HomeMy WebLinkAboutBuilding Permit 03-1077
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec'd
7- (g. 03
:~i~:' ~::y I PERMITNO'Q)j_/"7-71
3. Yellow Applicaot ~ U
(Please.!vt>e or vrint and sign at bottom)
ADDRESS ZONING (office use)
6'-1-34 "l\.u~eLL~rdL ~ ;eZ.
LEGAL DESCRIPTION (office use only)
LOTI!? BLOCK I ADDITION 1\,(1 f-~I'.1 J 9Tl-v' PID Z5 dOC). ()/5. 0
OWNER
(Name)
(Phone)
(Address)
BUILDE~I () 1.l. A...... .....,.....,
(Name) UK. ~ {l7Y'1 ITYl l.i1c,
(Contact Name) (')h,...I,.p. r Tl ( \U;rNl
(Address) l.b raIL D ~( i/I }-)" ('dOtC c.+. ~t'.e ,I OtJ
UJ/ A/\ n l' f~/lA ^--' g;)) Ill}
(Phone) "'f,L.'4g<;'-I~IJ6
(Phone) 351 . 2-2./.p - e.J~
~ New Construction
TYPE OF WORK
DDeck
DPorch
DAddition
ORe-Roofing
ORe-Siding
DLower Level Finish
o Fireplace
DAlteration
OUtility Connection
\()If lf11
o Misc.
PROJECT COST IV ALUE (excluding land) $
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 l-'.v!-'.....) and that all construction will conform to all existing state and local laws and will proceed in accordance with
submitted plans. I am a'oJ@fe that the building official can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may
;ter~i~)i~'t;.~:r ,..,.')0005lPS:-7 '7-I'-I-{).J,
Signature Contractor's License No. Date
v
I Permit Valuation
I Pennit Fee
I Plan Check Fee
I State Surcharge
I Penalty
I Plumbing Permit Fee
\ Mechanical Permit Fee
I Sewer & Water Permit Fee
I Gas Fireplace Permit Fee
rlil)p BalJ.ool
$ /rf~? $"51
$ . &'75.014 I
$ ,C)~,t)a I
$ I
$ /aO.~O I
$ /00.00 I
$ , ~""l. 5'0 I
$ J,/ll,dO I
I Park Support Fee
I SAC ---=.-
I Water Meter (SiZe 5/8")1";
I Pressure Reducer
I City SAC and WAC
I Water Tower Fee
I Builder's Deposit
I Other
I TOTAL DUE
$
$
$
$
$
$
$
$
8"';<)6. at)
J 27S. 00
2-$"0. DO
LfS.'DO
I-zo.::>. 00
700.00
#
#
#
#
$~,..J' c,,3 _ / I
I R~cei~o. 4-[,>.fu
BV(/ .
This Application Becomes Your Building Permit When Approved
~ ~ Jl7~3
"7(P 7_ II
Y .IS, t.5)
Paid
Date
Building Official
Date
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
~7-~ W7'&:3
"Date Special Conditions, if any
24 hour uotice for all inspections (952) 447.9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
Planning Director
'..'"
..
Address (l)3 if Ikr~ eo" r
Heating Contractor J1I~ IkFW
Name of Tester ~.... ~
Percent CO
Percent C02
Stack Temp
/1-'4<{-t!J)
q.D t:-o
t!~
(p,11"
,~~ I of
Date
Percent 02
.
Combustion air is adequateiy supplied per
UMC Sec 606 y.es
input 8QD::f) ~J -
/
.~
~~
While . Building
Canary . En!'{ineering
~k . Planniilg>
Tht Ctnlft of lhp L.llp COUnlf)'
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLI!;T
NAME OF APPLICANT
APPLICATION RECEIVED
/1 /c/ l/r'-) ( o~--j
-/ /6.6?
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at: .
4 /,. '..-
,r:"-::> /..../
.) ',4- , fJ ( )/U"-(c~>L
// /.
( (/ (',LC
--'
Accepted
/
Accepted With Corrections
Denied
r
.~
Reviewed By:
tomments:
~
9-~
Date:
fl7~ 3
, .
.
f
"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."
~\
---;"'"I'tlfll& tlUIIOIn9.)
l;anary . Engineering
Pink . Planning
Th~ (.~nl..r of lh.. 1,8kf Counlr,"
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
IQ IC /::ku ~
-Z /f1,o?
I
The Building, Engineering, and Planning Departments have reviewed the building permit
apP~~;;f~;;structi2b~~~w:::Me~ at: 0A ~A ~
.t rJ-~---
/
Accepted
Accepted With Corrections
Denied
C V /J J __. :
Reviewed By: ~~
7~
Date:
Pl7la3
I .
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."
~~
Sff. y{\Aj}J f<tL-k
Tbll' Cmlff of fhll' Lab <,'ounlry
White - Builllinq
.::eanarv - Enginee~
~ --. t"lannlng
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
!(j;. {::' L./ ~(. (')--1
I ~. ~- L /.
--7 I,A} 0'::>
/. 1:1. J
I
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at: '
C4:::>4- /f'/ r /', (;: /~./)/
'_} j . ....... . 'f--.i.( I /~.(.~- /~ (A.. f.. .'k.J?... .I
1/
Accepted
x
Accepted With Corrections
Denied
Reviewed By:
Comments:
~~-^
Date:
1!1.--'"L-! 03
"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."
! 'I: i d. : 0 I) 1 i: 1 :]Pi,i
GENZ RVAN PLUMBiNG AND HEATiNG
ik:763 P 6 id
CITY,OF PRIOR L.u<:E
SEWER AND WATERPER1\lIT
.;,~~.\:~~~"
Date Rec'd
~ :; .
i,fc/:
~~....:, .~.
(Please typ~ or vrin( and. SJE':!1 <It bottom)
ADDRESS
51-/8'-1
- ~..
IJuRAeJ-d ~ ~
ZONlNG (om::;'us'iJ:_ .... .
./1
LEGAL DESCRlPTION (ollice Uk only)
LOT I-c:JBLOCK I ADDITION ~/:.fidA q-/h
Pill
OWNER
(Name) DR llQrtl>ll .c.."stcm "nwa~
(phone) _ ctS2- - q 85- I g ,",1\
(Address)
208..cO Ke.v"1PKI!:Ce Or S-n:>JI1r.
(Addte<,)
La~..\Jille...
(City)
"5C1'f--l L!
(Zio Code)
>.PPLICANT
(Name) Genz-Ryan Plumbing & Heatin~
(phone)
651-423-1144
Address) 14745
..~JCAl'IT SIGNATlJRE
So Robert Trai1
Qh~~0i fo?lir
Cd l LZ1Ej ~ 1t./7
Rosemount. HN
(City)
55068
(Zip Code)
COP tact Person) .
(phone) 651-423-1144
DATE _7.-ff(~
A.PPLICANT PLEASE COM:PLETE BELOW
Size of water service inches.
Location of any couplings from structure
Type of se\Ver pipe. 0 ABC 0 PVC
Estimated length of sewer line feet.
Clean out (ifrequired) located at feet from structure.
feet.
o Cast Iron
esidential sewer a:od water lme connection
~wer connection only
FEE SCHEDULE
$35.50 Industrial, Com'J & Multi-fimuly 1% of job cost WIth a .$09.50 minimum
$17.50 Water cOrlllectWn ouly $] 7.50
EstlIDated Cost $
Building Pewit #
SEWER AND WATER PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$'
$
PAID WITH
atftLDING PERMIT
i
ffiCL UU Oaly)
rhis Application Becomes Your Building Permit Wllen Approved
Buitdi~ Official
Date
~~~@ ~ ~ ill ~ ll1
U~ DAUG i 8 Z003 ~ll By
Receipt N Q.
24 hour notice for all in'pection. (952) 4.1 '-9850, f:u: (952) 447-4245
By
{~'
€~
.~1":",.. ,~frIN O<~
'~;~~\~'~;- '~\\'::'. HE 5
'<l'~"
'.~-,~'~iil.\~"f:'
~"'.""':.~\~
j III i 3 ~ 0 0 J i ~ :] 3PM
GENZ RVAN PLUMBING A~D HEATING'
IIG~76JP 7 '1
Date Rcc'd
CITY OF PRIOR LAKE PLUMBING PERMIT
;.'
,tt,~' .~
~d,
:kf
Af~':"'"
:....,.....""'"i '.
~__..~.~,./ l
:""-i"Jf{:i;',.
',<,~-~
I PERMI. l' Nri4J. -":",,:,:' --~~'~.' .
. ,.. "/O-"J
-- I !: .1
\. Blue FIla
;!.. GOlA Cil:Y
~ Ylilow .'-flplOr.Jnt
(P1~ase' tV'De or 'Orint and Si~ll at boa'01:n)
ADDRESS
o 4,~L/ /Jil(<. fi<tJct
-",
tCR
I ZONTNG(~,~C)J,
Sf.
LEGAL DESCRll''110N (office US< only)
LOT l(;LOCK I ADDITION !ltJAf..hM~ qpv
PlD
OWNER
(Name) DR Horton. Custom Homes (Phone)
QS2-CfxF,-7'6DD
:Address)' 2O'S.~O KeV']5~1 DGG CO Sre! DO
uduvt!IG itlAN EfuLjLl-
,^>1'PLICANT
(Name:)-G~"'-"r"-
Address) 14745 So Robert Trail
CAddress)
CoPtaCt person) f'J0 ~f~ +-/ h lA,s
lJ>PLICANT SIGNATURE _,_CiA. ' ..~
Quantity
d<
I
J
."3'
f
I
r-2
'0,......1-........'2' 1:. u"""-".."'.....o-
- ~
(phone) _.65.'-6? 0_ 1~,;!"
Rosemount
MIl
55068
(Zip Code)
(City)
~//J
(phone)
651-423-1144
DATE
;- /rf~o~
APPLICANT PLEASE COMPL.ETE BELOW
I Type of Fixture
Bath Tub with or without shower
Dishwasher
Floor Drain
Lavatory (Bathroom Sink)
Laundry Tray (lor 2 compartment sink
Shower Stall
I Sinks
Bar Sink
I Water Closet (Toilet)
Quantity
.3
j
It! "" 1.-
\
Type of Fixture
Rough-ins
Water Heater
Wawr Softo.er
Stand Pipe (VI asID!) g Machine)
Sew~e Ejector
Backfiow Assembly
Backflow Assembly Test
Lawn SpriJ1kler
I Other
FEE SW1LlJULE
Industrull, Comm"",,.j &. Mulu-famlly 1 % of Job CO" ""Ib a 53950 mmimum Residential, New One &: Two-Fanlll)' $99,50
Residential, Addllions &. Alterations $39.50
Esnmated Cost $
Bullding Permit #
~AID WITH
eulLDING PERMIT
.50
,
i
PLUJyIBlNG PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
tlic. U.. Ooly)
This AppliC3tion Becomes Your Building Permit When Approved
Bbildiog Ofl'icisJ
D.",
-~If@ ~ UW .~ . 11\ Receipt No,
~l )atAUG 1 8 2003 l!\BY
24 hour ootice for .11 io'pectio", (9SJ) 447- '850, fa:< (?5J) 4474245
By----:_:-c".
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONlNGIFIREPLACE PERMIT
Date Rec'd
~3/9
E!~i~t I PERMIT NO. 03-/0711
I. Pink
2.Gfeen
3, Yellow
~1ease ~or orint and sign at bottom)
ADDRESS
5Z/~1 /kL/h-// (}///" 5E
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOr~BLOCK / ADDITION
PID
OWNER DR HORTON
(Name) - 20860 KENBRIDGE CT
(Address) LAKEVILLE, MN 55044
(phone)
APPLICANT /'J, /. ~
(Name\ /-7'///P~ /AJ'/"../A4/r-./
(Address) L-~~ ~~~" '" /2r.
~AddreS
(Contact Person) A~ . ~ ~
APPLICANTSIGNATURE. _ ;7" ~ - _
(phone) h,5/.. q.:r,j'-'p.?7~
,..c; .~ ~.5: i.1 "'J
- (~ (Zip Code)
(phone) ~/- q~-~77.:2:
DATE
, APPLICANT PLEASE COMPLETE BELOW
j;!lNEWCO~TRUCTION o REPLACEMENT DALTERATH?NS-1,
FURNACEMAKEANDMOD~/r'-,;~. :?/O/-JA~ FUEL d. ~.:..-.e
FLUESIZE.y~.Az~.A RETURN OPENINGS ~ INPut6~ ~ OUTPUT ~~t:...v "
TYPE OF SYSTEM HEATING OR POWER PLANT
DWann Air Plants
DGravity
o Mechanical
~ir Conditioning
~ent. System
o Stearn
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
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 & NC (New Construction)
Residential, Heating Only (New Construction)
$39.50
$39.50
Estimated Cost $ ~ a::> Building Permit # 'lNrt"""
, L? PA\O Ef\~\1
$~/ ~...../~\NG"
$ _ .50
$ ?
(Office Use Only)
This Application Becomes Your Building Permit When Approved \ -01}~.~'~~'~'""
~~I IA~ 1 8 2003
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
24 hour notice for all inspeetion. (952) 4, 7-9850, fax (952) 447-4245
IBy
,j\ .,
\
J
Receipt No.
Building Official
Date
FIRESIDE CORNER
#4087 P.003/007
~_ ~_MJlriIlt an6 ot1!ft Of boltom)
ADDRESS
CITY OF PO~R LAKE
HEATING/AIR CONDITJe" GIFJREPLACE PERMIT
FIRESIDE~. ~~,"" I PERMIT N0-3-/0 77
Date Rec'd
HEARTH&HUMb-
5434 DEERFTELD CIRCLE S.E.
ZONJNG (om.. Ule)
LEGAL DESCRD'TION (office ule only)
LOT
Br_OCK
ADDITION
PTD
OWNER
(Name---D.JU;IQFT0N
(Address)
(Phone)
APPLICANT
(Name) 6J.lJJ'.PJlM.M.P-r';'p.JlMlRESIl2);l!,EARTH & HOM!::
(Phone)
~51~13-25~ I
(Contact Person)
RRENDA BUSTON
1l0SEVILLF.
(eilY)
(phone) _651.633-2561
~5113_
(Zip Code)
(Address)
2700 NORTH FArR-VrEW A VENUE
(Addre"l
APPLICANT SIGNATURE
BRENDA HUSTON
DATE
1 0/8/0.3
APPLICANT PLEASE COMPLETE BELOW
xD NEW CONSTRUCTION 0 REPLACEMENT 0 AI. TERATlONS
FURNACE MAKE AND MODEL FUEl.
FLUE SIZE RETURN OPENlNGS INPUT OUTPUT
TYPE OF SYSTEM mATING on. POWEll PJ.ANT
DWann Ai, Plants
OG""vity
o McchMical
OAir Conditioning
o Vent. System
o Sre:un
o Hot Water
o R,di,tion
o Speciol Devices
o Or~er Devices
PLEASE NOTE:
Air Conditioner Un;1S
Cannot Encroach into
Required Side y.rd
Serb.c"-,
I'IREPLACE MAKE AND MODEL
HI' AT 1'1 GLO Sl~ 750TR-C
(ndllstria!. Commerci,l & Mul~j.F.mily
FEE SCHEDULE 1',.,\0 W\i\-'l
1% orjob cosl Residential, GO! Fireploce OING PERM\I
$39.50 minimum aUI\.:
$99.50 Residential, Additions Ii. ^!f.er:3tion~
$64.50 Residential, AC Only
$39.50
Estimated Cost $
HEATING PERMIT FEE
STATE SURCHARGE
TOT AT- PERMIT FEE
Building Pennil #
$
$
$
.50
$39.50
'in\ ~ ~'i~ U
;l>)
"r~ OCT () 8 7001
',Iii
UL:.
R""idenli.J, Heoting &. NC (New Con,I,,,,.r.!on)
Rcside/lliol,lieDling Only (New ConSTruction)
10m.. IJ.. Only)
,By_-c.
-,....:.~~---
Tbis Application Becomes Your Building 1JF'I9lM~l!ln/~9t~Il' (o~&.wJ'alld I Receipt No. _
I ~f. Builder D;vi"i~ , I Dale I By
r<%~ B.;IdineOlllaaO Fa'TVlew Avenue NOTll, 1(0_10, MN ))1 U J horl065J.633-2561 Fax 651-i33-888~
.'"L"".' 0;'."" J~)() WeS111J~I'w.lY J.j 1;1)I"n5Vllle, MN )jjj I l'none 952-890-0758 Fox 952.890-5408
2. hOllr notl.e ror all in'Deetlon. 19S21447-985n,fnx (952) 447-4245
_.nmlCl'ellIlllD1'/I MN Ointr~ Ill' 1.lc.en~lI i/ "fiMJ)1f1
I
f11.'/jMJ.'
/ .
,.
, ' ,
--- --
U ~1:lt.p.'J('~.~~~~J.~
PRIOR LAKE
INSPECTION RECORD
SITE ADDRESS RQ./j c;~~
NATURE OF WORK fYJNgr- ~d~
USE OF BUILDING $~A. ~ .
PERMIT NO. 'Z3-/07rz QATE ISSUED '1
CONTRACTOR . PH N - - ..,
NOTE: THIS IS NOT A PERMIT FO ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTOR
DATE
I FOOTING
~')..7'~
to- VIr- r/l,
/0-)./..1- if)
GRADING (Prior to Sodding)
BUILDING "'I~ u~'hl q-I'Q'\
~
I ELECTRICAL
I PLUMBING
I HEATING
DO NOT OCCUpy UNTIL ABOVE HAS BEEN
NOTICE
,
r4'/e
/0// /".".
-
f7/Y/
I/1/f/7
J). -).."'O?,
~ -l::q-o!!l
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
Qlrrfifirafr lIf @rmpanrl!
CITY OF PRIOR LAKE
~rpadmruf of ~uilMug Jlusprdiou
~Final 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:
Use Classification
SINGLE FA!1ILY
Bldg. PerrnitNo. 03-1077
Occupancy Type R3
Type Construction
VN
Fire Zone
N/A
_ Zoning District
R2
Legal Description
LIS, Bl, DEERFIELD 9TH
Site Address 5434 DEERFIELD CIRCLE
20860 KENBRIDGE CT., SUITE 100.
S.E.
LAKEVILLE
Owner of Building
Contractor's Name & AddresP. R. HORTON, INC'-I,
ROBERT D. ~UTCHINS f#
:" ~ BY!'dio~fficial
/,/ / /C-y
City Planner
DON RYE
Date:
Date:
..
. .
.'
~
" .
DATE TIllE
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
//l. -.1. -cJ}
ADDRESS
,~q'2l.f ()_~ it L/~
OWNER
CONTR.
PHONE NO.
PERMIT NO.
3, -I tJ7'")
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
M PLUMBING FINAL
o MECH FINAL
o EXIGRADlFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
COMMENTS:
e) Y f vWJlr<
V'(){,rC".I7S
o WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT W~R.K,~L FOR REINSPECTION BEFORE COVERING
Inspector. fV/l~ Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY/
"<S,,''''
DATE TIME
CITY OF PRIOR LAKE ~'2:J-q
INSPECTION NOTICE SCHEDULED
ADDRESS ~l{ <:4 O"./h.,. / ~ ~rv
,
OWNER CONTR.
PHONE NO. PERMIT NO. "3-/077
o FOOTING o PLUMBING RI o EXIGRADIFILLlNG
o FOUNDATION o MECH RI o COMPLAINT
o FRAMING o WATER HOOKUP o FIREPLACE RI
o INSULATION o SEWER HOOKUP o FIREPLACE FINAL
W"l'INAL o PLUMBING FINAL o GAS LINE AIR TST
o SITE INSPECTION ... MECH FINAL 0
COMMENTS:
fl,
~
~w1-t_..+ rJ"'-iun....,tL-/
FI.:t" I c--. ""d,... e7ud:?~T1v'I
v- .- -
.r;k-l 4- ?nu."I i/'...r
,
I
- L-L..q<t'or?~r-
'k'~ C/J1ftl
f
q -I-(jc-(
(
o WORK SATISFACTORY, PROCEED
o C~T ACTION AND PROCEED
~RRECT :~K, ~ FOR REINSPECTION BEFORE COVERING
Inspector: ;1' if Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE..
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH ,{ SAFETY!
"""""
DATE
CITY OF PRIOR LAKE ~ /. /
INSPECTION NOTICE SCHEDULED /tj/y~
S~d~ der/le II c)-
TIME
ADDRESS
OWNER
CONTR.
PHONE NO.
PERMIT NO.
(5 3 - /(7)>
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
.,.a-FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EXIGRAD/FILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
COMMENTS:
~
( .........-;/
( _ j6..se
_._"--'--'~ -----
~- .~
~\
.---'
hk
-----
~ORK SATISFACTORY, PROCEED
o 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 & SAFETY!
INSlWTI