HomeMy WebLinkAboutBuilding 06-1111
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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
IZ.Z1.Dfo
(Please
ADDRESS
/7L71
/"'1,;f It '; -1 F {c-.O
L.,-r,v<Z
5c
LEGAL DESCRIPTION (office use only)
I White
Pink
\(ellow
file
City
Applicant
\ PERMIT NO. f/. / / / / \
ZONING (office use)
LOT
BLOCK
ADDITION
PID
OWNER -
(Name) --J Q-Cf<...'C
t/U ( '-~
(Address)
5 4--r~
BUILDER
(Company Name)
(Contact Name)
(Phone)
Co, < L .J' J - ? 7%
...:Joe
0.x~<--e
1-(.7 --7 _~ /l2-174-'~ L.... C
(Phone) 7::>-1_' <:,;,.:>'3 _'-'.>0 >
(Phone) C _ </ "-1-- - L '7 '-.- .,-:~ J"7
If ;7."'"7.c- ~ t::".:-> ,- c:~
.5r~ L.-t::;>
-........
l:D -/.+
"';'-7 J L
(Address)
,-c,,"'0 L- (..JC-,)~tI/ 0/2
Lower Level FinIsh 0 Fireplace
JtIf1Jl-~
TYPE OF WORK 0 New Construction ODeck OPorch ORe-Roofmg ORe-Siding
OAddition OAlteration OUtility ConnectIOn
PROJECT COST /V AL\JJ.<:.. $ _____
(excluding land)' ~
'"
"-
"-
l hereby certIfy that I have furmshed mformatlOn on tIllS applleatllln which IS tLl the best of my knowledge true and correct l aIso certify that I am the owner m authOrized agent for the
abovc-mentlllned property and that all construction wlll conform to all eXlStmg state and local laws and will proceed 10 accmdance with submitted plans I am aware that the building
omeial can revoke thlS perm 1r Just cause Further ore, 1 hereby agree that the my official or a deSignee may enter upon the propC11y to perf<Jrm needed InSpectulllS
CODE: rXI.R.C. OI.B.C.
Type of &nstnlction:
Occupancy Group: A B
Division:
I
E
II
F
I
III IV
H I
2 3
V
M
4
A
R
5
x
Permit Valuation , C C (\ 0 ()
.'
Permit Fee $ 3'-1. 7'>
Plan Check Fee $ -
State Surcharge $ ')-0
i Penalty $
Plumbing Pertnit Fee $ 1-6 O{)
Mechamcal Permit Fee $
Sewer & Water Permit Fee i $
Gas Fireplace Permit Fee $ \
This Application Becomes Your Building Permit When Approved
~~
lluildlllg. Ulrlclal
I 'J.;~~c 7 /0 fp J
o Mise
B
S U
~.L /1- )(0'-
Contractor's License No
Date
Park Support Fee . <---- # $
SAC # $ =-
Water Meter Size 5/8"; 1"; $
Pressure Reducer $
Sewer/Water Connection Fee # $
,
Water Tower Fee # $
Builder's Deposit $
Other $
TOTAL DUE $ 1S.2-5
I ROC':; 5 J56 31
I By ,
Paid
Date
,{~-: d~ _ b
TIm lS to certIfy that the request 10 the above applrcatlDn and accumpanymg ducuments IS 10 accordance With the City Zoning Ordinance and may pruceed as requested TillS ducument
when signed by the City Planner constitutes a temporary Certificate of ZOl1lng cumpllance and allows constructlun (() cummenee. Bdl)re uccupanev, " Certltieate uf Occupancy must be
issued
Planning Director
Special Conditions, if any
Date
24 hour notice for all inspections (952) 447-')1l511, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372
Residential Building Permit Checklist
Basement Finish or Interior Alteration to Single Family Homes
~
Date: /2-/ z.. -, It) (.,
r-;< _ :
BY:~
~J). I--
Building Permit #
Site Address / 7 2- 7 I
PID:
Zoning:
Legal: L
B
...
M~jJ ~ S:6~
Subdivision:
Existing Structure:@r NO
\ CONFORMS TO ZONING
ORDINANCE
NO
I
l @~
\
YES NO
Is this an expansion of the existing footprint or Refer to Planning
building height? ~O
Is the property located within the flood plain? Refer to Planning 1Jo
Does the alteration include any additional kitchens? Refer to Planning ~~
Does the proposed alteration include any outside Refer to Planning
entrances other than patio doors? rJO
Is the proposed use of the finished space or Refer to Planning
alteration for anything other than a normal single pi)
family home (office, group home, day care, etc.)?
THIS CHECKLIST MUST BE COMPLETED AND INCLUDED IN THE BUILDING PERMIT FILE TO
MAINTAIN A RECORD OF THE REVIEW.
L:\TEMPLA TE\AL TCHCK.DOC
12/27/2008 02 88 FAX 7884271847
,J I] E :? P L IJ M 8 I ~ ll3 I ~ l C
~ 1.)1.) 1,0' 1)1,.' I
Date Rec'd
CITY OF PRIOR LAKE PLUlVIBING PERl\lIT
I RiuL.- 1=",1.:
~, c..;.::1,j Clr,
) Ye~l~"'" '~\F'?l\"::~,.;'l
I PERMIT NO.~
( J'\
NcJ ./
ZONING !iOifl,:.'
'=)
(Plea," t ,'or rinl.nd ,iil:n ~t botlQm)
\ LEGAL DESCRIPTION (.lfiice use only)
I
II LOT 1:\ LOCK ADDITION
PID
I O\NNER
I
I (l'b.rn e )
I
I
I (Address)
(Phone)
ArPLICA~ . \ ~ 0\ 1
(Name) , _J( X.;).-'~ l'l uyv\.tJ- j ~.
(AlUress) 1~?:v-?(5 DVZz.Y./,S-r JJ &L)
(AddrGss)
(Phone) 1 L'? '3 -L{L.- L / \ "37-
..sf. f(4)\G/S C550J Ci
(City) (Zip Code)
(Contact Person)
(Phone) 1 fo3 .-LQr -7l 3d
,
.\ PPUCANT SlGN A TURE ; .J
I APPLICANT PLEAS
uantitv \ T ' e of Fixture
I Bath Tub \",'jth or without shower
I Dishwasher
i Floor Drain
I Lavatcr . (Bathroom Sink)
I Laundrv Tray (] or 2 com artment sink
Shov,'er Stall
I Sinks
I Bar Sink
I Water Closet (Toilet')
\ I
DATE J)-- ! ~&~
OMPLETE BELO\V
uantitv
T' e of Fixture
RoUt?h-ins
Water Heater
Water Sofmer
Stand Pi e (Washing Machine)
SC."",if:e Eiecror
Backtl,)\V Asse:nbly
Backtlov,' Assemblv Test
Lav.'Jl S rinkler
Other
I
FEE SCHEDULE
Ini1uwial, Commercial & Multi-family \ % ofj<)b CO;l wllh a S39.50 minimum
ReSldcntial, New One &: TWQ-Family
1{=~.idcn:j:1J, :"\,ddili(ms 8.: .->..11cr;,lI0[J,
$99.50
);39 SO
:;0
r" · DIL ·
f.
Estimated COSl $ Building Permit "!;
PLUMBING PERMIT FEE :);
STATE SURCHARGE S
TOT AL PERl\lIT FEE S
(Office I)," On"l
Date
I Paid
I
[ Date
-,-' .,.
J;'-l.lll
8 ZOJ7
\ Receipt No.
I By
I
This APplication Becomes Your Building PermitWhCll Approved
Iluildin~ Olrlci~1
24 hour notice for llll in~peeti()M (952) ..1'17.9850, fax (952") 447-4245
16200 Lagle Creek Ave., S.E.. Prior Lake, \1i'< 55372.1 il-I
..
PRIOR LAKE
INSPECTION RECORD
~ 'IE, CP ~.
DEPARTMENT OF
BUILDING AND INSPECTION
SITE ADDRESS
NATURE OF WORK
USE OF BUILDING
PERMIT NO.
CONTRACTOR PHONE Z. if
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
~~ \ \
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
ItSPECTOR
DATE
--
---
FRAMING
INSULATION
ELECTRICAL
PLUMBING
HEATING (if required
I
Wv
vJ (,
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
, I
FINALS
BUILDING
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