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Home My WebLink AboutBldg Permit 01-1295 CITY OF PRIOR LAKE BUILDING PERMIT, TEMPORARY CERTIFICATE OF ZONING COMPLIANCE AND UTILITY CONNECTI~N PERMIT (Please type or print and SilUl at bu..u~) ADDRESS /1 J I c./ bJ, 1 d. er I1../M ~~ LEGAL DESCR1.t' nON (office use only) LOT 10 BLOCK I ADDITION Deer-+' e-lCL OWNER (Name) (Address) BUILDER D ,L~ L _ II (Name) . .R.. "~IYl.~. / (Contact Name) I ~'f~_u-f i:r; tK.&dh (Addr ) U>8~h~~~ cPo ~.IOD ess ~ _MY f6'"0t/'-I TYPE OF WORK ri!New Construction ODeck OLower Level Finish o Fireplace 1. White File 2. Pink City 3. Y cnow Applicant (Phone) Date Rec' d I!../ PID z5-370 - 01 0 -0 (Phone) ti~"''1Hh-/9D'fJ (Phone)3S;.-2U" I~~" o Porch OAddition ORe-Roofing ORe-Siding OUtility Connection o Misc. PROJECTCOST/VALUE (excluding land) $ ! R4-D---c:;q 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 desigiiee'may:.. _ enter upon the operty to pe[form d inspections. J X c2o~o~tr:':or~JcenseNo. ---'-o/~~~ $ 8;:LJ. CO $ /. (!:D.~ $.' /2!;cbO $ . ~tJO $ I,~" dJ.;Q $ .. _cu:>. }~tr~ $/.5(;/0 -<0 $. ~ t BLt2BJ. tl) J !-qz,'l. :SS- Cf.t{o .7~ I YtJ _ S() I Permit Fee $ Plan Check Fee $ State Surcharge $ IP~wry $ I Plumbing Permit Fee $ /00, t9 0 I Mechanicw Permit Fee $ 100 ...6)0 I Sewer & Water Permit Fee $ ~I ~(:) I Gas Fireplace Permit Fee $ '-t(), lYeJ /J}tto I i//1 u7\_YO",-;;:':/"- \P~i~din/Official Date OAlteration I Park Support Fee I SAC ~ I Water Meter Size~; I"; I Pressure Reducer I Sewer/Water Connection Fee I Water Tower Fee I Builder's Deposit lather I TOTAL DUE J:1Wt 0 # # # # JI-IU-Ol . Y 3}. .lV, I:) 1- ~~-Ol I Paid I Date $ ~. 3M . IS- . ,}~../I Receipt No. L/U"lv / By ~ This is to certi1Y 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 h~(;<~~,; I'LJt:i/&ri ~hzJ[~~. / ,; Planning Director Date Special Conditions,lf any . 24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245 White . Building Canary . Engineering Pink . Planning Tho ('onlff ollho Lib ('ounlf)' BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT ~ /? -HOI'-tt1;J APPLICATION RECEIVED 11-1- J The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: 17J.I;J uJi JJerAJe,55 ~1- Accepted Denied )( Accepted With Corrections f Reviewed By: AlII f2J . Date: //-8-01 ,. Comments: See RAv~r~~ ~iciA for Additional Information! , . ' ; i See Attachments: 1) Grading Plan, 2) Erosion Control Measures ::n Frosion Control Plan .... liThe 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." " ~ lh, (O,nl" of Ih, l..k, ('ounlry White - Building Canary - Engineering Pink - Planning BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT ~ 12 +lDrt~~ APPLICATION RECEIVED / /..... 1- I The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: /'lJJiJ Wi JcJerAJe-SS ~j- . f Accepted Accepted With Corrections ~ Denied j Reviewed By: (l: Q a,A Comments: Date: 9 -1 t -- 0 1 _~_ af)Q~U M~ "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." Tho Conlo' of tho t.kt Country White - Building Canary - Engineering Pink - Planning BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT 1./ Ir'l/ /i /"/ 6/../ APPLICATION RECEIVED 1/- 1- / The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: / /'lJI i..J LJ l )t.l e r AJe~~ (j/1- Accepted ~ Accepted With Corrections Denied Reviewed By: ~~jlltC'- --~ COkr ~JM\"~ ~LJ~~ ~ f~ ~DCt:ClA ~V'-~e/1t<)y- <~J20 LAar~ ~k.. v6 JO ~\ 1n~ {f;i-Y~~_ S-Fr- ~~,;~~ ~?:vd-k I~ ~~" Date: ll-qio( MM 1 \h1tL9~ 10 ~,cf2p_ "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." CITY OF PRIOR LAKE HEATING/AIR CONDITIONINGIFIREPLACE PERMIT Date Rec'd (Please type or print and sign at bottom) ADDRESS \12-\4 'N, \de.rness (+- ~. ~;e~n ~~~y. .1 PERMIT NO. IV 1_''1 nd 3. Yellow Applicant U ~7J' . ZONING (office use) LEGAL DESCRIPTION (office use only) LOT I D BLOCK I ADDITION PID ~=~R b.K. 1- orf(')V) (Address) ZD8hD /!.P1Jbn'dge;11--. _ LakLVL{)P~ 55IJ'1./I./ . APPLICANT A II,' I"'l vi - - M ' , -r-:.. (Name) \..1\1 I eenQ.V'\\(t<t ~/e._. (Address) 3~ 50 1~V1(lebe~ J)r. Lo...C{QV1 (Address) (C~) (Contact Person) _ --J e., fr Zi mrn erman ~ (Phone) X 620 I APPLlCANrSIGNATU~ (I. ~ATE - /2-.L/4//y APPLICANT PLEASE COMPLETE BELOW IXJNEW CONSTRUCTION 0 REPLACEMENT 0 AL TERA TIONS FURNACE MAKE AND MODEL :Br<<j~t'\-t 9~ % FUEL t....JQt. Gas FLUE SIZE ol Y2- DV~ RETURN OPENINGS INPUT /()O,t)O 0 OUTPUT 80, cre-o I TYPE OF SYSTEM HEATING OR POWER PLANT (Phone) (Phone) u5/- .t./ 501- &J 775 66/d~ (Zip Code) DWarrQ Air Plants o Gt'avity o Mechanical &Air Conditioning DVent. 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 I % of job cost Residential, Gas Fireplace $39.50 minimum $99.50 Residential, Additions & Alterations $64.50 Residential, AC Only $39.50 Residential, Heating & A/C (New Construction) Residential, Heating Only (New Construction) $39.50 $39.50 Estimated Cost $ 1 () 00 . (}-D Building Permit # HEATING PERMIT FEE STATE SURCHARGE TOTAL PERMIT FEE $ $ $ ~~~:~~cW,. .,.. \. (Office Use Only) This Application Becomes Your Building Permit When Approved Paid Receipt No. Date By Building Official Date 24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245 15:04 651 633 BBB4 FIRESIDE CORNER #0567 P.002/003 CITY OF PRIOR LAKE Date Rec'd I1~ATING/AIR CONDITIONINGIFIREPLACE PERM.. (Pleue n,e Dt 'OrlnI: a:nd. s.itn III boUDm l ADDRESS i: ~ =IAIII I PERMIT NO. 01-1 ?- Cj S- ZONING (Qllk:nll:) /7 J-I V tJ/I~J &~r LEGAL DBSCRIP110N (office UJll only) LOT BLOCK ADDITION PIn OWNER (Name) rat2 .~ (Phone) (Ac1dtess) APPLICANT (Name) ALLIED FIRESIDE DBA FIRESIDE CO~ER (Phc ne) 6S1-633-~?f?1 (Address) ..l:JOO N. FAIRVI~ AVENUE (Address) BRENDA HUSTON (Contact Person.) _..__ I (Pho nc) APPLICANTSIGNATU~~1b.dl- d~ _. DATE 1!?/iR? APPLICANT PLEASE COMPLEmlBELOW ' ~;:w CONSTRUCTION 0 REPLACEMENT 0 ALTERATIONS FURNACE MAKE AND MODEL . FUEL FLUE SIZE RETURN OPENINGS INPUT OUTPUT TYPE OF SYSTEM HEATING OR. PO. NER PLANT :J StCllllD ::J H:~ Wek.r :J Radlallon J Spec:ial D.:vlccs J Other Devices aQSEV! J:.Llir MN (City) 651-63 J -2561 E:;E:;;'~ (Zip Code} Bwmn Air Ptlllts Qravll:)' o McchanlctJ DAlr Conclitioning DVent. Systllm ~ AJ C;60 SL, .~ PLEASIt NOTE: Air Conditioner Units Cannot Engooach into Rc~jred Side Yard Setbacks FIREPLACE MAKE AND MODEL Residential, Heeting & A/C (NEw Conl~tlon) Residential, Heating Only (New CODstn.lQtioll) FEE SCHEDULE I % of Job co5t Residentia'. 01 s Fircpluc:e $39.S0 mlnimum $99. SO Raidcntl.l. A< ditions &. AlfeI'BlioDS $64.S0 Resldential, Al : Onl)l $39.50 $J9.~O $39..50 Jndllstrial, Commc:rc:iaJ & Multi.Famlly Estimated CeSf $ Building penni' '# HEA TINO PERMIT FEE STATE SURCHARGE TOTAL PERMIT FEE $ $ S .,..- 0 'N\\r:'. . 51> p~\ G Pt:.~,\~.\t . eU\\.O\t-l l: I.omee Vile Only) Thill Application BecOmes Your Building Permit WIlen Approved .mldllll omd.1 I)IItc Da1r.N 3 I ZOOl I RecdplNV1 By /If./ / Paid Z4 "our nodc:e ror .11 InJpet:tions (95:2) 441.98S0, fal (95%) <U'7-4Z4S Nov.27. 2001 8:14AM GENZ RVAN PLUMBING AND HEATING No.6838 p. 19/19 Date Ree'd LIT i ,OF PRIOR LAKE ~~.WER ~ WATER PERl\i.ul . - .------. i ~ =-- .r'J!..tU\fiT NO. 1_ (~a,- . , Gold APpIl~ -, ) (1'1c:a&c: ~ orw:;inl:and~.atb..._-.) ADDRESS 1'12.-1 U lJJi\cu-~ rrn~ ZONING (l;lma: lIIC) 12J LEGAL DESCR..l.r uON (o.1lice use only) LOT ID BLOCK ADDmON 1)l...U ti ~D PTDdb"~/tJ -()/O-(J OWNER (Name) :P~ ltQn:Qll ""':"~?m g1O'm~- (Address) 3459 Washington Dr Ste 204 (Addre$s) (phone) 651-/151..-" 61:. ':l Eagan, MN (city) 55122 (Z'~ Cede) APPUCANT ~Mn~ Gen~-Ryan Plumb.ing & Heating (phone) 651-423-1144 (Address) 14745 Sb Robert Trai.l Roeemount:. MN (Address) (CitY) (Contact Per.IOIl) Marv Olson \ .;j (Pbone) .. ~UC;\NTSIGNATURE lA~. S) - PAl'E C,) APPLlt,.;~'l rlLEASE CO:M:PLETE BELOW 55068 (:zJp Code) 651-423-1144 11/211DI Size of water service inches. Location of any couplings from strut;ture 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. FEESL'J:1.lLDULE Residential sewer and water line connection $35.50 Industrial, Com'l & Multi-family 1% Qfjob cost W1th a $39.50 minimum Sewer connection only $17.50 Water connection only $17.50 Estimated Cost $ Building Permit # SEWER AND W AU~,K PERMIT FEE $ STAlE SURCHARGE $' TOTAL PERMIT FEE $ .50 (Offiu U~e Only) This Applh:ation Become." Your B1liIdillg ;Perm;. Wben ApprD'Ve~ Paid I , I1:U1, P,q,'t) / "4~ 11/~ .G ~.'H n - N . ~l', ' ",ec:e:ipt 0 - ,. i "'. .. J/"4/ .,.., L.. B\lildlag Oftic:ial Date Date li- () 7-1 I By (}c/ j 14 hour ,u,tlce for alllDSpedioDJ (952) 447~9850, fu (99) 447-4245 8:14AM GENZ RVAN PLUMBING AND HEATING No.68:J8 p. 18/19 Date Rec:'d CJTr OF PRIOR LAKE PLUMBING PERlVuJ. I. JlJuc ,.u~ I PERMIT NO 2. CloIcI Citl' . I-}f-) 6 ,--- 3. Yello... AppIi<aDl 1'0- 7..::;J (.Plea:;c M'e or p11nt and s1gu at bOtll)Jll) ADDRESS I i2t L\ {l );\D(YN..A6 C ~"il J. .yc.;r ZONING (affia: WIlt) RI LEGAL DESctUPTION (o1fk:e use only) LOTiO BLOCK \ ADDITION D.eY~eLo PID [)5'- 370-0/ C, -0 OWNER ~wne)_ DR Hor~on Custom Homes . (phone) 651-454-4663 (Adme~) 3459 Yashingt9n Dr Ste 204 Eagan. MN 55122 . APPUCANT (Name).'7 i'~.':"..=i.3'~~ '1'1 "....b.~...e 1(. u....of' i.::.;; (A~ess) 14745 So Robert Tra.il (Address) (Phom:) --E" 1 -~ ~- 1 u.Ja. Rosemount MN (Oty) 55068 (Zip Code) (Contact Person) Mary Olson (phone) 651-423-1144 APPLlCANTSIGNATURE \ ~ _U \i, ~ DATE 1\ 11.1 (0 t - APPLkANT P SE COMPLETE BELOW Qu.antity. I Type of Fixtllr:e---- Quantity I Type of Fixture I ? __ I Bath Tub with or without shower ~ I Rough-ins I I Dishwasher I I , I Warer Heater J 1 Floor Drain I ttll I Water Softner ~ 1 Lavatory (Bathroom Sink) I ,I Stand Pipe (Washing Machine) r I Laundry Tray (lor 2 compartment sink I I Sewage Ejector I I Shower Stall 'I Backflow Assembly I I Six1ks I I Backflow Assembly Test I Bar Sink I I Lawn Sprinkler ?? I WateT Closet (Toilet) I I Other FEE SCJ:U!,JJULE IndustnaJ, Cr;lrnmercial & Multi~farnlly 1 % of job cost with a $39.50 minimum Residential, New One & Two-Family 599.50 ResidEntial, Additions Be. AJtetations $39.50 Estimated Cost $ Building PBnnit # PLUMBING PERlYIIT FEE $ STAlE SURCHARGE $ TOTAL PERMIT FEE $ .50 I. f ....'lJUP DP~(V; IA .. IN. vv77: .G~ Ii I Receipt No. ~I '. " i I By {jV' f (Omer Use Only) I This App~iC::3tion Becou;les Y OUT Building Permit When Approved. . Paid Date //-;)7-) JI~ildiJlK Ollicial :Oau 24 bour nodce for aU inspections (952) 447.~850. fax (952) 447-4245 .PRIOR LAKE INSPECTION · RECORD 0~. DEPARTMENT OF BUILDING AND INSPECTION SITE ADDRESS -0al~ W,lrQRrV\~S NATURE OF WORK 1\. \ P It , USE OF BUILDING S~D PERMIT NO. 0/ -- / Zt!!7 DATE ISSUED J I - q - 0 I CONTRACTOR ..D. Q \-k~ PHONE ~5::2 -;;2.~ -/3stj NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW THE PERMIT IS BY SEPARATE DOCUMENT INSPECTOR . .DATE , FOOTING I Jz/I~I .... ) FOUNDATION (Prior to Backfill)"JIj;.r I ~1 IL/~/o I I ~ ' jJjJJ JOJ PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ROUGH -)NrS_ SEWER I WATER I SEPTIC f3+- Jz/ J '7 )41 FRAMING ' FPr eJ-/7 It) ~ INSULATION ,..~ .2 -//-orC.... ELECTRICAL PLUMBING \,{.~. ~ 172.1/D" HEATING (if required) I FIREPLACE GAS LINE AIR TEST ~, ~~.f"~, 8r COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED ~ ~. 1/8'/Ov I I " t' FINALS ;filS .t/I;>~~v 0. A V ~ ~. f2r.r ~ 14 7/tJ 2,- , m/ klJ 1.:>I7/lJ~ 1 ~j?/~ GRADING (Prior to Sodding) BUILDING r, C,O.1;1J R'/ // /Jl.. ~ ELECTRICAL ' ~ . PLUMBING HEATING DO NOT ~PI /0 G. If III /0 'l,.- t/1.3~~1 /rZ.; I . V 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 a.dditions where no service cabin~t 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 tir~.~~.r...--r....,,~. . ; ,.. . . .~..:.".. t.:.'lllP,; t .~ t ~ t~. ~,.:, ~ ';-".-.i'....)\.mM\~, ,., ~":" (. ~fl t :; t Qttrtiftrau of Q}rnqtaltqJ ~ ':.~ CII f OF PRIOR LAKE 1Stpartmtnt of _uUbing In'ptttlon . Final Permitted 0 Conditional C.O. Expires This Certificate issued pursuant to the requirements of Section 307 of the Uniform Building Code certifying that at the time of issUtIIICe this structure was in compliance with the various ordiMIICes. of the City of Prior LaJce regulating building construction or use. For the following: Use Classifj ~,,:.. Bldg. Permit No. 01-1295 Occupancy Type R3 Type Construction VB _ Zoning District _ R1 Fin:: Zone Legal Desc:ripcion LOT 10, BLOCK 1, DEERFIELD Owner of Building 17214 WILDJ!.1U~J!.SS CT Site~ Contractor's NlUDe & Address1?R HORTON, ;;860 Ui..DRIDGE CT. #1 00. ROBERT D HUTCHINS vYt . City PIInne~ DON RYE BuiIdinl Official Cf - L.. S -01.... LAlu.V.1.LLE 55044 o.te: Date: . DATE TIME CITY OF PRIOR LAKE q -).r- INSPECTION NOTICE SCHEDULED ADDRESS L7)../4 U/; fdt/nt"S..s LT OWNER CONTR. PHONE NO. PERMIT NO. of-I ~q.f" 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 ME7H FINAL '5tJd-/ 7 reelS " COMMENTS: , /1~c.. o EX/GRAD/FILLING o COMPLAINT o FIREPLACE RI o FIREPLACE FINAL o GASLINE AIR TST o t1\') ( It ...,....., .1 }-ir~ . WORK SATISFACTORY, PROCEED o CORRECT ACTION AND PROCEED o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING Inspector: I4f q -2S' -<>>-- Owner/Contr: CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.. INSNOTl CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH &: SAFETY! DATE TIME CITY OF PRIOR LAKE INSPECTION NOTICE ~~-()z..- /7 21'1 W,'tIcrv1~ ."N./ ~ - " CONTR. p.~. I-In~/J. PERMIT NO. .Q I - L.a..1b SCHEDULED ADDRESS OWNER PHONE NO. o FOOTING o FOUNDATION o FRAMING o INSULATION ~FINAL , OSn-E INSPECTION o PLUMBING RI o MECH RI o WATER HOOKUP o SEWER HOOKUP o PLUMBING FINAL o MECH FINAL ,oJ!f E~L1NG "~ o FIREPLACE RI o FIREPLACE FINAL o GASLlNE AIR TST o COMMENTS: Gye,/,/~ - O~ No ~.pr ~WORK SATISFACTORY, PROCEED o cl,RRECT ACTION AND PROCEED o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING InSpector:~~~ ~R~r: CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE. CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY! INSNOTl CITY OF PRIOR LAKE INSPECTION NOTICE DATE n~t ADDRESS i/~2.. l:/~ <J Cl /7-1/L/ ~ "-. ~4J (!1-, SCHEDULED OWNER CONTR. PHONE NO. PERMIT NO. O(-/~9S . o FOOTING 0 PLUMBING RI o FOUNDATIO~ 0 MECHRI o FRAMING 0 WATER HOOKUP o INSULATION : \1 0 SEWER HOOKUP " FINAL \ 0 PLUMBING FINAL o SITE INSPEC.(1vl~ ~ MECH FINAL COMMENTS:~_ # CD p~ ~-*S "NJ Jllltl tI2J . ~ ~ ~ ~ iA r7:"1"_ /~. ~ ~.) f~~.~~~ , ,., I \ ' ~ 4i<<~~ ~.:.,. t# -~~ ~ ~. ~ ~ $-~ -b'U. ~ _-A.~ aJ)~ ~~U~ ~~ o EX/GRAD/FILLING o COMPLAINT ~ FIREPLACE RI FIREPLACE FINAL o GASLlNE AIR TST o .. - 77 e r 0. b.Lr [Sf 1/07....- I . ~~a o WORK SATISFACTORY. PROCEED " CORRECT ACTION AND PROCEED o CORRECT WO~LL FOR REINSPECTION BEFORE COVERING Inspector: - ~ Owner/Contr: l/ CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE. CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH &: SAFETY! INSNOTI SCHEDULED ~ /O:/~ uJ~ ~, CITY OF PRIOR LAKE INSPECTION NOTICE ADDRESS I?d/ '-/ OWNER CONTR. PHONE NO. PERMIT NO. o FOOTING o FOUNDATION o FRAMING o INSULA nON o FINAL o SITE INSPECTION COMMENTSro o PLUMBING RI o MECH RI o WATER HOOKUP ~ SEWER HOOKUP PLUMBING FINAL o MECH FINAL ~~ ~-~ w-oiv ~ ~ DATE TIME tJl -/~"S- o EX/GRAD/FILLING o COMPLAINT o FIREPLACE RI o FIREPLACE FINAL o GAS LINE AIR TST o o~ 's( WORK SATISFACTORY, PROCEED )! CORRECT ACTION AND PROCEED o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING Inspector: ~___" Owner/Contr: CALL 447-98~ 10R THE NEXT INSPECTION 24 HOURS IN ADVANCE.. INSNOTl CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY! A APPLIANCE PERFORMANCE TEST Attach to gas line adjacent to regulator Date ~~~ ~Gr. 1/- \d ,~ ~ Heating Contractor Name of Tester Job Address n~ \4 \..J :\t.l. C:l. Heating Contractor -1ll~ H~ Name of Tester Ct....J G. _L.i-U'r{)g ~,,,S- ~~ <t.~ \)ii'o Date Percent 02 Percent CO Percent C02 Stack Temp Combustion air is adequ~e!y supplied per UMC Sec. 606 '( ... ..s input ~ S; 00 C