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Building Permit 13. 0999
�/ �/ �/:[ �/ a �/' �/ U �/ �/_ �/ �/ �/ . , u u v u <><*, ?c„ < t�?►;" C ,lei, : i`� � � � ,; . � C, d) + X y I I C rrftfixafr of ®rrnpanrU CITY OF PRIOR LAKE_ Priaarfittrztf of atibittg cIttsprritott Final Permitted ❑ Conditional C.O. Expires This Certificate issued pursuant to the requirements of Section 110 of the❑Residential/❑International 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. 13-0999 PUSD �`:r Occupancy Type Type Construction Zoning District�� _ Legal Description L4, B1 HICKORY SHORES SECOND ADDITIONI 3821 TURNER DRIVE K Owner of Building Site Address Contractor's Name&Address D.R. HORTON, INC. ROBERT D. HUTCHINS'` _ City Planner Building Official Date: (�—1,-k Date: POST IN CONSPICUOUS PLACE fr 2 0 0 • n 000000 -0 0 > 20 n n a 0 0 K 2 § � K� � � 4 % r. n 73 Xi 7 s - §r- E§ § z § ca -I % t -1 -I E Z -0 %K§ B 0 cn -I to t . ■ a a -4 m o § 8 b & o q - q � .z o■ § 7 a 0 0 t o a > o U0 m m XI r § 7 NIP 0 0 ❑ 00000 o x z m m in rfl ■ r ■$� r m r \ c f m cn 00 -IOC m ! I I1 0 C CO § E � m q › 000 0 q � \ m J / 0 - r � § o x r o -a z $ m r 12Ti o .i‘ m 0 X \ 0 ■ § E $ cO21O _ 'ii Re II < E 'V -0 -0x j� j 0 � mm4. -a7 1 2 C n Z m -Ir o y 0 ❑ C) 0 0000 = 0 > yA n " o 3 a y" „ -oo, 0 13 a m 5 D o 73 73 73 m m N �, r, �` m — rraZd_161_.> 0 p y p� 4 C; i r_ .. --I _om q il 'r" ° 2 0 73 73 x xl n n G �' ❑ 0000 ❑ m RI o z 0 v ro71 cyamc � CA ; gym p C co ° zzpxppxpEI 73 Z zGxi E _ , m Iv'' 1 o z • rr' m00 xi =1 p C Ivi _ Zcc N g x m �1 c0 -.I tin m % 00000 ❑ -\_p LI 1\1 `> 4 I! m55 ; o n > mm = � m 53 + 2° -1 F m r 0 S"' O 4-0- C) 000000 = 0 c yC) 0 C) o 0 Hm _ m „p� O p 53 0 c� 0 O O O 3 en 28 m m m m0 c o y m use> � o y c� M 1 Z1iU o Z ° 5 o z hi � hi O > > z mm z r0 z x073 0 0 000000 rp --I 41 x N v o mrc 111 OCrmc I- kf MC m = 3 0 \.( cn c - ZZpippX� 3 0 m b Cm) �j 0 rrnOO z 4 0 OZ ? m r '3 '0 O p A m x m p N m00000 e� 11 >n m5556 11 > mmZl yy m T � -IF -1r O of rrzr *P CITY OF PRIOR LAKE BUILDING PERMIT, Datta Reed TEMPORARY CERTIFICATEOF ZONI'rT COMPLIANCE g-; '/ / 3 ° kI ik AND UTILITY CONNECTION PERMIT p.p/. See Main tilt rVEsa 2 scity PERMIT NO aD Y � tt�.� /3. (Please type.oir mint and sign at bottom); 4 ADDRESS c ZONI.F (erre use) 33 2- t /) /'1 L'5i) LEGAL DESCRIPTION(office use only) _ llc LOT ( BLOCK / ADDITION /f j Cho Y 5 Z f2..5 Gi PID;,l i -7© .c)c.i j' OWD�, �P---Tv A-1 (Pitt) (Name) _ (Address) ouBR D R NORTON, INC 952-985-7272 (company Naiad (Ph (Colaet Nam._., Brooke Hareid bmhareid@drhorton.com fie) 952-985-7806 - .. (Adams) 20860 Kenbridge Court, Lakeville, MN 55044 TYPE OF WORK V New:Construetton EIVeek C IForeh [Roofing ° -Siding ElLotwerlevel Finish El Fireplace ['Addition [}Aitetation °Utility Cater CODE: OLR..C. CILB.C. 0 Misr. Type-tsf COUStntetiont I Ii Iii r'4' 7 A Bf7 Occupancy Group:, A B E F If I M R S IJ I'RDCT Ct��I'lY ..t3i3 $ 59, 5/A, / (excluding bead). I Division: 1 2 .3 4 thereby certify that 1 have inri isherl;7nfttrihatiott no tatrappiteation which isle the best of my hublenge.ttve and Correct. I also ea"that lam the owner or authortaethagna kir the above-mentioned:po ny 000 that all-eattstniction will ctml rrrn to all existin mate and local lotto and will proceed in accordance whinnied plans. f ant aware that die blending official can revoke this permit fOr cause. ` they .• 7 thereby agree.that the cur attain ser a**PO[W/ter up tithe" erly to p't foal t hey t ..,•taint. BC605657 A' / X w Sign, SW w W Contf tt►rrs License No_ ' ,e Permit Valuation „RS/7 C'f90 • Park SSupportPee ft $ Permit Fee /, S SAC , c o Plan Check Fee S90 Water Meter Size 5/8"". $c5-9© no State Surcharge $ //'r1. L�"0 Pressure Reducer $ A.5-0,, ("0 Penalty . $ —// Sewer/Water COnneeiiOn Pee f $ 45-06.off Plumbing Permit Fee $ /3/7( l0 Water Tower Fee # $ ler e ^- 00 Mechanical Permit Fee $ S Builder's Deposit $ ,�j G�'). ('p Sewer&Water Permit Fee $ ,.--6) Other Gas Fireplace Permit Fee $ : S' TOTAL DUB` 9/e. j $ / 93/ 11 I This Appi A"tie teco, es Your Building Pe iYf ApPt ed Paid /4 �{ '/. JI Re tNo. -262).S7, / r J i t ldit-v. loaf '•-- o tto Tins is to entity that t a request in the above application and accompanying document in arc. i ante with the City Zoning Ordinance and may proceed as requested. This document when signed by the j Plp er constitutes a tempprary Certificate of Zoning comps ice and otos construction to commence. Before occupancy,a Cettificate of Decorum",must be issued 4 I pima.: :. Dat. Special Conditions,if any 24 hour notice for all inspections(952)447-9550,fax(952)447-4245 4646 Dakota Street Prior Lake,MN 55372 CONTRACTORS MATERIAL&TEST CERTIFICATE FOR ABOVEGROUND PIPING PROCEDURE: Upon completion or work,inspection and tests shall be made by the contractor's representative and witnessed by an owner's representative. All defects shall be left in service before contractor's personnel finally leave the job. A certificate shall be filled out and signed by both representatives. Copies shall be prepared for approving authorities,owners,and contractor. It is understood the owner's representative's signature in no way prejudices any claim for faulty material,poor workmanship,or failure to comply with approving authority's requirements or local ordinances. PROPERTY NAME: Hickory Shore DATE: 12-30-13 PROPERTY ADDRESS: Lte Z 1 0.1+nry GdV.trr ACCEPTED BY APP OVING AUTHORITIES(NAMES) PLANS ADDRESS: INSTALLATION CONFORMS TO ACCEPTED PLANS • YES 0 NO EQUIPMENT USED IS APPROVED • YES [] NO IF NO,EXPLAIN DEVIATIONS HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS TO LOCATION OF CONTROL VALVES AND CARE AND MAINTENANCE OF THIS NEW EQUIPMENT j] YES [] NO IF NO,EXPLAIN INSTRUCTIONS HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES: • YES 0 NO 1.SYSTEM COMPONENTS INSTRUCTIONS • YES C] NO 2.CARE AND MAINTENANCE INSTRUCTIONS • YES [] NO 3.NFPA 25 • YES [] NO LOCATION OF SUPPLIES BUILDINGS SYSTEM ENTIRE BUILDING DESCRIPTION MODEL YEAR ORIFICE SIZE TEMPERATURE QUANTITY Reliable Fl 58 2013 1/2" 155° 13 Reliable Dry F3QR 2013 1/2' 155° 1 SPRINKLERS CPVC with CPVC Slip fittings PIPE&FITTINGS ALARM DEVICE MAXIMUM TIME TO OPERATE THROUGH TEST ALARM VALVE CONNECTION OR FLOW TYPE MAKE MODEL MINUTES SECONDS INDICATOR Vane Potter VFS-R ® DRY VALVE Q.O.D. MAKE MODEL SERIAL NO. MAKE MODEL SERIAL NO. TIME TO TRIP* WATER AIR TRIP POINT TIME WATER REACHED ALARM OPERATED THROUGH TEST CONNECTION PRESSURE PRESSURE AIR PRESSURE TEST OUTLET* PROPERLY MINUTES SECONDS PSI PSI PSI MINUTES ' SECONDS YES NO DRY PIPE WITHOUT OPERATING Q.O.D. TEST WITH Q.O.D. IF NO,EXPLAIN *MEASURED FROM THE TIME THE INSPECTOR'S TEST CONNECTION IS OPENED. OPERATION 0 PNEUMATIC 0 ELECTRIC 0 HYDRAULIC PIPING SUPERVISED El YES El NO DETECTING MEDIA SUPERVISED 0 YES I]NO DELUGE &PREATION DOES VALVE OPERATE FROM THE MANUAL TRIP AND/OR REMOTE CONTROL STATIONS Q YES El NO VALVES IS THERE AN ACCESSIBLE FACILITY IN EACH CURCUIT FOR TESTING IF NO EXPLAIN 0 YES 0 NO MAKE MODEL DOES EACH CURCUIT OPERATE DOES EACH CIRCUIT MAXIMUM TIME TO OPERATE SUPERVISION LOSS ALARM OPERATE VALVE RELEASE RELEASE YES NO YES NO MINUTES SECONDS HYDROSTATIC: HYDROSTATIC TEST SHALL BE MADE AT NOT LESS THAN 200 PSI(13.6 BAR)FOR TWO HOURS OR 50 PSI(3.4 BAR)ABOVE STATIC PRESSURE IN EXCESS OF 150 PSI(10.2 BAR)FOR TWO HOURS. DIFFERENTIAL DRY-PIPE VALVE CLAPPERS SHALL BE LEFT OPEN DURING TEST TO TEST PREVENT DAMAGE. All ABOVEGROUND PIPING LEAKAGE SHALL BE STOPPED. DESCRIPTION PNEUMATIC: ESTABLISH 40 PSI(2.7BAR)AIR PRESSURE AND MEASURE DROP WHICH SHALL NOT EXCEED 1-1/2 PSI(0.1 BAR)IN 24 HOURS. TEST PRESSURE TANKS AT NORMAL WATER LEVEL AND AIR PRESSURE AND MEASURE AIR PRESSURE DROP WHICH SHALL NOT EXCEED 1-1/2 PSI(0.1 BAR) IN 24 HOURS. ALL PIPING HYDROSTATICALLY TESTED AT a PSI FOR 2 -HRS. IF NO,STATE REASON DRY PIPING PNEUMATICALLY TESTED Q YES 1=1 NO EQUIPMENT OPERATES PROPERLY Q YES 0 NO TESTS DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT ADDITIVES AND CORROSIVE CHEMICALS,SODIUM SILICATE OR DERIVATIVES OR SODIUM SILICATES,BRINE,OR OTHER CORROSIVE CHEMICALS WERE NOT USED FOR TESTING SYSTEMS OR STOPPING LEAKS? El YES El NO DRAIN TEST READING OF GAUGE LOCATED NEAR WATER SUPPLY TEST PIPE: RESIDUAL PRESSURE WITH VALVE IN TEST PIPE OPEN WIDE STATIC PRESSURE: Jar PSI _/(2_„>__ PSI UNDERGROUND MAINS AND LEAD IN CONNECTIONS TO SYSTEM RISERS FLUSHED BEFOR CONNECTION MADE TO SPRINKLER PIPING. VERIFIED BY COPY OF THE U FORM NO.85B El YES 0 NO OTHER EXPLAIN: FLUSHED BY INSTALLATER OF UNDERGROUND 1=1 YES 0 NO SPRINKLER PIPING BLANK TESTING NUMBER USED LOCATIONS NUMBER REMOVED GASKETS WELDED PIPING 0 YES El NO IF YES........ DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING PROCEDURES COMPLY Q YES El NO WITH THE REQUIREMENTS OF AT LEAST AWS D10.9,LEVEL AR-3 WELDING DO YOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS QUALIFIED 0 YES El NO IN COMPLIANCE WITH THE REQUIREMENTS OF AT LEAST AWS D10.9,LEVEL AR-3 DO YOU CERTIFY THAT WELDING WAS CARRIED OUT IN COMPLIANCE WITH A El YES 0 NO DOCUMENTED QUALITY CONTROL PROCEDURE TO INSURE THAT ALL DISCS ARE RETRIEVED,THAT OPENINGS IN PIPING ARE SMOOTH,THAT SLAG AND OTHER WELDING RESIDUE ARE REMOVED,AND THAT THE INTERNAL DIAMETERS OF PIPING ARE NOT PENETRATED. CUTOUTS DO YOU CERTIFY THAT YOU HAVE A CONTROL FEATURE TO ENSURE THAT ALL CUTOUTS El YES 0 NO (DISKS) (DISKS)ARE RETRIEVED HYDRAULIC NAMEPLATE PROVIDED IF NO,EXPLAIN DATA NAMEPLATES 0 YES El NO REMARKS DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN: Z-(/-Z U/r NAME OF SPRINKLER CONTRACTOR: SUMMIT FIRE PROTECTION SIGNATURES TEST WITNESSED BY F• ri,j11k O ER(SIGNED) TITLE DATE: /71‘, SUMMIT FIRE PROTEGTIOn FOR SPRINKL CONTRACTOR(SIGNED) TITLE DATE: 7?" 2 --(/- ZC77 1 rRto CITY OF PRIOR LAKE Date Recd . 4;>i 5;; HEATING/AIR CONDITIONING/FIREPLACE PERMIT . ‘.%,, „NIVEsdo I.Pink File 1.Green Csr PERMIT NO. /j �J. iPlease d.Yellow Applleie 13 ”e / type or print and alga at bottom) ADDRESS ZONING(office use) 3521 \ (kt W St....AD . LEGAL DESCRIPTION(office use only) LOT BLOCK ADDITION PID R � � '' O(Na (Phone) �5Z- / /27 • (Address) 20'C90 Key+idle C-I •tIW Lake le,li IfU S5 NU APPLrT �=i reside kf�e1� i ' v vie (Phone) 051- [P 53-Z Sto1 (Address) 7100 f t lT V 1 e u / e N0 i oje Lit I te, L AA ki +J5 I 13 (Address) (City) / (Zip Code) (Contact Person) Leah �•erw_ t or- (Phone) •6 ` f3 •- , APPLICANT SIGNATURE \ _ DATE 1 Z 4 .1 • APPLICANT PLEASE COMPLETE BELOW . • W CONSTRUCTION ❑REPLACEMENT 0 ALTERATIONS FURNACE MAKE AND MODEL FUEL FLUE SIZE RETURN OPENINGS INPUT OUTPUT TYPE OF SYSTEM BEATING OR POWER PLANT ❑Warm Air Plants Steam PLEASE NOTE: Air Conditioner Units and Fireplaces Cannot Encroach )]gravity D Hot Water into Required Side Yard Setbacks. amts! ❑Radiation ❑Air Co ditioning 0 Special Devices Fireplaces with Box Additions or Went.System 0 Other Devices Cantilevers to the Outside of Buildings Require a Building Permit. FIREPLACE MAKE AND MODEL L--`( 5 ',YL-- Vi—� FEE SCHEDULE Industrial,Commercial&Multi-Family I%of job cost Residential,Gas Fireplace •$49.50 $49,50 minimum pp��y Residential,Heating&A/C(New Construction) $149.50 Residential,Additions&Alterations P A tD yen Residential,Heating Only(New Construction) $64.50 Residential,AC Only-' = � Estimated Cost$ \ ) V Building Permit # � AR . The Minnesota Statutes*32613.148 BEATING PERMIT FEE $ "SURCHARGE"hes been changed for one year effective STATE SURCHARGE $ .50 July J,2010,until June 30.2011. TOTAL PERMIT FEE $ Tbc minimum surcharge for a"find fee"permit (Orifice Use Only) Is SEE,beginning.luly 1.20111 This Application Becomes Your Building Permit When Approved Paid Receipt No. Date By i Ruildiae Official Date 24 hour notice for all inspections(952)447-9850,fax(952)447-4245 4646 Dakota Street Si.,Prior Lake,Minnesota 55372 • F PR/0 CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd ° `�' ' TEMPORARY CERTIFICATE OF ZONING COMPLIANCE l 9 AND UTILITY CONNECTION PERMIT 44A'NESo'Cp. i White File PERMIT NO. / r' rj/ 2. pink City y`, 3 Yellow Applicant - (Please type or print and sign at bottom) `_ ADDRESS ZONING(office use) Ortve_ LEGAL DESCRIPTION(office use only) LOT BLOCK ADDITION PID OWNER , (Phone) (Name) I L i NW (Address) • BUII DER1 ��'o (Company Name) I ! !_e• I (Phone) (p 5� - z.5-/-1 (Contact Name) 5()en n71 I-7-e Pf o l-er' r 0, (Phone) S-7S eei iriek4 '14 Ave w (Address) c �, Ips,, ll el,t-, SS—ta3 • TYPE OF WORK ❑New Construction ['Deck ❑Porch ❑Re-Roofing ORe-Siding ❑Lower Level Finish 0 Fireplace ❑Addition ❑Alteration ❑Utility Connection CODE: ❑I.R.C. ❑I.B.C. ❑Misc. 2 coo Type of Construction: I II III IV V B PROJECT COST/VALUE $ — 3 3 00- Occupancy Group: ABE F HI M R SU (excluding land) Division: 1 2 3 4 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 pro. rty 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 Pae building official can revoke permit for just y:use. Furthermor- hereby agree that the city official or a designee may enter upon the property to perform needed inspections. x /% .ii (10:7 55 oe- a 7- / 3 Signature Contractors License No. Date Permit Valuation /'�� OD Park Support Fee # $ Permit Fee $ �j SAC # $ W.o0 Plan Check Fee $ (6 •FS--- Water Meter .Size 5/8"; 1"; $ State Surcharge $ 2. .00 Pressure Reducer $ Penalty $ Sewer/Water Connection Fee # $ Plumbing Permit Fee $ Water Tower Fee # $ Mechanical Permit Fee $ Builder's Deposit $ Sewer&Water Permit Fee $ Other PAID W1111 Gas Fireplace Permit Fee $ TOTAL DUET ��PP""�� v�^. �j �1�� B This Lica ' :ecomes Your Building Permit When Approved Paid 4J Receipt No. di-A- Date BY .48 /3______ . Buil'ng Official utf This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed 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 issued. Planning Director Date Special Conditions,if any 24 hour notice for all inspections(952)447-9850,fax(952)447-4245 - as - - _ . - •:. ..- 14 1. Co. p Rtp Date Reed �°s CITY OF PRIOR LAKE /I) • 1// /3 � SEWER AND WATER PERMIT I�NESO�P 13. 750 /3- /7 I. Greco File PERMIT NO. l 2. Yellow City / ' � /O 3. Gold Applicant (Please type or print and sign at bottom) ADDRESS ZONING(office use) 438/57- 20— 2 7 iev-- sl eet 11.5Z LEGAL DESCRIPTION(offibus_kelyi cip�, E 2 WVI z/g - 6-43-4 t� �G1�/ // /I ff,/ 25- 912- P20,,/— .. LOT 'y BLOCK / ADDITION 0,1 75'';rik O 1, _ '- OWNER /`®° �J y iie� „f (Name) /i� (Phone) (Address) (Address) (City) (Zip Code) APPLICANT /) $ f. 1.i7�7 /d( S7 W6 /3•$ (Name) 1J y r//, ���Y�7 " !o (Phone)// (/ (Address) 2q/Y gArre,r 6 A1614J s "sa33 (Address) i (City) (Zip Code) (Contact Person) ___Jekg' 4# ,'✓J� / (Phone) 4'/2qqi2 /l9 34i "-- APPLICANT SIGNATURE I/ . ii LLr st DATE /6-1-13 APPLICANT PLEASE COMPLETE BELOW Size of water service I inches. Location of any couplings from structu feet. Type of sewer pipe. ❑ ABC PVC ❑ Cast Iron Estimated length of sewer line eet. Clean out (if required) located at feet from structure. FEE SCHEDULE Residential sewer and water line connection $51.50 Industrial,Com'l&Multi-family 1%of job cost with a$51.50 minimum Sewer connection only $25.50 Water connection only $25.50 Estimated Cost $ Building Permit# SEWER AND WATER PERMIT FEE $ STATE SURCHARGE $ .50 TOTAL PERMIT FEE $ (Office Use Only) This Application Becomes Your Building Permit When Approved Paid Receipt No. Date By Buildine Official Date PAID WITH 24 hour notice for all inspections(952)447-9850,fax(9 "4Q5' =0 PERMIT 4646 Dakota Street S.E.,Prior Lake,Minnesota 55372 .�r Rra Date Itee'd A i' CITY OF PRIOR LAKE PLUMBING PERMIT AO . i . / ii, ,s , _ ,_,..„,..• ._____•,,,,2„.. jNrraso tp 1.ems >lla PERMIT NO. l� 3..Yell Applicant l� 3.Yellow Applicant -- 11 (Please type or print and signat bottom) ADDRESS ZONING toil Ice.use) C . ! u ) €. Pf -t U .- 5.W , P a St LEGAL DESCRIPTION(office use only) LOT 4 BLOCK I ADDITION K ra4 5t4Og-€ 5 PID A5- `/t -17D Ai- 0 OW (Naame)R f -0v (Phone) 12'-V5- 7Z 7 Cr (Address) 2 Q l 6124 0&- o g-r 4/00 t.A- 1 U.'E 1 MN.I 5 °gel APPLICANT �� . , p (Name) �'il lr % : t (-.66 r If 7-6- •C (Phone) 4:7',';/-3/?—4 2 oo (Address) 31 5 7--L7PAi tNA I., Det t%0-> it-zoo EA&pr j /11,N) f f Z / (Address) (City) (Zip Code) (Contact Person) (7 b c 4:+' (Phone) 4,5,- 3/1-— 4 2 2. APPLICANT SIGNATURE _1 .__- 9 3-,....,-, DATE /1.)1 �� 0/ APPLICANT PLEASE COMPLETE BELOW Quantity Type of Fixture Quantity Type of Fixture I Bath Tub with or without shower 3 Rough-ins 1 Dishwasher i Water Heater i - Floor Drain Water Softener 3 Lavatory(Bathroom Sink) i Stand Pipe(Washing Machine) Laundry Tray(1 or 2 compartment sink Sewage Ejector t Shower Stall .. Backflow Assembly _ I __:Sinks Backflow Assembly Test Bar Sink Lawn Sprinkler 2- Water Closet(Toilet) Other FEE SCHEDULE Industrial,Commercial&Multi-family 1%of job cost with a$49.50 minimum Residential,New One&Two-Family $149.50 Residential,Additions&Alterations $49.50 • Estimated Cost $ Building Permit# PLUMBING PERMIT FEE $ STATE SURCHARGE $ .50 TOTAL PERMIT FEE $ (Office Use Only) This Application Becomes Your Building Permit When Approved Paid Receipt No. — Date BFAID WITH Building Official Date 24 hour notice for all inspections(952)447-9850,fax(952)447-4245 • 4646 Dakota Street S,E,,Prior Lake,Minnesota 55372 • 1 !RI,'v CITY OF PRIOR LAKE Date Rec'd . t° k HEATING/AIR CONDITIONING/FIREPLACE PERMIT i Z 9, l3 ki soar 1 o en Z., PERMIT NO. I 3.Yellow Applicant /�. I ( , (Please type or print and sign at bottom) ADDRESS 2 `I.` U � I L.lC.1, SC) ZONGli )w ✓ J r LEGAL DESCRIPTION,� (office use only)gcip/2.1( f LOT "BLOCK/ ADDITION �.�1!✓�LZS 2A)2/ PID of5 ' t,ig °eq.- 6' (Naim) Q r I,,�t O Y'br, -1-tomes (Phone) 6/5Z:165-7272~ . (Address) 2D U C sten bridle C�• i(J) 11 ake ycl 1G, !r t �J5Nc APPLICi�p (Name)ANT Ti!Y e si e /kc fr Y I q Nome (Phone) (O5 i tp J5-L 5LL l (Address) 7100 Fa i ti e vi Ave. !V ieo --l.. Lit 1It- ( A/11\1 41 t 13 (Address) (City) / (Zip Code) (Contact Person) Lea k Leer eI O (Phone) 96 - r3 .- 1 1 , APPLICANT SIGNATURE __� DATE 12'' 1 • , • APPLICANT PLEASE COMPLETE BELOW : NEW CONSTRUCTION 0 REPLACEMENT 0 ALTERATIONS s FURNACE MAKE AND MODEL FUEL FLUE SIZE RETURN OPENINGS INPUT OUTPUT i "'"'" TYPE OF SYSTEM BEATING OR POWER PLANT ❑Warm Air PlantsPLEASE NOTE: Air Conditioner 0 Steam Units and Fireplaces Cannot Encroach ❑Gravity ❑Hot Water into Required Side Yard Setbacks. arni0 Radiation ❑Air C ditiitioning 0 Special Devices Fireplaces with Box Additions or [Vent System ❑Other Devices Cantilevers to the Outside of Buildings Require a Building Permit. FIREPLACE MAKE AND MODELi- 1 c j -- el- , FEE SCHEDULE Industrial,Commercial&Multi-Family I%of job cost Residential,Gas Fireplace •$49.50 $49.50 minimum Residential,Heating&A/C(New Construction) $149.50 Residential,Additions&Alterations $49.50 Residential,Heating Only(New Construction) t$64.50 Residential,AC Only $49.50 Estimated Cost$ \3' Building Permit # The Minnesota Statutes*32613.148 HEATING PERMIT FEE "SURCHARGE"has been changed lb'.one • year effective STATE SURCHARGE $ , i Ps" July 1,2010,until June 30.2011. TOTAL PERMIT FEE $ The minimum surcharge for n"fired fee"permit (Office Use Only} is$+,beginning 1,21110 This Application Becomes Your Building Permit When Approved Paidet P WIT . Date By „fico Banding Official Date 24 hour notice for all inspections(952)447-9850,fax(952)44'7-4245 4646 Dakota Street S.E.,Prior Lake,Minnesota 55372 12RIOR LAKED.EPARTMENT OF BUILDINg AND INSPECTI9N Nee Main File INSPECTION RECORD SITE ADDRESS 3&V 7 ...t1Gle A4. w o RD`'��1 beck NATURE OF WORK ,S' � USE OF BUILDINQ� a 42 • PERMIT NO. / ZG,. DATE ISSUED h'V CONTRACTO- Y .� t T.� I PHONE d' INSTALL EROSION CONRTOL AND MAINTAIN CLEAN STREETS AT ALL TIMES INSPECTOR pq FOOTING FOUNDATION (Prior To Backfill) RADON RETARDER e3 — PLACE NO ONCRETE UNT OVE HAS BEEN SIG E ROUGH - INS SEWERIWATER/SEPTIC FRAMING INSULATION /10 yeVetELECTRICA1.14,4=44-4,"/ r.4.Q/. oft /,��/ PLUMBING , u 4s-T / � J0' 4 HEATING FIREPLACE GAS LINE AIR TEST //14 eig RADOMJ1I �/. / COVER NO WORK UNTIL THE ABOVE HAS BEEN SIGNED HOUSEWRAP LATH " 'fa FINALS iced. A$�,,�/ GRADING ( PRIOR TO SODDI G) ''� � (i BUI ,DING ELECTRICAL PLUMBING HEATING (d DO NOT OCCUPY UNTIL ABOVE HAS BEEN SIGN 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. FOR ALL INSPECTIONS (952) 447-9850