HomeMy WebLinkAboutBldg Permit 05-0067
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
See Main File
Date Rec' d
I 1/,06'
White File
Pink City
Yellow Applicant
I PERMIT NO. OS, (JO&11
(Please ~e or P1 lot and siEll at bottom)
ADDRESS
)'l41) l).,......r--0<o-\cJ.... DY"'I.l<-- s,~
ZONING (office use)
/CL
LEGAL DES :RIPTION (office use only)
LO~ BL JCK.;L ADDITION <-D.u~~,"<C ~(.,Q \ \ ~
PID 25". -Iv7. 04-7. 0
OWNER
(Name)
(Phone)
(Address)
BUILDER ....., n \ \
(Company Na me) U. ''-. H-ov-to ~
(Contact Name) V\Aik LUOh"''''U.+I:'-<<....-/
~'6'(.,.O ~>--,t-LLr<-c-.\.
1 fA \LuJ I U.... , M jJ' s.~o y LJ
(Phone)
(Phone)
C(S:J- ci~S-'TW<S'
C\S'd- .d--d-~ '-\{~ d-
(Address)
TYPE OF WI)RK )E;[ New Construction ~Deck DPorch ORe-Roofing ORe-Siding ~ower Level Finish D Fireplace
"El\.ddition DAlteration DUtility Connection D MISC.
CODE: IXILR C. OLB.C.
Type of &;'nstr lclioD:
Occupancy Gn up: A B
Division:
I
E
II
F
I
III IV
H I
2 3
V
M
4
A
R
5
B
S U
PROJECT COST IV ALUE $
(excluding land)
htLL, ,t~
[11.,33 Y
J.JJ/o I
I
I hereby certity 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.mentlOned pi )perty and thaI all construction will conform to ail existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official can revoke tl is permit for JUSl cause F~heml()re, I hereby agree that the city offIcial or a designee may enter upon the property to perform needed Inspections
X ~~~ d-oO<'S\"'Sf \\\D\bS
"- Signature Contractor's License No. Date
Permit Valuaticn iril./ /. 000.00 Park Support Fee # $ I
Permit Fee $ /2.99.50 SAC # $ 1 'Iso ,0 0 I
Plan Check Fee $ Po/ tf. (" po' Water Meter ($i;e "5!.i? 1"; $ Z.S-O.OO I
State Surcharge $ 70.<"0 Pressure Reducer $ 50,00 I
Penalty $ Sewer/Water Connection Fee # $ 15dtJ,OO I
Plumbing Perm It Fee $ 100,0 C!) Water Tower Fee # $IOOCJ.DO I
Mechanical Pel mit Fee $ (OO,OO Builder's Deposit $ I
Sewer & Water Permit Fee $ ~,~O Other $ I
Gas Fireplace I ermit Fee $ 40,O~ TOTAL DUE $ ~, 7 tl-O J r I
This Applicatio 1 Becomes Your Building Pennit When Approved Paid "7'; IJ.tY ReceiptNo. ~2.
~~ ~ 1//~/(j5 Date I.;;L ,O,r-- By ./1
c:r
Buildll.!!. Otlicial
ThiS IS to certify th, t the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may pwceed 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
~~~~'Pl~t:,) 4a~~ See l\!i~!!!s'i!:ile
24 hour notice for all inspections (952) 447-9850. fax (952) 447~4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
(I)
fhe C~ntpr "r lhf l.akt (""unlr).
See Main File
"--Whita - Ruildin~ """""">
- Cana',-y - l::.iig,neerlng
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
N4ME OF APPLICANT
APlpLlCATION RECEIVED
. , .
tJ) '-Ie ~~9/l/
I II. 06
Th ~ Building. Engineering, and Planning Departments have reviewed the building permit
aPl";oa~~~';;ru"1C;+;Z~ / C;;
/
AGo :epted
Accepted With Corrections
De lied
~~
,...
~~
Date:
//;9,/or
I
Re Jiewed By:
Co Tlments:
8ee-Main File
"The issuance or granting of a permit or approval of plans, specifications and
cOflnputations 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
pre suming to give authority to violate or cancel the provisions of this code or other
orc inances of the jurisdiction shall not be valid."
~XJ'RIOI)',/
t '~'-;.
U . ~
See LVlain File
White - Building
Canarv - Enqineering
a.u;.1c ~nnin~
'-
TIH ('~"le nf lhe J,mke (-ounTr)'
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
N! ,ME OF APPLICANT
AF'PLlCATION RECEIVED
/1
, ,
oJ,/) J,.v/(--r--, /}' /
/1... .../ It {. ,I _./
III,C.;;-
The Building. Engineering, and Planning Departments have reviewed the building permit
ap Jlication for construction activity which is proposed at:
jr/',.;tNr;' ;'/' 'f' / ",
I "{ f,-I> ( II-{' A>\.../ j,)/ I / , c.....-
, I
, ,
'J
// '}
~
.
I,C
...
Ac ~epted
/'
,~,
Accepted With Corrections
De nied
Re viewed By:
~
;JulJr--
Date: / Ii 9:~ r
- Co mments:
,~
St:el\tlain File
'The issuance or granting of a permit or approval of plans, specifications and
conlputations shall not be construed to be a permit for, or an approval of, any violation of
an~ of the provisions of this code or of any other ordinance of the jurisdiction. Permits
pre suming to give authority to violate or cancel the provisions of this code or other
ord nances of the jurisdiction shall not be valid."
~~
~
/~~~
See Main File
White~
~narv - En~inee~
Pink - Pla'nmng
"
Th.. ('f""~ of Ih.. J.ak.. Counln'
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
1/'-
I, /1,
[I \./
. ,
,,-'.;J ,~,---'/', if'~ .<
'Ie. ~U? '_./
I /1. cC
T1e Building, Engineering, and Planning Departments have reviewed the building permit
aJplication for construction activity which is proposed 'tt: /',
j',7,f '1 8 /~62iL/{(--t~:;('.- /(1:1AG(.-, {~
I {/
A ~cepted
x
Accepted With Corrections
D 3nied
R 3viewed By:
/!IKff;
See...- (J1c,/", F;-II
Date:
1- Z(!)-O$
C Jmments:
"T he issuance or granting of a permit or approval of plans, specifications and
cc mputations shall not be construed to be a permit for, or an approval of, any violation of
ary of the provisions of this code or of any other ordinance of the jurisdiction, Permits
pr 3suming to give authority to violate or cancel the provisions of this code or other
orjinances of the jurisdiction shall not be valid,"
01/19/2005 WED 9:42 FAX 6513226147 GENZ-RYAN
141 007/009
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
I. B., ,n, I PERMIT NO.~O~
2. Gold City
1. VeJlow AppliQ!l.1
A. , II ZONING (offic.us.) I
PrIor I.o.k7"/ lJjill
q'lease~e ~rprintandsi2n arbottom)
ADDRES)
/7178' D,o'_a"~'61l Dr-, Sf;.
LEGAL L ESCRlPTION (office us. oXliy)
LOT.24 BLOCK l ADDITION pp_F"~~I,..~ / IP--
PID
OWNER
(Name) I R Horton Cus tom Homes
APPLICAl IT
(Name)~R.-al'." \'l"-"<M~ ,. ~"M:
(Addre~) 14745 So Robert Trail
(Address) .
(Contact P<rson) t'..,[v-; c;J-fJ-ff:!/-'7
APPLICAt'TSIGNATURE (.~-:;)~t.{.0
(Address)
I Quantit)
I cl
I 1
I i
I tl..
I
I /
I I
I
I J....
(phone)
902. q <;~ -78lJO
:2o'S"'D lUV1B~Il:l<SG C. Sre itJQ
uduvillG bUN .56bLJ Li
(phone) _65'-I.?~-Ulw
Rosemount
MN
55068
(Zip Code)
(City)
(phone)
651-423-1144
DATE ! Irq /O/J
---- ---..
APPLICANT PLEASE COMPLETE BELOW
I Type of Fixture I Quantity I
Bath Tub with or without shower 13 Rough-ins
I Dishwasher I j' I Water Heater
I Floor Drain I KL I Water Soflner
I Lavatory (Bathroom Sink) I P I Stand Pipe (Washing Machine)
I Laundry Tray (lor 2 compartment sink I Sewage Ejector
I Shower Stall I Backtlow Assembly
Sinks Backflow Assembly Test
I Bar Sink I Lawn Sorinkler
Water Closet (Toilet) I Other
I
I
I
,
I
I
I
I
I
Type of Fixture
FEE SCHEDULE
Industrial, C lmmercia! & Multi.famUy 1 % of job cost with a $39.50 minimum Residential, New One & Two.Family $99.50
ResidentiBl, Additions & Alterations $39.50
Estimated Cost $
Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
PAlO wTTH I
.50 8\J\\.D~ PE~
(Offiet USt Only,
This Applic .tion Becomes Your Building Permit When Approved
Paid
I; Receipt No.
, j By
Build :ng Official
Date
'Dj~N'2 7 2005
24 hour Dotiee for 311 i..pectioR' (952) 441-9850, fax (952) 4474245
01/19/2005 WED 9:41 FAX 6513226147 GENZ-RYAN
~ 006/009
t($~
. "IV"ES )~,.
-
Date Rec'd
CITY.OF PRIOR LAKE
SEWER AND WATER PERMIT
q'lease t'\:P~ lfurint: andsi"ll at bottom)
ADDRES,
{fl)f?, D<"_t:-o+l"rJd jJr.
(' r-
()t;::,
~ ~w ~\; I PERMIT NO." ON d,
3. Gold ApplitaJlt .::.I . '-IftI/1
I ZONING(o_....)
~r-l,,-k, / /!I~}
LEGAL r: ESCRIPTION (office use only)
LOT J4 BLOCK J.., ADDmON D.. , "I) , iJ II f~
.' ,
PID
OWNER
(Name)-llR IlQrtoll. C".tQIR Il<>IR'-
(Address), 2o&nO KevlPK\tX:e C:r SIT.- ,/N\
(AddI<,,)
(Phone) _ '152 -q 1r5- L8..c1\
, La~\J i I Ie.,
(City)
06'JWU
(Zip Code) ,
APPUCAi IT
(Namel Genz-Ryan Plumbin~ & Heatin~
(phone)
651-423-1144
(Addr~s) l4745 So Robert Trail
(Address)
(ContactPwon) _ (jf1('~'~l--r 91"7 '
T,.ICA,11TSIGNATURE (A / i'?!i--,) +a.1/./\
.
~osemount~ MN
(City)
55068
(Zip Code)
(phone)
DATE
651-423-1144
1//41IJh
APPLICANT PLEASE COMPLETE BELOW
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
FEE SCHEDULE
Residential s< ,wer and water line connection $35,50 Industrial, Com'l & Multi-family 1% of job cost with a $39.50 minimum
Sewer conne"tion only $17.50 Water connection only $17.50
Estimated Cost $
Building Permit #
SEWER AND WATER PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
.50 ~\O ~~tJ\\1'
':,U\tP\NG ,:
(Office Use Onl~ l
I This Applil alion Becomes Your Building Permit When Approved \
L_'
Builc ing Official
-t~-c
.IDllte -
Dare . JAN 2 7 zon<;
24 hour notice for all iaspection. (952) 441-11850, fa. (95Z) 447-4245
I Receipt No.
I By
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
I. Pink
2.Greell
3. Yellow
File
City
Applicant
--
I PERMIT NO. C> ..
{a7
(Please tv1N: II r orint and sim at bottom)
ADDRES~
ZONING (office use)
17478 DEERFIELD DRIVE S.E.
LEGAL D :!SCRlPTION (office use only)
LOT 1 LOCK ADDITION
PID
OWNER
(Nam~ n ~Jl"()l?T()N
(Phone)
(Address)
APPLlCAl IT
(Name) AT.1.T1'D FTRFSTT1F DRA FTRFSTT1E HEARTH & HOME
(Phone)
651-633-2501
(Address)
2700 NORTH F AIRVIEW A VENUF
(Address)
ROSEVIT T.F
(City)
55113_
(Zip Code)
(Contact p, rson)
BRENDA HUSTON
(Phone) _651-633-2561
APPLICAIIT SIGNATURE
BRENDA HUSTON
DATE
2/9/05
APPLICANT PLEASE COMPLETE BELOW
xD NEW CONSTRUCTION 0 REPLACEMENT D ALTERATIONS
FURNACE ''VIAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM
HEATING OR POWER PLANT
DWarm Air Plants
DGravity
D Mechanical
DAir Conditioning
DVent. System
D Steam
o Hot Water
D Radiation
D Special Devices
o Other Devices
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
Residential, ~ eating & AlC (New Construction)
Residential, 1- eating Only (New Construction)
HEATN GLO SL-750TRD
FEESCIIEOULE
1% of job cost Residential, Gas Fireplace
$39.50 minimum
$99.50
$64.50
$39.50
. FIREPLACI: MAKE AND MODEL
Industrial, Co nmercial & Multi-Family
Estimated Cost $
HEATING PE1UvllT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
Building Permit #
$
$
$
Residentul, Additions & Alteration~ $39.50
Resldentl"l, AC Only So. ~ $39.50
~O ~ I1h...
~G i,: ~
~J;>A .
">7/:r
.50
(Office Use Or Iy)
This Appl ication Becomes Yonr Building Permit When Approved
Bu Idine Official
Date
1I','id
I Date
Receipt No.
reo
A ZGUJ
By
24 hour notice for 811 inspectioilS (952) 447-9850, fax (952) 447-4245
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONINGIFIREPLACE PERMIT
Date Rec'd
",.,-,;,'"
" -'. .-.::"":,',
~~~~::H~c ,~
LEGAL OJ SC~, (office_use only)
~, - \
'\ '~,---'~-,~\)\
F~~ Ei~;~, IPERlVll!NO. 14~f1l
ZONING-iome,us,)
\~": ~ :) <:
~"-
LOT, !'LOCK
" .;..0-'
ADDmON
PID
~::R . \) ?-. ,0.,^,,;~, ," ('.l '-'3--\-c,yn ~ol"res (phone) q_~21 -.;g;{!)
,(~dffi~~irl..C;;'Si06,:'-~~ \\ \,\'\~ c-'\E'_C :\. ~cj(e..'-l ~ \\<2-
,"",,~, ',:\:~n:.>:~,-.'~;;':-' <....;
7')1~
""--"','0,,_,_,
'iA:PBj;,I@~'\ -' ,--' "","
<:N;;m~} '- \ \\c~ ~\-'~r 1-., --r Y\C __
CM'''"'" .0'."). i:.~,'f\~O \:;..."- \}<-
, ,'- (Address)
(Cont;,,(:(P<rsor;) -. hb.';?0"-17UC;...j .
P,.PPUCAlrtSIGNA~<.i-" ,- L ~~____
(phone) ~~t; I ,'; 1../ ~ :)-.::i"1~ ~-
~n:_ ~.IZ:r-~ ::Jo:'X) .' ~...~H~,
(CIty) . (ZIp COde)
(;,,k," I -L,I ~:)-- dIll:;
DATE [,;;J.;\ \ ....;.,S -
:>:>-:,,'. 'i:':
;<> i ',_ ._,._,' "_::_:";"_'" '. _ ._..'.. .'<._<:._._:..':,.'.:.... :.......__....:. ._.....::.'::... .:,:
,ArP"LICANT PLEASE COMP~ETE lJELOW '
, ,-_ - ,~\VCONSTRUCTION DREPLACEMENF, OALTERATI9NS, , " ,
,HJRNACEMAKEANDMODELt:'SR'YA.,"-, "3,lnt..~\IoI.../2oqo F'UEL N~ ~A.S.
FL0ESIZE :s1'.' ,......k~OPENINGS (-, 'INPUT 'b'b. CJno. OU1PUT'70,.'-lQn
TYPE OF SYSTEM HEATJ:N:G OR POWER PLANT .' '. ..... . "
.,r.,G.<reVc'ih~anArrI;~~lan,':ts_, B~~~at~r~~~~~;rO~~~its
UJ 1Vl ~ 0 Radiation "c;u;notElib;oach intO
ii; dO:~i1iiiOi1ing 0 Special]).;,vices R:~quir~d.:S-i~e~Yard .
FIREPLACO~~~:~~~r, _ D0therDevices _ Set?,~~1q. .... .
...."T...'....,.-:-:......'"
;.<."';":>,.:'>">!c.:'t.__','.:
. '.. '>:'""..:"-,'
Industrial; 0 mmercial:~ Mlllti~~iunily -.
Residential, :reating, ~". AlC,(N:e\v, Sonstruction)
Residential, {eating Only. ~e"Y~.Construction)
Estimated Cost $
FEE SCHEDULE
1% of job cost R~fde~tial~ (}as ~i~eplace . ,', $39.~O
$39.50 minimum ,,) ',' . . ,-'.c " .'t<:),.;" ,_,_ ," .'
$99.50 Residential., Additions & Alterat~&. . . -$3..9.50
$64.50 Residen ti.al' AC Only . ~^ .' ~'. '. $3.9.50
'. v;:: .
~
Building Penuit # G' -<)
.~
$ \J. )/\\,,\:1e.,,-
$ .50
$
HEAlTNG PERNITT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
(Office Use 0 rlly)
This ApI lication BecomesYour Building Permit When Approved
Paid
I Receipt No.
I By
B lilding Official
Date
. DfES 2 4 2Dn~
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
PRIOR LAKE
INSPECTION RECORD
SITE ADDRESS ~a J:::E..etl..r=-i€JD. P/l1've ~F.
NATURE OF WORK I"/nAJ ~1II'1"A ~ 1",-
USE OF BUILDING S.7=:A. ~ S
PERII1IT NO. 0 s: 00 '7 DATE ISSUED I " S-
CONTRACTOR ~ e.. ~I&""~ PHONE '52.. &'Uo. "'.1&
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
, THE PERMIT IS BY SEPARATE DOCUMENT.
See Main ~'ile
DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTOR DAT~
'FOOTING I //f'~ I ,/'/J/os-
I FOUNDATION (Prior to Backfill) Mc"..J~" ~' I 142:-6-
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS . /
SEVI'ER/WATER/SEPTIC ~ ';fr:r-/~
FRAMING ~ ~ /?/o:::,~
, INSl JLATION fio/- . j"~r/ as--
ELE :TRICAL 'i sIo..s-
PLU MBING JU'-i, 3' /z1'105
HE~nNG (if required) j4~ f/ /? /0:;, j
'FIR PLACE _I) ~ f'/?/aJ~
I GAS LINE AIR TES~k f- ~)II ~/ Y/7/c.;>S
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
, /.l'itlllF / H~IIS~1AJAI+p I I
FINALS
_.
GRA DING (Prior to Sodding) c " e e h"~ 1.. /; / e .
BUILDING R/vj;- P'/~6s-----
ELEGTRICAL _ _0?~f
PLUMBING fft4 S//(,/.,~
HEAulNG ~ x;/~~.r
DO NOT OCCUpy UNTIL ABOVE HAS BEEN SIGNED
i NOTICE
this card must be posted rear an electrical service cabinet prior to rough-in inspections
nd maintained until all inspections have been approved. On buildings and additions
here no service cabinet is available, card shall be placed near main entrance_
FOR ALL INSPECTIONS (952) 447-9850
@rrtifirzdr lIf Ql}rmpzmrl!
CITY OF PRIOR LAKE
~tparf1Urut of ~uilMug Jfu$ptdiou
~inal Permitted 'J Conditional C.O. Expires
/
rhis Certificate issued pursuant to the requirements of Section J J 0 of the _J Residential! C International
fJuUding Code certifying that at the time of issuance this structure was in compliance with the various
7rdinances of the City of Prior Lake regulating building construction or use. For the following:
SlNGLE FAMILY 05""0067
Jse Classification Bldg. Permit No
Jccupancy Type
R3
. Type Construction
W', DEERFlELD 11 TH
VN
Zoning District
R?
~egal Description
L21,
17478 DEERFiELD DRIVEESE
)wner of Building _ Site Address
D.R. HORTON. 20860'l'KENllRIDGE COURT, LAKEVTLLE, MN 55044
:on"act",~~;,;~;~~re~UTCHINS /z/l'// "PI JANE KANSIER
~ City annpr
0' " B~ding Official
)ate: /-\/"- 9"'/6 \ Date:
"" /
iii"" ""-,',,,,,,,",,,-
" ,'"', .o~
.
"'.
CITY OF PRIOR LAKE \3-- ~):
INSPECTION NOTICE SCHEDULED a,/"~~)--
ADDRESS /7y?rr ffi~r4i14
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
~L
o SITE INSPECTION
COMMENJS:
~'-'///C~/
TIME
CONTR.
PERMIT NO,
0S--~ 7
o PLUMBING RI
o MECH Rl
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
~ECH FINAL
o EXIGRAD/FILLlNG
o COMPLAINT
o FIREPLACE Rl
~EPLACE FINAL
o GASLlNE AIR TST
o
J
~;"'.../ -:r/.~
.s-//0!~
- -
~-.!"Ch, h.i..." / .
ff.:,t"'~/;f/.j ~r,c;.-/-
e//-
~f/
;C'1-e4~// ~__"'" / ~k
{/_~.~ C?' ,:,~,--<,u.~:/
...--;/
7rhq
./"
O(e
--
~
h/c=- '))
----
C C/:-ye
~RK SATISFACTO" I . ",,,,..ail'
~~~RRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
V.L.a-/
Inspector: /~ ~
Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE,
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY/
INSNO"
~A nUl:
CITY OF PRIOR LAKE ;, /
INSPECTION NOTICE SCHEDULED ?'6/"oT
ADDRESS /7y7r ,L/~r/j (/ ~
OWNER
CONTR.
PHONE NO.
PERMIT NO.
tJs---- 6 ;7
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
o PLUMBING Rl
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
~UMBING FINAL
o MECH FINAL
o EXIGRADfFlLLING
o COMPLAINT
o FIREPLACE Rl
o FIREPLACE FINAL
o GASLINE AIR TST
o
COMMENTS:
//~~op-z~ h, Ao'~
/'
C/((
.--: ./
j-/h., t'
/'
Off
/""'\
(!./
#;~/ ~ 7U .d'':''.r~//ed
r'~/{ (J
d,/~
e-.-/C
~/
*~/
o WORK SATISFACTORY. PROCEED
.-
~ -,V"RECT ACTION AND PROCEED
lJ CORRECT WORK. CALL FO REINSPECTION BEFORE COVERING
Inspector:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSItOTl
.
APPLIANC~
PERFORMANCE TEST
Attach to gas /ina adjacent to regulator
Heating Contractor
Name of Tester
Date
.~(?""U'~
4b/Pr R
S-/nhr--
Job Address /7~7" /)",.,v../
Heating Contractor $..?""'.-.?....G~
Name of Tester ~h'HA
Date ->#/4 ......
J?, ~
-ih
Slack Temp 171 ~
Combustion air is adequately supplied per
UMC Sec. 606 IV.f
'h
_ . h'J
Percent 02
Percent CO
Percent C02
input