HomeMy WebLinkAboutBuilding Permit 99-0949
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CITY OF PRIOR LAKE
INSPECTION NOTICE
..,r~1,M /E
SCHEOULED ~
~~Lrv-,} I'n
CONTR. D
ADDRESS ,45 9 ~
OWNER
qq- t:;'{q
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
#F ING
ULATION
INAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EX/GRAD/FtLLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
0,
COMMENTS: \.., ~ ~
00 _
- ~ CiL"n~
I,S, V
' /,(A".J Ii J"^-
~
10
(~I~
rl
/1U,
/'
.L
INSPECTION BEFORE COVERING
Inspector: I I owner/Contr:
CALL 447.9850 lOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE ~MENTS ARE FOR YOUR PERSONAL HEALTH & SAFET~I
INSNOTJ
II
,
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
II
DATE TIME
~-2T-'1.i ,1W'o-~~
ADDRESS LJ5Jf d1~~ n.
J
OWNER CONTR.
PHONE NO.
PERMIT NO.
qq-oI1~
o FOOTING 0 PLUMBING RI
o FOUNDATION ~ MECH RI
o FRAMING WATER HOOKUP
o INSULATION SEWER HOOKUP
o FINAL ~ PLUMBING FINAL
o SITE INSPECTION 0 MECH FINAL
,,~ ~ vl/
COMMENTS: / /14-ru ~(rAHJ_ ~
r r r (;1 ., . ..
d&;' .A..- .~~ _ _ -
I
~,.......... ~- ~~
,~ .t.J~1 ,/I 11 n .d:
'33 ~ S'~ _.P..d4~ 7~
...P'/ c.. '5?-'+u..k or1J
(r7:J d~ ('~"?\~ ~~
'---- .,
rn-.f( M:R- +& ~ / ~ (
~ zru -Arr- /1d---
o EXIGRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
r
I
3'"3 B-<~.Jl6
~~ f-n.
/'
/
~WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT W92K, CALL FOR REINSPECTION BEFORE COVERING
Inspector: m { Owner/Contr: _
;:ALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
INSNOTl
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
,
II
OWNER
31~l~
~W\.{h?;LrYd
CONTR.
TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
J~:~
ADDRESS Lj scr 8
PHONE NO.
PERMIT NO. 'ft, - q'4""1
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
.1\ D.fLUMBING FINAL
r ~MECHFINAL
COMMENTS: ~4w 1)&'11" ~ oiL ~ () k-
, (Q t=-i'A.c..J D~ ~ 1),.erV" . V\ "\ de..d- -
f?J E,cd o'r-..a Utv-e.e<:... \j~^ Hp~ ~~
(~\4.aV-o. SUlr+b.U, n.n'Ve..J),J~V
(~~rw ~ CY-d-e.- \
@.Me<.-<\-\.,h'\r\f;roC;CMcard"ru€
((Q! Pe.r"^~M'.;* ~~
~ ~
~~. ~O. .to B-~ \
- /
"'-
o FOOTING
o FOUNDATION
o FRAMING
o INSULATIO'jrJ Pr
~NAL
o SITE INSPECTION
o EXIGRAD/FILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
.IJ1V l4-C
/
o(L/
o WORK SATISFACTORY, PROCEED
o CORRECT ~ AND PROCEED
~RE
1 nspector:
ALL FOR REINSPECTION BEFORE COVERING
Owner/Contr:
CAL~447_98liO FOR THE NEXT INSPECTION 24 HOURS IN ADVANC!;",
CODE QUI EMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
INS/iOT1
,
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS '-/S'te HU\MIM\~t.;......d... T~.
OWNER CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
dIP SEWER HOOKUP
1tJ/}I( PLUMBING FINAL
o MECH FINAL
COMMENTS:
- I
- f))1
-/~I~~
...
-/ ~~~
~..~ U(
.-Ll~~/l A ~ /h. 0:;1.", (
II
DATE TIME
'3.'2'2.caG ~
/!'30
'fl. "'1'1
o EXlGRAD/FILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
lIiilIa W~ If' ,f)..
U'
.
fiORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector:
/Y\2A
Owner/Contr:
CALL 447-9860 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
INSNOTl
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
,
s~~
,QATF RFCFIVr;,Q
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
1. While
2. Pink
3. Yellow
File
City
Applicant
!3/~/91
Permit No.
91- qt/-CJ
,
I DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
12, SITE ADDRESS .. I
4~qB WM~/""};IM LM-lL--
1DAe;iA'~
e./
BUILDING INFORMATION
1" SIZE OF STRUCTURE
(Height) (Width) (Depth)
3, LEGAL DESCRIPTION
:;z...
KAPA
12. NO. OF STORIES
LOT
J::
3
3ul
PID
2..f=5-34C(-6n-o
ADDITION
14. OWNER
15. ARCHITECT
6, BUILDER
(Name)
(Address)
(T~q~ _ 4fp05
(Tel. No.)
13TY'V~ST~
14, FLOOR AREA APPORTIONMENT OsE
Tl.e '^lIr:ld'.'I9sS Ce~;w, IRO.
(Name) P.O. Box 2~ ss
a .._
(N€r\Io\I-''':::' Vtlllt::ly, IVllnntlliilalaspOl<!4
(Tel. No,)
15, NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
7. TYPE OF WORK Fireplace Cl Septic 0 Deck 0 Ae-roofing CI Porch 0
New Construction ~ Alterations 0 Addition Cl Finish Attic Cl Ae-siding 0 Finish Basement 0 16. PROJECT COSTNALUE
ChimneyLl Misc, /3"..$",Pa> .
la, PROPERTY AREA OR ACRES 19' PROPERTY DIMENSIONS 1'0' CULVERT SIZE 17. cOMPL~~~~A~9
Sq. Ft. I Z. 4-'1 S' Width Depth Yes No ,0/ ~'/ "/
I hereby certi mat I Ili:lvl:ioo(.umished injQ tion 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 m tioned pro~ that all construction' nform to aU existing state and local laws and will proceed in accordance with submitted plans. I am a::~at the
:Uilding official evoke this .. urthennore, I hereby agree that the city official or a Ur;/7ay enter upon the property to perform nee;;::!;~9s.
/ License No. loaJl
"./
SEATS
I /
SETBACKS: Requ~
Actual
FOR ADMINISTRATIVE USE
MATERIAL FILED WITH APPLICATION
Front
Back
Side
Side
SOIL TESTS
Ll
ENERGY DATA
Ll
SFD
OFF STREET PARKING
SPACES REO,
SPACES ON PLAN
PERMIT VALUATION -J3S I)~. rJl'""J
-
PILING LOGS 0 PERCOLATION TESTS 0
BUILDING DEPARTMENT VALUATION
USE OF BUILDING
PLANS & SPECS 0
SURVEY C)
PLOT PLAN LI
SETS
COPIES
TYPE OF CONSTRUCTION: I II 111 IV V
OccupancyGroup A B E F HIM R S U
City:
Amount Brought Forward .................. <t
Park Support Fee .... .... ................... $
SAC ......................................... It
Collective Street Fee ....................... <r
Sewer Tap ................................... $
%,. <
Pressure Reducer .......................... <t
BSo.r"l"'l
lose .elO
Division 1 2 3 4
Permit Fee ................................... $
I, o/..L2';-
{p"'l.IJ.t/h
(0"1. E5)
Plan Check Fee ............................. $
State Surcharge ............................. $
Penalty ....................................... $
Plumbing Pennlt Fee ...'Jr.:.1~... $
Mechanical Permit Feet.f..:.1f1,.... $
. 3S.SD
Sewer&WaterPennit. ..1...1.~.... $
GaSU.J:J1~"l: .:.If-fl'" $ </0.00
~ls[I!:I!!fJm Y ur Building ~:tr;~h:{ t:P!3ltcr
Certificate of Oc ancy
4b." 15
I 00. no
11\0. D6
MeterHom....s/'w........................ $
Water Meter ..~a........................... If::
Sewer&WaterConnectionFae ........... $~OO.C9-6
Water Tower Fee ........................... <t '10(J .t''::) r'l
I 2"-. a::>
Water Tap ................................... $
Builder's Deposit ............................ $ I. ~t:J 0 .0(""')
- .
Other .............................. ...... ..... $
Total Doe .............................. $ 7 'Jh~- 'J---
Paid 7S-"~.,1 Receipt No, 3~ z.4-4-
Dale?h oz.-/9'f By.fIQ .-/
req est in the above application and accompanying documents is in accordance with the City Zonfng Ordin~n~ and may proceed J requested. This document when
~ne' nst"'tas a tempo<ary certifi~H}ing ;omPliance and allows construction to commence, Betore occopancy. a CertiHcate 01 Occopancy most be issoed,
City nar t'71 Special Conditions if any
Issued
24 hour notice for all inspections 447.9850
-.. ....n T -,
1'9 'lei?
White - Building
Canary - Engineering
Pink - Planning
Tltr C....lrr of 1M Lakr Co"n'.,..
BUILDING PERMIT APPLICATION Dr=PARTMENT CHECKLIST
NAME OF APPLICANT
/V / IV V I vOOLJ (,_0.
f
e/ 4/9??
APPLICATION RECEIVED
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at: '
L/ 598 ./1(/ /'-1/'f / /''/q C / K 0 --rK:--
Accepted
,,/
Accepted With Corrections
Denied
Reviewed By: /J.4L -rfJl.. ~1i.F.s_..J.J
Daie: 4nJi9
Comments: 17"ASoFF Mvs"- 'BE C.oJvr;.yE:D
10 "'ND Ik...AJf. DIlt<>tuIfGE
I
f ()11l..,r< EASE:"'''~ A< MvCl-( J'1s. PIt.Ac.TtelIL.
^'~ 7H~ ~MEAG6JC.'r'
nv~Ft'o..J E:IE"'ATloN oF ~.u. ".... rri~ vol."f1./ PLoPt9UY LlAJE: WUtQL
W\...~ 1St: QR..Aorn 1"-' AT' nAJA'- GIlIlO€.
~C;F: I.J~nR...A"",OAl (),..) REcJU':" <'A~
5F~ A'f1',<lcHt"!.~: I. h""t4l.. CnAM JAlsPl:en.,J (NF"n.,.,ItT7,tJ Z. C;ItIfO/^,,~P/.J4JJ
'3'. E:a"SIO.u L.ot>Jrfl.ol..- MEA<UIl.t:5:
c/., Ello<'IOt\J CDt>JT?lO'- PL."''''
"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 I ~ -. .__"_4--~_"'---~~-=--"::,::::::,:-~-=-:~:,::_~:==~'::=":_.c:'-~'''''--'''~-'=---.-
~1
99- "left
White - Building
Canary . Engineering
Pink - Planning
Th.. CC'nlC'r or lh.. L.kf Counl".
BUILDING PERMIT APPLICATION DEPARTMENT CHeCKLIST
NAME OF APPLICANT
tv/NO WOOD (!L).
6/4--/<:7<7
APPLICATION RECEIVED
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
4596 ~t/ /"1M //'/6 L5' /-eD 7L
Accepted Accepted With Corrections X
Denied /J
Reviewed By:m
Comments:
W 4(( Ci&~ ~~
~-
Date:
8-/(,-91"
"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."
II
~'" "'I'\l"~,iC.~~";" -"",_;,";,~<':.'~'..'o'O'".'''' ,~"...._~;: "~g:;~, -. ....""""'.- "t" ,=.' " ~_~ '17'1'.""'. J _ ..'/"'!I'l:;.:ot' ._~. ,.,'^_~.... ......,....."'"'~~,.. ."".' 'I "r.I..,-.I""' I 1\. ......~'^_"'~~ -v ,
White - Building
Canary - Engineering
Pink - Planning
Thr Crnlrr of thr Lakr Country
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST:
NAME OF APPLICANT
APPLICATION RECEIVED,
//
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
./ )
/A_
Accepted
\/
Denied /1J '" --..
Reviewed By: nltf1- ~
Comments: ~ fl--71c.. i Mif (' .llmtJt e..VJCrcb-c..h
Accepted With Corrections
Date:
g-'l ~/7
/0' sfde yarefs _
"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."
-- ......-...........
GMe. - ,....e
YELLOW - AI'I'LICA.T
GOLD. elT"
CITY OF PRIOR LAKE NO. tj)9- 9tf9
SEWER AND WATER PERMIT
NOTE: Sewer and Water
contractors must
be registered
with the City.
APPLICANT: D (l i. s /I t0L 6 ~ C .
ADDRESS: 1(.,118 lOf'L~ ...,,;,.4-/
SIGNATURE: ~~ '\)~L
SITE ADDRESS: <!S'P )/UcYVl,.., ~&K1 ~-"
L/(t!L.
PHONE: ,R 9.:2-c:. 'lot..,
DATE: '1/;/9 "1
BLDG. PERMIT # t19 - 9t/9
//2. PID# 25-3<P?- ol7-()
FILL IN THE BLANKS
1. Estimated length of water service ~O
feet.
2. Size of water service
/" inch(es).
3. Location of any couplings from structure
feet.
4. Type of sewer pipe. ABS
PVC J('
Cast Iron
5. Estimated length of sewer line
so
feet.
6. Clean out (if required), located at
structure.
feet
from
==================================================================
This apP1i~atio_~.f~C::;~I)tt~ .'Y9,,;r permit when approved.
BY ,{:0- ;,:1, ..., DATE: q /3('}/91
==================================================================
FEES:
s
s
s
35.00
.50
35.50
Sewer and water line connection permit.
Surcharge
TOTAL
* Fee for either sewer or water individually is st'.50 plus
S .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 0 '\j~\-<~i'::I:~
REC I D BY ~~\ ,~0 ft::.
. '0\)\\-"'\'
4629 Dakota SI. S.E.. Prior Lake. Minnesota 55372 / Ph. (612) 4474230 / Fax (612) 447-4245
AN EQUAL OPPORTUNITY EMPLOYER
--..-- --_..-~._."~.
~~
\31 HEATING APPLICATION I PERMIT
Dale II-II-qq PIC' 25~ 34'7- 017-0
Sill Addr~ss 4'7'''8 +lu.mmm~h/~ Ii- N,r~ K: I
Lot L BIodI.3 Mdilion. k()()h HJ)/ Jrri.
O'N~er'. ~la"'l. iifiitj,(jl'ft1rti. j.Jm J
AddIOSl~{) PiN. ~& a tJ(J/( VoiJ.Lu" YYJN :J5/tJ,f
Healing Co~~ltlo(.1KiJdnb' IIt/Jh ....fI:::ki Residenl~al. Addilions a. Alt91allona
1L-I85 IIA. A Am' /lA /) L I '"j. ..J- e;'''V;}. (J Resldenl,al. AC Only
Add,e" ,.01 l/K/VUlW'J'-'f aJllM 1YJ~mtflU7u flJtI U<AftI (
TIlephone' ,(o51-tfd.3-tf'J,,1 V' Remember 10 add the Stal. Sultha.ge en Ihe IKlltom ollhlaappllcalicn.
Fumace Makl l Model ~~-Jh(J TIPE OF SYSTEM
. f' '
Warlll f>Jt Planll
Grovlly .
Mechllllcal tirn-..4 Af'
Ai Condilleni.... .-
VenL SYSIIlll .
HEAliNG OR POWER PLANT
Steam
Hel Waler
Radiation
Speci.. Ol.ices
..
o
~
...., 'v. "11""". - --..... Me
16200 EIgl. Creell Av. S.E. Per... No. Cf?-- 9t.C::i
Prior Llh., MN 55371 " ' /
Modol 511.
1M f)nO
COlln.Load
Fuol Nntl'm C Flu. Sin
::> rr
Supply Oponlng!
~D
III
7'/ M/J
Rllurn Openl"lll
Inpul JM,fjJO Oulp....
Edr.
Clm.
~
O'he, Devic es
...
...
..,
o
Ahratlonl
TIPE OF WORK
~
ElL Cpmp, Oal. ,
. Replac.m.nI New Conewcllon
Rlpalr
Esl. Coli .
HEATING PEIlMIT FEE'
91- 9/f9
/" t'f>,.\O \!'Jli'-'
\ eU\\.OII'lG I: -'
p.ecap"
Bu~dlng PllmJ .
CJt?50
'"
'"
"
..
...
"
...
...
STATE SURClW\GE .
roT AI.. FErJ.aT FEES .
.50
J!m,tflJ
. .......: f," ~IN'~. ,1t4H-
Singl. Family
~"'Family
MulU-FlII1i1y
Olh.,
Commerd
Induskial
pubrlC
Foe Scheduto
ImJuslrial, Commercial &. MulIi-Family
ReS1denli.~ flealing'& fIC
R.s:den'i.l, Healing Only
l\eside~lial. G~s Firepl.ce
I~. 01 job cosl 1'J9.50 minimum)
599.50
$64,50
SJ9.50
SJ9.5O
S~9.50
The price 01 your healing pelmit Includes on. rough-in and on.llnal inspG<:lkIn.
Additionallnspeclien. will be biKed al $35.00 81th.
House Heating Tesl Reco,d must be slbmillod with "',.Wo"llI!IIIl O""'~P' bolo/. bu~ct-
ing ce.lIticale 01 occupancy will b. Issued. .
l!EAI r.A1 r.UI AllOtolll qFf\I 1I11J:n, w~h ..,mbel 01 supply and relum op.n1ngt nslecl p.
room wi'h CFM's pSl.<'penmg. NIW s'ruelule, 01 addillollll send 0001 plan w'lh supply
and retuln lceallon. 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 business houri ... 8 I.m. - 4~:JO p.m.
ALL WORK MUST BE INSPECTED (ROUGH-IN AND RNAL)- CALL CITY HALL
447 ...n8
I herlby Ipply 101 a m.chanlcll sw,teml pllmll Ind I Icknowledg.lhlllh.
inlormallon abo.. II compl.,. .nd accurat.; Ih.1 th. wol1l will b. In co~rormlnce
with Ih. erdln.nceI and cod.. ollhl elly Ind wllh Ihl 1,.1. bundlngfmechlnlClI
code.; Ihlllhl. lelm do.. not b.eom. I pllmll unlll signed br lh. BUILDINO
OFFIt:IAJ.;...lt!lllh. work wlll b. In Icco,d.nc. with "'. Ippro..d pllllln III.
c....Afl1l wl\lk which r.qulr....rCiiI.'" anIl opproval el pl.n..
,\
-- /1-//-91
Dal.
I ( lis-he;
c...
.1'-
A~UII 0
3'Fo\I C::ic.>fl S;plIn
/
,
10/21/99 THU 13:14 FAX 6124474245
u
l4i 01
CITY OF PRIOR LAKE
Phon'"
I. Blut" fi~
2. Geld City ~
# ~;I~W9,r\U
CITY OF PRIOR LAKE
PLUMBING PERMIT
. . . J ,
Applicant", VA I.A_.E,! PLU!':1(31 AI~_
Address: - ". .. H . ~__ ..
Signature: . /' ~ /?.//, /J?r::4 /7 ,'), ./
Legal Description: Lot 2. Block.:3 Sun KNOB HI"-"--' 3teO
SileAddress:, .tI59f3 ~UHMINt'5d?/R..o 7"12... /II
Building Permit # qq- q~ PJD# 25-:344- 017-0
NOTE: This permit will not be processed without complete information.
,,., ("'tlIU It' lhe' I...., C'nu".r~
Quantity
?:
)
I
~
/
/
/
.::S
Type of Fixture
FIXTURE UNITS
Bath Tub with or without shower
Dishwasher
Floor Drain
Lavatory (bathroom sink)
Laundry Tray (1 or 2 compartment sink)
Shower Stall
Sinks
Bar Sink
Water Closet (toilet)
FEE SCHEDULE
Industriel. Commercial & Multi-Family
(1 % of job cost, $39.50 minimum)
Residential, New One & Two Family
Residential, Additions & Alterations
State Surcharge
Quantity
Type of Fixture
,-;::;;
/
Rough-ins
Water Heater
Water Sollner
I
Stand Pipe (washing machine)
Sewage Ejector
Backflow Assembly (RPZ, Double Check, PVB)
Backflow Assembly Test
Lawn Sprinkler
Other
$99.50
$39.50
$
$
$
$
.50
GRAND TOTAL
~/ I:)AlnWITH
lBUILDING PEi'iMIT
Thi:l permit is granted upon lhe express condition lhat said
contractor. shall comply in all rc.'pccl. Wilh the ordiMncc.
or the St:ttc Plumbi~'ng C eand the amen mcnls thereof.
- 1lF. :Jri>'lt!; _ /I Z4 q DATE
IL.AJ Ikp n- ^' TTEST
Call for all jns~ections 24 hours in advance.
16200 Eagle Creek Av. S.E., Prior Lake, Minnesota 55372/ Ph. (612) 447-4230/ FAX (612) 447-4245
An Equ<1l Opportunity Employer
'"
.
II
"
.Permit#
~Job Add,... 'I59? ~c;._I1,h-I
'H..ting Cont",cto< METRC)AIR
'T.,'.r>/Sign.Me I /
.Gas Une
Pressurized
Inspected
.. Percent CO2
"Plncent ~
Final Inspection
Q!!!
~
Pounds
f!!!!!!!!
PERFORMANCE TEST
~( 76(0
7./'1rJ
'Percent co 0 c/e;
'Stack Temp. ,;2;2. 7""
Dote
"
CITY OF PRIOR LAKE
16200 Eagle Creek Av. S.E. P.rma No.'\. 'I, ,,'\ <\
Prior LaIce, MN 55372
HEAnNG APPLICATION I PERMIT
...
n.: Dal8 \- ~ ~u PIO# 25-3t..jq- eJ/7-0
SiIa Address _'-\ S9 ~ r\",V'1""'; 11 ~h'- r~ . IC /
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~ lo1 ~ .BIOck..l Addillon _ k Y\ ~ \-\ I \ \ -
g Owner'sNarne. \..1~"c\.W\}(',J.. Lo~Y-'
Address r~ '6)b :l."'~~\ ~](Jph \J"'\\tv
Helllill9Corllfaclor .~~ {~ ~\,.... 'TY"\\.-
Addr.... \\n~~("" \.k\tON.~Vl "Pr; l.J'"'~l1)C~d
TeJepllonU . LI,"\I- ~ \:l~
Furnace Make & Model \.Il.. 'lV\ Q)(
ModelSIza .G- ':) c ~ -.,/ \J.' \ 0 C\
Conn. load \.0 \ "'\ 110
Fuel N l.\" FIU~ Size 'S fJ
Supply Openings _ \ 1
Rtlum Openlngs .1
~ Input \ tl t)_ \\~ Output ~ \ . ~
IT
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W
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TYPE OF SYSTEM
Warm Air Plants X
Gravity
~c:al
Air CondftiGning x
VenL System
HEAnNGOR POWER PLANT
Sl8am
Hol Waler
Radilllion
Special Devices .
Edr.
CIm"
\ :;- d- .\;)
Other Devices
lYPE Of WORK
~.
E
"- Altendlons
en
Lf)
OJ , Repair .'
....
Rep!al:ement New Consl",cllon
Eat Comp. DlIl8
~ <<to,
Rulldj.... Permh It
TYPE OF STRUCTIJRE
1.1'lIIk
'1. .....
3.. YdltIW
~
CiIy
Coo_..
Single Family X
CO!T\1IWlreiel,
Twc>-Famlly
lndustriel
Multl-Famny
Public Other
Fee Schedule
Indlli1rial. Commercial & Muni-Famlly
Residential, Heating & AC
Residential, Heeling Only
Residential, Gas Fireplace
Residential, Addlions & AII.rations
Residential, AC Only
l%Oljolm:~J
E: lirl.! .S ...~.~~ 2~
$39.50 : \ \
$39.50 J U
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Remember III add Ihe Slale Sun:harge on tile bottom of !his application.
The price of YIlur healing permit includes one rough-in and one linal inspection.
Additional inspections will be biflecl al $35.00 each.
House Healing Test Record must be eubmltledw~h ""r!"!"" IW!llil numb." before buDd-
ing certilk:ala 01 occupancy will be issuecl.
.l:lfAI CAtr.lJI AT!nN~ "''''!'I "'l~ wfth number 01 supply and retum openings "sled per
room witII CFM'e per opening. New structures or additions send floor plan with" supply
and retum loclIIions shown. HEAT LOSS CALCULATIONS, PAYMENT AND
APPLICATIONS MAY BE MAILED TO THE CITY OF PRIOR lAKE, 16200 EAGLE
CREEK-AVE. S.E. PAl OR lAKE, MN 55372.
City HsIll!vslnees hours are 8 ILm. - 4:30 p.m.
ALL WORK MUST BE INSPECTED (ROUGH-IN AND FINAL). CALL CITY HALL
447-4238
I hereby apply for a mechanical syetems permn and I acknowledge thai the
information abow Is complele and accllrate; lIlallhe work will be In conformance .
with ilia ordinsncee end code. ollbe cily II!Id whlllhe lIIale building/mechanical
codes; that Illls form does not become a pa~" Ilntil signed by the BUILDING
OFFICIAL; thaI the work will be in accordance willi tile approved plan in the .
cue of all work which requires review and approval 01 plans.
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B)?fi'g 0IIIc:aJ'e Signalure
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I Ilale
PRIOR LAKE
INSPECTION RECORD
DEPARTMENT OF
BUILDING AND INSPECTION
SITE ADDRESS 45"'1 pi) l41,)""'1M;~ ~""J -t- .
NATURE OF WORK .1b..~ ('''''h~ ~
USE OF BUILDING
PERMIT NO. of? -1c(~ DATE ISSUED '0 {f"....qq
CONTRACTOR 1.J",."ow~..Q. ~ '
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
IN~R
I FOUNDATION {Prior to BaCkfill)~" I \9x lo-tt~ I
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
I SEWER I WATER I SEPTIC ( AJ) ~ tR q ~-;;/
FRAMING vJ f,~ I ) -
INSULATION J>.sl"lT. (![/ 2./../0". ~{)
ELECTRICAL v
PLUMBING 1/ IS ~ /1111" <7J; 1f*IIJV
HEATING (if required) ~ /111/44
FIREPLACE I
GAS LINE AIR TEST I frl4V //;1#0
\ DATE
I FOOTING
I .. 1.'\ ItQ
I i~~).Jflr
1 ~- ~ ;JSt;&m
I~.
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
! \., I I
FINALS
~ 7-/2' 00
GRADING (Prior to Sodding)
BUILDING ,--;co 2' ~/oo
ELECTRICAL
PLUMBING
HEATING
DO NOT 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 been approved. On buildings and additions
where no service cabinet is available, card shall be placed near main entrance.
~ :$/~/uv
Call between 8:00 and 9:00 A.M. for all inspections
FOR ALL INSPECTIONS (612) 447-9850
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