HomeMy WebLinkAboutBuilding Permit 01-0453
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
). White File
2. Pink City
3. Yellow Applicant
+53 I
q?lease ~ or nrint and sil!11 at bottom)
ADDRESS
~(J C- II. .,1'"'\ Mondf"')IJ) (\ I Lr'_LL SE
ZONING (office use)
R-:J.-
LOT ~ BLOCK I ADDITION
b1ol<jf' 0 Lt n.+ l~
Q..Dr-C:;~11"t' ~ro(
PID,?f;- .~'7""3-o0S- 0
BUILDE"- (', \ I _ I ~
(Name)~_l f;9~
(Contact Name) -Lf\ I 'r:...e..-P- . ;, y"""
(Address)~O~(P() IGH\~r;rL('~(1+' .~. lOOt {j)fI)lJt'l/tJ, (h0e::;~
~ Construction ODeck OPorch ORe-Roofing ORe-Siding
OLower Level Finish 0 Fireplace OAddition OAlteration OUtility Connection
LEGAL DESCRIPTION (office use only)
OWNER
(Name)
(Address)
TYPE OF WORK
o Misc.
(Phone)
(Phone)
(Phone)
to,7/J;:).5f, - '7 J -:;~
PROJEcrCOST/VALUE (exc1udingland) S
/) ;::l . } t"J 1'/
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 I"."l"-.i and that all construction will conform to all existing state and loca11aws 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
;terupon~O~dedinrrO~ dOOO6{t?~'7 5-d-tl/
V Signature. - Contractor's License No. Date
Pennit Valuation
7':). J om .t'), :)
'1qry. ") <<)
c;- {Po . ~C/_
"'11_ _ r>ln
Pennit Fee $
I Plan Check Fee $
I SmreSurch~ge $
I Penalty $
I Plumbing Permit Fee $
I Mechanical Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace Permit Fee $ l.( IJ . (')n
~... z..,...y-......_-"""""
~ 'r-/(,-Z<<JI
uildh}j6fficial Date
I Of') . (Y)
/IJ() ."0
,
P~k Support Fee
SAC
$ A<\b. a2..:
$ 1/5lJ.oo
$' I
$ I
$ /. 'ZtXJ. cx:3
$ I 7tJ~. CO
$
$
$ 54Q2.. 2-'1
#
#
I Water Meter Size 5/8"'1'"
, ,
I Pressure Reducer
I Sewer/Water Connection Fee
I Water Tower Fee
I Builder's Deposit
lather
I TOTALDUE
#
#
,
I Paid :> ~ GI 01... 0... y
I Date '5-,,,-61
I ReceiytNo. 345 '1'1
Bv ~___
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 -
::;.:igned ~ City Planner constitutes a lemporazy Certificate of Zoning compliance and a1Iows consltuction 10 commence. Before occupancy, a Certificate of Occupancy must be
~g~c;or-- O/'6f;n 5~ ~~i~~~~~
24 hour notice for all inspections (952) 447.9850, fax (952) 447-4245
MaY,14.2001 2:09PM
GENZ RVAN PLUMBING AND HEATING
No.3810 P.5/13
Date Rec'd
~.l.l i OF ,~~,.J:.An PLUMBlN'"G P~RMIT
..,...>'.
?-"",.~:.r ~ -
. -
~ :" :,;'.
... '.
.i:: ~ IPERMITNO./_Ji,-:J.
, J.Y" ~ ~.J :;:;
(!'lcuc.!.l?: Qr """tand si.>o! .. bollDml
ADDR:ESS' '. .. ..
_~tJ?y-j .,,,>.,, t'"A\ 1 \~ \ rT SE:....
Zp~?'
- . - '"
. -
LEG~ DESCRIPTION (olIicc ... <=IT)
Larf}BLOCK..!-' ADDmON\'opo~pQD ~ V('lr-r.\ PIDdS-:-373-00~(,'
OWNER
(Name) DP w..,.,." 'T1.:> ~
(Address) ?::'Uf'5:l:::>, \.1. ., ~\ ~ --C~ 'I't>Jtr ~p 2.04
(Phone:) \.oSI -l.\6\, - 4\.d.o ~
~.nr_ ,.......,
<<:::\77
APPliCANT
(Name) ~p .K'\ 7 - (l.i. YI '"
(Address) \1.l."'L.\~ ~ (l ~ -m L
(Address)
(ContaCt Person) ~ ) ~....;
n~
()'"
(I'hone) .12~ -l..\.?_~ - II ~\.1.
{lDR JfV"t"n LY>t S~lrS(
(Oty) (Zip Code)
(I'hone)
Ie PLEASE COMPLETE BELOW
QlIantity I Type of llhtare I. Q1IlUltity I Rough-ins Type of F"JXture I
I I Bath Tub with or without shower I
, I Dishwasher' I { I WaterH_
I I Floor Drain I """ Water Soflncr I
2 1 r... ~". J (Batb.roo.ln. Sink) I I Stand Pipe (Washing Machine) I
I I Lal.lnc!ry Tray (1 or 2 compartment sink I I Sewage Ejector I
I Shower Stall I I Bacldlaw Assctnbly' I
I I Sinks i I Bacldlow Assembly Test I
I Bar Sink f I Lawn Sprinkler I
'2.. I WatJ::r CIoset (Toilet) I I Other I
DATE
hllL\\O\
APPLICANT SIGNAruRE
FEE S....l1JL.UULE
lo<l~, Comm.CClaJ &; Muln-famlly 1% ofjoh CO:llwitb. $3~..SO minimum Rosidcntial, New On. &; rw...FomlIy S~9..S0
1lesidCll1la1, AddItions &; AltcndioDS $39_S0
Estimated Cost $
Bl!1IdiDg P.rmit #
PLUMBING PERMIT FEE S
STATE SURCHARGE S
TOTAL PERMIT FEE $
.50
BUI' pt.ID WITH
, ~/NG pc-
t;;;R;';/ur
(Ollie. Use Ooly)
. Tbis Applicatioll Becomes Y Dqr BuildlllC Penn.it Whell ApproVed
BuDdlo, O1IIdol
Dint:
I Paid
, DIIl:c V
&rl-Ol
I Rec:eil>tNo.
IBy~
(J
,
24 bou. notice mr .U iospecllons (!IS) 447-98S0. fas ~) 447-4:l4S
May.14. 2001 2:01PM
GENZ RVAN PLUMBING AND HEATING
No.381o P.5/13
Date Rec'd
(ui O~ ~~..~.J:.AKE PLUMBIN'G p~
.."., .'
~'" ~"~ - .
.".'M
:'.'..
~. '.
~uc~ OI''PI'int.aad.s!lPllI.I: boaDml
. ADDRESS . . . ~ < : . . _
:"=;0 ?y"), > '. -t" ~\ I \ to. \ r \" Sf:....
,.~a E-I PERMlTNO"j_4g""]
I ZONING (aA -;j
~?---. ..
LEGAL DESCRlPTION (olIb ..., oalJ)
LOT 0LOCK./ ADDmONbi?o\i~QD ~ \JI'l\r-r.'\ pro~5'-313 '065--0
OWNER
(Namc)TJP. ~ '\
. -
(Pbane:) \.oSl - ~ - 4\.G.o 'b
(Address) ?-,u,So... LU ~\ ~ -{'~ ~ ~P. 2.04
~..or --A. Y'\
~\7-.7
APPIlCANT
(Name) . ~....JCl.7-~} ~ (:PbolIe) ~~-I..\.?:~- \\\4.U.
(Address) \\.1\L\c:...... ~ (( ~ -n1J..... (lrJ.I? JfY"'en Lnt SQ"',lr)~
(Address) (City) (Zip Code)
(Co=Person) .Jl... ) Pra.:....( n~ (phon<:)
~PLlCANTSIGNATURE\l...bJLJl n ~ DATE oilY \0\
. kt.rcJ; PLEASE COMPLETE BELOW
Quantity , Type offb.._~ I QuaDtity I Type ofFJXture
I Bath Tub with or without shower . Roup-ins
, I Dishwasher' I I , Wat<lr Heater
I I Floor Drain i "" ,. I Water Soflncr
2 1 Lavatory (BathroOlIl Sink) I I I Stand Pipe (WashinF; Mal;hme)
I I Laundry Tray (l or 2 c._.._ :""'ent sink I I Sewage Ejec.tor -
I I Shower Stall I I Backtlow AssllUlbly'
I I Sinks i I Backtlow Assembly Test
IB~Sink I luwnS~cr
'2- I Water Closet (ToiIet) I I Other
FEE S............v:u:
lndulilnal, Commo.raal &. Muln-famUy I % of joh <o.ot with a $39..50 Illinimum R..,dcnlial, New One ok Two-Fomlly $99..50
IlaldCJIlial. AddltiODS ok AItcralions $39.50
Estimlll'ed Cost $
B1ItldiDg P.rmit #
PLUMBING PERMIT FEE S
STATE SURCHARGE S
TOTAL PERMIT FEE $
.50
BU/~1WG W'tH
PEJ:;;://Ii
(Ollice Us. ODIy)
I Tbis Application Becomes Y OQr BuildwC Permit Whell Approved
BuJldlDr OlIldIIJ
:0;.",
I Paid
!DatIl (;,-(-01
-r--~ }fa. /
24 boor outies> !'or aUI..pecUo... (95J) 447-9850, fu (,95]) 447-4;1~
IBy U-L-
I/u
L:11 r OF PRIOR LAKE
HEATING/AIR'CONDmONlNGIFlREPLACEPERMrr
Dlde Rec'd
~. ~ ~~I PERMIT NOJ -' {S"..3
l. YdloW AppIlC:inC. /,..;,.
(Please type or DriDt and si2ll at bottOm)
I AD:;~ H1Wn C.-t
I '~Offi~U")
LEGAL DESCRIPTION (office use only) /() _ /J
LOTc~-;WCK ! ADDITION ~;jJN
~=e~R 'J) (( \-rodl'il \J
(AddreSs)3~ WOt,cAtL~imt, fWL ,,~J
~~;~~ANnl hLtnf Yf1e.cJltU1/CaJ
(Address) ~D ~J}nfbt{'./"'l)r
c., (Address) . (City) (ZiP COde)
(Contact Person) ~.f'lTf~ .' . " (phone) ~5 I 451--2-,70
. APPLICANT SIGNATURE ~~l./ 1JrrUTUYfna/l (IYI/ID)DATE tf-lz:JDI
, APPLICANT PLEASE COMPLETEBELOW
[Bm<:W CONSTRUCTION 0 REPLACEMENT [JALTERATtONS
FURNACE MAKE AND MODEL Bi'~J- 218'3kJiV02.-4b1 DFUELf\t'tftu-ll1
FLUE SIZE L-\l\ clcts<;J & RETURNOPENINGS 4- INPtJr1D..DQD OUTPUT51o,bDD
TYPE OF SYS'I'BM HEATING oIl. POWER PLANT
OWarm Air PhlJ1lS 0 Stearn
OGravity 0 Hot Water
o M..,hanical 0 Radiation
lBJ.ir Conditioning 0 Special DeVices
CiJ.""Ont. System 0 Other Devices
~ r-l--
.
PIIQ.r -373 "iOS-v
,\til.!e. \
(phone)
~ MI\J 55/2.2-
(phone) Jtf.5L 4'52- - lll5'
PLEAsE NO'I'El
Air Cortdidoner Urtits
Carinot EncroliCh Into
Required Side Yard
setbacks
FIREPLACE MAKEAND MODEL
FEESCIIEDULE
Industrial. COlnmer<:ial & Multi.Family I % of job COst Residential; Oos Fireplace '
$39.50 minimum
Residential. Heating & AlC (New Construction) $99.50 Residential, AddiiiMS& Altel'ittions
Residential, Heatirig Only (New Constrtiction) $64.50 Residential, AC Only
$39.50
$39.50
$39.50
Estimated Cost $
Building PerinI! #
HEAtING PERMIT FEE
STA'I'B SURCHARGE
'rOTALI'ERMIT FEE
$-
$
$
.50
eu. PA.ID .
II..i:JING 1177"1-{
P~A:V:I7"
(Office Use Only)
This Application Becomes Your lJtdldlng Permit W1iert Approved
"'-
Paid
J ReceiptNo.
,
Bulldintufficial
~
Dlite & 'ctL~/..J B~
24 hour notice tOt "" inspections (952) 447.9850. tax (952) 441-4245
n.te
)
OCT.31'2001 OB:47 651 633 BBB4
FIRESIDE CORNER
#4106 P. 0061 OOB
CITY OF PRIOR LAKE
BEATING/AIR CONDITIONINGIFIREPLACE PERMIT
Date Rec:'d
: =. ~~ I PERMIT NO. {- 'IJ%
',Vell_ Afpll.-nt ....
~ ~ ....,rlnt an4lim .,boIIDml
ADDMSS
5C(Jo ~~ ~ Gww-r-J:e.
ZONING (.IIke....)
LEGAL DESCRIPTION (offlce u.. only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name)
(Address)
r:f)1Z- ~
(Phone)
APPLICANT
(Name' IlLLIED FIRESIDE DBA FIRESIDE ...,,""'......
(Phone) ~-F;:n-25fU
(Address) _ 2700 N. li'AIllV:I:EIf A\rt'lffiF.
(Addro..)
(C P ) BIlENDA H1]STCN /J
on!/lCt ""on
t;};Aufh..
J
TlOoS::'PVTT,T.':; ~
(CiIy)
(Phone) 651-633-2561
"_._'~__, DATE .,...
S~":
(zip Code)
APPLICANT SlGNATVIl.B
~~_hr-
,
APPLICANT PLEASE COMPLETE BELOW
'GfREW CONSTRUCTION 0 REPLACEMENT 0 ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPBN!NOS INPUT OUTPUT
TYPE OF SYSTEM HBATING OR. POWEll PLANT
3WPmI Air Plont&
Oravlly
Mechanl..1 .
JAlr CondillDnJng
JVonl. Syslem
FIREPLACE MAKE AND MODEL
JJrJrd- ,U r;. fJ>
gStooln
HOIWlIter
J Radiation
J Special Dcvice.
J Othor Dcvlcell
~~?.ffi7JZ....
PLEASE NOTE:
Air CDIldltloner Units
ClUll10t Encroach IntD
Required Side YI!1d
Setb.cks
InduSII'laJ. Commercial &:. Muiti-FlIllIlly
Roosldontlal. Heming &:. A!C (Now CDn.trUction)
Residential. H.OIlllng On1r (New Construction)
FEE SCHEDULE
1% .fJob COJt ll,esid...daJ. Gos Flrepl""t
$39.50 minbnum
$99.50 Reside.lll!. Additions &:. AI... ...:.....
$64.50 Residential, AC On1r
$39.50
139.50
$39.50
Eslimlltl:d CDS! IS
BlIilding Pcnnit I;
HEATING PERMIT FEE
STATE SURCHARGE
TO'J.'AL PERMIT FEE
5
$ .50
5
.olldlo. OIlJdol
lI.le
I Paid
I Dale /o-ijJ~(
8u P4/D
. 'LDING t1""'/-f
FJEiP.'l:J:.I""J-.
I ReceIOl No. ~
I
I By C-1tv
(om.. u.. Onl)')
Thi. Appllc.tlon Becomes Your BlJlldln, Permit WIlen Approved
v
14 hOllr noli... fur .lIln.pedlon. (,g) "7-!1l1S0, ru /."a} .....,-4a45
C?1-1f~
White - Building
Canary - Engineering
Pink - Planning
Th~ C~nl~r of Ihe Lake Counlry
BUILDING PERMIT APPLICATION DEPARTMENT CI-(ECKLlST
NAME OF APPLICANT
APPLICATION RECEIVED
DR
Nt] r-J-oAJ
.5 - "3 -0 I
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
,-tJ'I30 PiLWA/ /J1eDc!oU/e?UrtlC!..5F
Accepted
x
Accepted With Corrections
Denied
Reviewed By:
Comments:
/J 1I?--f3
5 ~e IYIC.I'~ r::;. / (
Date: 5 - '7-0 J
"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~nl~r of Ih~ Lak~ Country
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
DR
No ri-oAJ
05- 3~O/
APPLICATION RECEIVED
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
-..~tj30 ri'LWA/ /J1~odo/,(/ewrtle-5~
-I- Accepted With Corrections
Denied ~/l -1L
Reviewed BlP~/
Comments:
Accepted
Date:
~-/(.,. -~ (
(~ A M~ -Dk +;r- C ?(~
-i:tc .
"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."
OH4^)
Th~ C.nl~r of Ihe Lake Counll')'
White . Building
Canary . Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKUSI
NAME OF APPLICANT lJ R
Hor-f-oAJ
.5 - 3-01
APPLICATION RECEIVED
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
,t:; tl3 0 P>:UU A/ III r" c, d u j.( / (;'?<I' tI C?- 5 F.
Accepted
~
Accepted With Corrections
Denied -/!j
Reviewed By:~tt-<'... . "- .. 'f? ... ~ ;:.
Comments:
Date: . <:.7'tf /n I
'- S::41'""'''L-~~:- ~~~~ ~
_ :jS.0.('). ~J ~ra-~ ~~
3\,A ~.
"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
INSPECTION RECORD
DEPARTMENT OF
BUILDING AND INSPECTION
SITE ADDRESS 5(/30 ..fuwVL M"'D~ (\..~
NATURE OF WORK ~e.....)
USE OF BUILDING S PIA-
PERMIT NO. B 01- 0453 DATE ISSUED 5-/(. - 2-,,(
CONTRACTOR -(')f) ~~A PHONE c.~ {- '251.. - 7/ Jc.
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
I FOOTING~ ~ 7/&.jr- I 1 ;;'SPEC:TOR 15/'31/;
I FOUNDATION (Prior to Backfill) I ~ {~ I (0 atl 10'
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
SEWER I WATER J SEPTIC
FRAMING
INSULATION
ELECTRICAL
PLUMBING ~ U.~ t?:r. "It??(e I JJwj. ClG. 1Jt-, 7, /, ~ / . 1/ ~ 6'
HEATING (ifrequired) T~.-zLk &...I()j;71J-r~. ~ 7/,g,'(J/ . /~ ILt (
FIREPLACE 't:}q.. '11'//4/01 I I
GAS LINE AIR TEST ~e. i,"";:;; &r. /I/;;;!t"
I 1
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
l~~~ t'r-7-, q//?;bJ ~ ~. 1~/31,JiJl
FIN'ALS
I GRADING (Prior to Sodding) n/ f; J f 8
BUILDING ~L.o.-tJ.1 rll/o1.- ~, I!'/o~'
ELECTRICAL ' , ,
PLUMBING
HEATING
DO NOT
4f::;;r
. ,
If /1'I/bJ
/I };S//J /
, ,
t(//-;v;:;....
q-l"d-iJd---
'1
r.:7;r ~
~
I
OCCUpy UNTIL ABOVE HAS
NOTICE
Ohl
I 13/~l--
( .
1/9/" 2,;
, .
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
.~,'~~._, '.
~::.J. ~. ,.. '-.-:-:" . "'_ ;.... I.f.....'. Io;,;"".'''i.: ~~.
~r' ~~IaJ.f! .. .l!ttltiftrll4 at <<lmJjlllJlqJ
f} elIi' OF PRIOR LAKE
~r.'I: ri Ilepartment of .utlbing Jn~pedion
:f Final Permitted 0 Conditional C.O. Expires
'.
.::~ ( This Cmijicate issued purnuuu to the require"",fIIs of Section 307 of the Uniform Building Code
r;; certifying that al the time of isslIQIICe this structure was in compliance with the various orditlQ1l(;es of the
City of Prior Loke regu/aling building construction or use. For the following:
UICClusi_
SINGLE FAMILY Bldg. PermiINt' 01-0453
R3 Type Construction VN . File Zone N / A _ Zoning DiIIricl R2
L5, B1, BLDG 5. UNIT 18. DEERFIELD THIRD ADDITION
(" '" " ". Type
LeplJ:.....,,:.,.
Owneroflluildina 'lite Address 5430 FAWN MEADOW CURVE SE
D.R. HORTON, 20860 KENBRIDGE COURT, LAKEVILLE, MN 55044
c.,. ... ',Name&:Address.
Do..:
ROBERT ~~=INS ,~CityPlanne;
a./d.--Od--. \fV. Dote:.
POST IN A CONSPICUOUS PLACE
DON RYE
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
OWNER
PHONE NO.
.5'/30
SCHEDULED
90... .,...
-
CONTR.
PERMIT NO.
o FOOTING 0 PLUMBING RI
o FOUNDATION 0 MEcH RI
o FRAMING ~ 0 WATER HOOKUP
o INSULATION 0 SEWER HOOKUP
o FINAL Ill: PLUMBING FINAL
o SITE INSPECTION b' MEcH FINAL
COMMENTS~ ~)f ~
U
~-~
CA TE TIME
1/3/dZ.
,
//:ao
lJl - </S'.$
o EXlGRADIFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
~.
o WORK SATISFACTORY, PROCEED
~ CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPEcTION BEFORE COVERING
~I
Inspector:
Owner/Conlr:
CALL ~7.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY/
IN$NOTJ
DATE TIllE
CITY OF PRIOR LAKE t'J
INSPECTION NOTICE SCHE~ED 7 -I,;). - ~ \
ti'tI 3D- 301- rCUVh YJJ:.e.Cl. cieJW
ADDRESS' ,5'1;;"Cj-f5/ ~e:r
OWNER
CONTR. ct-
OJ- 1{5'~ 5' V 6!j1 VU
PERMIT NO.
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
COMMENTS:
o PLUMBING RI 0 EXIGRADIFILLING
o MECH RI 0 COMPLAINT
o WATER HOOKUP 0 FIREPLACE RI
o SEWER HOOKUP 0 FIREPLACE FINAL
o PLUMBING FINAL 0 GASLINE AIR TST
o MECH FINAL 0{::-. 0
/JS~/_ ~; ~
. j Cl5-f::; V
"-"
o WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: (v.b OWner/Contr.
CALL <<7-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY'
"""'"'
"'
CITY OF PRIOR LAKE
INSPECTION NOTICE
6~()
ADDRESS .5'#32..
~'--..-
DAn TIllE ~~:'~v'
:\
.-
SCHEDULED
FflVt/J
!-f-() z.. /()I-UJ.
OWNER
CONTR.
K:3
/ - 4- &;r:;'
I
PHONE NO.
PERMIT NO.
[] FOOTING [] PLUMBING Rl [] EXlGRADIFlWNG
[] FOUNDATION [] MECH Rl [] COMPLAINT
[] FRAMING [] WATER HOOKUP ~ [] FIREPLACE Rl
~NSULATIO!!lt:i\ [] SEWER HOOKUP '(J!I J!p FIREPLACE FINAL
~.INAL l!9 m [] PLUMBING FINAL [] GASUNE AIR TST
[] SITE INSPECTION 'I:j1~ MECH FINAL []
COMMENT~ ~ 114...ikt .11 ~
(z-P ~__,~, U-<-J 4~ -~ ,.... g t1
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[] WORK SATISFACTORY, PROCEED
)tCORRECTACTlONANDPROCEED
[] CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: ~ OwnerfContr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH 01 SAFETY!
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APPLIANCE
PERFORMANCE TEST
Attach to gas line adjacent to regulator
Heating Contractor
, Name of Tester
Date
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JobAddress S'l3of...._~....CV"'......
Heating Contractor ,L\' \. ""'""" \"'>.e.."-
Name of Tester ~c: i"\- S.
Date I~_I..-C)\
Percent 0. 9, :l-
Percent co - 0-
Percent co. i. to
Stack Temp 'J 1\ ..
Combus\i9n air is adequately supplied per
UMC See, 606 '{~
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