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Home My WebLink AboutBldg 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