HomeMy WebLinkAboutBldg Permit 04-0395
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
MMtt f4jl~CTION PERMIT
~i~:' ~:;y IPERMIT NO. A --'. 03a~ I
Yellow Applicant I - - tJ'I"'" /J
Date Rec' d
04- :2-2.04
(Please ~~ or orint and sign at bottom)
ADDRESS ZONING (office use)
5:5 (It, wJ QJ. 'FblJ ~ ('~ SE i2 I
LEGAL DESCRIPTION (office use only)
LOT /.Q BLOCK I ADDITI~,€j d
. 6:+v-
I --
PID,.:;) 5- '-10/- oa -()
OWNER
(Name)
(Phone)
(Address)
~~~K,~(jL-b.F'~'1
(Contact Name)---IY ,,~ lJ..')~KO-
(Address)
(Phon.(:jf5;), )98'5 -/63 3
(Phone) (J5 -:K) d. ')[p-lf 7/') Z
TYPE OF WORK
~New Construction
DLower Level Finish
DDeck
DPorch
ORe. Roofing
ORe-Siding
o Fireplace
DAddition
DAlteration
Dutility Connection
/59, /8_::S
I
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/s' ee may
~:rtytoper~:C~ll~d;:::ns ~/o57 I- M -d{
!- d Signature Contractor's License No. Date
I Permit Valuation } 5<1. (](')O- I Park Support Fee # $ S5D,OO I
I Permit Fee $ /t;n1.<O I SAC 4f/35"(),~ ......~-I
I Plan Check Fee $ qIL/,~1 WaterMeter~I"; $ ;;)5'/)..OD I
I State Surcharge $ "lei, _.:; () I Pressure Reducer $ /.-l~ ,00 I
I Penalty $ I City SAC and WAC # $ / ~m 100 I
I Plumbittg Permit Fee $ lOO,06 I Water Tower Fee # $ ?O()r07) I
I Mechanical Permit Fee $ /60 ' 00 I Builder's Deposit $ I, 1'; DO. 00 I
$ .~ t)"C)O I Other $
$ 40,00 I TOTAL DUE $ 6.57Z.3B
/)
Receip()qo, ~?:JQ
By ';V.
I
o Misc.
j.f5.e., e.,J.~,
PROJECfCOST/VALUE (exdudingland) $
I Sewer & Water Permit Fee
I Gas Fireplace Permit Fee
This Application Becomes Your Building Permit When Approved
~'~ Sh5~'I'
I Paid %C72.] f
I Date r./7.,r;--
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 Certificate of Occupancy must be
Bsue~ ~ ~~<,I ~ad ~l t<;.,rj,
Planning Director Date . Special Condrtions, if any
'''____, 24 hour notiee for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
~
Q.~
Main File
C]hite - Buildini:::>
3Aary Ln9meering
Pink - Planning
lhr Crnlr< "f lhr I....t Counlr).
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
tJ J2 hkrl-oiJ
Lj -- ;;...;)... -0 <--I
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
..D () (0 W ~ Oa...k
Accepted
Accepted With Corrections
P1-. p-d
/
Denied
Reviewed By:
~~
&~
~
Comments:
~e./~t<J
0./( ~~-
Date:
s~ ~ 'I'
"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
~- n ineering
ink - Planm
----
Tht ('fnln"f lhf I..kf COllnl',
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
..'
NAME OF APPLICANT
APPLICATION RECEIVED
fJ Ie:' 1-1,/) r+U0
!. / - J ;l -0 <.. I
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
",:,~~,) I (I) IA/ -) Ie /" T - !< d.
Accepted _
Accepted With Corrections V'
Denied
-
Reviewed By: ~ ~
r
Comments: m~. .~. Lf~, , M-' J
~ tU-t ,J
Date: ~~ SI
.....,
t:l'" ~ h"l -,!- .
"" ~
.
J
fi .~
~th
-~::1
"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
While - l;JuildinR
->-I"&~J.' ~"g.il1..eerlnCO
Pink - Planning
lh~ ("..nl.., nf U...I..b Counl.,.
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
IJ 72 fit) P+DiJ
L/~- J;)- -0<'/
..
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
-../'\ 11/ .~) /
.3 u / to v' (~ a !(:
.-" cd
/;...-I.t..... n
I - 1'--..
Accepted
y
"
Accepted With Corrections
Denied
Reviewed By:
m-~
r-
Date:
5"'7'-0'1
Comments: -BA~ R~verse Sidp. for Additional I nformation I
See Attachments: 1) Gradin,: Plan, 2) Ew"inn rnntrol 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,"
AD r 29 2004
~~~
",.f(.,;\,..-:"..'-t'frNB,O"tt-
tt,~t
12: 05 PM
GENZ RVAN PLUMBING AND HEATING
No.3893
P, 3/12
Vale Kec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
. Blue: 1'U=
'-Gold Cic;y
1, Ydlaw A.ppl(canl
~
I PERMITNO~
ZONING (oJliceuse)
. (Please r:'{l?t: or 'OriI:1t :and SQ:.I;D. .u bottom)
ADDRESS
V5b IlP LA) Hi-- (MAL Pv iVlt
T>7L ~ E
LEGAL DESCR1PTION (ofl!ce "-'" only)
LOT 10 BLOCK I ADDITION IW~-h P.Jr1 I D+v1
PID
OWNER
(Name) DR Horton Custom Homes
(phone)
9C>2-Q;;.,-i15ZJC
(Adthess)
2-O'S~o KeV')B~IDGe.. Co 5re, leD
w./uvIlIG IMN .5~l.j LJ
APPLICANT
(Name)'>,:--:,:'_'9r?p ~J "W"'-:T'lg !;; J:I~Qri'!'l.f;
(Phone) ",1_/,? ~- 1 11,1.
(Address) 14745 So Robert Trail
(Address)
en ~;8-h
Rosemounc
MN
55068
(Zip Code)
(Contact Person)
(City)
fi lIS (phone)
01 U~~flLJ DATE
651-423-1144
L/--~q7JJ
APPLICANT SIGNATURE
APPLlCANT PLEASE COMPLETE BELOW
I Quantity I Type of Fixture Quantity I Type of Fixture I
I 1- I Bath Tub with or without shower ~ I Rough-ins I
I 'I Dishwasher J Water Heater I
I 'I j Floor Drain 12.- T I Water Softner I
I 3 Lavatory CBathroom Sink) I I Stand Pipe (WashiD~ Machine) I
I 1 I Laundry Tray (1 or 2 compartment sink Sewage Ejector I
I I I Shower Stall I Bacldlow Assembly I
I f Sinks I Bacldlow Assembly Test I
I I Bar Sink I Lawn Sprinkler I
I 6< , Water Closet (Toilet) I Other I
FE:E SCHEDULE
Industn." CommerCl.' & Multi-family 1 % ofJob cOSt WlIll. $39.50 minimum RCSldOltoal, New One & l'wo-Famlly $.99 SO
Residential, Addltions & Alterations $39.50
Estimated Cost $
Building Permit #
Buildaag Otficial
Date
$ 1
.$ .S<V AID W 11.tI'
.$ ~.."om;~DING
~lU] it, .1'.1 U;; . EltiVul'
\ ~fa.AY 12 WlN I;;, .
I
J
PLUMBING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT F.E.E
(Oflicc: u~c: OuJy)
I This Application Becomes Your Building Perm.it When Approved
24 bour notiee for all inspections (952) 447- ~, fit.. (952) 44?-4245
U I 'i OF PRIOR LAKE .
HEA'fIl'lG/AIR CONDITIONINGIFIREPLACE PERMIT
17J0.3
Date Rec'd
'-,,',', ,;-';
q:'l~ivEe,om)Iintandsienaibotfurii),
ADE>RESS
5()/~ Oolc'IJf'
r=. Z~i=' I PERMITN~..~
ZONING (<>fflce\".)
LEGAL DESCRIPTION (office';" only)
LOT BLOCK
. AD1;>ITION
PID
DR HORTON
20860 KENBRIDGE CT
LAKEVILLE, MN 55044
(phone)
MFMG;A;Nr
.&tllliie\
(Address)
. (Gon*tPerson) 1-1 Q(:Of}' .
(Address)
)( -,2/.i.
ALLIANT MECHANICAL INC
J650 KENNEBEC DR
EAGAN, MN 55122
651-452-2775
:', , '-' - - - ,:,,:,.:,-_: < ,"-~:!-_:<:: .,:". ::,-:;-':'-
4XfPtIGJiNT StGNA~<' .
';:;:.-.~'-
DATE
..-_.'.,....',---',;, ,-.\
.'. '. >\ APPLICANT PLEASE COMl?'tF,rPE.BELOW
.:',- .'- ,-'-'-V.,';.-.-,..,... <."::, ......._ '_ ,_,'_:, _ __', ',_' ,_,"':..""..__,',__,...,__".____,._',_,,"""., _" __ .. ,'_,
--- ,~WC0NSTRUCTION DREPLACE~. OALTERATI<;>"NS- . " "
FURNACEMAKE/NDMO~EL ~tA:-\- 1 <\n /J1.A-V{) 3,60 &'0 FUEL ;Vb:-, .
FLUE SIZE. a 'PtJG,I}ETuRNOPENlNGS 7iNPtrr ~CjWo . OUTPUT 75,,000
n'P:E.oP~YstEM HEA'I'ING:ORPOWERPLAN't .' '.,
..',;.,,''.<. . ..... 'I,'LI':"'$:E;N~~r
rnWAA-Aii-.~lants OSteam . ,. . . At. :Co'n"'dJ'tJ"-. '-C,'-'- '.U'D"fs' '.
DGtilVlty 0 Hot Water':' . "" Uller
. ,- ....,'i~'.. . 0 Raclial(on., Cannot Eneroocbinto
~g 0 Speciw~evices' Requ~;~;~i'~ard
OOtherDevi~ S~tbacks .
-'-'-''',~\ p';'-.,>'
FIREPLACE ~~~~:qm~L .
:',,< ':' ::::~;:,-i";"::<:,,:
,..,........-,.-.,......
Industrial, Cornrnercial'& Multi:Family
Residential, Heating & AlC (New' Construction)
Residential, Heating Only (New'Construction)
FEESCHEDULIi'
I%ofjob cost ReSidential, Gas Firq>lace
$39.50 minimum ..
$99.50 Residential, Additions & Alterations
$64.50 Residential, AC Only
HEATTNG PERNUT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
.50
$39.50
$39.50
~~';9.50
IK C'J~
~-(~'nA&V'"",
.. -..,. t',;-
~~;",:
Estimated Cost $
Building Permit #
./'.
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
~I~ to U; U IJj [E FnifeliitNo,
ff~e MAY I 9 2004 J
-J
r
24 hour notice for an inspections (952) 447-91 ~ fax (952) 447-4245
[ '.
Aor,29, 2004 12:04PM
GENZ RVAN PLUMBING AND HEATING
CITy.oF PRIOR LAKE
SEWER AND WATER PERMIT
No, 3893 P 2/12
Date Rec'd
q'lease ~ orlldnt and stet.t botb:lm)
ADDRESS
fJ[)( (0 IAN", + nrd<_ Dnln t 00
..
i ~w ~~. I PERMIT NOo^.U /}~.
], Gold AflpIbG, IL..:/ .. WW' ~
ZONJNG (oJlie< w.)
\17
LEGAL DESCRIPTION (o1Iice "'. Ollly)
LOT 0 BLOCK
ADDITION De.dZ....-h ,€-( d I ~
Pro
OWNER
(Name) DR Elo.,.........T'l r"otQBl Hem9r
(phone) _
ct52--QSS-,ISM
&J6"J.-lU
(Zip Code)
(Address) 20&60 Kev1Bi2..\t:6e. Cr Sr-PIM
(Ad<l..m)
Lau\JllIe.
(City)
APPLICANT
(N~~ Genz-Ryan Plumbin~ & Heacin~
(phone)
651-423-1144
(Address) 14745 So Robere Trail Rosemount. MN 55068
(;I.dd<e..) (City) (Zip Code)
(Conractl?erson). _ Q,V1 ~:S:.t7 & (I ~ (phone) 651-423-1144
0) t~) ~/\ DATE
r
YJCANT SIGNA1U:RE
.L{- 2ft 'iN)
APPLICANT PLEASE COMPLETE BELOW
Size of water service inches.
Location of any couplin.:,o-s 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
FEE SCHEDULE
Residential sewer and water line connection $35.50 Industrial, Com'l & Multi-faintly 1% of job cost Wlth . $39.50 minimum
Sewer connection only $17.50 Water coonectioll only $17.50
Estimated Cost $
Building Permit #
SEWER AND WATER PERMIT FEE
STATE SURCHARGE
TOTAL PERl\D.T FEE
$
$
$
,50
L.
BlIildiag QfiiciaJ
;:~ u ~r
'\fAy I J WOL
Da~. I
24 honr noti.. fot >lIln'p_ctloDs (9~) 447'9~lj. fsx (9S2) 447-4245
PAID WIIH'
!J'.T {;
1IT
(om._ u... ODly)
I This Application Becomes Your Building Pennit Whell Appr.ove<i
I
,
I
,
J
CITY OF PRIOR LAKE
HEATING/AIR CONDlTIONING/FIREPLACE PERMIT
Date Rec'd
; ;;;.:. ~:~ I PERMIT NO. J -'-.':)9~
3. Yellow Applicant ",., ~
(Please tvpe or print and si~ at bottom)
ADDRESS
5016 W. OAK POINT DRIVE
I ZONING (office use) I
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION
PID
OWNER
(Name D R HORTON
(Phone)
(Address)
APPLICANT
(Name) AU IED'RTl;>'R"'TTl~ DBA PT'RFSTDF. HEARTH & HOME
(Phone)
651.633.2561
(Address)
2700 NORTH FAIRVIEW AVENUF
(Address)
ROSEVILLE
(City)
55113
(Zip Code)
(Contact Person)
BRENDA HUSTON
(Phone) _651.633.2561
APPLICANT SIGNATURE
BRENDA HUSTON
DATE
6/29/04
APPLICANT PLEASE COMPLETE BELOW
xD 'NEW CONSTRUCTION 0 REPLACEMENT 0 AL TERA TIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM
HEATING OR POWER PLANT
OWarrn Air Plants
OGravity
o Mechanical
DAir Conditioning
OVent. 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
HEAT N GLO SL.750TR.D
Industrial, Commercial & Multi-Family
FEE SCHEDULE
I % of job cost Residential, Gas Fireplace
$39.50 minimum
$99.50
$64.50
$39.50
Residential, Heating & Ale (New Construction)
Residential, Heating Only (New Construction)
Residential, Additions & Alterations
Residential, AC Only
$39.50
$39.50
Estimated Cost $
REA TING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
Building Permit #
$
$
$
.50
<'~? (:..:'lr..
-U,? "'1;.':'<,
.]/!'Y,..v{,,-..,
~''''~ V. ~,
.tf~-,e.l~
,.-.;::-....
.............,'.:'."
,,",; ,"
,v"'~,.'"
(Office Use Only)
Building Official
I
I PW~ @ .~ U ~ \~~W iptNo.
I DaTh} .I11L 7 200. ~
24 hour notice for all inspeetions (952) 447-9850, ,,:!:,, (952) 447-4245
~y
Date
ff'
)
This Application Becomes Your Building Permit When Approved
PRIOR LAKE
DEPARTMENT OF Main File
BUILDiNG AND INSPECTION
.
INSPECTION RECORD
SITEADDRESS ~Oll. w. &.k 'Pf-._
NATURE OF WORK ~
USE OF BUILDING ~
PERMIT NO. -CU- 0395 DATE ISSUED 5. t:,. 04-
CONTRACTOR -~. ~ PHON~~-""~
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS ELOW
THE PERMIT IS BY SEPARATE DOCUMENT
1~~E;r~
, FOUNDATION (Prior to Backfill) I ~ I c/? fi.~
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
fr.q-
:tl
, FOOTING
SEWER I WATER I SEPTIC
FRAMING
INSULATION
ELECTRICAL
PLUMBING {/, ~ II{/! Iltf!; 1
HEATING (if required)
FIREPLACE
.. GAS LINE AIR TEST
~
~
~~
~
DATE
r;- ],0- C11
, ,
Ii /~/dt/
~~r.
7/ If"" 10'/
?/~y
Z/fI/t:7J'.
7A-?;{~
7ftJ>hy
7ftJ~r
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I I
FINALS
1I(j 1/./5. 04-
~
GRADING (Prior to Sodding)
BUILDING
ELECTRICAL
PLUMBING
HEATING
DO NOT OCCUPY
6/r,f1~
?"~~ .
P~~j
6 "/..f/&5 ,...
BEEN SIGNED
~
~
UNTIL ABOVE HAS
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 piaced near main entrance.
FOR ALL INSPECTIONS (952) 447-9850
,^
~rdifitatr of Qf}trnpauq!
CITY OF PRIOR LAKE
@.rparfuumf of ~uilMitg Jfu$prdiou
ictl Final Permitted
D Conditional e.O. Expires
This Certificate issued pursuant to the requirements of Section 110 of the D Residential / D International
Building Code certifying that at the time of issuance this structure was in compliance with the various
ordinances afthe City of Prior Lake regulating building construction or use. For the fallowing:
SINGLE FAYtILY 04-0395
Use Classification Bldg. Pennit No.
Occupancy Type
R3
Type Constructin-
L6, F1, DEERFIELD 10TH
VN
Zoning District
Rl
Legal Descriptiof'
Owner of Building
D.R. HORTON, 20860 KENBRIDGE
Contractor's Name & Address . y.
ROBERT D. HUTCHINS /.7~
'/ ~./ - City Planner
./ / BU~'ldin fficial
,..,./ /~ 0"'-- Date:
I
Site Address
5016 WEST OAK POINT DRIVE S.E.
COURT, SUITE 100, LAKEVILLE 5504
DON RYE
Date:
,.~,
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
S?J/b
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
..-l!I-1'INAL
o SITE INSPECTION
_ C9,Pc\MEtfI'S:
b/--ec/",-, ~/
#kc4 <
----- ,
h)---L //he- t'
,
~e;/
DATE , TIME
SCHEDULED ~~~
~J'/ a;? ~/;r
CONTR.
PERMIT NO.
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o ~UMBING FINAL
.A:lMECH FINAL
~I
/
~~
O'/-J.9S-
o EXIGRAOIFILLING
o COMPLAINT
o FIREPLACE RI
~EPLACE FINAL
o GASLINE AIR TST
o
9' ~/O7
-
&/<-.
(/A
".
~
h~ )
------
lNSNO"
---- ---,_.,--
--------'
( /ft'".r e
~ORKS~'''~'",..Q("'---
/~ORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: ~ -OWner/Contr:
-----
hh..(
hJz~ /
/31..
-
----
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH'" SAFETY/
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
5{j~
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
COMMENTS:
II-If (5) [,
DATE TillE
SCHEDULED 1/1)-04
w<!>+ /)e, t .pl-. II
CONTR. p. K. H{)4"',/l
PERMIT NO. ()L! - 3 5S-
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
~~"L1NG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
)( WORK SATISFACTORY, PROCEED
"0 \ORRECT 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 4< SAFETY/
INS/'IOTJ
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS ~~~~
wes/
OWNER
CONTR.
PHONE NO.
PERMIT NO.
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
~PLUMBING FINAL
o MECH FINAL
COMMENTS:
/h~o~
Tille
DAre
7Y~<</
CJ.;/ p';/ Or
C7r- J?S-
o EXIGRAD/FILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
/
77:',--
f /'
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/
o/c
,
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r~~ / Ok
./' /
/f/-et!'d ft77 u
tiC-
(!;
, /' --" /'
1,-r:.5)'Y:;//~d
~/
/ .-<#t:;i'
-Ph~/ (pJ ef,;/L9
. \/
40RK SATISFACTORY. PROCEED
I~ ~ORREcT ACTION AND PROCEED
o CORRECT WORK'f~~ ~INSPECTION BEFORE COVERING
Inspector: /t-W- Owner/Conlr:
v
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
INSl'lOTJ
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!