HomeMy WebLinkAboutBuilding Permit 03-1507
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec'd
/ () ~-tJO
Main File
; ;;~;~ ~:~y [PERMIT NO. 03 -/501 I
3. Yellow Applicant 1-
(Please ~e or print and sign at bottom)
ADDRESS
'11;9'
"ZLilFF J!PIt.Jl75 /M/L
I I
ZONING (office use)
PUD
LEGAL DESCRIPTION (office use only)
LOT 1? BLOCK 3 ADDITION 'l;mBflt CtL(~7- ~
PID ;(?~ L/(}';)-()'l-I-D
OWNER
(Name)
PUJ-T& HdIK&5
GIs MIl{JfWUr lA/2J{/,J./A."'f
".-'
t::,4tkh .
(Phone) &5/~1/S-?- 52'00
J1) v/"')S J 21
(Address)
BUILDER
(Namp\
(Contact Name)
(Address)
SAn! e-
fltJ7:r
'ZlAYI-! JljJ
(Phone)
(PhoneLh/2. - ZZI- l/r(rf5'
TYPE OF WORK
~ New Construction
DLower Level Finish
ODeck
OPorch
ORe.Roofing
ORe-Siding
OUtility Connection
o Fireplace
DAddition
OAlteration
o Misc.
PROJECT COST IV ALUE (excluding land) $
9,;?, ~5
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
submitted plans I am aware that the buIldmg offiCIal can revoke thiS penmt for Just cause Furthermore, I hereby agree that the City OffiCIal or a deSignee may
;teru~~op~=~ J5c- /371 /()/z~~3
7~ /~ature , Contractor's LIcense No '.7 -%t~
I Permit Valuation i/o. {)() (), 0 0 I Park Support Fee # $
I Permit Fee $ / q;)5', /IS I SAC # $
~
I Plan Check Fee $ boo,c.;Lf I I Water Meter (Size51.a;l; 1"; $
I State Surcharge $ ~ 5, 0 0 I I Pressure Reducer $
I Penalty $ _ I I City SAC and WAC # $
Plumbing Permit Fee $ /0 (), 00 I I Water Tower Fee # $
Mechanical Permit Fee $ /00, 0 c I I Builder's Deposit $
Sewer & Water Permit Fee $ .'?5.5''' I I Other $
$ "-/0,00 I I TOTALDUE $~.I3I~.~q
12-7<<:),00
~O, DO
~5.cJO
!2.0d,OO
100,00
/ SOt!), 00
Gas Fireplace Permit Fee
~~J:)~
Building Official
/~"/l1 :?
Date
I Paid
I Date
~Y/~.tI"
/1-,2-.0 -r
11
Receip(Mo.
Bv /1/.
I
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This Application Becomes Your Building Permit When Approved
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
~'~;ngZ~o;/}/..J /f/6fiS &~ ~nd;t:~1fi~
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
~i
Main File
/finite - Buil~
~ Canary - Engineering
Pink - Planning
Th~ Cenln of lhf l..kt Counu.,..
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
L/ 9 6>9 jJ~/;tz 1Jn~
1/5- acf-03
(
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction Jli9 'fif is p~:~ ~~ )/z;; 0./L.J
( ~r7~1
Accepted
Accepted With Corrections
/'
Denied
~
,
~ ~ ,j],fJ Date: /0/6 '3
e(J~,,-? a.d ~ ~
~~~
~:~~
AI L-. ~ (?~.---.. J ,
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."
'~~~ PRIOR <"
'"'-
$. ~~,
Thr(-..ntrrofthrtakr('ounln
MAin File
White - Building
Canary - Enpinp.ering
/?,lnK_ :!Ianniil!!)
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
"
//'
) -
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
-i-.- .,'
/ I
/
,
/: / )
i
Accepted
Accepted With Corrections
~
Denied
,
Reviewed By: ~ ~
Comments: -1YZc> : - ~ tP" 4
- <~
~ ,/.'cT~.
7
Date: I t/ 4:> / CJ 7
~ Ir:/~
,e~d.t2 /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."
~~
Main File
White "Building
.... ~ -......-..-W)' - ~..."JlnAerlnc:lJ
Pink " Planning
Thl' CrnfrfOr '''f L.b Counlry
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPI.,ICANT
APPLICATION RECEIVED
" /
"-c-'
,- ,",
Y"--:f
j
.1
l.. '/
t" k
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i./. - ;:;.. ,1 .'
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
:' / ,r. ~""
'-/-- '7 L..'
I I' /
,
i /--;:r-'-
.1"'4 ,'-/{"',J ~":/ ~/L.._".
Accepted
x
Accepted With Corrections
Denied
Reviewed By:
1V14J3
Date:
11-'1-63
Comments: -,"PI" Rpvpr"'F! SiejP. for Adrlitioo<lllnformation!
n1c./V\ FIle
See Attachments: 1) Gradinl! Plan. 2) Erosion Control Measures
"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."
'.,
REPORT OF DENSITY TEST~
Reviewed By:
Date:
PROJEC1Tl'v\f.u..r /1. ,_----;-;
L..r~5-t lark-
PROJECT MANAGER:
?1fY\....
ART JOB NO: "7 "" i {LV]
yu-o:?, n
~iV\.....
TECHNICIAN:
,
FIELD DENSITY TEST DATA
ll'/
~ .
I r-- ~ I . .'
~:ft~, Tr.1j J~ "4. ,\~~ \q.'Lg ~.J
I V"\.J!.. 11\-.'A.3 I" 1 .
\4-'\'\ l-r44'B l?iufFHh. T(: , -z-.. \ \, I.~, I 4 q<tk
. ~ ~-v \l t;<Lg D 1L W1
\q
ho
..
Nuclear (ASTM D2922, AET #20-S01-2) 'L
7
Method: Sand Cone (ASTM D1556, AET #20-S01-1)
_..,-----=~~-
LABORATORY MOISTURE-DENSITY RELATIONS OF SOILS (PROCTOR)
No,
Tech.
Soil Des.crintion
%+#4
Method
Opt. Moisture Max, Dry
Content % Oensitv ncf
\1J
C;'P . tj~~
-..
fA
\'-iD ..
) I to.2;
Il ~l US-L-
tt
~
~
A
Procedure & Method: Standard (ASTM 0698, AET #20-SOI-3) )lModified (ASTM 01557, AET #20-SOI-4) _
C:\dala\wp8\FonnS.lSt\T -10
Oct 22 03 02:04p
METRO GENERAL SERVICES
763-428-2968
p.2
GaEEI . n.!
nLLOW . "'.lICAIT
GOLD. eln'
CITX OF PRIOR LAKE
SEWER AND WATER PERMIT
q~2.r '1'17~tf7.-l/r
.2 -/S61
s.w. No. ;./
FA '"
NOTE:
Sewer and Water
contractors must
be registered
with the City.
APPLICANT: (h CIR() {!'E/lIERAi. SE:.R.I/~E.fiRONE: tb3 -4-d-.fJ-CJ,13[f
ADDRESS: 57Qo (.::).uAIY1 AI/E..NIO: :CAJCDATE: OCT222003
-------I "./\ '~r --II+-- ST: j'Y) IC!../i f'lF-L, ""ll\l. 55376
SIGNATURE: ~l- .ayO'~(_~'''JV . B~DG.. ~ERMIT #
SITE ADDRESS: LJ-.'1'/5Q I ~~1'-
u
FILL.. IN THE BLANKS
l.
2.
3.
4.
~ 5.
6.
Estimated length of water service
b^
feet.
Size of water service
I"
inch(es) .
Location of any couplings from structure
() feet.
Type of sewer pipe. ABS
PVC Lfll Cast Iron
Estimated length of sewer line
5n
feet.
Clean out (if required),
structure.
located at
NIIt-
feet
from
=====================~====~=====~=================================
This application becomes yo~ permit when approved.
BY ~~ ~,r;-~ DATE: Q~T ?.:unn.'
========ff~i~-~~~==~==~=======================================
FEES:!lldL~e..,M'7- Sewer and water line connection permit.
,.--...;::- Surcharge
-..,. No I-e.e... TOTAL
......
* Fee for either sewer or water individually is $20.00 plus
$ .50 surcharge.
* Sewer and water permits issued for new construction must be
rec<?rclll~ pn-thel::n.~:tdi~'il' permit card at the time of issuance
to ~nSl.pi@. tl)at; ;l1Qd\1.l?+~cate sewer and water parmi,Ss are
DATE~I:,:::d. NOV 1 i 2003 ' '.1 AMOUNT PAID ~(.,I<d~D ~
RECElW' _.. ~... REC" BY ~'?~.l;.4,~
.,
16200 EagkCreek Av. S.B., Prior Lake, Minnesota 553721 Ph. (95'2) 447-4230 1 FAX ('1';;2) 447-4245
An Eoual Ooooltunitv Emplover
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PL(;~IB[NG PER.\tIT FE;:: S
STATE SURCH."-.,1.CE .s
TOT.U P.ER"IIT FEE S
50 PAiD :tVIT' ,
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Tau ,",,~~lic::ltion .8~t;Qmes Your Buddin: P~rm.it Wb.t::t Approved.:
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~ijCHCr ~NI8~n'd ^3~lij^ Wd 81 :2: ~Hl ~002-a2-Nijr
2- 9-04; 2:51PM;
;952 894 0925
# 1/ 4
.
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
(Please.!\:'EC or Print and si2D. at bottom)
ADDRES41Zcr B I u rr-
lI+s.
(
r.
;;;'::., ~:~ I PERMIT NOna '.K7
)_Y~lll)w Applieanl _
ZONING (olf", use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
P uJie
(Address)l) 15 f\,jw
Homes
P\:'.wL\l
S~l~ I ltG
(Phone) (t6(- Y5,l-s::J:OD
EaQ(]J) . IY! r0 55/.:z I
LI
OWNER
(Name)
'--'
APPLICANT
(Name) __ -'/il''' Uo"tino & NC, LLC (Phone)
12481 Rhode Island Ave. ~O.
(Address) - - ~e Mill 6537fl-1122
",avu ,. (Address) (City). (Zip Code)
(Contact Person) ju.u.. 'c (Phone) CfS:d-- '6'14-0005
APPLICANT SIGNATURE .\",,\l..:.R. G. ~O,{)Y\.. DATE ;}.. [91 0 Lj
U '-.J
APPLICANT PLEASE COMPLETE BELOW
FURNACE MAKE AN~::~~N~U;~\~6J (Y)~_J:~A6E_MDJS 0 ALTE~:~NS tJU. qaS i!~
;,>1
FLUE SIZE RETURN OPENINGS _ CS INPUT 45; ODD OUTPUT tf II'-l\ 0 D ~fl
TYPE OF SYSTEM HEATING OR POWER PLANT
OWarm Air Plants
OGravity
o Mechanical
~ir Conditioning
OVent System
[.Vfl ~ir~ 0). q
ID fr.LC
d- ,\"0 N
o Steam
o Hot Water
o Radiation
D Special Devices
D Other Devices
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
FIREPLACE MAKE AND MODEL
FEE SCHEDULE
I % of job cost Residential, Gas Fireplace
$39.50 minimum
Residential, Heating & NC (New Construetion) $99.50
Residential, Heating Only (New Construetion) $64.50
5 c: 0 00
Estimated Cost $ I 00, Building Permit #
Industrial, Commercial & Multi~Family
$39.50
,
Residential, Additions & Alterations
Residential, AC Only
$39.50
$39.50
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
\;-
^
r PAiD WiTh
~c::louILDING PFR~!;"
.50 bj blUl W' """
(Office Use Only)
Tbis Application Becomes Your Building Permit When Approved
Paid
Receipt No.
.
Building Official
Date
Dat'fEB 1 0 20of-" By
24 hour notice ror all inspections (952) 447.9850, fax (952) 447.4245
16200 Eagle Creek Avenue, Prior Lake, MN 55372
CITY OF PRIOR LAKE
HEA TING/ AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
;:i:, ~:~ I PERMIT NO. =>_ ~~A?
J. Yellow Applicant c.::J1 ,'-"...,..
(Please type or orint and siltll at bottom)
ADDRESS
ZONING (office usel
4989 BLUFF HEIGHTS TRAIL
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION
PID
OWNER
(Name PULTE HOMES
(Phone)
(Address)
APPLICANT
(Name) ALLIET)PT~PSTr)P DBA Fl~FSTr)F HPA~TH & HOMP
(Address)
?700 NORTH F AIRVIEW AVENUE
(Address)
(Phone)
ROSEVILLE
(City)
651-633-2561
S5113
(Zip Code)
(Contact Person)
RRENDA HUSTON
(Phone) _651-633-2561
APPLICANT SIGNATURE
BRENDA HUSTON
DATE
3/24/04
APPLICANT PLEASE COMPLETE BELOW
xD NEW CONSTRUCTION D REPLACEMENT D ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM
DWarm Air Plants
oGravity
o Mechanical
DAir Conditioning
oVent. System
HEATING OR POWER PLANT
o Steam
o Hot Water
D Radiation
D Special Devices
o Other Devices
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
FIREPLACE MAKE AND MODEL
HEAT N GLO SL-550TR-C
Industrial, Commercial & Multi.Family
FEE SCHEDULE
I % 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
Estimated Cost $
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
Building Permit #
$
$
$
.50
. "~
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.../: "'"' "....Jrn
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(Office Use Only)
Buildine: Official
.1 Paid \~ ,receipt No.
tteate ,,~ \\.'! 'i,.llY /" Y
Date ': All 2 6 7004 ,1 L/1
," -~ U
24 hour notice for all inspections (952) 447-9)5 ,fax (952) 447-4245
By .____.___=: ..-
This Application Becomes Your Building Permit When Approved
Main File
PRIOR LAKE DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION RECORD
SITE ADDRESS J/9t8'1 '$Ltll-l-' #~ ~/'
NATURE OF WORK NEIAJ C.6IJSrlUJ.cnd~
USE OF BUILDING S;F\A.., .
PERMIT NO. 03-/CD'7 DATE ISSUED IlliIJ{07
CONTRACTOR fLu:r ~ HeM.~ PHONE!<<.t. lZ r.. "8S
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
I FOOTING I 1/1-1: I /2 - /- 0 5; I
- .
, FOUNDATION (Prior to Backfill) I WV /I//l/ I /J_~ f~(r~ /r;l -/O~
PLACE NO CONCRETE UNTIL AB'bVE HAS BEEN SIGNED
ROUGH - INS
,s H :~g~ _
11#
1M/' ,J
SEWER I WATER I SEPTIC
FRAMING
INSULATION
ELECTRICAL
PLUMBING /),(r- y1It? Vf5t141
HEATING (if required)
FIREPLACE
GAS LINE AIR TEST
INSPECTOR
DATE
/I./er, ~
"3 -A,5'-oL
?.2 (-atl
I
-
n{/_
;/W/
5- .2 YcJl{
;j--.?..s: Pij
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I I
FINALS
jf/~ 7.~ "~U~/ ""
/~ f'/..2r'/'t7y
GRADING (Prior to Sodding)
BUILDING t/~ 1M h1 ~-I-cJ1
ELECTRICAL
PLUMBING
HEATING
DO NOT
-
JIVlP
I~
OCCUPY UNTIL ABOVE HAS BEEN
NOTICE
L/_ J.71'1 ~I
S - lhl' \
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
QItdifitaft of @ttupanty
CITY OF PRIOR LAKE
~:eparfutlmt of ~uilMug c3Jusp:ediou
~Final Permitted C Conditional CO. Expires
/
This Certificate issued pursuant to the requirements ~f Section 307 of the Unifonn 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 Classification
SINGLE FAMILY
Occupancy Type
R3 Type Construction
VN
Fire Zone
Bldg.PermiINo. 03-1507
N / A Zoning District
pun
Owner of Buildin!!
1,1. B3. TIMBER CREST PARK
SileAddress 4989 BLUFF HlliGHTS TRAIL
Legal Description
Contractor's Name & Address PULTE HOMES, 815
ROBERT D. HUTCHINS~~'
~ B~i1<!jl(yOf ial .
Date: 9',,,<.;/ / ()
"/
NORTHWEST PKWY.. SUITE 140. EAGAN
55121
City Planner
DON RYE
Date:
DATE TIMe
J>>~y'
~/Y7 //~# #h 7//
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
--dFINAL
o SITE INSPECTION
o PLUMBING RI
o MECH R1
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
COMMENTS:
03- /S"o7
o EXlGRADIFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
~
~-
/.........,/ ,--r/
(C--/OS-€ // /p /'
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------......
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AWORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, C~~pEINSPECTlON BEFORE COVERING
Inspector: .#~ uwner/Contr:
CALL 447-9850 FOR TillS NIS",T INSPECTION 24 HOURS IN ADVANCE.
COnE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
INSNOTI
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
tfflffq (7,(,ff ~
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
l' FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
A MECH FINAL
COMMENTS:
~C....(
(;,J ')o.L
DATE TIME
s~ -:l-7-dft
3 -(!>7J7
o EXIGRADIFILLlNG
o COMPLAINT
o FIREPLACE Rl
o FIREPLACE FINAL
o GASLINE AIR TST
o
~",u.J. <W~ ,I
+- nv~''5 .t1'h- rI-'v/-Yl-.r1
7"....~ f/H LJ
?l ~ ( -oc-r
o WORK SATISFACTORY, PROCEED
o C~RECT ACTION AND PROCEED
~RRECT ~O;~OR REINSPECTION BEFORE COVERING
Inspector: -J:....O../ Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOllRS IN ADVANCE.
~,
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
!. -(/>V /
BUHNSVILLE
Heating & Air Conditioning, L.L.c.
12481 Rhode Island Ave S, Savage, MN 55378.952.894-0005
Orstat Test Report for Job# (" { 18
Address4"18'1 f3wFF /-1tJr."r.,'5
Occupant
Date of Install
Type of HT. F/A XHW
Other
-r,e . City Finop t.Aj(.i':.
Space HT
UnitHT
Make L[. i000 x
Model (:::"SII-IP 2~6- O"lS 0\
Serial 5 go '-1;4 /{d" '1 0
Input ""',DOO 61\.'-14
'I.
Pilot Type HQTSI,JRFACE IGNITOR
~ Pressure, 35 \u.:,c CO2 l.o3
Input CFH ~'-l 02 '1.5
Stack Temp <q\ CO \0 Dorn
Date Tested 5 3 - 04
Company
Technician
BURNSVlLLE HEATING & AIR CONDITIONING
Wv
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
L/~ J-7-tA-j
ADDRESS
'Hrr
(11/f" If n
OWNER
CONTR.
PHONE NO.
PERMIT NO.
s-/)7J7
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o j;EWER HOOKUP
"l!{ PLUMBING FINAL
o MECH FINAL
o EXIGRAD/FILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
COMMENTS:
~ mJfC?7fP?
, -
o WORK SATISFACTORY, PROCEED
YCORRECT ACTION AND PROCEED
o CORRECT Wi7';:;7'ORREINSPECTION BEFORE COVERING
Inspector. -f-tLI- Owner/Contr:
CALI.. "7-~850 FOR THE NEXT INSPECTION ~4 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH'" SAFETYI
""""T>
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
DATE nilE
7-ZO-Q.j
ADDRESS
1!79~ E/tJ-rr. fJ/~ 1/
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
~NSULATION
INAL
o SIT INSPECTION
COMMENTS:
Grc,l'llC- rOf(,
.:0
[u r 1-1 i3,Q;(.. (
CONTR
PERMIT NO.
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
r')~
O~-/')I? 'V
A-EXIIdRADIELLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
rrI WORK SATISFACTORY, PROCEED
V"D'bORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
lnSpector~
Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH'" SAFETY!
lNSNOn