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Home My WebLink AboutBuilding Permit 04-0705 CITY OF PRIOR LAKE BUILDING PERMIT, TEMPORARY CERTIFICATE OF ZONING COMPLIANCE AND UTILITY CONNECTION PERMIT Main File q?lease ..!VDe or Drint and si5!J1 at bottom) ADI?~SS () 11~sq f'y,pr+rAA_ ~rl"L~~' Date Rec' d b-/7-tf I PERMIT NO. Q4-.D70sl I.White File 2. Pink City 3. Yellow Applicant LEGAL DESCRIPTION (office use only) LOT 't BLOCK I ADDITION ~.f{ll. l ttJV OWNER (Name) (Address) BUILDER 1\ 0 ~ (Name) J'f\ . --I-VLC . (Contact Name2 -fiz,rr'l- (Address) ~~rf{[~'1€~)tgtOV , , ~ew Construction OLower Level Finish TYPE OF WORK I I ZON~G~ffine) I PID zr. 401.(J() S ,0 (Phone) (Phone) Vlo~4gS/1~?'? (Phone) q5Z-U~-r~?tf ODed< OPorch ORe-Roofing o Misc. 1.,(2.... c., o Fireplace OAddition OAlteration PROJECTCOST/YALUE (excluding land) $ /~7IffJS . 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-menti ed property and that all construction will conform to all existing state and local laws and will proceed in accordance with submi lans I am aware t cia! can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may ;ter on p. openyto perfo 'ons. ~O{)FJ6"1 ---1/1' f/tJ-pr I Contractor's License No. Date' I _ I Permit V'al~on # /~ / dO 0 , DtJ I Permit Fee $ '/Z9Q . ,5"~ I Plan Check Fee $ l?'I~, &,2. I State Surcharge $? tJ. ~ 0 IP~al~ $ I Plumbing Permit Fee $ I Mechanical Permit Fee $ I Sewer & Water Permit Fee $ I Gas Fireplace Permit Fee $ !oo.tlO IO(),80 :3S"". >() Lf~. ()O ~:n.Be;~~p;;:;z;ed Building Official ' Date I Park Support Fee I SAC I WaterMeterlSize5~1"; I Pressure Reducer- I City SAC and WAC Water Tower Fee # # # # ORe-Siding OUtility Connection $ $ /3'50.00 $ '2SC.t) () $ 4~..fjO $ I Z/JO. f) () $ 10D .00 $ '5"00,00 $ $ '1,535, /8 ~7.~7" 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 ::e;/gned by th, City Jo:~tes ~emporary Certificate of Zoning jmpu.r.c, and allzction tn commence. B;i:zefore occupancy, a CertiJkate ofO;;upancy most be ~.A I'f), ~ 2..1/00{ J. a..Lf' _ _._ ~.. J Planning Director ~te Special Conditi , "if any 24 hour notice Cor all inspections (952) 447-9850, Cax (952) 447-4245 16200 Eagle Creek Avenue Prior Lake, MN 55372 / Builder's Deposit I Other I TOTAL DUE , /"\ I Rec~pJ;;No. Bvr r I Paid 7L,J }.r.(r I Date 7 '1 () Ai ~ Main File ~t.. . RulI1fina An. _ I=nolnAArlna) Pink . Planning TttrCtoltror...# (.....Co.nlry BUILDING PERIIIIIT APPLICATION DEfARTMENT CHECKLIST NAME OF APPLICANT APPLICATION RECEIVED D. k !'l-C1CrUIJ (.,r 17 .OJ--' The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: -/ <4--51 DU:;i triaD Vle_ Accepted )( Accepted With Corrections Denied Reviewed By: 1Yi'ff) Date: 7, I-oy Comments: See Reverse Sid!'! fnr Additinn~1 Infnrm~tinnl , . 1!Jt;,,'it ~,' I ( ~ee Attachments: 1) Gradine Plan, 2) Erosion Control Measures "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." ,. ~~ Main File White - Building ~n"qt - ~2.~neering 1.._ nln~ ThO' ('..nln of Ih..I..k.. Counlry B.UlIrDING PERMIT APPLICATION DEPAflTMENT CHECKLIST NAME OF APPLICANT APPLICATION RECEIVED D,L flel/Telv (, ",(.,V The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: -I 4- S'l I)Ql L r 1[..\..../ ) I) Ie- Accepted Accepted With Corrections /' .. Denied Reviewed By: Comments: ~ , , ,.. ~ ~ Date: ~,ef o.....U ~ v .-h..'/~ ....k;"',.~ 71ft-lorl I . <.........-... .. "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." Main File ~it.. - ~~i1diiiS) Canary - Engineering Pink - Planning Th..Oml..r<lflhpl._k..<.'ounlry BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT D, Q - fiVrz;rvr\J Co . , 7 .0 V APPLICATION RECEIVED The Building, Engineering, and Planning Departments have reviewed the building pennit application for construction activity which is proposed at: (I 4--5'1 ro-t:8YWtel)) 1? k..-- _ Accepted Accepted With Corrections /' Denied ~~. ::;;~~ Date: ~V()V _~.~ 4.L/ ~, 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. Pennits presuming to give authority to violate or cancel the provisions of this code or other ordinances of the jurisdiction shall not be valid," JUN. 24. 2004 1: 20PM GENZ RYAN SERVICE NO. 515 P. 8 Date Rec'd CITY,OF PRIOR LAKE SEWER AND WATER PERMIT trio... r1i.e orllrintand.imltbotlOm) ADDImSt1~PjC1. buJe-.{j e{cl D1e..S& :: =. ~~ I uKll'ilT NO.M. 1Y'IIJ5 :I. Glhl ^,p111lUl1 u::J..a.IL.-IM ZONING (ollie....) LEGAL DESCRlPTION (ome. use only) . LOT ~ BLOCK I ADDmON b.e.e.RPJ' etcl / 1-/11 PID OWNER (Name) 1)1 l:l~rtgR ~;]lt9m ROlla: (Addre'SS) 2o&tJO ~1O~\Dbe. Cr Sn-.I1V"\ (Addnllll (Phone) _ o/.;J2. .q~-1.81Jf' La.u.~ille... Ifj~U (City) (Zip Code) APPUCANT (Name' Genz-Rvan Plumb1n~ & Heating (Phone) . 651-423-1144 (Address) 14745 So Robert Trail Roaemount. MN 55068 11/ ~~~ ~. S. (CIty) (Zip Code) (Contac[ Person). ~.jL1I(..J.J 'i1 t h ()-n (phone) 651-423-1144. I '~.ICANT SIGNATURE X j f;f.J~P ../""hATE (1)- 6U(~1JLI APPLICANT PLEASE COMPLETE BELOW Size of water service inches. Location ofany couplings from structure' feet. Type of sewer pipe. D ABC D PVC D Cast Iron Estimated length of sewer line feet.' Clean out (if required) located at feet from structure. FEE SCHEDULE Residential sewer and water line cODl1ectlon $35.50 Industrial, Com'l ill. Multi-family 1 % of job cOlt with a $39.50 minim1lll1 Sewer conneetion only $17.50 Water connection only $17.50 Estimated Cost $ Building Permit 1# SEWER AND WATERPE:RMlTFEE . $ STATE SURCHARGE $ . TOTAL PERMIT FEE $ .50 CZABZJ ViI"J1'A r.:>U:mil\~ R':"'"r1t t::.. ~...,.I"";" lam.. Il,. Only) In.. Application B..omea Your BuUding Permit WheJ\ Approved , ~- Bul1dln~ Offid,1 Ill.. ].~ rJl ~ 0 ~ ill K...iptNo. I I 0IUl 1 "lUU4 ~I By I /. I 24 hour noli.. for ,II in.p.etton. (9S2) 4 liMO tn (%2\ dd7-'2M; ... . . '., . ' . .' ,- , . , " .",-:;;,-'.'-.:--,- ""\"'-"'';-''-/ . '~ ",. , . '. ",', .~1t'~~~tJ .' ., " ,. .'.. ".:",;:,>~,:.":;":, :.'.:' '. . . . ..~~::~~~~,~: 'Q~ D R HORTON ".&i1ft1iQ\,--, 20860 KENBRIDGE CT i;,}j~~~ LAKEVILLE, MN 55044 '~~~:~~":~~~i.,~~~.m__~_ _ _C" :. , :' >,'" \"'~".'.\!X!:&{,lMi1Pi'j;.\';\)!!.;i'ALLlANT MECHANICAL WC ..J 1~:"i~~,~;;\~;:J';.':t'0'~{:;;;;~~~~1,;?~~;;3650 KENNEBEC DR . "(X~ .' .....,...,..,J.,..""",...,..EAGAN MN 55122 ...... ~S!!~;~52:m5 ........ KO-~';;;..,.,jt'..".... F'?'"k~,n'.. .mJl;t~:~t~W~~,;"..~....jfaltiht {- ~~"~"D~TE.,..~~~...,,,,.,,,,,,,.,,,,,,,,W . ..",~?.:,:;..),,;t:'.'ii';'i:.'i.;~,;;i~~\il~ft%;~1j~:il~.€~.PLEi\Sl,:t~j~til~w';'i;:jjt.m:;t(l?t;;.):".j::Lj'i~~!;(jf:;~'~,);!."'..'....' FEt1W$~.""'" ..S.,.."" "'''(~QPENlNGS S .........,.,~..CJOA6>a......OU..,V."..~il,:~~.. . .' .' .' ..... ..' CITYOFPRIORtm '. -{F'l900 HEA:.irNG/MR CONDITIONINGiFiREPLACE PERMIT .' ....-,;---..-.'. :.-.,-. '-" . Date Rec'd .'lJtlJe "SE . .' .' '.".... . '~'......:... I'PERMlTNO,"L'..~!JII.5" , :~.Z:;icant _ .-'.:>.' h;:':'",,-:,,-,_,U~:.~ .. -' . . .;: : "", >--',..', '.' :. '."' ,:~~;:.::;:-,,:;:,~::,;,,: '.. '::", ... .. ZONijl~~,iiilo). . . -:,., ,. ).-'. .. .~, " . . .PID.. ','" , "-",,,-, " -:'-"",... : '. ;,: :--~..: '~~~""""- :::::3~iLJ . Residential, Heatiilg 0\11)' (N~C?~<;tion) .j\V~' .. . : ',~:., -- ,\". ..''-, ",--,-:':".'.:';".;';'-d,.l";' . , '. . ",:;." . ',;-, :'.::-;:':' :.~:;.'- ;.'. '., '- . FEE 8.-BJ!.",l.JWj:,>' ................;. '. .. I % of job coSlRes(<l~lial; Gas Firepla.cC $39.50 minimum ' . ...,y.:..o,,-,.... '. $99.50 Rhsidtntial.Addilion. &: AJtCritioni · $64.50 RCsideniilli, AC only . Building Permit # " :,',.c, '-'.;,..-,' ":, "~~'~' $39.5& . .~9jO , ,,'" "~tedCoSl $ HEATING PERMiT FEE STATE SURCHARGE TOTAL PERMIT FEE $ $ $ . '. 'P~::J~1iJ1'rr .... .50 eu. '~"M~.!i>6 'f"'l-~^,,~. WWr,':iiil~'r4:~i.~~ljjij L' (ome.u.. Only) . . . '~iJAPPlication Bec.o.mesvour Building Permit When Approved 111}i'. i~ 0 \YJ ~ l' By . . Building OfI\eial. ..' . Dat.. . . m .!Mt 1 6 2004. . , Receipt No. . .' .'24hour notice Cor alllnspettioDS (952)' fiy91J5O' Cax(952) 447-4245 JUN. 24. 2004 1 :20PM GENZ RYAN SERVICl NO, 515 p, 9 Date Rec'd CITY OF ,PRIOR LAKE PLUMBlNG PERMIT ~...ltpt or llriIIrllld nl!llll bottom) ADDRBSS .' . ~ '~f7'e1a. t ~ ~ ~:~ , PERMIT NO.~ O-.nc: . 3, YII5Iw "'pIiClllt ; v-. . ~ LEGAL DESCRIPTION (c&e we OIlly) LOT l BLOCK I AJ.i!J1 uON b4e.SS D.u1€.,(1' e feC I t fh ZONDllG (oJIIce ...) PID OWNER (Name) DR Horton CUBtOl1l Homes (Address) ':ZO~ll7D KeI1B~IMe.. CT S,e.ltJO (Phone) %2-Q'ifFi --1'3DD Lt.l.Ju-II;II~ lUN E60l../u APPLICANT (N8me) Qt~",-1)j~P- 'D1"mbiT'8 L Ui!!I r1t-Ut3 ~one) ~~l_~'~_tl~~ (Address) 14745 So Robert Trail ll.osemount MN 55068 (Address) (City) (Zip Code) (Contact Person). 0J~!6s-h ffi! I 5' ~. (Phone) 651-423-1144 r ( APPLICANTSIGNATORE (111 h~) -+eu'L:() DATE lpf,i(4/ Oil L""'1 ~'. APPLICANT PLEASE COMPLETE BELOW I Quantity I :J.. I I I I I ,~ I I I I I ;;.. I Type 01 Fixture Bath Tub with or without shower I Dishwasher I Floor Drain 1 Lavatory (Bathroom Sink) I LaundIy Tray (lor 2 compartment sink I Shower Stall I Sinks I Bar Sink I Water Closet (TOilet) Quantity L1 I '. 12-']:. I TYI'e of Fixture Rough-ins Wa~r Heater I Water Soflner I Stand Pipe (Washing Machine) I Sewage Ejector I BlII'kflow Assembly I Bacldlow Assembly Test I Lawn Sllrinkler . I Other FEE SCHEDULE JndllSltial. Commercial & Mulli-l"mily 1% of job coSt wilb. $39.~0 minillllUll Rcsiclcntial. New Ona & Two.Pamily $99.50 Reticlenti.l. ArtditiOlll &. Alterations $39.50 Estimated Cosl S Building Pe~it # PLUMBING PERMIT FEE $ STATE SURCHARGE $ TOTAL PERMIT FEE $ .". ' PAED ~.,';J1J.. J 1. ,so- u-mc@JS p~~j~J'I".~ ' L:;:;~-.JJ_.; (om.. u.. Onl~) I Thil Application Becomes YDur Building Penult When Approved BuUd;.~ om.1I1 Da.. .~' ~ 0 fJ] ~ freiPI No. !l~a~UL 1 6 2004 I~ ~ %4 hour nott.. tor aU Inlp.otlolll ~5%) 447. 1!l\Il. Ii. C9S2) 447-4245 CITY OF PRIOR LAKE HEATING/AIR CONDITIONING/FIREPLACE PERMIT Date Rec'd :~ ~. I PERMIT NO.AL ,.,.,o~ 3. Yellow Applicant ~.. ~ ~ ~ Dr mint and sian atbottoml ADDRESS ZONING (office use) 17459 DEERFIELD DRIVE S.E. LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID Vt1'l''t..na. (Name 0 R HORTON (Phone) (Address) APPLICANT (Name) AT T TED FIRESIDE DBA FTRJ'.~lDE HEARTH & HOMR (phone) /;51-/;33-25/;1 (Address) 2700NORTHFAIRVIEW AVENTlF (Address) (Contact Person) IIRENDA HUSTON ROSEVILLE (City) (phone) _651-633-256] 55I13_ (Zip Code) APPLICANT SIGNATURE BRFNIlA HUSTON DATE 9/22/04 APPLICANT PLEASE COMPLETE BELOW xD NEW CONSTRUCTION D REPLACEMENT D ALTERATIONS FURNACE MAKE AND MODEL FUEL FLUE SIZE RETURN OPENINGS INPUT OUTPUT TYPE OF SYSTEM HEATING OR Pu \1' J>... PLANT OWarm Air Plants 0 Steam OGr.vity 0 Hot Water o Mechanical 0 Radiation OAir Conditioning 0 Special Devices OVen!. System 0 Other Devices PLEASE NOTE: Air Conditioner Units Cannot Encroach into Required Side Yard Setbacks FIREPLACE MAKE AND MODEL HEATN GLO SL-750TR-D Industrial, Commercial & Multi-Fantily FEE SCHEDULE 1% of job cost Residential, Gas Fireplace $39.50 minimum $99.50 Residential, Additions & Alterations $64.50 Residential, AC Only $39.50 Residential, Heating & NC (New Construction) Residential, Heating Only (New Construction) $39.50 $39.50 Estimated Cost $ HEATING PERMIT FEE STATE SURCHARGE TOTAL PERMIT FEE Building Permit # $ $ $ tL._'. '.' ir)~'"' . j ;jJ;'l-;'J Li[",,)' ,:.~ 1"jI Dlm.nlNGPERMfr .50 (Office Us. Only) This Application Becomes Your Building Permit When Approved BuUdiol: OfIlcial Date . -~} m ~i~ u; U \!J 11 "]\\ Receipt No. lID D~p 2 9 2004 )~ By 24 hour notice for all inspections (952) 44'. .9850, fn (952) 447-4245 By ...- PRIOR LAKE PePARTMENTOF Main File BUILDING AND INSPECTION INSPECTION RECORD SITE ADDRESS .1'1 "~9 /)t-c/ZF)~~ I!f!.UII ftG:; NATURE OF WORK ~~ C4~ r~ft:f7A11 USE OF BUILDING s.~Jt.. . PERMIT NO. fJ4. 07 OS- DATE ISSUED ~ CONTRACTOR .Petl. ,...,.,,~ PH6NE!Si.'~-/.7~ NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW THE PERMIT IS BY SEPARATE DOCUMENT 'INSPECTOR DATE r . I FOOTING I //q(. I j1 /1"1'1'. , FOUNDATION (Prior to Backfill) h.!rmYtUq// "4 I ff4}:;f PLACE NO CONCRETe UNTIL ABOVE HAS BEEN SIGNED ROUGH - INS I I SEWER I WATER 1 SEPTIC JftP- tY//~/-r FRAMING ~ ~~V INSULATION ~ /r;;/oy' ELECTRICAL . f . I / ,/t:'/ l/ Ic4 PLUMBING {/.6. H-f .,fjz(j()"I' ~~ /,,;/,Y'lor; HEATING (If required) .~ /d6-~,I" FIREPLACE ';/ ~ /.,.4-.h~ GAS LINE AIR TEST~;' ;-;:; ~ /tf)/5~7' COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED I,. . J j I I ~r:''',~(Vell~ unl",,~/..,. FINALS GRADING (Prior to Sodding) /1/8 BUILDING ELECTRICAL PLUMBING HEATING DO NOT /1. I r. /) 4- . I ~ /~/I~/N ,., ., ,/~~fiJ v1fr~ 1l1'1~ ~ ;~~;;~ 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. FOR ALL INSPECTIONS (952) 447-9850 dlnfifitaft nf (@ttupatttll CITY OF PRIOR LAKE ~eparfmenf of ~uilMng Jlnspedion final Permitted D Conditional C.O. Expires. This Certificate issued pursuant to the requirements of Section 110 of the 0 Residential I 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 04-0705 Use Classification Bldg. Permit No. R3 VN Zoning Distrirf R2 Occupancy Type Type Construction. LB, B1. DEERFIELD 11TH Legal Description Owner of Building Site Address Contractor's Name & AddressD. R. HORTO$N .~2086~ KENBRIDGE ROBERT D. HUTCHINS ~ City Planner. Dare: ~//~~r& Dare: 17459 DEERFIELD DRIVE S.E. COURT, SUITE 100, LAKEVILLE 5504. IJIIlIlERDNSIER \,' r;'.;IIIiI....,'.",.,." ~ ' ,..,'" -'Iii\ii.i ~ DATE THlE CITY OF PRIOR LAKE . ~L~ ) L INSPECTION NOTICE SCHEDULED /4fl7ur ADDRESS //~.5,':'-9 ,4c;-/!vl /Jr OWNER CONTR. PHONE NO. PERMIT NO. d'L/ - 7a..~ D FOOTING D PLUMBING RI D EXlGRADlFIWNG D FOUNDATION D MECH RI D COMPLAINT D FRAMING [] WATER HOOKUP [] FIREPLACE RI D INSULATION [] SEWER HOOKUP .HFIREPLACE FINAL )iHlfiAL [] PLUMBING FINAL [] GASUNE AIR TST D SITE INSPECTION ~CH FINAL [] CQIIIMEfJlTS: f -- " d' - , ~lcc /fie.. ~.k~ / ~e.. // // b,Asy' __.l ____ h>:'~d,. ~C~. /7149/ . 61.<< / '~'l~A.:.... r-a~.~/d - / fl. d7.e>~_~r r;; ~g .ac # 4....L!'r!'.v"'-) c?..r.r_:I- 7~<" r- ~RK SATISFACTORY ;ROCEED D CORRECT ACTION AND PROCEED [] CORRECT WORK, ;A;:F~ REINSPECTION BEFORE CdVERlNG Inspector: ~___ OwnerlContr: CALL "7.9850 FOR THE NEXT INSPECTION 2A HOURS IN ADVANCE. ~ /,/:cdS~ '-.::-. h'~.1 UC{ -- - ---- .A" / _______" h/~ ./ ----- CODE REQUlREMEN'TS ARE FOR YOUR PERSONAL HEALTH'" SAFETYI -. DATE nilE CITY OF PRIOR LAKE INSPECTION NOTICE SCHEDULED /I-tt'fll/ ADDRESS /7lf G! fk~!<l D- OWNER CONTR. PHONE NO. PERMIT NO. 4-7a~ D FOOTING D FOUNDATION D FRAMING D INSULATION D FINAL D SITE INSPECTION D PLUMBING RI D MECH RI D WATER HOOKUP D ...sEWER HOOKUP 'PLUMBING FINAL D MECH FINAL D EXIGRADlFILLING D COMPLAINT D FIREPLACE RI D FIREPLACE FINAL D GASLINE AIR TST D COMMENTS: (QY<~ m~uf? J1IIWoRK SATISFACTORY, PROCEED D CORRECT ACTION ANO PROCEED D CORRECT ~A~LL FOR REINSPECTION BEFORE COVERING Inspector: P - Owner/Contr: CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE. CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI 1NSIfOT/ DATE TlIIE CITY OF PRIOR LAKE /1-15 -0'1 INSPECTION NOTICE SCHEDULED ADDRESS I 'J'IS( D..e.rt:,,11 Qt". OWNER CONTR. ]), R. }-/{J/ 10... PHONE NO. PERMIT NO. 61./- 7&' r D FOOTING D PLUMBING RI ~~ILUNG D FOUNDATION lJ MECH RI o CO INT D FRAMING lJ WATER HOOKUP D FIREPLACE RI D INSULATION lJ SEWER HOOKUP lJ FIREPLACE FINAL ~NAL lJ PLUMBING FINAL D GAS LINE AIR TST [J SITE INSPECTION [J MECH FINAL [J COMMENTS: bN.te - ttJ/t' (..JIb f<,.d-(')/C ~WORK SATISFACTORY, PROCEED [J CORRECT ACTION AND PROCEED [J CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING InSpector:~ ~ Owner/Contr. CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE. CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI IJGN011 . ..- , APPLIANCE PERFORMANCE TEST Attach to gas line BdjBcent io reguletor Heating Contractor ~ ~ Name of Tester c.J.,,~ Date ~ " JobAddress ~sq t'lt:.J'f",rJ Healing C_..~~..;_: ~ 1).t ~ Name atTester G~ ll~ 14 rl \':,_ 7 ~ r/i- (/4- -!iJ't. ~~~;: Date Percent 02 Percent co Percent Co2 Stack Temp Combustion air is adequately supplied per UMC Sec. 606 '( IIh ~ input