HomeMy WebLinkAboutN2017-0043r�.+�•„�r City of Newport Beach IIIINIIIIIIIIIIIIIIIIIIIIIIIIIIIIgllllllllllllllllllllllll Permit No: N2017-0043
4 G� 100 Civic Center Drive Newport Beach. CA 92660
Permit Counter Phone (949)644-3311 Project No
. Online Inspection Request - www.newportbeachca.gov / Online
Services • �. r �` \j +L
Inspection Requests Phone (949)644-3255
Job Address : 713 POINSETTIA AVE NB Thomas:Guide: 919F2
Description : removal of existing concrete carriage walk, installation of pavers set in sand with 3 concrete ribbons/mow strip (4" wide maximum). Maintain a
minimum 5 foot tree well for existing tree. Encroachment Agreement Required.
Parcel # : 9398-203-0 -
Legal Desc : CORONA DEL MAR BLOCK 186 LOT 13 OF PROJECT 939-82 LOCATED ON
AP
Owner:
ALI AND MAUREEN KHAMSI
Contractor : 7 PALMS LANDSCAPE & CONSTRUCTION
Phone :
0
Phone : 909-329-1995
Address :
713 POINSETTIA AVENUE
Address : 4545 JERICHO ST
NEWPORT BEACH, CA
JURUPA VALLEY, CA 92509
Contractor State Lic: 990478
Applicant:
ALI AND MAUREEN KHAMSI
License Expire : 02 28, 2018
Phone:
[
Address
Business License: BT30055591
Business Expire : 06 30, 2017
Special Cond.:
Pre -construction meeting required
Workers' Compensation Insurance - -
Carrier : EXEMPT
Policy No:
W. C. Expire:
Permit Processing Fee :
$0.00
Sewer Connection : $0.00
Total Fee
$982.00
Agreement Fee:
$817.00
4TT Box Cover: $0.00
Paid :
$982.00
Traffic control Plan Check :
$0.00
Total Water Meters : $0.00
Balance :
$0.00
Inspection Fee :
$165.00
Water Meter Connection : $0.00
Receipt No:
Refundable Deposit:
$0.00
Total Water Meter Box: $0.00
Street Tree Fee :
$0.00
Adjustment : $0.00
Processed By:
Date : _/ /
Other Department :
Date:
Utilities Approval :
Date: _/_/
Permit Denied
Date:
'C `
/i
Traffic Approval :
Date: _/_/
Issued Permit :
Date : /S /
General Services Approval: Date: _/_/
WOMIMET FORROAC . , N .. PE IT
OF
PU �, ENT -
COMPLETE THE BELOW INFORMATION
PROJECT ADDRESS: 2 ( Ui nSC C M C a?
DETAILED DESCRIPTION OF PROPOSED WORK:
T-n54,;I4lb►, U ocivovs ititnee cq
APPLICANT: s •
Phone: � 3/O - _a 1
Email Address: a i , (��G , —co rn
Mailing Address:
3
City/State/Zip:
OWNER: is a (- ,,
Phone:
Email Address:
Mailing Address:
City/State/Zip:
ALL CONTRACTOR INFORMATION IS REQUIRED -PLEASE COMPLETE
CO RACTOR: } Pe, I r4 s Lq a CoM
Office Phone: O - -
Company (if different):
Jobsite Phone:
Other Phone:
Email Address: A I'yls �6 EJl . C�r'►'1
Mailing Add ass-
!3d ass-
hous'- CT
City/State/Zip.
Fyn Uhcr Ch lo?336
State License Number & Class:
13 -C aO
City Business License Number:
��>�Expires:
i
WORKERS COMPENSATION INSURANCE - Certificate of Insurance (Section 3800 Labor Code)
Company: Poll c No: Expires:
Municipal Orations: 949-644-3055
Utilities: 949-644-3011
Urban Forestry: 949-644-3083
FOR OFFICE USE ONLY
Special Conditions of Permit: /�
Vkkr �Iy� L
ADDITIONAL APPROVAL REQWRED FROM THE FOLLOWING DEPARTMENTS
Utilities:
Municipal Operations
Traffic: 0 Fire: 0
Other:
Engineerin Technician:
73CIL
Permit S ' st
Date:
Ci -7
Permit No.
1142017- 004
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Public Works Department 9494"-3311
100 Civic Center Drive, Newport Beach, CA 92660
All Fees Are Non -Refundable Unless Otherwise Stated
PROJECT ADDRESS: y
pe,
<<
PERMIT N2017- Ce c
`'�`"I
l
I ' 7
NUMBER:
APPLICANT: f
TO
wo
Permit Processing Fee:
Public Works Only
Other Department
Agreement Fee:
Preparation of Report/Agreement
Document Recordation Fee
Monitoring Wells
Q Inspection Fee:
$241.00 Public Works Field Inspection $165.00
$275.00 Utilities Field Inspection $121.00
1!
General Services Inspection $165.00
Water Quality/Artificial Turf Inspection $108.00
$817.00
$192.00 Refundable Deposit: TBDB
$502.00E Improvements TBD
Street/Alley/Walk Closure: $65.000 Newspaper Rack Inspection $108.00 [�
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
THE FOLLOWING ITEMS REQUIRE APPROVAL FROM THE 19ven-us-Divislon
REVENUE DIVISION PRIOR TO PAYMENT OF FEES Approval: 1
may
1
(Water Meter:
Installation Charge $528.00
13/4" Meter
$50.25
Water Meter Boxes:
I V Meter
$121.50
For Parkway & Sidewalk Area (Box + Cover =Cost
11 1 /2" Meter
$285.00
1" Meter: 13.00 + 37.00 $50.00 1
11 1 /2" Turbine Meter
$700.00
2: Meter: 27.00 + 61.25 $88.25
12" Meter
$425.00
12" Turbine Meter
$845.00
For Traffic & Alley Areas (Box + Cover = Cost) 1
13" Meter
14"
$3,310.00
1" Meter: 13.00 + 38.00 $51.00
Meter
$4,730.00
2" Meter: 27.00 + 162.00 $189.00e
6" Meter
$7.190.00
1
Certificate of Compliance Fee (+100% 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% of hry over 4 hrs)
$1,022.00
5200-5031
Street Tree Fee ($700 Planting Fee)
....................................................
TBD
030-2284
.............
Engineering Tech:
Total Amount Due:
For Finance Use Only
) co
Permi ecialist
Receipt No.
Lj
44
f:/users/pbw/shared/encmach/meslen/ep front and beck masters)
Rev. 1/5/2017
epfeesheet As -revised 10/2112016
ALL UNDERGROUND WORK SHALL BE PERFORMED BY A LICENSED CONTRACTOR
Contact "Underground Service Alert" At Least 48-Hours in Advance of Any Excavation at 800-422-4133
TERMS AND CONDITIONS OF ENCROACHMENT PERMIT
1 Fncroacltrnenl Permits may be taken out by the Owner of benefited property or a licensed contractor A licensed
contractor must provide a Lefler of Authorizationto allow another party to pull a permit. An approved copy of the
permit and construction plan shall be kept at the lob site at all times Work which has been done prior to issuance of
a permit is subject to relection/fine City reserves the right to void permit if work does not commence within 30 days
\
after dale of issuance
2 The Perrnlfee agrees to defend indemnify and hold the Oily. its authorized agent. officers, representatives and
employees harmless from inv rosponsibi6ly, 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
3 All work sha!! be done in accordance with the approved plans. Slarrdaal Spfacr l Provisiorr.s and Standard Drawin!ls
of the City of Newport Beach. and in compliance with all applicable State laws and City ordinances
4 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
5 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 Slate Contractor License Class C-42 is required.
6 All trenching and/or resurfacing shall conform to City Standard 105-L for parkwayiroadway and City Standard 140-L•
in the alley. where a minimum half -alley 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
7. 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 backfilling, 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.
8 All trench restoration must be inspected by the Public Works Department. No utility installation(s) shall be allowed
over or within 5 feet of any City utilities unless approved by the Public Works Department. Locate and pothole
existing City -owned utilities fie 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
4 TT box over the riser
9 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
Warning Signs. Sights and Other Devices for the Use in Performance of Work Upon Highways issued by they
California Department of Transportation If needed. barricades can be obtained from the City at a charge of S10 00
per barricade per dav, with a minimum charge of S35 00 It is the responsibility of the applicant to place barricades to
protect the general public; Access to fire hydrants most be maintained at all times
10 Work within or near beach sensitive areas will not be allowed during. City holidays, sprang break Memorial Day
weekend summer hetween June 15 and September 15 and during the holiday season from December 19 to
January 1 unless approved by the Public Works Department
I I Any work that extends into traffic: or parking lanes and impedes the normal flow of traffic requires the applicant to
acquire a 1 entporary Street Caosure Permil from the Public Works Department Access for fire. police and
emergency vehicles must be maintained at all tines Traffic Control must be per Work Area Traffic Control
Handbook (WATCH) No nighttime traffic lane closures, unless prior approval has been granted Any lane(s) 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 Slate Highways traffic or within the Slate Highway right-of-way
will require a C.altrans Pe.rmlt All vehicles shall be lawfully parked
12 This permit does riot authorize the closure Of sidewalks streets. or alleys for constriction access. storage of
materials. or parking of construction vehicles unless detailed on an attached Temporary Street Closure
13 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
14 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 days by 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 roust be. obtained from the Public Works Department.
WORKER'S COMPENSATION INSURANCE (Section 3800 Labor Code)
I certify that I have a Certificate of consent to self -insure, Certificate of Worker's
Compensation Insurance, or a Ce led Copy thereo f.
Date: ` - I1nature:--
CERTIFICATE OF EXEMPTION (Section 3800 Labor Code)
I certify that in the performance of the work under this permit, 1 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
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. 1 shall indemnify
and hold the City harmless for any liability associated with the minor
encroachments.
Date: Signature:
24-hour notice for Encroachment Permit Inspection is required by calling
Public Works at 949-644-3311.
15 Any above ground utility facilities will require documented nt,provnl from the adjacent
affected properly owner(s).
16 Homeowner, contractors. and subcontracolrs may each be liable for violations of 'V'Jawl
Quality Laws Best Management Practices will be enforced 1 is agarnsl the law to
discharge construction debris into file guller and storm drain f eloriv violation,: of VPIalcrr
Quality Laws are punishable by fines up to $25 000 andror up to llvae year:', !n Slat,
prison plus the full cost to clean up an illegal discharge or spill
17 If a refundable deposit was paid. applicant must submit a Soils Comp;v itcn
Certificate or Evidence of a Slurried Backfill and request a final Inspection from tfu:
Public Works Department. Monies may be held for six months after final inspection
before a refund will be. processed
18 No trees in the public right-of-way shalt be planted. removed. tr!rnrned. o; wlot..ded
without approval from the General Services Department.
19 All work in the public right-of-way must meet the approval of the Public 11dork•,
Department or corrections will be required (i.e. removals. exposinq connc!ctirns.
etc.). Additional inspection fees may be required.
20 Permit is for standard materials in the public. right-of-way only. unless previuuSIV
approved by Public Works and an Encroachment Agreement has been processed
21. Permit is valid for description of work noted on front only AdditionA work
performed may require issuance of a separate permit and,or additional fees
No work related to this encroachment permit shall be performed until the Public Works Department has issued this permit. Applicant hereby acknowledges helshe has read and undwstands the terms and
conditions of this permit and he/she agrees to abide by them. Permit is void if work is not commenced within 30 days after issue L
Permit fees are nonrefundable. Date: �ignature:
RECORDING RFOUESTED BY
TICOR I I FLG
ORANGE BKiA;•4CN
RECORDING REQUESTED BV:
Blue Water Escrow, Inc.
Order No. 225387
Escrow No. 14-3624-JM
Parcel No. 939-829029,—
AND WHEN RECORDED MAIL TO:
ALI KHAMSI
280 NEWPORT CENTER DRIVE, SUITE
100
NEWPORT BEACH, CA 92660
Recorded in Official Records. Orange County
Hugh Nguyen. Clerk -Recorder
11111111111111111111111111111111111111111111111111111111111111112.00
*$ R U U U 6 6 a 9 3 6/$
2014000181768 4:30 pm 05109/14
90 401 G02 3 07
643.23 643,22 0.00 0.00 6.00 0.00 0.00 0.00
AHUVE iHISLINE
GRANT DEED
T1:E UNDERSIGNED GRANTOR(S) DECLAR.c.(S) THAT DOCUMENITARY TIRANSFER TAX Is S1.286.45 and CSTY S
® computed on full value of property conveyed, or
❑ computed on full value less liens or encumbrances remaining at the time of sale.
❑ unincorporated area: Gs`� ® t (itjPs1#I* 04-4A.' P&1r+ Q4joLC
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
Frank J. Efiler, Jr., as na named man
hereby GRANT(S) to Ali Khomsi and Maureen Khamsi, Husband sad Wife as Community Property with
Right of Survivorsbip
the following described real property in the County of Orange, State of California:
PARCEL 1: An undivided %t interest in and to Lot 13, Block 742, of Corona Del Mar Tract, in the city of Newport
Beach, county of Orange, state of California, as per map recorded in Book 3, Pages 42 and 42 of Miscellaneous
Maps, in the office of the County Recorder of said county. For complete legal description see Exhibit "A" attached
hereto and made apart hereof.
Mail Tax Statement w: SAME AS ABOVE or Address Noted Below
RECORDING REQUESTED BY:
Blue Water Escrow, Inc.
Order No. 225387
Escro%% No. 14-3624-JM
Parcel No. 939-82@v29--- ( 1�
AND WIIEN RECORDED NIAILTO:
ALI KIIAMSI
280 NEWPORT CF,NTF,R DRIVE:. SUITE'
100
NEWPORT BEAUI, CA 92660
ABOVE; THIS LINT: FOR RE CORDF,R'S USE
GRANT DEED
1'Illi UNDERSIGNED GRANTOR(S) DECLARE(S) "r11AT DOCUMENTARY TRANSFER TAX IS S1,286.4.5 and CITY S
® computed on full value of property conveyed. or
❑ computed on fluff value less liens or encumbrances remaining at the time of'sale. r
❑ unincorporated area: Gi � ® 0,110,11".91 jGt* 04—UL., Pvy,
FORA VALUABLE CONSIDERATION. receipt ofwhich is hereby acknowledged.
Frank J. Effler, Jr., an unmarried man
hereby GRANT(S) to Ali Khamsi and ;Maureen Khamsi, Husband and Wife as Community Property with
Right of Survivorship
the tbllowing described real property in the County or Orange. State of California:
PARCEL 1: An undivided 1/2 interest in and to Lot 13. 13lock 742. of Corona Del N lar Tract. in the cite of Newport
Beach. county of Orange. state of California. as per map recorded in Book 3. Pages 42 and 42 of Miscellaneous
Maps. in the office of the County Recorder of'said county. For complete legal description see Exhibit "A" attached
hereto and made apart hereof'.
Mail lax Statement to: SAME AS ABOVE or Address Noted Belo%%
Date April 8, 2014
Frank J. Effler, Jr.
STATE OF CALIFORNIA }
}S.S.
COUNTY OF .u�q►� }
On QG ,�,e,Q�o! , before me, Xl Q Z/ 1 Af Aft , notary public,
personally appeared /WAAFM r,r ''L who proved to me on
the basis of satisfactory evidence to be the person whose name(4 is/ask subscribed to the within instrument and
acknowledged to me that he/sV/th9y executed the same in his/hjfr/thj01r authorized capacity(, and that by
his/hjfh/their signature() on the instrument the person( or the entity upon behalf of which the person(( acted,
executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is
true and correct.
WITNESS my hand and official seal. KIRTI I PATEL
NOTARY F'U8LIC - CALIPORNIA
z oc COMMISSION # 2004695
Signature (Seal) d t� SANTA CLAnA COUNTY
^"'' MY Comm Fzp. January 27. 2017
" IDE X 12 DEEP
ICRETE MOW
;B FLUSED WITH
CURB AND
:WALK
EXISTING
CONCRETE
�ONSTRUCT
\VERS
Pf--
EX. CURB
6" WIDE X 12" DEEP
CONCRETE MOW
CURB FLUSED WITH
EX. CURB AND
SIDEWALK
w
Q
g
w
z
O
a
WIDE X 12" DEEP
)NCRETE MOW
JRB FLUSED WITH
C. CURB AND
DEWALK
'RUCT 4"X16"
S
JSTING
WALK TO
ITHE
Ali Khamsi
713 Poinsettia Avenue
Corona Del Mar, CA, 92625
PAVERS
1" SAND
COMPACTED
SUBGRADE
PAVER SPECIFICATION:
ORCO - PLAZZO
COLLECTION - CASITA 4X12,
IN GREY COLOR
PAVERS DETAIL
6"
#4 BAR
N
CONC. MOW CURB DETAIL
* No. C74768
Exp. 12/31/17.
CIVIL._,014
_
PARKWAY IMPROVEMENT PLAN 1/4"=1'-0" 1
4/6/2017 City of Newport Beach Page 4 of 14
6:34:16AM INSP150 - Daily Inspection Request Report
Requested Inspection Date: 04/06/2017
Inspection Type: ENCROACH
Inspection Area: PW
Site Address : 713 POINSETTIA AVE
AJM1 in monfc
Activity : N2017-0043
SubType :
Status : APPROVED
OWNER: ALI AND MAUREEN KHAMSI Phone: p
ALIKHAMSI@KPFF.COM
Description : removal of existing concrete carriage walk, installation of pavers set in sand with 3 concrete
ribbons/mow strip (4" wide maximum). Maintain a minimum 5 foot tree well for existing
tree. Encroachment Agreement Required.
Item: 10100 FORMS WITH COMPACTION - PW
Requested Time: 4/6/2017 12:00:OOAM Requestor: NBIVR
3108922177
Entered By: NBIVR
Comments: AM
Assigned to:
Inspector: `�
Comments: Gf/,L! �/) ',
2` 77>L
n
Date: l `7
/ S7TJ1/147
F:\Users\PBW\SharedENCROACH\MASTERS\FORMS\InsvectorSheet.doc
REPT131
Time: 9 =0j PM
SGO��vau-
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L0�
Reflle
ry �•-c�'S �S'
WI
Run Id: 4018
411312017
•4:30:25PM
City of Newport Beach Page 2 of 9
INSP150 - Daily Inspection Request Report
Requested Inspection Date: 04/14/2017
Inspection Type: ENCROACH
Inspection Area : PW
Site Address : 713P'OINSETTIA AVE
.71 ,,y`',.,,L x�yyl.i5cu=n• ar .-.' tdp�aC a
F. i! �yi Y. M:•{Hj �i#.YM•.'LtE <xt�k7� •uL'. !.
Activity :
N2017-0043
SubType:
Status :
APPROVED
OWNER:
ALI AND MAUREEN KHAMSI Phone: 0
ALIKHAMSI@KPFF.COM
Description :
removal of existing concrete carriage walk, installation of pavers set in sand with 3 concrete
ribbons/mow strip (4" wide maximum). Maintain a minimum 5 foot tree well for existing
tree. Encroachment Agreement Required.
aft
.... lFad�i
L ?.•:•l.
......
Y':�� ds4.-i�l .�.. w 0. ?�1'�,'♦ < ... .. .1�1•�
Item:
10250 FINAL - PW
Requested Time:
4/14/2017 12:00:OOAM Requestor: NBIVR
3108922177
Entered By:
NBIVR
Comments:
AM
Assigned to: /
Inspector: Date: / Time: i 1 AM
Comments:
COMPLETED
F:\Users\PBW\Shared\ENCROACH\MASTERS\FORMS\InsoectorSheet.doc
REPT131
Run Id: 4018
4/14/2017 City of Newport Beach Page 9 of 16
6:34:27AM INSP150 - Daily Inspection Request Report
Requested Inspection Date: 04/14/2017
Inspection Type: ENCROACH
Inspection Area: PW
Site Address: 413 VIA LIDO SOLID
AM in atlOc
Activity : N2016-0340
SubType :
Status : APPROVED
OWNER: BARRY INC Phone : 0
APPLICANT: AT&T CALIFORNIA Phone : 714-618-9132
Description : Install (2) 4-inch conduits (63 LF), ground rods and new AT&T cabinet. Concrete and
pavement restoration per City Standards.
M�P(s1
Item: 10250 FINAL - PW
Requested Time: 4/14/2017 12:00:OOAM Requestor: NBIVR
Entered By: NBIVR
Comments: AM
Assigned to:
Inspector: V Date: ' / / 7 Time: 10 : Z-0 A PM
Comments:
F:\Users\PBW\Shared\ENCROACH\ MASTERS\FORMS\InsoectorSheet.doc
4/14/2017 City of Newport Beach Page 8 of 16
6:34:27AM INSPI60 - Daily Inspection Request Report
Requested Inspection Date: 04/14/2017
Inspection Type: ENCROACH
Inspection Area: PW
Site Address: 725 VIA LIDO SOLID
A1PAi I -111a ado c
Activity : N2016-0343
SubType :
Status : APPROVED
OWNER: PENCE J JEFFREY JSP Phone : 0
APPLICANT: AT&T CALIFORNIA Phone : 714-618-9132
Description : Install (2) 4-inch conduits (78 LF), ground rods, and new AT&T cabinet. Concrete and
pavement restoration per City Standards.
R�equssied inspvcdon(aj
Item: 10250 FINAL - PW
Requested Time: 4/14/2017 12:00:OOAM Requester: NBIVR
Entered By: NBIVR
Comments: AM
Assigned to:
Inspector: Y Date: Z1'f 1' Time: 0 AM M
Comments:
C 0 li -FT E D
F:\Users\PBW\Shared\ENCROACH\MASTERS\FORMS\InspectorSheet.doc