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CITYOF T II GA R D CERTIFICATE OF OCCUPANCY
DEVELOPMENT SERVICES PERMIT#: BUP2.002-00315
13125 SW Hall Blvd.,Tigard,OR 97223 (503)639-4171 DATE ISSUED: 7,18/2002
PARCEL: 1 S134AA-01800
ZONING: I-P
JURISDICTION: TIG
SIDE ADDRESS- 10240 SW NIMBUS AVE L-8
S0001VISION: SCHOLLS BUSINESS PARK
&LOCK: LOT:002
CLASS OF WORK: AI.T
TYPE OF USE: COM
TYPE OF CONSTR: 3N
OCCUPANCY GRP: B
OCCUPANCY 1..OAD: 15
TENANT NAME:ITISIGNIA/ESG
REMARKS: Create 2 new offices and existing walls.
Owner:
ROBINSON, CONSTANCE A + ^�
ROBINSON, LYNN + BELL, KAY ET
BY INSIGNIA COMMERCIAL GROUP
BEAVERTON, OR 97008
Phone:
Contractor:
GUILD CONSTRUCTION
5215 SE FLAVEL DR.
PORTLAND, OR 97206
Phone: 503-788-7778
Reg 0: LIC 109116
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WThis Certificate issued 7/31/2002 grants occupancy of the above referenced building or
portion thereof and confirms that the building has peen Inspected for compliance with the
State of Oregon Specialty Codes for the group, occupancy, and use under which the
referencofi permit was is
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POST IN CONSPICUOUS PLACE
-CITY OF T I C A R D MECHANICAL PERMIT _
DEVELOPMENT SERVICES PERMIT#: MEC2002-00310
13125 SW Hall Blvd.,Tigard,OR 97223 (503)639-4171 DATE ISSUED: IS13 2
PARCEL: 1 S 134AA-01800
SITE ADDRESS: 10240 SW NIMBUS AVE L-8
SUBDIVISION: SCHOLLS BUSINESS PARK ZONING: I-P
BLOCK: LOT:002 JURISDICTION: TIG
CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS:
TYPE OF USE: COM UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: B VENTS W/O APPL: VENT SYSTEMS:
STORIES: _ BOILERS/COMPRESSORS HOODS:
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
3 - 15 HP: COMML, INCIN:
MAX INPUT: BTU 15-30 HP: REPAIR UNITS:
FIRE DAMPERS?: 30-50 HP: VYOODSTOVES:
GAS PRESSURE: 50+ HP: CLQ DRYERS:
FURN < 100K BTU: AIR HANDLING UNITS O'fHER UNITS:
FIIRN >=100K BTU: <=10000 cfm: GAS OUTLETS:
> 10000 cfm:
Remarks: Ducts and defusors. Alteration of existing HVAC system.
Owner: _ _ FEES
ROBINSON, CONSTANCE A+ Type By Date Amount Receipt
ROBINSON, LYNN+ BELL, KAY ET PRMT CTR 7/18/02 $72.50 2720020000
BY INSIGNIA COMMERCIAL GROUP 5PCT CTR 7/18/02 $5.80 2720020000
BEAVERTON, OR 97008
Phone:
Total $78.30
Contractor:
HUNTER DAVISSON INC
3410 SE 20TH
PORTLAND, OR 97202 REQUIRED INSPECTIONS
Mechanical Insp
Phone:503-234-0477 Duct Inspection
Reg P LIC 01612 Misc. Inspection
Final Inspection
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wThis permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if work. is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR
952-001-0080. You may obtain copies of these rules or direct questions to OUNC by calling
�tin�i�dn_q�A4
Issue By: )a 4 �1�r,f �J Permittee Signature:
Call(503)6394175 by 7:00 P.M. for Inspections needed the next business day
VMecbanical'Pern it Application
Date received: /'� 0� Permit
City of 'Tigard "(_ct/appl.no.: Expire date:
C'itvofTixard Address: 13125 SW Hall Blvd,Tigard,OR 97223 Date issued: r H Receiptno.:
Phone: (503) 639-4171 —
Fax: (503) 598-1960 Case file no.: __ Payment type:
Lana use approval: Building pen pit no.:
U 1 &2 family dwelling or acc— myE!ommercial/industrial U Multi-family U Tenant improvement
U New construction ❑Addition/alteration/replacement U(Xher:
Job address: I OUD1,., A; ✓►116-5 Indicate equipment quantities in boxes below.Indicate the dollar
Bldg.no.: L Suite no.: ,r e value of all mechanical materials,equipment,labor,ove�imad,
Tax map/tax lot/account no.: profit.Value$ __�Vy _ .
Lot: Block: Subdivision: 'See checklist for important application information and
Project name: SCkvLtc, 1EV5 L TtL. jurisdiction's fee schedule for residential permit fee.
City/county: t i L) (r5 L, I'LIP:
Description and location of work on premises _► L G �T W=AK
Gn t S _ Fee(ea) Tonal
Est.date of completion/inspection: 7- /,Yel _ DestAO— m Re..00l Rea.ad
Tenant improvement or change of use: Air handling unit CFM
Is existing space heated or conditioned?*-Yes rJ No it coiuo
n nmire
g(site plan required)
d) _
Is existing space insulated?', Yes U No terauon of ec—t ng system X.
of er compressors
State boiler permit no.:
Business name:
✓t TCA O ut v'V _ HP Tons---BTU/H
Address: J,j p p �e k irusmo ceamper, t uct�molce electors
City: ►t:TLu.a.0 p I cat pump(sne plan required)
Phone: e Z `1 77 Fax:s•�.231 /61 mail: nsta rep ace urnac urner__
Including ductwork/vent liner U Yes U No
CCB no.: 160,1 _ tista rep ac rc ocste heaters-suspended,
City/metro lic.no.: 11 6;L Iwell,or floor mounted
Name(please print): e,r1 L; /? /)A ( Vent fora ance of er t an furnace
Absorption units_ ,_— RTU1H
Name: Lr ,t/1 A*L _ Chillers _ _---- lip
Address: �,� athir Coors — HP
nr ono eeM ea wd and veM at
City: E it) C e: ZIP: Appliancevent
Phone: Fax: E-mail: erex oust
H;Ms-,Type V Wres.kitchenthaimat
hood fire suppressioii,system
Name: T C, $,1 t6,- S , Exhaust fan with single duct(bath fans)
Mailing address: • re
aunts atem apart from heating or
IL sood dkilribullon up to
outlets)
a City: L4._Se c'7r°• , state: (_7 At I ZIP: zl73
JTy LPG NO Oil
F" Phone: e�.,k1- -at4 Fax: E-mail:
� sue m each additional over 4 outlets
(schematic required)
Name: Number of outlets
appliance or pawl:
J
W Address: e ec r^ Decorative fireplace
City: State: ZIP: nsert-t
W Phone: Fax: -mail: too pe et stove
Other:
Applicant's signature:' U. Date: ' !0 1 —�
Otber-
Name rt
Not all ladediciionf accept ci cards,please call jurisdiction for w"e ma
infordon Minim fee......................$ /z
rtdi
U visa ❑MasterCard Notice:This permit application Minimum fee................$
expires if a permit is not obtained plan review(at _ 96)
credit card number:
F.apire, within 190 days ager it has been State surcharge8% $ y
Name or cardhclder as non credit cod accepted as complete. ( ) •'
s TOTAL.......................$
C alp-mm Ammm 4104617(601M COM)
MECHANICAL PERMIT FEES
COMMERCIAL FEE SCHEDULE: 1 &2 FAMILY DWELLING FEE SCHEDULE:
TOTAL VALUATION: PERMIT FEE: _ DescAptlore P" T°ial
51.00 to 55,000.00 Minimum tee ST1.50 Table 1A Mochanicol 22S!g _ Qty (Es) _Amt
$5,001.00 to$10,000.00 $72.50 for the first$5,000.00 ant; 11, Furnace to 100,000 BTU
$1.'2 for each additional$100.00 oc Including ducts 8 vents_ 14•r�0
fracticn)hereof,to and Including 2) Furnace 100,000 BTU+
$10,000.0 Including ducts d vents 17.40
510,001.00 to$25,000.00 $148.50 fo the first$10,000.00 and 3) Floor Furnace
$1.54 for ea additional$100.00.x includin vent _ _ 14.00
fraction thero ,to and Including 4) Suspended heater,wall heater
_
$25,000.00. _ _ or floor mounted heater 14.00
525,001.00 to 550,000.00 $379.50 for the t$25,000.00 and 5) Vent not Included In applies permit
$11.45 for each ad Ilonal$100.00 ur _ 8.80
fraction thereof,to d including 6) Repair units
$50,000.00. 12.15
550,001.00 and up S742.00 for the first$ ,000.00 and Check all that apply: Boiler Heat Air
$1.20 for each to
$100.00 or For Items 7-11,s or Pump Cin d
_ fraction thereof. footnotes below Comp
Mmum Permit Fee$72.50 SUBTOTAL: 71<3HP;abs unit
ini
s to WOK8T 14.00
eX 81st=Surcharge = 8)3-15 H ;absorb
unit 1 to 500k BTU 25.60
25%Plan Review Fee(of subtotal) $ 9)1 HP;absorb 35.00
_Re ulred for ALL commercial permits onl unit 1 mil BTU
- -- -g-- ------ - ----x 1 30-50 HP;absorb
TOTAL COMMERCIAL PERMIT FEE: $ it 1.1.75 mil BTU 52.20
11)>50HP;absorb -
��` J� unit>1.75 mil RTU 87.20
ASSUMED_VALUATIONS_PER APPLIANCE: �I 12)Air handling unit to 10,000 CFM 10.00
Value Total 13)Air h2ndiing unit 10,000 CFM+
Description: Q Ea_ _Amount 17, 0
Furnace to 100,000 BTU,Including 955 1 Non-portable evaporate cooler
ducts 8 vents _ 10.00 _
Furnace> 100,000 BTU Including 1.17015) ret fan connected to a single duct
ducts 6 vents __ 6.80
Floor furnace In ludin vent _ 955 16)Vent tion system not included in
Suspended heater,wall heater or 955 applia permit 10.00
floor mounted heater 17)hood se d by mechanical exhaust
Vent not Included in appliance 445 10.00
ermit 18)Domestic In erat(xs
Repair units 905 17.40 _
<3 hp;absorb.unit, 955 7 19)Commercial or iin sMal type incinerator
to 100k BTU 69.95 _
3-15 hp;absorb.unit, 1,7 20)Other units,including stoves
101 k to 500k BTU _ 10.00 _
15-30 hp;absorb.unit,501k to 1 2,3 0 21)Gas piping one to four 00
%ets
mil.BTU _ _ _ 5.4030-50 hp;absorb unit, 3 00 22)More than 4-per,;it (e
1-1.75 mil.BTU _ 1.00 _
a >50 hp;absorb.unit, 725
>1.75 mil.BTU Minimum Permit Fee$72.50 SUBTOTAL: $
�
Air handling unit to 10,000 cfm858 8%gain Surcharge $
iq Air handling unit>10,000 cfm _ 1,170
Non rtahle evaporate woler 658 TOTAL RESIDENTIAL PERMIT FEE: $v
Vent fan connected to a single duct 446
-t Vent system not Included in 856 _-_.__ ____ I
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appliance unit
u Hood served b mechanical exhaust 656 481lf!!1l�Slt4'rs and Fsss:
Domestic indnbraior 1 170 1. Inspoctior s outside of normal business hours(minimum chaise-two hours)
162.50 pe hour.
- Commercial or Industrial incinerator 1 4,590 2. Inspectk rc for which no fee is spedfically indicated (minimum charge-hall hour)
Other unit,Including wood stoves, 656 sw.50 ser hiu,
Inserts etc. 3. Additional plan review required by changes,additions or revisions to plans(minimum
Gas pi ip ng 1 4 outlets 380 charge-0rte-haM how)$02.50 per hour
Each additlonal outlet 63 *State Contractor Bollar CerMicatlon required for units>200k BTU.
TOTAL COMMERCIAL : ~Residential AM requires site plan showing placement of unit.
VALUATION: All New Commercial Bulldings requlrs 2 sets of plions.
I.\dsts\forms\mech-fees.doc 02/11/02
• •�� CITY 4F TIGARD
Approved. I
76' ••• ••• • •• • :'• 1 inditionally Approved.................... I I
f or only the
• • ••" °'° or
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Se3lltimr to: Follow..
J Ad r Attach '-- T• I 1
By: _ Date: d
_Demo
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Demo Wane
Demo Door UpeninB "♦
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-4 DEMOLITION PLAN
3 t° 10240 SW Nimbus
f Suit
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Scale 1 8 1 90"
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New Walls
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Floor Plan
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10240 SW Nimbus
Suite L-S -
I Scale 1/811=110"
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REFLECTED CEILINCI Pt.A
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10240 SW Nimbus
I I Suite L-8
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HVAC Plan
10240 SW Nimbus
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BUILDING PERMIT
CITY OF T I G A R®
PERMIT#: BUP2002-00315
DEVELOPMENT SERVICES DATE ISSUED: 7/18/02
13125 SW Hall Blvd.,Tigard,OR 97223 (503)639-4171 PARCEL: 1S134AA-01800
SITE ADDRESS: 10240 SW NIMBUS AVE L-8
SUBDIVISION: SCHOLLS BUSINESS PARK ZONING: I-P
BLOCK: LOT: 002 JURISDICTION: TIG
REISSUE: FLOOR AREAS _ EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: ALT FIRST: sf N: S: E: W:
TYPE OF USE: COM SECOND: sf PROJECT_OPENINGS?
TYPE OF CONST: 3N sf N: S: E: W:
OCCUPANCY GRID: B TOTAL.AREA: 0.00 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: 15 BASEMENT: sf AREA SEP. RATED:
STOR: HT: ft GARAGE: sf OCCU SEP. RATED:
BSMT?: MEZZ?: _ REQD SETBACKS_ REQUIRED
FLOOR LOAD: psf LEFT: ft RGHT: ft FIR SPKL: SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 10,308.00
Remarks: Create 2 now offices and demo existing walls.
Owner: Contractor:
ROBINSON, CONSTANCE A + GUILD CONSTRUCTION
ROBINSON, LYNN+ BELL, KAY ET 5215 SE FLAVEL DR.
RYYE qIINSIGNIA COMMERCIAL GROUP PORTLAND,OR 97206
BPFione TON, OR 97008 Phone: 503-788-7778
Reg#: LIC 109116
_ FEES REQUIRED INSPEII,' NS
Type By Date Amount Receipt Framing Insp
PRMT CTR 7/18/02 $148.90 27200200000 Insulation Insp
Gyp Board Insp
5PCT CTR 7/18/02 $11.91 27200200000 Susp Ceiing Insp
PLCK CTR 7/18/02 $96.79 27200200000 Final inspection
FIRE CTR 7/18/02 $59.56 2.7200200000
Total $317.16
a
NThis permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes
U) and all other applicable law. All 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 thorn 180 days. ATTENTION: Oregon law
-J requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in CAR
m 952-001-0010 through OAR 952-001-1987. You may obtain a copy of these rules or direct questions to OUNC by
W calling (503)246-6699 or 1-800-333322-2344.
Permlttea A
Signature:
Issued By: xe-
Lill
Call 639-4175 by 7 p.m.for an Inspection the next business day
i
Building Permit Applicati®n
City of Tigard Date received:7 i S O Z Permit no.:
City ref Tigard
Address: 11125 SW Hall Blvd,Tigard,OR 97223 ProjecVappl.no.: Expire date:
Phone: (503) 639-4171 Date issued: By: Receipt no.:
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval' 1&2 family:Simple Complex:
U l &.2 family dwelling or accessory U Commercial/industrial U Multi-family U New construction U Demolition
U Addition/alteration/replacement wTcnant improvement U Fire sprinkler/alarm U Other —
M
Job address: 0 - IBldg.no.: Suite no.:
Lot: Block Subdivision: -�-- Tax map/tax lot/account no.:
Project name:
Degcriptipnnd IM atjoq of prk n 7mises/special conditions:� �
4 �rl/1 >f(t) Wu
Name:
Mailing address: Y - IPIW ✓ d I &2 hmily dwelling:
City: kc- r , tatc�t _ZIP: Valuation of work........................................ _
Phonc: Fax: E-mail No.of bedrooms/baths.................................
Owner's representative: Total number of floors.................................
Phone: Fax: E-mail: New dwelling area(sq.ft.) ..........................
NUFM Garage/carport area(sq.ft.)......................... ---
Name: Covered porch area(sq.ft.).........................
Mailing address: Deck area(sq.ft.) ........................................
City: _ State: ZIP: Other structure area(!S.ft.).........................
Phone: Fax: E-mail: Commercial/indintriallmalti-fatttttillr:
Valuation of work........................................ S Q 3d
Existingbldg.areA(s .ft.
Business name: U � c I/pi g q ) ..........................
New bldg.area(sq.ft.).....................
Address: - —L
City: y State:Qn zip: q � D
Number of stories........................................
Phone: Fax:') - /IfIE-mail:
Type of construction................I...................
Occupancy group(s): Existing:
CCB no.: — —
New:
City/metro lie.no.: Notice:All contractors and subcontractors are required to be
licensed with the Oregon Constructioc,Contractors Board under
Name: provisions of ORS 701 and maybe required to he licensed in the
Address: i jurisdiction where work is being performed.If the applicant is
L Cit State: ZIP:
exempt from licensing,the following reason applies:
Contact person: Plan no.: —
Phone: Fa X: E-mail: — - -----
s-
J Name: Contact person: Fees due upon application ........................... —
n Address: Date received: _
jCity: State: ZIP: Amount received .................. _
-'t Phone: Fax: 7-mail: Please refer to fee schedule.
I hereby certify 1 have read and examined rpplication and the Not an}udsdicdons WcW c"t arm,P;nw call Jads&tinn for more information.
attached checklist.All provisions of laws and ordinances governing taco Uvisa U MasterCard
work will be complied with whether s ci red hetrin or not. Credit card number:_ _
/)�A - I '-��Z Ea lea
Authorized signature: Q ��d�-( Date: Name ej��on credit curd
Print name: t ti --- _
Crdbdder djtrattvo Amount
Notice:This permit application expires if n permit is not obtained within 180 days after it has been accepted as complete. 4404613(twoMCOM)
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Commercial Plan Submittal
Requirement Matrix
City ofTigard
I
.3.
Site Work � 4
\ !must include loc.atlon of ail accessible porkli g)
i
lumbing - Site Utilities 2
Building 1
Fire Protection S tem 3**
Mechanical 2
Plumbing - Building Fixtur s 2
Electrical 2
IL
N Plan review is depende/PIs
upmittal of a completed application �nc( p After
} plan review approval, thminer will contact the applicant to request
additional sets of plans on purposes (for Contractor, City of Tigard,Washington County, analley Fire & Rescue).
w *For over-the-countertenant improvements, submit 2 sets of pians.
**"New" fire protection systems require that pians bear the original seal of an
Oregon licensed fire suppression engineer, or N10ET level "3" technicians.
1Adats\loans\C0M-ma6Ix.doc W24/0'
i
Accessibility:
Barrier Removal Improvement Plan
City of Tigard
REQUIREMENT: OREGON REVISED STATUTE (ORS) 447.241.
(1) Every project for renovation,alteration or modification to affected buildings and related
facilities shall be made to insure that the path of travel to the altered area and the restroom,
telephones and drinking fountains are readily accessible to individuals with disabilities unless
such alterations are disproportionate to the overall alterations in terms of cost and scope.
(2) Alterations made to the path of travel to an altered area may be deemed disproportionate to
the overall alteration when the cost exceeds twenty-five per-cent(250).
VALUgJtON: of all renovation, alteration or modification being done '/
excluding painting,wallpapering. [1]$/0 01
multiply. 25%Barrier removal requirement. 25
BUDGET FOR BXR1ER REMOVAL [2]$
In choosing which accessible elements to provide under this section, priority shall be given to those
elements that will provide the greatest access. Elements shall be provided in the following order:
(a) Parking $
(b) An accessible entrance: $
(c) An accessible route to the altered area: $
IL
N (d) At least one accessible restroom for $ Z. V9 Y
+� each sex or a single unisex restroom:
(e) Accessible telephones: $
m
W (f) Accessible drinking fountains: and $
(g) When possible,additional accessible
elements such as storage and alarms: $,
TOTAL: Shali_P_qua1LJn@ 2 of Valu@imputation $ _
iAdstslfom\Acccssibility.doc 06/07/02
7959 SW CIRRUS DRIVE,WAVERTON,OR 07006
(503)6414634,FAX(503)64143&6
Menlo
To:_ City of Tigard Plans Examiner — From: Kevin Koser __ 1
Fax: Dates July 11,2002
Phone: 503-639A 171 Paps:
Res ADA upgrades CC:
❑Urgent ®For Review (I Please Comment O Please RePly 0 Please Recycle
Comments:
This suite, L-8 located at 10240 SW Nimbus is ADA compliant exoept for the bathroom and lever
handle passage sets. Conversion of the bathroom to make R ADA compliant would be disproportionate
under ORS 447.241 The cost of the job is $9,346.00. The oust to upgrade the bathroom would be
$5,200.00 to$5,600.00 Lever handle passage sets are to be added at a cost of$401.00.
Kevin Koser
Estimator,Guild Constriction
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� CITY O F T I�A R D ELECTRICAL PERMIT'
PERMIT M ELC2002-00333
DEVELOPMENT SERVICES DATE ISSUED: 7/18/02
13125 SW Hall Blvd..Tigard,OR 97223 (503)639-4171 PARCEL: 1S134AA-01800
SITE ADDRESS: 10240 SW NIMBUS AVE L-8
SUBDIVISION: SCHOLLS BUSINESS PARK ZONING: i-P
BLOCK: LOT : 002 JURISDICTION: TIG
Proiect Description: Electric demo and new plugs.
RESIDENTIAL UNIT TEMP ERVC/FEEDERS MISCELLANEOUS _
1000 SF OR LESS: 0 - 200 amp: PUMP/IRP,IGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN/OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNALIPANEL:
MANF HMI SVC/FDR: 601+amps-1000 volts: MINOR LABEL (10):
SERVICEWEEDER BRANCH CIRCUITS M ADD'L INSPECTIONS
0 - 200 amp: WISERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 1 IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+amp/volt: >-4 RES UNITS: >600 VOLT NOMINAL:
Reconnect only: SVC/FDR>=225 AMPS: CIA§IS AREAISPEC OCC:
Owner: Contractor:
ROBINSON, CONSTANCE A+ GUILD CONSTRUCTION
ROBINSON, LYNN+ BELL, KAY ET 7959 SW CIRRUS DR
BY INSIGNIA COMMERCIAL GROUP BEAVERTON, OR 97008
BEAVERTON, OR 97008
Phone: Phone: 541-4634
Reg#: LIC 109116
SUP 3868S
ELE 26-986C
_ FEES Required Inspections
Type By Date Amount Receipt Rough-in
PRMT CTR 7/18/02 $53.50 2720020000( Elect'I Final
5PCT CTR 7/18/02 $4.28 2720020000(
Total $57.78
This Permit is issued subject to the regulations contained in the Tigard Municipal Code,State of OR. Specialty Codes and all other applicable leve.
All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance,or f work Is
suspended for more than 180 days. ATTENTION Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
p, rules are set forth in OAR 952-001-0010 through OAR 952-001.0080. You may obtain copies of these rules ordkect questions to OUNC at(503)
p� 248-6699 or 1.800.332-2344.
M - �
rn Permit Signature: / �,.z ,roti' Issued By:
m OWNER INSTALLATION ONLY
f.9
w The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: _ _--- __-- _ DATE-
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: 1 C�_- - — DATE:
LICENSE NO: C ` C- - - - ---
Call 6394175 by 7:00pm for an Inspection the next business day
` Electrical Permit Application
- -- Date received: /gyp G Z Permit
City of 'Tigard Projecttappl.no.: Exphedate:
CityofTigurd Address: 13125 SW Hall Blvd,Tigard,OR 97223 Date issued: Byle,Pj jReceipt no..
Phone: (503) 639-4171 —
Fax: (503) 598-1960 Case file no.: Payment type:
Land use approval:
=Ncw
mily dwelling or accessory U Commercial/industrial ❑Multi-family 14 Tenant improvement
nstruction UAddition/altcration/re.placement ❑Other: U Partial
Job address: _ t-J! �( ( 1�_ Bldg.no.: L ISuite no.: Tax map/tax iot/account no.:
Lot: I Block: Subdivision: �—�-
Project name: p , 1 r sctiption and location of work on premises: ��YL! !Jt i+�D ql-Arra
Estimated date of completion/ins V,
ction:
Job no: Fa Ma
Business name: I _ V &-t, Dewrl ion a 1'olal as lea
r*W nudddelW-sbigle ar NOW familly per
Address: -' _ SKW-
aPhon �rk
k State: ZIP: 0 eervlaYsc`de�
Fax: - ' mail: 1000 sq.ft.or leas4
b Each additional 500 sq.ft.or portion thereof
Elcc.bus.Iic.no: Umhedmergy,residential 2
o.: _ /D-I -�� Limited energy, 2
7 Each manufactured home or modular dwelling
Signature of su isin electrician(required) Date Service and/or feeder 2
Sup.elect.prams(print): t Z •C n License m j (, &ervicea or feeders-Installation,
alteration or relocation:
200 amps or less 2
Name(print): f 201 amps to 400 amps 2
401 am s to 600 amps _ _
Mailing address: ✓ t 601 amps to 1000 amps 2
City: L C� St 1te'Q ZIP: Over 10(x)amps or volts 2
Phone:s0 - 1 of x E-mail: Reconnect only
Owner installation:The installation is being made on property I own Temporarywrrlcesorfeeden-
which is not intended for sale,lease,rent,or exchange according to Indolintion•aiterstion,orreloestion:
200 amps or las 2
ORS 447,455,479,670,701.
201 amps to 400 amps 2
Owner's si nature: Date: 401 to 600 amps 2
Branch circaits-new,alteration,
or extension per peel:
Name: A. Fee for branch circuits with purchase of
Addlr.ss: — service or feeder fee,each branch circuit 2
Slate: ZIP: B. l-ee for branch circuits without purchase
-----T- of service or feeder fee,first branch circuit: / 2
0. Phone: Fax: Email: Each additional branch circuit:
Ike.(Service or feeder not Melded):
~ O Service over 225 amps-commercial U Health-care facility Each pump or irrigation circle — 2
n lighting(]Service over 320 amps-rating of I fit U Each sign or outline htin Hazardous location 6 g B 2
familydwellings U Building over 10,000 square feet four or Signal circuit(s)or a limited energy panel,
O System over 600 volts nominal more residential units in one structure alteration,or extension*
2
U Building over three stories U Feeders,400 amps or more *Description:
U Occupant load over 99 persons U Manufactured structures or RV park Heir additional Insprtllae over the allowsMe in any of the above
U.1U Egmas/lightingplan U Other. _ - --- Perini tion
_ Submit Subsalt__aeis of plan+whb any of the above. Investigation fee
The above are not applicable to temporary condructioe service. Other
Not all iurisdictiona secept credit card,,pteaw call imisdiction for more irdonttatIon. Notice:This permit application Plan r fix................. ) $ _
U Visa U MasterCard expires if a pemiit is not obtained ��review(at _ 96) _
Credit card namtwf __ _ within IRO days after it has been State surcharge(896) $
....s
_.._
Fxp res accepted as complete. TOTAL .......................$
Name of cardholder s.shown on credit cwt ---_-- -
-Cardholder sijrutrae - Arnount - 440-4615(600iCOM)
J"
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES:
Comp/etP Fee Schedule Below: TYPE OF WORK INVOLVED-RESIDENTIAL ONLY
Restricted Ensrpy Fee...................................................... $75.00
Number of Ins ons k SIW*Sd (FOR ALL SYSTEMS)
Service included: Items Cost Total Check Type of Work Involved:
Residential-per unit
1000 sq.R.or loss $145.15_ 4 ❑ Audio and Stereo Systems'
Each additional 500 aq.ftor
portion"rept _ $33.40 1 � Burglar Alarm
Limited Energy $75.00
Each Manuf'd Home or Modular
Dwelling Service or Feedar 590.90 __ 2 ❑ Garage Door Opener'
Services or Feeders 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 Vacuum Systema'
401 amps to 600 amps $180.80 2
601 amps to 1000 amps $240.60 2 Other _
Over 1000 amps or volts $454.65 2
Reconn6,x 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 490 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"alcove. [� Audio and Stereo Systems
Branch Circuits
New,alteration or extension per panel Boller Controls
a)The fee for branch circuits
with purchase of service or Clock Systems
feeder fee.
Each brandy circuit _ $6.65^ _ 2 Data Teiecommunicatio n Installation
b)The fee for branch circults
without purchase of service ❑ Fire Alarm Installation
or feeder fee.
First branch circuit _ $46.85 � ❑
Each additional branch circuit $8.65 HVAC
Miscellaneous ❑ Instrumentation
(Service or feeder not Included)
Each pump or irrigation cirrie $53.40 Intercom and Paging Systems
Each sign or outline lighting T _ $53.40 ❑
Signal clrcult(s)or a limited energy
panel,alteration or ext,)nsion $75.00_ n Landscape Irrigation Control*
Minor Labels(10) $125.00 E] Medical
Each additional Inspection over ❑
the allowable in any of the above
Per Inspection $62.50 Nurse Calls
Per hair $62.50
In Plant 573.75 ❑ Outdoor. Landscape Lighting'
CL
CL Fees: Protective Signaling
NEnter total of above fees $ C . n Other
8%Sbte Surcharge $ _ Number of Systems
m 25%Plan Review Fee
See"Plan Review'section on $ ' No licenses are required Licenses are required for all oltbr installations
Wfront M application. —
W Fees:
Total Balance Due $ :� %
Enter total of above fees S __
❑ Trust Account 0 8%State Surcharge = _.
Total Balance Due >)
All New Commercial Buildings require 2 sets of plans.
0Ats\formskic-fees.doc 09/30/01
CITY OF TICXIARQ 24-Hour
BUILDING Inspection Line: (603)6304176 • MST
INSPECTION DIVISION Business Line: (503)639-4171
6UP _
Received ___. Date Requested —AM---PM— sup —
Locationc� c� _(� —_Suite_ �-- MEC
Contact Person _ _ Ph(—) _ 7 S-Z ' Sam PLM
Contractor Ph( ) SWR —
BUILDING Owner Zla e_e rt, ELC = 333
Footing ELC
Foundation Access:
Ftg Drain ELR _
Crawl Drain
Slab Inspection Notes: SIT
Post&Beam
Shear Anchors —
Ext Sheath/Shear
Int Sheath/Sheat —-'
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL —
PLUMBING _
Post R 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
4. Smoke Dampers ----
Final
N PASS PART FAIL
c ELECTRICAL
Service
TV
I UG/Slab
lu Low Voltage
J Fire Alarm
PASS RT FAIL Reinspection fee of$_ required before next Inepeotion. Pay at City Halt, 13125 SW Nall Blvd.
_ F] Please call for reinspection RE:_—` n UnatAe to inspect-no access
Fire Supply Line
ADA '_
Approach/Sidewalk Daft— ' -� Z-1e �— l-_?"�`"�� ut
Other: ,
Final AO NOT REMOVE this Inlsfpedlen feOOw;�_/ �bvg
PASS PART FAIL
CITY OF TIGARP 24-Hour
BUILDING -+ 0 Inspection Line: (503)635-4175 � MST
INSPECTION DIVISION Business Line: (503)635-4171 OUP
Received . _ Date Requested— a-' AM PM BUP
Location —
— &* � _ Suite 4 MEG —
_ _ _
—
Contact Person _ `�'��"�''''`� Ph( — ) �p PLM
Contractor --
Ph( ) SWR
BUILDING Tenant/Owner —_-- - ELC 3
Footing ELC
Foundation Access: ELR
Ftg Drain
Crawl Drain SIT
Slab Inspection Notes:
Post&Beam —
Shear Anchors _
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall -
Fire Sprinkler
----���1 v�
Fire Alarm
Susp'd Ceiling
Root
Other: —
Final
_PASS PART FAIL
PLUMBING -- - --
Post&Beam
Under Slab -
Rough-In
Water Service —
Sanitar 13ewer
Rain Drains
Catch Basin/Manhole _
Storm Drain
Shower Pan
Other:
Final
PASS PART _FAIL —
MECHANICAL _ —
Post& Beam
Rough-In -
Gas Line
a Smoke Dampers —
Final
PASS PART FAIL
ELECTRICAL
Ser.ice
00 —
O UG/Slab
W Low Voltage
Fire Alarm
Fin Reinspection fee of$_—___ required before next inspection. Pay at City Hell, 13125 SW Hall Blvd.
Ass ART FAIL
S I I Please call for reinspection RE: Unable to inspect-no access
Fire Supply LineADA r
—
Approach/Sidewalk Daft'17-
Other:_
Final DO NOT REMOVE this Ins m
on ord trothe
PASS PART :•AIL
CITY OF TIGAMP 24-Hour
BUILDING . Inspection Lire: (583)639.4176
INSPECTION DIVISION Business Line: (503)639.4171 MeT
k8UP
Received Date Req-/uested_��(� AM —PM_— SUP
Location ��4y 541 /1/�? 64'> MEC
Contact Person __ — Ph( ) -s L�3 PLM —_
Contractor_. _ Ph( ) _ _ SWR
BUILDING Tenant/Owner _— -- ELC &W 7-00 333
Footing ELC — —
Foundation Access:
Fig Drain ELR
Crawl Drain
Slat, Inspection Notes: SIT
Post&Beam _
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing —
Insulation
Drywall Nailing —
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Coiling
Roof
Other:
Final
PASS PART FAIL .�
_PLUMBING
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-hi
Gas Line
¢ Smoke Dampers
F-
Final
PA PART FAIL --
e L�—
m Rough-In
UG/Slab
W Low Voltage
J — -- - --t
larm
S PART FAIL
C Reinspection fpe of� required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
LI Please call fog reinspection RE: Uname to inspect--no access
Fire Supply Line
ADA 7..
Approach/Sidewalk Dates.
Other:
Final DO NOT [REMOVE this Insp+ctlon nword from jMb tilt.
PASS PART FAIL
CITY OF„TIGiARD 24-Hour
BUILDING Inspection Line: (503)639-4175 .
INSPECTION DIVISION Business Line: (503)639.4171 MST �-
r .BUP
Received _ Date Requested —7 AM PM BUP '
Location _ Suite — MEC .31
Contact Person Ph(—) Sa ��� PLM _
Contractor _ _ _ Ph( ) SWR
BUILDING_ Tenant/Owner ELC
Footing ELC
Foundation Access:
Fig 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:_
Final
PASS PART FAIL
PLUMBING
Rost&Beam
Under Slab _
Rough-In
Water Service — —
Sanitary Sewer
Rain Drains
Catch Basin/Manhole
Storm Drain
Shower Pan
Other: -
Final
P FAIL —
eam
Gas Line
L Smoke Dampers --
p�
JePTASS
T FAIL —
Pt*C_ CAL
Service
m Rough-In
UG/Slab
LU Low Voltage -
-j Fire Alarm
Final r�
PASS PART FAIL 1 � Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW HAD Blvd.
SITE [ Please call for-inspection RE:_ _ C=� Unable to Inspect--no access
Fire Supply Line
ADA
Date------ �`� tnspeetor _ -
Approach/Sidewalk
Other:
Final DO NOT REMOVE this InspeWoD rolmrd from filo job lib.
PASS PART FAIL
CITY OF TIGARD 24-Hour
(WILDING Inspection Line: (503)630-4175
INSPECTION DIVISION Business Line: (503)639.4171
OUP
Received _ Date Requested! 3 G -..AM--PM- DUP -
Location 40 Z q6'
Contact Person _ _ ____ Ph(_) _77P 3 ZIC3 PLM
Contractor _ Ph SWR
BUILDING Tenant/Owner __... _ ,— ELC
Footing ELC
Foundation ®�;
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: S SIT -
Post&Beam
Shear Anchors
Ext Sheath/Shear
Int Shesth/Shear A �� 4V 1(zW
Framing
Insulation
Drywall Nailing AA
Firewsll
Fire Sprinkler – — --
Fire Alarm
Susp'd Ceiling
Roof
Other: z V��_
Final
PASS PART FAIL
PLUMBING
Post&Beam
Under Slab
Rough-In
Water Service
Sanitary Sewer
Rain Drains
Catch[basin/Manhole
Storm Drain —
Shower Pan
Other:
Final _
PASS PART FAIL
L
Post&Beam
Rough-In
Gas Line
CL SnIgke Dampers — -
ac i
U) XSD PART FAIL
L RICAL
J Service
m Rough-In -
0 UG/Slab
WLow Voltage
Fire Alarm
Final i J Reinspection tee of�_ _._.required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL r
SITE [� Please call for reinspection RE:___ �__ __._ �___ L Unable to inspect–no access
Fire Supply I Line )
ADA ��^ Q J 6 'Z� � 24
Approach/Sidewalk Daft
Other:
Final DO NOT REMOVE this 111Bp/1111o111+OW Ih'oM Me job olio.
FABS PART FAIL
CITY SOF TIGARD 24-Hour
BUILDING Inspw lon Linc (503)635-4175
INSPECTION DIVISIt',>iN Business Ciro: (503)635-4171 - Mme' —
SUP
Received __ Date Requed d_ AM---PM___.__— SUP �
Location a` 4J )Ij�✓ &ft I-" MEC
Contact Person te�2,— .__ Ph( ) 252 - Ste.Ss'3 PLM
Contractor _ 1 /Ph( _) SWRy
511 ----- e Owner4_e a—d A Y— ELC
0o ing
Foundation Acc"cELC
Ftg Drain ELR —
Crawl Drain
Slab InspwAlm Notes: SIT
Post&Beam
Shear Anchors — - -------
Ext Sheath/Shear
Int Sheath/Shear
Fire Sprinkler01
Tit)A-4 =Lr-q//n
Fire Alann
Susp'd Ceiling —
Roof
Other: -Final-
PASS PART FAIL _
Post&seem /
Under Slab
Rough-in
Water Service
Sanitary Sewer
Rain Drains —
Catch Basin/Manhole
Storm Drain --
i
Shower Pan
Other: _
Final
PASS PART FAIL
MECHANICAL
Post&Beam
Rough-in
Gas Line
L Smoke Dampers
12 Final
PASS PART FAIL —
ELECTRICAL
Service
Rough-In
UG/Slab
LU Low Voltage —
Fire Alarm
Final Relinspectlitm fee of a�_ _required before next inspection. Pay at City Han, 13125 SW HaM Blvd.
PASS PART FAIL
SITE Plows call for reinspection RE:_ Ll Unable to inspect-no access
Firi Supply Line
ADA / 4�
Approach/Sidewalk Mss
Other:
Final DO NOT REMOVE this Inspodlon i+seerd tf' M the bb sibs.
PASS PART FAIL
I
i
CITY 4F TiCCARD 24-Hour
BUILDING Inspection Line: (503)6384175 MST _
INSPECTION DIVISION Business Lino: (503)638-4171
SUP ,3/J�_
Received lk4e Requested ' Z AM PM BUP
Location --/1 Z q 6 Ili L %w—_ - MEC _
Contact Person _ _ Ph(_-_._) 3 Z f'5 pLM
Contractor— ----- Ph(—) SWR
WIR-50 W Tenant/Owner _ ELC
oozing —
Foundation crew. ELC
Ftg Drain
Crawl Drain ELR ------_.-- �__
Slab Inspection Notes: SIT
Post&Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear — --
Framing
Insulation ---
Drywall Nailing
Firewall
Fire:hrinkler _
Fire Alarm
oof j
Other:
Final
PART FAIL _
t-PURBING
Post&Seam -
Under Slab _
Rough-In
Water Service
Sanitary Sevier --"—
Rain Drains _
Catch Basin/Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART _FAIL —'
MECHANICAL LZ
Post 6 Beam
Rough-In
Gas Lins
IL Smoke Dampers
0: Final
N PASS PART FAIL
ELECTRICAL _
Service
Rough-In _
UG/Slab
W Low Voltage
J Firo Alarm
aminal Reins
PASS PART FAIL pe ion fee of S_ _required before next Inspection. Pay at City Hall, 13125 SW HaM 9 .
SITE u PIAa&A call for reinspe ion RE:----L---,- � Unable to Inspect-no access
Fire Supply Line
ADA
Approach/Sidewalk Q� 111speett g _ —,
Other: tl�llt -
Final ----- DO NOT REMOVE this Ins pecUon record from the job*he.
PASS PART FAIL
CITY OF TIGARD 24-Hour
BUILDING • Inspection Lith: (503)63"175 MST
INSPECTION DIVISIONSt� Business Lire: (503)630-4171 BUP P'f'd
� � �
G�O
Received —.Date Requested-- 7/3/
/ 3/ AM _PM y BUP
Location Q Suite MEC
Contact Person Ph 5-al PLM
Contr I' ____ Ph( ) _ SWR
UILDIN Tenant/Owner _ _ __ ELC _
Vo
i�n tion ELC
OCABd:
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 PART FAIL
P ING
Post&Beam
Under Slab —
Rough-In
Water Service —
Sanitary Sewer
Rain Drains —
Catch Basin/Manhole
Storm Drain
Shower Pan
Other-
Final
PASS PART FAIL
MECNANICAt.
Post& Beam —^
Rough-In
Gas Line
a Smoke Dampers
H Final
PASS PART FAIL
ELECTRICAL
-j Service
Rough-In _
W UC/Slab
J Low Voltage -- --- -- -----
Fire Alarm
Final C1 Reinspection fee of required before next Inspection. Pay nt City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
$ITE ❑ Please call for reinspection RE:__ _,_._-_ _-_—..____ r 1 Unable to inspect-no access
Fire Supply LineADA
Approach/Sidewalk --� D .- MsPsatar — —__ _. �___ bd
Other: _
Final DO NOT REMOVE this Inspootlon recoird bm Me Job alb.
PASS PART FAIL
CITY OF TIG&RD 24-Hour
BUILDING Inspection Line: (503)639-4175
INSPECTION DIVISION Business Line: (S03)639.4171 MST
SUP _
Received .Date Hequested_ AM —PM BUP
Location .__ - _- a` U _��,�j_Suite- L do MEC
Contact Person -- __ ____ _ Ph(—) _. PLM
Contractor___�VrQ�� _ _ Ph(__r) �► SG -7.3 94 SWR
BUILDING Tenant/Owner ELC 0h1V,(–
Footing
Fotindation ELC
Ftg Drain CCe9t3: ELR _
Crawl Drain
Slab Inspection Notes: s SIT —
Post&Beam
Shear Anchors 1
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall VA
Fire Sprinkler
Fire Alarm
Susp'd Coiling — — —
Roof
Other: _ — --
Final
PASS PART FAIL
PLUMBING
Post&Beam ^—
Under Slab
Rough-In
Water Service —
Sanitary Sewer
Rain Drains — - —
Catch Hasin/Manhole
Storm Drain
Shower Pan
Other: _ —
Fina!
PASS PART FAIL -"
MECHANICAL
Past&Beam
Rough-In
Gas Line
d Smoke Dampers —
a Final —
PASS PART FAIL —
ELECTRICAL
Service �l�� i
Rough-In �1�ilE�_._ J 1 _ �__Tl 11 W s N-I i FV O�,
0 UG/SlabUJI T
Low Voltage
*FiAlarmE] Reinspection fee of$� required before next ins.r"ction, Pay at City Hail, 13125 SW Hall Blvd.
PART FAIL
SITE _ Please call for reinspection RE:---- 0 Unahie to Insppm -no access
Fire Supply Line
ADA
Approach/Sidewalk Dade--- 1 — _ Ld
Other:
Final __. DO NOT REMOVE tills lnspeafto reeWd fto 9W 10 ells.
PASS PART FAIL