HomeMy WebLinkAboutBuilding Permit 03-0258
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CITY OF PRIOR LAKE
~rpZtrtmrnt of 2Jjuil~ing J1nsprrtion
~Final Permitted D Conditional e.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 FAMILY
Bldg. Permit No.,
03-0258
Occupancy Type
R3
Type Construction
VN
Fire Zone
N/A
Zoning District _
Legal Description
Ll, B3, JEFFERS SOUTH
Owner of Building _
Site Address 15050 JEFFERS PASS
Contractor's Name & Address WENSMANN HOMES, 1895 Pl.AZA DRIVE, SUITE 200, EAGAN, MN 55122
ROBERT D. HUTCHINS YW _ City Planner DON RYE
Date:
J,) Building Official
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-
Date:
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CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
/s~OSo
,-Tdh, 5
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
DATE 'TIME
/2. cr-u ,>
~~7
~-2-S-~
o PLUMBING RI 0 EXIGRADIFILLlNG
o MECH RI 0 COMPLAINT
o WATER HOOKUP 0 FIREPLACE RI
o SEWER HOOKUP 0 FIREPLACE FINAL
o PLUMBING FINAL 0 GASLINE AIR TST
o MECH FINAL 0
_ c;;/f/ r /'7'(' 'S
COMMENTS:
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-
~~TISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WO", ~R REINSPECTION BEFORE COVERING
Inspector: f t/ r Owner/Contr:
, .
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
INSNOTI
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
.
DATE TIME
CIlY OF PRIOR LAKE
INSPECTION NonCE SCHEDULED M-.Ji!- ~ ':<.' S- ()
I/).I :n"tJJ
ADDRESS I 50SO I ca:&~ ()t:t J..5
OWNER CONTR. Woll1.s~
PHONE NO. PERMIT NO. tt) ~- ;;) ~~
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
o MECH FINAL
~ILLlNG
o ~pi.Aitfr
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
COMMENTS:
6f~- t9 t:.-
c,J/bfSn-t.-- Or
(}('WORK SATISFACTORY, PROCEED
~ a;RRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
A/'~ / . _"
Inspecto~~ --..:.-.- Owner/Contr:
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTI
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
(;-11
ADDRESS
I ~OS() J <efCr~ as>
OWNER
CONTR.
PHONE NO.
PERMIT NO.
2-uY
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
.JiiIP'1iLUMBING FINAL
o MECH FINAL
o EXIGRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
COMMENTS:
o V~YI40IX
rrvJf ~q (Y5
o WORK SATISFACTORY, PROCEED
~ CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: ltv! (r ll-(f) Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
lliSlIon
DATE TIME
CITY OF PRIOR LAKE ~-(3
INSPECTION NOTICE SCHEDULED
ADDRESS lSOq) ~_.nS~~
OWNER CONTR. ~
PHONE NO. PERMIT NO. s,?7~
o FOOTING o PLUMBING RI o EX/GRAD/FILLING
o FOUNDATION o MECH RI o COMPLAINT
o FRAMING o WATER HOOKUP o FIREPLACE RI
o INSULATION o SEWER HOOKUP o FIREPLACE FINAL
~FINAL o PLUMBING FINAL o GASLlNE AIR TST
o SITE INSPECTION o MECH FINAL 0
COMMENTS:
,.
A ttf.e. ~~<s
lA);~
rock Dl\
"
"
/'
~RK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT LL FOR REINSPECTION BEFORE COVERING
Inspector: _
Owner/Contr:
CALL ~ 98 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYl
INSNOTI
-T
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
(Please type or print and sign at bottom)
ADDRESS
is OsO je fFct';<1
Po.-ss
LAnd, n 'J
LEGAL DESCRIPTION (office use only)
I. White File
2, Pink City
3, Yellow Applicant
LOT ) BLOCK 3 ADDITION J e. f P e 1'"5 .50 A l' h
OWNER
(Name) LV ens mAYl)'\ J-foP1eS
(Address) I ~qS - ;'JLA Z Il- (J r I j e
BUILDER
(Name)
(Contact Name)
(Address)
~
m,C!..K
TYPE OF WORK
o Misc.
Date Rec' d
yl vO?"
PERMIT NO'Q? ~ 025~
ZONING (office use)
,q)
PID~ ~,.~q5- 053-0
(Phone) b:>-/- l.J 0 ~ -'I if b 0
tfl,CjI1 n. fJ1,.., r:;5 JZ 2-
1.1t:'{LmnY/
~ New Construction
~Lower Level Finish
(Phone)
(Phone) (p /2. -3 "9 - ') b Z- q
Ii! Deck
J. kJ Fireplace
OAlteration
OPorch
ORe-Roofing
OAddition
PROJECT COST IV ALUE (excluding land) $
ORe-Siding
OUtility Connection
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, "u::~/ t~are that the building official can revoke this permit for just ca,use, Furthermore, I hereby agree that the city official or, a designee may
~teru~~pe~~r~ Itfs-~ A -11-03
~ignature Contractor's License No. Date
I Permit Valuation
I Permit Fee
I Plan Check Fee
I State Surcharge
I Penalty
I Plumbing Permit Fee
I Mechanical Permit Fee
I Sewer & Water Permit Fee
I Gas Firepla ermit Fee
/
p.' ati
1- Li. eo/l).
$ II;,~O. (') ,
$ 1011./0
$ ! CJCf. ~.
$
1$ //JO.~
1 $ 1/11.'-
1 $ ( ~~_:::;-o
1 $ .LJ.L;~ --
,
Bwiling P7 J;:';'ro
, Da
I Park Support Fee
I SAC
I Water Meter Size 5/8"; 1";
I Pressure Reducer
I City SAC and WAC
I Water Tower Fee
I Builder's Deposit
I Other
I TOTAL DUE
..-
I Paid X' / rp1. tf ~
I Date - '3 </ II /() J
$
$
$
$
$
$
$
$
_ $fS. /~ 9. z5T
f/ ../
ReceiV, No. '1'3 T?i1 I
By ~1-" _ I
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'300. -
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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
:-vhen SiJ11.gn by he CTJj'lY. Eonstitutes a temporary Certificate of Zoning compliance and allows construction to com, mence. Be,fore occupancy, a Certificate of Occupancy must be
=~ A
)..-l()-('/3 e t'(I J. t:t 1/ fl() to ~ /--I.r."..,cJ 4ZJ 1- S
P ning Director Date Special Conditions, ifany' .
24 hour notice for all inspections (952) 447.9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
.
~:.~~ J : :U~~~ng
Pink - Planning
The' <'f'nln of Ihr t.lkr ('ounlry
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT ttJ~~ .~
APPLICATION RECEIVED :;;2 - ! j-() 3
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construct!:;~; ;iC(j~ fJlU4--
Accepted
Accepted With Corrections
v
Denied
MflL
Date:
2~J.,o~dS
Reviewed By:
Comments:
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."
I I
I
............."~. ,."" ,-"t,," "'.",
The etn'.. .1 the Lake Counlry
White - Building
~ - En~3Sg
Ink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT /~~.>l'
APPLICATION RECEIVED
o'"~
...i..-
'1:1"
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
/ () ,S- I) . I It:!' ,.'.', / / ,,-,.
,. ~, j J /' ;' -
I ! ( J
Accepted
Accepted With Corrections
//
Denied
f/d~
Date:
).JJ.)..(r d3
Reviewed By:
Comments:
"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 ~-
T
I
The' ('e'nte'r of the' l.ake Country
White - Buildinc]
~anarv - En~in!frlng~
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
t<.i
I 1/." .,.; "/1'),1 .r '1 " A
/./ ':..R.4tu'/l'I:/1,4&'."/'.'--'
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APPLICATION RECEIVED
....---.
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The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is..-Pfoposed at:
~/ ,
r;-/jS-O" :/ /)'//.1""'1 t.,./.."
/ ~ V I ~'-'{-1'T-,'1' //./:) ,', 2,_'IfJ~-
. {/U
Accepted
x
Accepted With Corrections
Denied
Reviewed By:
/JIJ4.l5
Date:
3-/0-03
Comments: ~P.A Reverse Side for Additional Information!
Driveway Must Have A Concrete Approach
See Attachtnents: 1) Grading Plan, 2) Erosion C:o.ntrol ~~l1rf'~
"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 I
.
i
11.200311:50AM
.(1M
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!i.^ ".,. ,'N'lIrp'SO
~.:' ~A"'~"",'~~'"l'..
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GENZ RVAN PLUMBING AND HEATING
No.9444
P. 2.4
Date Rec'd
CITY 'OF PRIOR L.AKE PI..UlVlBING PERlVul
) Blvti: File
2, Gold City
3, yel(.,.., "'p~H.""t
I PERl\'UT NO-l3 ./ ;7581
(please tYPe or. OJ'll)[ and ~J.j:O) at bottom)
ADDRESS ,
jt)D9J ( -efff?Je-c
{k1!J
ZONJNG (oo;ce llSC)
LEGAL DESCR.JJ?TION (office use oIJly) , ' t..
LOT I BLOCK.~ ADDmON Jc1~r
I tlI1dcnCf
~/
PID
OWNER
~ame) Wensmann Homes
(Phone:) 651-905-3709
(Address) 1895 Pla.za. Dr
Eagan, ~IN 55122
APPLICA.l'IT
(Name) Genz-Ryan Plumbing & Heating
(Address) 14745 So Robert Trl
(Address)
(Contact Person) r Jfl. rt [Sh, ;--' FuLt!),
APPLICANf SIGNATURE ._._~
I
I
I
I
I
)
I
I
Qua-noty
I
'I
I
L/
. ,
1-
I
/
-~
(phone) 651-423-J.l44
Rosemount. M.N
(City)
55068
(Zip Code)
~Rv7
(Phone) 651-423...,1144
_ DATE 3)/1103
APPLlCANT PLEASE CO:M:PLETE BELOW
, Type of Fixture Quantity
I Bath Tub with or without shower
I Dishwasher
I Floor Drain
Lavatory (Bathroom Sink)
La.undry Tray (lor 2 compartment .sink
I Shower Stall
Sinks
Bar Sink
I Water Closet (Toilet)
Type of Fixture
i
R-I-
J
Rough-ins
I Watex- Heater
I Water Softoer
I Stand Pipe (Washing Machine)
Sewage Ejector
Backtlow Assembly
Backflow Assembly Test
Lawn Sprinkler
I Other ..
fl.- j:
FEE SL..t1J!jDULE
rndlJ!trIal, Commerqal & MUlti.farruly 1 % of Job cost with a $39 50 minimum RC51dc:ntlal, Ncw One & Two-FamIly $99 50
Rl:Sidcntial, Addjtions & Alterations $3950
(Offic:e Use Only)
Estunated Cost $
BUlldmg Pem))t #
PLUMBING PERMIT FEE
STA TE SURClMRGE
TOTAL PERMIT FEE
$
$
.$
Building OlGdal
50
8lJ/J ~Jf/() I~"
I Paid ~~
D,.lfie(i;i l~ G m (g l By ~~
24 hour notice f(lr 3.11 i?.spections (952) 447- i ~), &JWs2! A-rlg~ ~ '-'j1
This Application Become! Your Building Permit When Approved
Bv
~Il
.
I
11.2003 ii:50AM
GENZ RVAN PLUMBING AND HEATING
No.9444 p. 3.4
~i~\
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'~;~\~~~~~~~~':':~'~NNE s o~,..
Date Rec'd
'?
CITY OF PRIOR LAKE
SE'WER AND WATER PERl\tUT
/, r.;~..., i'lle PERlM1T NO ~
2, Y.Haw Cir'r' I. :J _ <") e::-
], c",d Applian. V 0 V '
(Please tYPe or pnn[ and S~ at bottom)
ADDRESS} Crv::}-) J JL rDasc
-j V :JL/ f7f eleS ft. ,2:)
ZONING (office us",)
LEGAL DESCRIPTION (office use only)
LOT I BLOCK3 ADDITION ,,).e-fftJe.-J
La-/7dC17lf
,,J
Pill
OWNER
(Name) 'Wensmann Homes
(phone:)
651-905-3709
(Address) 1895 Plaza D-r Ste 200
(Address)
Eagan, !:IN
(City)
55122
(Zip Code)
APPLICANT
~wrn~ Genz-Rvan PlumbinR & Heat1n2
(Phone) 651-423-1144
(Address) 14745 So Robert ITl
(Addrec"J, -PtX?,L\h fallS ~::~<).
'(.ICANT SIGNATURE __ ___1,,~UZ~~::~iJ ~ DATE
Rosemount. '~
55068
(Zip Code)
(Contact Person) _
651-423-1144
4) /I/O?>
APPLICANT PLEASE COMPLETE BELOW
Size of water service inches.
Location of any couplings from structure feet.
Type of sewer pipe 0 .ABC 0 PVC 0 Cast Iron
Estimated length of sewer line feet.
:Clean out (If required) located at feet from structure.
Residential sewer and water hnc connection
Sewer connection only
}i~J!j SCHEDlJLE
$3550 Industrial, Com'} & Multi-famlly } % of job cost WIth a $3950 minimum
$17.50 Water connection only $17.50
Estimated Cost $
Buddmg Permtt #
SEVv'ER AND \V A TER PERtvllT FEE
STATESURCHA.RGE
TOTAL PER.JmT FEE
$
$
$
.50
j,
1
This Application Becomes Your Building Permit When Approved ' - 4'1>.....: -' .
J~ @ ~ ~ ~ I'", i
\ U J)ate - \ I I \ By
Date ,,' --AP-R 1 ~] \,b-
24 hour notice Cor all Inspections (952) ""~- 850, (2'; (952) 447-4245
By
Building Offiosl
.14~0 ~
~G i/.!/f
Receipt No, ~4t1}-
{!/
(Office Use Only)
~I 1
.
2003 11 :50AM GENZ RVAN PLUMBING AND HEATING No.9444 p. 4'4
'?' CITY OF PRIOR LAKE Date Rec'd
tl~ATING/AlR CONDIT.lONlNG/l'JJ:{EPLACE PERMIT
."
.",.
1 Pink Fil.
2- Gr.." Ciry
J. Y.lI"", ^~pliCllllI
.PERlVnl'N03_~
(Ple:uc: ~c: or pont and sien at borrom.)
ADDRESS
It::JDQ;> J-eff~s
~
ZONING (oflicc:use) ,
LEG.AL DESCRIPTION (office use only)
LOT 1 BLOCK -3 ADDITION \...]effe;eS Landtnq
J
PID
OWNER
~ame) WA~~rn~nn Hn~Q~
(Phone) hC;1_0r1C;_<7r1Q
(Address) 1895 Plaza Dr Ste. 200
Eagan, MN
55122
APPLICANT
(Name) Ge.nz-Rvan. P~lIJ!l~ Heati'Q&.
(Address) 14745 So Robert Irl
(A~~
(Conta.ct Person) fJfJ (l (.f h rirJJ j /'J
A.PPLICANTSIGNAro~ _f1_i~ ~i!h
(J?hone) ';C:;l-t.?':\-llU
Rosemo1.1nt, MN
(City)
.55068
(Zip Code)
(Phon:A~ c:; 1 -t.;;7 ;/~1tJ :5
, APPUCANT PLEASE COMPLETE BELOW
-.. ~w CONSTRUCTION 0 REPLA{elENT 0 ALTERA Tl0Nl,
FURNACEMAKEANDMODEL (}JJnn'f., t);l0Q lfp.:::./;)-~ FUEL .1/ !trf::;ffS
FLUE SIZE RETURN OPENINGS L1 INPUT /~ 000 OUTPUT II S/ axJ
TYPE OF SYSTEM REA 11NG OR POWER PLANT
3\Vann Au- Plants 0 Steam
:)Gravity 0 Hot Water
Q.~ech8mcal 0 Radiation
~r Conditioning 0 Special DevIces
OVent System 0 Other Deyices
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
FlREPLACE MAKE AND MODEL
IndusmaJ, Commercial & Multi-Family
FEE SCHEDULE
1 % of Job cost Residential, Gas Fireplace
$39 50 minimum
$9950 ReSidential, Additions & Alterations
$6450 Residential, AC O11ly
$39.50
ResIdential, Heatmg &: Ale (New ConstrUction)
Residential, Heating Ooly (New Construction)
$3950
$39 50
EstImated Cost ,$
Bwlding Permit #
HEATING PERMIT FEE
STATE SURCtMRGE
TOTAL .t' .t"J:<l\:1IT JrnE
$
$
$
.50
~~~
f.()14J, f) hh-..
l>'~~
~~
(tV~ - U,c Only)
I
I ....s ApplicatioD Becomes Your Building Permit When Approved
Building O!ilciaJ
))a tc
'~ ) ~~ l; U m ~ ~.
.1 D~~R 1 4 2003
Receipt No.
24 hour noUte for alllnspecttons (952) 44'Ef~50, fax (952) 447-4245
By a/
'v
.
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
~. ~::n ~!;y I PERMIT NO. ':< - d.- Sf{
3, Yellow Apphcant '--"
(Please tvDe or urint and SilOl at bottom)
ADDRESS ZONING (office use)
15050 JE.t'.t'.t.RS PASS
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name) WENSMANN HOMES
(Phone)
(Address)
APPLICANT
(Name) ALLIEP 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
BRFNDA HUSTON
DATE
5/9/03
APPLICANT PLEASE COMPLETE BELOW
xD NEW CONSTRUCTION 0 REPLACEMENT 0 AL TERA TIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM
DWarm Air Plants
DGravity
D Mechanical
DAir Conditioning
DVent. System
HEATmGORPO~RPLANT
D Steam
D Hot Water
D Radiation
D Special Devices
D Other Devices
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
FIREPLACE MAKE AND MODEL
REA TN GLO 6000TR-OAK
Industrial, Commercial & Multi-Family
FEE SCHEDULE
1 % of job cost Residential, Gas Fireplace
$39.50 minimum
$99.50 Residential, Additions & Alterations
$64.50 Residential, AC Only
$39.50
$39.50
$39.50
Residential, Heating & NC (New Construction)
Residential, Heating Only (New Construction)
Estimated Cost $
REA TING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
Building Permit #
$ PAID W/7i
: .50 BUILDING PE~M'T
\~I~l.r[~ Q ~1 \~ ~\\\
U Pa ~ i J Receipt No.
J)oltli<': 1 3 2003 ') By (f
24 hour notice for all inspections (952) 447l~I.' y'i; ~,j
Date
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Buildin!!: Official
.
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
(Please type or print and siJtll at b " ~.", "".)
ADDRESS
I. Pink File PERMIT NO 3 I
2, Green City . ' - '5 ~
], Yellow Applicant rX
ZONING (office use)
15050 JEl'l'bRS PASS
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name)
WENSMANN HOMES
(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
4/14/03
APPLICANT PLEASE COMPLETE BELOW
xD NEW CONSTRUCTION D REPLACEMENT D AL TERA TIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE
RETURN OPENINGS
TYPE OF SYSTEM
DWarm Air Plants
DGravity
o Mechanical
DAir Conditioning
DVent. System
INPUT
HEATING OR POWER PLANT
o Steam
o Hot Water
o Radiation
o Special Devices
o Other Devices
OUTPUT
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
FIREPLACE MAKE AND MODEL
REA TN GLO 6000TR-OAK
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
Residential, Heating & AlC (New Construction)
Residential, Heating Only (New Construction)
$39.50
$39.50
Estimated Cost $
REA TING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
Building Permit #
$
$
$
.50
PAID WITH
BUILDING PERMIT
(Office Use Only)
Building Official
l~d(Qf~ U ill ~ r Receipt No.
IfaAPR 1 R 7001 I By
_'u LJ
24 hour notice for all inspections (952) 447 .9850, fax (952) 447-4245
By
This Application Becomes Your Building Permit When Approved
Date
.
PRIOR LAKE
INSPECTION RECORD
DEPARTMENT OF
BUILDING AND INSPECTION
SITE ADDRESS ~O SC HN~ ~.JS
NATURE OF WORK IIl&.MI ell'" ~ "'..,c. ~..."
USE OF BUILDING ~. (J.
PERMIT NO.03--~ DATE ISSUED 3./0' o.s
CONTRACTOR ~...s"'a"" H'tIIIt.~ PHONEGJl"X!J-7/,~1
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT 11 )
~ ~ INSPECTOR /2.1f 0 I~ DATE
I FOOTING ~lo""~l ~tb ~~ t C; ~ I g 1'^3 M
FOUNDATION (Prior to Backfill) I tP.dJ :r...cr I
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
SEWER I WATER I SEPTIC rfl:!) -3"- e 0
FRAMING r..J jf-t'7v'VV!;( ~ ~ If! '2--L L 1-- (.2... t 0, I L- <) C4...
INSULATION f!/l ,.d-cs;:-
ELECTRICAL et1-.
PLUMBING
HEATING (if required)
FIREPLACE
GAS LINE AIR TEST .
~b
~L1-
S;~
~/ -.2./
4'/ -Y1.-!d2,
( "
t/J~/t:J3
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
~/1!IJ1.T1I~'lH:D....YMI' I I
FINALS
;v'f) II.Z1. '"
GRADING (Pri~r to Sodding)
BUILDING r~ -\-0 8 - r
ELECTRICAL
PLUMBING
HEATING
DO NOT
JIW'
lIP
OCCUpy UNTIL ABOVE HAS
NOTICE
C;,- If ~ dJ
~ (,6
BEEN SIGNED
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.
FOR ALL INSPECTIONS (952) 447-9850
11
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