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MASTER PERMIT 1
CITY OF TIGARD DATE PERMIISSUED: . 05/01/965-02 /
COMMUNITY DEVELOPMENT DEPARTMENT PAR(:EL.: 1S.1331)A-02700
13125 SW Hall Blvd.Tigard,Onyyon 97223.8109 (503)839-4171
S I I I. N1.)DRESS. . . : 16='B;25 SW GLACIER LILY C-rt
SUBDIVISION. . . . : AMART SUMMERL.AKE: ZONING: R-7
til-O(:K. . . . . . . . . . . LOT. . . . . . . . . . . . . :49
Remarks: addition PATH I
-------------
---------------------------------------------- BUILDING -------------------------------------��-------------
REI65UEt STORIES.......: 1 FLOOR AREAS---------- BASEMENT...: 0 sf REQUIRED SETBACKS--- RE(XIRED-------------
CLASS OF NORK.sADD HEIGHT........: 12 FIRST....: 192 sf GARAGE....,: 0 sf LEFT..........1 9 SMOKE DETECTRS:
TYPE OF USE...:SF FLOOR LOAD....: 40 SECOND...: 0 sf FRONT.........: 0 PARKING SPACES: 0
TYPE OF CONST.s514 DWELLING UNITS: 0 FINBSMENT: 0 sf RIGHT.........: 0
OCCUPANCY GRP..-R3 BDRM: 0 BATH: 0 TOTAL------: 1T2 sf VALOL.A: 12415 REAR..........: 30
PLUMBING ---------------------------------------------------------------
SINKS.........: 0 WATER CLOSETS.: 0 WASHING MACH.. : 0 LAUNDRY TRAYS.: 0 RAIN DRAIN ft: 0 TRAPS......... : 0
LAVATORIES....: 0 DISHWASHERS...: 0 FLOOR DRAINS..: 0 SEWER LINE ft: 0 SF RhIN DRAINS: 0 CATCH BASINS..: 0
TUB/SHOWERS...: 0 GARBAGE DISC..: 0 WATER HEATERS.: 0 WATER LINE ft: 0 BCKFLW PREVNTR: 0 GREASE TRAPS..: 0
OTHER FIXTURES: @
-------- MECHANICAL --------------------------------------------------
�UEL TYPES----------- FURN l 100K ..: 0 BOIL/CMP ( 3HP: N VENT FANS.....: @ CLOTHES DRYERS: 0
FURN 1-100K ..: 0 UNIT HEATERS..: 0 HOODS.........: 0 OTHER UNITS...: 0
MAX INP.: 0 BTU FLOOR FURNACES: 0 VENTS.........: @ WOODSTOuES....1 0 6AS OUTLETS...: 0
----------------- ELECTRICAL. ----•--------------------------------------------------------
--RESIDENTIAL UNIT--- ---SERVICE/FEEDER---- --TEMP SRVC/FEEDERS-- ---BRANCH CIRCUITS--- ----MISCELLANEOUS---- --ADD'L INSPECTIONS-
;000 SF OR LESS: 0 0 - 200 amp..: 0 0 - 2a0 amp.. : 0 W/SVC OR FDR..: 0 PUMP/IRRIGATION: 0 PER INSPECTION: 0
LA ADD'L 500SF.: 0 201 - 400 amp..: 0 201 - 4@@ amp..: 0 1st W/O SVC/FDR: 1 SIGN/OUT LIN LT: 0 PER HOUR......: 0
LIMITED ENERGY.: 0 401 - 600 amp..: 0 401 - 600 amp.. : 0 EA ADDL BP CIR: 0 SI44AL/PANEL.. : 0 IN PLANT......: 0
MANE 4M/SVC/FDR: 0 601 - IN10 amp.: 0 601+amps-1000 V: @ MINOR LABEL -1@: 0
1000+ amp/volt.: 0 ----•------------------------------ PLAN REVIEW SECTION --------------------------------
Reconnect only.: 0 )=4 RES UNITS..: SVC/FDR)=225 A.: ) 600 V NOMINAL: CLS AREA/SPC OCC:
------------------------------------ ELECTRICAL - RESTRICTED ENERGY ----------—-------------------------------------
A. SF RESIDENTIAL-------------------------- B. COMIERCIAL----------------------------------------.—�_---__----------------------
AUDIO 6 STEREO.: VACUUM SYSTEM..: AUDIO I STEREO.: FIRE ALARM.....: INTERCOM/PAGING: OUTDOOR LNDSC LT:
BURGLAR ALARM..: O1Ht :s BOILER.........: HVAC........... : LANDSCAPEiIRRIG: PROTECTIVE SIGNL:
GARAGE OPENER,,; CLOCK..........: INSTPUMENINTIUN: MEDICAL........: OTHR: ::
HVAC...........: DATA/TEL' COMM.: NURSE CALLS....: TOTAL 1 SYSTEMS: 0
Owner: -----------------------Contractor: -------- -- ------------------ TOTAL FEES:$ 204.21
MIKE MEREDITH SEQIOIA BUILDERS INC
12825 SW GLACIER LILY CIR 10540 SW LAUREL ST
TIGARD OR 97224 BEAVERTON OR 97@0`
Phone 1: Phone 1: 646-4606
Reg 1..: 68156
This permit is issued subject to the regulations contained in thr Tiga.,d Municipal Code, State of Ore. Specialty Codes and all other
applicable laws. All work will be done :n accordance with approved plans. This permit will empire if work is not started within 180
days of issuance, or if work is suspended for more than 180 days.
- --------- REQUIRED INSPECTIONS ---------------------------------------------------------
Footing Insp Gyp Board Insp ---
Foundation Insp Rain drain Insp __ --- ---
Electrical Servi Llectrical Final --
Framing Insp Building Final --
Insulation Insp Erosion Control
I-,ermittee Ui.gnati.tre . _ Issl.teri Dy : 6G:X
L.ai I
for in pe tion — 639-4175
_Residential Building Permit Application clI!' c/- 36
City of Tigard _
13125 SW Hall Blvd. y�^��l y�
Tigard, OR 97223
(503) 6394171
Jobsite Address,: 128 -2-Y- 6-�u �- Ci c _
�_ ' ),^'<P- Lot # -7"T
OfiIce Use Only t�_•a�� ,
Subdivision: _ YWWe�r
Contact Date / ! Initials _
Valuation: R ,47 U — Result
New Construction nly: (Square Footage) Planck/Rec # _
Aa' i Permit # �—
'douse _ Garage: Reissue of_
Map & TL # $ I St 3>0/1 i, >
Corner Lot? Y N Flag Lot? Y N Lone 7
Owner: lti l �/�1� t O I Z'1 Plat # _
Address.
Approvals Required
—__
Planning Setbacks Solar -
- - Engineering — -- ------_--�--
Other
Phone -- ) -- — — — -------
Items Required
Contractor: S�'Q, �c� �c.TcdZvtC
.D Sk0 L r.��.vt( Sfi , Subcontractors
Address: c
_ �. _•_. Truss Details
bt _ Other �t -
�� Notes lj t eu
Phone:
Contractor's License # G !�-R
(attach copy of current Oregon license)
Contact Name
ontact Phore
Subcontractors: Arrhitect/Engineer:
Plumbing --- - ,address -
Mechanical,
(attach copy of current OR Contractors License)
t( •` n(N 0:vk- Phone
JOB DESCRIPTION:
-knclimnt Sianac Appiicant Phcre number
Received byy ��t/I1. '�t-t- Date Received
. IC��n,NacC l VfM1/'•7 O� �` ` - `ice % � �/I_1
(Irk C ALZ 5,, . I ✓r'R,
Permit ;$ Account Description Amount Amt. Pd. Bal. Due
azo 7 Bldg. Permit (BUILD) S"U
Plumb. Permit (PLUMB)
Mech. Permit (MECH)
Stat*-T.QX (TAX)
Bldg:
Plur b:
Mech
Plan Che k (PLANCK)
Bldg: _1
Plumb:
Mech:
,
_ Sewer Connection \'\,(SWUSA)
Sewer Inspection (S) INSP)�
Parks Dev Charge (PKS C
Residential TIF (T)F ) \
Mass Transit TIF jtIF-MT)
Commercial TIF (TIF-C)
Industrial TI� (TIF-1) —
Institutior{a``I TIF (TIF-IS) —
Office TIF (TIF-0)
Water Quality (WQUAL)
Water Quantity (WQUANT)
Fire Life Safety (FLS)
Erosion Cntrl Permit (ERPRMT)
Erosion PlanckiUSA (ERPLAN) _
Erosicn Planck'COT ;EROSN)
r Al
T07ALS:
Uk
SEE 3 T,/IM
ROLL 1
FOR
L,ARG-E-
DOCUMENT
lddress:
1s,�tied by: _ __ Date: wo�
Statement: Information Notice to Property owners
About Construction Responsibilities
Note. Oregon Late, URS 701.055(4), requires residential construction permil alyVi-
cants teho are not registered tvith the Construction Contractors Board to sign the
Ji►llutring.+lulernc►tt 11C Ji►re a building perWrit ccrn he i.s.sued. This statement is required
,Jnr residential building, electrical, mechanical, and plurrrhing permits. Licensed
architect and engineer applicants, exenrlll from registration under ORS 701.010(7),
need not suh►nit this•slatentent. T► ntCrtemenl :1'rll he JdC'[I 11Yt/1 the pC'I'nrlt.
Fill in the appropriate blanks and initial boxes 1 and 2. and either box 3A or 313:
(� 1 . 1 own, reside in. or will reside in the completed structure.
(�
2. 1 understand that I must register a!, a construction contractor if the structure is sold or offered for sale
U helore or upon completion.
(�
3A. My general contractor is —
l—J (Name) Contractor regis. #
1 will instruct my general contractor that all subcontractors who work on the structure must be
registered with the C•cit,;truction Contractors Board.
OR
3B. i will be my own general contractor.
If i hire subcontractors, l will hire only subcontractors registered with the Construction Contractors
Boats. 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 ofthe
name of the contractor.
herchy eertif,* that the ahm a inf►►rm,tIion is correct anti that I liaN e read an t du understand the Inform atit►n
Notice to 1'ropert► 0%,incrs about Construction Itesh,►nsihilities on the reverse side of this form.
(Signature ofpci mit applicant) (Date)
(White cope•to issuing agent,•perrrtit_Jile,
pink c•opt•to a 1±carltl
I nforMAtion Notice to Property Owners
About.Construction Responsibilities
Note. I'Ili% hrformalion .%Wkc to I'rnfrrrll-(boners about('onclruc lion ResImnsihi/llies
was lhr,(.*oil rlrrn lir-rr contractors L our of m oc ordulrc,' ►rilh ORS -01.055(5
I 1 \,,u m c,ming as your own contractor to construct a net% home err make a substantial imprm cment to an e\i,t im,structure,
\�rn can 1.rc%cot many problems by being aware orf the follcm inig respornsihiIities and areas of Concern.
EMPLOYER RESPONSIBILITIES:
If you hire persons not rcpstcred with the ( ,w iructio.nl Contractors hoard to 01t, hl-ol n1 constructing ur assisting in the
construction or improven,--nI ofn residcr►tial structure,you will, in most instances,be ruled to toe,,n employer and the people
\ou hire will be employed A,;the ertl11lover.you must comply with the following:
Oregon's withhold Ing tax law- Asanempluver,you mustwithholdincometaxesfrom erttplo%ccwages atthetinleemployees
are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more
information,call the Oregon Dept.of Revenue tit 945-8091.
Unemployment insurance tax: As an employer,you are required to pay a tax for unemployment insurance purposes on the
wages of all employees. For more information.call the C:)regort Cnlpluyment Deparhncnt at 378-3524.
Workers'compensation insurance: As an ern ploN cr,%uu are Subject tothe Oregon Workers'CompcnsatIon Law,Ind must
obtain workers'compcnsatwn insurance for\tour employees. I f vuu rail to obtain workers'compensation insurance,you may
be tiubjcct to penalties:+nd will be liable firr al I claim costs ifonc uf• nor employees is injured un 01e.1011. i'or more information,
call the Work.-rs' 'ompensation Division at the I7cpamneni ofC"onsunlerand l3usinest;qcr\ice,nt 1145-7888.
U.S,Internal Revenue Service: Asan employer,you must withhold federal inccmle tar from err acs'wages. You will be
liable for the tn\payment even ifyou didn't actually\\ithhold the tax. For information,calf the I eternal Re\ell Lie Service
at 1-800.829.1040.
OTHER RESPONSIBILITIES AND AREAS OF CONCERN:
C odecompliance: As the perm it holder for this project.% w, arc respon . �i. i,trresolvingan\ f;uu:
luretomeetcoderequircnnts
tint may he brought to your attention through inspections,
l.iahilitr and property damage insurance: Contact your insurance af,ent 10 We if\uu ha\.adcgirate insurance coveragra^l0r'
aL6dv;jts and onli5sions such as falling,tools,paint overspray,water damayc from pipe punctures, tire,or work that roust be
re-dune.
Time to supeI-vIse employees: cr\iso\0I I U ellI k,%ecs.
t:a pe rtisr: !\1.►kdure vuu ha\e the c\her!isc to a,:r as y 0�ur irw n�tcncrrl crntractvr,t��cnt1rdinate the\,nr1.0�1 rr,u;•.h-in;:end iiniai
trades,and to notifv huildint.officials etthe appropriate times so they can perform the recluired inspections.
If you have additiomnl questions. write or call the Construction Contractors Bugrd(110 linx 1 11 11), fiO 1vtit (W9 -5052,
M/378-•102.1 ). T;he litxird.isl(+ aced at 700 Surnmer St. NL Suite 300, in SaleW
�.r
tmmrp•u„n pm4
1 94
CITYOF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLM2004-00052
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 2/6/04
PARCEL: 1 S133DA-02700
SITE ADDRESS: 12825 SW GLACIER LILY CIR
SUBDIVISION: AMART SUMMERLAKE ZONING: R-7
BLOCK. LOT: 049 JURISDICTION: TIG
CLASS OF WORK: REP GARBAGE DISPOSALS: MOBILE HOME SPACES:
'TYPE OF 0SE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS: i RAPS:
STORIES: WATER HEATERS: CATCH BASINS:
_ FIXTURES _ LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB/SHOWf_RS: SEWER LINE: ft
WATER CL03ETS: WATER LINE: 60 ft
DISHWASHERS- RAIN DRAIN: ft
Remarks: Replace 60' of water servirc.
FEES
Owner:
-- —- Description Date Amount
MEREDITH, MICHAEL D + KATHLEEN M
12825 SW GLACIER LILY CIRCLE �I'I I i1113I I'rrmit Fri• 2/6/04 $72.50
TIGARD, OR 97223 l MN I State surchill 1 2/6/04 _ _ $5.80 _
Total $78.30
Phone :
Contractor: _
()WNER
REQUIRED INSPECTIONS
Phone : Water Line Insp
Final Inspection
Reg #:
chis permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OrZ.
Specialty Codes and all other applicable laws. NII work will be done in accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
I sued By; 71 Permittee Signature:
4/ , -
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day
Building Fixtures
Piumbinu Permit Application
Received PennnNa
City of Tigard Date/By: L
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review Other Permit No..
Phone: 503.639.4171 Fax: 503.598,1960 Date,B - --
Date Ready�By tis See Page 2 fur
24-Hour Inspection Line: 503.639.4175 Supplementallnform:uhm
Internet: wv'w.ci.tigard.or.us Notified/Method:
TYPE OF WORK FEE" SCHEDULE
---- For s tectal in ornratlon use ckeckllsr.
❑New construction ❑Demolition Descri tion t . Ea. ITotal
❑Addition/alteration/replacement J []Other: New I-2-family dwellings(includes 100 R.for each utility connection)
CATEGORY OF CONSTRUCTION
SFR(1)bath 249.20
SFR(2)bath 350.00
[] I-and 2-family dwelling ❑Commercial/industrial 399.00
-- SFR(3)bath
❑Accessory building ❑Multi-family 45.00
Each additional bath/kitchen
❑Mester builder ❑Other: Fire sprinkler( sq.ft.) Pnge 2
JOB SITE INFORMA:ION AND LOCATION Site utilities
Catch basin or area drain 16.60
Job site address: �1 �a 5 ? � G IG r r P r �, � --
Z 3 ._I S y 0 Drywell,leach line,or trench drain 16.60
City/Stale/iSP: Tr q r-4 a k Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name: Manufactured home utilities 110.00
Cross street/directions to job site: Manholes 16.60
Rain drain connector 16.60
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.: ) Page 2
Lot no,: Water service(no.linear ft.: Page 2 •
Subdivision _ ___ Flxture or Item _.
Tax map/parcel no.: Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
Backwater valve 16.60
te10�G('Q (PU �1Hy �n/OffT /1rP 16.60
— Clothes washer _
Dishwasher 16.60
-- Drinking fountain 16.60
(� PROPERTY OWNER ❑ TENANT 16.60
Name: MIC he �y
e I / I P r eq I+t, Expansion tank 16.60
5 +✓ �G( IP+ L-t (y �t r,(- Ip Fixture/sewer cap 16.GU
Address: 8 y U
q 71 2 j! Floor drain/floor sink/hub 16.60
City/State/ZB'; n r✓ n / Garbage disposal 16.60
Phone:(50 3 6 i s 6 '� Fax:( ) Hose bib 16.60
❑ APPLICANT ❑ CONTACT PERSON Ice maker 16.60
Business name: Interceptorogrease trap 1660
Contact name: Medical gas(value:%__t Page 2
Primer 16.60 _
Address: 16.60
Roof drain(commercial)
City/State/ZIP: - Sink/basin/lavatory 16.60
Phone:( ) Fax::( ) Tub/shower/shower pan _ 16.60
E-mail: Urinal 16.60
CONTRACTOR Water closet 16.60
Water heater 16.60
Business name: Q�� %�-�'
Other: _--I
Address: otal �
City/State/ZIP: 72.5 5;
Fax:( ) Residential backflow minimum permit fee: %36.25 ;7,q
Phone:( ) Plan review (25%of permit fee) III
CCB Lie.: Plumbing Lic.no,:
State surcharge(86/6 of permit fee) 5•i�
Authorized signature: TOTAL PERMIT FEE ~'
jj This permit application expires If a permit Is not obtnlned t�ithin
Print name_ /II I t a P ( Q r vl.f Date: �p b U y
IRO days after It has been accept.d as complete.
`Fee methodology set by Tri-County Building Industry Service Board.
i\auilding\Pttmit4WLMF-PemdtApp d6c 12/07
440-4616T(Ia/0'✓COMMEB)
1'lumbinp. Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee(ea) T°`al Square Foota e___ Permit Fee: -�
Footing drain-I°100' S5.(1U U to 2,000 $115.00 -
2,001 to 3,600 $160.00
Footing drain-each additional 10046
' .40 3,601 to 7,200 $920.00
Sewer-1 at 100' 55.00 7,201 and greater $309.00
Sewer-each additional 1 U0' 46.40
Water Service-Ist100' s5.00 Medical Gas Systems: _
Water Service-cach additional 100' 46.40 Valuation: Permit Feta:
Storm&Rain Drain-Isl 100' 55.00 $1.00 w$5,0(1(1.00 Munnnun fee$72.50
Storm&Rain Drain-each additional 100' 46.40 $5,001.0(1 to$IO,OOG.00 $72.50 for the first$5,000 A and$1.52 for each
Qty, Fee(ea) 'Total additional$100 00 or fraction thereof,to and
Fixture or Item _ including$10,000.00.
Commercial Flack Flow Prevention Device 46.40 $10,001 n0 to$2.5,000.00 $148.50 for the first$IO,000AO and$1.54 for
each additional$100.00 or fraction thereof,to
Residential Backflow Prevention 1).vice and including$25,]00.00,
minimum etmit fee$36.25 27.55
Rein Drain,single family dwelling 65.25 $25,001 AO to$50,000.00 $379,50 for the first$25,000,00 and$1.45 for
each additional 5100 00 or fraction thereof',to
Inspectiun of existing plumbing or and including$50:000,00.
specially requested inspections er hour 72.50 _ $50,001.00 end up $742.00 for the first$50,000.00 and$1.20 for
Subtotal: each additional$I GO.00 or fraction thereof.
Fixture Work:
Are you capping, moving or replacing existing;fixtures? If
",yes",please indicate work performed by fixture. Faihlre ut
accurately report fixtures could result in increased sewer fees*.
(uantity b Flxlurc 1Vork t'erformed
Fixture Type: Replace
Ne v Moved Fxlsting Capped cart vents regarding fixture work:
Bath -Tub/Shower
-Jacuzzi/Whir! ool - --- -- ---__._
Car Wash -Mach Stall __ _ -_--------------.__.
-Drive Thru _
Cuspid t/Water Aspirator --- --
Dishwasher -Commercial _- - ------ - - -
-Domestic
Drinking Fountain _
Eye Wash ---- - --- _ -
Floor Drain/sink .2"
4" _ -- - -- - - ---
Car Wash Drain
Garbage -Domestic
Disposal -Commercial *Not-' :f the fixture work under this permit results in an
-industrial increase of sewer EM Is, a sewer hermit %fll he issued and
Ice Mach./Refri .Drains fees assessed for lite setter increase nntst be paid before the
Oil Separator Gas Station
plu
Rec.Vehicle Dump Station nthfttg permit call Ile issued.
Shower Gang
-stall
Sink -Bar/lavatory Q11111 tt Total
-Bradley lsometric or riser diagram is required if fixture quantit.
-Commercial - total is'9.
-service -
_S`w�imtrunjt Pool Filter
Washer-Clothes -
Water Extractor _ I'_lan Review
waterClo;et-Toilet -_ - flan review is required if fixture quantity total is>9.
Urinal
Other Fixtures: - -
i\Building\Pentdu\PI.M-PermltAppdoe 3/03
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175
MST ----
INSPECTION DIVISION Business Line: (503)639-4171
BUP ..
Re,:eived -----Date 11 nRequested,.- �� AM-_ I PM - BUP =- -
Locat'on a P Suite MEC _
Contact Person _ i) - PLM 0 _ dd0�
_,�Y J 1�\b- Ph(
Contractor -________ Ph( _) SWR
BUILDING Tenant/Owner _ -_ ELC _
Footing ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain SIT
Slab Inspection Notes: ---- -
Post&Beam ----- -- -- - - _
Shear Anchors
Ext Sheath/Shear - ---- - ---
Int Sheath/Shear
Framing _ -- -- - -
Insulation
Drywall Nailing - - - ---- - - --
Firewall
Fire Sprinkler ---- _- - ----
Fire Alarm
Susp'd Ceiling --
Roof _Other-
Final
PASS PART FAIL
Post&Beam
Under Slab - -_
Rough-in
Vftttll AtlivTC%-,
'iarn ary e ei _-
Rain Drains -- - --f"�--
Catch Basin/Manhole -
Storm Drain - -
Shower Pan
' i
AS PART FAIL
MECHANICAL - --
Post&Beam
Rough-In - - -- - - -- - - -
Gas Line
Smoke Dampers --
Final
PASS PART FAIL - - —
E_LECTRICAL_
Service
Rough-In - - --�.- ---
UG/Slab
Low Voltage - -
Fire Alarm
Final [ Reinspection fee of$ - required before next Inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE [l Please call for reinspection RE:_ F-1 Unable to inspect-no access
Fire Supply Line -
ADA Date inspecto► -
Approach/Sidewalk
Other:_
Final DO NOY REMOVE this Inspection record from the ob site.
PASS PART FAIL