HomeMy WebLinkAboutBuilding Permit 01-0390
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CITY OF PRIOR LAKE BUILDING PERMIT, I: .~.". DateRec'd
TEMPORARY CERTIFICATE OF ZONING COMPLI~E -2'
AND UTILITY CONNECTION PERMIT . ""'
I. White File
2. Pink City
3, Yellow Applicant
'_. I
q>>lease ~ or mint and siiW. at bottom)
ADDRESS
~~ ]{d1 (!Jjfl>(.)J /L p,;) f)j);",.<-
(..D3~
ZONING (0_ use)
flU)
LEGAL DESCRIPTION (ollice use only)
LO-&' L-/BLOCK I ADDITION
\
LU.; Iris .'? t2J
/J1 e fbrt JJ () C>r..c~.7 (
(Address) ') fJ?O I I [;/~I /- s-T' 0)~ 7. Jt4.U..)c;..!b
PID,.JS-33'\- (J).J-f' (")
OWNER
(Name)
(Phone)
BUILDER!1 ) -
(Name) 711(! "'-0 l!':_ f',."..:) 7(
(Contact~ame) :JCPP (lr.l.Q.l~""
(Address) l)f...nr--t-bt-s- ,.t.-~ J I,,}.e <;'1 .
(Phone) ~-t/~fJ.-?W(
(Phone)(.;..:l ,')DI-KbQ U
~//Jf- '-(~ /::J 4
TYPE OF WORK
ANew Construction
DLower Level Finish
ODeck
OPorch
ORe-Roofing
ORe-Siding
o Misc.
o Fireplace OAddition OAlteration . OU~onnection
PROJECfCOST/VALUE (exc1udingland) S ..9 tlO &f!Jo - .
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 the above-mentioned r~~r-.J' and that all construction will conform to all existing state and loca11aws and will proceed in accordance with
submitted plans 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
;terupo e ~~lrm;::::ctions 9 3 Lfj tl-f:)c)-D L
!ignature Contractor's License No. Date
I V. 8.1:)(). O(j
I Permit Vaauation ~'1o..000.(Y) I Park Support Fee # $
I Permit Fee $ '-"I~'1 ?C:;: I SAC # $ 1.1 56 .~
-
I Plan Check Fee $ -, - I Water Meter Size 5/8"Q) $ '~so .0;;'
1- J ,t;S. r;,-cf
I State Surcharge $ , i2n.41-l1 I Pressure Reducer $ ?D . ef:l
I Penalty $ I I Sewer/Water Connection Fee # $ J. ':)./?/).~
I Plumbing Permit Fee $ 100.00 I I Water Tower Fee # $ ,
'(1)/J.rii:J
I Mechanical Permit Fee $ loa al'J I I Builder's Deposit $ r S-tJo.oC,L
I Sewer & Water Permit Fee $ 3(' /;:D I I Other $ .
I Gas Fireplace Permit Fee $ l/o:~ I TOTALDUE tp(,U!:[) 5,3-01 $ '1 /)4-8. 79
, .
- (I I R~3q<t)7/
~tCOmesYourBull~:;~~7"ved I Paid ~.7q
I Date . .c--.~J Bv /' ./
. Buil lliciaJ Date
I
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
when signed by the Ci't!r.P lanner constitutes a temporal)' Certificate of Zoning compliance and aJIows construction to _".._~..~~. Before occupancy, a Certificate of Occupancy must be
usued./'J__ ' ~. ~ 'l~ I' ~ /};j";>_.o
~ _<"...,.,,;>~...~, -; 0'\ ~O __~-~~
. Planning Director <] 2../ Date' Special Conditions, if any
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
~~
White - Building
Canary - Engineering
Pink - Planning
The- ("""IC'fO' the- I..kr Country
BUILOING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT tnGnlJ)..J()..,1d U 1.I.<j-r-
APPLICATION RECEIVED LJ- dO-OJ
.
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
33/cO !lJroDDVLk Dr
Accepted
Accepted With Corrections>E-
Denied () ,Q 11
Reviewed By: (j;{p/~ ~
Comments:
Date:
I.( - 25"- ?4Jc;)/
Jku.a nil ~~ ~
"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."
Thc-('c-nluoflhc- L.kC'Counlry
White - Building
Canary - Engineering
Pink - Planning
.BUlLDING PERMIT APPLICATION DEPARTM!;:NT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED Lj - c)
!l7c ni) ).)({ /d CoJ./C.T'r
-() J
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
:/ :2 I' .' 1 /1 .
,...) rJ:O / /... {, LiU Jt. /j r
Accepted V-
Accepted With Corrections
Denied .
Reviewed By:/9-~j\~~
Comments:
M~,^IIAA JM.\ 30 pr ~Ja-I/e ~L<
~ ~ U9Q'F' HwL ~ C}_~,r;,o fF\..
Date: -9/2-.1~ l
.
It-.A~ ~IMj.M1 ?-'-IFr- f:\ I ~~-.1Ai-
----h~~ I~ <{-Yhr0 IAIOluJ
C (J~,
~ -
"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
.J
.J
The> Ce>nle>r of lllf L.ke> Counlry
...
Ol-3<jB
White - Building
Canary . Engineering
Pink . Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLI~T
NAME OF APPLICANT me-no)..JU Id Ul./<j-r-
APPLICATION RECEIVED '-1- dO-O J
,
The Building, Engineering, and Plan,ning Dep<}rtments have reviewed the building permit
application for construction activity' which is proposed at:
3:3 &J I JJWD DV-cK... Dr
Accepted
x
Accepted With Corrections
Denied .,., -J \
1-1" j U
Reviewed By: Al'Il-B
Date: LI-:;, 3-01
Comments; See Reverse Side for Additional Information!
'"
see Attachments: 1) Grading Plan, 2) Erosion Control Measures
~, I=rosion 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."
CITY OF PRIOR LAKE
HEA TINGI AIR CONDITIONlNGIFIREPLACE PERMIT
n"te Rec'd
(PleaI<: M?< or oM' and sic at bottom)
I ADDRESS
..:3~n (, '\--n.() -7Jr./(' gp,
i ~ SkU, I PERMITNO'O'~03qo J
I
ZONING (ollioo use)
AJ.~r
PUD
LEGAL DESCRIPTION (otlice use only)
LOTZ4LOCK I ADDmON ~
~~c~Rh7~)D r:~1
A,~/p U~/1.
APPLICANT }../ n
(Name) r:.",u77Y'i!/ e ~
(Address) rP/c9/C €5.f.....,
(A~,)
3tW,
PIDZS~3"37 ~ ozA-.'O
(Phone)~.1;)- ~ .
(Address)
(Contact Person)
~:..4
~~f}
- (phone) (c,!>"D
..4"ii.t^,. 1?20 ,
. 0 '(City)
(phone)
,.y~n - ~,:;).;2
"<<~""9'
(Zip Code)
(]~"
A r ~,..
APPLICANT SIGNATURE
DATE
c. - /'.~(") I
~
__ APPLICANT PLEASE COMPLETE BELOW
~W CONSTRUCTION 0 REPLACEMENT 0 AL TERA TIONS
FUR.NACE MAKE AND MODEL Crv.r? E.,.., /'~ /' ~ ~s'A.J~ FUEL A.JA-.A
FLUE SlZE ;; I' P Vc RETURN OPENINGS / / INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
~ Air PllllllS 0 SteI1m
'OG';:~ity 0 Ho' W_
o l\I!ochanlcal . 0 Radiation
.0l"r ~ondilioning 0 Spcolal Devices
~t. System 0 Other Devices
PLEASE NOTE:
Air Conditlcner Units
Cannol Encroach into
Required Sid. Yard
Setback.
FIREPLACE MAKE AND MODEL
Industrl.l. Commercial It Multl.Family
FEE SCHEDULE
l'YonCjob CoSt Residential, Oas fireplace
$39.:5'0 miniml,lm
$99.$0 ResldClltial. Additions &: Altcrotions
$64.$0 Residendal. AC Only
$39.50
Re.sidl!ll'ltial. Heacing &. l-VC (New CQnstructioll)
RtL"Iidl!:l1tial. Ht!lating Dilly (Ne:w Cumrtl'\n;titm)
$39.:50
$39.:50
Estimated Co,t $
Buildin& Permit #
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PER.1\1lT FEE
$
$
S
.50 BuIt:t/O WITH
..... ~NG PIER.'lGL'"
I J>a~//5'/O/ I R~ceiptNo. .
I Datel Lv- I By ~
U
(ornCf! v."" Only,
Thi, Applioation Seoome" Your BuiIdloll Pormit When Apprnved
Buildine Offh:ial
Dut"
24 hllue noti.. for.1I insp..tloos (9~) 441.91150, fa. ('SZ) 447-1Z45
1001li
lilY <I!fl10ILLNO:>
9LU09t199
"
CITY OF PRIOR LAKE
SEWER AND WATER PERMIT
Date Rec'd
(!'1ease.!"p< or print and sian at bollOm)
ADDRESS
J3bt Wc\O~~)~
; =.. ~\: I PERMIT NO. t - 3 Ci' 7'0
J. Gold Applk:aDI t u
\'1;
ZONING (oftIce use)
.
LEGAL DESCRIPTION (ollice use only) \
LO~q BLOCK I ADDmON l1t... Uj I' \ d.s
~=~~(' Dt\\'\I\~~ ~ kst
8J
I
PID;ZS-- 3""37-O~
. (Phone)
(Address)
(Address)
(City)
(Zip Code)
APPLICAm,--> _ \ C'
(Name) U ~~ '=>'l..u
(Address) t'6 \ t 0u kL~ \q ct~
~ (AddJess) \
(Contact Person) ~ '0 J ~ N [\ h
APPLICANfSInNATURE Y ~
- V .
APPLICANT PLEASE COMPLETE BELOW
(phone) G (:I ')~ 0 J lfJ:b.
l~ I ~fvt ~-5- ~ 31
(City)' l.r (Zip Code)
(phone) S',t7T-
DATE t?-N-OI
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.
o Cast Iron
FEE SCHEDULE
Residential sewer and water line connection $35.50 Industrial, Com'l & Multi-family 1% of job cost with a $39.50 minimum
Sewer connection only $17.50 ~connectiononly $17.50
Estimated Cost $ 4,)"4)
Building Permit #
SEWER AND WATER PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
,50
r.,\ID WITH
BUILDING PERMIT
(om.e U.e Only)
This Application Becomes Your Bulldlug Permit When Approved
Building Official
Dale
~a.id61
Date~/('l/~/
Receipt No.
24 hour notice ror allln.pectlon. (952) 447-9850, ra. (9S2) 447-4245
BY~
C'
FIRESIDE CORNER #6148 P.DD1/DD6
CITY OF PRIOR LAKE Date Rec:'d
HEATING/AIR CONDITlONINGIFIREPLACE PERMIT
;::::. ~ I PERMlTNO. 1- 300 I
I. y~~ ~ y .
(PI.... "",. or oriu'lIldlim "botlDm'
ADOiEss
~1."..()
lili10 Du.eL.
- ..
VA.
ZONING t-....l
~ul)
LEGAL OESCJUYI10N (ollloe u.. only) , d-
LOTJt\LOCK I ADDmON ..Jh 0 I j ) ~~"y' ';;( r
OWNER. iV\ r _. L
(Name) _, I I ( J)()Vl ~ cJ LW'l 'n- tl cli (\n
p~r"'331) -6()1h)
(Phone)
(Address)
APPUCANT
(Namel ALLIED FI.RESIDE DBA FIRESIDIll CORNER
. (Phone) 651-633-:' F;,,'
(Address) :z 700 N. l"AIRITIl!:W AVEm"'
(Acldroll)
l:lRENDA IIUS~OO
(Con,~ Penon) 7.... . , (Phone)
APPLICANT SIGNATURE ~ ~(1.. l ~\,~rl .At"' DA~ _,1Q::.,J..,) - 0 I
APPLICANT PLEASk-tOMPLETE BELOW
r$-reW CONSTRUCTION 0 REPLACEMENT 0 ALTERATIONS
FURNACE MAKE AND MODEL FUEL /o..J. <oA~
FLUE SIZE REnJRN OPENINGS INPUT OUTPUT
TYPB OF SYSTEM HEATING OR. POWER PLANT
OW8IIIlAirPlanb
~Gn.VIl:Y
Mechanical
Air Conditioning
I- )- DVCllt. Systmn
FIREPLACE MAKE AND MODEL J1 (, l,. N \,pLo
RO~F:VTT.r..Jt M1\1
(Clty)
651-633-256l.
5~"_':.
(Zip Code)
\
S1:.:::-illL G
PLEASE NOTE:
Air Conditioner U~its
CaIlnot Encroach into
Required Sid&! Yard
Setb..,ks
(Dl'l9'\ Tf(- 04-L
~Sleanl
Hot Walm
~lIlion
:J Sp.eial De.;_
:J Olh.rOovioes
Residential. Heallnl '" AJC (Now Co~str1lction)
Residential. Heating Only (New ConMlclion)
FEE SCHEDULE
I % of job coSl Rc:sldcntlal. Ou Flre:pt...
$39,50 minimum
$99.50 Rc:~jd...lial, Additions'" All&!mllans
$64.50 RCJid""tial. AC Only
.e,ou-
Estimlltlld Co,t $ 1/00 .lD Building Pcnuit #
( );).OU. c>> >
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
539.50
'ndulllliol, Commcrcilll '" Multj.Fomily
$39.'0
$39,50
S
$
S
.so
PAID\/IiiTt.
BUILDING PEF.iv.iT
(0111<< u.. Only)
B"ndllll ON..
IPald
. D... _ I Oao/~/O I
~4 hour notice ror all In.p..tlonl (9SZ) "'7-9850. ru (95)) 447..c:lA5
I Re""ipt No.
IB~
Tltil Appllcltion Bacom.. Your Bulldlnll Permit When Approv.d
CITY OF PRIOR LAKE ~: =. S-
PLUMBIN%fERMrr PPNo. /-3CjD
APPllcant:_ElY..P "C::+or ml;hj JhC Phone' (,,\/.- Ys1- &/<90
Address:.:2~9~ rJ:"11J:V~1 Av~.s;o.. C-'2i/nOj!J 6-Y'Ol/e, l1t> ",..s--ol-6
Signature: t1.l.fMJ..JL... ~ ~ .
Legal Description: Lot -Q Y Block 0 I. sub_The IJJ; /rJJ;::: ,"?rd_
Site Address: _~.:s0() V1//)~I1Ck: VflllJ!? NUl
Building Permit # 01- (),"""? () PID #_2lJ-;.'2,t-T.HL-{-O
NOTE: This permit will not be processed without complete Information.
FIXTURE UNITS
Quantity
~
)
J
v
}
I
I
I
'?;
..,
Type of Fixture
Quantity
Type of Fixture
Rough-ins
Water Heater
Water Sollner
Stand Pipe (washing machine)
Sewage Ejector
Backf10w Assembly (RPl, Ool.tlle Check, PVB)
Backflow Assembly Test
I Lawn Sprinkler
I' Other
$
$
$
$
.50
Bath Tub with or without shower
Dishwasher
Floor Drain
Lavatory (balhrOom sink)
Laundry Tray 11 or 2 compartment sink)
Shower Stall
Sinks
Bar Sink
':\N'a$r' C"losei '<(toilet)
Lf
J
$ r--~~
~"'~/()
~4'Q ~7'J.t
~~I}-
This permit is granled upon the express condition thaI said
conlfllCtor. shall comply in all rcopcctl with the ordinances
of lhe Slate Plumbing CocIc and ~ amendments thereof.
1\<>.."",. N<J& /,;l-~ 0L.. DATE
_ r/ fATTEST
Call for all inspections 24 hours in advance.
16200 E~leCreeki'AV; $fE:iPrior Lake, Minnesota 553721 Ph. (612) 447-4230 / FAX (612) 447-4245
. .' -' , '- An Equal Opportunity Employer
I
,
ti
FEE SCHEDULE
Industrial, Commercial &MLilti-Famlly
(1 % of job cost, $39.50 minimum)
Residential, New One & Two Family
Residential, Addlti9ns & Alterations
State Surcharge
$99.50
$39.50
GRAND TOTAL
-
PRIOR LAKE . DEPARTMENT OF
. ' BUILDING AND INSPECTION
,
INSPECTION RECORD
SITE ADDRESS 3.sCo() eJ o~ 'D 0c.l<- ~.'v.....O
NATURE OF WORK -AJ.DL.' ......
USE OF BUILDING S Fp
PERMIT NO. 01... 03C!O DATE ISSUED
CONTRACTOR _Me..~\I\.~ ~c:.\. c'IZ -'701-8C.<t4
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
. INSPECTOR . pATE
I FOOTING 11Hl ~ I ,;-l1.Y^'
I FOUNDATION (Prior to Backfill) I ~ . \ ~ I If I ~~J!I(
PLACE NO CONCRETE UNTIL ABOVE H-AS BE~ED
ROUGH - INS
(1< \)ft4
<E-~
I <e.. \\>~
I. r
.1 <i<. \\,,~
I<\S \~
j%- \Jo-v-q'
I \
SEWER I WATER I SEPTIC
FRAMING
INSOLATION
ELECTRICAL
PLUMBING
HEATING (if required)
FIREPLACE
GAS LINE AIR TEST
e> ~-O(
t'{' 10/r9/
~ J'I" 1',,\
I
tJ~ ~ ~ I
<1/S-~ol
"7 161m
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
,~ I I
" FINALS
GRADING (Prior to Sodding) TlR _ /I/y~
BUILDING t-,CJlttfJlI41t,1o, Ij v~ 'f.~(g/o/ A i/
v '
ELECTRICAL
PLUMBING
HEATING
DO NOT OCCUpy
{- 3 <> 0--;).--/
I "g ~o.o..
I i5~.
UNTIL- ABOVE HAS
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.
ql4 01
rp~/h
BEEN SIGNED
Call between 8:00 and 9:00 A.M. for all inspections
FOR ALL INSPECTIONS (612) 447-9850
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
,3300
DATE TIME
SCHEDULED q-L/-{) / 3; 30
It)lJcJdduc K-
OWNER
CONTR,
PHONE NO.
PERMIT NO.
1-, -"59C)
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
./\/.0 SEWER HOOKUP
l'1"~PLUMBING FINAL
o MECH FINAL
o EXIGRADIFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
COMMENTS:
~W\~ O~
~IlL~~Pf oJ- ~ ~'v\41
/
~RK SATISFACTORY, PROCEED
o CORRECT ACTION 'ND PROCEED
o CORRECT WOR r ALL FOR REINSPECTlON BEFORE COVERING
Inspector:
Owner/Contr.
EXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALm .. SAFETY!
IN$N()Tl
ADDRESS
33 to 0
~.I".:Tf _
SCHEDULED ~ ot
r.L)t9bd. ~
TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
OWNER
CONTR.
PHONE NO.
PERMIT NO.
to 1- 3 90
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
o EXlGRADIFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
COMMENTS:
r;
&-\-\Pf e.A~ lll1e~
(j~e ~,(-e.
a l) &I m-t! aJ
-, r
J-~s.u.~
-
c.,O .
(J/
,Ar
_~ ~fJ'~}l1/
~ v\
\.
~ORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, ALL FOR REINSPECTION BEFORE COVERING
Inspector.
Owner/Contc
NEXT INSPECTION 24 HOURS IN ADVANCE.
conE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH'" SAFETY/
lNSNOTl
CA TE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
/I"--O"L
ADDRESS
~6W~
Due K-
CONTR. /I'k~~e;V ~.
fi{~03qo
PERMIT NO.
OWNER
PHONE 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 FINAL
o MECH FINAL
~X1GRADIFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
COMMENTS:
,.
01LADC:::. ~ () '^'
-fI<.{:;f.S r-c,n(\ l"..J,.J...f.LAr~_
)JcwORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: --iJJ. .I. Owner/Contr.
CALL~ T:E NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY/
INSNOTI
DATE TIME
SCHEDULED tf-;2t,-()/;;; ;tiV
tU~
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
3300
OWNER
CONTR.
PHONE NO.
PERMIT NO.
(- ~ 90
o FOOTING 0 PLUMBING RI
o FOUNDATION 0 MECH RI
o FRAMING 0 WATER HOOKUP
~ DJNSULATION 0 SEWER HOOKUP
If' Af"FINAL 0 PLUMBING FINAL
o SITE INSPECTION ~MECH FINAL
COMMENTS: \ \
lo,~~\
--'faJ;"'i~:'J<"L 1,1 (4
>sat rJ ~< r clwJofw.e.J -
o EXIGRADIFILLING
o CDMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
~RK SATISFACTORY. PROCEED
o CORRECT ACTION AND PROCEED
o CORREiRCOR REINSPECTION BEFORE COVERING
Inspector:. Owner/Contc
CALL 447-9860 FOR -rLE NEXT INSPECTlON:U HOURS IN ADVANCE.
1NSNO"
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!