HomeMy WebLinkAboutBuilding 02-1293
JOB #
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HOUSE HEATING TEST RECORD
SUBURB
ADDRESS
OCCUPANT
HEAT LOSS
SOLD BY
Electrical Work By
TYPE OF BEAT
APT. _FLOOR _CITY
OWNER
DATE HTG. INST.
INSTALLED BY
, ' Gas Line By
GA _ FA -k-HW _STEAM _SPACE HTR. _UNIT HTR. _OTHER
i (
,';:7 /",7, '/-G~.s D~K>N .'- ~ /';:"'1,/1 CONVERSION
MAKE /::;;>}:.:- l//~ / ./ 17})-"/0" tvi.- MAKE OF BURNER
, "
Model " Model
Serial
INPUT
d ~TROLS
THERMOSTATi.rJf:v)wv Heat Plug
Valve
Limit
Limit Setting
Fan Setting
Pilot Type
Pilot Make
Pilot Model
Pilot Timing
L. W. Cut Off
I j
tt:S
I
J
t
Pressure
Input CFH
Stack Temp.
Form 235
fU
(,. 1u
q:0
Zc;fft?7
Percent CO2
Percent O2
Percent CO
Iv / D
Max. BTU Rating
MAKE OF FURNACE
Model
-:? if
Vent Size .;.-,
KIND OF LINER
SIZE
NONE
Draft Hood
Fi hers
RegulaTor
Size /G.:'X 2-0" { Number I
Chimney Location
Chimney Construction
Inside
?'
Vl..--.'
Outside
Smoke Bomb
Draft
Door Pressure
Wiring
Test Tag
Lighting Inst.
! / ,--,
Dote Tested .7 if I <::,.?
. I
Company Testing Frederickson Heating & A/C,3650 Kennebec Dr., Eagan, MN 55122
,,? A'" , .
Name of Tester ,?v,~, ,,:::/,,'.;~:'>/'''''i'<<''
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DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
t 2/t J-{tJ3
SCHEDULED
ADDRESS
/4--/1/- 6/
FOUA/JJq/ AI Hli L,~ e.T:
OWNER
CONTR.
PHONE NO.
PERMIT NO. tJZ-/z.-:;O - 95
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
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
('
COMMENTS:
tL05[
(106
!
~ORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector:
7t4-
Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTl
-
S-ee. +hst. M 0. \ l-\.. f; Le
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
/'/
----. -')
, .
'\_ ).....1 i'/ "i -.~c... i.V
I ' /,' .
I! ! ::
LEGAL DESCRIPTION (office use only)
LOT C:> BLOCK2- ADDITION -0 'J ,v' I.;::... : ,.J
OWNER
(Name) WC,IV <) 701"2,-") rJl')
/ L. /. ",_
t 7",.> ..,<.~ ..)0
(Address) ) t9~
:' ';
IY/~\ ;[:. ,....:\
1\ 17-
:;pet'"'' ;,('){)
'-*_..A ~.
<'7' / ~Jr,
Date Rec' d
White File
Pink City
Yellow Applicant
q-4-O~
I PERMIT NO. oCr -I ?9_3
,,~
( ./1
'-
ZONING (office use)
12
-.h/!<
/7 7'>
.t.,.Ai,.;
PID
"1 . ...., I)
- ,- ")-- c. ) - 6 U ;- '"
I' ,- '.-/' /l / --, / / /(1 (')
(Phone) Ie _' I . (j"", ././ " ,-/
BUILDER II
(Name)
(Contact Name) ~ (. 2- 7-
'--,
(Address)
.---; .-
--- ! / I & " r', ~~
_/ /~ .<.... ~f.(..-,
(/
/,
h' 1<
(Phone)
(Phone)
:?c-':;' ';';?r.(_ I/D [7'f
I J'V t/'~", ~ an
..TYPE OF WORK
New Construction
DDeck
ORe-Siding
OLower Level Finish
o Fireplace
PROJECT COST IV ALUE (excluding land) $
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 the building official can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may
enter upon the property to ~eeded inspections.
.....:" .,.-- ..-
/1/ /. ~,
X . /1
/./ Signature
o Mise.
Permit Valuation
Permit Fee
Plan Check Fee
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
$
$
$
$
$
$
$
$
Sewer & Water Permit Fee
Gas Fireplace Permit Fee
-62-
DPorch
ORe. Roofing
DAddition
o Alteration
DUtility Connection
I </ < \."
I . L'
,-') ."). ~_ "7
-, -- L
/ L -.'
Contractor's License No.
Date
Park Support Fee
SAC
Water Meter Siz 5/8 1";
Pressure Reducer
# $
# $
$
$
# $
# $
$
$
$~ fJ /
I ~5 -rzrlJ
City SAC and WAC
Water Tower Fee
Builder's Deposit
Other
TOTAL DUE
Paid (p 2 J/ Y.t I
Date Ie).. f r/Z--
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
when 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
issued.
~~tJ
Planning Director
Idht-z- ~ ~ ~
. 'Date Special Conditions. if any
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
Tht Ctnfff or Iht "ok< ('ounlry
White - Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT /))~~/J1../ (/O~
APPLICATION RECEIVED 9-q-()~
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
/ LIII? h-) u vi (/ //U iI. r 1/ s (J-r
, , .
Accepted
'X
Accepted With Corrections
Denied
bate: ~W{01-
, ..
See Reverse Side for Additional Information!
,
Reviewed By:
Comments:
S [f h1 ~ f"tj:.l-C..
. See Attachments: 1) 'Grad1ng P.lan, , 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."
White - Building
Canary - Engineering
Pink - Planning
Tht' ("t'nlt'r of lht' Lith Countf).
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT h~~ (I~
APPLICATION RECEIVED 9 - q-~ J..
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
liftl! f;UVfa;'A) i/,r 1/5 Or
Accepted
y
Accepted With Corrections
Denied
vi?
Date:
9-{c;-CJ2-
Reviewed By:
Comments:
SeQ. +k VY\~ 8..tL
"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."
~~-A
ThE' ("f'nlt'r of the Lab Count"."
White - Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
,..
c'
"
oJ _/ i
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
;---
Accepted
Accepted With Corrections
v
Denied
Reviewed By:
~~v
k~Pk
Date: 1174-7/
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."
FILE No.938 12/18 '02 10:56
ID:PLYMOUTH PLUMBING
FAX:7635331121
PAGE 5/ 7
~:~~
,.~ .." 1.'" ,/1
.......~':M.........
Date Rec'd
CITY OF PRIOR LAKE P1JUMBING PERMIT
; ~~~~ ~:;I' I PERM_,'~I.T NO, tJ - fo--..f)'3-' "II;
) Yclluw AI'I,licl,nl ,", V -(
(Pl~asc' IVP~ ur print and. si~fJ :II hOl.~~l!!!l_ ._
j .A. DfJRESS
1-1~li']l fc u~~-L~(\.~ \\ ~
I
".__1
ZONINC; 1 o If I e(' me: I
..I
r LEGAL L','ESCRIPTION (dl!ic:t u.. ollly)
L_,~qI-___!?!:.oCK __..... ADDITlON
PID
r--......--..
OWNE~
(Name) _'\I.... ~-'L.v\..~m 'av\v\. H~DV\A....Q.~_
(Phonc::) ___ ,...
I (Addrml
I' APPLICANTD ~'~'-, 1M -~ '-~:-~ - J) \, . ---;- ;l,1 ". . c= -~~_.._.-_..-
. (NameL. "~1<{ fL-lllVI (,..tt'\'\,\d.Lya'''' ,. (Phon~) '0,U: ..y,,)::,?:>.-l..rb,d...../
IIAdllrc:~~;) .. lOC{ C13....._ "'111/\ I'I.L + ~ ~ h ~o,..I. k ...brtlL"\k.tjVl {t~~k-._, f)~LL;l..7S
(Address) (City} (Zip Code)
i (Cont~cl Person) =1=.,1..~ .,L-.::>C,\/~_ . -{ \ \ fr ,cPhone/IU ~}Y)~:?'- ll, .3f):z.....
L~L1CANT S,aNA 1"- ~ _ ('] ~, __I Lq oQ~ __DA:tfc_J:) - _ lli -C;.;;t---
APPLICANT PLEASE COMPLETE BELOW
r"Qual1tit~Y"- ., ' .,.- Type of F
t~:::~.: .-a._._~ ':~~~~~;_il.~~-witho
L'__j-~~~~~r;~[~atll"'''m Sil
L.<lLlndry Tray (lor 2 co
I ----- Y"- Shower Sta II ..'".
[~,=:-r' - J. Sin'i:~-.-
~.._.__.,
1_, .~
inure Quantity 1.
sl';:lwer ..... .... 3 Ro;:~ll~ins
LIt
..,", .- -. ....... .. ". ~
\ WaTer Heater
---.. -""'" W aiel' Sonner
1
lk) -' - l Stand Pipi'(W
Iilpartment sink ._, Sewage Ejectc
'.
BLlckflow A.ss
., ,'" Backflow As;'
.. -.,. -
'ypc.,(.~.f. Fi)\tun~
.:l:!>hmg M~"l:lli~~) '''=~~~~'~-'-j'
\I'
ellli;i), ' ....-------..,--...
t:l1IblyTesl ........- ,. ..,
I 1...11111 ...J,"I\.
J..Y./~'Il(::r Closel ..c:I>)~jel)
1=-'\
~;~~'.' ..~~~.-'
" --._1
,---_..1
J~EE SCHEDULE
Industrial Ctl1l1mCrC\:.1I & Mulu,,!'ulJ1ll\ I'~." tlfjllb C:LISl wilh ~l $39.50 minllllltm
Residcnlilll. New (lne &. Twu.Full1ily ~l)l).511
RC:~I\'I/:nlIiJI. AddiliL1IJS &: .'\ 1\I;:r:llIClns $:; ~. 511
1::.Slinl:ned Cost $1.Q1~5. 00
Building Pcmllit # ...
;'~"'"
PLUMBING PERMlT FEE
STA TE SURCI-1AHGC
TOTAL PERMIT FEE
$
0'
.j)
$
.__.., .,s0
I( )IliCt 1:5, Onl)'1
l'r.l:~jQ ---'--l'i~cct:irl Nt)
I I
I D;lI~ ;~ic i' -_.. ---'-'ilf:,--'7l1/
,,,-- - .L1..2002 m._.___.-.vr
14 hOllr IIlllJt't' Ihr allll1spcClwlI~ (lJS:!1 .14"7-9H5lt. rn~ (95:1) 4.;l7-4~4~
This Applic:Qtion I~t!c()m~;; Your l~lljlQjng "c.-mil When Appmved
IllIilllill~ (llfll""i
P:d,'
l'I~.(tll !:.i'~~(' ('n,,'I, .\'t'I.:.. s.F". "filii f..d\c. 1\'11\" 3337~.171~
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
;//,???7
i' ~~w ~~~icant I PERMIT N~;2 - / d-.q :"J I
ZONING (office use)
77 h~~ k.L. /~//
-- /-.
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name)
(Phone)
(Address)
yJ 6:;5/~
APPLICANT ./J , / ~ _ ./ -
(Name) '/7///~ //L~C~/C~ (phone) &5/-ij5/--777~
(Address) .3Z~ZJ /~~ke.- LJ-~ ,S--U/k / ~~q'ar; /??A
(Address) (City) J (Zip Code)625~
(Contact Person), k /(~ ?~~ne) ~57- L/~- d 777
APPLICANT SIGNATURE 1 It. r~ . DATE
APPLICANT PLEASE COMPLETE BELOW
OWarm Air Plants
o Gravity
o ~echanical ,
.efAi!, Conditioning
~t. 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 SCHEDULE
I % of job cost Residential, Gas Fireplace
$39.50 minimum
$99,50 Residential, Additions & Alterations
$64.50 Residential, AC Only
$39.50
Residential, Heating & AlC (New Construction)
Residential, Heating Only (New Construction)
$39,50
.$39.50
Estimated Cost $
Building Permit #
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$ c:;;;r
.50
~
~
',' n~
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Paid
Receipt No,
Building Official
Date
2 0 2002
By
Date
24 hour notice for a\1 inspections (952) 447-9850, fax (952) 447-4245
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
~. ~~:n ~~:y I PERMIT NO. J--/?43
3. YeHow Applicant 0:...
ZONING (office use)
14177 FOUNTAIN HILLS
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name)
WENSMANN HOMES
(Phone)
(Address)
APPLICANT
(Name) ALLIED FIRESIDE DBA FIRESIDE CORNER
(Phone)
651-633-2561
(Address)
2700 NORTH F AIRVIEW AVENUE
(Address)
ROSEVILLE
(City)
55113_
(Zip Code)
(Contact Person)
BRENDA HUSTON
(Phone) _651-633-2561
APPLICANT SIGNATURE
BRENDA HUSTON
DATE
1/10/03
xD NEW CONSTRUCTION D REPLACEMENT D AL TERA TIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
DWarm Air Plants D Steam PLEASE NOTE:
DGravity o Hot Water Air Conditioner Units
D Mechanical o Radiation Cannot Encroach into
DAir Conditioning D Special Devices Required Side Yard
OVent. System o Other Devices Setbacks
FIREPLACE MAKE AND MODEL HEA TN GLO SL 750TR
APPLICANT PLEASE COMPLETE BELOW
Industrial, Commercial & Multi-Family
FEE SCHEDULE
I % of job cost Residential, Gas Fireplace
$39,50 minimum
$99.50 Residential, Additions & Alterations
$64.50 Residential, AC Only
$39.50
Residential, Heating & AlC (New Construction)
Residential, Heating Only (New Construction)
$39.50
$39.50
Estimated Cost $
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
Building Permit #
$
$
$
.50
r",,'l'~1il
~, r~ I .,-." . """c" fI
-\.:::.' ~'. "',~:' r
'-'<oJ u" '=. '
<J """"iJJ
Buildinl! Official
Date
(Office Use Only)
This Application Becomes Your Building Permit When Approved
24 hour notice for all inspections (952) 447-
FILE ~.Jo. 303 02, 14 ' 03 10: 55 I D : PL"fTl0UTH PLUm H.JG
rA><: 7635331121
PAGE 15/ 47
allll!t. . FILE
VeLLOW . ."PLICAIlT
GOl.O . CIT'f
CITY Of PRIOR LAKE
SEWER AND WATER PERMIT
NOTE:
S,w. No. :< - ( d- (1-3
Sewer and Water
contractors must
be registered
with the City.
APPLICANT: ~i~O'')'tlA PlLAV\'I ~, ~
f'DDRESS:JL/ (-- ro~V\t<>i,^ ~ - \\":> C:'\-
~IGNATU~~Ji& "~'l'l\U.QtiI1.
SITE ADORES ~ :
PHONE :/7ls:~)5?l!J" L\ :7:J57
""" .;
OA TE : d- - \ L\ - 0 ~
BLDG. PERMIT #
PIO#
FILL IN THE BLANKS
1. Estimated length of water service
I
AD
feet.
\ "
inch(es).
2. Size of water service
3. Location of any couplings from structure
feet.
4. Type of sewer pipe. ABS PVC~ Cast Iron
5. Estimated length of sewer line j-fO
feet.
6. Clean out (if required) I located at
structure.
feet
fr:::>m
;==~;~=======;==================~~~=~~~===~==;=;=======;==~~=~~~=~
This application becomes your permit when approved.
BY
DATE:
~~~==~========~==;==============~=~~===~~=======;;===========;===~
FEES:
$
$
$
35.00
.50
35.50
Sewer and water line connection permit.
Surcharge
TOTAL
Fee for either sewer or water individually is $20.00 plus
$ .50 surcharge.
Sewer an~;~\{it?~r,=;:~ '. 'ssued for new construction must be
recorded~1 itJri '.' ~"'..M....."elf;bij..~l/d.IIIim permi t card at the 't...i....m e.. Of.i.S.. suanCe
~o insu):thCl,t nodu'p . I ate sewer and water 'Aermi ts are
lssued. U FEe 8 ;110'~ . ~. I H ~.'D tM/1", .
c, " ,,~iJj.;.,D!;\!G r'
DATE PAID . .,' AMOUNT PAID "",
y ::::::---..
RECEIPT ~~ REC'O BY
:.<
""
q=
16200 Eagle Creek Av. S.E., Prior Lake. Minnesota 55372/ Ph. (612) 447-4230 I FAX (612) 447-4245
An Equal Opportunity Employer
~ee +Vt.e v ria. \ V\ tt \-e
PRIOR LAKE
INSPECTION RECORD
\-\, l\s Q.\-.
DEPARTMENT OF
BUILDING AND INSPECTION
SITE ADDRESS ~COv\'\o..\V\
NATURE OF WORK _Nell..)
USE OF BUILDING 3~A
PERMIT NO. 02 -/2,13 DATE ISSUED -3 -14- 6?
CONTRACTOR ~V\SVYlo.YW' PHONE Q5J... -'J.j3-E39 (P/
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR
DATE
I FOOTING I IN\ t' {t9!z.g (03
I FOUNDATION (Prior to Backfill) I (jv\,.p I L 0 I LS? 03
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
SEWER I WATER I SEPTIC
FRAMING vu ~~
INSULATION
ELECTRICAL
PLUMBING I I B
HEATING (if required) L 183
FIREPLACE e$ II ').-1 /trr 3
GAS LINE AIR TEST ~ J t 2. l ~
COVER NO 'WORK UNTIL ABOVE HAS BEEN SIGNED
I I
FIN A L S cf""'t[.,~ c
GRADING (Prior to Sodding)
BUILDING l-V ~
ELECTRICAL
PLUMBING
HEATING
DO NOT 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 shall be placed near main entrance.
I
o -r;, ~. t~ e3
t ~ 103
J-( ~te>"3
~/(;t l!I;3
;z./l/We(j
J-1lJrJ/ D.3
Call between 8:00 and 9:00 A.M. for all inspections
FOR ALL INSPECTIONS (952) 447-9850
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