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�� ICC EVALUATION Most Widely Accepted and Trusted S SERVICE ICC-ES Report ESR-3342 ICC-ES I (800)423-6587 I (562) 699-0543 I www.icc-es.org Reissued 08/2015 This report is subject to renewal 08/2017. DIVISION:04 00 00—MASONRY SECTION:04 05 19.16—MASONRY ANCHORS REPORT HOLDER: HILTI, INC. 7250 DALLAS PARKWAY,SUITE 1000 PLANO,TEXAS 75024 EVALUATION SUBJECT: HILTI HIT-HY 70 ADHESIVE ANCHOR SYSTEM IN UNREINFORCED MASONRY ICCICC ICC L_ELS"-""**, PMG LISTED Look for the trusted marks of Conformity! ►' ,CC "2014 Recipient of Prestigious Western States Seismic Policy Council (WSSPC)Award in Excellence" �NIERAATIOhA A Subsidiary of coi couNpC Acr, II ICC-ESS Evaluation Reports are not to be construed as representing aesthetics or any other attributes not �-0xi } specifically addressed, nor are they to be construed as an endorsement of the subject of the report or a ANSI , recommendation for its use. There is no warranty by ICC Evaluation Service, LLC, express or implied, as ANSI Amedited Program PS to any finding or other matter in this report,or as to any product covered by the report. + Ate eCCN Copyright©2015 E^ ICC EVALUATION �.. SERVICE Most Widely Accepted and Trusted ICC-ES Evaluation Report ESR-3342* Reissued August 2015 This report is subject to renewal August 2017. www.icc-es.orq I (800)423-6587 I (562) 699-0543 A Subsidiary of the International Code Council® DIVISION:04 00 00—MASONRY 3.0 DESCRIPTION Section:04 05 19.16—Masonry Anchors 3.1 General: REPORT HOLDER: The Hilti HIT-HY 70 Adhesive Anchor System consists of steel threaded rods or reinforcing bars, plastic mesh HILTI,INC. screen tube(s),the adhesive, and installation equipment as 7250 DALLAS PARKWAY,SUITE 1000 described in this report. PLANO,TEXAS 75024 3.2 Materials: (800)879-8000 www.us.hilti.com 3.2.1 Hilti HIT-HY 70 Adhesive: The Hilti HIT-HY 70 HiltiTechEnc us.hilti.com adhesive is an injectable hybrid adhesive mortar consisting of urethane methacrylate resin, hardener, cement and EVALUATION SUBJECT: water. The resin and cement are separated from the hardener and water by means of a dual-cylinder foil pack HILTI HIT-HY 70 ADHESIVE ANCHOR SYSTEM IN attached to a manifold.An injection nozzle with an internal UNREINFORCED MASONRY mixing element is attached to the manifold, and the adhesive components are dispensed through the injection 1.0 EVALUATION SCOPE nozzle to ensure proper mixing of the separate adhesive components. The injection nozzle may be replaced to Compliance with the following codes: permit multiple uses of the foil packs. Available foil pack ■ 2015, 2012, 2009 and 2006 International Building sizes include total mixed volumes of 11.1 ounces(330 mL) Code®(IBC) and 16.9 ounces(500 mL). • 2015, 2012, 2009 and 2006 International Residential The adhesive expiration date is printed on the manifold Code®(IRC) of each foil pack (month/year). The shelf life, as indicated by the expiration date, is for an unopened foil pack stored • 2015, 2012, 2009 and 2006 International Existing in a cool, dry, dark environment at temperatures between Building Code®(IEBC) 41°F and 77°F (5°C and 25°C). Gel and curing times for • 2013 Abu Dhabi International Building Code(ADIBC)t the Hilti HIT-HY 70 adhesive and the respective masonry temperature during installation and cure are shown in tThe ADIBC is based on the 2009 IBC.2009 IBC code sections referenced Table 1. in this report are the same sections in the ADIBC. 3.2.2 Threaded Steel Rods and Reinforcing Bars: The Property evaluated: threaded steel rods are 3/4 inch(19.1 mm)in diameter,and Structural must comply with the minimum mechanical properties of ASTM A307. Alternatively, the 3/4-inch threaded rods may 2.0 USES be used in a prebent 221/2-degree configuration.Threaded The Hilti HIT-HY 70 Adhesive Anchor System is used rods are supplied with nuts conforming to ASTM A563, to anchor threaded steel rods or deformed steel Grade A, hex style, and with washers conforming to reinforcement bars in unreinforced brick masonry.Anchors ANSI B 18.22.1, type A, Plain. The steel reinforcing bars installed in unreinforced masonry with the HIT-HY 70 are No. 4, No. 5, or No. 6 deformed bars complying with adhesive system are designed to resist short-term loads ASTM A615,A706,A767,or A996,Grade 60. imposed by earthquake or wind, as noted in Section 4.0 of 3.2.3 Plastic Mesh Screen Tubes: The mesh screen this report.The anchor system is an alternative to anchors tubes are plastic with a black driving collar at the open end. described in Section 8.1.3 of ACI 530-13, as referenced in They are available in diameters and lengths as described Section 2107 of the 2015 IBC and Section 2.1.4 of ACI in Section 4.1. Different lengths can be achieved by 530-11, -08, -05 as referenced in Section 2107 of the assembling multiple screen tubes together, as depicted in 2012, 2009 and 2006 IBC, respectively. The anchors are Figure 3. an alternative to bolts described in Section A107.4 and 3.3 unreinforced Masonry: Section A113.1 of the IEBC.The anchor system may also be used where an engineered design is submitted in The existing unreinforced masonry walls must have a accordance with Section R301.1.3 of the IRC. minimum nominal thickness of 13 inches [three wythes of *Revised September 2015 ICC-ES Evaluation Reports are not to he construed as representing aesthetics or any other attribute.,not specifically addressed,nor are they to he construed :,,.s as an endorsement of the subject of the report or a recommendation for its use.There is no warranty by ICC Evaluation Service,LLC,express or implied,as } to artyfinding or other matter in this report,oras to any product covered by the report. µ-ao i"ware Copyright©2015 Page 1 of 7 R 'ESR-3342 I Most Widely Accepted and Trusted Page 2 of 7 brick]. The average in-place mortar shear strength of the 4.2.2 Configuration B, Bent Threaded Rods in Shear building's unreinforced masonry determined in accordance and Tension(22112-degree Combination Anchor): with IEBC Section A106.3.3 must be no less than 50 psi a. Installation of assemblies using prebent threaded rods (345 kPa)net. intended to resist a combination of tension and shear 4.0 DESIGN AND INSTALLATION loads must comply with Sections 4.1 and 4.3, and Figure 3 of this report. 4.1 General: b. The maximum allowable tension load for the Two types of anchor assemblies are available: 3/4-inch-diameter (19.1 mm) prebent threaded rod Configuration A (shear anchor or rebar dowel) and (Configuration B)is 1,200 pounds(5340 N),as shown Configuration B(221/2-degree combination anchor). in Table 3. No adjustment for wind or earthquake 4.1.1 Configuration A, Threaded Rods or Steel loading is permitted. Reinforcing Bars in Shear (Shear Anchor or Rebar c. The maximum allowable shear load for the Dowel): Configuration A is the anchor assembly resisting 3/4-inch-diameter (19.1 mm) prebent threaded rod shear loads only. Configuration A consists of a 3/4-inch- (Configuration B) is 1,000 pounds (4,450 N), as diameter(19.1 mm), ASTM A307 threaded rod or a No.4, shown in Table 3. No adjustment for wind or No. 5 or No. 6 reinforcing bar and a 1-inch-diameter-by- earthquake loading is permitted. 8-inch-long (26 mm by 200 mm) plastic-mesh screen tube (HIT-SC 26x200). Figure 1 shows details of an installed d. The maximum allowable load for the bent rod anchors shear-resisting assembly. subjected to combined tension and shear loads is determined by the following equation: 4.1.2 Configuration B, Bent Threaded Rods in Shear and Tension (221/2-degree Combination Anchor): (Ps)+(V)< 1.0 Configuration B is the anchor assembly resisting a pr yr combination of tension and shear loads. Configuration B where: consists of a 3/4-inch-diameter (19.1 mm), ASTM A307 threaded rod prebent at an angle of 221/2 degrees and a Ps=Applied tension load 1-inch-diameter-by-13-inch-long (26 mm by 325 mm) Pt=Allowable tension load plastic-mesh screen tube obtained by combining 1-inch- diameter-by-8-inch-long (26 mm by 200 mm) and 1-inch- VS=Applied shear load diameter-by-5-inch-long (26 mm by 125 mm) plastic-mesh Vr=Allowable shear load screen tubes (HIT-SC 26x200 and HIT-SC 26x125). The anchor must be embedded a minimum of 13 inches e. The allowable tension and shear values as (330 mm) at a downward angle of 221/2 degrees to the determined above are applicable only to anchors horizontal. Figure 2 shows details of an installed shear- installed in walls where in-place shear tests indicate and tension-resisting assembly. minimum mortar strength of 50 psi (345 kPa) net in accordance with IEBC Section A106.3.3. 4.2 Design: 4.3 Installation: The Hilti HIT-HY 70 adhesive anchors are intended to 4.3.1 General: 1-inch-diameter(25.4 mm) holes must be resist only short-term loads imposed by wind or drilled using standard carbide-tipped masonry drill bits earthquake. The anchors must be approved by a registered design professional and installed under special complying with ANSI Specification 8212.15-1994. Holes must be drilled using a rotary drill or a rotary hammer drill inspection in accordance with Section 4.5 of this report. The edge distance and vertical and horizontal spacing for set on "rotation only. Impact tools are not permitted. the two types of anchor assemblies described in Section Assembly installation must be in accordance with Section 4.1 must comply with Table 2. 4.3.2 or 4.3.3, and Figure 3 of this report. The adhesive must be allowed to cure for the full curing time listed in Conditions of acceptance for threaded rods and Table 1 before anchors are loaded.Cure time refers to that reinforcing bars in unreinforced brick masonry are as period of cure after which hardware may be placed and follows: nuts tightened. Design loads may not be applied until the full curing time has transpired. Installation must not occur 4.2.1 Configuration A, Threaded Rods or Steel when masonry temperatures are below 41 °F (5 °C). The Reinforcing Bars in Shear (Shear Anchor or Rebar Hilti HIT HY 70 Adhesive Anchor System is intended Dowel): to resist only short-term loads imposed by wind or a. Installation of assemblies using threaded rods or earthquake. The anchors must be approved by the reinforcing bars intended to resist shear loads only registered professional and installed under special must comply with Sections 4.1 and 4.3, and Figure 3 inspection in accordance with Section 4.5 of this report. of this report. The edge distance, and vertical and horizontal spacing for all anchor configurations described in Sections 4.3.2 and b. The allowable shear load for the 3/4-inch-diameter 4.3.3 of this report,must comply with Table 2. (19.1 mm)threaded rod is 1,000 pounds(4450 N), as 4.3.2 Configuration A: Holes for threaded rods or shown in Table 3. The allowable shear loads for reinforcing bars intended to resist shear only must be the No.4, No.5, and No. 6 reinforcing bars are 500, 750, and 1,000 pounds (2225, 3338, and 4450 N), drilled perpendicular to the wall to a minimum embedment respectively, as shown in Table 3. No adjustment for depth of 8 inches (203 mm). The holes must be cleaned wind or earthquake loading is permitted. with a wire brush and compressed air to remove debris. The Hilti HIT-HY 70 adhesive must be injected into the c. The allowable shear loads noted above are applicable supplied plastic mesh screen tube that is then inserted into only to anchors installed in walls where in-place shear the predrilled hole. The threaded rod or reinforcing bar tests indicate a minimum mortar strength of 50 psi must be inserted and pushed into the screen tube in a (345 kPa) net in accordance with IEBC Section rotating manner to force the adhesive into the hole. Figure A106.3.3. 1 illustrates an anchor installed in this configuration. Figure r ' ESR-3342 I Most Widely Accepted and Trusted Page 3 of 7 3 illustrates the Manufacturer's Published Installation 5.1 Use and installation must be as set forth in this Instructions (MPII), also referred to as Instruction for Use evaluation report and the Manufacturer's Published (IFU). Installation Instructions(MPII)illustrated in Figure 3 of this report. In case of conflict,this report governs. 4.3.3 Configuration B: Holes for installation of assemblies using prebent threaded rods intended to resist 5.2 Calculations and details must be submitted to the shear and tension must be drilled at a 221/2-degree angle code official for approval. to within 1 inch (25.4 mm) of the opposing surface. The holes must be cleaned with a wire brush and compressed 5.3 Special inspection must be in accordance with air to remove debris.The Hilti HIT-HY 70 adhesive must be Section 4.5 of this evaluation report. injected into the supplied plastic mesh screen tube that is 5.4 Use of the anchor system must be approved by the then inserted into the predrilled hole.The prebent threaded registered design professional. rod must be inserted and pushed into the screen tube in a 5.5 Anchors must be limited to resisting transient wind or rotating manner to force the adhesive into the hole. Figure 2 illustrates an anchor installed in this configuration.Figure seismic loads only. 3 illustrates the MPII,also referred to as IFU. 5.6 Anchors are installed in holes predrilled with a 4.4 Field Tests: carbide-tipped masonry drill bit complying with ANSI B212.15-1994. a. Tests for in-place mortar shear strength of the building must be done in accordance with Section 5.7 The adhesive is not used after the expiration date A106.3.3 of the IEBC. In-place mortar shear strength stamped on the cartridge. testing must indicate a minimum mortar strength of 5.8 The Hilti HIT-HY 70 adhesive is manufactured by Hitti 50 psi(345 kPa). GmbH in Kaufering, Germany, under a quality control b. Anchors resisting tension forces or a combination of program with inspections by ICC-ES. tension and shear forces must be tested in 5.9 The Hilti HIT-SC screens are manufactured by accordance with Section A107.4 of the IEBC.The test Herbert Kaut GmbH & Co. KG in Sigmaringen, report must include: Germany, under a quality-control program with 1. Test location(s) inspections by ICC-ES. Z. Brick/mortar condition 6.0 EVIDENCE SUBMITTED Data in accordance with the ICC-ES Acceptance Criteria 3. Bolt movement/elongation for Adhesive Anchors in Unreinforced Masonry Elements 4. Embedment depth and masonry wall thickness (AC60), dated December 2009 (editorially revised March 5. Applied load, loading procedure, load 2015);and quality-control documentation. increments,and rate of loading. 7.0 IDENTIFICATION 4.5 Special Inspection: Hilti HIT-HY 70 adhesive cartridges are identified by a label 4.5.1 IBC and IRC: Continuous special inspection must displaying the product name, name of the manufacturer be performed in accordance with Sections 1704 and 1705 (Hilti, Inc.),lot number, expiration date, a description of the of the IBC. product,the ICC-ES evaluation report number(ESR-3342), and installation instructions. The Hilti HIT-SC screens are 4.5.2 IEBC: Periodic inspection, direct-tension tests, and identified by a label displaying the product name, name of calibrated torque wrench tests must be performed in the manufacturer (Hilti, Inc.), lot number, a description of accordance with Section A107.4 of the IEBC. In lieu of the product, and installation instructions. Threaded rods, testing and periodic inspection, the IEBC permits nuts,washers,and deformed reinforcing bars are standard continuous special inspection during installation of bolts elements and must conform to applicable national or resisting shear forces only. international specifications. 5.0 CONDITIONS OF USE The Hilti HIT-HY 70 Adhesive Anchoring System for Unreinforced Masonry described in this report complies with, or is a suitable alternative to what is specified in, those codes listed in Section 1.0 of this report, subject to the following conditions: ' ESR-3342 I Most Widely Accepted and Trusted Page 4 of 7 TABLE 1—HILTI'S GEL AND CURING TIMES FOR HILTI HIT-HY 70 ADHESIVE MINIMUM BASE MATERIAL TEMPERATURE' ,F oC GEL TIME2 CURING TIMES 41 5 10 minutes 4 hours 42-50 6-10 7 minutes 2.5 hours 51-68 11-20 4 minutes 1.5 hours 69-86 21-30 2 minutes 30 minutes 87-104 31-40 1 minute 20 minutes For SI:°C=5/9(°F-32). 'The temperatures listed above refer to the base-material temperature,not ambient air temperature. 2The anchors may be adjusted during the gel time following installation. 3Anchors must not be disturbed between gel time and curing time.The anchors may be loaded after the full curing time has elapsed. TABLE 2-SPACING AND EDGE DISTANCE REQUIREMENTS FOR HILTI HIT-HY 70 ADHESIVE INSTALLED IN UNREINFORCED BRICK MASONRY ANCHOR MINIMUM VERTICAL SPACING MINIMUM HORIZONTAL SPACING MINIMUM EDGE DISTANCE ASSEMBLY (inches) (inches) (inches) Configuration A,Threaded Rods or Reinforcing Bars in Shear 16 16 16 (see Figure 1) Configuration B,Bent Threaded Rods in Shear and Tension (221/2°Combination Anchor) 16 16 16 (see Figure 2) For SI:1 inch=25.4 mm. TABLE 3—ALLOWABLE TENSION AND SHEAR LOADS FOR THREADED RODS AND REINFORCING BARS FOR HILTI HIT-HY 70 ADHESIVE INSTALLED IN UNREINFORCED BRICK MASONRY''2 CONFIGURATION A-SHEAR ANCHOR OR REBAR DOWEL(FIGURE 1) Threaded Rod Dia.(Inch) Minimum Embedment Minimum Wall Thickness Allowable Tension Load Allowable Shear Load or Rebar Size (inches) (inches) (pounds) (pounds) 3/4 8 13 - 1,000 No.4 8 13 - 500 No.5 8 13 - 750 No.6 8 13 - 1,000 CONFIGURATION B-22'/2 COMBINATION ANCHOR(FIGURE 2) Threaded Rod Dia. Minimum Embedment Minimum Wall Thickness Allowable Tension Loads Allowable Shear Load (inch) (inches) (pounds) (pounds) s/4 Within 1 inch of opposite 13 1,200 1,000 wall surface For Si:1 inch=25.4 mm,1 lbf=4.45 N,1 foot-pound=1.356 N-m,1 psi=6.89 Pa. 'Allowable load values are applicable only to anchors where in-place shear tests indicate minimum mortar strength of 50 psi,net. 2No increase for short-term loading is permitted,such as loading induced by wind or earthquake. 3Anchors must be tested in accordance with Section 4.4 for use with the IEBC. , . 'ESR-3342 I Most Widely Accepted and Trusted Page 5 of 7 VARIES r .... S. - . A / / / / / / , = / / / / / / ///.11 ! ' SHCAR ANCI-OR?:4"OIAIA-7 Hi / / • ri ASTM An7 / / / ITHRr AIN D ROD / ,,/'" "/ /'/ „/ 2/,,,, /I / S4EAR DONE:. NO.4,NO.50R / / ,.. / / ,t \ /i NO.6 RFS/4i / / j:\ / '' / /' . /./ ',V / / SCREEN TUBE IR \ "LAMB:TIR Hot t, rOR SI:'1"=26A=nrn FIGURE 1—HILTI HIT-HY 70 ADHESIVE SHEAR ANCHOR OR DOWEL(CONFIGURATON A) 7 / '., /,, I //, , / / / ,,i . , //./, ,..: , „.._ SW DIAMETER / ASTMA,137 ="// // , / A , , 'I fiRLADLD SOO ---- — — — / ,.'-'411110112 ,-- (6-1-1'*') / / _,---. :----:--- 1.1 i / ------. ' i ' t13 : „„,,,---;;;:„ , ..,,, -2,a-- / , • , \,-.• _.„--- „ „ • , / / /_....--- 1 1-MAW.I 1-I I-101 MAXIMUM FCR SI: 1'=71'.A Irll FIGURE 2—HILTI HIT-HY 70 ADHESIVE 221/2°COMBINATION ANCHOR(CONFIGURATION B) 1 ' ESR-3342 I Most Widely Accepted and Trusted Page 6 of 7 Iu_ I Nal Y " "` --J-, rdir ,i-mom N fRas ,SiEda', 4...••••,4,-R•i.i• .�.6 . 'Allw' I r e.... n err i Mewrw* ".,. 1.lerR.I.uNi/��V sabrtAslrM+a 1 ••r 11+400Yektob*A4 bAAAYd.. . 11.iq I 4.. I NO HUM H1?0 S c>n 11 I 1` I A A Aa.primend,.e.rmdd dd a....I}•rawslwse {a1,� .j � -_.r .� `-.� 'Mr AAreee~IN w eAAe ONndl.w. rOdiAed Wm 1 1 J}'^yYi , ##4 3. 333 AA i aA w w 141 I Ln -, 1 440,6E146.4.44444646464.44144664 1.6..Aw...ee/44P. I L> I OMR w1 4MGP l�F rr: ax s.m ,„,I IAA r1.MA - 1AAW i✓.IRW61/41464*ON 40"sift A.M.AIb I .�. Aim. 1 KO .e►`1 I arr x v 1 tit.e i,,;''''''. ..1'_'''t,ie ., 1 � . egg .A{ to j ',, www. 10 4 0,. C164,1444,— Am..... , ,,o oo , 7 i h?C. w�yiyei _.._ +p Cd0d.)"vf iM i!J( '.\ ... arc-..: _.... . is- ,,,r4'440-.,°.,%,— � a5�1'ST ' P., '''',V1' %" � ' .. 311 k„ t 31 leNt #$-$3t3 2L..14) 2 MtnAt3 1$13,1L 1 A'.-/W 3i..413 I AI>c. 24 tr. 11111111410 IW ! } ".1s A 1' e -f 11 "' 'tiNlpmrro 11 al. SOSO ek' Se % •= 284ln I t$avette , €3 I 4464 I rA 1E ,, ivy . El ... ��.nI. w_.. i 1 li FIGURE 3—HILTI HIT-HY 70 ADHESIVE MANUFACTURER'S PUBLISHED INSTALLATION INSTRUCTIONS(MPII) . . —..... ,, ESR-3342 I Most Widely Accepted and Trusted Page 7 of 7 Nati HIT-Iff 70 NM SINN 70 ,...... Nemlad MtWill states Ion ntbar and amber fastenings. Product Information ,..,„8 t....,,,I'Al-,49,9,,,.39,4,9,1i,,,,44 3-,3,31,,,3:,93,...8 4,A,..,...3:3:3:,s,,,,,,-8,,,s.•'3.,1....?...,.,t,,,,,,9:.1.,....,,,,u, ,,.3,,,,t,...;,,,..,....,.,.; r--' . - Chscsossitaltas We la'-r rif,,,,i c,4 r.•:”•', T cf....,-.,,f HIM 017411 71 , -fsli psi waparatare torNI Mar r,-,,,,,,,,..1 ,er 4,2 f 4', ,„.,j 40.,. 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K , , 41 -....... —.......-... i,....,-,, , usi Await is Ike WM,Isstradass as most Is lobos st 4404 sslad :,a-:,,.a:'a :a..,-a„,s.a.t, Wart 0.i,i,:' '','INV' '''10 r" 1 i.,,i :i Psol ."-iv i*ti.,..z S.:'13:3: 3:'4 FIGURE 3—HILTI HIT-HY 70 ADHESIVE MANUFACTURER'S PUBLISHED INSTALLATION INSTRUCTIONS(MPII)(Continued) FOR OFFICE USE ONLY-SITE ADDRESS: `112 ZS—Sal /2Q- This form is recognized by most building departments in the Tri-County area for transmitting information. Please complete this form when submitting information for plan review responses and revisions. This form and the information it provides helps the review process and response to your project. City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT I1Transmittal Letter -E ,,,,,,) 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov TO: % DATRE 'Oft/1F r DEPT: BUILDING DIVISION pc(; 1. 4201( �/� CITY OF $r '� ' FROM: Kow-C.6,,o C-7 ok.rBU!LD!NG lV S ! ' COMPANY: C-10.v-Zc, r, -I--✓ c,)-\'a►� PHONE: 5 Q 3 -- q 3 3 - / cis By: 07J' RE: 1 L4?----7� ,9J )2-S t AVE --r-4�r3 D,V Oi'7LZ� 141 .r ?, /7 -007-07-- Site ddress (Permit Number) ' oject name or subdivision name and lot number) ATTACHED ARE THE FOLLOWING ITEMS: Copies: Description: Copies: Description: Additional set(s)of plans. Revisions: Cross section(s) and details. Wall bracing and/or lateral analysis. Floor/roof framing. Basement and retaining walls. Beam calculations. Engineer's calculations. 2 Other(explain): REMARKS: /4/ rov✓,/'/1 U'e. 417 040,,- 7 (... efie2 444v Df 5 FOR OFFICE USE ONLY Routed to Permitechnician: Date: ) ' J .— J7 Initials: Fees Due: Dile' S No Fee Description: Am - ❑ ount ue $ $ $ Special Instructions: Reprint Permit(per P ): 0Yes pit No C Done Applicant Notified: Date: (L J/ 1I) Initials: fr. I:\Building\Forms\TransmittalLetter-Revisions.doc 05/25/2012