HomeMy WebLinkAboutBldg Permit 05-0616
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
", /5, OS'
I. White File I PERMIT NO
2. Pink City . OS 0 (, 1(,
3 . Yellow Applicant
(Please type or orint and silm at bottom)
ADDRESS ZONING (office use)
dLdS ~E:.,
\
LEGAL DESCRu' nON (office use only)
Z{QCeO
A/t0
Pt//J
LOT 2b BLOCK I
ADDITION S7UC,/A./fr ~ (.J~ J~ZJo~PID Z.<;"-'-/b...~-t")
OWNE~
(Name) v6- _XCJ-7S~
(Phone)
(Address)
BUILDE~ . /
(Name) /)/ffZL.; :{;~ ~a , ~c..
(Contact Name) L::ht../& ~b'fL'2
(Address) Z /7'?3 b-rF.A/~A
(Phone) q~z."<f~- ~~
(Phone) 7S-Z-9"r-~/79
/1vL . cA."c.EI/.aE... ~# t' ~~~7'
, .
TYPE OF WORK
-
@'New Construction
~ower Level Finish
~eck
~Fireplace
~orch
OAddition
ORe-Roofing
ORe-Siding
OAlteration
OUtility Connection
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 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' ~perty to p~ ~eeded inspections. -'_ ~
X ~ U~~A ~ ZO/~C), 4~'5k
~ Signature Contractor's License No. ' Date
- ,l
I Permit Valuation I ff"oLtrO, I I Park Support Fee #
1#50,~ ' '
I Permit Fee $ /S'I f;: ~6 I I SAC # :t>
I Plan Check Fee $ "0(;'4,.6'f!: I I Water Meter Size 5/8'6 $ ~m~-
, ,
State Surcharge $ qi. C;Jb I I Pressure Reducer $ '7 S .,....,
Penalty $ I I City SAC and WAC # $ j:JC!JO,"- I
Plumbing Permit Fee $ /OOr- I Water Tower Fee # $ I ~C!JO.- I
Mechanical Permit Fee $ jtX),-- Builder's Deposit $ IS ,10,-- I
Sewer & Water Permit Fee $ 3S-- S D Other $ I
I Gas Fireplace Permit Fee $ lI/J" - TOTAL DUE ~ (p . z.fJ, 0.5 $ 8.7~!. 58 I
This Application Becomes Your Building Permit When Approved Paid {j1it/ /~'i-~-/ Receipt N.6:Ic.t? 50
2;~ ~ 6/Z-{'hs- Date /~- .;:;..t; - C; By ('
!!'
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
is~ ~ ~(Z{;;S-
Planning Director Date Special Conditions, if any
24 hour notice for all inspections (952) 447-9850, tax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
White - ~uilding
~a~rv - t:nolneerln'Cl)
Pink - Planning
NAME OF APPLICANT
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
"fa / va P/-
~/ /S-/5
Vi I
APPLICATION RECEIVED
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is propos~d at:
:2&GO ~lLf~ GAJ
Accepted
Denied
,)(
Accepted With Corrections
Reviewed By:
,!l1i13>
Date:
6-~R-CX-
Comments: See Reverse Side for Additionallnformationl
See A ttachtnent~. 1) Grading Plan, 2) Erosion Control Measure~
"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,"
r1'NhltB - Bunglln&D
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMJ;NT CHECKLIST
Kai--2la-P/"
&/ /j/~
r/ /
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is propos~d at:
:2" 0 WL/!dXJ 6AJ
NAME OF APPLICANT
APPLICATION RECEIVED
Accepted
Accepted With Corrections
.,/
Denied
I~
~J
~~
~
,...
~
~.
Date: , ! Zt{ /..t;s
~~~
Reviewed By:
Comments:
..M-.t; ~ '
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."
Date Rec'd
CII f OF PRIOR LAKE
SEWER AND WATER PERMIT
(Please type or print and silm at bottom)
ADDRESS
L Green File PERMIT NO ~
2. Yellow City . _L!::"'_ ~ I
3. Gold Applicant ~ .J (,..,
ZONING (office use)
~4t,o
(p./ 4- 1.- 0 ~
I./".J, r./. vJ .
LEGAL DESCRil'uON (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name) {J. A.. ( "Z- L 0 f-,c
(Address) .;:..
(Phone)
(Address)
(City)
(Zip Code)
APPLICMU:.
(Name) ~ .Lc /4 6- tf.x c ,
(Address) .2. 3 I (;J -..f O)N"c- .<;
(Address)
(Contact Person) 13 o{3
APPUCANT SIGNATURE~ ~ ~ O~ _
(Phone)
PL.
U' L tJom=-../1il '70N . ~S3I~~ I
(City) - (Zip Code)'
(Phone) ct~J -[>(1-7.2.1 J
DATE 7 Ii J"...r
,
(
APPLICANT PLEASE COMPLETE BELOW
Size of water service j inches.
Location of any couplings from structure ,.- feet.
Type of sewer pipe. D ABC, ~PVC D Cast Iron
Estimated length of sewer line .1 ..f feet.
Clean out (if required) located at - feet from structure.
Estimated Cost $
$35.50
$17.50
o.-()
tt 80 .
FEE SCHEDULE
Industrial, Com'l & Multi-family 1% of job cost with a $39.50 minimum
Water connection only $17.50
Residential sewer and water line connection
Sewer connection only
Building Permit #
SEWER AND WATER PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
~l\ ~~~NO
~JJ-!5 By ra-
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
$
$
$
.50
(Office Use Only)
This Application Becomes Your Building Permit When Approved
I Paid
Date
Building Official
Date
\
\
\
\
\
\
.,,:
White . Building
Canary . Enplneerlng
~ . Plan~
BUILDING PERMIT APPUCAll0N DEPARTMENT CHECKUSI
1?a -I.:zk ,c> r-
~/ /S/t/
/ /
NAME OF APPLICANT
APPLICATION RECEIVED
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is propos~d at:
d C, ~ 0 WLt1d::; ~AJ
/
Accepted
Denied
Reviewed By:
Comments:
Accepted With Corrections
~,:
...
~
Date:
C:, (z./-( /0 ~
,t'
Air Conditioner aLd O..:her Mecba.nical
l)mts l.iarnot Encroach inoo .n.equlred
Side Yard Setbacks
.'~-
liThe 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,lI
Residential Building Permit Checklist
New Construction for Single or Two-family Dwellings in R-1 or R72 Districts',
Subdivision: ~ ~ ~ <It..t.'~ d-~
Existing Nonconforming Structure? YE~
Reviewed by: ~;
~
Date: &;;( z. L( ~ S-
. .......
Building Permit #
Address: c:2(' c" Q
Legal: L dO , 8
PID:
w~~
/
Zoning:
1--1. fAY /
Existing Structure? YES@
CONFORMS TO ZONING
ORDINANCE
YES
Yard Setbacks: NAI FAILsz::.cOMPLI~
. Front Yard (can be 20' if avg. w/in 150')
. Side Yards
Standard
25'
10'1
25' if abutting a street
. Sidewall exceeding 50' requires additional side 2"
setback for every l' over 50' in length
I. Rear Yard
. Patio Door. provide for minimum 10' deck or sign
statement indicating no deck will be built in the future
. From 100 year flood elevation ofwetland/NURP
pond
. From OHW (Prior or Spring Lake)
10' setback +
2"/1' over 50'
25'
10' sidel
25' rear
30'
75' or setback average of
adjacent structures, but no
less than 50'
J Floor Area Ratio: NA 1 FAILS~Mi5"LIEp>
.30 Maximum
Yard Encroachments: NAI FAILS(CnMPLlE~)
Eaves and Gutters no more than 2 feet in width and no
closer than 5 feet to a lot line (Easements).
Ale and other equipment-cannot encroach on interior
side yards.
Standard
Tree preservation:(NL FAILS I COMPLIES
. Total caliper ind~es
I. Permit 25% Removal
I. Caliper Inches Removed
I. Caliper Inches Preserved
I. Replacement
Standard
%:1
L:\TEMPLA TE\BLDGLIST.DOC
,
NO
Proposed
-Z S t -t.& C1-J.r-
"S t - t"{-'IM. W,
fA) ,
51" _ lq~_~h, 1341~
. ~,.:"
P.v. {' LIJ:>
NA.
~\A
NA
I fl.1\ pI,( 0
I
Proposed
...."......
K) 0 tJ;(::i-....
l \1..-
J'lOFtt':J
Proposed
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I
CITY OF PRIOR LAKE
HEATING/AIR COND.lIIONING/.lH.I:lEPLACE PERMIT
Date Rec'd
i =.. ~~ I PERMIT NO. ~ L J'-:
] YoI'- AppIicono , fIIW'. .,,117
~ ~ or print ad IliRZl at bottoa)
ADDRESS .
~C-rl I..,) i /Qs iA~r;p ,0. l.U.
ZONING (offiI:e
uee)
LEGAL DESCRIPTION (office use only)
WT BLOCK
Pro
ADDmON
~=1<9/LIA~J}
~trP
(Phone)
,q~s' ~ s<fs<1
(Address)
APPLICANT J f I f'\
(Name) (' /\tJr/h lip ~ )
(Address)
-;..:::; I IV I ()
(Phone)
JlCJ:r) - ~
(]Jt1
~ ()~ oj tlne., J.::f.i ~. ~AJ t' c:;' <:::A ~.J{
(Address) - I. U (dr) (Zip Code)
(Contact Person) /"'7 / J / 1 (phone)
APPUCANTSIGNATU'RE .~r:r~ ~~ DATE 7 - ~ "C)<
_ APPLICANT PLEASE COMPLETE BELOW
....E]NEw CONSlRUCll0N 0 :REPLACEMENT 0 AL TERA nONS
FURNACEMAK.E~~ODEL 7/,~,(=l 7U~("\~or, Q~ FUEL /1141-
FLUE SIZE ,AIr tvr " RETURNOPENJNGS' INPUT ~~ OUtPUT _7-3;: ~C(l2
, TYPE OF SYSTEM HEATING OR POWER PLANT
DWmm.Air Plants 0 Steam PLEASE Non:
DGravitY 0 Jiot Water Air Conditioner Units
~hanical 0 RadW:ion Cannot BDcroach into
~___ . :;;j,Ur Conditioning 0 Spc;cia1 .Devicles Requited Side Yani .
( c9 / ~ J'VCnI. Sysa:m 0 Other Devices Setbacks'
"lJ(E.h..ACBM~ANDMODELIf'.m.f A,)4'(':)SL- 7S:0
FEES...m.DV~
1 % of job cost R.esidelltiil, Gas Fireplace
539.50 Ellinimum
Rmdcntial. HeI1iDg It Ale (New CoDStruetion) S99.50
R.esideatia1, Heazing Only (New: Constructiol1) $64.50
Industrial, Commercial&. Multi-Family
$39.50
Residential, Additions .t. Altelatioas
Residential. AC Only
$39.50
539.50
Estimared Cost $ Building Pennit #_
HEATING PERMIT FEE $
STATE SURCHARGE S
TOTAL PERMIT FEE S
(omce Uae 0111)')
Thit Applieation Beeomes Your Building Permit When Approved
PAID WITH .
dOING PERMIT
~) lf~ i~ 0 \~ ~ r7. Receipt No.
- , DJfjL 1 2 2005 J , By
Baildiq Official
Date
24 hour -otic. for.1I iIlspecrloDa (9S2) <C1!-9850, !la ('52) 447--424S
IBy
too~
HIV \I.:1110H.LNO:J
9L6909rtS9 IVd 6S:Ct IHd S006/80ILO
FROM :FARMINGTON PLG & HTG
FAX NO. :6514637835
Oct. 01 2005 02:28PM P1
CITY OF PRIOR LAKE PLUMBING PERMIT
Date Rec'd
.1!".lcll.': t~.!?~ ~~t. ~~~. sjsn.:!thn.ttnfl!).
ADDRESS
().. (,I) CoD
lUtl('l~
)...... /(\..,.- .--
LEGAL OEseR 1/" ! ION (office use only)
LOT BLOCK
ADDITION
OWNER
(Name)
Ka;\... b ({ J--~(') ".);...vl;.
-J'
~14~?) Gr~V\~~
f-\ v€-
(AddIess)
APPLICANT
(Name) 'Fart"v'\I....,d~"':\_...~[c ~
(Address) a-I O?,t.l Ch ;~V1$Ie.
(AddYe~s)
(Contact Person) J ~ IIV'\ L~D Do.. v'- __.. .._..
APPLICANT SIGNATURE ~~) D..AA~oD L. ~Ja..
Hk
d
A. v!2.-
; ~~;~ ~~Il~ . PERM_.I. T._.. N. O:S~-",--"N
J Vclll'\W ^ll1llilatJl' , ,.
-ZONING (nI'ficcLllr.)
PlD
__.,.___ (Phone)
\....0.. k e. l): I /.e...
(phone) .,,(o.S-, ~ l/ lD3- '?g;^~
~rrVlI' V'O~l" ('f\V\ ~-~.O.) q
(City) (} (Zip Code)
(Phone)
DATE.
q~?;t) - DC"
APPLICANT PLEASE COMPLETE BELOW
Quantity Type ()f Fixture
:;J- Bath Tub with or without shower
I Dishwasher
, /:"Ioor Drain
4'" "'Lavatory (Bathroom Sink) ._.,.....
t Laundry Tray (lor 2 compartment sink
......__._;l._,_ Shower Stall .....".., .'
. \ Sinks
I Bar"'Sink' q-'.
I . ___3.._...__.Water Closet (Toilet)
Quantity
Type of Fixture
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
BackOow Assembly Test
Lawn Sprinkler......_..._... - .
Other
FEE SCHEDULE
Industrial. Commcrcial &. Mulli,ramily 1 % of job cost with II S39.50 minimum Rcsidential. New One &. Two-Family $99.50
Residential. Additions &. Altcrations $39.50
Estimaled Cost $
Building Permit U
PLUMRING PERMIT FEE
STATE SURCHARGE
T01'.4.1... PF,RMIT FEF,
(omt~ {I.... 0,,1,,)
Thill Application Bec:omcs Your DlIlIdillg I'ermit When Approved
llulldln~ Offici..
OllIe
14 hour notice ror aUlnlpecrlons (951) 447-
16100 Ea21e Creek Ave., S.E., Prior La
$
$ .5Q.. PAID wm-t
$ ...,~UILDING PERMIT
~)'lI @ ~ rr [1)JE~::eiPt :_~~.
/7t1eoC tl-
bt! T 0 6 6985 _.--,--
50, rill (951) 447-4145
)M.'11 -l;"3~714
~
PRIOR LAKE DE~ARTMENTaF
BUtDING J\ND INSPECTI~N
INSPECTION RECORD
SITE ADDRESS 0 Wi idS' LJJ _ .
NATURE OF WORK ~t ~ I.. . L.. FlPir~2
USE OF BUILDING -----r
PERMIT NO. 1) ~ ~ (pj e:,. ~~E ISSUED . .
CONTRACTOR ~~ 2 I.. t:r PHOf\K;'.KS t t(l7!j
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
I FOOTING .f-' ~..u.l." cl-\kJ~( 1(-: I ]/~ !d:?
I FOUNDATION (Prior to Backfill) I /tfJ? I ? k-3 /--tJ5
PLACE NO CONCRETE UNTil ABOVE HAS BE-EN slGNED
LL...(l\ _ ROUGH - INS
SEWER I WATER I SEPTIC . (fh
FRAMING
INSULATION
ELECTRICAL
PLUMBING
HEATING (if required) _,
FIREPLACE " 4/ /S 9' 8" 0
GAS LINE AIR TEST ~ rO~ -
COVER NO WORK ~Tll ABOVE HAS BEEN SIGNED
J,ATNU-HP-S',IAJIIA!' ~~~(,~ I
FINALS
GRADINd (Prior to Sodding) ..M /7
BUilDING, 'f~ $ to. '* 011 ff P
ELECTRICAL ,
PLUMBING
HEATING
DO NOT
7-4;'....tJ("
vfJ>
tltP
g -fCf... Ch
8- y-C~
>I ~
///<r-b
J(;/
OCCUpy UNTIL ABOV~ HAS
NOTICE
t_ I t 0-([' ~
I Jf!>! 'Jf
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
Q1~rfifitaf~ of @trupant\1
CITY OF PRIOR LAKE
~epttrfmenf nf~uilhing Jfnsperfinn
,
, ,
ClFinal Permitted
"'~Conditional C.O. Expires
This Certificate issued pursuant to the requirements of Section 110 of the 0 Residential / 0 International
Building Code certifying that at the time of issuance this structure was in compliance with the various
ordinances of the City df Prior Lake regulating building construction or use. For the following:
-- SINGLE FAMILY 05-0616
Use Classification ;."".'" ,N'W Bldg. Permit No.
t R3 VN
Type Construction Zoning District
L20M B1, STERLING SOUTH AT THE WILDS
Occupancy Type
PUD
Legal Description
..
"
2660 WILDS LANE NoW.
Owner of Building _\ Site Address .'
ddr RATZLAFF HOv11S) 21483 GRENADA AVE., LAKEVILLEt MN 55044
Contractor's Name & A ess 'l"'u '}
RO.,~ERT 9, HUTCHINS ./J' -;'.( JANE KANSIER
City Planner
B~ldi~OffiCial Y J
! II' Date:
/
/
-:0
Date:
I
""..~,"....e.;" 'i'~.,.~,,'~...:..t:. ""L..'/._,~:;''; ; :. '''~"",,'' '
'" "',., ' " ,
,....\.'". "":"oV <.:'''' .'.,..'....~ '1'11'
"~' (I".:"''''
ADDRESS
UJ;o
DATE TIME
SCHEDULED I~f~
IA/I~
CITY OF PRIOR LAKE
INSPECTION NOTICE
OWNER
CONTR,
PHONE NO,
PERMIT NO,
~~
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
o PLUMBING Rl
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
,rpLUMBING FINAL
o MECH FINAL
o EXIGRADIFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
COMMENTS:
~
1)-..(7
fle~~
~A0
. r
o WORK SATISFACTORY. PROCEED
~ORRECT ACTION AND PROCEED
o CORRECT WORK. ~A~ REINSPECTION BEFORE COVERING
Inspector: v1 /Y ./ Owner/Contr:
V .
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE,
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH &: SAFETY!
/IfSIIfOT1
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS 2 ~ltb
OWNER
PHONE NO,
[J FOOTING
[J FOUNDATION
[J FRAMING
.~ ~SULA TION
E!~NAL
[J SITE INSPECTION
SCHEDULED
w('~ LLA
CONTR.
PERMIT NO,
[J PLUMBING RI
[J MECH RI
[J WATER HOOKUP
[J SEWER HOOKUP
[J PLUMBING FINAL
[J MECH FINAL
r/1Ci.../"' TIME
I~
$"- (, aLP
[J EXIGRADIFILLING
[J COMPLAINT
[J FIREPLACE RI
[J FIREPLACE FINAL
[J GASLlNE AIR TST
[J
COMMENTS:
f · F; ~ (p ~~ i...J4- ~ {.0-
Z. SbJ ~?-T/1~
~, ~~'/~..:- ~.,;~ U~
#. Q~f"/ .uz.I_ }. ~ 1 ~ -
--
rI
~
,
--~ &/, ,4;
I /
[J WORK SATISFACTORY. PROCEED
o CORRECT ACTION AND PROCEED
X. COO~C RK! CALL FOR REINSPECTION BEFORE COVERING
Inspe r: ) Owner/Contr:
. ;......--
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE,
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH &I SAFETY!
INSIfOTI
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
OWNER
PHONE NO,
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
COMMENTS:
SCHEDULED
2~(P 0 Wli-OS L.-.I'i.
CONTR,
PERMIT NO.
o PLUMBING RI
o UECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
5//
/
/l i /\rr
V '-' v -.-::> 0
//J~
r- I / ..,
r / L/C:.../
w~
as,Ot;/(p
o EXIGRADlFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
/'
~ SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT L FOR RElNSPECTION BEFORE COVERING
CA
Inspector:
Owner/Contr:
850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE..
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH (( SAFETY!
lNSIfOTI
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
~~hD W,.,/s Ln,
OWNER
CONTR,
PHONE NO.
PERMIT NO,
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
~ FINAL
o SITE INSPECTION
o PLUMBING RI
o UECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
COMMENTS:
/J (,1 IYW CAp {.dJ
Gr4k- ~ '- -
DATE TIlle
I /-I'I~
~.,I ~/. f.f-
05-"/'
~LlNG
o COMPLAINT
o FIREPLACE Rl
o FIREPLACE FINAL
o GASLINE AIR TST
o
C V t-6 Rt9- ""-
....
~d-r
o WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
XCORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: ~ _ Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE,
INSNOTl
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!