HomeMy WebLinkAboutBuilding Permit #03-0282
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
See Main File
(Please type or print and si~ at bottom)
. ADDRESS
I. White File
2. Pink City
3 . Yellow Applicant
Date Rec' d
Z..Z,5-0?
I PERMITNO.03-02~24
6"02& :itJiPF i/~/ bH1S f MI L-
LOT /3 BLOCK /
LEGAL DESCRIPTION (office use only)
ADDITION
~
// m $Ctl
OWNER.J J )
(Name) T IJJ-$ 110 m[.:>
(Address) f/5" rVo/2T11tJ/f.Sr
BUILDER
(Name)
(Contact Name)
(Address)
&r rYlV1
PA~~
,
04mE-
C U 12:1 'Z 'Jv4.5c# kQ
TYPE OF WORK
o Misc.
Permit Fee
I Plan Check Fee
I State Surcharge
I Penalty
I Plumbing Permit Fee
Mechanical Permit Fee
Sewer & Water Permit Fee
I Gas Fireplace Permit Fee
~w Construction
o Lower Level Finish
t/U$r
/J.t:J/JIJ/ t/YL
(Phone)
SUITt
I'ID
,.....
~ A6M1
ZONING (office use)
~(/J:)
PID 25. 4-02.. -0/3- ()
(,51- ijsZ -5Z00
rJ1 f1 55'/ ;:../
(Phone)
(Phone) bIZ - 27/- 'I9~
o Deck
OPorch
ORe-Roofing
o Fireplace
DAddition
OAlteration
PROJECT COST IV ALUE (excluding land) $
/DtJ, tJO
JO(L 00
"SS.5"O
#t'.t10
This Application Becomes Your Building Pennit When Approved
r
~ =1J..JP
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 confonn 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 pennit for just cause. Furthermore, I hereby agree that the city official or a designee may
;"';::~Z/~ 'bt- /37/ ~k~3
? ~ 7 Signature Contractor's License No. / 1::late
'/ Ii
Permit Valuation II 1bl 04tJ, Od
$ , 'Jt}$, 75
$ ~oo,l/r
$ 4~(J 0
$
$
$
$
$
Building Official
:J/;S A.Y
- .
Date
I Park Support Fee
I SAC ......_
I Water Metee Size ~ I";
I Pressure Reducer
I City SAC and WAC
I Water Tower Fee
I Builder's Deposit
I Other
I TOTAL DUE
I Paid
I Date
,?3 / ci /(P '/
'1-1 r <h
9~c:qs
, .
#
#
#
#
ORe-Siding
OUtility Connection
$
$ rZ75'.O(J
$ d?' t:j:J, f) ()
$ 45, lJ()
$ /2..00.00
$ 7a{), 0 ()
$
$
() $5; 3/4-. J,9 I
~~c:~o. 4?CJq I
B(j. I
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
~-l~
Planning Director
~
~a.;l ::Jk
~~3
. Date Special Conditions, if any
24 hour notice for all inspections (952) 447-9850, tax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
See Ylain File
White - Building
Canary - Enqineering
( Pink - Planning:)
Thr ('rnlr' of lhr I..kr Counlry
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
/'1 L-'T( f-{ ( fj/ E-5
r', -:>_ ,~-;;.
c:: - (..,' - C0
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
( ,-7 G' /', r'F f-" [" ,(."/-1-/-
f i I~'" f ',. ,. ,. I ,.' 1 j
,j </ r.- { {j l V f v I .. i I __._'
, 'I
i t:.' '-' .
Accepted
Denied
Accepted With Corrections
/
Reviewed By:
~ -:;t!~
Date: ~ j>~ '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
CWhite - Building)
Canary - Engineering
Pink - Planning
Thr Centrf of Iht' l..kr Counl,."
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
':>UGI6 l-oM65
2- - ~r- -03
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
502,,0 BL-U~F 1--61~HT.5 1~.
Accepted
Accepted With Corrections
V'
Denied
Reviewed By:
~:f~
Date:
S;/3~3
Comments:
See Y~mn ?i~~e
"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
White - Buildin~
~anarv - Enc:lineer~
Pink ~ - Plal'iiiiiig -
Th. ('.nltT n' lh. tak< Country
NAME OF APPLICANT
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
1~1' : i ~I ~ f-' I /"'11Vl e':"j-
I j,..... V ,\.)..r
APPLICATION RECEIVED
':::> -' ?'-' - r. :)', ~
r...:.--,.... ~.~ \.._c '--'"
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
r-'/ "7 I , D ! ,",,- [.'-- l, i-' i /'~ /-1--/-
. '; I j / le-' .." L L! I - ,- J-', t- I C"", "\ I '
,_./ 1..,,... C",.- \. ./ I ...J I r I ! I \,-,' I /j I -__..)
i L=.:~) I
I t-- _ t......... .
Accepted
>(
Accepted With Corrections
Denied
Reviewed By:
ArAA
5" r _ tho, ,~n F,' / e...
Date:
5 - Cr' -etJ
Comments:
'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."
Mar 04 03 09:54a
METRO GENERAL SERVICES
763-428-2968
F'.4
&~
~NEt1
ORU. - FILE
"EllOW . APf'llCA.'
OOlD . CITf
..
Sewer and Water
contractors must
be registered
with the City.
APPLICANT: m.o~~-"J~~_PHONE: 7h~" ct.~-~~38
ADDRESS: ~Cf() r:J.~ ~ NE . DATE: ~
SIGNATURE: ~g ~ BLDG. PERMIT #
SITE ADDRESS: SOd.~ PIO#
CITY OF PRIOR LAKE
SEWER AND WATER PERMIT
FAA 95-2-- '1'17--'/"J, t/-G"
-:/ - ') &>~
S.W. No....:". J cI-
NOTE:
~
;.
,
~
~
ft.
1. Estimated length of water service
S-r\
feet.
.
'.
2. Size of water service
( "
inch(es) .
3.
Location of any couplings from structure ~ feet.
Type of sewer pipe. ASS PVC ~" Cast Iron
.~;
:.
4.
<'
~.
5. Estimated length of sewer line
;::>c}
feet.
~
"!'"'.
6 .
Clean out
structure.
(if
required), located
o/A-
at
feet
from
~'-~
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.-
........
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.
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============================================~==================;==
This application becomes your permit when approved.
~I
BY
DATE:
. ;.~
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========Ib~i~=~~~=============================================
FEES~. a ~ ,~~M;)L Sewer and water line connection permit.
~~-; ~ Surcharge
N~ ~ TOTAL
Fee for either sewer or water individually is $20.00 plus
$ .50 surcharge. --
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" . Sewer and water,.1lern. ~s issued for new construction must be
~ r,ecor.ded on the ~~ ~~~;+ card at the time of issuance
~ . ~o insure that .0 d ~~a~~ er and water PAJI5lWl't,., are
r~ ,:';, .... Issued. ~ f BUILDING P
~f .:":."oATE.'I'AID u MAR 1 8 2003 AMOUNT PAID ERMIT
1.... 'J~~~ RECE;i>r # ~~ REC'D BY cr
1= : "~:tF'(, '''',. '.
ri :., ."; . 16200 Eagle:Creek Av. S.E., Prior Laket Minnesota 55372/ Ph. (~S2) 447-4230 / FAX ('~52) 4474245
~i. ..; _~Y.. An Equal Opportunity Employer
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CITY Of PR10P- LAhI Pl r~r.3r\'G PER\rIT
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;-\PPUC...l.........T PLEASE CI):\[PlETE BELO',:\'
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S<:..\i.l:;~ EJ-::.::or
8o.ckrlow A.:;sc::nblv
8acktlow A.:isembl~ T.e:.;r
! lawn Sorinkle:-
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T~r~ of Fi..;:~ur:.'
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b':IJS~:~:I. C:l~'~C~::::1! J-. .\It;Jtl.r~r:'1II:J l'~':. ofjoo co~t '."ien ~ SJ9.ii) minimum
R..:sidemi31. New One .l Two-F:l.mil:, S~9;O
R.::;ic;:::tc::1J. ,J..,Jdic:ons & ...I,,::;::~c:un.;; S.i9~O
E;;;::i.1:.!t~:": c.;~;: :s
8L.:iil.!i;1; P~~ic; _
PLf..ii:vtBC!'iG PER..\UT fEE
STATE SURCHARGE
TOTAL PER\!IT FEE
:s
s
s
.50
elq~AII0 ~
V"'G ;,.~, Ii
,o~~
~~
--t
I
(OfCice LH~ Only)
Tilj:; Applic~Clon Bccr,me;:; YOIJr BIJildill~ Pl:rmit When Approved
B ..ilJ i,.~ O(uei,&l
I R,:ce:pc t"Q.
. '~ @lSnnn(j:lr=lBYcp-'
o~~ ~1!
;. '''"' '"'''' I"~ ,,' '"P''''''' I"" "".tt. (1.'P'l1'16'z~E; it -
J~H OJ~~H E ~~i.J',~ ,-.HA--. ,,-,~--~r : 80 m0C:-91-ddtl
Paid
"'----
--
t>O/t>O"d
4-30-03;10:07AM;
;952 894 0925
# 3/ 4
.
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
(Please tvDe ortlrint and si~ at bottom)
ADDRESS {, L
5o~" 6f ltf /ki9vvS
J
I. Pink Fi!. I PERMIT NO 3 ;?J::J...'
2. Gn:en Cny . _ .....-
]. Yellow Applicant
I
.--
I r.
ZONING (ollice use)
g,:
of"';
'\.~::;
LOT
BLOCK
ADDITION
PID
:~:':/.,
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;:..
I
LEGAL DESCRIPTION (office use only)
OWNER
(Name)
P\,L\\e.
%\S-
l~{\'\..t~
N ~ Pa (!CWtLA.11 5LLA'-Ie.
"- j I
. (Phone)
/ Lf(J .
I
~5r- 4-5;;2-5;200
ta~qal? MN 5)t)}
./ I
_ (Address)
APPliCANT
(Name)
(Phone)
~",,",:,;;;lIc I ;c;atiIlY &. Ale, inc.
12481 Rhode Island Ave. So.
~eVqElt;1 lVI"(AaHtlfP-11;':4: (City) (Zip Code)
(Contact Person) '-- \ ~L \.. L . 1 _ -- (phone) 9 )? ~ c;;rv - Oc:1J5
. APPUCANT SIGNATURE -6-v&.u li ~/)YOyl DATE "1./ :5~ /03
. APPLICANT PLEASE COMPLETE BELOW
~NEW CONSTRUCTION 0 REPLACEMENT 0 ALTERATIONS, 1_-1-
FURNACE MAKE AND MODEL Let? /l,ol( G:< (oQ;:l - 50 FUEL A..)(}-'I , qf1..3
FLUE SIZE RETIJRN OPENINGS '5 INPUT 50,rf){) OUTPUT t.j0~OOO
(Address)
I
OWarm Air Plants 0 Steam
DGravity 0 Hot Water
o Mechanical La.y) M;( 0 Radiation
~Ajr Conditioning I D f\. . D '). I _ 0 Special Devices
OVent. System 'lL-IJo'- "1 ;JlOiflj 0 Other Devices
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
I
TYPE OF SYSTEM
HEATING OR POWER PLANT
FIREPLACE MAKE AND MODEL
FEE SCHEDULE
1 % of job cost Residential, Gas Fireplace
$39.50 minimum
Residential, Heating & AlC (New Construction) $99.50
Residential, Heating Only (New Construction) $64.50
S' r:P
Estimated Cost $ I noDe
I
Residential, Additions & Alterations
Residential, AC Only
$39.50
$39.50
$39.50
[ndustrial, Commercial & Multi-Family
Building Penn it #
HEA TING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
~ J(\
I
( PO-I d b~ ~v\.;\ ~'TH
.50 ..J BUILDING PF=Qft".-
(Office Use Only)
This Application Becomes Your Building Permit When Approved
'--. --1.
,'_. \
:1 I
"It~ftipt No.
1 lGO: ~/.
Cr
Building Official
Date
Pi j) ~ D.'] ;
1 UA"
D: ~~ J IVI,... l
24 hour notice for all inspections (952) 447-9850, e, !952) 447-4245
16200 Eagle Creek Avenue, Prior Lake, \111'1 :>::lJ I./.
______" J
5 - 6 - 0 3; 1: 1 4 PM ;
;952 894 0925
#. 1/ 4
.
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONINGlFlREPLACE PERMIT
APPLICANT
(Name) Bumsvillc Heating & A'C, In'"
(Add) 12481 Rhode Island Ave. So.
ress - r l.Oo...L..~E"'""!2.1" "'"
iiJClYa~W, ..IT'''lI- - (Address)'--
(Contact Person) J \A..l..\ L _ \~.:"\
APPLICANT SIGNATURE ~~ lJ (\LlJ..U b-YrN\
'-J \J
. APPLICANT PLEASE COMPLETE BELOW
~NEW CONSTRUCTION 0 REPLACEMENT 0 AL TERA nONS _,
FURNACE MAKE AND MODEL Len /'ff::5X (3 to;( Q;;<- <50 . FUEL _ tJ {).::(. 5Q..s
FLUE SIZE RETIJRN OPENINGS ~ INPUT 'f?J. 000 OUTPUT Lfb I OCXJ
TYPE OF SYSTEM HEATING OR POWER PLANf
OWarm Air Plants 0 Steam
OGravity 0 Hot Water
o Mechanical 0 Radiation
o Air Conditioning 0 Special Devices
OVent. System 0 Other Devices
FEE SCHEDULE
1% of job cost Residential, Gas Fireplace
$39.50 minimum
$99.50
$64.50
Lj ,000 , 00
(Please tvDe or Drint and sil!l1 at bOl1Dm)
ADDREJ5. n' {'t'
~O~{oD (). I
H1-S
..-r-
1(,
LEGAL DESCR.u-- lION (office use only)
LOT
BLOCK
ADDITION
~=~R Pv.1 \L \-\uYVUS
(Address) <6 \ S Nw p(1{ ~w~ I Stu ~ l tfD
FIREPLACE MAKE AND MODEL
Industrial, Commercial & Multi-Family
Date Rec'd
I. Pink file PERMIT NO
2 Green City . .;;:.( ___ J 0 ., 1
3. V.llow Applinnt ,_/ rl--(J <::>"00,.
,,:1
,
ZONING (office use)
.'i.i
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PID
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t
I
(Phone) {oS f- ~ 5;2 - 5;;1 00
CC'(JA {l/} fVj N -S-:r-/ ,;2~
u I
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I
(Phone)
''4j
c:~
(City) (Zip Code)
(phone) 05:2 - 8~4 - OOOS
DATE 5-0-03
~I
..;
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PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
Residential, Heating & NC (New Construction)
Residential, Heating Only (New Construction)
Residential, Additions & Alterations
Residential, AC Only
$39.50
$39.50
$39.50
Estimated Cost $
Building Permit #
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
(Office Use Only)
N}t\ - (pd, ~ b0fcbiid
.50 BUILDI WITH
NG PERMIT
,.'"
This Application Becomes Your Building Permit When Approved ),I~'~ (r2 r~ ._ I &"ceiptNo.
- ~11S; (~ I~ 0 IT) [r--:l1
Building Official Date - ~4e II W . ~ / ~
24 hour notice for all inspections (952) 447.98 ,~2~0r - r'
16200 Eagle Creek Avenue, Prior La MN 55372
-
-_._~..,.,--"--_.._~-"~_.__.-.^'-~_.~.~---_.~,--
PRIOR LAKE
INSPECTION RECORD
DEPARTMENT OF
BUILDING AND INSPECTION
SITE ADDRESS
NATURE OF WORK
USE OF BUILDING
PERMIT NO. ~
CONTRACTOR PHONE
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
H.I.!~ . .
7MJL..
INSPECTOR
DATE
I FOOTING I/w>'^
I FOUNDATION (Prior to Backfill) rJ^oMA I I
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
SEWER I WATER I SEPTIC i,N..1JM,.
FRAMING
INSULATION
ELECTRICAL
PLUMBING
HEATING (if required)
fiRIiPl/"CE
GAS LINe AIR TEST--
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
. I I I
FINALS
Y1f\O 5'-30
tI1IV' G- ~
yw_ ~--.... 3D
vJ/r S-- g l)
GRADING (Prior to Sodding)
BUILDING tf;(v1010 Vl<\ h\ 4-.+111
ELECTRICAL
PLUMBING
HEATING
DO NOT
V II1P -'-lJ~
/Il-vI 7 - / ~ tlJ
OCCUpy UNTIL ABOVE HAS BEEN SIGNED
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
~.. .. . ",,-
<tIerfifitaft of <IDttupautlJ
CITY OF PRIOR LAKE
~rparfmruf of ~uil~iug Jlusprrfiou
lE Final Permitted D Conditional e.O. Expires .' .
110 J ,It... L
This Certificate issued pursuant to the requirements of Section ~ 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
Bldg. Permit No.
Legal Description
R3 Type Construction. VN
L13, Bl, TIMBER CREST
Fire Zone
N/A
Zoning District
PUD
Occupancy Type .
5026 BLUFF HEIGHTS TRAIL
Owner of Building
Site Address
Contractor's Name & AddressP'UI,TE HOMES, 815 NORTHWEST PKWY., SUITE 140, EAGAN
-1./'l
j/l/f
5.5121
ROBERT D. HUTCHINS
Buildi~ Official
1- 50. (j {j
City Planner
DON RYE
Date:
Date:
,-
.,-:,:',"/" "".,,'Wi.,,('..
~
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BVftN~ ~ILLE
Heating & Air Conditioning, L.L.C.
12481 Rhode Island Ave S, Savage, MN 55378 . 952-894-0005
Ors1at Test Report for JoW 5 15 ~
Address 5D2tp &1..1/1 Ikif-1ifi ~
Occupant
Date of Install ::" '2 ~ - 03
Type of HT. F/A x' HW
Other
Make
Model
Serial
Input
Pilot Type
Pressure
Input CFH
Stack Temp
Date Tested
Company
Technician
,r<., Cityrthul~ LA;: i
/'
Space HT Unit HT
1. c:.t-ltVD \
6')(;'Q;) SD ~
5803E 1'-178 'g
50, ODD 6\\A ~
,
.
.
HOT SURFACE IG(VH-OR
'35 \v0V C02
50 02
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BURNSVILLE HEATING & AIR CONDITIONING
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CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
SQ?.C
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
COMMENTS:
01\ TE TIME
SCHEDULED J-']6,O '/
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CONTR.
PERMIT NO.
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
5-2~-2
o EXIGRADIFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
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B"'WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CA~REINSPECTION BEFORE COVERING
Inspector: 1/1 It' .~ Owner/Contr:
. .
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTl
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
~c (j(,E-r Nt's
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
.tr"FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
jrMECH FINAL @
COMMENTS:
(j) ?,; tf,. (
'-'
<1'"'''''~-r-:.
DATE TIME
7r-/~
J ,.2r1
o EXIGRADIFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
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o WORK SATISFACTORY, PROCEED
Ja,;-eORRECT ACTION AND PROCEED
o CORRECT WORK. CALL FOR REINSPECTION BEFORE COVERING
Inspector: ~ -z::JS--IJJ Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
II'iSNOTI
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
DATE nME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
7-~'cry.
ADDRESS
SCl-4
ffJuPPIJ6
OWNER
CONTR.
PHONE NO.
PERMIT NO.
~-~/l....
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
ji!P PLUMBING FINAL
o MECH FINAL
o EXIGRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
COMMENTS:
(]) ,-f 1/1A0V(
/'{)~P5
,
o WORK SATISFACTORY, PROCEED
/CORRECT ACTION AND PROCEED
o CORRE~CWORK. C II FOR REINSPECTION BEFORE COVERING
7..- 0. 01-
Inspector: ," Owner/Contr:
J
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INVion