HomeMy WebLinkAboutBuilding Permit 99-0896
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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 LoJce regulating building construction or use. For the following:
Use Classificatiof'
Sin..le Fsmilv
Bldg. Permit Nt
99-896
Occupancy Type
R3
Fire Zone
H/A
VN
Zoning District R1
Type Construction
Le",,,,1 """.......".:"
'-
L6. B1. Windstar
.~~
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~.;.. -
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""
i~z' ~ POST IN A CONSPICUOUS PLACE
I''''' . '.. '" .. . .,~. -:.... ..~._ c', .~_..
i: ,....-.-, ......-",.....,',..._...;~~:"..~~_,_~;".._" , "'~~..._'1,_....."..... ",'. ___ ~...,.-:.~. ....."
~~~l~ft~.'[~'~~'~:...'A":..-.t~,,~~~~ ~~t..J..l~.!c;'
- . ~ ,- - - - - - ~ -, - ~ -='"" - - ~ - -=--
Owner ofBuiJding
4458 Pondview Trail S.E.
Site Address
utm~ 1895 Plaza
V r'ity Planner
r/
Contractor's Name" Addre~" Wensmann
Dr.. Suite 200. Ea2an. MN
Robert D. Hutchins
Jenni Tovar
Date:
BuLiding Official
II-S-0Ct
Date:
ADDRESS
Y45~
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
~F MING
o SULA TION
AL
o SITE INSPECTION
COMME~l\
/
/'
~tt&u:'tW 'In.-
CONTR.
PERMIT NO.
'1Q - 8'q {.,
o PLUMBING Rl
o MECH Rl
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EXIGRAD/FILLlNG
o COMPLAINT
o FIREPLACE Rl
o FIREPLACE FINAL
o GASLINE AIR TST
o
~LL~
c.Lo Ke- .{=. k
\G"h,~ ~L:f", 'i
J1'''s~1-
//
CALL 447- 50 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE,.
'QUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
II
INSNOTJ
, ,
II
DATE
CITY OF PRIOR LAKE .^ L _ "'~
INSPECTION NOTICE SCHEDULED ~
ADDRESS 44513 PC/IIO V/e;W
TIME
ID :.3fJ
OWNER
CONTR.
PHONE NO.
qc;-PJ fjh
PERMIT NO.
o FOOTING 0 PLUMBING Rl 0 EX/GRAD/FILLING
o FOUNDATION 0 MECH RI 0 COMPLAINT
o FRAMING 0 WATER HOOKUP 0 FIREPLACE Rl
o INSULATION 0 SEWER HOOKUP 0 FIREPLACE FINAL
YFINAL ".-r ~ PLUMBING FIN~ 0 GASLINE AIR TST
/D"SITE INSPECTION ~CH FINAL ~ 0
COMMENTS: 1. 5(."r ,'-.:.'~ fitovr; R~~
'2... ~~ T~ '-.
'~....-..l .. ~~tww~ I
04J~ ~~ U~ 'FL-~_ .J:1Vl~NM
;(c:!X~ H~
O{2-5~ 6). (<-
,. Ir N 5'H-r.#c:.x...b ~ ~ 1Ji4C{<... ~
o WORK SATISFACTORY, PROCEED
~RRECT ACTION ~ 'NO PROCEED
, 0 CORRECT W~, C, .LL FOR REINSPECTION BEFORE COVERING
~~t:\ Owner/Contr:
CALL 44t9850tOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIRE ENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTl
, ,
CITY OF PRIOR LAKE
INSPI'CTION NOTICE
ADDRESS ~S <;i:
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
)l( FINAL
o SITE INSPECTION
DATE TIME
SCHEDULED
~ 3:-I5f'1'1
PoAtDlIlc'd J;.AI<'-
CONTR. M.JS/I'IANN H~<;
PERMIT NO. 9't- ff'tfe
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 Rl
o FIREPLACE FINAL
o GASLINE AIR TST
o
COMMENTS:
QRAOE. 1.'i~L.E
CVRt3[to",
l~ ()PI'"tlA-r'MA.ollL
P/11/AJTI!t/,.! -;;'L~cE (../AL-r'L 5obOE:D
)(WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: L. ~ fib
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
S.. "..ICon!r:
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
II
INSNOTl
I
, ,
SCHEDULED
TIME
CITY DF PRIOR LAKE
INSPECTION NOTICE
Ir_~
ADDRESS ~PJ
OWNER
g1\d U -::t.u J
PHONE NO.
CONTR.
PERMIT NO. qq- 8tf f>
o FOOTING f'>. 0 PLUMBING Rl
o FOUNDATION r 0 MECH Rl
o FRAMING ~WATERHOOKUP
o INSULATION ~ SEWER HOOKUP
o FINAL 0 PLUMBING FINAL
o SITE INSPECTION 0 MECH FINAL
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE Rl
o FIREPLACE FINAL
o GASLINE AIR TST
o
COMMENTSi;' ,1 .
'5(.,' ~ &.J4
4(./ 'f II' c..
.-
"2 G,.' + )!>J)....... .J..--i-
I.... 1 LL
k.;-t ~ r -tuy
c~ _ ~ c...........::f ~
LL~
f/c..& r. ~ '-' J-~ So --01
(~ ~ MtJI~ ~ /...0'<
fu (-r0\&:...
1 _f
~
Ii tJ
Cio.w-
~
~u.A'
o ~K SATISFACTORY, PROCEED
~'~~~ECT A~ IN AND PROCEED
o CORRECT W( i .~LL FOR REINSPECTION BEFORE COVERING
Inspector: ( I / Owner/Contr:
CALL 447-~~~FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQgREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTJ
II
, ,
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
COMMENTS:
(0 ~~ TuB
~Q....
Vc...l Q
~
*-1515
DATE TIME
SCHEDULED /~1 Z:30
pOIJOV/6W
CONTR.
PERMIT NO.
c;q - ~90
o PLUMBING Rl
o MECH Rl
o WATER HOOKUP
A.MEWER HOOKUP
" PLUMBING FINAL
o MECH FINAL
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
'P-nz..A6?
~<;s
.
Ce, 1..0 ~
r.A(.......-
~
V rr
FACTORY, PROCEED
TIO ND PROCEED
LL FOR REINSPECTlON BEFORE COVERING
Owner/Contr:
C LL 447-9850 OR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CO~ REQUlRE..(ENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY/
\J INSNon
II
~:fJ"" 7 /Z:/~':~.
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
I. White
2. Pink
3. Yellow
File
City
Applicant
1'fJ8rh
Permit No.
1. DATE
DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
\1 ,'-> IC>.. "\
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(t1e!.[ht) (Width)
~, \PI
12. NO. OF STORIES
~
120 SITE ADDRESS
'"""''"' 'S.'l>. ~-"'''''' ~~
3. LEGAL DESCRIPTION
'f~. S. E.
(<..-\
{Depth1ss-t
PID ~S-~:,Io-bD",- 0
\.0
\
BLOCK
LOT
13. TYPE OF CONSTRUCTION
~<;;.~ ~"c---..c.-
14. FLOOR AREA APPORTIONMENT USE
ADDITION ~.....~\..'S... "'.....-c-
4. OWNER (Name)
\.,..,)(.............'::l.~"'-__ 'c-~~~
5. ARCHITECT (Name)
c:""",,,,,,-~
6. BUILDER (Name)
(Tel. No.)
'" 'S. \ - '-\.0.... - '"'-'-1..00
(Tel. No.)
(Address)
Q.c-""","~_
\"'~~
""" -" ....
(Address)
(Tel. No.)
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
(Address)
<".,^-"'^-e
Fireplace 0
Alterations 0
SEATS
Deck 0
Finish Attic 0
Re-roofing 0 Porch D
Re-siding 0 Finish Basement 0
Septic 0
Addition 0
7. TYPE OF WORK
New constructlon)6
Chimney 0 Misc.
18. PROPERTY AREA OR ACRES 19. PROPERTY DIMENSIONS 110. CULVERT SIZE
Sq.Ft. SOS'-I.O W;dth'ii.'" Oepth .3S<;:l Yes No - ~<..." ~C>
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, 1 hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
"\,'\~..~ ~"""-...-<.=.r- ',",S,," :,.~~ '''' .,~"'-'"
Signature License No. ~ Date
16. PROJECT COSTNALUE
~ \"'-(:l \>"-0
17. COMPm,ON DATE
\
I MATERIAL FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA 0
PILING LOGS 0 PERCOLATION TESTS 0
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
Side
Side
Front
Back
BUILDING DEPARTMENT VALUATION
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION IqC').I'Y'Y'"\. C')(")
PLANS & SPECS 0
SURVEY 0
SETS
COPIES
s~
USE OF BUILDING
PLOT PLAN
C1
TYPE OF CONSTRUCTION: I II 111 IV V
DccupancyGroup A B E F H , M R
Division 1 2 3 4
Permit Fee ................................... $
Amount Brought Forward .................. $
Park Support Fee ............. .... .... ...... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
1!l:J" It $
Pressure Reducer ..:~.......t.......... $
MeterHom....~\".......I;.............. ~
Water Meter ...(!/P.......k................. <f:
Sewer & Water Connection Fee ...........~, I.
City:
S U
B",a . Cl':>
I aso. ClO
I.~~'t.";l."
~lA .2j
9<;' . 00
Plan Check Fee ............................. $-
State Surcharge ............................. :F
"~I
, ~v. ./
"? 0 .llO
k"57'J .00
'2nO .Ot=)
'lI'J1'l.00
Penalty ....................................... $
Plumbing Permit Fee .~...&........ $ 1 ~o . 00
Meohan;caIPenn;tF.. ..,~~""...... $ 100.00
Sewer&WaterPermn ...i9:~...... $ o~.so
Gas Fireplace Pennit ...1~.:..~W.... $ 40.0 C)
ThIS~' 't)rj)Jkome~our Building Permit When ~er.ove~ c.
By :I~ V"i'. Date ,- '..J.a-"'t-{
- {/'
Certificate of Occupancy
1.w.QI{
Water Tower Fee ........................... $
Water Tap ................................... $
Builder's Deposit ............................ $
Other ......................................... ot'.
f,5CY> .c:>-O
Total Due .............................. $ 9/ f'. 'Ita
Paid ~/ t:;r,. 9 (, ReceiPt~/ ~eZ-4-
Dat. ~/3/~ By ~
This~IS C .~ requ in the above a~lication and accompanying documents is in accordance with the City Zoning Ordinance and may proceed I!. requested. This document when
sig by t ner stitutes a temporary CertifiC"fte of ~1~ compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be issued.
. . 7Ld$J.a
( / City Planner W Dale Special Conditions if any
,:..
Issued
"
24 hour notice for all inspections 447-9850
--""T"'!""-...T'
"
,,' ,. ,.,"'(;,~ <. '
~
~
II
,~
1 ~ - 8t ~
Thr ("t'nlt'f of lh" tab Country
White - Building
Canary - Engineering
Pink - Planning
NAME OF APPLICANT
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLlSr
VJC".j'>f'I'\~ ~L~
---1/ '2 2 I Cj '1
APPLICATION RECEIVED
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
Accepted
./
y'-"r--<l \1 / E ~ 1l2- ~. E-
,
'. -"..
~ -'\
,..~,..
Accepted With Corrections
44':>2:>
Denied
Reviewed By: ./.kLTF"d EudF.<:MIl,y,v
Date: -tI zl.Il"
Comments: ~FF MoJsr
BE: CONvE.'I'/Ul To A,JI) ,qL."NG. Dfl.A'AlAl.€.
A^,b /JrluT\{ E:A~.:..I'M~..J'i'"S A~ MIl'c.H Ac:. PnArTJ.-'..Al__
"1""E: ~MEIt~E.x.Y
J><JEIl. FL."....
ELE",..,.,o,J ",F 9t.t..'t
tW "1"'"' ~
5,~u-rH~IL't'
SIDE: P,z,PEAty
L/lJ€.
MoJ:;T" ae: tSItAOf:D
IN
I'IT
FiAJ"'L G.Ao4OE.
i:'A<lA(,E. J4NlJ
Da'uli:....4....
LOe..I4TIOAJ ,q. Ite:
AtccPrAi!L.E.
SEE: IIJ~OA."'A"i"lON ON REoJ~Il.SE S.OIO .
S~E A"TTAUolME.n-s: I. F:.......<- C.A.IlOE J..JSPE<LT",OAoJ )AJF.ltJ"o\AT,~^, 2. t..Il.Al>'''''' ?u.t,L
~. El'lo~,oll<..!. CDIJT1lJOIL Y'1EA~.J"'E.s..
of. E40 S,.'" ~"''''TI'''<- "fU'N
"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~:"",,~,~~~~--,.,~-..~,*
",..;n.-"'"':~"""""t'-'''';::,,,,,-,:~,,,~!;,,,r,,<t<''---'''''''''W'':'-~''''iO'i,,:''''''~''',,:....,..-....^"'-"l---.l-"'X,,:,,:,'ji":;:lQ'''''!''''''"','''..~t~?'=''D?''-~~,;:~j,to.~._,"i>i,~~-'~v':,
I, (-I [>(',
;' ,_.": \~-.;'
,
Thl' ('I'nll'r of lhl' L.kl' Counlry
White - Building
Canary . Engineering
Pink . Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
,
, ^), ^,"- ',' \"'",1
V' '- .. j "-.
J
'I' 1-- 1 c.
'" I
\
t _ ,,\ " ~
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
.1'1 ,<,' '..... "'-", --I' ,', '. I-
~, -.. (::_...) ! ___ I-~-< "\} 1 t" L ~-' """-- -~_) , ~.
Accepted
/
Accepted With Corrections
Denied 9 j
Reviewed By: _ tfij. :JC1/O/tJ Date:
Comments: A I ''-' n I + +0 P( :5t..-rIo,c(!e...
I
Jt) 'fVuYYl -So ,Lc \iiI - d /J { b< h ;. yj
,
7-,,3-'7;
t1 11/1 in l..-:n j,"" cf,
~-v~
''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"f5~c.
White . Building
Canary - Engineering
Pink - Planning
The> ('C'nltrof thr Lib Counlry
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT VJe~m.^,,^, .L €>
'1 I '2-<.-/c; ~
APPLICATION RECEIVED
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
k4:Se:> ~\JI~ 1R- 'S:.E.
Accepted
Accepted With Corrections ~
Denied
Reviewed By: f2. f LI-
Comments:
I. R =d.. t>..( I "l-th..dA_'''& I+e......d.. o-z.SL
Date: 7~'D - {' '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."
II
lIT
"
,.
Job Address tjr~'8 >,'1?h'.JtX( u
Heating contract&' p~ ,;;~
th.',!/.
/tf).'19-'?~
7
o
Name of Tester
Date
Percent O2
Percent CO
Percent C02
'f>
~
Stack Temp.
Combustion air is adequately supplied per
UMC Sec. 606
Input
qq""fi1~
I r
"
II ~99
~~
3:33PM
GENZ-RYAN
NO.612
P.2/7
T1W C'8JQ' III Ik ....., c....,'"
CITV OF PRIOR LAKE
", Pl-UMBING PERMIT
Applicant: '[8 Q..-n "l..- i2q ~
Address: ---/.!=f7L/:<; ~..........+-
Sigrmture: i (;l~ ~~
Legal De8Crjpti~n: LQt --1P Bleek J sUb..Laa.':'<lI-tl,r ~
Site Address: I #~~ PDY1rlA/'~) <rrl R/
Building Permit'i/ qq- f39bplD it 25-33(.,- oO,p-C
,
NOTE: This p~rmil w,i11 not be processed without complete information.
FIXTURE UNITS
.-."-
2. Ooid Cll)'
3, YclkJ,.. AppUCUC
Cf9-8CJb
#
.Phone: (4"';/. W2.~. ))yq
...,..,1 ~O<.h<.J1 5.5~
I Quantity Type af Fixture : Quantity Type of Fildure
I ,~ Bath Tub with or without shCl'l'er L"'1 Rough-ins
I I Dishwasher , Water Heater I
I I Fleer Drain Water Soflner J
I J..j Lavatory (bathroom sink) Stand Pipe (washing machine)
I ,. Laundry Tray (1 or 2 comp_r!mllnl sink) Sewage Ejector,
I J Shower Stall Backflow Assemllly (RP2, DoUble CI1ec;k, F'VB)
I r Sinks Backflow Assembly Test
1.. Bar Sink Lawn Sprinkler J
;3 ,
)- Water Closet (toilet) i' Other J
!
FEE SCHEDULE
Industrial, Commercial & Multi-F~miIY
<1 % of Job _cost, $39.50 minimum/ $
Residential, New One & Two Farj,lIy $99.50 S
Residential, Additions & Alterations' $39.50 $
I .50
State Surcharge I $
!
GRAND TOTAL ~*~:$~\"
eU\\J)' .
(,,~.)
G
This permfll;. Sf1l"ted upon th. exp.... condition that said
""ntractor, ~h'l1 ~amply' - II! '.spoolS with !h. ordinances
o( tho Sla"I'I~"'~i" nd . mondm%9.~f.
Pi/.s; DATE
A Tl'SST
Call for ill
16200 Eagle CreekAv. S.E.. Prior Lake, ~nl1esota 55372/ Ph. (612) 447-4230/ FAX (612) 447-4215
All Eqllal Opportunity Employer
"
, :
II I
'JUL.22.1999 3:34PM
GENZ-RYAN: .
NO.612
P.3/7
-......~.
ftUDW. IMICuT
IIOLD . CIT.
o:r!l'Y OP PRIOR LAKE
SMR AND WATER PERMIT
NO. qq. gqcP
NOTE: ,Sewe~ and Water
contractors must
be reqistered
with the city.
APPLICANT:~'Z.-. ~
ADDRESS: 1L./'7.L/t5 ."50 ~kr+ rr-l
SIGNATURE: (J/1JY:'^ ~
SITE ADDRESS: 4t-/5< !PlTYldl/(e,...)
PHONE :_LIz -;=r,.I)~.:/
,DA'l'E: \l:2&./q~
BLDG. PERMI'!' * qCf-Pfj{p
II'"" J .eJpIDtI 2.5-33(" - 0 0 t<> -'0
.
F:tLL IN THE BLANKS
l. Estimated lenqth of ~ater service L/o' feet.
2. Size of water service '" inch(es) .
3. Location of any cO~~linqs from s~ructure feet.
n 4. Type of sewer pipe.. I\BS_ PVC )/ Cast Iran
,
5. Estimated length of' sewer lin'i-l t..(p , feet.
6. Clean aut (if re~:\.;,ad) , located at feet from
structure.
=_._~......---........._--- ------~-- -==""1"'"--.....------- ===1-_____.. -..--...__~_.o:liI'====;;s;====:;;;====
ur permit when approved.
D~TE: l!5 / S- /q "1
This
BY
========-..====2:=--=:-....____. ~....".,..,.........IIlI=========--. .. ___=;;o:r.:==________'----_=___===~
,
FEES:
$
$
$
35.00
.50
35.50
Sewer and Water line connection permit.
, Surcharqe
;'l'O'l'AL
* Fee for either sewe~ or water individually is $20.00 plus
$ .50 surcharge. : ~
* Sewer and water permits issued for new construction must be
recorded on the buildin~ permit card at the time of issuance
to insure that no ~up11cate sewer and water pe~its are
issued.
. ..""
( . I
\:..;.,~
!:lATE; PAID
RECEIPT ~
AMOUNT PAID ..~ I/ti)~~"((}
REC'D BY ~~
. 4629 Dakolll SI. S.E, Prior Lake, MJnnesota 55372' I Ph. (612) 4474230 I Fax (612) 4474245
,HI "'lIJA\. OPPOlmJNrTY EMPlDYeR
I I
CITY OF PRIOR LAKE
16200 Eagle Creek Av. S.E.
Prior Lake, MN 55372
Me
Permit No.
9t?-SPC,
HEATING APPLICATION J PERMIT
PID' 25-33"~ ()C(,-o
<A.I", p J?,71,ic/~.L. ,f:'U~ At! I
Date
11 / .',
1...:/_ //,~J_ '-jC)
Site Address
Lol ~ OIock
I Addition
WIND.s'rRA!.
J.;J'J<L,
Owner's Name.
1~_i;1I1.~ifJ'
Address
HealingConlraclor ALLIED FIRESIDE dba FIRESIDE CORNER
Address 2700 N. FAIRVIEW. ROSEVILLE. MN 55113
T elephon" , 6 5 1 - 6 3 3 - 2 56 1
FIREPLACE .!
IMlw~ Make & Model 'Uh f' j) (,I.,
, .
Model Sizo.
I,n):),~
TYPE OF SYSTEM
Warm Air Plants
Gravity
Mechanical
Air Conditioning
Venl. Syslem
Conn. Load
Fuel
{... ,
(Cfl.....,-,-"
Flue Size
Supply Openings
HEATING OR POWER PLANT
Stoam
Hot Waler
Radialian
Special Devices
Relurn Openings
Input Oulput ,:)7, :1,7,
Edr.
Other Devices
Clm.
TYPE OF WORK
Allerations
Replacemenl
New Conslruclion
xc
Repair
Esl. Comp. Dale
ct/,7/',",,/
Esl. Cas I $
1!()UrL
99- e9~
,~O~-
BU\\.O\NG PERM\T
Building Perm~ ,
HEATING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEES $
.50
Receipl ,
TYPE OF STRUCTURE
I. Pin.
1.(~fl
1, Yellow
III
file It)
Cily 1J
Conine lor I
...
0\
I
III
III
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Single Family
Two.Family
Induslrlal
Multi-Family
Olher.
Commercial
Public
Fee Schedule
Induslri;:l!. Commercial &. Multi-Family
Residenlial, Healing & AC
Residenlial, Heating Only
Residential, Gas Fireplace
Aesidenlial. Addilions & AIIerations
Aesidenlial, AC Only
1 % of job cosl ($39.50 minimum)
$99.50
$64.50
$39,50
$39.50
$39.50
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Remember 10 add Ihe Slale Surcharge on Ihe boltom ollhis applicalion.
The price of your healing permit includes one rough-in and one '",al inspection.
Addilional inspeclions will be billed al $35.00 each.
House Healing Test Record must be submitted wilh !2i!ilQing Rermi.\ nllmhAr belore build.
ing certificate 01 occupancy will be issued.
HEAT CAICIII.AI!.Q.!iS. BJ:;QIJ!BfQ wilh number 01 supply and return openings listed p'
rOO/l1 wilh CFM's per opening. New structures or addilions send lIoor plan with supply
and relurn 10Calions shown. HEAT LOSS CALCULATIONS, PAYMENT AND
APPLICATIONS MAY BE MAILED TO THE CITY OF PRIOR tAKE, 16200 EAGLE
CREEK AVE. S.E. PRIOA tAKE. MN 55372.
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City Hall business hours are 8 a.m. - 4:30 p.m.
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ALL WORK MUST BE INSPECTED (ROUGH-IN AND FINAL). CAll CITY HALL
447-4230 ~
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I hereby apply lor a mechanical systems permil and I acknowladge lhat Ihe ~
informalion above is complete and accurate; thallhe work will be in conformance
willi lhe ordinances and codes of the city and wilh the slate building/m9chAnic81
codes; Ihallhis lorm does nol become a permit until signed by Ihe BUilDING
OITICIAL; Ihal Ihe work will be in accordance with Ihe approved plan in Ihe
case of all work which requires review and approval 01 plans.
Building Olliea!". Signalur.
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. CITY OF PRIOR LAKE
. UI2IIO Eligle er.ik Av. S.E. p.nnft No.
PrIor La., UN 55372
tiEAllNG APPUCAll0N I PERMJT
0118 7/7.7jO,Q PID' Z5-3~- OOr,p-O
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ShAddr';' 4e..t~ PaY1d...f/z'~ -r.d reI
LoI ~ Block I Adtfdlon l..Ji-n~r Add.
Owner's Name, O~t2.--n .", -I-/-o.r.., e. ~
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qq - ty:l(p
:rvPE OF STRUCTURE
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Single Familv
Commen:tal
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Two-Family
Indusl,TaI
Fee Sdledule
Induslrlal, Commercial & Murfl.FamUy
Re&lden6al, Heaflllg &. AC
Reslden1la/, Heating Only.
Realdenllal, GlIS Fireplace
Residential, Adll'dlons &. Afterallona
Residential, AC Only
Add/MS.
H'1I1I1llJ Contractor
Mirrua
Telephone. (oSI. U2.:~. 1/44
-Furna Maia.~81tJ,.nTlml
Mod.JS~. -G1...~(3J-~i/~/()()
~ ~Y1"'7 - r2.. 1 tA/'rl
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Cam.1..cad
Fuelk'tU. ea.~ue Size 5"
Supply Openings /1
Retum Openlrv. ~
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Ed,.
Cfm.
AlIeMlon.
R8paIf .
Ese. Cost $
HEATING PERMIT FEE $
STAlESURCffARGE $
TOTAlPEmllTFEES $
typE OF WORK
Replacement
Est Co1rfI.. DlII8
MulU-Famlfy
PIbli<> Oll1er
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1 % 01 job llllIl (SS9.5O rrInImlm)
$99.50
$64.50
$39.50
$39.50
$39.50
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Remember 10 add lhe Stals Sun:harge on the bottom 01 this "':"" ':. 1.
TYPt:DFSYSlt:M
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Mechan1l:al
AIr Cond llonlng
Vent. System
HEA11NG OR POWER PLANT
Steam
Hot Waler
RadiaIlon
Spacial Divas
The.pricelllyourllaallngpermitll "'. ""1lfl8rough-inn_lirIalt""T'" L .
Additional inspections will be billed al $35.00 &adJ.
H_ Healing Tesl Record musl be IlUbmltllld wilh IlIllIl!ing IiIlImlIIIYIII!!ti before build-
Ing certilicalll 01 occupancy will be Issued.
tif6[ r.A' r.w AT!n...~ "'~f\1 ''<IF'l w1Ul number of 8~ly and ,alum openlngsllsled per
room willi CFM's pe, opening. New slnJcturea or addaions Il8fId nOOT plan wtlh s14>PlV
and I8lum locations sbown. HEAT lOSS CALCUl.JtirIDNS, PAYMENT AND
APPUCATfONS MAY BE MAILED TO THE CITY OF PRIOR LAKE, 16200 EAGLE
CREEK AVE. SE PRIOR LAKE, UN 55372.
OIber Davas
ClIy Hell buslne.s hours are 8 a.m. . 4:30 p.m.
ALL WORK MUST BE INSPECTED (ROUGH-IN AND FINAL) - CALL CITY HALL
447-42SO
I hereby apply for a mechanical sy.lems permit and t acknowledge Ihel the
inlormallon Gova is complste and accunaIs; that Ihe work will be In conlonnanca
wJth Ih. ordinances and codes ollhe city and with the elale bulk/lntlmechanlcal
codaA; Ihalthls form does nol becoma a permll unUI sIgned by the BUILDING
OFFICIAL; thal1ha work will beln accordan~ with the lIfIproved plan In Ihe
cass 01 all work which requlrss review am' epproval 01 plans.
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New Conslrucllon
99- B9h
~ PAID WITH
r BUILDING PERMIT J
BuildJng Pannllll
.50
Recept It
Building otrK:a1's SJgnaIuN
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JR LAKE
..~SPECTION RECORD
DEPARTMENT OF
BUILDING AND INSPECTION
SITE ADDRESS 44,s-po, ~~1I""'L.) \;.
NATURE OF WORK N"c.' (\.<M.J.~",J\.....,","",^
USE OF BUILDING SF\)
PERMIT NO. '1Cj'-~~lP DATE ISSUED "-1~-q'\.
CONTRACTOR 'v.IJ,^"""~'~~ l~....
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR
DATE
I FOOTING ~ 1_&. I ?-/I-'11
, FOUNDATION (Prior to Backfill) in) #J7!1'J ~&vl ll-dO 9J
PLACE NO CONCRETE UN7rtc ABOVE HAS BEEN SIGNED
ROUGH - INS
SEWER I WATER I SEPTIC (' /J) Zl/'r.?~ fi
FRAMING (/.
INSULATION uqf~r ~, 4-~-'f) ~ {i v.ph ~'
ELECTRICAL
PLUMBING
HEATING (if required)
FIREPLACE
GAS LINE AIR TEST
, U& '4
(/1) 6); 5/'"
/VP ~I-I 'f7 A-:f1 'F,p, ~, Cj-::I1-1I
V ~ U, Cj-if?-11
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GRADING (Prior to Sodding) ..
BUILDING Tfllo,~ ('.-D. ""-06\ r 11\<,
ELECTRICAL
PLUMBING
I HEATING
.. DO NOT
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
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FINALS
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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. ..
Call between 8:00 and 9:00 A.M. for all inspections
FOR ALL INSPECTIONS (612) 447-9850
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