done Dore Date By
----- -------------•---------------- -------- -------- -------- --------------------------------------- ---- --- -------- ---
MSTA765 Appr/Sdwlk Insp / / / / 02/24/97 OK PASS PI 02./24/97 RB
1. FEL1AT C'JI-D JOINTS.
2. COMPACT ROCK (CARUREM ST2)
MSTA790 Electrical Final / / ; / 04/03/97 GROMMET FOR T-STAT WIRE; SEAL DOORBELL DIS GS 04/03/97 GES
TRANSFORMER AND AT DOWNSTRS SMK DET; SMK
DET NEEDED AT LOWER BDRM; NO BULBS IN
MSTR BD SCONCES
MSTA790 Electrical Final / / / / 04/04/97 APP GS 04/07/97 GES
MSTA795 Mechanical Final / / / / 04/09/97 A/N KS 04/10/97 KBS
MSTA795 Mechanit.al Final / / / / 04/09/97 APP KS 04,11/97 KBS
MSTA795 Mechanical Final / / / / 04/11/97 APP KS 04/11/97 KBS
MSTA797 Plumb Final / / / / 04/07/97 PASS MS 04/07/97 MRS
MSTA799 Buil.A ng Final / / / / 04/09/97 #-1- support gas piping at water heater DIS KS 04/10/97 KBS
#-2- remove mud/tape from B vents and
install collar
#-3- smoke detectors not workinr
MSTA799 Buildi„y Fin, ( / / / / 04/09/97 APP KS 04/11/97 KBS
MSTA799 Buildfnn Final / / / / 04/11/91 APP KS 04/11/97 KBS
MSTA960 (F) Issue Cert. of Occupancy / / / / 04/09/97 mailed 7-22-97 07/22/97 S*W
MSTA970 Case Finaled / / / / 04/09/?' APP KS 04/11/97 KBS
a
cc
Vn
r
F--
J
C
C9
til
J
CITY OF TIGARD
.
DEVELOPMENT SERVICES
13126 SW Hall Blvd., Tigard,OR 97223 (503)639-4171
CERTIFimrc- OF
OCI.:UPANCY
PERMIT 1. . . . . . . ; MST96-0515
DATE Uz3SUED: 04/09/97
PARCEL. 2S)103LAD--HG01,':-*
11 TE ADDRESS. — i 1268t SW WTH AVE
3UBDIVISION. . HUNT'ER' S GLEN ZONING-R-4. 55 Pr)
BLOCII. . . . . . . . . . LO :. . . . . . . . . . . . s011-2 JURISDICTIONt
CLASS Or WORK. tNEW
TYPE OF USE-- . :SF
TYPOr CONST12j5N
OCCUPANCY GRP. :R3
OCCUPANCY LOAD;
PemarWt I New single-favily reiidenc*. PATH I
Owner,: __. _.._. .__.,_._...... .._.....__. __...___.__....__. .__._...._�._. _.
I_E.GEND
wnev-
LEGEND HOMES
01900 SW HAINLG GT
rIGARD OR 97223
Plione #c 62. 0-13080
I-EGEND Homuis CORPORATION
7160 SW HAZELFERN RD.
3U I TE 100
TIOARD OR 97224
Dholle #: 620 -BVIOO
Reg N. . -. 60563
Phis Certificate qt-ants occupancy of the above i,eftsi-enced buildirig or pov,tiott
r:hev-eof and confit,ms that the building has been inspected for compliance with
the 5-,tate or Ovegon Speci -alty Cods-s for, thw Ut,cm I occ7upancyj and use under
oc
t-ihich the 1rofer,ncpermit was itisued.
Ilriu INSPECTOR OFFICIAL
�kril
CC
POST IN CONSPICUOUS PLACr
CITY OF TIGARD
DEVELOPMENT SERVICES MASTER FDERMIT
13125 SW Hall Blvd.,Tigard,OR 97223 (5031639.4171 r,FRMIT #. . . . . . . : MST96-0515
DATE ISSLJED: I1/2`7/96
P,ARCEL: 29103131)-FIG012
S I TE ADDRESS. .. . : SW 1. 1.6TH AVE
S1.JBD I k,I S I ON. . . . HLINTE R I S GLEN ZONING: RIi. 5 PD
BLOCK. .. . .. . . . . . . LOT. . . . . . .. . . . . . . .�!2' 1 1-!
Remarks; New single-family residence. PATH I
-- ------------------------------------------------------------- BUILDING --------------------------------------------------------------
REISSUE: STORIES.......: 2 FLOOR AREAS--------- BASEMENT...: 0 sf REOUTRED SETBACKS---- REQUIRED----------------
CLASS OF WORK.:NEW HEIGHT........: 23 FIRST....: 1124 sf GARAGE.....: 743 sf LEFT..........: 21 SMOKE DETECTRS: Y
TYPE OF USE...:SF FLOOR LOAD....: 40 SECOND...: 1295 sf FRONI......... 24 PARKING SPACES:
TYPE OF CONST.:5;1 DWELLING UNITS: i FINBSMENT: 0 sr RIGHT.........: 5
OCCUPANCY GRP.:R3 BDRM: 3 BATH: 3 TOTAL------: 2419 sf 174%7 REAR..........: 42
-------------------------- ----------------------------------- PLUMBING ----------------------—----—----------------------------------
SINKS......... I WATER CLOSETS.: 3 WASHING MPCH..: I LAUNDRY TRAYS.: I RAIN DRAIN ft: 0 TRAPS.........: 0
LAVATORIES....: 4 DISHWASHERS...: I FLOOR DRAINS—: 0 SEWER LINE ft: 0 Sr RAIN DRAINS: I CATCH BASINS..; 0
TUB,'SHOWERS... 3 G0BAGE DISP... I WATER tfEATERS.: I WATER LINE ft: 100 BCVFLW PRCVNTR: I GREASE TRAPS..: 0
OTHER FIXTURES: 0
----------------------------------------------------------- MECHANICAL -- -----------------------------------------
FUEL TYPES----------- FURN 100K 0 BOIL/CMP ( 3HP: 0 VENT FANS.....: 5 CLOTHES DRYERS: I
/GAS/ / / TURN ='W, I UNIT HEATERS..: 0 HCODS.......... 1 OTHER UNITS...: I
MAX INP.: 0 BTU FLOOR FURNACES: 0 VENTS.........: 0 WOI)DSTOVES....: 0 GAS OUTLETS...; I
-----------—-------------------------—--------------------- ELECTRICIR_ —-----
—RESIDENTIAL UNI',--- ---SERVICE/FEEDER---- --TEMP SRVCI'FEEDERS--- ---BRANCH CIRCUITS--- ----MISCELLANEOUS---- --ADDIL INSPECTIONS--
1000
NSPECTIONS—100@ SF OR LESS: ! 0 - 20@ imp..: @ 0 200 amp..: 0 W/SVC OR FOR..: 0 PUMPIIRRIGATION: 0 PER INSPECTION: 0
EA ADDIL 500SF.: 5 201 - 400 amp..: 0 201 400 amp..: 0 1st W!O SVC/FDR: 0 SIGN/OUT LIN LT: 0 PER HOUR......: 0
LIMITED ENERGY.: 0 40! - 600 pop..: 0 401 600 amp..: 0 EA ADDL BR CIR: 0 SIGNAL/PANEL... : 0 IN PLANT......: 0
MANF HM/SVC/FDR: 0 601 - 1000 amp.: 0 601+amps-1009 v: 0 MINOR LABEL -10: 0
10004 alp/volt.: 0 -------------------- PLAN REVIEW SECTION ------------------------------_-
Reconnect only.: 0 )=4 RES UNITS..: SVC/FDR)=225 A.- ) 600 V NOMINAL: CLS AREA/SPC OCC:
--------------------—---------------1___-- ELECTRICAL - HESIRICTED ENERGY ---—-----------—--------------------—--------
A. SF RESIDENTIAL---- B. COMMERCIAL-------------------------------------------------------------------------
AUDIO & STEREO,- VACUUM SYSTEM..: AUDIO I STEREO.: FIRE ALARM.....: INTERCOM/PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM..: 0TH: X BOILER.........: HVAC...........: LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER..: CLOCK..........: INSTRUMENTATION: MEDICAL........: OTHR: 1:
HVAC...........: DATA/TELE COMM.. NURSE CALLS....: TOTAL # SYSTEMS: 0
Owner: -----------------------------------Conn ------------------------------ TOTAL FEES:$ 2937.86
LEGEND HOMES LEGEND HOMES CORPORATION
6900 SW HAINES ST *7160 SW HAZELFERN R"u.
SUITE 100
TIGARD OR 97223 TIGARD OR 97224
Phone #i 620-8080 Phone 4: L-1-8080
01- Reg #..: 60562
cc
V) This permit is 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 permit will eypiri if work is not started within lee
days of issuance, or if work is suspended for more than 180 days.
------------------------------------------1_____.._ REQUIRED INSPECTIONS ----------_--------------------------------------------_
Footing
-----------------------------------------------------
Footing Insp PLM/Underfloor Framing Insp Gas Fireplace Water Sr,-:'.ce In Building Final
Foundation Insp Mechanical Insp Shear Wall Insp Insulation Insp Appr/Sdw;,( Insp Erosion Control
Post/Beam Struct Plumb Top Out Low Voltage Gyp Board Insp Electrical Final
Post/Beal Mechan Electrical Servi Fireplace Insp Rain drain Insp Mechanical -final
awl Drain Electrical Rough Gas Line Insp Water Line Insp �Fjna'.
F�v-mittee '-3ignati-we: ISSIAeC.1 D
Cal 1'4ot- inspect ion 639-4175
CITY O F TI G A R D SEWER CONNECTION
DEVELOPMENT SERVICES F,F R M I T
13125 SW Hall Blvd.,Tigard,OR 97223 (503)639-4171 PERMIT #. . . . . . . SWR 96--0321
DATE ISSUED:
PARCEL:; 25103BD—HGO12
:5I TFC ADDRESS. . . : 1.2680 SW AVE
SUBDIVISION. . . . : HUNTER' S GLEN ZONING: R.--4. 5 FID
BLOCK. . . . . .. . . . . . LOT. . . .. . . . . . . . . . .012
TENANT NAME.
USA NO. . . . . . . . . . . FIXTURE UNITS. 0
CLASS OF WORKI. . . :NEW DWELLING UNITS. . : 1
TYPE OF USE. . . . . :SF' NO. OF' BUILDINGS: 1
INSTALL TYPE. . . . : 11%_1 SWR 111FIERY SURFACE- 0 s
Remarks : New single--family residence. PATH I
ov)nev,. ------------- FEES
LEGEND HOMES type amos_tnt by date r-ecpt
6900 SW HAINES ST P R MT $ Z-200. 00 DRA 11/1-7/96 96-267069
INSP $ _1j'5. 00 DRA 11/27/96 96--287069
TIGARD OR 97223
Phone #: 620--8080
CONTRACTOR NO-r 01\1 FILE
if: $ 2225. 00 TOTAL
Reg if.
REQUIRED INSPECTTONS
This Appicant agrees to comply with ail the rules and regulations Sewer, Inspection
of the Unified Sewage Agency. The permit expires 180 days from
the date issued. The total amount paid will be forfeited if the
permit expires, The Agency does not guarantee the accuracy of the
side sewer laterals. If the sewer is not locatea 0 the measurement
given, the installer shall prospe�' 3 feet in all directions free
the distance given. If not so located, the installer shall purchase
"Tap and Side Sewer" Permit and the Agency will install a lateral.
�
ret-mittee zv33, q,1,1k1,e "O
ISSIAed By :
Call for, inspection 639-4175
- _
ITY OF TIGARD Residential Building Permit Application Plan ChetRecd By
3125 SV!1 HALL BLVD. New Construction Additions or Alterations Date Recd //- CC-W,
IGARD, OR 97223 Single Family Detached or Attached Date to P.E. /1 7 q(-.,
03) 639-417-1 Date to DST
t'rint or Type Permit# TS^ (''_0�j
Called
Incomplete or illegible applications will not be accepted
Name of Subdivision Lot# I Name
JobI LEGEND HOMES _
FI U N T E R ' S GLEN `'
Address Site Afess Architect Mailing Address
d
126E17 SW 116th Aveiiur, 6900 SW Haines St .
Name City/State Zin Phone
LEGEND HOMES Tigard , OR 97223 620-80E0
Owner Mailing Address Name
FROELICI-I
6 5 0 0 SW Haines�� S t . pp Engineer Mailing Address
Tigsard , OR 97'223 6'LOQ8080 g 6969 SW Hampton St .
Name City/State Zi Phone
LEGEND HOMES Tigard , OR 9723 624-7005
General Describe work new la" addition O alteration O repair O
Contractor iMailirg Address to be done: _
6900 S W H a i n e s SL . Additional Description of work:
City/state Zip Phone
Iirard OR 97223 620-8080
Oregon Const.Cont. Board Lic.ft Exp.Date
Attach Copy of 060563 6/19/97 Project -'
Current COT Business Tax or Metro# Ex .Date Valuation $ /
Licenses- Na e �; /"C ,J�li 67097 NEW CONSTRUCTION ONLY:
Name '/V-;,!'�/ _
Mechanical SUNGLOW INC . Sq.Ft. Hou seJ: y/r Sq.Ft.Garage:
Sub- Mailing Address y ,r
Contractor 2428 S E 10 5th Corner Lot Yes No Flag Lot Yes No
City/State - Zip Phone (check one) ((.heck one X,
I Portland . --OR 97216 253-7789 Restricted (i , Audio/Stet erg _, Burglar
Oregon Const, C:mi. Board Lic.# Exp. Date Energy System Alarm
Attach Copy of 48131 _ ' 4 C
Current j COT Business Tax or Metro# Exp. D to Installation Garage Door HVAC
Licenses 11276 C 6j, t - '/ j I'' } Opener Systems
Name u (check all that Other:
Plumbing WOLCOTT PLUMBIN ,
Sub- .!ailing Address - VVN the electrical subcontractor wire for all Yes No
Contractor l'0 Box 2007 restricted energy installations?
City/State Zip i Phone
Has the Subdivision Plat recorded? N/A Yes No
Gresham OR 97030 667-9891 t
Oregon Const.Cont. Board Lic.# Exp Date Reissue of MST# Solar Compliance
Attach Copy of _ 10/19/97 � (Calculatior, Attached)
Current Plumbing Lic.# Exo Date I hereby acknowledge that I have read this applicat.on, that the
Licenses 2 6-2.0 8 P B 8/3 1/9 7 information given is correct, that I am the owner or a ithorized agent of
COT Business Tax or Metro# Exp. Date the owner, and that plans submitted are 0 compliance with Oregon
96-4281 12/96 _State laws.
`r' Name Si ature pf o Date
r t�
�- IL
Electrical GARNER ELECTRIC F' ` ''
Eo ctpr5on,tgame '• Phone
-t Sub- Mailirg Address
L Contractor 21765 SW TV Highway FOR OFFICE USE ONLY:
w CitylStateZ!p Phone Plat# Map/TL#:
-' AIah3 , OR 97006 591-1320 ? /�
Oregon Const. Cont. Board L c# Exp. pate J L�• �- ��7C''�
Attach Copy of ' ! ' l - Setbacks Zon Solar
Current Flectricar Lie. # Ex . Dae ("'lr y \�r� `; z/
Licenses 3 4- 3 0 5 C
COT Business Tax or M fro# Exp.Date Enginee ng Approval. Plan ing Approval: TIF:
stsVnstap—pd o„
Permit # Account Dej rigtior1 Amount Amt. Pd. Bal. Due
�I'sryG sig MST. Permit (BUILD)
Plumb. Permit (PLUMS) Z � I v s;�,)
Mech. Permit (MECH) ,/ WOV
ELC/ELR Permit (EuPRMT; i 27� ..
State Tax (TAX) / j ," f .,/ 3
Bldg: J 33
Plumb.-
Mech:
ELC/ELF-
Plao Check
�SD
MST: (SUPPLN) 03. 3 IS 3. 3
_qggPlumb: (PLMPLN)
Mech: (MECPLN)
CDC Review (LANDUS) 1 �,y• ,r��
S�,RyG v5� Sewer Connection (SWUSA) _
Sewer Inspection (SWINSP) 3
Parks Dev Charge (PKSDC) /O j v
LO
Residential TIF
Mass Transit TI IkO (IIF_4A-T_�_ --------7``''�r�--
Water Quality (WQUAL)
Water Quantity (WQUANT)
Erosion Control PC mit (ERPRMT)
Erosion Planck/USA (ERPLAN)
Erosion Planck/COT (EROSN) 2LL4 aL �
Fire Life Safety (FLS)
i
TOTALS: (o�, ( ,?1 �� /Z • b'(o
t pp
doc
Rev. 7196 --
9 �.
• 11/:7,'90 11:47 '8503 BQA 7297 CITY OF TIGARD 002/004
CITY OF '11GAi�D
OREGON
'.November 27, 1996
1Vr..r.Larry York
Metrix Developm-ut Corp.
6900 SW Haines Street, Suite 200
Tigard,OR 97?2�-2.514
RE: FU=,RS GLEN TIF CREDITS
Dear Lary:
Er_closed is your Credit Voucher for the J F credit in the amount of 4 39,296.09. A copy of this
vvu&..er must be presented by your builders eanh rime they come in to n'utain a building permit.
We will keep the master copy ort Gle in our office(at front counter)+a keep track of the cre&t3
used. This voucher will go into effect w;of today-
if you
oday_ifyou have T.iestiovs,pleme call.
Sincerely,
Brian D. Rager,PE
Development Review Engineer
c: Jill Aldrich,Development Service;
VENIARRAM 11177nuNI TIF
f-
J
L
i iJ
13125 ,%%N Hall Bred„ Tlonrd, OR 97223 (603) 639-4T71 TDD ;503) 681-2772 ---
11/27/98 11:48 TY903 894 7297 CITY OF TIGARD Q003/004
CITY OF ITIGARD Credit No.:
Date Issued: 11!2709
Engineering
Authorization
A L Date: 11127!96
TRAFFIC IMPACT FEE
CREDIT VOUCHER Land Use
Casefiie A?o.: ---- 000--
in accordance with Ordinance 379" iirix Development G�p�r_ation
tnw.w s.wkv�
is entitled to39.?_9_6�0$in Traffic Impact Fee Credits that can be applied to TIF charges
for development on lot(s) L-2 of the HuntMS-0-le-0 Development To use this credit,
present this forrr,at tho time of issuance of the building permit.
Date Permit Numbers L,ot Numbers Credit Used Ba'ance�
Beginning Balsnct
G Balance;coned forward to TIF Credit No.
Y
• Ordirian(*319 provides br an expiration 7 years from authodration.
r
(Jae Additional pages if necessary.
• 11/27/98 11:48 2303 884 7207 CITY OF TIGARD R004/004
• Y
Date Per,nit Numbers Lot Numbers Credit Used Balance
Beginning Balance
J
Balance carried forward to TIF Credit No
• Ordi,tance 379 provides for an expiration 7 years from authorization
R W*dM TWOO t C
CITY OF TIGARD
\ 13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
WOLCOTT PLUMBING CONT. INC
P O BOX 2007
GRESHAM OR 97030
Plumbing Signature Form
Permit # . . . . : MST96-0515
Date Issued. : 11/27/96
Parcel . . . . . . : 2S103BD-HG012
Site Address : 1268/ SW 116TH AVE
Subdivision . : HUNTER' S GLEN
Block. . . . . . . : Trot : 012
Zoning. . . . . . : R-4 . 5 FD
Remarks :
New sinrjle-family residence. PATH I
Your company has been indicated as the plumbing contractor for the permit indicat,d above. In order
for the plumbing permit to be valid, please have the appropriate indiviau:,l fro-, 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.
N INK SIGNATURE IS REQUIRED ON THIS FORM
OWNER : PLUMBING CONTRACTOR:
LEGEND HOMES WOLCOTT PLUMBING CONT. INC
6900 SW HAINES ST P O BOX 2007
TIGARD OR 97223 GRESHAM OR 97030
Phone # : 620-8080 Plione # :
Reg # . . : 23847
N xQ
~ Signature of Authorized Plumber
J
J se-e-turn this completed form to the address above.
?fuTTN: Building Dept.
If you have-any que§t'ions, please call 639-4171 , ext. #310
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
GARNER ELECTRIC
21785 SW TV HWY
#L
ALOHA OR 97006
Electrical Signature Form
Permit # . . . . : MST96 -0515
Date Issued. : 11/27/96
Parcel . . . . . . : 2S103BD-HG012
Site Address : 1268 SW 116TH AVE
Subdivision. : HUNTER' S GLEN
Block. . . . . . . : Lot : 012
Zoning. . . . . . . R-4 . 5 PD
Remarks :
New single-family residence. PATH I
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 e:ectri.,:an
is required.
Please have the appy opriate individual from your company sign below and return this Electrical
Signature Form prior to the start of work. No electrical inspections will be autlinrized until
this completed form is received.
AN INK SIGNATURF !a REQUIRED O',' THIS FORM
OWNEP : ELECTRICAL CONTRACTOR:
LEGEND HOMES GARNER ELECTRIC
6900 SW HAINES ST 21785 SW TV HWY
#L
TIGARD OR 97223 ALOHA OR 97006
Phone # : 620-8080 Phonecc
# :
Reg # . . .: 116721
T
X ��
Si ature of SO ery n9 Electrician
G
LLJ
-� Please return this completed form to the address above.
ATTN: Building Dept.
If you have any questions, please call 639 4171 , ext. #310
SW W
ANUS ST,%�
r rrr rrrr m
ON a 1?440 O
Na SW BAMBI LN 11577
r 12454 j
V
J M d1 0 cn 510
11 12453 1Q450N
N .►
UI 12511
12526 12519 �n
1251_4 � v
12517
XOL .
_ CC*
"• 1.
12 12537 --% 12549
SW E ROL ST. 12540
s
0) 12555 12557
�Cl)_ 012,562412602
D
562 M 12575
Z S12586 c= C
w olY
N Z m
M -I 12 W0 2609
1 12615
C.14 12626 (0 ��
� C 1263\9 12622
12618 m
OZO-
C 1265
(� 12664 m
Z
1:2W
N «
cro
'f" co 12679 coco
D
SW C,��KI EN ST.
12703 '
J 01
m 12719
-�
iJ
12720 12727 CP 1
I
TRACT '9'
12449 BAM N
2 +,53 _``
1 157
2535
45 245 24*50
Too
co O 2519 2526 51
O 2514
2537
o ERR L ST. 557 c.n 540
v, .
-- 71
N Z 12555 56 12554
V � 8 257 � _
D O (Tl 2983 y z 562 c' '
m p � °° m 609 m 12602
a 2Fs 15 z 10
2Ft39
�
262 7621
• 2 6'53
G2679 2648
Un N 2681
2664
CARMEN ST. 12
L 27
2703
716
2727 12
720
I