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HomeMy WebLinkAboutBuilding Permit #00-0183 CITY OF PRIOR LAKE 5l3b /VI/!/ AI 1. White BUILDING PERMI'r ~~~ L::' #. ^_/~ 2. Pink , , I ~ -J..I .' 3. Yellow TEMPORARY CERTIFICATE OF ZONING COMPLIANCE AND UTILITY CONNECTION PERMIT ~ DATE RECEIVED .22 2000 . DIRECTIONS SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom) 2. SITE ADDRESS 33.53 G/v/VItJ.Ja 11'1 3. LEGAL DESCRIPTION ' LOT I 'Y" BLOCK ADDITION b lyN watf7r (Name) 7 r It /' J 3 ~ Nc/ NtJ Permit No. 1. DATE J - :2.2,. ~ Di) I.) File City Applicant IJU -01 f3-- BUILDING INFORMATION 11. SIZE OF STRUCTURE (Height) (Width) (Depth) 12. NO. OF STORIES PID "',- 3&15' - O:JtJ ~ {) Od/; 7/ oN 4. OWNER (Address) 5. ARCHITECT (Name) (Address) 6. BUILDER (Name) IN I'NJ/Tltf/V/V fJomfs 7. TYPE OF WORK New Construction ~ Chimney 0 Misc. 8. PROPERTY AREA OR ACRES Sq.Ft. Fireplace 0 Alterations 0 (Addrj3~) /6 y.> ~11f:2.~ f ti 91i jV /11 N ~tiC 0 Deck 0 Addition 0 Finish Attic 0 9. PROPERTY DIMENSIONS Width Depth 13. TYPE OF CONSTRUCTION (Tel. No.) . 14. FLOOR AREA APPORTIONMENT USE (Tel. No.) Or, (Tel. No.) '5/- .y/) ,. y',/()" 15. NUMBER OF OCCUPANTS OR SEATS OCCUPANTS Re-roofing 0 Porch 0 Re-siding 0 Finish Basement 0 SEATS 16. PROJECT COSTNALUE 10. CULVERT SIZE Yes No 17. COMPLETION DATE 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 mention ed prope~d that all onstruction will conform to all existing state and local laws and will proceed in accordance with submitted Plans.. I am aware that the building offj;pl can revoke this ermit fo st cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections. X AJ ~ t. /ys<f 3-.;.7.)-,;J.ot) iJ / II Signature ' License No. Date V FOR ADMINISTRATIVE USE SETBACKS: Required Actual MATERIAL FILED WITH APPLICATION Back Side Side SOIL TESTS 0 ENERGY DATA 0 OFF STREET PARKING PILING LOGS 0 PERCOLATION TESTS 0 SPACES REO. PLANS & SPECS 0 SETS SPACES ON PLAN SURVEY 0 COPIES PERMIT VALUATION I Oo,~ a:?O. (!) 0 PLOT PLAN 0 Front BUILDING DEPARTMENT VALUATION USE OF BUILDING $fl4 TYPE OF CONSTRUCTION: I II III IV V Occupancy Group A B E F HIM R S U Division 1 2 3 4 Permit Fee ................................... $ APfl. as- 1??(g!11 5D.()Q Plan Check Fee............................. $ State Surcharge ............................. $ Penalty ....................................... $ Plumbing Permit Fee ....................... $ lO-O . on l 00 .6>(L 3S.SD Mechanical Permit Fee ..................... $ Sewer & Water Permit ...................... $ ~::~F;ace !d;~]...~i~~.;e:tt When AeP.roved By ~u Date "3 -2~-20C)o - / Certificate of Occupancy City: 'Jw) '3.31\00 Amount Brought Forward .................. $ Park Support Fee ........................... $ SAC ......................................... $ Collective Street Fee ....................... $ Sewer Tap ................................... $ 'i~ \I . $ Pressure Reducer ...... eL............... $ Meter Horn................................... $ Water Meter ................................. $ Sewer & Water Connection Fee ........... $ Water Tower Fee ........................... $ BSC.OO W OChoa LIS. "D I t;tS. 00 ~CJO .00 !-DO , ~O Water Tap ................................... $ Builder's Deposit ............................ $ ~ I~ -.-s> Other......................................... $ Total Due .............................. $ 5k'7fp9. ~ Paid Receipt No. =>/13 J :::" ce<tify thattha request in the above application and accompanying documents;s in aCCOldance will> the c:;on~y P'.OC.:d a~C(;._AJuested. This document when sign by the C' lanner constitutes a temporary Ce~cate of zoni~mPlian~nd allows c~tion to com'9.ence. Before occupancy, a ~~icate f 0 cupancy must be issued. _ .~r2Pt- 2)~. ~ (~beLKlta- ~ M.dir~~. City Planner Date Special Condiiio~s l' any 24 hour notice for all inspections 447-9850 r;v - I tJ The Center of the Lake Country White - Building Canary - Engineering Pink - Planning BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT APPLICATION RECEIVED W6Nb fV!/i1J1l! 3/22-/00 The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: 3333 GL'v/ tJ '1/ ~~ / (-::;,!<- TIC- I Accepted Accepted With Corrections~ ::::::ed By: QJ a!~)C Comments: Date: 3-2.9'-~ Se~ ~\~.tP. S5:2~ GI1rV\w~ 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.1I .~ (J1J -( ~3 Thr Crntrr of thr Lakr Country White - Building Canary - Engineering Pink - Planning BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT APPLICATION RECEIVED I I f i /...-., Y' ,....-- /. ' : I { I' ..' J.I .~ j' II i..... \.. ". / "'-('\ L. I ( ~-j I ~? / .......--/ I The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: ~.) . .~.~ ~'\"L' . i/'/I / I t,,/ /-'1 I I-'.-'/~ -7-7::- ~,,----..J---LJ' C:, \.. \j f 1 ............. '" I - Accepted v Accepted With Corrections Denied ~ '/A__.. . Reviewed By: A ~ Date: 3 ~ 2- ~ ~ t.9O Comments: .~~ ~~~ ~6 ~_ ~"\~$ ~ ~lAL C-. L). (). I &~ .Afqv-~ ~)bt) ~ (/ ~'It~ l~ w....,h~... fV'~~ ~vbd{~ ~~ ~e- L->>cU/l'V\ L~ ~~-aAAtl LL\M4~ ~~~ ~Vvv~ 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." "" .. Job Address 333 3 ;f~~~f'i/ Heating contract<6',r.-e /<r-'" Name of Tester fl. , . Date 9 - / /, t::?o Percent 02 7 Percent co p Stack Temp. 35"z> Percent CO2 {5 ',,- tSV ~o{f3 The' ("nle'r of lhe' Lake' Count" White - Building Canary - Engineerhlg Pink - Planning NAME OF APPLICANT BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST i"~/E /\/~ /l"J Ii /t/ IV 3/22-!()O I . I APPLICATION RECEIVED The Building,. Engineering, and Planning Departments have reviewed the building permit application for construction activity wh~ch is proposed at: . 3333 GL~j/\JyVA I ~R- Tl::-. f Accepted Denied Revi~wed By: ~. EwtlfSMI4.A1Al / Accepted With Corrections Date: 3/t. '/OD Comments: -.StE. rt-\E B\J''-~\~(,,' ~b4I'T Fott.. 3JZS aLYNWATEtt 7R~Ic_ FeR. , .. CoW"'\l"'\ ~AJT"SI IA.JFo r1..~ ,'c'JN fATTt:t CJ-IMGJI.5 . "The issuance or granting. of a permit or' approval of plans, specifications. arid 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. 30. 2000 4:59PM GENZ RYAN 6513226147 NO. 357 P.6/7 _..... . ~...-.~ ~ .. err., CITY OF PRIOR IAXE SEWER AND WA.J:.A PERla'l' NO.on -tiE 3 NOTE: Sewer and Water contractors must be reqistered with the City. APPLICANT: (;z.}/J:Z- (U~n ADDRESS: ll.!..., l,~ , ~ & 0Uf_'1 .T t2..L-. DATE: SIGNA"L'u..x:Jk., b L\l.C=S::: ,BLDG. SI:TE ADDRESS: .~~ G'~I.COT~~"'fY-.L..PI:D# FrLL IN 4n~ BLANRS 40, 1. Estimated lenqth of va~er service ,H 2. Size of water service inch(es). PHONE: (,I~I- lf~~(\~LJ 3' ?-'o ! tJ L.) PERMIT i ~O-OJ~3 QS:-3~- O~-O feet. MM 3 , 2IIJ) 3. Location of any couplings from s~ructure feet. .~ . . ~l.- 4. s. Type of sewer pipe. ABS PVc X Estimated length of sewer lin~ ~l Clean cut (if required), located structure. Cast Iron 6. feet.. at feet from -"_,'\..\.I_"'~l'rf_~__-I-'''1 .. ,-ol..I,...'~_____'''..I~L-~~ Thi.~ ~jli:a~ion ~ecQme$ Y~it ~&en approved. . B~_ ~~ 1~'rL.~ ~ J D~TB: CJl.f/I'J6joo --tJ--~.."._._--_.,."., ,"'~-- FEES: S 35.00 Sewer and water line connection $ .50 Surcharge $ 35.50 TOTAL * Fee fer either sewer or water individually is $20.00 plus $ .50 surcharqe. perm!t. .0. ,. * Sewer and water permits issued for new construction must ~e recorded on the buildinq permit card at the time of issuance to insure that no duplicate sewer and water permits are issued. - r PAID \rViT;-1 . , BUILDING F~. ""if DATE PAID AMOUNT PAID' ~ I ~ ",~,--- .....,-,r RECEIPT f REC'D BY . 4629 Dakcta St. 5.E., Prior Lake, Minnesota 55372 I Ph. (612) 4474230 I Fax (612) 4474245 AN EQUAL OPPORroNrTV EMPtoVER - . DA TE TIME CITY OF PRIOR LAKE INSPECTION NOTICE SCHEDULED ~ L/:M 1'3 S-- Gl'f(\~ ADDRESS 3 3~q J" 31) " 3 '6 OWNER CONTR. PHONE NO. PERMIT NO. UO - I ~ J I ) B ~) '8 S ,_lRq o FOOTING o FOUNOA TION o FRAMING o INSULATION o FINAL o SITE INSPECTION o PLUMBING RI A 0 MECH RI }zJ::.yvA TER HOOKUP " p< SEWER HOOKUP o PLUMBING FINAL o MECH FINAL o EX/GRAD/FILLING o COMPLAINT o FIREPLACE RI o FIREPLACE FINAL o GASLlNE AIR TST o '. CO~ ~T~. (t<~~ ~J&:jSf Uhv~ 0 -H (/ '7r' ~ (V ~K -r ,'-,; (~- (;) ~ ~~ 40 PV'~ ~ ~. lv'-c4- - ~~ ~ ~6t/- o vrORK SATI~C ORY, PROCEED ~RRECTf"'TI NO P OCEEO o CORRECT W K, C lL R REINSPECTION BEFORE COVERING Inspector: Owner/Contr: CALL ~7-985;;~ THE NEXT INSPECTION 24 HOURS IN ADVANCE. CODE R~QUlREMjNTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI V INSNOTl - CITY OF PRIOR LAKE .' (i..) . 16200 Eagle CreekAv. I.E. ParmtlNG. fP'JO -()fff 5 Prfor Lake. MN 55372 TYPE OF STRUCTURE I. PI" ,- -. All: 1. Ore . i 0tJ 3. Ycl~ " DafIIrIdIII IJ) ....-t "- ('IJ ....-t Single Fsmlly Commercial x Multi-Family Olher Two.Famly IndualrJal Publlo PID'~) - t"~~-oro-o b\VtV\~~ \ll-fl' L '-l Est: Comp. Oa1e , Bundlng Permll" dO....o r g 3 0.. ~ """ If) o z Telephone t , Furnace Make & Model \ .J} In.~'''' ModelSlz8 C:::>>2~L\ ~-~ . Conn. Load ~ Fuel ~Pf1,Ga~l=lue Size 4 It/!}vurr IJ) ~ Supply Openings I' (T) ....-t ~ Return Openings ~ Input <<1(",MJO Output laO.reo >- 0:: - NEd,. . z ~ Cfm. Lj TYPE OF WORK E fE Alterations If) CD Repal. Repiacemenl, ~ Esl. Coal $ ~ ~ HEATING PERMrr FEE' If) . STAlE SURCHARGE . 0:: . 8: TOTALPEAMITFEES to .50 Fee Schedule r ,..!> 'D \ ' . . ~~ l. .. /llITl-l 1% of Job cost (~) "=':~:vur $99.50 . '64.60 '39.60 139.50 $39.60 "-.P I ~ Indusl,lel, Commercial & MullJ.Faml'v Reskrenllal. Heating & AC Reakfenllal. Healng Ontv r;,~N ~'r'Z.:'L R.rdenlf.l. Gas Arepl8ce R&8'dentr~l. Adrtlllons & APterallons ResldenUa', AC Only Rr\C4 rnou.n\ - ~lt Remember to add the State Surchalg8 on the bo1tom oIlhfa .ppllc.~Jon. f\P~ - 5 2llJl Other Davlces The.price 01 your healing pelmJ11ncludl8 one rough.!n and one IInallnspeclloll. Adcltlonal !nspecllons wAI be blrred al .36.00 eaoh. House Heatrng Test Record must be l.mmJUBd wllh bulklno ~rm' numb&r be'ore bufJd. (ng cerlllicale 01 occupancy wi. be Issued. I-U=A'" n.ol r:. u _Tln~t~ ~Fnt UJU=O wllh number of lupplV end ,eturn openings Riled plf room with CFM. per opening. New struclures or adelllons Hnd 'foGr plaia wllh eupplv and rtturn locetton. shown. HEAT LOSS CALCULATIONS, PAYMENT AND APPLICATIONS MAY BE MAILED TO THE CITY OF PRIOR LAKE, 16200 EAGLE CREEK AVE. S.E. PRIOR LAKE, UN 65372. CIIy Hall buslO8s. hOUII ar. 8 a.m. .4:30 p.m. ALL WORK MUST BE INSPECTED (ROUGH..JN AND FINAL) · CALL CITY HALL ~47-4230 I herebv appfv lor a mechanical systems pelmll and I acknowledge Ihat the Informallon above I, compters and accurate; that the work will be In conformance with the ardln.nces and codes of Ihe cUV end with the 81.'. butfdlnglmechtlnlcel codel: 'hat Ihl. 'olm does nol become 8 permll until elgned by the BUILDING OFFICIAL; Ihat the work wIll be In accordance wUh the approved p'.n fn Ine case 01.11 work which requrres review and approval of plans. ~Ol__ · LJ/S ~ ..~,an~a sture I (/. .. ~ . i ')ete 11' ~1~ o//h/~ 1 BuU5ng Office · 9 alure I I ~ New Construcllon ([ ..; Recefpl' --- APR. 5.2000 8:55AM GENZ RYAN 6513226147 NO. 540 P.6/16 'I'1w Cn.. a' ... La... C, ~ CITY OF PRIOR LAKE . PLUMBING PERMIT AppliC:ant: ~ "?-- ~ Address= t4"~ ~ -r~l- Signature: lsgal Description: Lot f q Block_ fJ., Sub~ af'4 ~ SiteAddllHls: ~~'? ~T\.~t!}. 1f..~11 ~ BuildingPermit# t)(!) -- 3 PIC. ~,- ~~-c Nv I c: This pennit ~ill not be processed without complete infonnation. FIXTURE UNII.:) . I. ... .. l.&Id CIy 3. Yea.. ~ # aO -0(l(8 Phone:~l - Lt L. ~-\ l\.ll.( (/ r-v '.v..r... -LJ. .., . , Quantity T~e of FIXture l II. Bath Tub with or without shower \ Dishwasher l Floor Drain 2 Lavatory (bathraam sink) \ Ulundry Tray (1 or 2 compartment sink) t Shower Stall , Sinks Bar Sink ""- j '. 2- Water Closet (toilet) QtJantity Type of FIXture ,3 , Rough-ins Water Heater Water Softner \ Stand Pipe (washing machine) Sewage Ejector BacIcfIoW Assembly (RPl, Cauble Check, PVB) Backffow Assembly Test Lawn Sprinkler Other FEE SCHEDULE . Industrial, CommerdaJ & Multi-Family (1 % of job cost, $39.50 minimum) Residential, New One & Two Family Residential, Additions & Alterations State Surcharge GRAND TOTAL $ $ s S .50 --- '. $ 599.50 S39.50 ~ P,.'. -'0 OUILt':~~ ,~vV.lj~I1" ......., " "r:.;.. - . ~. '. dr : . 'j \ .' - This 1-.._it is gnmed upon the =r.....s col!dflion that said contraCtor, shall comply in all "~t'~ wilh the ordinances of the. Stacc: Phambinl Code me! ElM: am dm ES thc:.,..!~ R.E NO. DA TB .. APR - 5 2000 1 u:.ST 16200 Eagle CreekAv. S.E., Prior Lake, Minncsor.a 55372/ Ph. (612) 447-4230/ FAX (612) 44742~S - An Equal OpportWlity ETtlployer PRIOR LAKE INSPECTION RECORD DEPARTM~NT OF BUILDING AND INSPECTION SITE ADDRESS 3~~ C{--r--Lu~ T'r-C5,i\ NATURE OF WORK ~"\ C:~~{"'-tJcJ.'<...J\. USE OF BUILDING ~+= ~ PERMIT NO. no :..- () 183 DATE ISSUED :s .. 2cr -'"2 CJ~ CONTRACTOR lA.)~ ~ ~ ~ NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW THE PERMIT IS BY SEPARATE DOCUMENT _ It:#ECTOR DAT~ FOOTING~"(O'X(2t~, ~/rll()() & /) Llill/go FOUNDATION {Prior to Backfill)ftlp6"'" . ~r {-I ,., ~tJO (j; l' ,fpP7 PLACE NO CONCRETE UNTIL ABOVE HA~E~N SIGNED ROUGH-~S , SEWER I WATER I SEPTIC - ( ~ ~/ 6/(T[ / FRAMING (fJzit. .1~7l) # INSULATION /' 17i, P/of /10 ELECTRICAL / / PLUMBING HEATING (if required) FIREPLACE GAS LINE AIR TEST ~ ~f 11 lIe-; Ill/) , . COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED WALLBOARD GRADING (Prior to Sodd~ng) BUILDING~~ \\/\161> ~ lI2ll~//Yb ELECTRICAL PLUMBING HEATING DO NOT FINALS I / If 5 ~1. } 1 ~, Ilk, ,/ OCCUPY UNTIL ABOVE HAS NOTICE . . /~ /12/~ ;) II ~/t76 I I BEEN SIGNED 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 (612) 447-9850 This Certificate issued pursuant to the requirements of Section 307 of the Uniform Building Code cenifying 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 Famil V _ Bldg, Permit No. 00-0183 Occupancy Type R3 Type Construction VN Fire Zone N/A Zoning District .R2 SD Legal Description 114, B3, Glynwater 2nd Addn. ..I Owner of Building Site Address 3333 Glvnwater Trail NI,o/ Contractor'sName&Address Wensmann, 1895 Plaza Dr., Eagan, MN Jenni Tovar ! Robert D. Hutchins Building Official Date: ~ \'/1 '.III V7-0~ Date: ~ POST IN A CONSPICUOUS PLACE City Planner r . r T1 .L..-:....;.. - ...- ~ DATE TIME CITY OF PRIOR LAKE INSPECTION NOTICE SCHEDULED ;;2-;;J:7-oa ADDRESS z>.3~) ~ M W~ \ r OWNER CONTR. PHONE NO. PERMIT NO. 00- Dl~3 o FOOTING o FOUNDATION o FRAMING o )NSULA TION H FINAL o SITE INSPECTION o PLUMBING RI o MECH RI o WATER HOOKUP o SEWER HOOKUP o PLUMBING FINAL o MECH FINAL o EXIGRAD/FILLlNG o COMPLAINT o FIREPLACE RI o FIREPLACE FINAL o GASLlNE AIR TST o COMMENTS: "~S"€ C~O ~.C>~ e.. ~~'-{e ~RK SATISFACTORY, PROCEED o CORRECT ACTION AND PROCEED o CORRECT WORK. CALL FOR REINSPECTION BEFORE COVERING Inspector: ~_ \IJ.ANJ Owner/Contr: CALL 447-9850 FOR Tt E NEXT INSPECTION 24 HOURS IN ADVANCE. CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH &: SAFETY! INSNOTl DATE TIME CITY OF PRIOR LAKE INSPECTION NOTICE ADDRESS \? 3"3 3 S"CHEDULED ;O-B..{)O (:, / lj)/J tv t2 ~y- I CONTR. ;2~60 OWNER PHONE NO. PERMIT NO. I)-/~~~ o FOOTING 0 PLUMBING RI 0 EX/GRAD/FILLING o FOUNDATION 0 MECH RI 0 COMPLAINT o FRAMING 0 WATER HOOKUP 0 FIREPLACE RI o INSULA TIO~ 0 SEWER HOOKUP ~ 0 FIREPLACE FINAL ~ FINAL ! ~ PLUMBING FINAL 'e9ltJ/c..O GASLlNE AIR TST o SITE INSPE TION j:t MECH FINAL ~ 0 p~ I t.:r:5I COMMENTS: ((:) ~ ~ ~, ~J~ ~(g) ~ kJf~' ~ ~~~1 ~.-~ ~m~~ ~ _~ rn- ~ ~ ~~I. @~~ ~ t"" ~ l<) ~.~....:.-;;;;...-:;:._.;....:.;.. -~._.~-- T;'C.O;-- ~ ""'~..'" -o.::"'lIfi!r .... . /, /tJ-o ( , ----.... uJ~ ~~ ~ o WORKSATISFA~ ,PROCEED (~~ )ir7CORRECT AC' ND PROCEED o CORRECT WO , CALL FOR REINSPECTION BEFORE COVERING ~( .-. / CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE. Inspector: Owner/Contr: CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI INSNOTI DATE TIME CITY OF PRIOR LAKE INSPECTION NOTICE SCHEDULED 54-0/ ADDRESS 333 3 &~V'1 WC1 {(, T/". OWNER CONTR. W~~MqlJY) PHONE NO. PERMIT NO. 00-1 ~ o FOOTING o FOUNDATION o FRAMING o INSULATION .::m... FINAL o SITE INSPECTION o PLUMBING RI o MECH RI o WATER HOOKUP o SEWER HOOKUP o PLUMBING FINAL o MECH FINAL ~ EX/GRAD/FILLING o COMPLAINT o FIREPLACE RI o FIREPLACE FINAL o GASLlNE AIR TST o COMMENTS: LV r b [5(') ~ - c:; K {;rctc!t'n:/ - 6> K. T;"u~~. No 5(1)1 / ~ORK SATISFACTORY, PROCEED o CORRECT ACTION AND PROCEED o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING Inspector: ~ Owner/Contr: CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE. CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYl INSNOTI