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Report � °2 079 (p— S Z E J E J or O PMoO OM1 r Jlc�" \ INSPECTION TYPE . • Report of Inspection INSTALLATION EXP: • y ( �i A • :- ;.0 k Department of Consumer & Business Services c � r m ;• ' T""r" z, Building Codes Division • Elevator Safety Program ELEVATOR # I INSP # I DOCUMENT ▪ .* :•:;,;. `:;y'' 1 of 2 '•'9"� 1•' 1535 Edgewater NW, Salem, OR :*g Mailing address: PO Box 14470, Salem, OR 97309 -0404 Inspection information: (503) 373 -1298, TTY: (503) 373 -1358 AREA I INSP DUE BY I LAST INSP BY NNE Permits: (503) 378 -8559 • Web site: www.oregonbcd.org RESPONSIBLE PARTY NAME AND ADDRESS I SITE NAME AND ADDRESS I INSPECTION RESULTS — SEE REVERSE SIDE 14568 15086 so SATISFACTORY INSPECTION DICKS SPORTING GOODS DICKS SPORTING GOODS aD UNSATISFACTORY INSPECTION 2 00 INDUSTRY DRIVE 94D0 SW HASHINGTON SO PD aD WRITTEN VERIFICATION ACCEPTED PITTSBURG, PA 15275— F'URIIMHD. OR 9i ® PROVISIONAL: EXPIRES CD REQUIRED BY NEXT ANNUAL DOWN 12 ® REMOVED FROM SERVICE INSPECTION REQUIREMENTS (M /R = MACHINE ROOM) I NO LOAD FULL LOADI ' ELEVATOR INFORMATION ® Fire service test is overdue (8.11.2.2.6) mol year mol year HFG. SERIAL PIUHBER 5372 SCHINDLER 9 ® Annual safety test is overdue (8.11.2.2.2) ® CD CD ®® GD CAPACITY 0,180 LANDINGS CO Full load safety test overdue (8.11.2.3.1) ® CD CD ® CD CD CODE DATE 03/07 PiODEPNI lED ® Keep M/R access doors closed & locked (8.6.4.8.4) ® CD ® ® © CZ) !IA I VE1(S: ® Test & seal pressure relief valve (8.11.3.2.1) ® CD CD ® CD ® . . ® Maintain min. illumination level in M/R (8.11.2.1.2/8.11.3.1.2) ® OD O ® Provide proper signage; see below (8.6.1.6.7) ® OD ® OD ® CD SPECIAL INSTRUCTIONS ® Emergency light/bell is inoperative (8.11.3.1.1) ® CD ® ® ® OD CONTACT t ® 24 -hour communication device is inoperative (8.11.2.1.1/8.11.3.1.1) ® CD ® ® co co ® Verify /reduce kinetic energy on doors (8.6.4.13.2) ® ® ® ® CD ® A17,3: ® Provide /update record of oil usage (8.6.5.7) 131) CD COD OD CE COD ® Maintain a clean & dry elevator pit (8.11.2.1.5/8.11.3.1.5) TD (ID CM Elevator M/R has unrelated storage (8.11.2.1.2/8.11.3.1.2) ® Maintain min. illumination level in pit (8.11.2.1.5/8.11.3.1.5) PRIOR INSPECTION REQUIREMENTS ® Bldg. and/or M/R not accessible (ORS 460.135) REOI!IREMENIS: NONE ® Seismic tests overdue (OR amendments 8.11.2.2.10) • ® Maintain /provide M/R fire extinguisher (8.6.1.6.5) EC EIV ED ® Anti - egress device requires repair or adjustment (8.6.4.13.1) \d ® 0 g JAN 2 8 2003 c.) CITY OF TIGARD BUILDING DIVISION c 'f(Sirk..1..- 1 f l<<.',0P(.�'f / t■ J j �- r / lA. 14--- t l ; • INSPECTION DATE I NO T hrs mins 1 hrs mins mo day yea p CD m v CD ED p CD OD ® m E ® © E CD E C CD CD L CD ® C CD TO ED CD GED T ® CD ® T CID qS5) Ca CB R ®m T m ® o® ® ® cam N ! otherwise noted on this report and pursuant to ORS 460.125(2), you are hereby notified that all work ® ® M OD Nl cited on this report shall be completed within 60 ❑ 120 ❑ Other days from data of this • Inpedtlon or the unit may be removed from services. ® ® E CD E ® a ® CD N c CONTACTS SIGNATURE INSPECTOR'S SIGNATURE DATE ® A /\ j i + R.,, I.., (r,�� I l? �i 440- 2536(09/02/COM): AN ELEVATOR WHICH HAS CAUSED AN INJURY SHALL NOT BE OPERATED UNTIL APPROVED BY THE ELEVATOR SECTION, PER ORS 460.045(7) PM OI=IE:3ElL 1O:D0I=Ot3O If= 0004 • f a INSPECTION TYPE °F ' Report of Inspection 14:1i:LLi;TI3u E AP: v - , c+ Department of Consumer & Business Services m ` ; "r i Building Codes Division • Elevator Safety Program ELEVATOR # I INSP # I. DOCUMENT ' •:rz� 1535 Edgewater NW, Salem, OR P\n-1761C :$2953 :' of 2 . 59 Mailin g address: PO Box 14470, Salem, OR 97309 -0404 INSP DUE BY I LAST INSP BY 0 101-A N IN Inspection information: (503) 373 -1298, TTY: (503) 373 -1358 AREA I tl4 Permits: (503) 378 -8559 • Web site: www.oregonbcd.org RESPONSIBLE PARTY NAME AND ADDRESS I SITE NAME AND ADDRESS I INSPECTION RESULTS - SEE REVERSE SIDE 1145!:41 41 t 5'1 a '--i SATISFACTORY INSPECTION .16c I'i 1i , ..f .;,,; PlC 13120f:', t :r.:,,.•i .:',(!F_' CID UNSATISFACTORY INSPECTION :00 (i1la1E,1R t =; u ': iA i „- i t: li.iN '.'+ Ft' CD WRITTEN VERIFICATION ACCEPTED r' t1 I'ci3ttkti . :'i, . : Iii I , ,.;;L . 'i '- . ® PROVISIONAL: EXPIRES CD REQUIRED BY NEXT ANNUAL ® REMOVED FROM SERVICE INSPECTION REQUIREMENTS (M /R = MACHINE ROOM) I NO LOAD FULL LOADI ” ELEVATOR INFORMATION VD Fire service test is overdue (8.11.2.2.6) mol year mol year PiFIi. SERIAL fllltIBER f,373 SCN1l1BLER 5 ® Annual safety test is overdue (8.11.2.2.2) D tD C ® O CD (.nf'AL1 i i 2,506 L (111!'11;'38 - (4 Full load safety test overdue (8.11.2.3.1) o CD OD ® O OD C ,t E ` ='i; I E C i3 / hti1;Eha(t'E') 4 Keep M/R access doors closed & locked (8.6.4.8.4) ®©©®©© 1 4 114 't' - ' ' ® Test & seal pressure relief valve (8.11.3.2.1) ( CD ® ® ® Maintain min. illumination level in M/R (8.11.2.1.2/8.11.3.1.2) o ® GD o O O ID Provide proper signage; see below (8.6.1.6.7) o CD ®o CD ® SPECIAL INSTRUCTIONS • o Emergency light/bell is inoperative (8.11.3.1.1) © © ® 0 © © CBI ACT: ® 24 -hour communication device is inoperative (8.11.2.1.1/8.11.3.1.1) CD OO © o (7 07 ® Verify /reduce kinetic energy on doors (8.6.4.13.2) CS OD OD ® OD CO A17.3; ® Provide /update record of oil usage (8.6.5.7) ® ® ® ® (6 ® Maintain a clean & dry elevator pit (8.11.2.1.5/8.11.3.1.5) al CM ® Elevator M/R has unrelated storage (8.11.2.1.2/8.11.3.1.2) ® © . ® Maintain min. illumination level in pit (8.11.2.1.5/8.11.3.1.5) PRIOR INSPECTION REQUIREMENTS ® Bldg: and /or M/R not accessible (ORS 460.135) F:EOU Ehf 1 t(iit{E ® Seismic tests overdue (OR amendments 8.11.2.2.10) ® Maintain /provide M/R fire extinguisher (8.6.1.6.5) RECEIVED ® Anti - ogress device requires repair or adjustment (8.6.4.13.1) - JAN 2 8 2008 CITY OF TIGARD BUILDING DIVISION [ 41 qtr (1 D v l� I i 1 1; -,, l( C i I l JJ i! (G1rilidL`.� ��fTI�7 Y -- L- (I t' t t I _i-"- r t k Lit ` 1 `i (`-.- -- .._ - .. -.. -. CO 7 Y , INSPECTION DATE NO T hrs mins 1 hrs mins mo day yea S O A ® S� .�:: ® o p CD CD V CD OM p CD o ®© OD OD E © E ® E CD OM CD CD CO C CD 03 L OO ® C © ® o® OO o o® ® ® o o® R CD Os o ® 16 ® ® o ©® © ® ® ®o CD © T CD ® T C ® o ® te N Unless otherwise noted on this report and pursuant to ORS 460.125(2), you are hereby notified that all work ® oSt O t] o ® o c cited on this report shall be completed within 60 CI 120 1V1 120 ❑ Other days from data of this inpection or the unit may be removed from services. ® ® E CD ® 10 ® E. a CONTACT'S SIGNATURE / . j INSPECTOR'S SIGNATURE r) DATE ® n. X X ( 1),A. ( aOel.\ (\ I � I (, ? /i( -) 6 440- 2536(09/02/COM): AN ELEVATOR WHICH HAS CAUSED AN INJURY SHALL NOT BE OPERATED UNTIL APPROVED BY THE ELEVATOR SECTION, PER ORS 460.045(7) 'DE ®000 ®00 ®oill000lll1El . INSPECTION TYPE '� - • - Report of inspection INSTALLATION E %P: -rte / -% , Department of Consumer & Business Services - 7 � Building Codes Division • Elevator Safety Program ELEVATOR # I INSP # I DOCUMENT 'r °�::�:�� ";�' ESC -!7606 26':951 1 of 1 ' ':! _ , 1535 Edgewater NW, Salem, OR Mailing address: PO Box 14470, Salem, OR 97309 -0404 AREA I INSP DUE BY I LAST INSP BY Inspection information: (503) 373 1298, TTY: (503) 373-1358 A 10/31/08 28 Permits: (503) 378 -8559 • Web site: www.oregonbcd.org RESPONSIBLE PARTY NAME AND ADDRESS I SITE NAME AND ADDRESS I INSPECTION RESULTS - SEE REVERSE SIDE 14560 15i92i6 9 SATISFACTORY INSPECTION DIM SPORTING GOODS DICYS SPORTING GOODS al UNSATISFACTORY INSPECTION 280 INDUSTRY DRIVE 94DD S;'; '.+ASlli^IG1GN SO RD m WRITTEN VERIFICATION ACCEPTED • PITTSBURG. PA 15275- POhTLA*. OR 97223- O PROVISIONAL: EXPIRES ® REQUIRED BY NEXT ANNUAL Al UP OD REMOVED FROM SERVICE INSPECTION REQUIREMENTS (M /R = MACHINE ROOM) I NO LOAD FULL LOADI ELEVATOR INFORMATION ® Fire service test is overdue (8.11.2.2.6) mol year mol year MFG. SERIAL NUMBER D5372 SCHINDLER ® Annual safety test is overdue (8.11.2.2.2) ® CD CD ® CD CD CAPACITY 8.100 LANDINGS 2 ® Full load safety test overdue (8.11.2.3.1) ® m (D m m CODE DATE 03/07 11ODERNI1ED ® Keep M/R access doors closed & locked (8.6.4.8.4) ® CD CD ® m CD WAIVERS: ID Test & seal pressure relief valve (8.11.3.2.1) D CD m ® m CD ® Maintain min. illumination level in M/R (8.11.2.1.2/8.11.3.1.2) IED GID OD ED OD OD ® Provide proper signage; see below (8.6.1.6.7) ® ®m ® CD GD SPECIAL INSTRUCTIONS ® Emergency light/bell is inoperative (8.11.3.1.1) ® m a) ® m m CONTACT: ® 24 -hour communication device is inoperative (8.11.2.1.1/8.11.3.1.1) ® CD ED ® Verify /reduce Kinetic energy on doors (8.6.4.13.2) ® OD mama) A 17.3: m Provide /updatOecord of oil usage (8.6.5.7) ® CD) m ®m m ® Maintain a clean & dry elevator pit (8.11.2.1.5/8.11.3.1.5) ® ® ' ` ® Elevator M/R has unrelated storage (8.11.2.1.2/8.11.3.1.2) ® Maintain min. illumination level in pit (8.11.2.1.5/8.11.3.1.5) . PRIOR INSPECTION REQUIREMENTS ® Bldg. and/or M/R not accessible (ORS 460.135) REOUIREMENTS: NONE . ® Seismic tests overdue (OR amendments 8.11.2.2.10) ® RECEIVED Maintain /provide M/R fire extinguisher (8.6.1.6.5) ® Anti egress device requires repair or adjustment (8.6.4.13.1) ® k ` JAN 2 8 2008 " CITY OF TIGARD t..1 BUILDING DIVISION 3 C. (< .-S I � Ff ..�t :' L/ I 11 < �I .0 ( 1 1 05 J � ( / 1,•t (--- (- l Pk A., - 0 INSPECTION DATE I NO T hrs mins I hrs mins mo day yea S CD m A m S CD ® m OD W p CD m V m® p m® ® ® Cl) E elD © E ® E © ® m C® m L m ® C ©® ® OO ED R CD CD m® m a a m OM CO m a) • m OD m • CD CD OD CD (6 ® ®® I Unless otherwise noted on this report and pursuant to ORS 460.125(2), you are hereby notified that ell work ® ,. - M m M m ® m ® c 'cited on this report shell be completed within 60 ❑ 120 ❑ Other days from date of this ® ® ® 9 Inpectlon or the unit may be removed from services. . m m E m E °' CONTACT'S SIGNATURE INSPECTOR'S SIGNATURE DATE © a` ® n 44n- 253R(09/02/C0M1: AN ELEVATOR WHICH HAS CAUSED AN INJURY SHALL NOT BE OPERATED UNTIL APPROVED BY THE ELEVATOR SECTION, PER ORS 460.045(7) - •� Elevator In Ret u �-+ ''�~ �`�� ��` Supplemental , Inspection ection Form por ID no.: E �, � T �-- iwir.- , Nfav� Id c pp ' De of Consumer & Business Servic �`� Building Codes Division • Elevator Safety Program 1535 Edgewater NW, Salem, OR JAN 2 8 2008 Mailing address: P.O. Box 14470, Salem, OR 97309 -0404 (503) 373 -1298, Fax: (503) 378 -4101, TTY: (503) 373 -1358 CITY OF TIGARD www.oregonbcd.org BUILDING DIVISION 1Ir ?S,di` ) . , ,i ` 1 . - , :::.' , RESPONSIBLE- PARTY• INFORMATION ..'. Site name: / '�CS 5,m-/' G ('c k /4 Name: pi iL S f)ow r1 i cxod Physical address: 1 -/ -.0 0 S, W, WASH / it7 ; K Mailing address: -Cc) t tt Gc. C7wy 6v r v(, s t,...0_452_ A City: »r ZIP: ?7 2-13 City: pi - ficbtM, '9 StateP/( ZIP: /S 2, . Phone: Site no.: / C006 Phone: / Fax: Address correction? 0 Yes 0 No Not previously permitted 0 Federal site ❑ Residential 0 Commercial • W.,6 ! , 10, '''":F0 - MATION , _-- -- Inspection Type Billing Information Result ❑ Annual Stall., Stop 1:1 Satisfactory; operation permitted Date: / / b / dc2 Date: / /?', 10A 0 Re- inspection ❑ Unsatisfactory; p operation denied 4i Installation/Alt Time: hr. Time: hr. 0 Required by next annual O IR / MR Travel hrs.: / : b hr. Insp. hrs.: %/ : L hr. 0 Construction use operation only ❑ Co operation; T Conditional o see comments , O Alt. in progress Bill to: ❑ Removed from service ❑ Construction use Address: ❑ See COMMENTS below O Special Provisional permit; expires: ❑ Reactivation City, State, ZIP: p p 3 / /s / D8 O Consultation O Decommission p Billable ❑ Non - billable Total hrs: /a Rate: $55per hr. + surcharge =$ �. -1 ?l °: ...QU RED / T 7-76') ` . 2 3e vd (.c./ / • (° / ,r a_ iPri rv,_ 1_41' ` ' •, ' ,f/ -CAS// - C ?!O 1 l e a-et / i 64.-f LJ • •r�, ' j// 5/ / .e CV 0- /l ALA D l r' 4 i lti1 ,f' t , 0/ by - e , G� - ce /f)--e � i ! ( e / /Rc- iec • ,./ s " . 7S (iG�✓/ i e/� -/i-et. // SGLc i lrr. ;. /iii �2- L L _ i�� AC �. '� ' `, 1 7 beef .1;64...d....,%,?' i a,- S GZ k es u- 0 ' • G G i- -tf., P/S •4t./ 1 I €e4 ' (-i TI i - rt '4 a /=cv, / , va4ry o 9e1 lL /0 x(i > -,6../k: en_ 4 /i c& ' /S /l4 , y 3/ / b '/ Inspector: P 30 - `'- I . c No: 2 ?" EVI: I 3 3 Elevator contractor: . --? Company: SC-IL ` i `- c ( CA-- Owner /responsible party: L -- �- Title: DEPARTMENT OF 1 OQrlta White BCD Yellow- Inspector Pink - Elevator contractor Blue -Owner or responsible party Page -- of GUa/e-A , S gg Jc/ U Informatio ®To Build On Engineering • Consulting a 'resift January 4. 2008 R EC E W E Alin: Lisa I liesler JAN 2 8 2008 Dick's Sporting Goods CITY OF TIGARD 300 Industry Drive BUILDING DIVISION Pittsburgh, PA 15275 Subject: Final Summary Report 9902 SW Washington Square Rd Tigard, Oregon _ ,{� PSI Report No. 873 - 70041 -267 Uf hE COPY Dear Ms. I Professional Service Industries, Inc. (PSI) is writing this letter to document that, in accordance with Section 1701 of the State Building Code representative(s) from our firm have performed special inspection during construction for the following project: Permit No: BUP 2006 -00562 • Project Address: 9902 SW Washington Square Rd. Project Description: Dick's Sporting Goods #342 • Our project file(s) indicate that PSI Special Inspection(s) activities listed below were conducted as scheduled from April 3rd, 2007 through December 18th , 2007. This letter represents a summary of work observed and reported by PSI representative(s) and the resolution of any documented noncompliance. • Foundation Subgrade Verification. • • Reinforced Concrete. • Epoxy Adhesive Anchors. • Structural Steel Fabrication and Erection. To the best of our knowledge, the special inspections referenced herein were performed by our firm in general accordance with the requirements, approved plans and specifications, provided change orders that impacted plans and /or specifications, and applicable workmanship provisions of the State Building Code and Standards. If you have any questions or we can be of further assistance, please do not hesitate to call. Sincerely, Professional S rvi Industries, 1 • . • Jay I latlia vay Techn' Director Construction Services c: City of Tigard, T. Marvich Professional Service Industries, Inc. • 6032 North Cutter Circle, Suite 480 • Portland, OR 97217 • Phone 503 /289 -1778 • Fax 503/289 -1918