HomeMy WebLinkAboutBldg Permit 01-0573
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
(Please type or orint and sign at bottom)
ADDRESS
JS~~ ?
~ ~ ~
R:tf-
)Lf)A~ ..
fJ~.,. C'
5-/0 -0/
I PERMIT N~731
/' I ZONING(officcuse)
)::./
I. White
2. Pink
3. Yellow
File
City
Appl;cam
At u.J
LEGAL DESCRIPTION (office use only)
LOTtO BLOCK ca. ADDITION TJ.,.~ u/.'lJr ~ rho-
OWNER 11 I )
(Name) /J1t/'j.r>~ ~l~
(Address)
BUILDER /h Il. 'J
(Name) /' f Il "'~_/"
(Address) 7("01 IW'<.,.7)...
0('?~o;:;;,7
Cr,___<.7 .
~T f.R .c:::f
TYPE OF WORK
~New Construction
di:!'ireplace
ODeck
o Mise,
OLower Level Finish
Date Rec' d
PID 25-.37..5-015-0
(Phone) C,51l- 4<?;)-7/,.,cJ/
(Phone)
1tp-~J
[/cJ(r;
U1_
";-,- r--::::l4
C ..//
OPorch
ORe-Roofing
ORe-Siding
OAddition OAlteration OUtility Connection
Q.J
PROJECT COST/VALUE (exdudingland) $)).,"{J sCo 1-
I SAC
I
I
I
I
I Builder's Deposit
I Other
I TOTAL DUE ~
#
#
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 1 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
'xnt;:jJjr u n e propf'( ~pe;'form :eded inspections.
(11......./';]/_ )}.,]"7 &> S-- ti)-Of
/ ~ Signature - Contractor's License No. Date
VflLI
~I
I Permit Fee '. ~
I Plan Check Fee ~
I State Surcharge \ V
I r ",u:" ~
I Plumbing Permit Fee
I Mechanical Permit Fee
Sewer & Water Permit Fee
Gas Fireplace Permit Fee
$ ;;{ 3~ , OW.4:0 I Park Support Fee
$
$
$
$
$
$
$
I,-'~?_ 9~1
(, I 2f,. 47.. I
(liP.06 I
160.QO I
100 .C$V
35 .sD
/.(f) , t'J;)
e ames Your Building Permit When Approved
6", l7 - 2#rP1
Date
Water Meter Size S/S"V
Pressure Reducer
Sewer/Water Connection Fee I. ?t/J.tfJj
Water Tower Fee -, #
~-"l. -01
I Paid 8 cl70 e7
I Date '/". / Z . III
$8so.w I
$ II I SO.OJ'" I
$ '29? .tJ(5 I
$ ~ jO.(,tJ
$F-.J a...... IlL;'
$ 7tJO -od I
$ f,,~.oO I
$ I
$9,. Q10. '1;7 I
.
1~~c~3~1)s"
/
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
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
i~~ f-/~ ~d ~te4Jkk9~
-- Planning Director - Date Special Conditions, ifany /" .o~... .
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245 l..-C.-" ~ -.:J"'~
/
S~1
White . Building
Canary - Engineering
Pink - Planning
Th.. C..n'''T "r th.. L.k.. ("ounlry
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
tkOI2.NA00 fj)tJST12--
5-IO-()J
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
15373 BIS, /-tiJetJ PASS NW
Accepted
Accepted With Corrections =><--
Denied /) 17 /J? ___
Reviewed ~ Y ~ Date: ~-(?- 2ot.)
?/
Comments:
~aill ~ (~o-,Y:,
"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."
"
.~
--~-_.~ ^
Tht Crnltr (If Ihr tab Counlry
White -~
Canary"li; . .
Pink - Pit"", ~
BUILDING PERMIT APPLICATION DEPARTMENT CI:IE.CKLlST
NAME OF APPLICANT
rid )()/VAlO r j)NST12- .
5- IO-()j
.
APPLICATION RECEIVED
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
/537'?J B/9 j-f()etJ PASS NW
X
Accepted
Accepted With Corrections
Denied
Reviewed By:
~
Date:
5 -/'-I--d I-
Comments: ' See Reverse Side fo( Additional Information!
,
See Attachments: 1) Grading Plan, 2) Erosion Control Measures
::\) Frosion Control Plan
"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
Th.. (''''''..r or Ih..l..k.. Count!')'
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
let, i )(" i~ 1\ L U
~" IC-(:j
/l ( ^ ("',.-- j
(,l i\.j./ (k .
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
/'-~)~) ,-~ L::/~I :' I (k!\j ~l\ ~, \\j
f
Accepted
,..
Accepted With Corrections
~
Denied
Reviewed By:
'\
.
"\.,
"Thle 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."
1. Blue
2. Gold
3. Yellow
File
City
AppliCBDt
CITY OF PRIOR LAKE
PLUMBING PERMIT PPNo, 0/ -0573
APPlicant:~'" S.1J/1"~b'.9. IDe Pho~
Address: :r orc~!fI~Vt> 0n. 'C')H{J!J'2 6rOi.'(~ f!1... ~\()/6
Signature: Ii. ~ ./, r/~,
Legal Description: Lot....in - , _Block () ol.sub_J1LiJJJ -S""th
SiteAddress:-4.~7~:J lJI'I_tjnfl'l l-hs.5.. N. tv;
Building Permit # n ) - ns-' / 3. PID # ....7'7 qr)-- fJYf
NOTE: This permit will not be processed without complete information.
FIXTURE UNITS
Th~ (:~nln of lh~ L.k~ Counlry
Quantity
rt
)
)
--s-
/
J
J
'-. ~
Type of Fixture
Bath Tub with or without shower
Quantity
y
)
Type of Fixture
Rough-ins
Water Heater
Water Sollner
Stand Pipe (washing machine)
Sewage Ejector
Backflow Assembly (RPZ, Double Check, PVB)
Backflow Assembly Test
Lawn Sprinkler
Other
$
$
$
$
.50
Dishwasher
Floor Drain
Lavatory (bathroom sink)
Laundry Tray (1 or 2 compartment sink)
Shower Stall
Sinks
Bar Sink
Water Closet (toilet)
/
GRAND TOTAL $. . .",nA.d
fr~ ~ !/,vr.vv
This permit is granted upon the express condition that said
contractor, shall comply in all respects with the ordinances
of the State Plumbing we amendments thereof.
R .:L-'3.{)J DATE
A'ITEST
Call for all in ections 24 hours in advance,
-\ 3 ?fV\i
JUL "'
16200 Eagle Creek Av, S.E,. Prior Lake, Minnesota 553721 Ph. (612) 447-4230 / FAX (612) 447-4245
An Equal Opportunity Employer
FEE SCHEDULE
Industrial, Commercial & Multi-Family
(1% of job cost, $39,50 minimum)
Residential, New One & Two Family
Residential, Additions & Alterations
State Surcharge
$99.50
$39,50
FIRESIDE CORNER #6930 P.001/003
CITY OF PRIOR LAKE Date Rec'd
HEATING/Am CONDITIONINGIFJREPLACE PERMIT
(pl..... ~ or arinundid." at_I
I ADPRP..5S
15~3 /1fr i-<k.. /LJ
l~ ~:;, I PERMITNO'I_r'?~
3.Tflll_ ,A,ppllC11nt ......'::> ,.:>
Z~G(Dffia:"') I
LEGAL DESCRJPTION (DfIloo use DDIy)
/ / !' 'iJ /1/ L.-V--
LOT If) BLOCK :J.AJJJ.lUJON LA /.J.A.J-M "'"
,
p~S-37S=-61 S-c)
OWNER
(Name)
(Address)
f)i'1c.. ~V..P.<D t!A...;r .
(phone)
APPLICANT
(Nam.e) ALLIED Il'IMSIOE DBA FIRESI!)!: CORNER
(Phone) 651-633-256]
(Address) ~100 N _ FAIRVIEW AVENrT"
(Addle..)
BRENDA HUS'rON
(Contact Person)
APPLICANT SIGNATURE
&"',~-
I
-1J..~
~O~EVTT,LE MN'
(City)
651-633 -2561
(Phone)
.',".__ DATE
"511 ~,
(Zip Code)
APPLICANT PLEASE COMPLETE BELOW
ONEW CONSTRUCTION 0 REPLACEMENT 0 At TERATIONS
FURNACE MAI<E AND MODEL FUEL
FLlJE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OJ? SYSTF..M HEATING OR POWER PLANT
JW""" Air P'''''IS
JO...ll)'
J Mechanical
]Alr Condi~onjng
JVenl. System
FlllEPLACE MAKE AND MODEL ~ ;.J rd.o
DS....m
o Hot WolM
o Rlu:ljollon
D Spool,.1 o..;ces
D Other Devices
PLEASE NOTE:
Air Condidoner Unit.
Cannot Encroa.ch into
Required Side Yard
Setbacks
~
Induslrial, Commer.lal & Mu'~'P,,"lly
FE&SCHEDULE
1% Dfjep cost Residontial. G.. Pin:pl_
~39.S0 minimum
$99,50 Resldentla'. Additions &. Alt<:rations
$64,50 Rcsidontlal. AC Only
S39,50
Resldenlial. H..ting & NC (Nelli Con'tnu:don)
Residenr.iaJ, Hc:nt,ing Onry (New Canstrucdan)
539,50
$39,50
Estimllted Cost $ Building Pennit /I
HEATrnGPERNUTFEE $
STATE SURCHARGE $ .50
TOTALPERNDTFEE S
,BLJ/~:f I/lll7"H
G P€A,'V:I7"
(om.. u.. Only)
Thi. Applicatlon Becomes Your Building Pormlt Wben App....ved
Saild;al Olli""
DRl.
I Pllid
W~/~-O/
I Receipt No.
I
14 hOllr noli.,. r.. .lIlns"..tlan, (95:) 447-9850. rllX (95:) 447-4145
IB~
CITY OF PRIOR LAKE
HEA TINGf AIR CONDITIQNINGfFIREPLACE PERlvIIT
D3te Rec'd
~ ~::, ~:~ I PERJ.'rUT NO-j_5/J:<
~,Y~llI'" Av!lllt.l.al "----J
tP!Ci."\$r;: iV,ee Or prine anrJ. :fi~ at bollOm)
I ADDRESS
/5",.'$,Q 3
<A>'1 JI,/'N
L.EGAL DESCRlPTION (oilie:"", only)
WT ! iJ BLOCK ex. ADDITION U) JL.rJ,g ~
~s
)/; t;J . I ZRiG loOk, U"l I
plD,)5- 375- U/s-b
(Phone) &::~") ~~ - 7C,Cl I
OWNER A1
(Name) ~rJ::ll"'., n/kJ
(Address) A. f/ ,.
[1~ 'is.1_
Au e. ,
(Phone) (' h SI )
-. ./
/'Q I^ 1
cJ (Cicy)
-'lU")- hOd~
..s--'.s-"~ J.j
(Zip Code)
. APPLICANT 1 11 n
(Nam~) YftJ.Jfi'o!/P..;"'/
(Address)d/,.Q/C'" ~,fQ..LJ
(Address)
f1 ~/'
(ContaC[ Person)
APPL.ICANT SIGNATURE -.d-=i
p__Z:-: ~
(Phone)
DATE
7 - //-0 I
/ APPLICAt"lT PLEASE COMPLETE BELOW
~EW CONSTRUCTION 0 REPLACEMENT 0 AL TEM TIONS /
FURNACE MAKE AND MODEL. {;.,n-"l!o...h.::nkr GAl<'~/C. fUEL 'J.. )4r.
FLUE SIZE ,,\ II IJ I J{'" RETURN OPENINGS J( INPUT OUTPUT
TYPE OF SYSTEM
~mAlrp(:Jl1ts
OGrav ity
o Mech""icol
~ndjti(lnjng
~nt. Sysrrm
HEATING OR POWER. PLANT
o Stcom
o Hot Warer
o Rlldiation
o Special Devices
o -Other Devices
PLEASE NOTE:
AiT Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
. FIREPLACE MAKE AND MODEL
!ndustriaL Comrncm:ial &: Multi-Flmi!>-
FEE SCHE.DULE
\% of jOb cost Residencial. Gas Fireplace
SJ9jO mmimum
S99..s0 Re$id~ntial, Additions & AJt~ru.rions
$64.50 Rosicontial, AC Only
539.50
Re.sid~n[jal, Hearing & Ale (New Con~"tl1Jction)
Residential. HetLting Only (N~w Construction)
539.50
$39.50
Esdmated COSt S Building Permit '#
HEATING PERlVlIT FEE $
STATE SURCHARGE $5Q
TOTAL .PER.'\IUT FEE :s
. tjUIL~~~~ li'v"'/-f
PEr:;,',.,.
Vii,
(Oft1c~ USr: Onl~)
Buill:ling Official
Dut!
I Paid
I
I Dare
~_'Ice;nt No.
7~ jJjO! I By (je/
It
ThiS Application Becomes Your Building Permit When Approved
24 hUdr nuliclC. (or "II inspectiun.!l (95Z) ~4'7-98:S0, f.:IlI (952) ;.l.4i....,j,245
100 III
K1 HOIHd Xl~ ~~~
HIV <la'I10lllNO~
9L~909t199 XVd Cl'tl <laM 100~/11/LO
II
Date Rec'd
CITY OF PRIOR LAKE
SEWER AND WATER PERMIT
(Please .!fDC:.or Print and sim at bottOm)
ADDRESS
l5 3JJ ~~ \t()\^~ ~Q~
LEGAL DESCRIPTION (office use only)
LOTtD BLOCK~ ADDITION W}.u: \J:< S-11
I. ""'" FHo I PERMIT NO
2. Yol~w c;Oy . I /' T1->
l. Gold Applicant -j" 1
,
I R~ING(OfficeUS')
.
PID,p )' -375' eJ/r:? -( )
, OWNER \ fl. D . I \
(Name) -1.r\ L t\ 1I.1l~
(Address)
t, tlLil
(Phone)
(Address)
(City)
(Zip Code)
APPLICANr.-- \
(Name) J E'....LJt.j l:;- Xv
(Address) ~/) ~I~
(Address) .
(ContaClPerson) Qt\ \J 15()~'\ II
APPLICANT SIGNATURE ~
o
APPLICANT PLEASE COMPLETE BELOW
Size of water service \ inches.
Location of any couplings from structure 6
Type of sewer pipe. 0 ABC g'PVC
Estimated length of sewer line 1,0 feet.
Clean out (if required) located at feet from structure.
(Phone)
Q [kf}-~
(ci\y)
t..~ 7JO 7t.jJ~
Sjl{1(
(Zip Code)
s~
r~ -\1\-1>1
(Phone)
DATE
feet.
o Cast Iron
Estimated Cost $
FEE SCHEDULE
$35,50 Industrial, Com'l & Multi-family 1% of job cost with a $39.50 minimum
$17,50 Water connection only $17.50
.....---
q $l) Building Pennit #
Residential sewer and water line connection
Sewer connection only
SEWER AND WATER PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
PAID WITH
,:lJU1LD1NG PER;I.IT
(Office Use Only)
Building Official
Date
I Paid
I Da(;,_lq-{)(
Receipt No.
This Application Becomes Your Building Permit When Approved
24 hour notice for an inspections (952) 447-9850, fax (952) 447-4245
BYa
/C
U
JUN-11-2001 12:22
MCDONRLD CONSTRUCTION INC
P.02/02
.
McDONALD
CONSTRUcrlON Ine,
7~01 'J 46'l'H sr. WEST
APPLE VALLEY, MN 55124
(952) 432-7601
Construction Office
FAX (952) 432-13/,8
June 11,2001
Attn: Paul Baumgardner
[n regards to the future retaining wall on the left side of the house on Lot 10
Block 2 the Wilds 5th, 15323 Big Horn Pass. The bottom of the wall is to be
953.5 with the top to be at 956.5. This wall will not be attached to the
foundation and it will not exceed 4 feet high_
JetfCarlson
McDonal Construction
~
'.
TOTRL P.02
~
PRIOR LAKE
INSPECTION RECORD
DEPARTMJ:NT OF
. BUILDING AND INSPECTION
SITE ADDRESS ~~s bfj H-or-Vt ~sc:;
NATURE OF WORK AJ.aJ
USE OF BUILDING ,r:::::;P[2
PERMIT NO. Q J - 05T5 DATE ISSUED 5-1'?-a::or
CONTRACTOR J1C'~'^~ ~ PHONE_'1<;/-4~~~?/L)(
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR pATE
I FOOTING I ~ \l~~ I to t(0 0\
, FOUNDATION (Prior to Backfill) I <K \) II ~ I . (I) ~'O,
PLACE NO CONCRETE UNTIL ABOVe HAS BEEN SIG~ED
ROUGH - INS
SEWER I WATER I SEPTIC I - $ \\';t1 lo IIICl! (I
FRAMING W c...- "b ~ '1.;;7 tJ]
INSULATION "K \b. \ cg( II/'):
ELECTRICAL
PLUMBING ~ ,,~ \ '1.J~J(){
~I~~T~~~~: required) 'f- U~~l ~l~~~,
GAS LINE AIR TEST ~ f'~ 1, ~I ') f:J,.,r
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I I
FINALS
IV P (;,4"6 zt
~'" ~~ 1b1/*-d&(
\ l v'
~ \\~ . ~ q J~d",
.....-~ -\lllVtI I '(lld/f)(
OCCUpy UNTIL ABOVE HAS B..EEN {SICNED
NOTICE
GRADING (Prior to Sodding)
BUILDING
ELECTRICAL
PLUMBING
HEATING
DO NOT
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 i1ddltlona
where no service cabinet Is available, card shall be placed near main entrance.
Call between 8:00 and.9:00 ~.M. for all inspections
FOR ALL INSPECTIONS (952) 447-9850
Qttrtifirau at OOrrupanry
CITY OF PRIOR LAKE
~. illtpartmtnt of lSuilbing 3Jnsptttion
rlinal Permitted 0 Conditional C.O. Expires
This Certificate issued pursuant to the requirements of Section 307 of the Uniform Building Code
certifying toot 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:
Use CIassificatior
SINGLE FAMILY
Bldg, Penni' N^
01-0573
Rl
Occupancy Type
R3 Type Cunstruction VN . Fire Zone N / A
LlO, B2, THE WILDS FIFTH ADDITION
Zoning District
Legal Description
Owner of Building
~i"'Address 15323 BIG HORN PASS NW
7601 145TH ST. W., APPLE VALLEY, MN
DON RYE
ConlractOr's Name & Address. MCDONALD CONSTR.,
ROBERT D. HUTCHINS
"'V ~ lBo"ding Otficial
Da",: I) Vf.v1 b ~ (1' lL---
I
f"'ity Planner
Da"':
POST IN A CONSPICUOUS PLACE
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
~'3-oz ,4M
!5'S23 Er'c, horl1 Pw
'''60NTR. rVJc..'[;oI"lf{!.cI C016/
PERMIT NO. () I - (; 73
SCHEDULED
ADDRESS
OWNER
PHONE NO,
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
~INAL
o SITE INSPECTION
o PLUMBING Rl
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
A E~ILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
COMMENTS:
C(;,b J3('))Z - ()/~
b/N./'~ 6 r-
!fi.wORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR RElNSPECTlON BEFORE COVERING
'~
Inspector: 1"/ E'" . Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
INSNOTJ
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
DA. TE TIME
(,.I7-c.'z.. fr.l_
ADDRESS
/532.,3 SIC, HOIVJ r"'/-fs,j
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
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
SOD / 7le.E6
COMMENTS:
/
()~
'I /1
di If ,~ ~
IYrU
4
62-0"2-84-
o EXlGRADIFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
o WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CtLL FOR RElNSPECTION BEFORE COVERING
Inspector: -g . \/ at-4 Owner/Contr:
CALL ~7-9850 FOR T~E NEXT INSPECTION 24 HOURS IN ADVANCE,
INSlVQTl
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
ADDRESS
15'3d-.~
DATE TIME
SCHEDULED 1-::""/I{-;:J :61)
lS~J- f.knfiI.--J fJ{d 2' ~
CONTR,
CITY OF PRIOR LAKE
INSPECTION NOTICE
OWNER
PHONE NO,
PERMIT NO,
(-~I ~
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
f'i -" 0 S~ER HOOKUP
~A!1"'PLUMBING FINAL
o MECH FINAL
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE Rl
o FIREPLACE FINAL
o GAS LINE AIR TST
o
COMMENTS:
tMQMOw.J-u- 6L~
lM ek S;~'p~~
~ORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRE~OR< CALL FOR REINSPECTlON BEFORE COVERING
Inspector: ~~ Owner/Contr:
CALL 447.9850 FOR tHE NEXT INSPECTION 24 HOURS IN ADVANCE,
CODE REQUJREMENTSARE FOR YOUR PERSONAL HEALTH & SAFETY/
INSNOTl
Job Address I )~> It
Heating ContractorCu.-J,,) 'AJ.-.
Name of Tester ff{
'n~
),t
7
(:?
/10
Date
Percent 0
Percent CO2
Percent CO
Stack Temp,