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Report w_ °•' , Bo ler Pressure Vessel Registration �,,, 4 ) ; Department of Consumer and Business Services . ' :. '.e ,, Building Codes Division • 1535 Edgewater NW, Salem, OR Mailing address: P.O. Box 14470, Salem, OR 97309 -0404 '� --y�.am� , 0 - ©d X5, 5) 503- 373 -7499, Fax: 503- 378 -2322 MCA www.bcd. oregon.gov This temporary operation authorizations is valid for 120 days from the inspection date. ORS 480.585(4) states no ,persona shall operate a boiler or pressure vessel without a valid per a violation may result in fines lip to $1,000 (ORS 480.670) c . r b A# ��i i�11 Q C fl , y�r�, , {�pp/ , 61�Iy �' 1J ��t .��.(y� t q . i t Yi �'-S, -� r' v '. r 1..,'4 1' _ a £ I t ., c. W � 1 ,,,,,, 7 f � 0 ,,,, M R �4 3 ! (�' , , 1�� 4 c 9 4ti a bi w l,. t ` ;fi I : Y Y K. a ��i'w- . ..a..'N'.. �..., �, � 2.eH1�ti� � �.i- .�,.�,�.,.ol�.,�: ,..;lw -� etf'._!.W _Y�..:•.ae��+'g�h4., .1, };';��" ,��.�r"1�,�[l�Y'1��I� ,r'���5,��,t;�n fsf��`r�:� 6 a:�. Fyn /5.`it al f 5k Owner /responsible party name: Responsible party no.: \/. ( i , l n ri "L Address /(street or P.O. Box): City: .., , ` State: ZIP; _ _ Contact ndne: Phone: � Y } y A k Y'"4 6, r� .tw..Ian �r� �^.ep - f'P i'tiY Y"''�V is�'�a ,'` -'di P S "' - �,'.. u. eo :Ha rr n +. ff�r k1 r 'li s :v 3 . F i ! ate 1 11 4 ] 1yx i + , , ! > t .> ,.. L F ;.,Rt „wA ^4 0.. . :1, tQ, Rc'i . t N+. , m r a .,PS'I. {'r , [�. ' .' ( s '. .....� , d' i.) 'rtV ilt ' MP d . 1. fig, k % > i: W 'k :.!"w • _.: -' '.'" .��r e,te F nii.il,,,.urs - _" a N+br `�. :r.a';a Site name: Site no.: I • . Iru ci.u1 Address`(street or P.O. Box): !! City:_...-- City: c State: >• /y ZIP. Contact frame: Phone: yi' "f a ( i 'Y..aI�. °y i i'9'^ f , > d J. ', ti `?�t e t wit i[1' . ik .�..,y r G �i' t`C r,...rs,.�n.ng� ...d,. ar. ��.,a,�- �at�ar a !, ,�E 4 d Y . ° " '�'� �.t�,•+ .SFr Mans n��.;Yx,�r.� 7 rri ,..r. Y:! f...��t,r�r, ���N�!'��aw��* Location: ., •'`J Vessel permit no.: Expires: 1; k QC )AA p Agency of record: Code: Type: Service: I C. l F - T J H 14/ ) Mfr. name: 9 , ; - jYearofn1f.: Code symbol: NB no.: Serial no.: OR State no.: 1 nn a 3 -,—, n ri 1 0 c - , r, , -t, 1 1 C_ ► 14 DIA (inches): Length (inches): Volume: KW Boiler design capacity: Boiler horsepower: 1 / 1? T a r c ,, , ^ Z MAWP: SV SET: SV CAP: Fired /unfired: Fixed /port' • 4 P Manned: ' Alarm: Fuel: ! / I , f (.:4,-(41 n � Y c ' e .. _,' ; " c ' � /—; C�' r fir r., Installation Company: — Permjt_n t Special instructions: a �.� ` �- ,L , -_. } ` ,h _ : • ' ' 4..T Y l t y a'tl ��NigtWi Y'Y" *- titKIY'O,YYAIGIYV + r 1 t r ii • I /E: Replacement in kind: D Yes 0 No CSD - 1 verified:2 Yes O No O N/A Issue permit;. t Minor req.: O_ Inspection time: L�," Travel time: -- F'r =,' ' i (� Inspector signature �'-- T . ` , : t r 7= ' - insp. no.: — , f .. , • D appt�,, "� i �'..� D��(CT N T. i r „..„,,,...„,...,„,„, ,.,,.:,„,„:,..:, .:,„:„.„,,,,,„::,,,,„,„-,..„...,,:: ,. ,,, C�'( B J�1 .. r lS _RVICE White - BCD Yellow - Posting 440 -2596 (7)09 /CUM) can Boller & Pressure Vessel Registration Department of Consumer and Business Services Building Codes Division • 1535 Edgewater NW, Salem, OR Mailing address: P.O. Box 14470, Salem, OR 97309 -0404 503 -373 -7499, Fax: 503- 378 -2322 www.bcd.oregon.gov This temporary operation authorization n. is valid for 120 days from the :inspection date. ORS 480, 85(4) states 11141 person shall_ operate a km.piier or pressure vessel without a valid permit; ao violation may result in fines up to $1,000 (ORS 486.670). ,c t f- r ; r'�wri.:,. ��SO,�va -n '�e�,k� [�f y e� y � /� +�tyK r' :� } e r�f� ,� �. ����`(�� �e��k� .. +:.0i7 i b ;qt: �..gtr'zta 5F 1' � K r i IY ". r11�y /- R `s iletl 1iiitiVONWPYI YF " i'9 f•.VC/"II`t N e F l �akYc�� �� i i "��r �v ,. 0t 5 -.v. , [,r„,,,,w.. ry ,,.„ s4„ ,r ?w l ; r „ .. G. ,• n „ =. kM `w..i.. ' t y 6 t r l E . r 4 - %? Owner /responsible party name: Responsible party no.: 1/ , q, I ! ., ; t' Address (street or P.O. Box): +/I f �' 2 T CV c IA i C: 'i in '� , I .) II"/G , 7 l% r7 r."' f l City: ) I State: ZIP: Con n Phone: � d `{ �' 7 i+�.`�+�rl aN -s r )< �IF;t y j� '� . `� }.�,r�..iJ�. Y .y.. .,.l �* ' y 1 �..: ' t. , ., M i �' Fj'i'��,.,`:�?�Zi. " {z* � .'b i 7 �t; r �F:!i:� : "` Y n -�:I { A,{,. `F'C+' ,wt A,� , ' 6 a }�4F1�} 4�� r' "K �R � i IN R �. , , 6 r r "� } ,. i , i 2 f,144.: ;:wiz .-0:., n,,,:17. 4s r F li� h a s 1.:7,„,;:,i , k�I L 4.- 044.x. ,.., -p. ;.: T.; ±.,.,s { d � ,r ..i t 11:W k r3 y, �r ,, h 1 e n Site name: , Site no.: V; :-/ t / Q ' 1 7 - . Add (street: or P.O. Box): // 6 , F F j4/ (', {'F -e.., / ' /i r, 4 G4 1 ; � 7 • , Q - /— City: 1 State: ZIP: 2 Contact name: Phone: v�'��1 fi;+swa��Ky °` ,,��yy..f` �. t�(b i':p^? - i , u, y +.�Y:1R k, 47�t'�r'F; jF +::' k 1 y i t . ` 5 I , a A . rA jf y '? , 7ti x "+} a.. 4: azi >w��a Jev�r. -? „r.� �f'4 �a, c a•Fx =rlr r . .' ,�, .yr.r;�.e.a. nn,r.•; u,ar�,..w .: 2+1:?r• -. , � w •k : y �� ��r.�i'd ' �se'.��.��,�S ; i>�r ` , " f;� * t' Location: Vessel permit no.: Expires: 1 lie i Agency of record: r Code: Type: Service: i i U e , h � .: ,- I • 7 k Mfr. name: t^ Year of mfg.: Code symbol:,', I t NB no.: Serial no.: OR State no.: D]A (inches): Length (inches): Volume: KW )K / Boiler design capacity: V �, Boiler horsepower: MAWP: SV SET: SV CAP: Fired /unfired: I 7 r° I 7 z;- Fixed /port: F .- PA: Manned: Alarm: Fuel: i _ t .- ,, `/ r Installation compan • Permit no.: -,_ i / Special instructions: "- 1 s T r1 u y " r i " 9 ! -St ldN rOt:SI919U9 q E� "� e. - a .. .. ., �.t',flr: ::... .. .'. i .rte,. ,: .: t 4♦is 4 t, l/E: Replacement in kind: O Yes ❑ No CSD -1 verified: ❑ Yes Cl No fa /A Issue permit:Al Minor req.: CI Inspection time: 7 Travel time: Inspector signature: }I 4 ' / `.` ..r Ins). no. / k ,, /ll Date: /6/7 O _' R EM �I g�,, C�SNSMUM Mt E RVICES White - BCD Yellow - Posting 440-2596 (7 /09 /COM)