HomeMy WebLinkAboutBuilding Permit 00-0387
~'
"'D1\'rERECQ\lliO...._._... r' CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
JAN ~ (. ZONING COMPLIANCE
ANb UTILITY CONNECTION PERMIT
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
C I e.-J () -1;-- J7,
I 'tS'J J
3. LEGAL DESCRIPTION
LOT L/ BLOCK
() A it LA-YJ~ IllA-Ut
4. OWNER (Name) I A J . ).Address)
fYlAd4<- It uti: :.rV I J~ < ,.# C
(Name) HlA (Address)
FIlI.1 r . \ ~ " ,i r',.J
(Name) (Address)
Y6 A \#I'"q. Y ( IIJ n,-. .JI, ^"'" /
7. TYPE OF WORK Fireplac~ Septic 0 Deck 0
New ConstructiO~ Alterations 0 Addition 0 Finish Attic 0
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES
Sq.Ft.
Ie/~
/
PID .2.5-131- oo'f-o
ADDITION
5. ARCHITECT
(Tel. No.)
~"2 " ,.. Z..J l:j 'f
(Tel. No.)
it'lfl-~' ~~
(Tel. No.)
6. BUILDER
GfJ~-lf()J
Re-roofing 0 Porch 0
Re-siding 0 Finish Basement 0
9. PROPERTY DIMENSIONS
1 O. CULVERT SIZE
Width
Depth
Yes No
1. White
2. Pink
3. Yellow
File
City
Applicant
Permit No.
00 - 03ri7
I
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
12. NO. OF STORIES
13. TYPE OF CONSTRUCTION
14. FLOOR AREA APPORTIONMENT USE
15. NUMBER OF OCCUPANTS OR SEATS
OoC~ANTS
SEATS ~
16. PROJECT C~\LUE
17. COMPLETION DATE
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 's permitJ-or just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X .- ,....~'. 7--0)'1 C'~..ro/ / -2A ~~
Signature License No. Date
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
Front
Back
Side
Side
BUILDING DEPARTMENT VALUATION
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
USE OF BUILDING
.s EO
PERMIT VALUATION
l &.\ '1
000 · 00
TYPE OF CONSTRUCTION: I II III IV V
Occupancy Group A B E F HIM R S U
Division 1 2 3 4
Permit Fee ................................... $
MATERIAL FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA 0
PILING LOGS 0 PERCOLATION TESTS CJ
PLANS & SPECS 0
SURVEY 0
SETS
COPIES
PLOT PLAN
o
City:
Amount Brought Forward . .. .. .. .. . .. . .. ... $ _
Park Support Fee ........................... $ ~ ~ .CJ6
SAC ......................................... $--L-J- 0 CJ .00
Collective Street Fee ....................... $
Sewer Tap .............................. ..... $
9'P 't $
Pressure Reducer ... ..eL........... ...... $
Meter Horn ... .... .... ......... .... ........... $
Water Meter ................................. $ L2~
Sewer & Water Connection Fee ........... $~ 00 .. c:J C
Water Tower Fee ........................... $ ? t.2.O. t!J tj
Water Tap ........... ........................ $ c9b
Builder's Deposit ............................ $ I. ~-z::t::>.
Other ......................................... $
Pakl T7720;.71.........~:i~;~0$~i~; 71
Plan Check Fee ............................. $
1,\:l2.2S-
'7 ~ CJO' e-f (.,
'13.)0
State Surcharge ............................. $
Penalty ....................................... $
Plumbing Permit Fee ... .. .. .. . .. . .. . .. . .... $
Mechanical Permit Fee ..................... $
I 00 · oc)
100.00
~.sv
t.{a .C)O
( ~ I
_, flC. lU
~ ~~~v
\1, l1~tI ()l;
~I'
Sewer & Water Permit ...................... $
uilding Permit When ~roveg..,.
Date ~-'ol-~~
Issued
Date
'-IS. oc;
By
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
s~ _the . Planner constitutes a temporary Certificate of Zoning comPlia~d allows construction to commence. !B:ore occupa~f.:~" of OcoJpancy must be Issued.
~\N.o (~,..~(.st:) ~ ^^AT": I' \1\01 (' _--
City Planner Date -~ Specia Conditions any
24 hour notice for all inspections 447-9850
4
aPRJ~
./O'~~/. .. '" ~'{~
c u..rn
~
TIte Center of the Lake Country
White - Building
Canary - Engineering
Pink - Planning
BUILDING peRMIT APPUCATION DEfARTMt:NT CHECKLIST
NAME OF APPLICANT 'I (k vvA 'I'; (~ lj ~ ToM H ot'l & 5
l I /
APPLICATION RECEIVED 1/ 3 1/(;0
I r
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
14-~ /3 6 L 6/VL>~-) L.6 rt v6
Accepted
Accepted With Corrections
v-
Denied
Reviewed By:
~.-~
Date:
'\.5~ 26-- eo
Comments:
rf:,u:~-1Mt1 {Je,vVlA1"t IS S~eL\l.o i/w~C-{?
~~",c>\.Aj(p&Y\ et5)-1997 f:::.t' l ~r't;~~ ~
~W~f'\ A L b~ A-~'/ IIled "SIz,(Jv'4-) rJ
~~v'w~0Ye- ~.A. ~ ~d ~..K.VL-"<J14 A-<,
~c-,eJ 191--L SUR~L{ $1~ ~~.~
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."
Whro. ~91~~ 1
Canary - Engineering
Pink - Planning
The Cenler of Ihe Lab Counlry
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT YOIeWAf (!,U~ 10M HOI1GS
APPLICATION RECEIVED / / .3 II0D
I I
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
/45/3
Gt-,6N0/7 t.,;6 Av6
Accepted
Accepted With Corrections
x
Denied
Reviewed By:\j20 fPa..... A,L -
1
Comments:
). FEM~ F\~ t:lfjlQ_*l~ <Lu-ttf\'c~ te~\Jll'-Qol ~
u
Date: ~ - '"2. - 200-0
CCC.LJ~o--c.d-- .
2. Mo...',"^- ~~ o,.}~(\CJY\ W~
5. ~ec..ct tk.\ \ ~T\-Clc.-Lutc& V\~ ou-k..
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
1
--[
pf!
White - Building
Canary - Engineering
Pink - Planning
00- 387
The Cenler of Ihe Like Counlry
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
'yOt:: I;V/1 '( C.US 10M Hotl&S
/ / 3 I / uO
I ,
APPLICATION RECEIVED
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
/ 45/3
6L-6NOrt~C Av6
Accepted
Accepted With Corrections
./
Denied
, .
Reviewed By: IJAI,.TEJt [~IlU1llfA",tJ
Date: . 5/ J,I()O~
Comments: see.. J NFoRMf4TlcAJ OAJ -r&.lC llEtllilt.sf, SlOE
SEE.. ~-n'Al.~Me.~f"S: /. F:1\J{:&e.. ~ttA-.o..E. \~SPfC.T'lON 'NFoflMA-"-,O,.,J
2. ~fJl ~ kJAT~ S~ IJJFe>ft.M.Ar,ON 3. f/(.OSIO~ Co~-rIt.Ol... MEAS\lIlL.:-
'I. E.aO$ IO,.J CO ~,.ttOl... P(..t:l....J
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.1I
*Permit#
*JobAddress. I 'f 5/; 4,1Q//Jlfk,f\k..
*Heating Contractor METRO AIR"
"ro..o",Signo..,o ~
-.I
.Gas Une
Pressurized
Inspected
* Percent C02
· Percent 02
Final Inspection
..
Date
Time
PERFORMANCE TEST
7. ~ D 10
~.~
.Percent co
.Stack Temp.
Pounds
Pressure
()1o
$0
Date
"
NOV.-,03'00(FRI) 14:31
,.-- .
PROBE ENGINEERING CO
TEL:612 432 3723
p, 002
(f
O.M.L NO.. 3067--.",
ELEVATION CERTIFICA.I t: C-,.n.May:I1,l996
FEDEAAL:EMERGENCY MANAGEMENT AGENCV
. NA"nCNAL. FLOOD INSURANCE PROGRAM
A. i CJ+lT10N: Use of this csttmcate doss not pravtcle a waiver af the fIocd Insurance purchase requirement. This ferm IS used only la.
provide elevation Infcrmatfcn necessary to ensunll =mpllanca with applicable ccmmunlty floodplain mariagement erdlnancel5, to .
deterr,nlne me proper insunulce premIum racs, and/or te suppan a requsst for a Latter at Map Amendment or Revision (LOMA or LeMR).
- - lnstructlona for completing this 10nn can b. fauna an the fallaw'ng' pegas.
51!\., I.ON A PROPEt1. ( lNFOAMAnON
BUlllJlNG OWN6rS NAME
flCR INSUAAHCa COUP...., use
PQLJC't ...U....ER
SZ!:\ t4Do I T ~ c.c...rI-S-
mn -
~
.SECTlON B FLOOD INSURANce RA1':E MAP (FIRM) INFORMATION
Provide lhe followtng frcm'the preper FlRM (See. Instructions):
Y 0 v"''l.O a... '-\ ~ IM.-U
STFleeT ADDRESS (Including AD'- UniJ. SUle -1* 'Id;'-NU~ OR P.O. ROUTE AND SOX NUMBER
14- 51 ~ ~ l e..-....4gJ ~ L\- \I ,; '^ \) (.
C~ER CeBCRJPT10N (L.clI and 81aia NurnbllrlO' lie.)
(.g{ 4. ~l.~(c.. 1. . l'AI~D 1~
'erN n I I
Yr;~r ~
CQUPANY *Ie filUMSe:.
{II
Z1P CODe
1. ca.4MUNIT"I NUMBs:l
2. p""a. NUMIEA
:I. SUFFIX
'- DATE OF ARM INOex
5. FlFlN ZONE!
II. BASE fLCCO aEVA"CN
(In AQ z.-. USII .,..,.
. t 10 '-t}t OOD, c... I ( - 19. -t:tl
7. IndJcat81he elfMUfon datUm system. used 0;;'. FlRM 101' Bas. Flaod elevations (BFE): "S! NGVO '29 0 Other (describe on backJ
_8..Fof Zcn~s A'cw V, where no SFt: Is provided on the FlRM. and'1he ccrnrnunity has estabUlh:d a SF: for'this building site, IncDcate
the =mmunlly's BFE:' , I I , I.U fest NGVC (or other FlAM datU~ Sedlon B, Item n.. .
-LJ.. ....... ___ ..
SECTION C BUILCING ELEVAT10N rN~RMATlQN
1. l:Jsing-the Elevation CertifICate Instructians, indicate the diagram number frcm the diagrams found en Pages 5 and S that best
dBsaibes the subject building's reference rev.. :l .
2(a).. FlRM Zenes A 1 -1\30, AS.. AH, iU'Id A (with BFE). The top at U'1e referenc:a level fleer from the Sel~8d diagram is at an elevatJan
aff I ':IOIt].1!f,8. NGVO ~or.CJttIer FlRM datu~ee Sedion B"l~m 7). (~O't" q + ~G..,..Cfte fl.cc ~
(b). FlRM Zones V1-\f30. VE. and V (With BFE)~ The bcmcm at the Icwest hcrizontal strucuraJ memb af me rafllranC8 revel frcm
the.selected diagram, is at an elevation of I f I I I \ ,U fest NGVO (or other F1RM daWn1-S,ee Sectlan B, Item 7).
(e). FlRM Zone A (wkhout SR:). The floor used as the r.eferencs level from the selected diagram is I 1 (.U feet above 0 Of
b~~a.w 0 (chedc one) the highest grade adjacent to the buildIng.
(d). FlRM Zone AO. The floor used as the referenca level from the seledBd diagram is I I I.U feet above 0 or below 0 (check
ena) the .highest grade adJa.cant to the building. If no tlead depth numbaf is available, is the building's lowest flaor (reference
Isyeij elevated in a.-.rdance with the commLlnity's tloodF2lain managemem ordinancs? 0 Yes 0 No 0 Unknown
3. Indicate the elevation datum sYstem used in detennining the abav8 reference levsl elsvations: ~ NGVO '29 0 Other (describe
under Comments on Page 2). (Nu I r::.: If rtJe ./svarlon datum usad ;n measuring the eJevationf[; different lhBn thai ussd on
the FIRM [see Section S. "am 7J, then ctJnWlrt r/1e eJsvmions 10 1he daTUm systBm used 01'1 Ihe FIRM and snaw the =nvslSicn
fJquatlOn under Cammen~ on Page 2.) ,
4, Elevation reference mark used appears an ARM: 0 Yas ~o (Se.. lnsInlc:1lans on Page 4) ,
S. The reference level elevation is based on: ~::al'!t"aJ c=nstnJct10n 0 c::=nstnJction drawings
(NOTE: Use of c:onstnJe1ian draWl'ngs ;s o~d- if the buDdIng d';BS not yst have the rsferBncs level Roar in pJaca, in whl~
case this carrJfjcat'8 will onJjl be valid (or rhe building during the t:DU/S1J af c:onstrtJr::rian. A postooe;Qnstrudion Ssvarlcn Certificate
will be I ~ ., Jif'!Ni once r::onstructjcn is CDmp/ets.) . , .
6. The eJevatj~n cf the lewest grade immediately adj~nt tD thl building is: I I RIO jGll.I.2J feet NGVO (or ether FlAM datum-see '.
Sectlen B.ltem 7).
SEcnCND.~OMMUNnYINFORMAnON .
" If the community officiaJ re~ponslble for verifying ,buildil'1g efevatians:specffies that the refersnca level indicated In Sedlcn C, llem ,
is net the 'owest ~aor- as defined In the community's floodplain management oti::linancs. the elevation 0' the ~ildlng's 'cwest
floor- as defined by tn. ordinanca is; I I I I I I. U fsel NGVO (or ather FlAM daturn-GBe Sec:tJon B. 11em n..
2. Cats of the'start of a:JnstnJctton or substantia! improvement .
FaM r ..nn B 1.31 , MA. Y '13
RaUaS ~ PR.EVIOUS ECCT10IlS
sa: AfVeRSC stbE FeR CONTIt"'UA'11CN
NOV. -03' 00 (FRI) 14: 32
PROBE ENGINEERING CO
TEL:612 432 3723
P. 003
..
SE"-I.CN E CEn ..FlCA71CN
-~
This Q:rUficadan is 10 be signed by a land surveyor, snginesr, or an:hitllCl who Is aulhCHi%ed by stale or Iac:allaw to certify elevation
information when the elevadon information rer Zones A1-A30. AE. AH. A (with BFE),""'-V30,VE. and.V (with BFE) is raquir&dO'
Community atlfdals who are authorized try IccaJ Jaw or ord"lnanca to provide floodplain managsmetlt informatfan. may also sign the
certification_ In the case of Zone. AO and A (wlthour a FEMA or ccmmunHy issued SFE). a buRcfll1g oft1cfal. a property owner, or an
owner's repreS8nm1fve may also slgn the csrtiflcatfan."
-Aefersnca l&Ve. diagrams S. 7 and S. Oisrlnguishlng Featu~1f me a!lrtffier is unable 1e certify fa breaJcaway/nan-breakaway waU,
encJOSUIIJ size, IbCadan 01 servicing equipment. arllta use.. wall apenings, ar unfinished area FeaWre(s), then Us: the Feature(s) net
incfuded in the certificatIon under Comments below. The diagram number. Sedion C, Item " must still be entered.
I csrtffy tflat rhfl information in Secticns 8 and C an this cartificats f'Bpressnf3 my besteffotfs to intsrprst Ihfl data avanabls.
I understand that any falSe sraremsnt may be punishable by trne q Imprisonment. under 18 U.S. Code. SfldiGfl r001.
Ku > s ~ ({ P . a ~ - {~ . l c:r 0 2:> G:,
I';:C;M. IFJER'S NAMe UC~SE "U~BeA (or "1CIx Saat) .
Tm..E ~~,t,~rf'&. L~' '{'-l.V"'~:P'-'NAMIi P"C~f!~''''-''':~ Ct,.~~c.
tOOO~fr/- .14(.,'& ~!. Bc.JV",,^Sv~((, M,'~~' S-:iJ11
ACCRESS h Il erN STAn: ZIP
, . I ~ P. A..J~ ~ ~ 11- J - 'ZiJoo If 5" z - q.) z. - J 07Ja
SIGNATURe . DATE PHONE
Cop1e.:s ..h~uld be made of this Certificate for:: 1) community official, Z) Insuranca ag~ntlcampany, ~nd 3) building owner.
CCMMEImlo 1',.0-.....,.. sl...b .,lpl/..l; 0-- Wt r 1M~~r,;rU I:u~
~ f/.y.pt/,'ouSlfA k.~GA/~ .e(-et/a.I-,~~ of- ~ rJ-f b(oc(c.
~ 'I -' ;; e.1- ;t:?- J I- I 111. i) /,...eI) Floe) V t'1 'f'Vrz..?'~ :.. J"5 0...
" ( 4. ~ """" , .,. J ~ f '? cq 1.Il'" >-' I, f:3 kv tllJiI--- C'-'J'tt1'.-
: J~
aN
SL.U
WInI
IIASEIIEMT
all PII..ES.
PtElnl, aR COWIMG
A Y
~..,.:;;... ZONES
I~~~ ~ 1
r ~~ tlW~
&1M J.
'\.lXlD
B.EVA'neIlI
t
r
MIlE
fIlCI:I:)
!l!V4TDf
J
.. y
ZONES ~
I-="Il\ :=-_ ~1
~~ \ - t'
~ lAd
~ .~ ~
- ,. l
.. "1, . . - . _
. . .,.. :'1 ~ . . , , "".
~~. ~. ~\3!P..&:~\!~~lB!i~i!J:: & f,c,:i.Jo;.I~!":
.: ~ :\ ..._~ 'r:'1:"":"~Ai" ~~. ;~i.07
~..1) . ~I,j~~~h':c~~~'b,'i Yt\ :2.. a.. ...
_..-at . ~~...-......ot.~'U....:~. ~:;: - -.. - '"
~~. :'~!:J.l~~:;i:l::~~li\l:~ ~ ~
:~:::J. ~ '. -~i~ ,.
~~. I .1""'="'1
'iJJt~':t~~
1"-;..' ;-ClI ~
I.ZWl!!I. ' . ~
11:8 dIagrams above iIIU5U'a1E1 the paints at which me eie~ons should be measured In A" ~n8s and V Zonss.
EJe"ations fer aU A Zenes should be meilSured at the top of the refefence leY~ floor.
EJevatJons far .aJl \I Zones should be measured at the bottom of the lowest horizontaJ strucrural member.
-
.
/c/w P ~g. 2
L-1~ ;~ ' {!i-~U4 ~~
~~
~NE~
GllEE. - FILE
YELLOW - APPLICA.T
GOLD - CIT.,
CITY OF PRIOR LAKE NO. 0 0 - 387
SEWER AND WATER PERMIT
NOTE: Sewer and Water
contractors must
be registered
with the city.
APPLICANT:h!JI1^ G~flf)E ::}:;AJC PHONE:Z5;;?-~-_Jtf(DO
ADDRESS:-I:'{J~ d)1I~S .51RJ;:e:r#-j $J.lIlKDf/EE-DATE: 7//Y/bV
SIGNATURE:_~~~~~4) BLDG. P~I{ 11 Do-38l
SITE ADDRESS: J.l/513 ~fl~....~~ PID# 1.5 - 1'3"1-004-0
FILL IN THE BLANKS
/r'
1. Estimated length of water service ~
feet.
2. Size of water service
I
inch(es) .
3. Location of any couplings from structure
4. Type of sewer pipe. ABS PVC X Cast Iron
5. Estimated length of sewer line ft;5"' I feet.
feet.
6. Clean out (if required), located at
structure.
o
feet
from
=======-~==--=i-== ===== F====:=====================================
This ap . i b permit when approv~. J
BY 'J.. t - ,DATE: 7//4- lOo
=======================~===================================
FEES:
$
$
$
35.00
.50
35.50
Sewer and water line connection permit.
Surcharge
TOTAL
* Fee for either sewer 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
PA-IJ':> w I p~M ,,-
,
AMOUNT PAID
RECEIPT #
REC'O BY
16200 Eagle Creek Av. S.E., Prior Lake, Minnesota 55372 / Ph. (612) 447-4230/ FAX (612) 447-4245
An Equal Opportunity Employer
T'"'l
IS)
"-
T'"'l
IS)
a...
~ Date
v
IS)
1;- J - Uv
T'"'l Site Address
IJ)
CD lot J..i Block
Owner's Name
Address
w
~ Conn. lDad
.....J
a...
w
Il::
.....
LL
~
U
W
Il::
W
.....
:>
~~~s
A tt rJ t. ~ N c!<'"i.-
Fuel.Na" G:MErue Size
CITY OF PRIOR LAKE Me
16200 Eagle CreekAv. S.E. Permit No.O() - 02) g1
Prior Lake, MN 55372
HEATING APPLICATION I PERMIT
PIC t#~6 -/~q -'u 6L' - 0
lY 5/3 (-, ~cW
Addition (){JJ;J f)JYl C hu I d:J.-2 tv d,t
Yt)f WllAA \-+0 ~ -
,
S 't\-\j ~JL.
.J
\,. ~ €-1~
Healing Contracaor
Address t_b \ 5 , ~ A,.J
.. . .
. 1A!!lJ.a J~.~
TelephonQ # ~ ,- , II.-
Furnace Make & Model -~~c:.
Model Size ~ \J ''1 b 0 R ~
Supply Openings
Relurn Openings
Input
Edr.
crm.
IJ)
Lf)
IS) .
T'"'l Alt9raljons
o Ulput
~
F,'(~\~
P<,\uC- LA40l
L[C{U 5~~
AIR CONDITIONER' UNITS CANNOT
ENCROACH INTO SIDEYAAD SETBACKS.
TYPE OF SYSTEM
Warm Air Plants
-Gravily
Mechanical
Ai r Condition i ng
Vent. System
HEATING OR POWER PLANT
Steam
; Hol Water
Radiation
Special Devices
Other Devices
TYPE OF WORK
Est Comp. Date
Replacement New Construdion
IS) R .
IS) epau
IS)
~ Est Cos! $ t ~ ttv
IS)
3 HEAliNG PERMIT FEE $
z
STATE SURCHARGE $
TOTAL PERMIT FEES S
Build iog Perm it 1#
.50
PAID WIT'
BUILDING Pt:1 "
...
Receif>t '#
TYPE OF STRUCTURE,
I, fiu.
2. ween
), Yellow
Fi3~ T'"'l
. Oty lSJ
CODlractOf i
.....J
a:
.-
o
.-
Single Family
Commercial
It-
Mulli-Family
Other
Two-Family
Industrial
Public
Industrial, Commercial & Multi-Family
Resjdentiarl Heating & AC
Residential, Heating Only
Residentiall G8$ Fireplace
Residential. Additions & Alterations
Resldentialr AC Only
Remember to add the State Surcharge on the bottom of this application.
The price of your heating permit incudes one rough-in and one final inspeclion.
Additional rnspecfions will be billed at $35.00 each.
House Heating Test Record must be submitted with buifdinq Dermit IlJImbQ[ before buiJd-
ing ce r1fficate of occupancy wiIJ be issued.
.t:I.EAI CALCULATIONS REQUIRED wilh number of supply and relurn openings isted per
room wi1h CFM1s per opening, New struclures or additfons send floor pfan with supply
and return locations shOWll. HEAT lOSS CALCULATIONS. PAYMENT AND
APPLICATIONS MAY BE MAILED TO THE CITY OF PRIOR LAKEI 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
.. r hereby apply for a mechanical systems permit and I acknowledge that the
,information above js complete and accurate; that the VJork wiJI be in conformance
with the ordinances and codes of the city and with the state building/mechanical
codes; that this form does not be~ome a permit until signed by the BUilDING
OFFIC'Al; that the work wiU be in accordance with the approved plan in the
case of all work which requires review and approval of plans.
~~~I~
AppJicant's SigndM.Jre --
~..---
Building O&i"s Sfgnalul'e
\\ - ~-O"\)
Date
/1-- (0 .-od
Date
-r~~~ \,;1& T \..J~ t-'H.IUH LAKE
{ ~ ~ , 6200 Eag~ Creek Av. S.E. ?ermh N~ ~~ -{)O ~)J I
l~ Prior L.a.ket MN 55372
" ~ HEATING APPUCATION I PERMiT
~-l- au P1D#, 1,5-13'1- oo~-o
i:Addre~, \~S,~ c,.~V\~~~ f\"'-..
_ B~:):k Ac:itir..o.,
l.D \J '
~ 'nets Name. I b V''''f '-\ Y .,
~Qress , ,~\ I 0 <<,' t ~\ P (' >> J\t Y
'~ \ ~\
~.i1inS Ca:nra..~,,' "\ \,~ l"'\-\ r- ~ \, \
A:Sdrus , '\ \0 ~ ~ t\ ~ \.. \ l Or~Y \
18\;~rcn.' ~\.\\ - ~ \~"'\
Fuma::e Maks & tJ.odel ,( ~ V T\ \~
M:d.l ShI \'\ ~ 1\ .. ~ n
Com. Lead "/ ~ ,,'
Fuel N 4" NUl Size flv L
''\
\. T'YPE OF WORK " I I heRby apply fw .. m.chIIlicaJ sysbms ~ ani! I BdcnDWllodge IhIlllle
\ ~ . .mtonndcm. above ill camplta and 8CCUr1IR.; thai the 'WOrIc wUI-b1 in confGnnanca .
Alandions , Ra~3:.1d .... Ccmslr....:..n. " , w1Ih ... ~ 11IIII cod. of !be clty Ud wIIIIlho ,...: '. buildinJlfmacbaniCIII
E "-. , . cadIS; UlIIt Ihia fDlIIl does nDl be_ .. P8nmt until slpcI by !he BUILDING
It. ~ . · ~ CoII'IIL . . ft' " - OFi'ICIliII..; 1IIal .... ~ will ft In ~--..sanQ, wIIh lhO ~~w..ad I'IIm 1ft ...
:..~;$2:rr~~. ~~P~' ''U~~o~rr~~Il1 '~I~~~~~Dd~''':~l_:,~:''-:~ :
lSl . . .. .50 ....' "'IB pEnn- ,... . . . u.r... . .
~. STATESuActww: $ . """~\Dt,..~ . . ._ _ _. ~ . '."",. .
(\J. . - -' · gVl . 8,' & ...00 .. .
.... ", .
r-:.:'TOrAlPEFurr;-.. $ "-"'., - _ lID . .
<9~1ii ;~:":'. _. .' .' . , " '.'~ _.:' ...: '. ... .. ....,... . . .. ....>> '.~ :, ,; :~ ..:.~ '_~. ::.:;.. . ...: ~ ~:. .... ::. .::..~.~':.. :~ . ;,.. .
::5~:.:'. '..~~. .... ~ ..,..~: ',. ~L......,.~......,.;,,,,. '.' .~' . ...... :-'':; .....,.. ......r-. "~~1-~~-.~""~...~~~1__~. ~-'~.~4;:~~
~"'V- .E-. .... · - ---."..~. ~ ........I,L~ ~..~ .- '". ~....~....... · . -, ......,-.:. '"'''''' ~ . _~ <_ <. '. . .,_ :if'l>" ., .
.~ --~..~.., . ......_...;,."..'"'~:::;:.~......'~~~,h;...,........~~~,.:,.,"'...- :~: "~'~"""~'""-i-"'" . ~ ~ .~~. _' ".~ , _ ,_ ,.
~.. ,'. · '. '. ,.... · ,. .....,.... -":.. . =. ': .'.- . .~".. . .- .' . . '.: ~. -':...-., ::-., '. ~:' . ,~'; ",,~'- ~ .~'. : .".. .;""';;""r,:::';;.:.,(-.:
.'- .. ',' . ~ ." -... .' .,. ~ ,,-' " ",' ..,,""......~ ~. ~- . """.\to,. ...",.",.~~~~.~. ,cWl!~.tt~'I>__"'"
. - :-:~:-~;;:~: ~: i.~':;.. \;:~ .....~ .; / :: -':'.0 '~.. ~\: :-?::~5~.\.~~<"': "~';:'-:-::j7~;~-~~~~->''''';''-:-.'~ ,(~~;'~j;f-t-:=-; ~., :': ~':. 4;~_- :',.~ ,.,,~.. . ..\. " ~. .
cte
~'Y C9an'Ln;s 1 \n
AtdUtn 0;Mmin;s, ~
mpui.l{\.~ OutpUt, \~i~~t)
\
\ s~s-_ ",
~ :dr.
<I ·
octm.
(k:: ,
I-
W
E
.n1'E OF ~ I ~UCTURE
1. nIIlI. . i"U&
1 Gn= . eu,
1. YdlN - ~-~
Single Fi.l-nityX
jW~ramny
lnd\.!Siri:al_
Mutti-::aTTl~ _. ____
Commercial
?u:Hi:
Ct'igr
~!e S:henule
lc:. (0,
tnd~, COri'.rnertial & Muft.'-?a..~~y
Rgskign1ial, Heating & ~
nesi~ential. H~aling On;y
~~sider\tt!l, Gcs Rrep~a..~
Mesidential. A::i:iltions & Attg;a!ions
::iesidential, At Only
saS.50
~.SO
~e.so
, ~~ ~ job :::I!r. (S33.50 minimum)
Sa2..50
S~,SO
Vr; v~\~lt~
rternember to atid the ~ SUr:harpe on the b~m d 1his z;:Ip1i:ation.
TYPE OF SY~ I:M
Warm AiT Pbin!:s V
G.-.why _
Mechani::al
AIr Conditioning ,....\--
Vent. System ,
HEATING. OR POWER PLANT
Steam ,
~ Wzler
p~..r~ .
Spa:ial Devi:es ,
Tne pri:e aI )'DUf r.'"l+~9 pennit in:1uda...s ani rD1.Jgh-in md Dne N ~:ti0fL
Ad-jj6onat ~ol'\S will be bUled at ~= .00 ~""'"'L.
HO'.!Se Hp~g Test r~rd 1nust be submitted with p.tirfrn..... Mm. nnm~r b=tDre buU~
ing ce~. of oc:upan..-y wi b! issued.
,H='" .C""Al ~JI ATlnN!; ,i='=N tI~=n with number at su;r,JJy and fetLIm. D;Jenin;S lS!eQ per
roam with eRA's- per o~ New stru:1Ures or adcfitiOrE 5end nD:.T pJan wiltrsupply
and return I.....,..ons shown. HEAT L.OSS CALCU1.J\ilONS, PAYhENT AND
APPUCAnONS MAY B:wn ::T\ TO THE CITY OF rnlOR ~ 16200 EAGlE
Ci\~ AVE. S.E.. ?RlOR ~ MN 55372.
C!1y HBll Qusiness htul aft e a.m. . ~:30 pm.
AU. WORK UUSi BE "N~u~.o (ROUGH-IN AND FINAL.) . CALl. CITY HAlL
Othllr Dev;"-
4Q"~
CITY OF PRIOR LAKE ~ =.. E-
PLUMBING PERMIT PP No. D- ~~. 9'i
ApplIcant: 'Sc.he,er Plll~~~~~ P~:'=t5d -441-107 3'-1 .
Add.- !~A ~.,.." ' ~. l'rW- I ~
~~~: II:: ~,.. ~
LeQeJ~. at BIock__ I SUbJ1!ru~
... AGdrua:-1.Y.SJ ~ ' l;~ . ~
Bulldlnl Permit, ,PIC ,? C;' - ( -11:: 06t/-O
NOTE~ n.. Ptltmit will nor be proce... without complete information.
FlXTURI! UNITS
n. c.... .. .. ..... c-"
,,\~
ou....ttty
~
t
l
,1
I
[
I
~~
Type 01 Fbdul1l
lam Tuo "'"" or \WfttIout shower
Ole........,
Floor 0,..,
lav.toty (bathroom sink)
Laundry Tnay (1 or 2 colftl)anmem .Ink)
Shower SIaIr
Snka
Bar Sink
W.Ie, ClOaet (taMeO
JIB aCHBDULa
IndUltrtal. CO....rciall MuItJ-Family
(1,. of Job coet. 131.50 minimum)
A..ldenial, New On. I ,.., Family
R_ldentlal, AddltfoM & Aft.radons
... 8un=herge
QuarnIry
,,1'
I
Type of Fi~u,.
Rough-ins
Water H..ter
-
I
Water Softn.r
Stand Pip. (washing machine)
Se~.g. Ejector
Baddtcw Assembly (APZ. Oo~. Check. PVB)
Beekitow Assembty Test
LaW" Sprinkler
l Other
I
$
S
S
S
.50
OAAND TOTAL $ .
PAID WITH
8UII.DING PERMIT
.,.... ....C I. .,.... ..... .. ezpnsl condiliQfl chat laid
~. tWI QlIJtfI1 fa III ..,.. .tlb tile OfttilllnCel
0(..... ... PIu.naIIiac CadII lIftCI die ~CI ~I_
- . --' IECIIPr~J 1 - 3' 0 DAn
. '/ .A\ .c.ST
Call for aU Uaap.ctioat hours ift advance.
t .eo1" ..JII CIU...l ,,"V. !.!... Pnor l~e. Minnesota 553721 Ph. (612) 447-4230 I FAX (612) 447-4245
,... SqUIll ~IY Emplo,et
11
PRIOR LAKE
INSPECTION RECORD
DEPARTMENT OF
BUILDING AND INSPECTION
SITE ADDRESS flS 13 Q\Q.",&.o1o
NATURE OF WORK rvP.!J' 0an..-c..~ti1_C)\I'r'j)f
USE OF BUILDING ~
PERMIT NO. QO - 0 3 ~L DATE ISSUED ;J - ~ - :<000
CONTRACTOR j:Qyr- t.Uo.-<- .
NOTE: THIS IS NOT A piERMIT FOR ANY OF THE INSPECTIONS BELOW
V. C. THE PERMIT IS BY SEPARATE DOCUMENT
eri ~ Fn ~ ~~Vo::t"'cJV'. INSPECTOR DATE
( ... FOOTING"'~~. k,(/Z/OO
\.. ~ FOUNDATION (Prior to Backfill) . fJ;r. t,/ u I bO
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
. t
~'!aab7rD
l~ ~~Ofl1J \.
....
(rhiJ. . ~hd f
I zni~ ~ ~/'t1;l (Jb
V d 5th:lh J ) 5., ~z,1 i".,(
~ · ~ } ~
SEWER I WATER I SEPTIC
FRAMING
INSULATION
ELECTRICAL
PLUMBING
HEATING (if required)
FIREPLACE ·
GAS LINE AIR TEST
7/ztjJ~
I .~ \
S7ll~
~U~
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
~ /-: /-':.. ~ ~ ~ ~
F E..l"\A Ra:J. E' l~v.... hCM 0.e,. ~\. C' lcc\.~.'eM. FIN A L S ea....~ 0. ~ cr Ci,'1. 'ft btbc. 0:cq:'LM..
4. GRADING (Prior to Sodding) /V~ .8... . I 7 /3// () I
BUILDINGi,~D~ ~llltH bf-. a/3/bi f!.- H 'f .
ELECTRICAL
PLUMBING
HEATING
DO NOT OCCUpy
~l (!,
~,
jtJ/3tJ/()7J
uli1n>
, ,
UNTIL AIjOVE 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.
Call between 8:00 and 9:00 A.M. for all inspections
FOR ALL INSPECTIONS (612) 447-9850
~'
i..II_.."-II.r'-'."....,'".;...~'
-"
-
CITY OF PRIOR LAKE
INSPECTION NOTICE
DATE TIME
SCHEDULED
7/t.. 4!c)o J I ~ '30
ADDRESS 1'-10/:5
t3LCN OA'-G AJe I
OWNER
PHONE NO.
CONTR.
PERMIT NO. 6 -3l7
o FOOTING 0 PLUMBING RI 0 EX/GRAD/FILLING
o FOUNDATION 1) 0 MECH RI 0 COMPLAINT
o FRAMING )(r WATER HOOKUP 0 FIREPLACE RI
o INSULATION . ~ SEWER HOOKUP 0 FIREPLACE FINAL
o FINAL 0 PLUMBING FINAL 0 GASLlNE AIR TST
o SITE INSPECTION 0 MECH FINAL 0
COMME~TS: 4J Lt.-:..j I ~ I P; f, F-' ,J
~~~be~L-I
a;y~_~ ~/~ 'fe ~
~~.
@~ ~~~Q~,
\ 1 ~ ~- t
\~~l"'}J-a ;-~,.(LD ~~,
//
~'~ .
\lZ'~ ~~ 4/~~.~
It( T~ '-) (C'/I ~ ~ ~ (/U~)
dQ ~
4'1 ~ 10 fl';~ . ~ -#:=- A ~ r
o WORK SATISFACTORY, PROCEED
? CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
~I
,
Inspector:
Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYl
INSNOTl
CITY OF PRIOR LAKE
INSPECTION NOTICE
DATE TIME
SCHEDULED //- ~ - 0 /":(: Ot)
/Lf~/3 G/t"'A/{/a/-c
ADDRESS
OWNER
CONTR.
PHONE NO.
PERMIT NO.
O;,(::rR7
o FOOTING 0 PLUMBING RI
o FOUNDATION 0 MECH RI
o FRAMING'~ 0 WATER HOOKUP
o JNSULA T)dN ~ 0 SEWER HOOKUP
~INAL fi 0 PLUMBING FINAL
o SITE INSPECTION ~ MECH FINAL
COMMENTS(1) ~ I?n~_.J-;/:Ii ~~
- ~~ rJ:]
~)~ hI"', f'~~
T~~ ~ ~ ut ~~~,
'./ ~~;P~?~
(f;J e~t7~ ~ J I
~)~~,~~~~
i~ ~,J{~ d .Q
~j~o-U ~ Ais~_.~ ~ ~
~~ .,..,-.-~ .
fJfJ~~it~~~-
(YLUL- ~ ~,
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
o WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
~CORRECT .a CALL FOR REINSPECTION BEFORE COVERING
Inspector: << ~ r Owner/Contr:
- /
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE..
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTl
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
/'-15/3
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
)@(FINAL
o SITE INSPECTION
COMMENTS:
6/'~L, -0 I(
DATE TIME
SCHEDULED
'7 -3/6>1 11>>1
b/c 11 dc, I f ,4v~.
CONTR. Jb ... 'V'C,f C""s!""", Ht!~
PERMIT NO. (9 (!) r <~ ,s{ 7
o PLUMBING RI ~~ILLlNG
o MECH RI 0 COMPLAINT
o WATER HOOKUP 0 FIREPLACE RI
o SEWER HOOKUP 0 FIREPLACE FINAL
o PLUMBING FINAL 0 GASLlNE AIR TST
o MECH FINAL 0
C't J-c. ~ B~J< J ."... D I(
~ORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspecto~~..tt.- Owner/Contr:
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTI
J'i tTE /
'D!{2- IEJ
(7i r'f3N DALb
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
-'4<) (3
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
:5 J-:r
COMMENTS:
G~ O~
TIME
f) .~7
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
/"
~ORK SATISFACTORY, PROCEED
o CORRECT ACTI01f- PROCEED
o CORRECT~, .L FOR REINSPECTION BEFORE COVERING
Inspector: K....! Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
INSNOTI
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
/c:J/3'O /~ / /J --' dO
,
ADDRESS
/45"/ 3 G~4
OWNER
CONTR.
PHONE NO.
PERMIT NO.
d - 3?7
o FOOTING n PLUMBING RI
o FOUNDATION 0 MECH RI
o FRAMING (F) 0 WATER HOOKUP
o INSULATION 0 SEWER HOOKUP
o FINAL ,. '/~~ PLUMBING FINAL
o SITE INSPECTION ,." , 0 MECH FINAL
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
COMMENTS:@ ~ ~ ~
r.S) i1.~__ ~ J~',",-rl:~ ~ -
~ ~ ,-~-~
. . ~V~ ~'fj ~)
~~-tJ~~
No
~.~
vs-
u~~~
~-~ 4~~ ·
I"~ ~O'~
o WORK SATISFACTORY, PROCEED
\t'1 CORRECT ACTION AND PROCEED
(0 v CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: ~I Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYl
INSNOTI