HomeMy WebLinkAboutBldg Permit 04-0711
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
~ --Jj}- -{) L/
I PERMIT NO. 04 ,07/1 I
White File
Pink City
yello..... Applicant
(Please rvee or print and sign at bottom)
ADDRESS
Ill'7 Lj Lj
,~................~..l;;' ~e:.. ,,,--
,,~
N'-">
LEGAL DESCRIPTION (office use only)
LOT "1~BLOCK \ ADDITION""'\ "'-___ ~"'...~.,.
""" ''-- '-"-'>.,~"'~
OWNER
(Name) "" "-" '- ~ ",,-...=..::.-... ~
\.~'lt~":..."Q"""""
(Phone) ,...." :;:,s', "" >.'\
(Address) ~,~........... "'_____
BUILDER
(Name} ~~~...............----
(ContacIName) \.,<><"'-
(Address) ,~"" <::.
,"',,"--'"-
ZONING (office use)
p L.( tJ
PID d.l] ~3 f3-0YJ-d
(Phone) ~~S" ~I:>'" ""-'--.<> <;;>
(Phone) "',~ ..~, ",......,_
~t\....-..
~-"".-
""""'........
TYPE OF WORK
rE. New Construction
19Deck
ORe.Roofing
DPorch
1ji1Lower Level Finish
J!J Fireplace
DAddition
DAlteration
PROJECTCOST/VALUE (exc1udingland) $ ~ ,,",~I..), 0<;<::>
DUtility Connection
o Misc.
DRe,Siding
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 \.'\<:..<;-. ~""-", ---< \""~~
Signature Contractor's License No.
I Permit Valuation 4ql) )(JtJlT I Park Support Fee
I Permit Fee $ :'3 fld .-5'CJ I SAC
I Plan Check Fee $ ;:):J..{)5, 7 R I I Water Meter Size 5/8"; I";
I State Surcharge $ d {IS,--- I Pressure Reducer
I Penalty $ I City SAC and WAC
I Plumbing Permit Fee $ tOO. -- I Water Tower Fee
I Mechanical Permit Fee $ L06.~ I Builder's Deposit
I Sewer & Water Permit Fee $ ::gS.5D I Other
1 Gas Fireplace Permit Fee -$ LltJ ' tJO I TOTAL DUE
This Application Becomes Your Building Permit When Approved
~~
I Paid I::J-./J Ir'( - 'l ~
Date --; - / '-1- '-/
,
Building Official
7j?zla<l
Date
#
#
#
#
W ,'t;.L~,,-
Date
$ Or- (JO
/)~"'JO-
$ 1?J~-o,OO
$ 300,00
$ 70,O()
$ /;)-00,0<;
$ 7cJo.OO I
$ I~ 00,00 I
$ I
$('2. {)8Q. 1?J I
I R.eceiT2.INoli'7Lf /5
By ~
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
~ ~ 7?Z~'/ fi~J( o.L{ . -4 L-.,._ -'~
Planning Director Date Special condit~ "
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake. MN 55372
~
Q~1
While - Building
Canary - E!1qineering
Oink - !'llInnin,:, -:>
Thf Cenln of lh.. I..h Counlrl
BUILDING PERMIT AppLICATION t)EPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
_1(
) ~ ..
/
~-
'" ....,
..-..., .')
!:;' I
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
II ),/,,/'-/ / ~ -
L,
Accepted
Accepted With Corrections
~
Denied
Reviewed By:
~
~ a...U
,
0-, {J.I- Date: 7 /1 ~~ '-I
~- . -(}, ;,;)
Comments:
"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,"
@~
CJUhi~,: - Rui~
Canary . ~iigrneering
Pink - Planning
Th~ (...nl... or Ih.. 1..10.. ('ounlry
NAME OF APPLICANT
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
~~~
APPLICATION RECEIVED
~, ;::). 'd--()L!
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
/Lj/}LjtJ- c4~~ ~
Accepted
/
Accepted With Corrections
Denied
Reviewed By:
~,:
~
~
,.:t~Q /-J
u.-e.C ~ n-.":."K.
Date:
7/;-z...lav
Comments:
"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,"
{C~~.~ "KIO/?,
!::: ~
U en
White - Buildinq _
(..!:iiIWIll( - t:nqlneermg..>
PinK - Planning
Th~ C""ln of lht' Lak.. Counlry
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
!
NAME OF APPLICANT
APPLICATION RECEIVED
}t ,",{,_~_,...
,4-_/
.)
.I ,..
. ;
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
,/ {./"J //,-:'./.-
/ .. . /
"..--;.-,
/\
/_~ Jl /}_ 1,;( '"" _ ,~.J-.-(._.....,
Accepted
x
Accepted With Corrections
Denied
Reviewed By:
m4A
,~
Date:
/- /-01./
.
Comments: See Raverse Side for Additionallnformatinnl :
See Attachments: 1) Gradin~ Plan, 2) Rrosion Control Measures
"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,"
JIL 23. 2004 849AM GENZ RYAN SERVICE. NO, 683
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
p, 4
Date Rec'd
(Plellle Me or'DrinI: And siRD. at bottotn)
ADDia14 ~ Tfm ~ CJU~+ 11V .
i:;, ~:~ I PERMIT NO.AiL. ~ II'
J, Ydlaw ""llu.nl r ~ .t.l..L.U
ZONING (omce 'Ie)
LEGAL DESCRIPTION (o/Bco u" only)
LOT 30 BLOCK I ADDITION 1nI. W11xl...( ~ Wi I d..
PID
OWNER
~mne)~o~~~" ~~m~e
(Phone) ~51_9n'_17no
Eagan. MN
55122
(Ad~~s~ 1895 Plaza Dr Ste 200
APPLICANT
O'un~~n.-~v.~~mhjng & He"";n.
(Address) 14745 So Robert Trl
f'\/A "'~N.: ~~'ts
(ConlactPerson) -0'tfUUt I ~, - -P' .
APPLICANT SIGNATURE (Ij~) ~
(phone) ~o;l_b.?~_11~l<
Rosemount, MN
(City)
55068
(Zip Code)
(Phone) _..r,1_l<?1.::.l.1.4.4 .
_ DATE ?-,51.8..()cj
APPLICANT PLEASE COMPLETE BELOW
~NEW CO~~]lCTION .1;) REPLACEMENT 0 ALTERATIONS
FURNACEMAKEANDMODEL LUtnQK . bl~2Uf-Uv'D" /3t;; FUEL n:x.f. qas
FLUE SIZE RETURN OPENINGS It{ INPUT J3'5'IOOo OUTPUT ~ ~l
TYPE OF SYSTEM HEATING OR POWER PLANT
~W...m Air Planu 0 Steam
OOravity 0 rIot Water
o Mechanical 0 RAdiation
<<p-ir Conditioning 0 Speoial Devioos
DVcnt Sy.tem 0 Other Dovlces
PLEASE NOTE:
Air Conditioner Unlls
CanIlOt Encroach into
Required Side Yard
Setbacks
FIREPLACE MAKE AND MODRL
FEE SCHEDULE '
Indul[fi.I, Commeroial &. Multi.Family 1% of job cost Residential, Gas Fireplace
139,SO minimum
Residential, HCllting & Ale (New Construction) S99,SO Residential, Addilions & Alterations
Residential, Heating Only <New Construction) $64,50 Residential, AC Only
$39,50
$39,50
S39.50
Estimated Cost $
Building Pennil #
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
s
.50
-"1"
.., , ...
~ ,r,... 11;-.. ~
. "',-., , '/ -,
-' ...,':?..~:.3.~~"",,'.... I
1.1'3'J.l ,......... ~1 '
, ",....'"7:....~
'f"'_. Us. ,Only)
. .... Application Become. Your Building Permit When Approved
BuUdln~ OfficiAl
DlIo
24 houl' not/oe for All In.pection. (952) 447.1i5n. In (Q~1~ 441-4245 , -J
'~~ @[EO 6J mfi)~rceiPt No,
MatdUl Z :J 2004 [!J/Y ,
JUL. 23, 2004 8:49AM
l'fkue 1V.2~ or t1ti.a.t and .siE'.,ll at bottom)
ADD~i41t{4 Tfm~ OIUbt 1rJJ.
~ Wi 1M
GENZ RYAN SERVICE
NO. 683
p, 3
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
IlJJu Jill
z. Gold Cily
1, Vella. Appliclul
I PERMIT NO. 04-. ern I
ZONING (ome. ",,)
LEGAL DESCRIPTION (office "Ie only)
LOT 'WBLOCK11 ADDITION 1Y\L wm>&
Pill
OWNER
(Name) Wensmann Homes
(phone) 651-905-3709
(Address) 1895 PIau Dr
Eagan, MN 55122
APPLICANT
(N~e) Gen~-Ryan Plumbing & Heating
(Address) 14745 So Robert Trl
1"1,,,, JAdd,rest_. ~
(Conlllct Person) J,&J ~&t1 f'\J~ ~ ...p " .
APPLlCANTSIGNATURE ~~
QUll/ltity
-~
;
(
'5
(
1
,
lI.i
,~
(phone) 651-423-1144
Rosemoune. MN
(City)
55068
(Zip Code)
DA:l-~~1~~4!oq
(phone)
APPLICANT PLEASE COMPLETE BELOW
I Type oll1'i,;ture
Bath Tub with or without shower
I Dishwasher
Floor Drain
Lavatory (Bllthroom Sink)
Laundry Tray (lor 2 compartmeul sink
I Shower Stall
I Sinks
I Bar Sink
I Water Closet (Toilet)
Type of Fixture
QUllUtity
...:?
i
o:z.
,
Rough-ins
Water Heaier
I Water Softner
I Stand Pipe (Washing Machine)
I Sewage Eject{)r
I Backflow Assembly
I Backflow Assem bly Test
I Lawn Sprinkler
I Other
FEE SCHEDULE
Industrial, Commercial & Multi-family 1 % ofjol> cost with a $39.50 minimum Residential, New One & Two.Family $99,50
Rosidcntial. Addition. &. Alteration. $39,50
Estimaled Cost $
Building Permit 1/
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTALPERMUTFEE ~
,so
'1'-,
_" ;"1'.'11"'-.
.""'7 -,. II ~.
_'\f.:' 7"~.3"~ ' j
....17"1"..-.-
--..""1),..'...;;",....-
'[2 ~~\I . '....1.: I'
r ' '4 !
~l coipt No,
~
(om.. u.. Only)
This Application n..olne. Your Btrilding Permit When Approved
Buildln.Omd'l
Dole
24 bour notice ror ,U in.pectlon. (952) 447-9KlK
','IJ4.)"
u.;-
JUL, 23. 2004 8:49AM
GENZ RYAN SERVICE
NO, 68 J
P 2
Date Rec'd
CITY OF PRIOR LAKE
SEWER AND WATER PERMIT
LEGAL DESCRIPTION (offic. use only)
LOT~BLOCK I ADDITIONi1J\O, WttYk @ Wild~
~ ~':. ~R~ I PERMIT NO.....I ;I" II'
J.o.hf A,plieanl ~
ZONING (olT"" '''1
PID
OWNER
(Name) Wensmann Homes (phone)
651-905-3709
(Address) 1895 Plaza Dr Ste 200 Eagan, MN
(Addr...) (City)
APPLICANT
(Name). Genz-Rvan Plumb ins & Heatins
(Address) 14745 So Robert I~l
ill'~~~ .
(COlltaCI Puson) _ IJ/l ~I ~ '
'~ICANT SIGNATURE ~
55122
(ZiD Co~)
(phone) 651-423-1144
?_~~~_1~. '1"
(CilY)
illQ.!I
(Zip Code)
(Phone)
DATE
6H-4U:.l)44 ,
1"~~,
APPLICANT PLEASE COMPLETE BELOW
Size of water service inches,
Location of any couplings from structure
Type of sewer pipe, 0 ABC 0 pve
Estimated length of sewer line feet.
'Clean out (if required) locate<:l at feet from structure,
feet.
o Cast Iron
Residential sewer and water line connection
Sewer connection only
FEE SCHEDULE
$35.50 Industrial, Com'l & Multi.family 1% of job cost with a $39.50 minimum
$11,50 Water connection only $17.50
Estimated Cost $
Building Pennit #
SEWER AND WATER PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
(om.. u.. Only)
s
$
$
" ~
,..../.1-'\ '1..--.,
'"::',""" , -' ---~, Jt."
"",lDi~:'"\"", I, j
J ~jU-:~l.~~,-.;
'.'..1,-
,so
__.__n
This Appll..Uon Decome. YO"' Bunding Permit When Appro~.d 11\"ilil (i\l, ru,~ TI"'W-U \0; iln,*.'iPt No.,
III I U; tlJJ Ie, L l. I_~ f 'I fJ
I, rrate ' II'B;Y
BulJdlog Omdll Pot. ~ l .1111 ! jJ 2mj~ I: "
24 hour notice ror IUlnspe.tion. (952) 441.9 ISO, rax (952) 441-4245
8y_-..,.'.
I'
I
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
(Please tUH: or olint and siJm at bottom)
ADDRESS
;:i:'~ ~::, I PERMIT NO.O+. 07/1 [
3. Yellow Applicant
ZONING (office use)
14744 TIMBERWOLF
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION
pm
OWNER
(Name WFNSMANN ROMPS
(Phone)
(Address)
APPLICANT
(Name) ALLIED FIRESIDE DBA FIRE<TDP UP A_~"'U'" T;JOMF
(phone)
1i51.1i33.251i1
(Address)
2700 NORTH FAIR VIEW A VENlJl'
(Address)
ROSEVILLF
(City)
55113_
(Zip Code)
(Contact Person)
BRENDA HUSTON
(phone) _651.633.2561
APPLICANT SIGNATURE
BRENDA HUSTON
DATE
RI2li/04
APPLICANT PLEASE COMPLETE BELOW
xD NEW CONSTRUCTION 0 REPLACEMENT 0 ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE .oF SYSTEM
DWarm Air Plants
DGravity
o Mechanical
DAir Conditioning
DVent. Syslem
HEATING OR POWER PLANT
o Steam
o Hot Water
o Radiation
o Special Devices
o Other Devices
PLEASE NOTE:
Air Conditioner Unils
Cannol Encroach inlo
Required Side Yard
Selbacks
FIREPLACE MAKE AND MODEL
HEAT N GLO 6000TR-OAK
Industrial, 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 & Ale (New Construction)
Residential, Heating Only (New Construction)
$39,50
$39.50
Buildine: Official
Date
Building Permit #
$
$
$
-.....
~ It' '" r:s-Ifl m '
U -l!aili'D [.s (II 1'1 I
~ ~r 1 02004 I)' By
I
PAID "Vv lit!
_5~Ull.DING
Eslimaled Cosl $
REA TING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
(Office Use Only)
This Application Becomes Your Building Permit When Approved
24 hour notice for all inspections (952) 4tfS?,!'iO raY (9521.44':'-4245
r FOOTING
SEWER I WATER I SEPTIC
FRAMING
INSULATION
ELECTRICAL
PLUMBING
HEATING (if required)
FIREPLACE
GAS LINE AIR TEST
D!=PARTMENT OF
BUILDING AND INSPECTION
DATE
J
7 - Z,;Z,..,-Cl 'f
,
7PY/Qc(
cj:-/ ?
---
7:-/S
lI/rJY/~
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
.
'M:ZlIe/@~rtI/tIfiJ~1 I
~ "",~:w.~J. FINALS
. GRADING (Prior to Sodding) P..P'
BUILDING-J........,p .j.,.., ~.l-f'l':1
ELECTRICAL '
PLUMBING
HEATING
DO NOT OCCUPY
PRIOR LAKE
INSPECTION RECORD
SITE ADDRESS /r'll/t./ 7iiM~IAJ"Lr 7iU. III./AJ.
NATURE OF WORK ~ II,) a,Js~S7?"~ .
USE OF BUILDING S~F:f).
PERMIT NO. 0 ~. 0 '1// Qe-TE ISSUED 7/1 z.hl/'
CONTRACTOR 1J}E1V~~IJ~ '/Hilla p~. UI-7m
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPE0v
I FOUNDATION (Prior to Backfill) I ~ I '< /2,yft--/
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN 'SIGNE'D
ROUGH - INS
11)!: ~.; (~
I.~ ?..~~
~~
W.
, ff/b
/l.
rIJ
/l
V:7:r
CI~
UNTIL --A-aOVE
NOTICE
HAS
/~/~ ~
" J /
II!fS'/&'/
11/2.'+I,,-.j
BEEN SJ(~N'ED
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
, , ,."._~._.__________.___.__"_..".._..__..,,___.__ '___..____._______.____.__w.____ ._
OATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE SCHEDULED /1-1 J-vy
ADDRESS / '17'11 r/#i41' wjJl{..' t:rl
OWNER CONTR, 1/11(,., (m",,,,,,, ;-/0,.,."
PHONE NO.
PERMIT NO,
ot(- 7//
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
o PLUMBING FINAL
o MECH FINAL
, ),(,,"""tV.MILLING
OC~T
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
COMMENTS:
(~f'Cf/:k - /0 Ie..
(" /0 rsu 7" iJ) It.
J4vORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTlON BEFORE COVERING
Insped.Or//'tt.p~ /" Owner/Conlr:
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
I. DA'I
7 j? Jev
...
TillE
ADDRESS J C./7 l.J 7 T.....I... I>.J.U .,0 ( P
OWNER
PHONE NO,
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
';l FINAL
?c; SITE INSPECTION
COMMENTS:
I
01......;' J
c:>""l,
CONTR,
PERMIT NO,
L/_ () 7/1
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EXIGRADlFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
~
~SATISFACTORY. PROCEED
o CORREC TION AND PROCEED
o CORR T ALL FOR REINSPECTION BEFORE COVERING
Inspect
C L '"7-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
Owner/Contr:
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY/
llaNO"
CITY OF PRIOR LAKE
INSPECTION NOTICE SCHEDULED
ADDRESS ft.I7lj'l T....~ (l.
OWNER
,/:~l.
I~
TIME
PHONE NO,
CONTR,
PERMIT NO. 9 -(') fJ I
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
:J!. FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
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
o
CQMMENTS: _
~ (4,~ ~ ~ .D;.ds~..
:2. t:',...,J, r.:;~ lIACU.lIlI&,.,.,.,.. ~.tf s;,,(
3. Ma.",,\.J...~ ~.~ ~..J
d. ~.L.~~
I)'~ ~
tf-I-Q1\
~~~
o WORK SATISFACTORY, PROCEED
o CORRECT A N AND PROCEED
)BLCORRECt LL FOR REINSPECTION BEFORE COVERING
Inspector: '7 Owner/Contr:
CAL 9850 F~THE NEXT INSPECTION 24 HOURS IN ADVANCE,
CODE REQcn:;MENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY/
INS1WTI
DATE nME
CITY OF PRIOR LAKE
INSPECTION NOTICE SCHEDULED 11,/r<;;/ocf ZJ Sa,
ADDRESS / l./ 7 1./ <-( I ~ &U,
OWNER
PHONE NO,
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
COMMENTS:CW
"
CONTR,
PERMIT NO, -.r:; t( - 7 ( I
o PLUMBING RI
o MECH Rl
o WATER HOOKUP
o SEWER HOOKUP
'iiCPLUMBING FINAL
tJ MECH FINAL
o EXIGRADIFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
,. (
~ 4- -r-~.p:;, (if ~ rf:Z(ulJ
tvt "/l.-( J ~ ""
~~~.
(J
-~
~
,
~
II
o WORK SATISFACTORY, PROCEED
~CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: ~ < Owner/Contc.
CALL "7-9~O -;lOR THE NEXT INSPECTION 2. HOURS IN ADVANCE,
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEA.LTH & SAFETY!
INSNOfI
uvu nuu' "''''...,. . .. -. .
Heating Contractor~" .e..vA-rl
Name of Tesler
Date II/I'f /od
/,7.-
"
Percenl C02 'i. I
11"".
Percenl 0,
Percenl CO
Stack Temp
Combustion air is adequately supplied per
UMC Sec, 606
Input 13Z.~
--
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