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HomeMy WebLinkAboutBLD04-003 CITY OF PORT TO WNSEND PERMITACTIP7TYLOG PERMIT#__._c6 txb DATE RECEIVED: SCOPE OF WORK- ................ ....... s iAz ................... DATE ACTION 1"NITIALS Entered into TRIPS ESA—to Planning ( -no evidence of ESA- Vested Date Checked for Completeness "T . ..... o A LS -nA Y 1Y,1/ i L+ I 2A e� f .............. L V) kt5D(e,6�66q. m -R?"\- 17 f 3 455 J4 *5_5 .............. ............ ........... \\13cd_permits\fonns\BUILDING\Pcnnit Activity Log.doc o rn m CD O m n 2 a�i o c p Z co M s n o Z Z D C o O m m O = � Z o m Q) m o ° %n C l co C m r CD ca 0 o N ` ♦ N o. o ID m Imo m c o CD CD v, o W 1 0 O -i 0 XM 0 cn CD n z 0 a 0)i d CD _ 0 m m w O 0 4"� c �. O m m Z - C� m o " , n. r 0 n c m s Z m " m N o o p CD O Z m '0 It w -p N a . j. N in m T w N D � F v p � O cn CD CD m n ° m :3 0 W Z to a m m Z Z O afD < C 0 o fD rt CD 6 7 m 7 C m a CD CD .,, p m � CD 0 X PL CD rop, O N _ m a � ? �, CD a µ mO Wei f, 1R O o c CD z `° M m o A CD r 0 s D � IN to c � m n � < y r Z m m n O (D V 1 ZW am " Q O Ipp o < 7 rF 11 A CD = u B Waterman&Katz Building 181 Quincy Street,Suite 301 Port Townsend,WA 98368 Phone:360-379-3208 Fax 360-385-7675 CITY OF PORT: TOWNSEND CONSTRUCTION PERMIT & INSPECTION RECORD THIS CARD MUST BE POSTED AT CONSTRUCTION SITE Call 385-2294 for Inspection Permit Number: BLD04-003 Issued: 01/21/04 Parcel Number: 948 310 704 Job Address: 1709 Sheridan Ave Zoning: R-II Construction Type: V-N Occupancy: UU=1 Total Occupant Load: No Change Use of Building: Garage/Laundry Nature of Work: Addition to garage.. Owners: Vernon Barnett&Emily Holmes Contractor: Owner SEPARATE PERMITS REQUIRED: Electrical—Contact Labor and Industries @ 417-2702 GENERAL CONDITIONS APPLY - SEE LAST PAGE REQUIRED INSPECTIONS APPROVED/DATE DEMOLITION Materials shall be deposited in Jefferson County Landfill or other approved location in accordance with State and Local laws FRAMING (if applicable) MECHANICAL (if applicable) FINAL Electrical (L&I) Building Address Numbers Final -Building qp p 7 ''. Call 48 hours before you dig for Utility line locates 1-800 424-5555 Page 1 of 2 Permit#BLD04-003 GENERAL CONDITIONS 1. Contractors working on this project are required to have a Labor &Industries Contractor's Registration Number and a City Business License. Failure to provide proof of this documentation PRIOR to work may result in job shutdown while this is accomplished. 2. TESC—Temporary erosion and sediment control measures shall be installed on-site and inspected prior to beginning construction; call 385-2294.Measures shall include installation of silt fencing and graveled construction entrance(see attached details). Soils exposed during construction shall be temporarily stabilized with mulching,plastic sheeting,etc. Soils shall be permanently stabilized with seeding,plantings,sodding,etc.,once construction is complete.Applicant is responsible for protection of adjacent properties. 3. All engineered elements including sheathing,nailing,holdowns,ABWP's(alternate braced wall panels), etc.,requires inspection PRIOR to cover. 4. Owner or owner's agent shall review and oversee correction of any and all deficiencies noted by required inspections. 5. Re-inspection is required after Inspection Report corrections are completed. 6. The Building Department is unable to pass Final Inspection on your project until Public Works requirements have been completed and inspected. For Public Works inspection call 385-2294. minininni of 24 hours notice is required. Public Works approval must be received prior to schediffigg the Building De artinent's Final lies)ection or _issuing a Temporary Certificate of Occupancy. 7. Final Inspection and Certificate of Occupancy(nonresidential only) required PRIOR to occupancy. 8. All building permits expire if no progress has been made within six months,or if no inspections are done by the Building Department within one year. Call for at least one inspection per year to keep your building permit active. 9. Revisions require submittal& approval prior to making changes in the field. Contact the Building Department @ 379-3208 prior to making changes to the approved plans. 10. POST THIS PERMIT ON-SITE WITH THE APPROVED PLANS. Call 48 hours before you dig for Utility line locates 1-800 424-5555 Page 2 of 2 Permit#BLD04-003 GENERAL CONDITIONS 1. Contractors working on this project are required to have a Labor &Industries Contractor's Registration Number and a City Business License. Failure to provide proof of this documentation PRIOR to work may result in job shutdown while this is accomplished. 2. TESC—Temporary erosion and sediment control measures shall be installed on-site and inspected prior to beginning construction; call 385-2294.Measures shall include installation of silt fencing and graveled construction entrance(see attached details). Soils exposed during construction shall be temporarily stabilized with mulching,plastic sheeting, etc. Soils shall be permanently stabilized with seeding,plantings,sodding,etc.,once construction is complete.Applicant is responsible for protection of adjacent properties. 3. All engineered elements including sheathing,nailing,holdowns,ABWP's (alternate braced wall panels),etc., requires inspection PRIOR to cover. 4. Owner or owner's agent shall review and oversee correction of any and all deficiencies noted by required inspections. 5. Re-inspection is required after Inspection Report corrections are completed. 6. The Building Department is unable to pass Final Inspection on your project until Public Works requirements have been completed and inspected. For Public Works inspection call 385-2294. A iuinimum of 24 hours notice is required. Public Works a goroval must be received prior to sclieduflug the Buildin g Department's Final Inspection ectio,n or issuing a Temporary Certificate of Occupancy. 7. Final Inspection and Certificate of Occupancy(nonresidential only) required PRIOR to occupancy. 8. All building permits expire if no progress has been made within six months,or if no inspections are done by the Building Department within one year. Call for at least one inspection per year to keep your building permit active. 9. Revisions require submittal& approval prior to making changes in the field. Contact the Building Department @ 379-3208 prior to making changes to the approved plans. 10. POST THIS PERMIT ON-SITE WITH THE APPROVED PLANS. Call 48 hours before you dig for Utility line locates 1-800 424-5555 Page 2 of 2 Waterman&Katz Building 181 Quincy Street,Suite 301 Port Townsend,WA 98368 Phone:360-379-3208 Fax 360-385-7675 CITY OF PORT TOWNSEND CONSTRUCTION PERMIT & INSPECTION RECORDu THIS CARD MUST BE POSTED AT CONSTRUCTION SITE Call 385-2294 for Inspection Permit Number: BLD04-003 R-1 Issued: 01/21/04 Parcel Number: 948 310 704 Job.Address: 1709 Sheridan Ave Zoning: R-II Construction Type: V-N Occupancy: U-1 Total Occupant Load: No Chan Use of Building: Gara e/Lannd Nature of Work: Addition to garage. Owners: Vernon Barnett & Emily Holmes Contractor: Owner SEPARATE PERMITS RE UIRED: Electrical—Contact Labor and Industries @ 417-2702 GENERAL CONDITIONS APPLY - SEE LAST PAGE REQUIRED INSPECTIONS APPROVED/DATE DEMOLITION Materials shall be deposited in Jefferson County Landfill or other approved location in accordance with State and Local laws FRAMING (if applicable) MECHANICAL (if applicable) ....... FINAL Electrical (L & 1) Building Address Numbers Final - Building ........................._... ..........._................ .. I. ........ _ ........ ...................................................................... Call 48 hours before you dig for Utility line locates 1-800 424-5555 Page 1 of 2 Permit#BLD04-003R-1 GENERAL CONDITIONS 1. Contractors working on this project are required to have a Labor&Industries Contractor's Registration Number and a City Business License. Failure to provide proof of this documentation PRIOR to work may result in job shutdown while this is accomplished. 2. TESC—Temporary erosion and sediment control measures shall be installed on-site and inspected prior to beginning construction; call 385-2294.Measures shall include installation of silt fencing and graveled construction entrance (see attached details). Soils exposed during construction shall be temporarily stabilized with mulching, plastic sheeting,etc. Soils shall be permanently stabilized with seeding, plantings,sodding,etc.,once construction is complete.Applicant is responsible for protection of adjacent properties. 3. All engineered elements including sheathing,nailing, holdowns,ABWP's (alternate braced wall panels),etc., requires inspection PRIOR to cover. 4. Owner or owner's agent shall review and oversee correction of any and all deficiencies noted by required inspections. 5. Re-inspection is required after Inspection Report corrections are completed. 6. The Building Department is unable to pass Final Inspection on your project until Public Works requirements have been completed and inspected. For Public Works inspection call 385-2294. A miniuinm of 24 lours notice is re uired. Public Worlcs approval must be received prior to scheduling the Building Department's Final Inspection_ or issuin a Temporary Certificate of Occupancy. 7. Final Inspection and Certificate of Occupancy(nonresidential only) required PRIOR to occupancy. 8. All building permits expire if no progress has been made within six months,or if no inspections are done by the Building Department within one year. Call for at least one inspection per year to keep your building permit active. 9. Revisions require submittal & approval prior to making changes in the field. Contact the Building Department @ 379-3208 prior to making changes to the approved plans. 10. POST THIS PERMIT ON-SITE WITH THE APPROVED PLANS. Call 48 hours before you dig for Utility line locates 1-800 424-5555 Page 2 of 2 PORT City of Port Townsend Development Services Department 250 Madison Street, Suite 3 ' Port Townsend WA 98368 WA 360-379-5095 Fax 360-344-4619 REVISION TO BUILDING PERMIT# 131- 0`1 — oo-3 Revision # W OWNER: i : ! h)SITE ADDRESS: 1205' Total Value of Revision: $ �/d Op Impervious Surface Change? ❑ Yes ,100 Revisions require 2 sets of plans and a written scope of workthat fully describes the proposed change plus any additional information that will be of assistance in issuing your revision. If your plans were stamped by a design professional,all revision submittals require a stamp with a wet signature. Be avare that changes to the existing approved plans may also require you to revise your original building permit application(lot coverage,impervious surface,structure square footage,etc.)and energy code documents(changing windows,heat source,etc.)to conform to your proposed changes. Scope of work: 0 d M an= Jam. ° . °nm /I- .......... � . i i . JI ZZ Z, 15 orl /l licant Sig&ture Date OFFICE USE ONLY: Submittal date: Two sets of plans for revision: Approval of engineer of record(if original plans engineered): ❑ Yes ❑ No ❑ NA PADSMDepartment Fonms\Building FormsUpplication-Revision.doc CITY OF PORT TOWNSEND BUILDING&COMMUNITY DEVELOr AENT 'PORT�o Waterman&Katz Building,181 Quincy Street,Suite 301A Port Townsend WA 98368 Phone: 360-379-5082 Fax 360-385-7675 RESIDENTIAL BUILDING PERMIT APPLICATION �. NEW CONSTRUCTION,REMODELS, & ADDITIONS m Property y Owner's Name ' r,- —/V— Mailing ' Address . , City State Zip �eT' " ._ Property Street Address Zoning Districts Parcel# C IS v0 . General Contractor's Name Mailing Address Phone °'W Cell Phone State License Number City Business License Number Authorized Representative/+contact.Person: Phone: mry Estimated Value of construction M Financed By Date Work is to Begin . Date Work is to be Completed Scope of Work: Please check all items that apply for the type of building permit you are redquesting:. ffRepair/Remodel ouse Addition arage or Carport Repair/Remodel Garage House Accessory Dwelling Unit please describe): Floor Area: the proposed structure is to be used for: Finished Heated Space sq. ft: Garage sq. ft: Unfinished Heated Space sq ft: Carport sq. ft: Unfinished Basement sq ft: Porches sq. ft: Semi-Finished Basement sq ft: Decks sq. ft: Storage sq. ft: Other(please describe): \\Citypdc\bcd\AII Forms\Building Permit Application.doc Page 1 of 1 CITY OF PORT TOWNSEND RESIDENTIAL BUILDING PERMIT APPLICATION NEW CONSTRUCTION,REMODELS,&ADDITIONS Pro ert Site Area/Coverage Information: 1. The total area of the property in square feet: 2. The total area covered by existing and proposed structures in square feet: (total ground coverage from the outside of walls or supporting members) .......... ............------------------------ Percentage of lot coverage: (2-- 1 Impervious Surfaces: Please provide the square footage of the roof area of the proposed and existing structures, and the square footage of the total area covered by porches, walkways, patios and driveways. Do not include decks allowing drainage to earth below. Proposed House Roofprint sq. ft: Existing House Roofprint sq. ft- ........... Proposed Garage Roofprint sq. ft: Existing Garage Roofprint sq. ft: ............... ............... ............ Proposed Porch/Walkway sq. ft: Existing Porch/Walkway sq. ft: ............. ......... .............. Proposed Driveways sq. ft: Existing Driveways sq. ft: ........... Other (describe): Other (describe): .......... ........ ...... Total Proposed Impervious sq. ft: Total Existing Impervious sq. ft: .......... Total Proposed + Existing sq. ft: Percentage Impervious: * 00, (Impervious surface -- lot sq. ft) *If total impervious surface is equal to or greater than 40% of the lot area, you must submit a written stormwater plan to address run-off. Please check which plans you are submitting with this application (2 sets needed): Site Plan Interior & Exterior Wall Bracing (panel locations shown on floor plan) Drainage Plan (if 40% or more Typical Wall Framing Details (section from impervious) foundation through roof) Foundation Plan Elevations Floor Plan 2001 WSEC Compliance: Prescriptive Component Floor Framing Plan WSEC Construction Checklist Roof Framing Plan Other: ........... \\Citypd6bcd\All Forms\Building Permit Application.doc Page 2 of 2 CITY OF PORT TOWNSEND RESIDENTIAL BUILDING PERMIT APPLICATION NEW CONSTRUCTION,REMODELS,&ADDITIONS Special Conditions Please check YES or NO as applicable YES NO 1. Is the property within 200 feet of a fresh or saltwater shoreline? 2. Is the property within the Port Townsend Historical District? 3. Is the property located within or adjacent to an environmentally sensitive area? 4. Will this proposal involve any sewer, water or other utility extensions that will, or could serve vacant properties other than the project site? If yes, please attach information identifying the utility extensions and sites. 5. Have any special conditions been placed on this property, or has the property been subject to any conditions on any prior action of the City(if"Yes"to any of the following, attach copies of appropriate documents): Subdivision/Short Plat/Boundary Line Adjustment? SEPA(environmental review)? X Variance? Conditional Use Permit? Street Vacation? Planned Unit Development? Restrictive Covenant? Easement? 6. Are any properties within 800 feet of the site owned or controlled by the applicant, any relative or business associate, or any partnership, corporation, or other entity affiliated with the applicant? (If es attach list. 7. Have any of the properties listed in item#6 been developed within the last two years? (If yes, attach list.) 8. Have you previously discussed this project with a City staff member? If yes,who and when? -/. 1V „ 90 APPUca �cett+ t The applicant hereby certifies to have knowledge of those sections of the Uniform Building Code and the Port Townsend Municipal Code pertinent to the above project and that the applicant is responsible for constructing in conformance with these codes; the applicant understands that the permit, if issued, expires in six months unless work is started; that the permit, after construction has started,will expire after one year if an inspection is not made to show significant progress on the structure; the applicant agrees to abide by the ordinances, codes, regulations, restrictive covenants, deed or plat restrictions, and water and sewer plans attached hereto; the applicant certifies that all information given above and on accompanying plans is complete and accurate to the best of their knowledge; and the applicant understands that this information will be relied upon in granting permits and that if such information is later found to be inaccurate any permits may be withdrawn. \\Citypdc\bcd\AII Forms\Building Permit Application.doc Page 3 of 3 c-, rc) o y c C p is Q N m � W * n CD � vo _ Z fA C L m C) Z —h m c0i � C O °_' v ( O n "IN o o"� Z m m �� � o o O (n C a m m ? taro n n Q "'," N M m � _ w � lD O P_ 0 c o O m lD m ; S w 2 cn to .�,�n�■ m (D :17 n O N� i a O =r CD � e h�nm, rr C) �"w mm Q `�,� CD CD C C 0 m " O r D ddd "�" zy ' �� n c m - ,?1u"„ N z N In cn O m 0 ////�� N4 skyy Q N O f \V cn cn m Lj m, :y; < �" 0. CITY OF PORT TOWNSEND RESIDENTIAL BUILDING PERMIT APPLICATION NEW CONSTRUCTION,REMODELS,&ADDITIONS The undersigned hereby saves and holds the City of Port Townsend harmless from any and all causes of action, judgments, claims, or demands, or from any liability of any nature arising from any non-compliance with any restrictive covenants, plat restrictions, deed restrictions, or other restrictions which may have been established by parties other than the City of Port Townsend. Complete 5 Port Townsend Municipal Code, Section 16.04.140, Vested Rights -Substantially Complete Building Permit Application: applications for all land use and development permits required under ordinances of the city shall be considered under the zoning and other land use control ordinances in effect on the date a fully complete building permit application, meeting the requirements identified in this section, is filed with the Building and Community Development Department. Until a complete building permit application is filed, all applications for land use and development permits shall be reviewed subject to any zoning or other land use control ordinances which become effective prior to the date of issuance of a final decision by the city on the application. An application for a building permit shall be considered complete when an application meeting all of the requirements of Section 106.3 of the Uniform Building Code, 1997 Edition, is submitted which is consistent with all then applicable ordinances and laws. In addition, to be considered complete, such an application must be accompanied by complete applications for a subsidiary land use or development permits needed, such as a complete shoreline management permit application and/or complete applications for other discretionary permits required under the ordinances of Port Townsend. An application for a partial permit under Section 106.4.1 of the Uniform Building Code, 1997 Edition, shall not be considered complete unless it meets all requirements stated above and contains plans for the complete structural frame of the building and the'architectural plans for the structure. Signatur '" f Applicant or Authorized Representative Date For Official Use Only Permit No. Building Official Approval Date Issued f �® 8L-06 V Balance Due $ Date Validation Stamp below: Owner/ resent tive nature Date \\Citypdc\bcdWll Forms\Building Permit Application.doc Page 4 of 4 Suzanne Wassmer From: Ed Jones Sent: Friday, January 02, 2004 4:35 PM To: Penny Westerfield; Suzanne Wassmer O thou ladies who take many vacations ! I posted a stop work at 1709 Sheridan last Wednesday(Happy new years eve !). The owner was in today and picked up a permit pkg. He knew he was supposed to get a permit. However, he didn't think we'd be"out in force"on new year's eve. Anyway, I'd double the fees when he comes in. He can help pay for all the vacation time you'all take. 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I Inspection Report Project Permit# Date Inspector Inspection & Notes e_......_ VNK mm 9 �d I .._.__........._ 2 Vvr to CITY OF PORT TOWNSEND DEVELOPMENT SERVICES DEPARTMENT INSPECTION REPORT WA s For inspections,call the Inspection Line at 360-385-2294 by 3:00 PM the day before you want the inspection. For Monday inspections,call by 3:00 PM Friday. DATE OF INSPECTION " " _PERMIT NUMBER �� ' �" " SITE ADDRESS: der;:, ' PROJECT NAME t° x ,w r�� ��'�� CONTRACTOR: CONTACT PERSON: . - ���� ;,.ask"�� �° PHONE: _.. ........TYPE OF OF INSPECTION: ....' � ---' � ' � �t a w � 5 .. ._ ❑ APPROVED ❑ APPROVED WITH ❑ NOT APPROVED CORRECTIONS Ok to proceed. Corrections will be Call for re-inspection before checked at next inspection proceeding. Inspector. 4 Date, 11, ... — ... 1 ----........ 4. . , � Approved plans and permit card must be on-site and available at time of inspection. A re-inspection fee may be assessed if work is not ready for inspection. Vonr r CITY OF PORT TOWNSEND DEVELOPMENT SERVICES DEPARTMENT s k INSPECTION REPORT WA For inspections,call the Inspection Line at 360-385-2294 by 3:00 PM the day before you want the inspection. For Monday inspections, call by 3:00 PM Friday. DATE OF INSPECTION. .m _PERMIT NUMBER: 1: .. '., ........_. SITE ADDRESS: r� r PROJECT NAME: w c.2- r CONTRACTOR: A --- �._ CONTACT PERSON: PHONE: ILI mmITITm TYPE OF INSPECTION: 1 . 7 ,w � l aµ�! a aw mw ... ..... _ . ..__ U y.. . ._ _.......� ­(17�1� V m � '9• 11 :^tk��err �m. ,...., N� ......... .... 1..._ _ -- r� a, 11 APPROVED ❑ APPROVED WITH �"° tiN NOT APPROVED � CORRECTIONS Ok to proceed. Corrections will be Cal1 for re-inspection before " checked at next inspection 1p oceeding. w, ww Inspector � ��.,.. � � Date .../.'..6�/�e'-,y--L Approved plans and permit card must be on-site and available at time of inspection. A re-inspection fee may be assessed if work is not ready for inspection. CITY OF PORT TOWNSEND DEVELOPMENT SERVICES DEPARTMENT INSPECTION REPORT PERMIT NUMBER: �' �� A�� 00 t Site Address Contractor ..�..._ � Owner Date of Inspection _ � 7 .....�.�.m. w .. .�......_ �. �_.... . _.......� Worksite or Cell Phone# �. ❑ Erosion/Sediment Control ❑ Plumbing/Top Out ❑ Propane/Wood Appliance ❑ Setbacks/Footings/UFER ❑ Propane Pipe/Pressure Test ❑ Manufactured Home Set-up ❑ Foundation Walls ❑ Propane Tank/Line ❑ Fire Department ❑ Footing Drainage ❑ Mechanical ❑Temporary Occupancy ❑ Slab/Interior Footing/Insulation ❑ Framing ❑ Fees Paid ❑ Groundwork/Plumbing Test ❑ Insulation ❑ Final Occupancy ❑ Underfloor Framing ❑ Interior Shear/BWP Nail 14ff Otlier/Consuultation ❑ Ext. Shear Wall/Holdowns ❑ Drywall/Fire Wall ___------ ......... For inspections, call the Inspection Line at 360-385-2294 by 3:00 PM the day before you want the inspection; for Monday inspections call by 3:00 PM Friday. Additional fees may be assessed for multiple re-inspections if the work is not ready and the inspector must return to the site. Failure to provide inspection record and approved plans on the site will result in $47 re-inspection fee charge. (OCCUPANCY REQUIRES PRIOR WRITTEN APPROVAL BY DSD.) ❑ APPROVED APPROVED WITH CORRECTIONS ❑ NOT APPROVED XSEE BELOW SEE COMMENT(S) BELOW M w ., m ...�...... ...� .�oi�. �...p.... .. ..m,..,.-.,.�.. ,�,.,,. ,� ...�..._.,�.� ......_. .........__mow ,...�..�.,. m.,m.., ___ ........��,,...._,.._..___.,,,, ..,. Approved p a is and p r it c r must be on-site and available at time of)Inspection. .�. ..n .. �. .._....w.�._ . ....�.�___ Date Inspector Acknowledge by Date CITY OF PORT TOWNStND DEVELOPMENT SERVICES DEPARTMENT � W INSPECTION REPORT PERMIT NUMBER: Site Address Contractor _....... �.._._.......��.. �� __ .............. .... ..�.� ___ _w�... e. ....... Owner Date of Inspection . ................� �� mmm..�..............�. .. � .aw-_� ... ..mm_... Worksite or Cell Phone# ❑ Erosion/Sediment Control ❑ Plumbing/Top Out ❑ Propane/Wood Appliance ❑ Setbacks/Footings/UFER ❑ Propane Pipe/Pressure Test ❑ Manufactured Home Set-up ❑ Foundation Walls ❑ Propane Tank/Line ❑ Fire Department ❑ Footing Drainage ❑ Mechanical ❑Temporary Occupancy ❑ Slab/Interior Footing/Insulation ❑ Framing ❑ Fees Paid ❑ Groundwork/Plumbing Test ❑ Insulation ❑ Final Occupancy ❑ Underfloor Framing ❑ Interior Shear/BWP Nail th r/ cn staltation ❑ Ext. Shear Wall/Holdowns ❑ Drywall/Fire Wall .. ___.---.. _...�. a� For inspections, call the Inspection Line at 360-385-2294 by 3:00 PM the day before you want the inspection; for Monday inspections call by 3:00 PM Friday. Additional fees may be assessed for multiple re-inspections if the work is not ready and the inspector must return to the site. Failure to provide inspection record and approved plans on the site will result in $47 re-inspection fee charge. (OCCUPANCY REQUIRES PRIOR WRITTEN APPROVAL BY DSD.) ❑ APPROVED ^ APPROVED WITH CORRECTIONS ❑ NOT APPROVED „SEE BELOW SEE COMMENT(S) BELOW u .,. � I .�I'' ':�... _ �-... �.. .. , _ gym. . ........ . ..... .... � y . o ,5fy� f' of j1 N aim a V Approved lads and erIit and must be on-site and available at time of inspection. DateInspector � w�V � ..� .,: ..��._ _ � .. �_ -�.-�� Date Acknowledged by _ �__ ........ .