HomeMy WebLinkAboutBuilding Permit 99-0179
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ADDRESS
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BLIND
DATE TIME
7~5m ZJ~312
/ /
L/C- ~
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
OWNER
CONTR.
PHONE NO.
PERMIT NO.
q1-/79
~?6
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't1wlIllfoeIS.
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O:llueOJlId. QL g
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lS313:lNVt'4l:l0;jIBd'
C:o IUIIOJlId.
C:0:lIUIIOJ9d.
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
,4 0 PLUMBING FINAL
X MECH FINAL
COMMENTS: L . B. 7 - 3 - Q
Ct-) ~()f ~.f ~~s C--rJl
fZeeu\J'tcJ (JVblA5t k+--
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
o EX/GRAD/FILLING
IV 0 COMPLAINT
rr }t( FIREPLACE-ftt- A. .1,
/0 FIREPLACE FINAL
o GASLlNE AIR TST
o
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Ok-
NSPECTION BEFORE COVERING
Inspector: Owner/Contr:
CALL 447~850 FOR ~ E NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQ~S ARE FOR YOUR PERSONAL HEALTH & SAFETYl
INSNOTl
CITY OF PRIOR LAKE
INSPECTION NOTICE
DATE TIME
ADDRESS / ~Ce, 9 J
SCHEDULED 8~31-~9 A, L
3L nJ./J (A/<..E T72 I
OWNER
CONTR.
PHONE NO.
PERMIT NO.
99 -/79
o EXlGRAD/FILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
//
~RK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT ~~K. CALL FOR REINSPECTION BEFORE COVERING
Inspector: ~I . Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE..
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTI
_._-~.._------_._._.._.
DATE TIME
CITY OF PRIOR LAKE 7i}j-'i 1
INSPECTION NOTICE SCHEDULED :1:00
I
ADDRESS ~q\ 5\~ L~~.
OWNER CONTR.
PHONE NO. PERMIT NO. C(q -/79
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION A ( ~
~ FINAL .'Vt-'f
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
OtrECH FINAL
COMMENTS: \~l(.J OGc:.n... Ol,""', ~ .Ja. D t"
(U ~ tx.\ ~'r~ ~
(iJ ~d oL& We; ~~ ~~~
_ ~ fw~ ~t' ~ i
fA DC'- <1)'" C-Av i
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li~_-~~'--'-~ ~-~
~ C{), +v 1-I-q~~)
~
o EXlGRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
o WORK SATISFACTORY, PROCEED
. ~RECT ACTI D PROCEED
~RRECT WO K, C FOR INSPECTION BEFORE COVERING
Inspector: Owner/Contr:
CALL 447-98~O F~ T\ EXT INSPECTION 24 HOURS IN ADVANCE..
CODE REQUIR~ ARE FOR YOUR PERSONAL HEALTH & SAFETYl
INSNOTl
-'~-'~"'-,._-,..~_._~
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.......
f PR\OR LAKE
erNe OCT\OM M01'\CE ....~~.
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ADDRESS -_::-----;;.--:: /. ~~G ~\ d
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~
25
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Ok-
Inspector:
. Owner/Contr:
CODE REQ
E NEXT INSPECTION 24 HOURS IN ADVANeE~
TS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTl
_.^'_.._;~,.._._'-,.-.,_.....'"."-_._--~~._...----"'_..-.-.-
~ME~M _ y +v
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CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
OWNER
PHONE NO.
o FOOTING
o FRAMING
o INSULATION
o FINAL
o FOUNDATION
o DEMOLITION
o FIRE PREV.
DATE TIME
SCHEDULED
~t,I/1''l
OL :.3l)
/ ~ 0 9 I BL/N 0 L.K:.. _ '7/<::..
CONTR.
PERMIT NO.
99-/79
/
o PLUMBING RI
o MECHANICAL
o WATER HOOKUP
o SEWER HOOKUP
^~EPTIC INSTALL
I'd PLUMBING FINAL
o SITE INSPECTION
o EXC/GRAD/FILLING
o LKSHORElWETLAND
o COMPLAINT
o SEPTIC FINAL
o FIREPLACE
o
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Inspector: I Owner/Contr:
CALL 44/-4230 FOR fHE NEXT INSPECTION 24 HOURS IN ADVANCE.,
CODE U"" ARE FOR YOUR PERSONAL HEALTH & SAFETY!
~"..,.
I
"T"-
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
Gl-fD/~ 2. :?L)
/V(Pq I eLlA/a Li::.. / /< .
SCHEDULED
ADDRESS
OWNER
CONTR.
PHONE NO.
PERMIT NO.
99 - /7 e?J
o FOOTING
o FRAMING
o INSULATION
o FINAL
o FOUNDATION
o DEMOLITION
o FIRE PREVo
o PLUMBING RI
~MECHANICAL
WATER HOOKUP
EWER HOOKUP
. 0 SEPTIC INSTALL
o PLUMBING FINAL
o SITE INSPECTION
o EXC/GRAD/FILLING
o LKSHOREIWETLAND
o COMPLAINT
o SEPTIC FINAL
o FIREPLACE
o
COMMENTS:
/~iL
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/:-:n I J~ ~
-~~~
~
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~~
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./
/
/
, WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WOR~AL~ ~R REINSPECTION BEFORE COVERING
Inspector: \ Owner/Contr:
, V
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
gfi SI'1
J.;fi M
ADDRESS /1." 8t-JJ.JJ) /..Ad 70-
OWNER CONTR. j!,LN1fY t1Js:rzlld.l~J
PHONE NO. PERMIT NO. h -/7l
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
~ EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
COMMENTS: ~
J<. CJK
;1~ 1..1 <!J~1ffjtfJ~lf~
t11~ .51(.."- n~
CltV7l t- 5.1 /)4m
X WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTlON BEFORE COVERING
Inspector:l1~ Own~r/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTl
c
PRIOR LAKE
INSPECTION RECORD
DEPARTMENT OF
BUILDING AND INSPECTION
SITE ADDRESS JkL, <i I ~,,~ LaJ~P Tr-.
NATURE OF WORK New Cr17AC;~tVcJfc::J"V1
USE OF BUILDING SFD
PERMIT NO. arer - \ ~,9 DATE ISSUED "3 -'24-97
CONTRACTOR ~r- WO)r O~ -* .
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPEfTIONS BELOW
THE PERMIT IS BY SEPARATE DO::t~o~NT DATE
I FOOTING I' I Y \J Ilf'-I" q, I
. '
I FOUNDATION (Prior to Backfill) I a I I L{-~-C(1 I
PLACE NO CONCRETE UNTIL Aal6vE HAS BEEN SIGNED
ROUGH - I~
Ii"} ~ ~
SEWER I WATER I SEPTIC v
FRAMING~ 1Z-1\1"(G~f21!iill r
INSULATION / I) ~ \
ELECTRIC~L )
PLUMBING /" .
HEATING1(if required) ~ i - 5-U)~ ,~ !ro. ry
FIREPLACE /J.t. f1) 1/1.r; 1'1 \l
GAS LINE AIR TEST ~:\. ~ (/ ~ 5-~-lfl
~,u... 'I.
~.t..~~
c;,u,. 11
c.,.1.-(, - 14
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
WALLBOARD I I
FINALS
W.E.
1'J ~t>. m <(,311J
GRADING (Prior to Sodding)
BUILDING -r C.O 70 1/4~ ,Y;
1
ELECTRICAL
PLUMBING
HEATING
DO NOT
R', I~ 17
~
MJ 7 lie t/rcr
I ff) 1/;sj['/ -
OCCUP6V UNTIL ABOVE
NOTICE
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 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
qc; -/79
Tho Conlor of tho Lob Counlry
White - Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
2b/LU'1LI &wslc ~
3-11-99
J
APPLICATION RECEIVED
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
/t,b71 &Lncl ket Trad
Accepted
Accepted With Corrections
--<'
"
Denied -- ')/J
Reviewed By: (,! ()~ k-
L1'. '- I
Date: 3-:2V-9 ~
Comments:
I~ So~ ('").. ~ +T1..QJL~ F elL uJq/)......1- g::t~ ~ 7
cQ... MQ.,'Vl~~,^- 2J..oS\C/vL W~
\
<. ~ oJ L Q:1tC~gIA~J ~_ ~
"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'~..AW~~~'.i~~_"jIM.I'i~.lif~,'i<:~'~A:\:ti~~i~~'\';f!~';;;';"t';;,;o1t'Y"'~"'!I'
',,",,'-" '~-" ',;, ,':.--'<f"'-', '" '0(,,"\' ",.
White . Bulldlhllt
Canary . Engineering
Pink . Planning
Th. C.nl.. or Ih. Lak. Counlry
NAME OF APPtlCANT
BUILDING PERMJT APPLICATION DEPARTMENT CHECKLIST
if I {( r? ( I I/c/I '",I. 'fIJ I Lf ..j../
/:.-.;..;j 9 ~
APPLICATION RECEIVED
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
/1e6 tj / i/I ilcl JCl et 7rt2l;(
Accepted
Accepted With Corrections.
v
"/;. Denied
Reviewed By:
~.
Date:
L,{- 2-~
Comments:
~'t8(~ '"""~ 10~ ~U#~ ~1-~'1,
"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."
..~ .---.T- .
t?~-/7Y
fl.
White - Building
Canary - Engineering
Pink - Planning
tf'
The Cenl.. of the Like Counlry
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT If 1(( r?(l (I(/I~/' ffjIL{~'
APPLICATION RECEIVED/" /1- 9'1
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
/~6t11 6((/leI j~b Y;'a_J
Accepted
./
Accepted With Corrections
Denied
Reviewed By: jJ!lJ=:r€tt. Ct-tRe:.s""ANI\J
Date: 4-/71'19
Comments: J'(vNoFf' ft1.J5-r 15E feiU~o,JUi '/0 (.}.v~
Al..t7N (" /)ltl4t JlJYlt".J::
&1> 1.l.D.!.:' TV WE ME'..vT"i. A.!.. MrJC.H 14<,. ~c A L , tiJl1!1fl CuJltJEIlS.
..JEll. e ,.., E (.J.J..AS Ell.. AiV () i) , A ^" E t:! L. '" s fA..
AR.E
Awl4ll.E: """,.,.. UlA/AJAGE'
J:>oe..s
NOI fO'-L.oW 'THE
R EMt. ~o Da. A-IN Au F- E,q ~ E: Mf:...n-.
5E.E:'
1I\Jl='"It.MAT1o^J OIoJ REJEIC.c;.E S-,bt=.
?;if..
~ L. ~..J A-.,,,ct..J AT" TH e.
-ro~
~f' "'f..-/E. .5L..o?E:'..
MI'f't"
~E R~Is.e:b A-~ McJo.( ,.c:::. .. ~ ';"r
-
10
Hfd>
L.A-TEIt.I A '-
DIlA,,,,AC. te:.
DAl'o1~Eb CoAlCIlETE +>AAlEI..~ I"W:S,
1>~
R€PAIR-€.~
B ." -riot E.
3 vU..o~Q...
5.ff. A-7TAtHME.v""-' /. F.:.J~If.AOE l~Ptc:nOIU~F.IfN4-L/oAJ z.. aAlfb"I.IoM ?L-~
3. ~I)SI()1U CCJIoJT~OL MfA.~vllE.s
1. Ca.OSIOJJ c'''AJ'TLoc... tt.41J
"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."
101^
APR-06-99 TUE 03:55 PM JERRY GLA~ER
612 452 4218
P.02
April 6, 1999
City of Prior Lake
City Hall
16200 Eagle Creak Avenue SE
Prior Lake, MN 55372
Dear City of Prior Lake:
This letter is in regard to the building permit we have under your review for 16691 Blind
Lake Trail, which is lot 5, block 1 of Wilderness Pond.
We understand the natural drainage of the lot does not flow along the drainage
easement and that it travels across the natural slope of the back yard. We
acknowledge this is the way the yard will drain and give the go ahead for Yorway
Construction, Inc. to commence building pending the approval of the permit.
Sincerely,
J~r.~ Z)~9'~
Jerome E. GlaserlDiane J. Glaser
DATE RECEIVED
MAR I 11999
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
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
/'- (p c; J /J l-~a L~~ ~~
J
3. LEGAL DESCRIPTION
LOT...5"'--- BLOCK
ADDITION Iv ~~ f) ~ ~ p ~ 55
(N~e)
~ IJ:Z AN .~
(Name) I I
/I-"\. oL , E' ,.. ..f
(Name)
4. OWNER
.~~ ,'r "t
5. AR<;<t!!TECT
rt<~b
6. BUILDER
\!dr1-...J ,4- '-of
7. TYPE OF WORK
New ConstructiQP1l"'r
Chimney CJ Misc.
C vj TI/--
Fireplace~
Alterations CJ
,~,~~_"i
(Address)
G- &1.("-
(Address)
(Address)
1t<1'-. f
Septic CJ
Addition CJ
Deck CJ
Finish Attic CJ
1. DATE
3-lf'~11
1Z+50
PID
'U3- ?~-/?OG-O
A~ ....--
,.,f"a -~J .. D~
c
cJ IV"
(Tel. No.)
t;.S- /-- Lf-Jftt ~ S- T J '-/
(Tel. No.)
<-j 'f () ." 4 lr. 0 '-
(Tel. No.)
8'if: ""1 ~~y
M. (p tJr-ll.jt> '1
Re-roofing CJ Porch CJ
Re-siding CJ Finish Basement CJ
8. PROPERTY AREA OR ACRES
Sq. Ft. ? II 00 () -L
9. PROPERTY DIMENSIONS
Width
Depth
1 O. CULVERT SIZE
Yes
No
1. White
2. Pink
3. Yellow
File
City
Applicant
Permit No.
qq -( it:[
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
12. NO. OF STORIES
13. TYPE OF CONSTRUCTION
14. FLOOR AREA APPORTIONMENT USE
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
SEATS
16. PROJECT COSTNALUE
17. COMPLETION DATE
I
I hereby certify 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 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
buildjpg oIIicial can revoke .tt:is permit for just cause. Fl.IIIhermore, I hereby agree that the city official or a design~e may enter upon the property to perform l:l.eeded inspections.
XL--" ~ ~ . .. . --;?~;) ) '''I 2: r F'1/'~ /r--<1 l'
~~ -- Signature _f~T - . - _. License No. Date
SETBACKS: Required
Actual
Front
BUILDING DEPARTMENT VALUATION
USE OF BUILDING 'j Yb
Back
FOR ADMINISTRATIVE USE
Side
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
Side
PERMIT VALUATION
IO~~. t')~
TYPE OF CONSTRUCTION: I II III IV ~
Occupancy Group A B E F HIM '-R' S U
. Division 1 ~ '\ 2 ""J"-
Permit Fee ................................... $ ~. <.. '")
91 '7 .1.{7
S-S. SO
Plan Check Fee ............................. $
State Surcharge ............................. $
Penalty ....................................... $
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
Sewer & Water Permit ...................... $
It)O. c>O
J Od . 06'
3s . S-O
~D. 01'
City:
~~
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
\ $
Pressure Reducer ..?/~.~.................. $
Meter Hom ........ \~........................ $
Water Meter .'2/a........................... $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
MATERIAL FILED WITH APPLICATION
SOIL TESTS
CJ ENERGY DATA
CJ
PILING LOGS CJ PERCOLATION TESTS CJ
PLANS & SPECS CJ
SURVEY CJ
SETS
COPIES
PLOT PLAN
CJ
f1~{).oO
/ () SV . Cl IS'
'15. t9C>
I ~S' ..-00
I. 2C>C> CJ?
. ") rJ l') - c:o
WaterTap ................................... $
Builder's Deposit ............................ $ /. t!)() CJ ~ e--eJ
.,
Other ......................................... $
TO:LJJfi.........~.~...:,.... L2320. 72-
Paid '3 W'Il~Pt No. ~ +~ ~?--
Issued . Date /1;/ (J(tI! BY.-11.1 0..1.1.. .
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning brdin~nc~nd may proceed asUqO'ested. This document when
sign he Ci I ner constitutes a temporary Certificate of z~omPliance and allows construction to commence. Before occupancy. a Certificate of Occupancy must be issued.
/' ~l-,'-
ny lanner . Date Special Conditions d any
ur Building Permit When wPro~%>
Date '3-2~
't -
24 hour notice for all inspections 447-9850
T
I. Bille Fll.
l. Gold City
3. Y~UDW Appij~1
# qq-/7q
Phone: 4Y'7~lc73L/
Vr-inr L~
CITY OF PRIOR LAKE
PLUMBING PERMIT
Applicant: ~Q.."arer P\urn\)\f'q
Address: ~("r~~~_
Slgnature~ Cf~
Legal oesc~. Lot 5-Block_
Site Addl'ess: 'ln~ q) R \ iM ~ 1rci I
Building Permit # qq- 1'19 .PID# 2.5-338-005-0
NOTE: This permit will not be processed without complete information.
FIXTURE UNITS
Th. C....- of ,". LIMo Coli"'"
I
'\()<~
SUb~S J/"d
Quantity Type of Fixture Quantity Type of Fixture
I Bath TlJb with or without shower ......'1 Rough-ins
I Dishwastler I Water Heater
I Floor Drain Water Softner
~ Lavatory (bathroom sink) I Stand Pipe (washing machine)
I Laundry Tray (1 or 2 oompartment sink) Sewage Ejector
d. Shower Stall Backflow Assembly (RPl, Double Check, PVB)
I Sinks Backflow Assembly Test
Bar Sink Lawn Sprinkler
~ Water Closet (toilet) Other
FEE SCHEDULE
Industrial. Commercial & Multi-Family
(1 % of job cost. $39.50 minimum) $
Residential, New One & Two Family $
Residential. Additions & Alteration $
State Surcharge $ .50
GRAND TOTAL $
This pennit is granted upon the: eltpte~$ conditiQlI th.~ said
conr.ractOC', .haJJ comply in all respects with the ordinances
of the State Plumbing Code and ~he amend7~ thereof.
~hNO. 5,/7, DATE
r ~ . ATTEST
Call for all inspections 24 hours in advance.
.---
//,~O~V.\l>t(
fQU\~O\~
16200 Eagle CreekAv. S.E., Prior Lake, Minnesota 55372/ Ph. (612) 447-4230 I FAX (612) 447-4245
An Equal Opportunity Employer
CITY OF PRIOR LAKE
16200 Eagle CreekAv. S.E. P8,mitNo. qq - (7q
Priar Lalca. MN 55372 -
HEAT1NG APPLlCAll0N I PERMIT
-; Data ~ - :;t J - '\ G\ PIC" 2.5 - 338- OOS - 0
0.. .
SiteAddress \ \n~ ~ \ ~\~'-,\ \.J'\\~~'rCl\ l~.
~ Let 7) BIocIc \ Addition, \..l ~ \ ~....hi S. ~ d. ~ ~
g Ow"er's Name . ~ Q~ w v.. '" ~ O~S
Addre. \ ~ ~ ~") ()'^ \l~~~ \. ~ " ~
HHIlng Contrador ~ ~..-('J .{\ ~,... -1- () ( ·
Addre.. \ \0 ~~\.\ \.~ \\': ,uN. f\v L ~(', Or"'LJ.t\\o.l
Te'.phone' , "" ~ 1- ~ \ d ~
Furnace Make & Model f c... r y ~ \. -
Model Slzl ~ A - \ a~
Conn.load ~ '\ ")"\\0
Fuel, 1\\ <\\- FlueSlze ~ 'I ~VC
Supply OpInfngs
,~
'9..
Return Openings
~ 'nput \~O .OtlO Output ~ ~_ 0 ~O
a:
o
Il:
I-
W
E
Edr.
Cfm.,
,c;SQ
TYPE OF SYSTEM
Warm Air Plinta ~
Gravfty
Mechenlcal
A'r Condlllonin~
Vent. System
HEAnNGORPo~RPuun
Steam
Hot Water
Radiation
Special Cevices
Olner Devices
Replacllllent
TYPE OF WORK
New Construction
x
E[ Allendions
..-l
If) ,
CD . Repair Esl. Comp. Cat. ,
Est. Cost . ~ C\ t\C\ ~/ BuDding Permit"
en
~ HEATING PERMIT FEE $
l:e STATE -SURCHARGE ,
a:: " '. - -. ., ." '-
& . TOTAL PERMIT FEES .
,
! _ .i-:t +.~.~ ~":"'.'~',~.. - -". '. .~.
I ~3:~~-y'., -" , .1-
I ~~4!~I~~~'~ ..: ~~'=.~' ~.-
.50
O\C\. \\ q
rPA'DWITH~:
l B.UILDING .PE~
RecllpU , . -
: ':'i-_.~/'_: -, .~ . I
.~-t.;! ....;-. :,:...-
TYPE OF STRUCTURE
J. Piak - Fits
1. GRaI - City
3.. YcDow - ~."" - "1
Single FamUy
Commercial
x
Two-Family
Industrial
Mufti-Family _
Public Olher
Fee Schedule
Industrlal, Commercial & Multi-Family
Resldental, Healing So. AC
Residential, Heating Only
Residential, Gas Rreplu:e
Residential, Addition. & Alterations
Residential, AC Only
1% of job cos1 ($39.50 minimum)
$99.50
$64.50
$39.50
$39.50
$39.50
Remember to add the State Su rcharge on tne bottom of lhjs appUcatlon.
The price of your heating permit Includes one rough-In and one final Inspection.
Additional inspections wID be billed at $35.00 each.
House Heating Test Rec:ord must be submitted wIth 1,1' '1'1011:",,, ,,,'\,,,,Il ""'I"~" before build-
ing ~enifioate of occupancy wi! be issued.
HFAT r.AI r.1 U AT/n~~ ~F'" IIRFn wiIh number oI8Upply and return. openings listed per
room with CFM's per opening. New sllUctures or acldilons .end floor plan wlth auppJy
and return locations shown. HEAT LOSS CALCULATIONS, PAYMENT AND
APPUCATIONS MAY BE MAILED TO THE CITY OF PRIOR LAKE, 18200 EAGLE
CREEK AVE. S.E. PRIOR LAKE. MN 55372.
Ctty Hall business hours are 8 a.m. - -4:30 p.m.
ALL WORK MUST BE INSPECTED (ROUGH.JN AND FINAL) - CALL CITY HALL
447-4UO
I hereby apply for a mechanical systems permit and I acknowledge that the
inlormallon above Is complete and accurate; thallhe work will be In conlormance
with !he ~rdlnances and codee of the cily and wilh the state bulIdin~mechanlc.1
codes; that Ihis form doe. not become a permit unlilslgned by the BUILDING
. OFFICIAL; (hat the work wI) be in aceordance with the approved plan'n the
~:~r~.".,~n:.dlo 519
.~/~.- -' '. .~li;"Jqq.
<8wirdlng Offlcal'i Signature ' QaU - .-
f
I
.-. ,.
. "
::- . '.J'
.~.
--. ..:
. " "- .-"
GREEN - FILE
YELLOW - APPLICANT
GOLD. CITY
CITY OF PRIOR LAKE NO. qq- /79
SEWER AND WATER PERMIT
NOTE: Sewer and Water
contractors must
be registered
with the city.
APPLICANT: IL! '~i':'. ~ ... I.,/~ )}IL
ADDRESS: ~ .ij~ ~ . ~
SIGNATURE: ~
SITE ADDRESS:p.,~ riM.
FILL IN THE BLANKS
1. Estimated length of water service ~~
PHONE: -'/-,1 J -\. U / '/
DATE: 6-1/ -- 99
BLDG. PERMIT # qq-/79
PID# .2.5-339- 005-0
feet.
2. size of water service
}
inch(es) .
3. Location of any couplings from structure
feet.
4. Type of sewer pipe. ABS
PVC ~ Cast Iron
5. Estimated length of sewer line
'-f~- feet.
6. Clean out (if required), located at
structure.
feet
from
------------------------------------------------------------------
------------------------------------------------------------------
This appl ~;~n becomes your permit when approve&:> \N\1'r\ ~\\
BY ~/? Sft"ft?9 DATE: ,tI~\~GI'Ei"
------------------------------------------------------------------
------------------------------------------------------------------
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 and water permits issued for new construction must be
recorded on the building permit card at the time of issuance
to insure that no duplicate sewer and water permits are
issued.
DATE PAID
RECEIPT #
AMOUNT PAID
REC'D BY
16200 Eagle Creek Av. S.E., Prior Lake, Minnesota 55372 / Ph. (612) 447-4230 / FAX (612) 447-4245
An Equal Opportunity Employer
T