HomeMy WebLinkAboutBldg Permit 05-0567
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
White File
Pink City
Yellow Applicant
PERMIT NO. 05 {J5t? 71
(Please type or print and si~ at bottom)
ADDRESS
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LEGAL DESCRIPTION (office use only)
LOT ~ BLOCK \
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ADDITION \.::)' .,,<:.~ c.....\. ,,-,,- '-~"~
PID 26.30&. c08/0
OWNER
(Name) ~~"-......... ~
\~~ ~.........o>...."'-'vo..
~......,
(Phone)
(Address)
BUILDER
(Company Name) ~--~ ~"--__
(Contact Name) \)C'_'- ""
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(Phone) ~ \_ '""'-~""
(Phone) \c, \..'- ~ ~ '-
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(Address) \ \..c...s
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TYPE OF WORK Ij;J New Construction [BDeck o Porch ORe-Roofing
OAddition OAlteration OUtility Connection 0 Misc.
CODE: MI.R.C. DI.B.C.
Type of &nstmction: I II III IV V A B
Occupancy Group: A B E F HIM R S U
Division: I 2 3 4 5
Date Rec' d
5: IO,Ob
ZONING (office use)
~/
"'-~~ ~
~",,\o
ORe-Siding !XlLower Level Finish CB.Fireplace(~)
PROJECT COST /V ALUE $ S c,\::) ,0 () ~
(excluding land)
I hereby certify that I have furnIshed mformation 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 existmg state and local laws and will proceed in accordance with submitted plans. I am aware that the buildmg
official can revoke this pelmlt for Just cause Furthermore, I hereby agree that the CIty official or a designee may enter upon the propeny to perform needed mspectlllns
x \.. ,<:-.'-.......
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Signature
'\ "'-S ~
Contractor's License No.
Permit Valuation
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$ 34'S3,t;;;o
$ 2 Z L{t.{. 71;
$ 2 S"o,'OC)
$
$
$
$
$
TOTAL DUE
Permit Fee
Park Support Fee #
SAC #
Plan Check Fee
.-
Water Meter Size 5/~
Pressure Reducer
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
Sewer/Water Connection Fee #
Water Tower Fee #
/00,00
I D D. C) 0
~,S"o
Lfo _ <Dc
Builder's Deposit
Other
Sewer & Water Permit Fee
Gas Fireplace Permit Fee
~ I c... I (,) 'So
Date
$ 8so,00
$ /~:> ~ , () t!)
$ SCO_~O
$ 7S: bQ
$ IS-a 0 .tJCJ
$ 100 (), (}(J
$ ;SOO .00
$
$ /Z, 61e, . ]'i:;
This Application Becomes Your Building Permit When Approved
~,~ 6'~tj05
1'- (A':;' O. - 7C..r .
l .~ t5 -, :s ( l' ____
10 - 1"7- '/
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Receipt No, t./~I ~....'C)
By ~
Paid
Date
ThIS IS to certify that the request m the above applicatIOn and accompanymg 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 Zonmg compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
'''~m"i~ h,//0~ ~ 4--- ~s~ ,r,- S'fl:
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245 ~ ~~~ S"
16200 Eagle Creek Avenue Prior Lake, MN 55372 If/I1 _ I "S f /'
~~. "LJ'
---
Residential Building Permit Checklist
New Construction for Single or Two-family Dwellings in R-1 or R-2 Districts'>
Reviewed by: ~ -:; ~~ Date: '0 (16/o.r
Building Permit # PID: Zoning:
Address: 14 6'5.3 u.J4 ~
Legal: L '6 . B I Subdivision: /JjJO<J @; ~ 0~
Existing Structure? YE@
CONFORMS TO ZONING
ORDINANCE
Yard Setbacks: NA 1 FAILSI(~~
. Front Yard (can be 20' if avg. w/in 150')
. Side Yards
. Sidewall exceeding 50' requires additional side 2"
setback for every l' over 50' in length
. 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 of wetland/N U RP
pond
. From OHW (Prior or Spring Lake)
, Floor Area Ratio: NA 1 FAILS~P~
! Yard Encroachments: NA 1 FAIL~MPLiES \)
Eaves and Gutters no more than 2 feet1l1 wluLtrand no
closer than 5 feet to a lot line (Easements).
Ale and other equipment cannot encroach on interior
side yards.
Tree preservation~ FAILS 1 COMPLIES
. Total caliper inches
I. Permit 25% Removal
I. Caliper Inches Removed
. Caliper Inches Preserved
. Replacement
Existing Nonconforming Structure? YES@
YES
NO
Standard Proposed t
25' wet~( I
10'1 c?L( t ,,s~
25' if abutting a street
I {5~
10' setback + I
2"/1' over 50' N~- S,t-( ?
251 I L{7,S~
10' sidel
25' rear N DtJE
30'
tJ~
75' or setback average of
adjacent structures, but no tJA.
less than 50'
.30 Maximum ~(l... Pu.D
Standard Proposed
\0c~E:
t--Jf) f0 C
Standard
Proposed
I
I
I 12:1 I
~ 1r ~ ~ 7.~t.;;d-~
L\TEMPLUE\BLDGLlST.DOC 0-<> ~..... I ,>' ~ -1J"'- ~
~ r g~ K. ~~. tollo(65"
iiio
Driveway: NA / FAILS((r(1MPLl~
. Maximum width at property line
. Required setback
. Maximum slope
. All parking areas to be paved including R-Vor
spaces adjacent to the qaraqe
. Location to match subdivision grading plan
~
I Building Height("Q6M..EUE8'7 FAILS
Shoreland District(t{)l() FAILS / COMPLIES
Minimum lot area (square feet)
Minimum lot width
Shoreland alterations
Impervious surface
Bluff in Shoreland(NA) FAILS / COMPLIES
~
· Setback from top of bluff
I. Bluff impact zone
I. Enqineerinq certification submitted/approved
I. Grading in bluff or bluff impact zone
Floodplain(fjj / FAILS / COMPLIES
. 100 year flood elevation
. Lowest floor elevation
. Proposed lowest floor elevation
. Elevations 15 feet from structure
. Road access must be no more than 2 feet below
Requlatory Flood Protection Elevation
I Accessory Structure: (fQA) FAILS / COMPLIES
. Size
I. Not located in front yard (Materials)
I. Side yard and rear yard setbacks
I. Maximum heiqht
I. Materials compatible with principle structure
L\TENIPLA TE\BLDGLIST.DOC
Standard
24'
5' from side lot line or
30' from r-o-w on comer 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 /
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.
Must be flood elevation or
hiqher
907.9' for Prior Lake
913.4' for Sprinq Lake
Standard
832 sq.ft. or 25% rear yard
10'
15'
Proposed
t2..f=J t
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Proposed
Proposed
Proposed
Proposed
c:-- ~ahn~ry ~ :~~:!ri~
. Pink . - Planning
BUilDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
!i} 1,1> 'I,' C/:t/ j....J A / /V
t,,.rVL,"'/i/--< ./1/\..../
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The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
/ 4. f}!j.3 /" VI L-L) ,5 l,/;1 J::!.-/:::.?iV>_} ;1
!
Accepted
')(
Accepted With Corrections
Denied
Reviewed By:
~
Date:
h-I-OJ
Comments: Bee Reverse Side for Additional Information!
See Attachments: 1) Grading Plan. 2) Erosion Control Measures
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."
C Whit". - B~
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
LIl/CNSMI1NN 1101'16'.5
5. /Cf. OS-
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
/~g53 tl1//t-D5 P/1~t4AV
I
Accepted
Accepted With Corrections ~
Denied
~ ~ Date: 6/~/c;s
!
Comments: !:..tUJ-tI( a...h ~, ~,,~ ~
~_' I ~.,~.
C/
Reviewed By:
,
"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."
iR",.
White - Building
Canary - Engineering
fS1iiI( .. - t"lannlnst>
BUILDING PERMIT APPLICATION DEPARTMENT CHI;CKLlST
NAME OF APPLICANT
APPLICATION RECEIVED
/ l {' It _--/;'/1/ ii/V I-I (//L~::;
-:5: /1. (!."
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
/ .'[ yr:;.. /-? I / I i --- /j "-1//'/ j./t' L ....j 1/
/ 't ,. -/ "'-' l-- --" ___ E' -~_ 1-- v / )'
I
Accepted
~
Accepted With Corrections
Denied
Reviewed By:
~
~
,.
~ Date: Ir,/I a ,lor
13,.iJ"//2~ ~ ~
..J
~
""
Comments:
/~I
,
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."
04/28/2005 THU 8:51 FAX 6513226147 GENZ-RYAN
l4J 005/005
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONINGIFIREPLACE PERMIT
Date Rec'd
i~ ~~, I PERMIT NO.Ar AliA
3, Yellow Apph.."t r ~. ., ~ I
(.Please type or print and sil:l1 at bottom)
ADDRESS
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..A..../\.../ ,-,."
ZONING (office use)
LEGAL DESCRIPTION (office we only)
LOT
BLOCK
ADDITION
PID
OWNER
~~~ Wpn~mann Hnmp~
(Phone) --6" 1_0QS_'nQ.9
(Address) 1895 Plaza Dr Ste 200
Eagan, MN
55122
APPLICANT
(Name) GetlZ-RVAT1 Plumbing & Heating
(Address) 14745 So Robert Trl
(' :~ I r, (':,\ (Addrres:)'fll i i ,<
(Contact Person) _,,---,' \ ( i,)fl rL\.\ \ -~')
, ') f /", 'fI
( I Ij'i NJ..n-.
APPLICANT SIGNATURE ,.A' ///A,!'~:u
(phone) fi'l1-Li?1-1144
Rosemount. MN
(City)
55068
(Zip Code)
'--,-/ 11;/
'-ft(YJ!;(J
(Phone) f\ " 1 -b ? 'J._ 1 1 bh.
/ '/~'" lIb
DATE --<--- ( "-'~\..C, U.
APPLICANT PLEASE COMPLETE BELOW
~W CONSTRUCTION , 0 REPLACl?,MENT 0 ALTERATIONS I
FURNACE MAKE AND MODEL lfJ/'Ij''\jji- (.::143 L{~' U~(l--I \0 ,FUEL rlct~ . C({~
FLUE SIZE RETURN OPENINGS ~ INPUT \ d\ \( rfj OUTPUT C1?~ttL)
TYPE OF SYSTEM HEATING OR POWER PLANT
....8l.Warm Air Plants
OGravity
o Mechanical
.{9Air Conditioning
OVent. System
o Steam
o Hot Water
o Radiation
o Special Devices
o Other Devices
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
FIREPLACE MAKE AND MODEL
Industrial, Commercial & Multi-Family'
FEE SCHEDULE
1% of job cost Residential, Gas Fireplace
$39,50 minimum
$99.50 Residential, Additions & Altenltions
$6450 Residential, AC Only
$3950
Residential, Heating & AlC (New Construction)
Residential, Heating Only (New Construction)
$39-50
$3950
Estimated Cost $
Building Permit #
HEATING PERMIT FEE
STA TE SURCHARGE
TOTAL PERMIT FEE
$
$
$
PAID WITH
.:gUILDING PERMIT
Ir --~ Use pnly)
..i.:i Application Becomes Your Building Permit When Approved
Paid
Receipt No.
Building Offieial
Date
D~N 2 4 2005
I By
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
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LO/24/01 WED 11:22 FAX 6124474245
CITY OF PRIOR LAKE
[{h 00 1
CITY OF PlUOR LAKE PLUMBING PERi'\1IT
D!te Rec'd
(pJell't: type or print and Jif!:!] :n bottom)
ADDRESS L () ~-" """") '\.," \ \ ~ /
\) ';::) ':::> ~, ck~ \1\\1:,'1
;, ~~ ~i'; PERMIT NO...... A .u~
l. YiJIaw Appl,c.", ~~ . V~
, ZONING rotlleeu~1
LEGAL DESCRIPTION (offic:e UM only)
LOT
BLOCK
ADDITION
PID
J
~~~R ,,\eA'\Sm~y\ 1\ ~ om~S . (phone) 6.S)-'tD{, -tfL/()Q
(Address) /2<tS'" 'f>lo.L~ ~. ~\k ri>])t) ~Y\ ,V4f\, .",-..., J ~z.
~:~~}ANr tJ~el 'V\b~~~ . . (Phone) m-f5;2-/S~
(Address) /7JD 'I\~b.~ \~J, ~ tv\n. 50/:2/
(Con'actPerson) ~~E) .->~:: ts/~-} I~~
APPLICANT SIGNATURE .~ OATH loj)q _ OLJ
._~~ ~-
Quantity
I
-7
I
J/
I
~
t '
PLICANT PLEASE COMPL.r.,.l J!. BELOW
T Type of Fixture Quantity
I Bath Tub with or without shower
I DishwlISher
I Floor Drain
7
Rough-ins
Water Heater
Water Softner
Type of :Fix.~,,-",
I
L ,.-::S
I LavatQry (Bathroom Sink) ., I Stand Pipe (Washing
I Laundry Tray (I or 2 compartment-sink Sewage Ejector
Shower Stall Backflow Assembly
Sinks "B'iCktlow Assembly T
I Bar Sink Lawn Sprinkler
I Water Closet (Toilet) Other
-
Machine)
est
FEE SCHEDULE
lndustriRI, Commercill' & Multi-family 1% of job cost with a $39,50 minimum Residential. New One & Two.Family $99,50
Re:;,idential. Additions &: Alteration, S,39,50
Estimated Cost S
Building Permit #
IC)fnJ;~ Uje Ollly)
I Th j", ~ PPlitiltion Jkc"".,e, Your
;~ :-, ?~~~1'1~\t~ce,\'.,:-,<-~-:: '__--f::-~i:~'/:k_-t:~:\-re~ :-:-~,'
PL UMBING PERJ"DT FEE S
STATE SURCHARGE $
TOT AL PERMIT FEE $
PAID Wm-J
~~fNG PERMIT
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'I 1\'''.:';'\\0 fl.l ',Il hl'iij/<aCt\\l11J (:)51) .;47 ..;'r;';;i,;iC>. \y;:;:\) ,;..~.!. ,n;;~'j
,- .<~ Receipt No.
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PRIOR LAKE
INSPECTION RECORD
SITE ADDRESS /~crs3 AJIi.IJS '?M~wAfl It.
NATURE OF WORK NI:J,I.J ~~I~ ~. L, F11J16N
USE OF BUILDING ~J:;D~ .
PERMIT NO. tJ5. OSto '7. DATE ISSUED MV.~
CONTRACTOR _f-) ~ PHONE"'.-II'.?'~
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
DEPARTMENT OF
BUILDING AND INSPECTION
FOOTING
w;tk ~(4
I r6 INSPECTOR
DATE
I V - '2 0 - ",\:\
I FOUNDATION (Prior to Backfill) I ~ ;> A,/ I
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH...: INS
1$ ) 1 /
We (,Jb 1-;.1-
(l f? ~"'7~
SEWER I WATER I SEPTIC
FRAMING
INSULATION
ELECTRICAL
PLUMBING U~ :.:
HEATING (if required)
FIREPLACE
GAS LINE AIR TEST yv\.. f.1.....
9 t'Z(,.~
n
./
t/Vf'
8"" J-L( ~ 0<'
~...., J - C11:.-
V'~ ,y-
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
lAmE /1i_lI-trAJAN' Ik~~'~~q/v%~ ~IV 11> '.u,
FINALS
A(5 /1. 9". d S
/VJ j j)
GRADING (Prior to Sodding)
BUILDIN~~.e-r ~ s+()~
ELECTRIGAL
PLUMBING
HEATING
DO NOT
~- ?-(j-b
H/ft>/~
J
OCCUpy UNTIL ABOVE HAS BEEN SIGNED
NOTICE
! ~ II.s..oS
/If;
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
<ITertifirate of @rtupanrl1
CITY OF PRIOR LAKE
~tpztrfnttuf of ~uilbiug Jfuspttfiou
'~inal Permitted 0 Conditional C.O. Expires~??..?-~Bb-;t:I0
I
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 of Prior Lake regulating building construction or use. For the following:
Use Classification F _ Bldg, Permit No" () 5"-- __5' 1
A? .3 Type Construction v;l/
Legal Description L S-
f f '
/~i //
Occupancy Type
L /
'.+
/I~I / f' _L.../1.
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,~, ,~ . / ,,' ' 1.1
L/t-[,. /' I~. c. (~'~f, ..l (~<,"_ L~0'
l'
Site Address /1/'6 ..!J-,1 IlJ fLU. -'
_ Zoning District
_/,'
(j~J
Owner of Building
'y)'(
/-'f:.,J./)
Date: ? )
i
}/I if--
Building Official
Ii
j, l' "J ;/
1/ I hi;1 1itY Planner
Date:
-~
,- !"/~ "
;' /, ' j
l (' i/:7/C V
Contractor's Name & Address
c<
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS BeS3
UJ.J& ~
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o .JNSULA TlON
.JK FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o YLUMBING FINAL
..er MECH FINAL
COMMENTS:
Ie f\~, G~ ~\~.
"2.., CSt;) eA..r '"l f'2,Q. ^
'T.s-r
Uo
-~
DATE TIME
I\~
~'-. ........~
4
s - 1:)(,,7
o EXIGRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
8.-1- ~~
o WORK SATISFACTORY. PROCEED
o CORRECT ACTION AND PROCEED
~ CORRfI2EK' CALL FOR REINSPECTION BEFORE COVERING
Inspector: Owner/Contr:
CAL 44V.~ FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
--" '
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
INSNOTl
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS J!iB~
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
~:~i~NSPECTION
COMMENTS:
Gr~- t!) K.
SCHEDULED
DATE TIME
jH-fJS
W,liJ PKwy
CONTR. _WUtSn'l f r, 11'\
05.Sl,7
,
P~LLlNG
DC~T
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
PERMIT NO.
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
Lv/to B(Jl" nIL
VWORK SATISFACTORY, PROCEED
~ ~RECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: "7'lU -- Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE...
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH .I SAFETYI
INSNOTI
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS ~3
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
DATE TIME
SCHEDULED a/ 0 ~~~
\~ DkwV
CONTR.
PERMIT NO.
e;- ->&7
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o ...sEWER HOOKUP
~ PLUMBING FINAL
o MECH FINAL
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FI~EPLACE FINAL
,.erGASLlNE AIR
o
COMMENTS~ _~..----
J. lk ~\h~
y' - ,~
~. Gln.o 0l~ I";>~+
~ ~~~~
o wj)I(i( SATISFACTORY, PROCEED
~ORR~~:;.210N AND PROCEED
I 0 CORREffJ'<<"/JK' ALL FOR REINSPECTION BEFORE COVERING
Inspector: Owner/Contr:
CAL ~ -~o FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.,
'---""
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTl
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
DATE TIME
e . -:J. 0 G
ADDRESS
14853 WitA:JS Pt::)/JLj
/
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
~ULATION
~ ~~~AL
o SITE INSPECTION
COMMENTS:
^
G (J'I ~
CONTR.
PERMIT NO.
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
c:) - J
( (
\
)
~.... J.
/l
~ / (
\1 \.0
\
55~7
I
o EXIGRADIFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
)( WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORR T WOR ALL FOR REINSPECTION BEFORE COVERING
Owner/Contr:
OR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
REMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
INSNOTI