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°_'� �ti ��IanufactureL ,�tructures I�lspec�ion - �. . <br /> ``' ��Az f)cp:u•tmenl of Cunsumer R Itusi»esti Scrvices C!=(�re���m <br /> �� -��.�� I{uildin� Cudcs lli��isiun • Iji; P.d!�c«.uci N�V". S�dcm. OR `;]���V:ishiir�t��i! <br /> �"'7° \�I�iilin,� :iddre.s: P.O. Gox I-1d70. S:il�m. OR 97309-0�lU�l J�-Idxhu <br /> (i(131 :7ti-3U80. PGx: (j031 i7S-3(�56 <br /> �Veh: bc�.��re!�on.go�' ' J Oth�r. _ - <br /> TYPE OF INSPECTION <br /> � �Vternalc Comiructi�m ;�'-Visuul �J:Jn-pltml �J' In-siate J S�ccial ❑ On-site �� Out-of-state <br /> INSPECTION WFORMATION <br /> ,,_ ' — <br /> � � r I \I � U.iic o(iu,pection � �,�,'��Da�e requested: �� �'%��S <br /> �71r n;m�e:� .� .i �r't`• /:� - �.- _ i = — . . <br /> Ins�cciion locution: `. �� Installaiion location: <br /> 4 f;��.it�� :�V� i.�.� _ <br /> � � r, _ ' � <br /> party lo bc billcd: 1,(�{����.r' � 'r'V.: /,5i`�-. Conlact person: <br /> BillinE address: ` , ��.-:x L{ t. Phone:� -�.;� ll.j" ( '�, D�' <br /> 'I � Statc: �J(,�' ZIP: - ?� Z�� <br /> City: f'_i I p i c -" i i i L-( If . <br /> J� r ., <br /> L�spector name: �� �..�- r:` .'`�a y�� i?-T��'�'i'..:�' Time in: / Timc ouC �� 7nsignia issued: J 1'c, =I�;ic- <br /> ❑Covcr 0 Mli -70�I I/1195 ❑Tinal � ��LFI - 70-1I I/119� '� Ro-inspection ❑ M}i - 7041 Ill 1 J� <br /> ❑5 - 70711/I191 ❑P-70(ill/I191 ❑5 - 7071I/II��I _7P- 7061 1/1 1 91 ❑5 - 70711/1191 ❑P-70611/1191 <br /> ❑ M -7U711/119I ❑ '�G- 70111i11I1 ❑V1 - 7071 111 191 ❑ "E - ?OIII11191 � �nt -7071I/] 191 �J"E-i0111/1191 <br /> INSPECTION REPORT <br /> Plan:ippmvul nu.: � Scriul»o.: � GK to eocer. i��'es �No � P <br /> i.r . <br /> / ' S 7`j_� `-� �4'J7 '/ J .. '7 '' 7 �,-. - r". '_ / 7 '^�'/ L�-��l Z i /`,.�:,�''_ ,�, <br /> ;� , <br /> 1�57 <br /> ,; � ,; ,, i�,,�- -� L �;,, V,'� <br /> �.,_�_=C-i`�✓1 <br /> �/�=/� _'1 / 'f' , ^%':S! '� <br /> �� , r ;�vr � . ��"'✓`� <br /> - ' �_� .Y � /. ..r'" <br /> 1� ll � f1Y �� l7�.,�r�,�(. <br /> '\ <br /> i' \-_"_ -' <br /> �� �DJ'I.t--f� ' 1 ,i� Y _. � <br /> / <br /> Impcclor'tisi_nitu���''�� -_, °` ' ,' t� : 7'r.i�eltimc: ' _Houis ❑ Ycrmit <br /> ❑nuice tu follo�ti �'n'nicid dut �II d ns IYom � Ltspecuon time: � � - Hours Totttl hoW'S <br /> billin�dnlc. '� ' i' Consult:vian: Hours '. " <br /> ( ' l �, <br /> Itcccicrdb�:._���..�I11. \ ��.._ Dnle:-I �-:�i�...._`,'. I <br /> .. � � � - \�lile.age: ''.J I-hour <br /> •. �, i <br /> . � � ' mininwm <br /> � Mcals: <br /> Lodging: <br /> �� �'<�NsuniEiz <br /> �rj 3USWESS �� <br /> �. �SFRVICES �� �' �� <br /> �.m.,;�;.+nrurr�nnn I�irsicaue-Billine Serundcone-Pile ThirdconcAi;mufacturer �Qo` --�- 0 <br />