HomeMy WebLinkAboutBuilding Permit 04-0087
CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE II
AND UTILITY CONNECTION PERMIT ~ ~ -5"'0 T
; ~i:i:' ~:;y I PERMIT NO. (j A-. 000.71
J. Yellow Applicant .., V
(Please.!VUe or mint and sign at bottom)
ADDRESS ^ ()
IL.fJ qf2> rPrpG/ffl.. \..:r12.CLEJ (~tOIL.~~ /'N ~1'7'2.
I Z1?7 (office "<oj I
LEGAL DESCRIPTION (office use only)
LOT 1 BLOCK'" ADDITION ltJ, Lf) C; iQvlZ..~
OWNER ('""'\__ --;)
(Name) ~ !/f ~
(Address)
PID..:)5- ,'/OLl-IJLj &1-D
(Phone)
~~~~)J1(rr~(...~~l>t ~ lMn/hlS ~5~G-"11~e) u~1-5"'i.~"''1IL/o
(Contact Name) ~6.J fW~ ~O, (P~) -1"L'2. - '7!l1-L
(Address) ~ol.>-z.o 'S'~ ~..u- ~~"A
FfJR./I/IJ,J /lJf;), /ItItJ - .
TYPE OF WORK
o Misc.
t.~c.
Ce-o~.
~ Construction
DLower Level Finish
j&lDeck ~S OPorch ORe-Roofing [JRe-Siding
ONc:.'( .Je
o Fireplace DAddition 01" ,ration [ JUtility Connection
PROJECT COST IV ALUE (excluding land) $ "3. q '1. o.e- 0
I hereby certify that I have furnished information on this application which is to the best of my knowledge true and correct. I also cert fy that I am the owner or
ave-mentioned property and that all construction will conform to all existing state and local laws and will pl oceed in accordance with
e that the huilding official can ,evoke this permit for just cause. Furthermore, I hereby agree that the city )~ a '1igTIee may
e,form"needed insp:ctiOns en ':1 LI t{ '5 t!) ~ '/"'O'D '1
Signature Contractor's License No. r Date
x
I Permit Valuation
I Permit Fee
I Plan Check Fee
State Surcharge
Penalty
I Plumbing Permit Fee
I Mechanical Permit Fee
I Sewer & Water Permit Fee
I Gas Fireplace Permit Fee
u
~ f'~iL()()d.l)(} I
$ 02. .,L/'7. .t:;tJ
I $ /~,5.s.W
I $ /7'/. !;O I
I $ I
I $ Jot), () 0 I
1$ IOD.('J() I
1$ .3r;.~o I
1$ J(fJ.oo I
This Application Becomes Your Building Permit When Approved
~~
Building Official
o?/33,1o if
bate
I Park Support Fee
I SAC ~
I Water Meter Size5/8"V
I Pressure Reducer
I City SAC and WAC
I Water Tower Fee
I Builder's Deposit
I Other
I TOTAL DUE (lt4.uMlJ'Z-.W.o4--;9173.3B I
.,
I Paid v-i'I]. 2;g" I ReceiptNc.'I~ <!u5'
I Date ~- J _ () U I Bv ()
, 0,
#
#
/350.00
.300.00
70.00
(2..00.Do
700. tJo
IS-oo. 0 ()
#
I
#
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
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Cer ificate of Occupancy must be
~anning~ o1~3{~71 ~ ~Cial~~~;r~
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
~~
-----
White . 6lIildinQ
(" CanarY -ll;nglneerTriij::>
Pink . Planning
Th~ C~nl..r or lh.. I.."" <:ounlr'i
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APP~ICANT
" ", ":-7-1 1, --0<- " "..
- '! 'u-c"'" 1----1-
.~" ,. /1' .- /: " .[..f' "... i I
~ .' ,-' y '.:' - ,,'
. , I-l" C_ L/,:.A_, , Y
," ........,
':c&~-
APPLICATION RECEIVED ,,--2 -~-- <:.f
The Building, Engineering, and Planning Departments have reviewed the buildi ng permit
application for construction activity which is proP9Sed at:
it.'/ I
ILI'/' ---;:f .v "tr/' >.- "/( , '
I I I ./ ",'"'-<'/r/ .
/ -,' ,_ '-0",' ,-,._/
I
Accepted
Denied
Reviewed By: IJ14 'A Date: :2 -/7-0 Zj
Comments: _c:"" RF!vp.rse Side for Additional Information!
><'
Accepted With Corrections
See Attachments: 1) Gradiug1>.l:m 2iFro~i(m rontrol Mea~llfe~
"The issuance or granting of a permit or approval of plans, specifica:ions and
computations shall not be construed to be a permit for, or an approval of, any \ iolation of
any of the provisions of this code or of any other ordinance of the jurisdictioll_ Permits
presuming to give authority to violate or cancel the provisions of this cod~ or other
ordinances of the jurisdiction shall not be valid,"
~1
White
9!''l'llV
.,- I-'n'K
. Building
. I;ngineering
. I"lannlr1b
---
Th~ Cfnlrr of lhf L.kf ('ounlfJ
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
i / / -l ((:" ,(~,~
-r
I '
l
't
_ .' 5"' _ t:_/
The Building, Engineering, and Planning Departments have reviewed the builc ing permit
, application for construction activity which is proposed at:
)l//if / !/ 1/
/
Accepted
Accepted With Corrections .....---
Denied
~
~ .-(q. dJ~
I~ aL(/
Date:
c7/d- 3/0 r
Reviewed By:
Comments:
tI
"The issuance or granting of a permit or approval of plans, specifica .ions and
computations shall not be construed to be a permit for, or an approval of, any \ iolation 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."
~~
ue~
..-wnrt.. . BuildinO
cariary . Engineering
Pink . Planning
---
Ttl~ ("~nl~r nf tllr L.Ii. Counl~
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
m~['LI ~---'
;;;.. -5'- Lf
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction a)7;~ ;h;h is Pkd~ &
/
Accepted
Accepted With Corrections
~
Denied
Reviewed By:
~
K'~
~v Date: .;Jb3~</
t1.Lf a....ce~
Comments:
"The issuance or granting of a permit or approval of plans, specifica lions and
computations shall not be construed to be a permit for, or an approval of, any "iolation of
any of the provisions of this code or of any other ordinance of the jurisdictior. Permits
presuming to give authority to violate or cancel the provisions of this cod l or other
ordinances of the jurisdiction shall not be valid."
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
{p./o.04-
(Please ~ or 'Orint and sign. at bottom)
;:;:, ~::y 1 PERMIT NI). 04 00" 7
3. Yellow Apphcant "
(Phone) _h/2-I/JS (}-i)" 0/
//Z/ M- /HKr :::;"Ss7""L
(City) (Zip Code)
(Phone) /; I ~ - tri,l') - "7 '\0 /
~~l-/
ADDRESS L a
/-rilv
.tJ'I9D4EJL-; U~
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
OWNER
(Name)
(Phone)
(Address)
APPLICANT/)
(Name) tlFnn! 1f(Jt,(;e/VIl'fl/c/
(Address) / t-/ /7 '0 I? /14 (,1'/2 L u? ( t-r
(Address)
(Contact Person) .J2F A vV
APPLICANT SIGNATURE
8tJ~g/
r. M. _
DATE
ZONING (office use)
PIDZ6: 4--04--.04e,O
- /
APPLICANT PLEASE COMPLETE BELOW
DNEW CONSTRUCTION 0 REPLACEMENT 0 AL TERA TIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUIf
04-. ()o&;7 (J f
pIYlj) oz-
<<\.Ill,.D
IP~
Date I f>a~,rO. 04- oBY tA ~
24 hour notice for all Inspections (952) 447.9850, fax (952) 447.4245 - J /;
16200 Eagle Creek Avenue, Prior Lake, MN 55372
TYPE OF SYSTEM
OWarrn Air Plants
OGravity
o Mechanical
DAir Conditioning
OVent_ System
HEATING OR POWER PLANT
o Steam
o Hot Water
o Radiation
o Special Devices
o Other Devices ~
FIREPLACE MAKE AND MODEL
Industrial, Commercial & Multi-Family
FEE SCHEDULE
1 % of job cost Residential, Gas Fireplace
$39.50 minimum
$99.50 Residential, Additions & Alterations
$64.50 Residential, AC Ooly
Residential, Heating & Ale (New Construction)
Residential, Heating Only (New Construction)
Estimated Cost $
Building Permit #
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$ -------
$ """"-:-50
$ /'
/
(Office Use Only)
~
This Application Becomes Your Building Permit When Approved
Building Official
PLE, ,SE NOTE:
Air C Jnditioner Units
Cann )1 Encroach into
Requ red Side Yard
Setba oks
$39.50
$39.50
$39_50
Recei
03/01/04 MaN 12:30 FAX 6128902753
STOCKER EXCAVATING
Id1 001
. _..I..~._._..- _.'
Date Rec'd
CITY OF PRIOR LAKE
SEWER AND WATER PERMIT
(Pkase tvp~ ororin( and sil.!ll ac bottom)
ADDRESS
14178 Badger Circle
; e:;;,."- ~~; I PERMIT NO. 04-0087
,. Gold Appli",,~\
I ZONING (om", use)
LEGAL DESCiUPTION (OtTIC' use only)
LOT 3 BLOCK 4 ADDITION Wilds North
PID
OWNER
O'a~) Mittelstaedt Brothers Construction
(Phone) 65I!3,2-4140
(Address) 2520 i51st Court_ W.. SuUe 100, Rosemount. MN 55068
(Address) (CitY)
(Zip Cod<)
APPLICANT
(Name) STOCKER EXCAVATING COMPANY, INC.
(Address) 12336 Boone Avenue. Savage, MN
(Add"')
(ContacrPerson) Curt If:--.~~ I
APPLICANT SIGNATURE ~~ .
(Phone) 952/89_0-4241
55378
(CiIy)
(Phone) __:.ame
(Zip Code)
DATE.
3-1-04
APPLICANT PLEASE COMPLETE BELOW
Si7.e of water service inches.
Location of any couplings from structure _ feet.
Type of sewer pipe. 0 ABC 0 PYC 0 Cast Iron
Estimated length of sewer line feet.
Clean o~: (if required) located at __ feet from structure.
FEE SCHEDULE
Residential sewer and water line connection $35.50 Industrial, Com'l & Multi-family 1% of job cost wit \ a $39..50 minimum
Sewer connection only $17.50 Water connection only $17.50
Estimated Cost $
Building Pennit # _.
SEWER AND WATER PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
.50"?'lj',~'J&. O~
,{. '~'I'" -:..~ V t'J .
K....~<
, . ''8f;r{;fr
(Otfice:U:\:cOnly)
This Application Becomes Your Building Permit When Approved
BlIilding omcial
I Paid
I Date
ivi~ 4Lt)U'f
24 hour no';<< for.1I inspection, (952) 447-9850.:tiX (952) 447-4245
Receip. No,
By
0-
J
Dlltt
_._.__.~_~._.._._.... w._._~,. __._._._._"~__, '_n___.__.__._~..___.__._ '_'__,"__'.'_'___ ,._.____._.~..___._~-.....-
4- 5-D4;,':27AM;
;952 894 D925
# 2/ 3
.
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
(Please type or Print and sie;n at bottom)
ADDRESS
; ;;;~, ~:~ I PERMIT NO. ,r )-.;' A
3 Y~IIDW Apphc.anl 7' Q - II
ZO .-;ING (otr", Ule)
/4/ I k
~h
~,.jJL
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
~~e~R 1h,..jJr::/r-/-or>rll HvflU<:L-/ (Phone) (oC;-I-3;;;';:'-ljIL/O
(Address) .;;S;)() -151ft c.+ tcJ kB<'O/yvnu1! fJ1/J. 5'50LPf
APPLICANT
(Namp)_
(Phone) Q..~;)- 'X9(/-OOO~;'
(Address)
Burnsville Heating & Ale. LLC
~~;;~::,O~~I~~~'2~g.
(City)
(2p Code)
(Contact Person)
(I '_
APPLICANT SIGNATURE L2Lkh
(phone)
.BJvJiYL)-)C~ DATE If-S~(Y-/
APPLICANT PLEASE COMPLETE BELOW
~EW CONSTRUCTION D REPLACEMENT [] AL TERA TlONS
FURNACE MAKE AND MODEL LO .7/11OY- (;S//17P-'IlC - 0 9 () FUEL OJ+ ~ tLs:J---'
.
FLUE SIZE RETURN OPENINGS /1( INPUT 90 (fl() OUTPUTLl fWO
TYPE OF SYSTEM HEATING OR POWER PLANT
\l
;;:;:~
:"l
"i
OWarm Air Plants
OGravity
o Mechanical
DAir Conditioning
OVen!. System
o Steam
o Hol Water
o Radiation
D Special Devices
o Other Devices
PLEASE NOTE:
Air Cond lioner Units
Cannot E: Lcroach into
Required ,ide Yard
Setbacks
I
FIREPLACE MAKE AND MODEL
Industrial, Commercial & Multi~Family
FEE SCHEDULE
1 % of job cost Residential, Gas Fireplace
$39.50 minimum
$99.50
$6450
Residential, Additions & Alterations
Residential, AC Only
$39.50
$39.50
$39.50
";E::i
~I'!
i~,H
I
It/~:\
Residential, Heating & NC (New Construction)
Residential, Heating Only (New Construction)
Estimated Cost $
Building Permit #
.~ / B~~
$ x..50 It ~V-
y " '.
j pald--------L_;~eijll-N<l.. ~ I
I Da~PR 0 6 2004 ' I \BY u=
.. = V
24 hour ~:~~~ ~:g~~1 ~:.:c~~::~:~~ri~:t.~~. ~~ ~::;2447-424S J
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
(Omet USt Only)
This Application Becomes Your Building Permit When Approved
Building Official
Dale
Jun 10 04 07:07a Emil~ Radant
08/1Q/01 WED 15:48 FAX 61Z447t24~ ~... -.
651-451-4809
p.l
CITY OF P1::;10& LAKE PLUMBING PERMIT
Date Ree'.
I
t:. :;' I PERMIT t'JO. ;""":,,,.~
J.~~"""-" -,OJ
ltleue tme or eItat....... atbolb:lm)
iJ.,..~
rL{17~B~)4:Lg_L.{;J<. PaM 40-
J
I ZONING (........)
LEGALDBS\..N.ruv.iCollioo........l . t-I"~-"l'~ '.
LOT 3 BLOCK '--l Av"u....," \hf, W', \ (\ S i j) Ar\ c\; + \(~ \'l'PJD
~':.::e';'lYY,-\.ff'k.\nFrlt '(2}(ht~t'C:J KY\,;-\i:u,fIlIYl\l.nc {PhotV:.)(z[J-?, L?~-"tNO
(Acldress) 2..5 2J\ -~ ,i-l \ ':>.1 (''''^ r.-.:.L...b!.('r~ ~i-ipi CD ~.)J11ill,l;-d /!tiN tt~
~~~r\~\TrlO fJ\II~.8fCL-1;~
(Add!a!) :)71~ t\ l",t"f'I m'll!.!:...
(Address)
{CDllw:tPenon} .l3PIl :f::(lA ("d. ___
APPllCANT SIGNATURE _9- CL( ~~
~ ---,.._-
. -r~(, (phone) i n"'J I - '-\ xh - \ 1 q c::::
H :1\-ii 11 '\ <:;, . t:}:Jl1 C)\(,'2,3
..J (City) (z;p Code)
(Fbone) I n\l ~ "7 q 5 -lip 7\
_DAn ~IL3 jo'1
APPLICJ.l'T PLEASE COMPUTE BELOW
QaalltiW I Type or Fin....
:). Bath Tub wilh or withoutsh "... ,r
\ Dishwasher
\ Floor 0nIi1l
ir. '-/ I Lavak)i-y (Batbroam Sink)
II I ~=s:':'iy(l or2comll..tr'''l1tsm:,
I I siai<s
t- I Bar S'mk
-:!Ii ,1 I \vii... Closet (Toilet)
I
I
I
I
I
I
I
I
f
i
I
QaaD1!ty I Typeorr;_._..
'~ Rau"lI-inB
I I Watolr Heater
D I Wmr Softncr
\ I Stand Pi!", (WBSbing MAchine)
(') 1 Sewsee aiCC1XlT .
,,.' T-I Bacldiow'AsSembly
- J~ r, I Bac~ow A""embly,Test
f I Lawn Sp:r,izcl::l=r
() [Other
FEE S...:....... ",..E
Indu:milll.c'. "'" ~,..-IllAMutti-&mily 1IlW.ofjob.:(:,~'i'!b.fl S39.50mmimuDa.
"I.... ('oJ
EslimallodCoot s~..:::/OOO'-
IlI:sitknUal, Nr;w One &. Two-Pamily $99.SO
RE3i_.Additio..&^II....~ .$39.50
B1likliDc Permit"
PLUME: ING PERMIT FEE S
STATE'URCHARGE $ .50
(OIIIalJ..o.I1l TOT,'J:' J'IlJRMlTFJ:E S f1r1t P~D~ .
nisA., i.-.. :.._....\'o.rB.lldiD&:::.='.~W1t. .',,' 'nn' (~mnn ~~iIi
.....,........., D... . rfrJUN J 5 ZM4 ml ~
24l.....Um r., ,\H._.. (95J) 447. ~ IlIS1) ..7-t24.5.'!J U
--------..,.......-....-..-
By
PRIOR LAKE
INSPECTION RECORD
SITE ADDRESS -'.9 I "8
NATURE OF WORK AJ..E..p.) (: A NSr-,.4.U c:tLO~
USE OF BUILDING ~.t:\ D.
PERMIT NO. 01-.000'1 DATE ISSUED al'l~/c 1/
CONTRACTOR MITt€"PT-" o,-~('. CO~'t. PHONE'~ ...JJ2 ..ah"fo
NOTE: THIS IS NOT A PERMIT FOR ANIOF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE D~CUMENT
DEPARTMENT OF
BUILDING AND INSPECTION
-.. IN..SPECTOR
U1h
I FOUNDATION (Prior to Backfill) I tIS I ~-/7
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
t!4> ~~./;
r?IJ
fig ,S'. I ~ !!lIP
DATE
I FOOTING
I ~-JD
SEWER I WATER I SEPTIC
FRAMING
INSULATION
ELECTRICAL
PLUMBING
HEt.T!NG (if required)
FIREPLACE /J~
GASLlNEAIRTEST ~(~ III)
COVER NO WORK UNTIL AB.:o-VE HAS BEEN SIGNED
I/..ATHf/ CUt.~ mtJG I rb Vc-'::> I
FINALS
Nt
l}- '7-t)f/
6/- /1./0'..1
.
((IJ
(m
L/', -Gf/
0/-7
GRADING (Prior to Sodding)
BUILDING1~ ~ ~-(-6f
ELECTRICAL .
PLUMBING
HEATING
DO NC7 OCCUPY UNTIL ABOVE HAS BEEN SIGNED
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.
~
/()-l(-oy
///f/ay
lUe t!: b
Y6
FOR ALL INSPECTIONS (952) 447-9850
------- ---------------- --
-- -----~-~-- ---------------
m:rrfifirztfr of @rtupanrl!
CITY OF PRIOR LAKE
~tparfmtnf of ~uilMng c3JnsJltdion
%Final Permitted D Conditional CO. Expire~
This Certificate issued pursuant to the requirements of Section 110 of the 0 Residential! 0 International
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:
SINGLE FAMILY 04-0087
Use Classification Bldg. Permit No,
Occupancy Type
VN
Type Constructil'^
D, B4, THE WILDS NORTH
R3
Zoning District
Rl
Legal Description
Owner of BuildirH!
Site Address
14178 BADGER CIRCLE
MITTELSTAEDT BROS., 2520 151ST CT. W., FARMINGTON 55068
Contractor's Name & Address r..
ROBERT D. HUTCHINS H/! DON RYE
/0,,) City Planner
Date: //0rfficial Date:
OA. TE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
J..]()-.'f
,
OWNER
i'-1l7~ ~ r elf
CONTR. A1,.II~/slr.ul1- 1/1Dj.
PERMIT NO. :94- & '1
ADDRESS
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
~~NSULATlON
".....FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
~~ILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
COMMENTS:
(-,/(uh - t9 ~
LVII b ~f.;, (') 1/ -/'
~RK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR RElNSPECTION BEFORE COVERING
Insped.O~. - Owner/Contr:
CALL 447-9850 FOR THE: N'=1(T INSPECTION 24 HOURS IN ADVANCE_
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
I"",""
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
/~?t>' ~~er
CONTR'
OWNER
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
~L
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
COMMENTS:
DATE TIME
/~/o/
Cr
&?,,-- ? 7
o EXIGRADlFILLING
o COMPLAINT
o FIREPLACE Rl
o FIREPLACE FINAL
o GASLINE AIR TST
o
I
, \~A 7' 7/--ee.s
//7" ~ / /e../
/;?'/ t/;:'n/
/ C
- / I /
/4-/oCqTZ""d.
...........,
/--r A"i /
- -'
OK-
~_.. --
;;~ ~
~;.\~--~/
AORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CAL7~}REINSPECTION BEFORE COVERING
Inspector: ft~ Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
INSNOTl
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY/
BVRNSVILLE
Heating & Air Conditioning, L.L.C.
12481 Rhode Island Ave S, Savage, MN 55378.952-894.0005
I
)
Ors1at Test Report for Job# &1'8 '?,
Address-L11 1(, (;:>Y1'r~'f r (',,' r City ~,6, ~
Occupant
Date of Inslall
Type of HT. F/A v--- HW Space HT Unit HT
Other
Make L n .Yi(lrJX)
Model ~S-I/I1P' 'IF<'/' / CJ::in-D;;1.
Serial 59odc.8../ "D?c:D
Input ~ OC>O
,
Pilot Type
Pressure
Input CFH
Stack Temp
HOT SURFACE IGNITOR
----
7" ~ C02
'lCC 02
J O<l i:> CO
(",,~-%
Cf.8 %
071 'Pr
.
Date Tested
Company
Technician
,
~/; 10,-/
I ,
BURNSVILLE HEATING & AIR CONDITIONING
&~
7