HomeMy WebLinkAboutBuilding Permit 01-0033
,.
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
DATE RECEIVED
L White
2. Pink
3. Yellow
q;'
/2--/1-00
DIRECTIONS
SPACES NUMBEREO 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
2. SITE ADDRESS
I S!)\n
3. LEGAL DEsCRIPTION
4
1. DATE
1)'-I'1-~DOO
,e/
.57(, . ogo ~ (.J
PID ~S"- 3.~7-0():1-o
BUILDI RMATION
11. SIZE OF ST URE
..!~t~ ~ G# ~
PIl~KWAY
~~.
lfJ~
12. N:;t'F STORIES
13. TYPE OF CONSTRUCTION
51"t!~ r-t{lI)f1e
(Address) 0 (Tel. No.) 14. FLOOR AREA APPORTIONMENT USE
/1CfS-fJL/l-ZA -1'. tRqll11 &>/-"IDL-/ll{/J(J 651nr - J75;1, $1'
(Address) I' (Tel. NO.)" ' I ~ FLt. 7,i)3s
" 1., ~ ~ '..1.f' 'Z.
(Address) (Tel. No.) 15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS .5"
fo
BLOCK
Is+
LOT
ADDITION Wf....< f1IA." n
4. OWNER (Name)
W e?\ ~ 1M n n H01/'lt:s
15. ~CHITEC,:{ (Neme)
t'eJ" UAL5tRDJf'l
6. BUILDER (Name)
/.
I. I,SJ-QOb -'1400
Ho ..., e,s
We.71~m(1)1h
SEATS
SepticLl
AdditIon LI
DeckLl
Finish Attic LI
As-roofing LI Porch LJ
As-siding LJ Finish Basement LI
7. TYPE OF WORK
New Constructlon'}(
Chtmney LI MIsc.
IS. PROPERTY AREA OR ACRES I S. PROPERTY DIMENSIONS l' O. CULVERT SIZE
Sq. Ft. /5'. '14 7 Width'dLf- /17 Depth 1(,0 Yes ~
I hereby certify that I have furnished infonnation 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
bUi~~;:gke~thls pemjt fOrhst cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to peltorm needed Inspections.
X . l~ I'iSf? JA-lq-:;r"tJO
Signature License No. Date
Fireplace ~
Alterations CJ
16. PROJECT COSTNALUE
~ ~(), 'C~
17S0Ttl/';; /
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
MATERIAL FILED WITH APPLICATION
SOIL TESTS LJ ENERGV DATA LJ
PILING LOGS CJ PERCOLATION TESTS CJ
PLANS & SPECS LJ SETS
"ok
Side
S~.
Front
BUILDING DEPARTMENT VALUATION
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
S,J:D
USE OF BUILDING
SURVEY
LJ COPIES
PERMIT VALUATION '"'")~:C>~.~ PLOTPLAN LJ
Amount Brought Forward ................~ t':i~-o. ~
Park Support Fee .........................~~
SAC ......................................::1' ...
TYPE OF CONSTRUCTION: I 1/ III IV V
Occupancy Group A B E F HIM R
Division 1 2 3 4
Permit Fee ................................... $
CIty:
S U
1,~'5). '1~
I, 1'1. "I<f_
1'2.<;'. De>
Collective Street Fee ....................... $
Sewer Tap ................................... $
(" $
Pressure Reducer .......................... $
Meter Horn ...................1................ $
WeterMeter ...........L.................. $ ;;;l~.oll
Sewer & WaterConneotion Fee ........... $-1. 'jf ~
Water Tower Fee ........................... $' () ..
Water Tap ................................... ,01:
Buildef. Deposit ............................ $ , / t:;"'0Q .m
Other ......................................... ,of:
Peld T09,/;.i~'.""I?"""~~~~I~;~i$~t;r!f-
Date 1- ~ z. - 0 I By,;;e: .
request In the above application and accompanYIng documents IS In accordance with the CIty Zoning Ordinance and may proceed ;V~uested. ThIS document when
ner constitutes a temporary Ce1~~ lZ7D tPliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be Issued.
C' Planner ' m.te Special Conditions if any
Plan Check Fee ............................. $
State Surcharge ............................. $
']0. tXl
Penalty ....................................... $
IM.GO
l~.OO
~.sp-
'If) .0"
~\
1'1.-
Plumbing Permit Fee ....................... II:
.
Mechanical Permit Fee ..................... $
Sewer & Water Permit ......................!t.
our Building permit)"~,,/'PP~
Date ~"l I
Issued
24 hour notice for all Inspections (952) 447-9850
White - Building
Canary - Engineering
Pink - Planning
Th~ C..nln of the L.k.. COllnlr)'
BUILDING PERMIT APPLICATION QEP.ARTft11ENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
WENsMANtJ
\'2- /q -0 ()
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
Accepted
L 4- { 13 (p, Wf:,N5MA t\I N l~
Accepted With Corrections
Denied (rD/) _ /
Reviewed BY~~
I
Date: {- 1I-'2Do,
Comments:
~ a..OO d~~J. /.tc.Jo., *.R
"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."
0\ ~M3 ~
Thle Ct'nlpr or the L.ke Country
White - Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLIcATION 'Ol;PARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
\,\J [. \\:S H f-\ i'-J t\)
\-2-10-00
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
Accepted
L ~ e G:- \,'1 l i~~I'i i-\ l\j 10 I ';.;L
~ I I .
,/ Accepted With Corrections
Denied
Reviewed By:
Comments:
_~'AAAAA( 7-0. 'f-~ t}v~IJe-f ,~_~01r td;
*J'N\'t- ~ l~ ~\f1'w1) ~<O~~,
G' /O.;;,.1~~.....r A'A4.
~ -.. -
Date:
tJ1B/e1
"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."
b\ ---00))
Tilt Ctftlt; of the- uh CODnlr)'
White - Building
Canary - Engineering
Pink - Planning
BUilDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
\ · I r NiC /\/' " t ' ~)
\1\) u '--::> I -I f-\ \l 1\.
17-/0-00
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
1!;3J7 Vlilds. PA~YI.vAV
L 4/13 1.0 I 'We,I'\JSI"I r\ N 1\J I ~
Accepted -./ Accepted With Corrections
Denied
Reviewed By: L LL
Date:
1//7/01
. .
Comments: ~ee.. ~pr(p> ~'OG Ft.:R.. /hD/flfJAJ/JL ~e.J75_
"
~ Il7T/?CI1'/J'le:JyT5:: I) (bel7{)1/11/J 1lA/tJ zJEM{//J~/Jl~~q
3) Er<tJs;nlll a,11/rP/X.. PeAn]
"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."
MAR. 13.2001 5:11PM GENZ RYAN 6513226147
NO.995 P.21
1. .... .... .
ll.CIoId. ..ClA!.", '
S. .,-. AMIiIor
. PLUMBING PERMIT 4# () 1- () () 3> ~ ..,
Appllcant.....au-n-- .~ ~hone:..I.~LO?-\ -III./.'y:-
AddNII: ~.,u. c.... \~u ~b '" r -nt? J _ "~(fY"D1.Ll"r Q:2:)c..~ .
Signature: ~
Legal DeIorlptlon: Lot L..j, BIock~
SIte Addre.: l"'>.a.,.1 -, I' 'X \ ~ \:)\1 l l ~
Buildlng Pennlt. 0 I . 0033 I'ID. zK ~ 3'7&;.(':/),0 - 0
NOTE: Thla permit 11(II1 not be. ." '. Ichvtthout complete 1m. ."" n.
FIXTURE UNITS
-
:~CITY OF PRIOR LAKE
'I1It e.......r .. ta. QMht
Sub
,::"'A-J",,~1AAJ ~Jr~
"':~:t
QUII1tily Type of FixtUre Quantity Type of FIXture
2- Bath Tub WIth or Without .hower 9lo Rough-ln.
I Dlahwa.her \ Wa.r Heater
\ Floor Drain (.11 Watar Softnar
~ Lavato'Y (lll!llroom .ink) \ Stand Pipe (wuhlng machine)
I Laund'Y Tray (1 or 2 compartment .ink) Sewage EillGtor .
I Show.r Stall BIaIdIaw Auambly lRPZ. CoubIe Chaclc, PVB)
I Slnka BlClldlow A.embly Tellt
1_ Bar Sink Lawn Sprlnkl.r
\. ' (I G Water Clout (toilet) Other
I
FIE SCHEDULE
~ Induatrlal. Comrneldal & MultI-Family
(1'" of job _t, .-.so minimum) $
Flesldentlal, NfiI 0". . Two Family $99.150 $
RHIcI.ntlal, AdOiUo", . AI_Uo", saUD $
$tea. Surcharge $ .50
P~\~t~~M\i ,
GRAND TOTAL. . BU\\,.O\ .
.
.;-....
ThI. permltl. putod upan the Illp..... amdltlon that We!
.. . ."". ". .hIIl COIIIply in all 11I1*1I with the onIinances
D(theSlalePlUrnbl~the~~f.
~ . 3.'Zo'Z..1l1 DATB
A1TIlST
Call for aJlln~Dl\S 24 hours In advanCIl.
~ '::"'..;
115200 Basle CrcckAv. S.B., Prior Lake. Minnesota 55372 J Ph. (612) 447-4230 J FAX (1512) 447-42~S
Aza Equal Oppalt1llllty Employar
MAR. 13.2001 5:12PM
GENZ RYAN 6513226147
NO. 995
P.22
,-~ _.....
y........ . ..,...: -....,
........
. . I'
CI'l'Y OF mOR LlD NO. ,0 1- nD~
SIWD AND VATU. PDKIT
NCl'l'B: Sewer and Water
contractor. mQ.t
be n,btered.
witb the city.
APPLICANT:..ss::tr\.;J.- ~wmb'~"'- UonorlA.Jll. PHONB:~1-4'2:!o-1 ,~LJ
.,)1'...." "[1 ~ .......-. ~. """" .CA").\ ';'- \ l) I
SIGNATURE: BLDG. PB:MIT '...12.1 ~OG.S5
SI" .,)1'....) I~ .'.'~;.\""".V~ '. N PID! 2.,>.37_ .rR!O-D
,PILL IN THB BLANKS
1. Estimated. length of water .ervioe 40' feet.
Z. Size of water .ervice ,it inchees).
3. Location of any coup1in,s from st;ructure feet.
.- 4. Type of .ewer pipe. ABS pvcL Cast Iron
".' "
',._1 5. Eatimated. lenqth at l1n,..iJr'.' feet.
.ewer
Ci. Clean out eit required) , located. at feet from
structure.
...-
apPl:atian JJ,d.~&:: ~e~it When-::proved.
1JTl1fL- DATE: 3. "2-2-.'0 I
, "'" "..{J.. ..... .".. "., . ~------- . ..' ......... ". ..... . ..
-----
This
BY
,
...."
FEES:
$ 35. DO
$ .50
$ J~.~Q
Sewer and. water line connection permit.
Surchar,e
'1'OTAL
*
Fe. for either a.wer or water indiVidually i. $20.00 plus
S .50 eurohar,e. --
S.wer and. water permit. issuee! for new construction must be
recorded. on the buildinq permit card at the ttme of i.suance
to insure that no duplicate .ewer and water permit. are
issued. n\N\\~"J'\\
{ ~p..\v G 'r'c-'"
AMOUNT PAID ,)J\\.. n\~ ,
*
DATE PAID
.'.,
I
'" .,.,1'
RECEIPT *
REC'O BY
,
. 4629 Dakota St. 5.E., PIicIr I&ce. Mlnl'luota 55372' I Ph. (612) 4474230 I Fax (612) 4474245
AN BQLW. OPl'OKT\lMlY I!MP1D'l'!It
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J~
, , ~
c:Jj
'~~, , . . . , ~
' 8 '1 :r.tn
..!.? i Fill 1;:;.).
Q.'o '. E;j.>< I ~: ~ i
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" ~iJjl!lJBLjq Jf~. ..! I
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~UIU i i 1 I !fn .! iuUJ.
i Jill tJB~1 : (I JfW .
~H:- ! f' II !J;~ II !AHU
J ~ff.U ! ! f I- i ,-; J I fJUH
2'd S66'QN l"'19~lS9 Nt:j~ ZN35 Wd90:S lOO2'El'~
I
CITY OF PRIOR lAKE Me
16200 Eag'e Creek Av. S.E. Permft No. 01- CXJ;;;i3
Prior lalm, MN 55372
HEATING APPUCATlON I PERMIT
OBIa ~.;'/'" I p.o, 2.5 - 37{p .050 - 0
Si18 AddrHS /53/ i l ),dJ.) Ih~~~ "'..
r
lot
Block
AdlQlon
fA }"_""A.- ..-- /J.AaiL1
Owner'" Name
Addnw
"ealing ConlnM:lor ALLIltn FIRllSIDIl dba FlRESIDI CORlIEll
Jlddreu 2100 N. I'ATIlVIEW. ROSEVULI. HB 53113
T,,," " ;, 651-633-2561
FtRIPLAC~ 11._. ,I
IlLIIlIIP Make .. Model ~ (;, (-0
NodeI Siz,,- ..s-r - 7ZL
Com. load
Fvel~
SlIppIy OpeIIlngs
RelUm Openings
Flue She
Input
Edr.
Qutpul...::1Q.ooo
Cfm.
TYPEO"............
Warm ,.. Planb
Gravity
Mechank:aI
Ail OandIformv _
VIIl1L System
HEAlIHG OR POWER PLANT
Sl8MI
HotW- .
Ra<IIIlun
Special OeYlc8s
0IIllII DlIYicu
AheraliDns
Replacement
lYPE OF WOAK
v
Ell Camp. Dale
Repair
Est. Cosl ,
.
HEATING PERMIT FEE $
STATU\JRCHARGE $
TOTAL PEAMlTFEES $
//C>>.ID
Ncwr Conslroction
.$heJOJ
, ,
. 1llII1c/In1l P81IIlft ,
.50
1',6,\0 wr\\-\
'*- eU\\.O\NG pE.RMIT
rpt.,
IYPE OF STRUCTURt;.
'--
1.0.-
l._
fIIo
~R"~
.
....
w
SIngle Family
Commercial
-
'"
"
"
....
T" ..."
MUU-FemIIy
Public Olher
....
'"
In<llslrlal
Fee Schedule
..
m
Induslrlel, C .' ,; . iBI & Mufli.FamIly
Res1denllal, HUIIng .. An
Resklellllal. Healing Only
Resklenllal, Gal FInlplec9
ResidentIal, AdIIl!f...... &. """"'Ions
ReshJenlilll, An Only
'"
'"
....
1% of job ".., (S39.50 rrb1MIll
199.50
184.50
139.50
S3ll.5U
S39.50
'"
w
w
m
m
m
..
r",."" to add 111& SIeIe Sun:hlllll9 on" boI1om of this IIJ'PICtIinn.
...,
H
The price 01 Y""" '-ting permlllncUles one rougtt-In and _ IhIII ,,', ,.,-.,.. 6:
'"
Adliti.....11nrpecIionB wi! .... bih!d 8\ 135.011 ead\. 8
'"
House I:f.ealhlg T8tI RecanI must. be BUbmitted with h~ 1IIIIIiI... beIcn buIlog
log ., .-, -., aI ocx:upaI1CJ wit ....Isaued. ~
'"
HEM CALCUlATIONS REQUIRED wilh, ". ,,' utaupply WId nbn , ,',. '". 1IsllM:I1'"
room wlIh CFM's per llJl8'*'!I- New a\JucUU Of ad<IIGw 8Md1oar plan wIh IUIIPIr
end return Iaca............... HEAT LOSS CAlCUl.ATlONS, PAYNENT AND
APPUCATIONS MAY BEMAIlED101HEClTYOFPAlORl.AKE.112OO EAGlE
CREEK AVE S.E. PlUOR lAKE. MN 55372.
CJy HaD'" ,: ....., hoUl!l are 8 am.. 4:30 p.RI.
.
ALL WORK MUST BE lNSPECTEO (ROUGH-IN AltO FINAl) . CAll CRY HALL
447-4%10
I hereby apply lor a mechanIcal syslems permll and I aclulawtlMfge lIlallhll ~
In, ," :'; ablmt" complete end lICt:Intll; lhath work will be In conIomanc~
wilh lhe ollllnances and codas oIlhe clly and with lhe lIIale buIIdlnghnechanlco
codes; Ihallhls Iorm does not become B permll until signed by the BUllDlN:"
OFFICIAL; Ihal\he work will be In a<:corthr.nce wllh \he ;"" .' J plan In Ih.~
ease oLall \'Iork wblch requires review end approval 0' plans. ~
"
"
....
-?,1 j'/<JI
. 0818
MAR 2 I 2001
0eIII
BUitfr{9~ Slgnalunr
PRIOR LAKE . DEPARTMENT OF
. . BUILDING AND INSPECTION
INSPECTION RECORD
~/
I
SITE ADDRESS JR~llf lfJ,jrO_<::.
NATURE OF WORK - IJ~I.J)
USE OF BUILDING S t= a
PERMIT NO. 01- 0033 DATE ISSUED l - 0- ~I
CONTRACTOR LI.),~LL'''' .""-' PHONE 6C1- C{d.- ~
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
I lfQ-4-r;
I FOUNDATION (Prior to Backfill) ~(e-. t \:LS> 15V I~d') &.) dOl
PLACE NO CONCRETE UNTfL ABOVE HAS BEEN SIGNED
ROUGrH . INS
,I ) ~.V~
wlv 17:, \W
'1"u~
INSPECTOR
, FOOTING
-
I r16 '/Lv...ll
1./t> ,101
3/ /I,) OJ
1,1,>l~1~
SEWER I WATER I SEPTIC
FRAMING
INSULATION
ELECTRICAL
PLUMBING ~'~ri 'I,/i"I,D1
HEATING (if required) ~. ~ILW iluJt>1
FIREPLACE l,-M 1JliJol
GAS LINE AIR TEST f\"'~)~t~ "fy I~ -if {~/,O(
COVER NO WORK UNTIL ABOV~ HAS BEEN SIGNED
"
I
FINALS
GRADING (Prior to Sodding)
BUILDING 1.c.. 0, ~ gyl! ()'2-
ELECTRICAL '
PLUMBING
HEATING
DO NOT
'1>. \ lIlA,
Q.va,,,\
is ,\\...
OCCUpy UNTIL ABOVE AS
NOTICE
J
4 htJtl\
. ,
4!;;l'$')el
tljJ~I/)1
BEENf SIGNED
This card must be posted near an electrical service cabinet prior to rough-in Inspections
and maintained until ail Inspections hill/e been approved. On buildings and additions
where no service cabinet Is available, card shail be placed near main entrance.
Call between 8:00 and 9:00 A.M. for all inspections
FOR ALL INSPECTIONS (952) 447-9850
.......
..1
,."...."'",...,,,..'.,.-.1.;,,_..,';.;
, ..t'n' ...1;.,;
-'
j
CITY OF PRIOR LAKE
INSPECTION NOTICE
DATE TIME
SCHEDULED
JI-J),'OZ-
ADDRESS
lr:J3f7 wacls p/:'."""
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULA nON
o FINAL
o SITE INSPECTION
COMMENTS:
CONTR. 1AI~..,sm;nl1 ;i'\' y
o PLU::I::':,NO. -CLl-;~G:~1r~ \
o MECH RI 0 COMPLAINT
o WATER HOOKUP 0 FIREPLACE RI
o SEWER HOOKUP 0 FIREPLACE FINAL
o PLUMBING FINAL 0 GASLlNE AIR TST
o MECH FINAL 0
5iot, .,.../ ~ ,c;V
~ORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector:~
..:?-
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
Owner/Contr:
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY/
INSNOTl
DATE TIME
CITY OF PRIOR LAKE f(:u../dl
INSPECTION NOTICE SCHEDULED /tJ!3~
ADDRESS .JS~ I 7 v.j~ fJ/~
J
OWNER CONTR,
"E~ - i=',P,
PHONE NO. PERMIT NO, '<')0-5.5' bl- 1~.3
o FOOTING 0 PLUMBING RI
o FOUNDATION 0 MECH RI
o FRAMING 0 WATER HOOKUP
o INSULATION 0 SEWER HOOKUP
I>r j1( FINAL 0 PLUMBING FINAL
o SITE INSPECTION ty)ll. MECH FINAL
COMMENTS: ~, f\~ ,..~A-,);1M;. ~
16ft Q,}o,fOI
~ J
-'V~AMt UJolks ~ dv~"p_
/~~~ a~)(e~ !iJ,\ Cl~i t"~lv\ee.r
+ktM
~~l~ +{~er
------- --'~"-
~ .
( 1-~UP~-h
'---
o EXIGRAD/FILLING
o COMPLAINT
o FIREPLACE RI
PrE FIREPLACE FINAL
o GASLINE AIR TST
o
,P'WoRK SATISFACTORY, PRO
o CORRECT ACTION AND PR ED
o CORRECT ~~K. CALL FOR REINSPECTION BEFORE COVERING
Inspector: ~ ~Uil.M.d Owner/Contr.
CALL "7-9860 FoJ THE NEXT INSPECTION 2A HOURS IN ADVANCE.
)
-
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY/
INSNOTl
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS 15~/7
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
. J :,-'TEI .
SCHEDULED 4~
W,'fds 1/l.-.uJ6M
I
CONTR.
PERMIT NO. --p 1- ~_~
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o JEWER HOOKUP
YPLUMBING FINAL
o MECH FINAL
TIME
Ihl90
o EXIGRADIFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
COMME~S:
.,- t1v a.~Ma.;~
- 1/1." ~J;:+ ~r- t"'ft'J'j<..C" .\/\ tLiQ ,'",
~r-
- y/) ~<e- cL~~Was1e1'"" J0~'^- ~r ~tu&~
;atse- I'!.~ ltA,J.~F /J)WA4r.r ~
~ V\&~e, {..k (em\c (V\ ~ .WAc4,
&oDd Y\to.AA1s' \
W\ mAil IN\.. eter () \<
la~
o WORK SATISFACTORY, PROCEED
o jl'RRECT ACTION AND PROCEED
.JZ CORRECT WOR)' CALL FOR REINSPECTION BEFORE COVERING
Inspector: ~ '-\ IiJ.J.u ( Owner/Cont,:
CALL 447.9850 FOR ~HE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS AIlE FOR YOUR PERSONAL HEALTH & SAFETY/
INSNOTI
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!I?/- 33 w,'1 ~
Job A'adress -i.-D/7 fl(lfLV~'1.
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