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Home My WebLink AboutBuilding Permit 01-0332 CITY OF PRIOR LAKE BUILDING PERMIT, TEMPORARY CERTIFICATE OF ZONING COMPLIANCE AND UTILITY CONNECTION PERMIT (Please '!ype or print and sign at bottom) ADDRESS ...P.;;?// Gl==~~O Date Rec'd 4-5-0/ ,PERMIT NO.O/~Z- I ZC/f... ING (officeu,,) I ' 12-/ t, White 2. Pink ), Yellow File City Applicant A~";;- ou=- LEGAL DESCRIPTION (office use only) /? ./ LOT BLOCK ADDITION OWNER (Name) (Address) ~Ei':"<,,,*"""'Z%J ~ PID -70 37;)-D /5<) BUILDER (Name) v'J_Q_ ~~~7. (Phone) (Phone) &;57..-<6?': ..7/;3';{; :557';?;;:z, (Address) 0'.y~;'-9 ~~ >tCl</~-~ di?O~ IfS-New Construction OLower Level Finish TYPE OF WORK o Misc. ODeck o Fireplace ~~ OPorch ORe-Roofing OAddition OAlteration ORe-Siding Contractor's License No. # # Size~ I"; # # I Builder's Deposit I Other s,+lJ I TOTAL DUE ~~9,~ ' OUtility Connection Paid Date <HZ- 2-t I Rec$No. 3&fArJ,S Bvl11b_ PROJECT COST IV ALUE (excluding land) $ .7-::7. /""l:? 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 construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building official can revoke this permit for just cause, Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections. X /~, ,').....=._\<1 ~ -:x~.cV f7 2/)06 .<:90 fJ"!? I S- I Park Support Fee SlfJ.S4 I SAC _~_llt1 I Water Meter I Pressure Reducer I Sewer/Water Connection Fee I Water Tower Fee $ $ $ $ $ $ $ $ I OCl . C!)6 100 . CY5 :?"5~50 tto.oO Signature Perrnit Fee Plan Check Fee State Surcharge Penalty Plumbing Permit Fee I Mechanical Permit Fee I Sewer & Water Permit Fee I Gas Fireplace Permit Fee aa:1ationp BUildin;;~~t~:;proved ~ B~:ftnJbffiCia1 Date Date $ $ $ $ $ $ $ $ 9~.oo 1)1 SO. eo 12<::;".ClrJ 46.67J l. 2c:96.~ ~~ I S~O.C90 'sS.~ I $',2.33.21 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 aIlows construction to commence. Before occupancy, a Certificate of Occupancy must be ~~tr:c,~ tfA;./6Jl ~ ~c.~~fj'1V(~l'if~ 24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245 \ " v '}-- :;3 Jr- Department of Administration 1.P. January 29, 2003 Roy Jones 5211 Deerfield Lane SE Prior Lake MN 55372 RE: Chair Lift Residence: Jones, Roy Residence 5211 Deerfield Lane SE Prior Lake 55372 - Elevator 10# -07964PT01-28R Dear Sir/Madam: Minnesota Statutes Chapter 16B provides that the Department of Administration, Building Codes and Standards Division, Elevator Safety Section, inspect and approve elevators and manlifts (endless belt lifts) before they can be legally used in Minnesota. An Inspector from the Elevator Safety Section recently inspected your residence and determined it meets requirements of the Minnesota Elevator Safety Code. NOTE: Compliance with Minnesota Rules and the ANSI/ASME A 17.1, Safety Code for Elevators and Escalators does not necessarily assure compliance with the Americans With Disabilities Act of 1990. Sincerely, BUILDING CODES AND STANDARDS ~~ Bill J. Reinke State Elevator Inspector bjr/rkr (CE-2) c: Hutchins, Robert Dana, BO, City of Prior Lake Arrow Lift Accessibility EIFormCE2R Building Codes and Standards Division, 408 Metro Square Building, 121 7th Place Easl, St. Paul. MN 55101-2181 Voice: 651.296.4639, Fax: 651.297.1973; TrY: 1.800.627.3529 and ask for 296.9929 ~7 ,ue~ Th", Ctnln of the L.kr Country While . Building Canary . Engineering Pink . Planning BUILDING PERMIT APPLICATION DEPARTMENT CHECKLI~T NAME OF APPLICANT ,'} !{:- J T---. /' I,." :----- APPLICATION RECEIVED L / -:.j- - / The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: \ I _. r'. I; ,/.i' ( - l Accepted 1./ Accepted With Corrections Denied 1- t Reviewed By: ~ b~~>- v - ...., Date: t.( Ati Ie ( Comments: ~_ ~ tr~ ~Y~V'""_l ~~ ~k~ J- .Q/~O' ~tv~ ~--VI,A~I'l.('~ ('~ ~~ {J(>~ ~~~<,.' - )~cMJJ ~.A_Sj~~ ~ ~. ~i~~ '* ~ ~:t.9. /J . ~ vOLct- r=6\r ~yO~ 2-.J A4A)T' I&V\ 10 "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." I I I I I J $~'" White . Building Canary - Engineering Pink - Planning ThO' rIPn.... of lh.. L.k.. Counlry BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT APPLICATION RECEIVED :.1J 12 ~tUT~ Lj -S"' -('~ ) The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: _7)J!/ LOtl+trf 40u .$;;- Accepted Accepted With Corrections .><. Comments: Denied .....----. V) I Reviewed By: ex::VlI). .,)4- / W 402 t1~ Date: t/-. cr. ~ ( - A~J)~ c~~ ? 2J't'l L r't "- -it' IAJ) ~.iJ~ - "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." .~~ Th~ C.-",.., of Ih.. Lair... COUGln I(h,/" F,'/( White - Building Canary - Engineering Pink - Planning BUILDING PERMIT APPLICATION nt=PARTMENT CHECKLIST NAME OF APPLICANT 1) -k? 1J.MJ ~ APPLICATION RECEIVED L/ -!l -oJ The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: . ~/)JI/ (.oc7fl~jJrl ~ oS;; Accepted x Accepted With Corrections Denied Reviewed By: tv IH3 Date: -'-1- '1-0 J Comments: ~See Reverse Side for Additional Information! " ,>ee Attacnments: 1) Grading Plan, 2) Erosion Control Measures 3) Erosion r.nntrnl PI:;m "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." " CITY OF PRIOR LAKE REA TING/AIR CONDlTIONING/FIREPLACE PERMIT Date Rec'd (Please type or mint and sien at bottom) ADDRESS ~1J I Dflx-hetd I fm-f, SE: i i:,:. ~:~ 1 PERMIT NO. -"">/- 7~"1 ). Yellow Applicant .L/f" _-J:,JeI-- ZONING (office use) KL LEGAL DESCRIPTION (office use only) LOT lGBLOCK I ADDITION PID';<'7"-37;Z- 0/5-0 ~':e~R l)~ \-tDY'fbrt (Address) '3U5q WOtcAtLh1hm Aw~ ~;;;~ANUtl'lQM Y11e.c,htUL/caJ (Address) --.3ff)D j(.fJ)nfbfrJ'1)r ,\lilfe, \ c (Address) . (City) (Zip Code) (Conbct'm=J .If:t1[l1J~. L ~ '-'J 105/45Z-2776 APPLICANT SIGNATURE ... L ~ (~DATE t.f/Z3/D/ I n I --- . APPLICANT PLEASE COMPLETE BELOW [gNliw CONSTRUCTION 0 REPLACEMENT 0 AL TERA TIONS FURNACE MAKE AND MODEL BI'~J.. 315?>k.Prv D2J..Jbl D FUEL f\t\;i-u..rttl FLUE SIZE 1..\,\ C\a.S';J e, RETURN OPENINGS i.f- INPUT 10. Df)D OUTPUT 5/0. bon SWk 'lOd . (Phone) Eo.M.h Mf0 55/2.2- J (Phone) ltf31 4-Sl-lT15' TYPE OF SYSTEM OWann Air Plants OGravily o Mechanical W-ir Conditioning GJ'I"ent. System HEATlNGORPO~RPLANT o Steam o Hol Waler o Radiation o Special Devices o .other Devices PLEASE NOTE: Air Conditioner Units Cannot Encroach into Required Side Yard Setbacks FIREPLACE MAKE AND MODEL Industrial, Commercial & Multi-Family FEE SCHEDULE 1% of job cost Residential, Gas Fireplace $39.50 minimum $99.50 Residential, AddiIions & Alterations $64.50 Residential, AC Only $39.50 $39.50 $39.50 Residential, Heating & Ale (New Construction) Residential, Heating Only (New Construction) Estimated Cost $ Building Permit # HEATING PERMIT FEE STATE SURCHARGE TOTAL PERMIT FEE $ $ $ .50 Bul)A1DVVI7'i_1 . DING PE;,. . I,~,. j t (OfficellseOnly) This Application Becomes Your Building Permit When Approved Building Official Date I Paid I Date <:; ~ 11-0 / Receipt No. 24 hour notice for all inspections (952) 447-9850, fax (952) 4474245 Bne--- V APr.17.2001 1:53PM GENZ RVAN PLUMBING AND HEATING No.1932 P.7/9 Date Rec'd LUr OF PRIOR LAKE PLUMBING PERMIT (Please ~ or ~rlnt ancISU!D at_' I ADDRESS ~211 UiiG&D InlflO J __'-1= ~ ~t ?':l_ I PERMIT N02)!~ 33~1 ZONING (olIloo",.) 1</ LEGAL DESCRIPTION (olIia use O1I!y) LO'l1t;BLOCK \ Avl.J1l10N~..Mefu ZvLO OWNER,--... ~ (Name) .~ '1<"'- , APPLICANT (Name) R--t .Jf\? - r2t:f ~ (phone) (Addres.) 14- i/..J5 c~ ~ 'TI'l-L- ~'E.e..Jrv>tn..LV\T (Addres.) (City) (Contact Person) ~'-f Q\W0 (Phone) APPUCANTSIGNATURE lA ~C)... - DATE AP~ PLEASE COMPLETE BELOW Type ofFi~r. I Quantity Bath Tub with or without shower I Dishwasher I Floor DJ:ain I 1 Lavatory (Bathroom Sink) I I Laundry Tray (lor 2 compartment sink I I .Shower Stall I I Sinks I I Bar Sink I ?~ I Water Closet (Toilet) I (Address) ~<:i.l Quantity J I I 'Z-- I I I PID~S- 31~-OI5-C:' ~~ (phone) Ea..~ I A ns\A,~~ 'l\..z.. ~ ZOLJ ~BI- L.f 2:"->-11 L/li , ~loX (zip Code) L{-("Inl Type of Fixture I I I j 1 I 1 I I ,ell , Rough-ins Wair.r Heater I Water Softner I StBnd Pipe (Washing Machine) I Sewage Ejector I Backflow Assembly I Backflow Assembly Test i Lawn Sprinkler I Other . FEE SU1J!dJULE IndlJStrlal, ConuncrClal &: Multl-famlIy I 'Yo of job cost Wlth a $39.50 minimum Ro"dOllllal, 1'1- One &. Two-Famtly $~9jO RosidOlltial, Additions &: Altenttion> $3950 Esbmatel1 Cost $ Building Permit # PLUMBING PERMIT FEE $ STATE SURCHARGE $ TOT.AL PnuwT FEE $ PAIDW/-. SUILDING P~; . tlV"j .50 (omee u.. Only) l This Appli<atioD Becom... Your B'dldiDC Permit When Approved BuildiDg Ollidal Dattl r Paid I Date L(~~O~() / IBy~ I Receipt ~ 24 hu.r notice for oll insp<dions (952) 447-9850, fax (952) 447-4245 ApI,17, 2001 1 :51PM GENZ RYAN PLUMBING AND HEATING No,1932 P, Ll9 Date Rec'd CITY OF PRIOR LAKE SEWER AND WATER PERMIT ~.,?5C ~ orprint anc1sten-atboDl:m:i) ADDRESS _~> 52-I! JY..eLJi{?O n (n. ~J ,~ LEGAL DESCRIPTION (offi<e use only) LOT 15 BLOCK I ADDmoN~qe.LJ[) 2J1L() OWNER....-... (Name) '1.. ")Q~ (Address) 5-IcA fJ.r--1i2.-~ t ). h..~ '.~~_ ~ ~ 20L.\ (Addm&] i ~ ~~. I PERMITNO,.,"I)/~ U33'" I :1. Goold ",",U.u V d- ZONING (Dlllc....) t/ p~;- 37).-o/~-d . (phone) EQ,.<b::).....lf'I (City] &"0:::;-' '2-1 (Zip Code) APPUCANT . (Name) ~'2.- f' eft V'-. (Phone) (8 - (j 7. 2l - II Lt u (Addre.ss) 1L/~4S ~ ~bvu- ""t1I'l ~IIV"\l''',Ll~ tfr'J{~ (1'._) (City] (Zip Cod<) (ConlactPe:son) ~~ O'-<'),,_.j (Phone) ~PLlCANT SIGNATtJRE -.JI\. ~(\ ~ DATE 4- /1 ( /61 APPLICANT PLEASE COMPLETE BELOW Sizc of water scrvice inchcs. Location of any couplings from stru.ctUre Type of sewer pipe. D ABC D PVC Estimated length of sewer line feet. Clean out (if requiIed) located at ~ feet from structure. feet. D Cast Iron FEE SCHEDULE Residential sewer and water line eonnec:tion $3S_S0 Indus1rial, Com'l & Multi-family 1% of job cost with a $39.50 minimum Sewer connection only $17.50 Watet connection only $17.50 Estimated Cost $ Building Pennit # SEWER AND WATER PERMIT FEE STATE SURCHARGE TOTAL PERMIT FEE (Om<e Use Only) I This Application Becom... Y OUI: Building Permit Whea Approved ) Suildial OSiall1 Oat. 14 hour Dotice for an in.paction. (95.1) 447-9850. ru (95.1) 447-4245 $ $ $ .50 PAID WITH BUILDING PEF);,;;T ~ Paid Receipt No. DOT; ~ 30-0/ BY.r 'J PRIOR LAKE INSPECTION RECORD SITEADDRESS 5211 f)oor-C'Pld ~ NATURE OF WORK ~ USE OF BUILDING S FI4- PERMIT NO. (J( -0"332.. DATE ISSUED If - {, '?tp>( CONTRACTOR rd <.. 1-1a~ ~ ~/ - 2'5(." - 7 { 3 C. NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW THE PERMIT IS BY SEPARATE DOCUMENT DEPARTMENT OF BUILDING AND INSPECTION SEWER I WATER I SEPTIC FRAMING INSULATION ELECTRICAL PLUMBING HEATING (if required) FIREPLACE GAS LINE AIR TEST M. /IJ I~AI~v' . COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED , WALLBOARD I I " FINALS I6R . /; y~( A bPr- t _ ~, I FOOTING ~+. lQv\. ~ 7(3/01 I _ INSu;.R I ?/.?-///;D;TE~ ~,JWI~O( , FOUNDATION (Prior to Backfill)111~ I 0, 17 la1/ol In 718".1'1 PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ROUGH - INS I I ~ t.+u& I W=11 k. /-I- ,I I I If;. 1//;/tJI ~, III ff, It} I 'ffhr, 1lh/D' , 1 ~ I&"/ ::5-U\ l!4-./tJ /.:J; /01 III/I/t)f" I . I I GRADING (Prior to Sodding) BUILDINGr.C..O.-tJJ rl r /6 'Z.- ~ ELECTRICAL I . PLUMBING HEATING DO NOT ~ 7-- /7. 'P"2. <h~!D'Z.- . OCCUPY UNTIL ABOVE HAS 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'Z.flL} (tl rlilt; k I . \ BEEN SIGNED Call between 8:00 and 9:00 A.M. for all inspections FOR ALL INSPECTIONS (612) 447-9850 ~=--=.~=..=.-~ - .- i_.." ..,' ... . ...., '.., "--:.J~' ",' "-":" , . '~.?'" 10; ....t "'_ .:....."'\: _,~':. ,~;..:.. ",,'Z.""i'" .,~. ,,.....,....~,~...,..........I!!i"lo:. ~. ......- ~, ~ i~ ~_fl~''"''J."_ ~-_-~ ~_r I j ~ - ~ :i; i QLtrtiftrau of OOrmpanry ~i;~i Ct.! i OF PRIOR LAKE i~ : mtpal'tmtnt of Jluilbing Jn~ptttion rl.;. 9(rinal Permitted 0 Conditional C.O. Expires iJ"( , ;t.~~..r (~ f~([. {t:.! ;~- Owner of Building DR HORTON, 34S9 WASH~i=;:~" DR~~I ~U~::R:~:I:D E~:~ ::122 ~t c.. ... 'sName &Address. ~...~ ROBE~~n; 6i:i;HINS r ~_City~onncr r.~ Dale: //)~/!,)v _ Dale: ~!.- . .,.. .~1. ..:.."~-.jl~'pI~;~~~:~;:S:~::,, ~~~.'.I ..... ~.-!, :...~~"':'i~~I~~~,"- "'''''' I" .. I"-'I;""-I~ 'I" ,'.'''''~ .''''r''' ~.-c:~ ~ ~~~~=--"" This Certificate issued pursUQ1l/ to the requirements of Section 307 of the Uniform Building Code certifying thai at the time of issuance this structure was in compliance with the various ordinances of the City of Prior LaIu! regulating building construction or use. For the following: SINGLE FAMILY Use Classification Bldg. Permit N", N/A 01-0332 R3 VN Rt Occuponcy Type Type Construction _ Fire Zone Zoning Dislrict LIS, BI, DEERFIELD SECOND ADDITION Lego! 1:_,.. :r~--. DON RYE CITY OF PRIOR LAKE INSPECTION NOTICE SCHEDULED DATE TIME 7/'(,.2- AI /, ADDREss6l./I, 13, 15 DE~Rl3/.IJ t-tV. OWNER CONTR. PHONE NO. PERMIT NO. o FOOTING o FOUNDATION o FRAMING o INSULATION ~FINAL o SITE INSPECTION o PLUMBING RI o MECH Rl o WATER HOOKUP o SEWER HOOKUP o PLUMBING FINAL o MECH FINAL .sOD/77U5b COMMENTS: , / ~ .3.32., 333..334- o EX/GRAD/FILLING o COMPLAINT o FIREPLACE RI o FIREPLACE FINAL o GASLlNE AIR TST o ~ 0.(. r<- ./ (~~ ~~~~~ . ~.ilJ '''~ f.1. ......1' 1"U..... ,P'WORKSATlSFACTORY, PROCEED '(/""F "1,,/ o CORRECT ACTION AND PROCEED :S:::O:ECT W~~ FOR REINS~::::/::::FORE COVERING CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE. INSNOTl CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY! CITY OF PRIOR LAKE INSPECTION NOTICE SCHEDULED DATE ~ TIME ADDRESS .51J4S-1J'1., J ';';7_/<) Oa.-<:r1LLn 1_,,\ OWNER CONTR. fl f< +IORIO", \ o FOOTING o FOUNDATION o FRAMING o INSULATION )l( FINAL o SITE INSPECTION o PLUMBING RI o MECH RI o WATER HOOKUP o SEWER HOOKUP o PLUMBING FINAL o MECH FINAL PERMIT NO. n I - ~"''';L :,\,\,\_,?,~ . - -::g EXI~FlLLlNG o COMiii::AlNT o FIREPLACE RI o FIREPLACE FINAL o GASLlNE AIR TST o PHONE NO. COMMENTS: ~2~ 1- i<)l0Ct? G..JI'..6 fc,n'X 6(A)~-~..~~.~~ ~l\ A .b? f ~; I~""~""''''''n'.~ -~ l./~..l.~)~ nv\ ~.-P -Y-"K ~FT o WORK SATISFACTORY, PROCEED .>cORRECT ACTION AND PROCEED o CORRECT WORK, CALL FOR REINSPECTlON BEFORE COVERING Inspector: ~~-...P. Owner/Contr: CALL 444s50;;:Z T~E NEXT INSPECTION 24 HOURS IN ADVANCE. CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY! lNSNOTJ CITY OF PRIOR LAKE INSPECTION NOTICE SCHEDULED DATE TIME 1z/19icJl /o.'~ ADDRESS -' 52-If ~;fJ) ~ . CONTR. OWNER PHONE NO. PERMIT NO. DI-.s5 <- o FOOTING 0 PLUMBING RI o FOUNDATION 0 MECH RI o FRAMING (fE) 0 WATER HOOKUP o INSULATION 0 SEWER HOOKUP JIl\ FINAL I1i'€. PLUMBING FINAL o SITE INSPECTION ~ MECH FINAL COMMENTS: "B~~ . m Y'CMv'-1:~ A.~~......... J l~'-'" , ro '2.,~,~ ~ -01 6 _ h:. ~ OJ ~ ~ tMJl.d ~V ~~ ~ ~. ~vu.J;, ~ /'rTl.r.........~....,._ - () U.....J o EX/GRAD/FILLING o COMPLAINT o FIREPLACE RI o FIREPLACE FINAL o GAS LINE AIR TST o -I. (..< 0 . -ti..QJl 8/ \ IIY'L- fJ14f;.:f- ~'<--<fJ o WORK SATISFACTORY, PROCEED '11 CORRECT ACTION AND PROCEED :S:::O:ECT WORK~ FOR REINS~:~::I::~:FORE COVERING CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE. INS/'iOTl CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI ADDRESS ,~/( DATE TIME SCHEDULED I~ J!J!tJ(J ~..(J ~. CONTR. CITY OF PRIOR LAKE INSPECTION NOTICE OWNER PHONE NO. PERMIT NO. tJl - 372- o FOOTING 0 PLUMBING RI o FOUNDATION 0 MECH RI o FRAMING 0 WATER HOOKUP o INSULATION 1M 0 SEWER HOOKUP o FINAL ~ PLUMBING FINAL o SITE lNSPECTlO . 0 MECH FINAL o EXIGRAD/FILLlNG o COMPLAINT o FIREPLACE RI o FIREPLACE FINAL o GAS LINE AIR TST o COMMENTs(\) ~~ ~, (IV) I~ ~~ ~ ~- ~ ~~r>>-n~~ -~~ (~ f~. J ~~~- ~-~ II' ItlC - <'Yk.., o WORK SATISFACTORY, PROCEED ~ CORRECT ACTION AND PROCEED o CORRECT W~ALL FOR RElNSPECTION BEFORE COVERING Inspector: ~. Owner/Contr: CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.. CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY! INSNOTl .. APPLIANCE PERFORMANCE TEST Attach to gas line adjacent to regulator Heating Contractor AI \ ,"-_"- ~ <.L.. Name ofTester (.,,:~ ~. Date 1;1.-\:1..01 Job Address 5;1. II O.<,~ .~I.l. L.-<.- Heating Contractor AII;_+ h..",- Name of Tester \C.e: ""- S. Date \;;1-\:1.-01 Percent 0, I. 0 Percent CO - 0 - Percent CO, .. 'il', :1 -,0-)" Stack Temp ",,0 Combustion air is adequately supplied per UMC Sec. 606 c.." input ~~ooo