HomeMy WebLinkAboutBuilding Permit 00-0903
DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (P!2,.ase Print or Type and sign at bottom)
2Ttf4R~ f<A:\J8 ~ lS<.tre., NE..
3 LEGAL DESCRIP{l~N /1
LOT LQ BLOP"I -.:J _ PID 7"i-3'-8-057-D
ADDITION '\CA.lOg HILL S~ AL>o i J-10~' 'W900bCON~
4. OWNER (Namel-:/", _ (Address)I rJ~~\."" (Tel. No.~ , -,'1~ ( 14. FLOOR AREA AP]P.ORTIONMENT USE
f}')ITTEL<;'l'AI=-l)1 \,t.L.l"~!; 5:l'-f.::><;"' ~(,~~..sT Gr So r ~l~* 'L _
5. ARCHITECT (Name) (Address) __ ;;-rU7 r (Tel. No.) -';".'JJJCttIA
S~ ,'~
6. BUILDER
S\tvP
7. TYPE OF WORK
New constructio~
Chimney 0 Misc.
18. PROPERTY ~AOr t'flJEh 19. PROPERTY pIMENSIONS^ 0' 1'0. CULVERT SIZE ., j 17. COMPLjTlON DATf.
Sq.Ft I ~? ~ .)) Widlh I~{q Deplh I Uo Ves No lV/A- I L; '2.1 jG-()
by 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 lam the owner' or authorized agent for
the a v t pe a that all construction will conform to all existing state and local laws and will proceed in accordance with submitted pia s. I a~ tware that the
:u~din o' i .11... .u. ,....... ........,,3. Furthermore, I hereby agree that the cily o~lc1a,~r~e may enter upon the property to Pf!(o neede,'&Oions.
Signature License No. te
~1
]lATF "Fr.FIVF.]) CITY OF PRIOR LAKE
Q 22 . 00 BUILDING PERMIT,
/. TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
IOQ7;;) Jj CtO
~I
(Name)
(Tel. No.)
(Address)
~
FirePla~ Septic 0 Deck 0
Alterations 0 Addition 0 Finish Attic 0
Re-roofing 0 Porch 0
Re-siding 0 Finish Basement 0
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
Front
Back
Side
Side
BUILDING DEPARTMENT VALUATION
OFF STREET PARKING
SPACES REa.
SPACES ON PLAN
USE OF BUILDING
SF..f;)
PERMIT VALUATION
2 I L. . (')f'Y') . ex:>
.
TYPE OF CONSTRUCTION: I II III IV V
OccupancyGroup A B E F HIM R S U
Division 1 2 3 4 (
PermilFee................................... $ I, /{.'7 'Le;
Plan Check Fee ............................. $_Qi:;'",. 7L
loR . ~o
1.
2.
3.
(Delih4> I
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS ~l'-"<
SEATS ;';1"\
'~Jn:~~S~OLO
MATERIAL FILED WITH APPLICATION
SOIL TESTS
o ENERGY DATA
o
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS 0
SURVEY 0
SETS
COPIES
PLOT PLAN
o
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ............. .......... <t
Sewer Tap ................................... <t
City:
State Surcharge ............................. $
f1.c)l"J.O(')
',Il'lO .r'JO
Sf1 " $
Pressure Reducer ....e................... $
Q5.('J()
Meier Horn ................................... $
WalerMeler ................................. $--1 :2~. 00
Sewer & Water Connection Fee ........... $ I J 2(!Jn .(!t 0
WaterTowerFee ........................... $~f\ . t::9O
Water Tap ................................... $
B"ildersDeposit ............................ $ I. &:)0(') .lgel
.
Other ......................................... $
Paid ;ffi;~4.:.~......~~~~,~;~$ ~:~:h
Dale/IJ, I/.(J(/ BY~./
ThIS IS to certify that the request In the above application and accompanying documents IS In accordance with the City ZOning Ordinance and may procee requested ThiS document when
s~ _annercon~'"tesaffimpo'a~ce~I~~mp"an~~~m~~e~~~
City Planner Date Special Conditions n any
Penalty ....................................... $
Plumbing Pennit Fee ....................... $~('). t? 0
, 0,., ./")0
3s-. S'~
~.trYI_
Mechanical Permit Fee ..................... $
Sewer & Water penni! ...................... $
Gas Fireplace Permit ....................... $
Thi
By
ermit When ~roved.
Dale q- 7q.~
Issued
24 hour notice for all inspections (952) 447.9850
.~~
OO..()Q03
Thr ('tntt. of lh. L."r Country
White - Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
//FTTEL::'/ficDI
.'-~'" "-, /'
/, 2..z. '/jC)
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
-- -
/ /J /2 /.-.~ <- /:,/.'-1' /. /...:- i', I /, / C'
~ I ___ (" \. l . 1..-_ '- 1'..-'
Accepted
v-
Accepted With Corrections
Denied
~-,
Reviewed By/ ,,:h-.
, .
Comments:
2-'--l r;2r ~ \'VUl M-\ ~lAH' fA ~ 1A);..dj;r ~
vQttbl fA) ~ (' AN'b. J
~~~
Date:
q/~/Gt'J
'^
1'/\ I~ 30 F-r 4tJJ..I.M)z~~
~ ~6~~ lJ:;Q C~ V20~
U\N> _ 0
"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,"
~~
00- o~o3
Thr (~tnlfr of Ihr L.". Country
White - Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
1'/1 / IbL.STA6.D/
'1- 1-2- . 00
APPLICATION RECEIVED
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
/4-450 k'A-V6N cr NES
Accepted
Accepted With Corrections ~
Reviewed By:
o
Denied
Date:
'f- 2'1. 7000
Comments:
-
~ aJ.Q. a.tf~ ~ ur. L
"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."
*
DO .o~o3
Thf- Ctlllrr of tbt Lab CQunl1'y
White - Building
( Canary - En4meennqJ
Pink - Planning
.BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
-
r/!7T6L-5Tr) ED /
9. z. z. . ()O
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
/4450 /-<?A VC/V Sf Ii E:
/
Accepted With Corrections
Accepted
Denied
Reviewed By: Gra.d CdSOl1
Comments: 5& -Hie reVerse... _c,i.Je.
EIJ ler -ilIis ~J ~.n1 ko 11M (ldflr(--
Date: ;~Io
-for- adj,J-i~'Vlllfl
tJ/I/Y.
/
il1}ol'"fI1,JI"",,,,-_
c;ee ~~4.~€n~:' i. fil~~1 r;r~f :M-~dlL1.z:~;rl~4t/~n ;:z k~~4,~ e6-Lf~
~ ..r-,:...
3. E::rDslotl {iol\+rci~r~5
<./
.~ .;- , /1 1,/ r-?!
'1. l:::. rtJ 51 th1. C tH/+ra I nO. rl
-
"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."
11/29/00 WED 10:17 FAX 8128902753
STOCKER EXCAVATING
141002
/'D'.' ~ @a;:',-:lC' ;:-:'. -,
I U~.H.i:::~.i' o.
I ,. ':
I' \ i cr Ie -. 1.1); 'i! _.....
'I' I' QW fJ~..ll! ,.w...-~~
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L..- . ~~:..J./l -.-.
I --II.-' i
~.IIIII 1111.11 I
CITY OF PiUOR LAKJj;
SEWER AND WA'XER. PEIUaT'
NOO- '103
NOTE: Ss....r and 'water
~ontraetors must
be registered
with ~hs City.
....,.".-
~
APPLICANT: DC 11...:hanlo:al/Stocker Exc:a'9'at1ng
PHONE:
890-4z41
82~ "es~ 1Z5toh Sv: JlAvJ!"a.. Ml\I
SIGNA'l'URE: f)'}tLrJI.! ~
SITE: ADDRESS. 14456 by.... C"UT~ li1ll
ADDRESS:
~~,'1~DATE::
ln~n
BLOG. PERMIT # 000-903
P1D# ;;. 5 - :31o'l- 037- 0
FILL IN THE BLANKS
1. Estimated length of water service
f....t...
2. Size of ~ater service
inch(e:s).
J. Location of any couplings from s~ructure
feet.
-"'''''-
4, Type of sewer pipe. ASS
pvc ...
Cast Iron
S. Estimated len9th of sewer 11ne
feet.
6. Clean out (if required), lOCated at
struct\u"e.
f....t;
from
=-~-------- '''.
~-~~~~~~----------
This application becomes your permit when approved.
8Y
DATE:
...
Ji;_~___...____
._-~__~______s_________~~=---~___
FEES:
S
$
S
35.00
.50
35.50
Sewer and water line connection permit.
Su~cl1ar9"
TOTAL
Fee for eith.~ sever ~ water indivi4ually . is $20.00 p~us
S ,so surcharge.
. Sewer and water perDits issued ror new const~ction ~ust be
raCQr~ed on the buildin9 permit card at the tim.. of issuance
to insure that no .duplicate sewer and vater pe~it. are
issued. - PAID WITt.;
DATE PAID 16 -/~ -00 AMOUNT PAID .~LDING PERM~
lU:CEIP'1' 11 REC'D BY .(1 ~
U
*
....,...-
115200 Eagl" Crc:c:kAv. S.E.. PriorLakc, Minnesora 55372' Ph. (1512)447-4230' FAX (612) 447-4245
All EtlIia1 Oppa""nil1 Employ....
100 III
~NIJ.VAv:>n lI3lI:lOJ.S
CSLZG8RZ19 YVd oo:tt NOH 00/91/01
-
-
CITY OF PRIOR LAKE MC
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Dale
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Address
Healing C<lnlraclo, AL1.IED FIRESIDI!. dba FIRESIDE CORNER
AdwI.. 2700 N. FAIXVIEW. ROSEVILLE. KN 55113
Tlle~hon..'. 651-633-2561
F REPLACE 1),0 j- ,() t: 6,
llUnlIII!I Maka & Model TYPE OF SYSTEM
Model Slz. ko::nr... W31m Air Planls
.... Gravity
ell
ell
ell Conn. load Mechanical
'" ~ Air Condllonlng
'"
lD Fuel Flu. Size Vent Syslem
~
'" Supply Openings HEATING OR POWER PLANT
lD
Slnm
Relurn Openillgs HOI Wal81
~1II Outpul. .}-7.n", Radiation
Special De'lices
Edr.
Othll Devicls
Clm.
TYPE OF WORK
a:
LU
Z AlleralioRS
a:
0
u Repair
LU
0 / JOO{YI
H Est. CDsI $
en
LU
a:
H HEATlNG PERMIT FEE $
u..
.. STATE SURCHARGE $
>-
!D
.... TOTAL PERMIT FEES $
c
"
en
Replacement
Now Conslruclion
v
Est Comp, Date
.~
Buildirlg Perm~ .
.50
PAID WITH
BUILDING PERMIT
Receipt N
I. .Pi"
Z.Gnn
i.Yon-
fl"
Cll,
Co-':Iuf
TYPE OF STRUCTURE
Single Family
Two-FBmIly
industrial
Commercial
FIe Schedule .
Indus.lrial, Commercial & MuIQ-FamiIy
Residendal, Healing & AC
Residential, Healing Only
Residentia~ Gas Fireplace
Residentlsl, Add~ions & AAe,aliono
Residential, AC Only
~~-l1mily
Public Olher
1'" 01 job cosl ($39.50 minlmunl
$99.50
$64.50
$39,50
$39.50
S39.5O
I
OCT 27 mli.'lii
_IL;)
RemenbM to add Ihe Slale SUrcha'll8 on Ihe boUom of tfiisoppica_.
The price ol yo.... healing permi! includes ana rough-In snd one llnallnspection,
Mdi!ionallnspeclions wi" be bifed al $35.00 """".
House Heating Teol Recofd must be submitted wil1llll1diog IlllIIDIIlllIOlllIl belD.. build-
ing cerlillcale 01 0CCIJp8I1Cy wiN be issued.
IiEM CALCUlATIONS REQUIRED willi number at suwly and re!urn openings listed pe
room with CFM's per opening. New slrudures or addillons SInd noor plan wilh supplV
and relurn localions shown. HEAT lOSS CALCULATIONS. PAYMENT AND
APPUCATlONS MAY BE MAILED ro THE CITY OF PRIOR LAKE, 16200 EAGLE
CREEK AVE. S.E. PRIOR lAKE, MN 5537:l.
CRy Hal business hours are 8 8-1IL' 4:30 p.m.
,
All WORK MUST BE INSPECTED (ROUGH-IN AHD FINAL) . CALL CITY HAll
441-4230
I hereby apply 'or.a mechanical systems permil and t acknowledge lllallhe
informalion above is complele and accurBte; Ihallh. work will be in conform.ncB
with the ordinances and codes ollhe cily and wilh lhe state buDding/mechanicel
codes; Ihal Ihis lorm dlXls not become a permll unlil signed by the BUILDING
OFFICIAL; lhal lhe work will be in accordence wilh the appraved plan in the
case 0' an work which requires review and approval of plans,
~- fiL~ /M1/D.)
I ~... Applicant's Signature .. . ' Dale../>-? j
ffi / /{)~~O -U '--'
i7 Bunding Officars Signalu.., Oal.
CITY OF PRIOR LAKE Me . (, ~
162.00 Eagle Creek Av. S.E, Pe/mit No. 0.- i 0 ~
Prior Lake, MN 55372
HEAl1NG APPLICAT10N J PERMIT
.'-J'DD PIO' ~5/3lcg- t)~'l-6
S~e Address \ \oj '-i CL'...., On..VV\ ('.J.. ll. E:.
Lot ~ Block :6 AdcI~lon ~)t b 1-f:(1 ~~~/
OwnefsName U;-\-t-"\&\-fl()~+ ~'f'^~S
AddJllSS ~
Heating Contractor ~l fY\ c:, v\ \\ II ~ Orclorl.A
I
AcIdlass \-,q\\<{\ \LhDc:.LL \G\n...(\dL '4ve
q,Q- yqL(-CDO-S-
0aI8
-t-A( c
S.
T 8lephone II
FUll1ace Make & !IoIodel 1.,ln<>l< (1f1lI.{)Iflij..,r TVPE OF SYSTEM
_ Warm Air Plants
Model Slzo '1 ~ J/ 'C1 () Gravity .
Conn. lDad ~"'Jt1lI Mecll8l1lcal
. AlrCondNloning lI( '10 Ar.v.l/;J.
Fuel t0cJ.. (~Flue Size - Velll. System
PI
g
S"PI'ly Op.M;n9~
HEAnNG OR POWER PLANT
Sieam
Hot Waler
Radlalion
Spacial Devices .
Return Openings
InpuI7":lX70
Edr.
OIlIpUI
Other Devices
Cfm.
TVPE OF WORK
AIlorations
New Construclion . X
Repair
Es!, Cost $
Replacement
Est. Comp. Dale
Building PermNIt
HEAnNG PERMIT FEE $ - {f9 - OD
STATE SURCHARGE $ .50
TOTALPERMITFEES $ /bO .00 Receipt.
PAID WITH
BUILDING PERiV" I
TYPE OF STRUCTURE
J.p\l
2. Grem
1. Vello'>\'
r",
City
Coouw..
Single Family X
Commercial
,
~
~
,
~
~
Multi-Family
Other
Two-Family
Industrial
Public
....
Fee Schedule
Induslrial, Commercial & Multi.Family
Residential, Healing & AC
Residential, Heating On Iy
Residential. Gas Fireplace
Residential, AdcIftions & Afteralions
Residential, N:, Only
1 % 01 job cosl ($39.50 rnnimum)
(199.50 ~
$R5O
$39.50
$39.50
$39.50
~
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,
'"
c:
'"
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~
<:
~
~
m
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>-
...
z
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Remember 10 add the S1aIe Surcharge on the bottom oIlhis application.
The price 01 your healing permil includes one rough-in and one final inspection.
Additional inspeclions wllbe billed al $35.00 each.
House Healing Test Record musl be stAlmilled wiIh bY!!l!ing ~ !IWllIllll: before build-
ing certIficate ct O<:CIIpancy wIn be issued.
J:lfAI CAI.cuumoos REOUIRED. with number 01 supply and relurn openings listed pE
room with CFM's per opening_ New structures or additions send Iloor plan wilh sup!,ly
and return locmions shown, HEAT lOSS CALCULATIONS, PAYMENT AND
APPUCATIONS MAY BE MAILED TO THE crT'( OF PRIOR LAKE, 16200 EAGLE
CREEK AVE. S.E. PRIOR LAKE, MN 55372..
City Hall bllSiness hours are 8 a.m. - 4:30 p.m.
ALL WORK MUST BE INSPECTED (ROUGH-IN AND FINAL) - CAlL cm HALL
447-9850
+
~
~
-
-
....
~
-
~
~
I hereby apply lor a mechanical systems permit and I acknowledge that the ~
information above is complete and accurate; that 1I1e work will be in conformance ;;:
with the ordinances and codes of the city and with the stale building/mechanlca
codes; that this form does not become a permit until signed by lhe BUilDING ~
OFFICIAL; thaI the work will be in accordance with the approved plan In the ~
case 0: attork W~iCh reQUir'i'/fWiew and approval of plans.
~J.U-Lt- /~ //-.2-QG
'\ Ap~nl's Signllll2re Dale
G~ ((- 3-60
BUil<!l\Jll Officel's Signature Date
~
,
~
~
...
I. Blue" file
2. (illkt at)'
J. Yellow ^rrlicanl
PLUMBING PERMIT # D-403
~PPlicant:fa((I/~ 1J!d;, {}J,. JtJ1.< Phone: -r?s2:'?/{J;>-ZllI
Address: ,yt/O {j,ha/:t?/' tit/ft_ - W/'daA' fi(A _ -f:'5'..K..;2-
Signature: ('1A~ 'v , "II ~..
Legal Description: Lot ( () Block:) Sub "'/Job I-; I II ~ '
Site Address: /t./q~(, R-'UI~J1 11'
Building Permit 11
NOTE: This permit will not be processed without complete information.
---- --....... ........ "".............. ..........
~.~. v~ ~~~vn ~~
.....".
~ UUJ.
CITY OF PRIOR LAKE
This permit is granled upon the express condition thac said
contractor. shall comply i" all rc,''ipccts wilh the ordin:lncc$
or the Stotc Plumbing Coae and the Amcndmcn~cof,
-' RECEIPT No..ffi-3tJ DATE
Go ___ ATTEST
Call for all inspections 2~rs in advance.
6~~
IJlt'C,,,tt".."....r...t'C'm....,.,
{),j JUt 00
FIXTURE UNITS
Quantity - Type of Fixture Quantity
J Bath Tub with or without shower .3
I Dishwasher /
I Floor Drain
3 Lavatory (bathroom sink) I
I Laundry Tray (1 or 2 compartment sink)
I Shower Stall
( Sinks
Bar Sink
.3 Water Closet (toilet)
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
GRANO TOTAL
'\.
PID # :Jj) - '3'- ~ -Uy {- '-'
Type of Fixture
Rough-ins
Water Heater
Water Sollner
Stand Pipe (washing maChine)
Sewage Ejector
8ackflow Assembly (RPZ. Double Check. PV8)
Backflow Assembly Test
Lawn Sprinkler
Other
$
$
$
$
.50
$
PAID WITH
BUILDING PERMIT
. '-
.21_
i :,:
dJ)
16200 Eagle Creek Av. S.E.. Prior Lake, Minnesota 553721 Ph. (612) 447-42301 FAX (612) 447-4245
An Equal Opportunity Employer
PRIOR LAKE
INSPECTION RECORD
a< c.. 11 f'V\ OJ .
DEPARTMENT OF
BUILDING AND INSPECTION
SITE ADDRESS Il./ l./ c:;- ( n
NATURE OF WORK ~lpl.'\
USE OF BUILDING 'S F[)
PERMIT NO. (In'()f03 DATE ISSUED Cf-Z'J -?fV?D
CONTRACTOR M:H..I...""D7,-.J) ~.
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
I FOOTING b:m:roR I /()/I~i;o
I FOUNDATION (Prior to Backfill)~;:' I fb:t, /~ 1/1(,1 D{J r:DA /0 .(t). c-O
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
SEWER / WATER / SEPTIC fb:r; I'/~/(/I)
FRAMING f> ~ . 1/1/7100
INSULATION #fro /;;/cl9~
ELECTRICAL
PLUMBING 6:h. I 11/16/tfl)
HEATING (if required) /'1?1J. . I I 1/'-/17 / /H)
FIREPLACE @;7. IIIII'?( b7J
GASLlNEAIRTEST(~~ -& V, I JI/l7/~o
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I~ I I
FINALS
I GRADING (Prior to Sodding) NJ;::f s-c.;-OJ
BUILDING-/.L6. ~Yli!()i .@::r f/.2c31o/ f)y, 9//2/~/
ELECTRICAL .,
PLUMBING {fp,
I HEATING t:i"
DO NOT OCCUpy UNTIL ABOVE HAS
NOTICE
,
I lI/lIo{
I 1j,;2~/6/
BEEN SIGNED
This card must be posted near an ele~tri(:l,1 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
----- - - - --
,.- .-..-, .. ~- ----
QLertifirat! at OOrrnpanry
CITY OF PRIOR LAKE
J)tpartmtnt of .uilbing 3Jn~ptttion
~ Final Permitted D Conditional C.O. Expires.
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 compliance with the various ordinances of the
City of Prior Lake regulating building construction or use, For the following:
Use CJassificatiop
SINGLE FAMILY
Bldg. Permit No
00-0903
Legal DescriptiO"
R3 Type Construction _ VN Fire Zone
L6. B3. KNOB HILL FIFTH ADDN.
N/A
Zoning District
R1
Occupancy Type
Owner of Building
_ Site Address
14456 RAVEN COURT NORTHEAST
ST.. INVER GROVE HTS.. 55075
DON RYE
Contractor',Name&AddressMITTELSTAEDT BROS.. 2425 96TH
ROBERT D. mITCHINS f/J:;, ('. N____
.ltyruuulCr
Burli O;! 1 .
Date:
Date:
-
BUftNSVILLE
Heating & Air Conditioning, Inc.
12481 R!wde Island Ave. So., Sovagt, MN 55378 . 894.0005
O~Test Report for Jobl i 0,$ _ .'
Ill, , r" j...+- .J " L L..
Address ,! I..j ':> <.. 1;.4 v'\" n ,: .: City rf f" (' [~14'
Occupant ,1I1i fiLlsl '-< If PYDS
Dale of Install 12" 7<J.- P3
Type of HT, FIt. V HW Space HT Unit HT
Other
Make U..." 0 \..
Model ~ -zjp tl> l/ fr,... . cf' r
Serial 5' So(':) f5 I ') 7C, J -
Input '7 r: DO 0
Pilot Type III J
Pressure 5', '\
Input CFH 7);, Df) D
S1aCkTemp.. /10
C02 ! <j'
02 C:"/
cn !J
Dale Tested I -( 5. 0/
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DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
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ADDRESS
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OWNER
CONTR.
PHONE NO.
PERMIT NO.
-'J -905
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
@ 0 SEWER HOOKUP
I JII PLUMBING FINAL
1'0- MECH FINAL
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
COMMENTS{/]). ~ ~ ~ I
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o WORK SATISFACTORY, PROCEED
)t CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTlON BEFORE COVERING
Inspe~or: ~, Owner/Contr:
.J
gALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
INSNOTJ
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
5-8-6 I
ADDRESS t 'fLI5 h R r;, V M c.. r. N.c.
OWNER CONTR. _/i1/Hjl~ /...
PHONE NO, PERMIT NO. (')() - 90.3
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
.a. FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
~ EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE Rl
o FIREPLACE FINAL
o GASLlNE AIR TST
o
COMMENTS:
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o WORK SATISFACTORY, PROCEED
)l(CORRECT ACTiON AND PROCEED
o CORREC:~K, CALL FOR REINSPECTlON BEFORE COVERING
lnspectorff ~ Owner/Contr:
L
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
INSNon
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
I/..u/o(
I
/tJ:cJO
ADDRESS
/ <.j'lS!"..,
RAJr;J C.T;
OWNER
CONTR.
PHONE NO.
PERMIT NO.
0- 90:3
o FOOTING 0 PLUMBING Rl
o FOUNDATION 0 MECH RI
o FRAMING 0 WATER HOOKUP
o INSULATIO~ 0 SEWER HOOKUP
~ FINAL \... N ......- .J 0 PLUMBING FIN~
o SITE INSPE" ",UN 1< MECH FINAL fI:/JV
COMMENTS: ~\AlG\. LacK t;alL F:- L ~ '0
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o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
o WORK SATISFACTORY, PROCEED
)ill CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR RElNSPECTION BEFORE COVERING
Inspector:
~
Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTJ
'1/12-/01
/ 'i t..j ~t'~ ~~ flY-,
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING @
o INSULATION
!il"FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
r
COMMENTS: S'''<.'''r (
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~:t;
,
;(,j'p;
DATE TIME
A ;17
00 - '1d 3
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
~,
()
'MI WORK SATISFACTORY, PROCEED
(0' CORRECT ACTION AND PROCEED
o CORRECT WORK, ~L FOR RElNSPECTION BEFORE COVERING
Inspector: tl-:'f\ Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
INSNOTI
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!