HomeMy WebLinkAboutBldg Permit 01-1386
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERlulCATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
/1-2, 9-C> /
(Please type or print and sism at bottom)
ADDRESS
n ~'3 {p JeerJ;" j d, Or. r 6
~: ~i~: ~:~ PERMIT NO. "/_!''A.Q/-,
3. Yellow Applicant V. .../ V f"
, ZONING (office use)
,€/
LEGAL DESCRIPTION (office use only)
LOT ~1 BLOCK ADDITION {)u.r-nd.i ~tJ-
PID Z5 - 372.. - Ci37 - 0
OWNER
(Name)
(Phone)
(Address)
BUILDER 1\ () LL ~I
(Name) U fL. ~/Y\
(ContactName) ~/~ ff)ik~1IVl
(AddreSS}~~O K~n.~~-te. IOf)
. . M N F;1:;I) tJ t./
f - - ,
(Phone) ~t;- 7l../J d
(Phone) q~-OICl('- /~t.J
TYPE OF WORK
~ew Construction
DLower Level Finish
o Deck
o Fireplace
OPorch
DAddition
ORe-Roofing
DAlteration
ORe-Siding
DUtility Connection
o Misc.
PROJECTCOSTIVALUE (excluding land) $ /{)$...if;~
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_m~' oned property and that all construction will conform to all existing state and local laws and will proceed in accordance with
submitted p s. I am aware thl t building official can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may
~terupon ~ ropertyto pe. ::.;::.ons. dOOO~~C::7 1I/1-SW
- I. ture 0 Contractor's License No. - Date
..
Permit Valuation J Ofo .(jOO.qj Park Support Fee # $ >15'.00
Permit Fee $ /,/')71. 5~ SAC # $ !, I 5'0.06
Plan Check Fee $ Water Meter S~;I"; $
(p{P. 7 I 2c; .t::)O
State Surcharge $ J Pressure Reducer $ </q"c t9d
.S'3 -1)0
Penalty $ Sewer/Water Connection Fee # $ L 2 a...o . 00
: Plumbing Permit Fee $ tbO LC) 0 Water Tower Fee # $" c::a
~
Mechanical Permit Fee $ JOe? -0 C) Builder's Deposit $
I Sewer & Water Permit Fee $ . '35. ~ V Other Sd-W Re.~~ $ .$$:Su
I Gas Fireplace Permit Fee $ lfo .OC? TOTAL DUE FA",p ft."1I '...., L $ fR.' I Z ~ '1
Paid ''l.. S I 0t;t .44-
Date 11.'/",1/01
Receipt No.4-I' 'Z-f-
By fU) ~
Date
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
wh~n s' db. y. the City Planner constitutes a temporary Certificate of Zoning comPlianc. e and allows construction to commence. Before occupancy, a Certifi. . cate of Occupancy must be.
issued ~ .
_ __ ..... - ~ '_"L-Lft, /e1- _ _ .J ~flN"~ s
I PI ann g Director Date Special Con ItlOns, I any
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
Th. ('.01.. of Ih. tlk. Couolry
White - Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
;J. /~. ~
//-dtf-.O/
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
/r1~~.Af.J_ /.~" ".j' . hl,./:' /i}
/ -~ 7P1P /'. '..LO{. fuLr
(./
Accepted
r/
Accepted With Corrections
Denied /'l i
Reviewed By: ?fP -VJ -~~
com~e ts: _)
_~lt(P ~e>:~ 1732Q ,0 :/@Jj
l ,- .Qt~ &1AA.Wvt,s _ "eft
Date:
II2-/t reI
"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 .. '
..j
~~t~ - '~I~i~9
Canary - Engineering
Pink - Planning
Tht ("tnltr of tht L.kt Country
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
tP.I2.~
J/-;)-9-() 1
The Building, Engineering, and Planning Departments have reviewed the building permit
apPlic~';;3:;:~n activity which is proposed at: ~ .
Accepted f>(
Accepted With Corrections
Denied
Reviewed By:
11/ fJ- ~
5~{ /Yl&,{/' F,1~_
Date: /2-10 -0 I
.
Comments:
IThe 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
Thf ("fnl.. of Ihf Lok< ('ounlry
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
11.12.~
J/-d-9-t) J
The Building, Engineering, and Planning Departments have reviewed the building permit
apPlici7~~n activity which is proposed at: ~
Accepted
Accepted With Corrections ^
Denied Q) rIJ
Reviewed . ~~, ~
. )'
Date: /2 -0")-0/
.
Comments:
~-\-~_ ~\t\ C lc
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."
2001
2:02PM
GENZ RVAN PLUMBING AND HEATING
LIT:i OF PRIOR LAKE PLUMBlNG PERl\fiT
No,7996 p. 12/21
Date Rec~ d
DEe I 3 2001
.,'
I, B'" 1i1.
2. Gold city
3. 1.110.. A.ppII-
PERMITNO'(f1_13~
(Pl~ tvp,e or mmt and. SUlD I.I bottom)
[~;:;; ... .
rJ ~i',~)"'W {) (~~ ~~
[LEGAL DESCRIPTION (oflic:e 1iIe only)
LOT~ BLOCK ( ADDITION 't)? iJ Ir ~..O
. ZONING (o~usc:)
PID
r ~= Dll!lo.ton cu.tom !lome.
L (Address) 3459 Wash:ingtoD; Dr Ste 204 Eagan~ MN 55122
(phone) 651-454-4663
-
, .APPUCANT
(Nwn~~~~~-~'~~ ~~~~g ~ R~-~~~d
(Ad~~s) 14745 So Robert Trail
(Addres,,)
i
(Contact Person} Mary Olson ~ \- ( I (phone) 651-423-1144
Al'PLICANTSIGNA1'URE {J\. ....~"-- , _._ DATE 12-/ iD J'1',j
.uJI~ANT~ COMPLE~ ~ELOW
I Type of;:;.,,~ .are I Qllantity I l},t"e ofF~~..re
. Bath Tub with or without shower l' ~ I Rough-ins
~ '
Dishwasher t I Water Heater
I Floor Drain ' I W stet Softner
1 Lavatory (Bathroom Sink) , I Stand Pipe (WashJng Machine)
I Laundry 'tray '( i or 2 compartment sink l Sewage Ejector'
Shower 81:311 . I Backflow Assembly
Sinks I Backflow As:sembly Test
I Bar Sink' Lawn'Sprinkler
I Water Closet (Toilet) I Other
(phone) r;\ ~ 1 -A' 1._ \..ltLA
Rosemount
MN
55068
(Zip Code)
(City)
Quantity
/.
I
I
2-
I
i
2-
,1l'J!..J!; S(:;.tI.JUJI'ULE
Industrial, CommetC!aJ &: Mu1n-famlly 1% of job cost with a $39.50 minimum RllSidenttaJ. New One: & TwO"-Fmuly $99,50
Rclsidcntial. Additions &: Al~ons $3~.50
Estmlated Cost S
Buildlng Permit #
,
. . It'\-\
fJ~\O VJ~EFtW\1', f'
~U~~J)\~G ,
PLUMBING PERMIT FEE $
STAlE SURCHARGE $
TOTAL PERMIT .lI'.I!iJ!j $
2Q
:>fflu. Use Only)
Thi. APPlicatlf ~g~7~;r'"'cd
BUildulg Ooidal ~ " Date '
Paid
I Receipt No.
Pate
IBy
Z4 bour notice for .11 inspections (952) 447-9850, fax (952) ~7"'245
Dec,10.2001 2:02PM
GENZ RVAN PLUMBING AND HEATING
No.7996 p. 13/21
Date Rec'd
Cl'l t .OF PRIOR LAKE
SEWER AND WATER PEAAul
DEe l 3 2001
flwe ~c: C1t'Dnnt and mm 'at boagm)
ADDRESS
\1~b!e("'ne:1 D
[LEGAL DESCR.il:" nON (omca use only)
LO'I?)1BLOCK I ADDmON
- .
t tf :~ I PERMIT NO'O/-/38b
ZONlNG (~lI.W)
Oe
r'
<::: r:.
~ Jt':.
D{/t?f:1?~n
....." l..---
PID
i OWNER
~mn~ D~ UgX~-~ Ca8~g. ggm~~
(Address) 3459 Washington Dr Ste 204
{~$)
(phone) 651-',5'1_/, ~~':l
Eagan, MN 55122
(City) (Zip Code)
APPUCANT
~ron~ Genz-Rvan Plumbin~ & Heating
(Phone)
651-423-1144
(Address) 14745 So Robert Tra:tJ- Roselllount. MN 55068
. (Addras) 1 (CiM (Zip Code)
(Contact Person) Marv Olson {i ,_ ' 11 (phone) 651-423-1144
'''UCANT SIGNATURE 1 i V ~ ),.,U ...DArE "} 2-/ I Q' /I"j I
- 7- ) ,
APPLIC~ASE COMPL.ElJii BELOW
Size of water service _ 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.
FEE S,--.t:lJ!J)ULE
~c.sidentxa.l ,Sewer and water line connection $35.50 Inc:iustriaL, Com'l & Multi-fanliIy 1% of job cost with a $39.50 minimum
;cwcr cQIJAection only $17.50 Water ~ec:tion only $17.50
Estimated Cost $
Building Permit #
SEWER AND WATER PERMIT FEE
STATE SURCHARGE .
TOTAL ;t..a!.AMlT FEE
$
$'
$
IF ,j(iO \N\1\-\ ~'f'
50~ p""...,r.i:. pEFc~,fSb"
. . ~\\.Dt~~~
~--- l
>mt.. Ule Ooly)
1bgAp~r;~:~pp,""d
1I1,1jJdlng Oftid'aJ . Date
Paid
I :Rcc;ciptNo.
By
Dll'te -
~ hour notiCE for all Inspections (951) 441-.9850, fu (.95%) 447-4245
CITY OF PRIOR LAKE
HEA TING/AIR CONDITIO~G/FIREPLACE PERMIT
Date Rec'd
(Please type or print and sism at bottom)
ADDRESS
t =w ~l~icantl PERMIT NO. (jf-13~(t, I
1'1~3U
I) ee r t1 ~ld '1:::>..- ~
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
~~e~RD~. Horfon Cu.stom Horne~
I (Address)~ K.enbrid~. QJ., l-o.k ev; l1e. M~
APPLICANTAll' M ---
(Name) r CAr'-' e~ 1. ~.
(Address)3(P50 K~bec..~. Sfe. #/ Ea3al1 55/.22
' [ (Address) (City) (Zip Code)
(Contact Person) .J:ef-Pre.1/ Z;mmp.rrn GAn (Phone) (P51-~~~- tl77~
APPLlCANTSlGNA.J~"ft(?1?-;"'B~ DATE ~ lInIn...
APP ICANT PLEASE COMPLETE BELOW
10NEW CONSTRUCTION o REPLACEMENT 0 ALTERATIONS
FURNACE MAKE AND MODEL -:Br~4n+ 3S3KA-vb2}!.lrl0 FUEL I'JCl{U.in..]
FLUE SIZE 'I-"cla.stz. EL RETURN OPENINGS ~ INPUT '1().Ot>O OUTPUT 6l.oLlJOO
TYPE OF SYSTEM HEATING OR POWER PLANT
(Phone) C;5~ - q ~5 -7017.2..
.5 5o~ Lot
(Phone) LQJ- ~- tf<775!
DWarm Air Plants
OGravity
o Mechanical .
~ condi. tioning
[]!'Vent. System
o Steam
o Hot Water
o Radiation
o Special Devices
o Other Devices
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required SideYard
Setbacks
FIREPLACE MAKE AND MODEL
Industrial, Commercial & Multi-Family
FEE SCHEDULE
1 % of job cost ReSidential, Gas Fireplace
$39.50 miriimum
$99.50 Residential, Additions & Alterations
$64.50 Residential, AC Only
$39.50
$39.50
$39.50
Residentia.I, Heating & AIC (New Construction)
Residential, Heating Orily (New ConStruction)
Estimated Cost $
Building Permit #
HEATING PERMIT FEE
ST A TESURCHARGE
TOTAL PERMl'r FEE
$
$
$
r PAID V'V"-i, I
.5<g\JU..DING PEFU'J1rr.
Ie
(Office Use Oldy)
This Application Becomes Your Building Permit When Approved
.-~
Building Official
Date
Paid. .~........... ... ....
.~...........
Da~ 15 2002
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
FI RES IDE CORNER
#5514 P.OO2l005
CITY OF PRIOR LAKE
It~A.l.uiG/AIR CONDITIONlNG,tlKEPLACE PERl\tu 1
Date Rec:'d
~: ~!:, ~'" I PERMIT NO"-f3<6to
,~ Jeue me or uriDc _ ften at bottom)
ADDRESS '
/7331., ~~ D,. .,p:-
LEGAL DESCRu uON (. .000f h \IX Ollly)
ZONING (ottia: WIO)
LOT ,BLOCK
ADDmON
PIO
OWNER.
(Name)
IJ) fl UAu\...
(phone)
(AdJ:1ress)
I APPLICANT
(Name) ALLIED FIRESIDE DBA' FIRESIDE COlmER
(Phone) 651-633-2561
(Address) 2700 N. FAIRVIEW A~W
(J...d41m.)
B:RENCA HUSTON
(Contact PeJ:$on) . /1 I
~~
ROSEVTT.T.~ MI\T
(CJty)
(phon~ 651-~33-2S61
'::"11':t
CZip CCJde)
APPLICANT SIGNATT.1RE
r-
DATE
.sJJ~<>> _
" APPLICANT PLEASE COMPLETE BELOW
t:pu::. W cONSntJ....l LON W .KbJ:"l..ACEMENT 0 AL TERA TrONS
FUkNACE MAKE AND MOPEL FUEL
FJ...UE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
:JWID'ltt Air PllIIIlS D S~Al1t
:JOnIvil:y C] ~ Water
:J Mechllftical. . 0 Radjation
:JAir Condjtjonin, 0 Special Devices
JVent. System CJ Other DlrYjces _
FlREPLACE MAKE AND MODEL k P ~lo J1'~ 7J1)7E.
PLEASE Nu'J..&!.:
Air CoDditioner Units
Canool: Encroacb bllD
~qu.it'ed Side ylltd
Setbacks
Industrial. Cc:n:nmcrell1l A Multi-PlIDJ,Uy
~id.entittl, HcafJng IlL NC (New ConstnJctfDn)
Re;lidential, Heating Only (New Ccmstruction)
FEE SCHEDULE
1% cr job cost ResidenrlaJ, Gu Flrep/~
$39.50 minimUIn
$99.50 ltesidentlaJ. Addltlohllll. AllIlJ1ll:lons
$64.50 Residen.ti... AC Only
539.50
$39.50
539.50
Estimated. Cost $ .
Building PermIt #
REA TING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT ..,r.,JlO
$
$ .50
$
r-
l BUIL~1/~;;'~n-. ,
~e Use Only)
" Appllc8tion Beeomes Yo.., l:IuUdln1 PermIt When Approved
. Paid
JlJJ11dl.... otfid.,
D_,.
Date
MAY 2 2 20ij?
I Receipt No.
IBY 0V
v
~ hour nDtil:C forallln.pedjon. (951) 447-9150. Ins (952) 447.4Z45
s~~ ~ M~'tA.. ~ k
PRIOR LAKE DEj)ARTMENTOFJ.
... "BUILDING AND INSPECTION
INSPECTION RECORD
SITE ADDRESS 1 r,7..~L. T)p.pr~~ Dr-;\Jo-{J
NATURE OF WORK ~e...d
USE OF BUILDING 5 FA-
PERMIT NO. 17/- /30(0 DATE ISSUED /2 -Ie.) -Of
CONTRACTOR ...D..\[. ~_ PHONE 95;l-~ f..p-I~~~
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
SEWER I WATER I SEPTIC
FRAMING
INSULATION
ELECTRICAL
PLUMBING Ua,. ulo. ~ S/(/)/o30-
HEATING (if required)' .
FIREPLACE
GAS LINE AIR TEST
INSPECTOR DATE
FOOTING I ~ I '5/ ~/6l--
FOUNDATION (Prior to Backfill}r;:;; I ~. 3f?.%'V I ~ .. 3P,?!~
_~I-ACE NO_CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
~
/~,
~.
.
- ,r>7/~;r
tp/~ 1/
folia t () ~
i?:r, 5/C)~~z.,..
~,
f:n.-, . ~4/ov
~pJ ~~) ~,' 101t/~fJ/ '. .
" f r
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I I
FINALS
GRADING (Prior to Sodding) IZR
BUILDING .,:e-o. tJ! ItJ/;iI/c;V- ~~ ?/31/tJZ-
ELECTRICAL
PLUMBING
HEATING
DO NOT OCCUpy
!o/~/~~
J(- ~~
UJo~ l'~ vt{/lf-&-aL
.~
tT+ /7 lk3/tJ'G,
. !:tr-. 7/3/ /o?-/
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 ha~Q. bv""'l1 ~pproved. 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
<"~,,~~,~' -' ", ':'.. ;<'!'~. '.il: 'ji;;:...<J::'J' ,.,~-.:o' ,,~,~,; X';;::;j-j''':~:;.'~~3:;-:' ,'.
DATE TIME ,~
CITY OF PRIOR LAKE 7-8J-d- frl'.1
INSPECTION NOTICE SCHEDULED
ADDRESS L131 ) ~~
OWNER CONTR.
PHONE NO. PERMIT NO. 1- /33p
/
o FOOTING 0 PLUMBING RI 0 EXlGRADIFILLlNG
o FOUNDATION 0 MECH RI 0 COMPLAINT
o FRAMING (!) 0 WATER HOOKUP 0 FIREPLACE RI
o INSULATION 11 0 SEWER HOOKUP ~ FIREPLACE FINAL
aFINAL 0 PLUMBING FINAL t..lJ). 0 GASLlNE AIR TST
o SITE INSPECTI ~MECH FINAL 0
^OMMENT~ ~ ':)'~ -11
( 'D) ~ i.~ I --
--- v
..--
1t"C..{),
r _ ;t
..w-v
~ ,
IOlsl/d2"
.
~~
~/~
.
~~
o WORK SATISFACTORY, PROCEED
)II CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: ~ Owner/Contr: .
I
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYl
INSNOTI
CITY OF PRIOR LAKE
INSPECTION NOTICE
DATE TIME
ADDRESS
J7$S6,
SCHEDULED 7~~2.-
~
e;~
OWNER
CONTR.
PHONE NO.
PERMIT NO.
tJ/-/36' ,
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 0 MECH FINAL
COMMENTS@ ~
o EXIGRADIFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
~,
I
~ -erh-
~j~~
o WORK SATISFACTORY, PROCEED
jd CORRECT ACTION AND PROCEED
o CORRECT WOR~ALL FOR REINSPECTION BEFORE COVERING
Inspector: V1=f-. Owner/Contr.
'- J
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTI
,/
..'
DATE nME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS I r~~ :Sf? De,e.,r(;~1c! Dr:
OWNER CONTR. D.2 J-It')~Y1
PHONE NO. PERMIT NO. -..b L -/38 3
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
~KAutrlLLING
"0 cOMlrI:x1fr
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
------ -
COMMENTS:
/73<^ -(QL
})~ ~ ~ - (;)('
/753'1 -- OK...
~- -----
\ 17~- tY)
~
,1)1 WORK 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!
INSI<<)Tl
..
\
CITY OF PRIOR LAKE
INSPECTION NOTICE SCHEDULED
AOORESS j7~O '-r;:;;;J P65eRez.JJ
~NTR.
DATE
TIME
If. T.
LJ Af!!?-, .
OWNER
PHONE NO.
PERMIT NO. OI-I3~3 - (J1-13f!;(,
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
-SQ(//~m
'--"""
o EXlGRADIFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
------.- ..
COMMENTS:
Qos~
c: / I:
t I f
if WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: ~ tJ -(, -OJ.... Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE..
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
lNSNOTI
\
ill
"---'"
APPLIANCE
PERFORMANCE TEST
Attach to gas line adjacent to regulator
Date
~
~. ,.,......
Heating Contractor
Name of Tester
Percent CO
Percent C02
Stack Temp
Combustion air is ade~uat I su plied per
UMC Sec. 606
Input
Job Address
Heating Contractor
Name of Tester
Date
Percent 02