HomeMy WebLinkAboutBuilding Permit 01-0067
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
(Please tvQ.e or orint and sign at bottom)
ADDRESS
5<102 -hwn /!Jt"M~W
Date Rec'd
/--;1-01
1. While
2. Pink
J. Yellow
File
City
Applicant
Gdl/ /- .{ r:::.
LOT / BLOCK I
LEGAL DESCRIPTION (office use only)
beuJ:dd $nl.
PID Z6-~ I-S- 001-0
OWNER
(Name)
(Address)
BUILDER , I
(Name) /).(( 1-liK-'/.m
ADDITION
(Phone)
-:Er,c
ltkSh, n.<:/.....
;
(Address) 3,-/"}Q
-mA/
Lk'vr sk,~(J<I
(Phone) bS/-2.57r 71;?9
ec.?r1, //fA! '2"}/.,2,,1
I
TYPE OF WORK
~New Construction
DAlteration
DDeck
Dporch
DRe-Roofing
DRe-Siding
DUtility Connection
DMisc,
DLower Level Finish
D Fireplace
DAddition
-OOftn I
1<..2... I
PROJECT COST /V ALUE (excluding land) $ 71J ~ 70
/
$
$
$
$
$
$
$
$
7 )/(5)00.60
710. @. 7.s-1 Park Support Fee
~/~.t{ct I SAC
-~~-. 5n I I Water Meter
I I Pressure Reducer
I (l)C). 6)0 I I Sewer/Water Connection Fee
It') C) . 00 I I Water Tower Fee
,~5 ."50 I I Builder's Deposit
C{o.ar I I Other
I TOTAL DUE
#
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
enter upon the property, ~form nee~ed ,i~,ec~ons.
X YjtJ'2Lbo uk~ dOoO.5L,S7 /-/f/-tJl
Signature Contractor's License No. Date
850.~ I
/, I ~.col
.: 0 ~ I
I
1.200.c() I
7m. I
I
I
$5.5/574-1
, .
I ~~cer .~f 00 1
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
i"U'~__~
~ ~".,..
..... Pia in;D;re~to'r "'\
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
#
#
~':::;:/Q":~;
#
Date
Paid
Date
~/S-. -;U--
7/ r:t-I'J I
,
$
$
$
$
$
$
$ - 0-
$
2-/~,{19\ S~ ~e::,an~
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
Thr ('rntrr or thr I.Mkr Country
White - Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
f). R... HOK'-ION
1-IB-QI
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
54-02.. ~\N N V\ePD6\N ('l)v.E
Accepted
Accepted With Corrections
Denied
{2 ~ g,~
Date: 1-'2S .'2cc:>r
Reviewed By:
Comments:
c;:.et_
6<fco h, W<A- ~ CCJjV.J..,. 'h, t- ~c....... ~ '.
"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."
..
..~~~1( PRIO-?"
!::: ~
U en
While - Building
Canary - Engineering
Pink - Planning
Th~ C..nt..r of the- L.k.. Country
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLI~T
NAME OF APPLICANT
APPLICATION RECEIVED
f), 12. f-1C~lTf',J
,
I-(Pre I
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
,- 4' '7 r.- \ c'. I
'~; C _ 1-" f\ \"-: IJ i- \ C. r\U(\;\J
I j GV=::
Accepted V
Accepted With Corrections
Denied
Reviewed By: ~~~
Date: Q / I /(9 I
Comments:
k/W~ ~,t,'1f~X ()O ~ (> ~m-I&tAC 4 ~__
1Q1Y./j. 4- (.J1Asl ~ V:\ee-~~ 3vd~,
-. - ..
~C.~4 $P+Ar~Av1 <j;~J. &:, .~ I~
~ Yv~_\\-cjM~~ ~~A-~ \\WD rSlk~~,
"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."
~\
01-(07
The ['..nle, of the L.k.. Counll'l
White - Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
D. I~, HCJ~ I ON
. -
I-(PJ-O I
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
54-02.- ~ A \N N f/\ Cf\DO\N c,( IDE
V
Accepted With Corrections
Accepted
Denied
Reviewed By:
L-LL-
Date:
1-29-01
Comments:
,or
'II<'
J
.tY"~~_"~
"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."
JAN. 24. 2001 2:31PM
GENZ RYAN 6513226147
NO.B65- -'"P.7/9- .
I. .100 l'iIc
.. ClaW c.,.
3.V_ ~
. # 01- ()()(o7
Phone; lcAH,f1~- I f I..J t../.
"7)? L-' vt"rY:../l ~ I n'- ~
CITY OF PRIOR LAKE
,PLUMBING PERMIT
. Appncant_r......1 t7_-~tSr V\
Address: I U'Iu. < 1"'1~ ~
Signaiu;e: J ..~ ~ .
Legal OelSCription: Lo~ ~ alock Sub
Site Adclress; h.u.{Y2- Ffl1' \1.. \ MO~J' r'J IP vf~ <iF
auildlng Permit It PIO It
NOTE: This permit ~II not be processed without complete In;.......::.:In.
rIA ".IRE UNITS
n~ c..1~ ef __ ...Iw ea.",
Quantity
\
\
\
I...>
\
,. j
,
7_.
,
. . I.
,,--,
"':...1
Type Qf FJXlure
Quantity
Type of F"IXlure
Rough-ins
Water Heater
Water Softner
Stand Pipe (washing machine)
Sewage Ejector.
BacJctlow Assembly (RPz. Double Chec:k, PVB)
Backflow Assembly Test
Lawn Sprinkler
Other
$
$
$
$
.50
Bath Tub with or without shower
Dishwasher
Floor Drain
Lavatory (bathroom sink)
Laundry Tray (1 or 2 compartment sink)
Shower Stall
Sinks
Bar Sink
Water Closet (tonet)
I
~1 \
.
$
PAID WITH
BUILDING; ;:::;:::.:;;
FEE SCHEDULE
.
. Industrial. Commercial & Multi-family
(1% of job cost. $39.50 minimum)
Residential, New One & Two Family
Residential. Additions & Alterations
State Surcharge
$99.50
$39.50
This pennil i. J!lII1ce<l upon lbe up..... condition that said
eontm:lor. .holl comply '0' em IlIidJ <he ordinlDC"
of Ill" Sail" Plumbing th" lIll\eIlclmetllS lhe."ot.
------ . 7.. ....fr'tJ ( DATE
ArrEST
lions 24 bours in advance.
-~-~--~-_.._- .._.__.._...._._-_.,_.._---~-~. ,-,
16200 Eagle Creek Av. S.E.. Prior Lake, Minnesota 55372 I Ph. (612) 447-4230 I FAX (612) 447-42~S
An Eq~a1 Oppommil)' Employer
GRAND TOTAL
JAN.24.2001 2:30PM
GENZ RYAN 6513226147
NO. 865 ---P. 3/9---
-."'"
'fII.u. - IoiOftC.Ur
-.. . aff
"
CITY OF PRIOR LAKE
SEWER AND WATER. PERMIT
NO. 0/:"'0007
'.
NOTE: Sewer and Water
contractors must
be reqistered
with the city.
APPLICANT:..B:G",.;J,- ~J"1 ell.J",.,nl~ jJJ"-rI.ur~ PHONE:..li;6I-~2:!.-1 ,L.I-LI
ADDRESS: '4'Lll:~"''- t'_"-'-nm""r S''"eI<lil..DATE:
SIGNATURE: L_~_______. ~ BLOG. PERMIT #
SITE ADDRESS:.f>-\Q'.!- Io"'~~. \ ~ ,~I\(lU>1ltl'4>IDiI
FILL IN THE BLANKS
40'
1.
Estimated lenqth of water service
,"
Si~e of water service inch(es).
feet.
2.
..-....
I . ~', ..1
, :;J"
":,.......,
, "
3. Location of any couplinqs from s~ructure
4. Type of sewer pipe. ABS PVC )[ Cast Iron
I
5. Estimated lenqth of sewer lin~~ feet.
6. Clean out (if required), located at feet
struoture.
feet.
from
=~;;lL__.____~_
This applicati
BY
,.._~__n""."" ,.."" _._".___--==-~__
..=;;;;1;;:;:====--;;;;;:
permit
wnen approved.
Z,/ f; '/0"
D~TE:
_______......_--ll!!!:
_;;;;;;;r.;;;====;;;;;===__,,--,"___._..__.___~=====-__~_~~_____.----_
FEES:
$
~
$
35.00
.50
35.50
Sewer and water line connection permit.
Surcharqe
TOTAL
· Fee fer either sewer or water individually is $20.00 plus
$ .50 surcharqe.
* Sewer and water permits issued for new oonstruction must be
recorded on the buildin~ permit card at the time of issuance
to insure that no dupl~cate sewer and water permits are
issued. .
.- '"
i _,,- j
'.---'
DATE PAID
RECEIPT *
AMOUNT PAID
REC'O BY
-,
BUILDING W/[/-f
.-- t.:.::.t....,~' ,~'-.,..
"'.i.'
. 4629 Dakota St S.E., Prior Lake. MlnnuQta 55372 I Ph. (612) 4474230 I fa,( (612) 4474245
AN eQUAL OPPORTUNm' EMI'l.C'1ER
11:5B 651 633 BBB4 FIRESIDE GORNER
CITY OF PKlUJ:< LAJ,U!;
HEATING/AIR CONDITlONINGIFIREPLACE PERMI-T
#3534 P.002/004
....,.Jl.Il.CA'Ot"I;...,...
rPlu.....!'a1" or .rint lUIIl,bm oJ: botIIlml
ADDRESS
.5l.fo:J. ~ 1Yl1/~ /)-. f'.IAA.U-L
,
ia ~_ \ PERMITISOO/-OOt,11
I ZONING(.ffi.....)
LEGAL OESCRIln'ION (o&~.. .1Ily) "-
LOT I BLOCK / ADOmON (/, lJl~cQ
rJ:xl. ~
I~ rd--
PID r-.:s - ;y13 -001-()
OWNER
(Name)
(Phone)
(Address)
'"I,
APPLICANT
(Name' ALLIED FIRESIDE DBA FIRESIDE CORN&R
(Phone) 651-633-2561
(Addres.) 2100 N. F AIRVlEW AVE:NUJ;:
(Acldn:so)
(C .._ P ) BRENDA HUSTON
on_I. croon ,V_
APPLICANT SIGNA11JRE ~~jj~
RO!::F.VTT ,r.F. "'N'
(ClIy)
(Phone) 651-633-2561
S~, 1 '::t
(Zip Code)
DATE
l//;l0I
APPLICANT PLEASE COMPLETE BELOW
~EW CONSTRUCTION 0 REPLACEMENT 0 AL 1'ERA nONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE REnJRN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
OW.rm. AI' Planl:i
DGra";,>,
:J M.ehonicaJ
JAlr Conditioninll
JVenl. System
FIREPLACE MAKE AND MODEL _~ JJ ~c"
gSl""'"
Hot Woter
B RadiB1lon
Sp.<:illl Dcvle..
o Other Devices
...st:. 7n-m.-
PLEASE NOTE:
Air Conditioner Unils
Cannot Encroach tnto
R.qui....d Sid. Yard
Setbacks
Industrial. Comm.rclal 8< Multi-flllllily
FEESCBItDULE
1% .f job eaSt R.esidcntlol, 0.. Fireplace
$39,50 minimum
$99,50 jl.o.id"'li~l. Addition. " Altemons
$64,50 lUl.idential. AC Only
539.50
R.esidentilll. Healing &. Ale (Now COhSIJUetlon)
Re:iidcntiol, H...ung Only (New C""'lI'Uction)
539,50
53950
E:slimlllcd Cost $
BUilding Permit #
HE....TlNG PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
S
.so
t'AllJ WITH
WIWINI.:I PERMIT
com.. u.. Only)
This Applleatioll Becomes Your Dulldln~ Permit When Approved
>-
Pai.d
~ipt NO,
nundlnJI OlllcIol
DolO
0' ~J3-0/
B~
~4 ~o~r noli.. 'Dr nlf Inspoetlonl (!IS~) 441.9850, rOJ (953) 447....:245
CITY OF PRIOR LAKE Me
16200 Eagle Creek Av. S.E. Permn No. 0 I ~ 00(01
Prior Lake, MN 5,5372
, HEATING APPLICATION / PERMIT
21'2DID\
SilsAddress' F\L\bl... r1u'Jn
lot .2:L Block \ Addition
Own..... NamelJ1< fu (+mt
Addr8SS~~5q W[LSh~i1M1!XUV -:t-2f)~ 01mGYl f/J'055/?2--
Healing ContraclOi' .C\ it I 'aJ':J ,) (t{!fIi1Ilfu (iLl j
Address-;\tC:iL' KJ11i'l{./1eLUr 'iJ=-i 81 tJ{U1 MfJ 56llZ
Telephone' L'Cj f 402 - 2/1G ./
Furnace Make & Mod., g rl'iU1t- TYPE OF SYSTEM The price of your heating permil includes one rough-in and one final inspection.
r> Or> " l~ \ /f~' J,., Warm Air Plants
Model Size ..., '" ') <-tl Ii ~'1-4 L' t [J Gravity Additional inspections will be buled at $35.00 each,
Conn. Load L 1 ;; 4- Cl Mechani~l; hlrutuic' " J-.. House Healing Tesl Record must be submitted with blli!gimllmuDil ~ before build.
" ..h(' -," f) AirConditlDn~~ L---'vl') ingcer1i&cale of occupancy will be isaued.
Fuel khlt Au.Size /1' dCiS~!5 Vent.System -l3IJ(~m 1.I->t.it:11~3,
Supply Openings g sHEATlNG OR POWEll PLANT
" team
4- HOIWater
Radiation
Special Devices
Date
Return Openings
InpUl1D [' bD
Output 5/", r /ll,
1.; J,/...I....--
Edr.
Clm.
(}t7
WI...-
PlOtI
(tfELlat,\,'J
ei!vi'W" 'Sf
Other Devices
TYPE OF WORK
A~eralions
Repair
Replacement
Est Comp. Dalll
B"Heling Perm~ .
Est. Cost $
HEATING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEES $
New Conslruclion
L./
0/- 061'0 '7
L
.50
PAID WIiH
R BUILDING r-i::.?,;i.;,
eceipllI
TYPE OF STRUCTURE.
J. Piak
2.. Gual
J, YdlGw
,
r
,
,
.
.
....
CJty
CanlI:8Cmc
Single Family
Multi-FamBy
t.-----
Two-Family
Commercial
Industrial
Public
Other
.
<
"
F8{l Schedule
.
.
Industrial, Commerclal & MuW'Family
Residential. Heating & AC
Residential, Healing Only
Residential. Gas F""place
Residential, Additions & Alterations
Residential, AC Only
.
c
1%'01 job cost ($39.50 minilTXlm)
$99.50 PLEASE NOTE; ~
$64.50 Air Conditioner Units Canm c
$39.50 Encroach Into Required Side ~
~
$39.5C Yard Setbacks. ~
$39.5C ~
~
~
Remember to add the State Surcharge on !he bollom of this application,
~
~
~
~
!:!EAt CALCULATIONS REOUIRED with number of supply and relt.m openings listed per
room with CFM's per opening. New .truClures or adcfdions send floor plan with supply
and return locations shown. HEAT LOSS CALCULATIONS, PAYMENT AND
APPLICATIONS MAY BE MAILED TO THE CITY OF PRIOR LAKE. 16200 EAGLE
CREEK AVE. S.E. PRIOR LAKE, MN 55372, '
c:
~
CIIy Hall business hours ere S e.m, . 4:30 p.rn.
.,
:z
~
c:
:z
~
..
IT
ALL WORK MUST BE INSPECTED (ROUGH-IN AND FINAL) . CALL CITY HALL
447~
I hereby apply for a mechanical systems permit and I acknowledge that the
information above is complete ancl accurate; thalthe work will be in conformance
w"h the ordinances and codes of the c"y and with Ihe stale building/mechanical
codes; thaI this form does not become a parmit until signed by the BUILDING
OFFICIAL; that the work will be in accordance with the approved plan in the
case of an work which requires review and approval 01 plans.
b-U),J\ I.' - f-LmJ11lVr/ItU"V (n1f/6)
I I~icanrs ~~eL.
Buildo,g of~~e
Ll2tle!
Dale
2--2-& -0 I
Date
J!j;
<:
<:
....
PL. FA){ 447- 4245
PRIOR LAKE DEPARTMENT OF
.' BUILDING AND INSPECTION
INSPECTION RECORD
,-,,\:
SITE ADDRESS Sl/ ())., ta.u.1,^~J...sJ
NATURE OF WORK UP,.,
USE OF BUILDING K.uUt ~}-
PERMIT NO. 01- OOtP7 DATE ISSUED (~'2.'5,2",1
CONTRACTOR tJ. R. t-lo....b PHONE r.,c; I ~7-5(~ -7/2..cr
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR
DATE
I FOOTING vJfc..1 fh-. 1 .J./;"';/tJ/
I FOUNDATION (Prior to Backfill) I ft7r Id/~8"'/"1 ~ 4-.3(5/JI
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS ~~ ~ ~r.,(c))
SEWER I WATER I SEPTIC
FRAMING
INSULATION Ii--. o;i/}idr
ELECTRICAL
PLUMBING~ IA,Q;. ~. ~f5I()/ ~~IA.(,:,. ifJ:1. 4/~foJ ~/-1-+;)lj.OI ffl-'''y,x,;01
HEATING (if required) ~ ~, 4/(7/t'/ -gV/JAW 5"ldbl
FIREPLACE . <tVo.wt .5'1 bJ o(
GAS LINE AIR TEST 1; u~ 5-1 ~l/" r
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
/'>
l~~ /if--. 11'1/7;0) I
V FINALS
. t1! G
'"E. \\lUNt I!Vf
1-,v't'\.
't _~IlAN
~ Uf.I.o'iJ s-tc,ior
~. Jl;J 'b .~olvJ
\.
SJOtIDI
, .
GRADING (Prior to Soddi~~)
BUILDINGT,t..l) ~ 'isfl(6 ( if;:,.fr-b,/tJl
ELECTRICAL ' .
PLUMBING
HEATING
DO NOT OCCUPY UNTIL ABOVE HAS
NOTICE
J ?<=1 L}-O Cl-- I
t ~~'e1 11-'2/.cJv
fo/IOJ./OI
I '!9111
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.
Call between 8:00 and 9:00 A.M. for all inspections
FOR ALL INSPECTIONS (952) 447-9850
Q!;trtifU8U of ~rrnpanry
CII r OF PRIOR LAKE
mtpartmtnt of .uilbing 3Jn~ptttion
~Fina1 Permitted 0 Conditional C.O. Expires
This CertiJicaU issued pursuant to the requirements of Section :J07 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 C1assificatioo SINGLE FAMILY
R3 VN
Occupon<:y Type Type Construction _ Fire Zone
Lep! [~,.',:. Ll, Bl, DEERFIELD THIRD ADDN.
Bldg. Pennit N^
N/A
Zonin DWrict
- g
01-0067
R2
Owner of Building
D.R. HORTON, 3459 WASHINGTON DR., EAGAN, MN 55122
Contractor's Name. Address -
ROBERT D. HUTCHINS flI!j'~ityPl_r
Building Offi<:ia!
II j.J OL
Site AddreSl
5402 FAWN MEADOW CURVE SE
DON RYE
Date:
Dire:
I
POST IN A CONSPICUOUS PLACE
HOUSE HEAT~,~.TEST RECORD
'/"Al '" /1JPd fJnu./ (" u t"~APT. _FLOOR
nWNER.
ADDR ESS --5'!LIJ rl-.
OCCUPANT _
HEAT LOSS
SOLD BY
E lectricol Work By
TYPE OF HEAT
DATE HTG. lNST.
&, /< /rJ}
MAKE
Model
Serial
INPUT _
A GAS DESIGN
p/,y"" /Jr-
. / 3r<Q,4}1'()3C,. 07()
()7 iYfj(T(;;'i??
C:;,?,.rnf)
MAKE OF BURNER
Model _
Max. BTU Rating
MAKE OF FURNA'"c
Mod.1 _
JOB#_
.4.' c'~Ae
CITY L/''''/, SUBURB
CONVERSION
"-. /
V
/"-..
CONTROLS IJ//
THERMOSTAT hi>r"~eot Plug Vent S;,. ..."
Valve /1/~ . KIND OF LINER C 1"'1<5 ~ SIZE ,I) // NONF
Limit 7'o>>J....... -z:...,.,~ ~ Drah Hood RegulaTor /h""y/Y.ca/
Limit Setting ::h~o.p Filters Size /6Y,d)/)JI.J Number /
Fan Setting 4~_~..q~ / /J~~~/#~ Chimney Location Insid.)(' Outside
Pilot Type - Chimney Construction _C./..u"-'-, '.R
Pilot Make / / r- 'r-
Pilot Model /7 (~
INSTALLED BY ////. :'-.1>'1 ~
Gas Line By _
GA _ FA LHW _STEAM _SPACE HTR. _UNIT HTR, ~OTHER
Pilot Timing
L.W. Cut Olf
Pressure s/..fi// Percent CO2 7,"
Input CFH Percent O2 ----.7 &./
Stock Temp, ::;()()OF Pe,cent CO _ :z. ",4#1
.' '
Form 235
Smoke Bomb
Draft _
"-./
.........-.
(0/5//,\;
Door Pressure
Wiring _
Test Tag
lighting Inst.
'X.
\
Date Tested
Company Testing FrtJierick;op Heating & AIC, 3650 Kennebec Dr., Eagan, MN 55122
Name of Tester ~I..I,J./
CITY OF PRIOR LAKE
INSPECTION NOTICE
DATE TIME
SCHEDULED &,- .u,-6J d-;c))
,~'-I{)~-::J-au.n0 ~
ADDRESS
OWNER
CONTR.
PHONE NO.
PERMIT NO.
/-07
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
~NAL
o SITE INSPECTION
o PLUMBING Rl
o MECH Rl
o WATER HOOKUP
o SEWER HOOKUP
o eLUMBlNG FINAL
--c::r--MECH FINAL
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE Rl
o FIREPLACE FINAL
o GASLlNE AIR TST
o
COMMENTS~ ~ ~ ~
~ ~- - l/
~ ~ ~~djf
'SJ ~ -i: -K,;Q;, r2-v\.v ~ c , ~
LJ} ~ ~ f
~'~''''~''.",..;,,.,,-...._,.,.,,,.,"
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o WORK SATISFACTORY, PROCEED
~CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR RElNSPECTlON BEFORE COVERING
~,
/
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
Inspector:
Owner/Contr:
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTI
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
(p 'IZ-() /
II;/.;v
ADDRESS _,,::;4() 2 FR1VIV
OWNER
CONTR.
PHONE NO.
PERMIT NO.
01- ()orc 7
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
o PLUMBING Rl
o MECH Rl
o WATER HOOKUP
A>8 SEWER HOOKUP
T I ~ PLUMBING FINAL
o MECH FINAL
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE Rl
o FIREPLACE FINAL
o GAS LINE AIR TST
o
COMMENTS:
M CUAO V\A S+~V LJ ~
;{'WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WOBl5, fi;ALL FOR RElNSPECTlON BEFORE COVERING
~/\\
Inspector: _ ~. (4 Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE,
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY/
INSNOTl
Job Address
Heating Contractor
Name of Tester
Date
Percent 0
Percent CO2
Percent CO
Stack Temp.
U
cr>f~~
~-
(pItt /2.00 I
o 70
-;171
o
u:;..o
-----