HomeMy WebLinkAboutBuilding Permit 04-0286
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
(Please type or print and sign at bottom)
ADDRESS
iL/72,~ -r1,"A~.e tJ"L;C
LEGAL DESCRIPTION (office use only)
-rRAII '_
Date Rec'd
3-3/-cxj
IPERMIT NO. 04. () z6 b
I zZ7Zh"u>01
I. While File
2. Pink City
], Yellow Applicant
LOT~ BLOCK J ADDITION 7~ t<JaI!:1SA-, lHE. WIL./)S
PID ~S-3g302.(!J-O
OWNER
(Name) 1<1C JC
~ ~A-"'~Y
,
(Address)
..4""'R/2LJ~
(Phone)
BUILDER
(Name) IAJ"a/)/)At..E. ~c./P J\"'.e.~ /., r- .
(Contact Name) -'i3J2A.11 -;:L:;U^I~a~
(Address) 6'135' rEL.TL ,e()A.tJ I rY))AhVt=70Nk4) /)1 N
TYPE OF WORK
~ew Construction
DLower Level Finish
DAlteration
~
PROJECT COST IV ALUE (excluding land) $ (p "v (JO() .
DAddition
o Misc.
/
~DeCk
o Fireplace
(Phone)~O -.~</C:- -oS'SI~
(Phone)QS2 -.3<;6' ~81D
!:>"'"53 c,l3
/
/
~porch*~
ORe-Roofing
ORe-Siding
Dutility 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
submitted plans. I am aware that the building official can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may
~nter up~.y ~erform needed inspections.
~ _ P' . 4L"'~u A....":>,MS 13i:;.- t100292-t". ..3/".2.0//11
' Signature Contractor's License No. Date
(/
Permit Valuation
I
I Permit Fee
I Plan Check Fee
I State Surcharge
I Penalty
I Plumbing Permit Fee
I Mechanical Permit Fee
I Sewer & Water Permit Fee
I Gas Fireplace Permit Fee
$
$
$
$
$
$
$
$
t-OtJ.!J(Jo.ao I
392--7. 7~
Z Z::;<:"""'?llrll
;300.00 I
I
I
/OQ.(JD
I dO. OC)
3<::;, so
4tJ.()O
This Application Becomes Your Building Permit When Approved
-~~
Building Official
~II~/d~
Date
I Park Support Fee
I SAC
I Water Meter Size 5/8~
I Pressure Reducer
I City SAC and WAC
I Water Tower Fee
I Builder's Deposit
lather
I TOTAL DUE
#
#
#
#
$ ~O,OEl
$ 13sa.~o
$ 3<'0. D Gl
$ 70.GlC
$ I Zl)O. od
$ 700. Do
$ /5'0".00
$
I
I
I
I
$/3 6z(o zq I
I
.
,f-(; r; 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
"~~ U/-J 1"/;oSate16 t( e~ a<<~, /," - . ~
Planning Director I" / Special Conditi~s, if any
24 hour notice for all inspections (952) 447-9850, tax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake. MN 55372
Paid
Date
~~.v.n
/..f.t!Zc...z'T
tJ-. vI. 6 I---
1f.I~A .j
//
I Recejj5t No.
B-/f __
f
.~~
Th. ("~nl... of lh.. I..b Coulllry
j!lUVt.. - Buildinq
C-- C-'lnarv - EnqineerinV
P1ri1<"' - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
;1 / /".i/pj,j/ ,.) "
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The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed pt:
! (. Ii n 1 J- ,/ i I ,,/.1' -r ' /'
f ., I ,J' j A:'/7;"t ;...,L.,,(--uo u '=.q.., / A.O<... C
()
Accepted
x
Accepted With Corrections
Denied
Reviewed By:
I'rJ::J.j~
Date:
LI-/LJ-~4
Comments: ~e Reverse Side for Additionallnformafum!
f'r1t./nk.,'", l:--"flV~'A c',,".Jro / Un-/-, I Turf t'<. E~j~bl,:(J.,t',1
See Attachments: 1) Gradinf Pl:m, 2) Erosion C'ontrol 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,"
-
rhO' C-..nl..r or lh{' 1..10:.. Counlr~'
White . Building
Canary - ~ngineering
(' "inK - "'Iannln~
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
I i
, i
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I (./C-r
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
;
n i'i '
~~ ,:'1..-.;-/ ()
.1
-t-.
, ,
!) I.( (
/. '..' ~."
Accepted
Accepted With Corrections
~
Denied
Reviewed By:
~
If~~ a..Lt
~
~
~~
J!".
Date: 9j 'S/a i./
,
.:..~ 'l
Comments:
I
"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,"
~~
C White - B!Jild~
Canary - Engineering
Pink - Planning
Th~ (-..nlN nllh.. !.Mk.. Counl')-
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
!j)!/cd~ fO I~~
3- 3-/-64-
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed fit:
/4'lJ3 ~!A/lU~-ts T~ .
Accepted
Accepted With Corrections
/
Denied
Reviewed By:
~
t?~
~ Date: r;/ /S~ q
tU.f! ~~,
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 CONDITIONINGJFIREPLACE PERMIT
Date Rec'd
(Please ~ or tlrint and sim at bottOm)
ADDRESS
Ji1133 Tlmhnr(,(y)/f- Tr[~J I
i ~ ~I~. I PERMIT NO ".11_ "'\ W1"/
), Vellow Apphcanl ~..,... c=ac ~
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
g.':e~R Ii )()(yjrJrLffl hu ild.f(\
\
(Phone)
(Address)
~;;~~ANT J(/(I( /) r
(Address0?Jl7 StnilnV1 PO.J KI,\ 'CUA
(Address) U
(Phone) 1 (0':<) -1rJ.i- 4000
Arrl()\!f r 55(2;(y--1
(City) (Zip Code)
(Contact Person)
~A A1^ -d.., 0rrI V,( L1
(Phone)
DATE
Lj - ~ - (j Lj.
APPLICANT SIGNATURE
v
. APPLICANT PLEASE COMPLETE BELOW
~EW CONSTRUCTION 0 REPLACEMENT 0 ALTERATIONS
FURNACE MAKE AND MODEL @fem !?{1RA-IJEH.L:US, FUEL ~(t+. (-]0-(
FLUESIZE Q3.5 RER:llliWPENINGS .Lf1+o+I1J INPUT lii/U){Y') OUTPUT tf,~.'()OO
TYPE OF SYSTEM
. l8lWarm Air Plants
IGraVity
Mechanical
Air Conditioning
Vent. System
HEATING OR POWER PLANT
o Steam PLEASE NOTE:
o Hot Water Air Conditioner Units
~ Radiation I A.' E Cannot Encroach into
Special Devices \ I'..l.lMo..Y IV xc1, Required Side Yard
Other Devices Setbacks
FIREPLACE MAKE AND MODEL
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
$39.50
$39.50
Residential. Heating & AlC (New Construction)
Residential, Heating Only (New Construction)
Estimated Cost $ _ JEJ l)('J{)
Building Permit #
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$ IOfJ.()()
qq,so
,50
V;'}or!P
U!!f}~ i>J)~
7W?i P&~r;"
~."I''''rr
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
Paid
h5attF f\ 2 i ZX-l
L. U
- I
, . Receipt No,
I
U By
24 hour notice for .11 inspections (952) 447.18~O, f.. 195~
05/03/2004 12:57 7532532233
11/05/02 TOE 12:2J FAX 61244742~~
(Plt:ase t\"tle ortuintand.s;muboctom1
ADDRESS
/9'{;23 / ~--P //~
LEGAL DESClUPTION (offiCI: use only) 0
LOT
SCHULTIES PLUMBmG
CITY OF PRIOR LAKE
PAGE 81/02
~002
Date R~'d
CITY OF PRIOR LAKE PLUl\i1BING PERMIT
1_ Blur; 'Fa,
~, c...t.!l. Ci~
3, Y~Il,,"" ^p~n~lJ'Il
rPERMIT NOUw NJ,
z;;;;;
ZONING (offi" =)
BLOCK
ADDITION
PID
~
OWN:ER /J /J ~ (/
(Name) ~ .:.. fL,dL...4 #.1 _ ..Vf X.q.l
- # <.-/.-
(Address) -'S"0s.'-5 /77H/ ~
APPUCANr _i J..\ 1\ - I ._
(Name) IYJ'\Ld (Ies, .v1U1Y\b Ulb, L.Y 1 L (phone) JIo~'I~ 1...100'1
(Address) \S.}\. Q4 Lv-- l1lJ\.Q!\:,-y ldLlJf\Q mY\ S 'SLjL{ q
. (Address) (City) (Zip Code)
(Conr.a.ctPenon) \:::tuG. :S:-~ (phone) '/103 1'&0 yc.o~
APPLICANTSIGNATUIi'~,.,~"t DATE ;""h,/;-J t,I
~ANT PLEASE COMPLETE BELOW
\ Typt of Fixture Quantity
I Bath Tub with or without shower
I Dishwasher
Floor Drain
L.avatol)' (Bathroom Sink)
Laundry Tray (lor 2 compartment sink
I Shower Slall
I Sinks
I Bar Sink
Water Closet (Toilet)
Quantity
~
I
I
c-,
i
_?
;;:;
I
Y
(Phon~) 9~.3Y5"-&JS<71
Type of Fixture
I
Rough- in s
Water Heater
Water Softner
Sand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
I Backl10w As~embly Test
I Lawn Sprinkler
I Other
I
I
FEESCBEnULE
lndumial. Commercial 8t. Multi-f:!mil)' lo/. ofjcb cost with.. SJIJ,SO minin,um Rcside.ntiELl, New One &. Two-Family $9950
Residential. Additions &. Alu:TatioJ'\9 S39.50
Estimated Cost $
B~i1ding Pennit #
PLUMBrNO PERMIT FEE $
STATE SURCHARGE S
TOTAL PERMIT FEE $
,50
(Oft"Lc.e U:U' OnlYl
This Applleation B..omes Your Bul1ding Permit When Approved
Receipt No.
Baildinor; Offici.l
n"lt'
I Paid
\ DateMAY 0 5 Z004
I
By
'24 bouJ' notiee for all il\'pection:s (952) 447~9$SO,. fax (951) 441-4145
16200 E.~l. Cr.ek Ave., S,E.. Prl<>r Lakt, MN sSJn-\ 714
05/03/2004 12: 57 7532592299
.1J.lV.,/U.i:: ,L'U.t; .l;t::~~, biU ',tSl.l4474i!45
-
SCHULTIES PLUMBING
~rTY OF PRIOR LAKE
PAGE 02/02
~OOl
Date ll.ec'd
CITY OF PRIOR LAKE
SEWER AND WATER PERMIT
(P!e:Ioe..... ar_ awl. si... at be""..)
I~DUSS ..~
/C/I;;13 /~~~ ./44VY.
U'
i =-.~ ) l:1li.N~NO.I.i_-rb-l..
).CIaIIl AnileMl --, ~~
ZONING (olh=l I
LEGAL DESCRll'1'ION to&: "'. only)
PID
(Phone) .!#~-Pfi:f-~
'--'"
(AIId:<..,
(Clly)
cz" Cadol
APPLI~_l.. ,. "";"\j' - I ~
(N=) '.Du\t1e~.y wY\btibll..llL.
(Adclzas)IS;;A\. q L:I:-li) ,LlC\"-\ r..-"BlaJ1'\D.,
'" .. (Addlw)
LDU\) .'10f\.QS
(Contact PmoIl)
APPLICANT SIGNATURE
(PhCllle) r'llo~- Tl'&o. I...\D01
1'vIr\ 5~LiY~
(C,~ (zip Code)
(phone) 110''2:. i'fSU? '-{CO...,
DATE
APPLICANT PLEASE COMPLETE llELOW
Size of water service / -'/ inches.
Location of any couplings from strUcture'
type ohewer pipe. . 0 ABC, Rf PVC
Estimated length of sewer line~ feet.
Clean out (if required) located at _ feet from str\I.<:tutl:,
feet.
o Cast Iron
Rosidential 3ewer and wltlllr line cOlllle<:tion
si:wet eonnection only
. FEE Sl"lni'l)UL:E .
S35,50 Indu3ttial, Com'! & MUlll-t'anlJIy 1% of job cost with a~39.50 minimum
SI7,50 Water C01lIleetloll only $17.50
Estimated Co!t :s
Building Permit if
:.i
SEWER AND W ^ TER PERMIT FEE
STATE SURCHARGE
. .TOTAL PERWTFEE
$
$
S
.50
(061"" Ill. OIlY)
This Appliestioll Be.omc:l Your Bul14lag 1'.el1lllt When Approved
BuUClIng OMci.,
1'.-- .-...
111'~.
'I'-Date .
Due' '.. MAY II fi ?nnA
i
Z4Iha.r .otiter., all i..pccti..& (9SZ) 44,-piSo, fa, (952) 447042AS
I ~.ipt No.
I By .
-.
_._._---'_._--~,--"-_..__._--
FIRESIDE HEARTH AND HOME
#6646 P,OOl/002
(l"leasp. tvpl! or print and. ~f,~ :It bottom,)
ADDRESS
CITY OF P~~LAKE
liRA TINGJAIR CONDITIO~.J' JFIREPLACE PERMIT
FIRESIDE ~,~" I PERMIT NOCI4.OZIfI
Date Rec'd
.t1. t A J"'- J. /"1. Cr /"1. U NJ. J:.
14,723 TIMBER WOLF TR
ZONING (0_
.lel
LOT
BLOCK
ADDITION
"-,.
lC'J
"'11 .h,.
~~4';*-;:'(/~~i!.'_".
I r ......".'". .)~ '
._,
PID I .
~
l.EGAL DESCRIPTION (office"... onl.y)
OWNER
(Name) WOODLAND BUILDERS
(Phone)
(Address)
APPUCANT
(Name) ALLIED FIRESIDE DBA FI~ESlDr: CORNJ<R
_2700 NORTH FAIR VIEW A VENUE
(Mdr."1
(Phone)
ROSEVILl r-
IClty)
"51-633-2561
(Address)
55113__
(Zip Code)
(Conl;a.ct Person)
BRENDA HTJSTON
(Phone) _651.-633-2561
APPUCANT SIGN A TURE
BRFN/)A I-IU.<;TON
DATE
7-9-04
APPLICANT PLEASE COMPJ.ETE BELOW
XD NEW CONSTRUCTION 0 RF.J>I.ACEMENT 0 ALTERATIONS
fURNACE MAKE AND MODEL FUEL
FI.UE SIZE RETURN OPENINGS INPTJT OUTPTJT
TIrE OF SYSTEM HEATING OR POWER PT.ANT
BWIlI11l Air PI:l1Irs
Ora,vity
o Moob.nicsl
OAi, Conditioning
OVent. Sy!llcm
J ST.~m
J Hot Wal.,
J ItIldintion
] Special Dcvice,
J Other Devices
PLEASE NOTE:
Air Conditioner Un.;rs
CannOl Encroach into
Required Side Yard
ScIlla.'"
FrREP/.ACE MAKE AND MODEL
HP.A TN OLD ST -HV]3.IPI & 600ll1'B:-ADK
Industrial, Commercial & Multi-Family
FEE SCHEDULE
1 % orjob CfJst Residenl:ifJl, Gas Firepl:Jce
$39.50 minimum
$99.50
SM.50
$)9.50
Residenti.!. Jie.'lting & AIC (New Conslnlction)
Re,idenUoJ, Hcaling Only (New COWJ1Jo1ion)
Residential. Addjr,j<ms & Alterations
Residential, AC Only
$39.50
$39.50
,.... r .or-'
_\',,",1""".,.,
~ ,_, oI"'IJ............~I.I...:..;[;;
I-,n f',ry f"\.",ClDi1:il (-"~,. C""'-
'.'~u.'IUI;Ilr"I--'''';'';ir...iil
--.., ~~,.Ic'~ "
ESlimated Cost $ Building Pemit #
HEATlNG PBRMIT FEE $
STATE SURCHARGE $ .50
TOT AI. PERMIT FEE $ _ '"'\
(om<<vocOnly) i .~ @ a; u ill I] '~I
. .. A ""ar1JJ 6:: l:Ionre lee", r(l '1 ~6foll. I'
Is pphcot/on Derome. Your BUlldrn~ Ptrm,f Wilen Approvod I'aiij ReceIpt No.
, Bl/ilder Divi.r 0, I ~II 9 WlIL,_
~ (, . 2700 Falrview Avcl\ue Norrh Ro~ev;lIe MN 5~1l3 P I \i&l!l[t)-633-2561 Fax5~~~-8884
lid... om,I.~R5n West Hiuhwnv 13 BllnR~)e_ MN 55337-E.,lc 11/<1 ~90 Qj.$SJ,a"-9 -$4Q.o
~....,...nnt!l1d.U~Jl.r:;"m MN COnfrltdttr I '_"' '" ,I-, "", .
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I1lolll......,~ .w~.,~:H'J1"
......4'...._........
.
PRIOR LAKE DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION RECORD
SITE ADDRESS 1/.1 ? l3 ~;"'4n.t)Du::- nAIL
NATURE OF WORK AJI;w ~/'~
USE OF BUILDING ~. ~
PERMIT NO, 04, 0 2fJ(p DATE ISSUED ~
CONTRACTOR . . PHON~SI-~" S-I.&J!
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECT~ !l _ DATE
j U/ I Lj-Z?
,J;( 'FOUNDATION (Prior to Backfill) I ~ 5"'- }'?I
cJ PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
~ ROUGHdlNS
~ SEWER I WATER I SEPTIC ' (;f b 1r A-
FRAMING kfc... . @ -.f -'-$ -&
S INSULATION UL.!f1~ J-c;
ELECTRICAL
~ PLUMBING /-6 b 'qp
HEATING (if required)
FIREPLACE /),
GAS LINE AIR TEST (~t 7-jr1o( \ . ff !h ~-c.-
CO.VER NO WORK UNTIL ABo;;E HAS BEEN SIGNED
~t.71I4~ ~1JvM" I? 8-~/ I
FINALS
GRADING (Prior to Sodding) IV /J It. i qy.
BUILDING I'1'tf.i
ELECTRICAL
PLUMBING
HEATING
DO NOT
I FOOTING
.
//frtfi;c/
/I/t/lnq.
'-L> //;/-0..1-, .. I
/If/)- /0~ftl
OCCUpy UNTIL ABOVE HAS BEEN SIGNED
NOTICE
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
QItdifitab of (IDtmpantl!
CITY OF PRIOR LAKE
~rparfmrnt of ~uilbing ~nsprdiIln
'Final Permitted [J Conditional CO, Expires
i
I
This Certificate issued pursuant to the requirements of Section i i 0 of the [J Residential / 0 international
Building Code certifying that at the time of issuance this structure was in compliance with the various
ordinances afthe City of Prior Lake regulating building construction or use. For the following:
SINGLE FAMILY 04-0286
Use Classification _ Bldg. Pennit No.
Occupancy Type
R3
_ Zoning District
PlID
VN
_ Type Constructior
Legal Description .
L28, B1, THE WOODS AT Tfu. WILDS
14723 $IMBERWOLF TRAIL
Owner of Building
WOODDALE BUILDERS,
Contractor's Name & Add--p",<: /
ROBERT D. HUTCHINS~~
. /~B.ldin~ffiCial
Date: ////h 0'<./
;' /
Site Address
5435 FELTL ROAD, MINNETONKA 55343
DON RYE
City Planner
Date:
I
,
I
J
&(kr
1. ' t,);lOVS'i) HEATING TEST RECORD f\' A1
ADDRESS 11{Z;z.?'\llN16<rwcM~ U APT.~FL~~CITY~lD[ ~UB~~
OCCUPANT I nWNER _ WOCJMCJ.(
HEAT LOSS DATE HTG, INST, JfJIQ! 2, .
SOLD BY INSTALLED BYl! \.LO-~
Electrical Work By _ Gas Line By
TYPE OF HE":, T GA _ FA ~HW X-STEAM _SPACE HTR, _UNIT HTR. _OTHER
() k GAS DESIGN CONVERSION
MAKF MY\{\Ct.C. .MAKE OF BURNER
Modol VI- pq - A~e.. Modol
Sodol_ 1Z.?.h'l(.Q;{J1 Max. BTU Rating_
INPUT PO,CbO ~h. j MAKE OF FURNAr~
Model
\\ CONTROLS
THERMOSTtEttu../ - Heat Plug
Valve .A ~
Limit 1 .J _
Limit Sotting. ?.-Cd 'I-
fan Setting --
PHo' Type DS 1;
Pilot Make
Pilot Model
Pilot Timing_
L.W, Cut Oil .
'? S'I .
Pressure "'J.'. l(\~,. ( .I
Input CFH \"jJ,cJC!C)
Stack Temp. _~/('}/';C
->1;
Vent Size .c..
KIND OF LINER_
Draft Hood -
Filters Siz.----ilA-
o,imney Location Inside?
Chimney Construction r I_IP___
Percent CO2 ~
Percent O2
_ Percent CO
Smoke Bomb
Draft
Door Pressure
9,0 ~ Oat. Testod I J let }f'/<'I.
~.t2.A2. Company Testini " It \.C4'..........-
61 UPh. Name of Tes... . /"~
Form 235
SIZo;
ReguloTor. ~~tJ...t~
,
Number _
NON~
Outside
Wiring
Test Tag
Lighting lnst.
Form # 5
. Fur 11 ct<:::'C .
- [\IjlP4S~ HEATING TEST RECORD ~ , ..
ADDRESS 1l..I7D WI".rl ili\(J~ IYV APT, F.LO.Q" f, CITLD/I;'-1~
OCCUPANT nWNE~Qx)~
HEAT LOSS DATE HTG, INST, )OJat n,
SOLD BY f . INSTALLED BY K'-Li':c7
Electrical Work By _ _ - G:.s Line By
TYPE OF HEAT GA _ FA -!:--HW _STEAM _SPACE HTR, _UNIT HTR, _OTHER
~ <}/I,GAS DESIGN CONVERSION
MAKE. .fCY>1 ~ MAKE OF BURNER
Model l ~ 17 ,,;::4-<;<; Model
Sedol ' ~ 1m "tZlOL.lr> 7;/. <,?, Mox, BTU Rotin"
INPUT _ I>U/X):) aL.- , MAKE OF FURNAC~
I
Model
""> "
Vent Size ~
KIND OF LINER SIZF. NON~
D,oft Hood I _ Regulo,o, .::z.'S!>A-J.J(
Filters siz.ifr-'Ii<:::Y ( Number-
Otimney Location Inside.^ Outside
Chimney Construction e I J t'
THERMOSlt.T tL
Valve~""""""
Limit J
Umit Setting _ tlLlf) '/~
Fan Setting '1~(C\
Pilot Type {J si--
Pilot Make
Pilot Model
Pilot Timing_
L.W, Cut 011 .
Pressure 7./5 ::~_L ~
/. . 10
Input CFH-4-7(~~ ?
Stock Temp, f} .
Form 235
CONTROLS
_ Heat Plug
Percent CO2
- Percent O2
o/P_ Percent CO
Smoke Bomb
Draft
Door Pressure
C..~LfJDote Te,ted II/q!~
4.J Company Testing - ~
2q ffV'\ N.ame of Tester (p
Wiring
Test Tog
Lighting Inst.
Fonn#5
DATE
Jj;~/cf
JY?~? 7/),.krU/c'/;:' 7r/
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
OWNER
CONTR,
PHONE NO,
PERMIT NO,
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
~~NSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
.,.I!l'1\fECH FINAL
COMMENTS:
RZ:L ~~ / .
~"//u../d O/S<;;/-
~K
7;.-JA
TIME
M-,z?,~
o EXlGRADIFILLING
o COMPLAINT
o FIREPLACE RI
~REPLACE FINAL
o GASLINE AIR TST
o
~
;f;rf-~' n2,.k Ok /
~ :yAk-e--5 r:;:J ~/7/ <k,/ d
4,/
~/
/~
~
""
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/
------
~ke
~ORK SATISFACTO~~:-~~~~~D
o CORRECT ACTION AND PROCEED
o CORRECT WOR);i~;,R RElNSPECTlON BEFORE COVERING
Inspector: /171..- Owner/Contr:
- r
----- / '.,
,-, -
r--- / f'C
~
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE,
INS/tIOTJ
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
ADDRESS
J l/1 2'3
III} "i:/
SCHEDULED ~
--C~~ I.'lolr
TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
OWNER
CONTR,
PHONE NO.
PERMIT NO,
q-7-F'&
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
o PlUMlllNG RI
o MECH RI
o WATER HOOKUP
D SEWER HOOKUP
.}It PlUMlllNG FINAL
D MECH FINAL
D EXIGRADlFllllNG
D COMPLAINT
D FIREPLACE RI
D FIREPLACE FINAL
o GAS liNE AIR TST
o
COMMENTS: 11 J
I.~ ~ (~ r:-..
~.kr -t~ d...1l- ~~)
(\'. Q.D *~ir- ~ ~qe
o WORK SATISFACTORY. PROCEED
\it CORRECT ACTION AND PROCEED
/d-.CORREQ;.RK' CAll FOR REINSPECTION IlEFORE COVERING
Inspector: J ) Owner/Contr:
, I
CALL . 850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE,
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
tNSJlOTl
DATE TillE
CITY OF PRIOR LAKE
INSPECTION NOTICE
PHONE NO,
11-'f~CJL( 3 ~ao
1'1 71 ~ TJ Y'>1b.t/Vt9 {(!- Tr..ll
Wt'),,"tA/~ Stk)
0'1-),<;"
SCHEDULED
ADDRESS
OWNER
CONTR,
PERMIT NO,
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
pIiUlNAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
~LING
o COMPLAINT
o FIREPLACE Rl
o FIREPLACE FINAL
o GASlINE AIR TST
o
COMMENTS:
r;".cuh - v IL
Lulb BaJl.- (?) I(
).f WORK SATISFACTORY, PROCEED
{}. CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTlON BEFORE COVERING
lnspector~~ ~ Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE,
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH &, SAFETY!
""N<>T/