HomeMy WebLinkAboutBldg Permit 05-1035
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
A c 0. S~e :v1ain Fii~
(Please type or print and siKJl at bottom)
ADDRESS
J"l'b4 Po.rb.,;t..w LIJ.NW
LOTa.3 BLOCK I
LEGAL DESCRIPTION (office use only)
Date Rec' d
u../}~'~
PERMIT NO. 05, 1035
ADDITION 3~.ff~rS ~ J:"irSt- A~a.: ()^
OWNER
(Name)
BlJ; l t:l er
(Address)
(Phone)
BUILDER
(Company Name) W~SI'-i6^^ ~C'~~S
(Contact Name) ~r'\^: s g SJ,,,<<..:Jtr
(Address) ~U.s B.v~ \J:,,~ ~ lJC'q S" f!1tu.o.. DI""uc... \
ZONING (office use)
p{frJ)
PID d.s"-l{31-0~-O
(Phone) j..!> I - 4...Q.f..- c..eJ 00
(Phone) b. ~ - ~~ q - .., q ~ l.f
S"'; ~L;)..o{); ~~^I MAl SS" J ~~
TYPE OF WORK ~New Construction aQDeck o Porch ORe-Roofing ORe-Siding ~Lower Level Finish II Fireplace
15Addition DAlteration DUtility Connection
CODE: I2I.R.c. DI.B.C.
Type of Construction:
Occupancy Group: A B
Division:
I
E
II
F
I
III IV
H I
2 3
V
M
4
o Misc.
A
R
5
B
S U
PROJECT COST /V ALUE S .JJ 0: Cl.Q.O _ () 1"'1
(excluding land)
I hereby certifY that I have li.lmished mformation on this application which is to the best of my knowledge true and correct. I also celtifY that I am the owner or authonzed 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
:cial<a:~:::p;it f~~~ore. I hereby agree that the City official or a deSig~ee~~~r upon the property to perform nee~d~::~S5"
Signature Contractor's License No. Date
Permit Valuation
Permit Fee
I Plan Check Fee
I State Surcharge
I Penalty
I Plumbing Permit Fee
I Mechanical Permit Fee
Sewer & Water Permit Fee
Gas Fireplace Permit Fee
,,/ ZO,()t!J().OO
$ I (7 .~, t;O
$ 7hZ. 741
$ ft,~. 0 0
$
$
$
$
$
/OtJ.D()
I fJ t'J . l.J "
3$",. 50
tfa 10 0
This Application Becomes Your Building Permit When Approved
~~
Building Ollicial
10 IllJ lOr
~e"
Park Support Fee
SAC
I Water Meter Size 5/8'@
Pressure Reducer
Sewer/Water Connection Fee
Water Tower Fee
Builder's Deposit
Other
TOTAL DUE
#
#
#
#
$-
$ 1'-1 SO. 00
$ 3~~ . 0 0
$ 7C;. 0 D
$1"$00.00
$,OC}<:J.OO
$
$
$ t..r,r,. '1 r
Paid "r ,,, I"H./ Rec~gt No.
Date /4.'1'. ~r By) _
~J@
P J""'+---- I
I
~
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
:~~ '~. ~'" P"~" "-my C~,~". or;''h:'h; md ,nom ro,,~o;oo" See'"Miiln=ktrre m", b.
PlfuIning Director ' I Date Special Conditions, if any
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
/"
... "Ia
('" ~.... .
- .. utq..)
.... ,. . "
r- . ", . "
~'~-~,:,-,-, > '/i'" ,
. f1I6rJ S-/7 /1 (v'A/
q. Z(P.oS-
~flP~ing Departments have reviewed the building permit
.~W'hiCh is proposed at:
fJ/J~VI6 tAl W.
~
Date: / {J - 6..oS
.
"The issuance or granting df6;:p.flrtl'\itor.rQv8l.Qfpfans,. .~.' ..... . a
computations shall not be c. .....,...~..~Of' an approval'.,.......
any of the provisions oltbis .. '... ..' M .f.lnY' Othir ordinance 01 the jUrisdiCtfOri.Nmtls
presuming to give authorily to~... .or canee'. tn. provisions of this code. or Other
ordinances of the juriSdictieA. sl'ial Aotbe valid." .
j. .,
-"
'"
See Main File
White - Building
Canary - Enaineering
C2inJt' - Dlan~
BUILDING PERMIT APPj..ICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
llj6IV'~/'1 rJ ;V'/J
c;. 2fc.6-S-
t'
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
/4/fc4- /YAK-IC-V/6 {/v L-IJ.
Accepted
Accepted With Corrections /'
Denied
Reviewed By: ~ ~
Comments: ftJo ~~D~-a} 4J ~.~ ~
~~~~~,
Date:
IO~~r
, .
See'Vlain File
liThe 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."
See Main File
I'1lIfhitA .. Bul~
Canary . Engineering
Pink . Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKUSI
NAME OF APPLICANT
APPLICATION RECEIVED
W6N~/7 /If'/AJ
C( "Z(p. 05:"
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
/4/(P/f f//I~V/6W W.
Accepted
~
Accepted With Corrections
Denied
Reviewed By:
~~/-
Date:
/a~h,S
I .
Comments:
See Main File
"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."
12/08/2005 THU 10:39 FAX 952 767 1900 GENZ-RYAN
1aI 006/029
CITY OF PRIOR LAKE PLUMBING PERMIT
Date Rec'd
~=R IJjpl('hVY\(l yyj \-1nrv'{S (phone) f d)i4YS.-37t/1
(Address) \ ~q6 p, O\W- Dv, ~+t :;tjj FO Cl (Ii y, I\JlN ry-)(;)';l
J
APPLICANT (1_ n qr-::.
(Name) C1-ttll.- ~iJaVI (phone) ''-.i2-'Url,. (ODO
(Address) 21-00 \N. l-h,'\1(;f 1..3 PxA-t2.Vl~V(!rt> MN ~37
\ I(Ad~) ) (City) (Zip Code)
(Contact Person) ..r_rCAtLJC f) U.i1i f'V'CU\ (phone) q51- llD 1- 11 ~12
.PPUCANTSIGNATURE~'Y ~ DATE \\ !-;Aq 05
. APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity
- i.. Bath Tub with or without shower
: I I Dishwasher
t I Floor Drain
-. t.. I Lavatory (Bathroom Sink)
'/ I Laundry Tray (1 or 2 compartment sink
( I Shower Stall
t. I Sinks
I Bar Sink
I Water Closet (Toilet)
(please tvDe or print and sUm at bouom)
ADDRESS
_!j'2(P~ ~or (Vityy LCU1f_/.
I.,EGAL DESCRIPTION (office use only)
I tOT ~ BLOCK J ADOmON
?
I I
I ,1 --pi
I
I
I
I
I
I
~ = ~~ I PERMIT NO..- IA ,.,.. .
J. Yeltow Appli.... V . 'V~
ZONING (office use)
PID
Type of Fixture
Rough-ins
, Water Heater
I Water Softner
I Stand Pipe (Washing Machine)
I Sewage Ejector
I Backflow Assembly
I Bacldlow Assembly Test
I Lawn Sprinkler
I Other'
.{IJ!..l!iS~.t1J!,DULE
Industrial, Commercial & Multi-family 1% of job cost with a $39.50 minimum Residential, New One & Two-Family $99.50
Residential, Additions & Alterations $39.50
Estimated Cost $
Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
(Offiu Use Only)
This Application Becomes Your Building Permit When Approved
Building Offitlal
Dale
14 hour notice for all inspections (952) 447:.9850, fax (952) 447-4245
! \ [C'o.
. ipaid.
I
PAID WITH
!JU'LDING PERMIT
Receipt No.
IDle 0 9 2005
..,1
By
12/08/2005 THU 10:41 FAX 952 767 1900 GENZ-RYAN
~ 010/029
Date Rec'd
CITY OF PRIOR LAKE
SEWER AND WATER PERMIT
(Please tYDe ortlrint and aim at boaoml
ADDRESS
Hl(p4' I .\){',)f. ~V':-(iv~, lclJ\e,
~: Sw :,.. PERMITNO$:/~
ZONlNG (ofIice use)
--
LEGA T, DESCRIPTION (office use only)
r.:ot 4 BLOCK 1 ADDmON
PID
~=R (1 )fAI)~ I"rryifW'1 \-t()i1~ICS
(Address) l ex Q 5 P I6\ZOu D v, Stc (Xl)
(Address)
(phone)
-fCLQ [1 VI fvl N
(City)
(t6J-. q(f)- 51CCj
55"1).
. -" I r.:l'"
(Zip Code)
I APPLICANT (1_, n me;
(Name) ~(1~1.~ 1l.-0 a [11 (phone) "(Y /2 - 7 1fI- (000
(Address) L 2DO vv. ~~ ^ () J I.~ Bu itll/ S V / lI-G- ~ 7)~3 7-
l. (A~ ~ (City) (Zip Code)
(Contact Person) r'(l \ \ \C \l\~fYY'\(l'\ (phone) qF)2 ~ 7iD 1- I~ ~ 2-
. '?LICANTSIGNA - ~~ .,.L~ DATE III ~Cj !o'-\
. ,
APPLICANT PLEASE COMPLETE BELOW
Size of water service inches.
Location of any couplings from structure feet
Type of sewer pipe. 0 ABC 0 PVC 0 Cast Iron
Estimated length of sewer line feet.
Clean out (if required) located at feet from structure.
.r'EE S\':.l1.I!;DULE
Residential sewer and water line connection $35.50 Industrial, Com'l & Multi-family 1% of job cost with a $39.50 minimwn
Sewer connection only $17.50 Water connection only $17.50
Estimated Cost $
Building Pennit #
SEWER AND W A lER PERMIT FEE
STA TE SURCHARGE
TOTAL PERMIT FEE
$
$
$
,50 PAID WITH
8UtLDING PERMIT
(Office Use Only)
I This Application Becomes Y OUT Building Permit When Approved
i'~J-..._;.-._---,- . " i ReceiptNo.
. " -., (
l' I' I
Bulldillg Omciaf
Date
Date
,.DEe D 9 2Qm:
. !By
I; i
24 hour notke for aJllnspectioo! (952) 441-9850, fax (952) 447-4245
11/17/2005 THU 9:03 FAX 952 767 1900 GENZ-RYAN
~ 008/013
Date Rec'd
CITY OF PRIOR LAKE
SEWER AND WATER PERMIT
(Please type or print and sign at bottom)
ADDRESS
I~ HQl( P~~View J\ NW.
_ 1
I. Or... Pile I PERMIT NO~ 1BS..
2. Yellow Chy
l. Gold Applicant .
----'_..
ZONING (office use)
~
LEGAL DESCR.I.r J.J.ON (office use only)
LOT'lOBLOCK 1 ADDITION p~V i tw
~=R \1 )f:V'\~ \'YvH,\n HD\'VILS
(Address) l y: Q 5 PI OLLOv D V , StC:)())
(Address)
PID
(phone)
EClOan fvlN
(Ctty~ . .
(oF; J -- QCf5- 57 QC?
55j)~
(Zip Code)
f ~;;~~ANT ~(tlL- 12M a vl
(Address) ~ 21)0 \~A~SS ~fV\fp
(Contact Person) fW1 VL\ ~tl ~ _ )~ ( ( s "
(111~.1 \..-f~ll......
"LICANT SIGNATURE ~ ~
(phone) 11 Vf2 ~ 7 !PI - (000
f3lA Jljl] S Vi f I-t- f\AN (7:337-
(~) ~ip~~
(phone) 1 ~1ll1 ~ jJ)OO
DAlE f l-lJ-OS
APPLICANT PLEASE COMPLETE BELOW
Size of water service inches.
Location of any couplings from structure feet.
Type of sewer pipe. 0 ABC 0 PVC 0 Cast Iron
Estimated length of sewer line feet.
Clean out (if required) located at _ feet from structure.
Residential sewer and water line connection
Sewer connection only
FEE SCHEDULE
$35.50 Industrial, Com'J & MuJti~family
$17.50 Water connection only
Estimated Cost $
Building Pennit #
1 % of job cost with a $39.50 min~.
$17.50 \
\"
SEWER AND WATER PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
.50 PA\D WITH
5UtlD'NG PERMIT
(Office Use Only)
I This Application Becomes Your Building Permit When Approved
I Paid
Date
, Receipt No.
I By
Buildiog Official
Date
Z4 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
11/17/2005 THU 9:03 FAX 952 767 1900 GENZ-RYAN
~ 009/013
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
i:~~: ~:~ PERMITNO~. ~~~
3. V.llow Appfi....' ~~ 'V~
(Please type or print and sign at bottom)
AD\4(ltL. Pa~~itw ()1 N vV
LEGAL DESCR.lt'.nON (office use only)
LOTfJ.2J BLOCK I ADDITION - Ja~v;-tV\J
~=~R \ JUflf~ fnn Yj(\ \--\DYY't'5
(Address) \ ~q0 Plo\'zO--. Dv, ))~-t 9(YJ
APPLICANT f\ _ n
(Name) t:lt111- - ~iJ aV\
(Address) 21-00 W. 1-h,,,J [/ k3
(Addrtss) _
(Contact Person) r M ltI& t1 fa ( ( S
A.PPLICANT SIGN~TURE r
Quantity
,
I
I
1-
I
,
I
/)-
ZONING (oIliceuse)
PID
( "c:::; i 01"/'-..- '2 "7("'';;'
(phone) (,:") J -K j J :) j'~1
FOC1/AV) IvlN CfSC;J,d-
,. J .
(phone) 0[r61--/lP1 .. (ODO
B(Atl.~1~V" {I(, M N 95337
(City) (Zip Code)
(phone) tiC?1-1frf-fOOO
DATE Jl:11-05
APPLICANT PLEASE COMPLETE BELOW
Type of Fixture
Bath Tub with or without shower
I Dishwasher
I Floor Drain
I Lavatory (Bathroom Sink)
I Laundry Tray (lor 2 compartment sink
I Shower Stall
I Sinks
I Bar Sink
I Water Closet (Toilet)
Quantity
'-1
1
n..:r
, Type of Fixture
I Rough-ins
I Water Heater
I Water Softner
I Stand Pipe (Washing Machine)
I Sewage Ejector
I Backflow Assembly
I Backflow Assembly Test
I Lawn Sprinkler
I Other .
FEES\,.;.t1..I!;DULE
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 $
Building Pennit #
PAtD WrrH rr
.se\l\lO\NG PERM
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
(Office Use Only) ... ----.
, ,
, This Application Becomes Your Building Permit When Approve( III \I, flrid i ", i 'I' '\ I
\ \ \~ 1 " 2005
Building Offidal Date II_ \'L\
I Receipt No.
I By
.24 hour notice for all inspections (952) ~V.~~5~~=~~_(~~1.~1:4145
11/17/2005 THU 9:04 FAX 952 767 1900 GENZ-RYAN
~ 010/013
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/.llu<.EPLACE PERMIT
Date Rec'd
~:~:. ~~ I PERMITNO~ ~A~
3. yell..... API'I"'" ~ ~
(Please type or print and 6i~ at bottom)
ADrLirt;y Pa ~V; IAN f)1 N W
ZONING (olIl!:e
use)
LEGAL DESCRIPTION (office use only)
LOT fbBLOCK I ADDITION PaJU.-vitW
~~: \ ~ ){l\~\(y\n {VI \-\on~
PlD
(Phone) Ct51- GrU5.. 370S
(Address) \ gq5 iC)lcrlCL- ()r. Sic ?OD
I~~M rJ{j ['\J\ f\1
- .._~ - -
C""-C{ 'J:).
;..,_) J (/'(....
(Phone)
.._ DATE ill 7 -0 S-.
, . APPLICANT PLEASE COMPLETE BELOW
,gjNEW CONSTRUCTION 0 REPLACEMENT 0 AL TERA TIONS
FURNACE MAKE AND MODEL lJJI1 VI.oX' - ~ l( 0 U H -3106 -[Yre> FUEL V\aJ ... tf as
FLUE SIZE RETURN OPENINGS 4 INPlIT Rf, DOD OUTPUT 1b, 40D
TYPE OF SYSTEM HEATING OR POWER PLANT
APPLICANT r ''J
(Name) c:TenL- I-.cJja J"I
(Address)n tJrn llj Hi.W ~ I r.J..
t7v7UJ v '. Vi:J
(Contact Person) r i1Jt~ ~(Addr~ ( (S
- c::;;.
APPLICANT SIGNATURE
6Wrn~>v1'llt
(City)
(Phone) Q'F-)fA':7 if? - 1000 \
c:::ro..? -7J
,_,']~) J
(Zip CtJ::.
8!Wann Air Plants
OGravity
o Mechanical
&ir Conditioning
OVent. System
o Steam
o Hot Water
o Radiation
o Special Devices
o Other Devices
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
FIREPLACE MAKE AND MODEL
FEE SCHEDULE
Industrial, Commercial & Multi-Family 1% of job cost Residential, Gas Fireplace
S39.50 minimum
Residential, Heating & AlC (New Construction) $99.50 Residential, Additions & Alterations
Residential, Heating Only (New Construction) $64.50 Residential, AC Only
$39.50
$39.50
$39.50
Estimated Cost $
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
Building Permit #
$
$
$
.~,n WITH
--. ..~, PERMIT
.50 .,..........-
(Office Use Only)
)1' !
i ,~ !
This Application Becomes Your Building Permit When Approved I.' (Paid
. . --NO.V 1 'L.ttl05
i i Date
~ceipt No.
BuildiRl! Official
Date :,-_i -
- \
24 hour notice for all inspections (952) 447~jtSQ,~4"14245
13~
PRIOR LAKE DEPARTMENToSee Main File
BUILDINq AND INSPECTION
INSPECTION RECORD
.
SITE ADDRESS I 4-1 / ~ I.f PM ~ t1 &1iJ LlWs- 1.1. ~, _
NATU RE OF WORK IJ6j,J c.JJn-1J,A,c.:rN~ C/,AJ I ....e... Fi;JI'r If)
USE OF BUILDING ~,F: A. .
PERMIT NO. ()5./a35 DATE ISSUED /fJ!"'/o, :
CONTRACTOR ~~S~ ~.~. PHONE,,'t.3l-4-"'-'
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR
DATE
I FOOTING I
FOUNDATION (Prior to Backfill) I I
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
SEWER I WATER I SEPTIC
FRAMING 'i.) L
INSULATION o~ J f1u.,s; ~
ELECTRICAL I '
PLUMBING ~l-3"l,l~b
HEATING (if required) ~
FIREPLACE
GAS LINE AIR TEST
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
LIt.,.",. J H~lUcwlt~ I I
, FINALS
( rp - " ~ I (~
. p ~6t~.
(I' 12ft 1t1t) ~
I ItS / . 11,/ t'
.
L..~
t.f
GRADING (Prior to Sodding)
BUILDINP ~
ELECTRle~AL
PLUMBINCJ
HEATING
DO NOT OCCUpy
&Jp
w,-f~ ~~?
UNTIL ABOVU, HAS
NOTICE
.-
I I}
lY/ltrA
f
,g..u.-a
BEEN SIGNED
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:
FOR ALL INSPECTIONS (952) 447-9850
I
--
~trfifitaft of @ttupantl!
CITY OF PRIOR LAKE
~tpnrfttttnf of ~uil~ing JI nspttfion
/~ Pinal Permitted
D Conditional C.O. Expires
This Certificate issued pursuant to the requirements of Section 110 of the 0 Residential / 0 International
Building Code certifying that at the time of issuance this structure was in compliance with the various
ordinances of the City of Prior Lake regulating building construction or use. For the following:
Use Classification ~5 IN q L C F;--/ I' / / '- V Bldg. Permit No. c; 5. I (., .3 ~
L:5 r I/IJ
f'-- Type Construction. V Zoning District
/': / I ,:Jt-:r-;:: E K.::: Pc IV D /=-r
/4-/04- FI-)/C/C V/6t,V '-N.
1-1 01'-1 F----S
Occupancy Type _
Legal Description --'- 23,
Pt/5D
Owner of Building
Site Address
COiVtor's,Name & Afdress f t, L, /\1.:711 f~~ /\1/\/
\)"L,} ~ /./J L-L ,4' \\(7
o Building OffiCial \r
Date: ('I - \ \0 -- {/ II
City Planner
Date:
,. ~.,
'."i,",'"i' ...
'lIIIioIloIiiIiI:,,'::'
~"-" ,;'; 'M;.;.1~:J.: "~M~i.!'l'L< I I
:-,
::..,;;~~,;..'" ,..;';:'..,';...i;;;l.:",' '....
"',i;~i;~' .,'.~r"
-. ,;.;~.' _aU'
i, '~:i: ,:" . . " . ".
"':"-,
. '" ". ......~.,,;...Ji.,
ij',\...,;.'~,,;, .;
../..,.
...............
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS 1!:1 { c;.,
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
~INAL
o SITE INSPECTION
SCHEDULED
DATE TIME
.~OV
(? Q.T kv t' .c...J
CONTR.
PERMIT NO.
~-I03~
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EXIGRADIFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
COMMENTS:
\. ~~ ~~ Co-t/5'
'2... ~,^,\I.f.J<.L~ ~r ~~l-h>
li~
T ~ Q.. eS 0 -h,r- s/vt.J..J.
o WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
~RRECT OR REINSPECTION BEFORE COVERING
Inspector: ,
Owner/Contr:
CALL
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
/II$NOTI
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS #l.Uf
OWNER
PHONE NO.
o FOOTING
o FOUNDA nON
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
COMMENTS:
I
C:..(~~
()SCHEDUlZ-D tJ~
f{w~\J[~
TIME
CONTR.
PERMIT NO.
~ -JAs~
,.....-
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EXIGRADIFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
I h
,~
("1
<-\-, \ .Q
- - "-
jWORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CO('':iJ. . WORK. CALL FOR REINSPECTION BEFORE COVERING
Inspe :tor: Owner/Contr:
-:ALLI. ~9850 OR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
~D~MENTS ARE FOR YOUR PERSONAL HEALTH &: SAFE~/
\J INSNOTl
DATE TIllE
CITY OF PRIOR LAKE lJ~~~
INSPECTION NOTICE SCHEDULED
ADDRESS lYll.14 .1-kvce~w
OWNER CONTR.
PHONE NO. PERMIT NO. S- JO"5S-
o FOOTING o PLUMBING RI o EXIGRADIFILLING
o FOUNDATION o MECH RI o COMPLAINT
o FRAMING o WATER HOOKUP o FIREPLACE RI
o INSULATION o SEWER HOOKUP o FIREPLACE FINAL
o FINAL ~PLUMBING FINAL o GASLINE AIR TST
o SITE INSPECTION o MECH FINAL 0
COMMENTS: " .- _
,. QJl .+.-,,: fv\ ~ tJ
.J.. ~~ D,.~~
3. i4~ ~~ ~~
, ~
--~..-----
o WORK SATISFACTORY, PROCEED--
~ORRECT ACTION AND PROCEED
/ 0 ~RRh!5E' CALL FOR REINSPECTION BEFORE COVERING
Inspector L, Owner/Contr:
CA ~7-9850 F THE NEXT INSPECTION 24 HOURS IN ADV~NCE.
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CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH &: SAFETY!
/NSNOTl
Job Address ~"h'/,III Lk
Heating Contractor t?nUl 'Z .Ry~
Name of Tester 'f.~.
Date 2/1/-f,
Percent 02 7."'/'
Percent co L/ ",,_
Percent C02 7: 1'/'
Stack Temp?L/9'
Combustion air is adequately supplied per
UMC Sec. 606 'I ~5
Input ---
Job Address 1!:I1t,'f..M.V:t,1II ~
Heating Contractor G7uz 'Z .Ry~
Name of Tester 'f..t..
Date~! //./,
Percent O2. 7. '1'/'
Percent co..!:f..t2/-
Percent C02 7. 1'/'
Stack Temp?<l9'
Combustion air is adequately supplied per
UMC Sec. 606J!~5
Input --