HomeMy WebLinkAboutAPPLICATIONS, CO, MULT DOCS - 12-00151 - 565 Pioneer Rd - Rockcreek Townhome #123Gertifleate sf 0ecupancy
{. i i l {} :-
KEXX}LTRG
{_1:' ,* _* . .
.ir;rrr;cali l:,rriiii', Co!it;111ttti il
City of Rexburg
Department of Community Development
35 N. 1st E. / Rexburg, lD. 83440
I Fax
Building Permit No:
Applicable Edition of Code:
Site Address:
Use and Occupancy:
Type of Gonstruction:
Design Occupant Load:
Sprinkler System Required:
Name and Address of Owner:
Electrical Inspector:
Contractor:
Special Conditions:
12 00151
International Building Code 2009
565 Pioneer Rd, #123
Rock Creek Townhome
Type V, non-rated
N/A
No
Rock Creek Hollow Llc
504 N 4000 E
Rigby, lD 83442
Northern States DeveloPment lnc
Occupancy:Residential - 2 units or less, permanent in nature
This Certificafe, issued pursuant to the requiremenfs of Section 109 of the lnternational Building
Code, certifies that, at the time of issuance, this building or that portion of the building that was
inspe,cted on the date tisted was found to be in compliance with the requirements of the code for
the group and division of occupancy and the use for which the proposed occupancy was
classified.
Date C.O. lssued:
C.O lssued by:
There shall be no further change in the existing occupancy classification of the building nor shall any structural changes'
modifications or additions be made to the building or any portion thereof until the Building Official has reviewed and
approved said future changes.
Plumbing
Building Official
tn"p"rtgl'F'-- -l-(-4- Fire Inspect"rr Nlft ^
,n"o""r p&Z Administrator' lr' j k
w
.)e , l-{ .*:4{ii:[rJl.
$tH.;
$1Hi-
c
att,, '&l
.-€'.r1.-!1,
..U-loj .,t.! l
8rv3-{mtmtzslg
*ls*{l
ot ,zl
:l
fil ,
il'(rt.:
,i
.
ffi
ffi
',t t;r " '
t.:i:.... : :r,.:ri,-,.. r -.::.
:;: t:rr.: i . .'. iir:
. :::,::!,,:...,: :1,': ;it .r,:,:.
''.]
'.1'l
'(\
,\
ir
*trg.t
3eo
Em7=E
.*
r- ^'
J,
it\)
'O
IO
--s.
l^o' *
7,It,g
,Fll
{-o
$
lrf,3,{,ix,_
rlllr,frf ,to
:,1 .t,,.ir ,a:'zg,gt,
:G,
,lll,.. ,
o-p"
oa,$11L
3la'
3i.',q:1 .i
o"l5.i
O.:',
TI,
l$,i:'
...t ,
*.'l
:l lt:,i.t
.,' '' :
:i':,::!ii''.1.'.;.j,
rii,.l:i,i::i::iia
t;,r,..t1
, li,r..
a tt:t,.:'
l:'] ., r,'i;r-
,,a::].::
.:'.t:: I::a: :l_:ii
,'l '.:.;,',
,.' .l:'
L.
(3sl
o
?t.lrlo
o!L
{3
{f,
z01'
, lllr){
:Q',:: ZEo=bE3zo
iiI
I
L il ) .',.t
RNX$U1TG
ftr
rir;rsrjrrri l:.1 tjilr {:\}n1il1 t.ttii t}
COMMERCIAL & MULTI FAMILY BUILDING PERMIT APPLICATION
35 N 1" E, REXBURG,ID 83440
208-372-2326
PARCEL NUMBER: (We will provide this for you)7Slra5*E
SUBDIVISIoN: JZ^,, L- r,,'.e,.-L Ltit-,.: uNIT# BL}CK#' (t'"' LoT#
Please Complete the Entire Application!
If the question does not apply fill in NA for non applicable
is based on the information - must be accurate { &'i
D{€
OWNER NAME: CONTACT PIIONE, #
PROPE,RTYADDRESS: 5tK .}i>^pe<.
"JPHONE #: Home Ad . ?qq-q;S i Work e6D - t5\ -1"1F? Ceil ( ) JpA-;*?n * BCf )q
O\X/NER MAILIN G ADDRESS: e /L €.corq.CITY:.fi'te'tr+q STATE:Fb ZtPrSEttBL{
(If other than owner)
, a statement authorizing applicant to act as a(Applicant if othii
APPLICANT INFORMATION :
accompany this application.)
MAILINGADDRESS, ctw lfre*q+n sTArF&U_zrp8_&551
PHONETCeII#wort+eD8 - ?5t * ?$F-l Fax# J08 -951 *{}5 i
IDAI{O REGISTRATION # & EXP. DATE
many on this property?
Did you recently purchase *ris property$16Jes Qf yes,list previous owner's name)
.f-\Is this a lot spht{!p) YES @lease bring copy of new legal description of properry)
PROPOSED USE: - ,2<-.
(i.e., Single Family Reside
APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Underpenartyorperiury,rhercbycertilzthatr
have read this application and state that the information herein is correct md I swer that my infomation which may hereafter be given by me in herings before thePlming md Zoning Commission or the City Comcil for the City of Rexburg shall be truthful md correct. I agree to comp.ly with all City regulatiors aid State la-s relating
to the subjct mltter of this application md hueby authorized representatives of the City to enter upon the above -mentioned property for inslections purposes. NoTE:The buil4lAoffcial may revoke,a p.t::,:". "pPt""| issued under the.provisions of the 2003 International Code in cases or my ialse st^tement or miirep'resentation of factotonthepWFonwfuchthepemitorapprovalwasbased. PemitvoidifnotstartedwithinlS0days. Pemitvoidifworkstopsforlsodays.
.// ytr<t--.-- S r )y / ft-
Owner/Applicant DATE
prefer to be contacted by fax, email or phone? Circle One
WARNING - BUII.DING PERMIT MUST BE POSTED ON CONSTRUCTION SITE!
Plm fees ue non-refundable and ae paid in full at the time of appti cetion begjnbgJtalleJ-fuL
City of Rexburg's Acceptuce of the plu teview fee does not consriture plil approvat**BuildingPemitFees{edueattimeofapplication** **BuildingPemitsarcvoidifyoucheckdoesnotclear*r
Business Applicofion
t\n e ri ati Fb n i ly 0ar n n u n i ty
Please take the time to answer all questions so that we can further assist you and yourfacility Thank you.
What type ofbusiness will be performed (-.. ^.L-,*-**, *
Will the business have food preparations?
Will there be any cooking of foods?
Will there be any deep fat fr:ring?
Will you have food disposal on site?
Will therebe any maintenance or mechanical work in the building?
Will there be sumps or floor drains in the facility?
Will the business require more parking?
Will the business have any chemicals on site ?
Is this business occupying an existing building?
Will the business be doing any structurallor remodeling changes to the building?
Any changes to the electrical?
Any changes to the plumbing?
Is this business planned to be the same with different ownership?
Will there be a change of occupancy?
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes
Yes
No
No
Applicants Signature Phone Date
I Certifi that The information that I have provided above is to the best of my hnowledge accurate and true.
35N IrF
Rexburg, lD 83440
Re m o de /z'ng 7o z r'8 z z/dzng/Ho m e (ne e d total cons tructions e stimate, excluding f ire,
electrical, plumbing, and Mechanical valuations) $
www.rexburg.org
City of Rexburg
Phone: 208.372.2326
Fox: 208.359,3022
REXBT]I{G
ReszVeztzh/
pcr tlnrl
SURFACE SQUARE FOOTAGE: (Shall include the exteriorwall measuremenrs of the building)
Fint Floor Are"_l_!106 Unfinished Basemenr area
Second floor/loft area
Third floor/loft area
Finished basement area
Garage area___*dtu j{g(}
Shed orBam CaryordDeck (30' above grade)Area
.-r.tLOmmerczal
C-.onstruction Type:OccupancyType:
SURFACE SQUARE FOOTAGE: (Shall include the exteriorwall measuremenrs of the building)
New Construction sq. ft.
Commercial Remodel sq. ft.
Commercial Addition sq. ft.
Utility, Misc. Private Garage sq. ft.
Storage sq. ft.
tUz/tz:,Fam zbt/,fz'ng /e .ftz de n t Ho zs z'ng
sq. ft. per unit
lvlanager Unit sq. ft.
Buifng Sofety DeporJ,T:p clt'y er:-*ITEXBIII{G'(\,
,''rttt rico's Fttwly (it;ttn tn i l:
35 N. 1" E., Rexburg, Id 83440
Phone -(208)359402A / Hotline -Q08)372-2344 / Fax -Q08)359-3022
OV/I{ERS NAME
PROPERTYADD
x
SUBDIVISION ?,-=-L. -,..*.=_i.. " .r.L-\l -t_,> L t-<-PFTASE ) LOT___ >_ Brocc
Permi# f L CCO 15 I
l**o^^l P(i'u'e+'
ReqzzTed///ET,ECN?/C4T
Mdress Gty_Zg_qf:,.__State:l .r> ZrpES:1}!
Crll Phone FDD 3qO - 3\ >\Business Phone 0og D 6r.- ?:g"i
F*QE)-?sr - q)Br Email
(COMMERCIAL/INDISTRIAL) Total costof electrical system(C-onrractedAmount)
(nclttdes the mr of nateiak installed regardlus of tbe parg stpp$ing it. Tbefeet listed uider tbh inspecrion gpe tball Eplt n ooldtl ,-t rt t*/not specifcaljt nentioned elsewhere on thisfom).
D Up to $10,000 (total cost of slctem x 0.02) + 50 : $
! Between $10,001- $100,000 ( (total cost of s)ntem - 10.000) x 0.01) + $260 : $n over $100,001 ( (total cost of slatem - 100.00b) x o.obs) + $1,160 : $Small Vor{rs (C-ontracton ONLY): $10 fee forworknot exceeding'$2OO incost and not involving a change in
service connections. Does NOT require inspection.
RESIDENTIAL
tVeru:.fzzg'/e .Fa,mz/7Dur//ng', tzc/zdz'zg z//bzzTdngs aztb azVzzg bez'ng cozsttzcte/oz eacbproperty. /""Rasedoz /z,zzrzg s?ace,see defzzhbz be/ou)
n Up to 1,500 sq ft -- $130 D 1,501 to 2,500 sq fr _ $195tr 2,501, ro 3,500 sq ft - $260 ! 3,501 to 4,500 sq fr _ $325D Over 4,500 sq ft $325 p.l* $51 for each addfuional 1,000 sq ft. or portion thereof ($:zs * ($65 x # of additional1.000 sq. ft. orportion thereo0).
tVe re: tVuhz:Fan zh,Dzoe//ng, (Q naactu n Oz/y/
! Duplex Apanment $260
X, Three-or morg yuki.famillunits.-$i30 per building plus 195 p.r uniu ($1-30 x # qf buildings) + ($65 x # of unia)DExistingResidence,Modular,ManufacturedofMobileHomes,""do
branch circuit,_up to the maximum of the_c_orrespglqg sq. ft. of the building ($55 + ($10 x # brancl cir;ui*))n C-entral Heating/C-ooling Systems: $55 \X1hen NOT parr of newreside"til "rffip.r-ir *irtr rro "dffirr"lMring
Spas, Hot Tubs, and swimming Pools: $55 fee for each trip to inspect
?umps- l.Y'ate4, ,Irng,ztzb4 .feuage (eacb matoy'
! $65upto25HP n$95- 26to2O)ltr r$130over200FIp
MISCELLANEOUS
tr Tempomry Construction Services ONLY: 200 amp or less, one location (for a period not ro exceed 1 par) - $65
! Temponry Amusement $e5 fee plus $10 per ride, concession or genernror
D Irrigation Machine: $65 for center pivot plus $ 10 per tower of drive moror
tr Technical Service: $65 perhour
! Plan Check $65 perhour
! Requested Inspection: $55
"Lititg Spac-e.- space within a dyel}1S unit intended for human habitation which mayrcasonablybe utilized for sleeping, eating, cooking,bathing, g$S, recreation, and sanitation pqposes. An unfinished basement is considered pan of the li"i"g;p;;;.
,2.{3* Bc.*r.)%License number &ignature of Licensed Contractor date Date
vJ/ lJ/ tv tz r.J. uu rAA
35 N. il" E.. Rexburg, Id EJ44O
r4 00 r /001
Sofety Deporlmenf
Clly ol Rexbrrg
olclt.,rERs NAr,rE (: rr+ -r/c/g rPROI'ERTY l*DDre permid
VrcrMetcrQuarrtity:
REXBURG
l^,. rL',r L@:rr | ../r^r.rtilr
+*r".}'t+t+""VaE r Merr Sizc :
Reqrred///P/umbng
Plumb ine Contractor's Nrrnc Busircs5 5116p
Addreus
0 \^.K trlo+"r {Pl, ^b'
-s.*._! D_zip_&3lltZ
GuPhone QA %2|- lz*
F <(Emarl
( col'IMERcLat/ I NDUSTRTAL) Torat c ost of plumbing sys Em (comnc ra arnilg $
([atbdet il* nil ol malcnah urtolhd npn!futs oi rln pa74. .ennhint it,'ih, th, brtlirrrlrr thi.r ianntion h,he itil] dtbh, tn put([atbdeli*nio|ma!cnahur|o/hdn'yn!ftsoirlnpar4.enppf1i4it'.ih,.1h,b't,'i,,'l,rthi.,iatPlttion4peilll4pt1,toouy@
xot :pcciJia/!1' mnlioasrt cktwhtn on ttrc lbrm).
n Up to 310,000 (toral ccr of sJrrer,' x 0.02) + 60 - g
o Ben,aen $10,001- $100,000 ( (rornl cct of sJmcm - r0,0S) x 0.01) + $260 - $o oner $100,00t ( (rord cosr of sFtcm - l00.QQ0) x 0.005) + $1.160 - $RESIPENTIAL
uee--t:r! rytltthetlbg, hcladtag a//6aldiagt enhL atzag berg coartyyclcdon crcbpmprzy. flaeloa l*iag 1rycc,rcc dqfnitbn 6tbd
o Up to 1,500 sq ft - Sl30 D 1,501 to 2,500 sqft- $195
rr 3,501 ro 4,i00 sq ft . Sl252,501 to 3,5@ sq fr - $260
9:I o,5T sq [r $325 phs 565 for cach addirional [,000 sq ft- or ponion rhenof (sfrS + ($65 x Lof addirional
1.000 sq, ft' o.ge$ip,^ thereofl),
Nc e Mr/* fan tj',fue/8g /A nownn Onfi)
D Duphx Apanmcnr $250
!." 'rhrec or nrorc muhi-farnilyunits:Sl3O pcr building plus s65 pcr unir $rl0 'f of buildiqgs) + ($55 x # o['nix)nExis.tinE|'esidence,arrdDetrchcdShop:%5.fecplrs$lopcrfinurt,p,".n@
sq. fr. of the building (955 + ($lQ v / of finrsd)
D Gny VaterSystcms: $t!0
n Lawn Sprinklers/Backflo*, Device: !65
r:t Modular, Manufacnrred or Mobile Horncs: $65 for sewtr and rmter stub conrrctioru
o Multipurpose Firc Sprinklerand Domestic VaerSupply Sptem: $65 fee or 94 persprinkhrhe.rd, whichcvcr
a grEatcr
.fewr& Valer
o $38 Sever Linc a538 Vuer Line o565 Scucr Bg Vaten if insxcrcd ar rlc srarc rirnc
o $65 Scsar rurnnround urrdcr ho,rsc (cttengc from scpni,c to cig)
MISCELLAI.IEOUS
o Plen Chech $65 pcr hour
o Technical Senice: $65 pcr hour
o Gas Linc; $65
o VeterHcatcrRcplaccment t65
0 Reqr.rcsrcd Inspection: 555
i:r Hy&oaic Hcadng: 365 + ($10 x I of rnanifol&/znnes)
'Livrng SFle ' sPact wirhin r durlllng unir inrcndcd for hurnan habftarion whkh may rc-rsonably bc un'lizcd for sleepiqg, earing, cooking,
bdlttn& r,:shing, ncrt;tdon, and sanirad,on purposcs, fur unJinishcd blrenrcnt is consi&red prt of rhc tinq spocc.
PtB{- tSOal,.-tZ*t-tZ 3-zq4z
Ucerue numbcr6c
n
D
of
Brsincss Phoni (
g
Req. BY
fr*ieel
Address
-r'lL.
C/- J
-)
lmsrncrronq!gg;!
Brdg. t Plumb'ffigh{cch'uFrn
r&rrsif w* /-?;liZ
ptronc no- 't(3 71'V')
n comm"
lnsPction TYPrtt)!r*urrv'. "r'
: lf,:l t
D*y ffim* R-q
F Res.
nt T- flN'An p$rss
ilp;,-rur*'T'^"--e,,
f,.o (HNAL)
trfi0N Rt'Qul*ED:
ilRNAL
B.*e'l Ackr$*lcdged
$irr*"fiSeG$ofry
r'rta.cwl
ibloe "rdACtFt
lntpector't Rryort
Inspection
Req. BY
Pr*"ieel
Address
Inspetion TYPe
Dey ffimc Req.
L
'/ 2b -i
t INsrEcrIor-{"ICKarO
p FIdg.n ilumb.
l/l i
By .e/MtJ!J,(!-eL:-utc
Phone No,
Pennit No.
& Rcs n comm.
R-t cl.or*- r;
tlg""ttw < ,
12 r,atS I
lntpectsr'r RePort
Cra--l <u
trr^61/z
'rs
$q
\p'
a)a fur
(ttv\
A^^a Sed <uV?L ;;t- ir,.atlcra*l'
INSPTTTE" 'TCM$ CONFO*M TO APPRCIVED trY tlN flN,A
t aFIAl"
Ilbtp ilgrF{$F€CTilNOTAPPI-KASLE
fNSPECTOR'S ACTION ./
nAPPRovED tz6tsePrnovro
Rrc'l Aelnr*fcdged
|r'rft " *srt SoBf
f.F16'6firt
hao*..,oacs0f mr. n*rOofterff
ilCO,{FINAL}
I rr*sr*CTlonrn**, O
I Plumb. S Ehct. tr Mech. fi firc
'd 8y
Phone Ho.
Pcnnit N*.
Address r. n -- +tnspecrion Type k-/r!/,4O Kathtr?ec:t *-
Day ffime neq. l( ?U - t 4 /4 '/yl L'rut- ty1P1 '
Inrpect*r'* Rtport I nu'n comm.
NY ilN
lNsPpCIR's ACTl0t*
Mfrrnovrn n slsArrn*vsn nFlHAL
dc.o. (F|NAL) ilN$TAPFLUABLE nFIPlwrlilsFfcr
ACfioN R€QUI*ED: \n \\? -- - * -
Rre't Acl*ur*lrdged
t.|bit*.fi|i{rCop?
F.rlS-6fit:!
!|ltr. JobCtor ro - *rgrAortCoPr
INSPECTIS ffTMS fO$FO*Id TCI APPRSVEI) $IT65
O m*sFacTlol-l tlcxnt O
X BH*n Ekct. * Mccll fi Fin
luspcrion Rqucst R* d 8Y
fieq" By
Pr*iecl Pennit No.
Address
tnspector's RtPort S o*,
ffiTCIAPPswEnFwss nv nN [.]N/A
lNspgfT$R'$ AcTl0N./ginvrxavta
ilrO {FINAL}
-k arnoru rlamnr
nf^lr,,r, /nr') lliz-
Ptrone n" ?nl-itU3
[J DlsApPROvcD
ilN$f ATPLUABLE
N NHAL
flFlP r{If n'l$FECT
R*c'lAclmxbdged
lYlrlr " Ql$ct $aFt
F-fin'cs:
&lor " Jdb Co0!r*.h*#rc.fr
tnspetion TYPc
Day /Tim* Req'
O nqsracrlorqttcxnt O
Plumb.wElcet.
Fruiecl
Address
lnrpfctOf'r Rtpcrt X Res.I fomm.
Mcctt.FiruSldg.
lnspciio* Requast: F*ti
fieq. By
I
w ,la
' Da.* k/4"/J4
trrlat Fhonc Nr" i0l'77L3 "'
/z /4 ){/
INSPffiT$&'$ ACTICIN
mAPPROVEF
nf.o.{FINAL}
AfTl0N f;lQlilfisD:
#rn*o*oo*u
NY ilN
N RNAL
flbls l.6f ll'lsFECT
Rre'l Acknoxltdgcd
f{h{. - mft CoPf
r.rlfi-cffi
rtlq* . .JoU CoFt ft*. rrsrcrs.}c*l
lnspcetion TYPe
Day ffirne Req'
ffiT0APPnwErlntJrfis
ffi*F-*r,.n Elcct' n Mcet' n sin
en. '-, ,^ltqll-
Inspcf ion Request: Rec'd By W >atc tu t '''rU'
,,***-. t;l:11?(
I rnsracrlot{ TIcKar O
lA1;
Addresl
lnspclion TYPc
Day /Time Req.
lnrpect*r'$ RrPort
+
n Cnmm.
rNspr-rmus coxronlt ro ATPRCIvED nwos nY ilN
N ANAL
fl I'*tA
TNSPHCTUII'5 ,{C:TI*N
ilAFpRovEs
X. " {FINAL)lohrcx REQUTRED:
lJ DtsAprRovsD
ilNSTAPFLICABLE [JBIS l{(Irlils?fcr
Sign*d
Rec't Aek"tuwlrdgcd
w!l{|. Clbct fopf
f .ftft-cfill'
!tlo? . JoA CtFt ffi.kriDd.lcryt
gF{ S tr trt {.j"K'Ht}f*g T [{'';b{'iii
-:::i=+--
L.*$ ij lu *.'il :':L-:::L:' i*1 :'t""' '
, -rcffi"y{*#w
x?'r1!"
4[r 'v v
;h!$rS"
Idr^&"e/
ROVED DWCS
ffi' drrsiAPPltovEDtrfu
IY []:.J ;,ii!i.
fl F,lsi'AvP!-icAsLfi
n FlNli{-
f] illp idC*'iNgfi-4i-l
nCliON REQUlF'Eli:
TNSPECTION TICKBO
mto,.oMcch.oFirs
*r" t l',lt =*
fnspcrion Requesr Rec'd By g -.rnw
-ffi -7 7 6
LLa--'->
Ksq' .,
Perrnir No' /7 e
Project Tlct-lc g-''--
naa*"8""L:Ge-V-,'b t$r, , *
lnspection TYPe
Day /Time Req.
Inspector's RePort { n'
ROVED DWGS uY nN flN,A
INSPECTOR'S ACTION
p6eYxoveo
nc.o.(FINAL)^yEwv,
f] DISAPPROVED
f]NOTAPPLICABLE
DFINAL
u DID NOt INSPECT
Rec't Ackruwledged
tivha. - Cltic. CoPt
F-f rR.codl
PH'lnr.dott@ttbror.JobCo9t
INSPECTION TICKET
Inspction Rquest:
Req. By
Projecl
Address
lnspection Type
Day ffime Req.
| ' r' tll ,/ F:
LL4'llJl{*.dr*ffiyt
Lr-2,t1- iL a , s. cr f
lnspector's RePort E Res,tr comm.
lr.rSpECreO ITEMS CONFORM T0 APPROVED DWCS nY ,tr N fl N/A
DFINAL
n DrD NOr INSPECT
'-m?:;:trws,,o,,*ou,o
tr c o. (FINAL)
ACTION REQUIRED:
f] NOTAPPLICABLE
wl*t!-O{rice Copy
F.rrR.C$03
!b$o* .,rob C0PY Fr* - lnspelCsW
O rNsPECrroN rrcKn
tl r:
lnspcrion Request: Rec'd By 'iJ,*i +t-t-'Date
Req. By Phone No.
-"1 o\;-\9:5c:
Project
Address
Inspction Type
Day lTime Req.
.".]1V.*-lt*."t r (.i),t.i i.( t:*-
ie at
Inspector's Report q Res O comm.
INSPECTED ITEMS CONFORM TO APPROVED DWGS []Y DN flN/A
D FINAL
D DrD NOr TNSPECT
INSPECTOR'S ACTION
iMappnoveor\
f]C.O. (FINAL)
ACTION REQUIRED:
fJ DISAPPROVED
NNOTAPPLICABLE
Pil - ltrprfir.r@r
JnsrncrroN rrcKnr O
W BHg. tr ptumb. fl Ehcr. O Mech. O Firc
Inspclion Request: Rec'd By
t
/i'o< t".t-tct'cL Date k " /t " [,]
Req. By Phone 11o. t/!"s -77{t".5
Project T;fU'L'hi,1n^-a: f! Li' tlt4rPennit No. IMCQ31
Inspection Type
Day /Time Req.
Inspector's Report F Res.flc(p#m.
rfl Pa:-op
h.,-'ea"d,.E &*rv-:lxa
e$a-(,15
,l,e-r h.xss fuar,n tu
'- hlo rolacha,
W 5 r,r r{- a# Joi tr^ltl
"ee t r.,;c.,t( 7
INSPECTED ITEMS CONFORM TO Dv Dx flN/A
DFINAL
D DrD NOr TNSPECT
INSPECTOR'S ACTION
!APPROVED
nc.o. (FTNAL)
ACTION REQUTRED:
'16,rorr*o,r,
f}NOTAPPLTCABLE
Signed
Rec'l Ackhowledged
tt{tirc .oflicc Copt
F.FrF.C003
Ycfor . Joo Copy F** - hop.clorl Copt
t opment Receipt Number:
i440
359-3022
[1Tr 0F Rt;iiruFi6
PAIIT BYr GF:[G i'ttl5'iti
IIATET il4lt5ili
TII{t: l6:81:3?
t{s i tr4i5lft'tTR
ftF:UIIFT ]10: 15t90?
FtF H0: 1131
30 tt t{E{:H. peftHIT Ui,tIrEF: t i:.ili|
11 FF ELtlT. FtRtiIT .i 3 HI n5.tilJ
]t !F FttIL irtp plAi't[i{tt}iFt i31.,:t
]] BT, F,LUI'IF. F,EftI'IIT UNTIHR *5.0I]
]4 Fllit lrt\!. ItiFA[T i-r.[g 6?.4I
35 $ElltR CAFITAL C[ilNt[TItr 6??.0[
:6 lrATtR IAFITftL [0i{Nit]IIrJ 63?.0*
-i? FAFfiS IrrU. Ii'iF,f'[T rftS 4gi]"tg
3S F[Li[E-IirUEL[t]lEi,lT IHpn 5S.tS
39 STREI-T Ir[L!, I1'1F'A[T fffs 6?Ld,i
4[ I'p IrUiL. F[Frlt jTs uHirER I ,318,55
[Ht[]i Aft[Ltt{T 4,I54"i1
FAYHTNT 4,iI4. ri
[HAHut i].fir|
TERHIT # 13rS151
THAIIIi 'fTU AilIi HA|!I A HIIT TIAY
idential Fixtures
al
nbing Permit Fee
wer
rter
,l
ee
ee
I Fee
$65.00
$65.00
$131.86
$6s.00
$69.43
$697.00
$637.00
$458.8s
$55.26
$691.66
$1 ,318.55
Total:
$6s.00
$65.00
$131.86
$65.00
$69.43
$697.00
$637.00
$4s8.85
$ss.26
$691.66
$1,318.55
$0.00
$0.00
$0.00
$o.oo
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$4,254.6'l
$4,254.61
$ 4,254.61
f or* z5?n1?-
fiqry qry qlExBLjRG
genpmtrreceapts Page 1 of 1