HomeMy WebLinkAboutBldg Permit 04-1134
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
/(). zs. ()4-
White
Pink
Yellow
File
City
Applicant
PERMIT NO. 04-. It 34-
(Please type or print and siltll at bottom)
ADDRESS
/396'; Ke~s,'t\~-l-oV\. A-..."-Q. U~g.
ZONING (office use)
RI
LEGAL DESCRIPTION (omce use only)
LOT~ BLOCK 3 ADDITION
Go: ,^-6S01' Gs-b.-les.
Pro z,5: .tf13. oz.o. 0
OWNER
(Name)
SQ2....
6\n<..o
( ~ CJ oJ t-lo~)
(Phone)
(Address)
BUILDER
(Company Name) ~(,'~N":>l~ ~""""\'~O'\A<2-s:...
(Contact Name) lS Gl iA G ~I ~
(Address) /SQ6') rdnNLA lJ.'.....w ~.), /'-J.I.AJ.
(Phone) 9-,\CJ,-I.JIID-VQat.1
(Phone) 9SZ-d-.OD ~36J>6
P>Nor- LJe,,/JulJ. SS30;t
TYPE OF WORK ~ew Construction DDeck o Porch ORe-Roofing ORe-Siding DLower Level Finish 0 Fireplace
DAddition DAlteration o Utility Connection 0 Misc.
CODE: 'l;i(LR.C. DLB.C,
Type of &nstruction:
Occupancy Group: A B
Division:
I
E
II
F
I
IIIIVVA
HIM R
2 3 4 5
B
S U
PROJECTCOST/VALUE $ J//C>. 000
(excluding tand)
I hrrcby certify that I have furnished mformation on this application which is to the best of my knowledge true and corrcct. I also certify that I am the owner or authonzed 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 buildmg
:"~'::~;c~/ hmby,gr"lh"lhC"~Offid'IOC~C;;;~'; ;:upon IhCPIOPCrtylopecfocm;;i;;7D ~I
Signature Contractor's License No. Date
'"
Permit Valuation ~ 4/0. ()t}o. 00 I Park Support Fee # $
Permit Fee $ de, /3.50 I SAC # $ 13'5o.o~
~
Plan Check Fee $ /gq 3. 7~ I Water Meter( Size5/]/,l1"; $ Z>'o.OV
State Surcharge $ Zos.eo I Pressure Reducer $ L#S,o~
Penalty $ I Sewer/Water Connection Fee # $ l2..€Ja .00
Plumbing Permit Fee $ /00. /) 0 I Water Tower Fee # $ 700. D 0
Mechanical Permit Fee $ /00.00 I Builder's Deposit $ ISoo .00
Sewer & Water Permit Fee $ .J<:;. $0 I Other $
Gas Fireplace Permit Fee $ '-/O.tJo I TOTAL DUE 1R'lMn? If .I.O+- Yo, 332, 71!J
This Application Becomes Your Building Pennit When Approved Paid /0 3.32.70 I ~~.r~
~ ~ lIlt /0'-/ Date /1.' 5' .O~
Buildlll.!!.Otlicial ' 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
~.
9-~
/(/, /0 t(
, Date
Special Conditions, if any
Planniflg Director
24 hour notice for all inspections (952) 447.9850. fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
Residential Building Permit Checklist
New Construction for Single or Two.family Dwellings in R.1 or R.2 Districts
~
Reviewed by: ~ ~
Date: II II /0'1
Building Permit #
Address: /3 9 ~ '7
Legal: L d- , B 3
PID: Zoning:
K~~ b. A),6~,
subafvision: tJtAlOS61e. 2J5"rAf&'r
Existing Structure? YES ~
Existing Nonconforming Structure? YES~
CONFORMS TO ZONING
ORDINANCE
YES
NO
, Yard Setbacks: NA I FAILS,tC'"OMPLIEV
I 0 Front Yard (can be 20' if avq. w!ln 150')
o Side Yards
Standard
25'
10'/
25' if abutting a street
Proposed
ZS.3~
I
10 I\r
t
I
I
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 ofwetland/NURP
e.ond
o From OHW (Prior or Spring Lake)
10' setback +
2"/1' over 50'
25'
10' sidel
25' rear
30'
I
IDi~.,.
~..'2..'!S"
NDt.lc;
tJ~
75' or setback average of
adjacent structures, but no
less than 50'
Nt\.
I Floor Area Ratio: NA/FAILS/~'
.30 Maximum
17%
\.
Yard Encroachments: NAI FAIL~COM15ileV
. ,
Eaves and: Gutters no more than 2 feet in width and no
closer than. 5 feet to a lot line (Easements].
I. AlCandother equipment cannot encroach oninterior
side yards.
Standard
Propose!f'-
<.,:,,;.,c;;J".
~j.J8;:;;':' ~.'--
~_.. --.-...
,~~i.:_',j'i"''''' ,
',:,-~~_~,,..,,,.;,,.c -
:.f.:.'J~':'\::i,~i,:.\!i',J!::::
Standard
r
Proposed '.
\
,
, Tree Preservation:~A1 FAILS I COMPLIES
'0 Total calioerinches
o Permit 25% Removal
I 0 CaliPer Inches Removed
I 0 Calloer Inches Preserved
I 0 Replacement
I
I
I
l
I
%:1
I
L
I
L:\TEMPLA TEIBLDGLlST.DOC
, Driveway: NA/ FAILrfOOMPLlE.$'
I 0 Maximum width at property line
I 0 Required setback
I 0 Maximum slope
10 All parking areas to be paved including R-Vor
spaces adjacent to the qaraqe
>
I 0 Location to match subdivision qradinq plan
-
, Building Height:(t'dMPLlI;,S)' FAILS
, Shoreland Djstrict{(NA1/.JAILS / COMPLIES
I Minimum lot area (square feet)
I Minimum lot width
I Shoreland alterations
I Impervious surface
, Bluff in Shoreland:~~FAILS I COMPLIES
I. Setback from top of bluff
I. Bluff impact zone
I. Enqineerinq certification submitted/approved
I. Gradinq in bluff or bluff impact zone
, Floodplair(IiI'MFAILS I COMPLIES
I. 100 year flood elevation
I. Lowest floor elevation
.
Proposed lowest floor elevation
I.
I.
Elevations 15 feet from structure
Road access must be no more than 2 feet below
Requlatory Flood Protection Elevation
, Accessory Structur~ ~A) FAILS / COMPLIES
. Size I
I. Not located in front yard (Materials)
I. Side yard and. rear yard setbacks
. Maximum heiqht
I. Materials compatible with principle structure
L:\TEMPLA TE\BLDGLlST.DOC
Standard
24'
5' from side lot line or
30' from r.o-w on corner lots
10%
35' Maximum
Standard
7,500 Rip, 7,999 Non.rip
50' Rip, 57.3' Non.rip
30% Maximum
Standard
By planning dept.
20' From Top of Bluff
By City Engineer
No importinq/exportinq
Standard
908.9' Prior Lake
914.4' Spring Lake
909.9' Prior Lake I
915.4' Spring Lake
Must be l' above flood
elevation for new and existing
structures. If existing
structure was constructed
9/19/90-11/22197 then
additional foot IS not required.
I Must be flood elevatlOf1;or
higher
I 907.9' for Prior Lake
913.4' for Spnng [aRe
Standard
832 Sq.ft. or 25% rear yard
10'
15'
Proposed
2.'\ '
I'Ll
.q 0 ta'?o
o-h...
f'4/\ ~. J)~~o
~ \
Proposed \
I
I
I
Proposed
f
I
I
Proposed'
. ~: ( :'
~",5
Proposed
f
I.
I
I'
~~
White - Building
Canary - En!l,ineering
~ko - PI,,!,n,i'n}
The- (.(,TlI... of Ih..l..... Counlry
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
OJ E. '"0 ( L Lj
I
i ( . '-
[Ie
(4-
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
/ '.-7
f i\i
,\ L"
,. '.,
i
'0
o '-
Accepted
Accepted With Corrections /'
Denied
r----
Reviewed By:
~
~
Date: ,/1/1/0 c.j
.'~ ~"~
~~~
l/
Comments: A.(!.. u..o ~ ~ ~.-
~.....u ~ e.12 . -,~ ....uz.... H' ~ ".0
.A2..IJJ~ r ..f!c:t- L.' -:- .
v
"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."
~~
dt,hite - Buildiiiq:)
Canary - ~ngineering
Pink - Planning
rh.. C..nl..r of Ih.-I..".. Counlry
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
9E-rLOLD Bf2."os.
I 0 . Z,b. 04-
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
13/(07 K.6Nsl NqTON AVE;. N.E.
Accepted
Accepted With Corrections ~
Denied
Reviewed By:
~
~
~~-
1~ Date: 1/) ,/0 <-(
a1tl ,k ,.P~.
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 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."
11/05/04 FRI 12:50 FAX 952 890 2753
STOCKER EXCAVATING
Ii1J 001
Date Ree'd
CITY OF PRIOR LAKE
SEWER AND WATER PERMIT
.. G,~, f,lo I PERMIT NO
1. Y~lla"" CilY . 04-1134
1 Gold "ppli~"\
t{- /131./
I
f?lease rvoe or orinc and siP1l a.t boUOCYI)
ADDRESS
13967 Kensington A~e
I ZONING (ollie,",,)
LEGAL DESCFJPTION (ollic' use only)
LOT 2l3LOCK 3 ADDITION
Windsor Estates
PID
O'NNER
(Name)
Gerold Brothers
(Phone) 952/758-2842
(Address)
P.O. BOX 128
IM<lrcss)
Ne.. 1"!'1,!<>e. MN ,6071
(City) (Zip Code)
APPLICAN1'
(Name) STOCKER EXCAVATING COMPANY, INC.
(Phon~ 952/890-4241
12336 Boone Avenue Sava~e! MN 55378
curtIAddre1') ;j;0~~
(Contact Person) (phone)
APPLICANT SIGNATURE /I//.h '# /'J ~
-Vv -V
(Address)
(City)
(Zip Code)
same
DATE
11-,_M
APPLICANT PLEASE COMPLETE BELOW
Size of water service inches.
Location of any couplings from structure feet.
Type of sewer pipe. 0 ABC 0 PVC 0 Cast Iron
Estimated length of sewer line feet.
Clean out (if required) located af_ feet from structure.
Residential sewer and water line connection
Sewer conne<:lion only
FEE SCHEDULE
$35.50 Industrial, Com'j & Multi-family 1% orjob cost with. $39.50 minimum
$17..50 Water connection only $17.50
Estimated COSl $
Building Permit # _
SEWER AND WATER PERMIT FEE
STATE SURCHARGE
TOTAL PERMlTFEE
$
$
$
t. .
,~.",: .
.50
e.
o ';'~-"':Jf7lt"'_':" j'
~\:1 t ':,~,; "-
....,~.<
(Office USt Only)
This Application Becomes Your Building Permit When Approved
o !I. Ie
I:PaT<;I
I Date
lIInv
R,~eipt No.
Builtlil1g Orr.c:ial
By
o 9 7nn4_,
-r
24 hour not;"" ror.ll in,pedi.n, (952) 447-9950, (ax (952) 447-J245
CITY OF PRIOR LAKE
HEATING/AIR CONDlTIONING/FIREPLACE PERMIT
Date Rec'd
(please tvoe or mint and sien at bottom)
ADDRESS
; ~::, ~:;, I PERMIT NOA.. f I~
3. Yellow Apphcanl .,..... ~ I
ZONING (office use)
13967 KENSINGTON AVE NE
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION
Pro
OWNER
(Name GEROLD BROTHERS
(Phone)
(Address)
APPLICANT
(Name) ALIJRD FTRRSTDR DBA FTRRSTDR HEARTH IV HOME
(Phone)
651.6JJ.2561
(Address)
2700 NORTH F AIRVIEW AVENUE
(Address)
ROSEVILLE
(City)
55113_
(Zip Code)
(Contact Person)
BRENDA HUSTON
(phone) _651-633.2561
APPLICANT SIGNATURE
BRENDA HUSTON
DATE
1/24/05
APPLICANT PLEASE COMPLETE BELOW
xD NEW CONSTRUCTION D REPLACEMENT D ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM
DWarm Air Plants
DGravity
D Mechanical
OAir Conditioning
DVent. System
HEATING OR POWER PLANT
o Steam
o Hot Water
o Radiation
D Special Devices
o Other Devices
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
FIREPLACE MAKE AND MODEL
HEAT N GLO 6000TR-OAKX 2 AND SL350TRS
FEE SCHEDULE
1 % of job cost Residential, Gas Fireplace
$39.50 minimum
$99.50 Residential, Additions & Alterations
$64.50 Residential, AC Only
$39.50
$39.50
$39.50
Industrial, Commercial & Multi-Family
Residential, Heating & NC (New Construction)
Residential, Heating Only (New Construction)
Estimated Cost $
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
Building Permit #
$
$
$
.50 PAlO :~M\T
BU\LO\'"
(Office Use Only)
HuUdine: Official
Date
I Paid
I D'AN ~ I ZOUJ
, Receipt No.
This Application Becomes Your Building Permit When Approved
By
24 hour notice for an inspections (952) 447-9850. fax (952) 447-4245
PRIOR LAKE DJOiPARTMENTOF
. BUILDING AND INSPECTION
INSPECTION RECORD
.
SITE ADDRESS ~q" 7 K~sl N<4~~..AVE. fJ.C.
NATURE OF WORK Ofi'
USE OF BUILDING
PERMI1 NO. _ JJ.f..il.l:
CONTRACTOR PHO..J t.
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPEC'rOR
DATE /"
I FOOTING ~ , /~J/o/
I FOUNDATION (Prior to Backfill) I /J'tfI I 1/ /",11 ft('
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS .
SEWER I WATER I SEPTIC $~A // /~! ;:';1
FRAMING /"vr / htjo ~ J
INSULATION JtV?t- ' /71' / ~
ELECTRICAL, , J . //#);,5-
P\.LUMBING //n' ~/Z7 /t;s/ ).f L-, I?t/7 J,krPl-'S--
ffi:ATING (if required)//# ~~'1' th 11II //)1/tc:
FIREPLACE :4'::;/J I J)ul1/'A. J'Ul /..b/tJ.5
GAS LINE AIR TEST r#;p/;Zf~~ t- /.3) f;f;!JIII //;1/06
COVER NO WORK UNTIL AB9VE HAS B,EEN SI<;xN.ED,
L~""'E'j H~tj'EWItAP ~/ #.% /.,2/2?~J/j.,/1-I/J4~/I1f). /
4/b L2er IS 4~#cj FINALS ~e,r' ~d h~,s/-zO
GRADING (Prior to SOddi'1J1) . . . jiB /3. () (p
. BUILDING 1ll'1'U',C;O. u",Pl O!lftS- Jl/frfjlos JfI/- / //I,!aG
ELECTRICAL'~ ~;6,~'"
PLUMBING /'ZYk' J./ 14"/05-
HEATING 4' /i10J'
DO NOT OCCUpy UNTIL ABOVE HAS BEEN SIGNED
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 placed near main entrance.
FOR ALL INSPECTIONS (952) 447-9850
Qt:ertifitatr of Ql}trnpanq!
CITY OF PRIOR LAKE
~rpadmruf of 'lJiuilMug c1'usprdiou
/
;3i Final Permitted
/
This Certificate issued pursuant to the requirements of Section 110 of the I Residential/ r--I International
Building Code certifying that at the time of issuance this structure was in compliance with the various
ordinances of the City of Prior Lake regulating building construction or use. For the following:
SINGLE FA"1ILY 04-1134
L:J Conditional e.O. Expires
Use Classification
_ Bldg. Permit No.
Occupancy Type
R3
Type Construction_
VN
_ Zoning District
R1
Legal Description,
L2, B3, WINDSOR ESTATES
Owner of Building
Site Address
13967 KENSINGTON AVENUE NE
GEROLD BROS..
Contractor's Name & Address -'"
ROBERT D. HUTCHINS /~~
/ 0Uilding Official
////,cJ&,
/-
15967 ISLAND VIEW RD., PRIOR LAKE. MN 55372
JANE KANSIER
City Planner
Date:
Date:
-
.
i
.
I
J
DATE nME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
/39(07 !::EIlIS/ /liG rotJ
OWNER
CONTR.
PHONE NO.
PERMIT NO.
4- -113'4-
o FOOTING
o FOUNDATION
o FRAMING
~NSULATION
INAL
o SITE INSPECTION
o PLUMBING RI
o MECH Rl
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EXIGRADIFILLING
o COMPLAINT
o FIREPLACE Rl
o FIREPLACE FINAL
o GASLlNE AIR TST
o
COMMENTS:
Uosp; PILE"
/
/"
/~ r<
/ /'
/ 01<-
-'#" t
~WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK. CALL R REINSPECTION BEFORE COVERING
Inspector: A Owner/Contr:
"
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH cl SAFETY!
INSIW"
//Lz~S-
,
/JY~7 h~S'~Y~K 4[e-
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
-..,
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
~AL
o SITE INSPECTION
o PLUMBING RI
o MECH Rl
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
COMMENTS:
I /
,-Ey -t-e'1d,
tV,n ~ -/
DATE TIME
1./ -//3~
o EXIGRADIFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
----
'hPP?"o ,. C. U'
- /~//..? /c:?\
./7
......
,
Vj / /' ~ ,. ------ / ,/ (
(}../ f~ed ~A4:/ ~d'~~/~
o WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
~ECT WOR': :A:L7R REINSPECTION BEFORE COVERING
Inspector: #~ ~er/Contr:
~
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
INSNOrl
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
,39(, 7
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
COMMENTS:
6.",,04- c9Y
CJf,l;, )7,,')1-- (9 i
DATE TIME
SCHEDULED
)-"5"0(;,
Ke"iSib~M 1Il/r?
CONTR. hr,rvlJ
PERMIT NO. OLI-J/YI
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
'2('~LLING
" D"cO'MPIXINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
~RK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector~;<Z. . . Owner/Contr:
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH'" SAFETY!
IJUNO"
DATE
/tK;6s-
, -
/J9~7 ~c'.n:S/A~~ ~
--"
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
~NAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
COMMENTS:
TIMe
y- //j~
1
o EXIGRADIFILLING
o COMPLAINT
o FIREPLACE Rl
o FIREPLACE FINAL
o GASLINE AIR TST
o
/
.er/ red
/^') ~ /./ / .--, .
(It/' (, ;9'"// ~dv'/), uP ;.;t.""k'C~/h91
- ~pffi . ~Y' "7 -r/;'../ qA~ 04?~v.
---=-r-' J/'I7- ?J'Jo . / //
4-----. / I' - (' _/-
~ /VB I'-d . /, t )b,..! ~ /;/t::.e-s
//-e/ /:lou, h~r-
/'
.-/ .......-?-
7.:.e~ . C::::, U
//
A/'~r--
//./ f~ /? /'
/' 6/( rft:::1r /4?/~~C72I;A-
o WORK ~SFACTORY, PROCEED /
o CORRECT ACTION AND PROCEED
,.,-~..,,,.:cT WOR;~~~ REINSPECTION BEFORE COVERING
Inspector. ,~ / ~rlContr:
- -
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
I1ISlWTI
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH cl SAFETY!
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
/.176"7
OWNER
PHONE NO,
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
~INAL
o SITE INSPECTION
DATE nilE
SCHEDULED ~ -
h~J~Y-~- d~
CONTR.
PERMIT NO. ~ - /pe/
o PLUMBING RI
o MECH Rl
o WATER HOOKUP
o SEWER HOOKUP
...a1>LUMBING FINAL
~ECH FINAL
o EXIGRADIFILLING
o COMPLAINT
o FIREPLACE Rl
o FIREPLACE FINAL
o GASLlNE AIR TST
o
~9M~N16: /)
~ /feed /i~t///-.Ice- ,e;h~e.<...r~ r/
~/ // de", /7/.:-./ G;:.."de .#.4'#/"7'1/"1: /
'.~~~ lf~'y/.J.C (/e.&l/- Q/ W;7-9J"Jo
/J: A4R . ~rJh 7/ees .tJl>r d.,.."". ..d&.___
c::; -,,-
~~./;y hX~ / e/~
- --- -
~c 4, . ~'?,.~~/ ..---:> '1
jU'~r:--+C/ rcs ~ (C?4(S4~,>
:::t;.. i G?J fi Ij; -~ r",yn"ce./"
. .&r /' I'r -I- /Lv"Y't'-
7e~/ C;Ot U~/;/ Y/hs
/
o WORK SATISFACTORY, PROCEED
~RRECT ACTION AND PROCEED
o CORRECT WOR~, ~~7REINSPECTION BEFORE COVERING
Inspector: y~~ Owner/Contr.
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
....."
Job Address
Heating Contractor
Name of Tester
Date
Percent 0,
Percent CO
I ? (ltd ~-S,Ar#rt^
~ A "'" M...A
~
.5 .['2, S .~
1.1
017-7)
</.., ')
Percent CO,
Stack Temp.
Combustion air is adequately supplied per
UMC Sec. 606
Input
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