Loading...
HomeMy WebLinkAboutBuilding Permit 12. 1020 w. .�r..n.rm.., .�.- �.r..».... -. ... ..�^ ,, #' .,a' w.,"eg�g`?g9"�' Tl.` 'Y'*:', .� •'- *a+* °5+:: vB*' /+,r•rtrn. �.+�.rr- r. ° i � , i� h r t P; ;; ih 1 r..ih rJr..ih .. i� r. ih .� 1 ih i♦ ih . i i r , � ..� � �h.. : .:: .i y I • 4 ��� s r: .. r, a ... a .. .. 1 . .1 .�... ...1.. 444 :.ru n.:4. n +.+. nn.l . ru:.: .n ... +r4$ luu .r u. nl 1 lll r 5:1, r .r•i) ( /.., r: +: +:In: 1 . na ■ Ir 1 1 u llrl 1 ■ r „r 1 Inl 1 »11..1 n, � // 1 n 1 1 ,.� 1 1 1 1:. 1 1 1 1 1 1 �1 r � 11 r, � lllr 1 1 ul, lr.�.,ll,lr, .11lrlrr a t/ VVwS1 „111,1 \..• _: 1 r l. ,l - ∎, (.,:1 $ - 1, 1 ,,. 1111 . r, 1 , 4 111 1 1 , .11 1 11:::. I • IMIrr .11111„ . ,rw111rr _ n iii lllllrr llllfrl INIM, II/O 1/1f r (1f 11 t _ {I (. l.._, .- 1 14 {It _ t 1 .. ; .. + .. 1 x lu 11,4 hull ,... hull (ll r fU,ll a 1,� .: J I,Ir1 �.IIIIN, 11{llrl <IIHf r 1 11 lit 1 1 {It 1111 � .�rll s!!tl sry11, ; sl!n - + � sl!s ,.+1!!11 +.' t!! It h' iihhli�hM�! P�' �Ialh4hhht�l�llh4i�1' �llhliuhla W! I! u' I�llu' uh41x114' idPliWi4M14h1�1114J�h' 11�114hit' dl�ll' 1' w' 1' �1: 1 14h664' dl I! Ih' �I11' dllVt 1 'Ilzllhln'i'd�lwrlhVl#luwnl n ' -' ;; . -3- Crrrhhfuuafr of Octupant r °`' CITY OF PRIOR LAKE (;,: !iparfmruf of ixiI usprrhot _ . `" . El Final Permitted ❑ Conditional C. Expires -f _ (06.:-- This Certificate issued pursuant to the requirements of Section 110 of the ❑ Residential / ❑ International ,4 Building Code certifying that at the time of issuance this structure was in compliance with the various // 'l ) i ' ordinances of the. City of Prior Lake regulating building construction or use. For the following. , , .,r Use Classification SINGLE FAMILY Bldg. Permit No. 12 - 1020 . R5 VN PUD ^� Occupancy Type Type Construction Zoning District , IE` - � L22, B1, JEFFERS WATERFRONT Legal Description %,.- 14368 PARKSIDE COURT Own er of Building Site Address "` . MATTAMY HOMES ›� \ ` Contractor's Name & Address - ROBERT I d , H H I NS City Planner X (!' ui ding icia Date: .. I. Date: 1;t; � / POST IN CONSPICUOUS PLACE p s n '9i „ 6 _ __ .. r , :� .. r :.0 1 1 "N : s N ®"', (111 Ipr : ,, , 1 1� 1-004, 7 1 N 1 1A' 1111 sN I N ,1111 I _ 11 __ '': : 114 174k 1 1 1 1 s lls :Ills na llallu ,1111 lla us 1 111 11 11 I . , ; .mnl Illl >, .Ill, 111111 Ill l,,ll ll ll s 000 " 111 II I . 11 . 11 I 11 I , I , „ i : '' ,\ ,. , 1 .:: „ 1 :1, , r 114 ,1111 . .... uu1/ 1,1,111 /414 4,:,2 u :411111 i +. . 1 , : .. 1 A 11 1 1 :1 11 / :.: ll . ..Ill WON . 1,11 `.1 „11114: „ ,1 1 11 1 1, ..1111111 u11 1 1 111 4.: , 11111 1. 1111 1 N1 1 (1. 1 1. , p i � 11 : 11111, 1 /111Np ,.1111 . .1111 11111 .,1111 1 1111h . 1111 11. 1 1. (lh. r .1.. + /: . r .:l +1 whir rr 1 w I6 +, f,ll +lll.r L+l,l.r ,l.:.r . ..; + 1 1 1, A11 .1 V 11111. 111111 :11111 A 11114 INll .11111. > .r /114 .I.NI /1//,1 .1116 Nh. j NY .11 . 111f 11 ril 11 1 .. .r l .. .r , .rrr 11.. I :rl. ♦ vrr.. l ,.rr. :.. N•:V♦ Irrr: 111 r. 1.1.: Irl:� 1 Irlrl 111.:1 11111 11111 .rlr. 1 +1111 � .rIH.�� ..rll � j !1111 �Ij :1111 � .r..l �. Irlr. � :11 �j :r.11 ��I . :11. �Ij .r1r �Ij 11111 y � r.l.r � .�r �� .d'1 ♦I 4++0 �� .. �� . .+. {� 1 +� .I ::.1 �� :.:: �� :r+: .:JI 1 (+.♦l •�V!:'�I, ICI, :��1: k ♦+: S .: .��1 . \�G♦ ♦ , . . .: 0” • i DATE TIME CITY OF PRIOR LAKE INSPECTION NOTICE SCHEDULED /0/4/.3 ADDRESS /436, 8 fd_—/k--,.5 ice-- 6 OWNER )_H ctItLY CONTR. PHONE NO. !! PERMIT NO. /7 ` z.f.9 ❑ FOOTING ❑ PLUMBING RI ❑ EX/GRAD /FILLING ❑ FOUNDATION ❑ MECH RI ❑ COMPLAINT ❑ FRAMING ❑ WATER HOOKUP ❑ FIREPLACE RI ❑ INSULATION ❑ SEWER HOOKUP ❑ FIREPLACE FINAL ❑ FINAL ❑ PLUMBING FINAL 0 ASLI _ AIR TST ❑ SITE INSPECTION 0 MECH FINAL COMMENTS: ! 7 - r 5 4— 5,a;161 a-, - )(WORK SATISFACTORY, PROCEED ❑ CORRECT ACTION AND PROCEED ❑ CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING Inspecto� Owner /Contra CALL 447 -9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE. CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY! INSNOTI aN Z Z � n w J 4'LL�_ W Z W ~ LL Z U U a , 2 5 c3 N 01WWcI Z z ✓ � . 8 55Q . w u� ❑❑❑ ❑❑ > =O 7S -j---- I W o x 0 v N W Z c o yy W O »a A Z U O W Z , O U a, 0 li H re O O LL J ilk U c a i u, 1- z -xxz? i a 8 z 3 N 0 w =Uw ? \ ^ 111 . w w W w W w z 0_2Q 0-w Z a 2 3v�a QC ❑ ❑ ❑ ❑❑ Il °Pill d a a ° \ x Z Q O W (� O Z U LL p� W .. 1 U O ti 55, Z o z 0 a � ' • ■ 0 ti i U —"moms. - " 4 4, 4 ` � • ZaZ~ Z W I � Y w o Q O o 0 cc a _ m co 0 W w Z 0C•ae 2 - 4L.. 52 U 0 N 0 U? a 0 a 1:10000 0 _ N M 0 «0) Ill 2 ƒ IX u s- - 00 Z , 2 n 0 .d aa ( i� § k§§/ E z O2OE ❑O § & o 0 2 re x 0 m \ z a_ a � ¢ § L § 0 2 22 z 0 § E R 0oil� } 0 1 ■ o 000 ® m a § ` k 0 < § 2 x § w m } j / z \ ( V j 5§a.2 N ° 0 0 § Q o � z 000054 0 0 § / } LL -901 u Y 0 \ � \ ! W uj § 0 � © § 0 :. . CO § z q § § ( QIN 2 oazl- $ 2 „ Iww . g U. L0 W 0 0 jaw % ce & f § / / 0 2§ oo p _ 3 S S E 0? < 0 a 000000 U — N \ 5 ( 0 0 .E o § ] e ƒ ui E 0 L k_ 0v z & 2 §t.I- > @ aaa5 o 2UJW co 0 0 43 I o■ « z q� 0T. ii o 2 z W °� 000000 § g o 0 ■ o m / 0 z D § ® Z k o 2 k /ƒ 0 0 o S § ■ Q 000< 65 W / 0 0 w §a33§� §/ k 2 k ® 0 §§/ §%§ 0 0 z e o a�§ b wb W § IX 41b—.1 000000 00 § M CL a LL R 2 s@ 0 Z 0 Di u % R. Q o0 k § R. R u. § a 0 2 § z w /- CO < / a� c 2 z0 z W & } § 0 uj 2 re b§■ Dat W � � « § / � 0 0 oo p 2§ 0 E §? < o x 000000 0 0 0 0 f O Q I W Z _ Z f P _j 2 u. rt 11111111. w L Z UU Q • Z k � �gg > (7 W W(,) fL_4 0 ° W W — �oreceal,. Z a O _1 1 W ULLLLU' W Z 6., `V 0000016, w fA a o U =O "` W = CL V N O ci O u_ L 1 z Y Y Z Z U 0 g 2 0 o 0 o4 W • ' mo H LL .I 0 ' I- m 0 000 Q J F- 2 Z ce Z— 2 2 Z Z U c N O y co �� (Oi Q m zw�mz a 0 z _ 1 wQ yj _jw O ° Z I- o 4� w w W x (4 CL O 0000 0 z n I Cc, o o 0t Z 0 C4 re O 2 w w 0 Q Z U O W Y u M Z U o ° p� � O J Z O N N ~ 4U a O Z O O W F H f- W a z Z o Z` ' z Z N w w -' w z J O W re W Z 00WNZH 0 0 0 y U O i ° 0 LL LL LL Z LL 5 0 U a UZ a 0 a 00000 0 0 0 0 C of rnfp4) ` CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd TEMPORARY CERTIFICATE OF ZONING COMPLIANCE ....,AN t:z1 AND UTILITY CONNECTION PERMIT q . 36 , (Z t Nlv ES ° �� ` yyy JJ �� See M.ain ale I. White File PERYIIT 1\ O . 2. Pink City Z 1 Z 3. Yellow Applicant (Please type or print and sign at bottom) ADDRESS 1 '-,1 6 g p_ S t D E. C pv1.2--T ZONING (office use) POP LEGAL DESCRIPTION (office use only) 1 / LOT ( ADDITION -�(zs V v� 1 -1 o r - .1 -- 1 PID 2 -S` '2- OWNER (Name) ;'1 A T i A 1 'T' - I4 U N1 ES (Phone) - (Address)12 a 1 W A S 14 t t l iv t,1 Q tie s STE 2p t t=0 t 1 4\ 1• N SS L. 3 9 BU LDER (Company Name) 1 - 1 Is 'T t-i'. >`-t i' 4-1-U t`-t E S (Phone) (Contact Name) S U E - g' (Phone) (Address) 1 ' 2 t l . s . . ' S 14 lit ( T O J A, vE S S z_c) t t -p t IN) .A, t-, i , -1 SL '3) TYPE OF WORK $ New Construction ElDeck ❑Porch ❑Re- Roofing ❑Re- Siding ['Lower Level Finish ❑ Fireplace ['Addition ❑Alteration ['Utility Connection CODE: 110I.R.C. ❑I.B.C. ❑ Misc: Type of Construction: I II III IV V A B b p UU Occupancy Group: A B E F III M R S U PROJECT COST /VALUE $ t Division: 1 2 3 4 5 (excluding land) 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 upon the property to perform needed inspections. Signature Contractor's License No. Date Permit Valuation ( 000_ - Park Support Fee # $ Permit Fee $ (35-3 .SU SAC # $ 7 - - C .._ Plan Check Fee $ o/c( 18 Water Meter Size "; 1 "; $ ¢e) State Surcharge $ ..j S- Pressure Reducer $ r `` Z ` J Penalty $ Sewer /Water Connection Fee # $ t S-OV. Plumbing Permit Fee $ ( _S- Water Tower Fee # $ t 00,..), ._ Mechanical Permit Fee $ (G-4-. _ Builder's Deposit $ r Sewer & Water Permit Fee $ 54?. ' T` Other /rl S $ `� Gas Fireplace Permit Fee $ TOTAL DUE $ rl • 713 This /pp ' . i it : e comes Your Building Permit t en pproved Paid 9 ' Lam 1. iTY Receip No. ( 7 C r S ' � i42 �� �� ii Date `J.(t By • L : ilding Offic . - CIF This is to ce that e re 'st in the above application and accompanying do• • ments ' in accordance with the City Zoning Ordinance and may proceed as requested. This document when sign by the P .i • •.. • = -. . - • • _ • •f Zoning ..mplian - and allows construction to commence. Before occupancy, a Certificate of Occupancy must be issued. f',11 9 1 1 (2_ Planning h r . l ate Special Conditions, if any 24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 4646 Dakota Street S.E., Prior Lake, Minnesota 55372 Contractor's Material & Test Certificate for Aboveground Piping PROCEDURE Upon completion of work, inspection and tests shall be made by the contractor's representative and witnessed by an owner's representative. All defects shall be corrected and system left in service before contractor's personnel finally leave the job. A certificate shall be filled out and signed by both representatives. Copies shall be prepared for approving authorities, owners, and contractor. It is understood the owner's representative's signature in no way prejudices any claim against contractor for faulty material, poor workmanship, or failure to comply with approving authority's requirements or local ordinances. PROPERTY NAME: JEFFERS POND DATE ) — 2 j ) PROPERTY ADDRESS: 14368 PARKSIDE COURT ACCEPTED BY APPROVING AUTHORITIES: CITY OF WOODBURY ADDRESS: PLANS INSTALLATION CONFORMS TO ACCEPTED PLANS OYES ONO EQUIPMENT USED IS APPROVED YES ENO IF NO, EXPLAIN DEVIATIONS HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS YES ONO TO LOCATION OF CONTROL VALVES AND CARE AND MAINTENANCE OF THIS NEW EQUIPMENT? IF NO, EXPLAIN INSTRUCTIONS HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES: EYES ONO 1 . SYSTEM COMPONENTS INSTRUCTIONS YES ONO 2. CARE AND MAINTENANCE INSTRUCTIONS OYES ENO 3. NFPA 25 [DYES ENO LOCATION ENTIRE BULDING YEAR OF TEMPERATURE MAKE MODEL MANUFACTURE SIZE QTY. RATING RELIABLE RES 49 2011 1/2 12 155 SPRINKLERS RELIABLE RES 44HSW 2011 1/2 15 155 RELIABLE F3QR 2011 1/2 1 155 PIPE AND Type of Pipe BLAZEMASTER FITTINGS Type of Fitting CPVC MAXIMUM TIME TO OPERATE ALARM DEVICE THROUGH TEST CONNECTION ALARM VALVE OR FLOW INDICATOR TYPE MAKE MODEL MIN SEC FLOW INDICATOR POTTER VSR -F (7 Lf DRY VALVE Q.O.D. MAKE MODEL SERIAL NO. MAKE MODEL SERIAL NO. DRY PIPE TIME TO TRIP TIME WATER ALARM OPERATING TEST THROUGH TEST WATER AIR TRIP POINT REACHED OPERATED CONNNECTION` PRESSURE PRESSURE AIR PRESSURE TEST OUTLET* PROPERLY MIN SEC PSI PSI PSI MIN SEC YES NO W/O Q.O.D. WITH Q.O.D. IF NO, EXPLAIN LOCATION MAKE & SETTING STATIC PRESSURE RESIDUAL PRESSURE FLOW RATE & FLOOR MODEL (FLOWING) PRESSURE REDUCING INLET (PSI) OUTLET (PSI) INLET (PSI) OUTLET (PSI) FLOW (GPM) VALVE TEST N/A OPERATION: ❑ PNEJMATIC ❑ELECTRIC ❑HYDRAULIC PIPING SUPERVISED OYES ONO DETACHING MEDIA SUPERVISED OYES ONO DOES VALVE OPERATE F3OM THE MANUAL TRIP AND /OR REMOTE OYES ONO CONTROL STATIONS DELUGE & IS THERE AN ACCESSIBLE FACILITY IN EACH CIRCUIT IF NO, EXPLAIN PREACTION FOR TESTING VALVES OYES ONO N/A DOES EACH CIRCUIT OPERATE DOES EACH CIRCUIT MAXIMUM TIME TO MAKE MODFI SIJPJIIVISION 1 OSS Al ARM OPFRATF VAI VF RFI EASE OPFRATF FFI FASF YES NO YES NO MIN SEC HYDROSTATIC: Hydrostatic test shall be made at not less than 200 psi (13.6 bars) for two hours of 50 psi (3.4 bars) above static pressure in excess of 150 psi (10.2 bars) for two hours. Differential dry -pipe valve clappers shall be left open during test to prevent damage. All Aboveground piping leakage shall be stopped. TEST DESCRIPTION PNEUMATIC: Establish 40 psi (2.7 bars) air pressure and measure drop, which shall not exceed 1 -1/2 psi (0.1 bars) in 24 hours. Test pressure tanks at normal water love, and air pressure and measure air pressure drop, which shall not exceed 1 -1/2 psi (0.1 bars) in 24 hours. ALL PIPING HYDROSTATICALLY TESTED AT 200 PSI FOR 2 HRS IF NO, STATE REASON DRY PIPING PNEUMATICALLY TESTED OYES NO EQUIPMENT OPERATES PROPERLY [OYES ONO N/A DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT ADDITIVES AND CORROSIVE CHEMICALS, SODIUM SILICATE OR DERIVATIVES OF SODIUM SILICATE, BRINE, OR OTHER CORROSIVE CHEMICALS WERE NOT USED FOR TESTING SYSTEMS OR S LEAKS? OYES J]NO _ DRAIN READING OF GAGE LOCATEQJ)IEAR WATER RESIDUAL PRESSURE WITH VALVE IN TEST CONNECTION TESTS TEST SUPPLY TEST CONNECTION / . PSI CONNECTION OPEN WIDE (. c PSI UNDERGROUND MAINS AND LEAD IN CONNECTIONS TO SYSTEM RISERS FLUSHED BEFORE CONNECTION MADE TO SPRINKLER PIPING. VERIFIED BY COPY OF THE U FORM NO. 85B EYES ONO OTHER EXPLAIN FLUSHED BY INSTALLER OF UNDERGROUND SPRINKLER PIPING ® YES ONO IF POWDER DRIVEN FASTENERS ARE USED IN EYES ONO IF NO, EXPLAIN CONCRETE, HAS REPREE ENTATIVE SAMPLE TESTING BEEN SATISFACTORILY COMPLETED? BLANK TESTING NUMBER USED LOCATIONS NUMBER REMOVED GASKETS 0 WELDED PIPING OYES NO _ IF YFS DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING PROCEDURES COMPLY WITH THE REQUIREMENTS OF AT LEAST AWS D10.9, LEVEL AR -3? EYES ONO WELDING DO YOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS QUALIFIED IN COMPLIANCE WITH THE REQUIREMENTS OF AT LEAST AWS D10.9, LEVEL AR -3 EYES ONO DO YOU CERTIFY THAT W ELDING WAS CARRIED OUT IN COMPLIANCE WITH A DOCUMENTED QUALITY CONTROL PROC EDURE TO INSURE THAT ALL DISC ARE RETRIEVED, THAT OPENINGS IN PIPING ARE SMOOTH, THAT SLAG AND OTHER WELDING RESIDUE ARE REMOVED, AND THAT THE INTERNAL DIAMETERS OF PIPING ARE NOT PENETRATED? YES ONO CUTOUTS DO YOU CERTIFY THAT YOU HAVE A CONTROL FEATURE TO ENSURE THAT ALL CUTOUTS (DISCS) ARE RETRIEVED? ®YES ONO HYDRAULIC NAMEPLATE PROVIDED IF NO, EXPLAIN DATA !EYES ONO NAMEPLATE _ REMARKS DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN: NAME OF SPRINKLER CONTRACTOR: FIRE SUPPRESSION SERVICES, LLC. TEST WITNESSED BY F P -a OWNr ;SIGNED) .- TITLE! D E SIGNATURES / z/ • FOR SPRIG •NTRACTOR (SIGNED) ' TITLE DATE r - � ..... r�'_' i►T► _ ,. L , 144.4.1x - 7 ADDITIONAL EXPLANATION AND NOTES A Date Recd N CITY OF PRIOR LAKE PLUMBING PERMIT �F V . glue File Lola P A. LPERMIT NO. (Please type or print and sign at bottom) 7. Mow Appl cmn ADDRESS /�� \N ZONING (orrice use) t TaX - f — gk 1V LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PM (Name) fl ( \D _� (Phone) (Address) • • ) APPLICAN T (Name) 2---WO 17_ . 1 2- 10,J, (Phone) (Address) 2- " �� v .1 j U (1'LS V 1 1 ire GS' 37 ( 1 1 ( / ) ,� ;S2J'' (City) --7 (Zip Code) (Contact Person) GU '� l 1 J — `� (Phone) 05 1 6 7 1 6 _D APPLICANT SIGNATURE L Fe , %L� DATE _ 9/ • APPLICANT PLEASE COMPLETE BELOW Quantity Type of Fixture Quantity Type of Fixture ,3 Bath Tub with or without shower Rough -ins Dishwasher ( Water Heater 1 , Floor Drain 'Vj1 Water Softener 5 Lavatory (Bathroom Sink) j Stand Pipe (Washing Machine) Laundry Tray (1 or 2 compartment sink Sewaje Ejector Shower Stall Backflow Assembly Z Sinks _ Backflow Assembly Test Bar Sink f , Lawn Sprinkler -4 Water Closet (Toilet) Other FEE SCHEDULE Industrial, Commercial & Multi - family I% of job cost with a $49.50 minimum Residential, New One & Two - Family $ 149.50 r� 1 Residential, Additions & Alterations $49.50 The Minnesota Statutes § 3261.14R ^ $ 7 , `� " B Permit # "SURCHARGE" has been changed for one year effective PLUMBING PERMIT FEE $ .luty 1, 2010, until June 30, 2011. STATE SURCHARGE $ .50 'i'he minimum surcharge fora "faxed fee" permit TOTAL PERMIT FEE $ [ski, beginning July 1, 2010 This Application Becomes Your Building Permit When Approved Paid Receipt No. WITH Date By PAID BundtneOfflclal Date NI.? 1 " 24 hour notice for all inspections (952) 447 fax (952) 447 - 4245 BUR III 4646 Dakota Street S.E., Prior Lake, Minnesota 55372 1 PR10 CITY OF PRIOR LAKE Date Rec'd ° `° HEATING /AIR CONDITIONING/FIREPLACE PERMIT J�NESO�r I.ISnY Filc PERMIT NO. 3 IUD . o,K„ IZ • J. Yellow A70iicw, (Please type or print and sign at bottom) ADDRESS °, AA ZONING (office u se) 1 '1 Tei:iyk‘o.e_ a— LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID OWNER ra_ 0 1_ _ _ r\ (Name) YIC�i..t' I (Phone) (Address) . APPLICANT^ � ('n , �� (Name), � �\ (Phone) ^� (Address) 2-2-0) l` V v L J V V 7) l`1"� �� / /, (ddress) (City) (Zip Code) (Contact Person) CC 11(,) I „j \J e- (Phone) (27 (4:7 — ( J tP APPLICANT SIGNATURE 00 Or ' A. At ' DATE 9 ! 2-0 / 1 2— APPLICANT PLEASE COMPLETE BELOW pilEW CONSTRUCTION ❑ REPLACEMENT ❑ ALTERATIONS A � FURNACE MAKE � AND MODEL�jGU - t — IZS �p 1V O S [7 FUEL . 61a-S FLUE SIZE RETURN OPENINGS (O INPUT 4 Dot) OUTPUT G3;3 0 TYPE OF SYSTEM SEATING OR POWER PLANT PLEASE NOTE: Air Conditioner Warm Air Plants ❑ Steam Units and Fireplaces Cannot Encroach ❑ • t avity ❑ Hot Waler into Required Side Yard Setbacks. echanical ❑ Radiation • Air Conditioning 0 Special Devices Fireplaces with Box Additions or • nt. System ❑ Other Devices Cantilevers to the Outside of Buildings Require a Building Permit. FIREPLACE MAKE AND MODEL _ FEE SCHEDULE Industrial, Commercial & Multi- Family 1% of job cost Residential, Gas Fireplace $49.50 $49.50 minimum Residential, Heating & A/C (New Construction) $149.50 Residential, Additions & Alterations $49.50 Residential, Ileating Only (New Construction) $64.500 ��y� Residential, AC Only $49.50 Estimated Cost $ S i LJ (� • (/V Building Permit # The Minnesota Statutes § 32613.148 HEATING PERMIT FEE $ "St iRCI1ARGri" has hecn changed for one year effective STATE SURCHARGE $ .50 .luIy 1, 21)111. until June 30, 21111. TOTAL PERMIT FEE $ The minimum surcharge for a "fixed fee" permit (Office Use Only) k Via, beginning July 1.2010 This Application Becomes Your Building Permit When Approved Paid Receipt No. lial Date l a ' A ' 4 Buntline Official bate 7 1 24 hour notice for all Inspections (952) 447 -9850, fax (952) 447 -4245 4646 Dakota Street S.E., Prior Lake, Minnesota 55372 CITY OF PRIOR LAKE BUILDING PERMIT. Date Recd ... e TEMPORARY CERTIFICATE OF ZONING COMPLIANCE fw. 7 — aK :.... rr NND UTILIT1' CONNECTION PERMIT ...1111111.0 PERMIT NO. VAN Oylip 2 e CaN Ye*. apeaa ______________ ________ ___________------ i ADDRESS -- ), u...■ r% 1 LEGAL DESCRIPTION (office use only 1 PID LOT BLOCK ADDITIO; —_--_ 1 ----_---- ------- _----_—__— (Phone) (Address) 1 Zc t \..0 t\S A (NOT ■ i 1N'J a i.At•I 54 , vosimosit C_,,t-rpz A c_Tc_ve. (Company Na.me) c I • _ 6 P • -5 --') kCe- L---1--Q-- (Phone) (Contac rsiarne) (Phone) ---- (Address) I 1;i C. _ -1-V_, A,__ ■._.,'' :i7-.4_4_, 1\1 SQ cic ■-1 C--1.-k- Z t-- __I r (.•.—. TYPE OF WORK 121,New Construct:on OLleck 0rorch ORe,Rosvfing 01:se-Sic.trIt :j Level Firush 0 Face 0 Addition 0AI:ere:on OUtlitry Connecttor CODE; rgI.R.C. OI.B.C. 0 M:sc Type of Construction: 1 li m ry (P A CIO Occupancy Group; A B E F H 1 M (g; S U PROJECT COST/ VALUE S = • - ' ' Dirtsion: I 2 0 4 5 (excluding land) ! htmen. cell: the : nave futmthtett thtformation oh tha arpttatitOr wbsch IS to the NV of my knowledge nye and rrect l alw ,:errity that ! am the :.. - 7, AZI").:1'.7.V.: AerD( for the abese.tnentiored pmeterry and that all eons:rut wilt corttxtri to all canting ware and local laws and will proceed Ir. so:nista= with r.thrrutted plans 1 ant aware C-4: the haidtrig Ofict3.1* revoke this mend (Or Tun cane Futthcernore l 't-ait erre r'ar •re e rr ofncial etr a ,.:tiptee may enter uncle the property lo perform needed rrisper.. X tateAt=i----------- C - 14- 5 ti- Z7 - iZ SterVatttre Cerra) T 1 :.,;:ta.Se :`• Da!e r can:: V a:ult.:on Park Support Fee - - $ Ferrntt Fee 5 SAC # S t I _--------- Flan Check Fee 5 Water Wier Slat' 5 8 , : 5 State Surcharge 5 Pre5sure Reducer S I Penalry S Sewer/Water Coniecrl ©n Fee # 5 , Plumbing Perr...r. Fee S Water Tower Fee $ Met:hacal Permit Fee S ButIder's Depot,:• 5 Sewer St Pe Water rnnt Fee $ Other s Gas Pacp'.ace Perrut Fee S TOT I. N DUE . I IIINA 0 1 Fri „,„ co". rs Your Built:Wig Permit When A pr,oved !! Paid • -1 1_12_1te 0 31k . v Igor '46,1 /2/ ( -2--- I B.,,.. O Ofitelat . 1-...: ' nin o to zertsfy that the request to the ano‘e arVa: ar ACLOMPILVanig GICO,MICtItS 11 lal accordance wait ride Ctr. tans..g Ordmartec and may proceed as requested ran docanent ' C Marne: zunsttutes i :CMPCrar, Cer4fi,,,er ci 7..orurt$ ..Inrymiutnce ans! allows consenter= to zornruenzr Before occtipancv a Cer--ficate of Occupancy must be ise,,ea _------. ?Unroll DIrectot Darr Spesun CW4.11f P'1 s1 Wit :4 hour notice for all Inspections (952 4a"-9850, Ws (952) 44 4646 Dakota Street S.E., Prior Lake, +11nnesou 552 frIZ los! st , %,..J.„,‘ it • rallb ---- PRjo,p CITY OF PRIOR LAKE Date Rec'd 4 . ,A 1N 3 HEATING /AIR CONDITIONING/FIREPLACE PERMIT 2 / 6 jA'NESo 1. Pink File PERMIT NO . jjam�, 2. Green City /Z � � L V 3. Yellow Applicant (Please type or print and sign at bottom) ADDRESS / 113 6 g /'"a„,kO.46- N Z.( ZONING (office use) LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID OWNER.�yy, (Name) " ' tci, 6x.,M 1 Y►ti9i (Phone) ( 162 - R n - (Address) 72. v i ZL;,z N , 01 5 c,�. i `-/-11,,-v- S i 3 c/ APPLICANARTH & HUME TECHNOLOGIES, INC. (Name) dba FIRESIDE HEARTH & HOME (Phone) LAC. t$CO512060 (Address) 2700 FAIRVIEW AVENUE N RUSEV!LLt, NQbr)113 (City) (Zip Code) A .� 651.633.2561 (Contact Person) fU (Phone) APPLICANT SIGNATURE , - DATE 2 - — 11 1 - 1 3 APPLICANT PLEASE COMPLETE BELOW 1/114W CONSTRUCTION ❑ REPLACEMENT ❑ ALTERATIONS FURNACE MAKE AND MODEL FUEL FLUE SIZE RETURN OPENINGS INPUT OUTPUT TYPE OF SYSTEM HEATING OR POWER PLANT PLEASE NOTE: Air Conditioner ❑Warm Air Plants ❑ Steam Units and Fireplaces Cannot Encroach ❑Gravity ❑ Hot Water into Required Side Yard Setbacks. ❑ Mechanical ❑Radiation Fireplaces with Box Additions or ['Air Conditioning ❑ Special Devices El Vent. System 0 Other Devices Cantilevers to the Outside of Buildings Require a Building Permit. FIREPLACE MAKE AND MODEL fi'N-0 S L S SD f 2. --L/9 - ` ,--)O 94?B7zc- FEE SCHEDULE Industrial, Commercial & Multi - Family 1% of job cost Residential, Gas Fireplace $49.50 $49.50 minimum Residential, Heating & A/C (New Construction) $149.50 Residential, Additions & Alterations $49.50 Residential, Heating Only (New Construction) $64.50 Residential, AC Only $49.50 Estimated Cost $ 16 67 00 Building Permit # HEATING PERMIT FEE $ STATE SURCHARGE $ 5.00 TOTAL PERMIT FEE $ (Office Use Only) This Application Becomes Your Building Permit When Approved Paid Receipt No. wimp' Date BU 9i ING PERMIT Buildine Official Date 24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 4646 Dakota Street S.E., Prior Lake, Minnesota 55372 0;) Builders Deposit City of Prior Lake A $1,500.00 Builders Deposit is included in the Building Permit fee. The Builders Deposit is issued as security to insure compliance for a Final Occupancy Permit. (It is not an escrow account.) All exterior items including but not limited to grading, sodding, landscaping, tree planting, driveways, siding and painting shall be completed 180 days after the date the building permit is issued. If the work is not complete within the 180 day time period, the City shall notify the applicant of the violation and the applicant shall have 10 days to comply or the $1,500.00 builders deposit will be forfeited and the applicant will be billed for clean up or corrective work to rectify the situation. A $500.00 Tree Deposit may also be required and will be refunded if specified trees are preserved for a period of one year. By signing - this I, the undersigned contractor, acknowledge that I am aware of the erosion control requirements of the City of Prior Lake as outlined in the Erosion Control Measures for Building Contractors handout. //� DATE: 6 d -'z-9 - k - SITE ADDRESS: 14- b P� -S t b GaL �'r PERMIT # (Z . 1 REFUND TO BE MAILED TO: 11-A F 12 G poi E_ S SV t E 2O {fir / !–tri SS PLEASE REMEMBER 1. KEEP STREETS CLEAN DURING CONSTRUCTION 2. KEEP EROSION CONTROL IN PLACE 3. TEMPORARY OCCUPANCY PERMIT MUST NOT EXPIRE OR $500.00 WILL BE FORFEITED AUTHO ZATION TO RELEASE SIGNATURE: — di 506. 0 Lynda 1.gale uil g Services Amount V • • LI Acct. 801.20204 Date C:1Documents and Settings \sbare \Local Settings\Temporary Internet Files \Content .Outlook \BD8OXI9A1BUILDERS DEPOSIT FORM.DOC PRIOR LAKE DEPARTMENT OF BUILDING AND INSPECTION r 3 INSPECTION R"' SITE ADDRESS • , /d6 V • NATURE OF WORK 1� ' liiJl I /irioCl —*" USE OF BUILDING s PERMIT NO. Llr • • DATE ISSUED '' CONTRACTOR elf . Are _ PHONE A:WM / 4i NOTE: THIS IS NOT A PERMI FOR ANY OF THE INSPECTI • NS BELOW THE PERMIT IS BY SEPARATE DOCUMENT Install erosion control & maintain clean streets,sproa11 times. DATE FOOTING 1 1 FOUNDATION (Prior to Backfill) 1 1 PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED radon system under concrete slab rrrUrGH - INS SEWER / WATER / SEPTIC FRAMING toc 67e / ?/-2 - 2 ( INSULATION A/ ELECTRICAL PLUMBING HEATING (if required) 2/2 -- FIREPLACE GAS LINE AIR TEST tadon piping COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED system. FFTD 1 Fire Sprinkler ?i PO I`z?/ 'FINALS GRADING (Prior to Sodding) BUILDING ELECTRICAL PLUMBING ;hi )/-. HEATING DO NOT OCCUPY UNTIL ABOVE HAS BEEN IGNED 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