HomeMy WebLinkAboutBuilding Permit 03-1415
Date Rec'd
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT ...-, "?
I()- I'--J
I PERMIT NO. 03-/tfIJ I
Main File
I. White
2. Pink
3. Yellow
File
City
Applicant
(Please type or print and sign at bottom)
I ADDRESS
5440 ~(ieJd CJ ~ 2E-
LEGAL DESCRIPTION (office use only)
LOT 11 BLOCK ADDITI~'e_J-I. q-rk.
OWNER
(Name)
(Address)
ZONING (office use)
7<CJ-...-
PID ;;)5- L./tXJ-O/7-C
(Phone)
BUlLv-. D IJ') 11... _ J
(Name) I t<- tiUL~_
(Contact Name) _ <)t~. Nt'_ fZr I' (' J<.so'^- \. Fr 1i2. . brnWY\..
a.cel.Q.() b",~CJ:. ~~/OO
(Addressf'l..O...J4ua ,mrJl 'sS~~,
(Phon<(q5~}crf)S-7C/)~
(PhOn~~aa 1.0 - 133~
TYPE OF WORK
o Misc.
~ew Construction
DLower Level Finish
ODeck
ORe-Roofing
OPorch
OAddition
DAlteration
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
~erty~=r~~ons ,-;) OOOSl&5, '0 / r. /O~
\ ~ Signature Contractor's License No. ~lDate
I Permit Valuation
I Permit Fee
I Plan Check Fee
I State Surcharge
I Penalty
I Plumbing Permit Fee
I Mechanical Permit Fee
\ Sewer & Water Permit Fee
I Gas Fireplace Permit Fee
o Fireplace
PROJECT COST IV ALUE (excluding land) $
"S Cf6'l
I:';'ro. <<J9 I
$ J/ Q5'. 35
$ 11~. CffJ-
$ loY. -
$
$ tt?O,-
$ /00 -
$ 3$,6V
$ L/O~-
This Application Becomes Your Building Permit When Approved
~~
Building Official
J'r:i270 J'
Date
I Park Support Fee
I SAC
I Water Meter Size 5/8"; 1";
Pressure Reducer
#
#
$ 5?50, -- I
$ /;).75.- I
$ ;25?)- I
$ ~S-- I
$ 1;)..60-- I
$ - /)OD /' I
$ /50D./ I
$ I
$ 'R/3S. Xc, I
Paid
Date
~/":)5 -/
If- :1-/)"";
. ,
I Receipt No_ '1 'J- 'S ,-J....-,
By d ---.
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
~ ~ 4L?;:3 ~ ad
Planning Director Date Special Condi
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenoe Prior Lake. MN 55372
City SAC and WAC
I Water Tower Fee
\ Builder's Deposit
I Other
I TOTAL DUE
#
#
e-1
. --' ._._._----~-;.._..-
Heating Contractor
Name of Tester
S/JF,1 ~@6,r,
M;t}~ .u.fXJ/
l'1onr B
.0-!~
_I{ ~7""
ft;;;,~
. I
"'7 I")~
.~~
Job Address
Date
Percent 0,
Percenl CO
Percent CO,
Slack Temp
Combuslion air is adequately supplied per
UMC Sec. 606 1'-"5
'!t',~.tTJ
input
~~
Main File
"
,
White - Building
Canary - I;nqineering
~nK - ....Iannlng)
Thl' (-..nf('r or thf I.ak.. Country
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
, ;.;
~,
I
-
.~ / ";-1..-/
APPLICATION RECEIVED / /)
-/- ~'
_.':"
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
/';'/I~/) / ,\.
",,--.
Accepted
Accepted With Corrections ~
Denied
Reviewed By:
~
~~
,..
~ Date: /CJ;! z;' :f
n1Y' ~~,
~ 6" : &fl, - _
o
Comments:
K.fU.e,
p
~'.
"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
..----1Ynije " - tjuilal~
Canary - Engineering
Pink - Planning
Tn~('UI..rn'lh..I..b{'ountl'}
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
;0R
~
APPLICATION RECEIVED /0 - /-":3
The Building, Engineering, and Planning Departments have reviewed the building permit
'pp';~t;O" tocOO""'"'; ~;~Wh~~ ~
Accepted
Accepted With Corrections
~
Denied
Reviewed By:
~..
~~
'?..dJ ~ Date: /~/; 7/0 'J
ail ~~
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."
~
Main File
White - Building
L I ':.naD' - cnqlneenna--,
Pink - Plarmiiig .
Ih,t..hCounlry
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLlSr
NAME OF APPL,ICANT
APPLICATION RECEIVED
;) /-:)
:1--'.... ^
-
,I "
'"f "
~7;".A / ,~/,' ./
"I' ..../-L--\,.f~ -
/0 -
7-3
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at: I
.- I.. /61' j/, I '/".-Ce,
...",..; ?f''''./' # f! If -' / ? i'. . U.....A'..--' .
....;.' ," ,i '__><.l.;:._...t:.//t /;-...,.Y, '_.(~...... _ _ '"'--'"
(j
Accepted /z.....
Accepted With Corrections
Denied
Reviewed By: m4 (2., Date: It).;) 7- () 3
Comments: See Reverse Side for Additional Information!
llle. ,'^ F,' 'r
See Attachments' 1) Gntrline P1:m. 7.) Rrosirln rnntrol Measures
"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 01 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."
Oct. I 0 2003 11: 0 1 AM
GEN2 RVAN PLUMBING AflQ HEATING
No.5363 p. 69
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
i~: ~~ I PERMIT NO.3 -/L/! r I
J'Vdlow A,pptICAllC J
q>lc:.1s~ t'Vl)e Ofpnu,T. and sjp;n atbonom)
ADDRESS ZONJNG (offi<,US')
6040 Deq2..f1 dcf OJ fL &6-
LEGAL DESCRIPTION (office u,. only)
LOT II BLOCK
I ADDITION
~f1~Q 1~
PID
OWNER
(Name) DR Horton Custom Homes
(Add:rcss)
(l'hone)
%2-Q;;P,-,Bno
:20't.l.oD K.evlB~l ~ c. Sre!(;.O
Lcdu_ville- PIAN 56bLJLJ
. APPLICANT
(Name).r'o-~_t>.:.." Fl"lIl!;Oitl3 t. u__><_:
(Address) 14745 So Robert Trail
(Address)
"'m~P_) ~ Wi <; '-J},
APPLICANT SIGNATURE (l) ~ . I... P w
....
Quantity
'L
I
J
~.
I
"~
(l'hone) ~<;'-I.?~-' 11.1.
Rosemount
UN
55068
(Zip Code)
(City)
(Phone)
651-423-1144
DATE
/ ()--(O-Q '2"
APPLICANT PLEASE COMPLETE BELOW
I Type of Fixture Quantity I
I Bath Tub with or without shower Rough-ins
I Dishwasher J . I Water Heater
Floor Drain lL;C- Water Softner
Lavatory (Bathroom Sink) I Stand Pipe (Washing Machine)
Laundry Tray (lor 2 compartment sink Sewage Ejector
Shower Stall Backfiow Assembly
Sinks Backflow Assembly Test
I Bar Sink I Lawn Sprinkler
Water Closet (Toilet) I Other
I
1
I
I
I
I
j
I
I
Type of Fixture
FEE SCHEDULE
rod""".!, CommercIal & Muln-f>m'Jy 1 % of Job cost with a $3950 minimum Re.<ldennal, New One & Two-P>mtly $99..50
Re,;identiaJ, Additions & Alteration, $3950
(Office Use Only)
Estimated Cost $
Building PeJ:TDlt #
PLUJ\1BING PERMIT FEE
STATE SURCHARGE
TOTAL PE:RMIT FEE
$
$
$
50
BulldiDg OCSdo.l
I
i
PAID WiTH
~'_'H~.~. BUiLDING PERMIT
in~cfiptNO I
I" '
DOle I c nil OCT 2 8 20031 flfl t:I-- I
L /1
24 hour notice for all inspections (952) 447-985~~(952)~1~2~5~_~J ?
Tilis Application Becomes Your Building Permit When Approved
r "'.
I P~ld.
Oct.IO. 1003 I 1:01AM
GENZ RVAN PLUMBING AND HEATING
No.5 363 P 1 9
Date Rec'd
CITY .OF PRIOR LAKE
SEWER AND WATER PER.J.mT
; ~~ ~:~ I PERMIT NO'3-(l//!J
l Cold .",ppJiQ/l,t
(Please me or'Prtnt and siPJlarb01tOm)
ADDRESS
5L.1~D f\u.Rf1dd 0-( ~ Sf-
ZONING (ofliC<!..e)
LEGAL DESCRIPTION (office use ollly)
LOT ! 7 BLOCK ADDmON l:x..e-f2-n ei J q ~
PID~5- LjDO- O/'7-~)
OWNER
(Name) Di' H=tGIl. ("I~.~- ""lllC:
(phone) _ Cf52--Qgs-iRr,/\
(Addre.. )
2.ofuO ~BR...\t:6e Or- SrP.Jf'l'\
(Ad<m,,)
La~~IUe...
(CIty)
"5exJWI)
(ZiP Code)
. APPLICANT
(Name' Genz-Rvan Plumbin.l1: & Reatin",
(phone)
651-423-1144
(A~e~) 14745 So Robert Trail
Rosemount.. :M:N
(City)
55068
(Zip Co<k)
(Address)
(Contact Person) _ 0.A/'i ~is+l ~(L.~
-JC>\NT SIGNATURE _ C-<,( ~ ~ ~..I.A'\
(phone)
651-423-1.144
DATE
IO-IO....O?,
APPLICANT PLEASE COMPLETE BELOW
Size of water service inches.
Location of any couplings from structure
Type of sewer pipe. 0 ABC 0 PVC
Estimated length of sewer line feet.
Clean out (if required) located at feet from structure.
feet
o Cast Iron
Resldenl1al sewer and water line connection
Sewer connection on!y
FEE SCHEDULE
$3550 Industrial, Com'! & Multi-family 1% of Job cost with a $39.50 mmlmum
$17.50 Water connection on!y $J7.50
Estunated Cost $
Bwlding Permit #
SEWER AND WATER PERlvIIT FEE
STATE SURCHARGE
TOTAL PE~ FEE
:;
$
$
.50 PAID WITH
BUILDING PERMIT
l,Offkc UK Only)
I This Application Becomes Your Building Permit When Approved '
Builcli.ng Offic.ial
r Paid____.__-:-_____.~eccipt No.
~-"\, r; .. . 'J~';; .
I Pll,l~-, I i~(... If..
Date 1'\ :!' Ih
" Ul.fZ ~ lUUj
24 hour ootice ror.1I inspectioll3 (952) 447-98~~J.. (95.2) 447-4245 .. j!
!n./
l~=--~-
CITY OF PRIOR LAKE
REA TINGJAIR CONDITIONINGIFIREPLACE PERMIT
q>lease ~ or orint and silm at bottom)
ADDRESS ~
32/~O ~--P~b/,J /~/r/L?
= -
LEGAL DESCRIPTION (office use only)
LOTI/BLOCK I ADDITION
OWNER DR HORTON
(Name) - 20860 KENBRIDGE CT
(Address) LAKEVILLE, MN 55044
APPLICANT /7 0 .1"2.
(Name) /--f /- ~ Q 4L..,L- //7.' r.-/ ""4/'''''''' -"
(AddreSS)~ ~A.I~I t? 4
"~A~/
(Contact Person) Aez/7'-':. .
APPLICANT SIGNATURE ~ ;-,.... ~
Date Rec'd
hc/9?
--
i ;;;~" ~:~ I PERMIT NO.3.' Jl--/( ~ I
3_ Yellow Apphcant
ZONING (office us,)
..<c;
PID
(phone)
(phone) ~~~ 4~""--..I'/?~
~ .olP..A'4.t< ~.5:!- '] ?
(alJiff (Zip Code)
(phone) ~- c;/~--1?7..::2:
DATE
APPLICANT PLEASE COMPLETE BELOW
.
J!lNEW CO~TRUCnON 0 REPLACEMENT 0 ALTERA nONS
FURNACEMAKEANDMOD~/rpJ'~ :?/oAA~ FUEL J.1. ~......~-e
FLUESIZE..y'g~cARETURNOPENINGS ~ IN~iJTU I"~ OUTPUT 6"Z~~
~ .
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 Resideotial, AC Only
DWann Air Plants
DGravity
o Mechanical
~ir Conditioning
Jl'IYent. System
o Steam
D Hot Water
D Radiation
o Special Devices
o Other Devices
FIREPLACE MAKE AND MODEL
Industrial, Commercial & Multi-Family
Residential, Heating & Ale (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 $ "'- q~a::>BuildingPermit #
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
PAID WITH
tjdlLulNG PERMIT
$~/ &'.//c4./
$ ~ .50
$ 1!7
r:.:.:-=-:---
.Paid
~eceipt No.
I
, -
iff-
.Da~ov 1 2 2003
24 hour notiee for all inspections (952) 447- 1850, fax (952) 447-4245
iJy. .___'_
CITY OF PRIOR LAKE
HEA TING/ AIR CONDITIONING/FIREPLACE PE&.\HT
Date Rec'd
I. rink
2. G'-~el1
J. Yeilow
File
Ltv
Al'ulicnnt
I PERMIT :"103 --l!f/f'
I ZONING [office LIse) I
I
i
(Please tvoe or llrint and sil1;n at bottom)
I ADDRESS
I
5440 DEERFIELD CIRCLE SE
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION
PID
OWNER
(Name DR HORTON
(Phone)
(Address)
APPLICANT
(Name) AU.THl FTRFsmF DRA FTRFsmF H!'ARTH & HOM!'
(Phone)
651-1133-25111
(Address)
2700 NORTH FAIR VIEW A VENl'E
(Address)
ROSEVILLE
(City)
'5113
(Zip Code)
(Contact Person)
BRENDA Hl'STON
(Phone) _651-633-2561
APPLICANT SIGNATURE
BRENDA HUSTON
DATE
1/30/04
APPLICANT PLEASE COMPLETE BELOW
xO NEW CONSTRUCTION 0 REPLACEMENT 0 AL TERA TlONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE
RETURN OPENINGS
TYPE OF SYSTEM
o Warm Air Plants
DGravity
o Mechanical
DAir Conditioning
DVent. System
INPUT
HEATING OR POWER PLANT
D Steam
o Hot Water
o Radiation
o Special Devices
o Other Devices
OUTPUT
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
FIREPLACE MAKE AND MODEL
HEAT N GLO SL-750TR-C
Industrial, Commercial & Multi-Famiiy
FEE SCHEDULE
10/0 of job cost Residential. Gas Fireplace
539.50 minimum
599..50
564.jll
~39.51l
ResidentIaL Heating & /\le (New Construction)
Residential. Heating Only {New Constructlon'l
ReSidentiaL A,dditions & Alterations
ResidentiaL AC Only
$39.50
$39.50
Estimated Cost $
HEA TfNG PE1UvlIT FEE
STA TE SURCHARGE
TOTAL PERMIT FEE
Building Permit ~
$
$
$
.50
(Oflicc Use Only)
This Application Becomes Your Building Permit When Approved
Paid
Receipt No.
Date
Bv
i"
BlIildiul!:Official
Dale
~4 hour notice for:111 inspt'r-tiolls (952) 44'7-9850. fax (952) 447-4245
PRIOR LAKE
INSPECTION RECORD
SITE ADDRESS 51/1/t> D f!.. eY~,.e.ld Q i V
NATURE OF WORK -'lie W
USE OF BUILDING ---.S P A .
PERMIT NO. ~ - /4/5 _ DATt: ISSUED
CONTRACTOR ~I!)~ PHONE~~~ - I i3~ 41
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
INSPECT99 DATE
I FOOTING IlI1/V' I J I-/L-D> I
I FOUNDATION (Prior to Backfill) I . /~ / fW'1 11-lfr-t/3 / l/-.z.r.
PLACE NO CONCRETE UNTIL ABOVE1IAS BEEN SIGNED I :J
ROUGH - INS
MIIl.lib itl/l-tl-O--; ~('?
f1/P
Dr-
SEWER I WATER I SEPTIC
FRAMING
INSULATION
ELECTRICAL
-'"'"'
PLUMBING U fr, J/1,{'/ ;/L{ ,r '" 1- 2;!-cJe/
. HEATING (if required) Y Vj/ _ J-- Cf - tJ,- I
FIREPLACE _ vtx/ J. - q - diJ
GAS LINE AIR TEST'/I/f " I-I)-o<-{
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I I
FINALS
VB (,.. 1(,. P4.,
H#
Ii - :- t!f-
. "
) -q-(Jtj
:2//,;;/0 '/
GRADING (Prior to Sodding)
BUILDING rr-t.~ u'Itll
ELECTRICAL
PLUMBING
HEATING
DO NOT
4. +,,~
, -
cfY/ Z/oy
_ A
ryr
,.JVV7
OCCUPY UNTIL ABOVE HAS
NOTICE
2-);;-d0/
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.
FOR ALL INSPECTIONS (952) 447-9850
QItrfifitaft of @ttupanty
CITY OF PRIOR LAKE
~eparftUenf of ~uil~ing Jlnspedion
P Final Permitted D Conditional C.O. Expires _
This Certificate issued pursuant 10 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._
03-1415
Occupancy Type R3 Type Construction VN
Legal Description L 17, B 1, DEERFIELD 9TH
Fire Zone N/ A
Zoning District
R2
ROBERT D. HUTCHINS
~/ 2~?OffiCial
HORTON, INC." 20860 KENBRIDGE
/~J- ~ City Planner.
Site Address 5440 DEERFIELD CIRCLE S.E.
CT., SUITE 100. LAKEVILLE
Owner of Building
Contractor's Name & Ad~st R.
DON RYE
Date:
Date:
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
s~~o
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
~NSULATION
IHAL
o SITE INSPECTION
COMMENTS:
~
/'Y 7E TIME
SCHEDULED ~,2~
a e/-fl II c;,
CONTR.
PERMIT NO.
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
/i /
//,vt'?/
----
( ~/
~/o...se
~/
Ule.
CJ3-/Wj-
o EXIGRADIFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
-~::::::::::::---
" )'\
~
kJ;,
~ WORK SATISFACTORY, PROCEED
!;j-- CORRECT ACTION AND PROCEED
o CORRECT WOR~~ c~:7FOR RElNSPECTION BEFORE COVERING
Inspector: F~ Owner/Contr:
r
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE,
conE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH of SAFETY!
INS/f.,.,
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
S'I'IO
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
CB-RNAL
o SITE INSPECTION
DATE TlIIE
SCHEDULED t. -/I-(j'f
D.a.rr:/'e,/I C/ 'I
CONTR. l> R./M.....
PERMIT NO. D:J . I t./ I r
o PLUMBING RI
o MECH RJ
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
')t{ ~ILLlNG
" O'cOMlif:AiNT
o FIREPLACE RJ
o FIREPLACE FINAL
o GASLINE AIR TST
o
COMMENTS:
bre.e/,'IJ: f) f
C.V I!:J R "'"'" ,'.5 - c9 r
(9( WORK SATISFACTORY. PROCEED
V 0 boRREcT ACTION AND PROCEED
o CORRECT WORK. CALL FOR REINSPECTION BEFORE COVERING
Inspect4-- - _ Owner/Contr:
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE..
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
"'SNOn
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
.9lLfO
f1..,h:. !:J
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
..l!F1>t:oMBING FINAL
o MECH FINAL
COMMENTS:
(r) ('( 1A1" I
;'drf> UpS
CA TE TIME
~.,!./; t'y /
:Z-If(\
o EXIGRADIFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
o WORK SATISFACTORY, PROCEED
~ORRECT ACTION AND PROCEED
o CORRECT '7t,";P"L FOR RElNSPECTlON BEFORE COVERING
Inspector: 4-1{" Owner/Contr:
CALL 447-9850 FOR THF. NEXT INSPECTION 24 HOURS IN ADVANCE,
lJiSNOTJ
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SIIFETY!