HomeMy WebLinkAboutBuilding Permit 00-0879
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DATE RFCEIVED
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
q.l'l-oo
DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign al bottom)
2. SITE ADDRESS
1. DATE
9""--Y-od
~A /<../
/72 B2-
;/V~
c.A://...<<)I
3. LEGAL DESCRIPTION
12. NO. OF STORIES
"')/
PID ZS-370 -030 - 0
,0
LOT
BLOCK
>!'
13. TYPE OF CONSTRUCTION
/V~ ~~>?'~
14. FLOOR AREA APPORTIONMENT USE
ADDITION
4. OWNER
(Name)
(Address)
(Tel No.)
5. ARCHITECT
(Name)
(Address)
(Tel. No.)
6. BUilDER (Name)
<}.~. )Y",,,,,\,~.,)7'K:'.
(Address) (Tel. No.) ...../
,J-Y,?9 ~/1.6!.>17;v~ ~- d?O,
~.nvv' ~.7/~,;;1 6:17-eMSi15-7/';?S
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
SEATS
16. PROJECT COSTNALUE
7. TYPE OF WORK
New ConstructionK
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES
Sq. Ft.
Fireplace 0
Alterations 0
Septic 0
Addition 0
Deck Q
Finish Attic 0
Ae-roofing 0 Porch 0
Re-siding 0 Finish Basement 0
17. COMPLETION DATE
9. PROPERTY DIMENSIONS
Width Depth
10. CULVERT SIZE
Yes No
I hereby certify that I have furnished information on this application which is to the best 01 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 aU existing state and local laws and will proceed in accordance with submitted plans. I am aware that the
building official can revoke this pe~ lor just caJ:>e. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X ~ \./.J.;z. ~ c>i'~..s6~7 ~-/-r'-ot:/
Y Signature License No. Date
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
MATERIAL FILED WITH APPLICATION
SOIL TESTS
o ENERGY DATA
o
Front
Back
Side
Side
PILING LOGS 0 PERCOLATION TESTS [j
BUILDING DEPARTMENT VALUATION
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PLANS & SPECS 0
SURVEY 0
SETS
COPIES
SFD
USE OF BUILDING
f{.s.ooo.oo
-
PLOT PLAN
o
PERMIT VALVA TION
TYPE OF CONSTRUCTION: I II 111 IV V
Occupancy Group A B E F HIM R S V
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
City:
fJS"IJ .de')
!;I()O.~
Division 1 2 3 4
Permit Fee ................................... $
I,l.\'? . '2 <"'
78l.'H..
S'?SO
Plan Check Fee ............................. $
State Surcharge ............................. $
Penahy .......................... ............. $
Plumbing Permit Fee ....................... $ 100. () 0
Mechanical Permit Fee ..................... $ 100.00
3<;. S-O
C/o '. DO
s/.. $
Pressure Reducer ......l&................ $
Meter Horn ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $ J I
,
WalerTower Fee ........................... $
Water Tap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
Total Due .............................. $
Paid d-- J Receipt No.
~s: 00'
~v~.oo
q'
I 2 t;"". c9C)
?n(") .00
iOd.o C)
our Building Permit ?hen ~pro?ed.
Date - 2 CD- rYI
Date
24 hour notice for aU inspections 447-9850
~\
a(} 6~14
Th"(:"ntnofth"I..bCountry
White . Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
D. ie, I-/O~/()N
r. /~OO
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
WI t-06JeN 6.s.r T7<-.
t. 'I, $ z.. Oe€~E20
Accepted
Accepted With Corrections
D,";ed ~
Reviewed B
~mments:
~ ~ o-fka-l.e..c..l_ ~ ~_ ,,0,- .
Date:
1- z ~ ,? 1':Je;>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."
.~1
06-0611
Th", C",nl... of lhe L.k", Counlry
White - Building
Canary - Engineering
Pink - Planning
NAME OF APPLICANT
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
D. K. I!t/:::;UN
f/dcO
APPLICATION RECEIVED
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
/72-~L IviLC/f),/\cS Tk.
tL/, L:Z i'>Ecf.-fIELL"
Accepted .V" Accepted With Corrections
Denied
Reviewed By: ~~ <!<~ Date: C]('Z-?/(!)(J
Comments:
~~lS2't,.~ ;t,~~~
4''''& ~~JNMuVlU~ti~/~S:=
--4JlDMk t V\ v1-- .. C), t.,J t>r _/>..: ~__
'd~.Pt; ~t<'13UV~~ ~ ~V\.rt~.
~ II-{ ~Slk- (J...~ f!) I LJ f9-tr ~c.~),
~~~v;re:z'~~~~!&bl
"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."
~1
b 0 'O~1q
TIlt Ctflltr or the Lakt COlln11')'
White - Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
D Je _ fIQR-IDN
f / t.j.. 0 ()
APPLICATION RECEIVED
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
t'l,
17J.!:l VVfLOEkI'J6S,r;:
J5 z OE6.K.FIE-t.-L)
TR-.
Accepted
Accepted With Corrections
./
Denied
Reviewed By:
Comments: /)riYRIU'l
e'lvq / h qJr p.
See -lite
!a/te! tle/Jos'A$
Grallt Carlson.
/I" e tis
w/t?e
Date: ~fk
-fa b"" /t!S5 -/l,Q.I( () r-
611 lie LJ"'~er7 ';':d~_
/ /
r.pve,5e sitle ~r dcl'd//;"no/ Ihh;rfl7er-filN(.
I~ -lit kcl rrl k .9/",110/ 4f'c7>/j,~.
See allttdbJp!&: J. h,ullGak -y;,fIJ~e6~/I-~A146<1rL ~.~JtJ h-...
3. Er/J<:i,ut (%,/11/,(;1/ /JIt'lts/{,es 'i 50S/1m- {!;,,,,k/ . .If~
"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."
OCT. 11.2000 4:11PM
GENZ RYAN 6513226147
NO.079--P.2/2---
CITY OF PRIOR-LAKE ~ ~ E&ou,
. PLUMBING PERMIT # P - ~171
Applicant (J-;,Jr\? - tL"'i&iV>;::>fbr/+<<=. Phone: loe;;-r- '-12-3-11 '--lLJ
.A~dress: IUltf~ ,"";p;~rur- ,,0 / ~~ S~O(~
Signature' ~"
"'" D":-', ",- u - ~ ~r"" Z- T":~ "J ~
Site Address: 1729. 2. Li. ),", IX tEJr'V's;.,c.. ___
Buildingf>ermit# PID# ;).J;-370- O~-o
NOTE; This permit will not be processed without complete information.
FIXTURE UNITS
n. (rII.... ..r I,. Yk OMtnlry
OU<lntity Type of Fixture Quantity Type of FilCture
Z- Bath Tub with or Without shower ,~ Roush-lns
- c_, \ Dishwasher I Water Heater
I Aoor Drain Water Sellner
'-+ Lavatory (bathroom sink) 1 Stand Pipe lWashing machine)
I Laundry Tray l1 or 2 compartment sink) Sewage Ejector
I Shower Stall , l3ackIJow Assembly (RPl, Double Check, PVB)
4Ir Sinks Backflow Assembly Test
Bar Sink Lawn Sprinkler
-
i ~ Water Closet (toilet) Other
. .
FEE SCHEDULE .
Industrial. Commercial 110 Multi-Family
l1% of job cost. $39.50 minimum)
Residential. New One & Two Family
Residential. Additions & Alterations
State Surcharge
$99.50
$39.50
$
$
$
$
.50
GRAND TOTAL $
-
Thi. permit i. granted upon the exp.... condidon thot said
canlr:l.Ctar. shall comply in all ....p""ts with the ordinances
of the SlOlC Plumbing Code anti the aJl1j,dments th""",f.
- 8~~/3/{)o^=
Call for all inspections 24 ho~rs in adllaJlce_
PAIDh"
. BUILDING PERMIT
J.IW~3d 8NI0llna
HJ.IM a1~d
11,200 Eagle Creek Av. S.E.. Prior Lake, Minnesota 55372/ Ph. (612) 447-4230 I FAX (612) 447-4245
An Eq~a1 Op~ottunity Employer
OCT.23.2000 11:13AM
GENZ RYAN 6513226147
NO.4BB
P.2/2
_. ....
.,IUOW.__
-.zI - aTW
CITY OF PlUoa ~
SEWER AND WA'rEEl PERMIT
NOTH:
NO. t) -819
Sewer and Water
'~ontractors mu~t
he reqistered
with the city.
,
APPLICANT: c!"Jr\~.~ ~Plultrlbl.-'" u.a-n..V'~ PRONE: ~~1-~2~'144
.O"""SS' J~ ~......<..... ..... ",.j'..:!.1 c..::>
SIGNATURE: ~ - BLOC. PERMIT #
SITE ADDRESS:I1"2!'2.-- l"C),\1:I''''IAG p,."b, 1).L..SE.,pIDi~') 370-0.36-0
PILL IN THE BLANKS
1. Estimated lenqth of water service 40'
\.
2. Size of water service~inch(eS).
3. Location of any co~plinqs from s~ructure feet.
4. Type of sewer pipe. AElS_ pvc:L Cast Iron_
I
of sewer line~
required), located at
feet.
6.
Estimated lenqth
Clean out (if
structure.
feet.
5.
feet
from
==~~=======mca- ---___====----======____
----====-=-----===.---=-==::::=-
This application becomes your permit wnen approved.
BY
Dl\TE:
====~~-
----~~~=======~
---=:==
-----.--
FEES:
$
S
S
:35.00
.50
35.50
Sewer and water line connection permit.
Surcharge
TOTAL
* Fee for either sewer or water indiVidually is $20.00 plus
$ .!;iO surcharqe.
* Sewer and water permits issued for new construction must be
recorded on the huildin~ permit card at the time of issuance
to insure that nc dupllcate sewer and water ~cmit~H are
issued. ""own,
/ /J _ ,-:2 _ /" 6 BUILDING PERMIT
DATE PAID _ (/ C7 J (J AMoUNT PAID .
RECEIPT # REC'D BY if ~
.,......
, 4629 Dakota SI. S.E. Prior Ulke, Mlnne$Qta SS~172' I Ph. (612) 4474230 I Fax (612) 447.4245
AN EQUAL OPl'ORT'UNtTY IMPLC'I'OR
OCT. 5.2000 8:14AM
GENZ RYAN 5513225147
NO. 802
P.2/2
-- -....
ftI.I.OW . ~ ....~-r
IIOLD - CIT.
CITY OF PRIOR LAKE
SEWER AND WATER PERMIT
NO. ()-~'lq
r'~l
NOTE: Sewer and Water
contractors must
be reqistered
with the City.
-
APPLICANT: r-.,Y'\~- "tff)Ptu""b'~ u."""/,ljl'~ PHONE: 1D51~L+2-~-I''-+ll
ADDRESS: 141&l:"lp !~~~J.,r '5"~CIJll DATE:
SIGNATlJRE:~.bL..l.. BLDG. PERMIT #
"TE ADDRESS' J'" ~ l' \ , "\ '" "'" "" Tfl .."', :J;j- 31 D- 036-D
FILL IN THE BLANKS
. I
1. Estimated lenqthof water service 40 feet.
\!
2. Size of water service~inch(es).
J. Location of any couplinqs from s~ructure feet.
4. Type of sewer pipe. ABS____ PVC~ Cast Iron____
5. Estimated lenqth of sewer line ~' feet.
6. Clean out (if required), located at feet
structure.
from
~"
----- ---
~-=======
This application becomes your permit when approved.
BY
D~TE:
============~.:;gz::=~======--=========__========__ =
FEES:
$
$
$
35.00
.50
35.50
Sewer and water line connection permit.
Surcharqe
TOTAL
* ree for either sewer or water individually is $20.00 plus
$ .50 surcharqe.
* Sewer and water permits issued for new construction must be
recorded on the buildin~ permit card at the time of issuance
to insure that no dupl~cate sewer and water P~~VVIT~e
issued. BUILDING PERMIT
AMOUNT PAID
REC'D BfI~
L.-
. 4629 Dakota St S.E., Prior Lake, Minnesota 55372 I Ph. (612) 4474230 Fax (612) 4474245
AN EQUAL oPPORT'llNITY EMPt.O\'!ll
I'lIe
Cloy
~
....
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3
TYP
CITY OF PRIOR LAKE MC
16200 Eagle Creek Av. S.E. Pe.mil No.
Prior Lake, MN 55312
on .007Q
-
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Mullt-Fmllly
Olbar.
Pubie
SIngLe Family;( Two-Family
.
Commercial lmlls1rial
PERMIT
-~70 - 030-0
I
HEATING APPUCA110N
f'%.. ol job cost ($39.50 minimum)
$~9.50
SEHO
$39.5I()EC - 4 mJ
$39.50
$39.50
Fee Schedule
Induslrial, COl1"l1larcial 8. Mufti-Family
F\esLdential, Healing & AC
Residential, Healing Only
Residential, Gas Fireplace
Resldentiel, Additions I. Meralions
Resideotiel, AC Only
Hof2:l0N
1'10'
Dal.
Owne,'.
Address
SUe
lot
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--.-.--.
Remember \0 add lhe Slale Surcharge on lhe bollom oIlhi. applicllion.
dba FIRESIDE CORNER
55113
MN
ROSEVILLE
He9!IngContraclor ALLIED FIRESIDE
2700
TIle price 01 your heating permit includes one lOugh-in end one Iin.. Inspeclion.
MditienallnspeclJons wi! be billed at $35.00 each.
House Healing Tesl Reconl musl be submiUed MUt IMJliDg llIDDiI DiIdIII: beIore buld
Ing certilicate 01 occupancy will be iesued.
TYPE OF SYSTEM
Warm Air Planls
Gravity _
Mecl1anical _
Air Conditioning
Vent. sy..em
l!. FA11lVIEW
TelePhone' 651-633-2561
FiREPLACE -
Ilm1tIP Maka 8. Mod. ClD
Model Size.
Adelless
COnn. Load
FIJ81 0A-' Flue Size
supply Openings
ReWrn Openings
Inplll Output
Ed.
tlfliI REQUIRED with numb&r ol.upply end ..turn IlpflringS aIled p
room with CFM'. pe' opening. New .lr\IctU"'. 0' additions tend 1100. plan ..... auppIy
and ,elum tocallom s"""". HEAT lOSS CALCULATIONS, PA.YMENl' ~D
AppUCAllONS MAY BE MAILED 10 THE CITY OF PRIOR U\KE, 16200 EAGLE
CREEK AVE. S.E. PRIOR LAKE, MN 553n.
HEATING OR pOWED PLAKT
StlUllll_
Hot Wats, .
Radlalian _
S petiaL Dev'
..
..,.
III
III
III
'"
'"
'"
~
LO
'"
City Han buslnass hou,. a'" 8 ..m. - ,(:30 p.m.
All WQRK MUST BE INSPECTED (ROUGH-IN AND ANA4
4.41-4230
I hereby apply lor a mechalllcal systems parmit and I acknowledge \/lat "'.
Inlormalion above Is complele and accurate; Ihatlhe wo.k "HI be in <:01110._","
with tha ordinances and cod.. III the cily and with Ihe slate building/mechanIc
codes; Ihal thl. lorm does not become a permit un1il signed by the BUILDINt
OFFICIAL; thet the work will be In accordance with Ihe approved plan In ".
case 01 all work which requires review an<! approval ot plans.
.
. CAll CITY HAlL
y
Ices
New COnslruction
Other Devices
TYPE OF WORK
Replacement
Esl. Comp. Dala I
Building Perm~'
1
elm.
A,..,aliDns
-Ol
00
,
Oal8
2...4.00
Diie
oB1
PAlO ~\iH
euib'MG pe,p.t.J\\i
~
Receipt _
50
J:>
Repair
Est. Cosl .$
HEATING PERMIT FEE $
STATE SURCH,s.RGE $
TOTAL PERMIT FEES $
..
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3. Ycllaw
[r R'79
CITY OF PRIOR LAKE Me
16200 Eagle CreekAv. S.E. Permit No.
Prior Lake, MN 5.5372
I-
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.
1%'01 job cost (S39.50minimum) :
$99.50 PLEASE NOTE: ~
$64.50 Air Conditioner Units Cannt c
$39.50 Encroach Into Required Side ~
$39.5C Yard Setbacks. ~
$39.5C ~
.
.
Multi-FamlIy
Other
Pubic
Two-Family
Industrial
Induslrial, Commercial & Multl-Famiy
Residential, Heating & AC
Resiclential, Healing Only
Residential, Gas Fireplace
t Ak.. Residential, Additions & Alterations
Residenllel, AC Only
K
Single Family
Commercial
Fee Schedule
HEATING APPLICATION I PERMIT
~~
-,
Address
T al.phone ,
~
~
~
..
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~
.,
:-
~
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:-
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Ihe bollom 01 this application.
rough-in and one final inspection.
each.
buildina lllIlmillli!l!!l!!!!: before build-
Remember to add the State Surcharge on
The price 01 yo.. heating permil includes one
Adcfllional inspeclions wil be biUed at $35.00
House Healing Tesl Record must be submitted with
ing certi6cale of occupancy will be issued.
TYPE OF SYSTEM
Warm Air Plants
Gravily
Mochanical _
Air Cond~ioning
Vent. Syslllm
!:IE&: RECl4JRED With number of supply and return openings fisted per
room with CFM's per opening. New structures or addUions send floor plan with supply
and return locations shown. HEAT LOSS CALCULATIONS, PAYMENT AND
APPLICATIONS MAY BE MAILED TO THE CITY OF PRIOR LAKE, 15200 EAGLE
CREEK AVE. S.E. PRIOR LAKE. MN 55372. .
4:30 p.m.
(ROUGH-IN AND FINAL)
4C7~
Clly Hal business hours are e lLm.
All WORK MUST BE INSPECTED
HEATING OR POWER PLANT
Steam
HolWater _
Radiation _
Special Devices
Other Devices
J,Y.l.. I'
~t/~.
C/D
Model SizB
Conn. Load
Fuel W A-f). Flue Size
Supply Openings
Return Openings
Input / D 0. IJ<J" Output
~ .
Edr.
Clm.
CAll CITY HALL
I hereby apply for a mechanical systems permit and I acknowledge that the
information above is complete and accurate; thaI the work win be in conformance
with the ordinances and codes of the city and with the state buildingfmechanical
codes; thaI 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
case of aU work which requires review and approval of plans.
//"
;/
01
New Construction
7.....j /
TYPE OF WORK
Comp. Dale
BuUding Perma ,
Replacement
ESl
Ii!;
c:
c:
....
4245
FA;{ 447-
P.L
PAID WITH
BUILDING PERMIT
Rocoiplll
.50
Repair
Est. Cost $
HEATING PERMIT FEE $
STATE SURCHARGE $
TOTALPERMITFEES $
Alteralions
PRIOR LAKE
INSPECTION RECORD
DEPARTMENT OF
BUILDING AND INSPECTION
SITE ADDRESS Jry~B;;l w,'IJ~'-<t T
NATURE OF WORK fJ&..J
USE OF BUILDING SFD
PERMIT NO. ()(). 067r- DATE ISSUED '7 -2 Co. 2c>oo
CONTRACTOR P. 'i2 c.~-,- '25C.- ""25""'
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
I FOOTING -+ ~\L- k,,?
INSPECTOR , Dj;
f'. ~, I 10 Ie; tiC
.
FOUNDATION (Prior to Backfill) /0 T)
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SI N
ROUGH - INS
SEWER I WATER I SEPTIC
FRAMING
INSULATION
ELECTRICAL
PLUMBING u.il'
HEATING (if required)
FIREPLACE
GAS LINE AIR TEST . z,..
COVER NO WORK UNTIL ABOVE HAS BEEN SIGN
I ~.ti~UL-.__~ ..JfvAlLj ~ * ~)~ f8r I /(/t9-(/tJtJ
FINALS
GRADING (Prior to Sodding)
BUILDING -r;c.o. ~ j,
ELECTRICAL
PLUMBING
HEATING
.
DO NOT OCCUPY UNTIL ABOVE HAS
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.
Call between 8:00 and 9:00 A.M. for all inspections
FOR ALL INSPECTIONS (612) 447-9850
~trtift(att at (@rmpanry
CITY OF PRIOR LAKE
Department of .uUlIing .Jn~pection
.0 Final Permitted 0 Conditional C.O. Expir~s
This Certificate issued pursuant to the requirements of Section- 307 of the Uniform Building Code
certifying that at the time of issuance this structure was in c~e with the various ordi1lD1lces of the
City of Prior lAke regulaling building construction or use. For the fol/owing:
Use Classification
SINGLE FA..lIfILY
R3
Occupancy Type
1.4,
Legal Description
Type Construction
B2, DEERFIELD
VN
Fire Zone
Blda. ~rmit No.
N/A
Zoning District
00-0879
Rl
Owner of Building SjteAddrcss 17282 WILDERNESS TRAIL
Contractor'sNamc&AddressD.R. HORTON, INC., 3459\ WASHINGtON DR., SUITE 204, EAGAN
ROBERT D. HUTCHINS it1?' CilyPlanner DON RYE
Building Official
(/ ( 6>
Date :
Date:
POST IN A CONSPICUOUS PLACE
..
'.'
HOUSE HEATING TEST RECORD
(..), I d~ (' ", ~::: ~ ("') t to.. ~ I
ADDRESS i -r;:; a.:;z
OCCUPANT
HEAT LOSS
SOLD BY
Electrical Work By
TYPE OF HEA T
JOB #
APT. _ FLOO~CITY
OWNER b (I.... '-.0 '^-
SUBURB
DATE HTG. INST.
.. I . '- ~'S(j,~ INSTALLED BY -C<-0 f' C i:.~o",
Ga. Une By F;'E'~ r .( f ~O"'-
GA_FA~HW _STEAM_SPACE HTR. _UNIT HTR. _OTHER
GAS DESIGN
MAKE
Model
Serial
INPUT
, ' ,
I....~..\I()<-\'...., r
"]t; u MIt- V i)Lf 8/ DO
Lf'-fon,fJ'li'J & -; 7
JI,)(] /1 )'j
CONTROLS
THERMOS~T rJ-..,,\ f:dl.-1lr(\ Heo. Plug
Valve (". J,- 1,__ ~~, 01 r. ......
Limit ~:: {'A-f (). < c.. .
-', ""'
Limit Setting r-X,~-"( I....)
Fon Setting -rl ".......~..L
P;lot Type ;;.r
Pilot Make _ .f
Pilot Model
Pilot Timing
L.W, Cut Off
Pressure ~? <;
Input CFH /:)~)QDU
Stack Temp. ,f/:' .::-
,--
H"5
/ <::'
"". .;,,'
q,L-J
J ,~
Percent CO2
Percent O2
Percent CO
Form 235
CONVERS N
MAKE OF BURNER
Model
Max. BTU Rating
MAKE OF FURNACE
Model _
Vent Size
?' ;-,v'<....._
KIND OF LINER
r' __c~
3 NONE
s: ;;C. 5-
I
SIZE
Draft Hood
Fi Iters
ReguloTor
Size /4,'<....;;<5,;<. I _Number
Chimney Location
Chimney Construction
,_ f'
..:J!i!.
~
Inside
Outside
.... 1,.._
J
~--
Smoke Bomb
Draft
Wiring
Test Tag
Lighting Inst.
~-
Door Pressure
~
---
Dote Tesled / - ..2 f -0
Company Testing F~e~son Heating & A/e, 3650 Kennebec Dr., Eagan, MN 55122
Name of Te5ter ~--
/
_..~,-,-~-_._,..__._~_._---_.
ADDRESS
/7~f?c5),
DATE
~CHEDULED /~
A.J (LD bru\Jes-S
TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
1:30
TIC,
OWNER
CONTR.
PHONE NO.
PERMIT NO.
0- 8'( '1
o FOOTING
o FOUNDATION
o FRAMING ~
o INSULATIO ~
,.. FINAL
o SITE INSPECTION
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
~
~A
/
,~, ~,
c-.-l
c,o,
---..--
o WORKSATISFACTO
" CORRECT ACTIO
o CORRECT WO LL 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 & SAFETYl
INSNOTJ
DATE TIMe
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
PHONE NO.
172~Z- W/'Wt/yJ/SS PI
p. R- Ho.r/oo'l
CO-6> If [(11
CONTR.
ADDRESS
OWNER
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
~AL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
~EXI~LLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
COMMENTS:
.. D/;vev'-/'! /'1
'V WORK SATISFACTORY, PROCEED
f~ CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTlON BEFORE COVERING
Inspector~~ Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HL4LTH & SAFETY!
,.,,<<m
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
DATE TIMe
fl-(;-~ ?
ADDRESS
/1~2 U/T/d~r$ '7'l--
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:
oo-n1
o EXIGRAD/FILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
riORK SATISFACTORY. PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, C L FOR REINSPECTION BEFORE COVERING
Inspector:
Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
"",<<m
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
DATE TIME
/~4jtn /tJ:&<J
. .
ADDRESS
/ '7 d-?'~
. J'A " '\
VJ~ rJe, 5".6-"
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
~D ~i~~B~~G RI
WATER HOOKUP
SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
11- !!'7"l
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
COMMENTS: @ ~ -- a......- ;Yr ~ Irr
@ 7J1a--J-; ~ ~
~ ~;1l;: 7~,
~
I
, .
-~~
o WORK SATISFACTORY. PROCEED
PORRECT 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.
INSNOTl
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY/
CITY OF PRIOR LAKE ..
INSPECTION NOTICE
SCHEDULED
DATE TIME
7-!v-ol
/Iv;
ADDRESS
17~
IN'/de ,flfSS Tr
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
.l!f:.FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
COMMENTS:
LU,h Boy - () K
6r"j,~OJ .~ OK
00-9.79
~GRAD/FILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
/IIuc! hc.rd
(;V,-k {I'
Dr i . V( 1.4'&' v.
I
o WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
XCORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspecto~~ Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
INSNOTJ
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!