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Home My WebLink AboutBuilding Permit 01-0692 " 10", .. , '7 . " <.l '" ~/^,IVESO'\'" Date Rec' d CITY OF PRIOR LAKE BUILDING PERMIT, TEMPORARY CERTIFICATE OF ZONING COMPLIANCE AND UTILITY CONNECTION PERMIT MAl N FIl-B (Please type or Drint and si2II at bottom) ADDRESS &SL/ "'I ftt,w(l m <a.Avw WnlV S6" LWhite File 2_ Pink City 3_ Yellow Applicant LEGAL DESCRIPTION (olliee use only) Cl LDb ~ It \J/\~'" It 60 LOT 1 BLOCK I ADDITION ~u.(:;..A~ 3v-ti OWNER (Name) (Address) (Phone) BUILDER (Name) () (1.. ~ (Contact Name) ~.IU~+~ (Address) -'0 fiuo ~bnk;( c../-. 5+<. lOt) L"-'lUv.ll~ Jl'IXn ~..,..., TYPE OF WORK i1I New Construction DDeck o Misc. DLower Level Finish PROJECTCOST/YALUE (excluding land) $ '7J.,loo $ $ $ $ $ I $ $ $ r') f) . ,MO ~t::C> 797. 7< Sia~ - , 3(", .100 (~.~O IN) .t:JtJ 17' ~o,--O -c{t) . ff6 ur Building Permit When Approved , lr2'1-z./ Date I 1- 01 ZONING (office use) I!:.z.- PID zS-373- 007-0 (Phone) -1S?6-~ (Phone) '1t;d.-4 ~ 1-'E10(j DPorch ORe-Roofing ORe-Siding DUtility Connection f 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 P~rrJl nee . spections. X J.t 3.06061,51 t,-::l/)-O / Signa eV Contractor's License No. Date V I Permit Valuation I Permit Fee I Plan Check Fee I State Surcharge I Penalty I Plumbing Permit Fee I Mechanical Permit Fee I Sewer & Water Permit Fee I Gas Fireplace Permit Fee o Fireplace OAlteration # $ ~.061 $ 'i (Sc).~.J $ 2hrJ ~C:O $ 'It'J . c96 $ / I f'lD/'J . ,.,0 $ 'f"7AA.c;6 I $ l FiCX9 <XL $ . DAddition I Park Support Fee I SAC I Water Meter SizeS/8"G I Pressure Reducer I Sewer/Water Connection Fee I Water Tower Fee I Builder's Deposit I Other I TOTAL DUE I Paid /~}/I'/' 7'1 I Date ~~iJ-()1 # # # $If 31j1. 7lf I Receipt No. lk) / 0 <( Bv'1+-. /" [J 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 ~hen signed b. y the ~i Planner constitutes a temporary certifi.cate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be "~ L-J~ annin~ ~/"UO\ <:ee. 1~~~Ianf:~~"" 24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245 . Jun.28. 2UOI 2:U3PM GENZ RVAN PLUMBING AND HEATING No.6964 p. II/II Date Rec'd CITY _OF PRIOR LAKE SEWER AND WATER PERMIT (Please l'tPe ot'Prii:1t_1tld. n.n '~'t bO=:tn) ADDRESS ~tJlnll 1",7...,1 n~;lolf.- ;: ~ ~ I PERMITNO.!_ / /i---. I ,. QdG AppllcMt k:+f ~ fA-u JL 1 111.oAfJa7J..J CUr,;{ Y:_ ZONING (om.."",) R?, , \ LEGAL DESCRIPTION (office use ollly) LOT 1 BLOCK I AuUIUON r\, P R-.\1 t1 0 V\ 2)Q[) PID d 5" 3'1 -3 - ocn--b OWNER (Name) 1)~ ~Q:,:,"~""~ ('ni'~""m. ~Qm':"'" (phone) ~., 1.C;~/...c:.'2 (A~es~ 3459 Wash1ng~on Dr S~e 204 (Addoessl Eagan, MN 55122 (City) (Zll> Cod<!) APPLICANT (Name) Genz-Ryan Plumbing Ii. Heating (phone) 651-423-1144 (A~ess) 14745 So Robert Trail \ I (Address) (Contact pets,oh) Marv Olson l '~ 'L!CANr SIGNATURE Rosemount ~ MN (Clty) (Phone) 55068 (Zip Cod<:) ~ ~ , DATE 651-423-1144 .(~~ /(J I ASE COMPLETE BELOW Size of water service inches. LOl;8tion of any couplings from stru.ctw:e Type of sewer pipe. 0 ABC 0 PVC Estimated length of sewer line feet. Clean out (if required) located at feet from Slructure. fe~. o Cast Iron FEE SL,nJ!..U ULE ResidentIal sewe{ and water line Connection S35.50 Industrial, Com'1 & Multi-family 1% of job <ost with a $39.50 miuimwn Seweroonne<tion only S17.S0 Water <ollDec:tion only $17.S0 Estimated Cost $ Building Permit # SEWER AND WATER PERMIT FEE $ STATE SURCHARGE $ , TOTAL PERMIT FEE $ .50 I TWs Applieation Bec:omes Your BIliIding PerlRit When Appro,,"4 . Paid ~ ,o..ql J;' 'lJ/~1. D "'-7]; ""GPr::-?! I ReeeUlU'o ' . '1/4/'1" I 1-. IBY~ I (J (Offie=r: U.lC OQly) ~ lluJld1rlg Official Date I. . Dot. -lc /1!t 24 hoor ..tlu for aU iD.pectio... (951)447-9850, fa (95:%) 7 Jun.28. 2001 2:03PM GENZ RVAN PLUMBING AND HEATING N0.6964 p. 9/11 Date Reed ~.lI -L OF PRIOR LAKE PLUMBlNG PERMIT (plea>e ~ ..prio~am1n...AI_) IADDRESS .-.-','.'.,. 5Y~---I" ~A~0 iE. E,.... ,I PERMIT NO. 1- ~9'c?-i ~AD()W Cu-tzVL 3E- ZONING (-=~ /2.x I LEGAL DESCRIPTION (ollia: >=~) , , LOT 1 BLOCK 7 Av.uwON JJfl2.,{ ~eJ)O ()R--O prrY?:i- 373 - u01-0 OWNER (Name) DR Ho:rton CustOJll HOJlles (Address) 3459 Washington Dr Ste 204 Eagan, MN 55122 APPLICANT (Name) r..'=>na-i:~~- b1.,".;:p,g t, u........".II.8 (Address) 14745 So Roben Trail (Address) (COJ:ltactP~~? Mary Olson Ii APPLICAl\i't\IGNATO:RE r A.. V " i Qllantity I I 1 2- ( t I 9-- "t. o ~) 651-454-4663 (phoJ:l~ -6:'_b?~_"4h RosQ1Ilount MN 55068 (Zip Code) AP I Type oCFi:rture I Bath Tub with or without shower I Dishwasher I Floor Dnrin 1 Lavatory (Bathroom Sink) I Laundry Tray (l or 2 compar1ment sink Shower Stall ' Sinks Bar Sink Wattr Closet (Toilet) (City) (Phone) 651-423-1144 \...01 2.fJlnl DATE PLEASE COMPLETE BELOW Estimated Cost $ I I I I I I I I I Quantity I I I I I I J I I Type of Fhture ;RoUgh-ins Wa1er Heater Wa1er Softner Stand Pipe (Washing Machine) ! Sc;w~e Ejector I Bac:kfIow AsseIiJ.bIy I Backflow Assembly Test I LaWD. SprinkIer I Other l 1'1/, / FEESLJ:1I!il.IULE Indl1:ltnaJ, CommCl",al &< MU!1l-f"",(ly 1% of job cost wjtlx. $3950 minimum Rosld...Ual, New One & Two-Famdy $99..50 Resldcntiol, Additions lit AI_ons $3950 )ftj~e Vae Oll,ly) Building Pcrmit # . PLUMBING PERMIT FEE $ STAJE SURCHARGE $ TOTAL PERMIT FEE $ Thi. AppliC2tioll Decom... Y ou~ Building permit WheD Approved .5Q (](J/~4/D 4.:. . I'tVG pI/At ~p, I Receipt No. . Ill' /' I By 90..-/ I I Paid .. Dole I DW/j/ J-;!d/ 24 hour ootiC" for all ioopeoDon. (952) 441-9850, ~~) 441-4245 BulldiDll OUicial .~ CITY OF PRIOR LAKE HEATING/AIR CONDI1'IONINGIFIREPLACt PtRMI'r Date Rec'd (Please tvoe or uritLt aiid shoo at bottom) ADDRESS :~, ~:,~ , PERMIT NO. 1_ 6c'; -, J. Yellow Applicant 0/ 54!o1 Hlwn lY\PMD\AJ tLLr VfJ ZONING (offioeu.e) I?~ LEGAL DESCRIPTION (olliee DOe only) -/- ( LOT'53 BLOCK 1I ADDITION PID..2,- ~7-::S-.JW7--O ~=~R '1){( \1DYM (Address) -3Wscr Wlt(A'kLn~lm1, AvL I ~~;~~ANtl-1.I laM Yi'luJIJCU'1/CaJ (Address) 3rhD J({nnd)efJ\:)( .~il-l-f/ I r. (Address) . (City) (Zip Code) (Contact Person) JpJrrf-0. C 1fm~ (Phone) IdS / 45Z- 2-176 APPLICANT SIGNATURE ~/ 1)mmtnna/1 (~)DATE JUS! () I , APPLICANT PLEASE COMPLETE BELOW i!3l'ffiw CONSTRUCT/ON 0 REPLACEMENT 0 ALTERATIONS FURNACEMAKEANDMODEL g,,~J. 2/6'?kAVDt4b1DI'UEL~tLJ FLUE SIZE Yl\ Glnss &_ RETIJRN OPENINGS 4- INPtrt1D, Dr>D OUTPUT 6/0, bf)~ TYPE OF SYSTEM HEATINO OR POWER PlANT ~ (Phone) EaPan MfJ 55/22- --:2 n - --- __ (Phone) /1f.51 4'52.-ll15' DWarm Air Plants DGravity o Mechanical W-ir Conditioning [j]XOnt. System o Steam o Hot Water o Radiation o SpeCial Devices o Other Devices PLEASE NOTE: Air Conditioner Units Cannot Encroach into Required Side Yard i Setbacks FI!tEPLACE MAKEAND MODEL Industrial. Comniercial & Multi-Family FEE SCHEDULE 1 % of job cost Residentiiil, GaS Fireplace $39.50 minimum $99.50 Residential, Additions & AlteJ'iltions $64.50 Residential, At Only $39.50 $39.50 $39.50 Residential, Heating & Ale (New Constructiort) Residential, Heating Only (New Construction) Estimated Cost $ Building I'etlhit # . HEATtNGPEnNnTFEE STATE SURCHARGE TOTAL PERMIT F.EE $ $ $ .50 SUIL.. 6~N!D 1-1-'//,L' . I Gp 17 12R./v/.';"- 1.11' (Office Use Only) This Application Becomes Y oor Building Permit When Approved Paid I Receipt No, -I 1- ;)}-c/I I Bffr/ Date Building Officiltl Date 24 hour notice for.1I inspections (952) 447'9850, fax (952) 447-4245 NOV.09'2001 15:07 651 633 8884 FIRESIDE GORNER #459 CITY OF PRIOR LAKE HEATING/AIR CONDITIONINGIFJREPLACE PERMIT I. Pmk :1:_ Gr-n ]. Y~kJW' ES.IPERMlT NO_ 1-~Cj:A (!'1eQc ,'1Rt 0' print...4 ';lIl1 01 "",",m) ADDRESS .s Y (p I CS) t4.n, fhu...fL,N &.,1.,/< S.l- ZONING (olHl>! "Ie) tz d.- LEGAL DESCIUPnON (olli"" uo< only) D ~ LOT f( BLOCK I ADDITION ~cR., ( J 1'10<::2 ') - 373- 007-<') OWNER (Name) 'J). '/2.. ~..J-- (phone) (Addres.) APPLICANT (Name) ALLr.ED E'IRE510E DBA FIRESIDE ComER (Phone) 651-633-2;61 (Addx"".) 2700 N, FAIRV:J:EW AVENUE (Addte..) BREt'lDA HUSTON ~TT.T.r.: ~ (City) (Phone) 651-633-2561 s.1:",;. (Zip Co4<l (Contact Person) APPLICANT SIGNATU~ /buo.C.. A~ DATE II. q-Oj APPLICANT PLEASE COMPLETE BELOW ~W CONSTRUCTION 0 REPLACEMENT 0 AI. TERATIONS FURNACE MAKE AND M.ODEL FUEL FLUE SIZE REnJRN' OPENINGS INPUT OUTI'UT TYPE OF. SYSTEM HEATING OR POWER PLANT FlREf>LACE MAKE AND MODEL Jjpp.:t Ai Gc.. OStetUII o Hot War.cr o Ra4ialion o Speeial Device, o Other n.vices ~ (.)l1i)r... PLEASE NOTE: Air Conditioner Units Cannot Encroadl inlo Required Side Yard Setbackll -:JWonn Air PIIlIlIS JOravily JMochOlliOlll JAir Condltlon;n~ JVent. System -- ._~.- - - -. -. Industrial. Commorcial &. Multl-Pamlly FEE SCHEDULE 1% of job Cost R.esidcolial. GlI$ Fireplace $39.50 minimum $99.50 Residential, Addlllot\S &. AI..tlltlon.. $64.'0 RC$;dClllial, AC Only $39.50 R.sidenti.l. HeatinB & AIC (New Construction) Rcsldenl.ial. H.ating Only (N.... Construction) 539.50 $19.50 Estimated Co.t $ Building Pennit # HEA 11NG PERMIT FEE STATE SURCHARGE TOTAL PERMIT FEE $ $ S " .50 .l::l.1/fOP,!(/D I. .. IA;. y~'t.,., G p~.?-! I Receipt No. "",;..,. IBY~ U (om.. V.e O.ly) Thi. ApplicadDn Becomes Your SJ"fdinC Pennit WIlen ApprDved Building om.I.1 D.lc I Pai.d I D'i/~/3~1 14 hou, noli"" far all in'poctlon. (9Sl) 447"'850,'" (9Sl1447-4145 .-.-.. __._n___.__m___"_.____ Thl' ('l'llll'r of lhl' L.kl' <-'ounlry White - Building Canary - Engineering Pink - Planning I3UILDlNG PERMIT APPLICATION DEPARTMENT CHECKU~T NAME OF APPLICANT APPLICATION RECEIVED D t2 I-I ( l!_--rC I\,j (/ -21- () I The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: ~~4-lc I FA~'JI'~ i'il- r$ X \,$ Accepted V ll-_vE::- '~L Accepted With Corrections Denied ~' ~ Reviewed By: . ~ ~ Date: 7/Ub( ~ ~,M~'{ To ~ (l~/tJ!n;t< h=bv- (,1)~I/j" + fJl~'\ Fov- ~/&iw 'AtW;r\JM k , -' "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." ~~ White - Building Canary - Engineering Pink - Planning The ('rnlrr of the takt Country BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT APPLICATION RECEIVED D g - l-Io~ll)(\.1 (I) - 2/- 0 I The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: 54-&,1 FAWN MEAOOW ~uR.Al6 S5 Accepted Accepted With Corrections X Denied _ Reviewed B ( ~ l3~d- 'i\: r/- Date: c. -;). ? - 200 / Comments: ~J, c, ~ 0 ~-bto.~. ~ r~J ~O-~ I.~~ 2. Mv\ \, ~a.-"(d- 5. ~.(.\f\e.tra. t:CM-S "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." ~1 WQI! ~ ~u{,ing Canary - Engineering Pink - Planning Th~ ('fnltt of tht L.kr ('ounlf)' BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT APPLICATION RECEIVED D f2, HOt2-TDf\./ (f)- LI- 0 I The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: 54-1.0"1 FAWN fvlEADOvJ "~u~v6 S~ Accepted )( Accepted With Corrections Denied Reviewed By: AI.4~ Date: )-fc-o I Comments: See Reverse Side for Additional Information! ff}Ct/'Vjf.,:i.{, i , ---.-.-..... .....; ~ee Attachments: 1) Grading Plan, 2) ErOSion Gontrol Measures 3) Erosion Control PI:;!n "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," " PRIOR LAKE INSPECTION RECORD DEPARTMENT OF BUILDING AND INSPECTION SITE ADDRESS -.M(P( h:.JVIA ~ 1 (jJ~ NATURE OF WORK Ak..J USE OF BUILDING SF/) PERMIT NO. O}- rpq;).. DATE ISSUED (, -7..c CONTRACTOR Ile. I-I-.,~ PHONE NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW THE PERMIT IS BY SEPARATE DOCUMENT \ I r.z .,;:::crOR J Df'TE I FOOTING V\'.nt ~, 'Jle:;!tl' ~ ~_) I '1 ;;u:.lol , FOUNDATION (Prior to Backfill) 1I</e.J~, '8110(0' IeXit. ih 7!J.., b- lj'/t~/f)1 PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ROUGH - INS SEWER I WATER I SEPTIC a FRAMING i?t 1/ 1,?l!r:J/ INSULATION ~~ It/d9j~ ( ELECTRICAL PLUMBING ~ lL.c".. Iftr. ?7(iJ(6{)~_c.' iSr./I/Cn/D' HEATING(ifrequired)IJI.I'N/t)... ti..- 'f{/II~flll.~ ~.- '/i/~/(J#f.. Ilkf/ol FIREPLACE . ~ JI/;:;.r-/4/ ' GAS LINE AIR TEST ~~, FU~ t?-r- /tI';;7/o1 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED ~, 11/7;~/ I I FINALS h Ifb V\1O ~ GRADING (Prior to Sodding) BUILDING-r e.o 1:J1 !5r dDt f67. ,;.hlD z.. ELECTRICAL ' , PLUMBING HEATING DO NOT /()~ ~ y~ Or 11-'1 ~- 62- J-J<j k d)./7/oJ. OCCUpy UNTIL ABOVE HAS BEEN SIGNED NOTICE tYLJ 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 placsed near main entrance. Call between 8:00 and 9:00 A.M. for all inspections FOR ALL INSPECTIONS (952) 447-9850 CITY OF PRIOR LAKE INSPECTION NOTICE SCHEDULED DATE TIME 2-1.(}2- f'YJ ADDRES@t)02-. t.s" 6.4- FrtWtJ 1'16ROtJfA../ OWNER cONTR. ~ _ 01- (p 7C-- '1.:5 PHONE NO. PERMIT NO.l. . O~ o EX/GRAD/FILLING o COMPLAINT ~FIREPLAcE RI FIREPLACE FINAL GASLlNE AIR TST o o PLUMBING RI o MEcH RI o WATER HOOKUP o SEWER HOOKUP @o PLUMBING FINAL ~ MECH FINAL , COMMENTS:([1) ~ ~ ~ ~. r4~~-:_~ ~~ OY- ~~U.l:mn.l~ ~(, ~ I o FOOTING o FOUNDATION o FRAMING (E o INSULATION % FINAL o SITE INSPECTION .' To ~r tJ. u:..t'C ~ ~- ~/I ItJ'l-- I o WORK SATISFACTORY. PROCEED ,Pl1CORRECT ACTION AND PROCEED o CORRECT WORK, CALL FOR REINSPEcTION BEFORE COVERING Inspector: 8....-. Owner/Contr: CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE. 7 lNSNOTJ CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH'" SAFETY! DATE TIME CITY OF PRIOR LAKE INSPECTION NOTICE SCHEDULED /-f 4-- 0 2. . 7~; a-o ADDRESS ~I j::'A\,I\J to OWNER CONTR. PHONE NO. PERMIT NO. l - roq z- o FOOTING o FOUNDATION o FRAMING o INSULATION o FINAL o SITE INSPECTION o PLUMBING RI o MECH RI o WATER HOOKUP o SEWER HOOKUP ~ PLUMBING FINAL I'D MECH FINAL o EXlGRADIFILLlNG o COMPLAINT o FIREPLACE RI o FIREPLACE FINAL o GASLlNE AIR TST o COMMENTS: . I '\ Ili,~~ l:! ~-UaL'': l.)lA<{e..'.6reU JL f J lA ~ 17"~ "- . .1.1.~D \17.. \} ~K SATISFACTORY. PROCEED K COR T A AND PROCEED o CO ECT W , CALL FOR REINSPECTION BEFORE COVERING o '1 Owner/Contr C ~98 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE. CODE~REMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY! 1N<NO" /0 -;;W-:?-. $~"I- ra<<JJt IJ4.pA-dlt11J &.v~ CITY OF PRIOR LAKE INSPECTION NOTICE SCHEDULED ADDRESS OWNER CONTR. PHONE NO. PERMIT NO. o FOOTING o FOUNDATION o FRAMING o INSULATION Dcl"'FINAL D"'sITE INSPECTION o PLUMBING RI o MECH RI o WATER HOOKUP o SEWER HOOKUP o PLUMBING FINAL o MECH FINAL COMMENTS: 5'1~ 1- () ~ -6 LIt. d- ' 0'1- ,>q63~h'{.- SL-(&, (j - FJY DATE TIME L'iJ / - &; 9' (;L.. ~X1GRAD/FILLlNG o COMPLAINT o FIREPLACE RI o FIREPLACE FINAL o GAS LINE AIR TST o s tl-1" t( WORK SATISFACTORY. PROCEED o CORRECT ACTION AND PROCEED o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING Inspector:$~~_ _ Owner/Contr: CALL 447,9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE. /J'ISNOTI CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH 4< SAFETY! CITY OF PRIOR LAKE INSPECTION NOTICE ADDRESS OWNER PHONE NO. o FOOTING o FOUNDATION o FRAMING o INSULATION o FINAL o SITE INSPECTION COMMENTS: CATE. TIME SCHEDULED If -dO ~ -tJ'I0/,5-Qb) ~ 1I1e4ckz.o- CONTR. &:/i :3 PERMIT N o PLUMBING RI o MECH RI o WATER HOOKUP o SEWER HOOKUP o PLUMBING FINAL o MECH FINAL .:5f-ig) RAD/FILLlNG o COMPLAINT o FIREPLACE RI o FIREPLACE FINAL o GASLlNE AIR TST o /I.p G[V~C r '; I I <..J< ~ WORK SATISFACTORY, PROCEED o CORRECT ACTION ANO PROCEED o CORRECT WORK. CALL FOR REINSPECTION BEFORE COVERING Inspector: jI1If? fl-l-t-Ol., Owner/Contr: ,CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE. CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY! ll'iSNOTJ .. APPLIANCE PERFORMANCE TEST Attach /0 gas line adjacen//o regula/or Heating Contractor A.\ \; - __ lo. t'\(--,-- Name of Tester K... ~~ ~. Date 1.1' '~-u, Job Address S-'lt.1 ~_ "".~." C,,<"'-.- Heating Contractor AI \ iA_~ ho"t-i-. Name otTester "-"- i 'h..... 'i . Date \~- I~ -0\ Percent 02 <..'1 Percent CO - <::>- Percent Co, ~.'-I Stack Temp ":) i 'i . Combustion air is adequately supplied per UMC Sec. 606 'f · ::. input ",".0<::>0