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HomeMy WebLinkAboutN2017-0521s 1r, City Beach IIIIIIII IIII�IIIIIIII�III IIDIIIIIII�IIII II Permit No: N20`17-052'f 'VocNewport 100 N 2 0 1 Bacn, CA92660 7 0 5 2 1 �? t4 Permit Counter Phone (949)644-3311 Online Inspection Request - www.newportbeachca.gov / Online Project No : SCANNED tl � D Services Inspection Requests Phone (949)644-3255 Job Address : 6104 W OCEAN FRONT NB Thomas:Guide: 888F5 Description: Remove 3 Mexican Fan Palm trees in the West Ocean Front right-of-way (beach) to allow for extended patio per City Council Policy L-12 and Oceanfront Encroachment Permit. Parcel # : 0451-020-8 - Legal Desc : SEASHORE COLONY TR LOT 3 BLK A SWLY 60 FT -INC 15 FT ADJ ON SW- TH Owner: ONE FINE PROPERTY NB LLC Contractor: CHARISMA CONSTRUCTION Phone: 0 Phone: 760-272-6031 Address : 901 N GREEN VALLEY PKWY air,": Address: 6910 PALM AVENUE HENDERSON, NV i 7 YUCCA VALLEY, CA Contractor State Lic: 981137 Applicant: KATHERINE SANDERSON License Expire : 02 28, 2019 Phone: 949-500-0867 [ Address: 6104 W OCEANFRONT NEWPORT BEACH, CA 92663 Business License: BT30060787 Business Expire : 10 31, 2018 Special Cond.: Pre -job inspection required. Workers' Compensation Insurance - - Carrier: STATE COMPENSATION INSURANCE Policy No: 9090430 W. C. Expire: 02 25, 2018 Permit Processing Fee: $241.00 Sewer Connection : $0.00 Total Fee $4,410.32 Agreement Fee: $0.00 4TT Box Cover: $0.00 Paid: $0.00 Traffic control Plan Check : $0.00 Total Water Meters : $0.00 Balance : $4,410.32 Inspection Fee : $330.00 Water Meter Connection : $0.00 Receipt No: Refundable Deposit: $0.00 Total Water Meter Box: $0.00 Street Tree Fee : $3,839.32 Adjustment : $0.00 Processed By: Date: _/ / Other Department: Date : Utilities Approval : Date: _/ / Permit Denied Date/ Traffic Approval: Date: _/ /_ Issued Permit: Date/ _C/ 7 General Services Approval: Date: _/ / 5 COMPLETE THE BELOW INFORMATION PROJECTADDRESS: 1 p DETAILED ESCRIPTION OF ROPO ED WO K: &webve- & -C.es V\ b-ca-* _rl F �b Vr\� �e 0A 6 to q Wei Cea ��ez,wfi APPLICANT: KC i LV11 l Pz1. I Phone: 76 0 " O Email Address: cjkuwil C_U Vl r,+tV vlct t7" !D ^ co vn Mail' g Ad ress: 67, D �CA-1 VA R-Y e. i /Slat Zip: t'L�q vet I l C Z 1 Phone: c}O/^ J dv OWNER: C'k exse Goh -e 0,1 Email Address: aSLo s vAergo l Mailing Address: City/ ate/Zip: O G 0 - VJ SV ©LC h- titu l N eu CG A- 116 3 CONTRACTOR: af- L'5 VN G - C-006All(R.44417 Office Phonll ^ 7\\ - 6 6 3l Company (if differe Jobsite Phone. 60- 6L-1 p - U other Phone.76 0- ,�i9 - 0 �1/j Email Address: G tti-rksiCtfkl!h \10p) (��-(_OVII MailiG 6" loPC' /In �l se `1 ty/�CCG(pOW1 yQ f ` -a2OT SMS to L�c�nse Number �}CI s: I/ 57 Ro '"� Expires: '2-2-I ir City Business License Nurkiber: 13 �Cl b C 0-7S y Expires: 10 "f0 ` WORKERS COPPyENSATION INSURANCE - Certificate of Insurance (Section 3800 Labor Code) 'T Company: S "► � t 0 SUS �Jdl Policy No: 7 / C� L/3 0 Expirel e Zs'- Municipal Operations. 90-644-3066 Utilities: 949.6444011 Urban Forestry: 9494644-3083 `r. Special Conditions of Permit: wE etitof l.S.rsY n.4+�'i.3"£+anwY T.Jir:r ...'�'-+tea u.r P.ril�nc�w'a' o�lT> Utilities: Traffic: 0 Fire: 0 Municipal Operations Other: Engineering Technician: Per ' Specialist ate: rIG9 Permit No. N2017- C6)1 f./users/pbw/shared/encroach/maste Wepwo*sheetxts r7 k0 I(;/ Public Works Department 949-644-3311 100 Civic Center Drive, Newport Beach, CA 92660 Permit Processing Fee: Q Inspection Fee: Q Public Works Only $241.00 Public Works Field Inspection $165.00 Other Department $275.00 Utilities Field Inspection $121.00 General Services Inspection $165.00 Agreement Fee: Water Quality/Artificial Turf Inspection $108.00 Preparation of Report/Agreement $817.00 Document Recordation Fee $192.00 Refundable Deposit: TBD Monitoring Wells $502.00 Improvements TBD Street[Alley/Walk Closure: $65.000 Newspaper Rack Inspection $108.00 0 Traffic Control Plan Check 8-1/2" x 11" $65.00 Sewer Connection Fee $250.00= 24" x 36" $143.00 4TT Box & Cover $64.00 Additional I THE FOLLOWING ITEMS REQUIRE APPROVAL FROM THE Revenue Division 1 REVENUE DIVISION PRIOR TO PAYMENT OF FEES' REVENUE DIVISION PRIOR TO PAYMENT OF FEES]ApprovaL�� Qty. Qt . I IWaterMeter: Installation Charge $528.001 13/4 Meter $50.25 ` Water Meter Boxes: J 11"Meter $121.50`" For Parkway& Sidewalk Area (Box + Cover = Cost) 1 11 1/2" Meter $285.00 1" Meter: 113.00 + 37.00 $50.00� 11 1/2" Turbine Meter $700.00 I 2: Meter: 2 7.00+ 61.25 $88.25 1 12" Meter $425.00 12" Turbine -Meter 13" Meter $845.00 $3,310.00 i For Traffic & Alley Areas (Box + Cover = Cost) 1" Meter; 13.00 + 38.00 $51.00 14' Meter $4,730.00 2" Meter: 27.00 + 162.00 $189.00B r1 16"Meter $7,190.00 `, � Certificate of Compliance Fee (+100er of hrly over 3 hrs) $288.00 5200-5029 Development Services Fee (Plan check hourly) $155.00 5200-5015 Final Tract Map Checking Fee $2,488.00 5200-5026 Final Parcel Map Checking Fee - Moderate $2,488.00 5200-5027 Lot Line Adjustment Fee $1,079.00 5200-5028 Park Dedication Fee Zone _ TBD 405-470_ Street Easement/Vacation Fee (+100 i. of hrly over a hrs) $1,022.00 5200-5031 Street Tree Fee 4Z99-F4ar8ing eo TBDI 1 030-2284 a S, I3q. 3i, Engineering Tech: Total Amount Due: For Finance use only i\ed.1' M A+,1410.32, Permit Specialist Receipt No. f/userslpbw/shareNencmach/masterslep front and back masters/ Rev. 1/5/2017 epfeesheetAs-revised 10QW016 1 2. 1 5. 1 6. i TERMS AND CONDITIONS OF ENCROACHMENT PERMIT Encroachment Permits may be taken out by the owner of benefited property,or a licensed contractor. A licensed contractor must provide a "Letter of Authorization" to allow another party to pull a permit. An approved copy of the permit and construction plan shall be kept at the job site at all times. Work, which has been done prior to issuance of a permit, is subject to rejection/fine. City reserves the right to void permit if work does not commence within 30 days after date of issuance. The Permittee agrees to defend, indemnify and hold the City, its authorized agent, officers, representatives and employees harmless from any responsibility, liability, suit or action of any description arising out of any accident, loss or damage to persons or property occurring as a result of work undertaken under this permit. All work shall be done in accordance with the approved plans, Standard Special Provisions and Standard Drawings of the City of Newport Beach, and in compliance with all applicable State laws and City ordinances. Permittee guarantees all work performed under this permit to be free of hidden and latent defects. Any failures shall be corrected within two weeks after notification to the satisfaction of the Public Works Director. A valid State licensed contractor must perform all construction within the public right-of-way, unless waived by the Public Works Director.. A valid State Contractor License Class A can perform any work in the public right-of-way. For construction or connection to water lines a valid State Contractor License Class C-34 is required. For construction or connection to sewer lines a valid State Contractor License Class C-42 is required. All trenching and/or resurfacing shall conform to City Standard 105-L for parkway/roadway and City Standard 140-L, in the alley, where a minimum halFalley width resurfacing shall be provided, unless otherwise directed by the Public Works Dept. Contractors shall obtain permits to perform excavation or trench work from the California Division of Industrial Safety prior to commencing underground construction as required by State law. Walls and faces of all excavations over 5 feet in depth shall be protected by a shoring system, sloping of the ground, or other equivalent means. Trenches less than 5 feet in depth shall be guarded when hazardous ground movement may be expected. The Public Works Department Inspectors must inspect all work in the Public right-of-way. Forms and subgrade must be inspected and approved before concrete is ordered/poured. Sewer, pipelines, and subgrade construction must be inspected and approved before backfiiling, or applicant may be required to excavate site. Separate Utilities Department or General Services Department inspections may be required depending on scope of work performed. All trench restoration must be inspected by the Public Works Department. No utility installation(s) shall be allowed over or within 5 feet of an City utilities unless approved b the Public Works Department, Loco a an pothole y y pp yt d p le existing City -owned utilities (ie. water, sewer, or street lighting conduits) to verify locations. Maintain a one -foot clearance over or under existing City -owned utilities. Sewer cleanouts require VCP or PVC SDR35 be used with a 4TT box over the riser. Properly lighted barricades must be provided and maintained around all trenches, excavations and obstructions. All signs, flags, lights and other warning and safety devices shall conform to the requirements of the current "Manual of Warding Signs, Sights and Other Devices for the Use in Performance of Work Upon Highways', issued by the California Department of Transportation. If needed,'barricades can be obtained from the City at a charge of $10.00 per barricade per day, with a minimum charge of $35.00. It is the responsibility of the applicant to place barricades to protect the general public. Access to fire hydrants must be maintained at all times. Work within or near beach sensitive areas will not be allowed during, City holidays, spring break, Memorial Day weekend, summer between June 15 and September 16, and during the holiday season from December 19 to January 1, unless approved by the Public Works Department. Any work that extends into traffic or parking lanes and impedes the normal flow of traffic requires the applicant to acquire a Temporary Street Closure Permit from the Public Works Department. Access for fire, police and emergency vehicles must be maintained at all times. Traffic Control must be per Work Area Traffic Control Handbook (WATCH). No nighttime traffic lane closures, unless prior approval has been granted. Any lanes) closure on a major street will only be allowed between 9:00 a.m. and 3:00 p.m. (Monday thru Friday), unless approved by the Public Works Department. Any work affecting the State Highway's traffic or within the State Highway right-of-way will require a Caltrans Permit. All vehicles shall be lawfully parked. - This permit does not authorize the closure of sidewalks, streets, or alleys for construction access, storage of materials, or parking of construction vehicles unless detailed on an attached Temporary Street Closure. Applicant must notify USA at 1-800-227-2600 2 days before starting any underground construction. Applicant must notify all affected residents 24 hours in advance of restricted access and any inconveniences. Refuse or unused materials shall be removed within 24 hours after completion of the work. If not removed, the City may remove and bill the applicant. Coordinate alley closures with City's refuse pick-up daysby calling 949-644-3066 for the collection schedule so service is not interrupted. To place a dumpster or materials in the public right-of-way, a Temporary Street Closure Permit must be obtained from the Public Works Department. WORKER'S COMPENSATION INSURANCE (Section 3800 Labor Code) . certify that I have a Certificate of consent to self -insure, Certificate of Worker's CompepsatiolnlIns /y6 rance, or a Certified Copy th Date_ ` —17 Signature: CERTIFICATE OF EXEMPTION (Section 3800 Labor Code) I certify that in the performance of the work under this permit, I shall not employ any person so as to become subject to California Worker's Compensation Laws. If, after signing this certificate I become subject to the Worker's Compensation provisions of the State Labor Code, I must comply with the provisions of Section 3700 or this permit shall be deemed revoked. Date: Signature: CONTRACTOR LICENSE EXEMPTION As the Owner of the benefiting property, I certify I am personally performing all work in the Public Right -of -Way. Date: Signature: HOLD HARMLESS STATEMENT 1 understand that I am locating minor encroachments within the City Right -of. Way/Easement. As property owner it is my responsibility to maintain the encroachments. I will be responsible for replacing the improvements if the City removes them for maintenance of utilities or other public need. I shall indemnify and hold the City harmless for any liability associated with the minor ` encroachments. Date: .� l © -'- 6 — i I Signature: Ci 24-hour notice for Encroachment Public Works at949-644-33101/ is required by calling 15, Any above ground utility facilities will require documented approval from the adjacent affected property owners). 16. Homeowner, contractors, and subcontracotrs may each be liable for violations of Water Quality Laws. Best Management Practices will be enforced. It is against the law to discharge construction debris into the gutter and storm drain. Felony violations of Water Quality Laws are punishable by fines up to $25,000 and/or up to three years in State prison plus the full cost to clean up an illegal discharge or spill. 17, If a refundable deposit was paid, applicant must submit a Soils Compaction Certificate or Evidence of a Slurried Backflll and request a final inspection from the Public Works Department. Monies may be held for six months after final inspection before a refund will be processed. 18. No trees in the public right-of-way shall be planted, removed, trimmed, or relocated without approval from the General Services Department. 19. All work in the public right-of-way must meet the approval of the Public Works Department or corrections will be required (i.e. removals, exposing connections, etc.). Additional inspection fees may be required. 20. Permit is for standard materials in the public right-of-way only, unless previously approved by Public Works and an Encroachment Agreement has been processed. 21. Permit is valid for "description" of work noted on front only. Additional work performed may require issuance of a separate permit and/or additional fees. PUBLIC WORKS DEPARTMENT 3300 Newport Boulevard, Newport Beach, CA 92663 949-644-3311 o��Ewap @ ANNUAL 3 OCEANFRONT ENCROACHMENT PERMIT PERMIT NO: Depth of Encroachment: Fee Paid: Re^c_ellpt No: Site Address: r^ I W QST o :" 6 7i 'sUri Descripti n of Work: b Applicant: Phone: ba d Address: Owner. anC hone: rlljn�kAddress: Contractor: jAk wi, rii, jPhone: Mailing Address: ub mil"I , C jAtt) ?elkn Avcnuet Yucca Votie r CA 4122824 City Business License: a'r3oo(a0-I$4 Ex . Date: M - sl-t$ State Contractor License No: $ f Class: t if L - \ O Worker's Compensation Insurance (Required by section 3800 of labor code) Cora an c Ct, I,,Tz-v h Policy No: Lf 0 7 D q3 0 lExp: x - 2S -1 9 Contractor has furnished to the City a certificate of workers' compensation insurance issued by an admitted insurer and conforming to Section 3800 of the Labor Code; or an exact copy thereof certified by the insurer. The insurance certificate shows the expiration date of the policy. If the policy lapses or is cancelled this permit shall be deemed to be revoked. Signature: Date: The terms and conditi of t i p it are as stated in the Oceanfront Agreement. Owner hereby acknowledges that he/she has read and to s said terms and conditions and agree to abid by em. Owner's Signature: \ Date: - Approval of Permit Per Citv Council Policv L-112. f J to k ,i y'y"3£ i7 Ftµ 14 tom? 5;�' WK.$elgw T G t If. r r U?. Additional special conditions of approval required by City as follows. 11e Obtoivt aPPrOVOls 4*011 ?Or" ovd TWIGS `DM---42-A 04' Mudici 1 t%Pey'oi-iaNS %pu4we44, -('or free tewwvak +N14jh1w Vd&ei- Permit Issued B Date Issued: a - to - 1-1 Expiration Date: Permit Denied By: Reason for Denial: CITY OF NEWPORT BEACH OCEANFRONT ENCROACHMENT PERMIT AGREEMENT FOR c O ew f6J (Property Address) 1. Definitions (a) "Authorized Improvements" shall mean those improvements within the Permit Zone, which are shown on Exhibit 'B", provided the improvement is consistent with the Policy and the LCP. (b) "LCP" shall mean Amendment No. 23 to the Land Use Plan of the Local Coastal Program, as approved by the City Council on October 22, 1990, together with any amendments approved subsequent to that date. (c) "Permit Zone" shall mean the area oceanward of the property line that runs generally parallel to the shore line and within the oceanward prolongation of those property lines that are roughly perpendicular to the oceanfront shore line on the Balboa Peninsula and West Newport Beach as follows: 1. "A" Street to 250 feet southeast on "E" Street - Property line approximately 7-1/2 feet to back of sidewalk. 2. 52nd Street to 36th Street - Up to 10 feet. 3. Santa Ana River to 52nd Street - Up to 15 feet. (d) "Permittee" shall mean Grose O. 5on4ersm fir. once ne G. 5onderswn, knr.�kes ot- T",5&ndw~ F&"AW Tr„54- , the owners of the property at woo W. 0"an4vwr Newport Beach, California. (e) 'Policy" shall mean City Council Policy L-12 as approved by the City Council on October 22, 1990, together with modifications approved subsequent to that date. (f) 'Public Works Director" shall mean the Public Works Director for the City of Newport Beach or a designee. u 2. Permit Principles Permittee acknowledges that the issuance, administration and interpretation of the Permit is based on, and shall be consistent with, the following: 3. (a) This permit is the product of more than 2-1/2 years of study, meetings, hearings and analysis that culminated in City Council approval of the Policy and the LCP. (b) The Policy and LCP represent a compromise in terms of the extent of the Permit Zone, permitted improvements, and the nature of public access impacts improvements to be constructed along oceanfront with funds derived from the permit fees. (c) By issuing this Permit, the City is giving up any right to contend it is the fee owner of the Permit Zone; The City concedes it possesses only an easement for the street and public access purposes. Implementation of the Policy requires Permittee to concede the existence of the easement and give up any right to challenge its validity. , (d) Permittee, as the owner of the property adjacent to, and the underlying fee in, the Permit Zone has the legal right to construct and maintain Authorized Improvements within the Permit Zone subject to compliance with the Policy, LCP and conditions to this Permit. (a) The fees charged Permittee are to be used solely to defray the cost of administering the Policy and, in accordance with the LCP, mitigate the impact on beach access stemming from the construction and maintenance of Authorized Improvements. The annual fee shall be in accordance with City Policy L-12. Standard Conditions Permittee shall strictly comply with the following standard conditions to the approval of all oceanfront encroachment permits and any special conditions. (a) Permittee must execute and file Oceanfront Encroachment Permit. (b) Permittee must file a completed Oceanfront Encroachment form (Exhibit "A"), a sketch of the improvements within the encroachment zone on Oceanfront; -Encroachment form (Exhibit'B")-and pay annual fee per City Council Policy L-12. (c) Upon sale of property, the new property owner must execute and file Oceanfront Encroachment Permit before close of escrow. 2 (d) Permittee shall construct and maintain only the Authorized Improvements; (e) Permittee shall maintain all Authorized Improvements in good condition and repair; (f) Permittee shall defend, indemnify and hold the City and its officers and employees harmless with respect to any claim, damage or injury related to Authorized Improvements provided the Permittee shall have no such obligation if the claim, damage or injury was caused by any officer, employee or representative of the City; (g) Permittee shall remove any unauthorized improvements within ten (10) days after notice to do so, consent to City abatement of unauthorized improvements if not removed within the time specified in the notice and shall pay all costs incurred by the City in removing any unauthorized improvement. (h) Permittee shall allow the Public Works Director, or designee, to inspect improvements within the Permit Zone during normal business hours without notice to Permittee. (i) Construction within Permit Zone: 1. All construction within the Permit Zone must be performed by licensed contractors, unless waived by the City. 2. The City must inspect all work. Forms and subgrades must be inspected and approved before concrete is ordered. Inspectors are normally available during working hours upon 24 hours advance notice. Call (949) 644-3311 to schedule an inspection. 3. Barricades and/or flagging must be provided and maintained around all trenches, excavations and obstructions. 4. Refuse or unused materials shall be removed within 24 hours after completion of the work. If materials are not so removed, the City may remove the materials and bill the applicant. 5. Work that has been done prior to issuance of a permit is subject to rejection and/or fine. 3 4. Encroachment Permit Term/Renewal (a) Term This permit shall be effective on the date of issuance and shall expire on the 30th of June following issuance. (b) Renewal In order to maintain Authorized Improvements within the Permit Zone, Permittee must pay an annual encroachment fee. 2. In order to construct new improvements or modify existing improvements within the Permit Zone, Permittee must pay applicable Encroachment Fees, and file both a completed Oceanfront Encroachment Permit application (Exhibit "A") and a sketch of the improvements (Exhibit "B") for approval prior to beginning work. 5. Stipulation to Easement Permittee stipulates that the City has an easement for street and public access across the Permit Zone. The construction or maintenance of authorized encroachments pursuant to any Oceanfront Encroachment Permit constitutes a waiver on the part of the Permittee and all successors to dispute the validity of this easement. City stipulates that Permittee owns fee title underlying the Permit Zone subject only to the easement for street and public access easements. S. Location of Erosion Control Devices The Authorized Improvements shall not serve as justification for the construction of erosion control devices oceanward of private property. Seaward revetments or other control devices, if necessary, shall be installed in accordance with the Coastal Act and placed as close to the property line as feasible. 7. Termination City shall have the right to terminate this Permit, or require Permittee to modify Authorized Improvements, if the City Council determines that all or a portion of the right of way is needed for construction of a public improvement. 4 8. Revocation The Public Works Director may revoke this Permit after notice and hearing upon a determination that Permittee is in violation of the terms or principles or conditions of this Permit. 9. Notice Notice shall be deemed given when personally delivered to Permittee or when deposited in the United States mail, first class postage prepaid, and addressed to Permittee at the address specified on the Application for Permit. IN WITNESS WHEREOF, the parties have caused this Permit to be executed on the day and year first written below. Dated: q'b"t-7 Dated: q-s-i-7 Dated: q _g Date of Ownership Change: fAusersXpbw%haredbceanfront permitsWorms\agreement.doc CITY OF NEWPORT BEACH A Municipal Corporation IN Name: r..At) also 1 �y 1 chtinavi (-- i yes V'D --aL-49 -170 i9 ��Mll 5L""tili T-7 I,A i� • Removal approved for three (3) City Washingtonia robusta, Mexican Fan Palms. Applicant to incur costs to remove the palms utilizing a qualified landscape contractor. • Applicant is required to submit a payment for the value to replace two (2) 48- inch box trees elsewhere in the City. Please forward your payment of $3,839.32 ($1,919.66 per tree) to the City of Newport Beach, Attn: Municipal Operations Department, P.O. Box 1768, Newport Beach, CA 92658-8915. • There will be a conditional hold placed on your Building Permit. Final occupancy will not be granted until the site is re -inspected and verification is made that the requirements have been met. '10416/2017 City of Newport Beach 4:30:47PM INSP150 - Daily Inspection Request Report Requested Inspection Date : 10/17/2017 Inspection Type: ENCROACH Inspection Area: PW Site Address : 6104 OCEAN FRONT W Activity : N2017-0521 SubType: NEW Status : APPROVED OWNER: ONE FINE PROPERTY NB LLC Phone: 0 APPLICANT: KATHERINE SANDERSON Phone: g, Description : Remove 3 Mexican Fan Palm trees in the West Ocean Front right-61 for extended patio per Citv Council Policv L-12 and Oceanfront Encr Item: 10200 PRE JOB - PW Requested Time: 10/17/2017 12:00:OOAM Requestor: Entered By: WEBUSER Comments: AM - Assigned to : zzzzzzzzzzz* �Lt4� Page 18 of 18 (beach) to allow WEBrr� S _'�c2%� USER 760-272-603, r6tIV Iq ®``�'� 1/8/2018 City of Newport Beach Page 3 of 5 4:30,36PM INSP150 - Daily Inspection Request Report Requested Inspection Date: 01/09/2018 Inspection Type : ENCROACH Inspection Area: PW Site Address : 6104 OCEAN FRONT W Activity : N2017-0521' SubT.ype: ,NEW Status: APPROVED; OWNER: ONE FINE PROPERTY NB LLC Phone: 0 Phone : 949-500-0867 Description : Remove 3 Mexican Fan Palm trees in the West Ocean Front right-of-way (beach) to allow forsxtended atio erCi Council Polic L-12 and Oceanfront Encroachment Permit. Item: 10250 FINAL - PW l Requested Time: 1/9/2018 12:00:OOAM Requestor J NBIVR 7609726031 Entered By: NBIVR Comments: AM Assigned -to (° Inspector. � Date.: Time: C� - AM PM Comments: Z/sr—L°� COMPI JED F:\Users\PBw\Shared\ENCROACH\MASTERS\FORMS\I nsoectorS heet.doc REPT131, Run Id: 4018