HomeMy WebLinkAboutBuilding Permit 99-0367
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CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
OWNER
PHONE NO.
-alFooTING A
~ ~RAMING
o INSULATION
o FINAL
o FOUNDATION
o DEMOLITION
o FIRE PREV.
r~
t;~
DATE TIME
~hc; 2,.: 0 6
/7/34- PfI€RSANt 1'16~Q?W
SCHEDULED
CONTR.
PERMIT NO.
99-3(P 7
o PLUMBING RI
^ 0 MECHANICAL
r 1WATER HOOKUP
A SEWER HOOKUP
o SEPTIC INSTALL
o PLUMBING FINAL
o SITE INSPECTION
o EXC/GRAD/FILLING
o LKSHORE~ETLAND
o COMPLAINT
o SEPTIC FINAL
o FIREPLACE
o
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DARK SATISF~T RY. PROCEED
~ORRECT ACT N ~OCEED
o CORRECT WO K.f' L F; R REINSPECTION BEFORE COVERING
Inspector: I Owner/Contr:
CALL 44j.t:~O e./THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE RE~EMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
o FOOTING 0 PLUMBING RI
o FOUNDATION 0 MECH RI
o FRAMING 0 WATER HOOKUP
o INSULATION j 0 SEWER HOOKUP
o FINAL ft ~ PLUMBING FINAL
o SITE INSPECTION A }("MECH FINAL
COMMENTS: r \
,) ~ -I-N.-Th.t" tw~
,. ~ ~..d-r?J~ ~ cio
r~f ~ -Ff
'ju:i Lrr~K"'-'
:~lllft(l}. OV<; oJ-
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I. WORK SA TISFA ~TORY, PRO
(f; CORRECT ACTI NAND B OC ED
o CORRECT WORK, C ,.,.~ I PECTION BEFORE COVERING
- ..OR LAKE
..:~T10N NOTICE
SCHEDULED
ADDRESS
/'7/34- ?#ErIShA/T
OWNER
CONTR.
PHONE NO.
PERMIT NO.
~
Inspector:
Owner/Contr:
DATE TIME
jtJ/S-/9C, "?:OU
. I / '../
n6/l00tJ
99'-3& 7
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
/\711
L/Vl..
T INSPECTION 24 HOURS IN ADVANCE.,
FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTI
._~.^~._-----------,_._--
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/.. ~.~,....... ~~k__"'~__'_"'''''.~,'''''' ," ........ ,.~... ""''' . .~~...::::._. ~.J....--..:.~"~..,~....r,"'~l' ;.~""'.~
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~~;I <<trtiflrau of ~(mpanry I..~
r;-~I~ CITY OF PRIOR LAKE
n~! . jJ9tpartmtnt of .uilbinll Jn~ptttion
~:I': . ctf.inal Permitted 0 Conditional C.O. Expires
- : This Certificate issued pursuant to the requirements of Section 307 of the Uniform Building Code
t~. c~rtifying ~hat at the time o!issua~c~ this structu~e was in compliance with t~e various ordinances of the
-: 1: City of Pnor Lake regulatmg bUilding constructIOn or use. For the followmg:
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Use Classification
SinSl;le Family
. Bldg. Permit No.
99-367
Occupancy Type
R3
Fire Zone
VN
N/A
Type Construction
Zoning District R 1
I
1~~
Legal Description L6, B2, Pheasant Meadow Phase 2
OWRCr of Building
Contractor's Name & Address WiJ-liams D~y .j,/ 1535
c;iteAddress 17134 Pheasant Meadow
""
.-
Bavariaa Shores, Chaska, Mi9~esota
,Jenni Tovar ~ .
1;,/11&1- ,/
.."..,
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
QATE R!;l;EIVED
File
City
Applicant
~R~/ ,
Permit No. qq - 3& '7
I. White
2. Pink
3. Yellow
., 'b/ ~'\
tt~ ~
,
. DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
1. DATE
4-/ f 5/ cftl'
~
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) \ (Width)
:!.:lo.L '::;2<<- \
12. NO. OF STORIES
I
2. SITE ADDR~SS /J
-17 /3 ~/.<A. ~AbLT
3. LEGAL DESCRIPTION
LOT C... BLOCK ~
ADDITION f' ~A-N r- ~A-O(!:) tV
fAl~. <'. ~
(Depth) ,
. 7 4.l-
f'ct.ll A DO v.;)
PID .2S-3t1-7- 017-0
'2.
13. TYPE OF CONSTRUCTION
Frt A-M...Q () ~
14. FLOOR AR~A JPPORTIONMENT USE
I :;J.. 5:,- Q i:J'
(J1A-A.gtZ..
(Address)
(Tel. No.)
4. OWNER (Name)
"'5~
5. ARCHITECT (Name)
A r'1.a,.l ('T-e cTL<.,-tA...(..
6. BUILDER (Name)
(Address) (Tel. No.)
()es I~N LlIlSCbN'..s:' IW i-7St::..7IS -317(.,.
(Address) (Tel. No.)
15. NUMBER OF OCCUPANTS OR SEATS
C;:'N(d t.~ F"~"'" -...,
OCCUPANTS A ?-or- A.<. tal .qO
SEATS ~ ~_
16. PROJECT COSTNALUE
q t:J Ot!/O...
17. COMPLETION DATE
(P104.~S.-L'L~~
u., t Lt.. f\- f-tS
OeVJL.Lo fl"-1.e"fl ,-. L <-
I
Re.roofing 0 Porch 0
Re-siding 0 Finish Basement 0
Deck 0
Finish Attic 0
Septic 0
Addition 0
7. TYPE OF WORK
New constructio~
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES
Sq. Ft. '"3 0 '"L't
Fireplace 0
Alterations 0
9. PROPERTY DIMENSIONS
Width 3 c... Depth C6 4
1 o. CULVERT SIZE
~
Yes
'"T u c...--...J
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\>wner or authorized agent for
the above ention~pr rty 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
b i1din ~I can re this permit for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perf1rm nered inspections.
X. ,'~" J1A~oL. 0 OtOb I';. '&4- U. I'!> ~ 1
Signature License No. Date
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
MATERIAL FILED WITH APPLICATION
SOIL TESTS
o ENERGY DATA
o
Side
Side
Back
Front
PILING LOGS 0 PERCOLATION TESTS 0
BUILDING DEPARTMENT VALUATION
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PLANS & SPECS 0
SURVEY 0
SETS
COPIES
:)I--f.l
USE OF BUILDING
III Jonf) .~ f')
PLOT PLAN
o
PERMIT VALUATION
~
TYPE OF CONSTRUCTION: I II III IV <.JP
Occupancy Group A B E F, '"\ I ML1f S U
Oivision 1 2(Y4 Q<{ ,.-
Permit Fee ................................... $ I d. '1..,:>
Amount Brought Forward .................. $
Park Support Fee ........................... $ 650 . m
SAC ......................................... $-1 ('J ~(')F)
Collective Street Fee ....................... $
Sewer Tap ................................... $
c:z. rI $
Pressure Reducer ..:re................... $
City:
fo/2 ~47
~~.50
Plan Check Fee ............................. $
State Surcharge ............................. $
Penalty ....................................... $
45/00
12':;,ot)
~
/. 2~CJ .()O
, ,oo.as-
I DO .00
!C,o .00
3S-.50
40.60
Meter Horn ......<2:.;;..................... $
Water Meter ... ..11:)........................ $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
t ~\~of\
~1-
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
Sewer & Water Perm~ ...................... $
Water Tap ................................... $
Builder's Deposit ............................ $-1,- ~ ro .0(')
Other ......................................... $ _
Total Due .............................. $:735'3). 7~
Paid 1~n.72 Receipt No. 35'14tf
Issued .
Date ~-/-'1.~ By C iJ J.)
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 reql.,ied. This document when
sig~ City PI n canst, ~utes a temporary Certificate of Z~mPliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be issued.
\....:.,}I .A >I ~ X~.2-.'
~ "\ anner Date Special Conditions ~ any
Building Permit ~pe~pr~~.
Date -!:! -.I. ::> - Ll
Certificate of Occupancy
24 hour notice for all inspections 447-9850
GREEN . FILE
YELLOW . APPLICANT
GOLD. CIT1
CITY OF PRIOR LAKE NO. 71-3'67
SEWER AND WATER PERMIT
NOTE: Sewer and Water
contractors must
be registered
with the City.
APPLICANT: h/JIfL 6~/}fJE :JJJC PHONE:p/:?-~~l)-J64)
ADDRESS:.f'O go~ Jf) fJ~ "liKE PJAJ DATE: .1)&;151'11
SIGNATURE: ~~/fl~L4.U7h BLDG. ptRMIT' # r9-3t:,7
SITE ADDRESS: J 713~ P;fEI/S/JAJ/ t1J~uJUJIf)EPID# 25-3'-1-7- tJl7-()
FILL IN THE BLANKS
1. Estimated length of water service
?31 feet.
2. Size of water service
I
. inch (es) .
3.
Location of any couplings from structure lJ feet.
Type of sewer pipe. ABS PVC V Cast Iron
4 .
5. Estimated length of sewer line
~5
feet.
6. Clean out (if required), located at
structure.
-
feet
from
------------------------------------------------------------------
------------------------------------------------------------------
This apPlica1ffi'-.ia mes your permit when approved. .
BY ./ DATE: 5/Z-5/9'~
~ . I
------------------------------------------------------------------
------------------------------------------------------------------
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 #
AMOUNT PAID ~D \N\\t~\1
{> . G~
REC' 0 BY ~\\..O\~
16200 Eagle Creek Av. S.E., Prior Lake, Minnesota 55372 / Ph. (612) 447-4230/ FAX (612) 447-4245
An Equal Opportunity Employer
8-16-99; 7:51AM;ELANDER MECHANICAL
02/26/98 TBD 11:38 FAX 6124474245
;612 445 7487 # 2/ 2
CITY OF PRIOR LAIm IQ 002
CITY OF PRIOR LAKE l;~,,~!t:}"
l. YcIJaIf AppIi...
PLUMBINGPERMrr # 99-3(;;,7
AppIbI1t.~ A ", ~" /!If f ~ I C rl-C- Phone: b ~ ? - +'" Y J::' Y b j' ..J-
Address:: ~9 /~ ~~~rQ,-r _ 2>/j~'<' 5 h II!Jtc..oR6L..- /U~
S1gnGtuIe: ~ ~
Legal Qo;.......:..lI..n: Lot ~ Black 2. SUb 1'#EA911V/1'16rrooW' 2~
sa., Addrun: / 7./ .3" if ~ /r e 4 ~ 4 we. -/ Af, 4li. ~ -t/ ~.-J4f:..... ;Ie ";
B\IIIdIrlgPennit# qq- 3f&;, PIO' 25-34-7 - 011- 0
Nv I c; Thill petmil will not be pme:eS88CI wIthclur cornp/8te Information.
FIXTURE UNrr5
..... eo- 01 ....... ~
Cuen_ Type of FIXtUre Quantity Type CIf FllCture
, Bath Tub wIIPI or without shower .3 Rough-Ins
I DIshwasher / WaiBr Heater
I FIaor Drain W_ Sonner
Z- u.vataty (bllthltlam sime) I Stand Pipe (washing machine)
/ LatItIdry Tray (1 or 2 compatItnent sink) Sewage E"jf!lCtar
/ Shawst Stall BdIaw ~- Il'II:Itf (RPZ, DautM a.a, PVB)
I SInIca B8ddIow Asaembly Test
Bar SInk Lawn Sprinkler
2- WalSr Closet (tollet) OIhIr
FEE SCHEDULE
rnm.trilll. eommardal& Multi-Family
(1'1. at job c:olIlS39.so minimum)
R..amtIaI. HIM One 5. TlIIO Family
( R...I~. AddItIoN.l 5. Alterations
1. $'818 SurchaJge ,
$99...50
139.50
S
I
S
$ .50
~- tl0 \l'J~f\N\\\
G~DmT~ ~ \NGPE
eU\~
Thi.a p!:nIir 15 p'IIIUd upaa tba ll'.IIPJI=I' CDndiciaa dw said
!:Un',. _.. '. 5hal.l .,,".. 'y in all ,., ... 'ooilll.,.___
oflMSCMal'l~um.D . ILw~~J:e;"~~~~.
. .. . . A4>.c:'-&<
Call for all spcetions 24 boars iu advllllCe.
16200 Eagle Cr=k Av. S-E.. Prior Lake. Minnesora 55372 I Ph. (612) 4474230 I FAX (612) 447 -4245
An Eqllal C ~ ~ . , .1lIi~ Employer
~~rr PR'QI? ~ CITY OF PRlOR LAKE Me
if. v ~ 16200 eagle Cnlk Av. S.E. Permit No. 99-3fo 7
E Prior Lake, MN 55372
a:
~ HEAnNG APPUCAnON I PERMIT
~ Da18 o//~/q9 PID,2.S-a4-7-0,i-O
~ Site Add.ell \ f \ ~ J-J ~ 0. t;C("\t . (Y)n....r\oL-J ~ \
....... '
'<t Lot ~ 81oc:Ic 2- Addlllon P#erJS~NI ,Me/1~ IN Z",.o
.......' .
j. Own.'" Name W I 11 i WY'\ \~ DeUe.. \00 IY\LC'"\ t-, "1 L L
Ill' \'
E Add.s. l J)~.<\ ~o..vo.C"\(",('\~o,t'.s Qr\vL.
Hel1lng Cont.lClOr'D ~ I ~ ~P\ +1 C\CA -( ~ Ie
Md.eas fDfJ:> ~'1U')(. ~\l~.. ~\~Au\ \\". Mt\) ~~2IJ\
, . '
~ Telephone' .)..Jql- ~~ \
~ Furnace Make 'Model ~MW'6. Be ''0
tJ'I
~ Model Slu Gol OD'70 - .lD1 ceo
.......
l.D Conn. loBCI c '':l.A I '~5l?:>
o Fuel.~~ t Flue Size 1-l t r .
z
~ Supply Oplnings . J 0
~ Relu.n Openings. -5
Input fJi.(X)O . Oulput 55 . 2.. OD
Edr._
crm._
TYPE OF SYSTEM
W.rm Air Plants
G.avlly
Mechanical
Air Condilloning .
VenL Sys1em .
HEATING OR POWER PLANT
Steam
Hot Waler
Radiation ,
Special Device,
Othe, Devices
TYPE OF WORK
R~ac:enient
_ Ell Comp. Oat. .
Building Permil' ,
Alterallons .
~
~ Repair.
I-
a:
w
I
lfl
I-J
Cl
E
o
0:::
LL
Est CUsS $
HEATING PER~~nT fEE $
STATE SURCHARGE $
TOTAL PERM\TFEES l
New Conelructton
x
QQ-3fo1
.50
PAID WITH
l BUILDING PERMIT
Aecelpt .
TYPE OF STRUCTURE
I. nIII .. ....
1.. 0... . all
1. Yellow ~
Single Family
CommoFi:ial
Two.Family
lnduatrial
'J...
MulJl.femllV .
Olher
Pubtic
Fee Schectule
Industrial. Commerclll & Mulli.FamRy
Residltntta4, Heating & N;
Residential. Heating Only
Residential, Gas Arepla<le
RelidenUal, Addlions & Allerations
Residential, AC Only
'''' of Job COlt ($39.50 minimum)
$99.50
$84.50
$39.50
$39.50
'39.50
Remember 10 add Iht Stale Surcharge on 1111 bottom or IhI8 appllca1lon.
The price 01 your healing permlllnctudes ooe IO\lgll-in and one flnBllnspecllon.
Addilictnallnspections w~l be billed at $35.00 each.
House Healing Test Record must ba Bubmllled with bWidiDg IlIIIDil DJmIbIL befelle build-
ing certificale or occupancy win be issued.
HFAT r.Al r,I" ~Tln~~ ~J:n' 'Ip~" wllh number of IUpply.nd re(um openings Isttd pet
room with CFM'. per opmng. New elrucluru or addnions send floor plan wlh liUPply
alltlretum localions shown. HEAT LOSS CALCULATIONS, PAYMENT ANO
APPLICATIONS MAY BE MAllED.TO THE CITY OF PAtOR LAKE. 16200 EAGLE
CREEK AVE. S.E. PRIOR LAKE. MN 55312-
Cily Hili busIness houra are 8 a.m. . 4:30 p.m. .
ALL WORK MUST BE INSPECTED (ROUGH-IN AND FINAL). CALL CITY HALL
447-4230
I hereby apply 10f a mechanical syslems pefml! and Ilcknowledge that the
l"tormation above Is complels and accurate; thallhe work wlll bl In con'ormance
wilh Ihe ordinances and codee 01 Ih. city and with 'hi 81lle building/mechanical
codes; Ihat this fo.m does not become a permit unlllsfgned by the BUILDING
OFFiCIAL; Ihallhe wo~ will be in accordance wUh the apProYed plan In Ibe
!~I ~hlch ,"""Ir.. '~~ .ppro.oI.' pion..
. - - ._,~~. \ .
OB1e
6' !J t/ / '1<:J
Dale
qCf" 5~ 1
TIw c..... .f .Ilr La". c...,'''
White - Building
Canary - Engineering
Pink - Planning
IllIIIJ)ING PERMIT APPLICATION DEPARTMeNT CHECKLlSI
NAME OF APPLICANT \\J ILL 11-\ IVI S '~F)Jt.,L(;P II S N I
I ,.
APPLICATION RECEIVED 4/ I ~ / 00
I /
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
J7/3tf
PufAsA-d/ I1fEA~ L..u
Accepted
./
Accepted With Corrections
Denied
Reviewed By: J,.J;lfr..TEA. &~~AliU
Date:
cf/JO/ ?9
Comments: 'Zw.soF':-I'IiCJ$T E€ (!DIU~EYED 7"0 If~ ALDN~ DIl.""'AJ"'~
. A^,O f"JT1c..(rY EA~E:-"1.E..u~ A~ ~u(.ti Ac; ?tUIC.71C!fL _ DIftt-f1ft;Eb
COA.JGlt.E:rE- 1JJrf-c..K PAAl~LS
t.AJI u..
13L. REPLAl Eh ~v 13v"..l:}~1t _
~ IN'FD;t~AT'loA) ON ~~"'E'~sf: StDE'.
q::~ A"''f'H*",~: I. 6&..t... {5rt"DE //tJ.$fE~TlC1"'L.J.)JFoRMI4TJ()tV ~ _ ~"DI,.J(. Illf.N
-3. f/b)SIOiV t'CMJ7ilc:lL. t4 F..,gc..IfGc;
tJ.. &D,$I<JIU Cn~ T..clOL.. I1..AN
liThe issuance . or granting of a permit or approval of plans, specifications and
computations shall notbe 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."
_ ._._... __._..:.~..-__,>_'"'_~...._.._ '__.~~____~'._~ _ _. .. ~'".,_ __.,.... _'_"~__._.'4... .....__ "_~_... "''''_ ...,,".......' ... ','. __.... ...J.___.'~~ ~.. ._~..- . _ _ ..-,.-----:-....--'--";~-.-.-. - - .-. -,-.----------. .
~1- S~ 7
Th. C.nl.. of Ih. Lab Counlry
White - Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT W rlL"~s D~J
APPLICATION RECEIVED Ll- \ S - l qq ~
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
1~13c/ p~~ ~ ev\,
Accepted
Accepted With Corrections X
Denied
Reviewed By: @ U)---..,J
. /
Date: 4- ~~-'1Cf
Comments:
1. ~oJ o....JL f.f"1.JlQ..C; ~ ~ CO(o.....,..
\
2. Mc..:v..~~",- &~ i"'aVL ~
3. ~ec.dL a. ~ \. 0. -Ho.c. ~~ t\~olOtJ-R
"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."
':~ ~"'. ',~;.:;1'~'::";"'~";" ",.;~.~;;; ,,,.,:~;;i,.;-..~~'-,."r ,J:;i:,;J:~~..:'i'!'i.'~;~':'jo;;F":"~'- , '''ii''l,-;;''",~,,;.;>,,:"::,~;.-;,--'Y'r'~--''''-"'r,;,,~'f':\;y.~:.' :' "r';'''~._'>.-:'-~'t:-, ,-r - "';~::-v. -" -'C,T::-."---~-)'_.""'I'l "-"T;;Y:~~-;;iI:-';"II/f--.::y,;~- 'T --'" ...._~ -';:,......-.;~;:75:"~-::""'.,..;c,~..."""~'I:. ....
"'_"'i~~''':''':__O
qq~ 36; 7
Th~ C~nl~r of Ih~ L.k~ Counlry
White - Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
\ r. i .-'
-, !
\~ ~~~, \_-
, .:' I
/""..,
!....- I
/
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
/,134- Pt-\SASA~T Mt;,ADOW LN., 'SV\f
.
Accepted
v
Accepted With Corrections
Denied
~~
Date:
Lt-LL-7'7
Reviewed By:
Comments:
"/beo~ '3u~ ~UjIIe- ~
('(9~ ~,-.lfdr~ ~<::fD 0~~'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."
CITY OF PRIOR LAKE MC
18200 Eegle Creek Av. a.E. Permll No. qCJ- 3~ 7
Prior Lalal. IIN &5312
HEATING APPLlCAnON I PERMlT
PID .25" 3tj.7 - or7 - 0
~c: ~~ ' (Y)f ",r\nl..-l . k,
~ Fuel Flue Sl1e
~ Supply Openings
o
I
a.. ReMn Openings
Inpul , OU\pvl
Edr.
Clm.,
AII.1tdlonl .
~
~ Repair,
I-
er
w
I
(J)
1-0
o
Eat. Colt $
HEATING PERMIT ne . 34
STATE SURCHARGE $
~ TOTAl. PERMIT FEES $
I:r::
l.L
nPEOFSYSTEM
WIIRII Air Plants
Gmt" .
Mecl1lniClI .
Air Condllloning
Vent. Srs1em .
HEAnNQORPOWERPlANT
SIeam
Hot Water
RadleUon
Specill Devie" .
CtlMtr Devices .
TYPE OFWORK
x
Rep\8ctm"ent
New Conslruclton
Eat. Comp. Oate .
Building Ptmlit f ,
~
qq~3(P 1
.50
110 ~
PAID WITH ......,
,
BUILDING PERMIT
ReceIp1' ,
:TYPE OF STRUCTURE
..J. ,.. . r.
1. 0nlIn . Ckr
). YIlhw . C'iDIhdar
Single F8m1ly
Commercial
Two-FamMy
Induattlal
-x
Mulll-FamIV
Olhtr
PubAc
FIB Schedule
Indultrlal, Cormnen:lal 8. Mulli-Famlly
Rasidenllal, Heaang 8. AC
RBlidenllal. Heling Only
Rasld,n6111, GIs FlreplllCtl
R,.denOal, Adrllkms & Allerallona
Residential, N; Only
1 % of lob GOat (139.&0 mlnmwn)
199.iO
184.so
$39.50
$39.60
$39.50
Remember to add 1he Stale Surcharge on 'h, botlam Gf 'hie .ppIIcalIon.
The price 01 your heaUng permlllncludes one rough-In and on. flnallnlpec1tan,
Addillonallnspeclions wAI be billed at 135.00 eadI.
Hous. Healing Test Recold mult be lubml"ed with l1IIlIdloIlIIDDilllllDJll[ baton buN-
Ing cerUticate of occupancy win be llsued.
I.II:::~T r.AI ("Ill Al'.nfll~ "FOI IIRFn with number of IUPPly and return openrngllllted pet
rClom wllh CFM'. per openTng. New .'n1dvree or addldona and Pool plan with euppIy
Bnd relurn localions .hawn. HEAT LOSS CAlCULAnON~ PAYMENT AND
APPLICATIONS MAY BE MAILED TO THE CITY OF PRIOR LAkE. 18200 EAGlE
CREEK AVE. S.E. PRIOR LAKE, MN S5372.
City Hall busineas hours ant 6 a.m. . ~:30 p.m. -
ALL WORK MUST BE INSPECTED (ROUGH-lN AND F1NAL). CALL CITY HALL
447~230
I hereby apply for a mechanical _y.teme permit and Ilcmnowledgl 'hilt thl
1"lolm.llon .bove I, complete and accura'e; Utat Ihe wo." wm bl In COIIfonnance
wllh the onflnanc88 and codee of Ihe city and with thl IIlle bulldlnglmechanlcal
codes; thai this lorm doe. not become 8 permll until ."nld by the BUIlDINO
OFFICIAL; that the work wUl be In accordance wUh thl approved plln In thl
f~,~ of all work which n1~ulr.. review and approval of ptan..
~~~ ~ 5~}cj~~q
~. Appl nfaSI lmJ -.. Dall
, 5//~/qq
. Dale
PRIOR LAKE
INSPECTION RECORD
DEPARTMENT OF
BUILDING AND INSPECTION
SITE ADDRESS ~ ~.&lc-t.d;)rml \ ~.
NATURE OF WORK ~
USE OF BUILDING ~Fi-\-
PERMIT NO. 94 -~(Q~ DATE ISSUED L/-'J.3-9cr
CONTRACTOR u )il\,~ ~ r .
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR
DATE
W ~/.)A' l C}2 ,0~~.
J FOUNDATION (Prio~ Backfill) &tV ~h"/t; ! I
PLACE NO CONCRETE Ut(TIL ABOVE HAS BEEN SIGNED
ROU_~ 71/NS
SEWER I WATER I SEPTIC. r (. / (' 0- If ~
FRAMING lJ~ (. L/ I ( tv
INSULATION (AJ ?/36/l9 U
ELECTRICAL GF - _
PLUMBING (4.) e, '/8/CftJ
HEATING (if required) (;I, I~~.,
FIREPLACE . - j;I.:0rr
GAS LINE AIR TEST j;r4,w1
COVER NO WORK NTIL ABOVE HAS BEEN SIGNED
I I
FINALS
~r ~)/~ /1''7
FOOTING
'i}K/~~
,
. -= -::--.. -..
GRADING (Prior to Sodding)
BUILDING ~-trJ d,'/,~'
ELECTRICAL
PLUMBING
HEATING
DO NOT OCCUpy
t}1/cls/1 os
eJ) I /r/-s-/! ~
U~L 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.
HAS BEEN SIGNED
Call between 8:00 and 9:00 A.M. for all inspections
FOR ALL INSPECTIONS (612) 447-9850
~ .,......................-""'"'r'-.....~.., ~~-'--'i
i OJ'S H....'l'ING . AIR COlfDITIOHIIlG, IRe. \,
HOUSE HEATING TEST RECORD .
.permit No.
Owner
j I Iii ,,~
t:, (; ,'") i'"'\-<", ",..
Address} ... J i
~I
Installed By
,:~t
GAS DESIGNED UNIT
Make II
p.' ~/.'
M d ] ~-..,.., T.'
o e:~;'
-. r
,-.
Serial
~ (. "'7":.~ i""I\ ~.t i
:\
Date Tested
,~ i~i'';.~'';~d i':~; '''''-';';'i' ,;,0)"" ~: '~';.oW~~.';~~ -';'.'
, .
/..~.;,,.,,/,d,..: " ,~",f'~l;"Ii.~'<'!,;;~-~I,;;e::,:"":<;':-~':H~~,;,j" -,d ,~\ 'r;,'~.~,.~~,~~;t~':t.:":,''''':~~-',:':::;}
.J
.,)
Name of Tester