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Home My WebLink AboutBuilding Permit #00-0070 CITY OF PRIOR LAKE BUILDING PERMIT, TEMPORARY CERTIFICATE OF ZONING COMPLIANCE AND UTILITY CONNECTION PERMIT II 0 007() Permit No. -LI - I (Tel. No.) (612) 424-4955 6. BUILDER (Name) (Address) (Tel. No.) Novak-Fleck, Inc., 8857 Zealand Ave. N.. Brooklvn Park 55445 7. TYPE OF WORK Fireplace LJ Septic LJ Heating LJ Plumbing LJ Reroofing LJ Porch LJ New Constructio~ Alterations LJ Addition LJ Finish Attic LJ Residing LJ Finish Basement LJ Chimney LJ Misc. 8. PROPERTY AREA OR ACRES 9. PROPERTY DIMENSIONS 10. CULVERT SIZE Sq. Ft. Width Depth Yes No Approx 5/24/00 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 entioned 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 b i1din cialcan revo e 's p~~mit for ust caus . Furthermore, I hereby agree tha/j ~;;/ ~es~/,may enter upon the property to perf~.z?4/a:>ns. Signature Ucense No. , 'bate Amount Brought Forward .. .. .. ... .. ... , ... $ Park Support Fee ........................... $ 85'D . ~O SAC ............ ...................... ....... $--41 00 . 00 Collective Street Fee .... .. , .. .. .. .. .. .. . ... $ Sewer Tap ................................... $ License Check Fee ...",................... $ t::1. c. Pressure Reducer .... ::16................. $ Meter Hom ........... .-%.;0'................. $ Water Meter ........... ~.. .. .. .. .. .. .. .. .... $ ItIS - 7 2000 . DIRECTIONS SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom) 2. SITE ADDRESS 1. DATE 1/24/00 14680 Bluebird Trail N.E. It 150 3. LEGAL DESCRIPTION LOT 2 PID 2.5- 31 0- 02.2- 0 BLOCK :3 Knob Hill ADDITION 4. OWNER (Address) (Tel. No.) (Name) 5. ARCHITECT (Name) (Address) FOR ADMINISTRATIVE USE SETBACKS: Required Actual Front Back Side Side PROPOSED GRADE FOUNDATION IN RELATION TO CURB OR CROWN OF STREET USE OF BUILDING SF ...D OFF STREET PARKING SPACES REO. SPACES ON PLAN PERMIT VALUATION 15'7) rJrr).~(j TYPE OF CONSTRUCTION: I II III IV V City: Occupancy Group A BEl H R M Division 1 2 3 4 Permit Fee ................................... $ I , I '1~ .:15" ~, .9~ '1fL....SO I 0(') .e C:> J nO . n(J 3S-.~O 4l>.00 Check if Deferred LJ Sewer & Water Connection Fee ........... $ LJ Water Tower Fee ............ .. .. .. .. .. . .... $ I ~S- . 00 1.?-00.06 . t'} c> 0 ~ 60.... Plan Checking Fee ......................... $ State Surcharge ............................. $ "Pen8Ity .. P\~.. .. .. .. .. .. .. .. .. .. .. .. ... $ ~ J ..~...., ......);\~.................. $ .:....i<:.' ............~.~..~................ $ SulMetel ......;........................ $ 1. White 2. Pink 3. Yellow File City Applicant BUILDING INFORMATION 11. SIZE OF STRUCTURE (Height) (Width) (Depth) 12. NO. OF STORIES Split 13. TYPE OF CONSTRUCTION SFD, Detached, Res. 14. FLOOR AREA APPORTIONMENT USE 1522 Main 602 LL 2124 TOTAL 15. NUMBER OF OCCUPANTS OR SEATS OCCUPANTS SEATS 16. ESTIMATED VALUE $156,925 17. COMPLETION DATE MATERIAL FILED WITH APPLICATION SOIL TESTS LJ ENERGY DATA LJ PILING LOGS LJ PLANS & SPECS 0 SURVEY LJ PERCOLATION TESTS LJ SETS COPIES PLOT PLAN LJ l/6 , ~6 Water Tap ................................... $ This ~lication Becomes Your Building Permit When Approved. Builder's Deposit ..........................,. $ I! (;' C)~ .. eeL By W.... k-- Date ~ - ~ .. Z t!)C>O , Certificate of Occupancy Paid Issued -~ () , Dme 0 By This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Qrdina e and may proceed request;d. This document when ~. tttletle. C Ci". ~n nner constitutes a temporary Certificate of Zoning compl~and a11ows~onst. ruction to co {lmencEf\ ~~~upancy, a CertificatK of 9fcupancy must be issued. ~hl\~ 2--'~,.,CSO ~ -(\.!Nw~ ~r.l~ " - CitYP1anner Date _ I SptlEial Conditi~~ n~y 24 Hour notice for all inspections 447-42309:00 a.m. '10:00 a.m. ',"* 00'Qo7D Th. C.nt.r of th. Lak. Country White - Building Canary - Engineering Pink - Planning BUILDING PERMIT APPLICATION DEPARTMENT CHECKLISI NAME OF APPLICANT APPLICATION RECEIVED I/\./(~/ to' /--j t::~~ - f'-L [, C: I< i 2 / -7 / (6 / /~/G . The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: / ,,,~L /~. <;;:-.. \/'. /'.-'" I.. 1.~- /.'" / /-: I... -7....7..;.:'. ' '" 7- '..', (..' '._" ~'__- 4.....,,, ..... L-. ..._,,--~' > ......--...-/ 1'----..... . /--, L-,.-' . , i I Accepted v Accepted With Corrections Denied Reviewed BY:~~~AA Comments: ~~ / ';P-v Vt2tP~ ~~ &J;J 2:1S:-r99~ Date: 1-lB-t)Q .~~ ~'\ ~.4\t\AthM- 4't~ VV~ d5tl7~ ~'1 LW~ +'i ~ A_D-L-V ~O Cvvhl.!- 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 rthis.. code or other ordinances of the jurisdiction shall not be valid." . [) J' I \: FEB - 7 2000 \ i - .-...., '.~--,-_...- "'., .....-- ...-..--...-...J @-6b1 D White - Building Canary - Engineering Pink - Planning Thr ('rn.rr or 1M t.kr Counl". BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT APPLICATION RECEIVED /~\'/0' ~..>:.jf::- - Fi- ~CK I / j'v'C. 2 II -J /1 (",:GJ I I " ../ I I The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: ,/' 4- t.:. e (; e L.. {" E 13 II~::' 0 77<- /\/: c' . Accepted ./ Accepted With Corrections . Denied Reviewed By: tJyL.rF~ r- -"... '_.do... I CJ:/1/r.:.S..~..., I I 2/1I/01J , I Date: Comments: ALr Sr~nM wA1"'~1t. ,ZUAJoFF' t"vsr i3E C tiN l,/ E.'f' CD 10 8L vt!.SIIU1 .::Iil-A I c.. ' ~ J~Fo(t.MA"'/o,V ON THe. REvEnsE- Slf)~, S'~ ArrACHr'1Ekl11=: I. hAJ~(' ~E.. ~OA.J J".J~Mt4II/)~ Z,. CIl,qOIJJID RI1t\J 3, &OSIOA,) Co,.srn.o,- rftE'Asvt1.E.S 'I, &/J S I () t..J LO,Jr/t D c... i1..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 (iji IR!s ~~ude~or-: other.- .- ordinances of the jurisdiction shall not be valid," .; rl \ _~!::: (~" I~' . . ': :-. . .' I : ~ (! H:tl - 7 2000 Thr ('rnlrr of Ihr Lab Counlry tfU - cJD70 White - Building Canary - Engineering Pink - Planning BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT APPLICATION RECEIVED ;VOV/-lK-- F~6CK- I / NC,. 2 / 7 / 00 , I The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: Accepted Accepted With Corrections Nb. ~ /4-~eo BL-V6/3 / /'eO II~ Denied -. Reviewed B~ y- Comments: Date: ~ - A - 2000 React a\~ a\:t~~ ~~~ 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,lI IIIItJ - 7 2000 UEE. . fIlLl YELLOW . AP~LtCA. GOLD - elT., CITY OF PRIOR LAKE NO. OO,lI(;P" SEWER AND WATER PERMIT NOTE: Sewer and Water contractors must be registered with the City. APPLICANT:)ho~l')--.:pJ~. ('~F . PHONE~-96.~77tl ADDRESS: /Kenl (Y\jJlA_ CJn(i. ~ ~ 5~~ATE: ~ ~~ SIGNATURE: ~4/'1V>'-' fjJ~jJ.A BLDG. PERMI~"".-{ SITE ADDRESS :14~.. \J..,.t\: 1.> tJ (, PIO; 25-3'0- O'2.:z.-0 FILL IN THE BLANKS 1. Estimated length of water service /~ feet". FEB - 9 LiJ", , 2. Size of water service / inch(es) . ."'+.. ... .. 3. Location of any couplings from structure feet. 4. Type of sewer pipe. ABS X PVC Cast Iron 5. Estimated length of sewer line ~ feet. 6. Clean out (if required), located at structure. feet from ======================================================~=========== This apPlic~tiO J79~~~your permit when approved. ,/ BY ~ DATE: z/23/60 - - . , ( =========== --==================================================~== FEES: $ 35.00 Sewer and water line connection perm~t, $ .... ~O Surcharge _\ 6 .~ ~5 . 5~ TOTAL ../ po a~' * Fee for either se~er or water individually is $20.00 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 PA~- ~~~~~~ \ REC'D BY ~\~O\~ \ RECEIPT # 16200 Eagle Creek A\'. S.E., Prior Lake, !\1innesota 55372/ Ph. (612) 447-4:30/ FAX (612) 4-l7~245 An Equal Op;:,cr:.uniry Employer 6/-<g-OD 1. Blue 2. Gold 3. Yellow File Ciry AppliClDt CITY OF PRIOR LAKE PLUMBING PERMIT APPlicant:~;~~ C~ Address:1 . .J tk~, ~ Signature: ~ tf2r~,,' Legal Description: Lot Z- Block ~ Sub K.N08 HI L-L- SiteAddress:~ ~_ \r~ ~L 1</50 Building Permit # r]J).". 00,0 PID # 25- 310 - 02.2..-Q . NOTE: This permit will not be processed without complete information. PP No. -DO - 00 7ft , Phone:!.t2s -lfd:3-- 77/? f'.~~l4S TIt. Cft'.' 01 lilt Lab COU".,.,. Quantity c2, / I ~ I I I / ~ FIXTURE UNITS Type of Fixture Bath Tub w}th ~ wit~out shower .or Dishwasher Quantity Type of Fixture 3 J Rough-ins Water Heater Floor Drain Water Softner Lavatory (bathroom sink) Laundry Tray <[Door-e compartment sink} Shower Stall Stand Pipe (washing machine) Sewage Ejector Backflow Assembly (RPZ, Double Check, PVB) Backflow Assembly Test Lawn Sprinkler Sinks Oar 0 i P1 k............ (\ . cLJ\S~ G..Jot- Water Closet (toilet) -/ Other .5u.tnp pt.A1Yf FEE SCHEDULE I Industrial, Commercial & Multi-Family (1 % of job cost, $39,50 minimum) Residential, New One & Two Family Residential, Additions & Alterations $ $ $ $99,50 $39,50 State Surcharge GRAND TOTAL FEB - 9 2000 Call for all i spections 24 hours in ad\ance. 16200 Eag1e Cree~ Av. S,E., Prior Lake, J\linnesota 55372 / Ph. (612) ~/-4230 / F.~X (612) ~/-4:45 An E~~al Oppor:u::iry Employer t. Piak File 2. 0Icm . <.it)' 3. Yellow . CI)/llnlerer 1"1 <:> <:> ISl ~......~,KE 1___ Creek M..' E. P.rmitNo,..DO.., 0070 Pd.'take, MN 55 HEATING APPUCATION I PERMIT ;:J/ c;/cn PIO, 2.5 - 3( 0 - 02Z- - 0 SfteAddress ' 14?,'iSO ,{};IJ~~j ,{1rvY ~/sg leI z.. Block "3 Addition K NO B H ( L, L- OWner'sName A b a/c-,.Cl;rl ~cj4W//J~J-h!p-~ RIGCA R HE A TING 0 ^,"" .. '-"''0111 2387 COMMERCIAL BLVD, NW ANUUVt:H, MN 55304 Telephon8" 7F\&-4000 Furnace Make & Model I! Ap'::fP /YI . TYPE OF SYSTEM I( v' "~~'f Warm Afr fJants Model S;Z8 LA-../ () L-J Gravity Mechanical Air Cond.tioning (( h ~ ~ -"V1 Vent. System HEAliNG OR POWER PLANT Steam Hot Water Radiation Specrar Oe.,ic8s TYPE OF STRUCTUfIE x Single Family CommeraaJ Two-Family . Industrial . Mulll-Famlly . Public Other Date Fee ScheduJa Induslrial, Commercial & MuPti-FamUy Residential, Heating & AC Residentfsl, Healing Only Residential, Gas Fireplace Residential, Additfons & Alterations Residentis', AC Only 1% of job cost ($39.50 mint mum) $99.50 $64.50 $39.50 $39.50 FEB I 0 2000 $39.50 Address Herding Contractor Addr.. ~ ~ ....1 ~ o t-4 g: !:01.. o ;;... f-t t-4 U Remember to add the Slale Surcharge on the bottom o' Ihis application. The prIce Df your heating permit .ncrudes one rough-in and one final inspectron, Addilional inspedions wm be billed al $35.00 each. House Healing Teat Record must be submitted w'lh.b.l.liJ.raag I2IDJlll numbIr before buUd- Ing certilicate of occupancy wlrJ be issued, J:tfA! CALCUlATIONS REQUIRED with number of su,pplv and return operings lisled per roDm wilh CFM's per opening. New stNctures or additiDns send floor pFan with supply and return locations shown, HEAT lOSS CALCULATIONS, PAYMENT AND APPUCATIONS MAY BE MAILED TO THE CITY OF PRIOR lAKE, 16200 EAGLE CREEK AVE, S.E. PRIOR LAKE. MN 55372, Cily Hall business hours are 8 a,m. . 4:30 p.m. Conn, Load Fuel A;;4.J- flue S;Z8 ~ I' I' It" q Supply Openings Return Open;ngs Input J C:V, OJO OutPt.lt <60, w-o I/) ~ N ~ t- ~ ~ N- 1"1 <:b l<l -<<: ~ Cl) N It) 1"1 Edr. elm, Other DeVJC8S Cj6'-) -h hl~,;k,4?- ALL WORK MUST BE INSPECTED (ROUGH-IN AND FINAL) - CALL CITY HALL 447-4230 TYPE OF WORK I hereby apply for a mechanical systems permit and I acknowledge that the In'ormaUon above is compJele .nd accurate; that the work wilF be in confDrmance with the ordinances and codes of the city and with the slate buildJng/mechanics. codes; that this form does not become a permit until signed by the BUILDING OfFIC'Al; thai the work wilt be in accordance wilh the approved plan in the case 01 all wDrk which requires review and approval of pJans. ()lft} /Jp /1 ... , ~pliclll'lW IJi AfterBllons Repal r Repracement New ConstructiDn _ Est. Comp. Dale , Building Permit., (JO -r 0070 ~~{fj Receipt II Est. Cost $ HEATING PERMIT FeE $ ~ ;;;J f-t d/<j/~ _ jDate I ?/Z,3/dO Date ..,.,-. $ /.50 $/ - ,; aD Cl) "'- (") N "'- <0 <:> STATE SURCHARGE TOTAL P~MIT FEES ~ CITY OF PRIOR LAKE ~7, .\~ Me u r.. ' "' 16200 Eagle Creek Av. S.E. Perm" No. OO-d) 70 .a Prior Lake, MN 55372 ~ ~ HEATING APPLICATION I PERMIT (~J~d/ao PJD# QS-'3\tJ-aaa-o Site Address · J q ~ ~ () 12Jl (J.t .n rt'1 Trw I N E Lot Q Block.3 Addition ~l\1'\b \+1 e L, P. 0 ~fP/( ~(tP I t; te~ J1/,*= VJ /~92Z ~S~ s:-, Date \ '') Addre < Heating / Address ! Telephone # ,fo~/- 777.... ,pi(-f \....... Furnace Make & Model /IA../JIl ~ Iv S-.54J TW-AIR CONDITIONER' UNITS CANNOT ENCROACH INTO SIDEYARD SETBACKS, azAl< r>AL~ M/'\J Model Size TYPE OF SYSTEM Warm Air Plants Gravity Mechanical , Air Conditioning Vent. System HEATING OR POWER PLANT Steam Hot Water Radiation Special Devices Other Devices Conn,Load Fuel ~.f- \ Flue Size Supply Openings Return Openings Input ,,2 );.G1UU Output Edr, Cfm, TYPE OF WORK Alterations v Replacement New Construction Repair Est. Comp, Date Building Permit #. CJO - (107 () Est. Cost $ HEATING PERMIT FEE $ /' STATE SURCHARGE $ /.50 TOTAL PERMIT FE~ Receipt # . TYPE OF STRUCTURE 1. Pink File 2. Green City 3. Yellow Contractor Single Family Commercial / Multi-Family Other Two-Family Industrial Public Fee Schedule Industrial, Commercial & Multi-Family Residential, Heating & AC Residential, Heating Only Residential, Gas Fireplace Residential, Additions & Alterations Residential, AC Only 1 % of job cost ($39.50 minimum) $99,50 $64,50 $39.50 JUN II. . $39,50 $39,50 l.._'''' Remember to add the State Surcharge on the bottom of this application. The price of your heating permit includes one rough-in and one final inspection. Additional inspections will be billed at $35.00 each. House Heating Test Record must be submitted with buildina Dermit number before build- ing certificate of occupancy will be issued. HEAT CALCULATIONS REQUIRED with number of supply and return openings listed per room with CFM's per opening. New structures or additions send floor plan with supply and return locations shown. HEAT LOSS CALCULATIONS, PAYMENT AND APPLICATIONS MAY BE MAILED TO THE CITY OF PRIOR LAKE, 16200 EAGLE CREEK AVE. S.E. PRIOR LAKE, MN 55372. City Hall business hours are 8 a.m. - 4:30 p.m. ALL WORK MUST BE INSPECTED (ROUGH-IN AND FINAL) - CALL CITY HALL Phone: (952) 447-9850 Fax: (952) 447-4245 I hereby apply for a mechanical systems permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the city and with the state building/mechanical codes; that this form does not become a permit until signed by the BUILDING FFICIAL; at the work will be in accordance with the approved plan in the cas ~_ all w whi requires review and approval of plans, "- \ /c; ,.. 22 -dV (~-n:~~,~ o Building OfficarSignature Date ~/~~tfO- / Dat~ - I' - : ~::. 9 i TI"E 0 8 : :: S F.U I) L.: .. . Cln OF PRIOR L.u\E ~oo~ Cl!''{ OF PRIORLJ\KE Impervious Surface Calculations (To be Submitted with BuilcUng p_&..jt Appllcation) For All Properties Located in the Shoreland Di:)u.~ct (SD). The Maximum Imp~.. ~rious Surface Coverage PeuJ.Jtted in 30 Percent. Property Address 14680 BLUEBIRD TRAIL Lot Area 12,000 Sq. Feet x 300/0 == .............. 3,600 ....**....****.****.**********...**********.**..************************ LENGTH WIDTH SQ. r t:..c 1 HOUSE x s x = AllACHED GARAGE x = TOTAL PlUNl.ll"LE Sl,KUC.J...rRE... ....,......... 2,183 DETACHED BLDGS (Garage/Shed) x X TOTAL DETACHED BUlLDINGS-.---.......--... DRl'lEW A YIPA Vw AREAS (Driveway-pavecl or not) (Sidewalk/Parkinl Areas) x x X - = == 792 W TOTAL PAVED AREAS.._.._ --- 892 PATIOS~ORCHESmECKS 12 X 14 - (Open Decks 1/4" min. opc:aiDI between X - boards, with a pervious surf&c:e below, are not considered to be impervious) X - . TOT ~ DECKS..........-...............---............-......... 168 OTIiER x X - =- TOTAL 0' 1 J:1J!.R.....................___-..........._...._... TOTAL IMPERVIOUS SURF ALJ!. c/J ,'~ Jj,d ,4 UNDERlOVJ::K ~ ./ I o/~ Prepared By MILTON E. HYLAND 3,243 357 Date JANUARY 26, 2000 Company HY-LAND SURVEYING, P.A. Phone # (612) 493-5761 t -" ttlOR LAKE INSPECTION RECORD DEPARTMENT OF BUILDING AND INSPECTION SITE ADDRESS 14la...So T)\uelo,r-& ~l\ NATURE OF WORK 1Jll\U ~~5h-t:)d\'dV\. USE OF BUILDING S~D PERMIT NO. no- OOI() DATE ISSUED ;)- B- dOOO - I CONTRACTOR NO\1~~ - t:"\ec.\::: , NOTE: THIS IS NOT A PERMIT FOR ANY OF THE~SP~~IONS BELOW THE PERMIT IS BY SEPARATE DO:~~N.\~ C\ \(~ATE FOOTING ~;, . :~.l \ ,J \; 1- \ 2A- \<kS FOUNDATION (Prior to Backfill) fP 3/~ . PLACE NO CONCRETE UNTI~BOVE AS BEEN SIGNED . ROUGH?1NS SEWER I WATER I SEPTIC (jjl ~~/dD I I ~:SAU:~T~ON u. \~~/t,%:o~. $~: ELECTRICAL PLUMBING (N 3b41lfV /-,t- ~r ~,h~D6 HEATING (if required) L.t.,. .~ 1;z'?~ ,,' , FIREPLACE ~.f",(€) ~-(~,.,-(~~~tV~D' \";'0 "~( sjJ~/JrJ GAS LINE AIR TEST p. p. 3/30/00 ",,~t' ~ffi (:U. ' rf<J!r\ '<[ji/ tJJ COVER NO WORK UNTIL A~E AS EEN SIGNED ~ III . .. J.'~."<'~~:~",'...~w.~~ FINALS GRADING (Prior to Sodding) IV R 5 - /? - 0 / BUILDING l,c.Dd~..u~IID~ q; ~~ ~!I1? ( ELECTRICAL /'.. PLUMBING {A ~ )aO'/< ' \ ' HEATING (/ v / \ V (},\ 1KJ DO 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, ca.......__hall be placed near main entrance, Call between 8:00 and 9, '~.~~t' for all inspections FOR ALL INSPECTIONS (612) 447-9850 ADDR ESS OCCUPANT HEAT LOSS SOLD BY Electrical Work By TYPE OF HEAT (4(P~{) rt) O~ k.. ~ . -RATE HTG. INST, Vl,. t ~L ~~v7Irt.n~{t!SE HEATING TEST RECORD . APT. ,FLOOR, OWNER GA FA ~HW /) iL__ ~ I GAS DESIGN MAKE I(,~ Model flJePft... I D~ VV\~... Serial A~'~2~qq()B01') INPUT J~~ CONTROLS THERMOSTAT 1~-L1dj~ Plug Valve -:~--r..;~C"'"_r Limit ,~-lWiL- Limit Setting_ ("'10." - Fan Setting ~ <!:UvJ n.ck' Pilot Type ~~ :"pMtJ' Pilot Make l~~ Pilot Model ~ Pilot Timing ~C.l L.W, Cut Off. ~ Pressure ~1I ~ Percent CO2 ,. Input CFH \~Q Pe,cent O2 Stack Temp. . t f Percent CO Form 235 '--l:bb _STEAM INSTALLED BY Gas Line By SPACE HTR, CITY, ~DrLLAKt:r SUBURB f2. I c:.LP L- I _UNIT HTR, OTHER _ CO..bI>>E RS I ON _MAKE OF BURNER ~ Model ./ Max, BTU Rating ./ MAKE OF FURNACE / Model / .L Vent Size 7) J' . KIND OF LINER ./4:JT~ SIZF NONF Draft Hood ~2, RegulaTor Yl1A ~{'IM L-. Filters Size ,,~)LLNumber:Z Chimney Location Inside X~~ ,~,I Outside Chimney Construction C!1JA~~ (7 !'b Smoke Bomb _ Wiring _ v.. Draft Test Tag J( Door Pressure Lighting Inst, _ 'l... t,f~ Date Tested 3 -~~... f\ .I! q. i:2o- Company Testing JL\.~'fJ-j J . t.1 J {' tj~ Name of Teste, . I j -----M'V,. Form # 5 DATE TIME f-,ll/-rJ/ /f.T ~~~ CITY OF PRIOR LAKE INSPECTION NOTICE SCHEDULED ADDRESS /t/bt'tJ I . OWNER CONTR, PHONE NO, PERMIT NO, o FOOTING o FOUNDATION o FRAMING o INSULATI~ FINAL tg SITE INSPI:~ II N o PLUMBING RI o MECH RI o WATER HOOKUP o SEWER HOOKUP o PLUMBI G FINAL o MECH AL ~~ \...,.../ COMMENTS: > ~/tl~ ~ /'~" ~ \~,~~~ ~ - --""""~~'-, .:-" - ~ 0- 76 o EX/GRAD/FILLING o COMPLAINT o FIREPLACE RI o FIREPLACE FINAL o GASLlNE AIR TST o 'J,;. .".,~""'~:,_~' .... . . ........ -',' - - ~ I '1f)WORK SATISFACTORY, PROCEED ( 0 - CORRECT ACTION AND PROCEED :S::O:ECT ~OR REINS:~::/::n::FORE COVERING J,.. / CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE,. INSNOTl CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYl CITY OF PRIOR LAKE INSPECTION NOTICE SCHEDULED DATE TIME s-( '7... 2tx:; { ADDRESS J <-/ (0110 'lSLuQJolr-d {. r 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 o MECH FINAL COMMENTS: brt:t ~.-( .... " t.. L~ J3~ ~ -- CJ 1(, 00 -(]O/~ o EX/GRAD/FILLING o COMPLAINT o FIREPLACE RI o FIREPLACE FINAL i? GASLlNE AIJi TST . ~ ~Ll,;1od ~ SoJ J- T~ X WORK SATISFACTORY, PROCEED - 0 eoRRECT ACTION AND PROCEED o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING 'nspectod~".:!' ~er/Contr: CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE, INSNOTI CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY! DA-E TIME CITY OF PRIOR LAKE ~Zlt.a') INSPECTION NOTICE SCHEDULED 2>-;m ADDRESS ,l4-~~o ~/)\'v('A -rL OWNER CONTR, PHONE NO, PERMIT NO, 0-70 o FOOTING o PLUMBING RI o EXIGRAD/FILLlNG o FOUNDATION o MECH RI o COMPLAINT o FRAMING o WATER HOOKUP o FIREPLACE RI ~SULATION o SEWER HOOKUP o FIREPLACE FINAL FINAL ~PLUMBING FINAL o GASLINE AIR TST o SITE INSPECTION MECH FINAL 0 COMMENTS: W ~Y\ ~crP 1('ea(~ d -n ~ I'v\S'~~ _ U ~'" ~V~ ~ 0lA-. \ ~)Y' I\~ I / / / / / / / / COVERING Inspector: OWner/Contr: CALL ~7-9850 lOR THE NEXT INSPECTION 24 HOURS IN ADVANCE, CODE RE~MENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY! INSNOTl CITY OF PRIOR LAKE INSPECTION NOTICE SCHEDULED DATE TIME ~ /: I~ ADDRESS /'1' 8'0 ~ ,hiLd Ira J J PHONE NO. OWNER CONTR, PERMIT NO, o FOOTING o FOUNDATION o FRAMING o INSULATION o FINAL o SITE INSPECTION o PLUMBING RI o MECH RI o WATER HOOKUP ~D SE~RHOOKUP PLUMBING FINAL o ECH FINAL ~MMENTS: (t)~. f- 0 ~ f\ \.,.-- ^ jUvJ^ I ~~ () _~Ail f~ "MP v ( )() - {J()7Q o EX/GRAD/FILLING o COMPLAINT o FIREPLACE RI o FIREPLACE FINAL o GASLlNE AIR TST o ucJZ: ~ ~j Inspector: Owner/Contr: THE NEXT INSPECTION 24 HOURS IN ADVANCE. INSNOTI o/l1? TIME CITY OF PRIOR LAKE INSPECTION NOTICE SCHEDULED JO:~ ADDRESS \4G,to ~.~ -IlL- OWNER CONTR, PHONE NO, PERMIT NO, 6-70 o FOOTING ~UMBING RI o EX/GRAD/FILLING o FOUNDATION o ECH RI o COMPLAINT o FRAMING ~ TER HOOKUP o FIREPLACE RI o INSULATION ~EWER HOOKUP o FIREPLACE FINAL o FINAL o PLUMBING FINAL o GASLlNE AIR TST o SITE INSPECTION o MECH FINAL 0 COM~E~TS~ 3~ ~~ ~() ~,,<- .~~l 1'1 <)L- \~ ~.~ ~,'?C- ~b I Co~\~. . ~ ~/<.J..- (5V~ ~ '~~ ~ G)~ ~~ t~ q~ 0,~ e Gr~ ~~f~ ,L tJ~ CwJa b ~~ Inspector: Owner/Contr: CALL 447_~50 OR THE NEXT INSPECTION 24 HOURS IN ADVANCE, CODE REQU ~ ENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY! INSNOTI