HomeMy WebLinkAboutBldg Permit 01-0595
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
J. White File
2. Pink City
J. Yellow Applicant
/r;~ /~y
I PERMIT NO'0t4srt5I
1;1'
,'~ONING (office u",)
(Please ~e or orint and sism at bottom)
ADDRESS
/5 ,-:)O'.~
\'\ 0 D ,,(:.; f' Irl
10
'\ ^ :1
<" ----.. r::-.
7<1
LEGAL DESCRIPTION (office use only)
LOT I K'BLOCK
ADDITION () ( r, '\" \2-; p \of /~ ",01
PID ,OC; - .~ 1;)'-() ,g-O
OWNER
(Name)
(Phone)
(Address)
BUILDER f'... f'\
(Name) ,)) IL 1--+0 r +cyl
(Contact Name) l_ CLL.~.A".. (J P r \ rli
(Addr ) c,D'i)'.,.,O /1..' n 'Q\"lo-tcce Q:h , S-te
ess L a Ul) I/IP ,/0'\ t\,") ;"') s 04--'+
. I ~"ir"::;'
(Phone) q tJ,~
(Phone)
-q85- /gC 7
TYPE OF WORK
~ew Construction
DLower Level Finish
DDeck
DPorch
DRe.Roofing
oRe.Siding
o Fireplace
oAddition
OAlteration
OUtiIity Connection
o Misc.
PROJECfCOST/VALUE (excluding land) $ 9(~. ntlc:'
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. r am aware that the building official can revoke this permit for just cause. Fwthermore, I hereby agree that the city official or a deSignee may
enter uP'ifthe openy to perform nc;eded inspe'71ns.
X (j L--z.../Lu. .f/."'-.....i n a ooc, Sin C, r'J 5.c) 9... ('; /
. Signature' Contractor's License No. Date
I Permit Valuation I '1 It, I (21')11 I Park Support Fee # $ Rc::ti " r'Y'J I
\
I Permit Fee >.tV J$ 1eof. "7~ I SAC # $ 4-150 .0(>1
-
I Plan Check Fee $ fo';ff ~d I J Water Meter Siz~l" $ I?c' rlli
' ,
I State Surcharge $ . , I I Pressure Reducer $ f}:; ..., t"l I
~ 'If?,. &}
I f<a~;'J $ I / Sewer/Water Connection Fee # $ r.L~J/J.r(} t? I
Plumbing Permit Fee $ IfV'> .(9a> I I Water Tower Fee # $ 'f (1')600 I
Mechanical Permit Fee $ J (In .12 tJ I I Builder's Deposit $ ~ () -- I
I Sewer & Water Permit Fee $ '~<;",.m I I Other >..:J- b.J I4Ab $ ,~ c;r') I
I Gas Fireplace Permit Fee $ c" J)/:) I I TOTAL Duf $t,. OZZ.~ I
~jY_'.''''_'w~_, ~
I Paid ~Od-cJ. ''-1 '1 I ~~ceiPt Nf ~ d-,:J
/.. {,-7- '2eI I Date ~-JA ~r,1
..... ,
. :a-~fficial Date
This is to certifY that the request in the above application and accompanyiI1g documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document
~~~n signed bY~the City Planner constitutes a tempoc"'l' Certificate of Zoning compli",ce and allows construction to commence. Before DCCUP"'CY, a Certificate ofOccup"'cy must be
~ ~~ ....fL/('2.-!U> ( ?:"aR ~-/~~ 'l--n>.r Cen,J1\IC\4,:.
. Planning Director - Date - Special Conditions, if any
24 hour notice for all inspeetions (952) 447-9850, fax (952) 447-4245
~'O" PR/OIi' (
t ~
U t'1
S15
White . Building
Canary - Engineering
Pink - Planning
Th(' Crolfr of th(' I..kf ('ounll'}'
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
[) /2 AI/n/ ~
fo- /-0 J
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposei:! at:
.5 dO~ - l"L~JV.-/'({.fi1O L;u
() ~
Accepted
Denied
x.
Accepted With Corrections
Reviewed By:
NiA6
Date:
&-1 ~-O I
Comments:
S-(e
,
Me;, f '"
-C../-<.
"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."
@XPRIO"'(
t ~'~
u . rn
White - Building
Canary - Engineering
Pink - Planning
The' ("f-nll" of lhl' ".1It <."ounlry
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
b R 1:I0-7/~
- ~- /-0)
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposea at:
,5f)f):1- ~icQ LN
Accepted With Corrections -I--
Accepted
Denied 0tt(J
Reviewed# J( ~
I
Date: to - 7 - ~ r
Comments:
~eQ.. ~ ~o.h^ CT.e.
"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."
~
.o~~
Thll' Cf>nlfr of lhf L.kf ('"unIfy
White . Building
Canary - Engineering
Pink - Planning
"
Jrull-DING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
!
! j /<
/ / i (~~'-Yl.--'
('0- /-(i)
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
,
, -l i -...) i_/ 7 ;' __ .,/t~.J
--' "-) - '---..
Mcepted
v
Accepted With Corrections
Dlflnied ~
Reviewed BY:~-1- /~
e;..r - --...,.
Date: t,/I'2-/e I
Comments: .
?_I~~ h~ ~5<: rA ,5;}-Dl
~~.v:; ~ ~BY' (~lit&tl\~ ~
--.4fr&tJ.' A-~ }..-
"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."
J U II, 4, 2881
3:38PM
GENZ RVAN PLUMBING AND HEATING
Nil, R 214
P, :17/411
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERNllT
"
I.. Blue :rn.
,Z.,Go/4 City
, . :I..' y...... AppIkul~
I PERMIT NO. / -1)9 ~I
ZR,GlOfike=l l
(l1as.e ~e or 'Print md. ~ at boEtDm)
ADDRESS . "
5203
n6lpY',h'pjJf) LkJ. Sr=.,
LEGAL DESCRlPTION (office we ."uy)
LOT JPJ3LOCK 1 ADDIDO.;r-yt?l?f/eiJ.n
I OWNER
: (Name) DR Horton CustOlll Homes
2!\..JO
PID 95~ 3 7d-~O(f(b
(phone) 651-454-4663
(Address) 3459 Washington Dr Ste 204 Eagan, MN 55122
APPLICANT
(N"ame) (:!"".....'7_11ya.... "Dl.:l1r'J".~.....g A. "D.o."'+-.;....~
(phone) ~'1-4'~_116J,
(Address) 14745 So Robert: Trail
(Address)
Rosemount
MN
55068
(Z'lp Code)
(City)
(Contact Poson) Mary Olson f\ (Phane)
APPUCANT SIGNATURE I A ~ 0 p. DATE lo \ L.( \ D I
APPLI\-Al'U rLEASE COMPLETE BELOW
Type of Fixture I Quantity I Type of Fixture
Bath Tub with or without shower I I Rough-ins
Dishwasher I ." Water Heater
I Floor Drain I' R II I Wattr Sofiner
1 Lavatory (Bathroom Sink) I I Stand Pipe (Wasbing Macbine)
I Laundry Tray (1 or 2 compartment sink I Sewage Ejector
I Shower Stall Backflow Assembly
I Sink,s Backflow Assembly Test
I Bar Sink Lawn Sprinkler
/_ I Water Closet (Toilet) I Other
651-423-1144
Quantity
I
I
,
Z.
I
I
I
I
I
I
I
I
I
FEE SL.I:IJ!,J)ULE
Industrial, Commoroial 8< Multi-family 1% of Job cost witb. $39.50 lIlio.imum Resldentlal, New One &. Two-Family 599.50
Residential, AdditioDS & Alterations $39,50
Estunated Cast S
Building Permjt #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
.50
-t)
P. ILl
BUlL ~r[) IA'!,.,. ' ( i
D.NGF".: '
L;:f1IV,j'[
Dflice Use Only)
Tbis Application Becomes Your Building Permit Wheo Appro'Ved'
BoiIdlng Olli.w
I Pold
I DlW:~?j/C(/O I
(
24 hour ooti.. for .11 in'pections (9S;l) 447-9850, fu (m) 447-4245
D...
I Receipt No.
I By 40
./
,I un, 4, 1 U U 1 3: 3 U PM
GENZ RVAN PLUMBING AND HEATING
Nu.5114 P, :",/4U
Date Rec'd
CITY .OF PRIOR LAKE
SEWER AND WATER PERMIT
.. .
t G_ '"" I PERMIT NO
1. Ye.l~ CitY" .
3, Gold. ....l',IICNlI
!-5101
(PI=- 'Yl!. orpdll' .1l4.1g,ntbo"""')
ADDRESS
62D?::> 'T;eL>,' -B &..0 LN. :\G-
ZONING (ollialllO>
7Z1
PID ,--i.S-....3t,;!-O!o-J
LEGAL DESCRlPTION (offu:e """ only)
LOT r6BLOCK \ ADDmON~ 2N~
OWNER
(N~e)_n1) 11.................... r..~+-.....m J::r...........=...
(l'bone) ~'" -& ," 4 (i'"
(Address) 3459 Washington Dr Su 204
\Address)
Eagan. MN 55122
(Ciry) (Z;P Co&)
APPUCANl'
(N~~ Ganz-Ryan Plumbing & Heat:ing
(phone) 651-423-1144
(Address) 14745 So Robert Trail
(A.dd=s)
(Contact Pmon) Mary Olson
~PLICANT SIGNATURE 1"-
Rosemount:. MN 55068
(City) (Zip Code)
(phone) 651-423-\144
DATE 1!1 \ I 'f'\ I
APPLICANT PLEASE COMPLETE BELOW
Size of water sernce 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
Re:sidenbal 3ewer and water line connection
Sower connection only
FEE SCHEDULE
13550 Industrial, Com'l & Multi-family 1% of job cost with a $39.50 minimum
$11.50 Water connection only $17.50
Estimated Cost $
Building Permit #
SEWER AND WATER PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$'
$
.50
BulldlllgOlllcial
Date - '
, nab: ' !Jare/o//i/Ol
14 hour .ode. for all inspedio.. ('51) 447-98~1AO
.
)t!
P'''O '. j,.;
BUILO;N! Gh, I Ii i '
, , PE"'"",
rUV.H'
I R.ecelpt No.
IB~
OBIe:c: U:lC OI;lJy)
This Application Becollles Your Building Permit When Approved Paid
CITY OF PRIOR LAKE
HEATlNG/AIR CONDlTIONINGIFIREPLACE PERMIT
Date Rec'd
], Pink
2, G",en
J, Yellow
~::y I PERMIT NO. J- -r05
Appliclnt "") I
(Please tree or Print and sim at bottom)
ADDRESS
'S'Lb3
/) eer +11" IrI
ZONING (office u",)
Lane~ S~
R\
LEGAL DESCRIPTION (office use only)
LOT I'8BLOCK I ADDITION ~~ 1),;.Q.cQ ;:t Jd.
g.'::e~RD'A. Horfon (lu~P,,,,,
(AddreSs)dOl1W Ke.nhrictOf ()J~o.k ev1.l1e.-M~
APPLICANTA /. + M h--
(Name) L ,an el!...!1.J-,VX'. (Phone) !p51-45:L-,f?775
(Addressh3<OSO rtenne bee.."fx,. 5+e. #/ .i--: QfJQn 55/~,2
(Address) v (City) (ZiP Code)
(Contact Person) ~f.pre-V Z;mmp.r.rn Glln (Phone) &5/-.i../5()- ;l77~
APPLICANTSIGNATUk. Jou&(!4J,.-.~~ DATE 8/"'101
{/ (/(/ . V
. APP ICANT PLEASE COMPLETE BELOW
I0NEW CONSTRUCTION 0 REPLACEMENT 0 ALTERATIONS
FURNACE MAKE AND MODEL "Br'1~~A-VIlVU>; 0 FUEL l\JCl.hAt"n I
FLUESIZE~ICI(l.S<D "2L RETURN OPENINGS '-I- INPUT 1D,ODO OUTPUT 6lD.tJOO
TYPE OF SYSTEM HEATING OR POWER PLANT
PID::ls-- '31.)-I)/f"1.l
(Phone) 95a, q ~5 -7.;l7.:L
5501...p../
OWarm Air Plants
OGravity
o Mechanical
~)r Conditioning
[!fVent. System
o Steam
o Hot Water
o Radiation
o Special Devices
o Other Devices
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
FIREPLACE MAKE AND MODEL
Industrial. Commercial & Multi-Family
FEE SCHEDULE
1% of job cost Residential, Gas Fireplace
$39.50 minimum
$99.50 Residential.. Additions & Alterations
$64.50 Residential, AC Only
$39.50
$39,50
$39,50
Residential, Heating & Ale (New Construction)
Residential. Heating Only (New Construction)
HEArING PERMIT FEE $_
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $_
~'L p,
-"""t;tf, ri/C).
(Dl/ij, i 'v / I.
G Pt:J!
IIY4:t,
Estimated Cost $ Building Permit #
(Office lIse Only)
This Application Becomes Your Building Permit Wheu Approved
Paid
Receipt No.
Building Official
Date
Datey_?_o/
BY~
V
24 hour nutice for nil inspections (952) 447-9850, fax (952) 447-4245
DEC.11'2001 07:40 651 633 8884
FIRESIDE CORNER
#6031 P.003/013
CITY OF PRIOR LAKE
HEATING/AJR CONDITIONINGIFIREPLACE PERMIT
Dpte Rec'd
\'s._ S..... \ PERMIT NO'OI-OS95 \
(Pleo.sc: ~ 01:' 'DriDe lUJd stan at bCJtlOm)
I ADDRESS
5J.v .~
ZONING (offl.....'
1>>,+;/.; ~~_
.J: {;.
LEGAL DBSC:lllYTION (Dffice llSe onJ,y)
LOT
BLOCK
A,-,uLuON
PIP
, OWNER
(Nam~)
(Adclress)
rJ)1Z.4,~
(Phone)
APPLJ.CANT
(Name\ ALLIED FIRESIDE DBA FIRESIDE COl\NEEI
_ (Phon,.,) 651-633-2<;/;1
(Address) 2700 l'l. FAIRVIEW AVENrr.,
(AdMcs')
(C 'p ) BRENDA HUST.otl
on= erson
APPLICANT SIGNATURE(,tSt,4A,tt .tL...=..
'>I'l"""'T.x.{,F. M1I1
(Ci!y)
(Phone) 651-633-2%1
5'>:' 103
(ZI,p Co&:)
DATE
/.)./,d-I'
APPLICANT PLEASE COMPLETE BELOW
O'ffiW CONSTRUCTION 0 REPLACEMENT 0 AJ.TERATJONS
FURNACE MAKE ANb MODEL FUEL
FI.UE SIZE RETURN OPENINGS , INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
OWArm Air PIBIlIS 0 Stelll7l
DGravlty 0 HOl Water
o Mechon;c:al .J Radllllion
DAir Conditioning J Specl,sl Devil,..
DVenl, SYSlem J other Device.
FIREPLACE MAKE AND MODEL --.-!slu", N GI.o. SL'l.fl>
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Sid. Yatcl
Selbocks
InduSO'ial, Commercial & Multi.FAmlly
FEE SCHEDULE
1 % of job <0.1 fl.esidential, 0.. Flreplaoe
$19,50 minimum
$99,50
$1;4.50
Residential. AdditlDn. &< Allelll!jons
Rcsidontial, AC Only
Building Penn it # O/-{)5q-5"'
$39,50
$39,50
$39,50
Resldenlial, Heating I!L Me (New Construal on)
Residentilll. Heating Only (New Con,,",o'lo")
Estimated Cost $
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
s
r- PAID wrn-l
.50fBU1U)'N~ p(;.ro"~
,----
(orne. 11",00111
Thls Appll~~ ho~o"r Building Permit When Approved
f2J/1tr {7/ 11-0 I
Building omeln' II.'"
I Pwd
I Date
I Rl:cei.pl No.
I By
:zA ho.r notice for olllolpoeti"n, (95Z) 447-98SO, r.. (95Z) 447-4Z45
PRIOR LAKE
INSPECTION RECORD
UeQr-0eJJ! t: V'-.
\Se~ \..~ \'\.o.,~ '\',-\..e
DEPARTMENT OF -
BUILDING AND INSPECTION
SITE ADDRESS S~ 1"1<-
NATURE OF WORK k ,~ T
USE OF BUILDING ~ I=' J4
PERMIT NO. 01- 0595 DATE ISSUED h-i-'1=1
CONTRACTOR D.:K. ~~~ PHONE Q8') r7~(")7
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INJPECTOR DATE
I FOOTING~ \ \J l'-lID' Ih-, I ffA- I ?fJ/OI
I FOUNDATION(PriortoBaCkfill)~1 ~. t//4/ol I~ .}!(~?JI
PLACE NO CONCRETE UNTIL ABOVE HAs BEEN SIGNED
ROUGH - INS
SEWER I WATER I SEPTIC
FRAMING
INSULATION
ELECTRICAL
PLUMBING IA~, 0;6. I:r-r. q 17/01
HEATING (if required)
FIREPLACE
GAS LINE AIR TEST
Mt 1/1J,~'V
i
,
6.11,_
Ifrh
I /-t/6 7-
I /:~'/b z.
, ,
~*~f,
Ii>> /Z/Zo/tJ/
'~~ /2/"7 llol
-/);-/ Jif"IJrJl
6:t-, lZ/lG/f) J ·
I GRADING (Prior to Sodding)
I BUILDING -r; C.t). 1:iJ../ 8'/, /62.- f/. 8.
I ELECTRICAL
I PLUMBING
I HEATING
DO NOT OCCUPY UNTIL ABOVE HAS BEEN SIGNED
NOTICE
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
fA (z/(1kr I I
FINALS
~. rc.. 7/1 7~ z.-
A- 7/~-1~v
I~
\
(b ~ CJ..lI'U\
B\t!:>\o~
\
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 9:00 A.M. for all inspections
FOR ALL INSPECTIONS (952) 447-9850
~'~.~~ '
"':,'. '.'.."" .,..... 1.;-'" "I~.~"~, .oji,t"~;..:......,,,,,. ~". '""".".' ,,,.' ..t.-,,~
~7'r" '.'.. ....'1~;~;~~").:it..."'
i - ~ '
:i' ! Q!:trtinrau at (@rrnpanry
;~ CITY OF PRIOR LAKE
;t~ J.ltpartmtnt of .uiIbing In'ptdion
(j;.. ~Final Permitted D Conditional C.O. Expires
(l'-'
(~
( )"::,
(;
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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 ordinances of the
City of Prior Lake regulating building construction or use, For the following:
Use Classificatir ft
SINGLE FANILY
01-0595
R1
mdg. Permit Nn
R3
, VN F' Zo N/ A
Type c..__ ._..... _ If. ne
B1, DEER FIELD SECOND ADDITION
?
7Qning District
Occupancy Type
L18,
Legal Description _
Owner of Building
,Site Address _ 5203 DEERFIELD LANE SE
KENBRIDGE CT., SUITE 100, LAKEVILLE
C tract . N LAddre D.R. HORTON,
on ors aIDel;X. 55
ROBERT D. HUTCHINS 1::!i....
Building Official
7/;:;'( I iJV'
20860
City Planner
DON RYE
Date:
Date:
POST IN A CONSPICUOUS PLACE
~
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
DATE TIME
2. ,2.1'0:z. j :~(J
ADDRESS
5203 Dt:.S/2.F/E,L-U UJ
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
)! FINAL 'lSL.-D(-"
o SITE INSPECTION'-
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
~LUMBING FINAL
"\MECH FINAL
COMMENTS:
0/-595
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
I. SOJt ..\- \~
2, ? M-<. ~ '^QJl.'r C\^ L. ~ 't>\a. ~ .f),. ,;;;f r.~... ~
? AI P. . (). ~- '--
, ~. Tvy':>.""" r-:"I.l"'. r /,..lJbJ-.
<( tJ..iA.I,^h: IA. ;yO".,c("'.A (\~~
rr /\ r 0 j e; -) - COO ./
l~ {~....1' - ~ c> Q <-.
o WORK SATISFACTORY, PROCEED
o CORRECT TI AND PROCEED
X CORRE W , CALL FOR REINSPECTION BEFORE COVERING
Owner/Contr:
447-98sd1:0R THE NEXT INSPECTION 24 HOURS IN ADVANCE.
Inspector
INSNOTl
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS 5;:).02.. 'Dee..r-C;'J,t LV\
PHONE NO.
OWNER CONTR.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
COMMENTS:
/L,r';:'~ _ PERMIT NO,
~INGRI
o MECH RI
o WATER HOOKUP
~ ".sEWER HOOKUP
{\ ~ PLUMBING FINAL
o MECH FINAL
DATE TIME
~-/3-DrJ.. ql~o
01- ~sqF:"'
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
vV\~.p./~~ Ole
lI1A ~ /-\e AI'- ~ en \.:p 1
./
~ORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK CALL FOR REINSPECTION BEFORE COVERING
Inspector: ~ \. ~ Owner/Contr:
CALL 447~9850 FOR TH~ NEXT INSPECTION 24 HOURS IN ADVANCE,
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
IlVSNorl
CA TE TIME
CITY OF PRIOR LAKE "7IJt:l 1..
INSPECTION NOTICE SCHEDULED ~ A.P
ADDRESS 5201..:!>, 5. 7 OE;€,e,q6LD LA! .
OWNER CONTR,
PHONE NO. PERMIT NO. /-59~ 595. .59~
-
o FOOTING o PLUMBING RI o EXlGRADIFILLlNG
o FOUNDATION o MECH RI o COMPLAINT
o FRAMING o WATER HOOKUP o FIREPLACE RI
o INSULATION o SEWER HOOKUP o FIREPLACE FINAL
o FINAL o PLUMBING FINAL o GASLlNE AIR TST
o SITE INSPECTION o MECH FINAL 0
COMMENTS: .5I)D / "Tl./E6 [;;J t2& <..---
, I
//~~
~ lLy...,. ~ /,7{/,~-1J.
PWORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPEcTION BEFORE COVERING
Ii.,
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Inspector:
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CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
Owner/Contr:
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
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Job Address S'2.0'J O",",,~\l> k--<-
Heating Contractor A \\,....... M < '-'--.
Name of Tester
Date
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Percent 0,
Percent CO
Percent CO,
_0_
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'3 '\ <lo
Stack Temp
Combustion air is adequately supplied per
UMC See, 606 -.(~
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