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Home My WebLink AboutBuilding Permit 03-1509 CITY OF PRIOR LAKE BUILDING PERMIT, TEMPORARY CERTIFICATE OF ZONING COMPLIANCE AND UTILITY CONNECTION PERMIT Date Rec'd See Main File] Whi<, 2. Pink 3. Yellow -- v/6S \0' dO I PERMIT NO. 03-/509 I File City Applicant (Please ~ orvrint and sign at bottom) ADDRESS '/If 3 bwPP Jlt?/c"HT5 'frr.*, L ZONING (offi" use) ?UD LEGAL DESCRIPTION (office use only) LOT? BLOCK 3 ADDITION 'f(rnBlIt W$r ~ PIDd5 -tjtJJ,.- IJ7;)'-[' OWNER (Name) ?//J..rC- IItmtES ffJ:5 MflIl/fv'LSI ?/If2t1.-WI'rj (Phone) {,5/- l)sz - 5Z00 FAi!H-1 J11 r1 ss- / Z/ (Address) BUILDER (Name) (Contact Name) (Address) S'I-m E- &127 ,'?,tA<CUXf) (Phone) (Phone) 112 -27/ - 99-Y'5 TYPE OF WORK )'itNew Construction DLower Level Finish DDeck DPorch DAddition DRe.Roofing ORe-Siding o Fireplace DAlteration DUtility Connection o Misc. PROJECT COST IV ALUE (excluding land) $ 9~ tJ9~ I hereby certifY that I have furnished information on this application which is to the best of my knowledge true and correct. I also certifY that I am the owner or authorized agent for the above-mentioned property and that all constnlction will conform to all existing state and loca1laws and will proceed in accordance with submitted plans I am aware that the budding offiCial can revoke thiS permit for Just cause Furthermore, I hereby agree that the City OffiCIal or a deSIgnee may enteruponth )rope~tope~rm?ededmspections. ./ ~ 0 / X h...p--"Zh_d../~ i5c. - /37/ /0 ~AJ 3 ~ -, ,/ Signature Contractor's License No .J11'ate I Permit Valuation 'If '7~ dt)tM}tJ I 1 Park Support Fee # $ I Permit Fee $ ~~3'. 751 1 SAC # $ IZ7S'.Oo Plan Check Fee $ 4>00.'1'11 I Water Meter QIZe 5/83'1"; 1$ Z-5;O .De State Surcharge $ LIS-DO I Pressure Reducer $ L{S. D-o 1 Penalty 1 $ I City SAC and WAC # $ I ZOo .00 I Plumbing Permit Fee 1 $ /00,00 I Water Tower Fee # $ 700.00 I Mechanical Permit Fee $ f(JI).O{) I Builder's Deposit $ Sewer & Water Permit Fee $ ~SS-.50 lather $ Gas Fireplace Permit Fee $ qO.oo I TOTAL DUE $53/"f-. t, 9 , , This Application Becomes Your Building Permit When Approved I Paid .5;0319-.1:; 7 I Rec1J4o- ;:'/,(j:J ~ ~ ~ 11/'/0:1 I Date '/lIL.01 Bv _. (J Building Official Date This is to certifY that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document ~n:~~ Ci~ Plm~::'mpomY c'roficat'of:nm~o;limce md allow, con'truroon to cSeevamatpIfemuSlb, Plmn;ng Director .Lf/t d Special Conditions. If any 24 hour notice for all inspections (952) 447-9850. fax (952) 447-4245 16200 Eagle Creek Avenue Prior Lake, MN 55372 ~ See Main File White - Building Canary - !;n9ineering ~InK -t'lann~ lhr('tnltr"fthtl..b('ounlr)' BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST , NAME OF APPLICANT APPLICATION RECEIVED I , ./ I , //)1 " """. (,) i ~" //J /' ,--1~ .I. . The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: (/ I ;' :;. . j l:;;'! ,,</l/7; (' J -~.. /' /111 I "., ~.. '. Accepted ...,--- Accepted With Corrections Denied Reviewed By: Comments: ~J~ ~~ Date: -LI ~ /d :5 "The issuance or granting of a permit or approval of plans, specifications and computations shall not be construed to be a permit for, or an approval of, any violation of any of the provisions of this code or of any other ordinance of the jurisdiction. Permits presuming to give authority to violate or cancel the provisions of this code or other ordinances of the jurisdiction shall not be valid," ~~ See Main File Th~ Crnlrr "f lhr I....r Counl!'}. r While - ~uildiiia::> '"Canary - Engineering Pink - Planning NAME OF APPLICANT BUILDING PERMIT APPLICATION DEPARTMENT CHECKLlSr (? d:ti Yf~ 10 -o<R~~~ APPLICATION RECEIVED The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: ~ G!993' AQ #. J./ ;j{;; o~.f .~ Accepted ~ Accepted With Corrections Denied ~ r ~f..- Date: / ~ I" 3 Reviewed By: Comments: "The issuance or granting of a permit or approval of plans, specifications and computations shall not be construed to be a permit for, or an approval of, any violation of any of the provisions of this code or of any other ordinance of the jurisdiction. Permits presuming to give authority to violate or cancel the provisions of this code or other ordinances of the jurisdiction shall not be valid." ~-"<;) ~~ See Main File White - Building ~'V'rv - !rnq,"eerln~ Pink - Planning Tht' ('t'nlt'r of lht' t.kt' Country BUILDING PERMIT APPLICATION DEPARTMENT CHECKlIRT NAME OF APPLICANT APPLICATION RECEIVED .-~ i i ." I 1/ if r ~ljL(l :J \ I! /~---'J ' )' f-.-J ....j ,/' /c.~-,~...< I ~ ,*';. "'r'~ /-l '. ~'.;( '~'Ir, ,...,.. /'(./ {_' ,> c./-..I The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is propo~ed at: (../9 Sf:3' /<~C~'~'~1r1;/r;; n Z1 dJ ,f Accepted ~ Accepted With Corrections Denied Reviewed By: /Wl/~ ~ C. 111c./ YI Date: / /~6L/-OJ Comments: h'l<... "The issuance or granting of a permit or approval of plans, specifications and computations shall not be construed to be a permit for, or an approval of, any violation of any of the provisions of this code or of any other ordinance of the jurisdiction. Permits presuming to give authority to violate or cancel the provisions of this code or other ordinances of the jurisdiction shall not be valid." Oct 22 03 02:05p METRO GENERAL SERVICES 763-428-2968 p.4 CIIU. . "-I. 'fELLOW . APPlICAIT GOLD - elT" CITY OF PRIOR LAKE SEWER'AND WATER PERMIT qS-lr 'I'I7-'1"J, I/.tr S.W.NQ;-3 -15'Or FAy... NOTE: Sewer and Water contractors must be registered with the city. APPLICANT: fh ~I r<J) (5 Ei'lJERFli . Sr=R.VIC-t:.OOONE: it> 3 -4--d-.'3-d,'13g "-""1 :c;\J C - ADDRESS: :;), 0 hl L/(-\r(l Ai/&- Nt:: . _ DATE:-1)rT 2. 2 2003 ~\ ----"'1'1 '~r --A:>.---, ST J'YIIC!.67-iGL,"'Y>'JIV. ~5376 SIGNATURE: fLVo_'+( "" QAV BLDG. PERMIT # SITE ADDRESS;- 4-9'13 ~ ~lPrDi.b.;~j,~Dl -FILL,' N THE BLANKS 1. Estimated length of water service 5,.., feet. 2. Size of water servica I" inch(es). 3. Location of any couplings from structure () feet. 4. Type of sewer pipe. ABS PVC L/- (I Cast Iron "-- 5. Estimated length of sewer line 5 () feet. 6. Clean out (if required), structure. located at N/~ feet from =========-----=====================~================~===~=======;== This ap~ation becomes y~ permit when approved. BY (~:::uPj)Of)---~Q.-- DATE: OCT 222003 ========jO~i~-~~~============================================= FEES: /1ld ~e.M;i- Sewer and water line connection peAmi t. ...j!a f-"..ee- ~~~~~arge ~U!!.c~~~ ~~< * Fee for either sewer or water individually is $20. 00 pius-'~"v~!'J $ .50 surcharge. * Sewer and water permits issued for new construction must be recorded ol'l..t.heb1.1i,1d.iJjl~ permit card at the time of issuance to in~ure that no dupllcate sewer and water permits are issue~. . DATE\~ArD c,' NaV) 2 2003 ~.. . . '.. AMOUNT PAID - RECEIPT i i REC'D BY 1 16200 Eagl~:Creek Av. S.B., Prior Lake, Minnesota 55372/ Ph. (Cfs2) 447-4230 / FAX (q,z) 447-4245 An Eoual ODDortunilV Emolover I'. ,,< . .;.~/.' -." , ,/' !",' .......,.. ;-' , I. . 0 _ I I . 1:: C"-.' - . - \ ~ -- ..... r -'- \i~- l l '{ G;:- ? ~ O~, l.--". .........r.. t' '- L:~\. r 3l:,' G ? c.. ~__ ~ ~ L . .....~ ~'., ~=Vi '... .... . ~., ~ ~ oJ ' ." ~:":~I: -r"':'~ "." -:':-;":= ''::': d''=: I~ ~"'\"":'::."":":: f'iJ-O ~s:s ' -;;') ;JjJ" I c!{/(jJ b/u;:r /I//(Jjrs (;- , / I , U6Ai..OE:SCRJl'7U2Ifwl.,=;,," ;~I:'I , , . Lor BuJC.iC- .A~~ rTuZtJ Or,;JrJ1iit- J) / L r;;,.."".' ,If ;-1 r j+U/tJ S A~POt.AL' f / ) /1/ /) J / 'pJa.i1" (/11 /i! U. r If) i f,Ja:.':!S-1 8'dv r!t(!2 Iti aI/if/. {A~i , C;;,rlMfi~ -,rd~J : ApfUCA}rft;[6,VA'fUrte- (J /,{ //'-J l. .--t,4_/-U.L1;1 JI.... P E: !<-.\{ iT ,;) iJ -::z./ ::---;., ,-- j I~ -zaLlf]~ -"".. ...-' ".".,_ . o~"~~... ----- -- -,- .- ~;"I - ----- (Jtt4n1tJ _ - (YltdM) 9d-'2/{/t'cJ-j'/J/. ----r-- j ,/ /:;; I ___ !o /'rfCt A, ;7 ,j -../j )./ (J:f4;) cz;:p C4'd!:) Mi<ar,<g t)g-I~J -1)/// . 1 eMS: flAt{ ; f (/!/ I I f)rJ:.:..1 c:t'": , . APPLICANT PLEA;:;!:: CDMPLETE: 8El()\V T."p~ 11f fi.t':1Jr~ I Q1l:.:r.Or:: ( e:.:.:~ fiJIJ ',\o(c11 iJr WIC~il.;U: ;:-:,;'....'-:=- I. rJ ;,'; lll]1t: r'J{ Fi.-:~'Jr:: ,,!- i I s I ! / I DIS~\I..'.:1'::'':::- I r'i\.:11r Or:lLr: I c..':'j:l~Ci': r 2;t::;:"::lJt7: ~I(-:X) i L.lur.l.:.r:. T~'." II lJr: ....::;r.;r:.:.:.r::-:-::::::c ~ii-::, I ShaWe: S c.::.J1 I Siot!<:l I c;u-Sink I'.i~,.: C:a~.' lloile:1 ? ft:.E ;SCCZD\;LS ltlcus..-::.t C:lmr.-,':::-:::.u ~ ~'~ti"Cw.iL~ [~-;at~jce C:J:;i{ ".It."1:t !:J9.JO mi"im~ a:;:iQ;,;r~~ Cl.l.:s;; S ?[.w't-C3c-fG PER..v(fT FE:::: S STATE srJRCH..1JtGE .s Tat.-u. p~~'rm FE:': S (oroce: t:',fC On'~) T~liJ AppLic.:1aoa aG:t:t1m~ Your al.liId'a~ Pt:nnit When App.roved 3uildir1V; omci2' Date ~ nlll.l.r 11IJOt.:: (Of" ~ll irupc~oQn:s; \:J:::) .,l.J.7..'):j~iJ. (:l.t l'J:5:) ~-;~:.;.J' _~;:t~:::f.~-, ,_.,.... -- K,JU.:;:i~lnS 1 I IJ..J ~:::" F:=:::.:-~:- I \l.., ~c=;'" ~J r.:-:~:- I ~c.:...:~ ~;\."': ,\,V::':;::Ir:..: :;r::'l:;~'l\;-::::) ;).:::"."':1.:;-= E;t:"''::,J1"' 3.:c:.<:hJw A.,i';::~ C ('J BOlC!C:\OW A:;s~:n~I~ T os, I l;lwn Sor.akle: I Ot.,.: - - - -- - Rdidt:':C::.l. ~o::;-.'t Cnc: J:. T"..,a..f=:n':.ii:-r S7~.~O a,::;::.:::.::::.:J.~ ,.....,.:~:=t:n:; 1.:. .""-;:;:-....:::::r..;l 'sJ"9..50 E~iit.!i~:; ?:.::;;.it.~ , ' .,J ''"'''I"''L.. . ( ~- i,J~ l' , .50 --- I ?~J<i ] O.","c:C J .., JiJc I Ro<=:,:c NO. I El:< ----- . ,-. ------ :0 ,::] '- i9226\72S6 '011 XY~ iJYGeJOf ())II g~Jn,o ,,3i,Y/I ;10 c: ,21 nH.1. 7002-62-iiYC 2- 9-04; 2:51PM; ;952 894 0925 # 3/ 4 U 1 i OF PRIOR LAKE HEATING/AIR CONDITIONING/FIREPLACE PERMIT Date Rec'd (Please,!\pe or Ilrint and si@atbottom) ADDRELf~ q 3 is I u It- /#s . ( r. ; ~:':.. ~:~ I PERMIT NO.~_~ '~N!l l. Yellow Appheant "~ ZONING (alike U>O) I~ LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID OWNER (Name) . (AddresS)g' I 5 P uJ1e f\.\v0 t-fo fY/ e. S P(w1..-\, '-' S u.:i.~ 140 . (phone) ((/5(- Y5;;l-'SJ:OO Ea4(JA; . M f\) 55 ( .:2.1 '-' APPLICANT (Name) FLUE SIZE _ ",_ uo.linn & AlC, LLC 12481 Rhode Island Ave. :;0, , . ") MI>l F;F;::\7R.1122 ~"'-"':J I. (Address) (City) _ (Zip Code) (Contact Person) ~\A-u. 'L (phone) qS;).~ ~q4-oooS APPLICANT SIGNATURE jA' \h R. C\. ~Ol:)Y\_ DATE ;). r 9 I 0 Lj U \J- . . APPLICANT PLEASE COMPLETE BELOW i;lilNEW CONSTRUCTION [] REPLACEMENT 0 AL TERA TrONS FURNACEMAKEANDMODEL '-u1I1DX G51fY1P-J,4~- DLfS FUEL Itja.;.t. 00 . "S INPUT 45; ODD OUTPUT L( (/ '-'Lj OD HEATING OR POWER PLANT (Address) (Phone) (i'@' ~;Q ;8 w' OWarm Air Plants OGravity o Mechanical ~ir Conditioning OVent. System {,Zfl (}fff- 0 7- 4; 10 f\CC-- d-- ",\D N o Steam o Hot Water o Radiation o Special Devices o Other Devices PLEASE NOTE: Air Conditioner Units Cannot Encroach into Required Side Yard Sethacks I RETURN OPENINGS TYPE OF SYSTEM FIREPLACE MAKE AND MODEL Estimated Cost $ FEE SCHEDULE I % of job cost Residential, Gas Fireplace $39.50 minimum $99.50 $64-50 5 Coo, cO J 0' Building pennit # $39.50 I [f ~J )' " ; Industrial, Commercial & Multi.Famiry Residential, Healing & Ale (New Construction) Residential, Heating Only (New Construction) , Residential, Additions & Alterations Residential. AC Only $39.50 $39,50 HEATING PERMIT FEE STATE SURCHARGE TOTAL PERMIT FEE $ $ $ \/ /\ l f PAID W- . .50 ~;b21t;J~~Mi7 (Office Use Only) Building Official Date I Paid I DfEB 1 0 20l}}-- I Receipt No. IBY '" . This Application Becomes Your Building Permit When Approved 24 hour notice ror all inspections (952) 447.9850, rax (952) 447.4245 16200 Eagle Creek Avenue, Prior Lake, MN 55372 CITY OF PRIOR LAKE HEATING/AIR CONDITIONING/FIREPLACE PERMIT Date Rec'd (Please tvDe or -orint and silro at bottom) ADDRESS ;~:,:" ~:~ I PERMIT NO.rl2.I'Ch.J J, Yellow Applicant '-4...iJ ~~ 4993 BLUFF HEIGHTS TRAIL LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION OWNER (Name PULTR HOMES (Phone) (Address) APPLICANT (Name) ALLTED FIRESIDE DBA FTRFSTDF HEARTH & HOMF (Phone) 651-633-2561 (Address) 2700 NORTH F AIRVIEW A VENUP (Address) ROSEVILLE (City) (Contact Person) BRENDA HUSTON (Phone) _651-633-2561 APPLICANT SIGNATURE BRENDA HUSTON DATE ZONING (office use) PID 55113_ (Zip Code) 2/]9/04 APPLICANT PLEASE COMPLETE BELOW xD NEW CONSTRUCTION D REPLACEMENT D ALTERATIONS FURNACE MAKE AND MODEL FUEL FLUE SIZE RETURN OPENINGS TYPE OF SYSTEM OWarm Air Plants OGravity o Mechanical DAir Conditioning OVent. System INPUT HEATING OR POWER PLANT o Steam o Hot Water o Radiation D Special Devices D Other Devices FIREPLACE MAKE AND MODEL HEAT N GLO SL-550TR-C Industrial, Commercial & Multi-Family FEE SCHEDULE I % of job cost Residential, Gas Fireplace $39.50 minimum $99.50 Residential, Additions & Alterations $64,50 Residential, AC Only Residential, Heating & Ale (New Construction) Residential, Heating Only (New Construction) Estimated Cost $ HEATING PERMIT FEE STATE SURCHARGE TOTAL PERMIT FEE OUTPUT PLEASE NOTE: Air Conditioner Units Cannot Encroach into Required Side Yard Setbacks $39,50 $39,50 $39,50 Building Permit # $ !:I"'c'l ~AWr" ~ l"iJ!!..' '(r~/:;J 8""1 $ ~::,[(\\{? D'F':;.~ ,lIT $ - ..\, (Office Use Only) This Application Becomes Your Building Permit When Approved ] Paid I ~~~ 2 4 2004 Buildinl! Official Date 24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245 Receipt'lo. By , . C- PRIOR LAKE INSPECTION RECORD SITE ADDRESS '1993 ~rF HGISH73' ~iL NATURE OF WORK NEW (:4N$"'ilJAe:r/~ USE OF BUILDING S.F: A.. PERMIT NO._ fl?-/.q')7 DATE ISSUED ~/fJ:t CONTRACTOR ~*a PHONE&IZ-U/-"'SS NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW THE PERMIT IS BY SEPARATE DOCUMENT DEPARTMENT OF See Main File BUILDING AND INSPECTION INSPECTOR DATE I FOOTING , FOUNDATION (Prior to Backfill) I I PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ROUGH - INS 0H t/W ;/U// SEWER I WATER I SEPTIC FRAMING INSULATION ELECTRICAL PLUMBING U&, Nt 3-- (-0<-1 HEATING (if required) FIREPLACE GAS LINE AIR TEST f(- )q-3 t:) , Ii'o tl '7,)-j.'C)L/ I ~ f/I.A// J ~(hJ!1 <'<, -6C/L/ , GRADING (Prior to Sodding) BUILDING tw/I ""nl ~I~I ELECTRICAL ' PLUMBING HEATING DO NOT COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED I I FINALS ,)ee ~/,~ d# VW/I I/\/V / OCCUPY UNTIL ABOVE HAS BEEN NOTICE This card must be posted near an electrical service cabinet prior to rough-in inspections and maintained until all Inspections have been approved. On buildings and additions where no service cabinet is available, card shall be placed near main entrance. h-k . Wy /0/ L-1- ]. tOLl S't;-ol..1 SIGNED FOR ALL INSPECTIONS (952) 447-9850 Ql~rfifitaf~ of @tmpanq! CITY OF PRIOR LAKE ~~parfm~nf of ~uilMng J1n$p~dion (Final Permitted D Conditional e.O, Expires _ This Certificate issued pursuant to the requirements of Section 307 of the Uniform Building Code certifying that at the time of issuance this structure was in compliance with the various ordinances of the City of Prior Lake regulating building construction or use. For the following: Use Classification SINGLE FAMILY Fire Zone Bldg. Permit No. N / ~ Zoning District 03--1509 Occupancy Type R3 Type Construction VN PUD Legal Description L6. B3. TIMBER CREST PARK Owner of Building Site Address 4993 BLUFF HEIGHTS TRAIL Contractor's Name & Addre" PUL TE HOMES, &f 5 NORTHWEST PKWY., SUITE \'40. EAGAN 55121 ROBERT D. -HUTCHINSF/~d _ City Planner_ DON RYE Date fh ~yiffi Date j DATE TIME CITY OF PRIOR LAKE INSPECTION NOTICE SCHEDULED ~-l{" -()1.1 ADDRESS qqq5 rJ ( ""fF-- 11 t., OWNER CONTR_ PHONE NO. PERMIT NO. :r -fJo'1 o FOOTING o FOUNDATION o FRAMING o INSULATION ITFINAL o SITE INSPECTION o PLUMBING RI o MECH RI o WATER HOOKUP o SEWER HOOKUP o PLUMBING FINAL o MECH FINAL o EXIGRADfFlLLING o COMPLAINT o FIREPLACE RI o FIREPLACE FINAL o GASLINE AIR TST o COMMENTS: (>) y....~ ( (l \ s..~\ ?'~J.. 4-- f\.-t-1) c.r1C"'"...Iv1I l ~ rld-/If?"""-o r I o WORK SATISFACTORY, PROCEED rf CORRECT ACTION AND PROCEED o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING Inspector: t/lY' Owner/Contr: CALL "7-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE. CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY! lNSNOTl CITY OF PRIOR LAKE INSPECTION NOTICE DATE ?fl#s/ , f'?FJ /?/-# /7;{ 'fr/ TIME SCHEDULED ADDRESS OWNER CONTR. PHONE NO. PERMIT NO. QJ~/S8? o FOOTING o FOUNDATION o FRAMING o INSULATION ...erFINAL o SITE INSPECTION o PLUMBING RI o MECH RI o WATER HOOKUP o SEWER HOOKUP o PLUMBING FINAL o MECH FINAL o EXIGRADlFlLlING o COMPLAINT o FIREPLACE RI o FIREPLACE FINAL o GASLINE AIR TST o COMMENTS: ~ / - /' ~/as-e /-------=:::::::--.... __ r )'" /r/~ ------ ~RK SATISFACTORY. PROCEED o CORRECT ACTION AND PROCEED :'::O:ECT ~OR REINS:::::::FORE COVERING CALL 447-9850 FOR TH': N':1fT INSPECTION 24 HOURS IN ADVANCE. CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY! '''''"''' DATE TIME CITY OF PRIOR LAKE INSPECTION NOTICE SCHEDULED bj r J.-7-a./ ADDRESS LJf(fr"'Y @'g INs OWNER CONTR. PHONE NO. '7, -/rtJ1 PERMIT NO. o FOOTING o FOUNDATION o FRAMING o INSULATION o FINAL o SITE INSPECTION o PLUMBING RI o MECH RI o WATER HOOKUP o LEWER HOOKUP ..ePi'LUMBING FINAL o MECH FINAL o EXIGRADIFILLlNG o COMPLAINT o FIREPLACE RI o FIREPLACE FINAL o GASLlNE AIR TST o COMMENTS: V'f vn t.l--< ~<-r?5 o WORK SATISFACTORY, PROCEED /CORRECT ACTION AND PROCEED o CORRECT WO,K, C~OR REIN5PECTION BEFORE COVERING Inspector: I vr- Owner/Contr: CALL 447-9850 FOR THF. NEXT INSPFCTION 2. H()URS IN At:lVANCE. CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY! Il'iSNOTl -- -! BIJHN~,~.L~~ Heating & Air Conditioning, L.L:C. 12481 Rhode Island Ave S, Savage, MN 55378 . 952-894-0005 \ ;' <'.\ Orstat Test Report for Job# lP t 'L (j Address '-1'1'1'3 ~rr 1-Ic16,i/75 (12. Citv ?P1o,( c.l-ll'-c Occupant Date of Install 'S - ""'" - Q '-i Type of HT. F/A Y HW Space HT Unit HT Other Make '--... 1() t06 '< Model c"s t ....d' - Z L\ fJ - OLI", --(:)1 Serial StJo'-t Ao Ll Ll'(:' Input '-I L\, C,UC' FJ"\\A '* Pilot Type HOT,$URFACE IGNITOR Pressure . "::;2:C \u.'C CO2 (.,.3 !~.~ Input CFH '4'-\ 02 "'I '1 S1ackTemp \\~ CO 1"3 PPfY) , I " Date Tested Company Technician 4- .7.8oL1 BURNSVILLE HEATING & AIR CONDITIONING \.-.sLO ", ,/\\, ',"'.; i i ~ I .,