20040525.pdft)mj / 1� � DATE RECEIVED
mun�
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CITY OF EDMONDS ZONE iAgii
LICATION JOB
CONSTRUCTION PERMIT APPLICATION ADDRESS
OWNER NAMEINAME OF BUS INESS
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MAILING ADDRESS
CITY
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NAME
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ZIP
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NUMBER EXPIRATION DATE
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PROPERTY TAX ACCOUNT PARCEL NO.
CC — 7 lrl�, eq4 /10100
0 NEW E] RESIDENTIAL
ADDITION COMMERCIAL
.-Or
E] REMODEL MULTIFAMILY
GRADING
REPAIR CYDS
E] DEMOLISH TANK
GARAGE RETAINING WALL
CARPORT ROCKERY
0
(TYPE OF USE. BUSINEAS OR ACTIVITir EXPLAIN:
W NUMBER NUMBER C
a OF DWELLING
M
o STORIES UNITS
DESCRIBE WORK TO BE DONE
Lod(�7 fecrom
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HEAT SOURCE I GLAZING %
PLAN CHECK NO:
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CH;CKM BY
PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
( — X—
E]
OTHER
FIRE SPRINKLER
FIRE ALARM
CRITICAL
AREAS
NUM13ER
LOT SLOPE %
VESTED DATE
S*-///
PERMIT EXPIRE ZO�
I
PERMIT
N U M B E Ft�Y
el SUITE/APT#
LOT NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
REQUIRFI) DEDICATION— FT
METER SIZE LINE SIZE NO. OF FIXTURES
LID NO
LID FEE $
I ESCP Approved 13
SW Permit Required 11
Street Use Permit Hori'd 13
Inspection Required 13
Sidewalk Required 13
Undergrokind
Wiring roqUirrid 13
PRV REQUIRED
YES 11 NO 0
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
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SEPA REVIEW
SIdN AREA
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COMPLETE EXEMPT
ALLOWED
PROPOSED
ALLOWED PROPOSED
EXP I
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LOT COVERAGE
REQUIRED SETBACKS (FF.)
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
FRONT
SIDE REAR
FRONT L/R SIDE REAR
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PARKING
LOT AREA
PLANNING REVIEWED BY
DATE
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REQ'D I PROVIDED
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Fr) I REMARKS
THIS PERMIT AUTHORIZES ONLY�HE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST. AGREES 10 INDEMNIFY, DEFEND AND HOLD HARMI ESS RITZ CI FY OF
EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NAIURE,AIIISINGDIRECTtYORINDIRECi(Y
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT 13E
DEEMED 1`0 MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION *
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THAT THE INFORMATION
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DU& AUTHORIZED AGENT OF
TILE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASIIINGTON RELATING TO
WORKMEN'S COMPENSATION INSURAN C/ AND RCW 18,27.
SIGNATURE (M�Nj:R-3)0 �EN T)
DATE SIGNED
0
CHECKED BY
OF CONSTRUCTION
COPE
OCCUPANT
ITYPE
I
`1-7
GROUP,
SPECIAL INSPECTION
OCCUPANT
REQUIRED ES
JAREA
LOAD
I&Y
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
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VALUATION
$
Description
Plan Check
Building Permit_
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
Y
FEE Description
State Surcharge
City Surcharge
Base Fee
FEE
Plan Chk. Deposi'_
Receipt # rl e-�aa
Total Amt. Due
Receipt #
APPLICATION APPROVAI
This application is not a permit Until signed by Ina,
Building 011icial or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space prqvided.
A17ENTION EXT 1333L4'
Ir
IT IS UNLAWFUL 0 USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBG SECTION 109
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
1167
13Y b TE
) 11 (d a
"C bu )/6) (
ORIGINAL FILE YELLOW - INSPECTO
PINK - OWNER GOLD - ASSESSOR
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Ma�j 19 04 07:45p
-ma�j 11 04 02:37p
MAY-O?-2eo4 11:26
NW Teamworks / CarCobat
NW Teamw6rks / Cargabat
425-893-9371
425-833-9371
CITY OF EDMONDS
SPECL4LL INSPE M.ON AND TESTING AGREEMENT
p. 2
P. 02/04
p. 2
The Project at -Z-cP-1 1 1-1 . . . %*& , ed tnxkT builditl
W=1 mnx=twn an&ar testing per UBC Chapter 15
list of inspecdong is attacl%cd to this docurdeaL
1702 Urf
AUN742�71e �=W
specia]
com etc W=
BEFORE, A FERMff CAN BE ISSUED: The owner and conftWor and somal inspectcar shall
complete this agreement aDd the attached structurd ust(c) and i risr "pris schedule iticluding the
required ackrmwledgmcnts.
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APPROVAL OF SPECUL INSPECTORS: Each special inspQcWr xb&U be aW ved by the
Building Offmial prior to perfo duties tions. Each speold n"Pector Shall subrait
or '
Hng OfficialiT Speciol in�rs. display
'thc�%=
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ficalions to review. sha LU
onnin iiii impq�c �i on &itc. S inspection and bestmg shall Tricet
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a =nrmuin "ouimema of TMC Chapter 17 and the folkywirW
A- Dutim and Basna hillUM Of "t si=W 1"W.4c4ar
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1. owerve WWk
The special hupector shall observe 1he sitc work for conformance with the ved
the TJBC
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phtw. and Bpc.cifications and applicable wodmmsbip provicions of
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"a=1W or Engineer rim ed dmwingg nmy be used anly as an zid.to, inspectiom
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pecu ppicemm am t i
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iiispectur is on site at alJ fmcs observing (he work requirmg specis in�xi. Periodic
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mspectionse if MY, must have pr-= 20w val by the City based an a ceparaft written plan
eM ved by the Biaildin0f5cial and Ow edgincor or mrhitect ofrecord.
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mylewed and
2. Report Noi*-coilformill 16MU
The sp=al ixivectar = Wing noncenfb Awn to the bnmediate attention of the
r4r
Cn
contracior and rote aH such item in h, fit report. Any item not resolved in a dnwly
72
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mmmcr shall be immediate cam of the Special in5p� to noW the Buildhig Official of the
-h
plan devialion , c=r, change: or OmissiorL It Shall also be the duty Of the SPOCial finPecw to
Promptly noi�& the crigmecr or wrJnt=L
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3. Compkta Dw-ly K
'W inspection record and the daily
Each spccW* compicic mul sign both the sp=_
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report fwm for each day's inspectim Thczc records shall remain at the jobste wrth the
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4. Furnfab Wv9W RePOrft
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The special inspector or ingpectioxi agency shall. fmaish the City with weeldy reports of tests
'
INW iiapectiona. The ect * ond others as dempueed sball also be
c000datireparb- wwyrcpoT"tsprm"�r-o=rluam&Wtlbecct.61hminr.
ordwil - Nemons and tcsft madc with applicable locatk=
B1,i:a"0?a1UMn==0YrMMg
items
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Rcpori an obihs of nanconfunning itcw=sz. lved or unresolved)
included in
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L.Confornmarice, item
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S. Funaiiali Final Construe Rxpert
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The special inspector or mqxx:t.wm agency shall submit a final mi to the City stating
that all item and ' were tzra A.4 to the
inspec tion testing td and M and
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owl i plans
'ficatiorm approved chanse =9 and the applicable higntro*lOns of ft
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C . Item not in ccm1brmimce or unrcsolved items or any diw�-�,cs m inspection
coverage. (i.c.. inissed inspacu *odic inspection whexi continuous ir�nis wt=
pe.=
_qn�, . -
requdnxL etc.) shall be specifically iteftiizod m tWs.Mm
Matj 19 04 07:45p NW Teamworks Cargabat
Ma!j 11 04 04:17p NW Teamworks,/ Cargabat
mny-420-2004 11.27
425-893-9371
425-o93-93?1
F. 3
p. 2
P. Mo,04
CanlMdur 1Iesgj=&ifiWJj=a
1. NoW the Special Ii3qHxtW
11 is the duty Of the 00afteW to notify the spwigl inspe� wbm work is rcady for special
inspeefion. Note, the items listed an the attached schodule nd as nuted On the approved
plans and specifications am mquh-ed to have special inspectimm Adequate notice shau be
prcmded by the coutractor so that The special inspector has fw2c to becOM filmiliar with the
Project.
2. Provide A..c W Approved PI&R3
The ccmftcwr is responsible for PT*VidU3g ft special inspcdor aceess to approved ptMs 24
theiabsite.
3. Retain Special InspectIOD Records
The contractor is responsible to rctain at the 'Obsitc; 11 jai inspection records submitted
qec' City building irmptaor upon
in�r. Then McaT& we C pro
by dw specW to vided to the
request.
1. ApprwespeeWinspechn orlasp"flonagencies
The.building dqMtMmC=t shall RPPMY-- all Vexisl WqW-'WM and VMW UISPectiOn
7- Moottor special Ins 'an and &#prove weekly reports
pecb
WoCk 8VTOal bon. and dw perfannmee of . sPeCI IMBPOCtan &hall be
= Inspector, Mvlmr approval nyust b,-- obtained prior to
rnoni City BI
placement �ocaucrete or officr simiLir activides in Axidition to thd of Me Special kFpedur-
3. Issue Certificate of Occupancy
-me BUIWW official way isme a Caltificate of Occuplancy after all Weekly special hqxxtion
- _g
iepow incItAing the final report have be= stibmitted and iccepted.
D- 0wmItr Hmta�ftwl
7be project owner or the eagincer or mrhited of record ading as the ownces agent mhall,f�nd
spwal inMection scmces.
EnrineernrArrhifectofftwicdIt
The enginecr or arcldtect of record shall include Wcc;W inspection requkmwts on the plans mad
specificafions.
ACIMNMEDGEMENIS-
I have read and agree to comply with tAr,- reraw and Condwom of this agreement.
own —Pat�
—( - /C.-Wo - -
-Td -t, Z11 E7&*� - L^OL.
,C...,i-ar---SpeciaJbispector:d�� I t�'��J�Affk I-e- P )01�&
Gcneral
City Building
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ma�j 19 04 07:46p NW Teamworks / Cargabat 425-893-9371 p.4
0.5/12-12004 WED ILI: 14 F,�X 425 672 0501.1 Lyzinwood flonda -Wrrin. Q) 0 0 0 0:;
3 A,!V, Co,,I�e Amento No-4981 P,
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Ma , , , - -, ;, 4 - , r
I'AY-07-2004 li-_37 P - 03/04
QW10001C &MOANNUO
L Nofd� The SpecW Inspector
It ir thD duty Of the QGfftrRctQr to 110fify the special inspector when wwk is peady for spmial
hmpectiam Note, the items listed on the anadwd schedule gad as noted on the approved
plans sad speefficatiow am rrqubed to havc special inspectiow. Adequmme nofice sW be
pluvidcd by the cnntmetor go that the special inspectar baa time ID bcoomo fiuniliar with thr,
pr*cl.
2. Provide Access to Approved PIRms
The cona=tor is trzponsi"ble for providing the special inxpector acems to approved plans at
thajobsim
3. Reftla Slpechd Inepw1lon Recorda
nw conftctor is mspongible lo rctain at the j*obst* to all is] InWcaripu records wbrnined
by the special inspeclor. Thme recoirda are to be provi=ft City building kapector upon
request.
C- x1f EdWands Building DellgrMcut RrayanAblHfies
I . Approve ispecial inspectors or hLqxrdoIm qg*ncles
nc building department shaD Vprovc all spedal iwpecto= and speaw bWrxtion
rcquimmeaft.
2. Monitor spedal Inspechion and 40prove weddty reports
Work . . 'al tift Wd ft 1=,=
=UUM9 Spec] ��; of special - tom shxU N:
MOW h 11Y F=g bspector. anmroval Masi bc=- Od 007 to
Y the C,
placcrtnent ot-concmte or athcr dadlzir wtivities in aMiti0iito thfil of the special inspeacy.
3. lung certillcate Of GeLapancy
The Building OMWwAY icsuc 2 Ce"ific2tC Of 0=Ta0cY after an vveeldy'specw inspection
=POM incigWU�8 the fittal rr-port have been Fuhmi and accepted.
in- oymerjj"ponliblintle,
The p!oject'ownw or 11he ergincer or ambLitect of record =ling as the ownces Sgemt Shan.fund
SpMal irsspCciJon services.
E, Fnrilleer or Arch of Recard-F
, mongibilMew
Ile emgiuccr or wchitcet of record sbail inchute special inwectiorm mquimmucnts an the pL= aM
specifications.
ACKN0WLEj)GEhC&lVTS-
I have read and agnm to cvmply wigh I)w term and condidons offAb aereemr*.
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NW Teamworks / Cargobat 425-893-9371
P.5
Ma�j 11 04 02:37p NW Teamuiorks CLrgobat 425-033-9371 p. 3
t-AY-O?-2004 11:2? P.04/04
01". �Nftp a W.'2 &JUT" Opt-ftrAPULAL
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XEMVEPORCED CONCRETE. GUNrM GROUT AND MORTAIL SMVL7URALSTEkEJWELDMG-
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ADDMONAL INYMUCnOM ON OTHOt I rS
AND MPECTIONS:
TWC
Te' Na:
TOTAL P.04
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File Number
GEoENGINEEI`tsr� FIELD REPORT I 1136- 001 -00, TO 100
Project Data
Ebb Tide C01111LI0111illil.1111S. Unit # 10 1 I"loor/lIalio Slab .1111N. 16, 2004
8410154... AVENUE NE
REDMOND, WA 98052 Repail
(425) 861-6000 Owner Time of Arrival: Rworl Nompor
EbbTide Condominitinis 0845 FR 7-16-04
Prepared by* Location Time of De-p-arlure Page
IlOyd Bellsoll Calitionds Washington 1430 1 of'12
purpose Of 'A-41 %*leather Travel Time Permit 1`11111`11301'
Special Inspection; Pill Pile Insiallalitm Stililly. wal-ill 1.75 2004-0525 (Ednionds.)
Upon arrival to the silo I assessed personal %altily hrizards, 0 Y(l or [3 Releffed to Stio Safety Plan and Salely Tailgate if applicable
Safety HaZatdS Were Addressed by . 0 Staying /Yed to Construction and Equipmoni I lazards 0 Other (describer
General
I visited tile Ebb Tide Condonlillit.1111S at tile request or Jells Johanson of Corke Arnento. Inc. 10 COIllPIctC Special
inspections during pill pile installation ror tile Jillit H101 Floor/Patio Slab repair work. The Ebb Tide
Condominiums are locate within a 4-story building on the shore of Puget Sound at 200 Beach Place ill
Edmonds, Washington. The special inspection visit was completed as part of tile City of Edmonds permit
requirements as summarized ill tile docurnent titled -City of Edmonds Special inspection and Testing
Agreement." OL111-services were completed in general accordance with our Change Order No. 2 dated May 18.
2004, and authorized by tile Cory Heins ordie EbbTiLle Condominium Association oil July 8. 2004.
T -ris.
When I arrived at the site I met with Josh Krause of NW Tearnworks (General Conti -actor) and Carl Bill
Justin Burris. and Adalberto Martinez of" Pacific Piling and Underpinning (pill pile installer). I observed tile
rollowing:
0 A I -root wide (east -west), 1.6-root long (norill-SOLIth) strip of concrete been removed along the West
edge orthe tile -covered concrete patio slab at Unit #101. Tile east edge of tile removed strip had L-K-en
Saw CLIt and the West edge or tile removed strip was coincident with the cast edge of tile exposed
aggregate concrete courtyard. A 4- to 6-inch void was observed beneath the patio slab (see Photo
Sheets). No voids were observed bellizaill tile exposed aggregate courtyard slat) along the saw cut
r-1
trench.
• Concrete and other construction waste had been stockpiled and covered with a tarp, within the courtyard
area.
Pin Pile Installation
• Plywood sheets were placed against tile windows -and sliding doors or Unit #101 to protect them frorn
breakage (see attached photo sheets).
ITATel
IE�IXAEPRESENTATIV DATE
THIS FIELD REPORT IS PRELIMINARY 7
A prolinimary report is provided solely as evidence that field Observation wasperl
eyod
in, 1 '1', n
Observations an(Vor Conclusions nndlor n.-cornmendirlions conveyod in tho final report V.1
i TE
ot
-tied in if pielimnary report
from and shrill take precedence over those indict
THIS FIELD REPORT IS FINAL hIEVIEWED BY DATE
A final ificioll is .11, Instrument Of pralosr4onai soroce. Any conclusions drawn from lills repor
should be oiscussed with find OVilhinled by the Professional involved t 7 k0foLf
r to comply with the plans and specification thrOughOul
This report presents opinions loinind as a result of Cot ahservallon of activil:es lelaiing to Otto 59rvices only. We rely oft the con facto
trio dulal'On of the project Irrespective Of the presence of our represonliltivs Our work does not include supervision o( wection at the workal Others Our firmyAll not be fespon&ble fo,
job or site s.1j&1y of olhers on this project, DISCIAIMEn Any olactiefiie lorin. !ncs,milo or hard copy cl the original docurnerill (ernnil, toxi, table. andfor figure). if provided. and any
attachments nro only a COPY Of file Original cloctunrint I ho original dr�-urrenl is stored by CeoEnginerfts, inc and %ill sylve Iq
1110 ojf�cijj docurnow of record
Attachments: Pile Site Plan, Photo Sheets (3 pages), Pin Pile Installation Record sheets (2 pages), Pin Pile Test
Record sheet, Certilicate of Certification for the test ram (3 pages)
Distribution: Corke Amento (Jens Johanson: Pacific Engineering Technologies
(Mark Uchimura: 111LICNI'llUraftaceriltech.com), Pacific Pile and Underpinning (Carl Burris tax 425-486-4025),
NW Teamworks (Josh Krause: info@ nwtearnwgrks.corn), TAT, File
Ise
JUL 2 12004
PERMIT COUNTER
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IFile No. 11130-00 1 -00. Task 0 100
July 16. 2004
Paue 2 1
Pin piles were installed by Pacific Piling and Underpinning
o The pin piles were installed using a 140-I)OUnd, hand operated pileurnatic jack -hammers.
0 The pill piles consisted of 5.25-foot long lengths of 2-inch diameter ASTNI A53 Grade A ER.D
Schedule 80 pipe.
o Slip connections between the piles consisted of 1.75-inch steel bar. The connections were 12-
inches long %vith a ?--inch long sleeve pre -welded at the middle of' the bar for a total apparent.
additional pile ieiip
th or 2-inches once installed. No welding was completed during tile installation.
o Five piles were installed at 6.5 root intervals along tile centerline of the trench (see attached pile
plan)
0 Tile piles were advanced until enibechlient rates of less than [-inch per minute were attained at
embedillent depths of 17 to 25 feet (see attached Pin Pile Installation Record summary sheets).
o Tile piles were cut-off at approximately 9-inches bclo\v est-inlated finish slab elevation per NNV
Tearnworks.
0 Pile Caps Consisting Of a '/4-inCh thick, 4-inch by 4-inch plate that had been welded oil to 18-inch
long 1.75-inch steel bars were slipped into the top or each pile. The steel bars of soille of the pile
caps were cut down to 12-inclies in length to avoid interference WiLli slip connections per the
structural engineer (Mark Uchimura of Pacific Engineering Technologies).
Pin Pile It I was load tested by Pacific Piling and Underpinning
• A load test criteria of 8,000 pounds was specified (200% of the 4,000 pound design load) with less
than 1/2-inch of additional embedment.
• Tile load test was completed with a Simplex 100-ton rain reacting against a steel load fraine that
was bolted to tile building. An Enerpac gage and hand pump were used to charge tile rain.
• An incorrect gage calibration relationship was used during the initial load test and Pile #1 was
loaded in excess of the required test criteria. Pile #I was loaded to approximately 11.250 pounds
(1,000 psi gage pressure) with 0.084 inches or additional embedment and then to approximately
20.500 pounds (1,700 psi gage pressure) which resulted in additional embedment of 1.75 inches
(see attached Pin Pile Installation Record summary sheets).
o Pile 41 was unloaded and then driven with little or no eilibedillent following the initial load test.
Tile load test was repeated using tile correct gage calibration relationship. A load of 8, 100 pounds
(approximately 2001X, of the 4,000 pound design load) resulted in a total or 0.079 inches of
additional embedment. The 8, 100 pound load was maintained for 10 Minutes.
o Based Oil Our observations and measurements. Pile #1 illet the required load test criteria. It is our
opinion that Piles #2 through #5 also niect the required load criteria because of' the consistent
installation activities at the site.
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Looking southeast at Unit #101
12-inch wide saw cut trench tit west edge of Unit #10-1 patio slab. Note
the 6-inch void beneath the patio slab. No void was observed beneath
the exposed aggregate courtyard slab to the west (right)
GWENGINEER� Ebb Ticle Condominium: July 16, 2004
Photo Sheet #1: Pin Piles
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welded onto 18-inch long 1.75-inch steel bar. Note: sonle of tile top plate bars
were Cut down to 12 inches to avoid interference with slip couplers.
GWENGINEERS,�g
Ebb Tide Condominium: July 16, 2004
Photo Sheet #2: Pin Piles
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Gage pressure at -720 psi resulted in ram force of -8,100 pounds or -200
percent of design load. A total of 0.079 inches of additional embedment was
recorded during the load test.
Ebb Tide Condominium: July 16, 2004
GWENGINEER� r --
I - Photo Sheet #3: Pin Piles
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PIN PILE INSTALLATION RECORD
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Comments on
Footing comments
starvStop Start/stop
Pile Ddvinq (feet) Driving Resistance
Dat Chipping !0 ` " 1 11
Number
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Engineering C013SUIting Testing
Cexti-ficate of Calibration
PS1 Cerfific"('Ite NUmber 7127-30137
Calibl'ated li-quipment Info;
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Client Tril'orniation:
Pacific Piling and Underpining RAM: Manufacturer: Simplex
Atm. Howard Clark Model: 100 toil hollow,
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PO Box 2080 SIN: Model 001
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Woodinville, WA 98072 G A G E: N/lanufficturer Enerpac
0- 10,000 psi
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(425)-185-8869 Nlodcl�
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Fax: (it'-5)-4189-4025
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PROFESSION AL S14CIZVICE INDus'rRIES hereby cei-tifies that...
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The above-clescribed instrument III CL or exceeded all published Spec ifications at tile time ot,
'fied below The instrument has been calibrated Lising standards whose
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accuracies ai*e traceable to 1 lie National Inst*tLite of Standards and'Feclinology ts,r) within the
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limitations oi'the InstiWW'S I
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Cal Date & Tirne '7130103 'rernperatui-e 23"C Pass
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Next Cal Due 7/3 W04 1111111idity 50% Seals OK
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Results: Left aS found, no adjustments made
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Asset Model Description Cal Date
Due
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712-IC lUjlejc/�knietek- RA- Cornpression'Test i"dachine 6/16/03 6110104
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLCASE SIGN
ENGINEERING DIVISION DATE
PLEASE SIGN
PLANNING DIVISION DATE 1G1!z1bq-
PIE&AGN
PROJECT -C'b� T'Y
SITE ADDRESS- 7,
PERMIT Z,!5o 4- - o is- z ._ADB#__________�DATE INSPECTED 710
DESCRIPTION OF WORK TO BE INSPECTED
A field inspection was conducted to determine compliance with -approved plans. Final approval
denotes that there are no objections from the above signed Department to the release of
PERFORMANCE BONDS and the granting of:
V-_�GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
[I Copy of CONDITIONS given to owner/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRE CTION NOTICE given to owner/contractor by inpector
2.
3.
RE-INSPECTEI) OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:fomis:ocaprv1 3/25/04
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ...................... wv�
Wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final ......
HEATING:
GasTest ....................
Gas Piping .................
Equipment ........ ........
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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