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Home My WebLink AboutBldg Permit 03-0232 CITY OF PRIOR LAKE BUILDING PERMIT, TEMPORARY CERTIFICATE OF ZONING COMPLIANCE AND UTILITY CONNECTION PERMIT Date Rec'd Main File 1. White File 2. Piok City J. Yellow Applicant :J-l-03 I PERMITNO'~""OZ32-1 ZOND: 7"U"') I (Please typ~ or -print and si2Il at bottom) ADDRESS .r-c'" .., :)( __:J..... l.de'../- 8.." i1 , "I:- D.d/t {,E. LEGAL DESCRIPTION (office use only) d I\./ LOT BLOCK ADDITION /)e,;.,..{-e!J Il! (L, PID.~S:- L//)/-o()~-d OWNER (Name) (Phone) (Address) BUILDER\. " (Name) V.L. t-/v.-k" -/. ,., I - (J11./ (Phone) (Phone) '1S2.<JJ'5'.-7%Cllf (Contact Name) :r~L,s.,.. /. fSh" k ~ (Address) ;(Og&;O j(c..~,"c'~ {fJ....,A L ,; 'a' '" 1/ f' m JJ ""'-'Z"/L/ TYPE OF WORK ~New Construction ODeck OPorch ORe. Roofing ORe.Siding DLower Level Finish o Fireplace DAddition DAlteration PROJECT COST IV ALUE (excluding land) $ / '-11. Of IJ () . OUtility Connection 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 y."Y....j and that all construction will conform to all existing state and local laws and will proceed in accordance with submitted pI 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 ;terupo epro toperfo~;~e-!-'bMA1~ 6(OO() SiRS" 7 :<.-v-03 Signature Contractor's License No. Date 1/ "'l~? ()IJ'LJO I Permit Valuatic3n Park Support Fee # $ 6'50,00 I Permit Fee $ jZ{"z'SS SAC # $ 1,J.7s-.0a -- I Plan Check Fee $ B2tJ. (,/~ I Water Meter ~ze~ I"; $ .,,2$0.00 I State Surcharge $ '/#,ao I Pressure Reducer $ L{ 5: C;D I Penalty $ I City SAC and WAC # $ / 2.f:XJ . t) 0 I Plumbing Permit Fee $ 100.00 I Water Tower Fee # $ 700, Do I Mechanical Permit Fee $ 100. 00 I Builder's Deposit $ ISoo.OD I Sewer & Water Permit Fee $ .:35.5'"6 I Other $ I Gas Fireplace Permit Fee $ '1o,t) 0 I TOTAL DUE $~.Zl52..11 This Application Becomes Your Building Permit When Approved Paid 9"2S2...7! ReceiptM. -1.::19 # ~ r ~bY~3' Date ? _I 'd'~ Bv -r' ~ / 0 Building Official 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 Certificate of Occupancy must be "'"~i;'ni?~ d)</~3 ~ aL{Cicl'~an~ 24 hour notice for all inspections (952) 447.9850, fax (952) 447.4245 16200 Eagle Creek Avenue Prior Lake, MN 55372 Th~ Cfnl~r 0" Ih~ L.k~ COllnlry While - Building Canary - Engineering Pink - Planning BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST : < I" f , ,;' _...,....,..-.'" l / /(./!/' 1:::rJ/ ' ,1-(- "-..1-- '-- NAME OF APPLICANT lEi APPLICATION RECEIVED /;! __ rj/ - Gi.:';\ The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: --?:;- /) ::-:-..." _.., I . ";;::;::pi r./ .._/,::..1..... . _,.(,/> }" i . I _:._,. of.... '-" . '_/( -/:'.//( / .. /. ,~,~.,/ Accepted x Accepted With Corrections Denied Reviewed By: /n4-"/3 Date: :) -;2 7-03 Comments: SAA RAVArSA SirlA for AdrJitionallnformation! /Ylc.f/'n h'l{. ",," ~"),m"nto' 1) Gradinr: Plan, 2) Erosion ('()ntrol M:ea~ur"o "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 CWhite - BuildlniP Canary - Engineering Pink - Planning Tht (-rntrr or lhr J.akr COUnll')' BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT &y_!( Ylen~ APPLICATION RECEIVED ,;;2.- 7-tz~ The Building, Engineering, and Planning Departments have reviewed the building permit application for conff~3~itY;22 is (;~_ at~1- ;j) /k~ Accepted Accepted With Corrections / Denied Reviewed By: ~ ~ Date: sj/L//03 I Comments: ~.o-.f} a..U ~ ~-~. "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." 5~~ Main File White - Building Canary :. ~!1f1.ineering (' .-In", - ...,anninlC> Th.. ('..nl"T o(lh"I..k.. ('ounlry BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST -- NAME OF APPLICANT APPLICATION RECEIVED '--' ., The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: .',- ) , / . / ':"'."'" 'X.-'. Accepted Accepted With Corrections /"" ..-......~._-,...., Denied Reviewed By: ~ '":J~ Date: ..J/t/ leL? Comments: ~~ 025 '../~ ~ ~ J .A.." 't.;...J. A.e. ~...J ~~..I-- ~ ~ -~- ~ ~.'_r-~.L~) . (j ~ a:.I7. - "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." l APr. ~. ~003 9:14AM GENZ RVAN PLUMBING AND HEATiNG ~I 0 8 ~ 3 I p, 1 1 9 t~LJ~ l'R~10~ '; - \ '" u \ '" "\'.~\,. .,\.~\.~:,,\~\,%q~. ''VN'E s 0 ~ to ~'l,\.,:~"",~" , Date Rec'd CITy.oF PRIOR LAKE SEWER AND WATER PERMIT I G"", ,,,. I PERMIT NO ~ ,,,'ow CJ.;- t . 3 _ "j-:2.n I ) ~jd Appheal\t t~ -./ cr- (.PJea:se ;,'Pe or pnnt lUld .~12Oat bottom) I ADDRESS vjXJ;~ W, Vt{K rr Die.. &~ ZONJNG (9iliceu,~) LEGAL DESCRIPTION (officc u<e ollly) LOT ~ BLOCK~ ADDITION r1eueh-eCc{ to*' PID OWNER (N"am~) nn t.T':':':.'':....~.-'.,_.'"'...-:.'':':'_ U,,:,_'"',:, (Phone) _ Lcl~~ IlI~ (Cil'/) c;52-Qgs- LIk:D__ 0eci....lU (Zip Codc) (Address) .2.OSi.cO KeY1i3i<..\u.--e C:r S,e>-lM (Addre",);) APPLICANT (Name) G"nz-Rya.n Plumbin~ & ll"aci.ng (phone) 651-423-1144 ._ICANT SIGNATURE (Addr=) rVl ~(Sn t'1!111 \ (~( 11 J~ Rosemount. MN (City) 55068 (Zip Code) (Address) 14745 So RobHt Trail (Contact Pe!$on) . (phone) 651-423-1144 -?~ DATE 3/31/03 APPLICA1~T PLEASE COMPLETE BEL'OW Size of water service inches. Location of any couplings from structure Type of sewer pipe. 0 ABC 0 PVC Estimated length of sewer line feet. Clean out (if required) located at _ feet from structure. feet. o Cast Iron Res.ldentJaJ sewer and water line connection Sewer connection only FEE SCHEDULE $35.50 Industrial, Com'l & Multi-family 1% of job cost witb a $39.50 mmunum $17.50 Water connection nnJy $17.50 Estimated Cost $ Buildmg Pemllt # SEWER Aj\lD WATER PERMIT'FEE STATE SURCHARGE TOTAL PERMIT FEE $ $ $ .50 A I3lJ/l.D~~~ 'N/'l"H i Pl2f:1~r,. (Office U!it! Ordy) I This Application Becomes Your Building Permit When Approved Building Official p~r~~D\1]~ ~ By D.te . ~ATPR 'OV003 II 24 hour notic. for allln'pectin., (952) 44 -9850, f.x (952) 4474245 By Receipt No. (1--. V ~ €~~ , "~:',,~'NN~SO~" q;~>>:,~\it%'~':f; Apr. ~, ~003 9:14AM GENZ RVAN PLUMBING AND HEATING P 4 i 9 No 8 ~ 3 i Date Rec'd CITY DF PRIOR LAKE PLUMBING PERlvllT 181\1'" Fil.. 2. G:.ld eit)' J Y~I!t')- A.pplr~t I PERMIT NO. 3-;;2 3d.-J (Plt:ase tyDC!: or prine and sj$tJ1 ..t bottom) I ADDR:ESS t]/J3 ~ W. OtlvK. fJDlVtt W. J;f-. I ZONJNG (offi", ~,,) I LEGAL DESCRIPTION (office us. only) LOT d-BLOCK ADDITION /)&K- -h -e tJ I ()~ Pro OWNER (Name) DR Horton Custom Homes , (Address) (phone) Cft:,2-CJ2c:.-!2M '?O'Sl.oD ILeI'1P,ittl)Ge., C. .$re. IDO Louvdlc:.. ~UrJ 5C01-i<.J APPUC.Al'l'T (Naroe)..co.....,,_"tI:."'.... P1H.....1-,,-:....,.. t;, ~.......i--:....,.,. ~ - (phone) ;,t;1_L.?":l._11h.b. Rosemount HN 55068 (Zip Code) (Address) 14745 So Robert Trail (City) (Address) (Contaa Person) .()i1 II( cdi ~ APPLICANT SIGNATURE -.C11 j~ ~ Quantity ,..;l.. l I }, \ J I 01... 651-423-1144 "-.3/8/ / DB (Phone) _ DATE APPLICANT PLEASE COj\.i(pLETE BELOW Type of Fixture Bath Tub with or without shower Dishwa.~bet Floor Drain I Lavatory (Bathroom Sink) I Laundry Tray (lor 2 compartment sink Shower Stall Sinks Bar Sink Water Closet (Toilet) Quantity .? I ' y(.-.r. I Tvpe of Fixture Rough'ins Water Heater Water Softner Stand Pipe (Washing Machine) Sewage Ejector Backflow Assembly Backflow Assembly Test Lawn Sprinkler Other FEE SCHEDULE Industnst CommerCIal & Multl~fsm1iy 1 ~'~ of Job cost with a $-39.50 minlmUtD ReSIdential, New One & Two-Parody .$9950 RCSldentisJ, Additions & Alterations $39 50 (omee Use Only) Estimated Cost $ Budding PermIt # PLUJvIDING PERMIT FEE $ STATE SURCHARGE $ TOTAL PERMIT FEE $ 50 8u/~1~ W/7"H G PERM,.,. This Application Becomes Your Building Permit When Approved f~@ ~ n '(V) Ie -IReceiPtNO. _, <)at. j By cr S1Illding om,;.1 D.t, t __AER 0 2 ZQQ3 24 hour noti~ for 311 in'pections (952) 447- 1850, fax (952) 4474245 By €~: Ar'J\I'NESO't'" HEATING/AIR ~b~%~~~;~PLACE PE~~tt : ~:, ~::y I PERMIT NO. 3. Yellow Applicant (Please type or Driilt and sim at bottom) ADDRESS 5O.52?U. Oa.,C A/~ d. 5~ ZONING (office use) 3- d3~ LEGAL DESCRIPTION (office use only) LOT ~OCK / ADDITION PID ~':e~RD'M. HorTon {Iusbm Home..... (Addres'),.:)()8&o K.Mbrict':f. {lJ.; Lo.kevi /(p_ Mi\J APPLICANT /\ II. t M h--- (Name) t1.LlJ an e~ ..La.. (Address) 3(P50 11..e.n"... be('. 'Dr. 5+p #j (Address) .p Z;mmpr.rn I2ln (Phone) tR5/-.<../5!)- ,;(77~ f (l..42AU~----- DATE v(/ II V . APPLICANT PLEASE COMPLETE BELOW 0NEW CONSTRUCTION o REPLACEMENT 0 AL TERA TIONS FURNACE MAKE AND MODEL 1JY~4n+- 3~A-V~"1l"1 FUEL 1\Jo.ftAm.1 FLUESIZE't11c!a.Sor. "EL RETURN OPENINGS A{. INPUT lb. 000 OUTPUT 5lD./)OO TYPE OF SYSTEM HEATING OR POWER PLANT (Phone) q5~ - W??5 -7':<7.2. S5o/./J..1 (Phone) IpSI- 45:L- cf?775 Eaaon _/f51.2~ v (City) (Zip Code) (Contact Person) OWarm Air Plants OGravity o Mechanical ~ Conditioning ~ent. System o Steam o Hot 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 lndustrial. Commercial & Multi-Family 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 & AIC (New Construction) Residential, Heating Only (New Construction) $39.50 $39.50 (%50 (Omcel~eOnl~ E This Application Becomes Your Building Permit When Approved ~~id; 'C=, C~ 0 W If: r~~eceiPt No. Building Official Date WteAPR 0 7 2003 II ffY (f(J 24 hour notice fnr all inspections (952) 447-9 "9. fax (952) 447-424s...._~1 uJ HEATING PERMIT FEE STATE SURCHARGE 'fOTAL PElU\1IT FEE $ $ $ PA./O W, tSU1LOING liH PERMIT Estimated Cost $ Building Permit # CITY OF PRIOR LAKE HEATING/AIR CONDITIONING/FIREPLACE PERMIT Date Rec'd ; ~;.:" ~:~y I PERMIT NO?'??-- I 3_ Yellow Applicant :...::;- tJ :> (Please type or vrint and sim at bottom) ADDRESS ZONING (office use) 5032 WEST OAK POINT DRIVE S.E. LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID OWNER (Name) DR HORTON (Phone) (Address) APPLICANT (Name) AT J .TED FTRFSTDF DBA FTRFSTDF HEA RTH &. HOME (Phone) 051.033.2501 (Address) 2700 NORTHFAIRVIEW AVENUE (Address) ROSEVILLE (City) <;5113 (Zip Code) (Contact Person) BRENDA HUSTON (Phone) _651.633.2561 APPLICANT SIGNATURE BRENDA HUSTON DATE 4/29/03 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 POWER PLANT OWarm Air Plants OGravity D Mechanical DAir Conditioning OVent. System o Steam o Hot Water D Radiation D Special Devices D Other Devices PLEASE NOTE: Air Conditioner Units Cannot Encroach into Required Side Yard Setbacks FIREPLACE MAKE AND MODEL HEATN GLO SL-750TR-C Industrial, Commercial & Multi-Family FEE SCHEDULE I % of job cost Residential, Gas Fireplace $39.50 minimum $99.50 Residential, Additions & Alterations $64.50 Residential. AC Only $39.50 Residential, Heating & Ale (New Construction) Residential, Heating Only (New Construction) $39.50 $39.50 Estimated Cost $ REA TING PERMIT FEE STATE SURCHARGE TOTAL PERMIT FEE Building Permit # $ $ .50 l3lJ. P"4/D 1LD,,.. w,.,.,., "'G PI:, "FiAif,.,. This Application Becomes Your Building Permit When Approved " ~i~ j) ~~~ L~ ~ ~o; l J Date L.I By Receipt No. (Office Use Only) Buildine Official Date VJ ,tjy 24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245 PRIOR LAKE INSPECTION RECORD SITE ADDRESS ~$ NATURE OF WORK USE OF BUILDING PERMIT NO. 03 - () 232. DATE ISSUED CONTRACTOR ]).R. t\CJtret-3 lwc... -?r(I NOTE: THIS IS NOT A PERMIT FOh ANY OF THE INSPECTIONS BELOW DEPARTMENT OF BUILDING AND INSPECTION Main File ~il6 SG. ~ THE PERMIT IS BY SEPARATE DOCUMENT INSPECTOR DATE l I FOOTING lM./. I ? ~ (7-0} I I FOUNDATION (Prior to Backfill) I i/f/{./ / YIIf? I J - N -O:J, / J' ~ 24 - U') PLACE NO CONCRETE UNTIL ABOVE/HAS BEEN SIGNED ROUGH - INS SEWER I WATER I SEPTIC fW./ c:....; ~/) - GQ FRAMING 5~o.,'V) (hJfh, Ul1[t:J t-/- 3D Vty/ j"- '1-C/3 INSULATION JIll( / s- / ~ ~ ELECTRICAL PLUMBING {].{~'_ v1A' t.Hl(-iJl; IvY' S--r-OJ HEATING (if required) VW- S - q- r.J) FIREPLACE GAS LINE AIR TEST GRADING (Prior to Sodding) BUILDING ~ lMkl 'i{~(..q'1 ELECTRICAL PLUMBING HEATING DO NOT OCCUPY UNTIL ABOVE HAS BEEN NOTICE COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED I I FINALS AljJ /Po/ /z_"Zu.cf 6'/~S---- VW' fVIJ 7-)-..&"Cf"; [;>)..0 -0'-1 SIGNED 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 _.--,._~-_._--,._._~'_.._-_.~,.._-_._-_...__.__._'-_.-.-..-.--.--. QIrrfifitafr of <IDuupaUty CITY OF PRIOR LAKE ~rpartmrnf nf '!iuilbing Jfnsprdinn (Final Permitted 'J Conditional e.O. Expires This Certificate issued pursuant to the requirements of Section 307 of the Unifonn 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: Use Classil1cation SINGLE F~"lILY Bldg. Pennit No Occupancy Type R3 _ Type Construction VN Fire Zone N/A Zoning District 03-0132 Rl Legal Description L:~, Bl, DEERFIELD 10rB Owner of Build' Ing Contractor's Na . me & Addre" D. R. HORTON ROBERT n .! 20860 . . HUTCHINS W# Date: ,t, /r-:B~ing Official .//2/'/ ;/'/ O~ Site Address 5032 WEST OAK POINT DRIVE BE KEN1lRIDGE CT., LAKEVILLE 55044 City Planner ')ON RYE Date: CITY OF PRIOR LAKE INSPECTION NOTICE ADDRESS ~QY OWNER PHONE NO. o FOOTING o FOUNDATION o FRAMING o INSULATION ~NAL o SITE INSPECTION COMMENTS: DATE TIME SCHEDULED ~~~-- tL4 S" /- c:Je;A ~/ 4- CONTR. PERMIT NO. o PLUMBING RI o MECH RI o WATER HOOKUP o SEWER HOOKUP o PLUMBING FINAL o MECH FINAL /" / /--1"/?q./ ,~/ U/c ~ //./"') /' ~ _/oS-e os- - .J3'.:Z- o EXIGRADIFILLING o COMPLAINT o FIREPLACE RI o FIREPLACE FINAL o GAS LINE AIR TST o -- ) /2 I'e ./ ------ ,~./ ,(WORK SATISFACTORY, PROCEED / 0 ~RRECT ACTION AND PROCEED R REINSPECTION BEFORE COVERING Inspector: /' Owner/Conlr: - !<ALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE. CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH'" SAFETY/ D<SNOTJ CITY OF PRIOR LAKE INSPECTION NOTICE SCHEDULED ADDRESS .Q)3L- 'w oq!c.lr OWNER CONTR. PHONE NO. PERMIT NO. o FOOTING o FOUNDATION o FRAMING o INSULATION jiJ- FINAL o SITE INSPECTION o PLUMBING RI o MECH RI o WATER HOOKUP o SEWER HOOKUP o PLUMBING FINAL )iJ'MECH FINAL COMMENTS: oI~) F,...~ I ~d. C'J/O"k tJI.O/>(}t/ZA. I 'd... TJ,..,...,\ ~ /a~ f/YlJ. / I V DATE TIME s=-.zo-C/'-( s -}.. ~J...., o EXIGRAD/FILLlNG o COMPLAINT o FIREPLACE RI o FIREPLACE FINAL o GASLlNE AIR TST o c!.a...1 tH'7~ +- k-(7)"c.( o WORK SATISFACTORY, PROCEED jiVtORRECT ACTION AND PROCEED o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING Inspector: K Owner/Contr: CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE. 'IUNOn CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY! DATE TIME CITY OF PRIOR LAKE INSPECTION NOTICE PHONE NO. /2-ZO.0<( 'lf~6:!'2 'V{< I- 1'9.. f( ;J j Dr- D. R.. 1-/01/0" PERMIT NO. ...0<- 2.. ~ L SCHEDULED ADDRESS OWNER CONTR. o FOOTING o FOUNDATION o FRAMING o INSULATION ~~NSPECTION o PLUMBING RI o MECH RI o WATER HOOKUP o SEWER HOOKUP o PLUMBING FINAL o MECH FINAL ~LLlNG '0 CQIIlaINT o FIREPLACE RI o FIREPLACE FINAL o GASLlNE AIR TST o COMMENTS: (..,r...u{...... AJ( uJ/b lS(z,~! oY_ rVWORK SATISFACTORY, PROCEED ~ECT ACTION AND PROCEED o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING Inspecto~ -So Owner/Contr: CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE. CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY! INSNOTI CITY OF PRIOR LAKE INSPECTION NOTICE SCHEDULED ADDRESS ~1>s.t. F, tY,k fiJ--r OWNER CONTR. PHONE NO. PERMIT NO. 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 'II PLUMBING FINAL o MECH FINAL COMMENTS: (tJ '-/ ch, A--Jd h("~ /r/ru/<o. ~1/'5 ~ of 1/I.Mv<. (0*""/15 DATE nile ?.2.K'" 'S-)3L o EXIGRAD/FILLlNG o COMPLAINT o FIREPLACE RI o FIREPLACE FINAL o GASLlNE AIR TST o ri1q~". b<+t, o WORK SATISFACTORY. PROCEED i2 CORRECT ACTION AND PROCEED o CORRECT WORK. CALL FOR REINSPECTION BEFORE COVERING Inspector: (l;f 7 - J,-t; -{?Owner/Contr: CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE. INSlIOTI CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY! Job Address Heating Contractor Name of Tester Date Percent 02 Percent CO Percent C02 Stack Temp -- 503;:;1. V. Mt<.. 'i,~ ;:f r~ slu./ov ~ (p (a (2J,OJ? n..... (,.<(r~ jOb'" ,L Combustion air is adequately supplied per UMC Sec. 606 jIt' 5 I input 1'd. titJt)