HomeMy WebLinkAboutBldg Permit 00-0681 & Demo 682
DATE RECEIVED
7 /I~J(JO
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
1. DATE
7/12/100
I. White
2. Pink
3. Yellow
File
City
Appli_
. 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
J-#o 13
3. LEGAL DESCRIPTION see- S.U'cJ~
LOT ~.}..3,~ BLOCK ()TW PIlS-
~
Lo"J J
fsf-r~ e..-f-
12. NO. OF STORIES
PID bls-Q,'?S~'-6-0
L,+~~ o-l. L.JnN_~ .f1ttJ-
13. TYPE OF CONSTRUCTION
ADDITION
4. OWNER (N,",)
~MV. Lk' ~
5.~Zi~~;:: I
6. BUILDER (Name)
R.,4.Kor f-~~J ~
(Address) (Tel. No.)
Wln.iJd t../6( ~ LowL r.<:'I '-1//7- 18Cf'l .
- /'; (Address) (Tel. No.) 892.. -OS"'~~
~V1/Z( 1(1'2--~ ~ ;' I
~ (Address) (Tel. No.)
7(g 9 V /2-814 .ff w- /1.1/. b(~t:-f)r3 {)
14. FLOOR AREA APPORTIONMENT USE
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
SEATS
7. TYPE OF WORK Fireplace a Septic a Deck a
New Construction cY"'" Alteration~ a 1ditiAat. .,'Inish Attic a
Chimney a Misc. ~ ~6 ~ _ ~ ~ ~
8. PROPERTY AREA OR ACRES 9. PROPERTY DIMENSIONS
Sq. Ft. Ifp~b'1
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 '"i
the above me . ned perty and~ltEfnst tion will conform to all existing state and locallawsancl will proceed in accordance with submitted plans. I am aware that the ____-1
building o' can re e tho fo 'u . Furthermore. I hereby agree that the city official ora designee may enter upon the property to perform needed inspectlons.-
X , ' 000 I sob . 7/,2./00
Signature License No. . Date
Re-roofing a Porch a
. fe-Siding a Finish Basement a
t/lJ t;tI) e
1 o. CULVERT SIZE
Yes No )'\
16. PROJECT COSTNALUE
17. COMPLETION DATE
Width
Depth
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
MATERIAL FILED WITH APPLICATION
SOIL TESTS a ENERGY DATA a
PILING LOGS a PERCOLATION TESTS CJ
Front
Back
Side
Side
BUILDING DEPARTMENT VALUATION
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION $/7~~IJO. (gO
PLANS & SPECS a
SURVEY a
PLOT PLAN a
SETS
COPIES
~
USE OF BUILDING
,
TYPE OF CONSTRUCTION: I II III IV V
OccupancyGroup A B E F HIM R S U
Division 1 2 3 4
Permit Fee................................... $
City: Amount Brought Forward .. .. .. .. .. .. . .. ... $
Park Support Fee ........................... $
~ [k~~' SAC ......................................... $
f"r Qre&;k Collective Street Fee ....................... $
Sewer Tap ................................... $
$
Pressure Reducer .......................... $
Meter Horn ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
-0
-0 -
II ~ 7. zS-
~2S.71
,~.~
Plan Check Fee ............................. $
State Surcharge ............................. $
Penalty ....................................... $
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
~0tS
9
,?~
- 0-
J (JO .~
ifJo.oo
$S' -5'0
'If) .DO
IV
1>>'.;1
rl'
Sewer & Water Permit ...................... $
Water Tower Fee ........................... $ - 0 -
Water Tap ................................... $
Builder's Deposit ............................ $ J lS'a~
~ "'-~, .
Other--:';\~~~.......... $ ~~
Total Due .............................. $ - . "1:10-
Paid ~~. ~ Receip --
Date E'./f'J .0 () 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 pr S requested. This document when
s. . ner constitutes a temporary Certificate of Zoning compliance and allows ~ruction to commence. Before occupancy, a Certifica of Occupancy must be Issued.
_ {4.t...l!O ~~- .~tAII)A~ c.\A_,,~ ~t'~
City lanner Date Special Conditions if any
This
By
Iding Permit Wh~A.BPro~~ J
Date 7-~
Issued
24 hour notice for all inspections (952) 447-9850
I.r"
I
CITY OF PRIOR LAKE
DEMOLITION PERMIT
1. White
2. Blue
3. Yellow
5. Ie; .00
DIREcnONS
1. DATE
SPACES NUMBERED 1 THRU 10 MUST BE FILLED IN
BEFORE PERMIT ISSUED
(Please print or type and sign at bottom).
7. SIZE OF
8. NO. OF STORIES
2. SITE ADDRESS
L{lo r:s. Lds ~+.
3. LEGAL DESCRIPTION
<tM- Sec. ~ 1!.... ...K-=r:w ~ US
ABBffIQf~ ~.. Lo4:t1 e ~
9. TYPE OF CONSTRUCTION
PID :2S-CJZS- Ol{.-O
10. COMPLETION DATE
4. OWNER (Name)
(Address)
(Tel. No.)
5. ARCHITECT (Name)
(Address)
(Tel. No.)
6. C~ijtCT~pme) J ""l. (Address) ~._I (Tel. No.) (30..,_ Off:'p~
1'..."'. ~CIt ~~.J..~ 'llf'l I~"" S.\. \.0. 4It,. . ~~~ . CJL<..J ~
I hereby certify I have furnished information which is to the best of my knowledge true ~d 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 Wi". proceed~' accordance with submitted plans. I am aware that the building official can revoke this permit for just cause.
Furtherr~' I h r n.gry t'rt the city official or a designee may enter upon the property to perform needed inspections.
x LA ,IV\ . 'I!r9!b 1> .
~~~ ~
METRO SAC UNIT DETERMINATION
I
FOR ADMINISTRATIVE USE
D~n() f} EPdrn- tU=- -# ,"S'I.7
IN .r/l~e S.18.(j()
MATERIAL FILED WITH APPLICATION
LJ Site Restoration Plan
LJ Utility Abandonment Plan
LJ Sewer Abandonment
USE OF BUILDING
SITE RESTORATION PLAN
Accepted by
Rejected by
LJ Water Abandonment
LJ Electrical Abandonment
LJ Other
TYPE OF CONSTRUCTION:
II
III
H
IV
R
V
M
CREDITS
Park Oed. Credit ................................................ $
SAC Credit .. ..... ................... ............ ..... ....... ....... $
Sewer & Water Connec. Fee Credit .................. $
Water Tower Fee Credit .....................................$
Other .................................................................. $
TOTAL CREDITS ........................ $
Occupancy Group A
B
E
Division
2
3
4
Issued by
Date
-.:r-v
This is to certify th t the request in the above and accompanying documents is in accordance with the City Zoning Ordinance and
may proceed as requested.
City Planner
Date
Special Conditions if any
CO -o~rl
Th~ C~nl~r of lh~ L.k~ Counlry
White - Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT Q.. A. _ K 0 t \+r..., fY\ P ~ \ \ (\ (..... .
APPLICATION RECEIVED :} I} \ j \ ~ ) -;J 00-0
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
LI ~ 13 J (~. ~J ~ ~ I-l,ed
_.. ~ - t
Accepted
Accepted With Corrections
~
Denied
~f~~
Date: ~ -I"~
Reviewed By:
Comments:
~~ Wtu> ~'r'-l:eg,.w't/e/J, tf.
~<k>~~<f/0lM\ jJt{~ .-
~ t(~ ~ Pr:t~ ~~~ ~e.e-~
~~ ~ ~- 'C? Ik.-r\~ i,- ~
~ /k,t9S- c&: ~S b~.~~ f?reJ~
AA.. <17": . . . ' ~ ~.Lll"\ \.) . (\A A~. ~ .
1-4('jOY'"" '\0 . Oc::;IL.I~,YleR.~ ,..
J--'{pr-~~ ~ &v~ ;t)( -~ .
fY~ ~.~ qtWL'~"cJ (~O ~c
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 I 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
~
06.()(p~1
Th~ C~nl~r of lh~ L.k~ Counlry
White - Building
Canary - Engineering
Pink - Planning
8WJ-DING PI;RMIT APPLICATION DEPARTMENTCHecKLIS!
NAME OF APPLICANT ~f\ . K 0-+
APPLICATION RECEIVED :} IJ l~
\ \ hmp " \Y\~.
\~ ) 6LuuO
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
L; IJ 3. L Q.ry-cJ-2
Accepted 'i... Acce
::::::ed By:Q ~
~
..I
Date: 8.. ,~~
Comments: r
~~ )~~ ~t:-T-
S:JL~1ffi.- ~ ~ ~_ ~Ot~
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."
I
J
----O(/~-&PJ...
Th~ C~nl~r of Ih~ L.k~ Counlry
White ... Building
Canary .. Engineering
Pink - Planning
.BUJLOJNG PERMIT APPLICATION DEPARTMENT CHECKLISI
NAME OF APPLICANT Q.. A\(,.o+ \ I n rne......~ \ \ '(\ (,... .
APPLICATION RECEIVED ~ \ti) -;2 OVQ
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
4 ~ 13. L ell- cJ,s;
Accepted /
~ .freJvJ-
Accepted WjtiJ . Corrections
6.T(
S'f1; aI/-QaM:u>/l1s / i "c;4/ Cn:?~
~b.s/I/// &,L/7/) ~/e5
7~e~-644 :2i4M,~j", .;{~?~1
if b>/;~ /Zm/ /%/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. II
.~
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_ 'Ill..-
CITY OF PRIOR LAKE Me' - }
16200 Eagle Creek Av. S .E. Permit No. () f.o 8
Prior lake, MN 55372
HEATING APPLICATION I PERMIT
Dale m/q ,If'O PlOt R S- - q "35- oJ..1. - D
She Address. '&'3 Lo(U)J SrAMJ-
Addition Pi ifl5e4-~,-f
. (/ .-
~~8r'~ ~a"-,8 R!'.. ~ ..J.Iorv..w
Lot
Block
Address .
Heatfng Contractor ~ lL IRD FIR fS IDE db a FIRES I DB CORNER
Address r 2700 N t FAI~VI EW..
Telepholl8 #: _ 65 l... 633 - 25 6 1
FIREPLACE
FXnll9 Maks & Model ~J #..) (D u.
Model S~ze_ J.,r- 1ht-
ROSEVILLE. MN 55113
Conn. Load
Fuel ~
Flue SilB
TYPE OF SYSTEM
Warm Air Plants
Gravity
Mschanjcal
Air Co ndhloning .
Vent. Syslem .
HEATING OR POWER PLANT
Sleam
Hot Waler
Radiation
S peel al Devices
Supply Op&nings
Return Openings
Inpul ,
Edr. .
elm..
OutpUl 4D,(V\n,
Other Devices
TYPE OF WORK
Alterations
Replacement
New Conslruclion
M
Repair
EsL Comp. Dale
101 '~IO;>
- , .
Est. Cost $ I) Nlo:)
. - .
HEAlING PERMIT FEE $
STATESUACHARGE $
TOTAL PERMIT FEES $
Building PeJmit ,
.50
PAID WITH
BUILDING PERMIT
Aecelpl .
TYPE OF STRUCTURE
I. Pillk
1. Cinr.
J. YrJ~ -
FlI~ t en
City' ~
CDn4r.Ct~ r+
CD
'<
Single Famity
Commercial
Mulli-Famity
Other
"
....
,
(I)
en
....
0-
(I)
n
o
,
::J
(I)
,
Two-F amUy
I nduslrla1
Public
Fee Schedule
Jndu~trialr Commercial & Munj~Famiry
AesfdenLta'. Heating & AC
ResioontFat. Healing Only .
ResidenUalt Gas Fireplace
ResidenUal, Additions & Alterations
ResidenUal, AC Only
1 % 0( job cost (S3i3.50 minimum)
S9'9~ 50
$64.50
$39.50
$39.50
$39.50
Remember to add lhe Sla'e Surcharge on lhe bottom of lhis application.
OJ
U1
The price of your healing parmi Includes one rough-in and one final h1splclion.
OJ
Additionat inspeclions will be b;ned al $35.00 each. ~
House Healing T esl Recoi-d musK be submitled with buikJinO I1An~J "In~" berore build :
ing cerfilicale of occupancy wiD be .ssued. ~
HEAT CALCULATIONS ~F'" 'lRF:n with number 01 supply and return openings listed p
mom with CFM's pet opening. New slructures or additions send Roor plan with supply
and return loealons shown. HEAT lOSS CALCULATtONS. PAYMENT AND
APPLICATIONS MAY BE MAILED TO THE CITY OF PRIOR LAKEr 16200 EAGLE
CREEK AVE. S.E. PRIOR LAKE. MN 55372.
o
o
r+
City H&1J business hours are 8 ..m.. 4:30 p.m.
ALL WORK MUST BE INSPECTED (FlOUGH-IN AND FINAL) - CALL CITY HALL
.47-4230
,
to
,
o
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N
I herebv apply tor a mechanical systems permit and I acknowledge thai the ~
Inlorrnalion above is complele and accurate; that the work wi~1 be in conlormanct...~
wUh the ordinances and codes 01 Ihe cJly and with the sla1. buildiog/m8(:hanici
codes: that lhls rorm does not become a permjt uom &igned by the BUILDIN(
OFFICIAL; lhat the work win be in accordance with the approved plan In the
case of all work which requires review and approval of plans.
~ I/,.z..--
(J;;;:;~Signn~
Z"ilif~'" S~..e
,,,/qfw
;/J' IIOJ~{)
'ft / ,oale
"U
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<C
!D
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FROM WENZEL MECHANICAL 612-452-0367
(WED) 10. 04' 00 11: 48/8T. 11: 46/NO. 3561851298 P 1/1
(f;P~
u:~E
"-"-~NE~
.... . PII.2
YBI.OW . A~.,.
..... - ar~
APPLICANT:
irl.l2.1-1 Z 1" ,
C~TY OF PRIOR LAKE
SEWER AND WA'.&.l:.x PERMIT
/~.~ ~:::;a~~:r_1f~:~
_~;:-: --;-, r: _ \';-' '\ \\\ )8 reg istered
f ~~>_//__ /- f\ ')\j\)\\ \~ith the eit:y"
\ . , ~ ~ .
~~J~IJ.J /- AfP)J.J4 PHONE: ('-51) ""I~~ - /5fa5'
\
\
NO. tJ -'la~/~
ADDRESS = 1959 1~r",JuLL
S IGN~TURE : ~'iJ. . , I-/', {-
/ ,"
SITE ADDRESS: ~(,/~ L~J2n~
DATE:
/0 I i..f J O()
, .
.c, "lLll r
BLDG. PERMIT t#
PID*.25-CJ35- Olfo~{J
FILL IN THE BLANKS
r /~
1. Esti~ated length of water service
'79
feet.
2. S;i.ze of water fSuj!:rvice I"
inch(es) ..
. I... I ~.. ,~'.,
3. LOcation of any couplinqs from structure
fee't.
4. ~ype of sewer pipe. ABS
PVC ./' Cast Iron
5. Estimated length of sewer line ~
feet.
6. Clean out (if required), located at
s'ti.ructure.
teet
trom
~F~~c==~s~e~=~~~====:===~~_=____==a=~~~~e~~===_=~~~~~~~~~==~=~==c~
Thi~ application becomes your permit when approved.
BY
DATE:
~===-=C:J:!!S!:S!!!!!!!S!=:=====_..C==C:s:::!!!!!~!!!~====::==;:::::;==;==:~Z::%:~=C:::Z::C:::~~!m!E!l!~!!!!_,_~!l!!!~~!!!!l!!!!==~~~~-=F'=r::=~
, FEES:
$
$
$
35.00
~50
3.5. So
Sewer ana water line connection permit.
Surcharge
TOTAL
. I.. NI I,r-".<".";
* Fee for either seWe~ or water i~dividually ia $~.~o plus
$ ~50 surcharge.
* ~ewer and water permit~ issued for new construction mu~t be
rec~rded ~n the b~ildin~ permit ~rd ~t the ~~me . 'ance
~o 1nSUr$ that no dup11cate sewer and wat are
issued.' . , IT
DATE PAID (/')-.1.4-00 , AMOt1N'l' PAID JII~WG~~~MIT
RECEIPT # REC'O B~ ~~~
4629 Dakpta St. S.f., Prior Lake, Minnesotc 55372 I Ph. (612) 4474230 Fu (612) 4474245 '
I\N EQU^L OPPO~ITY r.MPJ..O"aR
.. ..
10-10-2000 11:53AM
MATTHEW DANIELS, INC.
423 3017 P.01
I. a.. 1RJe
1. GIld :~
J. V... 'Aftlc::ua
PLUMBING PERM" PPNo. CJ-~f?1
Applicant hll.lJ.lh~J~l J'Jnni,16. Jrll1-r' Phcne:-",S;\_~I~-"'+~
A~dress= ~LJI",.nl1~~#'~ ~. !J!J.~~Jnr.. AfN' ~d~~
Slgnature~ '-at:~.1 JL..J...~~-u~~ . ~
Legal Oescription. Lot __ Bloc;;k 0 . Sub ff ~ ~; 3 )
Site Address: 4t.~ ~ ~I~I: V j
BuDding Permit 1# PIC .d :; -1.3 5 7 0 I (, -0
NOTE; This permit will not be proce8sed wtthQut comp(e~. information.
FIXTURE UN. I .=t
CITY OF PRIOR LAKE
,.,. c__ fill ..... ~ c_,'"
-",".
Quantity
:l-
I
I
4
I
2-
I
-3
Type of FiXture
Quantity
Type of Fb:ture
Bath Tub with or without shower
Dishwasher
Fleor Drain
ulvatory (bathroom sink)
Laundry Tray (1 or 2 compartment sink)
Shower Stall
Sinks
'Bar Sink
Water Closet (toilet)
I
Ro~g~-ins
Water Heater
Watet Softner
Stand PilJ& (washing machine)
" '
Sewa;e ejeCtor . ~
I
I
Baek1lOW Assembly (RPZ, Double Check. 1''18'
, I
Backflow Assembly Test
Lawn:, Sprinkler
Other
FEE SCHEDULE
Industrial, Commercial & Multi-Family
(1 % of job cost, 539.50 minimum)
. ,
R$$idential, New One & ,Two Family
Residential, Additions & Alterations
State Surcharge
$99.50
$39.50
s qtl..41J
S
,
S .50
GRANO Tu I AL
$ ~..Jy -4u~ i
l
I
This permit is J1'UllCcl 11l"'" the e1.. ,,,'..... condidon mar said .
coatractar. shan GOll1ply in all res.._..I wir.h the cxdiuano:s
ofebe Staw Plumbm, Code IIId the amclM"W"N tbeI:eof. ' j
- -- R.E~, r NO. i 0/10/ ()() DA'TC: __,!,p~ WITH 1
(;1 (l,(,/\~' . Al&c:.& ...~PERMIT
~r all ~tiODS 24 hours in adtlance. t
, I
16200 Eagle Creek Av. S.E.. Prior Lake, Minne~l& 55372 I Ph. (612) 447-4230 I F...x (612) 44711245
AD Equal Opportunity Employer ' .
l ,,'
I
TOTAL P.01
\
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~~~~'l! CITY OF PRIOR LAKE Me /
n . 1:. 1&200 Eagle C....... /IN. 8.E. Permil No. (?-:- f.o l?'
\ ,PrIor Lake, .. 55372 .
"./ HEATWG APPUCATION 1 PERMIT
()elo /0-6-0(;/ "1)1 {)5~1?};-Dlb-O
S..;ddr8SS q~/":? J....""dl<; b)'/~. .
La B~k Addlion fJt- fl" (y v-r ~ S-
ownQ"sN~me, ~ ,.:i ,'kd-J- :N~me ~
Addre- '?~9q a~-rb: .sI-/A/~~1 ~&-t/~o/
Healing Contractor . An ~1/ -'Ai /l..-P
Address /~~ /l/J./~if A~~ &//h~J///It' ~//
Telephone' 9~-7<VtC'5'ek;lc?'
fUr'lace Make II Uod.. ~y.~J-- SSo~~V~f'l4tJKYpe OF SYSTEM
d Warm Air Plants (I)
Model Sizo, ~q ~ GravlN.
</ .., -
Conn. load MechanICal ;o"G~ Ai2-
. --- - ..- Ar Condilkril1g (I)
Fuel /1/;c-t FIueSize ~.I'~tlyV Vent. ~em IQjll.l~)Jl/
. #'
HEAnNG OR POWER PLANT
Stltsm
Hot Walsr Q~..... -f1:/f,,-N//l.,./
Radiation __________
Special Devices
~
~
~
o
~
~
~
1.1.0
o
>-
r~
1<-1
u
Supply Openings
':/0
9';
Aelurn Openi ngs
It)
;0
C'..
-I'
t-
....
...,
C'.J
r!
~
><I
<
u..
~put _ 8'<3 ~
Edr.
OUtput "7P CId C/
Otbar Devices
am.
TYPE OF WORK
x
Hew CoostructiCll
It)
1:"'.
Merations
Rapair
Est. Cod $
. RIpIac8II1811t
Est Compe Date
EkII4A19 Petmll' ,
. .
'l"4
?'1
~
w
~
Q
o
.50
PAID WITH
BUll "aNG PERMIT
tiEAT1NG PERIfi FEE $
STATE sURCHARGE S_
TOTAL PEFNT FEES S
Receipt'-
lC
<:)
"
....
o
TYPE OF STRUCTURE.
1. ftaIt
2 0reeIl
]. Y~1cM
File
. 011
CDanaIJf
Single HIfni/y
Commen:iaI
)c
lWo-FamIIy
Indus1dal
Fee SchedUe
, Industrial, CommercBl & ....~Family
Residential. Heatilg & AC
Residential, Hootlly Only
Residential. Gas Fireplace
Residential. AdcItions & Alterations
Residential, AC Only
Muli-Family ~_
Publ1c , o.her _--
1%.01 job cnst 1$.19.50 rnirWoom)
$99.50 PLEASE NOTE:
$64.50 Air Conditioner UniLs Callfio
$39.50 Encroach Into Required Side
$39.50 Yard Setbacks.
$39.SC
RemembBf to add the State Sur.:harge on the bottom of lhie appUcatloo.
Th~ price of your heating pwmit includes one roogh-In and one final inspection
AdriIonal inspectiot.s wiH be biled at $..~.OO each.
HW88 Heaing Test Record roost be subrrilted wiI'llllMdina, pArmlt nt nhAr bebe build-
ing certilcate of (J(:cupency wiD be issued.
HF-AT CALCUlATIONS RF.o. IIAFn wid1 nt.JTJntr of s~ and retwn openings Ii8IBd per
N)OO1 wi" CFM's per opening. New atructureI or adCIdons send Ioor plan wilt supply
and IStam IocaIont: shown. HEAT LOSS CALCUlATIONS, PAYMENT AND
APPLICATIONS MAY BE MAILED TO THE CITY OF PRIOR lAKE, 18200 EAGLE
CREEK AVE.. S.E. PRIOR LAKE. MN 55312. -
City Hall buSIness hours are 8 a.m. - 4:30 p.rn.
ALL WORK MUST BE INSPECTED (ROUGIHN N<<J FINAL) - cALL ClnHALL .
I
441-e650 FM ~i - i.&o2J.I.5 ..
I heroby apply for a mec::hanJcal systems permit and l acknowledge that the
information above is complete and accurat.~ that ftle work will be in confofmance
with the ordinances and ~ .....85 of the cJty and witl1 the state building/mechanical
codes; that tide form dOeD not become a permit unlil signed by the BUILDING
OFFICIAL; that the work wtll be In ~~dance with tile approved plat' in tho
case ollll7work which requires ~ond approval 01 ~4/ 6"--0"/
Date
/01/1 / t/O
,()ate t
..
ELEVATION CERTIFICATE
FEDERAL EMERGENCY MANAGEMENT AGENCY
NAnONALFLOOD INSURANCE PROGRAM
\11 cNTION: Use of this certificate does not provide a waiver of the flood insurance purchase requirement This form is used only to
..rovide elevation information necessary to ensure compliance with applicable community floodplain management ordinances, to
determine the proper insurance premium rate, and/or to sUpport a request fora Letter of Map Amendment or Revision (LOMA or LOMA).
Instructions for completing this form can be found on the following pages.
O.M.B. NoJ067-D077
Expires M.y 37. 7993
SECTION A PROPERTY INFORMATION
FOR INSURANCE COMPANY USE
POLICY NUMBER
BUILDING OWNER'S NAME
STREET ADDRESS (Including Apt. Unit. Suite and/or Bldg. Number) OR P.O. ROUTE AND BOX NUMBER
4613 Lords Street
OTHER DESCRIPTION (Lot and Block Numbers, etc.)
COMPANY NAIC NUMBER
STATE
MN
SECTION B FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
Provide the following from the proper FlAM (See Instructions):
CITY
Prior Lake
ZIP COOE
55372
1. COMMUNITY NUMBER 2. PANEL NUMBER 3. SUFFIX 4. DATE OF FIRM INDEX 5. FIRM ZONE 6. BASE FLOOD ELEVATION
(in AO Zon... UI8 depth)
270432 0005 B 9/29/78 A7 909
7. Indicate the elevation datum system used on the FIRM for Base Rood Elevations (BFE): 0 NGVO'29 Ii] Other (describe on back)
8. For Zones A or V, where no BFE is provided on the FIRM, and the community has established a BFE for this building site, indicate
the community's BFE: I I ; : i I.U feet NGVO (or other FIRM datum-see Section B, Item 7).
SECTION C BUILDING ELEVATION INFORMATION
1. Using the Elevation Certificate Instructions, indicate the diagram number from the diagrams found on Pages 5 and 6 that best
describes the subject building's reference level 3 .
~(a). FIRM Zones A1-A30, AE, AH. and A (with BFE). The top of the reference level floor from the selected diagram is at an elevation
of:! 913 ...aJ feet NGVD (or other FIRM daturn-see Section B, Item 7).
(b). FIRM Zones V1-V30, VEt and V (with BFE). The bottom of the lowest horizontal structural.member of the reference level from
the selected diagram, is at an elevation of I ! I I I I.U feet NGVD (or other FIRM daturn-see Section B, Item 7).
(c). FlAM Zone A (without BFE). The floor used as the reference level from the selected diagram is I I I.U feet above 0 or
below _ (check one) the highest grade adjacent to the building.
(d). FIRM Zone AO. The floor used as the reference level from the selected diagram is I 04i~1QJ feet above:xJ or below 0 (check
one) the highest grade adjacent to the building. If no flood depth number is available, is the building's lowest floor (reference
level) elevated in accordance with the community's floodplain management ordinance? ~ Yes 0 No :::J Unknown
3. Indicate the elevation datum system used in determining the above reference level elevations: [!l NGVD '29 :-.J Other (describe
under Comments on Page 2). (NOTE: If the elevation datum used in measuring the elevations is different than that used on
the FIRM [see Section S, Item 7), then convert the elevations to the datum system used on the FIRM and show the conversion
equation under Comments on Page 2.)
4. Elevation reference mark used appears on FIRM: iiJ Yes [J No (See Instructions on Page 4)
5. The reference level elevation is based on: ~ actual construction 0 construction drawings
(NOTE: Use of construction drawings is only valid if the building does not yet have the reference level floor in place, in which
case this certificate will only be valid for the building during, the course of construction. A post-construction Elevation Certificate
will be required once construction is complete.)
6. The elevation of the lowest grade immediately adjacent to the building is: I I ! 91i2 ~.~ feet NGVD (or other FIRM datum-see
Section B, Item 7).
"
SECTION D COMMUNITY INFORMATION
If the community official responsible for verifying building elevations specifies that the reference level indicated in Section C, Item 1
is not the "lowest floor" as defined in the community's floodplain management ordinance, the elevation of the building's "lowest
floor" as defined by the ordinance is: Ie I I I I I. U feet NGVD (or other FIRM datum-see Section B. Item 7).
2. Date of the start of construction or substantial improvement
FEMA Form 81-31, MA Y 90
REPLACES All PREVIOUS EDITIONS
SEE REVERSE SIDE FOR CONTINUATION
SEcnoN E CEn IIFlCATlON
This certification is to be signed by a land surveyor, engineer, or architect who is authorized by state or local law to certify elevation
information when the elevation information for Zones A1-A30, AE. AH, A (with BFE),V1-V30,VE, and V (with BFE) is required.
Community officials who are authorized by local law or ordinance to provide floodplain management information, may also sign the
certification. In the case of Zones AO and A (without a FEMA or community issued BFE), a buDding official. a property owner, or an
owner's represe..tcJ: ,Ie may also sign the certification.
Reference level diagrams 6, 7 and 8 - Distinguishing Features-lf the certifier is unable to certify to breakaway/non-breakaway wall,
enclosure size. location of servicing equipment, area use, wall openings, or unfinished area Feature(s), then list the Feature(s) not
included in the certification under Comments below. The diagram number. Section C, Item 1, must still be entered.
I certify that the information in Sections 8 and C on this certificate represents my best efforts to interpret the data available.
I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
7095
LICENSE NUMBER (or Affix Seal)
Boerhave Land Surveyinq, Inc.
COMPANY NAME
14243 Mitoka Circle NE Prior Lake
ADfJRe;:JA'~"A ;,f ffk6~P'~./
SIG~" ~
James E. Boerhave
CERTIFIER'S NAME
President
TITLE
55372
ZIP
Jan. 6, 2001
DATE
MN
STATE
(952)445-9154
PHONE
Copies should be made of this CertIfIcate for: 1) community official, 2) Insurance agent/company, and 3) building owner.
COMMENTS:
ON
SLAB
A V
ZONES ZONES
'~~1~ T ,
~ ~""
lASE ~ lJ }~:{:~.!::;t:.~
fLOOO
ELEVATOI I~l ~
WITH
BASEMeNT
ON PILES,
PIERS. OR COLUMNS
..
A
ZONES
lASE
IILOClD
ELEVAT10N
J
v
ZONES if .
I...~all\ :~ -:1)-="1
~.~jf ~ 1- t'
~ ~~
1~~~lfIJ~~
::..'~.:J..;'~.ii.: ...:i.:~, ~.
..~'t~: ~: / I-=" 1
. ,~~ift(
The diagrams above illustrate the points at which the elevations should be measured in A Zones and V Zones.
Elevations for all A Zones should be measured at the top of the reference level floor.
Elevations for all V Zones should be measured at the bottom of the lowest horizontal structural member.
..
Page 2
"
. .
THE NATIONAL FLOOD INSURANCE PROGRAM
ELEVATION CERTIFICATE
PURPOSE OF THE ELEVAnON CERnFICATE
The Elevation Certificate is an important administrative tool of the National Flood Insurance Program (NFIP).
As part of the agreement for making flood insurance available in a community. the NFIP requires the community to adopt a floodplain
management ordinance containing certain minimum requirements intended to reduce future flood losses. One such requirement is that
the community "obtain the elevation of the lowest floor (including basement) of all new and substantially improved structures, and maintain
a record of all such information." The Elevation Certificate is one way for a community to comply with this requirement.
The Elevation Certificate is also required to properly rate post-RRM structures. which are buildings constructed after publication of the
Flood Insurance Rate Map (FIRM), for flood insurance in FIRM Zones A 1-A30, AE, AO, AH, A (with Base Flood Elevations [BFE's]).
V1-V30, VEt and V (with BFE's). In addition. the Elevation Certificate is also needed for pre-FIRM structures being rated under post-FIRM
flood insurance rules.
Use of this certificate does not in any way alter the flood insurance purchase requirement. The Elevation Certificate is only used to provide
information necessary to ensure compliance with applicable community floodplain management ordinances. to determine the proper flood
insurance premium rate. and/or to support a request for a Letter of Map Amendment or Revision (LOMA or LOMR). Only a LOMA or
LOMR from the Federal Emergency Management Agency (FEMA) can amend the FIRM and remove the Federal requirement for a
lending institution to require the purchase of flood insurance. Note that the lending institution may still require flood insurance.
This certificate is only used to certify the elevation of the reference level of a building. If a non-residential building is being floodproofed.
then a Floodproofing Certificate must be completed in addition to certifying the building's elevation. Floodproofing of a residential building
does not alter a community's floodplain management elevation requirements or affect the insurance rating unless the community has been
issued an exception by FEMA to allow floodproofed residential basements.
INSTRUCTIONS FOR COMPLt: liNG THE ELEVATION CERTlRCATE
The Elevation Certificate is to be completed by a land surveyor, engineer, or architect who is authorized by state or local law to certify
elevation information when the elevation information for Zones A1-A30, AE, AH, A (with BFE's), V1-V30. VE, and V (with BFE's) is
required. Community officials who are authorized by local law or ordinance to provide floodplain management information may also
complete this form. For Zones AO and A (without BFE's), a building official, a property owner, or an owner's representative may also
provide the information on this certification.
SECTION A Property Information
The Elevation Certificate identifies the building, its owner and its location. Provide the building owner's name(s}, the building's complete
street address, and lot and block number. If the property address is a rural route or PO box number, provide a legal description or an
abbreviated location description based on distance from a reference point.
SECTION B Flood Insurance Rate Map Information
In order to properly complete the Elevation Certificate, it is necessary to locate the building on the appropriate FIRM, and record the
appropriate information. To obtain a FIRM. contact the community or call1-80Q-333-1363.
The Elevation Certificate may be completed based on either the FIRM in effect at the time of the certification or the FIRM in effect when
construction of the building was started.
Items 1 - 6. Using the FIRM Index and the appropriate FIRM panel for the community, record the community number, panel (or page)
number, suffix, and Index date. From the appropriate FIRM panel, locate the property and record the zone and the BFE (or flood depth
number) at the building site. BFE's are shown on a FIRM for Zones A1-A30, AE, AH, V1-V30, and VE; flood depth numbers are shown
for Zone AD.
Item 7. Record the vertical datum system to which the elevations on the applicable FIRM are referenced. The datum is specified in the
upper right corner of the title block of the FIRM.
Item 8. In A or V Zones where BFE's are not provided on the FIRM, the community may have established BFE's based on data from other
;ources. For subdivisions and other development greater than 50 lots or 5 acres, establishment of BFE's is required by community
floodplain management ordinance. When this is the case, complete this item.
Page 3
,
INSTRUCTIONS
~.
The following 8 diagrams contain descriptions of various types of buildings. Compare the features of your building with those shown in
the diagrams and select the diagram most applicable. Indicate the diagram number on the Elevation Certificate (Section C. Item 1) and
complete the Certificate. The reference level floor is that level of the building used for underwriting purposes.
Nv I c: In all A Zones, the reference level Is the top of 1M lowest floor; In V Zones the referen(;e level Is the bottom of the lowest horizontal
structural member (see diagram on page 2). Agents should refer to the Flood Insurance Manual for Instruction on lowest floor definition.
DIAGRAM NUMBER 1
ALL SINGLE AND MULnPLE FLOOR BUILDINGS (OTHER
THAN SPUT LEVEL), INCLUDING MANUFACTURED (MOBILE)
HOUSING AND HIGH RISE BUILDINGS, EITHER DETACHED OR
ROW TYPE (E.G., TOWNHOUSE, ETC.); WITH OR WITHOUT
AlTACHED GARAGE.
Distinguishing Feature. The first floor is not below ground level (grade) on
all sides.. This includes .walkout" basements. where at least one side is at or
above grade. (Not illustrated)
I
I
I
I
I
'----
HIGHER FLOORS
(IFANV)
FIRST FLOOR
GRADE
/
REFERENCE .
LEVEL
(TOP OF FLOOR)
DIAGRAM NUMBER 3
ALL SPLIT LEVEL BUILDINGS, EITHER DETACHED OR ROW
TYPE (E.G., TOWNHOUSES, ETC.); WITH OR WITHOUT
AlTACHED GARAGE.
Dlstlngulahlng Feature - The lower level is not below ground level (grade) on
all sides.. This includes .walkout- basements. where at least one Side is at or
above grade.
HIGHER FLOORS
(IFANV)
I
I
I
I
I
HIGHER FLOORS
(IF ANY)
UPPER LEVEL
GRADE
INTERMEDIATE /"
LEVEL ,
~~~.#W~/&..~'~'
REFERENCE
LEVEL
ITOP OF FLOORl
GRADE
DIAGRAM NUMBER 2
ALL SINGLE AND MULnPLE FLOOR BUILDINGS (OTHER THAN
SPUT LEVEL), INCLUDING MANUFACTURED (MOBILE)
HOUSING AND HIGH RISE BUILDINGS, EITHER DETACHED OR
ROW TYPE (E.G., TOWNHOUSES, ETC.); WITH OR WITHOUT
AlTACHED GARAGE.
DIatIngul8hlng Feature . The first floor or basement (including an
underground garage.) is below ground level (grade) on all sides..
I
I
I
I
I
1--
HIGHER FLOORS
(IFANV)
FIRST FLOOR
GRADE
/
~//
AE"Cl'u:NCE
LEVEL
(TOP OF BASEMENT FLOOR .)
DIAGRAM NUMBER 4
ALL SPUT LEVEL BUILDINGS, EITHER DETACHED OR ROW
TYPE (E.G., TOWNHOUSES, ETC.); WITH OR WITHOUT
AlTACHED GARAGE.
Dlstlngulahlng Feature. The lower level (or intermediate level) is below
ground level (grade) on all sides..
HIGHER FLOORS
(IF ANY)
I
I
I
I
I
HIGHER FLOORS
(IF ANY)
UPPER LEVEL
GRADE
INTERMEDIATE /
LEVEL It'
,~~/?C' ,
GRADE
V\.,'~
LOWER LEVEL
+
REFERENCE
LEVEL
(TOP OF BASEMENT FlOOR.)
· Under the National Flood InsuranCtJ Program's risk cJassification and insurance coveraQtJ. a floor that is below ground level
(grade) on all sides is considered a basement tJWHI though the floor is used for living purposes. or as an offiCtJ. garage.
workshop. etc.
Page 5
.. ..
P RIO R LA KE ~~rtD~~~~~TD~~SPECTION
INSPECTION:RECORD
~
SITE ADDRESS ~ ~ lonQc
NATURE OF WORK N~v.J
USE OF BUILDING ~1= D
PERMIT NO. _ (){J ~O(pg / DATE ISSUED t'J..;).'1'-20oo
CONTRACTOR ~. A. Kttt ~ ~ P~D"E'" 6j;;}-~R~O
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BElOW
THE PERMIT IS BY SEPARATE DO~.S~~NT \ DA)E /
FOOTING I I QJ 1> ').of ~
FOUNDATION (Prior to Backfill) t 9{(l1 M \ , ,
. PLACE NO CONCRETE UNTI"Lj ABbfE ~SI3EEN SIGNED
ROUGH - INS
SEWER/WATER/SEPTIC t!t-. /O/t./IH
FRAMING L,.,l." ~ ///1,/66 /fl:r4 Id/lr/~
INSULATION ~l, f19-; /1/'1/6'0 6n i()I2-~//ft)
ELECTRICAL . . ,
PLUMBING J-t. f?fi:-gr~.>'. /~// 1Ib'D
HEATING (if required) ~l.. 6n 11/2,ft e S tnt i IJ II; / trO
FIREPLACE . I' ~. I ~/!~/;. I /
GAS LINE AIR TEST ~,Y:f'."h-' /b//I 11ft
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
___.Jllldt
/
GRADING (Prior to Sodding)
BUILDING 1,0.-.0 I .tJJ '?t \ 10 l
ELECTRICAL \ I
PLUMBING
HEATING
DO NOT OCCUPY UNTIL ABOVE HAS
NOTICE
FINALS
ANfi~-1
t?1-J I" It, I ~
I I ..
~
11"~0 .0/
7!Jz)/)v
I - L
I .
21/%(", .
I/'tlbl
BEEN ~IGNED
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 s"'aft 6e placed near main entrance.
Call between 8:00 and' 9:00" A.M. for all inspections
FOR ALL INSPECTIONS (612) 447-9850
Itrtificau of (()aupanry
CITY O}4' PRIOR LAKE
Department of .uilbing In_pection
~ Final Permitted-O Conditional C.O. Expires
This Certificate issued pursUlVlt to the requirements of Section 307 of the Uniform Building Code
certifying that at the time of issU/UICe this structure was in compliance with the various ordinances. of the
City of Prior LoIce ~egulating building ccmstruction or use. For the following:
Use Classification SINGLE FAMILY Bldg.I..""."jtNo. 00-0681
Occupanq Type R3 Type Construction VB Fire Zone HI A Zoning District R1 SD
SECT 35, ulP 115, GOV'T LOT '8 OF UNRECORDED PLAT
Legal Des... :...~on
Owner of Building Site Addiess 4613 LORDS STRr..r.i
Contractor'sName&Address R.A. KOT HOMES, INC.. 7694 128m ST. W.. APPLE VALLEY
ROBERT D. HUTCBINS/P, '.CityPlanner. DON R16
-;~~ ~ Date:
,
POST IN A CONSPICUOUS PLACE
Date: .
<,j..,.....i, ;'" ..,.... .'d~.....~ .J:.:,;.L ,;i."i. ic, ""'~';'..'''-;''~'''''l'' ..'.f i~"~.....;..;tj,>;,'" ,.".,.;.;,..:,.....,,(\. . :'i...l..>...;:,."'..."".".... .Li.~.~..:;.:., '.;";,,. .,;,',.~, ~"'.,zt"'''''~b:~'' :.b';:i'.>....,t.c, .,. :,.'.~,.. .;i.,c.'", .;Jl. .,,"':..... :."". . ;'c. ;"'. ~", . ".... ".". .",',.. ~...'
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
Lj(PC\3
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
1lt FINAL
/0 SITE INSPECTION
COMMENTS:
DATE TIME
SCHEDULED ~~
! ..Bf<-0J~ ~..
CONTR.
PERMIT NO.
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
" '" - \" ~, /)
.J~~
00 - 0(, Sf
o EXlGRADIFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
~
- '"
~ SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspedor: ~ - Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE..
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTl
7"rz~ z...
~./;5 L-(')~ r st.
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING 0 PLUMBING RI
o FOUNDATION@) 0 MECH RI
o FRAMING 0 WATER HOOKUP
o INSULATION 0 SEWER HOOKUP
~ FINAL 0 PLUMBING FINAL
o SITE INSPECTI 0 MECH FINAL
COMMENTS: S"{)D/~
~ .!:l..~
J~~
\<,. . I
TAt.JL, ~
~ 1/'1/(1/
, . ,
DATE TIME
14-
., .
~ tJ- O~ hI
o EXIGRADIFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
(~"..c'
/J
~ {~7;C,(J,
~ WORK SATISFACTORY, PROCEEO
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: ~ Owner/Contr:
CALL 447-9~-;ZR ;HE NEXT INSPECTION 24 HOURS IN ADVANCE..
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH &; SAFETY!
INSNOTI
CITY PF PRIOR LAKE
INSPECTION NOTICE
DATE TIME
SCHEDULED
II IZb/O J
,
ADDRESS "~/3 Lc rA
s+- .
OWNER i::lr",~ Wt",~ CONTR. fA ~r ~5
c..tt ~W~ f",'~f. ofe~"" ~ S,'(-Q
PHONE NO. '11.1'1- JB1"" PERMIT NO. 00 - 0 ~(
~cQ,:ILLlNG
o COM~LAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
)( FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
COMMENTS:
~a'\J!;.U~A'f JN~n21 I I:.ll
~fV\t!1S. tlu&. II ~ t::O'n1.P"u:
X WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: ~ '1.
rmner'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
DATE TIME
ADDRESS
~t,J.1'
/~~M()
L~l'UJs SJ,'
/~,'5()
SCHEDULED
OWNER
CONTR.
PHONE NO.
0- 6rl
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
o PLUMBING RI
[j 0 MECH RI
~ WATER HOOKUP
SEWER HOOKUP
. ~ PLUMBING FINAL
o MECH FINAL
o EXlGRAD/FILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
~~:TST
tV
COMMENTS:6)1 Jd- ~ <-4 ~ r-~.
f~ ~) ~ b~~~
~ ~-~~J'
V /- ~
fJR-~~ ~,~;
t
1~ . I.JI~-
!J' ~V ---:I- ~ ~-
YuuL oftJ (X J1/~.. A L ~ ~r
3t'~ ~~~ ~
J" 7Z ' IL" It ~ a ~ ~
. I ~ -r::~ ~
.11'... - Yl(J ~. /1.-tY 4.......,
war u ,
",. ~. ~ de ~ ~ t?)-'
~ ~ ~ Jf".FJt/~ ~,~o
5~A~
o WORK SATISFACTORY, PROCEED
It CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: ~, Owner/Contr.
CALL 447-9860 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.,
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTl
DATE TIME
CITY OF PRIOR LAKE l~dJd
INSPECTION NOTICE SCHEDULED /lrSO
ADDRESS '-/b/3 ~S" S(-,
OWNER CONTR.
PHONE NO. PERMIT NO. (J - /-,?/
o FOOTING 0 PLUMBING RI 0 EXlGRADIFILLING
o FOUNDATION 0 MECH RI 0 COMPLAINT
o FRAMING 0 WATER HOOKUP 0 FIREPLACE RI
o INSULATION ~SEWER HOOKUP 0 FIREPLACE FINAL
o FINAL PLUMBING FINAL 0 GASLlNE AIR TST
o SITE INSPECTION 0 ECH FINAL 0
COMMENTS:({) fd~ ~ ~
~.M~~~
~~ (){i~"~ t--'?- L, L , '
lVV~ (" lA.tc(~, - J4,..,..Q. I
I~~~
o WORK SATISFACTORY, PROCEED
~ CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector. ~
Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.,
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTJ
CITY OF PRIOR LAKE
INSPEcnON NonCE
SCHEDULED
ADDRESS 4f;f
~13
.. .
OWNER
L.."..ti Ci.
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING 0 PLUMBING RI
o FOUNDATION 0 MECH RI
o FRAMING 0 WATER HOOKUP
o INSULATION 0 SEWER HOOKUP
~NAL 0 PLUMBING FINAL
'i:. ~~TE INSPECTION 0 MECH FINAL
COMMENTS: ~
DA-E
~1..1 I?'
<;-1-
TIME
<6~~
.3<< C>~ P(;PM'-T 4f;oo'C(pel
O-bi'Z
o EXlGRADIFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
1_ '3-
I~ d' ~
/ -
cVI- j..- t -
~~~~~.
I
~~ ~,.
P~. tr)~ ~ oJf-
~
~l't(JDj-
~ ~ ~ ~l' ~ i.KJJ.j"
~. ~ ~~ en- ..a--!) b-1 J-.
AR-1 ~. ()
,J.:Y r- iA ~ ~
pl WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WOR!, CALL FOR REINSPECTION BEF~RE :ERI lfL 1/ /
Inspector: ~ I Owner/Contr: / {.;[:---
. v
CALL 447-9860 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.,
INSNOTl
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH d: SAFETY!
DATE TillE
ADDRESS
4~L3
SCHEDULED ./. 8 .0 I
~O,eo ST.
z.. ~ (i\:)
CITY OF PRIOR LAKE
INSPECnON NOTICE
OWNER
CONTR.
PHONE NO.
PERMIT NO.
tJ-f91(
o FOOTING 0 PLUMBING RI 0 EXIGRADIFILLING
o FOUNDATION 0 MECH RI 0 COMPLAINT
o FRAMING 0 WATER HOOKUP 0 FIREPLACE RI
~INSULA TION 0 SEWER HOOKUP 0 FIREPLACE FINAL
FINAL 0 PLUMBING FINAL 0 GASLlNE AIR TST
o SITE INSPECTION 0 MECH FINAL 0
COMMEN~S: ~Cre.. /9CO-t~.
....... Uv.d-\4 ;r-r QA(UCf;. ~h~~kr
. - ~~ ~ ,e('''''~t:p.~~'^
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o WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
IJ CORRECT wc:y. CALL FOR REINSPECTlON BEFORE COVERING
'nspecto%~ V~ . Qwner/Contr.
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE~
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH &: SAFETY/
INSNOTJ
~
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE sCHEDULED ,.1.0 I 3"vCfU
ADDRESS '~13 {J) eA) 5 ST.
OWNER CONTR.
PHONE NO. PERMIT NO. o - lo8 I
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
.e PLUMBING FINA~
r MECH FINAL f(!9
COMMENTS:@ ~ ~ >#~
&2~~' l ,
(2) ~ /, 11 A">-
~~~
J~ ~~~~
. ~~.~ Ii" ~
~ ~ .M>-'~-' ~ ' ~ . · ~
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(@ ~, .
o FOOTING
o FOUNDATI04EJN
o FRAMING
~NSULATIO
FINAL
o SITE INSPECTION
o EXIGRADIFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
Ir
~
,;
o WORK SATISFACTORY. PROCEED
)f CORRECT ACTION AND PROCEED
fo CORRECT~. CALL FOR REINSPECTION BEFORE COVERING
Inspector: (. Owner/Contr:
I
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.,
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH &: SAFETY!
INSNOTl