HomeMy WebLinkAboutBuilding Permit 03-0570
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CITY OF PRIOR LAKE
~eparfmenf of IOuilbing Jfnspetfion
~Final Permitted 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 of the City of Prior
Lake regulating building construction or use. For the following:
Use Classification
SINGLE FA."1ILY
Bldg. Permit No.
03-0570
Occupancy Type
R3
Type Construction VN
Fire Zone N / A
Zoning District PUD
Legal Description L57. B1. STERLING SOUTH
Owner of Building
Site Address 2839 WILDS LANE N. W.
7601 145TH ST. W.. APPLE VALLEY 55124
Contractor's Name & Address MCDONALD Ce.NSTR..
ROBERT D. HUTCHINS{I / IT.
Building Official V
Date: !r1 - '( 1- (ltj
,
City Planner
DON RYE
Date:
l
~ .. j
CITY OF PRIOR LAKE
INSPECTION NonCE
SCHEDULED
DATE TIME
) I
.1Q.[L"Z-!.c3
ADDRESS Z-.~ ~ ~ GJ.-r..L.Jj~ ~0
OWNER CONTR.
PHONE NO.
PERMIT NO.
()~-c..l0
o EXI~ILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
~FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
COMMENTS:
Gtz'6. c..,~ of - O~
br(WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Ins_or. ~i". ~ Owne,lConl,
CALL 447-9850 FOR ~~EXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH &: SAFETYI
_OTI
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
263'1
WI f...;[)...f
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
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
JD MECH FINAL
5~ I
I
COMMENTS:
ok.b r~. fJ~-g{Q
DATE TIME
L-N,
:s- ~S7U
o EXIGRAD/FILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
,/
~ORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORREC7$' CALL FOR REINSPECTION BEFORE COVERING
Inspector: _ Owner/Contr:
\
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
lNSNOTI
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH &: SAFETY!
CITY OF PRIOR LAKE
INSPECTION NonCE
ADDRESS ~q
,
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
COMMENTS:
DATE TIME
SCHEDULED 18 - 21....01'
,/
~)~
~
CONTR.
PERMIT NO. {-t;fJ7
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EXIGRADIFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
I r - - IJ (~J.-.~_().
· r-'\.V~ ~, ~ ~
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~
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..w .~ I'
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o ri'6)
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o WORK SATISFACTORY, PROCEED
if CORR AC} ON AND PROCEED
/0' COR EC w6, .K, CALL FOR REINSPECTION BEFORE COVERING
Inspectc .r: I I Owner/Contr:
CAa.. ~j850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
COD'; R~UIREMENTS ARE FOR YOUR PERSONAL HEALTH &: SAFETY!
/ INSNOTI
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
0183~
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
COMMENTS:
SCHEDULED
W:lka ~
CONTR.
PERMIT NO.
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
:s(' PLUMBING FINAL
o MECH FINAL
J. ~~ ~r ~"'_~
). (}CL~e ~ L^'\flJ
DATE TIME
't-u,.6'?
1:10
,
:3 -
570
o EXIGRADIFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
4.Y!]- ~f~
o WORK SATISFACTORY, PROCEED
X CORRECT ACTION AND PROCEED
o CORREC]i'frK' CALL FOR REINSPECTION BEFORE COVERING
Inspector: ~ ' : j ~ Owner/Contr:
: l';
CALL' "50 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
/
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH &: SAFETY!
INSNOTl
CITY OF PRIOR LAKE
INSPEcnON NOTICE
ADDRESS ;;)p1j l
OWNER
PHONE NO.
~F NG
o NDA TlON
FRAMING
. 0 INSULATION
o FINAL
o SITE INSPECTION
COMMENTS:
DATE TIME
SCHEDULED 7-.:1 l( ~ D 7
LJ.J.&, ~Vt
CONTR.
PERMIT NO.
s-
,1;?0
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
~UMBING FINAL
~ MECH FINAL
o EXIGRADIFILLING
o gpMPLAINT
~IREPLACE RI (2)
-9' ~I~PLACE FIN~
7;'l~E~~
/
~ORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT~ORK. CALL FOR REINSPECTION BEFORE COVERING
Inspe~ I ,.~ Owner/Contr:
C~~ 44~98~ FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CO~REMENTS ARE FOR YOUR PERSONAL HEALTH &: SAFETY!
INSNOTl
CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT O'~- d -03
(Please type or print and sign at bottom)
ADDRESS
JK3'7 w,'1J$. L<>-A"f!_ A( LJ
I. White File
2 Pink City
J. Y tllow Applicant
I PERMIT NO. 03 -Ot:> 1()
ZONING (office use)
PlL()
LEGAL DESCRIPTION (office use only)
LOTS1BLOCK I ADDITION Sf" .e.Q1.',.,.C; ~.;rA.
OWNER
(Name)
fJ7 ~/)~ /lc..)J (1- ro ~ j ~
(Address) ,)fou( / (.r <;" II-. S7' r~-j
BUILDER )
(Name) IJ1 r/f),... ""' /.C C~~....~/.
(Contact Name) -:J::,i j:: 0c:..1) ( SC)~
(Address) ? G:, CJ { '(.,f"';- I h OS "t Ct 1" ... J .
TYPE OF WORK
o Misc.
Permit Fee
I Plan Check Fee
I State Surcharge
I Penalty
Plumbing Permit Fee
Mechanical Permit Fee
I Sewer & Water Permit Fee
I Gas Fireplace Permit Fee
G(.New Construction
~ower Level Finish
1$
I $
I $
$
$
$
$
/ot),lJa
/ at). IJ 0
3$5'0
4~,da
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 p.v....:..~f 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, I hereby agree that the city official or a designee may
;'" U'J(!j":1J to pedorm e-.J _0", is e -.9. '< -; &. 05-- (_ 0 :3
~ Contracto7s License No. Date
Permit Valuation ~,;J..Lf. tJ ()t!), "0 I I Park Support Fee # $ ~5'a, 0 ()
$ -/~ 88.15+ I SAC # $ 1Z,7S,~o
I tJ ~ 7. ~"t I Water Meter Size 5/8"@ $ 300,00
11'2. , II 0 + I Pressure Reducer $ 7", a a
I I City SAC and WAC # $ /Z-Or;. tJ d
Water Tower Fee # $ 7do, 0 fJ
Builder's Deposit $ /~
<JOO.OD
lather $
I TOTALDUE U'tH.(\') 5J? .O~ $q (JUl. 95
/ -,
9o~'J. '1.~ ReceiptNQ.(/ifytlS
.5-Nb-O ~ By (-,f-~
This Application Becomes Your Building Permit When Approved
~~
Building Official
s-/9/4'3
, Date
PID~- 36/}-OSI-()
(Phone)
J,4fJ r-<- p&/(;;
H ~ '...,~ . S-~,/ g.. If
(Phone)
(Phone)OS~- 4'S;). . ? 60/
~ck
8eorch
ORe-Siding
ORe-Roofing
!R Fireplace
~Utility Connection
OAddition
o Alteration
PROJECT COST IV ALUE (excluding land) $
I Paid
, Date
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
is~ 7~p ~h~3 fJ aL.( A-'.IM;. ~:-)
Planning Director Date Special C~ditions, if any
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
.
White - Building
Canary - Engineering
~k - Planni~
The ('('nfer of Ihf' Lah <-'ountl")'
.BUILDING peRMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
//YJ
~'.~---
.,' , ""J
- l.j .,-
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
S ''1-
/
/J
Accepted
Accepted With Corrections ------
Denied
Reviewed By:
Comments: A, e.
r;;?~ 9~
.
~~
Date: -isj.lAj.) l
.I'J ~~ c - . JJ",.
rJl
~~,
( '\
I !
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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."
rwhill - Buildin(Q
Canary - Engineering
Pink - Planning
The ('tnerr of the take Countr)'
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT 'I1!tJ 0 /lm o.J~ ()~
APPLICATION RECEIVED 5 - ~-O~
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
Nf~9- ///h~ L,A/
~ ..........- - .
Accepted
Accepted With Corrections ___
Denied
,....
Reviewed By: ~ ~ Date: S/9/tJ3
. ,
Comments: ~ ~ ~~
~ ~' I~ 61>JA~ -to A~
,
~ ~ ~ AAu-f ~S~ jo
~ /'( ~ ~ ~ ~ ~.
y, "
It!
~.
,
'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."
~ite _- Building
c anarv - En~lneellll~U
Pink - t'lanning
Th. (' ."... nf .... I..k. C oU"'ry
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT -',;~ / (.J :,/ /{Y!tl . '/_~::(~L.,.
APPLICATION RECEIVED,.:!..) ..::{ - () '2
J.-.--y i l,,-,
../' / ....re---..........
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity ~hich is proposed at:
..-.....- ....~:- ., r-
" ! v-, "1-
"C"'...;) J
.. , ,/A ._,"',..1
.. / .I I; / :--'
,"-.,t;. '_~cc..4
l- ,A/
Accepted
x
,
Accepted With Corrections
Denied
Reviewed By:
.# 13
Date:
S' ,/2-0]
Comments: See Rp.vp.rsp. Side for Additionallnformationl
Drivewav Must Have A Concrete Approach
See Attachments: 1) Grading Plan. 2) Erosion Control Measures
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 of the jurisdiction shall not be valid." -
II .
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
I. Pink
2. Green
3. Yellow
~::y I PERMIT NO. 3-- 5'70 I
Applicant
(Please type or llrint and siltll at bottom)
ADDRESS
2839 WILDS LANE
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name) MCDONALD CONSTRUCTION
(Phone)
(Address)
APPLICANT
(Name) ALLIED FIRESIDE DBA FIRESIDE HEARTH & HOME
(Phone)
651-633-2561
(Address)
2700 NORTH F AIRVIEW AVENUE
(Address)
ROSEVILLE
(City)
55113
(Zip Code)
(Contact Person)
BRENDA HUSTON
(Phone)
651-633-2561
APPLICANT SIGNATURE
BRENDA HUSTON
DATE
6/17/03
APPLICANT PLEASE COMPLETE BELOW
xD NEW CONSTRUCTION D REPLACEMENT D ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE
RETURN OPENINGS
TYPE OF SYSTEM
INPUT
HEATING OR POWER PLANT
OUTPUT
OWarm Air Plants
OGravity
o Mechanical
OAir Conditioning
OVent. System
o Steam
o Hot Water
o Radiation
o Special Devices
o Other Devices
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
FIREPLACE MAKE AND MODEL
HEAT N GLO 6000TR-OAK X 2
Industrial, Commercial & Multi-Family
FEE SCHEDULE
I % of job cost Residential, Gas Fireplace
$39.50 minimum
$99.50 Residential, Additions & Alterations
$64.50 Residential, AC Only
$39.50
Estimated Cost $
REA TING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
Building Permit #
$
$
$
.50
$39.50
$39.50
8lJll.~i:~ WI'H
, v'G p!:-
,'FlAil,
Residential, Heating & AlC (New Construction)
Residential, Heating Only (New Construction)
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Buildine Official
Date
r-~~d@ ~ 0 ill ~
fDatf1 . By
Jt JuN 1 8 2003 ~
". Receipt No.
24 hour notice for all inspections (952) 447 9850, fax (952) 447-4245
By
~ /
~
, I
-.,.~~ ..... r^.LUX LAltE
@001
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/J:il1<EPLACE PERMIT
Date Rec'd
(please ~e or w'..nt and. liEn :it botttlcn)
ADDRESS '
Lr:.:. .~!~ /' PERMITNO=--~_~
), v."",, Appllc"" J") · I
ZONIN G (offic:t Use)
r:J x>'3 q
(;.J//~
~It.)e'
jJ r v.:J r
- ,
LE:GAL DESClUPTION (omc::e Use ol1ly)
LOT
BLOCK
ADDITION
PID
OWNER"r\ / r'\
(Name) P1c'0:.)OI0(). 0...)
Co,u~/..
(phone) ..,y~.9 ; 7G.a I
(Address)
, A!'PLlCA.N1:. , '" A~
(N~e)~~~/
(.A.ddTC:SS)C;;/.::;)./1""'J ~ ~
. (Addres~)
'~f
'cz.u.."
(Phone)
.~ (Ci~)
..y~- GO rl "='
~s602 4
(Zill Code)
(Contact Person) J (phone)
APPLICANT SrGNATU~ ~./{M. _~?:;f~~ DATE
~.-/h,..6~
_ APPLICANT PLEASE COMPLETE :BELOW
, ~W CONSTRUCTION . 0 REPLACEMENT 0 AL TERA nONS
FURNACE MAKE AND MODEL fZl"? J!<vk~ r - C9M ~OO FUEL .JJ~I-
FLUE SIZE .-3/1- Pl)G RETURN OPEN1NGS 5" INPUT. :lOCJ.OOO OUTPUT q..;l.~cx::l
/
TYPE OF SYSTEM HEATJNG OR POWER PLANT
~llfm Air l'lllllts 0 Ste~
oyl'llvit}' D Hot Wllter
.....e:J Mechanical ..' 0 Ra.dilltlOI1
./AAir Conditioning 0 Spec:ial DcVlc:cs
pent.systcri1 O:OtherDcvices
FIREPLACE M..AKE AND MODEL
PLEASE .N'OT;E;
Air Conditionet Units
Cannot Encroach into
Required Sid.e Yard
Setba.ck..s
Tn.dustrial. Commcrcill-I &: Multi-Family
FEE Sl..t1.ttDULE
1 % orjob co~t Residt;:ntial. G~ FiTepla~e
$39.50 minimum
. S'39.50 Res)dential, .Additions &. Alterations
$64-.5Q Resid~ntial, Ar: Only
$39..50
R<:sid~ntial, Heating &. J.JC (New Consuuction)
Residential, Heating Only (New Co'nsrructioo)
S39.50
S39.50
Estimated Cost S
Building Permit #
'"
.,
$
.50
8,. P-4/D 'A"
U/l../)/~ rt'/"1'1y
- G PI:/3
riM!'r
REA TING PERMIT FEE
STATE 81JRCHARGE
TOTAL PER~T F'EE
s
(ome. Use Only)
Tbi.t Ap.plkatlon Becotlies Your Building Permit When Approved
Building Official
I Paid
D.l~ (Jlft@ ~ n ~7 re ~j'W>'
,. '''''0'''' ,,, -" t",.d;'" (952) ...' t fl" gel R''r) lI'tiT03 ,'),
, Receipt No.
~j
lOO~
HIV G3:110KLNO:)
By
r
--~~d~YYt~d gg:~l NOW COOZ/91/90
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERl\-Ul
~.~:, ~~y I PERMIT NO. "\:2 --5'1(\1
) Yellow Applicant ~ ) u
~!e t'{Pl! or print ancl.i2/l at b~ttom.i_
\ ADDRESS "J.;:] ~ 9 M- /d~ !. d. h e It f1(
ZONING (ol'li<:euse)
.
LEGAL DESCRIPTi0t-' (office U~" enly
LOT~1 BLOCK 0 !__~~TrrTO>; ..s- -fer J, 'I} \9 SO' 4 ft,
PID
~':e~R )1('.; D~h.JJGh -s fru C/ f,"n n.IrtG.
(Address) /bO/ LfdJ sf 0/ o,,~
APPUCANTT:- n S:..J.. IJJ) f
(Name)C, (,II: .. ,_Pl.~_1'1qhJ<J"hg, ':;nc
(Address) /~9',y deUJeL.LJ/f!, [;0,. CotloJ fJ
(Contact Pmon) JJa ~~:'~ >/-h / _ . .
APPLlCANTSI~NATURE _ctYrMid/~,~~
Quantity
.:....i
/
J
Lj,
I
/.
I
/
...Y
(Phone) 'is;) ... YJ'~-l 601
J/o~( /V( h ~r /a? Y
(Phone) t~/,- Ys-9 - J> / ~ 0
&Y10jlf? J1J1 ,,-," ,J 01 6
(City) (Zip Code)
(Phone) {~/- }<JJ~cP / J;(j
DATE 6-/7.....0~
APPLICANT PLEASE COMPLETE BELOW
Type (If Fixture
Bath Tub with Qr w;~hout shower
Dishwasher
I Floor Drain
I Lavatory (Bathroo'1: Sink)
I Laundry Tray (lor .2 compartment sink
Shower Stal.J
Sinks
Bar Sink
Water ClosetJ~oi!~,.t)
I Type of Fixture
I Rough-ins
I Water Heater
I Water Softner
. Stand Pipe (Washing Machine)
Sewage Ejector .
Backflow Assembly
Backflow Assembly' Test
Lawn Sprinkler
Other .
Quantity
/
/
FEE SCHEDULE
Industrial. Commercial & Multi-Cam'ly J ''r. of.joh cost witb a $39.50 minimum
(OfTH:~ USf Only)
ResIdential, New One: & Two.Pamily
Residential, Additions & Alterations
Estin ated Cost $. J 0/ -SOO. fJ() Building Pennit # 0:] -- O~ /()
PLUMBING PERMIT FEE $ ,IJJJ.. 'fA ~
r STATE SURCHARGE $ r7 - .50
TOTAL PERMIT FEE $
$99.50
$39.50
PAID WITH
8UILDING PERMIT
,
This Application Becomes Your Bllildlng Permit When Approved
Receipt No.
Building Offidal
.....,.-- --1
~ I~a~ ~ U \D ~ \
. Date .
Date I JUN 2 a Z003 ..
14 hour notice for all inspections (952) 1-9850, fn (9~2) 447-424~~
By
By 0
i Ii
From : JECHEEXC
PHONE ~~o. 612 8926396
Jul.012003 6:21AM P02
"
"
: " . I
CITY OF rRIOR LAl<E'
SEWJ~R AND WATER PERMIT' .
\t. Dafe RBC'd
I
I c),_ 'u. I PERMIT NO '-TJb
2, ".II~.. Cht ~o ? '....c
J, o..ld Attll_ . ~ .;>
V1e~,t)'P.c ort)rlnt All" ~I,p.", at bunum)
WDRESS
J ''? ,1 q LV ~ Ls.-Lu,..o - ~W
....
ZONING (~uu) I
,
I
:.BGAL DBSClUPTION Colnet \Ise only}
LOTSIJBLOCl<) ^DD,.r~~!::. ~~t:.~~~y.SiJ.
:>WNBR 11'/1 0 \ (\ .t'-.
:N umc) -LlL (I l..D.l1 11 r\ \.-'..,0 V1 So . .
A~s)~1 .... l~nT~ ~'r
(~~"""':.{;:h ,~' !,. (AddreuL
~;..~:~;ifl) :',~:'l ,'~
rID
(Phone) SY;; 4V I7..ft, () I
A'l 2..J~ 1/'" IL/,'~~."::"" .
__ ., (~":h~(ZIoCode)
~~eL~~ f:yQ,
~~~~r~daLf) J D..}u.~ eJ.a_l' J e -- _
,1"ti;:-~~,': ' <Addreu)
~:~:~~GN~:1~ ~.
'1)
I,
APJ~LICANT l~LEASE COMPLETE BELOW
Size of water sCrViceT inches.
Location of lUly couplings frum sttucture , feet.
Type of sewer pipe. 0 ABC 0'PVC 0 Cast Iron
Estimated length of sewer line;.:t> feet.
Clean out (if required) 10~<1lcd at teet [rom structure.
(Phone) 1,./;; ')clO 74 QJo
8/[)!Hfl;~j(JYI MJ:J b.f743!
( 'ty) (ZIp Cock)
W '7~ 0 7i.f~ .
7-1-'() ~ . .
..
(Phone)
DATE
,esldenllal sewer and water line connection
ewer connection only
FEE SCHEDULE
$35.50 Industrial. Com'! & Multi-family 1% of job cost with a $39.50 minlmum
$17.50 Water connection only $17.50
E&timalc.d Cost $ ~ J t)
Building Permit #
tillll P~/D ~
DING P. .,.,..,
0, ". '1:1141,.,.
SeWER AND W A nm PERMIT FEE $
STATE SUR.CHARGE $
TOTAl", X'ERMIT l;.m~; $
_.!~O
.m~. u.. Onl.)') . ,..- r ~ ng fe n WI r~ ['
Thll AppUcatlon Becomes Your DuildlltC ()crmil When Approw I. P,aid "; I ~
. J }bal~ 2 zaO] I b ,;'_.....
'buihlln,Officiil '" - --'-1);";--'" ,- - lJ I
14 "OUt. 1Ic)~lcc: ~:-:-I~';:":JlCCtlO'''S <9~ih . "~?", .r.. {J'i2) 447 O~
Receipt No.
~
By 4
\9
'1'
'II
PRIOR LAKI:
INSPECTION RECORD
SITE ADDRESS Z8.!' W'LOS l.~.: ~.W.
NATURE OF WORK \-JE.~ CCN4Jrf2LkT'e~
USE OF BUILDING ~.~ t). _
PERMIT NO. ()3-0S7Q ~:D~.
CONTRACTOR t\4t'DoNltlrO · PHONE~-7IJJ
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
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FOUNDATION (Prior to Backfill) I ~ /$' S'~~ I
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
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FOOTING
SEWER I WATER I SEPTIC
FRAMING
INSULATION
ELECTRICAL
PLUMBING U \ ~ J/lIP ~~ /q-c/)
HEATING (if required)
FIREPLACE
GAS LINE AIR TEST
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BUILDING AND INSPECTION
INSP~OR
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DATE
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COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
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GRADING (Prior to Sodding) _ . Itt:
BUILDING (( /;
ELECTRICAL
PLUMBING f//,I 'Y'y/
HEATING
DO NOT 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.
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FOR ALL INSPECTIONS (952) 447-9850