HomeMy WebLinkAboutBldg Permit 01-0579
~~
QATF RFr.FI'lIOQ CITY OF PRIOR LAKE
5-24-0/ BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
-DIRECTIONS 11. DATE
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT [S ISSUED (Please Print or Type and sign at bottom)
2. SITE ADDRESS I 4 /\ =- =- 0 I
,,-"" _ ~ [)oVe.... r. '"' I I r+ "-
3. LEGAL DESCRIPTION
LOT ~ BLOCK 3 PID 2.:5-3bE;- 034'0
ADDITION~1 ~tj,
4. OWNER (Name) (Address) (Tel. NO.)
5. ARCHITECT
~~'k.F1ec1<, 'nc.
tltllttJniujI..i.."u ;"Yo. 1(.
Brooklyn Park, MN 55445
1(,3 -(6'ti'),424-4955
(Name)
6. BUILDER
(Name)
1. White File
2. Pink
3. Yellow licant
Permit No.
.
(Depth)
2~mn
I 13. TYPE OF CONSTRJTION' . I
;"'fll. ~ Si!fbhaL
14. FLOOR AREA APPORTIONMENT USE
(Tel. NO.)
(Tel. NO.)
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
.
SEATS
7. TYPE OF WORK
New Construction 0
Fireplace 0
Alterations 0
Deck 0
Finish Attic 0
Re-roofing 0 Porch 0
Re-siding 0 Finish Basement 0
00
Septic 0
Addition 0
16. PROJECT COSTNALUE
.;LOO , ~ c)o .
[~~L.Ei'B!~1
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES 19. PROPERTY DIMENSIONS 110. CULVERT SIZE
Sq. Ft. Width Depth Yes No
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 aU construction will conform to aU existing state and local laws and will proceed in accordance with submitted plans. I am aware that the
:Unt~Okq;n~tfO:jUst~~~hhallheCi~OfOOd6rr;,3tnfueprope~lopertO~:1~~ib
SignatureJ . license No. ' Date . ,
SETBACKS: Required
Actual
FOR ADMINISTRATIVE USE
Wale' Mele' ................................. $ /2tt:'.A-rsL
Sewer & Water Connection Fee ........... $ II 2. C) r.J . on
Water Tower Fee ........................... $~(!)/1 ...'!'!l..t:l-
Water Tap ................................... <t:
Builders Deposil ............................ $ 4. SL:7/f". 1:z1
,
Other ..........................................c;,
Paid Ti5{Jf;PF...~~~i~;~o$<~~?Jl'(
Dale (P-I!f-Oj By ix:' ~
at the request in the above a~lication and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as req~d. This document when
anner constitutes a temporary Certificate of Zoning compliance a allows c nstruction to commence Before occupancy, a Certificate of Occupancy must be issued.
c....-_ Jz.i..J!.k::J\., <:.
iIy Planner Date Spe lal Conditi s ~ any C
Front
Back
Side
BUILDING DEPARTMENT VALUATION
OFF STREET PARKING
SPACES REO.
USE OF BUILDING
SF'D
SPACES ON PLAN
PERMIT VALUATION ~
~/
TYPE OF CONSTRUCTION: I II III IV V
OccupancyGroup A B E F HIM R S U
Oi.'iM12'. fL- 7-
Permit Fee ................................... $ 1 :::)~. ....
Plan Check Fee ............................. $ I, 0"(. If't
StaleSu"'ha'ge.............................$~tJt'J. e
City:
Penalty ............................... ........ $
~\
\D' \11
Plumbing Permit Fee ....................... ~
I~o. DO
I~O.t:) 6
'3G:50
f.h _ I'X"J
Mechanical Permit Fee ..... ................ $
Sewer & WaterPennit ...................... ~
uilding Permit ~en Approv~ .. /
Date - q ":,It?q(
Issued
MATERIAL FILED WITH APPLICATION
Side SOIL TESTS 0 ENERGY DATA 0
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS 0 SETS
SURVEY 0 COPIES
~. aJ.. PLOT PLAN 0
Amount Brought Forward .................. $
Park. Support Fee .... .... ................... $
SAC ......................................... $
Collective Street Fee ......... .... .......... <f;
Sewer Tap ................................... <!:
sfr. <f;
Pressure Reducer ........!.2:t............. <f;
Meter Horn ................................... <f;
RC;-CJ.nC>
1./5'n .n;?
, .
45, ~ '"
24 hour notice for all inspections (952) 447-9850
.._-,,------"~-.-...__.."
.~
~e~
White - Building
Canary - Engineering
Pink - Planning
Thr("rnlnoflhrl..Iir{"ounlry
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
N()VA~- Ft.,ECt:-, I N~.
5 - 2-4- - 0 I
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
J44q5 DDV5 ('J)U2-1
,
Accepted
Denied /01
Reviewed ~ V I
~:oo a~~-J
Accepted With Corrections
Date:
c- tj-;)oo(.
"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,"
~
;
Thr("fnttToflhtl.lhCounlry
White - Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CH~KLlSl
:~.
NAME OF APPLICANT
APPLICATION RECEIVED
N IJ VJ-\ ~ - r-l f-:Cr::.. I N ~.
5 - 2-4- - 0 I
,
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
J 44q 5" D()VS CJJUk-1
Accepted
~
Accepted With Corrections
Denied
Reviewed By: J/1I-/3 Date: S~ ~9 -C1/
CommentsSee Reverse Sid!'! for Additional Information!
See Attachments: 1) Grading Plan, 2) Erosion Control Measures
3) Erosion Control PI:;1n
"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."
~
t
';')'l.~XPR/OR(
!:: ~
u rn
The ('t'n1e~ <If lhl' L.kt' ('OUlllr}'
White - Building
Canary - Engineering
Pink - Planning
6UILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
;\/ vA f( - FL f. ~, I Nt-.
'..) - 2-4 - C I
APPLICATION RECEIVED
Thie Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
// /J 0 r-:- . i(-, I., r;:'
I ~ I _--' L.. V I...--
I
) ( I , L ", I
, \... I----
Accepted
~
Accepted With Corrections
Denied ~
ReviewedBY:~ .-~<~
Comments:
Date:
?/tl/.tr1
~_r<-1Cv~
l~ ~\fW'v
v~JJJf?-e4-
.L,) W (~-
"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."
Mi: OF STRUCJU.Be
Addre..
Helling Contr8ClOr h \ (l r 0. '( (lo ( ? .
Adlh.. ~~9'-,.., (C',YY\tl\P((liA \\?'\l ")(1\ ()Yld('ll !If.
f.lpIIon., It O? - l"')L\ - L\CC:C)
Fur~MlicelModel ~Y\Q(iJY\ TYPE OF SYSTEM
"\2.,Qi'l'tA' \O€Z(A.~:::' Warm A1rPlanll
Mad.. Size I () ") . o(")C) Qravlly AddlllonlllnspeCllons wilt be billed II $3s'OO IllCh.
Com.loIId MICh~_nh rYI ~ _ ...~'" House HeallngT..! Reco'"",usIbe submilledwlhllWlllllglllDJlilllWlll1trbefol8 build-
~ . . Air Cond..onlng W . 'l1t)1 I Ing cerlilicele 01 occupancy will be :S$ued.
Fuel 1\ lrl-:'r' flue Size -:z, 1/ Vent Sysl"", DeLl mev'" ~ () Conol:
.1::lEAI CALCUlATIONS REOUlREll wiIh number 01 supply and return operings lisled per
HEA llNCUJR POWER PLANT room with CFM's per opening. N.., &troctures or aGdillons send floor olan with "'4'pty
Steam and return locations shown. HEAT LOSS CALCULATIONS, PAYMENT AND
Hot Watll APPLICATIONS MAY BE MAILED 'f0 THE CITY OF PRIOR lAKE. lB200 EAGLE
Radiation. CREEK AVE. S.E. PRIOR lAKE. W'N 65372.
Speeisl Il8vlce.
...
o
o
S
lWo.Flmill'
Induslrla!
CITY OF PRIOR LAKE
16200 Ellgle Creek Av. S.E. Permil No. () (. 0 57q
Pr'.,. LeIat, ... 65372 /
HEAlING APPUCATION I PERMIT
Oate to I ':"ll 0 1 _ PIO.
SIIaAddr_ jyLjC\f1mw r()t \ f+
y
Single Family
Commen:ial
Fe. Schedule
Lei _ Block Add.ron
OMIer'a Narne f\..) (\ t )r\ 'h ' t= \ (l (' . VI
Inulrl8l, Commercial" MuIti.FIn'11y
Residentlel. Heating I AC
Resldenl18l, Heating Only
Residenllat. Ges Fireplace
Raaldenflal, Adcltlonsl A'"rallon.,
R,. ....,.:,,1. ACOnly
~
I.-
%. 0.-
3. .....
R"
City
CDfIInchlr
MuIIl.Fam/Iy
Public Other
~ cDSl ($39.50 m~mum)
~.)
$84.50
$39.50
$39.50
$39.50
Remlmber to add !he SIaIe Sun:harge on the bottom ollhl. application.
.,.;
o
-
g:
The price 01 your heating permit ,..,Iud.. one rough.in and one Ilnell...poction.
...
o
j::
-
u
Suppt, C.. ", '.
'"
...
IN
'...
...
...
...
N
...
'"
Return Opening.
Input )()"'.CJa) OulPl't-9l,cm
Edr.
CIIy Hel businesa hoUlS are 8 a.m. .4:30 p.m.
elm,
other Devlc..
ALL WORK MUST BE INSPECTE!' (ROUOH-IH AND FINAL) - CALL CITY HALL
447-4230
I hereby apply lor a mlchanlcal syslems permit anell aCknOWledge !hat Ihe
Inlormatlon above is complele .nel acourete; lhallhe work will be In conforma"c..
with the ordlnancee and codes of the cily anel wllh the alate bulldlng/mechenleel
codea; thatlhla form doea not "ecome a permit until signed by the BUILDING
OFFICIAL; lhatthe wOl1l wHI b.. In ""cordance with !he approved plan In the
CBSe of.all work which requlra, review and approval of plans.
'-~,'~(A. -
J U' Applican".
~
TYPE OF WORK
AIIerllllona
Replacement
New ConslrucUon
X"
...
N
'"
...
Repair Ell. Comp. OBla
Ell. Coli' A . ~ Building Permk ,
Hl:ATING PERMIT FEU CJC:\..F() PAID WITH
STATE SURCHARGE . .50 BUILDING PERMIT
TOTAL PERMIT FEES .-.J..C{'l. ("Q Reo"""
01.05"7Q
II
~
...
...
"-
..
N
"-
'"
o
BuDding1'S Sillnlture
{J1~/Oj
alG
(0 . 12.-' 0 I
Date
~
s~~~
....,"'I'IE50~1"
CITY OF PRIOR LAKE
HEATING/AIR CO~l)ITIONING/FlREPLACE PERJ.vIIT
Date Rec' d
;~;::, ~~ I PERtVIIT NO. 1-570
:;. Volkl... Appli.::uu I
IPle:J..Se ~e Of prine and sl~ Ole bottom)
I ADDRESS
I \l.\Y9S tJOVe.... C-T
LEGAL DESCRIPTION (offie< \1,. only) y
LOT ~LOCK ,:::' ADDITION 1\A.JOb
fh II
5~
O~R 1
(Name) Nt> 'I "" 'L - ~\ e..s:...~
ZONTh4G (office: 11S~)
R\
1
I
pI.If)S- -3 b'5- o3ll-G
(Address) 9, ~ 5 I
(Phone) 1b"3- '-l,";;l.~- u,'I ss
(phone) 763-315-7500
BROOKLYN PARK, MN 55445
(City) (Zip Code)
(Phone) 763 315-7500
DATE
1- <e.-A \p...J t::. \='\ ll~: . ,,)
APPLICANT
(Name) AUTOMATTr r:ABAr:, nnnR /l. FTRFP~CES
(Address) 9210 WYOMING AVE N
(Addre,,)
(Contact Person)
DIANA
APPLICAl'l"T SIGNATURE
APPLICAJ'IT PLEASE COMPLETE BELOW
~EW CONSTRUCTION 0 REPLACEMENT 0 AL TERA TlONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE
RETURN OPENINGS
TYPE OF SYSTEM
INPUT
HEATING OR POWER PLANT
OS'e=
o Hot Water
o Radiation
o Special Devices
o .Other Devices
OWarm Air Plants
OGravity
o Mechanical
OAir Conditioning
OVent. System
FIREPLACE MAKE AND MODEL \\\.3" 33 B t::.\J RJLN
Industrial. Commercial & Multi-Family
...
FEE SCHEDULE
I % of job CO.5t Residential, Gas Fireplace:
$39.50 minimum
59950
564.50
ResidentIal. Heating & AJC (New Construction)
Residential. He:lting Only (New Construction)
Residential, Additions & Alterations
Residential, AC Only
Estimated Cast 5 Building Permit #
HEA TING PEfuVlIT FEE $
STATE SURCHARGE $ .50
TOTAL PER.'\1IT FEE $
lome!: Use Only)
This Application Becomes Your Building Permit When Approved
I Paid
i
I Datx_10 -{j I
auildin~ Orficia/
Dart
24 h.our Ilociee for all ins-pectlon.:l (952) ~4"~9S50, fa:\ (952) 4474245
OUTPUT
PLEASE NOTE;
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
S:.i9.50
5J950
$39.50
'~0~0
~Q "t/l';
..e~ /y
i);t."
'J~^
ReceipT Nn
By ()G
u
"'nn rm
1';l'lnnJ..J ';f~V)JV~ :)l.Tvwn.r.nv
7.0/.0~Tr7.TH yv., r7,: TT 10/91/80
_~1
CITY OF PRIOR LAKE ~ ~t ~"=l
PLUMBING PERMIT PPNo. 1-;<;'19
APPIiC~""'e~".~ ('o,r-p. Phone:Cj~-q33-n n
Address: J..I5Or>I ,Q..J.. f'(\',,,,,,,..-i-o,,'.L= N\ D ~~4S
Signature: ~...... ~ ~ - : Ora. J, .
Legal Description: Lot ~ Slock S Sub l<""h \lli\,.,~ .
Site Address:\~C\<;::; ~.J'... (' F">.. d ~
Building Permit # PID # :)f::;- ~ 10 <;{- OJ I.f-o
NOTE: This permit will not be processed without complete information.
FIXTURE UNITS
1M Crflln or lhl Lakr Counl".
Quantity
c::<.
I
f
~
I
cQ
I
.3
Type of Fixture
Quantity Type of Fixture
J:.j Rough-ins (&n..Sl\:b.~3/4~)
/ Water Heater
Water Softner
J Stand Pipe (washing machine)
c:01- ~"w"9~ .jeSISI'::;\\'c.('r~
Backflow Assembly (RPZ. Double Check. PVB)
Backflow Assembly Test
Lawn Sprinkler
Other disp:>sJ
Bath Tub with or without shower
Dishwasher
Floor Drain
Lavatory (bathroom sink)
Laundry Tray (1 or 2 compartment sink)
Shower Stall
Sinks
Bar Sink
Water Closet (toilet)
J
$
$
$
$
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
. l!JUI. ""II D
'l.D/tv, {,1,.,-,..
Gf.:
"
"1'/1,
16200 Eagle Creek Av. S.E.. Prior Lake. Minnesota 55372/ Ph. (612) 447-4230 / FAX (612) 447-4245
An Equal Opponuniry Employer
GRAND TOTAL $
,
This permit is granted upon the express condition that said
contractor, shall comply in all respects with the ordinances
of the State Plumbing Code and the ~~m~nts tJ:le;:eof
RECEIl'TNO. ~5'/O/DATE
~ff / A TIEST
Call for all inspections 2{hours in-ad \ ance.
....~. . .....~
'YIUOW - ",.."LtCAlfT
GOLD. en y
CITY OF PRIOR LAKE NO. 1- 5'77'
SEWER AND WATER PERMIT
NOTE: Sewer and Water
contractors must
be registered
with the City.
APPLI CANT ~~~''''^''~'("t\ (''''r-r PHONE: 9.&1. ~ qM- '7 '7/7
ADDRESS :)6'"Cl'l\ ~~.~.. ~ fS-o\.t("DATE :_r;r:..-':>'4-f\\
SIGNATUREJ\f~ Y()n.r-1J...A- BLDG. PERMIT iI
SITE ADDRESS: 1~4Cl~ ~V'f' ~\",,,*_ PID; J)- 3Qf-03z..;~
FILL IN THE BLANKS
1. Estimated length of water service
l..{S'
feet.
2. Size of water service
1
inch(es) .
3. Location of any couplings from structure
4. Type of sewer pipe. ABSs';'J/o PVC Cast Iron
5. Estimated length of sewer line Lf~ feet.
6. Clean out (if required), located at
structure.
feet.
feet
from
=============~===;===;===================================~========
This application becomes your permit when approved.
By:J)M-",-,^ )B2~ DATE: 5- .)...4-()1
========================== ======================================~,==
FEES:
Sewer and water line connection perm:t
Surcharge
TOTAL "pi. ~ ~.
Fee for either sewer Dr wa~er individually is 520.00 plus
5 .50 surcharge.
5
5
5
35.00
.50
35.50
.
Sewer and water permits issued for new construction must be
recorded on the building permit card at the time of issuance
t6 insure that no duplicate sewer and waterPA~WtlI~ _,_are
issued. . BUILDING PEhIV.1 i
DATE PAID 0//0/;')/
*
AMOUNT PAID
RECEI PT iI
P.EC'D BY
~
(J~
------
16200 Eagle Creek Av. S.E., Prior Lake, Minnesota 55372/ Ph. (612) 447-4230 / FAX (6]2) 4-17-1245
An Equal Opportunity Employer
"
PRIOR LAKE
INSPECTION RECORD
SITE ADDRESS J4tjq~- fhJ.P c:.-I- /
NATURE OF WORK IJ_~<..~ .
USE OF BUILDING SF!)
PERMIT NO. ()/-057Q DATE ISSUED t>l/- 2aor
. ~
CONTRACTOR ~'Q\<=-"':" €l:erl- ,/~. PHONE c,/2-q2<1-W5~
NOTE: THIS IS NOTA PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
DEPARTMENT OF
BUILDING AND INSPECTION
I FOOTING t;,NSPEcrOR I b/U/~A/TE
I FOUNDATION (Prior to Backfill) I ~ I 7/1 1/01
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
~
SEWER I WATER I SEPTIC
FRAMING
INSULATION
ELECTRICAL
PLUMBINGlj . /]..
HEATING (if required) u:JI-
FIREPLACE
GAS LINE AIR TEST ~ (~. rch i t~i
I
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I I
FINALS
1/11 Id-i?S'.iJ)
~ f~?111 5.0) H(f"./Ol
2
;
OCCUPY UNTIL ABOVE HAS
NOTICE
,
l/.5/ tJ/
'~ .
~\l
.
~
~J1.1/ oj
~ ~GS~!/
R -). ~ -oi
/I
flJ.;r: ,
GRADING (Prior to Sodding)
BUILDING!:c..b. <t.f I~/~/{)I
ELECTRICAL
PLUMBING
HEATING
DO NOT
9/;;"5/ tJ7
'1l::~.~~ I
., 1
BEEN SIGNED
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, can! shall be placed near main entrance.
Call between 8:00 and 9:00 A.M. for all inspections
FOR ALL INSPECTIONS (952) 447-9850
~~""~"'~~-.6-"'-."!~~~~fqf. , . - . ,.
" '''. !....,."'~~...',~~.;~~~. ",. ~b~~~y.a .liit:!( ..". '~'. '.....,. .",...,,,.. 'J'~', Xt.'" ..'.. "".'.''''',' '.'(
..;~__.~ ......__===.~Q: ,~--.. '~--=~j -""-___,..",~~r:~-.....-...-..lr'...r.-.,.-~..-:~...,,..I,......'-,."I~~~'1
. i\ ~
~trtiftcat!nt (JDcrnpanry I~' <
CITY OF PRIOR LAKE I ';j
-L lltpartmtnt of .utlbing 3Jn~ptction ~t'~
~Final Permitted 0 Conditional C.O. Expires I ,i
i~
I'~
,~
j.:l
i~,"
I~
iii,
-
This Certificate issued pursUQ1lt 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 ordinances of the
City of Prior Lake regulating building construction or use. For the following:
SINGLE FAMILY
01-0579
Use Classificatin..
Bldg. Pennil No
NIA
R1
Occupancy Type
R3
Fire Zone
Zoning District
VN
. Type Construction
Legal Description
L3, B3, KNOB HILL FIFTH ADDITION
Owner of Building
'ire Address 14495 DOVE COURT
contractOr"Name&Addr...NOVAK-FLECKll~" 8857 ZEALAND AVE. N., BROOKLYN PARK 5544
ROBERT D. HUTCHINS '7 \ . PI DON RYE
_ <:J/ Ity anDer
Building Official
Date: II-E; -t) I Date:
POST IN A CONSPICUOUS PLACE
ADDRESS /4L/ Ci ~
OCCUPANT
. HEAT LOSS 'ATE HTG. INST. '-lIer
SOLD BY (INSTALLED BY
Electrical Work 8y _ Gas line By
TYPE OF HEAT GA _ FA ~HW _STEAM _SPACE HTR. _UNIT HTR. _OTHER
f7\ tiC GAS DESIGN CONVERSION
MAKF \~"'-eeVV\ ~. MAKE OF BURNER
Model (I (.fI {.l.-- lQ-,? It-l\_
S"iOI~. D "Z)-f1::ZI'1Cj2.14L1~
I NPUT-f[J-SPC>O
\JC'\!(
HOUSE
Ct-
~ CONTROLS
THERMOS~ . _ Heat Plug
Valve J'
Limit I. .^~1'1('C.,-~~
Uml' Sottlng. ~ri'\j:::
Fan Settin~' +. \(""),..i' c,
Pilot Type . {)~
Pilot Make LJ"h/ "f"<r..J
Pilot Model
Pilot Timinr
(...,yp
L.W. Cut Off .
_~'i'
Pressure '-.....:' L-'lJ. (
Input CFH {(I),CQ c)
10" a I'::
Stack Temp. .->
Form 235
74
Percent CO2 .
Percent 0 ?,,, S
- 2- -::;::;--,
_ Percent CO r
H EA T ING TEST RECORD
{)r ~C/, lcl~
CITY SUBURB
APT. _FLOOR
nWNER
Y\r _~ ~
. ........ 'l..,-l- .....-~
Model
Max. BTU Rating _
MAKE OF FURNAC~
Model
(i
Vent Size -Z
KIND OF LINER SIZ~ NONF
Draft Hood R...,uloTor 3~"?"<""3J.l../
Filters Siz./f."Y'7C:-;(' r Number .
Chimney Location Inside)(' Outside _
Chimney Construc:tiO~! C
Smoke Bomb
Draft
Door P,es$ur.
Dote Tes'edCf/7.C;-/O r
Company Testing ~_c....
Name of Test.r ---r;
'-
Widn""
Tut Tog
LightinSil Inst.
Form # 5
DATE TIME
CITY OF PRIOR LAKE 9('Z.-'~(o I I (,'Oil
INSPECTION NOTICE SCHEDULED
ADDRESS /,-/L{9~ J)O v€ c.r.
OWNER CONTR.
PHONE NO. PERMIT NO. t)1 --5? 'J
o FOOTING 0 PLUMBING RI 0 EX/GRAD/FILLING
o FOUNDATION 0 MECH RI 0 COMPLAINT
o FRAMING 0 WATER HOOKUP 0 FIREPLACE RI
o INSULATION 0 SEWER HOOKU~ 0 FIREPLACE FINAL
Ii{:,FINAL ~ PLUMEltNG FINA ~ GASLlNE AIR TST
b -SITE INSPECTION J:iL MECH FI~~L l!5/' I=: P. "b~.......
COMMENTS(/) }(O.-A7 f1.-:1-i.c- ~ ~ ~
~...k- ~ I~J/- (~ ~ ~.)
aJ (IPL.A-...- /)0.010 )t?1~ ('~~ 1kI~,
@VJi~~ ~~-411 dY- roPO> f~
~ .5dorf,L ~~
~) Vv\.al.'. ..~' ~1rv-- ~ ~,
~ $zJ) <- 1-~ OR...-<. ~,
m-, J~ ~ f ~ .~ jN1u J).!J ,
tg\.J J' (--.. T --.J
,
'1.(...8 l ~ [0(30(01
~ ,.q......A.~ ---------..~
tJ0~av-- ~~-~_~",~Q.~
o WORK SATISFACTORY, PROCEED
]:a CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: ~ /
I
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
Owner/Contr:
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNon
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS 1'1'19 [) Dove.. C T
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
:a:..!'INAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
COMMENTS:
bro"h.- at::..
DATE TIME
IO-');--O{ .4fV1
J1/0vt1 J(. Plce-K.
(?{ -bIt
)(E~ILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
)\ WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector~~ t~ - -OWner/Conlr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
INS/'IOTl
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
~
CITY OF PRIOR LAKE
INSPECTION NOTICE
DATE
TIME
SCHEDULED
1/-5-01
A,
ADDRESS
/44QS 1)&ve a
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
CONTR.
PERMIT NO.
1- $;7CJ
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 +T
~
~ I.~(A p,
r .!AS.
f;
/
..
rORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT :-VO~, CALL FOR REINSPECTlON BEFORE COVERING
Inspector: 'h .\\r~ Owner/Contr:
CALL 447-9850 FOR ~E NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY/
INSNOTI