HomeMy WebLinkAboutBldg Permit 04-0348
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
4-.Z2. c4-
Main File
I, White File
2. Pink City
3. Ye\low Applicant
(Please type or print and sign at bottom)
ADDRESS ^
5011 ~+ oJL Cj6L'~' 'br. SE
LEGAL DESCRIPTION (office use only)
LOT)..3 BLOCK 2- ADDI~O~fiL: ld I rJ".v.-
OWNER
(Name)
(Address)
(Phone)
'BUIL~q') \ \_ ~\ /'
(Name)' u.~..~~n~. I
(Contact NamV"- \ ,.t : lWA--h,ou..."t J<...-u.....
(Address)
TYPE OF WORK
~New Construction
DLower Level Finish
o Misc. r.8.L. ~
PERMIT NO. 04. 03ff)
ZONING (office use)
Jel
PID05" '101- 043-0
(Phonef{'2>~)98S-~~3
(Phon{95~''/73Z
ODeck
o Porch
ORe-Roofing
ORe-Siding
o Fireplace OAddition DAlteration DUtility Connection
PROJECTCOST/VALUE (exc1udingland) $ 1'5'7) /53
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
~ter ) n the property t~o~~p:ctions.
d Signature
I Permit Valuation
I Permit Fee
I Plan Check Fee
I State Surcharge
I Penalty
I Plumbing Permit Fee
I Mechanical Permit Fee
I Sewer & Water Permit Fee
I Gas Fireplace Permit Fee
$
$
$
$
$
$
$
$
/~C!J t'OO
lJ(o,/..SO
Cl, Lj" s.? ~
7q.~-o
I tJfJ. 00
/ Of).- ()()
3-5.5' D
'-10. -
This Application Becomes Your Building Permit When Approved
~~
Building Official
9PaAt(
Date
~CXDS(PSl
Contractor's License No.
I Park Support Fee
I SAC
I Water Meter Size 5/8"; I";
I Pressure Reducer
I City SAC and WAC
I Water Tower Fee
I Builder's Deposit
I Other
I TOTAL DUE
y" IJ.--_J!~
5 /1"...,)"9"
I Paid
I Date
J,- clYA-o~
"
Date
# $ ?..j-o.OOI
!(f/~5'()~~ -)1
. $ . d50. - I
$ ~/). ~I
# $ }~OO. - I
# $ ?Ot}.- I
$ /.500. - I
$ I
$Y,57Z..~ I
~cci! ~ Pd
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
~i~~"~C_~7;p-'md7i:i";;~:;;:::::;;:;T;;;:;;
Planning Director ~ , Date Special COnditions, if any r-
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
Main File
White - Building
Canary - ~!1Jlineering
(f""1.!:!,!C - t"'ll:u,"~
Th(" C'f'nftr of .he L.kr Countf')"'
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLlCANTjD 1<. f-!(>l/+O/j
APPLICATION RECEIVED
L/- ! ~: _ ,.'')/
',,7 ,,~ "'-...,.. "/
I
The Building, Engineering, and Planning Departments have reviewed the building permit
application for cons~ructi~n activity"!. _ hich is~roposed at: i .. ,"" /
A () /1 ! i:: . . ~/l L..-.. /.-I-;<C/
......../ // L. "\_ t<. / ,-
Accepted
Accepted With Corrections
/
Denied
~
~ ~ Date: LjiJ.?) c/
I
~ ~~. .;. ...4D(,-J:2L,(.~ ~ ~
I r
d/ ~ '
Reviewed By:
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."
~~
Main File
CWhite - Buil~
Canary - Engineering
Pink - Planning
The ("('"fer ()f Ihl!' I.ab Counl~'
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT -1J _R.
APPLICATION RECEIVED
t-fovfo;J
,
,-/--;t~ -0<(
\
The Building, Engineering, and Planning Departments have reviewed the building permit
application for c5aC;Zi activi~tch~eed apt- ~d
Accepted
Accepted With Corrections /
Denied
r--
Reviewed By:
~
~
~
~~
Date:
~h~/o~(
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."
&\1ain F[e
White - Buildinq
C.can.ilO' :~ I7.naineerinQ::>
~k - Planning
Th~ Crntrr or Ihr l.akr Counlry
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APP~ICANT ]J _l<:. HOt-,f--O;.}
APPLICATION RECEIVED LJ - J,,~ - 0</
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at. I
. A /l~; I E. ,/;?2'-1 ~ /Z;~,L k.cJ
,-../(/ t/'t..--t..
Accepted
~)(
Accepted With Corrections
Denied
Reviewed By:
IvfJ- r~
Date:
'-1....,2(;' -0.;
.
Comments: See Reverse Side for Additional Information!
IfIc,,~ F,''/ e.
See Attachments: 1) Gradine: Plan. 2) Erosion 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."
p, 7/12
.uate Kec'd
\ Bm FU.
2. Gold City
l yell..... A.IlPllC"Il1
I PERMIT Nf!J1{- al(l
CP1= ;vpc or print and sU>:n at bQtl:OXD,)
ADDRESS
1JD1l t1A M-.
nf!lK PiYl~V1f D-tL.}5
ZONlNG (Ol'!iccusc)
T..:EGAL DESCRIPTION (office use only)
LOT13 BLOCQ.,.. ADDITION . ~~ (ff111
PID
OWNER
(Name). DR Horton Custom Homes
(Address)
(phone)
q62-qS{,~ -i8D6
2-CSLo 0 )(.en Bit 1 'D6e.. Cr $re. I DO
uduyi Ue., ~i-J b.f:;OLpj
APPLICANT
(Name)...c;,;..")'7-l):..,,..,
(Address) 14745 So
P1 "~hi:"0 t. t:r"'''''';''''Z
(l:'hone)
k'" _I,? ~_ 11/d,
Robert Trail
Rosemount
MN
55068
(Zip Code)
(City)
(Address)
(Contact Person) r Y1 rif ~ ti fi;ll S
APPLICANT SIGN~TURE ,. C\ ^ J. J~ ~.J~ J/}
Quantity
Ci
I
I
,~
i
I
I
,:)
(Phone)
651-423-1144
4;- ;Jq -IJ c/
I
DATE
APPLICANT PLEASE COMPLETE BELOW
I Type of Fttture
I Bath Tub with or without shower
I Dishwasher
I Floor Drain
1 Lavatory (Bathroom Sink)
I Laundry Tray (lor 2 compartment sink
I Shower Stall
I Sinks
Bar Sink
Water Closet (Toilet)
Quantity
,~
'J .
I(I
I
Type of Fixture
Rough-ins
I Water Heater
Water Softner
Stand Pipe (Washing Machine)
I Sewage Ejector
I Backflow Assembly
I Backilow Assembly Test
I Lawn Sprinkler .
I Other ~
FEESClIEDULE
IndustrIal, CommercIal & Multi-famIly 1% of job cost with a $3950 minimum ResidentIal, New One & Two-Family S99 50
Residential, Additions & Alterations $39.50
Estlmated Cost $
:Building Permit #
PLUMBING PERMIT FEE $
8T ATE SURCHARGE $
TOTAL PERl\fiT FEE $
.50
(OfficI! Use OtJly)
This Application Becomes Your Building Permit When Approved
Building Oft1dlll
DQte
Pllid I Receipt No.
Oatt MAY 0 5 2004 lEY
24 hour notice for sll iJupectiorul (95Z) 447~985(l.f~ (95~) 447-4;!45
Apr.29. 2004 12:05PM
GENZ RVAN PLUMBING AND HEATING
CITY.OF PRIOR LAKE
SEWER AND WATER PERlVul
No.3893 p. 6/12
Date Rec'd
i ~ ~;, PERMIT NorX. -~ _ -::l-H.()
3.. Gold .\Pl'liGolu ......... -r .J ~
(l'lease me ot unnt and si2natb...,~...)
ADPRESS
VJrn l GaA+ Vtvf~ 170) n-f
ZONING (Clffit:e use)
f>DL, ~1J
LEGAL DESCRJPTION (olfi.c:e use only)
LOT)3BLOCK'2- ADDITION ~e)d i1fH/)
PlD
OWNER
(Name) ~1;'. :?'/.":":':'.....-:: ~.1.~':?:e. :t-:,~::,~
(Address)
20&00 '~eK\ t::6e. Cr- $rp.) {\{J
(Addn:ss)
(Phone) _
.La~\J I He.
(Ciry)
C762 -q 8,5- -, g 6^
.&J~U
(Zip Code) .
APPUCANT
(Nam.e) Genz-Ryan Plumbing & Heatine;
(phont:)
65 L-423-1144
(Address) 14745 So Robert Trail Rosemount. MN 55068
(A?dress). (City) (Zip Code)
(Contact PetSon). OJ') )f) Stl ~L \ (Phone) 651-423-1144 _. i
';JCANTSIGNATURE~).f ( (/1 ~_) ~,--q~ /] DATE lJ~dq~
APPLICANT PLEASE COMPLETE BELOW
Size of wetter sexvice inches.
Location of any couplings from structure feet.
Type of sewer pipe. 0 ABC 0 PVC 0 Cast Iron
Estimated length of sewer line feet.
Clean. out (if required) located at _ feet from structure.
Residential sewer and water lme connection
Sewer connection only
FKE SCHEDULE
$35.50 Industrial, Com'l & Multi-family 1% ofjob cost with. a $39.50 r.nil'limUDl
$17.50 Water connection only $17.50
Estimated Cost $
Building Permit #
SEWER AND W All:K PERMIT FEE
STATE SURCHARGE
TOTAL PERl\fiT FEE
$
$'
$
.50
J
(Of.6cc Use Only)
This Application Becomes Your Building Penuit When Approved
PaId
Receipt No.
oJ'w. 9 S 2004 By
,
'--
Building Official
D2.tt
. ,
24 bour notice for all inspections (952) 447-'S';fi;1'olJ.(9S2) +l1~~1~_.
CI'rrOF PRIOR LAKE
JiE.A..1JljG/MR CONDJ: l'IONING, ~'IKEPLACE PERlVuI.
Date Rec'd
. (Pleasetype.or;printandsi~atb...;;"''':'::)...
ADJDRESs ,': ,''-'-.: "-:. '-,' - ,.
501! ./3_:i)aIcPf.
~~~; I PERMIT NOO..O....... ...,....':Z,;.......... ..,JI>
Applicant . .7 v-rO
. -. . .
..
ZON1NG(Cl~.tis~) .
LECiAL DESCR.IPTI:ON'(6f1i2f:.tiseOnIy)
LOT BLOCK
-.-..' ,
. -,. - - ' , .
A:I>~I'I10N .
'DRHORTON
20860 KENBRIDGE CT
. LAKEVILLE, MN 55044
~.:~=;:~:I'i~:i3pr'....
ALLIANT MECHANICAL INC
3650 KENNEBEC DR
EAGAN, MN 55122
651-452-2775
~.....'-:-::~_ ~.~-:- -:-. I.
-: ":',: \" -~. ; '-".' .'-, .
.'-', ':~(: '~:-:.--:: ':"
PLE 'S . '~L:'>.'~;:'.:.:<' .
i~!}~~;.
.. '.FIR;EPLACE~}~~j:~mgfu'~
. , ...
..~~:;\:.~~t$rifF(ri};:;: ': '.
',,-.",'
FEE SCHEI)'QLE . ..
1 % of job cost ReSideritial, Gas FirlWlace
$39.50 minimum . . ..
$99.50 Residential,Additions & Alterations
$64.50 ReSidential, AC Only
. ,- .....
.lildustrlal, Commercial.~ MUltl-Fiultny ..
"'.;:". ';.". ..:..:
. .' - .-......'...:
R.esidential, Heating &.. .. NC(NcwConstruction)
. Residential, Heating 6nlY(New.Co~ciion)
HEATING PERMiT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$-
.50
'~~9 .50
$~9.50
~~"-'
..1,~~~
.' !~~,
. "ttj' ~. ..... ..tf
{1i~~
,,'(:7~
... <,""
Estimated Cost $
Building Pennit #
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
Pa ~ ~ @ [! 0 ill [i(~ltNO.
D~' MAY 1 9 20C4B~~
;If
~U
24hour notice for all inspections (952) 447-9850, ja,J (952) 447-4245
?y-
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
I. Pink
2. Green
3. Ye\low
~~~y I PERMIT NO. ~L '2 U~
Apphcant ~ J-~
(Please type or print and siJtD. at bottom)
ADDRESS
ZONING (office use)
5071 E OAK POINT DRIVE S.E.
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION
PID
OWNER
(Name DR HORTON
(Phone)
(Address)
APPLICANT
(Name) ALLIED FIRESIDE DBA FIRESIDE HEARTH & HOME
(Phone)
651-633-2561
(Address)
2700 NORTH FAIRVIEW AVENUE
(Address)
ROSEVILLE
(City)
55113
(Zip Code)
(Contact Person)
BRENDA HUSTON
(Phone)
651-633-2561
APPLICANT SIGNATURE
BRENDA HUSTON
DATE
6/23/04
APPLICANT PLEASE COMPLETE BELOW
xD NEW CONSTRUCTION 0 REPLACEMENT 0 AL TERA TIONS
FURNACE MAKE 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
D 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
HEAT N GLO SL-750TR-D
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
Estimated Cost $
REA TING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
Building Permit #
$
$
$
.50
$39.50
$39,50
$39,50
I~&I)? ~~Q:
";~7?h..~.. &~?":-'J
I( .p;." "6'~
l~. ~ l'
~ I ~)/:V^
" ;{':,
.'. / .
Residential, Heating & AlC (New Construction)
Residential, Heating Only (New Construction)
(Office Use Only)
Buildine Official
Date
rl~@ ~ O.~ ~
,<\')ate
JUN 2 5 2004
Receipt No.
This Application Becomes Your Building Permit When Approved
By
g-
24 hour notice for all inspections (952) 447. )850, fax (952) 447-4245
By
PRIOR LAKE DEPARTMENTOF Main File
BUILDING AND INSPECTION
INSPECTION RECORD
SITEADDRESS .5a'll e. t'4K ?t:J,.AJr Dr
NATURE OF WORK ~
USE OF BUILDING ~
PERMIT NO. ~()3~ t:I::.. 1?1}T~ ISSUED · . ~1n2~
CONTRACTO~ ~ aPrrtJAJ PHONEJIIl-l.. 7-' J '^
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR
DATE
J FOOTING I ;;1.1fJ I S - t (..(-011
- I:. , -
, FOUNDATION (Prior to Backfill) I v1;Y./ / VVt01 :' !:;--/q-rJLl ~.~ Jtui
PLACE NO CONCRETE UNTIL ABOVE )lAS BEEN SIGNED /
ROUGH - INS
W
~'
~> )'J. 01
1/4/04
/' /.9/0.1"
G /.2fi' /tr/
C /Jt> 1~1
/4~o/
;7/6/0;/
f /6/ucy'
I
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
. /J)'" I I
~.e,-/-t-'..~t!- ( a !In,d .f c cf FIN A L S ^.
GRADING (Prior to Sodding); , , 1\J B
BUILDING~~#,. C C/. c./vr f; I Jltk ~.4~/
ELECTRICAL / ' -
PLUMBING 11121 .
HEATING .##-
DO NOT OCCUpy UNTIL ABOVE HAS
NOTICE
~
SEWER I WATER I SEPTIC
FRAMING t~f, {)/t,1/.94 ~ b/;.I/~ r
INSULATION ..-L .
ELECTRICAL
PLUMBING () (J /IIJ 6(;6;;,/
HEATING (if required)
FIREPLACE
GAS LINE AIR TEST
1#:1
~
H14
~
\
q;d-LD~ .
/Id r,..hy.s-
/ - t?/ZS/oy
ffPiCllf
J/R/tJ~
BEEN 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
QIerfifitafe of @ttupantu
CITY OF PRIOR LAKE
~tparfttttnf of ~uil~ing Jf nsptrfion
'Final Permitted D Conditional C.O. Expires
/ .
This Certificate issued pursuant to the requirements of Section 110 of the 0 Residential / 0 International
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:
SINGLE FAMILY 04-0348
Use Classification _ Bldg. Permit No.
Legal Description
Type Construction
L23, B2, DEERFIELD 10TH
R3
VN
_ Zoning District
Rl
Occupancy Type
Owner of Building Site Address
C D.R. HORTON, 2086Q KENBRIDGE
ontractor's Name & Address ~
ROBERT D. HUTCHINS (,. ,
// _ City Planner
~ L~U' ing Official r
'9'/.23: 0 \ Date:
r I' -
5071 EAST OAK POINT DRIVE SE
COURT, SUITE 100, LAKEVILLE 55044
DON RYE
Date:
01. TE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
5CJ7 I eA-.J t 6/T/C- PT
OWNER
CONTR.
PHONE NO.
PERMIT NO.
+.3>18
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
~NAL
o SITE INSPECTION
COMMENTS:
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
? MECH FINAL
S;{ f
o EXIGRADIFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
,.....-; /
f-?ft~1
/
OK-
-
~
._~. ')
..~..'\
/ -- /' ,............
( C '/6 S'~ /7 /e- ./
kORK~ORYl PROc;EED ~
o CORRECT ACTION AND PROCEED
...-----
~'--
o CORRECT WORK, ~~;.;'~EINSPECTION BEFORE COVERING
Inspector: ~~ Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH'" SAFETY!
lNSNOTl
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE SCHEDULED '-l~ ~ljo
ADDRESS ~ l! Et:t~ JL fJl>/~.J- U
OWNER CONTR. D. i. ~
PHONE NO. PERMIT NO. () L/-3'1 V
o FOOTING
o FOUNDATION
o FRAMING
o .INSULA TION
..)t.Il"tNAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
~ILLING
""'0 C011lJtAiNT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
COMMENTS:
G,I'J,!-, (1 L-
ev f 6 13,,;L.;' 0 ,c.
Sfr
I\IWORK SATISFACTORY, PROCEED
~ CORRECT ACTION AND PROCEED
o CORRECT WORK. CALL FOR REINSPECTION BEFORE COVERING
Inspector:~ Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
INSNOTl
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
507/
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
,..a--FJNAL
o SITE INSPECTION
O:-TE
,?/9k
) ,
8.[1 Ck;: JJ!
SCHEDULED
CONTR.
PERMIT NO.
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
~ ~MBING FINAL
~MECH FINAL
C<?"'ENT.8: . r---r /' /
~/ecf?1<u1 ~/i'"Z/ cYAe
TIME
CJr-J~r
o EXIGRAD/FILLING
o COMPLAINT
o FIREPLACE RI
~EPLACE FINAL
o GASLlNE AIR TST
o
/ / /
0/2do~
,
"'/ ......-. - /
//7-r::cA~~'/7h7 (/ ej)/C __ f
/4cetved O/<sq T /.esr
/\ ...",-;;. / /) /'\ / /
(:;J ~/I ~i/ ~ ~~~/ Or~ct~
~~B'~~I...;.~ / /:;;) -Y'r' 7- rJffD
/1
--
7e~~t
c?6L
/( ,
u~ 7//
//
k///os ~
.
o WORK SATISFACTORY, PROCEED
rORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: ~ Owner/Contr:
/
?---/C
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
lNSNon
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS ~L)!1~
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
0... TE TIME
t'/~/fy
/ -
hdl- ell jJl tJr
SCHEDULED
CONTR.
PERMIT NO.
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
~MBING FINAL
o MECH FINAL
CJL(;?~
o EXIGRADIFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
COMMENTS:
#'4~~~h."- ~J /'
/~
~/
/ /" -
dRed /~TV
7i/;L;:
WN/s
~/
/JC
/'
CJ c<.
... ? -" #' ~
/J.t6 T~./ ~-L
--./' /
/I"~P> cq- (
o WORK SATISFACTORY, PROCEED
~ORRECT ACTION AND PROCEED
/.;cORRECT WORK, Ctj;l/~LL F. .oR R NSPECTION BEFORE COVERING
Inspector: Owner/Contr:
, -
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH .{ SAFETY!
INSNOTl
.
APPLIANCE
PERFORMANCE TEST
Attach to gas line adjacent to regulator
Heating Contractor
Name of Tester
Date
~~~
~~
?#~.t-
.
Job Address ,$D) lEd -4V,P;r
Heating Contractor ..Lt#~ AG#"
Name of Tester ~~./':?
M.!/~
/a7?;'
f3;,~
S.~h
/11& 4F
Date
Percent 02
Percent CO
Percent C02
Stack Temp
Combustion air is adequately supplied per
UMC See, 606 Y.;'.f'
input r H' '* ff' 1
I