HomeMy WebLinkAboutBldg Permit 01-0608
QATF RFr.FIV~ CITY OF PRIOR LAKE
5- Z +-tJ / BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
1. White
2. Pink
3. Yellow
File
City..
AppliCl\lll'
"K
.,p
DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
2. SITE ADDRESS
1. DATE
5/23/01
ING INFORMATION
F STRUCTURE
(Width) (Depth)
~I
14362 Dove Court
3. LEGAL DESCRIPTION
4
~dlsot a-t-
13. TYPE OF CdNSTRUCTIO~
:~(:r). r~)
14. FLOOR AREA APPORTIONMENT USE
PID 2..&)...3fD B- 004--0
1
BLOCK
LOT
Knob Hill 5th Annitinn
ADDITION
4. OWNER
(Address)
(Tel. No.)
(Name)
(Address)
(Tel. No.)
5. ARCHITECT
(Name)
6. BUILDER (Name) (Address) (Tel. No.) ~~.. '- 15. NUMBER OF OCCUPANTS OR SEATS
Novak-Fleck, Inc., 8857 Zealand Ave. N., Brooklyn Park 763-~ OCCUPANTS
SEATS
Septic 0
Addition 0
Deck 0
Finish Attic 0
Re-roofing 0 Porch 0
Re-siding 0 Finish Basement 0
7. TYPE OF WORK
New Constructio~
Chimney 0 Misf.
Fireplace 0
Alterations 0
16. PROJ~T COSTNALYE
:1b , 00,'" lO
l;t~T'SiO}
9. PROPERTY DIMENSIONS
Width Depth
10. CULVERT SIZE
Yes No
8. PROPERTY AREA OR ACRES
Sq. Ft.
I hereby certify that I have fumished 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
:Uil' offic~1 can rev~e thbeArmi~r i:::J;~:~:or:~ ~gree that the city offiD~ebe\ m(~;:r the property to p~~ n7ed~\eclr\'
-- Signatu'" license No. ~) Date ' \
V FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
MATERIAL FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA 0
PILING LOGS 0 PERCOLATION TESTS 0
Front
Back
Side
Side
BUILDING DEPARTMENT VALUATION
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION ----1.l3lJ,~0cY.J ' a::r
PLANS & SPECS 0
SURVEY 0
PLOT PLAN 0
SETS
COPIES
s~o
USE OF BUILDING
TYPE OF CONSTRUCTION: I II III IV V
Occupancy Group A B E F HIM R S U
Division 1 2 3 4 ,I, III II. '"'"'\ C -
Permit Fee ................................... $ ft +~. u
'i3!J. It
'1()_r90
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
cL If $
Pressure Reducer ....11................. $
Meter Horn ................................... $
WaterMeter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
City:
Bc:;n m
I; /-SO"ar
Plan Check Fee ............................. $
.~
lfj~
/Z6"'.cJt:f ~
/~CJ.t:X/
'f 7/?/J. t9{)
State Surcharge ............................. $
Penalty ....................................... $
lot) . 0 V
1./)/1 - t) 0
.,~~. c;-O
~tJ
m~~tr.~~.e:~W n Approved.
~ Da f?/
- Ui'f7(
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
~~1
U ,lq
Sewer & Water Permit ...................... $
WaterTap ................................... $
Builder's Deposit ............................ $-& IJ . Ch:1
Other ......................................... $
Total Due ...'jl"...;;;?C;........... $ ~/4.~
Paid 51 3/ '1;- v I Receipt No.' 1f5 L./~
Date (s') ~j-;)-vl By -t.;j-C/
'<11 certify th~. uest in the above application and accompanying documents is in accordance with the City Zoning ordina. nee and may' proceed as requested. This docU. ment when
..the City I ,r constnutes a temporary Certific2Je oJ.l~ni98 comPli~ allows cons ction to commence. 3efore occupancy. a CertifiC~CU~
'" l "t:.:t!!? - c Cc(l4L~( ~ N:r L<~~
ianner Date ~i>8ClarConditions ~ any -
24 hour notice for all inspections (952) 447-9850
C
Ol-o~g
The ('fnler of thf Lake Country
White - Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
t\! C \/1\ ~ FL E C 1/
'~~ ~ 2LJ - G I
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
J4:3(tL L)(v'E C(lJ{~1
Accepted
~
Accepted With Corrections
Denied - /J
Reviewed By; ~ ~---z:-7? ~-r--:-
Comments:
~i\&(J..!&\_ in5 F\(ttC,") ~ CY1
~f,J'-'\.IN-e _ kI. 2 D t=:'1 f?A~ ~
~ 1-&9"" ~
Date: ? /rq {t9 {
~_:tAM~1W\ ~'-/t=-r-~~ ~~
..~ ~>~ ~~~ ~y t1vJ V<.{)-LJ
(fO ~ veet ~Vl,
.
"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."
6 (~Oh at
The ('entf'r or the L.kt Counlry
White - Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
NOVAIC"- FLZcY J
5-2-4-01
APPLICATION RECEIVED
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
! 4-3(oL DOVe; ~OUf2-1
Date: ~-V--~(
/1
f/-oJ-
/1
~
"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."
;
Th. ('.nl.. nllh. LIb ('ounlry
O( "()~61
....wRite . R~Jildina
( Canary - I;.ngineering )
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
.1-. .
NAME OF APPLICANT
APPLICATION RECEIVED
NOVA~ ~L-6C~
5 - 24 - 0 I
The Building, Engineering, and Planning Departments have reviewed the building permit
application folr construction activity which is proposed at:
} 43(02. DOV~ GOUR-l
Accepted f>( Accepted With Corrections
Denied
Reviewed By: - ~.R Date: , -?-o I
Comments: ~ Reverse Side for Additional Information!
See Attachments: 1) Grading Plan, 2) Erosion Control Measures
. :i) E.msion' Control Plan
"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."
08/29/01 15:22 FAX 6123150702
AUTOMATIC GARAGE FRIDLEY
@002
~
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONINGIFIREPLACE PERMIT
Date Rec:'d
,
~: ~ ~:~ I PERMIT NO. J - / 0('./
J. Yellow Appl.....' I.,p (f
(Please rype or print and siKD at bottom)
ADDRESS
\'-\~.~~
~D\J C- c.--.t-
ZONING (office use)
t<l
LEGAL DESCRIPTION (office use only)
LOT t1 BLOCK / ADDITION ~ob IJ:;tf f3-L1\
\ ' l....
PID:)J; J~f- O()~O
&~~R Nb\lf\'L- ~ \~C.\~
\
(Address) tb <? 5\ -z.....~\~t-l t:> ~ ~
(Phone) 71., ~-',-\ ~~ -~ ~sS
APPLICANT .
(Name) AV~f\~-c- ~r",,\.p ~r- (Phone) ,(".3 - 3 ~5- I S \ Co
(Address) 4~\/) l.t 1 L..tNY\'I~ ~ \J . ~crr-rt}'\''':'"'. ~"r\( 5S'--fL/S
:. \ (Address) (City) \. (Zip Code)
.------ ~ f\ ('\
(Contact Person) \ ~~ A ~LL VA '>--'-\..vv,n<" (Phone) I L ~ ~ ~l S- - 7s \ <0
APPLICANTSIGNATURE~ II~ DATE i"~bl.~ \
. APPL~CANT PLEASE ~OMPLETE BELOW I
~w CONSTR~CTION 0 REPLACEMENT. 0 AL TERjA TIONS
FURNACEMAKEA~DMODEL 'm ~ 3 3() ~V(Le...N (.2 Mr~",,~""') tEL .
FLUE SIZE RE11JRN OPENINGS INPUT i OUTPUT.
TYPE OF SYSTEM HEATING OR POWER PLANT
.. OWann Air Plants
OGravity
o Mechanical
OAir Conditioning
OVent. System
o Sleam
o Hot Water
o Radiation
o Special Devices
o Other Devices
PLEASE NOTE:
Air Conditionet Units
Cannot Encroach into
Required Side Yard
Setbacks
FIREPLACE MAKE AND MODEL
Residential, Heating & NC (New Construction)
Residential, Heating Only (New Construction)
FEE SCHEDULE
I % of job cost Residential, Gas Fireplace
$39.50 minimum
$99.50 Residential, Additions & Alterations
$64.50 Residential, AC Only
$39.50
Industrial. Commercial & Multi-Family
$39.50
$39.50
Estimated Cost S
Building Permit #
HEATING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
.50
lJ~6!/() hh....
~~ i,',..,11f
~~..c>.. _
- ql1'/'J'a
Receipt No.
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid
--...
Date
~r ?-;{J'() I,
B~
Building Officilll
Dire
14 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
GltI[I[. . ....1[
"1 Ll.O. . ","",-!CA,"
GOLD . C1T1
CITY OF PRIOR LAKE
SEWER AND WATER PERMIT
NO. /-WJ7
NOTE:
Sewer and Water
contractors must
be registered
with the City.
APPLI CANT: \ h()~~" --:r>\h. ~ 0'\ " f - PHONE H ~ -" ~- '77/1
ADDRESS:.\9:N ~~\ ~~4S..DATE: S-~,\-("i
SIGNATURE~~CV'r_ f o.p~L BLDG. PERMIT #
SITE ADDRESS: 14at.,~ '"b<:N~ C..RlJ.. A- PID; ,)f)-- :9L/Z-ODtfl-D
FILL IN THE BLANKS
1. Estimated length of water service L4f:
feet.
2. Size of water service
inch(es) .
3. Location of any couplings from structure feet.
4. Type of sewer pipe. ABS~~VC Cast Iron
5. Estimated length of sewer line ~:; feet.
6. Clean out (if required), located at
structure.
feet
from
==================================================================
This application becomes your permit when approved.
B~ ~ DATE: 5-d.~-O\
================================================================:==
FEES:
$
$
$
35.00
.50
35.50
Sewer and water line connection perm:~
i~~~~arge ~. ~ ~
,.
* Fee for either sewer or water individually is $20.00 plus
$ .50 surcharge.
* Sewer and water permits issued for new construction must be
recorded on the building permit card at the timepf issuance
t6 insure that no duplicate sewer and water perIDits are
issued. . b" PA.I./"'\
t gu//.Jj v 11"~
DATE PAID '1~ 3 - ~J AMOUNT PAID ~^'G ,;~"
RECEIPT # REC'D BY ~ . ..
16200 Eagle Creek Av. S.E., Prior Lake, Minnesota 55372/ Ph. (612) 447-4230/ FAX (612) 447-4245
An Equal Opponuniry Employer
Thr Cfttfl'r 01 thl' lalit Coun,,.,.
Quantity
~
I
6t.
5
I
02...
I
J
Lf
1. Blue File
2. Gold Cry
3. Yellow ApplicaDl
PPNo. J -L,O~
Phone9& - q &&--7'7/ '7
/Ytf::ko.. 5S5~.s
CITY OF PRIOR LAKE
PLUMBING PERMIT
APplicant.J-h,I"rv\p:;:,r.r:R b~~ ('_~
Address: J~I ~ ~. +<:-to
Signature:J')i~ t~~J"'" '
Legal Description: Lot 4 Block J
Site Address:1 t.\6l.J. ~ \/~ CC'~u. r+-
Building Permit # PID # d- S - 3 r.o st--' I)O'1--U
NOTE: This permit will not be processed without complete information.
FIXTURE UNITS
Type of Fixture
Quantity
Sub~ l\.;JIt. ~
Type of Fixture
Rough-ins
Water Heater
-we:ter ~:/~I1€i'S\ \~
Stand Pipe (washing machine)
Sewage Ejector
Backflow Assembly (RPZ, Double Check, PVB)
Backflow Assembly Test
Lawn Sprinkler
Other
$
$
$
$
Po ~
~.
Bath Tub with or without shower
Dishwasher
I
.;J.-
.50
Floor Drain
Lavatory (bathroom sink)
Laundry Tray (1 or 2 compartment sink)
Shower Stall
Sinks
Bar E:il"ll. d.\s~bL
Water Closet (toilet)
FEE SCHEDULE
Industrial, Commercial & Multi-Family
(1% of job cost, $39.50 minimum)
Residential, New One & Two Family
Residential, Additions & Alterations
State Surcharge
$99.50
$39.50
$
../
GRAND TOTAL
( I1lq~/D
~J\lG ~/t:1y
, J:o- /',
,'{
IIV.
" .
,
This permit is granted upon the express condition that said
contractor, shall comply i"n all respects with the ordinances
of the State Plumbing Code and the amendments tjlereof.
RECEIPT NO. /, =3 ~Ol DATE
'CJC. A 1TEST
Call for all inspections 24 hours in ad\ance.
16200 Eagle Creek Av. S.E., Prior Lake, Minnesota 55372/ Ph. (612) 4-+7-4230 / E-\X (612) 447-4245
An Equal Opportunity Employer
QLtrtifirau of _rrupanry
ell f OF PRIOR LAKE
1Bepartment of }luilbing Jn~pettion
tiFinal Permitted 0 Conditional C.O. 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 ordinmaces of the
City of Prior LoJce regulating building construction or use. For the following:
SINGLE FAMILY
Use ClassificatiOP
Bldg. Pennit No
01-0608
Occupancy Type
R3
_ Type Construction
VN
Fire Zone N / A
Zoning District R 1
Legal Description
L4, Bl, KNOB HILL FIFTH ADDITION
NOVAK-FLECK, 8857
C". ...,."lOr's Name & Address ~
ROBERT D. HUTCHINS --::':y,1' I City Planner
r:ni ~ V Date:
( -
14362 DOVE COURTI
Site Address _
ZEALAND AVE. N., BROOKLYN PARK
Owner of Building
DON RYE
Date:
POST IN A CONSPICUOUS PLACE
I~/ol
lJthX- ~,
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS / L/ 3 C, ,:)..
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
~ PLUMBING FINAL
b MECH FINAL
COMMENTsf.7f) ~ p~
~ ~.~ (rA-.~ ~
'-" ,'-"". I""'"
~~~
V\1/~ -oiL..
DATE TIME
/1,' "'(J
01 -roo1'
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
o WORK SATISFACTORY, PROCEED
~CORRECT ACTION AND PROCEED
o CORRECT WaALL FOR REINSPECTION BEFORE COVERING
Inspector: ~ ~I Owner/Contr:
/
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
INSNOTl
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH'" SAFETYl
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
/~3~ 2-
~
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING 0 PLUMBING RI
o FOUNDATION 0 MECH RI
o FRAMING @ 0 WATER HOOKUP
o INSULA TIO ~ 0 SEWER HOOKUP
~ FINAL ~ 0 PLUMBING FINAL
o SITE INSPECTION JV:Y Jll MECH FINAL
COMMENTS: ~,
m ~J~-l1
~d. ~ ~L -f:;cPL-. 0 ~
hA - ,., --+-- ~, I
..yv~~
~
DATE TIME
tojJr.,/o1
{!)I.,
II: fa
Of-bOP
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
~ ~t D, +-Jf ~/,)lJ Z-
, I
-
~~
o WORK SATISFACTORY, PROCEED
~ CORRECT ACTION AND PROCEED
o CORRECT WO~ CALL FOR REINSPECTION BEFORE COVERING
Inspector: ~ ' Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
INSNOTI
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
CITY OF PRIOR LAKE
INSPECTIO.N NOTice
SCHEDULED
ADDRESS 1'I3~d. DnvC- (r
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
cji(.fINAL
o SITE INSPECTION
CONTR.
PERMIT NO.
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
COMMENTS:
CtJ Ib [3,?X - () k...
brc,L~~ - O~
DATE TIME
ff2:JP'-OI If M
A/nvc,t-- F'/e{.;f.
(JI-~g
J!{ EX/GRAD/FILLING
. d COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
"J( WORK SATISFACTORY, PROCEED
./ 0 'coRRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: #tt? ~.~
Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYl
INSNOTl
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
143(, 2-
SCHEDULED ~llilO"Z, A, lJ
~~,
OWNER
CONTR.
PHONE NO.
PERMIT NO.
01-' or
o FOOTING
o FOUNDATION
o FRAMING ~
o INSULATION
FINAL
~ SITE INSPE T N
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
COMMENTS: S~Ti
1 ~ ~
u ~~~
AtA_d~ jJn~Ao"'l"';/-~'
- ~--. 1/
~ WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT W~LL FOR REINSPECTION BEFORE COVERING
Inspector: \'-"r Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTl
.-4
C)
C)
SI
Industria', Commercial' MuIIi-FImIty
ResJdentlel. Heatfng . AC
Resldentia', Healing Only
Residential, Gas Flreplece
Residential, Adclllons & Al.,atlons
R8lidBnllef, AC 0nI)'
CITY OF PRIOR LAKE
11.00 E.... Creek Av. 8.E. Permit No.
PrIor...... ... 11I72
1-(QoFl
TYPE OF STRUCTURE
I. I'iak . file
2..... . atJ
J....... . C....e_
Ad4k... .
Helling ContrlalDr ~ 'I (J (i Cl.r (> (') (' D
Addr... ::r~ "1 . (hrn me' J; (? iO A '5 \,. '(.:l..Q.rr ('\( ) (J (
Tel.....' '1 ( 07)- ',F)L/ - L/O(>)(})
.FUJINIGt MIIIce & Model ~ P~r:n . "PI! OF SYSTEM
~M- \GeZ~~_ W.rnlNrPJanas
MadIIS_ I r:> n I (')(!'(2) aravll1 . - AddllloNlllnspeClIons wit be b.. .. 135.00 each.
Com.lRoI -- ~~~.~ "" "on House ~allnlJ Test RecORt ~uat be submitted with buIkIDIl RlllDlIIIdmt beto.. buld-
Air Ccmdltlon~ II I -;:J' , 1_' I Ing cer.... of occupancy will be Issued.
Fuel l '}11 ::\-, FM Sfze Q I J Vent. SyIIem (if ,Q.n rom t.
o I:IEA1 ~ALctJl.AT'lONS ~EaUjRED wIh number of supply and return Gp&rings listed per
HEAlING 011 POWER PLAMT roDm with CFM', per opening. New structures or &dlllon. send floor plan with supply
Steam and return Jocstlons lhown. HEAT LOSS CALCULATIONS, PAYMENT AND
Hot Wat.r _ APPUCATIONS MAY BE MAILED TO THE CITY OF PRIOR lAKE, 18200 EAGLE
Radiation CREEK AVE. S.E. PRDR LAKE. MN 55372.
Spedal Devb. Oily Hal busIne.. hour8 are B 8.m. . 4:30 p.m.
Other DewIcH ALL WORK MUST BE M8PEI:TED CROUGH-,. AND FINAL) - CALL CITY HALL
441-4280
y
lWo-F.~
Inclustrlal
Slngl. FamIIv
Commen:iaf
Fee Schedule
OWner's Name
t
.
..
MuIII-FamIIy .
PuIlIIc Other
,% of ~ coat ($31.50 mlnlmum)
c: S99.50 _)
$64.50
$39.60
$39.5D
$39.50
Remember to add the SIaIe Surcharg8 on the bottom oIlhIJ appllca~n.
@$
...
I:
The price of your heating pen~ lncfudea one rough-Jn and one fln8llMpec:t1on.
lIo
o
~
...
u
\
1ft
..
N
..
...
..
..
N
.-4
CD
SuPPtt Opentnga
Return OpenIngs
Inplll / Of=). ~ Outpt,lt q I .000
Edr.
CIrn.
~na RepIIlaemenI New ConIIruaIion
Rlpalr EeL CoInp. DIlle ~ .
Ell. CollI a:~ lulling P,"""
HEATIG PERMIT FEE' CA .,1=13
to
~ STATE SURCHARGE I .50
5 TOTALP~MlTFEES ,. )fY). cx:2)Aec~',
C)
I hereby apply for a mechanical systems permit and t ackl1Dwledge that the
Inlormallon above is comple'e .nd accurate; that the work wilt be In conformance
with the ordinance. and codes of the city and with the slale buHdtnglmechanlc"
codes; that thl. form do.. not become a permit unlllllgned by the BUILDING
OfFICIAL; that the work will be In accordance wllh the approved plan fn the
..,_ ~ c.......~.. I WDr~, which requlr.. review and approval of pI.,a.. .
~{r, ~/~JoJ
au PAID \/V/TH () ~nt~.r .' Date
ILDJNG PER."il.IT ' /il/ 1t'lIOD LQI
BuUdlng 0IaI'1 _ lItUre ,,Oate'
nPl OFWOAK
re
2(
..
N
..
1ft
P4
~
OCCUPANT
HEAT LOSS
SOLD BY
Electrical Work By
TY P E 0 F HE A T GA _ FA _ )(
/J ^ Q(\ rGAS DESIGN
MAK E _ K il\E'eVVL -l \j'-
Model (d(..a.f-\-10e~A1S
Seria I es<\~7 P2.19<i Z I L/88
INPUT Ie$" [OCD &-cJ
ADDRESS /Lf3{;'c
THERM9HAT ~-.J
Valve \-t\.JJ
Limit Uv'\\J-<J~CA~
Limit Setting -I f.Cl'>oQ,('
Fan Setting J\~V\€ C)
Pilot Type (j~r.
Pilot Make uI\We/~
Pilot Model
t..>-:e... .
Pilot Timing
L. W. Cut Off -
.,. <; (I
Pressure :J. \,jJ.e
Input CFH. IV; 1~6
Stack Temp. I vii r-
Form 235
tl'..iL C~OUSE HEATING TEST RECORD
APT. FLOOR
OWNER
:J., n (
CIT~ nor ~5aURB
DA TE HTG. INST. Ie le/l
(
/() ,
INSTALLED BY !J< CCcu-
Gas Line By
SPACE HTR.
HW_STEAM.
UNIT HTR. _
OTHER.
CONVERSION
CONTROLS
Heat Plug
MAKE OF BURNER
Model
Mox. BTU Rating _
MAKE OF FURNACE
Model
--=:> ( I
Vent Size S
KIND OF LINER
,Draft Hood
Filters Size
Chimney Location
Chimney Construction
SIZE. NONF
RegulaTor '3C:S-:SJl)(
! t,,.. '1Z<;Y { -Number
Inside X Outside
1111'"
r ~ -
Smoke Bomb
Draft
Door Pres sure _
_ Wiring
Test Tall
Lighting Inst.
Percent CO2 7 '.~
Percent 02t".O
Percent co -0
{O)C;-!Ol
- /:::!t C' c.t
4>
'-
Form # 5
Date Tested
Company Testing
Name of Tester
PRIOR LAKE
INSPECTION RECORD
"
DEPARTMENT OF
BUILDING AND INSPECTION
SITE ADDRESS '4.k2.. OcJlJ-e.. at-.
NATURE OF WORK ')
USE OF BUILDING -.-S FD .
PERMIT NO. 0 I - 1.9 0 g DATE ISSUED &> -L./ ~ LocI
CONTRACTOR _ND~ - Eled c PHONE.2r..~ - 42tJ - <{j~
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INltPECTOR
DATE
I FOOTING f7:r( I 0/ ;-&(8 '(
FOUNDATION (Prior to Backfill) I ~ I 7/1 { /01
PLACE NO CONCRETE UNTIL ABOVE HAS BEE'N SIGNED
ROUGH - J.:NS
~CA b/l.R/()l
/ ~ 11(41
f;;:r 9/er/()J
(~ \w.,uA ~rnr 01
~ " '!)l.//(),'
k ~/ ~~~. '1$1
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I I
FINALS
It/ ~ -
~
,
SEWER I WATER I SEPTIC
FRAMING
INSULATION
ELECTRICAL
PLUMBING
HEATING (If required)
FIREPLACE
GAS LINE AIR TEST
f'k\~ oc>.-\,
\
().)
,
~
GRADING (Prior t~ Sodding)
BUILDING). 0.D \ fJf'illID1..-
ELECTRICAL .
PLUMBING
HEATING
DO NOT OCCUpy
V?!:n / () J /&(DI
10';7-0)
(1)-II'I/a 2-
. I
,J/e ~, It?/! / (N ;{, 10// 1,161
- ~I ./~'
I '
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.
Call between 8:00 and 9~OO A.IVI. for all inspections
FOR ALL INSPECTIONS (952) 447-9850