HomeMy WebLinkAboutBuilding Permit 99-1428
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'~H CITY OF PRIOR LAKE s'!~;
'1h, , ~epartment of lSutlbing 3Jn~pettion )"'~~" .'1
:h 0 Final Permitted 0 Conditional C. O. Expires ' ! t ,~
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:'t i~ This Certificate issued pursuant to the requirements of Section 307 of the Uniform Building Code ;~<)
t~~ ce.rtifying that at the time ofissuanc~ this structu~e was in compliance with the various ordinances ofthe'x,.-.',':', )
;.~~ CIty of Pnor Lake regulating bUilding constructIOn or use. For the follOWing: :;:.)
UseC!assificati"" ~0'1p. 1i";uD...;'~ Bldg. Permit No QQ-1428
.,,":ir OccupancyType R3 Type construction VN FireZone N/A Zoning District R1SD
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L9, Green Heights
Legal Description
3856 Green Heights Trail
Owner of Building
,~ite Address
Contractor's Name & Address Hansen Constr.. 6737 Anache Rd. > Edina. HN
Robert D. Hutchins
Building Official
Jenni Tovar
,I";ity Planner
Date:
Date:
POST IN A CONSPICUOUS PLACE
DATE TIME
~ /J 30
C""7~~
CONTR.
,..COMMENTS: _
(u ~",xl'V\r^ +'V\cJ t
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CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
~:/i<. t::; (...
OWNER
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
,.tY.NSULA TI~ A
~ ~INAL
o SITE INsP CTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
1;
99 - I '-I ;::)<f-"
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TsT
o
-------------
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--------------
o WORK SA T~A T RY, PRoc:ccn
o CO CT A TI PROCEED
~CT ,-.C L FOR REINsPECTION BEF~
Inspector: '/ . Owner/Contr:
CALL 447.9~5;; FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQU~MENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
/NSNOTI
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
~/;).vdJ
{.'30
ADDRESS '~5(~
OWNER
c, ~ 0 YL..,iJ.e....IrJlts
U
CONTR.
11r[11/
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01'/ (u l ('/
PHONE NO.
PERMIT NO. .J)::p,-()( 14 to>
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
.A ~EWER HOOKUP
r' . PLUMBING FINAL
o ECH FINAL
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
\COMptlENTS:~ ~
UJ~ ~.
C IV\.. J
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Q' \: #/ 41 _ I
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Inspector: Owner/Contr:
CALL t.709S,lFOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE~REMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTl
~
Grf'.P-~ JI~ltk -;;,,/1
CONTR. ;ftl/sen C.lfif/,rt:h4A..
rf # I'I.?R'
~GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
195'"6
OWNER
PHONE NO.
PERMIT NO.
o FOOTING
o FO DATION
o F MING
o SULA TION
FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
COMMENTS:
('.,,,Jj~y If ~
(;",#"" /'lJ!!Ll'f~t7ltl~
I
';;I/('*fl'1
I
DATE TIME
;n~h,(k~
/
/'"
~ORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WOR~, CALL :-"INSPECTION BEFORE COVERING
Inspector: ~/~
'\.----
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.,
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
INSNOTl
. TE(
~ 10\00
-=<v3~ G~ ~ T~
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
OWNER
CONTR.
PHONE NO.
"
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
1\ ~ATER HOOKUP
n j)zJ<.$EWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
COMMENTS:
TIME
\~"l4?6
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
~K SATISFACTORY, PROCEED
o CORREC AND PROCEED
o CORR CT W LL FOR REINSPECTION BEFORE COVERING
Inspector: 1/ Owner/Contr:
- ,
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
INSNOTJ
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH" SAFETY!
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
&~~
DATE RECEIVED
DEe 2 2 1999
DIREcnONS
SPACES NUMBERED 1 THRU 17 MUST BE FillED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
2. SITE ADDRESS II
:~K7(o r;.,Dftvt> 'thf/~"t::5 l1-t1} /
3, lEGAL DESCRIPTION
q
BLOCK
I (9" f~W ~(c;,^- 1'-5
4, OWNER (Name) (Ad~rt'}")
<i' \t \ c... ~ A-M LI f=rt ih'LK
5 AIn~~-t (~~mi~ (1 J Mv
6. SLJlLDER (Name)
LOT
ADDITION
~~~\<,
~O~~
New ConstructiOn)(
Chimney 0 Misc.
~,~iQ'"
Fireplace Cl Septic 0
Alterations 0 Addition 0
8, PROPERTY AREA OR ACRES
Sq,Ft fJ05'l;
19, PROPERTY DIMENSIONS
Width Depth
x
I
1. White
2. Pink
3. Yellow
File
City
Applicant
Permit No.
99~/4Z8
1. DATE
JfJh;.j 9 C;
(
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BUilDING INFORMATION
(Tel. No.)
11. SIZE OF STRUCTURE
IHi!fi1I I1'A
12, Nci.~TORIES
13. ryoOFCONSTRUCTION
~
14, FLOO1J"!? ~P~RTlONMENT USE
.~~
PIC .z,5-oqt./.- rmp>-rJ
(Tel. No.)
j
/
~
110. CULVERT SIZE
Yes No
FOR ADMINISTRATIVE USE
MATERIAL FilED WITH APPLICATION
(Address) n:el. N,,) 15. NUMBER OF OCCUPANTS OR SEATS
lD 737 rtpl- u"t.1'CJ OCCUPANTS
r~~" fJJ.l/"~ CfIf.3'~.'55 SEATS
Deck lJ / Re.roofing 0 Porch 0
Finish Attic 0 Re-siding 0 Finish Basement 0 .:!If P107~~~~LUE
17, COMPLETION DATE
~/60
I e information on this application which is to the best of my knowledge true and correct. I also certify that Itam the owner or authorized agent for
that.. construction will conform to all existing stale and local laws and will proceed in accordance with submitted plans. I am aware that the
I or just caooe. Fu:rmore, I hereby agree that t~ltl)~ designee may enter upon the property to perp!~!J fl77ns,
Signature License No. Dale
SETBACKS: Required _
Actual
Front
Back
BUILDING DEPARTMENT VALUATION
Side
Side
SOIL TESTS
o
[j ENERGY DATA
PILING LOGS 0 PERCOLATION TESTS [1
USE OF BUilDING
.., f'1J
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION 1'7S"J N'"b. ..,,..,
SETS
COPIES
Amount Brought Forward .................. <t.
Park Support Fee .......................~ . S SO. OD
SAC ....................................*. L-4-' (")r\ . <")0-
Collective Street Fee . ........ .... .... ...... $
Sewer Tap ................................... $
Pressure Reducer ..~e:/.t................ :
MeterHorn....~........................... $
Water Meter .;-;:e.......................... $
Sewer & Water Connection Fee ......M.. $ J
Water Tower Fee ......................~. $
Water Tap ................................... $
Builder's Deposit ............................ $~' Dr-:J
Other ....:TJ:..q,~................... $ SOD. r.i:2-
Total Due .............................. $ ~....~. '7..).
Paid B4-t.~..., Receipt No. ~4
Date 'Lr, ( tII!l By (t.JJH" .
uest in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document when
constitutes a temporary Cer:ti te 0 Zoning compliance and all~/C2!!.strqction)l commence. Before occupancy, a Certificate of Occupancy must be issued.
I $u~{1>>""~'~ If~~
, Dale Special Conditions d any/
TYPE OF CONSTRUCTION: I II III IV V
OccupancyGroup A B E F HIM R S U
Division 1 2 3 4
: ~2 .7~<;;'
8<'0. 'i V
~7. t::;rj
Permit Fee ................................... $'
PtanCheck Fee ............................. $
State Surcharge ............................. $
Penalty ....................................... $
L c:x9. ("JO
I~D. d€>
65'. so
Gas Fireplace Permit ..................,.... $ 40 .60
Th~'IJ-? B"lIdh'9 Permit When Ap.l!roved.Q 7
By Date _/2- 2"5-1 _
Certificate of Occup cy
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
Sewer & Water Permit ...................... $'
Issued
City:
~
PLANS & SPECS Ll
SURVEY 0
PLOT PLAN
o
4S .O'C>
l';;2D:~
;tOCl ,<9 0
? 00 ,ex:)
24 hour notice tor all inspections 447-9650
IIco
INSTANT TESTING COMPANY
4000 Beau D'Rue Drive. Eagan, Minnesota 55122
Telephone: 651-454-3544
Fax: 651-452-1826
Hansen Construction Company
6/37 Apache Road
Edina, Minnesota 55439
February 16, 2000
RE: Letter of Compliance - Bluff Impact assessment
3856 Green Heights Trail
Prior Lake, Scott County, Minnesota
Dear Jerry:
At your request, a site visit was conducted on February 03, 2000 to
evaluate the excavation at the subject lake shore prope~ty for
compliance with our impact assessment dated January 12, 2000. The
certificate of survey prepared by Probe Engineering and dated
December 21, 1999, which identified the property as lot 9,
Greenheights, provided the necessary elevations and dimensional data
for this inspection. All observations and opinions set forth in our
initial bluff impact letter remain inforce, as a integral part of
our assessment for this lot,
The site, had been cleared of unsuitable materials and excavated to
footing elevation. Handauger probes conducted at random within
the footing lines indicated well consolidated clay loam soils,
below optimum moisture. The physical dimensions of the residence,
its location within the lot and to adjacent structures, including the
bluff setback, were taped and found accurate with the certificate of
survey.
It is our opinion that the observed construction, including
erosion control measures are acceptable and comply with the
bluff impact assessment, building plans, and Prior Lake city codes
and zoning ordinances.
Assessor
/} -
..~ b-'< 4d?~ jJ?e:
Carl E. Anderson, P.E.
Chief Engineer
MN registration no. 10736
Charge codes: #605 - 1.0 hours
#608 - 0.5 hours
#612 - 34 miles
Job Address J:;r? bi-~IIr/I'"
pontrolled Air
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.
Heating Contractor
Name of Tester
Date
Percent 02
Percent C02
Percent CO
Stack Temp,
.r
l'1 ..- ( f l~
-,
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--
'APRIO,,;,
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Thr Crnln of lhr L.krCounlry
White - Building
Canary . Engineering
Pink - Planning
6UILDING PERMIT APPLICATION DEPARTMENT C~CKLlSI
NAME OF APPLICANT
APPLICATION RECEIVED
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The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
,,' :~~ ~- ~.~ l~:
J
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Accepted
Accepted With Corrections
/
Denied /J; J
Reviewed By: (1~-~ Date: '/;;0/00
Comments: ;\,.4-(t ....1'1;1" Can/l6i te- IUCet.fr.ef in Sid<.vC<,c!s.
-k Yer 'iksolUhD('lS 'i'j-.)d-'F'c. i"A0d 9'1-~3 Ft. 'see..C!.t.Ydd1'ufJ.S
..f 5~l<;f;t"lJ ~~el ~ ~ temovt:d
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9..A-,~ ON- 3" twy) cYN- 3 VI tr-uo 10 (/( jCllttJ':(/.
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'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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White - Building
Canary . Engineering
Pink - Planning
Thf Ctnltr of lhr Llkl' Country
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLISt
NAME OF APPLICANT
APPLICATION RECEIVED
l-/7I/1/.:5'ClJ C!) A/.J. I K- .
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.
The Buildjng, Engineering, and Planning Departments' have reviewed the building permit
application for construction activity which is proposed at:
3650 0te'E pjJ /--I-r s. ~
;
L
Accepted
Accepted With Corrections
/"
Denied 111 J
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~Per 'l2eSOItJtiDflS (=jq-J-;;YPc.. I'Iv-d 9"i~d-3 Ft. ~S&-CJYrd(fi()h:8
'~.Bjl<:;.h;")J ~.e.l ~-n k re-m()\gcL
~ }Jtu1 10 <Jtcwvt (p Ill{ (lL)/b.W\..bncJ.y; . dJ/'tni/l- 'SiU -
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9.A-J? oN. 3" twrd ~ 3 V' #ao 10 lJt-~/~' .
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"The issuance or granting of a' permit or approval of plans, specificatio'ns and,.
computations shall not be construed to be a permit for, or a.n approval of, a.hYViolati6h of '
any of the provisions ,of this code or of any other ordinance of the jurisdiction. p'ermits
presuming to give authority to violate or cancel the provisions of this cod~';o.r!.~thE:lr
ordinances of the jurisdiction shall not be valid."'''''' '
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--'-
CITY OF PRIOR LAKE ~ ~:W :6....
PLUMBING PERMIT PP No. _qq-/4-Zl'?
Applicant: 't/e-rrJ,-;j) &.4;/;;;), .....hl'!., Phone: (t.~'J) *,---"l-037~1l
Address: ~() (J ~ ~' *o,v-:' ('-1 VI/ rl. " 11-;. Yf..., .52\ot.S?
Signature: C:lJI',,",~ _~_!,J:." !"","(
Legal De~CriPtion:V Lot '? "IloclP Sub--'2,eP.:A'1If HE.IC'iHT.S
Site Address:~ '\.1i" 1/ Ii ) IJ.J'0~ -/-/1 ') ~> I}
Building Permit# QQ-142..e> PIO # 2.5-0Q4-- ()()fl-t") -
NOTE: This permit will not be processed without complete information.
FIXTURE UNITS
Th C~I", 01 11M Lake COUIU",
WR 3 2000
auantity
:l-
I
I
!)
/
/
I
-.3
Type of Fixture
Quantity
Type of Fixture
Bath Tub with or without shower
--.3
/
Rough-ins
Water Heater
Dishwasher
Floor Drain
Lavatory (bathroom sink)
Laundry Tray (1 or 2 compartment sink)
Shower Stall
Water Sollner
/
Stand Pipe (washing machine)
Sewage Ejector
Sinks
Backflow Assembiy (RPI, Double Checl<, PI/B)
Backflow Assembly Test
Lawn Sprinkler
Other
Bar Sink
Water Closet (toilet)
FEE SCHEDULE
Industrial, Commercial & Multi-Family
(1% of job cost, $39.50 minimum)
Residential, New One & Two Family
Residential, Additions & Alterations
State Surcharge
$99.50
$39.50
$
$ 99,.s-tJ
$
$ ,50
$
GRANO TOTAL
This permit is granted upon the express condition that said
contractor. shall comply in all respects with the ordinances
of the State Plum~in and the amit::nrs thereof.
. 3 ,/60 DATE
. ,. ATTEST
Call for all ;'~ections 24 hows in advance.
16200 Eagle Creek Av. S.E., Prior Lake, Minnesota 55372/ Ph. (612) 447-4230 / FAX (612) 447-4245
An Equal Opponunity Employer
OAEEM . PILE
YELLOW . A,nICANT
GOLD-CITY
. CITY OF PRIOR LAKE
SEWER AND WATER PERMIT
NO. Q1-/t../-zg'
NOTE:
Sewer and Water
contractors must
be registered
with the city.
APPLICANT: ()t2-i:H( bl- oGl(C .
ADDRESS: ''''/lR J;Of'I7:--,../ '-VA"I L/LtfL. S;:,-(j'q<-/
SIGNATURE: r L~l-' G. ^, (1",
SITE ADDRESS: 'J"qSt. Gilt.&) Nf:HJJ'r5 Tn..
FILL IN THE BLANKS
PHONE: f? '1,).-'- 'jlJ to
DATE: :)..'/11..10 a
BLDG. PERMIT # C79-1t/zg'
PID# 2.5-0<l4- 008'0
1. Estimated length of water service
"
/06
feet.
2. Size of water service
I
inch(es) .
3. Location of any couplings from structure
feet.
4. Type of sewer pipe. ABS
PVC X
Cast Iron
5. Estimated length of sewer line 6, 0
feet.
6.
Clean out
structure.
(if required),
located at
-
feet
from
BY
ur permit when approved.
DATE: :2.//0/ DO
I ,
This
-------------
-------------
===================================================
FEES:
$
$
$
35.00
.50
35.50
Sewer and water line connection permit.
Surcharge
TOTAL
* Fee for either sewer or water individually is $ tJ. 50 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
AMOUNT PAID ~
:o'-l'l\\"."S\
REC'D BY /' {'l>..\ 9t:::".
\ ~\j\\.O~G.
RECEIPT #
4629 Dakota St. S.E.. Prior Lake, Minnesota 55372 / Ph, (612) 447-4230 / Fax (612) 447-4245
AN EQUAL OPPORTUNITY EMPLOYER
/'
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('Jr.;:, /1./7 Wi
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While . Building
Canary - Engineering
Pink . Planning
ThrC'rnfrroflltrl.ahCounlry
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
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1'Z./2'2-/99
APPLICATION RECEIVED
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
38SC;;, ('7;/::"(.. f.A/ H/.~~. '7F'--
Accepted
./
Accepted With Corrections
Denied
Reviewed By: jJAL.T"ER. E:...t<ESMA.JJO.j
Daie:
. ,
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. '
Comments: IF' SklA~e:S "'''' -r;.,E :<;'01". LD. U.JE~
CA.Jo<JDT' BE I'A6<TE:^.
'70 I'.,""-'E.... n.~"'.FF ALO"", or,,€. ,-or l../.JES -ro -r",E. L.AkE: Oil. ''(00'10",,,.
~r'...J (.l f?,tITEIl d1Jro.J~ J:)ou..MJOSA,ur "'V~Tt:'M rf1VST" i3.e: l~rt4LLE..J:} 7"".., t:o,Jv€.y
B",,,.o..v. R"'/JoFF
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RUILDF'.t Mu-<r I'C&L~Y s.€uJU
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!1ull.nFJt I.J,U ~e:. 'RESf'aA.J<l;;,RLE:. ~~rG:ST<;' ~ss4Cu'lTE..b
WITH (!O.....AJE:'t!:'1'IAlf,p 1"'0 ~F" c,.rv ".F,JEA. IF" "'rut!. ~E\..Jf"Jt ~(nvl'~ ~R 1<\Al'''- Law
~\'..,.r.J "Th Au..ow f"on a C'l1lUrV u.1Jf:. rt'l -rl-lf:. I_~';:.r PttoPJl.StD FLonn:.
~,:- IIJFoa9'l1..AiloN n....~ .,-....r t<F~tl.s.F .sInE
.s..C."- ~\.I..."...rr-~: I. h,JA, 1.:'''.<IoE IfoJ<,PErnoAI I ..'F",n ....~'12M1
l E::ltns\oIU ~-o.NntOL- r'1EA.''''(tEf\
'I. SEwrn. ~ w....-a, 4s-i3",,~rs
"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."
~. G,1AO,.J(. / f"aD'....'" C"LlTfu>L P."'A J
,
~~
q9~/t/2-8
ThfCt'nltfoflht LabCounlry
White - Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKUSI
NAME OF APPLICANT
APPLICATION RECEIVED
/f;l:f IV .z::,C N CO;V-!. I K--_
17.-/ Z '2-/971
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
3850
6eePJJ J-I-rs. /?
1
Accepted
Accepted With Corrections
Denied L
Reviewed By: r;!jJ(Ji~
Date: J '2.- 2<;-9 <;'
Comments:
Uo. _O~
2, M"':lo\.kl''''- ~~~ ~ UIA_tl~
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tor'/:' ,''So -e<;;"k\J.l~o(
4.
Rov:&. C''''T~\r,~cM.. 1.0.....1
-...J
€~"I..JO>- ~.I\ ~.""':::>",^\M.~I'CIV\.",_
a~\^"'h'JJ .\-C') .
or; 4.h.o ',?,~~, 'l'.>lf''''''\. lA~ ~'" ^
'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,"
CITY OF PRIOR LAKE Me
t6200 Eagl. Cr..k All, a.E. Pelm. No, 99- / Lf;;g
Prior lIIk., MN 15312 ~ '*' 0() -(J(1-If,
'HEATING APPLICATION I PERMIT Slngl, Feml1y
Oal' "..; _ J?... (\() PIO. AS' oq 4 ...(Xf6 ~ CamMtlc11l
SlI, Mdr.., ~ ~<'c. r.;::"'.......... tIJt,,;,.,h./( 7;'. Fe, Sch,dlll,
lot Of IIladI Addlllan ('~ U-e M-> I<<\\s Indl1llJlel. Commerclrll r. MulHeml,
, / /' 1 \) . Re.ldtnllal, HI.11n1l & AC
Ownl'" Nlllle, Un '" \~". A I en.. Is:-r, R..ldenlle~ Heeling Onlt
RaldenUaI, all FI,IjII_
ReIIdenU.~ Addlllane & A1lelBOolll
Ruldlnlle~ AC Onlt
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Addl"l ,
MacIel Sile /;:;;c. . C(",O
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a:
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-'
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Conn.loacf
Full VA-I- Flue Sin t;"
Suppl, Opening. /9
Relu,,, Openlngl 8'
IJ1pl11 Olllplll
Edr,
Clm.
,;:;/-.., M,. .<,,<10;W
.?I
Lan.. . Dr
LYtI.. '
TYPE OF STRUCTURE
,/' Two-F'mBt Mul""',
Induelrlll Publle . Oller
1% 01 lob coel (S3ll,&D...... ,-
S911.50
$84,50
1311.50
$311.&0
.39.50
......,-
Remembtf 10 Bold lhe Slale Su,charge ClIIIh, banulII oIl111t Ippliclllol\.
Th' prllltl 01 your hllllllng pIIml1 Inallld.. _ ravgh.1n aMI Ollt llnlllnlpldltl\.
Ad1I1Ilonal lnlJHldlanl IVII be bled al $35.00 ,ach,
HOUle U"""g Te.I Reca,d lIlul1 be eutJm1\llld wllh IdIlioIIIWllllIIIIIdE ._IIuId.
"" clrllllcall 01 oCcupllnc, wi! be IIsUlld. .
I-I""'T r..' ,.). j\TlnNl'ii Clr-n' "''''''1 wtI11 number 01 eupply IIld I8Un _"'..,."1. par
.oom wllh CFM'e pII opening, New ,ltuc:lu... or addlllo.. ..1\<1 ... p...........,
and ,elurn locallone "'own. HEIQ' LOSS CALCULATIONS, PAYMBfT NO
^PPlICATIONS Ml\Y BE MAILED 10 THE CITY OF PRIOR lAKE, 11_ EAlaE
CREEl< AVE. S.E. PRIOR LAKE, MN 1i6372.
ell, HI' blltl~_ h_ ant 8 .m. . 4:30 p,m.
ALL WORK MUST BE INSPECTED IROUGH-IN AND FINALl- CALL CllYHALL
447-4130
I hereby applv la, a m.chenlClllveleml permll and I aclmawl...._ the
In/oymallen above Ie complsle and accurale; IlIallhe wOlk "II be II _........nll8
wllll Ihe oYdlnancII and code. ollhe ell, end wi'" Ihl .lalellug.~,"""jJlcel
cadel; Ih.llhl. lo.m doee nol become 8 pe,m" un," 81gned by ..BlaDING
OFFltIAl: Ihellh, wOlk will b. In accordanCII wllh Ihe IqIprov111....n.. the
. Cu, 01 ell wo,k whIch reqult.e ..IIIIW end epprove' 01 plant,
~'r.i Z~~
'( -4;I~r, ~
/I 0, ~,.J..o, --1' J 0 ir,) P J 11 ~ (l, ;)
(} OulklriQ Olllcllr. ~
TlPE OF SYSTEM
Warm AI. PIan.I V
Grevl',
Mec:hanlclll
Alr Cond.lanIng
Vent. SyJIlm
HEAnNQ OR POWEll PLANT
SI.....
Hal Wale,
RaoIiellon
Special Oovlce.
OIhe. D,vlcal ,
III
I'l
['-
IS)
Aftllelml
TYPE OF WORK
New Conlllucllan ,
IS)
IS)
"
['-
IS)
"
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IS)
Rlpalr
E'I. Coil S
Replacemlnl
Ell. Comp. Dale .
_ Buldlng PelmU
HEATINa PEAMIT FEE~
STATESURCHMGE ,
TOTAl. PERMIT FEES ,
1Ci - I L.f;}.:k
~ i\- (j() -CCHb
,50
R_\>I' ~
"" - Sl' ' (",)A
C/ 1t'77 (T[L
I ~
4"~
~
CITY OF PRIOR LAKE Me
16200 Eagle Creek Av. S.E. PaTmi! No.
Prior Lake, MN 55372
9'1- /4",/~
HEATING APPLICATION I PERMIT
Dale, S-;lY'-<.:h PID. ~S -(")q <-) -(\/)"1 ~()
SlleAddr.ss .qXSJ~ h1itJh ''kkJ',JJ;:. lA",j
lal 3- BIook Addition _ ~ ~f'\ lJ.., k-nln.+-r-
d . /) U
Wn" , ofn ( ;..,")J'
Owne,'s Nam. ,
Addr.s.
Heating Contraclor ~LlIED FIRES IDE dba FIRESIDE CORN!':R
Addr..., 2700 Ii. rAIRVIEW, ROSEVILLE. 10It 55113
Telephond. 651-633-2561
FIREPTJCE J /
~IIP Mak. & Model ././' J A) c. ("
.-Sl- 7JO
TYPE OF SYSTEM
W..m ~. Pianls
Gravily.
Mecharkal
A.i, Candltklnillg
Ven\. System _
HEATlIlG OR POWER PLAHT
Steam
Hot Wale,
Radialian
Special O.vicss .
Model Sile ,
Conn. Load
Fllel k.J
Flu. Siu
Supply Op9nilll/S
Ralmn Openings
Input
Edr,
'1"
Output "'..l.Ll.~
Oth.r De~ices
Clm,
TYPE OF WORK
~
AI\ora:lons.
f19placement
New Conslnrclion
Repair, Est. CaJr4l. Dale s7;}r1-v
. / r
Esl.Cost$ //0':> tG> BuDdinqP",mU 9cr- /4~
HEATING PERMIT FEE $ / ~~O~~
STATESURC1-IARGE r /50 ~~~
TOTAL PERMIT F~
Receipt ~ .
TYPE OF STRUCTI,lill;
1. pt_
1.C'1IJft'1I
3. Yellow
A'.
0'1
C!)~r
rn
lD
:>
...
.OJ
~ '<
Single Family
Commeroiel
Two,Famlly
In<lJslrlal
MuJli..FemRy
Public Other
I"
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a.
lD
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o
.,
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.,
Fee Schedule
Induslrial, Commercial & Multt-Famiy 1% 01 fob 'iIIl'\ (S39.50 minimum)
Aesklefllial, Healing&. M; S99.50 W [g 0' rc~-';-
Residenlial, Haling Only $64.50 -,t.
I'.esidenlial, Gas Fireplace $39.50 Iii I .
Residential, AddUioo.. &. AlteraliorlS $39.50 ,! i: ': i 2 5 an>
Residential, M; Only $39.50 I U U '
[ ._~
-
Remember 10 add Ihe Slale Sur<:harge on lhe bolIom allhis applioaliOO.
'"
Ul
~
The price or your healing permil includes one rough-in end one IInallnspuclion.
'"
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Hoose Healing lest Reeord must be submilled wilh Il!.!iI!irJg IlIIJIIi1 "'......., before build, 'f
ing c",tificale 01 occupancy wil be issued,
A.ddilional inspeclions wil be bined at S35,oo eech.
'1FAT CAICIIIATlONS RFOLJIRE]2 wilh number 01 supply eod relum operings bled pe
room wilh CFM's pel opening. New slructures or adolllon8 send lloor plan wilh IUpply
and retum localions shown, HEAT lOSS CAlCUlIUIONS, PAYMENT AND
APPUCATIONS MAY !IE MAilED TO THE CITY OF PRIOR LAKE, 162.00 EAGlE
CREEK AVE. S,E. PRiOR LAKE, MN 55312.
;::
ll>
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Ul
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City Hall business hours are a a.m. - .4:30 p,m.
AU WORK MUST BE INSPECTED (ROUGH-IN AND fiNAL)" CAll CITY HALL
447-4230
-
....
...
I\)
I hereby apply tor a mechanical syslems permil and I acknowledge lhat It'll J>
irdormalion above is complele and accurate; Ihallhe wofk wlN be in <:onlormancll .":
wilh the o,dillance5 and codes of lhe city and wilh the stale building/mechanlce
codes: lhat Ihis ""m does nol become a permit until signed by the BUilDING
OFFICIAL; \hel Ihe work will be In accordance wilh the approved plen in Ihe
ease of all work which requires review and approval 01 plans.
~~M' 'Jh~
. AppliCanl'}Ali!lf'alure
(.J'"."lv/r." ---{ I" .'>01" ~
o Building Offict Signalure '
-0
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<D
lD
Oale
dq,dn
-, Da141
~
-
~
PRIOR LAKE
INSPECTION RECORD
DEPARTMENT OF
BUILDING AND INSPECTION
SITE ADDRESS 355(,., Gt~h~, ~,L~A.st:s ~~
NATURE OF WORK tJpL.. \ Ca-v...s"Tr>u-;:JJL.0'7"
USE OF BUILDING SF D
PERMIT NO. '?i-ILf2.CO DATE ISSUED 12"2'3-9:/
CONTRACTOR 1.,tev--<u........ ~
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIO~ BELOW
TH~ PERMIT IS BY SEPARATE DO~s EN~ 1ft) ;:~t' 5/e/tro
I FOOTIN~ no J!1~uD I __ - I "t, S _ f' I
I FOUNDATION (Prio.vto Backfill) I I' l
PLACE NO CONCRETE UNTIL ABOVE lAS BEEN SIGNED
ROUGH - INS
7JS z/17 /M
iJ/(! ~, sit /0 0
viI" BP, 9LJ!DtJ
~
ytk,
ItR" (
&r,
SEWER I WATER I SEPTIC
FRAMING
INSULATION
ELECTRICAL
PLUMBING
HEATING (if required)
FIREPLACE
I GAS LINE AIR TEST ~,pQ ~
I
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
IWM"7;1..N:- I I J
\S\uWCQMtJ:'fCQ..-kOYt bL\ ~ilAe.'1\"FINALS R2.~, ~ (}-.r~
/ GRADING (Prior to SoCr'din~ 6J e- :/;Jre,- ue ---r 0
L-p. BUILDING
ELECTRICAL if.
PLUMBING ~.f' ~;e.,d~ / ,;,1/1
HEATING 1 ! 1 1t2? ro/)f
l
DO NOT OCCUpy UNTIL ABOVE HAS BEEN SIGNED
. . . . NOTICE
LJ / D / rlf)
-4 !..Z(--/JtJ
51Z-(,,/~ ~
4- lr -o()
. . . .
This <>ard 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