HomeMy WebLinkAboutBldg Permit 01-1392
1. White File
2. Pink City
3. YelJow Applicant
Date Rec' d
1/-21--:01
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
(Please type or print and SiWl at bu...u~)
ADDRESS
11~d... DeerhdJ.. IJ<. S 6
ONING (office use)
/2-/
LEGAL DESCRIPTION (office use only)
LOT '0 1 BLOCK
ADDITION
~f&1L JJJ
PID 2-&:; ~: ro - b3/- 0
OWNER
(Name)
(Phone)
(Address)
BUILDER /\ /) I I A
(Name) U. Jl'\. t11I'Vl11Y1 -
(Contact Name) Jf-!.t"Lt r- Vl c.1U I'll/}
(Address) ~O~V 0 (~bn.M.( ct..t'1e./()b
. ~[A..-~ .l(/ m rY ~f)l../ L/
(Phone) ~-a -q B6"'1..fu29
(Phone) q 5J.. aal.JLJ?J?J c..J
TYPE OF WORK
~ New Construction
OLower Level Finish
o Deck
o Porch
OAddition
ORe-Roofing
OAlteration
ORe-Siding
o Fireplace
OUtility Connection
. 0 Misc.
PROJECTCOST/VALUE (exc1udingland) $ 1H:/JI
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 constroction will conform to all existing state and local laws and will proceed in accordance with
submitted plans. I am aware th building official can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may
ex"", upoo l)\;..(..,pr;:;:,ct; ded in()specti~s.
~ _ dO()()5{,t;i I /jOlQ 10/
Contractor's License No. Da~
Permit Valuation 9~ 068 Pc:9z1 I ParkSupportFee # $ ~.Cid
Permit Fee $ 47-'1 _?h I SAC _ # $ /.1 SO.t:>f$
I PlanCheckFee $ i:e~ . ~ I WaterMeter Siz(Ef"; I"; $ 12<;',o()
I State Surcharge $ l.ftI _ iib... I Pressure Reducer $ Cf';. CiJ
I Penalty $ I Sewer/Water Connection Fee # $ .I I ~ .oD
I Plumbing Permit Fee $ J DO .0-0 I WaterTowerFee # $ ''2I)O.f)O
I Mechanical Permit Fee $ II> cJ . C) l:J I Builder's Deposit $ 't-
I Sewer & Water Permit Fee $ '$5",50 I Other S~t.J ~ ~~~ $ 55.SO
I Gas Fireplace Permit Fee $ * ( i)O I TOTAL DUE $ ~ I ~ ~~ 5'L-
I ~ omes Your Building Permit When Approved I Paid ~ ~ ~ . Elf? . RecejtlPt. . ';/I/! ..
I Date ,i! ,!fltA! By I
/2 -05-o( - I
, D~
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
y ~;- ~M.~_", cmfi~. of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of occupancy. must be
issued.. ~ (2-/6kX ~N~
,?/ Plannmg Director Date Special Conditions, if any
24 hour notice (or all inspections (952) 447-9850, tax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
Th. e.nl.. of lh. tok. Country
White - Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
JP. If-. .JJnr:nJ
//-d-9-0f
, ,
The Building, Engineering, and Planning Departments have reviewed the building permit
apPlicat/7';~2ona4t;~t: ~
Accepte~ Accepted With Corrections
Denied
Reviewed B.,(). ~
Date: /2. -05--0/
"
Comments:
Sa, --.4 VVl~t'" t~Lo
"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."
The ("enter of Ihe Lakf ('ountry
f,,~~~'J;", ~
White - Building
Canary - Engineering
Pink - Planning
BUILDING PERMlLAPPI)CATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
JP. /2. .JJnrLTFJ
//-d.-tj-{)(
, ,
The Building, Engineering, and Planning Departments have reviewed the building permit
apPlicatI7~~2on~~t: ~
Accepted
()(
'--
Accepted With Corrections
Denied
Reviewed By:
IJI)tJB
Date: /2 -II-Of
Comments: See Reverse Side for Additional Information!
~<-L /Ylc,,',,, F,'/e
See Attachments: 1) Grading Plan, 2) Erosion Control Measures
3) Erosion Control Plan
"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."
The eenl.. nr the take Counlry
White - Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
iY'. /(. .Mt7i7J
//- d9 -() (
, I
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
/7322 /1jP>>tr:ot.- ;C~1~
Accepted
/
Accepted With Corrections
Denied J..
/<7/ ~
Reviewed By: ~f:.h (~
Comments:
Date:
12-16 !f) (
..
"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."
Dec.l0. 2001 2:03PM
GENZ RVAN PLUMBING AND HEATING
No.7996 p. 16/21
Date Rec'd
L.l.l K OF PRIOR LAKE PLUMBING PERMIT
DEe I 3 2001
'~"
~~'- ~_l PERMIT NO. (J/-/39Z/
ZONING (01Iia:UJC)
(Please tytle or t1nnt .and S1Ia1 ill: boUgm)
[;;~~ 1J;.U.\jg 0 0 \lK.- SF--
r LEGAL DESCRJ.rnON (offia: use: only)
_ LOT .~\ BLOCK f ADDmON 'l1z.e..r fl-{( j) J0
PID
OWNER
(Name) DR Horton Custom Homes
. (Phone) 651-454-4663
(Address) 3459 Washington; Dr Su 204 Eagan. MN 55122
-
. APPUCANT
(Name)...(;.,:,~,?-:".y-"':' l)~"~"\~g ~. ~M""-I~g
(Address) 14745 So Rober~ TJ::ai1
(Address)
(Phone) Ii; ~ 1 -4' 'ol.....11..L../.
Rosemount
MN
55068
(Z~ Code)
(City)
.\
(Contact Person) Mary Olson r L J. I (phone)
APPLICANT SIGNATURE l j't~^- DATE
_ ~__ I~ANT ~E COMPLETE BELOW
I ".1 ype 01 }fJXtiiie ! Quantity I
I Bath Tub with or without shower ! .. .;;oi) I Rough-ins
I Dishwasher ! t r Water Heater
I Floor Drain I I Waier Soflner
1 Lavatory (Bathroom Sink) I Stand Pipe (Washing Machine)
I LaUlldry Tray (i or:l com.partment sink Sewage Ejector
I Shower St8.n - . I Backflow Assembly
I Sinks I Backtlow Assembly Test
I Bar Sink I. Lawn Sprinkler
I Water Closet (Toilet) I Other .
651-423-1144
t 2--1 ID j'i\i
Quantity
I .
J
J
2-'
Type of F;....~..rc:
I
I
2-
JfJLJL Sl:...I1ILDULE
Industrtal. Conunerclal & Multi~famIly 1 % of job cost with II $39.50 miniInum Rosidenti.al, New Ooc:= &:. Two.Fl!lIuly $99.,50
Residc:=ntilll, AddirloIlll & AitetatiOD$ $39..50
Estmlated Cost $
Building permit #
PLUMBING .t'~T FEE $
STATE SURCHARGE S
TOTAL PERMIT FEE $
r.. PAlO W\TH .' I
.50 9\)\U)\NG PEf-;M,1 /
c-,.
)ffice Use 0111)')
.l:uwaiDg Pennit Whea ApprO'l'ed
Paid
I Receipt No~
IBy
IS I 4 2001
Dati:
Dab:
14 hour notlc.e for all inspections (952) 447-9850, fax (952) 447-4245
Dec.10. 2001 2:03PM
GENZ RVAN PLUMBING AND HEATING
No.7996 p. 17/21
Date Ret~ d
CITY ,OF PRIOR LAKE
SEWER AND W ATJ!j-K PERMlT
DEe I 3 2001
~ ~ =-1 PERMIT NO'Of-/3QZ-l
(Please type or-r:umt aIld s12J1.at boUDm)
I ADDRE. 55
11:'2.- -z...Dee.rt1~1 D Oe,
ZONlNG (~DlIl)
SE.
[LEGAL DESCltu'uON (oiIk<-.D\vl
LOT j \ BLOCK I ADDITION
~...n.7n
I . / .'
. -
-- -
PID
;
. OWNER.
(NSJne) 1':1). llQx'tQ1"1 ""~~91R 17.........
(A~~ 3459 Washington Dr S~e 204
(Address)
Eaga.n. MN
(City)
(:phone) 651-45JI-4';~:?
55122
(Zip Cl;lCL=)
APPUCANT
(Name) Genz-:Rvan Plumb~:n~ & Heatin~
(phone)
651-423-1144
(Contact Pason) Mary Olson.
"'LICAN'T SIGNATURE ~A..
(Address) 14745 So Robert Trail
(Address) 1
I; _
.~ ~
Rosemount. MN
(City)
55068
(Zip Code)
(phone)
--.DATE
651-423-1144
/2-/ J L'r / /.\ I
,.
ASE CO:MPLETE 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 stIUcture.
~esldentJ.a.I SCWI!:{ and water bJ;lc connection
;ewer connection only
J:fJ!,;J1; SL~DULE
$35.50 Industrial. COIXl'l &. Multi-family 1% of job cost with a $39.50 mm.i.u:lum
$17.50 Water connection aoly $17.50
Estimated Cost $
Building Permit #
SEWER AND WAlERPERMIT .t'~~ $
STATE SURCHARGE $' .50 PAID W\TH"
TOTAL r.u<MIT FEE $ I\JlW1NG PERM'!. I
r
~ - r
)ffic~ US" Ouly)
lug Permit When Approvc~ Paid I Receipt No.
DEC'I A 2001
Date . I By
n.te
:24 hour J,lGUee fGr aU wsplldioJ:U (952) 447-9850, {ax (~52) 447-4145
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONlNG/FIREPLACE PERl\ruI
Date Rec'd
(Please type or Print and siWl at bottom)
ADDRESS
I"';~ I) e.ert1 ~ld br S&
J. Pink File PERMIT NO
2. Green City . ...0./-1 <q""J
3. Yellow Applicant ....J L--
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT 31 BLOCK I ADDITION
PID
&~~RD.~. Horfon Gustom Home~
(Address)~ ~rid')~. QJ'I Lo.kevi.ile. M~
APPLICANT 1\ II. M h---
(Name) l:lllJ (A(l' . e~ . .:.L~ .
(Address)3&;SO fcte.nnebfr. :sfe. #/ .i~aaQn
(Address) V (City) (Zip Code)
f Z;mmp_rfY'\ Q.n (Phone) (P51-~5/)- (}'l7~
t1.4{~ DATE . '1l\I01.-
. V
. APP ICANT PLEASE COMPLETE BELOW
0"NEW CONSTRUCTION o REPLACEMENT DALTERA TlONS
FURNACE MAKE AND MODEL 1Jr~4nt- 3~vb2&l.O' 0 FUEL 1'JQ.~Ufn.l
FLUE SIZE 41'clQ,S,. iL RETURN OPENINGS ~ INPUT "'10. l>OO OUTPUT 6lD../JO 0
TYPE OF SYSTEM HEATING OR POWER. PLANT
(Phone) 95:J... q~ -7,;l7:L
5501..lL./
(Phone) t.&../- ~-r:f(775'
55/~
(Contact Person)
OWarm Air Plants
OGravity
o Mechanical .
~ Conditioning
~ 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
FEE SCHEDULE
1 % of job cost Residential, Gas Fireplace
$39.50 miriimum
$99.50 Residential, Additions & Alterations
$64.50 Residential, AC Only
$39.50
Residential, Heating & A/C (New Construction)
Residential, Heating Orily (New Construction)
$39.50
$39.50
Estimated Cost $
Building Pennit #
REA TlNG PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
r- PAlO W\TH
.5~9P~~Mli,
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
~
Date JANI 5 2002
..-
24 hour notice for all inspections (952) 447-9850, fax (952) 4474245
p.OOl
..,id.,,"'; ......... '&&
MAt< 'L L (U02
I. Pink 'I" I PE.....1IL.-T'T' NO \
2. o,.on Cilr 'AJ.'JU J. 'I}/-I-::J.n. J
3. y*,ll,w All1l"....., ,- /117'
(Please !'Eel or'DriJst Md. S'i~ lit boCm)
, ADDRESS
/'J3,)) ~....t.I ~
Ll!GAL DESOU", ,..oN (ok... oo1y' (~
LOT3I BLOCK I ADDITION ~ ~ !lid-
OWNER. ~
(Name) ~ IZ r:I>IoJ4.
, (Phone)
. ZONING (offknSl)
1<:1
proa5- ~P/~-'" O~ I-D
(Ad-dress)
APPUCANT
(Ne.tm:) ALLIED FlUS IDE OBA FIRESIDE COilNER
(Ph.one) 651-1533-~561
(Address) 2700 N. FAnV1.,D..Jw~tm RO~E:V'I.L T l<' M"'7
(Addres5) (CI1:y)
(Contact Person) BRENDA HUS'rON _ J . (Phone) E51..63:3 -2 55l
APPLICAN'TSIGNA~;;?n1A<4. -kI~ DATE -_--~.JL~/.~
APPLICANT PLEASE COMPLETE BELOW
~W CONSTIlUCI1qN 0 kEPLACEMmlT 0 ALTERA TlONS
FURNACE MAKE AND MODEL FUEL
FLUE SlZE RE'l'URN OPENINGS . INPUT OUTPUT
TYPB OF SYSTEM HEAnNG OR POWER. PLANT
JWIl'm Alr Plllllcs J Sleam
JOraYity ::J HoC W*r
] Mechllllical :J JW!iatfOD
:JAlr Conditioning J SplllCiaJ Device3
::JVcnt. System J .other Dev/eell ,
FIREPLACE MAKE AND MODEL J:tu ~ Gr.: Sc.. 7frJ 7YL
. .rILESCHEDTJLI
I~ of job ~ :Residential. Gas Pireprlce
$;39,'0 minimum
Reslcb:ntial. Hearlng A AlC (New Conmu.ctlon) $99.j(l
Residential. Heatina Only (New ConSIrUr;tion) $64,'0
In4l,lstria1, Commercial &:. Multi.Family
Residential. AddltigJl.S At Alterllion$
~dlllt1al, AC Only
Estfm_d CDst S
Bundlng Permit #
HEATING PERMIT FEE
51 ATE SURCHAllGE
TOTAL rl!t~ FElt
$
s
5
.50
(omCI U'I Only)
This Appllcllltfon BllCClma Your BuildIng Permit Wben Approved Paid
Buildlo, onlc/ld
Ih!e
Oat<<:3. d;)-- d-
%4ltoDr d"d~ for aU In.pdo''' (9g) ~7~'150, IltJ (952) 11II4'7-424$
1:i1:i11 ~
(Zi:p Cede)
PLEASE N", U:.:
Air Conditioner Units
ClIIU10t Enc::roach into
tlequfrect Side Yard.
ScrtbllCks
$3'.50
$39.50
S39.50
r
PAID \/,J""
~SUILOING F-
L,
I Receipt ND,
IBY~
U
PRIOR LAKE
INSPECTION RECORD
I <;e.e. ~tJ\a\l,^ ~J~
DEPARTMENT OF
. Bl:JILDING AND INSPECTION
SITE ADDRESS --tYS~;;t. D.t<R,~e1~ Dr-..
NATURE OF WORK ~ F A
USE OF BUILDING N-et.J
PERMIT NO. 0/- /.3c(;J.- DATE ISSUED /2. - OS- -01
CONTRACTOR -D-~ ~ PHONE tfS"2-~'2(P...l~s<I
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR
DATE
I FOOTING I ~ I
~ FOUNDATION (Prior to Backfill~~~ I ~. / ba/ot I fi:r d/L( la z..-.-
PLACE NO CONCRETE UNTIL ABOv1 HAS BEEN SI'GNED
ROUGH - INS
SEWER I WATER I SEPTIC d. Rfl
FRAMING .v:=r<
INSULATION ~ _ .
ELECTRICAL
PLUMBING {,t,~ I I?n-.
HEATING (if required) ,~ ~ .. . 1 ~-1--
FIREPLACE ~, I/s/o-z--
GAS LINE AIR TEST tH,..:.- ~ L. L. ,f: rt ,~. 3 /~ /oJ I' .
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I Jfi~ ~. 1//SN?/ I I
- V FINALS
. 12 rz I '/- d-I.R 0 d--
~ ! " ~/tJ2/ <:.- D 0>1\ 11- (, ~ /1-(,' 0)""
0/-30'0c.
111~/15V
1/17~c
, , ~ -
GRADING (Prior to Sodding).
BUILDING ,-:c...C)t~ rl \ foe.- ~
ELECTRICAL
PLUMBING
HEATING
DO NOT OCCUpy
~
~.
---b-. )
UNTIL ABOVE HAS
NOTICE
6/ ,2.. '7ltJ '2-
t.,llfltJ~
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
r 1O't.:
,,:....,......: ~:';" ;,~:..' 1',.
, "0', 1:'-'~ .....,.1,.,
TIME
.6r J..-C) -rl d- 3 c
1?3~~ONTP.D~d)
/- 13!jc;r-
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
OWNER
PHONE NO.
PERMIT NO.
o FOOTING 0 PLUMBING RI
o FOUNDATION 0 MECH RI
o FRAMING ~WATERHOOKUP
o INSULATION 0 SEWER HOOKUP
o FINAL UMBING FINAL
o SITE INSPECTIO- 0 MECH FINAL
COMMENT~ ~
(i) f4n1 ~,
p ,
" ^
~~~
DATE
o EXIGRADIFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
'0 WORK SATISFACTORY. PROCEED
)1' CORRECT ACTION AND PROCEED
o CORREC~1:RK' CALL FOR REINSPECTION BEFORE COVERING
Inspector: l Owner/Contr:
CALL 447-98 0 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE..
INS/iOTl
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
CITY OF PRIOR LAKE
INSPECTION NOTICE
DATE TIME
SCHEDULED t--/fA ~'
J ) ~ _ _ J.. d /) ,/O~ 36
('13;(~ ~J.12M~d)
u
ADDRESS
OWNER
CONTR.
PHONE NO.
PERMIT NO.
01
/,~ q ~
o FOOTING 0 PLUMBING RI 0 EXlGRADIFILLING
o FOUNDATION 0 MECH RI 0 COMPLAINT
o FRAMING 0 WATER HOOKUP ~ 0 FIREPLACE RI
o INSULATION 0 SEWER HOOKUP ~ ~FIREPLACE FINAL
~AL ..1ft 0 PLUMBING FINAL tJ GASLlNE AIR TST
o SITE INSPECTION <ll5lY'" MECH FINAL 0
COMMENTS(il ,<~ p~ ~/~ ~ ~
tJJ ~-I#dlJl/~J---~J'o.:tt_ L1JtA~~
(~J ~~ ~-~
@ 9cr~ ~ ~Ot7 ~ pt-X v ~
T.ClctJ, ~ ti lio'V
I .
~~
o WORK SATISFACTORY, PROCEED
., CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector. ~ Owne,lContr.
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH &: SAFETY!
INSNOTl
DATE nMe
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
7-2'-07....
ADDRESS / 73z0 ~~r.{',</tI Dr,
OWNER CONTR. PR f-krh'1
PHONE NO. PERMIT NO. 0"" I~" I ~ Pa:.J.J ~r~
o FOOTING
[J FOUNDATION
[J FRAMING
o INSULATION
c:a:.a..NAL
[J SITE INSPECTION
o PLUMBING RI
[J MECH RI
[J WATER HOOKUP
o SEWER HOOKUP
[J PLUMBING FINAL
[J MECH FINAL
.::m:.EXJ~ILLlNG
[J COMPLAINT
[J FIREPLACE RI
o FIREPLACE FINAL
[J GASLINE AIR TST
[J
------- .
COMMENTS:
{{j20 ./ L.JDUJt-L (;( ~-a... ~d'X
_ ___ 0~AD" C'-AA -
~ ,"- ") \
1732 <.... -/U.J.f<..R-. P-,q)/ r)1.(
/ r...,(<..tt-.Dt.. (') ~ "-
-- ....
173z..Lj - l-o~ (, rof.~ ~('J'x:
, ,
I ~...Af) ~ () \.J...
1 73l((; ..- CU R f;;, ~o X .... (Y l/.
C;. freE - () \L. "
"
.. 'lr)--] ~ 'rl S
I
o WORK SATISFACTORY, PROCEED
~CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL OR REINSPECTION BEFORE COVERING
Inspector:.A~ .. Owner/Contr:
CALL ~7'9854FO~ T E NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
1/VSNOTl
.././'
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NonCE (ji) SCHEDULED / {-(, .A./.
/7'3 ZG, CJ6~6W
ADDRESS /7320 -
OWNER CONTR.
PHONE NO. PERMIT NO. (J/-/39/ 0/-/.$t?4--
COMMENTS:
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
..5 0,1) / 77l-6G
o EXIGRADIFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
GD
-------- ..
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
$ WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: -1i4!-/{-C-OJ..... Owner/Contr:
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYl
INSNOTI
..
...
....
APPLIANCE
PERFORMANCE TEST
Attach to gas line adjacent to regulator
Heating Contractor 4AtV? Af1ItfF.e'K
- ,4,//11,
~;Az-
').
Name of Tester
Date
Job Address 17 ~t<-z,. a..r-4V.{)r.
Heating Contractor ,#/AI'JI? ~
~"
~3/l7-
/,5; +'~,
~.M-
, '
?..2~
'? ,r" r
Name of Tester
Date
Percent 02
Percent CO
Percent C02
Stack Temp
Combustion air is adequately supplied per
UMC Sec. 606 j4-'J'
input ~ ~/.?7V