HomeMy WebLinkAboutBuilding Permit 00-1063
~1
QAT" R"""J\f"n CITY OF PRIOR LAKE
II .1 3 . DO BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
1. While
2. Pink
3. Yellow
Permit No.
DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
12. SITE ADDRESS
/7~'Y~ ~~ VU'/~t!T ~
3. LEGAL DESCRIPTION
1. DATE
/-j/~/~
I!!-/
BUILDIN
11. SIZE OF ST CTURE
(Height) (Width) (Depth)
12. NO. OF STORIES
LOT / BLOCK ,.,,<
ADDITION .5'12!:~ ~~ ~'J&
14. OWNER (Name) (Address)
5. ARCHITECT (Name) (Address)
PID 2.""-<'7-7- - (JII..~- 0
13. TYPE OF CONSTRUCTION
(Tel. No.)
14. flOOR AREA APPORTIONMENT USE
(Tel. No.)
7
Fireplace D
Alterations CI
(Address) :i1E)/b 3'-".. 770,{(Tel. No.)
J$.y~ ~~....... ~ ~...tO.,c
.,A. "'"'.... V ~.-v ~"'.;r~ ,;r$7'-.,,:r56-?~
Septic D Deck 0 Re-roofing 0 Porch 0 j
Addition 0 Finish Attic 0 Rs-siding 0 Finish Basement 0
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANT~
6. BUILDER (Name)
<J.~.. )<It:I"'f~ ~.
7. TYPE OF WORK
New Construction"
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES 19. PROPERTY DIMENSIONS 110. CULVERT SIZE
Sq. FI. Width Depth Yes No
I hereby certify 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 official can revoke is permit for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
.,a ~ =:f~~JSS-:;>- .//.a./PO
Signature License No. . Date
SEATS
16. PROJECT COSTNALUE
9,tJ I?C'~
17. COMPL(TION DATE
x
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
Front
Back
Side
Side
MATERIAL FILED WITH APPLiCATION
SOIL TESTS 0 ENERGY DATA 0
PILING LOGS 0 PERCOLATION TESTS 0
BUILDING DEPARTMENT VALUATION
USE OF BUILDING
;:;;::;.q
OFF STREET PARKING
SPACES REO.
PLANS & SPECS CI
SETS
TYPE OF CONSTRUCTION: I II III IV V
OccupancyGroup A B E F HIM R S U
Permit Fee ..........~~~~~~~...1...~...~..~... $_~~ \
SPACES ON PLAN
PERMIT VALUATION _'-[J:~. O~ PLOT PLAN 0
City: Amount Brought Forward .........~.. $-----850 ~ ~O
Park Support Fee ..................../. $--41-1')(') .~
SAC ......................................... $
SURVEY
o
COPIES
Plan Check Fee ............................. $
.Dn
c;~
If., . c;n
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
State Surcharge ............................. $
Penalty ....................................... q-
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
10() .OD
{()O'OQ
J6" .5D
Pressure Reducer .......................... $
MeIer Horn ... .... .... ........................ $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
WaterTowerFee ........................... $
--u:;. ClO
/2C:. C)r;:>
If 'J t".lO .t!JC
7aY ~a>.-I
Sewer & Water Permit ...................... $
GaSFirePlaceperm~it ..................... $ lfc> 't4::.2-
Thi A t' Beco es Y Building Permit When Approved.
By Date~
Water Tap ................................... $
Builders Deposit ............................ $ /. ~;iO,., ~OJ
Other ......................................... $.
Total Due .............................. $.~ Z I Z ./fJ
Paid 72-/2-./\ Receip in? '1
~n..1,,8t0
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
sig,:P<f::\-'Y "'~Aa.'nner constitutes a temporary Certifi~te .9f Zoping comPlian~d,::ows ~J!;~ to (!mence. Befe. reFccu. .pancy, a Certifica
'--7')v.-;&-_..-_~-" ~/~ ~I~~
- City Planner Dale SpeCial Conditions ~ any
By
Issued
24 hour notice for all inspections 447-9850
._.._-_..._.._.._-~-,'
~~
White - Building
Canary - Engineering
Pink - Planning
Th~ C:..nl..r of Ih.. L.k.. Counlry
BUILDING PERMIT APPLICATION DEPARTMENT CHl;;CKLlST
NAME OF APPLICANT
APPLICATION RECEIVED
DR. HOR..I ON
/1. 13. 00
. I
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
/7243
D85R..FIELO bR-.
L
Accepted
Accepted With Corrections
Denied
tlYfl
'01
Date: _ / 2. - 7 -7~c:>
Reviewed By:
Comments:
~O-
tLif-cu:W
"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
White - Building
Canary . Engineering
Pink - Planning
v
Th~ <:..nl... of Ih.. I..k.. Connlry
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
D ~.~ I \ k~ I (it,,)
I I. I ~;~, . C C;
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
J -7 --;; L- ? '. r:: . .-:. . :-1 -- ; I'
/' i --~ l j " c:. k..1 G ~~..U _) \<2.... .
Accepted
Accepted With Corrections ~
Denied
Reviewed By: ~~
, -,
Date: l ']...//#/6C>
Comments:
N,o ~ ~~ ~/JL~<e-: 52'VlLlu~
/j~k<:.. J ~tv,f~_ ~~/L-. (h.e {J/"~17
~.9VV1~.rt'e-.~ ...
---Ar1v,uiL 'W~,~ \0 Mo c,n-v}J,tc9M< f).f-
~,{J,LJ,~. ~ (JLj-Fbv ~
Q..,~ ~l.6W\ , .
"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
oo-/o~
Thr Crnl." of Ihr Lakr COllntry
In II/IV Au:
White . Building
Canary . Engineering
Pink - Planning
.BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
D ~~ r\or2--1 ON
11./3. 00
.
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
r7~43
'./
DS 5 r<-1-1 ELO .D R...
Accepted
Accepted With Corrections
Denied
Reviewed By:
LLL
Date: /2 -10 -00
C ~__._IfJ.___
ommen(~ --
5~ 1-= Re:v EP1~ (jS:d}o ~CfIC>OIT7f)A//-It...
.__;"',"'lo~
G.I1:1/7:Jc/l/73.
)(
.5C'.C /l717iCHfllE:/J.J73.- /) 0r<J:JOI/fJG fbHu 2)Ro~/}A/ C~~/JlSYi:V~
3) E"t:.rJY/J/I} ~Ot.... Pc..A/1}
"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."
JAN. 9.2001 12:36PM
GENZ RYAN 6513226147
NO. 225
P.9
J
CITY OF PRIOR LAKE
" _ RIo
a._ ~
3, Y_ AppIi_
. PLUMBING PEflMIT 41 00 -IO(p3
I Applicant~ Pl'i17 - 1/, ('....---, . Phone: lohl- t....I2~,-J/4l{
ACldrea.:~,<:.r-: 12.oV:z.tL:r ''7'/'l..l.- R~1I'V1ro j rnr '.~
SIgnature: II. U~ q '.
L~a1 De'criptlo~'~ L~ \ 'Block 2... 8Ub~ pA~ /.YtO
Site AddlHll: n-z..u ~ ~"......QpO '" ~_ \~ ':
; BUildi,n; Permit 'PID #
. NOTE: This permit will: not be proceased. without complete Information.
. .
F1XTUR! UNITS
11w c..m -!"II! l.II. e.1l1t,,"
Quantity
I
\
\
2-
1
I
I
......".
"r':.)
2-
-.'
Type of Fildul'8
Bath Tub with or without shower
Dishwasher,
Flocr Drain ~
Quantity
. I.
f2../ I
J
Type of FIXt1Jre
Rough-Ins
Water Healer
Water Sollner
Stand Pipe (Washing mac;iline);
Sewage Ejec:lor. , 1
BaclcfIow Assembly (RPZ. Double Check, PVB)
Backflow Assembly Tm
Lawn Sprinkler
Other
$
$
$
$
.50 .
\f'l\"\\-\ :t
f'~\o G ~€.f'-tJ\X
e,\)\\..O\N . .
,
,.
Lavatory (bethrcom sil;lk)
Laundry Tray (1 or 2 comp~l'lm.nt sink)
Shower Stall
Sinks
Bar Sink
Water Closet (toilet)
FEE SCHEDUU'
. ':
$
,
Tht. permitla II'IDI-.l upan the ..p..... condition .hat .ald
c:Onlractot, .haI1 campl~ in all rcapoats willi tho ordin.nces
o( 1/1. Slate Plumbi~!~e amendments thon:oI.
.. IU! ,1..:.'1.0' 'oATE
. .'
. . - AAUinlU
Call for all insp . ons 24 hours in advan~e:
16200 Eagle Creek Av. S,E.. Prior Lake. Minnesota 55372/ Ph. (612; 447-4230 / FAX (612) 447-4~5
An Equal Opportunity Employer
:.1: .....
~ '.. ,
. ,
"j~
> Industrial, Commercial & Multi-Family
(1 % at job cost, $Sa.50 minimum)
AHidemial, New One & Two Family
Aesid.ntial, Additions & Alteration.
Stale Surcharlle
$118.50
$311.50
,-
. r
GRAND TOTAL
-
GREEN - FtLE
YELLOW - APPLICANT
GOLD - cn.,
CITY OF PRIOR LAKE S.w. No. 00 - /oft,3
SEWER AND WATER PERMIT
NOTE: Sewer and Water
contractors must
be registered
with the City.
APPLICANT:
Genz Ryan
14745 S. Robert Tr., Rosemount
17243 Deerfield Dr.
_PHONE:
DATE:
_BLDG. PERMIT #
00-1063
ADDRESS:
SIGNATURE:
SITE ADDRESS:
PID#
FILL IN THE BLANKS
1. Estimated length of water service
feet.
2. Size of water service
inch(es) .
3. Location of any couplings from structure
feet.
4. Type of sewer pipe. ABS
PVC
Cast Iron
5. Estimated length of sewer line
feet.
6. Clean out (if required), located at
structure.
feet
from
-------~----------------------------------------------------------
------------------------------------------------------------------
This application becomes your permit when approved.
BY
DATE:
-------~----------------------------------------------------------
--------------------------------------------~---------------------
FEES:
$
$
$
35.00
.50
35.50
Sewer and water line connection permit.
Surcharge
TOTAL
* Fee for either sewer or water individually is $j~.~ plus
$ .50 surcharge.
* Sewer and water permits issued for new construction must be
recorded on the building permit card at the time of issuance
to insure that no duplicate sewer and water permits are
issued.
DATE PAID
This permit covers the double
AMOUNT PA:
fee for the sewer and water.
REC'D BY Paid by Genz Ryan check
#0073412 dated 1/29/2001.
RECEIPT #
16200 Eagle Creek Av. S.E., Prior Lake, Minnesota 55372 / Ph. (612) 447-4230 / FAX (612) 447-4245
An Equal Opportunity Employer
fIRESIDE CORNER #1519 P.003/005
CITY OF PRIOR LAKE Date lb!<:'d
HEATING/AIR CONDITIONINGIFIREPLACE PERMIT
MAY I 5 2001
(Pi..... "1!':. or Print iIlI4 iii"" at be."",)
ADDRESS
/7:J.€t3 ~.p AJI'!. .f-c
i =. ~..~ I PERMIT NO. 00- /O&,~ I
I ZmG(I'I/flcoUICI
LEGAL DESCR..r BU'" (oll\co "'< ooIy)
LOT t BLOCK J-. ADDmON
')' ,
& OJ ;1Lu1rfJ ,~u1
I)
OWNER
(Name)
'D 12 ~
(Phone)
(Add.ress)
APPLICANT
(Na\I1t".' ALLIED FIRESIDE DB;' I'IRESIDE CORNER
PTD~ 5....3 J)-I) w, -,
(Phone). 651-;;33-2561
(~ss) 2700 N.. Jl'AIRV..~~''''
(Adrlre,,)
BIU;:NDA HUSTON
(Contact Person) ..tl
APPLICANT SIGNATURE ~
""'SElTTT.T,F MN'
(Clry)
(phone) 651-633-2561
7j~
.. DATE
.S~l'~.
(Zip Code)
!'~/J-tJJ
APPLICANT PLEASE COMPJ.ETE BELOW
qJ'NEW CONSTRUCTION 0 REPLACEMENT 0 AL TERA nONS
FURNACE MAKE AND MODEL . . 'f'UEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF S, ,,,,,,rd HEATING OR POWER PLANT
OWann Air Plants 0 Steam
OGrnvily 0 HOI Wow-
o ~lIl1leol 0 RodlBlion
OAir Cnn61,ionlng 0 Speelol Devle..
DVcnl System 0 Olher Devt=
FlREPI_ACE MAKE AND MODEJ_ J,,~ Ai (d.. .5t.. ~.J7J~ ..
,
Indu.lrisJ, Commercial &. MUlti.Fornily
FEE SCHEDULE
I % of job ens! Resid<lllial, Gos fl'''I'Iacc:
539.'0 minimum
$99.'0 Residential, AlIdlllons It Altonllions
564.50 Residential, AC Only
Residential, Healing It NC (N"", UmstnJr;tion)
ResidentioJ. H..dng Only (New Con''"'ction)
&timated Casl $
Building Permit #
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERWT FEE
$
$
5
.50
rom"" u.. 0.1)'1
This Application Decom.. Your BuilcliDg Pormlt Who" Approved
PB~
DPte5 ,/5, 0 I
B..lldfD" omlllnl
D.tlt
%4 hour ""Ii... ror .1I1..pectlon~ ('52) 447-9llSD, f.x (!IS) 447-4%45
PLEASE NOTE:
Air Co"ditio"'" Unitl
CllJIIlot Encroach into
Required Side Y PlI!
Setbacks
$39.5D
$39.50
539.,0
Buu!ri'/D V1/!T'
INGp"
i-o.,
ll.ceeipt No~
--;;: /J.'
By (~
f
CITY OF PRIOR LAKE Me
16:wD Eagle CreekAv. S.E. Permit No. 00 -10&3
Prior Lake, MN 55372
_. HEAnNG APPLICATION I PERMIT
Date~1 PiO.
SileAtldress .11V-1'~ tJp2x-ttLld l)r
lDt --L Block. '7-- AdoniDn
Owner's Name. l)Q \1t;V+UYl
Address 3L1:i1 \~llyh.it\Cli-nrL l)r -.tU~ f..M{UJ NJJ
{\ 'll . 1\ ",.J..- IAn 0 n L ,,' . ^ I J ?~I~-z...
Ii&ating Contractor H t Iw ,1 II ILU ILU'U r J.L-t
Address3i'5~J(jJ:lli.fJ?fLurtf;i ~ /L1J\f 55127-
Telepnone' /1':J l t.V5Z-l.ilS
Furnace Make & Model 6 hN1Ytf- TYPE OF SYSTEM
'2 (}<) ;.; fl \ '{j ..,JrlO 70 Warm Air Planls
Model Size ~)D:J1V1 V L.-'-t Gravity
Conn. Load '21 \ "3 Ljtj Mechanical
1't ( Air Condilioning j?YlAIlYtf ?_~
Fuel tJ CJd-- .Flue Size GdLSsf; Vont. System. 1- 56 c.PfV\. ~ . S
Supply Openings 55 HEATING OR POWEll PLANT
)) ~nm
'I liotWater
Radiation
Spacial Oevices
Return Openings
Inpur JI2&N)
Output 5lM5DU
Edr.
Other Devices
C1m.
~r5b
TYPE OFWORK
A~eralions
Replacement
Est Comp. Date
~,mm.1Sb auHding PermU
..,.........
New ConSlrucliDn
Repair
Est. Cost $
()() - /0(03
HEATING PERMIT FEES
STATE SURCHARGE $
TOTALPERMrrFEES $
.50
t"\ \Nf,r\
~p..\v-_,Y,;i
",'{3. l'~0'"
Receipt # eU\\.P\'"
~
TYPE OF STRUCTURE
I.PiIlk
2.. Greta
3. Yelluw
.
,
.
.
.
.
.....
C>oy
<AD........
Single Family
Commercial
t....-/
Two-Family
Industrial
Muni-FalTUly
Other
Public
.
<
~
FBf! Schedule
Industrial, Commercial &. Mulli-RImiIy
Residential, Haerrng & AC
Residential, Heating Only
Residential, Gall Fireplace
Residential, Additions & Alterations
Residential, AC Only
.
.
.
<
1%'01 job cost /$39.50 minilTXlm)
$99..50 PLEASE NOTE: ~
$64.50 Air Conditioner Units CanIll c
$39.50 Encloach Into ReqlUred Side ~
.
$39.5C Yard Setbacks. ~
S39.5C ~
.
~
Rememberto add the Stale Surcharge on !he bottom of this application.
The price of your heating permit includes one rough-in and one final inspection.
Additional inspections will be billed al $35.00 each.
House Healing Test RSCDrd must be submitted with buildina Ilm!llil number before build.
ing UIiOI ~g,le of occupancy will be issued.
!:!fA1 CALCULATIONS REOUIRED with number of supply and return openings listed per
room wnh CFM's per opening. New structures or additions send floor plan with supply
and relurn locations shown. HE!l.T 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 S a..m... 4:30 p.m.
ALL WORK MUST BE INSPECTED (ROUGH-IN AND FINAL) . CAl..l.. Cln HALL
447~
("
~
~
~
C
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.,
"
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c
"
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..
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I hereby apply for a mechanical systems permit and I acknowledge that the
informalion above is complete and accurate; that the work will be In conformance
with the ordinances and codes of the city and wilh Ihe slate buHdingfmechanical
cDdes; thai this form does not becDme a permit until signed bV tne BUILDING
OFFICIAL; that the work will be in accDrdance with lhe approved plan in the
case of all work which requires review and approval 01 plans.
1.1 JJ h HI., )),jii'll'l"J YY'..u1..vV~)
:1fr ~PP.1JJllllllure '
Buildlngftiical's Signature
~
'2~ Z,0() /
~
'"
'"
....
Date
PL. FA.;! 447- 42..43
PRIOR LAKE DEPARTMENT OF
.' BUILDING AND INSPECTION
INSPECTION RECORD
SITE ADDRESS I 'l'2..Ll3 'D=-.ar~e.L,1 t\_.
NATURE OF WORK ~,,,.1
USE OF BUILDING SFrL c
PERMIT NO. 00 -, W ~ DATE ISSUED //-21-2Dco
CONTRACTOR D. R \..1,...~ ~61-2~G,-?13(,.
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
...... INSPECTOR
DATE
I FOOTING ~,IIICj/o/
I FOUNDATION (Prior to Backfill) 1~ I 13 ~~ I! Ui! OL I~. I /zL.j IDI
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
SEWER I WATER I SEPTIC
FRAMING
INSULATION
ELECTRICAL
PLUMBING ~ lA.c". ~. 4.(-.:1(6/ (~ 41 5(~'1~1 A
HEATING (ifrequired>-Ua.~..J I:Jq(", ~ ~.. z"i 0 I p:;.. u, !Jj./J /
FIREPLACE . ' I /~ !, /.el1" /
GAS LINE AIR TEST ~ . 1/7/ / / /) J
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I ~ ~ I f!A.. f)/3i/tJ/ I
FINALS
>>6
Co 0., (f-S- -(fL. ,/~
..
t;q-
.~
(pftj/Ol
t/~!a i
GRADING (Prior to Sodding) _
BUILDING i,to tW orll'5'(o/ ~. 7!Jvlo/
ELECTRICAL . I
PLUMBING
HEATING
DO NOT OCCUPY UNTIL ABOVE HAS
NOTICE
/2
~fJJr
71 U1fll .
7/) L/-io (
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 ./Ihallbe placed near main entrance.
Call between 8:00 and 9:00 A.M. for all inspections
FOR ALL INSPECTIONS (612) 447-9850
:.J ~ .,,', - I . I, .. t '" .,.' ~
'. I ~.... ~~ '/l~""" ...... . ~
(, - I' ,-
I. - I
(i" i QLertiftruu nt OOrrtImrnnt
I.. , YOM ~t!
'i~: CITY OF PRIOR LAKE
..:~! Department of jiuilbing 3Jn~pettion
:f WFinal Permitted 0 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 regulaling building construction or use. For the following:
Use Classificatiol'
SINGLE FAMILY
Bldg. Permit N"
N/A
00-1063
R1
Occupancy Type
R3
Zoning District
VN
_ Type Construction
Fire Zone
Legal Descriptio. 1.1. B2. DRERFIE1.D SF-CONn
Owner of Building
17243 DEERFIELD DRIVE S.E.
Site Address
L..__._. 's Name &: Address D. R. HORTON, 3459
ROBERT D. HUTCHINS /1/1/
'I~ASHINGTON DR. SUITE 204, EAGAN 55122
DON RYE
Date:
"
/ '
Budding Official
, 0,----
City Planner _
Date:
"',, ,_.~'.",.... ,.... ,',1 _,
~....Ji..,
'~"-
~. .
.~',.'..,'('..,'~
/1h)
//>, l
-I
HOUSE
")f
APT. _ FLOOR
t1WNER
JOB#.
HEATING TEST RECORD
ADDR ESS
OCCUPANT.
HEAT LOSS.
SOLD BY
Electrical Work By
TYPE OF HEAT
DATE HTG, INST. ').,
CITY _
/
SUBURB
I
INSTALLED BY //.
,..~S Line By /// / .-
GA _ FA _HW _STEAM _SPACE HTR. _UNIT HTR. _OTHER_
GAS DESIGN
MAKF '>,
Mod.1 -r') 7/ ,""", ~.J /,
Serial
INPUT
MAKE OF BURNER
Model
Mox. BTU Rating
MAKE OF FURNACE.
Model
THERMOSTAT
/"
CONTROLS
Heat Plug
Vent Size
KIND OF LINER
Draft Hood
Filters Size
Chimney Location
Chimney Construction
Valve
limit
Limit SeHing
Fon Setting _
Pilot Type
Pilot Make
Pilot Model _
Pilot Timing
L. W. CuI Off
f f+{\ ~ tJ
J /
/j/ ./ /
Percent CO2
Percent O2
Percent CO
/
Smoke Bomb
Draft _
Door Pres sur"
Dot. Tested
Company T .sting
Nome of Tester _
Pressur-
Input CFH
Stack Temp.
Form 235
CONVERSION
SIZE
RegulaTor
.Number
(nsid.. Outside
NON~
Wiring.
Test Tag
lighting Inst.
I.
r
I
Frederickson Heotlng & Ale, 3650 Kennebec Dr., Eagan. MN 55122
DATE TIME
CITY OF PRIOR LAKE / J r-
INSPECTION NOTICE SCHEDULED //-c') AT.
ADDRESS r;;;~ /7Zr9 t?~/6LL) D,e..
~
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
COMMENTS:
CONTR.
PERMIT NO.
(x)-Ioa~
o PLUM61NG RI 0 EXlGRADIFILLING
o MECH RI 0 COMPLAINT
o WATER HOOKUP 0 FIREPLACE RI
o SEWER HOOKUP 0 FIREPLACE FINAL
o PLUM61NG FINAL 0 GASLlNE AIR TST
$O~ME/~ (f)
/ II
I
{)O..s~ ~
-r-" I
I--r(0
~ WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTlON BEFORE COVERING
Inspector: JItIr? 1(- {"-Oz... Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
lNSNOTJ
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
2/.iJ.k ~,' 50
ADDRESS
/7J'-/3
~
OWNER
CONTR.
PHONE NO.
PERMIT NO.
rY) -10&5
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 INSULATION 0 SEWER HOOKUP 0 FIREPLACE FINAL
o FINAL )ll:'PLUMBING FINAL 0 GASLINE AIR TST
o SITE INSPECTION 0 MECH FINAL 0
goMMENTS:fI\ &~~ AW~,
(?:}J rLu.~ ,p JTI1 (f~ I r
VlJ\0..1~L.., _ rs1---
Wt~ V/IlJIVU ~.
o WORK SATISFACTORY, PROCEED
~ CORRECT ACTION AND PROCEED
o CORRECT WORK, ~L FOR REINSPECTION BEFORE COVERING
Inspector: m . Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE..
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTl
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
DATE TIME
?(>i /01
r
1.' ?O
ADDRESS
17 ~ lj 3
~~
l/
OWNER
CONTR.
PHONE NO.
PERMIT NO.
[):- /Ot.o3
o FOOTING 0 PLUMBING RI
o FOUNDATION 0 MECH RI
o FRAMING r13 0 WATER HOOKUP
o INSULATIO ~ 0 SEWER HOOKUP
!liD FINAL 0 PLUMBING FINAL
b SITE INSPECTION ~MECH FINAL
COMMENTS:(/) ~ ~ - tI14.
~ uu
8J ~ r ~ .
....,...~.--._.~~..
t
C-) / I 5/ ()/
Tc,o
;.>~
~~
o EX/GRAD/FILLING
o COMPLAINT
...fl 0 FIREPLACE RI
tt:sJ )lJ: FIREPLACE FINAL
o GAS LINE AIR TST
o
" '.N__,.....,.__~.....
~~
)
o WORK SATISFACTORY, PROCEED
)q7CORRECT ACTION AND PROCEED
o CORRECT W~RK ALL FOR REINSPECTION BEFORE COVERING
Inspector: r- OwnerlContr:
CALL 4047-9850 F R THE NEXT INSPECTION 24 HOURS IN ADVANCE.
IlVSNOTl
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
CITY OF PRIOR LAKE
INSPECnON NOTICE
DATE TIME
SCHEDULED
ADDRESS / 7 )Lj~ -/72'11 D~~//~JllJ'"
OWNER CONTR. D/(. No";"","')
PHONE NO. PERMIT NO. Jo/'/"! 01:... 3
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
)!(fINAL
o SITE INSPECTION
COMMENTS:
17~,-/J
/7)'1 b
/7).Lf 7
f7:J LJ'1
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
~X1GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
td. t../ / 10 Box, r:) ~
ft.. L///b 130-1- olC-
L.Jh &)10 o~
[111L, Bo"l- -01(
X WORK SATISFACTORY, PROCEED
o 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!
INSNOfl