The URL can be used to link to this page

Home My WebLink AboutBldg Permit 04-0553 CITY OF PRIOR LAKE CITY OF PRIOR LAKE BUILDING PERMIT, TEMPORARY CERTIFICATE OF ZONING COMPLIANCE AND UTILITY CONNECTION PERMIT .5 -/ / -01../ MAY-03-2004 15:01 (Pl.... tl:1'! or.rim ond sin It bon om) , ADDRESS ';284 Y6''x TA-IL- 7/Z/1/L NW 9524474245 P.02 Date Rec'd ; r.-::. ~~,,~, I PERMIT NO. 04. 0553 I LEGAL DESCRIPTION (om<. use only) LOT1 BLOCK Z. ADDITION -r~ w/LD~ 67?1 /li/PI77oN OWNBR (Name) (Address) <'~'r--.l ~<.. BUILDER (Company Name) (Conraer Name) (Address) I ~ / ~c:.Z-'=);...;. \\-r),v\"iS<; -r Y't-&Z S;C..~Z.~?N g,;;ZA}C,V 1Ll.-~ ?/<::c,JY Ir-JC (Phone) ZONING (om" UK) f<J PlD 25"- '-1 IZ- e08' 0 (Phone) '?52 -'882 -1111 (Phone) ('~/Z - 1,;(35 - L..-I 34- Z//. 3vJ</o..J5JI'-l-,~ Mt0 ssIT7 ,t-.JG. Slh71i::c TYPE OF WORK ~N.w Conlt,u<,ion oDe<. CJPon:h oR..R.ofin~ e TIAddltlon DAlteratJon OLltihtY ConnectIon 0 MI~c CODE: .R.C. OI.B.C. Type or OftStrUttion: I II III IV v A B O=pancy Group: A B l! F H , M R S U D1vwon: 1 Z 3 4 S oR,.Siding OLo"'., Lev,1 Finilh 0 firepl.<< PRomCTCOST/VALUE S 2..41. bOO (ucJodinc11lld) J her'by cl.'rtiry !.bIt ll1i1ve r\lrn!~hcd inturmRllon OS'I this ilpplkiiU<nt .....hich is to (hI:' tint of my xl'low1cdgt' hllC ilnd ci)rtfCl, I nuo C'trlify thlll am In. owner ill ilUlht'lC'iZl:d "acnr for Utr ibl,)\t,.l'I\l:'nnoncd proptt~ !\\.iU AI lion will eonfnrm to 111 c~iJlll"lA slaw and IOClIIIWl /Ind will j'lrncred in iccordancc with submitted plans, ,I :10m .~ that tke buUdill1 111T1dI1 Ub rcvtlkc lhi,,permb ~r-u 1~1~ fo\lr1htrmQte, I hereby lcree that eke city nfncial or A dd~" may enter upon th~ D'!'opcrty to perform netdc:d IIl'pec:ttonl, X I/.-t., ./": . /L-. ~ . Igor, sl> /0""1 ;1 SilVJllture COl\tractor~s LiccnSt No. DACe I Permit Valualion I Permit Pee I Plan Check Fee State Surcharge' Penalty a tis.., ('J(7() 5 /r/d~.5() $ /:::;.t::(), a-'>.'"" $ '/d.J,/c,'O I: I : --I $ lOt? tJO 100 00 35. c,-o ut),--I Plumbillll Permit Pee I Mechanical Permit Fee [ Sew.! '" Wate! P.rmill'ee I Oas ffrlO4fferrnit Fee 1/ II f) t^. -'on t!C~o\lrB"lldIIl\fPcrmitWbenAplWOvcd (1'2;" Y Pale r Park Support Fee SAC Water Meter Size SIB"; I"; I Pressure Reduce, Sewer/Water Connecrion Fee Warer Tower Pee I Builder's Deposit I Other I TOTALDUE I Paid I Date yr,q I. 7B c:'JO.O~ /I # S $ I :3S{) , - $ :3<::'0,- S '? () ,-----" S t;}OO,--'" -7ctJ.- 1560.- ---- /I /I IS S $ s ~"9 J, 7f1 ! R~rC~9Cl I B / Thill ~ to <<nlr~ lh;it the request in the abOvc ~pplltauon ;md ilcc:ump;i.I\)'lrIa: doc\1m('na U in Il;CQrdanC:l: with Ibe CIty Zuni". Ot4il'luC'C 4nd Pl')' prl)eHd :It l1!Q\ll."Jtrd. 'rhi, document wt\('o 118ned by the City PI~nner ConJIltUTC!i illcmpura" e.rlilicatc (If Zolung Ctlm"h;lnCI: ,nd aUllljols t'onstlV'tIOl"l 10 C{\I'l'IMeN.'f BtfQ1'C~ ~lC"N~f\CY, .1 CcrtlrQle of OCrUtaliftCY mltll be .~. ;{:.i::."'1of - - ~M ~ 24 hnur norift Cor tl1ln"pc:c"tinnJi ('!'il) 44'.98~1 en. (1)~1) .(I47w42~ 16200 eaole Crock Avenue Prior Lake. MN 5~372 SJ*:\JIl COftditiona, If lift)' '~ ~~ White . Buildina <~an~ - ~naineeriruV Pmk ~ F-rlllilling Thr ('.,nlrr of Ih" 1..1<" ('ounlry BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT APPLICATION RECEIVED ''t:;.;..' / ,/ ./ I ~~! The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: "'""'. .-"" Accepted x Accepted With Corrections Denied Reviewed By: /}')I}J3 Date: 5"-21-0'1 Comments: See Reven:;!'! ~ide for Addition::!1 lofnrm::!tionl See Attachments: n Qrading Plan, 2) Erosion Control Meastlrp~ "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." '~ \6~' White - Building Canary - Engineering Cl"'lnK - ""ann~ - The ernlfr of Ih..I,lkr Counln' 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: / ( . Accepted Accepted With Corrections )< "'Denied Reviewed By: r U~ A.L'~~ ~y.-" g~~ ~ Date: (0/<.(/0 c.( ~~ Comments: '~ (J "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." /CIO'H'io-o> ~~ Ih~ Crnrn or Ihr I.akt ('ounlr} ClYhite - [luildind', Canary - t::ngineering Pink - Planning BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT {gPAKAA;J cM-n~ - - . ..:5 - 11-0 if APPLICATION RECEIVED The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: g rJ-t L/ - -::; cniC2d ",l/iAtP Accepted Accepted With Corrections :::::" By U ~-I-. Cl:o~:J() J~ /oJ;;: - I' - )1-- Date: &- 2 -0 V "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." 85/88/2884 11:35 5877445555 BADGER EXC ~Al1l:. ~l - , ". -. ~ ~ . ,.., ~. ~...., ~.. '\ '" ...... ,,' ll\......l\ .....h... 'It./....... Dale Rec'd CITY Of' PRlOR LAKE SEWER AND WATER PERMIT ~, ~:. ~,~ I PERMIT NO. 11., ~~ ,. c.l4 A""_ ., ..",:;).,J;I (7lc&.M ~. or Df'1.IIt ~ W &.t bomne) I ADDRESS -;j~g-I.{ ~ "'all \r~' I ZONING (O~ '''Il I LEGAL DESCJUP110N (otll.."" cnIy) I i Lor BLOCK ADDITION PID i OWNER ! (Narne) I (AddJes,) Sf' ue-r.sur--.. ~ /'5"" I W (-3......rNSo-JJq ~",..k.(.>..,~ (Addrt,.i (Phone) Q'S':L...J'82-777) ..J"# .J If 8c...V"lIs <St..Jk /J"ll\..l SS:3J i eei"" CZi!>Co4ol APPLICANT n I (Namt)_I:--'c..o.~ I (Addml) X" 3, ( S Ex.. (cu--' ..;1t-;;"'..., W 7aT1"\ S-tr~. (phone) .501-7'-1'1- SS"G.S"' !../Al.$ clJ.e ..ssv '-/ " (Ci",) eZl;> Cede) (phone) _ .~o7-(Y'f- .s~..s- DATl! (. -,f-CJ 'f (Con tIe! Peuon) I i APPLICANT SIONATURE (Addn1l) . Sc, "~L; S, /Y)(!"('.. A~~ APPLICANT PLEASE COMPLETE BELOW SI:l:C of wal.er 5ervice .....:::L. inches, , LOClltion of any tOl.lpllngs from SU\lClUl'e ~ feel. Type of sewer pipe. 0 ABC ~ 0 Call Iron Estimated lenlllh of sewer line.5Q feet, Clean out (ifreql.lired) located at ~._ feel from sU\lcture. FEE SCHEDULE R.,idonti.I..,...r and Wller 1\1\1 eOMeOllon Sl!,SO Indultrial. Com'l '" Mvlti.family 1% of Job cost with. SlUO minimum s.",., oonn'etion only $17,50 W&t.rconnccllon only $17,50 E.,irnated Cost S Building Pormit ~,.,.. 'q ~(~ , , I Thl. A.ppllCllion Booomu Your Bulidlnll PorrnH Wln" APpr~"d ,~' -~ (Ci'i1; n m '[c 'f'. I~t No. I DIL'. 'lto..~ rl 'l.IlIdi~1 Omtll.l ~. ho.' nollo. lor ,lIln,pIC'ion. (~Sl) 4" I 0, III (~1) "'-<14$ , !;ly_ .' SEWER AND WATER PERMlT PSB STATBSVRCHAROE TOTAL PERMIT FEE $ S S (omCt c., Otlly) " . . ',: ~ ' ,~' u r < MAy-e4-e4 1e:18 AM VALLEY AIRE 952 8ge 3351 p.el CITY OF PRIOR LAKE HEA TlNG/ AIR CONDITIONING/FIREPLACE PERMIT Dale Rtt'd !'~ J;t, I PERMlTNO.l./_ 55.8 ZONING (oflle'III') 1'.. \ ~ Ll) PID 5ev,..JsotJ 1401M.~s. I~I LV ~}loi. ~KvJ\J I (Phone) ,1{n. ')!L ~ !( ~,""K..J:\( oJ) (\.t\N S"C~ (l", , ~ ~r... "l' _._ (Phone) 'il'LC) v 'Ill \ lJ) I')b~ .~-+- <1101..<,",- ri (Addreu) - ('Cl1yl 1 ,.i (Contact Person) fv\.,' ~....... 4Ut~tJ (phone) ___~O - .f:iD 1 1~~!APPLlCANTSIONATURE .;J}f&.... .,~ DATE ~-.....-o., llJ> / 7APPLlCANT PLEASE COMPLETE BELOW '1::; ~EW CONSTRUCTION 0 REPLACEMENT 0 ALTERATIONS if" FURNACE MAKE AND MODEL Jtz """,-if'.< r;. s- 1..'..'._ FUEL IV^, T Iii FLUE SIZE :3.~_PVc.. __ RETURN OPENINGS INPUT 11l).-'~~, OUTPUT l..Q~/""') 1.:'-.:- l ,l, TYPE OP SYSTEM BRA TING OR POWER PLANT I: ,J::;, DWlIITTl Air PlantS 0 Steam J: o Gravity 0 Hot Wa,er H;.f-: ~CChanica.1 0 Radiation t-i", f':,',:,',:, 'r Conditioning 0 Special Devices I, 1" ' ent. System 0 Other Dovices t~~ ,FIREPLACE MAKE AND MODEL ,!, .f' ~ !/." , ',:~::! Industrial, Comme,ciel '" Multi-Family ;';': ::~~:{ ~!lldentiaJ, Heating & Ale (New Construction) (';; ,t,; a..ldentl.l, H..tinll Only (N.", Construction) .,:l:';/ tf.., Estimated Cosr $ Building Perinit # -, ,;lo~ .4\ IJ:: ;;~'i'l (_Of? ~~ f! i . REA TING PERMIT FEE $ ~~ 0i'-? !.. i ~~~~LS~~R~:E ~ .50 ~~~ ti' I (om!e Ule Only) '<-.:1l4 . \, i' Th",':::'~:-. "'::".."".':" ."ron' f!c;J~~ ~ ~o~ rf,'~N' =~_ 24 hour notke lor aUI..ptetlona (9S2) 447.$ ~ lax (9S2) 447.~24S - 16200 Eallle C~ek Avenue. PrIor L,I!fyMN 5537Z l '-4"1U I fY\,v ~'1 ~_Jk (Zip Code) PLEASE NOTE, Air Conditioner Units Cannot Encroach into Required Side Yerd Setbacks FEE SCHEDULE 1 % of job cost ResIdential, Gas Fireplace: $39,lO minimum $99,lO $600 $39,lO Residential, Additions & Alt"ations Resldendel, AC Only $39.l0 $39-'0 Ma~ 14 04 04:01p J~f'f' Scherer 952-447-6735 p.l Date Rec'd CITY OF PRIOR LAKE PLUMBING PERMIT S<z- \JQY'S:)", ~G\YI.!LS L Blue Fill! 1. Gold. City J. YellD'o'< ....pplicaal I PERMIT NO. ""tJn r?lcase tvp~ or mint and sim at bottom) ADDRESS ~d.~Y~r-\-oj \V"~l \ I ZONING(offi"=) I LEGAL DESCRIPTION (olli<< use: ollly) LOT BLOCK ADDITION Pill OWNER (Name) KD(..ks (phone) , (Address) APPLICANT c::. \-..n>c 0\ \' () \ \1 \" , -'"">1; (Namel .JC2...\ \\GJlQY '( Ui"\,\\)\Y\j (phone) -\~d..- \'4 l-\D I y.; (Address) Y~GD \\c:~kiCli" CJVcSe S'Z. \\-~Cl\- Lc...~ \\""\\'0 S'S 37;). (Address) (City) (Zip Code) (Contaet Person) -S ~ ~~ ""\ c..\"\Q..\( QV (phone) <D I J- - lL{ 1- ::;D is :5 APPLICANTSIGNATURE(~f:1J~~ DATE _01{~b3_ APPLICANT PLEASE COMPLETE BELOW Type of Fixture I Quantity I __ Bath Tub with or without shower I j-Rc5iJgh-ins Dishwasher ~ I Water Heater Floor Drain I ~ I Water Soflner Lavatory (Bathroom Sink) .........-1 I Stand Pipe (Washing Machine) Laundry 'fray (lor 2 eompartmt:!}t-5iiik I I Sewage Ejector I Shower Stall ./""' I Backflow Assembly I Sinks /- I I Backflow Assembly Test I Bar Sink./""' I I Lawn Sprinkler I Water Closet.Rf'oilet) I Other Quantity Type of Fixture FEE SCHEDULE Industrial, Commercial & Multi-family 1% of job cost with a $39.50 minimum Residential. New One & Two-Family $99.50 Residential, Additions & Alterations $39.50 Estimated Cost $ : ~~ i<::;:> 4! '0~ 1,*, ~"" ~~.",,,, Y,~vfi '\./.'\\ t@ ~ ~ \Xl ~i~ iPtNO\~._, Date I " - J 5 zJJt- 14 hour notice for aU inspections (951) 447-985. (951) 447-4145 y- Building Permit # PLUMBING PERMIT FEE STATE SURCHARGE TOTAL PERMIT FEE $ $ $ .50 (Offite Un Only) This Application Becomes YOllr Building Permit Wben Approved Building Official By CITY OF PRIOR LAKE HEATING/AIR CONDlTIONING/FIREPLACE PERMIT Date Rec'd I. Pink 2. Green ). Yellow ~::y I PERMIT NO.l1L ^J::. ~"Z. Applicant ~ (please ~ or Print and sian at bottom) ADDRESS ZONING (office use) 3284 FOXDALE TRIL LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID OWNER (Name SEVERSON HOMES (Phone) (Address) APPLICANT (Name\ ATJIFn FTRRsmR DRA FTRRsmR HRARTH IV HOMR (Phone) 651-633-2561 (Contact Person) BRENDA HUSTON ROSEVTr TF (City) (Phone) _651-633-2561 ';5113_ (Zip Code) (Address) 2700 NORTH FAIRVIEW A VENTII' (Address) APPLICANT SIGNATURE BRENDA HUSTON DATE 7/19/04 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 POWER PLANT OWa,m Air Plants OGravity o Mechanical DAir Conditioning OVen!. 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 Setbacks , FIREPLACE MAKE ANDMODEL HEAT N GLO 6000TR-OAK Residential, Heating & NC (New Construction) Residential, Heating Only (New Construction) FEE SCHEDULE 1 % of job cost Residential, Gas Fireplace $39.50 minimum $99,50 $64,50 $39,50 Industrial, Commercial & Mu1ti~Farnily Residential, Additions & Alterations Residential, AC Only $39.50 $39,50 Estimated Cost $ HEATING PERMIT FEE STATE SURCHARGE TOTAL PERMIT FEE Building Permit # $ $ $ ...."'...........-lI../w'JJ-.. 'l! Ir- \~~l -__-,~,..~, ,50 - ~.:.LJ.:J\~" 1)"", 'eM " (Office Use Only) Buildine Official Date I:)J~ l~ l_~ U W ~ l' Receipt No. WaljUL 2 2 2004 I By -1 This Application Becomes Your Building Permit When Approved 24 hour notice for all inspections (952)447. ~~O. fax (952) 447-4245 PRIOR LAKE INSPECTION RECORD DEPARTMENT OF BUILDING AND INSPECTION SITE ADDRESS J.;lAl\ t;.>e 1:t \ \' r- NATURE OF WORK ~ USE OF BUILDING Sf r') PERMIT NO. (J4. 05>J> DATE ISSUED c..-2.-o..../ CONTRACTOR 'S"\I.t1~ I~~ PHONE lDl2.-c..el)-'Z.IAI{ Co.Il NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW THE PERMIT IS BY SEPARATE DOCUMENT QS2-882.--n1'7 DrriCo( I FOOTING ;'~ I ~::-o l FOUNDATION (Prior to Backfill) I ~ ~ -2> I PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ROUGH .... I~~ SEWER I WATER I SEPTIC /7'.-/ ~-<:;:> FRAMING wi" ..J1:Y./ INSULATION ~/IJ ~~y ELECTRICAL PLUMBING HEATING (if required) FIREPLACE GAS LINE AIR TEST M.....::rf ~, COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED ICu~......l Sb..L t~ I J . ~ I . FIN A L S 6) lS..s.e.-a- {~UJ.4I J-"/I J'i ~ ~ 17/ I? 7 - 1- 7-r,l{ tT"8 ;>'/r M'/ ~ 7 A/7-'1 7- t-?~ . GRADING (Prior to Soddinfl) BUILDING l~ J.." 3-/.o,!/; ELECTRICAL / PLUMBING HEATING DO NOT 11- C, dJ pI)' 7}/<5)O:s VJb IIi v OCCUpy UNTIL ABOVE HAS BEEN SIGNED NOTICE I . Io"J 10 -l., 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 DATE TIME CITY OF PRIOR LAKE ~ INSPECTION NOTICE SCHEDULED 325<1 AODRESS tb~ \a.-I \; OWNER CONTR. PHONE NO. PERMIT NO. '-I -,~~ o FOOTING o PLUMBING RI o EllIGRADIFILLING o FOUNDATION o MECH RI o COMPLAINT o FRAMING o WATER HOOKUP o FIREPLACE Rl o INSULATION o SEWER HOOKUP o FIREPLACE FINAL o FINAL o PLUMBING FINAL ;GA~~R TST o SITE INSPECTION o MECH FINAL COMMENTS: 6~ .- . +-..s. :\ r l~4..' - ~ ~G I ~WORKSATISFACTORY. PROCEED o CORRECT ACTION AND PROCEED o COtJIDCALL FOR REINSPECTION BEFORE COVERING Inspe or: Owner/Contr: d . 85D FOR THE NEXT INSPECTION 24 HOURS IN ADVANCI;. CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI INSNOTI CITY OF PRIOR LAKE INSPECTION NOTICE SCHEDULED DATE TillE ? -(, OJ ';(:a:J ADDRESS ~2J~ ~lk, ( 1f'<1' l CONTR. ~evc!YJ'") 1-/" M"'i OWNER PHONE NO. PERMIT NO. o FOOTING o FOUNDATION o FRAMING o INSULATION ~INAL o SITE INSPECTION o PLUMBING RI o MECH RI o WATER HOOKUP o SEWER HOOKUP o PLUMBING FINAL o MECH FINAL COMMENTS: /,u /10 1)01<- 1") k:. 1-1 rC1 vlt - bt.. eN..!- SS3 )(~ILLlNG o COMPLAINT o FIREPLACE RI o FIREPLACE FINAL o GASLINE AIR TST o TraoS Sod"", ~r; )-~,~ (WORK SATISFACTORY, PROCEED o CORRECT ACTION AND PROCEED o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING Inspecto#4~- Owner/Contr: - CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE. ,,.,,.,,., CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY! DATE SCHEDULED /o~ ADDRESS ::QB"/ Pok.J....l 1;.. TIME CITY OF PRIOR LAKE INSPECTION NOTICE OWNER CONTR. PHONE NO. PERMIT NO. t( -O~SS o FOOTING o FOUNDATION o FRAMING o INSULATION .Jlf FINAL o SITE INSPECTION o PLUMBING RI o MECH RI o WATER HOOKUP o jEWER HOOKUP )2'1'LUMBING FINAL o MECH FINAL o EXIGRAD/FILLING o COMPLAINT o FIREPLACE RI o FIREPLACE FINAL o GASLlNE AIR TST o COMMENTS: I. ~jotD.l o.~...I-t il\spOrJ..~_ C'.-.l\ 't5:l~ LItO - "IR:~o '2..., ~.&- T....el' ~. Scr"IJ ~""'~~ ca.\- ~ rv\~ ~ ~~r- Nt,U........g lalf.,.... ~ F.~ a.r..A. ~ ~ ~-I- oC;- ~, !/. f). _fll{~~ uKW ftJ; ~-r- o WORK SATISFACTORY. PROCEED o CORRE CTION AND PROCEED X CORR CT RK, CALL FOR REINSPECTION BEFORE COVERING Inspect ' f /V Owner/Contr: C US50 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE. :...J-" CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY! ''''NOn . LP Gas Natural Gas ~ JobAdd~q~ ~-+14-1 Tt Heating Contractor~NC. Name of Tester - ;:, ..... -; - Date /O-L/~nU Percent 0, Q" I Percent CO () '7 , 9,c;-V _,7.(;~ ::t,()/~ J/() ~U- Percent CO, Stack Temp. Pressure Input