HomeMy WebLinkAboutBuilding Permit 04-0710
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
See Main File
I, While File
2. Pink City
3. Yellow Applicant
~-I'?-'1
Df<:::-
I PERMIT NO. 04-. 07/ 0 I
q'lease type or Print and si2ll at bottom)
ADDRESS D
1'144Ll ~tlMJ.. n"u ~t;
ZONING (office use)
f<.Z-
LEGAL DESCRIPTION (office use only)
LOT 1/ BLOCK L ADDITION
\)pp~ tU. I to'-
PID z.t': ~7 034-. ()
OWNER
(Name)
(Address)
(phone)
BUILDER 1\ () II .
(Name) lJ.l'\. i11rftTY\ W.
(Contact Name) +u ) t-t.. a'ntJ..iYl!
(Address) U)~00 ~1:;;,cl'le.. ct- s"e .tOO
-/ ~ I<6.AA IIi". J NI f'\ '€15DLtL/
(Phone) qc::;1.- q ~S -7Q, "3.2..
(Phone) ..9Sz. - z..2b-I~if
TYPE OF WORK
~ New Construction
DLower Level Finish
ODeck
OPorch
ORe.Roofing
ORe.Siding
o Misc.
o Fireplace OAddition OAlteration
PROJECT COST IV ALUE (eXcluding land) $ 1:21. 59.5
OUtility Connection
J
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 l"~~y""'~J and that all construction will conform to all existing state and local laws and will proceed in accordance with
submitted plans I am aware ~ ~. . ding Offi." cia1 can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may
;ter~:;;:;__... __ ~ons rfA~iJ~7 _ (~-/f.,-ry
siPa Contractor's License No. Date
I Permit Valuation "'/"1/. DDD.o 0 I Park Support Fee # $
I Permit Fee $ /!:J.q9.S'(J I SAC # $ I'3So.~o
I Plan Check Fee $ -8"iJif. fDe' Warer Meter CSize-5/tiVI"; $ Z.SO .00
I State Surcharge $ 70. r:;tJ Pressure Reducer $ &.Is. 00
I Penalty $ I City SAC and WAC # $ I z..oo, CO
I Plumbing Permit Fee $ /00. 00 I Water Tower Fee # $ 700.00 I
I Mechanical Permit Fee $ IOO,DO I Builder's Deposit $ - I
I Sewer & Water Permit Fee $ 3S.S-" I Other $ I
l Gas Fireplace Permit Fee $ Y'tJ I ()o I TOTAL DUE /1 $ ". ()3S./~ I
... /I
This Application Becomes Your Building Permit When Approved I Paid ~Q n..ur I RecellSt No. ~ 7 'L-"17
~~ 7//zIo'f I Date .. If u4-- By/, . .
I
(
Building Official Date
This is to certify that the request in the above application and a...........t'_.Jing 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
~ ~ j '?/i~<( See Main Eile
Planning Director I Date Special Conditions, if any
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
See Main File
White - Building
.r1;anarv - Englneetlh9->
Pink - I'UflUlIIlg
.
Tht-("ftlrrnflhl/l.akf('oanllJ
flUILDlNG..ef.RMIT APPLICATION DEPABniIENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
~I--~ "k' l.i'_'jl -"1'1\ I
f ,,_' r v L~' v v'..,
(0
,-1 r 7-"-' -
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The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
ITt+ 4-4- i)F-~,\l ~ I t.-L() Oil.-
Accepted
y
Accepted With Corrections
Denied
Reviewed By:
fW}-f)
Date:
7-/- "'I
Comments: SeA Reverse Side'for Addition~llnfnrm~ti;.ml ;
I!lQ;~ Fi It,
S.... Attachments: 1) Grading Plan. 2) Erosion Control Measur8
"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."
~~
See Main File
Thr ('t'oln of lht' t.b Country
BUILDING PERMIT APPLICATION DF;fARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
D ~! - f lCII.TC\\..)
((.1/_(,4-
J
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
1'/"" If (r 1)\ F\ f 'l t/j Uil... .
...
Accepted
Denied
.,/
Accepted With Corrections
.
Reviewed By:
Comments:
~
~f...;
Date: 7/1 0 0/'
.
ct'
....
Set' M3in File
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
ord~ances of the jurisdiction shall not be valid."
'\.,4 ~
,%
~
-.
~~
See Main File
~hite - B"UiI~l!:'SS
Canary - I::nglneerlng
Pink - Planning
Th~ Cfnln of Ihf L.kr <-'ounlry
BUILDING PERMIT APPLICATION DEPARTMl;NT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
f) Je_ H-o rcroN
(0.11.04--
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
n 4-4--4- 1)~6LO DfL ~
t/
Accepted With Corrections
Accepted
Denied
Reviewed By:
Comments:
:Z-~
~ f,./
Date:
7/1 ~/o~
. . -
See Main lfile
"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."
JUN. 24, 2004 1 :20PM
GENZ RYAN SERVICE
NO, 515
p, 6
Date Rec'd
CITY ,OF :PRIOR LAKE
SEWER AND WATER PERMIT
q'lease ~l!! ormint 1Dd.1i1Ul"lt battDm)
ADDRESS .
11 LfLfLj. ~-h ttJ l)1L $&-
- -
i ~.: I PERMIT NO~ O'7lf}
),0.'. At,.ICIlll ~. ~
ZONlNG (oDic....)
LEGAL DESCRIPTION (olIlcc UIC ollly)
LOT Ii BLOCK (). ADDITION ~hetC( I (fvt.
PID
OWNER
(Name) "n. u....~....._ ~."......~. 1I~1R'1
(Addzess)
2D~1lO KeY\~~\ti::e. CT- Sw 1N'\
.. - cAddie..)
(Phone) _ go2. .qB8~ ~
..La.u\lillE'J e:j~lJ
rCiIY) rZil>Collel
APPLICANT
Oi~' Genz-Ryan ~lumbin~ & Heatin~
(phone)' 651-423-1144
55068
(Zip Code)
(Ad~u) 14745 So Robert T~ai1
n I ^ ~drn21 ri.-o.f I (I ~ .
(ContaCt Person) . lJV 11'\oN I l -r t{,) '_'
'T.ICANT SIGNATURE (\fi:;! 'T:t:.tll~
RoseUlount. MN
(City)
(phone)
DATE
651-423-1144 I
11-1))-1)4.
,
APPLICANT PLEAsE COMPLETE BELOW
Size of water service inches.
Location of any couplings from sttucture' feet.
Type of sewer pipe. 0 ABC 0 PVC 0 Cast hon
Estimated length of sewer line feet.
Clean out (if required) located at _ feet from structlU'e.
FEE SCHEDULE
Residential sewer and water Iiue connectiou $35.50 Inclustria~ Com'l '" Multi.family 1% of job CM with a $39.50 minimum
Sewer connection only SI7.50 Water connection only S17.50
Estimated Cost S
, Building Permit #
SEWER AND WATER PERMIT FEE ' $
STATE SURCHARGE S .
TOTAL PERMIT FEE $
~~zj V,,'m-D
.SIlN,..... ':'~~Ia
~~pa~J:UJrlij..
(Ollice 1).. Only)
11'h1' AppUelltlon Decom.. Your BuUI1111g Permtt Wlloll APprOV''']1 .~ ~ It U \D \~ ~! \.\
. I DI'le . 1\1 By
l... lIulldlDg Omclll ' DIIe \I II 1 6 2004 ~ j
~ hour noli.. tar ,n inspo.lioDI (952) ~7.'~O, fllX (952) 4474245 1
,By'
R.CCip! No.
,.
I
JUN. 24. 2004 1: 20PM
GENZ RYAN SERVICE
NO. 515
P. 7
Date Rec'd
CITY OF ,PRIOR LAKE PLUMBING PERMIT
,
'.
t ~io ~~ I PERMIT NO.Ot' n-,1It
',"'llIP A"'inlll . ~
ZONING (DlBct .It)
q>1cuc tm 01 ~riD, and um.. bottoml
I ADDRESS .'
nWL/Ll]w(lZ.t, €1.cC D12- ~t
LEGAL DBSClUPTION Como..se only)
LOT II BLOCK J.. ADDmON ~ eel II'*'
PID
O'WNBR
~une) DR Horton Custom Homes
(Addl'esa) 'ZO'S(PO KenBItItx=e.. CT Sre IDO
APPUCANT
(Name) (!a..fIO v!U''l' Pl;'m.~1"'g L u.ul....RC
(phone) --3e>2.q~.~ -'7f$lJO
J.,Qju.ville.!UN EC61.j t.J
(phone) ...6.S.l::/.??- 1 , {J,
(Address) 14745 So Robert Trail Rosemount MN 55068
(A,ddress) (City) (Zip Code)
(ContactPmon) rMlU&t7 ,+a I (S . (Phone) 651-423-1144 ,
APPLICANTSIGNATURB 01117Jfi. ) ~,(J DATIl .--C./J-d'-I-ty./
.-'.'.
Quantity
;"l-
I
I
Li
.;J.
(
~
APPLICANT PLEASE COMPLETE BELOW
Type ofFiJ.ture
Bath Tub with or without shower
Dishwasher
Floor Drain
1 Lavatory (Batbroom Sink)
I Laundry Tray (I or 2 compartment sink
I Shower Stall
I Sinks
, Bar Sinl<
I Water Closet (Toilet)
Quantity
I Type of FIxture
I Rough-ins
I Wsw Heater
I Water Softner
I Stand Pipe (Washing Machine)
I Sewage eiector
Backflo~'-Auembly
Backflow Assembly Test
Lawn Snrinkler
I Other
I
I
I
I
I
I
I
I.
I
I
I .
1U"'
FEE S\..DJ!.uulJE
Industrial, Commereial &; Multi-family 1% of job cost with & $39.50 minilllum Residential, New Ooe & Two-Family $99.50
Ilesidential. Addiriollll & Alleratiollll $39",0
Estimated Cost $
Building Permit #
PAbDVlI~
(?UaW~i\lG P;:~~lJT
.50
PLUMBJNG PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
~[ 0 W [1 ~eCeiPtNo,
. ~acfUl 1 IJ ZUU4 L'ffY
I
(om.. Ute Only)
I Tbls Application BeCOmel Your Bulldlng PermitWhcn Approved
.uUdlq Omelll
Dlle
24 hour noti.. rDr III inlpeetlonl (152) 447.,_11, fn (95~ 447.4245
. . '. .... ." ........... CHYOFPRIORLA;I{E,' . . ... . '. .
..HEA:FING/MR CONDI'l'IONINGIFIREPLACE PERMIT
.- .._'::.......-.,.,.".... " - . '-,. .,. .
:/(1~q9....
Date Rec'd
,'; :~': ....
,':,
. ,.'
.' .
.,' '._, . - . "-, '
,;p."".,..:. a.. [PERMIT. '. . NO-6&.:.;.A.'.Ifl7IJ .., ..' .... .
'r.:~"~k:.at . ....y. -~-",..:).._,:.."'~
. . .' . .:' .~, '," :, ~-_::."'.::t;';;>"'.:{,::/,:"i': .::" -'
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'.'o~li,'
. . ... '.' ..,,'........ DR HORTON
@\lame)
:,.r;,('i:r; 20860 KENBRIDGE CT
J'""~''''iLAKEVILLE, MN 55044
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....PIR
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(Pholic) ..
.' '-.;_,<:f'::.':::;_';::-~:::i~~:W;;?~PjI~]i~Ttr!~:t~};~~ ' " ,'- .
;'.'.." ....,.".,"',.,"',.~.".".".ALLIANT MECHANICAL INC
...::j~~}ii.::';"";"~:l,::;;:)t~1n~i)~t;li(:,i,3650 KENNEBEC DR
.(-A~" ,.",;""",~,"EAGAN MN 55122
~1{~;:452:2n5 . . X::;:;;;,,~,;;~:.: ,;@!'Zi,i(;r;!ii.,~;\i:.,
.;'i(;',1:~,\,~\~'()';J:J;:',::'k;;i.;;:;~;i(ii~~;~@;~~~~~~~..PLE~~,€~i~~i.iW,j!:~~"J;:\g"i'/j,:\~l;:;",;:::,j::t:j:,!OI;.,:(!.E;,:'l...:' .
. " :\::, ..:'. , ' .,." \:\/lrlt:tAnIi:€@l'STRUCTIOj'l 0 l{EPLAEmMBN1J":;,,::, 'EJ1A1i.TERATIQl'ISl" ': ,,; ',;.i.yv :>,.'
'~~€E~~~~~:l'::~:::,;: ,Bl~Mt ?'lo4-ff.vC!)riB/B,~ii,:.' " ',,"'hmil;:' /;lv6fiLG\:,:: '.' '
,. "',".il . ":I!"..tl :;:) ~;:i' ,,'. 1T.. .~,,' ,,",^ '. ~;;I 'fu"\'A' .;.', ." , "', 'af"~""
,F1\tl't;;:!$E ~., ::,'.";:V";" :". OPENINGS 0 "~</~~ " ,';'O~, TJ"~~ '.
. \. "" 'It.\~~:€:r '., HEA1'RII;q,~R'Po~PLA:Nt'., .,'.. .'....\' ,; ;,'J,1'..:\.\\:,. ':.
; . . I.E. :. ';?W~ji,:Ei6:0;ff;;; I.. . "'If
'.,. o"u~;. '"..,'.,..... . ",
....'.
. ,-~' i'..;.....,..:....',...'.'......':..:.:..:.:..,~.'_~.....:.-.:.,;.'....~:A..,.)..........'...':",'.......'::.:..' ....... ... .: ", ,,~ '" . - , . - ., . -- ,- 'I" . .
'. - ,.', ;';- ~>. -;' ;';-; ;'~: :-:_~)':;; ~.'.-~'\~~:t~~::.:: <:/":,:<,r\:_~ :::-,:;{~: :~?~;:?:;-~ ~ i \ ~' {'
" ,'"
.' ,-~t~\X":T;1:!t~:~'i'J~t??} '.' ..... .
illdUSiriol; Conimercid,i, Multi;FldDlIy ..
~id~~~. ~eating~tc;~,~ction)
. Residential, Heatiitg Onl)i (N~~o~ction)
..".,,'.... . -,- '" .'-',','," .',<',.;' '
" -~.>-,:;;;,~:';'--",>:"
FEE SCHEDt:JlJ:\. : ..,.
1% of job coSl~i~~#.~F~I8f'C .... '.'
$39.S0minimwn '.."'0.
$9950 R..id~~.Add~ons & A1tOratio";' .'
. $6450 Residei>ii.l;ACQlily .
.',,'..:,
, ",.,. .
:~.~
":-
,$39:So
>3)9 ~O
"'.::,,'-
, " .' :: . '; - "- " ~
'Estlntated Cost $
Building ~ermit # .
HEATING PERMiT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
. w"".~,'.. .
..,;' ";,..o"li~rrjJ. .'. '.
(-.n,l.I,,",,~. . .
......~~~. .. ~ e ~'II.jJ~'"
.... 1I'"1;;:,;1;'''"Ji,
,50
(Office Use Only)
. This Application Beeomes Your Building Permit When Approved
Building Official
./ ~~ lr? [! D 1Vm.. ...~jPtNo, .
'. ' !r~L 1 , zoo~Pi IBY .
_ _ L._,_. ~
14 hour notice for a1l1nspections (951) 447 Jl:l' fax (951) 447414~. ~ :!
j
Da..
I
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---
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
q'lease !y.p<: or 1Jlint and sillD at bottom)
ADDRESS
~:;?:w Ei~nt I PERMIT NO~()4.a ~
ZONING (office use)
17444 DEERFIELD DRIVE S.B.
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION
PID
U",J.~.r..I.\.
(Name n R HORTON
(phone)
(Address)
APPLICANT
(Name) ALLIED FIRRsmR OBA FIRESIDE HEARTH & R()MR
(Phone)
651.633-2561
(Address)
2700 NORTH FAIRVIEW AVENU"
(Address)
ROSEVILLE
(City)
<;5113_
(Zip Code)
(Contact Person)
BRENDA HUSTON
(Phone) _651-633-2561
. APPLICANT SIGNATURE
BRFNDA HUSTON
DATE
8/12/04
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
OWarm Air Plants
OGravity
o Mechanical
OAir Conditioning
OVent. System
HEATING OR POWER PLANT
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
HEATNGLO SL-750TR-D
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
$39.50
Residential, Heating & NC (New Construction)
Residential, Heating Only (New Construction)
Estimated Cost $
HEATING PERNUT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
Building Permit #
$
$
$
...~~
.50-.c.'lllB~
m~d(r2 p 0 \In [i: 1
..... \V U;; ~ Lb Receipt No.
I DlllWG 1/ ZUU4 J By
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Buildine: Official
Date
24 hour notice for all inspections (952) 447 "10, fax (952) 447-<:17.1C\
PRIOR LAKE
INSPECTION RECORD
DEPARTMENT OF See Main File
BUILDIN~ AND INSPECTION
SITE ADDRESS 1~1./1I"1 /)i::&~CN:J ~~/t.k SoEI
NATURE OF WORK AI~ ~,,..,~
USE OF BUILDING ~,cr A. .
PERMIT NO. (J<{-. 07/ Q DATE ISSUED 7/1 z..&#
CONTRACTOR D.tl.. fI.oD3~ 1tJC:. PH6NE9.5'l.Z~,,"'/.r..l~
NOTE: THIS IS NOT A PERMIT FOFt ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
,
btv /.e_1 /s ~/'rL4L
GRADING (Prior to Sodding)
BUILDING
ELECTRICAL
PLUMBING
HEATING
DO NOT
INSPECTOR pATE I
I FOOTING ut!I 7/~/t'(
. -~ .. r
I FOUNDATION (Prior to Backfill) I di,un../ U/~ ~ I ~.a~
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN'SIGNED
ROUGH - INS
SEWER I WATER I SEPTIC .
FRAMING ~4 .9' /j'~ r/
INSULATION ~ ? /;:::-/oj?
ELECTRICAL.. . A. , $' / ~4;(
PLUMBING Vr (5. /If(/' r/21ol./' 4J' . _ ;rl?//()~
HEATING (if required) I' / /~ 9' /j' ft; Y
FIREPLACE _ ~ 9/J/Ot/.
GAS LINE AIR TES~/A -r f; ~ ~ 7' /?A~
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I I
FINALS
-S~~ /R4.j.
~
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hl-e I
/J~/~"
/t>/!S/oY
/ o//-V"Y"
/ ;:2/6/ /y.
OCCUPY UNTIL ABOVE HAS BEEN SIGNED
NOTICE
.4
/It'd
~
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
@trfifitaft of <IDttupautl!
CITY OF PRIOR LAKE
~efladment of ~uilMn~ Jl'nsfledion I
lvmm Pemri"'" 0 Cornlitimml c.o. Expire' " .
This Certificate issued pursuant to the requirements of Section 110 of the 0 Residential / 0 Internatio~al
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:
SINGLE FAMILY 04-0710
Use Classification Bldg. Permit No.
Occupancy Type
R3
R2
VN
11TH
Legal Description
Type Construction
L11, B2, DEERFIELD
Zoning District
,
I
17444 DEERFIELD DRIVE S.E. ,
COURT, SUITE 100, LAKEVILLE 5504'
DON RYE
Owner of Building Site Address
D.R. HORTON, 20?,860 KENBRIDGE
Contractor's Name & Addres~ ~
ROBERT D. HUTCHINS /1 .
_ #', _ City Planner
/;0' ing 9'ficial /
Date: /,7 / L. 1')4
/ - I
Date:
,..., '~".~~ ~',,'.. "", ~,....,..,
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';',' 'I...::.:.>,
DATE tillE
/J.My
//-7/.y~ .d.ee'~M/d )It
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
OWNER
CONTR.
PHONE NO.
PERMIT NO.
lJ FOOTING
lJ FOUNDATION
lJ FRAMING
lJ INSULATION
pt:INAL
lJ SITE INSPECTION
lJ PLUMBING RI
lJ MECH RI
lJ WATER HOOKUP
lJ SEWER HOOKUP
lJ PLUMBING FINAL
~H FINAL
COM.MEms:
~ch,.,'c.r h7-/ ~~_
07-7/0
lJ EXlGRADlFIWNG
lJ COMPLAINT
. lJ FIREPLACE RI
.J. '.... "'"'Y:r ...ACE FINAL
lJ GASUNE AIR TST
lJ
, .;
/0#0,/"
{
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&d'!'~/9c~ /7':'~/ CJ4-.
'7 / tAt/ue l.@ ~..~~/cf
/fkc4:. ~ C~ C/L'( ~
~c-~lC;-c.d ~r;"'q;f- 7LerT-
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-----
---
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,#'WORK SATISFACTORY, PROCEED
lJ CORRECT ACTION AND PROCEED
lJ CORRECT WORK, CALL FOR REINSPECTlON BEFORE COVERING
Inspector: ~ OwnerlContr:
t7
CALL 447.9850 FOR THE NEXT INSPECTlON:U HOURS IN ADVANCE,
I1trItOTl
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
DATI! T1lIE
CITY OF PRIOR LAKE J ~ i. /
INSPECTION NOTICE SCHEDULED /O//f/&r
ADDRESS I 7 Jj 'i t/ Ik ert~ /1 Llr
OWNER
CONTR.
PHONE NO.
PERMIT NO.
a FOOTING
a FOUNDATION
a FRAMING
a INSULA nON
a FINAL
a SITE INSPECTION
a PLUMBING RI
a MECH RI
a WATER HOOKUP
a SEWER HOOKUP
..,.l!t'15luMBING FINAL
a MECH FINAL
~c:/- 7/(}
a EXlGRADlFILUNG
a COMPLAINT
a FIREPLACE RI
a FIREPLACE FINAL
a GASLlNE AIR TST
a
COMMENTS:
AA r J 7
/ / / I?~ c:Jptt! rc /' r~CS r
CJ A/Cer/./' ///7U
'--/
/'
hj,~/
A(
1..../ /L
./
<)/C
- /' ~/'
/4S fi,/k.,i
f.-
a WORK SATISFACTORY, PROCEED
%CORRECT ACTION AND PROCEED .
a CORRECT nd C~'yOR REINSPECTION BEFORE COVERING
Inspector. / pt~ OwnerlContr:
CALL "7.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
DiSNOT'
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH 4 SAFETY!
.
.
APP!.IANCE
PERFORMANCE TEST
Attach to ga5 ii"ne aciiacenl to reguJ8Ior
Heating C.....Q.:.. .1III~1II4CU'
Name atTester .~ ~
Date /0 -/I:'..-n+
,.
JobAddress ~ !' .~
Heating Contraclo. ~~
Name at Tester ~ --... &
....~
/0-/11 -OV
7.l1 ~
~'
3j, q .<?:
Date
Percent 02
Percent CO
Percent C02
SIad< Temp
Combustion air is edeqIlateIy supplied per
UMC Sec. 606 -/'S
input JI(I~