HomeMy WebLinkAboutBuilding Permit 03-0081
C'\~i~ FeLE
. . CITY OF PRIOR LAKE BUILDING PERMIT, ~ U~
TEMPORARY CERTIFlCAIE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMII
IcJ- 36-0:,1
/
(Please type or print and sign at bottom)
ADDRESS
~: ~i~~e ~:~ PERMIT NO. ()~~ _ O^o./
3. Yellow Applicant ~ V{/
/c{/9~
t=Ov/-.7l~
biz1L <
e:1
ZONING (office use)
RL/
LEGAL DESCRIPTION (office use only)
LOT /3 BLOCK;;J.. ADDITION ,:(v~~ ~ l:Ln.s
OWNER
(Name) V...Je.p~frJ~ N IV
(Address) l.J?~ pi A ZA
?~
prD ~c}o -Q1!f -0.
l-hm~
o fL~' 4:/:. ZOO
6AhA,J
(Phone) fr,~! - C/(;~ -c.;qOCJ
MJJ S'~/~02
BUILDER ~
(Name) ~ AIM~
(Contact Name)
(Address)
A
~
.- ~-.J
(Phone)
(Phone)
~ 12-- Zz (-/~~~
TYPE OF WORK.
~ New Construction
o Dectk
o Porch
ORe-Roofing
ORe-Siding
OLower Level Finish
o Fireplace OAddition OAlteration OUtility Connection
PROJECT COST/VALUE (exc1udingland) $ lL3: OZt:} .
o Misc.
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 pel11l1it for just cause. Furthermore, I hereby agree that the city official or a designee may
enter upon the property to perform needed inspections.
~_ # JlJil .
., /' Signature
/~S-}
x
Contractor's License No.
Date
P.;.uuit Valuation fill ~. fJO{J, t:)D I Park Support Fee # $ ~5D,oa
P.;.uuit Fee $ ItJ~(P,5~ SAC # $ I~ 75"r DO
I Plan Check Fee $ (0 't3. t..ftL I Water Meter Size 5/8"; I"; $ 2..50,OD
State Surcharge $ 5lD.SD Pressure Reducer $ tfs, 0 (J
Penalty $ --.. City SAC and WAC # $ /lAD.OO
Plumbing P.;.uuit Fee $ /tJD.OD I Water Tower Fee # $ 7()(J, Of:)
Mechanical Permit Fee $ /6(),DC> Builder's Deposit $ I$()O,OO
Sewer & Water Permit Fee $ 3S-:~1J Other $
Gas Fireplace Permit Fee $ ~,OO TOTAL DUE $",qll~
, ~. '/'i//~- ~/~ Receipt No. y'5'/ flJ
This Application Becomes Your Building Permit When A}'}'4 u led Paid
~ f~~ Date ,~~-II-""~ _ By -/
I / .,}.~/tJ ~ F
Building Official I 'Date
This is to certify that the request in the above application and accompanying docum~ts is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
~ed. .
~~IJ
Planning Director
/P~3 ~.uJ. ~-~,
, , Date - Special Conditions, if any
24 hour notice for all inspections (952) 447-9850, tax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
I
~\N FiLE
~
Thr C'rnlrr of lhr tab ("ounlry
(' !VOIte :Suildi"B::>
Canary - Engmeering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLiSt
NAME OF APPLICANT
APPLICATION RECEIVED
!iU~~~
I~- 3D~~
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
I. . d'J~~ /1. (2 -I
1'-I/9.~ r~ ~
Accepted
Accepted With Corrections /'
Denied
Reviewed By: ~:j~ Date: //~h3
~~ ~-L/~M~~
Comments:
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
'",
'~~li -~
The ("eRler of IIle take Country
White - Building
Canary - Enqineering
<Pink - ~ning)
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
['
/ /
I I
i //_' .
v
j..,?
,:"
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
/
{'Jd'! /)t,
J (/ / <{
'''---''
! 1---
Accepted
/
Accepted With Corrections
Denied
t
Reviewed By:
~+~
Date:
/ p:2-A:3
/ '
Comments:
! "
('/
G (;.. ') 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, 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
ordinanc~s of the jurisdiction shall not be valid."
Th~ ("~nl~r of Ih~ I...b COUltlry
White .' Buildin
< ~anary ... Enqineerln
. Pink . Plan
BUILDING PERMIT APPLICATION DEPARTMENT CHecKLISI
NAME OF APPLICANT
II' //", ' /' . J"/<"/ '~r--';'..i,-. .
//. / :':/./{,l..',;;.-"Yh.:/>"Z-."J..t ./ /1\. / ("" I/l'}-€.;'~"-
r\.J' ..." / l" '. .,",'t.." ,;J /' ' ,Lo '~',. ' ...,."", .... ~
i " .....- :&
~ .
APPLICATION RECEIVED
1'1, .;z -,
I G?( _-,'
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity whiCh is proposed at:
/ '-II 9 .~ ,-;1 ()?~/}ctt,(::-,-Jt;, 1{)(~.#/~(~~(2 '1-" .
Accepted
)(
"
Accepted With Corrections
Denied
Reviewed By:
4?1B
Date: 1-{:--a3
Comments: See Reverse Side for Additional Information!
1YIC,lh (',l/~
See Attachments: 1) Grading Plan. 2) Erosion Control Measures
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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Job Address
Heating Contractor
Name of Tester
Date
Percent 02
Percent CO
Percent C02
Stack Temp
('{('IS FH~
~f e~tf
CUe.
~ -~-/)3
'),~ '~
ta,
\U7"O ;-
Combustion air is adequately supplied per
UMC Sec. 606 t( e5
input '0 If) af)
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FILE No.174 05/09 '03 06:41 ID:PLYMOUTH PLUMBING
FAX:7635331121
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CIT\~ OF PRIOR LAKE f'LtJI\1BING PERMIT
PAGE 8/ 13
Date- Rec'd
~ ~~~, ~~~r PERJ\.{IT NO. .::5_ ~)
:, YdllllL' .\pphClnt
(T'letl$l l\l'l (.)1 print ;tnd Siftfl al botmrn'
ADDRESS
14lc{~
l= () ( A. v~.'.- ,(\-< 11'\, ~ { t. <:,
LEGAL DESC:RlPTION (lIf1"lC:l' lJ5(' onlYI
LOT
BLOCK
.A PDITl ())~
O'vlNER ~ L ..
(hlarnr.l \r,:-pV\ ') i.11.j,)~'\ t"\ rH) VlA./i ~
!Addres$1 f~C{ Cj P ( 7) 7:;::', (\C, c.O) ( )'j~' I~t{) Y '0{) (~ '
/ \! /
(Pbone)
20NrN G t 1'R'ic:C 1m/I
rID
A1f~ ..-tlLlC()
~0 '?S\ ~1
APPLI CANT/') I ./'") I \' j
CNaml'\, t" I p/v\f"l t....: -\- \,'\ Y L.-tr\'\, /) I l" Q (Phone:) \ r-( lC ~ ) ~j :,'"')-.Lr?::>5 (
Io,ndf","I .I.C{(~q ~dlu1 + h... A,~ kJ fVtl(~\j,"j)~~ ()S~'0
(,Addn~~~:') (L.HY) (Zlp l""J!de)
tCOOICtCI Person) __1:~.l ~ ~ t .\'\. ~'\....Q tl'l(J j'1A (), f L .t: r _ ()~r()n~) 17lt~) S"Z;;) ,- L/.3,~ '7
~' ~ ~ 1'R ~.-/.' .
( l I. ~f,\ f J ^~J.I'j/l- .. ( ''J c:.. q -)
"PPI..iCANT SIGNATllRE- (. '. \ JLA^-"" "tr-ll1A j V I 1.1 DATE ~ ) '. -.n .,
Ar~rL1CANT PLEASE CO~1J>>LETE BELC)\~J
Typl' of Fixtu n: Qu~m til)l
B,lt11 Tllb ,,,,ith 01' withNlt sh~\\"Jr::r :,
Dishwasher t
Floor Drain ,
L~vator~1 (Bathrc1om SlI1k) 1
Laundry Tr~~' ( 1 ur 1 (.~(ll11partJ11enl sinJ,
Shower Stall
Sinks
Q U~l r:.t!.T~'
_._--~
,
~
~
TYIH;' of Fi,:tt'un
Rough-ins
\Vater Ht~ttr
I WaU:r Softner
Stund Pipe (\V~hlng Machine)
Sewag~ E:lectm
B,lCkll0\\' Assembl~'
B~ckflow Assembly Test
t
,
, ....J..., ..,.J" u,
~_L 'NateI' Ckl:~cl (T(\ikll
-
I ....... ,.,. ...~. ..,."......
10th!:!'
FEE SCHEDULE
Indu11r1ill. Commcrclul & 1\l\lllli.llllllily l'~." llt'jl)b l.:llSI ...vith ,I li3+ljO minimum
H.t~iJcnljill, N&.:w One, & TVN-F l.Imi ly $4L)jO
Rt:sid!:nliul. Addililln;; &. Al1cl1lli(ln~; $~ 1.),50
E:SIIl1I~Li::d (:'llSl $ ~4.co..
Buildill,g Pt:mlil #
I.)LU1\~BING PERMIT FEE:: j;
ST.:.. TE SURC]-lARGE ~ '::'0
TOTAL PEl:tMlT FtE. $
IO~::,l:':;':::~riun (Iecume, \"",. HuilclinR Permil Whon Apl'ru,', ~ ~ ~Jr\f(f~
Huilif ill:': lJf/in:1I
11;111'
JlAlHIcJ. 3 ZUU3 .
i ;d
;ol hHil Illii;CL' (/II' :.!J1I1I~pL:l.:'lllll~ (II~ BY4J.411\;;fl LIl 1(15\\.t4j~45.
111:011 r':''.!,I,' l'I'I"~I, ,\,""'" '"F,. 1,,",;;;':"i.tI,c, '1,,'~~~;'~.:it~~f~;~'.1;:'.
PAID \IV.. tel
BU'LD'NG PERUIT
Rc:c::ipl !~o, I
I
e"_-+.~~~J
ell y OF PRIOR LAKE
H.EAlll~G/AIR CONDIIIONING/~l.KEPLACE PERMrl'
Date Rec'd
~7P.F
~: ~ ~:~ PERMIT NO."Q _ 01
3. Yellow Applicant ,} 0
(please ~ .Qr print and sign at bottom)
ADDRESS
/q/9:::?
L
//"r'/~
ZONING (office use)
e/A
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDl.110N
PID
~~RW~S,-wi4t!4~ /~~
(Adcfress) / ~95 ~~2~ ~C c.~-,~
. ~ ......,,-
::~~~/A~/ /?l,~~~...~:...<, (phone) ~S'"/- ~~""--'?'?:75-
(Address) , ~~) ~~6~,c!' ~- 4~~ ~~....?~
(.contactp. erson) _,.4'~~L ,1l-...~~. (Phone) ~~/l ~-,?7:?~
APPLICANT SIGNATURE ~,_. DATE ~Li:l/ ~
APPLICANTPLEA$ECOMl!.BE IE BELOW
~W CONSTRUCTION :1 REPLACEMENT DALl~KA TIQNS
FURNACE MAKE AND MODEL ~~An- -a<q~" (7Z- L/o6t? FUEL .A.lA.., C:A.. c::::..
FLUE SIZE ;Z." PV<!- RETURN OPENINGS 5 INPUT bo.' ~ OUTPUT s~ 00 ~
TYPE OF SYSTEM HEATING OR POWER PLANT
DWarm Air Plants o Steam
~:~::nical . 8;i~=
ir Conditioning DSpcci81Devices
Vent. System o Other Devices
(phone)
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
t'lKEPLACE MAKE AND MODEL
Industrial, Commercial & Multi-Family
FEESL:I1J!1DULE
1 % of job cost Residential, Gas Fireplace
$39.50 minimum
$99.50 Residential, Additions & Alterations
$64.50 Residential, AC Only
$39.50
Residential, Heating & A1C (New Construction)
Residential, Heating Only (New Construction)
$39.50
$39.50
Estimated Cost $
Building Permit #
Building Official
~&A
, O'~ ~ ':fib
.50 ~~ ~Q~
~~~ ~~
~\~ f\ '\ ~~
paid\('~\ \& - \ l~ei -
'~l ~ ~ ~
Date Date '\ ~ \t.~ ~ a----
24 hour notice for all inspection. (952) 447-9850, fax (95~~ //
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERl\tu. J. 'FEE
$
$
$
(Office Use Only)
This Application Becomes Your Building Permit When Approved
CITY OF PRIOR LAKE
HEA TING/ AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
~
\, Pink File PERMIT NO. d _ ~ I
2, Green City
3, Yellow Applicant
(Please type or print and sip at bottom)
ADDRESS
14195 FOUNTAIN HILLS
LEGAL DESCRIPTION (office use only)
LOT
ADDITION
BLOCK
OWl'l~.K
(Name) WENSMANN HOMES
(Phone)
(Address)
APPLICANT
(Name) ALLIED FIRESIDE DBA FIRESIDE HEARTH & HOME
(Phone)
651-633-2561
(Address)
2700 NORTH FAIRVIEW AVENUE
(Address)
ROSEVILLE
(City)
ZONING (office use)
PID
55113
(Zip Code)
APPLICANT SIGNATURE
BRfNDA HUSTON
DATE
651-633-2561
5/21/03
(Contact Person)
BRENDA HUSTON
(Phone)
APPLICANT PLEASE COMPLETE BELOW
xD NEW CONSTRUCTION D REPLACEMENT D ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
Building P"uuit #
$
$ PAID V,rp,.,
$901 · - -
LDIN<3 Pt:HMIT
Bv__
Paid ReceipTNu:-.....:.:.:--'---
TII".r. OF SYSTEM
DWarm Air Plants
DGravity
D Mechanical
DAir Conditioning
DVent. System
.I:1.r.A.l.u~G OR POWER PLANT
D Steam
D Hot Water
D Radiation
D Special Devices
D Other Devices
FIREPLACE MAKE AND MODEL
REA TN GLO SL-750TR
Industrial, Commercial & Multi-Family
FEE SCHEDULE
1 % of job cost Residential, Gas Fireplace
$39.50 minimum
$99.50 Residential, Additions & Alterations
$64.50 Residential, AC Only
Residential, Heating & A/C (New Construction)
Residential, Heating Only (New Construction)
Estimated Cost $
HEATING PERMIT FEE
ST ATE SURCHARGE
TOTAL PEJU\1..I FEE
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Date
Buildine Official
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
$39.50
$39.50
$39.50
]E@E]JJ]--
MAY 2 7 /00_1
BY~.
()
PRIOR LAKE
.
INSPECTION RECORD
SITE ADDRESS lL.lJqS, ~T ~ J~~'LLS' a;
NATURE OF WORK NJ:~ _~st...I.i.iit law
USE OF BUILDING ~.
PERMIT NO. 03'-()@/ &.ipATE ISSUED ~
CONTRACTOR ~Qll*a PHONEI.tSI.'IQI,.~,
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
DEPARTMENT 0
BUILDING AND INS
INSPECTOR
DATE
~
FOOTING ~ ~II Nt03
FOUNDATION (Prior to Backfill) ~ Lt /z,tft'LJj
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
SEWER I WATER I SEPTIC
FRAMING W / C- ~. ~ (f;yt 'b ?er3
INSULATION
ELECTRICAL (9'vt...
PLUMBING 1).b""~'5ltt. ~ '-t3 te3
HEATING (if required) ~. _ tr/,~ J ~
FIREPLACE ~~ ~ ~. t 3 I e~
GAS LINE AIR TEST ~~ ~t7 lea
COVER NO WORK UNTil ABOVE HAS BEEN SIGNED
>4
GRADING (Prior !o Soddin~)
BUILDING /\-{~ 1'1\ ~\/t/cJ)
ELECTRICAL
PLUMBING
HEATING
DO NOT OCCUpy
FilNALS
N~
4-. s: 04-
"
/lW I ~/ Uyp
(LJ ~ C~:t 7/0)
UNTIL ABOVE HAS BEEN SIGNED
NOTICE
This card must be posted near an elect~ical service cabinet prior to rough-in inspections
and maintained until all inspections h~ve been approved. On buildings and additions
where no service cabinet is available, ca~d shall be placed near main entrance.
FOR ALL INSPECTIONS (952) 447-9850
<1ltrfifitaft of Q~ttupant\!
CI'I'Y OF PRIOR LAKE
~tpartmtnt nf ~uilbing c1fnsptttinn
~inal Permitted D Conditional C.O. Expires .
This Certificate issued pursuant to the requirements of Section 307 of the Uniform Building Code, certifying
that at the time of issuance this structure was in compliance with the various ordinances of the City of Prior
Lake regulating building construction or use. For the following:
Use Classification
SINGLE FAMILY
Bldg. Permit No.
03-0081
R4
Owner of Building
R3 Type Construction _ VN Fire Zone N I A _ Zoning District
L13, B2, FOUNTAIN HILLS SECOND ADDITION
Site Address 14195 FOUNTAIN HILLS COURT
Occupancy Type
Legal Description
Contractor'sName&Address WENSMANN HOl1ESd 1895 PLAZA DR., SUITE 200, EAGAN 55122
ROBERT D. HUTCHINS fvr' _ City Planner. DON RYE
/ I /_ Building Official
Date: ~-OL! Date:
HOUSE HEATING TEST RECORD
V .FowUrW- ,1/,'LLf _APT..
OWNER
FLOOR
JOB#. 7/ J-fT
CITy!1ilol L, SUBURB.
ADDRESS -L!tJ
OCCUPANT.
HEAT LOSS.
SOLD BY
Electrical Work By
TYPE OF HEAT
DATE HTG. INST.,
- -
GA~FA V.HW
lJl? Y;1-;f-rAS DESIGN
MAKE, _
Model -4f 0 tMj/ t'J . U 0 t:. 0 F
Serial I It..'f1 3 A U 7 <7
INPUT. OJQOO
I
CONTROLS
THERMOSTAT
Valve 11/ - ~#
Limit
Limit Setting
Fan Setting
Pilot Type
Pilot Make
Pilot Model
Pilot Timing .
L.W. Cut Off.
Pressure. .:3 I .S'
Input CFH 9.5,3
Stack Temp. .' I z,. 5
Heat Plug
/'
Percent CO2 5 I ~
Percent O2 /2-( ...?
PEjrcent CO 0
fJ/1 s I OJ..~:37
C'fll~(/fl
STEAM
INSTALLED BY
Gas Line By
SPACE HTR. , UNIT HTR.
OTHER
CONVERSION
MAKE OF BURNER _
Model
Max. BTU Rating _
MAKE OF FURNACE
Model
1-11
p, V,c,
Vent Size
KilND OF LINER
Draft Hood
Filters Size
Chimney Location
Chimney Construction
SIZE NONE
Regulator
Number
Inside Outside
Smoke Bomb Wiring
Draft..... _ Test Tag
D100r Pressure . ~ ... "7 _ ()L.!jlhting Inst. .
Date Tested 0 ~ "
Company Testing Alliant Mechanical, 3650 Kennebec Dr., Eagan, MN 55122
NiameofTester CI/dAt.a- -"Zlhh€~HAI':I
CITY OF PRIOR LAKE
INSPEC~N NOTICE
p~.. ~ Z-
SCHEDULED
~
DATE TIllE
2/U4J3
ADDRESS t L{ L ~~
OWNER CONTR.
PHONE NO.
PERMIT NO.
[] FOOTING
o FOUNDATION
[] FRAMING
~ INSULATION
/'-f FINAL
[] SITE INSPECTION
[] PLUMBING RI
o MECH RI
[] WATER HOOKUP
[] SEWER HOOKUP
[] PLUMBING FINAL
~ECH FINAL
~-g, {
o EXIGRADlFILUNG
[] COMPLAINT
o FIREPLACE RI
[] FIREPLACE FINAL
[] GASUNE AIR TST
[]
~'
-
CMlL ~ ~~A~~-;Y ~
o WORK SATISFACTORY, PROCEED ~ .A ~-(). '1 _
.0 C9RRECT ACTION AND PROCEED V J ~ ~
1;v60RRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: 4A OwnerlContr.
v-
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
INSNOTl
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
CITY OF PRIOR LAKE \~'2.--,g?, DATE
INSPECTI9N NonCE SCHEDULED J 1'1 b1-
AD~ J!1L4b ~ t4.-tt<.
TIllE
OWNER
CONTR.
PHONE NO.
PERMIT NO.
~~(
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
~ FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
A PLUMBING FINAL
pi MECH FINAL
o EXlGRADlFILUNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASUNE AIR TST
o
COPlMEtj..TS:. ~
\.~ ~~~ (~~~
.J4.-' ~\L <:r7. - ~ r ~ ~ .
~' . '~~ ~ vtft;~
=:3 .J. \~~J1, ~
~~ ~Y?_-~I~~ ~
~ .. ~_-~Crv-",/ ~~.:~
~ <r~ cr~ Arl'"~<'<"",-
7hkft,~~~ ~f) ~/1/t73 ~
o WORK SATISFACTORY. PROCEED
o c;mRECT ACTION AND PROCEED
~ORRECT ~ C~LL 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 & SAFETYI
'^~ j.....~
yf\~ ~ DAlE
CITY Of PRIOR LAKE ~
INSPECTION NOTICE SCHEDULED ~
r t.{~:o4
ADDRESS f '11 ~ S .+:' tX.>JJ\A-f...u l...11-L <) cr
TIME
OWNER
PHONE NO.
CONTR.
PERMIT NO.
6~-~
o WNG
o COMP T
o FIREPLACE RI
o FIREPLACE FINAL
o GASUNE AIR TST
o
o FoonNG
o FOUNDATION
o FRAMING
i{NSULATION
FINAL
o ITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH RNAL
COMMENTS: .
Gr~~
(C) (.
. "\
kRK SATISFACTORY. PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK. CALL FOR REINSPECTIO
IMpedor. dL
ORE COVERING
CODE REQUIREMENtS ARE FOR YOUR PERSONAL HEALTH &: SAFETYI