HomeMy WebLinkAboutBuilding Permit 99-0112
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i,:~ii QLertifiratt at (lDcrnpanry · --'
r:f CITY OF PRIOR LAKE
rt jDepartment of ~uilbilllJ 3Jn~pettion
j''';;' ~inal Pennitted 0 Conditional C.O. Expires
l-~t " This Certificate issued pursuant to the requirements of Section 307 of the Uniform Building Code
~. . certifying thot at the time of .."",,nee this ,,",ctun was in complionce with the various my}inances of the
.,..::. . City of Prior Lake regulating building construction or use. For the following:
X;
'. Use Classification Single Familv . Bldg. PennitNo 99-0112
Occupancy Type
R3
Type Construction
VN
Fire Zone
N/A
Zoning District R 1
Legal Description
LlO, B1 Pheasant Meadows Phase II
Owner of Building
c;ite Address 17192 Pheasant Meadows LN. SW
Contractor's Name & Address Williams Dev. 1535 Bav~rian Shores Dr Chaska MN 55318
Robert D. HutchinsD"J. C. PI lenni Tovar,
- f-V " tty anner ~
1/ I "t-l.- It; ~
...
Date:
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSU~
~FINA
o SITE IN PECTION
COMMENTS:
DATE TIME
SCHEDULED If/ZZ t,
Ut t:~ 41G11.J7~
r-,/ Ci7
, I' I --
CONTR.
PERMIT NO.
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
(I~~
/'J
(~-V;ZrJ
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
;::-r ur
/l
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(WORK SATISFACTORY, PROCEED
o CORRECT ACTION A~N~CEED
o CORRECT WO~L REINSPECTlON BEFORE COVERING
Inspector: -ICe /- Owner/Contr:
/
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.,
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYl
INSNOTI
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
"? _2.. ~ ...qq -z.. r ~()
o FOOTING
o FRAMING
o INSULATION
o FINAL
o FOUNDATION
o DEMOLITION
o FIRE PREV.
o PLUMBI RI
A 0 MECHANICA
~ATER HOOKUP
SEWER HOOKUP
o SEPTIC INSTALL
o PLUMBING FINAL
o SITE INSPECTION
~
JI'~~.I-!~
qq-l~ ~~!{(. /
~G
o LKSHOREIWETLAND
o COMPLAINT
o SEPTIC FINAL
o FIREPLACE
o
ADDRESS \ 1\ '1 '2.. +- '16,
p~
OWNER
PHONE NO.
COMMENTS: t
\,oBI s~~ 1\0 plfG-
~o T~ CoffV- - No Co~
AM ~ ~t c..;t- ~. looP( Lo~
CO *- ~;VL-- D1-{.
\'0 \ Svk.~ 4:0 Plfr- r
tit T~ p<- u.. Co ~ r<.A - \ ~ \ 5' -t-roVV\
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PAD PI Pe.
~-g/+- ~ ~ ~o>c:es -to &-~cl6
WrUf W~ L-Ml<: ~ C-cJvlc-ydc..-Flour
G.vvk
~o)C
o WORK SATI!"~ACTORY. PROCEED
~RRECT A : N AND PROCEED
/0 CORRECT R L ,)R REINSPECTION BEFORE COVERING
Inspector: I Owner/Contr:
CALL ~4.~OR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE t llEMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
- -. ,..- "T'
T
DATE
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ll:Q)
'" -2.5-q<:j
Phe.o~ ~
ADDRESS \ ~ I q z..
PHONE NO.
CONTR.
PERMIT NO. <1q - 111-
OWNER
o FOOTING
o FRAMING
~SULATIOt}^
FINAL 1'\
o FOUNDA TI N
o DEMOLITION
o FIRE PREVo
~LUMBING RI ,+.
~CHANICAL '*"'~ c--'
o WATER HOOKUP
o SEWER HOOKUP
o SEPTIC INSTALL
o PLUMBING FINAL
o SITE INSPECTION
o EXC/GRAD/FILLING
o LKSHORENVETLAND
o COMPLAINT
o SEPTIC FINAL
o FIREPLACE
o
~MENTS:
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Inspector: / Owner/Contr:
/"-/
CALL ~-4230 "OR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
roDE R. ~ENTSAlIE FOR YOUg PERSONAL HEALm & SAFETY!
DATE TIME
r/dB s,. c-m
1'7/92- P/-I6ASrJAJI ~C/lOO vJ
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
OWNER
PHONE NO.
o FOOTING
o FRAMING
o INSULATION
o FINAL
o FOUNDATION
o DEMOLITION
o FIRE PREVo
COMMEN.TS:
jA _ \cUt-
''11ill
~
V
,/
SCHEDULED
CONTR.
PERMIT NO.
qq-/ /2-
o PLUMBING RI
o MECHANICAL
o WATER HOOKUP
o SEWER HOOKUP
AD SEPTIC INSTALL
,.:s:J>LUMBING FINAL
o SITE INSPECTION
o EXC/GRAD/FILLlNG
o LKSHOREIWETLAND
o COMPLAINT
o SEPTIC FINAL
o FIREPLACE
o
A n
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~ WORK~SFAc-rbRY'
<..0 CORRE ACTlOJ ~ ED
o CORR 7W RK ALL F R R INSPECTION BEFORE COVERING
Inspecto ': 1,----, _ Owner/Contr:
CALL 447~~qR THE NEXT INSPECTION 24 HOURS IN ADVANCE.,
CODE REQ~NTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
SCHEDULED
DATE
~/2-3
TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
AT.
ADDRESS
354- 7
6U/rJ 1Nf\ \ t;R- I KA\ L-
OWNER
CONTR.
PHONE NO.
PERMIT NO.
g9-112..
o FOOTING
o FRAMING
o INSULATION.
o FINAL
o FOUNDATION
o DEMOLITION
o FIRE PREVo
b PLUMBING RI
o MECHANICAL
o WATER HOOKUP
o SEWER HOOKUP
o SEPTIC INSTALL
~ V PLUMBING FINAL
/o""SITE INSPECTION
o EXC/GRADfFILLlNG
o LKSHOREnNETLAND
o COMPLAINT
o SEPTIC FINAL
o FIREPLACE
o
COMMENTS:
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Inspector: Owner/Contr:
CALL 47-4: 30 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.,
CODE R}J;IREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
(Tel. No,)
1-7~<:'<- ~,.~
(Tel. No.) .,,) 15, NUMBER OF OCCUPANTS OR SEATS
. Gt:.}-~5~"O";)rr
/-6>1;'~ ~'rh......; -b"/.M"
c.A~LL -:55: ':t W
7, TYPE OF WORK Fireplace 0 Septic 0 Deck 0 Re-roofing 0 Porch 0
New Construction)r Alterations 0 Addition 0 Finish Attic 0 Re-siding 0 Finish Basement 0 16. PROJECT COST N ALUE
Chimney 0 Misc, Cj'JI. ,(:r~
8, PROPERTY AREA OR ACRES 9, PROPERTY DIMENSIONS 10, CULVERT SIZE 17. COMPLETION DATE
Sq, Ft. :; J ~ Width 3.IJ,.' Depth g 1J I Yes No . )-1 ~ ~, I?- "'tA-
I hereby certifY that I have fumished information on this application which is to the best of my knowledge true and correct. I also certify that I am'the ownef or authorized agent for
the above mentioned pro that all ction 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 __ e it f use, F~~rmore. I hereby agree that the city official or a designe. e may enter up, on the property to perfOrm~~i pections,
X V"'\~-f7?~ _~./ i..C. l\ A ,q~ /7<%7' /. ~ 9-?
~ignat'ure Uf.t1.t1..- / I tJ ,( J7""rt U '(/-i'1nM ~ 4Lf Date
Amount Brought Forward .................. $
Park Support Fee ....................,...... $
SAC ......................................... $,
Collective Street Fee ....................... $
Sewer Tap ................................... $
c,Lf' $
Pressure Reducer .:1t3.................... $
Meter Hom ....t::JT......................... $
Water Meter ...19............................ $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
Water Tap ................................... $
Builder's Deposit ............................ $ I ~ 5~(!) ~~
Other ......................................... $
Total Due .............................. $ -~I::1,~I3.22.-
Paid 7873 .ZZ Receipt No, 3jjJcJ7W
Issued
Date 3 -c;- -q 7 By G
This is to certify that the req est in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requ!Jted, This document when
signed by er n utes a temporary Cerli te of Z nin co pliance and allows construction to commence, Before occupancy, a Certificate of Occupancy must be issued,
I'
~..r
DATE RECEIVED
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
':C~ \ 9.
2. SITE ADDRESS
/ 1...1!3....,~ -
3, LEGAL DESCRIPTION
1. DATE _
2/~h ~
J ,,_ J, ' / (""" I')~
jL/tJi4.e/I(Ii.U~~ ~ ;;J, L-1" I
- '341
PID:;)5-~-OI{J- ()
PLo~6 .:LL
,
DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
Pl~~~-~
LOT IV BLOCK I
ADDITION _,.,i:..y ~r.... ~ jL48r:Y.dou-r..
(Address)
(Tel, No,)
4, OWNER (Name)
C:::;:;.....----
5, ARCHITECT (Name) (Address)
.,4y./"~,,~j}G;/~I----"g;--'. ();s-....-.b('.v~ "IA 2~ 0-
6, BUILDER (Name) (Address)
tJ!!/;~ /)GCJ/I'PjJ;~ ~ J./C
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
Front
Back
Side
Side
BUILDING DEPARTMENT VALUATION
OFF STREET PARKING
SPACES REO,
SPACES ON PLAN
I PERMIT VALUATION I IS,&:!r) .CCl
USE OF BUILDING
5H=A-
TYPE OF CONSTRUCTION: I II III IV (1il
Occupancy Group A B E F H I M~ S U
Division 1 2 (j) 4
Permit Fee ................................... $
City:
Plan Check Fee ............................. $
q S::L':::t S-
iD 115. '(7
5~.SO
State Surcharge............................. $
Penalty ....................................... $
100.00
l DO .O()
55.S'"
ce Pe it .~.... ................ $ 40 .00
acom Yo "n9 Permit When~p.ro~'t1
Date 7- 10
-7
Certificate of Occupancy
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ...................., $
Sewer & Water Permit ...................... $
Special Conditions ~ any
24 hour notice for all inspections 447-9850
1. White
2, Pink
3. Yellow
File
City
Applicant
Permit No.
qq -DilL
BUILDING INFORMATION
11, SIZE OF STRUCTURE
(Height) (Width)
:l.1/- .;;r, -I:. .,
12, NO. OF STORIES
J
13, TYPE OF CONSTRUCTION
~
14. FLOOR AREA APPORTIONMENT USE
J,..-,L/P
(Depth)
~I
OCCUPANTS
SEATS
MATERIAL FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA 0
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS 0 SETS
SURVEY
PLOT PLAN
o COPIES
o
s:\ sn ' 00..
lo~.QQ
45',t1IL
t '2. S. 0(')
,I, '2.00 .(ITJ
(01) .tJrJ
..
-(
OJ'S HEATING & AIR CONDITIONING, INC.
HOUSE HEATING TEST RECORD
No. f1Yf/'fJ /IY
,\;
;i'.',~
",
'i;:
, Permit
Owner \~-'. ".1__... ~vc...
Address~ ~J..'<IS.C',^,..( ~~
Installed By L\ ..\ ~ II ~.et'1(() .c.
l
GAS DESIGNED UNIT
A ,_.,.~;(,; ~
(,UAU7 (.) A y ~u
'1 <) () </ I j <i ~ .31
f'J.,.';
~~~
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~'.:.:
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Make
Model
Serial
-t'-t
--;1' C'!c- 0
, /
Rated Input
,. ~ .
;,;'~
Jio:, ,
~~~
,.
~i~
','
TEST
pilot Timing .,.., -:')*c
Pressure
Percent CO.
Limit Setting
1/)
~-<;
J )
/ c."
Percent O.
Input CFH
':r
I j,)..
Percent CO
J'" Stack Temp
, <;1
;r;
..' Heat Anticipator setting
}:,
),""
~t';- Date Tested /; /' I....I.~(- J ')' T ."""
11'::'" '. " K ,/' /'/
~';Naltte.,.b~Tes:t7r '" ,,'''' " ~
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CITY OF PRIOR LAKE Me
18200 Eegle Creek Av. S.E. P.rmit No. ~ -Of /2-
Prior Lake, MN 55372
HEATING APPLlCATJON J PERMIT
Date LJ -8- qc; PID, 25- ~4( - 010 - ()
Sit. Address 1"7 /9 ~ I Yh.,C( ~""'-\- (Yk1 6o~ ).p.f\~
Lol 10 Block ( Addition ?f:\EA~tSr M6A.DCUJ 2.~ N){)N.
Own~(SN~meWj JlIGVr\\C) 'Dwe..\o 0 mt.r'\\- . 'iLC .
, .
Addle.. J6~~ ~Q.vo.c-i,-"C"\. ,~O\~.~ Q("'VL
HealIng Conltactor ,D:\ I ~ ~Y\ -\-; C\c:.A -t \\ c..
Addr," ~ J.Jx~uX ~vc.... ~\~r\v', \\Q_ Mt\\ 5S2D \
. .
T~~phon.' J.lq'7 - ;)..(do \
Furnace Make & Model He.qt-N-Glo
ModelSifl ~~-.550
en
ISI
I-
~
<I
If)
en
1..0
N
f'-
en
""
N
..-i
1..0
Conn. load
Fuel
Flue Size
o
z
w
z
o
I
Il..
Supply Openings
Aelum Openings
Inpul Oulput
Ed!.
Clm.,
TYPE OF WORK
Alwralions
Replacement ,
Esl. Comp. Dati
~
z
.....
I-
<I
W
I
(J')
...,
.0
Repair.
TYPE OF SYSTEM
WIJm Air Plaols
Grawity
Ned1anlcal
Air Condllionlng
Vent. System
HEAnNGORPOWERPLANT
Sleam
~oI Water
RadiaUon
Special Devices
Other Devices
New Construction
x
C!q;o //2-
PAIL> WITH
BUILDING PERMIT
Esl. Colt S
HEATING PERMIT FEE'
STATE SURCHARGE .
TOT At PERMIT FEES S
BIlUdlng Pelmh ,
~~~
.50
2f 0 ~ ReceIpt'
E
o
~
1.L
TYPE OF STRUCTURE
L 0.... . Oly
3. Yellow . eo-or
Single Famly
Commercial
)(
Mulll--Famlly
Othe,
lWo-Family
I ndull,III,
Public
FBe Schedule
Industrial, Commercial & Multr.Fllnily
Residenlal, Heating & AC
ResidenRl, Heating Only
Resldenlal, Gas Fireplace
Residenlal, Additions," Alteralions
Residenlll, AC Only
1% 01 job COIl ($39..&0 minimum)
S99.50
$64.50
$39.50
539.50
U9.50
Remember 10 edd the State Surcha'ge on the bottom olthll 'PpllcaUon.
~
I
Th& pric. of your heating permillncludel one rough-in Ind on. nn.1 In8pecllon.
Additional ifIspecllons will be bllled.t t.J5.00 each.
H OUSt Heelng Tesl Record musl be submllled with buDd!nII "lIIfmlj numbIr belore build-
ing certificate of occupancy wll be iuued. .
HFAT r.Al r.I ",,"TlnN,~ ~F(\1I1RFI'l wIth number of supply and "lum openingllla1ecf pe'
rC)()m wilh CFN's per opening. New structUI8I or additions IBnd Ooor plan with supply
IlId relurn localions.hown. HEAT LOSS CALCULATIONS, PAYMENT AND
APPLICATIONS MAY BE MAILED TO THE CITY OF PRIOR LAKE, 18200 EAGLE
CREEK AVE. S.E. PRIOR LAKE, MN 56372-
Cily Hall business hourI are 8 I.m. . 4:30 p.m.
AU WORK MUST BE INSPECTED (ROUGH-IN AND FINAL.) . CALL CITY HALL
447-4230
f hereby apply for a mechanical IYBllms permit and I acknowledg. tha' the
informaUon above Is complele and accurate; thai the work will be In conlorlMllCl
wlllllhe ordinances and code. of the city and wUh Ihe Ila'e building/mechanical
codes; Ihallt1is form does not become a permit until Iluned by Ihe BUilDING
OFFICIAL; thallhe wo,k wlll be In accordance with lhe approved plan In the
case 01 all work which require. review and approval 0' plans.
\~ ~ ~ L)-B~q9
- /? ~pt~ SIg " Dati
M-r.vr/l J 4- / /(() I qq
- Building Ollieara S Dati
)'
./
9'1-0//:2
Th. (..I.r or Iho La" CO..lry
White - Building
Canary . Engineering
Pink . Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT ( CL (( (( (i' II ( \j
APPLICATION RECEIVED :.).,:? /(/ ~'?
f. )(' (..v: r(YIJ / llfl ct
I
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
/ " / 'f) 1-/;(( ({ fit. c( ;( ( -(/1 r'-( rf V..J !(-; I ( ( J./
Accepted
./
Accepted With Corrections
Denied
Beviewed By: ~ EWR.E5.rVl.ANN
Date:
3/,,/rn
I I
Comments: MAJ(J~ ~.... ~ eO\JLJ~YE'~ 10 ,qAJl'. .tkc,^.I6 nll.l4,...JA6E..
...BAjf\ tJTlL Ir"y E"~~MEAlT"'t ~~ ~ J'ls 'rlt~,_ .
~ 1,uFoItMAnnN f).A) ?~ SiDE.
::i'LT f="...f'Al c1
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1?~Afl. ?I<.T"'~I <<= I,cr SH-~LD 'K/i. tR~crG{)
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S"e-E" A-1"-rACJ::f...MtAJ'r'S': i. h#-Jr"tt... ~"'Ol.1J~ IllhPEc.r,oloJ IAJFolt~47Jd...J z. ;:;'",DIAJi..
B..au 3. fl{o~~ Cc.,vrt<.~~4Su",€.s
tf E~~,J e~A.117t.<I L :;:( tIf";
"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."
~~~,
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Th~ ("~nl~r or Ih~ L.k~ Counlry
White . Building
Canary . Engineering
Pink . Planning
j3UILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
.I i /',
!'
./
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
Accepted
~
Accepted With Corrections
Denied
~ 'Reviewed By:
~Ure-R~ Date:
:Sr-~-?]9
'-"
Comments:
~~
g - 2 r-~0
1
W~ cfJ
~)6m~ t1u,~5
~'1\th /~1) ~ hT;-rf).
c:trv}U d/!t/~ ~, ~~
Kp'r ~ C~ ~tlikvl)4IMMp-.
fJ F.9h9 -:VeeS) ~
(./
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"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."
99-0//2
The Center or the L.ke Country
White - Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT ~~(JtJ j ~ i~ l1Vt1..,;(:
APPLICATION RECEIVED 0/'-/1-99
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
J 7/tfJ. PlUCUZ1V-Z ;U-tad&W ia~
Accepted
Accepted With Corrections
'--:,L..
Denied
Reviewed BY:~ ~ i:-
f
Comments:
Date: :z - '2. ~- CJ c:;
/. MQ.llA~t""- ~~,~ ~
"2. '3o~ ~ J.- +-11 o..Q..Li
3. eeo.& ~ll lt~ol
(lu- ~ fIr, ~
W ~r.n an.:..L
.~
"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."
I. Blue
2, Gold
3, Yellow
CITY OF PRIOR LAKE
PLUMBING PERMIT
Applicant: GI'l/f)'1. f1<<.c...l.t.
Address: 11 IS') 1'1'0 ~ A.~.
Signature: (U Jt/i- _
1/
Legal Description: Lot I 0 Bloct
Site Address: )7/ "I J... f)h"'l.1">,,,{.. (7",,,-: 'Lv
Building Permit # qq - (rz--- PID #..25- 34"7- ol 0- D
NOTE: This permit will not be processed without complete information.
File
City
Applicant
# qq-//2-
Phone(~JJ) ~~
Cji (~'"'3 /po
The Cenler nr Ihe toke Counlry
Quantity
I
t
I
02-
I
I
I
.2
Sub Plt€'f\S'PoJT l1e1\O~L,J'
~> I~'.J.
FIXTURE UNITS
Type of Fixture
Quantity
Type of Fixture
Bath Tub with or without shower
Dishwasher
Floor Drain
Rough-ins
Water Heater
Water Softner
Stand Pipe (washing machine)
Sewage Ejector
Backflow Assembly (RPZ, Double Check, PVB)
Backflow Assembly Test
Lawn Sprinkler
Other
Lavatory (bathroom sink)
Laundry Tray (1 or 2 compartment sink)
Shower Stall
I
Sinks
Bar Sink
Water Closet (toilet)
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
$
$
$
$
.50
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 amen9~e~ts thereof.
RECE17)ffJ. ~IILfqq_DATE
)<f~ AITEST
I
Call for all inspections 24 hours in advance.
PAIL) WITH
BUILDING PERMIT
16200 Eagle Creek Av. S.E., Prior Lake, Minnesota 55372 / Ph. (612) 447-4230/ FAX (612) 447-4245
An Equal Opportunity Employer
S~9 Address
Owner's Name
Address
Healing Conlraclor
Address
Telephone"
Model Size
Conn. load
Fuel
~'\
CITY OF PRIOR LAKE MC
16200 Eagle Creek Av. S.E. Permil No. qq- / / 2-
Prior lake, MN 55372
Flue Size
Supply Openings _
Relurn Openings
Inpul , OutpUI ~(.1).)
Edr.
Clm.,
Al1eralions
Repair
Esl. Cosl $ / J(JJ())
.
HEA TlNG PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEES $
PJD, .2S~.34-7- 0 10- 0
AOON.
TYPE OF SYSTEM
Warm Air P/anls
Gravily ,
Mechanical
Air Condilioning _
Venl. Syslem
HfA TING OR POWER PLANT
Sleam
Hal Waler
Radialion
Special Devices
Olher Devices
Replacemenl
TYPE OF WOnK
kJ
Est. Comp. Dale
, New Conslruclion
~73
Building Permit. _
qq-I/2-
.50
PAID WITH ~""
BUILDING PERMIT)
Receipl . ,
TYPE OF STRUCTURE
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l. Ci......
1. y~"o..
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Cil, "1
CunluClO I
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Single Family
Commercial
Two-Family.
Induslrial
HEATING APPLICATION I PERMIT
Dale (jj,3) / '9 Cj
/7/ '1 ~ :!!~ 1rLu..Arw",..)
lol 10 Block / Addilion _nl€RS~N'T I"16'AO() W 2 ~
;{)tLu7"t CJaLia..vJ
Arlied Fireside
dba Fireside Comer
License #20090911
2700 N. Falrview Ave.
nosevlne. MN :>>:ill:t
6511633-2561
Furnace Make & Model d:lt,,,,:! A.J (d u
~T - "7It?.L-
Fee Schedule
Industrial, Commercial & Multi-Family
Residential. Healill9 & AC
Residenlial, Healing Only
Residenlial, Gas Fireplace
Residenlial, Addilions & AlIeralions
Residenlial, AC Only
PllbUc
Multi-Family
Olher
1 % 0/ job cosl ($39.50 minimum)
$99.50
$64.50
$39,50
$39.50
$39.50
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..10
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ID
VI
..10
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ID
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ID
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Remember 10 add Ihe Stale Surcharge on Ihe bollom of Ihis applicalion.
The price 01 your healing permil includes Olle rough.in and one final inspeclion.
Addilional inspections will be billed al $35.00 each.
House I lea ling Tesl Record musl be submillcd wilh buildino np,mi' nllmhr.r be/ore build-
ing cerlilicale 01 occupancy will be issued.
HEAl CAI CUI ATlONS REOIJIRE"O wilh number 0/ supply and relurn openings lisled pe
room with CFM's per opening, New struclures or addilions send 1I00r plan wilh supply
and relurn localions shown, HEAT LOSS CALCULATIONS, PAYMENT AND
APPLICATIONS MAY BE MAILED TO THE CITY OF PRIOR LAKE, 16200 EAGLE
CREEK AVE. S.E. PRIOR LAKE. MN 55372.
Cily Hall business hours are 8 a.m_ . 4:30 p.m.
01
....
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01
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to
to
to
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ALL WORK MUST BE INSPECTED (ROUGH-IN AND FINAL) - CALL CITY tiALL
447....230
I hereby apply lor a mechanical syslems permit and I acknowledge lhallhe
in/ormalion above is complele and accurale; Ihal Ihe work will be in conformance
with Ihe ordinances and codes ollhe city and with Ihe slale building/mechanical
codes; Ihatlhis lorm does nol become a permil until signed by Ihe BUllUING
OFFICIAL; Ihal Ihe work will be in accordance wilh Ihe approved plan in the
case 01 all work which requires review and approval 0/ plans.
.&~~,'
-, ..- p-l
BuiltJing Ollical's Signalure
'#J~9q
, , Daie
\l
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....
Dale
PRIOR lAKE
~NSeECTION RECOR
DEPARTMENT OF .
BUILDING AND INSPECTION
:~,SITEADDRE.~S 17lot. ~ 9keo.,,().AA.\..' P'\~0b-t.0c:, ~.p
NATl.JRE'OFWORK. New ~~.
USE OF BUILDING SFA
PERMIT NO. '1'1-nll"L DATE ISSUED 2- ~Co --q'l
CONTRACTOR Wln;~c.. f\o\'J..Q~~"1"':: "..', '""..
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS'Ct'B'ELOW
THE PERMIT IS BY SEPARATE DOCUMENT
FOOTING
INS~ECTOR
i\)
, 1.,
. ~I ."~ t. .,:',,:~'" t,.\ .
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FOUNDATION (Prior to Backfill) r~ 1\,) I
NO CONCRETE UNTIL ABOVE HAS BEEN SI
. . . . ,
f) ROUGH- INS
.SEWERIWATERISEPTIC If s..Z2'97
FRAMING 1/
, i
INSULATION
ELECTRICAL'
PLUMBING- C}f tf~n-'1't J>. '-/;;..J.6'7'~'fj.dJ::";,;~!("':;
HEATING (if required), (J~ lf~!3..qq :\' S, t/-~ ~q;
'I" .
FIREPLACE ~ . \-\ . <: -'~;1\
GAS'L.INEAIRTEST ClSl 'f-J;-'~'
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I I
FINALS
v0, (2)
(). \-\. ~ .\-
- <::\~.
GRADING (Prior to Sodding)
BUILDING 1.e.,); -r'.J;2q'-l-'1'~ !, - ?,r;';1~)
ELECTRICAL
, PLUMBING,
HEATING
,DO NOT OCCUpy
q.i. j ,
;j'4( ,7';1' .
,iJj '~~/~. ~ 3-5.
UrJ:rlL ABOVE HAS
NO TI C E
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, card shall be placed near main entrance..,.
Call between 8:00 and 9:00 A.M. for all inspections
FOR ALL INSPECTIONS 447-4230