HomeMy WebLinkAboutPlg Permit 04-0011
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
/. 1.04-
REQUEST FOR FINAL
INSPECTION SENT TO
(Please type or print and si2ll at t_~;,__) H 0 MEO WNER 01-05
ADDRESS I lpL/-lpO ~9UA.dDn.a., Beach Ct rCl&
~~~. I PERMIT NO.OA... 00 / 'I
' Applicant r _
ZONING (office use)
LEGAL ~rSCRIPTION (office use only)
LOT.t:j~LOCK ADDITION DAt\n A~
\_rYJ 1 ~\
&~e~R ~~tttu, [:;Q/l
(Address) , U4-lPO ::tnq u.0J1 (JY1t;L B~
IJ
PID 7'-1_095. ()43. /
(Phone) I q 'D2)Q lRQ- I ?iJ.-q
Clr~
APPLICANT N or tJ IlrYV'l fJ LurrlIJ,. Y1 n
(Name) . ~I
(Address) ~05 tlar.ffetd /tV. So.-'
(Phone) (l.t 12-) <O~ 1 ~ '-/-0'33
I (V/, 0/5 . f:fS4D K'
(Address) (~(Zip Code)
(Contact Person) Jeff Nor 171 ()YY) (Phone) (LR /2--) g2-1- 4D33
PPLICANT SIGNATURE c#J~ DATE I 'lI2?;;/ ()::,
APPLICANT PLEASE COMPLETE BELOW
Type of Fixture Quantity
Bath Tub with or without shower
Dishwasher
Floor Drain
Lavatory (Bathroom Sink)
Laundry Tray (lor 2 compartment sink
Shower Stall
Sinks
Bar Sink
Water Closet (Toilet)
Quantity
Type of Fixture
--
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
Backflow Assembly Test
Lawn Sprinkler
Other
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 # 04-. DO / /
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
~.~
.50
40.~
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
Paid
4tJ < C/O
Dati. '7. 0 4--'
Receipt N~~ Z(}3
By A.
U
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714
DATE TIME
1/1~-
/~~60 .-k~c,~.#<4 ~-;.c.!
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
--(
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
.,...a:-PLUMBING FINAL
~ECH FINAL
C!f'</,:'- / /
o EXIGRADIFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
C~MEf9"S: /' / /1 /
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J ' I 1
urt?/~e d Ct~t; t 7~.j T
./"') I / A. ./
LbYHPVSJ?~ /5+1- C/rC-
.A/ / /1 /
/-//C L//1 / r-- .KL/-.J cl
~.&/ $'{//1;r1/302"tI;r)12
UL. LL'S.~~d .
~ ~
h~/
/
C/ /'-
~RK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: ~, Owner/contr:
/....--
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
/NSNOTl
HOUSE HEATING TEST RECORD ~
ADDRESS _ / b II W -J M4-'U!l-d(/f'A &at-J, ~T_ FLOOR .CITY IA~ SUBURB
...--- ,
OCCUPANT 'If -'OWNER
HEAT LOSS {i!fI{;C/,' pATE HTG. INST. /.;J. .J~ -03- ~'~." .
SOLD BY f/~~ INSTALLED BY '$. ~
Electrical Work By ~ :.- Gos Line By _. . 1'(", . .
TYPE OF HEAT GA FAX:: HW .STEAM _ SPACE HTR. _UNIT HTR. OTHER
/J , IJ GAS DESIGN CONVERSION
MAKE _K.t t..C1..,f' - .MAKE OF BURNER
Model II p'-P Y'" - 07 e,p;ne. K . Model
Serial :t/~J;I>7JtJ:; j:: '1t,I')~079'/~Max, BTU Rating
INPUT (., {""-1/ pt;fij _ MAKE OF FURNACE _
Model
I/!
THERMOST~T ~... I' - Heat Plug
Valve W, tv .
limit 1-// h/
Limit Setting' II' ZJ
Fan Setting 4 ()
Pi I at Type rs=-t:1UI
Pilot Make J"'/IR
Pilot Model 5 rt:}/ If!?e; </0//,0
Pilot Timing 7~,
L. W. Cut Off
5/'
~
Pressure /' I'
Input CFH~ i?
Stack Temp. :r'::;'/JD
CONTROLS
Vent Size n :t:' " / I'
KIND OF LINER r ~ L> SIZE>> NONE
Draft Hood RegulaTor _
Filter. siJ~)(Q<y.1 _Number_ I
Chimney Location I~side ~/ Outside _
Chimney Construction.
'."'-
"
Wiring _
Test Tag
"
Lighting Inst.
/2 -cfl.? - O.?A "
~~p~~~W2~/ ~
r::r;.Z;~ic .
v
Smoke Bomb
Draft
. Door Pressure_
'"\t...-
...,/
Percent CO2 t1 ~
- Percent O2 ~
- Percent CO ('!7
Date Tested
Company Testing _
Name of Tester
Form 235