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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
Z-Z-fj-Oz.
1. White File I PERMIT NO I
2 Pink City . 02- 01 i2.~
3. Yellow Applicant , U r2.. ,
ZONING (office use)
4421
I'~NOV/ fEW
~'-.s~
leI
LEGAL DESCRIPTION (office use only)
LOT ~ BLOCK L ADDITION
11/1/1/ DS-rrrlf!-
PID
OWNE~ r L~':~tl
(Name) /\'~ 7l' '~
./
(Address)
0) 2 -~tf-l--03 <Cl
(Phone)
BUILDER
(Name)
(Contact Name)
(Address)
(Phone)
(Phone)
TYPE OF WORK
o New Construction
~ower Level Finish
2 Je/VlS
ODeck
o Porch
ORe-Roofing
ORe-Siding
o Fireplace
o Addition
OAlteration
OUtility Connection
o Misc.
PROJECT COST IV ALUE (excluding land) $
I hereby certifY that I have furnished information on this application which is to the best of my knowledge true and correct. I also certifY that I am the owner or
authorized agent for the ab,ove-mentio perty and that all construction will conform to all existing state and local laws and will proceed in accordance with
submitted plans. I a~, ~~,' ' buildin , official ca revoke this permit for just cause. Furthermore, I hereby agree that the city official or , designee may
;ter upon the propertyt~~ ded i ~~on~ z?iJ 02./
Signature Contractor's License No.
Permit Valuation 2,000.00
Permit Fee $ t, Z. 2S
Plan Check Fee $ -
State Surcharge $ I. 00
Penalty $
Plumbing Permit Fee $ 40.00
Mechanical Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace Permit Fee $
Park Support Fee
SAC
#
#
$
$
$
$
$
$
$
$
$
Water Meter Size 5/8"; I";
Pressure Reducer
Sewer/Water Connection Fee
#
#
Water Tower Fee
Builder's Deposit
Other
TOTAL DUE
.25
es Your Building Permit When Approved
I Receipt No. 41'S; / "'J
By r?~
Paid
Date '3 -7..D - 0"(
:5 -I-{)L--
Date
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 Certificate of Occupancy must be
issued.
Planning Director
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
CITY OF PRIOR LAKE PLUMBING PERMIT
1. Blue File
2. Gold City
3, Yellow Applicant
LOT
BLOCK
ADDITION
Se
d~~
ZONING (office use)
LEGAL DESCRIPTION (office use only)
OWNE~
(Name) _ , SA
(Phone)
G0z -4Lf,-()?ff1
(Address)
APPLICANT & a
(Name) , _Vll - j ~n
(Address) ~\l\~ M 'fLd.QL(tT
(Address)
)
(Phone) -Lo0'\ - ~ L ~ ~( {U U
-\Yl. /l_ (t5tLIfYlO1^~V\l S~n~
(City) (Zip Code)
(Contact Person)
(Phone)
APPLICANT SIGNATURE
DATE
2--
L
A leAN LEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher Water Heater
Floor Drain Water Softner
Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
Laundry Tray (lor 2 compartment sink Sewage Ejector
Shower Stall Backflow Assembly
Sinks Backflow Assembly Test
Bar Sink Lawn Sprinkler
Water Closet (Toilet) 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 $
Building Permit #
\-39SD
.50
4~
PLUMBING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
(Office Use Only)
T, his APPlk~Y our Buildiug PermU When Approved
. 2. ~ZZ-OL
Building Official Date
Paid 4-0.00
DaZ_ 2.-2- 0
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
Bilt
Residential Building Permit Checklist
Basement Finish or Interior Alteration to Single Family Homes
Date: Z/Z8fi,2-
Building Permit # OZ-O /8'0 PID:
Site Address 4-4-21 PtJNOV/6W
2-
Zoning:
leI
Legal: L
to
B
~S6
Subdivision: WIN OS7/fte-.
Existing Structu~ NO
I CONFORMS TO ZONING
ORDINANCE
YES
NO
YES NO
Is this an expansion of the existing footprint or Refer to Planning
building height? ><-
Is the property located within the flood plain? Refer to Planning ..f'
Does the alteration include any additional kitchens? Refer to Planning ;b
Does the proposed alteration include any outside Refer to Planning
entrances other than patio doors? ~
Is the proposed use of the finished space or Refer to Planning
alteration for anything other than a normal single -/
family home (office, group home, day care, etc.)?
THIS CHECKLIST MUST BE COMPLETED Al'iD INCLUDED IN THE BUILDING PERMIT FILE TO
MAINTAIN A RECORD OF THE REVIEW.
L:\TEMPLA TE\AL TCHCK.DOC
P RIO R LA KE . ~~itD7~~~N:D ~~SPECTION
INSPECTION RECORD
SITE ADDRESS 44 Z / POND V (6W TeFl I L .5 E:.
NATURE OF WORK ? OWe;K: t-E,V6 L..-
USE OF BUILDING ,e&.5 AI/<. . .
PERMIT NO. 02-0/f3P3 . DATE ISSUED 3/1( 02-
CONTRACTOR. Sieq6t.- PHONE #7- 038f
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
.... I
, I
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
INSPECTOR
DATE
!{Ii -
~-~- ---
FRAMING
INSULATION
ELECTRICAL
PLUMBING
HEATING (if required)
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I I
FINALS
BUILDING
ELECTRICAL
PLUMBING
HEATING
DO NOT OCCUpy UNTIL ABOVE HAS
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.
---
Call between 8:00 and 9:00 A.M. for all inspections
FOR ALL INsocCTIONS (952) 447-9SC:'1