HomeMy WebLinkAboutBuilding Permit 00-0671
DATE RECEIVED
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
7. L..OO
~Al
1. DATE
7/13 /00
12./ S D
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 d
11a739 WI'I'") Sea
PID d5~~J'(f)2(p ()
SEccm..J
(Tel. No.)
p"e~Nf 7 ' 7 ?m
'(Tel. No.)
(Tel. No.)
Permit No.
1. White
2. Pink
3. Yellow
File
Oty
Applicant
00- CP1 l
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width)
a-S- ,......
12. NO. OF STORIES
SEATS
~ne;~
-z,
13. TYPE OF CONSTRUCTION
W~
14. FLOOR AREA APPORTIONMENT USE
~~
PLANS & SPECS a
SURVEY a
PLOT PLAN
a
3. LEGAL DESCRIPTION
LOT 7 BLOCK .3
ADDITION Wt'ld~~ f6nJ ~
4. OWNER (Name) (Address)
~JA~ 8~ nU J.-:r71 CA.5Fv
5. ARCHITECT (Name) (Address)
J~~ n2~;fJU
6. BUILDER {Name
/
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS~:"~~ ~ 7Jt-
(Address)
~"OO /3( ST C~
~!~€f-jORK Ce~FireeUA(~e~a
New construction~ Alterations a Addition a
Chimney a Misc.
8. PROPERTY AREA OR ACRES
Sq.Ft. l!lJ5l .Width 7Z,,07 Depth 1.1. 19 Yes
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 abov 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 . iar can revok~is permit for ~Furthermore. I hereby agree tha~ t~:':~$ficial or a designee may enter upon the property to perform needed inspections.
X lP ~ ~ -'/13/GO
Signature License No. Date
SETBACKS: Required
Actual
Front
BUILDING DEPARTMENT VALUATION
USE OF BUILDING
5~D
'11:1 9079
Deck a
Finish Attic a
Re-roofing a Porch a
Re-siding a Finish Basement a
9. PROPERTY DIMENSIONS
1 O. CULVERT SIZE
(N9
16. PROJECT COSTNALUE
I ftJo (Xt:)
17i~MPh8rJO
FOR ADMINISTRATIVE USE
Back
Side
Side
MATERIAL FILED WITH APPLICATION
SOIL TESTS a ENERGY DATA a
PILING LOGS a PERCOLATION TESTS a
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION IleG ~O. nr)
TYPE OF CONSTRUCTION: I 11 III IV V
Occupancy Group A B E F HIM R S U
Division 1 2 3 4
Permit Fee ................................... $
Water Tap ................................... $
Builder's Deposit ............................ $ I, S {Jt!J · ~ IL
Other......................................... $
Total Due .............................. $ , ~ f .4("
Paid Rece:~~ C(O~
Date 't..::.8 - ? ~BY l.:f/1
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
~~:::::""Y Ceftificate of Zoning compliance and allows coo ction" ~ ~ncy.. Ceftificate of Occupancy nwst be Issued.
.. ?-1-?~ ~~~l.,.~
C Planner Date Special Conditions if a"y------.. ~
24 hour notice for all inspections (952) 447-9850
Plan Check Fee ............................. $
State Su rcharge ............................. $
Penalty....................................... $
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
Sewer & Water Permit ...................... $
Amount Brought Forward .. .. .. .. .. .. ... ... $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee .. .. .. .. ... .. .. .. .. .... $
Sewer Tap .......................... .... ..... $
~.' $
Pressure Reducer .. .~................... $
Meter Horn ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee . .. .. . .. .. .. .. . .. .. .. .. .... $
City:
1,18~ .:JS
-t"J I'] l. '1l
~400
LbO. ~o
100 . dO
35. 5'0
LI O. 00
~
(S { 1-/ "'"
Your Building Perm~heI).fi>9roved.
Date -' - L Co("~
This
By
Issued
SETS
COPIES
~~
41.00 .a(L
i./5:ao
I 25. O(L
1.200.m'\.
"'rlO.~CJ
~
..~
The Cellter of the Lake COUlltry
White.., - Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT.CHECKLIST
[)c:;J~ ~ ~r
,. 'r-97?
NAME OF APPLICANT . (~..' L /.3C k!. ~I (~. GiV'-:;, , '- · .,
I
APPLICATION RECEIVED /. /4- . Ci ()
The Building, Engineering, and' Planning Departments have' reviewed the building permit
application for construction activity which is proposed at:. ' ,
/&73B t'v'/I'./V5Ct:::- LIJ.
Accepted
./'
Accepted With Corrections
Date: ?)p /tV
/ '
S'/bP~ o,c' :3: /
I
-4r-d/rt'-h)Ufl7/
.sPl- ll.JJ.a(>J,~('"fs = l. h"tl' ~ 1:rufechim ~I ~ ad:; 1'-"
1.. Er(J~;n. t:'d7tIn/ /lkl/>VF~ -i M51hr /tAJr.,! ,P/~
\
liThe issuance or granting of a permit or approval of plans, specifications and
computations shall not be construed to' be a permit tor, or an approval ot, 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 sha.1I not be valid. II "
v,~
. _ _. _ _w ~.. ___ ......~._.-....... ~_ '_'..__~ _'_ ,_." ..,.. ------- -.-.,...---.-.......
I
White - Building
Canary - Engineering
Pink - Planning
Th~ C~nl~r of lh~ L.k~ Counlry
NAME OF APPLICANT
BUILDING PERMIT APPLICATION De.eAFlTMENTCHECKLIST
[)O(J6;~ ~r
/"l" I ~ - -:'I ;:;. A t.:l.A1 c>ii9
~ K:-\...A { ./~'- .,.
f -
7. /4 · 00
APPLICATION RECEIVED
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
r/~73fJ W/NOsoe- LN.
Accepted
Accepted With Corrections ~
Denied
Reviewed By: 7-2.'-I.-~o
Date: 9- c- q ,. 2~
Comments:
,. RPod. al ( o.-&,pW ~_ J~ ..
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. II
.
White . Building
Canary . Engineering
Pink - Planning
The Cenler of the L.ke Counlry
BUILDING PERMIT APPtICAtIONIj~PARTMENTCHECKLIST
~v6~ e~ -
NAME OF APPLICANT / L (~ E~' I-~' e.) (:1 (/(V-:-:'_)r")--j<.!--;--
I
APPLICATION RECEIVED
/. /4-. LtG
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
/ ( 7:3 f) / t, I /v V ~c' I:" L /\/ ·
Accepted ~
Accepted With Corrections
>;<<'
Denied
Reviewed BY:( ~ 6d ~ Date: 7- 2-7 - GC)
Comments:
2~ Yv~W~1.AA tJ/~.u}~ wi- ~ -
~'1 ~ J-~~J f.1..~r9\W <J D ~Io,
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."
Tllr Crn.rr of .Iar Lakr Coun.ry
Quantity
~
I
,
3
J
)
J
3
1. BIlle Pile
2. Gold Oty
3. Yellow AppIiClDt
PPNo. 00.OC,i7/
Phone:.-!:U ~ q O} 1. ~ \ . \
V''A~ ~
CITY OFPAIOFlLAI<E
PLUMBING PERMIT
Applicant: () LS ~. .f 1, ~ "m 6:t~L
Address: -'-9-"'" ra)'1if ST CV' A ~<PL- ~
Signature: ......A.At--- cRk.---
Legal Description: Lot Block Sub
SiteAddress:J'L..~ g '^J';tJJJ>.<;;f. J-A ~
Building Permit # On - O&, I , PID #
NOTE: This permit will not be processed without complete information.
FIXTURE UNITS
Type of Fixture
Quantity
Type of Fixture
Bath Tub with or without shower
Dishwasher
Floor Drain
Lavatory (bathroom sink)
Laundry Tray (1 or 2 compartment sink)
Shower Stall
Sinks
Bar Sink
Water Closet (toilet)
,J
1
)
,
Rough-ins
Water Heater
Water Softner
Stand Pipe (washing machine)
Sewage Ejector
Backflow Assembly (RPZ, Double Check, PVB)
Backflow Assembly Test
Lawn Sprinkler
Other
FEE SCHEDULE
Industrial, Commercial & Multi-Family
(1 % of job cost, $39.50 minimum)
Residential, New One & Two Family
Residential, Additions & Alterations
State Surcharge
$99.50
$39.50
$
$
$
$
.50
GRAND TOTAL $
This permit is granted upon the express condition that said
contractor, shall comply i all respects. with the ordinances
of the State Plumbing amendments thereof.
-- 1.1- 7-1-DO DATE
L-All.t'..ST
-
_'Ll~
Call for all in ections 24 hours in advance.
16200 Eagle Creek Av. S.E. Prior Lake, MN 55372/ Ph (612) 447-9850/ FAX (612) 447-4245
An Equal Opportunity Employer
CITY OF PRIOR LAKE
HEA TING/AIR CONDITIONING/FlREPLACE PERMIT
(Please type or print and si2l1 at bottom)
ADDRESS
/(, 13~ WIIl/OSOJf!-
/-tV fe;
LEGAL DESCRu'l10N (office use only)
Date Rec'd
?-I,-()2--
~: ~~ ~:~ PERMIT NO. 00 _ /)/1/
3. Yellow Applicant vv
ZONING (office use)
LOT 7 BLOCK .3 ADDITION WI'-/)~NI=~ p(JtJOS 2. NJ:)
OWNER
(N ame)
(Address)
.,,-- , - .
(~:=~~~ !-flOcfL5oJ 4M ' '~
~ 5 03 ~t~ t1~1, iZ.l
F (A ess) "
(contactper:.?_l:::? 01/\ V\~V'.5"~..s()~
PPLICANT SIGNATU~" ~ A IM'--
~ ~ I,' J
PID 25- ~7!;8 - tJu"O
.
. (Phone)
Phone) ? IS-~ .. ~1 Lf' t9'5 9
url.V,vll k. 5~ s'5 'I
(City) (Zip Code)
(Phone)
~6~'-02
APPLICANT PLEASE COMPLETE BELOW
DNEW CONSTRUCTION 0 REPLACEMENT 0 AL TERA TIONS
FURNACE MAKE AND MODEL , FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
DWarm Air Plants
DGravity
o Mechanical
DAir Conditioning
DVent. System
~ANDMODEL
~ --
o Steam
o Hot Water
o Radiation
o Special Devices
[] Other Devices
/'1,,-...fl3J / I (' ~
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
FEE SCHEDULE
1 % of job cost Residential, Gas Fireplace
$39.50 minimum
$99.50 Residential, Additions & Alterations
$64.50 Residential, AC Only
Industrial, Commercial & Multi-Family
Residential, Heating & AIC (New Construction)
Residential, Heating Only (New Construction)
$39.50
$39.50
$39.50
Estimated Cost $ Building Permit #
HEA TING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERlV.ll.l FEE
(Office Use Only)
This APPI~" Your BUildlnr:r~ :,~rOVed
Building Official Date
~
~
<Date~_,_~
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
,a " , '. _ a , ,. at" a a." .a, ;-
: ::'.. ;.. , . ..\ .,.-', '..-1.... ~ ~,' . , '.
," . .. ,', ,.,',. " . ,t'.
~e" . ....
"ell.O- . jI\~~~I~..T
001 n - OIT..
CITY OF PRIOR LAKE
SEWER AND WATRR PERMIT
S.W. Nn. ~- ~ 71
v
f#' . NOTE:
;L}
:0', ~I"
''''. t~".lf.'.'O-. './
.U},/o..,.\_ Ii'
Dewer ond Water
cOhtro.ctor:!! muet
be -rcqistored
'Wi~h the City.
APPl.,ICANT: t. ..~,~A.l.- t:-~~ PHONE:W ~:.>~'")
AIlORES S : J.3 I. P l m4It,/1;, r:tc.uL OA'rE: 'l:::.ildJ 0
S-I"GNJ\TURE: . LJJ/~jd60t'" L.v S~wc;" PERMIT II O~f)'
S TE ^DDRESS: l(p,. .~fr" ~ l'd.M.e.... PID#-.d..2:.2.31- 0,:;...10--0
1.
FIliI. TN '1'TtE DLANKS
Estimated length of \later service ~D
C E;U:ll:. .
2.
olze of water s~rvL~e
inch(es) .
4.
~ype of eewar pipe.
Location of nny couplings from structure
PVC./ Cas.t I ron_w
~D
G)
'fcaet.
1.
ADS
5.
Estimated lehgth of
sewt! c-
line
fee t .
6, ~tean out (if required),
struc'ture.
located cl t
f(,~et
f['om
_~r_~~~~~=~~~~~~~__~~~==~====~~~~~~=~====~~~~~~__~~~~~===~~~~~~_~~~~
Tl.is application becomes your peJ:mit when a~lJr:ovud.
BY
DATE:
iIt...~ r~=--======a:.:~ a.". -~"':::'======-====::..:!~=~====:::::I:::I2S:!!!_._....__"C'=::%==~u:.:.t_=-....a~======::.:2.z.:.:!J.:.!:'::::;:S':':"";
II' F F.~ ~
$
$
$
'J!;'.UO
.50
:) 5-:"5'0--
Sewer and water line connec~ion permit.
SU1'chu t'~E:!
'1'0'1' A L
"'" Feo for. ~ither sewer or- WI':lter individually is $Z~./St) plll~
$ .50 surcharge.
*
Sewer ann w~ter permits issued for nc~ conGtruction mQst be
rocorded on ~h~ buildin~ parrnit card at the time of i~5uancc
~o insur:o that no d\lpll.Cllte sewer Qnd watel.' p~t'mlt~. l:\ce
.issued.
'.,
Ofl'l'E PAID
r PAID WITH
BUILDING' P~RMIT
City of Pnor L ,L-
AMOUN'!' PAl D l!. . .,..
REC'D BY. ~ ~
''\
RI!CF.TPT 11
I (,2na Engle. Creek Av. S.H., Prior T..clke. Minnesota 55372 I Ph. (612) 4.'17-'1230 I FAX (612) 447-4245
^Il Ollllul Opportunity Brnl"loYt.lr
l0d W~0G:9 000G GG.d~S
96~9G68 G19
'ON 3NOHd
:JX33H:J3r WO...l.:J
.
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APPLfANCE", . ...
PERFORMANCE"fESt,~;'_::
Attach to gas line adjacent to regulator
Heating. Contractor --A.a.J'~P~'l.--~,.r-
Name of Tester ~~~ ~
?-I S:..O t:d-
Stack Temp.
~-"I'~~.' -~-'~..'.-_~_'-.~~~~~"~_
DEPARTMENT OF
BUILDING AND INSPECTION
P.RIOR LAKE
..
INSPECTION RECORD
SITE ADDRESS JILJ'71:1f W,'IAJsdr Ln ·
,
NATURE OF WORK ~
USE OF BUILDING StFO
PERMIT NO. DATE ISSUED ? '1 t.J - 2000
CONTRACTOR ~~. .~~ Pt\O"~"" 1./rJ.-f()7-' ~-f?-"iC:>O
NOTE: THIS IS NOT A 'PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
FOOTING IA. " . '1/t~/1k
/ ~ ~
FOUNDATION (Prior to Backfill) I 4. 9/ -=';>/~
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
~~\
~ ~,
~ '.~. [/)'.('1
SEWER I WATER I SEPTIC
FRAMING ~:. ~.
INSULATION ~
ELECTRICAL
PLUMBING ~u ll1JOO~u) ~A:r, ~
HEATING (if required) \ br .
FIREPLACE .
GAS LINE AIR TEST
q \ f, ~~\t'lh
r (1ft, !Ut
Ll1~ 161
J 1111/.'
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
-~
\
FINALS
J,/),
~f
~
I '
7r'
OCCUpy UNTIL ABOVE HAS
NOTICE
GRADING (Prior to Sodding)
BUILDING
ELECTRICAL
PLUMBING
HEATING
DO NOT
! hi" lUll
~ I ~/b&/
, .
4(Cf'ljz.-
.fJ I (, 1011
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
.. "" .
,;j-"..__'. ~:~ "";:J.ikA; :i:-~"-I'l '" :., '" ::'J.;j.'':,:>" t~:('~:::J(-\.,,;'-~;~~~f;':;;.~l.:.t "::;;:';'~.:.i.;:.-,;:.;;<:" :-~ :'.:i/ ;,\;.'/\i:i..-:~, ,.,~,-l.,i;~~'~' l".l'yji,":~.\,~'''.'' ~-1.~;:\.~'.i: ;"i~~; -.'.;-~;. '~
I
; ".,'
ADDRESS
I ~ 7 3g.
DATE TIME
SCHEDULED ~,~ z.. I" .' :3 0
tJU Il~ ~. t..J
CITY OF PRIOR LAKE
INSPECTION NOTICE
OWNER
CONTR.
PHONE NO.
PERMIT NO.
(J()- " 71
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
@o WATERHOOKUP
o SEWER HOOKUP
~ PLUMBING FINAL
o MECH FINAL
o EXIGRADIFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
COMMENTS:
~-~
~~~
~ WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector:~... OwnerlContr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTl
ADDRESS
/ If) 73<:f
DATE TIME
SCHEDULED ~~,hl /tJ:e(1
tU/rJ /)~m--
CITY OF PRIOR LAKE
INSPECTION NOTICE
OWNER
CONTR.
PHONE NO.
PERMIT NO.
e - &, 7/
o FOOTING LJl 0 PLUMBING RI 0 EXIGRAD/FILLING
~ FOUNDATION(DI 0 MECH RI 0 COMPLAINT
o FRAMING , 'Ii" WATER HOOKUP 0 FIREPLACE RI
o INSULATION '.~SEWER HOOKUP 0 FIREPLACE FINAL
o FINAL -] PLUMBING FINAL 0 GASLlNE AIR TST
o SITE INSPECTION 0 MECH FINAL 0
COMMENTS: Q) S).~" ~ tAJ~ .fJ"- t" :r ~~I~.
~~ ~@ ~ ~ cJlp~.
~ ~';'.t-!~ 4)~ ~ ~ ~
0/;' LJ" fJlI~ ~ I./(J -
5'~ A:\. t -eok)
t" "'-:;p 'tL " ~ ~, ~ 7ft, " c...-.
~-CD ~ ~ ~ (lJ A1:Y ft--cfl
~ ~ ual;JJJ'~ ~ ,jr6-,
~ ~"fr-- ~ ~~..::.- 1..1-.
~ ~ ~-:r ~ I'Itp!.,- t ,
~~ ~ ~,~~- .
~~-o ~ ~~-.~JRA ~ ~ ~
(2.-l0 t.i-- ~~
o WORK SATISFACTORY, PROCEED A- ~ --JJ.~ ~, 3Z.1# e. Cot
~ CORRECT ACTION AND PROCEED.,.e. ~ .y.-~ ~.
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING ~
Inspector.~, Owner/Contr: ~ T"""1'
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
· 1
~
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CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH &: SAFETY!
INSNOTI
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE SCHEDULED {;, -~ ,;?- I () ! o.P
ADDRESS J/p 7fJ5? tlJ~.:n.)~
OWNER CONTR.
PHONE NO.
PERMIT NO.
6- ~71
o FOOTING 0 PLUMBING RI
o FOUNDATION 0 MECH RI
o FRAMING 0 WATER HOOKUP
~NSULATION@ 0 SEWER HOOKUP
~INAL 0 PLUMBING FINAL
o SITE INSPEC ION @J<lMEcH FINAL
COMMENTS:
o EXIGRADIFILLlNG
o COMPLAINT
uf)\ 0 FIREPLACE RI
W pc FIREPLACE FINAL
o AIR TST
~~
~r
I
1JWORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
I'~.
I
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
Inspector:
Owner/Contr:
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH &: SAFETY!
lNSNOTl
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
10-1--1-
ADDRESS it 739 I/I,-,.kl' Ln.
OWNER CONTR. Of 8J~- C4;u/.
f",/
PHONE NO. PERMIT NO. O(JJ -" 7/
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
~NAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
~RADj):ILLlNG
- 0 COMJ!l1:AlNT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
COMMENTS:
!..JJlh W-nK..
~.p I.ALC../ C I~f V1- Du f-- --- a..t.
(qY'~- O~,
~ WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
InSpecto~ ~ -- Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH &: SAFETY!
lNSNOTJ