HomeMy WebLinkAboutBuilding Permit 03-1566
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
(I" 1d-1))
iffiRMITNO. osJSfoft;
Main File
I. White File
2 Pink City
J. Yellow Applicant
(Please tvP~ or print and sim at bottom)
ADDRESS
17L/{ () ~(;~Id '1)-1\-,e.~E
LEGAL DESCRIPTION (office use only)
LOTl1 BLOCK"3 ADDITIO~'-eJd q1L...-
OWNER
(Name)
(Phone)
(Address)
BUILDER-r--... G") H '\
(NameL U.I<..... ~ ;=rn~_.
(ContactNam~-h-;+~.. ~' ,
~ 0 I <.!..t. ~""""/OO
(Address'f" Lr. 01' Lv.. (h SSOZ/C/
I
Date Rec' d
ZONING (office use)
1(:2-
PI!b7S - Lj 00- 0& o-J
(Phone) 95.:J. 5f8S -7?DP.
(Phone) QS2 - 22(0- ,=?~...J
TYPE OF WORK
~New Construction
DLower Level Finish
DAlteration
PROJECT COST IV ALUE (excluding land) $ II S. q F) '1
DDeck
DPorch
ORe-Roofing
o Fireplace
DAddition
DMisc.
ORe-Siding
DUtility 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
ex~\onthepro ~pe;.to,pe~o~\, l;~.:tions
K- , ~,~ r .~()OOS(07;'1 --1l=J1-{')3
J U Signature Contractor's License No. Date
I Permit Valuation ., /3A.(JO() ,VO I Park Support Pee
I Permit Fee $ I t..ll6, . SS- I SAC
I Plan Check Pee $ 7 'iN. 2.(" I Water Meter ,.8fre 51W; 1";
I State Surcharge $ G,q,oo I Pressure Reducer
I Penalty $ I City SAC and WAC
1 Plumbing Permit Fee $ 100.00 I Water Tower Fee
I Mechanical Permit Fee $ /00.00 I Builder's Deposit
I Sewer & Water Permit Fee $ ~~, 5'0 I Other
I Gas Fireplace Permit Fee $ Llo , 0 () I TOTAL DUE
This Application Becomes Your Building Permit When Approved I Paid k( {55 .:J (
~+~~ ~O~ I Date I 'Z--.S"..o1
Building Official ate
#
#
#
#
$ 8S0, Do
$ 12. 7S .OU
$ 2So.oo
$ t.(S'.oo
$ I 2..00 . DO
$ 700.00
$ lC:;oo .00
$
$?'. /55. 31
/1.
I ~8j,NO, ~t1 (J
This is to certity 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
~::;u.AJ-)
Planning Director
/2/~/o~ Ao.-i aU ~~.~
'Date Special CoIHtions, if any
24 hour notice for all inspections (952) 447.9850, fax (952) 447.4245
16200 Eagle Creek Avenue Ptior Lake. MN 55372
)
..,
Job Address
Heating Contractor
Name of Tester
Date
Percent 02
Percent CO
Percent C02
.
Stack Temp
~p ~d/
~;"v7~;()I'-
/h....... 2
S(~t#
S.3 .?c,
~-u
7,f :.>'..
1 77 ,...
Combustion air is adequately supplied per
UMC Sec. 606 y"" >
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input
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Main File
White - Building
Canary - Engineering
cPlnk - Plannin'!>
-
Th~ Cpnlfr of lhf Lakf Counlry
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLlSr
NAME OF APPLICANT
APPLICATION RECEIVED
i
;
/.
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//-/,;:;,-3
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
/)/1//)
/(~
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.I
,
-----,.~
Accepted
Accepted With Corrections
/'
Denied
Reviewed By:
Comments:
~
4~
-;2~ Date: I':l/j'~'j'
.n1e ~~
/
.
"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,"
$~~
Main File
rWhite - Bu~
Canary - Engineering
Pink - Planning
Th~ CtOl..r of Ih..I,.k.. Counlry
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
JJ K f/~
11- /:::2 - 3
APPLICATION RECEIVED
The Building, Engineering, and Planning Departments have reviewed the building permit
'ppBoa';o" fO"O"","~:;;; Wh~&~ ~ . ~ .
Accepted Accepted With Corrections /'
Denied
Reviewed By:
~) ';:J~
;e,~ rLL{l ~
Date: 10/3'/0 s
~,
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,"
~1
Main File
White - Buildinq
c: ('~narv - Enalneeri!!.9;:>
Pink - Planning
ThO' ("Ul..rof lhr L.kI'{'ounlry
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
, fl
Lt.
,
11-
r) 1./ _.,-;:~~,...-
./. \"" /'\ / .'r7/"r")I---'
"--._ I '..-' f..,' '-./
/,-2 - 3
The Building, Engineering, and Planning Departments ha~e reviewed the building permit
application for construction activity which is.,proposed at: .
1 ,..., _...... <.,,~
<,p /?/(/ lJ,/ J .
-- -- ~"",~,,~,~, - . -.............-....-<
/V-'l///)
/ ,,I ,.
," "
! /
,/ 1
-
Accepted
x
Accepted With Corrections
Denied
Reviewed By:
M4fS
Date:
/) -2-03
Comments: See Reverse Side for Arlrlitinn::ll Infnrm::ltionl
, /fZ;"n (, 'I"
See Attachments: I) Grading Plan, 2) Erosion Control Measl1res
"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."
Nov.20, 2003 5:40PM
GENZ RYAN PLUMBING AND HEATING
No.l147 P29
;~~~
(JL~",
'I. ."<;'\');"'~
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, 'it.'J~~J~\::'rrH.,Q
Date Rec'd
CITY,OF PRIOR LAKE
SEWER AND WATER PERMIT
i;w g; I PERlVIIT NO.~jC: 0 (1
J. (ja.ld ApPlltlltlt ~ {J .ICf
LEGAL PESCRIl'TION (office use only)
LOT //1 BLOCK I.:S ADDITION
~le3Se ~c: or mmt and s.imat bOttOm~
ADDFE/'i1/ (D /Jee12i1e;~ iJ-e C\E-
&~_hdl & q~
ZONlNG(ooou<t)
PID
OWNER
(Name) D~ l.l"",.......... fl...,..........m 'P....wr...
(phone) _ 0,52 -Q'65- i8{,,{\
(Addre!S)
2olliO KeJni3I<..\!:::l::e C:r S-""lrv-,
(Addre,,)
La..k:~~ i lie..
(Cir:y)
&SttLlU
(Zjp Code)
APPLICANT
(N~~ Genz-Ryan Plumbing & Heating
(Phone)
6.51-423-1144
(Address) 11,745 So Robert Trail Rasemaunt. MN 55068
f\ (AddreSS) (Clcy) (Zip Code)
(Conractperson) _ IIJ7 ~ _:8JJ....\ _ (Phone) 651-423-1144
UCANTSIGNATURE (1".1 ~~)~j/x:J DATE II~Jll-()(~
";,'i",,'1
APPLICANT PLEASE COMPLETE BELOW
Size of water service inches,
Location of any couplings from stlUcture
Type of sewer pipe, 0 ABC 0 PVC
Estimated length of sewer line feet,
Clean out (if required) located at _ feet from strucnrre,
feet.
o Cast Iron
FEE SCHEDULE
Residential sewer and water line eOlUlcctton $35..50 Industria~ Com'l & Multi-family 1 % of Job cost with a $39.50 m1nimum
Sewer connection only $17.50 Water cOlUlection only $17.50
Estimated Cost $
Building Penl1lt #
SEWER AND WATER PERl\1IT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$'
$
.50
. PAf^
~Ul1 ,"'iJ I~
. "DI.!I rl{/h
,!I~.~ _..
I.~""]le:-: .
.Fi'~ "I
..~. ....
., I
I
I
10fll.. u.. Only)
I This Application Become. Your Building PermIt When Approved
~
BuildiDg Official
I Paid I Receipt No,
r[~ '1-
I Date - - a 'jO By ( c.-
Oate 1--' of
24 hour notice for.1I inspections (952) 447-9850, rl;r;li"") """-"H~ --0.- o~ ~U
Nov.20.
t~~
,\~,':).",'r~'N"" o<~
,JJ,1,,~'~\'I'.i?~( .....5
".\i>!! ~,,)~1..
"""1\\'1',,\!I-
2003
5:40PM
p. 3 3
Date Rec'd
GENZ RVAN PLUMBING AND HEATING
No. I 247
CITY OF PRIOR LAKE PLUMBIl'lG PERMIT
1 Bw.c Jil.
Z. Gold Clty
1 Yeilow AppliQm
I PERMIT N03-/5 0~J
~1eaJe l'\l1le orn11Dt and. sieD. ltbonom)
ADDRESS -
171(/ 0 1Ja~I1!?frL & eft;,
ZONING (office u...)
. LEGAL DEScRIP110N (offie:<"", only) /l _ . . I /J
LOT /q BLOCK.. r:{ ADDITION 1M kltelct.
CI/iv
PID
OWNER
~ame) DR Horton Custom Homes
(AddresS)
(phone)
qt::,z-q)jl; -iBlJD
ZObLoC 1UnP,~1 ~ce.. CT Sre IDO
L..':tfu...vtllc. M-fN .5Eoi.-/ U
APPLICANT
(Narne)...c""......._'Dr....... 1)1"....,.,,"....3: ~.,.~.~.:
(phone) ~ <, _I"? ~_, 1l.1"
(Address) 14745 So Robert Trail
Rosemount
MN
55068
(Zip Code)
(Address) (City)
,C",~,=,) (lhRioh liillL . 0 ,,,,,,,,
APPLICANT SIGNATURE & j J ~ M // /I DATE
I Quantity
I ,;,(
I /
I (
I ,.;l.,
I
I I
I
I D?
651-423-1144
//- Y:/)-IA.'?
APPL.ICAtVT PLEASE COlVll'LETE BELOW
I Type of Fixture I Quantity I
Bath Tub with or without shower I' ~ I Rough-ins
I Dishwasher I . I Water Heater
Floor Drain I /2.]::. Wa1J:r Softner
I Lavatory (Bathroom Sink) I I I Stand Pipe (Washing Machine)
I Laundry Tray (J or 2 comparnnent sink I Sewage Ejector
Shower Stall I BackfIow Assembly
I Sinks I BackfJow Assembly Test
I Bar Sink I Lawn Sprinkler
I Water Closet (Toilet) Other
Type of Fixture
FEE SCHEDULE
Industrial. CommercIal & Multl-i'Duly I % of job CO" With a $39 50 minimum Re>ldennal, New One & Twn-Falmly $99.50
Re>identiaJ, Additions & Alterations $39.50
Est1lllated Cost $
BUlldmg PermIt #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERi\1IT FEE $
50
PAID WiTh ;
BUILDING peRMIT
(om.. Use Only)
This Application Beoomes Your Building Permit When Approved Paid
DuiJdiag 0111elal
Date
Da.. .' . DEe 8 2QQ3
::,1\
24 hour notice for all inspections (952) 447-9fl5n, fn (952) 447-42-15
1 Receipt No,
I" r
CITY OF PRIOR LAKE
REA TING/AIR CONDITIONINGIFIREPLACE PERMIT
q'lease ~ or orint and silm at bottom)
A77~O Ve'b-k// U
Date Rec'd
#~~
:;;:~ ~:~ I PERMIT NO. 3 -/5-- ro Il-
3_Yellow Applicant ~
c::;-r- I ZONING (0_"")
LEGAL DESCRIPTION (office use only)
L01I'1' BLOCKS ADDITION
OWNER DR HORTON
(Name) - 20860 KENBRlDGE CT
(Address) LAKEVILLE, MN 55044
APPLICANT A 0 ~
(Name) ./7'/. L1'~ ~ ./#"r~AA/''''g./
(Address)~ ~A..IA.. t? 4:
.~A~J ~ -
(Contact Person) A~~-4 ~
APPLICANT SIGNATURE ~'-.~' .-.2:_-::. . _
PID
(phone)
(phone) ~~p. 4,:r...?-.f?.?75'
~94A _~$;:".?' ~
(fll11Jf (ZIp Code)
(Phone) ~/- q9--t77~
DATE
. APPLICANT PLEASE COMPLETE BELOW
.3lNEW CO~TRUcTION 0 REPLACEMENT 0 AL TERA TIONS
FURNACEMAKEANDMOD~/y""',;~. :?/a,4A~'/07c) FUEL"I2 .4-.....:..-..e
FLUESIZE.y'~!S~RETURNOPENINGS ~.e/ lNPUTU /__ OUTPUT 5~_~
>
TYPE OF SYSTEM HEATING OR POWER PLANT
FEE SCHEDULE
1 % of job cost Residential. Gas Fireplace
$39.50 minimum
$99.50 Residential, Additions & Alterations
$64.50 Residential, AC Only
DWarm Air Plants
DGravity
o Mechanical
~ir Conditioning
~ent. System
o Steam
o Hot Water
o Radiation
o Special Devices
o Other Devices
FIREPLACE MAKE AND MODEL
Industrial, Commercial & Multi-Family
Residential, Heating & NC (New Construction)
Residential, Heating Only (New Construction)
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
$39.50
$39.50
$39.50
Estimated Cost $ -' ~C:::Z:::>Buildingpennit #
HEATING PERNUT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
$ ~~/~""~~~~/D
$ ~ ,50 D/~G /lvil)y
$ if' ,()~-9.. ~
'VII...
Paid Receipt No.
IllIel. <I ~ LUUJ By
24 hour notice for all inspections (952) 44~.fax:(952)44'--4~"S .
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
1 Pink
2. Green
3_ Yellow
~::y I PERMIT NOn:... .1I91il1t
Applicant _
(Please type or Print and sim at bottom)
ADDRESS
ZONING (office use)
I74IO DEERFIELD DRIVE S,E,
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION
PID
OWNER
(Namp 1] H .H0RT(ll\!
(Phone)
(Address)
APPLICANT
(Name)~ T T TPl! l?IRESIDE DBft FT'RFSTT)F. BEA l?TR &. HOME
(Phone)
651-633-2561
(Address)
2700 NORTHFAIRVIEW AVENUE
(Address)
ROSEVILLE
(City)
55I13
(Zip Code)
(Contact Person)
BRENDA HUSTON
(Phone) _65I-633-256J
APPLICANT SIGNATURE
BRENDA HUSTON
DATE
2/19/04
APPLICANT PLEASE COMPLETE BELOW
xD NEW CONSTRUCTION 0 REPLACEMENT 0 ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE
RETURN OPENINGS
TYPE OF SYSTEM
o Warm Air Plants
OGravity
o Mechanical
DAir Conditioning
OVent. System
INPUT
HEATING OR POWER PLANT
OUTPUT
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
HEATN GLO SL-750TR-c
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
Residential, Heating & Ale (New Construction)
Residential, Heating Only (New Construction)
$39.50
$39.50
Estimated Cost $
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
Building Permit #
$
$
$
'''J1:'J:l '!J'lj'f':'
-".50 ::"~IV~ I:,,~~=", .
,,~ '''''~*-.:.J;.:;.:; 1..1'_,':'"., ':;T
.. ....~ ~.',",w_
(Office Use Only)
Buildine Official
Date
I Paid
I D*'EB 1 Il 2004
I Receipt No.
I By
This Application Becomes Your Building Permit When Approved
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
PRIOR LAKE
INSPECTION RECORD
SITE ADDRESS \ '7'" , C Ei
NATURE OF WORK Ne~ ~f2b(:t'a
USE OF BUILDING S.F\A.
PERMIT NO. 03_/5~ro DATE ISSUED =
CONTRACTOR l).tl. Mo..."tJ J ItJ(, PHON - -ZZ4""3'f
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
DEPARTMENT OF
, BUiLDING AND INSPECTION
Main File
S.E.
Il.-/{-<J!::. l
I FOUNDATION (Prior to Backfill) I JlVrt'" /~ f) -17~o ~ /1.21-.2f"dj>
PLACE NO CONCRETE UNTIL ABOVE "AS BEEN SIGNEa'
ROUGH - INS
INvrT::
DATE
I FOOTING
SEWER I WATER I SEPTIC
FRAMING
INSULATION
ELECTRICAL
PLUMBING {)d;t All uIIH;
HEATING (if required)
FIREPLACE
GAS LINE AIR TEST A-It UlI1 If)
jI}/p
]- /-r--Clt:;
"
-
H';,
t/J/f/ _
J//g
I/W'"
,;l -lir-d 'j
3 '/.<:'-CJC-t
? -/J'-(l(
'I
;J-e tF--/
"GRADING (Prior to Sodding)
BUILDING r~tI>lhl <0 +oc I
ELECTRICAL
PLUMBING
HEATING
DO NOT OCCUPY UNTIL ABOVE HAS BEEN
NOTICE
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I I
FINALS
AJ C f,--/t.t/I
~
" ,
%//2/o~
!
/1
VI /V'~
J/iyY
-5--(, 1J~1
.s --;o-(/,I
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 nllar main entrance.
FOR ALL INSPECTIONS (952) 447-9850
<tlrrfifitaf:e' of @trnpanqI-
CITY OF PRIOR" LAKE
~tparfuttnf of 'lJiuilMng J/nsptdion
pinal Permitted [J 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:
Use Classification
SINGLE FAMILY
Bldg. Permit No.
03-1566
Occupancy Type R3
Type Construction
VN
_ Fire Zone
N/A
_ Zoning District
R2
Legal Description
119, B3. DEERFIELD 9TH
Owner of Building
Site Address
17410 DEERFIELD DRIVE S.E.
Contractor's Name & AddreJ? R. HORTON, INC.A
ROBERT D. ~UTCHINS~~
" /. Buiip1'?ffi 9'flcial
~/ /,..2/07
20860 KEN BRIDGE CT., SUITE 100. LAKEVILLE
,"~.\
City Planne('--
DON RYE
Date:
Date:
~
DATE TIME
CITY OF PRIOR LAKE . /. /. /
INSPECTION NOTICE SCHEDULED R //.<;/c:f y
/7Y/c? ~erf1cl/ 4--
~
( ///'~
\L 'CCJ~ ~
"'-..
~ ---
WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK" ~;L ;~EINSPECTION BEFORE COVERING
Inspector: /~ OWner/Contr:
,
ADDRESS
OWNER
PHONE NO,
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
~L
o SITE INSPECTION
COMMENTS:
~
.
r..- P? q-
--- ---
CONTR,
PERMIT NO,
03 -/,j~~C
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EXIGRADIFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
I
01/
Ufe
---~
)~
/
/
/~'
~/ /~
~
CALL ~7-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE..
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
/NSNO"
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
~-Ih:Ji-
ADDRESS
/71//0 lJ-,-,rCil"{
PHONE NO,
PERMIT NO.
7J/{. I::k'b'"
_b3'/S-~
-st"~ILLlNG
1J ColPLAlNT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
OWNER
CONTR,
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
(JI4ltlAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
COMMENTS:
('?/~r f'J1'
L 0.1 ,-1..,
l<u7-
U(
r':f.{ WORK SATISFACTORY, PROCEED
v D'\:ORRECT 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 & SAFETY!
,,,,,,,,n
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
.s--C,-cn./
ADDRESS
/74(6 fh-uh'-</cl
OWNER
CONTR.
PHONE NO,
PERMIT NO,
~ -/~~
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
)61 PLUMBING FINAL
o MECH FINAL
o EXIGRADlFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
COMMENTS:
Jfrt';'l1Ol/(
~) c-rlil
r,ff~r,(;4?~
~~;
o J'ORK SATISFACTORY, PROCEED
/CORRECT ACTION AND PROCEED
o CORRECT ~~ FOR REINSPECTION BEFORE COVERING
Inspector: ' Y , Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
lNSNOTJ