20040514.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NIMEIF BUSINESS
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GRADING
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FENCE
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TANK
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CARPORT
RETAINING WALL
FIRE SPRINKLER
ROCKERY
ALARM
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-FIRE
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HEAT SOURCE I GLAZING % I LOT SLOPE %
PLAN CHECK NO: I VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180DAYS
PERMIT LIMIT., I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BE14ALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOtD HARMLESS IIIE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECIlY Oil INDIIlFCTIY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF 1 HIS PERMIT SIIAl L NO I [IF
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS A131LIlY TO ENFORCE ANY ORDINANCE PROVISION "
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THAT THE INFOIIMATION
GIVEN 15 CORRECT, AND THAT I AM THE OWNER, Off THE DU& AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSIRUC
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGION RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18 27.
A T) . SIGNED
4// DATE SI
I '. If
ZONE
1100
ADDRESS i ty\ %
PLAT NAME/SUDDIVISION NO
I PERMIT EXPIRES
PERMIT 11�7
NUMBER
0 Ll Vd- I.- I SUITE/APT#
LOT NO. LID'kJO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved 13
AW Permit Required 13
EXISTING
Street Use Permit Roqd E3
- PROPOSED
Inspection Required Q
Sidewalk Required 13
REQUIRED DEDICATION. FT
Underground
Winno required
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 1:1 NO 13
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REMARKS
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OWNER/CONTRAC1OR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
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ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE Lu
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VARIANCE OR CU SHORELINE OR ADEI# [INSPECTION BOND
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SEPA REVIEW SIGN AREA HEIGHT
- I EXEMPT ALLOWED PROPOSED ALLOWED , PROPOSED
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ALLOWED PROPOSEV', U�g lar�
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REO'D I PROVIDED
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GROUP
SPECIAL INSPECTION A OCCUPANT
REQUIRED [- LOAD
ES
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REMARKS
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PROGRESS INSPECTIONS PER UBC 108/IBC109/IRC109 FINAL INSPECTION REQ1D a
VALUATION
Description
Plan Check
Building Permit_
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
FOR INSPECTION
(425)
FEE Description
State Surcharge
City Surcharge
Base Fee
Plan Chk. Deposit
FEE
Receipt If
Total Amt. Due 4-5 . 47`
Receipt #
—
APPLICATION APPROVAL
I his application is not a perinil until signed by the
Building Official or his/tier Deputy: and Fees are paid, and
receipt is acknowledged ill space provided.
OFFICIMP,SIG�ATURI�� DATE
771-0220 L_11F1 EA!!
ATTENTION E)ff 1333
IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110.
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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NOTICE IF THE DOCUMENT IN THIS FRAME IS LESS CLEAR THAN THIS NOTICE
IT IS DUE TO THE QUALITY OF THE DOCUMENT.
1,04-k
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall .......... I ...............
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final ......
HEATING:
Gas Test ....................
Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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DATE RECEIVED
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[ PERMIT EXPIRES
U E -1110� -
CITY OF EDMONDS ZONE PERMIT
NUMBER
CONSTRUCTION PERMIT APPLICATION JOB
OWNER NAME/NAM OF BUSINESS AODRESSL22� SUITE APT #
PLAT NAME/SUBDIVISION No. LOT NO LID, 07'_
A LING ADDRES�
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> LID FEE S
0 glo 6t o;V A) PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved
CITY Al RW Poinut Required
TEONE IIS Street use Pareilt Flect'd E3
;t14 E
7,eCl Inspection Floquifed ia-
> ZIP TELEPHONE EXISTING � pAOpOS
Sidewalk Required E3
REQUIRE[) DEDICATION underground
NAME A FT Wiring required
7�
METER SIZE LINE SIZE TNO OF FIXTURES PRV REQUIRED
I`_ 1 93
U 74I)l
W YES NO
ADDRESS
REMARKS
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OWNER"CONTRACTOR RESPONSIBLE FOR EROSION CONIROL/URAINAGE z
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CITY ZIP TELEPHONE
NAME BL 0 AIN I LA!��_ zkiiwo.) 77aa r Z)NF ��:4
L11_"_ . I CLIC T- fi�NALF iri-L ikc
CC AUUMESS GINEERING REVIEWED BY
0 DATE
13 A71
4 e-_-, ZZW7
CITY ',ARE REVIEWED B�_
0 ZIP EL20NE DATE uj
U
VARIANCE OR CU SHORELINE OR ADB# INS BOND
STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY PECTION' I POSTED
EQ DEIYE�S �.j ID
SEPA REVIEW SIGN AREA
< PROPERTY TAX ACCOUNT PARCEL NO, HEIGHT
a 0 COMPLETE EXEMPT ALLOWED PROPOSED AILLO D PROPOSED
W 0 .;.
1,�u
NEW EXP I C
RESIDENTIAL PLUMBING MECH LOT COVERAGE UIR SETBACKS(FT) PROPOSED SETBACKS (Fr.)
r$ M ALLOWED PROPOSED FRONT SIDE REAR FRONT LJR SIDE REAR
ADDITION COMMERCIAL COMPLIANCE OR 0, 11) r::� 1 0
1:1 CHANGE OF USE :15% 272- 445�/57 9 /
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REMODEL MULTIFAMILY PAKING PLANNING REVIEWED BY DATE 5
1:1 SIGN REO'D I PROVIDED 0.
GRADING CYDS 11 FENCE ;?, ; i q it v
REPAIR x FO REMARKS
DEMOLISH
TANK 0 OTHER
TV GARAGE RETAINING WALL FIRE SPRINKLER
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0 FIRE ALARM
E (TYPE OF USE. BUSINE�S�OR ACTIVITY) EXPLAIN:
CHEQKI��B TYPE F C CTION I Cj:OD�E OCCUPANT
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ILLING — -V-.&/-- N.�k))
NUMBER BER OF
:5 1�1 Y
OF 1___�
o STORIES 2%� U ITS SPECIAL INSPECTION AREA OCCUPANT
REQUIRED [-
DESCRIBE WORK TO BE DONE YES LOAD
F2
REMARKS
-PROGRESS INSPECTIONS PER UBC I 08/FINAL INSPECTION REO'D z
C-)
5 1 t 2 1
yj� VALUATION
Descrip'tion FEE Description FEE
RCE
1 1) 1 � '. Plan Check State Surcharge
HEAT SO 14-1-J
GLAZING %
A/Ij 01 Building Permit City Surcharge
PLAN CHEC VE 9
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
cc Engr. Review
UJI PERMIT APPLICATION: 180DAYS
EL PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr. Inspection 'J.'5z)
U)
*APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
FICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON. ITS OF Fire Inspection
< ALLCLAIMS OR DAMAGES OFWHATEVER NATURE, ARISING DIRECRY OR INDIRECTLY Receipt #
FROM THE ISSUANCE OF THIS PERMIT. -7
ISSUANCE OF THIS PERMIT SHAI L NOT HE
_j DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapeinsp. Total Amt. Due
x 0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION..
Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THAT THE INFORMATION
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DU& AUTHORIZED AGENT OF APPLICATION APPROVAL'
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTnUC- This application is riot a PcrrTlit until signed by the
TION ' AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION fcculpt is acknowledged in space provided
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
SIGNATLIR dwNEA R GENT) OF - FICIA "SIGNATURF DATE
DATE SIGNED
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(425)
1, '71 M(I
771 0220 RE-1 EA5ED BY
AT-TENTION' DATE
E)ff 1333
IT IS UNLAWFUL TO USE On OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 ORIGINAL - FILE YELLOW INS CTO
041�02 PI NK-OWNER GOLD -ASSESS(
PRESS HARD -YOU ARE MAKING 5 COPIES GREEN ACCOUNTING 20
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SCALE: 1 " = 30.00'
ASSESSOR'S PARCEL NO.
00 5927 000 012 00
OWNER
HOWARD AND LEANNE ANDERSON
1006 CAROL WAY
EDMONDS, WA 98020
LOT SIZE
14,810 SQ. FT.
LOT COVERAGE
3152 SQ. FT.
PERCENTAGE OF COVERAGE
21.20 %
ANDERSON RESIDENCE
1006 CAJROL WAY, EDMONDS, WASHINGTON 98020
SNOHOMISH Q0IJ-NTY-,-WA.S1+NGTON
NEW BUILDING & ROOF AREA
3549 SQ. FT.
NEW WALKS AND DRIVES
1206
TOTAL NEW IMPERVIOUS AREA:
LEESQ.FT.
EXISTING BLDG/ ROOF AREA:
2400 SO. FT.
EXISTING WALKS/ DRIVE AREA:
670 SO. FT.
TOTAL EXISTING AREA:
3ffO-S-0. FT.
NET NEW IMPERVIOUS AREA:
1685 SQ. FT.
Q'Amwej-T 66%KrT
iutsl 1KPev-q16ktS
gv�'W(n ?'cA6v9�r'>.
HEIGHT CALCULATIONS
DATUM PT. @ SEWER M.H. IN RD.
DATUM SET AT 100.00'
A= 108.5'
B=109.5'
C=111.0'
D-108.0'
AVERAGE HT = 109.25'
ACTUAL HEIGHT = 131.78'
MAX. HEIGHT = 134.25' 3
datum point
Top of sewer MH
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OVERHANGS
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102'
CD -104'
-- ----- --- 7- .-0--"- --106'
........ ..... ...............
+D1 108'
CONCRET� V LKWAY 1 Is a
floor leve
112 00*
""-'.'�--;-7,�70UTLINE OF EXISTING
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ESIDENCE
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0 GARAGE CL
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I PROPOSED
CONCRETE
I OVER
EXISTING
GRAVEL DRIVE
L 6911615�rG fE-T—BAEK ENE' — — — — — — — — — -
PL= 100.07
sewer MH EXISTING EXISTING GRAVEL
Alley DRIVEWAY
110,
RE-e WED
DEC 12 2003
PERNIT COUNTER
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Height Calculation Worksheet
Address: Q�D �C�
Date:
fiLspector(s): YY-)
1. Datum Point:W 14 3�
2. Datum Point Elevation:
3. Average Grade: 0
.4. Maximum Elevation Allowed: -((averqgb &ade)`+-- 25'."--
5. Reference Point Elevation Shot to House:
(datum elevation) +e,'� (grade to transit level line'shot to house)
6. Measurements from line shot onto house to roof ridge:'
Total
7. Actual Elevation: 1 0 �(reference point elevation) +t (measurements
from #6) �78
ConclusiQn:
13 �- i � 8 . (actual) is greater / less than (allowed); therefore the house is/
is not over the height requirement per ECDC 16.20.30 requirements
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Agency Case No, I'UG ET S 0 1-1 N 1) C L FLA N A I R Dafe Receiv cd
,�G
jENCY
I 10 Union Street, Suite 500
Seattle. WA 98101-2038
—001
200400625 www.pscleanair.org
OM NOTICE OF INTENT
B.
Property Owner: PL - Phone: q2-f-'- 3 �k *, -z-
Mailing Address: City: State ZiE:
, Fc-.,
11LF-4SE'1'RhV1'C1J�4R1J'. 7111.1; 1171.1.11E
C. Asbestos
Contractor: GOP%
Owncr/CEO:
Contractor
Mailing Ad ress:
d Aue-
P 11 o n c: �-(2 -7 -3 - 133
Job N o.:
Citv:
State:/,;;/1
Zip: '3
Fax:
D. Site
Address: it!X-�G (f�j— Tcity: J� ��7 zi : 10'5t:, 2-0
1 Site I — -1
LocalPhone:
E. U
Asbestos Survey or
No. of
Date of Asbestos
Was Friable Asbestos Identified? 1�)Yes LJNo
El
Mat'l Presumed
Structures:
Survev:
Was Nonfriable Asbestos Identified? E]Ycs ONO
AHERA Buildil
Certification 9:
A llach a copy of the suri,ey whenfiriable asbestos
, 11 /.
Inspector: r C't'
Exp.Date:
has not been identified.
AnAHERA Suri,e), is required before all demolition projects
F. Demolition
Swart
No. of
1. U Trainine Fire (List Fire Dept.)
Information:
I Date:
Structures:
2. El Ordered Demolition (attach copy of Order)
Demolition Insert demolition contractor's mailing address on back.
Will rionfriable asbestos be left in place during demo? U Yes )�F —No
Contractor:
If yes, I ist type and qty.
H. Asbestos[Demolition Project Categories:
Notification Period
Project Demolition
1. Single -Family Residence (own e r-occu pied):
Fee SurcharLye
A . C] Asbestos Removal Project Only
A. Prior Notice
A. $25
B.'UDemolition Project (with or without asbestos removal project)
B. 10 Days*
B. $50
*(Asbestos removal can begin upon notification; demolition must wait 10 days)
Note: tr1he singlefami1j: residence is owned bj) onefatni1j) who has been or will be rising the residence ir i �1�e ff/h above boxes
&191�efil
1.4 or IB may be checked If this is not an owner -occupied residence, one of the categories listed be Qle fain ily
residence does nol include rental property, mulli-fainill) units, or anj) inixed-use buildi g.
2 [3—
All Other Demolitions with no Asbestos removal or Nonfriable Asbestos
10 Days JUN 3
0 2004 $200
only
Friable Asbestos Projects (otherthan Single Family Residence):
Asbestos
CC), wTF=R
3. LJ
�: 10 - 259 linear feet and/or �: 48_- 159 square feet of asbestos
- -PPRI
Prior Notice 10 Days
-$-I(rO' $100
4. Ll 260 - 999 linear feet and/or 160 - 4,999 square feet of asbestos
10 Days
$200 $100
5. 1Y 71,000 linear feet and/or >5,000 s�uare feet of asbestos
10 Days
$750 $250
6. M-E—mergency Asbestos Project or LJ Emergency Demolition Project
Prior Notice
Twice Project Fee
(Sin�fle-Farnily Residences are exempt from emergency fee; however, property o%%iiers must provide a
written emergency request)
I certify/that the Inforpation con . d in this notification & supplemental data is, to the best of rny knowlecige, accurate & complete. AgenSy USC Qnly
7 �#/
rsl� r, fl- L(
Representirng L) 0 Date WRe�vieuv�t'd
Puget Sound Clean Air Agency Form No.: 66-160 (Revised 1/04) TS P. 211 V U I f1c, Y
CK, �
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The Puget Sound Clean Air Agency requires advance notification before any person commences a friable asbestos project
involving materials equal to or greater in size than 10 linear feet or 48 square feet and for all demolition projects
(regardless of asbestos content) involving structures with a projected roof area greater than 120 square feet (Regulation
111, Article 4). All asbestos removal and demolition notifications must be submitted to the Agency on current Agency
forms. Asbestos removal and demolition pr�lects involving
, materials and structures below the notihcation threshold are
still subiecttoall other requirements of Res4ulation 111, Article4.
After receiving a complete notification with the appropriate project fee, tile Agency will review the form and return a
copy to the asbestos and demolition contractor by mail. The returned copy will be your validated notification.
0
J. Demolition PU-4SEPAJA7CLF4RL)' 111IN V W, BF I tit A ROT K% .1 UIIJA�; L481-'
Contractor: 13r.q
0%%ncr/CE0:
Mailing Address: 2 r
2- PC14'(�e�
Illone:
Contractor's
Job 4:
tr.�ei/etr�'
City: 0
State:i L,.,914 W
lZip: 9'_6 _Z7 5�
1 Fax: Ll 25— —,3 i5 -3 —
GUIDELINES FOR SUBMITTING AN ASBESTOS\DEMOLITION NOTIFICATION
Step 1. Check tile appropriate project type in Box A. Friable asbestos includes popcorn ceiling material, sheet vinyl flooring, cement
asbestos board siding, and duct insulation. Nonfriable asbestos is normally found in vinyl floor tiles, window putty and most roofing
materials.
Step 2. Enter property owner information in Box B.
Step 3. Enter the asbestos contractor or property owner information, if the property owner is conducting a single-family residential
project, in Box C. Print clearly this is your return mailing label.
Step 4. Enter the site address for all notifications in Box D. For multi -structure projects, attach supplemental sheet with a site map
(include an address for each site) and a list of the type and amount of friable asbestos to be removed from each structure.
Step 5. Check either asbestos survey or material presumed in Box E. All demolitions require that an Asbestos Hazard Emergency
Response Act (AHERA) asbestos survey be conducted by a certified AHER.A building Inspector. Attach a copy of the survey to the
notification of a demolition 12rooect when only nonfriable asbestos or no asbestos is identified on the survey.
Step 6. Enter the project information in Box F. and check the training fire or ordered demolition box if appropriate (a copy of the
official order must be attached). All asbestos must be removed prior to conducting a training fire. Additional training fire
requirements are contained in Regulation 1, Section 8.08. If any nonfriable asbestos materials will be left in place during demolition,
check yes and list the type and quantity of material.
Step 7. Enter as bestos project information in Box G. List types of friable asbestos material to be removed: surfacing material such as
popcorn ceilings or plaster, sheet vinyl flooring, duct and pipe insulation, cement asbestos board siding or pipe, etc.
Step 8. For owner -occupied Single -Family Residential projects, check BOX HIA for renovation projects or BOX HIB for
demolition projects (with or without asbestos removal). Asbestos removal may be conducted after a complete notification is
received, but demolition activities can only begin on the 10h day after the notification is received. Note: If the singlefamily
residence is oirwied by onepindly who has been or will be using Me residence as iheir domicile, boxes ]A or 1B may be checked. A
singlefamily residence does nor include rental properi�v, inulti-fatnily units, or any niLred-use building.
For Commercial asbestos projects (or projects that do not qua lify as Single Family Residential); check tile project category H2 -
5 that matches the amount of friable asbestos that will be removed. If a demolition is involved, include the appropriate surcharge
(additional fee) in your payment. To file for an emergency asbestos or demolition project, check the appropriate box I — 5 and the
applicable emergency box in,H6. All emergency requests must be accompanied by a letter from the property owner demonstrating
' the
need to conduct the proiect immediately in accordance with the requirements in Regulation 111, Section 4.03 (c).
Step 9. Please certify the accuracy and completeness of tile information provided by signing the notification in Box 1.
Mandatory amendments to tile notification are required for changes that increase the project category, change tile types of asbestos
materials to be removed and changes to start date, completion date and work schedule for asbestos projects. No fee is required for
work schedule changes if the contractor is participating in the Agency work schedule fax program. A $25.00 processing fee is
required for all amendments.
Puget Sound CleanAir Agency asbestos regulations and forms can be downloaded from the Agency web page at www,psclealiiir.org.
For technical assistance call (206) 689-4058 and for administrative inquiries call (206) 689-4090.
Puget Sound Ocan Air Agency Form No.: 66-160 (Revised 1/04) TS
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FINAL PROJECT 'A PPROVAL FORM.
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLEASI SIGN
A-J'Y] a J��.21r�Pjt,�ENGINEERING DIVISION DATE 7
PLEASE SIGN
PLANNING DIVISION DATE
PLEASE SIGN
PROJE CT A y-rb
SITE ADDRESS —
PERMIT # 201 tb-4- r4 Z 4 9 _ADB# DATE INSPECTED '7 7
DESCRIPTION OF WORK TO BE INSPECTED
A field inspection was conducted to determine compliance with -approved plans. Final approval
denotes that there are no objections from the above signed Department to the release of
PERFORMANCE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
D Copy of CONDITIONS given to ownei-/contractor by inspector
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
0 Copy of CORRECTION NOTICE given to owncr/contractor by inpector
2.
3
RE -INSPECTED OUTSTANDING ISSUES - GRANTFINAL PROJECT APPROVAL
Date Signature
1:temp:b1dg:forn1s:ocaprv1 3/25/04
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS ..................... Pf )s
FOUNDATION:
Footing ......................
Wall.......................... CV)
Pier/Porch ............
Retaining Wall ........... z
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Slab Insulation ..........
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PLUMBING: M
Underground .............
Rough -In ...................
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C 0
Commercial Final ...... M 0
HEATING: -40
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Gas Test .................... X M
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Gas Piping ................. C
Equipment .................
Commercial Final .......
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EXTERIOR SHEATHING
NAILING .......................... -7 In - -,Z-6
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0
FRAMING........................ 0
-r23 - 0 M
FIRST FLOOR FRAMING ... C cf)
CO)
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INSULATION ................... Z f—
Floor Insulation .........
Wall Insulation ........... 3:
Ceiling Insulation ....... z
SHEETROCK NAILING ... C/)
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SPECIAL INSPECTION ... 0
IDS
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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