HomeMy WebLinkAboutBuilding Permit 04-0784
CITY OF PRIOR LAKE BUILDING ~
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Main File
~f;~
Date Rec' d
1.8.0-1-'
~. ';:i~;: ~:~ I PERMIT NO. /1/1_ -1 rT J II
3_ Yellow Applicant (/'-1- / (S ....,
(Please ~ or Drint and si2l1 at bottom)
ADDRESS
~O 'vJ~ 16tJ-7)r.
I ZONING (oi!;eeuse)
ft.,1
LEGAL DESCRIP. TION (office use On1~
LOTI~BLOCK I ADDITION 0e.u-f1-eJd
OWNER
(Name)
(Address)
I ()-f'o-
PID Zs. 401, 0/3.0
(Phone)
BUILDa,.... 7) I 1 ')
(Name) l...) .1"\., ~ /.::rf1t'
(Contact NameHll ih.. Lt')OJvtou:t:kCL.-
~OBlD.C> U ~ - 1-... \.dQe.. (2;( --/DO
(Address) L~k1_0\\tr;Yhl\r ~4-4
I hereby certify that I have furnished information on this application which is to the best of my knowledge true and COtTeet. I also certify that I am the owner or
authorized agent for the above-mentioned r-~r';'.-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 that the building official can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may
~ the property to perfo~rfeded inspections.
''x I"U.(\~ +l~N.-v ~&/57 zr/{P-O.-::S
~ (} Signature - Contractor's License No. Date
I Pennit Valuation /5t DtX'. carl I Park Support Fee # $ r: ~6..l ~I
I PermitFee $ I.a 07. $V I I SAC # $/ _ ~ ~.~ I
Plan Check Fee $ -', Il{.~ IWaterMeter Siz~I"; $ r .:iso-~ I
State Surcharge $ 7t? .S() I Pressure Reducer $ f./5".~. I
I Penalty $ I City SAC and WAC # $ I. '200 . c')t9 I
I Plumbing Permit Fee $ /1)0. ef)t) I Water Tower Fee # $ . ')a;>. ~
I Mechanical Permit Fee $ 100. ~ I Builder's Deposit $./. t'lc:t:l. ocr
I Sewer & Water Permit Fee $ 3'",SO lather $'
I GaSFir~F7...itFe;j $ fIlt1.00 I TOTALDUE . $~S7Z...30
~~.A~;9n /J our . gPermitWhenApproved I Paid Y~7~.7l I Re~li,tNo. ~d-.77
/ i j/;} 7- 22.-~'- I Date~ ?_a-:Y..4 ~ By!':..
V -BJiJrcial Date l_______1
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance anCfmay proceed as requested. This document
when s' 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.ued. . rr:fd.,jp 7 t-1# r ~ iiI "1.#11 ,. t-. ~-
Manning Director -, Dkte I Special Conditions, if any
24 bour notice for all inspections (952) 447.9850, fax (952) 44~-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372 '
TYPE OF WORK
o Misc.
...,..'
(Phone)(Cr~'18'5-lR33
(Phone{]::::( dr3.L-1732-
~ Construction
DLower Level Finish
ODeck
OPorch
ORe-Roofing
ORe-Siding
o Fireplace OAddition OAlteration OUtility Connection
PROJECTCOSTIVALUE (exc1udingland) $ 159 1\'8 ':.)
, I
,,/
Main File
White - Building
Canary - En ineering
~'n'" - Plann n
Thr(:""nlnof lhr l.akrCountry
,
,
BUILDING PERMIT APPLICATION DEPARTMENT CH~CKLlST
NAME OF APPLICANT
APPLICATION RECEIVED
Jj, 1< , H ( k~I-C (.J
-; ~,( 4-
I
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
L;-0/7 (; lv E ~ ( ;\ iC I (Ii'... I C) Ie:.. .
I
~.
Accepted
Accepted With Corrections
.....--
Denied
~~
.~~ dff
Date:
~3hv
,
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."
Main File
Th~ C..nlp. of IhO' L.k.. Country
,.-w1il'te - Buildi~
t~nary -El'iglneering
Pink . Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKUSI
NAME OF APPLICANT
APPLICATION RECEIVED
D,R. H-ORTOtJ
t. ~,o4-
I
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
4-4QO vV5"61 OMG POtt-JT PlC..,
I
Accepted
Accepted With Corrections
/
Denied
~.
Reviewed BY:~' ~r--J Date:? /.::z 7~ '"
Comments: ~ a..LI' ~~,
"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."
\ I
White - Buildinq
c::;l::.1't1'!,.rv - Enqinee~
PiiI1r - Planning
Tht C'i~nlft' of 'lilt Llh CO".'"
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
D.I<. HCI~TO f'J
-.., r,. I. A __
/_ I/,!,...,~
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
I ....._......
/L-"'(...'- (,
-r '." / J l./
~VES I (fl,. ~
t"';' C I "rr-
[::> i<:- .
Accepted
x:
Accepted With Corrections
Denied
{
Comments: ~.... Rpvprc::p ~ide for Additional Information!
Reviewed By:
iYJ&A
Date:
7-23-0 ,/
1114/ :.,
,
F, I,.
See Attachments: 1) Grading- Plan. 2) Erosion Contro.lMeasures
"The iss~e or granting * of a permit or approval of plans, specifications and
computations shall not be coi'lstrued 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
pre.sumingto give authority to violate or cancel the provisions of this code or other
ordinances of the jurisdiction shall not be valid."
\I
JUL. 19.2004 11: 05AM
GENZ RYAN SERVICE
NO. 431 P. 3
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
l:J: ~~ I PERMlTNO~'" (J"~
1. YcllllW Appllcinl "T. f l(/f'r
~e l'IJ!e 01' .riot and aim at bottom)
I ADLM~o ~Jiqf'n~Po; Yl +- ~
. . I'
I ZONING (em....e) ,
LEGAL DESCRIPTION (ollll:e u,. olll!rl
LOT6 BLOCK (ADDITION OOJl-h.eirl. I~'
Pro
OWNER
~une) DR Horton Custom Homes
(Address)' ZO'b(PD KeI'1B~li:lGe. Cr Sre IDO
(Phone) q62-q~r,-'7'iSlJO
L~_u/i II(~ /.UN .5C:tl1..! LJ
APPLICANT
(Name) QA"''1_ly:-_ 'D'''-b~'''g ~ 11....."'_-:
(Contact Person)
~nc) ~,1_~?,_11~'
Rosemount MN 55068
(City) (Zip Code)
(phone) 651-423-1144 /
~ I lL) DATE ~ '1-/4~t?
(Address) 14745 So Robert Trail
APPLICANT SIGNATURE
APPLICANT PLEASE COMPLETE BELOW
I Quantity I Type of FIxture I Quantity I Type of Fixiure
I 'if. I Bath Tub with or without shower I I Rough.ins
I 1 I Dishwasher I 1. I Water Heater
J j Floor Drain I j2..'.f I Water Softner
I 'Lavatory (Bathroom Sink) I I I Stand Pipe (Washing Machine)
I l I Launchy Tray (lor 2 cO\11parttnent sink I I SeW8lle Ejector
I a... I Shower Stall I I Backflo'lli" Assembly
I i I Sinks I I Backbow Assembly Test
I Bar Sink I I Lawn Sprinkler
I :!J I W liter Closet (Toilet) I I Other
FEE SCHEDULE
Ind..lrial, Cnmn1Crcill I< Multi-family 1% o{job cost with l 539.50 minimum R..id",lial, New One 01: 1'wo.PllIlily $99.50
Rcsldenti&!, Additions 01: Alterations 539.50
Eatimlted Cost S
Building Permit 1/
(om.. u.. OOly)
I This Application BecollllI Your BuJldlng Permit When Approved
. .
PLUMBING PERMIT FEE S
STATE SURCHARGE S
TOTAL PERMIT FEE $
;;:^'''"'I ~,.,---. ,
'oJ~.... vlIt,IUlli1 ,
-~rJ"mENG. F'l::'~:'VT" l
.ulldlng omcJol
DAte
'\~r~ l!9 ~ 0 I'i1 ~ nrceiptNO.
~~at~UL 2 9 2004 Il ~
14 hour nottee ftlr JUlnspeclioDl (952) 44" rr:' fo ClS2) 447-4245
JUL. 19.2004 11 :04AM
GENZ RYAN SERVICE
NO. 431
P. 2
Date Rec'd
CITY.OF PRIOR LAKE
SEWER AND WATER PERMIT
l!'Ieuc l'(2e or IlriDllllld liar.. botlllml
APDULJq~O VV{&t DaJ': f+ Dr<.$O
i ~:i':" ~~ I PEBMlT NO.~ (J4It'.Il.L
3. Galli AppliUf\l ~. '''''-'
ZONlNG (9lfic< '''l
LEGAL DESCRJPTION (ollicc UI. only) ,
LOT B BLOCK I ADDITION ~.eli /tfIfl
l .
PID
OWNER.
(Address)
2o'&nn ~~I'..\t:be Cr- SrvIN"\
- (AcIdIoll)
(phone) _ 't62-Qgs-1RM
La.~i lie.. "7If1'!..lU
(CltYl (ZIo Code) ,
(Name) no v..........._ "........0'$ 1i~....
APPLICANT
~mn~ Ganz-lvan Plumbin~ & Reatin~
(phone) 651-423-1144
(Address) 14745 So Robert Trail Rosemount, MN 55068
~(Addr"r: (CitY) (Zip Code)
(Contac(Person) . . ~lli n' /)'. (Phone) 651-423-1144 I
. ".ICANTSIONATlJRE__-_'J.J.jj;Jf;: ) jcJ ii/) DATE t(4;h'1--l.q'lJ4
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 Iron
Estimated length of sewer line feet.
Clean out (if required) located at feet from structure.
FEE Sl.;l1l!OuULE
Iletidenlial sewer and water line connection S35.50 Industriai, Com'l &: Multi.family 1% of job eost With a $39..50 minimlJll1
Sewer eoonection ouly $17.50 WatAlr cannection only 517..50
Estimated Cost $
Building Permit If.
SEWER AND WATER PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
~~D t"&'jV'}J
~!J" I'"I!~ ~""'''rr
. ,~~;..b.iig,~ roc',,,;:: \I" .
l,;~..i l
r
(om.. v.. Only)
I Thia Application Beeom.. Yoar B1Ii1dlng Permit Wllea Approved ~'D ~~ ~ 0 \!J ~ ~ I Receipt No.
. 11?<<lC - ~ I B
l... Bulldln.Ol!ie;1l ' Date LJUI 2 9 ,nDL- ~ . y
24 bour noli.. tor .1lIRlpe.llons ('53), 4?'150, fn <,52) 4<17-4245
By
/.
I
.. ..,. CITYOFPRIORLAicE,.. .. .... ...
IlEA:JiClN6l:MR CONDmONINGIFIREPLACE PERMIT
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4(;?9IJ
>>iltil.~ec'd
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>,
......~_.........R)LAl. ..t~
':: :....,pl:. ... .:. .. .. ...
. :.\,:-:",.-,,,;:,,:,..,-. . . '. .
EO' ,.PERMITNO 4. . .....UA...
C-"', .'. ......A':.O'".,. ....
ApplIClftl - .' .'" . , '. u ".> :~I,._ .,
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. ... ..ZONQ;l:.':..~. !...~.:,...:'.~...'.'..'.! ..1...
'." , ~. ",' :-::-.:>~:-.','>-.. "."
. ..L~~:...l!~O~s:::,;I.i#.~~N .
....<.:...':-.-:x:::\'{::~.
..OW$lt D R HORTON
.. :.,~~~X::& 20860 KENBRIDGE CT
.."'."". LAKEVILLE MN 55044
. " .~:,)",';;~j;':,~ "\k~~~: ,
t ;~
:';:~::},i~6~~I~~ii~A~CAnNc'::;~..:.;;.:.,.:.'.:.:,i.i,(.:.i.:.'.:.'.'~.;...:.,'i........'.:.,.
. .i..'''':'''.'...';..EAGAN ;.,
.~4il~~,": ,MN 55122,:>,:;',:f}:". ,
J._~, ...... . ,.'. i '..;~'.;~iI~~,~i~~f~t;)~~fjt.
')~~~ Qi...fl,,,~~~.~~,,,,~...".,,
,.
,................. :.... ,i',i""""'" ~QPENlNGS . . ... .".>':~",'O\i~1!~.,:t7g,~.,.:'t;
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. .~~:~.~~=!l:#~~t~;I~,. '..
Res1"entia~ ~eating ~ Nc;. .af~; \;~nstroction)
. Residential. Healihg 0\1IY(l'<~~6~ction)
., .";'.," '. -, :-.-'...,:.',:!;:-',....,',',.
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<-'-;'1".
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r.\~1:'ftr!\ .,?~.< ~:~~~~I~~:,'~< '~:'\:'.~~~:;-t~; \ :"'~:' :"
,..,,-,.'
"',
'. ,'1''-''
.._':,,:-,;,--.'-,_:"
FEE SCH1U)~'''; .,. . . ..
1% ofjo~ COSlRes!~~tial;GasFirqlla.ce
$39.50 minimum . .y,.' "
$99.50 ROsiil~i;l1; Additions & AltOraiioo.. .
$64.50 ROsici~ACon1y' . .
..,,' :,,<;:.,,'::.',.'....
,,"'.)-'
$~.5Q:
. .-" ",-'."',
.~:~q
....--,,-',.
. Estimated Cost $
'. ''-'-'.-'
. -',:,- ,
',.< .-
Buildirig ~ermit #
HEA1'ING PERMiT FEE
. . STATE SURCHARGE
TOTAL PERMIT FEE
$
$
S
. f1l\ro .... ... ... ...
. BfJU.oING WITH ........
....~-
. " . '-"MIl
. . .
.50
(om.. Use Only)
This Application JleeoinesYour Building Permit When Approved
Building omdal
Date
f~~ ~ 0 Iilifl
. JfJWG 1'1 2004 I By
Receipt No. .
. 2'lbour notice for an inspectiona (952)447 ~850, fn(952) 447-4245
'. . By
, .
Page 1 of2
Lynda Allen
From: Christa Wegwart [WegwartC@hearthnhome.com]
Sent: Thursday, September 09,20041:14 PM
To: Lynda Allen
Subject: PERMIT FOR 4990 W OAK POINT DR SE
CITY OF PRIOR LAKE
BEATING/AIR CONDITIONlNG/FIREPLACE
PERMIT
Date Rec'
lJ'!ease ttPe or ,riDt and siln at bottom)
ADDRESS
l ~ S... I PERMIT NO. 04-.0'7*
4990 W OAK POINT DR SE
I ZONING(ollieeuse)
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION
PID
OWNER
(Name DR HORTON
(phone)
(Address)
APPLICANT
(Name) ALLIED FIRESIDE DBA FIRESIDE HE" WI''''''' HOM"
2561
(Phone)
651-633-
(Address)
2700 NORTH FAIRVIEW A VENF"
(Address)
(Contact Person)
2561
BRENDA HUSTON
~OSEVILLE
(City)
(phone) _651-633-
55113_
(Zip Code)
APPLICANT SIGNATURE
BRENDA HU~TON
DATE
9-9-04
APPLICANT PLEASE COMPLETE BELOW
X NEW CONSTRUCTION REPLACEMENT ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT
OUTPUT
TYPE OF SYSTEM HEATING OR POWElR PH1jTm .u'\T L.lH
Warm Air Plaots Steam 1:' All.J 1JlEASI:. E:
Gravity Hot Water ~~er U ills
Mechaoical Radi~tion . BUll ~~ach i lto
Air Conditioning SpeCIal DeVIces . ~ -l~ide Yal I
Vent. System Other DeVIces l' Jj~~
FIREPLACE MAKE AND MODEL HEAT N GLO SL-750TR-n '2 FIREPLACES). '_ u
FEE SCHEDULE O-fflE ~ LE U I1llt fiT
1% of job cost Residential. Gas Fu '. . eSEP 1 0 "0 ~II i. :39.50
$39.50 minimum i . ,,04 'j!
, dl
Bv I,
Industrial, Conunercial & Multi-Family
9/9/2004
rtlOR LAKE
INSPECTION RECORD
~; oaJL Qr Main]]le
USE OF BUILDING 'SJ V\. _
PERMIT NO. (Jt/-.0784.- DATE ISSUED 7-2'2..-04
CONTRACTOR j) \I ~~ PHONE CfS2-2'2CtJ-4732-
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT .
~ 'F~ \..e--
DEPARTMENT OF
BUILDING AND INSPECTION
SITE ADDRESS Y9'1.(')
NATURE OF WORK
INSPECTOR . pATE /
I FOOTING ~ . 1 ?~o/
I FOUNDATION (Prior to Backfill) Y?ol,.", / t'.-V4t'1S ~~ y<5fiy};1
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS I t
. SEWER I WATER I SEPTIC ~ ff~/&t:f.-
FRAMING ~I )li!4Il~# '1),1#:1' _ ~ JIUZ- "9i;dW
INSULATION . ;P;P" ?-<'y - ,
ELECTRICAL _ _ / I I' lof,s/.
PLUMBING If. ~r ~ Xtfl/o'; ~ ?/..1//o;f,
HEATING (If required) ;). ~ A ?/2-Z-U
FIREPLACE ~ r~//' ~ ~ /2.z-;6</
GAS LINE AIR TEST ,u,,;t.. +- ) ;/1. ~ ef /2-2-7#
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED/
I I
FINALS
1 AlB I/, IS-. , A-
....-i:.~,j' ~
!
.
-GRADING (Prior to Sodding)
BUILDING ~.r" . . -/{," (/~;'W
ELECTRICAL I I .
PLUMBING
HEATING
DO NOT OCCUpy UNTIL ABOVE HAS
NOTICE
11fII.
#PI-
. L' .
/~/c:-y
11/9 ft~
11/ ~ /" -(
/2-7~1
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
\
@ntifieaf:c of <IDernpauel!
CITY OF PRIOR LAKE
~tpadm:cnf of '!!luHMng Jfnsptdion
fFinal Permitted 0 Conditional C,O. Expires
This Certificate issued pursuant to the requirements of Section 110 of the D Residential / D International
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 04-0784
Use Classification Bldg. Permit No.
Occupancy Type
Rl
Type Constructior
1m
Zoning District. R 1
Legal Description LOT 13. BLOCK 1. DEERFIELD 10TH
Owner of Buildinr
Site Address
4990 WEST OAK POINT DRIVE
55044
Contractor'sName&AddressD R HORTO~:,32'O KENBRIDGE CT, #100. LAKEVILLE
ROBERT D HUTCHINS ~ CityPlaon" JANE KANSIER
Date: aA~rCial'
Date:
DATE
//j/j(
t./?9o U/ eJ r C1;L Jk
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
,.et1'JIlAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
,A-MECH FINAL
CO~~NT~ ._
;::-/~C~ ( Rh..../ d~
TillE
o~- '/?r
o EXlGRADlFILLING
o COMPLAINT
o FIREPLACE RI
,...I!f1'IllEPLACE FINAL
o GASLlNE AIR TST
o
///~ ~r/
_ -2 . h)-I!. /.JP--~ . hh../~ /J ~;(
LA:-/ ~~ ,:p ~H,';L.;L'/
~ ,J~hr /
/&c.6Ved
&:/Ic- ,
CPr.sq r /~ r-
-r-:' / _ / ~_u -.:;.-:)
/ .(:7 ~ ~;L.r (~ase h/e
~""''''b ,l. ,,~'''''''L '-0J.,..~-- ~
..-,~~~ c..r--\~":'. / - ,./~.-
_ ".__ _. I ,.., 1I,,_,_~i -/D
o WORK SATISFACTORY, PROCEED /....
~RRECT ACTION AND PROCEED ~ ~
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: ~
OWner/Conlr.
CALL "7.9850 FOR THE NEXT INSPECTlON:U HOURS IN ADVANCE.
llaNO"
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY/
~OF PRIOR LAKE
~ INSPECTION NOTICE
ADDRESS
y?;t5
OWNER
PHONE NO.
D FOOTING
D FOUNDATION
D FRAMING
D INSULATION
D FINAL
D SITE INSPECTION
DATI! TIME
SCHEDULED ~~~~~
~ ;
W4J J-o.,.L ?~
CONTR.
PERMIT NO.
oy'~ 7'?<Y'
D PLUMBING RI
D MECH RJ
D WATER HOOKUP
D SEWER HOOKUP
~MBING FINAL
D MECH FINAL
D EXIGRADlFILLlNG
D COMPLAINT
D FIREPLACE RJ
D FIREPLACE FINAL
D GASLlNE AIR TST
D
COMMENTS:
/~~~
/7",
-f-ctj- 7- C5 IC
~
r~'i:/
tL/d),.-/ztlI'''' /
-/4,'0 " -fr:'-" <..
/ / /'
~.." "kr-~~""'"
/ /
#re-ec/
d ,(.,/
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rJ)
CPIC
. /"
.A!4r O~~
/P7;TL/
- /
/S ~h ~/C
/ . /
/x674:/ ...e c!..
I
~/{--,
D WORK SATISFACTORY, PROCEED
tt'CORRECT ACTION AND PROCEED
/~CORRECT WO~ c:f""/!!J" REINSPECTION BEFORE COVERJNG
Inspector. /1/' Vf.,--- Owner/Contt:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE_
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
I/fSNOn
DATE TIME
tlTY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
tl-/~'tJ'I..
10, 'r! I 1)...
_D R. tkLlr.",
ADDRESS
'/770 W{5..f lJ'it
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
e~NSPECTION
o PLUMBING RI
D MECH RI
[] WATER HOOKUP
[] SEWER HOOKUP
[] PLUMBING FINAL
[] MECH FINAL
pY~LLlNG
D COMPLAINT
[] FIREPLACE RI
[] FIREPLACE FINAL
[] GASLlNE AIR TST
[]
COMMENTS:
3J.~D !:.C"fc..'I. <;,'1/ F".A~(. hy F/~-.s.
f..ulV> {J/"?' 1$"":,,
lf7 '12
f<",/'Jf /',0/'" f3tJ~
D WORK SATISFACTORY, PROCEED
[] CORRECT ACTION AND PROCEED
.K CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector. ~ _~ OwnerlContr:
CALL .&47.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEM.TH & SAFETY!
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APPI-IANCE
PERFORMANCE TEST
Attach'" gas line adjacent to regulator
Hea~ng Contractor ~H",JI
Name atTester 4c:.~
Date ..1!&.! . <1
Percent CO
Job Address ~tJ'IlI4tJs.:r
Heating Contractor ~. rJJ..u)Jf:
Name or Tester ~I
Date
Percent 02 .~ '0
-'lh,.,
n.f.{q~
-.!1f,';;
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Percent Co2
Sl8c/( Temp
Combustion air is adequately supplied per
UMC Sec. 606 V 1S
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