HomeMy WebLinkAboutCALLOW AVE. N., 337
Certificate
Of
Occupancy
. Department of Community Development
This certificate issued to the requirements of Section 110 of the International Building
Code, as adopted by the Bremerton Municipal Code, certifies that at the time of issuance
this structure complied with the requirements of the code for the occupancy and division
of occupancy and the use for which the occupancy is classified. Issuance of a Certificate of
Occupancy shall not be construed as an approval of a violation of the provisions of any
building code or of the other ordinances of the City of Bremerton.
ISSUED TO: GW'S SOUP, SALAD & SUBS
SITE ADDRESS: 337 N CALLOW AVE
OWNER:
FORD GREGORY & WANDA
337 N. CALLOW AVE
BREMERTON, W A 98312
V-B
Occupancy
Classification
~/
Occupant
Load
49
Common Use
Code
Edition
Sprinkler
Req'd
N
lJ!i!!.!!i
Construction
RESTAURANT
lEe: 2006
Permit Number: BB0900103
Business License Number: 27177
Date: 09/30/2009
An ea L. Spencer, Com
Special Cond: ons:
Occupant load is limited to 49 because of inward swinging doors
THIS CERTIFICATE MUST BE POSTED AND PERMANENTLY MAINTAINED IN A CONSPICUOUS PLACE
d-I \ I'
CITY OF BREMERTON
,
DEPARTMENT OF COMMl-lNITY DEVELOPMENT
345 - 6th Street, Bremerton, (vA 98337
(360) 473-5275 Fax: (360) 4713-5278
1
PERMIT NUMBER: BB0900103
DATE ISSUED:
ASSESSOR NUMBER: 3733-006-006-0009
APPLICANT NAME: FORD WANDA
OWNER NAME: PENDLEY DARLENE A
CONTRACTOR:
LENDER NAME:
ZONING: DCC
PHONE: (360) 471-8073
PHONE: (360) 692-2372
PHONE:
PHONE: 0-
SITE ADDRESS: 337 N CALLOW AVE
ADDRESS: 1112 N MONTGOMERY, BREMERTON, WA 98312
ADDRESS: 9900 OGLE RD NE, BREMERTON, WA 98311
ADDRESS:
ADDRESS:
SUBMITTED:
02/24/2009
APPROVED:
EXPIRATION: 08/23/2009
STATUS: PENDING
VALUATION:
Tenant Improvement, No Work (Business license)
TI No Work (Business license)
$47.00 2211
$47.00
TI-NO WORK FOR RESTAURANT CALLED GW'S SOUPS, SA ADS & SUB'S
Building Code Edition: IBC: 2006
Occupancy Group:
Type of Construction:
Flood Zone:
Setbacks:
Sanitation Method:
Number of Bedrooms:
Fl L E:.
1-0&
~J
~l pz e:. I
~C-C-
TOTAL FEES:
(Front) (Side) (Rear) (Other)
Inspection Requests
DCD: Building Inspections
L&1: Department of Labor and Industries
(360) 473-5870
(360) 415-4000
Fire Inspections
HID: Bremerton, Kitsap County Health District
PW: Department of Public Works
(360) 473-5394
(360) 337 -5285
(360) 473-5270
This permit shall become null and void if the described and authorized by this permit has not commenced within 180 days from the date of issuance, or if the work is suspended or abandoned
at any time afterthe work is commenced for a period of 180 days. It is the responsibility of the permit holderto see thatthe required inspections are made. Failure to obtain required
Inspections may resuit in stoppage of the work until such time that the permit holder can susbstantiate to the City of Bremerton that the concealed work meets or exceeds code
requirements. Any demolition, testing, or financial burden shall be borne directly by the permit holder. Failure to substantiate code requirements will indemnify the City against any and all
responsibility or liability connected with the construction. I hereby certify that I have read and examined this permit 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 specified herein or not. The granting of a permit does not presume to give authority to vioiate or cancel provisions of
any State or local law reguiating construction or the performance of the construction. If listing the owner as general contractor, I certify that) am exempt from the requirements of the State
Contractor's Registration Law under Section 3, Chapter 126, Laws of1967. All revisions to an approved plan require DCD review and approval prior to performing work. All building and tenant
occupancy permits are required to pass final inspection prior to permit expiration and obtain a certificate of occupancy prior to use or occupancy.
I have read, and agree to abide by the conditions of this permit including all conditions of zoning, building codes, and State and Federal laws.
SIGNATURE OF OWNER OR
AGENT:
PRINTED NAME:
DATE:
CONDITIONS
City of Bremerton's approval of this application pertains only to the City's regulatory jurisdiction, and thus compliance with City
regulations does not necessarily ensure compliance with federal or state laws.
DCD: Tenant Improvement - No Work Conditions:
This permit is issued based on the assumption that a valid certificate of occupancy had
previously been issued for this building, and that the occupancy classification has not been
changed. Following issuance, if it is determined that there is not a valid certificate of
occupancy, it will be necessary to obtain a commercial tenant improvement permit to
address all of the occupancy requirements prior to any use or occupancy of the building.
General Provisions:
'All doors shall have barrier free hardware (lever or panic) and shall be openable from the
inside without the use of a key or any special knowledge or effort. Exception: Key-locking
hardware may be used on the "Main Door" provided there is a sign, with minimum 1"
letters, on or adjacent to the door stating: "THIS DOOR TO REMAIN UNLOCKED WHEN
BUILDING IS OCCUPIED."
'All means of egress (exits) must be illuminated at all times that the building is occupied,
at an intensity of not less than 1 footcandle at the floor level.
10. (DCD-48)
Page 1 of 2
,!J6oc; u{)!O~3
RECEIVEDPERMIT CENTER \D L; C ~~
City ofBremerton C /J:::k:. '7
FEB 242009 COMMERCIAL
Building Permit Application
D~entof
Department ofComnl!)miiVllblllY~!345 - 6th Street, Suite 600 * Bremerton, WA 98337-1873
(360) 473-5275 * Fax \36,'0) 473-5278. * ~:ci,br.e~~rton,wa.us ..... ............ .. ........... ..
liip'pJ.jf.mit.~:::i:i:ij:::iiii:iiiiiii::Diii:::i:i:i:HI;(Hiii:i:::i:j::ij::i:::i:i:iI:i:::::i:O:IlqAtri~I}J:i:i:':)::i:i:'I:i:':':'ii:':i:'t::::::iD:::::luwiEWHw!iij;t::i:::i:i:i:i:i:i:::i:::::::j:::::::::i:::i:lt:::::j:j:j:j:::i:':::i:i::j
:JGWIS
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CITY OF
BREMERTON
(-:~",:~~~-:r::r;:~:'::"~!? '
Busin~s's~Name::f. "
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To apply for a property address, contact Public Works at (360) 473-5270
D NEW COMMERCIAL D JENANT IMPROVEMENT WITH WORK
D COMMERCIAL REMODEL ~TENANT IMPROVEMENT WITHOUT WORK
D COMMERCIAL ADDITION 6 NEW SIGN
D COMMERCIAL REPAIR D GRADING (Cubic Yards:
D NEW MULTI-FAMILY D REROOF
D DEMOLITION _ Interior _ Exterior** _ Foundation Wall** _ Roof I SectionH
** Separate demolition permit and fees required.
Contact Public Works for sewer cap permit (473-5270). Sewer must be capped prior to demolition permit issuance.
D OTHER:
IS THIS PROPERTY WITHIN 200 FEET OF A SHORELINE? YES D NO W
Scope of work proposed:
(< o\":xJnl..ll~
"- ,)
CL 02-D ~-UA{::t,1\J- -
Square Footage:
Building:
Construction Type:
/
Valuation Plan Review Fee Permit Fee Surcharge Total Fees
47.6'0 DC j\
. . .
Application for which no permit IS Issued within 180 days following the date of application shall expire by limitation, and plans and other data
submitted for review may thereafter be returned to the applicant or destroyed by the building official. The building official may extend the time
for action by the applicant for a period not exceeding 180 days on request by the applicant, showing the circumstances beyond the control of the
applicant have prevented action from being taken. No applicant shall be extended more than once. In order to renew action on an application
after expiration, the app'licant shall resubmit plans and pay a new plan review fee.
C),JCt:,\(-),d}.y",zv;i/;;i;;L
h6i:iPlicant:s Signature':]
~_!i< }:)4 (Ol
I.,> Date ;':)
~"'~..J
Rev. July 2008
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RECEIVED
City of Bremerton
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fEB 2 4 2009
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Department of
Community Development
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SENT BY..; KCHDj
3603375291 j
AUG-25-09 2:04PM;
PAGE 1/3
'PCrfJH
A' ....
1ST R .... .'
SCOTT W. ~INoQUI.T~MD, MP". DIRECTOR
345 8 101 STR~eT, SU1TE 300
BFlEMERTON. WA 98331.1866
:(380) 331.623~
Fax Cover Sheet
DATI!: . fjJ - 'Z0 -tffl1
'TO:'~/~
PHONB: ~ - f)1-44
41?J- Cj1-1b
FROM: iu---b~ ~ ')
PHONE: ?ilJt- 41D~ ': . .
4J9i~ '
FAX:
FAX:
Number of pages including this page: ~ .
Thil me..... may (ontain informadon of a confident." nature.
If Yoluec:ein this fo In i!rror, plea.. notify ue immediately.
. and return the faxed material to us by man.
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SENT BV:.. KCHD;
3603375291 ;
AUG-25-09 2:04PM;
PAGE 2/3
SCOTT W. L1NOQUIST, MD, MPH, DIRECTOR
.\4.) (,lh s'rl~r.ET, SUITE;\OO
nRF.MERTO)\. WA 98B7.11l6l,
(3(,0) ~B7-52.\~
August 25, 2009
Wanda and Greg Ford
1112 North MontgomeJY A venue
Bremerton, W A 98312
J.{J::: PLAN APPROVAL FOR GW'S SOlJP. SALAD & SUBS
Tax ID Numher: :i7:1:1-0n6-006-0009
Dear Mr. and Mrs. Ford:
The Kitsap County Health District Food Progrum has reviewed thc plans with rc!;pcct to toed
service operation for GW's Soup. Salad & Subs to be locatc,d at 337 North Callow io
Bremertol1, Washington. In accordance with the Rules and Regulations ofthc Statcl30ard of
Health for Food Service (W AC 246-215) and thc Kitsap County Board of Health Onlinance
2005-8, the plans are approved with the following conditiuns:
1. All refrigerution must maintain food at 41 degrees Fahrenheit Or I~ss.
2. The Food Code requires sufficient refrigeration to cool and cold hold foods a;ssociated
with your food preparation activities, If upon future inspections or by repeated
violations it is determined that the capacity or capability of your propos~d
refrigeration Is insullichmt to handle the cold holding and cooling needs for your
food service operation then you may be required to supplement refrigeration with
commercial grade equipment OR your menu preparation will be restricted by !!2!
nllowlne lel'lovers tu be (~l.loJed and reheated for ,subsl'()uent use. Under tllis option
leftovers will need to be served or di~carded althc end of the day.
3. The waste lines of the fond preparal.iDn sink ajuI ice machine must be indirectly plumbed
to the sewer with u minimum one-inch air gap to prevent the backup of wa'itewutel' or
sewage.
GW's Soup, Salad & Subs will be permitted as a TYPE "It" (Rcsl,llIcant) food service
establishment. Prior to opening for ruod servic;e or rllOd preparalion, a pte-()p~ralil)nal inspection
of the facility must be done. At this lillie, construction work must he completed 3ndJood service
equipm~nt must be installed und operating. Please contuct me ut least five days in advance of the
intended opening to alTunge for the prc-olx',rGlional inspc\:tion.
SENT BY;. KCHDj
3603375291 j
GW's SOUp. Salad & Subs
Allgwa 25. 2009
Page 2
AUG-25-09 2:04PMj
PAGE 3/3
Thank you for your coopcration. rr I can be of furthcr assistance, please Cllnla~~l me lH (360) 337-
4703.
Giunloli
Env 'onmental Health Speci~.lIjst
Food and Living Environment Program
cc: Rremelton Department of Community Development
Brcmcrlon Business Tax & Lkense
~~w,v.:IJII!,;~\('q(,d\Wi;IW{IHl\r~b"'~W~~:F.I,\11.,.1\1!!1~Mi.\\'.::l ~"'l~. SflllId.$l. ,'\II'!\ .'.17 Nll.III (::i.I1\)~ . nI'L'Il":llulI .l!m:
r" '1'~
RECEIVED
City of Bremerton
City of Bremerton
Aug 25,2009
AUG 2 5 2009
Department of
Community Development
Due to unforeseen expense we have had to change our day of opening
,which we anticipate will be September 28.2009.We have had our pre-
inspection and was told to contact Building Dept 2 weeks before we
open and they'll return and the Fire Dept said to contact them 2 days
before we open and Health Dept should be out sometime this week.
Therefore we are requesting a 6 month extension at this time
in order to complete the work and have the needed final inspection to
be done .We will be contacting each Department that we are near
completion and request that they return.
Sincerely,
GW's soups, salad and subs
exfe,Vl5/1
~
)5"~S" DC?
uJ~!1 ~JL.
August 20,2009
Gregory & Wanda Ford
1112 N. Montgomery Avenue
Bremerton, WA 98312
Dear-Mr.-andMrs. Fer€!-,
/
"
The Department of Community Development has received your Tenant
Improvement No-work Building Permit and Business License application for the
proposed business GW's Soup, Salad and Subs at the location 337 N. Callow
Avenue. Both applications are pending due to inspections approval required.
Inspections still pending are the Fire Marshall's, the Building Department's and
Health District's approvals. It has come to my attention that the Tenant
I
Improvement Building Permit will expire on August 29, 2009. A one 6-month
extension can be granted, however a written request must be submitted prior to
the expiration date which demonstrates why additional time: is needed. "
i
I
To request a 6-month extension of your permit, you will ne~d to contact:
- Valarie Jacobsen, Permit Technician: 473-5244
o Email: Valarie.Jacobsen@ci.bremerton.wa.usl
If you are ready for inspections, please contact the following inspection lines:
· Health District: 337-5235;
· Building Department: 473-5870; and
· Fire Department: 473-5394
.'V_"__"..."...,_____,",..,'" . _'",__ ~'_~_.._'. '_'_'__'~'_"'_'_'___
The information required when leaving an inspection mess~ge:
- Permit number: BB09 00103
-Address: 337 N. Callow Avenue #1
If a written request is submitted prior to September 1. 12009, your business
license will be denied and the permit will expire without additional notification. If
you should have any questions, please contact me at (360) 1473-5289, or email at
Allison. Daniels@ci.bremerton.wa.us.
Sincerely,
i\
Allison Daniels
City Planner
CITY OF BREMERTON
DEPARTMENT OF COMMUNITY DEVELOPMENT
~..~., FULQ 0 1
I 00 d--d-4-~~ VL0
PERMIT NUMBER: 880900103
DATE ISSUED:
345 - 6th Street, Bremerton, WA 98337
(360) 473-5275 Fax: (360) 473-5278
ASSESSOR NUMBER: 3733-006-006-0009
APPLICANT NAME: FORD WANDA
OWNER NAME: PENDLEY DARLENE A
CONTRACTOR:
LENDER NAME:
ZONING: DCC
PHONE: (360) 471-8073
PHONE: (360) 692-2372
PHONE:
PHONE: 0-
SITE ADDRESS:
ADDRESS:
ADDRESS:
ADDRESS:
ADDRESS:
337 N CALLOW AVE
1112 N MONTGOMERY, BREMERTON, WA 98312
9900 OGLE RD NE, BREMERTON, WA 98311
SUBMITTED:
02/24/2009
APPROVED:
EXPIRATION:
08/23/2009
STATUS: PENDING
VALUATION:
Tenant Improvement, No Work (Business License)
TI No Work (Business License)
(Front) (Side) (Rear) (Other)
TOTAL FEES:
RECEIVED
City ofBremerton
FEB 2 5 2009
Inspection Requests
DCD: BUilding Inspections
L&I: Department of Labor and Industries
(360) 473-5870
(360) 415-4000
Fire Inspections Department of
HID: Bremerton, ~wi~lne\irttrlct
PW: Department of Public Works
(360) 473-5394
(360) 3~7 -5285
(360) 473-5270
: ThiS permit shall become null and void if the described and authorized by this permit has not commenced within 180 days from the date of issuance, or if the work is suspended or abandoned
I at any time after the work is commenced for a penod of180 days. It is the responsibility of the permit holder to see that the required inspections are made. Failure to obtain required
inspections may result in stoppage of the work until such time that the permit holder can susbstantiate to the City of Bremerton that the concealed work meets or exceeds code
requirements. Any demolition, testing, or financial burden shall be borne directly by the permit holder. F aHure to substantiate code requirements will indemnify the City against any and all
responsibility or liability connected with the construction. I hereby certify that I have read and examined this permit 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 speCified herein or not. The granting of a permit does not presume to give authority to violate or cancel provisions of
. any State or local law regulating construction or the performance of the construction. If listing the owner as general contractor, 'certify that' am exempt from the requirements of the State
. Contractor's Registration Law under Section 3, Chapter 126, Laws of1967. All revisions to an approved plan require DCD review and approval prior to performing work. All building and tenant
occupancy permits are required to pass final inspection prior to permit expiration and obtain a certificate of occupancy prior to use or occupancy.
I have read, and agree to abide by the conditions of this permit including all conditions of zoning, building codes, and State and Federal laws.
SIGNATURE OF OWNER OR
AGENT:
PRINTED NAME:
DATE:
CONDITIONS
City of Bremerton's approval of this application pertains only to the City's regulatory jurisdiction, and thus compliance with City
regulations does not necessarily ensure compliance with federal or state laws.
10. (DCD-48)
DCD: Tenant Improvement - No Work Conditions:
This permit is issued based on the assumption that a valid certificate of occupancy had
previously been issued for this building, and that the occupancy classification has not been
changed. Following issuance, if it is determined that there is not a valid certificate of
occupancy, it will be necessary to obtain a commercial tenant improvement permit to
address all of the occupancy requirements prior to any use or occupancy of the building.
General Provisions:
.AII doors shall have barrier free hardware (lever or panic) and shall be openable from the
inside without the use of a key or any special knowledge or effort. Exception: Key-locking
hardware may be used on the "Main Door" provided there is a sign, with minimum 1"
letters, on or adjacent to the door stating: "THIS DOOR TO REMAIN UNLOCKED WHEN
BUILDING IS OCCUPIED."
.AII means of egress (exits) must be illuminated at all times that the building is occupied,
at an intensity of not less than 1 footcandle at the floor level.
Page 1 of 2
\0
c;oJLQ @ 0 G( ST:V'L-
J.;) Dei
- 1- - P~RMIT NUMBER: 880900103
DATE ISSUED:
CITY OF BREMERTON
DEPARTMENT OF COMMUNITY DEVELOPMENT
345 - 6th Street, Bremerton, WA 98337
(360) 473-5275 Fax: (360) 473-5278
ASSESSOR NUMBER: 3733-006-006-0009
APPLICANT NAME: FORD WANDA
OWNER NAME: PENDLEY DARLENE A
CONTRACTOR:
LENDER NAME:
ZONING: DCC
PHONE: (360) 471-8073
PHONE: (360) 692-2372
PHONE:
PHONE: 0-
SITE ADDRESS: 337 N CALLOW AVE
ADDRESS: 1112 N MONTGOMERY, BREMERTON, WA 98312
ADDRESS:
ADDRESS:
ADDRESS:
9900 OGLE RD NE, BREMERTON, WA 98311
SUBMITTED:
02/24/2009
APPROVED:
EXPIRA nON:
08/23/2009
STATUS: PENDING
TI-NO WORK FOR RESTAURANT CALLED GW'S SOUPS, SALADS & SUB'S
Building Code Edition: IBC: 2006
Occupancy Group:
Type of Construction:
Flood Zone:
Setbacks:
Sanitation Method:
Number of Bedrooms:
VALUATION:
Tenant Improvement, No Work (Business License)
TI No Work (Business License)
$47.00 2211
TOTAL FEES:
$47.00
(Front) (Side) (Rear) (Other)
Inspection Requests
DCD: Building Inspections
L&I: Department of Labor and Industries
(360) 473-5870
(360) 415'4000
Fire Inspections
HID: Bremerton, Kitsap County Healt
PW: Department of Public Works
Fl L E:-
OL-OL?!
L~
~I ~ E:-
~C-C-
"(360) 473-5394
(360) 337-5285
(360) 473-5270
'..,.\
This permit shall become null and void if the described and authorized bY't~is permit has not commenced within 180 days from the date of issuance, or if the work is suspended or abandoned
at any time afterthe work is commenced for a period of180 days. It is the responsibility of the permit holderto see that the required inspections are made. Failure to obtain required
! inspections may result in stoppage of the work until such time that the permit holder can susbstantiate to the City of Bremerton that the concealed work meets or exceeds code
. requirements. Any demolition, testing. or financial burden shall be borne directly by the permit holder. Failure to substantiate code requirements will indemnify the City against any and all
. responsibility or liability connected with the construction. I hereby certify that I have read and examined this permit 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 specified herein or not. The granting of a permit does not presume to give authority to violate or cancel provisions of
any State or local law regulating construction or the performance of the construction. If listing the owner as general contractor, I certify that I am exempt from the requirements of the State
. Contractor's Registration Law under Section 3, Chapter 126, Laws of 1967. All revisions to an approved plan require DCD review and approval priorto performing work. All building and tenant
. occupancy permits are required to pass final inspection prior to permit expiration and obtain a certificate of occupancy prior to use or occupancy.
I
I have read, and agree to abide by the conditions of this permit including all conditions of zoning, building codes, and State and Federal laws.
SIGNATURE OF OWNER OR
AGENT:
PRINTED NAME:
DATE:
CONDITIONS
I City of Bremerton's approval of this application pertains only to the City's regulatory jurisdiction, and thus compliance with City
regulations does not necessarily ensure compliance with federal or state laws.
10. (DCD-48)
DCD: Tenant Improvement - No Work Conditions:
This permit is issued based on the assumption that a valid certificate of occupancy had
previously been issued for this building, and that the occupancy classification has not been
changed. Following issuance, if it is determined that there is not a valid certificate of
occupancy, it will be necessary to obtain a commercial tenant improvement permit to
address all of the occupancy requirements prior to any use or occupancy of the building.
General Provisions:
*AII doors shall have barrier free hardware (lever or panic) and shall be open able from the
inside without the use of a key or any special knowledge or effort. Exception: Key-locking
hardware may be used on the "Main Door" provided there is a sign, with minimum 1"
letters, on or adjacent to the door stating: "THIS DOOR TO REMAIN UNLOCKED WHEN
BUILDING IS OCCUPIED."
*AII means of egress (exits) must be illuminated at all times that the building is occupied,
at an intensity of not less than 1 footcandle at the floor level.
CB1\TED
~ & 'O."elllertOn
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CITY' OF IBREMERTON
CERTIFICATE OF OCCUPANCY
I
i I BUILDING DEPARTMENT
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. 337 N. CALLOW!, I ,.if, j.
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TYPE ',' OCCUPANCY iFIRE,
OCCUPANCY;i LOAD i I ZONE"
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B-2 1.;,:,: : 20.:. ,i1: iN/A.,' RETAIL SALES
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OCTOBER: 28, 1985 ;!!::-":'j)~I;:.j)~~/Lu '
! ii'" ,flJ~ @/fk<<d' :: DA V I D K. 6E LPI-l
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This certificate must be posted ;and permanently maintained in a conspicuous Place.
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TYPE
BUILDING
USE
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N? 37555
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Fee $mmmm.mu.m__.___. .m.m...............mu....m....... Receipt No. "rm..m.....umuuuuuuumuuummuu...
BUILDING PERMIT
CITY OF BREMERTON BUILD'ING DEPARTMENT
F. E. IRISH, Building Inspector . ESsex 3-1411, Ext. 36
Owner's Value I Bldg. Dept. Value I DESCRIPTION:
$ /0 0 I I Lot Block Additions
Address on Job .:2!!.Zn?!I?.:.(!~e~nnnn'hu.unu_nn.n.nn'hnnnnhU_'U_.nnhn Date nm.hnm9.::.n~.~n196.~
Building '_mn,'.mm x nm'n_m'n. and _mhmmm. stories Un_n.nm.mnmn basement. Lot m,'mmmn x .mh_...nm.
Front Yard nmnnnm._.___.__. Rear Yard ._.mm.mmmnm Side Yard mmmmmm_m__ Garage .n.m.mmnmmnm.n__
OcCUpanCY(;/~~'-V:J.n''''Uh.._~"_..n~,/n..___.u;m)'''UUh''_''' _._.._..n.hm...h....hnh..hn Fone n..m...mn.m7'~
Owner ....v~-n-.~1.~p!...&:-~~.......n..-..- Address ....n..n....-.hn.-.._...._..h...7Pnone..nmm.mu
~~7st;;::t .i~ni~7::;T::~~mjmmlmmmmmm--m. Address .m.m.m.nmm.bhmm Phonemmn.n.....
............................... ...,::: 00...... .~'. ~"V" --............ "'; \................. ...........................................................................................
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................................00......................... 00.......... u....u."j........................................ _......................................................
All work to conform to all applicable building ordinances and amendments. Please note the following
special instructions and requirements.
DETACH HERE AND POST THIS SECTION ON JOB
INSPECTION - Reinforcing steel must be inspected after placing and before covering. FORMS shall be inspected
and approved before pouring. All plumbing, wiring and the frame of all buildings must be inspected and approved
before covering. Wood preservative to be used on all wood against masonry. Ventilate foundation and attic. Sepa-
rate permits required for plumbing, wiring and heating. See City Engineer before working on sheets or sidewalks.
. _ _ _ _ _. _ _ _ _ _ _ _ _ _ __ w _ _ _ __ _ _ ___ __ _ _ __ .__ __ _. _ __ _ _ ___ __ _ _ ___ _ _ __ __ __ _ ____ _ _ __ _ ___ ___ _ ___ __ _ . _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ __ _ _ _._ __ __ _ _ __ _ _ _ __ ____ _ __ __ ___ __ _ _ _ __ _ ____ ___ ___________
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -. - - - - - - -~- - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - -... - - - ~
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -~- - - - - - - - - - - -- - - - - - - - - -... - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - -..
Own er' s Signa tu re ........ u. __ 00 00........ u, 00 U 00 un......... U 00 00 00"'" By......... U 00 00.........00.. U __. 00........ ....u... 00 00.. .00. U __... 00.0000
_ cfJ. R His Authorized Agent
Buil ding Inspecto r _... _...... u. .-:;t.::.. = .;~ _'.:: :'"::-~... u. ........... 00 00..00 00 n...u.m..n 00
B ~~~i
y 'nun .... .......nu __ U 00 __ 00 00 00.00 00 00..00 nu. __. ..u ......~.. __......00.. .... 00.__
.... OF