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HomeMy WebLinkAboutPermit Electrical 1989-08-28a,,I I Job Locaticn: Tas Lot llAssessots Map t Subdiuieton: 7_ 3/ePhone: AAtmer: Addvess sf.5 S, 7ybuy.( Neu rht VaLueDate of App Lieaticn Additicn RenoCeL BIdrs lloar< Recei tl..RESIDENTIAL.. SPFlINGFIEI.I) zzs Notth sth s;tueitPPLrcATI --/PERMrr Spr"tngfteld, 1negon 97477 Building Diuision 7 26-37 53 cl Date: resont ractors General l,Iechanic Plurnb in ec tr ca Elec tr:clanSrr 4 DEI.IOLITIO!! OR !]OVED Sanita.ry eeser capped at property Lire Septic tank putped ant filled uith gra:sel linal - I{hen abcoe i.tens aye ccnpleted and uhen Cemolt tion is complete or. st!,Li,r- ture noued ard premises cleaneC up. Hcnes Blocking and Set-up Plunbing connections -- sa)e? and uater Electrical Connection - Bloeking, set-ut and plutnbing conneetions rrust be appnc;.ed. b efot, e requeeting eL ec*-r,i cal inspee tiot Accessot,e- BuilCing Pinal - After pcrckes, akirting, decks,etc. are conpleted. Page 1 of 2 It ia the reaponsibility of tle permit lwlder to see that aLL inapectione ate nade at the propet time, that ecch ad-dress is neadabl.e frotn the at?eet, and, tlat the permit ca.td is Located at the fnont of the propet,ty.*Buildirq Nuiciot appz,o"*ed plan slnll remai.n on the Builtlinl Stt; at aLL- times. PB):EDUPE F1R INSPECllert qEQ/ES!:CALL 7 eady forr.,iLL be nade the sane dcy, requests .made SI?E INSPTC?ION: ?o be nade aftez,ercau;tlon,-ilt pr.tor to set up of forma. UNDERSLAB PLUM)!Nq, !!,ECIRTCAL e MECHA.,4IICAL: To be made before any uonk ie cottered. ?OOTING & FOUNDATICN: ?o be traCe;Fa=rerrct;s at,e ercazsated and. forms at,e erected, but prior to pout"tng ccnarete. TNSULATT)N/7APOR BARRTFR IilSPEClr)N : To be rnaCe aj'ter aLL insulaticn and, required uapon barriel's ane in place but before atty Lath, gypsun boarC or rnLL coueting is applied, ard before oty ineulation is concealed, DRYWAI,L INSPEC?ION: ?c be made Aftev,-dT-6wiTTis in ptace, but prior to any taping. MASONRI: Steel location, bond beans, grouting or oerticals in accordance bith U.B.C, Section 241 5. WOODSTOVE: ccnpmfi. After installation is 26-3769 (tecorder) state your City desigrwted job nutnber,, iob aCdrees, type of inspeeti*r 'inspection, Contractors or A,mers rctne and plane nwrber'. P.equests recei"*ed befcre 7:00 ct aftet, 7:00 @n diLL be nnde the nest:,nrking daA. 6._) .\ , -_1 Ioun City Designted Job l,lwnber rr, 5l\L\ \ 35 UNDIRGROUIID PLUM9ING, SEWB, W,qTER. 0841!4gl: To be maCe prior to fil-T|Q-iFinchee. UI|DTRFLOOR PLUI,EINC & MECHANICAL : oy floor ineulation or decking. POST AND BE4M: To be nade pr"iot, toTiil7Tafr6ti-of floor insulition or decking. R)ucH PLU!.tBntC. ELE?TRTCAL & MECH: ANICAL: No uotk ie to be co.-et,edGliTthese inspeettons haue been made aruL approueC. PIPEPITACE: Prton to plccirq facingma.terials and before frantng inspee-tion. FRA\'|INC: Wst be requeeted aften approual of rough plutnbing, electyi-cal & meclwnical. ALL roofing bracing & chinmeys, etc. nrast be cotnpleted. lto uork is to be con- cealed until this inspection lws "been nade anC approoed CIRB e APPRQACH APPON: After forms at e erect;{T;{nilo1" to pouring concrete. SIDEWALK ,9 DR.TIAilAY: Fot, all con- ct "te p",/G-;ltln street right- of-?ey, to be made after aLL erca- oattng complete & form utot'k & sub- base naterial in place. IENCE: t{hen complete -- PtooiCe gate6 or motsable sectians through P.U.E. FTilAL PLUMBING FTNAL MECHANICAL FINAL ELECTRTCAL AIL pnoiect conditions, such as the i.nstallation of street trees, conpletion of the requined Landsccping, etc., rmtst be satisfied befoye the BUILDIilC FINAL canbe requested. a\ PrNAL B|ILDINT:- The Final Build,ing. Inspection rrust be t,equested after the pinal plwnbing \_-/ Electrical, and. Mechanical rnspeetions hque been nade ard'apptooed. *AT,L MANHCT,ES AND CLEANOUT: MI]ST BE /ICEESSIBLE, ADJUSTIIEII| ?o BE M!1DE .4T NO CL)ST ?o c7y Describe h'ot'k: l tr r SOLAR ACq.ESS REQ.-* t JOB NO L-CO Bedrooms Sout ces P, T,,House Lot Faces -LOT ?YPE _ fnterior _ Cofner _ Panhandle CuL-de-sac # of StorLes Lot Sq. Ftg. % of Lot Coueraga Total Height Topography -- Pees -- ITEM FTG l Value Building Volue & Permit This permit is granted on the erpress cond-ition tlut the. saidrconstruction iholl", in a-l.L rLspeets, conform'to the 7rdinance edopted h;U the City 9f ipilrgYlnU, i.netidrng' the 2oning crdinanc-e, regulati1g l;he ccnstructicn *a "'i"n of Luild.ings,"ond ^ry be suspend.ed ot, reuokeC at cny time upon uic- Lation of any prcuisions of eaid 1rdinances' TOTAL VALUE s.D.c. 7, S x Butlding Permit l:ut;e latd: SLate Receipt #: Total Clnrges ,(Signed ,11'EM N0.CHARGE Plumbing Permit No Derson slutll constmtct, inetal|-, aLtet ot'cltanqe -anA ne,-cr ecisting';ir;;b;;"";"iiti"iZ" "i"t* in xhoi.e or. in part, unless such petson is the legal possesson of " rZtti pl"iei'i L;,.n'sZ, ercept that a pierson ma'g do pliiairi uot'k to p"opnrty-inl;h- is o"t'nd, Leased or operated by the appli- cant. Fixtures Residential (1 bath) Seuer Wctet' Pl*nbing Pernit State * Neu/Estend Circuits Electrico I Permi t were state Lan requires tlwt the electt'icaL uork be dane by an Electrieal Contraetor, the eleca'l"cot po"tto" -of this -permit shall not be oaliC until 1711s latel'lus been signed ty the Eleetrical Cantractor' Seruice a oo State oo Total ,00 NC,FEE CIIARCE Mechqnicol Permit tzhanst Hoo,7 Vent Fan PermLt fssuanee Mechanieal Perwit * Sec-urity Depoeit Storage l,laintenanee Permit Cvtbcu! SidetsaLk Fence Electri.cal 14b91-- Mobile Home DaLeTf,ant Eraniner IHAWIAREEULLyEXAMINEDtleeonrpletedaoplicationforpermit'anddo hereby certify *oi"a-L'L"itioiqyib" hertii is true and cbrrect' and r irrl1", zn"tlliy taot")iy'ai.d alt uork perforned sltall be done in accor- dance tLth tnn onai"rT"zr-Jr ;ir" ili zr bpri-ngfield, .and Lh.e .Lass of the * State of ,tegon p";';;;;;;;s-'to'tie wirt< CesLrib-ed herein, cnd ttnt N0 ,ccu- pA,cy dlitl be rnade'i7-;;;'"i;;i"r2""it7""1- p)rmieeion of the Buitdins Di- uision. I furl:he.r, c-ertilit that ,only .onlii"'ton" and erpTcgees uho are in ZJptl"".L'rLtn cns'zol,'o'Ls 'Ltt be-ueed on thie proiect: TotaL T7TAL AM)UNT DllE: * te I?TiE Tatal Charaes rTEM Wcodstope -?otal Clarges - State Surchdrae * Rceeipt # |r32 Lr-Z 0c- Date: 2- a GeneraL L Coasjtuctton_!etdel_ rOR 56022 EIectr z2s North strr streeawLrcarrcN /PERI',rr SprLngfieLd, 1regon 9Z4ZZ BuiL&Lng Ditsiston 7 26-37 53 " RESII_jNTlAL"SPTINGFTELD North 26th D\ Job Locaticn: Subdittision: Aesessors Map #r6s Iat *299L8349533O ield, OR 97477 -01r00 asner: Mike Fredrickson fieldAddt ess:OR Phone: 747-3121 City:zip: 97478 t--t t-t value 3400.00Date of epplieatian- 2/20/89 Addi.tion RemoCeL Desct"tbe llork: Fire danrage re[Eir. x I-t io the tespottoibility of tte perwit ho&e?ft*, tln atreet, and tltat the pinrit eazd. ie*Building D,ioicion appz,o"*ed pThn sVnLL ni^iin to aee that aLL insoections ee nade at the ptope" tine, that eaeh ad,4ness is reaCableLocated at the froai of the orooettu.on the Bunlding Site at aLL'ttmes.' PRocgDUPE FoR rNSPEcrroN.El-Pwsr"cALL726-3769 (reecvde*) state ac,tv city d.estgrn-ted job nunbet,, job aciress, type of inspec=icn,equested and uhen uou ui1-T Eeneady foz' inspection, co;;;"ol;;;- oi a,ners- nane Lnd ptnne nuqbet,. p.equests receixed befc,e z:00 an'*iLL be nade the edze d.as, ";A-.;l;"^La'ilt* z,oo'n "ii tz- ia" th;,;;;;;;ri;;;,E,'Aa. Y?D /25Iour City Desigrated Job Nutnbey fs: x SITE TNSPEC?ION: escauation, but forns trenches. FNIAL PLUMBTNG ETNAL MECHANICAL PTNAL ELEC?RTCAL ?o be nade after pt*iot, tc set up of to W*aork is cooet,ed- require4 oqot, bmrie?a @e in place but_ before oty Lath, Wpsun baazC ortnLL eouez,ing is applied, and. beforeoty irnulation i,s concealed. FO2TrNc & F)UNDATTCN: To be maCeafte" t"enches a?e escaated and. forms- ate erected, but priot, topout-ing ccnez,ete. f- DRYI.ALL INSpICTTON: Tc be made lX I aftet, aLL C"rguaLL is in pZace,but p?ior to any tapirq. Final - Wen abctte itms ate cqnoleted and uhen Cqnalition is complete br sfuue-ture moued and. pretrLaes cleaneC up. 4AAS)NRI: Steel Location, bond beans, grouting ot ueyticals in accordorce Lrith U,B.C. Section To ?o be concrete. WOODSTOI.E:@;ra. aLL insu After instalLation is 0R tiowt Saritary seuer eapped at properfu Lire Septic tank p;,nped and filled trith gra:;el Hcmes Bloeking old Set-up Plunbing connectians -- saie? od. aater Electrical Ccnneetion - Bloeking, set-uD and_ plutnbing connections m;st b-e- apprctZd.before requesting eleelytcal inspeitpot Accessory BuilCing wpyPPLo)! PLUJETNG & MEC\LANT1AL:ro De moie praor to instalLation offloor insulction or decking. P_)ST 4t!P IEAM: ?o be made pnior toinstallatian o! floon insulation oz,decking. ROUGH PLU,!BII\?, ELECTRTCAL & !,\ECH-ANICAL: no uoik-7i-t-i-6i-iiieiZZ-za:til these inspections hatse been mad.e cnd approueC. EfPEPLACE: Ption to plceirs faeinamaterials and. befot:e fror,in| Zr"pnl_ xLOn. FRAI.,IING: ltust be requested afterapp-toual of z,ough plwnbing, eiectri_eal & nechanical. ALl. toofin4 bractng &- chinmeys, etc. nust" becomPLeted. Ilo wcrk is to be con_.-cealed until this inspeetion lws'been made anC approoeZ. CURB & APPRCACH APPON:ee erecteC but prior After fonnsto paning SfDEWALK & DRfiEWAy: For aLL con-cr-ete paoirq uithin street right-of-uny, to be maCe after aLL -e*ca- uating conplete & forn uotk & eub- base rm.ter.ial in place.Firnl - After pctches, skirting, decks,etc. an,e c.cmpleted. !Ell!E: Wen conplate -- ptouiCe gates or motsable sectians thtough P, U.E. ALL proiect conditions' such as the i.nstallation of street trees, conpletion of thetequit'ed Landsceping' ete., tm,tet be satiefied. t.ii""-it""-iu-;;r'" F1NAL can be requested.. !tNAL BUTLDTNG: The Final Building rnspection nruat be requested. aftet, the Final plwnbingElectrical, anC Mechanical rnspectio".;i;;; o"n *La"- iri ippri"a. - ' Pege 1 of 2 *ALL I4ANHCLES AND CLEANOIJTS T,IUST BE A CCESSTBLE, ADJUSTIIEIII ?O BE IL4DE Ar NO CCST rO CNY r tr T JOB NO. Zone: TotaL 5 soLAR AceEss REe.-0r r--co C Gro,Bedrooms Planl Eraniner Date f HAW CAREEULLY EXAILINED the eornpleted application for permit, and do hereby eertify that aLL inforrnation hereon is tv'ue and cow'ect, cnd f furthet, eet,tifg that any ard aLL uork perforrned sVnLL be done in aecor- danee vith the Ordinances of the City of Springfield, and the Lats of the* State of 1regon pertaining to the uot'k Cescribed herein, aTtd tVnt N0 }CCU- PANCY uiLL bb maCe of any structw'e uithout petTnission of the SuiTding Di- uision. I funthen cez,tifs- that otly contractors cn^d enplcyees dho are in eanpliance uith 1RS 70L.055 uiLL be used on this pt'oieet ;e3-b? Aecess Lace L.House Lot Faees - lleat Sout ees # of Stories ?otal Height Iopography LCT ?WE _ fntenior _ Comer _ Panlnndle CUL-de-sac Iot Sq. Ftg. % cf Lct Cooenage o^^^ I?EM EJU x Value Building Volue & Permit This pemn t is gnanted on the erp?ess cond.ition t?wt the said eonsttaction stnll-, in all z.bspects, conform to the 0ndinance adapted tiy the City of Springfield, including the Zoning Crdinance, regulating the ccnstracticn and. use of buiLdin4s, cnd may be susperd.ed or reuokeC at cny tine upon oic- T,ation of GnA prcoisions of said 1rdir,ances. TOTAL VALUE S.D.C. 1.5 c ,t Building Permit ((, Sta.te 3 Receipt #:lotal Charges * Si.gned: N0.FEE CHARGE Plumbing Perrnit No person slnll consttact, instal'!., altev' or ehange anA nea cr etisting plwnbing or drainage systen in ulole or in part, unless sueh person is the Legal possessot, of a ,talid plunbet"s L'Lcense, eseept that a pe?son mag do plwbing uork to p?ope?t! uhich is otned, Leased or operated by the 6ppli.- cant. ?i*ttpes Residentia.L (1 bath) Seuer Plunbing Pernlt Nau/Extend. Circuits Electricol Permit -rlhev'e fii;ate La.n i,egui"e$ th,at the eLectr'Lcal uork be done by un E\ectrical Contraetozt, the electz,ical portion of this permit slwlL not be ualil until the Label has been signed bg the Electuical Cont?acto?.Setwice State TotaL * NC FSE CIlARCE I Mechonicql Permit tuhanat HooC tlcodstote Vent Fan PermLt fssuanee Meclnnieel Pernrtt .- ENCROACIIMENT .- Seeuritu Deposit Storage Mainternnte Penrit Cutbcut Sida,nlk ?ence Eleetz,ieal Label Mobile Hone TOTAL AMOUNT DUE: *4 bJ3 Date ITEM llatpt ?otal Charaes Pl anni ng & Devel opment Job. No.0 - gIlT:T OF SPR,IT\TGFIEL' 0FFr,i 0F C0MMUNITY AND ECONOMIC DEVLut)PMENT 225 North 5th Street Date Buildjng Divis'ion 7,"?/-:82 JOB ADDRESS l.0ot {r'L6fr| o t >t+c 4t, fatsY /h/LL- N LeE, {p N TN L CALL FOR REINSPECTION INSPECTOR **** CALL F0 R: --- INSPECTI0N 726-3769 ---- INF0RMATI0N: 7?6-3753 ***'( TO:l,,Jx t ILF Fft€-p At, ( ' eaa/ SPF|lt.6f|ELD I,IOOD STOVE/INSERT INSPECTION APPLICATION CITY OF SPRINGFIELD BUILDING SAFETY DIVISION 225 F 'ifth Street Springf ield, 0regon 97417 Offi ce : INSPECTION LINE: 726-3759 7 26-37 69 CITY OF SPFINGF'ELD, OREGO'V J ob Loc at'i on :loot N.)GL Assessors Map #:3*Tax Lot #:I L_Oo 0wner:{Y\'t LL Frrfui 1*-3 LowtL) Address, 6q+ S, 1Ve Phone #:141-ztlt(i@ ) City: Val ue of (pt &State:v-Zi p , qlqtl Insert: appr0pr a app ance Prel'im'inary Inspection is $15.00 l,lood Stove/Insert Permit 'is $15.0 Type of Inspect'ion Requested: contractor: tTl fite,L-' installation of insert) state surcharge ( 0 or to $0.75 ipr + Stove Address:Phone #: city:--_---state:Zi p: Construction Contractors Registration #: Ex pi res : By sign'ing this permi required (726-3769). perm'it is correct and for wood burni a ur t/ appIal that f ication, I agree to call for an inspection(s) as so state that all information on this application/I was provided with the Wood Stove Safety information inspection standards. 2 2-74 Date FOR OFFICE USE c REQUIRED INSPECTION (S ):I,IOOD STOVE/INSERT 2-)-1o PREL IM I NARY Date of App'lication:Job #: Total Amount Collected:Ls.1{ Receipt #:)5a49 Issued By: r c1 9q checked for Delinquenci r* L/ checked for Historical status . l-"..t) FiRE DA}4AGE REPORT OR ELECTRICAL HAZARD krcrb' DATE:t- t 5 -8 ? TO: FR0t"l: SUBJECT: Building DePartrnent Springfield Fire DePartment Structural Damage to Building lra'lb tA 8)1.l Address or location of building 5 q ^aJ Name of ol',ner Type of buildjng dFt (Dwelling, Store,rehous e, etc. ) Est'imated val ue of bu j 1di ng Estimated loss to building Date of fire 2- /S-f 4 Location of damage 'in building L 'r /' /^" ! // u'//t/ (Rcof, Wall, Exterjor,Interlor, e tc. ) Structural weakness as a result of the fire Jar ;./( 6 ta ,L- a (Bu d raf ters , Beams , .lo i sts, e tc. ) Add'i iional Derr-jnent'i nformation 2t El ectri cal Hazard -/ (tiJi ri nq , 0utl ets , etc . cc {,rd lu {q Jd Sjqned kfob' FiRE DA}4A.GE REPORT OR ELECTRICAL HAZARD DATE:2 _t5 -8? TO: FROI,I: SUBJECT: Build'ing DePartment Springfield Fire OePartment Structural Damage to Building t_b Address or I ocation of bu'i'ldi ng {q ^aJ Name of ov,ner Type of building dE1 (Dwelling, Store,re house, etc. ) Estimated value of building Est'imated loss to bu'ildjng Date of fire 2- /S-f,? Location of damage 'in bu'i1di ng / (Rcof , l,,lal I , Exteri or ,In terior, etc. ) Structural ureakness as a result of the fire 6 I (Bu n ed raf ters , Beams , .lo i its, etc. ) .r/ El ectlical Hazard t / ' .t' 't',o (Ui ri nq , 0utl ets , etc .) l(,CC 'g.t\){q J-tr Signed rt/ )/ aa ,t-Jor ;/( Add.i11cna1 pertinent jnforma tion .Ftt r /.,t.ct J brt ,r /o'r t:x P. NO. S'T'ATE ()T' OIT UGON T.'IRI.) REPORT STATE ITIRE }'tARSTIAL r; I t'or.t'urca.lNy E DEI']' o IA - - t:otnty --i,AZ. ! s.rn fl Tuc I Tt'ur I Mo" E rred I Rri 9l I (Tie Line) 'l'l[tE l,\cK lN SEIiVICE District of Incident 2 INCIDENT ADDITESS DAY OF \YEEK .L/ ! Srt,,, 3 OCCUPANTNAME(hst,First,MI) { BUSINESSOWNERNAM (last. Fint, MI) 5 OWNER NAME (Last, Pirst, Ml) 6 FIRE RI'POR'I'ED BY NII) o_o,J- > @:-l in -*jr{ rr,.t .1 APl.l. o1z a; ='r{F'J .E, i{ :1 A a-r.rl oo t. rl o rr U).l t. F' \1 F)a U)rl "l tr, ?0F' U) zl. Telephone Diret Municipal Alarm Systcm tladio Verbal No Alarm Rrc'd ALANM I PrivateAlarmsysttm 8 # Ot't'tRE SEIIVlcll PERSONNEL RESPONDED I 9 TYPEOFSITUATIONFOUND fi Structure Fire ! OutsideStruclu/value ! vehicleFire ! Brush, Grass, l*ave I Trash, Rubbish Voice Signal l{uni Alarm E NotClassifiedAbove D other(List) D AutomaticExt.Syst m ! Pre-connect ho*/tank only [l Pre-onnect hose/]rydrant, standpipe Over 70 fet IO N,IETHOD OF EX'I'INGUISHMENT PROPER'TY USI] M MOBII-E PROPERTY I2 ROOI\I/ARF]A OF FIRE ORIGIN E IN l3 lGNll'roN FAC'I'OR l{ Fortl,tot'HnAToFICNI'I'loN D Self-Extin8uished D Ntake-shiftsids ! PortableExtinguisher Hond-laidhose/hydrsnt,standpipe I Undetermined D ]UasterStreEmDevice ! NotClassifiedAbove /l l/)b 15 LEVEI,OF tog E 20 to 29 feer 'u vnl-utt LOSS l7 n-Ul\'tAER OF S'l'Oltltls to 7 to 12 stories l8 IlUll,DlNG AGE (ln Years) l9 TYPE 20 EX'I'I:NT O}' DAMACE CONFINED TO: I Theobjcctoforigitr 2 Part 0froom or area oforigin 3 llrxrm oforigin .l ['ire-rated comp. oforigin 5 Floor oforigin 6 Structure oforigitt ? ExteDded bcyond structure oforigin g Nodamagcof thetlpe (N/A) 2l Rl:IUARKS WeatherConditiorrs 22 l'ollrv Up Invesligati{,n llequeste(l lfyes, who sill invcstigate 23 Nurnbcr of Injurics I'ire Se rvire !.1 l|ember Mnking lleprrt '15 Arkliti,rurl lnfornution fet 30 to 49 feet 50 to 70 feet in Flisht Below grd. level Not Classified l3 to 2,1 stories 25 to.l9 stories 50 6tories or more D 3to{stories l'la me trtr tr D D .E D I 2 3 4 5 6 7 SmokerD 2[ 3D4f]5n6p ?D eI ARnIVAL TllvlE I ALARM TIME /0t^ MO DAY tts I tst6fl YEAIr CENSUS I'RACT ISO CLASSztP 3 DOB (optional) S-a t -51 1tt,l- 35?o TELIiPHONt.] DOB (optional)TELEPHONEADDITESS 171- j t2 I 'fELEPHOhvEDOB (optional) 3-21-y15?// t,7) ADDRESS 'd st f/"/, TELEPHOn*E1n-3510DOB (optional) /o- // -ss ADDRESS /oo t P. 2 t tj S, /1./ I Reeived Mutual fl ciren E N/A T OTHER VEHICLES RESPONDED (do not include PA'., 2- I OF ENGINES RESPONDED a lf OF AERIAL APPARATUS RESPONDED TYPE OF ACTION TAKEN Q Extinguish fJ Investigation ! Removed Haard I stana Salvage Not Classified MOBILE PROPERTY (Complett line I\l) LICENSE ilN{OD!lL SERIAL #YEAR T{AKE/ EQUIPI\IENT INVOLVED lN IGNITION (Conplete Line E) SERIAL T VOLTAGEYEARI\tAKE MODEL MA'I'I.:RIAI, FIRST ICNITED WAS MADE OF ITEM FIRST ICn{l'lED: .1 Vehicle and Contents .00 .00 'to'tAL .00lluilding .00 Contents .006 .00 .00.00/l o .00.00 50,000-99,999 sq ft 500,000 sq ft ft I000-{999 sq ft 10,000-19,999 sq ftBUILDING SIZE (Crnd Flr Only) Unprotectrd Wood Frame Not Classified Above Unprotst. Mssonry l:xt. & lv@d Int.Unprotct. Stel Bldg Prot6t.llxt. & S PItI N K LER PERFO ttI\,IANCE I D Fhuipmentopersted z E F\uip. should haveoper.-did not 3 D &|uip. present fire too small tooper. 9 [ Not clussilicd a&rve 0 ! Undeterminedor not reportcd 8 ft Noequipmentprexnt (N/A) SprinklereControlledFire: YES E NO D f,ofHeads O;rned D I]T[.:C'IO R P I.]It FORMA NCT: B! tr!tr n tr D In rmm of origin-oper. Not in room oforigin-oper. In rm of origin-notoper-fire tmsmall Not in rm of origin-not oper, 6re too small I n roorn oforigin- not opcr. ID*er disconncct r\ot in rm of origin-not oper.lrcwer discon. In room oforigin-not oper. dead buttery Not in rom of origin-not o6r. dend battery Nodetectorpresent I l0 Undeterrnined Numbor of l'atalit ies Other '''n'" /, t /t ,t rt 2- /s, )"qI)ate 'l'ille ./lhle 8r.1.4.10-10 (n-84) Y-Nx Other ! cont. on back DO.\OT WIIITE IN* TIIIS SPACE I -t?5 I