HomeMy WebLinkAboutBuilding Permit #03-0281
(Please tytle or print and sign at bottom)
ADDRESS
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
See Main File
Date Rec' d
2r ZS--03
~. ~i:i~e ~:~y I PERMIT NO. /17-0 ? a. /
J. Yellow Applicant lk/ c...-v
SOZ-V
ZL,UFF- J-IGlbf1/S l' (Vrl L.-
LEGAL DESCRIPTION (office use only)
LOT /'1 BLOCK / ADDITION
11m!)?/(
OWNER] I I
(Name) r01-lc Homes t)r
(Address) tiS, /'lJoJ21}lhJ[SJ Ptlultf.
BUILDER
(Name)
(Contact Name)
(Address)
f!t; (5;7"
IJ1vt
ffA6A11
(Phone) t,5J -1/5Z -SZOb
, .
~E
{]V~ ,bMSCHfL.tJ
TYPE OF WORK
o Misc.
*ew Construction
OLower Level Finish
~/ZI
ZONING (office use)
p(jO
PID Z5 - 4-~z - 0/4-- ()
(Phone)
(Phone) !//Z-Z--?/' - 4?~~
DDeck
OPorch
DAddition
ORe-Roofing
o Fireplace
o Alteration
?tJ. tJ9~
ORe-Siding
OUtility Connection
I hereby certifY that I have furnished information on this application which is to the best of my knowledge true and correct. I also certifY that I am the owner or
authorized agent for the above-mentioned property and that all construction will conform to all existing state and local laws and will proceed in accordance with
submitted plans. I am aware that the building official can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may
~teru.Z/to~4~ 8&-/371 2:!c.~h3
//' / Signature Contractor's License No. 7" ~~ 4_
,./
I Permit Valuation
I Permit Fee
I Plan Check Fee
I State Surcharge
I Penalty
I Plumbing Permit Fee
I Mechanical Permit Fee
I Sewer & Water Permit Fee
I Gas Fireplace Permit Fee
PROJECT COST IV ALUE (excluding land) $
!q{)~ ()()O, 00
$ 9~3, 7?'
$ "O~. If'!
$ ~s;.O 0
$
$
$
$
$
/tJ~. d"
/dtJ, tJa
35'- sa
J/tJ,o.
This Application Becomes Your Building Permit When Approved
~
:J..ad2p
Building Official
0/d~3
Date
I Park Support Fee
I SAC ~
I Water Meter (Size 5/~ 1";
I Pressure Reducer
I City SAC and WAC
I Water Tower Fee
I Builder's Deposit
lather
I TOTAL DUE
I Paid 9/ ~ ,C( '/
I Date 1'/1" ....(J)
#
#
#
#
$
$ tz.. ~::> ' 0 0
$ ~50, 00
$ #Sr do
$ /2~O. 00
$ 700,()f!)
$
$
_ $5~.(p9
!l' .J -
ReCXNo. ~J'JJ'
By~ '
()
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
is~ 7~
Planning Director
Y~Y~3
~
~~
Date Special Conditions, if any
24 hour notice for ail inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
See Main File
~ - Building:)
Cana-ry - Engineering
Pink - Planning
Thr Crnlrr or chI' tab Counlr)'
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
PUGtS r'OnES
2- 25-03
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
SOY/- Bl ~ uP:-~ 1-61 qr=TS I ~
Accepted Accepted With Corrections /'
Denied
Reviewed By:
~
,..
:;1~
Date:
j!J. ':<, /0 3
I .
Comments:
See Main File
"The issuance or granting of a permit or approval of plans, specifications and
computations shall not be construed to be a permit for, or an approval of, any violation of
any of the provisions of this code or of any other ordinance of the jurisdiction. Permits
presuming to give authority to violate or cancel the provisions of this code or other
ordinances of the jurisdiction shall not be valid."
See Main Fi_e
White - Building
C~I'!!!Y-: Enqlneering
r rink - P!aDolna ')
The (O'nter of Ihf t.kr Country
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
f'){j LIE. ~I c ,. IE::=-
2 'J. r. c?
- c:...../ - J--.,./
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
I::t \./ r~' f-{~' (:11-1'= I k,.L".
Accepted With Corrections /
/' , r-~;_.> //'1
, I ....:::.-i--
___' < L-- I
Accepted
Denied
Reviewed By:
~.:
~
:7d'~
Date:
3/13~ '3
,
Comments:
See Main-File
"The issuance or granting of a permit or approval of plans, specifications and
computations shall not be construed to be a permit for, or an approval of, any violation of
any of the provisions of this code or of any other ordinance of the jurisdiction. Permits
presuming to give authority to violate or cancel the provisions of this code or other
ordinances of the jurisdiction shall not be valid."
~~-~~
See Main File
~ - BWldin
rCanary - Engine~
Pink - t-"ar'lIung
Tht' Cf'nlC'r of Ihr t.kt' ('ounlry
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
.
T)UL I t: HO~IES
~-;) - ;>"C._ /) <)
<=- ~"./ L/--
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
r:::- ( ) ? d~.. ~.'.':) l lJ r:-C: .HCl M I-j-l-"~-'Tl.>) .J
_) v.c.-:: I 1.-/ j r' ; I . l / I -,-1 ! . '-.) I i"--./L---'
i
Accepted
K
Accepted With Corrections
Denied
Reviewed By:
Comments:
NA!b
St.e ml1lln f",'!.
Date:
's -~-()3
liThe issuance or granting of a permit or approval of plans, specifications and
computations shall not be construed to be a permit for, or an approval of, any violation of
any of the provisions of this code or of any other ordinance of the jurisdiction. Permits
presuming to give authority to violate or cancel the provisions of this code or other
ordinances of the jurisdiction shall not be valid."
Mar 04 03 OS:54a
METRO GENERAL SERVICES
763-428-2S68
p.3
~f.. . Fllf.
YELLOW - A~"-ICA.T
GOlD - CITY
'..
,
Sewer and Water
contractors must
be registered
with the city.
APPLICANT: m.oti:o .~-,J~~.PHONE: 7t,~ - tfag-c;l/138
ADDRESS: S(9J) ~ ~NE . DATE: ~
SIGNATURE:I..'~g ~ BLDG. PERMIT #
SITE ADDRESS:. SO.;l4~. ,:<"'~\~'lQ Plot
FILU iN THEu BLANKS
1. Estimated length of water service ~~ feet.
(If
2. Size of water service inch(es).
CITY OF PRIOR LAKE
SEWER' AND WATER PERMIT
FA)/. l}5.:l..-- 1{'I7-'1;' l/$"
S.W.No. ~:s' d-~I
NOTE:
3.
Location of any couplings from structure ~ feet.
Type of sewer pipe. ABS PVC ~l Cast Iron
4.
,
5. Estimated length of sewer line
~
feet.
6. Clean out (if required), located at feet from
structure. ~~~
=================================================~==;~==========~=
This application becomes your permit when approved.
.!
,
BY
DATE:
f~~
>:It ~
'llf.i"';'.:'.'~
. ':f;
~ "~I
..1..... .........:.~...'.:
. ;:~
. ~~t~
.' :J
. '.
~.,~~.
tl,;
~~~::
========}?~hr~==~~~=====::=======================================
FEES: f1 fd"1 F~t.M.~1- Sewer and water line connection permit.
.,~~-.: ") surcharge
CAr" ~ TOrrAL
* Fee for either sewer or water individually is $20.00 plus
$ .50 surcharge. --
* . Sewer and water permits. issued for new construction must be
recorded on the building permit card at the time of issuance
to insure that no duplicate sewer and watePAI~'~~s are
issued. ~. [E @ ~ 0 ill [E--:" BU'LO'NG"~'H
:DATE'.~.P.AID I Uj AMOUNT PAID 'ERMIi
'RECEIPT 41 L_ MAR 1. 8 2003 II REC'O BY IV
-.I \./tJ
By., ,,:....
,
.~.,.,.
~., .
f~
~
't.
....
':""t6200 Eagle:Creek Av. S.B., Prior Lake, Minnesota 55372/ Ph. (~s'2) 447-4230/ FAX ('152) 447-4245
An Equal OpportUnity Employer
..- -"'--:-" ..-.
,,/~' ~~~ ~.. .~
. .'"
'I .
CITY 0 f .? KIO R L.';'r-.:E P l l":. fo r:-.'c P E R.\ IIT
D.. ~
-\:: "~''':'l:
, . \ I 'i
~..., .. '
'~,.;r .I
" '.':~:~::2'::':':'-/
?l~,,:~~~ :-/:~~ i~~ 7~;",:C \"'11: :l',,':":IC""r:r::;;r:-::
P t R.\ r:; 1 ~\ (J3=9"Cg,'
----
.: -:: ::, \.. ------
,.;..: .::
JtH't' :~''''
:. ::.,"1 '::;"
("IJ.I_ '"th:"rU
. .:- _I: !;.~:: ...'
Ilt/ ;L6
,- f
1;
,., ) '") 1'./
.6 1:/ ::!.:~':L
"(( /; J fl.1I )
p~
:~::''':.'..,,:.. : :::~ ~::~:=~:t":l~; 'J{::~: ')~': :~;:")
"'J' ... -,.,.
... _ ... 1_.'..
.J..=: c~ C"':-~I :-. ~,;
?:~
.... '-....
r .: .....
,/ -/ ;J-
/' lA- If
L ?~l';:-:~~
'--.--...--...
-'-----
---..---
"",r "."' "'" I) I 7 I
:<~~.~,~.,.,. (/,{)/ /I(}!t JiiJ.iI
"J// -"./") ~ Aft t7
,.:. ,...... ()t..'/() -'..fIlurt.rl/ rl).f/
\,' . ......-. -'...... ,. ~
,;?~.:r.::.' 9s~.. t/tlJ., , ;2/ j /
~ t1 ./ /1 /1..
(! I'! .,.d!I1:,rf: ~ ..5v ',j C'..,
(C:~'I , _.:: ',_.:":'::
( ~ I 1....,-... l
. '_....~ _.... I
.. -
.. ..."::.:',.;: ," ~:'>,,::)
\: .:C: :-:-=)
.
tv( MAt~
, .~?;: ~~ t (:_~,:\''':~:~:'': :~. ;,~, 7~~.:Z':=:
/)
/ 1 .' )f
, ,--~ ~~~ .
)/) fl I '_/ ,I J.f/~. lJ
c .:.. 7~ -L.L/}M./' {f
I"~ lJ:.li: r: ,i
,-'~;/
.-l..P P UC-l..."'T P lE.-\.5E CO':-'IP LETE BELO\-\-"
T:irH~ (if fi..~.ur~ Qtl:Jnric:: I
2;H:1 T'JlJ t....lell 'Jr Wlr:l\Jl.l[ zhl;wt::- :J I
DI$11W,J$il~r I
T :,p~ () ( Fi::: ~a r:
,I
R..)ugn-tn:i
W:zee:- r.~:J.Ce:-
~1;.J.r::" ::i..,r::n~i
i $e.::.nd Plr:,,: (\\,,'~;-;li1:; :'>-I..J.I.:~m-:~ '
; ::i~w~:;-: Ejc::'..;:,~r
r 8.J.ckrlow A~~~:noly
I Backtlow Ass~:nbly T ~St
I Lawn Sprinkle:-
I Oche::"
(
5'
--"'-;'
I
/
.-"
I rll)(;r ur:l.ln
\ C.1.'i:J.ccrf (A;lCh,cl1r.i SIr.!-.:l
I LJ.Llnr.:.-:. Tr:;.'; ( [ IX : ":Qr.~r;:..:.r.:-;-;o:::lt :;lr,;\
I Sl1owe:- Sc:z!(
I Sinks
, Bu Sink
I w':ue:;- Closet (Ted.::)
)
FEE ::iCIiEDl;LE
!rtl!u::;:.-:,~I. C'Jr.:..tC::;"! &. ~(lJlci.f:.mil;, 1% ofjqc, C:).:iC 'NjC:J J. S:i9.50 minimum
R::.::idc:1ciJ.l. i'lc-.v One & Two-r~ily S~~.~O
R:::siclc:tciJ.I. AJaidons .s: Al::::l.c:on.s S~? .::0
E:;,im:l.te:.!. Cv.si: S
~ ~-f~
~~Ci 11?v,
,o~
'l'
6~iit!b~ P::7:lic :;.
(Otr.<:~ l.u Onl~)
PLtJ1\.(BCNG PERi.'-UT FEE S
STATE SURCHARGE S
TOT.u PER.:.'rfIT FEE s
.50
B",lll,nt: Ol'IiCI3(
~ --
I~ft @ ~ n f!1 ~ r.:1 R<<:",P'~.. ____
0,(<: ~~i1APR 1 6 28J3 l,r/BY /i?l
.::... hllur 1\O(ll.:O: (\Jr :l.i1lnsp~CClllnJ; t9:::) J..l.7P:i:iJ, (:1.1: (9:5:) ~7~:..s L:J . ,---
Isy _'
J~~ I OJSI~~ I 8J.Jnld/.3lltWI - -;-...: 80 [00c-9~-ddlj
T;'IS .-\ppli'::::Icion BCC(HI1<::i Your BuiIdin~ Permit Wh~n Approved
t:'O/[O'd
I
-I
~
--
--
5- 6-03; ,: 1 4PM;
;952 894 0925
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONINGIFIREPLACE PERMIT
Date Rec'd
(Please tyDe or print and sil'Jl. at bottom)
ADDRESS ()' r r
5o~ L- D Ltrr
21. Par ink FCi~. PERMIT NO. G"..-} -,?-8'1
..... 111 -
J, Yellow AppHunl
H-ts
If.
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDmON
PID
\~'fVUS
f(1{~W~ I Stu~ IlfO
OWNER ().. \ \ n
(Name) \",\J\A '\C.
(Address) ~ \ S Nw
(Phone) lo5/-<i 5;2-5;200
CC'.aQ (1/) ^1 N -S-;-/ del..
u I
, APPLICANT
(Name)
(phone)
ou,n;:niHe-He::.ting & Ale, InC'.
12481 Rhode Island Ave. So.
(Address) 4.:. ~ '"'::toO, :.IIN S?11~e s1s)" r1~
(City) (Zip Code)
(Contact Person) J\A..-L\L _ L... -:"\ (Phone) 05;2 - 8<J'I- OOOS
APPUCANTSIGNA1UREd~U~~ DATE 5-110-03
APPLICANT PLEASE COMPLETE BELOW
~NEW CONSTRUCTION 0 REPLACEMENT 0 AL TERA nONS _ I
FURNACE MAKE AND MODEL L-r?n/'ff:JX 6fo;{Q;<- 50 . FUEL No.:::r I ~~r::j3
FLUE SIZE RETURN OPENINGS S INPUT fi), 0 00 OUTPUT Lib / 000
TYPE OF SYSTEM HEATING OR POWER PLANT
OWarm Air Plants
o Gravity
o Mechanical
OAir Conditioning
OVent. System
o Steam
o Hot Water
o Radiation
o Special Devices
o Other Devices
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
FIREPLACE MAKE AND MODEL
Industrial, Commercial & Multi-Family
FEE SCHEDULE
1 % of job cost Residential, Gas Fireplace
$39.50 minimum
$99.50 Residential, Additions & Alterations
$64.50 Residential, AC Only
$39.50
$39.50
$39.50
Residential, Heating & AlC (New Construction)
Residential, Heating Only (New Construction)
L11 000 (GO
Estimated Cost $
Building Penn it #
(Office Use Only)
N!r' - (Pd, ~ blU~J
.50 SUlLO WITH
ING PERMIT
fY~.'\~ @[EO ill tE~. eceiptNo.
. i ~at~AY - 8 2003 y /A
Ll W \
. -I (j
24 hour notice for aU inspections (952) 447-9 ~50, fax (952) 447-4245
16200 Eagle Creek Avenue, Prior L:.l.I}j'.l.~r-T CC1.TI, .
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
This Application Becomes Your Building Permit When Approved
Building Offitial
Date
# 2/ 4
.
I
;,~;.I
tlf
ri~
if
I
iil
::;1}-
;i~
":,.~~~
';""'::
I
PRIOR LAKE
INSPECTION RECORD
DEPARTMENT OF
BUILDING AND INSPECTION
SITE ADDRESS Hl~ .
NATURE OF WORK 7II!11L-
USE OF BUILDING
PERMIT NO. tIS- DmL PATf;.ISSUED ~
CONTRACTOR ~ ~ PHONE
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR
DATE
J FOOTING \MJA.V" I
J FOUNDATION (Prior to Backfill) Mo.W' I I
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
SEWER I WATER I SEPTIC
FRAMING
INSULATION
ELECTRICAL
PLUMBING
HEATING (if required)
..FIRIiPLACE-
GA~ , 'WE Aln Tii'L
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I I
FINALS
f\ltt,^
I/JIJ!l
v!/I/P
G,q
I
(; r S-:v'>
JI7/P _
yYr
[. L{
G- tl
GRADING (Prior to Sodding)
BUILDING ~ \J~~ ~"'I-O?
ELECTRICAL
PLUMBING
HEATING
~
'-"d-U7
1-/(11)
SIGNED
DO NOT OCCUpy UNTIL ABOVE HAS BEEN
NOTICE
This card must be posted near an electrical service cabinet prior to rough-in inspections
and maintained until all inspections have been approved. On buildings and additions
where no service cabinet is available, card shall be placed near main entrance.
Call between 8:00 and 9:00 A.M. for all inspections
FOR ALL INSPECTIONS (952) 447-9850
--- .,
"
.~..
aIertifirate nf @rrupanrl!
CITY OF PRIOR LAKE
~tparfmtuf of ~uilbiuB JIuspttfiou
~ Final Permitted D Conditional e.O. Expires
Ilu 1-- . f(, L I
This Certificate issued pursuant to the requirements of Section jfRo of the Uniform Building Code certifying
that at the time of issuance this structure was in compliance with the various ordinances of the City of Prior
Lake regulating building construction or use. For the following:
Use Classification
SINGLE FAMILY
. 03-02-01
Bldg. Permit No.
Occupancy Type
R3 _ Type Construction VN
N/A
Zoning District
Plm
Fire Zone
Legal Description
114. Bl. TIMBER CREST
Owner of Building
Site Address 5024 BLUFF HEIGHTS TRAIL
Contractor's Name & Address PULTE HOMES, 815 NORTHWEST PKWY.. SUITE 140.
- 'l
ROBERT D. HUTCHINS j/l,/'
Building Official
J - Sf) . () (
EAGAN
55121
City Planner
DON RYE
Date:
Date:
I
l.
~.~
" .....,; ,j,..~....... I....,.
'1"', "o..~ ,:,:
>~
~.: ~','
''''' ~ .
. ........J
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
SO;.. LI
SCHEDULED J --.70 {).:..(
flJ uf'F 1+k 7r-
OWNER CONTR.
PHONE NO. PERMIT NO. 3-U;
o FOOTING o PLUMBING RI o EXIGRADIFILLING
o FOUNDATION o MECH RI o COMPLAINT
o FRAMING o WATER HOOKUP o FIREPLACE RI
o INSULATION o SEWER HOOKUP o FIREPLACE FINAL
o FINAL o PLUMBING FINAL o GASLINE AIR TST
o SITE INSPECTION o MECH FINAL 0
~ n- \
COMMENTS: -+- . I f' -(;(' 5
~ .
/ //
~ C.____ L6Sc-
'-----
--
.....
-----
.f" ".~
h(~ ')
./
-----
~~ATISFACTORY. PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT ~O~.~OR REINSPECTION BEFORE COVERING
Inspector: j/ t/j" OWner/Contr:
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH ,{ SAFETYI
Il'iSNOTI
BlJftN~V.LLE
Heating & Air Conditioning, L.L.c.
12481 Rhode Island Ave S, Savage, MN 55378. 952-894-0005
Ors1at Test Report for JaW 5 I S- S-
Address S02t..( I3turr !lOC,J/TS fR. City /flIOK JAKe
Occupant
Date 6f Install 5/27/03
Type of HT. F/A X HW Space HT Unit HT
Other
(
"
Date Tested
Company
Technician
Make
Model
Serial
Input
/ i'tJIUOX
J
Cd~Q;;l. so - f..e,
S803€ 1'-/ 'i 0 b
50 . 00 () ~I'-^ -,.4
Pilot Type HOT SURFACE IGNITOR
Pressure "3:0 \ vJ'- C02
Input CFH SO 02
Stack Temp \ \ 1... CO
sq
\D.Y
Zz. pp......
i- 8-03
BURNSVILLE HEATING & AIR CONDITIONING
~l)
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
s-o).. ~
~(()f.f- 1ft;
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATI~
~NAL
o SITE INSP TION
o PLUMBING RI
o MECH Rl
o WATER HOOKUP
o SEWER HOOKUP
o ~MBING ~
~MECH FINA l!I/
COMMENTS:
~
...../
Ald V1tj i Ie 10
. P~V1qf' 0~~
~
~ "l ~~:S ().c~
l
(j1JU1 ~.{;-s
a Il/J~~q / rfl.u ^
~vc/P?~
sdd
r HVV1,p tfi1,fi /
Or5o f-
~"-rv-e ~
DATE nilE
7-/~
-z -~~ /
o EXIGRADIFILLING
o COMPLAINT
o FIREPLACE Rl
o FIREPLACE FINAL
o GASLINE AIR TST
o
~-I-d?
o WORK SATISFACTORY, PROCEED
~ORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: U 1,r ((-4/'7 Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
INSNOn
CODE REQUIREMENTS A.RE FOR YOUR PERSONAL HEALTH .I SAFETY!
DATE nME
CITY OF PRIOR LAKE )r-f'0
INSPECTION NOTICE SCHEDULED
ADDRESS 50).4 (11 uF /ttS 1v-1
OWNER CONTR.
PHONE NO. PERMIT NO. l-L~ I
o FOOTING o PLUMBING RI o EXIGRADlFllLlNG
o FOUNDATION o MECH RI o COMPLAINT
o FRAMING o WATER HOOKUP o FIREPLACE Rl
o INSULATION o SEWER HOOKUP o FIREPLACE FINAL
o FINAL ..,a'PlUMBING FINAL o GASLlNE AIR TST
o SITE INSPECTION o MECH FINAL 0
COMMENTS:
Uh~~
rlJ f}.( ell to 5
~ I -
o WORK SATISFACTORY, PROCEED
~CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: K 7-r.....O} Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH &: SAFETY!
IMlNOn
3-- )70