HomeMy WebLinkAboutBuilding Permit 03-0498
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
See Main File, Whiw FU.
2. Pink City
3_ Yellow Applicant
~lease ~ or print and sign. at bottom)
ADDRESS ~
5Lf1-7.. u(}..i"Ll rAYI/1
~"t=" .
Date Rec'd
4 ~ so -03
I PERMIT NO. 6] ~ 0 4 q r
LEGAL DESCRIPTION (olliee use OnlY~
LOT[O BLOCK I ADDITION Du.--h'Jlll q-n.'\....-
OWNER
(Name)
(Address)
BUILDER ,) ,) ,I I ~
(Name) U/.1'\, ~81 ..L...~Lr.-
(Contact Name) _ ~ vo€__ t?~~ I,",
(Address) LO, 'O.."P ~l' _ . ~~<- c....-t. 'bt-e: l}YD
,-,,-1:::tA.-. 1.(', M. VI 55bL/ ....,.
TYPE OF WORK
o Misc.
~New Construction
OLower Level Finish
(Phone)
(Phone)
(Phone)
DDeek
DPoreh
ORe-Roofing
I ZONING (office",,)
PID2..')- 4-00. 010-0
Ot5z...- "12<;-,2-11P>
9 S2- L"2..(.,' I "'J"34
o Fireplace OAddition OAlteration
PROJECT COST IV ALUE (excluding land) $ I D go, c.( 4.1
ORe-Siding
OUtility Connection
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 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
SUb~ I am aw= fuat ilding official can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may
ente up the property t~ perfi rm de' spe .ons.
X AM..M,...- cf20oo<;;{jJi';', t./-7"1-fl":l.
S-ignature Contractor's License No. Date
1/
Permit Vaiuation
Permit Fee
Plan Check Fee
State Surcharge
I Penalty
I Plumbing Permit Fee
I Mechanical Permit Fee
\ Sewer & Water Permit Fee
I Gas Fireplace Permit Fee
106, 000 _ 60
$ l().3f>.55'
$ &7>.0(0
$ 5+- 00
$
$
$
$
$
/00.00
/oo.ac)
.Js.5V
.fO . C/O
~
~I-
This Application Becomes Your Building Permit When Approved
Building Official
q'?~j
Date
Park Support Fee
SAC
I Water Meter Size 5/8"; 1";
I Pressure Reducer
I City SAC and WAC
I Water Tower Fee
I Builder's Deposit
lather
I TOTAL DUE
I Paid
I Date
4.5'(,5
.s-. l,.-"l
II
.)
#
#
#
#
$
$
$
$ ~,(/V
$/,200,00
$ 700. () 0
$
$
8<;;V - 0 0
I. 2-7~. 00
~S{J . 0 0
$~/3 (;3. ) I
I 1 _
I ~~_NO. ~U'r
(; ~
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 as requested. This document
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
",'ft) . ~
~ :7~~
Planning Director
~
. ./} . Iff
7rla, ,~.
5/:~:3
Date Special Conditions. if any
24 hour notice for all inspections (952) 447-9850, tax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake. MN 55372
.
Job Address
Heating Contractor -t2/IL.;4V7 ;7€l ~
Name 01 Tester ~ ~
(~~'!oJ
. ~/,)
-fJ,'P,01V
-%
. fRo~
~
Date
Percent 02
Percent CO
Percent C02
Stack Temp
~
Combustion air is adequately supplied per
UMC Sec. 606 II!!S
f
input ~r? r17\~ ;\ -1:{J
"
~~
White_ - Building
r !;:.anarv - !;'n'l.lneer,ilg;>
l'iiik - PlannIng
Th.. Crnlu of lhf 1..bC(lunlry
BUILDING PERMIT APPYCATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
I), 1/
/. 0 /<-.. .
U ?c.'
{ ..- "_I ..J ,."..
}/u/C,7Vlj
G3
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
,c;- 4 2' .7 L/'C;" to: P ,c" J F-J /l (_'i j j...-'
'--" ~ <-- c ..-'.- '-" '1.--' L..d..-/ "--
Accepted
x
Accepted With Corrections
Denied
Reviewed By: /J/J1- j)
Comments: S c c.. 1)1., ,''''' F.' 1'(
Date:
C-S--Q]
"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."
~~
~hilp; . R!'i1di~
Canary - Engineering
Pink - Planning
TII.. C..nl..r of Ih..I..I<.. Counlrl
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLI~T
NAME OF APPLICANT
/J- /2. 1Io1ClV;J
L/- 30 - 03
APPLICATION RECEIVED
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
5422- OE6erlfJL) ~/R-
Accepted
/'
Accepted With Corrections
Denied
r
Reviewed By:
~
?~I=-J
Date: S/S-~ 3
,
Comments:
"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."
~~
White - Building
C;>l)ary - En!'l.ineering
(Pink - Planning:,
Thr ('rofn of thr L.kt (."ounlry
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLI~T
NAME OF APPLICANT
APPLICATION RECEIVED
1/. Ie-
LI_
/I(/C /{/Ij
..:j" C - C3
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
'~4-7-7
___/ I t-' L-
. .i.....W' '.
, ; r .- r..- _~ 'J..-. .
I~'/L C./...__-I I c" -
IlL
Accepted
/
Accepted With Corrections
. .
Denied
~
1~
Date: S-/S-/03
Reviewed By:
Comments:
"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."
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONINGIFIREPLACE PERMIT
Date Rec'd
I. Pink
2.Grllen
), Yellow
/7/3G>
~:~ I PERMIT NO. --:1 _ / J a Q. I
Apphcant ( P) <-1/ -r I)
q:'lease.!VDt:. 'or Drint and sim at bottom)
ADDRESS
"!5'/-22 /2~/~e/J (7//c~""
ZONING (office use)
LEGAL DESCRIPTION (olliee use only)
LOT
BLOCK
ADDITION
PID
OWNER DR HORTON
(Name) - 20860 KENBRIDGE CT
(Address) LAKEVILLE, MN 55044
(phone)
APPLICANT A 0 A
(Name) /-f/- A'~ .....,r../d~/.'a../
(Address) .' ~~ ~AJ AI P /2-:
I (Addie, ~ ~ -
(Contact Person) A~~
APPLICANT SIGNATURE ::;;:;:t.'<;7' r;-~___
(Phone)~5fi d~"?- ..f??/2
~~~ ~$;~??
(CllS1/f (Zip Code)
(Phone) ~/ - c;/g --177.5"
DATE
f APPLICANT PLEASE COMPLETE BELOW
~NEW CO~TRUCTION 0 REPLACEMENT DALTERA TIONS
FURNACE MAKE AND MOD~/y-.; .~. ~/~~~070 FUEL J 2. ,4......~.e
FLUE SIZE9'~.k~.A RETURN OPENINGS '., INPUT ~ OUTPUT 6'Z_ t"~
TYPE OF SYSTEM HEATING OR POWER PLANT
OWarm Air Plants
OGravity
o Mechanical
~ir Conditioning
~ent. System
. 0 Steam
o Hot Water
o Radiation
o Special Devices
o Other Devices
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
FIREPLACE MAKE AND MODEL
Industrial, Commercial & Multi-Family
FEE SCHEDULE
1% of job cost Residential, Gas Fireplace
$39.50 minimum
$99.50 Residential, Additions & Alterations
$64.50 Residential, AC Only
$39.50
Residential, Heating & Ale (New Construction)
Residential, Heating Only (New Construction)
$39.50
$39.50
EstimatedCost$ . ~Q:)Buildingpennit #
Building Official
$ u.J/ ~,./c:4..r
$ _ .50
$ Y'
fff'!1f @ [E OW re !\>.eceiPt No,
riJ>ate 'II Y
Date UU JUN 0 4 ZOO] if
24 hour notiee for all inspections (952) 447. (!50. fax (952) 447-4245 li;
0_ I
---- ,
-~
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
PAID WITH
BUILDING PERMIT
(Office Use Only)
This Application Becomes Your Building Permit When Approved
1.1, v. I;. ;003 I; I ;PM
GEN= RVAN PLUMBING AND HEATING
No.;964 P. 4 I I
'c
Date Rec'd
CITY,OF PRIOR LAKE
SEWER AND WATER PERi\1JT
; =. ~tl PERMIT NO.d _!.jrP'
l.Gold ~pliarr.( "0?
CPle.'Ue .!'fPe_ or 'Df'1D.t and dgnat bOttom)
ADDRESS ,
9-Id-~ .~-dcP. 6. J2.. Sf..
ZO'N'D'lJ'G(Offlc:ell$~)
LEGAL DESCR1PTION (office we only)
LOT 10 BLOCK { ADDIT!ON kte..f1d.J qivl
PID
OWNER
(Name) -PF.-Ho.rt"" <'''''0'' ~:
(phone) _ %2 -qgs-,Rt>",\
(Address)
2-O&{)O Kev1e>~\u.R_ Or S,....JI'r\
(Address)
La~\jllle..,
(CiOJ)
.0CCj...JU
(J-;p Code) .
APPUCANT
O'ame\ Genz-Ryan Plumbing & Heacing
(phone)
651-423-1144
":.JCANT SIGNATURE
Rosemount. MN
(City)
(Phone)
DATE
55068
(Zip Code)
(Addre~) 14745 So
Robert Trail
(Addr",,)
rVlJR J ~ -b faJJ~
651-423-1144
6- 1;2.-D?:.
(COnlact Person)
APPI_ICANT PLEASE COMPLETE BELOW
Size of wateJ: service inches.
Location of any couplings from structure
Type of sewer pipe. 0 ABC 0 PVC
Estimated length of sewer line feet.
Clean out (if required) located at feet from structure.
feet.
o Cast Iron
Residential sewer and water line connection
Sewer cODlleClion only
FEE SCHEDULE
$35.50 Industrial, Com'1 & Multi-family 1% of job cost With a $39.50 romimum
$17.50 Water cOllllection only $17.50
Estunated Cost $
Building Permit.#
SEWER AND WATER PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$'
$
.50
PAID WITH
BUILDING ~ERMIT
IOffice Use. Only)
This Applic.alion Becomes Your Building Permit When APprOV'~I'I~ ~~~L Ii --~ Ie Ci~!
Bu.ldlngOfficisl Dm filAr. :1 :'nn, "
~ 24 hour notice for aU inspections (95ZfEfy'-98SO, f.X_(9~2!_44'-42t;51
=:-:J
Receipt No.
By
tC'
Ma y i,.
~Rl~
~"'~L~\ '\
- I \ ~
<.) u'"
. -:..\"'I'N/oI 0"''''
.;~~;~:~~~t~;~~;::: IS
,003 I, I ,PM
GENZ RVAN PLUMBING AND HEATING
110.2964
p. \. i I
Date Rec'd
CITY'OF PRIOR LAKE PLUMBING PERMIT
I BIlle File
1 GoIII e,f)'
J'{cllow l\pp1i~
I PERMIT NO. ~-qqf5 I
(Pk,.ue tlQ)c OnmD[ and siJ:'l:l. arbonom)
ADDRESS .
04;r~ ~f1-e(tl- C~fe. S~
ZONING (ollie< "<oj
LEGAL DESCRIPTION (ollico use only)
LOT I D BLOCK ( ADDITION
bid?-d ~ qth
PID
OWNER
~ame) DR Horton Custom Homes
(Address)
APPUCANT
(phone)
9&;2 - q )(~ - 7'3l!C
2O'SlPo ~nB~l ~ CT Sre. no
u1lu..vd k'~ JVI i,J 5CtJ4 Li
(Phone) ....6..5.1=/.? <-, 1.A/.
(Name}.~.........._1J:~........ P1......l-...f""{: t.. l-1~g
~m
55068
(Zip Code)
(Address) 14745 So Robert Trail
(Contact Person)
Rosemount
(City)
r J1jt;Z~ Falls
i::-":'
r~ II 1 u1 1::-')
651-423-1144
(pbone)
~
DATE
5 -/;)..-o?-.
APPLICANT SiGNATURE
Quantity
(
I
l
:J..
;;z
APPLlCANT PLEASE COlMPLETE BELOW
I Type of Fixture Quantity I
Bath Tub with or without shower 3 Rough-ins
I Dishwasher " I Water Heater
Floor Drain R ~ I. Water Softner
Lavatory (Bathroom Sink) I I Stand Pipe (Washing Machine)
Laundry Tray (I or 2 compartment sink I Sewage Ejector
I Shower Stall Backflow Assembly
I Sinks I Backflow Assembly Test
I Bar Sink I Lawn Sprinkler
Water Closet (Toilet) I Other
Type of Fixture
FEE SCHEDULE
Industrial, CommercIal & Multi..famiIy 1 % of Job coSt with a $39.50 minimum Residentlal, New One & Two-Family $99S0
RCSldcntial, Additions &. Alterations $39,50
(om" 11.. Only)
EstImated Cost $
Building Peront #
PLUMBING PERlvIIT FEE $
STATE SURCHARGE $
TOTAL PERl\fiT FEE $
.50
PAID WtTH
BUILDING PERM'"
This Application Becomes Your Building Permit When Approved I I Paid . I Recetpt No.
~II~.@ ll: [J liJ u, 11'( By
. Dat. ni ! '
24 hour notice for allln!feetloos (952) 4. ~85~~~ J52~ 4~~]J45 I
I
~I\ I
Building Official
.By
FIRESIDE CORNEl<
#1999 P.004
CITY OF P . lOR LAKE
HliA TING/AIR CONDITI GIFIREPLACE PERMIT
Dl1te Rec'd
'!'Ie... ~e or orin! RJld Bill! '" bonoml
ADDRESS
FIRESIDFJ;;w
~,"~ I PERMITNO..:s~ 1!1~ I
HE ART H {'T H 0 M E'"
5422 DEERFIELD CIRCLE S.E.
ZONING (offie< u",) I
LEGAL DESClUl'TION (alii", u" only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name DRHORTON
(phone)
(Add~ess)
APPLTCANT
(Name)----6/.JJED FJUCSTor-' l2JlaJ'JllE..51J?J;l'EARTIllliQMr-
(Phone)
~5T-~~~
(Addre~~)
,700 NORTH FAIRVTEW AVENUE
(Ad'd:rc:<<~)
ROSEVILLE
(City)
55113_
(Zlp Cod,)
(Contact Person)
FlRENDA HUSTON
(Phone) _651-633-2561
APPLICANT SIGNATURE
BRE/Yf)AHUSTON
DATE
8/25103
APPLICANT PLEASE COMPLETE BELOW
xD NEW CONSTRUCTION 0 REPI.ACEMENT 0 AI.TERATI0NS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETTJRN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POVl<T:Jl. PLANT
OW,rm Air PIHnls 0 Ste,m
OGrnvity 0 Hul W,(cr
o Medlonicsl B Rn.dinlion
OAir Conditioning Speci.1 Devices
OVenr. Swem 0 Other IXvi".
Pl.EASE NOTE:
Air Conditiontr Units
Cannot Encroach into
Required Sidc Yard
Setbacks
FIREPLACE MAKE AND MODEL
HEAT N GLO 6000TR-OAK..__ .
Tndustrial, Commercial & M1Jlrj~Fnmily
FEE SCHEDULE
1% I)fjob cost Ra~idenrioJ. GfJ$ Fin;pll1cc
$39.50 minimum
S99,50 Rc~idenrjal. Addirjl)ns & Altcrar.ions
$64 .50 R..idenri,l. AC Only
$39.50
$39.50
$39.50
Rcsidenl,iat. HC3r.ing & NC (New Crmsmlcrion)
Re~idenliaJ. He3ting Only (New Construe1ion)
r::~tjmoted Cost $ Building ro""it #
HEATING PERMIT FEE $ PAID W:
STATE SURCHARGE $ .50 BUILDING 7rH
TOT AI- PERMIT FEE $ _ PEFlfvllr
(O;::~:::;:::Hon Becomes Your Building Perro;t Wl,cnAnn roycd ',iU.' ~o~i~dn\ i~l! ~ ~i~\ Rcceipt No.
A Jleurtll di: /f#Jthe /e(']JnII r';!ltJrron. _ _ ._~ ~
~ Q"i1dcr /2M;;" '\ ','iI\ D:jl.\JG i!o j Luu3 By
~~ Bulldin. Of1}'1.Dh.ra;rv;ow Avenue Nnrth R (}R'IIIJ Ie. MN 55] 13 I 'lbIl.l65J~< 11_ ,<<, ",~
nUll.';"'. ',.un, 3850 West l"1ilhW8~' JJla~bP~YI'IRlp~e~o~mM~ ,~~99q .a ,- (
..,,,,..rI~dClllPfl.eom MN ('l)tlIr1cIOr l.i ;nrJfJ
PRIOR LAKE
INSPECTION RECORD
SITEADDRESS ~Z?-P~A?~~~L..
NATURE OF WORK ~
USE OF BUILDING ~ ."
PERMIT NO. · DATE (SS ED rI
CONTRACTOR a PHONE :J"r.J;a /3.3
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELO
THE PERMIT IS BY SEPARATE DOCUMENT
-
DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTOR
OATE
I FOOTING ~k ~Uc,-j. ~ 7,<'2.
I FOUNDATION (Prior to Backfill) I I
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
SEWER I WATER I SEPTIC
FRAMING
INSULATION
ELECTRICAL
PLUMBING U.~, d,A, fi;n.,
HEATING (if required)
FIREPLACE
GAS LINE AIR TEST
7 hi/X)
,
VI/f' j'
/IVY
f/[/v
itLr/ _
J1/("
W./
1 ~Il~~
4~ Jt;-oc,
q - t..1- rf3>
q-q-tfJ
~,-q-d3
q -1 -fI1
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I I
FINALS
GRADING (Prior to Sodding)
BUILDING
ELECTRICAL
PLUMBING
HEATING
DO NOT
OCCUpy UNTIL ABOVE HAS
NOTICE
0!?--e ~'-A ~ /.~ .
~. /:i:!/ V/II I 41 9~ Y
rl-
~VV/ (O-2/~
t5-:r .;rj /I J 0 'I
. .
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.
FOR ALL INSPECTIONS (952) 447-9850
QIrrtifiratr of @rrupanru
CITY OF PRIOR LAKE
~tpZtrfmtut of ~uilMug Jlusptdiou
~inal Permitted 'J Conditional e.O. Expires
This Certificate issued pursuant to the requirements of Section 307 of the Uniform Building Code certifying
that at the time afissuance this structure was in compliance with the various ordinances of the CityafPrior
Lake regulating building construction or use. For the follmving:
Use Classification
SINGLE FAMILY
Bldg. Permit No.
03-0498
Occupancy Type R3
Type Construction VN
Fire Zone N I A
Zoning District
Legal Description
LIO, Bl, DEERFIELD 9TH
Owner of Building
Site Address
5422 DEERFIELD CIRCLE S.E.
Contractor's Name & Add~~R. HORTON, INC ./"
ROBERT D. HUTCHINS /#f
'0 h BujJdi~g 7fieial
~~O/07
20860 KENBRIDGE CT., SUITE 100, LAKEVILLE
DON RYE
City Planner
Date:
Date:
I
--.........
...........
DATE
14()ft~
Lkerld// 0;--
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
s-Y/~.2
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
,...e-FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
COMMENTS:
-....----
. -------~
TIME
CV-?"9,.rJ
o EXlGRADIFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
~
/.....,/l ~,
\ C---/8se r /e.
'-... ---
'- -----------
-, '\
',,- )
../
~ORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK'JC~~L"R REINSPECTION BEFORE COVERING
Inspector: ~~ Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
INSNOTJ
CODE REQUIREMENTS A.J/E FOR YOUR PERSONAL HEALTH & SAFETY!
ADDRESS
5~2-2....
DATE TillE
SCHEDULED d.1II/o'i 9: Y t:J
r7)/~u, C-t~
CITY OF PRIOR LAKE
INSPECTION NOTICE
OWNER
CONTR.
PHONE NO.
PERMIT NO.
(J)'-'f7K'"
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
JiI FINAL
o SITE INSPECTION
o PLUMBING RI
o ME:CH RI
o WATER HOOKUP
o SE:WER HOOKUP
II\)\iJ PLUMBING FINAL
~ ME:CH FINAL
o EXIGRADlFILLING
(fJo COMPLAINT
o FIREPLACE RI
'A ?a!JFIREPLACE FINAL
o GASLINE AIR TST
o
COMMENTS{?i1) ~ 0
~.
~
/J
~
y
~~
(J
. ", "''''-:'1!~..,'t;.'>.;,..
....,.''"_.::~
"e,(), -&Jt Ri5t)1o~
(
o WORK SATISFACTORY, PROCEE:D
~CORRECT ACTION AND PROCEE:D
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 4< SAFETY/
"""""
CITY OF PRIOR LAKE
INSPECTION NonCE
SCHEDULED
ADDRESS
.01 L.L O-l'ofI-h..,!d
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOlJNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
o PLlJMBING RI
o MECH RI
o WATER HOOKlJP
o SEWER HooKlJP
.....PLlJMBING FINAL
o MECH FINAL
COMMENTS:
Y1cVl1f/1A
~~7
1/
DATE TIME
~' IO~)./-O::>
c,::.-
:!- q"r
o EXlGRADIFILUNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
/
~K SATISFACTORY. PROCEED
MORRECT ACTION AND PROCEED
o CORRECT WO~K.;;"R REINSPECTION BEFORE COVERING
lnspedor: Y 1/ f .r Owner/Contr:
CALL .&47-9850 FOR THE NEXT INSPECTION 24 HOlJRS IN ADVANCE.
"""""
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SIIFETYI