HomeMy WebLinkAboutBuilding Permit 03-1524
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec'd
/0.2--3 03
Main File
1. Wh.ite
2. Pink
3. Yellow
File
City
Applicant
I PERMIT NO. 03 -/524-1
(Please ~e or mint and sign at bottom)
ADDRESS
~q:A &d Chk YOGYl 1- Dr! IX. '2E
ZONING (office u,,)
.e,
LEGAL DESCRIPTION (offiee use only)
LOT 5 BLOCK ~ ADDITIO~h dd (6ft::
PID.?5 4'.()/. 02..5. 0
OWNER
(Name)
(Phone)
(Address)
BUILDE~T' 11 ~ I.
(Name) ~,I<', t-mJDY\ ....Lr\_C-.
(Contact Name) {Y1i!<..'-( ~(oh~I.+ku..
..2C8\QO.J<"_.I'Ylcl~Q;t:~ l\lO
(Addressr' L:...b:rJL:. YYPI\! "53:Jt/t/
(PhonI ~~8~ ~ - 7[f:PJ
(Phone) ;(./? -1-7 (~2.
TYPE OF WORK
~ew ConsbUction
DLower Level Finish
ODeek
DPorch
ORe-Roofing
[ ]Re-Siding
o Fireplace
DAddition
DAlteration I JUtility Connection
1'55, '11~
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 cert fy 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 p 'oceed 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 :>fficial or a designee may
enter upon the property tQJ>er4rm,~efded inspecl1, .ons.
,~t.u_ rtt.L~ ci<CXD 3.0 57 ~S--/f.,.O~
, (j Signature Contractor's License No. Date
I Permit Valuation i/~Co 00<9.001 I Park Support Fee # &350, ()O
I Permit Fee $ /. ~a7. $51 I SAC # /275',tJ"
1 Plan Check Fee $ eLf,?, 781 I Water Meter (Si~l"; Z5;'CJ,OO
State Surcharge $ 7~ ()O 1 I Pressure Reducer 4'5', 0 CJ
Penalty $ 1 I City SAC and WAC # /200.00
Plumbing Permit Fee $ lo".()o I I Water Tower Fee # 700,lJtJ I
I Mechanical Permit Fee $ !tJCJ,tJtJ 1 I Builder's Deposit /5"OtJ, fJO I
I Sewer & Water Permit Fee $ 35, $'"'0 I lather 1
I Gas Fireplace Permit Fee $ .t.ft1. 00 I 1 TOTAL DUE S~330,h.3 1
-,
This Application Becomes Your Building Permit When Approved Paid .fJJo,c,) I Receipt 1 l' +iD. 0 t";L. I
~ ~ 10 Ia--'J ~ 3' Date It-.I. elJ By J ~ I
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 Cel tificate of Occupancy must be
~.
~
~ aLe ~~
Date Special CondiMlns, if any
24 hour notice for all inspections (952) 447-9850. fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
/0/.;').-,,,03
Planning Director
~~
White . Building
r l.an;:lrv :...C.DfllneermQ ')
Pink - Planning
Tht' ("f'nlt'r of lhfl' tab ("ounl.,..
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
L) r-.
"0'" ~_._
f'-I' ('rr ' I
k , k/
1/
'1 -
('-
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
-, .---"" -'"
(' '7 T-" ,,- ( i Kj. )/'1 h " 1--' ..' . t
/ ?- e-l\--. I ,"\,- _....) 1\) I ) 1,- ",.;
Accepted
c<-.
Accepted With Corrections
Denied
Reviewed By:
J1/YJ-/)
If! e," v'"\ f{'/t__
Date: 10 '--sO-03
Comments:
!=;pp Rpverse Side for Additional Information!
See Attachments: I) Grading Plan. 2) Erosion Control Measures
"The issuance or granting of a permit or approval of plans, specific ~tions 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 coe Ie or other
ordinances of the jurisdiction shall not be valid,"
~~
Main File
White ,Building
Canary , !;!1gineering
( Pink ,I-'Ianninq)
Thr (fnlrr of lhf 1.akf Count!')
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
I ,'-
.
i
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
....\
, .
!~
--
,
- .-\ I
f.....-.~
! I
--
! ) I _'.
c-
Accepted
Accepted With Corrections
~
.
Denied
Reviewed By: ~ ~~ Date: jO/;Pljo:r
,
Comments: I? ~ _ a..-Lf -..:. /.: ~
fJ-V..l<-4-' .A _. _ '>/-- ~ 3tJ I ~~ ~
v
~ ~~.f} tu-e..HA-,.JJ tJ, H. tJ, t. ,
, 1/ / -
l\..tltJi J~ Ad,.PL-L~'
"The issuance or granting of a permit or approval of plans, specific1 tions and
computations shall not be construed to be a permit for, or an approval of, any fiolation of
any of the provisions of this code or of any other ordinance of the jurisdictiOlI. Permits
presuming to give authority to violate or cancel the provisions of this cod 3 or other
ordinances of the jurisdiction shall not be valid,"
~1
Main File
r1vhite 'Buildiliib
Canary , Engineering
Pink 'Planning
Tht (-..ntt. nf Ih.. I.."" COUnlf)'
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
D, e. Hoe.-rofJ
10,2.3.0.3
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
50Q2- E-A5I OAK... POI~T DR- :;6
Accepted
Accepted With Corrections v
Denied
Reviewed By:
~.
IF~
V.ul:20
,~,
Date: 16/..<?~:5
I,R,c. ~
~
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 \'iolation of
any of the provisions of this code or of any other ordinance of the jurisdictior, Permits
presuming to give authority to violate or cancel the provisions of this codn or other
ordinances of the jurisdiction shall not be valid,"
Oct 31, 2003 310PM
GENZ RVAN PLUMBING AND HEATING
No,8526' P, 6/41
Date Rec'd
...~z~ I'Il~lO~~
t:: r ~
(,) , lrJ
,-
':\~~~,':~~tl&.~ <(to
'<.t'w~~'~~.'ll'IIIESO
CITY ,OF PRIOR LAKE
SEWER AND WATER PERl\tllr
q'le.ue cvp~ 01' l>fUlt and Si2J1at bom)m)
ADDRESS b
0ML 'fast Car... -pDj V\. t 12.... & E;..
, (;,'.. "', I r NO
2, YolI,.. Ci" J: .I!,.KJ~ll . ;;? _ / 5 ..... ) },
3. Gold ^'PFIlcD.().! I.. / cT '"+1
. ,
ZO~G(otl'ic.,,<)
LEGAL DESCRIPTION (o/lice use only)
LOT f) BLOCK 1 ADDmON h.u1e.. -n dot I ~
PID
OWNER
(Name) PIl IInrt--, ".._~^- "^r,-:
(l'hone) _ q52 -q65- ,8{)"
(Address)
2.o&.co kVlBi<-IDL--e Or- :m.Jf\r\
[,Ad<l=,)
Lal<.t~I\le...
(C,{y)
0ajUU
(Zip :ode)
APPUCANT
(Nam~) Genz-Ryan Plumbing .\. Heating
(phone)
651-423-1144
'rJCANT SIGNATURE
(Address)
rAil ~J~ti F&"ll r
Cut1i:~ J l/l
Rosemount. HN
(City)
55068
(Zip Code)
(Address) 14745 So Robert Trail
(Contact Person) _
(phone)
DATE
651-423-1144
JOJ:zuko-,
APPLICANT PLEASE COMPLETE BELOW
Size of water service inches.
Location of any couplings from structure
Type of sewer pipe. 0 ABC 0 PVC
Estimated len.,ath of sewer line feet.
Clean out (if required) located at _ feet from suucture,
feet_
o Cast Iron
ReSIdenual sewer 3nd water Ene connectlon
Sewer cOIUlection only
FEE SCHEDULE
$35.50 Industrial, Com'] & Multi-family 1% of job cost Wlth a $3! '.50 mtnlIDum
$17.50 Water connection only $17,50
Estimated Cost $
Bullding PermIt #
SEWER AND WATER PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
.50
JJWt:l3d 9NIQl/na
Hl/M (/Vd '
(Office U.se Only)
I This Application Becomes Your Building Permjt When Approved
Building OfJici.1.J
I Paid I Rec:ipt No.
I Date - I By
. ~Z'. .
'.. .~' " tU03
24 hour nO'lee for allln.peetio.. (9S1) 447-9S;JJ. fu (952) 447-4245
Date
I
~
~
Oct,31, i003 311PM
GENZ RVAN PLUMBING AND HEATING
No,3526 P, 7 41
Date Rec'd
CITY OF PRIOR LAKE PLUIVrnlNG PERMIT
\ !Iw" J?ll~ I PE.RMIT NO
, Gold ej~ - ;:;l, _ (.c-'dD I
J. Ydlow App!l..::ml ~ V ( 7
(P1ase: ryne ortn"int and S1!'31 at'bottOJD)
I ADDRESS -
Tj D01 'S1,n- M Ie. 'POI VI+
b~SF
ze NJNG (offu:. "',j
LEGAL DESCRIPTION (office use only)
LOT 6' BLOCl( 1... ADDITION tu~-A tIJ. llJttllJ
PI])
OWNER
(Name) DR Horton ClIscom Homes (phone)
9~-,2-q'2F -7'6lJO
(Address)' 2-01,"'0 J(enB~1 DGe... CoSte IDO
APPUCANT
(Name)-G-:t~.1._~;::_::-. :,~_..=_,...t....: .to l;l.e.a.ci.,""13
(Address) 14745 So Robert Trail
(A ddresp..
(Conracr Person) 0 AlvwJtti t1f) Is,
APPUCANT SIGNATURE .:-_._/J... A .(~-_W j /-0
I
I
I
I
I
I
I
I
I
Quantity
'l-
\
lJ
I
1-
\
(-<;
u,{L_cvi 1I~, .UN .sCX)Lj..J
(phone) _~" 1 _I,? ~_ 1 1 loA
Rosemount
MN
55C68
(Z;, Code)
(City)
(phone)
651-423-l.J.44
DATE /Of?;} f /)?.,
APPLlCANT PLEASE COMPLETE BELOW
I type of Fixture I Quantity
I Bath Tub with or without showe.r I
Dishwasher
Floor Drain
Lavatory (Bathroom Sink)
I Laundry Tray (lor 2 compartment sink
Shower Stall
I Sinks
I Bar Sink
I Water Closet (Toilet)
Type ofFixtlJ re
i
1L-:I:
I
Rough-ins
Water Heater
Water Softner
St:md Pipe (Washing Machne)
I Sewage Ejector
I Backflow Assembly
Backflow Assembly Test
I Lawn Sprinkler
Other
FEE SCJI:EDlJI.E
InduslliaJ, Comm"",..l & Mullt-famlly 1% of Job cost with. $3950 minimum ReSldenllal, New One & Two-Fsmily $9950
Residential, Additions & Alterations $39 50
ESlJroaled Cost $
BujJdmg PermIt II
PLVlv.1BING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERl\fiT FEE $
50
PI' ,0 W\1t-t \1
SU\tO NG PERM
IOllie, Use Only)
This Application Becomes Your Building Permit When Approved
n...
I Paid
I DareNOV 2 6 2003
/)
By vr
U
Receipt No
Building Offici:al
24 bour notice for '1I1n.pection. (95;) 447-9850" fax (952) 447-4245
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONlNGIFIREPLACE PERMIT
Date Rec'd
# 7:5N
i ~~~w ~!~;~, I PERMIT N( '. 3 - J o.J-Lf I
_ q>lease tvDe or Drint and sign at bottom)
ADDRESS /' ') , ,
-5?)fd ~ ~~
/7. /, // . ~?-_
/'S/"cr- L/: ~=:
I ::ONING(o_use)
LEGAL DESCRIPTION (offiee use only)
LO~LOCK~AUUlllON
PID
OWNER DR HORTON
(Name) - 20860 KENBRIDGE CT
(Address) LAKEVILLE, MN 55044
(phone)
APPLICANT /10 .A
(Name) /~h'/~ //?~'r../d.A./"a./
(Address)~ ~~A~p A
i?:AddreS --
(Contact Person) A~ ,,6'.~~
APPLICANT SIGNATURE ..- - ,....~-
(phone) k~/- 4~?-J.?;?5
~~~
(Clis/If (Zip Code)
(Phone) ~/- q~-~77S.
I
'7.::.;L}' ?
DATE
. APPLICANT PLEASE COMPLETE BELOW
~NEW CO~TRUCTION 0 REPLACEMENT 0 ALTERATIONS ,
FURNACE MA~ AND MOD~/ Y,b'; ~. :?/O/QA d':.k?~07t::J FUEL -L -b ..4-";,.:,,..- ..e
FLUE SIZE~;'./a....A RETURN OPENINGS ~ INPUT ~ OUTPU" 6Z,~
TYPE OF SYSTEM HEATING OR POWER PLANT
OWarm Air Plants 0 Stearn
OGravity 0 Hot Water
o Meehanieal 0 Radiation
~ir Conditioning 0 Special Devices
JJ'1Yent. System 0 Other Devices
PLE) SE NOTE:
Air C mditioner Units
Cannc It Encroach into
Requi red Side Yard
Setba oks
FIREPLACE MAKE AND MODEL
Residential, Heating & NC (New Construction)
Residential, Heating Only (New Construction)
FEE SCHEDULE
1 % of job cost Residential, Gas Fireplace
$39.50 minimum
$99,50 Residential, Addilions & Alteralions
$64,50 Residential, AC Only
$39,50
Industrial, Commercial & Multi-Family
$39,50
$39.50
Estimated Cost $ . ~a::>BuildingPermit #
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$~/~._"'/~ PAIDWITH
$ .... ,SO aUI LDlNG PERMIT
$ ~
(Office Use Only)
This Application Becomes Yonr Building Permit When Approved
Building Official
Date
I Paid
I Da~OV 2 6 2003
Receipt /'lo,
,
By
-
ro
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
Ol~l04
(Please type or Print and si5tll at bottom)
ADDRESS
; ~;,:" ~:~ I PERMIT N 0-.... .--- ~ -
3 Yellow Applicant ~
5092 E, OAK POINT DRIVE S,E.
ZONING (office use)
LEGAL DESCRIPTION (offiee use only)
LOT BLOCK ADDITION
PID
OWNER
(Name DR HORTON
(Phone)
(Address)
APPLICANT
(Name) AU.TED FTRFSTDF DBA FTRFSTDF HEARTH & HOME
(Phone)
65 I -633-256 I
(Address)
2700NORTHFAIRVIEW AVENUE
(Address)
ROSEVILLE
(City)
55113_
(Zip Code)
(Contact Person)
RRENDA HUSTON
(Phone) _651-633-2561
APPLICANT SIGNATURE
BRENDA HUSTON
DATE
1/22/0' .
APPLICANT PLEASE COMPLETE BELOW
xD NEW CONSTRUCTION 0 REPLACEMENT 0 ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPL T
TYPE OF SYSTEM HEATING OR POWER PLANT
DWarm Air Planls
o Gravity
o Mechanical
DAir Conditioning
OVen!. System
o Steam
o Hot Water
o Radiation
D Special Devices
D Other Devices
PLE ~SE NOTE:
Air ( onditioner Units
Cann )1 Encroach into
Requ Ired Side Yard
Setb, cks
FIREPLACE MAKE AND MODEL
HEAT N GLO SL-750TRN-C X 2
Industrial, Commercial & Multi-Family
FEE SCHEDULE
I % 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 Only (New Construction)
$39,50
$39,50
Estimated Cost $
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
Building Permit #
$ ....AIU WITH
$ BUILDINB!PERMIT
$
(Office llse Only)
Buildine Official
Date
I Paid Receipt No,
I Oe Jl ? 1 0 4: By
This Application Becomes Your Building Permit When Approved
24 hour ootice for all inspections (952) 447-9850. fax (952) 447-4245
PRIOR LAKE
INSPECTION RECORD
SITEADDRESS -.ff"'lZ ~AST lJAJt. ~. l)gJilE's.~
NATURE OF WORK AJe w - CJ:WSl"R.Ue:nIlN
USE OF BUILDING ~ · -
PERMIT NO. 03-/524- DATE ISSUED 1()/2.?/'~
CONTRACTOR 'D.t-Ji. +lolL~tJ C . PH6NE~ -Z2"-'/132-
NOTE: THIS IS NOT A PERMIT FORANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
DEPARTMENT OF Main Fil
BUILDING AND INSPECTION
INSPECTOR
OATE
I FOOTING I I ,
, FOUNDATION (Prior to Backfill) I j/!/J/"!tM / IlL - /( ~ /; J - Ih
PLACE NO CONCRETE UNTIL ABOVE4tAS BEEN SIGNEDI
ROUGH - INS
~
M1ur1I-.:- ~
~/
f/I/)/7
, GRADING (Prior to Sodding)
I BUILDING 'I e~ I.fi1til q 'f--IIL.
I ELECTRICAL
PLUMBING
HEATING
DO NOT
SEWER' WATER' SEPTIC
FRAMING
INSULATION
ELECTRICAL
~
PLUMBING j/Yf/ ~ ;2 .,r.(J(,/
HEATING (if required) t/'W-::; .2-~C(-oC;
FIREPLACE WI' ~ ~qrd'CI
GAS LINE AIR TEST ;1/1'/ ~r,,~c-I-/.JLi
/
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I I
FINALS
Ale
~
/)--)q-o>
2-2tfP-j
;z.. ). ?<IlJ
I!dJ-' I ~
/04/0/
M...J
rAIP
OCCUpy UNTIL ABOVE HAS
NOTICE
Ll--t ':-Q't/
c.u ~,
BEEN SICiNED
This card must be posted near an electrical service cabinet prior to rough-in in~pections
and maintained until all inspections have been approved. On buildings and i dditions
where no service cabinet is available, card shall be placed near main entrance.
FOR ALL INSPECTIONS (952) 447-9850
QIedifirate of <IDrtupanqz
CITY OF PRIOR LAKE
~rparf1Urnf of ~uilMng J}nsprdion
,JfFinal Permitted D Conditional CO, Expires
This Certificate issued pursuant to the requirements of Section 307 of the Unifonn Building Code eel rifying
that at the time afissuance this structure was in compliance with the various ordinances of the City ~ ~Prior
Lake regulating building construction or use. For the following:
Use Classification
SINGLE Fk"lILY
Bldg, Permit No, 01--1 'i 24
Occupancy Type
R3
. Fire Zone
N I A _ Zoning District
Vii
r1
Type Construction
Legal Description
L5. B2. DEERFIELD 10TH
Owner of Building
Site Address 5092 EAST OAT< POINT m TVl' ,S.E.
"0860 KENBRTDGE CT. _ SIlTTl' 100.
Contractor's Name & Address D. R. HORTON. INC..
ROBERT D ~ HUTCHINS~
,/ ~Ui1d': Off5ial
Date: .///2.7 ~ <./
" - - f
City Planner
DON RVl'
Date:
.
4
~. ",
,.'
DATE TillE
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
//-IS-o'l
PHONE NO.
502-- i=~,+ t9../( /17).,...
CONTR, _f) ll-kJ,?",
PERMIT NO, b S - /,t;dl{
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
~ EXIdRAi>>FILLING
o CO"GJ5i:AINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
COMMENTS:
SD5r. - ,'C)K!-
'-"
~ORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: 1?76~ Owner/Contr:
CALL 447-9850 FOR THe NeXT INSPECTION 24 HOURS IN ADVANCE,
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INfNOTI
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
L/;)L, -eN
ADDRESS
5lxfL E a~i. Pt
OWNER
CONTR,
PHONE NO,
PERMIT NO,
'~-I.C.?-tl
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 EXlGRADIFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
COMMENTS:
/T)
'(fl)
v-:. "
r1,)
v
V.(,ol1~",e..-1 +- S ,da,..d'/( .;- d ,y'1ft <""'';/
r::;:.,,,,, / D., ~~c& a..?!P...-ov.,/
<;;,1.J cL- r-r_f- \' p...~ c..J"ul"(rfiO ;~:'
\1 ~ ./7
1--<:: tMfJ ~
I I
L/v{rr\
./'I I
-(~/=Ucl
o WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
~ORReCT W~RKJ'pR REINSPECTION BEFORE COVERING
Inspector: 111/1' Owner/Contr:
CALL 447-9850 FOR, TJ-lr: NEXT IN~PECTION 24 HOURS IN ADVANCE,
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
U<SNQn
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
~O :7,.2
OWNER
PHONE NO,
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
A:t1'INAL
o SITE INSPECTION
COMMENTS:
~^ /
~#q/
-
~
.~
/; ..-, A
~ _I"~.s-e
DATE TIME
SCHEDULED ~,1~~~
j' -
~r ~ Oq.-t // ;/r,
CONTR.
PERMIT NO.
C3 -/s;2y
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EXlGRADIFILUNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
/'
U/C
----
..--: /
/-? / to
~
~
/
./
\
~ORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: ~
CALL 0147-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE,
OWner/Contr:
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
"""""
-
Job Address
Heating Contractor
Name of Tesler
Date
Percent 02
Percent CO
Percent C02
Stack Temp
.......
5()7Z. F.CI~PT~2.
M\.i~ 114cl.f
Aor.--.\:S
3( ''''[04-
ID.L/v
ap~
6.1J 70
qCJ Or
Combustion air is adequately supplied per
UMC Sec, 606 V~$
input W ~ ~'T\J