HomeMy WebLinkAboutBuilding Permit 00-0833
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
ADDITION
14. OWNER (Nam.) (Addr.ss) (Tel. No.)
15. ARCHITECT (Name) (Address) (Tel. No.)
16. BUILDER (Name) (Address) (Tel. No.) 15. NUMBER OF OCCUPANTS OR SEATS
N::Jvak-F.laX, In::., f!857 Z63larl PM=. N., Bra:klyn Park, M'l 5:M5 763-424-4955 OCCUPANTS
7. TYPE OF WORK Fireplac8L1 SepticCl Heating 0 Plumbing 0 Reroofing 0 Porch 0 SEATS
New Construction 0 Alterations 0 Addition 0 Finish AtticCJ Residing Cl Finish Basement 0 16. ESTIMATED VALUE
Chimn.yCl Misc. $176,400.
18. PROPERTY AREA OR ACRES 19. PROPERTY DIMENSIONS 110. CULVERT SIZE 17. COMPLETION DATE
Sq. Ft. Width D.pth V.s No ESt. 11/2<XXl
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 1 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
~~d~~d~ ~''ll/.~;celj~ ~~'9f her.by agr.. th.tth. dty OffiC;mr(";.~~j' upon the property to p.rIor n"7 inSr)ons
..-} , I -~ UcenseNo. te
f
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMITVALUATION~
Water Tap ................................... $
Builder's D.posit ............................ $..1..; E'ar'l.~
Other ......................................... $
PaJd T?,D;7~.:~.~~~;.. $ ~:Jj;.4-h
~ A !
Oat. ~. 19--QV Bv _
This is to certify that the request in the above application and accompanying documents is In accordance with the City zonig Ordinance and may proceed requested, This document when
~nner constlutes. t.mporary Cenfficat. of ZOning oomphanoe"Jl'l<llklws constr 10/1 to comm.",e Before occupancy. a Certific:ete of Oooupancy must be issued.
r ~d'--- -M'i/{)tO -s.... //!:,...-4./fI7'^,_~ ~
~8rVner . Date -. SpeclalCci ltion' --.~
24 Hour notice for all inspections 447-4230 9:00 a.m. . 10:00 a.m.
8~ ~CJ-W
DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE ALLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
12. SITE ADDRESS
14402 Raven Court N.E.
3. LEGAL DESCRIPTION
LOT
22
Knob Hill
BLOCK 1
5th Mdition
I SETBACKS: Required
Actual
front
PROPOSED GRADE FOUNDATION
IN RELATION TO CURatoR CROWN
OF STREET
USE OF BUILDING 5FL:>
Baok
TYPE OF CONSTRUCTION: I II III IV V
Occupancy Group A BEl H R M
DMslon1234
P.rmitF..................................... $~,'2(' 7. 7~
Plan Checking F.. ......................... $ R 2. ~
~./!)()
I 60 ,t'Y1')
100 ,f!)f?)
(In .~~
"?S"SO
statesurcharge01,........................ $
~.......f..!'"........................$
9!1'ti!l8,~l~," .H~...................... $
-em.r e...f.'~.................. .......... $
~__._._ ......<3~ ............ $
This
.. -
., Approved,
'7 'If - 'Zr:co
By
Oat.
1. White
2. Pink
3. Yellow
File
City
Applicant
Permit No.
on.oPJ33
1. DATE
8/11/00
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width)
If? I
(Depth)
PID 2.5 ..:~~e. 02.2.- 0
~i~~rj+-
~~J~~hq~IO~,-*
14. FLOOR AREA APPORTioNMENT USE
~
FOR ADMINISTRATIVE USE
tiiae
MATERIAL FILED WITH APPUCATION
SOIL TESTS Cl ENERGV DATA Cl
PILING LOGS c:J PERCOLATION TESTS LI
PLANS & SPECS LJ SETS
::lice
SURVEV
LI COPIES
PLOT PLAN 0
City;
I!t,
Check n Cl
Deferred Cl
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
LicenseCheckFee ......................... $
Pressure Reducer .......................... $
'('5;', 00
B5n.~
/..Jf')('"J,~
I
l
Meter Horn ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $1r-? J'lf) _ t!)l!>
WaterTowerFee ........................... $ 7tA::> .t!> t::!>
/ '2(; . 00
~~
00.0033
Thr {".ntn of Ih. L.k" Country
White . Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
NOVA/C- FLECK-
co-3D-OO
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
/44-02- eA Vf3N c:T
Accepted
Accepted With Corrections '"'"-<--
7L
Date: ~ -/ ';:;bcJc:i>
Comments:
~JQ~
-
I-I-JI-'-J~
"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."
'5~~
Th..('..nl<'roflh..l.ak..Country
OO'O~33
White . Building
Canary . Engineering
Pink . Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
,/l (I rJ K. [/ /~.. 'J/
I <.. '-- __,/<--
~" - _-= C /
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
.////'/J,,/ ,.,
-'f . ____ /'...llvt.,-.J
......'. f
Accepted
Accepted With Corrections
v
Denied
Reviewed By: ~A~ ~~
Comments:
~ /..0 <iP <;"il&.Q ?wU'/1 .fhI:#-O ~
{J..-uv ~J ~ t.A fV/~~ ;; ~3 F'"
\fvy~ 'A. ~.t...&,- ru\~ ~ L '-<_/P9TI'~.
.A1-iYr~ '.
4/L~9~~ ~~~
~ \?.v\UlV\'(~ T~B./1~ 'S~ ~/1 5D~.
Date:
q Ilt{/ &:>
"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."
While - Building
Canary - Engineering
Pink - Planning
Thr Crnlrr of lhr lIkr Country
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
,A (; 1//7 t::-
o_ ? 0
U .......:.- -
F(...EC/C_
00
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
144()L K/ll/E;0 CT
Accepted
./
Accepted With Corrections
Denied
Reviewed By:
Comments: -'s'PA -If" rpl/"at!:.
(}''dIi ~,.;"lJh
.<) ;;Ie
Date: ~~k
/.u/o{~"/7<</ ~n1I"hd/1_
~
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~p alkt1k1Mk: I. 1'iq,,1 ~n~ MJHt'A;,,, --t(/JrPJ"h~,. .2 44/k
.3 b-As//Jn (kh/ ~S'I/'#'f" /f ,L:n5kHf ~d/ d~
"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."
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Conlt1lelot
CITY OF PRIOR LAKE
16200 Elgie Crull Av. S.E. Permit No.
Prllll'L.... MN 55372
0- 133
TYPE OF STRUCT~
'{
Single Family
Commercial
HEAl1NO APPUCATION I PERMIT
O8Ie x:b;;;. J t"",C\ PIO. 2~'" 7J/.oc;." D (J-'J-- b
SReAcfdrelS JL1LfO;:1 f(.Gr -r?11 LCxH+ ~E
Lo! ~ Block --1- Add_Ion \C., (\j-<h I-\-) II S-'H'\ r1 & &;vv
OVlnefsName A' /-t.:o): - c~k
Addle.. ~ ?t?r-/cnd.4"
lWo-Family
Industrial
MuIII-Famlly _
Olher
Pulllic
Fee Scheelule
I nduslrlel. Commercial & Mufti-Family
Residential, Healing & AC
Resldentlel, Hellllng Only
Residenllal. Gas Fireplace
Residential. AddilJons & AlIrallolls
Resldentlel, AC Only
t% 01 job cosl ($39_5Cl minimum)
$99.50 ~/
@ @ 1J3!l/\ \i '.
.~ '1,1"
50 \\ \\\,
1\:. ~ 1t - III)!\
1\11 ~\/
'.!I
AemBmber 10 add !he Slale Sure"."'" on the b I 'on. ..
.,... ',' \.>- ..--------
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The price 01 your healing pennlt Includes ona IOUgn-fn end ona flnallnspeclion.
Addlllonallnspeclione will be billed.. $3&.00 eacIl.
Houae HealWlg Teal Record musf be Sllbmltfed with Jwillaag llmDiIlllIlIlIlI.r beloll! build-
Ing cer6c818 of ocoupancy win be lasueel.
I:IJ;AI CALCULATIONS REQUIRED wiIh number 01 aupply and relum operings lisled per
room wilh CFM'a per opening. New slruclures Dr addilJons send floor plan wllh supply
and relurn locations shown. HEAT LOSS CALCULATIONS, PAYMENT AND
APPLICATIONS MAY BE MAILEO TO THE CITY OF PRIOR lAKE, 162Cl(i EAGLE
CAEEK AVE. S.E. PAIOR LAKE, MN 55372.
-/). /3,rrr\I::.~{J .far):
R(CCAR HEATINr. R. Alp
2387 COMMERCIAL BLVD. NW
Helling Contr_r
Addre..
~
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, .. ..-'-....,vcn,--JVT1" JJJU'"t
TellJlho'" ,
Furn_ Melee I Model tRheeYrl
ModeISJa Q::':;crz.::, FiLl cn~Ji....
754-4000
01:
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TYPE OF BYSTEM
Warm Ai.Plarlta
Gravity
Mechanical
Air ComIalonlng t;he:E/Y>
Vent. ~......
HEA1INGl OR POWER PLANT
Sleam
Hot Wate,
Radietlon .
Special D',ylc..
Com. Lolld
FII8I Ahf-!:!c" .Flue Size . 2; II
Supp~ Openings I."")
S?
i::
....
u
Return Openings
,"pill c;o (X;O
Output 'FN. CJcX)
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CIIy Hal business houra ara e lI.m . 4:30 p.m.
Other De~lc.. t}" Fv Ar~,~. ALL WORK MUST BE INSPECTED (ROUOIf-IN AND FINAL) - CALL CITY HALL
1./.l/i/YCr ('cn~,faHk). i. 51 0b1o"~ ) 447-42l1O
TYPE OF WORK
Edr.
elm.
~
I hereby apply lor a mechanical syslems permll and I acknowledge lhat Ihe
Inlol " . above ia oomplele and aocurale; thatlhe wo.k will be In oonformance
wilt> the o.dlnancas and oodes ..I tho cily and with the alale building/mechanic.
codes; Ihatlhia form does not become a permil until algnad by tile BUILDING
OFFICIAL; lhallha work wi' b. In accordance wllh the approved plan In the
caae 01 all work which requl.as review and approval of plans.
(J11~
qd:hnraM:;~
,; ~g Ollie81's Slgnll1ure
Ahrallon.
Repair
Est. Coil'
Hl:ATING PEAMIT FEE $
STATE SURCHARGE ,
TOTAL PEFlMlT FEES S
x
Aeplacement
New ConnucIlon
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e.l. Comp. OllIe
IMdinll Perrni . ,
..
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PAID WITH
BUILDING PERMIT
,
c--\Jrpd
;;:/;)~b
.. Dole
t! v 8-/ - ot>
Oale
..
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.50
Aeceipt.
I
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F,'ftc- plAtt"
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CITY OF PRIOR LAKE
lIZDD Eallll er.k At. S.E Permil No.
Prior Lau, a.w 5!D72
()~713
III
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III
8
I-
Auasaa
SupplJep.nna. .
"-IumOpMll",. ,
......:l',.,.... .OIllpUl
Edr.
elm,
"5 rJ'l.t
TlPEOf........M
Wwm ArPI..1s ,
GlIlvity
MlChlllill
AllCa "I,.,
V.nl. ~am
HQWCOR,OWERPUUff
.SlIlm
Ho: w...
Rldlaler
Sp.dll Caval
OIIa, DlIas
Ahrallanl ,
Ra,,_manl
"Pi OF WORK
Hili ::Onllluc:llan
/
a:
iil~'" lal Camp. D.a
.. -ilj-- -- -. E& QIII' ..-----.-- -.--:-Bulldlllf-Parmll.--..- =
I HEA11NG PEIMITfEE 1- /. ~
/' STATE SURCHAR3E I / .50
, TOTAL PEM FI~ A.cllp!'_
.--.~-..,-
PAID Willi
BUILDING PERMIT
1VPE OEJiJRUC~
Singla Family
Cll~al
_ lWo-Flmlly
Induslrlal
Fel Schaclula
Industrial, Commln:ial & MulU-Famfty
RealdenUal, Haeting a IIC
Raldlnall, Haaling Only
Aeslden"I, GIS Fireplace
AntlllnO". Addillons & AllsraUons
Relldandal, AC Only
I. PI.\ Filo
1. GUll ai'
1. Yell_ CaIIr.'.
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$31 !
13! !
sat:sO
IIOV -, am
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Addrl"
HI-'ConIratOI ~,I'; HPI,4-t.e:r! f,ir<fllcfJ
MhU~~'J ~J4-. S~. ~o.l~. fWJ
T, , ,II' ~'1..,-r;Jr'"
~ J'n- w.z:; "'I( 'Urc'+i,.. )
~ . MDdII SIll _ 5S01~
.. CarllLLDad
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Rlmember 10 add Ihe SIIII Surchargl an IhI troIlom ollhls lfIIIIiclllon.
Thl priel al your heeling perm~ Includl' onl lOugh-ln ond ani l..oIlnspedlon.
Addiaanll Inlplcllona will bl billed II $35.00 each.
HIMe Hlallng Teal Rlcord musl be lubmillld wilh IIYikIIDlI RlllllllIUIIIIIII1Ircla11INl~
Ing clrlllCI'1 01 occupancy will bllllUld.
~ r:&l r:ULATIONS RFOUIRED wllh number aI aupply and ilium apa_lllloled ~r
100m wlh CFM'a per ' , . I' Nlw "Nelllrel or oddllOnl IInd 11- pllIl will lupplt
ond ilium I_"ona shown. HEAT LOSS CALCULATIONS, ""WENT ANO
APPUCATIONS MAY BEMAlLEOlOTHECITYOFPRIORLAKE.Ie2Ol100LE
CREEK AVE. S.E. PRIOR LAKE, MN 55372.
CIIy HIli bulln"l IlOUII are 8 a.m. . 4:30 p.m.
ALL WORK MUST BE INSPECTED IROUGH-IN AND FINAL). CALL em HALL
,
447-4230
I hereby Ipply lor I mlchlnlcalsysllml permit and I acknawlldgl l'lllhl
inlormalion IboVI Is Complltl Ind Iccurall; Ihallha wark will bl In co"ermallC'
wllh Ihl ordinances Ind cod.. allhl clly and wllh Ihl Ilall bulldlng/"Ichllllcll
cod..; Ihallhl.~ do.. nol blcome I permit unl" Ilgnld by Ih. BUILDING
OFFICIAL; Iho' wark will bl in Iccordlncl wllh thl approvld pllIlln Ih.
CISI 01 1\1 wor blch ,Iquire. review end approval al planl,
--'---"
~liC.~". SignllUII
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BUilding, Oftlcol'l Slgnllure -
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l. Blue File
2. Gold Ory
3. Yellow AppIiCIUIl
PPND.O- <;;l~ ~
Phone:q~-q~-'7'111
~A.. . '\\'".0 ~s.9-.4.~
, .
CITY OF PRIOR LAKE
PLUMBING PERMIT
APPlica~~{'"~,,", ~.\.....{)' C'O'l.'"ih
Address: tc:;........., ~~... \=l~.-:::t!'."...O
Signature: ~~ !A""-- <;:On..."Jl,-
Legal Description: Lot t J...0l-.. Block..$- (
Site Addresd<\1.i (');l. ~r",,"...... C\..-L N E-- .
Building Permit # PID # ;)5 -3lo8- ();)..J.- 6
NOTE: This permit will not be processed without complete information.
FIXTURE UNITS
TfHo C~ln ld Ihf I..h Coyn,,.,.
Quantity
~.
/
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3~
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Type of Fixture
Quantity
SUb.ka..1-. \l. \ll.- S-tb.
Type of Fixture
Rough-ins
Water Heater
Water Softner
Stand Pipe (washing machine)
Sewage Ejedor
BackilDw Assembly (RPI. Double Check, PVB)
Backflow Assembly Test
Lawn Sprinkler
Other 0( - ';:)\ IIC-oc..\u.
I-rb~&)"'"
I-)~\\~
$
$
$ rd b~
$ .50 &J;t.
Novo1<:- :t\~
$
This permit is granted upon the ex.press condition lhat said
contractor, shall comply i'n all respects with the ordinances
of the State Plumbmg Code and the,amendments thereof
- ~ RECEIPT NO ~/ /f7J DATE
..~ I ATITST
PAlu WI' I-j
BUILDING PERMIT
16200 Eagle Creek Av. S.E., Prior Lake, Minnesota 55372/ Ph. (612) 447-4:30 I FA..X (612) 447-4245
An Equal Opportunity Employer
Bath Tub with or ..:tp,:,yt shower
Ii
J
Dishwasher
Floor Drain
Lavatory (bathroom sink)
Laundry Tray <1 or 2 compartment sink)
Shower Slail
Sinks
Bar Sink
Water Cioset (toilet)
84
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
GRAND TOTAL
II for all inspections 24 hours in ad..ance.
_1.1:. . PILI:
TI:LLOW . """\.tCAn
GOLD. CtT'
CITY OF PRIOR LAKE NO. (')- ~ .32
SEWER AND WATER PERMIT
NOTE: Sewer and Water
contractors must
be registered
with the City.
APPLICAN~Cl~~\ +\h). 0Jl),,, , PHONEf\~-9~~'7'7/'7
ADDRESS:I6C:i:i~\,~\ ~~S- DATE: q-dll.~
SIGNATURE~:"'- _.fOr... ~ BLDG. PERMIT #
SITE ADDRESS: \414~Ko..ven.~-t tJr- PID; ~S-3t..3'-au-O
FILL IN THE BLANKS
1. Estimated length of water service
-'-/r::::
feet.
2. Size of water service
inch(es) .
3. Locati.on of any couplings from structure
feet.
4. Type of sewer pipe. ABS PVC~ Cast Iron
5. Estimated length of sewer line 45 feet.
6. Clean out (if required), located at
structure.
feet
from
==================================================================
This application becomes
BY~O~ E{{]~
your permit when approved.
DATE: q-Ol. g-tJJ
===============================================================::==
~L~
~~L7~ .~
Fee for either sewer or
S .50 surcharge.
35.00
.50
35.50
Sewer and
Surcharge
TOTAL
water line connection perm:t
*
water
individually is S20.00 plus
*
Sewer and water permits issued for new construction must be
recorded on the building permit card at the time of issuance
t6 insure that no duplicate sewer and water PPAftj~THFre
issued. . BUILDING PERMIT
~
/ () / ;;/1 DO
I I
AMOUNT PAID
RIC'D BY r9
(J~
DATE PAID
RICEr PT if
16200 Eagle Creek Av. S.E., Prior Lake, Minnesota 553721 Ph. (612) 447-4230 1 FAX (612) 447-4245
An Equal Opportunity Employer
PRIOR LAKE
INSPECTION RECORD
OJ.
DEPARTMENT OF
BUILDING AND INSPECTION
SITE ADDRESS ~fJ2 ~v'-eJ..A..
NATURE OF WORK k)p",
USE OF BUILDING SF..D
PERMIT NO. ()(). 0 B3-S DATE ISSUED
CONTRACTOR kbt/aK -Hecl '1fs,~f21*~
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
e;;~PECTOR
I FOUNDATION (Prior to Backfill) I 4:A: ~ I <9 - ?/-~~
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
8-4-
i'?:t-,
~,
;, iJ,
~,
(In,
~, /oj?t/tn>
I FOOTING
SEWER I WATER I SEPTIC
FRAMING
INSULATION
ELECTRICAL
PLUMBING
HEATING (if required)
FIREPLACE "r. Ort- ~..,.~
GAS LINE AIR TEST ~
I/~ P6
L-L.- PI3
DATE
I 1//CJ/tft
lI-;).-CJ1)
/~jat,/~ ll-J.-?o
Ij/~ /IJO II-:;'-db
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1~/j.(,Itr4
IJ/;o/n
,
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I~ I I
FINALS
1/~
/ /:x; 01 If);;.,
I
GRADING (Prior to Sodding)
BUILDING -r:c..O. -Wi ?/r/() I t'R-.
ELECTRICAL . ,
PLUMBING
HEATING
DO NOT OCCUPY UNTIL ABOVE HAS
NOTICE
z~
q-/~-ol
9/';/M(
II /~tTl>
I /~i://tJ I
BEEN S(GNED
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 ",hall b.; placed near main entrance.
Call between 8:00 and 9:00 A.M. for all inspections
FOR ALL INSPECTIONS (612) 447-9850
t:'\i .'I~"::"!J~~j~,\~...~h.
i r QLtmfuau of fllctlq1llllry
:~~r CITY OF PRIOR LAKE
i_I ]ljFmol~tpatl:'~~Uo~:, JllBpttlion
(~. _I' ThiSifyC.ertif!.c.ate iSh sued p~,:uant to thh~ requirements ~f Sectil~n 307 ~fh thhe Un.iform dB~iltling Sod he
(1"'..._"1 certl mg tnat at t e nme OJ Issuance t IS structure was m comp lance WIt t e vanous on mances OJ t e
. City of Prior Lake regulating building construction or use, For the follawing:
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Use Classificatiol1'
SINGLE FAMILY
Bldg. Permit N', 00-0833
N/A
R1
Occupancy Type
R3
VN
_Fire Zone
Zoning District
Type Construction
Legal Description
L22, B1, KNOB HILL 5TH ADDITION
Owner of Building
SiteAddress 14402 RAVEN COURT NORTHEAST
Contractor's Name & Address NOVAK-FLEqI<, 8857
ROBERT D. HUTCHINS (rr
< I ~~dJ~ official
r I Ie I
ZEALAND AVE., BROOKLYN PARK, MN 55445
City Planner
DON RYE
Date:
Date:
POST IN A CONSPICUOUS PLACE
,-, ~
ADDRESS
OCCUPANT
HEAT LOSS
SOLD BV
Electrical Work By
TYPE OF HEA T
MAKE
Model
Serial
INPUT
Form 235
I 4 '/02-
alS .
,<.d)v...../--l
HOUSE HEATING TEST RECORD
CITV.
OA TE HTG. INST.
il , " ( 1.:>t:L
_APT. _FLOOR
OWNEP 0nVl)K
rL'.1Z. L~
.SUBURB
.INSTALLED BV _ I) ,-, E,
. Gas Line By \-.. \ 1t--.5' N\.,--
GA_FA~HW_STEAM_SPACE HTR. _UNITHTR. _OTHER_
~'I .~ GAS DESIGN
Irnl-tt'eJllA, ,_ . .
t'U. (lA.~ G'-tt.' L-N~
e:H-~ l \\ l-t'f.3..'.lnM 3l,2{r
'7 n. D[j[)
,
/ "1 DO';: _
(nS-j.",( > 7(...<15U
I,).?~ (.
I.) ,.;ll ) ('1;2.-"'J 6..L
CON~DN
MAKE OF BURNER _ ~
Model ./"
Max. BTU Rating ../'"
MAKE OF FURNA~
Model ./'
Vent Size /' 3 U
KIND OF LINER
Draft Hood
SIZE NONF
Regul",", _illJJ.... IntI:, L
\ 10)1.. 'US:'/-. \ _Numbe, I
Insi~. _' Outside
\VVC,
,/ , CONTROLS c
THERMOSTAT J-f~lu. Heat Plug ....... 0
Valve Il1 J..~
Limit 'pr0
Li mi t Setting
Fan Setting
Pilot Type
Pi lot Make
Pilot Model Smoke Bomb
Pilot Timing----L:>:)rr-.> 7.~ Draft
L. W. Cut Off _ Door Pressure__
P,ossu,e. ?j. < iI'~.cent CO2 --i:f~~ Date Tested
Input CFH ?rLIi.'(l'i~j Percent 0 _ . rJ~ Company Testing
I'D on~ 2 r>.<'l
Stack Temp. __ 'l.....-r Percent CO c..... n Name of Tester
Fi It.rs Size
Ch imney Location
Chimney Construction
Wiring _
_Test Tag
_ Lighting Inst.
I I vI y, --lJD
v f._Ie fAXL.
_ \ Ll...)\,,,z,\j) i7
Form # 5
DATE TIME
CITY OF PRIOR LAKE I - ~5-01
INSPECTION NOTICE -SCHEDULED ~:oo
ADDRESS IL.{~ ()') Qt') Ue '^ C+-
OWNER CONTR.
PHONE NO. PERMIT NO. D-(JR~\
o FOOTING 0 PLUMBING RI
o FOUNDATION 0 MECH RI
o FRAMING @ 0 WATER HOOKUP
o INSULATION 0 SEWER HOOKUP
.s FINAL 0 PLUMBING FIN~
'1' SITE INSPECTI f< MECH FINAL \.!9
COMMENTS: ~IA.~.
!J) ~ ~ ,fflLli, ~~(~
~ ~ha'~.ojj -11 ~ er -k ~-
~ ~ U~~ ~ .
'M[l~ ~./\~~~4~.~'
ft}/l,,",,~A.f/Pyt
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
._----''"'''"'--
,..;. --- ------
. -........ -----....
T C-, (!), -ti..lJ B/ [ { 0 I "'
.. -~
~
. .~
o WORK SATISFACTORV, PROCEED
'/J- 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 & SAFETY/
INSNOTI
SCHEDULED /I/~;I~
KA-J67V ~fl
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
/Lf"'/OZ-
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
~ WATER HOOKUP
lif SEWER HOOKUP
tJ PLUMBING FINAL
o MECH FINAL
COMMENTS:
(~.
f
L
\
\y~"'
j
DATE TIME
/(): :$0
o - 8'3~
o EX/GRAD/FilLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
/
~$
I
I
I
\.
\ /
......
/4.-
LK SATISFACTORV, PROCEED
o CORRECT ACTIO~~PROCEED
o CORRECT W~rJ' A FO INSPECTION BEFORE COVERING
Inspector: --f_.. Owner/Contr:
CAll 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
INSNOTl
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
DATE TIME
CITY OF PRIOR LAKE IIJ-ff/1J1J II: go
INSPECTION NOTICE SCHEOULEO
, .
AOORESS It..JLlrJ 2 ;? rh/erJ cr.
OWNER CONTR.
PHONE NO. PERMIT NO. t) -.P33
o FOOTING 0 PLUMBING RI
o FOUNDATION 0 MECH RI
o FRAMING ~ J WATER HOOKUP
o INSULATION J SEWER HOOKUP
o FINAL ;t:: PLUMBING FINAL
o SITE INSPECTIO '0 MECH FINAL '
o EXlGRAD/FILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
COMMENTS: 0 ~..O~ ;t;;.. l-;::;jy
(E>> j/. I-:-:t:i, ~!' .A~
~, I&'~~ ~ (J~, r
@ fJLd-, ~ r l~fWto~
f-~
l.t.1"r ~
IJJ"[JJJI. Moli/U .!..
rvv~-~r
o WORK SATISFACTORV, PROCEED
~ CORRECT ACTION AND PROCEED
:S::~O:ECT WO~~ FOR REINS::::::::FORE COVERING
;;.
,
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY/
INSNOTl
9--/2~ )
J:? cvJC-l0C:t-
IJIPU'1t--- f/<<-K
()- R33
CITY OF PRIOR LAKE
INSPECTION NOTICE
v~
SCHEDULED
ADDRESS
} LjUO;::)..
OWNER
CONTR.
PHONE NO.
PERMIT NO.
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
o PLUMBING FINAL
o MECH FINAL
COMMENTS:
LJrlo $ox -0 K...
17/"..,1-<. - D t
DATE
TIME
>> EXIGRAD/FILLlNG
"ct- COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
)( WORK SATISFACTORV, PROCEED
, D1:0RRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
~_' "":
Inspector:/d~ Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
INSNOTl
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!