Permit may'
�\� ' CITY Off' Y IGARD BUILDING PERMIT
PERMIT #: BUP2002 -00009
u .�l� DEVELOPMENT SERVICES DATE ISSUED: 9/18/02
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 1S135DA
SITE ADDRESS: 11505 SW HALL BLVD
SUBDIVISION: ZONING: C -
BLOCK: LOT: JURISDICTION: TIG
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: NEW FIRST: 4,667 sf N: 1HR S: 1HR E: 1HR W: 1HR
TYPE OF USE: COM SECOND: 0 sf PROJECT OPENINGS? \
TYPE OF CONST: 5 : sf N: N S: N E: N W: N
OCCUPANCY GRP: A2.1 TOTAL AREA: 4,667.00 sf ROOF CONST: B FIRE RET? Y .
OCCUPANCY LOAD: 553 BASEMENT: 5,489 sf AREA SEP. RATED:
STOR: 2 HT: 45 ft GARAGE: sf OCCU SEP. RATED:
BSMT ?: Y MEZZ ?: N REQD SETBACKS REQUIRED
FLOOR LOAD: 125 psf LEFT: ft RGHT: ft FIR SPKL: Y SMOK DET:Y
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : Y HNDICP ACC:Y
BEDRMS: BATHS: IMP SURFACE: PRO CORR: N PARKING:
VALUE: $ 779,500.00
Remarks: TEMPLE: Construction of new temple facility. (No Park SDC)
Owner: Contractor:
BRAHMAPREMANANDA ASHRAM/TEMPLE D & A GENERAL CONTRACTORS
11515 SW HALL BLVD 3100 TURNER RD SE #204
TIGARD, OR 97223 SALEM, OR 97302
Phone: 503 - 222 -4151 Phone: 503 - 581 -8036
Reg #: uc 145089
FEES REQUIRED INSPECTIONS
Type By Date Amount Receipt Electrical Permit Required Framing Insp
PLCK DEB 1/9/02 $1,854.20 2002 -79 Sprinkler Permit Required Insulation lnsp
Sprinkler Permit Required Gyp Board Insp
FIRE DEB 1/9/02 $1,141.06 2002 -79 Fire Alarm Permit Requirec Susp Ceilng lnsp
PLC2 CTR 9/18/02 $296.39 27200200000 Foot/Found lnsp Fire - proofing final report
FIR2 CTR 9/18/02 $182.38 27200200000 Footing Drain Lic.fabricated steel final rpt
Struc Steel Insp Fire Alarm lnsp
(additional fees not listed here) Reinf Steel lnsp Smoke detector insp
Total $17,837.32 Slab lnsp Final Inspection
Masonry Insp
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes
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 than 180 days. ATTENTION: Oregon law
requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OAR 952 - 001 -1987. You may obtain a copy of these rules or direct questions to OUNC by
calling (503) 246 -66" or 1- 800 - 332 -2344.
Permittee /
Signature:
Issued B _• ' ' �' //' ...-_,
Call 639 -4175 by 7 p.m. for an inspection the next business day
Building Ferrnit Application , .
Date received: / • ^ Permit no.: j,�jli , op — aim 9,
o ltic;i l l'i s City of Tigard
Project/appl. no.: Expire date:
City ojTigard Address: 13125 SW Hall Blvd, Tigard, OR_9. 22
Phone: (503) 639 - 4171 /� Date issued: By: Receipt no.:
Fax: (503) 598 - 1960 +
Case file no.: Payment type:
Land use approval: (LP 2001 — 00003 1 &2 family: Simple Complex:
•D 11 —Ili 1 •
:"..ii...":. } ; TYPE OF PERMIT - 7 . 'y
❑ 1 & 2 family dwelling or accessory ❑ Commercial /industrial ❑ Multi - family I® New construction ❑ Demolition
❑ Addition/alteration/replacement ❑ Tenant improvement ❑ Fire sprinkler /alarm ❑ Other:
r , 1 .:., .. JOB SITE. INFORMATION , ; ° '''c. . .
I'
Job address: ( SOj S.W. HALL BLVD. e TIGARD, OR 97223 Bldg. no.: Suiteno.:
Lot :1 400 , 1 5 Block: Subdivision: N E T Z G E R : CR ES Tax map /tax lot/account no.: 1 S1 35 DA .
Project name: BRAHMA PREh1ANANDA A" * TEMPLE LOT:1400, 1500 &3500
Description and location of work on premises /special conditions: SEE SITE PLAN .
; FOR SPECIAL INFORMATION;USEiCIIECKLIST ,t
Name: BRAHMA P R E M A N A N D A ASHRAM (Floodplain, septic capacity, solar, etc.) -.
Mailing address: 1 1 5 1 5 S .W . HALL BLVD . 1& 2 family dwelling:
City: T I GARD State: OR ZIP :97223 Valu. on of work $
Phone: 5 - 0 l 3 Fax:
E-mail: No. abedr.. .aths
Owner's representative: SAM ADD I T I WAR . Total number of floor ... ...
Phone: • I $ — . 1 0 Fax: E - mail: New dwelling area . :. .)
• ' . ' APPLICANT`' . ' Garage/c._ ,.ert area (sq. ft.)
Name: VICTOR M NOBLEZA vered porch area (sq. ft.)
Mailing address: 1 1 5 1 5 S . W. HALL BLVD. Deck area (sq. ft.)
Other structure area (sq. ft.) 7-6-1/1/-6-- ° 7 7 q, MM0. &
City: T T r Ai � n StateOR zIP:9 7 223
r
Phone: • . _ Fax: E -mail: Commercial/industrial /multi- family:
CONTRACTOR a ": ' , '` Valuation of work $
1031,3
Existing bldg. area (sq. ft.) • ,64477 SET.
Business name: New bldg. area (sq. ft.) 7,086.31 SET.
Address: Number of stories 2
City: State: ZIP: Type of construction TYPE V 1 I I R .
Phone: Fax: I E-mail: Occupancy group(s): A3 Existing:
IZESID[NCE.
CCB no New:
- City/metro lic. no.: - CHURCH .
• Notice: All contractors and subcontractors are required to be
. AR /DESIGNER - ' licensed with the Oregon Construction Contractors Board under
Name: AV I N A S H G . PRADHAN provisions of ORS 701 and may be required to be licensed in the
Address: 921 S . W . MO R R I SON # 415 jurisdiction where work is being performed. If the applicant is
Z IP: exempt from licensing, the following reason applies:
S tate:
City: PORTI AND . OR 972
Contact person: A V I PRADHAN Plan no.:
Phone: 22 _ I . Fax: E -mail: 57.17/- 70 37 Of
. ENGINEER - ,.
Name: B L I I ER F N G. Contact person: C Y R I L Fees due upon application $—
Address: 30323 S .W . HEATER ROAD Date received:
City:' S H E RWOO D State: OR ZIP: 97140 Amount received $
Phone: 6 2 5 - 7 4 3 2 Fax: E -mail: Please refer to fee schedule.
I hereby certify I have read and examined this application and the Not all jurisdictions accept credit cards, please call jurisdiction for more information.
attached checklist. All provisions of I. :4d ordinances governing this ❑ visa ❑ MasterCard
work will be complied with, whe i er 9- cifi •I herein or not. Credit card number: / /
1 �j� Expires
Date
Authorized signature: _Al / ? • C✓e Name of cardholder as shown on credit card $
• n
Print name: • a. r
.►.n11 ate' ■ ■ vti Cardholder signature mou
Notice: This permit application ex ire if a permit is not obtained within 180 days after it has been accepted as complete. 440-4613 (6/00/COM)
tiet
t/9 a-
te a — Oo - o 9 11 —
Form 4a Project Name: Page:
SYSTEMS. - GENERAL
Exceptions 1. Exceptions (Section 131 .. -
Discussion of d No HVAC. The building plans do not call for an HVAC system. Skip to Item.12 below.
qualifyingexceep kw Exception. The building or part the building qualifies for an exception from HVAC code
dons on page 4 -14 , requirements. The, appli le code _exception is Section 1313, Exception Portions of the
building that qualify: a k
l
See page 4 -14 fora 2• Simple or Compl Systems .(Section 1313.2. or 1313.3)_
discussion of simple Simple System. The planned. HVAC system qualifies as a Simple System. If true, complete this
vs. complex ' . form (4a) and equipment efficiency worksheets as required. Form 4b is not required.
systems .
❑ Complex System. The planned HVAC system is a Complex System: Complete this form (4a),
Form:4b and equipment efficiency worksheets as required: . .
Exceptions . 3. Economizer Cooling (Section 1313.1.2) ,.
Complex systems
l' No Cooling. The building plans do not call for a new fan system with mechanical cooling.
maydaim the same lii Complies. The new fan system has an air economizer capable modulating outside -air and
exceptions allowed return -air dampers.to provide up to 85 percent of the desi I air as outdoor air.
for simple systems, - 9 n su PP Y
plus three excep- ❑ Exception — Simple Systems. The new fan system qualifies for an exception. The applicable
tons allowed in . code exception is Section. 1313.1..2, Exception • . or Section 13132.1. Portions of the
Section 1313.12 building that qualify:' ,
S e e p a g e 4 -15 fora
discussion ofMese U Exception — Complex Systems. 'he new fan system qualifies for an exception. The applicable
exceptions. code exception is Section 13131.2; Exception or 1313.3.1, Exception - . Portions of
the building that qualify: .. .
4: � Economizer Cooling — Overpressnrizing (Section 1313.1.2)
� No Economizer. The building plans do not call for a new fan system with an economizer.
❑ Complies. The drawings specifically identify a pressure relief mechanism for each fan system
that will exhaust the extra air introduced by the economizer, and the economizer system is
capable . of providing partial cooling even when additional mechanical cooling is required to meet
the remainder of the load. ' .
5. System and Zone Controls (Sec. 1313.1.3.1 8a 1313.1.3.2)
Ikhf Complies. All new HVAC systems include at least one'temperature control device responding to
temperatures within the zone. . .
, - ❑ Exception. The new HVAC system .qualifies for an exception from the zone control require -
Exceptions 'bents. The applicable code exception is Section 1313.1.3.2, Exception 1 and 2. Portions of the
Discussion of building that qualify:
qualifying excep- ' ' ' . ' . .
tons on page 4 -16. 6: Control Capabilities (Sec: 1313'.1.3'.2:1)
CO Complies. Zone thermostats are capable of being set to the temperatures described in Sec.
1313.1.3.2.1. Where used to control both heating and cooling, 'zone controls shall be capable of
providing a temperature range or deadband of at least 5 degrees F within the supply of
. heating and cooling energy to the zone is shut off or reduced to a minimum.
❑ Exception.. The building qualifies for an exception to the deadband re • it nfS7Tihe' :. plicable
code. exception is Section 1313.1.3.2.1, exception ��
• I N F ` S�
, . 65770PE
1 ! �� RE P
14G t „, S ys �
rt S M&€ F T o P rv� i c N I N o r ` h - si
V0t`S ONLy a tills �OL(NJ 4 f 11/4 ` -' � t:j o
(1 0/00) . ' Forms & Workshnats ` — 3 -I- - - 4 -1
Form 4a (cont.). Project Name:
Page:
SYSTEMS - GENERAL
•
?.Off hour Controls - HVAC Systems (Section 1 313.1.:3.3)':
If Complies,. All new•HVACsystems are capable of automatic setback or shutdown during periods
of non use or alternate use of the space served by the system: •
❑ Exception. Equipment has full load heating demands of 2 k (6,826 Btu/hr) or less and is
controlled by a readily accessible manual off- hour.controL •
•
X 4 8. Off -hour Contrail. Supply `and Exhaust Systems (1313.1.3.3)
Complies.. Plans require that outdoor air supply and exhaust systems have a means of auto-
matic (either motorized or gravity damper) volume shutoff or reduction during periods of non -use
or alternate use of the space served by the. system.
Exception. The building qualifies for an exception•to the 'requirernent'fr automatic shutoff or
reduction. The applicable code exception is Section 1313.1.3.3, :Exception .
9 Heat Pump. Controls. (Section 1313:1.3.4) ' ' .
M No Heat Pump. The plans/specs do not call for a new heat um
P P -
❑ Complies: All new heat pumps equipped with supplementary heaters are controlled as required
in Section 1313.1.3.4. . .
10. Equipment Performance (Section 1313.1.4)
❑ No New HVAC Equipment. The building plans do not call for new electrical HVAC equipment,
combustion heating equipment or heat- operated cooling. equipment.
Os Complies. All new HVAC equipment has efficiencies not less than those required by the code.
The following equipment efficiency worksheets am attached: 49.4 '"iPireouT FP5cIF,8O Age'
. .m.14EA-7',v OAP
11. Duct Insulation (Section• 1313.2.2 86'1313.3.2)
• ❑ No Ducts. The building plans and specifications do not call for new HVAC ducts or plenums.
• llSimple System: Complies. The plans and specifications call fora Simple System, and all
exterior supply /return air- handling ducts and plenums and all outside air ducts are insulated as
required by Section 1313.2.2.
❑ Complex System: Complies. The building plans/specs call for a Complex System, and all air-
handling ducts and plenums are insulated as required by Sec. 1313.32.
1 Piping Insulation (Section 1314) '
Exceptions (No New Piping.'Thelbuilding specifications do not call for new piping
heating or Coding � serving a
Discussion of
g 9 sY orpart of a circulating service water heating system.
qualifying e xacta ❑ Complies. All new piping serving a heating or cooling system or part of a circulating service
page a -re water heating system complies • w _ ith the requirements of the Code, S ection 1314.1.
❑ Exception. New piping qualifies for the following exception: Section 1314,, Exception .
.:.13. Service Water Heating (Section 1315)
Cole No New Water Heating. The building plans and specifications do not call for new water heaters,
. hot water storage tanks, service hot water distribution .s stems,. Swimmin
Exceptions � Y g pools or spas.
❑ Complies. All new water heaters hot .water storage tanks, service hotwater distribution sys-
Discussion of tems, swimming pools or spas comply with the requirements of the Code.
qualifying ex cel:" ❑ Exception. The applicable code exception is Section , Exception . Portions of
lions on page 4-18 the building that qualify:
•
•
4-2 Fnmzc R Wnrfkchcvtc
Instructions: Form 5a
LIGHTING - GENERAL
Example 1 . Iaterior Except€ons (Section';1316 1}
No.`Interiar:Li kiting r`The buildin `la is .do;not call.for- new - or'altered interior lighting: Skip
. Item 4; Exterior,-. Building_ Lighting General, below: .
El. Exception Th e budding or part of the for an'exception from code- liightmg
• requirements The applicable'code;exception is Section ; Exception 6 Portions ofttie
building that qualify.. -. Pdini= to garage ones.:
Line 1. Exceptions
• No Interior Lighting. If your building plans do 15. Emergency lighting that is automatically off
not call for new or altered interior lighting, check during normal building operation and power
this box and go to Item 4, Exterior Building Lighting required for trickle- charging of battery-
- General. powered emergency lighting.
• Exception. Section 1316.1 allows a number of 16 Art accent lighting required for art exhibits
exceptions to the code requirements for interior or displays in galleries, museums and
lighting: monuments.
1. Non - permanent lighting. 17. Sign lighting.
2. Production lighting for theatrical, television, 18. Lighting for high -risk security areas such as
spectator sports and like performance areas. Automatic Teller Machines and night drops.
3. Outdoor athletic facilities. If your project qualifies for one of these excep-
4. Lighting for apartments, lodging houses, one- bons, enter the section and exception number.
or two-family dwellings, and guest rooms. For example, if you claim an exception for stage
lighting, enter Section 1316.1, Exception 2. Next,
5. Industrial plants -- manufacturing spaces describe the area(s) of the building that qualify for
only. the exception.
6. Paint shops and painting spray booths. Additions and alterations must comply with the
7. Decorative, special effect and production code, but there are exceptions to that rule.
lighting for those portions of entertainment Section 1316.2.3 covers the requirements and
facilities such as theme parks, night clubs, exceptions that apply to additions and alterations.
discos and casinos where lighting is an Alterations are exempt from the performance
essential technical element for the function (power) requirements of the code if the following
performed. two conditions are met: 1) the alterations to
8. Lighting equipment that is for sale. existing lighting systems do not increase the
connected lighting load, and 2) less than 50
9. Lighting for detention facilities. percent of the luminaires in the permitted area
1 are replaced. Both conditions must be met to
0. Road, open parking, exterior retail and
landscape lighting. meet for this exception. Also, new lighting must
meet the controls requirements of the code. This
11. Task lighting for medical and dental pur- exception allows unlimited movement of existing
poses. luminaires and limited replacements or additions
12. Lighting in areas specifically designed for to the light fixtures.
people with visual disabilities. If your building plans call for altered building
13. lighting and you want to claim this exception,
3. Bench lighting for research laboratories.
enter Section 1316.2.3 , Exception 1. Next,
14. Lighting to be used solely for indoor plant describe the area(s) of the building that qualify for
growth during the hours of 10 p.m. to 6 a.m. the exception.
(moo) Instructions 5 -
Worksheet 5a Project Name: Page:
LIGHTING SCHEDULE
Lum. ID is the (a) (b) (c) (d) (e) (0
identification
number or letter
used in your plans Lamp Ballast2 Luminaire
or specifications
'Enter the number Lum. Power
and type of lamps in ID Luminaire Description No. Description No. Description (Watts) 5b
the luminaire. See
Table Sb for typical I J 5EE _ - T inic. & --lo) I F32 Tg I &L.EeT 32
lamp codes.
2 Enter the number F f F 32 TS' i E" L E '-T 62
and type of ballasts _ /�
in the luminaire. For 1- b F 63i T: I C L. eeT C�7 2
fluorescent and 2 �7
high - intensity F6 cFc 2 260 /; �r 3
discharge lamp,
a re aUast F A CFQ 2 O LF 2t
abbreviatrbns are:
MAG STD for F7 F32.7 I ELreT 6 2.
Magnetic Standard
•MAG EE for F 1 + � ` — --- 16a
Energy Efficient I1
Magnetic F i t 4 F32 7g' 2 E LE I24
•ELECT for
E l e c t r o n i c Fit 4- b a d a — Z o o - Ant' I.
See rbaast F13 1 QrrW 1 &LF-T 21
abbreviations. -
Fiif- I .•w 1119
Fi5' 1 CFQ26 W i EL-E' Ei-Ec 26
FI4 mil 7oW £ T 'O
F17 4 Cig26A) I ELF GT 104.
� 3IN I 6 . 1 41
�� 2 ,y? x f
1 I. 65770' E A
II ll 0 Mil
■ ■ 1111 °I
U SIRES: 3 la .o-
5 - 4 Forms & Worksheets (10/00)
,
Worksheet 5b Project Name: Page:
INTERIOR LIGHTING POWER
° 'Enter the quantity (a) (b) (c) (d) (e) (f)
for every non-
exempt luminaire Luminaire Lighting
Do not consider Room or Luminaire Quantity of Power Power
track lighting on this
worksheet. flack Sheet No. Room or Plans Designation ID Luminaires' (Watts) (d) x (e)
lighting is accounted r7 2 L�-
for on Form 5/i. Eel+ . LoyWE�Z LFV & Fl 72 32 " 30
F .4- 6'2 X 0
F5 21 62 1302
F6 21 5 092
F6' Pr 5 26 15
F 7 7 62 L1 --31-
F ( 104 621 -
.To ` FM_ 6, 1 `Sec -1,1
E oc U PPF LE Y F l 12. 32 381 -
F5 I 6 1116
F6 6' S2 312.
F 9 4 160 6 4-o
Fit 1 2 4 - . 2--
F 1- 7 200 1 4-00
F 13 26 21 54-6
F 14- iZ 6o 720
F t 5 2 60 120
- Tor L_ _ if-8'56-41
2 Addtona/ pages
may be necessary if - ,
building has more 1. Page Total. •
rooms than there
are fines on this Total the amounts in column (f). Add the sum of all pages on Form 5b, line 8.
Om
(iwoo) Forms & Worksheets 5 -
te) a
STATE OF OREGON
Interpretive Ruling No. 98 -1
ELEVATOR SUMP PUMP INSTALLATION REQUIREMENTS
QUESTION: What is the proper method of installation for elevator sump pumps meeting the
requirements of the 1996 Oregon Plumbing Specialty Code?
Asked by: Brad Roast, Building Official, City of Beaverton
BACKGROUND: The Oregon Elevator Specialty Code (OESC) changed effective January 1,
1998, and now references Oregon State Plumbing Specialty Code (OSPSC) for elevator sump
pump installation standards. Although the OSPSC addresses pumped drainage systems, it does
not specifically have a section or reference for elevator sump pumps. A request for an
interpretive ruling was made by Brad Roast, the Building Official of the City of Beaverton,
requesting clarification of which Plumbing Code provisions apply to these installations.
DISCUSSION: Authority. ORS 455.060 authorizes the Division to issue binding interpretive
rulings on the building codes and on acceptability of materials, design or method of construction.
Advice received from the Attorney General in OP #5208, October 1, 1981.
The elevator code requires elevator pits to be dry. Where an accumulation of water occurs, a
permanent means shall be provided to remove it. This can be accomplished by installation of a
gravity drain to daylight, indirect waste or a sump pump.
In hydraulic elevator pits there is negligible potential for oil leakage, due to oil leakage collection
and maintenance requirements of the elevator code. Therefore, oillwater separators are not
required.
Chapter 8 of the OSPSC is applicable to elevator sump pump installations. Dual pumps are not
required. When practical, elevator pits shall be drained by gravity. Sump pump discharge pipes
shall connect through indirect waste connections to the building drain or sanitary sewer. Indirect
waste receptors for elevator sump pump connections shall be protected from trap seal loss by an
approved automatic means meeting_ OSPSC Section 1007.0. Sizing of elevator sumps and pump
discharge piping shall be based upon the anticipated gallon per minute (GPM) flow of the pump
installed and the manufacturer's installation standards.
FINDINGS: The 1996 OSPSC addresses pumped drainage systems with respect to two types
of systems: sewage ejectors and storm/ground water applications. Elevator sumps are intended
to remove water from the pit and shall be installed under the provisions of Chapter 8 of the
OSPSC. Elevator sump pump systems are expected to operate infrequently and should be
controlled by an automatic switch. The OESC does not allow elevator sump pumps to be
directly connected to the plumbing drainage system. Discharge piping_ must be routed outside of
the elevator hoistway and exit the pit as soon as structurally feasible. The discharge piping shall
1
not be located in elevator machine rooms or machinery spaces. Gravity drains may be used
where adequate grade is available.
Although hydraulic elevators may contain oil piping systems, the likelihood of oil leakage is
negligible and oiUwater separators are not required under the provisions of the OSPSC.
CONCLUSION: The State Plumbing Board accepts the above findings for elevator drains and
sump pumps designed and installed within the applicable provisions of this ruling and the
Oregon State Plumbing Specialty Code and recommends adoption of this ruling:
��r C. - .1. ./,- , q/>7/115
Arthur G. Atchison, Chairman Date
State Plumbing. Board
The recommendations and findings of the Board are accepted and the Interpretation is adopted
effective immediately.
1 i
-� - .• Ari
4/78
j osep J A. Brewer III, Administrator Date
Build s g Codes Division
2
i
CITY OF TIGARD
B1LDING DIVISION PERMIT #: 6UP2002 -00009
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9118/2002
Phone: (503) 639 -4171 k uaa�m� "j
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 9/7/2005 TIME: 7 :08AM PAGE: 141
SITE ADDRESS:
11506 SW HALL BLVD CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: BRAHMAPREMANANDA
DESCRIPTION: Reinstated for purpose of FINAL INSPECTION (for 30 days). TEMPLE: Construction of new temple
facility. (No Park SDC)
OWNER: BRAHMAPREMANANDA ASHRAM!TEMPLE, PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 9/7 /2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
299 Final inspection 014828.01 503-598 -3073 Y
Corrections /Comments /Instructions:
e—j2 C ) ca t
7 ' (of ECJ lciSP c f -Fnc2
Fkaype__ es GI feEoprt-
6 tiO EU) t 'Ll6---
• [ ( - • STR c7 C) 43SE( i
( .
•
I PASS ARTIAL APPROVAL ❑ CANCEL n NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDIAL FEES ASSESSED
Inspector: AIN � /k Date: ?k #: (503) 718-
low