HomeMy WebLinkAboutBuilding Permit 00-1007
~1
DATE REC~tVED
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE 0
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Permit No.
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
<.03/4 WI(..1) ~. L.Q.LA Ace.....
1. DATE
\l~t~ctJ
. White
. Pink
. Yellow
NOV - 2 2000
;e/~D
BUILDING IN
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
3. LEGAL DESCRIPTION
12. NO. OF STORIES
LOT
\0
WILb
BLOCK
(t<)A)L<:;:
I
PID
2.~-3,{,,4- - nl()- D
13. TYPE OF CONSTRUCTION
ADDITION
4. OWNER
(Name)
(Address)
(Tel. No.)
14. FLOOR AREA APPORTIONMENT USE
5. ARCHITECT
(Name)
(Address)
(Tel. No.)
6=~ame)
7. TYPE OF WORK Fireplace 0
New Construction ~ Alterations 0
----;:" (~'.! /f . -l.Tel. No.)
, . O. !SOX y'5(" '1''5L ill9W-7~
~(OY' Ute ~ 55377
Deck 0
Finish Anie 0
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
Septic 0
Addition 0
Rs-roofing 0 Porch LI
Re-siding 0 Finish Basement CJ
SEATS
16. PROJECT COSTNALUE
Chimney 0 Misc.
B PROPERTY AREA OR ACRES ff 19 PROPERTY DIMENSIONS 110 CULVERT SIZE
Sq Ft /l ~ Width ~Pth Yes No
I hereby certify th I ha~e ml d Information on th plica on which IS to the best of my knowledge true and correct I also certify that I am the owner or authonzed agent for
the above men ned pr ~d t t all construct Will co form 10 all eXlslmg state and local laws and will proceed In accordance With submitted plans I am aware that the
bUilding offlcla an rev e p for Just caus urthe re, I hereby agree thaI the City .sglclal or a deslgnej JT!ay enter upon the property to pertorm J1fJ8di InsQItCJipns
X /,OO~"5"T~ fr. ~u;/
I f SlgnBture '--- License No. o..te
~
17. COMPLETION DATE
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
Front
Back
Side
Side
MATERIAL FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA 0
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS 0 SETS
SURVEY 0 COPIES
PLOT PLAN 0
BUILDING DEPAATMENTVALUATION
USE OF BUILDING
C:;J::"/+
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION -18O.-...-t:lt') ,go
TYPE OF CONSTRUCTION: I II III IV V
Occupancy Group A B E F HIM A S U
Division 1 2 3 4 ~!?
Permit Fee ................................... :/I~~ . Z. <:)
Plan Check Fee ............................. <t ~.,~"'.....J;
City:
Amount Brought Forward .................. $
Pe"'SuppMFee ........................... $~S'O .00
SAC ..............It./5tl.tJ..O"...--4J (!J(5
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
State Surcharge ............................. cr
90.0'
It/LI!. 75
. '137 / t.f
Other ......................................... $~
Total Due .............................. L (,,, 8/tf3t
Paid (06/4-.3 q RecelPfrtn :39f1 ~
Dete 5- 2/;. 01 By tY)fJv
This is 10 certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may pr~ requested. This document when
signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificatl of Occupancy must be issued.
........... $
/00"" 0
(00 .00
"3(".50
C/o.cd
Pressure Reducer .......................... $
MeIer Horn ................ .... .... .... ....... $_
Water Meter ................................. $ /25. aQ.
Sewer & WalerConnection Fee ........... $~ .. O-'=L-
WaterTowerFee ........................... $ '?tJO .cllC:>
Water Tap ................................... $
Builder's Deposit ............................ $_
Q'5.: dO
Penalty ....................................... $
Plumbing Permit Fee ....................... cr
Mechanical Permit Fee ..................... <t
Sewer & Water Permit ...................... ~
ermil When ~proved.
Date -1/_ ??~
-(1)-
Issued
C~y Planner
Dale
Special Conditions ~ any
24 hour notice for all inspections (952) 447-9850
6~~
DG' 6(007
White - Building
Canary - Engineering
Pink - Planning
Th~ C~nll!'r or Iht' Lab Counuy
.BUlLDlNG PERMIT APPLICATION DEPARTMENT CHECKLlSr
NAME OF APPLICANT
APPLICATION RECEIVED
)11 (. I..- C/<! E 57 j-Io 1'/ cs.
/ j. /' . ()O
f
;
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
&374- I V / L. 0 () j-} t:. =Tt; kr: r:l {;E
Accepted
v
Accepted With Corrections
Denied
Reviewed By:
LLL
Date:
/1-/3-0n
Comments: .SEE Re:vER.~E .>;O~ fore {lnF)J77,J/J/;<1l- C:>~_
"
kE fl1T~~ 0 GieAOIAJM R. AnY 2..)E~OA)~.rrRDl- /J1n:k{~
. -- -- -. - .. - 3)E~//J///O~l- R..IW
"The 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."
~~
o 0 . '00]
White - Building
Canary - Engineering
Pink - Planning
Th.. (:..nl..r of th.. L.kr Country
BUILDING PERMIT APPLICATION DEPARTMENT CHFCKLI~T
NAME OF APPLICANT
APPLICATION RECEIVED
JI/uf.....C4Zef::> I HoH55.
/ l 2- . DO
- I
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
&374- W / c--O CJ rtk:S I b~1T ec:
Accepted
?Z-
Accepted With Corrections
Denied ~
Reviewed BY:( =1:?~A
Date:
/(-8-~
Comments:
See. G;3'7(p LJ.'!cl Cl~ T~I'''- ~ {;,,-
QUI~ ~.
Ro....., t' .s;a..c..c:;. ~
"The 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."
---...
4
D () - lool
Thl'("l'n,..roflh..I..bCoUftlry
White - Building
Canary - Engineering
Pink - Planning
aUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
1/",,'
. 'i I
'-'
r' -'7' ;"1,, . t'-:- (~
/'~ C .; / . ~'_
APPLICATION RECEIVED
/1
. /
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
/, ,1
,( /"'1-"
'-
(/ ,I I
-. ,
, ./ /1,' 'C
Accepted
~
Accepted With Corrections
Denied
Reviewed By: ~~,' ~/~A--!
Date:
U,h2-/I91?
com~
~, S~:cL"t ,,~~" (~r\~~'
I ) ~ 'f:L-V>Ai'r +- ~t4; h.r /1.1 i W-"9,,_ k:-<; .
Un tJev-~ty v0p~k4~~<jJ~~.
No ~(~~~~~~~~.
"The 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."
JUN-13-2001 08:48 PM STAR PLUMBING & EXC.
952 884 7468
P.01
-.. . ....
YlLLCIW . 1lHL_'
""0 - Cltf
CITY OF PRIOR LAKE
SEWER AND WATER PERMIT
NOTE: sewer and Water
contractors must
be registered
with the city.
NO. 0-/061
PHONE: rs-:J- ~K'{-<tIY7
.... ;::{-p-v, DATE: A-/3-dl
,,~- . .BLDG. PERMIT .
,_/' 37~ tJ;.RdJ~+fkPID' ,9.?:3l,L/- blO-(j
SIGNATURE:
SITE ADORE
1.
fILL IN THE BLANKS
Estimated length of water service ~~
J ,I
size of water service inch(es).
feet.
2 .
3 .
Location of any couplings from structure
feet.
5.
6.
Type of sewer pipe. ABS pvc ~
Estimated length of sewer line ~ L?
Clean out (if required), located
structure.
cast Iron
4.
feet.
'A
., .
at.
feet
from
=====~============~========================================--=====
This application becomes your permit when approved.
BY
DATE:
======~=================================================:=========
FEES:
$
$
$
35.00
.50
35.50
sewer and water line connection permit.
Surcharge
TOTAL
*
Fee for either sewer or water individually is $20.00 plus
$ .50 surcharge.
* Sewer and water permits issued for new construction must be
recorded on the buildin~ permit card at the time of issuance
~o insure that no dup11cate sewer and wa.t.e.z:.. \ Der.mits are
1ssued. PAil) ^ilIH
/ _11111 . I BUILD:NG PEh~';;IT
DA'rE PAID (0 '1 () AMOUNT PAID
! 'Cu
RECEIPT # REC'D BY U' -
16200 Eagle Creek Av. S.E.. Prior Lake, Minnesota 55372/ Ph. (612) 447-4230/ FAX (612) 447-42
An Rqual Opportunily Emplnyer
--"------~~..._._--~
--.
CITY OF PRIOR LAKE
,
v 0 2MBING PERMIT
.;;( Appllc:ant: 'l'A,/A,P/h?n~Y
Address: :;:i:9 ?--1' rQ~ A~
Signature: ~ '.' _. )f...,.,p
L.egal DBSc:rtptlon; L.ot Block Sub
Site AddrB$s:-::(,;3')iil" J,IN.~/1 Zhl~
Building Permit II PID #
NOTE: This permit will not be prooessed without complete Information.
11/05/2001 11:10
9528947972
L.AKESIDE PL.BG
Thf C~IlI,r or Ih. u.k, C'llInt,.,
FIXTURE UNITS
fl_MAM7 ~
QuantitY I Type of FlxturB
.::! I Balh Tub with or without ShOWBr
I I Dishwasher
/ I Floor Drain
..3 I Lavatory (bathroom sink)
I Laundry Tray (1 or 2 c:ompartrnent sink)
, Shower Stall
I Sinks
Quanl/tY
~
/
;L
Bar Sink
Waler Closet (toilet)
I
I
I
I
I
I
I
/
/
I
\ .....
... ;" ~
FEE SCHEDULE
Industrial, Commercial & MUlti-Family
(1% of Job cost, $39.50 minimum)
RBsldentla', New Ona & Two Family
Residential. Addltlo~s 8< Alterations
State Surcharge
$99.50
$39.50
GRAND TOTAL.
Thls ~rmit j$- granted upon the c"pres8 condition that said
contra~tClrl IIhall comply In all r~pccts with the ordinances
Qf the State Plumbing Code -.nd the amendments thereof.
~CmPTNO. DATIl
A TTBST
Call for all inspections 24 hours in advance,
PAGE 02
1- BlulI
2.001<;1
J. YellOW
Fd~
C<y
Appli.....,1
# OO-IDtf7
Phone:f'.5..J..f7V 7,f.OU
'Q.-,"",,~' hf.oU .4"S..37)
Type of Fixiure
Rough-Ins
Water Heater
WBter :;loftner
Stand PlpB (washing machin8)
Sewage Ejector
Bacldlow Assembly (RPZ, Double Check. PVB
8ackflow Assembly Test
Lawn Sprinkler
Other c.."t'oS"~
$
$
$
$
q' f ::P
.50
$ /00'"
~~~\~ \Nrr~\t
eu\\J)\~~
16200 Eagle CreekAv. S.E., Prior Lake, Minnesota 55372 / Ph. (612) 447-4230 / FAX (612) 447-4245
An Equal Opportunity Employer
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIRJE:PLACE PERMIT
Date Rec'd
l.Pink
S. "'=
J Yell_
E~,_, I PERMIT NO-m_ ( 00 f
ZONING (ollie< ""J
IPlea;e rvtle or Orll1r aIld sio at bottom)
I ADDRESS
I (P37Lf t..J..;.....ed.... ooAu:J /~
i LEGAL DESCRlPTION (office Use only)
I LOT
BLOCK
ADDITION
PID
OWNER
(Name) JL:.f1!c.. fA:/- ~LJ.~-
\ '
(Phone) 95";;) -Wl? -7(d.,3
(Address) PO ~ ~6(" ,P~. Yh"
:::;S",,>7;;J.
~
APPLIC,.eu."lT -
(Name} t,.trrr;,.t..,L.;" \...,n:~9Q~ + S.=I~o.~ (Phone) fll,;-3.'.315'7500
(AddreSs)~IO (.J( Cmll'1.0 (11 f. 0. ()~ \.....,...., ~Jt rnn SS'...i'-i <::;
. ' ~. CJ'dar"") , CI . (City)
(Contact Person) -k'ri"-.,fJ. (PhODe) ;JG;3-31 S-7S/w
,.,PPLlGANT SIGNATURE '7f;/...L::?) .li.,,-.~.7"r.a~
(Zip Cock)
DATI'
APPLICANT PLEASE COMPLETE BELOW
~EW CONSTRUCTION 0 REPLACEMENT 0 ALTERATIONS
FURNACE MAKE AND MODEL F:tJEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
OWarm Air Plants
DGravity
o Mechanical
DAir Conditioning
DVent. System
o Steam
o Hot Water
o Radiation
o Special Devices
o Other Devices
PLEASE NOTE:
Air Conditioner UnitS
Cannot Encroach into
Required Side Yard
Setbaclcs
FIREPLACE MAKE AND MODEL ~ DY,'i(LDRFIV
Industrial. Commercial & Multi..Family
FEE SCHEDULE
I%ofjob cost Residential, GilS Fireplace
539.50 minimum
599.50
S64.50
539.50
Residential. Hcating & NC (New Construction)
Rosidenlial. Hoating Only (New Construction)
Residential, Additions & Alterations
Residenti,1. AC Only
S39.50
539.50
\
Estimated Cost S
Building Pennit #
nuilding Omclal
$
$
S ~ _
-[D!~ (f) IE U ill re ~I.
[aid I r'Receipt No.
FEB t 8 200] A ' "
~ ate -.J I By ~f.'
-J_
14 hour notice for .11 inspections (952) >147-9850, r.. (9~..i..... ,~~
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
.so
(Omee U,. Only)
This Application Becomes Your Building Permit When Approved
Dlfe
~oollJ
XalGIHd a~VHV~ JI~VNO~1V
~oLoStcn9 XVd 6S: ot co .'n / ~o
From-BTRNSVILLE HEATING' Ale
T-348
P 01
F-554
Date Rec'd
+95Z-894-C9Z5
qTY OF PRIOR LAKE
HEATING/AIR CONDITIONINGIFIREPLACE PERMIT
;: ~~':. ~:~ \ PERMIT NO. OD ~ I 007\
1. VollQW AWI~1I11t
(Please ~ or min[ and si~ at bottom)
\ ADDRESS
{ o?-7L/ u.lli.rl
fu~, '-(Wfil'D"
-ZONING (oAieeo,") I
LEGAL DESCRIPTION (office",c only)
LOT
BLOCK
ADDITION
PID
OWNER . J.
(Namel,\..-li \l /' res:+-\IO~
. (Phone) 96a-'i<<1 K - )(,(" :5"
(Address)
. APPLICAN~. ,. rLo ~\ n - ,..., l\Q..(r
(Name\ 'DUl' nio>V\.\ '-D\QD.-v-l {Vi ~III~
(Address)~Rl ~_l~ S.
(Address)
II/YJ C ')
APPLICANT SIGNATURE J)(...p{ ~/, -. .' 7'
(Contact Person)
(Phone) q6a -Mil-Dent::..
:5,/'u )/)dl ~ 5531 r
." "(&;)7 (Zip Code)
. (phone) ---962-R9'f-tJOO ~
//gu/Ol
~
DATE
~ APPLICANT PLEASE COMPLETE BELOW
[3IIl'EW CONSTRUCTION 0 REPLACEMENT 0 AL TEM TrONS
FURNACE MAKE AND MODEL ~'L r~Q3;-7S"" . FUEL JJa!J-:>{) 0;
. ~
FLUE SIZE RETURN OPENINGS I () INPUT J"",()f){) OUTPUT
.
TYPE OF SYSTEM HEATING OR POWER PLJ\.N'T
OWam1 Ail" Plants
OGravity
o Mechanical
DAir Conditioning
OVent. System
o Steam
o Hot Water
o Radilllion
o Special Devices
o Othcr Devices
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
FIREPLACE MAKE AND MODEL
rndustrial. Commercial & Ml.llti~Family
FEE SCHEDULE
1 % Qfjob cost Residential, Gas Fireplace
$)9.50 minimum
$99.50
$64.50
$39.50
Estimated Cost $
';'-,7)00. d:)
Residential, Additions & Alterations
Residential, AC Only
Building Permit # Db,.1 DO 1
.-fi . wrn-\
$ 99, .:> v ' PAID C:F'.f,IT
$ .so BU\l.D1NG P,:-" .
$ ,/ I"JO. (..)C) -
$39.50
$39.50
Residential, Heating & Ale (New Construction)
Residential, Heating Only (New Construction)
HEATING PERMIT FEE
STATE SURCHARGE
TOTALPERMlT FEE
(Office list Only)
-1l:i1-D I
natl!
::---
, Datil/(q~OI
'Re~
BYfl
eCDm.S Your Building Permit When Approved
24 hour notiee for .n ;ospeotions (952) 447-9850. fax (952) 447-4245
PRIOR LAKE DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION RECORD
SITE ADDRESS illlJt{ {A);lJ OCA.(....s J'~n, _ "
NATURE OF WORK ~p..,
USE OF BUILDING SF 4
PERMIT NO. 00.n/007 DATE ISSUED /f -8- 2:x:>o
CONTRACTOR .w.;l(('~ ~ 898 -7(,~3 /
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR "lATE
, FOOTING W ! tJ... ()).. M {~/d / I t, ~n..; I sl go 01 l
, FOUNDATION (Prior to Backfill)r~ I t;r-r ,l./4-11J I I~.. '//,7)/':;/ l
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
ttl
Jd:r
(4?0/
rz-f -z..4-{o f
C3/;;'-;:f (Dr-'
SEWER I WATER I SEPTIC
FRAMING
, INSULATION
ELECTRICAL _
PLUMBING V"1c.. M
HEATING (if required) It:' ,
FIREPLACE . I ~ 117r. ,;;;/Jt./ bt...
GAS LINE AIR TEST ~ ~~.p. 1~1 ~ 1h, I/Io!ui---
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
,~ I I
., FINALS ~ M/r:J2--
.
11//3/'1
j
GRADING (Prior to Sodding)
BUILDING 1.( lVl[?
ELECTRICAL
PLUMBING
HEATING
DO NOT OCCUpy
to-; (- J?
~#?;
f /
2/(?O/Oy
I I:f5 t,-/3"
I VVlf'
UNTIL ABOVE HAS
NOTICE
C1-+ 0-:,
BEEN SIGNED
This card must be posted near an electrical service cabinet prior to rough-in inspections
and maintained until BII inspections have G'3l!n approved. On buildings and additions
where no service cabinet is available, card shall be placed near main entrance.
Call between 8:00 and 9:00 A.M. for all inspections
FOR ALL INSPECTIONS (612) 447-9850
-
DATE
7~~:/
6J?~ 6v;/d L/vh ~/
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
~L
o SITE INSPECTION
COMMENTS:
----
\//..e.es
/./,.
( C~.se
TIME
SCHEDULED
CONTR,
PERMIT NO,
r"")/)- /QJ/
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EXiGRADlFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
____ / // I
~;.?.-() A I' / e d
----~~
--------------~
(:--'/ ')
i/ (~ ../
~
~ -----
/;:;_ :ORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT W~;: ~~R REINSPECTION BEFORE COVERING
Inspector: ~tr-- OWner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE-
--
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
,,$NOT,
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
~'374
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
p1'INAL
o SITE INSPECTION
COMMENTS:
(j)L f>Ji. 1/1' bllY:/L
A(AVl/^,~' h'tw
rJ' .
. ) /hl)JIL
S,..o /
411
SCHEDULED
DATE TIME
q- 4r{/$
wil"! M//. c "T-f'--r<~~
CONTR.
PERMIT NO.
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
I7MECH FINAL
''''
P4-/.' cll\~'"
/lU/;! S ( (' all
1/-, v1 +~-
(J() - /J/(Y) 7
o EXIGRADIFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
U...,+;/ J
r" - 1'1 s/?n:_./-.o'1
.f-f'.J/,i"f"/"
IO'Jt.,j7
o WORK SATISFACTORY, PROCEED
,..#cORRECT ACTION AND PROCEED
rI CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: ~
Pur"'lP/",
I r... ,
(>1 b>
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
IcVf1(/ Uv!1-! /
Owner/Contr:
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH 4 SAFETY!
lIUNOTJ
BlJftNSVILLE
Heating & Air Conditioning, L.L.c.
12481 Rhode Island Ave S, Savage, MN 55378.952-894-0005
Address fr s -, L/ IJ,I / CtJ J
Occupant ,
Da1eof Inslall ?/It/02
Type of HT. F/A ...-- HW
Other
Space HT
UnitHT
Make
Model
Serial
Input
(PN"'" Y
Gl{pG51\ "
SkblL 2"3\-'-,
-7 \' 1m-.. -'1;;]1:>1 I
Pilot Type
Pressure
Input CFH
S1ackTemp
HOT SURFACE IGNITOR
"">) C02 k-~
7 -;-. 02 f'~
/c,\( CO-P
Date Tested 7- L f 04..
l
Company
Technician
BURNSVILLE HEATING & AIR CONDITIONING
{"r(~
""
"::-3:*
ADDRESS
~37L/
DATE TIME
SCHEDULED t r!3 --;)--.;;) ~ =t:O
1/ )JfdJ (P/J./(,S
CITY OF PRIOR LAKE
INSPECTION NOTICE
OWNER
CONTR.
PHONE NO.
PERMIT NO.
(J- ( OOf
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
...,!lI"flLUMBING FINAL
o MECH FINAL
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
COMMENTS:
J~ ~ ~~--'
o ~K SATISFACTORY, PROCEED
~CORRECT ACTION AND PROCEED
o CORRr5?,j' CALL FOR REINSPECTION BEFORE COVERING
Inspector\) r Owner/Contr.
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
INSNOTJ