HomeMy WebLinkAboutBuilding Permit 99-0131
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, CITY OF PRIOR LAJ(l?
'\/ J)epartment of JluilbinlJ Jn~pedion
~~al Permitted 0 Conditional C. 0, Expires
This Certificate issued pursuant to the requirements of Section 307 of the Uniform 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:
Use Classificatiol'
SinlZle Famil v
Bldg. Permit N'
99-0131
Occupancy Type
R3
Type Construction
VN
Fire Zone
N/A
Zoning District
PUSD
Legal Description.
Ll, Bl Cardinal Ridge 4th Addn
r
O fB ild. 16310 Victoria Curve
wner 0 u mgC;ite Address
Contractor'sName&.Address C Ex M Hofl~lders 2949 86th St NW Medford MN 55049
Robert D. Hutchins' r / r. PI Jenni Tovar
. / Ity anner
/.? Building Official /
Date: l?' /0 . Cj c:; Date:
CITY OF PRIOR LAKE
INSPECTION NOTICE
DATE TIME
SCHEDULED
L ~qc, ,AT
ADDRESS \("'31t) V Lclulflr~ ~
OWNER
CONTR.
PHONE NO.
PERMIT NO.
qq~l31
o FOOTING
o FRAMING
~NSULATION
FINAL
FOUNDATION
o DEMOLITION
o FIRE PREVo
o PLUMBING RI
o MECHANICAL
o WATER HOOKUP
o SEWER HOOKUP
o SEPTIC INSTALL
o PLUMBING FINAL
o SITE INSPECTION
o EXC/GRAD/FILLlNG
o LKSHORE/WETLAND
o COMPLAINT
o SEPTIC FINAL
o FIREPLACE
o
COMM(j~b
~;t,eQ
~ .fZA (J
~. W is-CO _ 00
'~:.J- .
_ldl;J~ /
tJ_, <0 ~~7) Cf). V
ty ~ 10, "';lrL...:
....-----/
Inspector:
CALL
CODE
"
'--_._""'"-r--'~
CITY OF PRIOR LAKE
INSPECTION NOTICE
.
SCHEDULED
DATE TIME
",/n/" "pM
ADDRESS /(,3/0
PHONE NO.
thC101l./1t1 t1 odJLf
CONTR. e f ", f/,,,,es
PERMIT NO. 99-/3/
OWNER
o FOOTING
o FRAMING
o INSULATION
)i( FINAL
o FOUNDATION
o DEMOLITION
o FIRE PREVo
o PLUMBING RI
o MECHANICAL
o WATER HOOKUP
o SEWER HOOKUP
o SEPTIC INSTALL
o PLUMBING FINAL
o SITE INSPECTION
)( EXC/GRAD/FILLING
o LKSHOREIWETLAND
o COMPLAINT
o SEPTIC FINAL
o FIREPLACE
o
COMMENTS:
6'A.Abl...x::-. I~
A-t'''::P'nJ~.. F
1'. U8JJ4f>>c IS
oPGIliIT/o AJAL-
i/t4.A^ ~ ~c. z::.w ~&t...I4Y
1.$ II'J p~
,t1 AIMm/AJ
SIc... -,- t='"ENI L
I JIJ'T"/t.- sDDoEn
)(WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector:~.J' 1...,,., ~. \lI1er/Contr:
CALL 447-4230 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
.... ........ - .. - . ..--....
"._-~~"--'-"'----- '
,
CITY OF PRIOR LAKE
INSPECTION NOTICE
DATE TIME
SCHEDULED
,r J. -97
1:30
ADDRESS {(Il.~ [0 \/r.c.h,ilo..... C->>I""v'-4-
OWNER
CONTR.
PHONE NO.
PERMIT NO.
?=i-/)/
o FOOTING
o FRAMING
o INSULATION
o FINAL
o FOUNDATION
o DEMOLITION
o FIRE PREVo
o PLUMBING RI
o MECHANICAL
lL~ATERHooKUP
f' ~SEWER HOOKUP
o SEPTIC INSTALL
o PLUMBING FINAL
o SITE INSPECTION
o EXC/GRAD/FILLING
o LKSHOREnNETLAND
o COMPLAINT
o SEPTIC FINAL
o FIREPLACE
o
CZ~7NTS:~~
h il 11. lL-
~D U1f-Lt.\.~
52J. ~11-
&v-~
6Q P'fC-
&rr-- ~<>~,
Dl-L
~
{~+~Wkp(
+v ~u-de-
~./
Owner/Contr:
.' ---.----..... ._... .< .'.-..-, -'-_~_"""'" __.__h____..,
. . ~~~~~.-
CITY OF PRIOR LAKE
INSPECTION NOTICE
DATE TIME
SCHEDULED
~-I\-qq
\(;:):'30
ADDRESS ICo31b V futo(;~_ ~
'-
OWNER
CONTR.
PHONE NO.
PERMIT NO.
'j'1~ \3/
o FOOTING
o FRAMING
o INSULATION
o FINAL
o FOUNDATION
o DEMOLITION
o FIRE PREVo
o PLUMBING RI
o MECHANICAL
o WATER HOOKUP
It 0 SEWER HOOKUP
s..~EPTIC INSTALL
IQ..1'LUMBING FINAL
o SITE INSPECTION
o EXC/GRAD/FILLlNG
o LKSHOREANETLAND
o COMPLAINT
o SEPTIC FINAL
o FIREPLACE
o
Ci;So
u~-'" ~ ~
4 r ----0-
w,u ~
(L,..d
Gf ~~
~A_ ~~
ok---
/
/
/
/ -
D"ORKSA~S CTORY, PROCEED
r! CORREC AC N ND PROCEED
o CORREC R, C LL FOR REINSPECTION BEFORE COVERING
Inspector: . Owner/Contr:
CALL ~;" 4230 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE."
CODE R\JUlREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
.....".._,-
___'"_0.'. '--'-'-'-T--'~ ^
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS \ ~ '3 , b
OWNER
PHONE NO.
o FOOTING
o FRAMING
o INSULATION
o FINAL
o FOUNDATION
o DEMOLITION
o FIRE PREVo
COMMENTS:
'2'0
~~'
hJAdJ
~
DATE TIME
SCHEDULED
~-z,-qq
J 1:0'0
if I c.1-0" r 0...- ~
CONTR.
PERMIT NO.
C\Cj -\ 3>)
11 ~"UMBING RI -
~ ~ ",ECHANICAL +-N L
o WATER HOOKUP
o SEWER HOOKUP
o SEPTIC INSTALL
o PLUMBING FINAL
o SITE INSPECTION
o EXC/GRAD/FILLING
o LKSHOREIWETLAND
o COMPLAINT
I\. 0 SEPTIC FINAL
f1" yIRE~ T sf
to
href~
U,^-
Ir(r _~ if (0\.
aY~
+CS;1-
DATE RECEIVED CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
_~. ZONING COMPLIANCE
. AND UTILITY CONNECTION PERMIT
PID~5 - 3:\J -Cfj 1-0
l/ i...'1- A~l'
(Tel. No.)
/J.<1 (/ q /11"" )f 6 -t.!J :s I
(Tel. No.) ~
7&0 -Vt.12:", -<
(Tel. No.) 15. NUMBER OF OCCUPANTS OR SEATS
I&--In/'/~
C U/"r/~
LOT
BLOCK /
~ 'c/ ("'(...
,
ADDITION
i~ame)
(Jb III c-
(Name)
(Address)
J:;re--
(Address)
~E/JFOW
.,/V. 5"50'19
& LUJeI',>
6. BUILDER
(Name)
(Address)
7. TYPE OF WORK
New Construction\r1
Chimney 0 Mlk-
Septic 0
Addition 0
Finish Attic 0
Deck 0
1. DATE
2. ,..2.r- ii
PUSD
Re-roofing 0 Porch 0
Re-sidlng 0 Finish Basement 0
16. PROJECT COSTNALUE
_ _: 13 Of. ~O
8. PROPERTY AREA OR ACRES 9. PRcr.~t!>DIMENSIONS 10. CULVERT SIZE 17. COMPL'ETION DATE
Sq.Ft. / .1, /2-"3 .Width'(JIP Depth/fir _ Y~ _ -;)J~C!..... JO fcpyer
I hereby certl/{ that I have fumished Information on this application which is to the best of my knowledge true and correct. I also certify that I am the owner or'uthOriZed 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 offici revo t ~s p~ ~r just car1. Furthil~reJhereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X ~ ;'~~ t~."" 1./ $'"1 ~ 2- -2.-r- 9*7
Signaiure License No. Date
Fireplace 0
Alterations 0
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
Front
Back
Side
BUILDING DEPARTMENT VALUATION
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
USE OF BUILDING ~. ': .~
Sr=-,;p
Side
PERMIT VALUATION
130;(')['\/').c:;l/"')
TYPE OF CONSTRUCTION: I II III IV ~
Occupancy Group A B E F HIM '-Fl" S U
Division 1 2 ~ 4
Permit Fee ................................... $
City:
Plan Check Fee ............................. $
State Surcharge ............................. ~
l, 0:\'1.. ~'5
lo7lj . Z~
{gS.OD
Penalty ....................................... ~ ______
~..
\9 Gf\
~! I)'
, ,)
.1
I)
Plumbing Permit Fee ....................... ~
100.00
'oO.~
sS . S()
Mechanical Permit Fee ..................... $
Sewer & Water Permit ...................... $
Gas Fireplace Permit ....................... $
Thist::JcAilBecom.4. Ynllr Building Permit ~en ApRroved.
By ~ ~ Date ~-t-'7
f/
Certificate of Occupancy
Issued
Amount Brought Forward .................. $
ParkSupportFee ........................... ~
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
'5J If $
Pressure Reducer ..Ia.................... $
Meter Horn....... T......................... $
Water Meter ..:lat........................... ~
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
1. White
2. Pink
3. Yellow
File
City
Applicant
Permit No. qq ~() 13 (
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Heig~ It.?' (Width)ho' (Depth) 30 I
12. NO. OF STORIES2..
13. TYPE OF CONSTRUCTION
.:5lJv ,. ft. /=i; /I'll to. r
14. FLOOR' AREA AP~ORTIONMENT USE
OCCUPANT~
SEATV'
MATERIAL FILED WITH APPLICATION
SOIL TESTS
o ENERGY DATA
o
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS 0
SETS
COPIES
SURVEY
PLOT PLAN
o
o
A SO.4.$O
()SC.OO
Ll S .O^
l "2$.00
11'200.0Q
lOe. r10
Water Tap ................................... $
Builder's Deposit ............................ $ 'I S-cX). 0 ()
Other ......................'................... $ ~ - -; 9 7
T~Due .............................. $ 14 ~ .
Paid (j16. Receipt No. S c.{'? 't.l
- ,
Date 3-l'-CZ-' By
This is to certify that the,:r~~ in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document when
signe~ ~~1~~ temporary Certifi~ ~~iance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be issued.
~' City Planner ~ Date Special Conditions ~ any
24 hour notice for all inspections 447-9850
".'-
'"
------------------
.Permit#
.Job Addr.../t3/0 (/ie-J6r/4
~Heating Contractor METRO AIR
/~
.T esters/Signature
,.
.GlIS Une
Pressurized
Inspected
Q!!!
Ii!!!!
~
Pounds
Pressure
.Percent CO2
PERFORMANCE TEST
<: 9'~ ope,centco-L)%
7 . ~ % .Stack Temp. 2;J~O
.Percent O2
Finallnspeetion
Date
,I
"\
~ '19-0/3/
no Con'.. of lho Lak< C08n,.,.
White - Building
Canary - Engineering
Pink - Planning
BUI~DING PERMIT APPLICATION DEPARTMENT CHECKLlSI
NAME OF APPLICANT (1///1 HCllLf /}tr.ddf. t
. ,
J .
~
APPLICATION RECEIVED
,,' I C
-x. I)r -/. C/ 7
.. /'..,':;
The Building; Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
/ t. 31 C ~/; C 1m I r c<... ({OJ't L"-(
'.
Accepted
/
Accepted With Corrections
Denied
Reviewed By: ~~ &RESJ4.(I4Il1,v
Date: 3/z/99
Comments: j?tJAJoEF &.,- Be t20NvE ~EJ) To J'l.loJO J'lL~N~DaAIAJAG e
A,.,~ U1lc...IY'V EA:!EI4(Et-Jl""i As IfIlVGH As m.41.T1t:.I'tI....
SEE J"'Fen.MA-T'/oIl..1 t1A,) REVE1l...~ SIf)E:
5[:E.. ATJ"IlIt..wMF~ : I. F;"",r4J. a"Mj/AJ it /.lVS~U1AJ /NFaIl.I'tArTtM} z. bl(/10 INh FLAlI..l
"3. €A.fJ~'4tY C'OIVTItOt.... f'I1e~~c;
If. FIl...(,]ELfJ't! (JON71f.DL- R14A.I
"The issuance or granting of a permit or approval of plans, specifications and
computations shall not be construed to be a pennit 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,"
.;c"/" j,.,"'''' "~;~~~""'..Y~\"'~~~r'~~3rY'""~:~~:-:~E'\!,;
".....~.-,;;,;,1'..'~~\-::-"""~.:li,~~-;--O,'~t~~~"i..;7....-mt~",~--~----;'-
,
'1'""~ //'_ ,i' ~/t
Th. e.nl.. or lh. lIk. CounllY
White - Building
Canary - Engineering
Pink - Planning
BUILDING peRMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
;:: /
! .
,/
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
c
Accepted
v
Accepted With Corrections
Denied
~~ l~~ Date
'3 ~ l - t1~
Reviewed By:
Comments:
~~ M ~~fjf'eiJP
"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."
-,,:1'
~ C;t?~ol3/
Thf' ('f'ntrr of thr Lake Country
White - Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
-
NAME OF APPLICANT -.f!>/-fJ1 ~ Bu.d~
APPLICATION RECEIVED c::2/cJcs-/tJ 7
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
/~31()
,
Llr'c'bUQ
01A( J.-e
Accepted
Accepted With Corrections ^
Denied
Reviewed By: C!J2 ~ k-
. v
Date: ~ ~-I - /'7
,
Comments:
I. S;~ ~ ..\..'-.... a...r
,
~I/Jl~1>~ pra.-..
~Jy:.J
~~
'2, ~lv\..~Q..I'~ 1'~~~
3. l?ec..oR.- Co. (( ~& ~
"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."
c, ~~
~~
CITY~OF 1'nf()~R LAKE
PLUMBING PERMIT # 99- /3 /
Applicant: 5~~ P\U~b~' Phone:41.J'l--1&'73l./
Address: ~~ :5e fnDr4J.lf.. il1A.l .'5S37;l.
Signature:
Logal Des 'pi n: ~o I Block / Sub tfl~"'N~" ~'P66 -.m'toaJ,
Site Address: Iii 31 D lJ/{J}Ortl1 ~
Building Permit. _ q q - /3 I ,PID # ;z...5 - 32..2..- 00/- 0
NOTE: This permit will not be processed without complete information.
FIXTURE UNITS
I. Blue
2. Gold
3. Ydlo..
Jllil.
Cily
APj)lil;".Ul
Th~ (" ......., or .k LaIt. co....,.
Quantity
T~pe of Fixture
Quantity
Type of FbClure
I
I
/
2-
I
;)
J
Bath Tub with or without shower
Dishwasher
Floor Drain
Lavatory (bathroom sink)
Laundry Tray (lor 2 compartlTl8nt sink)
Shower Stall
3
(
I
Rough-ins
Water Healer
Waler Softner
Stand Pipe (washing maohine)
Sewage Ejector
Baacftow Assembly (RPZ, Double Check, PVB)
Backflow Assembly Test
Lawn Sprinkler
Other
:1-
Sinks
Bar Sink
Water Closet (toilet)
FEE SCHEDULE
Industrial, Commercial & Multl-Famil~
(1 % of job cost, $39.50 minimum)
Residential, New One & Two Famll~'
Residential, Additions & Alterations
State Surcharge
$39.50
$
$
$
$
.50
GRAND TOTAL $
This ~ ..,.:t is gnu2ted upon die CltpresS condition that said
C:OOlJ'Ktor, 1ba11 comply in all respects with the ordinance$
of the State P1umbiilg Code and th~ amendments thereof.
RHI!l'1'2. 4-Az../ tf ., DATE
~~. ATTEST
Call fOf a.ll in.llrw_tions 24 hours in advance.
16200 Eagle CreekAv. S.E., Prior Lake, Minnesota 55372/ Ph. (612) 447-4230 / FAX (612) 447-4245
An Equal Opponunity Employer
CITY OF PRIOR LAKE
16200 Eagle CreekAv, $.E, Permit No. qq,.. /3/
Priar Lake, MN 55372
Retum Oplnlngs
8:i Input ~'b_ h~-n
a: '
o
e:::
I-
w
E
Edt.
Cfm.
\\~Q
TYPE OF SVSTE~ ,
Warm Air Plants A
Gmity
Mechanical
AFr Condtlionln~
Van\. System
HEAnNGOR POWER PUUfi
Steam
Hot Wale,
Radiation .
Special Devices
Other Davlcel
Replacement
TYPE OF WORK
New Conatructlon X
E
fl1 Alte~atlons
IS)
N Repair
Q'"I Esl; Cost ,
Q'"I
~ HEATING PERMIT FEE $
If)
~ STAlE SURCHARGE .
e::: . .'
& .. TOTAL PERMIT FEES .
e.t. Comp. 0lt8
S~(\~.~ 'BuUdingPerm~I
qq- /3/
.50
PAlO WITH
BUILDING PERMIT
ReceIpt"
TYPE OF STRUCTURE
1. Pial! - Pile
1. o-a - CIlJ
J. Yellow - 00ntm:10l
Single Family
CommercIal
x
Two-Family
Industrial
HEAnNG APPLICATION I PERMIT
~ Date ~ - \ ~ -" ~ PIDI 2.5- 3'2..2.- 001- 0
Site Address \t" J \ t) \l ~ L \-\\v ; u L'-^.-\J-tJ
CD
~ Lot / Block I Addition ~~//V',I9t- ,e/t:::it.5i-c 4-7#- /lOON.
2 OWn"r'I Name l '\ ~ "OM l ~
Address~ ~~ ~~~'\ ~"" ~\c ~~ fu t\\\\rtk
HNllng Contractor ~~-\r('J .(\ ~,... - ~iJ ( ,
Address \ \0 ~~() \.~ \\'~.CJP\L 1\VL ~('\ot'"'l~\\D.J
Telephone" "" ~ 1- ~ \ d. ~
Furnac& Maka & Model C l\ 'i'V' > ~'""
Model Size f 1\ V - G '1 \.\
Conn. Load S S I ~~ (
Fuel f\) ~ '"" FJue Size S"
Supply Openings ~ \0
~
Output:ll.. M) ~
Fee Schedule
I nduslrtal, Commercial 8. Mulli- Family
Residential, Heating & AC
Residential, H&aling Only
Residential, Gas Fireplace
Residential, Additions & Alterations
Residential, AC Onty
Multi-Famiy ,
Pubflc other
1% of lob cost ($39.50 minimum)
$99.50
$64.50
$39.50
$39.50
$39.50
Remember 10 add lhe State Surcharge on the botlom of this application.
The price of your heating permit includes one rough.in and one final inspection.
Additional inspections will be ~lIIed at $35.00 each.
House Heating Test Recon:l must be submitted wilh .,. ~\I"infl Mnnil numbBr before build-
ing certilk:ale of occupancy' will be Issued.
HEAT ~"I r.1 U A"lnr-,l~ RF.:OIIlRFf1 with number of supply and reun opltnings fisted per
room with CFM's per openIng. New structures or additions send Gaor plan with supply
and return locations shown. HEAT LOSS CALCULATIONS. PAYMENT AND
APPUCATIONS MAY BE MAILED TO THE CITY OF PRIOR LAKE, 16200 EAGLE
CREEK AVE. S.E. PRIOR LAKE, MN 56372.
cny ~I business hours are 8 Lm. - 4:30 p.m.
All. WORK MUST BE INSPECTED (ROUGH-IN AND FINAL) . CALL CITY HALL
447-4210
I hereby apply for a mechanical systems permit and I acknowledge that the
informatIon above Is compfete and accurate; that the work wil! be in conformance
whh the ordinances and codes of the cllyand with the Itale building/mechanical
codes; that this 'orm does not become 8 permit until signed by the BUILDING
: OFFICIAL; that the work will be In accordance with the approved plan In the
"Vf\1l work wNch ]~rOVOI.f ~.:~.~ _ C1 ~
. . ~II~ Slgnl1u~., N' ". Date
.. '. v' ,..~ ~ 4-/l(/) /qq
ng Oflical's SlgnatuN. , _ Date '
. -
- -- -- - --- --- ....- -. ---!-:.... -.......~ .--
31/99 WED 08:35 FAX 6128621223
ua/Jl/99 WED 09:2~ F.~ 61244;4245
JD EXCAVATING, INC.
CITY OF PRIOR LAKE
~.OOl
@oOl
-- - I'IU!
"El.UIIW . ~ca.r
GDLIl . aY'f
CITY OF PRIOR ~
SEWER AND WATER PERMIT
s.~.No.~
NOTE::
SOwer and Water
contract.ors !In~st
be reqist:ered
wi1:h the city.
x APPLlcANT~ ::r~ E..K CIi"" I"t7//VC7_' I Ai C . "':PHONE: ~~,.. ~43~ <..
;JI.. ADDRESS: 11-4 2. - I ~2. N D r+VE. C06N e.API D -S DATE: ~ - "5 i - 99
'" SIGNATURE: tJ): ':-_ - _ ~W ~ 8~. PERMIT ,CfI-(31
X SITE ADDR.ESS: l~\Q '\J\C.,....Oe.\~ Cue\~e ~~IDitl~~-3U-{)O(~
FILL IN THE 8LANKS
1. Estimated length of uatar service
feet..
2. Si~e of wa~er service
_inch (QsJ .
3. Location of any couplinqs from structure
feet.
4. Ty~e of sewer pipe. ABS
pvc X'
Cast Iron
5. Esti~a~ed length of sewer line
feet.
6. Clean out (if required), loca~ed at
structure.
feet
from
-~~~~~~==~z=~~_~ 42~~~~=~-~'--~~~-~~~~=~__~__~2___C==~~~
This a~~a~JnJtt~~ your permit ~h.n ap~ro~eQ.
BY ,~~I"I<::- DATil' 3~
~===~====2=~~~==~==~~-~=~-==~~====~~~___~~_~___~~~~~=====2~_~
FEES:
S
$
$
35.00
.50
35.50
Sewer and wat~r line connection pe~it.
Surcharge
TOTAL
*
Fee for either sewer or water individually is 520.00 plus
$ .50 SUrcharge.
* Sewer and wat&r permi~s issued for hQW construction must be
recorded on the building permit card a~ the time of iS$uance
to insure that no duplicate seVer ~nd wa~e4 permits are
issued_
DATE PAID
C PAID WITH
1 eUILOIMG PEI-i;'1IT
RECEIPT #.
REC'D BY
AMOUNT PAID
(v\lW
o
16200 Eilgle Creek Av. S_E.. Prior Lake, Minnesota 55372/ Ph. (612) 447-4230 I FAX (612) 447-4245
An Equall)",mrt.unily Employer
PRIOR LAKE
INSPECTION RECORD
DEPARTMENT OF
BUILDING AND INSPECTION
SITE ADDRESS ~ V l c.t (It \ 0.... Qut\NL.
NATURE OF WORK N€lJ-' ~~twch'crv\
USE OF BUILDING ~\-D
PERMIT NO. qg - () /3/ DATE ISSUED "3 -{- i~
CONTRACTOR - C -J- M \-\.d1M..D ,\?or\.d.cz.t-';
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DO~;NT DATE
FOOTING I 'Il7 I .~ --'LS -q 0
FOUNDATIO~ (Priorlo Backfill) I W \ J 11., 1-- qq I
PLACE NO CONCRETE UNTk. ABO'VE HAS BEEN SIGNED
ROUGH - INS
SEWER I WATER I SEPTIC rJ ~ 1./ '2- Q'1
FRAMING \;
--:r, ~~
INSULATION
ELECTR,CAL
PLUMBING
HEATING (if required)
FIREPLACE
GAS LINE AIR TEST W"jtJ /q g f< H\ ~.- '-J- ~~~~
COVER NO WORK l.JNTIL ABOVE HAS BEEN SIGNED
J I I
FINALS
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GRADING (Prior to Sodding)
BUILDING
ELECTRICAL
PLUMBING
HEATING
DO NOT
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0!),)z\}fj~ .
.- ,
OCCUPV\.;UNTIL ABOVE
NOTICE
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LQ'" 1.AiC1
to /to-LV1
HAS 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 addit'jons
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 (612) 447-9850