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Home My WebLink AboutBldg Permit 04-1041 CITY OF PRIOR LAKE BUILDING PERMIT, TEMPORARY CERTIFICATE OF ZONING COMPLIANCE AND UTILITY CONNECTION PERMIT Date Rec' d 9. I('.O~ Main File White Pink Yellow File City Applicant I PERMIT NO. ()~ ./{)4-/ (Please tvue 0] print and sism at bottom) ADDRESS' Ir3.>O tJerTtJrh 1/ CT /VtJ ZONING (office use) ~ LEGAL DtSCRIPTION (office use only) ! LOT J 4LOCK <I ADDITION tJ f'NS/1?Q/V/V . I OWNER ' (Name) ~TJ.. ()8.8 PID;l:)- ~/.r' ~ -0 (Phone) (Address) BUILDER! (Company*ame10/'/VJm'f'/l//V (Contact N4me) G q I" y (Address) /t?7s /' //4 Z e- ./Jdm t>J (Phone) C;S/ - j/O (, . (,I,J" - 3& 'J- SS/;J..2... (Phone) $/1/ 7I1t1/) 7,{,/.:2- /.)r ,Fa 'let/v -V TYPE OF WORK €fl:few Construction DDeck DPorch ORe-Roofing , DAddition DAlteration DUtility Connection 0 Misc. CODE~' aiR.c. OLB.C. Type of on truction: I II III IV V A B Occup cy roup: A B E F HIM R SU Division: ! 1 2 3 4 5 ORe-Siding DLower Level Finis>> 0 Fireplace .:iI'\38/O"d.U~ PROJECT COSTlV ALUE S #-6. .:;.;'-tJ- (excluding land) / 2- - 5'~ ....-., -... 10' VI" a.,,~ I hereby certify t~at I have hlmishcd mformation on this application which is to the best of my knowledge true and correct I also celtify that I am the owner or authonzed-agenlfor'rhc abovc-menllOne~ plOpCrty and that all constlUctlOn wlIl conform to aIll'xlStmg state and local laws and will proceed m accordance with submitted plans I am aware that the bUlldmg :fi"/j'O,!, th" pnrn" r"'}';/~bY '"'' th" the my offi"" 0" ;''';/:;-; "pon th, pmperty to pn'o.rn netd,d tn'pnlton, V I j/ SIgnature Contractor's LIcense No Date ~o-r:f-, Wh'/'i'..!. ~ Permit Valuarion I Permit Fee I Plan Check F1ee State Surchate Penalty Plumbing pe~it Fee Mechanical ~ermit Fee Sewer & WaQer Permit Fee Gas FireP1ac1 Permit Fee . :! 1"5:;5000.00 $ IZ'[;/I. e;- () $ ~ :3 2.. 18 $ Io<j.oo $ $ $ $ $ Park Support Fee This Applica~on Becomes YoU~ Building Pennit When Approved ~ ~ 9~ah'; Blli~dl1l.!!. Official D^te . Paid Date '7 ~O/. ct!' / /fJ /0' $ $/3~O,Oo $ z.s- 0 . 0 0 I $ 't"S . 0 0 I $ I Ulo. 0 lJ 1$ ?D 0.00 1$1'500.00 I $ I /~ 10. ".M--- I $ 15l>3. 9aJ I Rei'J,t No ':ru 4' ~ r # SAC WaterMete~I"; Pressure Reducer # Sewer/Water Connection Fee # /00.0-0 /()(). tJo 35.50 L(O.tJo Water Tower Fee # Builder's Deposit Other TOTAL DUE ThiS IS 10 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 when signed by tpe ClIY Planner constitutes " temporary Certificate of Zonmg camphane!' and allows construcllon 10 commence Before occupancy, a Certificate Df Occupancy must be ;"~anning~ 9/Y1ir ~ ~ial~yl- ~ t.5::--J 24 hour notice for all inspections (952) 447-9850. fax (952) 447-4245 16200 Eagle Creek Avenue Prior Lake, MN 55372 ---~._-_.~..._._.."."."-+-----.._.--~--- 10/11/2004 MON 8:36 FAX 6513226147 GENZ-RYAN CITY OF PRIOR LAKE SEWER AND WATER PERMIT ~ 002/037 Date Rec'd l ~w ~~~. I PERMIT No.JfIl1... tiuJI 3. GoI'd APl'liCM~ f~ I ZONING (Oflj" "',) (Please tvp - or'Dr:mt and sirm at bottom) ADDRE ,S I~,~ fj() . W alfl1J~ {I (1+ .' I LEGAL DESCRIPTION (office us, oniy) LOTC1i BLOCK 4 ADDITION vi! ei'ts VlIl {U1I1 411/1 PID OWNER! (Name) I Wensmann Homes (Address)! 1895 Plaza Dr Ste 200 (Address) (Phone) 651-905-3709 Eagan, MN (City) , APPUCJ.NT (Namel Genz-Rvan Plumbin" & Heatin" (phone) 651-423-1144 (AddreS~'I' 14745 So Robert Trl , 0 (~ddressl L I (Contact ~erson) _ 1111 ~~0f tJ[. 1 51 'L.-?<C1 '_ICAjNT SIGNATURE _ L.!A6JL ' _ J RO!=le'qlo.unt. "'N (City) . :; _ (phone) 6S1-423-1}44 ~ f II,/) DATE /0111 APPLICANT PLEASE COMPLETE BELOW Size of water service inches. Location of any couplings from structure Type of sewer pipe. 0 ABC 0 PVC Estimated length of sewer line feet. . Clean out (if required) located at feet from structure. feet. o Cast Iron ! , Residential ~ewer and water line connection Sewer connrction only FEE SCHEDULE $35.50 Industrial, Com'l & Multi-family $17.50 Water connection only 1% of job cost with a $39,50 minimum $17.50 Estimated Cost $ Building Permit # SEWER AND WATER PERMIT FEE STATE SURCHARGE TOTAL PERMIT FEE $ $ $ ,50 (Office Use On y) This App( cation Becomes Your Building Permit When Approved I urtl! ll~. II; Ii ill ~ IleceiPt No, I i1fatOCT 1 3 2004 I ~y L1u LJ' Blli!d;ng Official ! I Date 24 hour notice for all inspections (952) 447. 1850, fax (952) 447-4245 By 55122 (Zip Code) ')Sp68 (Zip Code) , /0<1 {'.'. . ,.... '",',:-- ,,"'~'I.. ~";....,.~ , " -'-;\i" I' I 10/11/2004 MON B:36 FAX 6513226147 GENZ-RYAN Ii!J 003/037 Date Rec'd CITY OF PRIOR LAKE PLUMBING PERMIT ! (?lease !YPi Of print and rign at bottom) ADDRE$S . ' (C t ! ,'-{ '~0D Wtti~{lA'l1z1 t ;1- i:~: ~~ I PERMIT NO. 1"'_ Iv' .J I ). ytllDW Applil;&lll VI ~ I I ZONING(o_=) I LEGAL: JESCRlPTION (office use only) LOT 0 BLOCK 4 ADDITION \N~11l1~11 CU1 Vl ~hll PID I OWNER! ~amel iWensmann Homes (Address)! 1895 Plaza Dr ! APPuc.hrr ~~e)-!Genz-Ryan Plumbing & Heating (Phone) 651-905-3709 Eagan, MN 55122 (phone) 651-423-1144 (Address) I 14745 So Robert Trl () I (AddreS~~ r~ ( ( (City) (Contact ~erson) -LA1 ~ ~ t l 1711 <J (phone) APPLICPjNT SIGNATURE r J { ~-:) ~ j./ /\ Rosemount. MN 55068 (Zip Code) DA:1-421/~rll I/)e/ APPLICANT PLEASE COMPLETE BELOW I Quantity I Type of Fixture Quantity I Rough-ins Type of Fixture cJ..1 , Bath Tub with or without shower ~ I I l' I Dishwasher I I Water Heater I I. I Floor Drain ~. , Water Sofiner I 1-/' I Lavatory (Bathroom Sink) 1 Stand Pipe (Washing Machine) I I ,i Laundry Tray (1 or 2 compartment sink I Sewage Ejector I I Ii I Shower Stall I Backflow Assembly I , Ii I Sinks I Backflow Assembly Test I I I Bar Sink I Lawn Sprinkler I I 2)! I Water Closet (Toilet) I Other J FEE SI...J:1J!.;JJ ULE industrial,! Commercial & Multi-family I % of jab cast with a S39.50 minimum Residential, New One & Two-Family S99,50 ! Residential, Additions & Alterations S39.50 Estimated Cost $ Building Penult # , (Ome. Us. O~1y) This Application Becomes Your Building Permit When Approved PLUMBING PERMIT FEE STATE SURCHARGE TOTAL PERMIT FEE $ $ $ .50 \ . ,. , '.~'-, . "';,l' , ,"':';'1, w"'v~t. ~'.,." 't".... 1- \;" ,;.d. B1i1ding Official ?1, aRI rT,il"nr.'] ic IlcllleceiptNo, II Tr 1\.'"' I II II, I" II 1 ';'a~ ..' - I !~r Date :! li~ OCT 1 3 2004 II. 24 hour notice for all inspections (952) 447.t~ fax(9S2) 447-4245 __j I l~-----.~~~- 10/11/2004 MaN 8:37 FAX 6513226147 GENZ-RYAN ~ 010/037 CITY OF PRIOR LAKE HEATING/AIR CONDITIONING/FIREPLACE PERMIT Date Rec'd I !please me or Print and siD. at bottom} ADDRE$S i \Ll3'lJV vvttmliv! I O-{ LEGAL ?ESCRIPTION (ollice use only) LOT fji BLOCK 4 ADDITION W P AIlSJ0/1 ttr1 YI 1. Pin}; . ""'" l, Yello'llt E~;_ fPERMITNOoij_ 10#1 ZONING (ollk....) 4111 PID OWNER (Name)J1.e..n.sm.ann J:J....mlOc:! ,(Address) 1895 Plaza Dr Ste 200 (phone) _" 1 _Qn~nQ Eagan, MN 55122 APPLIC) .NT ~am~_ Genz-Rvan Plumbing & He8~;na ! - (Addres~1 14745 So Robert Trl () . . (A~") C' . (Contact 1 'erson) _LJ~llfA O-nra II S _) APPLlCPNTSIGNA~ ( ~ fi::{h 'r-11Alj/) (phone) ~,1_I<?~_' ,1<1< Rosemount, MN (Clly) 55068 (Zip Cadl:) (Phon:A~"-I<?~f'O? If /od , I r' APPLICANT PLEASE COMPLETE BEL~W , ~NEW CONSTRUCTION , 0 REPLACEMENT 0 ALTERAT10NS FURNAdMAKEANtJMODEL Jel1rlDLBl~DUJI-8(P[/)-0!) FUEL ntt1--q U<J FLUE SlZ, RETURN OPENINGS 1) INPUT c?[ n I nn () OUTPUT I~; Ow TYPE OF SYSTEM HEATING OR POWER PLANT J0Wann Air Plants 0 Steam OOravity 0 Hot Water D,Mecl1anical 0 Radiation .-MAir Cooditioning 0 Special Devices OVent. System 0 Other Devices PLEASE NOTE: Air Conditioner Units Cannot Encroach into Required Side Yard Setbacks F1REPLAC E MAKE AND MODEL .- Industrial, C )mmercial & Mu[ti~Family FEE S'-nJ!.!luLE 1 % of job cost Residential, Gas Fireplace $39.50 minimum $99.50 Residential. Additions & Alterations $6450 Residential, AC Only $3950 Residential, cleating & AlC (New Construction) Residential. cleating Only (New Construction) $39.50 $39.50 HEATING PERMIT FEE $ STATE SURCHARGE $ .50 TOTAL PERMIT FEE $ , .1 ~'~"" '''';;,~':~,~,s;':~l:'' - ,',' ,,", :?t\""' \ 'r.~_.' ' . ::..v .~ ,of<" Estimated Cost $ Building Permit # (r-., U,..O Ily) I BJilding Official "-~r~ @ r~ n \1) ~ ~cejPt No, Dale ! ~fteOCT 1 3 2004 .~., . 24 hour notice for all inspection. (952) 447-9~~y ~x (952)_447424~.__.._., . .... App ic:alion Becomes Your Building Permit When Approved CITY OF PRIOR LAKE HEATING/AIR CONDITIONINGIFIREPLACE PERMlT nate Rec'd ~Iease ~e or print and sif!Xl at botteom) I ADDR 5 Iy So W~u- I,Plnk 1,Cfttom l, Y.!lO'W ". Ci~ Al'r1i.....oI I PERMIT Nci./-trJltf I ZONING lofli" 'U6e-) LEGAL DESCRIPTION (olfico uso only) LOT BLOCK ADDmON PJD OWNEl. (Namel (A)Oh>.....~~ (phone) (p~/- I..fCJC,o-L/C/OO (Addres~) ~S p~ a.... , H.;JeJQ ~.frJn '::;-,"/.,:)4, I I APPLl<hNT (N."'ell.l..~h;.. ,~~"~A. r\- i=" P . . V (Addres ;L X9cn /09.u. OAtl'_ iJ -#tr:f)() cAo~j-,:"". rYJl'1 553/~ (Addres.s) , (6ty) (Zip Code) (Conl:acl Person) t:~\3 \..1.K\npn--r.,-.. (Phone) ~~ - Sf/to-I;) 'lo APPUCjANTSIGNATURE ~~ DATI: / /-30-()<-f I APPLICA.NT PLEASE COMPLETE BELOW , ~w CONSTRUCTION 0 REPLACEMENT 0 ALTERATIONS FURNAI :E MAKE AND MODEL FUEL FLUE SllE RE11JRN OPENINGS INPUT OUTPUT TYPE OF SYSTEM HEATING OR POWER PLANT OWarm Air Plants 0 Steom OGravity 0 Hot Water o Mechaniclll 0 Radiation DAlr Conditioni.ng 0 Special Devices OVen!. System 0 Oth., Devices (Phone) '1LD3. S'1I-dS'dS I'LEASE NOTE: Air Conditioner Units Cannot Encroach into Required Side Yard Selbacks FIREPL.lCE MAKE AND MODEL jJ,.n./.' hYv .!.J/1t=(.(,.O FEE SCHEDULE lndustrial Commercial &. Multi-F;unUy l% of job cost ResidC"nti;l1, Gas Fireplace 539.50 minimum Residenti L1~ Heating & AlC (New Con.Wuclion) S99.50 Rcsidcnlial, Additions &, Altera.nol1s Rcsidenli J, Heating Only (New Construction) $64.50 l\c,idcntial, AC Only $39,50 $39.50 $39,50 Estimated Co,t $ HEA TING PERMIT FEE STATE SURCHARGE TOTAL PERMIT FEE Building Permit # $ $ $ .50 (Office u~ : Only) This A pplieation Becomes Your Building Permit When Approved BUlldinl! omcinl Dille II'Bid i I Pa0EC ~ceipt No. 1 2004 By cr 2.4 houl" natice Car 0.11 inspections (952) 44"f~,~DI fo.x (952) 441-4245 ~-./ If - C.__..... m~ Hooa a~VHV~ JI~VWO~nv 66.L 9LS t9L XVd tt:.t tO/Ot/tt Main File White -l'luildln9 C Lanarv - Enqlneerin..s;P Pink - Planning - Thr {'rn!rr of lhr 1,lk. ("o..nll")' BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST ~AME OF APPLICANT APPLICATION RECEIVED . /<//.j ,c, , . i. I 0,.' (,C. /. ~.'.' Tpe Building, Engineering, and Planning Departments have reviewed the building permit a~plication for construction activity which is proposed at: / '.C' I !/I-/ i.1 h.~ /'/- / (. L A :cepted >< , Accepted With Corrections Dmied H wiewed By: 1YYll3 Date: /0 - 12-C)~ C<>mments: See Reverse Side forAciditionallnformationl IYJ,.,'V/ Fr '(( See Attachments: 1) Grading Plan, 2) Erosion Control Measures "The issuance or granting of a permit or approval of plans, specifications and cOl1putations shall not be construed to be a permit for, or an approval of, any violation of anv of the provisions of this code or of any other ordinance of the jurisdiction, Permits prosuming to give authority to violate or cancel the provisions of this code or other orqjinances of the jurisdiction shall not be valid," Main File rWhit.. - F\lJildina ') 'Canary - Engineering Pink - Planning Th.. ('..ol..rlor Ih.. I..k.. ("ount.,.. BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST N1ME OF APPLICANT A9PLlCATION RECEIVED W6NS/"1~Iv'A/ (1- /~ (j4- T~e Building, Engineering, and Planning Departments have reviewed the building permit ap plication for construction activity which is proposed at: /4-350 W,4 T5/Z-F.4-lA-- CA. Ac cepted Accepted With Corrections t/ DE nied R~viewed By: ! , Cqmments: ~~ K~ .eLL/' Date: 9J3()~y I "Tl,e 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 pn lsuming to give authority to violate or cancel the provisions of this code or other ordinances of the jurisdiction shall not be valid," 7< ,.~ ~x PRIOIi' ( ? ~ '-;. u .rn Main File While - Building Canary - I;ngineering ("inK . - t'.anniilg:;> - rhf ('fnlp ..f lhp L.lIP Count.,.. BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST N) .ME OF APPLICANT / ,/ '> //',1 I I' AFi'PLlCATION RECEIVED I / /ft(~. Tt e Building, Engineering, and Planning Departments have reviewed the building permit al= plication for construction activity which is proposed at: lei II I:" / f/;-! {L ( 'i Ac cepted Accepted With Corrections ~ De nied Re viewed By: Cc!mments: ~~ ;?uO, k~ ~.' ~ it';~~'J ad Date: 9 ;3 ~ /0 'f ..uJ""-1~ :. .u:i!~ / 1i~ I "Tille issuance or granting of a permit or approval of plans, specifications and cO(T1putations shall not be construed to be a permit for, or an approval of, any violation of an~ of the provisions of this code or of any other ordinance of the jurisdiction, Permits pr suming to give authority to violate or cancel the provisions of this code or other or inances of the jurisdiction shall not be valid." I : ..---,-~~. '~-~_.~"".~"".o . ~'"'~'__"'~'~_""._""___ PR,IOR LAKE INSPECTION RECORD SITE ~DDRESS ~ ~SO W"'iE:7l.1='"~ ~ cr: ~&...:). N~TURE OF WORK ~f:w c.o~, IIlIMc.Tl'OA USE pF BUILDING 'S. s:; ". . PERMIT NO. 04- ./04-1 D~TE ISSUED !/SO /0'1 CONtRACTOR WENs M.."'....~ ~S PHONE " a. · ~&. NOT~: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW TH~.~RERMI'V IS/BY SEPAAATE DOCUMENT R!5 7{ I ~II ~ LL 'f- L INSPECTOR DATE TING DEPARTMENT OF . "illn File BUILDING AND INSPECTION NDATION (Prior to Backfill) I ~ /~ P...? I IPLACE NO CONCRETE UNTIL ABOVE 'HAS BEEN SIGNED ROUGH - INS <i "lA, :& t?-::f::> ..... d" -"r--- W{ (4f); , t. t~ R~ r2--r SEWER I WATER I SEPTIC FRA tiliNG INSlLATION ELECTRICAL PLU IIIBING Ul2> V U;7 UlC (;/) HEAlrlNG (if reqUired) .i, FIREPLACE \) c. I (;tb~ GASI LINE AIR TEST .1 (ll> . COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED llA7~E / /010119. ~IJ I I , FINALS GR~DING (Prior to Sodding) I /!If r; ~J, I r- BUl4DING I rr!5 ELE(:TRICAL I _ PLUMBING I ,lV4J. cPY?_~ HEA'rING I '(JJ7 <=t -"2- 100 NOT OCCUpy UNTIL ABOVE HAS BEEN SIGNED NOTICE . 'his card must be posted near an electrical service cabinet prior to rough-in inspections llnd maintained until all inspections have been approved. On buildings and additions 1 ~here no service cabinet is available, card shall be placed near main entrance. /zh. I?....~ JZ-:f 7':>.. 2- --d7 FOR ALL INSPECTIONS (952) 447-9850 __..__...._._--L-__ QIrrfifiratr of @rrupattry CITY OF PRIOR LAKE @.~parfm~nt of ~uilMng Jlnsp~dion !wFinal Permitted D Conditional C.O. Expires This Certificate issued pursuant to the requirements of Section I J 0 of the [J Residential / 0 International Building Code certifying that at the time of issuance this structure was in compliance with the various ordinances of the City of Prior Lake regulating building construction or use. For the following: luseclassification _ SINGLE FAMILY _ Bldg.PennitNo. 041041 I r4 Occupancy Type _ R3 _ Type Construction VN _ Zoning District 1.12, B4, WENSMANN 4TH Legal Description _ Owner of Building _ Site Address 14350 WATERFALL COURT N.W. IDate: . , ROBERT D. HUTCHINS _..... Building Official rl_~-(j'; HOME~:(]1895 PLAZA DRIVE. EAGAN. MN ~51n I " :..1/ / City Planner .TANE KANSTER Contractor's Name & Addres;JENSMANN Date: CITY OF PRIOR LAKE INSPECTION NOTICE ADDRESS J Ll3 SD OWNER PHONE NO. o FOOTING o FOUNDATION o FRAMING I::J ~SULATION ~~INAL o SITE INSPECTION COMMENTS: I _ "'4:... I "tL2 /' SCHEDULED cr~~~~ Ii )nlft--.. ROd TillE CONTR. PERMIT NO. l.../-/Oy( o PLUMBING RI o MECH RI o WATER HOOKUP o SEWER HOOKUP o PLUMBING FINAL o MECH FINAL o EXIGRADlFILLING o COMPLAINT o FIREPLACE RI o FIREPLACE FINAL f~~T { \() (~\O~ --:JU'_ (\J \ /" /' ./6' WORK SATISFACTORY, PROCEED / 0 CORRE A 0 AND PROCEED o CO ECT WO ALL FOR REINSPECTION BEFORE COVERING (nspe OR THE NEXT INSPECTION 24 HOURS IN ADVANCE. Owner/Contr: lREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY/ msNO" CITY OF PRIOR LAKE INSPECTION NOTICE DATE nilE ADDRESS J (./ 3'::>0 SCHEDULED 8 - It-c;J>1 Ld~ .Q..,QQ. OWNER CONTR. PHONE NO. PERMIT NO. <-I -/01/ o FOOTING o FOUNDATION o FRAMING o INSULATION o FINAL o SITE INSPECTION o PLUMBING RI o MECH RI o WATER HOOKUP ~RHOOKUP PLUMBING FINAL o ECH FINAL o EXIGRADIFILLING o COMPLAINT o FIREPLACE RI o FIREPLACE FINAL o GAS LINE AIR TST o COMMENTS: <- I. (,J~ t-- ljL1lj L{l/7-1eJt?/ 2- I~..... t..::=fj- f"'.. j1.... o WORK SATISFACTORY, PROCEED '>;:CORRECT N AND PROCEED o CORRE W , CALL FOR REINSPECTION BEFORE COVERING Inspector: Owner/Contr: V CALL 447-98 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE, -.-/' CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY/ tNSliOTl CITY OF PRIOR LAKE INSPECTION NOTICE ADDRESS Elc;-o OWNER PHONE NO. o FOOTING o FOUNDATION o FRAMING o INSULATION ~AL o SITE INSPECTION COMMENTS: r7 rcu.}<1 - <:::>K... DATE nMe SCHEDULED ~ $ -10-0) ~J~/ ~T CONTR. LV"'I'1<~"'W' PERMIT NO. M-/t)L/ / o PLUMBING RI o MECH RI o WATER HOOKUP o SEWER HOOKUP o PLUMBING FINAL o MECH FINAL ~~ILLING o COMPLAINT o FIREPLACE RI o FIREPLACE FINAL o GASLINE AIR TST o C.wb Rr..-/ -r? J( . ~ WORK SATISFACTORY, PROCEED o CORRECT 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/ ""'''''' Heating Contractorbo1~Z-AY'" Name of Tester -r:t.. Date 11t"j" { Percent 0, f"to Percent CO 3/t'A Percent C02 7 .(. Stack Temp _ :SS 2- 0# Combustion air is adequately supplied per UMC Sec. 606 Input r~5