HomeMy WebLinkAboutBuilding Permit 99-0144
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-';-:. CITY OF PRIOR LAKE!~I',:-i
h, Ilepartment of ~uilbinll In'pettion ~~j
~ ..,:t. 0 Final Permitted 0 Conditional C.O. Expires fl:....'
a ~ ,~
L This Certificate issued pursuant to the requirements of Section 307 of the Uniform Building Code !S;I::'~
certifying that at the time of issuance this structure was in compliance with the various ordinances of the 1:--. :X.', ~
City of Prior Lake regulating building construction or use. For the following: ;l~ I
',".
Use Classification SINGLE FAMILY
Bldg. Permit No 99-0144
Occupancy Type
R3
Type Construction
VN
Fire Zone
N/A
Zoning District
Rl
Legal Description _T 1 _ 'R? fJ-{ "..ds.t-".... A,dA -{ t-; n-n
Owner of Building
Site Address 17217 Mushtown Road
Contractor's Name & Addresilensmann HOl!!es Eagan Mn.
~, City Planner
Robert D. Hutchins
Building Official'
)(3/),'10,
Jenni Tovar
Date:
Date:
POST IN A CONSPICUOUS PLACE
CITY OF PRIOR LAKE
INSPECTION NOTICE
DATE TIME
SCHEDULED 8 ... 3~" 77 A. T.
fV1 t.e NnwtJ tf~ ,
ADDRESS /?~/?
. ,
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION r?:J\
~ FINAL I \f::;)
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
9 9 -I</~
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
COMMENTS: ~l? r r ilc~ A-t..E-
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~~.
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( ~ 1)~+~, )
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11..11111111 _
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~K SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WOR~ C;LL FOR REINSPECTION BEFORE COVERING
Inspector: U Owner/Contr:
VI
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
INSNOTl
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
"
.
CITY OF PRIOR LAKE
INSPECTION NOTICE
DATE
TIME
, / ,~i '....<;GJqC' ,
~
.iJ: D..."lt1~
SCHEDULED
ADDRESS /7217 J4tvSdt;!);.;.)J ;<[)
OWNER CONTR. i& )p;.j~; t"1..I4AJ~' t!-9..-<-tt.$...
PHONE NO. PERMIT NO. 9~ - / t/-Y-
,
o FOOTING
o FRAMING
o INSULATION
~FINAL
o FOUNDATION
o DEMOLITION
o FIRE PREV.
o PLUMBING RI
o MECHANICAL
o WATER HOOKUP
o SEWER HOOKUP
o SEPTIC INSTALL
o PLUMBING FINAL
o SITE INSPECTION
'~XC/GRAD/FILLlNG
"0 lkSHORElWETLAND
o COMPLAINT
o SEPTIC FINAL
o FIREPLACE
o
COMMENTS:
6'~ ,1-i\.e:
1.$ I1c ('t::"P~3I.,J::
{J)l<,G;3qx:
12
o PtE..a.ATiO-^. J~ L
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b,'S., '771 (5 L-I <:;r/ ir/\
o WORK SATISFACTORY, PROCEED
)( CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: l1J~ ~..:
'"1wner/Contr:
CALL 447-4230 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE..
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
T
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
4- J. '-'7]
AT
ADDRESS ) 'T;).l t( Mu<;l. ~o:> I.A... tf2.c..t
PHONE NO.
CONTR.
PERMIT NO. 9~ - f C/ </
OWNER
o FOOTING
o FRAMING
o INSULATION
o FINAL
o FOUNDATION
o DEMOLITION
o FIRE PREVo
o PLUMBING RI
o MECHANICAL
~ATER HOOKUP
r J\OEWER HOOKUP
o SEPTIC INSTALL
o PLUMBING FINAL
o SITE INSPECTION
o EXC/GRAD/FILLlNG
o LKSHORElWETLAND
o COMPLAINT
o SEPTIC FINAL
o FIREPLACE
o
\;12 W~
~
3
40 \? II c...
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~
o W,9RK SA TORY, PROCEED
~ORRE T ACTIO ROCEED
o CORR CTr C LL FO EINSPECTION BEFORE COVERING
InspectO\: \,' Owner/Contr:
CAL~ 447-4230 F OR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE ~EN," ARE FOR yOUR PERSONAL HEALTH & SAFETY!
T
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
t."f;'j,
~
TIME
,: ~
ADDRESS t 7 Z I,
IYlvS'~~
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FRAMING
o INSULATION
o FINAL
o FOUNDATION
o DEMOLITION
o FIRE PREVo
~ PLUMBING RI
o MECHANICAL
o WATER HOOKUP
o SEWER HOOKUP
o SEPTIC INSTALL e
~UMBING FINAL
o SITE INSPECTION Pr
COMMENTS:
,
pL"
0- fL.
(
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i WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL F.O~ !_SPECTION BEFORE COVERING
Inspector: (2 \ Owner/Contr:
Cfq.1#
o EXCIGRADIFILLlNG
o LKSHOREIWETLAND
o COMPLAINT
o SEPTIC FINAL
o FIREPLACE
o
CALL 447-4230 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
T
CITY OF PRIOR LAKE
INSPECTION NOTICE
. .
DATE
TIME
ADDRESS
/72-/7
SCHEDULED (P/z~tf7 /: /~
Muslliwl1 Rt(
OWNER
CONTR.
PHONE NO.
PERMIT NO.
,4 g;i~~~~,~:~ PN'--'
o WATER HOOKUP
o SEWER HOOKUP
o SEPTIC INSTALL
o PLUMBING FINAL
o SITE INSPECTION
q Cf- I tiC/-
o FOOTING
o FRAMING
o INSULATION ..nA
~FINAL ~Pl!j. 1'''.
o FOUNDATION
o DEMOLITION
o FIRE PREVo
o EXC/GRAD/FILLING
o LKSHORE~ETLAND
o COMPLAINT
o SEPTIC FINAL
o FIREPLACE
o
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/
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~~SA/ A~~ OCE~
o ORRECT ACTIO NO EE
ORREC WORK, C FO NS~ORE
Inspector: Owner/Contr:
CALl 447-4230 FO~ THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE~TS ARE FOR YOUR PERSONAL HEALTH" SAFEm
T
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
DATE RECEIVED
1. White
2. Pink
3, Yellow
File
City
Applicant
MAR 4 I-Y\
1~:1J
Permit No. qq - ((l V
,
DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
2, SITE ADDRESS
1. DATE
1 ~:..:J \ [~"\
((\
BUILDING INFORMATION
11, SIZE OF STRUCTURE
(Height) (Vti.!ft~ '
~()' '\\~.
12. NO. OF STORIES
\
(~~,
Qt~c.....<,~
\'"'"\~'\
""'- ~ .,,,:.:'-- '- ....'-" ---
3. LEGAL DESCRIPTION
LOT \ BLOCK ~
ADDITION ~"", "'_~~ ~"'-..c- A-riclif\-
4. OWNER (Name)
\,..:) '-.............~""____'-"'- '''''u ___ "- """
5. ARCHITECT (Name)
~ v.... ~ \--::.
6, BUILDER (Name)
LPID dS- ~~lo- b\\.-O
13. TYPE OF CONSTRUCTION
~<:>~->c~ ~~"""'--e....
14. FLOOR AREA APPORTIONMENT USE
"'1. \ \. "-\
(Address)
Q.c....."", Co.........
(Address)
(Tel. No.)
~\ - ~~\.Q- '" ~OO
(Tel, No,)
(Tel. No.)
15. NUMBER OF OCCUPANTS OR SEATS
(Address)
OCCUPANTS
s. '^" ~ G.
7, TYPE OF WORK
New Construction ~
Chimney 0 Misc.
SEATS
Fireplace ~
Alterations 0
Re-roofing 0 Porch 0
Re-siding 0 Finish Basement)f
Septic LI
Addition 0
Deck LI
16. PROJECT COSTNALUE
~~ "--'-~ (.) 00
\.
8. PROPERTY AREA OR ACRES 9. PjtOPERTY DIMENSIONS 10, CULVERT SIZE 'l1t COMPLETION DATE
Sq.ft.,~ ~~t)~~ Width ~IG Depth .\~O Yes No 'f:\~'-"'.... \./30
I hereby certify !haM 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 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 rev~e this permit for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X \.J ",-c--- ~\........-..'"" ~ ,~~ ~ ~J \ 1a.....fJ4..,
Signature License No, Date
Finish Attic 0
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
MATERIAL FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA 0
PILING LOGS LI PERCOLATION TESTS LI
Side
Side
Front
Back
BUILDING DEPARTMENT VALUATION
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PLANS & SPECS 0
SURVEY 0
SETS
COPIES
USE OF BUILDING .. 51=-[:)
2 ~(')I'.)l:) . an
PLOT PLAN
o
PERMIT VALUATION
/1
TYPE OF CONSTRUCTION: I II III IV ~
OccupancyGroup A B E F HIM R S U
Division 1 2 j3 4
Permit Fee ................................... $
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
.. $
Pressure Reducer ...!...................... $
City:
A€l9. a.L
I. (') 56 . on
,
I , 5~'1. ~S-
, , (') 3l. ')'2...-
1 '20 . 00
Plan Check Fee ............................. $
State Surcharge............................. $
,~
~r
'l.C\j
'1 () . {1 ('J
Penalty ....................................... $
Plumbing Permit Fee .P.{?~.c:l~.:l~q. $ I 00. 06
Mechanical Perm~ Fee~f:':~::d~.. $ I On. 06
Sewer & Water Permit ~.f.::n~L~~.. $ 35. ~D
It .Ml~.~~~L.J~~ $ 4 (). 00
acome Your Building permit)l{~ r-:-r:e;Vil!l.
Date ~ -;
Certificate of Oc~p:lcv .
Meter Hom ................................... $
\ ,.
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
Water Tap ................................... $
Builder's Deposit ............................ $
? ~ .l'2.Q.
'I "200 . rJ 11
ry tJ () . ("Y7
\ L So D . W
:'~iiD::;:;:;:::::~:;~~o: g$f1~ 41
Date 3-z)-f. 9 By OKI Y
This ~ that the req in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requ~ed. This document when
sign? uy 1.!(!!:!:!;J!Jn:r nstitutes a temporary Cer:!flrJl,i!! compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be Issued.
l/ ~ City Plinner D te Special Conditions ff any
Issued
24 hour notice for all inspections 447-9850
qq-((j{!
The- ('rnltr of thr Lakt Counlry
White - Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT _11 Jet/t<:;/1/l(jUIYl ~LS
APPLICATION RECEIVED 3 - 3 -99
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
/7;;217 /J~u.shlouJj/1 Ifd.
Accepted
Accepted With Corrections ~
Denied r ')
Reviewed By: ( ~ 'J) f..t-I ~ -
Comments:
Date: J . 11-77
I. M. a._V\. \.c-. \ IA
"~/'nv\. CMt~{ 9 G?otert +t..c.. W <2.t \ ~c-l t"C1lAA 5:: I ~ e Ie .
{~~ ~ &eu~J rp(~_
t...~~ ~c.... ~J aU+S .
"2, So cR c-....J...
s- ~J2 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."
,-:,''<\' 'r:';:~~~'Y''''T;.::f:-;"''''''''";':~,;T ~,:'(.~
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Tht Ctnltr or Iht L.kt Counlry
White - Building
Canary - Engineering
Pink - Planning
,BUILDING peRMIT APPLICATION DEPARTME;NT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
;.
i
.'
I
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
,.
i
Reviewed By:
~ ,
(] /J{~
V
Acceoted With Corrections
Accepted
Denied
Date:
~/J7/71
,
- ,
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."
01/19/99 TUE 14:21 FAX 612 447 5263
CITY OF PRIOR LAKE
~002
WETLAND CONSERVATION ACT
CERTIFICATE OF EXEMPTION OR COMPLIANCE OR NO LOSS*
1
City of Prior Lake
16200 Eagle Creek Ave
Prior Lake, MN 55372
t& ~~,,~ '\ :S~ ~OW~
(Name, address, and phone of applicant)
I " 1..' f) 1'1\ ~\-\ \C)v.) rJ AD 1\ P
Wetland fill for house oad to meet 30' setback
(Description of projectlName of development)
T114N. R22W. S11. NE% Lot 1. Block 2 Windstar Prior Lake. Scott Countv
(Location of work: Township, Range, Section, Qtr. Section, Lot, Block, Subdivision, City, County)
(For seasonaVannual exemption attach proposed generallocatlon Information, I.e. maps, aerial photos)
The wetland activity at the above site is exempted from or in compliance with the Wetland Conservation Act
0NCA) for the following reason: [Please Circle (A)(@)<C), (0), OR (E)]
This exemption certification expires Jan. 15. 2000
(Date)
(A) A Wetland Does Not Exist; OR
(B)
Exemption '#
9
(per MN Rule Chapter 8420)
Description of Exemption, fill area and type of wetland:
De minimis - Proiect will fill less than 400 sa. ft. of wetland,
;OR
(e) Wetland Loss Has Been Avoided; OR
(D) Wetland Has Been Replaced As Per Approved Plan (attached); OR
(E) No Loss Determination (attach plans).
,. THIS CERTIFICATION ONLY APPUES TO THE WCA OF 1991. Permits from local, state, and federal agencies may
be required, Check with the appropriate authorities before commencing 'work in or near wetlands, The Combined Project
Notification form can be used for thIs purpose.
FOR ALL EXEMPTIONS: A landowner draining or filling a wetland under an exemption shall ensure that; appropriate erosion
control measures are taken to prevent sedimentation of the water, the drain or fill does not block fish passage, and the drain or file
is conducted In compliance with all other applicable federal, state and local requirements, including best management practices
and water resource protection requirements established under Minnesota Statutes, Chapter 103H.
A:exmpcertJor
(BWSRlJJ 10117/93)
qr;./t/I(
n.. ('.n..r of .b. Lak. Con..ry
White - Building .
Canary - Engineering
Pink - Planning
BUI,",OING PERMIT APPLICATION DEfARTME,NT CHECKLIST
. I
NAME OF APPLICANT /.!.I( II <j I 111111 J flf'/ lit'S
APPLICATION RECEIVED 3 ' ::5'. 79
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
1'/2/7 I J lt15/71DuJ11 lie!.
Accepted
./
Accepted With Corrections
Denied
Reviewed By: WAI.:d.R EHu~... ~NN
Date: .3/" /99
, I
Comments: -rIlE.. AUtEPrANc.E
oF
'1i!,,,>
~A.'" I r- ~ ~AJl) I ~ t!MJ
"f"ttE C.GMPLErulIAI
QF"1JI~ WETUltNO CoNsej(,lJATION AcT- aeA.nF,CATE:..
OF U&1Pi10N .
A 'i€~INb€A... iH~T ~cANat.I'TS AR~ REd1.Uln.~ Ar
ItJlll ~"'A(..'" 'N(.LU[).N(.. -r;,t::. R.s.E.Il. aN SfLoJ/'TAIf,.Y SEcJJEIC. SE=1f.\JIcES.
SEe: 'NFottMATIO.J ~ ,?c:'~E ~u:.
~E- A-rrAOI-'tE'~: '- -h""""..:_ o.ltAA'Nl-. J"}sP~c.r,OIU IAJJ:Qb>tiIfT..gJ Z. Gf4.D'I\J~
?c..A ,J
3. E'ltq$ lOA! ~AJnuL.. MEAso,)lt.~S' 1:. E'ItDSHA! e.Alr~'- PI-t4tV
5. Vj(t\JEv..sAY t dJltl.laA.lLE::
. I.... "3>..u-"tt
~ -l---""lW-'~ tlRJU.
"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."
< '
, ,
, BmLDING PERMIT APPLICATION DEPARTMENTLI1~CKLIST (CON'])' .
, >>
, "
. ,ENGINEERING COMMENTS
l'
. .. , .
Surfacestonnwater cIrainageflowingto the perimeter of this lot to andfiv~ adjoining properties, '
must, be conveyed to the ioad~y andlorto the rear of the lot in drainage swales within the
draiIias!e easements. All' bare soil ,areas' must be 'protected from eroding into neighboring,
properties througb.t:he IDstanation 'of DTonerlv installed silt fence or bales. . The silt fence required.
by theerosioncontr91 plan inust be installed prior ,to anyeiuthwork being started. "The rock ,
'. construction entrance must be installed at the time ofbackfilliDgof the foundation.'
. , . , . . .
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, BOSlON.DOC
CITY OF PRIOR LAKE MC
16200 Eagle Creek Av. S.E. Pormil No. Cfq- /L/LI
Prior Lake, MN 55372
HEATING APPLICATION I PERMIT
Dale Y/,;). R Iqq PID, 2.S - 33' - () /1- 0
Site Address. / '7c:l/7 /Y) ./..J..:J.A tffuJh <7? fi t< /
Lol I Block 2. Addition. IV/NOS7'J1Je.. ~OON.
/.( )~~ ~
Owner's Name
Address
lIealing Conlraclor
Address
Allied R_ide
dJa t-lreSiCle Comer
Ucense #20090911
~7'OO'"N. ~alMew Ave.
Roseville, MN 55113
,#'If '"' ~~. ~.. 1
"'...."
Telephone /I
Furnace Maktl Model H~ AJ G w
r p,-~r "'f!..C- 01-
Model Size ~ 7rL
Conn. Load
Fuel
Supply Openings
Relurn Openings
Inpul
Edr.
elm,
Alterations
Repair
Esl. Cost $
Flue Size
40,!b.)
Output ~ J'"U)
TYPE OF SYSTEM
Warm Air Planls
Gravity,
Mochanical
Air Conditioning
Venl. Syslem c
HEATING OR POWER PLANT
Sleam
Hal Waler
Radiation
Special Devices
Othor Devices
Replacemenl
TYPE OF WORK
New Construclion Vie
~~~.'D
Esl. Comp. Dalo
5'1.;J./QQ
( I
Building Perm~" , 99 - / W
HEATING PERMIT FEE $
51 A TE SURCHARGE $
TOTAL PERMIT FEES $
.50
PAID WITH ~
BUILDING PERMIT
Receiplll ,
APR-,
TYPE OF STRUCTURE
I. rink
1. Cirf'rrt
), Yellow _
l>
file '0
Cil, "1
Cnnluc 1Uf' I
N
to
I
\0
,\0
o
'0'1
..
~
to
)>
'TI
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"1
ID
III
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Q.
ID
n
o
"1
~
ID
"1
t-
Single Family
Two.family
Industrial
Commerci<ll
Fee Schedule
IndUSlriaf, Commercial & Mulli-Family
nesidenlial, Healing & AC
Residential, Healing Only
Residenlial. Gas Fireplace
Residenlial, Additions & Alleralions
Residenlial, AC Only
Public
Multi. Family
Olher
1 % 01 job cosl ($39.50 minimum)
$99.50
$64.50
$39,50
$39.50
$39.50
Remember 10 add Ihe Slale Surcharge on the bolloOl ollhi$ applicalion.
The price of your healing permit includes one rough-in and one linal inspeclion.
Additional inspcclions will be billed at $35.00 each.
House Heating Test Rccord musl be submilled with buildillQ np.rlllil nllmhnr belore build.
ing certilicale 01 occupancy will be issued.
HEAT CALCULATlO/'iS REQUIRED wilh number 01 supply and relurn openings lisled pe
room wilh CFM's per opening. New structures or addilions send /Ioor plnn willi supply
and relurn localions shown. HEAT LOSS CALCULATIONS, PAYMENT AND
APPLICATIONS MAY BE MAILED TO THE CITY OF PRIOR LAKE, 16200 EAGLE
Cn:EK AVE. S.E. PRIOR LAKE, MN 55372.
Cily Hall business hours are 8 a.m. - 4:30 p.m.
0'1
....
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ALL WORK MUST BE INSPECTED (ROUGH-IN Arm FINAl) . CAll CITY HAll
447-4230
I hereby apply lor a mechanical syslems permil and I acknowledge Ihat Ihe
inlormalion abo\'e is com pie Ie and accurale; Ihat Ihe work will be in conformance
wilh lhe ordinances and codes ollhe cily and wilh Ihe slale building/mechanical
codes; Ihat Ihis lorm does nol become a permil until signed by lhe BUilDING
OFFICIAL; Ihal Ihe work will be in accordance wilh lhe approved plan in lhe
case 01 all work which requires review and approval 01 plans.
,If&*
. ,~, Buitdirrg-Olfil<:.l'" ;<;;;,.. . '..n
I//d.JI/rr;
. , Dale
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Dale
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....
CITY OF PRIOR LAKE ,1, I
16100 E-cl1e CreekAv. S.E. Permit No. qq -I Lf'1'
Prhu Lak., MN 55372
rvPE OF STRUCTURE
~Wo-Famitv
I. Pi..
2.Gn:
l. Ydl..
...... , I ~ ... . .
If)
"-
~)Ile
IL
Site Addllss ,
l2.o1 I
If)
2)wnlts Name,
Addless
Conn. Load L
Fuel t0a:J ~~Iue Slzl 8'
J4
Relum Openlnga lo
fpul~rrtDulpu' ~o_ rro
~d,.,
I
N
Z'm.
w
l!l
SupplV Openings
TYPE OF WORK
fi:llerallons
(\J
~ spalr
(\J
Es1. Co51 $
en
~EAnNG PERMIT FEE .
.-i
Repra~m.nt
Est Comp. Oats _
Building P41,mit.
qq, g:)
TYPE OFSYSlEM
Wum AIr Plant.
Glavny
Mechank:al ~
AIr CandllJonlng .;;>1/ ~ -+Or\.
Venl. Svstem .
HEAlING OR POWER PLANT
steam
Hal Water .
RadiaUon
SpKfaJ Devices
Other Devas
NllW Construction
~
qq-l44-
~ PAID WITH------
BUILDING PERMIT
~TA1E SURCHARGE $ .50
~O~Al PERMIT FEES $ I f:X:) .00 Receipt'
a:
1'1&
OJ
Single Famlly
Commercial
Multi-Family
I ndus'rlaf
Public
Other
Fe& Schedufe
Induslrial, Commercial & Multi-Family
AeaidenliaJr H&atlng & AC
ResidenliaJ, Heating Only.
Residenllat, Gas Fireplace
Residential, Adltilions & Altelllliolls
Residential, AC Only
1% of lob co81 ($39.50 minimum)
$99.50
164.60
$39.60
$39.50
$39.50
Remember to add !he Slate Suacharge on the bottom ot thls application.
The. pricl 01 your heating permit Includes one rough-In and one flllallnspectlon.
Addiflonallnspeclions wiD be billed 81 $35.00 each.
Hoose Healing Tes' Record must be submitted wilh IlWkIDg PUDil on~~,,",,"A'" before build-
ing certificate 01 occupancy wlll be Juued.
UF~T r..... r:... ATlnM~ >AFOIIIIlFI} wbh numbet of eupplv and .eturn openings listed I18r
loom with CFM's per openfng. New struclures or adciIfons send t1oorpl8n wbh supply
end relum location. &hawn. HEAT LOSS CAlCULAnONS~ PAYMENT AND
APPUCATlONS MAY BE. MAILED TO THE CITY OF PRIOR LAKE, 16200 EAGLE
CREEK AVE. S.E PRIOR lAKE, MN 55372.
City HaD busineu hours aTe B a,m. - 4:30 p.m.
ALL WORK MUST BE INSPECTED (ROUGH-IN AND FlNAL)- CALL CITY HALL
447-4230
, I hereby apply 10' a mechanical &Vatems permit and' acknowledge thai the
informati~R above Is complete and acculate; that the work will be In conformance
wllh the ordinances and code. of the city and wllh the stale buildlng/mechslllcal
codss; thai Ihls form doss nol become a permit until .Igned by the BUILDING
OFFICIAL; lhat the work wlU be In accordance with the approved plan tn tha
case of all work Wh~~a review and :pproval 0' plana.
~_. ~ Jlllqjqq
b? Ajpl~ Sig - Dale
~ ~hf2fitq
- BuEfding Otties"s Si . Ddta .
APR. 19. 1999 2:12PM
GENZ-RYAN
NO. 565
P.2/5
--. ....
YnLOW . a"'-leAIIT
GOLD . ar"
CITY OF PRIOR LA!CE NO.~
SEWER AND WATER PERMIT
NOTE: Sewe~ and Water
contractors must
be re'i1isterec!
with the city.
APPLICANT: ~... ~
ADDRESS: IY1YS .:;.. ~ ~ b~+ J.-'
SIGNATUREr {Jt..IJ7\,..n ~
SITE ADORE;; Il'aJI lI\..u.5hfuwn Rd
PHONE; 49.~- 1\44
DATE: 4~
BLDG. PERMIT '#
PIO# z...e:; - 33G, - 011- 0
1.
FILL IN THE BLANKS
I I ;;"'\ I'
Estimated length of water service ~~
feet.
2. Size of water service
J '4
inch{es) .
J. Location of any couplings from s~ructure
4. Type of sewer pipe. ~BS PVC ><.:) Cast Iron
5. Estimated len9th of sewer line w..o" feet..
6. Clean out (if required), located at
structure.
feet.
feet
from
=~~=========-==~-======~~~~==============~~===~=========--==~~~=~~
This apPlicat~'O mes your permit ~hen approved.
B~ D~TE: ~q~
I
===___;=3_~_= -==--=;~=========~~-~-=~~~~=~=======~__~~m~~~=======
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, --
* Se~er and water permits issued for new construction must be
recorded on the buildinq permit ~ard at the time of issuance
to insure that no ~u~licate sewer and water permits are
issued . ~ PAID WITH
BUILDING PERMIT
DATE PAID ' AMOUNT PAID
RECEIPT #
REC'D BY
. 4629 Dakota St. S.E.. Prior Lake. Minnesota 55372 I Ph. (612) 4474230 I F~x (612) 4474245
....'1 EQl."AL. OF'POIm..'NrrY E.'1f'lOVEfl
RPR. 19. 1999 2:12PM
GENZ-RYRN
NO. 565
P.1/5
CITY OF PRIOR LAKE
PLUMBING PERMIT
Applicant: ~- ~
Address: 141Y.~-- S, Kn~
Signature: ~t._~ ~ " , ~
Legal Oescription: Lot I Block ~ ~Sqb ~ ~*"~ C).A
Site Address; \ 'I r;t l. ~.ol.Ur"\ ReI.
Building Permit # qq - [44- PIO #j2.5 - 33" - 0 II - 0
NOTE: This permit "'!ill not be precessed without complete information,
FIXTURE UNITS
I. l\we FIle
2. GDId ar.y
3. Yellow App\ic:lDl
# qq- t#
Phone; 4";t~-\ l \.1 L.\
~
Th. eO"II" qt ... L.~. CoulIl"
This p4rmil is gr.u'1tlld upon the elpress condition th::lt s:aid
C:Ontrllttar. shall comply in all respects with the ordinances
of the St:lle Plumbing CDcll:! :lnd the AmAdm~ereof.
E;NO. -4: 2.~ DATE
ATI'EST
Call for nIl in pections 24 hours in lldV:lJ1ce.
PAID WITH
l BUILDING PERMIT_
16200 E3g1e CreekAv. S.E.. Prior L::ake, Minn.esocOl 55372/ Ph. (612) 447-4230/ F.-\.X (612) 4-47-4.2~5
An Equal OpflOrtunity Employer
PRIOR LAKE
INSPECTION RECORD
DEPARTMENT OF
BUILDING AND INSPECTION L
SITE ADDRESS 112fJ M\.\~~\nu..)\A R~~
NATURE OF WORK ~u.' ~c:.hvclttM
USE OF BUILDING S'F~
PERMIT NO. '1i -/l{<4 DATE ISSUED 3- \t-<i9
CONTRACTOR -1 )eAc]'~4..D\.\I\. ~Q~
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCU NT
FOUNDATION (Prior to Backfill) 4- - 91 ~~~ 3,s. _ ,-t~-"
PLACE NO CONCRETE UNTILUABOVE HAS BEEN SIGNED
RO~GH - INS
SEWER I WATER I SEPTIC ! U . 4-2. ...q,\
FRAMING WI ~ v (YO ~.~.~'
INSULATION :J.s rrjlH. ~.tl~'"
ELECTRICAL I
PLUMBING :T~. q $". Y ~ ~-'3S i.J-3o~
, HEATING (if required) J'"5. ~.". 111-30-" ~/Cf.OJ" -
FIREPLACE . I~~ I ~- 5"- 'tt .>"'I'U8
GAS LINE AIR TEST 15 U' -. 14~~'""
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
, ..----- if -F I I
FINALS
vJL
. fwR C,[),- ~'~.'1
FOOTING
GRADING (Prior to Sodding) ~)
BUILDING \CD ~~~-H~I 3> k""L~-~1
ELECTRICAL
PLUMBING
HEATING
DO NOT OCCUpy
DATE
I 3"~-19
5 ~ 5 - '1 cr 5'- J'_ct~
S-rtjJ $'~JY-S~ s= l'..q~
(, - 1/1 ~9?
M,
I I
tr-I!.JJ. ~ /~ !'{f.
~~ ) l.D -1i~ -11
UNTIL ABOVE ~S 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.
Call between 8:00 and 9:00 A.M. for all inspections
FOR ALL INSPECTIONS (612) 447-9850
. J
~
Job Address /l;t./7 /l1 (/ j ),10<./ /If
Heating Contracto~t"~;- / W
r
If.
Name of Tester
Percent C02
-17'~
"7
()
CZ
, 3kiJD
Date
..
Percent O2
Percent CO
Stack Temp.
Combustion air is adequately supplied per
UMC Sec. 606
Input
/