HomeMy WebLinkAboutCertificate of Occupancy
1
CITY HALL
Inspection Services Div
215 Church Avenue
PO Box 1130
~ ~:;:;~~;~.:
OJHKOJH
ON THE WATER
City of Oshkosh
Approved:
Issued:
December 23rd, 2002
January 15th, 2003
Daniel & Ginger Lenz
1651 Iowa St
Oshkosh,VVl54902
CERTIFICATE OF OCCUPANCY
An Occupancy Permit is hereby granted for the new two story home with 3 car attached
garage and patio located at 1776 Hunters Glen Drive, Oshkosh, VVisconsin 54904 as
described in Building Permit Application number(s) 95712.
This building is to be used only as a single family dwelling and is located in the
R-1 Single Family Residence District.
LIMITATIONS:
Maximum Floor Loading: 40 Ibs. Per square foot live load
Maximum persons and/or living units: One living unit
CONDITIONS:
1) Final grading must be done in accordance with the approved subdivision drainage
plan. This plan is on file in the public works office, 3rd floor of City Hall
2) Erosion control measures must be maintained until the lawn is established.
Note: Final grade must be a minimum of 6" below all siding.
NOTE:
1) Copies of inspection results are available upon request in room 205, City Hall.
2) Future permits may be required for additional work to your property.
A new Certificate of Occupancy shall be required prior to occupancy, should additional
building(s) be erected, or should any buildings mentioned above be altered or moved.
The use of land, or buildings, shall not be changed until a Certificate of Occupancy is
issued for that occupancy. All conditions noted above must be complied with in order
for this certificate to be valid.
~r:-~
Buildi g Systems Inspector
Building Permit Work Card
Job Address 1776 HUNTERS GLEN DR Permit Number 0095712 Create Date 7/5/02
Owner DANIEL J. AND GINGER M. LENZ Contractor OWNER
Category 110 - New Single Family
Type . Building o Sign o Canopy o Fence o Raze I Plan D1-094-0602R
Zoning R-1 Class of Const: 8 Size IRRG Value $133,000.00
Unfinished/Basement 1065 Sq. Finished/Living 2164 Sq. Ft. Garage 968 Sq.R
Ft. -
Rooms 8 Bedrooms 4 Baths 3 D Projection I
Stories 2 Height 25 Ft. Canopies 0 Signs 0
- -
Foundation . Poured Concrete o Floating Slab o Pier o Other
o Concrete Block o Post o Treated Wood
Occupany Permit Required Flood Plain No Height Permit Not Required
-
Park Dedication Required # Dwelling Units 1 # Structures , 1
Use/Nature NSFRI New 2 story with 3 car attached garage and 14' x 14' Concrete patio.
of Work
HV AC Contr MCM AIR INC Plumbing Contr KOCH PLUMBING
Electric Contr CUMINGS ELECTRIC
Inspections:
Date 12/23/02
09:30 AM
Type Re Final
Inspector John Zarate
approved
DatelTime requested: 1/14/03
Access:
01 :25 PM
Notice Type:
Phone Number:
Ready DatelTime: 12/23/02 08:00 AM Requested By: owner
o Reinspect Fee 0 Fee Waived
D Reinspect Fee Paid
Building Permit Work Card
Job Address 1776 HUNTERS GLEN DR Permit Number 0095712 Create Date 7/5/02
Owner DANIEL J. AND GINGER M. LENZ Contractor OWNER
Category 110 - New Single Family
Type . Building o Sign o Canopy o Fence o Raze I Plan D1-094-0602R
Zoning R-1 Class of Const: 8 Size IRRG Value $133,000.00
Unfinished/Basement 1065 Sq. Finished/Living 2164 Sq.Ft. Garage 968 Sq. Ft.
Ft. D Projection I
Rooms 8 Bedrooms 4 Baths 3
Stories 2 Height 25 Ft. Canopies 0 Signs 0
-
Foundation . Poured Concrete o Floating Slab o Pier o Other
o Concrete Block o Post o Treated Wood
Occupany Permit Required Flood Plain No Height Permit Not Required
-
Park Dedication Required # Dwelling Units 1 # Structures 1
Use/Nature NSFRI New 2 story with 3 car attached garage and 14' x 14' Concrete patio.
of Work ....
HV AC Contr MCM AIR INC Plumbing Contr KOCH PLUMBING
Electric Contr CUMINGS ELECTRIC
Inspections:
Date 10/24/02 Type Re Insulation Inspector Allyn Dannhoff not approved
Phone request - poly is covering windows where placard is - did not leave opening in ceiling, if inspector wants to look through scuttle that
Nould be great.
DatelTime requested: 10/24/02
Access:
07:28 AM
Notice Type: FC
Phone Number:
Ready DatelTime: 10/24/02 07:28 AM Requested By: OWNER-Dan Lenz
o Reinspect Fee 0 Fee Waived
D Reinspect Fee Paid
Date 12/20/02
Type Final
Inspector John Zarate
not approved
REQUEST LINE. The message was breaking up really bad.
IHVAC passed. Inspected the insul. in the attic as well.
DatelTime requested: 12/18/02 11 :22 AM
Access:
Irhe key for the front door is in the garage.
Ready DatelTime: 12/18/02 11:22 AM Requested By: OWNER - Dan Lenz
Notice Type: FC
Phone Number: 685-6401
o Reinspect Fee 0 Fee Waived
D Reinspect Fee Paid
Building Permit Work Card
Job Address 1776 HUNTERS GLEN DR Permit Number 0095712 Create Date 7/5/02
Owner DANIEL J. AND GINGER M. LENZ Contractor OWNER
Category 110 - New Single Family
Type . Building o Sign o Canopy o Fence o Raze I Plan D1-094-0602R
Zoning R-1 Class of Const: 8 Size IRRG Value $133,000.00
Unfinished/Basement 1065 Sq. Finished/Living 2164 Sq. Ft. Garage 968 Sq.Ft.
Ft. -
Rooms 8 Bedrooms 4 Baths 3 D Projection I
Stories 2 Height 25 Ft. Canopies 0 Signs 0
- -
Foundation . Poured Concrete o Floating Slab o Pier o Other
o Concrete Block o Post o Treated Wood
Occupany Permit Required Flood Plain No Height Permit Not Required
-
Park Dedication Required # Dwelling Units 1 # Structures 1
Use/Nature NSFRI New 2 story with 3 car attached garage and 14' x 14' Concrete patio.
of Work
HV AC Contr MCM AIR INC Plumbing Contr KOCH PLUMBING
Electric Contr CUMINGS ELECTRIC
Inspections:
Date Type Insulation
reque,. Uoe - wants to .".,.1110/25/02
DatelTime requested: 10/17/02 02:13 PM
Access:
~II on the way to project so he can meet you.
Ready DatelTime: 10/24/02 07:00 AM Requested By: OWNER-Dan Lenz
o Reinspect Fee 0 Fee Waived
Inspector
no time
Notice Type:
Phone Number: w: 685-6401 h: 236-9318
D Reinspect Fee Paid
Type Insulation
Inspector John Zarate
no time
Date 10/23/02
Insulation should be ready Wed. Late afternoon.
DatelTime requested: 10/21/02
Access:
08:38 AM
Notice Type:
Phone Number:
Ready DatelTime: 10/23/02 03:00 PM Requested By: OWNER
o Reinspect Fee 0 Fee Waived
D Reinspect Fee Paid
Building Permit Work Card
Job Address 1776 HUNTERS GLEN DR Permit Number 0095712 Create Date 7/5/02
Owner DANIEL J. AND GINGER M. LENZ Contractor OWNER
Category 110 - New Single Family
Type . Building o Sign o Canopy o Fence o Raze I Plan D1-094-0602R
Zoning R-1 Class of Const: 8 Size IRRG Value $133,000.00
Unfinished/Basement 1065 Sq. Finished/Living 2164 Sq.Ft. Garage 968 Sq.R
Ft. D Projection I
Rooms 8 Bedrooms 4 Baths 3
Stories 2 Height 25 Ft. Canopies 0 Signs 0
- -
Foundation . Poured Concrete o Floating Slab o Pier o Other
o Concrete Block o Post o Treated Wood
Occupany Permit Required Flood Plain No Height Permit Not Required
-
Park Dedication Required # Dwelling Units 1 # Structures 1
Use/Nature NSFRI New 2 story with 3 car attached garage and 14' x 14' Concrete patio.
of Work
HV AC Contr MCM AIR INC Plumbing Contr KOCH PLUMBING
Electric Contr CUMINGS ELECTRIC
Inspections:
Date 8/5/02 02:45 PM
IREOUEST UNE.
DatelTime requested: 8/5/02
Access:
Type Re Foundation
Inspector Nicole Krahn
approved
09:27 AM
Notice Type:
Phone Number:
Ready DatelTime: 8/5/02
09:27 AM Requested By: Lori from Delrar
o Reinspect Fee 0 Fee Waived
D Reinspect Fee Paid
Date 10/21/02
Type Rough In
Inspector John Zarate
not approved
Request Line - advance notice for insulation inspection also.
Passed HV AC.
DatelTime requested: 10/17/02 02:13 PM Notice Type: FC Phone Number: w: 685-6401 h:236-9318
Access:
~II on the way to project so he can meet you there.
Ready DatelTime: 10/17/02 02:13 PM Requested By: OWNER-Dan Lenz
o Reinspect Fee 0 Fee Waived D Reinspect Fee Paid
Building Permit Work Card
Job Address 1776 HUNTERS GLEN DR Permit Number 0095712 Create Date 7/5/02
Owner DANIEL J. AND GINGER M. LENZ Contractor OWNER
Category 110 - New Single Family
Type . Building o Sign o Canopy o Fence o Raze I Plan D1-094-0602R
Zoning R-1 Class of Const: 8 Size IRRG Value $133,000.00
Unfinished/Basement 1065 Sq. Finished/Living 2164 Sq.Ft. Garage 968 Sq. Ft.
-Ft. D Projection I
Rooms 8 Bedrooms 4 Baths 3
Stories 2 Height 25 Ft. Canopies 0 Signs 0
- -
Foundation . Poured Concrete o Floating Slab o Pier o Other
o Concrete Block o Post o Treated Wood
Occupany Permit Required Flood Plain No Height Permit Not Required
-
Park Dedication Required # Dwelling Units 1 # Structures 1
Use/Nature NSFRI New 2 story with 3 car attached garage and 14' x 14' Concrete patio.
of Work
HV AC Contr MCM AIR INC Plumbing Contr KOCH PLUMBING
Electric Contr CUMINGS ELECTRIC
Inspections:
Date 7/22/02 10:45 AM Type Footings Inspector Nicole Krahn
REQUEST LINE - They don't know how far they'll get today because of the rain. NOT READY - NOTE: Soil is OK.
not approved
DatelTime requested: 7/22/02
Access:
07:27 AM
Notice Type:
Phone Number:
Ready DatelTime: 7/22/02 07:27 AM Requested By: Lori from Delrar
o Reinspect Fee 0 Fee Waived
D Reinspect Fee Paid
Date 7/30/02
10:15 AM
Type Foundation Backfill
Inspector Nicole Krahn
not approved
REQUEST LINE.
1) A min. of 12" of stone is req over the draintile.
2) Foundation jumps can not exceed 3' without engineering.
DatelTime requested: 7/29/02
Access:
11:38 AM
Notice Type:
Phone Number: 731-5464
Ready DatelTime: 7/29/02 11 :38 AM Requested By: Lori from Delrar
o Reinspect Fee 0 Fee Waived
D Reinspect Fee Paid
Electric Permit Work Card
Job Address 1776 HUNTERS GLEN DR Permit Number 96280 Create Date 07/09/2002
Owner DANIEL J/GINGER LENZ Contractor CUMINGS ELECTRIC
Category 611 - Residential-New Single Family Wiring
Service bNew o ChangeO Temp ON/A I Type o Overhead . Underground ON/A I
Volts 120/240 Circuits 1 Fixtures 1
Amps 200 Switches 1 Receptacles 1
Fee $90.00 D Value $3,500.00
Appliances ~ange, Water Heater, Garbage Disposal, Dryer, Dishwasher, Fan or Blower, Furnace & A1C.
Use/Nature ~SFRI New home wiring. . Job #5038.
of Work
Inspections:
Date 10/21/2002
Type Rough In
Inspector John Zarate
approved
DatelTime requested: 10/21/2002 12:29 PM
Access:
Notice Type:
Phone Number:
Ready DatelTime: 10/21/200212:29 PM Requested by:
o Reinspect Fee 0 Fee Wavied D Reinspect Fee Paid
Date 12/23/2002
Type Final
Inspector Jon Fischer
approved
Request Line - wants to move in on Christmas
DatelTime requested: 12/20/2002 12:24 PM
Access:
Notice Type:
Phone Number:
Ready DatelTime: 12/20/200212:24 PM Requested by: CUMINGS ELECTRIC-Jan
o Reinspect Fee 0 Fee Wavied D Reinspect Fee Paid
------------------------------------------------------------------------------------
, ,
Electric Permit Work Card
Job Address 1776 HUNTERS GLEN DR Permit Number 96280 Create Date 07/09/2002
Owner DANIEL JIGINGER LENZ Contractor CUMINGS ELECTRIC
Category 611 - Residential-New Single Family Wiring
Service p New o Change 0 Temp ON/A I Type o Overhead . Underground ON/A I
Volts 120/240 Circuits 1 Fixtures 1
Amps 200 Switches 1 Receptacles 1
Fee $90.00 D Value $3,500.00
Appliances Range, Water Heater, Garbage Disposal, Dryer, Dishwasher, Fan or Blower, Furnace & A1C.
Use/Nature NSFRI New home wiring. * Job #5038.
of Work
Inspections:
Date 08/05/2002
Type Service
Inspector Jon Fischer
approved
8/5/02 approved
8/5/02 called in
8/12/02 mailed in
DatelTime requested: 08/02/2002 02:27 PM
Access:
Notice Type:
Phone Number:
Ready DatelTime: 08/02/2002 02:27 PM Requested by: CUMINGS ELECTRIC - Jan
o Reinspect Fee 0 Fee Wavied D Reinspect Fee Paid
Type Rough In
Inspector Jon Fischer
no time
Date 10/17/2002
Request Line
DatelTime requested: 10/17/2002 08:14 AM
Access:
Notice Type:
Phone Number:
Ready DatelTime: 10/17/200208:14 AM Requested by: CUMINGS ELECTRIC-Jan
o Reinspect Fee 0 Fee Wavied D Reinspect Fee Paid
------------------------------------------------------------------------------------
, ,
HVAC Permit Work Card
Job Address 1776 HUNTERS GLEN DR Permit Number 97247 Create Date 07/09/2002
Owner DANIEL J/GINGER LENZ Contractor MCM AIR INC
Category 502 - Residential-Both Plan
Fuel ~ Gas I UOil I I I Electric I I I Solar I U Solid I Value $6,800.00
System o New I D Replace I D Other I
~ Forced Air I U Radiant I U Steam I ~ A1C I U Vent I
U Electric I U Hot Water I U Suppl. I U Con. Bumer I
Chimney Type o Chimney A o Chimney B o Direct Vent . Not Applicable I
Heat Loss o As Approved o Existing . Not Applicable I Value 0
BTU Rate o As Per Plan o Variable . Other I Value
Use/Nature NSFRllnstall 60m btu fumace, 36m btu A1C & ductwork.
of Work
Inspections:
Type Rough In
Inspector John Zarate
approved
Date 10/21/02
Faxed request (rec'd 10/8/02 @ 4:44 PM)
Notice Type:
Phone Number: 582-4402
DatelTime requested: 10109/2002 07:00 AM
Access:
Ready DatelTime: 10/09/2002 07:00 AM
Requested By: MCM AIR INC
o Reinspect Fee 0 Fee Waived
D Reinspect Fee Paid
-----------------------------------------------------------------,-----------------~---------
Date 12/23/02
FAXED REQUEST.
Type Final
Inspector John Zarate
approved
DatelTime requested: 11/26/2002 01 :48 PM
Notice Type:
Phone Number:
Access:
~all Dan lenz @ 685-6401.
Ready DatelTime: 11/26/2002 01 :48 PM
Requested By: MCM AIR INC
o Reinspect Fee 0 Fee Waived
D Reinspect Fee Paid
--------------------------------------------------------------------------------------------
, ,
Plumbing Permit Work Card
Permit Number 96622
Contractor KOCH PLUMBING
Create Date 07/09/2002
Job Address 1776 HUNTERS GLEN DR
Owner DANIEL J/GINGER LENZ
Category 410 - Residential-Interior Plan Value $7,900.00
Bathtub 2 Shower 0 Ejector/Grind 0 Dip Well 0 F Prep Sink 0 Gar Drain 0
Whirlpool 0 Floor Drain 1 Water Softner 0 Drink Ftn 0 Serv Sink 0 Soda Disp 0
- -
Lavatory 3 Lndry Tray 1 Local Waste 0 Wait. St. 0 Shamp Sink 0 Coffee Maker 0
Toilet 3 Lndry Stndp 1 Clothes Wshr 0 Ice Chest 0 FlrlWst Sink 0 Int Grease Trap 0
- -
Res. Sink 1 Disposal 0 Bidet 0 Exam Sink 0 Catch Basin 0 Ext Grease Trap 0
Bar Sink 0 Dishwasher 1 Beer Tap 0 Sculry Sink 0 Wash Ftn 0
-
Water Heater 1 Sump Pump 1 Dent. Oper. 0 Hand Sink 0 Urinal 0
Site Drain 0 Classrm Sink 0 Lab Sink 0 Plaster Sink 0 Standp Rec 0
- - - -
Roof Drain 0 Breakrm Sink 0 Sterilizer 0 Surgeons Sink 0 Ice Maker 0
Use/Nature rSFRI PI"mblng ro, new home.
of Work
Size
Material
Type # Conn.Type
0
0
0
0
0
0
0
0
0
0
Sanitary Sewer
Storm Sewer
Date 12/23/02
Type Final
o
o
o
o
o
Inspector WJ (Chip) Callies
approved
Water Service
DatelTime requested: 12/19/02 09:50 AM
Notice Type:
Telephone Number:
Access:
Ready DatelTime: 12/19/02 09:50 AM Requested By: Keith Koch
o Reinspect Fee 0 Fee Waived D Reinspect Fee Paid
----------------------------------------------------------------------------------j----------------------
~
Plumbing Permit Work Card
Permit Number 96622
Job Address 1776 HUNTERS GLEN DR
Owner DANIEL J/GINGER LENZ
Contractor
Plan
KOCH PLUMBING
Category
Bathtub
Whirlpool
Lavatory
Toilet
Res. Sink
Bar Sink
Water Heater
Site Drain
Roof Drain
Use/Nature
of Work
410 - Residential-Interior
2 Shower
o Floor Drain
0 Ejector/Grind 0 Dip Well 0 F Prep Sink 0
1 Water Softner 0 Drink Ftn 0 Serv Sink 0
- - -
1 Local Waste 0 Wait. St. 0 Shamp Sink 0
1 Clothes Wshr 0 Ice Chest 0 FlrlWst Sink 0
- -
0 Bidet 0 Exam Sink 0 Catch Basin 0
1 Beer Tap 0 Sculry Sink 0 Wash Ftn 0
- - -
1 Dent. Oper. 0 Hand Sink 0 Urinal 0
0 Lab Sink 0 Plaster Sink 0 Standp Rec 0
- - -
0 Sterilizer 0 Surgeons Sink 0 Ice Maker 0
3 Lndry Tray
3 Lndry Stndp
1 Disposal
o Dishwasher
1 Sump Pump
o Classrm Sink
o Breakrm Sink
rSFRI PI"mbln. fo, new home.
Create Date 07/09/2002
Value
Gar Drain
$7,900.00
o
o
o
o
o
Soda Disp
Coffee Maker
Int Grease Trap
Ext Grease Trap
Sanitary Sewer
Storm Sewer
Water Service
Date 10/21/02
Size
Type Rough In
Material
Type # Conn. Type
0
0
0
0
0
0
0
0
0
0
o
o
o
o
o
Inspector WJ (Chip) Callies
approved
Access:
DatelTime requested: 10/21/02 07:41 AM
Notice Type:
Telephone Number:
Ready DatelTime: 10/21/02 07:40 AM Requested By: KOCH PLUMBING
o Reinspect Fee 0 Fee Waived D Reinspect Fee Paid
-----------------------------------------------------------------~----------------~----------------------
Plumbing Permit Work Card
Job Address 1776 HUNTERS GLEN DR Permit Number 96622 Create Date 07/09/2002
Owner DANIEL JIGINGER LENZ Contractor KOCH PLUMBING
Category 410 - Residential-Interior Plan Value $7,900.00
Bathtub 2 Shower 0 Ejector/Grind 0 Dip Well , 0 F Prep Sink 0 Gar Drain 0
Whirlpool 0 Floor Drain 1 Water Softner 0 Drink Ftn 0 Serv Sink 0 Soda Disp 0
-
Lavatory 3 Lndry Tray 1 Local Waste 0 Wait. St. 0 Shamp Sink 0 Coffee Maker 0
Toilet 3 Lndry Stndp 1 Clothes Wshr 0 Ice Chest 0 FlrlWst Sink 0 Int Grease Trap 0
- -
Res. Sink 1 Disposal 0 Bidet 0 Exam Sink 0 Catch Basin 0 Ext Grease Trap 0
Bar Sink 0 Dishwasher 1 Beer Tap 0 Sculry Sink 0 Wash Ftn 0
- - -
Water Heater 1 Sump Pump 1 Dent. Oper. 0 Hand Sink 0 Urinal 0
Site Drain 0 Classrm Sink 0 Lab Sink 0 Plaster Sink 0 Standp Rec 0
-
Roof Drain 0 Breakrm Sink 0 Sterilizer 0 Surgeons Sink 0 Ice Maker 0
Use/Nature INSFRI Pl,mblng "" new home.
of Work
Size
Material
Type # Conn.Type
0
0
0
0
0
0
0
0
0
0
Sanitary Sewer
Storm Sewer
Water Service
Date 8/16/02
REQUEST LINE.
Type Underground
o
o
o
o
o
Inspector WJ (Chip) Callies
approved
DatelTime requested: 8/14/02 12:36 PM
Notice Type:
Telephone Number: 379-1708
Access:
Ready DatelTime: 8/14/02 12:36 PM Requested By: KOCH PLUMBING - Ken
o Reinspect Fee 0 Fee Waived D Reinspect Fee Paid
-----------------------------------------------------------------~----------------~----------------------
"
~
CORRECTION NOTICE / FIELD INSPECTION REPORT
JOB LOCATION: /771/ xl.~pj--:::S ~k ~
CONTRACTOR: N n?
PROJECT TO BE INSPECTED: ~~ ~
~
City of Oshkosh
Inspection Services Division
215 Church Avenue, PO Box 1130
Oshkosh, WI 54903-1130
Phone: (920) 236-5050
Fax (920) 236-5084
BUILDING: HVAC: ELECTRIC: PLUMBING: EROSIO)l CONTROL: PROPERTY MAINT.:
Pooting Rough Rough Rough Tracking Setback Park.
Poundation Furnace Service Test On Silt Pence Unlicensed Veh_
Rough ~ AlC Temp_ Penn Undertloor Stone Access Garbage
Insulatio ., Fireplace UG OH SewerfWater Straw Bales Dilapidated bId's, fences,
Re-insp. ~ , Re-insp. Re- ;;;sP:-- Re-insp. Re-insp. etc.
Final Final Final Pinal Pinal Ex!. Main!.
>.CODE.
..!5...-
VIOLA nONS MUST BE CORRECTED AND APPROVED WITHIN 30 DAYS UNLESS OTHERWISE NOTED. CALL FO~ RE-INSPECTIONS PRIOR TO
CONCEALMENT AND/OR OCCUPANCY. WHEN CORRECTIONS ARE COMPLETED THE OWNER/CONTRACTOR IS REQUIRED TO SIGN & DATE THIS
NOTICE AND RETVRN IT TO THE INSPECTION IVISION WHEN RE VESTING ARE-INSPECTION.
COMPLIANCE DATE:
o MailedIFaxed
~.sto~ty/.J.-
Phone #
~. 1l.:f. $-
~
City of Oshkosh
Inspection Services Division
215 Church Avenue, PO Box 1130
Oshkosh, VVI54903-1130
Phone: (920) 236-5050
Fax (920) 236-5084
CORRECTION NOTICE / FIELD INSPECTION REPORT
JOB LOCATION: t 77(;, HUA./7ERJ 0t.~>>
CONTRACTOR: LEN';:;'
PROJECT TO BE INSPECTED: ;lie '^ I J-lo rl E"
TYPE OF INSPECTION: r<Clv 7'^ '&ld
~
Violations must be corrected and approved within 30 days unless otherwise noted. Call for re-inspections prior to concealment
and/or occupancy. Upon completing the corrections, the ovvner/contractor/agent must sign and date at the bottom ofthis notice
and return it to the Inspection Services Division by the Compliance Date of
;QD'E:... INSPECTION
13l
Print Name
Company
Signature:
Date