HomeMy WebLinkAboutBldg Permit 06-0322
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIA~CE
AND UTILITY CONNECTION PERMIT
)lain FD~~:
(Please type or print and sip at b" ,......)
ADDRESS
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/;JtJty
,
File
City
Applicant
I PERMIT NO. Oft;. 03 z~
/VtJ
LEGAL DESCRIPTION (office use only)
LOT I BLOCK i ADDITION fA)~N.J'lI1qA//V
OWNER
(Name)
(Address)
BUILDER
(Company Name) WeNSnU;/VN
(Contact Name) G.o r y
(Address) /'95 1'4~~ ~r
CODE: ~I.R.C. OI.B.C.
Type of 6nstruction:
Occupancy Group: A B
Division:
d"" t'J
I
E
IDlY
H I
2 3
A
R
5
~ r J...
PID ;Js- ~II- gll-o
(Phone)
Date Rec' d
+./7. 0(,;
ZONING (office use)
Je.{-
(Phone) &.,j/- Yilt, ... ~~IJO
(Phone) 6/~-J"7- 7{,/.J-
~.5 / ,;J.:2....
$,A/
ORe-Siding
JrJLower Level Finish
JCI Fireplace
B
S U
PROJECT COST /V ALUE $ / .y (). O{)(J
(excluding land) ,
Park Support Fee
SAC
#
#
C4 ra#
./ V
TYPE OF WORK rlrNew Construction ~Deck l1IPorch ORe-Roofing
OAddition OAlteration oufiliiy Connection
o Misc.
V
M
4
n
F
1
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-menttoned 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
;cial A~errnit for jus ause F ermore, I hereby agree that the city official or a deSije;:gpon the y.uY'....J to perform need:Y:;;_ 0 ,
. /'/ /, Signature Contractor's License No. Date
v V
Permit Valuation
Permit Fee
I Plan Check Fee
I State Surcharge
Penalty
Plumbing Permit Fee
I Mechanical Permit Fee
I Sewer & Water Permit Fee
I Gas Fireplace Permit Fee
#; 50 O~tJ. OtJ I
$ 13'53,50
$ B7'.7B
$ 75, OD
$
$
$
I $
1$
I co. () 0
/tJt:), DC
3~. S""C
J..!D.DO
. This Application Becomes Your Building Pennit When A. ..... ,ed
~i,:im'i~ $~?ftf.,
Water Meter (Size 5/8"; ";
Pressure Reducer
Sewer/Water Connection Fee
Water Tower Fee
Builder's Deposit
I Other
I TOTAL DUE
#
#
~/
$
$ ISS'O,OO
$ 2. 5' c. '-9 0
$ SD, e!:J 0
$ I SOD. 110
$ lOOt:). till 0
$ i500. 00
$
I Paid
I Date
./
~.f-3J. 71
S-. 3. ()V
I'J
Rec~wt No.
B'V1
o
$Il. 433. 7fJ
Sld-TI
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 City Planner consl1tutcs a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
i~ ~ d/~zA(, ~ a.L( ./
Planning Director Date spec~
\ 24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
/
~/
Residential Building Permit.thecklist
New Gonstruction for Single or Two.family DweUingainJt.1. orR.2Distticts
., :..';".~~, ,..
Reviewed.bY:,~ ?~ Date: 1'p.?~G,
I' I, ."
BuDdlng'Pirmlt If PID:
Address:. .;;5'"~ 'Z)z, 2. 2..s2.. "I z..rz..<,.
~ ) I I
Legal: L: ~ '2.,', L(. B 'f Subdivision:
Zoning:
~ ~7 )J.iJ,
Existing Strucfure? YES@
Existing Nonconforming Structure? YE~
CONFORMS TO ZONING
ORDINANCE
JII"----'''
~ Yard Setbacks: HAl FAlLS(<!OMPLlE~
. Front Yard (can be 20' if avg. wlin150')
. Side Yards
. Sidewall exceeding 50' requi~ additional side 2-
setback for every l' over 50' in IeIl91h
. Rear Yard
. Patio Door: provide for minimum 10' deck or sign
statement indicating no deck will be buRt in the future
. From 100 year flood elevation of wetlandlNURP
pond
. From OHW (Prior or Spring Lake)
.
I Floor Area RatIo: HAl FAILS I fDMPLIEJY
I Yard Encroachments: HAl FAlL&1tOM;Uea)
Eaves and Gutters no more than 2 teet In Wldth and no
closer than 5 feet to a lot line (Easements).
AlC and other equipment cannot encroach on interior
side yards.
I Tree Preservation: ,.;A'b:AlLS I COMPLIES
. Total caliper inches
. Pennit 25% Removal
. Caliper Inches Removed
. Caliper Inches Preserved
. Replacement
L:\TEMPLATE\BLDGLIST.DOC
\
(VEY
Standard
25'
10"
25' if abutting a street
10' setback +
2-/1' over 50'
25'
10' side!
25'rear
30'
75' or setback average of
adjacent structures, but no
less than 50'
.30 Maximum
Standard
Standard
%:1
NO
Proposed
"L 5" I
I
ZS'. f
I I I
27," ': z6
~ 'Z.s I
,JJ4.
IV'"
NA
I ~ ~-9
Proposed I
t-Id).li!J
N",(/G'
I
Proposed
, Driveway: HAl FAILS rciMPLiLV
. MaxImum width at propertY line
. Required setback
.'
'."'.'0 .
. MaXlmUmstooe
. Altpartdng areas tp be pave<fincluding R-V or
Sl>8c$s 'liJiacenno the """ . ..; J".' . .,
. Location to rn8'Eh subdivision Qfading plan
~~: NA/FAlLlL~'"
, ShcnIInd 0i8bt0t{4&M FAI.S IGGMPUES
Minimum,fot'area (SQuire feet) "
Minimum lot width
stIOreIancf'deta6bllS
Impervious swfaca~
, Bluffln~FAlLS/.COMPUES'.
. s8tbacIt from top of bluff
f " ~,~~.
,.BIuff impact zone
. ' 'lil~"_~tion su~aPDroved
. , Giadil1\1 in bluff or bluffimDect zone
~w1 . ,_ ~" .....c
, ,
I ~I!:=..,COIIPUES
"'11'\
. LoweSt ftoor elevation .,
. ,
. Pro~ lowest floor elevation
. Elev_", 15 feet from structure
.;\'''' , <,
. Road, access must be no more than 2 feet below
Reaulatbi,..FIood Protection Elevation
'AcceI~,~ FAlLSI COMPJ..IE8
~l.o.i..' ,. . j
. "*R
. NotJocated in front Y8Jd (MIttri8Isl
· Side Yard and rear yard setbacks
· MaxImum height,
. MatedaIs COt1lPaIiIIe with ..DrinciPIe, structure
L:\TEMPLATE\BLDGLIST.DOC
I
Standard Proposed
24'" JJ(IM, I"
. 5' f!o!n side lot Rne or ;~\...;.. I
30'_ r-o-won c6mer1ots::J: 'en.-
10% #.""~/eJ~ 14 "l,
'., trl.-
.~
. ~... ..'. ..'
I
35' Maxil1lJBn
Standard
7.500 Rip. 7.*'N~
SO' Rip. 57.3'Non-rip
30% Maximum. .
Standard.
By planning dept.
20' From Top of Bluff
BYCity~: "
Noim~"
~ I
90$.$', pOOr Lake
914.4' SPrtngLake
909.9' PrIor Lake I
915.4' Sprin9 Lake
Must be l' above flood
elevation for new and existing
structuIJlt.tf'....
structure.was ~
.9I1i/90-11122aI,ttJftn
additlCJnalfool is .ncll8QUl1M.
Mustbt'ffcjod eIevatiQn.or
~
907.9' for Prior Lake .
913.4' for Spring Lake
1. ~....l
832 SQ.ft or 25% ,..ar Y*d':',(
10'
15'
I ~z,'
Proposed
\
I
Pro.-.ct
PtOooMd
\
I
PI'OPOMCI
.) .'.
f)~ PRlo~
S ~
U /!l
~NESO~
Main File
White - Building
Canary - ~In..rlng
<:::::PInk ..:. P .nnln~
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
VV f IV f /~I rJ IV Iv
4. /7. 6ft:
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
'~ Z 5) ZO ~ ~ 1-1 rc IG,~ ~I L f..". t, Vii r
_If"',."
.......
Accepted
Accepted With Corrections ~
Denied ,<' It, ,..
'~eviewed.By: ~ ~
Date: o/h..74,'
Comments:
..
.~
...\iF COBditieB'U p.lld Other Mech.........: ~
Units Cannot Encroach into Required
nOJ ,.~, J ..... I. . .1,.__
iJ.I. -.:;.a.h..t.. o.J\c,'-"uQ,~
'"
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. II
Main File
<White . BulldlrS::>
Canary . I:nglneerlng
Pink . Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
W6NfMftNN
4~ /7. o~
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
ZG ZO Vv'1/ 713!eFA~ Wit Y
i
Accepted Accepted With Corrections /'
Denied
Reviewed By:
Comments: ~
~
(2.L/
~
~ Date: o/P7 ft ~
~,~
t'
.~.
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.11
~-- --..-
Main File
White - Bulldl~
<::..aDIU:L- EnglneerlnV
PInk . -l5iannlng
BUILDING P~RMIT APPLICATION DEPARTMENT C.,ECKUST
NAME OF APPLICANT
APPLICATION RECEIVED
W6NSf/liJNN
4./7. Ow
The Building, Engineering, and Planning Departments have reviewed the building pennit
application for construction activity which is proposed at:
Z52-0 (11/1-/ 7C/q:>1L~ WAY
L
Accepted
x.
Accepted. With Corrections
Denied
Reviewed By: --'lAJIl.
Date:
LJ ;Zy<U
Comments: . S'e~ ~everge Sid~ for Adr{itional Infonnationl : :
. .
IY/.,/yt F.' I,
"
). : I..
\ -" . . ~:~r~ ""1.". '
See Attachments: 1) Gradini.i,lan. 2) Erosion OmltrolMeuurf:!.q
.. . " 1 .' ..
"The issuance or granting of a pennit or approval of plans, specifications and
computations shall not be construed to be a pennit for, or an approval of, any violation of
any of the provisions of this code or of any other ordinance of the jurisdiction. Pennits
presuming to give authority to violate or cancel the provisions 'of this code or other
ordinances of the jurisdiction shall not be valid. n
04/26/2006 WED 13:08 FAX 952 767 1900 GENZ-RYAN
~ 008/009
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
(Please type Or J,rint and siKn at bottom)
ADDRESS fl
/~SJ () .A) () ]J!f/ (l,G(
~:~~t... ~~f. I PERMIT NO.O'- .032 oj
3. Yeliow Apphcant "'t--
(j) ~!J
ZONING (ofllt~
use)
LEGAL DESCRIPTION (office use only)
LOT BLOCK
ADDITION
PID
OWNER
(Name)
W f/19rYJarl /1 dJ {)n1 f~'
I ffJt; pj a Zrz :hY ,1f-. :/00
f ,1CI-./}Il/:~-31/)o.1
(phone) (j) J 'fU"?,. (...
tlu1{()l. /J1/V56120
.J
(Address)
APPUCANT ('. ~ ~ Q
(Name) d en c.. ~ <. ",j (1 n
(Address) ~XO W. 't-\-wlj' I?> B lAYIf\Svi lie 553'7;)-7
i ~. (Address) (City) . (Zip Coc1e)
(Contact Person) ''K-l hf\ )./' -: . _ -..... (Phone) t,1 ?d -7ftJ7 - ! ill )
APPLICANT SIGNATURE (.~ .~~ DATE <.//;?u/r0
, ~--APPLICANT PLEASE COMPLETE BELOW
~w CONSTRUCTION . 0 REPLACEMENT 0 ALTERATIONS ..
FURNACE MAKE AND MODEL Lenn 0 J... tJ:7.{ au H -~~ tJ~ .. ql). . FUEL lIed: ct cw
FLUE SIZE RETURN OPENINGS !3 iNPUT t~ () 6UJ OUTPUT c~;;J((j)
(phone) qr)(A -"7lrJ7 - 1000
TYPE OF SYSTEM
;~Wa~ Air Plants
-1::lGrevlty
iechaniC81
ir Conditioning
, cnt. System
HEATING OR POWER PLANT
o Steam
o Hot Water
o Radiation
o Special Devices
o Odler Devices
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
FIREPLACE MAKE AND MODEL
FEE SCHEDULE
Industrial, Commercial & Multi-Family 1% of job cost Residential, Gas Fireplace
$39.50 minimum
Residential, Heating & Ale (New Construction) $99,50 Residential, Additions & Alterations
Re.~idential, Heating Only (New Construction) $64.50 Residential, AC Only
$39.50
$39.50
$39.50
Estimated Cost S
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMlT FEE
Building Permit #
$
$
?AID WITH
.50 BU'lO'NG peRMIT
$
ru lia~ ~ 0 \fl ~ ~ Receipt No.
MAl .. , ZUUb ,By
(Ornet Use Only)
This Application Becomes Your Building Pe'-mit Wben Approved
Dulldin!! Official
Date
~
--'
24 hOUI' notice for all inspections (952) 4 ~-98S0. fAX (952) 447-4245
04/26/2006 WED 13:08 FAX 952 767 1900 GENZ-RYAN
~ 009/009
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
~: :; ~:y PERMIT NO. O~. , 03 2 ?
3. Yellow AppHcan\ 'II ~
(Please lVDe or llrlnt and sl2n at bottom)
ADDRESS
;)0 d() UJIktP ir)~\ a}) U Jr]j)
ZONING (ofliceuse)
LEGAL DESCRIPTION (office we only)
LOT BLOCK
ADDITION
PID
~~~R \V~.'V\9V1n. (A JltVl
(Address) I g 61_6 :) ()1fA ])v .
4tZW ~tLn
,.J
. (prne) v61~ C/05.'~(l)
\/ ~ t!~ l<d ;)--
APPLICANT r,_ 1)
(Name) Cl.eJ1l. - l~~lClV\
(Address) 21-00 \N. l-h,'\) fA k3
1/. JAddress) )
(Contact Person) ~) VYl .,
(1$;;
APPLICANT SIGNATURE
t1,.-::..
(Phone) "'1 "7"L--Ilf1 ' (DDO
~iAJ2J1~irl'{I~ rVl N ~~'3?J7
(City) (Zip Code)
. (phone) tfj") -7U7--( LlO
~?u1AiUp DATE .4/0&1 /(X~
/ \... i
APPLICANT PLEASE COMPLETE BELOW
..LI
I
I
I
Type of Fixture
Bath Tub with or without shower
Dishwasher
Floor Drain
Lavatory (Bathroom Sink)
Laundry Tray (lor 2 compartment sink
Shower Stall
Sinks
Bar Sink
~ ~ I Water Closet (Toilet)
Quantity
-3
I
I
/
I Type of Fixture
Rough-ins
I Water Heater
I Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
Backflow Assembly Test
I. Lawn Sprinkler
Other
I
Quantity
~
I
,
FEE SCHEDULE
Industrial, Commercial & Multi-family 1 % of job cost with a $39.50 minimum Residential, New One & Two-Family $99.50
Residential, Additions & Alterations $39.50
Estimated Cost $
Building Penn it #
Building Offitial
Date
i ~~
.fJ}lm (G; lE 0 \YJ [E '~.cejpt No
\ I )attAY U 9 2006 LJy
PLUMBING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
(Office Use Only)
This Application Becomes Your Building Permit When Approved
24 hour notice for all inspections (952) 447-l~' fax (952) 447-4245
;b RIO R LA KE DEPAR'PMENT OF
I r" BUILDiNG AND INSPJt;j;O~
INSPECTION' RECOR~ QII~
z.:5~#V1t7'EJ449l" WdY
NATURE OF WORK . .
USE OF BUILDING . ~
PERMIT NO. ~ 032 z.. DATE ISSUED -1IZ. 7.' '21. ~
CONTRACTOR ~"NAI PHONE I. ..~./Z.
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
SITE ADDRESS
INSPECTOR
DATE
FOOTING I I
FOUNDATION (Prior to Backfill) I //tI' I \~M/~
PLA~ ~ '(C~OfRETE UNTIL ABOVE HAS BEEN SIGNED
f...L~~ ~ 1. z.; ROUGH - INS -
~
SEWER I WATER I SEPTIC V\flI ~~ (,0&
FRAMING LJ(.. dJ/ 7117/ u
INSULATION f/~~'/6? ~
ELECTRICAL v
PLUMBING " )t{r. ~ 1r}vL IJ ( IJ.J..( ~
HEATING (if required)
FIREPLACE
GAS LINE AIR TEST . fII/; 9/~
CO ER NO WORK UNTIL ABOVE HAS BEEN ~IGNED
'IIJ~11IlP I I
FINALS
AI..b' ~ -. ". de '
~ltJ
GRADING (Prior to Sodding)
BUilDING
ELEOTRICAL
PLUMBING
HEATING
DO NOT
"")A I J
r $'/
OCCUPY UNTIL ABOVE HAS
NOTICE
#
.9V
BEEN 'SIGNED
This card must be posted near an electrical service cabinet prior to. rough-in Inspections
and maintained until all Inspections have been approved. On buildings and additions
where no service cabinet Is available, card shan be placed near main entrance.
(
FOR ALL INSPECTIONS (952) 447-9850
~
>t.
~ttfifitaft of (0ttupantll
CITY OF PRIOR LAKE
~tparfmenf llf!lluilbing J(nspetfilln
pinal Permitted
o Conditional C.O. Expires.
This Certificate issued pursuant to the requirements of Section 110 of the D Residential / D International
Building Code certifying that at the time of issuance this structure was in compliance with the various
ordinances of the City of Prior Lake regulating building construction or use. For the following:
Use Classification SINGl.tE FJ&1MIW Bldg.PerrnitNo. ~. O.::$'Z:Z_
. ,
Occupancy Type Ie3 Type Construction V AI Zoning District J€ 4-
Legal Description t../ Ie+- i W&/V'S/'1/1 NA/ ~ 711 .. ... ..
Owner of Building Site Address z,5 ZoO W A ~fi u..:,1t;tf'
C-_-,N_&^"""", _ WBNS'!f')ffN HO/'1e6 · ."
~. :::~?Jd/NS!ff- CityPlanner .TlliJe KA/V'flf5,e..
Date: II / r, /1)/ () DU Date:
{' tV -
DATE 1WE
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
,-~
ADDRESS ~<lo tN..k '+:;/' ~I
.
OWNER CONTR.
PHONE NO.
PERMIT NO.
-L!:J6.. 32,1..
"'~IWNG
~c6MiiCir'NT
o FIREPLACE RI
o FIREPLACE FINAL
o GASUNE AIR TST
o
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
~L
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
COMMENTS:
fN~- DJ!,
CtvJIo ~< - (:).K:
~ WORK SATISFACTORY, PROCEED
~ORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: ~ OwnerlContr:
CALL "7-1150 FOR THE NEXT INSPECTION M HOURS IN ADVANCE..
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS 2':rJ{)
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
DATE
SCHEDULED ~
~~LW,
CONTR.
TIME
/' PERMIT NO.
~UMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
~ PLUMBING FINAL
o MECH FINAL
'32.."L
o EXlGRADIFIWNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASUNE AIR TST
o
COMMENTS: ^!
l.~ r;& ~h
~I
" WORK SATISFACTORY, PROCEED
/;; CORRE A ION AND PROCEED
o COR CT L FOR REINSPECTION BEFORE COVERING
c
Owner/Contr:
FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE..
UlREMENTS ARE FOR YOUR PERSONAL HEALTH cl SA.~ IH 1'/
lNSNOTI
CITY OF PRIOR LAKE
INSPEcnON NonCE
ADDRESS 2~
OWNER
PHONE NO.
[] FoonNG
[] FOUNDAnON
o FRAMING
~SULAnON
INAL
[] SITE INSPECTION
COMMENTS:
I. ~ J-+-~
. ~
DATE TIllE
SCHEDULED ~~
tJ~.~
- -
CONTR.
PERMIT NO.
[] PLUMBING RI
[] MECH RI
o WATER HOOKUP
[] SEWER HOOKUP
[] PLUMBING FINAL
~ECH FINAL6~
11'--1~ 0 J () ~
(I?/ 0 )2-2.
[] EXlGRADIFIWNG
o COMPLAINT
o FIREPLACE RI
~IREPLACE FINAL
~GASUNE AIR TST d t
[]
0[(
#"
~RK SATISFACTORY, PROCEED
[] CORRECT ACTI ND PROCEED
)I. CORRECT WO , LL FOR REINSPECTION BEFORE COVERING
Inspector:
Owner/Contr:
CALL 447.
R THE NEXT INSPEcnON 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH 41 s..t.f'lU z'/
IN6NOJ'l
DATE TIllE
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
Z520 W,4~,e,c~LA-WffLt'
,
OWNER
CONTR.
PHONE NO.
PERMIT NO.
(,.322-
[J FOOTING
[J FOUNDATION
o FRAMING
[J INSULATION
b6INAL
ti SITE INSPECTION
[J PLUMBING RI
[J MECH RI
D WATER HOOKUP
[J SEWER HOOKUP
D PLUMBING FINAL
[J MECH FINAL
sf-,-
[J EXIGRADlFILLING
[J COMPLAINT
D FIREPLACE RI
[J FIREPLACE FINAL
D GASUNE AIR TST
[J
COMMENTS:
r/If//rL ~e Ir O()~B:'
/
/ .
f "\
I () )
,'\Cot ~ LG
iA WORK SATISFACTORY, PROCEED
;'~\cORRECT~CTI NANDPROCEED
0, CORRECT ~LL FOR REINSPECTION BEFORE COVERING
Inspector: Owner/Contr:
(/ ...-/
CALL 447-1850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE..
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH cI: SAFETYI
III8NOTl
--
\
j
.":i~
Job Address ZS Z~ VJ-v-l''411 w.,.
Heating eontraetor fn~~~
Name of T,.... f;./r .
08t8 '11'd,~.. .
peICIftl Oa ~..V'
Percent co.!:IM-.
Pen:ent CO2 "9. .s
S1aCk Temp ..:I""
CornbUI&iCJn air ...- ~ IUIJPIIId pIl'
UMC Sec. 606 -r.~'#
,nput - ........:----
-
~