HomeMy WebLinkAboutBuilding Permit 00-0547
DATE RECEIVED
f>!Is(JJ7J
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
1. White
2. Pink
3. Yellow
File
City
Applicant
Permh No. OO..,() ~
. DIRECTIONS 1. DATE
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN / 15- ~\.
BEFORE PERMIT IS ISSUED (Please Print or }ype and sign at bottom) lJJ - ,- VU
2. SlTEAOORESS /5575 /6t-oDks7dL LN. N~
3. LEGAL DESCRIPTION
LOT ;:).r _ _ ~L'fK. ~ I . PIO;)5' ~('7 '()dI,D
ADDITION ~r, ~. "3 rd ill.
4. OWNER (Name) (Address) (Tel. No.)
5. ARCHITECT
(Name)
BUILDING INFOM1A TlON
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
12. NO. OF STORIES
13. TYPE OF CONSTRUCTION
14. FLOOR AREA APPORTIONMENT USE
(Address)
(Tel. No.)
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
SEATS
16. PROJECT COSTNALUE
Back
Side
Side
MATERIAL FILED WITH APPLICATION
SOIL TESTS LJ ENERGY DATA LJ
PILING LOGS LJ PERCOLATION TESTS LJ
OFF STREET PARKING
SPACES REa.
SPACES ON PLAN
PERMIT VALUATION
t:t 5".. tIIbO .C20
PLANS & SPECS LJ
SURVEY LJ
PLOT PLAN LJ
6. BUILDER (Name)
lA)-e,n~~r'\
~O\-e.~
7. TYPE OF WORK../" Fireplace LJ Septic LJ
New Construction V Alterations LJ Addition LJ
Chimney LJ Misc.
8. PROPERTY AREA OR ACRES
Sq.Ft.
\ 8QSlp\07fl.. t>r. ~~,:.~~
CS\A\~ ~
Deck LJ Re-roofing LJ Porch LJ
Finish Attic LJ Re-siding LJ Finish Basement LJ
. 9. PROPERTY DIMENSIONS
10. CULVERT SIZE
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 at all co truction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the
bUildi":JJ~oke this p it for ju use. Furthermore, I hereby agree that the city Off.iC1~ oJ ~!!nee may enter upon the property to perto" needed inspections.
X _____ /4; ---y-/,~-t:J{;L
/ r. . License No. Date
{/ FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
Front
BUILDING DEPARTMENT VALUATION
USE OF BUILDING ~
Width
Depth
Yes
No
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................................... $
Plan Check Fee .... ............. ............ $
State Su rcharge ............................. $
Penalty....................................... $
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
Sewer & Water Permit ...................... $
City:
Amount Brought Forward .. .. .. .. . ... ... ... $
Park Support Fee ........................... $
SAC ................. ................. ....... $
Collective Street Fee . .. . .. ... .. .. .. .. ... ... $
Sewer Tap ................................... $
Pressure Reducer .... ~.~............... :
Meter Horn........... ................. ....... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee . .. .. .. .. .. .. .. .. .. .. . .. ... $
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5:S""' · c.(o
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U2f:) .,~ (::)
It:JD .~~
35 ,~.t.J
'k; .t!) c)
SETS
COPIES
9!d>. OC>
, rJ eJIJ.. l!) ~
t./ 'i--oo
I 2S-:oa
I,~" ~
100- ~
Water Tap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
Certificate of Occup T~I Due .......-;..".;."1"............... $4-? SS ~O
Paid <;; fJ -,... ... q''' Receipt ~o. n t r I-
~ r/I ~
Date 1{ it !(fi/ By _
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed requested. This document when
~ Ianner constiIuIBs a temporary Cel1ifica1e 0/ Zoning COlTllian~ alows ~., commence. _. OCCIJpOI1pCertifO~ust be issued.
~ avUs./Ob ~.\~. C~~!A14t""" '. . _
Planner Date Special Conditions any
ilding Permit \2Ih~~rov~
Date lD .-c1 -~~
24 hour notice for all inspections (952) 447-9850
eJ
~
Do -oS41
Thr Crnlrr or Ihr L.kr Counlry
White - Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT ~ ~"'\r') ~.P-.
APPLICATION RECEIVED :Jl_V\t. \,~ j ;;J.JrIN
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
SS~S ~ 1c:>J.~ Nw
Accepted ~ Accepted With Corrections
Denied I
Reviewed By: ~~d'~ Date: C. '2't~~
Comments:
Se~ I~"r'] 'E_Jstk . r.... -f;:,,- p,4-Q . ~ ~.
liThe issuance or granting of a permit or approval of plans, specifications and
computations shall not be construed to be a permit for, or an approval of, any violation of
any of the provisions of this code or of any other ordinance of the jurisdiction. Permits
presuming to give authority to violate or cancel the provisions of this code or other
ordinances of the jurisdiction shall not be valid.1I
l'lJ\MEO~AP$.~r-H' W'N')>~ .~
, .. . . \>...<........,,\. ........~,.'............,>h................ ......',~....... ....'..4....:,""\7............ .'~................. .,'
Afi~~QA1't()tilflf;r3EI\lEO <UAt~ _.:> ,CT"'f'- J..UJ.J
The Building, ,EngineEn'ing,'a(ld.f'If1nning'D~partmel'lts~ave'. reviewed. the building.permit'
application forqon$UCtion aclivitywhich is proposed at: ...... 'L ..... ..... ...... I .
..ssr,n .$~\c!J t.a.J\t ~
Accepted v-r. AC'.cepted With Corrections
Denied ~
("', . '
. Rev~wed By: )tw,......... .. ... . ...
Date: ~ - .2/.9.. &0
t
Comments:
.ANv~~, To ~ ~N7rt' 4 .
~~ c,u.~. ~ ~~AA ~G1j~
3("& 1Wt-\ tev\. .
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."
, ,.,.. ."e-
, ",:.. .'.o' ... ,.,:~..-...i :... '.o
',. ,~',,;,,~ .,..~ ~ '; ..::~ ~ ,
':: '~,(",~I.~~.... I'.:" ::"'\~ ... :'=~~.' . \,:'. .". .~'.'..~ :~..'"
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· 00,($4-1
Thf' (-f"In ,~r Ihf ~.b Counlry . .
. . , White - Building .:..
Canary .; Engineering
. Pink ' - Planning
BUU~DING PERNUT'APPLICATION DEPARTMENt 'CHECKLIST, .
. ..
. NAME OFAPPLlCANT .WqX\~Y:b.oA .Q.tl.. .-~
, ' . .. .: ", '. '.. ' . .," . ..' ',' :: .'. .
APPUCATIONRECEIVED . .\ (AAL;... \.~ t'b) ~-) (TO
The Building, Enginee.ring, and ,p,lann'ing Departments/have 'reviewed thebuiiding permit
... application ,for construction activity which. is proposed. at: . ; .. . ., .
.. . \5SCC1"?>~~dJ_~NW
, . " . , , : ' , ; ,. .
Accepted ,.?, .. .
. . Accepted \^{ith' Corrections, ..
Denied .. ' .'
. Reviewed By: · 0rallF (l(JJ'/@ .. . ... Date: ~h~/(1).
.:.C6rT1m~nts:',.5fC..' ,. ~~4lior\ on" -t-ht, rtverse ' s.icl.-P~
..- -- ..---- ------_...._~----- --- ---
. . ,
---'----------
. .,
..--.-.-:----:-.----,--- ~-------_...---:-~----: - -_._--_.- - ....- --- --~_:._--~-
. .. . .' , ' ,: " ..' .
5cl.~: I.AIf,.I&rd~ :r;,~~.);,,,. <?: Gr~ ,P&u,
3. Eros/'arJ .. d,JydN(.ttS'~"'~ 'I E"'osi()H {;~Irt'J1 E!/411-
. .
. . .
. . . .
, "The .. issuance. or . granting of. a. permit. .or approval 'of plans, specifications and,
computationsshali not be const~ued to be a permit for,.or an approval of, any violation of
any of. the provisions of this. c<;>de 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 shalf not be valid."
\~
CITY OF PRIOR LAKE Me ~ ~7
. 16200 Eagle Creek Av. S.E. Permit No. -fJlJ.. ~
Prior Lake, MN 55372
Si1gle Fami~
Dale
PID ,
/.rr-?S ~. r~~. ~
S~8 Address
lot Btock
AddiliDn
t )JArJlt~"1f . Jt~
Owner.s Name
Address
Healing Contractor ~LLIED 'FIllES ID! d ba FIRES IDE CORNEll
Addntss 2700 N. FAIRVIEW ~ ROSEVILL! t MN 55113
Telephone I 651...633- 2 561
FIREPLACE
8I.W1IfII Make & Model .jj,.J JJ C fA
Mod-' Size. ~ 1Sl 1tL
Conn. load
Fuel ~
Flue Sill
Supply Openings .
Re1urn Openlngs
Input .
0utP'J1 .J 3. (\)D
Edr.
Cfm.,
TYPE OF SYSTEM
War.... AM Plants
Gravity
Mechanical
Air Concr4ioning
V.nt. Srstem
HEAl1HG OR POWER PLANT
Steam
Hol Waler
AlcI1alion
SpedaJ Dlvice.
OCher Devices
TYPE OF wonK
New Conslruclon ,
)(
AfteraHoos
R.pacement
Est Camp. Date
Repair
Est Cosl $
I J 00. rttl
Bulkling Permit..
HEATING PEAMlT FEE S
STATE SUACHAAnJ: ,
TOTAL PERMIT FEES .
~II-OJ (JO -Os47
.50
PAID wmt
BUILDING PERMIT
R8C~'
TYPE OF STRUCTURE
en
CD
::J
I. ..... . filE r+
1. URn . 0Iy OJ
3.... . c.....c.. '<
Commercial
Two-FemHy ,
Industrial.
"
H
::c
m
en
H
o
m
o
o
::c
z
m
::c
MuIU-Femly
p~ OhM'
Fee Schedule
100001rial, Conmercial & Mufti- Famly
Resldenlal. Heating . AC
Residential, Healing Only
Residenlaf, Gas Fireplace
R es;denliaJ, Additions & Allerations
Residenliar. AC Only
59,~~~\ '
~~.- I'.
'~'i 1 ~t"
t ~ I
)
-
Remember 10 add 1he Stale Stln:harge on the bonom or VMs appication.
m
U1
....
The price or your heating pannillnclude. one rougfHn and one 'flllFlnspeclion.
m
~
~
Addlional inspeclol1s will be biIed at $35.00 each. ::
C>>
House Heali1g res. Record nwst be submitted with ~ RIUDlIIIIiIII babe tuk ...t:
ing cdie.'e or occupancy wit be IlIUed.
HFAT CALCULATIONS RF"'I.Ra=~ with runber of I~ end ret.." openings ..ted I
room with CFY's per opening. New Il(rUCMes 0( additions ..nd ftoor plan witt a.ppIy
and f8IUm localiona shawn. HEAT LOSS CAlCULATIONS, PAYMENT AND
APPUCATIONS MAY BE MAl.EO 10 THE CITY OF PRIOR lAKE, 1.00 EAGLE
CREEK AVE. S.E. PRIOR lAKE, MN 55372.
City HIlI buslneu houra are . a.m. - 4:30 p.m.
o
lD
."
I
m
I
o
o
I
ALL WORK MUST BE INSPECTED (AOUGH..ft AND FnAL). CALL CRY HALL
447-4230
C>>
....
o
)>
~
I hereby .pply fOf a mechanical systems permiland I acknowtedve that the ...
InfOfmallon aboye is complete and IIccvr.l.; lhat the work wHl be in confomanc
with the ordinances and codes of 1he city and with the s'.le tJuHding/mld\anlc
codes; that lhis form does not become a permit until signed by the aU'LOIN.
OFFICIAL; that the work win be in accordance with the approved plan In the
case of all work which requires review and appnwal of pt..,..
p'AA~~. ,,., "
~fl//J:JL-
8uildin~I" Signature
qft~/QJ
, · o.te
~ /5 "r/l)
0_
"
lD
co
lD
OCT. 17.2000
4:37PM
?bpt..A (l..-I'k), 316
CITY OF PRIOR LAKE ~ =- a-
PLUMBING PERM., # ..IY>- 051./7
==-1~~?-- ~ Te-:OOne~;'~~~~
Signature: l. J.c;o ~ _. 'a
--1..sQaI DescrIptton: Lot Block t Sub ~1~Vlv.,)~ ~
Site Acldress: I~'\C::; ~~ \~ \ ~
BuRdtng Permit # PIC # ;).. Z) - 3 ~ ~l - O~/ - 0
NOTE: This permit ~ill not be precessed without complete information.
RXTURE UNITS
GENZ RYAN 6513226147
P.2/2
T1w Celliif' .r .... Lalli c.n",
Qua ,tily Type of Fbdure Quantity Type of FIXture
~ Bath Tub with or without shower ,~ Rough-ins
Dishwasher ( Water Heater
~
\ Floor Drain t<.l \ Water Softner
4 La,-CLLwry (bathroom sink) I Stand Pipe (washing machine)
- ..-.-.- .
1 Laundry Tray <1 or 2 compartment sink) Sewage Ejector
1 Shower Stall Backflow Assembly (RPz. CotAble Check. PVB)
Sinks Backftow Assembly Test
Bar Sink Lawn Sprinkler
Water Closet (toilet) Other
FEE SCHEDULE .
-,-'--e.-"'._.
.. Industrial. Commercial & Multi-Family
(1 % of job cost. $39.5Q minimum)
Residential. New One & Two Family
Residential, Additions & Alterations
State Surcharge
S99.50
$351.50
$
S
S
$
.50
GRAND TOTAL S
PAID WITH
-... PERMIT
~
- .-",'
This permit is IIUJ1bd upon the expteSS coDdiaon that said
conCQCrOr, 5ball comply in all rcspcc:u with the ordinaDCCI
of the State Plumbing Cacte and the arnendmencs thcrI:of.
- Jrj - ~ml' 1 No.1 t:) -: -If" vUDA 1'E
f~l1~ Al&c.ST
eah.t6r allinspections 24 hours in advance.
I. . _ ._'-_0-"..'
16200 Eagle Creek A". S.E., Prior Lake, Minnesota 55372/ Ph. (612) 4474230 I FAX (612) 447-42~5
AD. EqWll Opponunity Employer
JUN.30.2000 8:35AM
GENZ RYAN 6513226147
NO.":J((
P.8/9
3.
3.
., 4.
5.
6.
7
'. ./
- - ....
YILUIIf . ar- -....
__ . ar.
NO. cn-6S~7
t. ~.. 8 2000
Sewer and Water
contractors must
be reqistered
with the city.
APPLICANT~ ~Y\~- f2~ Pt~,..",- ~.u&. PHONE:.J.;6I...4J,'2."!a--I,LIL.I
ADDRESS:.I&4'l.I~" ~ t1...u_''''r" <<"a.c..DATE: l 0,2:0 10()
SIGNATURE: ~. BLDG. PIRHIT IJJtJ~O'SLJ7
SITE ADDRESS: ,~.,~ ~'D<.-L~ PlOt as -,~'7- Qo;>l:.D
FILL IN THE BLANKS
40. ,
1~ Esti.ated length of water service feet.
r 'c
Size ot water service inch(as).
Location of any couplings trom s1;ructure
teet..
Type of sewer pipe. ASS pve ~ Cast Iron.
Estimated length of sewer lin~ ~' teet.
Cl.an out (if required), located at teet from
st.ruet.ure.
......JtJl.LU....._
.1lI..........
,,~
..d
.t..
..
e ames your aermit when approved.
.' r-:") ~"6: 7/a*l'J'
'II .'Ji -1 -- --
Sewer and water 11n8 connection permit.
Surcha.-:I.
TOTAL
Fee tor either sewer or water individually is $20.00 plus
$ .50 surcharqe.
Sewer and wa~er permits issued tor new cons~ruc~ion mu.t be
recorded on the Duildin9 pe~it card at the time ot issuance
i~s~:~~r. that n~~UP11cate sewer and water 7erm s are
DATE PAID, / ",,"u' AMOUNT PAID .
/.r" twU '14\ ,n t.A\1' /
/ ~\MG pEPI ge' 0 DY I
*
*
RECEIPT i
. 4629 Dakota St. ~ Prtar LaM. MInnaoba 55372' I Ph. (612) 447~230 I Fax (612) 447-4245
1i(!QUAL OPPORTUMTV 1MPtOVER.
i I
~ ~~. ~~~.-.-., 'r . CITY OF PRIOR LAKE' . i. -)
~ '. 18200 Eegle Creek Av. S.E. Peldl No. l'X) - Cl t5 4 ~
Prior Llka, UN 85372
~ ~ \ ttEAnNG APPLICATION I PERMIT sm~ X
N <> I ~ ~ Commerctal
a: Dale r\ In r J\..J PID. O'\S - ?'(~"1- f""'\~ I-{,
. .-
Site Adel,e.. r ~'"1 ~ ~~ '- ,f""'.O l.JW
~ Lot ~l BkM:k' Addllon (''''~\-A. ~r ~ A-OOrU
. - CJ
~ Owne". Name (.l ')) ~VV"'\(l lA '^ ~~ S-.. .
AdchIS.J'Or~ 1)b ~ I)~~ <::Ve. Zero Fnr~1U
H..q Cantractor r ~ .f1 Z - '-tJ'! Y"'
Acf....rU"1U' ~ .~'~PT- Tal- 1~'.Ytr
Telephone' '.ot;I- LJ7~ ~ - I fLlLl
Fur.ace M8k8 & Madel ( "IA..A~ ~ 1YPE OF SYSTEM
. Warm Air Plants )(
Madel SIze 9i\iY1R_!'.-1t:;' Glavlly.
Mechanical
" Air Cond~lanina)( 2. l J.,., -n-,,J
LI hltYtr Venl. Syllem
HEAnNQ OR POWER PLANT
Steam
Hol Wat., ..
Radiation r
Sptdal Davlce,
CoM. Load
~ Fuel ~ bI\~eSlz.
......
~ Supply OpeAlngs ! II'
Lii Retum Openl~. ~
I.D
~ Input 1~nnf) OUIpulJt/)rnl)
r ·
Il:: .
Ed,.
N
z
~ Cfm.
Other Devlcn
TYPE OF WORK
New Construcllon X
E
~ Aft, rations Replacement
eil
[.: Repal, Eal Comp. O.le ,
eil Ell. Colt. Building Pennll' ('\() - Ob Lf'I-
~ HEATING PERMIT FEE' / I' ~ 'IJ~~Mn
~ STATE SURCHARGE $ /50 1fJ\\D\tlG
~lO~ALPERMJTFEES !,/ R-'PI'" - -'
TYPE OF STRUCTURE
I. II~ --, Ria
10. . at,
,. YdIL_.) c..n:....
lWo-FamJly
lndusttlal
Mutti-Famly
Other
Public
Fee Schadufe
Industrfal, Commercial & MullI-Famlly
Rl6kfenllaJ, Heating & AC
Reskfenlat, Heatlftg 0IaI~
ReakfenIIaJ. Gal fireplace
RMldenllal. Addition, & AllenUone .
RNklenllll, AC Only
1% of Job coat ($39.60 minimum)
:~~..@~ J~Jr'Li .
138.1 X'
13D.~ _ \\. . )
Remember 10 add the SI.. Surcharge on 1M bottom cltW. .....~.ft.
The.prlce 01 your heetfllg permit lncIudea one rough-In and one tlnllln8pedJon.
AddiIonal fnlpeclronl wll be billed et '36.00 each.
House HeaUng Test Record must be stDnItted wflh I1uIdIruI marmIl DIUDbIl before buld--
Ing eertlftcat. of occupancy wil be ....ed.
I.U:" ~4~ r.t.f AT~~'~ ~I=f\t _~~ wlh rMnber 01 euppty and return operlnglllsted per
room w5lh CAts per opening. New aWctulel or addtionl send floor plan wIIh aupplv
and retum locationa shown. HEAT lOSS CALCULAOONS, PAYMENT AND
APPLICATIONS MAY BE MAILED TO THE cnv OF PRIOR LAKE. .8200 EAGlE
CREEK AVE. S.E. PRIOR LAKE, UN 65372.
CIV Han buslneaa hours are 8 8.m. · 4:30 p.m.
ALL WORK MUST BE 'NSPECTED (ROUGH.IN AND FINAL) · CALL CITY HALL
Jf... 447-4230 ~
I hereby apply for a mechanical -V.leme permit and I acknowledge thai Iha
Inform.tron above II complete and accuralei that Ihe wOlk will b. In conlorlnance
with lhe ordinances .nd codea ot 'h. city and with 'he.I.te bulldlnglmeoh.nlcal
codeli Ihallhls form doeS' nol become a pelmll unlll algned by the BUILDING
OFFICIAli Ihat the work win be In accordance wl1h the approved plan In the
cas. of aU work which requires 'ev~ew Ind approval 0' planl.
r1 / o~ .' q I, (o{f'r(J
r. Sign r I Dale
G1f1.l' . ~}o./~" h~ 07~m
o BuIlding Ollleara -sr / . D~
PRIOR LAKE
.,
INSPECTION RECORD
DEPARTMENT OF -...
BUILDING AND INSPECTION
SITE ADDRESS --L5~ ~ L~
-
NATURE OF WORK ~
USE OF BUILDING ~-D
PERMIT NO. ()() - 0)4-1 DATE ISSUED G,''2'~2CJof)
CONTRACTOR IAJ~~~~~ ~~ QHOHEtI'6,SI- Sial. - "Illoa..-
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
I\.. INSPECTOR DATE
~ 7((7(01
FOUNDATION (Prior to BaCkfill)t'~ ~. ?/;C;/"" lB 7JcSl:?/~
PLACE NO CONCRETE UNTIL ABOV'E HAS BEEN SIGNED
ROUG~ - INS
/ ~7IB/RJ
~. ~. 9/;9/tH
"'/~I {j;., ~....//~
f,1_~. .J1/Jr/~
J!!?;" ~ /1 ~/ Jtt
.(S; · 1 /;'1la (j
~ ~Ffi ' ~. .~/I5!/to
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
-~~
FOOTING
SEWER I WATER I SEPTIC
FRAMING.
INSULATION
ELECTRICAL
PLUMBING
HEATING (if required)
FIREPLACE ·
GAS LIN'E AIR TEST
GRADING (Prior to Sodding)
BUILDING
ELECTRICAL
PLUMBING
HEATING
DO NOT
FINALS
tV ~ .. . I D ')d, . () ",
· k' JJ- 7!Mfl:f). ICJI/8'./OO
f!f:r 1/~1t7/1J1 '
~ ItJf7/#
OCCUpy UNTIL ABOVE HAS BEEN SIGNED
NOTICE
This card must be posted near an electrical service cabinet prior to rough-in inspections
and maintained until all inspections have been approved. On buildings and additions
where no service cabinet is available, card t;hiil( b, placed near main entrance.
Call between 8:00 and 9:00 A.M. for all inspections
FOR ALL INSPECTIONS (612) 447-9850
-#
. -, " ".;.' ~/ ~- i'~. ,,,:,, ";i>:~' ': '.;';~~;~:~:'>,; '~":'t: -'~.' ,'r..". ,"~':" :'i ..i,L(f~ '. ::,. ~ :.~r~(':,:~: 'l~ : ~:;;::: ',:::;~?)1i~:#~::: ~.:L ~;-ii'~':':- ;~('~/V~~;7 .;:,,". ~"t.:~t '~_ i~;::' ;7' ,> ~~t~:iJ':':~~h~./ ;~:~::~;:'~i' :\~ :: ':;
A"LiiNCE f.t'e: ~:-
PERFORMANCE TEST
Locate near the furnace manual
~
LP Gas Natural Gas
JobAddress/0""15 B'<:St9tSld~
Heating Contractor @I';f Z- ~y~
:1~ ( . ~
Name of Tester
Date
Percent O2
Percent CO
Percent CO2
Stack Temp.
Pressure .
It!'--IG- t;/C>
'7
o
<0
3~o
~. /~r C,.
White - City Copy Tag - Site Copy
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
IA
TIM!:
ADDRESS
15575 BROOKSIDE LANE
PERMIT #00-547
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o )NSULA TION
fl 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 GASLINE AIR TST
o
COMMENTS:
~.su.~ (.,0
d~e, ~~
~ORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK/CALL FOR REINSPECTION BEFORE COVERING
Inspector: 'B v }fJM4 Owner/Contr:
CALL 447-9850 FOR ~HE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
INSNOTl
CITY OF PRIOR LAKE
INSPECnON NOTICE
SCHEDULED
DATE TIME
/0 ./~..()7) It ~T.
ADDRESS
/5575 eet)~,,-sloe
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
~SULATION~/~~
FINALP rTI ~
o SITE INSPE
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
/?L- r:/k~J).
~ II
7bv11 CD. To a/llof
I. SO f{~ . . ,
'2- . G fJG:>. /)~ 5(GN ~
COMMENTS:
o 0 -O~7
o EXIGRAD/FILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
I I
Zg g..;:, I 0/;7 /Cb
( {
o WORK SATISFACTORY, PROCEED
"(-CORRECT ACTIO~.D PROCEED
o CORRECT~. '.~L FOR REINSPECTION BEFORE COVERING
Inspector: JLj j. Owner/Contr:
II
CALL 447-9860 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
INSNOTl
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
CITY OF P~OR LAKE
INSPECTION NOTICE ""
DATE
TIME
ADDRESS
OWNER
SCHEDULED 10- I" . 0 ~: 3D
IS'S- /}s- B ~o~5 k/e )..,u
CONTR.
PHONE NO.
PERMIT NO.
0- ~Jj7
o FOOTING 0 PLUMBING RI 0 EX/GRAD/FILLING
o FOUNDATION~ 0 MECH RI 0 COMPLAINT
o FRAMING 0 WATER HOOKUP FIREPLACE RI
o INSULATION 0 SEWER HOOKUP FIREPLACE FINAL
J(FINAL BL ~~PLUMBINGFINAL ~ GASLlNE AIR TST
o SITE INSPECTION ~MECH FINAL 0
COMMENTS: ;h. ;::>~a/ - ()-Cj~
fJ) ~~. 7-11 ~ .~ ~
~ ~/
~ .f ~~ 0-<> ~ ~~I
t ~ VA-Lil~ tA-- ~I
~ tJ1 ~ 40 L.lL,
A- rC--r ~ P Q
~, ~ .v-.vI- ~ ~
~. -()~
~~~
w~ ~ -l.l..:3-
o WORK SATISFACTORY. PROCEED ~
o CORRECT ACTION AND PROCEED
)It CORRECT WO~ CALL FOR REINSPECTION BEFORE COVERING
Inspector: ~j Owner/Contr:
CALL 447-9860 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH &: SAFETY!
INSNOTl