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Home My WebLink AboutBldg Permit 06-0207 CITY OF PRIOR LAKE BUILDING PERMIT, TEMPORARY CERTIFICATE OF ZONING COMPLIANCE AND UTILITY CONNECTION PERMIT Main File (Please type or print and sil!;n at bottom) ADDRESS B ('~'/ b C.''- V , / 14111 P t>-.r "- v; l.vV L" ~ LEGAL DESCRIPTION (office use only) LOT 30 BLOCK ADDITION :J e(~....s OWNER (Name) Gu; lAc-.r (Address) BUILDER (Company Name) (Contact Name) (Address) R. ~S W~.s Mt>-^" Ho.-..c...t De",,,~S IL ScA^~ :-el,r Bv;' It;t......~ I I 8 q.s- PIe>.. 'l.4 Dr: v'- J w~ White Pink Yellow File City Applicant Date Rec' d 3, tJ. oft; PERMIT NO. O~. Oz.o71 ZONING (office use) PtlsD PIDdS-~\B7- 030-0 (Phone) l..s- J - I.{ D (, -- I..{ L{ 0 b (Phone)--.bl,).- 369 - /q~L/ Sv" k. .}oo, ct>..t:Y.,~ I /\AN SS-Id-~ CODE: ~I.R.C. DI.B.c. o Misc. Type of onstmction: I II III IV V A B Occupancy Group: A B E F H I M R S U Division: 1 2 3 4 5 !vw fe ...1 ]=," rS ~ Ali:t.'t.')." (Phone) TYPE OF WORK ~ New Construction ~Deck OPorch ORe-Roofing ORe-Siding ~Lower Level Finish 12 Fireplace OAddition OAlteration OUtility ConnectlOn PROJECT COST IV ALUE $ L3o. 000, ,:J D (excluding land) II I hereby certify that I have hlrnlShed IOformation 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.mcntlOned 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 btllldlOg "fflcial can revoke thIS permIt for Just cause Furthermore, I hereby agree that the City official or a designee may enter upon the propelty to perform needed IOspectlons X <0~L ~~~ IYSS 3-Cj-Dl., Signature Contractor's License No Date Permit Valuation 'f4"/~1. 000.00 Permit Fee I $ , I~ ~ .5"0 Plan Check Fee $ '90 s, "21 State Surcharge $ fo~t 5"'"0 Penalty $ Plumbing Permit Fee $ J ()O. ao Mechanical Permit Fee I $ IOO,Od I Sewer & Water Permit Fee $ 3s-, SO Gas Fireplace Permit Fee $ ~4,tJO This Application Becomes Your Building Permit When Approved ~ ~ S/z.,:1/fJl, Buildlllg Official Date /J() Fit. TUKE Park Support Fee SAC Water Meter Size :;.408", I", Pressure Reducer II~' Sewer/Water Connection Fee Water Tower Fee Builder's Deposit Other TOTAL DUE Paid ;/[". ,% I Date L/ /.3 d? M~\t:.Y2- ~~S I J1iLIPt:JrLI/{; /AS ~ # $ # $ /'55"0,00 \ '4!' ~, $ 500. i)o $ z.. z..s, 00 # $ lS'oc. 00 # $ IDao.OCJ $ I S"~O, DO $ $ g, (f;~ I. /8 I) f Rec~Pt No. .r0.3 ~ I ~1 I S c.;-frt,.ro Sj 'Pl....4 ~~ I~ e:;s A l-U);JG2J ThIS IS to certify that the request in the above applicatlOn and accompanymg documents is in accordance with the City Zoning Ordinance and may proceed as requested. TillS document ::::~""",,~ry C"""",, "' ;7;;;';'; "'""' ,"","'d';;;::;"':;'"''"""''''' " e"w""'" "' 0""'"";' m,," "" Planning'Director Oate spe~ 24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245 16200 Eagle Creek Avenue Prior Lake, MN 55372 Residential Building Permit Checklist New Construction for Single or Two-family Dwellings in R-1 or R-2 Districts Reviewed by: ~ ,.. Cl_ ~ Date: ,3( Z- 3/ (J G:, PID: Zoning: r I 4 I ~ I f /t1l.ft:- t/ I c-W LAJ.-JE:' ,..J I IA.J. Subdivision: 6~ PO~f) I)'f-' Building Permit # Address: 1t1/71 Legal: L5b-sS". B I Existing Structure? YES @) Existing Nonconforming Structure? YES ~u__..m...._.. CONFORMS TO ZONING ORDINANCE (vE]) ~ Yard Setbacks: NAI FAIL~CfJMPLlE~ . Front Yard (can be 20' if av'g, w/iri 150') . Side Yards Standard 25' 10'{ 25' if abutting a street . Sidewall exceeding 50' requires additional side 2" setback for every l' over 50' in length I. Rear Yard . Patio Door: provide for minimum 10' deck or sign statement indicating no deck wifl be built in the future . From 100 year flood elevation of wettanq/NURP ~~ " . From OHW (Prior or Spring Lake). 10' setback + 2"/1' over 50' 25' . 1 0' sidel 25' rear 30' 75' or setback average of adjacent structures, but no less than 50' - , Floor Area Ratio(~}) FAILS (~IE~ .30 Maximum - . J Yard Eneroachment5~ NA 1 FAIL~COMPUES)- :c.Eaves: and Gutters. no mare than lfeetin width andlna ' croserfiliartS:fE~etta a lotlfne(EasementsY. AlC-ancfother-equipment cannot encroacft0 lJ: interior . , sideyards:. Standard J lreepres:erv'atiolT~FAILS I COMPtlES. I., Totafcalipef'fnches I. PermitZ5:o!ii Removal I .'., CaliperJaches Removed. .. I:. Cali'perJnches Preserved I.. Replacement I: I I I Standard %:1 L\TENfPLA TE"BLDGLlST.DOC NO Proposed' ,""', l ~5 ' J.S".3 -, .""~"-~ ; I~,~~I ()$~'~,I$~JJ:;. , i" ~-~~:~^;:;Ti7!j;;,-"'-'- r Ji'.-Yi>/,':~ifJiE-' I, Nit tJlf' I f(!;lL pt(SQ,~Sets- c/t1+1t. ,. I Driveway: NA / FAllS (COMPlIEP · Maximum width at property line · Required setback I. Maximum slope · All parking areas to be paved including R-Vor spaces adjacent to the garage I. Location to match subdivision grading plan , Building Heighy."'CoM'PLIESftAILS " --- - - , Shoreland District: NP-)/ FAILS (tOMPlIE~ I Minimum lot area (square feet) - I Minimum lot width /'!.. ..,., I Shoreland alterations 5~ ~- I Impervious surface V ! Bluff in Shorelan~NJ/ FAILS / COMPLIES · Setback from top of bluff I. Bluff impact zone I. Engineering certification submitted/approved I. Grading in bluff or bluff impact zone ! FloodPlain~ FAILS 1 COMPLIES · 100 yeanrGod elevation . Lowest ftoor elevation · Proposed lowest ftoor elevation · Elevations 15 feet from structure ., Road access must be no more than 2 feet below Regulatory Flood Protection Elevation ,... , Accessory Structure(~4t'1 FAILS 1 COMPLIES I., Size- I. Notlccated in front yard (Materials) I.. Side yard and rear yard setbacks I. Maximum height i. Materials compatible with principle structure L: 'TElvIPL-\ TE' BLDGLlST.DOC . " . - Standard 24' 5' from side lot line or 30' from r-Q-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 importing/exporting Proposed I ~ I L4-cJ-. ~ 1',4,5:3. S. . h. '1,~f b,3''?<o , , " . , I .. ~ rl- trl- ~71 'j Proposed i: . . :, - ." '.__N", ;".".. 7 ?,7~4..-..l?t.tll~ ~'. Proposed f, Standard 908.9' Prior Lake 914.4' Spring Lake 909.9' Prior Lake / 915.4' Spring Lake Must be l' above ftood elevation for new and existing structures. If existing structure was constructed ,9/19/90'- f1J2219ithe n.::, . addifi6I1aFf66'fIS"nof'fequfteCf:' "','''-'' Must be f1oode[~v~tfC)rt:9f, ...- Jligfie{':;".c,,:, ' 907.9' for Prior Lake 91 J: 4' fot S'prfrigTaRe I Standard 832 sq.ft. or 25%, rear yard 10' 15' " ~ l\IIaiIl -File The Cfnlt>f nf the L.kt Counll1' White - Building c:::~aineering dInk. ,. - PlanninQ"J BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT APPLICATION RECEIVED , ,/ ~ / ! /'-; / ,1-// r The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: / .,....; / / "/ " / 'I' '!, /'j !., l / C I I L., /'/ fe" , l~_~o'. Accepted Accepted With Corrections ~ Denied ~ ~~ td-f "./;~. _ ~. '"J1A ~ oj~~~~' Date: 5/2-..? /OG. Reviewed By: Comments: ~ M'air~ l11,IJe "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." lVIaln ~File <... White - Building'"':) Canary - Engineering Pink - Planning Tht' ("(""fer nf Ihl" I..kl" Countr, BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT APPLICATION RECEIVED WEAlS/1ANN HOt1ES 3 . q. 0(0 The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: Accepted Accepted With Corrections 1-11A16 / /4'/7/ PrJK~VI6W Denied Reviewed By: ~ ~ Comments: ~ o-l.-f ~. ~ r ~ ~-cJ ~ 4~O Date: 3!z.3 !tJ(0 ~W~ "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." ..... ''V '-,,,..~. ."" , ~, . ~"'~p'\_-"','T'"l ~VIajIl :File Tht ("thin of Ihf" t..kf" COunff')' White - Building /:'C8naI:Y~ '=;ilijii'i~erlr.!V Pink - Planning BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT APPLICATION RECEIVED WENSI'1i-1N/V /-/OI1ES 3.9. Q(c The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: /4/7/ f~At::k'VIEW I-AAlE Accepted 1 Accepted With Corrections Denied Reviewed By: ~ Date: 3-2~~Oh Comments: See Reverse Side for Additional Information! /J?~, 'n hi (, , ' , /, rVJai,1l ,F',ile , ...... See Attachments: 1) Grading Plan, 2) Erosion Control Measure~ ',' , ': . "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." 03/09/2006 TIIU 12:39 FAX 952 767 1900 GENZ-RYAN [4J 014/037 CITY OF PRlOR LAKE HEA TING/AIR CONDITIONING/FIREPLACE PERMIT Date Rec'd I Pink 2. Gretl\ :3, Yellow fii, ! PERMIT 1\.10./__ '] Ll1 ;~0i<onl I ' l' tv ' ~ ZONING (office use) (Please type Or print and sign at botlom) ADDtLJ /1 / POvrkIJ/fll.) L.h LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID j ~:~R ())fYJ9J110_fl,n 4j())71tS (Address) / fqf) p/(}l[U Dy. -tt2{j) (Phone) L6/-(]()5- 37IJIj i /!7Ja{lU) MN 55/;) ~,L- ,.,.) (Phone) qr-)~~7LF7- (000 APPLICANT r. Q (Name) c~rCrYZ_ - ' eJ A (J Jl .J (Address) ;A)[j) UJ ' t~~1JJL'1 (~ [; Lt(V'SVi ! Ie c:J5S':S7 (Con"" Pe"on) KI in(Add"~ . . ~ . (Phone~c;4~-70 7- / IJJCt APPUCANTSIGNATURE (~ fr1:;~ DATE 3/c?/U'~ , / APPLICANT PLEASE COMPLETE BELOW , X)NEW CONSTRUCTION , ,C RE'LACEMENT ,0 AL TERA T10NS FURNACEMAKEANDMODEL lfnn~X (--rUIJ)H-3&PrIJQO. FUEL ndt-, ~Q_ FLUE SrZE RETURN OPENINGS r/ INPUT Yf1Jj) OUTPUT JiL.Ui..l.rz./) TYPE OF SYSTEM HEA TING OR POWER PLANT ~arm Air Plants 0 Steam DGravity 0 Hot Water ~eChanical 0 Radiation . 'r Ccmditioning 0 Special Dcvices enl. System 0 Olhcr 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 5:39.50 minimum 5>99.50 $64,50 $39,50 Residcntia!, Healing & AlC (New Construction) Residential, Healing Only (New Construction) ResidenLial, Additions & Alterations Residential, AC Only 5>39,50 $39,50 Estimated Cost $ HEATING PERMIT FEE STATESURCI-IARGE TOTAL PERMIT FEE Building Permit # $ $ $ ,50 PAID WITH BUILDING PERM/; (Office Use Only) This Application Becomes Your Building Permit When Approved I Paid " I Receipt No, Dat~tAR-2 J 2006 By Iluilcline Orfidlll Ihte 24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245 03/09/2006 TIIU 12: 38 ~) ~/NNE50"'''' FAX 952 767 1900 GENZ-RYAN I4J 013/037 Date Rec'd CITY OF PRIOR LAKE PLUlVlBING PERMIT 1. Blue File 2, Gold Cily J, Yellow Applicant I PERMIT Nr~- aD!} (Please type or print and sign at bottom) ADDRESS } L/ 17 / PJirkUJt!-UJ Ln ZO:NlNG (office use) LEGAL DESCRlPTION (office use only) LOT BLOCK ADDITION PID ~':e~R I j)tJ16JYYJJI)Ji} d}orrt5 (Phone)U6l-c)()5- 37M (Address) / tqS p (trzw Dv ,#-:2(J[) f1142/J UN $/:;);)- -' /, APPLICANT fl_ f) jll Vt /',. (Name) Ch./ (1.:... - ~,.1 uLvl "l </0" ) \ t\ ! } I' j" (Address) .Cf- C. , I .-1 V\J fA I) . (Address) ) (Contact Person) ~ JlTI I /, . APPLICANT SIGNATURE rf')t1y) (Phone) t10'2- /01 ~ i 000 [3 h(A.lll1C,V (( Ie., M N CJ53?--:n (City) (Zip Code) _ (Phone) (};5;a-7k7- /!J!J ) W /~ DATE l' Jq /J (ff '-- APPLICANT PLEASE COMPLETE BELOW Quantity J I ! Type of Fixture Bath Tub with or without shower Dishwasher I Floor Drain ;:.J I Lavatory (Bathroom Sink) i I Laundry Tray (lor 2 (;ompartment sink i I Shower Stall I I Sinks i Bar Sink .d-'I Water Closet (Toilet) Quantity .3 I I I I Type of Fixture Rough-ins Water Heater ! Water Softner I Stand Pipe (Washing Machine) Sewage Ejector Backflow Assembly Backflow Assembly Test I Lawn Sprinkler I Other FEE SCHEDULE Industrial, Commercial & Multi-family 1 "It, of job cost witll a $39,50 minimum Residential, New One & Two-Family $99,50 Residential, Additions & Alterations $39,50 Estimated Cost $ Building Permit ti PAID WITH ,5~UrLD'NG PERMIT PLUMBING PERJvlIT FEE $ STATE SURCHARGE $ TOTAL PERMIT FEE $ (Office Use Only) This Application Becomes Your Building Permit When Approved Paid Receipt No. nuilding Official Date Date ,-~."p. 2 e 2DOG 24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245 By P R 10 R LA KE DEPARTMENT OF BUILDiNG AND INSPECTION INSPECTION RECORD SITE ADDRESS _ L/ /Ll PAtLi'. tli f!u) I-AJJE N. CA.) , , NATURE OF WORK tJE\.J ~.~tT. (},I..... W/-I.-J-.. Fr)J;tll f Ht,IC.L USE OF BUILDING S.F=:A. ((... YNjrl~ ~aclffS PERMIT NO. O(P. o~o7 DATE ISSUED 3P-" f CONTRACTOR Wb.JS'W\At.\t-l "'-n. PHONElDn..- ~., - 79Z"( NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW THE PERMIT IS BY SEPARATE DOCUMENT Main '}t'ile INSPECTOR DATE . I )l2'i~r I' 1 I I f /]6/t16 . P' CO~ER NO WORK UNTIL ~B,OVE HA,S ~EEN SIGNED ItJ(7?f" I' Ht:JUS6"'IIJItIfP M;~ tJ2t,ptJi. I , FINALS I GRADING (Prior to Sodding) N.f5 'I, Z,Z. (J.,l, BU'JLDING /")~ r/ -1'DL, ELECTRICAL - , PLUMBING HEATING I FOOTING I /~ I t./J /8/0"- I FOUNDATION (Prior to Backfill) ~""'t~+f"~"" #t"//6' I PLACE NO CONCRETE UNTIL.. ABOVE HAS BEEN SIGNED ROUGH - INS I SEWER I WATER I SEPTIC "t.J~1 Y-r @ 0/ /t>/!'1ff . J FRAMING Wc- / .'1rti 7P.Y //;/ INSULATION pfP ?/t:r~ ' I ELECTRICAL ' , PLUMBING \j-\i iI"'lJ '1'1") (N Ii' ;jI"iJ~ HEATING (if required) !i11 FIREPLACE a GAS LINE AIR TEST ifp DO NOT OCCUPY t?R f/~b -~~" UNTIL A~E HAS BEEN NOTICE 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 ,1'>'\o'tt"llt' """,,,,., 'f('; ~II. ......r 1"',_ "'f\id)''-.' " ,.".:..-,,,,~.,, ,.....'~ I~~" 'I"" '*",']"",\.'i". ". ,. .........'..,..." '''''l~''.~ ;,~"" ,.;'...:.:.,...~,~ I"~' .A:..",,,,,,,~.\~.~ 4Itrfifiadt nfQ1}ttupantll CITY OF PRIOR LAKE ~~patfnt~td nf ~uilbing Jjnspttfinn ~/t''ina1 Pcuu.itted o Conditional C.O. Expires_ This Certificate issued pursuant to the requirements of Section 110 of the 0 Residentiall 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 SING '-'6, hi H I (..A../ Bldg. Permit No. 0 ~. () Z 07 , Occupancy Type _)!:.3 Type Construction Y AI Zoning District Pt/S (;) Legal Description _ ~ OJ e I;, JE.Ff:"' 61€S PONO I CI Owner of Building ,SiteAddress 1417IPA-~Vle tv' l.AI" Contractor's Name & Address tv 6/11...frt /1 ~ ,htJ/*16S /adacr a HI/TCI-I/NS (I(J City Planner JRN~ KANfle/f!- I . I Building Official V Date: II (I 0 V Date: \ ' I DATE TIME CITY OF PRIOR LAKE U/Qfh INSPECTION NOTICE SCHEDULED {2!LVI' .....J ADDRESS Ie{ (7 ( OWNER CONTR. PHONE NO. PERMIT NO. ~-207 o FOOTING o PLUMBING RI o EXIGRAD/FILLlNG o FOUNDATION o MECH RI o COMPLAINT o FRAMING o WATER HOOKUP o FIREPLACE RI ~ULATION o SEWER HOOKUP o FIREPLACE FINAL AL o PLUMBING FINAL o GASLlNE AIR TST SITE INSPECTION o MECH FINAL 0 COMMENTS: a-L '1 () , . / //' / ~rLL V t.Q. ~ORK SATISFACTORY. PROCEED o CORRECT ACTION AND PROCEED o CORR(J7K. CALL FOR REINSPECTION BEFORE COVERING Inspector I Owner/Contr: ......... CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE., CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI lNSNOTl DATE TIME CITY OF PRIOR LAKE ~1-4 O~ INSPECTION NOTICE SCHEDULED ~rk\lLew ADDRESS I <-It '1 ( OWNER CONTR. PHONE NO. PERMIT NO. ~ - 207 o FOOTING o PLUMBING RI o EXlGRAD/FILLlNG o FOUNDATION o MECH RI o COMPLAINT o FRAMING o WATER HOOKUP o FIREPLACE RI o INSULATION o SEWER HOOKUP o FIREPLACE FINAL o FINAL X PLUMBING FINAL o GASLlNE AIR TST o SITE INSPECTION o MECH FINAL 0 COMMJjNTS: /J" -1 .K...-. ~_'. f.-.,,, +- ~ _H.~ Q;.~~ --------- ~ORK SATISFACTORY, PROCEED o CORRECT ACTION AND PROCEED o CORREl1CK CALL FOR REINSPECTION BEFORE COVERING Inspector: /7 Owner/Contr: CAL.1 -98~ THE NEXT INSPECTION 24 HOURS IN ADVANCE. C~REMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY! INSNOTl DATE TIME CITY OF PRIOR LAKE INSPECTION NOTICE SCHEDULED 1-2l~ ADDRESS I 'i J 7/ P, ( J( 11 " t (./ PHONE NO. PERMIT NO. W i.fSM4", , 0(, -At) 7 OWNER CONTR. 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 ~X~ILLlNG -'ci CO~T o FIREPLACE RI o FIREPLACE FINAL o GAS LINE AIR TST o COMMENTS: GrY0- ~1( Cvlb ~~ - Qt.. , ^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! INSlVOTI CITY OF PRIOR LAKE INSPECTION NOTICE ADDRESS 14' l ( OWNER PHONE NO. o FOOTING o FOUNDATION o FRAMING o INSULATION ~FINAL o SITE INSPECTION JZdJ:: 7. ~J_ SCHEDULED LL~ CONTR. PERMIT NO. o PLUMBING RI o MECH RI o WATER HOOKUP o SEWER HOOKUP &~LUMBING FINAL )tl....MECH FINAL ~ l1s:a.\- ~ r- L . J n OJ}../) - - S'1-iLL~ 0~ jl,~p ~ r' r_~ ~ I J( -I -DCt 1_')1A r.~~~~ DATE 9~ TIME ~ - OJ? o EX/GRAD/FILLING o COMPLAINT o FIREPLACE RI o FIREPLACE FINAL ~INE AIR TST o WORK SATISFACTORY, PROCEED X CORRECT ACTION AND PROCEED o CORRECT ORK L FOR REINSPECTION BEFORE COVERING Inspector: Owner/Contr: CAL -9850 FO~HE NEXT INSPECTION 24 HOURS IN ADVANCE. ____. COD~NTS ARE FOR YOUR PERSONAL HEALTH & SAFETY! INSNOTl