HomeMy WebLinkAboutBldg Permit 04-1083
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
C!,30 .04--
(Please type or print and si~ at bottom)
ADDRESS
11L/B '1~h"ejdu.,lJL ~E
Main Fi:e
White File I PERMIT NO
Pink City . 0 A- .//1 Q3
Yellow Applicant or (J 0
ZONING (office use)
12-;2.
LEGAL DESCRIPTION (office use only)
LoTi4 BLOCK J ADDITIO~~\~ld l~
PIq~~5- L/O?-()/ tf-()
OWNER
(Name)
(Phone)
(Address)
~C~~~~Na;;n:R~~~l'. (Phon([jf)~crtE;-18~'5
(Contact Namenn\k.. ~odk.Cv (Phone)(Co~ 3iRL> - 4J~ ~
(AddreSs)2~'oO(U~V"lhA ~~CJ-:~/Q:) Ld:.t...vil/.t,mIV ~t/t/ - -/
) -~ j I I
TYPE OF WORK ~ew Construction ODeck OPorch ORe-Roofing ORe-Siding OLower Level FInslShjJolre/PJjlace Y.7
OAddition o Alteration OUtility Connection 0 Misc.
CODE: ~C. DI.B.c. PROJECTCOST/VALUE
Type of Construction: I II 1lI IV V A B (excluding land)
Occupancy Group: A B E F HIM R S U
Division: 1 2 3 4 5
I hereby certity Ihat I have filrnished information on this application which is to the best of my knowledge true and correct. I also certity that I am the owner or authonzed agent for the
above-mentIOned property and that all construction will conform to all existing state a.nd local laws and will proceed in accordance with submitted plans. I am aware that ti building
official can revoke this permit for. u.t cause Furthermore, I hereby agree that the City official or a designee may enter upon the property to perform needed mspecl1ons. t.j
'~ ~~v- ~CSo?"~~;2Jo q ;?to
I Permit Valuation /...2~ 000 I ~O Park Support Fee # $ I
I Permit Fee $ /.;2 t:!l9. ...$-0 SAC # $ / 3stJ. ~ I
-- .
I Plan Check Fee $ 7f'b, 18' I Water Meter ~;l"; %lS"O~ &<' I
I State Surcharge $ 63.~ I Pressure Reducer $ ~S ,41 I
I Penalty $ I Sewer/Water Connection Fee # /.;ttd - ~ ~ 1
I Plumbing Permit Fee $ /CJO. ~ I Water Tower Fee # $ ;?t1~, ....u I
I Mechanical Permit Fee $ /po. ..- I Builder's Deposit $ /..5~ -...J I
I Sewer & Water Permit Fee $ ..J,S":.s~O I Other $
I Gas Fireplace Permit Fee $ ~CJ. ~...c.J I TOTAL DUE ~ ID.U.uf- ,7 $ /~nleY
77/~ ( & / ~,)V
This Application Becomes Your Building Pennit When Approved Paid Receipt~o.
#~d>- /tW4~ Date Id~pr By A--.. .JO
U
Building Ollicinl 'Date
Thts IS to certity 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 conSl1tutcs a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certtficate of Occupancy must be
iSSl~?d~_
Planning Director
/t'P ~'-/
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
Special Conditions. if any
Residential Building Permit Checklist
New Construction for Single or Two.family Dwellings in R.1 or R.2 Districts
Reviewed by: ~ ~~-rso---
Date:
/o/>~y
Building Permit # . ~I.o: . / Zoning: ;2...2-
Address: /7%7-93 b1ee, f.'e/d ~F' j e
/~,;UJ /7-YR? / 7-Y?/ /7~3 17 ;L
Legal: 1.,..2/-f.hl. 8 / Subdivision: tJeeri-,''eld //7-
Existing Structure? YES~ Existing Nonconforming Structure? YE~
CONFORMS TO ZONING
ORDINANCE
YES
NO
Yard Setbacks: NA 1 FAllSI COMPLIES
· Front Yard (can be 20' if avq. w/in 150')
. Side Yards
Standard
25'
10'1
25' if abutting a street
· Sidewall exceeding 50' requires additional side 2"
setback for every l' over 50' in lenqth
I. Rear Yard
. Patio Door: provide for minimum 10' dec~ or sign
statement indicatinq no deck will be built in the future
. From 100 year flood elevation ofwetrand/NURP
pond
· From OHW (Prior or Spring Lake)
10' setback +
2"/1' over 50'
25'
10' sidel
25' rear
30'
Proposed:
..zS:~1
:t/Jr~
.2.i-ti1. -'
.&...., /d;~'
';,;;J1..--
.y~ " 7 .
AI'?/l)!
;till
75' or setback average of
adjacent structures, but no
less-than 50'
-;:,
/ l
I Floor Area Ratio: NA 1 FAilS (COMPLlW
,--
I Yard Encroachments: NA I FAILS I~MPLlE~
Eaves and Gutters no more than 2 fee .'0' width and no
closer than 5 feet to a lot line (Easements}.
AJCandother equipment cannot encroach on. interior
side yards.
.30 Maximum
I. fJvlJ
Standard
Proposecf~);:"? ."
.~it~~';rl ~:.
%:1
I'
. ~
t.
r
.......
Tree Preservation:NJ}.JFAILS 1 CO MPtJES
· Totaf calioer inches
I. Pennit 25% Removal
I. Caliper Inches Removed
I. Calfper Inches Preserved
I. Replacement
Standard
(-
~,.
L\TEMPLA TE\BLDGLIST.DOC
~~
Ylain File
White ~f'ing )
Canary - Engineering
Pink - Planning
Tht' Crnll"r of Ihl" tab ('ounlry
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
at?
~
() - ,::J o-6Lj
The Building, Engineering, and Planning Departments have reviewed the building permit
application for ~;~~;~ctiVii1~M ~
X
Accepted
Accepted With Corrections
Denied
Reviewed By: ~.a~ Date: /"'/,7~7
Comments: /<?7/ 4// ~h L......~
../ /~~ ~ -/,
ffi; c..- --.S ~ r..-c.../ r Cf /:J / -r S L:> -,G' C! '7: (; r'---'
, /
"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."
../
;'
~~
~ain File
White . Building
Canary ~aineering
Pink ean~
The Ct"nler of the take ('ountry
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
-- /
I "
. . //f .-,,/
..-, ...! --':J/ / ;/
,. \..."....... (........._.
...../ '.
'" The Building, Engineering, and Planning Departments have reviewed the building permit
application for construc.tion activity wi)ich is propo~ed a.~ ~ I /1
/'Jt/f/l 1 J~u~1d/y ,/j~
Accepted
y
Accepted With Corrections
Denied
Reviewed By:
#~
Date:
/o~~y
Comments:
.
~~ ;;,..,,'
,L, '//7
J'~~/~ 4~
"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."
Main File
White - Building
~anary - t:.nQlneerl"9:>
Pink - Planning
The CPd'", of the Lake- Country
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
. .-NAME OF APPLICANT
APPLICATION RECEIVED
,;
,If? . -~~
,,' '-)
~~.,. ~ .-;~ \::~)
/L .i
___~;t'" ~: ,~."
(~l ',7/
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity wlJ:ich is proposed at: ""
'';L/('.n ). /,:'" ~/: /01"' .--(/ l' /)
I ' V,r j ,'/ I/,,:? ..1 -.1' ,,:l' ;' /t 1../
I . -; /J '", . k'__,~<,.-r ,.,. T'. I, ..A' , ~.t:' ,~( j~;,.
. . , .. /" / .
Accepted
~
Accepted With Corrections
y
Denied
Reviewed By:
/i?9-b
Date:
/(J- /7-0Lj
Comments: -.S.e.e Reverse Side for Additional Information!
See Attachments: 1) Grading Plan. 2) Erosion Control Measures
"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."
10/11/2004 MON 8:54 FAX 6513226147 GENZ-RYAN
~ 002/017
Date Rec'd
CITY ,OF PRIOR LAKE
SEWER AND WATER PERl\1.fl'
(Please ~e or print and sim at bottom)
ADDRES~ . . ~
! 1 Ll g'7 lXtfll-H ~(ct ')rL. YS'
~ ~w ~\~ I PERMIT NO.AilIIt '11..
3. (laId Appliwu ~
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT I~ BLOCK
ADDITION
h.lLIW e,{ {!
I Cih
PID
OWNER
(Name) Plil
(Address)
20&00 Kev'li3i<..\s:x::.e C:r S:,p ,1.[)r\
(Address)
(phone) _
. La~1J i lie.-
(City)
Cf52. -q 85- 1B.J..')f\
.'?Ct)L1U
(Zip Code) .
Hart"'" ""'r:''tom-T:J,':'ft'lb~
APPLICANT
(N~~ Genz-Ryan Plumbing & Heating
(phone)
651-423-1144
(Address) 14745 So Robert Trail Rosemount, MN 55068
f'\ (Adclress) r=.-, . (City) (Zip Code)
(ContactPerson). IAj11/L(</'1 rt-l( (.S . () (Phone) 651-423-1144, ,.
T..ICANT SIGNATURE . '~,{,L?T~ '-kJ jj/:] DATE ( 0 ( If IO(j.
APPLICANT PLEASE COMPLETE BELOW
Size of water service inches.
Location of any couplings from structure feet.
Type of sewer pipe. 0 ABC 0 PVC 0 Cast Iron
Estimated length of sewer line feet.
Clean out (if required) located at feet from structure.
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
Estimated Cost $
Building Permit #
SEWER AND WATER PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$'
$
.50
PA1U WIl'tI
Building Official
Date
L_
24 hour notice for all inspections (952) ~7.9850, fax (952) 4474245
Y ,
10/11/2004 MON 8:54 FAX 6513226147 GENZ-RYAN
~ 003/017
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
(Please ~e or print and sign at bottom)
ADDRESS. ,
11L~'1 l\'(lt~'~(d. bn ~'&
~:~: ~~~ I PERMIT NO.A UJD ar2
3. Yellow ^pplicant UT c;Q
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT I V1 BLOCK I ADDITION ~-L{lfi -e ( ct / II.fn
PID
OWNER
(Name) DR Horton Custom Homes
(Address)' 2..c'S(o() K.b1B~1 DGe... CO Sre IDO
(phone)
962 - q)? fl -78DD
udv,ville... VUI N .E)C6L.PJ
APPLICANT
(Name)..c....n.,_~~n P1.wr'\,;n,c K. ll....,Hn,g
(phone) ....65 1 _b. ? ':l_ 1 1JI.!..
(Address) 14745 So Robert Trail
Rosemount
MN
55068
(Zip Code)
(Address) .
(Contact Person) rA11t6( S 11 fi1 [(.S ^
APPLICANT SIGNATURE ~ljA52It ) 'fa....f J/CJ
APPLICANT PLEASE COMPLETE BELOW
(City)
(phone)
651-423-1144
DATE 10 III (ocf
) .
J2:-r
I
I Type of Fixture
I Rough-ins
I Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow- Assembly
I Backflow Assembly Test
I Lawn Sprinkler
I Other .
)
I
I
I
I
I
I
I
Quantity
'J-
1
I
JS
I Type of Fixture
I Bath Tub with or without shower
j Dishwasher
I Floor Drain
1 Lavatory (Bathroom Sink)
I Laundry Tray (1 or 2 compartment sink
Shower Stall
Sinks
Bar Sink
I Water Closet (Toilet)
Quantity
cZ
FEE SCHEDULE
Industrial, Commercial & Multi-family 1% of job cost with a $39.50 minimum Residential, New One & Two-Family $99.50
Residential, Additions & Alterations $39.50
Estimated Cost $
Building Permit #
Building Official
Date
$
$
$
-\17 in', P 'i 1 _W1lLDING
l~r;pJki, L~ li \- -"T1.~1'
i1. -B"fJ ~ hu~ ~ i;y
.5PAlU VVIl'H
PLUMBING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
(Offite Use Only)
This Application Becomes Your Building Permit When Approved
24 hour notice for all inspections (952) ~~8S0, fay (1)"1) 4A7..4'24~
~ ~OCoG
CItY OF PRIOR LAKE
REA TING/ AIRCONDITIONINGIFIREPLACE PERlVIfI'
Date Rec'd
(Please.type.OrtlI1nr and sign at bottom)
ADDRESS
\~~~~ . ~~,~~ '\)~. ~<c-
~: ~'l.~:~..1 PERMIT NO~. I O~.Q
3. Yellow Applicant , ~ . ~
ZONING (office use)
f.,EC1.A.I.;DESCRll'nON (office use only)
~
LOT
BLOCK
ADDITION
PID
O~ER DRHORTON
(Name)L 20860 KENBRIDGE CT
(i\dqI-~~).. LAKEVILLE, MN 55044
(phone)
APPLICANT../1 ~ /. ~ ~d .
(Na.rtie)'/~/// 12:/ - ...".. .... ... ... ~.":,,..~
(AddreSS)....~ ~~.....'..,t? a
I (Addie'
(COri~~~n) ... A~4!~
APPLICANIF SIGNATURE ... -:,.., I .,~. ... ,.____
(Phone).~5.A4.:r~- ~ /?.:E;
~.~4-< ~~...?
~. (c1:ii1If (Zip Code)
(Phon~)~/" ~ '- p177.:5:
DATE
APPLICANT PLEASECOMPLETEBELO....W
- ,I . , -, ' " , " , ,'. - .' '. ,', ' ,
I!lNEW CO;!j...TR........u... C.T!ON ...E]RE.........Pt.A. c.. E. ME. NT. >. ..................'.}n....EJ.c........~TE. RA TI9NS:.2
FU~^$EMAKEANDMOD~/y~7r, ~. ..rVe7Q. FUEL. ~. ~~
FLUBSIZE~M~RETURNOPENINGS. ..i.......INPut'~~~ OUTPUT ~.,~
TYPE OF SYSTEM HEATING OR POWER PLANT
DWann Air Plants
DGravity
o Mechanical .
~ir Conditioning
~ent. System
[JSteam
OHotWater
O...Radiation
[lSpeci;i! Devices
O,OtherDevices
.''''-
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
:\
FIREPLACE MAKE AND MODEL
Industrial, Commercial & Multi-Family
FEE SCHEDULE
I % of job cost Residential, Gas Fireplace
$39.50 minimum
$99.50
$64.50
$39.50
Residential, Heating & AlC (New Construction)
Residential, Heating Only (New Construction)
Residential, Additions & Alterations
Residential, AC Only
$39.50
$39.50
Estimated Cost $ 3..sza a::> Building Pennit#
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$ u.//~~....t"Ai;~\1i~ .~
$ " .50 - "tL.CCJl':: I',": ''/11:
.'IU W-",h....,
$ Y'
(Office Use Only)
This Application Becomes Your Building Permit When Approved
. PIdO
\ )\-
! Receipt No.
Building Official
Date
pa~ov 1 5 2004
By
,'--
24 hour notice for all inspections (952) 447.tJ~50, fax (952) 447-4245
1,::\-- ..---.,--.----- ---
______J
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
(Please type or print and sign at bottom)
ADDRESS
1. Pink File PERMIT NO I ~ () f1'11
i ~~:w Z~icant . .,.1 . .J!
ZONING (office use)
17487 DEERFIELD DRIVE S,E.
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION
PID
OWNER
(Name DR HORTON
(Phone)
(Address)
APPLICANT
(Name) ALLIED FIRESIDE DBA FIRESIDE HEARTH & HOME
(Phone)
651-633-2561
(Address)
2700 NORTH F AIRVIEW AVENUE
(Address)
ROSEVILLE
(City)
55113
(Zip Code)
(Contact Person)
BRENDA HUSTON
(Phone)
651-633-2561
APPLICANT SIGNATURE
BRENDA HUSTON
DATE
11/26/04
APPLICANT PLEASE COMPLETE BELOW
xD NEW CONSTRUCTION 0 REPLACEMENT 0 AL TERA TIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
DWarm Air Plants
DGravity
o Mechanical
DAir Conditioning
DVent. System
HEATINGORPO~RPLANT
o Steam
o Hot Water
o Radiation
o Special Devices
o Other Devices
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
TYPE OF SYSTEM
FIREPLACE MAKE AND MODEL
HEATN GLO SL-750TR-D
Industrial, Commercial & Multi-Family
FEE SCHEDULE
I % of job cost Residential, Gas Fireplace
$39.50 minimum
$99.50 Residential, Additions & Alterations
$64.50 Residential, AC Only
$39.50
Residential, Heating & AfC (New Construction)
Residential, Heating Only (New Construction)
$39.50
$39.50
Estimated Cost $
REA TING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
Building Permit #
$
$
$
,50
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Paid
Receipt No,
Duildin!! Official
Date
;D~C 1 20U4
By
fA~
fA,
24 hour notice for all inspections (952) 447~850, fax (952) 447-4245
PRIOR LAKE DEPARTMENTO~~~
BUILDING AND Iti&ftIO~ File
INSPECTION RECORD
SITE ADDRESS /7Yi'7 t'e'e-"~e/.r 0,..,
NATURE OF WORK J ~~
USE OF BUILDING
PERMIT NO. () '1'-, 108;3 J- DATE ISSUED to, "zo. (I~
CONTRACTOR a. R. M~~ PHONE~/..z ~J,p--
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
. THE PERMIT IS BY SEPARATE DOCUMENT
'1
INSPECTOR ~ oyE I'
I FOOTING I /~ I I/' /.1 /6 r
I FOUNDATION (Prior to Backfill) d' ~t ,-n/U /~// r- ff~..d /~~':*f
PLACE NO CONCRETE if~TIL ABOVE HAS BEEN SIGNED
ROUGH - INS , , /'
~::~~~ WArER I SEPTIC ~ ~ /~~~~17;-
INSULATION llftJ- ;///p5' -
ELECTRICAL . /f .' , ,/ ~/~
PLUMBING t/t6- &1/ /~/(!/():f, / 4~ ~oS/ _
HEATING (if required) ~G~ N /..-t/tlS./o&l ~~. /~);24~~
FIREPLACE _ /J # . ~ /' /~~/
. GAS LINE AIR TEST,4~/k f- f; j,{ ~ /.,2k/o/
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
lATN&/ H(J"'JrA)~ 11"'4- ~ 1 (~~~-
FINALS
GRADING (Prior to Sodd,ing) , , . Alp=' ?d-7- IJ ~ I I
BUILDIN,*Jo'f/CC1",~tf/ J11o~~~~/IS-- fI1J{ 1/lq.(t!)
ELECTRICAl' . .,,;'//7 A>.r-
PLUMBING ~ 4 ~/as-
HEATING #~ J?rfis-
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.
FOR ALL INSPECTIONS (952) 447-9850
QIrrtifiratr nf <IDrtUpanry
CITY OF PRIOR LAKE
~tparfttttuf nf lBuil~iug JI usptrfinu
~ Final Permitted D Conditional e.O. Expires
This Certificate issued pursuant to the requirements of Section 110 of the D Residential / D 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 04-1083
Use Classification
Bldg. Permit No._
Occupancy Type
R3
Type Construction
L19, B1, DEERFIELD 11TH
VN
Zoning District
R2
Legal Description
Owner of Building
D.R. HORTON, 20860
Contractor's Name & Address ~A
ROBERT D. HUTCHINS ~
/ ~ City Planner_
~ BuiJtling Official v
7' ~ '/'9/0 ,- Date:
- , ,
Site Address
KENB?lDGE COURT, 11100, LAKEVILLE
JANE KANSIER
17487 DEERFIELD DRIVE S.E.
55044
Date:
~"~~,~<~..4,_~-'.,",_ ':";'''L"_,._..,_J":''',,,_.}.;.~,,",Jirll__.,.,,.._'..-~
"""
._-'~~~
""~-. ",--.
'..
..I!l. "
0" TE TillE
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS /74-87 - /74L1.3 O&6K:F/6r....o
OWNER CONTR.
PHONE NO.
PERMIT NO.
4- ~(083
o FOOTING
o FOUNDATION
o FRAMING
~I SULATION
FINAL
SITE INSPECTION
COMMENTS:
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
sir
o EXIGRADIFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
./"
~/ /
~/4q/
" -
,I
/'
O~
----
/' ..."
/\~
(~/ f')/ )
\ / laSe ~/I'e /
~S~~~" ~
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CAll FO 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!
INSNOTl
CITY OF PRIOR LAKE
INSPECTION NOTICE
DATE TIME
SCHEDULED J;;~5--'
aer/;~I/ iJv
ADDRESS
/?~P7
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
~AL
o SITE INSPECTION
CONTR.
PERMIT NO.
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
~H FINAL
CQltftJIIENJS: __. /'
~/~/-~C~ ( h~ I c:/r;~
/
h/~ .1;J ~c: e
/
A ~ /
~v4-, k~"i / 6J/c ,
.:lZe-a.J /., J e; rSt::t'r -ks / '
/~//.-/ /I A
fZ:;/~'f!;.~,J ~rJ.r..iJf /~~C- C- /P-~ ~ ~ y
7f- ..6~ r (5~~ // ",..rho / "
//f/-&./!:-d ~j::;~I,~e P7P//QV~ I
,4/ ~t::d J"6d ~ ~e ~,r' /
~L,//j: ~,o~x-eI Re"h-c::..r,:,~n~
d/c i:J- (2b 6-/(",;,;---
'%7' ~ ~h1 ~/a~
o WORK SATISFACTORY, PROCEED
~ORRECT ACTION AND PROCEED
o CORRECT WORK, CALL OR REINSPECTION BEFORE COVERING
Inspector:
,
/"
~/
6J1'c
c:; t/ - /oJ:2
o EXIGRADIFILLlNG
o COMPLAINT
o FIREPLACE RI
..Ji!HItREPLACE FINAL
o GASLlNE AIR TST
o
, ".
-2//7/0 ('"-
. v-
d
/
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
Owner/Contr:
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH Ie SAFETY!
Il'ISNOTl
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS ) 74~ '7
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
~FINAL
o SITE INSPECTION
COMMENTS:
~-(!)K-
DATE nME
SCHEDULED _jr-l~
Dur(l'Jd 17r,ve.
CONTR. D. R- Ho,ky')
PERMIT NO. 64 - )083
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
V EXlGBiDJFILLING
tl COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
Cc..l/~ 'f3CO/1' 5- to C
$;-,
. VWORK SATISFACTORY, PROCEED
~ORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
'nspector:~d /.. _ OwnerlContr:
"..- - -
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
IllSNon
DATE TIME
,,2PJ'~-
/ I-
tle~rRe/d 'or-
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
/7Y?7
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
~UMBING FINAL
o MECH FINAL
COMMENTS:
l.
_# /"
/Y'k"t1~ e--~r
c7r- /CJ?J>
o EXIGRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
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~
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r/ h e, t
/
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~) k{~ / /#;(/
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r"/tJ'/" / /ed
~ORK SATISFACTORY, PROCEED
.7;;\;ORRECT ACTION AND PROCEED
o CORRECT WOR~, ~'? ~EINSPECTION BEFORE COVERING
Inspector: ?7~ Owner/Contr:
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
_Ofl
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
-
APPLIANCE
PERFORMANCE TEST
Attach to gas line adjacent to regulator
Date
jJl/~ ~
~".. '&
Z-2Z--o~
Heating Contractor
Name of Tester
Percent CO
17~17 1It1,~t1
~~
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. z - 'Z '-as'"
_$.;2 ~
~AJIV
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315 Ot:*
Job Address
Heating Contractor
Name of Tester
Date
Percent 02
Percent C02
Stack Temp
Combustion air is adequately supplied per
UMC Sec. 606 VL~
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