HomeMy WebLinkAboutBuilding Permit 04-0156
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec'd
Main File
I. White File
2. Pink City
3. Yellow Applicant
-.......
0i-
I PERMIT NO'64,O/5h
/ ? -04
(Please ~e or mint and sign at bottom)
ADDRESS
/jc;53
ZULff J1.G'1t#P 'lt1A-/L-
ZONING (offic,u,,)
rouP
LEGAL DESCRIPTION (office use only)
LOT IZBLOCK.J ADDITION 'J;/11/31:" wGr ~/tZ
PID ~5-- I/O,'}.' t/J~'~
OWNER
(Name)
(JuJ..re.. tlomfS
b-~M"ZPlt(/[g- fAt21L.U/1W ,
/ '
(Phone)
tS/-/lfZ -~ZCO
(Address)
0UIre.. /~.
~
t:'A6M1,
JIYJn .
55/21
BUILDER
(Name) :5A111&
(Contact Name) tULT 2W1#;/O
(Address)
(Phone)
(Phone) &/Z-ZZ-/ - ~~
TYPE OF WORK
/'
lB'New Construction
ODeek
OPoreh
OAddition
ORe-Roofing
ORe-Siding
OLower Level Finish
o Mise \. R .<1-, CmQ.e..,
o Fireplace
DAlteration
Dutility Connection
PROJECT COST IV ALUE (excluding land) $
~-~('s::..-' q~,(JO().()O
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
~teruP~7'1F2:n;e~~ons /3e - /5 7/ ~~~ A</
ff"!'.A{.e , , Signature Contractor's License No. / / Did'"e
I Permit Valuation ,t9t; 000,00 I Park Support Fee # $
I Permit.fee $ '/""27.5:0 1 SAC # $ Is.ro.otJ
~
I Plan Check Fee $ fotp 7. W I 1 Water Meter (Size~l"; 1$ Ol5:d. 00
! State Surcharge $ 4(, 0 ~ I I Pressure Reducer 1$ I.{":}.OO
I Penalty $ 1 City SAC and WAC # $ l~o.Oo
I Plumbing Permit Fee $ 10(J,oO I Water Tower Fee # $ 700, 0 f)
I Mechanical Permit Fee $ 100.00 I Builder's Deposit $ IS-dO, Of) I
I Sewer & Water Permit Fee $ 35.>a 1 Other $ I
I Gas Fireplace Permit Fee $ '-I () .OD 1 TOTAL DUE $ '1/) h3 PM I
,
This Application Becomes Your Building Permit When Approved I Paid '/00.::5. q"1f I Receipt No. L/(A/-1t./
~ UI-- I Date .3 - Iq -0<-/ ' I
c;)/~/D~ BY'J- -
Building Official ---, Date
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
~ning~c~r~ #'i~y /!~~al~
24 hour uotiee for all iuspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
~~
Main File
Whit" - Buildin!t
~anarv - Enain""r1~
Pink - Planning
Tht (',nlu fir Ihf I..kt ("ountry
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLI!=iT
NAME OF APP~ICANT
,j ID'~'Z(,
;
f:,,/ ./ 1"'.'J;'l
. /./; ',. ., .-1
('-il";' ".' ~. (v<.;
APPLICATION RECEIVED
'J
('")'"
" . ,,/'
''''.'i-('.') c:/
I /'
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at: .
.. .,', " /
/;/(>.<';";';'-' -. . / / {..-j
t- ~7.j '__.,/ ,L-"',')I::J'- /' '~J- ':>:;')
/' ,0
'..,/
Accepted
><
Accepted With Corrections
Denied
Reviewed By:
Iff7. /<.
Date:
3 -/5 -OL{
,
~
Comments: See Reverse Side for Additional Information!
See Attachments: 1) GTading Plan. 2) ETOsion ContTOI 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."
^ PRIO;,,~
1At\
sej
/
Main File
~hite - Blj~
Canary - engineering
Pink - Planning
-
lhr Cfntrr"fth.l,llk.{'ount~.
NAME OF APPLICANT
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
.9~ fh~4
~- 1/7-()~
APPLICATION RECEIVED
The Building, Engineering, and Planning Departments have reviewed the building permit
aPPI<aH,"f"OO",f~9;~~_Wh&~~ ~
Accepted Accepted With Corrections /'
Denied
~~
Date: cJ/";-{g fo c.f
Reviewed By:
Comments: K~
j7 ~ CL.il
J~!l- .
v
~~
4".A'"~,1,, A:UA ~,
, /,
"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
White - Building
Canary - Engineering
(1'>ink _: Pl8nn"'3:;>
Th~ Crnrrr of Ihr I.akr ('ount~.
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
"
NAME OF APPLICANT
APPLICATION RECEIVED
,
j
,
/
1,
./ /,
, ,
/
I I
//
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
Accepted
Accepted With Corrections
/'
Denied
Reviewed By:
~~
~ a.-U ~,
t7
Date: '-'v'/~c.lo if
-I-:- ~
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."
Residential Building Permit Checklist
New Construction for Single or Two.family Dwellings in R.1 or R.2 Districts
Reviewed by ~ v:.-, (J p
Date d-/~~/(J '-/
Building Permit # PID: Zoning:
Address:f'5~ '1'75'5',. ~'750 ?(s-c; 4 ~~ TKJL.
Legal: L ~ (D, B..5 Subdivision: 7 ~ ~ ~
II} 12-
Existing Structure? YES@ Existing Nonconforming Structure? YES L@
CONFORMS TO ZONING
ORDINANCE
, Yard Setbacks: NA 1 FAllSI COMPLIES
I. Front Yard (can be 20' if avq. wiin 150')
I. Side Yard
1 .
I .
I.
I.
.
Sidewall exceeding 50' requires additional side 2"
setback for every l' over 50' lonq
Rear Yard
Patio Door: make certain that a future deck meets
minimum required setback
From 100 year fiood elevation of wetlandlNURP
pond
From OHW (Prior or Spnng Lake)
I Floor Area Ratio: NA/FAllS~P~
Yard Encroachments: NAI FAIl,81tOMPLlEV
Eaves and Gutters no more than 2 feet In width and no
closer than 5 feet to a lot line (Easements).
lAIC and other equipment cannot encroach on interior
side yards.
! Tree Preservation:(NADFAILS 1 COMPLIES
. Total calioer Inches
i. Can remove 25% of total
I. Calioer inches Removed
I. Calioer inches Preserved
.. Reolacement
L: TEMP LA TE\BLDGLISTDOC
YES
NO
Standard
25'
10'/
25' if abutting a street
10' setback +
2"11' over 50'
25'
10' sidel
25' rear
30'
l
I 'ZS' I
E, ZG.. DS~"t;,.
25./ t.V, ~A'
P.PA- flLJ ~~
fUo,JC >. I
I
~j/U,
I
I
I
Proposed
NA
75' or setback average of
adjacent structures, but no
less than 50"
NA
.30 Maximum
Au?.
Standard
Proposed
,JD N E
r-Jot-l6
Standard
Proposed
~/2: 1
#
('?Jcase.!'a>~ or Dlint and ..;ion at bortnm'
ADDRESS . . . .
: ~ ~~~ I PERMIT Noi/-IS~ I
J, Yellow Apphc311l
LjQS3 1\\1 pU t-\4-c:., TY(l'l \
ZONING (olli"m) I
LEGAL DESCRIPTION (office use only)
.LOT
BLOCK
ADDITION
PID
OWNER,"\\ 1\' \ \_
(Name) t-u,.~k . \\T)('Y'iCS
(Address) '8.lS NDfWi. ~ It-. [t
j ^ Yl1 j
-- --,
(Phone)~I-U<:")~ -Q[D
S:~. \llO F(lf'{~n_Un
(phone) Os7 --'XtU..rxXJ'2:,
APPLICANT
(Name)
Burnsville Heating & NC, LLC
12481 Rhode Islana AVe. ;:'0.
Savaae. MN 55378-1122
(Address)
(City)
(Zip Code)
(Address)
:Contact Person)
(Jy~
~PPLICANT SIGNATURE /111
}5r\P..!J/h hfJ tf7
(phone)
DATE
Lj, 7-2 -ol/
APPLICANT PLEASE COMPLETE BELOW
~EW CONSTRUCTION 0 REPLACEMENT 0 ALTERATIONS .
'llRNACEMAKEANDMODEL \.0 YlVlnY AS\ f..A ~~ 2l( Pr N..JS FUEL .vnJ-y{j.o
'LUE SIZE RETURN OPENINGS l..j INPUT S-1S tif) OUTPUT L\ \1 Lj()!)
TYPE OF SYSTEM HEATING OR POWER PLANr
OWann Air Plants 0 Steam
DGrovity 0 Hot Woter
o Mechanical 0 Radiotion
OAir Conditioning 0 Special Devices
OVent System 0 Other Devices
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
~
11
:;13
I
ir
[REPLACE MAKE AND MODEL
',:,",.'
dustriaI, Commercial & Multi-Fomily
FEE SCHEDULE
1 % of job cost Residential, Gas Fireplace
$39.50 minimum
$99.50
$64.50
$39.50
I~
"
j
:=sidential, Heating & Ale (New Construction)
,sidenliol, H<ating Only (New Construction)
Resident~l. Additions & Alterations
Residential, AC Only
$39.50
$39.50
Estimated Cost $
Building Pennit #
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
:y"
/7\. . tUn ^ Vu O,Ot-J
~~
.50
f1ice Use Only)
"
Fbi. Application Beeo';'es Your Building Permit Whea Approved Paid
DIIlI!'K 21 Z004
'I ReceiptNo.
IBY r-
Building Official
Date , '
14 hour notice foc all. Inspections (952) 44t~1'850, fax (952) 447-4145
16200 Eagle ~ekAv.nue, Prior""""; M~$5312..~~ ..
Nov 26 03 01:20p
METRO GENERAL SERVICES
763-428-2968
p.2
MEU . '...E
YELLOW. A,,.lICAIIIT
GOLD. CITY
CITY OF PRIOR LAKE
SEWER' AND WATER PERMIT
q~:J.r '1'17-11-1//
S.w. No.~.()15'
FA '"
NOTE:
Sewer and Water
contractors must
be registered
with the city.
APPLICANT: fh C-JR() (~EfLIERRi SERViC-F=:PR.ONE: rb3-4-dA'iJ-d,'13,l>
"'--7 rive,
ADDRESS: .:;;> I c/o (:). uArtl AilE. Ne DATE: iIIQ.\L? Ii illi.l.l.-
~\ \f\ ~r ~ SI.)'Y) lC!.fi r11~L 4"'1tJ. '55376
SIGNATURE: ~_ a.vO'+-\_~..A':'W . BLDC;: PERMIT 11
SITE ADDRESS: L{.Cf.5.~ 1l.!.( P"M,~'?MfL
. FILL IN Wr. BLANKS
1. Estimated length of water service [; () feet.
2. Size of water service
10'
inch(es).
3. Location of any couplings from structure
n feet.
4. Type of sewer pipe. ABS PVC L/-il Cast Iron
'-- 5. Estimated length of sewer 1 ine :5 () feet.
6. Clean out (if required),
structure.
located at
/'JIA:
feet
from
==================================================================
This application becomes your permit when approved.
BY
DATE:
========I';/~=~~~=============================================
FEES:~_P~..~~~.7L~~~~~a~~~ water line connection permit,
<:!V(J.re.~-:;;> 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. MAR 2.;1 2004
AMOUNT PAID ~i.~P ~ .'
. . ~~~l1: . :/:
REC'D BySr-:J:,t)l~
":iJ./)
DATE.);>AIO
"
\...;.. ..
.
R.ECEIPT!I
.:r
16200 Eagle:CreekAv. S.B.. Prior Lake, Minnesota 553721 Ph. ('152) 447-4230 1 FAX ('I!J2) 447-4245
An Eaual Oooartunitv Emolover
MAR-26-2004 FRI 08:50 AM VALLEY PLUMBING JORDAN
FAX NO, 9524922617
p, 01/0
CITY OF PRIOR LAKE PLUMBING PERMIT
Date Rec'
'M~
I
APPLICANT PLEA$E COMPLETE BELOW
I Type of Fixture I I Quantity
Bath Tub with or without shower I . 3
Dishwasher I)
floor Drain I
Lavatory (Bathroom Sink) I
Laundry Tray (lor 2 compartment sink I
Shower Stall I
I Sinks I
I Bar Sink I
Water Closet (Toilet) I
i
FEE SCHEDULE
Il1du~lri.J. Commercial &. MUlti.family 1% o.job cost with. S39.50 \ninimum
PLUMBING PERMIT FEE $
STATE SURCHAR~E S
TOTAL PERMIT FEE S
(omtt'V,eOnly) I
This Application Becomes Vour Building Permit When APpl\roVed ,mil,
" .
,Ji);ltiiMAR :t 6 ZUU4 I' By
Buifding Official bAtt I ,,,,,,I , "j J
24 hour no'ice ror III in.pee'lon~ (951) 447-91 sp" Cox (9.52). 447-4~A~c.::.._.__l
16200 Eagle Creek Ave., S,l!.. Prior Llk.;:MN'!'S3n'17f..-'
I
(Plea.se ra?e or Drin~ and. si.cm a[ bottom)
ADDRESS . I
L-\~ 5 3 '5~ 1-\il~ JJ\~
I
LEGAL DESCRIPTION (omee u.. only)
LOT BLOCK
ADDITION
I
I
I
I
. APPLICANT '^ n l'
(Name' \fo. ~ ~ 0.1 ~ I'" llU. YYl~l (l~;
(Address) 'Sbr\ n UoJill A-\ x:>..
(Address)
(Contact Person) ~hn. Y\..lXVU'
APPLICANT SIGNATURE cJ{ ~
OWNER.v1 (\ t
eN ame) l:--' J t \I 0
(Address)
. I Quantity
I d.
I I
I I
I .3
I I
I 1
I I
I
I
~
Estimated Cost $
,f
~.~.:;: ~,'~ I PERMIT NO~ ~_ /..,T' I
1, Vtlkl~ AflPlitAII1 ~' ;.;;;I~
ZONING (om""",)
PID
(Phone)
(Phone) ..95d ,l\Q j\ -ej \ ril
,")MOClY\ G53Sd.
(City) (Zip Code)
(phone) Q ~~ -l\ q d -1 a n~
DATE ':2.",:}tr, ,QtJ
Type of Fixture
Rough-ins
Water Heater
Water Softner
I Stand Pipe (Washinp; Machine)
I Sewage Ejector .
I Bacldiow' Assembly
Backl10w Assembly Test
I Lawn Sprinkler
I Oth er
Residential. New One &. Two-Family $99.50
R.esidential. Additions & Alterations $39.3'0
Building Permit #
,.:0<1n
"":':~D~
""",
'~,/~,~~~ ,', It
~'l'" /:'1'</
'~v
;>Th
~<~;;;.,,)
,50
\~; I
. I Receipt No.
! 'j
~,'
'"
(J
~~E
~ .<..'"
:r,yJVE SO
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
~. :i;~" ~::y I PERMIT NO'04-. 0/5 b I
3. Yellow Applicant
(Please me or orint and siltD at bottom)
ADDRESS
ZONING (office u,,)
4953 BLUFF HEIGHTS TRAIL
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION
PID
OWNER
(Name PULTE HOMES
(Phone)
(Address)
APPLICANT
(Name' ATJJRDFTRRSTDF. DRA FTRFSrDF. HFARTH & HOMF
(Phone)
n, 1-n11-25n 1
(Address)
2700 NORTH FAIRVIEW AVENUE
(Address)
(Contact Person)
BRENDA HUSTON
ROSEVILT P
(City)
(Phone) _651-633-2561
'>5113_
(Zip Code)
APPLICANT SIGNATURE
BRENDA HUSTON
DATE
5/1 I /04
APPLICANT PLEASE COMPLETE BELOW
xD NEW CONSTRUCTION D REPLACEMENT D AL TERA nONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
OWarm Air Plants
DGravity
D Mechanical
OAir Conditioning
OVent. System
o Steam
D Hot Water
D Radiation
D Special Devices
o Other Devices
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
FIREPLACE MAKE AND MODEL
HEAT N GLO SL-550TRN-D
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
Estimated Cost $
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
Building Permit #
$
$
$
.50
$39.50
$39.50 N 0J
O 01
p{\\ ()\J\V 11
..I \,1 t\ .... (tfi
f' pt/
Residential, Heating & NC (New Construction)
Residential, Heating Only (New Construction)
(Office Use Only)
~ u IjJ ~\ll\
t 1.~004 ~I By
Receipt No.
Buildine: Official
Date
m~~
Wllllr1
This Application Becomes Your Building Permit When Approved
24 hour notice for all inspections (952) 4, B~850. fax (952) ~~7-4245
PRIOR LAKE DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION 'RECORD
SITEADDRESS _ '1953 ~u~ )-/F/GN7S 7:tL1
NATURE OF WORK A/tEW CLJAJS"'~l(arbN
USE OF BUILDING S.Fi A .
PERMIT NO. (j4. {)/5b DATE ISSUED ,;/l/;.t;,MI/
CONTRACTOR -PULTE #tf'JWC e5 PHONF~/Z. ..Z~
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
I FOOTING I INSPmj/ I ~~~TeIC{--ol{ I
'FOUNDATION (Prior to Backfill) I VWJIn-A' L+'/~otl /~7{)l/
PLACE NO CONCRETE UNTIL ABOVE His' BEEN SIGNEdl
ROUGH - INS. -?
I SEWER I WATER I SEPTIC f vJI/ _
I FRAMING r Yy /J
I INSULATION fJ /V( /
.- ,
ELECTRICAL ~
PLUMBING I J, {" <<'I ''''lit-; 1/11 /( U1-P"'} (t11t S"'-- J }-Ut-I
HEATING (if required) , ;11/ C'~.:z..u-c,lLf
I FIREPLACE / .
I GAS LINE AIR TEST ~ b/~4oi
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I I
FINALS
. GRADING (Prior to SOdding) _ / jl/lJ 1. z,.o~
BUILDING ~p./J. ('.0. f~~y' /"#Y
. ELECTRICAL '
PLUMBING ~
I HEATING ~
DO NOT OCCUpy UNTIL ABOVE HAS
NOTICE
, .
Main Fit
] -(6 -ell
o-;...-~
5'M-011
, /
?2/-2~o/
6/?~Y
b/~Y.
~/ c::s7o/'
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
QIrrfifirafr of {0,tPJpaut}!
CITY OF PRIOR LAKE
;!Elrpadmrnf of ~uilMng Jlnsprdhm
1Final Permitted C Conditional C.O. Expires
This Certificate issued pursuant to the requirements of Section 307 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 fallowing:
Use Classification
SINGLE FAMILY
Bldg. Permit No.
Occupancy Type
R3
Type Construction
VN
Fire Zone
N/A
_ Zoning District
PUD
Legal Description
:"1:" B3, TI'ffiER CREST PARK
Owner of Building
Contractor's Name & Address _PUL TE HOM~.~.:,....~
ROBERT D. HUTCHINS /~
/ ,Bu~m~ '.)I'lelal .
Dat, 0::.2-2/ 07
Site Address
4953 BLUFF HEIGHTS TRAIL SE
NORTHWEST PKWY., SUITE 140, EAGAN
DON RYE
55121
City Planner
Date:
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
DATE TIllE
7-Zo'or
ADDRESS -3...$5J flu f.f-- H /-s
PHONE NO.
PERMIT NO.
Pvlll.
04- ,0/5(,
OWNER
CONTR.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EXIGRADIFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
COMMENTS:
6 rr,rL, \ ~ C9 fL
Lvf!J 8" ~ - 0 K..
XWORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: ~ . Owner/Contr:
~
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH'" SAFETY!
'"",,"I
DATE TIME
;;~/oY
~PS~ f?tC.IJ dls -;; /
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
OWNER
PHONE NO,
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
...,a'1'INAL
o SITE INSPECTION
COMMI;NTS;
~r~,'Cq/
SCHEDULED
CONTR.
PERMIT NO.
oL/- /S-~
o PLUMBING R\
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EXlGRADlFlLllNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASUNE AIR TST
0_
./ / /f
hJ..... kl"" (:.
~ir;/
~ / I' _ I ()/
(!-/ A/ee d 0"d 7- 'li-t!-CJ q.i ff~~
-fjhcrt/ "?rc;;cle q~.d,i'/JCJQ (
, ..... h r, . - .
.~~
I
(?o, ohl/{(/ 9~k
OWORKSAT~FACTORy,PROCEED
~ORRECT ACTION AND PROCEED
o CORRECT WOR\<, CAll FOR REINSPECTION BEFORE COVERING
Inspector: .~ OWnerlContr:
'"
CALL ~7.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE..
CODe. R.EQUIREMENTS ARE FOR. YOUR PERSONAL HEALTH & SAFETYl
"""""
OATE
CITY OF PRIOR LAKE , .4c~/
INSPECTION NOTICE SCHEDULED -'V.:;,.)~
;f!. r'tfS.5 . -
ADDRESS ~fI'J"? ~.0 t'-/' #'k % /
OWNER 7""""",,_, ~.s CONTR. /.57'. /S<;;.
, r
PERMIT NO. ~I'.s? /~
/
o EXIGRADIFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
D GASLINE AIR TST
D
TIMe
PHONE NO.
o FOOTING
D FOUNDATION
D FRAMING
D INSULATION
D FINAL
o SITE INSPECTION
o PLUMBING RI
D MECH RI
D WATER HOOKUP
D SEWER HOOKUP
~LUMBING FINAL
/- MECH FINAL
COMMENTS:
~.H4~.e h_
~rft';;' ~S
hs~~
,...
~-
~",;. dv,-r
/ ,
R., C." ~/ "",/
A . I 7/
~ /7? 7~ t!7/~
/ '
'7;.sh
c//"S'. ~
/. /
/,/n~
/'1/
O/t
~ORK SATISFACTORY, PROCEED
/0 'CORRECT ACTION AND PROCEED
D CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
~
Inspector:
Owner/Cantr:
,
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH .l SAFETY!
"''''''"
DATE nile
CITY OF PRIOR LAKE . 1/
INSPECTION NOTICE SCHEDULED 6'Lkwo-;,/
f(!'SJ ~ ".
ADDRESS . ~~.7 A'~ #' ~/~ 7/-/
OWNER ~ Or.... 'fi- CONTR.
-
PHONE NO,
PERMIT NO. ~--/c5/
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
)ljfPLUMBING FINAL
r OMECH FINAL
COMMENTS: .
~-.,..-tJI':..h,-
A'7K
I
r-~S ~
o EXIGRADIFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
{/; ~~~/r-rJ~._w-';:- G~
.k4/e_ h~ / .,e,..z: ~.e.
----- /
H /-Hf /
/'
C-c:--- / C
t
-' ,. - /.
~:kft' f' aaJ /sCuV d,~ to.
-= J
k-
c:......-/r
-
--- ./
h.h<:.o /
,
. ~ORK SATISFACTORY, PROCEED
~:ORRECT ACTION AND PROCEED
o CORRECT WORK, ~~L~ ~EINSPECTION BEFORE COVERING
Inspector: ~ Owner/Contr:
.
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
INSNOTJ
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH .I SAFETY/
"
.:~'
i ;, '{I
DVRNSVILLE
Heating & Air Conditioning, L.L.c.
12481 Rhode Island Ave S, Savage, MN 55378.952-894-0005
Orslat Test Report for Jobl ~d;; /
Address QQS3 DluJ( HUe"" sTi< Citv'?r ,or lA<<:
Occupant
Date of Install
Type of HT. F/A'; HW Space HT Unit HT
Other
Make
Model
Serial
Input
L, ,",0""
G51HP Z4~0~S'O\
5C't04~OIIII
L.\~\ 000 8"\...< t\
Pilot Type HOT SURFACE IGNITOR
Pressure ?,<S IWe. CO2 (~~
Input CFH L\lj 02 g.g
Stack Temp \0'3 CO 14 9-."""
Date Tested
Company
Technician
l/, Z'S' OLl
BURNSVILLE HEATING & AIR CONDITIONING
L.o
DATE TillE
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
LJ-II-ct
ADDRESS 1/953 BJuK HI:s r,.1
PHONE NO.
PERMIT NO.
PtJ/1r ~eJ
JJl!-/,g
OWNER
CONTR.
D FOOTING
D FOUNDATION
D FRAMING
D INSULATION
~NAL
D SITE INSPECTION
D PLUMBING RI
D MECH RI
D WATER HOOKUP
D SEWER HOOKUP
D PLUMBING FINAL
D MECH FINAL
~Gll]:DILLlNG
D COMPLAINT
D FIREPLACE RI
D FIREPLACE FINAL
D GASLINE AIR TST
D
COMMENTS:
~. "if ~~ nit'
CJlf, ~-f)l
f)(WORK SATISFACTORY, PROCEED
D CORRECT ACTION AND PROCEED
D CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector~ - Owner/Contr:
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE..
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH cI: SAFETY!
/NSNOTI