HomeMy WebLinkAboutBuilding Permit 03-0707
<trtrtifiratt lIf @rtttpanru
CITY OF PRIOR LAKE
~tpttrfttttuf nf ~uil~iug Jluspttfinu
~nal 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.
03-0707
Occupancy Type R3
Type Construction VN
Fire Zone N / A
Zoning District _ R 1
l:. ,
Legal Description L22. B2. JEFFERS SOUTH
Owner of Building Site Address 3899 RASPBERRY RIDGE ROAD NW
Contractor's Name & AddreWENSMANN
1895 PLAZA DRIVE. SUITE 200. EAGAN. MN 55122
ROBERT D. HUTCHINS
Building Official
Date: I' -Iry-D)'
HOME S .
/1
/ ,
(( /
City Planner
DON RYE
Date:
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS '3~ Cf1
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
p(' FINAL
/0 SITE INSPECTION
COMMENTS:
6\(
SCHEDULED
~~t}
CONTR.
PERMIT NO.
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
/MECH FINAL
tv I" \O~
..~
OA TE TIME
ll-t7-cJ) 7:60
'( - 7~7
o EXIGRADIFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
gLo
-fL~ B\A.'~~
o WORK SATISFACTORY. PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspect~. r Owner/Contr:
C Ll.; _I 850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
COD UlREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
JN$NOTJ
I"
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
I1f:CG~
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
COMMENTS:
OA TE TIME
SCHEDULED lA/1/C3
A c
~~~., {L/~,
CONTR.
PERMIT NO.
3~7iC7
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o'PLUMBING FINAL
.fl MECH FINAL
o EXIGRADIFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
\~~p~~~ I')y\ Lti~~TW
\/~J
V~~ Ik~ 61(\:
LA
h
'--""
(' lbvJL_,.3t-
~lA2~ hv~
?" 'jf ORK SATISFACTORY, PROCEED
tr,' CORRECT ACTION AND PROCEED
/
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: ./)~
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
Owner/Contr:
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTl
",__~,,,,___,__.,,___'M..._._~~ ...._~,..._"_.___._.__
I"
-T
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
(Please type or print and sign at bu"uu.)
ADDRESS
See Main File
.~~qq,
~~
~
LEGAL DESCRIPTION (office use only)
L White File
2. Pink City
J. Yellow Applicant
lJ\J
.~.t _.L a
T {Jf
~.
LOT~BLOCK ~ ADDITION It'i:-
OWNER
(Name)
1.. "{'"1\S~
.
(Address)
IB~~
BUILDER
(Namet
(Contact Name)
(Address)
~ OL"S
D~
TYPE OF WORK
o Misc.
~&.
p~ D~
Date Rec' d
~-Q~3
PERMIT NO. 03 - 761
ZONING (office use)
If2-
ID ;;..t:::; - ~% - 0~c' ~o
~-k -2ae
(Phone) C.SJ 4fY"" -L/40t1
o.~e
~~
~ew Construction
OLower Level Finish
>=~
(Phone)
(Phone) C::t5J
'/ 0ts;t )
l
o Deck
li'orch
DAddition
ORe-Roofing
o Alteration
PROJECT COST IV ALUE (excluding land) $
o Fireplace
~'IJ
~5r'.J?
4t..tOO
440 -4':>'67
t...I.ot'"
ORe-Siding
OUtility Connection
tee') pa:) -t ~t't'h
#
#
#
#
8}oa:)
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 awarelhat the building official can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may
enter upon the property to perform needed inspections.
Signature
113,000,-
$ / O~~5S-
$ /rfi'a" d., b
$ - ,~1o,r50
$
$
$
$
$
1M"
'/tJIJ,
3S.l5"D
40r-
This Application Becomes Your Building Permit When Approved
~~M~
to/lfa/oJ
I Date
Contractor's License No.
I Park Support Fee
I SAC
Water Meter
Siz--4. I'"
r,m/, ,
Pressure Reducer
I City SAC and WAC
I Water Tower Fee
I Builder's Deposit
I Other
I TOTAL DUE
I Paid &) ti & i, f ;
I Date /- -J- ~
Date
I
I
I
I
1~(X),- I
71>0. - I
I
$ I
$ SSIoI~<fl/1
- ,,,..--
Receipt No. t:J ~ X'l{.J I
(r~-~ ~ I
$
$
$
$
$
$
$
I;}. 75--
.. a50.-
t/.5. -
x
Permit Valuation
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 Fireplace Permit Fee
Building Official
By
This is to certify that the request in the above application and accompanying documents is in accordance with the C,tjoning ordinX ~ may proceed as requested. This document
~~: signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction t.:)ee Bel VI a1 a Certif'F'Ilupancy must be
~~ ~~.,v t:,/I~/d3 n 1 e
- Planning Director ' Date' Special Conditions, if any
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
(/) 3 - 7<~)-7
'-.-J'
See Main Fi~e
White - Building
Canary - En9ineering
('"f"mK -= Plann~
Thr ('enltr or thr take ('OU"1I1'
~
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED~
'J ) J ,,.,, ".'1
'j'./ )('/'v/f /" d:/J,(.-/)'U
0~;~ -() 3
l//l!
<"J C, /
J
.,:,,~~~;-t~
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activitywhich is proposed at:
...-", r; /1'1' /"-"1 I ; , I"
~x ~' ~- ,','
C:/ j (/j I,~; ,,<'i~-~,
j ,J
I""\'ll#
I
,", I
k<cL.
Accepted
~
Accepted With Corrections
r.
Denied
Reviewed By: ~~
,
7/~
Date:
&'/;~.M 3
.. Comments:
~
f;,
-""
.-
(' -
...
.-
...
l ~""'_""-
, t
,.-....
"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,"
j") _'"2.- "-7/;-7
; / -./) l '-' I'
'."-
See Main File
White - Building
<1iana.2 - englneerin!:l}
Pink " - ~Iannlng ,
Thr ('"nlpr of Ihr tall, ("ounlry
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
,$1".-", ,
l/.//Z<;'vJ."1~1 (.'l/~t.--'}{/
\
,
. j
;lj(l)'J1_J:2g...,./'
! ~ .,...... :-.~...
/" ", -' ......} _ ' I \.".;
~..<..." (.../\ - {jl ,.}
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity_~hich is proposed at:
.::;~,) g-' q (.;/,. "I ) j
f\ !~'-:! (7 _I ,1 J ./
~j 1.1 , '. . 'r..J:::/ V ,;.J'.',,~_
T"> I
{L/. (i~
I
l
v
/" I
i) _::~ !
/~- ct,..,.
u
Accepted
x
Accepted With Corrections
Denied
Reviewed By:
/11413
5c< !J1Q/I,.... Fr' 1<.. .
Date:
6 -9-'03
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."
-II
I
03- 7{J7
See Main File
~hite - ~1.Jiliflrilt>
Canary - Engineering
Pink - Planning
Tht' C('nlrr of Ihf' t.kf Counlry
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
IV PJt<.0U~
....
(o-~-D G
The Building, Engineering, and Planning Departments have reviewed the building permit
application for cSf99 aCliVpWhiC~ is proposed at: ~? J2-eL
Accepted
/
Accepted With Corrections
Denied
Reviewed By:
Comments:
~
7I~J.; Date: ~/;~/tJJ
, .
"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."
"... .-.....',Jlln. 9. 2003' 8:30AM"'" -'GENZ RVAN PLUMBING AND HEATING""-'
.....,. No.6 6 9 3-......P. 6 24 "'-'v_."'_""""
Date Rec'd
CITY OF PRIOR LAKE
SEWER AND WATER PERlVIIT
~. ~w~.;. I PERMIT NO.
'Cold Appllcmt
3-1011
(Please tYPe or print and !WI at bottom)
ADDRESS . ..
3~ry RMi2~~ /Y.
I LEGAL DESCRIPTION (office use only) .
LO'~LOCK;t ADDmON (. f.eff.f!1J(2S
ZONlNG (office U$e)
PID
OWNER
(Name) Wensmann Homes
(Phone) 651-905-3709
Ea~an, MN 55122
(City) (Zip Code:)
(AddI~) 1895 Plaza Dr Ste 200
(Acld.ress)
APPLICANT
(Name) Genz-Rvan Plumbi~f! & Heating
(phone) 651-423-1144
(Address) 14745 So Robert Trl
(Addn:ss) ft I / .
(ContactPc:rson) _ CI/i Je.LS fJ 1Z<.A.A.A'
~ _U ~);-) ~
Rosemount. "N
(City)
55068
(Zip Code)
it.
\-.:;~';~'~)'~'
....JCANT SIGNATIJRE
(phone:)
DATE
651-423-1,144
I.dJ 1.1 d. ~
, II'
APPLICA1~T 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) lOcate9at feet from structure.
Residential sewer and watCX' line connection
Sewer co:o.nection only
.J:1.E.E SCHEDULE
$35.50 Industrial., Com'l & Multi-family 1% of job cost with a $39.50 minimum
$17.50 Water connection only $17.50
Estimated Cost $
Building Permit #
SEWER AND WATER PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
.50
(Office: Use Only)
This Application Becomes Your Building Permit When Approyed
Paid
Receipt No.
I(~'[.i'""C',
\", c., . BulldlDg Otnc:lal
Date -
By
Date
24 hour notice for all iospecnolls (952) 447-9850, flax (952) 447-4245
_ 'I'ILE
....., - .....1IWIr
-.--an
'-~:&.~ OP PlUOR LAD s.1r..Jth
..:s~d.~. DO 1IA.....lo..~ ,~.!." ,,~.;,'
..lo'~ ....b: S,,,, 1 :"J. and Water
contractors must
be registered
with the city.
APPLICANT: S~&~ ~ F~. ~1llo:1~'BR:J,J;) -;}dJ-3f;)0
ADDRBSS: d ~kL' I!... ~~ T fC.UAel.~"1'B:J--I'I- 0 3
..J / .J
SIGRA.......~: 9'- PBRlt.&.... ,
S.L4.A ADDRESS:
FILL IN :U'IA BLANKS
1. E~timated length of water service ...... ~
feet.
2. Size of water service
JIt
inch(es).
3. Location of any couplings from structure
feet.
4. Type of sewer pipe. ADS PVC V Cast Iron
r .
S. Estimated length of sewer line SO feet.
6. Clean out (if required), located at feet from
structure.
....----~====-lI:a-------- ..=_.....--..a--....,_.. ~ . . . ._~_
'.... -~---------=:=
This application becomes your permit when approved.
BY
DATE:
========-
------=...
__"'_" 0'.' .~... ,________;;;.____________
FEES:
$
$
$
35.00
.50
35.50
Sewer and water line connection permit.
Surcharge
TOTAL
* Fee for either sewer or water individua11y is $20.00 plus
$ . 50 surcharge.
* S"-'II':".
r.......y
toi
issu
. t~1 '.I~_"'i't~' ''l!~'~' i~..._ed for nev....i..oL.....ctiQD .ust: be
Le ~ D9 perait _....1 at the tilae of issuance
t: ,licate sever and water peril its are
JLJI 1 5 2003 U i
~d AMOUNT PAID PAID WITH
~PERMrr
-~--~'--:-:~,',,"-,:~=--l REC' 0 BY
DATE PAl
RECEIPT
16200 Eagle Creek Av. S.E., Prior Lake, Minnesota 55372/ Ph. (612) 447-4230/ FAX (612) 447-4245
An Pn...l n
11,,1'" 'R1'nnln.,....
z:e'd
89vL v88 Z:~6
'~X3 ~ ~NlaWn,d ~~iS Wd ~~:~e ~eeZ:-vl-,nr
j .1
If
T
SeD. 8. 2003 2:05PM
GENZ RVAN PLUMBING AND HEATING
No.0460 p. 513
CITY OF PRIOR LAKE
SEWER AND WATER PERlVul
Date Rec'd
~. ~;:.. ~\;., I PERMIT NO.,2 - /) /l /:7
3. ()old AppllQJl' - .J I v
(P!l:3.Se ~c: or print ~d siSW at botto,m)
ADDRESS 3
Qa fA,'A Yl /'/ CC}/l()f/) fOI!,/ /7" / /'1() )
o ( ~ ( KJ/f 0 C)'/--(I0K-A/A-' fiGl CC v)X...../
· U u
ZONING (c&euse)
LEGAL DESCR..u-uON (office llSe only)
LO~LOCK;;;2 ADDITION \...../ e,ff~f2'-.\
Joutlv
PID
OWNER
~~~ Wensmann Homes
(phone)
651-905-3709
(Address) 1895 Plaza Dr See 200
(Address)
Eagan, MN
(City)
55122
(Zip Code)
APPLICANT
~ame) Genz-Ryan Plumbing & Heating
(phone) 651-423-1144
(Address) 14745 So Robert Trl
(Ad.dress) .
(Contaa P=oo) _ C tI J{jr tj !ij/ / J ~ ;'
.'TJICANT SIGNATURE (J(A..t;;;);) --!td!/0
Rosemou:t1.t.. "N
( Ciry)
55068
(Zip Cade)
(Phone)
DATE
651-423-1144
PI I Plof)
...,1,\;....
APPLICANT PLEASE COMPLETE BELOW
Size of water semce 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.
Oean out (if required) lpcated at _ feet from structure.
Residential sewer and water line connection
Sewer connection only
FEE SCHEDULE
$3550 Industrial, Com'} & Multi-famjly 1% of job cost with a $39.50 minimum
$17.50 Water connection only $17.50
Esnmated Cost $
Budding Pemut #
SEWER AND WATER PERMIT FEE
ST A TI: SURCHARGE
TOTAL .l"J!;J:<MIT J:lJ!jJ!;
$
$
$
.50
(Offie:e: U5e Ollly)
This Application Become.<! Your Building Permit When Approved
Paid
Receipt No.
I,
Date
I By
Building Officilll
D:lte
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
.
_"0. . -:,:r- ~ ^
0<;1' .
2003"- 2: 06PM'::
G E N Z R V A N P L U M BIN G AND H EAT I N G :,.0 . ..
No. 0460' 'p. 1 3/1 3'~'''-:'.'':'~''''
CITY OF PRIOR LAKF; ,
.I:l.EA TING/ Am CONDITIONlNG/lf1.l<EPLACE PERMIT
Date Ree'd
(Please:: type OJ' Print and s~ at bottom)
ADDRESS '2,0-:
(?J qq
~. ~~ ~~ I PERMIT NO. 3- f 7D VIA
J. YO/low A.pplieont t
i&spb( fZr2J{,
LEGAL DESCRIPTION (offio: use only) .
LOWBLOCK;( ADDITION ~ .eff~r< s \jy1tlfu
J21da~)
J
ZONING (o~e\m:)
PlD
OWNER
(Name) .Jrlen.sl1''''''''' ~,.,.".,...
(phone) 65) -90 "-':l7.,M
(Address) 1895 Plaza Dr Ste 200
Eagan, MN
55122
A.PPLICANT
(Name) Gen:>:-Rv;:llLYl umhin&..-1L.He~t \:Q.g..
(Addres~_ 14745 So Robert Trl
rr . .(A~)
(ContactPerson) ...Jjh )2.ISh .f7;t,jJ \. ')
APPLICANT SIGNATURE _. (1)),.,tA,ib) -f6rfh.()
, ---.-,
(Phone) h C; 1 -h.? ~-l 1 6.L.
Rosemount, MN
(City)
55068
(Zip Code)
(Phone) ,; c; 1_~\? ~_ \0 lM
Cl / f1 ()~, ~J'
DATE
\ /' APPLICANT PLEASE COMPLETE BELOW
(2QNEW COl-STRUCTION I Q ~PLACEMEN1:. r 0 AI... TERA nONS
FURNACE MAKE AND MODEL JJ.../lJ Yl'Yt tjlfJJ.LL1l- '::-jpo~qu FUEL/1ET~nS
FLUE SIZE RETIrRN OPENlNGS ,5' INPUT 14.c.c-o OUTPUT f?!./{) 1J()
TYPE OF SYSTEM HEATING OR POWER PLANr
~a~ Air Plants 0 Steam
'OGravlty 0 Hot Water
. ~echa.nlcal 0 Radia.tion
';tQAir Conditioning 0 Special Devices
OVent Sygtem 0 Other Devices
I PLEASE NO'fE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbac1cl
FIREPLACE MAKE AND MODEL
-
lndustrlal, CommercIal & Multi-FamlIy
FEE SCHEDULE
I % of Job cost Residential, Gas Fireplace
$3950 minimum
$9950 Residential, Additions & AltcrUlons
$64.50 Residential. AC Only
$3950
ResIdentIal, Heating & Ale (New ConstmctlOn)
Residential, Heating Only (New ConstIu<;tion)
$39.50
$39.50
Estimated Cost $
Building Pennlt #
REA TlNG PERMJT FEE
STATE SURCHARGE
TOTAL rj!;Kl\fiT FEE
$
$
$
.50
(rrof Use paly)
, ,.,.. Application Becomes Your BuUding Permit When Approved
Paid
Receipt No.
Date
By .-
Building Official
Date
24 hour notice for all inspections (952) 447-9850, filx (.952) 447-4245
Sep. 8. ~003 2:05PM
GENZ RVAN PLUMBING AND HEATING
No.0460 P. 913
Date Rec'd
CITY OF PRIOR LAKE PLUMlllNG PERlVllT
1 lllu. Fil. PERMIT NO
2. Cold City . . '2 _ --?().-,
J, y.nc.w A,ppJlc:llll - J II I
(P1ease ~e or 'Prine and S1m at bottOm)
ADDRESS
, B[MCif f;;;~/)Wl2J{!ff Ii do/I!,
LEGAL DP..5CRIPTrON (office use only) ~ I~
LOT.#-BLOCK.?Q, ADDITION J.e,fFv~ \ W;:r?0
ZONJNG (ot5c:~)
PJD
OWNER
(Name) Wensmann Homes
(phone) 651-905-3709
(Address) 1$95 Plaza Dr
Eagan, MN 55122
APPLICANT
(Name) Genz-Ryan Plumbing & Heating
(Address) 14745 So Robert Trl
(Addr~ss) r
(CoDtact Person) _ elf ~ls-ri 1U" (( r __.
APPLICAN'r SIGNATURE (i( A'~ '-/&t,.{ .x/')
Quantity
;{
l
,
L/
I
t
,
'-?
(phone) 651-423-1144
Rosemount, MN
(City)
55068
(Zip Code)
(phone)
651-423-1144
DATE q/f/d~'~
APPLICANT PLEASE COlVIPLETE BELOW
I Type of Fixture Quantity I Type of Fatu:re
I Bath Tub with or without shower ,,::5 I Rough-ins
I Dishwasher I I Water Heater
I Floor Drain lZ-r. I Water Softner
Lavatory (Bathroom Sink) I I Stand Pipe (Washing Machine)
Laundry Tray (l or 2 compartment sink I Sewage Ejector
Shower Stall I Backflow Assembly
Sinks I Bacldlow Assembly Test
Bar Sink Lawn Sprinkler
I Water Closet (Toilet) Other
FEE SC'w:!'DULE
Industnal, CommerClal & Mulu.fanuly 1% of job cost with a $3950 minimum Rel'adennal, New One & Two~Famlly $9950
Residential. Additions & Altexations $3950
Estmlated COSt $
Bwlding Permit #
PLUMBlNGPERMITFEE $
STATE SURCHARGE $
TOTALr~w)fiTrE~ $
.50
(Office U!lt Only)
:!bjs Application Becomes Your Building Permit When Approved
Paid
Receipt No.
Dare
I By
B1I.ildillg Official
Dstt
24 hour notice for alllnsp~ctions (952) 447-9850, fu (952) 447-4Z45
--I
I"
1J
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONINGIFIREPLACE PERMIT
Date Rec'd
~: ~ ~~ I PERMIT NO. '3 ;:7(X7
l. Ydlow ^ppli..", .
(l'lc:asc tryc or prim and sii',Il4lt botll:Jm)
ADDRESS
3'8Cf9 ~ ~ /Goad
LEGAL DESCR.iJ:' nON (office use only)
LOT
BLOCK
ADDITION
zo:r-.rING (,,/lie.. ",.eJ
PID
OWNER , l I
(Name) L.J.oM~n IYVn ~
(AddresS)\1S35 p~ ;#~.~;
APPLICANT .
(Namef. ~AJ..l""j / I ,.0.h;(" .l,nJU:i.q~ \'.1. '.~ l~ -:\- &V<../:lCc~ (Phone) 'llJ~3- -3 i 5- 7500
(Address) ~ I 0 L} ,!~'YY\'..:. 1'1.9. tj J f~ 0: ~!cn-~0 ~rr' f=t... JL. rn n Ss '-ii..!. S
, "C1ddres5) () (City) (Zip Code)
(Contact Person) 4<;.\"". U. . (phone) '1G;3-3t 5-75/ ~
APPLICANT SIGNATURE 7f:t--i.~)j/Jj '~J77-:aJ"":::" DATE ~ J3:;J Icf\
(phone) (pSI - C/O(p -<.JC/OO
APPLICANT PLEASE COMPLETE BELOW
~W CONSTRUCTION 0 REPLACEMENT 0 ALTERATIONS
FURNACE MAKE AND MODEL F,UEL
FLUE SIZE RETURN OPENINGS tNPVT OUTPUT
TYPE OF SYSTEM
., OWarm Air Plants
o Gravity
o Mechanical
DAir Conditioning
OVent. System
HEATING OR POWER PLANT "
o Steam
o Hot Water
o Radiation
o Special Devices
o Other Devices
FIREPLACE MAKE AND MODEL (Y\~'D~ 3y,DDV~~u ,_ u. _
. V -- -. ,-
FEE SCHEDULE
w. of job cost Residential, Gas Fireplace
S39.50 minim\lm
599.50
S64.50
Industrial. Commercial & Multi-Family
Residential. Heating &. AlC (New ConSUilction)
Residential, Heating Only (New Construction)
Residential, Addition~ & Alterations
Residential. AC Only
Estimated Cost S Building Pennit #
HEA TING PERMIT FEE $
STATE SURCHARGE $ .50
TOTAL PERMIT FEE S
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Paid
nuilding Official
Date
Date (j C( U 3 2003
24 hour notiee fQr:\1I inspections (95'2) 447-9~O, fax (952) 447414S
i:OO~
X31aIHd 3~VHV~ JIlVWOlfiV
i:OLOSICi:19 XVd 6S:Cl CO/OC/60
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
539.50
S39.S0
$39.50
<9/ ,t.)
. '-~ ~I'^ .
0.- v I...
'-:'1'(~ v,?.",
",'" ,~.
"J~. ..,
'"<>'''
.t:~,).,.
.
Receipt No.
b-4
I
PRIOR LAKE
INSPECTION, RECORD
t'y K ,'4e- RJ
DEPARTMENT OF See ~Main File
BUILDING AND INSPECTION
SITE ADDRESS ~
NATUREOFWORK --'Ye~
USE OF BUILDING ~
PERMIT NO. n 3- 70-' DATE ISSUED
CONTRACTOR ~Wlalt.J~ PHOt&SI. I,JIJ,. I.IlJlJ(J
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR
DATE
I FOOTING
I FOUNDATION (Prior to Backfill) I I
'-( ~,....., PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
& d.. ROUGH - INS
V I SEWER I WATER I ~EPTIC;:
FRAMING fA) I ["
INSULATION
ELECTRICAL
PLUMBING
HEATING (if required)
FIREPLACE
GAS LINE AIR TEST ~ tes/7 ~
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I I
FINALS
/W~
0J4- ~@fl-;
~/>
-n()
4t
J
W?/~/~
I t) ,.~ v
~
7-':' 3tJ
tKYhtoO
GRADING (Prior to Sodding)
BUILDING
ELECTRICAL
PLUMBING (/\) tv ~ ~L/7 ft(s
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.
FOR ALL INSPECTIONS (952) 447-9850
I