HomeMy WebLinkAboutpitkin.bldg.264334405055DOCUMENT
LAYOUT
Certificate of Occupancy or Letter of Completion
(most recent project)
Permits
Final Inspections
Any Supporting Documents
Site Plans
(no architectural plans)
If there are previous projects they will follow in the same order.
5/18/?007 3:99 PM FROM: Far. Brough Lon ElecCric T0: 9205939 PF<
05~`t ,y~~ ,
ELECTRICAL PERMIT APPLICATION
PITKIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT CITY OF ASPEN
970 / 920-5526 130 South Galena 970 / 920-5090
970 / 920-5532 Inspection Line Aspen, CO Bt611 970 / 920-5448 Inspectio Lirie
t~ 1 t n. ZCe~
~-7
L-'
.
_
PERMIT NO. '.
JOD ADDRES6 (p AND STREET) -'
210 AABC Unlt C
i OWNER '° "" PHONE '~
Mark Uhlfelder 920-9520 ',
ELECT GAL CONTRACYO' '- MA LI ADDRESS - ZIP NE COLO. LC. N
Broughton ~ectric box3 81612 ~25-3484 45&a
BUILDING PERMIT N OCCUPANCY GROUP $ ELECTRICAL VALUATION SQUARE FOOTAGE
$ 3000.00
USE OF BUILDING COMMERCIAL ~] RESIDENTIAL ~ ~.
CLASS OF WORK ADDITION QALTERATION ANEW '' ONSTRUCTION SERVICE OTHER '
I
DESCRIBE WORK IN DEfAIL IFOR ADDf770N5.ALTERATIONS, INDICATE TYPE, NUMBER AND LOCATION OF SOVRCEOF CIRCUITS: ~~
New Electrical service 200 am sin le hase
OWNER/APPLICANT: The undersigned applicant to personally porform etoctrital work on the describetl property or residence hereby certifies, as a condition of
issuance of such permit, that the above descdhetl property or residence is owned by the applicant: that theapplieant is not engaged in the business of wnstruptiQn or
remotleling: and such property is not intended for sale or resale, nor is it rental property (occupied or to be occupied by tenants, whether transient or perrnanent), nor
will it be generally open to the public. It is understood that compliance with these assurancec'a a condklon of thelseuanca of an electrical pertnlt to the applicand pur-
suant to the provisions of 0.fl.5. Section 12-23-117 (2) (as amentled), and that failure to Comply herewith will be grounds Tor revocation of the electrical permit or' any
certificate of occupancy Issued wBh respect to the properly or residence described.
Applicant: Date:
PAYMENT OF PITKIN COUNTY USE TAX usE7Ax pERMl7 FEE ~ 5 DouRLE
MONTHLY OR QUARTERLY RETURNS WILL BE SUBMITTED
DEPOSn METHOD:'/.011 % OF MATERIALS VALUATION PAID NOW AT ISSUANCE. A FINAL REPORT ON
TOTAL ACTUAL MATERIALS COST MUST HE FILED WfiHIN 90 DAYS OF SUHSTANTIAL COMPLETION EE~~
$ `P
OF WORK AND/OR ISSUANCE OF CERTIFICATE OF OOCUPANCV.
0 MATERIALS VALUATION $ D ~
APPRDVED BY FIRE MARSHAL GATE ''
~_ J
FkEMPT. EXEMPT ORGANIZATION
RESALE: STATE AND PITKIN
~
ANYONE WHO USES AND/OR CONSUMES MATERIALS AND RIXNRESIN PITKIN COUNTY IS SUBJECT TO APPROVED BY HPC qjp
'.
\
THE .$%USE TAX. ~
\ {'
PROPERTY LIENS MAY BE PLACED ON THE OWNER'S AND/OR THF~ COMRAGTOR'S PROPERTY WHEN
THE USE TAX IS NOT PAID. ^
/~
NOTICE
For all work tlone under this permit, the permittea accepts full responsibility for compliance with BUILDING DEPARTMENT ACCEPTA
the National Rectric Code, the City of Aepen ortlmancos, and all other county resolutions, Cliy Ortll-
nances, state laws, whichever applies. Permit subject to-revocaton or suspension for violation of
any laws governing same. An accepted foal electrical Inspectlori shall be obtained prior to using
the electrical system. A final electrical inspection shall be requested witfiin 48 hours after wmplet- APPRO V PATE
i `I
~ ~/~ ~ -
ing an elCClncal installation. PERMR VALIDATION
SIGWRURE OF ppPLILMR DATE
Merlin Broughton
FnIM NAME DATE
/
5 3( ~} RECEIPT p
05~/~.~~
K
7 TOTAL
~ f
~~~i,/
fi 1 3 .
0
Z
D
D
v
2
O
Z
m
z
c
m
q won a-r :ANT
,~~~~ ~~s Firm, ~t~s,~t~`~hi~ Farm print ~'~IS ~"".grit:;.
5/18/2007 3:49 PM
L ~~..~~yy~~.5~ ~K^7
Electric T0: 9205939 PAGE Op~pp ~V ~, v~
I ELECTRICAL PERMIT APPLICATION ~3
PITKIN COUNTY. COMMUNITY DEVELOPMENT DEPARTMENT CITY OF ASPEN
970 / 920-5526 130 South Galena 970 / 920-5090
970 / 920-5532 Inspection Line Aspen, CO 81611 970 / 920-5448 Inspectio Lit,Se
~ C l n ZC~~~
,;:.. PERMIT NO.
JOa ADDRE56 (Y ANO CTRFFT -
Z1D AABC Unit C
OWNER
Mark Uhlfelder '"°"E
920-9520
ELECT ICAL CONTRACT Mq LI ADDRESS
Broughton electric box~~1 ~'R P "E coLO.u°."
81612M1 ~~5-3484 458a
„- z_..,,. , .. R,,.... _.,
BUILDING PERMR iF OCCUPANCY GROUP $ ELECTRICAL VALUATION'
$ 3000.00 ~SOUARE FOOTAGE '
',
USE OF BUILDING COMMERCIAL ~ RESIDEMfIAL ~ ~..
CLASS OF WORKADDITION ALTERATION NEW ONSTRUCTION SERVICE DOTHER
DESCRIBE WORKIN DETAIL (FOR ADDITIONS,ALTERATIONS, INDICATE TYPE NUMBER ANO LOCATION OF SOURCEOFCIRCUITS ~
New Electrical. service 200 am sin le hase
OWNER/APPLICANT: The undersigned applicant to persoba0y portorm elecVical work on the described property or residence hereby certifies, as a condition of
issuance of such permit, that the above described property or resldanpe is owned by the applicant: that the applicant is not engaged in the business of constmctlor' or
remodeling: and such property is not intended for sale or resale, nor is it rental property (occupied or to be occupied by tenants, whether transient or permanent), rior
will it be generally openTO the public. It rs understood that compliance with these assurances is a condltbn of the Issuance of an electrical permit to the applicant pur-
suant to the provisions of C.R.S. Section 12-23-~ 17 (2) (as amontlacq, antl that failure to comply herewith will be grounds for revocation of the electrical permit or any
certificate of occupancy issued with respect to the property or residence tlescribetl.
Date:
PAYMENT OF PITKIN COUNTY USE TAX
MONTHLY OR OUAgTEPLV RETURNS WILL BE SUBMITTED
DEPOSIT MEfHOD:'Go/1 % OF MATERIALS VALUATION PAID NOW A7ISSUANCE. A FINAL REPORT ON
TOTAL ACTUAL MATERIALS COST MUST BE FILED W (THIN 90 DAYS OF SUBSTANTIAL COMPLETION
OF WORK AND/OR ISSUANCE OF CERTIFICATE OF OCCVPANCV,
~ MATERIALS VALUATION $ D
EXEMPT; EXEMPT ORGANIZATION '
RESALE: STATE AND PITKIN
ANYONE WHO USES AND/OR CONSVMES MATERIALS AND FIXiLRES IN PRKIN COUNTY IS SUBJECT TO
THE .E% USE TAX,
PROPERTY LIENS MAV BE PLACED ON 7HE OWNER'S AND/OR THE CONTRACTOR'S PROPERTY WHEN
THE USE TAXIS NOT PAID.
For all work tlpne under this permit, the permittee accepts full responsibility for compliance wdh
the National Electric Code, the City of Aspen ortlinances, and all other county resolutions, etty ordi-
nances, state laws, whichever applies. Permit subject to iavocetlon or suspension for violation pf
any laws governing same. An accepted final electrical inspection shall be obtained prior to using
the electrical system. A final electrical inspection shall be requested within 48 hours after wmplet-
ing an electrical installation.
USE TAX
APPROVED BV FIRE MARSHAL
APPROVED BV HPG
SIGNATURF.OF gPT,I(,gM DATE
HATE
Merlin Broughton
nl AME ~/ ~ r
PERMIT FEE ~~
~~
GATE
DATE
sa~.~,
PERMIT VALIDATION
RECEIPTa TOTAL ~/jam
O
z
a
D
v
2
O
Z
m
Z
c
3
m
37
~, y' a ail
i ~
' ~ I
a 5
' ~ Date 9~/3G-/~1 Lot ~ Block ~ ~ 'i
'p Subdiv. Airport Business g
'~ _ .,'Center 4 i
.;
ASPEN VALLEY PLTT~BING °
~ I
•,
s
s ~~
,.
~ ~I
e g
This is to certify that a certain structure located at -Aspen ~
a 3
' t~~ge~t-&nAustr'al Center, gigt,~ ~~ R TT S.t_, AS°e~• Co7o
_ s
.and owned oY Ta,.,~~ inc,n77~ RnY 7179, A Pn, .nlor~do ~'
i
erected under Building Permit \o. 7_7q complies with
the requirements of the Uniform 5u'_lding Code, 1970 Editicr.. ~
3
a
,..... .Occupancy Group:. p_~ ~ `:.~,.
•,: ~
" Type of Constructioa:~L } it
a
d ~ ~~
i'ire Zone.'.. TI .. ~ I
' - ~ '~.
.. .... i
Co:.,rents and Restrictions:
_ '~.,.
,~
.: a ,,i.
_ ~ -'. !p
," }, ~,
,- ,
~. _. ....County Pu;.1d:.nglnspec~o. `
t ,',,.
to/b"s"Y'.a' ~~ ~y,,,. ~ .~-, „,~~y(x a ~ ~a~ ~.
h .Y€ 3Jk +P
~
1
~
?
~~
"
k
'>
,
.
q
A
VeW
n~9
'T~
i
~ ;~ ,.. ~~s=~." ~~,."~ C17~QF°;4~i~~"="'~O~N`"6F""~'i"i`K'~[~~ ~7CQRAbO
- ADDRESS ~
OF JOB ~
~/,,~,~„~'"~~~,Z'., ~,Cii`t,•r pLUM91NGtiR
DOAiLSYfCiCPpL.
_
t, .. __..,: ,,, ,.,« ,..:
w . . :, ,,, PERMIT
~. WHEN SIGNED"A`ND"~/AC(DATED`Bl"'"8`CiTC6'INC,"'117St'+ N'R"T'HHH'Y3'~€Y4'
. O'~I`fEY"°I`H""~E`'~YO`R'R~~~'E'b"`~L°~~.`•-•"w+«n~,...~ ..............
..
,~.
" ..
CLASS OF WOR'Ki' ''NE'W tFf!' ADDITIQN ~ _ ALTERATION L~ REPAIR L7 , _ ~AAOWE O~~~WRECK~
' OWNER ~
NAME ~ ~~
"
"
l.
,r,G~ DDRESS PHONE
~ LICENSE ~` ~ «L~ICENSE'
~
_
..
NAME tAS LICENSED) .fat ~ + CLASS" ~ NUf'y1BER
,Cr!a~.,? *,GVU
~ ~
ADDRESS ~ ., .. .,;
.. ' PHONE '
SUPERVISOR_ _ .. _ ., ~. ...
'"°^
FOR TH"15' JOB - "` " "`
NAME .:_ . , ,
~, _.
. ~ . s,
_ DATE CERTIFIED
_
f~'LUIvf~~~CN.G ~'
~
~~ . .
DOMESTIC APPLIANCE'S «~~~ `~
".= FLOOR ,. BBMT. } 2 3 4 $ 6 7 8 OTNER$
NO. O
'
~° AU70. WASHER UN~TS DESCRIPTION OF WORK
;~.: BATH TUB AUTOMATIC WASHER "`" '"
T`~"
DRINK..FOUNTAIN -
DISH WASHER DISH WASHER
,r~ FLOOR DRAIN WATER SOFTENER
' G
RB
A.
~
,. A
. DISPOS
L
" -- OTHER ,._...
' GREASE TRAP
` snND TRAP y REMARKS
SEWER-SANITARY ~~` ~ ~ ~ ^
,,s
SEWER STORM'" ,.: ..
°,,.,~. SHOWER .,......
'.,': SINK
~~ ~ ~~
;'W SLOP SINK
'~- UNDERGROUND""
`
_.
~, SPRINKLER SY5
`^%%~ UR7NAL
L wnsH Bowl ~. AGEI~fCY' AUTHORIZED
DATE
~i WASH TUB
;, ..
*
.,
WATER CLOSET° Z.. .
' ZONING-_
~.
91STR B SYST:
' PUBLV"C' TTFALTH
~~
WELL STATE
OTHER ~~ _ ENGINEER -
TOTAL ~iXTDR°ES
'„ BY FLOORS
" "
,
. TOTAL FIXTURES
oN ioe '
VALUATIONS
,,,
, '
NOTE3`ti'O`~ApPCl`CAFF'I°i "' _ OF WORK ~ :~rf-~°`~
~
FOR INSPECTIONS Oa IWi"O'R"1'N'A"fiTS'N'"t'X'CC'">~1'~~j """"""
}a _
THE VALUATION OF EACH 'OF"YHE P.B"OV`E"YYN7T5~~"B E"`~fN"~
. ,.
PLAN ~~ _
TOTAL FEE
FOR ALL WORKDONE UND`Ek 1'F1T5"hERnM'7't 1'F7`E`"~'ER
COMPLIAN CE WIT FY S
~
'
'
'
'
'"
`
'
'
'
'
' FILED T P ~ .
U
-~
+ HE
TE CNNTCA
C TCt7T
$B7NG COb
E lfE~
i ULATTO
MS YUBL
I
C
HE A
l:T
FT
°ARY'r~f~Yj
STATE OF COL'ORdY~"d °C'IY4`"tl"~"`A$'Pr'N°'O"R~57A"R`RC'E`S;`A"N"d`"dC['°'ISTFIBR COUN`TY"'RES'OlY7Y1`b'6ST""~
CITY ORDMANC'E`S
STATE "L~d'
W$' ~fi'~IYCy'E~'/Eh"~i'RY
S
" """'"_ DOUBLE CHECK
~
~ 4 L~
_
O_ ,
.
LIE
.
- -FEE ~ CASH
:REQVIRED INSPECTIONS SISA`LL`BE`R ~
`
y~ PERMIT SUeJFCT TO
REVOCATION OR BU$fFN$10N FDR VIDLATI`OR"DF ANY CAWS 60 VERNit~{i"TA`X+fE.
A. FINAL IN$PE2TION YNKLL"B"E"MA'If$"H'ET'O~"'b~Gi1PSNC~'°IS"`VER'ftl'Y"fE'D: ~ BUILDING INSPECTION "[7EPAR"°fMENY"
' - s
°, SIGNATURE , .~. ~- .., «.. ~, .., ,~ .;..
"~ ~ s
--
OF //
APPL~CA
~ ~~
~~~
~ NT'
+ .
., AP7ROVAL Y
DATE.
THIS"FORM A PERMIT ONLY o•TE PEaM}r Ho: I,PCENSC ~ BccEIRTS CLASS AMOUNT .~
WC-~EN VALCDA"7YE'~"`~`~""d" "`"""
I
I ~ ~ nY. ~~
I
1
nvi~sLL e~ac i. n.+fVmmYiSaY A ¢.t:Y wJ i. M .
a A 4- 651 6 B I ~& ~ m ~ s;-,-.wr ~'"' "'SRS z i7 ~ k A~ 9e.. .,...~Fw~"'eH`~` "w°
>,- ~~, ~ ~ f~1SPE "~J D~P~A~21' ~~
~ =,,.„ -ex ~ CITY OF ASPEN -COUNTY OF pITKINCOLO
. ,. _
<~ x~ ~ ~~~~~~~ ~~ `~ GAS FITTING .~~
ADDRESS L%~ ,l~d..t~ ~Q.~""""" LOT oc~=~~
~~- OFJOB "'-% ... ~ Aoomari°" - PERMIT
wHEx srcNEO ~ _n-= ~~9u7LDin~P~k"in'~~~fT"~9s v ~~""~""~."'"
1 .~
-• CLASS OF WORK: _NEWye _- ADDITION O~ REPLi1CE C1,- AL;~'ERRR~-,~IONfl~ wREPgIR ^ MOYE C~ WRE`CK^
OWNER '
NAME /~~r~~,T> ,!/,fir ~~^ j/'~ADDRESS PHONE
°, LTCEN SE LICENSE
o ~r ~_.CLA55 .. .. _. _ - NUMBER .~.
NAME (AS: LICENSED) ) - -,.,~....,~,.w»,...,,,...a.,,...,,~,.
-. " _~». _..w. --
. CJ _.,.
„ ,
Q.
~.AUDRESS. J'~'~'~ `PHONE ~_ ".. __ ..:
~:
...., ..O
-ll SUPERVISOR
- POR THISJ68 ,;.. NAME '. _ _... . .. .:.. ....
.' _ ,. m.~ ,.,
OCCUPANCY.
" GROUP ~ ~ ;~ DJVISIQN
2E '. NO. OF NO... F _.
NITS' TYPE OF UNIT UNITS TYPE OF UN17
DOMESTIC APPLIf~NCE54 COMMERCIAL APPLIANCES: ~~,
.~ ,.~z~.,.~....~
~..~ ~ ,.~~~„~~. _._ ,w....~,..~ ~..~.m_~.~-.~~
_.,_ ,_
- DRYERS ?.: BAKE OVENS
..~. _ .-..,............__.~-~..~,.~.»,-.,.,n
. ~ HOT WATER HEATERS _ _ ~, ~ BROILERS ~ ~~~.~~
., a
_. M.... -_ W.,-...,....,.,~..,..t~~..
'. OVENS ~ COFFEE URNS
°` RANGES` ~ '""` '""` '"" `-" DISHWASHERS ~~
__ .. .,«,.,_»,.,~.~..m
SAUNAS. ~ DRYERS.
K, CONTROLS, METERS, TANKS' .' INCINERATORS -
•' ~ OTHERS- f ~~. - RANGES AND PLATES :;, _
. • WARMING TABLES
., _..a,e......-. ..a. ..e.«~..,,.~. ....,.Y.. ._.,_._,..,.....~..~._.,.,.-....~..,e...
OAS PJf$1NG:' ~ *.;s.~':. OTHERS--
, .: _ ..
'~, ~!/~ SIZE ,/~rr,LENGTH ~, ~.
w -._ -. _.. .._.......:-..-.. .~. .. _: , .,..,,-....... .~....,-,. .~
xr :/ SIZE ... s' LEN'G~7H u.....: ,- <_, ......._-._.~,e
~;.;
~cea
,~. REMARKS......
NOTES TO APPLICANT FDR INS""" ros~cn'o"Gs oR i R A o Lt vss -~-,- g
., a
THE VALUATIO NOf EACH PERMANENT FIXTURE OR APPLIANCE SOH A~L~E ""'9 ^~ _rc ^ VALUATION ~} ~~'
INCLUDED IN THE PERMIT. APPLIC" IOYJ `~ ~ ~~~ -re.° ~~"~'~ ~~ Wy._~aaWr•~e»,r...w ~~
., ,..-.~_~. OF WORK 6d.
FOR'AlL WORK DONE UN DER,THIS RMFY~TME pER1GY7TEF-ACCEPTS FlJ'LL RESPONSIBILITY FOR COMPLIANCEPLAN T'OT'AL FPE
WITH THE GAS FITTING CODE, CITY OF ASPEFT; A '•~~ FILED T P ~ pp /]JJ
~ LAWS, WHICHEVER APPLIES... .. ~ ~~ ~- y -~ ~ .:+r~
_~ ... ,. ,. __ _ DOUBLE {HECK_Q
' p PERMiT SUBJECT, TO REVOCATION OR SUSPENSION FOR VIOL ATIO N'OF ANY LAWS GOVERNING SAME.,. FEE ~- CASH ~ 3,(}'O CT T'
.. --.kw+..,-,+.,...-,,.ww...
• _ ~_ z, ... ~w...~ .... ~.
REQUIRED INSPECTIONS SF~,AIati„BE REQUESTED ONE WORKING DAY"IN ADVANCE:
". - - ».»-.,~. BUILDING DEPARTMENT ,'-, ~
A FINAL INSPECTION SH ALL'BE MADE BEFORE C R ~: -
,..*~-www.,,... .r
.,~.~~-e~-e. ».au, ~-~.-w +M~._..,,_ .
SIGNATURE ~ ~
OF ern-^Le''..?
APPLICANT a APPROVACB DATE 1
THIS FORM A PERMIT ONLY DATEPERMIT If0 LICENSE ~ ECFIPTB CLASSw,~ AMOUNT,
WHEN VALIDATED'HERE~`r ~~ ~~ ~5,.-~J ~t~ / ~~~
' !v {
,., ~
~,
kr
w _ ~.,. ~~
" "~ ~ ~I
_. y
BUILDINGS I~~~PCI~Afi~~~N ~~ ~ ~~~-~
a.
Jurisdiction of ~t~l.n ~(3~!t1t~' D
m
Applicant to comalere numbered spaces only.
...,.. " ...e _ .. ..
vx.
.
LE4AL
1 DESCR. LOTy~N^O. `/~
Ed
I..a'31 GN Cn d~~ ~ BLN TRACT
1Aa.1 • {~~EI ..
.
1,
L®.
•. ~6S~~nI~eJJ y~~EE ~TACXJSH G[1. VW~O~
OWNEq MAIL ADDRESS 'ZIP
z ~ ~.~~.
~s en ~evelP Co. Inc, ~O~~ox' ~`~.~ ~soen C~~o ~ PRONE "'
~~v "
; , . R:~-.....,.
CON TRACTOP "' '' MAIL ADDRE55
s ~t~n~r 'PM ONE ~ L CENS[RO: "
M
~
APGXITECT OP'DESI GN ER MAIL ADDRE39
~qp9~ @yyY
' ."
"'
"~
,. PHONE LICENSE NOI
EuG NEER MAIL ADDRESS
5 ~IOner -see struetur~I: Inns PHONE LICENSE NO.
~~ ~~
~
LENDER MAIL ADORE55`.r:.
s ~an€~ of Gl~nood ~Ion~ood •~ P'In s ~~I®. ,. BRANCH
~
VSE OF BUILDING
." .. ..... :. ....n ..
Mora ~ sn~ sf~ice ~ ice,.,.
.. m, a ....w .>.. ~
~.: v ...~. _. ..v :.._
~u~ a. ~. m~
~,~~
8 Class of work: ~ NEW ^ ADDITION ^ ALTERATION .
^ REPAIR ^ MOVES ^ REMOVE
..
9 oescribework: ~X~3c+nS1Oi1 Q~ PX1Stln~ ~t;7t^d~~ ~Lill~°lne~ ~. .
,~..,H.:.:,
10 Change of use from
Change of use to .
~_.
:"_" _
__._
11 Valuation of work: $ 7(~B 180 r 000 • PLAN CHECK FEE 153 • 25 ~ 3 C?
PERMIT FEE ~~
SPECIAL CONDITIONS' ~~ ` Type of O
..
Cgnst. ccupancy
Group ~ ~ Y
Division
Size of Bitlg No
or M
_ .
(Total) Sq:F[. .
Stones ax.
Oca. Loatl '
- ~~ Fire U
4PPL
IC
AT
N ACCEPTED eV`_'
I/O~
PLANS CHECKED eY
gPPRpYED FOR 155U~tjCE BY:
ZOne .
se
ZOne Fire Sprinklers
Requlretl ^Ye5 ^NO
~~
((
/
+
C~- ~J
4 ~/~~ No. of
welling VnitS _ OFFST REET PARKING SPACES: ~ "
CovereA Uncoveretl
OTICE Special Approvals Re fired ~ Received Not Required
SEPARATFy`?J'E RMITS A~iE 'RE DUI REO "FOR ELECTRICAL, pLI`1M'8=~'
ING
HEATING
VENTIL"ATING OR A/R`CON'Dl"'fl'ON'f}~°G ZONING ~
,
,
THIS PERMIT~BECOIv1ES"NU~L~L AIV~D'G'Olb"/F NYOFt ff O`1i CbNS'rC-y'" HEALTH DEPT. - '
?ION AUTHORIZED`IS ROT CO'I~IYvTE'M11'C`E DwG~71Y}I~I'N"~0 DA'VS,;OR`YF""
C
`
"
`
-'
°
'
" FIRE DEPT.
ONSTRUCTION OR WD
R
K 1S SUS
DEb
bf; A
BANDOKTE
D FOR A
PERIOD OF 120 DAYS "'AT A'K1V'YYIJIE"`A~~'R"VV'O'FS `K"1$ C~Yv1="` SOIL REPORT- "~
MENCED. ;,~. ~ ... o7HER'(spediy)""
I HEREBY CERTIFY T~1T I HAVE READ AND"`~XAM7N~~TF(IIS~"`~
APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.
ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS
TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFfED ''.
HEREIN OR NOT, THE GRANTING' OF .A PERMIT DOES NOT
PRESUME TO GIVE AUTHORITY TO VIOLATE "OR CANCEL THE
CC
O N
S
T
RUCTION
A
O
R
O HE PERFO
R
MANCE
O F
CONS
T
R
7
CTION.
T
ORI~.EFJ
grI
yLg
I
yT
G
y
GEN~ I
/
r~^
(g
(
n
r
g
S, ~q OR~~
/
{
f~ GL.e7P.
F .~~~d
G
~
' fW
~
L
•
,
'
~
.
c. O
RJ•
q
Nq OF N P NE I
q DATE)
~. r•RUUwlou Urv Intl JYA{:CI IFIID IJ Y~)VR PERMIT
a-.c..
PLAN CHECK VALIDA"TfON cK. M.o. CASH PERMfT VALIDATION cK. M.o'. cases
~'~~`~
Form 100.1 INSPECTOR.. _.. ~ ;.;,.
--_