HomeMy WebLinkAboutBldg Permit 04-0577
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
I. White
2 Pink
3 Yel/ow
fqJY
(Please type or print and sign at bottom)
ADDRESS
63BY.> W.t t.r~
File
City
Applicant
I PERMIT NO. (J 4-. 0577 J
o A-'f ~
r&~R..
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID Z5. 3~4; o() 7. 0
OWNER
(Name)
(Phone)
(Address)
BUILDER
(Company Name) Llw.-f:;t...ANI)
(Contact Name) MDo
(Address) Ul?l/?
J C"'N1V2~~one)
(Phone)
Date Rec' d
9~ (P. OS
ZONING (office use)
{,12'" 28 2.- 711~\
'/2 - 2 "8 z.. - 78tJ~
~r<.:>ff':l
,
C fl(f.IoM ~-M 00 ~~b
VO.4-f\J S. 0 rJ
TV^,j;'rr:;~ ~1i1
5~1'~ :J:F >'0
L-1rILr;..J/r;'-,,~
TYPE OF WORK rlNew Construction ODeck OPorch ORe-Roofing
LJAddition o Alteration OUtility Connection
CODE: OJ.R.C. OI.B.C. ~MiSC.
Type of Construction: J II III IV V A B
Occupancy Group: A B E F HIM R S U
Division: 1 2 3 4 5
r
ORe-Siding OLower Level Finish 0 Fireplace
r1!AN5~ ~ ~TSIL.6:-~
I V LA-IC€'-A/\/o
PROJECT COST/VALUE $
(excluding land)
I hereby certify that I have furnished mformation on this application which is to the best of my knowledge tme and correct. I also certify that I am the owner or authonzed agent for the 1
above-mentlOned property and that all construction will orm 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 F ore, I hereby agree that the CIty official Or a designee may enter upon the propelty to perform needed mspecuons.
X --- ~ 7l.?C 17 5(PS
~ ~ Signature
~ ~
Permit Valuation
Contractor's License No.
Park Support Fee
#
Permit Fee $
Plan Check Fee $
State Surcharge $
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace Permit Fee $
SAC
#
Water Meter
SizeS/8"; 1";
Pressure Reducer
Sewer/Water Connection Fee
Water Tower Fee
#
#
Builder's Deposit
Other
TOTAL DUE
......
J
omes Your Building Pennit
~
I
Paid
Date
Receipt No.
By
q-(;,-or
Date
$
$
$
$
$
$
$
$
$
I
~)
/,
.
ThiS IS to certify that the request in the above applicatIOn and accompanying documents is m accordance with the City loning Ordinance and may proceed as requested. ThiS document
when signed by the City Planner constitutes a temporary Certificate of loning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued
Planning Director
Date Special Conditions, if any
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT .3 - ;U, ~
See Main File i E~ ?~,;". I PERMIT NO. 01.0517
(Please type or print and siRll at bottom)
ADDRESS ZONING (office use)
~~<r.\)~,{)~+-I'J't'Q.r~ ~,,)./ €. J2/.rJ)
LEGAL DESCRIPTION (office use only)
LOT 7 BLOCK / ADDITION tUf\~ ()Q.h~ PID~<S'""2-~?"{""OOt!f-o
~=RBtl.-~~ ~~ ~~l-(,~ (Phone) r;;(+-~lj3~Y
(Add,ess"i:)0 ?y.,Y'~ 4 o~\' \-L- \) W ~ \,.IJjJ ~,,^-,-4\C";7:l ct
~~~~~Name)BnJs ~M~' Lf _ (, (Phone) ~\CJ---SOh-~
(Contact Name) ~ \-?o \"-'''t'-e.U- . (PhOne)~.--r':\a~-l.K~~
(Address~rl~U>6Q.<t;e~p\'" Vo.1\J~VV' <l\o!2/r'
TYPE OF WORK gNew Construction oDeck o Porch ORe-Roofing ORe-Siding
tJAddition o Alteration DUtility Connection 0 Misc.
DLower Level Finish
o Fireplace
CODE: OI.R.C. OI.B.C. PROJECT COST /V ALUE $ --9J'J
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: 1 2 3 4 5
I hereby certify that I have filrnished 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-menl1oned propelty 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 buildIng
:'k:~;:~~ermore, I hereby agree that the City ~~~~ettft5 upon the property to perform needed mspectlons
Signature Contractor's License No Date
$
$
$
$
$
$
$
$ I
$ 7, (,5 +-. 7~ 1
. ~
Receipt No. 4fe>Cj{"1 b
By 3--
#
#
I Permit Valuation </5:eo4 Park Support Fee
I Permit Fee $ I /1"l3. SO SAC
1 Plan Check Fee $ \ ~ l~~ .~ I Water Meter SiZ@';1";
I State Surcharge $ , 0, ..sz:l I Pressure Reducer
I Penalty $ I Sewer/Water Connection Fee
I Plumbing Permit Fee $ j (Jt> . 01) I Water Tower Fee
I Mechanical Permit Fee $ I OD .f)fJ I Builder's Deposit
I Sewer & Water Permit Fee $ 35". ~CL Other
I Gas Fireplace Permit Fee $ qo . oiL- TOTAL DUE
#
#
Paid
Date
rtt?5 - tJ- -" 7f/
l, - 1'"1- 4
,
'iSO.OD I
.1,3.50,,00 I
a.so . G) il
I./~. /)JL
I, :J. (J/J . 0 ()
)OO.OQ..
cat' n Beco1s Your Building Pennit When Approved
A. ~-8-6<<1
. 110tliCial.... Dale /
ThiS IS to certify that the request in the above applical10n and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document
:::'a . ~"" ,", C," PI..," '00""'"'' "-~ C~~": '~7romp- md -, rorn.,"w, 'See B1\Ialii"File'" w,,, b<
ning Director I Date Special Conditions, if any
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
.~ ~~~~~i...:";~~j~..:;~-_t~;;.:-:; ~,..;.~.;.:.~~~-w;~: -.~.~~-:z--....~'-.;;,~... <J:,,~';:'-i~;.r;' ~,._<~.."".~-,(-,.~ ;"..i,,~~:(~.t(~ho~..,~~'~"";'~-r<<."-'" ..~,.+-. .j':-.'i,....y"t>f(l.f (""';,....".,. ,
See Main File
White - BuildinL-
~..,arv -...En9ineering)
Flink - Planning
Th. C.nl.. of Ih. tab ("ounlfY
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
BA ruS"" I-tOI~E5
5.2L.C-r-
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
6=Sr.c ~.~IL-I) OAlc( T82jU~
Accepted _
)(
Accepted With Corrections
Denied
Reviewed By:
/YiJ~
See:- (lJc,/'v, f, '/ (.
Date:
h-/t)r(5)'I
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 File
rwhite - ~UIISiog.J
canary - Engineering
Pink - Planning
Tht Crnlf'r of thr t.kr Country
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
BARTS" f-.OMSS
5 :l-lJ. or-
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
&3 g(o \}J (L-D DAleI
(~
Accepted X
Accepted With Corrections
Denied I/) /J f
Reviewed By:VJ f.:h/
,
Date:
(,-8 -0 Y
I
Comments:
~\.k (Y)~ QI"
"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."
1
I
.
I
,
I
t,
'I
- -I.
~'iJ..., t."
,
..
The {"enlef or tht l.lkt ('ounlry
See<\IoIain File
White - Building
r.:o"!lI~ - Engineering
(Pink_ - Planniii9)
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
[, 1\ j~"1 ~ ~ I U\"., L .~
NAME OF APPLICANT
APPLICATION RECEIVED
/"-
Lr-
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
( y fz \ L I) C f \ IC ( ftJ: I i-, L~
Accepted )I
Denied n /l .;;. t
Reviewed By: V-: j/ ~J7 /
(}t,-~ , ~ La
Comments:
/.- gQfL ~.~
7 (
Accepted With Corrections
Date:
&.8-01
;"1
"The issuance or granting of a permit or approval of plans, specifications and
complltations 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."
NOU-30-2005 08:56
CITY OF PRIOR LAKE
9524474245
P.02
CITY OF PRIOR LAKE.
HEA TING/ AlR CONDITIONINGlFlREPLACE PERMIT
. ,
Dille Rec'd
(Plcuc ~ or erinr ~ si2l1 at bOrtclZll
I ADDRESS. I ~ fJnl , I
I /p;) vr.o IN( '/f7.-, 01/? S If fftfr. e.
1. ~~. ~~ I PERMIT NO. A ~
). Yello", ^p,l,"""t ~ V ."
- ZONING (olm~ \I&C) I
LEGAL DESCRlPTION (ottier Ule onJy)
,lOT BLOCK
ADDIT10N
PID
A
Ted) SO ".S<y\ (i ~ktl4,i.. [,,-10+-. ~.,..Jl.I)'J,ne) _ {"IJ -.Ia,l - )85;'-
17t/.f!>- .J"4(\/~c..R ~~ C,.K 3/0 Ltkv.Yte S)oLft.f
~ APPLlCANT ' ( \ a
j (Name) 1~.~)Y.. 5j"....e.J~ 74t..bro ~e,'V~n.f trhone). ti? ~.7 ;) (J ;).17 ~
; (Address) 3tXo p~( j: u,f>tJ .( ~1,.r~ '2rt!HJrl &t
I
(AddTm) (City) . (Zip COde)
:- '
.tp~ 7-.;J.{ 5-~1 710
I; I~/~
OWNER'
(Name)
I
, (Addrc.ss)
(ContaCl Person)
J~1e
: APPLICANT SrGNATURE
~L/l-/u-;/
, (phone)
DATE
: ~EW CONSTRUCTION 0 REPLACEMENT
i FUR.NACF. MAKF. AND MODEL . Go()JYh.(v"I,
i FLUE sr2E ;)~' fl/(.. RETURN OPENINGS
TI'PE OF SYSTEM
OWa..'TT\ Air Plams J (pJ.o'( 'l4/.
OGravlty
00 Mecha.,lcal
,lIaAir ConditIoning
-OVenl, Sysltm
APPLICANT PLEASE COMPLETE EELOW
Co
INPUT 1,1, ()JIJ
,
HEATING OR POWER PLANT
o ALTERATIONS
FUEL MIw<r1 l
OUTPUT C;t.., ~o
,
I
,
I
i FIREPLACE MAKE AND MODEL
o Steam
o HOI Waler
o Radiation
o SpecitJ Devices
o Other Devices
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
. Requ'lred'Side Yard
Setbacks
---
FEE SCHEDULE
Industrial, CommerCIal &. Mulli.Pamlly I % of job ~Sl Residential, OIlS Fireplace
S39.s0 minimum
ReSldenlial. Healing & NC (New Construction) S99.s0 Residential. AddWons &. AUcrat!on3
Resldcnlial. Ht311rig Only (New ConslruC\ion) S64.S0 Residential. AC Only
$39.50
$39.50
$39.50
Estimated Cost S
Building Pe.rinil #
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
s
s
s
PAID WITH
,fJ'LDING PERMIT
IOlTicc L'5( Only)
This Appliclltion Becomts Your Building Perollt When Approved
Suildinc OfTIcial
Due
1~)I~a\4fi I~ 11 I
'i,~j t.r.~ 0 1 2005
-'\1 .
\1/ Recelpt No.
'I
i'.il By
';1
I
24 hour lIolJee (or alllllJpeCLlon~ (952) 4< 7.9850, In (952) 447.42.45
1 ,../'t^ 1':'.._1_ ""--..,. . ..--..- 1"l_I-t{r-l"'.. \'_~_~_'__~_~~~_~___~_______,___.._
\ ,-- -----' ---..-.-..-.-.,.- ...
06/18/04 FRI 12:04 FAX 952 890 2753
STOCKER EXCAVATING
141 002
Date Rec'd
CITY OF PRIOR LAKE
SEWER AND WATER PERMIT
I. Cr..n FiI. I PEnl\AIT NO
z. Veil<>.. c." .1.'-1".1. . 04-0577
). Cold Apolico.,
U.,,~~7
I
(.Please C'lfpe or print and sim at bottom)
ADDRESS
6386
Wild Oaks Terrace
I ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT 7 BLOCK 1 ADDITION
Wild Oaks
PID
O'WNER
(Name)
Barts Homes
(Phone)
612/306-4384
(Address)
P.O. BOX 240593
(Address)
Apple Vall~y) MN 55124
~~ ~~C~~
APPLICANT
~ame) STOCKER EXCAVATING COMPANY. INC.
(phone) 952/890-4241
12336 Boone Avenue
(Address)
Curt Lf
(ConractPerson) 1 ~ __~. jJ (phone)
APPLICAN'r SIGNATURE ..,..f /. ~A~ "_ ~ J.._ DATE
{/V-;6~6(/,
APPLICANT PLEASE COMPLETE BELOW
Size of wat~r service inches.
Location of any couplings from structure __ feet.
Type of sewer pipe. 0 ABC 0 PYC 0 Cast [ron
Estimated length of sewer line feet.
Clean our (if required) located at feet from structure.
(Address)
Savage, MN
55378
(City)
(Zip Code)
same
&; - I'i-...O\..f
Residential sewer and .....ater line cOl'lnection
Sewer connection only
FEE SCHEDULE
$35.50 Industrial, Com'l & Multi-family 1% of job cost with a $39.50 minimum
$17.50 Waterconnecriononly $17.50
Estimated Cost $ .
Building Permit #
SEWER AND WATER PERMIT FEE
STA TE SURCHARGE
TOT AL PERMIT FEE
~~ .
~~
. ~
. . ~~ l0 IE U IJ]-~ . fffciPt No, . ~ ".
,,:1" JUN 2 Ii 2004 I~I .. (kG
24 hour nlJliec (or all inspeujons (952) "47-9 ~~ fax (952) 4..7-4245 ()
$
$
$
.50
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Offici. I
Dale
CITY OF PRIOR LAKE PLUMBING PERMIT
Date Rec'd
9 3 o. oS
.
(please type or print and si21l at Lu..u_)
ADDRESS
I. Blue File I PERMIT NO
2. Gold City '0+. () ~ /-,'
3 . Yellow Applicant
APPLICANT n I /,
(Name) p"",,) 1-1 Z, .f) I U fflO/11 d; .z: /l/C , (Phone)
J
(Address) t S If 63A-/lr'n /?/Vd. Pi'I!')!' lakY' /?d/
(Address) (City) (Zip Code)
(Contact PetSOn) 7f? In /J-e.'~ 17, . .' . . (Phone) 3Z2 - ;292 -?-; "1 ( c". t I
APPLICANT SIGNATURE I~~./# DATE 9-3O---oS'
./ .
APPLICANT PLEASE COMPLETE BELOW
Type of Fixture Quantity
Bath Tub with or without shower
Dishwasher
Floor Drain
Lavatory (Bathroom Sink)
Laundry Tray (lor 2 compartment sink
Shower Stall
Sinks
Bar Sink
Water Closet (Toilet)
(,::5 y to tv I c-O () 1t'K-/'
LEGAL DESCRLr nON (office use only)
LOT
BLOCK
ADDITION
OWNER
(Name)
(Address)
(Phone)
Quantity
ZONING (office use)
PID
5..53 :?/
Type of Fixture
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
Backflow Assembly Test
Lawn Sprinkler
Other
Residential, New One & Two-Family $99.50
Residential, Additions & Alterations $3JJ~
BUildin$g Pennit # f) A-l 0 DO t'-
PLUMBING PERMIT FEE f/ n II
STATE SURCHARGE $$ .50 ~ V I
TOTAL PERMIT FEE 1/
/}
Rec~
By .a,.
U
FEE SCHEDULE
Industrial, Commercial & Multi-family 1 % of job cost with a $39.50 minimum
Estimated Cost $
(Office Use Only)
This Application Becomes Your Building Permit When Approved
~
Da~...r O. ()I
Building Official
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714
"
;
PRIOR LAKE DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION RECORD
t.38~ ~r~.
NATURE OF WORK ~"
USE OF BUILDING _ SF'" -
PERMIT NO. .. ~Sn DATE ISSUED 9. II.'S-
CONTRACTOR "'-'II:4IJfNO PHONE "z.2gZ,.11SS-
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
I FOOTING I ~. I ". 1,1.,,,
FOUNDATION {Prior to Backfill)JJdIM"IflIJ&l/ ~ I ". J.7. If
PLACE NO CONCRETf UNT"iLABOVE HAS BEEN SIGNED
eJrr~ 1.1'1.1'/ ROUGH - INS
SEWER I WATER I SEPTIC 114
FRAMING ~ M
INSULATION ~
ELECTRICAL , l/
PLUMBING Ift/J A
J
HEATING (if required) , >>111
FIREPLACE II I JfI
GAS LINE AIR TEST ~M r fJrll/ ~ 111.J'()l~
,
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
lMure~MfI~"1 4",'" ~ I 1&'~fI'.f
FINALS
vLy;
SITE ADDRESS
I
7. f.d4--
III ~3/1lS,
11/ j ~..,/tJ5
1/ /J/~/
/t>~~
/ Ij flo$"
GRADING (Prior to Sodding)
BUILDING
ELECTRICAL
PLUMBING
HEATING
DO NOT OCCUpy UNTIL ABOVE HAS BEEN
NOTICE
1(-(,- 0(.,
/W
~#
. -
J'/ ~6
( {-(P,.tA,
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
PRIOR LAKE
INSPECTION RECORD
~
O~~ I ur~
- S-.. H.e ~~ Pr:.tJ
DEPARTMENT oFSee }laiD FJ
BUILDING AND INSPECTION
SITE ADDRESS ~o W l~lt9.
NATURE OF WORK -f.J~)
USE OF BUILDING SFA
PERMIT NO. _ tJ4-, oYl'7 DATE ISSUED (. - B ~o-t/ '
CONTRACTOR ~~ ~, PHONE ~l,--~..t(:S9~
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
QATE .
I 6/.;z//o/
FOUNDATION (Prior to Backfill) hv,eV' Ib{,#" ~ I ~/~.4v
PLACE NO CONCRETE'UNTIL ABOVE .HAS BEEN'SIGN'ED
f;/~~/1,;~ P4f9/~ ROUGH - INS
SEWER '~A E~ I SEPTIC . / / ~
FRAMIN . ~"yM~ Q R/?&':
INSULATI ~~ ~ tf7/7/Py
ELECTRICAL
PLUMBING
HEATING (if gtquired)
FIREPLACE
GAS LINE AIR TEST
INSPECTOR
FOOTING
#'H
j
I
, ".
.7 /9/oY
"
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
, I' , .
~se U/"~,rJ ~# N/~h'"'6Y ~ I /OPd/o/"
FINALS
GRADING (Prior to Sodding)
BUILDING
ELECTRICAL
PLUMBING
HEATING
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
"(i'III'"irl\ll"I'" ~ir.r;\...-." '''':'',
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'.. .... .... "". .
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I
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
SCHEDULED
CONTR.
PERMIT NO.
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
~UMBING FINAL
o MECH FINAL
COMMENTS;.1' / /
~~ h/hQ
ffe~~ ~
~ ~ /' / A
(3/ ,A/yqed .~ ,t~/?
@ 4~.J ~if ~
~ 7'-......"" d U~ ~ }:::r
'/ /
TIME
~-S?7
o EXIGRADIFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
.-r- /'
~ht2--/
..-4 I/"
/tN / O/t
,
---I
h-~/vre
M
t~ //
.6& // ci,ko
/
~/~
/- ./
~(&J
~--/ /'
/Tk/
o ~SATlSFACTORY, PROCEED
~ORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: ~ --OV;;;r/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.,
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTI
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
(Pl[)(,
Wr td. ()d.&
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
~INAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING F~
~ECH FINAL~
COMMENTS:
~
/ /' /
\ L J Ox
"'----
DATE TIME
I !-(,-~
I-c-",...
4 -S-77
o EXIGRAD/FILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
~
r/ '\
1"/ ~ )
/
~
pORK SATISFACTORY. PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT W~~' ~A?R REINSPECTION BEFORE COVERING
Inspector: // vy Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
lNSNOTl
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!