HomeMy WebLinkAboutBuilding Permit 03-1459
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
/0.7.03
q>>lease ~ or mint and sim at bottom)
AWk; ~-W:?~
V
LEGAL DESCRIPTION (office use only) ~ . '\
LOTI~BLOCK ;;J-ADDITION I IA.e U )'IIJ~ ~~
I
r04"le~-s_
(Address) (f D, 60 X t4B11)
~~~utI8l~ /At:)
I. While File I PERMIT NO I
2. P;,k G', . /1"1 -/45Q
3. Yellow Applicant l..I-' /
I ZO~~(Officeme) I
PID t5. 404- . 032.0
-'
~ew Construction
OLower Level Finish
:v. (Phon(h/Z~<g - 2-158
JaIi!tM MN. ~f-d
'--/ I ..... y'
I'J KvL" ;Q"'-~I
F- 10 ,;;l- (Jo(Phone) .012--3'2-8 -2-/8:8
YfAl1. (Phone) ~ 7. - .3,:2g"":2/ ~S(
Vt11J!PrJ #1 tV I 55/'2-f
r /-
~ch
ORe-Roofing
ORe-Siding
OWNER
(Name)
(Contact Nt.j)
(Address) \'[' O.
TYPE OF WORK
II
,
[jDeck
o Misc.
o Fireplace OAddition OAlteration OUtility Connechon
PROJECTCOSTIVALUE (excluding land) $ ~ /tf:1
.
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
a . d agent for the a -mentioned r-wr"n. that all construction will conform to all existing state and local laws and will proceed in accordance with
bmitte lans. I am a e t the . g offi can revoke this permit for JUSt; Furthermore, I hereby agree that the city Offi'; or a designee may
~r~n ey..y...,t perf dm . /71 r /0/0/03
~ ( S' Contractor's License No. Da~
~
Permit Valuation 3~<j/J 000 I Park Support Fee # $ -
Permit Fee $ dtLJS3.6S I SAC # $ lJ..rJ6.-
I Plan Check Fee $ 1G'P.b' Dto I Water Meter Size 5/8"(0 $ - 300.-
I State Surcharge $ . J'1q. - I Pressure Reducer $ ?l? -
I Penalty 1$ I City SAC and WAC # $ /;;ZOO.-
I Plumbing Permit Fee 1$ !()t). - I Water Tower Fee # $ ?OCJ -
I Mechanical Permit Fee 1$ /a:J.- I Builder's Deposit $ I.~ t.l"J. -
I Sewer & Water Permit Fee I: 35'.~ I Other $
I Gas Fireplace Permit Fee 40.-- I TOTAL DUE . $'1..523. II
This Application Becomes Your Building Permit When Approved I Paid ClC7-'I-(! I Recei[)~. ~(H /
~ ~ /4 /~:.;;;:l I Date . -10..:11.0 f Bv 1/.vf
/ .
Building Official ~
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 re~. 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 ~ must be
iss~ ~ /6//(;,10:1' /&~~ aA. ...L/.n... ..;';-~
Planning Director Date Special conditiO:' ; ~ u
24 hour notice for all insr ,..:. .. (952) 447.9850, fax (952) 447-4245
16200 Eagle Creek Avenue Ptior Lake, MN 55372
,-white - BuildiJ1i::>
Canary - Engineering
Pink - Planning
Thr ('tnlt. of lhr L.... (.'ollnlry
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
6~~~
o
10 - 7-03
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
;)It,t/~- c2C77A'vtPAJ ~~
- ,
Accepted
Accepted With Corrections
/
Denied
Comments:
~- . <-/.;'-
Reviewed By: ~ ~
~~ LJ...L-I ~
~ ~~ -to ~D-<>.d ~
~~ ~ -?~'
Date: ItJj;r,1o :J
_ (1'1->. ~ .
.J~
~
"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."
.
lht C"tnlt't of Ih. (..kf ('ounll')
White - Building
~rv - En.9!neering
. - Plan",~
,.~.:.,
I3UllDING PE;RMIT APPLICATION DEfARTIVJENT CHECKUSI
NAME OF APPLICANT
APPLICATION RECEIVED
l;:; f/ ,// .
/...':.-iaAG,z/<--" ry O-~~1'C1.-_
I ^? ()
0- 7- v -.; -
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
,:90 (( S - (/}'C;?( {//(~0 I-ZJ ft.
,
Accepted
Accepted With Corrections
/
Denied
Reviewed By:
Comments:
~' 7'~fJ
/~ a.H
Date:
/d/;'/o7
,.
/
"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 - Buildlnll
(' CjInarv - fngln _ '., '\..'
Pink - Plann(ng .
TII, C.....,tralI'" l..k,CoulIlry
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME"OF APPLICANT
APPLICATION RECEIVED
~ f
/!:CU/(&-<-, :tlcru~'71CA_
()
10 - 7-03
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
a /"
, ,. .--. _/" ,,.-' - ,',~"'",
d(., l/~ - c:J'U.:/{.'l-<..j /.c:.:L--t.fL_
f
Accepted
Denied
.x
.-
Accepted With Corrections
Reviewed By:
~!S
Date:
If)r.~~-oJ
Comments: See Reverse Side for Additinn~llnfnrm",ti,..nl
J11.J~+ k..VI
t1 f- /t,lIVv
(;.,i/S I;-~/:''''~''
Wheo I.w......
((J,rrJ- , ~Y\ r~.1 '<1'1 l'ef,
; j t>-fI!. ~dJ,'"J Aw-/
(
~I~e Attachment.c:.j) Orading 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. .
t
~'.I<;;7:;.~:;i,~"-, ,- "1""-".'" '.'-'.
-..~.
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Re.
[. Pink
2. Green
J. Yellow
File
City
Appli<;;arlt
I PERMITNO~
ZU.1'lIll _G (office use)
(!'lease tv1N;: or Print and sian at bottom)
ADDRESS
.5 COUGAR PATH
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION
PID
OWNER
(Name BUTLER HOUSING CORP
(Phone)
(Address)
APPLICANT
(Name) AT.LlED FIRESIDE DBA FIRESIDE HEARTH & HOME
(Phone)
651-631-2561
(Contact Person)
BRENDA HUSTON
ROSEVILLE
(City)
(Phone) _651-633-2561
55113_
(Zip Code)
(Address)
2700 NORTH F AIRVIEW AVENUE
(Address)
APPLICANT SIGNATURE
BRFNDA HUSTON
DATE
1/22/04
APPLICANT PLEASE COMPLETE BELOW
xD NEW CONSTRUCTION 0 REPLACEMENT 0 ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
OWarm Air Plants
OGravity
o Mechanical
DAir Conditioning
OVent. System
o 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
HEATN GLO PIER-HV
Industrial, Commercial & Multi-Family
FEE SCHEDULE
1 % of job cost Residential, Gas Fireplace
$39.50 minimum
$99.50
$64.50
Residential, Additions & Alterations
Residential, AC Only
$39.50
$39.50
$3950
Residential, Heating & A/C (New Construction)
Residential, Heating Only (New Construction)
Estimated Cost $
REA TING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
Building Pennit # PAID WITH
~ ~ PERMIT
$
(Office Use Only)
BuUdine: OOicial
Date
I Paid
IJAff 2 9 2003
Receipt No.
This Application Becomes Your Building Permit When Approved
By
24 hour notice for all inspections (952) 447.9850, fax (952) 447-4245
..
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
1. Pink
U;"".
3. Yellow
~:~ ,. PERMITN~/'J.r1!J
Appb~l tIIfii'- .,-0-"
q>lease ~~ or Print and sign at bottom)
ADDRESS d& Lt5 (i at Ct1R /l; fh
ZONlNG (office use)
. LEGAL DESCRlPTION (office use only)
LOT
BLOCK
ADDITION
PID
. (Jone) q~:J. /431- 4/3:1,
JjPPi.1J ~< (. ~"Lfl11.tJ. ~'\5.1 ~4
~:;~~ANT ~A)" L I~ (phone) t/-:)., f;2y-if?1
(Address) i./~ "S1~/elt(jO Ie:. -~d -!lltn,,/J1J ~S/''ldl
. II) ~ i, I.) (Address) (City) (Zip Code)
(Contact Person) I, ,~~ " >J (Phone) _/,/.J, /.~J".6fZ/
APPLICANTSIGNATu.!<::E ~- ~ A/d!i. _ ___ DATE /-.Q-t>'l
., ,- - - -
OWNER
(Name)
Ylu t(L!Y1 l~aiS/,Jb
r1/),' (j~ 24:)11
(Address)
/ APPLICANT PLEASE COMPLETE BELOW
@flEW CONS'1k)!:Jr 0 REPLACEMENT 0 AL TERA TION~ ) J /ii,
FURNACE MAKE AND MODEL E- - 'TtN. / ,gt/ FUEL .M:L:4..<
FLUE SIZE RETURN OPENINGS ~ INPUT ) ;)1J;/)7Jt) OUTPUT . JtJFIt$V
TYP" 01" SVSTPM ""...AXING OR POWER PLANT
. ~E- Air Plants 0 Steam L...-r
oG . 0 Hot Wa",r
chanical 0 pdiation J l. D i, ~
I2rAjyeonditioning [Jij'Special Devices '''''1+1 I/JI,I/{;:A,_
[iJ'lfent. System 0 Other Devices
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into .
Required Side Yard
Setbacks
FIREPLACE MAKE AND MODEL
Industrial. Commercial & Multi-Family
FEE SCHEDULE
I % of job cost Residential, Gas Firepiace
$39.50 minimum
$99.50 Residentiai, Additions & Alterations
$64.50 Residential, AC Only
$39.50
Residential, Heating & AlC (New Construction)
Residential, Heating Oniy (New Construction)
$39.50
$39.50
Estimated Cost $
Building Pennit #
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
irii"'l;~'
,
.50
(Office Use Only)
Building Official
Date
I Paid
I Date
Receipt No.
This Application Becomes Your Building Permit When Approved
By
03/01/2004 08:55 9~28959394
ALLIED.EXCAVATING
PAGE 01
I
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/fI:_ _'U'r"_M<l~
ADDRESS . I
~LAY5 c.~U~o..~
LEGAl DESClUPTIO (0 ... DIlly)
LOT BLOCK mON
CITY OF PRIOR LAKE
SEWER AND WATER PERM rr
Date Rec'd
i?::. a; t PERMIT NO~
3, CIIl. ~ ....... r --,"'" JJ
p~ + ~ !?t- \1.))' l.p.lCt.., 1 ZONING c......) I
PID
I
I
OWNER /).... \
(Name) --h.,lU 1- "
(Addreu).fb ~
~~l~
~ Lh151
ildltu
. '(Phone) .9S~-Ll2>~
A\f,{)lt'" XI,. \. PAl 1tV\~) 5$ Jay
~=-r-u r (ZIpCDdo)
r"
APPUc::ANT
(N&llIC) . (Phone) en~ -ho41)
(AcId.tcso) "4 1 W. 128th tr... I
I :) ~~'-O;J, MN OD"'Cf. (City) '. (Zip Code)
'(CoIlt&QPerson). }t<> \'sJOV\. . (Pbone)..tJata-qlfQ-3~(07
APPLICANT~IGNA~~'--r- ~_.'~-/'O\{
i . UJPLICANT PLEASE COMPLETE BkLOW
Si~ of water service 'inches.)... I
Loq,Uc 11 of any couplings from struc:i ~ feet, I
Tm 0: ' sewer pipe_ 0 ABC PVC 0 Clljlt Iron
E5ti\D8.f ad lezllth of sewer line JJI':l. fe t. .1
Cl~ C lIt (if required) located ~ feet from strUCWfe.
,
Residential Sowor and W.!Dr Uno >onnacnan
Sow.r conaection oaly !
lEE SCHEDULE i
$35.50 Industrial, Com'l &: Multi.famiJ~ 1% of job cost wilh I $39.50 minimum
S17.50 Wa!Dr COIIIIectioa OI1ly , $17.50
Elti!nllld Cost S
Building Permit'
, ! EWER AND WATER PERMIT FEE
. !TATESUR.CHARGE
: OTAL PERMIT "I;
:
$
$
S
_50 l~~~~b H.t.....
; .~~
; ~ I[! ~ ~ ~j9T"O
;.~ 1 1 LUUIf I U i
. (952) .,.1oC45 LJ
I
r
(Otftu tl.. Otif) :
Thill Appllcaalon JIeeoIll~ Yc ar Bulldla. PI..lt When Approvod
'.Ildi.. Ollkial
Da.
14 haur nOtice for alii .,' , u (952) 4011.
FROM: WELTER & BLAYLOCK
PHONE NO. 612 8828573
Feb. 122004 11: 10AM P1
Date Ret'd
CITY OF PRIOR LAKE PLUMBING PERMIT
; ~ ~~, I PERMIT NO".. I~
IYeJlowAop,lk:llnl ~
ZONING (oil"".,,)
(Please rvDf or orint and siPIllt bottom)
ADDRESS
c 0 U q a r fa +1-,
c:< b'lS'
LEGAL DESCRIPTION (office .'" only)
ADDITION
PID
LOT BLOCK
OWNER
(Name) _
13 tt-l-/e t"
J-I()u.s.~nq COf'JO
>oJ ,
fiVJ" J.... ;)0 //~o./
. , ,
(phone) '15.,)- 'f 3/ - Lf/ 3 ~
55/.:>..4
. (Address)' Po 130)( .;;; J/S9 7
APPLICANT
(Name) I)),.:. I +-e r oJ-;:3 lall / PJ (! k
(
(Address) )..5"09 E'" Hw V I.~
(Address) I
(ConractPerson) ..elL Lor -:JU d..t
\
APPLICANT SIGNATURE .-W;, Q L:~ a.. 11 ~
fI lJ ~
APPLICANT PLEASE COMPLETE BELOW
I Type of Fixture Quantity
Bath Tub with or without shower / Rough-ins
I Dishwasher I Water Heater
Floor Drain / Water Softner
Lavatory (Bathroom Sink) / Stand Pipe (Washing Machine)
Laundry Tray (lor 2 compartment Sink Sewage Ejector
Shower Stall Backflow Assembly
Sinks Backtlow Assembly Test
Bar Sink Lawn Sprink.ler
Water Closet (Totlet) 0( Other qa.s .fro" ,; ;",eDI. e e.s
Quantity
.?
I
I
b
J
/
I
'-I
(phone) 15 d - 8"'8';J. - 'i( b ~ J
l3urns,,;/I-v. A1/V 55337
(City) , (Zip Code)
(phone) 9S;;;-[{Z ~- 81." g)
DATE
ol-J~- 0";
Type of Fixture
FEE SCHEDULE
tndiJ~trial. Commercial & M\llti~tan'l.ily I%ofjob cost with a $39.50 minimum
tomtit Ute Only)
Residential. New On~ &. Two..family 199.50
Residential, Additions &. Altcratlons 'S39.50
Estimated COSt S
Building Penn it # 03-- / 'ISq
PLUMBrNG PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
,.. WITH
~,wJlI~G PERMIT
n...lIdln~ Offici:.1
r!'<'~ Trec"Pt No.
i: I.,
n,,, ICjI F~B 1 2 2004 !il,BY
I L.~./ )
24 hour ll(Jtice for all i"~p~c:tjons (952) 44'''t~810. fax (9S~.) 447~."24SI'
Hi2()() f:.llRIl: Crl:ek Ave., ~U~:.~ Prior 1J:lki.:::Mtt:SS:3:7~.I'~.i4:---.-----.._
'~-,....._~~-
This Application Bceomes Your Building Permit When Approved
v
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
(Please ~ or. vrint and si... at bottom)
ADDRESS
2645 cougar path
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION
OWNER
(Name RUTLfR HOUSING
(Address)
Date Rec'd
~. ~:'M ~::, I PERMIT NO:'iiC ... ~uctJJ
3, Yellow Apphcant ...., ,.,~
ZVl. lfli -.G (office use)
PID
(Phone)
(phone)
-
ti51-ti33_2~
APPLICANT
(Name) ALLIED FIRESIDE DBA FIRESIDE HF.A RTH ,. HOME
,
"
(Address)
2700 NORTHFAIRVIEW AVENUP
(Address)
ROSEVILLE
(City)
(Phone) _651-633-2561;:'>
';5113_
(Zip Code)
(Contact Person)
BRENDA HUSTON
4/1/04
APPLICANT SIGNATURE
BRENDA HUSTON
DATE
APPLICANT PLEASE COMPLETE BELOW
xD NEW CONSTRUCTION 0 REPLACEMENT 0 A~TERAT10NS
FURNACE MAKE AND MODEL · . FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
OWarm Air Plants
OGravity
o Mechanical
DAir Conditioning
OVenl. System
FIREPLACE MAKE AND MODEL
Industrial, Commercial & Multi-Family
Residential, Heating & AlC (New Construction)
Residential, Heating Only (New Construction)
o Steam PLEASE NOTE:
o Hot Water '," . Air Conditioner Units
o Radiation ~. Cannot Encroach into
o Special Devices . Required Side Yard
o Other Devices .Ii . Setbacks
HEAT N OW SL-750TR.!2.~D F1REPLAC};)~d ~
FEE SCHEDULE . ~ Q""e 2?a'
1% of job cost Residential, Gas Fireplace
$39.50 minimum
$99.50
$64.50
$39.50
Residential, Additions & Alt~~.
Residential, AC Only ,<I4ff:)
BUil~ing Pennit #& ~
$ .50'T~
$
$39.50
$39.50
Estimated Cost $
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
(omce Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
-'1
,
:i i'Receipt No.
II"
i'i
1): By
I
24 hour notice for an inspections (952) 447" !IJ!iO, fax (952) 447-424~
Date
[ID)~ @ 0: C G U;
\I~atAPR U Ii LUU4
(r"
'-'oj
~
PRIOR LAKE DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION RECORD
tilh'lS
AJ~IAJ CDNn-
USE OF BUILDING $'.~. .
PERMIT NO. (/3-/fr9 .DATE ISSUED I(JII,!/IJ~
CONTRACTOR ~ ~ &Jl6 PHONEl/2- SZS- ZlIB
NOTE: THIS IS NOT A PERMIT FOfr'(NY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
SITE ADDRESS
NATURE OF WORK
SEWER I WATER I SEPTIC
FRAMING
INSULATION
ELECTRICAL
PLUMBING
HEATING (If required)
FIREPLACE
GAS LINE AIR TEST ('I\"'" f.~.
COYER NO WORK UNTIL ABOVE HAS_ B~EN SIGNED
\IA~t.71I~ ~ I ~ I
FINALS
^/J)
#1J
4
f 7;CTOR
I FOUNDATION (Prior to Backfill) I 'lffi:/2-r
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH-JNS
(lp ()
we ~~
, --)
I
<.:...J
DATE
I FOOTING
I IJK
Ie.-'<.
::?-z7
I
I
I
't
GRADING (Prior to Sodding)
BUILDlNGk....,1) ~ S -I ~ Pf+
ELECTRICAL .
PLUMBING
HEATING
DO NOT
llll7.--_0 4-
9 -~1,~C>~
~~.
'\i"'-
OCCUpy UNTIL ABOVE HAS BEEN SIGNED'
NOTICE
This card must be posted near an electrical Servlce cabinet prior to rough-in Inspections
and maintained until all Inspections have been approved. On buildings and additions
where no service cabinet is available. card shall be placed near main entrance.
FOR ALL INSPECTIONS (952) 447-9850
Q1ntifitat~ of Q1)t:cupanqz
CITY OF PRIOR LAKE
~tJlndmtttt of ~uilMng Jlnsptdion
~nal Permitted D Conditional C.O. Expires
This Certificate issued pursuant to the requirements of Section 307 of the Uniform Building Code certifying,
that at the time of issuance this structure was in compliance with the various ordinances of the City of Prior
Lake regulating building construction or use. For the following:
Use Classification SINGLE FAMILY _ Bldg, Pennit No. 03-1459
R3 VN N/A R1 .
Occupancy Type _ Type Construction Fire Zone _ Zoning District
Legal Description. L13, B2. THE WILDS NORTH
Owner of Building Site Address 2645 COUGAR PATH
Contractor's Name & Addres' BUTLER HO~. G CORP.. P.O. BOX 24597. APPLE VALLEY 55124
ROBERT D. HUTCHIN../iP DON RYE
"::f . City Planner
Date: q - Z (_ ()Bcurg Official V Date:
\ POST IN CONSPICUOUS PLACE
i
- -
1 HOUSE HEATING TEST RECORD .-
ADDRESS~C . "CA>. )$'d .tLiL,. APT _ FLoOR_ CITY _ SUBURB 1
OCCUPANT _ c-fb.../' OWNER ~
~~ ~~~/ i
SOLD BY i'JYt/ ;,/ lAb /A.i INSTALLEDBY ~V I / J'/
ElectrlcaIWclf1<-8J' / GasuneBy_1< 11.L.-//f/tI!- /"I..v-
TYPE OF HEAT GA _ FA _ HW _ STEAM _ SPA<;E HTR -=- UNIT Hril ~ OTHER /
. ' '- ~ ..i(
tP j() - GAS DESIGN CONVERSION
MAKE :-t.c !k~. MAkE OF BURNER
:: ~~~ '}fh1 C!fJ1!:! .. ~=TU RaIng
INpUT ~ ~rY)tJ MAKE OF FURNACF
Model
THERMOSTAT':)....<;
Ve~ ... r//
Um~ liJI:?~
Um~ SeUlng / C; 1'1
-' d
Fan Setting. .' I ",..~
Pilot Type . I
PlIotMake !I -::> -:-1
Pilot Model
Pilot TIming
L.W. Cut Off
.PreIIure _ 3, 5" I r
InputCFH/...)~ ~
Stack Temp / f .,
CONTR~
He8tPl....
-
Venl Size
KIND OF LINER
Dreft Hood
Fillers Size
"
Chimney Locallon.
I"hlmney~ -'''--
lit!'
SIZE
Reguletor
Number
NONF
1_
"utsId-
Percent COz ~O
Percent a.z 7 , ~
Percent co -1?
"'make Bomb Wiring
Dreft Test Teg
Door Pressure Lighting I""
Date T&*' ~ - ~ - CJl( . .
Company TeotIng ....P Jt- 'i. JV JA,Je .IIY-
Neme of Teater / jlJ ?J J'M L J'-tv,/ d L..
'Ii
..t,.~
........
.,
CITY OF PRIOR LAKE
INSPEcnON NonCE
ADDRESS
Q(P+f
OWNER
PHONE NO.
[J FOOTING
[J FOUNDATION
[J FRAMING
h! pULA TION
~~AL
[J SITE INSPECTION
COMMENTS:
,.~~
DATE TIllE
SCHEDULED
~t.~ ~
CONTR.
PERMIT NO.
5-N5 7
[J PLUMBING RI
[J MECH RI
[J WATER HOOKUP
[J SEWER HOOKUP
[J PLUMBING FINAL
reCH FINAL
[J EXlGRAD/FILLlNG
[] COMPLAINT
[] FIREPLACE RI
[] FIREPLACE FINAL
[] GASLlNE AIR TST
[]
t"""'- ()
~~~ ~7)
V
~RK SATISFACTO Y, PROCEEO
. ')(CORRECT AC 0 NO PROCEED
;r [] \oRRECT ALL R REINSPECTION BEFORE COVERING
Inspedor. OwnerlContr:
CALL 447~ FOR THE NEXT INSPECTION 2" HOURS IN ADVANCE.
CODE REQUIREMENTS AIlE FOR YOUR PERSONAL HEALTH & SAFETY!
''''''''''
DATE TIllE
CITY OF PRIOR LAKE
INSPECTION NOTICE SCHEDULED '5 - ~ --0 <I
ADDRESS ?i'/-!b 0(J{)~Q
OWNER CONTR.
PHONE NO. PERMIT NO. '] - / l./s 7
lJ FOOTING
lJ FOUNDATION
lJ FRAMING
lJ INSULATION
lJ FINAL
lJ SITE INSPECTION
lJ EXlGRADlFILUNG
lJ COMPLAINT
lJ FIREPLACE RI
lJ FIREPLACE ANAL
lJ GASLINE AIR TST
lJ
lJ PLUMBING RI
lJ MECH RI
lJ WATER HOOKUP
lJ SEWER HOOKUP
~ PLUMBING ANAL
lJ MECH FINAL
COMMENTS: _ to..
I f4~,. . ~l-' ( )~n<:
"'Z.D,(vt.. ~ 01.-...1 ~
~. r.......fiUt~""&. 4 ",j ~ . .
4. O.uil . __ Mil J olfl/7 -~rf6
(S: -s:...--b:...I1 GtD~~} \l~~ drt.J'JV<
ld,.. t.... ...._I'd- .
lJ WORK SATISFACTORY, PROCEED
.J( CORRECT ACTION AND PROCEED
lJ CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspecto~n OWner/Contr.
clL117h 0 FOR THE NEXT INSPECTION 2. HOURS IN ADVANCE.
VI
CO U1REMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
......",
,
DATE TillE
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
1/-/2"0(
PHONE NO_
~t 'I J Ct,()~ar Pfh..ft,.
'v
CONTR. Bvf/u- ~(/~t'fl/
PERMIT NO. 83-/JI~S
ADDRESS
OWNER
o FOOTING
o FOUNDA nON
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
~ F1UftII'i'M!Il UNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
COMMENTS:
~,k-t"lt.
Cu/6 ~-/ ~ AC
~RK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector. 4~ _
Owner/Contr:
CALL "7.9850 FOR THE NEXT INSPECTlON:U HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH 4 SAFETY/
"""""