Permit 4 /II.$, `.17 ■44 .p , bAtreArlal i.M. *,..,I,
i C ITY OF TIGARD MECHANICAL PERMIT
i, � DEVELOPMENT SERVICES PERMIT #: MEC2002 -00131
,.�� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/1/02
PARCEL: 2S 110CD -00105
SITE ADDRESS: 15900 SW 116TH AVE
SUBDIVISION: KING CITY NO. 2 ZONING:
BLOCK: LOT: JURISDICTION: KIN
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: 1 BOILERS /COMPRESSORS HOODS: 1
FUEL TYPES 0 - 3 HP: DOMES. INCIN:
ELE 3 - 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS:
FIRE DAMPERS ?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: 50 + HP:
FURN < 100K BTU: AIR HANDLING UNITS CLO DRYERS:
FURN > =100K BTU: <= 10000 cfm: OTHER UNITS:
> 10000 cfm: GAS OUTLETS:
Remarks: Installation of a type I hood and make -up air only. NOTE: FIRE SUPPRESSION AND GAS PIPING ARE NOT
PART OF THIS PERMIT
Owner: FEES
UNITED STATES NATIONAL BANK Type By Date Amount Receipt
REAL ESTATE MGMT DIV -T3 PRMT CTR 5/1/02 $72.50 2720020000
PO BOX 8837 PLCK CTR 5/1/02 $18.13 2720020000
PORTLAND, OR 97208 5PCT CTR 5/1/02 $5.80 2720020000
Phone: Total $96.43
Contractor:
FIRE EXTINGUISHER SERVICE
PO BOX 1391
BEAVERTON, OR 97075 REQUIRED INSPECTIONS
Mechanical Insp
Phone: 503 - 643 -3309 Hood Inspection
Reg #: LIC 69384 Final Inspection
This 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 o;tain copies of these rules or direct questions to OUNC by calling
(ns194R -q1 RU
Issue By: L 4 1. - -,y` A � / Permittee Signature: ,,,6 e
Call (503) •=9 -4175 by 7:00 P.M. for inspections needed the next business day
- ---A/1/ 00L9/ z
At: MechanicalPermit Application
Date received: Li- 3- b - 2. Permit 4 Permit n ,Zvpi e, 0 / 3L
°'.1I i City of Tigard Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: Receipt no.:
Phone: (503) 639 - 4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval: Building permit no.:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial /industrial CI Multi-family ❑ Tenant improvement
❑ New construction - - . ddi ion/. teration/teplacement ❑ Other:
JOB SITE INFORMATION COMMERCIAL VALUATION SCHEDULE
Job address: ,3 2'/'l n 5 it/ 1 1/ _., Indicate equipment quantities in boxes below. Indicate the dollar
Bldg. no.: Suite no.: value of all mechanical materials, equipment, labor, overhead,
Tax map /tax lot/account no.: profit. Value $ .
Lot: IBlock: I Subdivision: *See checklist for important application information and
Project name: jurisdiction's fee schedule for residential permit fee.
City /county: / ), (1 / ` 75/ ZIP: 1 & 2 FAMILY DWELLING PERMIT FEE SCHEDULE t
Description and le ,tf on of work o(� premises: AND COMMERICAL /INDUSTRIAL EQUIPMENTSCIIEDULE
C /Q SS //z 0 d . 7 - t 714-- / Fee(ea.) Total
Est. date of completion /inspection: Description Qty. Res. only Res. only
Tenant improvement or change of use: HVAC:
Air handling unit CFM
Is existing space heated or c r ed? ®'Yes ❑ No Air conditioning (site plan required)
,
Is existing space insulated? Yes ❑ No Alteration of existing HVAC system
MECHANICAL CONTRACTOR Boiler /compressors
Business - �^ State boiler permit no.:
usiness name
�' / r - f' x 7 ,- 7 �/ / I ...6---- HP Tons BTU /H
Address: .' - . Q 6 ! ' J I ` Fire/smoke dampers/duct smoke detectors
City: , J Stated4_ ZIP: 7 Heat pump (site plan required)
Phone: s • 3w Fax: E -mail: Install/replacefurnace/burner / /7 BTU /H
, Including ductwork/vent liner ❑ Yes LI No
CCB no.: ae 9 ,.3 �' l p./ 9'0.3 Install/replace/relocate suspended,
City /metro lic. no.: wall, or floor mounted
Name (please print): Vent for appliance other than furnace
CONTACT PERSON Refrigeration:
Absorption units BTU/H
Name: ,f , )...„ _De S ti a -r Chillers HP
Address: ,■S' S r' Compressors HP
7 �/ Environmental exhaust and ventilation:
City: ,.-f h/ e>4 r
IState IZZI P: 7 -c - / Appliance vent
Phone: ' • p c' Fax: E - mail: Dryer exhaust
OWNER Hoods, Type I/ 11/res. kitchen/hazmat
hood fire suppression system
Name: Exhaust fan with single duct (bath fans)
Mailing address: Exhaust system apart from heating or AC
City: I State: I ZIP: Fuel piping and distribution (up to 4 outlets)
Type: LPG NG Oil
Phone: Fax: E -mail: Fuel piping each additional over 4 outlets
Process piping (schematic required)
Number of outlets
Name: Other listed appliance or equipment:
Address: Decorative fireplace
City: I State: I ZIP: Insert - type
Woodstove/pellet stove
Phone: I Fax: mail: Other:
Applicant's signature: ^7.-._ ,I Date:,7- -3 . Other
Name (print): 4 a /' -r-Li /) 574', .,Z •
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Permit fee $
❑ Visa ❑ MasterCard Notice: This permit application Minimum fee $
Credit card number: / / expires if a permit is not obtained Plan review (at %) $
Exp within 180 days after it has been
Name of cardholder as shown on credit card $ accepted as complete. State surcharge (8 %) .... $
TOTAL $ Sinliir
Cardholder signature Amount 440 -4617 (6/00/COM)
MECHANICAL PERMIT FEES - 4
COMMERCIAL FEE SCHEDULE: 1 & 2 FAMILY DWELLING FEE SCHEDULE:
•
TOTAL VALUATION: PERMIT FEE: Description: Price Total
$1.00 to $5,000.00 Minimum fee $72.50 Table 1A Mechanical Code Qty (Ea) Amt
$5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and 1) Furnace to 100,000 BTU
$1.52 for each additional $100.00 or including ducts & vents 14.00
fraction thereof, to and including 2) Furnace 100,000 BTU+
$10,000.00. including ducts & vents 17.40
$10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and 3) Floor Furnace
$1.54 for each additional $100.00 or including vent 14.00
fraction thereof, to and including 4) Suspended heater, wall heater
$25,000.00. or floor mounted heater 14.00
$25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and 5) Vent not induded in appliance permit
$1.45 for each additional $100.00 or 6.80
fraction thereof, to and including 6) Repair units
$50,000.00. 12.15
$50,001.00 and up $742.00 for the first $50,000.00 and Check all that apply: Boiler Heat Air
$1.20 for each additional $100.00 or For items 7 -11, see Comp Pump Cond
C
fraction thereof. footnotes below. k
Minimum Permit Fee $72.50 SUBTOTAL: $ 7) <3HP; absorb unit
to 100K BTU 14.00
8% State Surcharge $ 8) 3-15 HP; absorb 25.60
unit 100k to 500k BTU
25% Plan Review Fee (of subtotal) $ 9) 15 -30 HP; absorb 35.00
Required for ALL commercial permits only unit .5 1 mil BTU
TOTAL COMMERCIAL PERMIT FEE: $ 10) 30 -50 HP; absorb unit 1 -1.75 mil BTU 1 52.20
11) >50HP; absorb
>1.75 mil BTU % 87.20
ASSUMED VALUATIONS PER APPLIANCE: 12) Air handling unit to 10,000 CFM 10.00
Value Total 13) Air handling unit 10,000 CFM+
Description: Qty (Ea) Amount 17.20
Furnace to 100,000 BTU, induding 955 14) Non - portable evaporate cooler
ducts & vents 10.00
Furnace > 100,000 BTU including 1,170 15) Vent fan connected to a single duct
ducts & vents 6.80
Floor furnace including vent 955 16) Ventilation system not included in
Suspended heater, wall heater or 955 appliance permit 10.00
floor mounted heater 17) Hood served by mechanical exhaust
Vent not included in applicance 445 10.00
permit 805 18) Domestic incinerators 17.40
Repair units
< 3 hp; absorb. unit, 955 19) Commercial or industrial type incinerator
to 100k BTU 69.95
3 -15 hp; absorb. unit, 1,700 20) Other units, including wood stoves
101 k to 500k BTU 10.00
15-30 hp; absorb. unit, 501k to 1 2,310 21) Gas piping one to four outlets
mil. BTU 5.40
30-50 hp; absorb. unit, 3,400 22) More than 4 -per outlet (each)
1 -1.75 mil. BTU 1.00
>50 hp; absorb. unit, 5,725 Minimum Permit Fee $72.50 SUBTOTAL: $
>1.75 mil. BTU
Air handling unit to 10,000 cfm 656 8% State Surcharge $
Air handling unit >10,000 cfm 1,170
Non - portable evaporate cooler 656 TOTAL RESIDENTIAL PERMIT FEE: $
Vent fan connected to a single duct 446
Vent system not included in 656
appliance permit
Hood served by mechanical exhaust 656 Other Inspections and Fees:
1. Inspections outside of normal business hours (minimum charge - two hours)
Domestic incinerator 1,170 $62.50 per hour.
Commercial or industrial incinerator 4,590 2. Inspections for which no fee is specifically indicated (minimum charge - half hour)
Other unit, including wood stoves, 656 $62.50 per hour
inserts, etc. 3. Additional plan review required by changes, additions or revisions to plans (minimum
Gas piping 1 - 4 outlets 360 charge -one -half hour) $62.50 per hour
Each additional outlet 63 * State Contractor Boiler Certification required for units >200k BTU.
TOTAL COMMERCIAL $ {""Residential A/C requires site plan showing placement of unit.
VALUATION: All New Commercial Buildings require 2 sets of plans.
i:\dsts \forms\mech- fees.doc 12/26/01
KING CITY
III lad
15300 S.W. 116th Avenue, King City, Oregon 972 -2693
mims■ Phone: (503) 639 -4082 • FAX (503) 639 -3771
Notice To Contractors Working In King City
Due to an intergovernmental agreement with the City of Tigard, many building related permits
for projects in King City are issued and inspected by the City of Tigard.
If your permit application DOES NOT REQUIRE PLAN REVIEW, simply complete the
appropriate application legibly and submit it to the King City staff The King City staff will
collect all fees and fax the application to the City of Tigard. City of Tigard staff will then create
the permit, issue the permit, and perform inspections. Please indicate on the permit application
whether you would like the Tigard staff to call you when the permit is ready for issuance or
whether you prefer it to be mailed without any notification. Any incomplete or illegible
application will be returned to King City staff for correction and no processing- will occur until a
complete, legible application is received.
If your permit application DOES REQUIRE PLAN REVIEW, this form must be signed by a
King City staff person. King City staff will simply sign this form indicating land use approval.
Take this signed form to the City of Tigard Development Services Counter located at 13125 SW
Hall Blvd, Tigard, to submit applications and plans. Development Services Technicians are
available at 639 -4171 Ext. 304 should you have any questions concerning submittal
requirements. All permit fees will be assessed and collected at the City of Tigard.
The City of King City hereby authorizes applicant to pursue permits at the City of Tigard
Building Department for the following project: ni- eita pitecq. Ill M/±
located at: Dd -t� �� � n10 <> iu� 6x Lgt, C an.
e o,. Ci-''/
King City Representative l! -3 ' 4 %z
I DSTS-XCINST DOC
April 5, 2002 � im,01 j j`(
George Kim CITY OF TIGARD
2655 SE 39 loop #F
Hillsboro, Oregon 97123 ORE
RE: 15900 SW 116 Ave. Known as Mashita Teriyaki Restaurant
The City of Tigard Building Division has reviewed the submitted building plans for the above
referenced address in accordance with the Oregon Structural Specialty Code (OSSC), 1998
edition and the Uniform Fire Code, 1997 edition as amended by Tualatin Valley Fire & Rescue.
Plans have been submitted for the construction of an A -3 restaurant with indoor and outdoor
seating.
The following items need to be addressed and are not in compliance with the above mentioned
Codes:
1) Site plans do not show enough information to show compliance with ADA parking
and site access.
2) Due to the occupant load, the restrooms are under sized as per chapter 29. Provide a
minimum of fixtures as per Table 29 -A. Please note the outdoor seating shall be
figured into the occupant load in regards to sizing fixtures.
3) If the outdoor seating is fenced the occupant load shall be added to the indoor seating
for the determination of exiting.
4) All required exits shall terminate at the parking lot see exit termination.
Due to the items identified as noted above the plan review has been terminated until the items
have been properly addressed. In no way should this partial review be considered as a complete
review.
Please submit revised plans showing compliance with codes.
If y. '>: e any questions regarding this review, please contact me at (503) 369 -4171 ext. 392.
S'�
0
D. v- Jo s
' ans aminer
c. King City
file
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 TDD (503) 684 -2772
` k\ G AR L "t i - = i = t
CITY OF TIGARD
APR -5'02 . z 0 .3 4 -- I
13125 S.W. Hall Blvd.
Tigard, Oregon 97223 , OR P : , . U.S. POSTAGE I
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CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP �� C
Received _ Date Requested — 7/7 AM PM BUP
Location 1 5 - "I a %J l l 4 6vite Ccitg 24,01.0- 0011/
Contact Person Ph ( ) 723 5 ' 7 P —00/V3
Contr. • Ph ( ) SWR
BUILDING Tenant/Owner `� f Teti ELC
T 1•
Foundation Access: ELC
Ftg Drain 6 ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear _a
Int Sheath/Shear O /�
Framing t�/4 S GI•/� L� i
Insulation
Drywall Nailing
Firewall
Fire Sprinkler -_
Fire Alarm
Susp'd Ceiling
Roof
Other:
:T FAIL
P • = G
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
;2:111111 PART FAIL
NICAL
Pos --�-f_ -
Rough -In
Gas Line
Smoke Dampers
inal
ART FAIL
ICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE Please call for reinspection RE: ri Unable to inspect — no access
Fire Supply Line
ADA
Approach /Sidewalk Date / 7 '(/ ' Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL
CITY -OF TIGARD 24 -Hour ,g
BUILDING Inspection Line: (503) 639 -4175 �j /
INSPECTION DIVISION Business Line: (503) 639 -4171 elf/ MST •
d e 2.,*-1)e- do I/ (
Received Date R quested 7 °S 4
AM . / PM BUP ,
Location 4570 .SW // Av-e 1/ Suite MEC
Contact Perso Ph 7 ( 2 5 1 : 5 - , 1 3 PLM
Contractor �n/1 Ph ( ) SWR
BUIL Tenant/Owner r t ' ' &C V1 * \_Q--t ' no--k.- t ELC
1-000ting
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear 0 4/1 �
' J J o S o Framing Insulation n 14 P 7,O e Z - 0-01 Co _ / ' < r .
GU
A, Drywall Nailing o uL 30�
Firewall -i P ' AtScGd 10 03 6 y (77--c d k,
Fire Sprinkler \/ ,/� -7 �1 /L.- /
Fire Alarm ./f (5 J� r I ei- t� U Z - 0 0 / - / < l ,S - 4'1 - A E 9
Y, Susp'd Ceiling OX Met-
/� �'
Roof G--7 A 1 - 5�d/ f � y � U 2- Cr — d � C..-----
e r : ( Final Pi,? 2 - O D Z- 6 / 4 3 ( 7'.L >
ASS PART . AS) PLUMBING
Post & Beam n0 L � Zia 2 - v d l 7 l
Under Slab
lU''
Rough -In tAl $ ; -e-e p -7 /3/6 Z ( i Je---
Water Service
Sanitary Sewer n g'/D -2,4a2.-- 0 Q / 7 s ( /).,2-,-n 43)
Rain Drains dw 1
Catch Basin / Manhole ----1 ,4<-5 ue ( tl//3/d Z . �) _ d
Storm Drain
Shower Pan CO iria.,Civs b ' ' ?<'' Sr C —
Other: a ^
Final _ _�
PASS PART FAIL re-4.1_
MECHANICAL t 9 - t.4 f L . 4 . _ _ e _ S r Q, r f
Post & Beam /3 /� AI g �_ 4 ., � S 46
Rough -In L � v l I
Gas Line ) C _‘ 5 ��
Smoke Dampers T/� % �' �. / _ aV
Final h> a tz t -c
PASS PART FAIL
ELECTRICAL e ill c,.r -'r 7v ILA-de — ¢ 0
Service
Rough -In d' ) / ,,
C.,�U"-'er c_r‘ c
Low olt e , ) ,/) ( � ' Q
Low Voltage I �" �" // �
Fire Alarm �.) ( 6- 4 �„v� #7.) e yl�- 1 S r �A
Final 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE El Please call for reinspection RE: El Unable to inspect - no access
Fire Supply Line > p
ADA Approach/Sidewalk Date 7 S. / d �— Inspector � ` c — Ext 2-(1 'Z(/
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL / .2---
CITY OF TIGARD 24 -Hour
t BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested AM PM BUP
Location Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear L L
Int Sheath/Shear j.) f ff4 — /'' e S i s r 4_.•� .L, �jl� -,r �.C-.�
Framing w
Insulation /. •/G � - 6�Gt,./C/
Drywall Nailing J/� �lJ �..�,
Firewall !? -1 / �: -7 !tee - e —1 U f� t yt • r i'
Fire Sprinkler
Fire Alarm LzS o-./1 y /.
Susp'd Ceiling
Roof
Other: _
Final Z ➢ Liu C + 4it1 Gl, e l • a r
PASS PART FAIL ( // 1'YI /2 /
PLUMBING � � J � -
Post & Beam � /4 n.( r/ � ,✓ e_ Under Slab �d
Rough -In ) ,� _ /
Water Service / /� •(! /
Sanitary Sewer C
Rain Drains /
Catch �"-
Basin / Manhole 1 )‹....1Q--/-
"Q Q "' „
Storm Drain � *
Shower Pan a-g "../s-9 , rte �` . _� e.”-
Other:
Final
PASS PART FAIL \ ��� 1 1 << (A-)
MECHANICAL }
Post & Beam - Q J� Ale.," `A •
Rough -In �./
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
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 ❑ Please call for reinspection RE: Unable to inspect - no access
Fire Supply Line
ADA
Approach/Sidewalk / � /�' f Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
CITY OFT,IG4RD 24 -Hour .
BUILDI G Inspection Line: (503) 639 -4175 Ufr 4
INSPECTION DIVISION Business Line: (503) 639 -4171 5--z-6 �?-61::' i I 1
Received Date Requested AM PM BUP
Location S0 fib Suite ,
MEC
Contact Person Ph ( ) -7 0 7 PLM
Contractor j Ph ( ) / SWR
BUILDING Tenant/Owner — InaSV/c, /-- e-4/v if a `C ELC
Footing
Foundation s ELC
Ftg Drain . _ , . ELR
Crawl Drain
Slab Inspect! n N • SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear OH, `/ i �yL 1 t ' % ft s �f
elefari
Insulation n "`� Q �Q _ c /2 c--- (r /ill-74
Drywall Nailing
Firewall O ?G C a-d 0 O d/ 3/ (77," .Z /-d1 4- 44 4 4 ---2- 1 0 ter)
Fire Sprinkler
Fire Alarm &Ai a-vd - c 0 I (./3 ( _ 4 - S1.r/3 , ! -Low i 6v%L
Susp'd Ceiling � L �� / � D , �
Roof GJ s Le _ o I'7 c ��
Other: 0 � D
Final I.12/V) Gad S �,� / L � J - � ^d // l (A-1^S' -(2-6 PASS PART
PLUMBING ? v /t �/( /_)2.0', , i< �' �7 2
J� / Post &Beam › - 6, /.-- ( rl� , 3vQ S.4 .
Under Slab
Rough -In f.C� �c.1/4.C, x'02. 5= j - r--s'' S S
Water Service
Sanitary Sewer l ' /i - / SS 2.- C) •
Rain Drains /
Catch Basin / Manhole ,) m) 4 . 4 re_ c c' - f n ,/ ,e . Q
Storm Drain G `'�
Shower Pan Lr n K 7 A / Ltj' ' A 7 h � � a-f i f
Other:
Final l) .R----, L I/1 kJ c--1.-- C •
PASS PART FAIL
MECHANICAL S•) 5-S ),.‘,4 c 4- j_,] 2 ri�
Post & Beam / . !�� � . /lam 1 � � �� ( .5A---,-, Rough -In 1D / � /J MTh
Gas Line Q� c�� / `77 L ^Z /
Smoke Dampers -A
Final L A-•/L.-■ •
PASS PART FAIL ) 6 �.e-c. h__I-.,/-e
ELECTRICAL �I-
Service - e e /
Rough -In -e /1 j S i '� � --ai G' �-Q- -� CA —:- .
UG/Slab ,( / _ �
Low Voltage 9 L1 ' 31 4 O C --ri-C D k : �-2e
Fire Alarm 9 o S z° ` " -, az,N - 2-y �.
y /' ,.,-- •_ 44 di - A;
F PASS PART FAIL 0 Reinspection fee of $ required before next inspection. Pay at Cify Hall, 13125 SW Hall BNa`. ` .
SITE 111 Please call for reinspection RE: 0 Unable to inspect - no access
Fire Supply Line
ADA 1 ,
Approach/Sidewalk Date �,✓" / � �� Inspector Ext r9
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL