HomeMy WebLinkAboutBldg Permit 01-0949
(Please type or print and sign at bottom)
ADDRESS
3ZI€J
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
1. White File
2. Pink City
3. Yellow Applicant
NOOD DUCIC- Dr<... N tv
LEGAL DESCRlt'nON (office use only)
LOT J 4BLOCK I ADDITION
OWNER
(Name)
(Address)
WII-.OS '3 eo
(Phone)
BUILDER__ J
(Name) , 1,- 1) tI- 1'1 O'C.- r' S
(Contact Name) R,.,. (;LV\.. I: Tr
(Address) I?)" c> I Bills,,;,,'\.. tf-V-L (I ,"7'""\) ..J .If.( 11 t"'-r-? I.J 7
L)CLU T~~t. (t: . ,) J .J-,
TYPE OF WORK
o Misc.
,
~New Construction
OLower Level Finish
Date Rec
-1- () I
7 (-{8*!
~ ZONING (office use)
PUD
PID ZG - 337-o/4--Q
(Phone) 7b ') - 7/2 - it;:2 tf
(Phone) 7h 3 - 1/;1, - f if 2 l (
o Deck
o Porch
OAddition
OAlteration
ORe-Roofing
OUtility Connection
o Fireplace
PROJECT COST IV ALUE (excluding land) $
ORe-Siding
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 building official can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may
enter upon the property to perform needed inspections.
x
I Permit Valuation
I Permit Fee
I Plan Check Fee
I State Surcharge
I Penalty
I Plumbing Permit Fee
I Mechanical Permit Fee
Sewer & Water Permit Fee
Gas Fireplace Permit Fee
~ .
Signature ~ --. ~.
c
It:tl. / &YJ.Ot:> I
$ I.s:.~ I. .3.C;- I
$ iz,s .3~ I
$ 18 . 0() I
$
$
$
$
$
(60 . ex::>
/~t:J .00
36 #.50
4lJ ., ct1
~16- ~
Date
Contractor's License No.
I Park Support Fee
I SAC
I Water Meter Size 5/80
Pressure Reducer
Sewer/Water Connection Fee
Water Tower Fee
Builder's Deposit
lather
I TOTALDUE ~
I Paid g I(; 2- O. z,J
I Date q -.C:: -tJ /
, ..
Date ~ _ 'f - 0 I
$ 850.0<::)
$ I, ISO .00
$ 6t'5/1. l!7O
$ 7~7)
I $ 'f~.~
$ 1m. C!)O
$ 1 vsoo. eo
$
6-30-01 $~20. Z3
Receiyfj} 'f05.J7
. BYT-
#
#
#
#
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
7~7 "'--7 J___ ~w.,. km>rr"Y c_.. of 1=m, "mp","~ md""", "2"" 7.: ..... -2- of_ ~<"
1~~~~ U~~(M IJ '~d~any~~
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
OJ 9~?
White - Building
Canary - Engineering
Pink - Planning
The Crnlrr of Ihe (..kr Counlry
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
TJ~ BUIi.-OERS
I
s- q - 0 J
I
tt~; "
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
32./6
WooD
DU~
Dg
NW
Accepted
P(
Accepted With Corrections
Denied
Reviewed By:
N Iff)
Date:
$>- ~t7-~ I
Comments:
See Reverse Side for Additional Information!
x
,
~ee Attachments: 1) Grading Plan, 2) Erosion Control Measures
~~ Frosion ~nntrnl..Elr:m
"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 ("rhlrr of Ih. takr ('OUhlry
White - Building
Canary - Engineering
Pink - Planning
'~..
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
TIe, ~ljILI)t::.kS
I
t(::.J- q - (j J
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
321 E) V\j(ICV D()(.~ uk. N vV
Accepted
~
Accepted With Corrections
:"..
r,'.
1
Denied ~
Reviewed By: ~ ~ 6'-? Date: ~ ~ 2Z-~ e-{
Comments:
J 'P-f ~ ~~ ~)7"1 tiSf:- ~~
\C)(" ~ 1 ~ -JI lIIv;, 1h _' ~ d ~ "'[:0
~v~ 'Cuvl:1
<:..-; -
\'~: ;:
1.
"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."
White - Building
Canary - Engineering
Pink - Planning
Tht" Ctnt..r or the Llkt {'ountry
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
, I /(2, BUIL_06I<.S
,
6- q - 0 J
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
3218
WOOD
DU~
De.
NvJ
Accepted
Accepted With Corrections ~
Denied n/Jrt f.--,
Reviewed BY:\.~ ~~
Comments:
fW.aJ1J,~,~ tu ~_.
Date: 8,. (s-, @t:j(
"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."
10/12/2001 11:15 512-427-3805
UW/UG/UU W~~ ll:44 y~ 6114474245
CITY o~A~iICi~tl~ CONT_J_ti._.._._"_"..._____._-_M__PAGE_.~.~uJ.
..... . .....
,..u.... . AP'rL1CWW
a.. . ctTY
CITY OF ~~IOR LAKE
SEWER AND WAT~R PBRMIT
NOTE: SeWer and Water
(:ontrao1:ors must
be reqist:ered
with the City.
s.w. No.
(- qL{1
APPLJ: :ANT:
ADORE: :5:
SIGNli~URE:
SITE ~OORESS:'
~ taW' Pork..1: CDntractlng Inc.
'4230 Basalt St. N.W.
.... ......~'nQ
~:t.,J. tYlh .. \.-
,1)./ g UJ60d..dv. ct. 7>r-
_PHO~E: 7 C, 3 :"42. 7.010 fj
DATE: . LQJ..ud..QJ
BLDG. PERMIT ,
PIO':J.6- -3"31- O(L/-O
1.
I: 1t=.1rnateo leng'th of wst.e:t' serviee
FILL IN THE BLANKS
50'
feet.
2. ~:...ze of water service
I
inch(es).
4.
5.
'II 'pe. of sewer pipe.
II,eation of any couplings from structure
PVC /' Cast Iron
50'
Eltimated length of SQver line feet.
teet.
J.
ABS
6. C.ean out (if ~equir~d), 1oc~t.d at
s. .ructure.
t'eet
from
~~_._ IG___~~~_____===___=~~=~~=~._.__======_...~=~~~~__~=~_____
This '~PP~ tion becomes your pe~mit when approved.
BY DATE: /O//UOI
. .
---.. ~==:Cw=~==._==~=~_s__.c=~~~~~_...===~_______~~&~===~~~~=_
FEES:
$
S
$
35.00
.50
35.$0
Sewer ancS water line connection permit.
Surcharqe
TOTAL
* F! e for eithar sewer or water individually is ~.~ plus
$: . SO surcha:t"9f!!.
~~;1:q\f.
Si wer and water p.rmits issued for -neW constr~tion must be
r. corded on the building permi~ card at the time of issuance
r: s~~~~re that no duplicate Sa~er and wa~5/~~~~its are
o (J I II\tG' . / I~'j
"DATE 'AID ':.Ik AMOUNT PAID f.L _ I>~S,;,..
.:i~lt"'RECEi: T'. . . ,- ~ RI!:C' 0 BY l/fV 'I,
V
:I:
16200 Ba&.', Creek Av. S.B., Prior Lak.c~ Minnesota 553721 Ph. (612) 447.4Z30 I FAX (612) 447-4245
i!', .,; '.., An Eql.lalOpportunlty BmplDyer .
10.'11/01 THt! 11:31 FAX eMU1.uu
'~'L
CIT~ OF PRIOR L~KE
IZI 00 1
'--.11. { OF PRIOR LAO PLUMBING PERMIT
Dale R.lel
.//-/~-Ol
rfa. trP5 if arin& 11I4 liD at lIo..,m)
AD&J~S
~~/<ir {AJoo'/~ "be.
LEGAL DaSCRu uON (oSb IAIIt GIIly~
LO'r /4-BLOCK / ADDITION /All t-.DS 3 J2L)
-
OWNER
(Nlme)~ (1 'B1d1?-.?
\
(AdlbntD56/ ~nl.~;am i. u ~ ':hlly/n~
APPLI~1
rNa~)....MJ i/6,u "I- ~flC~-'€"; . ::x.~L
(AcSdzas) ~(, /;01 ~ A)/ J1A.Jo/!J,.
(AlS4ta.)
(Conta.ct PetSCtI) .~ ---=:-J -'
APPLICANT SIONATtJIlE ~~ ~
QnaU'Y
.z
(
1
'-I
I
I
I
'1
~:;:, I ,,'~...1 l..U'()/ __ nAB
I. T_ ...Icoal 7,-,
ZONING (... UiI)
PlID
PID 2....5 - ..1---;7- ~-O
(Phone) ~. '7/ Z ~ /c/z(,/
56-~ :'J 7
(phone) ?(,~-~-Z~ZI
.;S~~03
(City)
(Photic) .&2
OAT!
(Zip Code)
"'/::17- 4':32 /
// //c,hl
,
APPLICA.NT PLEASE COMPLETE BELOW
Estimmd COlt $
, .
Type of 1'1_'.rc
q.aatit.'
~
I
kg"an.illJ
Water Heater
W.er ~ottD.r
Stand Pipe (Wuhlna Machine)
Scwall SJIClOt
alcldlow Aatembly
Backfl"... A...mbly ,Tat
Lawn S~ler
Uther
1)rM of I'btvre
Bath Tub with or without .how...
DJah\VUMr
Floor Drain
I...va'orY (B8lhroom Sink)
LaQodry Tray (lor 2 c:ompartment lInk
Shower Stall
Sinks
I Sir Sink
I W.ter Closet (TOIlet)
/
PEE SCHJ:.DUL'E
Industrial, COlflmcn:lal &. Mu lti.faml1~ I % of job celt -,.,hh. 539.50 minim\lm
COmet Ute 0IIb')
Ilaidlntl-.l. )\/c* One. Twa.Funlly S99.!O
b.lcien'lal, Add,hillJU. Alt.rltians $39.50
Bulldlnl Perm!t f#
r p~\O ~\~\1'
,SO . eU\\J)\~G ~ ....
~.
PLUMBING PEIlMIT FliE S
STATE SURCHARGE S
TOTAL PERMIT Jl'EE 5
In. \'our Bulldl....,.nl! WhiR AppfClnd
l1:..L~ - 0 I
Da.
Paid __
, -----
Da1e 1/ -I (/1 -- 0 ,
Il"clpt No.
~y7i
-
2~ ".lIf lIodee r.r .11 in,pcctlDJlI (952) "7..,ISO, Ia. (951) "".4315
5109
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
(Please type or orint and sil!Il at bottom)
ADDRESS
?)~ 1 ~ lAJOtx1~llt k Dp.
~. ~::n ~!~. I PERMIT NO. /./()ql/Q I
3. Yellow Applocant 7 I
u;lr~~)
LEGAL DESCRIPTION (office use only)
LOT jLl BLOCK / ADDITION
.
(vAdh ~ yel
PID;2S - ~7-() /t;-6
OWNER ""II \2
(Name) I (V. b< A '1 Dd_otu.::::.
(Phone)
(Address)
APPLIC~1; m \\-.... - - , _ 11 I
(N ame )-1+t J\ _ . Q r X Vl10 \ {J Q!Y N/Yl (_ ' (Phone)
(Address) -LI 0 CL1J .4bJl h rC 00 fin s'f, Yl L' <ciJ'~UV1 ~ .~,?:j- ?S()c.j
(Address) (Cicy) (Zip Code)
(Contact Person) ~ ~"t. (Phone) !lb ~ - L.f ~ q - '7.:2!:L~
APPLICANT SIGNATURE~),~ ~ \j t<f ~~ p~ ') DATE I f - } ~-O I
APPLICANT PLEASE COMPLETE BELOW
[gNEW CONSTRUCTION 0 REPLACEMENT 0 AL TERA nONS
FURNACE MAKE AND MODEL ArYY1s+rD 'n ~ (\...... I tJ q ~ A I J II ~ DaD FUEL A) A I.
FLUE SIZE RETURN OPENINGS INPUT lJ?J DDO OUTPUT J1LJ) /I of)
TYPE OF SYSTEM REA TING OR POWER PLANT
OWarm Air Plants
, OGravity
~echanical
OAir Conditioning
OVent. 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
I,' FEE SCHEDULE
Industrial, Commercial & Multi-Family I % of job cost Residential, Gas Fireplace
$39.50 minimum
Residential, Heating & AIC (New Construction) <S:~ /' Residential, Additions & Alterations
Residential, Heating Only (New Construction) $64.50 Residential, AC Only
$39.50
$39.50
$39.50
Estimated Cost $
Building Official
Date
Building Penn it # ~
$ 99. ~ 0 ~ .
~ lI~n ' ~o.'\ \j hw 01
.____(\\.) (y \FO V
Receipt No.
-"
Date
I j,. (J-/- () I
Paid
HEA TING PERMIT FEE
STATE SURCHARGE
TOTAL PERL'VIIT FEE
(Office Use Only)
This Application Becomes Your Building Permit When Approved
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
BYa(/
J
._.__._~.__".~.~_".____~_______~___..............-____'t._-~.~_. "."__.,._",*-,~"" _........_".,'"'^._.<.,,_..._,..~._".._"~_.."-,_.".__.~._,.,____,.,"4,..._....._~.,
12/10/01 MON 16:35 FAX 7635530887
GUY~S BUILDERS EXPRESS
_"'... @o01
REA TINGI AIR CONDITIONINGIFIREPLACE PERMIT
~: =. SicaM I PERMIT NO. ()1-~?4f
(Ple~ type or !)rint Il'Id 5ilUl iLt bol:l:om)
. ADDRESS ZONING (office use)
3;;./7 w~)~ j:>~IY~
LEGAL DESC'RH" ll.ON (office We: only)
LOT
BLOCK
ADDITION
pro
OWNE~
(Name) C!...
(Address)
BvIJ..IJP...S
(Phone)
APPLlCANJ:? C) ,. (?
(Name) <-?~~ ~ e:>V~..L.tt!J#:!'e5. dt/~hv
(Address) ~?t/b ~ / r 1:..1( IfI-V Nt!t
~ (AddJtlss) (City) (Zip Code)
(Contact Person)' c4,VO.....II.O . C KbhPJ!!..5 (Phone) ~ ~ ~9~ ,,,,&;~
APPLICANTSIGNATURE~ e.~ DATE/..;t-//d-/~
,
(phone)
-I APPLICANT PLEASE COMPLETE BELOW
~w CONSTRUCTION 0 REPLACEMENT 0 AL TERA nON'S
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
OWann Air Plants
OGf1l.viIy
o McchllJ1ical
OAir Conditioning
OVcnl. System
o Stearn
o Hot Water
o RDdiarion
o Spcl;ial DcvicC5
o Qthcr Dcvices
PLEASE N01'E:
Air Conditioner Units
Cannot Em;roac:h into
Required Side Yard
Setbacks
FIREPLACE MAKE AND MODEL/ p-U~ ~$r (' M.A/
FEE SCHEDULE
1 % of job cost Residential, Gas Fireplace:
S39.S0 minimum
Rcsidenlial. Heating & Ale (Ncw ConstrUction) $99.50
Rcsidcnlial. Hc:nting Only (No!:w Construction) S64.50
Estimated Cost $ /2J
IndUStrial, Commer<:ial & MUlti-family
S39.50
Residential. Additions '& Alterations
Residential. AC Only
S39.50
S39.50
HEATTNG PERMIT FEE
ST A TE SURCHARGE
TOTAL PER...~I'f FElt:
$
$
$
()/- (JtlH
r=" PA\O W\TH
.50 .~U~U)\NG PEHMAT
\
Building Permit #
l(')mc~ l.lu Only)
This APpn1iL~i7o~our Building Permit When Approved
_ ~ - 12---lLJ) (
Buildinl Oflicil\1 ' Dale
I Paid
Date
Receipt No.
By
l4 hour nllticc for all inspections (9S2) 447-9850. fJu; (952) .&47-4245
PRIOR LAKE
INSPECTION RECORD
DEPARTMENT OF
BUILDING AND INSPECTION
SITE ADDRESS ~ lB ~ t::J..vr.f? (l .-.
--
NATURE OF WORK ~
USE OF BUILDING 8 ED "
PERMIT NO. ()/70Cl4L1 DATE ISSUED e -l€"-2.r::J1
CONTRACTOR -, /c c60/IJlIl:rS PHONE 7l,."(, -1.J2-~
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
cd ~1~i
t FOUNDATION (Prior to Backfill) I ~;~ &c.- I to ';Dl 'O(
PLACE NO CONCRETE UNTIL ABOVE :lAS BEEN' Si'GNED
ROUGH - INS
rt~~
~Ur,
'6 ~ ll""l
1,~, _'~~l
,,~\(lw. lJ.. '. \' ,
(~ ,~~;L
INSPECTOR
t FOOTING
I~\\~
It> ,~~, 0 \
\'~:\\(
~a,
SEWER I WATER I SEPTIC
FRAMING
INSULATION
ELECTRICAL
PLUMBING
HEATING (if required)
FIREPLACE
GAS LINE AIR TEST
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I I
FINALS
GRADING (Prior to Sodding)
BUILDING
ELECTRICAL
PLUMBING
HEATING
DO NOT
(\ (P.
~\)~
fu
~tj~~
,I ~\lO~
~J14 O~
HAS BEEN SIGNED
OCCUPY UNTIL ABOVE
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.
.' ..
Call between 8:00 and 9:00 A.M. for all inspections
FOR ALL INSPECTIONS (952) 447-9850
.'. ,-"--.'--=~..,-~--"^~._---'"._~_._-
. - ~""'-'~--"-'_.._-,---,,'-"- '-,_._.,.._-~,.. '-"--,^"-'---~"'-"--'-------"--------,"
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
321 r um2
D (.I(.. Ie.-
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
Sod / 7 ,-,:,~)
(
COMMENTS:
(" .(05-<. h' ~
DATE TIME
/ O~)..,y
~.f
f),.-
o( qq'l
o EXIGRADIFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
It WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: JIi# I D-J-~-O (.., Owner/Contr:
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
32/B WOOD DUel:::-
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
11... 0 INSULATION
rr "il ~INAL
I[JSITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
)(.,MECH FINAL
DATE TIME
2~1&j-02- /:J.O
1- q+Cf
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
COMMENTS:
- -fe.1M}4 d\l'~tJe..vJ4:'1
- \c~Jd'\i\J'. p~ ' -+- '( vi \ L \
-- dealA' ~~ 1.tJ. - a..v\d. loT kl,eJC+ Mo r
a~d.. ~~\ I+- +e",c.e..- t)V1_
y,('o~PA'~ 'lll1Ae-
b~ fI> 0 l 0 C)...
\ I ' ~
~l4 ~K kh
~
~" aY\(- tr'AeS""
Ct'iu
(
l::::. WI ~
l
fiJe<' c....eveot1~ +--
~ ,
.D WORK SATISFACTORY, PROCEED
o c;pRRECT ACTION AND PROCEED
;a'CORRECT WORIt;, CALL FOR REINSPECTION BEFORE COVERING
Inspector: ~_ \~ Owner/Contr:
CALL 447-9850 FOri. THE NEXT INSPECTION 24 HOURS IN ADVANCE.
INSNOTI
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
3 ~/8"
SCHEDULED 1./.:11/ iJ L t l ; '3 0
~~
OWNER
CONTR.
PHONE NO.
PERMIT NO.
0(--90/9
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
'E PLUMBING FINAL
o MECH FINAL
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
COMM. E~TS:, \ \ . \ \
J-\'f. lsl~~ bop
IM~ c9 VlAf'{e.r- 0 ~
o WORK SATISFACTORY, PROCEED
~ORRECT ACTION AND PROCEED
o CORRECT WORK: CALL FOR REINSPECTION BEFORE COVERING
Inspector: ~ - \. illJ.d Owner/Contr:
CALL 447-9850 FOR T~E NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTI
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
bIll
ADDRESS ~c..I1<- L0 oOQ....j) u e)L r'.Q
" -, ,
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
;:g:: FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
CONTR. 'fIr, ~s
PERMIT NO. () 1- ~ L{~
o EY~/FILLING
o CO~INT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
OWNER
PHONE NO.
COMMENTS:
b/ tF-IcM - 61
C.Dvrlt'l if j ~ 6/(.{ ( , 'I.b f3o~
f) ut..},,'1I,' f1" br~.
o WORK SATISFACTORY, PROCEED
~ 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 & SAFETYl
INSNOTI
AIR IVIECHANICAL INC.
IIKATING & COOLING
"ClmATING CUSTOM COMFORT"
HOUSE HEATING T]~ST R1~C()H.D
(OHSATT TI~ST)
f~Lt' ~d~C~/J~________CITV___/~~ /;~
CG/.............. ~" -- OWNER 7L~ ---- ---
ADDRESS
OCCUPANT
.- --~---_.-
_____________I)ATE OF INSTALLATION /-/{}"O ~
INSTAI,L]~RA~_~__ ______________CiASIJNE I1Y _di:____/!2t!4j~~~Z:;~__-:-'.-_
TVPF OF I fEAT: CiA &' IlW SPACE IITR UNIT IITI~ (HilER
I
LW CUT OFF_______________H_________
PI{ ESSUR E _z..~_~~L;;1' CO2 .-_Zi____
INPUT C:FIl_//:&~_O~__% 02 "/, _ s-:__
. 0/'1
STACK TEMP / / 7r~{) CO e;7
COIVIP/\NY TESTING ,4;. ~'!-.~!:."-__~~_~___
IIEAT LOSS
C;AS DESIr.N
MA K E_~~2~C'7) ___________
MOl )EI,~/!fI1?:!/!;YZi_Q.! - ~
SERIAL "_d'?r~/e?--# 1.:1./ _____
INPlJl'___~~__~ 0..::________00____
CONTHOI,'S
T-s.IAr__lir~_IIEAT I'LIJCi_=_____
VALVE____-:-r~__Z.s-,j 0'__
LIMIT ~.~ ~S"I-
--.o- ----- -----------------------(Jf--/J-- ----
LIMIT SETrING______ ;2/ ~___C_____
FAN SE'ITING h-;:;/!!'d
.-If ,/ ~/L7
PILOT TYPE___~~/ ;'7_______________
PILOT MAKE #/ ~
PILOT TIMING ~ .,?- .5' >~:d....tlf
~~_'"-t~~.,>_.._'~..,.........
CONVlmSION
MODEL
MAX BTU RATING
MODEl. /I
VENT SIZE :3 II
--~~~~- ---.-- -. -- - ,.- -_.__.~--- --------..---- - ---~-
I ,IN ER_~4---- S 1/,I~ldLln_ NON I ~ ___-X.____
IWAFT IIOOD_4//A_RE(jtll,ATOI~u!}.?_-:_~
FILTER: SI/.Ed~.d~_Nt rrVIIlFIZ___/________
CHIMNEY I.oCATlON INsmEg__.c)UTSmE
CI IIMNEY TYPE_..&..c;___u____n__________
SMOKEIlOMIl
--
'- WIlZING
-
IWAFT
TEST 'I'M j
DOOR PRESSURE
- L(GIITING TEST-
NAME OF TESTER
Ld'
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