HomeMy WebLinkAboutBuilding Permit 00-0775
QIIIl; RFr.FIVIOQ CITY OF PRIOR LAKE
l BUILDING PERMIT,
r'jf:MPORARY CERTIFICATE OF
.... Ii ZONING COMPLIANCE
A ~[II~TILlTY CONNECTION PERMIT
~/j
1. DATE
,~ J ~ - -
7 "'2.1'-00
rJ If" e.1..
PID<95-<x,~.... (t) 7-{)
S-1:;!fJ.
Dt;>\le
CourT
LOT
-7
I
/
1-1-,' f(
~lncK
10/0 h
ADDITION
4. OWNER
Cor~
5. ARCHITECT
(N~'Fel
h-:- r4-
(Name)
(Address)_ (Tel. No.) : L."
Bu \ J)fl/ 5. .-JYe... :JfN 9 AJ w g 6 f~ J'(
(Address) {Tel. No.)
f1 G?fiM }I'\# $SOY'7
(Address) (Tel. No.)
6 BUilDER
(Name)
7f:90 -<f2( L
1. White
2. Pink
3. Yellow
File
City
Applicanr
Permit No.
OD-0775'
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Heigh'2. 'f (Width)t,o {D9Pth~
12. NO. OF STORIES
2-
13. TYPE OF CONSTRUCTION
5';"vdl. ~ "'OY
14. FLOel1 AREA APPORTIONMENT USE
<
15. NUMBER OF DCe
S OR SEATS
7. TYPE OF WORK Fireplace 0 Septic 0 Deck 0 Rs-roofing 0 Porch 0
New constructiO~ Alterations 0 Addition 0 Finish Attic 0 Ae-siding 0 Finish Basement 0 16. PROJECT COSTN ALUE
ChimneyD Misc. '2 Z-JI (900
18. PROPERTY AREA OR ACRES 19. PROPERTY DIMENSIONS 110. CULVERT SIZE 17. COMPLETION DAlE
S(;. Ft. J r- 71' Width' 7 <-f Depth;] cc::> Ves _ov OLt_ ('.\ Z- ~o...
I hereby certitf that I have fumished 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 officiaSJce . ke ttv.s .ge~ust ca~. FurJtlW~' I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X /l/(o,cN"\ V~ LI,/ G-, "7~29~<!>o
- Signature" - License No. Date
v
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
Front
Back
Side
Side
BUILDING DEPARTMENT VALUATION
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION '2'2~t!l~
USE OF BUILDING
3f.D
TYPE OF CONSTRUCTION: I II III IV V
OccupancyGroup A B E F HIM R S U
OMsion 1 2 3 4 I ,
Pennit Fee _____________________.............. L~ I'; '2.7..."<:
Plan Check Fee _________.................... $~ ~~. 't C&.
IIL.50
MATERIAL FILED WITH APPLICATION
SOIL TESTS LI ENERGY DATA LI
PILING LOGS LI PERCOLATION TESTS LI
~
PLANS & SPECS LI
SURVEY LI
PLOT PLAN LI
SETS
COPIES
Amount Brought Forward .................. $
Park Support Fee ________________........... $ f!lJSO.c!Jt>
SAC ........__..__________________________.__ $----1,' f'Jt.) .ax:J
Collective Street Fee .... ................... $
Sewer Tap ................................... $
City'
State Surcharge ............................. $
Penalty. ..................... ................. $
Plumbing Permit Fee ....................... $
, bO .,,0
~
IQ':>
e::J" $
Pressure Reducer .:e.................... $
Meter Horn ................ .... .... .... ....... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $ I,
WaterTowerFee ........................... $
I
~C06
I~
? 00 .d>J2.>
')""'" .",Po
(IX> .~n
~.5o
Gas irepl c P nnll __.~. ____............. $ 40.0 d
Th' A I i me i1ding perm)f~f{pproved.
By Date -~
Mechanical Permit Fee ..................... $
Sewer & Water Permit ...................... $
Water Tap ...................................4:
Builder's Deposit ............................ $
Other ......................................... 4:
(/snOL!n
Tolal Due __________________________.___ $ ~_ 403~ 2--/
Paid ~'- t/(J3, 2;/ ReceiP~'lj1l 394/4-
Date &j.t 3- IV By /fIVL
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 {s requested. This document when
sign~y thP.~ CC~ P r constitutes a temporary Certifica~ of Zo~g complia~nd allow~struction to commencx. _~efore occupan9Y' a Certificate of Occupancy must be issued.
'-!...lD '!/./~ f>{I!.~ ~-- _I' ~~ 'R-(r-C8"'--t".Q-<l1
~ City P anner Dale Special Conditions if any
Issued
24 hour notice for all inspections (952) 447-9850
s~~
White - Building
Canary - Engineering
Pink - Planning
Th., ('"nIO'. of th.. L.Ir... Country
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLlS-':
NAME OF APPLICANT ~ ~ m 12,llll i)!=R ~ I INL
APPLICATION RECEIVED ~1:h\V7 ~~'tI\\ Q n 00
- ZI
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
\ 4 ?),~ '8 D l"\vl=: ("01 112~ 1\1 E
Accepted
Accepted With Corrections ^
Denied (~/J/J ~A.
Reviewed B~r
Comments:
-
Date: [3- e.;~ 2000
~tk("~~ oc:J.s
"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."
Th., C.,nln of Ih., L.k., enunlf)'
White . Building
Canary . Engineering
Pink . Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT ~ ~ m 'RIll I 1'I~1~": \NL.
APPLICATION RECEIVED ~~\:!:l27 ~'6 < c;;) n 00
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
\ 4 3:z) 'is D "'vE. C ,Ol) Q"t' N E
Accepted
Accepted With Corrections
v
"
Denied
Reviewed By:
~1~
Date:
!36~/&lrJ
> -
Comments:
;2-'"1 ~ rlLax.~ l.fA.l,(M ~rAN!.I1 tr..l~_i;Vi~ ~
YfevV\- ~~ J-~LJ {2...6J. tV 10 LLxb..
"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."
E-ro s i c~
G...~I
.p (CU'\
White - Building
Can"",.y - CIJgineeri'IY
Pink - Planning
Th~ C~ntn of rhl!' Lah Counlry
.BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT ~ ~ r= R ", \ N c.
APPLICATION RECEIVED (if \!IJ~ ~'b "'\ Q n 00
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
\43~'8 D()VE (' ,()(lQ'"\ NE
Accepted
/
Accepted With Corrections
Denied
Grant (!ar{sOY1-
+he_ r-evf'f'S-P
Date:
side.
Rl3/cn
+tr ~ dd,'t-il"\V\o..l
Reviewed By:
Comments: 5' p p ~
inhrmo. -ht"rrl
>Ff=' ~ -t+C\.(' k ~+.s: I, h-"J ~rade- .r(\~r tl/llvl .:ti1~"..",oJi Ct-r\..
;;;?, GraAi"t\ Pl<A.k -=? 1='ro';r\VI ~,,+r/"\ \ K-f'a<:'\l~ Lf-
~ -
~
"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."
/
,.
..
.Permit'
"Job Add,ess
/t.f>3~ 11....-e Cf
METRO AIR
"Heating ContreetOf
.TeSle,./Slgn.tufe....~~
.~
/'
"Gas Une
Pressurized
Inspected
~
.. Percent CO2
"Percent 02
Final Inspection
Date
Time
PERFORMANCE TEST
--2","'1"
~. c.cy~
.Percent co
.Stack Temp.
Oale
Pounds
Pressure
,.....,,/
"" /.1
<{'f"
,
QLertifirate at OOrrupanry
CITY OF PRIOR LAKE
J)tpartmtnt of .utIbing 3Jn~ptttion
~Final Permitted 0 Conditional C.O. Expires
This Certificate issued pursuan' to ,he requiremenrs of Section 307 of the Uniform Building Code
certifying that a' ,he time of issuance this structure was in compliance with the various ordi1lQ1lces of ,he
City of Prior Lake regulating building cons,ruction or use. For the following:
Use Classificatif'n
SINGLE FAMILY
Occupancy Type
R3
. Type Construction VN
Fire Zone
Bldg. Permit Nn
NIA
Zoning District
00-0775
R1
Legal Description-L.7 _ HI.. TCtIDJLRTT.T. l1TFTR ~
Owner of Building
cite Address 14338 DOVE COURT NORTHEAST
6TH ST.. ]ou,.JUu<J). MN 55049
Contractor'sName&Addres. C&K HOME BUILDERS. 2849 NW
ROBERT D. HUTCHINS 0....-:.u
//1 City Planner
~i?n~ t;aJ I
DON RYE
Date:
Date:
5(, ~ :?--O/
/)oue ci+--
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
It; 3ak
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING 0 PLUMBING RI
o FOUNDATION 0 MECH RI
o FRAMING ;(f)' 0 WATER HOOKUP
~ INSULATION 0 SEWER HOOKUP
FINAL c 0 PLUMBING FINAL
SITE INSPECTION 0 MECH FINAL
COMMENTS: ~/ T
_ (jlfI~ -
(~'-~!U~ ~
Il!/ I
I>
"t~;'
l"
Al
,(if"
DATE TIME
ItT
r)-77c..,-
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
>-.
r/ .~\
~;)
/
>>ORK SATISFACTORY, PROCEED
(0 VCORRECT ACTION AND PROCEED
o CORRECT WO~ FOR REINSPECTION BEFORE COVERING
Inspector: r JD.., _______ Owner/Contr:
vA '
CALL 447-9850 FORTHE NEXT INSPECTION 24 HOURS IN ADVANCE.
lNSNOTl
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
o FOOTING 0 PLUMBING RI
o FOUNDATION 0 MECH RI
o FRAMING~ 0 WATER HOOKUP
o INSULATIO " ~EWER HOOKUP~
gFINAL I" LUMBING FINAL
o SITE INSF~.. ",;,. MECH FINAL
COMMENTS(/} ti.J. ~ /J~A'.A--U ~
(.2)) ~~~ fJ~ (J/~ L j~7)
I:Y~ ~, ~I!~ ~~
~"""- ~ I~ ~~ ~ J~
~ ~~.dJ
c1~~.;:~~;)~';if v~--- <h ~vd~-
rJ2 ./~ ~ il7J.=- r ~'!.. .. .~
~ ~~-:$- r~ r(7. c:(~
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
14-33~ DoVe; c:-r
OWNER
CONTR.
PHONE NO.
PERMIT NO.
Inspector:
~.---~.
~ --.:;..------
\:'- ---r;. C.o .
~.
~--
DATE TIME
1.;<:;.00
I: 10
o -775
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
/
8'/1/01:::>
" I.~,~~
"r. () ~
,\.:..,o-t:'I-~
o WORK SATISFAC
Ji CORRECT AC
o CORRECT . CALL FOR REINSPECTION BEFORE COVERING
Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
INSNOTl
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEOULED
ADDRESS
/'i33S D",vt' C r
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
~FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
COMMENTS:
f..'dh ~)l.. I) K-
6>(4// ~ - (:J It
DATE TIME
R -WO( 1/Y7
hl\ -() 11 <;""
)(r"~LLING
. D'cOMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
X.WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
~. ~--
Inspector: ~%.-,"'--~~ontr:
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
lN$NOTl
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS /L.j 3~ 7
J)() t/ 6'
OWNER
CONTR.
PERMIT NO. 0 - 77 ~
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
~
o PLUMBING RI
o MECH RI
)i(WATER HOOKUP
Ji( SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
COMMENTStjil ..t:J....
~~...:..._ J.. r
(ftl) ~.'_. \J~
_ 17........
{I"~
:...,-. .
~.J..
DATE TIME
/d/.;fto 10:3'0
C!.T.
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
~ ' /
fit;:.....,{} {2' ", 0.' c
I '
(l/~ ~ V-o ~
L l{
II 4"AJt: ~U~ ~~
Ij .. S~ A,/, 0">"-- ~ ~6f.....~)
I"~ I ll(.t.."~~~,
v, ~..u ~
N\ ~j, /L.OJ""'; ~-tJ.~ -~
o WORK SATISFACTORY, PROCEED
,ilII 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.
INSNOTJ
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
"'"
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"
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CITY OF PRIOR LAKE Me
16200 Eagle CreekAv. S.E. Pe,mil No.
Prior lake, MN 55372
--
00 '0770
UJ
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CD
HEATING APPLICAnON f PERMIT
\ I;" ~,. Ov
lti J 'J~
Date
S~e Address
LOI _ Block
Ownef. Name
Address
Healing Contraclo,
Address 1 ~
.
T &/ep/lone 1/
PIO.
~
c..T
Ada ilion
c::. - VV\..
\-10 ~
v \ ~~ ri r~/,..-..A-
~ 4-v
rll--Q4.
IJI-
I S"I
Y'--/a
5 G:.tO
Furnace Malle & Model rv\c(res......,..
ModerSize 0"-16. t'( ,~
llJ Conn. load
u
<I Nc....-f'"
..J Fuel Flue Size
(l.
llJ
'" Supply Opening.
-
LL
'" Return Openings
u
llJ
'"
llJ Input Output
::>
Ed,.
Clm.
IS>
IS>
;;. Alterations
"'"
Repail
"'"
IS>
re Est. Cost $
I .
If)
'T' HEA Tlf'o,IG PERMiT FEE $
z
g STATE SURCHARGE ,_
TOTAL PERMITFEES $
AlA CONDmONER'UNITS CANNOT
. ENCROACH INTO SlDEYARO SETBACKS.
TYPE OF SYSTEM
Warm Air Plants
. G,avity
Mechanical
Air Conditlonino
'-Veni. Syslem
HEATING OR POWER PLANT
Steam
. HofWater .
Radiation
Special Devices
OlIler Devices
TYPE OF WORK
Replacement
New ConSlruction
. Est. Comp. Date
_ Bui/ding Perm~ .
,50
Receipt
TYPE OF STRUCTURj;
L&k
2, Grete
J. Ycl(llW
"'"
IS>
Fa. (l.
Ci., ...J
COfUra!:tGla:
f-
a
f-
Single Family
Commercial
X-
_ Two-Famity
Industrial
. Other
_ Multi-Femily _
Public
Fee Schedule
Industrial, COmmercial & Mulli-Famoy
ResidOlllial, Heating & AC
Residential, Healing Only
Residential, Gas Rreplece
Residenlial, Add~;ons & Anerations
Residential, AC Only
1 % 01 job cost ($39.50 minimum)
$99.50
$64,50
$39.SO
$39.SO
$39.50
Remembe,lo add the Slale Surcharge on the bottom otthis applicalion.
The price DI your healing permit inclUdes one ,ough-in and one final inspeC'lion.
Additional inspeC'llons will be bined at $35.00 each.
House Healing Tesl Rocold must be submitted wilh l!YiliIing, llB!llli! ~ belore bu~d-
ing celliffcate 01 occupancy will be issued. .
HfAI CALCULATIONS REOUIRED with number 01 supply and return openil1!li lisled per
room with CFM's per opening. New structures or addilions send ffoor pran with supply
and return locations shown. HEAT LOSS CALCUlATIONS. PAYMENT AND
APPLICATIONS MAY BE MAILED TO THE CITY OF PRIOR LAKE, 16200 EAGlE
CREEK AVE. S.E. PRIOR LAKE, MN 55372.
C~y Hall business hours are B a.m. .4:30 p.m.
All WORK MUST BE INSPECTEO (ROUGH-IN AND FINAL) _ CALL CITY HALL
Phone: (952) 447~50
Fax: (952) 447-4245
if hereby apply for a mechanical systems permit antf f acknowledge that lhe
. inlormation above is complete and accurate; lhal the Work will be in conlolmellce
with lhe ordinances and codes of Ihe cily and with the state building/mechanical
codes; Ihallh;s form does no! become a permit unlll signed by the BUilDING
OFFICIAL; that!he work will be in accordance with the approved plan In the
case 01 all work WhiCh requires review and approval 01 plans.
A--~
Blil\flng Olllcal's SionaturA
(J - $-of)
Oate
1-1'0 J
CITY OF PRIOR LAKE Me
1UOO Eagle CreekAv. S.E, Permit No. 00 - 0/1 S-
Prior Lake, MN 55372
Return Op.nings
'"
::I'PlJ1 1CJ:l, 0l)'lI
o
god,.
w
t.1m.
HEATING OR POWER PLANT
Sle;!m
Hot WE'
Radiallon .
Spedal Devices
OLllpUl
Q,:,,'~
\ SSt::.
OIlier DeVices
TYPE OF WORK .
Replacement 'New ~n~lUcIion X
E
<I
~ltaralions
m .
nepalr EaL Comp. Dale
~sLCosI$ ~ ~~('\ ~ BlIJlcIlngPellllU
IS)
OJ
...; EATING PERMIT FEE S
['1
~TA1C SURCIWlGE S
o .
TOTAL PERMIT FEES S
()~ - <::':I'I \
PAID WITH
It.~ PERMIT
.50
Receipl'
. t
.,
.1
TYPE OF STRUCTUR~
LPIAl
2.r-.
3. YdlDW
I'll<
Cloy
Coancom
Single Family
Commercial
~
_ Muil~Family
Public OIhe.
Two.Famiy
Induslrial
Fee Schedule
Industrial. Commercial &. Mufti-Family
Resklentia~ Heating &. AC
Residential, Heating Only
Reslclential, Gas Fireplace
Residential, Addilions &. Altelillions
Residentfal, AC Only
1%'01 jttb cost 1539.50 minimum)
599.50 PLEASE NOTE:
S64.50 Air Conditioner Units Canne
S39.50 Encroach Into Required Side
539.5C Yani Setbacks.
$39.5C
Remember to adcIlh. Slate Surcharge on !he bollom 01 this applcalion.
The price 01 your healing permit includes on. rough-in and one final inspection.
Addltionallnspeclions wil be biDed at 535.00 each.
House Heating Tesl Record mus! be submftted with.llllitm!lg I!I!!I!iI DII!!Ilm before bufld.
ing cel'lilical& of occupancy wiD be issued.
I:lfAt CALCULATIONS REOUIRED with number oj supply anclrebJrn openings Islee! per
mom wl!h CFM's per opening. New structures or addijions send loor plan with supply
and ,eklm loeatJons shown. HOO LOSS CALCUlATIONS, ~YMENT AND
APPLICATIONS MAY BE MAfL.ED TO TI-lE CITY OF PRIOR LAKE. 16200 EAGLE
CREEK AVE. S.E. PRIOR LAKE. MN 55372, .
CiIy Hall business hoUB are 8 a.m. . 4:30 p.m.
All. WORK MUST BE INSPECTED (ROUGH-IN AND FlNAL)- CAll. CITY HALL
447.-sa AAIC lf47- *z.t+5"
I hereby apply to, a mechanical systems permit and I acknowledge !hat the
in [ormation above I. complete and accurate; lhat Ihe work willl>e in cOlllollllance
with the o,dinancl!s.and coelas 01 Ihe ~ and with the state bullding/mechallic;al
codes; that thIS form does not become a permil until signed by Ihe BUIlDING
OFFICIAL; thaI the wo,k will be in acconlance wilh the approved plen in \he
cue 01 all work which ,equi,.. review and app,oval 01 plans.
\\), S\- G\)
Dale ~
/tJ~3-I..v'-'
Oal&
~o.~ '" f~~
AppJicW'lrs ~~re .
( nJ--/
Building Offica~ Signature
i
I
OJi31ill~
WEP US:24 FAX ol:.4j~:iS
[['n: OF PIlIol!. UIl:E
JgJOl!L
laIo01
09/05/00 TUE 07:56 FAX 7638621223
JD Excavating, Inc.
_.N..
...a.....~r
'l!!iM.a-....
II~
CIn: OF PRIOR LiU\E
SEWER AND WATER P~~IT
NOTE:
s.w.No..DO.0775"
SeWer and Water
contractors _uet
ge re9istered
with t.lte City.
)( APPLICANT: :r D EXCFI V AI/ N C-, . IN C . ,.. PHONE: r(, -,- - 43 'is 2..
)I. ADDRESs; 11-42- -12>2ND AVE,. COON KI'TPlb'DATE:
,.; SIGNi\TURE: ~l"".". \~..:u ~ BLDG. PERMIT' (JO-0775
X SITE ADDRESS: \.\..1 ~~q, ~. "b--, prDf
2.
Size or water service
inch (es) .
c.SEP - 6 mJ
1.
FILL IN THE B~NKS
Estimated length o~ yater ser~ice f)()
] .
Location of any ~ouplinqs from structure
faat.
II.
i.0,
I
J
4. Type ot sewer pipe. ABS
PVc X
Cast Iron
5. Estimated length of sewer line f)()
teet.
6. clean out {it re:;uired}, located at
structure.
reet
from
:::-::==lJiIJ::=.t ::,-::'::"i~ _~-~
~===-"'=="-"''''--~IJ~:_- ----......,=. --==-==- ------=--"'=~-- - .=-=
FEES: $ 35.00 Sewer and water line connection p~rmit.
:s_ .50 Surdlarge
$' 35.50 TOTAL
*
Fee for either sewer or water individually is $20.00 plus
$ .50 surcharge. --
.
Sewer and water permits issued for new construotion must be
recoraea on the buildin9 p<<rmit c~rQ .~ thp. t!~~ Qf i~.uance
to insure that no Qup11cate sewer and water permih$ arM
issuect . f .,::::~"'ERtA\i
DATE PAID AMOUNT PAID
RECEIPT it REC'D BY .
16200 Eagle Creek Av. S.E.. Prior Lalce. Minncsaril 55372/ Pb. (612) 447-4230/ FAX (612) 447-4245
An Equnl o,.,.onuniLy ErnP"'J~'
..----
I..... Pit-
L..... 0.,
" Y_lJDw AfpIJ_
PPNo.()6-775"
PhOn..qCS -;} -Y41-~7 34
"rlO\'" L~~
CITY OF PRIOR LAKE
PLUIIBING PERM"
Appllcam' '5~~a..\'" ~\Umbi[\a
AddJ --; I...\.~CO ~dt(QI"\ Q\~\~ S~
SlgnatuIW: ~ -;T 'tr ~
lApI t ,..,.: Lot '7 Block f
8_ Add,..: \ 4 ~ 3")( \~WJ (ll
au"'noPermu Plo.)5- .~t:/6-0()?-o.
NOTE: TNa permit wi! nor be p ..,. ,. III wttnout complete inlonnalfon,
fllXTUAE UNn'S
n. c.._~.. 'LMI c..."
~~0 S
~ O\'i'(b
Quan!lly
?.
l
l
.cs
I /
-1. I
I
~
~1
Type of Film.....
Ialh Tub wIIh orwtll'loUl ~
DI. , ller
Floor O,.1n
Lavatory (betl'lloom sink)
LM.Indry T,.y (1 or 2 compartment sink)
~rSr.lI
81nk1
k 81nk
Waler e~el (Iollel)
I'IIIC"DULa
IndllMrial. Commeraal & MuIli.F."uty
(1'l1t at /OtI COM. ".SO mInImllm)
Fl....,IlaI. New One & Two Family
FlnldentlaJ. AclcIIIIonI & AIIer1ltlona
8Ia1e SlIrcnarg.
o.,.,,1Ity
SUb-/";)Q h tJil/ /9 ~
Type 01 FiXlu,e
Flaugh-ins
Wa.r Healer
Water Sortner
Stand Pipe (wulling machine)
Sewage Ejector
B8ddt0w Auerl1bly (RPZ. Double Chedl. PVB
&acldlow Aa.embly Tesl
Lilwn Sprinkler
Other
/
/
GFlAND TOTAL
$
$
s
.50
$
TIdI ........ I. .....-I ....... .... Ill..... coadilion Illo< Yid
-, ." ." ,1IlIII ca....)' iit 0/1 ,.,.... .;lIl .... OI'dln_cs
"'.... S- PI........ 0olo IIICI dlo .-~m.nu ~f.
. UCIIIPrNO. jA -,;)'7-<---<--b"TE
~ A~T
CaIIl'aull iNpeclioM 24 bows ill , ,! '" ...
16200 Eqle Creek Av. S.E.. Prior Lake. Minnesora "3721 Ph. (612) 441-4230 1 E'\X (612) 447-424.5
AD Eq.... C.. ,. ... ily Emplayer
r PAID WITH
BUI DING PERMI1
.
PRIOR LAKE
INSPECTION RECORD
Q.i-.
DEPARTMENT OF
BUILDING AND iNSPECTION
SITE ADDRESS 14~-:\~ Uo./e..
NATURE OF WORK' ~l, \ (lc:ni\c;-h
USE OF BUILDING '3~1)
PERMIT NO. -----.iJ[J,(J 17 S DATE ISSUED 8 - 4-~
CONTRACTOR~..L.M I~ PKONe-~? 12-
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTDIl> DATE.
~I ?t?f4n
, FOUNDATION (Prior to Backfill) ~~ bf) I iO I ~/ /J'&
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SHiNED
ROUGH - I}.JS
SEWER I WATER I SEPTIC I A,
FRAMING I
INSULATION I
ELECTRICAL I
PLUMBING I "Ifn. / 1/ S ~
HEATING (if reqUired) ~ ~ II /Y/1J-tJ
FIREPLACE . I . ,
GAS LINE AIR TEST ~ f6r. I J//~/trD-tp) -gL-0 (\)).1/00
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I ~fJ~RJ3.. I I
FINALS
GRADING (Prior to Sodding) /l/L3-.f'
BUILDlNG"f.(!.O.~ ~('/~I /ii.. /I~I m,
ELECTRICAL / I'
PLUMBING
HEATING
DO NOT OCCUpy UNTIL ABOVE
NOTICE
, FOOTING
I
~I V~
A1/~~
II/Wu
/
/J
/PJ,
6-14--0/
2f J'op /
I / __~/
I / ..//(/(
HAS BEEN SIGNED
,. ,
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,_ "'lrtl ","all be placed near main entrance.
Call between 8:00 and 9:00 A.M. for all inspections
FOR ALL INSPECTIONS (612) 447-9850