HomeMy WebLinkAbout2016-01227 - attached deck CITY OF ORONO * Z 0 1 6 - 0 1 2 2 7 *
' 2750 KELLEY PARKWAY DATE ISSUED: 10/18/2016
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 1285 FRENCH CREEK DR
PIN : 10-117-23-32-0007
LEGAL DESC : FRENCH CREEK
: LOT 008 BLOCK 001
PERMIT TYPE : ADDITION/REMODEL/REPAIR
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : DECK ATTACHED
ACTIVITY : 434-RESIDENTIAL
VALUATION : $ 25,000.00
NOTE: SEPARATE PERMITS REQUIRED:ELECTRICAL(STATE)
REPLACE DECK WITH SCREEN ENCLOSURE UNDER
APPLICANT PERMIT FEE SCHEDULE 433.67
STATE SURCHARGE(VALUATION) 12.50
PLEKKENPOL BUILDERS TOTAL 446.17
470 W 78TH ST Payment(s)
BLOOMINGTON,MN 55420- CREDIT CARD 6152 446.17
(952)888-2225
Minnesota State License#: BUIL-BCD01797
OWIVER
O'CONNELL&LYNNE RASUMSSEN,BRIAN
1285 FRENCH CREEK DR
WAYZATA,MN 55391-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed according to
the approved plans and specifications,applicable City approvals,and the
State Building Code. This permit is for only the work described and does
not grant permission for additional or related work which requires separate
permits. All provisions of laws and ordinances governing this type of work
shall be compied with whether or not specified herein.This permit will
expire and become null and void if construction authorized is not
commenced within 180 days of the date of issuance,or if construction is
suspended for a period of 180 days at any time after work has commenced.
The applicant is responsible for assuring all required inspections are
requested in contormance with the State Building Code.This permit may be
revoked at any time f r due cause. %
/� .
G�- " . /o //��!�
Applica rmitee ignature, Date Issued Signature Date
� � City of Orono
' Building Permit Application � , � �
for New Structures or Additions
� �
Mailing Address: s
PO Box 66 Permit number: .� � � �-- , �
���Q Crystal Bay, MN 55323-0066 Date received: G
Sfreet Address:� _ __' eceived by: y �
y ,Z- 2750 Kelley Parkway `,I-�I�,rQ Plan review fee: � �
�' c,` Orono, MN 55356 (�+� " �,,; "C ,
`AkfSHO�ti Main: 952-249-4600 Total Fee: -
Fax: 952-249-4616 www.ci.orono.mn.us
This application form must be completed in full and all required information must be submitted.
Incomplete applications will be returned. (Please print)
GENERAL INFORMATION:
Job Site Address: �u�5�'.5 �(�E"JJ1(,j¢ �;�'t,�,� ��
Will this be a Parade of Homes, Remodelers Showcase Home or other Display Home? ❑ Yes ❑ No
If yes,a special event permit is required with Police Department and City Council approval 60 days prior to the event. Shuttle bus service will be
required unless applicant demonstrates sufficient on-site parking is available. Non-permitted events will not be allowed.
CONTRACTOR I APPLICANT INFORMATION:
Name: �CC"K k��/I�oL L�U1-Zpc°-�S , '
State License# C,�c,�i�)4 7 Expiration Date: _� ' _
Phone: cell 6"i� -3� office ��2- -
Mailing Address: c� - �. Cit : "w �<rt,+n, ZIP: �' p
Contact Person: • /}N2c�/' ,=1.,,/� �� Applicant is: Contrac / Homeowner (CircleOne)
Email and/or Fax: •�qI�Z�C� a ( ' kPnr/�/ � C��
PROPERTY OWNER INFORMATION:
Name: � c1'CO N�ZL N L�/Vl�/C l�}.S/1'IG(S.S�7t✓
Phone (day): �- � �
Address: S 7�C C � -K Cit : ZIP:
Email and/or Fax Vnn�.. luw �vt/` � C�rn
� _
ARCHITECT/ENGINEER INFORMATION:
Name:
Phone (day):
Address: City: ZIP:
Email and/or Fax:
ARCHITECT/ ENGINEER INFORMATION:
Name:
Phone (day):
Address: City: ZIP:
Email and/or Fax:
PROJECT INFORMATION: Description of project: RE��/4C� �LCK �S?H SC/I��7� C-7�Ct��usC� Grat.rJ��
1.Type of Project 2. Proposed Use 3. Structure Type 4. Sewage Disposal&
Water Supply
❑ New Construction �Single Family with ❑ Accessory Bldg./Garage
❑Addition attached garage �Deck ❑ Public Sewer
❑Accessory Building ❑ Single Family with Office/Commercial
❑ Relocation detached garage ❑ Residence Septic
❑ Other: (specify) ❑ Multiple Family/Condo ❑ Retaining Wall(s) ( ompliance certificate
❑ Public 4-feet or greater may be required)
"*Any earth movement may require ❑ Commercial ❑ Storage
MCWD review&permits. ❑ Industrial ❑Warehouse ❑ Public Water
Minnehaha Creek Watershed District(MCWD) ❑ Other: (speCify) ❑ Other(speCify)
15320 Minnetonka Blvd;Minnetonka,MN 55345 �P�ivate Well
Phone: 952-471-0590 / Fax: 952-471-0682
www.minnehahacreek.orq
Estimated Construction Valuation (excluding land) $ 'e��;00(�
Packet Last Updated: January 2016
Page 21
STRUCTURE INFORMATION: `
1. Structure Dimensions 1.Structure Dimensions(continued) ,
a. Length(ft.)= `� Number of bedrooms= � 2. Occupancy: ��C`—�
b.Width (ft.)= � Number of garage stalls:
3. Occupant Load:
Areas in square feet Attached = �
�
c. Basement= ;��� ��� Detached = �' 4. Type of Construcion: c���
d. 151 Story = �,��
� �����p�
e.2"d Story= �i�GC 5. Code Edition:
f. '/2 Story =
g.Total Area= ��;C`O
REQUIRED SUBMITTALS:
All of the information must be submitted in order for your application to be processed:
Not
Enclosed A licable
❑ Buildin Permit Escrow A reement and Fees
� ❑ Plan Review Fee
❑ Com leted A lication Form
❑ Pro osed Buildin Plans—2 full size sets,to scale and 1 reduced 11 x 17 or 8'/2 x 11 set
❑ 1� Minnesota State Ener Code Calculations and Mechanical Code Re uirements
❑ ❑ Surve —2 full size,to scale meetin ALL surve re uirements
❑ ❑ Hardcover Calculations
❑ ❑ Se tic S stem Certification
❑ ❑ Minnehaha Creek Watershed District(MCWD)Permit or
Documentation from MCWD statin no ermit is re uired
❑ Landsca e Walls and/or Retainin Wall Plans
❑ Landsca e Plan
❑ Stormwater Pollution Prevention Plan SWPPP
❑ Access Permit
❑ Data Privac Adviso Form
APPLICANT/OWNER ACKNOWLEDGEMENT:
• Agrees to provide all information required or requested by the Building Department;
. Agrees to pay the City of Orono for engineering consultant review costs in excess of$500;
• Certifies that the information supplied is true and correct to the best of his/her knowledge. The applicant recognizes that they are
solely responsible for submitting a complete application being aware that upon failure to do so,the staff has no alternative but to
reject it until it is complete;
• Acknowledges the Escrow Agreement is completed and signed;
• Understands some or all of the information that you are asked to provide on this application is classified by State law as either
private or confidential. Private data is information which generally cannot be given to the public but can be given to the subject of
the data. Confidential data is information which generally cannot be given to either the public or the subject of the data. Our
purpose and intended use of this information is to annually update our records and records of other governmental agencies
required by law. If you refuse to supply the information,the application may not be issued.
• Agrees that in the event that weather or other conditions prevent the completion of an as-built survey at the time the
Certificate of Occupancy is requested, a temporary Certificate of Occupancy may be issued upon receipt of a $10,000
escrow to ensure completion of the as-built survey and all site improvements.
A licant's Si nature: �� � �� �G� ���� � � vZ�
pp g Date: ! Z �(7
Owner's Signature: Date:
Packet Last Updated: January 2016
Page 22
Christine Mattson
From: Christine Mattson
Sent: Monday, October 17, 2016 420 PM
To: 'tahzeeb@plekkenpol.com'
Cc: 'lynne@lawlmr.com'
Subject: 1285 French Creek Drive/#2016-01227
Tahzeeb,
We have the building permit for the proposed deck at 1285 French Creek Drive ready to be issued. The balance of the
permit fee due is$446.17.
Please don't hesitate to contact us if you have any questions.
Christine Mattson
Planning Assistant
City of Orono
2750 Kelley Parkway `� Orono ; MN ; 55356 (physical addressJ
PO Box 66 ; Crystal Bay � MN € 55323-0066 (mailing addressJ
�' 952.249.4620 ? � 952.249.4616
� cmattson@ci.orono.mn.us ' � www.ci.orono.mn.us
Office Hours: Monday- Friday 8 am to 4:30 pm
OUR OFFICE WILL BE CLOSED: Friday, November 11, 2016
Thursday& Friday, November 24& 25, 2016
1
PLAN REVIEW CHECKLIST FOR NEW STRUCTURES / ADDITIONS
Address: _ � �OJ �{.n� �,��`-vr'- �' Permit No.: �lYl ' !ZZi7
Description of work: �� � S�,rQfl,�� �(Cn �Q,�(� Date Rec'd: l 'Z`1'��
Septic review by: !— .�� Date Approved: � �
Zoning review by: Date Approved: �� • ��• ��
Building review by:_ �� �-�( � Date Approved: �b ' �Q•j�
Gradin review b � ' �
9 Y� Date Approved: ""—"'
. �
Zoning District. �� Reso#: Reso Date:
Zoning: Lot Area: �21 7L i�C��j_ � Lot Coverage: SF %
�
Survey Submitted: �Y e of Survey: Revised date(?): Q'�•t lU
/ j�,,, ,
Landscape plan submitteci-! �,o��� idscaper: �IVI Wv Y�.�l
,/ �
Proposed Setbacks:
Front (La Rear(Str ) (� S E W ) ( N � E W ) Other Buildings Wetland
Side ide
� '� � � � '^ t
lV
�� Defined Hei ht:
g __- Peak Height: FFE:T s ee = xis ing o
Perimeter(linear feet) _ �'� 50% _ �/' L.F. below
ase t? � Yes 0 No, Stories
FOR A BUILDING WITH A BASEMENT OR CRAWL SPACE: FOR A BUILDING ON A SLAB FOUNDATION:
The distance between the lowest proposed Slab at or above grade—
START WITH floor(of the basement or crawl space)and measure from hiqhest existin�c
the highest point of the roof. START WITH rg ade to the highest point of the
roof even if fill was brought in to
If you have a... elevate home.
SUBTRACTION • GABLE OR HIPPED.ROOF(no Slab below grade—measure
(BASED ON windows): Subtract half the distance from highest existing grade to t
ROOF TYPE) between the highest point of the roof hi hest oint of the ro
to the low point of the corresponding If you have a... ,.--`
gable or hipped roof SUBTRACTION ' GA �OR HIPPED ROOF
• G{�LE OR HIPPED ROOF(with (BASED ON ,,krt�ndows): Subtract half
�Cvindows): Subtract half the distance ROOF TYPE) --'"� the distance between the
between the top of the highest highest point of the roof to
window and the highest point of the .�`�� the low point of the
roof � corresponding gable or
hipped roof
• ALL OTHER ROOF TYPES(flat, . GABLE OR HIPPED ROOF
mansard,etc):No subtraction. (with windows): Subtract
SUBXF2ACTION Subtract the distance between the half the distance between
(¢ASED ON basemenUcrawl space floor and the the top of the highest
„-�XISTING highest existing grade adjacent to the window and the highest
� GRADES) foundation OR 10 feet(whichever is less). point of the roof
• ALL OTHER ROOF TYPES
(flat,mansard,etc):No
EQUALS Defined building height subtraction.
Defined building height
EQUALS
Updated: May 2016
z:\formslplan review checklist 5-2016.docx
Shorieland District MCWD Permit Average Lakeshore Setback g�uff
M et?
Permit Number: I _ �7 /� 0 Yes 0 No �q � Yes
Yes � No v No
❑ N/A—see attached Setback:
Stormwater Quality Existing Proposed
Overlay District Tier Hardcover Hardcover Variance Required CUP Required
circle one % and sf % and sf
1 2 3 4 5 � 1`��� w•�d � Yes o ❑ Yes o
� O�' Type(s): Type(s):
� 7Co3S 14 S�
Fees to be Char ed YES NO
Permit
Plan Review �/'
State Surcharge (/�
Investigation Fee �
SAC—Number of SAC Units Vr
Other(specify)
Square Footage $ per Square Foota e
Basement X = $
1 St Floor X = $
2nd FlOor X = $
Garage X = $
� l
Estimated Construction Value: $ 2 /,�(�d
Orono Inspections Required Work Requiring Separate Permits
�Footing ❑ Site � Plumbing � Grading/Filling
❑ Poured Wall Silt Fence/Erosion Control 0 Mechanical � Fire
❑ Foundation Survey ❑ Hardcover Removal O Fireplace � Water Connection
� Framing ❑ Other(specify) 0 Masonry � Sewer Connection
� Waterproofing/Drain tile ❑ Mfg. 0 Lawn Irrigation
� Foundation Waterproofing � Other(specify) 0 Landscaping
Framing
� Insulation
� As-Built Survey
Final
0 Lathe Required State Permits
❑ Other(specify)
0 Well Electrical
REMARKS (in-house): N U� rC,(�Qi(� �U•�7� ��
OFFICIAL REMARKS -TO BE NOTED ON PERMIT AND INITIALLED:
� See Builder Acknowledgernent Form
�Prior to release of escrow money an as-built survey and hardcover calculations must be submitted and approved.
Updated: May 2016
z:\forms\plan review checklist 5-2016.docx
City of Qrono
,o�o� Hardcover Calculation Worksheet
(,;� �,�' Property Address: �Z$s �'�.cnc.� Cvc�� Dr�ve
�'���,�,oF�° Prepared by: S«1 /s/e�z�a [�G. R�d� �•�r> Date: plL2//6
,y,�/ Lrc.. 5Z�o s
Stormwater Quality Overiay District Tier: (Circle one) Tier 1 Tier 2 Tier 3 Tier 4 Tier 5
Step 1: EXISTiNG HARDCOVER
!n the foilowing table identify�II items of existing hardcover on the property, keyed by letter to Certificate of
Survey (survey must accompany this form). Use as many lines as necessary to accurately depict existing
hardcover status of the property. �or Tier 1 properties, identify any features by letter which are split at the
75' setback line and calculate hardcover square footage separately for each portion.
Surve� Hardcover Item(Describe) Length x Wldth TO��
S uare Feet
Exam le Gara e 24'x 30' 720 S.F.
A fkvs� �- �rr�.��s-o G�,e� v�p,�r c�
�f 2Z S.F.
B L.4�1 o scRpial� 237 S.F.
C DEcK S87 S.F.
� S�rvnn� ovr v.J co 8 S.F.
E A�Y�KS fo/8 S.F.
F o 67F or[1.✓O�E' DE�,c� a S.F.
G
H S.F.
� S.F.
� S.F.
K S.F.
� S.F.
M S.F.
N S.F.
� S.F.
P S.F.
� S.F.
R S.F.
S S.F.
T S.F.
� S.F.
V S.F.
W S.F.
X S.F.
Y S.F.
Z S.F.
S.F.
1 Total F�cistin Hardcover iD -7(03 S.F.
Excludable Hardcover 3ee C Code Sec 78-1684 :
S.F.
S.F.
S.F.
S.F.
S.F.
2 Total Excludable Hardcover S.F.
3 Net Existin Hardcover Subtract line 2 irom line 1 �O ? S.F.
4 Total Lot Area 2 S.F.
Proposed Hardcover Percentage [(3)+(A)] f r.�,g o�o
(Proposed Hardcover next page)
This Is an/nfomtation packet regarding Nardcover. Every eHort has been made to fnsure the axuracy oi the lnformation contained herein;
howeve�if any fMormallon is not conslsfent with provislons of the City Code,the Code prov;sfons witl prevail.
KtC:tIVt�
Page 8 of 9
SEP 2 6 2016
cmr oF oRorvo
City of Orono
� �otio , Hardcover Catculation Worksheet
+,,,� ' Property Address: C /� D e
f\ ��` �2o S �'�'QnG� (_.v2G �C �.:i
`'A=S��c�` Prepared by: / n Date:
Sa� /l�i�ewtG��c (.EG �5�� fsons � ��L2�/�.
M� ��G� Sy�os
Stormwater Quality Overiay District Tier: (Circie one) Tier 1 Tier Z Tier 3 Tler 4 Tier 5
Step 2: PROPOSED HARDCOVER
1n the following table: identify al� items of proposed hardcover on the property, keyed by letter to
Ce�tificate of Survey (survey must accompany this form). Include all existing hardcover items that are
intended to remain, as well as all proposed hardcover items that will be added. Use as many tines as
necessary to accurately depict proposed hardcover status of the property. For 7ier 1 properties, identify
any features by letter which are split at the 75' setback line and calculate hardcover square footage
se arate! for each rtion.
Key to Hardcove�Item Describe Total
Surve � � length x Width S uare Feet
Exam le Gara e 24'x 30' 720 S.F.
A vS�i- �!ir�9GHEv ,�.,2/.}Cv� 237 S.F.
B �! Se��.�G Yt2 s.F.
C
D ir✓M No✓s p S.F.
L`T 3 S.F.
E � s � S.F.
F � ,✓i r rN0 DGGK o S.F.
G
H �^ 6 � 7Y . . . S.F.
� 3� S.F.
� � fl` mN S.F.
K 2 5.f.
� S.�.
M S.F.
N S.F.
p S.F.
p S.F,
Q S.F.
R S.F.
g S.F.
T S.F.
� S.F.
v S.F.
� S.F.
x S.F.
Y S.F.
z S.F.
1 Total Pro osed Hardcover S.F.
Exciudable Hardcover See Ci Code Sec 78-1684 : � � S.F.
S.F.
S.F.
S.F.
S.F.
2 Total Excludable Hardcover S.F.
3 Net Pro osed Hardcover Subtract line 2 from line 1 S.F.
4 Total Lot Area S.F.
7 S.F.
Proposed Hardcover Percentage ((3)+(4)] �CI � o�
KCCtIVEU
This is an lnformation pscket regarding Nenfoover. Every effort has been made to insure the eccuracy of tha rnfo»nation conta�
hen9in;however,!f any/nfomtation is not consistent with provisions of the City Code,the Code provisians will prevail. �P 2 6 2��6
Page 9 of 9
CITY OF ORONO
' � � Builder Acknowledgement Form
Permit #2016-01227 / 1285 French Creek Drive
Builder Representative Name: � I /`���Z(/� G�I�J�'�/1L�Z
Permit Conditions: Initials
Erosion control mechanisms must be installed and inspected by the City prior to any land
disturbing activities. The contractor must provide a minimum of a 24 hour notice prior to ��
inspection.
Erosion control shall be installed and maintained throughout the entire project and must ��
remain until vegetation has been established.
A haul route shall be submitted to the City Engineer for approval and inspection prior to
commencement of hauling from the site.The property owner shall be responsible for cleaning ,��iv
and repair of roadways for any adverse impacts. ��
Prior to the refunding of escrow money an as-built survey and hardcover calculations must be L1_4�L�
submitted and approved.
Advisory Comments
Any changes to the exterior/landscaping improvements, i.e. patios,grading, sidewalks, retaining
walls, etc. not currently shown on the approved survey and landscaping plan will require a �
separate Zoning Permit application to be submitted and approved prior to the work
commencing.
Any retaining walls that are over 4-feet in height or tiered walls not separated by twice of the ��
height of the lower wall require engineered plans and a building permit to be submitted and � !
approved prior to construction.
w:\street files\french creek dr\builder acknowledgement form 2016-01227.docx
C� � � r �
�— DATE TIME
CITY OF ORONO � CALLED IN �/�� �
INSPECTION NOTICE SCHEDULED
PERMff NO. � COMPLETED
ADDRESS ^ C t'f�-' ~ L� ��
OWNER TELEPHONE NO. �L� -S�
CONTRACTOR ��t`"C �����
� DESCRIPTION � � l- I C �=ca r� N�'�
�
�OOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL
❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING
Q ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑ TREE REMOVAL
Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION
Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ RATED WALLS
� ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT
Q ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP
W ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATION/REMOVAL
_ ❑ DEMO-SITE �TIC INSTALL
v
2 01MNERlCONiNACTOR TO MEET YiOU: YES_NO
y COMMENTS:
W � �vs- -�� � 1���ws s '
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� K SAT�SFACTORY:PROCEED ❑PROJECT COMPLEfE
❑CORRECT NfORK 6 PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY
0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORE CONERINO PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. ❑ pHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Cae for the next inspection 24 hours in advance. (952 j 249-4600
OwnerlContractor on site:
Inspector: � �
YYhit CopYllnsPector's FII� C�nary CopYISM�Notiee
� �7 ,'�✓ '
DATE TIME
CITY OF ORONO CALLED IN / '! �
INSPECTION NOT CE SCHEDULED � - —�
PERMIT NO. ��1�"�`�'�COMPLEfED
ADDRESS ���-� ��/ (���� ��`�'
OWNER T LEPHONE . �� ���6 �
CONTRACTOR �
� DESCRIPTION ���c ��� «�"
��OOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL
POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING
Q ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑ TREE REMOVAL
2 ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION
Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ RATED WALLS
� ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT
Q ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP
W ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATION/REMOVAL
_
J ❑ DEMO-SITE ❑ SEPTIC INSTALL
2 OWNENCONTRACTOR TO MEET Y�OU:_YES_NO
c� COMMENTS:
�
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o — o•� - 15 ��
)' ��r►/7 7�Cj. / K�it�� ��v►C✓
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W ❑WORK SATISFACTORY:PFIOCEED ❑PROJECT COMPLETE
��G.Al1F�CT WORK d PROCEED ❑ISSUE CERTIFlCATE OF OCCUPANCY
���❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECWERING PERMANENT
❑CORRECT UNSAFE CONDITION WRHIN HOURS. p p�{pT0 TAKEN
INSPECTOR WILL RETURN
O STOP ORDER POSTED.CALL INSPECTOR ��TATION ISSUED
�INSPECTION RE(]UIRED.CALL TO ARRANGE ACCESS.
Call tor the next inspection 24 hours�n advanoe. (g52) 249-4600
OwnerlContractor on sFte:
inspector: �_ �
Whits CopyAnspecto�'s FH� C�nary CopylSiN Notic�
� � ���- /
/Z^�TE/� TIME V
CITY OF ORONO cnLLED IN
INSPECTION NO E �HEDULED �� ��
PERMIT NO. �r �/co ere�
ADDRESS � � �-5 ��-�- �✓��
OWNER TEL PH NO�� "3�g^�3��
CONTRACTOR �����LJ CL
� DESCRIPTION C �'�'r�'�
�y ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC F AL
Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/G ADING ILLING
O ❑ FOUNDATION WATEHPROOF ❑ PLUMBING FINAL ❑ TREE RE VAL
Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION
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