HomeMy WebLinkAboutBuilding Permit 99-0362
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;" :; i Qtertifica1e of (lDCcttvunry ~Jf':
I ,- f ~~I
~~I CITY OF PRIOR LAKE:q~
'~~j J)epartment of ~uilbinlJ J~ptttion .~I
l,~tl ;I'il Final Pennitted 0 Conditional C.O. 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 afthe
City of Prior lAke regulating building construction or use. For the following:
Occupancy Type
Type Construction
VN
Fire Zone
N/A
'loning District
99-0362
R2
Use ClassificatioD
SINGLE FA.\fILY
R3
Bldg. Permit No
Legal Description
L22, B2 GLYNWATE~ 1ST ADDITION
Owner of Building
'\iteAddress 3393 SPRINr. r,T.EN CIRCLE
Contractor.sName&Addr.... WENSMANN HOMES 1895 PLAZA DR. EAGAN MN
ROBERT D. HUTCHINSAA. PI JENNI TOVAR
'I' ~lty anner
Building Official
/I-r} "3 - 'I q /'f\,; Date:
55122
Date:
...;, ,;..," '";,..~. ......~..,:w....;.,..~.'< '~"',' "":;_.t;l- ,.~'.~ '~~"t. ~',,"""'H,'
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CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION Ai)
~ FINAL I.{J/
o SITE INSPECTION
COMMENTS:
DATE TIME
II ~.J3 .~9
'J3?J S~ 6~ C1
SCHEDULED
CONTR.
PERMIT NO.
~ Cf- 36~
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
.~#
~ C.\').
)!Sf 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!
lNSNOTl
DATE TIME
SCHEDULED ~ 3: :,. 0
SPA2/NG; 6~6JVCAe..
CITY OF PRIOR LAKE
INSPECTION NOTICE
33'13
ADDRESS
OWNER
CONTR.
Q9... .3to 2....
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULA Ti~t4\
~ FINAL ra r'
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
A 0 PLUMBING FINAL
rC~ FINAL
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
COMMENTS:
CD ft\N. 0
~- t.U~ ~~
~ l\-t'.(./'\
~
("lL.~)fJ-
(v StJJ
I~
~
-,
~
IC~,---- _
l"-. . r~~ C.O.
~
.......,.
.h C,-/~
--
.//
/
/'
o RK tTIS~TORY, PROCEED
CORRE :T A~;I-~ AND PROCEED
CORRE~~, L~ REINSPECTION BEFORE COVERING
Inspector: \ ) Owner/Contr:
'~
THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE
TS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
INSNOTl
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS ~~q~
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
'..r,
DATE TIME
SCHEDULED
B-lS.cp, q:b
~ ~ (;,..
CONTR.
PERMIT NO.
9q-3G:,z
o PLUMBING RI
o MECH RI
o WATER HOOKUP
~~E~RHOOKUP
~ J!. ~LUMBING FINAL
o MECH FINAL
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
COMMENTS:
W~~
fvJJ. ~ rLo
NL
Dt~
)
d\.-
of,(
/
/
~ORK SATISFACTORY, PROCEED
o CORRECT ON AND PROCEED
o CORRECT
Inspector: Owner/Contr:
CALL ~-9850 FJ R THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE ~ENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTI
CITY OF PRIOR LAKE
INSP,ECTION NOTICE
SCHEDULED
OWNER
ADDRESS 3~<t3 SPA-ING. Cc..J:Al L.IlCI..E
CONTR. J.J E:,JS f\1.~ I Hot"t E.S.
9?- 3~'Z-
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
~FINAL
o SITE INSPECTION
COMMENTS:
eA.ACE \~ 01.::
PERMIT NO.
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
c.u~&(Sn)( \::- oPmAlIONA-I
DATE TIME
JOlZij'Ff
~X1GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
)( WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: ~;:r..lv.-
~ontr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
INSNOTl
DATE RECEIVED
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
APR IS.
DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
1, DATE
~-I'7'- ? 'j
~~
2. SITE ADDRESS
3J7J
~ ~ ~A1~
, /
3, LEGAL DESCRIPTION
LOT ,). ;J.. BLOCK
ADDITION ~A//l'J..."U,.J~
4. OWNER (/<Name)
;2..
1ST
PID :J S-- 35 J - 0.;1;;z. # 0
~Ar.
(Address)
(Tel. No,)
5. ARCHITECT
(Address)
(Tel. No.)
(Name)
7. TYPE OF WORK
New Constructiong,o--
(AddreSs~ ,
J,f95' 1'.(..47" ~
~/'JZ,y,
Se ti 0 Deck 0
Addition Finish Attic 0
(Tel. No.)
'5'- ~()' . ~YO 60
6, BUILDER (Name)
~~ IJ~
Fireplace 0
Alterations 0
Re-roofing 0 Porch 0
Re-siding 0 Finish Basement 0
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES
Sq. Ft.
9. PROPERTY DIMENSIONS
Width Depth
10. CULVERT SIZE
Yes No
~-3tO (
ft1ain 11 ~
1. White
2. Pink
3, Yellow
File
City
Applicant
Permit No.
QQ-30Z-
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
ftJool.J Cl<J
17. COMPLETION DATE
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
bUildi~fficial can rev.o~his ~it fo~st cause. Furthermore. I hereby agree that the city official or a designee may enter upon the property to pe~~ needed inspections.
x.A)~oZ fj t1o-~ /YStF y-j)/-9 C)
/7 f / Signature License No, Date
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
SewerTap ................................... $
~1I $
Pressure Reducer ...,2l..................... $
Plumbing Permit Fee ....................... $ (0 O. .co Meter Horn ....~r(......................... $
$ / 00 .0{) (water Meter .::"lL......................... $ / :25.0 ()
Mechanical Permit Fee ..................... c9
35. 3"'0 ,.~~J. Sewer & Water Connection Fee ........... $ 112CY'J. 6
=~::C:'7.:::::::::::::::::::::: : 40 . '" lJ t ~~~~ ::::;~:;e.r.~~~..::::::::::::::::::::::::::: : ~ oc . 00
:iS~l '1lBeC?~ourBUilding~:tr;:~~~t:~~t :~:~~~.~~~~~i:.::::::::::::::::::::::::::::: -. 0 ~ J
V.(/'--- J/ - I fo / ,-
Certificate of Occ'fiP~cy Total Due .............................. $ ,J rAi. I
\ Paid 5{p 72.- . q~ Receipt No. '"3 .r-v f
::i:: to certify that (request in the above application and accompanying documents IS in accordance with the C~:~oni~i;::L~dtay pr:: a~d' This ~ument when
signed the C~~: c ~utes a temporary Certificate of Zoning compliance and allows construction to commence, Before occupancy. a Certificate of Occupancy must be issued.
f1: 'z-t--q'1
Date Special Conditions ff any
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
Front
Back
Side
Side
BUILDING DEPARTMENT VALUATION
OFF STREET PARKING
SPACES REO.
<\'Fft
USE OF BUILDING
)
TYPE IONSTRUCTION: I II III '0
Occupancy Group A B E F H I M''tED S U
Division 1 2 D
Permit Fee ................................... $ ca~" . '25'
~ L{('(Z. Z.
ltG,. DO
SPACES ON PLAN
PERMIT VALUATION
'1'2,000,00
City:
Plan Check Fee ............................. $
State Surcharge ............................. $
Penalty ....................................... $
24 hour notice for all inspections 447-9850
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
~t::b.~
1050 .(")0
i../ 5.,.,6
Job Address ']893 .3;/~~ &k"
Heating Contract ~/1I~Jty;'",
c{;.11 ~ ~ '
Name of Tester ~ . (,
~~/1. '1'7
7
o
15
35")
\
\
Date
Percent O2
Percent CO
Percent C02
Stack Temp.
Combustion air is adequately supplied per
UMC Sec. 606
Input
.,
,..
C'q -- 3ro 7
T.r Crnlrr of I.r Lab Co.nlry
White - Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKUSI
NAME OF APPLICANT
APPLICATION RECEIVED
~ \j E I\J 5 ~ IA N f-l 01'-'1 t"S
4-/IS/qq
I I .
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
3"3'13
SPItI.oJ(" G L. E:.a.J (l ,~_
"
Accepted
0/
Accepted With Corrections
Denied
Reviewed By:
., -
Jl\JALTEIt. t::.HIlEs.MI4"r/\/
Date:
I 1
y,/z319'
I I
Comments: SE'E 8&Ju..I),AJl. P€Il.... ,.,- -#. ~ - 3 I. I (33" ~ PilI AJt.. BL €AI (',,~. J
Folt...
I tJ FOi.M"""'IOI\.I. ~4lw'M "",e;,.ns
,
~ Arrlllc ~"""EN""S
liThe 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 ofthe jurisdiction shall not be valid."
((7 -
-..... 1" ,...-,
-<'l' '. /
I..... ~.' '" .. ,,~.___
Th~ C~nttr or the Lake Country
White - Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
t, \, i '. ~'-, f'- I I \ (''J f <\ / r / r"- '.
, .~ ~, ! i....."' \ "'-..... '-.-1
.....,. /. -:-:- /' f' "....
q i") '"JI,.,/
J _"./ I
,- r '
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
Accepted
v
Accepted With Corrections
Denied
Reviewed By: ~~
Comments:
Date:
L1-2-Z -~
"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,q_ 3(g7
Thf' Crnter of Ihr L.kr Country
White - Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
Wf,NSMAN HOMSS
4-/ / 5/qq
, , .
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
35Cf3 s~ G~vlt!L
Accepted
"'-
Accepted With Corrections
Denied _
Reviewed By: /) f}{ijAc
Date: t/-2('-9'7
Comments:
J. g~c. I3Pd!- q'l-3~{ ~r- Ro.-.~! ~~s.'! 3utl1e~! ~~ ~f:;:,.
"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 PRIOR LAKE
8. r... ~~ 16200 Eagle CIHk Av. S.E. Permit ND. 99.. ~z.
~ Prior uk., UN 55372
~~ HEAnNGAPPUCAnON/PERMrr
IJ)
~ale W I Q II Qq PID. 2.5 - 35/- DZ./- 0
J~e Addfeu ?3qg S~1\.J..r\..o q \ ~ n ~ NW
~oI ;;l~ Block 9- Addilfan ~~unU){l"'t ~ We...<;-r
~nll'. N~me LU ~~\'Y\n.nn \-\D m.p~
l<gq" ~)M...Q ~R. ~a.ao..n
HemIng Conl#&dor . ~,.JLr~- R u OJ) U
Addreu t474~' <;:';- ~W+ "Tr I
4Q'?l- I J 44
Address
Tefephone. ,
Furn....Mue&Mocl., ""' nnf\O'l
Model Slra ~'Jm:.1J ~ -16
Conn. Load
fUllI N JVl . ~~FI118 Size
Supply Openings \ 1
4
4.1(
Relum OpenIngs
~nput 1 ~ ,ern Outpul{d:J, Cf:"'C)
>-. .,
0::
~:dr.
z:
w'l
l!).. m.
TYPE OF SYSTEM
Warm AI, Plallts
Gravity
Mechan1cal .---
AIr Condoning .
VIm. System
HEAllNG OR POWER PLANT
Swam
Hol Wat,r
RadIaUon
Special Devices
Other Devices
TYPE Of WORK
E
a..
~'Ileral\ons
N
~=lepalr c
Replacem&nl
EsL Comp. Da\e
New Construction V--
Building Permit"
q9-3~2-
~=Sl. Cost $
(J'l
,,;:iEATlNG PEEtMITFEE $
.-i
~ST~TE SURCHARGE $
a..
a:roTAl P ERM'T feES $
.50
. PAID WiT;.;
LaUILDfNG PERMit
Recelpl ,
TYPE OF STRUCTURE
l. ftllk
1. D~
1 Ydk.
I'W
City
CIlIllrKlDl
Single FamUy
Commercfal
v
Two-Family
Industrial
Public
Multi-Family
Other
Fee Schadute
Industrlat, CommercIal & MulU.Famity
Restdentlal, Healing & AC
ResldenliaJ, Heating Only.
Residential, Gas Fireplace
ResIdential, AGtilions & Alleralions
Residelltial, ACOnly
1% 01 Job CCl$t ($39.50 minim.lm)
$99.5D
$64.60
$39.60
$39.50
$39.50
Remember 10 add Ihe Stale Surcbarge-on Ihe ba"om of thTa appltcallon.
The. prioo of your healing permIt lnc/ucfes one fOlI9h-1n and CIlIe Jina1 Inspection.
Addiliollal inspeclfona will be blled at f35.00 each.
House HeatlngTesl Record musl be submitted with ty}l'dII'J5lPDDil number before build-
ing celtificate or occupancy Vllill be Issued.
..n=_T r:AI r,I.. ATln"'l~ R.I=f'lIlRF=n wIth number of supply and relum openings listed per
room with CRA's fle, opening. New slrucluru or addiUons send floor pran with supply
and r&lum locations mown. HEAT lOSS CALCUlATIONS, PAYMENT AND
APPUCATIONS MAV BE MAILED TO THe-CiTY OF PRIOR LAKE. 16200 Blnl r::
CREEK AVE. S.E. PRIOR lAKE, MN 55372.
City Hall business hours are 8 a.m. . 4:30 p.m.
ALL WORK MUST BE INSPECTED (ROUGH-IN AND FINAL) - CALL em HALL
447-4210
I hereby apply for a mechanical syslems permit and I acknowledge that the
information above is complele and accurate; Ihallhe work will be In conlormance
with Ihe ordinances and codes of the city and wllh the 61ale building/mechanical
codes; lhat this form dOBS nol become a permit unUI signed bV 1he BUILDING
OFFICtAL; that the work will be in accordance wilh the approved plan In the
Cyall work which roqulro. ...I.w and approval 01 plana.
l.Jnn~rO~ ) . L\:a\lqq
V Appli (' Ignature - I D~8"
l . 4- 'Ut/qq
Bul1 O/lfcal's Sisna"". ' 001.
RPR.21.1999 12:20PM
GENZ-RYRN
NO. 654
P. 5/11
_ . PILII
YIU,D- . """1Co\IIT
GOLD . ClT'
CITY OF PRIOR LAKE NO. !]g - .3(0 z..
SEWER AND WATER PERMIT
NOTE: Sewe~ and Water
contractors must
be registered
with the city.
APPLICANT: ~- ~ .PHONE: 4'd.~-1 lLll/
ADDRESS: \ 4"14 6 ~L e""".RD 'o-e.R..+ Ir 'PATE: 4l a.' J q 9
SIGNATURE~~ ~ ,BLDG. PERMIT. Qq....3C, 2-
SITE ADDRESS:33~a, ?~\\'n~ ~\~ QJR f\\WfID# 6;).S"-3~/-aZJ-()
FILL IN THE BLANKS
, )"AJ
1. Estimated length of water service ~LJ feet.
1'.
2. Size of water service inch(es).
J. Location of any couplings from s~ructure
feet.
4.
~ype of sewer pipe. ABS pvc)( Cast Iron
I 'OJ
Estimated length of sewer line ~ feet.
s.
6. Clean out (if required), located at
struct.ure.
feet
from
=====~:~-=============~=~-==================---===~~~~~~~=======
This application becomes your permit when approved.
BY
DATE:
=========~=~w================~~_=========~S~~========~~2~~-======
FEES:
$
$
$
35.00
.50
35.50
Sewer and water line connection permit.
Surcharqe
TOTAL
* Fee for either sewer or water individually is $20.00 plus
$ .50 surcharge.
*
Sewer and water permits issued fQr new construction must be
recorqed on the building permit card at the time of issuance
to insure that no duplicate sever and water permits are
issued. ~ PAID WITH
DATE PAID I BUILDING PERMIT
AMOUNT PAID J
REC'D BY ~_
RECEIPT #
. 4629 Dakota St. S.E.. Prior take. Minnesota 55372 I Ph.. (612) 4474230 J Fax (612) 447.t;245
AlII EQUAL oppoRTUNrN ~PL.OYER
APR.21.1999 12:19PM
GENZ-RYAN
NO. 654
P.4/11
n. Con'" ., .... 1A1l. C...nh'Y
I. .. fi1c
1. Cio/4 CiIJ
3. 'Yfllla- Al'PI=-
# qq., 3'"Z-
Applicant: ~~- ~OJ"'\ ,Phone;14';;l~-l ,\-\4-
Address: ILl/Y~ f";o 'l<obU-+ Tr I
Signature; ~~ ~~ .
I-egal Descripticn~ L.ot ~Q Block ~SUbS \un\.Ucrle.r vJ e.5T
Site Address: ":2..?,q~ 71~.~ ~l_~.n ~ NLU
Building Permit # q2) ~ .3 ~ 2--PID # 2.5 - 3~ 1- tJ z I - 0
NOTE: This permit v.:ilI not be processed without complete information.
FIXTURE UNITS
CITY OF PRIOR LAKE
. PLUMBING PERMIT
Quantity Type of Fixture Quantity Type of FIXture
\ Bath Tub with or without shower 3 Rough-ins
\ Dishwasher I Water Heater
\ Floor Drain ,.e., Water Softner
d- Lavatory (bathroom sink) , Stand Pipe (washing machine)
I L.aundry Tray <1 or 2 compartment sink) Sewage Ejector
I Shower Stall Bactcflow Assembly (APZ. Double Check, PVB)
I SlnJcs Backflow Assembly Test
Bar Sin\< Lawn Sprinkler
d- Water Closet (toilet) Ottler
FEE SCHEDULE ,
Industrial, Commercial & Multi-Family
(1% of jab cost, $39.50 minimum)
Residential, New One & Two Family
Residential, Additions & Alterations
State Surcharge
GRAND TOTAL.
$
$ qq,so
$
$ .50
$ -
$99.50
$39.50
This permit is ,r:mEed upon the exprcu cClndition lhllt said
cont1'llctOt, shilll comply in i111 respectS with the ordin:lPccS
Dr the St:atc Plumbing Code lU'id the QA-~TfI~tJ thereof.
RECE11l liO.~. Vi q DATE
~ M",--- A1i'EST
Call for all inspect~ons 24 hours in advance.
PAID WITH
l BUILDING PERMIT
16200 Eagle CreekAv, S.E.. Prior Lake, Minnesota 55372/ Ph. (612) 447-4230 I F~'X (612) 447-42~5
An Equal Opportunity Employer
CITY OF PRIOR LAKE MC
16200 Eagle Creek Av. S.E. Permil No. CjCJ-3foZ-
Prior Lake, MN 55372
HEATING APPLICATION I PERMIT
Dale -7//j1C;C; PID' 2.5 -35/- OZ2..-0
, , ,
Sile Address ,'-539:r ~L'lr~' tC/r'11 fL1.;(?L ,ez..
f/ (j _
Lot Z Z Block 2-- Addilion 6l:..V N tV A (c.-e W b~ (
.~
Owne,s Name
I
Ii ).;AIu1Lcd.-1HL.,
Address
HealingConlractor ALLIED FIRESIDE dba FIRESIDE CORNER
Address 27QO N. FAIRVIEW, ROSEVILLE, MN 55113
T eJephone 1# . 6 5 1 - 633 - 2 5 6 1
FIREPLACE
tXnltl Make & Model /.J.p!J. J AJ r:.(~
Model Size ~ 7 Siy T7rl.
Conn. Load
Fuel liA.<;
Flue Size
Supply Openings
Relurn Openings
Inpul Oulput ~ ~ (),on
Edr.
elm.
TYPE OF SYSTEM
Warm Air Plants
Gravity _
Mechanical
Air Condilioning
Venl. Syslem
HEA TING OR POWER PLANT
Steam
Hol Waler
Radialion
Special Devices
Olher Devices
Alteratiuns
Replacement,
TYPE OF WORK
New Construclion
)('
Repair
. Esl. Comp. Date
Building Permilll
'7- /9 - Cj7:
qq-3~2.
Est. Casl $
I I Oil. t1")
HEATING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEES $
.50
~ PAIDwn'H~
BUILDING PERMIT}
Receipllf. .
TYPE OF STRUCTUR~
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City I
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Singls Family
Two-Family
Industrial
Multi-Family
Other
Commercial
Public
Fee Schedule
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Induslrial, Commercial & Mulli-Family
Residential, Heating & AC
Residential, Healing Only
Residenlial, Gas Fireplace
Residential, Addilions & Alleralions
Residential, AC Only
1 % of job cosl ($39,50 minimum)
$99.50
$64.50
$39.50
$39.50
$39,50
Remember to add Ihe Slale Surcharge on Ihe bollom 0/ Ihis application,
The price 01 your healing permit includes one rough-in and one linaf inspection,
Addilional inspeclions will be billed at $35,00 each.
House Ileating Tesl Record musl be sub milled wilh buildina 1Jp.lmit number before build.
ing certilicale o. occupancy will be issued.
HEAT CALCl)JJ\TION~ REQUIRED wilh number 01 supply and relurn openings listed pe
room with CFM's per opening. New struclures or additions send floor plan with supply
and relurn locations shown. HEAT LOSS CALCULATIONS, PAYMENT AND ~
APPLICATIONS MAY BE MAILED TO THE CITY OF PRIOR LAKE, 16200 EAGLE I-'
CREEK AVE. S,E. PRIOR LAKE, MN 55372,
Cily Hall business hours are 8 a.m. . 4:30 p.m.
ALL WORK MUST BE INSPECTED (ROUGH-IN AND FINAL) - CALL CITY HALL
447-4230
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I hereby apply for a mechanical systems permit and I acknowledge thatlhe
in/ormalion above is complete and accurale; Ihat the work will be in conformance
with Ihe ordinances and codes 01 Ihe cily and wilh Ihe slate building/mechanical
codes: lhatlhis lorm does not become a permit unlil signed by the BUILDING
OFFICIAL; Ihat Ihe work will be in accordance with the approved plan in Ihe
case 01 all work which requires review and approval of plans.
.
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Building Oflical's Signalure
~ tiOR LAKE
INSPECTION RECORD
DEPARTMENT OF
BUILDING AND INSPECTION
SITE ADDRESS S'31~ ~ C\u Gr.
NATURE OF WORK New ~~.
USE OF BUILDING ~t:'"A-
PERMIT NO. 9'1.. 31n~-, DATE ISSUED 4~';;ll&.-9'
CONTRACTOR lA\~^ ~c::
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR
DATE
FOOTING~1?\1AI\-or\ J~7)41f1 05 & I S-...~'C;
FOUNDATION (Prior to Bacltfill) I \\ ';) 1S--~4"l
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
SEWER I WATER I SEPTIC
FRAMING
INSULATI0~.1-1l~' (j:J 8'/8/1'
ELECTRICAL tJ
PLUMBING G(7)-?/'~~
HEATING (if required) {/ f VV tI~h.?
FIREPLACE f/J:J 7 h /91 . W?/()'1,/rfl I.
GAS LINE AIR TEST ;V1It(lJ !(,(>. v ~/~- 7 /(~/f1
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
-- I I
FINALS
~
t;1)7/d'/f1
(/ ?/-I
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7 ;7g~
'V
GRADING (Prior to Sodding)
BUILDING T,c.o).rhIr1 '
ELECTRICAL
PLUMBING
HEATING
DO NOT
/O!Z1!9-Q
. I
II-J. 3 ~'1q
~
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I
OCCUpy UNTIL ABOVE HAS BEEN SIGNED
NOTICE
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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