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CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE I
AND UTILITY CONNECTION PERMIT tz., \B ( D (,p
I White
Pink
Yellow
File
City
Applicant
I PERMIT NOo( )~ -IIQQ
)l.
(Please
ADDRESS
Lis 17
PLEA:':>+tJT $T,
s.c.
Pl2loe. LA/t!F /YJAi SSl. 72.
rc. - Z-
ZONING (office use)
LEGAL DESCRIPTION (office use only)
o z.1 003 ('~rtS
LOT BLOCK ADDITION
PID .I(,Z)~02.03 S-o
'I
OWNER
(Name) 'DAVID
O'I3,e/G?J
(Phone)
~/Z-7o/" '/73/
(Address)
'1-. BUILDER
(Company Name)
(Contact Name)
(Address)
()ft ViI)
tY B/~ /8\1
(Phone)
(Phone)
6 /z - 7()f-L/73/
TYPE OF WORK 0 New Construction ODeck OPorch ORe-Roofing
OAdditIon OAlteration o Utility ConnectIon
ORe-Siding
OLower Level Finish
o Fireplace
"I f?<rn- S
-L'Lo~
30__ C/(}O
CODE: ~LR.C. OLB.C. ~ Misc. Ucahr ~_..~ ~"""r
Type of onstmction: I II III IV V A B PROJECT COST IV ALUE $
Occupancy Group: A B E F H I M R S U (excluding land)
Division: I 2 3 4 5
'I
x
/2--16- 0(,
Contractor's License No.
Date
).-
Park Support Fee # $
SAC # $
Water Meter Size 5/8"; I", $
Pressure Reducer $
Sewer/Water Connection Fec # $
,
Water Tower Fee # $
Builder's Deposit $
Other $
TOTAL DUE $ !:JIi. ,J.5
.
Permit Valuation
Permit Fee
Plan Check Fee
State Surcharge
Penalty
. Plumbing Permit Fee /;,{I.
~echanical Permit Fee
L,OO
Sewer & Water Permit Fee
Gas Fireplace Permit Fee
This Application Becomes Your Building Permit When Approved
I ~o,,~ -'~(~(~.
Paid
Date
f;q~ ~~ i ~~ceiPt N~ S-Z;-7 i
ThiS IS to certIfy that the request m the above apphcatllln and accompanymg documents IS m accordance with the Clly Zoning Grdmancl' and may pnlceed as requested TIllS document
when signed by the CIty Planner constItutes a temporary Certiticate of ZOtlll1g compliance and allows construction to commence. Befure occupancy, a Ccrtltlcatl' of Occupancy must be
issued
Planning Director
Special Conditions, if any
Date
24 hour notice for all inspections (952) 447-9850. fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372
Residential Building Permit Chedilist
Finish or Inn~~or }Jt.ennon to Single Family Homes
( '(V..A\,:J PUof)fl-)
BY ~. ~ Dare / z//'il/O '"
~i~~~~:~~ntit ~5 /~ ~(~~~-f
Zoning:
legal: 1 Z. t
B 3
Subdivision: ~ ~
~~ f?-..f~t'\~W,
E.:risring StTuc:ure:@or NO
CONFORl'YIS TO ZONING
ORDIN_AJ.~CE
NO
YES
NO
Is iliis an e:'9ans1on of d:.e e;,,i~...ng rootprm': or Rere:- ~o Plmri.:.-rg
building height? No
Is tile urOtleri:j lccatd wirh.,.., [he flood :Jiam.? I Refe:- co Plar.,."ng I I
o . . ~O
Does t.'1e ah:ention incluce any acdirior.ai :c"che::s? I Rere: ~a Pl:=rrrring I , , I
EX ISrllVq !
Does the pro'[:osed alte:arion i:!:.ciude any ot.:!.Sice Rere: ~o Pl::l]"'!~~g -....J
e::.rnnc~s othe-: than patio doors? , .
EX I STI r-J Cf
Is ci::e pr01JOsed. llSe of ;:he Erishe-: space or R~:-e::o Plarrl""l"~g .......,
alte::lr:.on ror a.."1.ytmng OG.1e:" d::m a :lon:al single No
Farmlv r.OIT'." (oce" O-:""U,.., :.cce. 6y C:l:"~, ""1'- 'I,'j
.. .. ."" "" -....... ~ ~ ~ -.... ) .
THIS CEECKLlST:'vn:ST BE COM?LETED ..\..'fD INCLlJDED IN THE B81LD[l'lG ?E~y[1T FU.E TO
tV L-\.fl'(T All'! A RE. CORD 0 F nIT RE 'lIT W .
PRIOR LAKE
INSPECTION RECORD
~? p /t!:.IA
r
DEPARTMENT OF
BUILDING AND INSPECTION
SITE ADDRESS
NATURE OF WORK
USE OF BUILDING
PERMIT NO. ~ &'SSUED ·
CONTRACTOR 0 " ieAJ PHONE , J
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
FRAMING
INSULATION
ELECTRICAL
PLUMBING
t ;.. .
.AO
-
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I I
FINALS
B
ELECTRICAL
PLUMBING
HEATING
DO NOT OCCUPY UNTIL ABOVE HAS BEEN SIGNED
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.
FOR ALL INSPECTIONS (952) 447-9850