HomeMy WebLinkAboutBuilding Permit 01-0387
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CITY OF PRIOR LAKE BUILDING PERMIT, .
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE I.
AND UTILITY CONNECTION PERMIT
I,White File
2. Pink City
3. Yellow Applicant
~.;-:.:-~.
'., 1''-
I
Date Rec'd
LuUI
I-,03CO,'
ZONING (office use)
11 I Sf)
/7?'// e:v/~A/$5S rA,'.J4;'~
LEGAL DESCRIPTION (office use only)
dl~ /'
LOT BLOCK ADDITION
-
~
PIDJ5-.37o -oJ~-()
I OWNER
(Name)
(Address)
(Phone)
BUILDER
(Name) '<:l""f. ~~ ~.
(Address) ..::r-Y6? ~8K<~ ~ ~
(Phone)
6GT-~~-';; -7/~t;
-
~. !7"~-z.;
.--vV :5?Sr..2 ~
TYPE OF WORK
New Construction
ODeck
OPorch
ORe-Roofing
O~e-Siding
OLower Level Finish
o Fireplace
OAddition OAlteration OUtility Connection
.....,.-,
PROJECT COST IV ALUE (excluding land) $ ;;r ~/O
o Misc,
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.
~~~
Signature
-r~6~7"
.-v-6 -0/
x
Contractor's License No.
Date
Permit Fee $ Park Support Fee # $
Plan Check Fee $ SAC # $
State Surcharge $ Water Meter Size /8'; I"; $
Penalty $ Pressure Reducer $
Plumbing Permit Fee $ {lb. ()() Sewer/Water Connection Fee # $
Mechanical Permit Fee $ ~.OO Water Tower Fee # $
Sewer & Water Permit Fee $ Z ~. '5V Builder's Deposit $
Gas Fireplace Permit Fee $ ~ Other $
. g Permit When Approved TOTAL DUE
~
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and y proceed as requested. This document
:~lanner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy. a Certificate of Occupancy must be
---'-..,~ .s-/~/8\ .~~ .
Planning Director Date Special Conditions. if any
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
/
..~~
Th" ('"nlt-rof lhll' L.ke Counlry
White . Building
Canary - Engineering
Pink - Planning
*
BUILDING PERMIT APpueA11QN,IJEPARTMENT CHECKLIST
NAME OF APPLICANT D 7? 'f-j(~; r fu/v I-JJ0
APPLICATION RECEIVED 1/ -;JO- () /
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
//70/1 it/lf(.f>f/I1"',j/ /r"/
Accepted
v--
Accepted With Corrections
Denied
Reviewed By:
~4.0~c'~
Date:
Lt/2?Ar1
~
vQ..OtlJ
o , D ~r
QtIW<.l~ ~b/ k W ~rJ. l~ ,
A/~ ~ ~'f~~~'
~vt:YU'_~ ~'^~~ <0r62P ~l-: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."
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.
White - lJuilding
Canary - engineering
Pink - Planning
Th~ ernltf or Ihl' L.kr Counlry
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT D l( 'fJ (,)rt-o;tJ I;Ju
APPLICATION RECEIVED L/~;;xo-o / .
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
/?O 1/ tf).ddJlA/f1.f)~ Tr.-
. Accepted
Denied
Reviewed By: M/H3. Date:
Comments: See Reverse Side for AdditinnallnformatigR!
)(
Accepted With Corrections
i/-;u-o/
"
See Attachments: 1) Grading Plan, 2) Erosion Control Measures
3) Erosion Control Plan
"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 canoel the provisions of this code or other
ordinances of the jurisdiction shall not be valid.'
~~
White . Building
Canary . Engineering
Pink . Planning
Thf ('.,Olu of Iht' Lab Counlry
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT D R No r fotJ .I)Jv
APPLICATION RECEIVED 1/- dO-cJ /
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
I?OII tI).d.d~ Tn
Accepted
Accepted With Corrections
~
Denied
Reviewed By
Date: c(- 2c:;.7ffJ(
"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."
FIRESIDE CORNER #6148 P.oo41006
(,.;rn~ Ub' l'KIUK LAKE Date Rec'd
HEATING/AIR CONDITIONINGIFIREPLACE PERMIT
l1'1eIUe ~ qr ..,;", on6 ."" II I>olal...l
I ADDRESS
\ '\.0 \ \ WHO f..te..N f.. ~,
IIZ.. ~ CC-
::~;. S-, I PERMIT NO. / - ?,r?'l
I ~75jj.R)
LEGAL DESCRIPTION (ollIeo J"'" only)
LOT BLOCK I ADDmON
OWNEll
(Nam~)
Address)
D
pr.od5- 370../ 6){.,-0
~
(phon~)
APPUCANT
(Nwme) ALLIED FIRESIDE DBA FIRESIDE CO~ER
(Phon~) 651-633-2561
(Addrellll) 2700 N. FAIRVIEW AVENUE
(AddreSl)
(Contact Penon) BRENDA HU CI!l
ROSEVTT.T,lI": MN'
(City)
651-633-2561
IIic;11'l
(Zip Code)
APPLICANT SIGNATURE
APPLICANT PLE
.W CONS1RUCTION
FURNACE MAKE AND MODEL
FWE SIZE RE11JRN OPENINGS
OMPLETE BELOW
REPLACEMENT 0 AL '!'ERA TIONS
FUEL --.JJ .6 A~
OUTPUT ~ot.O
TYPE 01'1 SYSTEM
BWIImI AJr PIOIlIs
G....il)'
McchanlClll .
BAit Condttlonina
VenL Sy'lOm
INPUT
HEATING OR POWER PLANT
DS=
o HotWar.or
o RadIOlion
o S)*11Il Devl"".
o Olll.... Devices
lPlo -
PLEASE NOTE:
Air Conditioner Units
Cannot EncrOllCh into
kequil1lcl Side Yard
Selb..:ks
FIREPLACE MAKE AND MODEL
-r~ ,c...
FEE SCHEDtlLE
InduSlrial. Commcrcilll 11< Multf.Pamlly 1 % of Job COlt ROllldon~lIl. Gu flreplllU
$39,~ minimum
Residential. Healing Ii; AlC (N... ConSlrUdion) $99,50 Residential, Additions" Alr.Olion.
Residential, Hating Only (New ConslnJctioD) $64_Sfl R.sidenti.r, AC Only
Estimated CDS! sll 00 a) Bulldini Pomlft II
539.50
$39.50
539.50
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT PEE
$
$
$
.50
BUIt%;:J>Gllv'ITH
PERMIT
(om.. 1].. Oily)
BuHdI.. 0IlIe1.1
I :h/;rJ-~/
! t
Z4 hour nom 'or'" """cellon. (952) 441-98!IIJ, ",. (952) 447-4z.t5
I:;'.
Thll Appllclltlo. Becometl Yoar Balldlnll Permit WheD Approved
D.."
nJ~/5fjI(
CITY OF PRIOR LAKE r
HEATING/AIR CONDlTIONING/FIREPLACE PERMIT
Date Rec'd
~atoo~~
ADDRESS
I . P..r e~S
i;;;;':, ~:~ I PERMIT NO. /fJ!-381
J. Yellow Apphcant {/ .
ZONING (ollice use)
{{(SO
-r;
Sf.
LEGAL DESCRIPTION (office use only)
LOT;2( BLOCK ( ADDITION
P
70-(),;).b-
Ig,=j).~. Ho....fp"
(Address)
(phone)
APPLICANJ4/ Ii :l: M e.c.h ...--
(Name) ~n . . -""fit,..
(Address) 3~r:.rJ ~t.rIt\~tI Dn, &~1'1
(Address)
f
(Phone) "6/-.~5 Q- '{1/1'15 .
MAl ti6/~
(City) (Zip Code)
(Contact Person)
(Phone)
DATE..5J. '()/
APPLICANT PLEASE COM TE BELOW
EW CONSTRUCTION 0 REPLACEMENT 0 ALTERATIONS
FURNACE MAKE AND MODEL :Br~n f 90. % FUEL
FLUE SIZE ~ RETURN OPENINGS INPUT 1fX4(1i')O OUTPUT aD, ()()O
TYPE OF SYSTEM HEATING OR POWER PLANT
.
DWarm Air Plants
DGravity
D Mechanical
c:i!5Air Conditioning
~ent. System
D Steam
D Hot Water
D Radiation
D Special Devices
D Other Devices
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yatd
Setbacks
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 Residenlial, AC Only
$39.50
$39.50
$39.50
Residential, Heating & AIC (New Construction)
Residential, Heating Only (New Construelion)
Estimated Cost $
Building Permit #
REA TING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
.50
flAIO WITH
BUILDING PERMIT
(om" Use Only)
This Application Becomes Your Building Permit When Approved
Paid
~
Receipt No.
~
Building Official
Date
5,;;9-01
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
Jun. 4. 2001 3:27PM
GENZ RVAN PLUMBING AND HEATING
No.5214 p. 29/40
Date Rec'd
CITYOFPmORLUffiPLUMBmGPE~
1..1JJv. Fn.
...Gold CIty
. " ]. 'I..... Appfi.ca
SF
I PERMIT NO. I~ 3 '?1
I,
ZONlNGCOll5..uc)
15.lJ
~~DZ:tllllAl~&t_"'L
G;; l~'i'\OJ'YfLO "^ )u1.1 ~
LEGAL DESCRIPTION <-= "*)
LOT 2lPBLOCK , ADDITION ~
Pro
! OWNER
(Name) ~R Bo,,!:"" CUS1:om Homes
(Address) 3459 Washug1:on Dr su 204 Eagan, MN 55122
(Phone) 651-454-4663
APPIlCANT
(N"ame) C~'J;]'7 'gy""'''" 'P1nrn.....it?g ~ llDoaor-i:t'S
. (Phone) "~1 ["1<1_11M,
(Addx'c::.s) 14745 So Robert Trail
(Address)
Rosemount
MN
55068
(Zip Code)
(City)
(Contact Pe:rson)
(phone)
651-423-1 44
APPLICANT SIGNATURE
PATE
Quantity
2-
,
LEASE COMPLETE BELOW
Quantity Type of Fixtnre
Rough-ins
W ffh:r e1:
Water Softner
Stand Pipe (Washing chine)
Sewage Ejector
Backflow Assembly.
Backf10w Assemb y Test
Lawn S er
Other
r
FEE SCHEDULE
lndllstn.l. Camm=ial &; M\llll-fanllly 1% of job cost ...itb. $39.~O lllinimum Residential, New One &; Two-Fl\lI1lly $9950
Residential, Addition. &; A./tenItions $39.50
&tJmated Co.t $
Building Pennjt # ..
50
.,
1 t
PAID WITH ~J !,
BUILDING PERiV,1T
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL:PERMIT FEE $
omce Use Ol1ly)
This ApplicatloD BecolD!" Your BuildUlg PCTlDit Whell ApproV'ed .
Buildlog Ollicial
na..
I P .d
. D:e
( -?~Ol
1~"
----
I
14 hour Doti... for aU iaapectioD' ~) 447-9850, fax (951) 447-4145
MaY.15.2001 9:27AM
GENZ RVAN PLUMBING AND HEATING
No.3859 p. 2/2
Date Ree'd
q~;tf PRIOR LAKE -.
SEWW'ANb WATER PERMIT
+'~: ~...' . . .
~~:::~~: ....
AD~S ."); '" f~_<;"c;,. T.e.l-
. ~ s:. :'-1 PERMIT NOoO'_ 38'/}
I ZONlNGc......11
. ~f slJ
LOT
ADDmoN'
PJ:Od' -'370- OJ!:> 0
LEGAL DESCRlPTION (oma -llIIIyJ
OWNER
(Name) 1)f2... ~ct\ON
(~) c3YA9 I I JAch".J"~m.....1),~ sr' 20'-'
(phone)
.
~;"""..4....\ ~
(
APPUCANT
(Name) G,mz-Rvan PIU1llbiflll & Real:inll
(phone) 651-423-1144
(~) 14745 So Robert Trl
CAddnssJ
.
R08e.mount:. "4N
(ClIy)
(Phone)
DATB
55068
(ZIp Code)
(Contact Pet_on)
APPL PLEASE COMPLETE BELOW
Size of water Service _ inches.
Location of any couplings from structure
Type: of sewer pipe. 0 ABG 0 PVC
Estimated length of sewer line feet.
'ClCJUI out (ifrequir!ed) locak:Gl at .. fc:ct fro1:n ~.
fc:ct.
o Cast Iron
FEE SCHEDULE
Residential _lit' and water line COIIIlOCtion $35.50 hlduslriaJ, Com'I ok Muld-family I % of job cost with a $39.50 miniDlum
Sowll1'connecdollcm1y " $17..<<'1 WaIlor connection cmly $17.50
Estimated Cost $
BuildiDg Permit #
SEWER AND WATER PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
.50
PAID WITH
BUILDING PERMIT
(0lIl.. u.. ooly)
Thill Appli..doll.lIe<:o.... Yo'!. BlIl1dillC P.l'lIllt Mea App......od
BoBolio. Ollidal
)).ta
I:;~/~~J
I;:
I'
24 hoor notice ror .U IDlpactloDl <'S2) 447-9150, ru (952) 447-4245
..
.~
PRIOR LAKE
INSPECTION RECORD
DEPARTMENT OF
BUILDING AND INSPECTION
SITE ADDRESS ~l wl'I~tA.a>:. <; ~te-.-<' {
NATURE OF WORK A.k...J
USE OF BUILDING ''i
PERMIT NO. -LL-9t ~ DATE ISSUED l.f-?~,&cf
CONTRACTOR {,5( ~'25{,- /J 3(P
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR
FOOTING
FOUNDATION (Prior to Backfill)f'"tl:J~ tP
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
DATE
SEWER I WATER I SEPTIC
FRAMING
INSULATION
ELECTRICAL
PLUMBING
HEATING (if re D}
FIREPLACE ~ 6J
GAS LINE AIR TEST ~" ;;-1101
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I~RD~ I &,(;;?/(ol I
FINALS
"
GRADING (Prior to Soddin ) /o~ '1-0 I
BUILDING't:t.e). 1!JP ~
ELECTRICAL
PLUMBING
HEATING
DO NOT 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.
Call between 8:00 and 9:00 A.M. for all inspections
FOR ALL INSPECTIONS (612) 447-9850
.. -
Q[trtifuatt of Icmpanry
CITY OF PRIOR LAKE
I)epartment of .uilbing Jn~ptttiol1
II Final Permitted 0 Conditional C.O. Expires
1hi$ CertijiCDle ismed punUQ1l1 to tM requ;remenJs 01 Section 307 01 tM Uniform Bwlding Cotk
certifying that at tM tiJM of is$JUIIICe this $t~ture war in compliance with tM variOIlS ordifl/UlCe$ 01 the
City 01 Prior LoIce regulDting building construction or lISe. For the following:
SINGLE FAMILY
0<:cupuI<y Type
Lop! Descrip<ion
Type Conslruction
L26, B1, DEERFIELD
Fire Zone
Bldl. Permit No.
N/A
01-0387
u.. CIasoifk:alion
. R3
VN
ZoniDa Dislricl
R1SD
OwnerofBuildiDl Sit._ 17011 WILDERNESS TRAIL
DR HORTON, 3459 WASHINGTON DR., SUITE 204, EAGAN 55122
COnInCIDr'sNIlIIea:_ ~
ROBERT D. HUTCHINS City PIunor DON RYE
f;.~ 0fIiciaI
4- r -01
Dore:
Dore:
POST IN A CONSPICUOUS PLACE
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
q .;...r
ADDRESS
170/( IAJi/dljnt'ss Tyq; ,
OWNER
CONTR.
PHONE NO.
PERMIT NO.
01 -03r7
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RJ
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EXIGRADIFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
COMMENTS:
SdeL
r /'e.~ :s
-
~.."..,.):..,
':. . C' ." "..,,~.:;<, ;..",'c'"
'.- "::'u'~
~ WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WO , CALL FOR REINSPECTlON BEFORE COVERING
Inspector:
--u '()~
Owner/Conlr:
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH ,{ SAFETY!
INSNO"
DATE nME
CITY OF PRIOR LAKE
INSPECtiON NOTICE
SCHEDULED
/07-Q( ~
ADDRESS /7olt wild-<f''II<.SJ TrL
OWNER CONTR. D..R - florf.rJ'"
PHONE NO. PERMIT NO. (:) 1- 3f7
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
'JIlFINAL
-0 'sITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
.;Jll EXIGRADlFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
COMMENTS:
(7t"d-< - C?i'
Lc-r6 B/9x. -OJ<
.
)( WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED ~.
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
InSpectOr.~~ ~Owner/Contr:
CALL 447-9860 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
INSNOTl
DATE TIME
CITY OF PRIOR LAKE 'tit f/ fJl 1/: co
INSPECTION NOTICE SCHEDULED
ADDRESS /7() II W~f.. ~.) T/Z-.
OWNER CONTR.
PHONE NO. PERMIT NO. t) 1 - !3 1'7
o FOOTING o PLUMBING RI o EX/GRAD/FILLING
o FOUNDATION o MECH RI o COMPLAINT
o FRAMING o WATER HOOKUP ~ 0 FIREPLACE RI
o INSULATION o SEWER HOOKUP )i: FIREPLACE FINAL
\lI..FINAL o PLUMBING FINAL o GASLINE AIR TST
o SITE INSPECTION J'< MECH FINAL 0
~~-~
~v<1RI1~ ~ ~ tj~h
o WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
J CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: ~ Owner/Contr:
CALL 447-8860 OR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HlULTH & SAFETY/
,"""",
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS J 7 Dc L
UJ;\&.u~
OWNER
CONTR.
PHONE NO.
PERMIT NO.
6/-D1A7
o FOOTING
o FRAMING
o INSULATION
o FINAL
o FOUNDATION
o DEMOLITION
o FIRE PREV.
o PLUMBING RI
o MECHANICAL
o WATER HOOKUP
o SEWER HOOKUP
o SEPTIC INSTALL
,.:(PLUMBING FINAL
o SITE INSPECTION
o EXCIGRADlFILLlNG
o LKSHORElWETLAND
o COMPLAINT
o SEPTIC FINAL
o FIREPLACE
o
COMMENTS:
/ WORK SATISFACTORY, PROCEED
o CORRECT D PROCEED
o CQRREC CA OR REINSPECTIQN BEFORE COVERING
Inspect :
Owner/Conlr:
447-4230 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY/
ADDRESS .{7D\, \
OCCUPANT
HEAT LOSS
SOLD BY
Electrical Work By
TYPE. OF HEAT
HOUSE HEATING TEST RECORD
-l.P\\d9.\V\Q.b'- m. ~ - APT._FLDOR_CITY
OWNER
JOB #
SUBURB
DATE HTG. INST.
INSTALLED BY
Ga. Line By
GA _ F~HW _STEAM _SPACE HTR. _UNIT HTR. _OTHER
::.~:t-!~~~~"~ f'
5.".1 I~
INPUT 0 ~
CONVERSION
MAKE OF BURNER
Mod.1
Max. BTU Rating
MAKE OF FURNACE
Mod.1
THERMOSTAT
Valve
limit
Limit SeHing
Fon Setting
PII.t Typo
PII.t Mak.
Pilot Mod.t
Pilot Timing
. L.W. Cut 01/
Pressure 3 \. S"'"
Input CFH
4"",,1e>
Stack Temp. --1--1 ~
Form 235
CONTROLS
Heat Plug
Vent Size
KIND OF LINER SIZE NONE
Draft Hood. Regulotor
Flit... Slz.l&,"lp.S'l:f Numb.,
Chimney Location Inside Outaid.
Chimney Construction
Smoke Bomb Wiring
Oraft T..t Tag
Door Pressure Lighting Inst.
~,\ q,\~.U\
Pereent CO2 Oat. Tasted
P.,..nt O2 ,I Comp.ny Testing ~HeoIin~,3650KennebecDr.,Eagon,MN55122
~P.rc.nt CO . n Name of Test.r ~_J''''''\.. t .
-'-.