HomeMy WebLinkAboutBldg Permit 04-1072
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
See Main
(Please type or print and sip at bottom)
--'.'
_,~l,e
Date Rec' d
9. ,}C,04-
I. White File
2. Pink City
J Yel\ow Applicant
I PERMIT NO. 04-. 10 7 z.f
ADD,S5lno~ OrO-Ke-ttrClE:I
~L0
ZONING (office use)
~SD
LEGAL DESCRIPTION (office use only)
Lor5BLOCK \ ADDITION C-rL-\staQ ~\~. \U\1CS PIOd5 tlIIfOO5""C~
. .
~=RM Ct.n )C ~ ~rot-t\eiS
(Address) ?-1/3 Cl'Itk=' Gv--. ~ CL34...i\ ('(\~
(Phone) lc61 ~ 1--00 ~ 1"( l X
551 a- 0-
~~~~~Name) M OJ\ ~ bfO-truus
(Contact Name) t--\.l c.\'lelLe...-
(Address) r:>\ \b ~ \\~ Qv. "t::LQrA n
u
(Phone) c..os; I ~ 'J-((:j ~ 1"7 I <Z
~e).lo5" Ir~' l'7l~
~~
------.
(Y\"-l
TYPE OF WORK l!(New Construction ODeck OPorch /ORe-Roofing ORe-Siding OLower Level Finish 0 Fireplace
OAddition o Alteration OUtility C~ection 0 Misc.
CODE: ~I.R.C. DI.B.C. PROJECT COST IV ALUE sSS-O/ 000 .1)0
Type of Construction: I II III IV V A B (excluding land)
Occupancy Group: A B E F H I M R S U
Division: I 2 3 4 5
I hereby certifY that I have hlrnished information on this application which is to the best of my knowledge true and correct. 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
official can revoke this permit for Just cause Furthermore, I hereby agree that the City official or a designee may enter upon the t'wt',';i to perform needed mspections.
xf\A..lcltu-L-l..o ~~ U-o-C05L-\:~~1 q"'13~tx-+
Signature Contractor's License No. Date
I Permit Valuation
I Permit Fee
I Plan Check Fee
I State Surcharge
Penalty
Plumbing Permit Fee
I Mechanical Permit Fee
I Sewer & Water Permit Fee
I Gas Fireplace Permit Fee
SS?J, {)(J o. 00
;I
$ 3'='77.75"
$ 2--390 ,5"'1
$ 2.-?S ,00
$
$
$
$
$
I()~.(JO
!OO.OfJ
. 3,t), 50
40 . 0 0
This Application Becomes Your Building Permit When Approved
~._~~
Bulldlllg Othcml
/o!!L~{
I Date
$
$
$
$ 4-~ ,00
$ 12-cC),oo
r-( 0 Q. 00
$
I $ I
1$/0//;3. 771
Receipt No. q;; ~I'-J Y
By ~
Park Support Fee
SAC
#
#
(
135?OO
'ZC::;O ,0'1)
~
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
~p;~ ~'., c,~,~. 'rz:"/~;~~;~~; 'OO'~See~:\Jain' FIl~"P~q m~'b,
'" Planning Director Oat! \ Special Conditions, if any
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4\45 J
16200 Eagle Creek Avenue Prior Lake, MN 55372 \
- -
WaterMeter ~e5/s:)'I";
I Pressure Reducer
I Sewer/Water Connection Fee
Water Tower Fee
Builder's Deposit
I Other
I TOTAL DUE Mtttf>
#
#
to .1't.OV
Paid
Date
It) /0 ,j - 7'i.
10 - .;)-0 -tJ4
I
See Main rile.
White - Building
~narv - engineering:>
Pink - Planning
Th. ('.nt., nf lh. I..k. Counlry
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
(_~~/ <<,1 ./J ,# /~? 1../ ,J.?", \.../1, ,(1...,:1.-/"/"
d /-1r "':';/.1" I "~7 ,( -:'~ /.U,...,
.u /:1~ _ ~,l /':-c;:/~
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which i.s...proposed at: / i "
IL:::-" I I l, .. J / '1/ I I
J (,..., () ~,;J.-.- ./ /"-'(I.--!C. -c (1/ / t/\;/'".,! ('
-!c. t _. .. v__
Accepted
x
Accepted With Corrections _
Denied
Reviewed By:
/ffJlS
See ,1Y7.,in ~,.II'
Date:
/o-s--oy
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."
See Main Fi~e
White - Building
Canary - Engineering
r"","K '- p,anninD
Thr ('rnlr, nf Ihr tlkr Counlry
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
Y1({7/Jf /~ /-Y1&-~"
APPLICATION RECEIVED q - d (-0-/
NAME OF APPLICANT
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at: ,
/ L)' 0 () ;;..,- /J y-u'it: c (;~ / J/,\ ( I ~ ~'
/
Accepted
Accepted With Corrections
Denied
Reviewed ~ rh. ~
Comments:
Date:
ID II I J-;)'1
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."
Sep Main ~'ile
cllhite - Bu~
CanarY - Engineering
Pink - Planning
The eenle, nf the \.oke Counlry
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
"-IfI~ /e.4/ ~
APPLICATION RECEIVED rq - a f-m
NAME OF APPLICANT
The Building, Engineering, and Planning Departments have reviewed the building permit
application for cons7~f,a~7:-hichl5;;;;;~ fl/ Y\ { j ~ /
Accepted
Accepted With Corrections
~
Denied
~ ~f-- Date; /d/~'i
~ a-Lf ~~-.
Reviewed By:
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."
10/26/04 Tt~ 11:03 FAX 952 890 2753
STOCKER EXCAVATING
141 001
Date Rec'd
CITY OF PRIOR LAKE
SEWER AND WATER PERMIT
I, Gr.... .il.
Z '1'011.", Cily
), ,.old A~Ii"'1
~ - IV);)...
PERMIT NO.Oc./__/07)'"
(Please tvEe or print and siJ:rl at bottom)
ADDRESS
ZONING (officeusc)
15602 Drake Circle NW
LEGAL DEScR1PTION (office use only)
LOT':> ~LOCK 1 ADD!TION Crystal Bay
PID
OWNER
(Name) Manley Brothers
(Phone)
651/454-4933
(Address) 2113 Cliff Drive
(Address) ,
Ea~an, MN 55122
(City) (Zip Code)
, APPUCAN'T
(Name) STOCKER EXCAVATING COMPANY, INC.
(Phon~ 952/890-4241
(Address) 12336 Boone Avenue Savage J MN 55378
(Address) ,(City)
Curt /
(Contact Person) / ._ / /? #hone)
APPLICANT SIGNATURE d/g-~ ~#~~l1ATE
--~ j' ~~ v ~ - V .... " ~ '1/ -
(Zip Code)
same
10-21-04
APPLICANT PLEASE COMPLETE BELOW
Size of water service inches,
Location of any couplings 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.
D Cast Iron
Residential sewer and waler line connection
Sewer connection only
FEE SCHEDULE
$35,50 IndustTial, Com'l & Multi-fanliIy 1 % of job cost with a $39.50 minimum
$17.50 Water connection only $17.50
Estimated Cost $
Building Permit #
SEWER AND WATER PER.M:IT FEE
STATE SURCHARGE
TOT AL PERMIT FEE
$
$
$
.50
~.;. It
:<~. ~,..."'l
"' '. ,.
~,~-' .... -'. #>
'I~~;', - ", :".::
'1",.... . '.,1'
.(;~';.;'; ...
"".~
:t~~.:t:~..
(omt~ Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
(.bit! I J:',"'Ccipt No.
il ~~ (B ~ n \~ ~ ~ V
Date Hi- OCT 2 8 ZBlFt I P
~4 hour notice for all inspections (952) 447-9 \jb, fax (952) 447-4245 -.J
-Ct
By
.,
Lll i OF PRIOR LAKE PLUMBING PERMIT
~. ~~ ~~ I PERMIT NO., ~ I. . #\ -t.'"
l. V,IIe.- ^P9IIe"'" *~
ZONlN G (DfI\~ "s~)
(?Iease tvoe or ol'inc and .dm at bottOm)
ADDRESS
/ 52~~ z.. d)rA.-i:::e c;/-C,te /1 ~~.
LOT BLOCK
LEGAL DESCRlPTION (office use only)
ADOITJ.ON
PIP
OWNER / L?. L../
(Name) .."-??an /-e ~ OYC;;,-AA..r-S
"
(Address) Ed f"~..A- /LA.-----
--~ . oJ
~~;~~A~'T ~"~ /?7~~.I~d-{l ~~- (Phone) 95'2~?t:?-c?~:1/CJ
(Address) 21L),t)5"' ~~/C J ~ JI!1r-~~ ~,55.5'5':.,;2-
(Address) .; (City) (Zip Code)
/G:?n . (Phone) ~/..z.-Z2.)-!?97!:?
.-/?~~ ~~AJe' DATE //-/7-cJ~'"
(Contact Person)
"'.'
,A
(Phone)
~:5/- ~~ ~'?53
..
APPLICANT SIGNATURE
I
I.
I
I
I
Qllanti~y
:)-
I
J
I
I
l
/
-3~
APPLICANT PLEASE COMPLETE BELOW
Type of Fbture ' I Quantity
Bath Tub with or without shower I
Dishwasher I
Floor Drain I
Lavatory (Bathroom Sink)
Laundry Tray (lor 2 compartment sink
Shower Stall
Sinks
Bar Sink
, Water Closet (Toilet)
Type of Fixture
/
Rough-ins
Water Heater
War,er Sottner
Stand Pipe (Washing Machine)
Sewage Ejector' ,
Backf10w Assembly
Backtlow Assembly Test
Lawn Sorinkler .
Other
. FEE SCHEDULE
Industria. Commercial & Multi-family 1% of job cost wit}1 a $39.S0 mInimum Residential, New One &. Two-Flmily Ji99,SO
Residential. t\ddilions &. Atu:ration~ f,,19,SO
(omct \.lse Only)
Estimated Cost $
Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOT AL PERMIT FEE $
.50
Paid
Receipt No,
ThIs Allplicstlon Becomes Your Building Permit When Approved
Date
I By
Buil(llnc Offici.'
Dlle
1A bout' notice ffll' .11 inspections (952} 447-9850, (u (952) 44?~24S
11:34
CITY OF PRIOR LAKE
9S24474245
P.01
n.te Ret'd
CITY OF PRIOR LAKE
HEATING/AIR CONDJ,110NlNGtJ.lldPL,ACE PERMIT
~. 0l'1'rW; IDdsin ~~=l
AJJDR.:E$S
A?t/O:L ~etJU C;'l--c4/7,.6:".
: ii ~1_1 PERMIT NO"t),,1 0 1rZ-
ZONING (oBIotUlie)
, LEGAL JDBSClllPTION (nS~ ace OJIly)
LOT BL,OCK
ADDlnON
PIn
OWNER
(N 1I.me)
(.Address)
/?"7~..., ko/ g;r-G) ~--...s
/
6t,.F ~ M--
... (phone) b5/-~5"Y'-:~.53
APPLICANT
(Name)
(Ad4ftS!,) .
(Contact Persot))
APPLICANT SIGNAroRE
'( J;;,~~ A"7ecA"",~~J
:z..IOCJ5 La~(F~ ~,
(,A.ddlw)
/(0/7
~~~
. (phone) 97~-~,;z. - ~;V.0'
J~--- ~ 55~~2.
(City) (Zi:\) C~II'1e)
(pllone) <</2.- ZZl-7~l7'S
~--- r DATE //-/ ,$7-07;'
". APPLICANT PLEASE COMPLETE BELOW
\ JZ1NEw CONStRUCTION 0 REPLACEMRNT 0 ALTERATIONS
FURNACE MAKE AND MODEL ~~ /C/"O; CJl7Z) 6/ "^- FUEL
l.../
FLUE SIZE ~'rt.JRN OPENINGS INPUT OU11'UT
TYPE OF Si :>l.e.Plf HEATING OR POWER PLANT
OW.ann Air Plants 0 Steam
O~~~ D~W~
~CIlI 0 Radi/llion
QAir-Candif.iOtJin~ 0 &pedlJ DevillJl$
avant System 0 Other Devices
'LltASE NOtE:
Air Condftiou!IT Units
Cmmot ElICf<JIlich into
B.equired SJc1e Yard
S etbaclc.s
FlREPlACE MAKE AND MODEL
liE! SCHEDULE
Industml, Commcraial & MU1U-Fwlly 1% cfjob ~O$t Re!idential, GAl: Fireplace
$39.50 mtlltmum
Residcnlilll, Heatlng.t. Ale (NIo1W ConsrruClion) $99..50 Residential, AdtllJton, &. Alr.eraliOT\S
Re!lckntiaJ. Heating Only (New COJllltJU~jon) ~4.50 RtSident)ll.l. AC Only
~13l~ .~o
$31~,S()
$39,SO
BstUnated Cost $
Building Pennit #
(omee t'le Oftly)
TIll, .t\pplitJatioa ~..,es Y4)ur Building Permit Wbea Approved
HBA. TING PERMIT FEe
STATE SURCHARGE
TOTAL nR.M1T DE
S
:Ii
$
39.50
.50
~..J2..{)
Paid
I Receipt. No,
I By
IbRd11lt Official
I Date
Dllte
:24 hoar notiCII! ~ lIID Inql<<6GM (952) 44'7-9850, tal[ <,S~) 447-4:MS
~OO Eagle Crl.'flk AYeQlUl, Prior lAke., MN 55372
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONlNG/FIREPLACE PERMIT
Date Rec'd
~~ ~~, I PERMIT NO'wr. 'A~'
], Y.n.", ^ppijP'l' '-'T' . I " , ...
(Plea5e trPe or print and si~ At bottolD)
ADDRESS
IS..PO~ ~ ~
ZONING (orace
lAG">
LEGAL DESCRIPTION (officeu5eonly)
LOT BLOCK
ADDmON
Pro
OWNER
(Name)~ ~~r.rn-vd-.
(phone) Co~/ -</Sl/-W:f3
(Address) ;)\1'3 ~OA..; ~,~ rnn SSI~::\
APPLICANT
(NaxneO--t~A"\ h :~'~.P fX-r", .:+- F". P
(AddressL
><9CO /09~ ~tf'. LJ ~/CXYJ CI:J.n~J..I~ jffJ/1 5S3J(~
(Acldress) , (Cty) (Zip Cod\:)
(Contact Person) ~ C\~ ~np~~ . (Phone) :J.lp~ - S~<.,p.- J~ I ~
APFUCANTSIGNATURE kl\A--;;' lJo~ DATE _
APPLICANT PLEASE COMPLETE BELOW
~w CONSlRUcnON 0 REPLACEMENT 0 ALTERA nONS
FURNACE MAKE AND MODEL FUEL
FLUE S[ZE REruRN oPENINGS INPUT OUTPUT
TIPE OF S).,.L.eM HEATING OR POWER PLANT
OWann Air PlanTS 0 S~
OGravity 0 Hot Water
o Mechanical 0 Radiation
DAir Conditioning 0 Special Devices
DVent, System 0 Other Devices
(Phone) ~3. Sr, l-dS'dS
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
FIREPLACE MAKE AND MODEL rY\n..a '~h..0 , f'\\lT~\..I Rl'.J
~~FEESCHEDULE
Indl1$!l'ial, Commercial & Multi-Family 1 % of job cost R~sidentia1, Gas Fu-eplace
$39.50 minimum
S99.50
$64.50
----
$39.50
Residential, Heating & AlC (Nf;w Construction)
Residential, Heating Only (New Construction)
Residential, AcJditiom & AltcTations
Residenri;Li, AC Only
$39.50
$39.50
Estimated Cost $
HEA TING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
Building Permit #
$
$
$
.so
(Office Use On1)')
This Application Becomes Your Building Permit Wbep Approved
I
! I
I I
BuildiOl! Offici."
Dare
~ r~d \~, U \n lE lM\ceiPt No.
1~a:fAN 1 1 2005 (1)W
24 hour notice for all in$pections (952) 447. 985(), fax (952) 447-4245
L~,\~' ...._._~__ ._____n~____..__' -
(00~ 68L..'ON
~VcvL..vvc~6 ~ ~ooa 38~~~8 JIl~WOln~
c0:n
~00c/~0/r0
PRIOR LAKE
INSPECTION'RECORD
DEPARTMENT OF See Main File
BUILDING AND INSPECTION
SITE ADDRESS I S '-0 2.. J),,~ ci ~ ~. \A) ·
NATURE OF WORK ~~ l.-.) Cb~,..ltJA.dr"."
USE OF BUILDING - S.F:A.
PERMIT NO. 04 ./0'12 DATE ISSUED JQj't 10'1
CONTRACTOR ~y ~tLo~. PHONE-'5'. ~ -7Z18
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR
DATE
..
.
I
I FOUNDATION (Prior to Backfill) I I
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
SEWER I W~TEfll SEPTIC. ;ft//
t:#'1r;T/~'~4'-~/~ II"Q.....o/q.../
FRAMING<JtL;t./k/tr-C1 ~N ..Ieve-L6;( /(.1 ~~ T t1c...
INSULAT(ON) . /II>
ELECTRICAL
PLUMBING ll'-
HEATING (if required)
FIREPLACE
GAS LINE AIR TEST
///...1/61
tZ J ~
/~/J t;/(
/
FOOTING
fib
Me
, ,
I::<II~~~Y
~c. r~ .'-~
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
LArHE J I ~ ~Jt1 I
( FINALS
GRADING (Prior to Sodding)
BUILDING
ELECTRICAL
PLUMBING
HEATING
DO NOT OCCUpy UNTIL ABOVE HAS BEEN SIGNED
NOTloe
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
O1rrfifirafr of <IDrtupaury
CITY OF PRIOR LAKE
I ~tpntfmtuf nf 1iuilbiug Jlusptrfinu
MFinal Permitted 0 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 of the City of Prior Lake regulating building construction or use, For the following:
Use Classification ~I N<::>e-::- r::~, 4..1 \1..G'<......,"- Bldg. Permit No._ 0 4- - I 0'1 7....-
Occupancy Type I ~t':.-- TyPl' Construction Zoning District f!.. - , $ D
Legal Description _ L.or c:; &..oc..t4 Ca., S~ t.~
Owner of Building _ Site Address
t SfoOL t>2A~~\p. t-.1.W.
, City Planner_
c..o....')\:
~,....e- ~s,~
"j ~/0Ia
Date:
~a..<:>nt'~
Date:
w~ TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE SCHEDULED
ADDRESS J ~//)D "Z.. ()~ (l~'n
OWNER CONTR.
PHONE NO. PERMIT NO. '/- 167.7
o FOOTING o PLUMBING RI o EXIGRADIFILLlNG
o FOUNDATION o MECH RI o COMPLAINT
o FRAMING o WATER HOOKUP o FIREPLACE RI
o INSULATION o SEWER HOOKUP o FIREPLACE FINAL
)l.!INAL o PLUMBING FINAL o GASLINE AIR TST
o SITE INSPECTION o MECH FINAL 0
COMMENTS:
I. }\1A..~ht;."" ~UM ()~J .J- RorIe DtllA1J
Z. ~ ~c,.rt:'C04~ Ah\~ ~.
3. ~I J{J ~ t'"~ .\ ~,. 1'ao~
~j~~
* "l..!!b r,.... ~ /I ".
*' I~ ~iett~
). C;;~ d-T~;, /'
~ - I4w. tALI ~ (\.os
- I
o WORK SATISFACTORY. PROCEED
o CORRE eTI N NO PROCEED
X.CORRE ~ T W ~' ALL FOR REINSPECTION BEFORE COVERING
Inspector: 1 I {. Owner/Contr:
CALL 44~OR THE NEXT INSPECTION 24 HOURS IN ADVANCE..
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY/
INSNOTl
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS I C;W?
.
Drt.Q ~ ~'r
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
,0 ~ULATION
~I~AL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
COMMENTS:
.......... /
\\ 'J
l:. \n~ -.J(j\L t,~ \Jl
1r~
TIME
(I r //)12-
o EXIGRADIFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
~RK SATISFACTORY. PROCEED
~'~RRECT TION AND PROCEED
o CORRE W . CALL FOR REINSPECTION BEFORE COVERING
Inspector: I Owner/Contr:
CAL .. ~7 '9~FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE'/tQ~REMENTS ARE FOR YOUR PERSONAL HEALTH &: SAFETYI
/NSNOT/
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
DATE
Y..w/6~
TIME
ADDRESS l.5loO'a..-
DTtlb. . O_t1-
OWNER
CONTR.
PHONE NO.
PERMIT NO.
4- Jb72.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
)It FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
~LUMBING FINAL
o MECH FINAL
o EXIGRADIFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
COMMENTS:
(. ~''''-\....iu... '1MUPtA ~ ~,,-l
2, H,,,~ SUt~r-ilM.. par A!,PkS~_ S~/
~, t'k\Ut'.;)k" ~~ 1
4. ~ ~ls \'r ~l,-
_~, Lv.-kr ~ Mo..~ ~ ait' F~ ~ ~
-". ~CIl'~ ~i",,- ~eck Drt"uQ... .. tJ~'<.. ,
I, ~ ~~ Gfs .
.~ ~,~ a~ ,''''-SO.
1. SoJ d- ~ flu- d~ ~\~
T.QJM.9 (' /\ 2 f) for ~
--f\A.\'l, ~
o WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
"'CORRECT 1RK. CALL FOR REINSPECTION BEFORE COVERING
Inspector: ~ Owner/Contr:
CALl.: 44\.,.J FQR THE NEXT INSPECTION 24 HOURS IN ADVANCE..
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH cl SAFETYI
INSNOTl