HomeMy WebLinkAboutBl Prmt 01-1061, Demo 01-1060
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
(Please tvoe or orint and sign at bottom)
ADDRESS
1. White File
2. Pink City
3. Ye\low Applicant
15330 EDGEWATER CIRCLE NE
LEGAL DESCRIPTION (office use only)
, LOT i) BLOCK I ADDITIONUAtt;f;A/SotJ /S~fJ ~N/) /t{)IJJ7J~;JPID 25-071-006-0
OWNER
(Name)
. (Address) 15330 EDGEWATER CIRCLE NE
GERALD MEYSEMBOURG
BUILDER
(Name) ~ I::bo~~" l'-.fe..
(Contact Name) '-'~ - ~ - '\S'l...- t;:S'1 - 71'31
(Address) u1 ~O L-Wt:<t oU AVE::
L A-1~( u.:e.. M .; <;"c:::n \oj ...;
. t
TYPE OF WORK
o Misc.
(Phone)
(Phone)
(Phone)
C} 1!> t;; - t:;; ct c;cJ
e!j ~ - 4/7':;;;
~~
P New Construction
~ower Level Finish
\'81'orch
OAddition
OUtility Connection
o Deck
ORe-Roofing
ORe-Siding
~Fireplace
OAlteration
PROJECT COST/VALUE (excluding land) $
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
;~ the property t erform nelinSpectiOns. "20 } U 307 7 _ J?, _ 0 J
(/ 'l . 'Signature Contractor's License No. Date
~ '0 aT). c:'9 I Park Support Fee c..~{'r $ ~.~
$ I/~",.S-~ I SAC C~~~ $ /. ,~.~-
SiZ(~; 1"; r-
$ I I' O-c.)~ I Water Meter $ ..
I as- .0.
$ '/OC"c:;j I Pressure Reducer $ 4S.~
$ I Sewer/Water Connection Fee # $ ~..~
$ lot!) .00 I Water Tower Fee # $ cNA\,-t-
$ 100 <X/ I Builder's Deposit $ IrSoo .00
$ 35.::> 0 lather $
$ '-10 . ~O I TOTAL DUE $~7~5al
--- I PaJ tjrflf:), bl t..{tJU ':J-9
our Building Permit When Approved ReceiPt No.
12J-~ I Date Ih-- 4-0 ( , By /j' ------
(Y
Date
his 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
len signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
'~5t. fA ~G?---~- ClI2S/(Q4 ~-A-t\~ ~1c.9v1~
1/ - ~~g1)irector Date Spe-cial Conditions, if any
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
CITY OF PRIOR LAKE
DEMOLITION PERMIT
1. White - File
2. Blue - City
3. Yellow - Applicant
Perm~ No. 0/- /0 (PO
DIRECTIONS
1. DATE
BUILDING INFORMATION
7. SIZE OF STRUCTURE
SPACES NUMBERED 1 THRU 10 MUST BE FILLED IN
BEFORE PERMIT ISSUED
(Please print or type and sign at bottom).
10-3- 01
8. NO. OF STORIES
2. SITE ADDRESS
IS3.3Q._.F=df.4f we,.. t~t"
3. LEGAL Ul:::)\';HIt' IIUI~ \J
LOT.5 BLOCK J
ADDITION t"\",.\-i. v\ SOIA.. I.e; \~&
Q~\ c\~
PID dS-Dt--z t
~V\ct 1:\,.1,4111 .
9. TYPE OF CONSTRUCTION
10. COMPLETION DATE
-DoID-(J
4. OWNER (Name) (Address)
C;p \"'Q.J,J.. t-'\.. ~ ~ Ii. \M 6,,", \. ~" ~
5. ARCHITECT (Name)...J V (Address)
(Tel. No.)
(Tel. No.)
6. MONTRACTOR (Name) (Address) (Tel. No.)
I<"'CX\-7' a U:' l'{-~s '78<) -.<)7 ~
I hereby certify I have furnished information 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.
Furth~.~more, I herebt ~ree that the city official or a designee may enter upon the property to perform needed inspections.
x~1 }!l/flO{ JY10Jl / (J ,'1-0/
() Si9'11ture Date
METRO SAC UNIT DETERMINATION
FOR ADMINISTRATIVE USE,. . {r$. _ ." ~
OC7f /.:>u04- ~ ()vv.-'t)
1. 77J 8G I16c..o IN ~
MATERIAL FILED WITH APPLICATION
CJ Site Restoration Plan
CJ Utility Abandonment Plan
CJ Sewer Abandonment
USE OF BUILDING
~1"\5\P ~\M;~ tJ.e~~~J_
SITE RESTO~~PLAN
Accepted by l~t>.
Rejected by
CJ Water Abandonment
CJ Electrical Abandonment
CJ Other N~ SFD g,t'IM~ \-
TYPE OF CONSTRUCTION:
II
III IV Q
H UP M
2 (1) 4
CREDITS
Park Oed. Cred~ ................................................ $
SAC Credit ......................................................... $
Sewer & Water Connec. Fee Credit .................. $
Water Tower Fee Credit .....................................$
Other .................................................................. $
TOTAL CREDITS ........................ $
L
Occupancy Group A
B E
Division
Date 10-5-01
Issued by
Date
This is to certify that the request in the above and accompanying documents is in accordance with the City Zoning Ordinance and
m}V1'rOCeed~reqUested.
( /( ~ ~<Z ~~ W/3/e{
e!1yPlanner Date Special Conditions if any
'.T--'"
~ ~. . .. ......J,. . "
Th. C.nlrr or lh. Lok. Counlry
White - Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT Ka4.~~'!A r!!/J-nta~J
{ r7>} I!( .
APPLICATION RECEIVED Cf- It -() I
.
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at: .-
/)
/5 33{) CdC1e~.0~
U
Accepted
.)(
Accepted With Corrections
-Denied
Reviewed By:
AJIIB
Date: '}-). 8-01
Comments: See Reverse Side for Additional Information!
~ee Attachments: 1) Grading Plan. 2) Erosion Control Measures
....3)Erosion Control Plan
liThe 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.1I
Th. ('.nl.. nf th. \.ok. Country
White - Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
.;; . I
/,J(.... J
- i/j ,) )
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
/...~ -'//'...0 " .-(~/._- /
1-1 , ,
Accepted / Accepted With Corrections
Denied ~ ~
Reviewed By: Date: q/~/O (
---., .
. --
FI!~\~ f;~J:l:e~v~~lJ
([6 ~.p~ ~ (A~"
~ V~A> Qr~~~ ~::
~Xc! Ct,~ );vV~ ~ L'I~ Lf "
~{-)~~~~. -~.b
M~J}AN~ ~liPI,....@wf4J~~ II
"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
The ('f'nlf'r of the Llkt Country
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT e~ J( ~ ~
APPLICATION RECEIVED I q! /f!I-6;
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at: __
,(533{) 6d~~~
(J
Accepted With Corrections <
Accepted
Denied n
Reviewed BY~~
/
Date:
9-2(- 2<r)/
Comments:
,. So~ Cll\ ~~il QJ'Qa..S
?, MQ.\\t\.W\JL 7'~(CM.. ~,J
3. .ptoV\~ f:"DN ~Jdtl.'~ ~ SUlv..e~~ ~~ FD~ ::rV\,>~d"dV\...
4.. Iiovi&. e\.evti1CJx <llt+l rrce.:t~""^- I=~ OCClJ lP<>-c~r....J.. i~,w
U
"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,"
\
ELEVATION CERTIFICATE'
FEDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANce PROGAAM
\TTENTION: Use 01 this c~r1iflcate does riot provide a waiver 01 the flood insurance purcha$e requirement. This larmis ulJed only to
,rovlde elevation Information necl!l$sary 10 gnsurf compliance with Ilpplicable community floodplain management ordinances. to
dl!!tsrrnine the proper Insurance premium rate. and/or to support a request lor a Letter of Map Amendment or Revision (LOMA or LOMR).
Instructions for completing this form can be found an the following pages.
O.M.I, No.lo67.QOn
eAplnuM~yJl. 199J
SECTION A PflOPERTY INFORMATION
FOR INSUAANCli COMPANY USE
POl.ICV NUMBER
eWIl.:l1NG OWNE;;l'S NAME
J<::.I..L 0{ ,. ~Mets....:..l....,.n:g
st!'\!5i AOOAESS t1MluO'Ilt:j Mil.. Unit. SUIl' ilnClQr 91011. Numb.rl OFl ~.o. ROUre AND !lOX NUMeei=l
15330 FrlQewateJ;: Circle __________________
OTHEi'1 oesc,qIPTION ILat ~nd aloek NumCetS. ele.)
Prior IakeL-
COMPANY NAle NUM,eR
)ti
STAT!
''''~22
ZIP cooe
I
I.'
I
I
I
- ,
CITY
seCnON B FLOOD INSURANCE RATE MAP (FlAM) INFORMATION
P~ovide the folloWing from lhe proper FlAM (See InstrUQtions);
5. FI~M lONE
2, ~"Ne!. NIJ"'BI!~
e. ,..S! "'.COD 5LEVATION
(in ,i C; !~I\.$. un l).t)ln I
3. SlJI'FIX
4. OAT! OF FIRM INDIiX
,. COMMVIJITY NUM9EFl
Revised 11-19-9 7 AE & X
270432
0004
908.9 ~
7. Indicate the elevation datum system used on the FIRM tor Base Flood elevations (eFEi: ~ NGVO '29 --; Other (desc:ibe on back)
8. For Zones A or V, where no 8Fi: is provided on the FI~M. and the community has established a BFt: lor this bllilcHng site. indicate
Ihe community's SF;: .980.9; .'~ leet NGvO (or other FI~M (IiltUm-$Se Sectiof'1 8, Item 7).
seCTION c aUILOING ELEVATION INFORMATION
1. UsIng 1M Elevation Celiiflcate Instru~iol'ls, indlcale Ihe diagram number Irorn the dla'ijrams fOUnd on Pages 5 and 6 t"at ::Jest
describes the sutljec: building'S reference level 1 .
i(a). FlAM Zones A 1-A30. AE. AH. and A (with BFE). The lOll of the reterence level rIoor from the selt!cted diagram is at an elevallon
01 9~4,4 '_ leet NGVO (ar OI1'1er FIRM datum-see Section 8. Item 7)_
(b), FIRM Zones V1 .V3Q, ve. and V (with Sf:). The bottom of the lowest horizontal struclural member of Ihe retere~ce level from
the selected diagram. is at an gl@VlillM of : I II! ,,-J leet NGVD (or other FIRM datum-see Section e, hem i). .~
(c). FIRM Zone A (without BFE). The floor used as I"e reference levellrom the selt!!cted diagram is ~.U feet above = or
below = (check one) the highest grade adjacB"t to the building.
(d). FIRM Zone AO The floor used as 'the relerence levgllrom the s8le~ted olagram is ,'.~ leel above [] or below CJ (check
one) Ihe M'ghli'st gr<,de adjacent to the building, If no flood depth nUn'lber is available. is lhe buildinljJ's lowest floor (rel~r1!nce
lellel) elevated in acco~da.nce with tM community's floodplain management ordinMce? .- ~!S ~ No U ~nknown .
3. Indicate the elevation datum system used in determining lhl!l above reference level elevations: ~ NGvO '29 .-.,; Other (describe
under ComlTlents on Flage 2). (NOTE: If the elevation datum used if! measuring the elevations is different than thoat u$,d an
the FIRM (see Section S, Item 7], then convert the elevations to the darum system used on rhe f:/AM and show the co.nversion
equation under Comments on Page 2.) .
. - ~
4. Ele~ation reference mark used appears on FIRM: U Yes :.X:~o (See Instructions on Page 4)
5. Thll reference level ,lavation is ba,ed on: =:t actual construction n CMstruc:tiot1 drawings
(NOTe: Use of constl1.Jc:tion drawings is only valid If thB building does flat yet /'lave the reference level floor in plac" in which
case this cerrifica/e will only be v~lid for ihe building during the course 01 construCtion. A post-construction elevation Certificate
WIll bs rlilQuired once consrruction is complete,)
13. The elevation of the lowest grad!! immediately adjacent to the building is: '--9J.i! 1:1! :. ~ reet NGVO (or ather FIRM datum.see
Sec:ion B. Itern 7).
SeCTlON 0 COMMUNI"rf INFORMATION
If the community oHlcial responsiblA for verifying building elevations specifies that the rBfertncelevel indicated in Section C. lIem 1
Is not the .'owest floor. as defined in the community', lloodpl/lin management ordinance, tl'e elevation ollhe b...ilding's O'owest
II00r" l$ defined by th~ ordinance 1$: ,:; i I.U feet NOVO (or other FlAM datum-see Section B. Ilem 7). .
2, Oate oi the start of c:mstruction or subslantlal irnorovement
SE!: m,YEi1SE SlOE FOR C;;ONT'NU~TlrJN
R~ ~t..\r.cS ALl. PREVIOUS cOI nONS
, .
.;
t
;:..,:
SEC110N E CER11FICAT10N
This certification is to be signed by a land surveyor, engineer, or architect who is authorizeQ by state or local taw to certffy elevation
Information when the elevation lntonnation for Zones A1-A30, AE, AH, A (witt1 SFE),Vl-V30,VE. and v (with SFE) is required,
.Community officials who are authorized by local law or ordinance TO provide f100dplaJn mranaoement intonnation, may alSQ sign the
centfication. In the case at Zones AO and A (without a FcMA or community issued BFe), a building official. a property owner, or an
owner's representative may also sign the certification.
Reterence level diagrams 5, 7 and a - Distinguishing Features-If the eerUfler Is unable to certIfy to breakaway/non-breakaway wall,
enclosure size. location at servicing equipment, IIrea use, wall openings. or unfinished area Feature(s). then list the FeatlJre(s) not
included in the certification under Comtnents below. The diagram number. Section C, Item 1, must stili be entered.
I certify thst chI Information' in SlifCfions Sand C on this cerrificat. r.presenls my b~sc efforts to imel'pret che daca ~vaj(able,
I understand. t/lat JJny 'BISEl statement may be punishsble by /in, ar imprisonment under 18 U.S. Code, Seaton 100r. .
Delmar H. Schwanz
CErrrlFte~'s NAMe .
Licensed LarD SUrvevor
8625
LICENSE; NUMeeR (Ill Mis Seal)
De:bm' H. Scl...~u. T.and S\lrYe)~o, lnc.
COMPANY NAMS
TITLE
...,.so IfJS:I:1tl1 ~ '7J!/J .." ~~~~_....
~1td)?/g; #/[tf/l(,1.t( -::_ March 28, 2002
SIGNAn)Ri! - ( (" ) OATE
'----""
Copies should bl!! mede elf this Cenlf\eate for: 1) community oNlc:;ial, 2) Insurance agent/company, and 3) building owner.
~
S':"AT"E
55068
ZIP
651-423-1ID
"HON\!
j
COMMENTS: _ BeId1 Mark: Tq> nut of hydrat'lt- N:>~
= 923.47 RMJ
~lW LI. If:]1n ~~ u:3'~A
..~ - ~~"ana:"":l:;;r. :m~\III1!III""lll
,~\\\,\ . "I E S IItlllb
,~~\ ~ '.......... 0 .,..~~,.
~'F ...:t;:;.,- ....."" "~.
...... '.. .~T ~
;~ J.. " " . ..::--
.,... -../ . \4. ~
i;t : -'DCI_/VIAA d. \ ~
~ f SCHWANZ 1 i
.~ , 13
%('\ -8625- !_s
~. ,~-~ .~'of
'-;'b 'A~".. .':'. H
~ ~v. '. .' ~ So'
~. '^ ....k......::; ~' ,~
'~:'~..s.y.p. '-I ~~
~/llllll/IIIIlII\~\\\\\\\'.
ON
SLAB
wmt
BASaaEItT
ON I'lLElL
lI'tEFlS..QA COI.\JI.lItS
I~~~] l~.c-~
l ~\~kJ~~~ ~w.tl); . " .,'
. ~ .~, '.i:')~;?:r.
.....& " ,.,...., ~ to' .
__ ..,....'..,1
~00ll .
n.rvA''''''
IPlII't.II~' .\&I.6CaIf
\RilL . Jl/Wle
A
lr lONES ,
~
.~~ ~
.. .....,.,~.....;~
',"" .t.~,.. ...~.:i61
'~.:.r':':~:\ ..~~.' r".".El<CEI
_f . ,. t'!X I.EVl!L
~,6.
.~
(~i~ IAr.,-:JJ.ff
~~~~
lASE
"'-00ll
b.IVA~
-..J
A v
ZONES ION~
IAe~~E~ ,~ 1~EM:f'
~ .rvtL
'~-I
'^""-~?r ~ ~.I
~ i ~
~, " ~
~l ,;,:;!...,,;;..,......,..,;,:..,.;.-:I. __.....
(",' \....i....f.t...................~.~..
~~)~i~:~iflf:;;JjfH.;if::4;/ ~;l~;.~
A v
ZON~S 2CNES
The diagrams above illustrate the point$ at which .the elevations should be measureq in A ZQMS ~nd V Zones.
el~vatlons for all A Zones shQuld t>e measured at the lOp 0/ the reference level lIoor.
Elevations for all V Zones should bg measured Ilt the bottom of the lowest horizontal structural member.
-------
Date Rec'd
\',? b
Y.M
CITY OF PRIOR LAKE
SEWER AND WATER PERMIT
t
/'
-6
\i \
; ~~~w ~ii;~ PERMIT NO. 0' -I ola I
3. Gold Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
J.f.l1o
E;. 0 ~ F:. fA.} AT;C--4.-
(..--7 .
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name). () /1,2- L-cJrtC-
(Address)
(Phone)
(Address)
(City)
(Zip Code)
APPLICANT
(Name) (;) Il t:S. JI-~ (( G XC 0
(Address) J ~ /I J?
.! c fJ eX',..J LV A-/
(Address)
(Phone) 0/ J~ol.
Ult.Jl.
(City)
~ '1,2 ... i:. q () ~
S .Jo4Lf
(Zip Code)
(Contact Person)
APPLICANT SIGNATURE e. L -,\t.-: ~~\\"
(Phone)
DATE
11 (, J C I
APPLICANT PLEASE COMPLETE BELOW
Size of water service inches.
Location of any couplings from structure - feet.
Type of sewer pipe. 0 ABC [8! PVC 0 Cast Iron
Estimated length of sewer line R 0 feet.
Clean out (if required) located at -- feet from structure.
FEE SCHEDULE ~
Residential sewer and water line connection $35.50 Industrial, Com'l & Multi-family 1 % of job cost with a $39,%riti;;imum
Sewer connection only $17.50 Water connection only $17.50 / .
Building Pennit # 0 - I 0(0 . t J
SEWER AND WATER PERMIT FEE $ 11 f\, \ ()
STATE SURCHARGE $$. /;% r f\ IJ /
TOTAL PERMIT FEE / ('\ V
/ ~V\)
Estimated Cost $
(Office Use Only)
Th;s Applkatioo _omes Y 00' Bu;tdmg ...ml' When App,oved p~<tT
Date r a1te_1 _ n I BY.pL
Building Official \
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
-
12-03-01 02:45 PM FROM FGTN PLG HTG
TO 6124474245
POl
I. ltlue Ale
CITY OF PRIOR LAKE ~: ~~ ~
PLUMBING PERMIT # ~ (
Applic:ant:.....Earrv"tI'''~ ('t~W\b":i & \-\~, Phone: 1.51-4fQ-:;-7~J.'I
A~dress: ~{0.3: ChirPell\~41e_ ~vd
Slgnature:-;I)na- u Q L.. ~I'" -
Legal De$Cription: Lot Block Sub
Site Address: 15330 eJ.~lL.~~r C; r
Building Permit. () / - loh / PIO #
NOTE; This permit will not be processed without complete Information.
FIXTURE UNITS
Ta.t (....Iff ., I'", ...... c...."..,
Type of Fixture
Quantity
Type of Fhdure
Bath Tub with or without shower
Oishwasher
Floor Drain
LBvatory (bathroom sink)
LBundry Tray (1 or 2 companment sink)
Shower Stall
Sinks
Bar Sink
Water Closet (toilet)
Quantity
-3
)
I
I
1
,
Y
)
:L
I
Rough-Ins
Water Heater
Water Sonner
Stand Pipe (washing machine)
Sewage Ejector
Bec:IdIaw'n rnbIy (RPZ. DocMt Check. PVB)
Backftow'Assembly Test
Lawn Sprlnkfer
Ottler
,
~3
FEE1fHEDULE
IrwJrJll".c.J.-i~lti-FamilY
(1%Ofjob~~_ Imum) .
I "'1.
Residential. New One & Two Family
Residential, Additions & Alterations
State Surcharge
s
S
$
S-#"~k
$ r;~~
~_.-,-
$~~,o leA"
$39.50 (,..'f "'1
GRAND TOTAL
This permit is granted uP9n tbe e.pn:ss condition that laid
c::onlr8l:tur. .hllll camp . I rcspects wilh thc ordiDIUJII:cI
of the Stale Plumbln! endment& thueof.
_____ ~"S"-O/DATB
ATTEST
Call (or all ins lions 24 hours in advance.
16200 Eagle Creek Av. S.E.. Prior Lake, Minnesola 55372/ Ph. (612) 447-4230/ FAX (612) 447-4245
An Equal Opportunity Employer
A_
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/J:4.lKEPLACE PER./VIIT
D:lte R~c'd
10 -5-0/
~. ~;.:.. ~;~. I PERi"IIT NO'O/-IOLI i
i. '(.IIo~ APIlh..nl ~ I
(.?l~t: t'Vt't: Or prine iUld sii!1~ ole boi:tOm)
ADDRESS
/r~~C"I ~€~~f'
LEGAL DESCRIPTION (office use only)
CI/rt:/ ~
ZONING (otlic~ usd
12. ISD
LOT
BLOCK
ADO[TION
PID 25 -07/- (JOe, - 0
~':~R t:lAI-d4ft fl-
(AddreSS)' L~ I
~~...e<:.
(Phone) !i5'-~ - ~- 5'95t1
APPLICANT
(Name) ~ _7;1.,",/I~,.O (] /f1
(Address) d/;;; /e!Je(.Uf,.u AI ,-~
(Address)
(Phone) ~b6 -- ho;:;);;:)
.1} hj
. ;?/,v,
, (city)
_ ~"i"6 OJ 4
(Zip Code)
(COl'1tuct Person)
~<~
(Phone)
DATE _La --5"- 0 I
APPLICANT SIGNATURE
./ APPLICANT PLEASE CO~!LETE BELOW r---"--'
~EW CONSTRUCTION 0 REPLACEMENT 0 AL TER.'\ TIONS
FURNACE MAKE AND MODEL )rcvu e 7ii)( /00 C. 9-V? FUEL .<J/f /-
fLUE SLZE _~~Yl/C RETURN OPENINGS INPUT /c:rJ, Ol')O O~PUT 9~.coc
TYPE OF SYSTEM HEATING OR POWER PLANT
OWarm Air Plilllts 0 Stt:tlm
OGrnvity 0 Hot W'dlt:r
~ ':;>{echanical tV 0 Radiation
~ Condjtionjn~ /') 0 Special Devices
Went. System 0' 0 Other Devices
F1REPLACE MAKE AND MODEL ~~a I. 1- ~S r: Ill/F~ / - /? - ..:/5"00
P'LEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
Industrial. Comrnerdlll & Multi-Family
FEE SCHEDULE
1 % of job CDst Residl;ntial, Gas Fireplace
539.50 minimum
S99.50 Rcsidt:ntis.l, Additions & Alteratiuns
$64,:;0 ReSidential. AC Only
S39,50
Residenti01. Heating &. Ale (New Construction)
Residential. Ht::lting Only (New Construction)
:539.50
539.50
HEATING P ERi'vlIT FEE
$T A TE SURCHARGE
TOTAL PERMIT FEE
Building Permit ~
$ r ,,~\O :~RWSr
$ ~\N
$ ~
Estimated CoSt $
(Ome. Us., Duly)
This Applica[ion Becumes Your Building Permit When Approved
Building r)ffich,I
Ollte
---
Paid -------I Receip~
_______ I ".--- I J /I"
~-Da[eIO_5_DI By 11M
f .
I
I
.J
2.:.1 hlll.lr notia;~ r/,r AU inspections (9:S2) 44i-9S50, /':u. (952) 447-l24~
100 III
X1 HO Hid Xl:> H+-
HIV <I3110HJ.N0:>
9LZ909t1S9 XVd t1:C1 IHd 100Z/90/01
PRIOR LAKE
INSPECTION
RECORD
SITE ADDRESS l 53 "5 0 ~..t.wcJL..r-
TYPE OF WORK ~ck I
USE OF BUILDING $FD
PERMIT NO:- OI-LOul DATE ISSUED 5- '2 -0'""'>
BUILDER ~ M~.-- PHONE# ~/2-80c(-2J50
NOTE: THIS IS NOT A PERMiT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
DEPARTMENT OF
BUILDING AND INSPECTION
J FOOTING 'btJL I Ikr. 5,/ 't I ! d"V' I
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
I FRAMING I ~ It, I JZ1av
INSPECTOR
DATE
l FINAL
<8h
.
I fS/~'&/02-
Call between 8:00 and 9:00 A.M. for all in~pections
FOR ALL INSPECTIONS (952)/447-9850
PRIOR LAKE
INSPECTION RECORD
DEPARTMENT OF
BUILDING AND INSPECTION
.
SITE ADDRESS 153 sO ~ G-.
NATURE OF WORK J:J~
USE OF BUILDING ~C::::F n .
PERMIT NO. ()/::. /Of4! u DATE ISSUED If- ~( "'0 I
CONTRACTOR ~ft ~. PHONE 9B~- q! -; C\
NeTE: TW.I~ Ie: A PERMIT FOR ANY OF THE INSPECTIONS BELOW
r.D~ 2:1 bTHErPERMIT ,IS tic....ARA"iE DOCUM~T
, ~~ O\^. ~U\'~ \Dtu t'-4- r-DtJ I",SQs'PECTOR ( DATE
. FOOTING ~ \J/~ ~. . IO/;).~/() ( I
\. '
FOUNDATION (Prior to Backfill) ~I'~ /' 'b'" ~~- 0 \ I
PLACE NO CONCRETE UNTIL ~tJaOVE HAS BEEN SIGNED
ROUGH-)NS
SEWER/WATER/SEPTIC IPt It! /~/~~/
FRAMING I . fi:?J- Id/r3/01
INSULATIONl"l-b 11I11o~ f!;".. 1'Z,11'{ol ~f}3l(' .' ~ III (7 (o~
:I. , , ,I
ELECTRICAL
PLUMBING \...\... 6-r '/ll/o'l- ~. /tN~1
HEATING (if required) 1,.1,. ~, \/\l!DZ, ~ /rj-/I '3lb I
FIREPLACE l,-.(..~ ~ tJ'i i6 1..- t.41e-' 1Zf:r J;}-/ /3111/
GAS LINE AIR TEST ~ ~ 124 It/o, I Ii. 4-'~' At. 'r/l \ /~z..
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I :4A~ );1-11(/0/ ~ I cJ~- w(c \J2.-/tl}OI
eco& ~.l.e\JoJt t'dV\. ~~.~ /.~ lI-N A L S &~__ \A.u,.,~ c....-F'O (
GRADING (~rlor to Soaatng) 111~-' V. 'l.-G. .0 z.--
BUILDING ~ 8. 'ZrJ .c;)~
.;
ELECTRICAL
PLUMBING
HEATING
DO NOT
.A
~ VJ 3/;)- 5(02-
, !fA, 41r:).) tJ 2.-
. II .
OCCUPY UNTIL ABOVE HAS BEEN SIGNED
NOTICE
This card must be posted near an electrical service cabinet prior to rough-in inspections
and maintained until all inspections have ~eeri &'pproved. 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
J
.,-,
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS 1~33(?
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
~INAL
o SITE INSPECTION
DATE TIME
~ ~ ::<C.-o2...
SC.HjDULED
W'11 -kJ J:'f"!:<.
t~ lJl:1,hr C I r
CONTR. R Cf I z.. Iet/i
PERMIT NO. C) 1-1f2j; /
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
~ILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
COMMENTS:
(c./Ih TS6~--~) K..
~ORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector:~ ~ _ Owner/Cantr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH &: SAFETYl
I/VSNOTl
OA TE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED ~r;2.3-~,,-~ 00
Jt-5" 3 ~o FrI~
I
ADDRESS
OWNER
CONTR.
PHONE NO.
PERMIT NO.
/-IO(P I
o FOOTING 0 PLUMBING RI
o FOUNDATION 0 MECH RI
o FRAMING 0 WATER HOOKUP
^ 0 INSULATI2N~ <tOUI,O SEWER HOOKUP
JrFINAL ~ I u...{' 0 PLUMBING FINAL
o SITE INSPECTION 0 MECH FINAL
~~ 111;uJCJ../~CtM(
#0-
'v4.~~ ( 1 thU ~
r~~q,~.~~
., -
LM-~~ .
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
COMMENTS:
~ WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: .. ~A..
Owner/Contr:
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTJ
SCHEDULED I../-B - ~ J ; ~
h'dce~h/~
- I
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
/5330
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATI~ _ "\A~
FINAL ~
~ SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
OA TE TIME
61- /6(;, J
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
COMMENTS:
v'I. ~O~ nOO bMJ ~Il~
V Z. "tki..Q,-. ~.... r Cn-tC~
V 3. MC4.t"VL ~ \ l-L ?~ C-rn,A h-") t
V <to H~ Coed: S-\UCGo d- &~~ &t'cJ L
~rl~*.c .t--(6""'l~-
-/ S. &-\..rrl"'" (' ~('...oh, ~ d- ~\~w""","\_
- I Oil
In. ~d~Q h~ ;h~ IAr'f>~-
vi" lJ>.or-'LA"^,,,--t- A~ .
/ (') ot 6
/ \-~..~ \.:..-
,'0 /1.UJr
V
I
( f
o WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
YCOR~, CALL FOR REINSPECTION BEFORE COVERING
Inspect~l/ Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
II'ISft/OTl
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
DATE TIME
CITY OF PRIOR LAKE 3/Z~/O'L '}: SQ
INSPECTION NOTICE SCHEDULED
ADDRESS /53?O Afe.~ ~.
P
OWNER CONTR.
PHONE NO. PERMIT NO. OI-/OlD/
o FOOTING 0 PLUMBING RI
o FOUNDA nON 0 MECH RI
o FRAMING 0 WATER HOOKUP
o INSULATION r@ 0 SEWER HOOKUP
o FINAL ~ PLUMBING FINAL
o SITE INSPECTION 0 MECH FINAL
COMMENTS~ ~ L ~J ~A.~
~~~~,
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
11(~ l ,\ V!I (.. -~
iJ~~ -~-<y - '*-
~~~,
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 & SAFETY!
INSNon
ADDRESS
/6331)
DATE TIME
SCHEDULED L; -.J -oJz t; ,# 3 ()
Ec/c;eax;fev-
CITY OF PRIOR LAKE
INSPECTION NOTICE
,
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o/-/o~ /
o FOOTING @ 0 PLUMBING RI 0 EX/GRAD/FILLING
o FOUNDA TIO 0 MECH RI 0 COMPLAINT
o FRAMING l \ 0 WATER HOOKUP @ 0 FIREPLACE RI r 1...'\
o JNSULA TIO'~ 0 SEWER HOOKUP ~ FIREPLACE FINA~ ~ /
~INAL ~ 0 PLUMBING FINAL . 0 GASLlNE AIR TST
o SITE INSPECTION Il.l:9~ECH FINAL rn
COMMENTSd1 k.R/~ ~,[j
, i:::J- ~ l'
"~~ I ~,
"$} tJeJ +0 <J~~ ~ J}~t1.J'..oo ~
~ ~, W/I ~ -tl+--~ (!..;",v+--
~, .
t<:~~ ~ ~~
:\<:~ ~lll'l ~-c:- ~ O~4.)1
5Jg U y><1 ~. . !
~~
o WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
JI 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 & SAFETY!
INSNOTI
ADDR ESS
OCCUPANT
HEAT LOSS
SOLD BY
/.rJJtJ
f,04<. w4k,.
Cr,.;.{
HOUSE HEATING TEST RECORD
FLOOR
DA TE HTG. INST.
Electrical Work By
TYPE OF HEA T GA FA HW STEAM
GAS DESIGN
MAKE
Model -r~,< 1,(<. ~ 'l.~"\
Serial It :J f\ '" 5"".\"1 G
INPUT
CONTROLS
THERMOSTAT Heat PI", .J'
Valve
limit
Limit Setting ?~41 ~
Fan Setting 7//1J...,/
Pilot Type L. lj n r-J7
Pi lot Make
Pilot Model
Pilot Timing
L.W. Cut Off
Pressure 7.1- Percent CO2 tf
Input CFH Percent O2 )
Stock Temp. /t:J'(J Percent CO d
Form 235
PT.
OWNER
CITY
INSTALLED BY CONTROLLED AIR
':'.. Line By CONTROLLED AIR
SPACE HTR. UNIT HTR. OTHER
CONVERSION
. I'~ OF BURNER
a ., I
Max. BTU Ratln,
r \KE OF FURNACE
Model
Vent Size
'J~
KIND OF LINEr
Draft Hood
Flit.... Size I ~....?...("">r;F
Otlmney Location In.ide
Otimney Con.tructlon PL/~
Smoke Bomb
Draft
Door Pre..ure
Date Te.ted L-> y~ "f
Company Te.ting CONTROLLED AIR
Name of Te.ter c::;tj
SIZE
RegulaTOr
"'umber
Wirin,
Te.t Tall
Lightin, In.t.
Outsid.
CUBURB
NONE
ADDRESS
/~?'3o
DATE TIME
SCHEDULED II - r; - / 1/" 3 cJ
~d~U)dia-~
CONTR.
CITY OF PRIOR LAKE
INSPECTION NOTICE
OWNER
PHONE NO.
PERMIT NO.
I.-/~
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
~PLUMBING RI
o MECH RI
)2r WATER HOOKUP
ZSEWER 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:0T~ ~ ~ ~5~ ~
q~~~P <Io~.,d- Cl-v-lrS~,
uJ! (l ~ -o"j- rl- ~ ftkAJ- J
-
T
:L
~
r--
t
9'
- LT \ ,
\ ':, \v I)J . fo~ '"2P ~ t ..,...,..,.-
, .. J.... wr' (1: (L ~
","- ~ .
o WORKSATISFAC RY. PROCEED No ~
.,. CORRECT ACTION AND PROCEED
:'::O~CT ~OR RE'NS::::::FORE COVER'NG
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTl
. ..d --r- .