HomeMy WebLinkAboutBuilding Permit 99-1057
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?~.'i. QLtrtificau at ~rmpan..1t ';..' (
~ ~ ~I-'
i~: . CITY OF PRIOR LAKE ';-"'i~
" ~j / lIlrparlmrnlof JIInilbiooJ,nJprttion '.'~. . I
~~.'..~~'; ~ Final Penrutted 0 Conditional C.O. Expires \, } ~!
- This Certificate issued pursuant to the requiremehts of Section 307 of the Uniform Building Code ~'. I
~ ' \:::- . cl!rtifvinfl thnt at thl! tilfU! ofi.n:unnrp thi.~ ...trurturPlwn." in rnmnlinnr,. with th,. tm.,.;nUf! nrrlin"..",.u. nt'th. '~J
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS %/J
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INllllLATION
IIl"FIIIIAL
o SITE INSPECTION
COMMENTS:
Dril/lw'il( 1<
DATE TIME
SCHEDULED
J#
I!UllllHij!,,'/ -J;,
CONTR. -.K'."y ~~-t,
PERMIT NO. '19. /~57
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
~GRAD/FILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
ir1<:.f,., (/..d
\,;(
/~.
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./"
~RK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspeclor
er/Contr
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
II
'-'--"
INSNOTl
ADDRESS
4hlz
DATE TIME
SCHEDULED 1712-1'11 2 :0-0
flVl1/Vl I rJ6f!,/.eo
CITY OF PRIOR LAKE
INSPECTION NOTICE
OWNER
CONTR.
PHONE NO.
PERMIT NO.
19-1057
I
o EXIGRAD/FILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
AD SEWER HOOKUP
I ja"PLUMBING FINAL
I" D-MECH FINAL
qO~~FNTS: r n
'^ )~ ~ t5h...-
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~
Inspector:
Owner/Contr:
ENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
J/VSNOTJ
II
9-1'9-99 7'1')0
4G.1Z- t{u.ItA.MI,jr~&(ft() lR.
. ,
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
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
Il:WATERHOOKUP
)l\ SEWER HOOKUP
'J PLUMBING FINAL
o MECH FINAL
COMMENTS: .g~( ~
.~(WP rl--
~l .....-:- , .1 rl II
. ~D 11/". I- I ~.P~
1'X')1~... ..,~qD~,
DATE TIME
q'1- ID~
o EXIGRAD/FILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
46 - 4f' IJG
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tfJJ) rt~ ~~~ .[.. ~ f ~
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~RK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: 61-( Owner/Contr:
/
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
INSNOTI
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
II
II I
CITY OF PRIOR LAKE
INSPECTION NOTICE
DATE TIME
SCHEDULED ~.3: 00
HUt1MINq BfRO
ADDRESS
L./-h /2..
OWNER
CONTR.
PHONE NO.
'19-/ os 7
PERMIT NO.
o FOOTING 0 PLUMBING RI
o FOUNDATION 0 MECH RI
o FRAMING 0 WATER HOOKUP
P INSULATION 0 SEWER HOOKUP
~FINAL 0 PLUMBING FINAL
o SITE INSPECTION )t! MECI})INAL
COMMENTS: lA-TIc> ~
A l;~ 1~ ~;nev"I~ tk.rd-
(2! S<d ~ -fvIl<.-U. p<... ~ 1TilirlV\tJ
(3) I~ sU.Ak"".,- tir,VLUJn..M
~ Glc~Or i.o~C-V'<.J-~ I
(f,j ~ '\<;; ~t- ~ -tv
W1t~ ~ V~ I?~~
(7}~ ~V\ ~~sk&U- L-rl
~ ".J'w-an:.~ ~I~ deL..."
~
v
o EXIGRAD/FILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
~J ~ OK-
01-L.
f-
{};-
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AZc RE
ORRE
Inspector:
c
uwner/Contr:
CAL .447. 1850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE ~UIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTJ
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS 4 C:, \ '2
OWNER
PHONE NO.
o FOOTING
~FO DATION
o F MING
o SULATION ^
FINAL t-'r
o SITE INSPECTION
SCHEDULED'
DATE TIME
~!i!J ~
'IlL
u~,,",-,y..0l....ol
CONTR.
PERMIT NO.
'1'1 -[657
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EXIGRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
COMMENTS: ^
, \"L (p - J\Q ~~..
~
/"
\
/
LKSATISF
o CORRECT ACT ON
o CORRECT WO
"'...
--
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Inspector: Owner/Contr:
CALL 447.JS50 FOI : THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQ~REMErTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
V INSNOTl
II
---'-','
~~
DATE RECEIVED
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
L White
2. Pink
3. Yellow
File
City
Applicant
8/?s/99
Permit No.
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
1. DATE
t-z'r~.,r
/(1
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(H.~ht) (Wodlh) (Depth)
t,JZ
3. LEGAL DESCRIPTION
(t::.
ADDITION )t".veel
4. OWNER (\'Pm.)
:J4s~ l-K~
5. ARCHITECT (Nam.)
,I):$/'?
--(1,-.
12. NO. OF STORIES
.$
2.5-339- ()3Z.-0
LOT
BLOCK
/..;/ /1 .:t^,.(J .
PID
;:J..".tJ.:1'T7 "'-
13, TYPE OF CONSTRUCTION
(Address)
~ ~/ (..-L
(Address)
(T.1. No.)
~-96' ,Y?
(T.1. No.)
14. FLOOR AREA APPORTIONMENT USE
" ;=OV-V~AI':: u.,..;.
o c. 04A-A- 1
6, BUILDER (Name)
)10.....".,
(Address)
'1:0. /53
.5I'1VA(!iG
(Tel. No.)
G es- -/1(0",/
15. NUMBER OF OCCUPANTS OR SEATS
C l1.tj ...L
OCCUPANTS
SEATS
16. PROJECT COSTNALUE
7, TYPE OF WORK
New Constructio~
Chimney ('l Misc.
8. PROPERTY AREA OR ACRES 9. PROPERTY DIMENSIONS 1 Q. CULVERT SIZE 17, COMPLETION DATE
Sq. Ft. 0'0 Ii' Width 'j D.pth /lr Y.s 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 offlclal can revoke is 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 '~L.- 70, <-t t. ~JV e,-CJ;'-?P
Signature license No. Dale
Fireplace Ll Septic a Deck LI
Alterations 0 Addition 0 Finish Attic 0
Rs-roofing a Porch 0
Re-siding [j Finish Basement 0
/
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
MATERIAL FILED WITH APPLICATION
SOIL TESTS (] ENERGY DATA (]
PILING LOGS LJ PERCOLATION TESTS 0
Front
Back
Side
Side
BUILDING DEPARTMENT VALUATION
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION _135,.600.0 CJ
PLANS & SPECS 0
SURVEY 0
PLOT PLAN 0
SETS
COPIES
s,cn
USE OF BUILDING
TYPE OF CONSTRUCTION: I " 111 IV V
OccupancyGroup A 8 E F HIM R S U
P.nni! F.. ..........~~~~...'...~...~..~... diD 1..>'2. . -;;{ 5"
Plan Ch.cIt F.. ............................. $ C,'} 11~O. ~
Stat. Surcharg. ............................. $ .:r. ~ ~ C, 7.50
Penalty ....................................... $
Plumbing Pennit Fee ..'f?...t0.1...... $
Mechanical P.nni! F.. .1'i:1?J2.7.... $
s.w.r&Wat.rp.nnll...n~.r.q7... $
Gas Fireplace Permit ....................... $
Amount Brought Forward .................. $
Park Support Fee ........ ................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
%" $
Pressure Reducer .....Et................. $
MeterHom........L%.. ....................... $
5' ,.
Water Meter ...... ....................... $
Sewer & Water Connection Fee ........... $
WaterTowerFee ........................... $
Water Tap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
Total Due .............................. $
Paid '75' Receip 0
Oat. '1
in the above application and accompanying documents is In accordance with the City Zoning Qrdi nce and may proceed
a te.n'()Orary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificat
Of -r(;D -!rj S 'Ie d" ,
ale peela on Illons any
City:
ARo.aD
I D S't'l .cO
Lis .06
l OlS. 00
I. :l(')O .00
, '7 {)() . (){)
Loo .()O
I 0() . nO
35.50
~
(I i::;on.DO
This
By
ur 8 '!ding Permit When ApproVedt;
Oat. "'{ -II) - '1
Issued
24 hour notice for all inspections 447.9850
--r---.... --....-"....---'"-----~''"
....
CITY OF PRIOR LAKE
16200 Eagle Creek Av. S.E. Penn" No. If! 9 ~ 1057
Prior Lake, tAN 55372
TYPE OF STRUCTURE
I. A""
2._
3.Y_
l'IIo
CilY
c._
HEAnNG APPLlCAnON I PERMIT
(L Dale \\:')~~5 -"'\.,,\ PIC. 25-339-03Z-0
SfteAddress.'1~\~ \\\..\"",'m'IIl\\o:~~ ,12/
.... ,
~ lDt.JJL Blcck2- Addftlan \(,N;'o \\,'\\ ~1J:l-
2 Owner's Name \) \)(' w u. VI ,,\.\ M..U
Addtess ~ ~ t') l/i)L \ S-;. S <Air ... ~'- '5 t; 1, l:?
HBallng ContraclOt \"\ (. ~ \\\,...."T" ,,"'.
Addl8u. \ \n ~ 'k () '\.l L \ l ON. ~ Y l 1J ,,; IT' \.l.t l<..t,
Telephone It _ ~"I- <1.\:l."\
Fum_Malut&Model (fI,r".: 1-
Model SIze i 'ft V- 0 ~ \::l
Conn. load '5 ~ ""'" ~
Fuel \\f Co\ t- flue Size S II
Supply Openings \$
Relum Openings '6
g: Input ~'b.~ Output I \. IH\\:)
([
~ Edr.
f- \3>> \,V, ~
~ elm.
. .
TYPE OF SYSTEM
Warm Air Planll X
Gravlty
M.chanlcal
All Cond"loning X
Vent Syllam
HEAnNG OR POWER PLANT
Steam
Hill Wa!et
RadIation
SpedBI Devlc8l
OthBr Devm
.-----..
'N.\~<<-\~
_..\V,r~ '{-
'( '<'\\"
."j"v
.
Single Family X
Cornmeroial
Two.FBmily
Induslrial
Multi-family
PuIlIic Olher
Fee Schedule
Indusl,]al, Commoroial & M<Jti.Family
Residential, Healing & AC
Resldenlfel, Healing Only
Residential, Gu Rreplace
Resldentlal, Adr:itions .. Allel'lllions
RBSidentiaf, AC Only
1% 01 job cos! ($39.60 minimum)
$99.50
$64.50
$89.5000f 21_
$39.50
$39.50
Remember to add lhe SlaI8 SUlcha'lle on !he bollom oIlhfs application,
The price 01 ~r heating perm" includes one fough-in and one finalinspecllon.
Addlllofl8llnspecllons will be tJlIled at $35.00 each.
House HeatIng T88I RBCOrd musl be submilled wiI!J .. ~tn!"" llil!Dl1 ~"",,,,,. before build-
ing colllllcale 01 occupancy will be'issued.
.'~.T ~.' r:1" III'ln~!<: A""" 1l!l~1l wMh numbet oI8~1y Btld relum. openiAg& Il&1ed per
mom wIIh CFM'. par opBllIng. New structures Of addiBons ..nd 11001 plan wi\h'BUPply
and relum locaUons shown. HEAT LOSS CALCULATIONS, PAYMENT AND
APPUcATlONS MAY BE MAIlED TO THE CITY OF PRiOR WE, 16200 <=A'" 0::
CREEK'AVE. S.E. PRIOR LAKE, MN 55372.
OREEN - FR.E
YELLOW - AP"-ICAMT
GOLD - CITY'
CITY OF PRIOR LAKE NO. QQ-/057
SEWER AND WATER PERMIT
NOTE: Sewer and Water
contractors must
be registered
with the City.
APPLICANT:
~ r~T0/;J,.
ytf1S ~.lL /b- /J-P-
SIGNATURE: k:-~ ~ it"
SITE ADDRESS: tj.~/1- J./,", ,j~
!I
FILL IN THE BLANKS
PHONE:
DATE:
if7?- ,j-lj /'1
ADDRESS:
9_?-Yl-'l'''?
BLDG. PERMIT # 99-10.57
PID# 25-33q - ()32-o
1. Estimated length of water service
tt<~- feet.
2. Size of water service
I
inch(es) .
3. Location of any couplings from structure - feet.
4. Type of sewer pipe. ABS PVC ~ast Iron
5. Estimated length of sewer line
'IS- feet.
6. Clean out (if required), located at
structure.
feet
from
------------------------------------------------------------------
------------------------------------------------------------------
This applicati~~~~our permit when approved.
BY ::fl:f~ DATE: q~Rj19
===========~=====================================================
FEES:
$
$
$
35.00
.50
35.50
Sewer and water line connection permit.
Surcharge
TOTAL
* Fee for either sewer or water individually is $t1.lro 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.
AMOUNT PAID C:'t:l(l.\"\f'I\1'~: \,'\
.. Jr. ((:--
REC'D BY ''0\)\\..0\\'''-
DATE PAID
RECEIPT #
16200 Eagle Creek Av. S.E., Prior Lake, Minnesota 55372 I Ph. (612) 447-4230 I FAX (612) 447-4245
An Equal Opportunity Employer
...
Tw<t-Family
Industrial
CITY OF PRIOR LAKE
16200 Eagle CrHkAv. S.E, Perm~No. 99-/057
Prior Lake, MN 55372
HEAnNG APPUCATION I PERMIT
Y,-).~ -<\ ~ PIO.25-339-032-0
TYPE OF STRUCTUF\E.
1.Pi.ak.
10.-
J.1_
F.Jc
Cd}
,",,,,.
Single Family X
Commeroi~1
[L Date
,tel
Fee Schedule
!All ....... glU"ri ~ Addition
OWnets Name ~ \:l".- u t\ '"
IndlJStrial, Commeroial & Multi.Family
Residential, Heating & AC
R8Olidential. H8lIling Only
R8Olidential. Gas Fireplace
R9$idential. Ackjilions & Alterations
Residential. AC Only
. Public
Multi.Famlly
Other
1 % 01 job cosl($39.5D minimum)
$99.50
$e4.50
$39.50
$39.50
$39.50
Remember 10 add Ihe Stale Sumhl1l!le on lhe bottom of Ihis application.
The price of your heating pennlllncludes one rough-in and one nnel inspection.
Addltionel inspections will be baled at $35.00 each.
House Heating Test Record must be submi1led with ""11I\1",, IWIIllI """'''~, beIotB bujl~
ing certificate of occ:upancy will be issued.
HEAT r.AI r.11I ATlOIllR RlOfllIIP""l with numbet of supply end retum openings listed per
100m wilh cm.. per opening. New slrUctures or eddiIlcna send ftcct plan witIr .supply
end relum locaticns shown. HEAT LOSS CAlClJLATlONS, PAYMENT AND
APPLlCiUlONS MAY BE MAILED TO THE CITY OF PRIOR LAKE, 16200 EAGLE
CRCEK AVE. 8.E. PRIOR LAKE. MN 55372-
City Hall '!Uelness hows are 8 a.m. . 4:30 p.m.
All. WORK MUST BE INSPECTED (ROUGK-IN AND RNAL) . CALL CJTY HAU
447-4230
I heteby apply lor a mechflnlcal aystems permit and I acknowledge thallhe
information abow ia complete and accu,.'e; lhallhe WQtk will ba In conlarmanoe .
. with tbe ordinancea and codes 01 the city and with the stal~ building/mechanical
EaL Comp. DaI. co~ae; that thill lorm dOH not become a permit until signed i!Y the BUilDING
"_' cIS/ (1 II OFFICIAL; that thlt'WOrk will ba in accordllDce with the approved plan In Ihe
g:i ,Est.. Cos! $ I A\ T\C\/ Building Permhl -, -, - / () 5 7 . ceM 01 all work ~i~~ requires revIew and approval 01 plane. ' . . _ . .'
~"_~llNGP~MITFEE$ . '-O\N1i\-\,\ -vi\~E:'~:;:. .>~ .' ..' 9_:;;~:St'q:c~:::
~~S'[.,A1EilljRCHARGE S .50 ~POP.~NG p\;;....o> . . ',.. /7 . "" ""~lI'1t,s~n ." . ..! .J Dale;: ~.'_ ,':"'.
bjP' '. eU\~. 1\M.br/l J ". '.' 9I'Z.,:?;/'l9.H ':-
'~J~TAL PERMIT FEES S Receipt - , ',~BIikinr; ""'-", ~ ' re ' Dal'e . , .
,_Z',;~X~-".;.'.' ,: .;, ':~i;'./;,;~f,}:i~~~"i.~~~;ti::gi*-~;;;~~:'~,S~: :;~~..:;;!J;:'Y;'~ S't-,i,?~~j~;:.~~~~~;;;ti~,i~" ;;~';-~));r:;,::-..' .';i:~i:~~;'~~~~'
\ S-
Return Openings ~
fl:i Input 'b '& ~ O~put \ \
([
~ Edr.
f-
w
E
TYPE OF SYSTEM
Watm Air Plants X
Gravfty,
Mechanical .
Air Cond~loning
Vent Sys1em
HEATING OR POWER PLANT
Steam,
HoI WatSt
RadillllOll
Special Dsvicee
..x
Supply Openings
~\'\
Clm.,
\ '\ \,\\J
Other Dsvicas
E
[L
\D A~e'a1Ion8
IS) . '
(\J
...
TYPE OF WORK
.~
Repla..mefll
New CoIlS\NCIion .
fHpaJr
99-1(,57
Th~ r..'t'r.' th.. L.k..Cognlry
While - Building
Canary - E:nglneering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
Yo/<( v'VA V CON:::-TT<..
,
B/2S/C;C;
,
The Building. Engineering, and Planning Departments have reviewed the building permit
application for construction ac~ty which is proposed at:
. tJ--{c I Z H (/ /'11"1 I IV q B / k.[) 7J<19 I L-
Accepted
,/
Accepted With Corrections
Denied
Reviewed By: .hHH..TtCJ1 &11"~"'AN,v
Date: 9/9/'9
, ,
Comments: i?....nF'F'
"""11<:"'-
BE:
Co",...f.,vt:l> 1<> 1'1,..,0 tlLoAl(, D<uu;JI/M:_ ~
UrfL I'T' V E4_"r:ME~ A"\ w"L-f..Jc.l-f 04<;'
PtZl4CTlCAL
A
<;OILS
'TIC,,.. r >'14....
BE
RE: Q.ut n..~n
130.{ THE.
'l3VIc..UINC.
.DIZPAA.r"'E"'r
Ar
"-~lS. rLM.e:
pF
""~E F"oo""I.AJ~S INsPttc.r.oQN
l:>...r
Ie -r1l4F-.
rACY 7",../14, rUE:
putlPo<:~
'Bull..bt,o.)b
'5
ovT-StOf[
"'F
T>-iE
~ult...l)l""r". ~.t\_
$E:~
INF"on..M.~TIO...J
o^-' 7"H.f: i~EJEj{s.~ SlOe:.
"Sf;F I'lrro'\C>'\Mf:AlT5: J. p'Al'''_ t.?114JlE ),.,P€eT,orJ J"'F......Ar.oN 2. bI?AO,N(, RA^-'-
]:. ER.oslo^, Cc,..J-rrt.Ol.- M~. tlSIJ R.E..~
cf.. E:'R.OStD,..} CONTlt..oL Pt AN
"The issuance or granting of a permit or approval of plans, specifications and
computations shall hot 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
9'9-/057
The- Ctnltr of Iht L..t Counlry
White - Building
Canary . Engineering
Pink . Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
YOR WAV CON5Tf<-.
8/Z.;/Qq
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
tf-(O I Z 1-1(/ t1 M I IV q B l,e.o 71C/J./ L-
Accepted
Accepted With Corrections ~
Reviewed By:
(t.!{Jc&./ D'te 710~'17
Denied
Comments:
rCY"_O. oil o++rof'l~ 1+c,~,J. CltAiJ::-
"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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White . Building
Canary . Engineering
Pink . Planning
Th.. (...nIUO' lh.. L.k.. Counlry
aUlLDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED.
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The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
(,
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Denied
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Accepted With Corrections
Accepted
Reviewed By:
Comments:
Date:
q -I (j -7'7
"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 jurisdictiqn. Permits
presuming to give authority to violate or cancel the provisions of this code or other
ordinances of the jurisdiction shall not be valid."
..
---------------
....ob Address
.
"TesterslSignature
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Pounds
~
*Gas Une
Pressurized
Inspected
.Percent O2
, PER~?RMANCE TEST
If -r... 'Po",entCO d 7'"
(,4, 'StackTomp.J~l)O
. Percenl C02
Final Inspection
Dale
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II
PRIOR LAKE
.
INSPECTION RE'CORD
DEPARTMENT OF
BUILDING AND INSPECTION
SITE ADDRESS Litol d.. HU\MVV\''^5I,;m~ \}"-' \.
NATURE OF WORK 1\\1'\' \ ~"t.
USE OF BUILDING S\='D
PERMIT NO. '1 q - J OS '1 DATE ISSUED q -/()-1"1
CONTRACTOR 'It'll ,,. \ 1 )r~ .
NOTE: THIS IS NOT A PEAMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
~ INSPECTOR DATE
I FOOTING r!!/ I /ff.;. I <1- OJ;; ~~
I FOUNDATION (Prior to Backfill) l,r C/ '" 0 ~ y I
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
SEWER I WATER I SEPTIC @ I~. i
FRAMING I' )
INSULATION I f(f1J ))/;~ 1
ELECTRICAL I ~
PLUMBING .,1 V)) 1;/ h1
HEATING (if required) i/
FIREPLACE I .
GAS LINE AIR TEST ~ 4//'11 I
COVER NO WORK UNTILL;(BOVE HAS BEEN SIGNED
I I
FINALS
I ~.S-d1J
I (;PI ~/~ <';
I
,~
GRADING (Prior to Sodding)
BUILDING
ELECTRICAL
PLUMBING
HEATING
DO NOT OCCUpy UNTIL ABOV
NOTICE
AS
9-",,'!"~(
" . 8- '~
9'1</.00
I Iy-+tb
BEEN, S \GNED
Th'is card must be posted near an electrical service cabinet prior to rough.in inspections
an:d maintained until all inspections have been approved. On buildings and additions
wl!ere 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
II I
I
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