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Date Rec' d
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
7?a5 p oerrL
L/13~
LEGAL DESCRIPTION (office use only)
LOT ~BLOCK 0\ ADDITION
t;-//-O~
I. White File I PERMIT NO ~
2 Pink City . /"\, - 035
3. Yellow Applicant (Lr?t _ _
12. d0~ t2.J
ZONING (office use)
R
JJet /lei ciAJ 1-0
OWNER ~ '
(Name) -....J DAN
[4lu Y'
(Phone) 9-...~2 -, 7'Slc-<i '7/ L
.L BRuuOA
(Address)
BUILDER
(Name)
(Contact Name)
(Address)
(Phone)
(Phone)
TYPE OF WORK
o New Construction
dZfower Level Finish
ODeck
OPorch
ORe-Roofing
ORe-Siding
o Fireplace
PROJECT COST /V ALUE (excluding land) $
OAddition
OAlteration
OUtility Connection
o Mise,
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 upon the property to er rm ne~ded ?~ons,
X - U~ 71hlloL
Signature Contractor's License No, Date
Permit Valuation 5 &'Y!> . Dt'
Permit Fee $ /<1. 7tJ
Plan Check Fee $
State Surcharge $ , .. t::;" 0
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace Permit Fee $
Becomes Your Building Permit When Approved
~-\\-o7 -
Date -
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 $ 7c:' "d-5
Paid
Date
?t~f:oo-
I Receipt No. ':!.! ,L:)?3
By ~
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
Residential Building Permit Checklist
Basement Finish or Interior Alteration to Single Family Homes
BY:
Date: L/- / /- 0;)
Building Permit ~ . Pill: d S-- 3QLi- ~o,b-:'lning: R J
SlteAddress ,y/.3t'J- ;?a~//berr/ %Id9t:/ ~
Legal: L ;:L. B d--. Subdivision: dvl /liIu ~ l!a'ij'irIr/
k~ '~t-e-
Existing Structure: ns or NO
CONFORlvIS TO ZONING Y"E S NO
ORDlliAl'l"CE
NO
Is this an expansion of (he exisnng footpnnt or Refer to Planning
building height? X
Is the property located within the flood plain? \ Refer to Planning I X
Does the alteration include any additional kitche:J.s? I Refe:- to Planning I X
Does the proposed alte:-ation include any outside Refer to Planning
entrances other than patio doors? X
Is the proposed use of the finished space or Refe:- to Planning ~
alte:-ation for anything ou,1.er than a normal single
family home (office, group home, day care, etc.)?
YES
Tms CHICKL1ST MUST BE COMPLETED .-\J.'ffi li.'lCL'lJDED IN THE BtnLDli.'lG PERl'llIT FILE TO
lYL-IJNTAJi.'I A RECORD OF THE REVTEW.
UTE:YrPLA TE\..!..L TCECZ.I:OC
White - Building
Canary - Engineering
Pink - Planning
Thr ("t>nlrr of lhr Lab Countr)'
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT ~/;IV h/'c,V""'
APPLICATION RECEIVED Y - ( /-0 ;)-.
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity who h is proposed at: · J7, / /) I
Y3~ as /Jerrl If Jd~ e K d.
Accepted X.
Accepted With Corrections
Denied ~~
RevieWedBY:~ Date: r(-I/-o'?...-
Comments:
~ ~ ;ew~ Le~ C~\~ !l-e.-~o-d-
"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."
PRIOR LAKE
INSPECTION RECORD
tlEPARTMENT OF
BUILDING AND INSPECTION
SITE ADDRESS 4/ 3(p ~sP8e;,eRY R;/OGE' .eo
NATURE OF WORK L- OW5e t.-<5l/t; L-
USE OF BUILDING Ee.5 A/~ ..
PERMIT NO. (J2 -0...36-0 'DATE ISSUED 4////02-
CONTRACTOR r/18E~ PHONE' 44-0.- 47/2-
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
_____ I
~~--I I
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
INSPECTOR
DATE
FRAMING
INSULATION
ELECTRICAL
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 b..~en 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