HomeMy WebLinkAboutBldg Permit 05-0309
CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'Q
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT .3 ,51 - ~
(Please type or print and sign at bottom)
ADDRESS
J~f/~ ~ v~r- }rJ1(
tJ.k) .
LOT I~ BLOCK
LEGAL DESCRIPTION (office use only)
ADDITION
w~
PI~zr: I/O'l-Ol?-O
OWNER
(Name)
(Address)
I. White File
2. Pink City
3. Yellow Applicant
I PERMITNO'05.U30q I
I
zit/1 bffice use)
tri,., .
· f
_ (Phone) -J12-10~ ...i:fI()(7
~;1}7~
BUILDER /. ~ _ /'. '_ ......_ J ~
(Name) ~"r~,.;
{Contact Name) , ~ 1_
(Address) ~'i? ~ -t14 At? ~ .*.
i~11r1l tl1AJ1 ~~ ?~ _'f/.
~(O ~r 1f( true- A~
I~(/ .
TYPE OF WORK
o Misc.
15- New Construction
OLower Level Finish
(Phone) ~ ~ ~~..tt III'
{Phone)t-:..(,IZ" 3~" -~ IttJ
66~79
,
DDeck
OPorch
ORe-Roofing
o Fireplace DAddition DAlteration
cD
PROJECT COST IV ALUE (excluding land) $ J..1 ()/Jrx; ~
I
ORe-Siding
OUtility Connection
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 e above-mentioned property and that all construction will conform to all existing state and local laws and will proceed in accordance with
submitted IP;::~ a aware that e building official can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may
~ter upon~e to perfo eeded ins ections. 1JA { 'J I,~ ~~
v Signature Conttactctr's License No. ,~;
"
11'2-70. ~()(J( O{)
$ ZO-7~. 50
$ t 3L! 7 I 7 r
$ 135 dJO
$
$
$
$
$
I Permit Valuation
I Permit Fee
I Plan Check Fee
I State Surcharge
I Penalty
I Plumbing Permit Fee
I Mechanical Permit Fee
I Sewer & Water Permit Fee
I Gas Fireplace Permit Fee
10 (), 6) ~
IOD. () t)
,35", s- a
#tJ, tJ CJ
This Application Becomes Your Building Permit When Approved
~
Building Official
.
1-rw;J/-J
11 rs/os
I
I
I
I
I
$,? ~~.7&2J
Receipt No. i/fidij I
Bd--- I
I Park Support Fee
I SAC
I Water Meter Size 5/8'0
I Pressure Reducer
I City SAC and WAC
I Water Tower Fee
I Builder's Deposit
Other
#
#
#
#
$
$ /~SO,OO
$ ~. 00
$ 7S, 00
$ IStJo, 0 0
$ f boo. 00
$ ISoa .00
$
This is to certity 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 i ned by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
. sued.
~'"
Date
TOTAL DUE d;tuclJ .{. ~ }- ~ . ,. s-
I Paid
I Date
q~b . 7~
''-!-~ 7-5
~ q./u IDr -ylo ff~~:-- ~....u-J. -
Planning Director ~ ) Special Conditions, ifany ~ ----rr-~
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245 - -u-- -
16200 Eagle Creek Avenue Prior Lake, MN 55372
White - F.!.uildinL
~rv - Enl)ineer1ffit)
Pink - Planning
The Center of the Lake Country
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
,c /
'; (:, ,:"..;-:, .'-/
j~ ~"". ~ // ,', .'.'r
F _._' -- .__.....""..::,...."'- . ....... V t
/
APPLICATION RECEIVED =? -5 /-- S---'
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
" .<> .:::;.~' //). ,... j )
C)j / ,:r ) -- c (/ 0 V Va f-';-'~"
.i .....__.~.1
Accepted
,)(
Accepted With Corrections
Denied
Reviewed By:
/IJfJf3
Date:
'(-7-0S-
Comments: See Reverse Side for Additional Information!
See Attachments: 1) Grading Plan. 2) Erosion Control 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
8:ny 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."
Thf ("fnlff of Ihf L.kt COUnl'1"
/Whit~ - Buildin9)
\"anary - EngineerlllY
Pink - Planning
BUILDING PERMII..APPLlCATION DEPARTMENT CHECKLIST
NAME OF APPLICANT ~~r'
APPLICATION RECEIVED ~ - 3/-,S-
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
df(ff...=)- (JOuvaf- 4)
, - ~ - I
Accepted
Accepted With Corrections
~
Denied
.......
Reviewed By: ~ ~ Date:
Comments: ~ aLe. ~ ,
tJO ~/~'...J. /~, &.;~,f2k,
/ / '
~ ~ fJ~ ~ ~JJ~~~
~) ~ t..o ~ -4-0 17 Ar4/ ~
~~A
4/3/a c:;;:
/
"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."
""
The ("("nler of Ihe L.kt Counlr)"
White - Building
Canary - Engineering
'-fink - Planninv
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT .~
APPLICATION RECEIVED
.e(_,~
I ,.
,~,
,..-...-'"
)
,.-,'
,,-
')
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
-'\
~;; ,/() Y f /'
Accepted With Corrections /
Accepted
Denied
Reviewed By:
~
l€~
,.
-7- vJ)f
Date:
~/13/0r
I
/'
Comments:
a (J R.
. p
-~ ~~~~--
"--U ~- M'. . ~
~~~~
"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."
05/05/2005 09:37
9528959394
ALLIED EXCAVATING
PAGE 01
CITY OF PRIOR LAKE I
SEWER AND WATER pERl\t111
Date Rec'd
~: S.; 5...... I PERMIT NO. 05b~Oq
....
If' ~+ 'h'.' 9, \' atl-c.. u
ZONING (GlIb -> i
I
I (Address)
,
LEGAL DESClUPTIOfaice II8C oaly)
LOT BLOCK IADOmON
(' OY\.bt..
(.~~ Av<?... ~chc t~.r ~
(
PIO
(phone) ~ .. 4D'~-~ IOU
m.vu~5~ll
(Zip Ca)
APPLICANT ^ \.\.
(Name:) f""""\ \, ,
. (Address) p() ~
(ContaCt Pmon) :-\ e..
. u ,-r n.C'. (phone) #-S~ -eNl/ .. ~)c>LU)
~~~~ 'IY\~! 5S3)~
. (City) (Zip Codl)
J c.., ~~~PhOne) ~t/... eBtLO
~ DAT!! _.J:)-~ -() r
~PLICANT PLEASE COMPLETE BELOW
Siz J of water service \.' inches.
L I tion of any couplings from strUCture _ ~ feet.
T e of sewer pipe. 0 ABC ~ 0 Cast Iron
Est ated lenitl1 of sewer line 4.0 feet. .
Cl qut (if required) located at .1:iJ..- feet from structure.
Residential sewer and water Ineconnection $35..50
Sewer connection onl)' I S 11.$0
I
Estimated coSt s
I
I
I
(om<< Ule Oily) I T.>\ iP (r'\- .~.~_..~
Thi. Application Beeomi Your BU,ilcliDI Permit When A, ppro\led ,::), ' ~icllir, Lr I I Rca:ipt No.
i ,: tlIf'Ay 1 0 2005 Ii il: By
luildt... Omctal 0... ~
I 24 hour Itotie. for all i...paerlo.. (9!1)44rrj~,'~I~~.!,!~~ "'-U45
'.".._~.:....._-~---,-"~.-+--- -.-
FEE SCHEDULE
Industrial. Com 'l " Multi-famiJl 1 % of job cost with a $39..50 minimum
Water connoCition only S 17.$0
BuiJdinl Pennit iI
SEWER AND WATER PERMIT FEE
5T A tE SURCHARGE
TOTAL PERMIT tI..~
S
$
S
PAID WITH
.BuILDING PERMIT
Ma~ 26 05 01:04p
l'IHI-C:O-~t!Jt:JJ .&..~.....):)
.....AJl LX'" r~IUl'\ ~I:.
952-492-5996 p.l
J~'~~r~C~J r.~~~~4
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
I - flit I PERMIT NO -;:jp 9
z 001' Cily
) VoIlo.. ...""iCU>l
(Pl~ tV\)e or llrint iUlll ,il!l1 at bottOQl)
ADDItESS ~
~~R3 r DLlQtLV -ra% (() tV
. )
LEGAL DESCRlPTION (office U$; Only)
'fy- \ O'{' L.(l K,0
ZONING (oIlireIlJl)
LOT BLOCK
AoomON
PID
~~e~R ~~a._n(tfL{.l ('bv'\S,*Yl.l~~)rt (PboncFl.~-4D3~ ~/ 01)
(Addl~s) ~b \ n e I l..f Yb trtte..;. 5 h ttV; ope e:.. , fvl t\! 5,5:;71'
'APPUCANT If2 n . . '(")1 I' '-,r q'. .
(Name:) ._ ~.,( J n~ Ii; Y\l~ .VIa) U/)j c.Lf/l\. . (~h:ne) . f) ~ - 4~ :: q10 :.~
(Addtess) J). \ \ y\ 1f.u \\ ~"i..-L(. .... \0 ((lb n .::J 5~. ) ,-1-___
, (Address) - (City) (Zip Code)
(Conta" Pmoo) r hv i :'-. ,.rl?v'jn111 .~. , (Pho",,> Q 5d. -q~.c)O- ~ i=<. i
APPLICANT SIGNATURE ,LJA.4v~'i cSil..ivzJt"/ DATE 5/;;J{P la005
(
APPLlcl U PLEASE COMPLETE BELOW
, Type ot"Fixture Quantity
Bath Tub with or without shower 0 Rough-ins
Dishwasher I Water Heater
Floor Orain 0 I Water Softner
Lavatory (Bathroom Sink) I Stand Pipe (Washing Machine)
Laundry Tray (lor 2 compartment sink 0 Sewage Ejector
Shower Stall () Backflow Assembly
I Sinks 6 Backflow Assembly Test
Bar Sink f) Lawn Sprinkler
Warer Closet (Toilet) () Other
r Quantity
i .:L
I 'J
\ I
I '/
1 I
I ,~
I 1 f
Lf
Type of fixture
U.L SCW!.uULE
Induslrilll. Commercial & Multi.fllm,ly J % of j(1h C051 wilh a 539.50 mil\imum Residential New Ono: &. Two-Fanul)l S99.~O
Residential, Additions &. Ahcratiuns S39S0
Estimated Cost S
Building Permit"#
PLUMBING PERMIT FEE S
STATES~~CHARGE S
TOTAL PER.1\(lT FEE S
,50
(omU U.'C Only)
This Application Beeomes You.r BuildinC Permit When Approved
Paid
Jd1
Date
By
v
Kllildin~ omciAl
Pate
24 lIour pOllee tor 111\ ill~~t1ions (952) 447.985t1, tn (9S2) 447-4245
16200 ElIgle Crll~-k^ve., S.I:., Prior Lake. MN 55372-1714
TOTAL P. 01
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
1. Pink File
2. Green City
3. Yellow Applicant
PERMIT NO. ,.1)- dOf
(Please type or print and si~ at bottom)
ADDRESS
8983
~C;Cvt- ~
ZONING (office use)
,
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER () I
(Name) ~CLI'\C(. '* Ck.,~~ J(A(CVX~Cn({1 i
(Phone)
(Address)
APPLICANT II. '" J IJ /' 0
(Name) ./tHI"'L(Jf'\ uYn-f~~II~ (Phone) ti/J~5'Oo' ~J"Uo
~1'l1 ~flier\. bh~ AI /;~ ~
(Address) V /,1 (City) (Zip Code)
(Contact Person) A~ ,~~ V\j //L---..""-... (Phone) &/J-5() <? - qJJ.b
APPLICANT SIGNA~~RE ,_~/I- DATE 5iJ "7/05
~. APPLICANT ILEASE COMPLETE BELOW
.@EW CONSTRUCTION D REPLACEMENT D AL TERA TIONS /J
FURNACE MAKE AN? ~ODEL Rlfj'la. rr-l IJ?tw AlvA _ FUEL 'I Jrc.Jt.
FLUE SIZE 3 ('~, RETURN OPENINGS I~ INPUT I)PIJ~ OUTPUT //f)~
TYPE OF SYSTEM HEATING OR POWER PLANT
(Address)
-S-S3 "71
~~ Air Plants
OGravity
o Mechanical
jd1(ir Conditioning
OVent. System
FIREPLACE MAKE AND MODEL ~~
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
Industrial, Commercial & Multi-Family
FEE SCHEDULE
I % of job cost Residential, Gas Fireplace
$39.50 minimum
$99.50 Residential, Additions & Alterations
$64.50 Residential, AC Only
$39.50
Residential, Heating & Ale (New Construction)
Residential, Heating Only (New Construction)
$39.50
$39.50
Estimated Cost $
Building Permit #
HEA rING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
.50
Date
(v 1~~ceiPtNO
By ()
'""
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid
Building Official
Date
,
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue, Prior Lake, MN 55372
05/20/2005 14:30
9524925005
GLOWING HEARTH N HOM
.,
PAGE 01
llEAo'f~Jn....~,
DIl1~:iR;ec'd
r","..
.:..~..:<('..:.. .
"..'r .'
rPlease:ttDe:Clf."Qfult a1td.~~I~at'b"~~~\~I' ...' .. ,....,. . . .":...::~J~l~!;" ..
A:DD~SS . . .~~",:il"i ..
, . 0 ~ ~ 5 C\)~,~?'( ~D+hNl0~-{)r~Of.,:(::~gke )
I", .....':.:,."::,....
. """.._'H'\";""
\. P.ink
1, (;reon
3, Y.II.",
~I:~.:..'. .'.:. ',f. IT'NQ~. A.~.
Ap'pll6b~f U., ~
'}i>/;~c- .....,...
ZONlNGCofficeuse)
fYlr0
LEGAL DltSORIf'tIGlNtomoeus-eonly)
LOT B:LGOI.<
Pi,DDITlqN
",,, ,',.",.,,', '
P,r.n.
. ";L~.
~=e~R 50.1) ~Q u.. C00.s-huC110'~
(Addtt;Ss) 3010'. t . .,.If\~.~5-+ .5~Ckope~J~~L
. ....'. .. ."...1....".".... .,- '\"r"'l\' r. ,
1N'i:~ c:., I \1" ,; Y1 ~ f+ eaf-!-h :I: 1--\ QTU~ <rho.o} lj q~ ' q ~'l..b
(Addre!:s) I () ~ r ~ d<"\'r o.~r') 1}'I ~ (")'( r\ 1If'.1 fYHJ .:)\.) &. ~ a..
(~d~#) , ) (City)
(Contact Penon) JIM 6~lmeK ., .. {Phoi'le) 4~cl.qd'lL.
APP~~~~SIPNATtJ,~, rlf0,6hl,~,~~t...CP;)~, "",~~"., . ,PATE b/~]'/Q~
: . ' . .. ..,.. ..;..;'...:. :..... '--" . .
g~~ ...... ..'p; .~>>~El~iJ~I6B~E:~~
- '.~W)60NSfR.d~:rl(g~.... ...,::.:,6:~~~,~~~~~~:k.;P~lltJkkLtERAT.I{;)NS
FURNACE MkRE,ANDMO'J)EL . d...-b?R9, I~;()A.K .. ~L
FLUE S.IZERETtJRN;l9:p,Bm1l!'O'lj$: .1NPUT Qt71pUT
!:imgiqP'SY.S~:e:M mlA:~$:.E5$;iPOWER PLANT
OW~;;~ird~la:ntsg::Stl!~'
o.GtltV:ily ;C]}'JatW1itet.
~:M'eriHti!)i~Qt! :. ,';' ~:l\lldil'1ffOl1
O'Ait Qol'i;ll)ij~tt1ng . .,' ,,", .~~1i]~i*~S
DVentS,4rttn . f,:t'>eVl~e$...
(Phone)
GZipC6d~)
PbEASE NOTE:
Air Gondition'er Units
Cann9t,EncrOMhinto
Requtfed'Side Yard
S~tbacks
FIREPLACE MAKEAND\M;W:l;.'~L,.~f.~Q~\)~.
Estimated COlitS
}l!E!~"S\::;nJ:!i1JidLE
~:%1)r'jd'pto~t ltesldefltial,G3SFir~lace
S99j Q.rttlf).1h\um.
$9~M:U Rcsitilcntial, Additions & AJterati-ons
S64.5tl Re~taential; ACOnly
I) ~ a .00 BUilding Pertriit #
$39.50
$39.50
$39.S0
r n dustrilll, . Commcreilll&Mlirti~Famtly .
Residential, Healing,&; Ale (New Constr0"~ti'Otl)
Rcshlential, HtatingOnly (NewCbnsrructioll)
Im~:r:tN$')11ZRMrT"1':EE.
:StATE-SYRCHAR.GB .
.TQ'l1;AiL,BERMIr,l>FEl:
$
$
s
PAID WITH
BWlDING PERMIT
(OOlccU$C Oilly)
r~-' r~' r;~-, C'
Thls-A:p.pli"Catlonllec:otne~.V:oUt"Btindin~F~rm.lt:WhetrApPtDv~' \ ~f-~dl'ln \ 1\ '
\ \ :>a:OON 2 4 ZUUJ
Dir.te i I,
24'h01li''l1otJct,tbrlillill1sP!!filollB;(?52)il47.. ~850,'MX' (951.)447 ~4245
t~2tJQ~Eagle-€tt_t1fi,.A'Y.enue; Pi'lor.~t~~-----=
,QtilldlngiOfficlnl
'\\\:11 Receipt No.
'I
U lay
PRIOR LAKE
INSPECTION RECORD
SITE ADDRESS 2.~' Cou.<='M. <?A.TH
NATURE OF WORK ~ Q).a"......JEND..~ WIT'" L.t.. F;i-JiI'H
USE OF BUILDING ~.P: O.
PERMIT NO. 05. o3C9 DATE ISSUED 'l/1./o~ .
CONTRACTOR ~S't", CO, ,'NC.. p~-I{65-'Ulc
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
DEPARTMENT OF
BUILDING AND INSPECTION
INS~OR
I ~ fI1>, . I tj-C 7\.J&(j
J FOUNDATION (Prior to Backfill) I ~ $; / ~/v I
\.. R\' 'LACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
;/} ..;; 'II'l ROUGH - INS
SEWER I WATER I SEPTIC
FRAMING
INSULATION
ELECTRICAL
PLUMBING pB l S/Z7/<?1
HEATING (If required) it? tJ~ ' ,
FIREPLACE It/J 1"'$
GAS LINE AIR TESTlZ~f' ~, f b . t/'t
I
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
lXI1\e4 HDclU\.bflAp I I
FINALS
.i
DATE
FOOTING
Po
'I'
111> ·
4//..s
GRADIN'~ (p,lor to SOddilUJ)
BUILDINC'~ 1 -t b 111- '6
ELECTRICAL \ I
PLUMBING
HEATING
DO NOT
g. zS". 0 r
(( 'h !~ '2.*1. ~ ~
1 f;/~~
//Wi ~if~ r-
fIt/Y t/t~/oS/
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
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
DATE TIME
8-2:1 -<
~~
ADDRESS 21583
o~
OWNER
CONTR.
PHONE NO.
PERMIT NO.
5-0'507
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
;:!t~INAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EXIGRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINrlR TST
o 5 rJ=::,
COMMENTS:
~~ r(o~-A4'>~
~ORK SATISFACTORY, PROCEED
o CORRECT 10 NO PROCEED
o CORRE ALL FOR REINSPECTION BEFORE COVERING
Inspector: _ Owner/Contr:
CALIl4A7- 0 FotTHE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE ;EQU~ENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
INSNOTl
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE SCHEDULED 8- ~a ~
ADDRESS '25eJ Cbuc-G.J (?-aik
~
OWNER CONTR.
PHONE NO.
PERMIT NO.
5 ,. ~o1
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
JI!f FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EXIGRADIFILLlNG
o COMPLAINT
o FIREPLACE R1
o FIREPLACE FINAL
o GASLINE AIR TST
o
COMMENTS:
I. ~\~ (;~ ~c.+"'6I\ "-'.. 'n~. ~.,(
2. S~ "-~~
~io
/()- fI? ,C4
-
o WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
~CORRFrORK, CALL FOR REINSPECTION BEFORE COVERING
InSpecto~: .A ~ Owner/Contr:
CAw;;;'lsso FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH &I SAFETY!
INSNOTl
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
9'~-O(
ADDRESS
2g~3 CoVc.G,. A,A
(,/
PHONE NO.
PERMIT NO.
~~v Wr1S1.
05~3os
,
)(~ILLING
o COllPLAlNT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
OWNER
CONTR.
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:
G,'t/it- (;) (
Cv/6 &>t--~'_
IIh ~rfT
)'wORK SATISFACTORY. PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
InSpector:4.!K- Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNon
",,;,-,
~-"---
"~L,,_,___,_____'...._
,;~
-