HomeMy WebLinkAboutBuilding Permit 01-0083
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec'd
1- Z3-0/
(Please.!VDe or orint and sign at bottom)
ADDRESS ~
3~51 WOOGD<.JcX.', ~ J21 ~
i J;;:~w ~~;Ii"" I PERMIT NO. O(~~5 I
'.,.~G(Offi"use)1
o"r PUD
LEGAL DESCRIPTION (office use only)
LOT f o BLOCK Z. ADDITION
OWNER
(Name)
WilDS 3W ADDtJ.
PID 25-.~ /- ()::I.p,-1)
(Phone)
(Address)
BUILDER 'f7. I \ (
(Name) 1~2LAff" ~G"S _ NC. (Phone) 9S?-9BS- ,r::;qc,:
(Address) '2.01 ~~ HoL-1 o(~ Aes. LMC4;\j-,-"ss-otf4~ 9'5'2-. ~,gS". 41,S
TYPE OF WORK ~ew Construction ODeck OPorch ORe-Roofing ORe-Siding
OLower Level Finish 0 Fireplace OAddition OAlteration OUtility Connection
I hereby certify that I have furnished information on this application which is to the best of my knowledge true and correct. J also certify that I am the owner or
authorized 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 building official can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may
.~ontheMJJ:~orrn7Jil~ .' ..~ / )
LX.r't Signature ,'(_ .....-contractor's License No. ~ Date
~OO, ~.C:CJ
I. '55 3 .7 S- I Park Support Fee
1 t)09 . '1<1 I SAC
t OO./b I Water Meter Size 5/8"QJ
I Pressure Reducer
I Sewer/Water Connection Fee
I Water Tower Fee
I Builder's Deposit
I Other
I TOTAL DUE
o Misc.
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
PROJECT COST /V ALUE (excluding land) $
$
$
$
$
$
$
$
$
#
..,.
I~o.oo
t ('!)O.190
'35".6"0
l{() .a:?
#
#
$ A:v. tn
$ 11150.00
$ ~SO.Ci) I
$ 70.Co I
$ 1.'100 .00 I
$ 17t.rJ .00 I
: I r~t')o .m
$ 8.(P59. /9 I
#
~~ca{1:.c=es.~~ BUildffig~e~;::~:;ved
Buddmg OffiClaf Date
~
1-/3 01
z.. - ;2..0- 0/
I Paid P>, ~S'9. L.,'1 I ReceiptJ'M, 39C1t/-Y
I Date i "2 ~Un~ 01 By AP/0-
I
This is to certify that the request in the above application and accompanying documents is in accordance with the Ciry Zoning Ordinance and m~ proceed as requested. This document
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows consnuction to commence. Before occupancy, a Certificate of Occupancy must be
7~p~~~ 2-/~!~ ~~L~~~r~~~~
24 honr notice for all inspections (952) 447-9850, fax (952) 447-4245 ~
o I-Oo~3
Th~ Ctnlt'f of lht L.kt Counlry
White - Building
Canary - Engineering
Pink - Plannirg
BUilDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
r<I-\T~LAFF H()NES
1- 2?,)- () I
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
33t:J I \;\JOOO DUC-K- D~
Accepted. vi Accepted With Corrections
Denied
Reviewed By:
iLL
;2-12-0/
Comments:
Date:
See Reverse Side for Additionallnform;:Jtinnl
See Attachments: 1) Grading Plan, 2) Erosion Control Measures
3) Erosion Control Plan
"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."
~~
01--0053
Th.. C..nl..r of th.. L.k.. <-~ounlry
White - Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
RAT~LAFF H()NES
1- 23 - () I
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
,~~t:>1 WOOD DLJ~ D~
Accepted
Accepted With Corrections 'f.-
Denied ~.
Reviewed By: 6~]J g -- 4-
/
~ments: 1
n~ f1 ~J, olb~ ~2(]/). i~,
Date:
I ~~~:200(
"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."
,.
.~\
o I ~ OO~
ThO' r..nle, of lhe L.k.. COOnl1'}
White . Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
k f\i -l. Lf\ F F f--j (! {'- d:::~-=-
I -- 2:::'_ - (,!
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
~~~~G I \,\j Ci /j IJUL.!<- D~
Accepted
Accepted With Corrections L/"---
Denied _ ; / /I
RevieWedBY:~~~
Date:
;2.-/2-/0 I
Comments:
9-t1 [:'1 MMJ.V~lMJ).Wl Wt/JPIA~W~ Ar
~v~ Pv~~ ~ d--~LJ V"o\' (!) (LA) \fa
(' Jwi1,
-.A/t ~^,~cfNQM~/~j) ~~ft~ ~,
~ V-1A{X-A~(lA ~\{p~ Sk/J!p ~A.
"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."
ORE!. - fN..E
YELLOW - APPliCANT
GOLD.CIT1
CITY OF PRIOR LAKE
SEWER AND WATER PERMIT
S.w. No, 0 1- Oo~3
NOTE:
Sewer and Water
contractors must
be registered
with the City.
APPLICANT: {Jf2-t.5i-/f/L .iX(
ADDRESS: lit, II,\' J {)fL~.~1 vJ'</'1 LIt uL. frt,./
SIGNATURE: t ~-I......ct\~
IT
SITE ADDRESS: S ~S I l"jooD O"lC.X {)/l..
PHONE: 1JJ -J9;;l-6, '10 (c-
DATE: / JI) / C I .c:;::)
BLDG. PERMIT # ~'\1~
PID# 1.,5,3T}~Dk?yO Dl
FILL IN THE BLANKS
1. Estimated length of water service
i..{D
feet.
..
2. Size of water service
I
inch(es) .
3. Location of any couplings from structure
feet.
4. Type of sewer pipe. ABS PVC~ Cast Iron
,
5. Estimated length of sewer line 40 feet.
6. Clean out (if required), located at
structure.
============== f+ I
This apPlicatj>?
BY \ I '- -.,J
,..,-
==============r===================================================
FEES: $ 3~.00 Sewer and water line connection permit.
$ .50 Surcharge
$ 35.50 TOTAL
feet
from
s your permit
when approved.
7--/4-- 0 (
DATE:
* Fee for either sewer or water individually is $t1.~ plus
$ .50 surcharge.
* Sewer and water permits issued for new construction must be
recorded on the building permit card at the time of issuance
to insure that no duplicate sewer and water permits are
issued.
DATE PAID
AMOUNT PAID
RECEIPT #
REC'D BY
16200 Eagle Creek Av. S.E., Prior Lake, Minnesota 55372 / Ph. (612) 447-4230 / FAX (612) 447-4245
An Equal Opportunity Employer
CITY OF PRIOR LAKE
PLUMBING PERMIT
Applicant: Far.....'ro..~^ ~\~ ","...jl... ~~
Address: .:lIO.~'-I c.."':rr",<..,J',.I<. ~~.......'
slgnature:Drw....;.O L ~L-.
Legal Description: Lol /0 Block ;)....
Site Address: .:n51 1A-<::r1/ )~...,.k. C).....
Building Permit ,
NOTE: This pennit will not be prooessed without complete 'nformation.
OHO-01 10:39 AM FROM FGTN PLG RTG
TO 6124474245
~
...---....
TJl,rc........f,...I..Juoc......,.
FIXTURE UNITS
Quanlity Type of Fixture Quantity
~ Bath Tub with or without shower .3
\ Dishwasher I
\ Floor Drain
l\ Lavatory (bathroom sink)
\ Laundry Tray (1 or 2 compartment sink)
, Shower Stall
, Sinks
Bar Sink
..3 Water Closet (loilet)
FEE 8CHEDULE
Industrial, Commercial & Mulli-Family
(1 % 01 job COBt, $311.50 minimum)
Residential, New One & Two Family
Residential, Additions & Alterations
State Surcharge
$99.50
$39.50
GRAND TOTAL
POI
I. Shoo Pile
1. c;.;,.kI CIy
3. reno..- AflpH;CJUIl
#()/ -tJOK3
Phone:~""1 - Yl.8~ 7jo:,).~
-
Sub.! J/fifP 4-
r./
~ /{ -
-
PID fI';{ (:, -3 ;rh!)Lj ll-Q
Type 01 Fixture
Rough-ins
Waler Heater
Water Softner
stand Pipe (washing machine)
Sewage Ejector
BIId\lIow/"., , ',' (RPZ.DolmIe~PYB)
BacIdIow Aaaembly Test
Lawn Sprinkler
Other
.J; It - .1-
$ . '-("d~
1;> S~
Q~,~
R-e,-..../..I
~'J--
",1. pennil i. 1'_ upon lh. ..p.... lXIndilion Iha. Did
PAID WI~lDr, lhalllXlmply in a1lrapcda with l/oc ordinances
BUILDING f1t:ritJ.1'Y" Plumbi"llAlo: and Iho arnendmentll/)er<of,
IUlCBlPT NO. -Ji::.J.I- 0' DAm
~:..... A1TEST
1-
Call for all inspc:ctions 2A urs in advance.
16200 Eagle Creek Av. S.E., Prior Lake. Minnesota 553721 Ph. (612) 447-4230 1 FAX (612) 447-4245
An Equal Opportuniry Employer
CJTY OF PRIOR LAKE MC . r7r~/II-C e OIS<.':1
162l!OEIgleC,.ekAv.S.E. p.,m'No.ili:nn~3 - _.~STRUCTURE
PIlar Lake, MN 56372 .
....... APPLICATION I p....T - - V Tn-_ ....,- -
;'l _ 0/ ....,,-,,;. -'"~. 040 -0 - - -'" -...
. . _.-
3.3:(1 LJ.,JJ f:)r,(!j( t:}._ jib.).
lo! _ 810dl IIddftlon
ow",('N,,,,.~h 1A,c..c
AddrlS1 _ / ,t./
HlaI\noConUc1oI Ci">,,-,hoikC') Q1;o
Addf'lSar~/n Ea~AJ ~ ~sf,::Jif
lelephon"~oo;") ~"" - C-n:;>:;) .
Fllnat:l hlaIIl' Mod.' 77>>>>~ 'NPl OF S'ISTEM
. WI,m AIr P1anls
Mod..Sll.;;Y;....,..,r.. 9hJ /lltf~ Gra.tty
M.ch8nlcl11
^" CondlllonlRO
flu. SllO ;r "!>t/L Ven\. Syal.'" 1/
HEAl1ttG OR POWER pLANT
....~...
.lloiW6\iii
JladlallDn ~..
Special U.vle..
E Edl.
ll.
I- 0Iha1 Devle..
ti Clm.' '-.4'\ Fi'/tefl.4'c-e
u
\.. TYPE DFWORK
III f\1I1111IonJ . Replacem.nt_ New Consltuc:llon ~.
.q
CD
<Sl Repl" ' Esl Comjl. \JaIl
-
"
~
r3
c-
ei
z
Oat. -L-'< -
Sltl McII."
I III
I .q
I ~
, .q
I ~
I t
U
I
a:
Q
~
2
-
ffi
:J: suflllly Op.nlnos
oc. _....-
(I' . ~lumo",;R1nV.
"
U "",ut
Conn. LOld
Fuel ~
;7
7"
OUlpIII.
.....
<Sl
"
[l\
.....
"
~
Ell. Cost'
HEATING ",,-RWT FEE'
STAlE SURCHARGE ,
TOTAL PERMITFEES '-
~.('
v
(./
./
, Bultdln; p.rmft ,
. .50
p,b.IO \N\l, ,
e\J1I..O\NGr' .;.;
R",,~t'
t_ 0 '0,
1.-0'--
Fee Sch.....
1% 01 Job cosl ($38.&11........
,9UO
$64.50
$39.50
Sa9_60
'39.50
\ndu.llll~ commerdal , M\lIlI-Flmlv
I\llIkIenlllll. H8ll11ng & AC
RlsldlnUIlI. H..linv Only
nlslden\l.~ Gas Flrepllca
ReMen"t. AddlUona .. A\laradon.
......klenllel, AC Only
Rem.mber to eud \hI SIIII SurchBlIl. on tha bottom of 1hI, appllca"!!n.
Th. price 01 your II.ltln9 plllri\lnc:lu1lu _ lOUgh-in and on. linallnapllllR.
AddllkmaI..SPICUonl wII b. bIllld al $3&.00 I18Ch.
Houss HH'ing 1e.1 Rec."d mulll ba ....m11led wlllt IIIdIdIDlIIIIJIDI ~1IaIvN lluId-
InII c..llllclle 01 accup8l1CY wlli be IUVld.
tlEA1 CALl'UIloTIDNS Bf'OUIREO with numbel 01 .uppl, .m11111llA. oplllnp .....1111
loom wfth CfM~. pIIl/p......g. N.w IIIUCtut.. 01 eddllolll lend Roo. p........ ...,pl1
8"d I.""" loe.lons .how.. HE^T LOSS Cl\LCUlATIONS, PAYMENT AIIl
^iiJf(~I&'fir'e.w(t:liiv'~'~Ci'ltVFI'~,JH~1_tiIltiU:. .......
CREE'<_AVE..S.E.I'RIORlAKE.MNWl2. . ." . ..... ........ .
eny Hen business h8ll11 a.. 8 a.m. . 4:30 p.rn,
ALL WORK MUST IE INSPECTED (ROUGH-IN AND FINAL)' CALL ClI1'IlAlL
441-4130
, hereby appl, 101 a meohanlcllll)'llem. psrmll and I acknowledglllhel...
Inlol",.llon above I. complete and .cCUlal.; Ihallhe wOlk w.1 bl 111....0...-.
with .,. onl1nlnoel and cod.. 01 the cllV and with Ihe Itlle buUdh9hMdoanlcal
codes; IItII Ihl. lonn dOl. not blcoms 1\ permll un'U .tgned b, t1118lIJ1lD1fllG
OFFICIAL: lhat Ihe work will be In aecoldanca wllh IhellppIDvedpl8a1 lnUte
. caBO oLaIl work which requllea levlm and apploval 01 plane.
,<.1'
"?_ 19-0/
r
. VtIiIt
l,jilk') I.
u.IIIo.
.,'-
PRIOR LAKE
INSPECTION RECORD
SITE ADDRESS ~~C:I W~ D",_~ 'J).1'I1p.-
NATURE OF WORK "\p",\
USE OF BUILDING S EO
PERMIT NO. nl- oOf)'-s DATE ISSUED ~O - ';;)..001
CONTRACTOR _t(o.'h_La.fU~ PHONEj5.:]. - ~<)~ c.:'l5Zj
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
DEPARTMENT OF
BUILDING AND INSPECTION
,\ INSPECTOR
I '8. \JCWt(
, FOUNDATION (Prior to Backfill) I 13.'}Ci.v4 I .?' L?, 101
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN'SIGNED
ROUGH: INS
SEWER I WATER I SEPT_IC) ~
FRAMING LL '5"/2101 ~,~\{w.oq
INSULATION 11. V~
ELECTRICAL l
PLUMBING
HEATING (if required) ,g.U"'-CI. "'(\ t~r\
FIREPLACE V'^-~,V\ q,~ A r-\Iol
GAS LINE AIR TEST I\\D.;"'!~ +,(' ~!l'\'f,V
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I I
FINALS ,
\ -
_ \.hI ~ ~a (? 2..-
~ \~r;\ &\:11 ~n(
(p)~I)iS\J' \, \
/-f-, i \.-U~l rO~~l_ ~O\
OCCUPY UNTIL ABOVE H~S BEEN SIGNED
NOTICE
I FOOTING
"
GRADING (Prior to Sodding)
BUILDING
ELECTRICAL
PLUMBING
HEATING
DO NOT
fATE
I ~ 01/01
31'j/~ I
4cwJoI
4 ;;l.iJo{
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 st'a!1 be placed near main entrance,
Call between 8:00 and 9:00 A.M. for all inspections
FOR ALL INSPECTIONS (952) 447-9850
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
(,'26.or
Z.',3o
ADDRESS 3351 WooO DU~
OWNER
CONTR.
PHONE NO.
PERMIT NO,
0\ - 0063
o FOOTING
o FOUNDATION
o FRAMING
~INSULATION
FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINA
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
-
eAA
61-. +r~<'-5 fv-deue\ur"""
en
I' .
r"ual. ~~ ~+rl
COMMENTS: 1 .
ig)fA
~ aral."J.o l
( ~
~ORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK\CALL FOR REINSPECTION BEFORE COVERING
Inspector: ..1- ~\\ri A^,~ Owner/Contr:
CALL 447.9850 ~R T~E\NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
INSNOTJ
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
7- /-.)- /It T-
woo::LcL ~
ADDRESS
3351
OWNER
CONTR.
PHONE NO,
PERMIT NO.
1- P,3
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
)!f' FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EXlGRADIFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
COMMENTS:
~l
.
(2) 1 ("
~te..r- e.M~e.eAl' (-'Iff riJ Ja 1
.:J:$~ U.l'? c,o,
r j os.P_ ~!p_
./WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORREC;;O~l' CALL FOR REINSPECTION BEFORE COVERING
Inspector: ~~ Owner/Contr:
CALL 447-9850 FOR,lE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY/
INSNOTI
DA.TE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
~'9'Or
I j)~cJcLct uc lc
-;:; an ! u. F-F
ADDRESS
33~L
OWNER
CONTR.
PHONE NO.
PERMIT NO. Of -go ~
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
:hAY/GRAD/FILLING
~COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
COMMENTS:
Ltdh Bt!?.1<- ~r
)l(WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector~ ~.'!''' Owner/Contr:
.~
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTl
.JI'Ilcu '}:'15
vJtta:t) Duel<.
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
3. ~ 5'/
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING 0 PLUMBING RI
o FOUNDATION /1')\ 0 MECH RI
o FRAMING 0:t'>.J ~ WATER HOOKUP
o INSULATION ~ i;! SEWER HOOKUP
o FINAL (CiY ro PLUMBING FINAL
o SITE INSPECTION '-- 0 MECH FINAL
COMMENTS(/), ~
(f}j r ;V[~- (1~, ~
(3) (1 ~I ft-v-. ~ /
DATE TIME
()/- R.-s
o EXIGRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
d- ,~ (I~~
c:J~,
,jI' /,/1' gJl r 4CJ ./Jo..o_/-€A.-,
I _ 5"~ A. I. tr+..-
~ h1c,M-'
'---'~ ..
I /;'1 I 'n.. '" "0(1 .. r \1 ',\/(1
.11 "- 4-- ~ ~" ,J~ I !,jA(" ~ (\-(1-'-<-
'1' Iti)' ~Cl~. ?~-'
t30 \'Uo t~/
o WORK SATISFACTORY, PROCEED
~ CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector:
~,
Owner/Cantr:
I
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
INSNOTl
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
ADDRESS
?,~ S / -
OA TE TIME
SCHEDULED 0 -;<.i-CY .;?)~
Wcod' JSl~
CITY OF PRIOR LAKE
INSPECTION NOTICE
OWNER
CONTR.
PHONE NO,
PERMIT NO.
() -?S-:5
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
~LUMBING FINAL
o MECH FINAL
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
COMMENTS:
~RK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRE~~ CALL FOR REINSPECTION BEFORE COVERING
Inspector: n.~ Owner/Contr:
CALL 447-9850 FOR TH\NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
IN$NOTI
Job Address 33>1 p l~"./L bLM
Heating Contractor.- If. 'rr!
Name of Tester -R
~
7.3
o
-f-3-.tf
Date
Percent 0
Percent CO,
Percent CO
Stack Temp,