HomeMy WebLinkAboutBuilding Permit 03-0262
CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec' d
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT ;;;J_i.r3
See Main File
(Please type or print and sign at bottom)
ADDRESS
S()/fl..f i&s.1- f"klc j),).A~ 'b.,vL
LEGAL DESCRIPTION (office use only)
LifT Br7>CK ADDITION DLbA'< 1<1 10il,.
OWNER
(Name)
(Address)
BUILDER'>.. .
(Name) !), ((, K-rv,-k,^
(Contact Name) :}C<.;S,C[
~:L",'
/,,r:,,h~
~;~:' ~::y I PERMIT NO. b3 - 02/- ." I
Yellow Applicant ICI~
ZONING (olli"u,,)
J2J
I
PIQQS- tfO/-OJ~-J
(Phone)
(Phone)
(Phone)
C}Y-.2-9/,,-7lo8
,
(Address);.;(,tu/:> ic~L.n'dd (~",./-- L,{J~i/r';i<, 11111I 3'SOYy
TYPE OF WORK
~N ew Construction
DLower Level Finish
DDeck
DPorch
DRe*Roofing
o Fireplace DAddition DAlteration
PROJECTCOST/VALUE (excluding land) $ I tf7 q Otl
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
submitte ans. 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 on ill operty to perform n~ded~ons. .
X A- ~ ~: do 00'5bS"7 d-Ir,-Il ~
/ I Signature
1/
Permit Valuation
DMisc.
I
I Permit Fee
I Plan Check Fee
I State Surcharge
I Penalty
I Plumbing Permit Fee
Mechanical Permit Fee
J/-v~ ~610,Ol) I
$ /.:2~.SS
$ ~ZO. l~r12-
$ 71.(, Of)
$ -
$
$
$
$
Sewer & Water Permit Fee
Gas Fireplace Permit Fee
la(J,aD
100,00
J5.~a
~O.OO
This Application Becomes Your Building Permit When Approved
~ffiC?~ co1!-1<'t3
Contractor's License No.
Park Support Fee
#
DRe.Siding
DUtility Connection
Date
I
I
I
I
I
I
I
I
$(,.752.1/1
(\
a-'1
$ 'irsa. 0'0
$ 12...7$.00
$ d'9:J,OO
$ 45. DO
$ /240.00
$ 700,00
$
$
I Paid
I Date
(/?'!:Jd-/-- 1/
3--:+---7-'?:-
Receipt No. '-fVfO
By D'-'
.v?fl
~
SAC
#
o1/~;G3
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
i"~ ~I--
Planning Director
7Yt;- ~
Date Special Conditions: if any
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
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
#
#
..
..
,
Job Address
Heating Contractor
Name of Tester
Date
Percent 0,
Percent CO
Percent CO,
Stack Temp.
"",.
SOG, t" E.~/)f!.
$t~ m.&::t-~
..4-~,,!
7#.r/c):J
II, 2.. 70
,~,..)
Y,.S' 7"
'10 -P F
Combustion air is adequately supplied per
UMC See, 606 V, <;
(
input R7. {ll1l c17U
"
/
~
,~'
/~
~"
See Main File
White - Building
Canary - E~ing
C Pink - Plannr~
Th~ (-..nl..r or Ih..I..... Counlry
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
... "7.- ~-
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: ~o/J.3
Comments:
See Main Flle
..'~
"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."
See Main File
White - Building
~a<y - engineering)
Pink - Planning
Tht'(",nlffQfIMl.akfCOllnlr,
BUILDING PERMIT ~ICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
i
1/ 'r." ,_.~!-""-'-
K {.I .:". /""~).f
;,,_ 1',4,...,../ i," ,.J ...._
~
APPLICATION RECEIVED
'-', -7 -- -
,
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
/'--~"/"" / / /'
~ ()ty '1
/..:.."-, t<'~'J;..<~ r~"f- J. '~y_.-.-
Accepted
~
Accepted With Corrections
Denied
Reviewed By:
1'Yfi(2,
Date:
2-27-0..3
Comments:
5, u-IY7t;,/ ~h' F t
"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."
See Main File
Th~ C.nlrr of th. L.k. ~'ounlrl
cilIihile _- Buildini;)
Canary - I:lIy"",o!rmg
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKUSI
NAME OF APPLICANT
APPLICATION RECEIVED
((2 R~
~-,-,~
-'
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
{;2~~ r; E (};cdG P+- ill. ,/
Accepted
Accepted With Corrections
~
Denied
Reviewed By:
~ -:f.v.AP
Date: d.Do~3
Comments:
See Mai!! File
"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 !J\ U' @ ~ u m u; C~te Rec'd
HEATING/AIR CONDITIONlNGIFIREPLACE ~1lW~~ 7
p"
~: ~i~~n ~i~y. "I" c Ctn.nn-i l~V. -;:;./ ~---'- ~ I
3, Yellow ApphcRnt 0 (TV
(Please tvDe or orint and silm. at bottom)
ADDRESS
~~ e: ~/A-/. LZ. 5~
ZONING (office use)
LEGAL DESCRIPTION (office use only)
Lcwf BLOC~ ADDITION
PID
~,:"~Ru.'M. HorTon ()Llsbm Home~
(AddresS)d()~W .~hrir\Oj~ QJ.; Lo.kevi Ifp_ MI\)
APPLICANT 1\ .1. t M h --- .
(Name) 1'111'01'1 e~ ..I.dX'. (Phone)ltl51-45:L-.:?775
(Address) d{oScJ Kp..........eo be('_ J:x.. 51p ~ #/ ~~ apOY1 ~1"5/.22
.~. (Address) v (City) (Zip Code)
(Contact Person) J;f'.rr...~ Z;mmprfY\Qn (Phone) {P5/-/-./5bJ- ;/776
APPLICANTSIGNATUk. LJ~hl'~~fl.42~ DATE .
l/ 1/(/ (j ~ .'
. APPLICANT PLEASE COMPLETE BELOW
!0NEW CONSTRUCTION o REPLACEMENt 0 ALTI;lRA TIONS
FURNACE MAKE AND MODEL 1>r';l1rIf 3~A-V~IlD; () FUEL l\Ja.tUo'l'A I
FLUE SIZE I.j.II cla.s% "EL RETURN OPENINGS '4- INPUT lb. 000 OUTPUT 6uJ. fJO 0
TYPE OF SYSTEM HEATING OR POWER PLANT
(Phone) Cf5a ~ q ,??5 -7r:l7.2.
550~L.1
DWarm Air Plants
DGravity
o Mechanical .
~ Conditioning
~ent. System
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
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 Orily (New Construction)
$39.50
$39,50
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
: ;7,50
t:J,. PA,'D
- '4.I'LD,,.. W,.,.,.,
'v'G P/2,
"J:iA.f,.,.
Estimated Cost $
Building Permit #
(Office Use Only)
Building Official
~'i~ ~ ~ U ill ~ 11 ~eceiPt No.
~teAPR 07 7003 [!l"Y (' h
" ~ n
24 hour notiee for all inspections (952) 447-950, fax (952) 447-4245 V
By _____
Date
This Application Becomes Your Building Permit When Approved
APr, :' 2003 9:28AM
GENZ RVAN PLUMBING AND HEATING
Noml P i5 19
~!Rl~
~,OLi' ",,'
t .1 \ ;:
lJ j~l'l
('
Date Rcc'd
CITY.OF PRIOR LAKE
SEWER AND WATER PERMIT
.:'"",..W;,;',.:
"~\~ik~'~?,::"'NE s 01 '"
. (Plc:ase: ~c orn.onr<l11d:ns::n9-thottom)
ADDRE~{I1' \
">>Ul'1 E fuK f+. ~ Sf-.
; ~ ~;~ I PERlVIIT NO. a _ ,I 'I
:l. Gold App!\Ql'It ") c;;4tJ c;t--'
I ZONINGCO/lk,,,,e) I
LEGAl_ DESCRIPTION (ollice use only)
'!.. -'. ,~(- 'er (j I rM1;\
LOT c9-BLOCK,;;( ADDmON I ~<--n C\ U I
Pro
, OWNER.
(Name) ,,~ ,,~ ~..~.__ U^_M
(Phone) _ c;52 -q~-/>r{'.i,
(Address)
2o&cO l<eVH3i<-\t:ee.. Cr- Si-P J{\l'
CAdclrc,,)
La~~~ die.,
(Cl!Y)
,'?c;:fY-IU
(Zip Code)
APPLICANT
(N~~ Genz-Ryan Plumbing & Heatin~
(Phone)
651-423-1144
(Addr~s) 14745 So Robert Trail
Rosernount. HJ:l
(City)
55068
(Zip Code)
(Contact Person) .. r;~dd~lZh Fur II s _
'JCANTSIGNATURE rju~~
cPhO:~TE 651-42~73;IO::<
APPLICANT PLEASE COMPLETE BEI:OW
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
ResIdentIal sewer and warer Ime connectJon
Sewer cormeorion only
FEE SCHEDULE
$35 50 Industrial, Com'1 & Multi-famIly 1 % of job COst wlm a 53950 minimum
$17.50 Wate)' connection only $1750
Estimated Cost .$
Building Perm.it #
SEWER AND WATER PERMJTFEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$'
$
50
PAID WITH
BUILDING P!=R~m,
(OOle. Us. OOly)
I This Application Becomes Your Building Permit When Approved
L_~
BuildIng om,;.!
_ P~i" j Receipt No
U)~$ it 0 W ~ ~f By
D." ~I: ~ L~
24 hnur nonce for.n lnspeetiolLS (952) 44 LiJJsO.~~95~)~~]q}5 j
By
IT
5~~
{\\~~i~;it~7NE $ o~ ~
APr, 2, 2003 9:28AM
GEN2 RVAN PLUMBING AND HEATING
110 823 i
P 14 19
CITY bF PRIOR LAKE PLUMlUNGPERMIT
Date Rec'd
<P1ea.::e Clroe or'Orult and Sll?Jl :t.tboltOm)
ADDRESS
f3) {p 4-
E nett<.
f+ hR- ~B.
LEGAL DESCRIPTION (olliee use ollly)
LOT J-BLOCK~ ADDITION
beLR--hdd I D-fh
OWNER
(Name) DR Horeon CuStom Homes
(Address)
2O'SLcD )[eV']B~l~ Co $re./DO
APPLICANT
(Na.me)..c.........._t:l:.~rl 'P1,.-\.,,,:-2' r. u.e.a.t.i.n..:;
I. Bluc ~ilc
2.. Gold J;:it;'
~ Yell(lw ^PF!iaru
I PERMIT NO.;j ~d-f.o d--1
ZONTI,\1G (office 1l,~C)
PlD
(Phone)
962- q)?F. -,'iDe
u:du.villc, .w.J 56,)L/Li
(phone) ~ ~ I_I,? 1_11 id.
HN
55068
(Zip Code)
(Address) 14745 So Robert Trail
Rosemount
(City)
I (Contact Person)
r/~~et\ 11 ~J 1\
~
(Phone)
~~
APPLICANT SIGNATURE
Quanti!)"
~
\
\
4
~
j
~
651-423-1144 I
3/3 ti Q3
DATE
APPLICANT PLEASE COMPLETE BELOW
Type of Fixture I Quantity
Bath Tub with or without shower I
Dishwasher I .
Floor Drain ~- .l.
Lavatory (Bathroom Sink) (
Laundry Tray (lor 2 companment sink
Shower Sta 11
Sinks
I Bar Sink
I Water Closet (Toilet)
mSCHEDULE
Indusmal, CommercIal & Mulu-f3n'uly 1 % of Job co:'\t \'l,'l!h a $3950 mjnimum
(Oflicl! Use Ooly)
EstImated Cost $
BUJlding Penult ~
PLUNffiING PERtvlIT FEE $
STATE SURCHARGE $
TOTAL PERiVIlT FEE $
This Application Becomes Your Building Permit When Approved
Building Ot'fici.ll
n.",
24 hour notlc.e for all inspections (952) 447~S
Type of Fixture
Rough;iJJS
Water Heater
! Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
BackfJow Assembly
I BackfJow Assembly Test
Lawn Sprinlder
I Other
Resldennal, New On: & T\vo.-Famlly ~99 50
Residential_ Additinns & Alrerations $3950
50
PAID WITH;
BUILDING PERMIT
) n~i~ 1 )~ecejpt No
~ @ ~ ~ IJ! ~ 1\ 3y
2 ZBB3 ~
_ ,rax (952) 447-4245
if
f
By
:t PRIO . .
W. .. 'of' .. .. CITY OF PRIOR LAKE: '
S .,.,.. .~ -- ~ ----HEATING/AIR CONDITIONrnG/FIREPLACE PER~U\rJIH
~" ,,'" \, .
-YlVESO \,]y-~
: :~" ~:~ 1 PERMIT NO./l? -0 <? I ?I
3. Yellow Applicant LV ~L..-
.,\.i ! .'h"~
Ii S ~~,+~,~_
(Please type or print and siJOl at bottom)
ADDRESS
5064 EAST OAK POINT DRIVE SE
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name) DR HORTON
(Phone)
(Address)
APPLICANT
(Name) AT.LJEnF~RESIDE DBA FTRR~TnF HRAR'fH & HOMR
(Phone)
651-611_2561
_"...",<t.,,~
(Contact Person)
BRENDA HUSTON
ROSEVJT T F
(City)
(Phone) _651-633-2561
<;5113_
(Zip Code)
(Address)
2700 NORTH F AIRVIEW AVENUE
(Address)
APPLICANT SIGNATURE
BRFN{)A HUSTON
DATE
7/8/03
APPLICANT PLEASE COMPLETE BELOW
xD NEW CONSTRUCTION 0 REPLACEMENT 0 ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
OWarm Air Plants
OGravity
o Mechanical
DAir Conditioning
OVenl. System
HEATING OR POWER PLANT
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
TYPE OF SYSTEM
, 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
$64,50
""<......'i.._._
$39.50
Residential, Heating & NC (New Construction)
Residential, Heating Only (New Construction)
Residential, Additions & Alterations
Residential, AC Only
$39.50
$39,50
Estimated Cost $
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Buildine: Official
Date
d})at~____
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
PRIOR LAKE
INSPECTION RECORD
SITE ADDRESS Sof.td cAST l)/tJL rel'..,r J)gi".
NATURE OF WORK NEW cotJsrl2.UGr~
USE OF BUILDING ~~ 1tr...
PERMIT NO. f23 - 2& DATE ISSUED 0 If
CONTRACTOR p,it, aOa.t nJc.. PHO E..
NOTE: THIS IS NOT A PERMIT FORJ ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
DEPARTMENT OFSee Main File
BUILDING AND INSPECTION
INSPECTOR
DATE
I FOOTING
I FOUNDATION (Prior to Backfill) I I
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
SEWER I WATER I SEPTIC
FRAMING
INSULATION
ELECTRICAL
PLUMBING liVV / ( / U. cI)
HEATING (if required) ~ I~ l--<{~V1,
FIREPLACE yVl' ""I - ~v..-iJ)
GAS LINE AIR TEST vW' 7-P't-<5J
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I I
FINALS
~e e ~...;. h /e., .
I ~ 9'/s%r
rvf
vV{/
7- J-hb
7/3{-C/)
GRADING (Prior to Sodding)
BUILDING '\ 'f."f
ELECTRICAL
PLUMBING
HEATING
DO NOT
1\/1 - 01-
vvv/
M/
OCCUpy UNTIL ABOVE HAS
NOTICE
BEEN
qf117 -V]
q.I1-C}
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
@rrfifiratr of @rtupanry
CITY OF PRIOR LAKE
~rparfmrnf of ~uilbing J1nsprdion
;1Final Permitted n Conditional e.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 Nn.
0"J-uUZ--
Legal Description
Type Constructi~
LL2, B2, DEERFIE1D 10TH
Fire ZoJ;l1 A
Zoning District
Occupancy Typ~3
Owner of Building
Contractor's Name & Ad~SMANN
Site Address
5064 EAST OAK POINT DRIVE
ROBERT D. HUTCHINS
t/AC1~u~7cia'
, , ,
HOMES, 1895
/..//r;/
///'l~
PLAZA DRIVE, SUITE 200, EAGAN, MN 55122
DON RYE
City Planner
Date:
Date:
I
I
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
q-!~
ADDRESS 9.Xf: tv. "fJ!L r?.-r Qcl_
OWNER
CONTR.
PHONE NO.
PERMIT NO.
~ - .2-C 2..
o FOOTING
o FOUNDATION
o FRAMING
o JllSULATION
'FINAL
o SITE INSPECTION
o PLUMBING Rl
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o Pj.UMBING FINAL
I7IiIECH FINAL
o EXlGRADIFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
COMMENTS:
(}) ~I"'{J / t /'if) t"
~ <:J,..I -l- f J'\LtJ /IJ~ d-ru~f ~M~-r
r:cd ( c.il--./ O~A S'~( l!l1::d.~-
(Z( .{';""Str. /1(~ Qv <1',. Ivy"" hn.-
~.JrTJ(/>oV\.
.-..
{ l-e- /? 1/01-/ f
, '
1(-- I-o-S
o WORK SATISFACTORY, PROCEED
,JiI"'lfORRECT ACTION AND PROCEED
.e CORRECT WORK, CALL FOR REINSPECTlON BEFORE COVERING
Inspector: ~ Q-f7,rl3 Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH'" SAFETY!
ININOTJ
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
'1-1741
ADDRESS
SUt-r
e ~IL ()T (),
OWNER
CONTR.
PHONE NO.
PERMIT NO.
3-U L
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
""'LUMBING FINAL
o MECH FINAL
o EXIGRADIFILLING
o COMPLAINT
o FIREPLACE Rl
o FIREPLACE FINAL
o GASLlNE AIR TST
o
COMMENTS:
y C Uol U1t'
Y~LqO{
o )I'ORK SATISFACTORY, PROCEED
~CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTlON BEFORE COVERING
Inspector: IVf? t( - I MOwner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH of SAFETY!
INSNOrJ
CITY OF PRIOR LAKE
INSPECTION NOTICE
DATE TIMe
~~r
SD6~ 6,/-' a.k' // 4
SCHEDULED
ADDRESS
OWNER
CONTR.
PHONE NO.
PERMIT NO.
63- -4:2
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
..P-f'IIIl'L
o SITE INSPECTION
o PLUMBING RI
o MECH Rl
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EXIGRAD/FILLING
o COMPLAINT
o FIREPLACE Rl
o FIREPLACE FINAL
o GASLlNE AIR TST
o
COMMENTS:
~..
(/....,~
~~OS-e
----' ~ ')
r/e ~
------
~ORK SATISFACTORY. PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK. CALL FOR REINSPECTlON BEFORE COVERING
Inspector: ~ Own"r!Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
UfSNO:n