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HomeMy WebLinkAboutBuilding Permit 00-1066 CITY OF PRIOR LAKE BUILDING PERMIT, TEMPORARY CERTIFICATE OF ZONING COMPLIANCE AND UTILITY CONNECTION PERMIT (Please tvD~ or orint and sign at bottom) ADDRESS /7 dt./9 ~.t~Jd OV/Vi' .51-' Date Rec' d 1\-13 -DO PERMITNOOOOL f;:;ffiCO">C) I I. White 2. Pink J. Yellow File City Applicant LEGAL DESCRIPTION (office use only) LOT '1'BLOCK .:< ADDITION bU....,./i~dJ 2..'/ OWNER (Name) (Address) PID 25-372-6#-0 . , (Phone) BUILDER (Name) n.~. l.4y../w,.:z::::. t.. -IhJJ (Address) 3'-/S'j W(JSk".t/h,~ DviVl. sJ..- v . ~ New Construction OLower Level Finish TYPE OF WORK o Misc. ODeck o Fireplace (Phone) ~5 /- ;!.5Z - 7J. '? I_ ::;;')~f':l'I. /74/ ~/.;2:J OPorch ORe-Roofing ORe-Siding OAddition OAlteration PROJECT COST IV ALUE (excluding land) $ 9t? X'oS- OUtility 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 local1aws 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 enter u~ prol)O~ to ~rform needed i?,pec",. ( X ~/A /I/dh~ ,.:lo/){)St.S7 //-.2-00 Signature Contractor's License No. Date Permit Fee $ Plan Check Fee $ State Surcharge $ Penalty $ Plumbing Permit Fee $ Mechanical Permit Fee $ Sewer & Water Permit Fee $ Gas Fireplace Permit Fee $ "'t/,ooo 83\. 00 I I Park Support Fee # S'tO. IJ& rs- I SAC # ~. 50 Water Meter SizeSI8"; I"; Pressure Reducer I ~O 0r3 /00 00 ~5.S0 </0. (X) ~n BeCrOUr BUddm;I~~;t.:;roved Building ~al Date , Sewer/Water Connection Fee # # $ ASD.OI) I $ 'llOO.dol $ 4s.t::t:)), $ ~ I~.OO I $ I. :100 .~I $ -70(). ~~I $ () I $ - I $5,7/Z. IS I I Receiptj;(:l3.f" c:[ 7 7 By /AIV - Ii' This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may'froceed 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 ~ss"e. ~. ,-4U-> ' anning Director I Water Tower Fee I Builder's Deposit I Other I TOTAL DUE I Paid 671.2-, I r I Date 1'2,_ 1 /V" ,lU ~ lUv(~ ~~~~~:. 24 hour notice for all inspections (952) 447-9850, fax (95-2) 447-4245 r , The C~"ntl'r ()f the I.."',. COllnlry White . Building Canary . Engineering Pink . Planning NAME OF APPLICANT BUILDING PERMIT APPLICATION DEPARTMENT CHECKUS1: f) t~~ ft0 (~ I U I\J I f - '3 . (J() APPLICATION RECEIVED The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: tlZ4CI DF.:EAC. Flt:.-L f') Dl2... I Accepted Accepted With Corrections ~ Denied Reviewed By: Sr AA-. !~.L4"~ Comments: ~ lMA.~ V~~S{~ .~_~ L72c.{,~ ~pAld~. ~ 0~~~~~t'Al,k.~, Date: L!)-/6/6O "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." White . Building Canary . Engineering Pink . Planning Tht Crnlrr of Ihr L.b eoune!')' BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT APPLICATION RECEIVED D R- /fore i (jf\) I 1- I 3 - () n - I The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: 17~4C? DS6f2..F(t:"LO DR.. . / ./ Accepted Accepted With Corrections Denied Reviewed By: Lit- Date: 12/0/a7 I Comments: ~ /JJ/lIA/ ~Glf ()7243~f/BP) ~ G-Pl//lEA/73- . - "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." ~~ White - Building Canary - Engineering Pink - Planning Th"C..n...roflh"r..bCounlry BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT APPLICATION RECEIVED 1) Ie- rtoe I Of\} 1/-/3-()() I The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: /77.44 D8EAcFfSLr) DR.. . / Accepted '/- Accepted With Corrections Denied (J Iu j) Reviewed By: ~~7- A Comments: See.. 1'D43 CbrPrJJ Dr. ~ p{/V-Q,. : Sorv'b- ~~. rtc... Date: 11-2/-2ooc "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." CITY OF PRIOR LAKE MC 1620D Eagle CreekAv. S.E. Perm~ ND. 00 -I OftJ(P Prior Lake, MN 5.5372 HEATING APPUCATlON I PERMIT . Z-12-D 101 PIDII Site Address '1l-L\ql)p1.I~-hf/iol1)y- Lot -!l. Block 1- AddftiDn Owner's Name l)Q rlL:.V+U Y\ Address 3Lt{1 \N n. s, hj V\i'\hn~v Uy -t Zb ~ Heating Contractor A IlICl11-r fr\F.tfJlrj au Address 3i"SD j0r)VIL1;Jf'(~1)rl:J:: i UWlI))! MM 55/2-2.- Telephone II LiSl 4-02 - 2-115 J Furnace Make & Model f3 i"v\i1n+- TYPE OF SYSTEM . '2. Q 2. i, (1\ i in ~, I L"7 c' , Warm Air Plants Model Size . ) J ,.1 N1 Ii J L- '-t' '. Gravity Conn. load 1_1, <:SLJCI Mochanical .. . ill t' . - Air Concfftioning j)ViAr.L/1f '2- tT-J(1 Fuel l\JCid-' AueSize 'T' G!(LSc.,]jVonlSystem_2.-6uGFM.Raih Supply Openings S HEATING OR POWER PLANT-fvJlS )~ Steam 'j HOlWaler Radiation Spe::;al Devices Date 0J.1Wf: NUv' . - .f !:J"S121- Return Openings '1 f\ ",'(7' Input 'c. ,;UI, Output 5 Ll, F!:;[) Edr. CIm. gut Other Devices TYPE OF WORK Alteralions v Replacement New Construction Repair Est. Cost $ Est. Comp. Date .-, 01-' " '-"". I I \, I ;J' I.., _,,'.......'-' Buiding Permn II ()O - / (}fd~ HEATING PEAMrTFEE$ STATE SURCHARGE $ TOTAL PERMIT FEES $ .50 . f'A\O '-NII~. .- ReOe1p1 # .eUl\.D\NG 'rC'-""" ~ TYPE OF STRUCTURE I. Pink 2. Orotll 3. \'eu.w , . Rio Cry eo._ Single Family Commercial 1..--/' , . . . Two-Fam~y Industrial Multi-FamDy. . Other Public , < " . . F~ Schedule Imlus1rial, Commerejal & Multi-Family Residential, Heaf"'9 & AC Residential, Heating Only Residential, Gas Fireplace Residential, Adallions & Alterations Residential, AC Only . c 1%'of job cost (S39.50 minimum) " $99.50 PLEASE NOTE: ~ $64.50 Air Conditioner Units Carull c $39.50 Encroach Into Reqllired SidE ~ $39.5C Yard Setbacks_ ~ $39.5C ~ . . Remember to add the State Surcharge on !he bottom of this application. Tbe po". of your heating permit'lncludes one rough-in and one final inspection. Additionellnspections wDi be billed at $35.00 each. House Healing Test Record must be submitted with IluiImmlIlmmi! number before build- ing certificate of occupancy will be Issued. J:lfAI CALCUI ATIOr.JS REQUIREO with number 01 suppiy and retwn openings listed per room with CFM's per opening. New structures Dr additions send floor plan with supply and return locations shown. HEAT LOSS CALCULATIONS, PAYMENT AND APPLICATIONS MAY BE MAILED TO THE CITY OF PRIOR LAKE, 15200 EAGLE CREEK AVE. S.E. PRIOR LAKE, MN 55372. City HaD business hours are 8 a_m. - 4:30 p.m. ALL WORK MUST BE INSPECTED (ROUGH-IN AND FINAL) - CAl.L CITY HALL 447~ c ~ ~ ~ c " , ~ ~ c ~ c > ~ ~ I hereby apply for a mechanical systems permit and I acknowledge Ihat the information above is complete and accurate; that the work will be in conformance wfth the ordinances and codes of the oity and with the state buHdingfmechanical codes; that this form does not become a permit until signed by lhe BUILDING OFFICIAL; that the work will be in accordance with the approved plan in the case of an work whic:l1 requires review and approval of plans. {'uJ1.iU~r~n~ /~) 9t~Pr(lj/~ Building ,fical's Signature I '" J "7 )\ .Ii , } 1:- /.A/. L I Date ?' U -0 I Date ~ <:: <:: '" PL _ FAy: 447- 4248" JAN. 9.2001 12: 34PM GENZ RYAN 6513226147 NO. 225----p.2----- ~. i' '., ,.' ~ ..;;;1 , .~T" ''\ f" ,.:'..'/ _. .... ....-. _lIT ... . CI" ;. , NO, fJO ~ IOiPiP CITY OF PRIOR LAKE SEWER ANe WATER PERMIT NOTE: Sewer and water . contractors must 1:Ie req1stered with t~e City. APP!.ICANT: 1".-.,,0. ~ rI PI.. .".,bl~:""- u.".,../A In. PHONE:..li?~1-1J.2:!.-Iil.jL.j AeeR:eSS:'l~"LlE,~~Q.r -r..., t?.....'."",''''r rrCllJl.DATE: I~ SIGNATtJRE:-1A.. .Y.\. ~. . BLOG. PERMIT:' . SITE ADDRESS: \~~~OY"~IDiI ! .. '. " . tILL IN THE BLANXS' 4o' 1. Estimated ienith o~'water servlce , I \~ Size of water service inch(e~). feet.. 2. 3. Location of any couplinqs from s~ructure feet. 4. : PVC)( . /IT"\' of sewer iin.~_ I required), . located at Type of sewer pipe. ABS Cast Iron feet. 5. 6. Estimated len9th , '. Clean out. (~f .tructure. ; feet frqm' , ' . ~ i ::::B~====_~~~~_ --~-~-S==-~=-----==-~r---'-'I!!;=:====- -===...-- --~~===== your permit when approved. I.-t!/O" This appUcatio BY e~TE: . . i ===a==;;==~= _____ ~===-=:e==_1=--~s==--~"---====----- ----_~~====____.._ae.===== FEES: $ , $ $ 35.00 .50 35.50 -' Sewer and .loI'llter line connection perm,it. . Surcharqe . t . TOTAL ., ., Fee for either sewe~ or water individually is $20~od: plu. $ .50 surcharqe. Sewer and water permits issued for new ccnstruction 'must be recorded on the bu~dinq permit card at the time of issuance to insure that no duplicata ~ewer and water permits! ~re iSIS~ed. -. . I DATE PAiD '. AMOUNT PAID f'~\O \N~p.M\\ . eU\\.V~- : . . RECEIPT lJ REC'O BY . 4629 Dakota 51. 5.E., Prior Lake, Mlmaotil 55372 I Ph. (612) 447-4230 I Fax (612) 447424.5 AN EQUJ\~ QppClI'n.JN1TY I!MPWI'EI\ JAN. 9.2001 12:35PM 1'1It ell"''' ~.ltw IMt CeqItl17 Quantity I I I J__ \ \. :\ 2- I I ~ :~. 'i~'Y 2- . ..,;."~~ ; : ..'. ',......;' ~ GENZ RYAN 65132261~7 NO. 225 P.3 , CITY OF PRIOR LAKE ~ =- Ea;... . PLUMBING PERMIT # 00- /o(P~ APPI~cant: p..~]-- ~.-ln ill , ~'Jon",e,_.: lo~~4~f"Lr:t Add.....: .. '. W,j lJ.~.~~!P r .!...K. ~ _.:m:s~ Signall.lre: \A. jI(""1I ~...-.- I Legalo..criptlon: Lr;t' L..\- Bleck z.. Sub tvp"Rt&. D 211"\ (.) SiteAddreee;' 1"''2.L\.~ ~n 'il~ ~ Building Permit * PIO * NOT.E: Thi. permit will not be processedwitnout complete information. - I , FIXTURE UNITS -.' Type ot Fixture Bath Tub with or without shower Dishwasher l=Iaar Oraln ' ~atory (ball1room si!llc) uundry Tray (1 or 2 campiutment sink) Shower Stall Sinks Bar Sink Weier ClasEll (tallet) . Quantity Thi. pem,il is 1"8IlbKI upon th. ""pr... <anditlbn that .ald <annetor, oball comply in all rapeou wilh thd oftlln.nccs ; o~lho Sta.. Plumbi"!.,'thi1 Of. . arrr lI/IlCIIclmenli th~f. ~ "'i~~q,o., pATS " _ ATTIlST . ClIU for all in.pet ~onl 24 hours in advan~. 16200 Bllgle Creek Av_ S.E., Prior take, Minneso1ll55372/ ~h. (612) 447-4230/ FAX (612) 447-4245 . All Eqllll OPllollUnity Employer . f ~_I, I. .' FEE SCHEDULE: . . . , Ind~lItrlal, Commercial & MUlti-Family (1~ of job cast, $311.50 minirnum) Residential. New One & Two Family Rllliidenlial. Additlon'l & Alterationl i ~te Surcharge $99.50 $39.50 . ,- GRAND TOTAL Type of Flldure Rougn-ins Water Heater Water Softner Stand Pipe (washing machine) Sewage Ejectar . . , 1 . Backffow Asumbl)' (RPZ, Double ChICk, PVBf I , Backflow A..embly Test . .J Lawn Sprinkler Other $ $ $ $ .50 . PAID wrn-\ :T $ Sl lIlDING PERM~ " ~ FIRESIDE CORNER #4549 P.OD5/005 CITY OF PRIOR LAKE Date Rec'd HEATING/AJR CONDmONINGIFIREPLACE PERMIT , MAY I 5 2001 1,"ilW. ,...... " y.na., s.... I PERMIT NO; 0"::/00 G 1 (Plea.. ~ or orin' and,\... or b"""m) ADDRESS ) 7 .p-/q ..s:? I ZONING (_""', DI dJ~,t:J~ () LEGAL DESClUPTION (otIlco US< only) LOT t/ BLOCK ;< ADDmON /kAJd&:J-Nd // Plr;>:;(5- ~7;;2- UI'?J . OWNER (Name) 7J ;2. ~ (phone) (.A<llhess) APPUCANT (Name) AIJ:.IED FIllESIPE PBA E'IllESIDE COIlNER (Phone) 651-633-2561 (Addres.) 2700 N. FAIlWIEW AliENI'''' (Add=<l BRmDA IlOSTaN.--l (Contact Per.on) 7 / APPLICANT SIGNATURE /,{A!td1 1/~ - ~ APPLICANT PLEASE COMPLl~TE BELOW ~W CONSTRUCTION 0 REPLACEMENt 0 AI.. TERA nONS FURNACE MAKE AND MODEL FUEL FWE SIZE . RETURN OPENINGS INPUT OUTPUT TYPE OF " L" I. r.,,{ SEATING OR POWER PLANT ':]W3tlD Air PllUlts J Slc1m JGravity J Hot War.or J MechMicol J lladllllon JAir Condllioning J Sp..laI Device. OVent Sy'll:m J Olher Devices deu tV fat.. ~"F.lTTT,r.'" ""'" (CIr;y) 651-633-2561 5~\" (:zip CocIo) (Phone) DATE ,r;,/r-" PLEASE NOTE: Air Conditioner Units CWIlIot EncroQ<;!l inlD Required Side Y.rd Setbocks FIREPLACE MA.KE AND MODEL ~l- 7Jll 71r!r~ IndUllrial. Commcn:iol \9. Multl-f"",ily FEE SCHEDULE 1% of job cost Residential, Gas Fireplace 539.'0 minim'nD $99,'0 Re.ldcnllll!, Addillon. & AllenUions $6'00 Rc:sfdentlal, AC Oniy $3950 Residenti.l. Hearing & AlC (Ne,", CDnslTUClion) Residential. HCllIing Only (N.,., ConmruClicn) $3950 S39.50 E.timatcd Cost S Building Pcnnit # HEATING PERMIT FEE $ STATE SURCHARGE $ .50 TOTAL PERMIT FEE S 13Ul'l.DPA,ID Ii!.. INO " F-. '-, (Office UlIe Onln Thi. Application Becomes Your Building Per", It When Approved Jlo<lIdln~ Ollid.1 Ila.. I~ I Date::J15_01 ~ec~ By J 114 I - ~4 bour nolleo f.r '1IIn.poetl.n. (95Z) 447-9350, Ill. (952) <447-4%4S PRIOR LAKE INSPECTION RECORD SITE ADDRESS /'7'1 qtj j;},ar[-e1J Or, NATURE OF WORK jili>L"\ USE OF BUILDING-SFj:\ PERMIT NO. 00 .I~ DATE ISSUED (1- 21-2a::Jo CONTRACTOR------rrrz. HC'\~ c,JI- ~-c..... 7/3(. NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW THE PERMIT IS BY SEPARATE DOCUMENT . DEPARTMENT OF BUILDING AND INSPECTION I FOOTING gi,SPECTOR 1//'1 ,0 ~ATE I FOUNDATION (Prior to Backfill)r^);... I ~ 1I11o11'l1 11A-. 1/;.1/D( J ~. PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ROUGH - INS SEWER I WATER I SEPTIC FRAMING INSULATION ELECTRICAL PLUMBING ~ /l.a.., t.(w-g/fJ! fb:r. 9aqftJl HEATING (ifrequired)""f'J.A I/t.ithi gh ~ &.. L.( /~~ ;/'/)/ . iN blltA. FIREPLACE ' I ~ \l~ {gl "iO\ ' GAS LINE AIR TEST o/^' ~(f, f?R \ /;:1/5-'kN COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED I ~ 41~ I 13:J--. I ~/3blol - ./ FINALS . 1.J".. fIir, l b}l~lol bi(t{~ / GRADING (Prior to Sodding) BUILDINGT.C.f.l. ..0.J "Jkf/~1 fS1. 8/11/0/ ELECTRICAL PLUMBING HEATING DO NOT OCCUPY 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 have been approved. On buildings and additions where no service cabinet is available, card shall be placed near main entrance. v1AJl;" ~ I l i~/ 0 J Call between 8:00 and 9:00 A.M. for all inspections FOR ALL INSPECTIONS (612) 447-9850 (~_",j~.~, -,''W,',~=,~,~,~, -'~l=,;",,,,_ .~I~.~ i~"~'''''''-'''Vjd",'''''' ~,~.- (. ~'.---: ~ ,',r '~:'l\ri~""....,~""''''' ~..('....~.jllt:...t.~....~ '~-"4~':"- ;, ~. ! ~trtifi(au of ~(mpanry ); : CITY OF PRIOR LAKE jDepartment of .uUlIing Jn~pettion ,I3l.Final PermittCd 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 Lqke regulating building construction or use. For the following: SINGLE EMILY 00-1066 Occupancy Type R3 Type Construction VN . Fire Zone N/A Zoning District Rl I I I I I I I I I I I I I I .I Use Classification Bldg. Permit No. Legal Description L4, B2. DEERFIELD SECOND Owner of Building C;;itc Address 11249 DEER FIELD DRIVE S.E. C . N L .""-- 0 R HORTON. 3tl59 WASHINGTO", -----"..... ame~~__-' . !l 'l P.OBERT D. HUTCHINS 1 i/f" CityPlllllller Building Official 1- J- (ji..1 DR. SUITE 204. EAGAN. 55122 !JON RYE Dare: Date: POST IN A CONSPICUOUS PLACE DATE TIME CITY OF PRIOR LAKE INSPECTION NOTICE SCHEDULEO j -J,-<J 1# ADDRESS /7}..t.{Q ~~/+;T Ie' OWNER CONTR. PHONE NO. PERMIT NO. OJ-fOCal. 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 o PLUMBING FINAL o MECH FINAL ~)C~ / 1H~- J o EXIGRAD/FILLlNG o COMPLAINT o FIREPLACE RI o FIREPLACE FINAL o GASLINE AIR TST o COMMENTS: ~~~. //" / /O~ ~ ~. - --~') 11 nLR ./ --------- ~RK SATISFACTORY, PROCEED o CORRECT ACTION AND PROCEED o CORRECT WO~K, ~ FOR REINSPECTION BEFORE COVERING Inspector: I~ Owner/Contr: CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE. CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY! '''''''''' DATE TIME CITY OF PRIOR LAKE INSPECTION NOTICE ADDRESS /7,;).<19 SCHEDULED ~ N~ &, /1, 00 , :~cJ OWNER CONTR. PHONE NO. PERMIT NO. tJo-/O/pf" o PLUMBING RI o MECH Rl o WATER HOOKUP o SEWER HOOKUP I.i\Il! PLUMBING FINAL I!\I~ MECH FINAL cq. MMENTS: "R-:k, C!J~ c?J $oQ tf/~ o FOOTING o FOUNDA nON o FRAMING o lNSULATio~ ~FINAL (f 1'lY)! b SITE lNSh::v "uN o EXiGRAD/FILLlNG o COMPLAINT o FIREPLACE RI o FIREPLACE FINAL o GAS LINE AIR TST o ~ -11J1 A">- ~ ~~~. . --~----- ... , ( ( > C, o. -G.J.f 1/ S1a / o WORK SATISFACTORY, PROCEED ?,CORRECT ACTION AND PROCEED o CORRECT WORKj"'LL FOR REINSPECTlON BEFORE COVERING Inspector: ;.,;r:; I OwnerfContr: f CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE. CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI INSNOTl CITY OF PRIOR LAKE INSPECTION NOTICE ADDRESS IIJJL/9 OWNER PHONE NO. o FOOTING o FOUNDATION o FRAMING o INSULATION . o FINAL o SITE INSPECTION COMMENTS: SCHEDULED ~ CONTR. PERMIT NO. o PLUMBING RI o MECH RI ~WATER HOOKUP o SEWER HOOKUP LUMBING FINAL o MECH FINAL ~-~ ~-~ ~/v~ ~ DATE TIME 7P-'fol '1.--:'30 f}~ -di/IIJ I() (~(,., o EX/GRAD/FILLING o COMPLAINT o FIREPLACE Rl o FIREPLACE FINAL o GASLINE AIR TST o o WORK SATISFACTORY, PROCEED ~ 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 & SAFETYI INSNOT.r