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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
l,uODD ]:::C>c\:::. ~vL.
Date Rec' d
2---/9-02-
I. White File
2. Pink City
3. Yellow Applicant
I PERMIT NO. 02-02-63
LEGAL DESCRIPTION (office use only)
LOT I BLOCK If ADDITION!h<:.. t<J,/rk SGu
OWNE~ 0 -.u..
(N ame) ~ -€..Vl P
-i-JorVI1U
(Address) J 3. s LJO AAG~T4P;t= ,4UC-
ZONING (office use)
/2/
PID
-0
(Phone)
~F 1/ j)-LLfZ
BUILDER fV\ ~ of \ I I
(Name)--1' IC.J~J\ tT m1v1~
(Contact Name) .::0 ~ W\-e.t IJ. m Ie Jd-.k;-4-
(Address) I 3~G/O r-tA-CcsrlJ-rF A-u.r /J-PPl-€
SSJZY
TYPE OF WORK
~ew Construction
ODeck
ORe-Siding
OLower Level Finish
o Fireplace
PROJECT COST IV ALUE (excluding land) $ "2 2 6~ Q 0 0
OPorch
ORe-Roofing
OUtility Connection
o Misc.
OAddition
OAlteration
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 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 official can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may
enter on the property to perform needed in e tions.
x
Permit Valuation
Permit Fee
Plan Check Fee
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
Sewer & Water Permit Fee
Gas Fireplace Permit Fee
tJo, cJO
.Or:>
~S .SO
.Dd
. n Becomes Your Building Permit When Approved
c;("~I~o2-
Date
Contractor's License No.
Z -/'1-07--
Date
;zoo:? &. 4/ II
Park Support Fee
SAC
#
#
$
$
$
$
$
$
$
$
$
Water Meter Size /8 ; I";
Pressure Reducer
Sewer/Water Connection Fee
#
#
TOTAL DUE
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 sig~ep by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
="~~ ~
~:~- ,A,.':'. ~.e~ ,'112e 187 ~ - . . ~~
lan~g 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
Water Tower Fee
Builder's Deposit
Other
I Paid 8 -j~':~
Date I. - " - o'Z-
~ -:----. ...~
~,--::.':;;f{'''. ~ ',-~.;"':~'.l;'.~'-'" ;1"._, T":,
T_. , ''';''''"1'''-' -.. ....""?' -."-'-- -;,..... ~,., ---.. '--'.~"'t' .
White - Building
Canary - Engineering
Pink - Planning
Thr ('tn'rr or fhr t.kr Counlry
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
Me.. QSV lIT H Ofv1ES
2~ Jq,~()2-
APPLICATION RECEIVED
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
J 52 4- 7 vv () ()D IJU tV~ ----reA r V
Accepted ~ Accepted With Corrections
Denied
Reviewed By:
/J/J1-13
Date:
S-2.2~~
Comments: See Reverse Side for Additional Inform;:JfionJ
See Attachments: 1) Grading Plan, 2) Erosion Control Measures
3) Erosion Control Plan
"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
ordin:mces of thl3 iurisdictinn ~h~lI nnt hp vAlirl"
White - Building
Canary - Engineering
Pink - Planning
The- ('enler or Ihe Lake Counlr}'
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
M ~ D5V In H otJlES
2-- /q -0 2-
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
/524-7 WOOD OU~~ .--rEA{~
Accepted
Accepted With Corrections
Denied J-
Reviewed By: ~_
Date: !)- ;)../- (J;L-
Comments: Il ~ ~ ~
~~~ a21 a~ ~~
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."
White - Building
Canary - Engineering
Pink - Planning
The Ct'nler of the Lake Counlry
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
~ ' : C """""'T I' --
(' \1 C. I j-" \j I I r i C~' I L'.., -.-'
.--) ",/'] (' . -,
.::- -- J V/" ) L-
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
r- . 'I"
'~) . .;",-
......." '
'"} I" ,'.~
! V .......l
/...,,1 '
L...........
Accepted
Accepted With Corrections
v'"
Denied ~
Reviewed By: A~:-~~~~~ Date: 3UO('C;2
:iLents:
':; ~~!:' tf3 ~,~~'f~ ~
c "- ~luL'-C (?~~ I
"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."
MAY.10'2002 16:04 651 633 8884
FIRESIDE CORNER
#5502 p.005/011
CITY OF PRIOR J~AKE
HEATING/AIR CONDITIONINGfFIREPJoJACE PERMIT
Date Rec'd
~ ~ f~iOn..1 PERMIT NO. ;J. - ;)-- g31
-7
t-")d-~"
/ S;;? t-/:7- t-UJO
~ -r~ .
~d").- J ,~
zoNING (DIfi.:el,l~r.)
T...EGAL DESCRIPTION' (ol!lce Wl~ only)
LOT . BLOCK
ADDITION
PIO
OWNER
(Na.l11c)
(Addre:s5)
me.
<Pbone)
APPUCANT
~am~) ALLIED FIRESIDE DBA FIRESIDE CORNER
(phon.e) 651-633-2561
(Con.tact Person.)
BRENDA HUSTON
ROSEV rT . LE Il:1N
(City)
651-633-256J.
(Phon.e)
'i511":1
(Zip Code)
(Address) 2700 N. FAIRVIEW AVENUE
(Addrep~
APPLICANT SIGNA Ttl'RE
DATE
.s ,;I rJ.L,
APPLICANT PLEASE COMPLETE BELOW
~W CONSTRUCTION 0 REPLACEMENT 0 At TERA nONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM H.EA TING OR POWP..R. PLANT
OWarm Air PlllIlts 0 Steam
OGravlty 0 Hot Wat~r
o Mechl1nlcal . 0 ltadiation
DAir Condit.ionIng 0 Spccl.al Devjces
OVcnt. System '0 Other Devices
P~JEASE NOTE:
Air Conditioner Units
Cs,nnl)t Encroach into
Req,ulreQ Si.de Yard
Setbacks
FIREPLACE MAKE AND MODEL
rndustrial. Commr:rcial & M1Jltl-Fll1Tlily
FEE SCHEDVI..E
1% of job cost Rellidentie.l, Gas Fin:plllCC
$39.50 rn.inimum
$99.50 RC:jidcntlal, Additions &:. Alterations
$64,50 Residential, AC only
539.50
$39.50
$39.50
R~idcntifJl. Heating &:. Ale (New Constn1t:t.lon.)
ResidentIal. HClLT.ing Only (New ConstrucT.ion)
Estimated Cost S
Bullding Pennit #
liEA TlNG PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
.50
o.
(omce lJ~e Only)
This Appl.h:atton ~ome5 Your Bulldfne Permit When Approved
Dntll.
BIIlldhl( Offielal
24 hour "otlce for all jnllptlCtlnn. (952) 447-!J8S0, fa" (9~:Z) 447-4245
Aug 12 02 08:36a Mike Schiltz
06/09/02 FRI 10:4Z FAX 6124474245
----
651-681-8306
CITY OF PRIOR LAKE
p.1
~OOl
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
~\ V"\= ) 12.. ~ /J./; 1 j ~Vl.f- )S-- ~r-O -Z-.
;\J,<fL~ \-~;.J... f*ff.
I, Bille Pil,
) GDld C~.
J. Yclb- Apptunt
I PERMIT NO. 0 - d-- ~J
WNING (ollic.u..)
Lv (j (J ~ ~v c t.-f
'-'0:..,' I
LEGAL DESCRIPTION (om~ use only)
LOT
BLOCK
ADDITION
PID.
OWNER
(Name)
~....... ;t+
u -,-.., "- 5'
(Phone) % 9 ) - ..57.1 CJ
(Address)
APPLICANT
(Name)
(Address) P
A~.sSiQn
PJ~
~~)( ~~ I,;;;:L
(Adcln:ss)
/2-1 ~ lA~
.
{~ .
...HLr..., '~J
J-
€.o ~Q "'-
(Phone) (0 S J - ~ 8")~ 8 ~ S ~
~.JI-' ..s S I 2 Z
(City) (Zip Code)
(phone) (.s:; S ) - ~ ? I - 8 ..2.s C
DATE ~~ 5.... 2-u.-a
(Contact Person)
APPLICANT SIGNATURE
Quantity Type of Fixture Q...ntity Type of Fixtun
Bath Tub with or without shower -( Rough-ins
I Dishwasher ; Water Heater
, Floor Drain Water Soflner
'r Lavatory (Bathroom Sink) I Stand Pipe (Washing Machine)
j Laundry Tray (lor 2 compartment sl1lk Sewage Ejector
') Shower Stall Backflow Assem6fy
I Sinks Backflow Assembly Test
Bar Sink Lawn Sprinkler
2 Water Closet (Toilet) Other
APPLICANT PLEASE COMPLETE BELOW
FEE SCHEDULE
Indumial, Commercial & Multi-lilmily 1% ofjab COSI wilh Ii $]9.S0 minimunl
~esldenlinl, New One A Two-Family 599.50
Residcnlial, Additions & Allerations ~39.S0
Estimated COlit $
Building Pennit II
PLUMBING PERMIT FEE S
STATE SURCHARGE S
TOTAL PERMIT FEE S
a.lldlne otIiri.1
Date
lomer Vie Only)
This Application Becomes Your Ballding Permit When Approved Paid
Dale
14 hour DOUce rDr all illlpeed8111 (!J51) 447-'150. ra. ('5Z) 447-424'
16200 E.~le Crftk Awe.. S.E.. Prior Lake, MN 55371-1714
04/15/2002 20:59 6127584912
1)01/111,1)2 lt1[ l)il: . f'~l tllZU74ZU
ALLIED_EXCT
CITY OF PRIOR LAKE
PAGE 01
~OOI
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CITY OF PlUOR LAKE
SEWER AND WATER PERMIT
..JlJL or
ADOQSS
~_ 15014J.._
~
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u......_._._.....
Pit>
!l.B;AL OB5c
LOT BLOCK
N (....... CIIb')
OW!...I!R
(ro;&ml!)
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(Phanr)
(0lJ)
fl A.PPl,.1CANT t\.
rN,,",e)_~
I (AdGm.J ., ~O
! (Contact Penoll)
I APPLICANT SltlN
I
~.,.ldendal lew.r omd
Sew. lOonnectlon onl
APPLICANT PLUS! COMPLETE BELOW
i. of Wllter .....lce iache.. --- L
on or aay ~lilll' he ~~ tg _.
ype of....r pipe. 0 ABC E PVC 0 Cut Iron
lltimated lenp of sewer line ~ feet.
llll1 out (ir~1.Iiftd) localed at ~ r.t from ttruCturC.
!
! rztSCKEDVLE
!ine Ce.~,tiOD S3~.SO htd.d'iai, Com". ~1".lImlly J~ ofjo'- call wfth .'39,'0 mmillum
'1'7.50 W"r.onll~_I~ S17,'0
1
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BullcSinl Ptrmit .---,
SIWSI. AND VI 1t'T!k PERMIT PEE
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Date Rec'd
CITY OF PRIOR LAKE
SEWER AND WATER PERMIT
I. Green File I PERMIT NO
2 Yellow City .O~ 7_ () ~ a '2
3. Gold Applicant '-' L-CJ~
(Please type or print and sign at bottom)
I ADDRESS
J S if Lf7
ZONING (office use)
UJ~rv
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name)
\V\
(Phone)
qS;)- ~9(-S?
(Address)
(Address)
(City)
(Zip Code)
(Address)
/tJ(('e& ~~
740 ( UJ4 I d 6+" Sf
(Address)
(Phone)
s-
~
t/)--q 7R-- ?3 b I
S'~371i
(Zip Code)
APPLICANT
(Name)
(Contact Person)
(Phone)
DATE
APPLICANT SIGNATURE
APPLICANT PLEASE COMPLETE BELOW
Size of water service ~ inches.
Location of any couplings from structure --=- feet.
Type of sewer pipe. 0 ABC fXl PVC 0 Cast Iron
Estimated length of sewer line S D &;t.
Clean out (if required) located at feet from structure.
Residential sewer and water line connection
Sewer connection only
$35.50
$17.50
FEE SCHEDULE
Industrial, Com'l & Multi-family
Water connection only
SEWER AND WATER PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
1% of job cost with a $39.50 minimum
$17.50
o Z/ - 0 203
-- wrn--\.
( PAlO PEP..J iT
~~~., .
Estimated Cost $
Building Permit #
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid
Date
Dat~ 2 3 20U~
By
Building Official
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
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PRIOR LAKE
INSPECTION RECORD
DEPARTMENT OF
BUILDING AND INSPECTION
SITE ADDRESS Js~t(7 W~ f)uc\~-~Tr
NATURE OF WORK AJ.eJ.J
USE OF BUILDING .sF 0
PERMIT NO. ()2 -0283 DATE ISSUED ..2. -,<. ( ~ a2
CONTRACTOR Me. D)u(f(- b\~~ PHONE tI2--toas--c'::;>~
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
FOOTING
FOUNDATION (Prior to Backfill) 'b ~ 4 l1
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
DATE
SEWER I WATER I SEPTIC
FRAMING
INSULATION
ELECTRICAL
PLUMBING
HEATING (if required)
FIREPLACE
GAS LINE AIR TEST
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I S\vcco ~ I I
FINALS
-----1:/
;)
GRADING (Prior to Sodding)
BUILDING OJ..
ELECTRICAL
PLUMBING
HEATING
DO NOT OCCUpy UNTIL ABOVE HAS BE N
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 INSPECTIONS (952) 447-9850