HomeMy WebLinkAboutBuilding Permit 03-0605
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
See Main ~'ile
I. White File PERMIT NO II 6'
2. Pink City · /1'\ "2 / 0
3. Yellow Applicant L/ J
PID ~ 5}.... :3 Cf b -01'1.-()
(Phone) tbrJ"'I()~-tj~/lD
d~~ J M.J ~/1--~
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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 bu' . g official can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may
enter upon the property to perfo spections.
x~/~
$
$
$
$
$
$
$
$
$&,,30#,/ ."7
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~. ecet' No. """'~
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(Please type or print and si~ at bottom)
ADDRESS
pl'fZ 3 (, Fa tJ r>Jl/\ iN U i Is t71J. tf
LEGAL DESCRIPTION (office use only)
LOT 3IBLocK:1 ADDITION Fou~~;,.J !-IJJs ~.}J1J
OWNER
(Name) we,J-Js ~Ar-J,.::J l~~
(Address) (g(S- P(v4 'Z.,A UJ-.
BillLDER Q
(Name) ~~
(Contact Name) -&~)
(Address)
~t{v U70
(Phone)
(Phone)
G,/Z," Z 2(-Il::> 'L 7
TYPE OF WORK
\
t1New Construction
OLower Level Finish
o Fitreplace
o Deck
OPorch
OAddition
ORe-Roofing
OAlteration
o Misc.
PROJECT COST IV ALUE (excluding land) $ / () 2 I zq I --
/l/rY
Contractor's License No.
Permit Valucfon
Permi~ ~ee I
Plan Check Fee
Park Support Fee
SAC
Water Meter Size @?";
Pressure Reducer
#
#
/()z/ 000.00
$ ~ 004-.95
$ , I~~J . ~z"
$ 57.00
$
$
$
$
$
#
State Surcharge
Penalty
#
City SAC and WAC
Water Tower Fee
Builder's Deposit
Other
TOTAL DUE
Plumbing P.:.uuit Fee
Mechanical Permit Fee
Sewer & Water Permit Fee
Gas Fireplace Permit Fee
JOo,(f()
Iro.oV
~..5-' fD
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This Application Becomes Your Building Permit When ~l'& ~ved
_~ ;f~
Paid & .30~,6 7
Date ~. I~ oJ
Building Official
~/fI /47
, Date
Date Rec' d
,.,,, ~o3
5 ~ c?-V
ZON~G Jffice use)
RI-f
ORe-Siding
OUtility Connection
~, J2,
Date
es o. CJZ)
I~ Z6(li)O
, 2f:j() . tJ7J
<<: 01)
It [,.,00 - 00
700- c:J 0
This is to certify that the request in the above application and accompanying documents is in accordance with the City .g Ordinance and may proceed as requested. This document
~::m~:~~~~~~O~i;;aod~ronmuroooro ~ee"YIainm;mu~~
Planning Director ' Date Special Conditions, if any
24 hour notice tor all inspections (952) 447-9850, tax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
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See :Main ~ile
White - Building
Canary - Engineering
("r"mK - "'.annlftg)
Thr C'rntrr of thr tab fountry
BUILDING PERMIT APPLICATION DEPARTMENT CHECKList
@A7;F>??/'~.' X/I...../ j)15 7-.;t1.fl~
/ }}" ,3 J '.'1-0ll/?d:~~.-~ (.J{LltJ ..4"-r
,.., CT Jo '-"
5- ~)o--03
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
/ LI,~7 -3 6 ~:1-I;7t{.-..~}?tkj"1~C/ cikj.?{/J ') ~=~t-
NAME OF APPLICANT
APPLICATION RECEIVED
Accepted
.,
/
Accepted With Corrections
Denied
.
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f
Date: ~L6 ~3
, ,
)~p
Reviewed By:
Comments: ..
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!oiIIl'iltWo
. .... .......~.,.,...,.".'''.7......'~..,.......;''''''''
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."
See Main ~ile
~ite - Bullding -;,
(;anary - Engineering
Pink - Planning
Tht (Otnttr of tilt hlet Country
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLISI
APPLICATION RECEIVED
(j}1/!/YkM?t~ ~
J tjJ-3t -:r~~ ikL10 V-
I C-d<?-03
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
1L/8g6 ::r~ ~ &- .
NAME OF APPLICANT
Accepted
~
Accepted With Corrections
Denied
Reviewed By:
~
-
'::/d p
Date:
/;/&'/0 '3
I ·
Comments:
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."
See Main }-tile
~: - Building
n rV - EQ9ineennQ.-)
Pink - Planning
TM C,..n It' ._ a..Il, c......,
BUilDING PERMIT APPL.lC.ATlON DE.EARTaaENT CHECKLIST
NAME OF APPLICANT {j/01)j/fJ/~'/)P1'-'" xk-;-,-r..a4-/
APPLICATION RECEIVED / L/(;-;. 31., '1u1~0f-.?:~~-~-',l ~.L{~~:i ({'_"(
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..5- dO-o..;
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at: _
/lli:.3) j.b ~~f-.:.>~tl /}1.,tfi-i.-'!..(_--" (X~';~j/{~~ (~_~~.t-
Accepted
Denied
)(
Accepted With Corrections
Reviewed By:
tm13
S~'(. A1"/~ F, '/(.
Date: '-l-()j
Comments:
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
-
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....
APPLIANCE
PERFORMANCE TEST
Attach to gas line adjacent to regulator
Heating Contractor A1I (A-tJ.J. ~
Name of Tester #.~- e. S'
Date ---'..D - ~~ -0 L
Job Address 1 ~ 2'3~
Heating Contractor ~ · ~
Name of Tester ~~ ~,
fo /1., 3/0:3
I
--10
(l fIJII
fp
{Or;fI
.f
Date
Percent 02
Percent CO
Percent C02
Stack Temp
Combustion air is adequately supplied per
UMC Sec. 606
input
/j/O K
",
Date Rec'd
ell i OF PRIOR LAKE
SEWER AND W A I ~R PERMI.l
II. .....
l. Green File PERMIT NO
2. Yellow City '. ~
J. Oold Applicant . 01.-,,~ )
(Please type or Print and sian at bottom)
ADDRESS ZONING (office use)
/'f1-3~
~ tJu"'-",,) ..... ,,' lJd.1L( e-r-
LEGAL DESCR.t.t-l10N (office use only)
il". ./.' .
LOT J( BLOCK ~ ADDmON F"o(,lft,..)~ b/i.lJ.s ~
OWNER
(Name) v/eNSbJ/A1tIJJ /-/ /JM<A.
(AdcLw~) J 8 q~ PIA'" A D fL
(A~)
. rill Ils---......-.,/lb ,,01 '2..-D
~A~
(City)
(phone) m''ItJ/' ''111'0
SS/~
(Zip Code)
ArrLICANT c-.
(Name) ~6-
(Address)
M
~
(phone)
(AddJess) (City) (Zip Code)
(Contact Person) E~.,. "--r;;(~,Mllr (phone) gl7.-~1d-I#a
APPLIcANTSIGNA~'" ~ DATE
APPLICANT PLEASE COMPLEtE BELOW
Size of water service J inches.
Location of any couplings from structure ztr feet.
Type of sewer pipe. ~ ABC D PVC 0 Cast Iron
Estimated length of sewer line ,62~eet.
Clean out (if required) located at feet from structure.
Residential sewer' and water line connection' $35.50
Sewer connectiQn only $17.50
FEE'SCHEDULE
Industrial, Com'l & Multi-family 1% of job cost with a $39.50 minimum
Water connection only $17.50
Estimated Cost $
Building Permit #
SEWER AND W A'I hK PERMIT FEE
STATE SURCHARGE
TOTAL PE~ll~ I4~.i!J
$
$'
$'
.50
8u/~O ~
. G ~Fi1l4,.,.
(Omce Use Only)
This Application Becomes Yoar DaUdinl Permit When Approve
L) U ~cIl1 D Iil ~ -'I
\ L IRfff 1 2003 -'
Receipt No.
By
~
Buildilll Orncial
Date
24 bour notice for all inspections (952) 147-9850, fax (952) 447-4245
By ....... . . J
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FILE No.389 08/29 '03 11:01 ID:PLYMOUTH PLUMBING
FAX:7635331121
PAGE 1/ 1
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........~Nc:S~..'
D~te Rec'd
CITY OF PRIOR LAKE PL1TMBING PERMIT
t Bklc File PERMIT NO'3 to .- ~
~ GL\ld c.itt " C-
. \dl,I... Applillatll - \..-J..J
(J'llc~SC' IVPC or tm.n( :u'lcJ silln :11 bot'\om I ~ .
AD/4 d.~Co- ;)2- 3D-3~- 3/1 13 eo )';urrlWt!Jt )S.' 2ONrNGt'ffi<<'''1
\. .-/' .
LEGAL DESCRlPTION (l~trIC" U$c only)
LOT BLOCK
ADDITJON
prD
OWNER
(Narrlc)
l.u.ens ~Y'
(phone)
~.
(Address)
APPL1CANT /). .
(NamoL_ P I ;jlM.n L:'''t h J:::.l!.:W'l,\,A>i ''''.)
(AddTe~s) (oc( C) q \^!; ,,'\ vd' + ~ ~A \.~ ' l.:
(Addre.ss)
(Phone) ("] Lc.~) ~):?~.-~o5 L.___..
hr-tlr,k. \ j./\. j).~;41~( r-)SL!;X~
(Cir~ (Zip Code)
(CnnnlC1 P~r~on) - /?
APPLICANT SIGNATURE ~ ~
~
(p 11 em c: )
DA"fE
f'/;;J/3
Qu~ntitJ'
8-
APPLl CANT I'LtASE COMPLETE BELOW
T)'pt' of Fh:tul-e Quantity
Bi:llh Tub wi1h or witho\l1 ShClwer I
Dishwasll~r
Floor Dra.ln /
L~lvatory (Bathroom Sink: j
Laundry TrClY ( I or 2 c(\m partmem sink
I Shower Stall
I Sill ks
I
TYI)t ()f F:ixturc
Rough-ins 'I} hJ1-
'A' ater Heater
Water Softner
Stand Pipe ('Washing 'tvlacI1ine)(J lJ;h 611
Sewage ~iector
Backflow Assembly
Backtlow Assembly T~Sl
f
~
I
I
I Uid/ ....1111'-
(... I 'ftJ t! ter C lo:,e1 (T ~\ i kn
....__..1 wi"" ...,...,...,
.. .1
I
Other
FEE SCHEDULE
lntluwi.ll. (:ommC:l'cial & Multi-family Ill,;, of'.,ub 'oSl wilh II $3~j() mil\lmLlm Rl:~iiJc:nlinL New On!; &rWl\.r-umil~, $9CJ.50
RcsidC:f1L;U!. Addilion:; 0:. AI1C:"~liun:l 1:.3 <<.:I. 5U
(slinlJ1Cd C~)st 5: &7jcf)/'e6-
.
Building Pcm,it #
PAID Wi
BUILDING 7TH
PERMIT
PLUMBlNG PERM1T FEE
ST.:'" TE SURCHARGE
TnT AL PERMIT FEE
$
U'
.II
.so
$
/Offic;r lis!: Olllrl
This A ppliclltW" l~o.omc. \' Oil" Building Pel'mil When Apl'l'llved ' '~ j\'!:l ~ ~ 0 \fl ~ t"1.<CCIP' No '
1}',II" _1.... ~lm"'EP 0 5 Z003 : ~. __ I h_
~Ili'llill" (Ink", , _ ;) ~ '
~ol hl)ur rlllli.l:4.; lur :.ill III sfJl:l.:llllm (!}~~1447.'~=,1l. 1:u. (95:) -14j."~4~
1..;1111 I.a~k / I",'d, >'\VI'. ',.f. I'rllll" 1.00.e~.r. '~'~-".I~"
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t..~...... .......,\:.....\.......... "......,.......~<;...~\
UW~
~~~~:rV
Cllt OF'PRlORLAKE
l:l~ATINGI AIR CONDl1 lONING'.lC1KEPLALE :PERM! l'
Dat\
i. Pinle File
2. on- City
3. Yellow AppIiClllt
PERl\tu.t NO. ~ -(005
(Please tvpe.QrDrintand siRn ad """" m)
ADDRESS
14.%:56 . TY_ .:>,""", ~,u....~' ~
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION
~=:u/~i$A''-4.L /~Aq!~
(~~) /' '""$ A'k~. a.. ~ ~..... <-
~. . . ,. . . . . .," .
~~~/'A'~A ~..."A..,<r (Phone) ~~/- ~S-'--2/7S-
(Address) \ ~~) ~~.6L"'~/~_. 4~~ ~~...?-?
.(contactperson)_~~o~~$: . (Plione) ~~/- ~-~77~
APPLICANTSIGNA~ . .- ....>.~~> ........... ..DALB c:rf~~ ..
:,. .~~!Jlq~.::PLJt~~;~(i)~,~~:I.:.E.,B~J;QW,.:. .
~WCONSTRUCTION.' D:h.rfACg~.. [JALTERATI<?NS
FURNACEMAKEANDMOD~L ~." "$~~Q~~ FUEL..l:J..A. ~
FLUEStZE ;XI P-Je. Iffi't1.mNopENINGS 7 INPUT .I:D,. - ;. ) OUlruT s~,..~ .0
n:l"~ OF SYST~M HEATING: OR POWER PLANT
~ann Air Plants .O:SteaIll
OGrav~tyO'lioi Water'
DMechanical .Ol'Wlhition
DAir qonditioning D.Sp~i81'Devices
DVent; System o Other Devices
PID
(phone)
. PLEASE NOTE:
Afr Ct:mditioner . Units
Cannot. Encroach into
Required Side Yard
Setbacks
rIKEPLACE 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)
Estimated Cost $ Building P;"lo;&.Jt #
. . .
HEATING PERMIT FEE $
STATE SURCHARGE $
TOTAL PED.I..I..l FEE $
. ~~8(J'~i~~ ~
.50. ~FlMrr
(Office Use Only)
Building Official
1J~ ug ~ J \D ~ -~f'..eceiPtNO'
Due y ~
Dalt. ~_ SEP 0 5 2003 :.., VO
'14 hour notice for all inspections (951) 447-9!50, fax (951) 447-4145 r
By
This Application Becom~ Your Building Permit When Approved
FIRESIDE CORNER
#2530 P.002/003
(l'Jease f.T1tC".. print .nd sip at Itottom)
- ADDRT::SS
Cl.t i OF ~~R LAKE
IIEATING/AIR CONDIll~ ;, G/l'll<EPLACE PERMIT
l1'IK~SIDf9;. za... PEAAul NO. 0-/.po5
Ii: E A R.l~-H & H: 0 M El'4
14:236 FOTJNTAlN HILLS COURT
Date Rec'd
ZO~G (cfJio: USf)
J...EGAL DESCllJr J.JON (office u&e onl.y)
LOT
BLOCK
ADDmON
PID
OW1'lJ:'A
(Name)
w:e~NN
(Phone)
612-221-1628
(Address)
APPJ~CANT
(Name) AJ..LlED Friu!sI~.AYJJ1ASIDr:J;:~RTTi k HOME
(phone)
651-633-2561
(Address)
2700 NORTH FAIRVlEW AVENUE
(Address)
BRENDA HUSTON
ROSEVILLE
(City)
5511.3
(Zip Code)
(Contact Person)
(ph.one)
651-633-256 J
APPLICANT SIGNATURE
BRENDA HUSTON
DATE
9-6-03
APPLICANT PLEASE COMPLETE BELOW
xO NEW CONSTRUCTION 0 REPLACEMENT 0 AT... TERA T10NS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENJNGS INPUT OT,; 1 t'UT
n J~ r.. OF SYSTEM n.r:A 1.1J.-lG OR POWER PLANT
::lWannAir PlanT,S 0 S~m
JGravi~ 0 Hot Water
:J Mechanical B Radielion
::lAir Condltjoning Special Devices
:JVent System Other Devices
PLEASE NOTE:
Air Conditioner Un.its
Cann.ot En.croacb iuro
Required Side Yard.
Setb3c)a
FIREPLACE MAKE AND MODEL
HEAT l:'l GLt) 6000TR-(lM(
FEE SCHEDUIJE
J% of job cost Residential. GBS Fireptoce
$39.50 minimum
$99.50 ResidentinJ. Additions & Alt.crEttions
$64.50 Residential. AC Only
$39.50
$39.50
$39.50
Jnd.ustrial. Ct>mmercio.J eft Multi-fomily
Rcsidential, Heating & NC (New Construction)
Ref:identiaJ, Heating Only (New Conmuction)
Estimated Cost $
HEATlNQ PERM1T FEE
ST ATE SURCH.AJRGE
TOT AJJ PERMIT FEE
Building Perm.;f. #
$
$
$
.~
(Office I.J~ Onl)l)
This Application Becomes Your Building 'PA9'RM}I(jJj!~11tRR1'fK4,m '/118 rH.a1ld ReceIpt No.
~f Builder Dlv;$;t;, It Date By
u . "Be.Udlne OrDVltO Fairvicw Avenue NOrrJl Rollnli.'Ue. MN 55] J 3 I rhoI Ie 65 J -633.2561 Fax. 6S 1-,,33-8884
PUII.Dr. iii Cl.un. 3850 West HJl!hway 13 13umsv,lle. MN 55337 Phone 952.~90-07S8 F:l.x 952-890-5408
14 hour notice for aU fnlpect;on~ f9SZ) 447-9850. fiX f9S1l447-424S
,..,....f)res..'C'.lIa,ftfW M N C'on.".\:tor UCGn,6 ~ ~/!tll'Jll
1M:'
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I'l "lJ'll"R~ A.WX:lNIIltC
.... ..,..11I . _ ... Ci'....
PRIOR LAKE DEPARTMENTOSee Y1ain ~ile
BUILDING AND INSPECTION
.
INSP.ECTION RECORD
SITE ADDRESS ~ ~<.JN ~./~ ar
NATURE OF WORK
USE OF BUILD~~ .
PERMIT NO. ~- DATE ISSUED
CONTRACTOR ~~ PHO...Q-til.,.. /J.~
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR
DATE
FOOTING
~ ~ ~'te
FOUNDATION (Prior to Backfill)
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
SEWER I WATER I SEPTIC
FRAMING
INSULATION t~ k- Attv~~
ELECTRICAL tJvt
PLUMBING ~ fA- q, / t 7 103 -
HEATING (if required) ~ q It? PJj
FIREPLACE ~ '1 Il 7/03
GAS LINE AIR TEST ~ q I f '7/Q3
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
~ -
{~~
q/!~J--br0
qjv-ltf;3
FI N A L S
GRADING (Prior to Sodding)
BUILDING q-. L ,,0 !,7eI' 103
ELECTRICAL !9L(
PLUMBING
HEATING
DO NOT OCCUpy
~~
~ LeIW<:8
~ t6/~
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 h.ve been approved. On buildings and additions
where no service cabinet is available, caltd shall be placed near main entrance.
FOR ALL INSPECTIONS (952) 447-9850
~ttfifitaft Itf d~ttupantl!
CI"l"Y O~' PRIOR LAKE
~tpartmtnt of ~uilbing Jfnsptttion
pFinal Permitted D Conditional C.O. Expires
This Certificate issued pursuant to the requirements of Section 307 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:
OCCJllf'8Ilcy Type
R3
Type Construction VN
Fire Zone
Bldg. Permit No" 03-0605
N / A Zoning District _ R4
Use Classification
SINGLE FAMILY
Owner of Building
L31, B2, FOUNTAIN HILLS 2ND
Site Address 14236 FOUNTAIN HILLS COURT NE
Legal Description
Contractor's Name & Address WENSMANN ~O~~:,}-895 PLAZA DRIVE, SUITE 200,
ROBERT D. HUTCHINS IL...Vf" . City Planner, DON RYE
/-. Building Official .
Date: ~ {G . Oll Date:
EAGAN, MN 5512
. ,
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ADDRESS
OWNER
PHONE NO.
DATE
fl)~
JI-l'LJh ~"~
TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
CONTR.
PERMIT NO.
.~-~~
o FOOTING 0 PLUMBING RI 0 EXlGRADlFIWNG
[J FOUNDATION [] MECH RI [J COMPLAINT
[J FRAMING [] WATER HOOKUP [J FIREPLACE RI
[J INSULATION [JI SEWER HOOKUP [J FIREPLACE FINAL
~ FINAL ~. aLUIISING FINAL [J GASUNE AIR TST
[J SITE INSPECTION " .AECH FINAL [J
COMMENTS: ^.... ~ /)rr
-L ~ .It (W-~f-~
~ \ '{~ CkL~ ~~<r~J
~ ';.M) \ L 6{) (()
1,7-/ UfJ3
[J J'ORK SATISFACTORY, PROCEED
V CORRECT ACTION AND PROqEED
[J CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: ~ OwnerlContr.
CALL 447-9850 FOR THE MEXT IN~PECnON 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
L.lj ~ j j
'"
DATE 1WE
CITY OF PRIOR LAKE ^ J.",
INSPECTION NOTICE SCHEDULED CLI j" 1./d3
ADDRESS -1tFl-?1Co ~~
OWNER CONTR.
PHONE NO.
PERMIT NO.
s .-, i{)~':;-
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
o PLUMBING RI
OMECH RI
o !WATER HOOKUP
o SEWER HOOKUP
;!.PLUMBING FINAL
OMECH RNAL
o EXlGRADlFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASUNE AIR TST
o
CO.-MENTS: _
~ ~~ ~Jlt1D .~~ ~~
{j:.' (~""-~, Gt:v1 ~. Vi.~ k,~
~ t:J/~~Q.V~
3'<:~aL'~?'s ~~~~/
t~; V~~ cJa.- \"Q~ ~~<
,5'~ V~~U' l~ ~
~~ ~l~
o WORK SATISFACTORY, PROCeED
~__._,~~. """. ......1. ANES 'R98&~&r-
VI CORRECT WO~~ FOR ~NSPECTION BEFORE COVERING
Inspector: .,. ~ Owner/Contr:
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CALL 447-9850 FQR THE ~E:~T IN,PECTlON 24 HOURS IN ADVANCE.
CODE REQUIREMENTS..ua FOR YOUR PERSONAL HEALTH &: SAFETYI