HomeMy WebLinkAboutPlg Permit 04-0901
CITY OF PRIOR IJAKF, PT,TTMBING PERMIT
REQUEST FOR FINAL
INSPECT19N SENT TO '}'~ L Blue File I PERMIT NO /
HOMEPWNE~ Ol-O~4k i ~:~w ~~~Iicant .000-QO
,lease type or print and si2lut bottom) .' \ I \ \ 1 ,', I"".
. ADDRESS ' ZONING (office use)
59 5S iiuM~ ({)~ {J~~ P</
Date Rec'd
(Phone) "51-'14*1 -119 \.1 '7.
6.5. ~ '7 :J-
,--
APPLICAN1( 1/. /\ (), \. 1. .
(Name) ?l;L'-I-' ~~ ~ (Phone) k:5J--~:lJr,!5 -I ~ ~l)
(Address) ~31o?O D".~~ 4/hO. &'Lt-LlAA-"l) I.../hJl}. _~6/02.3
(Address) ---U-- - {City) (Zip Code)
(Contact person)~ ~ +'-"'_ V ~VJ ~ (Phone) -'::"S/ -3 lL1 ~ -I c:=1l,iO
APPLICANTSlGNATURE ltil/l. ~ _ ~ lM.AUl) DATE f'1,f5tJ /,,"
APPLICANT PLEASE COMPLETE BELOW
Type of Fixture Quantity
Bath Tub with or without shower
Dishwasher
Floor Drain
Lavatory (Bathroom Sink)
Laundry Tray (lor 2 compartment sink
Shower Stall
Sinks
I Bar Sink
I Water Closet (Toilet)
Quantity
Type of Fixture
J
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
Backflow Assembly Test
Lawn Sprinkler
Other
FEE SCHEDULE
Industrial, Commercial & Multi-family 1% of job cost with a $39,50 minimum Residential, New One & Two-Family $99.50
Residential, Additions & Alterations $39.50
Estimated Cost $ r1 t:1r!J ... o-D
Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOT AL PERMIT FEE $
-39. SO
.50
4tJ ,CTO
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
Paid q - f-tj
Date t/ () /
ReCeiP;!7 if G3
By 3- __
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave" S,E., Prior Lake, MN 55372-1714
<$A/c1 ,otJ
AAj--
S7SS- d;/;;;~~ ~lr
df/'- 90/
0"/'- 6,"/ 7~
~ OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDA rlON
o FRAMING
o INSULA rlON
o FINAL
o SirE INSPECTION
DATE
TIME
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
~UMBING FINAL
~ECH FINAL
COMME~: / / /,4' / /
.R:eR' /~ ~ tJ!!.d ~ ~,.-- //f?q. "*~-
, I '
/1 / II-'./' ,,/
,!:::ey/9, e d /[/YP'l4'ce r' #/ C~
/ /'
~ /
A-€ C ~. 0-e ~_
/'
{~J~//
.-... ./ /'
L& ~ 6 {,A.I" /'7c,;>,h
../'7
/-?~
~
/Z///4'4Ce
/ '
w/ /,-/
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
,.,.
7~dT-
./
~/L
.-//' //'
r- ;tV/// L/'
?
C/ /c...
/'
{)I,f..
/'
f.l WORK SATISFACTORY, PROCEED
/
/ 0 CORRECT ACTION AND PROCEED
o CORRECT WORK, CAl-,L FPR,REINSPECTION BEFORE COVERING
i /',:l ,~/
'C 'I
Inspector: / .... .:" Owner/Contr:
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
Ifl/S/IOTJ
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!