Permit t'
CITY OF TIGARD MASTER PERMIT
PERMIT #: MST2002 -00190
.�i� DEVELOPMENT SERVICES DATE ISSUED: 4/8/02
''�' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 14125 SW FERN ST PARCEL: 2S104BC - 00700
SUBDIVISION: HANDY ACRES ZONING: R -
BLOCK: LOT: 011 JURISDICTION: URB
REMARKS: 525 sq.ft. detached garage
BUILDING
REISSUE: STORIES: 1 FLOOR AREAS REQUIRED SETBACKS REQUIRED
CLASS OF WORK: ACS HEIGHT: 14 FIRST. sf BASEMENT. sf LEFT: 6 SMOKE DETECTORS:
TYPE OF USE: SF FLOOR LOAD. 50 SECOND' sf GARAGE: 525 sf FRONT: 37 PARKING SPACES :
TYPE OF CONST: 5N DWELLING UNITS: FINBSMENT. sf RIGHT:
VALUE: $ 12,495 00
OCCUPANCY GRP: R3 BDRM: BATH: TOTAL 0.00 sf REAR'
PLUMBING
SINKS' WATER CLOSETS: WASHING MACH: LAUNDRY TRAYS' RAIN DRAIN' TRAPS:
LAVATORIES. DISHWASHERS: FLOOR DRAINS: SEWER LINES: SF RAIN DRAINS: 1 CATCH BASINS'
TUB /SHOWERS: GARBAGE DISP. WATER HEATERS: WATER LINES: BCKFLW PREVNTR: GREASE TRAPS:
OTHER FIXTURES:
MECHANICAL
FUEL TYPES FURN < 100K: BOIL/CMP < 3HP: VENT FANS' CLOTHES DRYER:
FURN > =100K: UNIT HEATERS: HOODS: OTHER UNITS:
MAX INP: btu FLOOR FURNANCES: VENTS: WOODSTOVES: GAS OUTLETS:
ELECTRICAL
RESIDENTIAL UNIT SERVICE FEEDER TEMP SRVC /FEEDERS BRANCH CIRCUITS MISCELLANEOUS ADD'L INSPECTIONS
1000 SF OR LESS: 0 - 200 amp: 0 - 200 amp' W /SVC OR FDR: 1 PUMP /IRRIGATION: PER INSPECTION:
EA ADD'L 500SF: 201 - 400 amp: 201 - 400 amp: 1st W/O SVC /FDR: SIGN /OUT LIN LT: - PER HOUR:
LIMITED ENERGY: 401 - 600 amp: 401 - 600 amp: EA ADDL BR CIR: SIGNAL/PANEL: IN PLANT:
MANU HM /SVC /FDR: 601 • 1000 amp: 601 +amps- 1000v: MINOR LABEL:
1000+ amp /volt :
PLAN REVIEW SECTION
Reconnect only
> =4 RES UNITS: SVC /FDR> =225 A.: > 600 V NOMINAL: CLS AREA/SPC OCC:
ELECTRICAL - RESTRICTED ENERGY
A. SF RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: VACUUM SYSTEM' AUDIO & STEREO: FIRE ALARM: INTERCOM /PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM: OTH: BOILER: HVAC' LANDSCAPE/IRRIG: PROTECTIVE SIGNL:
GARAGE OPENER: CLOCK: INSTRUMENTATION. MEDICAL: OTHR:
HVAC: DATA/TELE COMM: NURSE CALLS. TOTAL # SYSTEMS:
Owner: Contractor: TOTAL FEES: $ 419.72
This permit is subject to the regulations contained in the
'LARRY HULTQUIST OWNER Tigard Municipal Code, State of OR. Specialty Codes and
14125 SW FERN ST all other applicable laws. All work will be done in
TIGARD, OR 97223 accordance with approved plans. 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'
Phone' Phone: Oregon law requires you to follow rules adopted by the
Oregon Utility Notification Center. Those rules are set
Res #: forth in OAR 952 - 001 -0010 through 952 - 001 -0080. You
may obtain copies of these rules or direct questions to
OUNC by calling (503) 246 -1987.
REQUIRED INSPECTIONS
Erosion Control Insp 8 Electrical Rough In Plumb Final
Footing lnsp Framing lnsp Final-inspection
Slab lnsp Shear Wall Insp
Footing /Foundation Dn Rain drain lnsp
Electrical Service Electrical Final
Issued By AP, , ., _ _ r ALL/ ' Permittee Signature : l '" / �/. ,
//i /
Call (503) 639 -4175 by 7:00 p.m. for an inspection needed the next b iness day /
.)
Building Permit Application
Ah.. Date received: d Permitno.:m _ D(j i rU
1�+j a1•" 1 1. City of Tigard
- ' Project/appl. no.: Expire date:
CiryofTigard Address: 13125 SW Hall Blvd, Tigard, OR 97223
Phone: (503) 639 -4171 Date issued: By: Receipt no.:
Fax: (503) 598 -1960 /
/� / Case file no.: Payment type:
♦ , / ' 1�, I Simple U
Land use approval: ►,t. 'f 0 , &2 family: Sp le Com p
lex:
TYPE OF'PERMIT -
❑ 1 & 2 family dwelling or accessory Cl Commercial/industrial ❑ Multi - family ,'New construction CI Demolition
CI Addition/alteration/replacement I:1 Tenant improvement CI Fire sprinkler /alarm CI Other:
'
I lk
'' INFORMATION ATION
� QBSITE,INF RM
Job address: / ( r S 1,0 / c rr—� Bldg. no.: Suite no.: -
Lot: Block: Subdivision: Tax map /tax lot/account no.: ..
Project name: Iti er__ - et.r •C 4-sfi , 1
Description and location of work on premises /special conditions: G" GCT°L z _i
_ , OWNER ; FOR SPECIAL 'INFORMATION, USE CHECKLIST • 4
Name: r J / —t /4_ / f - cy t. . , , ' (Floodplain; septic capacity, solar, etc.
Mailing address: ( a-- 5 5 , .2) t f rK... 1 & 2 family dwelling•
City: 7' � � � r Statee) ZIP: ?x,2..-.3 Valuation of work If ..../.li.. -C6D$ . 1-Sm5 Phone: 5' _ ( Fax: E - mail: No. of bedrooms/baths a _
Owner's representative: Total number of floors
Phone: Fax: E -mail New dwelling area (sq. ft.)
`; .. , APPLICANT `" .` ' Garage /carport area (sq. ft.) S
Name: ok. r't - tt, 1/- p. L Covered porch area (sq. ft.)
Mailing address: / „1 S `j , e) , ..c rr` Deck area (sq. ft.)
City: i 9 Q State: D/ ZIP: '7 7,2_; ---5 Other structure area (sq. ft.)
Phone: 5 A (- ( ( e G g Fax: E -mail: Commercial/industrial /multi- family:
. • , CONTRACTOR - •
Valuation of work .' $
Existing bldg. area (sq. ft.) /
Business name: / 4,4 ( f - t-e 1.7.
Address: f c� ja 5 l.CJ, ,� /1-74...._ New bldg. area (sq. ft.)
. //:\
Number of stories
City: q ex.,-- /� I State: � ZIP: 77,L13 Type of construction
Phone:5 ,2 / .. / (o 6 g I Fax: I E -mail:
CCB no.: Occupancy group(s): Existin -
New:
City /metro lie. no.: Notice: All contractors and subcontractors are required to be
ARCHITECT/DESIGNER licensed with the Oregon Construction Contractors Board under
Name: �! -- r' `7 ht 44.- ( if t 5 provisions of ORS 701 and may be required to be licensed in the
Address: / ( �., , j `�— I L) , �- .C. ,'-� jurisdiction where work is being performed. If the applicant is
City: 7- , ---- q r I Plan no.: State: I ZIP: exem • m nsing 4 cl e fol o i.> reason applies:
�C "" ' ✓�
Contact person:
Phone: Fax: E -mail:
; .ENGINEER _ _
Name: r- / f� r ontact person: Fees due upon application $
Address: ! Lf /, - , L..), —+� "'Pc_ Ci r. Date received:
City: IState: IZIP: Amount received $
Phone: I Fax: I E -mail: Please refer to fee schedule.
I hereby certify I have read and examined this application and the Not all jurisdictions accept credit cards, please call jurisdiction for more information.
attached checklist. All provisions of laws and ordinances governing this ❑ Visa ❑ MasterCard
work will be complied ith, whether specifiel herein or not. Credit card number: / /
i �j�� n
Expires
Authorized signaturl `,w„r Date: I �` Name of cardholder as shown on credit card
. $
Print name: t' r .44 Cardholder signature Amount
Notice: This permit application' - xpires if a permit is not obtained within 180 days after it has been accepted as complete. 440 -4613 (6/010 /COM)
1"L-& ID q. .1-'
One- and Two - Family Dwelling
Building Permit Application Checklist Reference no.:
Associated permits.
City of Tigard City f Tigard Y b ❑ Electrical ❑ Plumbing ❑ Mechanical
Address; 13125 SW Hall Blvd, Tigard, OR 97223 ❑ Other:
Phone: (503) 639 -4171
Fax: (503) 598 -1960
. °. THE .FOLLOWING ITEMS ARE REQUIRED FOR PLAN 'REVIEW - • Yes No N/A
1 Land use actions completed. See jurisdiction criteria for concurrent reviews.
2 Zoning. Flood plain, solar balance points, seismic soils designation, historic district, etc.
3 Verification of approved,plat/lot.
4 Fire district approval required. X
5 Septic system permit or authorization for remodel. Existing system capacity
6 Sewer permit.
7 Water district approval. •
8 Soils report. Must carry original applicable stamp and signature on file or with application. �(
9 Erosion control ❑ plan ❑ permit required. Include drainage -way protection, silt fence design and location of
catch -basin protection, etc.
10 3 Complete sets of legible plans. Must be drawn to scale, showing conformance to applicable local and state
building codes. Lateral design details and connections must be incorporated into the plans or on a separate full -size
sheet attached to the plans with cross references between plan location and details. Plan review cannot be completed
if copyright violations exist.
11 Site /plot plan drawn to scale. The plan must show lot and building setback dimensions; property corner elevations (if
there is more than a 4-ft. elevation differential, plan must show contour lines at 2 -ft. intervals); location of easements and
driveway; footprint of structure (including decks); location of wells/septic systems; utility locations; direction indicator; lot
aw coverage area; percentage of coverage; impervious area; existing structures on site; and surface drainage.
12 ~ Foundation plan. Show dimensions, anchor bolts, any hold -downs and reinforcing pads, connection details, vent
size and location.
13 Floor plans. Show all dimensions, room identification, window size, location of smoke detectors, water heater,
furnace, ventilation fans, plumbing fixtures, balconies and decks 30 inches above grade, etc.
14 Cross section(s) and details. Show all framing- member sizes and spacing such as floor beams, headers, joists, sub -floor,
wall construction, roof construction. More than one cross section may be required to clearly portray construction. Show
details of all wall and roof sheathing, roofing, roof slope, ceiling height, siding material, footings and foundation, stairs,
fireplace construction, thermal insulation, etc.
15 Elevation views. Provide elevations for new construction; minimum of two elevations for additions and remodels.
Exterior elevations must reflect the actual grade if the change in grade is greater than four foot at building envelope.
Full -size sheet addendums showing foundation elevations with cross references are acceptable.
16 Wall bracing (prescriptive path) and /or lateral analysis plans. Must indicate details and locations; for
non - prescriptive path analysis provide specifications and calculations to engineering standards.
17 Floor /roof framing. Provide plans for all floors /roof assemblies, indicating member sizing, spacing, and bearing
locations. Show attic ventilation.
18 Basement and retaining walls. Provide cross sections and details showing placement of rebar. For engineered
systems, see item 22, "Engineer's calculations."
19 Beam calculations. Provide two sets of calculations using current code design values for all beams and multiple joists
over 10 feet long and/or any beam/joist carrying a uniform load.
20 Manufactured floor /roof truss design details.
21 Energy Code compliance. Identify the prescriptive path or provide calculations. A gas - piping schematic is required
for four or more appliances.
22 Engineer's calculations. When required or provided, (i.e., shear wall, roof truss) shall be stamped by an engineer or
architect licensed in Oregon and shall be shown to be applicable to the project under review. - A
JURISDICTIONAL SPECIFICS ,
23 Five (5) site plans are required for Item 11 above. Site plans must be 8 -1/2" x 11" or 11" x 17 ".
24 Two (2) sets each are required for Items 16, 19, 20 & 22 above. A"'
25 Building plans shall not contain red lines or tape -ons. "Mirrored" building plans will be not accepted.
26 "Reversed" building plans must meet criteria outlined in the Permit & System Development Fees document.
27 "Drawn to scale" indicates standard architect or engineer scale.
28 Site plan to include tree size, type & location per approved project street tree plan (if applicable), and COT Street Tree List.
Checklist must be completed before plan review start date. Minor changes or notes on submitted plans may be in blue or black ink.
Red ink is reserved for department use only. 440 -4614 (6 /00 /COM)
Electrical Permit Application s
Date received: Permit no.:
Alit," City of Tigard Project/appl. no.: Expire date:
CiryofTigard Address 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By: Receiptno.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
- TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial /industrial ❑ Multi- family ❑ Tenant improvement
tm' New construction ❑ Addition/alteration/replacement ❑ OtheraK/l- ❑ Partial
• JOB SITE INFORMATION - '
Job address: 11- e , Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: Block: Subdivision:
Project name: t- tp-yoL Oetricer'' Description and location of work on premises: tea -
Estimated date of completion/inspection: / A� — 0 ,2_ 0 0 X-
- `CONTRACTOR.APPLICATION , ., = . • • '` ,' - ° FEE SCHEDULE - . -
Job no: Fee Max
Business name: Description Qty. (ea.) Total no. insp
- '�� �! New res - single or multi- family per
Address: 4.- , , ---e ._ dwelling unit. Includes attached garage.
EaMima State Al ZIP: — 7 Service included:
Phone: - E -mail: 1000 sq ft. or less 4
J. Each additional 500 sq. ft. or portion thereof MOM_—
CC$ no.: a. Elec. bus. lic. no:
Limited energy, residential ___ 2
City /metro lic. no.: a d ANEEIMM Limited energy, non residential ___ 2
Each manufactured home or modular dwelling
Signature of r'pervisi �r duffed) Date Service and/or feeder ■■ 2
• Sup. elect. name (punt): License no: Services orfeeders — installation,
alteration or relocation:
PROPERTY OWNER 200 amps or less 2
201 amps to 400 amps ___ 2
Name (print): at - r AN 1 401 amps to 600 amps _—_ 2
Mailing address: # GO e r 601 amps to 1000 amps ___ 2
IIIZI StateO` ZIP: - Over 1000 amps or volts ___ 2
Phone: A,.,„,;# i. _ 0 . E -mail: Reconnect only � 1
Owner installation: The installation is being made on property I own Temporary services or feeders -
which is not intended for sale, lease, rent, or exchange according to installation, alteration, or relocation:
ORS 447, 455, 479, 670, 701. 200 amps or less
III 2
201 amps to 400 amps __ 2
Owner's signature: ��/ � D ate: De' 401 to 600 amps 1MM 2
ENGINEER . - Branch circuits - new, alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: State: ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: MN= 2
Phone: • Fax: E Each additional branch circuit: ___—
PLAN REVIEW (Please check all that 'apply) Misc. (Service or feeder not included):
❑ Service over 225 amps - commercial ❑ Health -care facility Each pump or irrigation circle IIIIIII 2
❑ Service over 320 amps- rating of 1&2 ❑ Hazardous location Each sign or outline lighting ::: 2
family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
❑ System over 600 volts nominal more residential units in one structure alteration, or extension* 2
❑ Building over three stones ❑ Feeders, 400 amps or more *Descn• don
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
❑ Egress/lighting plan ❑ Other: Per inspection __
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $
❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at %) $
Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $
Expires accepted as complete. TOTAL $
Name of cardholder as shown on credit card
. $
Cardholder signature Amount 440 -4615 (6/00 /COM)
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES:
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
p Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total Check Type of Work Involved:
Residential - per unit
1000 sq. ft. or less $145.15 4 ri Audio and Stereo Systems
Each additional 500 sq ft. or
portion thereof $33.40 1 n Burglar Alarm
Limited Energy $75 00
Each Manufd Home or Modular n Garage Door Opener
Dwelling Service or Feeder $90.90 2
Services or Feeders ri Heating, Ventilation and Air Conditioning System'
Installation, alteration, or relocation
200 amps or less $80 30 2
201 amps to 400 amps $106.85 2 ri Vacuum Systems
401 amps to 600 amps $160.60 2
601 amps to 1000 amps $240.60 2 n Other 11/4—
Over 1000 amps or volts $454 65 2
Reconnect only $66 85 2
Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Installation, alteration, or relocation Fee for each system $75.00
200 amps or less $66.85 _ 2 (SEE OAR 918- 260 -260)
201 amps to 400 amps $100.30 2
401 amps to 600 amps $133.75 2 Check Type of Work Involved:
Over 600 amps to 1000 volts,
see "b" above. n Audio and Stereo Systems
Branch Circuits
New, alteration or extension per panel n Boiler Controls
a) The fee for branch circuits .
with purchase of service or I Clock Systems
feeder fee.
Each branch circuit $6.65 2 Ti Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service n Fire Alarm Installation
or feeder fee.
First branch circuit $46.85
Each additional branch circuit $6.65 n HVAC
Miscellaneous ri Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40
Each sign or outline lighting $53 40 n Intercom and Paging Systems
Signal circuit(s) or a limited energy
panel, alteration or extension $75.00 n Landscape Irrigation Control
Minor Labels (10) $125.00
Each additional inspection over n Medical
the allowable in any of the above
Per inspection $62.50 n Nurse Calls
Per hour $62.50
In Plant $73.75 _ n Outdoor Landscape Lighting
Fees: n Protective Signaling
Enter total of above fees $ n Other 4
8% State Surcharge $ Number of ystems
25% Plan Review Fee
See "Plan Review" section on - $ No licenses are required Licenses are required for all other installations
front of application.
Fees:
Total Balance Due $
Enter total of above fees $
El Trust Account # 8% State Surcharge $
Total Balance Due $
All New Commercial Buildings require 2 sets of plans.
is \fists \forms \elc- fees.doc 08/30/01
Permit #: ' j V T a-C9O a- _-- 00 l 9r7
0
F O
at, fT�tn Address: I L S S F
N 4 —
' Issu b, Date: -O
185
Statement: Information Notice to Property Owners
About Construction Responsibilities
Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli-
cants who are not registered with the Construction Contractors Board to sign the
following statement before a building permit can be issued. This statement is required '
for residential building, electrical, mechanical, and plumbing permits. Licensed
architect and engineer applicants, exempt from registration under ORS 701.010(7),
need not submit this statement. This statement will be filed with the permit.
Fill in the appropriate blanks and initial boxes 1 and 2, and either box 3A or 3B:
1. I own, reside in, or will reside in the completed structure.
2. I understand that I must register as a construction contractor if the structure is sold or offered for sale
before or upon completion.
n n � Cl k it- t 614-1 i r 3
3A. My general contractor is
(Name) Contractor regis. #
I will instruct my general contractor that all subcontractors who work on the structure must be
registered with the Construction Contractors Board.
OR
3B. I will be my own general contractor.
If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors
Board. If I change my mind and hire a general contractor, I will contract with a contractor who is
registered with the CCB and will immediately notify the office issuing this building permit of the
name of the contractor.
I hereby certify that the above information is correct and that I have read and do understand the Information
Notice to P operty Owners about Construcn R ,ponsibilities on the reverse side of this form.
le 'IX 1- • • 7, A ir (' '
,,
(Sig ature of p - t applicant) 1.
(Date)
/
(White copy to issuing agency permit file,
pink copy to applicant)
onnekon Necs_ Pvapeny Owners
0)mi/ CcirD,C.Fuctjer, RnzponentliMes
Note: This inlOrrnation Notice to Property Owners about Construction Responsibilities
was developed by the Construction Contractors Hoard in accordance with ORS 701.055(5).
If you are acting as you: own contractor to construct a new home or make a substantial improvement to an existing structure,
you can prevent many probolors by being aware of the following responsibilities and areas of concern.
73fP'1_,VV.,Fq RESPONSBilLITMS!
If you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting in the
ccnstruction or improvement a residential structure, you will, in most instances, be ruled to be an employer and the people
you hire will be employees. As the employer, you must comply with the following:
Oregon's Tvit71'.77oleing tax As an employer, you most withhold income taxes from employee wages at the time employees
are paid. You will be liable for the payments even if you don't acaially withhold the tax from your employees. For more
information, call the Oregon Dept. of Revenue at 945-8091.
lInemplbyruentitnix.r-T:nee Itio,o As an employer, you are required to pay a tax for unemployment insurance purposes on the
wages of aU e.rnployec,s.s. Fe :toe t information, call the Oregon Employment Division at the Department of Human Resources
at 378-3524.
Worrr.L.eo' COLWerEn65 insnce: As an employer, you are subject to the Oregon Workers' Compensation Law, and must
obtain workers' coropeosatio ' lsurance for your employees. If you fail to obtain workers' compensation insurance, you may
be su'ojeet to penalties and wi;; be liable or all claim costs if one of your employees is injured on the job. For more information,
call the Workers' Compensation Division at the Department of Consumer and Business Services at 945-7888.
U.S. HtillternaL' ierae Ben As an employer, you must withhold federal incorhe tax from employees' wages. You will be
liable for the tax payment ever, if you didn't actually withhold the tax. For more information, call the Internal Revenue Service
at 1-800-829-1040.
(37 PIESPOAISFMTES AMU ARAB OF CONICERN
Code VOmpllitance: As the permit holder for this project, you are responsible for resolving any failure to meet code requirements
that may be brought to your attention through inspections.
Liability and pro,perty damage insurance: Contact your insurance agent to see if you have adequate insurance coverage for
accidents and omissions such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be
re-done.
Time to supervise employees: Make sure you have sufficient time to supervise your employees.
Expertise: Make sure you ha ve the expertise to act as your own general contractor, to coordinate the work of rough-in and finish
trades, and to notify building officials at the appropriate times so they can perform the required inspections.
If you have additional questions, write or call the Construction Contractors Board (PO Box 14140, Salem, OR 97309-5052,
503/378-4621). The Board is located at 700 Summer St. NE Suite 300, in Salem.
prop-own.pm4
1 /94
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST °2 — / q
INSPECTION DIVISION Business Line: (503) 639 -4171
J BUP
Received Date Requested ! / AM PM BUP
Location / z 7 1 l S 3e-A4 D Suite MEC
Contact Person Ph ( ) ( -- /6 6P e PLM
Contractor Ph ( ) Fgd & a /' SWR
BUILDINN3> Tenant/Owner ELC
o r ng
Foundation Access: ELC
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:
A - ART FAIL
\.... \NY) ..
P I MBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
fIcAL FAIL
+ n
UG /Slab
Low Voltage
Fire Alarm
ii, 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
RT FAIL
SI -111111 Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA 1 ( (
Approach/Sidewalk Date ( v Q ----\_ Inspector ,OV1/1 Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL