HomeMy WebLinkAbout2002-04-29 Certification of Building Elevations 6512751541
FROM :STILLWATER FORD L M FAX NO. :6512751541 'Npr. 23 2002 11:05AM P1
CITY OF 7Ab - 00/z /14K
OAK PARK HEIGHTS
.
14108 N.57th Street•Box 2007-Oak Park Heights,MN 55082•Phone:(612)439-4439•FAX 439-0374
CERTIFICATION OF BUILDING ELEVATIONS
THIS DOCUMENT MUST BE SUBMITTED TO THE CITY BUILDING DEPARTMENT
UPON COMPLETION OF ALL FOUNDATION WALLS AND PRIOR T Y FURTHER
CONSTRUCTION TO THE STRUCTURE. O
CONTRACTOR'S NAME: 11
ADDRESS: APR
CITY: STATE/ZIP
PHONE NUMBER: CM OP MK PARK-HEIGHTS
NAME OF SUBDIVISION: 2,+X F3fR K STrfT�d,U
LOT: / BLOCK: /
STREET ADDRESS:
I HEREBY CERTIFY,THAT ON 4 -2L/--az I CONDUCTED AN ON-SITE SURVEY
AND INSPECTION AT THE ABOVE REFERENCED LOCATION. I FURTHER VERIFY
THAT THE AS-BUILT ELEVATIONS OF THE BUILDING ARE IN ACCORDANCE WITH
THE SURVEY SUBMITTED WITH THE BUILDING APPLICATION AND AS APPROVED
BY THE CITY ENGINEER. ANY DISCREPANCIES FROM TH.E ORIGINAL SURVEY
ARE SHOWN AND LABELED ON THE AS-BUILT CERTIFICATE OF SURVEY.
SURVEYING COMPANY:/IWIR d 1 4*'/>StR Iib)JM Z.:4/6"/..--4.-/t I.'"",A'
ADDRESS: 12. `4Sr <d�R.TY Rb I
CITY:-/TTG DA STATE/ZIP
PHONE NUMBER: 6-1- 77/
PRINTED/TYPED NAME(Reg a d Surveyor) , c //• L D P / z• I /)4/
MINNESOTA STATE REGIS IO • -7 I 605-
SURVEYOR'S
SURVEYOR'S SIGNATURE:
NOTE:Attach a copy of the Certificate of Survey showing
all approved elevations and all revised as-built elevations.
Locate adjacent buildings and show their as-built elevations.
Tree City U.S.A.