HomeMy WebLinkAboutBuilding Permit 03-1598
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Main File
1. White
2. Pink
3, Yellow
File
City
Applicant
I PERMIT NO. 03. /5?B I
(Please "!vpe or vrint and siJm at bottom)
ADDRESS
5~~ Fd Ool. f>OlrJ LkI'lX.. SE
LEGAL DESCRIPTION (office use only)
LOT l[5BLOCK;? ADDITIO~~{"c..Jl IO-tl!:::
OWNER
(Name)
(Address)
(Phone)
Date Rec'd
/2... 5. 03
ZONING (office u")
Je-j
PIDZ5: -k/. tJ3~. D
(Phone(~)'j8S-T808
(Phone(9f)~~(P - <(73;;",
,/
BUILD~ If) I 1 ') ~
(Namp\ -L...), K... <riC5'1~ 1:::.Lnc... ,
(ContaCl~am (k LUcrlv\{')t.d:..Ko....
(00 brld~. --P-/{)CJ
. (Addres f...:D...J:..u, ~ I (h ~ 5<;0 ~
TYPE OF WORK
o Misc.
~ew Construction
DLower Level Finish
DDeck
o Fireplace
PROJECTCOST/YALUE (excluding land) $ (5~, 10.3
DUtility Connection
DPorch
DAddition
ORe-Roofing
ORe-Siding
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
~pe~:::fo::tn~ dinspections. dCOO5Cof)i ~/~!o3
X J ). (I Signature Contractor's License No. I tlate
I Permit Valuation
J Permit Fee
Plan Check Fee
State Surcharge
I Penalty
Plumbing Permit Fee
Mechanical Permit Fee
I Sewer & Water Permit Fee
I Gas Fireplace Permit Fee
r/ / 51 tJtJ t). {)o
$ 1.1~if, IS
$ 8/..0. 74 I
$ 79, ~o I
$ I
$ I (ie.oo I
$ /00.00 I
$ 35,":>0 I
$ ~o.o~ I
This Application Becomes Your Building Permit When Approved
~ ~,-/JJ-J
Building Official
Id-.M/03
I Date
DAlteration
I Park Support Fee
I SAC _ _
I Water Meter <..size 5/~1";
I Pressure Reducer
I City SAC and WAC
I Water Tower Fee
I Builder's Deposit
I Other
I TOTAL DUE
I Paid
I Date
o~c-'1~
/1._7J..al
#
#
#
#
$ 8 S"<l, 6-0
$ IZ7<s,OO
$ 02'50.0 Cl
$ t.{~, tJ CJ
$ IZ-Oo,oO I
$ 70D,Q<:J
$ lS-oo.Do
$
$f3 J.5'9.PJS
/l I
I Recll'fp.r'No. '9' (.. 0 '1' d-
BvY~
rf
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
~:,bY :~itr p; J}~tempomY Cffiifi:,02o;g,I-,::"'ce ,nd ,"ows/~ CO~'fO" occuP"'CY.' Cffiific", ofOccup"'cy must be
Planning Director ~e U Special Conditions, ifafiy
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
~
Job Address
Heating Contractor
Name of Tester
Dale
Percent 02
.
Percent CO
Percent C02
Stack Temp
5'232 E_o~l'ri),l2,
A-((il'\-1J-7 /Jrt&u-I
~~f;.
S/I'/O l'
/11. f?D
,C!4AJ"V
s-. <7 ?I
//d 'fJF
UMC Sec. 606
Combustion air is adequately supplied per
1/,.:?5
~ dIri tS-t-<.J
input
,
.'
~~
Main File
Tht (,nltr of Ih. L.kf ('ollnll'}'
White ,euilding
t l.;..snpr\( - En~ineennq;>
Pink . Planning
aUILDlNG PERMIT APPLICATION DEfARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
" I 1'0'-
,,!..) I
,_ _ ;~" A-/'O--Z 'I /')" ",' l~..-/
I -' "i--':"'';)..
l ".N \._#
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at: .
, -' ;;2 ..- . I .
/_.. "",{ .....?"' / I-.It , ,/ "
.J ,.,r {:' l...--< t,..L,;:-,'h._- I
/ -. .~'..""
Accepted
Denied
x
"
Accepted With Corrections
Reviewed By:
/1148
Date:
12-/ /-63
Comments: See Reverse Side for Additional Information!
/Ylc1'r" {,It
See Attachments: I) Grading Plan, 2) Erosion Control 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 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,"
~t
Main F1le
Th~ (-..nt..r of th.. I..k.. ("ounlry
White . Building
Canary . Enqine..ring
G.r'nK - Planninij)
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
'\ .r
I- /,/' ' />:--"t.-
I -)-:3
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
j.... ~ ..:; J ~ I'~- )_1 //
J -v -/c~ _- _.if._.. ((._
/ <./"'--
Accepted
Accepted With Corrections
------
Denied
Reviewed By:
~~~
/~ aL.tJ
^
Date:
A, / Y. 2tJd..?
/
_' Jf;,~
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
~hite - Buildinii)
Canary - Engineering
Pink - Planning
Th.. ('..nl... nf th..l.ak.. ('ounlr)'
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
D ,j2~ ;J~
/ a-5-3
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at: . / /J
Sc23J---' ?~ ~ (Jovd uv-
Accepted
Accepted With Corrections ~
Denied
Reviewed By:
~~~
~d -cJ/
Date: /~/;9 ~:r
~
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."
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
1. Pink
2. Green
3_ Yellow
#75/5
~:~ I PERMIT NO. -'2/1 ri ~rj
Applicant J - ) .....IP
(Please tvn~orDrint and sien at bottom)
ADDRESS
5d37? C, Ca--L ~/~ a. .~;=-
LEGAL DESCRIPTION (office use only)
LOr' j'BLOCK .::::? ADDITION
OWNER DR HORTON
(Name) - 20860 KENBRIDGE CT
(Address) LAKEVILLE, MN 55044
APPLICANT /J 0 A
(Name\/7'/. h-J' ~ ~/'".-/.d4./''''_./
(Address)~ ~~~" t? ~
-5!:AddreS
(ContaClPerson) A~ . ~~~
APPLICANT SIGNATURE. . -' - ___
ZONING (office use)
PID
(Phone)
(phone) /:,,~/.. q~-?-,I???2
~ 444,;t' ~~..hl~
(~ (Zip Code)
(Phone) ~/ - ~<?1-eR 77.:2:
DATE
APPLICANT PLEASE COMPLETE BELOW
,
j!lNEW CO~TRUCTION 0 REPLACEMENT. o ALTERATIONS ~
FURNACEMAKEANDMOD~/r,6';..t :?~A~,:/C)7a FUEL /f ~f~.e
FLUE SIZE.y~h...A RETURN OPENINGS 4 INPUT ~ OUTPUT 6Z~ 1".A..oL-.
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
}JiIYent. System
o Steam
o Hot Water
o 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 $ .3=>~ a:> Building Permit #
,/ .4 ,j _ PAID WITH
$~// ~//~U!!-')ING PC:P~4'T
$ _ ,50 -._-
$ Y'
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
I Paid
I Date
JAN
o 5 2003
Receipt No.
r-..,
By ~
Ij
De c. I 9.
~
""""~I-"~llyNISSD"C.t-
.tI;;~\;~I;~~,'~\'''.
~i~,~'t,
2003
9:53AM
GENZ RVAN PLUMBING AND HEATING
No, 4813
p. 35
Date Rec'd
CITY OF PRIOR LAKE PLUlVrBING PERMIT
I. Bh.. File
2. ('J(lld Cir)'
~,YtrI!ow AppJic:w
IPERMITNO.~
ZOJ:-lli"<G (o_uo:)
(PlC3-'ll: tV12c: or pnnt and .U=at bottom)
ADDRESS - ,
6g,3:A 'f,qJJf fJtlG Po)nf ~cJ t.
LEGAL DESCRIPTION (office usc only)
LOTI fBLOCK r1 ADDmON ~ tiel / ()~
Pill
OWNER
(Name) DR Horton Custom Homes (Phone)
(Address)
%2 - q;lt:; ,-i'6DO
2oSI.cD lLenB~\ DGe.. Co Sre /DO
uduvi ilL HAN .see/-.! LJ
APPLICANT
(Name)-'........."._D~....... '0) """'}..";"'2 .1:. UO -:Of'"..;..r C
(phone) ..65 L"? ~_ 1 1 <.,1"
Rosemount
55068
(Zip Code)
(Address) 14745 So Robert Trail
(Contact Person)
MIl
O (Addr';"s) (City)
V7JVM1' Gjj-!l ~~ (Phone)
~~ DATE
651-423-1144
U ~/C; ~
APPLICANT SIGNATURE
I Quantity
I ;.<
I I
I /.
I 1-/
I I
I ,:;,J
I I
I
I . ~
APPLlCANT PLEASE COMPLETE BELOW
Type of Fixture Quantity I Type of Fixture
Bath Tub with or without shower 'I'Rough-iJ)s
Dishwasher I - I Water Beater
Floor Drain I I Water Softner
Lavatory (.Bathroom Sink) I I Stand Pipe (Washing Machine)
Lall/Jdry Tray (J or 2 compartment sink Sewage Ejector
Shower Stall BackfJow Assembly
Sinks Backflow Assembly Test
Bar Sink Lawn Sprinkler
Water Closet (Toilet) I Other
FEE SCHEDULE
Industrial, Commerclal & Multl,fM'llly 1 % of Job cOg! with a $3950 minimum Resldenltal. New One & Two-famIly $9950
R"",dentiaJ. Additions &. Alterations $3950
Estimated Cost $
Bu1ldlng Perum #
PLUJ\.1BING PERMIT FEE $
STATE SURCHARGE $
TOTALPERMITTFEE $
PAID WITH
BUILDING PER~.m
50
(OffiCI: U~C: Onl,.)
This Application Becomes Your Building Permit "'hen Approved
Dltte
Il'aid
I ~ 3 0 2003
Building OBioiol
24 hour notiCE for.n inspections (952) 447,9850, r.~ (952) 447-4;l45
Dec. i9. 2003 9:53AM
GENZ RVAN PLUMBING A~D HEATING
No 4813 p, 25
Date Rec'd
CITY OF PRIOR LAKE
SEWER AND WATER PERWT
":-'<:\\';~;''A.",
"~~~~\~\~'{:~i;t'''~f! 5 o"ll'-
'''l'.fS;~\\\\.<\J.'. . .
(Please .!'i1'e or 'Orint ;md S'i2n 'at hottam,1
ADDRESS
6;23;:), ~ na~ PtJi rH-- &<513-
i ~\:. ~;~ I PERMIT NO.~~. I~
1. Gold .\!lpliunt "'~",
ZONING (office use)
LEGAL DESCRIPTION (ofliceuse only)
LOT IX" BLOCK ~ ADDITION 'NU2.---1Jdc( itif1'v
PID
OWNl'R
(Name)---lW.---H^...--- f'...~___ ,,_^~
(Address)
20&00 ~f\eK\t:6e C:rSOl?_If\I'
(Ad~')
(Phone) _
La~~llIe.,
(City)
,*,J2-q~- ,Bol\.
0CC<-jU
(ZIp Code)
APPLICANT
(Name) Genz-Ryan Plumbing & Heating
(l'honc)
651-423-1144
(Address) 14745 So Robert Trail
'JCANT SIGNATURE
0,I/) ~1Ji fat (s-
(ll~~
Rosemounc. MN
(City)
55068
(Zip Cede)
(Contact Person) .
(phone)
all"''\ DATE
651-423-1144
/{i. -I q 7JA
APPLICANT PLEASE COMPLETE 8ELOW
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 ax feet from structure.
feet.
o Ca5t Iron
ResidentlaI sewer and water line connectlOn
Sewer connection only
FEE SCHEDULE
$35.50 Industrial, Com'l & Multi,famlly 1% of Job cost wlIh a $39.50 mmuuUl1l
$1750 Water connection only' $17_50
Estimated Cost $
Budding PermIt #
SEWER AND WATER PERlYJIT FEE
STATE SURCHARGE
TOTAL pERMIT FEE
$
$'
$
PAID WITH
.50 BUILDING PERMIT
J
(Office Us~ Only)
I Tbi. Application Becomes Your Building Permit Wben Approved
'-
Building Orneill'
I Paid I ReCeiPt 0_
I UIa it U LUUj I(JY
Da.re ,
24 hout notl'" for alllnspeetion, (952) 4'\,:9350, fax (952) 4474245 ,~
I
J
CITY OF PRIOR LAKE
HEATING/AIR CONDlTIONING/FIREPLACE PERMIT
Date Rec'd
1. Pink
2. Green
3. Yellow
File
City
Applicant
I PERMIT NO~...J .16~
(Please type or Print and sign at bottom)
ADDRESS
ZONING (office use)
5232 E. OAK POINT DRIVE S,E.
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION
PID
OWNER
(Name D R HORTON
(Phone)
(Address)
APPLICANT
(Name)~ T.T ,TFTll:;TRF~Tnp. DBA PT'RFSTDR HEARTH &. HOME
(Phone)
651,6:J3,2561
(Address)
2700 NORTH F AIRVIEW AVENUE
(Address)
ROSEVILLE
(City)
'i5I13_
(Zip Code)
(Contact Person)
BRENDA HUSTON
(Phone) _651,633,2561
APPLICANT SIGNATURE
BRENDA HUSTON
DATE
:J/l0/04
APPLICANT PLEASE COMPLETE BELOW
xD NEW CONSTRUCTION D REPLACEMENT D ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
OWarm Air Plants
OGravity
o Mechanical
DAir Conditioning
OVen!. System
o Steam
o Hot Water
D Radiation
D Special Devices
D Other Devices
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
FIREPLACE MAKE AND MODEL
HEATNGLOSL,750TRN,C X 2
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
Estimated Cost $
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
Building Permit #
$
$
$
_50
$39.50
$39.50
~. .O""f"~_
;;:,Jf!J:1J..;) ,",:4.1 -:"V f u-g
~N0 plb.,
-""iiV9J7rr
Residential, Heating & Ale (New Construction)
Residential. Heating Only (New Construction)
(Office Use Only)
Buildine Official
Date
I Paid
I tWAIjl ~ 6 2004
I Receipt No.
I By
This Application Becomes Your Building Permit When Approved
24 hour notice for all inspections (952) 4~3'?~50. fax (952)_447~4~_4~J
---------...-
PRIOR LAKE
INSPECTION RECORD
SITE ADDRESS SZ~z. tiitfsr ()AJIt. ,4/~r .l>A./iIG
NATURE OF WORK JJI; W ClJJVrrI!.Uc.n~N
USE OF BUILDING S.F\ If. __
PERMIT NO. (J3./59f?J DATE ISSUED j>/I't./D'I
CONTRACTOR :1). tZ. t-W ~ ,. ~ ' PHONE19.. 2~4--.q >,. 'L
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
DEPARTMENT OF Main File
BUILDING AND INSPECTION
INSPECTO.R
DATE
, FOOTING liJlf/ / J- J,(-D3
I FOUNDATION (Prior to Backfill) I 1/(/]/ /' I /.. J !f'--(){
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS /?
j/!/r r
f/ip
I/!/P
SEWER I WATER I SEPTIC
FRAMING
INSULATION
ELECTRICAL
PLUMBING /J Jr- f11P'
HEATING (if required)
FIREPLACE
GAS LINE AIR TEST
1- 20uocl
7, - .:U___-<X/
3- 2.s--cA/
j//ff
.~~
I/J/p
~
7, /-cJ(,.1
S----b~____Ol/
$U utI
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
~ ~ :V;d/i7'l I
. t/ - .. FINALS
/I/~
/H$ /~~~
GRADING (Prior to Sodding)
BUILDING 11:f iJ'I~1 <(,-/-01.-\
ELECTRICAL
PLUMBING
HEATING
DO NOT
~
IlW(
1I'v(/
OCCUPY UNTIL ABOVE HAS BEEN
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.
..-
,L., - (n --01.0\
~... w.-~
SIGNED
FOR ALL INSPECTIONS (952) 447-9850
Qh~rfifiraft of @rrupanrll
CITY OF PRIOR LAKE
~eparftttettt of ~uilMttg Jlttspediott
~Final Permitted D 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 fallowing:
Occupancy Type
R3
Type Construction
SINGLE FAMILY
VN
Bldg. Pennit No.
Fire Zone
N/A
Z,;ming Pistrict
03-1598
Rl
Use Classification
Legal Description
L18, B2. DEERFIELD 10TH
Owner of Buildine:
Site Address
5232 EAST OAK POINT DRIVE S.E
Contractor's Name & Address D.R. HORTON, INC.A
ROBERT D.XRUTCHIN~~
/O~~y9fficial
20860 KENBRIDGE COURT, SUITE 100, LAKEVILL
City Planner
DON RYE
Date:
Date:
. - '.......-
DATE TillE
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
PHONE NO.
6-Z3 z.. 1::(-1-- /'9c.Y ,IJ.;,])_ .
CONTR. "D R, ~Io,:/& '"
PERMIT NO. 6~ -IS j f
ADDRESS
OWNER
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
o EXIGRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
COMMENTS:
(~-JQ..I":. _ c2 Ie..
L ,II" ~- ,?e
~ WORK 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!
'NSNOn
DATE TIME
CITY OF PRIOR LAKE ~/)Q-Oj
INSPECTION NOTICE SCHEDULED
ADDRESS 5) 3J- ~f (AIL fr
OWNER CONTR.
PHONE NO. PERMIT NO. 'S- / .[;'t 11
o FOOTING o PLUMBING RI o EXIGRAD/FILLlNG
o FOUNDATION o MECH RI o COMPLAINT
o FRAMING o WATER HOOKUP o FIREPLACE RI
ELATION o SEWER HOOKUP o FIREPLACE FINAL
INAL o PLUMBING FINAL o GASLINE AIR TST
SITE INSPECTION o MECH FINAL 0
COMMENTS:
(0 VtvvA I %l.-ack ",/1P.-vw. /
@ S:.J.J ~ J"h.,., '3
r( ~ (/I1h~)
<c -/--0<.1
!
o WORK SATISFACTORY, PROCEED
o C9JiftECT ACTION AND PROCEED
tyt;ORRECT WORK, c;})L 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
0/; en I
/'
ADDRESS
C;;,32-
'IS. Cot PI'
OWNER
CONTR.
PHONE NO.
PERMIT NO.
3 -IS<ff>
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 EXIGRAOIFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
COMMENTS:
(1 <;~al Mp~/
1V Ile j...,d/,{ r(]l)(Cc ~
~RK SATISFACTORY, PROCEED
~ORRECT ACTION AND PROCEED
o CORRECT ~'i1~/7R REINSPECTION BEFORE COVERING
Inspector: -----J!-!L,' ~ OWner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY/
UUHOn