HomeMy WebLinkAboutBuilding Permit 99-1007
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.i~i CITY OF PRIOR LAKE .- .
Ii ..~~ i :l1lepartment of Jiuilbing Jn~pection
~:' i pinal Permitted 0 Conditional C.O. Expires
~ -f II This Cenijicate issued pursuant to the requirements of Section 307 of the Uniform Building Code
;. I c~nifying that at the time of issuanc~ this structu~e was in compliance with the various ordinances of the
':~I City of Pnor Lake regulallng bUlldmg construcllon or use. For the folloWing:
~~ SINGLE FAMILY 99-1007
_.':J<:',r"
Use Classificatior
Bldg. Permit No
Occupancy Type
R3
VN
N/A
R1
Type Construction
Fire Zone
Zoning District
Legal Description
L8, B2, KNOB HILL 2ND ADDITION
4523 HUMMINGBIRD TRAIL
Owner of Building
c:,itc Address
17021 FIS~ POINT RD.. PRIOR LAKE, MN 55372
\
,
Contractor', Name '" Addre,' KEYLAND !lOMES,
ROBERT D. HUTCHINS m,
K'/J"9i~~ia1
I
Dale:
'':ity Planner
JENNI TOVAR
Date:
\
, ,
~ TIME
.;ITV OF PRIOR LAKE q~G'i tel : CIt:l
INSPECTION NOTICE SCHEDULED
ADORESS 4523 H~L~ lit.......
v
OWNER CONTR.
PHONE NO. PERMIT NO. '1Q- {O67
o FOOTING 0 PLUMBING RI
o FOUNDATION ~CHRI
o FRAMING ATER HOOKUP
o INSULATION SEWER HOOKUP
o FINAL 0 PLUMBING FINAL
o SITE INSPECTION 0 MECH FINAL
COMMENTS: :?4' ,?lIe ~
-
{ If --- 'fv"
-~ / {II' f'8A (l.{41-~""'" ......
, C( 0,. '(j
/7_ I (?-"{~ """- ~.... ~
(/j) 4Jo-d.- .Ad..! , ~
~ ,
~. ~6: <'I.. /~ /J..&.-t..
~ ~ N~~~""
" "
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
L/~,~ 4
~
'l/~
".........J, S"~ ~
-4
r-
~. .... e..... ~ /1..:f- ~
-
/
L SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT W?l.K'. CALL FOR REINSPECTION BEFORE COVERING
Inspector: 6. Owner/Contr:
/
CALL 447..9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
INSNOTl
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
I I, I I ---r-----,----
I I
, ,
11'1 I
..ITV OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
L/52-3
OWNER
PHONE NO.
DATE TIME
SCHEDULED /~/.::;S/c;<j /3()
j-'k'/JI"1! /VG,D//00
CONTR.
PERMIT NO.
19- /007
o FOOTING 0 PLUMBING RI 0 EXlGRADIFILLING
o FOUNDATION 0 MECH RI 0 COMPLAINT
o FRAMING 0 WATER HOOKUP 0 FIREPLACE RI
~NSULA~I 0 SEWER HO~OUP 0 FIREPLACE FINAL
FINAL f"( II(PLUMBING FIN 0 GASLlNE AIR TST
o SITE IN TION )iCMECH FINA ~ -
COMMENTS: ,_ t&llPt5fI-60 'rfJ 6~r
r+A~ G:rCtd6fJ b~s ,No-rlJS~
2. (J,'(y #fvsr ~ /I'~t-~
.)- .t<~~s ~'^'<5-~
4. e-/Uo. S{ON~
5. s: cu ~ ttze;C;S
Cb - ~ (<j;L- ,r fivc-?(2.-- \ I &1-- ~ JeAL.-
,
J
vr A-~
I
,
W~ JP/y.
Tl6IY\P
c..u -m
I I
~/l/tJO
. L
o WORK SATISFACTORY. PROCEED
~ORRECT ACTIO(I . 'ND PROCEED
/0 CORRECT vr?K, b \~L FOR REINSPECTION BEFORE COVERING
Inspector: rL i ~ Owner/Contr:
. l
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY/
INSNOTl
I I
, ,
CITV OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
'-/52-3
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
.l!1 FINAL
(ci SITE INSPECTION
COMMENTS:
>- SCHEDULED
DATE
~/;)-~/ tnJ
~,
TIME
A:r:
~/wJ)
CONTR.
PERMIT NO. 99-/007
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
G"o ~ iA.u.-
---
. ~ (~~ '?rh
c~~~
~
-
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o G.b.SLlNE AIR TST
o 5."r;
--- P~.2-
----
~~~.
~
-
~ORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
:S:::O~ECT W~L~ FOR REINS:~::,::n::FORE COVERING
/
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYl
I II
INSNOTI
I I
&~~
.l2AIC C1Fr.r=l\lE,Q
8/ f3/99
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
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
45Z~ \..I,Lll\^.t.\\tJ t..'l:.\~ 1"~\L
3. LEGAL DESCRIPTION
8>
LOT
BLOCK
~~ 1.l.\\..L ?.~
ADDITION
4. OWNER
(Name)
5. ARCHITECT
(Name)
6. BUILDER
(Name)
I. White
2. Pink
3. Yellow
File
City
Applicant
Permit No.
qq-IOO/
1. DATE
8-\\-'11
.€A
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(He.!g9t) (Widlh~
Z"t t'..Z
12. NO. OF STORIES
Z
(D"",,)
35."
z,
PID 2.&:; - p,tj..Cf - ()/ t/-- ()
(Tel. No.)
13. TYPE OF CONSTRUCTION
gF?\~'-
14. FLOOR AREA APPORTIONMENT USE
~~\:) ~~~ \702\ 'F\S\-\ f't>l~\~. ~
7. TYPE OF WORK Fireplace 0
New ConstructiOn,,: Alterations D
Chimney 0 Misc.
18. PROPERTY AREA OR ACRES 19. PROPEA~ DIMENSIONS. 110. CULVERT SIZE
Sq. Ft. \ Z. o4D Width 9C. Depth \40 Yes No
\
I hereby certify that I have furnished information on this application which is to the best of my knowledge true and correct. I also certify that I am the owner or authorized agent for
the above mentioned property and that all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the
building O~I r1 revj}e this permit for just cause. Furthermore. I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X _"OK -"-~ If:6~ ""-11- '11
Signature License No. Date
(Address)
(Address)
(Address)
SepticLl
Addition LI
OeckLl
Finish Attic LI
Re-roofing LI Porch LI
Ae-siding LI Finish Basement LI
16. PROJECT COSTNALUE
(Tel. No.)
(Tel. No.)
15. NUMBER OF OCCUPANTS OR SEATS
440-'1400
OCCUPANTS
SEATS
17. COMPLETION DATE
\ HB~11
SETBACKS: Required
Actual
Front
BUILDING DEPAATMENTVALUATION
USE OF BUILDING
sFn
TYPE OF CONSlRUCTlON: I II III IV V
Occupancy Group A B E F HIM A
Division 1 2 3 4
Permit Fee ................................... $
Plan Check Fee ............................. $
State Surcharge ............................. $
Penalty ....................................... $
Plumbing Permn Fee ...Jr..~/~1... $
Mechanical Permit Fee ...r.r:..:l{??~.." $
Sewer & Water Permit ...r'l.~.(f!2.7... $
e Permit ...'If.:.!m..1.. $
Issued
I II
FOR ADMINISTRATIVE USE
Back
Side
WaterTowerFee ........................... $
Water Tap ................................... ,t
Buitders Deposit ............................ $ / ,50? _ c0
.
Other ......................................... ~
Total Due .............................. $ 1 t:;4B. 2...\_
Paid 7S-4Rj v/ Receipt No. 3(j,fJ74-
Date 111/ f ., By 1.La __
st in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed J{re~e~ThiS document when
nstitutes a temporary Certificate 0 Zoni 9 compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be issued.
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
I ~'1..a=~~
S U
City:
1C'l,?7..5""
(."le. ,'H..
{011 . 50
lov.t')G
(PS . t!H7
sC:;-.~n
40. r'J/J
~ .otq
~'"f
ermit W..Ilen .&ewved. t2
Date ~,Z-c,-97
MATERIAL FILED WITH APPLICATION
Side
SOIL TESTS
o
LI ENERGY DATA
PILING LOGS LI PERCOLATION TESTS 0
PLANS & SPECS LI
SURVEY 0
SETS
COPIES
PLOT PLAN
o
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
Pressure Reducer ..,,~~............... :
Meter Hom ............"...... .... ........... ~
Water Meter .....~....................... $
Sewer & Water Connection Fee ........... ~
~r;(').~
/ ~ SC> .I!>O
W;.i".n'":J
( 2b.e~
I. '2." O.t94'
'7DI':>.00
24 hour notice for all inspections 447-9850
Special Conditions n any
",' ,-;af-.".,~ . .~
,-.--_,...v~~..,~...- -..~'_
~---". ",;<t'.; ~ ~'l"lP!'
r;;;:lI!lil!l';,
8Ia-i~> ,~~J-i. ~ '." ..:-
~'I'l!
:~~x PR/0-\,,;,,
,I:: ~
- '"
"u
(';' r j r , .'7'
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Tht ('"nIt( of lh" bb Country
White - Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTME~T CHECKLIST
NAME OF APPLICANT.
APPLICATION RECEIVED
/ ,..,__-1
... l I
/
/l,-/r'~ j ':_'''-''''-_
/-
,'-;' J I . /
'-- ,I'
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
"r~'- ;;.>
_.:- ,J ..;~.__ ".~_'
L
! / \,
,,', ,
l.._.' ,/ /. .-~: / ......./'.
/' J,.,"
f<-___ .
Denied
/
. .---t".-....
(L?)1.~
XI c. () nit CMruH
a,..,..onlon With Corrections
Accepted
Reviewed By:
Date:
?{ ---If{, '7}
info 10' Sicltyard,
Comments:
lj1CYlJcc. ch
"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."
._ n....... . ,~~.:
QQ-/CG7
Thr Cr.lrr .r ItH Lab Co......,
White - Building
Canary - Engineering
Pink - Planning
.!lll.lLDING PERMIT APPLICATION DEPARTMENT CHI;:CKLlST
NAME OF APPLICANT
APPLICATION RECEIVED
K 6 l,/ Lrt /'./0 HOt-I b5
B//3/99
, I
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
.4523 /-(U/'1I"1 ( dq 8/ /2'. 0 ~.
Accepted
,/
Accepted With Corrections
Denied
Reviewed By:
. .
IAJAlrF.1l
CMflESMA-AlJtJ
Date:
, I
't,1Z.3IY~
Comments: Ro,JoFF ",,,sr I$/i ~o""6v'EfJ To AAJD IILoAJ~ i:XI./I,,,IOf-E.
,
~
.
Unl-IrV 1="...o._o;E;I1EJUTS A~ Muc'H J4s m,q,nt:..al
c:.rt: tNFen-"\.AT",.......1 D,.,)
"J
RE"ER.........~ 510~ .
'SLt:A"f"T"A(I4.....~...tT.s ~ J. h......Al.. Gn.A-.oF JAlS~G..C.T.o.J J....rF'oll"""'...'1"t:lAJ 7 _ ~I'tACH^'''' PLAN
3. Cn.o......n,.j (" 0 ^'T~:')l- ~..CB.Lu4J."
<I _~,^.J C......,.Il.",- R.AN
"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 II II I
,-.----.
QQ-loo7
Tht' (:rnluof lht L.ke Counll)'
White - Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DePARTMI;NT CI-\ECKLlSI
NAME OF APPLICANT
APPLICATION RECEIVED
/C6YLrJND H0f16S
A / /3 / q 9
I I .
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
4523 HUI'1MII'IG, 8//CD
(~.
Accepted
Accepted With Corrections
>Z-
Denied
Reviewed By: (2 (/;;(A ~-
V - - v
Date: S .2t;....9'i
Comments:
I, eecA JJ. r.A+"'r~ ~J.I'~.fL
"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 I
T ..~--_..".~~~'--_."-~----- ---,--.-,----~-^--".---..-.-- ..---.--.--
1.1'1nk
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CITY OF PRIOR LAKE
16200 EilgleCreekAv. S.E. PetmitNo, tf? ,/()()7
Prior Lake, MN 55372
",-....-.-q
~ OF S.JRUCTURE
Single Family X
Commercial
.-< _ HEATING APPLlCAnON I PERMIT
0.: Date C\-~";;l ~\~ PID' ;;z.5~3<fC1-014--0
CD SitaAddr8llS . \..\ S")."1., \\v;"....,M'wb,\~ \r-u"\ \./ tel
: lot i. Block -.:L Addition. I,:!. ~. ~ (~. I ~ UI.-,
Z Ownet's Name X. Q \~ Iv,,,, ~ \t U \?u) J
Addte. y, G j \~'l.s~ H. aU.. fin \)-. v,II{) .
HeBtingConlracto,\'\ {~ \\,,... ~Y\ "-
Address. '\ \n ~ ~ C"\ '\.{ ~ \ l ()~ ~ v' l V r; IT' \.4 l<.t.
Telephone II . ~ '\1- ~ \ ~~
Fum_Make8.Model (~-r\ \......
Two.Famlly
IndustrIal
Multi-Family
other
Public
Fee Schooule
Induslrial. CommelCial 8. Multi-Fwly
Residential, Healing 8. AC
Residential, Healing Only
Residential, Gas Fireplace
Residential, Additions & Alleralfons
Residential, AC Only
, % 01 job cosl ($39.50 minimum)
$99.50
$64.50
$39.50
$39.50
$39.50
Remember 10 add lhe Slate Surcharge on lhe bottom oIlIlis application,
TYPE OF SYSTEM I
Warm Air Plants )t
GravlIy
Mechanical
Air Conditioning
Vent Syl1em
HEAnNGORPOWER~
Steam
Hat WalIn
Radialian
Spadal Devices
The price at your healing permit Inclucleo one rough-in and one finallnspec\ion.
Additional inspections wi. be bitloo al S35.00 each.
Ho.... Heating Test Reoord mull be aubmitted with """rl....IWIll.iI"""'''''' before bul~
ing cetlificale of occupancy will be issued.
HFAT C:ALC'.IILATIONlll'I"l'llIq"n wllh number of supply and re\um. openlnga Qsted p81
room witI1 CFM's per opening. New structures or eddftions &end floor plan with'supply
and retum locations shown. HEAT LOSS CALCULATIONS. PAYMENT AND
APPUCATtONS MAY BE MAILED TO TI-E CITY OF PRIOR LAKE, 16200 EAGLE
CREEK AVE. S.E. PRIOR LAKE, MN 55372.
City Hall ~ness houJI are 8 a.m. . 4:30 p.m.
All. WORK MUST BE INSPECTED (ROUGH-IN AND FINAL) . CALl. crrv HALL
447-4230
Model Size fAy Cl"'ln
Conn. Load S S") d. \
Fuel ~ ~ -\- Flue Size s: II
Supply Openings \ \0
~
RllIum Openings
~ Input 'j, ~ :t"JS:,
Output "I \ ~ 00
~Edr.
0-
w
:E Clm.
OIher Devices
\ '" '-'~
~~~.~ .
:E I heteby apply lot a mechaM:al syelems permltllnd I acknowledge Ihallhe
9; .AI1eraliDns ReplllCllment NllW Conslruction infotmallon above Is complete and accurate; that the work wlli be in conformence
;: . .- . with the Qrdinances and codes 01 the cJty and with the slllte building/mechanical
~ .R8paIr Est. Comp. D...., cod..; that \his lorm doe. nol become a permll unlil elgnlHl by the BUll-DING
..0; ;,:;,' " ,1. ~ n 1\ OFFICtAL; that Ibe work will be in aCCOtdllnce with lhe approved pllll1ln the.
~Eat.Cost$ '1l<.().a BulldingPermilll. ,,-\- /007 ._ case 01 all wotkwhlch requiresrevlew IlndapplOveI of plane. . . .' . . ~
~~"~PERMITFEE$. / 1'l.'W\N\\~' .',t -~'~" "" '~~'~'T~'~~.~;\:.,~\::' '";> .:t >.~.~"""~'.,.~..-~.., ':-::>
N ',' ."". . . ~ .-"" G '" ,,, .' ~ ..~ - . co!. .'
N".";,...:,' : :,' ..' O\N <.~ . - '. 0-' I . . ". .... ..
o.:'~~1E~RCHARGE $ .50 eU\\.:. '. '," .~~. ,'.' .... ....!.Of::::::-~::.~:~.:
~~~~~~J~,t~~~~~~"'Z::~,i~"~~;:Er,~
09/07/99 Tl~ 07:46 FAX 6126902753
STOCKER EXCAVATING
1aJ001
....... . "'-E
'.u.ow .. oVNc.alfr
GGLZ':I - CIT.,
CITY OF PRIOR LAKE NO. 99-/007
SEWER AND WATER PERMIT
NOTE: Sewer and Water
contractors must
be reqistered
lJith the City.
~
APPLICANT: DC Mechan1cal/Stockllr Excavating PHONE: 890-4241
ADDRESS: 8247 WPfl,25t:h ~(".l~.a!".eft:= ~~'nR DATE: "'(~ :)-1'1
SIGNATURE: 1'., _ _ BLDG. PERMIT II q9- /607
SITE ADDRESS: ~.3 1-lu..,....,ri..,t1~J\{..cI Tr. .e/PIDiI 25-349-0/'-1--0
FILL IN T~E BLANKS
1. Estimated length of water service
feet'.
2. Size of water service
inch(es) .
J. Location of any couplings from structure
feet.
4. Type of sewer pipe. ASS
PVC y
Cast Iron
5. Estimated length of sewer line
feet.
6. Clean out (if required), located at
structure.
feet
from
~--~----===~====~=~===~~========~~~~~==~~~~======================
This ap~5a~ b~~YOUr permit lJhen approved.
BY ~~ . DATE: 9~(,./'17
==JZ==-===___
-----~~==~__________=='=;;;:=a=='_____.______
. . -=----=====
FEES:
$
s
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 ot issuance
to insure that no dup11cate sewer and water permits are
issued. -
DATE PAID
RECEIPT II
AMOUNT PAID. .' / p.l~~~~~ >
REC'D BY '~~tlG~
16200 Eagle Creek Av. S.E.. Prior Lake. Minnesota 553721 Ph. (612) 4474230 I FAX (612) 4474245
An Equal Opponuni<y Employ.r
11,1
Sep-15-99 08:36 D&D MECHANICAL INC_
~
C ITV OF PRIOR LAKE
PLUMBING PERMIT
Applic,ll:: D -f- D rn~e...J+A-t\AcA L Phone:~'1 {!) _ Y~.JlJi'
Addre,;, '7//[ W. /~(.--$f-.: ::iL!-u~tL; 553iJf
Signa:u !: ~... _.::::::;)11 .- __
, /J v..."
Legal I) scription: Lot 2' v Block ~ Sub r-n" 8 if, L L 3 ~ _ ~
Site Ad,ess; 45:?.3 H t.(fYl m ,. "'" b .. r-d T R-. ,e / .
Buildi,,~ "ermil~ qQ - /007 oJ 'pION. 25-3<1'9- 0/4-0
, .
NOTE: 'his permit will not be processed without complete information.
n.. c...... 'If .... t..-kt C'Uln'n
Quantily
z.
I
I
L/
I
2
2-
..3
FIXTURE UNITS
Type l'f i,lure
Quantity
612-890-4650
P_Ol
Bath Tub with or will1' ut shower
Z
I
I U1uc
1. Gold
J, YcIlCl""
file
Cily
Applie:allt
Dishwasher
FI(',,, [It;\\r1
Lavatory (bathroon I: nk)
Laundry Tray (1 or l :ompartmenl sink)
Shower Stall
I
PPNo.
99-/007
Sinks
Bar Sink
Water Closet (toilet)
FEE SCHEDULE
Industrial. Commercial t. Aulli-Family
(1 % 01 job cost, $39.50; nimum)
Residential, New One & wo Family
Residential, Additions & lIerations
Stale Surcharge
$99.50
$39.50
Type 01 Fixture ')
Rough-ins
Water Heater
W,llor;.,'llil"l :1
Stand Pipe (washing machme)
Sewage Ejector
Backflow Assembly (RPZ, Double Check. PV8J
Back flow Assembly Test
lawn Sprinkler
Other
$
$ !L'1,St'J
$
$
e>V\
ad. V- .
r P->~
GRAND TOTAL
.50
:s h'D,O~\~ - ,
~P.\O G f'E?>~tt' .
e\.l\\.o\t~
I S permit is gTanletJ upon lhe ex.press conJilion (hat sauJ
lr:U:lor. !>haJl comply j.n all rc:spects with lhe onJinam:c5
, hc 5,0,e PIU",b;~~Z;::~hC 0~~;J9~cr~~~
/~ ATrE5T
all for all in~ectiolls 24 hoors ill advance.
16200 Eagle Creek Av. S.E.. p, ,r Lake. MinnesOIa 55372 / Ph. (612) 4-+7-.~230 / FA.:\ (612) 4-+/-4:':45
An Equal OppununilY Employer
I ',1 II
CITY OF PRIOR LAKE MC
16200 Eagle Creek Av. S.E. Permit No.
Prior Lake, MN 55372
t;9-loo7
r
HEATING APPLICATION I PERMIT
Dais If ~j..Jh/qq
. " ~
Silo Addross VS:.J. l'
Lol ~ Block
Ownor's Name
PID'~-.34q_ 014-0
;..hP"""':'" ~/'//) A'j /<.1
~ -
Add~ion K"JOB tilL-G 3~
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Address
Healing Conlraclor ALLIED FIRESIDE dba FIRESIDE CORNER
Address. 2 7 00 N, F A I R V I EW. R 0 S EVIL L E. MN 5 5 ) 1 3
Tolepllono' . 651-633-2561
FIREPLACE
~'" Mako & Model }.kd,j lOw
Model Sizs.
Conn. Load
Fual ro6 i
Supply Oponings _
Relurn Openings
Inpul
Edr.
Clm.
Aheralions
Repair
EsI.CoSI$ //{)ul1j
HEATING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEES $_
t,r'l:l;>
TYPE OF SYSTEM
Warm Air Planl.
Gravily.
Mechanical
Air Conditioning .
Von!. Syslem .
Flua Slza
OulpUI ...], rdl
.,
HEATING OR POWER PLANT
Sloam
Hot Watar
Radialion
Spocial Devices
Olllor Davieo.
TYPE OF WORK
Aaplacemonl
'y:J
New Conslruclion
Es!. Comp. Dale
1;-;
_ BuDding Permh . n
-,Q-lo07
t' PAID WITH
.50 I BUILDING PERMIT
Rocoipl , .
.TYPE OF STRUCTURE
I. Ph.
1. Gru-.
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Cif' I
COMIN
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Single Family
Two-Famity
Induslrial
Muhi-Famly
Olher
Commercial
Public
Fee Schedule
...
...
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Induslrlal, Commercial & Mu/li.Family
Residenlial, Healing & AC
Aesidenli.', Healing Only
Residential. Gas Fireplace
Aesldenlial, Addilions & Alleralions
Residential, AC Only
1% of job cosl ($39.50 minimum) "
$99.50
$64.50
$39.50
$39.50
$39.50
....
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nemember 10 add Ihe Stsle Surcharge on the bollom of Ihis applicalion.
The price of your heating permit includes one rough-in and one tina' inspeclion.
Addilional inspeclions will be billed al $35.00 each.
House Healing Tesl Record musl be submilled wilh bJIilgjng I!elIIIiIl!IIlIIIllll befOfe bull
ing certificale 01 occupancy will be issued.
HEAT C.A!&Ul,ATlONS AEOlIlRFn wilh number 01 supply and ralurn openings lisled I
room wilh CFM's per opening. New slruclures or addllions send 1I00r plan wilh supply
and relurn localions shown. HEAT LOSS CALCULATIONS. PAYMENT AND en
APPLICATIONS MAY BE MAILED TO THE CITY OF PRIOR LAKE, 16200 EAGLE 111
CAEEK AVE. S.E. PRIOR LAKE, MN 55372. ...
Cily Hall business hours are 8 a.m. - 4:30 p.m.
en
IN
IN
ALL WORK MUST BE INSPECTED (ROUGH-IN AND FINAL) _ CALL CITY HALL
III
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I hereby apply for a mechanical syslerns permit and I acknowledge Ihallhe ~
informalion above is complete and accurale; that Ihe work will be in conformance
wilh Ihe ordinances and codes of Ihe city and with Ihe stale building/machanica
codes; Ihal Ihis IorIO does not become a permit unlil signed by Ihe BUILDING
OFFICIAL: 1I,al the work will be in accordance with Ihe approved plan in Ihe
case 01 all work which requires review and approval of plans.
447-4230
fZ,J~d 1tJ-.6.n.-
:m!~
rding Ollica!'s Signa Iura
/I /,0;='1
Dala
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IN
--
.
. Permit#
'JobMdr..._~~-;(3 t/t<-ntJ1{':~/;.;d
'He.ting """"acto< METRO AIR
-Teslers/Signature ~ 1..('
.9J!!!
Time
Pounda
Pressure
.Gu Une
Pressurized
Inspected
.Percenl CO2
~ PERFORMANCE TEST
'f11 ;;;? .Pefcent CO
/,,{}
D
'305""
.Percent 02
.Stack Temp.
Final Inspection
Dale
I III II
PRIOR LAKE
INS'PECTION RECORD
DEPARTMENT OF
BUILDING AND INSPECTION
SITE ADDRESS 41::)':2<' l-f()w.w.,',^",h'~ct INl.il
NATURE OF WORK ~l ~. \.5
USE OF BUILDING '31=\\
PERMIT NO. C;q - 100, DATE ISSUED A -25-9:..~
CONTRACTOR /(. Ir....A ~
NOTE: THIS IS Ndt A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
IIJ'H\I!"l.il~1 u..-&
.-
'FOOTING (M J fJ::r, I '1-;0-9'7
I FOUNDATION (Prior to Backfill) ((V 9/;.ft1 I
PLACE NO CONCRETE UN~IL ABOVE HAS BEEN SIGNED
ROUGH - INS
SEWER I WATER I SEPTIC tf~ ~I ~
FRAMING
INSULATION II mil/a!'!
ELECTRICAL ~
PLUMBING Ici) It/;jq.,
HEATING (if required) IClt /o/'2'lh1
FIREPLACE I J)I)/Y~')
GAS LINE AIR TEST I( 1<>/" "'/i 4 I
I ~ IH"I-<J-r F.P.
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I I
FINALS
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f;a., Y: h'J /p G~ ~ 0 I
, f t
Il;-tJ(1.
(11~(M .
,
HAS BEEN SIGNED
INSPECTOR
DATE
9 - rJ,;J '1 c;
".4."4
GRADING (Prior to Sodding)
BUILDING -r u> -(., a-J 11 b1J t W'
ELECTRICAL
PLUMBING
HEATING
DO NOT
OCCUPY UNTIL 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.
Call between 8:00 and 9:00 A.M. for all inspections
FOR ALL INSPECTIONS (612) 447-9850
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