HomeMy WebLinkAboutBuilding Permit #03-0662
QItrtifitab~ of @ttupant\!
CITY OF PRIOR LAKE
f
~~partm~nt nf ~uil~i~g Jfnsp~ttinn
\.~ Final Permitted D 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 FAMILY
Bldg. Permit No. 01-0.6.62
Occupancy Type
R3
Type Construction
VN
Fire Zone
N LA- Zoning District
R1
Legal Description
Ll. B2. JEFFERS SOUTH
Owner of Building
Site Address 15187 JEFFERS PASS N.W.
Contractor's Name & Address WENSMANN HOMES. 1895 PLAZA DRIVE. SUTrF. ?OO. EAGAN.
Date:
ROBERT D. HUTCHINS
) ~uilding Official
't) 1\' '::'
, ,
V
_ City Planner
lli)N RVR
Date:
'.
.......'
,','1tiiIiiIJIoiI
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".............., ",..........
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-
I ill 1111
I II III
OA TE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
/ S!??~
IJ""?/-3
9~~ (/
SCHEDULED
OWNER
CONTR.
PHONE NO.
3 -~ CO :;2....
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
o MECH FINAL
o EXIGRADIFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
COMMENTS:
f::; ~ (
/ J /
/ ) j<.. ....-
L/ '
,
/l / ~Ce----
/ I )/ U j
L./'
o WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: J7~' Owner/Contr:
\/~
CALL 447-9a50 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
/NSNOTl
Id-3/-&3
/$/8'""/ (J~~'<J ~
cUv'--
3-h (r,Z;
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
OWNER
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
o MECH FINAL
COMMENTS:
OA TE TIME
o EXIGRADIFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
o WORK SATISFACTORY. PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector:
Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
/NSNOTl
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
n iI1I
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS J t:> I ~ 7
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
~ )NSULA TION
pF-FINAL
o SITE INSPECTION
SCHEDULED
CONTR.
PERMIT NO.
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
1)<pLUMBING FINAL
1f.-MECH FINAL
CO~MENTS: fTY r..
I. (Ltu ...- (\..........., ~r
c,~
~-r~
t'L,.to -~^
.2. h~_
3- So,J _
fI,
t>h~t,U.
C
-
~
~~
\:;.
~
L
I tA9-..A ~
- )P'
j
Q ~()
OA TE TIME
9-V;;~;
~ -I" fe.. '---
, .~
o EXIGRADIFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
-Ie
Co t-e. r.t:,
)
Jo
I,
/ 1- J - 0)
.-/
o WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
X CORRr2W }R~\LL FOR REINSPECTION BEFORE COVERING
Inspecto:.. 'II / Owner/Contr:
CALL 7~~FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
r1REMENTS ARE FOR YOUR PERSONAL HEAL711 & SAFETY/
lNSlIOTl
I III illl
OATE TIME
CITY OF PRIOR LAKE
INSPECTION NonCE
SCHEDULED
Iv -- 3-a,)
ADDRESS 1_<) I~ 1 .J ~.{C:~/} ~
OWNER CONTR. Wtt1~mtt n
PHONE NO. PERMIT NO. n,~ - 6? Z-
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
CCl'AHAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
~~UNG
o COMl'I:XINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
COMMENTS:
hrl:.trt - (J K-
L/)10
~~,~ -- e!-
D( WORK SATISFACTORY, PROCEED
o ~RRECT ACTION AND PROCEED
::~d:REINS:::::::ORECOVEmNG
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
/NSNOTl
I !II ~III
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
~-~6-o3
I. White File I PERMIT NO
2. Pink City 0/'7'71. _orr?
3. Yellow Applicant UJ VlR ~
(Please type or orint and si~ at bottom)
ADDRESS
ISI87 ~t e~ Pe. r-S
ZONING (office use)
Po...S5
",~w.
~/
LEGAL DESCRIPTION (office use only)
LOT I BLOCK rJ.. ADDITION j e. f 'f e YS
Sou.-t h
PID ~5-l195'4#O/YO
OWNER
(Name)
W e~ ?1 .5 Tn A- n (\
~ ?l'l6'- (J L ~ z.. 1}
H-ome5
tJrlUe,
(Phone)
(,6/- Lf 0 (, -4 CfDO
,;;-6-J^d..
(Address)
c: 1I-j It n
/J1 /1.
BUILDER
(Name)
(Contact Name)
(Address)
5 f}m e-
t1'Li c K
J1e.ILPJAn
(Phone)
(Phone)
iDs J....Lj 0 h - 4 4 DO
~/2-.Jb~-7'Z'I
TYPE OF WORK
'!J New Construction
'Lower Level Finish
pqDeck OPorch ORe-Roofing
J... JC Fireplace o Addition OAlteration
PROJECT COST/VALUE (excluding land) $
ORe-Siding
OUtility Connection
o Misc.
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 aware that the building official can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may
enter;~~ ~rl~pefr. t~erform need inspections,
X-!~ 0 J. (4s~ 5"- IG"-l>3
Signature Contractor's License No. Date
I Permit Valuation ,qS,Ooo I Park Support Fee # $
I Permit Fee $ 15d5.'75 I SAC # $ -/;),//5. /'
I Plan Check Fee $ 9Q/, ,4 I Water Meter SiZ~'I'" $ d.tJO, ,...,..
, ,
I State Surcharge $ qlJ. /,0 I Pressure Reducer $ l/5,~.....
I Penalty $ I City SAC and WAC # $ --
/ :J-O 0 ,
I Plumbing Permit Fee $ 100.- I Water Tower Fee # $ '100,--
Mechanical Permit Fee $ 'Of). - I Builder's Deposit $ I.? O(), -'
Sewer & Water Permit Fee $ a,s,SD I Other $
I Gas Fireplace Permit Fee $ L.( () .(J 0 I TOTAL DUE $ 7~6t).l/q
r
I Paid ' 7 5' r;,tJ , . I"., lilf:;-q J
This Application Becomes Your Building Permit When Approved Y'-1 Receipt No.
~ :4-,;rf),J ~/5";G '3 I Date ~ -/~--3 By rrc"""
Building Official 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 con~tutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued.
~~niio~J tt/S-~3 ~~o~
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
I 11 110
Thf' ('f'nl~r of ._ ..take Co....ry
White - Building
c::::!::!!.!!arv - cn~lneenn9:::>
Pink - Plannang
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
! I '"
NAME OF APPLICANT // ig-)-to-,j14-.:Z"j{PC, X-fef:;1{~!V
APPLICATION RECEIVED
J!:::.. ",......, _ /.., ':;;:?
~ ,~,{~ ,-f"';;
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity w~id1 is proposed at: ,c
,,-' -,..... /) /! :t ,- ; j'~/,,-- .
/.~-. I "I., , ..... J" A '.' _ ,.,. '
I _,' /',Y, \~,r/ .-/,_-C./ jL>c:"t,:_~_,.
r .._.",7). . /-
_,I ~ rJ' .
;;;./ {/ L.....,./
Accepted ~
Accepted With Corrections
Denied
Reviewed By:
M1-8
Date:
~-2-0]
Comments: See Reverse Side for Additional Informatinnl
See Attachment~. 1) Grading Plan, 2) Erosion, Control. Mtj::t~\Ires
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 If Iff
White - Building
~' - E: 'neering
ink - Plannin
-
-
Th. ConI., 01 Iho tako Counlry
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT jl it;'? ).1\,/ ;' /, -:7
APPLICATION RECEIVED
I
I
u
'1 .' _ /', ~
.I'..) i ' ..
..' '-/
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
,.;:-: /0,1'}-
I,' ....,../ /~.I('
I
,x
/" k" 'I.....~.
,/
Accepted
Accepted With Corrections ~
Denied
(~
Comments: A. e,
~ ~ ~~,
tl .
Reviewed By:
po
?~P
. ';;fr ~
Date: &;15~ 3
, .
t ~, J
d~~
~
, .:~:...'
)
"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 II iill
r~ - Building:)
Canary - Engineering
Pink - Planning
Thr ("enter of the Like Countl')'
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT ~,().#1~ .~
APPLICATION RECEIVED t5 - do -CJ ~
The Building, Engineering, and Planning Departments have reviewed the building permit
application for constru;; ;;; WU~.iS. proposed ~~
/ vi) --
Accepted
Accepted With Corrections /'
Denied
Reviewed By:
Comments:
rp, ...
~ ~~ Date: ~/s:iJ3
K ~ cU.(l -A-,~ -~.
"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 II III
.----"r ----- ',-
'JlJn, 9, 2003' 8:37AM '""'GENZ RVAN PLUMBING AND HEATING"'"
No, 6 6 9 3' ,., P, I 2 2 4 ._.,..",.,,,",,-
. CITY OF PRIOR LAKE
~ATING/Am. CONDITIONING/.ll'.u<EPLACE PERlVul
Date Rec'd
~ ~ ~~1i<.1nt I. PERl\'IlT NO. 3 -0 G:J-
(Please tvpe or print and. sie:n .u: boaom)
ADDRESS
1?/89- Je.ff~ Pa.&S I7W.
ZONlNG (ofiiause)
LEGAL DESCR.l.r uON (oflkc:: U:lC only)
LOT I BLOCK;;J.. ADDmON Wei1Sman.n /cS+
PID
OWNER
(Name) 't.J~1"\<:!1YUI1"\n H('Iftlc.a
(phone:) 651 -911 <:;_ ':l7..Q.9
(Addrc:ss) 1895 Plaza. Dr Ste 200
Eagan. MN
55122
APPLICANT
(Name:) Genz-Rvan Plulll.l2inl? & Ru,Hnf
(Address) 14745 So Robert Trl
. (Address)
(Contact Person) -.th ~ 5 tj ~ {( S
APPLICANTSIGNATURE rA A~ '---:fv<J.~.LJ
(phone:) fi ~ 1 -6.? 1_ 11lJ.6.
Rosemount. MN
(City)
55068
(Zip Code)
(phone) h <:; 1 -a ?':\_ 1 1 t.L..
DATE ~.3
APPUCANT PLEASE COl\1PLETE BELOW
Dd'NEw CONSTRUCTION
FURNACE MAKE Al'ID MODEL UYln~
FLUE SIZE RETURN OPENlNGS
TYPE OF SYSTEM
.airW ann Air Plants
tjGravity
o Mecbanical
;iAir Conditioning
'.JVcnt Sy~m
QREPLACE~ o ALTERATIONS
rq 2Jp QI../ /5' - / ~ S- FUEL na., f - 6a ~
. I
q INPUT I ~ 5" tWv OUTPUT II S; (Joe
EEAnNGORPO~RPLANT
o Steam
o Hot WaI.et
o Radiation
o Special DevIces
o Other Devices
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
FIREPLACE MAKE AND MODEL
Indu::tri.al, Commercial & Multi-FalI1lly
.l:'.t!..t, SCHEDULE
1% of job cost Residenttal., G9S Fireplace
$3950 minimum -'
$99..50 Residc:nttal, Additions &:. Alterations
$64.50 Residc:ntiaJ, AC Only
$39 ~O
ResIdential, Heatjng & Ale (New Construction)
Residenti:l.!. Heating Only (New Construction)
$39.50
$39.50
Estimated Cost $
Building PeIJDJt #
HEATJNG PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
.50
I1U11. /)~/D IA#
DIAI~ 'Vir-it
~ ,ocS
~4tI'"
Building Official
Date
~IE 're; ~ D 'WJ \~
I P 'a
.Ln 2~W! 1\ 19Q~
te
\\
, ' ~cejpt No.
~Q.G,::~ U~e Qoly)
,fri,":':,:. :"''.:.,'
\;~a~ Application Becomes Your Building Permit When Approved
i I
..1iy
( ,.r-'\
U
24 hour notice for ali inspections (9~) 447-98 ~y~~!, ~;":)~].'I:)
I II III
"UH"i"'-.'
,Jun, 9, 2003 8:37AM
GENZ RVAN PLUMBING AND HEATING
No,6693 P,10.24
Date Rec'd
CITY OF PRIOR LAKE
SEWER AND WATER PERl\tUT
I. Glusl Pil.
2. Y .n;"" CitY.
3. ~ld Appl<<:oDt
PERMIT NO. '3 '-~ b~
(pJeate type or -p,tiDt and:!iJul at bottom)
ADDRESS "
f?l8r Jeff~1e8
Pass
YLfA)
ZONIN'G (office=)
LEGAL DESCRIPTION (office we only)
LOT / BLOCK ,;)..ADDmON Wens rnfArlY) ISf
PID
OWNER
(Name) Wensman'n Horoes
(phone) 651-905-3709
(Address) 1895 Plaza Dr Ste 200
(Address)
Eagan, MN 55122
(City) (zip Cocle)
APPLICANT
~~) Genz-Rvan Plumbin~ & Heating
(phone) 651-423-1144
(Address) 14745 So Rohert Trl
(Addres~ C-. J I
(Contact Person) _ en teL~ h~ iC{,L(,f
':"ICANT SlGNATURE ~
Ro~~mount. "N
(City)
55068
(Zip Code)
(phone)
't/:u.~
DATE
61;1-42.1-1144
f4uI08
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) l,ocate9, at feet from structure.
}l'EE St.t:IJ!,;DULE
ReSIdential sewer and water line connection $3550 Industrial, Com'1 & Multi-family 1% of job cost with a 139.30 minimum
Sewer connection only $17.50 Water connection only $1750
Estimated Cost $
BuUding Pennit #
SEWER AND WATER PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
.50 /llJll../:I,lf/O IA,. , .
D1tvG r~/'11-,
Pt:IiA,ft,.
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Dat~
'\
(y
/
Iii illl
8:37AM
GENZ RVAN PLUMBING AND HEATING
No,6693 P, 11 24
Date Rec'd
CITY OF PRIOR LAKE PLUMBlNG PEAAuT
J .&ILle ?I,II!!:
2. Gold Cily
1 Yellow Appfiw!
PERMIT NO. '3 -~ " :l.l
C?lt:a.'le type: or 'Print and ftl?J1 ac boaom)
ADDRESS
/6/91- J ef-fc/@
PCl &s
NW
ZONmG (office;"sc)
LEGAL DESCRIPTION (office use only)
LOT I BLOC!{ 2- ADDITION W e n~ JrK:1. YI Y1
1st
PID
OWNER
~~e) Wensmann Homes
(phone) 651-905-3709
(Address) 1895 Plaza Dr
Ea.gan,MN 55122
APPLICANT
(Name) Genz:-Ryan Plumbing & Heating
(phone) 651-42.3-1144
(Address) 14745 So Robert Trl Rosemounc, MN 55068
(Address) L I I (City) (Zip Code)
(ContacrPerson) CYJ~i~h' ~ ,~ Q?hone) 651-423-1144
APPLICANTSIGNATURB fJtA~ ~/) DATE /,/y!()3
....'" , ,
Quantity
I")~
-4
,
LI,
,
I
-~
APPLICANT PLEASE COMPLETE BELOW
, Type of Fixture
I Bath Tub with or without shower
I Dishwasher
I Floor Drain
1 Lavatory (Bathroom Sink)
I Laundry Tray (lor 2 compartment sink
I Shower Stall
I Sinks
I Bar Sink
I Water Closet (Toilet)
Quantity
3
,
~ .. :I-
I
I Type of Fixture
I Rough-ins
I Water Heater
I Water Softner
I Stand Pipe (Washing Machine)
I Sewage E:jector
I Backflow'Assembly
Backflow Assembly Test
Lawn Sprinkler
Other
FE:E SCHEDULE
Industml, Commercial & Multi-famiJ)' 1 % of job COSt with a $39.50 minimu~ '
(OfllCt Us~ Only)
ResidennaJ, New One: & Two-Family S99.50
Re.';'identia.\, Additions & Alterations $39.50
Estimated Cost S
Building Permit #
eu/! .t>-4/D 'A. - .
D/1\IG r~.,.1y
,o~~
~I}-
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTALPERMITTFEE $
.50
This AppJieation Becomes Your Building Permit When Approved
BuildiDgOfl1cilll
P,~r ~eipt No
_ rn\ ~ ~ If n ffijJ.I n \
r~ ~ ~ - ~ - ~)1
Dace J r JBN 1 9 2003 -J J
24 hour Dotice for 311 ill:tpections (952) 447-985J ~cU (952) 447-4245 L
y
By
I II III
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
~. ~~n ~::y PERMIT NO. 3 -'_1_......... I
1 Yellow Applicant -l.Dc.o~
(Please type or print and sign at bottom)
ADDRESS
15187 JEFFERS PASS
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
OWNER
(Name WENSMANN HOMES
(Phone)
(Address)
APPLICANT
(Name) AIJ.JED FIRESIDE DBA FIRESIDE HEARTH & HOME
(Phone)
651-633-2561
(Address)
2700 NORTH F AIRVIEW AVENUE
(Address)
ROSEVILLE
(City)
(Contact Person)
BRENDA HUSTON
(Phone)
651-633-2561
APPLICANT SIGNATURE
BRENDA HUSTON
DATE
ZONING (office use)
PID
55113
(Zip Code)
7121/03
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
INPUT
HEATING OR POWER PLANT
o Steam
o Hot Water
o Radiation
o Special Devices
o Other Devices
DWarm Air Plants
o Gravity
o Mechanical
DAir Conditioning
DVent. System
FIREPLACE MAKE AND MODEL
HEAT N 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
Residential, Heating & NC (New Construction)
Residential, Heating Only (New Construction)
Estimated Cost $
REA rING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
Building Permit #
$
$
$
,so
(Office Use Only)
This Application Becomes Your Building Permit When Approved
OUTPUT
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
$39.50
$39.50
$39.50
Q ~
~^ IJD IA.
Vh\lG 'Y/~
,o~
~4f/l-
~~ CC; ~ 0
, Rlte JUL 2 8 2003
In fr'J ~~
\D lJ;; , teceipt No.
,~y
Buildine Official
Date
24 hour notice for all inspections (952) 447-91 ~ fax (952) 447-4245
I II 1111
--"---1
fr
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
~. ~e:n ~:~y PERMIT No.3' _ J /{
], Yellow Applicant (0 ~
(Please type or print and si~ at bottom)
ADDRESS
15187 JEFFERS PASS
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
OWNER
(Name WENSMANN HOMES
(Phone)
(Address)
APPLICANT
(Namet ALLIED FIRESIDE DBA FIRESIDE HEARTH & HOME
ZONING (office use)
PID
(Phone)
651-633-2561
(Address)
2700 NORTH FAIRVIEW AVENUE
(Address)
ROSEVILLE
(City)
(Contact Person)
BRENDA HUSTON
(Phone)
651-633-2561
APPLICANT SIGNATURE
BRENDA HUSTON
DATE
55113
(Zip Code)
8/19/03
APPLICANT PLEASE COMPLETE BELOW
xD NEW CONSTRUCTION 0 REPLACEMENT 0 ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE
RETURN OPENINGS
TYPE OF SYSTEM
OWarm Air Plants
o Gravity
o Mechanical
OAir Conditioning
OVent. System
INPUT
HEATING OR POWER PLANT
o Steam
o Hot Water
o Radiation
o Special Devices
o Other Devices
FIREPLACE MAKE AND MODEL
HEAT N GLO 6000TR-OAK (2ND FIREPLACE)
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
Residential, Heating & AlC (New Construction)
Residential, Heating Only (New Construction)
Estimated Cost $
REA TING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
Building Permit #
$
$
$
.50
(Office Use Only)
This Application Becomes Your Building Permit When Approved 'I ~'[!ai@ IT; U ~ ' n
"" II
. DA"G 2 1 2003 I
I
BuUdinl! Official
Date
24 hour notice for all inspections (952) ~~850, fax (952) 447-4245
I II 1111
OUTPUT
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
$39.50
$39.50
$39.50
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Receipt No,
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By fA'.
j
PRIOR LAKE
INSPECTION RECORD
DEPARTMENT OF
BUILDING AND INSPECTION
SITE ADDRESS /~/f?- ~-FP~rS' PaSS
NATURE OF WORK ~J
USE OF BUILDING S F [J
PERMIT NO. .-C)R- OC?(PZ- DATE ISSUED
CONTRACTOR UJ~{.Ct~ PHONE~/07. ~6c;-.7~a9
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
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DATE
, FOOTING
SEWER I WATER I SEPTIC
FRAMING
INSULATION
ELECTRICAL
PLUMBING
HEATING (if required)
FIREPLACE
GAS LINE AIR TEST
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"Y'
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COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
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FINALS
Af.lf I(), 7,.)3'
r
I
OCCUpy UNTIL ABOVE HAS BEEN SIGNED
NOTICE
GRADING (Prior to Sodding)
BUILDING
ELECTRICAL
PLUMBING
HEATING
DO NOT
I~.?;l '3
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