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Home My WebLink AboutBldg Permit 01-1346 CITY OF PRIOR LAKE BUILDING PERMIT, TEMPORARY CERTIFICATE OF ZONING COMPLIANCE AND UTILITY CONNECTION PERMIT Date Rec' d ll-fq-Ol 1. White File 2. Pink City 3 . Yellow Applicant 1<1 (Please tvDe or print and sign at bv..u~) ADDRESS /1 ?J/'L lJuA!dtl....,C~r. SG LEGAL DESCRIPTION (office use only) LOTJ.1 BLOCK I ADDITION nte.rML ~ PID zS -g-(2- Oz.,-O OWNER (Name) (Phone) (Address) BUILDER D . , A II (Name) . Q - f11JV1'1)y\. ~ . (Contact Name) ~f!uL &..'dL~ l.V\ (AddreSS)~!rk.~~,* ~e.~'01) (Phone) 1l.5a." Cfe~DB (Phone) qsa -~-/~<<I TYPE OF WORK ~New Construction ODeck OPorch ORe-Roofing ORe-Siding OUtility Connection OLower Level Finish o Fireplace OAddition OAlteration PROJECTCOST/VALUE (exdudingland) $ q~! o Misc. 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 }'.vt',;,'~f and that all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I aware that the bUil~Official can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the pr e to performJ1ee~: . ons. X V S_ --; 0- C~~~NO I~ I Permit Valuation 9~(lC)O..~, ~.OO Park Support Fee # $ ~.OO I Permit Fee $ ~./ c;- SAC # $ Ji, I~?>,DO I Plan Check Fee $ ~c~ .81 Water Meter Size~;l"; $ "{'2.q',OO I State Surcharge $ If' .00 Pressure Reducer $ l../ 5: 00 I Penalty $ Sewer/Water Connection Fee # $ !L.200 ~oO I Plumbing Permit Fee $ leJO.c!)O Water Tower Fee # $} 00,00 I Mechanical Permit Fee $ I 0 0 . C) (J Builder's Deposit $ I Sewer & Water Permit Fee $..35. 50 Other ~tu fuCQW:LC...~ $ I Gas Fireplace Permit Fee $ if. 0 . od TOTAL DUE $ I Paid I Date 'O~(p ..r~ / 7~-~-O J . Js.~-U UJ,' 0 t/- (,. 57 I Rece~ iI/t:J f 71 I By '" I I This is to certiJY that the request in the above application and accompanying documents is in accordaI)Ce. wirp the City Zoning Ordinance and may proceed as requested. This document ~ ommw... <<mponry c-:: of;::';:""'" md __;'":"'" M' ~. ... . _~ ~""'_" ~-e-- -W~~l ~ ~h91'l<_ an 'ng Director" Date Special Conditions, ifany 24 hour notice for all inspections (952) 447-9850, fax (952) 4474245 16200 Eagle Creek Avenue Prior Lake, MN 55372 ., ',- . ,- '''Wo', ._..'_ '\; ",' . '" ~'t'" . -:- White - Building Canary - Engineering Pink - Planning Thf ("f.lo. of Iho \.ok< Counlry BUILDING PERMIT APPLICATION DEPARTMENT CHE;CKLlST NAME OF APPLICANT APPLICATION RECEIVED . D. t2-~' f- ne-m ~I J I-IQ-O ( , I · The Building, Engineering, ~and Planning Departments have reviewed the building permit application for construction ,activity which is proposed at: 1/3/2 DEcR-r:-J 5LO.(R. se ~ Accepted Accepted With Corrections Denied Reviewed By: ~ 5 c ~ 1Yl~//' h'l-( . Date: 11- ~ c, -0 I 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." White - Building Canary - Engineering Pink - Planning The ("enl.. nf the take ("ollnlry BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT APPLICATION RECEIVED D. rL- !--01VD~ !!-!q-O! The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: 1/3/? DEEfGFJ 5LD IJ<.. 56 Accepted Accepted With Corrections X" Denied /)/}fl ~ Reviewed BY( /VJzr=> Comments: Date: 11- 21-af ~ ~1.0 Mltl'VI \7lp 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." t1 Th. e.n... of lh. I.lb ('oun.ry >'"lI'-' White - Building Canary - Engineering Pink - Planning BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT APPLICATION RECEIVED D. 12.. 1-1 (j/<l.ll) W II-lei-Of , i' . The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: I /3/7 Dt.tl~rJ cLu W. ~c Accepted V' Accepted With Corrections Denied --"' Reviewed By: ~~e>/~ Date: !L/~/e ( ~ ~ ~,~/\ ~ ~ ~'f'~.eJl tlik~' -{- .J~~ ~ ~~ "The issuance or granting of a perr,ni! 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." Nov.27. 2001 8:13AM GENZ RVAN PLUMBING AND HEATING No.6838 p. 15/19 Date ReI;' d CItY OF PRIOR LAKE PLUMBlNG PERMIT (Please type or Mill,t ~ s)Q at bottom) ADDRESS ... tJ~ LZ- 1>.ufieffi ~~ &- LEGAL DESCRJ.r nON (offiQ: l1$C o.oJy) LOT 2.1 BLOCK I ADDITION <Wrgr&../J "7..J/\ 0 OWNER (Name) .DR Horton Cust:om Homes . . (Addr~s) 3459 Wash1ngt9n Dr S~e 204 Eagan. MN 55122 APPLICANT (Name)-!;--~-1;>~._~ ~:-::=-g ~- o.,~ ....:\d (Address) ~4745 So Robert! Trail (Address) I Blue FiI. I PERMIT NO :to ClQIA CIty '0 ,- I '<.A f_ 3. lIe11o" AppIi- ...I'f1O ZONING CoJIia: we) PID (phone) 651-454~4663 (phone) {, 51-/0 ?":l.~ 1...1.44 Rosemount MN (City) 55068 (Zip Code) "\ (ContactPel"son) Mary Olson i (phone) 651-423-1144 APPLICANT SIGNATURE -1,\ ~ D - DATE I I '2- (\ 0 \ APP~CANT )LEASE COMPLETE BELOW Type of FixtUre , Quantity Bath Tub with or without shower I 3 I Dishwasher I I - I Floor Drain I ~I j 1 Lavatory (Bathroom Sink) I'J I Laundry Tray (1 or 2 compartment sink I . I Shower Stall I I Sinks I /B~S~ I ~ I Water Closet (Toilet) I Quantity . I I , 2- I , Type of Fixture Rough-ins I WaterHea.ter I Water Softner I Stand Pipe (Washing Machine) I Sewage Ejector I Backflow Assembly I BaclCtlow Assembly Test I Lawn Sprinkler I Other ~JLj!;S~J:1.)!;DULE Industnal. Commercial &. Mul1:l~famdy 1 % of job QOst witb a. $39..50 minimum Resident1aJ, Ne:w One & Two-Family $9950 Residential, Additions &: AltCI1!tions $39.50 Estimated Cost $ Bwlding Permit # PLUMBING PERMIT FEE $ STATE SURCHARGE $ TOTAL PEDUT FEE $ (om(c Un Only) ( This APPlica~r :"'A/f~r Building Permit When Approved · i0.!i;r 17,- 3 -0 I l .- Buildiua Omcllll Date 5r:~PA\B~~~:M.rr F .~~ I~ I Date 24 hour Dotil::fl for llUln$pectioJls (.952) 447~985o, fu: (9Sn 4l&7-4J45 Nov.27. 2001 8:13AM GENZ RVAN PLUMBING AND HEATING No.6838 p. 14/19 Date Rec'd ell i,OF PRIOR LAKE SEWER ~ WATER PERMIJ. C1'leue type or MiDt mil siD 'at })y<__) ADDRESS \1?J\ 7- ~~elO O{. SF- i: ='" ~~ PERMIT NO.O 1-13 A 1- /. 1. (JaW AppU-. ~tp ZONlNG (ot'Ib-) LEGAL DESCRlPTION (otflcll use 0Dly) LOT'~1BLOCK \ ADDmON UPf~do 2(\0 PID OWNER (Name) Dll Ilgr~QR Custom liomes (Address) 3459 Washington Dr Ste 204 (Addres$) (Phone) ~51 4.5/t 116~~ Eagan. MN 55122 (City) (Zip Cad.:) APPUCANT (Nune) Genz-Ryan Plumbin~ & HeaLin~ (Address) 14745 So RoberL TaiJ. (A~) (Contact Person) Mary Olson \ . -UCANT SIGNAl'ORE \ l J (Phone) 651-423-1144 Rosemount. MN (City) 55068 (Zip Code) - () (phone) DATE 651-423-1144 JI/zIIO( APPLI ASE COl\-u LETE BELOW Size of water se:rvice inches. Location of any couplings from structure 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. .w .l4'.Ii;J!,; SL.J:::U;DULE Resident\al S&:lWer IU1Q water line connection $35.50 Iudustrill~ Com'l '" Multi-family 1 % of job co,st with It $39..50 JIJ.D;tiJ;nUD1 Sewer connection only $17.50 Water cor,J,n.ecUon only $17.50. Estimated Cost $ Building Permit # SEWER AND W AU~.K PERMIT FEE STATE SURCHARGE TOTAL PERMIT FEE $ $' $ r~ PAlO W\TH .50 BUILDING PERM\T c-.. I .1' (Office Use Only) I TW. Appl~ ilaOdblg Pi:~:~PI'';al L.... BUildiDi Omd.J . n.tc 24 hour Iloti~ for all in$pections (952) 441-98S0. fax (952) 447-4245 ~- Date - CITY OF PRIOR LAKE HEATING/AIR CONDITIONlNG'..lKEPLACE PERlVl11 Date Rec'd (Please tvoe or orint and sign at bottom) ADDRESS 11312.. /) e.er t1 f'Jd ':Dy Se:. l. Pink File PERMIT NO 2. Green City _.. · '0(-( :?1 f L 3. Yellow Applicant ...J ~ ZONING (office use) LEGAL DESCRIPTION (office use only) LOT Z1 BLOCK \ ADDITION PID ~=~RD.~. Horfon nt.dom Home~ (Address)dai1oo Ke.obridos- (It. I Lo.kevi L1e.. Mf\) APPLICANT J\ '/' 1 M h--- (Name) l:1.L 'C\r1T e~. J...~. (Phone) 1.t..5.../- ~- tf?77!j\ (Address)3(g5() Kennebec-"b: 5:I:e. #/ AaaoY1 55/.22. r [ (Address) ....; (City) (Zip Code) (Contact Person) ~ P.j:l I"'~ Z. .. m rnp.r J'Y) .0. n (phone) ~4/~~. · .:J.77t'J APPLlCANT3IGNA~$~(?{d?_~(L~ DATE . ~lllo~ . . APP ICANT PLEASE COMPLETE BELOW 0NEW CONSTRUCTION o REPLACEMENT 0 ALTERATIONS FURNACE MAKE AND MODEL 1Jr~4n+ 3~A-vb7&1l), 0 FUEL 1\,)Q..h.A.n:>..] FLUE SIZE "IJ'clQ,Sfi, 'ELRETURN OPENINGS 4 INPUT "1b.l>t>O OUTPUT 6lD..lJOO TYPE OF SYSTEM HEATING OR POWER PLANT (phone) <{'Sa -" q ~ '"'7077.l. 550k(L.1 OWarm Air Plants OGravity o Mechanical ~ Conditioning (]!'Vent. 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 S\,;I1.1!;DULE I % of job cost . ReSidential, Gas Fireplace $39.50 minirnum $99.50 Residential, Additions & Alterations $64.50 Residential, ACOnly $39.50 $39.50 $39.50 Residential,Heating& AIC (New Construction) Residential, Heating Orily (New Construction) Estimated Cost $ Building Pcmriit# (Office Use Only) This Application Becomes Your Building Permit When Approved REA TINGPERMIT FEE STA TESURCHARGE TOTAL PERMIT FEE $ $ $ ~ PAlO WtTH BU\LDiNG PERMIT. .50 Building Official Date ~ ... DateJAN l 5 2002 24 hour notice for all inspections (952) 447-9850, fax (952) 4474245 J, PI"" PU. :. ar- ell' 3. 'f.!I_ ...",- PEN~U:" NO?_ /3 Lj~ rp1e1l8e tome gr m:bI111D4 sil!lllt L ... '" ) ADDRESS //31;; ~~ LEGAL DBSCRu L LON (oftic~ use Oldy) LOT,?1BLOCK / ADDITION I Q 0 p*~fc{) rPt&d l I ZONING (of.fl-=-UJI) PJDas-- 37~-002?-() . OWNER (N arne) (""]) t:, i-/o~. . (phont:) (Address) APPUCANT (Name) ALLIED FlREsm:s: DBA FIRESIDE CORNER (Phone) 651...633-,~61 (Ac14ms) 2700 N. FA:mYl:EW ~VENUE (AddresS) BRENDA HOS'I'ON (Contact Person) - APPLICANT SIGNATURE c...~ 1-j,.L.~ ~SJllVTT.T.~ ...M1'J (OJ)') 651-633-2561 liP:,' , ~ (Zip Code) (phone) DATE 41~/aL- . APPLICANT PL.EASE COMl'LETE BELOW ~W CONSTRUCTION 0 REPLACEMENT 0 AL rERA TrONS FURNACE MAKE AND MODEL . FUEL FLUE SIZE :RETURN OPENINGS INPUT OUTPUT TYPE OF S1:.) L I:.M: REA TING OR POWER PLANT DWarm AIr Pl&I'J.ts OGravity o Mechanical OAjr CClnditioning DVcnL Sy~ FIREPLACE MAKE AND MODEL _,~,Ju ,4J 6t.;, ~Stnm Hot Water R.Jclhstion Speci-.l Devices J Oth.cr Dovll;cs S'- "1.iIJ~ PLEASE NOTE: Air Couditioner Un.its Cannot BnQ'ollch imCl Required Side Yard Setbacks l.ndustrlal, CommCTQill1 & Multi.Famlly F1t1 S,-n..DULE 1 % of job collt Residential. Gas Fimplece $3!BO minImum $99.50 ResidcntillJ. Ad.ditlonllct: AI._..':Dn$ 564.50 Residential, AC Only $39.50 Residential. HlWing & Ale (N~w COnsUUCgCln) Resid.entil1l., Heallni On.ly (New CONtl'uctfon) 539.S<l 539.50 REA 'fING PERMIT FEE $ STATE SURCHARGE S .50 TOTAL PElUrDT FEE $ ,...-- , BUn!~WG WITH PERMIT E~d Cast $ Building 'Permit # (OffiCIIl fJ,c Only) This Appllatioll Becomll Your BuildIng rennet When Approved Paid R.tc;eipt No. BulldtllC Omdlll Date Dote 5' . 10- d-.. .B~ V Z' hour notil:e for allln.p.etlonl (95:Z) 44'-9850, ,.. (95') 447-4%4! P R 10 R LA Kc DEPARTMENT OF L....r BUILDING AND INSPECTION INSPECTION RECORD SITE ADDRESS 1'l3rZ. ~ ~eM (\-. NATURE OF WORK AJ'l-lJ..:) . USE OF BUILDING ~~ PERMIT NO. 0/-/34 DATE ISSUED 't-2'7....0( . CONTRACTOR 1212- \--b.~ PHONE QS2-2;)L-/33<f NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW THE PERMIT IS BY SEPARATE DOCUMENT INS,E:ECTOR DATE , FOOTING /h. IPIIs/o/ FOUNDATION (Prior to BaCkfill)fr~ I~. ~/ \~rr( I I PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ROUGH - INS ~ .~ SEWER I WATER I SEPTIC FRAMING INSULATION ELECTRICAL PLUMBING ltG. ~ 2)f;;:;)/Do- HEATING (if required) FIREPLACE GAS LINE AIR TEST ~~lfP, - r-~ iJ;r ~, d( :"/01,.; . rz,/z.?!or 3//?/ ()2.J 81~ 70"- I .3 / /2-1 () z.- 3; /Z/tJL ~~ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED I~ . ~_ d/c9pr-1 I ~. - - ~ - U / I FIN A L 5 GRADING (Prior to Sodding) J? IL BUILDING ~t.OI1ilQ Sf { I D"l.. ......- ~ I W!?/bz- ELECTRICAL PLUMBING HEATING DO NOT I!tr-~ . 7/" ()i, -0 d- 5//J~~ to/ {f/tJZr . < 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 additions where no service cabinet is available, card shell be'placed near main entrance. Call between 8:00 and 9:00 A.M. for all inspections FOR ALL INSPECTIONS (952) 447-9850 --. Date: .,.' ,c'-.;;'.,,,, .......~' .::';;.;",";' :"";r:;;~';,:''' .~-_,~;..., '^~'''-f,r":;,~~:~''~~::,,,:<:'.' <:.,,"'_~_,:..'.. ::' ..:, :;:, ;'-;':"',' ~---:,..,~~~, ... ~.".~.;~~...;: ..~.'~.~...S ....,.. ",:i."",.. .-.... { :( :iii Itrtifuau "~ot Okrupanry ).- . :tii CI.l f OF PKIOR LAM ;~"l 1Bepartment of _uUiring Inspection ~(" II Final Permitted 0 Conditional C.O. Expires (I~.-.:...~J:.~..._..-, 17W CertijiCDte issued pursuant to the requirements of Section 307 of the Uniform Building Cotk ~ I certifying that at the time ofisslllUlCe this structure was in compliance with the various ordinonces. of the x. - City of Prior lAJce regulating building construction or use. For the following: 1~~1 SINGLE FAMILY 01-1346 (~ - Use Clusificatioro Bldg. Pennit No :'i~" "-"""',.,.. R3 ,.,.. """""""" VN ..... "'"" N I A ...... -.. Rl itt. Legal Description. L27, B1, DEERFIELD SECOND ADDITION ~ 17312 DEERFIELD DRIVE S.E. :~i =~::&Address D.R. HORTON, 20860 K~~=GE CT., SUITE 100, LAKEVILLE (!:7' I I/J// (~. - f '1 City Planner ~~ \~. r3,l.,. . ~I::..: · ,.. .o.t tt. :.; P'l, ROBERT D. HUTCHINS Building Oft'icial /1- l..J- U1- DON RYE Date: POST IN A CONSPICUOUS PLACE .. CITY OF PRIOR LAKE INSPECTION NOTICE ADDRESS OWNER PHONE NO. DATE TIME SCHEDULED (,-If/ t?--, 10 ,.'3d v 1'13/a- ~. U- CONTR. PERMIT NO. /- l=Jlft;;, o EXIGRADIFILLlNG o COMPLAINT @)o FIREPLACE RI l)I FIREPLACE FINAL b GAS LINE AIR TST o o PLUMBING RI o MECH RI o WATER HOOKUP o SEWER HOOKUP ~ 0 PLUMBING FINAL \!y ! MECH FINAL COMMENTSffi ~ f;t.;, ~ I~ ,.\ ~ &.c1-'~ ~ --(A.JLor f~ €)~ ~ "~_/1~ r-.. ~~~two ~~. o FOOTING o FOUNDATION o FRAMING o INSULATION ~INAL o SITE INSPECTION , c (1... O. ~ 1('/, I (}~ - I · ~~I o WORK SATISFACTORY, PROCEED 'f!' CORRECT ACTION AND PROCEED o CORRECT WO<1>,CA~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 " '" DATE TIME CITY OF PRIOR LAKE INSPECTION NOTICE SCHEDULED ~6~ 1/)1 'J~ ADDRESS /73f2- ~_p,(l h.. CONTR. PERMIT NO. 01 -1"31{' OWNER - 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 o MECH FINAL o EXlGRADIFILLlNG o COMPLAINT o FIREPLACE RI o FIREPLACE FINAL o GASLlNE AIR TST o PHONE NO. COMMENTS@ p~- ~~. - - - ~-~ _l~~~. o WORK SATISFACTORY, PROCEED ~ CORRECT ACTION AND PROCEED o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING ....-::~ Inspector: -;;t'\.- _ Owner/Contr. . ~AU. 441.9850 fde. TlIE NE~.T INSPECTION 2' HOURS IN ADVANCE, CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH &. SAFETYl /l'lSIIOrl P~<:Y'r.'c,IJ Dfl Dt HoI'Iol"} PERMIT NO. 61-'~4.f5 ~~~~ .:=&(~ILLlNG o COMPLAINT o FIREPLACE RI o FIREPLACE FINAL o GASLINE AIR TST o CITY OF PRIOR LAKE INSPECTION NOTICE SCHEDULED ADDRESS / 7310 OWNER CONTR. PHONE NO. o FOOTING o FOUNDATION o FRAMING o INSULATION )(FINAL o SITE INSPECTION o PLUMBING RI o MECH RI o WATER HOOKUP o SEWER HOOKUP o PLUMBING FINAL o MECH FINAL DATE TIME 7- )6-oz.. COMMENTS: /7 ~iO l-oc.....JFIC (' of ,.A..(!.... ~O)( " G It!... (:;.I;)~ 0 Il 00-UJ~~ ~- O~ r ..a hli> ~ QIl 1731'1 - 1oc..0E4 UJA6 ~o~ ~A.p~ ()),( /7?1f -wJ(.JE~ t ~p,-~ 60v ('~Aaf. OK "- ~d-S P WORK SATISFACTORY, PROCEED ~ORRECT ACTION AND PROCEED o CORRECT WORK, CALL FOR REINSPECTlON BEFORE COVERING Inspector: ~. > !J -; L, Owner/Contr. CALL 447.aSO ~XT INSPECTION 24 HOURS IN ADVANCE.. CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY! IltSJ'iOTl \ /' --------- ~. DATE TIME CITY OF PRIOR LAKE INSPECTION NOTICE f~ SCHEDULED lY7 ADDRESS /73/0 /73/(, ~~e-L-O II :.,-. LJAZ-. OWNER CONTR. PHONE NO. PERMIT NO. o;-/1t1f''-- o/-/$4fJ [J FOOTING [J FOUNDATION [J FRAMING [J INSULATION [J FINAL [J SITE INSPECTION [J PLUMBING RI [J MECH RI [J WATER HOOKUP [J SEWER HOOKUP [J PLUMBING FINAL [J MECH FINAL SOO/77lEG ?K) / cry [J EXIGRADIFILLING [J COMPLAINT [J FIREPLACE RI [J FIREPLACE FINAL [J GAS LINE AIR TST [J COMMENTS: cJox J:;l~ ,. WORK SATISFACTORY, PROCEED [J CORRECT ACTION AND PROCEED [J CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING Inspector: ..t1e...J; -1-01-. Owner/Contr: CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.. CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEAL TH & SAFETY! If'/SNOTJ .. \ / ,/ i i ! i I r--- - ~. ....~~.u.. ..... .........._..~..._....~..... . . ,0"... ._' ...,0" ,_ ", '.> .",' _"'"::~___.:''' '''.. . n ;. APPLIANCE . PERFORMANCE TEST Attach to gas line adjacent to regulator . Heating Contractor Name of Tester Date _$/tt'IN7" Alfj;c.v" .4?n,/l o"//;;h "L 1 , Job Address /73!'V i)-~b~, Heating Contractor ~'KIN" ~6;"~ A,rdA ~'/a. I'.s; 2-.?O ~ .J.I ,:3 ~ &=3. t>JS Name of Tester Date Percent 02 Percent CO Percent C02 Stack Temp Combustion air is adequately supplied per UMC Sec. 606 ~~ input 1'4 fbtJ ..il ""lCJ