HomeMy WebLinkAboutBuilding Permit 03-1492
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec'd
Main File
I. White File
2. Pink City
). Yellow Applicant
ItJ-;11-rJ3
I PERMIT NO. ()3 - /49 2- I
(Please t\:'Qe or print and sign at bottom)
I ADDRESS
/7 3t.e:z ~1'lXf b"rJ-.. ~;)E
LEGAL DESCRIPTION (office use only)
LOT J.. BLOCK S-ADDITION L.lru:t (IO
OWNER
(Name)
(Address)
BUILD~ \,) I \ .\
(Name) ..LJ, K, 'I-OLT~~<:"'"
(Contact Name}-1Y\ llU... W o--AA<<-~
(Address) ~1~~rh~~~L/'i
TYPE OF WORK
~ew Construction
DLower Level Finish
o Fireplace
PROJECTCOSTIVALUE (exc1udingland) $
Cf'I'--YSO
o Misc,
DDeck
ZONING (office use)
1Clv
~(dJ;<() L:learf\eJd PID 85-39t-0 )LI-O
(Phone)
(Phon' 9s~Y/B 5-7803
(Phonef15~~ i-rf73~
- J
DPorch
DAddition
DRe.Roofing
ORe-Siding
DAlteration
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
enter upon the property to perform nee~~inspections. _ /
XC) ~c.y~ rl:b.re.v ~CX:::OR~7 in -c;?y.cX?)
, (~gnature . Contractor's License No. Date
1 Permit Valuation
I Permit Fee
I Plan Check Fee
I State Surcharge
I Penalty
I Plumbing Permit Fee
\ Mechanical Permit Fee
l Sewer & Water Permit Fee
I Gas Fireplace Permit Fee
$
$
$
$
$
$
$
$
9'1).;0"00.-- ,
Cd1- 75 I
;.eQ,91 I
'" Lllo_-
~
100. 00
100.Od
35.5""0
'-10.00
This Application Becomes Your Building Permit When Approved
~.~
Building Official
If /5/07
, Date
I Park Support Fee # $ ~r:;o, 00
I SAC # $ /2-75,00
I Water Meter Size~l~ I~" $ . ~P,o. 00
I Pressure Reducer $ 180.00
I City SAC and WAC # $ I 2..00. () ~
I Water Tower Fee # $ 700. DC
I Builder's Deposit $ (SOO.DC) I
Other $ 1
TOTAL DUE $ 7. q.s :;$.7'1
. ,
I Paid / }'f~-~ 7'1 I Receipt No. Yb~f ~ ~
Date II - I j.. -~ ' Bv r.'
0-
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 docume
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
i~~
Planning Director
_AA .~ /6"'1..H.~J
r~ ~ ~ ......"
Special CondltioKs, if any
24 hour notice for all inspections (952) 447-9850. tax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake. MN 55372
/1/~C13
/w
Job Address /J? G,.;L e,. t.-r ~;....,-
Heating Contractor ~.\l-A.Ur l'-lE ( 1/
~lA~
3/la/(j~
~3 7c,
Ci1f-
11 ~
38'f OF
Name of Tester
.,
Date
Percent 02
Percent CO
Percent C02
Stack Temp
Combustion air is adequately supplied per
UMC Sec. 606
input
.
1/~5
to1rllJr f?nJ
.~
5~~
Main File
White - Buildina
( ~~;-;;;,,, - Enqineeriria::;)
Pink - - Planning
Tht("tnlunflhtl.ak"Collnlry
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
I
/'"
[
/} "
,-/'.} t 'J'-_'o
APPLICATION RECEIVED
I p.,/
/'// -)u /":) -
j ..- '-"
i '\:~.:.:~>'/'?"~:/c.....-
.'!'l~
,,* ;
, .-
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
.j
-,7 -
,~
~
Accepted
><
Accepted With Corrections _
Denied
Reviewed By: I'Y7+ fJ Date: /1-Lj-03
Comments: ..BP'" Rp.verse Side for Additional Information!
/Yk,'", F,'!c.
See Att.achments' 1) Gr::lc1ina Phm 7' Frnsinn rnnlTnl MellsllT"'S
.... . ~
"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
,..-wtlite - Buildino
Canary - Engineering
Pink - Planning
-
Th~ (-"0'''' of ,h.. I.ak. ('nunt~'
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
j}A~
//l3C>a- '~I5/I~LIJ
,
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
/0 - ;) 7~0\3
Accepted
Accepted With Corrections ,/
Denied
~
Reviewed By: ~ ~ Date: I/s-;Ia 'J .
Comments: t14~ ~ /'<-' ~'L, /~
(I~o-fJ/ .k-y ~ C!..Lfl~.ry, ~ ~
~-~.
"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
Canary - Engineering
( Pink - Plannlnq)
Th~ (-..n'p. nf lh.. 1.1110.. ('ounlry
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
,
/.
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
,/., '.-
Accepted
Accepted With Corrections
/
Denied
Reviewed By: ~
Comments:
-I(~
.
-:::/" . /J./-J
~
. .
, -
n
Date: ItjS/a '3
. - ..-.
~. _...;r?a......::6:...,...J
"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."
Feb. 17. ~~~~ 1Z:~4P~
GEN~ RVAN P~UMB[NG AND HEATING
No.2221
P 317 I
Date Rec'd
/"'""
(."",.
CITY OF PRIOR LAKE PLUMBJNG PERlVIIT
~ 3 ~ Qff12-
\)~J11
I Elll.lo! i'ilc
:. G4kJ Cfty
1,,"4jI6>,\1.~
~-/~~
I PE:RMJ:T NO
~~ \,'\"'I)c ~t).rtnr andS12n at bono=.)
ADDRESS
11 ?J tP'2- K \ V't11.. 1?i '(2C/I1
()f). (; E:--
ZONING (offl<~",.)
LEGAL OESCRlPTION (ollice "'. ollly)
LOT BLOCK ADDffiON 'P1thf *~ btU(~Jl.cld/
OWNER
(Name) DR Horton CUH"'" Homes (phone)
APPLICANT
(N:lrne)_t'~-._,,~ '''''-~',-.!! c, u....-3 (ph<lTle) ..'_1",,_1,6.6.
(Address) 14745 So Robert Irail Rosemount}1N 55068
~Address) (City) (Zip Code)
(ColltactP.U!on) _'" /( S , ----D (!'hone) 651-423-1144.
I.o.:PLICANTSIGNATURE ~.--'ifj7 -fr'tel1 -::: DArE I~/?i/()~
.....:ppLlCANT PLEASE COMPLETE BELOW
I Type ofFixbl,re Qllllntity [
I Bath Tu.b with or without shower I Rough-ins
Dishwasher I. I Water Heater
Floor Drain -t.:C. Water Sottner
LavllJ:ory (Bathroom Sillk) \ I St:md Pipe (Washing Machine)
Laundry Tray (l or 2 compartment sink Sewage Ejector
I Shower Stal) Bacld\ow Assembly
[ Sinks Backflow Assembly Test
I Bar SiJ:lk ..... ' Lawn Sprinkler
I Water Closet (Toilet) I Other
(Add:ess)
I
I
I
I
I
[
[
I
[
Quantity
)
\
,
1.-
\
L
F!D
%Z-q?c:,-"78DC
:2CStoO
)Le.V1o,z,,\ !;:l6e_
.6 Sci..; l.J.
S,e i DC,
.,..
\..r
u.lU.-\f; IIG ;.u "j
Type oC}Utul"e
I
I
I
I
I
I
I
FEE SCHED-or.:e
Indu'Ir181. Corpmcr<l,1 '" Mulh-faolJly 1% of lob eosl Wlch. $39 50 minimum R<stdenoal. New Oll< & Two-P"'l1lJy S99.S0
R<:,jdAAtial. N1dirions & Alt.u<>tions $39.50
Estlmated Cost S
BulldJl\g permIt #
fAID WiTh
-"'/-r'''' -
dl.',,=,-I.Nf.;; PI:.:RMIT
SO
;
!'
PLU1VlBlNG PERMIT FEE $
STATE SURCHARGE S
TOTAL PERMIT FEE s:
(oroce Un O(lly)
This Application liecomes Your lluiJ4ing Permit When Approved
Bwlding OlJici.t
D...
r.;;.:-~" '::.~-'.,~>""'" ..:,," .._-:_....__ _
,I .Jfa1_d..: ':'!
'~~ I JIlOv () 5 2003
By
Rece;p{ No
24 ho~r nouee for .11 iD..OetiOn.s (952) 4'!o7;9J1~O, r..xJ?52) 4.47~215
--~._-~.. _.. ,.,--~~.;"::'-,::,~
Febl7. ;004 I; 34PM
GEN2 RVAN PLUMBING AND HEATING
Noml P; lli
Date Rec' d
fPlt::a.tc C'Y1'e ornlint md'-'U'Jl'a.tbo:rtr.lm)
ADDRESS
11 :S{~1.. R.iW.~ ~ i frAIl
CITYQF l'l.UORLAl(E
SEWER AND WATER PERMIT
P06--- iDCJ2-
1)~ \+1
$..1l/9~
1 0"", Fil.. I PERMIT NO
2, Yt/1Q.., Cty- .. " -
J, Gr:./4 A."ll~t \
-- I
ZONThlG (olli"",,)
I P1 SE.
LEGAL DESCRJ:!>TION (ollice u"" 0lJ1y)
LOT BLOCK ADDITION ~ #-2...0 tx..uv1 elof.
OWNER
(Na:rno::) ""'a ~?rt91\::\ ('HC~"""'" l:J"''m.Il-
PlD
(Address) .7...0&00 Kev)p~\!X:e Cr.Srtl'" 11'>"\
iAddm.)
(Phone) _
La.~\j Ii I€-.
ICiry)
'l-6.2 -qgS- '""7.2,'V-.
'56",w U
(Zip Code)
APPLICANT
~~e) Genz-Ryan Plumbing & Heating
(phono)
651-423-1144
(Address) 1/.745 So Robert Trail
fl r'~~ ~I
IContactPmoo) . l.j!I~I~J
',ICANT SIGNATURE ~c;:;s;;:;. L'l
. - .... ~,,;- ., . - ~.
Roa",",ount. 1-1N
(City)
55068
(A> Code)
DATE.
651-423-1144.
10 1?l1 ~';)
(phone)
APPLICANT PLEASE COMPLETE BELOW
Size of water !ervice 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
FE.E"SCHEDl1J~E
Rcsld,,"l1alsewer and water hnt connection $35.50 Tndu.strial. Com'l & MultH.mlJy 1 % of Job east With ,,~39.s0 mjruIlllllll
Sewer connection opJy $1750 Wat",. connection only $17.50
~timated Cost $
Buj)d.tng Permit #
SEWER AND WATER PERMIT FEE
STATE SUROiARGE
TOTAL J't"RMIT FEE
$
$
$
PAJD WITH
~U..:ilNG ~r:AMIT
I
"
(O(Ji~ U!i.l!: Oftly)
I Thi. Appllc:ation Becomes Your Building Permit When Apprond
'-", '~"--"""-'-'---""---'-'"
~
Buih:liCl'J OfIicial
))Ut
'. ./ P:aidi .,' '" '..'
I'" .,. ".- ,
, .
,,/ INtlv /) 5 2003 :
I Receipt No.
I By
I
I
H hour notice for 311 inspections (951) 44~:,9~SO, !.~J~~! 4~~~~45...
......---_.._._,_._-~
~-;2JZJ7
~:~ I PERMIT NO. :3 - (//9 --.1
Apphcant 7 ~
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONINGIFIREPLACE PERMIT
1. Pink
2. Green
J. Yellow
crleasetvo~or orint and sign at bottom)
. ADDRESS // # .
/7~2 /OL/-P/ L4"~c-A' ~.
~
LEGAL DESCRIPTION (office uSe only)
LovftlBLOC~ADDITION
OWNER DR HORTON
(Name) - 20860 KENBRIDGE CT
(Address) LAKEVILLE, MN 55044
(phone)
APPLICANT /10 .A
(Name) /~///tf2.L,t. /A~~.../A4/r-./
(Address)~ ~AJ:A~ ~ a:
~AddreS
(Contact Person) A6.A . ~~
APPLICANT SIGNATURE. .... =- .__
Date Rec'd
. ZONING(officeuse)
PID
(Phone) ~.,,/.. 4/,:r'?-.,.?;?;?5
~--*~ ~.5':~??
- (U!It1/f (Zip Code)
(phone) ~/ - c;/<a? --177:2
DATE
APPLICANT PLEASE COMPLETE BELOW
. ,
~NEW CO~TRUCTION 0 REPLACEMENT 0 ALTERATIONS
FURNACE MAKE AND MOD~/r""'J'..,.t :?/O/QAd:::?d407r'J FUEL /I.2,4.J ~ ..e
FLUESIZE9'~~...ARETURNOPENINGS .~ INPUT~~ ~ OUTPUT ~~~
TYPE OF SYSTEM
DWann Air Plants
DGravity
o Mechanical
~ir Conditioning
JI'O!ent. System
HEATING OR POWER PLANT
o Steam
o Hot Water
o Radiation
o Special Devices
o Other Devices
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
Residential, Heating & NC (New Construction)
Residential, Heating Only (New Construction)
Estimated Cost $ "._ q~a::>BuildingPermit #
$~/ ~.//c:4.r--
$ ~ .50
''':.":;;:~,.. """.. y~. D.'.'" ,~" .... A,,~.. ' s.F;, ~m
'r ~ I
Date 11}1~teNUV 1 2 2003
24 hour notice for all inspections (952) 447-JiSfJ, fax (952) 44_7..-4.z~
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
Building Official
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
$39.50
$39.50
$39.50
":1 ...PAtoJJl,,-_
'.. ul(t)INGrr,!..!-.
,:::J''';~~n
~nmf1"
-
--I
'Jl,ieceipt No.
:;1
.~
,Y
ov
o
,
i
--'J
PRIOR LAKE
INSPECTION RECORD
SITE ADDRESS J, 3~:J. 'R/ve., B,\~1t lJ..,J
NATURE OF WORK ~
USE OF BUILDING li If:. J4 '
PERMIT NO. -01 - L~ DATE ISSUED J - ,.
CONTRACTOR 0 R.' ~~r~~ PHONE ;a.;)".l/n~
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
Main File
DEPARTMENT OF
BUILDING AND INSPECTION
INSPECJ9R DATE
I FOOTING I v}('( I 11- I:' ~oJ
, FOUNDATION (Prior to Backfill) I rrF / tp.t Tile /111"1 i.1-1-6 -:> /12--'t-OJ'"
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGttED
ROUGH - INS
SEWER I WATER I SEPTIC
FRAMING CJtc"rl,"-j tAI/ I_(J--(Je, ~ 1'1f
INSULATION /1/1 /
ELECTRICAL
/1 ,
PLUMBING lkc-f' V,G. Ail tI"ib VL{/ //W"/ Ur/1 ~II UI1/1-.5 d:,..J//f/e; '1
HEATING (if required) p1..J'/;2- 18;-,,'1
FIREPLACE i#/ ;l--tt.I'5'
GAS LINE AIR TEST ~ J- -/(r-O(/
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
~~ / t!.ttt~,{).11acAff I
, FINALS
;l'-Ilr-O,/
.J. -M-o L/
G~ADING (Prior to Sodding)
BUILDING r~'f Mil)
ELECTRICAL
PLUMBING
HEATING
DO NOT
~a
t/W;
I/!/f/
OCCUpy UNTIL ABOVE HAS
NOTICE
<< -{-{}y
, /
7~VoY
~.J:.r OJ
3 >zc; 0(/
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
l
QIrdifirafr of @rmpanq!
CITY OF PRIOR LAKE
@.tparfnumf of ~uilMng JInsprdion
iFinal 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 following:
Use Classification
SINGLE FAMEY
_ Bldg. Permit No._
03-]492
Occupancy Type
R3
Type Construction
VN
Fire Zone
N/A
Zoning District
R?
Legal Description L2, B5, DEERFIELD 7TH
Owner of Buildin. Site Address 17362 RIVER BIRCH LANE
Contractor's Name & Addre" D. R. HORTON, INC., 20860 KEN BRIDGE CT.. SUITE 100. LAKEVILLE
ROBERT D. HUTCHINS /;&'d _ City Planner. DON RYE
_. /. B)llydin Official -
Date: 7//) /0 Date:
r /
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
"'( -J!!'?-o<;
ADDRESS
n3&l
filA h,.-r0
OWNER
CONTR.
PHONE NO.
PERMIT NO.
7-/fIq L
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o ~R HOOKUP
~LUMBING FINAL
o MECH FINAL
o EXIGRADIFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
COMMENTS:
/(Yf ~Wl/jlA
~05
.
o WORK SATISFACTORY. PROCEED
jk' CORRECT ACTION AND PROCEED
o CORRECT WO~. '},~R REINSPECTION BEFORE COVERING
Inspector: 11 /I'r Owner/Contr:
I
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH'" SAFETY!
mSNOTl
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
f7:J1,g..., iWlY!:>rL t,
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
P"fINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
}If MECH FINAL
COMMENTS:
(e- )fJ-tl"I'I\.r/'U<1.J
~ $q1. d-
(J) ,h..a!
OA TE nMe
$-~'Ovl
~ -If.{t( ":i
o EXIGRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
,J pi ~ UAI cJ ?: ;.-J... 1.</,,1//
(j}.p~ 5' cu::'P'/{)I/?:f, / .
/l n<,), '" /.? 17;-711"" I
- .
\ l--e /'11 17 tfl1 /1-,- (
V
q.I-()c/
,
o WORK SATISFACTORY. PROCEED
o CORRECT ACTiON AND PROCEED
"CORRECT WO:'>f~FOR REINSPECTION BEFORE COVERING
Inspector: j/I/ r Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
'N$NCn
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
DATE
Ms~~
/l'IVe.e. 4/AL../I ~
173fDZ - 17 '" 0 7 R jl/FX-I/,c.e;I ;ti?t.A7t6'
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
OWNER
CONTR.
TIME
PHONE NO.
PERMIT NO. (V. 1-!9Z - 03. /4-9'1
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
\l FINAL
IS' SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
,
S-' I
COMMENTS:
tYl-OS6
1-1 vB
elf
o EXIGRADIFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
XWORK SATISFACTORY. PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK; c.:';,~F7" REINSPECTION BEFORE COVERING
Inspector: /~ Owner/Contr:
CALL "7-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
msNOT'
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
Lr1.
D. f<. l-kdO>'1
11 < - 1'172..
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS /7'3 t;J
l?,vev'hJd1
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
~NSULATION
FINAL
o S TE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
COMMENTS:
Ghd"s..-- (!) t-
LVI6 ~- Ot-
DATE TIME
9-17-0'(
)('~ILLING
or D'cOi.1lll:AiNT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
X.WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: #~ .....Qwner/Contr:
^
QALL 447-9850 FOR, THE NEXT INSPECTlC)N 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
"",,,m