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Home My WebLink AboutBldg Permit 01-0817 CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd TEMPORARY CERTIFICATE OF ZONING COMPLIANCE AND UTILITY CONNECTION PERMIT -7- I q - J I. White Fil. 2. Pink City 3. Yellow Applicant (Please type or orint and silUl at t u ..u.D.) ~DRESS (i 1./ 59 f7uur, ~lW Ctww. us LEGAL DESCR.J.r uON (office use only) 'BL1) (:,..\l: \2. \.Ji\. ,+ ~j ,., LOT 0' BLOCK ADDITION ~~r..h(;'d ~J ~~ PID~S-:.?7j-- (X)g-O OWNER (Name) (phone) (Address) BUILDER /J (Name) D.f{. ~ Xn~ ' (Contact Name) _ M '~t LA 1(l}'\n01.t-tl((.{.1 ,(AddreSS) el()f3u,() I<.<.v,brl~ d. ~.ft..1 00 ~1)6J M k.J TYPE OF WORK ~New Construction OLower Level Finish o Fireplace PROJEcr COST IV ALUE (excluding land) S '7~: In 0 ODeck . o Misc. (Phone) !/G"A...ergt;"-iS ()~ (Phone) o,g-adro ~ 41?J2 '-hULl c../ o Porch OAddition ORe-Roofing OAlteration ORe-Siding OUtility Connection 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 lam the owner or authorized agent for the above-mentioned property and that all construction will conform to all existing state and 10ca1laws and will proceed in accordance with submitte ans. I am aware that th uilding official can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may enter up, n e property to pe:rform n d inspections. x V Permit Valuation ~ .<::>0... tz5.1. 7~ SI~.54 3G,. . (!)O Permit Fee $ Plan Check Fee $ State Surcharge $ IP~a~ $ I Plumbing Permit Fee $ 1&0. OQ I Mechanical Permit Fee $ I c:>O . t:f) 0 I Sewer & Water Permit Fee $ - 0 - I Gas Fireplace Permit Fee $ 40 . () 0 (~~ H -t=B-"7__tV;_~ Bui ing 0 cial Date ~IJO 0 ':::17p 5'~ Contractor's License No. Park Support Fee SAC #. # Y)- J(P-() I Date $ Mo.c::o $ 11 I SO .c:>Cl $ - 0 - $ $ $ $ $ l)- II 2tJO.6(:L - 700 , t!)i) - D- $ 54qJ,...;J.9 I Paid I Date 54?d-. ~ y ,/? ,I" ". , . ~ . Rec.cei:JlJJl9' </O.3~-o Bv/j(I.J ! . This is to certify that the request in the above application and a~~u...t'anying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document ~::d~e~ by the fA Planner constitutes a temporary Certificate of Zoning compliance and a1lo::;nstrUctiOn t: ~ Bero;e occu;an~ Certific~e :: Occupancy must be t' ~-i-~'VJ?"-t!!''-<:-~'" ~/Jelet ~ ~~ ~~.. - . Planning Director Date Special Conditions, if any 24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245 Water Meter Size 5/8"; 1"; Pressure Reducer SewerlWater Connection Fee I WaterTowerFee I Builder's Deposit lather I TOTAL DUE # # White - Building Canary - Engineering Pink - Planning Tht' Crntrr or Iht' tab Counlry BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT . lJ J( IJ~ APPLICATION RECEIVED (- /q - 0/ The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: Jilj S1 - FOW71 fJ{e.e&low ~ --... Accepted ~ Accepted With Corrections Denied QfJf4,~ - Date: /, ~ -- (J1)C? ( Reviewed By: Comments: k & Mfk\V\. l) J1 "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." . , -' Th. C.nler .'Ih. t.ke Coonlry White - Building Canary - Engineering Pink - Planning BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT. 7J J( } / 'I"' -/ /).-yL./ Nc ( .C ()/ - () c:) / /7 APPLICATION RECEIVED "'l- /'1 - (' ) I The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: ,<i( },,' ~- 1/ (I /lr - r-/ ' "'h_'~ ,.~-". r'l . /.(,< / I ; C{ ~( Accepted ~ Accepted With Corrections ,. . Denied -- /) tfk ~, . Reviewed By: ~ ,,, ~~~~ Date: Comments: ~~ ('~j.'1~,~"id tI~rrlL ,Mr).;-,...~ m<.j ~AA..-J ~~) ('V/'~ ? /~o/p 1 . ... I /,. i "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." White - Building Canary - Engineering Pink - Planning The CrRlrr of the t.kt Country BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT . 7J J( IJ o-iiA3rY1..-' APPLICATION RECEIVED (- jq-o J The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: }illS q - FUtAJ71 (J1-erlctJW ~ Accepted 0( , Accepted With Corrections Denied Reviewed By: ;W4JJ Date: 7-z .)"-GJI Comments: 5<. (., IY7fA/'h. F/ I ( "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." ;.%PR/~ €~~ 'qNNES~ CITY OF PRIOR LAKE H.EAlli~G/AIR CONDITIONING/Il1.KEPLACE PERl\tUl Date Rec'd ~:~ ~:~ PERMIT NO. I~PI'n- 3. Venow Applicant 0 I / (Please we or orint and silDl at :..u:~~_) ADDRESS '54-S'" K1WYlffifJMDW 01lyV~ a.r~ . ZONING (office use) A~ LEGAL DESC&:;ION (OffiCeuserU)nn J l~o 0& LOT IABLO~i<./~ ADDI'n~)~ PIDdS-- 373- 0&0 &':~R l/~ \1Dthi\ (Address) . 3(5Cf W lt9i1thtilllft Av(/ M 1JJL/ i I ~;;~~~lJ[lnf m~thCUl)icaJ (phone) .l1I3l (Address) 3Uf)D mntbef..;"\)r Stilfer \ (Address) . (Contact Person) ~tIj . Umt?'V'J;'/rlMl..-- APPLICANT SIGNATURE :1:1d'a.&h.f./ 11 mmJYl11aI1 '.1/ U / APPLICANT PLEASE COMPLETE BELOW ~W CONSTRUCTION 0 REPLACEMENT 0 ALTERATIONS FURNACE MAKE AND MODEL g,r~t- 2>&~ILA-V D2..!-IblD . FUEL~a}. FLUE SIZE L.\l\ UltSS ~ RETURN OPENINGS 4- INPUT "1D. DnO OUTPUT 5lo~bb.D TYPE OF SYSTEM HEATING OR POWER PLANT (phone) ~ MI\J 55/22- 452,-2-115' (City) (Zip Code) (phone) --1t5 I 451-- 2--1'76 UfJI1t)) DATE 7 /~() I tJ I OWarm Air Plants OGravity o Mechanical ~ir Conditioning [jJ.Jv'ent. 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 AND MODEL 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 $39.50 $39.50 Residential, Heating & NC (New Construction) Residential, Heating Only (New Construction) Estimated Cost $ BuildingPennit # REA TING PERMIT FEE $ STATE SURCHARGE $ .50 TOTAL PERMIT FEE $ l:JU/(.~~/D I.. 'I tvG ~'/"'Ij ~/))' . . I~:"'.,.,. II, (Office Use Only) This Application Becomes Your Building Permit When Approved Paid _ Receip~ No, -..4 Building Official Date DateX'~~ t By cr .~ 24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245 Jul,25. 2001 6:55AM GENZ RVAN PLUMBING AND HEATING No.8621 P, 24/30 L.lJ i OF .r AlOR LAKE PLUMBING PERl\'li.l. Date Rec'd , I' JUl 2 4 200\ ,",-'. J.. JIIw TII. 1GaW CIty J. 1..... AwJI-t PEBl\nTNO: 7=f / 7 ZONlNG (dctusel ;€-~ . ..1 ~ type onllmtau.cfsian at:... ,:'",. ~ ADDRESS - r_ -'- - . . ~L(.SC\"" 't:TAt'J.. ) L '\ "^ \ ()~ ~fl~ ,\P__ . LEGAL DESCRJ.r uON (gj6at'1JR 0Aly) LOT X' BLOCK I ADDmON (jp 0 r~LO. (')~ .... pn:g5-~/3 '"'oo~-6 OWNER. (Name) DR Ho;r:ton CUS'fODl Homes (A~ea) 3459 Wash~ngton Dr S~e 204 Eagan. MN 55122 (,phone) 651-454-4663 APPUCANT (Name)..Qellll--i.y.aa;- 'D1"Whof"'g 14. U.Q1~~1J (Phone) -f" 1 -~.'? ':t_ 1 1 U (Ad.dress) 14745 50 Robert: Trail Rosemount (Address) (City) (contactPers~~; Mary olson1 (1 /":\ Ll (), ~) APPUCANt'~IGNATl1RB J ...;(.. ~ ~ "r . ..PAlE ~ "~""'1" ~ J:.....ICANT PLEASE COMPLETE BELOW Quantity Type ofF:"':.,_. . QUaDtity I . Bath Tub with. or without shower ( Dishwasher J Floor Drain ~ . 1 Lavatory (Bathroom Sink) , I Laundry Tray (1 or 2 comp<u l....cnt sink I Shower Stall I Sinks I Bar SiDk z,.. I Water Closet (Toilet) MN . ;.55068 . '" ... . , ,L (Zip Co~) 651-423-1144 -rl 2-? 1.0 I t" I '. Type ofY...L., . I I I' I I I I . \ .. 12-/, I Rough-iDs I WB:tct Hea:tm' I WatCt Sofb1cr I Stand Pipe (Washing Machine) I Scw~e Ejector I Backtlow Assembly I Baclc:tlow Assembly Test I Lawn Sprinkler I Other "'- ~.JU!, SU1.I!..UULE Industrial. Cl)WXJ.etClal &; MuJti~tilm1ly 1 % of job cost with & $39-'0 minimum Raside,ntial, New One &; Two-Family S99..50 bsidCDtit1, Additions &; Alta'aticms $3~ .50 Estima18d Cost S Buildine Per.mit # PLUMBING r'J::.KMIT FEE $ STATE SURCHARGE $ TOTAL PERMIT FEE $ .50 SUII..~,.q/D fA j'I\1G f,7l"/-f . CS".b , 11111.,. )mc. Use Only) This Application Becomes Your BuiJdidg Perm.tt When ApPl. . I ,,,4 ~ I!eceipt No. ~ U Paid BlIiIdI., otIIdal PaR Date R ,.3 --0/ U boor aod'al for aU ilaspediOJlS ~) 447.lJ~O. fu (952) .u7~ FIRESIDE CORNER #6031 P.011/013 Date Ree'd CII i OF PRIOR LAKE .t1J!iA: ill iGI AIR CONDltlONINGI t ldPLACE P l.,~U I IE I 3 2001 ~::n ~ I ~J!.AL+fiT l'!O.O/,Q QL--7 J, Velt- ...ppIlanl . .0---# 0'1_ tVDe or l'rim lIIILf lilll1 aI: bl;llmm) ADDRESS 5'tt5-Q J~ ~ ~~: ZONING (oRb usc) LEGAL DBSCRIPTION (aftke I,JlIC only) LOT BLOCK ADDnnON pro OWNER (Name) (Address) ~ /2. ~~ (Phone) APPLICANT (Name~ ALLIED FIRESIDE DBA FIRESIDE CORNER (Address) 2700 N. FAIRVUW AVENUE (Addre..) (Contac:t P~on) BRENDA HUSTON APPLICANT SIGNATURE ( ~.. (Phone) 651-633-l5E.l J L ROSEVTLT ~ MN (Cley) (Phone) 651-633-2561 ar.r:;, 1 ".I (Zip Code) DATE 1'J:.JLv J APPLICANT PLEASE COMPLETE BELOW ~w CONSTRTlcnON 0 REPLACEMENT 0 ALTERATIONS FURNACE MAKE AND MODEL FUEL FJ...UE SrZE RE'TURN OPENINGS INPUT OUTPUT TYPE OF SYSTEM !mATING OR POWER PLANT ::J Steam ~ Hot Water ] Radiation ::J Special Dln'iccs :J Other Dev;l;l:l$ :JWIlmI Air PIIll~ :::J Gravh:y J Med\anic:a1 :lAir Conditioninl ]Vcnt. Sy~ PJ;...)tASE NOTE: Air Conditioner Units Cannot EnClOath into R.equired Sid. Yard Setbackll FIREPLACE MAKE AND MVlJc.L d-v IJ ClP ~ 7J1) IndUSlI'ial. Commercial &. Multi.Pamlly Residential. Heating & Ale (Nl!lW Construction) Rcsid.ential, Heelillll Only (New ConstrUction) FEESCBEDULE J% orjab cost Relllidmnial, ONl Fireplace $39.50 mlnlmllJII $99.50 Raidmtial, Additions &: Alterations $64.50 Re..<lidlll1tial, AC Only $39.S0 $39.50 $39,'0 Estimated Cost $ BIli1diuJ Permit # HEATING PERMIT FEE $ STA T.E SURCHARGE $ TOTAL PERMlT FEE S '" rrn..\ ~.. rl,&.\O 'I" r'- toll . ....' \NG Pe.I'~I~ll .50 eu\~/ (Offlec V'II only) Thl. APPucr'" Building Ptrmlt When Approved I DEe' 4 211I JIb" III I Dlth: :Z4 hour nodce for 811ID.paetJONl ('52) ....7~, (11'1 ~) 44'7-4%45 Paid Rec:eipt No. Date By PRIOR L.AKE~i~~D~!~ i~ . . INSPECTION RECORD DI-ogl) SITE ADDRESS ~4SCt F;.~ ~fl'~ ~ NATURE OF WORK -Ajo ~ USE OF BUILDING SI=J) · PERMIT NO. nl- (JRI"! DATE ISSUED ,-'2..0 - ~oJ CONTRACTOR ...D ,R. . (-b~ PHONE Cf~2 ...~~- o...sr NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW THE PERMIT IS BY SEPARATE DOCUMENT INSPE...'...... DATE , FOOTING IPn 11/~/61 ~ . , FOUNDATION (Prior to Backfill) I tJ:1." fOf1-/bl I ~i Ibls/bf /).1' PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ROUGH - INS SEWER I WATER I SEPTIC FRAMING INSULATION ~"f;j t:h.. / III In "2-. ELECTRICAL PLUMBINGh-f I1.G. ~I ~f h (dllt I'~' 1lfb<1loJ HEATING (if required)~ ~. J),TI en. to I~I 0 J ~ ~ I b (; 4/ ~\J J t . DJ. FIREPLACE ~ ( ,~o,.. GAS LINE AIR TEST 'i~ ~. I. J? ~~ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED .A.I~ es-. ,BItt/at I~ d.-. I y~~iz- ....-._-u - J FINALS 1I/8)? J3 ~. c31J-~/ti 9.-PiY ~ , tl t):t-_ ur ~l~~ ~_ GRADING (Prior to Sodding) BUILDING -r c. 0 I -t;!.1). r/ ~ /62- iELECTRICAL ' PLUMBING HEATING DO NOT q- I:J.-O-::L- q '" Jd-/~ , r:r, U p-yq ~( 111 () Z/ ~) t/;;~,,~ OCCUpy UNTIL ABOVE HAS BEEN SIGNED NOTICE 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 ~ddltlons where no service cabinet Is available, card shall be placed near main entrance. Call between 8:00 and 9:00 A.M. for all Inspections FOR ALL INSPECTIONS (952) 447-9850 QLtrtiftrau of QDrcupanry CII f OF PKlOR LAKE Department of _uilbing In'pettion ~ Final Permitted 0 Conditional C.O. Expires This Cemficate issued PUT$UQ1II to the requirements of Section 307 of the Uniform Building Code certifying thaJ at the firM ofisSUlUlCe this structure was in compliance with the Vdrious ordi1tQ1lCes. of the City of Prior LaJce regulating building construction or use. For the following: SINGLE FAMILY Use Oassific:alioP Bldg. PenniI.N( 01-0817 Legal n _,.",. :011_ R3 Type Construction _ VN rue Zone -1l! A Zoning Distric:l R2 L8, B1, DEERFIELD THIRD (BLDG 12, UNIT 6) .SireAddras 5459 FAWN MEADOW CURVE SE 20860 KENBRIDGE CT., SUITE 100, LAKEVILLE 0cc1"" "'.,' Type _ ~ ,. Owner of Buildina D.R. HORTON, c, ",,' .".sl'l'ameAAddreu ROBERT D. HUTCHINS~ lluilclibl 0Ificial UV 4-1 :J..-rJ ~ . City PIanIIcr _ Date: . DON RYE Dare: POST IN A CONSPICUOUS PLACE CITY OF PRIOR LAKE INSPECTION NOTICE SCHEDULED::l. -ll-o~ II; 00 ADDRESS 5"4-5"4 FA....... ~pr~,,11 Cw..t't/ DATE TIME OWNER CONTR. PHONE NO. PERMIT NO. 1-~17 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 ~PLUMBING FINAL ~ ~ECH FINAL o EXIGRADIFILLING o COMPLAINT o FIREPLACE RI o FIREPLACE FINAL o GASLlNE AIR TST o COMMENTS: _ 1 1M~o~wt.r f)ct -... " ~ORK SATISFACTORY, PROCEED o CORRECT ACTI1N AND PROCEED :::E~ FOR RBNS::::FORE COVE~NG CALL 447-9850 FOR' 'HE NEXT INSPECTION 24 HOURS IN ADVANCE. CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYl /NS/iOT/ OA TE TIME CITY OF PRIOR LAKE INSPECTION NOTICE SCHEDULED zf ~!/.a 2... 't; 5() F~ ~~ ~ ADDRESS 5</ s-CJ OWNER CONTR. PHONE NO. tJl-V/7 PERMIT NO. o FOOTING 0 PLUMBING RI o FOUNDATION 0 MECH RI o FRAMING 0 WATER HOOKUP o INSULATIO~ 0 SEWER HOOKUP ~ FINAL ~~ 0 PLUMBING FINAL o SITE INSPECTION M MECH FINAL COMMENTS: ('i) :12A.A1rC _ 1,:f-- ~ .:IL!S ctn~ ~. ~) ?~-,( tf- ~ 1 f)~ ~ ~~ ~,<J- @ ~-~-,.-..j ~01-/ J ~ ~f~~ ,j o EXlGRADIFILLlNG o COMPLAINT @)D FIREPLACE RI IIf FIREPLACE FINAL o GASLlNE AIR TST o t ~ ,.. , J, c!.-. 0, ti.d ~ / I / 0 'Z./ I ' ~ - Y2.u~ o WORK 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 &: SAFETYl INSNOTI ~ CITY OF PRIOR LAKE INSPECTION NOTICE 5Lj33 - ADDRESS \ -5'7"00 OWNER PHONE NO. o FOOTING o FOUNDATION o FRAMING o INSULATION o FINAL o SITE INSPECTION COMMENTS: DATE TIllE SCHEDULED 91eJ- o;l ! \ ~~ /Jie4)~~ , CONTR. _ ..-, CJ~i '/-' Ie;', I::'; (!:II' PERMIT NO. a flf!; g~~/~1 o PLUMBING RI 0 EXIGRADlFILLING o MECH RI Cl COMPLAINT o WATER HOOKUP 0 FIREPLACE RI o SEWER HOOKUP 0 FIREPLACE FINAL o PLUMBING FINAL 0 GASLlNE AIR TST o MECH FINAL 0 ~f--r -)1' (j~ 1 II , ,1,1 /\ / ..1:~ .)fj~ ({Jlcr~- '--.../ ( v ~ o WORK SATISFACTORY, PROCEED o CORRECT ACTION AND PROCEEO o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING Inspector: ()~ OwnerlContr: r 1/ ,CALL 447-050 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE. CODE REQUIREMENTS A.RE FOR YOUR PERSONAL HEALTH & SArl!.1 if J , "---.4 DATE nME CITY OF PRIOR LAKE INSPECTION NOTICE SCHEDULED PHONE NO. 5'153 (qWYl lY/{~/()w(u/vt'. CONTR. D~ HOIf.tJ~ PERMIT NO. 6 I - g/ I :1 ADDRESS OWNER o FOOTING [J FOUNDATION o FRAMING o INSULATION o FINAL o SITE INSPECTION o PLUMBING RI [J MECH RI o W",TER HOOKUP o SEWER HOOKUP o PLUMBING FINAL o MECH FINAL o EXIGRADIFILLING [J COMPLAINT o FIREPLACE Rl o FIREPLACE FINAL o GASUNE AIR TST o t 1 COMMENTS: 5LfS3 - WI..JI IAJo,/1 UrAlvt r)tI~J., WI f~.(<</ 54 C; L/ - hl&(~' 0 It- . 5'155 - &/~/t'-()~ - /' I ( I 0)( \ IJ L. c,<'- . ,\0 / ~-,{A 0 uv ~ ~ C1/1. SL/ C;~.;... &/~t/1- V f( S ~5 /- {;Ter 1,- nK- S ItS 8- (..d41/f- &1<- ~ 545 ,-&c,,(( -of<.. / I _ ~ 5, (, ().,- 0/ cllff.o( - v (... o WORK SATISFACTORY, PROCEED ~ORRECT ACTION AND PROCEED X CORRECT WORK, CALL FOR REl~$PECTION BEFORE COVERING InSpectOr:~.. Owner/Contr: CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE. CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY/ _1 . ~ \ \ APPUANCE PERFORMANCE TEST Attach to gas line adjacent to regulator Heating Contractor Name of Tester Date A\ \ ~ -A. M~c.o\- 'K.c....\-\--'-- ".:>--,-~~ Job Address S'1~ L_ ~,~~.... ~ Heating Contractor ~" .-" l'-'\~cJ...... Name of Tester K-<.'\- Date ~- \ - (:) ':l.. Percent 02 ---.S. . 3> Percent CO Percent CO2 -~- Stack Temp Combustion air is adequately supplied per UMC Sec. 606 '< ~ input Co,. 000 ~.'-i J~S.