HomeMy WebLinkAboutBuilding Permit 99-0987
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~~~' CITY OF PRIOR LAKE ;~
/ 1lBepartment of ~ulIbing JnS'pettion _~~-
prFinal Permitted 0 Conditional C.O. Expires
This Certificate issued pursuant to the requirements of Section 307 of the Unifonn 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 dassificatiol'
SINGLE FAMILY
Bldg. Pennit Nfl,
99-987
Occupancy Type
R3
Type Construction
VN
Fire Zone
N/A
Zoning District
R2SD
Legal Description
L3, B4, GLYNWATER FIRST ADDITION
Owner of Building
_ C:I(e Address
3387 GLYNWATER TRAIL
Conlraclor'sName&Address WENSMANN HOMES, 1895 PLAZA
~ -~, . City Planner
DR., EAGAN, MN
ROBERT D. HUTCHINS
~ l~ ;:ilio~fficiaJ
-, I
JENNI TOVAR
Dare:
Oa..:
POST IN A CONSPICUOUS PLACE
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
/4njn
ADDRESS ~3g"1 aL.....,...,A..-En. /aA'L
OWNER
CONTR. IAJE.J5NtINAI ~C
PHONE NO.
PERMIT NO.
f/?- '187
"
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
)Ii, FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
)l(.EXIGRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
COMMENTS:
1J/.ME 0/1:
(!unlUMll OK
~Ij,/ .5...:/ ~ 0oJ""L. ~"OIJEf',
)( WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: It.~J,..
:>wner/Contr:
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.,
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
lNSNOTl
~..__..~--^-_.,,~--.__._----_._-~---._--_._-- ^
I :1
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
DATE TIME
9/d9'Z /: 30
ADDRESS
3387 6LVNWrr / t:::..I€.-
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING A.
1lt FOUNDATION r
'D FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
o PLUMBING RI
~ 0 MECHRI
....~ WATER HOOKUP
,.. ?!--SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
COMMENTS:,
(pr;' ~ <SOIL
I"S~-hr~ ~
99- 967
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
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o ~K S SFACTORY, PROCEED
~;~~E T A ION AND PROCEED
o CORRE T . CALLJR REINSPECTION BEFORE COVERING
Inspector: Owner/Contr:
CAJ 447.~ ~ THE NEXT INSPECTION 24 HOURS IN ADVANCE.
COD1 REQUIlJ iMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
V INSNOTI
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CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
CA TE TIME
3"2-7/t:J I 1: 00
ADDRESS
...5' '? ,f' 7
$;r-'~
CONTR.
R,
OWNER
PHONE NO.
PERMIT NO.
99 - 9F''?
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
frg FIREPLACE FINAL
o GASLINE AIR TST
o
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
A B PLUMBING FINAL
A ~ MECH FINAL
COMMENTS: 151c16. , i
J vV\ (J,MOw.e.AU' Q\::::..
, Nle>>r c;.e...o \,.o~
~~~
o FOOTING
o FOUNDATION
o FRAMING
~ 0 INSULATION
-n 'l7 FINAL
'd SITE INSPECTION
, ::7';' vi. <fl,
/
~ORK ATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
, CALL FOR REINSPECTION BEFORE COVERING
Owner/Contr:
Inspector:
CALL 447-9850 FOR TI E NEXT INSPECTION 24 HOURS IN ADVANCE"
v
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
lNSNOTl
- .~_.~"----_."~_.._,,._.- ,,-_.__.,_._,--,,~._-~----."---.._. -_.__..~..__._.-
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
.oATF RI=r.I=JVI=D.
6/II/ClQ
DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
12. SITE ADDRESS
.JJK7 C/VN /..J<.-7-<,r
3, LEGAL DESCRIPTION
..3 BLOCK
ADDITION C/VN I..J"/,,r
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Nf--J
'SI
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1
PID ),,j-.3.5'2 -o/p- d
A'" // 1; O.IV
14_ OWNER (Name)
15. ARCHITECT (Name)
6. BUILDER (Name)
tJfWnoltlV1d
/J6mu
7. TYPE OF WORK
NewConstruction~
Chimney (j Misc.
B. PROPERTY AREA OR ACRES 19. PROPERTY DIMENSIONS 110. CULVERT SIZE
Sq. Ft. Width Depth Yes No
1 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 o~lal can revoke ~ pe)l1lit forJ'st cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
x----AJ.,a''''"' r7 .1/ ~ IYsi' ,j'-/O -1'?
/7 ~ / / Signature License No. Date
LOT
(Address)
(Address)
(Address)
/8ff /14Z"- Dr
[p. M N /J1 A/
V Septic 0 Deck 0
Addition 0 Finish Attic 0
Fireplace 0
Alterations 0
v
SETBACKS: Required
Actual
Front
Back
BUILDING DEPARTMENT VALUATION
1. DATE
<f-/o-? j
RZ5D
(Tel. No,)
(Tel. No.)
(Tel. No.)
t5/. ,--/Olr '1'10 0
Re-roofing 0 Porch 0
Re-siding 0 Finish Basement 0
FOR ADMINISTRATIVE USE
Side
Side
USE OF BUILDING
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION ---l-k3: (JOC>. t"J(')
Water Tap ................................... It
Builder's Deposit ............................ ~ - f\ -
Olher .................r=..,............... $ .:;.7, 10. 11-
Total Due ..L........................ $ t:.-':". ~
Pa;d I) 5 I o. 7 I Rece;p. No, ,JI" 0 3 s:--
Da'e fi/Z--l/1f0 By A14. _
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning 6rdinanc~ and nfay proceed aJrequestad. This document when
si by e City ner~~.a terJl>OraryCer;;r:~0~comPliance~~s:n~on~~m0n!vBef.:1~ a~stbe issued.
Planner Date - ~ . Special Conditions if any
,C; F' A
TYPE OF CONSTRUCTION: I II III IV V
OccupancyGroup A B E F H , M R S U
I. ? cf2. . rzh'
"(RI.C..U,
~I . ">0
Division 1 2 3 4
Permit Fee ................................... $
Plan Check Fee ............................. $-
State Surcharge ............................. $-
Penalty ....................................... $
Plumb;ng Perrn;' Fee ..1.1.:.91..7......... $ -, (')0. Oe.
Mechanical Permit Fee fr.:ftJ......... $ I ()(J ./1:) e>
Sewer&WaterPerrnl' ..'(1..:'!17......... $ ~.t:)O
Gas:r;ce pe~~.'f.~, ............. $ 40.00
Thi 11'.0 mes Ing Permit w~ _~tQYed.c:r 4-
By .\1' Date l":J '1___'-..- L/
-" -I -
Certificate of Occupancy
Issued
Amount Brought Forward .................. $
Pa" Support Faa ........................... $ ,qc:;v. on
SAC ............,............................ $J...QS6. (')0
Collective Street Fee ....................... $
SewerTap ................................... $
('L t. $
Pressure Reducer .~.................... $
MeterHom ........2::7....:...................... It
Water Meter ......:m...................... $
Sewer & Water Connection Fee ........... $
WaterTowerFee ........................... It
City:
tb ~
24 hour notice for all inspections 447-9850
I. White File
2. Pink Qty
3, Yellow,-,~~
.....t~.,I~~
NFI!.#
Permit No.
99 - 9137
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
MATERIAL FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA 0
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS 0
SURVEY 0
PLOT PLAN 0
SETS
COPIES
4s,a;
/ ;2. S- . c:.v
(.?,0f'l.00
r
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~
Cjq ~ tffj7
White . Building
Canary . Engineering
Pink - Planning
Th~ ('t'nlt'fof Ihr L.kr Counlry
j;lUILDING PERII!III..APPLlCATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
N6N.5/o//1NN
6/f( /qc;
APPLICATION RECEIVED
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
3387
CiLY/II WA~
/1<:""
NvI
Accepted
Accepted With Corrections
-<
Denied /!, /If'J k/
Reviewed By: (;/.l!L7/1 ........
Comments:
S}<<;L~:B 9CJ - 957
~j dQ cJj:~ ~~
Date:
[5.25'-99
"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."
I r
._----------~--'---
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-~, .,;....
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Thr Crnlrr of lhr L.kr Counlry
/',; ,,;' ~..;'
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,
,
White - Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPABTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
,:.: .J' /' / (/ ./
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
;"
I :J,.,.
I'.,
.. { ,
,.. I I ,,:,,-,'__..
}
, -.
.1/
Accepted I/"
Accepted With Corrections
Denied
Reviewed By:
~1~
Date:
~ - J-c.9 -Vi"?
Comments:
kf~fJ/e.)& &. ,S{e.cA\ 1{i) 'D-v / ~t~< 4
<;N, ('./ t) J\ / /M/Vl curvl9\}eA ~lA\<: ~
G-'tr^I_^"r;IP.AI" )~ ~~.
~~ WJ&o/~ ~ kk. ~~~VI
~ b~~ /~ ~<-~~l<_
y e.4')c9 ~"~,,
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," ..
*
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..
, .
,
:~~.
i ..6 en
y
'it? - 'lei
White - Building
Canary - Engineering
Pink - Planning
~
. lit Cfnlu of tll" Lak"Counlry
BUILDING PEBI\IIIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
/iE IV'::; 1'11"/ /1./ IJ
6/11 / Cj1
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
33B7 6LYNiVr)~T/c.. //VV
Accepted
./
Accepted With Corrections
Denied
Reviewed By: J.lltL11!.'!1.. E".n.....^'^'
Date: ~Zl)H
Comments: 17,,.,.,.-,.- "'os,. iJ<. C'....v~ ~""
1"0 Al<Jb AL.tJ",J(... Pllo'tCIl.r'1' Uf'JE.s
At:;. ,fifIJe.I-/ As Pttt4'nc.ll'-.
S~..
IAJ~".Q""""ruJJoJ
ON
r,.,c:
RFIIF....<~ Slt)~.
.5E"E ATT'"'Ar.MlY&:".'T'<. ~ J. h~4,- Qlltfl1~ IAkP,t!T'I.IU..J J..J&..a-M,qrU,^1
2. r:..dAlIl~4 ~_IlIAJ
? C~.<.oN Co-.J"~'- t11"'A<"n"~
</. Dlo<>oAJ C."Ti1DL PLIlN
"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."
I'
HEATING APPLICATION I PERMIT
Oato 1;).-/0 q <; PIDM 2S~.3SZ - 0/8-0
53/r 7 lJ/... Mll:.b, /f1.J
o
Lot ~ Block 4- Addition _ GLy'IVN,q~ SOUn-;
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....
o
Il.
Sito Address
<t
III
III
III
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Ownor's Name.
CITY OF PRIOR LAKE MC
16200 Eagle Creek Av. S.E. Permil No. 9?-?fj 7
Prior Lake, MN 55372
Address,
HealingConlraclor A~LIE.D_ FIRESIDE dba FIRESIDE CORNER
Address 2700 N. FAIRVIEW, ROSEVILLE, MN 55113
Telephone _. 65 1 - 633 - 2 5 61
FIREPLACE
1l!Jmt", Make & Model /Jp,J AJ G c...
Model Size
I-
QI
c:
I-
o
U
QI
-0
...
.,
QI
I-
Conn, Load
Fuol C"0.J
( .-x:.b?
TYPE OF SYSTEM
Warm Air Planls
Gravily
Mochanical
Air Condilioning
Vent. Syslem
Flue Size
Supply Openings
Return Openings
Inpul _ Oulput_ J. 7. "'uJ
Edr, ,
HEATING OR POWER PLANT
Sleam
Hal Waler
Radialion
Special Devices
Clm,
'r'
Ii.
<l:
III
<t
..
t-
O
C\
C\
I
o
....
I
U
QI
o
Alleralions
Repair
Est. Cost $
Other Devices
TYPE OF WORK
Aeplacemenl
>LJ
New Conslruction
Esl, Camp, Dale
/ ,.J ---1'-/-<; ?
99-987
/' l'~\D WI11-\ '
\ BU\LDING PEA-M\T j
II (),) ,cJ::>
Building Perm~ M
HEATING PEnMIT FEE $
STATE SUACHARGE $
TOTAL PERMITFEES $
.50
Receipl M
TYPE OF STRVCTURI;
I."'n.
2. nrrE'ft
J. Yeftow
Fo~
0',
CoItfIIlCIQr
Single Family
Two-Family
Industrial
Muhi-Family _
,Olher
Commercial
Public
Fee Schedule
Induslrlal, Commercial & Multi-Family
nesidenlial, Heating & AC
Residenlial, Heating Only
Residenlial, Gas Fireplace
Residential, A.dditions & Alterations
Aesidenlial, AC Only
1~ ~c~ ~.~"...i""i""1---,
10 _ t" I f ~ _
$99, D!'s '-
$64.!.~ :J
$39.~ol', \ DEe I 0 1999 I
$39,5!l/' \ I [) j
$39.$b1 U, : ' ~L/
I
Aemember 10 add Ihe Slalo Surcharge on Ihe bollom of this applicalion.
The price of your healing permil includes one rough-in and one Unal inspection.
Addition.1 inspeclions will be billed el $35.00 each.
lIouse Healing Test Record musl be submilled wilh lwiIIlinllllBlJlJillllllDller beloro build.
ing certificate of occupancy will be issued.
!:!.EI\I CALCULATIONS REQUIRED, wilh number 01 supply end relurn openings lisled PE
room with CFM's per opening. New structures or additions send lloor plan wilh supply
and relum laealions shown, HEAT LOSS CALCUU\TIONS, PAYMENT AND
APPLICATIONS MAY BE MAILED TO THE CITY OF PRIOA LAKE, 16200 EAGLE
CAEEK AVE. S.E. PAIOR LAKE. MN 55372,
City Hall business hours are 8 '.m, - ~:30 p,m,
ALL WORK MUST BE INSPECTED (ROUGH-IN AND FINAL). CAll CITY HALL
447-4230
I hereby apply lor a mechanical systems permit and I acknowledge that the
inlormation above is complete and accurate; Ihat the work will be in conformance
willi lhe ordinances and codes or Ihe cHy and wilh rhe slale building/mechanical
codes; Ihallhis lorm does nol become a permit unlil signed by the BUILDING
OFFICIAL; Ihal Ihe work will be in accordance with Ihe .pproved pl.n in the
case of all work which requires review and approval 01 plans.
&LLa d...ac..
~AP 1:.?5iogr,luro
<fA ~ ~
B .ng Ollica"s Signalure
/cl/h./q f'
. . Date
a/rofir
Dale
RUG. 24. 1999 6: 07RM
GENZ-RYRN' I'
NO. 611
P.2/3
.
_. ,...
y....... . -....
__ . CITy
I
I
, I
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;1
"
I ~TY OF PRIOR LAXE
51. ~~ ~D WATER PEMIT
I:
"
I'
"
:i'
NO. 9'9'-Q87
NOTE:
Sewer and Water
contractors must
be reqlstered
with the city.
,: I
r:J ~ii
APPLICANT: \~ .r, :.
ADDRESS: ,1U-1LJ.~' ':
SIGNATURE: Ll~
SITE ADDRESS:. ,~~~
PHONE: tD<;\-4"l..5~1l4~
.L1- ~ATE :~-z.~- 9"
BLDG. PERMIT 41 9<?- 98 7
Rz.s'O
..."" Tit. Nu...J PlOt 2-5- 352. - 01 6- 0
F L IN THE BLANKS
,I j
1. Estimated lenqth of!!, Ilhr service
2. Size of water servit I 1'\ inch(es) .
3. Location of any Qo~p,1nqs from structure
"
4. Type of sewer pipe. :i, ;.as
II
5. Estimated length of:;; eWer line
,..
II'
6. Clean out (if ret:lred), located at
st.ructure. i':
, ,I
___~=~____~__~_~:~~===c~___________~_~_~~--~=--=____=c=:~
" ,
~~~ to~r permit when approvef' I
., :J:;f/ .1,: - DATE: Bj?7j91
===r.;;_~_ .J_==~======_.'.'T"1, ~ --~==:z:.___._____.". ___~_._=====--.____~~~___-=====
j'j
$ 35.00 I,~,wer and water line connection permit.
$ .50 it\IJrcharg-e
$ 35.50 iJ'OTAL
. :1,
Fee for either sewe~ er water individually is $20.00 plus
$ . 50 surcharg-e. -;,,-
'I"
"
Sewer and water pe~l's issued for new construction must be
recorded on the bui~\ n~ permit card at the time of issuance
to insure that no PI l1cate sewer and water permits are
issued.: .
,
DATE PAID I AMOUNT PAID -'4\.\\ .
" ./" P~\UNG" PERM\T
RECEIPT # .'j' REC'O Bf~,!_nl
un I
feet.
feet.
pve ~
'-/[)'
cast Iron
feet.
feet
from
This
BY
FEES:
*
....
:
I;', ,
4629 Dakora 51. 5.E., Prior ~ke, Mil' 18$c>tll 55372 I Ph. (612) 4474230 I Fax (612) 447-4245
~ iQUAL wi'r....~' ~NTTY EMPlD'r'ER
1:1
Ii
NOV. 18. 1999 9:40AM
GENZ RYAN 6513226147
NO. 477
P.2/7
2.
3.
.-, 4.
, )
5.
6.
--. ....
"fG.UtIW .. u.uca.,.
IIDUt . CITY
CITY OF PRIOR LAIa:
SEWER AND WATER PERMYT
NO. 99-9& 7
.
NOTE: Sewer and Water
contractors ~ust
be registered
with the city.
APPLICANT: ~..CJ.:Z_- {,uA/\ I PHONE:~'7_':r.,-II\.l.~
- J
ADDRESS: IU"'\LiC~ (If''\\pMA~ 1171 ~ATE:~
:~::A:=~\~(~l~l1\A'ir~T/lL :::- ::~:;'?-#_C~f~:~7
FILt!IN THE BLANKS ,
4D teet.
1.
Esti~ated len9th of water service
I,'
Size of ~ater service inch(es).
Location of any couplin9s from s~rueture
Type of sewer pipe. ABS PVC 'I. Cast Iron
. I
Estimated length of sewer line J-.Jn feet.
Clean out (if required), located at
structure.
feet.
c ,r, "
t', .;-
""'\1' ".-- '
" ..),--~
,1'
feet
from
S;WIUE=====,___===_____,___ _======z... .. ,_ ......... ____=---_~_ =====--__..___=:=;=-:lI;;:;;;~
Thi~ apPlicat~~~ your permit
BY ~t[U't~
. ~/
v
==______=____ "..,,_.." . ~_..,... '''' li~=-
when approve)d. /
DATE: /1 J-78F?LJ
. I
-"=''I;I--.-.a;;___,,________.=======
FEES:
$
$
S
Sewer and water line connection permit.
surcharge
TOTAL
35.00
.50
35.50
* 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 ~AID
RECEIPT 1/
AMOUNT PAI~D . 'S,...tJ
"'1'\'''' '-'
REC'O BY, S'l" niNO.
. 4629 Dakota Sl S.f. Prier loske, Minnesota 55372 I Ph. (612) 4474230 I Fax (612) 4474245
AN EQUAL OPPORnlNITY EMl'LOYEIl
II
; ;1
NOV. 18. 1999 9:41AM
GENZ RYAN 6513226147
NO. 477
P.3/7
n.. c..w.r .11I' l.IIkc 4;eslm"
CITY OF PRIOR LAKE
. PLUMBING PERMIT
ApPIicant:~I1z...- P J '" .,.....
Address: I 1b-1<; c:r..r,~ ~ ---we I .
Signature: \~ ..~
Legal Description: Lot L..23 Block 4 Sub 6 LV A IVAT'6 ~ S O(j! H
Site Address' :~~~..., fJ-I..r~PffPi2..... -r'iI2J-.
Building Permit # qq- tJe7 PID# 25-,3(:;2- 0/8-(')
NOTE: This permit INJII not be processed without complete Information.
FIXTURE UNITS
1..100 l'iIo
1. GaId CiIy
3. YoIl.. ~
# q q- CI'r rl
Phone:.JL:I<:::::I-U'L~ -II uLl
. ,
Quantity Type of Fixture Quantity
\~ Bath Tub with or without shower
\ Dishwasher
\ Roar Drain
4~ Lavatory (bathroom sink)
\ Laundry Tray (1 or 2 compartment sink)
2.' Shower Stall
\ Sinks
Bar Sink
;--
?-, Water Closet (toilet)
Type of Fixture
Rough-ins
Water Heater
Water Sonner
Stand Pipe (washing machine)
sewage Ejector _
BacIdlow Assembly (RPZ, Double Check, PVB)
Backtlow Assembly Test
Lawn Sprinkler
Other
FEE SCHEDULE
Industrial, Commercial & Multi-Family
(1 % of job cost, $39.50 minimum)
Residential. New One & Two Family
Residential, Additions &. Aheratiom;
state Surchal\le
$99.50
$39.50
$
$
$
$
.50
GRAND TOTAL
~..~ Wlil-l.. ',' .
T' \"'G \"r:.hi..11
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l,,_ .../
Thi. penni. I, pllnted upon the .~p~. condition tit.. ,"id
con~tor. shall comply in all ...-peets ...;th the ordinan=
~the S<ale PlumbinrmC; w:'~, t c~~n)S ,he"",f.
R . : 'fj /<<'1 DATE
, '
.1; , "-- ' ATIEST
Call for all m4ections 24 hours in advance.
16200 Eagle Creek Av. S.E., Prior Lake. Minnesota 55372 / Ph. (612) 447-4230 I FAX (612) 447-42~5
An Equ~l Oppommity Employer
II
CITY OF PRIOR LAKE
, 16200 E-cl1I creek Av. S.E. Perm" No.
Prior 1.80, UN 55372
" )
CJ<j- 961'
Dlle
rj Po-()
tf..r..u V1I"'\IlO I V1 T
CoM. Load
Fuel ~.~Flueslze,
'2"2-
JO
TYPE OF SYSTEM
Wlfm Air Plants
Glavlly
Mechanlcal
AlrCondnlonlrr,Lj7n"-' ~n",'{
Vent Sy...em ,
HEAnNQ OR POWER PlANT
Slum
Hol Waler
Radiation
Spedal Devices
OlherDevlcae ~D Tn r-."nA1JIcL
Supply Openings
Return Openqs
lnpul IIm.crr1D Olllpul qJ.1'YJD
Ed!.
Clm.
TYPE Of WORK
x
A11l/allollS
NIlW Construcllon
Replloceme'"
Esl. Comp. Dale
Rapalt.
Est. Cost , ,
HEATING PERMfT FEE'
STATE SURCHARGE ~
C/Cf- 98'7
Building Permn II
.50
~ PAID WITH
R \ ElU\LO\NG h...,,'fi'
_!pI II -
TOTAL PERMIT FEES ~
me OF STRUCTURE
1.".'-'_ Filo
2, llIo )- CIly
3.YcIk._ .....,. ..,
Single Femlly _ X
Commetclal
l1No-Fem~v
Induslnel
Multl-Femily
Public Other.
Fee SchedtJle
Induslrial, Commercial. MullI-Famllv
Rlllldenllal, Healing I. AC-
R8Ildenllal, Healing OnIV.
Residential, Gaa AreplaOll
Rllllldenllal, Adl1ldons I. AHel'llllons
Resld8llllal, AC Only
1% 01 job cosl ($39.50 mlnlmllllll
'89.50
'64.60
$39.50
m.50
$39.50
Remember 10 add the SIat8 Surcharge on tl1& bottom 01 this eppIlcaflon.
Ths.prfce 01 )'Our heeling patmn Includes ona rough-In end one ftnal 1nspecl1on.
Addidonallnspectlons wYI be billed al $35.00 ead1.
House HeallngTesl Record must be swm!lled with ..,I\rI'..... RIItIIlI numbar bafGre bulId-
InII cartlllcale 01 occupancy wi. be issued.
ue,T ~., ("II' jIT'f1M,~ ",enll'"'''" wlh number 01 sUPPlv and relurn openlngslle1ed per
room wilh CFM'e per opening. New Ilrucluf88 Dr addillon8l8nd ftDDJ plan witt supply
and ,alum locallon. shown. HEM LOSS CALCULAnONS. PAYMENT AND
APPLICATIONS MAY BE MAILED 19 THE CITY OF PRIOR LAKE, 16200 EAGLE
CREEK AVE. S.E. PRIOR LAKE, UN 55372.
Cily Hall business hours ale 8 a.m. . -4:30 p.m,
ALL WORK IIIUST BE INSPECTED (ROUGH-IN AND FlNAL)- CALL CITY HALL
447--4230
I hereby epply lor a mechanical ayelems parmi I end I acknowledge Ihat Ihe
Inlormallon above I. complele and accurate; thai the work wUI be In conformance
with the ordinance. and codes of the clly and with the alate bundlng/mechanlcal
codee; Ihst thle (DIm doss not become a parmlt unlll sIgned by Ihe BUILDING
OFFICIAL; thai the work will be In accordance wllh the approved plan In the
case 01 ell work whIch requires review and approval o( plana.
\~ ' . 1\ \.-1 \ qo,
C ;t~. //;;~aiSXi
Buil<fing ~'s Signalure m,le
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....
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....
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....
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Dale
Sb Address
Lol ~ Block
Owners Name
J. PI..
1_ .....
,. YdIMl"
Rio
CIIy
TYPE OF STRUCTURE
Two-Family
Commerelal
Induslriol
HEATING APPLICATION J PERMIT
/;)//1/0<> Pro. ?5~3.1:)2- ole.O
I ,
.ssK7 to/1M /Jc:tl. /l>J~
4- ,. """'1 f/ ~WNhJffil:=Y' soltTl-/
LJl1A-.~~ j{~
Fee Schedule
I nduslrlal, Cenmlfcial & Multi.FaIn.y
Residential, Heallng & AC
Residen~al, Healing Only
Resideolial, Gu Areplace
Residential, Additions & AKerations
Residential, AC Only
Addrass
Healing Contraclot ALLIED FIRESIDE dba FIRESIDE CORNER
55113
Addtess, 2700 N. FAIIlVIEW. ROSEVILLE. HN
To'ophona' 651-633-2561
FiREPLACE , I
!MJ1t1llP Make & Model ALt.u;J 'U
,
folXD'1L
"
III
III
III
'"
'"
'"
~
'"
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a:
w
z
a:
o
o
w
o
H
en
w
a:
H
u..
Model Sjz~
CoM. Load
FIJ8l. (;;A-J
Supply Openings
"elUln Openings
Input
Edr. ,
Clm.,
Akeralions
Flue Size
OulplJt ,.jlOM
MuIII.Family
Nlfc Olher
1 % 01 job COSl (139.50 mllWmuml
$99,50
$64.SO
$39,50
$39.50
DEe I , tmJ
~'JIOCn.
I
Remember 10 add !I1e Stale SUlCha'1l8 on ,he boItom oIlhis appIcalion.
TYPE OF SYSTEM
Warm Nr Plants
Gnmly
M9chonltal
/1M Cond_lonlJ1g
Vent System,
HEAliNG Of! POWER PLANT
Sleam
Hal Walar
Radlalion
Spedal Devices
The price 01 your haating permil includes ono rough.in and .... 0naJ inlpoction,
Addmonallnspeclions wil be biled al $35.00 each.
House Healing Tesl Record musl be submitted with !ll.!iIdiDlll!tIIIIiI.llII!IDl before build.
in9 cerlllicale oIllCCUpancy will ba issued.
HEAT CAlCULATION!; "FOIIIRFn wilh nurOOer of supply end l8\Um IIp8f1ings bllld III
room with CFM's "'" opening. New .tructures or eddilione ....d Door pion ""'suppty
and ralum locations shown. HEAT LOSS CALCULAllONS. PA.YMENT AND
APPLICATIONS MAY BE MAILED 10 THE CITY OF PRIOR LAKE. 1112.00 EAGLE
CREEK AVE. s.e. PAIOR lAKE, MN 55372.
Cily HelllJusmess houn are 8 un. .,4:30 p.m.
ALL WORK MUST BE INSPECTED (ROUGH-IN AND FINAL). CAlL CITY HAlL
441-42.30
I hereby apply lor a mechanical systems permit and I acknowladlle lt1allhe
information aOOm Is complele and accurate; thallh. work wi' be In conformenca
with Ihe ordinances and codes olth. elly and wilh Iha slata bullding/_chantee:
codes; Ihalthis form doe. nol become a permit unlll sloned by the BUilDING
OFFICIAL; Ihallhe work wiD be in acco,dance with the epproved plan in the
case ~u work W;hlCh require. r"vlew an" approval of plan..
j:Jk4~ 14~ /:u"",,,
, ~J'~gnalur,. / . Oam
'If1/.,- . ~-JJ.OO
, ding Onical'e Signalunt Dallt
Other DIVita.
Aeplacamelt
TYPE OF WORK
New Conslruction
~
Repait,
Est. Cost ,$ .
Est Comp. Dale
II fI'},\, Building Permn .
/ ri-- /C/.-m
qq~ q?J1
..
>-
m
....
t:
Gl
en
HEATING PERMIT FEE $
STATE SURCHARGE S
TOTAL PERMIT FEES $
,50
"
, PAID WITH
BUn.DING PERMIT
Receipl ,
PRIOR LAKE
INSPECTION RECORD
DEPARTMENT OF
BUILDING AND INSPECTION
SITE ADDRESS'Z ?- B7 C,l "c.., l~ \ Co ~........
- - v
NATURE OF WORK NPL.\ cclv'li>-..\,.~\'oi'--(
USE OF BUILDING <:'1=" A.
PERMIT NO. 4'7 - q ~7
CONTRACTOR _LJ,~c.', t-f.."...,..2./l
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
~ INSPECTOR DATE
IFOOTING\(fV~,~\t€R,\D'''-4~ I fu, 19-3-'7'1
~5~1 FOUNDATION (Prior to Backfill).f'~ul 4-: 'J-y~" rN Iff: / q - / (J-9CJ
1/o/Jl/'''l PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
SEWER I WATER I SEPTIC (/J) rJe/f1 (L
~A~OO ~ !\)
INSULATION L-. L.. 1/tf/40 I /1'--"- 't7/rt1
I '
:~~~~~~~AL 1u7#/11- / oj In I I
HEATING (if required) ,}/ i I) 7.J II (;; I 0:
FIREPLACE" I ~ /Zo~~ '3 I
GAS LINE AIR TEST /"",... -Cy,1 '''I~l." leJ) II hl1-"} I
COVER NO WORK UNTIL <<BOVE HAS BEEN SIGNED
I I
FINALS
DATE ISSUED 8-2'5-7;
l
J
ru IlL / CIA
I. . - u
~ WAu.~ J L. .~
GRADING (Prior to Sodding)
BUILDING
ELECTRICAL
PLUMBING
HEATING
DO NOT OCCUpy
vyf
~. \)rwtt
I ~, ~(lN1.\
I t \)d A
UNTIL ABOVE AS
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.
f)., }"!-<t\
~ \~1. \01
, ,
3, }?-<6\DI
'-\::ZA V\
BEEN SIGNED
. .
Call between 8:00 and 9:00 A.M. for all inspections
FOR ALL INSPECTIONS (612) 447-9850
II I