HomeMy WebLinkAboutBuilding Permit 01-0068
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
(Please .!VP~ or print and sign at bottom)
I ADDRESS
5ij'03~wn (~'dJ-
:5~
LEGAL DESCRIPTION (office use only)
1 u.",.!:" / J .3,)
LOT j BLOCK / ADDITION
~L.
2451 JaS.h,'v7c/w.
OWNER
(Name)
(Address)
BUILDER,
(Name) P. (2.
Hv.--k
(Address)
Date Rec'd
I. White
2. Pink
J. Yellow
File
City
Applicant
. 01- oaId2J
ZONING (offlceuse)
R"L
PID
25-373- oo,-d
(Phone)
mAl
bvivt Sk.d{}l/
"
TYPE OF WORK
~New Construction
o Fireplace
oDeck
o Misc.
oLower Level Finish
(Phone) tsJ - ';?Sf.r 7;,;;9
r:'6j&H ,MN SS/~
oPorch
ORe-Siding
ORe-Roofing
oAddition
oAlteration
oUtility Connection
PROJECT COST IV ALUE (excluding land) $ 70 r; 70
I
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
;teruP31:;2~rmDj.:;z,ons d{)D{)S~57 / -/F-t1J
/' Signature Contractor's License No. Date
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
$
$
$
$
$
$
$
$
?~O. IS
ols,Of"
3'5'.S(~
J4:?-~
/aJ,{!;JfJ
~":~
L0d:JO
ppli tiO;Ces Your Building Permit When Approved
1-2t;;-~ol
Official Date
71,000
I Park Support Fee
I SAC
I Water Meter
I Pressure Reducer
I Sewer/Water Connection Fee
I Water Tower Fee
I Builder's Deposit
I Other
I TOTAL DUE
#
#
B6l>.l"lO
I. I 5O.0f:)
.
-0
Size ~,f8tlj
I'"
,
#
#
6~~.7 tV' I RByeCeiii.Rt,~._?q6D4
'7 /7-(\1 JUI'
I tl1
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and ma~ 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
is<~~ 2/l/&\ . ~_~. ~U-'i.~
. Planning Director Datc Special Conditions, if any
24 hour uotice fnr all inspections (952) 447-9850, fax (952) 447-4245
Paid
Date
JAN. 24. 2001 2:30PM
GENZ RYAN 6513226147
NO. 865
P.2/9
2.
3.
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CITY OF PRIOR LAKE
SEWER AND WATER PEllHIT
NO. ()I-OOCt>~
.
NOTE: Sewer and water
. contractors Must
be reqistered
with the City.
APPLICAN'l':..Gz.-J/"\.;J- "tJ" I""l P".JW'lb'".~ Ul'GfiA.lt'_ PHONE:..k51-1.J.2~-I'~
ADDRESS: ILJ"LJ~Sn B ~~..... S-S'"cr.Ii 0A'l'E::
SIGNATURJ'::-Il..lf.... 7~- _-. BLDG. PERMIT *
SITE ADDRESS :.~ -;,p, 'f Ji'J.u#
FILL IN THE BLANKS
40'
1.
Estimated lenqth of water service
/"
siZe of water service inch(es).
feet.
Location of any couplinqs from s~ructure
.feet.
Type of sewer pipe. ABS PVC X Cast Iron
I
Estimated length of sewer lin~~ feet.
Clean out (if required). located at feet from
structure.
---~===~:I!!!=
--~-_.._...~
--===~==
This application
when approved.
7-- -g -oi
DA;TE:
BY
==:-----~=-=--=~---~---
$
$
$
-==-
~=:::::====_~___===-=====;;;:o;;::
FEES:
35.00
, .50
35.50
Sewer and water line connection permit.
Surcharge
TOTAL
* Fee for either sewer or water individually is $20.00 plus
$ .50 surcharge.
,
* Sewer and water permits issued for new' construction must be
recorded on the buildin~ permit card at the time of issuance
to insure that no dupllcate sewer and water permits are
issued. "
DATE FAID
RECEIP'l' II
PA.ID .
BU/I Sh~ Wn",.,
II (;;. ,_'
j- I...: .-~;' ~
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AMOUN'I' PAID
REC'O BY
. 4629 Dakota St S.E., Prior LDke, Mlnnaota 55372 I Ph. (612) 4474230 Fax (6121 44742/15
AN EQUAL CPPOJmJlIlIT'I EIIli>ulY!R
JRN.24.2001 2:31PM
GENZ RYRN 6513226147
--NO.865----p.6/?
CITY OF PRIOR LAKE
. PLUMBING PERM" '#
,Applicant: (.,.,pfl7 - II j/JY1 Phone~~6HJZ~-I/W4
Add~8,; IY~/b-.In1...-r'f1Lj _ (/""-1 ~l nr- C.q)lcl~
Signatur.: J..... _~
l..agel Descriptfon: L _...J. 610ck Sub
Site Address; ~I ~f'\"'-. r:=- ~~ r\ADA-Qrru.. ~ C I J ,,\ (), .'-.F
Building Permit # PIO #
NOTE: This permit wjll not be prcceseed wilhout Clomplete information.
FIXTURE UNITS
I, DIao PiIo
.. o.w Cll'
J,y_ AjlpII_
n(-oOCof3
.
n... Cnlff" 1ft ..... eoa",,,
This permit is lJ'lIII,od upon tho express condi~on that said
con_, shall comply i .'111 poetS "'ith llt.ordinancu .
of tho SCale P1umbln, .. the amondl!lllllts thereaf.
), 0, -Z.:::.f. ~ 61 DATE
A1J~1
Call for all in~ftions 24 hours in advance.
16200 Eagle Creek Av. S.E.. PriQr Lake. Minnesota 55372/ Ph. (612) 447-4230 I FAX (612) 447-42~5
An Equal Opportuniry Employer
Quantity
\
\
\
?-
-
"" "
" .-)
i .
7--
,"-:-:...
'. I
" ..--J
. >
Type of Fixture
QuantitY
Type of Fillture
Bath Tub with Or without shower
Dishwasher
Floor Drain
Lavatory (bathrtlOm sink)
Laundry Tray (1 or 2 comparlmer,t sink)
Shower Stall
Sinks
Bar SinJ(
Waler Closet (toliel)
r
I'Ll \
Rough-Ins
Water Heater
Water Sotlner
Stand Pipe (washing machine)
Sewage Ejector.
BacIdIow Assembly (RPz. Cauble Check, PVa)
Backllow Assembly Test
Lawn Sprinkler
Other
FEE SCHEDULE .
. Induslrial. Oommercial & Multi-Family
(1% of job cost, $39.50 minimum)
ReSidential, New One & TIVO Fam~y
Residential, Additions & Alterations
State Surcharge
599.50
$39.50
$
$
$
$,
.50
PAID \IV
BUILDING . -
, I ~
I ,.,~ ..,
GRAND TOTAL.
$
11:59 651 633 8884 FIRESIDE CORNER
CITY OF PlUUl<. JJA.lU!l
HEATING/AIR CONDITIONlNGIFIREPLACE PERMIT
#3534 P.004/004
u......................
tpll:lIR 5YI"1 rJl Drmt aDd. :dKlllt boEDmJ,'
ADDRESS
Sl./oJ .d~ &-
: ~ ':, I PERMIT NO.
,. ....11-" "'ppUClIlIII
ZONING (offi..u..)
O/~O 010[5'
LEGAL DESCI.Ul?TION (olll<e U" only)
"'
OWNER
(Name)
~~
Elof1jMj~
PlDQ tY -3'13-Ool--D
Lor / BLOCK J ADDmON
(ph.one)
(Address)
APPLICANT
(Name) ALLIED FIRE:SmE DBA FIRESIDE C"""",...
(Phone) 551-"'33-2561
(Address) 77011 N... "'URVIEW AVFJIlU"
(Ad.dross)
BRENDA lIUSTON
(Contact Person) ;'I
&/Ilu.a
J
liL.~
WlC::lOVTT." .E....-W'T
(C1ly)
(Phone) 651-633-2561
5"1 ,~.
(:zip Cud<)
APPLICANT SIGNATURE
DATE
r:;-/.;- b
APPLICANT PLEASE COMPLETE BELOW
~w CONSTRUCTION 0 REPLACEMENT 0 ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENTNGS INPUT OUTPUT
TYPE OF SYSTEM HEAnNG OR POWER PLANT
OWOllIl Air Plants :J Stc:am
JOravily :J Hot Won:r
:J M.oeIlll1ljcal J Ratllatlon
JAI' Conditioning J Spechll Devices
OVen!. SySll:lll J Other Device.
FIREPLACE MAKE AND MODEL ~ JJ {{;r.:, -S<... 'J'::iD1lt-
PLEASE NOTE:
Air Conditione, Unlls
Can."ol Encroach into
Required Side Yard
Setback..
InduJIJ'i." Comm=iol & MUlti-Family
FEE SCHEDULE
1% of job eost lI.e.idGtlli.l. OIL' Flrepla""
$39,S(I minimum
$99.50 Residontlal. Addjtiol)S Ik. Alterallons
$64.50 lI.esldentioJ, AC Only
$39.S0
Residontial, HOllting lit AlC (N.", Construclion)
Residential, Hc.oting Only (New Construction)
539.50
539,50
Estimated Cost S
Building Permil #
REA TINO PERMIT FEE
STATE SURCHARGE
TOTAL l'ERMlT FEE
$-
$
S
,50
(om.. IJI< Only)
This Application Becomes Your Building Permit WIIea Apprond
Bulldl.. om"",
DRk
I Paid
I Date
I ReceIpt No,
I By
%4 hnur oollce for Rlllnop..llon. (9n) 441.9850, r.. (!I5~) 44'7-4:ld5
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Th. ('enter of Ihe I.ake Country
White - Building
Canary . Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
1
D I< 1-\Ck"TCJJ
\ -Ie - C I
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
'.J Lr C ?-- f-- f\ \\J 1\1 Cj '\) lei
Accepted
~
Accepted With Corrections
Denied
&./~~
'" v ,
Date:
2/1/& l
Reviewed By:
Comments:
'#i~ .c;,J4k.::-T"TO ~ ~'itt9vtS ~
-\['J, v LJ. .;:... v ~ \}JL0t- '- ~Dv- ~
~T-~l
r:StJ~ld~~JV1/~ ~~ ~-!J;- ~~.
,0_ w llo_~~~~ ~ 1?1e ~::;:tJAA_~. ~D r?xG~ 5
"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 - Building
Canary - Engineering
Pink - Planning
Th.. ('..ntn of lh.. L._b Counll')'
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
DR. HOK.\ 0"-.)
\-16-0 I
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
54-03 PAW I\J c.J)LJtGI
Accepted
Accepted With Corrections
Y-
Denied - II (j
Reviewed B{ ~ ~
I
Date:
(-2t::;'-2- (
Comments:
~ 5C(oa +aw...... ~ CIJhJ-.~ ~c,.,... VX........'"
T~
"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
0(- (oS
Thr erntrro! lhr (,.kr Counll')'
White - Building
Canary - Engineering
Pink - Planning
.BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
DR. HOKlO""J
\ -IS-O I
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
5 4-03 FA \N N c..;) l! lc:l
Accepted
v
Accepted With Corrections
Denied
Reviewed By:
LLL
Date:
/- 29-01
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."
Date
Supply Op..nings
Return Openings
InpUl10. t DO
Edr.
elm.
~L-
A~eralions
Repair
Est. Cost $
HEATING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEES $
CITY OF PRIOR LAKE Me
1620D Eagle ereekAv. S.E. P..rm~ No, .D.l.:i2t2fl!8
Prior Lake, MN 5.5372
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Output SU, CD!;
TYPE OF STRUCTURE
I. .P.iDk
2. GRlo.
3. Yellilw
,
t
,
,
,
,
....
Ocy
Contmc!Dr
Single Family
M~Iti-Family
.t.--
, HEATING APPLICATION I PERMIT
21ZDIO\
Site Address C:;LttP) rrl1\j n
Lot -1.. Black I Addition
Owner's Name 01<. fu{rmt
Addr8SS~45Cj W[l)sk~i1MrI)/LU1r ~2J)~
Dtl;' f'" ",. ; " .,'
- 1'1 '1\ ,...I 'W", '/11! ,"!
IiNllngC_.._~_._, ,LlIA-Iv r~ILI :ld1/11U
Address-;;liC";[:. UI~11f.}'JtL/)r .1:t=.i 81 WUI MfIJ 661U..
Telephone' . L<51 41)2 -1,1", J
{) ", ,
Furnace Mako & Model t:l1'T\(,l.,nr TYPE OF SYSTEM
,.,0"'" 1!l\I,,,,U'lr- WarmAlrPlanls
Model Size ")1\ 'J '--/'1 . ,.' L4 U LJ Gravity. A<fditionallnspections will be billed at $35.00 each.
Conn. Load L 1 ;;; 4. 0 Mechani~l. ~ . OJ -'-" House Healing Test Record must be submitted with buildin" Im!lIliI number before build-
,. AirCancflllo~ (' 0. or- L..'IVn . rtifi Ie f '1Ib' d
1-',1..- ..1;1(/10(" ^ ^~ /,.AJ-<-C; " Ingce ca 0 OCcupancyWl elSSue.
Fuel IVe\;! Flue Size t-( U-J~ 15 VlnL System - t:=I'; I.....rn -:x.iJ '1 rM",
I:lfAI.Q!U (:111 ATIONll. REOUlRED with number of supply and r..turn Gp..nings listed per
HEATING OR POWER PLANT room with CFM's per opening. New structures or addhions send floor plan with supply
Steam and I81Urn locations shown. HEAT lOSS CALCULATIONS, PAYMENT AND
liotWa1er APPLICATIONS MAY BE MAILED TO THE CITY OF PRIOR LAKE, 16200 EAGLE
Radiation CREEK AVE, S.E. PRIOR lAKE, MN 55372. .
Special O..vices
Two-Famiy
Industrial
PlDtI
m.f'Llc\l'>VJ I'V,XVf
Comm&reiaJ
Other
Public
,
<
e
.S[
FElf! Schedule
l-
I-
81tlW1
J
Industriaj, Commercial & Mulll-Famlly
Resid..ntial, Heafll'lg & AC
Residential, Heating Only
Residential, Gas Fireplace
Residential, Additions & Alterations
Residential, AC Only
.
<
NJ\J 55.JJ1-
1%'of job cost ($39.50 minimum)
$99.50 PLEASE NOTE; ~
$64.50 Air Conditioner Units Carull c
$39.50 Encroach Into Required Side:
$39.5C Yard Setbacks. ~
$39.& ~
~
.
R..member to add the State Surcharge on I/1e t>oIlom of this applicallon.
The price of your heating permit includes one rough-in and one final inspection,
~
~
~
~
c:
.,
City Hall business hours are B a.m. - 4:30 p.m.
..
:-
~
c:
:-
,.
..
"
"
Other Devices
ALL WORK MUST BE INSPECTED (ROUGH-IN AND FINAL) _ CALL CITY HALL
447-9850
I hereby apply for a mechanical systems permit and I acknowledge that the
information above is complete and accurate; that the work will be in conformance
wfth the ordinances and codes of the city and with the stat.. buhdingimechanical
codes; thaI this form does not become a permit until signed by the BUILDING
OFFICIAL; that the work will be in accordance with the approved plan in the
case of all work which requires review and approval o{ plans,
TYPE OF WORK
Replacement
Est. Camp. Date
B.,lding Perm~ t;
New Construction
!../
() / - OOhb
.50
f'",IO \Nlir\
R . BUII..O\~G \-,~,\'>"I'
ec"plll-
-..L 1llnv IA~ 1..trilmLYf'~ (jr../lt))
~~
BuiJdimr.>ftiCal'S Signature
J!j;
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c::
....
'2-!26 1 ('I
Date
Z.~U-OI
Date
PL - FA){ 447- 4245'
PRIOR LAKE
INSPECTION RECORD
DEPARTMENT OF
BUILDING AND INSPECTION
SITE ADDRESS 54n\ FawlAO+.,
NATURE OF WORK tJp. I
USE OF BUILDING .u..ult,.L...L.. ./'
PERMIT NO. Oi- 00(08 i:5 DATE ISSUED 1-2~~d::ot
CONTRACTOR niL. t.L-....b.n.... PHONE~/. ?r-)r..:zr~_r
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR
DATE
, FOOTING I}J/~ I tdr, I~/N/{JJ l
, FOUNDATION (Prior to Backfill) I ft>> lW.?-i'AJI ~ .6,-,~!~'i
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS ~' ~. 3/(P(01
I
SEWER I WATER I SEPTIC
FRAMING
INSULATION ikn. CJ I:n-. .5nPJd'
I
ELECTRICAL
PLUMBING ~ U.G.. ~ :?~fOI ~"i}.A. 0+. ~I(plbl
HEATING (if required) ~ ~ .. ~// 7~ /
FIREPLACE 'h V 0.1 ~""df)l
GAS LINE AIR TEST f8- ~-q-O( '& VlIN'<< . s:U"
I - .
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
4. ~/I?ft/ I I
FINALS
tt/~
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Z&..
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r;::: -7 _ ZtJ ""
~V4ML 6J,Jol
I
18(4
GRADING (Prior to Sodding)
BUILDING -(ell, -tiU ?/r'5/o/ f/J;r 7/110)
ELECTRICAL
PLUMBING
HEATING
DO NOT OCCUpy UNTIL ABOVE HAS
NOTICE
'/'If
10 ':JJI-OJ-.-
I kJ..HJJ....
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b~
iPl.;>I/D\
)/91f1 ~
BEEN SIGNED
This card must be posted near an electrical service cabinet prior to rough-in inspections
and maintained until all inspections have be~n 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
fIio~'~~~~ .
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:~ I CITY OF fRIOR LAKE
:.~ I mtpartmtnt of .uilbinll Jn~ptction
!J.;:! ~ Final Permitted 0 Conditional C.O. Expirer
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17Iis Certificate issued pursuant to the requirements of Section 307 of the Uniform Building Code
certifying thaI allhe time of issUDnce this slructure wa.I' in compliance with the various ordinances of the
City of Prior Lake regulating building construction or use. For Ihe following:
Use Classificatiop
SINGLE FAMILY
Bldg. Pennit No.
N/A
Zoning District
R2
01-0068
R3
VN
c ~w...'.. ...'Type
Type Construction
_ Fire Zone
Lop Description
Ll, Bl~ DEERFIELD THIRD ADDN.
Owner ofBui1dinl
D.R. HORTON, 3459
Contractor', Name &. Address
fl;t7 I~ity Planner
5403 FAWN COURT SE
Site Address
WASHINGTON DR., EAGAN, MK 55122
Dale:
ROBERT D. HUTCHINS
BuildJ"I Official
/(-21 OJ...
Date:
DON llYl'
POST IN A CONSPICUOUS PLACE
ADDRESS S 'kL ~
OCCUPANT
HEAT LOSS.
SOLD BY
Electricol Worlc By
TYPE OF HEA T
/":',dr1 ('--',
DATE HTG. INST,
HOUSE
5.E
w/5/01
H EA TlNG TEST RECORD
JOB #
CITY~/;')I'~UBURB
APT._FLOOR
OWNER.
INSTALLED BY /'1({,C1.~
Gos Line By
GA_FAX-HW _STEAM_SPACE HTR. _UNIT HTR, _OTHER
MAKE
Model _
Serial _
INPUT
GAS DESIGN
r:/'V4Llr A
/ sl7'4.V;ry";l() .:.;. ) 5..c
()~()Ul5"9,'7!\
'--::;;"If~
- ;.
CONTROLS
THERMOST~ //S"1>',o/"// Hea' Plug
Valve ./1/
- ~ ;-
Limi'_ /Po,/.-I1i -z;::.,,p'//~~
Umi. Setting ;;U"Y')OF
Fan Setting ~f3't7At/- Lr.JJ~~A_
Pilot Type - J -..
PHa' Make /1 _ "" /
Pilot Model _ ' - .
Pilot Timing
L,W, Cut Off
...-"
Pr.$sure~' -"-
Input CFH
Stack Temp.
Form 235
Percent CO2
Percent O2
Percent CO
'<:;)1'\
:;1,(,.
7,L:,!
3 ,O,tJ/M
. 1
CONVERSION
MAKE OF BURNER
Madel.
Maj(. BTU Rating.
MAKE OF FURNACE
Model _
~/
./'\..
./ "
L///
Vent Siz- -r
KIND OF L1NER.C:/",,,,,,,,> .R" SIZ" . I)ION"
D.alt Hoad Regula.o. ../#d_ YJr,-o'/
Fi Iters Size IA Jt' J Or / _NumbeL /
Chimney Location Inside j,(' Outside.
Chimney Construction _ ("/;A < ~ ~
Wiring
.... /
/~
Smoke Bomb
Draft _
< ./
"/
0'A. y)'J
F eri~~ Heating & A/C, 3650 Kennebec Dr., Eagan, MN 55122
yF
Door Pressure
Test Tag
L;ighting Inst.
Date Tested
Company Testing
Name of Tester
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS -",,540'5 FA W ;J
<7 OWNER
PHONE NO,
CONTR.
PERMIT NO,
o FOOTING 0 PLUMBING RI
o FOUNDATION 0 MECH RI
o FRAMING@ 0 WATER HOOKUP
~INSULATI :...\ r 0 SEWER HOOKUP
FINAL \" /f;).. 0 PLUMBING FINAL
SITE INSPECTION 'V?' MECH FINAL
COMMENTS:(fl) ~ ~
~+O~V!.- (;
@ Q~ i -rAL/LdJ~ ~J.dLT--'1
I ,
. DATE TIME
71,0/
f:aV
(-(, (
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
-11 tr>--
- - :1-,
~
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o WORK SATISFACTORY, PROCEED
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o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
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Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE,
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CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!