HomeMy WebLinkAboutBuilding Permit 03-1257
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
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;lfBl 6n~
Fdt~ w L-f"VUlrdS
(Please ~ or orint and sign at bottom)
ADDRESS
/</.I!O;;J. wdds
, LEGAL DESCRIPTION (office use only)
LOT ZOBLOCK" ADDITION
OWNER
(Name)
(Address)
BUILDER
(Name)
(Contact Name)
(Address)
SCtmtC
, TYPE OF WORK
v~
11-10('
We WILO.s
LFk'1t:U.J J
Shore 1)..-
I'.A-S:
C'Yullt"'v
JD New Construction
D Fireplace
PROJECT COST IV ALUE (excluding land) $
ODeck
o Misc.
DLower Level Finish
I PERMIT N,. 05 -/zE71
$'037.z1
PID25-2 "n, 070. ()
I
90- Jt./7- <{no
5'~ 37:L
I
(Phone) ~ /1m 9d - t.{tJ7- 'If/to
(Phone) '{l1'J1 qQ- 2i./O-o5.;J.7,
I
I
[ JRe-Siding
I. White
2. Pink
3. Yellow
File
City
Applicant
Date Rec' d
..,. iO. 03
ZONING (office use)
PVD
I JUtility Connection
I
I hereby certify that I have furnished information on this application which is to the best of my knowledge true and correct. I also eert fy 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 p oceed in accordance with
submItted plans 1 a~: the budding oVCl can revoke thIS permit for Just cause Furthermore, I hereby agree that the City JffiClal or a designee may
enter upon the prop~ rfnrm7e de~,mjPectlo
W 7-/ Q --03
X ~
SIgnature Contractor's LIcense No I Date
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fQi31o, /3
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I ~~ce~L ~aL?
I
I Permit Valuation
I Permit Fee $
I Platt Check Fee $
I State Surcharge $
I Penalty $
I Plumbing Permit Fee $ \ 00. -
I Mechanical Permit Fee $ \ CO. ...
I Sewer & Water Permit Fee $ 'Z, S. <""0
I Gas Fireplace Permit,Fee $ "I Q. - ,
/1 , A / /
. 7i. ti~ omeSYOprBuildingp~ikz;ved
Building Official 'Da,!,
"Z.?1. 000, - I
liZJ.';~ I
-"22.18 I
II~. 5"0 I
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#
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8'50, -
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ISC'O. -
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 requested. This document
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a eel :ificate of Occupancy must be
"SUe: 1) ( ~,
786~ ;?
(Phone)
,
P ('If)('
kie
IYlN
<i?~ A,lL- r,J fii A.ItN ::n~;J
. I Date Special Conditions, if any I
24 hour notice for all inspections (952) 447.9850, fax (952) 447-4245 I
16200 Eagle Creek Avenue Prior Lake, MN 55372
-_._._.~---- -----------.---,.--------.-----
Planning Director
OPorch
OAddition
ORe-Roofing
DAlteration
I Park Support Fee
I SAC
I Water Meter Size 5/8"; 1";
I Pressure Reducer
I City SAC and WAC
I Water Tower Fee
I Builder's Deposit
I Other ....419 "
I TOTALDUE ~ I(),'OJ
I Paid '!L<.:r~ ./J
I Date ./,( /2,. tJ7
~~
White ' Building
Canary ,Enclineering
~~, Plannin!l:>
Th~ C"oln of Ih.. I.ak.. Counlrl
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLlRT
NAME OF APPLICANT
APPLICATION RECEIVED
f ~ t iV' 1-\ Ie::.. U ~
---;. I ( . C3
The Building, Engineering, and Plannin~ Departments have reviewed the buiJng permit
apPlicatio~~o~onstruction a?t~vity ~hiC~ i~ropos;d at: \ /
I 4- 7 ( Z- lv I L I) _-' \/ / G \ V
Denied
/
g)iJ
,
Accepted With Corrections
Accepted
Reviewed By:
Date:
I /./c,1 3
( I
Comments:
"The issuance or granting of a permit or approval of plans, specifica ons and
computations shall not be construed to be a permit for, or an approval of, any \ iolation 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 codt, or other
ordinances of the jurisdiction shall not be valid."
<-_.m..-t-.._._-_.._~_""____..~_
~~
Th~ ern I.. of thr L.kr {"ounlr,'
(While I BuildiiiCi)
Canary Engineering
Pink Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
e,EN A reD5
/. i 0 _ 03
f
The Building, Engineering, and Planning Departments have reviewed the builc ing permit
apPliCa7~~?otZ:n a\:\?r :t3 SroP\i~ ~ W
Accepted
./
Accepted With Corrections
Denied
Ijj!;~)
Date:
Reviewed By:
Comments:
"/h ok?
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"The issuance or granting of a permit or approval of plans, specific a tions and
computations shall not be construed to be a permit for, or an approval of, any "iolation of
any of the provisions of this code or of any other ordinance of the jurisdictior. Permits
presuming to give authority to violate or cancel the provisions of this COd'l or other
ordinances of the jurisdiction shall not be valid,"
----'-- .._~--.._~_._--.._-, "'--".'---"'-".-,-'-- _._-_.------,~-~~~-- -,----
White. Building
",-a'larv . Enailleer,"!I~
Pink . Planning
ThO' ('..nlt'r Dr Ih..I.."r COUIIlr,'
BUILDING PERMIT APPLICATION DEPARTM~NT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
(-/ E j\/ )\ /(. [) ,0
---, "/' ' 7.
/. f,) _ U--J
The Building, Engineering, and Planning Departments have reviewed the buildi 19 permit
application for construction activity which is proposed at: ,
j'1 I Ii 7 l, \; I L D c: \ / I 1-" \,;'\ /
, l-of-" I \../ ____ - v, .U ,--'" \1 L.....,... V "
Accepted
Denied
x
Accepted With Corrections
Reviewed By:
1Y1H5
9 LilI03
Date:
1
1
1
1
I'
I
1
1
1
See Attachments: I) Grading Plan, 2) Erosion Control Measures 1
Comments:
See Reverse Side for Additional Information!
"The issuance or granting of a permit or approval of plans, specificati )ns and
computations shall not be construed to be a permit for, or an approval of, any vi.)lation 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
----t-----.-.-...-,.-.-"~~---.m
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
L Blue File
2. Gold City
3. Yellow Applicant
I PERMITNp. 3- 1;2,)1
I
ZONING (office"se)
(Please.!"Pc:: or orint and si2ll at bottom)
ADDRESS
/Lf7D?-
WI/tl5
1/;' e' JU.-
LOT
LEGAL DESCRIPTION (office use only)
ADDITION
OWNER
(Name)
(Address)
BLOCK
PID
EJi~
I
1
I
(Phone) ?7/- L/e:. '3 ~ / ,;l;l. "3-
rqR.1'11,,v.o;foTl/ ?JV
(Ciry1' J' Zip Code)
(Phone) ~/:;J. - 9& "J 55 ~ ;ze-
DATE 11<:. - ;;1 tr + 0' "'(
I
(Phone)
?- ?5 3/
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~D
-s:."
<) "" -'>1.- /.7 /> ,
~~;~~ANJ?.e-f" '.,
(Address) 3/ ~
(Contact Person)
"".~e /9" H
~N e 5';
(Address)
/5;// ,~_ u b-e~
~~~
APPLICANT SIGNATURE
I
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Quantity
-'^
/
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APPLICANT PLEASE COMPLETE BELOW
Type of Fixture Quantity
Bath Tub with or without shower
Dishwasher.
I Floor Drain
I Lavatory (Bathroom Sink)
I Laundry Tray (1 or 2 compartment sink
I Shower Stall
I Sinks
I Bar Sink
I Water Closet (Toilet)
/
/
I
Type of Fi~ture
Rough.ins I
Water Heater I
Water Softner I
I Stand Pipe (Washing M~chine)
I Sewage Ejector I
I Backflow Assembly I
I Backflow Assembly TeSt
I Lawn Sprinkler I
CXher I
FEE SCHEDULE
Industrial, Commercial & Multi-family 1% of job cost with a $39.50 minimum Residential. New One & Two-Fami y $99.50
Residential. Additions & Alteration: $39.50
Estimated Cost $
Building Permit #
PLUMBING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
~ tt~
I Paid ~tJ .
I Date ~" ;),il/O~
Receipt roo
By g-,
(Office (lse Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
24 hour notice fnr all inspections (952) 447.9850. fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714
CITY OF PRIOR LAKE
BEATING! AIR CONDITlONINGIFIREPLACE PERMIT
Date Rec'd
1~
21""'" SC'< or erint md oi"" 01 bonom)
ADDRESS
\Ll<1()'d. ~ V~
i~;. ~~. I PERMIT NOCl~~n I
]. Yellow ,lllph~l ~ -l-J
\ ZOfG (offi"''''')
I
LEGAL DESCRIPTlON (office use only)
BLOCK
PID
LOT
AJ.J1.H "ON
OWNER ~
(Narne)cT"""",oA.d/' no.. ~~
(Address) ~J .s Et-rn", Ik. PA'~.-:;/cJ., rnl"1
, ~ "
(phonef1S::> ,LILlI ~ ~'i?'5?0-
c;:s: 1""7.:l
I APPLICffiT. .
(Narne' ~ ,,~\.;_._..cioJ\fi<j D CT--r:^_. +- r-:P . (phone) Ilo3-::.J ~-I$"O I ')
(Ad.h-ess)~;:}\('I \Juo--:~'''' Ut~ i0. ~~J#n M: (\'\("\ ssJ;~
\ (A&s) (j (City). (i/'!' Code)
(Contact person) I-<i, 'S:, ~ro-QK'o'\CI...:J . (phone) --=:IJ,.r3'~1 'S,-7S-)l,.,
. APPLICANT SIGNATURE ..~.:;) J./vn/YI ,,~ DATE d/;:)v,/o'-ll
__ APPLIC~ ~EASE COMPLETE BELOW !
~WCONSTRUCTION OREPLACEMENT o ALTERATIONS 1
FURNACE MAKE AND MODEL FUEL
FLUE SIZE . RETuRN OPENINGS . INPUT OUTPtJT I
TYPE OF SYSTEM mATING OR POWER PLANT I
OWann Air Plants 0 Steam PLEM~E NOTE:
OtiTaYity 0 Hol WaIer Air CO! ditionor Units
o Mcchanicol 0 Radiation Cannot Encroach into
OAir Conditioning 0 Spcciol Devices Requifl d Side Yard
OVen\. Sys\eIIl OOOcrPovi= Setb'clfs
FIREPLACEMAKEANDMODEL~_:f:;:fJ~ ~JVP"2,933 - - I
FEE sCHEDULE
10/. ofjob cost Rc:sidcnlial, Gas Fireplace
S39.50 minimum
$9950 Rosidcntial. Additions &. Altorotions
$64.50 Rosidcntia\, AC Oniy
$3950
IndUStriol, Commercial &. Multi.Family
R<&idcntial, Healin& &. NC (New COIlS!r1lction)
Residential, Heating Only (New Construction)
$39.50
$39.50
Estimated Cost $
Building Permit #
REA UNO PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
S
_so
~~~~
,I)~
, ~'VI'J-
(om,C u.. 081)')
This Application Becomes Your Building Permit When Approved ' Paid
i, MAR I 7~n4
I~ Date
BIl\hliog QIlici2l1 Date" !
\i_,
24 hour notitt ror aD IDspeetions (952) ~:Iaxt';11---4~~ ..._,
161.00 Eagle Creek Menue, Prior Lake, MN 55372
Reeeipt No.
By
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---------.--
.00 Iii
J.::I1(JI~d ::!6_~~~~ ::lUVI'lO.L11V --
.OLOS1C.t9 XVd 0;:t1
t0/9U.0
JAN-12-04 08:52 AM JUDKINS
02/17,'02 WED 11:01 FAX S12HHZU
CITY OF p~tO~ LAKE
651423416'9
P.02
~IJ"'J.
CIlY OF PRIOR LAKE
REA. TING/AIR CONDITIONlNGIFIREPLACE PERMIT
=::s~ PIiDt... m'l_"'\
\ LJ'l 0 L l..J.--'); l c;LL l) \ ' ~J
I.I!GAL IlllSCRIPnON (ollc:t u.. ...y)
LOT BLOCk. ADIlmON
---------.-------
OWNER
(Name)
E' d. ~ O-.tl.. cL
~9,?J I $.0. S:J-o:Lt.- b iL-
(Addres.)
Dste Bee"
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::=. ~~ rPKRMlTNO.D3_~
..v.... ......1 ~ I
1110_-1 ,
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(ph.ono) c,<;'::2.. ~ '1/' 4<(~O .
PiG oeL L_o...i-G I
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~~~SI..A~j.L)\ r'\.A... ~.e..o..;h f'.Or _ (PhOBe) _/oSI. Lfd3~5r;S"1 !
(Address' IS\~~ ~~"2..0~.t lliy....;-'\ ?'()~I.-r'(DuA Is-;D~
'--... ~u) U r(CII)) IJ2'P Code) ,
(COl\Ia=~JQn) l..y~ LL,. ~~d ~ i f-.....J.:.,. (P~) l..LSL. Lj ;;)...31. sr1~ :
IoJ'PLICA1'IT SIONA'I'tm/--.:-L'\ ~ (X au :L.'gATE (J)....I.... /~ )o-O<:? ~ I
. '\, ...-/ ~PLlCANT PLEASE COMPLETE BELOW V I I
~WCONS'fRUcrlON ...---CJREPLAcEMENr o ALTERATIONS 1 !
FURNACl! MAKUND MODEL 0--r--... ~ (;-57 FT..lEI. Na:tu'lA.-i G~ '(
:fLUE SIZE 1Ul'lUJ(N OPENINOS INPUT ~1J OU11'UT ~ ,\f::C2 :
TYPE OF SYSTBM HEATING ORl'OWER PLANT I
PLEAS .; NOTI,
Air C0ll1ltlcmr Valli
CIlIIIOI llIC101lcb IIlra
'bqul!e 1 SIde V'"'
itlbt.c~
I
I
.OWII1IlAir'lanll
OGMIi1l'
tMethlnlcal
I, Con.ullooi~
~..t. 51'S_
8~1lIr
OWllllon
o $po<lal Oowiocs
o 0dI.. De.ices
FIREPLACE MAKE AND MODEL
JEE SCR!.Dt11&
Ind...tJlal, CommrreltJ 81 Multi.FIll\U)I 1'" of jOb 0011 RuldOl\liIJ. 0.. P1"P11C<
139.50 JlliIIi.,lIlln .. .-
Jlo$I4ontlal. Iioclna" NC (Now ea._on) 599.50 RtlidaltiIJ, Addl~cn> &: Allotllions
R'114el1tlal, lI"U'1 Only (N1l\lI CCllJllllcdon) led.SO R1'I14s1ll2.l AC Only
ElIllmotod COlI S
MEA TINO PERMIT FEE
STATE SURC!tAllGI!
TOl'AL PERMIT FEE
(on." u.. 0Il11)
TIIlI AppllCltlOIl DeeQlIItt YQur BulWlslI P&l'1IItl When .....pl'Oy..
"~41... OII1d,1
III.
'*" ~our .011.. lor .11 lup.dio., (9!i1) 6I7oI1!O, hI (751) 61'''2.5
,
....:11011'.',
Sl9.50
S~9.SO
SJ9.l<1
BUU(\ine PerTllk N
s
s
s
PAliJ WiTi-i
.;JILDING PER Mil
",-
-,-
1:-014
f..~~ j L. t) .
,lUCIlpt 'f
sy I
i;'\, ",:,...
- ~--_., ----, - - ~T
PRIOR LAKE
INSP,ECTION RECORD
SITE ADDRESS \4((") 2. W/W~ VICvJ
NATURE OF WORK -:5fl..y_ .~ r"~\~ ~~
USE OF BUILDING <:;.F(;) . / I
PERMIT NO. C23 - /2.57 DATE ISSUED '1 {3D /62., I
CONTRACTOR ~1>v.>A<u\ W L6JM~J " PHONE "lh _ /Ll.fo - e>S"Z!.
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
DEPARTMENT OF
BUILDING AND INSPECTIOI ~
I FOOTING JJ-€4k 0 f:::.. f/ j? I 1t - t7 i
I FOUNDATION (Prior to Backfill) I ~ /~. /'..- I I
PLACE NO CONCRETE UNTIL ABOVE HAS BE:EN SIGrED
/..-L- v'""---,, r?(fl, ROUGH - INS
. SEWER I WATER I SEptiC I i
FRAMING ffl)' I g~) I
INSULATION ~ m. -y~. I I / I
ELECTRICAL " _ _ I I
PLUMBING I/,.s.,~ t?!" / ~/$, p"'" 1/ ~ I '}; / I
HEATING (if required) I I
FIREPLACE I I
GAS LINE AIR TESTI$ ';;" I 6- .1 I
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNEp
LA-Tt+E:: I ~ Y:.Ji1 I I
FINALS ~~ r~
GRADING (Prior to Sodding) N L3 10 Jr.(j </--" - I
BUILDING (JL./:b (V.~ 11-\ I7)W4;;-'~t. ~!.;~ '
ELECTRICAL-
PLUMBING
HEATING
DO NOT OCCUpy
-iIlSPECTOR .
DA"E
I
I
UNTIL ABOVE
NOTICE
flit" 07/61
;t(..J ~~ ~,.
HAS BEEN SIGNED
,
This card must be posted near an electrical service cabinet prior to rough-in inspec,tions
and maintained until all inspections have been approved. On buildings and add tions
where no service cabinet is available, card shall be placed near main entrance.
FOR ALL INSPECTIONS (952) 447-9850
"---r----.--~--~------"---
~~rfifitaf~ of @ttupant1!
CITY OF PRIOR LAKE
~tparftttl~uf of ~uilMug Jfuspedillu
{!Final Permitted D Conditional C.O. Expires
This Certificate issued pursuant to the requirements of Section 307 of the Unifonn Building Code Cel tifying
that at the time of issuance this structure was in compliance with the various ordinances of the City q ~Prior
Lake regulating building construction or use. For the following:
Occupancy Type
R3
Type ConsbUction
SINGLE FAMILY
VN
Fire Zone
Bldg. Permit Nn
N/A
Zoning District
03-1257
pub
I
I
LkKE.
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Use Classification
Legal Description
L20, B6, THE WILDS
Owner of Bui1din~
Site Address 14702 WILDS VIEW
Contractor's Name & Address EDWARD W. LE~S,
R. O~RT D/. HUTCHINS.. ,,1(
!E /.," ~ilding Official / /
Date: </; --~/ /e'" / _ Date:
. POST IN CONSPICUOUS PLACE
2831 SOUTH SHORE DRIVE, PRIOR
City Planner
DON RYE
CITY OF PRIOR LAKE
INSPECTION NonCE
SCHEDULED
ADDRESS Bl"2 W,rlJs l/.'e..J
OWNER
CONTR.
PHONE NO.
PERMIT NO.
DATE TIME
'Y20-o{
'5-/257
o FOOTING 0 PLUMBING RI
o FOUNDATION 0 MECH RI
o FRAMING 0 WATER HOOKUP
o INSULATION 0 SEWER HOOKUP
o FINAL ~ PLUMBING FINAL
o SITE INSPECTION r MECH FINAL
COMMENTS:
ot~ort~. Dt-lIJ,J) Mo., 2q Dt~_R"1J U.....
~f.:"",Q o,~_ l\.\...~d.,.cJ'V\ h~o~ ~~O '
b/(<. ~ +- T~e.~ _ ~
iI. '&tu'""t-Ck~ t'~\
~' ~";.A~_' \, -:<'~ <.b..+," .
L.J111#4 lVeO
t/~ J=;"l".Q ~1)r''-'
o ..i' ()
~
\
~1- ~~,-~_
~ -I - ()'-{
o EXIGRADIFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
o WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
'1 CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
II~pector: Owner/Contr:
THE NEXT INSPECTION 24 HOURS IN ADVANCE.
INSNOTI
'MENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY/
CITY OF PRIOR LAKE
INSPECTION NOTICE
ff nME
SCHEDULED 0 CI('
~H~c, V..~
ADDRESS 14707.
OWNER
CONTR.
PHONE NO.
PERMIT NO.
'-1207
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
.. FINAL
h SITE INSPECTION
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
!;~~IRTST
COMMENTS:
OK .lc. rJ~ SL rIPu J '!J' ()
.:.-,
NO PROCEED
L FOR RElNSPECTION BEFORE COVERING
Owner/Cont~
o FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
tIWOTI
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS I L( 7 {J 7
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
SCHEDULED I~~ATE
iJ,./Js \/;~
nME
CONTR.
/
J/ J2r;-
I
PERMIT NO.
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EXIGRADIFILLING
o COMPLAINT
o FIREPLACE RJ
o FIREPLACE FINAL
o GAS LINE AIR TST
o
COft,tMENTS: _ . /!.
It(y? (j;)'rk-f:,.J--k1l1 f~~
2. Gx-i i.J. ~ /1"u ~ J.-
,
o WORK SATISFACTORY. PROCEED
o CORRECT ACTION AND PROCEED
fCORrfC r WORK. CALL FOR REINSPECTION BEFORE COVERING
Inspect .r: . Owner/Contr:
I
C 7-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE,
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY/
--_._~_.'~..."'-_._~---'.._"- ---
INSNO"
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
[J ~LATION
~INAL
o SITE INSPECTION
COMMENTS:
SCHEDULED
DA. TE TIME
/4702- /NIL-OS VIEW
CONTR.
PERMIT NO.
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
,<;'OD /.~
J
3./2.57
o EXIGRADIFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
I
/k'
J / / I) r '\ /
t6' C lrx- Q., fV\...e ll' IF
./
~ORK SATISFACTORY, PROCEED
o CORRECT TION AND PROCEED
o CORREC RK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: . . Owner/Contr:
CALL 7-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE,
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
INSI<<JTI
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ferll ~oy
ADDRESS N70Z-- Vv,'/ds I/;Cc.,/
OWNER CONTR. L~~""d5
PHONE NO. PERMIT NO. (95-1 zf7
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
~AL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
~~LLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
COMMENTS:
(,rt4P4 - (!7 r'
L///b i?..t?JC- (') // _
:i5-;
~RK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL 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" SAFETY!
INSNOTJ
.
'--
CJ~c, IINF:~ (Z ~?
APPI IANQE: PERFnR~ANr.E TF!iI
(Contractor to complete * items)
(Attach to gas line adjacent to regulator)
*Heating Contr~to(~ fIr .A _t..
"Job Address Ilf7tJ7 tv;/d ~ urA.,J
Approved
.Percent C02 -,-.
J
/6
.Permit #
.Percent co ---0
.Stack Temp. 99't:.?
.Percent 02
.Permit #
'JobAddress 1'I7c-2 ~t./I'/rIs (.J,~
Jt.I'Il"-
.Heatlng .......,............r 7
'Testers/Signature
llolo
Iimll
Pounds
!'romlrll
.Gas Line
Pressurized
~ -;:~~
Inspected
.Percent C02
PERFORMANCE TEST
c,.)' 'Percent CO
to
o
?J1~
.Percent 02
.Stack Temp.
Final Inspection
Date
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