HomeMy WebLinkAboutBuilding Permit 01-0437
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
q>lease'!ype or print and sign at bottom)
ADDRESS
54 3~
Date Rec' d
~-d-OI
11~....... ti\.Q..
I PERMIT NO. O!- D4'37
I.White File
2. Pink City
). Yellow Applicant
~, "f\ ro.P cAnw
(I Ll If' IjJ
5JC..
LEGAL DESCRIPTION (office use only)
LOT.1"f~LOCK.:? ADDITION
OWNER
(Name)
(Address)
l\d.~, g LLY"l'+ Yl
D~""r-Ll!"ld ?-,r-ol
ZONING (offie< ose)
J{J-
PID{;l5' - 313- 0/5-C::>
(Phone)
BUlLDEI\..
(Name) 1'\ 0 \-Lt'v-\-Qi'\, _~. .
(Address) ,:;)D'><l.pD ILeQ...'nr\rl~p (Il'1ur\-.
u
(Phone) I,., '5 J. ,JSk> ~ 7/~1A
5#, Ion '
I. a)c,VJ i/~ . ;nil J/{ 'it1i)'L
,
TYPE OF WORK
~ew Construction
ODeck
OPorch
ORe-Roofing
OLower Level Finish
. o Misc.
o Fireplace
OAlteration
ORe-Siding
OUtility Connection
'7,J, /00
PROJECT COST/VALUE (excluding land) $b~o-)
OAddition
I hereby certifY that I have furnished information on this application which is to the best of my knowledge trne 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 uP7-n th 'l'....y...ni to perform nee inspections.
X ([./..1 ~. ~ :1"14'" Q .:F d - eN
f I Signatu . Contractor's License No. Date
G,8 #,<SlE94_ ~ I Park Support Fee
500 3~1 I SAC
3</.00 I I Water Meter Siz~.
I I Pressure Reducer
J" 0 . ~ I I Sewer/Water Connection Fee
I ~O . 00 I I Water Tower Fee
3r.-s-o I I Builder's Deposit
l.(o . ~ I I Other
'cation Bec me, Your Building Permit When Approved I TOTAL DUE $ '1,694-.5'1
~ . m
. 5- c; ~ a...( I Paid ?r9 f/..r , I ReceirJdip. .J tr7 f I
Bu' ingO ial Date I Date r-I'fA r ,;,Pf7V ' I
This is ~o certify that the request in the. above application and .accompanyin~ docum~ts is in accordance with ~e City Zoning Ordinance andjl:t proceed ~ requested. This document
when sJ.glled by the City Planner constitutes a.l~...yw<-) Cernficate of Zonmg compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
~~,~. -: .1. s//,I.4\ ~. ~~(,
,. ~ Date Special Conditions, ifany -
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
Permit Fee
f] (J2..t;. $
$
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
')
.'
#
$
$
$
$
$
$
r I"
1"'/7:
#
#
$
$
$
$ I c.f (J .t}4
$1/2oo~ cO I
$ . 'leo .06 I
$ 'l~o.oO I
$ I
I
es-o.cn
1/If5'O.CJG,
4'7<) . r JO
"
14:12 651 633 BBB4
FIRESIDE CORNER
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONINGIFIREPLACE PERMIT
#25B4 P,OOl/005
uate l<.eC'O
(pI.... ""'" at ~riDllll4liJm at_l
ADDREss ZONING t__)
S~.33 ..J.aw-J.. fJ1e.pb.J &u-.. S:i:, Ph
~ =. ~, \ I'ERMIT NO. , J -:3"" 'I
). ',11cnr ,t.ppblllmt 1..., '-1 I
LEGAL DESCRJPTION (olI\L'e use ..,ly}
LOT ~LOCK d-.. ADDITION 1 Q 0 O~..IJl rJl
OWNER
(Name)
PrD,.9<,S-- B /3- Dr.~ ---C'
r:ff;? ~
(Pbone}
. CAdcl=s)
APPLICANT
(Name}_ ALLIED FI~~IDl!; DBA FIRESIDE CO~l':R
(Address) ..2700 N. FAIRVTEW AVJ:NtfI:'
(Add....)
BlU!:NDA HUSTON
(Contact Person) _
APPLICANT SIGNATURE ~I..L 'lL-:---'
,
_ (PhQlle) 651-633-250;\
'i"""'.~I.IoI'-'" 'I'"
(City)
651-633-2561
.5'" ,~,
(Zip Code)
(phone)
DATE
'1/0).'110,
APPLICANT PLEASE COMPLETE BELOW
~EWCONSTRUcnON OMPLACEMENT o ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE P.ETURN OPEN'INGS INPUT OUTPUT
TYPE OF SYSTBM HEATING OR POWER PLANT
OWIIIIlI Air PIllIIts :J Steorn
:JG....l'Y :J HOI Wor.cr
:J M.od1ll11ical ::J Rildllllan
JAir ConditiaJljng J Special Doy'ces
OVenl. SySlem J 0IlI... DcYI_
FIREPLACE MAI<E AND MODEL 9J,.. 1- JJ r:; I.:> _ ~ _ 7Sb TrL-
PLEASE NOTE:
Air Conclltioner Units
CIlIJDOI EllCI'lladJ Ulla
Requind Side yltd
SetbllCks
InduSlriol. COll1motClaI &; Multi-Family
Re$idcnlial, H...lng ok AlC (JoIew Conslrvc:tlon)
Re$idcnli.l, Hooting Only (N.... CO""!r\lClion)
FEE SCHEDULE
1 % of job DOS! RcsldCMlal, 011$ Flrcplocc
539.50 minimum
$99,50 R..ldenlfal, Additiotl. It A1JErOllons
$64.50 Resldellllal. AC Only
539,50
539,50
$]9,50
Estimlltcd CoR S
Building Permit 1#
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
,so
(om.. I).. On11)
Thl. Appll.ation Becomes Yonr Bulldln. P~tnllt When Approved
Paid
. eLJIL~1Wr~rH
Rece' I::.F/,'V:fr
B~
Building OIlJd.'
D.ll:
Date 1-,;)?-~ I
Z4llour noli.. for ellln.pectlo.. (952) ....7~lJ!lO, ru (952) ....7....245
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONlNGJFIREPLACE PERMIT
Date Ret'd
: ~ ~:~ I PERMIT NO.I_ / /3r"l
3. Yellow Appln:.nl 7
(PIe... !\'.P'!. or orint and siJ!l1at bottom)
I ADD~~~~
:"x-..J:..J H1Wn ffipMDvJ 0ltXVRJ
I ZONING(offia:o,,> I
If-A
LEGAL DESCRIPTION (office use only) ~<
LOT S- BLOCK if ADDITION ,-;;; ,.,1-
1)- . .-
g.~~R -pR. \--\DVM
(Address) 3lbcf Wo.~A~L., Prve.
~:;~~ANTiHlJiJyJmUjlCU1ICaJ
(Address) --.3riJD I:1JlnfJ;>ff./l)f .\til-tf/ I
(AddreSs) . (City) (Zip Code)
(Contact Person) -.JJftl0 .l1t~ (phone) 11/5 I '-151-- Z1'76
~PPI,ICANTSIGNATURE ' . mu1 {1!JI1D)DATE.~~
.
,
PID % -31'~ -05 --c'
(phone)
Sill~k 1JJl/ Ea.Mh Mf0 55/ ~ 1-
,J
(Phone) 1d51 4Sl-l1E'
_ APPLICANT PLEASE COMPLETE BELOW
. I!3NEWCONSTRUCTION OREPLACEMENT o ALTERATIONS
FURNACE MAK.E AND MODEL Br~t- ~8~lLA'VD2,4D1D FUEL fU1;huu
FLUE SIZE Lll\ e:,\a. SS & RETURN OPENINGS 4- INPUT1D,DDD OUTPUT 5/(), bOD
TYPE OF SYSTEM HEATIN'G OR POWER PLANT
OWarm Air Plants 0 Steam
DGravity 0 Hot Water
o Mechanical 0 Radiation
Wir Conditioning 0 Special Devices
!:iJ'fOnt. System 0 Other Devices
PLEASE NOTE:
Air Conditioner tJnits
Cannot Encroach into
Required Side Yard
Setbacks
FIREPLACE MAKE AND MODEL
FEESCHtDULE
Industrial, Commercial & Multi-Family 1% of job cost Residential, Gas Fireplate
$39.50 minimum
Residential, Heating & AlC (New Construction) $99.50 Residential, Additions & Altelillions
Residential, Heating Only (New ConstrUction) $64.50 Residential, AC Only
$39,50
$39.50
$39.50
Estimated Cost $
Building Perniit #
HEATING PEltMIT FEE
STATE SURCHARGE
TOTAL PEltMI'r FE:E
$
$
$
,50
13l.J/L~j~ VV/1'H
P~FiMrr
(Omeell" Only)
Buildlne Official
I Paid
Date I Date hid! 1m
14 bour notice for all inspections (951) 447.9850, fax (~51)~"'145
I Receipt No,
IB~C-
This Application Becomes Vour Building Permit When Approved
May,14.2001 2:10PM
GENZ RYAN PLUMBING AND HEATING
No,3810 P.8/13
Date Rel:'d
'-B. X O~,~r}AKE PLUMBlN'G p~~
....I' -
,,:-:.;- ...
-' .
DL,l~ . ~~\'; ~ ~ \ If\,,--"..Q ~~ .~ "\
. LEGAL DESCRlPTION ,_ ... 0lIIy}
LOT G tB~Ocx.' ADDITlON ~R r?~P Q D
(' II fc'\.\Q. ~
~ =- E..... I PERMIT NO.O /- L( 37
I ZONING (oil......)
po).
q'1euo.!"P! or ~taul nm.; ot bodPm)
ADDRESS' . ."
~..D "\ 1\ \ \0.."
PIDdS- ==573 ~QlS-:J
OWNE~ _
(Name)-L){t . ~ ~
(Addres,,) ,~ l A.. }~\ l Y1-;rr...... ) ~ Sre.. 2d-lo
(Phone) \26l ~ i..l""-U-l.ll A.r~
l=="~ ~l ?JZ-
APPUCANT
(Name)_f'<-/? 07- r?.(J1 .If)
(Address) lU'1Uc:..... ~ ~ "IY.I 1 .
- (Address)
(Contact Person) If.. ). PrO H () \~ ~
_HQ..:
(Phone) ("F,j - LI'Z ~ - 114 u.
{1~~~ ~"'{ I~
(clty) (Zip Code)
(Phone)
APPLICANT SIGNATURE
DATE
A\ ,L.dN
APPLIC E COMPLETE BELOW
I Quantity I Type of Fixtllre I QuaaUty I Rough-ins Type ofFlXtDre
I , I Bath Tub with or without shower
I 'f I Dishwasher I I I waier Heater
I I I Floor Drain I tiLl) I Watar SoftDer
I 2- 1 Lavatory (Bathroom Sink) I I I Stand Pipe (Washing .Machine)
I I Lallllc!ly tray (I or 2 compartmcmt sink I I Sewage Ejector
, I ShowCl' Stan I I BacJd'low' Assembly
I I Sinks I I Bacld1aw AssemblY Test
I Bar Sink I , Lawn SPrinkler
2- I Water Closet (Toilet) I I Other
FEE S\..nJ!dIVLE
ladUlltmJ. CommCl'l:iaJ 8< Mulll-ftlmUy 1" of job coot with. $39,'0 minimum
RC$1deaaol, Now 0lJe & Two-I'....i1y $99S0
Rdideati8l, Additi""" & AJ-... $39.50
_ Estimated C05t $
BuJIdiq Permit #
PLUMBlNG PERMIT FEE $
STATE SURCHARGE $
TOTAL l'ERMlT:FEE $
.50
PAID WITH
BUILDING PEh.v.iT
(orD.> U.. Ooly)
t TIlI5 AppllcadoD DecOD"" Y oor BlIlIdlq Permit Wh.. A,,, .' . I
&.M41ac 0lIId.1
lJ."
, Paid _
I D.5- (5""- (
I R.ecciptNo,
I By 9E-
%4 bour DOUce for .U iaop.ctioDS (!lS2) 447.9lISO, w; (!lS2) 447-4245
May.]4. 2001 2:08PM
GENZ RVAN PLUMBING AND HEATING
No.381o p. 2/13
Date Ree>,
__~OF pRlOR LAKE.......
S~~AND WATER PERMIT
:;. - ~ ' -
e ~ ..;....
q'1oue.!"i! ar_ ancI...."'boIlDml
~~~~i~-,.;\".-:l.,I,~~
LEGAL DESCR1PT!ON (olllce _ oaly)
tfp .
LOT 5. BLOCK).. ADDmON
",o.-n.
~ l":" ~ I PERMIT NO. OI-()t.(3 71
f=PII. )~ Uo -"QlSl.!' r.. q \.le..- N=..
ZONING(_1lIC)
R- ;;Z
1.2 ~~/J!rJIfJ ~ rrJ.
PID.;25-,=? 73 -o/s~O
OWNER
(N'1Ulle).:hiJ ~t2l
(Address) ?o.l1-~ \. \~\ '" "'-1'17""\,,- '\ l)y ~t... 2N-I-
(Address)
(Ph~) ~I-Uru -lj.lAt1~
Fflf"aJll 061'2.."2-
(Cllv) (ZiD Codol
APPLICANT
(Name)_f?-,P fl7. - ~l V""\
(Address) \U;'i.\..\~ st-1;o ~.:r 1(11
GAddn:l.)
(Contact POO'SOI1) ~ ^ ~
"""'PUCANT SIGNATlJRE.J.k
(Phone)
II)S-4'Z.:~-I\l.\1j
c;9"I ~
(Z;P~
~ _II.:Y'N \ ,,-.,.,
(City)
(Phone)
PA'I'E
s-II L.( hI
~
LEASE COMPLETE BELOW
Size of water service inches,
Location of any couplings from structure
Type of sewer pipe. 0 ABC 0 pvc
Estimated length of sewer line feet.
Clean out (if required) located at feet :from structure_
fect.
o Cast Iron
FEE S'-.w.I.UULE
Re.idential sewer IUld water line cODllectiOI1 535,50 Industrial, Com'l &: Multi-family I % of job cost with a 539,50 mh>imum
Sower coDMCtion only 517.50 Water CODl1~on only 517.50
Estimated CoSt $
Building Permit #
SEWER AND WATER PERMIT FEE
STATe SURCHARGE
TOTAL PERMIT FEE
S
$
$
,so
/
PAIDWi-'-
BUILDING p,-
- '
(om.. u.. o.ly)
I This ApplicatioD hcomcs Yoar BoiIdiol Permit Wh... Approved
l
1
8um.. 01&...1
Dale
I Paid
I Dale .
S -/5-/
Rec:e~
;14 bo~r boti.. for .11 i..podia,," (!IS.l) 447-l/ISO, Ills (l'S%) 447-4;145
By 0( ./
J'-
Th~ C~lIt~r or Ih~ L.k~ CoulOIr)'
White - Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
~
i
NAME OF APPLICANT h I? J-! () 'r+OJ-/
APPLICATION RECEIVED .t'J - ;;;)-0 J
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
Taw/ll /1t1t'cIJot-U ( ~V y-Vc:: '::>i::
l::J193
~
Accepted With Corrections
Accepted
Denied
~
Reviewed By:
., .........
Date:
s/le/&(
~
~~~ ~ ;:'VI~~St~~ ~
'(\L~ fiA-~ ~
lIE9v1 i'
i
1
,
,
~YvlW\LAA.\ ta8% ~ T ~br;~
C ~u-&- 0 t.lr~~ &'''l9V'''''-- tA_1z. Oa, \
1It~-t~ _ H-CMA ~14J {fthLLf2..o4))tP
,
"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, Pennits
presuming to give authority to violate or cancel the provisions of this code or other
ordinances of the jurisdiction shall not be valid,"
-
Th~ Ct'ftlt'r 0' tll" Lillr.t' COllnt..,
White - Buitdlnq
Canary~nglnee!!mP
Pink -=lolsnnlng
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT h 1? tJ Oy-(-Df-/
APPLICATION RECEIVED 5 - ~-O }
-
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
.t;./'r3~ TrLW)tJ M-eC-lJOl/J (~U-r-lIC ~~
-- , -
.
Accepted X
Accepted With Corrections
Denied
.
Reviewed By:
//IllS
Date:
5 -LJ -ot/;
Comments: See Reverse Side for Additional Information I
/fIo, I ~ f,' k
"
::iee Attachments: 1) Grading Plan, 2) I::.rosion L;ontrol Measures
.3) F:rosion Ccmtrnl PI~n
"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" C"nlu of Ih" t.lr., COllon)'
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT /) J? ~Or+o~
5-;)-o}
APPLICATION RECEIVED
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
_1:::'-193 PIUVJV M'e.&tJov.J (1___lLYVC- St=
,
Accepted
X'
f
v
Date: 6' - CZ' ~~I
Denied
Reviewed By:
v
Comments:
~~d~~ ~J)~k
"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,"
,
"
PRIOR LAKE DEPARTMENT OF
BuiLDING AND INSPECTION
INSPECTION RECORD
.
SITE ADDRESS S-'(~"3 ~tA'~ r,.",...,...A
NATURE OF WORK J.. lQ........
USE OF BUILDING gt=",t;i
PERMIT NO, QI-04$7 DATE ISSUED S--7-~/
CONTRACTOR D.J2. ~ c..s-(- 2sc.- '11 :rc.
NOTE:~THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
I FOOTING rJuP c-,.lw *oi~. 7,,:i;;croA r<,~- I 5/:"h~~ t!ir,S(/rJdf
, FOUNDATION (Prior to Backfill) I ~ t,/r!cr!E;&-6k &.. "rl?/~{
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
SEWER {WATER { SEPTIC
FRAMING
INSULATION~\~ ~. 11/14/01
,
ELECTRICAL
PLUMBING ~ 1.t,C-t, ~rl"Jfb{ ~ ~.l.(.~ .th-.V'Ar ~/o/'fff}J
HEATING (ifrequired).+_,-lli "4~- t\~lu\KV J7+r ~/DJ
FIREPLACE ~ / ~II:;-]';I
GAS LINE AIR TEST ~~ f- ,(', #:r I () 115/0 (
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I ~D ~ I ~ /0(;;'(0 (~ ~ /~/5/0f
" FINALS
GRADING (Prior to SOdding) AI/?
BUILDING "f.~.O' 1iJ4 gl\/6l. ~ 12 1~/r;J
ELECTRICAL
PLUMBING
HEATING
DO NOT OCCUpy UNTIL -ABO'VE HAS
NOTICE
k/
/f?;;-.
fiJI/old!
/f/I19 io /
i
(, -/c/-I z..
/1
/3;r
1kr:
1/ b7hl
Ii/fb"
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 (612) 447-9850
QLtttifkau of QDcmpanry
CJ.J. y OF'PRIOR LAKE
J)tpartmtnt of .uilbinlJ Jn~ptdion
f5i1Cfinal Permitted 0 Conditional C,O. Expires
This CertifiCDle issued punuaIlt to the requiremenlS of Section 307 of the Uniform Building Cock
certifying tlral at the time of isSU/l/lCe this structure wa.r in complionce with the wuiou.s ordillQllCft of the
City of Prior Lake reglliating building construction or u.se. For the following:
SINGLE FAMILY
BIdS. Permit N"
01 ~043 7
Use CIusi_
~Typo
R3 Typoc..., .:.. VN _FireZone
L5&6, B2, DEERFIELD THIRD
N/A
Zonins DiaIrict
R2
Lep! r _,.',:,
Owner of BuiIdi..
C. .. .,. '.Name&Addreu D.R.
~i.. Addreu
5433 FAWN MEADOW CURVE S.E.
ROBERT D. HUTCHINS
'in;r; 1.-
HORTON. 20860 KENBRIDGE CT..
~. t;ity Planner
SUITE 100. LAKEVILLE
DON RYE
Date:
0...: .
POST IN A CONSPICUOUS PLACE
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE SCHEDULED T)'StJ/"~ ....:Jt..~
ADDRESS ---.5'1$3 ':;;"',- ~.
OWNER CONTR.
PHONE NO,
PERMIT NO.
~ltb
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
_INAL
if:! SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EXlGRADIFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
COMMENTS:
..r;"'~3.3 ~&:: ~ U~ -4/-"~7
$~tI :;J&..'P- ~hsl""} (!.-wX -,tn-&BI
(J bu- 7UL
5A/!lS ~..,r f..wJ.cI.~ - Ol-'i~
t!.J....u.. ~'
.51~~ ~ _ - O,-""tJ
, / ... . -::;(G;" _
s....~37 ~..tb-~. l~.~ - (J/-I/ifl
(!"b.. ~ .. ... ..
5"4f~' ~,,~ ...~ ~... 11.J- I('@.
~ - r
A1u..,- '~a() ~ }U...._..~
.u... ,.:rr--
)I WORK SATISFACTORY, PROCEED I)..- JIl./ ~_, -.-
o CORRECT ACTION AND PROCEED ~ ~ ~
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: ~,Owner/contr:
CALL 447-9850 F: t:e ~EXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUiREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
lNSNOTJ
DATE nMe
CITY OF PRIOR LAKE
INSPECTION NOTICE SCHEDULED 6.-/lf-oz-
ADDRESS t; '1'??, ~n 1111""~ CUI"I/t'
OWNER - CONTR, - D R. f-br-ItJVI-
PHONE NO, PERMIT NO, A I / I.. ~ 7
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
VlCfINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
.)t,EXlGRADIFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
COMMENTS:
5 '733 ./ GrJ.....IJL
543'-1 '" G~ -of(
547,5'" bM.,. or
t;L/~ ? '" !9/r4.(,- EJt
s..1.{37-~t
S43~ - breU/(.t9{C
)lfWORKSATISFACTORV, 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/
INSNOTI
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
50/3?
~ /1-(jJ,
OWNER
CONTR.
PHONE NO,
PERMIT NO.
o FOOTING
o FOUNDATION
[J FRAMING
[J INSULATION
o FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
Iii\ 0 SEWER HOOKUP
lJ!j) ~ PLUMBING FINAL
o MECH FINAL
12m-!
v
COMMENTS: m flu~,.....,
tV! fl,..,...-;' ~ ,- ~
DATE nME
/~/;~I 11:50
12/ - "/3 ?
o EXIGRADIFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
(I~
I
'0 WORK SATISFACTORY, PROCEED
'1t CORRECT ACTION AND PROCEED
10 CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: ~l Owner/Contr:
CALL 447-9880 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
INSNt'"
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY/
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
54-3'3 ,cAw;J
OWNER
CONTR.
PHONE NO,
PERMIT NO,
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION~
'i1rFINAL ~
(0- SITE INSPECTION
DATE TIME
12..~.O I
/:3n
I -437
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
~ 0 PLUMBING FINAL
ICJ~ MECH FINAL
COMMENTS(j) ~ ~...... ~
~ f,... .......:..- .'V ~ -. 0v-..tI ~ '-
~ .j;JUq ~ f-' .,4....~1"'"'. .;...
o EXIGRADIFILLING
o COMPLAINT
If). 0 FIREPLACE Rl
/(f/ Ji! FIREPLACE FINAL
o GASLINE AIR TST
o
,T:c.o. -tiJ1
. .;'~~".
Bll/o'L-
· I
;;~., f" ,"
~~
o WORK SATISFACTORY, PROCEED
ld 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.
I!ISNOTJ
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
t',
'I",
.
- --- -----
'---"
APPLIANCE
PERFORMANCE TEST
Attach to gas line adjacent to regulator
Heating Contractor ~AIr ~/
Name of Tester ./J,~ g -
Date Jf47~/
.'
"
Job Address S~.R6uJ'f ~
Heating Contractor ~=g /llGI'J/
Name of Tester _ __ .
Date /~7h/
, .
~ (""?o
~~
, 7 .
Percent Co. _~ ,:.j/~.
Stack Temp d-?;t "/
Combustion air Is adequataly supplied per
UMC See, 606 V;"S"
Input i" hfJ
Percent 0.
Percent CO