The URL can be used to link to this page

Home My WebLink AboutBldg Permit 01-1391 CITY OF PRIOR LAKE BillLDING PERMIT, TEMPORARY CERIUICATE OF ZONING COMPLIANCE AND UTILITY CONNECTION PERMIT Date Rec' d 11-Z,1- 0 I (Please type or print and si2l1 at bVLLu~) ADDRESS /732-D 1erAdt( 0(". Sf: LOT -30BLOCK LEGAL DESCRL.t' llON (office use only) OWNER (Name) (Address) ADDITION I. White File 2. Pink City 3. Yellow Applicant k+;tli ~~~ BUILDER l\ - . \ A (Name) J..){{.. ~ (Contact Name) ~ ~~rJC.\Qyl (Address) ~~.uO J.c!~6,.,~~ U.S..f-t.., Ob lAI(p..vd 1& t'Y\ ('\ ",&U l./ I TYPE OF WORK o Misc. ~New Construction OLower Level Finish - 3CfJ- R./ PID 25- 3n- 030 - a.- (Phone) (Phone) ~8t;"'7lWB (Phone) ~ ~2U- ,~3t/ ODeck ORe-Roofing ORe-Siding OUtility Connection PROJECT COST /V ALUE (excluding land) $ 105, ~ (',~ , OPorch OAddition OAlteration 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 building official can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may :",up'nth'r~ ~ d~ ';ooo"'t;-, I~J 'i, ~ SigWind'e Jl Contractor's License No. Date. V v Permit Valuation Permit Fee I Plan Check Fee State Surcharge $ $ $ $ $ $ $ $ I O~ .000 . c;>O '.t'~"L3~ fo~. l.PJ S3 . (90 Penalty I Plumbing Permit Fee I Mechanical Permit Fee I Sewer & Water Permit Fee I Gas Fireplace Permit Fee ......, - WAyoorB-;;::;_-:( BU~ Official Date l 00 . (9--0 loo.(90 35.~ 40 ~t9l' $ f1JJ<::j') .co $ 1.1S'O.c5lP $ · 125',c!)-O $ Ll6. 00 $ /,;;).00 "t9C> $ '7~CJ .CJL $ l,oa?6CJO $ 35" -50 $~fp29. /3 . Receugjo. '41L1i By r " o Fireplace I Park Support Fee SAC ..... Water Meter Siz0'; I"; I Pressure Reducer I Sewer/Water Connection Fee I Water Tower Fee I Builder's Deposit I Other ~d-W ~~viP I TOTAL DUE # # # # Paid Date '7/.. d' "L,/1 - -J~ '-/1" If} , 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 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 ~U'~ tf2.-/~/el. <~ ~. > Qr~<. - Planning Director. Date . - ecial Conditions, if any 24 hour notice tor all inspections (952) 447-9850, tax (952) 447-4245 16200 Eagle Creek Avenue Prior Lake, MN 55372 CITY OF PRIOR LAKE I1EA TINGI AIR CONDITIONINGI ~ IKEPLACE PERlVu I Date Rec'd (Please type or Print and si2l1 at bottom) ADDRESS 1132.D I) eer +1 ~Jc ~: S:w J!~itant I PERMIT NO'Q( -f 3 q I ZONING (bffice use) "bY"SE LEGAL DESCRIPTION (office use only) LOT '&)3LOCK I ADDITION PID ~~~RD.~, Horfon (ll.4sbm Hom~ (Address)~ .~rid~. aJ" LUkeviLle. M~ APPLICANTAJI' M ---. (Name) . r ar')' e~ 1. JaLx!.... (AddreSs)3~SO ~e.nnehec..-~, 5:I:e. #/ EaaoY1 (Address) .J (City) (Zip Code) (Contact Person) ~r..pr~ Z;r"'nmf.?_~.rY".Q.n (Phone) (g51-.l.J5~- tl7~!'J APPUCANfstGNA~;W',IwL(l.~~ DATE 1/11101.. APpliCANT PLEASE COMPLETE BELOW 0NEW CONSTRUCTION o REPLACEMENT 0 AL TERA TIONS FURNACE MAKE AND MODEL "Or~t1n+ 3S31(.A-vb2J.un 0 FUEL 1\JC4.!u.rlA] FLUE SIZE ~""cla.s~ "EL RETURN OPENINGS 4 INPUT "10.I>CO OUTPUT 6lD../)OO TYPE OF SYSTEM HEATING OR POWER PLANT (phone) q5~- q~ -7017~ 550~.L.1 (Phone) /.&../- "-/ff:L- r:fl776' 55/.2~ OWarm Air Plants OGravity o Mechanical . ~ Conditioning [!V ent. 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 MAKEAND MODEL Industrial, Commercial & Multi-Family nESCHEDULE 1 % 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 $ Building Permit # REA TING PERMIT FEE STA TESURCHARGE TOTAL PERMIT FEE $ $ $ ,-- WrTH '.. ... PA\~G PERM\T .5~\\.D\_ . . (Office Use Only) This Application Becomes Your Building Permit When Approved ~ Building Official Date ~ . D:JAN I .5 aool ~.t?!. ......./..l........................... By /VUl.-r / 24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245 2001 2:02PM GENZ RVAN PLUMBING AND HEATING No.7996 p. 14/21 Date Rec'd L.fI' i OF PRIOR LAKE PLUMBING PERlVuI DEe I 320m i::~ ~ I PERMIT NOO/-/3Q/ ' . 1 101"'.. AppliOMl: (PleaSe: tYpe: or,mnt a:o.d. sip at bottom) fAOPRESS ' . . - . 11:wJ 1)i'J()r'~Q.p {) ZONING (QfIic: IIIC) (~fL ~E- I LEGAL DESCR1r .L.LON (Qtlice use only) LOTCDBLOCK I ADDmON l)?prB'QJ)J:) !OWNER I (Name:) . DR. Ro;rton Custom Homes PID (phone) 651-454-4663 (Address) 3459 WashingtoIl; Dr Ste 204 Eagan. MN 55122 - . APPLICANT (Name)~...-'Rr"" 'Plmn....."'....g ~ Hn~+-./~:J (Address) 14745 So 'Robert Trail Roselllount (Address) (City) (Contact Person) Mary Olson , 1'-'}.. II 1\, ^ (:phone) 651-423-1144 _APPLICANrSlGNATURE _ t. ,l ~- DATE , 2--/10 Ir.; AP~;CANT~E COMPLETE BELOW I Type of Fixtu.-e I Qllannty I I I Bath Tub with or without shower ..... ~ ' Rough-ins I Dishwasher ,. W ster Heater I Floor Drain I' I W ster So:ftner 1 Lavatory (Batl:u'oom Sink) I I I Stand Pipe (Washing Machine) I Laundry Tray (1 or 2 compartment sink I I Sewage Ejector I Shower Stall i"' Bac::kflow Assembly I Sinks I I Bacldlow Assembly Test I Bar Sink" j I Lawn Sprinkler I Water Closet (Toilet) I I Other Quantity I .. I I ;z.... i f 2- (:phone) --tiS l_L..1~_11 (W MN 55068 (Zip Code) Type of Fixture ,lfJl..IL St::.I:IJ!l)ULE IndustrIal, Comtnerctal & Multl~family 1 % of job cost with a $3950 minimum Rc:sidenl1al, New One: & Two-Farody $99..50 Residential, Additions &. ~rations $39.50 Jffiu U51: ODJy) EstiInat.ed Cost $ Building Pennlt # PLUMBING pERl\t1IT .r.t.t:. $ STATE SURCHARGE $ TOTAL PERMIT FEE $ r" PI\'O 'i'J\t}~M\1 .sO ~\\.O\ttG p \:--- J 1lildiDg Perwit When Approyed IE I 4 2001 . Date Paid I Receipt No.. I By Date 24 hour notice for all inspections (952) oIS47-9850, f>>.:l (952) 447-4245 Dec.lo.2oo1 2:03PM' GENZ RVAN PLUMBING AND HEATING No.7996 p. 15/21 Date Rec'd ell ~ .OF PRIOR LAKE S~WER AND W A.l~.K PERl\tll~ DEe l 3 2001 i ~-:. ~n,-.I.~ _ I PERMIT NO. ~/-13 12/ 3. Gold 1....... ..1 U 7 (Please tYPe or 'J)Ijnt aDd ~ 'at boaom) lADDRESS . , '1b'ZlJ. De:e(,tt~ D De Sf:: ZONING (QfBcc 1IR) r LEGAL DESCRIPTION (office \1SC ouJ;r) I I ~ LOT?PBLOCK I ADDmON 'l'P'{?RF?eJ~n ~ ---- PlD oWNER (Name) l'~_ 3Qrto:a ""_"-r'P'?1R li01RQS (Address) 3459 Washington Dr Ste 204 (Addn:ss) (phone) 651-1. 5L/16':;~ Eagan, MN 55122 (City) (Zip Code) APPLICANT QNam~ Genz-Ryan Plumb~Dg & Heating (phone) 651-423-1144 (Address) 14745 30 Robert: IT-ail Rosemount. MN 55068 (Ad.tkess) - (City) (Zip Code) (Conmet PersOll) Ila 1"1 0160n I /] _ . I 11 (Phone) 651-423-1144 'UCANT SIGNATURE 1 A \I(' -.)l<< ),,LYOA~ /'2-/ It) /"..>i APPLIC~ASE COMPLETE 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 SCHEDULE te3idenoa1 "ewer and water IJn~ connection $35.50 Industrial, Com'l &: Multi-family I % of job cost WIth a $39.50 miuimum lewer connoction only $17..50 WIrtef connection ouly $17.50 Estimated Cost $ Building Permit # SEWER AND WATER pERMIT FEE STATE SURCHARGE TOTAL PERMIT FEE S $' $ . ... " A. f',\-\ ..self' 1'p..\O~" Ef;:~,,~rt ~U\U)\l\\G P J .. . lfflc:e Use Dilly) This APP1ica~1l ;if1~Uildlng p;t ;V:e;~p_., ~ :B1QldJ'fUO . >>.te Paid I Receipt No. IBy Date - 24 hour lIoticm for aU inspections (951) 441-9850, tax (952) 4474240 16: 15 651 633 BBB4 . '1'1 X U FIRESIDE CORNER '- .ll rJ.'U,V.l" .....n.L~ #3127 P.002 I:lILA TINGI AIR CONDlllONlNG/ 14 .LJ:U1,PLACE PERMIT MAR 2, 2(12 I. r111~ I'll. PERMIT NO \ 1.0.- CIIY . OI-I3t')J . 1. varow ......k:Ml 7 f (PlelSll Me at o:lrint lIDd sillDJ. &I: baQl)m' ADDRESS /73"'-0 'U~.f ~;~ LEGAL DESCRLr l.l.ON (olRee UB mlly) ZONING (alWleUlll) KJ LOT BLOCK ADDITION Pr.o~- 3,;).-{)jQ-Gi j OWNER. (Name) . ~~ , (Phone) JAddress) APPUCANT (Name) lU,LIED FIRESIDE DaA lIQSIDE CORNER ~hon~ 651-633-~ (Address) 2700 N, F.ll.IRv.ywU.~ (Addl'l!5s) (C ~....;.. P ) BRENDA auS'rON on~. enon ~ APPLICANTSI~NA~ ,..L ~F.!VTr..L~ ~ (Cicy) 651-G33-2561 ~1l'1" (ZiJl Code) 7 /.d~ .._., (Pb.onc) '1'--' DATE _~/o" c APPLICANT PLEASE COMPLETE BELOW ~w CONSTllUCTlON W REPLACEMENT G AI. 'reM TIONS FURNACE MAKE AND MODEL FUEL FLUE ~IZE RETURN OPENINGS lNPUT OUTPUT. TY1'B OF SYSTE'M HEATING OR. POWER PLANT OWlll'm AIr PlBllts 0 Stellm JGravity B Hot W~ J Mechanical , Radiation OAk Candjtionm, 0 Spcclal Dn'I~ DVcnt. Sy~ CJ Ottler OevllllCS FIREPLACE MAKE AND MODEL #f1.t ~ ~ C1J ~ '1<D 1R-<.. . PLEASE NOTE: Air Conditioner Units Can.not Encroach into R.equ.ired Sj~ Yard Setbacks FIE SCHEDULE rndu!lDiaJ. Commercial &: Mlllt1-Fm1ily t % of job cost RIlSIcian.tillt. Oes Fireplace $39.50 minimum ResidentfaJ.. Heating &. AIC (New COnllb'Uction) $99.50 Residential, Acldhlon.!It Alr.entions Resid.cntlal., Kcatlllg Only (New Conswc:tion) S6~SO Rcstdcnti-.lt AC Onl)' $39.50 $39.50 S39.S0 HEATJNG PERMIT FEE $ 81 ATE SURCHARGE $ .SO, , TOTAL PERMIT FEE S ,. ~ SI.JIJ..~4!D t,..,. ING I. '-.. Estimated Cost $ Buildiug Petmit " (omcc V". O"Iy) This AppUcatloa BllCOnt~ Your BuUdtnl Permit When Approved Paid I Receipt No, .8Y~ v 1I"lIdt... omc:l., Die pue 3,- J-;)- ;7 %4 hDur natllle fpr III Inlp.I:tI,", (g5:) ~7_0, fax ('5:l) ~7~Z4! ,... .~~. "". j I , ,f<, Th. C.n'., of 'h. !.ok< Country White - Building Canary - Engineering Pink - Planning ., . BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT APPLICATION RECEIVED D. te, I- 012-( U~} , -29-0 I The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: '-'320 DEE/2.f=lSill [)f.2-. / ( Accepted Accepted With Corrections Denied Reviewed By: 4AA- (l?j~~ Date: J~/6~&1 Comments: ~t~~ \ q _ ~~) ~7J1--4~~~ .~ ~1?te-- PU./jl + I~ ~ ~~ .~ ~Q ; "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 Tht Crnlf'r or thr take ('ounlry BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT APPLICATION RECEIVED D. t2-. J- .O~( 01\ J - - , -2Q-O I The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: 1/320 Dt:t:J2J=r5CD D r2- , Accepted V Accepted With Corrections Denied ,/) IJ Reviewed BY~k. Date: ('2.....os- - 0 I Comments: _<i?I2~o90_ ~~ ~ "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." PRIOR LAKE. INSPECTION RECORD J Ma\V\ \=", k~ DiPARTMENT OF BUILDING AND INSPECTION SITEADDRESS Jt"?3::ln pe<:r-[~lJl nt-- NATURE OF WORK ~f?.a-J USE OF BUILDING S ~ 4 PERMIT NO. (JL:j3~V DATE ISSUED I?" ot:::.-of CONTRACTOR ~ ~ PHONE q5J-~-I??f NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW THE PERMIT IS BY SEPARATE DOCUMENT ,~CTOR DATE I FOOTING ~ /?;r (p/~ 2/" V tr L:f '. I (/...;,) ~ --- d~ , FOUNDATION (Prior to Backfill) ~"IV\ J Dl, _ "-I q /6 L PLACE NO CONCRETE UNTIL ABOVE "HAS BEEN SIGNED ROUGH - INS A SEWER/WATER/SEPTIC 6:+ /1..._- 1/.2,IIJt. FRAMING f2Z,1- ~ i.fll I j 0 ~ INSULATION /C:1::r #1$/ O~ ELECTRICAL " / ,., . PLUMBING fL~. ~ 1; 12JaS.jo b+- I 1./1/02- HEATING (if required) , ~. 11/ II If) -z I FIREPLACE .~ Il/j"/4 oz... GASLlNEAIRTEST ~ ~J \..L.. f;~. ~.. 3/8/02-1 ' , COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED ~ ~,'I!/5~v I I FINALS GRADING (Prior to Sodding) . I ~ R // d/:,--a:7> BUILDING 1. Q . 8. +JJ ~I r I b'2-- ~. "f rt~'2- [ok) on (1-& /J Lf / ELECTRICAL I . I '/1 ' PLUMBING /7:r . HEATING ,I' r~. I DO NOT OCCUpy UNTIL ABOVE HAS NOTICE S/~lJ J()l, ~~ BEEN SIGNED This card must be posted near an electrical service cabinet prior to rough-in inspections and maintained until all Inspections have bt!,en approved. On buildings and additions where no service cabinet Is available, card s"all be placed near main entrance. Call between 8:00 and 9:00 A,M. for all inspections FOR ALL INSPECTIONS (952) 447-9850 ~~. "'."'I!"It~~'rr' ... ,....", >.....J. ~..~:. ,. ,.r',':i'~"";'''''':'"-'''>~>>'''' 'f,"'i';J'-"":;);-'t;;.",~ ';~""',.;'; "..,..)+~., Gttrtifuau of (Jcnqtaltty ell i OF PRIORLA~ 1Ji'epartmentot JBuilbing In.pection ~ I(lJ Final Permitted 0 Conditional C.O. Expires ',/ 17W Certificate issued pursfUIIII to the requirelf1ents of Section 307 of the Uniform Building CQde certifying that at the tiI'M. of issUDIICe this structure was in compliance with the various ordinances. oj the City of Prior lAJce regulating building co1fStruction or use. For the following: SINGLE FAMILY I . 01-1391 Use Classification ' B dg. Permit No. R3 VN N/A R1 Occ:upucy Type Type Construction Fire Zone . Zoning District - Legal Description L3. B1, DEERFIELD SECOND ADDITION Owner of Building ,Site Address D.R, HORTON. 20860 KENBRIDGE Contrac:tOr's Name a: Address . II. ,/ j' ROBERT D. HUTCHINS Y II' City PlaDner Building Official I · . II- G OJ- Date: Date: . 17320 DEERFIELD DaIVE SE CT" SUITE 100, LAKEVILLE DON RYE POST IN A CONSPICUOUS PLACE PHONE NO. TIME SCHEDULED ~-(f?~ 11:- 0() /'1-3~TR'~~ 1- / ~91 DATE CITY OF PRIOR LAKE INSPECTION NOTICE ADDRESS OWNER PERMIT NO. o PLUMBING RI o MECH RI o WATER HOOKUP o SEWER HOOKUP ~. 0 PLUMBING FINAL \l.CY ~ MECH FINAL COMMENTSf'D ~ -P~ ~ ~ ~ ~~ :.a ~-(~, m ~~ ~ ~~ C9 ~ .'. I ~ eqv::bfaf · o FOOTING o FOUNDATION o FRAMING ~SULATION ...e'"' FINAL o SITE INSPECTION o EX/GRAD/FILLING o COMPLAINT o FIREPLACE RI t?'1\J\ II FIREPLACE FINAL . \..tY 0 GAS LINE AIR TST o ~ <2~O. 1J.j ~ I \ ()~ l ~ e,,,. if?, JdJ o WORK SATISFACTORY, PROCEED ~ORRECT ACTION AND PROCEED o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING Inspector. W Qwner.lContr. CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.. CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY! INSNOTl OWNER OA TE TIME ~ ., dO- J.. tL~ 07) r J/j Jd/) ~AdH) LA./ CONTR. SCHEDULED CITY OF PRIOR LAKE INSPECTION NOTICE ADDRESS PHONE NO. PERMIT NO. /- /'3CJ J o FOOTING o FOUNDATION o FRAMING o INSULATION o FINAL o SITE INSPECTION o PLUMBING RI o MECH RI @ 0 WATER HOOKUP o SEWER HOOKUP Lbl('PLUMBING FINAL o MECH FINAL o EXlGRADIFILLlNG o COMPLAINT o FIREPLACE RI o FIREPLACE FINAL o GASLINE AIR TST o COMMENTS: (f\ ~ ~ ~A,f~ ~ . o WORK SATISFACTORY, PROCEED ~ CORRECT ACTION AND PROCEED o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING Inspector: ~ t Owner/Contr: ..,,. \ ,CALL 447-9850 FO~ 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 7-2'-0 -z... ADDRESS /7320 ~t!:r('<let Dr, OWNER CONTR. PI< Har::b,..., PHONE NO. PERMIT NO. Ok I ~ot I ~.Ila:1-.) (:"~U::~ o FOOTING o FOUNDATION o FRAMING o INSULATION c:::s:.ElNAL o SITE INSPECTION o PLUMBING RI o MECH RI o WATER HOOKUP o SEWER HOOKUP o PLUMBING FINAL o MECH FINAL oX!:XJ~-ILLING o COMPLAINT o FIREPLACE RI o FIREPLACE FINAL o GASLlNE AIR TST o COMMENTS: {7J Z 0 ..... 1~r:...L ( ~ ,./! -a... ~ c:oI "x 0~Af)" 61 \ 173 Z 7.... - Guf<.. e... fll 0 )( (.,(</tiJt:.. Q ~ /732-LJ - L-o~ (nyt:,.~ ~Cl)<" r~~ ()\.( c)~ " 1732.C? -- c.uR.t:::. P-:,dX. -alL C::$_ftcf;. - (") \l..... " " J. W-l 1 ... "\I~ S o WORK SATISFACTORY, PROCEED ~CORRECT ACTION AND PROCEED o CORRECT WORK'~ CL Ollt REINSPECTION BEFORE COVERING Inspector: At... .' Owner/Contr: CALL ~;.9:~0~ T E NEXT INSPECTION 24 HOURS IN ADVANCE. CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH &: SAFETY! INSNOTl DATE TIME CITY OF PRIOR LAKE INSPECTION NOTICE SCHEDULED ,It, -r. ADDRESS /'/320 /7'3 Ze, Orffelfl6W PHONE NO. CONTR. PERMIT NO. 0/-/39/ 0/-1,3'14-- OWNER COMMENTS: o PLUMBING RI o MECH RI o WATER HOOKUP o SEWER HOOKUP o PLUMBING FINAL o MECH FINAL S OJ;) / 77t8G iA') \.l.V o EXIGRADIFILLlNG o COMPLAINT o FIREPLACE RI o FIREPLACE FINAL o GASLlNE AIR TST o o FOOTING o FOUNDATION o FRAMING o INSULATION o FINAL o SITE INSPECTION ~ ~r<- f:-; 4 . WORK SATISFACTORY, PROCEED o CORRECT ACTION AND PROCEED o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING Inspector: R /I-(,-OL Owner/Contr: CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE. CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH &: SAFETY! INSNOTI A ~ '-'" '\ \ 1 APPLIANCE PERFORMANCE TEST Attach to gas line adjacent to regulator Heating Contractor Name of Tester Date Job Address173ZD Heating Contractor Name of Tester Date Percent 02 Percent CO Percent C02 Stack Temp ~~7~~ '~ f/~L. kf.'cfcflr d/t19U'> .~ ~nJ~ #~ 99!d P;-"..~ (,,~ .~~ Combustion air is adequately supplied per UMC Sec. 606 V~ < input ' ~r.u