HomeMy WebLinkAboutBldg Permit 03-1565
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec'd
While
Pink
Yellow
;1- j;)--o3
I PERMIT NO. 03./5(,,51
(Please '~e or Ppnt and si2I1 at bottom)
ADDRESS '
2'10l (~Lc~CLr p~ ~
I J
LEGAL DEJCRIPTION (office use only)
File
City
Applicant
ZONING (office use)
~/SD
LOT 3' BlOCK I
ADDITION [V~ IJI !J(},.- f1,
PID ~S-~ijoL/~ t7()3 'C)
I
OWNER
(Name)
(Phone)
(Address)
BUILDER A J . I
(Name) (kr~ ~y~,^^- L2d-o "" '8",\ I d.(,-r)
(Contact Nate) bc,v~ &~ ",,^,
(Address) f 2-13 3 ~ ~^ fh--e
TYPE OF WpRK Ol! New Construction Q(beck
(Phone)
(Phone)
CJO-4b1- /&11
G/2 -j4f>-4f2..b
""
DPorch
ORe-Roofing
ORe-Siding
DLower Level Finish
o Fireplace
DAddition
DAlteration
DUtility Connection
o Misc.
PROJECTCOST/VALUE (exc1udingland) $ ]6r; O()()
I hereby certify t 1at 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 agenl 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
;te"\'l~Yr:: tu p,Z needed inspections fJ b '1 c#- /}- / /-03
----- 1- Signature Contractor's License No. Date
Permit Valuati?n I <:C;~ roo I I Park Support Fee # $ --- I
I Permit Fee I $ )..477. 1St I SAC # $ IL 7.<. Q7) I
e
j Plan Check Fel I $ J: ~(() .S-4'1 I Water Meter Size 5/8't2) $ - ~()O ,dOl
I State Surcharge I $ If). .S-O I I Pressure Reducer $ 70.0"01
I Penalty I $ I I City SAC and WAC # $ 1.1..tJfJ. VI) I
I Plumbing Pern it Fee I $ lCO.oo I I Water Tower Fee # $ - 7(;J() . It) I
I Mechanical Pe mit Fee I $ 100.00 I I Builder's Deposit $ I, .fl}i) dID I
I Sewer & W ate~ Permit Fee I : l' .(; SOl lather $
I Gas Fireplace fermit Fee '10.rJol I TOTAL DUE ~- /z.3 Q'? $r;. S-q /. Z1
Th/!JCilE. Your Building Permit When Approved Paid '1, 5&1 I. ~ 0/ I ~~ce!~o.ry
/t/J..-O ( Date I'Z-- ~O::J
Budd! g Official Date
This is to certify th~t the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document
~~:;/7Ji1d 7C'tiIDlo' a lompocary C,mfi,,,, ~ :'::O:lion" ond allOw,,~ t~;m'n;~B:'~O'ru:'Y' :::::;,:upan'Y mu" b,
IPlanning Director Date Special Conditions, if any
24 hour notice for all inspections (952) 447.9850, fax (952) 447-4245
L______,___.____~~=~_~~gl~_~~~~~~ve~_~~.~~.~_.~e. MN 553~.=.._ _ _. ____~_ .._...
White - Building
Canary - Engineering
Pink - Planning
Th~ Crn[.~ IIf thr L.... ('aUnlr)
N4ME OF APPLICANT
I
A~PLlCATION RECEIVED
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLlSr
~V(dd/~~
//_ /;(- 30'
i
T~e Building, Engineering, and Planning Departments have reviewed the building permit
aR..Plication for construction activity which is propo~at: IJ ----.
i d.-9D1- (/~~ yv~
A~cepted
Accepted With Corrections
e-.---
Denied
,1M f/L
U2 -l'a ,J a II I1rJ 4's
Date: 12 -) -0 "<
Rtviewed By:
Cqmments:
<4- ffur1,J Atl+c:..
i
"The issuance or granting of a permit or approval of plans, specifications and
cqmputations shall not be construed to be a permit for, or an approval of, any violation of
ariy 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
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST:
N,'ME OF APPLICANT
APPLICATION RECEIVED
! ,{ J / ?,
I ...... (/ '..j l.:..t /
L/~,_.~
//- /;?,- 3j
Tt e Building, Engineering, and Planning Departments have reviewed the building permit
a~ plication for construction activity ~ich is proposed at: I!
vJ ./ /; - / ~-I/ telA
'.".,A..... / _ ,,' (;..'0. _. ., L~',' f<
Ac cepted
Accepted With Corrections
~
Dnnied
,1M f2L
f/l-("() r' a II t1rJ/-,';
A
Date: /1-) .() "(
Ryviewed By:
CJmments:
<4 fftlY'!el ",;+c....
/
i
\, t.
". i
'iY
"T 1e issuance or granting of a permit or approval of plans, specifications and
cqmputations shall not be construed to be a permit for, or an approval of, any violation of
arly 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
ortlinances of the jurisdiction shall not be valid."
&it" - Buil!li[lq
I'}a!v -enQIn!t:rmh
Pink - Planning
Ttu' ('thIn ~lr lhr t.b ("ounlry
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAIME OF APP~ICANT
APPLICATION RECEIVED
i
,
/7 dd@
! " :'1 /"
(f _J i/ { . 1;1 LL'~-/
//_ /;;:~3 c'
Th, Building, Engineering, and Planning Departments have reviewed the building permit
ap~lication for construction activity which is propos,~~at: // ,-- I
, ,:'1 ll' L) /7- ( //;q..,.{ /; ':'_A . [V i(_ L.J...~..-
I .>C.... ....' / f, u Ie .L./
- -~ , .r
,~/
Ac1epted
I
,
Dellied
y
'-
Accepted With Corrections
Re' 'iewed By:
111415
Date:
Corlnments: ..13"'''' Rpv.er",,,, ~irle for Additionallnform:::ttinnl
,
V\}c.f.e, CUIS 6o;i MUS! nl1vt {orcl 1f-1 G,Y(lv
i"l D,.;//(7 WCt Y
(
"ip-e Attachments' 1) Grading Plan, 2) Erosion C:ontroJ M"",,,"r",,
"The issuance or granting of a permit or approval of plans, specifications and
cOrT11putations 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
pre$uming to give authority to violate or cancel the provisions of this code or other
ordinances of the jurisdiction shall not be valid,"
12/05/2003 11:54
5077445565
BADGER EXC
PAGE m
~ . '" .... ~ v . ....... ".,.. ~ ... . " .. .....
..... ....1 I 1,\~L.Jl\ I..'\....~
""-'\I......
~
((~~. .,~
1::/ (.,.
~i "
....\ ..
110'1""1,0""
Date Rec'd
l1'ls.t ~ Of llMIW.ft.I.D &t botn)QI)
, ADt"'RESS .
I i 'iI:9? Q07
I LE9AL DESCR..lP110N (olll" UJe OO1Iy)
! 19T BLOCK AP DITl ON
IOwr<ER f>'d.!. .
I (Nat') VU 0' fo---n Cqs1"1rYn
I (M~O:S') :::1.?-l ~~ Lur ~
I I (Addn:u)
CITY OF' PRlOR LAKE
SEWER AND WATER PERMIT
. _ (.r'1 ~
~ ~:.~; I PERMIT NO. c5 - ':/""-1
I. c.-~ ..wi..,..,
C O<-t C;Clr
rpo+-h
I zoN!fTG(."tr.. u'J 1
PID
6,~ (. U "'r.s:
Aw L <; k~ul "I/f
(Cltv)
I
(Phone) q5) - !..j~f_ ((;'I(
Y7'r0 S.SCJ vV'
(lio Cod<)
: APPLICANT\3aJ,..h_
I (N. nt\ x--
I lAd'ress) ~ 3, 7::)"" W 70~
I (Ad~.i''Ul)
~ I ~_ \;r-"",
(Cor tac< Perlon, <AAf
: A..!'P,LICANT SIONATURE. ~;-7'~ ~
_ .______R......., ._.
(?K c ,:, <Jl. -f-r r--c.
~~:..u...r
(Phone) :)0,- --, Y (( - :S""S-G,,~
1-.U^" drA. .$".~d-/.6
(Clly) (Zip Cod<)
(phone) 5"01-"7 Y (./~ SS-6> r
_,_'" DATI! /~-S--O '3
APPLICANT PLEASE COMPLETE BELOW
Si~ of walor service --.L- Inches.
Location of any couplings from structure -::::::.. foet.
Type of sewer pipe. 0 ABC.. [JgPVC 0 Cast Iron
Estimated len~th of sewer line ...;.~ feel.
Clean out (if required) located at --:l feet from structure.
FEE SCHEDULE
R"icentialnwllllld ",at" lilI. e~Meotlon Sl~.50 Indultrie\. Com'l '" Multi.(amily W. o(job eort with a Sl9JO mir\lmwn
So",", cunn.etion only S J 7.50 Water conntc:tion only $ 17.'0
E.,imated Cost S
BulldiQ, rermit N ....
SEWER AND WATER PERMlT PEE
StATESlJRCHARGE
TOTAL PERMIT FEE
s
s
s
~
& 1:>-4ID
.~/{DIIVG ~!~
. "".
'-N~l~i"
-(Ii!?
.,
lomel lItO..l)')
':
Ofr.
8 2aa.~ !
: ~'~t No.
Jfjt'j ~
nl. AppH..tion Bceom.. Yuur Bulldlnll Parmi! WI,," Apprond
8ulldilllom..1
011C
~'I Paid
, IDa"
'4 hClllr notjcr rar alllrllptc(ion. (.9S1) "4"~91JO, (II (952) ..'-04$
" ,,,'
CITY OF PRIOR LAKE PLur.u:.,...~G t.M\J.MI'
Date Ree'd
l7kue twe I lI'oritat aDd am atbDaom\
I ADD~ 01 C fJ1A o/lJ, Thtlil-,
.-
~ a ~ I PERMIT NO. ,--3-/5 t4
I I ZONJNG(_~ I.
LEGAL ~ESCR..- ..,,<'1' (o8b_ouJY>
LOT IBLOCK Au....uv.~
~= . ' .-tt(l))1f~ ~~-'\LJUlP
(Adlms) D n , ~I ~p I !,dJtlSdci 1 L, :_~. ~l:.tJ.1 o-()I SJ p
. =~1tl t1~ j +1 . ~ 0:0ljLJU()-317Q
(Address) jg2lon ~Trr) ~~.:::n:;}-
n . (A4dIess)
(Conract] 'erson) J' IA 1...L.LL.lL P \L~
APPUCJ NT SIGNATURE -7?f ffi~A) Ai J1.i;:12
v /'
,
I
I
~
Qvaatity
:-f.
I
I
~
I
)
,
ul
31
PlD
(CIty) (Zip Code)
~lor\~ )L/Uo-~ 1.L3
. DATE 2 -//-oy
APPUCANT PLEASE COMPLETE BELOW
Typeorr-". .. .
BatII Tub With or without shower
iJish"'I.fl....
Floor Drain
Lavatory (B8 .... Sink)
Lauftcb:y Tray (l or 2 compartment sink
Shower Stall
sinks
Bar Sink
wm:r Closet (ToillIt)
Q;.. .... J
'V
J
D
l
o
u
u
o
n
FEE ~.JLE
. llIduMII, Commercial cI: Mulli.f8mily. 1 ~ of job cost widu S39.s0 I;.;. ....
Estimated Cost S ~
Buildlng Pettnit #I
PLUMBING PERMIT FEE S
STATE SURCHARGE S
TOTAL PERMIT FEE' S
(omu u.. Daly)
Tbi.AlpllcatloaT."." . YourBlllldill&PermilWlleaA,,,., .1
1-"-
.-
Type of Ihb,d
Rough-ins
Wtda-H_
WIlIlI'Softner
Stand ~uhiDg MacbiDe)
~'^,-bly
fsaCQOw Assembly Test
LaWn Sprinkler
Other
lte$ideatlal,.New One cI: Two-Family $99.$0
ResIdential, AddIlions A Al1erati0lll $39.'0
-.$Q
e ~~~D wm.,
.. "~-',f~ Itle
. '. F.:i,~.4rr
Paid
~NO.
~B 1 7 2004
-
By
o
I (9SI) 44106150, fIlll (9$2) 447-4245
24 boar .olice for all i..
CITY OF PRIOR LAKE
HEATING/AIR COl'lulu...I.~.....~GIFIRIPLACE PQMIT
Date Ree'd
I
~l"J!!!p_lIl4sim"bcbal
IADDi QC1l2LC111Aqt~ Utth.
i:':' ~ I.PERMlTNO. <2 "'/'. ~. . ./ J. /
1...... AffII-t -., (;) "0 ~
l ZONlNGI_lIIIl I
LEGAL ~CR...: .."'.~ (oIIlce_~
LOT . JLOCK
~'UJ..I..lUj,..r
PID
(Pbcme~U- 'SUW V
. ~l'Ji{ o-()l@_n
(:~"L -Hjyj17112JA" (PboDe)~(}<~~-:':'
(Address).fM.aD ~Al~~(V1 'W. IX J()p'-rr1t1.~ .\~~ \~I?--
(ContaaP,mll) .~ (l9!jJIl~J1Llil~ (PboDc)(~ o-~11h-
Al'PLtCA:IT SlGNATUBE ,.~~~,1.,(l5.. DATB ~ ~-/(-I'Jv'
_ APPLICANT PLEASE COMPLETE BELOW
Ji5>>"EWCO S'I1lUCllON OREPLACEMENT.. OALTERA110NS, .
f'tJaNA~MAKEANDMODBL - r \ 1 n . FUEL Wf.i~Y~
FLUESj?)' Mf:., ~IUmJRNu,<.,.....-IGS 91 INPUt liO.J.C(IL OUTPUT . .)
,TYPEOFSYSTBM HEATlNGOll.:.. ".:.o.PLANT
.~W_AirPIaols ~SIeom
Oravity Hat W_
}.f-"-i-.I R.IdiIIiQD
[JAlt 01..."........1 Spcc/eI Devices
lJVCIIl.5yMa . OdwDeYices
.~
Pl.EASl NOTE: .
Aire.. ::.\." Unlts
CamotL, . ::II. into
hqIiiNcI Side Yard
SctbId<s
fIREl'LAC'E MAKE AND MODEL
Induslrial, C mt......ia1 '" MuJlI-Fl1Ili!y
RcsidontIt.L floating '" Ale (Now eo.,,,. ...... ..)
Residllllial, flCIIlnJ OIIly (New ConslnIcIion)
PEE s..............E
1% of job cost Rctlclelldal, Gu Fircp\_
S39.50mhrimum ...--.,.',
$99.50 Re.s.iclllllial. AddiliOllS & AlbnliOllS
$64.S0 . Raidcnlial, AG Only .
,. .
$39.$0
$39.50
$39.50
,PAgD ~
I::' .'r. ;~i,:";?>' !..-I
'': f':}'efRlIt417
F.,I...~CostS .
Bulk1lDs Permit #
(OlIIco VtoC!olJ)
nil A,r:,; ...:,,,:___. YlMIrBlllld"'l'enDItWloeD A"i'.' .1
HEATING PERMIT FEll
STATE SURCHARGE .
TOTALPERMn'FU
$
$_
$
-:50
1l*I"I0IIcI0J
-
I Plid
I ~B 1 7 2004
.'/
Kecolpt No.
By
(}--
~!J
14 hoar aotlee for all i....-.. (952) C47.ftSO, In (952) 4474:t4S
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
:J. /.fJtI-
I. Pink
2. Green
3. Yellow
~:;y I PERMITNO~. I...
Applicant ~
(Please tvve o~ vrint and siAm at bottom)
ADDRESS I
. 2907 COUGAR PATH
ZONING (office use)
I
LEGAL DESCRIPTION (office use only)
LOT BloCK ADDITION
PIDZ&""""". 003. b
OWNER
(Name :CUDDTGAN CTTSTOM HOMES
(Phone)
(Address)
APPLlCA! IT
(Name) AUJFD FIRESrDR DBA FTRFSTOF HEARTH & HOME
(Phone)
651-633-2561
(Address)
2700 NORTH F AIRVIEW A VENUE
(Address)
ROSEVILLE
(City)
55113_
(Zip Code)
(Contact petson) BRENDA HUSTON
APPLICANT SIGNATURE BRENDA HUSTON
I
(Phone) _651-633-2561
DATE
2/10/04
APPLICANT PLEASE COMPLETE BELOW
xD NEW CONSTRUCTION D REPLACEMENT D AL TERA nONS
,
FURNACE ~AKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
OWarm Air Plants
OGravity
o Mechanical
DAir Conditioning
OVent. System
o Steam
o Hot Water
D Radiation
D Special Devices
D Other Devices
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
FIREPLAC~ MAKE AND MODEL
HEAT N GLO 6000TR-OAK
FEE SCHEDULE
1 % of job cost Residential, Gas Fireplace
$39.50 minimum
Residential, ~ eating & Ale (New Construction) $99.50 Residential, Additions & AlteratIons $39.50 t
Residential, H eating Only (New ConstructIOn) $6450 Residential, AC Only $39.5.,
Estimated Cost $ Building Penn it #~(/l~' 0
HEATING PERMIT FEE $ I)) .
STATE SURCHARGE $ '^ -- ~
TOTAL PERMIT FEE $
--
Industrial, Co nmercia! & Multi-Family
$39.50
(Office Use Only)
This Appl!cation Becomes Yonr Building Permit When Approved
Bu,ldine Official
Date
I Paid
-
ID3./.~
-
Receipt No.
--
By
..
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
-_..~-j._..._._-
.. .--.-..-- _._~-'"'~.,,--
PRIOR LAKE
INSPECTION RECORD
DEPARTMENT OF
BUILDING AND INSPECTION
SITE ADDRESS -----M.D ~ (J.. 1'1,
NATU~E OF WORK tlI~tIV ~1M."'~udJ.'"
USE CF BUILDING ~~
PERM T NO. 03. /S(/;?5 DATE ISSUED.
CONTI~ACTOR ~ PHONE1il!J.- ).1J":. ""'J.'
NOTE. THIS IS N~ FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR
DATE
I FOOTING
(jf.;
! FOUl"IDATION (Prior to Backfill) t.Jia- /~ I /t2.--t ~
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
~
(;J L- n
?l! :?-/
-:< f) 1I7l() \/1'2.- 'D2Ch ;:::"{q I
J2-/7
'GRADING (Prjor to Sodding) I
BUIUJING/"IAf .t.z> 5"I-fJY
ELECTRICAL (
PLUpt'BING
HEA11NG
iDO NOT' OCCUpy
SEWF.R I WATER I SEPTIC
FRAUING
INSU _ATION
ELEC TRICAL
-
PLU~ IBING fIY(b
HEAliNG (if required) ~ - .~
FIREPLACE ~
GAS LINE AIR TEST A~ .~ J5fJ //j
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
W:f- I~ I
FINALS
.~D
NY
r?h
v-
t 7-i 38' tt::6
-- -
II. 12 ,D 4-
8-t-or
UNTIL ABOVE HAS BEEN SIGNED
NOTICE
this card must be posted near an electrical service cabinet prior to rough-in inspections
llnd 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
. ...__._..........~_...,.._,_h......._._~._._
QIrrfifiratr of <IDrmpaut1!
CITY OF PRIOR LAKE
~tpadmtuf of ~uil~iuB JlusptdillU
L::kFinal Permitted =:J Conditional CO. 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 following:
Use Classification
SINGLE FAMILY
Bldg. Permit No._ 03-1565
Occupancy Type
R3
Type Construction
VN
Fire Zone
N/A
Zoning District
R1SD
Legal Description
L3, Bl, THE WILDS NORTH
~.
Contractor's Name & Address CUnD 1. GAN CUSTOM
ROBERT D. HUTCHINS (/
B.ail.<iing Official
rh
Site Address 2907 COUGAR PATH
BUILDERS, 22133 LOGAN AVE.. LAKEVILLE 55044
Owner of Buildin~
City Planof"r
DON RYE
Date: ,r
Date:
~
~ "
'....
oM-'
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS 2 ~l
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
~NAL
o SITE INSPECTION
COMMENTS:
nk ~
DATE TIME
BI_C" ~~
SCHEDULED ~
(1~(~ (i?1k
CONTR.
PERMIT NO.
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
"
'\ 11)
r a<.R~
3 - I S lr/?:.
o EXIGRADIFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
n,
+>' (,0
/
~ORK SATISFACTORY, PROCEED
o CORREC CTION AND PROCEED
T . CALL FOR REINSPECTION BEFORE COVERING
Inspecto .
CA
Owner/Contr:
~
FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH '" SAFETY!
IN$IIOTJ
DATE TIMe
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS ?:7 01 (1 C17 )$je& J
OWNER CWNTR.
PHONE NO. PERMIT NO. 3 ~ I ')-( ~
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
~AL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EXIGRADlFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
COMMENTS:
l. -\l"",^ ~ 1<",;.1. ~
'7. ~4v-7 ~tc.-A~. O~-;{~
o WORK SATISFACTORY, PROCEED
o CORREC~N AND PROCEED
~ORRE R CALL FOR REINSPECTION BEFORE COVERING
Inspector: h V Owner/Contr.
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS A.RE FOR YOUR PERSONAL HEALTH & SAFETY!
INS/'IOTl
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
11-12"(.")1.(
PHONE NO.
~~6 7 Ct.9()C..~/ l,ft,
V
CONTR. t:JdW'"
PERMIT NO. ~ (9 ~ -/Sb!"""
ADDRESS
OWNER
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
~L
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
~~ILLING
o CdiiPlAlNT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
COMMENTS:
Gul6 /SO;<- t9 ~
(-.r"uf I' - C9/C
)(" WORK SATISFACTORY. PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: ~;p, Owner/Contr:
-
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
""""n
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS 2107
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
p-FlNAL
o SITE INSPECTION
COMMENTS:
DATE TillE
SCHEDULED 7- 2. (,
~)?)p#;
CONTR.
PERMIT NO.
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 GASLINE AIR TST
o
I . QJ D..or\;-\--~~ 1-hOL tl.o-1
;2. Iftbr-l ~ e~~.Qr\V-j d"flt .ISI?-O~
(I~.H JJaiJ.. ( ~~ 0/'1.7- '7(330
3- ()~.J::< ~ ~F_
" -
4, ~+;/.L<...o,.-X S:rJl ~ C::;/~
~~ /ZP~,
1S.<s.L
J. I/IJ- ~~'^~ ~ - ~ S,,,,,,1L rd....
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o WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
'I.-. CORRECT~ CALL FOR REINSPECTION BEFORE COVERING
Inspector: f,A; Owner/Contr:
CAL~i4!::;.50 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH,{ SAFETY!
_n
A
..-
'-
APPLIANCE
PERFORMANCE TEST
Attach to gas line adjacent to regulator
Heating Contractor
Name of Tester
Date
Clearwater P1umtMng & Heating
mITt-
LI--1--oy
Job Address
:l1v'i'r!.o....e,...L
Heating Contractor Clearwater Plumbing & Heating
Name of Tester ptvt.fc...
Dme 4-1/~~
1,~
1;V'
Percent CO2 q ~frl
Stack Temp. , ~
Combustion air is adequately supplied per
UMC Sec. 606
Percent O2
Percent CO
Input