HomeMy WebLinkAboutBldg Permit 05-0056
CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT / ;{ -a q _ 0$
(Please tl:Pe or )rint and sixn at bottom)
ADDRESS
d~7L( Witcb LOhP,
White
Pink
Yellow
File
City
Applicant
I PERMIT NO. 65. 0 05(P I
N\0
ZONING (office use)
PU.o
LEGAL DE ,CRIPTION (office use only)
ADDITION3lerlir~__~'lha1:~J}j;\ds"JfY.i.AiJ '
O~EM \ ()--
(Name) 1_ ~I"~S E )ilOOR.- KJiYlinq-loYl
(Address) QS3'7 ){'~S bot'y LaY\e. ""
~C~~~~~]\ame) 'Katz.,\Qt+~. ~ (Phone) CfS2 ~qgs -.sCJS9
(ContactNane) Cp\\eeY\ ~ \t::.l-t{: La "RPI".lJl / (Phone)_tfS2-Cff?5 - 4/70
(Address) 1,l4'i??l k~ fJrt'll__"- 120 'v Lah.u; lie. foil. ~l 65D44
LOT 21 B _OCK
(Phone)
f?d.tn Prain-e.
TYPE OF VI 'ORK l2'New Construction DDeck DPorch ORe-Roofing
~Addition DAlteration o Utility ConnectIOn 0 Mise.
CODE: 1i1II.ll.C. DI.B.C.
Type of (J;nsl roction: I II III IV V A B
OccupancyG:oup: A B E F HIM R S U
Division: 1 2 3 4 5
PID Z5. 430. nz./, 0
M}-J
66.3 '-I ?
ORe-Siding DLower Level Finish 0 Fireplace
,
PROJECT COST IV ALUE
(excluding land)
$ 2.,/7), f'51"5l). OV
I hereby certify lh It 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 lropelty 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
:~~;;s JUst 'US! Furth"mo I h",by "m t:t th,,,ry Off"i'2DT~t;~;:?t p",p,rty to p"rmm need,d t;~':30 -04
Contractor's LicenseNo. Date
Permit Valuat on
Permit Fee
Plan Check Ft e
State Surchar~ e
Penalty
Plumbing Per. nit Fee
Mechanical PI :emit Fee
Sewer & Watl r Permit Fee
Gas Fireplace Permit Fee
$
$
$
$
$
$
$
$
310.t:a>.oo I
;)/'3/3. C)() I
1/)~g.SO I
1~.6~
ItJtJ .00 I
/(p/? . 06 I
3<; ._~-o I
4(J .00 I
This Applicati ~m Bet:omes Your Building Pennit When Approved
~~~
Bui]lllluOtlicilll
/ //y!er
I Date
Park Support Fee
SAC
Water Meter ~
Pressure Reducer
Sewer/Water Connection Fee
Water Tower Fee
Builder's Deposit
Other
TOTALDUE CJ\1!l@
Paid /t'. tJ12.~
Date . /. 20<(-". iJ,!;
$
$ /'I~(J.()O
$ :J"I1. CO I
$ 7.~
$ 1. ,51JO.O 0
$ 1- 000.00 I
$ lSOO.a:J I
J$ I
1$/0.072..501
I ~~ ffU51
#
#
#
#
I .1(1.O~
ThiS is fO certify t lat the request in the above applicatIOn and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested This document
:~ ::lann';;~omY C,mfi''', orZonm, C02';nd ,How' co",~m'ne':O~' ''''''P~ca" of 0 ,"p,ncy mll"b,
Phrnnrng D"eeto, ~ Date Spec"l Contlinons. tf any
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenoe Prior Lake. MN 55372
'------- ---
rh~ Cpnln of Iht Lakf ('ounlr~'
White
Ca
ink
. Building
ineering
- Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NJ ME OF APPLICANT
AF PLICATION RECEIVED I
,
I
If
./
Tre Building, Engineering, and Planning Departments have reviewed the building permit
ap plication for construction activity which is proposed .at:
I /. '- I
"
/',
",/,/"./
j d(,71 0~~ p.J.vJ
y
j.
A( cepted
Accepted With Corrections
DE,nied
~. ' ''1 n.1
RliviewedBy: .~ ~
Comments: A. c, I~ ~ w~
r .
t~ L~ ~~ ~/~
./" ' C/ {..-.J
~cJ4u--r ~. Ih.~/L., ~'~ ~
, I
.k ~ w-.:u
Date: I/; Y/oS-
d]# CZ(, .;(' " .
~~
~t:.(,(/ ?f! ~ '
{/
'" 'he issuance or granting of a permit or approval of plans, specifications and
c )mputations shall not be construed to be a permit for, or an approval of, any violation of
a,y of the provisions of this code or of any other ordinance of the jurisdiction. Permits
p -esuming to give authority to violate or cancel the provisions of this code or other
ordinances of the jurisdiction shall not be valid."
ii'il"
--------. -
I h~ ("..nlO' ,,' ,h.. 1.1I.kr ("ollnlr~.
GNj1ite - ~i1din9)
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
Ni\ME OF APPLICANT
CZ? a:t:U~~l
- J (/ II .J
Id- ;:;29-oJ
APPLICATION RECEIVED
The Building, Engineering, and Planning Departments have reviewed the building permit
ar plication for con}Jruction ~ctiv~ which is proposed oat:
J.. (~j,)3L I ,6~C.%a/.i7fde c0'~ c;J(P71 vJ~ ~ pJ,U.
e
A, :cepted Accepted With Corrections /-
D ~nied r
R3viewed By: ~~/-A
C )mments:
~1~tO aG) ~_ ~
Date:
/ If fon-
f I
"fhe 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
a ny of the provisions of this code or of any other ordinance of the jurisdiction. Permits
~ resuming to give authority to violate or cancel the provisions of this code or other
( rdinances of the jurisdiction shall not be valid."
Thf Cfnlf' "f lhf 1..lof Cuuntrr
White - euilding
<---..l.4'narv - t:nq,neei..-iilb
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
N),ME OF APPLICANT
AF'PLlCATION RECEIVED
~,ll
j-' -
,.',; .......IC:::~/
') _0/ i 1
, ,~--'_/
Trle Building, Engineering, and Planning Departments have reviewed the building permit
apolication for,construction activity which is proposed ,at:
.1-_ )jL I <.J < .~~7<
Ac cepted
)(
Accepted With Corrections
DE nied
RE viewed By:
.~
Date:
I-/fl-o~
Cc mments: See Reverse Side for Additional Information!
Orivf!w",y MIl,;l H",vf! A r.nn"rf!lf! Apprn"rh
See Attachments: n Grading Plan. 2) Erosion Control Measnre!;:
"T le 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
ary of the provisions of this code or of any other ordinance of the jurisdiction. Permits
pr'lsuming to give authority to violate or cancel the provisions of this code or other
or,jinances of the jurisdiction shall not be valid."
Residential Building Permit Checklist
New Construction for Single or Two-family Dwellings in R-1 or R-2 Districts
REvieWedbY~ ?~ Date: 1/l5/O~
Bl i1ding Permit #
Ac.dress: c2t.. 7L(
Legal: L .;1/ , B /
PID: Zoning:
tt-l~ ~ jJ,vJ. . ~
SUbdiVision:~ ~ (;) ~ ~ c::<-- MJ '
Existing Nonconforming Structure? YES @
El isting Structure? YE~
C ::lNFORMS TO ZONING
ORDINANCE
, Yad Setbacks: NAI FAILsltOMPLlE~
o Front Yard (can be 20' if avq. w/in 150')
o Side Yards
10 Sidewall exceeding 50' requires additional side 2"
setback for every l' over 50' in lenqth
I 0 Rear Yard
10 Patio Door: provide for minimum 10' deck or sign
statement indicatinq no deck will be built in the future
10 From 100 year flood elevation of wetland/NU RP
pond
o From OHW (Prior or Spring Lake)
I Fllor Area Ratio: NA I FAILsreQfifPLlE~
, y, rd Encroachments: NAI FAIL~C~'
IE, ves and Gutters no more than 2 feet in width and no
e1r Iser than 5 feet to a lot line (Easements).
I AI: a,nd other equipment cannot encroach on interior
sir !e yards,
I Tr =e Preservation:(iNAY FAILS I COMPLIES
loT otal caliper inches
I 0 Permit 25% Removal
I 0 Calicer Inches Removed
I. Caliper Inches Preserved
i 0 Replacement
L: .:EMPLA IE' BLDGLIST.DCC
YES
Standard
25'
10'1
25' if abutting a street
10' setback +
2"11' over 50'
25'
10' sidel
25' rear
30'
75' or setback average of
adjacent structures, but no
less than 50'
.30 Maximum
Standard
Standard
%:1
NO
Proposed
e:>? 5 '
,
S
ItJ' ~ IYd,o.~.
6'1
/111 ~. ~lf(jlr
po..le
rJA
rVh
~ f~ f'u4
Proposed
1011 tJ ~
Wor! c
Proposed
CITY OF PRIOR LAKE
HEATING/AIR CONDlTIONINGlFlREPLACE PERMIT
Date Rec'd
i:~ ~~ I PERMlTN~ -.I,~
J.Y'" ~ ~
. e or "rInhnd om. at bottoml
I ADD~:?c, 71/ ~ \/D~
L..?;^,e
AI. L<-) (
LEGAl DESCRIPIlON (office use only)
LOT BLOCK
AVVUIU1>l
~~~~1-7j fl P \1-
~YY7eS,
(Phone)
(Addre ~)
APPLIe:ANT /' he (\
(Name L--oA, //-p ~J
I ZONING (_.
UN)
Pro
. q~~ - 5"Cfs<\
() f I"'
(phone) --'I c., () - <Mt"\ -:;l ';;L
(Comal t Person) . / (Phone)
APPUCANfSIGNATURE ~~ ~.J-T"'~ DATE
,/ APPLICANT PLEASE COMPLETE BELOW
~W CONSTRUCTION 0 REPLACEMENT 0 ALTERATIONS
FURNA::EMAKEANDMODEL ~^l-e -r,} )(l"'.~c"'lcq.i/~ FUEL AJA-f-
FLUESlZE .",:?rf 'frlJ( _ REnJRNOPENINGS ~ INPUT ~(),()O::) OUTPUT 7;<,C:-/'0
- , - ,
TYPE OF ". ". "Jd HEATING OR POWER PLANT
OW""" Air Plants 0 Steam
D1lRvity 0 Hot WatEr
flM~w;~ D~~
~ir Conditioning 0 Special Devices
.)2fVen~ System ~ 0 Other Devices
FlREPL ~CE MAKE AND MODEL ~ t-I GlQ So L - 7<5'(')
FEE SCHEDULE
1% of job <OS! Residential, Gas firCpl_
$39.50 minimwn
Residenri'l, Healing &. AlC (NewConstnlClion) 599.50 Residential, Additio... &. AI..... ~ $39.50
Residenti, I, Heo!ing Only (New COD$lnl<lion) $64.50 Residen1ial, AC Only ....UJ~b7/() ~39.50
Estimated Cost $ Building Pamit II ~G' .o.'.!1f
REA TlNG PERMIT FEE $ ~~
STATE SURCHARGE $ .50 ~~
TOTAL PERMIT FEE S
(Addles) L 11
~/;:;; Ie!) ~A-rC)u f1,jE-
(Addms)
~Qty)
Industtial .....""..."'-'1...~al &: MuJti.Yamily
. (OllIe. U. Ollly)
I Thi. ^ ~licalioD Becomea Your Building Permit Wb... Approved
BlIlldW< Official
I Paid
I Date
I- c.1:l 't 4 LUUJ I
14 hour .."ee for an i..p..ll....('52) 447-"50, fax ('52) 447-424S
Date
S"'S"'a c;2 C)
(Zip Code)
PLEASE NOTE:
Air CoaditiollOr Units
Caunot Encroacb into
Required Side Yani
Setbacks
$39.50
. Receipt No.
By
100 iii
lIIV anl0llLNOJ
9L~909~lS9 XVd ~l:Sl aaM SOO~/C~/~O
05/04/2a05 17:50
9528815975
BOB .JECHE
PAGE 04
,_n
DafeiR*c'd
',- t
CITY OF PRIOR LAKE
SEWER AND WATER PERMIT
MAY I) 2005
1)'1.... ~ 0: orin! ond ..... .. bottom)
ADDRESS
d-.~
-_.._..__..-._~.-
: ~;:- t~ I PERMIT NO".... k _ ......, I
3. Gold AIJ\'IJI.caru l)~
~ ; -;
ZONING (olfl~usc)
". ~-L
ste,l"hl.1(
I
~':'e~~ { ("\ t 7 I (] tf 1~ 0 \1t p, <;.
(Address) ~(l-...)(>.lI"[~ 1M' ,
"!/I.dclrcs. )
LEGAL D fSCRlPTION (otl\ce",e only)
LOT ~ I ~LOCK) ADDITION
~ a.11J
PID
~M
(phone)
Wr.lJt'/)e-)1~ tic;()Yy:'
( ipCode)
APPLICANT
(Name)
JECHE EXCAVATING
~310 JONES PLACE
(Address) F.lLQOMINGTON MN '1'1d!l1'2S~1
(Ad<ln:ss) I
(Contact P :rson) ~ h J JJ:i'ape....hL..- '--11
APPLICA"T SIGNAT~RE II,), ~ ~
- 1
(phone)
(Clty) (Zip Code)
(Phone) (pf ~ 7:;' () IJ l./ S ~
DATE
APPLICANT PLEASE COMPLETE BELOW
Size of water service .....l.- inches.
Location of any couplings from strUcture
Type of sewer pipe. 0 ABC /B'pvc
Estimated length of sewer line feet.
Clean out (if required) located at feet from structure.
feet.
o Cast Iron
R4sidential sewer and water line connection
Sewer conr ection only
FEE SCHEDULE
$35.50 Industrial, Com') &. Multi-family 1% of job cost with a $39.50 minimum
$17.$0 Wat.r connection only $17.50
Estimated Cost $
Building Permit #
SEWER AND WATER PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
'*10 WITH
BUILO'NG PERMIT
(OlT... u.. C Diy)
This ^Plllcallon Beco",.. Your Bllildinll Permit When Appro.ed
B JlldilJl Official
Dol.
palMAy I) 2005
I ,
'I' "ftece:ipt tjo.
By /
i-
J
i;PQ~d i
I!'
;!4 bour nollee for all ;.'peeljon. (9~) 447-9850, fOJ (952) 447-4245
S~~1.ii'~
INTERTEC
Broun Intertec Corporation
21-:)21 Hero" Woy
S'Jire 101
Lokeville, MN 5S8.i4
Phone Q 5 : 46Q.364L:
fox. 952469,8599
\Neb troL!:lintertec.com
Repo rt of Field Compaction Tests
Date:
August 16, 2004
Project: AV-04-05525
Report: 12
Client:
Mr. Jin I Stanton
Shamn ,ck Development, Inc.
3200 lv :ain Street Southwest, Suite 300
Coon F apids, MN 55448
11--------
I
Project Description:
Construction Testing Services
Sterling South 2nd Addition
Wilds Lane
Prior Lake, Minnesota
--------
Max. Lab Inplace
Dry Density' Inplace Dry
(Std.PrQc.) Moisture Density
(pcf) (%) (pcf)
------
121.2 12 122
112.1 17 111
112.1 16 111
112.1 15 109
121.2 14 121
121.2 14 115
121.2 13 117
Specified
Minimum
Compact.
(%)
95
95
95
95
95
95
95
Test
Soil
ill and
Classification
Optimum
Moisture*
(%)
Relative
Compaction
(%)
Date
Type
54
55
56
i 57
58
59
60
-- -----
8/12/04 N P-3: SC
8/12/04 N P-2: SC
8/12/04 N P-2: SC
8/12/04 N P-2: SC
8/12/04 N P-3: SC
8/12/04 N P-3: SC
8/12/04 N P-3: SC
101
99
99
97
100
95
96
11.8
15.6
15.6
15.6
11.8
11.8
11.8
Key: ] -l = Nuclear, ASTM D 2922
: :C= Sand Cone, ASTM D 1556
= O.M. and M.LD.D. rounded to nearest 0.1
~
I
Commentsl'
~Il::_____i
A
A
A
A
A
A
A
A = Test results comply with specifications.
B = Test results do not comply with specifications.
C = Test results meet zero air voids criteria.
-----
rT5e~t ~ Housing pad fill, 25'W, 25:N-~fSE Lot #1 ::~~rOC,,-tion
I 55 Housingpadfill,20'W, 13'Nof SE Lot #1 comer
I
56 Housing pad fill, 6'N, 8'E ofSW Lot #2 comer
57 Housing pad fill, TN, 3 'E of SW Lot #21 comer
58 Housing pad fill, 12'N, 8'E of SW Lot #15 comer
59 Housing pad fill, 4'S, 14'W ofNE Lot #16 comer
~ 60~treet fill,.Street A, STA 3+00,_~1 'W_of centerline
Technician: JRN
Elevation Reference:
c: M. Nick Pu1ta; Pioneer Engineering
Braun Intertec Corporation
0405525\ ;ts.12
JJ~~)0rV0 + ~
James M. Sam~{s~ v
Associate Principal
Providing engineering and enviTOnmemal solutions since 1957
Elevation
981
983
981
990
967
968
967 J
PRIOR LAKE
INSPECTION RECORD
SITE: ADDRESS c}ro ~ tf \Ali\~~ L,^ N. W ,
NATURE OF WORK ....'PI.\ (\rhl Ai- :
USE OF BUILDING S\=,\) . .
PE~MIT NO. o.S 00.5& DATE ISSUED , /11 I (JC;-
CO TRACTOR .Ro.t--?Jll-P2- +b.j PHcSN~is~-q?3<)-'57)1
NO E: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
. THE PERMIT IS BY SEPARATE DOCUMENT
DEPARTMENT OF
BUILDING AND INSPECTION
~ .
_ J~SPECTOR
DATE
I /;/1/ I (-?S-../JS-
I FO UNDATION (Prior to Backfill) I W~. ~ /(.1 I
PLACE NO CONCRETE UNTIL ABOVE HASBEEN SIGNED
ROUGH ,,j t,NS _
SE WER I WATER I SEPTIC ;//5 2/r~<;
117// -
FR ~MING i~T
IN~ULATION 1/0/
EL ECTRICAL
,
PL lJMBING F!.5 SO /CJ A
HEAriNG (if required) 1/W'3-(('lh
FIF:EPLACE . i/L1//J-tf/Cll:,
GASLlNEAIRTEST~,? I/?L';;~ /,p;t J/;As-
COVER NQ WORK UNTI~ABOVE HAS BEEN SIGNED
I \~."s~ Wk..~ / L-,dk. ~~. I
. / Ffi.JALS
G~ADING (Prior to Sodding) ;v' B 1". z,y....r
BUILDING ~ -h ~-J -06 Ii' P7
EL ECTRICAL ,f .
PL lJMBING
HE ATING
DO NOT
I FOOTING
J.llt:/c.-Vitch
-S-II~
? I:;--<J)
I J
'1/'2.-7 I (j
I I
UJ$O
OCCUPY UNTIL ABOVE
NOTICE
HAS 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
,
i
~
'.
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS ;;J.Co 74
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o )NSULA TION
.,llI FINAL
o SITE INSPECTION
COMMENTS:
SCHEDULED
.l.JLjAk
CONTR.
PERMIT NO.
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
~
TIME
~J.
S-C>OS~
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
(, f,.... P G\&:<.~__ "I~'
2. 5J;.J/.. a-- 1:;.-L)
5.. l.x{-a-tl!,.. (\ul'k: Q\.S Moo rD 1.. l.(
'-1,
t.
x-
------
I-Oc,
o WORK SATISFACTORY, PROCEED
o CORRECT TION AND PROCEED
f.- CORRE ORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: , Owner/Contr:
CAL Jr 850 F THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE RE~ENTS ARE FOR YOUR PERSONAL HEALTH.l SAFETY/
INViOTJ
DATE TIME
CITY OF PRIOR LAKE 5~
INSPECTION NOTICE SCHEDULED
ADDRESS ';){, 74 Wil&; l IA.
OWNER CONTR.
PHONE NO. PERMIT NO. S-~
o FOOTING o PLUMBING RI o EXIGRADIFILLING
o FOUNDATION o MECH RI o COMPLAINT
o FRAMING o WATER HOOKUP o FIREPLACE RI
o INSULATION o SEWER HOOKUP o FIREPLACE FINAL
o FINAL lir1'LUMBING FINAL o GASLINE AIR TST
o SITE INSPECTION o MECH FINAL 0
COMMENTS:
l. R-.- -'.. ~pr ("'--r~
o )IORK SATISFACTORY, PROCEED
J1f CORRECT ACTION AND PROCEED
o CORR~ORK. CALL FOR REINSPECTION BEFORE COVERING
Inspector: \tlJ Owner/Conlr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY/
INSNOTl
<iITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS 2{,7c.{ W,. l&s
~.
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
o PLUMBING FINAL
o MECH FINAL
COMMENTS:
I, .f.'lAb P :th> ~
i1J
-
~.JJ,..11\D8^
(J K..-
~zDA;II1~TlME
c;-~(p
o EXIGRADIFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GA~IN~R TST
~ ~,l.:1
O?, SATISFACTORY, PROCEED
/. CORRECT ACTION AND PROCEED
o CORRE T WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspe r: Owner/Contr:
C LL 447.SsJ FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
"--../
REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH'" SAFETY!
INSNOTl
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS .20'( w/tLs L""
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
o PLUMBING FINAL
o MECH FINAL
COMMENTS:
~..,t-IClt<-
Cud, ~.-t'l1L
DATE TlME
9-;J.8OJ
~l,llj,,~
1it:;".Sh
~LING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
6r?r
~RK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector~......, . Owner/Contr:
CALL 0147-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
INSNOn
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!