HomeMy WebLinkAboutBldg Permit 04-0559
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
O~ PRIO"'.
.:.. ~
,. ~
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U '"
A,~1VNESO'\t'"
(Please tyJe or print and siJro at bottom)
ADDRESS
Z91B
P/1TH
e.-() {/ Cj /fJ!:-
LEGAL DESCRIPTION (office use only)
LOT 2- BLOCK
$ADDITION
IV I '-O.f' ,NO/U---rt"
PID 2-5" 4-O<f-: tJ(P-; 0
OWNER
(Name)
(Address)
BUILDER
(Company Name)
(Contact Name)
(Address)
Yor"'J>y 0vJ7V-
6t.h lvI,
;tJ}-J k...e 4
k,,,,,IC~
While
!>ink
Yellow
File
City
Applicant
I PERMIT NO. O~ ,0551 I
I
ZONING (office use)
/V tV
(Phone)
Date Rec' d
5.Z-l.04-
Ie/SO
(Phone)
(Phone)
'7t'z?'1Z - <:;9Y6
TYPE OF WORK 0( New Construction DDeck DPorch ORe-Roofing
/[jAddition DAlteration DUtility ConnectIOn 0 MISC.
CODE: ~.R.c. DLB.c.
Type of&nstmction: I
Occupancy Group: A B E
Division:
II III IV <S) 1}.. G)
F H..,hM1!VSU
I 2 fJ-' 4 5
ORe-Siding DLower Level Fimsh 0 Fireplace
PROJECT COST IV ALUE
(excludiug land)
$ if 3/0, CAJO kJ
I hereby certify lh<lt I have f\unished information on this application which is to the best of my knowledge tme and correct. I also certify that I am the owner or authOrized agent for the
above-mentlOned 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 Fllrthermorc, I hereby agree that the city official or a designee may enler upon the property to perform needed Inspections.
x
~
"'------.:::-
--- _.._r-------
~gnature
I Permit Valuation 3/0 000 I
I Permit Fee $ do 6/3-!:() I
I Plan Check Fee $ 15D3. '7F' I
I State Surcharge $ /5~, I
I Penalty $ I
I Plumbing Permit Fee $ lof) - I
I Mechanical Permit Fee $ IOf), - I
I Sewer & Water Permit Fee $ =1S ,c) D I
I Gas Fireplace Permit Fee $ 40,- I
This Application Becomes Your Building Permit When Approved
r
~/'; /0 'I
D~te
BuiJd1ll20llicial
Contractor's License No.
Park Support Fee
SAC
#
#
5-2/-,;}"1
Date
$
$ l~,.E){),-
$ ?,,..-.,-() - -
$ '7().-
$ Id-.OO-
$ rzao.--
$ i Z)t';().-
$
~.
Paid
Date
. 7.-/
Lf ~ &'1' . "IS
(c- ?r6L1
~ 6-,'l..o#-- $t1307,7R
I ~;re"<Ni6 1>/.)
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 do
when signed by the City Planner comlitutes a temporary Certificate of Zoning compliance and allows construction (0 commence Before occupancy, a Certificate of Occupancy
i~lanne~ ~/~~ar /JJaLfs:1(f::::j~-t~':
24 hour notice for all inspections (952) 447-9850. fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
Water Meter Size 5/8"; 1";
Pressure Reducer
Sewer/Water Connection Fee
#
#
Water Tower Fee
Builder's Deposit
Other
TOTAL DUE
~~
uet
White - Buil!iin!l..
(. l,ianarv - Ena,"eer'"JL)
l'ink . IJ'lahmng
The <"enle-r or 1t1C' I..k. ('OUnlrl
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
I
NAME OF APPLICANT /IC; !" !
I
APPLICATION RECEIVED .;j-
J,I
.I.
___;i /.
~,~. ,
: -;;;;...-/'
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c)"->
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
..-i---"/
~._~;:) (/ /! ,~~>~- ./ /."L / l '......-,
Accepted
x
Accepted With Corrections
Denied
Reviewed By:
M-fJ
Date:
~- ~ -OLf
Comments: SeF! RF!verse Sirh~ fnr Arlrlitionallnformation!
See Attachments: 1) Grading Plan, 2) Erosion C.ontrol Measurp"
"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
~t.. - ~uildiruP
Canary - Engineering
Pink - Planning
-j
lhe {-enl.-,of.h.. 1.gk..('ountn
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAMEOFAPPLlCANT J/~ a~'T7K- ~
APPLICATION RECEIVE6 5- oLl-O~
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at)
9tf;f- (}JJUO{[0 rtaL
- /
Accepted
Accepted With Corrections
/
Denied
r
Reviewed By:
~ 7/",j}f-J
~~1 a-U
Date: ~/ t../.k '-I
~o-.::t:.
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."
T
~7;
White . Building
Can~"1f IiR9i"'~
<Pink - Planning
--
lh~ C~nlU "f lh~ I.ak~ CounltJ".
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
/
!
~--,"'-
/
APPLICATION RECEIVED -
//
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:
r-
~~
Date:
fo/~c(
,
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."
€~~
+'<\'NESO't'"
Date Rec'd
CITY OF PRIOR LAKE
SEWER AND WATER PERMIT
(Please type or print and sign at bottom)
ADDRESS
d q I ~ C. DLl':) Q" \)n.--\-\-\
; ~;;;':w ~~~ I PERMIT NO. I..J _ 55'CJ I
). Gold Applicant 7 I
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT d- BLOCK 5 ADDITION \ \ y, \ c\ <; fJ M-\ k-
PID
OWNER r II
(Name)'4fW\l\I1\\ ll~-\r,vv--. t\tJYY\L Rll;\de.rs (Phone)q5d-~1o -::),<-I,~ci
(Address) ( nnfll F J.l1\()V"\ ~~,J P. S, .,4.P \ 'KD StA \ 11'11''':>. SS-=<(/ 'X'
(-Address) (City) J (Zip Code)
APPLIC~T {\ \ n
(Name) \-- I (\ 11 \ L--;) >( n A,p fie (Phone) '15';> - ~33- J d.-on
(Address) \:S\c:;" 1\'\/1(11<.. Sti'e..e:i #\ ~f\kJ)f'e-E2- 5S3--r1
(Address) (City) (Zip Code)
(Contact Person) VV'N\ V"\ i p _~"L US\ \ \\n W\.<::;. (Phone) q 5 d - d3 3 - , :\ /1 ()
APPLICANTSIGNATURE~47/Jgd~~/J DATE /t;1.J?3J/J~
/ /
APPLICANT PLEASE COMPLETE BELOW
Size of water service I inches.
Location of any couplings from structure
Type of sewer pipe. 0 ABC oo..PVC
Estimated length of sewer line 5.5 feet.
Clean out (if required) located at feet from structure.
feet.
o Cast Iron
FEE SCHEDULE
Residential sewer and water line connection $35.50 Industrial, Com'] & Multi-family 1% of job cost with a $39.50 minimum
Sewer connection only $17.50 Water connection only $17.50
Estimated Cost $
Building Permit #
SEWER AND WATER PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
.50
Building Official
Date
II fl,/~
I Paid [j~'O . Receipt~
I Dat% <)1/-0 L-/ . By CL
C'
(Office Use Only)
This Application Becomes Your Building Permit When Approved
24 hour notice for all inspections (952) 447-9850. fax (952) 447-4245
Rug 2~ O~ lO:2~a
Jeff Scherer
952-~~7-S735
p.l
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
"J D\02Qj 1-\ (),Y'Q_ c-~
; ~::~:, I PERMIT NO.() A. 05S0 I
l. Ydlow AppliCW. .". 7
(PIease!v.pc or Drin[ and sim at bottom)
ADDRESS :\ I --;;
I do. ~ \ '6 C1.:llap.\" ~ Q \\\
ZONING (olli"...)
. LEGAL DESCRIPTION (office use only)
LOT BLOCK
ADDmON
PID
~=e~R '1J\c.d \-Da.\,\\ll'-'O-
'--'
~;~~ --:1e:sr Sc ner-e.r- Se.\1e.rex- Y'\U~~n'i'0 q '::ld - '-\4, -1073'1
(Address)~"6CO f-\d,\cC"\ C:..kde S'Z:.- ? II 0, L~\0. 5"Y3 TJ.
(Address) (City)' (Zip Code)
(Contact person)3<:':.\{' (phone) /old. - /47- 3D'3"3
APPLICANT SIGNATURE ~ (fl'fJ.11/lJYl :-c-_-.-,- DATE __JId..~l~
APPLICANT PLEASE COMPLETE BELOW
Type of Fixture I Quantity I Type of Fixture
Bath Tub with or without shower 1 ~ - Rough-ins
Dishwasher I I I Water Heater
I Floor Drain I Water Softner
I Lavatory (Bathroom Sink) I Stand Pipe (Washing Machine)
I Laundryifray(l or2 compartment sink Sewage Ejcctor
I Shower Stall I Backflow Assembly
I Sinks Backflow Assembly Test
I Bar Sink Lawn Sprinkler
I Water Closet (Toilet) Other
(Address)
Quantity
k
I
\
L...l
I
7.--
I
.'1
(Phone)
FEE SCHEDULE
Industrial, Commercial & Multi-family 1% of job cost with a $39.50 minimum
Residtlltl.(New One &; Two-Family $9950
l'ikntial. Additions & Alterations 539.50
Estimated Cost $
PLUMBING IT FEE
STA RCHARGE
AL PERMIT FEE
$
$ I --?\! m
$ .-1:8.lU VV I l.tI
~:'" .
II . U:) l-L,
l_ i 0 20
(om~c Use Oaly)
This Application Becomes Your Building Permit When Approved
Building O[f1Ci11
Dltt
24 hour notice for all i..poctio.. (951) 447 lil!6o, fax (952) 447-4245
----~-~ -~~ - ~- --
09/07/04 08:12 FAX 7635530887
GUYERS BrTLDERS SrpPLY
~003
Date Rec'd
CITY OF PRIOR LAKE
HEATrn"G/AIR CONDITIONING/FIR.EPLACE PERMIT
~~.:.. ~~. I PERMIT NO. 0"'- OSc.a I
j. Y~II_ .-.ppllaAl ..,- . -'7
t'Pl~ t\'Oc or m;nJ :'Inn ~i;P'n :a,l; botrom'
. AnDRESS ...... ..-.. - ~ -- ZONING (office",.)
';)9rrp;
~c.c~- h
(tJ,)o,G. r
v
LEGAL DESCRlPTlON (office us. only)
LOT
BLOCK
ADDITION
PID
OWNER , (
(Name) 'i ()1'~'1 C. Uo,,-+-oM /"tOMe')
, I
(phone)
. (AddIess)
-
~ Ei'-~~\ClLf'
I 5 --r'r- <>, I" _
(Addtt,,)
~c>/\
APPLICANT SIGNATURE b~ ~ YW';"'c
APPLICANJ:
(Name) c;,v'! ('"t'..,
(AddIess) i b '/05
(phone)
PI 'I ""OU+- J-....
(City)
5S'fY J
(Zip Cod<:)
(Contact Person)
(phone)
7fR 3 -(,9</- 7'ft,C> ~
c; /71o~
DATE
/
APPLICANT PLEASE COMPLETE BELOW
!llNEW CONSTRUCTION 0 REPLACEMENT 0 AL!ERA TIONS
FUR.....ACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
OWann Ai, P!aZlts 0 Stellm
OGrovity 0 Hot Water
o MeehllIlieal 0 Radiation
OAir- Conditioning 0 Special Devices
OVenl. Sy",em 0 Othe, DC"Yice:s
PLEASE NOTE:
Air Conditioner Units
Cannor Encroach into
Required Side Yard
Setbacks
FIREPLACE MAKE AND MODEL ;j() P e.~\ (> ("
tJ T (" O?)
Industrial. Commercial & Mul'i-Family
FEE SCHEDULE
1 % of jOb COSt Residential. Gas Fireplace
$39.50 minimum
$99.50 Residentinl. Addition, &. Alterations
$64.50 Residential. AC Only
$39.50
Residential. Heating & Ale (New Construction)
Re!idential. Hedting Only (New Construction)
$39.50
$39.50
..
Estimated Cost $ I (jrJl)
Building Pennir #
HEA TTNG PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
.50
IOllie. Us. Only)
This Application Beeomes Your Building Permit When Approved
Building Omcial
O.tc:
,p Ir' p rU. ','17 17 .
~~ ~d!9 ~ u Ll, II rl Receipt No.
j~ DULl"' 1 0 2004 I~ 8y
24 houl" notice for aU inSpc.c:tlOD:S (952) 44 ~50. fax (952) 447-4.245
108PM METRO AIR 952-447-8126 NO. 979
CiTY U1" t'1uuR LAKE'
HEATING/AIR CONDITIONING/FIREPLACE l'ERMIT
(J'l~ut: wile or Drint lU\c1 SllU1 at llo1.tom'
. AI,JDRBSS
~ '\ \ "h \. <)\1\ j "'~ t' (,,+'h
L~GAL DESClUP"nON (om.. use only)
. LOT nLOCK
ADDITION
~~:~R \j \:Y"wc..y ~(',\""'-.1
(AIldress) \ ~ \1' tl (S, '-~ ~k
P 1
lJale Rec'd
.."lnk
1..ClIetn
~. 'Yellow
// -~
~::, I PERMIT NO-If ~ 35 1
A.~lJunJ
ZONING (Olli<<...)
PID
p""\'i'. l" \\\
(Phone) ~ \ ~. '-~5 . \ \.\ CLL
s- C. -:rl -:),
ADPLICANT ^ '^ \ -S-
(Name) \. \<l..~(\' \",;,,... _ _ i~ L.
(AIldrclS) \\;,~~tl \J ,,\ l<JN Av'-.
(Add....)
(C'lntact Person) N c..\ l" '-\1 S L." ~ ...\ .....
~~.PLICANT SIGNATURE ~~ ..l? .L~.I.h~
(Phone) <\ S :). ~ \\ l- ~ \ -:) "'\
~r,o-\.<.,\~ N0 .S~~Id.
(City) (Zip Cud.)
(Phone) C) 0;. '). - "\ 'vi 1- 'lS \ () \.\
!JATE. 9.~ ~O. ~ ___
Al'l'LICANT PLEASE COMPLETE BELOW
!lJNUW CONSTRUCTION 0 REPLACEMENT 0 ALTERATIONS ^ I -1..
fUIl-NACE MAKE AND MODEL ( v,-rn' ~v ~A -\i::lCl rrUEL I\1Oi1'
PL!JESIZEiVC RETURNOl'ENINGS ~ INPUTIOc:', ) t)~ OUTl'UTq?, 0\l~
1YPE OF SYSTEM HEATING OR POWER l'LANT
'. ~Ium Air PIl\l1t1 0 Sl~l\m
OOrovilY 0 Hal Wale,
] Mechanlo.1 0 Il.diotiulI
~~ir COllc.lhioninc 0 Special Ocvius
~VCI1\' Syslcln 0 Other Devicts
FEE SCHEDULE
1% .rjob ".Sl ROlidomlnl. Gas FII'oplooe
$l9.S0 mlnlmullI
$99.S0
$G4.S0
\~,()M ~
. Ft~ I(@ l~ u ~ ~l.l1tiPt No.
run AUG 2 4 ZOO~ l~
14 hour 1I0ti,. rol' nllln'I".lIulI' (951) 447.985( , r.. (951) 447-4145
BL__
InUI'Sldal, Commercial &. Mulli.Pamlly
ROlldonllal. Iioalillg & Ale (Now CQIlSlrlloliol')
ROliuOllliol, J I.olin& Only (New COllslrllellon)
Estimated Cost $
(-lEATING PERMIT FEE
STATB SURCHARGE
TOTAL l'ERMIT FEE
(OI!,ICO U.o 0011)
This Application DccolllO! Your Dulldlllg Permit Wheu ^p\lroved
DUll~lnc Olfirl.l
Vlte
PLEASE NOTE:
Air Conditioner Units
Cnnnot l~l1cl'o:\ch into
Required Side Yord
Setbacks
$39.50
!lesid.ntlal. Addillon! &. Allemlons
Resid.nlial, AC Ollly
~.J9,50
$39.50
l3uilding Permit #
/:J p.,
-~~~C~.
~F-
~...t",
.~......
$
$
$
.50
fr
V
Residential Building Permit Checklist
New Construction for Single or Two.family Dwellings in R.1 or R.2 Districts
Reviewed by: ~ ~ Date: .0(1/0 i
Building Permit # PID:, I Zoning:
Address: c:29/? {'Jt:iug ~ WI-- ~. tJ .
Legal: L Z , B -5 _ Subdivision: oJ, Lt25' ~tCTrt-
Existing Structure? YE~
Existing Nonconforming Structure? YE@
CONFORMS TO ZONING
ORDINANCE
! Yard Setbacks: NA I FAILS@""MPLlES::/
o Front Yard (can be 20' if avq, w/in 150')
o Side Yards
10 Sidewall exceeding 50' requires additional side 2" I
setback for every l' over 50' in lenqth
I 0 Rear Yard I
10 Patio Door: provide for minimum 10' deck or sign I
statement indicatinq no deck will be built in the future .
10 From 100 year flood elevation ofwetland/NURP
pond
o From OHW (Prior or Spring Lake)
c::=a
, Floor Area Ratio: NAI FAIL~COMPLlE~
, Yard Encroachments: NAI FAILl(1C'(IJMP~
I Eaves and Gutters no more than 2 feet in width and no
closer than 5 feet to a iot line (Easements).
I AlC and other equipment cannot encroach on interior
side yards,
, Tree preservation:~~ FAILS I COMPLIES
I 0 Total caliper indies
I 0 Permit 25% Removal
I 0 CaliPer Inches Removed
I 0 Caliper Inches Preserved
I 0 Replacement
L:\TEMPLA TEIBLDGLIST,DOC
YES
Standard
25'
10'1
25' if abutting a street
10' setback +
2"/1' over 50'
25'
10' sidel
25' rear
30' .... t-I__
\0 ~e
75' or setback average of
adjacent structures, but no
less than 50'
.30 Maximum
Standard
Standard
\1,:1
NO
Proposed
27.7'7 '
N ~ 2'7 I
I
IS.Bo S.
'13; -!.. HvJL,
1'Jo~E:
t...{JI
NA
/31170
Proposed
,?~
N O,(l e:
NOr--l€
Proposed
PRIOR LAKE
INSPECTION RECORD
SITE ADDRESS Z9 J, ~ TH /!l.I().
NATURE OF WORK '6/AJ _ AJ~io~
USE OF BUILDING :rJ!:../),
PERMIT NO. .0<1-- 05SQ DATE ISSUED
CONTRACTOR ~A" curr-'"'- ~ PHONE - 'I
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
DEPARTMENT OF
BUILDING AND INSPECTION
SEWER I WATER I SEPTIC
FRAMING
INSULATION
ELECTRICAL
PLUMBING
HEATING (if required)
FIREPLACE
.;pAS LINE AIR TES'<.2),..';
.~ C~VER NO WORK UNTIL ABOVE e>HAS BEEN SIGNED
~1iA~LrUMm~ I rb I//.;?y
J. v.aJ 0v-~'hll;~FINALS I L /-
GRADING (Prior to Sodding) 1\1 17 d ,q oJ ,
BUILDING -1.L.~~, 1'Jv\-I'>'@ W . ~ 7/ V6s~
ELECTRICAL \. .-..,.
PLUMBING '" ~L-- VI6
HEATING kl A
DO NOT OCCUPY UNTIL ABOVE HAS BEEN SIGNED
NOTICE
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_
, FOOTING I r!' t INSPECTOR c; ~ ?A DATE
I FOUNDATION (Prior to Backfill) I P/) :> -/ I
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
ff/P 7?
/8
/'~
q--I"
1?_/cJ
-
we. HI
I
(1/')
12- f> -0'1
12'~ -",4
FOR ALL INSPECTIONS (952) 447-9850
'-,.
Qlrrfifirif~ of <IDrmpanr\!
CITY OF PRIOR LAKE
@.eparfmenf of ~uilMng Jlnspedinn
~inal Permitted D Conditional C.O. Expires
This Certificate issued pursuant to rhe requirements of Section 110 of the D Residential I 'J International
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 following:
SINGLE FAMILY 04-0559
Use Classification
Bldg. Pennit No.
R3
V:l
Zoning District
RISD
Occupancy Type
Type Construction_
1.2, B5, WILDS NORTH
Legal Description
Owner of Building Site Address
YORWAY CUSTOM HOMES, 18170
Contractor's Name & Address _ ..",-
ROBERT D. HUTCHINS~
'_ /~.---B!Jild!ngOfficial
7/-7./ 0 )""-
/
_ City Plannf'.
2918 COUGAR PATH N.W.
RICE ROAD, PRIOR LAKE, MN 55372
DON RYE
Date:
Date:
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
02?/.Y ~7t?f
CONTR.
OWNER
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o I~TION
,a1'INAL
o SITE INSPECTION
o PLUMBING Rl
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
COMMENTS:
..-
~~~
/
/
PJ/
C/^-
~~5~IME
A/t:
CJ~-.s.s9
o EXIGRADIFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
~. ~
/,/ ....--;/ \ "\
V/cse r~ /~ ./
.>>ORK SATISF~', '''''''''''u ---------
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_
INSNOTJ
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH .{ SAFETY!
DATE TIME
CITY OF PRIOR LAKE I~
INSPECTION NOTICE SCHEDULED
ADDRESS 2cr/8 (\~f .-
OWNER CONTR_
PHONE NO_ PERMIT NO. <(- ~7
o FOOTING o PLUMBING RI o EXIGRADIFILLING
o FOUNDATION o MECH RI o COMPLAINT
o FRAMING o WATER HOOKUP o FIREPLACE RI
o INSULATION o SEWER HOOKUP o FIREPLACE FINAL
jl..FINAL fLUMBING FINAL o GASLlNE AIR TST
o SITE INSPECTION MECH FINAL 0
COMMENTS:
I.F.'~ ~ ~
.z Sod( .J-~J..b ~&lJ>..~~
1. r;.~ /j~ucco Q.-vG
'{- 9~_;~ I1cfJL~
/~~ -10 B -( -("J S
" v
q..jy, (V~ / ~~
o WORK SATISFACTORY, PROCEED
o CORRECT A TION AND PROCEED
~ORRECT. , CALL FOR RElNSPECTlON BEFORE COVERING
Inspector:
Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE_
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY/
lNSNO"
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS ;;<'t/R ~C.r fJe,-/i.
V
OWNER
CONTR.
PHONE NO_
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
~NAL
o SITE INSPECTION
o PLUMBING Rl
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
COMMENTS:
(7;<t~1' b {(
( ,u ib [<.r.~ - <:9 "-
DATE nME
S"-cr-f<r
Dl./-~
~~ILLlNG
o C~NT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
C"r/-t-
o WORK SATISFACTORY. PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTlON BEFORE COVERING
Inspector~ Owner/Contr:
"-
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
""""n
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
.
IItPerlnitlll
.Job_..flh' ~~"t:
"_"",*ooto< "!.~R9 AIR
IItTestenJSignalur. .H.L
!l!!!
Poundo
~
!!!!!!
-0.. One
Preeaurized
..........
PE!V=ORMANCE TEST
.PM_Co, .<' g~ "PM_CO_ t?$
IItPercenl O2 <7~ Y ~ .Stack Temp. ~.-O
final ....1p8Ction
Dole