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Home My WebLink AboutBldg Permit 01-0596 CITY OF PRIOR LAKE BUILDING PERMIT, TEMPORARY CERTIFICATE OF ZONING COMPLIANCE AND UTILITY CONNECTION PERMIT ~lease type or 'Orint and silUl at bottom) ADDRESS r:) ,-] D ,-S \)"'({T' ~1'f'ld I ()~ LEGAL DESCRIPTION (ollice use only) LOT 11 BLOCK ADDITION OWNER (Name) (Address) BUILDER.-- f\ (Name) l) k' 1l--01' ,I=' I ef d Date Rec' d 0-/1 I PERMIT NO:..<ff -(J SqtJ - 7 I / Z5f,G(Offioeusel I 1_ White File 2. Pink City 3, Yellow Applicant ~ f:::. .,) r\d. (Phone) I-I-I'l r irl"{l I (\ , n' (Contact Name) L q' .L 1'1 0 'Y IIPr (Add ) 'ovo Cet.) u(\bnclC~ l~l. .51-<' li,V ress a- . . A") ~/' /,/ / f', 1/ f \ / I /1 1'. I\J .J'~/?-IL . - , TYPE OF WORK ~mw Construction DLower Level Finish o Misc. I f' ~ID~~ 91;'-Orl-D (Phone) Q5.;). - q r;'S-79D7 (Phone) ODeck OPorch OAddition ORe-Roofing ORe-Siding PROJECTCOSTIVALUE (exc1udingland) $ q f., () l/ (", OUtility Connection o Fireplace DAlteration 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 enter upon ~ property to pe~orm nee'; ins~ections. X 'l^ fLu .\ 4 V {I ('/~ d.. r.XY'.:J 5(<:07 6-,:). '1 -c f Signature Contractor's License No. Date I Permit Valuation I Permit Fee I Plan Check Fee I State Surcharge 1 ppn:::ll~r . I Plumbing Permit Fee I Mechanical Permit Fee I Sewer & Water Permit Fee I Gas Fir ce Permit Fee fA $ $ 1 $ $ $ $ 1 $ 1 $ .., ~ . 000 . 001 tN;<;:""~ 1 t_ :), -7t.f I <.f~.('JC 1 1 1 I I 1 I Park Support Fee 1 SAC I Water Meter Size 5/8"; I"; I Pressure Reducer I Sewer/Water Connection Fee I Water Tower Fee I Builder's Deposit 1 Other ~ ~W 1 TOTAL DUE I Paid I Date {...,Od-cA- LJ 9 ~ --1~ -(')'j $ ~n_a5'1 $ 1./ &;r, .(')0 I 1 $ 'i t2C:.oCJ I I $ q:{', I'l r'\ I $ I. 2.0 (') .<'l11r 1 $ -'?",,,_Ad I $ - I .--0- $ ~.sn I I $ c,. oZ2!j1 I Recet~t./O.::1 01-.'"5 I By -0---" I # # # # ~ , 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 issue. Ico ,1")0 / t:)(') .{!)O ,?C;-. c;;. 7S ~,{)1J _(, - 7~7_1 D~ Planning Director __uj~'2--{e1 ~ ~~C~~~ r:.,wl.,\~ Date Special Conditions, if any 24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245 ",~1( PR/o,?, !::: ~ ~ rn White - Building Canary - Engineering Pink - Planning Th~ C,nlu of lhf t..h <.'ounlr) BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT APPLICATION RECEIVED ()' /,. C' I C'-- (...... . { '.'! 01 IV (c,-I- () / THe Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: .. _,__ .)._.' II ( . ,/ '.' (,1..'",./ J. jJ.. 1... I.. .. ...,-- -.)-', '. .,)~/ t:::..k.. ''', f .. , Accepted I / Accepted With Corrections Denied 1 t Reviewed By: ~ ./ " Date: /,1/2/0 I C.s~ b~ \rile- ~<.<. )( sZa I f\eA-~~.JJ ~'^e- ~ ~~~ ~- ~PJJ/~ (4-1t;~~ ~ . "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." ~ ~7; White - Building Canary - Engineering Pink - Planning Th~ ('tnlfrflf tht L.kr (.'ount!) BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT APPLICATION RECEIVED () 7C HOrCoN tJ-fr-OJ The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is propos~d at: S- ;;20-S ])~cP (/ Accepted Denied n Reviewed BYV..v Comments: Accepted With Corrections Date: C. '?-~I' ./ ~PO _ t-le- /{e<-<'.... ~- (0 "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." ~~1i PRJOIj> <'" _ l' U rn S 7>' Th~ ("tntrr of Ihr L."" Coulltry White - Building Canary - Engineering Pink - Planning BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT APPLICATION RECEIVED -n 12- tf 0 r-CON 0- /- 0/ The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: S;;lO.s 7)~cP 1/ Accepted '/... Accepted With Corrections _ Denied Reviewed By: Comments: Nl4s ./ ~ Date: &-(<,-0 I rIl. ovV h .{;, 10 ~. "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." J un, 4, 1 U U 1 :1: 19 PM GENZ RVAN PLUMBING AND HEATING N0.5114 P, :JV4[] Date Ree'd un/' OF PRIOR LAKE PLUMBING PERMIT 1. Bh>B Jilll" 1. Geld City '-),'Yoolkl"" ~~( I PERMIT NO. / -{]C,,b q'le.asc tJI'e ~,prin:r and..D2n atbOtb:)m.) ADDRESS h?nc;.., ni9PY~'(J~f) L",). SE. ZONlNG ColII.:....) 'R { - I LEGAL DESCR.<.r uu"' (alllce us. only) , LOT 11 BLOCK I ADDmo.;J'p(/J'C_r;eiD ~O PTD)r-31J.... 0/1-0 OWNER (Nron~ DR Horton Cus~om Homes (~es~ 3459 Washington Dr Ste 204 Eagan, MN 55122 (phone) 651-454-4663 APPLICANT (Nrone)..c..-~-"",- 'UJ.'-1.<_-i'! .. u_"\t.,<-g (Address) 14745 So Robert Trail (Address) (Phone) 1\~1_6'~_11/.h. Rosemount MN 55068 (City) (Zip Code) (Contact Person) Mary Olson (phone) APPLICANT SIGNATURE I A OJ-. DATE lo \ L( \ D I APPULAJ.'l ~ t"LuSE COMPLETE BELOW I Type of Fixture I Quantity I Type of Fixture I Ba'lh Tub with or without shower I I Rough-ins I Dishwasher I , - - WateT Heater I Floor Drain R. / ) I Water Somer 1 Lavatory (Bathroom Sink) Stand Pipe (Washing Machine) I Laundry Tray (l or:2 COlllpartme.nt sink I Sewage Ejector Shower Stall Backflow Assembly Sinks I Backflow Assembly Test Bar Sink Lawn Sprinkler '. 2- I Water Closet (Toilet) I Other 651-423-1144 Quantity J I I :2- I I I I I I I I I I I I FEE S'-,J::U!;uULE lndustnal, Commercial &; Multi.famlly 1% of job cost with. l>J9.50 oiinimum Residential. New One &. 'l\vo-FsmiJy $9950 Residential, Additions & Nt=tions $39.50 &timated Cost $ Buildin Permit # g -' PLUMBING PERMIT FEE $ STATE SURCHARGE $ TOTAL PERMIT FEE $ .50 " " t '."1' I i PAID WITH Ii' BUILDING PER,'I.IT )fI)c.e Use Ollly) BuDding Omcial , Paid . n... ., D%j I~/() / 24 hour Doti"" for .11 i.,pe<l!oll5 (952) 447-9850, fax (952) 447-4245 I Receipt No_ This Application Becomes Your Buildi.ug Permit When Approved - IBY~ Jun, 4, 1UU1 :J:mM GENZ RVAN PLUMBING AND HEATING Nu.5114 P, 3HU Date Ri\1:'d CITY .OF PRIOR LAKE SEWER AND WATER PERMIT :: ;;:.~;. I PERMIT NO. / ~9) l.6aId Appiicaa.t -~7 to (Eleasc t'YJ!.c: or-prin!:aDd..si~-atbctmm) ADDRESS ZONING (<;>lIke use) rO..fn DLf-A.e1D l "-1. c')G- LEGAL DESCRIPTION (ollie. use o~) LOT /1 BLOCK ADDrTION'J)P'''p / g" ftO 1\ 2 N 2:::, ~ PIDd5'~ 3M - ()! r;-t.) OWNER (Nam.e) ",:,n "?7ll'~""'P ""1'?t:Qm tigm~:- (phone) Ei.5} <;.5~ ~=<;) (Ad4=l.) 3459 Washington Dr See 204 (AdO=.) Eagan. MN (City) 55122 (Zip Code) I APPUCANT ! (Name) Genz-Ryan Plu1l1bin" & Heating (phone) . 651-423-1144 (Addr~) 14745 So Robert Trail (Addt=) Rosemount. MN (City) 55068 (Zip CD';") (phone) 651-423-F44 ,_,_ DATE _I r. \ \ \1'"'>. I (ContaaPo:rson) Mary Olson "PLICANT SIGNATIJRE \ I\. & APPLICANT PLEASE COMPLETE BELOW Size of water service inches. Location of any couplings from sJ;ructure Type of sewer pipe. 0 ABC 0 PVC Estimated length of sewer line feet. Clean out (if required) located at feet from structure. feet o Cast Iron Residential Sewer and water line connection Sewer connection anly FEE SCHEDULE $35.50 fudustrial, Com'l & Multi-Jiunily 1% of job costwitb a $3950 minlluum $1750 Wate:r connection only $1750 Estimated Cost $ Building Pennit # SEWER AND W A1ER PERMIT FEE $ STATE SURCHARGE $ . . TOTAL PERMIT FEE $ .50 BuildiDr OUic:iaJ I P~d ID~ .It . D... ;' b '/~/O/ 24 hour ootic. for .U iDspemoUll (952) 447-9850, ri (9S) 447-4:1.45 , I If I BU/~~JfG W/TH / r ' PERr,n.,. I RcceiptNo. D(ljc:~ Use Only) This ApplicatioD Becomes Your Building: Perlllit When Approved I~~ CITY OF PRIOR LAKE HEATING/AIR CONDITIONING/FIREPLACE PERMIT Date Rec'd (Please tyee or orint and sign at bottom) ADDRESS ; ~;.';, ~:;y I PERMIT NO'1_rei I J. Yellow Applicant -:.7 I}O t:)1-.D5 /) eer +1 tAlrl l..JU'lpJ Se ZONING (office use) XI LEGAL DESCRIPTION (ollice use only) l~}JAIY-:Prf d~ g,':e~RD.'A. Horfon ()ucdom H()~p~<>" (Address)~gtoo ~hric\cy- (l+'; Lo.kevi IIF.. M/IJ 'APPLICANTAJI' t M h -- ' (Name) I CAn e~ ..Ltm. (Phone) 11J5/-,q5:L-,f/775 (Addres8)3(P5cJ fcle.n"...berfr. 5:l:e. #j Ea.Qan .55/:;..2 (Address) v (City) (Zip Code) f Z;mmprfY"\.GAn (Phone) fg5/-'(/5()-,51771:J fJ. 4J,___~___ DATE.2l/..UQ1 . V APP ICANT PLEASE COMPLETE BELOW 0NEW CONSTRUCTION DREPLACEMENT D ALTERATIONS FURNACE MAKE AND MODEL ':Br~+ 3~A-V"'ul" 0 FUEL J\JQJum.\ FLUESIZE4'lcla.S'b "B- RETURN OPENINGS 1.{. INPUT ,0,000 OUTPUT 5iD.bOO TYPE OF SYSTEM HEATING OR POWER PLANT LOT I1BLOCK I ADDITION ^' PIrQS-:~'l:; - 01 '7 -C (Phone) Cf5a- witS -7017..l. 5501../L.{ (Contact Person) OWarm Air Planls OGravity o Mechanical ~ Conditioning ~ent. System o Steam o Hot Waler o Radiation o Special Devices o Other Devices PLEASE NOTE: Air Conditioner Units Cannot Encroach into Required Side Yard Setbacks FIREPLACE MAKE AND MODEL Residential, Heating & Ale (New Construction) Residential. Heating Only (New Construction) 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 Industrial, Commercial & Multi~Fani.i1y Estimated Cost $ Building Permit # HEATING PERMIT FEE STATE SURCHARGE TOTAL PERMrr FEE $ $ $ .50 $1, p,,/ <./11..1), II) /1.. /111(3 77"/f ,.oJ::; 'f:l1t4'7" (Office Use Only) This Application Becomes Your Building Permit When Approved Date rPaid I Date [(-7-61 Receipt No. - Building Official BY~ V 24 hour notice for all inspections (952) 447.9850, fax (952) 4474245 DEC.11'ZOG1 07:40 651 633 8884 FIRESIDE CORNER #6031 P.004/013 Date Rec'd \..J. J. i OF PRIOR LAKE REA TING/AIR CONDITIONINGIFIREPLACE PERMIT ! s.:. ~;..,.I PERMIT NO. 01- 05'1 h I (PI~'M typI!: or 'Dr?t ind lIim It baI.'tDml ADDRESS ZONlNG I_'V") 5;;x,s 7\,,~ slWw i'€. J.BGAL DESCl'lll'TION (ollice u.. only) LOT BLOCK. AODmON PID OWNER -"J / . (Namel ""Duz. ~ (Address) (phone) APPLICANT (Namel ALLIED FIRESIDE DBA FIRESIDE CORNER (Phone) 651-n:B-'S51 (Ad.dress) 2700 IL PURVIEW ~r'" CAd.dI:m) (Conlllct Person) " Bro:;NDA HUSTON APPT.lCANT SIGNATURE (' J::tn~..o_ U "".,.... RQSE"i7TT r 1='.... MM (city) (Pho".,) 651-633-2561 SO:;1 n (zip Code) DATE l1./lJ /." APPLICANT PLEASE COMPLETE BELOW [2ll<lEW CONSTRUCTION 0 REPLACEMENT 0 ALTERATIONS fURNACE MAKE AND MODEL FUE/. FLUE SIZE RETURN OPENINGS INPUT OUTPUT TYPE OF SYSTEM HEATING OR POWER PLANT gwmn Air PhIIlT.' O/llV;l)' Mochanloal BAi' Conditioning Vt"l System o Steam ] Hot Wltcr J Radillfon J Sp""i.l Devices o Orner Devices _ ~,~,:..t AI r;. (;. Q-1.t7J PLEASE NOTE: Air CondltiODer Units CWIliot Encroach into Required. Side Yard Setb&cks FIREPLACE MAKE AND MODEL Esl,imated Cost S FEE SCHEDULE J% or job ooSI R""id""llaI, Ou Fire)llo<:e $3~.50 min!mum $~~.50 R.8ldentilll, Additions &. AllEr.tlon, ~64.50 Resid.,,"lloJ. AC Only Building Permit # 01- 05 q ~ $39.50 $39.50 $39.50 [nduSlri", Commercial &. Multi-Family Residenti.J, Heating &. NC (New ConSl1Uetion) Residential, HOIll;ng Only (New Con'tnlction) HEATING PERMIT FEE ST A TB SURCHARGE TOTAL PERMlT FEE $ $ s .50 ......PA10 WITH, '. . f ~U~lD~N~~~'["':" \o-.~___-- (om<o U.e Ooly) ThiS APP'PJ}1f~}Qur Building P.j2j~ ij":o7Ved B'.14In~ Oflld.,1 DRIo I Paid I Dale I Receipt No, I By 24 hour nolic" ror.n In,p"etton. (952) 441-9850, rax (~52) 447....245 ) See l-k ft....",- -r.. l~ DEPARTMENT ~ ...- BUILDING AND INSPECTION PRIOR LAKE INSPECTION RECO~~~,<" SITE ADDRESS t::;"::< () t::)' ~J',J.& LV'-. LovJ~ ~ ~ NATURE OF WORK IJ-e.... \1\~ \ 'l.5" USE OF BUILDING<;F~ PERMIT NO. ()/-osfb DATE ISSUED (, - ? -(.,,0' ( CONTRACTOR ~R.. ~ PHONE~R~-~n( NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW THE PERMIT IS BY SEPARATE DOCUMENT .. INSPECTOR DATE I FOOTING~ fIA-, Iljl'1/()( I ~ ~ll(/Ol I FOUNDATION(PriortoBackfill)"~.1 ~. rJI'fi'/~1 I~. gf~~fOJ PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ROUGH - INS SEWER I WATER I SEPTIC FRAMING INSULATION ELECTRICAL PLUMBING \A~. ViA. ~. tjhlf'i ~,~ HEATING (if required) tl"LJ FIREPLACE . GAS LINE AIR TEST ~ f P. P ~ JZ!luoI COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED . 7 l ~ if'r.:r /z-/I'-iID I I I J' FINALS GRADING (Prior to Sodding) . BUU..DING-r.e...D, .rJ.P.11.J.j.IJz" th---.3L 5/rJ 1:.- ELECTRICAL ' --r I /1 PLUMBING 0 u? HEATING . ~ I DO NOT OCCUPY UNTIL ABOVE HAS NOTICE - '" ffl /-7-02.... (' r) ~~ f~~~ fL.1 ~ /1r." . I) ~\ OJ.. I 1.,.19-(,\01 . . 7J/?/~ ?/.9--I/tJv , - D2- /Is I tP-z, 3/ytlo~ 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. Call between 8:00 and 9:00 A.M. for all inspections FOR ALL INSPECTIONS (952) 447-9850 S'": -.:':-,--. 'ool!I.,. -;-......,.:;t&'>'., , '","':.J,','.~I,.-,.I.~"l":.I,.;"'i'..I.~'!!'.,I''I'~I",;.,I"...~I',. I':!\ 'I~,".~~'h ..I..::..:.,,,)!!;.:!;:............. ",I. ," L: r },v;,a;" ' , , , . .... '-_'-.r._,r.;i"':.imf~ I.. ~. ! ~trtiftcau nf OOcmpanry ,- Ii: CITY OF PRIOR LAKE 1~ iBtpartmtnt of lIJutlbinlJ 3Jn~ptttion (~: )(Final Permitted 0 Conditional C.O. Expires (1'" .-_f ~~t (~,' (1"; ~..;.. ft~ IJ: (~ i1r: i'~:' J:I:;: ("" (!:: 1,,1";- ,oJ. - 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. For the following: Use Classificatio[l SINGLE FMlILY 01-0596 Occupancy Type R3 ~ldg. Pennit No N/A Zo'D'trt' Rl nmg IS ct Legal Description VN Type Construction Fire Zone L17, Bl, DEERFIELD SECOND ADDITION Owner of Building SiteAddress _5205 DEERFIELD LANE SE Contractor', Name "'Address D. R. HORTON,. 20860 KENBRIDGE ROBERT, D. HUT,CHINS f4- C' Planne _ . I~ r ,UiJding OffiCial ~l:;; '-lit, L _ Date: POST IN A CONSPICUOUS PLACE CT., SUITE 100, LAKEVILLE DON RYE Date: ~ SCHEDULED ,1!og/ () 2.- ~-tJl ~ p CONTR. CITY OF PRIOR LAKE INSPECTION NOTICE ADDRESS 5.;105 OWNER PHONE NO. PERMIT NO. o FOOTING 0 PLUMBING RI o FOUNDATION 0 MECH Rl o FRAMING 0 WATER HOOKUP o INSULATION~ 0 SEWER HOOKUP '111 FINAL ' 0 PLUMBING FINAL '0 SITE INSPECT N /1J.,Ji MECH FINAL ~.C~~/~I ~ ~,'_~'l..- ~-rll. . @ ~i.~ iJ ,- I TC.O, DATE TIME 1:<J-o t!J1 - 59~ o EXlGRADIFILLlNG o COMPLAINT ~ FIREPLACE RI FIREPLACE FINAL o GAS LINE AIR TST o A-J 4-' . ~eJ(., ?/II07- /~P"'~, )16 WORK SATISFACTORY, PROCEED )i! CORRECT ACTION AND PROCEED o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING Inspector: ~ I CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE. Owner/Contr: IN$NOTJ CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY! DATE TIME CITY OF PRIOR LAKE INSPECTION NOTICE SCHEDULED Z-(~'CJ'L-- /:~ ADDRESS ,C;ZOC;;- /?6l5eF/6VD OWNER CONTR. PHONE NO, PERMIT NO. (- S9~ o FOOTING 0 PLUMBING RI o FOUNDATION 0 MECH RI o FRAMING ~ 0 WATER HOOKUP o INSULATION 0 SEWER HOOKUP o FINAL PLUMBING FINAL o SITE INSPECTION ~ MECH FINAL o EXIGRAD/FILLING o COMPLAINT o FIREPLACE RI o FIREPLACE FINAL o GAS LINE AIR TST o GOMMENTS: ([\.[J..d- ~,\.0<Y;>.i.......~ (b) ~J ~- ~~ ~ ,^' . C",,S;l o WORK SATISFACTORY, PROCEED .J' CORRECT ACTION AND PROCEED o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING Inspector: ~ . Owner/Contr: CALL 44;~~:)O FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE. CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI INSNOTl OA TE TIME CITY OF PRIOR LAKE .., /1 Q l.. INSPECTION NOTice SCHEDULED ~ /+.7' ADDRESS 520/,.:3, :5, 7 0t56/C./961-D t...N . OWNER CONTR. PHONE NO. PERMIT NO, /-S9~ 595. S9~ - o FOOTING o FOUNDA liON 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 o EXlGRADIFILLlNG o COMPLAINT o FIREPLACE RI o FIREPLACE FINAL o GASLINE AIR TST o r-. v.J at,,-L-' I COMMENTS: SDD/"'TV.&6 f d~.~ ~ ~"'pc,~ Pg'/-~' IL . "b 0 l'..~ . ~ PWORK SATISFACTORY. PROCEED V"""/1"r1'O-z..... o CORRECT ACTION AND PROCEED o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING Inspector: k / . CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE. Owner/Contr: CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY! INSNOTl APPLIANCE PERFORMANCE TEST Attach to gas fine adjacent to regulator Heating Contractor 1\\ \ i '-- "" i"-i~<..L.... Name of Tester \<...u~.......... Date J-.- \'\- ~?-- Job Address S:l.'OS-lA'r'I;'I'-'~ ~ Heating Contractor ,,\ \ i -~"I ~,(.",-- Name of Tesler \ ~ ~ Date 0--' ~- "''":I.. Percent 0, c.. '1 Percent CO Percent Co, Slack Temp - 0,- 'lr.~ ''S''IS- Combustion air is adequately supplied per UMC Sec. 606 '<-<<:> input 'b~,,,c:>,,, -