HomeMy WebLinkAboutBuilding Permit 99-0718
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
DATE RECEIVED
B 1 ~Im
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
LII
6~/-... w~J Ctl,w ~
3. LEGAL DESCRIPTION
LOT
/J
ADDITION
4. OWNER
(Address)
i.c...
(Addres
(Tel. No.)
. ~ 1- ('i"{ - v-Jo
(Tel. No.)
V
(Tel. No.)
V,,1s I C\
1. White
2. Pink
3. Yellow
File
City
Applicant
Permit No.
q9~7/9
(
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
"'2.' /0 ..., (
12. NO. OF STORIES /
13. TYPE OF CONSTRUCTION
r.{6 ..-..c-
14. FLOOR AREA APPORTIONMENT USE
PID 25... 0.33 .. 011-0
6. BUILDER
(Name)
t4o~, -g~~~ Da,~ S\ll~ (.0
/J... fr'LA14-S ~rf-r-&fN\.,. :FAIL. eft - '(~2-~46'i
7. TYPE OF WORK
New constructio~
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES
Sq.Ft. ?, II~
9. PROPERTY DIMENSIONS
Width Depth
Fireplace 0
Alterations 0
Septic 0
Addition 0
Deck 0
Finish Attic 0
Re-roofing 0 Porch 0
Re-siding 0 Finish Basement 0
10. CULVERT SIZE
Yes @>
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 revokeJbi~rmi~t cause. Furthermore. I hereby agree that the city official or a designee may enter upon the property to perform~e/)spections.
X ~.r. IV..,) " 'f 1r'
Signature License No. Date
SETBACKS: Required
Actual
FOR ADMINISTRATIVE USE
MATERIAL FILED WITH APPLICATION
Front
Back
BUILDING DEPARTMENT VALUATION
Side
USE OF BUILDING
SPO
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
TYPE OF CONSTRUCTION: I II III IV
Occupancy Group A B E F HIM ~ S U
Division 1 2 (J 4 ~
Permit Fee..... .............................. $ I, 5 8~ .
Plan Check Fee ............................. $ I I (J,2.?J. l{1
State Surcharge............................. $ l (1 S"D
Penalty......... ......... ........ ............. $
Plumbing Permit Fee 1.(t.Jl.~....... $
Mechanical Permit Fee 1~::1.tf>....... $
Sewer & Water Permit .J!:1.Ji?..... $
Gas Fireplace Permit ..f.f:.Jl.B...... $
l~O.c;x5
(()O ~ t) 0
SS-.50
4o.eo
Certificate of Occupancy
Issued
Side
SOIL TESTS
o
o ENERGY DATA
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS 0
SETS
SURVEY 0
COPIES
~ 3,.tJt)o. C90
.
PLOT PLAN
o
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC .. . . . . . . . . . . . . . . . . . . . . . . . . .. . . .. .. . .. . ... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
1'1
Pressure Reducer .. ....................... $
Meter Horn ... .. .. .. .. .. .. . .. .. .. .. .. .. .. .. ... $
Water Meter..~.~........................... $
Sewer & Water Connection Fee ........... $
Water Tower Fee ............ ............... $
Water Tap ................................... $
Builder's D~Sit .....11.................... $-1. S- aD -{If
Other .........~~....~~............... $ SCO # OD
~ l(c; '1~
'35(,:, 2.,. c)
eSD · aJ
IO.C!)()
~60.06
Date
the reque t in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed a requested. This document when
anner . utes a temporary Certificate of z~~g compliance and allows construction to commence. Before occupancy. a Certificate of Occupancy must be issued.
Cf;("JQ1'Vf
Date Special Conditions if any
City:
~1/l111
1.t
24 hour notice for all inspections 447-9850
1~ 19 99 TUE 08:53 FAX 6124474245
ITY OF PRIOR LAKE
l4J 003
ELEVATION CERTIFICATE
FEDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM
~7'~N~ION: .US~",~f this certificate does nol provide a waivw of.the flo~d insurance purchase requirement. This fDrm is used only to
...-' oVlde, elevation Ill'o~matlon necessary to enSUre comp!,ance with applicable community floodplain management ordinances, to
c:ete.r1we P"l€ proper Irrsurance pr8~lum rat~, and/or to Svp~ort a request for a Letter of Map Amendrn,ent or Revision (LOMA or LO~\J1R:,
InstructIons for completing this form cen be found on the following pages. '
OCT2'.
Q,M 8_ No 3067-0077
~~pire~ May 37, 1993
SECTION A PROPERTY INFORMATION
FOR INSURANCE COMPM~Y USE
6'ukD:N3 OWNERS NAME
A:L.~ Maa ~
STREET ADD~ESS (inclI.Jdlng Apt., LJr'1il, SUite ~nd/or Bicg ~~lJmber) OR P.O ROUTE f,ND BOX NUMS"EA
-- 4-2..77 GrQi^woodC'V'"e(~ __
ot=;+sc730:' :Lot '~:;';(;;~J)
CITYp , k
y t'Ov- La ~e
SECTION a
~-
F'Ol,ICY,NUM8ER
,'.
CDMP^NY Nt.,lC NUMBER
'.--1
I
Provide the following from the proper FIRM (See Instructions):
> ~o-H- &t.JJ.,
STATE
-f M;1A11 ,pr~h....
FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
{J M.K-
II
.
$5372-
LIP CODE
1. COM Ml.,JNITY NUMBER ~, PA,NEL NUMBI;R :3 SUFFIX 04, DATE or FIF\M INDEX 5, FIRM ZONE (5 BASE ~LDOO !;\.EVATION
Z. 70 4 ~ 2- 0004 At (m AO Zones, uso deptM)
~ /-.I()fJ (1, 1117 Q08.Cf
7. Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE): ~GVD '29 D Other (describe on back)
8, For Zones A or V, where no BFE is provided on the FIRM, Bnd the commur'1ity has established a BFE for this building site, indic~te
the community's 8FE: LLllU. U feet NGVD (or other FIRM datum-see Section B. Item 7).
SECTION C BUILDING ELEVATION INFORMATION
,. Using the Elevation Certificate Instrl,.1ctions, indicate the diagram number from the diagrams found on Pages 5 and e that best
describes the subject building's refBr~nce level -L ,
2(a), FIRM Zones A 1-A30, AE. AH, and A (with BFE). The ~op af the reference level floor from the selected diagram is at an elevation
of I I !C)l \ [4].~ feet NGVD (or other FIRM datum-see Seeton 8, Item 7).
(b), FIRM Zonas Vl.V30, VEf and V (with BFE). The bar-om of the lowest horizontal structural member of the refarencelevel from
the selected di~gram, is at an elevation of l ! i I : :.U feet NGVD (or ather FIRM datum-see Section B, Item 7).
(0). FIRM Zone A (WiU10Ut BFE). ihe floor used as the reference level from the selected diagram is LLI JJ feet above 0 or
be:ow [J (check one) the highest grade adjacent to tne buildir,g.
(d). FI RM Zone AD. The floor used as thE! reference level from the selected diagram is l.~~U. U feet above 0 or below D (check
one) the hIghest grade adjacent to the building, If no flood depth number is avalleble, is the building's lowest floor (reference
level) elevated in accordance with the community's floodplain management ordinance? DYes 0 No 0 Unknown
3. Indicate the elevation datum system used in d9termlning the above reference level elevations: ~ NGVD '29 0 Other (describe
under Comments on Page 2) (NOTE: If th~ elevation datum used in measuring the elevations Is different than that used on
the FIRM {see Section 8, Jrem 7], then convert the elevations to the datum system used on tht;l FIRM and show the c;onvfJr~iQn
equation Undf)r Comments on Page 2.)
4. Elevation reference mark used appears on FIRM: [J '(85 g No (See Instructions on Page 4)
5. The reference level elevation is based on: ~ a,ctual ~onstrustion 0 construction drawings
(NOTE: Use of construction drawings is only valid if the building does not yet have the reference level floor in placel in which
case this certificate will only be valid for the building during the c;ourse of cOllstruc;;(ion. A post-construction Elevation Certificate
wii! be required once construction is cJmple!e,)
o. ihe elevatIon of the lowest gl'Clde immediately adjacent to the building Is: / I I'll (~I_~ feet NGVD (or other FIF-iM datum-se$
Section S, Item 7).
SECTION 0 COMMUNITV IN~ORMAT'ON
1. If the community official responsible for verifying building elevations specifies that the reference level indicated In SectJon 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" a5 defined by the ordinance is: i I I !.lJ _ U feat NGYD (or other FIRM datum-see SectiOfl 8, Hem 7)_
2. Oats of the start of construction or substafltial improvement
1~_'19 99 TUE 08:54 FAX 6124474245
CITY OF PRIOR LAKE
l4J 004
SECTION E CERTIFICATION
Tt'is certification is to be signed by a land surveyor, engineer, or architect who is authorized by state Or loca: law to certify elevatior
information when the elevation Information for Zenes A1-A30, AE, AH, A (with BFE),V'-V3Q,VE, and V (with BFE) is required.
Community officials who are a.uthorized by local Ia.w or ordinance to provide floodplain management information, may also sign the
certification. In the case of Zones AQ and A (without a FEMA or community lssued 8FE), a building official, a property owner, or an
owner's representative may also sign the certification.
Reference level diagrams 6, 7 and 8 . Distinguishing Feat\Jres-lf the certifier is unable to cenify to breakawaylnon-breakaway wa'I,
enc:osure Size, location of servicing equipment a~ea use, wall openings, or unfinished area Feature(s), then list the Featwe(s) lot
incliJded ii"l the certification under Comments below The diagram number, Section C, Item 1, must still be entered.
I certify that the information in Sections Band C on this certificate represfJnts my best Bfforts to Interpret the oars available.
I understand that any false statement may be puni$hable by fir"le or imprisonment under 78 U.S. Code, Section 100 I.
~,",sse({ P- DCl\M.lo
Lw
4b~ V~e 5
~c f)~TY
V"~c(
SIGNATUR~
(9o€>f,
Co,
ZIP
J~ - 3000
PHONE
Copies should be made of this Certificate for: 1) community OfficIall 2} insurance 8gent/cornpany, and 3) building owner.
COMMENTS:
ON
SLAB
A V
ZONES ZONES
WITH
BA5EME~T
ON PILES,
PlEAS. OR COLUMNS
The diagrams above illustrate the polnts at which the elevations should be measured in A lones and V Zones.
Elevations for all A Zones should be measured at the top of the reference level floor.
Elevations tor all V Zones should be measured at the bottom of the lowest horizontal structural member.
qq-1/(
Tht Ctnltr of lht Lakt Counlry
White - Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
,4. 1'1/11j S (!()"'S/7L .
{p (Icj /t:lC;
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
4277 6~/lll\IrvO(jO ~/t2Cf.-b
Accepted
Accepted With Corrections X
Denied ::d
Reviewed BY{ X2~^
Comments:
Date:
~.. 2/-?5
I. ~I ~ Snit atP(Q~
7.~ M~\~;V\... r~~ ~
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."
Thr Crnlrr of lhr Llkr Counlry
CJ1- )/ r'
White - Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
! . ~. / i~..
/' 1/ (j / I"': /""
. 17/'1/
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
" ,)
4:: ~.... ~ ,'"
Accepted
~
Accepted With Corrections
Denied
.9f
-* It c 'f' . vnent 10 I /de lfad's.
1- %ed ~ (lilA/oJ/On ~~~wt:z ~ ;tl)
~~ ~d:4Jn
Of 5 d(iVl~ siQtyr;rd Su+bCtJ:. froth all Side Lof L;N<J
Date:
Reviewed By:
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."
qq -1/ (
White - Building
Canary - Engineering
Pink - Planning
Th~ C~"t~r of th~ Lak~ Country
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
;-f. /'--j H r7 S (!.D /J .:; IlL .
?/1r/1C;1
I
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
LIZ77 q/:!//IIV'/ v' 0 c t) ~. i I~ eLf::.,
Accepted
~
Accepted With Corrections
Denied
Reviewed By: JJAc..~ EI4~~$~MN
Date:
7 / ~ /"
I ·
Comments: K.JAJoFf=
"""ST
/3E:
c.Ol\JlJe'(~ 10 1YJ.b. 191..O^,u L"Of C-'AJ~5
A-~
"'4.~ A~ ~ALTfC. At .
S~E..
JNFo a..M.q'Tial\l ..J j<~\Jf:1t SE: S, OE:..
SEE:. A'iTAc..H""E.,..rn '. I. hA.JAC- (JRAOf:.. IN~PEC.""OAJ !,.rFoIllM4-r/oN
2.. Cn..OSID t\JC.o...JTIt.l.- t'frA~ua(.E"~ '3. €'A.4SI...JCoNTfloc... ~ 6~"'o/J'oJ~ PLtlt.J
~. SE....sEn... ~ VJ-A"r~ SE:~\1lc..A. II\JFo.A~rQ^-,
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 ~e valid."
CITY OF PRIOR LAKE
1. Blue File
2. Gold City
3. Yellow Applicant
QC;r-7/Y
The eenler of Ihe Lake Counlry
Applicant: ~~Ul!~!!'~~~~'l
Address: 5? f I ,~O/t it
Signature: ~ ~ _
----
Legal Description: Lot /3 Block Sub G/2,q/N f'/o 0 Q P{<:.-.
Site Address: ~ 7) G/CAo-....(..;u cx:>o Q'-I- L ~/.sO
Building Permit # ~} q -- 7/ g PID # 2'5- 0 cr --0 I (...-0
NOTE: This permit will not be processed without complete information.
PPNo.
Phone:
("
FIXTURE UNITS
Quantity Type of Fixture Quantity Type of Fixture
0 Bath Tub with or without shower Rough-ins
I Dishwasher ( Water Heater
~ Floor Drain I Water Softner
1 Lavatory (bathroom sink) I Stand Pipe (washing machine)
-z,~ Laundry Tray (1 or 2 compartment sink) Sewage Ejector
'V Shower Stall 7/ Backflow Assembly (RPZ, Double Check, PVB)
Z, Sinks Backflow Assembly Test
-z. .... Bar Sink I Lawn Sprinkler
'I Water Closet (toilet) Other
,
FEE SCHEDULE
Industrial, Commercial & Multi-Family
(1 % of job cost, $39.50 minimum)
Residential, New One & Two Family
Residential, Additions & Alterations
State Surcharge
$99.50
$39.50
$
$
$
$
.50
GRAND TOTAL
." \'. .... .... ,{\
~;;'~.i.t.J ";c.~.,~i\i\ .~
\~G '
eU~ O.
\.
This permit is granted upon the express condition that said
contractor, shall comply in all respects with the ordinances
of the State Plumbing Code a the amendmen s thereof.
RE ?J I S 17 DATE
AITEST
Call for all ins ections 24 hours in advance.
16200 Eagle Creek Av. S.E. Prior Lake, MN 55372/ Ph (612) 447-9850/ FAX (612) 447-4245
An Equal Opportunity Employer
\~~~~;:!c~;~tti:*~:
:.;~..}"~:;<}~;;:i!~;f~<~f;t~;~,-~
. . ..' "TVi
~;~~'.;'
~
Murti-Famiry
Othel_
Two-FamilV
4ndustrial
Single Family
Commercial
HEATING APPLICAnON J PERMIT
PubflC _
11-
-0
Dale
Actlr8&S
~fiellli~ConlradOl ~INJ..J€"SO.jO. ~I~I /i-lG
~ mAod~ess2JL.Y. c; 'L.~w:rLr o..Je:e ?r.l
~~JY . ... . 55 I
(J1~~7~~phcfJe Ii &:, S I - -r 3~ - "1 {Cc ~
(V) '.' ~-
r-'" .
~~ Fur!la:1l Maka & Mod ~. (Ott2 ~TYPE OF SYSTEM
(\J 0(..
ill : .~:' u rl.1 ... j_ Warm Ab P'ants
.- IW.O..e. ~.Z8 G ~ly
.. _; : ray.
. :. .. Corm. load Mechanical
2 .:. Alr Conditionfl19
w .-: .Fu&t._ Vent System
Z :,
O. .
if ..... S..,ppJV HEATING OR POWER PLANT
Staam
Re1urn
Input
J:'
_Of.
1% d job cost ($S9.50 minimum)
$99..50
$64.50
$39.50
$39.50
$39.50
Fee Schedule
tndustriai. CommerciaJ & Multi';:am~y
R esidenlial. Heating & AC
Re sid9ntial, Hea1ing Only
Resident;ar, Gas Flrep4aee
Residential, Addilions & Alterations
Residential. AC 0" Iy
elSO
__ Addiiion
o.~St
Site Address
lot 13- 81Dck
O"t'lI":'Sr'S I~ame
T"-l
0....:
E:'
~}
(V)
r-
~
(J1
(J1
(J1
T"-l
(J1
(\J
0-
1I
(f)
Remember 10 add the Slat& Surcharge on the oottom of this appricalion.
The priaa o( you r heat;ng permit incrlto as cme rough-in GIld Dna final
Additional inspechons w;U be b.lJed at ~35.00 each.
HQuse Healing TesJ Record must be submitted wilh ~ ~ number before build.
Rg certmcate of OCCllparu:y win be issu~.
inspeefitln.
t!EAI rriO~.JS REaUIRED with number of soppfy ar:d mtum openings listed per
room with CFM's per opening. New structure-s or additiollS send floor pan with supply
and return rocati!\Tls shown. HEAT lOSS CALCULATiOnS. PAVMENT AND
APPLfCATIONS MAY BE MAILED TO THE CITY OF PRlOR LAKE 16200 EAGLE
CREEK AVE. S.E. PRrOA LAKEJ MN 55372.
City Hall busrnvss hours are 9 a. m. - 4:30 p.rn.
ALL WORK MUST BE INSPECTED
(ROUGH-IN AND FINAL) -
441-985D
Othel Devices
Rue Size
Output
Openings
Openklgs
CALL em HALL
J hereby app~y for a mecnanical systems permit and I acknowtedge that the
ilttormahon above ;6 complete and accura1e; Ihat the work will be in confolmaRCe
wUh the ordjnances and codes af the city and w;th the .state . buUding/mechanjcar
codes; that this form does not become a permit unfil signed by the BUJLDJNG
OFFICJAL; that the work wiH be in &ccol-dance witfl1he approved plan in the
case 0' aJJ work which requires review and 4lpproval of plans.
er~
9
~
RecBipt
.50
HEATING PERMrr FEES
STATE SURCHARGE
$
$
New ConstlUCtioll
TYPE OF WORK
Comp. Date
Building Permh #
TOTAL PERMIT FEE?
Replacemen1
Est.
~
.,.
...
.,.
.,.
.,..
u...
z....
......0
u~.
~.-::
(f)~
(f)
cr~
~
...J . .
...J~
cr-i
3
o~
ll::-I
O-i
Z
.. ~
E~
0:11')
ll::N
LL -,
"'"
-.
Cfm.
Ait8,' at!on$
Repair
Est Cost $
Fila
Cliy
CDnIlAnO<<
MLMi-Fam!Jy
Other
ffok
One.
Yell.,,,,
I
1
}
TWHamfy
Inc11.Idial
Singh. f3mIy _1/
Commercial
99-1/8
CITY OF PRIOR LAKE Me
11200 Eagle Cree" All. S.E. PMM No.
Prior LakeJ MN ~72
HEATING APPUCAnON I PERMIT
~
~
~
~
.....
a..
Pubic
,% of lob cost (sa9,50 minimum)
199.50
164.50
~.50
$l9.5O
S39.SO
Fee ScJ\edukt
Industrial. Commlrtia1 & M ulli-Famity
Residential, tieatlFlg & A.C
Resid&(\tial, Heatirlg Only
Re.sicfentraJ, Gas F.8p~e
~ldenUaJ_ Addilions So AJld raU0i'15
R.identia~ AC Only
-0
/e.l60
II
Date
511 Address
10I 13- Block
Owns(s Hame
V)
Mo.del Sill
Conn. Load
FUll .A}~'J Au. Site
Su~y Openings ()..
R9tvrn Openi~s ~
InplA. ff(X1XJ Outpul
Edt.
am
R.rnemb8f to 4ud the State Surcharge on the bof1am ~ lhis application.
rtle price of your ~ati\g perrn1i ~llCludes 00& iough-in and onB final
Acididonal w,spe(:t;ons wit! hA ~.. -' S35.00 each.
!lbrnitted with ~ urmi1 ~ before buitcl-
tad.
inspaclio n-
TYPE OF aVSTEM
War m Ail P~11ta
Add; (t&,\
Hearing
AddltsS
Telephone'
~. /{O . \ ~ Jh number ot supply ltfid re1um openings listed per
A /~ YJ t/'l ()n u.ctures or adct1ions send Ioor plao wilh S\Jppty
a , I U ~ CALCUlATIONS, PAYMENT AND
A 'HE erN OF PRIOR LAKE. 16200 EAGLE
C . /_ J--.J ~12_
C CW-r ; nc (X '\..j~ ~ "m.
Al ~UGH-IN AND FINAL) . CALL CITY HALL
~ \'\ Oi \ \ ~ \ rr, 't4J~_O
j h . lems f)8tmit and I 11:knowfedge thallha
ll1f'~r\ ' L curale~ tt1allhe WDtk will'" in canlolm8lnce
wit . K(M \ \ : eity and with the state Wilding/mechanical
C~( \ '18 a pSII1\it until signed by II'M BUtLOJNG
OF :cordanc& with the approved plan in the
cas !II and app,ovaj of plans.
HUnNG OR POWER PLANT
Sleam
Hot WatIJI _
Rad1alian _
Spec.iall)e,liC9S
L/
/'
= 6
PP.\O~ '--..,
e\J\\.O\NG PE~{t' 1
l
Rec&1pt .
50
HEATING PERMIT feE S
Sl ATE SURCHARGE S
TOTAl PERMIT FEES $
o.vices
New Ccnsltuttion
.&J
::a
<
(Y) .J
.q ~
('J :J
.q --
X
.q 3.,
I" ~
.q ::;)
C\I !"
-
..... ~
ill ;.;
U
<i
>
I
I-
~
0::
W an
::E ....
::"oJ
::E ....
o to-
O:: ::
LL :-.&
...
lI)
~
-<
~
~ ~
(Y) M
.q .n
.. .-l
(Y)
-
(J) re
(J)
(J)
..... 0
I-
~ "'
~
"I ~il
(J) .
~
Othe r
TYPE OF WORK
Replac&m 8f1\
Est, ~trIp. Date
Build~ ~.
y'1G
A.~erations
Repair _
Est Cost ,
PRIOR LAKE
INSPECTION RECORD
II
Qt-,
DEPARTMENT OF
BUILDING AND INSPECTION
SITE ADDRESS ~ '1 Gral~ ,^l('}"r~
NATURE OF WORK new ~S}rvc.+,~
USE OF BUILDING Sr=D
PERMIT NO. 'I ') - l (CO
CONTRACTOR A MoD..~
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
~k ~\ 'tf-ev 1i PERMIT IS BY SEPARATE DOCUMENT
>e. -h,):: l=: 1 ~ INSPE TOR
, FOOTING ~ .r 17,q
FOUNDATION (Prior to Backfill ~ --
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
DATE ISSUED (0 - 2f ~ f l
DATE
SEWER I WATER I SEPTIC
FRAMING
INSULATION ~ f\a-.
ELECTRICAL
PLUMBING
HEATING (if required)
, FIREPLACE
4 1()"/~""1
GAS LINE AIR TEST '-" J!3~/S-7a ~ . (tJ"Z~"1
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I \fMIJtg 8MlB I I
FINALS
c.,
GRADING (Prior to Sodding)
BUILDING -rw -ro $ ( /)U
ELECTRICAL
PLUMBING
HEATING
DO NOT OCCUpy UNTIL OVE HAS BEEN SIGNED
NOTICE
This card must be posted near an electrical service cabinet prior to rough-in inspections
and maintained until all inspections have been approved. On buildings and additions
where no service cabinet is available, card shall be placed near main entrance.
.:J/tJ 162>
Call between 8:00 and 9:00 A.M. for all inspections
FOR ALL INSPECTIONS (612) 447-9850
~.~'__.~'~''"'~' .,._L.....".<_...'""~..,._...........""""~~_,_...~..._____,~~,~""_,________.________________.........,__'._.___,._____.__.___._.,.__~
QLertiftcate at OOcmpanry
CITY OF PRIOR LAKE
J)tpartmtnt of .uilbing 3Jnsptttion
o Final Permitted 1,! Conditional C. o. Expires 8 - \ - ~
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 S. Y\ cJ e f "'''''. \ ~ Bldg. Permit No. q tl. l' B
Occupancy Type R 3 Type Construction V Fire Zone ~ Po. Zoning District e,
Legal Description L 04- ''3 C:-r ~ ~ \At ()()tt Par k
Owner of Building ^ MfJ.c,,",, ~V'st SiteAddress 4-1.11 Gr'CA.I'vlVJ()~d tv
(6CUt r ~~ U ll.({.
City P1anoer Dv II.. Yf
Date: 'Z - Z. '$ - c6
/
Date:
~
~<77
HOUSE HEATING TEST RECORD I
o . . .. V\!4- ~
G",c,t/1./At:Jt1,) C-i"l/t APT._FLOcjR_CITY~SUBURB
OWNER
t
'lip"
*'
i1,,,
ADDRESS
OCCUPANT
HEAT LOSS
SOLD BY
Electrical Work By
DATE HTG. INST.
INSTALLED BY
Gas Line By
SPACE HTR.
TYPE OF HEAT GA_ FA_ HW_ STEAM
(Yl . . 9AS DESIGN
MAKE ()~ , N L-
Model Hl\ LOA Hn"s4
Serial ?JfJO I , 0). ""/J.( q ("'I - 3' I J.....,
INPUT ("D ()~~ g"jt.\ I tJ L
CONTROLS
THERMOSTAT -r: ~, Heat Plug
Valve ~Je, 1'"'l J,';.II
limit F'; __,
limit Setting 07a~"" _P""
F . --r-- (
an Setting I · A.... _
Pilot Type I-J S::x
Pilot Make f\) tn' -4. /1
Pi lot Model .:2'" I i4I
Pilot Timing .!; ');.(",-/...,,"'/5
L.W. Cut Off
Pressure ~/.~" fA). ( .
Input CFH G,CJ (" F# _
Stack Temp. Co? \.~ "Y' "" /-
MAKE OF BURNER
Model
Max. BTU Rating
MAKE OF FURNACE
Model
UNIT HTR.~OTHER
CONV RSION
Vent Size
At 'f
KIND OF LINER
Draft Hood
SIZE NONE
/11. I
Regulator Q Jr: (,,(
3~s- .3
Outside
Filters Size
Chimney Location
Chimney Construction
Number
Smoke Bomb
Draft
Door Pressure
y
<
t"J L.t /:
Percent CO2 .
f .3 .~
Percent O2 I
Percent CO it.. C).. .1.'" t{
Inside k
y" ~.t/I"....-f
x
Wiring ~
Test Tag ~
Lighting Inst. Y
Date Tested :z. ~ - 0 cJ
Company Testing '::' ; ',1- tI (/4 c
Name of Tester __ , _ ti
" "_'-'07_
t'&.l~~~ <.....
.i:.LM~r ,.~
~"\,
OCCUPANT
HEAT LOSS
SOLD BY
Electrical Work By
TYPE OF HEAT GA_ FA~ HW_ STEAM
C GAS DESIGN
MAKE ..A. {J P , ~ iZ
Model ;5;i~X a ~ -I ~
Serial I 111170 71";" s 1.5 (J
INPUT .x-(~ cry) i'?rlJ/ ~
ADDRESS Y$/ 77
HOUSE HEATING TEST RECORD
C;, ti./I lA/oJ C,(f./f APT.___F LOOR_CIT~; 01 L", :!aURB
OWNER
DATE HTG. INST.
INSTALLED BY
Gas Line By
SPACE HTR.
CONTRO LS
THERMOSTAT"J-~;. Heat Plug
Valve L J..J_ __ _ r
Li mit t::::'.
d~~.t-
-;:.-vu
{JST
A.J c.; ,. -+C/7
Pilot Timing ~ 1::",,1-1.
L.W. Cut Off
Limit Setting
Fan Setting
Pilot Type
Pilot Make
Pi lot Model
UNIT HTR._OTHER
CONVERSION
MAKE OF BURNER
Model
Max. BTU Rating
MAKE OF FURNACE
Model
.., I,
Vent Size ~
KIND OF LINER
Draft Hood
Filters Size I ~ . 2 ~. ~/
Chimney Location Inside X
...., /:'
Chimney Construction t:><' ....
?Vl
SIZE NONE
Regulator /l1p)-,'I.. '" I
/
$,,"""1 S- -S'''
Number
Outside
Smoke Bomb
Draft
Door Pressure
y
)('
X
Wiring k'r
Test Tag
Lighting Inst. )(
Pressure <:::-" I.c/.("
Input CFH J1:j C ~fI
Stack Temp. q~ ~ F
Percent CO2 t':.. f" .~ Date Tested Z. - 0/ - 00
Percent O2 C. 2... '/: Company Testing /JZ,:-I L/Vl4c
Percent CO /lJ:;G- -I,vL Name of Tester .:5",,. #
"'" "
,.'
,.~ ~....
u~
",,',
1'""",,
......
DATE TIME
CITY OF PRIOR LAKE ?-2-fYl!
INSPECTION NOTICE SCHEDULED
ADDRESS 4.271 <O~ ~d) t2..
OWNER CONTR. 7/c?
PHONE NO. PERMIT NO. 'f~ - ~
o FOOTING o PLUMBING RI o EXIGRADIFILLING
o FOUNDATION o MECH RI o COMPLAINT
o FRAMING o WATER HOOKUP o FIREPLACE RI
o INSULATION o SEWER HOOKUP o FIREPLACE FINAL
o FINAL o PLUMBING FINAL ~ASLINE AIR TST
o SITE INSPECTION o MECH FINAL Ttu lIa
COMMENTS:
r}~ ~
clo~ ~<- LJ'lt..
~~\vh_I\~. ~~
LWORKSATISFACTORV, PROCEED
o CORREC CTION AND PROCEED
o CORRE RK, CALL FOR REINSPECTION BEFORE COVERING
Inspector:
Owner/Contr:
CA
-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
/NSNOTl
/O.z,.oo ",T.
G~/NWoOO C II€-
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
4Z77
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION I1A\\
tit FINAL l\t'9
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
COMMENTS:
SOD/-ne6~
I
DATE TIME
91-1/6
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
~ WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
:S:O::ECT WO~/ALL FOR REINS:::/::n:~FORE COVERING
CAll 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
INSNOTJ
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS if ~ J J
OWNER
DA TE TIME
SCHEDULED ~~
C/'/JJ/1WI'>>,/ e/-e/e...
CONTR."I ~ ~#;
9;;Z
EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
PERMIT NO.
PHONE NO.
o FOOTING
o FOUNDATION
~F G
o ULA TION
. FINAL
o SITE INSPECTION
COMMENTS:
GnlJ,:)
('fA; hho Y
r
IS
(5
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
DK
OJ<
~f
~I
~
/'
~RK SATISFACTORY. PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT W RK, CALL R REINSPECTION BEFORE COVERING
Inspector:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
/NSNOTl
~J;:/~~
t7r
~Wt&J c~
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS 42.17
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULA TIO~ fb
~INAL N r1
/ 0 SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
~EweRHOOKUP
LUMBING FINAL
o MECH FINAL
(~
TIME
II :Zv
~q -7trf
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
c.o in
~/-,_./
~r '? ~
~\~
(0 ~ "S~
\)j~ ~ [
0lA -
p~ ('~
Inspector:
N BEFORE COVERING
CALL 447- 850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
INSNOTl
'MENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
~~~Jqq
ADDRESS 4 '2.. I f ~Gvk vco4 C:-
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
TIME
3:"S()
OWNER
CONTR.
PHONE NO.
PERMIT NO.
~9 - cl Y
o FOOTING 0 PLUMBING RI
o FOUNDATION 0 MECH RI
o FRAMING 0 WATER HOOKUP
o INSULATION 0 SEWER HOOKUP
o FINAL /F\:: 0 PLUMBING FINAL
o SITE INSPECTION rtlS/" )'f" MECH FINAL
COMMENTS: ~ fLoc... ~
fd;jj,) ~ - Asr/V\- ~~Ft"77
AJ{- <Li-- '/~O A , -;: fJy.~;~_
-f~~~ ~~/r ~ ~ ~~ .-
~:Z ~/ /2-uf" lea" ~. c-. ~
~0~~'.~~
tJ~- ~~ ~~~J
~~~
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
.......--
/
i WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WOR . CALL FOR REINSPECTION BEFORE COVERING
Inspector:
Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
INSNOTI
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS 441.7
t:YwhwtDJti ~h
OWNER 10M.
PHONE NO.
CONTR.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
~SEWER HOOKUP
P UMBING FINAL
ECH FINAL
, JADJ~~
2f{-
TIME
~~
.!fl- 7LR
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
cjO~c ~~
~: ~~N1 ~V:~C: t(;-~;;~;~
Owner/Contr:
THE NEXT INSPECTION 24 HOURS IN ADVANCE.
INSNOTI
EMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYl
CITY OF PRIOR LAKE
INSPECTION NOTICE
f /0: TE
~
GruJ;, ~ ~)-
SCHEDULED
ADDRESS
'-/2 77
OWNER
CONTR.
TIME
4-,
j~; d-~
PHONE NO. SCtz - t; l!&,1 PERMIT NO. n - 71E
o FOOTING
o FOUNDATION
o FRAMING
,O)NSULATION
II FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
~nd
COMMENTS:
PI Clflfl /VlS
~-
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
{ t {A )-,/1::;(2/ T>"-./
C<.!tb 6{~f~~
o WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector:
Owner/Contr:
850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTI