HomeMy WebLinkAboutBldg Permit 04-0563
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Main File
I. White File
2. Pink City
J. Yellow Applicant
PERMIT NO. 04. 05 v,3
(Please type or print and sign at bottom)
ADDRESS
)7Lf~f~;;dd DzrixX'
LEGAL DESCRIPTION (office use only)
LOT5 BLOCK I ADDITI~~ ~ dd 111"'-
OWNER
(Name)
(Address)
Date Rec' d
s-Iq-(J(j
ZONING (office use)
~d-
PID;;> 5 - L/o1- ()()5- (>
(Phone)
BUILvtK~~ I I 1 '
(Name) ~ll<~<ti()rtr')Yl ~~ .
(Contact Name) ----cLt-l+z- ~.(~
(Address)
(Phon(~ )985-7853
(Phone)(95~ )~ ::2 ( - r::s3 tJ
- ../ -- .
TYPE OF WORK
~ew Construction
DLower Level Finish
ORe-Roofing
o Misc.
DDeck
OPorch
ORe-Siding
o Fireplace DAddition DAlteration DUtility Connection
PROJECT COST IV ALUE (excluding land) $ /21, (p S ~
,
-,
,..\ '
I~_c;t). 00 I
.;::)~"(), 00 I
- L/~_ 00 I
.J! ~,o~\ I
rJ tJ() IOU
}, ;;-01 ,()O
. This is to certify 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
:~ed by the City Planner constitutes a temporaty Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
VOYl RY-Jt nfj) -0-Cf-/Jt/
PlaP~ing Direct!:..? ~ 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
I
(l1:~.td_e~?B I
Receipt".y6. f'1I t;rrs I
B ./'/ I
y .
$
$
$
$
$
$
$
$
I~(J.(}O
//)(J,OtJ
35.50
'-IOO()
I hereby certifY that 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 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 Juilding official can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a desyee may
~ ~ I the property to ~'~v~. ~~ons. dlXD5f.oS~ 5-/7 r (J r
J Signature . Conttactor's License No. Date
1cJ..5. 000 I Park Support Fee # $
Jd-03.~ I SAC # $
7 R:J.. ~ I Water Meter Size 5/8"; 1"; $
t,;;L _ ~~ ( ) I Pressure Reducer $
I City SAC and WAC # $
I Water Tower Fee # $
I Builder's Deposit $
IOili~ $
I TOTALDUE
7..JlPf,li
~J<{t/'1
I Permit Valuation
I Permit Fee
I Plan Check Fee
I State Surcharge
I Penalty
I Plumbing Permit Fee
I Mechanical Permit Fee
I Sewer & Water Permit Fee
I Gas ~e Permit Fee
/ / /I
{;" 'rYO~B-;:?O~d
1fficial 6ate
II
I Paid
I Date
(;
Main File
White - BuildinL
~arv_ - Enaineer~
Pink - Planning
The ("rnlu of ,he I.ake Counlr)"
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
..r"",.,
NAME OF APPLICANT
F
I k /"("
c-S'-- /Cf -()L/
i c !.., '
I /'1-....,. /'~~-.'...,A /'
i i.J i ..:,.-,/ ,r"',,-'-
APPLICATION RECEIVED
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity whicll<<is proposed at: f,
/ /')> / ~ J_ .J /'.ji ./J '.''! "" )" &,1._// I . / , L
/ I ~ ::->1 "f't. '<-.f:..e.e.'/':(f~Le--C~A~ /.,Ci''JA.-/'j/--t.-.-
Accepted
.X:
Accepted With Corrections
Denied
Reviewed By:
/IJ1J3
Date:
6 - g -0 ~
Comments: See Reverse Side for Additional Information!
!flDt/~ ~d(J
(Yl"'fA fillY'\. ~- rc;9Q-- (61;\k(> (
l/ VI " ( 6IPt:I
I) plettd
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."
Tht" Ct>nft"r of Ihe 1.8ke Counlr)'
SWhitp -1=WikI~
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
/ J2 R rjj&7~~
~5- !C( -()LI
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity whic 's proposed ~t:
17t/3/- . cf ~
(/
Accepted
Accepted With Corrections
x
Denied //1 /) 0
Reviewed By: //'1 ~
(?l-- '7
~ a-fdl
Date: (p ,. l.{ -0 c..--.
~ --r:
Comments:
"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."
Thl' Cl'nler of the Lake ("ounlF)"
White - Building
Canary - Engineering
C-- ~I~ - PlanninO
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
i
i
\
'>' ./
/'
,,' I -(~.J/
~
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
;//111 3/ - i/ /1/,: r{/J I' ..~
.~<<
Accepted X Accepted With Corrections
Denied /J
Reviewed By: I / f' Ah) Date: t:, - t(- a L-----
~~t ~ l/
Comments:
"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."
Mav.25, 2004 9:40AM
GENZ RVAN PLUMBING AND HEATING
CITY .OF PRIOR LAKE
SEWER AND WATER PERlvllT
No,8581 P, 6/13
Date Rec'd
(Please me or p.rjnt <U:ld sip;na.t bottom)
ADDRESSl143l DaafJe(J D>1-. &'E
i ~:U:w ~~ PERMIT NO.d. C J ..~
, Gold Appr.~t ~ CiI u ~
ZONlNG (CIfij(:: u!e)
LEGAL DESCRIPTION (o.ffi.cc use: only) .
LOT 0" BLOCK I ADDITION [)u.l2n 'e/4
( 11V1
PID
OWNER
(N'ame:) '['p_ ~?rto'q CU!it()m-R<;--~~
(Address)
.2.o&.DO ~eK\!X::e. C:r- Si7Jm
(Address)
(phone) _
. Lakt,\J i lIe...
(City)
qo2-Q85- ,g{Jf'\
.&?C:OL! U
(Zip Code) .
. APPUCANT
~~) Genz-Ryan Plumbin2 & Heating
(phone)
651-423-1144
(Addr~s) 14745 So Robert Trail
(Contact P=on). 011I2:it ~ fit It \
..',iJCANTSIGNATURE (.l1.u~
Rosemount. MN
(City)
55068
(Zip Code)
,-fJ A (:phone) 651-423-1144 r
L11.J:j/J- DATE Cj~2); tJ4
APPLICANT PLEASE COMPLETE BELOW
Size of water service inches,
Location of any couplings from structure feet.
Type of sewer pipe. D ABC 0 PVC 0 Cast Iron
Estimated length of sewer line feet.
Clean out (if required) located at feet from structure.
j:l.t;E SCHEDULE
ReSidential sewer and water line connection $35.50 Industrial, Com'l & Multi-famlly 1% of job cost with a $39.50 m.inimum
Sewer connection only $17.50 Water connection only $11.50
Estima.ted Cost $
Building Permit #
SEWER AND WATER PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
.50
"~@9~. ~..>1. '-/"'7\
""'(.i W-6
" ~1~ ~~
~10 /",
.;~;:
"~)2
.y';4'?,~~
.',
(()fIlce Use Oaly)
I
.....~
Building Official
I r]f~ @ ~D ill ~1~cefptNo.
- f1. JlJN 1 5.2a04 11!
24 hour notice for sU lAspectloos (952) 447-980, fax (952) 447-4245
By
Date
0-
This Application Becomes Your Building Permjt When Approved
9:40AM GENZ RVAN PLUMBING AND HEATING No.8581
CITY OF PRIOR LAKE PLUMBING PERMIT
(Please tYPe OJ: 'Pont and si/?Il at boaom)
ADDREi1L[31 . 1)ee-2::-,'etd b~ ~E
LEGAL DESCRIPTION (office use only)
LOT r;; BLOCl{ I ADDITION 'tJRJf'7 __+7 e,( J
ll~+1
OWNER
~am~) DR Horton Custom Homes
APPUCANI'
(Name) G.."'?-i.3':,T' ~, ..",'h~.f,,~ Jj, :!iQi,ti:l.1:; (phone)
(Address) 14745 So Robert Trail Rosemount
(AfJ.dress) (City)
(Contact Person) ~ fA ( I \ ~ /) ~ (phone)
APPLICAJ"l'T SIGNATURE ( ~~ ~D
(Address)
..,......
.1. .~,~ ".
Quantity
'7-
I
t
.~
1
I
1-
2-o'S~o )(b1 B~ l tx::e.. Cr Sre I DO
p, 7/13 ,
.............. A'~C d
~ ~~ ~ill<anl I PERMIT NO. q- 5 h~
ZONIN'G (offi~U$e)
PID
(phone)
962 - q rf Fl -78DC)
UiUV( I k:.. HA ,'-.1 E6b~ L/.
~ c; 1 _h.? 1_ 1 1/,1.
MN
55068
(Zip Code)
651-423-1144 J
DATE C)-2);" iJ
APPLICANT PLEASE COlVlPLETE BELOW
Type of Fixture
Bath Tub with or without shower
I Dishwasher
I Floor Drain
1 La.vatory (Bathroom Sink)
I Laundry Tray (r or 2 comp<u ","uent sink
Shower Stall
Sinks
I Bar Sink
I Water Closet (Toilet)
Quantity
7 .
1Z-"f
1
I Type of Fixtul'"e
I Rough-ins
I Water Heater
I Water Softner
I Stand Pipe (Washing Machine)
I Sewage Ejector
I Backflow Assembly
I Bac.kflow Assembly Test
I Lawn Sprinkler .
I Other .
.rJ!.J!.S'-.l:lLDULE
Industrial, CommercIal &. Muln-family 1 % of job cost with a $3950 minimum Residential, New One &. Two-PamIly $99,50
Residential, Additions &. Alterations $39.50
EstlIllated Cost $
Building Pemit #
PLUMBlliG PERMIT J:<~~
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
(OffiCI: Use Only)
r This Application .Becomes Your Building Permit When Approved
Building Official.
Datt
50
~~
~
~~!
~.:/ v".,/
.~~
~g.?,-
~/"
r/
p~ ~ ~ L0 [E 0 ~ ~B~ iptNo
J)J~\ JUN 1 5 ZOOt ES
.II
I$"
vV
24 hour notice for all inspections (952) 447-9850, ~(952) 447-4245
/1.Jy11tt.!S
CITY OF PRIOR LAKE . ----rv
HEATING/AIR CONDITIONINGfFIREPLACE PERlVuT
Date Rec'd
(please type or print and sign atbottOln)
ADDRESS
~:~ ~!~, I PERMIT NO. l J_. cJ 2
J, Vellow Applicant -, .:J ~
IlL/if
'te~ rO ~ f~\ Dr.
ZONING (offiCe use)
Sf
LEGAL DESCRIPTION (offi.c~.tise only)
LOT
BLOCK
Aill):qITION
Pill
OWNER. D R HORTON
(Nam~)_ 20860 KENBRIDGE CT
. ...i ... LAKEVILLE, MN 55044
.... €~d,dIess)
(phone)
~PLIq.ANT-
(Na.m.e) ALLIANT MECHANICAL INC
. 3650 KENNEBECDR
(Addfess)_ EAGAN, MN 55122
651-452-2775 . .
(CorttactpersyuJ. . .AGt.?'~<.~~~h
APPLICANTSIGNA~./~~jf~7!
'. (phone)
(City)
(Phone)Jl6113
DA1Eeh ~j1J4
(Zip C6de)
~~C~~STRUCTION DREPLAC~~1'fF. ' .
FURNACE MA~/ANDMgR~~>2iht~ \- .. 3J () AA~ <.'J'f;) OC(O .'. ..
FLUE SIZE $. .'. ..)')"~'fl1RN OPENINGS f;;,INPUT .~.8j. o~ 0
'I'YPEORS;VSmEM HEATING OR POWER PLANT
. []t<\LTERA.. ..'TI... ON.S
'. . ....l: "
FUELJlJI:r
. ..... ',', "C,"
'. - '_._d"',, "',", . ',.....,
APPLICANt PLEASE.CO~J1Ei'F:lJELOW.
OUTPUT 7a~$t:Jo
owaim Air, fllants
DGiavity' ,. .' .
D~ec~aI1iCiil .
.Jd6fr Co~ditioning
j8;~rent~Sr,~~fI1...
o Steam
0' Hot Water
D Radiati.on
o Specia1E:>e~ices
0' Other D~yices
P~EA~~.~~~F.; ........ ...
, A~qbnditjoIle,rUnits
. GannotEllc~q~ch.into
Requrred ~if::l..eYard
Setblicks '
Industrial, Commercial&. Multi-Family
FEES'-.tl~DULE
1% of job cost Residential. Gas Fireplace
$39,50 minimum
$99.50 Residential. Additions & Alterations
$64.50 Residential, AC Only
FIREPLACEMAKEA:@,rvtQPEL.'
. . ..'. ...... ............,..",."...
$39.50
Residential, Heating & AlC (New Construction)
Residential, Heating Only (New Construction)
$39.50
$39.50
HEATING PERMIT FEE $
STATE SURCHARGE -$ .50
TOTAL PERMIT FEE $
b~"
"~r~
'"';)f r~. . ". .. .'.'~.'. ~~." I!
- ~'I P r""W;"t'!!! '13-,:/ fJ rrfJ
../V', "1'\:> ~(Q)
. ,. ~/'flb'1JJrv
Estimated Cost $ Building Permit #
(Office Use Only)
Building Official
(~~ @ ~ U ill D:rleiPtNO.
I 1~1 JUL 7 2004 I tJ OY
24 hour notice for all inspections (952) 447-9851EfyX (952) 447-4245 U
Date
This Application Becomes Your Building Permit When Approved
Page 1 of2
Lynda Allen
From: Christa Wegwart [WegwartC@hearthnhome,com]
Sent: Friday, July 23, 20044:16 PM
To: Lynda Allen
Subject: Prior Lake Permit
By
@Leilill~~~ ~ ·
JUL .2 6 2004 ,I
-.J
!1~,/'l'tL!~ r,.
'~j~~~~\
~~l:(:",~,r;~
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE
PERMIT
n
L Pink File
2. Green City
3. Yellow
Applicant
~3
PERMIT NO.
(Please type or print and sign at bottom)
ADDRESS
ZONING (office use)
17431 DEERFIELD DR
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name) DR HORTON
(Phone)
, (Address)
APPLICANT
(Name) ALLIED FIRESIDE DBA FIRESIDE CORNER
2561
(Phone)
651-633-
(Address)
AVENUE
2700 NORTH FAIRVIEW
ROSEVILLE
(Address)
55113
(City)
(Zip
Code)
(Contact Person)
2561
BRENDA HUSTON
(Phone)
651-633-
APPLICANT SIGNATURE
04
BRfN/)A HUSTON
DATE
7-23-
APPLICANT PLEASE COMPLETE BELOW
X NEW CONSTRUCTION REPLACEMENT AL TERA TIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT
OUTPUT
TYPE OF SYSTEM
Warm Air Plants
Gravity
Mechanical
Air Conditioning
Vent. System
HEATING OR POWER PLANT
Steam
Hot Water
Radiation
Special Devices
Other Devices
PLEASE NOl
Air Conditione]
Cannot Encroa(
Required Side'
Setbacks
7/26/2004
~"-S"lf
PRIOR LAKE DEPARTMENT OF Main File
~ BUILDING AND INSPEc'ti~N
INSPECTION RECORD
SITE ADDRESS /1~3' ~J.& Ot ..
NATURE OF WORK N(tA., ~
USE OF BUILDING ~ {:"V\
PERMIT NO. O<f. 06(,3 DATE ISSUED ~~ t..{-o y
CONTRACTOR ~ \bt~ PHONE ~u' 1'S'3<{
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
.. I
,
~~~fr~
, . ,
, FOUNDATION (Prior to Backfill) ,.,..L,t ,.v.-H ~~ I ~;l/-
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS /
SEWER I WATER I SEPTIC ~ ~//i"/~,
FRAMING ~ ~//7~~
INSULATION . /fijt ?p:;/<Y<f
~~:~~{?!q9~ir~) '?/~T/;r' n . ~Irt_~
FIREPLACE ,~ ~ ~S
GAS LINE AIR TESV'/tz,,~ f-hfJ /ti?' 010/0:;--
"
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I I
FINAL~ _.
.. GRADING (Prior to Sodding) , I N I.:; .
BUILDING~p?tJ, (cJ,i!;tf-;1 djr /~d>/Ak
ELECTRICAL ' . / I .
PLUMBING:t7~ ti-, ~j1r ';1I1JT~
HEATING I
INSPECTOR
DATE
, FOOTING
Q
fffJ
cr. (). J. D--l
IIRI ~7M~
9/?2/C;;Y
7'/2Z/~
// /f ft~
. /
BEEN SIGNED
09 NOT CWCUI1Y1NT'L ABOVE HAS
Ja,€'r kt/,t/ ,~ Vj4 j?tz /ob~ 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
QIrrfifirafr of <IDrtUpaurl!
CITY OF PRIOR LAKE
~tparfmtnf nf ~uil~ing Jfnspttfinn
,~inal Permitted 0 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 04-0563
Use Classification
Bldg, Permit No,
R3
VN
R2
Legal Description .
Type Construction,
L5, Bl, DEERFIELD 11TH
Zoning District
Occupancy Type
Site Address
D.R. HORTON, 20860 KENBRIDGE
Contractor's Name & Address ~ - .~
ROBERT D. HUTCHINS~~
:flY ~ City Planner
9' bd-' %~ Official
,
17431 DEERFIELD DRIVE S.E.
COURT, SUITE 100, LAKEVILLE
DON RYE
Owner of Building
Date:
Date:
~':,,~'__.,___l'ln'i 'l't..MiridifMA
~ ~
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
/7&/3 I
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
~NAL
o SITE INSPECTION
DATE TIME
SCHEDULED // /9 ft~
/ I' I
;}eey/!r. /c/ 4/
CONTR.
PERMIT NO.
6>L/- .s bJ
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
~CH FINAL
o EX/GRADIFILlING
o COMPLAINT
o FIREPLACE RI
"Ji8 FIREPLACE FINAL
o GAS LINE AIR TST
o
9ME;NTS: _ ./ I I
~/.eCmc~ I ,/7'h&tJ ~~~ ~~2ft(
///~4: i ,l=ii~ // CJ~ /
~ce/l/-e d c91'.f"4' /- 7tif /'
,
../ / -" ,.
/i/~.tJ/4f-e. ,hhrz/ &?~ /
~/ Uhe ~ ~'?J 'h/cf
-- / /
F/lq / CJ/t
~ ~/ / .-- / ~ " .4' /
(j/ /f/eu /;h~ / cb--;:~d~ //#Jr~VV I
"/
?f;# c: 0- ~i;/ f7~j;J
o WORK SATISFACTORY, PROCEED
~ORRECT ACTION AND PROCEED
I 0 CORRECT WORK.~AL OR REINSPECTION BEFORE COVERING
//~
Inspector: ~ vi Owner/Contr:
"
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
IIVSIIOTl
DATE TIME
CITY OF PRIOR LAKE -...k ; L _ /
INSPECTION NOTICE SCHEDULED >>"p~
ADDRESS / /~)I tJ~<?rlJe if. /k
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULA liON
o FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
~BING FINAL
o MECH FINAL
COMMENTS:
~~~/C,-
/' -4
/~r
~ /
r/ h~ /
(
(!J-~.~/ ~~j-~
/' /
rh-ec Ie- GJ
Jt? //
~/I!/~
/
~/C
..
~
,
C' ~ ~S6 ')
o EXIGRADIFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
/
r~/
~, -
/ -
c-,/ ~
r-; /
/7k:;, /
'r
o WORK SATISFACTORY, PROCEED
)d. CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: ~
r
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
Owner/Contr:
INSNOTl
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS /71./31 Dcet'(',~fI DI'.
OWNER
CONTR.
PHONE NO.
PERMIT NO.
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
COMMENTS:
G~- 0/<"
Cvlb &?' V I(
DATE TIME
'.lJ 'Q}
D.~ J-I"./~
dI- SfJ
~~LLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
S .j-.r-
~ORK 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.
I/ISliOTI
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY/
PATE TIME
~r
/743/- 174-..35 D66j!!!.,C/(;;I-O
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
o PLUMBING FINAL
o MECH FINAL
SIT
( -
COMMENTS:
h~ //
10
/
O/C
,
4- - 5Ce0
o EXIGRADIFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
~--_._'--,.._-' '.'--,
~'~
/ .. ~')
~/ ~-%s~ r/~~
.J:1: -------~
/~ ~ORK SAT r",~ I 1.1" I . r r\V\';ccu
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL F R REINSPECTION BEFORE COVERING
Inspector:
Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH cl SAFETY!
/NSNOTI
Job Address /7-Y3/ ~d/
Heating Contractor ~14fi?? Afl#
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Name of Tester
Date
Percent 02
Percent CO
Percent C02
Stack Temp
Combustion air is adequately supplied per
UMC Sec. 606 y/S'
input / t1c? (IZItJ