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Home My WebLink AboutBldg Permit 04-0171 CITY OF PRIOR LAKE BUILDING PERMIT, TEMPORARY CERTIFICATE OF ZONING COMPLIANCE AND UTILITY CONNECTION PERMIT Main File (Please type or print and sign at bottom) ADDRESS 1/9StJ $WFr: JI~/f-f/l5 I. White File 2. Pink City 3. Yellow Applicant ,.,...;- / IlA1 /.,- LEGAL DESCRIPTION (office use only) LOT3ZBLOCK J ADDITION ~rnE~ Clusr ~1Zt< OWNER f} IJ J (Name) rUJ...TF!- 110mL.S (Address) {{is 11/o12T#Wtif' BUILDER (Name) (Contact Name) (Address) ~~/ / Date Rec' d 2,. z,.~ .()~ PERMIT NO. 04-, 0 n II ZONING (office use) P()O PID'ZS'. +-02. _0.32, _ 0 (Phone) bs 1-- '1~z ~ 52D a ,)Qg-~ J~o. WMlr J1JVI ,-~SJ21 , I , .5A111iZ:--, , WJZ::l :& 1A<;Cf/ It r\ (Phone) (Phone) b/Z--ZLj ~ ~~ TYPE OF WORK ..;,,/ ~ew Construction OLower Level Finish . 0 Misc. '.R..c... &DE$. ODeck OPorch ORe-Roofing ORe-Siding o Fireplace o Addition o Alteration OUtility Connection PROJECTCOST/VALUE (exc1udingland) $ y~ ~ '1~.O()()IIJO 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 an existing state and local laws and will proceed in accordance with submitted pi . I am aware that the building official c revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may enter upo Pre pro~ to perform eded inspectio 0 / .~ f ~ Bt.- 1~71 2- ?h/nt/ / / Signature Contractor's License No. .;6aie / '( 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 it Cf " .O(!)() , 0'0 $ $ $ $ $ $ $ $ fo Z 7, r.;; 0 (Pia 7. fYY Iff.Od - /Of)..~ IJ (DO, 00 "3 >. SO "fO,d" ~ This Application Becomes Your Building Permit When Approved ~ 3J"/o~ ~ate Building Official I Park Support Fee I SAC _. .. I Water Meter ~ze5/83 1"; I Pressure Reducer I City SAC and WAC I Water Tower Fee I Builder's Deposit lather I TOTAL DUE . Paid Date iJ 0 (PJ,K'i' . :3. 2-4- .04- # $ # $ 13So .OD $ ZSO,()C1 $ t./~.oo # $ /'Z..-Oc:J,OO # $ /00,00 $\500..00 $ $1o(P3. fa . ReceitJfo. ~300 By :,r . U 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 ~hen signed by the City Planner con~es a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be ~~";"~ 311',~"j ~ ~;.~ 24 hour notice for all inspections (952) 447-9850, fax (95i) 447-4245 16200 Eagle Creek Avenue Prior Lake, MN 55372 vD r4~ (1~ Thr Ctnler or rhf' I..kr Country \1ain File White - BuildinL--. .-. ',,;~narv - Engineer.!!:!!t=' Pink - Planning NAME OF APPLICANT BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST ~/ L L'TE. {..IL II., I E S- APPLICATION RECEIVED I "-7 I ( iL- /...-. {... j . U I The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: 4~ 0 (~; () l;'l L, r r (-t T (~ '1-) L.... L-~ . Accepted ~ Accepted With Corrections Denied ~tr4~.- Date: '2J1t.'-IloLf Reviewed By: Comments: ~V1ain-EiIe See Attachments: 1) Gradin~ 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." ......<,.,..,.+...,.,<d_..."_,.,,.~~+_,."."___~..____....,. .'._.' _'__0 _ Main File White - Building ~ - 1= ineering (Pink - Plannin The C'enler of Ihe Lake Counll1' BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT i -[ I I (-I L ,- I (/ , I-r--- APPLICATION RECEIVED L { I The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: t:.r I ~. r f- i I I I , ~-, L- . Accepted Accepted With Corrections ~ Denied Reviewed By: ~~ ~ c5JS-' Date: ~I / ( ./6 t./ .{( 4th I ,.A a .rQ.~o-:tz.:. ) 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 ~i~e . - Building) Canary - Engineering Pink - Planning Thr ('rnfef nf Ihe l..kr Counlrl BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT APPLICATION RECEIVED PUL"TE Hofv1~5 ?" ~1I · 64-- The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: ~q 50 BLU Fr::- rtTs II'-.L-. Accepted Accepted With Corrections /' Denied Reviewed By: ~~ ~/-J tf'~ oJ-( ~" go-. ~ · Date: 3/1 f /0'/ , 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." .... __ .._- '---'_'_"^_"'"""+""~'."'_."_"""_"'___~_" .~-,.....~''t'''''"O'''''''~'''M'' _o.w" ~",_"...........",~,...."~.~~"_,,,",,,.~,_~~.~._....__,,,'_,"_...,~."~..'~"~'"~,"_____,,,__, _"_"__.'-1'-< F@b IS 04 02:07p METRO GENERAL SERVICES 7S3-428-2SS8 p.8 t.&~ ~NE~ GREll! - flU TELLO" - APflUCAIIT GOLD - CITV CITY OF PRIOR LAKE SEWER' AND WATER PERMIT FA 1-. qS~ tit( 7-'1"), l/r S.W.No. LI/~! 1. BLANKS Estimated length of water service r5~O Size of water service I~' inch(es) . Location of any couplings from structure () feet. LJP! Type of sewer pipe. ABS PVC'I' Cast Iron BLDG. PERMIT # PIO# feet. 2. 3. 4. "-- 5. Estimated length of sewer line _t}{) feet. 6. Clean out (if required), located at feet from structure. f1! ! 41 . {lf/Ii. ====~=======-=~============;===========-====~===============:===== This application becomes your permit when approved. B'i DATE: I , I. . ~-.' .{ l."; I, - . =~======jb~J~=~~~==;========================================== FEES: l1/elf Pee4;u7- Sewer and water line connection permit. _ .., Surcharge /VtJ (-e.e..- TOTAL * Fee. for either se~er or. water individually is $20.00 plus $ .50 surcharge. * Sewer and water permlt:sissued for new construction must be recordedr~ rne buildin9 permit card at the time of issuance l~s~~~~rF:/t~~~ ~OO ~u~~~-cate sewer and water permits are I . ,. r i .DATE-.:,.PAX..D ' :1 MAR 2 6 2DLlL I J "II AMOUNT PArR PAID WIn-- , h;:Jq..a'l1iJl]1O fFIt RECEI~T 'JI '".u REC'D BY i~llEG~-- 16200Eagl~:Creek Av. S.B., Prior Lake,'Minnesota 55372/ Ph. (~s2) 447-4230 I FAX (9s.2) 447-4245 An Equid Opportunity Employer _.MAR~} 1-~~04J!~D...Q1 : 08 PM VALLEY PLUMB I NG JORDAN FAX NO, 9524922617 p, 01 Date Rec'd CITY OF PRIOR LAKE PLUMBING PERMIT \. 91.1 fill I PERMIT NOOMr/j ~. ,,,,14 Cjl~ l. Vellow A.ppli'... (Please tvBc or 'OMt iUld sis:'J\ at bottom) ADDRESS 4~50 &u+l k\Qj~ ~ ZONING (Ome'II...:) LOT BLOCK LEGAL DESCRIPTION (office uSe only) PID ADDITION OWNER~ 01- (Name) -1.....11 0 .. (Address) (Phone) APPLICANT VI n I' (Name) \In..lloJ ~ ~'l m CJ 1(\Q. (Addrc:ss) ~lnO Q; 110. lcJ-, ~;8_ (Address) (Contact Person) ~0-(LlK'^ n APPtICANTSIGNATURE ~ /Y7 ~~ Quantity ~ I I :~ , I \ ~ (Phone) Q5~- L\9.~ - ~ \ ^0'\r\ (tj\ ~h::tS ~ LJ (City) (Zip Code) (Phone) q~~. 40d ~ l @ 00 DATE ,~.~)-OLJ APPLICANT PLEASE COMPLETE BELOW I Type of Fixture I Bath Tub with or without shower I Dishwasher I Floor Drain Lavatory (Bathroom Sink) Laundry Tray (lor 2 compartment sink I Shower Stall . Sinks Bar Sink I Water Closet (Toilet) Type of Fixture Quantity ~ 1 Rough-ins Water Heater Water Softner Stand Pipe (Washing Machine) Sewage Ejector . . Backflow-Assernblv . Backtlow Assembly Test Lawn Sprinkler . Other " FEESCHEDtJLE Industria.l. Commercial & Multi-family 1% of job cost with a $39.50 minimum Residential. New One &. Two-Family S99.S0 Residential. Additions &. Alterations 539.50 Estimated Cost $ Building Penn it # PLUMBING PERMIT FEE $ STATE SURCHARGE $ TOT AL PERMIT FEE $ 10q. nufi1 "t'iIJ::'I"j, ~....... LJ Z:::'\1I, 0:&' \:1 (j LJ ~ ~ I ~...~ ~~~.,..... r"'I--"r- fft)U,~.:~'~~i';,:~I;V I~ i~~i<t ;' (Office U!c Only) This Applic3tion Becomes Your Building Permit When Approved Paid I Receipt No. I By Bulldin~ O(fieial D~R 0 1 2004 Dllte 24 hour notice Cor aU inspl!c:dons (952) 447-9.8~0. rax (9S2) 447-4245 16200 Eagle Creek Avo., S.E.. Prior Lake,MN 5537z..1714 4-30-04; 2:23PM; .~ ;952 894 0925 # 2/ 9 HEATING/AIR CONDITIONINGlFlREPLACE PERMIT (Please type or print and si~ at bnltnm) ADDRESS . ._u_____ l4OJS(J ~\lt_.j~ \~ \~? \T(Q" 1. Q (.EGAL DESCRIPTION (office use only) ZONING (office use) m [1 :~1 ~ ~ I. Pink File PERMIT N I J , 1 ~: ~~ ~;;icanl <l:J-, - ,. .~.~ ';:~ q .LOT BLOCK ADDITION Pill !::{ F (I I . j ! ! )WNER Name) '~A..Q k_- ~'1crrf">- ~ddress) X \~-:> ~) \.l ') \tJJ fA Y't I J 1 \.ddress) dUIII..villo IlcaL;II~ & A/C. LLG 12481 Rhode Island Ave_ So. ;:'ClVi:lyt::, IVIIII o~~~z (phone) ( oC,i- (Jc;2 -S7(D Fao1n n. fl1 (1'1 5'S/21 (phone) . Ci.5; d -XCi U ~. (Y;Q S :'::~ .PPLICANT Name) ....~~ :~~ jlj W~ (City) (Zip Code) :ontact Person) . (phone) PPLICANT SIGNATURE ({ i1fl. ~JtLLZ:rk:.?7 DATE L!,.36 ~Olj APPLICANT PLEASE COMPLETE BELOW . . OINEW CONiTRUCTIoN D REPLACE~T 0 ALTERATIONS .. JRNACEMAKEANDM;ODEL D nm'i. r';'5IIVI/:J;;J,-/!?xJL/S FUEL r7CL-J QCL,.,. - I .UE SIZE RElURN OPENINGS '-I INPUT 'is ()(Y) OUTPUT lJ.4Y.ffl TYPE OF SYSTEM HEATING OR POWER PLANT OWumAu~anu .DS~ OGravity 0 Hot Water o Mechanical . 0 Radiation OAit Conditioning 0 Special Devices OVent. System 0 Other Devices !\l .23 !Jl '.'..'.ill' 1i~ .PLEASE NOTE: Air Conclitioner Uniu C~ot Encroach into Required Sjde Yard Setbacks ~PLACE MAKE AND MODEL .~}1 'i:;;;~:. :';;:-' ~i:.:~ lstnal. Commercial &. Multi-Family FEES~n.t.DULE I % of job cost Residential, Gas Fireplace $39.50 minimum $99.50 S64.50 Residenti~l. Additions & Alterations Residential, ~C Only HEATING PERMIT F~E STATE SURCHARGE TOTAL PERMIT FEE $ $ S. \. I 'X / \ .50 $39.50 [....y'/.. 1.,,(/., '.i./m~.c:.Q t.;_. I '.",,, ..:.1 ._ t "...0.). f,~~. Iii"'; .'1,'. I I \\!~ :;,u, L -V . ,. , (c.; r'~r , -!''''.'.~') " "/"'7[. !.. "oJ'" . l. ~~ ]~~~ ;:;;:[ ~1~ o{l I; ~ I...... ) J deiltiat, Heating &. AlC (New Construction) ,dential, Heating Only (New Construction) Estimated Cost $ Building Permit # ~ Use Only) Date BY. MAY 0 5 2004 . :is Application Becomes Your Building Permit When Approved Paid Receipt l!lo. . Building O'iikial . Datc . .24 hour notice for. aU inspections (952) 441-9850, filx (952) 4,41~~~ 16200 Eagle C~ek Avenue, Prior Lake, MN $5312 . I ('-" )\ ~ ;; ! PRIOR LAKE INSPECTION RECORD SITE ADDRESS t.8So 8lu"j-' HEI4.N/~ J AAIL, NATURE OF WORK N&UJ ~sr~l/diJ USE OF BUILDING S.':; A . PERMIT NO. 04-. 0 n / DATE ISSUED ~~I/ CONTRACTOR 'l?u.LrE HD""-E5 PHONE12l1- tZ/- ~ NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW THE PERMIT IS BY SEPARATE DOCUMENT DEPARTMENT OF Main File BUILDING AND INSPECTION INSPECTOR DATE J FOOTING 1/\I1{ ~- )..~-Oll FOUNDATION (Prior to Backfill) (.:7~ '1/4 ~ I PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ROUGH - INS SEWER I WATER I SEPTIC , FRAMING /ff~ INSULATION ,/Q ELECTRICAL .. ~ PLUMBING r\t\t).\\\--:. /J.lJ. v'\vv'j(~-H,\v 111_ _ ~, C/{//~ HEATING (if required) ~ 6//~ ' FIREPLACE GAS LINE AIR TEST /R'4 7 /2/~/ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED . . J I I hwerhve/ /.5 ~n~&-4<:.1 FINALS GRADING (Prior to Sodding) ,,/ t/I? BUILDING -/;~/, (;'tJ. 9/14Y' ~ ELECTRICAL. / . PLUMBING HEATING DO NOT OCCUpy / ~~/~r 6j/5/;r I TLC ,,/ {,'()'f' ~' /CJ~f?k" - . . ~~/dY', Ai#~ ~;rz~ ~ ?/~/~ -.r ,J 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 additions where no service cabinet is available, card shall be placed near main entrance. FOR ALL INSPECTIONS (952) 447-9850 ~ QIrrtifiratr of ODrrupanry CITY OF PRIOR LAKE ~tparfttttnf nf 2iuil~ing Jlnspttfinn ~Final Permitted D Conditional e.O. Expires / I This Certificate issued pursuant to the requirements of Section 307 of the Uniform 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. Forlhe following: Occupancy Type R3 _ Type Construction VN Fire Zone Bldg. Permit No. N/A Zoning District 04-. 0/7 I PUD Use Classification SINGLE FAHILY Legal Description L32, Bl, TIMBER CREST PARK Owner of Building Site Address 4950 m.UFF HEIGHTS TRAIL SE Contractor's Name & Address PUL TE HOMES, 815~ORTHWEST ROBERT D. HUTCHINS ~/~~ , ~ ~ City Planner PK~N., SUITE 140, EAGAN DON RYE 55121 Date: By.ilding Official /"J Ir:; /t:: <:; -- // ~ J / . / .J ~ / Date: DATE TIME CITY OF PRIOR LAKE ~ INSPECTION NOTICE SCHEDULED ~l'f/6S .-/ /JqSO $'/Bff' A ~/ ADDRESS e. OWNER CONTR. PHONE NO. PERMIT NO. ~-/7/ o FOOTING o FOUNDATION o FRAMING EjNSULA TION ~ ~INAL .0 SITE INSPECTION o PLUMBING RI o MECH RI o WATER HOOKUP o SEWER HOOKUP o PLUMBING FINAL o MECH FINAL o EXIGRAD/FILLING o COMPLAINT o FIREPLACE RI o FIREPLACE FINAL o GASLINE AIR TST o COMMENTS: -~ / frri~ / L"I / O/C ~~ /~/ ___"'J) ((' 1~,-P /-7/P / /)(WORKSA~CTO;. PR~ / 0 ~RRECT ACTION AND PROCEED o CORRECT WOR~. ;~~R REINSPECTION BEFORE COVERING Inspector: ff.,y Owner/Contr: , - , CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE. CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY! INSNOTI 12-;1.2"6'( ADDRESS ~'O 3iu r-r- VJ TL1 OWNER CONTR. P V If'- }-b~ ~i-/ZJ ca(~RA~LLlNG o COMPLAINT o FIREPLACE RI o FIREPLACE FINAL o GAS LINE AIR TST o CITY OF PRIOR LAKE INSPECTION NOTICE PHONE NO. o FOOTING o FOUNDATION o FRAMING o INSULATION r--1ilFINAL VOsrrE INSPECTION SCHEDULED PERMIT NO. o PLUMBING RI o MECH RI o WATER HOOKUP o SEWER HOOKUP o PLUMBING FINAL o MECH FINAL COMMENTS: h f' II Lo..- f2 r t..,.; b7J,A~ / ~O K ,- -.-- DATE TIME ~ORK SATISFACTORY, PROCEED ~RRECT ACTION AND PROCEED o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING InSpector:~~ - Owner/Contr: CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE. CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY! INSNOn 7Et54c/ ", / r950 ~/v [;f1 ~ 7J / CITY OF PRIOR LAKE INSPECTION NOTICE ADDRESS OWNER PHONE NO. o FOOTING o FOUNDATION o FRAMING o INSULATION ~NAL o SITE INSPECTION ~~MEbl-T~: ~cf;r,c~1 DATE TIME SCHEDULED CONTR. PERMIT NO. o~-/?/ o PLUMBING RI o MECH RI o WATER HOOKUP o SEWER HOOKUP o PLUMBING FINAL o MECH FINAL o EXIGRADIFILLING o COMPLAINT o FIREPLACE RI o FIREPLACE FINAL o GASLlNE AIR TST o ./' ~ A ./_ 7F~"i / ~~-p ? /~/c~ - , ~21 ~r A'~J/ ~ " ~~r L-ec/ fl / ./ C A" ~'5 ~/ .so) f'/';!L L//t /"'i) / / C / - j)/' e:.J ~_A/4ed cJ:je! 7- k:et<'~r _Q_7~'- if-'/A9/ 9/4'd, qp)'$/e:!Uc:; / , V /' ~-- // (' ~I CJr Oh 7'"/'/ 1!:ORK SATISFACTORY, PROCEED CORRECT ACTION AND PROCEED o CORRECT WORK, CALL FO EINSPECTION BEFORE COVERING t ~/#? ?J , Inspector: / /"' ~.J7dV t.- , Owner/Contr: CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE. CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY! INSNOTl DATE TIME ~~~~ L/YsZJ kZP ;7/:6 fr'/ CITY OF PRIOR LAKE INSPECTION NOTICE SCHEDULED ADDRESS OWNER CONTR. PHONE NO. PERMIT NO. o FOOTING o FOUNDATION o FRAMING o INSULATION o FINAL o SITE INSPECTION o PLUMBING RI o MECH RI o WATER HOOKUP A1EWER HOOKUP PLUMBING FINAL o MECH FINAL COMMENTS: _44 / //~~e~~/Tc'- ~~ a~/7/ o EX/GRAD/FILLING o COMPLAINT o FIREPLACE RI o FIREPLACE FINAL o GASLlNE AIR TST o -~/ vtt 4<r.f ~~/ hORK SATISFACTORY, PROCEED / ~-ORRECT ACTION AND PROCEED o CORRECT WORK, ~C~;, I3J REINSPECTION BEFORE COVERING Inspector: f~ Owner/Contr: , CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE. INSNOTl CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYl DATE TIME ,~4r 1/7f2? /1% -F/ ~S 7// ~ U;'f/ h- CONTR. CITY OF PRIOR LAKE INSPECTION NOTICE SCHEDULED ADDRESS OWNER PHONE NO. PERMIT NO. 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 ~MECH FINAL ~~- /7/ o EX/GRAD/FILLING o COMPLAINT o FIREPLACE RI o FIREPLACE FINAL o GASLlNE AIR TST o COMMENTS: uf!~ /' ,~ / )/0'~C~/ /~hC;/ -~ /' / -- / /<:::ec l!"" t, c d O~q r /-eS /' ~~_""h- ~Jr/ CJ^- . _4s-Lh~ ~), AJ-c/~c,_ L2-~y. r ~/ ./ ' / / / /f/ ~", q I ~/ Clle ~RK SATISFACTORY, PROCEED ~ ~~RRECT 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 INSNOTl 'r. .- /\\ BURN~"ILLE , . Heating & Air Conditioning, L.L.C. 12481 Rhode Island Ave S, Savage, MN 55378 · 952-894-0005 Ors1at Test Report for Jobl tr ,::t':;;~ Address 4 q L-, () ?t, \- \- U-{ <; City --:;;:, () ( ~..o ;~---Q Occupant Date of Install '> Type of HT. FlA .,,--. HW Space HT Unit HT Other ~ ~ Make Model Serial Input ~/' / r-~.-, - . ~ -'.l'.. ".. G5/1n ;;?-u41J -l)L\,,~ ,,c;q ()d I:: C1?, 7- 3D L/.I/~ Pilot Type HOT SURFACE IGNITOR Pressure Input CFH Stack Temp\ ':> <-S .,,:), f:. 4- ~'L. C) . Cj o/~ :~ { P'f"~ C02 02 CO '-It( In~O Date Tested Company Technician \ : ~~~ l!iCll 'T" ./- hf BURNSVILLElIfEATING & AIR CONDITIONING \\ ' y,~ , '_ I