HomeMy WebLinkAboutBldg Permit 04-0178
CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT 3 -L/-oLj
; ~i~i:' ~:~y I PERMIT NO. 0 ~. 0'/10.
3. Yellow Applicant .,- l/
(Please!v'p~ or orint and sign at bottom)
ADDRESS (f. (p CJS ~ ~
~
LEGAL DESCRIPTION (office use only)
. 1 '11 Ii fI J AI
LOT IDBLOCK 'J.. ADDITION W~ ~
I I
ZONING (officeu,,)
/2.1
PID ZO. 4"0+, OZq. t>
DLower Level Finish
DMisc'lAI.2.-C.-, ~j
DAlteration
/
PROJECT COST IV ALUE (excluding land) $ ~ DO. nlJ Z)
x
#r?!tJ Ii, oal'1.. DO
$ /'t,e1,so
$ I 0 't Y. Ii'
$ /0<,,00
$
$
$
$
$
1M, Do
100.00
35. ':>0
40,00
This Application Becomes Your Building Permit When Approved
~~i)
.:1/1710</
Date
OWNER \ ^ . J /I' ~~~,
(Name) ffl."~eJ +-"<::;f1,V-/.p~ r^<J./J.L_rl-
(Address) \LfS"'~~,..~ ~.
/
BUILDER .. J J ~'Ii t~
(Name) ~A'.M.- ~~~.t..- ~ (Phone) ~fZ'1. <' ~" " <:?
(Contact Name) ~. ."" p.J (Phone)!JS:;. s?C;~~L.t lj P X Ill.l..
(Address) \4.311 ~ ftA..,..e.. ._c;~~oc: ~,,~f)fe..- . mJU .<<..:30t:.,
I ,-, -
TYPE OF WORK ~ew Construction DDeck DPorch ORe-Roofing
(Phone) ~<~ ~~~~--:"~-3.S:
.<:K_~ ') '!
o Fireplace
DAddition
ORe-Siding
DUtility Connection
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 to perform ne ded insp, cOils.
I Permit Valuation
I Permit Fee
I Plan Check Fee
I State Surcharge
I Penalty
I Plumbing Permit Fee
I Mechanical Permit Fee
1 Sewer & Water Permit Fee
I Gas Fireplace Permit Fee
Building Official
I Park Support Fee
I SAC ~
I Water Meter Size 5/8'~
I Pressure Reducer
I City SAC and WAC
I Water Tower Fee
I Builder's Deposit
I Other
I TOTAL DUE ~ "I,U.o4--
Rdo-trP ~/f-
>1' -;::Ie; -OLf
,
CO~ L2seNO.
I Paid
I Date
#
#
#
#
~~5'lo y
Date
$
$ l'3so.00
$ 3o('),fYO
$
$
$
$
$
70,00
1200,00
700. Q D
F';OCJ. 00
. $ R/ 2-PJ~ ./ fJ
-/7
.oJ
I Receipt NoW&; 'I
By Y- .
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 constitut~ temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
"S~ ~ S//?I::.r /~ aLf \~ ;I,I'-n.f. )
Planning Director Special Conditionl,' if any
24 hour notice for all inspections (952) 447.9850, fax (952) 447.4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
~~
White - BuU!lj!'9~
~:lnarv - EII4Im,,"~l'Itlu ->
Pink - Planning
Thr (rnltr of thr Lakr ('o\lnlry
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPl,ICANT
APPLICATION RECEIVED
\IV I t'J [) Vv U t..,
--,4-
j-I (1"1 E<(~
:, /L~
[./ L_(
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
"<7 / (7 C' ..-'I', r \., ,: ,'~'-- I
/- lv I.,) \~j C () CI II, i \.... P 1\ r J-.
Accepted
)(
Accepted With Corrections
Denied
Reviewed By:
/y;4J3
Date:
s-19-0q"
.
Comments: See RevF!r~F! Skle for Additional Information!
P,~rY'1 ~ .~ ~/Dt'/,- ,tJ~""
M,
01-- (2,......,.1....
~,
J) tin t , 'nJ~ J '/l Ji..t; It ,",VI l-
I
11&.'" L~/I/.."j- Ii~,~u,,~
- CA.\~"- "SlJ..(2..IIE:'(
j)"Pf: (J r /11 I rJ,~
, ,.
hll"~ c,;,/J/ f1 J
See Attacht11ent~" 1) GnHiine Pbm, 2) Ero~ion Control Mea~ure~
"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."
.~
~~
,..--wfiite - Building::>
"tanary '-engineering
Pink - Planning
---_/
I to.. {-..nlN o'lh.. I.Rk..Countn
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
WINDWOOO I-/OM6<;
3 .~. 04-
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
2&'15 GOUl3JAru pAnt
I
Accepted
Accepted With Corrections
/'
Denied
Reviewed By:
c:~
~
~.,;
d'~_
;Jub
~
;f'~ ~
Date:
3/;7A .y
~~:!
~,
Comments:
4' /; b--vt--
"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 - En ineering
~ "inK - Plan",n
lht C~nlt. of lht L.kf COUnlr}
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
1// \ \' (, IJ 1,./ II, r' t
l. I .' .
~.i--
,
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
-
I / ~t
.,' _I l \
/
Accepted
Accepted With Corrections
/'
,
Denied
Reviewed By: ~ ~f-' Date: 3/r 74<(
Comments: f~ o.-e.I ~~'. //,(', ~
~~ ~ -::1' ~ ~- ~~
flLt)~ (I~~/Z-/~.
o
"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 Rec'd
CITY OF PRIOR LAKE
SEWER AND WATER PERMIT
(Please'!ype or Print and siJm at bottom)
ADDRESS
:1 b 9 s Co "\ G..-M Pri-rlli
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
I OWNER
(Name) wLv/Jwooll
(Address)
(Address)
APPLICANT
(Name) iP~'f-M_ [;..}tC-.
(Address) I~IIR rof/...;:...J ~
(Address)
a", ILl"
APPLICANT SIGNATURE (L. .. k:.. .tJ"'"'"-~ 0 ._
,
(Contact Person)
; ~~;:':w ~ii~. I PERMIT NO./) / LI/7'or
J. Gold Apphcant "1 D I
ZONING (office ",,)
PID
(Phone)
(City)
(Zip Code)
~.JJ.-i'?J - G. 't 0'
..s- ~c I.{ if
(Zip Code)
(Phone) _
4..\LVL.
(City)
(Phone)
DATE
I.f /:2/ 0'/
APPLICANT PLEASE COMPLETE BELOW
Size of water service / inches.
Location of any couplings from structure -
Type of sewer pipe. 0 ABC ( [29 PVC
Estimated length of sewer line '-I 0 feet.
Clean out (ifrequired) located at - feet from structure.
feet.
o Cast Iron
Residential sewer and water line connection
Sewer connection only
FEE SCHEDULE
$35.50 Industrial, Com'l & Multi-family 1% of job cost with a $39.50 minimum
$17.50 Water connection only $17.50
n J; [c0J
I Paid l)( ,,/
I Date r.
Dak I ~
24 hour notice for all inspections (952) 447-9850, fax (952)f47~245
..v
Estimated Cost $ '} 00 .
SEWER AND WATER PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Building Permit #
$
$
$
.50
Receipt No.
BYl(r 9- ~ '-f
06/01/04
07:59 FAX 7635530887
_9UYERS llUILDERS SUPPLY
\..11 X UJ:< rKlUK LAlU,;
REA TING/AIR CONDITIONINGIFIREPLACE PERMIT
~002
Date Rec:'d
€~:
+''''IW-eSO''t'''
(?1we.!\'1>< or print and sil'Jl at bottom)
I ADDRESS
d.fn 9S {' I'? ( ) '3 OJ
LEGAL DESCRIPTION (ollie<: US<: only)
~cA- ~
;;;.'.:.- ~::". I PERMIT NO./'JU '" I-M
), Yellow Ap()ll=.1IC V-f - U~
ZONING (alflC''''')
. LOT
BLOCK
ADDITION
PID
OWNER
(Name)
W,-Y1AUJ(""X")~
(phone)
(Address)
~~~T=-__G\)'1e..'i'?' )boL!Ae./'- ~L.)?pl'-l
(Address) /3405 /5-r~ J'1C/Ct1u-e
\ (Address)
(Contact Person) D '" '^--
(phone) 7"3 -fo9Y -51(,63
J:> /Yf7?l?ufJ"., 55';;~ /
. (City) (Zip Code) -
APPLICANT SIGNATURE
J"k '\. f' (phone)
~_ P1/lA~4tChr
DATE
-
APPLICANT l'LEASE COMl'LETE BELOW
r:: I ~C f> kc. e ~EW CONSTRUCTION 0 REPLACEMENT 0 AL TEM TIONS
;,,,-,.~,;;.MAI<EANDMODEL Le",f'oo'i. Et..,,/'ID'>";- FUEL /..JC<.-i- ~'<..3
FLUE SIZE ::: I, RETURN OPENINGS INPUT OUTPUT ~
TYPE OF SYSTEM HEATING OR POWER PLANT
OWann Air Plants 0 Steam
OOravity 0 Hot Wau:r
o Mechanical 0 Radiation
DAir- Conditioning 0 Spcci.eJ Deviees
OVen!. SyStem 0 Othor Oevi=
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
FIREPLACE MAKE AND MODEL
Industrial, Commercial & Multi-Family
FEE SCHEDULE
1 % of job eoSt Residential. OIlS Fireplace
$39.50 minimum
$99.50 Residential. Additions &. Altero.tions
$64.50 Residel1tial, AC Only
$39.50
Residential. Heating & AlC (New Construction)
Residential. H.ating Only (New ConstrUction)
$39.50
$39.50
Building Penn it ~~~
$ ",..,..~.~~.-
HEATING PERMIT FEE _,"'.,...;;
ST A TB SURCHARGE $ ..- .50
TOTAL PER,,\flT FEE $
(Offiee Use Only) __
ThIS Application Secomes Your Building Permit When Approved ]FJi ~ n \I] ~ -~ill Receipt No.
1M (J f 20M ,I By
8uilding Offic.ial Dstc U j!
24 hour no!;CA; for all insp.etion, (952)' 1Jf8:~: f.. (z;2244!-4245 I'
Estimated CoSt $
METRO AIR 952-447-8126 NO. 745 p 1
. > ,.'
CITY OF PRIOR LAKE U"'~ l,cc u
HEA TINGI AIR CONDITIONING/Ifll{EPLACE PERMIT
(lll,:llt~YD~ (II vrlnt al'll.! !I1m1 at bollow)
AIIr:lRESS
'). ~ '\ ~ <....Q"'-l~- ~ ~+~
LIlGAL DESCRIPTION (om" u.. only)
WT BLOCK
AlJDlTION
OW1'lER
(N~lTlc)
. (All dress)
\
\,-\:, '\'\
AIlPl-ICANT .N\ "- \ ',-'
(liaq,e' \. \~~,.\., \,,\, r- _\_ n l,
(A~dlc's) \~c\ )(\J \.j'l.\ Illl"\-o {\V'-..
(Md,e",
(Cytllnct Pmotl) N 1.\ I{\ '- ~ S G ~ ~ ".\ II..,
APP(.lCANTSIONATURr, '-.J'{\CIvWo..1 J...tJ..~
Oll-/?tf'
,r;.., "', I PERMIT NO ~--
1.01'''11 ell,
,. Yell(tw Ar,IIOJlnt
ZONING (om"u,,)
PlD
(Phone) ~ ~ J,_ )?, ~\ ~- }~ ioN ~
()v.....'I\!",'\\\a 's s-:\a\"
(Phone) c.\ S ~).. '-\ \\ l- ~ \ ~ \.(
(-l f"\ ('- \.l'\ll ~I\) s S,~I d,
(ei",) (Z;p Cude)
(Phone) '1 ~ /., "\ '-\ (- )S \ I'j \..\
DATE
APPLICANT l'LEASE COMl'LETE BELOW
)8tNEW CONSTRUCTION 0 REl'LACI!MENT 0 ALTERATIONS
FUI\~ACE MAKE AND MODEL c... "''''..... ~OV" \"\ if ~ \ C\\'::, rUE\. N C\~
Fl..\)~ SIZE"3" (J\I c.. RETURN OI'ENINOS '\ . INPUT' ct::-. \)~ OUTPUT q~, cr6\l
- ,
TYPE or SYSTEM HEATING OR POWER PLANT
. .~\V'l'In Air I'I,nl' 0 Sleam
OOravilY 0 Hol \Voter
~ Mech,"ical 0 It.dlnt;oll
JiaAir Conrlilionlll& 0 Spe:clal Devices
OVent. Systcm 0 Qlller DevicEl!!
Fll\EI'LACE MAKE AND MODnL
I'LEASI> NOTE,
Air Conditio".r Units
Callnot El1ol'O.cl1 illtO
Required Side Yard
Sethnoks
FEESCIIEOULll
1% of job co.1 R<<idenli.J. 00. Fi,eplooc
<~,)9.~O minimum
Rc,I'I~l'li.1. 1.lealing & AIC (New COllmuetlon) $99.50
Re,id~plial, Healillg Only (Now COII.lr\\Clioll) $64.50
E,(illlaled Cost $ \ \ . )\::, ~ '9'
~" I: . ,;" . i~"::-.' o.
;/'1 " V-
2~ hour nntiee for.1I hUlleclloll. (952) ~47.9 150, fRX (952) 447.U45, I
t0~--:--- j
~":.::...-........:::.~
hld\l~llial. <':umtncrcfa( & M\lllj-Family
l.mATING 1'IlRMIT FEE
STATE SURCHARGE
TO-rAL l'ERMl1' FEE
(Ol\i" 11,,01l1y)
TIIII AIlI'lIcaUon Decome. Your Dnlldlng l'erllllt When AVI,ro,.,1
OuJhllllg OUielnl
Un Ie
$39.50
$39.50
$39,50
Rt'SidclIllnll AlltliliohS &. Ahcraliolls
Re.idellll.l, AC Only
Building PerIllil II
$
;::I, ~O~
"(\P,' ""I.,.,.. . ;
"~,I"..,.":"~~^ iJ
\.....,t::!J,...".....
'''''",--''' -,...
- 1'1~,'./,
$
.50
$
MATTHEW DANIELS, INC.
423 3017 P.Ol
Dale Rec'd
CITY OF PRIOR LAKE PLUMBING PER1\1IT
(Ptc3Se gpe or pri.c,[ and siJm at bottom.)
ADDRESS
ZfoqEj ~ Oa:tiJ
1.81_ f/jh:
1. Cc:Jhl. Cil')'
J. V"IIO'>' ,1.p~I~M
t1!I--/'1'i'
I PERi.'"IIT NO~
ZONING (offi"w<)
LEGAL DESCRIPTION (olliee use only)
LOT /0 BLOCK Z. ADDITION *~ '-/.
'-
PlD
OWNER. -". I \
(Name)~LLAL..J \.,~
\
~1J/; fa-.-~. 20
U
APPLICANT: I . ~
(Name) ~tTl ,,7) f1, J } II... ) . '-..<1.. a.. (Phone) -M.', "4.>\. d:Jfi1"l
(Address) 1.'i":J..'Vl (l-"~Jdll".,d. ./00,. q4JtU.L'l AJI/ r. I....t-I. -;) -StJob8
(Address) 1/ ' (City) (Zip COde)
(Contact Person) ih J ; J ~ ) ,c '-41 i -fl' ~ '] (Phone)' b5"/. -Ii'" . .:t:gL)
APPLlCANTSIGNATURE ~.(X...I Y. ,;' ,uU~0 DATE '-r/~ 19, ~4
. ......... I -
APPLICANT PLEASE COMPLETE BELOW
I Type of Fixture Quantity
Bath Tub with or without shower -.3
Dishwasher J
Floor DraiJl I IU..
Lavatory (Bathroom Sink)
Laundry Tray (lor 2 compartment sink
Shower Stall
Sinks
I Bar Sink
I Water Closet (Toilet)
(Phone) 95'2". 'i?Q5". 'i?#'i?
~I Lh /JJ AI J'l.J d I~) I ~ 6tr"&":\'1
(Address) 143 J I
Quantity
~
J
2.-
$
2.
I
1
Type of Fixture
I~
Rough-ins
Water Heater
Water Sofmer
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
Backflow Assembly Test
Lawn Sprinkler
Other
...3
FEE SCHEDULE
InduStri.l. Commercial &< Multi-family 1 % of job COSt with. S39.50 minimum Rosidenlial, New One &< Two-Family $99.50
Residential, Additions & AlteratiOn! S39.50
Estimated Cost $
Building Permit #
PLUMBrNG PERMIT FEE
/ ST A IE SURCHARGE
TOTAL PERMIT FEE
$
$
$
94. ~ PAaiO WITh)
I~n~n~. '
.50 ......,. ." ~r,:i'Y'?hDT
/(){).tJ() ~ ~ .,
(om.. Use Only)
This Application Becomes Your Building Permit When Approved
Building omrill
D...
I Paid
IIJIlllII( T, iJ ,U04
I Receipt No.
I By
, .
14 hour notice ror III i,,"peelio.. (951) 4lU850. rax(9.$1) 447-4145 I
. 'u_._-T--_.j"-
TOTAL P.01
PRIOR LAKE
INSPECTION RECORD
SITE ADDRESS ~f. 9s rOUQA~ PArH.
NATURE OF WORK New (b1tJS-rbLCntJA)
USE OF BUILDING S:F:l).
PERMIT NO. Q4-.01'7f3 DATE ISSUED ~'7/4" -
CONTRACTOR MIJD WtJ~ PHON~ -S!/1s-2!IU
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
DEPARTMENT OF
BUILDING AND INSPECTION
, FOOTING
INS!~OR
k ftItJ-
~--;;. \;
, FOUNDATION (Prior to Backfill) I;YO 5"7- . I
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
S~ efl~J,..,ROUGH...,- JNS
SEWER I WAT~R I SEPTIC r {) ~/- c.
FRAMING w Iv '"
INSULATION /0 --S~o
ELECTRICAL
PLUMBING /1;; ./ 9' J I
HEATING (if required) . _ v /Z--Il L;/!7/&4--
FIREPLACE f/ /1 'r~~J /; . /
GAS LINE AIR TEST /!J/lftftJ ,fJIJ-f~ RJ. d7/:-Q{-
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
. - --
IIC(., / {}qlr/,(~ S1a~G #2J ..7::/1
,.. ~J. FINALS' };OE.eWoq,'-'\- \.l~v..iS~
GRADING (Prior to Soddil19) I /tiff ' ./- UJ--
BUILDING ~ r#s;w~:~!'J 6/il/~
ELECTRICAL I I
_ 11
PLUMBING jt,{ r
- .
HEATING
DO NOT OCCUpy UNTIL ABOVE HAS
NOTICE
DATE
I~~J
"7,. 73 -I') r
BEEN SIGNED
This card must be posted near an electrical service cabinet prior to rough-in inspections
and maintained until all inspections have been approved. On buildings and additions
where no service cabinet is available, card shall be placed near main entrance.
FOR ALL INSPECTIONS (952) 447-9850
y
CITY OF PRIOR LAKE
INSPECTION NOTICE
DATE TillE
SCHEDULED
6-1-0:;-
PHONE NO.
2(, 'IS- G.w4t;r P....f~
"CONTR. JItL~WsJ 1101'1($
PERMIT NO. 611- J""
ADDRESS
OWNER
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
~FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
~~ILLlNG
o COlll'l:AlNT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
COMMENTS:
(j~fb /58,c... 0 I:::.
GIWl, - ,.,t:.
~WORK SATISFACTORY. PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR RElNSPECTION BEFORE COVERING
Inspector~~
Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY/
,"""'"
CITY OF PRIOR LAKE
INSPECTION NonCE
SCHEDULED
DATE TIME
P~7
hK
ADDRESS /b .9')
c; C/ o<? q- ___
--'
CONTR.
d~
/7
~k?~F 'j,-
/1'1 ~. / /'/J =--I-
o ph / 4'n2...J~ I~#. ~eder.p ~r./
/:!>" v: -//1 I' /4
~J c:>oci r//ee.~ ~ L-k-velo#-r ~~
/ ~~~
(:0, u~77 ~k/oy"
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
~L
o SITE INSPECTION
COMMENTS:
/J
//' e<.-, bus
/1 /
/~e(:"-..... d
PERMIT NO.
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
./? /
r~//~c7?~
7 r U..Jer
e</-/7?
o EXIGRADIFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
----
'7eh/
o WORK SATISFACTORY, PROCEED
~ORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR INSPECTION BEFORE COVERING
Inspector:
Owner/Contr:
~
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOri YOUR PERSONAL HEALTH ,{ SAFETY!
INSNOTI
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
).C'(('
COUtw
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o jiEWER HOOKUP
.Ji!"PLUMBING FINAL
o MECH FINAL
COMMENTS:
@
fLe~
L.b(/
rtth.d'?~
-h h:-
M"L
ULI rJ- qr, 7 ~
DArE TIME
'7- ).. 3-(/lj
I
a.~
q - 6 ( ?B
~-li.U
o EXIGRADIFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
<;-rp!' ,t
o WORK SATISFACTORY, PROCEED
JifCORRECT ACTION AND PROCEED
o CORRECT ~O~K,Jt#R REINSPECTION BEFORE COVERING
Inspedor: Y /I' r" Owner/Contr:
I
CALL "7-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
INSN011
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH ol SAFETY!