HomeMy WebLinkAboutBldg Permit 05-0069
O~ PR/O",
.:.. j;.
5 I~
"'-'lVNES01."
Date Rec' d
I. II. CIS-
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
See Main File
While
Pink
Yellow
File
City
Applicant
(Please tvve or PI .ot and SiKIl at bottom)
ADDRESS
1'l4-~;f D",<.~.CT.: \cJt b.-Iv-€..- sf=
LEGAL DES :RIPTION (office use only)
LOVl-(,..BLJCK d- ADDITION l)e-<,r~,,:Jc.X. II+<-'
OWNER
(Name)
(Address)
(Phone)
BUILDER ~ n
(CompanyN,me) \..--1.1'-.. \-\D;'-\vi-o
(Contact Narre) A.Adl..L ~ vDk,^oJ~
9DglcO ~b--l c.R---,-c.- c.:t
LIIILL1Ji\\..... u II 5Sz,'4-'-I-
(Address)
(Phone)
(Phone)
I PERMIT NO. 05. c () (;, '1
ZONING (office use)
~2-
PID 25. 4--01. CJ4L? 0
'1S:t--~<6s, l~D8
'1Sd-;;d db-''-{ "\ ~ Cl-
TYPE OF WI JRK ~ew Construction rpDeck DPorch DRe-Roofmg ORe-Siding Ill1Lower Level Finish 0 Fireplace
DAddition DAlteration DUtility ConnectIOn D Misc. ;
CODE: ~R ,C. DI.B.c.
Type of ro~stJ Llction:
Occupancy Gr1lup: A B
Division:
r
E
II
F
I
mrVVA
H r M R
2 3 4 5
Id-.,-\, Sou
B
S U
PROJECT COST IV ALUE $
(excluding land)
~ I.L. ~/Fl.J..LL
W/o.
I hereby certify thai I have furnished information on this application which is to the best of my knowledge true and correc!. I also certify that I am the owner or authOrized agent for the
above-mentIOned p operty and that all construction wil!.conform to all existing state and local laws .and will proceed in accordance with submitted plans. I am aware that the building
Iltlicial can revoke t lIS pe~Ful1hermore, I hereby agree that the City official or a deSignee may enter upon the property to perform needed inspectIOns
X ~~_~ d-=O.:s <-".; , \llblbS
(/ Signature Contractor's License No. bate
Permit Valuatilln
Permit Fee
Plan Check F el '
State Surchargl
Penalty
Plumbing Pern.it Fee
Mechanical Pe omit Fee
Sewer & Wate Permit Fee
Gas Fireplace )ermit Fee
'1L/I. 0 00,0"
$ IJC; q . 5"0
$ '2N'I.tog'
$ ?t!J. 5'0
$
$
$
$
$
lot) . 0 eJ
100,0<>
3;;. $"0
'-/0,00
This Applicatil '0 Becomes Your Building Pennit When Approved
Build n,!!. Omcial
~~ 1-~
005
Park Support Fee
SAC
Water Meter ~zl5!J~; 1";
Pressure Reducer
Sewer/Water Connection Fee
Water Tower Fee
Builder's Deposit
Other
TOTAL DUE
/
Paid J 7 f-OJI
Date I. ~ ( ar-
I
I
I
I
I
00 I
--1
$??/746. /0 I
I Receipto, ff'-"'7.-.. I
By / . I
o
#
$
$ /o/s() ,00
$ 2-50,0'0
$ 5"0, <9 0
$ /500,00
$ /000.
#
#
#
.
$
ThiS IS to certify tf It the request in Ihe above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested This document
when signed by th City Planner constllutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a CertifICate of Occupancy must be
i"~~ ~ tIt<J/o~ See Main File
Planning Director ' Date Special Conditions, if any
24 hour notice for all inspections (952) 447~9850. fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
~~~
ue~
See IVlain File
White - Building
Canary - Enqineering
( _ ...m~ - Plannii'iQ>
rh~ ernr, r of tht L.k~ CoUnIT~'
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
N ~ME OF APPLICANT
/
/'(/ /1'/ r~1 ./
-
/ II (:)
'.
",
,f,
Ilt,
~
A :>pLlCATION RECEIVED
Tile Building, Engineering, and Planning Departments have reviewed the building permit
al >plication for construction activity which is proposed at: "
1/ ,/' /i.,$-..' 2 ! , , I ',. , ~
"7 '~L. l_! _;'-' (; ;" . (>'~./ <_J:. 1 (,C '1- J/ ...:..'" ./ ;J:
A :cepted
/'
Accepted With Corrections
Denied
Reviewed By:
~
~
Date:
;j19/o~
Comments:
See Mmn-Ime
"The issuance or granting of a permit or approval of plans, specifications and
( omputations shall not be construed to be a permit for, or an approval of, any violation of
1lny of the provisions of this code or of any other ordinance of the jurisdiction. Permits
wresuming to give authority to violate or cancel the provisions of this code or other
cl>rdinances of the jurisdiction shall not be valid."
/6<2" K/(Jfr
~1
',,--
lh~ C~nro ' of lh~ I..kr Counl')
See Main File
<-- While - Bvildin(f)
. Cana"ry - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NJ ,ME OF APPLICANT
All 'Ie ~7J
1_ 1/ OS-
AI'PLlCATION RECEIVED
n e Building, Engineering, and Planning Departments have reviewed the building permit
a~ plication for construction activity which is proposed at:. A
/74-82- /J)Pf//IjrfP'd/ kJ7AtA/Y' / r&:
Ac cepted ,/ Accepted With Corrections
De nied
Reviewed By:
~
~~
Date: ///~~S
Cqmments:
See l\iaIft--FiIt
"Th e issuance or granting of a permit or approval of plans, specifications and
corilputations shall not be construed to be a permit for, or an approval of, any violation of
an} 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
ord nances of the jurisdiction shall not be valid."
!~~
~~~'
,-~~
See Main F1Ue
While - ~ujlding
~ry - t:ng,"eerl~
Pink - Planning
ThO' ("..nIN "flhtl..k.. ('oqnl~'
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
Nfl ME OF APPLICANT
AFPLlCATION RECEIVED
. .'t
/U
> .,,/:;' .'
~-f;.../ .~<c' b. f /'""",-,
/ '__. ~~/-'7D'-71.(,lj
! / / c: ,,:;-
/
Th'l Building, Engineering, and Planning Departments have reviewed the building permit
apl llication for constructio~ activity which is proposed~t: i "
; Y'? d'c >=1 -, / r-, ~ " ..,/ ~/.-' " " - ~ ..../,.7 ')
/ / 7 -c) ~ i lV{(i// /L-( j/..t.:( ./ i CX,/)./U'-(./ L./ c{
I /
(,
A(".( 'epted
v
~ '--
Accepted With Corrections
Dellied
Re"iewed By:
/htJfJ,
Date:
J-2o.-C?!f
Cornments: )~~A ~r"'A !=;ide far Addman;:!1 I nfnrm;:!tirm I
~ f1)e,/V\ f,'{C-
---.J)PP Attachments. 1) Grading Plan. 2) Erosion Control Measures
"Tht, issuance or granting of a permit or approval of plans, specifications and
com putations 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
preSjuming to give authority to violate or cancel the provisions of this code or other
ordi~ances of the jurisdiction shall not be valid."
01/19/2005 WED 9:41 FAX 6513226147 GENZ~RYAN
~ 003/009
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
l. Blue: Yilt
1 Gold City
3. Y,lIow Applieanl
I PERMIT NO. ors.6tN'
ZONING (ollie. use)
(flease.,;vpe I ~r'Drint andsillJ1 acbottom)
ADDRES)
L2'1fQ Qr >,-r+;:t"JJ Ck. 5 ~
/f,j ~J~ . mL
. .
LEGAL r: ESCRlPTION (office use ooZy)
LOT 'JL9LOCK.;L ADDITION f)'~j", 1-/;.,.. IJ. I i J+-.
PID
OWNER
(Name) DR Horton Custom Homes
(phone)
962 . q 'if f=J - 7'3lJ{)
(Address)
2O'Sl.->D KeV7B~ll::><SG Co Sre.. 100
urlu.vi/IG ~UN .5fulN
APPLICAl fT
(Name)-Ge u-I'YS<l FJ'IIIl~<-t "-11-'.<-g (phone) -65.'-I,?>-".4.4
(Address) 1.745 So Robert Trail Rosemoun1,' MN
(Address) (City)'
(ContactPeson) . IJr-,'c,+; f;/!.:;, (Phone)
APPLICAHSIGNATURE _ ri;l.i jj~ ~ f jLJ.~___~.. DATE
55068
(Zip Code)
651-423-1144
J / /'1 lof)
APPLICANT PLEASE COMPLETE BELOW
I Quantity I Type of Fixture I Quantity I Rough-ins Type of Fixture I
I .1 I Bath Tub with or without shower I ") I
I / I Dishwasher I I I Water Heater I
I I I Floor Drain I l<i. I Water Sollner I
I .~ I Lavatory (Bathroom Sink) I I I Stand Pipe (Washing Machine) I
I I Laundry Tray (lor 2 compartment sink I I Sewage Ejector I
I / I Shower Stall I Backflow Assembly I
I [ I Sinks r~ I Backflow Assembly Test I
I I Bar Sink , Lawn Sprinkler
I J_ Water Closet (Toilet) I Other I
FEE S'-'W!.JJULE
Industrial, Cc mmereial & Multi-family 1% of job cost with a $39.50 minimnm Residential, New One & Two-Family $9950
Residential, Additions & Alterations $39.50
Estimated Cost $
Building Permit #
~\O W~R~\1
.508U\\..O\NG .J
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
(Office Use Only)
This Applicl tion Becomes Your Building Permit When Approved
Paid
I Receipt No,
I, By
Buildi Ig Official
i Dj~N 2 7 Z005
Ij '"
,
24 hour notiee for allln'pection, (952) 44t-9850, fax (952) 447-4245
na..
01/19/2005 WED 9:40 FAX 6513226147 GENZ-RYAN
~ 002/009
Date Ree'd
CITY ,OF PRIOR LAKE
SEWER AND WATER PERMIT
(f1ease.!V.E!7 Jronnt and s11tll at bottom)
I ADDRES) .
/7qffll- Oc..v-l'"?~'r:IA-n(\ St;.
. LEGAL rESCRIPTION (o1llce use only)
LOT ,"J(, BLOCK J.-. ADDmON ,De-1"'"[.{,' r-./rJ
/ / tf.-.
OWNER
(Name) --Jl R llQrt^^ ""^>QIIl IIQlIl:-
(Address)
2ofuO }(,ev)Bi<..Ib6e. C:r SwlN\
(Address)
APPLICA: IT
(Name; Genz-Rvan Plumbinl!; & Heatinl!;
.
~ ~"~:~ I PERMIT NO.., nolA'
l. Gole! ApplilWit ~
I ZONING (ofli<:<use)
fJrlnl Io.i-c ~
/
PID
(Phone) _
.La~villE'--,
(C;ty)
qs2,QSS-!JiV'\
&5f:::0LlU
(Zip Cocle)
(Phone)
651-423-1144
.
(Addre~) 14745 So Robert Trail Rosemount. MN 55068
(Address) (City) (Z;p Code)
(ContactPmon) . (.A.f'/~tr tr'"'" ,-" - . . (phone) 651-423-1144
. T..lCAlITSIGNATURE ( j L{,~.[-;) '-~/L1I~") DATE f Irq /0/';
. JV'
APPLICANT PLEASE COMPLETE BELOW
Size of water service inches.
Location of any couplings from structure
Type of sewer pipe. 0 ABC 0 pvc
Estimated length of sewer line feet.
Clean out (if required) located at feet from structure.
feet.
o Cast Iron
FEE SCHEDULE
Residential s ower and water line connection $35.50 Industrial, Com'1 & Multi-family 1% of job cost with a $39.50 minimum
Sewer conne :tion only $17.50 Water connection only $17.50
_+~aid_-
. [Date . .
1 JM 2 7 cGo] .
24 hour notice for all inspections (952) '\!I7dl850, fax (952) 4474245'
I
!-
Estimated Cost $
SEWER AND WATER PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
(Offiee Use Onl: )
I This Appli, aliGn BecGmes YGur Building Permit Wben Approved f
,
--
Buill :ing Official
Date
Building Permit #
$
$
$
.50 PA\\~:~~M\T
qU\\'O ,... ,
i
Receipt No.
I.
I
By
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
l. Pink
2, Green
3. Yellow
File
City
Applicant
IPERMITN05~ ~
(Please tvoe 0 ~ orint and silm at bottom)
ADDRES5
17482 DEERFIELD DRIVE S.E.
I ZONING (office use)
LEGAL D :!SCRIPTION (office use only)
LOT I ,LOCK ADDITION
PID
OWNER
(Name D] t HORTON
(Phone)
(Address)
APPLICAIIT
(Name)_ ALLIED PTRPSTnP, DBA PTR"STTW HEA,RTH & HOME
(Phone)
65]-633.256]
(Address)
2700 NORTH F AIRVIEW A VENUF
(Address)
ROSEVIT r p
(City)
55113_
(Zip Code)
(Contact Pe rson)
BRENDA HUSTON
(Phone) _65]-633-256]
APPLICM'T SIGNATURE
BRENDA HUSTON
DATE
2/9/0,
APPLICANT PLEASE COMPLETE BELOW
xD NEW CONSTRUCTION 0 REPLACEMENT 0 ALTERATIONS
FURNACE ..tAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM
HEATING OR POWER PLANT
DWarm Air Piants
DGravity
D Mechanical
DAir Conditioning
DVent System
D Steam
D Hot Water
D Radiation
D Special Devices
D Other Devices
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
FlREPLAC] , MAKE AND MODEL
Industrial, Co nmercial & Multi-Family
HEATN GLO SL-750TRD
FEE SCHEDULE
1% of job cust Residential, Gas Fireplace
$39.50 minimum
$99.50
$64.50
$39.50
Estimated Cost $
HEATING PERMIT FEE
STATE SURCH^RGE
TOTAL PERMIT FEE
Building Permit #
$
$
$
Residential, Additions & Alterations $39.50
eU b... $39.50
'l(,i:t'l() f1h...
~G ~:. ~
~-9A ~
..,,/~
.50
Residential, f eating & AlC (New Construction)
Residential, f eating Only (New Construction)
Residenti,d, AC Only
(Offiee Use 0, Iy)
This Appl ,cation Becomes Your Building Permit Whcn Approved
Date
I Paid
I Dale FEB
Receipt No.
Du Idine: Official
[; 2005 By
24 hour notice for all inspectiollS (952) 447-9850, fax (952) 447-4245
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FlREPLACE PERl\1IT
Cl >-3-\-c,'('(\ 1\.oil)2.S (phone) g?;::l...;q;(!3~ 7()(~
C _\;- . L--.c",Ke.'-l ~ \\~.JYll!
:'.:/' ~
. -"~'
',: -':,:-:.-<;'
'.-',,'-'-', ,-
CPleaservpe-orto!rint and"sigp.at bottOm)
, ADDRESS
,~(<~ \' y-"",,,- ':'
.~
CRIPTION (ofli~e use only)
,~ '
f\'"'\ I
\
=.. ---,
........;.-;"1
I, '\ ,
LOT BOCK'
ADDmON
'"
\'\\=r....\'" ,
-r: 'tV; . .
\)\,.
CAddIes;)
< \? : i\ ,\\p \;1% Q...
, .' . (Address)
on) . hb.';;zo"-I :-Rue. t-J ,
SIGNA:rUltB~-==..."t '- (
~- >){::) ':'
',-,-",,',:....,
Date Rec'd
F~:w ~:~i~' IPERMl!NO..q-IJ:,Cf
, ZONINGCoffioeuse)
\),.~, 3:::"'.._
PID
,(phone) 0-~1 _L,I ~~}-~:'l ~,'"
SZT'7_'~ 1E.4>A.c;.+-,.sJ:;\~~
(City) '-:"(ZiP Clide)
, rPhone) .i/.)~ I _J:.J:S:)'-d. I,\l)
,DATE I ,,: ' ;'\,\..; \:
-' ,', ' .",~:,;,--,.",."":..;.:::,:),,
, " APr'LlCANT PLEASE COMPLETE BELOW ',.'
......,-..-_.'
C-:'.;',
",:':\...
DREPLACEMENF" , DALTERA1T9NS', . . '.' :
slnA...6...\IQI../~o,go ' , FUEL N~ 6,f;.:S
(--; 'lNPTJi 'b 'b I onDOU1PUT'7o.. "'{on
:- '<:','.:::. ':',:"-;:-: ',:.-" -,"'.'...', -.-.-,:.... -...".,.... :",:. .... "'::".':~~.' .
HEATIN:G OR POWER PLANT
'. ' . . ':fiID:.rn.WCQNSTRUCTION
, FURNACE ~ rAKE AND'MQDEL:'l3t? YA..,,-n-
FLUE SIZE " . S' 1 " . " .. .... RETURN OPENINGS
rnEOF s.\;siE:r.1
~~:PI~~ '
'CJMechanital. ,
~~q~t;~f~;mg
FIREPLACE MAKE@!iiy1qDEL '
o Steam ,
o Hot Water
o Radiation.
o Special D'evices
o Other Devices
'~~~g~i~~~~i15 '
. Cannol Encrd.acl> inti>
. RequlriidSid&V';:ci
. Setba,~ks." "
-::':',_\("<i: '
, /.1,!;;'::
",--'-"
c::\:....:,-. ;......
;-''''--',
FEE SCHEDULE
1 % of job cost Residential~ Gas Fireplace
$39.50-minimum
$99.50
$64,50
rndustTial~. COllmercia1:;&:Multi..Family
Residential, H_ :ati~g ~A1ccN~~:qonstruction)
R~sidential, H :ating Only (l'le'Y'Construction)
Estimated Cost $
HEATING PER1v1IT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
(Office Use Onl y)
This Appli cation Becomes Your Building Permit When Approved
Building Official
Date
24 hour notice for all inspections (952) 44i-9850, fax (952) ..J47-4245
S39.50
Residential~ Additions & Alterations .- '$39.50
B:::::~' ~;
~I)-
$..k)/\'\" \"\ec
$ .50-
$
I Paid
! Date
Receipt No.
FEB 2 4 2(O~Y
PR.IOR LAKE DEPARTMENT OF See Main File
i BUILDING AND INSPECTION
INSPECTION RECORD
~ . .
SITE 6.DDRESS /?~ /)/iFIt.,:) 'J/,. S;€t
NATURE OF WORK AI'~ t"MWt:...M.t~,..:). rl;'~ ~.
USE OF BUILDING s.~ A. - ~
PERMIT NO. os: ooro 9 DATE ISSUED I //9/d ~
CONTRACTOR ~. ~rlJ~ 0Nt. PHONE-'-D. 2.'ZJ- · 'hI1.
Non:: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
. THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR, DATE
I FOOTING I /#f/' I ---?/pZ/dS
I FOUNDATION (Prior to Backfill) ,n.,..-.-VbUV/ dfi' I .?;%~{-i-j
'PLACE NO CONCRETf UNTIL ABOVE HAS BEEN' SIGNED
ROUGH - INS
SEV\ER I WATER I SEPTIC #?-: -2 L~Y k-
FRAMING ~ Zfkj~r
INSl LATION ~ r()Jp:s
ELEl:TRICAL f/?/~r
PLU~BING (/, C M J"O..,ks.-' ./Hf!~I_, 'i/6/oF
HEA ING (if required) ,...... r v}ey" f
FIR PLACE #'iY Y/IJ/~
GASLlNEAIRTEST~). 1-// ~ 7Y7~S-
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
llA)'Hr / ,.~~JItAI'.. I I
~-4c/ /3,(";'/,/ FINALS
GRADING (Prior to Sodding) ,...S~e A~/4 hie>
BUI'1DING ~ 6;/56.1:
ELEcI;TRICAL ~/..AJ/<.p"
PLUIIIBING J%I;f S /I?/or;
HEA"(ING ~ &//J7~
IDO NOT OCCUpy UNTIL ABOVE HAS BEEN SIGNED
NOTICE
This card must be posted near an electrical service cabinet prior to rough-in inspections
~nd 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~difirab of <IDrrnpaurtt
CITY OF PRIOR LAKE
~tpatfmtnt of '!JlluilMng Jlnsptdion
/
lZi'Final Permitted [J Conditional e.O. Expires_
I
This Certificate issued pursuant to the requirements of Section 110 of the U Residential / 0 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 05-0069
Use Classification Bldg. Permit No._
Occupancy Type
Type Construction
t26, B2. DEERFTELD 11 TH
R3
VN
Zoning District
R?
Legal Description
Owner of Buildin!:!
D. R. HORTON. 2086}l KENBRIDGE COURT, LAKEVILLE, MN 55044
Contractor's Name & Address ~ 7"......"
ROBERT D. HUTCHINS ~~
/ j-"it - _ City Planner_
Date -4'// s~rOffiCial
Site Address
17482 DEERFIELD DRIVE SE
,lANE KANSIER
Date:
~'"
,. 0 ~ .' . ..",
DATE - TIME
CITY OF PRIOR LAKE / /. d
INSPECTION NOTICE SCHEDULED t:7/ /'J / oS~
ADDRESS /7?"?2 Lke'rl2~/ ff
COM"ENT~ ./
ECCp./~ I
/~~~: /;dq/'- / Ot<:J /
- /feC~ved. .!3rs<:T? ;r-
~....-." --- ~ _./
h,t-c- ,/;;"'C c::.. /---h-v I' 0/<-.
, / // /)
A~~4 ~/./J'-'~~
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o JlISULA TION
~FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
~CH FINAL
...___... J ~
~~ f dA.-C-
-
0)
~'
/;h<:t. ( ctJ;{'
---~.--.-~
os-- ~9'
o EXIGRADIFILLING
o COMPLAINT
o FIREPLACE RI
~EPLACE FINAL
o GASLINE AIR TST
o
/' /
r/.z3ht-
, .
dve~ f/
I
-~''"--
h7~~
------
~/
( / ../t:<.(-e-
'-..-
%~ORK SATISF"", w"',', PRO('''lil1
o CORRECT ACTION AND PROCEED
o CORRECT WOJ~#>R ,!lEINSPECTION BEFORE COVERING
Inspector: ~ Owner/Conte
CALL "7-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
INSNO"
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
J_
DATE TIME
SCHEDULED ,~~
#~yA(;{ A
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
/7L(J.J
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
o PLUMBING Rl
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
..,Ii"-Pt.UMBING FINAL
o MECH FINAL
COMMENTS:
~.-.-o~c-h' ~,r~
~ /
/-?hy/
((5/
/'7.r-6?
o EXIGRADlFILLING
o COMPLAINT
o FIREPLACE Rl
o FIREPLACE FINAL
o GASLlNE AIR TST
o
r'~~
6; A/~er/ /WTt/ J~ r;//.ec/
.
/
v// t" J
o WORK SATISFACTORY, PROCEED
~ORRECT ACTION AND PROCEED
o CORRECT W~R~ 3'h~OR REINSPECTION BEFORE COVERING
Inspector: /Itff-- Owner/Conlr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
INSNOTI
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY/
.
...-
APPLIANCE
PERFORMANCE TEST
Attach to gas lina adjacent to flIgulator
Heating Contractor
Nama of Tester
Date
Job Address
Heating Contractor
Name otTester
Date
Percent 02
Percent CO
Percent C02
Stack Tamp
A//;Hr? .--~
h4>113
5#7/P5
/7'117.... ~,.av
M~/1f,.L4/
.A~.B
5~)~S--
7,,1 7:J
~......
i2~'
,371 ?'
UMC Sec. 606
Combustion air is adequately supplied per
input
y~
~a~