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HomeMy WebLinkAboutOld Permits 1 / JOB ADDRESS
LIIIIIIIIII
A.I.''. 6 /6":;e/ z) ee)a-)•r
•
NUMBER STREET
APPLICATION FOR A
I�1 g BUILDING PERMIT
' / BUILDING & SAFETY DIVISION
C"7�( C/I^/TY��OF ARCADIA, CALIF///ORNIA
H. OWNER ``' W TEL. NO 7 O'' MAILING ADDRESS // �/ Q ( a //_
ARCH. /w• TEL. NO. �J( J(
'\' ENGR.
w CONTRACTO: �7 STATE LIC. NO
F.O. 2i 7` r //f/' C o Yn�L 3?N75L
MAILING A D'Fi -�� .�Ci�-'.1��'7%'/ fl‘_S C/CJ
CITY '7�� 2 i i 5�7 �/ T .�J/`-5 fc°
• CONSTRUCTION TEL. NO.
c LENDER
DESCRIPTION OF�WjO�RK
NEW ❑ ADD'N ❑ ALTER ❑ F2EPA DEMOLISH❑
FLOOR AREA I GARAGES OR TOTAL
MAIN BLDG CARPORTS AREA
NO. OF NO. OF DWELLING
(,)," STORIES UNITS
• PRESEEN9T/BL�DGeUS9El2 Z PROPOSED BLDG. USE
DESCRIBE WORK /� /�
`. TO BE DONE i e ■ ./ ` air , 1y 1.!. ,
44.0-4-t./ — e -GS/W
EXTERIOR WALL MATERIAL /ROO RAMIN MATERIAL
PARTITIONING MATERIAL ROOF COVERING MATERIAL
VALUATION NOTE:Include Labor,Mat.,t 4/ X r, r,
Wiring, Plumb., Heat, Etc. l
LOT BLOCK
NO. NO. TRACT
LOT LOT DIST. FACE OF
WIDTH DEPTH CURB TO P. L. FT.
NOTE: PROVIDE PLOT PLAN ON BACK SIDE OF ORIGINAL COPY ONLY
INFORMATION BY BLDG. SECTION t-
USE FIRE OCCU-
ZONE ZONE PANCY Ln
R,Q'D FRONT (RIGHT SIDE LEFT SIDE REAR 0
seT
BACKS v
Q
_TYPE OF SPECIAL ce
- LONSTR. CASE NO. z
U
PLAN NO. CHECKER'S
APPROVAL PLAN CK. FEE
I hove carefully read and exomined the above application and
find the some to be true and correct. All provisions be the Laws PER ly;�l %E�
and Ordinances governing building construction will be complied 1% [l
with whether specified herein or not. No person shall be employed C �J
in violation of the Labor Code of the State of California. I agree S.M.I.P
not to occupy or allow cu ncy of any buildin• authorized by this L7o
permit until final ildi inspection has be= received.
TOTAL F
--/SSII URE OF OWNER OR AUT�e'�.1 AGENT
COI JCTION PROHIBITED BETWEEN 7:00 P.M. AND 7:00 A.M.
AND ON SUNDAYS AND HOLIDAYS AS PER ORD.#1321. Or I_
J
INSPECTION RECORD
ebk
BASIC INSPECTIONS AINI%
ITEM INSPECTOR DATE
TRENCHES: WIDTH DEPTH ■__
1st FLOOR JOIST
FRAMING
LATH
FINAL _.i' 1( , ?j7gV
PARTIAL OR MISC. INSPECTIONS
UNSUCCESSFUL TRIPS
ITEM INSP DATE ITEM INSP DATE
SET BACKS FRONT R. SIDE L SIDE REAR INSP. DATE
FIELD CHECKS
TO APPLICANT: PLEASE DO NOT WRITE ABOVE THIS LINE
PLOT
•
JOB ADDRESS
r' / 7 `Nc /NO Ca ct.k+ ',,,*
NUMBER STREET
)1Q APPLICATION FOR A
J Ir BUILDING PERMIT
A�` BUILDING & SAFETY DIVISION
\ CITY OF ARCADIA, CALIFORNIA
(.) OWNER
TEL NO.
/C;L46e�� Xi p o 497-
y53
- �a
MAILING ADDRES f /
�� aEiG/No L/,Ct-4241
ARCH. TEL. NO.
ENGR.
_n• CONTRACTOR Ai e_paa �^�� STATE_L1C._N 4
MAILING ADDRESS •}�j/ CITY LIC. O.
>�CGdS� Q-o/O 3 3j 1-
CITY j1n - TEL. NO.
-,-.1 �/ / V P ! r7
-' CONSTRUCTION TEL. NO.
to LENDER
° DESCRIPTION OF WORK
NEW ❑ ADD'N ❑ ALTER ❑ REPAIR ❑ DEMOLISH❑
FLOOR AREA I GARAGES OR TOTAL
MAIN BLDG CARPORTS AREA
NO. OF NO. OF DWELLING
STORIES UNITS
• 1 PRESENT BaDG. USE PROPOSED BLDG. USE
~' rieSI O MC E
`n DESCRIBE WORK.-..
It-. TO BE DONE K _ c. atiish_j
„...; r o� ' e�cr S 4-i N G
EXTERIOR WALL MATERIAL ROOF FRAMING MATERIAL
PARTITIONING MATERIAL ROOF COVERING MATERIAL
VALUATION NOTE:Include Labor,Mat.,$ {/O4LJs�0
Wiring, Plumb., Heat, Etc.
LOT BLOCK
NO. NO. TRACT
LOT LOT DIST. FACE OF
WIDTH DEPTH CURB TO P. L. FT.
NOTE: PROVIDE PLOT PLAN ON BACK SIDE OF ORIGINAL COPY ONLY
INFORMATION BY BLDG. SECTION
ul
USE NE/pi FIRE ZONE OCCU- , -
ZO 3 PANCY ^
SETS D FRONT RIGHT SIDE LEFT SIDE REAR 0
BACKS _ u
Q
TYPE OF 1 SPECIAL ce
CONSTR. •S CASE NO. ZO
U
PLAN NO CHECKER'S
APPROVAL *, PLAN CK. FEE
I have carefully read and examined the above application and `�
find the some to be true and correct. All provisions of the Laws PERMIT FEE
and Ordinances governing building construction will be complied 3 3e.Z s-
with whether specified herein or not.Na person shall be employed
in violation of the Labor Code of the State of California. I agree S.M.I.P.
not to occupy all occupancy of any building authorized by this
permit unt' final wilding inspection has been received.
TOTAL FEE
-SIG ATURE OF OWNER OR A ZED 33e i-
��W�
M
CON...RUCTION PROHIBITED BETWEEN 7:00 P.M. AND 7:00 A.
AND ON SUNDAYS AND HOLIDAYS AS PER ORD.#1321. ()L.
J
INSPECTION RECORD
BASIC INSPECTIONS
ITEM INSPECTOR DATE
TRENCHES: WIDTH DEPTH
1st FLOOR JOIST
FRAMING
LATH
FINAL 74-7 t/
�„ 7i
PARTIAL OR MISC. INSPECTIONS 666G6G
UNSUCCESSFUL TRIPS
ITEM INSP DATE ITEM INSP DATE
SET BACKS FRONT R. SIDE L SIDE REAR INSP. DATE
FIELD CHECKS
TO APPLICANT: PLEASE DO NOT WRITE ABOVE THIS LINE
PLOT
ea "1114111)
JOB ADDRESS
6/7 gpt.e..;_e_t_e,
NUMBER STREET
APPLICATION FOR A
frBUILDING PERMIT
BUILDING & SAFETY DIVISION
CD (A/ -CITY OF ARCADIA, CALIFORNIA �+
�, WNE-Q Rt= A-Sais,,441z IA '.C'I K \NO.3i .' 1
co MAILING ADDRESS
t� %o--,27 kq Kc►svk ie,.Tte G�4
W ARCH. EL.NO.
w ENGR.
CONTRACTOR STATE LIC.NO.
5/9MC=
MAILING ADDRESS CITY LIC.NO.
I—+ >/944 C
O CITY .•••• TEL.NO.
S/9/14L.
ON DESCRIPTION OF WORK
'U NEW s� ADD'N ❑ ALTER ❑ REPAIR ❑ DEMOLISH ❑
FLOOR AREA 'NO.OF t NO.OF DWELLING/
(SQ. FT.) STORIES / UNITS
PRESENT BLDG.USE PROPOSED BLDG.USE
,Qc 5/vC If"C
DESCRIBE E ' „. ?�lg, �? / /�
kti TO BE DONE :-
1 bl v r
NOTE: PROVIDE PLOT PLAN ON BACK SIDE OF ORIGINAL COPY ONLY
EXTERIOR WALL MATERIAL ROOF FRAMING MATERIAL
PARTITIONING MATERIAL ROOF COVERING MATERIAL LOT NO.OF
WIDTH / v ' DEPTH/ • l BLDGS.ON LOT
LOT T7 )VALUATION NOTE: Include Labor, Mat., „,/4,/e/)M�,�.
Wiring, Plumb., Heat, Etc. (•�
INFORMATION PROVIDED BY BLDG. SECTION
NO. I a BNO K TRACT, 3 J !C
M/FA r _ I-
N
USE r\ I FIRE
ONE POANCY .-L- SHC J
ZONE r cn
REQ'D FRONT. RIGHT SIDE LEFT SIDE REAR . o:SET O
BACKS ,-,_-S .. ;�ry.�., V
TYPE OF'7_ SPECIAL ce
CONSTR,j/ CASE NO. GRADE Z
0
Approval& Information by Others U
CITY ENGINEER EASEMENT
DIST.FACE OF I SEWER DRIVE
CURB TO P. L.l FT. AVAILABLE OVER
PUBLIC SERVICE PLANNING PLAN CK.FE
7.5
WATER ELECTRIC _ PERMIT FEE
PLAN NO. CHECKER'S APPROVAL
/,5--1/1/1 . /
I have carefully read and examined the above application and find the r TOTAL FEE
same to be true and correct. All provisions of the Laws and Ordinances
governing building construction will be complied with whether speci-
fied herein or not. No person shall be employed in violation of the Labor
Code of t State of California.I agree not to occupy or allow occupancy
of a b (ding authorize this permit until final building inspection has been received.
—■ SIGN RE OFOWNER UTHORIZED AGENToik
PEL.,tAANENT
FORM B- (REV.7-61) 21/=M Et)e
I
4NSPECTION RECORD
BASIC INSPECTIONS
I T E M INSPECTOR DATE
TRENCHES: WIDTH DEPTH ji v C
1st. FLOOR JOIST / Q
FRAMING
LATH /
FINAL
rlgillffaNA
PARTIAL OR MISC. INSPECTIONS
•
UNSUCCESSFUL TRIPS
ITEM INSP. DATE ITEM INSP. DATE
SET BACKS FRONT R. SIDE L. SIDE REAR INSP. DATE
FIELD CHECK
TO APPLICANT: PLEASE DO NOT WRITE ABOVE THIS LINE
PLOT
-
_ I
JOB ADDRESS(WHERE APPLICABLE)
C (`7 N.4/ Iv CC' IQ\
NUMBER STREET
0 MISCELLANEOUS FEE
00 RECEIPT
UI BUILDING & SAFETY DIVISION
CITY OF ARCADIA, CALIFORNIA
-M, RECEIVED OF Ul..9{}({RSI.4_ v, c1 )
5�s MAILING ADDRESS 1t 1 "2-1 1.04r RD SA
e-iv‘.• (Q Ci4tsi A(T
FOR:
©
® *PLAN CHECK FEE FOR VAL. $ D
❑ CASH BOND FOR
❑ PURCHASE OF BUILDING CODE
sa) ❑ PURCHASE OF PLUMBING CODE
VI ❑ USE AND OCCUPANCY CERTIFICATE FEE
0
► ❑ ROOFING
1
❑ PLASTERING
❑ HOUSE MOVING
❑ a
d
❑
REMARKS
AMOUNT DUE $- PAID by: CK. M.O. CASH
When properly validated this is a receipt for the amount shown on
th• VALIDATION ST P.
RNING: PLAN CHECK FEES, WHERE NO ACTION IS TAKEN BY THE
AP' ,T IN NINETY (90) DAYS AND NO BUILDING PERMIT "^[SUED, ARE
F J TO THE CITY. TEMPORARY
FORM RM B-58
JOB ADDRESS
'/
NUM ER STREET
0 % APPLICATION FOR AN
ELECTRIC PERMIT
kp BUILDING & SAFETY DIVISION
ITY OF ARCADIA, CALIFORNIA
to WNE / TEL.NO.
//��r�
v t MAILIN DRESS
CONT TOR A
I
STATE LIC.NO.
F.a ,�I 7
W Al ._ AD.: SS —
.....
, , i/ Clyf LIC,Na.,
UN
W '
or / ' I. r /. / TEL.NO.
p ai r, •
DESCRIPTION OF WORK
Li New Ezist. No Serv. Reconnect
USE
Bldg. ❑Bldg. ❑Charge ❑or Reseal ZONE
FEE COMPUTATION FEES
NOTE: TOTALS SHOWN BELOW MUST BE SUBMITTED IN DIAGRAM
RV ON SEPARATE WORK SHEET PROVIDED FOR THIS PURPOSE.
OUTLETS,BASE PLUGS,SWITCHES,FIXTURES @ 10¢EACH
O LESS THAN 18 APART @ 5¢EACH
♦ FIXTURE PERMIT FEE @$1.00
MOTORS — i__—
QUAN. RATE
O to I/2 HP @ .25 EA.
OVER 1/2 to 2 HP @ .50 "
OVER 2HPto5HP @ $1.00 "
OVER 5 HP to 15 HP
@ $1.50 '
OVER 15 HP to 50 HP @ $2.50 "
OVER 50 HP to 200 HP @ $5.00 "
EACH MOTOR MORE THAN 200 HP $10.00
TOTAL AIR COND.H.P. r
_RANGE,OVEN,CLOTHES DRYER @ 50¢EACH
RESIDENTIAL ENTRANCE SERV-100A MIN.
HEATING ELEMENTS @ 50¢ EACH HEATER
_AIR CONDITIONER
_WELDERS (TRANSFORMER TYPE) KK/VA @ 50c PER KVA`1
WELDERS (MOTOR GENERATOR) HP\75%MOO. ApONEAN/
CONSTRUCTION OR TEMPORARY LIGHTING @ $2.00
_MISCELLANEOUS
7 POWER POLE $1.00
I have carefully read and examined the above 1
application and know the same to be true and PERMIT FEE @ 1 00
correct. All provisions of the Laws and Ordi-
nances governing this type of construction will SUPPLEMENTARY
be complied with whether mentioned herein or PERMIT FEE @ .50
not. No person shall be employed in violation
of the Labor Code of the State of California.
INVESTIGATION
FEE
' /��OTAL FEE
SIGNATURE OF /,NTRACTOR OR
/Ilk AUTHOR! D AGENT
FORM B-53 (REV.7-61) 21/2M (P)is
INSPECTION RECORD
//14+ BASIC INSPECTIONS
ITEM INSPECTOR DATE
GROUND WORK ..
ROUGH
FINISH
FIXTURES
I J-
F l• •L B.•-ASE 4 PUBLIC SERV._ _ ',/ r
PARTIAL O' MISC. INSPECTIONS
UNSUCCESSFUL TRIPS
RECORD INFORMATION
O.H. U.G. TEMP.OK. TEMP.CONSTR. NO.OF METERS
LITE WIRE PWR PHASE HEAT KW
RANGE OVEN TABLE TOP W.HTR. DRYER
OTHER RES. APPLIANCES OVER 2 KW.
TOTAL KW OR HP. TOTAL HP.
S(1) 3(v
fro^ .0114k
I
JOB ADDRESS
d(_ f#,..000.1 , r,. ey, 001114
NU BER STREET
APPLICATION FOR A
41 WER- STREET CUT
� OR
RB AND SIDEWALK
O UILDING & SAFETY DIVISION
CITY OF ARCADIA, CALIFORNIA
OWN � � ." • TEL.NO.
MAILI,G ADDRES
_I G '"t $ iLea
'..3 CO TRACTOR J STATE LIC.NO.
C MAILING ADDRE C CITY LIC.NO.
G3
CITY TEL.NO.
0
W PERMISSION IS HEREBY GRANTED TO MAKE SEWER CONNECTION
AT
LOT_ BLOCK TRACT
LOCATION Y LATERAL
SADDLE
SEWER PLAN NO. CESSPOOL FILL
$1.00 $•CO
INSPECTED 196 $
Q TOTAL
Q BY BY $
• ALL CONNECTIONS MUST BE INSPECTED BEFORE BEING BACKFILLED.
1 24 HOURS NOTICE REQUIRED.
CURB AND SIDEWALK
CURB BREAK FEE a
MDRIVEWAY APPROACH r A. 4 ---.—
CURB BREAK & DRIVEWAY APPROACH
SIDEWALK FEET REPLACE CURB
CURB & GUTTER FEET
CURB, GUTTER & SIDEWALK FEET
yy� 6. tfl ( ' ,-,�.�a•
STREET SUPERINTENDENT
- ALL WORK DONE UNDER THIS PERMIT MUST HAVE INSPECTION BY THE
STREET SUPERINTENDENT
STREET CUT AMOUNT OF DEPOSIT
AT 75c PER SQ. FT.
_
ESTIMATED SIZE OF PATCH AMOUNT CHARGED
AT 75c PER SQ. FT.
ACTUAL SIZE OF PATCH AMOUNT REFUNDED
RECEIVED FROM CITY OF ARCADIA, STREET DEPT.
TOTAL FEE
196 $_
SIGNED STREET SUPT.
BY
AK" DDRESS PHONE BY
SIGNATURE OF CONTRACTOJ' •R AUT ORIZED AGENT
elk
B-54 (REV. 7-61) 21/2M 4e PER40*44,N ENT
o I f
INSPECTION RECORD
PI"IAL OR MISC. INSPECTIONS A11164
UNSUCCESSFUL TRIPS
JOB ADDRESS
4 / EAC/A, C /C.'3
NUMBER STREET
APPLICATION FOR A
SEWER —STREET CUT
(")) CURB ANDRSIDEWALK
BUILDING & SAFETY DIVISION
CITY OF ARCADIA, CALIFORNIA
OWNER TEL.NO.
TC�ar
Ci7 MAILING ADD E S
/7 4'Avc iev 6 Cr. 4 ce.
al CONTRACTOR STATE LIC.NO.
Sv$ iv A Q /o X'9i a
MAILING ADDRR�s CITY LIC.NO.
24°7 So S M a"I S
CITY TEL.N .
MO r, 'r' C/70 �/42 04
PERMISSION IS HEREBY GRANTED TO MAKE SEWER CONNECTION
AT
N //LOT BLOCK TRACT ,/gO
U LOCATION SAD L
,'D/r /'T Om,.
H
Q SEWER P ,NO. CESSPOOL FILL
z / '
> +oe $
INSPECTED dT. 7 196_4
$
TOTAL,))�
BY i $ i^p®
ALL CONNECTIONS MUST INSPECTED BEFORE BEING BACKFILLED.
24 -URS NOTICE REQUIRED.
CUR: AND SIDEWALK
CURB BREAK FEE
_DRIVEWAY APPROACH $
CURB BREAK & DRIVEWAY APPROACH
SIDEWALK FEET REPLACE CURB
CURB & GUTTER FEET
CURB, GUTTER & SIDEWALK FEET
STREET SUPERINTENDENT
ALL WORK DONE UNDER THIS PERMIT MUST HAVE INSPECTION BY THE
STREET SUPERINTENDENT
STREET CUT AMOUNT OF DEPOSIT
AT 75c PER SQ. FT.
- ESTIMATED SIZE OF PATCH AMOUNT CHARGED
AT 75c PER SQ. FT.
ACTUAL SIZE OF PATCH AMOUNT REFUNDED
RECEIVED FROM CITY OF ARCADIA, STREET DEPT.
TOTAL FEE
196 $
STREET SUPT.
SIGNED
BY
ADDRE. TE•LEPHON•.�
SI NA r' OF • CTOR R A •RIZED AGENT
#`^ BY
F, 5-54 (REV. 7-61) 2/2M -:P; PERK 4ENT
INSPECTION RECORD
PIAL OR MISC. INSPECTIONS
UNSUCCESSFUL TRIPS
i/h‘e-j
(eft, •
G°
•
JOB ADDRESS
NUMBER STREET
APPLICATION FOR A
PLUMBING PERMIT
BUILDING & SAFETY DIVISION
Q CITY OF ARCADIA, CALIFORNIA
) OWNER s TEL.NO.•Q MAILING ADDRESS 11
41111. CONTRACTOR ' J7 STATE LIC.NO.•
MAILING ADDRESS CITY LIC.NO
CITY TEL.NO. /
PROPOSED USE
ON USE ZONE
W
-v FEE COMPUTATION
co
BATHTUBS / CLOTHES WASHERS
REPLACEMENT
SHOWERS SHOWER FA`N3
N WATER CLOSETS DRINKING FOUNTAINS
l LAVATORIES_ URINALS
SINKS, KITCHEN, BAR
FLOOR,SERVICE SAND TRAPS
0
LAUNDRY TRAYS CLARIFIERS
r
DISHWASHERS GREASE TRAPS
/ GARBAGE DISPOSALS WATER SOFTENERS
WATER HEATERS AND/OR VENTS
TOTAL NO. OF ABOVE FIXTURES: // @ 1.00 EA. Jr
LAWN SPINKLER //,_400
SYSTEMS: @ 2.00 EA.
BACK FLOW 0.5 DEVICES ADD.DEVICES
DEVICES: @ 2.00 @ 25¢EA.
SWIMMING POOL PIPING SYSTEM @ 1.00
WATER SYSTEMS @ 1.00 /0
/ GAS SYSTEMS:
0.5 1.00 3 @ 200EA. / Y1
BOILERS STEAM OR HOT WATER @ 2.00 C/
SEWER CONNECTIONS ON PROPERTY
• SEWER CAP OR CESSPOOL FILL @ 1.00
SEPTIC TANK,SEEPAGE PIT
AND/OR DRAIN FIELD @ 3.00
I have carefully read and examined the above
application and know the same to he true and PERMIT FEE 1 00
correct. All provisions of Laws and Ordinances
covering this type of construction will be corn- INVESTIGATION
plied with whether specified.herein or not. No FEE
person shall be employed in violation of the '/
Labor Code of the State of California. TOTAL FEE /yc'/1/D
;$••• SIGNATURE OF CONTRACTOR OR AUTHORIZED AGpIII%
FORM B-52 (REV.7-61)21/2M ri e
7
INSPECTION RECORD
BASIC INSPECTIONS
M I INSPECTOR I ATE
c // Y rr_0/9: _
ROUGH GAS -'1' -/94;
PLUMBING TOP OUT fa 1>/'" 'V-- ‘3
HEATING VENTS Vr _ /��/
FINAL GAS hja q/1/� /
]�_7/�l
FINAL PLUMBING (!i
! -v o
PARTIAL OR MISC. INSPECTIONS
•fir /..,,1. 2„. / �
sty--•�
Att, 44-144,.1
/346Z‘ �` v;L
UNSUCCESSFUL TRIPS
JOB ADDRESS
0.14.\ 617 Encino Court
NUMBER STREET
APPLICATION FOR A
0 HEATING, VENTILATING, AIR-
qp CONDITIONING OR REFRIGERATION
N,„i PERMIT
BUILDING & SAFETY DIVISION
CITY OF ARCADIA, CALIFORNIA
OWNER TEL. NO.
Warren D. Fix GI 3.1057
MAILING ADDRESS
I
CONTRACTOR 1107 t osa,_Semp le City STATE uc. NO.
O Ise Haight Heating _ 158153.C2C
ei MAILING ADDRESS CITY LIC. NO.
P.Q. Real Fib .
IN CITY TEL. NO.
Ibrrovia, California . • • •
DES( 4 OF WORK
HEATING ❑ AIR CONDITIONING
❑ REFRIGERATION ❑ VENTILATION
:Ural, FEE.COMPUTATION
,`�^' VALUATION—$ 45Q,00
0 DESCRIBE WORK
g„ TO BE DONE
I
INCL
HEATING APPLIANCES(VENTS)
(INSTALLED, ALTERED, REPLACED, REPAIRED OR RELOCATED)
T Y P..E B.T.U. FEE
120,000 Holly
CIRCULATING AIR OUTLETS OR INLETS
REFRIGERANT COMPRESSORS (INSTALLED OR REPLACED)
QUANTITY OVER INCL. ACTUAL H.P. _ RATE I F E E
0 20
20 50
50 UP
I have carefully read and examined the above
application and know the same to be true and PERMIT FEE
correct. All provisions of Laws and Ordinances INVESTIGATION
covering this type of construction will be com-
plied FEE
with whether specified herein or not. No
person shall be employed in violation of the
Labor Code of the State of California. TOTAL FEE H - __
SIGNATURE OF CONTRACTOR OR AUT RIZED AGENT
0111111/4A B-55 (REV. 11-62) 1M (e 44
L f
INSPECTION RECORD
• AN
ITEM SPECTOR DATE
ROUGH HEATING IV°7i;
ROUGH REF RIG OR AIR COND.
?
DUCTS
b/
rL.EENAL HEATING g'-‘)
F I NAL REFRIG. OR AIR COND.
PARTIAL OR MISC. INSPECTIONS
ae..e4 ,$tife ;-4;"4,41"- 444-e:47431 a4A,
UNSUCCESSFUL TRIPS