20040931.pdfDATE RECEIVED ERMITEXPIRLES
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USE PERMIT
CITY OF EDMONDS ZONE UMBER L L
ITE/A #
JOB
CONSTRUCTION PERMIT APPLICATION ADDRESS
OWNER NAME/NAME OF BUSINESS
( N' A, c PLAT NAME/SUBDIVISION NO. LOT NO. LID NO
MAILING ADD rA�ji-4-1v, LID FEE S
W RESS
IESCP APPIO�fld 0
PUBLIC RIGIIT OF WAY PER OFFICIAL STREET MAP Hw Permit Atiquilod 0
'A street use Permit Rtmd 13
EXISTING — PROPOSED inspection Required Q
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C -7 IFT undergmund
REQUIRED DEDICATION
C_� ';�O -e c -ZL: 5 Wmno required 0
NAMEF- - METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
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E ADDRESS REMARKS z
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.STATE LICENSE NUMBER EXPIR TION DATE I tHECKE I REO' * ' POSTED
III I 10YES NO S
121. SEPA REVIEW SIGN AREA HEIGHT
P PROPOSP
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LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT)
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ADDITION F-1 COMMERCIAL COMPLIANCE OR �� 5 1 d' I (T
OCHANGE OF USE 35"'yC* tef, &,5 1 % z
PARKING LOT A�REA NNING REVIEWf D )3Y DATE :3
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A J11, '_��o X FT) REMARKS
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'5R CTION GROUP
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NUM-BER OF CRITICAL
w NUMBER
a OF DWELLING AREAS SPECIAL INSPECTION JAREA OCCUPANT
in LOAD
0 STORIES UNITS NUMBEa REQUIRED [] YES
DESCRIBE WORK TO BE DONE
REMARKS z
PROGRESS INSPECTIONS PER UBC 1081IBC109/IRC109 RNAL INSPECTION REO'D
'A V1 - .' :3
01\11 1A (� (7 A C3 17� __ M
0� (_0 UYj - VALUATION
$.�31 I/
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURC�_T GLAZING No
Ts 0- Building Permit City Surcharge
PLAN CHECK NO: VESTED DATE Plumbing 'If7 Base Fee
7 `1
Mechanical C/ f72V '�?U
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.
Engr. Review G
Cr PERMIT APPLICATION: 180DAYS
W
IL PERMIT LIMIT: 1 YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Cn 'APPLICAN1 ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
IN INTERE�T,' AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt It
a:
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECI LY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT LIE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
X.1 - Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF APPLICATION
THE OWNER. I AGREE TO COMPLY WITI I CITY AND STATE LAWS REGULATING CONSTRUC- CALL I his application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building 011icial or his/tier Deputy: and roes are paid, and
I IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. OFFICIALS SIGNATURE DA E
SIGNA/TU WNPR' AGENT) DATE S NED (425) IL
" I /
L
ATE
-0220
771 FIE'l F IlAwl
[Ij,�TAS (,( (
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ATTENTION EXT 1333
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADEAND APPROVALOR A CERTIFICATE OF OCCU- ORIGINAL FILE YELLOW - INSPECTOR
I -ASSESSOR
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110- PINK OWNER GOLD
09/03 PRESS HARD -YOU ARE MAKING 4 COPI S
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1.0 GENERAL *'44IL CP o,fIJ CtK%"C ELIE* 6-YE-
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4.0 CARPENTRY
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2,2 BACKFILL AND COMPACTION
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3.1 GENERAL �fllu o4E %Ntz J� ALI It 9 SLEVAT111
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=ItzIIroI �2%t`wz_ Soo`� Lot IN
3.3 MATERIAL . CEMENT, WATER & AGGREGATES PER ACI 301 sTANDeLicD
CE smavo CAIoME Asie iod a. T.E e
AP11,101V A;. 19 od:2.6"D WOR Ube a, TN401! I aIoT74! AAw. "�ICAI VIE IT -�Q CZ�%471C" 7.J.'04 rh�k
5 4.AoTolt tv 5z C.RA% � `C"�! Height Calculat On
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14 MATERIALS 5.0 MISCELLANEOUS 0 csl�
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Legal Description Lot Coverage
a 2.�q ACo, A-.,bE ,c Z*AE41! A�� ones PTIMA1.717. �ITG WW01N I.AV4 4WA 'EAR? �Akk Fit', is Otto C� P, oo� ?4IF §Oo'�tb't�y 115 Peet cr A"A 16ce
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I PLOT PLAN
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RECIEWE
SEP 10 2004
PERMIT COUNTER 104
NORTH
He—.01t Plan
SCALE. 11 - 2111.
Legal Description
THE NORTWLLESTERLY 35 FEET OF: TRACT 6. AND THE $OUTWU)ESTERLY 55 FEET
OF TRACT 8, TAYLOR IRLACTS, Ar-OCI;WING TO THE PLAT T14EFZECF RECORDED
IN VOLUME 12 OF FLATS. PAGE al. RECORD5 OF 5NOWO�IISW C,0.JNTY, LL5.5WINGTON
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CITY Cu"Py
Height Calculation
PONT A 05.15
PONT 5 ;05.25
POINT C 102-110
POINT D 101.15
TOTAL 41525
41525 DIVIDED 5 4 - 103BI25 MAXIL9*1UM AVERAGE GRADE
103,5125' - 25'-0' T t2b,6125' MAXlt'� ALLCWA5LE WE4WT
1285411 ' ACTUAL RIDGE ELEVATION
Lot Coverage
LOT AREA 12,belo SQUARE FEET
LO
CO�aRA��E 3455 S=A ET
!!E �E
LOT COVERAGE AS A PERCENTAGE OF LOT AREA - 71."%
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MA�CIIMUM RID41U. ELEVATION 12001151
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PERMIT COUNTER
H ht Calculation
POINT - A 105'.
POINT - 5 105.2
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POINT - C 10250
POINT - D 101.15
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TOTAL 415.25
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5�� AVERAGE GRADE
ALLCIA)AMLE WEI(SWT
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V
p LOT ARE 12boo 5=ARE FEET
TWE NORTWUJESTERLY 35 FEET OF TRACT 6, AND THE 5CUTWL)ESTERLY 55 FEET LOT CO E 34435 SCUARE FEET
AREA 21.1316
RASE AS A PEIZCENTA�GE
Cf TRACT S. TAYLOR TRACTS. ACCC-RDIW3 TO TWE PLAT T14EFZECF RECCSVED
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IN VOLUME 12 OF PLAT5. PAGE ti, RECORD5 OF 5NOWOMISW COLNTY. WA.5WIN5TON LOT C:;Il E A; A*F`Eq�liq �c 'LTnT A*FA
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ENGINEERING REPORT
and
INFILTRATION TRENCH DESIGN
FOR
LEIF HELLEREN CONSTRUCTION, INC.
1016 GRANDVIEW STREET
Edmonds, Washington
October 2004
WA, FIVED
OCT
PEFIMI-f CouNTER
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EXPIRES 8/
Prepared by:
Robert L. Long
5 1 5 U 4 V i Y 0 R z
Lovell-Sauerland & Associates
19400 33rd Avenue W. Suite 200
Lynnwood, Washington 98036
LSA No. 4647
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ENGINEERING REPORT
and
INFILTRATION TRENCH DESIGN
FOR
LEIF HELLEREN. CONSTRUCTION, INC.
1016 GRANDVIEW STREET
Edmonds, Washington
October 2004
38608
40
EXPIRES 8 /171 iV
Prepared by:
Robert L. Long
Now
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Lovell-Sauerland & Associates
19400 33rd Avenue W. Suite 200
Lynnwood, Washington 98036
LSA No. 4647
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LEIF HELLEREN CONSTRUCTION, INC.
10 16 Grandview Street
Introduction
This summary report provides site design information for the proposed lot development for
Leif Helleren Construction, Inc. It includes storm drainage(infiltration) and grading analysis
to support to the construction of a single family residence. The property is located at 1016
Grandview, in the southeast 1/4 of Section 13, T 27 N, R 3 E, W.M.
ApplicantlOwner.-
Leif Helleren Construction, Inc.
c/o Leif Helleren
P.O. Box 1764
Edmonds, WA 98020
(206) 533-8200
Site Address:
1016 Grandview Street
Edmonds, WA 98020
Tax Parcel Number., 005951-000-006-02
TABLE OF CONTENTS
NUMBER OF
SECTION CONTENTS PAGES
A. Project Summary ........................................... 2
B. Site Plan ................................................. 1
C. Parcel (Vicinity) Map ........................................ 1
D. Infiltration Sizing Calculations and Guidelines ...................... 4
E. Soils Map and Description .................................... 2
Lovell-Sauerland and Associates
October 2004
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Leif Helleren Construction, Inc.
1016 Grandview
LSA No. 4647
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Site Development Summary
Drainage Improvement Design:
A new proposed residence is proposed to be constructed on an existing 12,600 sf lot. The existing
house has been razed to allow for the construction of a new home. North Stream runs westerly
just north of the site (on the north side of Grandview Street). To mitigate the development of the
site, an infiltration system will be installed to control the drainage runoff from the impervious
surfaces. All on -site impervious surfaces are proposed to be collected and routed to the on -site
infiltration system. A 6" overflow pipe will provide a discharge outlet if the infiltration system
reaches capacity (to prevent flooding). Listed below is a summary of the infiltration trench design.
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Infiltration Trench Design:
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The on -site infiltration trench is to be constructed per the City of Edmonds'standard practices. The
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length of the trench is dependant upon the measured infiltration rate of the native soils and the
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collection area conveyed to the individual trench.
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SCS soil survey designates the area soils as an Alderwood-Urban land complex (#5- type C) soil.
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Alderwood, Everett and Norms soils. General soil characteristic can vary greatly due to the
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variation of multiple pockets of soil types (see attached description). Two test pits, in the area of
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the proposed infiltration trench were explored on -site. The soils found in the pits was medium sand
(at a depth of about 2.0 feet below the top duff). Thus, confirming the SCS description of an
Everett (#18- type A) soil. Two test pit percolation trials were completed on the soil to determine
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the on -site percolation rate (see attached calculations).
Using the City's design criteria (King County method), a required trench length was computed. A
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length of 50 feet of 4 feet deep, 4 feet wide trench was determined to fully infiltrate the 100-year
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Site Area Summary:
Total Site Area = 12,600 sf
Proposed Impervious = 6,700 sf
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House+garage = 3,900 sf
Driveway = 2,200 sf
Deck, Patio, & Walkway 600
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Lovell- Sa uerland and Associates Leif Helleren Construction, Inc.
October 2004 =M"Mu 1016 Grandview
LSA No. 4647
� �4
Grading and Erosion Control:
Thisproj ct will require grading to raze the existing house and construct the proposed single family
resident development. Standard erosion control measures are proposed to be used during
construction. The primary erosion and sediment control BMP during construction will be proper
soil stabilization methods. Exposed soils shall be stabilized by application of effective bmp's that
protect t e soil from the erosive forces of raindrops, flowing water, and wind. Applicable practices
include, t not limited to, temporary and permanent seeding, sodding, mulching, plastic covering,
erosion control fabrics, matting, soil application of polyacrylamide (pam) , the early application of
gravel ba �se on areas to be paved, and dust control. The contractor shall select a soil stabilization
method best suited for the particular situation. Stock piles must be stabilized and protected with
sediment trapping measures. In addition, site containment of exposed soils shall be sustained by
using silt�fence barriers along the down -slope boundaries of the site's disturbance areas. See the
site development plan for details.
Estimated grading calculations: Minimal project grading is expected due to the relatively flat site.
The following grading quantity estimations were calculated using a computer modeling program
within the AutoCAD computer drawing. The calculations are approximate. The quantities listed
are for the permitting process only and should not be considered precise amounts for bidding
purpose The estimated grading quantities are:
Approximate Fill: 100 CY
Approximate Cut: 200 CY
Conclusion: Included in the site development construction plans are specific grading and
clrainage� improvement notes and details. With proper installation, maintenance and inspections
of t he p I roposed construction the project should have minimal impact to the surrounding
environment.
Lovell-Sauerland and Associates Leif Helleren Construction, Inc.
October 004 M 1016 Grandvievv
.= LSA No.4647
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October 2004 1016 Grandview
U LSA No.4647
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Lovell-Sauerland and Associates
October 2004
Parcel (Vicinity) Map
Leif Helleren Construction, Inc.
1016 Grandview
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INFILTRATION SIZING CALCULATIONS:
The infiltration trench was sized using acceptable City of Edmonds design criteria ("King
County Method"). Two on -site soil test pits were evaluated to determine the design
infiltration rates of the soils on -site (see attached test pit logs). Both test pits contained a
medium sand. An average rate of 18 in/hr will be used (see field tested infiltration rates).
The following calculations size the proposed infiltration trench.
Required Trench:
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-Trench Surface area 8 ft. (see diagram below)
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Lovell-Sauerland and Associates Leif Helleren Construction, Inc.
October 2004 M 1016 Grandview
LSA No.4647
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33
INFILTRATION
SYSTEM DETAIL
N. T. S.
Construction Criteria
• Trench Preparation -Excavated materials must be placed away from
tile trench sides to enhance trench wall stability. Care shouldalso be
taken to keep this material away from slopes, neighboring property,
sidewalks and streets. It is recommended that this material be covered
with plastic. (see Erosion/sediment control Criteria in Volume 11).
• Stone Aggregate Placement and Compaction - The stone aggreaate
should be placed in lifts and compacted using plate compactors. As a
rule of thumb, a maximum loose lift thickness of 12 inches is
recommended. The compaction process ensures geotextile conformity
to the excavation sides, therebv reducing potential piping and
(Yeotextile clogging. and settlement problems.
• Potential Contamination - Prevent natural or fill soils from intermixing
with the stone aggregate. All contaminated stone aggregate must be
removed and replaced with uncontaminated stone aggregate.
• Overlapping, and Covering -Following the stone aggregate placement,
the aeotextile must be folded over the stone aagrente to form a 12
inch minimum longitudinal overlap. When overlaps are required
between rolls, the upstream roll should overlap a minimum of 2 feet
over the downstream roll in order to provide a shingled effect.
• Voids behind Geotextile - Voids between the geotextile and
excavation sides must be avoided. Removing boulders or other
obstacles from the trench walls is one source of such voids. Natural
soils should be placed in these voids at the most convenient time
during construction to ensure aeotextile confortnity to the excavation
sides.'- Soil piping, geotextile clogging, and possible surface
subsidence will be avoided by this remedial process.
Unstable Excavation Sites - Vertically excavated walls may be
difficult to maintain in areas where the soil moisture is high or where
soft or collesionless soils predominate. Trapezoidal, rather than
rectanaular. cross -sections may be needed.
Maintenance Criteria
0 Sediment buildup in the top foot of stone aggregate or the surface inlet
should be monitored on the same schedule as the observation well.
TNY August 2001
T1 IN "e
V0 drologicAnalys arA�"PontroIBM f016Grandview
JRcrober 2004 Z
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PERCOLATION RATE CALCULATIONS:
Two soil investigation test holes were explored in the area of the proposed infiltration system.
East Hole:
_ Soil Log:
0" to 8" Top Soil
8" to 20" Loamy Sand, loose, orangish-brown
20" to 42" Medium Sand, loose, grayish -tan, w/ 5% gravel and cobbles
- +8" dia. hole
- 42" deep
- Infiltration rate test:
Depth Draw -down Rate (in./hr.)
_1�ime 48
0 - 5 min. 4" 4
5 - 15 min. 811 4-1 24
311 36
15 - 20 min.
20 - 30 min. 1311 2" 12
30 - 45 min. 18" 5" 20
45 - 60 min. 22" 411 16
Average Rate 19.6 in.1hr. (excluding first 5 min.)
West Hole:
Soil Log:
0" to 6" Top Soil
-brown
6" to 24" Loamy Sand, loose, orangish
24" to 40" Medium Sand, loose, grayish -tan, w/ 5% gravel
+8" dia. hole
40" deep
Infiltration rate test:
TLime Depth Draw -down Rate (in./hr.)
0 - 5 min. 61' 611 72
5 - 15 min. 1011 41' 24
15 - 25 min. 14" 4" 24
25 - 35 min. 17" 311 18
35 - 45 min. 2011 211 12
45 - 60 min. 23" 31' 8
Average Rate = 18.5 in.1hr. (excluding first 5 min.)
Design Infiltration Rate (per DOE) = 18 in1hr.
Maximum allowable Design Infiltration Rate (per DOE) = 20 in1hr-
Lovell-Sauerland and Associates Leif Helleren Construction, Inc.
October 2004 1016 Grandview
1= EWE U LSA No. 4647 D-q
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Soils Map
Natural Resource Conservation Service (formally SCS) Map
Alderwood - Urban Land Complex, 2 to 8 percent slopes (soil # 5)
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October 2004
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=WN0 10 16 Grandview RE
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SOIL SURVEY OF
SNOHOMISH COUNTY AREA,
WASHINGTON
UNITED STATES DEPARTMENT OF AGRICULTURE,
NATURAL RESOURCE CONSERVATION SERVICE
(FORMALLY SCS- SOIL CONSERVATION SERVICE)
Alderwood - Urban Land Complex, 2 to 8 percent slopes (soil # 5)
This map unit is on till plains. Areas are irregular in shape and are 100 to 1,000 acres in size. The native
vegetation is mainly conifers. Elevation is 50 to 550 feet. The average annual precipitation is about40 inches,
the average annual air temperature is about 50 degrees F, and the average frost -free season is 170 to 190
days.
I The
This unit is about 60 percent Alderwood gravelly sandy loam and about 25 percent Urban and.
components of this unit are so intricately intermingled that it was not practical to map them separately at the
scale used.
Included in ths unit are small areas of McKenna and Norma soils and Terric Medisaprists in depressional
areas and drainageways on plains. Also included are small areas of soils that are very shallow over a
hardpan; small areas of Everett, Indianola, and Ragnar soils on terraces and outwash plains; and soils that
have a stony and bouldery surface layer. Included areas make up about 15 percent of the total acreage.
The Alderwood soil is moderately deep over a hardpan and is moderately well drained. It formed in glacial
till. Typically, the surface layer is very dark grayish brown gravelly sandy loam about 7 inches thick. The
upper part of the subsoil is dark yellowish brown and dark brown very gravelly sandy loam about 23 inches
thick. The lower part is olive brown very gravelly sandyloarn about 5 inches thick. A weakly cemented
hardpan is at a depth of about 35 inches. Depth to the hardpan ranges from 20 to 40 inches.
Permeability of the Alderwood soil is moderately rapid above the hardpan and very slow through it. Available
water capacity is low. Effective rooting depth is 20 to 40 inches. Runoff is slow, and the hazard of water
erosion is slight. A seasonal perched water table is at a depth of 18 to 36 inches from January to March.
Urban land is areas that are covered by streets, buildings, parking lots, and other structures that obscure or
alter the soils so that identification is not possible.
The Alderwood soil in this unit is used mainly for parks, building sites, lawns, gardens, and woodland.
The main limitations of the Alderwood soil for homesites and septic tank absorption fields are the depth to the
hardpan and the seasonal perched water table. Onsite waste disposal systems often fail or do not function
properly during periods of high rainfall. Drainage is needed if buildings with basements and crawl spaces are
constructed. Topsoil need to be stockpiled during site preparation and subsequently used to cover the
exposed material. Additions of fertilizer and peat are desirable prior to seeding grass for lawns.
This map unit is in capability subclass lVe.
Lovell-SaLierland and Associates Leif Helleren Construction, Inc.
October 2004 W-M U 1016 Grandview
LSA No. 4647
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Height Calculation Worksheet
Address: 10 i(p
Date:
hispector(s):
1. Datum Point:
2. Datum Point Elevation:
3. Avera�ge Grade: _to*$ � (�7
4. Maximum Elevation Allowed: +'25'**— -1
WL. -9-1 2.5-OvertiO. giade):
5. Reference Point Elevation Shot to House:
(datu m elevation) + 6, (grade to transit level tine *shot to house) - -T.
4.
6. Measurements from line shot onto house to roof ridge:'
Total: 2, 1 IS
7. Actual Elevation: j06,67 (reference point elevation) (measurements
from#6)= U'7
Conclusion:
ct 9, - (actual) is greater less than Iisr, c,� (allowed); therefore the house is/
is not over the height requirement per ECDC 16.20-30 requirements
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GARY HAAKENSON
CITY OF EDMONDS MAYOR
121 5TH AVENUE NORTH EDMONDS, WA 98020 (425) 771-0220 FAX (425) 771-0221
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Website: www.dedmondsma.us
DEVELOPMENT SERVICES DEPARTMENT
C. Q� Planning - Building - Engineering
May 2, 2005
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Leif Relleren Construction
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Edmonds, WA 98020
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Re: Building Permit: 2004-0931
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Expiration Date: 11/04/05
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The purpose of this letter is to inf rn you that the last remaining inspection on your
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p roject is a final inspection(s). The final inspe ction(s) determines that there are no
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outstanding life -safety issues and approval allows the City to close Your permit file.
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The City considers the final inspection to be one ofthe most important inspections
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conducted on a pr Ject. In order to grant Final approval the following must be complete:
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smoke detectors, house numbers, guardrails, liandrails, self -close doors between garage
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and residence,, egress from sleeping roorns, safety glazing, weather-stripping, any
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Engineering department requirements etc. Of Course not all of these things may
specifically apply to Your project but it does give you an idea about the kinds of things
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that must be complete as well as sonic items that do not need to be installed such as:
paint, carpet, moldings, wallpaper, etc. Please be adviscd perTnits expire one year from
the date of issuance. If you will need more time to coniple tc the work, permits can be
renewedprior to expiration for one half fees. If the permit expires without a final
approval granted by the BLlilding Inspector, full fees are required in order to renew the
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pen -nit. This can be vcry costly to You and we strongly encourage You to check Your
pennit expiration date and call for the required final inspection(s). Note: Ii'more than
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one department is rcq uired to Final your project, this is noted Oil Your Job Card.
Please feel free to contact me at 425-771-0220 if you havc any questions.
Sincerely,
JoAnne Z1.11aLlf
Permit Specialist
s\N,l aster I-etteri\SRwaani1-trSI-'R
Incorporated August 11, 1890
Sister City - Hekinan, Japan
FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
n2ASE SIGN
1/)q 0 ENGINEERING DIVISION DATE
rt"XE SIGN t
PLANNING DIVISION DATE
PROJECT /�C/ LF-- R F_ L,-( Lab,
SITE ADDRESS 7—
'DATE INSPECTED
PEFivfiT#20(;),/-/?9�1 _ADB# _5
DESCRIPTION OF WORK TO BE INSPECTED 6�2/--? /-7a4.11 - (,<
A field inspection was conducted to determine final 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
u Copy of CONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
cl Copy of CORRECTION NOTICE given to owner/contractor by inspector
I .
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Sign_
ocaprV1.doc.1:temp:b1dg:fonns 10/0 1
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
IPA I-r ) /_ vim _,nd
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ................... -
Commercial Final ......
HEATING:
Gas Test ....................
Gas Piping ................. - 7 C)5
Equipment ................. 05
Commercial Final .......
EXTERIOR SHEATHING
NAILING .......................... M T, -z-
FRAMING ........................
FIRST FLOOR FRAMING ... ZZJ 7-
INSULATION ................... q- 0-5
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ... MT
SPECIAL INSPECTION ...
e MT F.k.-Ce '4-2,q-05
KI
MISCELLANEOUS ..........
FINAL APPROVAL FOR L) -0_5
OCCUPANCY ..................
side Sewer Ll
Amout Paid $
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Date Usued ALId—
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Amount Paid -_—
Date Purch*.=Cd
The Initials MT at-e Milton
f.QIVI#
Thoilipson, a teniporary contract
;,T- 7r
inspector for tile City.
t. mcml
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