HomeMy WebLinkAboutBuilding Permit 99-0282
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OJ'S HEATING & AIR CONDITIONING, INC.
HOUSE HEATING TEST RECORD
Permit No.
ownerlV': I J.. fA ",'" _ Dc.~...~ V"I <...1
Address-t-J ' l-.! ~ J ';)j..,.... ... "',g.;r In It.q,,d:;~ '"
^~
Installed BY../..d.....~.,)~
GAS DESIGNED UNIT
Make A^"" "" a
/ / j C
Model V '- ; (. 0 11::J
serial~O 4~ L '4
Rated Input '-/5 t () (.) Q.,
pilot Timing. S ~c.c..
pressure-3 j S \/v' , l_ ,
Input CFH I-f"
...) C" " <;J
Stack Temp~ JC
Heat Anticipator setting
TEST
Limit setting~~~qC
Percent CO2 OJ- Oh
S c/
Percent O2 /~
c
Percent CO Qf () 0 i..
,S
Date Tested 7f - 'J....7 ~,7 <j
Name of Tester r}::J~'~
~
...
",'~"
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~-. 'J MAl. '.:....;."f.-'" ,'i;t....'.... .n..:....;i-:.-=_~~.. ",'",,-J' .d'.." .~&:t....;.;;.' ~,':';'~"I '~~,. '';'. ';~~i-~... ';;';';I-;ij<U;:~' u..;:J}t~ ~.:-~," r.).\'.z) :-7i,;; ""'-~;c. '~'~'.-.-'2;~J.:::O;,; ~~il~~;.:'+~, - ;."lcioOi......J.:., . ......h '
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
9jz:l~f
'Y'1
ADDRESS .' 7/ '" 5 1ktA~AJJ-r- 111t.A/JCu1 LI4NE.
PHONE NO.
CONTR. A JJtLl4#f1l~ l)E:;VE-UJN11S.AJ'r
PERMIT NO. !/J- 2-W..z..
OWNER
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
~FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
X EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
COMMENTS:
(]1VtbE. I ~ Ac.c.EPm& e
Cu~ /5 C)PfIt~11oN4 L
~~I,J <rL.r fE.,.,lE' uVTLt- <;D...DIJE(\
)( WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: tJrt/f;;f!lu.
"'wner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTl
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS / 7 J 'I ~
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
~ FINAL
o SITE INSPECTION
DATE TIME
!3-3f,.cr:; 2:30
~ # e7+.S~ ~ EA;tJo c...J
SCHEDULED
CONTR.
PERMIT NO.
<79-;)351
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: /e~- INS-Peer-
I. r~",-.\o..<. ti- ~A~IA_"';,~ C<f(JN1v--<-..(
C. 'Slot. ~ <t ~ p cr
~/~ GJo
~SCJ~ -1-(") n"V. l \ 1<11,7
o WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
~ORR we , CALL FOR REINSPECTION BEFORE COVERING
-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
Owner/Contr:
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTl
COMMENTS:
~frcu ~
Ik-lo f"'-~~
A-,,-~~ dazdl.~ ~
f-.b ~~ \1\<'-
S\{' lJlo ~
~~L
s~ ~
~--
~~.
/)
~~
/
/
r/ WORK SA~SF TOR~ PROCEED
o CORRECT AC I~AN[' PROCEED
o CORRECT \ R . AL FOR REINSPECTION BEFORE COVERING
Inspector: Owner/Contr:
CALL'r::r FOR TIlE NEXT 'NSPECTlON '" HOURS IN ADVANCE.
CODE lL(JMENTSARE FOR YOUR PERSONAL HEALTH & SAFETY!
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS 17 I i..f 5
OWNER
PHONE NO.
o FOOTING
o FRAMING
o INSULATION
~D NAL
FOUNDATION
o DEMOLITION
o FIRE PREVo
\U
No
DATE
TIME
/l'lv
SCHEDULED
5- J-99
~~
CONTR.
PERMIT NO.
99 ~.Z8'l
o PLUMBING RI
AD MECHANICAL
I r::YWATER HOOKUP
J\~SEWERHOOKUP
W 0 SEPTIC INSTALL
o PLUMBING FINAL
o SITE INSPECTION
o EXC/GRAD/FILLING
o LKSHORENVETLAND
o COMPLAINT
o SEPTIC FINAL
o FIREPLACE
o
~
-
r v In \i-tv~
. u
at<.-
Do
Vrr~
PUe
- No
/l
C.e~
Ok-
Ok-
w
,..
~<"1'--
.1-0
~~
T"
DATE TIME
CITY OF PRIOR LAKE I
INSPECTION NOTICE SCHEDULED BP7/r? 3: 30
ADDRESS /7/~S ;P/le:1S/lfi/"( nE7tZXJW
OWNER
CONTR.
PHONE NO.
PERMIT NO.
99- 282-
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
~PlUMBING FINAL
o MECH FINAL
o EX/GRAD/FilliNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
.,C.OMMENTS:
(.J Irevy
I(~
l~~
~~
LJ~~
dlt
. .
~ ~- Il,CulL Y\<.W W\UJ.10lh~
" , toy - V\(K + i\A Stge afOV\ !. l.. -
V
Owner/Contr:
NEXT INSPECTION 24 HOURS IN ADVANCE.
ARE FOR YOUR PERSONAL HEALTH'" SAFETY!
INSNOTI
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
0-5(jJ;9 ICl:-3tJ
ADDRESS / 7/~~ ~ "~~-".~ ?fI~?r5A1JT MC7\.DO ~
OWNER
CONTR.
-JI; - ..~
CJ - .J~;l-
PHONE NO.
PERMIT NO.
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 INSUa 0 SEWER HOOKUP 0 FIREPLACE FINAL
)!f FINAL N A 0 PLUMBING FINAUS . 0 GAS1.INE AIR TST
10 'SITE I PION )( MECH FINAL~ 0
COMMENTS: (. Se/iVd- ~ tN",ttY-' f>eP-M Icf
,1. ~ ~ T(1665
s- ~r--Y&. S\<otJ oFF'
t\o ELSe., I=INA.L-
o WORK SATISFACTORY, PROCEED
? CORRECT ACTIf>~ND PROCEED
o CORRECT~~~, ALL FOR REINSPECTION BEFORE COVERING
Inspector: k , Owner/Contr:
J
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTI
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INS~O
sltJ:lN A-:;;
o SITE ECTION
COMMENTS:
SCHEDULED ~ no,
t *7. I <f~ ?r-6e-~ Ifl~,
CONTR.
PERMIT NO.
rtf'. Z$ Z--
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
t!.-.vt:'s& R w
J7~/\1 ~
, h1kL C2-,O.
/
~ORK SATISFACTORY. PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WOn:o:;L 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
INSNOTl
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
DAn: R.I=~
7 ISm
~
DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
2. SITE ADDRESS
i 7 J 4:;~ - J .. , I' -I1J..,;,4.,Q f\.r<r ft..A-e A~
3. LEGAL DESCRIPTION
LOT ..5 1. ... BLOCK I I ")
ADDITION lib~ll","r ~I'\-O~u..?
1. DATE
It-( z.-( q '1
~ ,S.w~ ~\
PIC d'S -3'-/7-00:;-0
t? i./A- O? - :2.
4. OWNER
(Name)
(Address)
'SA-Ke-
5. ARCHITECT (Name)
~TecTu.~ L
6. BUILDER (Name)
0" S l,raN
(Address)
WIS Ct';)N g /N'
(Address)
"
(Tel. No.)
(Tel. No.)
/ -7!?S'~ 7JS: ~"3 J 7b
(Tel. No.)
7. TYPE OF WORK
New Constructio~
Chimney 0 Misc.
Fireplace 0
Alterations 0
aed..e<-Df^"e~rIL. ~_c..~ ((;,/0 '\,\:s- ~;z.4.-~
Septic 0 Deck 0
Addition 0 Finish Attic 0
Re-roofing 0 Porch 0
Re-siding 0 Finish Basement 0
b.J I LLtA IH~
I, White
2. Pink
3, Yellow
File
City
Applicant
Permit No.
/ (;-~2-
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Heighll (Widtty
~ v.. :J...,
12, NO. OF STORIES
I
(Depth)
7U
13. TYPE OF CONSTRUCTION
F/1.AM ~D
14. FLOOR AREA APPORTIONMENT USE
I :J,.5 ~ t:;:l
15. NUMBER OF OCCUPANTS OR SEATS
S tN~ le ~A-4'-\'~,J
OCCUPANTS 71"" 7'"":-.c..~; ~ I
SEATS jlJt. IA...._
16. PROJECT COSTNALUE
c:t: q~ O~..
17. CQMPLEl'TON DATE
8. PROPERTY AREA OR ACRES 9, PROPERTY DIMENSIONS 1 O. CULVERT SIZE
, \ 19...
Sq.Ft 30~'t Width 3" Depth g~ Yes ~ -r~ '~ ClI4
I hereby certify that I have furnished infonnation on this application which is to the best of my knowledge true and correct I also certify that I amu.e bwner or authorized agent for
the above mentioned property and that all construction will confonn to all existing state and local laws and will proceed in accordance with submitted plans, I am aware that the
buildi~g~iXia~ r~voke this pe~t for just cause. Furthennore. I hereby agree that the city official or a designee may e,nter upon the property to perfonn~ed d inspections.
X.~,.c~&o+"-- ~tJ/l fvILLIAN..t' D~Llo~' C. I"V).b~ 13J1t-.L
- .... - Signature License No..l. - 1 ate
SETBACKS: Required
Actual
Front
Back
BUILDING DEPARTMENT VALUATION
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
USE OF BUILDING
, V-fr
""-
I
TYPE OF CONSTRUCTION: I II III IV ~
Occupancy Group A B E F ~ I M lii> S U
Division 1 2 @ 4
Pennit Fee ................................... $ 'ts? .2')
Plan Check Fee ............................0 $~8. 'iJ
State Su rcharge ............................. $
Penalty ....................................... $
~'"'.~-o
100 . 00
Mechanical Pennit Fee ..................... $ IO(). f"'l~
~()
Gas F" lace P- it ....................... $ 4 () .00
Thi A Ii I n ecom-l-"r Building Pennit Wt)en Approved.
By r~ Date 4 -I'"-l -9r
Certificate of Occupancy
Plumbing Permit Fee ....................... $
Sewer & Water Pennit ...................... $
Amount Brought Forward .................. $
Park Support Fee ........................... $ R Cj('), c:ro
SAC ......................................... $1,05"0.00
Collective Street Fee ....................... $
Sewer Tap ................................... $
Pressure Reducer ~/e.~................... :
Meter Hom "'!iIil:' w....................... $
Water Meter .::e............................ $
Sewer & Water Connection Fee ........... $.1.
Water Tower Fee ........................... $
FOR ADMINISTRATIVE USE
Side
Side
MATERIAL FILED WITH APPLICATION
SOIL TESTS
o ENERGY DATA
o
I I '< . OOC'L ~O
City:
~
.~~.~
~<f-
~}
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS 0
SURVEY 0
SETS
COPIES
PLOT PLAN
o
t.l5.00
I 2S.eX)
200 .r.l6J
(a(') . r')r1
Water Tap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
~l:.e1l1O
J ,A-/.'.., . - '7
Total Due .............................. $ L'=l. ... ~
Paid -'373.2.-"l..- Receipt No.? S 0 SL:>
Date 4/1 q I q q By 116-
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordina~ce an~ may proceed as re'qUested. This document when
s~ la er constitutes a temporary ce~ti t;~q compliance and allows construction to commence, Before occupancy, a Certificate of Occupancy must be issued.
lanner Date Special Conditions ff any
Issued
24 hour notice for all inspections 447-9850
r"
APR2191l
GREEN - FILE
YELLOW - APPLICANT
GOLD - CIT Y
CITY OF PRIOR LAKE
SEWER AND WATER PERMIT
NOTE:
NO. 7'1.,~tf~
Sewer and Water
contractors must
be registered
with the City.
APPLICANT: F/j}IJL r;~It.ilE :I/VG PHONE: /7?'()-/5~ J
ADDRESS: PO $Qf It) I7?me L./})(E 4/l,J DATE: 7'/~7 /77
SIGNATURE:~~~~ BLDG. ;ERM;T #_7~~
SITE ADDRESS: 17)~5' fYflEA5AtJT fJJi3lfll)uJ MAJE PID# '2-5" ?J47 - 005-0
1.
FILL IN THE BLANKS
Estimated length of water service ;p~
/"
Size of water service inch(es).
feet.
3. Location of any couplings from structure ci
"
4. Type of sewer pipe. ABS PVC)( Cast Iron
5. Estimated length of sewer line (;.,6" feet.
6. Clean out (if required), located at
structure.
2.
feet.
feet
from
------------------------------------------------------------------
------------------------------------------------------------------
BY
This application becomes your permit when approved.
DATE:
------------------------------------------------------------------
------------------------------------------------------------------
FEES:
$
$
$
35.00
.50
35.50
Sewer and water line connection permit.
Surcharge
TOTAL
* Fee for either sewer or water individually is $20.00 plus
$ .50 surcharge.
* Sewer and water permits issued for new construction must be
recorded on the building permit card at the time of issuance
to insure that no duplicate sewer and water permits are
issued.
DATE PAID
RECEIPT #
+/27&1
. I
~~~~~0UNT PAID
~~~e ~~ REC' D BY .j{ It -
~v\\,V r-
'"
16200 Eagle Creek Av. S.E., Prior Lake, Minnesota 55372 / Pho (612) 447-4230/ FAX (612) 447-4245
An Equal Opportunity Employer
T
90/' - d- <i';)-
Tht' ('rnCrr or the L.ke Country
White - Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT /( JLluIll115
1h/yf
I-./{"( L[ICfJ/J tY t-( t
APPLICATION RECEIVED
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
/7/t.!S j1ztJOY?H I Jllr<<d6c.J LAJ.
Accepted
Denied
./
Accepted With Corrections
Reviewed By: JJALT"f,R.. E""~ESt\1A^,N
Date: c+/ Ie{ /99
I .
Comments: .&r;OFF
MUST"
BE
C olJvE V E:. b
'-0 APtl ALo.ur. D~AIAJ.q6f:
A"'b UT'~ITY €ASE'r\4.E.Jn AS Muc..H- A"> PIlAc.TICA,- <)(,..'1' FE....LE. ()I\J THE
REAR. 'P. ItTlDN
.F THE:.
LDr M.lWr /SE, ErUeTIq) AT THe EJx;E..
.or DL~TV A. &E.~ $('\ I L.
S.n: 'MFnrlMATlol\I aN R~uf:a.s6:. SIO~ .
~ ATTAcflMEAlrs: J. hNAL ~ INSfEcrloN JA"IFoil.MJ4T 1M) ZO tlll.t411'~6 P'-AiU
3. E Ro.s 10,J (' -"N'ftlO.. tvlfA.(,utlE'\
tJ. &o~ ION C oAlTR.OL P, "AI
"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 jurisdictiono Permits
presuming to give authority to violate or cancel the provisions of this code or other
ordinances of the jurisdiction shall not be valid."
IfN'
;
White - Building
Canary - Engineering
Pink - Planning
Th~ ('rntrr of Ihr Lakr Counlry
BUILDING PERMIT APPLICATION DEPARTMENT CHI;:CKLlSl
NAME OF APPLICANT ~d1titI115
fh/t7r
. .
Leu-dOp/wJ
APPLICATION RECEIVED
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
171q~ /!'1J1(25L2tLT ltIe~d~ m.
Accepted
Accepted With Corrections y..
Denied
RPt-ry{
Date:
<I -5 -~?
Reviewed By:
Comments:
j. .~rJ .&- -h~~ feJ ~ r I,~,
'2~ ~o.ci & ~~.e- Cc~ ~
"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."
,L'~~;'i'-;;::':'~"''''':~l;'' i"'" -.~, 'II'~>~"'~,'t~';
;"~~~:;;:.-'''',\'lI'',<~;;;':'
O;.~~..-'; ~'''!'''~'''F.'~'''' $'~~"~'"" """"'''-i'_'.',,'''''''''"
/".~:;.//
I. "
,
, (;..,....,
,..)., (, ,-..,-
White - Building
Canary - Engineering
Pink - Planning
Th. C.nl.. of Ih. l.k. Counlry
BUILDING PERMIT APPl..lCATION DePARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
.-- :/
//(// ') ,.
if ;' / t
(-.4"~
/
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
/ /,'''''''' ,
.I.) /..
/
/ /, ,T i.. / ' ;1"
<' : /1 . ,..'",. .,~ ." .- /
..- ~. . ' ~ / ( ;;, t...
/! /1
Accepted
~
Accepted With Corrections
Comments:
Denied
Reviewed By: ~~UI>J~~~J-r-
vltA\Jw.(', rJ~;" 'fJ
~~&g51- ~~_~~~,,_~O
p~~~ \i ~ '~-H~~ 'r~~1lt'.1..M1~ -
Date:
~ -{ J.--L)Cj
"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."
9q~d<?;;;-
Th~ C~lltu 01 th~ lAke CO".IJ'7
White - Building
Canary - Engineering
Pink - Planning
. : A.' _
NAME OF APPLICANT /( j Lf {j I? II i~
Jh,/Yf
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLlSr
i_.>( L{/LPII if i,c, f
APPLICATION RECEIVED
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
/7/(IS ;1zcfJ.::nH 1IIIr<<d6c.z/ LtU.
Accepted
./
Accepted With Corrections
Denied
Reviewed By: j.JAl..lf~ E.,.It\!;$t\1A1\illi
Date: if/ i.; / ~9
f .
Comments: ~ ~-r
AlJb U1"I'-'1"1( F.4~~ ,tis
of:
e Oi<JtJE V e: b
1""0
Ap~
ALA.vr.
M.4/AJ~E:
Muc.H- "'!O Pit Ac TICJU. .
$,4.'1'
FE NlL
DN THE
KEAA.. ? RTIDN
. F ~E.
LDr r'1~HT ~ EtUt!TQ} 141'" tHe EJ:Jt;E..
.of' D'Snl~M.b 'SoIL.
SEE" L~If'r..'lMATloN OAJ RE'\JF.lts~ 5'10(. .
sa ATTAl.~q,rS: J. hAlAL CI.AOr:. lAJ.,Sffcr'DN ' WFOIU'tI4T 1311..1 z. dlMOIIlG H.AI'J
3. €'Ao.110N {'.IJ....'f~.L I'1fAwItE....
LJ. &o~ ION C. oIJTIlOl. P. 4IJ
"The issuance or granting of a permit or approval of plans, specifi'cations 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."
08/31/1999 06:59 612-440-1524
-'V'''~''''~- ...._..........__.__.._',-_.... ,.,-_._-., ".. ....M.'......fP'.
1
FINAL GRADE INC
- ".,..,..".. ... .~......- ....-......, ..
PAGE 02
,
.... - .....
"~La.ow . ~
...... . etT.
CI'1'Y OF PRIOR LAKE NO. 99-#A'~
SEWER AND WATER PERMIT
NOTB: Sewer and Water
contractors must
be registered
with the city.
APPLICANT; FlbllL fu.#f1LJE .I/Jc.
ADDRESS: p{) Eox 10 /iO~ Lhk'E /Iv
I
'PHONE: '/?'tJ -/5#1/
DATE: ~/.A'7 h?
SIGNATURE:~h7A'?~i,,~~~U~~,,;J BLOG. ;ERM;T # ??;R;!4
SITE ADDRESS: 17/~5 ;;flEASAJ1JT PJEAIJaJJ MA)$ Plot. 2-& -..2......, - ()()5-0
1.
FILL IN THE BLANKS
Estimated length of water service ,fl)
I "
size of water service inch(es).
feet.
2.
3. Location of any couplings from structure ~
4. Type of sewer pipe. ABS PVC)( Cast Iron
5. Estimated length of sewer line ,~~ feet.
feet.
6. Clean out (if required), located at
structure,.
-
feet
from
s_==~_==_~~===~~~~~~~_~g_======__=s_____~==~_~:_=a~~=~~~~~-=#~~===
This application becomes your permit when approved.
BY
OATE:
==~~~~=~=====_=s~~~~===~___~~~=~=~=~~~~~~~s_~_~==~==::=~=~=S=~=M__
FEES;
$
S
$
35.00
.50
35.50
Sewer and water line connection permit.
Surcharge
TOTAL
...
Fee for either sewer or water individually is $20.00 plus
$ .50 surcharge. --
Sewer and water permits issued for new construction must be
recorded on the buildin~ permit card at the time of issuance
to insure that no dup11cate sewer and water permits are
issued.
~
DATE PAIO
RECEIPT #
4- /27 /(jCj
~~~ ~~
fl~Q G ~~~ AMOUNT
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~~ REC'D BY
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16200 Eagle Creek Av, S.E., Prior Lake, Minnesora 55372/ Ph. (612) 447-4230 I FAX (612) 447-4245
, An Equal Opportunity Employer
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CITY OF PRIOR LAKE MC
16200 Eagle CrHk Av. a.E. fllmlt No. qq...- Z 02-
Prior Lab, MN 55372
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Helltng Con1rac1Dr \):S' -) ~ -t; t'\c..A..( ~ c..
Addr... .~f:D Jb~)t ~~. _ \\\b,rt \J't \\0. M'" ~~ 2j:) \
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~ Furnace Makt"l Mod.1 A~CA. ty:) ~ TVPE OF SYSTEM
b) C; L:. J 1 Wum All Plan"
v Model Size . r\.C-OY- J - -,~,OOO GIIYl\y
~ ":> L" J I I q Mechanical
U) Conn. load "'"\"") · -, I Aw Condllionlng
. Fuel ~G\ -t Flu. S~ze J..4 Vent Svltem
~ 5\1-''{ Openings 9 HEAnNQ OR POWER PLANT
w ~. ' ~
~ Return Openings ) (~+~\ -\ .2 ~"-~~ Hot a;;at81
0.... Input l../bOcx::>output ~t" Pri"") =~~'vlc'S
Ed..
elm..
Other Devic..
TYPE OF WORK
AlIff.'IoM
R.placeni.nt
N.w ConslfUclion X
ElL Comp. DIt.
~ Repair,
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~ Ell. Colt . .
W
I HEATING PERMIT FEE S
en
8 STATE SURCHARGE .
TOTAl PERMIT FEES .
BuIlding Permll'
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.50
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('" PAID' WITH
lBU1LD1~CiJ:ERM1T >
Receipt .
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TYPE OF STRUCTURE,
J. 0... . (II,
J. Vel. . r.e.na.
Single Family
Commercial.
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Mulll-famlly
Other.
'lWl)oFemily
Indullrial
Public
Fee Schedule
JMluslritJ. Comm.rcial & Mulal-Famlly
ResldenUal, Hilling & AC
Residenli.I, Hlelint OnlV
Residential, Gu FllepllCl
Reliefenllal. AddU/one & AlleraliOnl
Relldentlal. AC Only
1 % 01 Job cott (131.&0 mlnmum)
$99.50
SM.50
_JiG
139.60
139.50
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Remember 10 add Ihe Sllle S\Jrcharge on the boaam oIlhlt lpp1iclUon.
Th. price of your healing penn'll Inc:luctes one rough.ln and one IlnaIlnapecQon.
Addilional inspecUonl wlll be billed 11.35.00 each.
House Healing Teal Record mult b, eubrftilled wtlh IIYfIdIDg IWIDIl IUIDlbIl before build-
Ing cer1iticete 01 occupancy wiN be i'lued.
~FaT roM rolll .T'ntl.~ ~l:nw~J:n with number of I\lPPIy Ind return openlnlJllilled per
room wilh CfM', per opening. New .lruclurll or additions lend floor plan with supply
and relum Ioclllon. shown. HEAT LOSS CALCULATIONS, PAYMENT AND
APIlUCATIQNS MAY BE MAILED TO THE ClTY OF PRIOR LAKE. 182.00 EAGLE
CREEK AVE. S.E, PAtOR lAKE, MN 55372.
Cfty Hall bUlinest hOUR I" 8 I.m. . 4:30 p.rn. .
ALL WOAK MUST BE INSPECTED (ROUGH-IN AND FINAl) . CAU ern HALL
447-4ZJO
J hereby apply for It mechanlcally.tem. permll and r acknowredg. Iha' Ihe
Intorm.lion above is compl.'e and accurate; thallhe worle will be In conformance
with Ihe ordlnancl' Ind cod.. of Ihl city and with the .,.11 bulldlnDlmechlnlcl'
codes; 'hltlhis 'orm do.. not become a permit until tlenld by the BUILDING
OFFICIAL; Ihat the work wfll be In accordance with the approved pl." In 'hi
CI.. or all work which requlr.. review and approval 0' plan.,
~ ~ ~ L/-29-9~
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Building Offlcal.. Slvn8hmt . Dill
CITV OF PRIOR LAKE Me
16200 Elgl. CIe.k Av. S.E. Permit No. qq" Z 0z....
PrIor Uike, MN 55372
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& Addre.., I J)~'-=:; ~o.V~CiJ'A'" .~o{"~~ \)C\vL
Helling Conl.ldot 'D 3 I ~ ~ -t: t'\CJ...f ~ I L-
AddI.. of1::;f:D ~~)( ""t...: ~\b,Av'l \~_ Mf\.' ~~3Q \
Tllephone. . J..Iq'7 - ;;'(c/o \
Futne.w Make' Mod.l \-\..c..t- tv - G l 0
Mod.l Siu ~ l ~ ,.t; t:;O:-r R
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.. FlleI N..;-
Flue Size
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w Supply Openings
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R&tu rn Oplnings .
Input.
Edr.
Output
Cfm.
TYPE OF SYSTEM
Wam Air Plants
Gnwil,
Mechanal
Air Conditlonina .
VenL Syslem
HEAnHG OR POWER PLANT
Steam
Hot Water
RadiaUon .
SplCial alvica. ,
OINT DiviDes
Al1.ralions _
Replace"'lnt
TYPE Of WORK
New Construction X
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~.~_~..._..CHARGE $
TOT At PERMIT FEES .
qc; .. Z 62-
~ PAID WITH
l BUILDING PERMIT
Recelpl ,
TYPE OF STRUCTURE
1. a.- . 0.,
J. Yd_ . c.-.
SI"o1& Family
Commercial
)(
MullI-Famlly
OIhI1'
lWo-FamJly
. Industrial
Public
Fel Schedule
lndu.tri&I, Commercial I. MUII-Flmily
Residential. Hellln" I AC
ResidenOal, Heating Only
R8IkfenU.'1 Gas Firepl&c:e
AnictenUaI, Additions & Alleralione
Auidentlal, AC 0nI,
1% 01 lob coli ($39.60 minImum)
$99.50
184.50
139.60
$39.50
139.50
Remember to add the Slate Surcherge on the bonum 01 thle Ippllc8tion.
Thl price of your healng perini Indud.. 0118 rough-In Ind one linlllnlplCtlon.
AddItional inspections will be bnled at $35.00 each.
House Healing Te.l Record mull be lubmllted wilh bulldlna JIIIIDilIUlD&lJ[ befGr. build-
Ing certilicate 01 occupancy win be ISlued. .
HEAT roA' ro, II AT'n~~ Ilr:(\f ,Iqr:" with number ol.upply and "turn openlnga II1ad per
room with CFM's per opening. New slruck... or addlUonl SInd lloor plan will supplv
and return localions shown. HEAT LOSS CALCUlATIONS. PAYMENT AND
APPliCATIONS MAY BE MAILED TO THE CITY OF PRIOR LAKE, 16200 EAGLE
CREEK AVE. S.E. PRIOR LAKE, MN 55372.
City Hal buslnesa houri .r. 8 I.m, - 4:30 p.m. .
AU WORK MUST BE INSPECTED {ROUGH-IN AND FINAL) . CALL CITY HALL
447-4UO
I hereby appty for. mechanical .y.tem. plrmlt and I acknowlldga thlt the
lnformallon above Is complete and accurate; that the work will b. In oonformance
wilh the ordinance, Ind codll of the cIty and with 'he .Ia'l bulldlng/mtchlnlcal
cod..; that 'hi. form doell nol become a permit unlK "gned by the BUILDING
OFF$CIAl; Ih81the work will be In accordance with the approved plan In the
~,h ,oqult.. ,OS:: opp....oI.' pi:; .Z1 ~ Cf)
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lmildlnll Ohl'. Slgnilur9 r Dtfte.
CITY OF PRIOR LAKE
PLUMBING PERMIT
Applicant: ~/a.. ..-t. ~V" tJ{ e e ka.. ^ , C. 4- <-
Address: '~~~2.,t;D~ ;lJ/IV--L
Signature: / ~
Legal Description: Lot 5 Block / SubPlleASfWr I1EA()(}W 2,No
Site Address: / 7/YS /~aS"a.J/I1.e.~~ LA.~
Building Permit # qq - 2.82. PID # US-3L/-7- 005-0
NOTE: This permit will not be processed without complete information.
Th. C.nlt' of lh. like Counlry
JUN .- 2 1999
Ouantity
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FIXTURE UNITS
Type of Fixture
Ouantity
1. Blue
2. Gold
3. Yellow
File
City
Applicant
Bath Tub with or without shower
Dishwasher
/
PPNo. qq-2f32
Phone:~~~L/b9~
Type of Fixture
Rough-ins
Water Heater
Water Softner
Stand Pipe (washing machine)
Sewage Ejector
Backflow Assembly (RPZ, Double Check, PVB)
Backflow Assembly Test
Lawn Sprinkler
Other
$
$ 97'~
$
$ .50
$ /t9t1~
~f>-\O ~~t?t\,~\\
~U\\,O\t-\
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 amendments thereof.
'~~~/z-/~1 DATE
"""-/z;e:e( t/ . ATIEST
Call for al~spections 24 hours in advanceo
16200 Eagle Creek Av. S.E. Prior Lake, MN 55372/ Ph (612) 447-9850/ FAX (612) 447-4245
An Equal Opportunity Employer
Floor Drain
Lavatory (bathroom sink)
Laundry Tray (1 or 2 compartment sink)
Shower Stall
Sinks
I
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
$99050
$39.50
GRAND TOTAL
T'
PRIOR LAKE
a, "
INSPECTION RECORD
SITE ADDRESS 17J t/~ f?h~ ~ ~~
NATURE OF WORK NeW ~~l-tJct\~
USE OF BUILDING S FA
PERMIT NO. cr1- ?PJe DATE ISSUED (j-/~ Ltcr
CONTRACTOR W;Ut'c:..-., ~ k-
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
DEPARTMENT OF
BUILDING AND INSPECTION
,
I FOOTING \.. J / U ,.,~
FOUNDATION (Prior to Backfill) I 5-- 3-~~
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
SEWER I WATER I SEPTIC _ :)~,
FRAMING ~' ' 7/~/~9
INSULATION ~7WV'f
ELECTRICAL
PLUMBING Uf) "14/;,~,1'
HEATING (if required)Q,\. {/ pg. ~;7~9
FIREPLACE~~~.9. @ tA~ 1(,,'d8"~5
GAS LINE AIR TEST ~m ff/{ G....--o~ ~9
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I I
FINALS
r,j([;.
DATE
~:3~
GRADING (Prior to Sodding)
BUILDING T~ Q ot () -to t I-I -1.- 1
ELECTRICAL
PLUMBING
HEATING
DO NOT OCCUpy UNTIL ABOVE
NOTICE
q~)}~9l
Jso a /2'7 A~S"'
R H . 6' ~c) )"E:
HAS 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 (612) 447-9850