HomeMy WebLinkAboutBldg Perm 00-0781;FP 00-0991
~~!,~ ~:~:uUi'J'M~E!~:~;}~;OF
c \ A ~ UTILITY CONNECTION PERMIT
1. DATE
t. White
2. Pink
3. Yellow
File
City
Applicant
Permit No.
C/)-()7f3/
DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FI~~t:;j ;;~
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
12 SITE A\D~S~ q I
3. LEGAL DESCRIPTION
::,
1\.) \ ?t,-\-\ "(llf~
:5
L1~
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NC@
PID as - 3'-d -oaq -c)
f.\ d rL\
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BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
12. NO. OF STORIES
LOT
BLOCK
~Nih \\1 \ \
13. TYPE OF CONSTRUCTION
ADDITION
14. OWNER (Name)
O'1f'1 "" 5h':'>
5. ARCHITECT (Name)
F r e/ '5 /J ,0<; ;C-./A
6. BUILDER (Name) ....-
(Address)
,,:;. , //:,,o.r:r
(Address) (Tel. No.)
( C NCQ,-D't#u7~;- P":~~~L~A->,o)
(Address) (Tel. No.) 15. NUMBER OF OCCUPANTS OR SEATS
'1t'.{"/ r4<e /5 .or ~~"~."",,. OCCUPANT~
5!o4,P'€e ';-S37'7 ~'" - ~q.;... /"'./'4'
Septic 0 Deck 0 As-roofing 0 Porch 0 j
Addition D Finish Anie LI Rs-siding D Finish Basement 0
(Tel. No.)
14. FLOOR AREA APPORTIONMENT USE
.~.-
1Z.?<t b(,i."t/"?
7. TYPE OF war
New Construction
Chimney LJ Mis.
lB. PROPERTY AREA OR ACRES 19. PROPERTY DIMENSIONS 110. CULVERT SIZE
Sq. Ft. Width Depth Yes No
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 J 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
~Uildi~;:car;l i' 7=nnit for just cause. Furthermore, I hereby agree that the city Off~ L a 9bee may enter upon the property to p~r~~~ections.
Signature . License No. Date
Fireplace 0
Alterations 0
SEATS
16. PROJECT COSTNALUE
---
17. COMPLETION DATE
/
/
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
Front
MATERIAL FILED WITH APPLICATION
Back Side Side SOIL TESTS 0 ENERGY DATA 0
OFF STREET PARKING PILING LOGS 0 PERCOLATION TESTS 0
SPACES REO. PLANS & SPECS 0 SETS
SPACES ON PLAN SURVEY 0 COPIES
PERMIT VALUATION , 3'1: "Ot'). C":)~ PLOT PLAN 0
BUILDING DEPARTMENT VALUATION
USE OF BUILDING ---:::;- r D
TYPE OF CONSTRUCTION: I II III IV V
Occupancy Group A B E F HIM R
Division 1 2 3 4
S U
City:
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
R~.~
I, I ('),.., r<V'\
Permit Fee. .................................. $
I.07~. Ze;-
o (..,~ . '7 f,
rde,. SO
Plan Check Fee ............................. $
State Surcharge ............................. $
Penalty ....................................... <t
Plumbing Permit Fee ....................... (t
Mechanical Permit Fee ..................... $
/IM . 0r:J
/tN' . d'O
~., ....,...,
~
!;L" $
Pressure Reducer .~.................... $
Meter Horn ....... .... ........................ $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
l/.6 >;):~__
Sewer & WaterPermil...................... $.
I :.l!. .OD
I, ,<-"0 - ~
76('). rl~
Gas?1t~.......... $
This Ii es uilding permkWhen~P:roVed.
By . Date:2 -~o
I
Certificate of Occupancy
Issued
Water Tap ................................... $
Builders Deposit ............................ $ 1..5m.c.o
Other ......................................... $
Paid T7, 59i...U......~~~~i;llA .t.;~~,Z I
Date e. 3/- 0 U By iffIJ:::;:
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 aJ. requested. This OOcument when
sig~ C~ P.imn~r const~tutes a temporary Certi~,of ~7~Plianc~~~s c struction to c mence. Before occup-!!ncy, a ~ficaulol Occupancy must be issued.
,<~1/'. ~ -". _ Ol'?- _... lj;>--r;'~~""
cly Planner Dale - - , Sial C dilions ~ any -
24 hour notice for all inspections (952) 447.9850
.
~~
aO ~orf I
Th..C,.nleroflh..l..k..Counlry
White . Building
Canary . Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
T()(y\ \\fi\lf\e.
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i .
, ), LA )(~ I )...xi-
,
1- \
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( ("YI\-"", ~.
""lor)
C'...::/ l./ ....._
APPLICATION RECEIVED
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
\ LILjq \ t\l IS"\hr:SAt J (.11" (G- r,Jr
Accepted
Accepted With Corrections ~
Denied
Reviewed B~(': .' .,...-z-
Date:
~'3/~
Comments:
~t..{ A- ~~ IM.U.M. vJvr.LU-eu ~_ u,~ ~
<fT~{r~i (~-.J-~f a..DeW r; C46,
,--)"F, ~ ~lZl-1 S,.,~ Q
~~ r ff (~ , / - - -
.-..
"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."
~
~~
tl?-7f/ ~~
Thr (~..nln of th.. Lak.. Country
White - Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
\ (") (Y) ~ \ r1\e__ C (J(\.'" t.
APPLICATION RECEIVED {1u }('t.\~ \C::;-\ ~()UU
a ~
T'(Bu~alng,t,Engineering",and Planning b~~artments have reviewed the building permit
applicati9n for construction activity which is P\l0posed at:
\ LI-4q \ \\)~tg L (A r rJ..L.. 1\JF
Accepted . / Accepted With Corrections
NAME OF APPLICANT
Denied
Reviewed By:
Comments: 5ef.
Grant far/snn
fAf I'fPl/{?,se s-/ck
Date: ~kb
;;r Ildtli,//t:lI/;';:n1tpI,Jd_
,
....
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.-
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See a#a.cJ...,vw Is: I. hnctl Gro.de :r:;,y>~('-h~ :r;,-krlf14-&"""" c:::r? G~ .P/<U1-
3. J;:rL')!; idYl (1Mrl-roll1po5:ur~.s L/: ~7?H'/__ a~/p~~
"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~f,r 37L c;
,/
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,
~~
White - Building
Canary - Engineering
Pink - Planning
Thf("t'ol..rof Ih.. L8bCounlry
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
\C\fY\ ~~<,J.
(lLl ~ \), ~UU
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
, ~Llq \ 1\) 'Jh,iifYjl1tL C J r--r ~ f\JF
Accepted
Accepted With Corrections
><
Denied
~
Date: S .2"5-2000
Reviewed By:
f2::/s~i N~
J _
~ ~--:iL
"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."
Q!:trtiftc8U nt\ ODcmpanry
CII i OF PRIOR LAKE
J)tpartmtnt of .uilbinll Jn~ptdion
~Final Permitted D Conditional C.O. Expires
This Certijicau issued pursUQ1lt to rM requirements of Section 307 of tM Uniform Building Code
certifying that at tM time of issUQ1lce this structure was in compliance with tM various ordinances of tM
City of Prior Lake regulating building construction or use. For tM following:
Use Classificatiol't
SINGLE FAl-lTLY
Bldg. Pcnni.No. nO-07R 1
LegallJescriplioo
R3 Type Constroctioo VN _ Fire Zone N j A
L3. 1\3. KNOi> HILL FOURTH ADDN
Zonins District
Occuponcy Type
Owner of Building
Site Address
14491 NIGHTINGALE CIR.CLE
Contractor's Name & Addrcu'fOH I:lOLHE. 447
R.OBERT D. l!UTCHINS~/-"
Buildj"BOlficial
r; I rjl () I
THEIS DR.. SHAKOPEE. MN
5517g
. ~ily PIanocr
Date:
DON RYE
Dare:
POST IN A CONSPICUOUS PLACE
,
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7-,) -0 J
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/LjL(9/ ~~~O-
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CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
OWNER
PHONE NO.
PERMIT NO.
o FOOTING 0 PLUMBING RI
o FOUNDATION 0 MECH RI
o FRAMING ~ 0 WATER HOOKUP
o INSULATION 0 SEWER HOOKUP
)IIl1 FINAL 0 PLUMBING FINAL
o SITE INSPECTI 0 MECH FINAL
COMMENTS: ~. f- /
DATE
TifT
o EXIGRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
~~ l~ OAIlJ ~,
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Sr-w..
~:)z-_.- '190 - 3iG.S
)\ WORK SATISFACTORY, PROCEED
10 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
BVRNSVILLE
Heating & Air Conditioning, Inc.
12481 Rhode l,fmuj Av<. So.. Savag., MN 55378 . 894.0005
.'
Orstat Test Report for Jobl I JzJ
Address I V(9 ) ;v/~h/.. -r;~ It! City_/? ~ ,
Occupant 6 J '- (t f.e.,- }
Da1eof Inslall /1/20/60
Type of HT. F/A V HW Space HT Unit HT
Other
Make UnYJOX
Model 6, 2t. (l ~ -7,,"'-
Serial 57300"- I ~ .:lV'!
Input 7)'00()
Pilot Type II/.!
Pressure '3. ~
InputCFH 7J:ootJ
S1ackTemp liD
Da1e Tested J/ It r); 0
Company i? I/I)~ I/~ 1-41t
NameofTester VI ~
C02 j--, <j
02 (, )
CO t:>
f
.
,
t-..
..
,.
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
rz..ZI.OO 2.',cJD
OWNER
144-'1 r N (G H-11 tJq M .E
CONTR.
ADDRESS
PHONE NO.
PERMIT NO.
() - 78 I
o FOOTING 0 PLUMBING RI 0 EX/GRAD/FILLING
o FOUNDATION 0 MECH RI 0 COMPLAINT
o FRAMING 0 WATER HOOKUP 0 FIREPLACE RI
o INSULATIONAP'l 0 SEWER HOOKUP 0 FIREPLACE FINAL
b{ FINAL CV,iJ 0 PLUMBING FINAL 0 GASLlNE AIR TST
10 SITE INSPECTION f\!:Y)liI MECH FINAL 0
COMMENTS:{fi~~ /lAAA.f,.n7 ~
~.~~,' ~__ -q( ~ .t. ~
=ffr (;"f <' ~ ~ ~ ~" - f-J
[!iJJ '!!rid/? ~ ~ b~ .~J (';
~~
6Jl).I.i- '-<ffL cJ~~ k;-O, .
@5/~~' .L'J1<-.~
~~ ~, r_, ~ .,J /.i~',~, ~1..L..c,
...........
/1 /f) / )
. I ______
,.~~~"-
- MuJ.- ~
--,-
~
T ('~. ()
~
o WORK SATISFACTORY, PROCEED
)llI 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..
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
INSNOTl
DATE TIME
SCHEDULED ~ q: 5"0
tJ~~ 6-1.,
1/ CJ
CONTR,
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
/LfL/CJ /
OWNER
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION {M
o FINAL
o SITE INSPECTIO .
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
)5 PLUMBING FINAL
o MECH FINAL
COMMENTS: (i'JJ ~..--..x
~
Ii
C) - ~n
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
~
MOJlP ~.
~ III~,~, _~,
o WORK SATISFACTORY, PROCEED
,A CORRECT ACTION AND PROCEED
o CORRECT WORK. CALL FOR REINSPECTION BEFORE COVERING
Inspector: ~J Owner/Contr:
~ f
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE..
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTl
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS 1'( '19/ fiI,~ h f-/fl!l1 Ie
OWNER CONTR. 7"h,..., 110/ m
PHONE NO. PERMIT NO. _,?(')- 7f{/
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
aJ-.FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
A:(EXlGRADIFILLlNG
. 0 COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
COMMENTS:
LU /I) J;;~,,/ --,/"\ e:...
0rQ&" - (') k:
~ORK SATISFACTORY. PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector:~ ~. Owner/Contr:
gALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE..
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTJ
CITY OF PRIOR LAKE Me
16200 Eag.. CreekAv. S.E. Perm~ No.O ~ 1f? (
Prior Lake. MN 55372
~ ~ HEATING APPLICATION I PERMIT
~ Date Jb-~-~ PID,2~-3.0),-O~q-D
:;: SIte Address 11/..tI1./ nJ< /lth ~ uJ., n y-
o: Lot 2L Block 3 Addftion k~ 0 h'~ H; I t ;.:pt+-, _~ .
~ Owner's Name '-rb lM Wo 1 ~ Co -~l.S t ^-tt... r..h 0 h
0- Addressl/41~~. ~. ~ 5:S-~~'1
Heating Conlracto~~U : ( {'I ~ '\- ~ue..
~ Address l&~~ ~L~ ~(~ L( "~ ~l"A
~ .
all t"":;; {I"'"" , _.-, _._ __ ._
~ Telelli .
~
~
~
_ lone'
':' Furnace Make & ModelU>11/\. ~
Mode/Size (i::l'- -(!jJ ~-.,S-
Conn. Load '"7 ~- 00 0
Fuel 1\ .Gr Flue Size
TYPE OF SYSTEM
Warm Air Plallts
Gravity
Mechanical
Air Conditioning
Vent. System
HEATING OR POWER PLANT
Steam
Hot Waler
Radlatlo n
Special Devices
Supply Openings
IS""
e:;(
Return Openings
~ Input
0-
-<
!I!
w
~ Cfm.
Output
Edr.
Other Devfces
0>
~
z
'"
=>
'"
I
!i Alterations
TYPE OF WORK
R'~"':,a,.',. ,Jnt
. NlIW Construclion
~
Repair
':: Est. Cost $
Est Comp. Date
Building Perm~ ,.
HEATING PERMIT FEE $
Q
:h SrATE SURCHARGE $
~
.
Q
PAID WITH
BUILDING PERMIT
\..
_50
TO'ftIL PERMIT FEES $
Receipllt
TYPE OF STRUCTURE
L Pi.nt
2.0-
J. Yel1lJW
Fil.
0..,
CootncIm
Single Family
Commercial
'I..
M uni-Famlly
Public Other
Two-Family
lnauslrial
Fee Schedule
Indualrial, C., "..."".:"1 & Multi-Family
R88identia~ Heating & AC
Residential, Heating Only
Residential, Gas Fireplace
Flesidential, Mdftions & Merations
Residential, AC Only
c--"; v; ;uu """,; ($39.50 minimum)
~9,50 ./
$64.50
$39.50
$39.50
$39.50
OCT 2 0 2lXXl
L~_.__..._......-' ---- - ----.,./
Re.. , "' 10 add the Slate Surcharge on !he bottom of this aPplication,
._._.____. _._n.____.~__~_
The price of your heating permit includes one rough-in and one finai inspection.
Additional inspections will be bRied al $35.00 each,
House Heating Tes! Reconl must be submilled wfth Il!.!iIlfuJg 1llUI!i1!lll1111mr beto", buHd-
ing certificate 01 occupancy will be issued.
I:I.EAI CALCULATIONS REQUIRED with number of supply and relum openings listed per
room with CFM's per opening. New structures or addMions send lloor plan w~h supply
and ",Iurn loca1ions shown. HEAT LOSS CALCULATIONS, PAYMENT AND
APPLICATIONS MAY BE MAILED 10 THE CITY OF PRIOR LAKE, 16200 EAGLE
CREEK AVE. S.E. PRIOR LAKE, MN ssa7Z.
City Hell business hours are 8 a.m,. 4:30 p,m.
ALL WORK MUST BE INSPECTED (ROUGH-IN AND FINAL) - CALL CITY HALL
447-11850
I hereby applv for a mechanical systems permit and I acknowledge thai fhe
inlormation above is complete and accurate; that the work will be in conformance
with Ihe ordinances and codes of the city and with the slate building/mechanlcal
cod8$; th IS nol become a permil until signed by Ihe BUILDING
OFFI ; tha the work I be in accordance with the approved plan in the
case I all war which re ires review and approval of plans.
1.v~/c:::>O
Oate
/0 - 2)-oU
Dale
-.,....-
AQ?;Z::'/1 ~
BUildB/"Oflical's Signature
CITY OF PRIOR LAKE MC
16200 Eagle Creek Av. S.E. Perm" No.
Prior Lake, MN 55372
HEATING APPLICATION I PERMIT
II. 15 - CO PID# zS - ~z.--:::-Oz.q-o
Date
S"eAddress ~ N(~ H-T1 ~f JF:'
Lot :3 Block 3 Add"ion k:.NOFS I-tl LL. 4--rH
OwnefsName --rofJI H-OLME C'..VN~.
~4-7 THGIS DR..... S~AK:OP6E
Heating Contractor 'v 18~6CJ:::. Fi R-EPLAC'JS'
Address I (g 15...1 MA /1\1 A\)l-:",.~,
(11/2.- 446 - F=;&;LQ
Address
Telephone # .
Furnace Make & Model Ii A ::J"'E$71 c:!....- AIR CONDITIONER UNITS CANNOT
D' I _ I ENCROACH INTO SIDEYARD SETBACKS.
Model Size V 3~D R 1'-1
TYPE OF SYSTEM
Warm Air Plants
Gravity
Mechanical
Air Conditioning
Vent. System
HEATING OR POWER PLANT
Steam
Hot Water
Radiation
Special Devices
Other Devices
Conn. Load
Fuel
AI A"I
Flue Size
Supply Openings .
Return Openings
Input
. Output
Edr.
Cfm.
TYPE OF WORK
Merations
Replacement New Construction
Repair
\
mfiyft -;r ~\
OO,,1'f)
Single Famil X
y.
l. Pink
2. Green
3. Yellow
File
City
Contractor
TYPE OF STRUCTURE
Two-Family
Multi-Family
Other
Commercial
Industrial
Public
Fee Schedule
Industrial, Commercial & Multi-Family
Residential, Heating & AC
Residential, Heating Only
Residential, Gas Fireplace
Residential, Additions & Alterations
Residential, AC Only
1% of job cost ($39,50 minimum)
$99,50
~ PLEASE NOTE: .
$39.5 Air Conditioner Units Cannot
39,50 Encroach Into Required
$39.50 Side Yard Set-Backs
Remember to add the State Surcharge on the bottom of this application,
The price of your heating permit includes one rough-in and one final inspection.
Additional inspections will be billed at $35,00 each.
House Heating Test Record must be submitted with l1lIik!ing ~ !!lIl!lIlm before build-
ing certificate of occupancy will be issued.
!:IfAI CALCULATIONS REQUIRED w"h number of supply and return openings listed per
room with CFM's per opening. New structures or add"ions send floor plan w"h 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,
City Hall business hours are 8 a,m. - 4:30 p.m.
ALL WORK MUST BE INSPECTED (ROUGH-IN AND FINAL) - CALL CITY HALL
Phone:(952)447~
Fex: (952) 447-4245
I hereby apply for a mechanical systems permit and I acknowledge that the
information above is complete and accurate; that the work will be in conformance
with the ordinances and codes of the city and with the state building/mechanical
codes; that this form does not become a permit until signed by the BUILDING
OFFICIAL; that the work will be in accordance with the approved plan in the
of all work which requires review and approval of plans.
Est. Cost $
HEATING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEES $
.50
Receipt #
3B~(P(P
/
~-y~
. App~~~
~j/~'
B~Ollical's Signature
I('/~' <!CJ
Date
/I/~.()O
. Date
Thr ('rnlrr nf thr I.akr Count!)
Quantity
CITY OF PRIOR LAKE
Applicant: r!~BI'P~r::'
Address:~;"7'T //~ .
~~~:t~~:criPtion: . Lot / d~' ~ /~. /,SuJ(/lJo h.H' (I ; ~
Site Address: / 7'79/ N"7'/t~---~ ' . _
Building Permit # PID # ~,) ~ 3bJ. - OiX 'j-L>
NOTE: This permit will not be processed without complete information,
FIXTURE UNITS
Type of Fixture
Quantity
-
y _ (ath TU~h or without shower
Dishwasher
f
/
-3
I
I
{
7
I
Floor Drain
Lavatory (bathroom sink)
Laundry Tray 1JJ or 2 compartment sink)
Shower Stall
Sinks
Bar Sink
..., Water Closet (toilet)
FEE SCHEDULE
Industrial, Commerciai & Muiti-Family
(1% of job cost, $39,50 minimum)
Residential, New One & Two Family
Residential, Additions & Alterations
State Surcharge
$99.50
$39.50
I, Blue File
2. Gold City
pp No. DO: 6~&Y
Phone: </VF-:>-?/7
Type of Fixture
Rough-ins
Water Heater
(
Water Softner
Stand Pipe (washing machine)
Sewage Ejector
Backflow Assembly (RPZ, Double Check, PVB)
Backflow Assembly Test
Lawn Sprinkler
Other
GRAND TOTAL
$
$
$
$
.50
$
This permit is granted upon the express condition that said
contractor, shall comply in all respects with the ordinances
of the State Plumbing Code and the amendments ~~eof.
~ .RECEIPT NO. t6 -::J/~ATE
(..)r( , A TIEST
Call Ul inspections 24 hours in advance.
MID WITH
...... PERMIT
16200 Eagle Creek Av. S.E. Prior Lake, MN 55372 / Ph (612) 447-9850 / FAX (612) 447-4245
An Equal Opportunity Employer
PRIOR LAKE
INSPECTION RECORD
DEPARTMENT OF
BUILDING AND INSPECTION
SITE ADDRESS ill 9 \ N is,^\:."\I\eai. ('l,..-.
NATURE OF WORK .)Jpu~ (\"'~_
USE OF BUILDING Sf="D
PERMIT NO. ()(). () 7 Y; / DATE ISSUED ~ ~ t. <...-~
CONTRACTOR ~I~\III\ \-\-"\IM...t2- 41'\-70"'1
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
SEWER I WATER I SEPTIC
FRAMING
INSULATION
ELECTRICAL
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PLUMBING f/?=r
HEATING (if required) . I?r
FIREPLACE I . ~
GAS LINE AIR TEST ~F.M~~ I (;y 1I/2-/~
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
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FINALS
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I FOOTING ~, ~,~" I 1/ r. /:
I FOUNDATION (Prior to Backfill) I ~ I q (/ q / TD
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN'siGNED
ROUGH - INS
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GRADING (Prior to Sodding)
BUILDING\.t.O.W f?(1!O/ m-,
ELECTRICAL r '
PLUMBING
HEATING
DO NOT
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OCCUPY UNTIL ABOVE HAS
NOTICE
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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, 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