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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
4-' ~;O Z-
Date Rec' d
I. White File I PERMIT NO ~
2, Pink City . 02 . al
3, Yellow Applicant . V _
ADDRESS ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT(gO BLOCK
ADDITIONS 1':
OWNER
(Name)
Ih ~ OB,.".JJ QO-5-'t t
I US:-J-
(Address) ,
o(
L..
PID 35-
-o~o--
(Phone) Qs.j-t./3" -I' 0 (
BUILDER J1 lJ
(Name) /t1 t f.J 0 " IV er~ J .
(Contact Name) 0t:. j:' /y- r ("~l5 0-
(Address) ) ~ ..c:- C J ,
TYPE OF WORK
JlQ. New Construction
~ower Level Finish
o Mise,
~ck
.!8::rireplace
(Phone) q~, .l(J:J. 7bO(
(Phone) ~ '1,~:J.-? C,o (
ORe-Roofing
ORe-Siding
OAddition
~tility Connection
.3 C>Q ~
OAlteration
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 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 p n e operty to perform needed inspections.
Permit Valuation
Permit Fee
Plan Check Fee
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
Sewer & Water Permit Fee
Gas Fireplace Permit Fee
$
$
$
$
$
$
$
$
Your Building Permit When Approved
L/S - o6C
Date
1J e.. j3") (p
/..,.. ,- oP-
Date
Contractor's License No,
Park Support Fee # $
SAC # $
Water Meter $
Pressure Reducer $
Sewer/Water Connection Fee # $
Water Tower Fee # $
Builder's Deposit $
~~ $
TOTAL DUE D 4-/a-oZ- $
7-t:!'!e7
'V(,"'~
I~~
Paid
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
::::~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
t.ijV&!Pz- ~ ~~~ c.~~
' 'p nning Director Date Special Conditions:"rf any
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
...
-'
TfMo c..t.. of tlw t..... C....".F't
CITY OF PRIOR LAKE ~. ~~~ ~~
) y ~Ilo.. Appbc.1ll1
PLUMB~. G PERMIT PPNo.;;(- 38?
Applicant' :;fa". 1ull?)/ n~ hC-. Phone, t-s-- 6r ~.9- !fto
Address: _' ' v. 0.. Co~ 61'0 ~ '11_-0
Signature: (# , ~
Legal Description: LotO~ Block 0 I Sub ~1e1' /;i!j ~ aufh
Sit. Address: &.g~ ~~ ~q ~ C ~
8uildingPermit# ~~-D3,g . PIC#_"----
NOTE: This permit will not be processed without complete information
FIXTURE UNITS
- -
Quantity Type of Fixture Quantity Type or Fixture
/ Bath Tub with or without shower Rough"ins
I ) / -
Dishwasher Water Heater
. ,-
/ Floor Drain Water Sottner
y Lavatory (bathroom sink) / Stand Pipe (washing machine)
/ -
Laundry Tray (1 or 2 compartment sink) Sewage Ejector
'rl. ,-
Shower Stall Backflow Assembly (RPZ, Double Chacko PVI
/ --
Sinks Backflow Assembly Test
/ Lawn Sprinkler -
Bar Sink
-::{' ,-
Water Closet (toilet) Other
FEE SCHEDULE
Industrial, Commercial & Multi~Fami'y
(1% of job cost, $39.50 minimum)
Residential, New One & Two Famlly
Residential, Additions & Alterations
State Surcharge
$99.50
$39.50
$
$
$
$
.50
GRAND TOTAL
$~~
This pennit is granted upon the eltprcss condition that saId
contractor, shall comply (n all respects with the ordinllnces
of the State Plumbing Code and the amendments tre~f.
RECEIPT NO.~ .oA IE
{ . A'IiEST
Call for all inspections 24 ho rs In advance.
,....
I &,Ilt/ PO'..-i..
~~- f'.,:~/,_.
'\._;- r
16200 Eagle Creek Av. S.E., Prior Lake, Minnesota 5.5372 I Ph. (612) 447.4230 / FAX (612) 447-4245
An Equal Opportunity Employer
MAY.10'2002 16:03 651 633 8884
FIRESIDE CORNER
#5502 p.001/0ll
CITY OF PlUOR LAKE
REA TlNGI AIR CONDITIONINGIFIREPLACE PERMIT
Date Ree'd
~: ~~aw ~~~,. I PERMIT NO.;]_ J gill
[~~REs;;:;"d:~ ~. 4J
I I ZONJNG(_~ I
LEGAL DESCRIPTION (clfr.c:e 1oI.e only)
I LOT ,BT..OCK
ADOmON
PIO
(h, ~ O-4")..tUJ Ur.d ,
(Phone)
I OwNER
(Na.me)
(Address)
APPLICANT
(Name) AT.JLIED F!REJ;SIDE DBA F:LRESIDE CORNER
(phone) 65J.-633-2561
APPLICANT PLEASE COMPIJETE BEIJOW
. W CONSTRUCTlON 0 REPLACEMENT 0 AI...!'ERA nONS
FURNACE MAKE AND MODEl.. FTJEl..
FLUE SIZE RETIJRN OPENINGS JNPT.IT OUTPUT
TYPE OF SYSTEM HBA TING OR POWER PJ..AN'I
ROSE.:iIU.F- MN
(City)
651""633-2561
(Pholl,e)
PATE
...5.51 1 ".l
(Zip Code)
(Address) ,2700 N. FAIR'i11EW AVENUE
(Address)
BRENDA HOSTON
(Contact: PersoJ:l.)
APPLICANT SIGNATURE
OWll.lTTl Air Plants
DGravily ,
[] Mechaniclll ,
DAir CcnditJonJng
OVent. System
FIREPLACE MAKE AND MODEL
o Stl!sm
o Hot WO:U:T
o RadiadQn
o Special Devices
o Otller Devii:cs
PLEASE NOTE:
Air Conditioner Units
Cannot En.CToach into
Required SIde Yard
Setbacks
(pd1Jstrial. Commercial &; Multi-Family
FEE SCHEDULE
1 % of job cost P-esidmtial. OIlS Fireplace
5:39.50 minimum
$99.50
S64, SO
$39.50
Residential. Hea,ting &: Ale (New CQIl$O"Uctir.ln)
Residentia.I, Healing Only (New COR!truction)
Residential, Additions & AltCl"ations
ResidentIal, AC Only
539.50
$39.50
Estimated CQat. $
Building Permit #
REA TINO PERMIT FEE
STATE SlJRCHARGE
TOTAL PERMIT FEE
$
$
S
.50
(omte JJre Dilly)
11,js Application Becomes Your Building Permit When Approyed
Paid
Receipt No.
Date
,r';
(
BlIlldlll\: ornellll
Dille
%4 hqllr notice for IflllntlpectipnlJ (9~2) 641-?8!O, fa, (952) 447..4245
__ _ ____.__ ___ _~--_~..:-_ .....J.. rl"\l.U~ L~.:tKr.:
~
t//l0,~)
I~( /11\ )\\
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CITY OF PRIOR LAKE
REA TING/A1R CONDITIONING/FIREPLACE PERl'r1IT
4J 001
D;;;.t~ R~c'd
,1\/ , 0
.:'llc
c;:~
.l..nl:c:."'~
i PE~1\.lIT NO. ,;) -301 j
:. pl"k.
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~l:.2SC CYiJe or ~.:nr ~C:. ~:.~ at oc~~m)
I ADDRESS
.---J IS -I ;)
I ~ Ie
-1.-)/' n ,~
~f0e
AJ-l~
LEGAL DESCRIPTiON (offic~ U~= enly)
LOT
BLOCK
ADDITION
r zOr-'TNG lo:fu:, '",=) I
: I
l I
PID
! OTWNER . .-- (\ ' (\ /-'--7
i (Name) ~~ta /~i', ~ n;,)M,
,.. A ~.A,..c>c:S) . \\. .u : ./ A J~ i \.
~~~- -- _ L) {~ / 'T L l J\
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.-'l.PPLIC;....NT,,.,.--, J )' J 0 ~ ·
(Name) (--D^I77'ol/-r:' (l , CA..!!'
(Adc!:;m) dJ ,:;./lu___-L7i ;1,;~,-) 41 ) 4'.
V.d&.,~)
(?hcne)
~).;):.-- 7(,c i
. (pnone) -4;~J
.__ k-~/A1-
--.'---0' (Ci':).'i
(CO:Jta~l Person)
(?hcne)
,1.// .' . "..:}. ..,
':ft:Ll .- 0(;,,_.... ~:.:~
,~5Ck~.1j
(Zip :::,,&',
~rrA ;ZAt~1
DP.TE
C(-Cd-
_A..P?LICA,2-JT SIGNATURE
-"
~!) -
, APPL1CANT PLEASE COMPLETE BELO\V
~-E-Y/ CONS,!:RU~TON " 0 REPLA~EMENT 0 AL TERATlONS '
HiRN.A.CE MAKE //oiD Mc:,DEL ft"j;.,,~:>ffif1l:r;?Ci41"-' ,C 0,!2E-8 /00 FUEL ~lLr-----
~ --? /:'v )( , r-j
. 'LV:: SIZE ,-) r" ,-' REnJRN OPENINGS __ INPUT ' OUTPUT _____ ,
TYPE OF SYSTEM
HEATING OR POv,'ER PLANT
n Steam
[J I-Iot 'Warei
U Rilcii'llion
o Special D=y:~::s
o O!h=, Devices
OWa;-rn Air Plants
.--, -, ,
LJ l,,,, V I!)'
~ r--1echanic~1
'~ir Condj,iol"_ing
.......E:rY eilT. Syst!::)"7!
PI?..E?LACE l'-iAKE _<'.,0 ,'.10DEL
FEE SCHEDULE
T:-,dusr..iaL COiTi:7.::;C~.f::.i & Mu!ti..r~rr,ily
I % of job cost
$39.50 IT:i'r.~~~!r:
Ke~ici,::~,t~~l. G-=5 r::-~?i~.c~
R~~iG:';:"1ti;.\. r-:~2.-;:L:!g &. .i..~!C: C"~\~,, C~r;s":;;Jc~i:::n>
S9S'.5'::,
::l:::s~d.-::~:~::.j~ /.ci:'i;::i:).;s. f:~: .c:,-!~-::~!'.":;-:c:~
~ . > .
7: !~..::: .~ 'j:,:".',
~'?:~;:--:~ (";"';;~J (:'-}"":".).' C":"~;;.S'~""J.:.:r,:".:-:.::
-;'.:...r:.. --;...,
::':'''':':::~:-_''''~?~. [:.(""' ,....)-.
Es::r:;::.t:=.d C~'5: S
BJiid~:J.g rcrm1t ~
HEA TING PERlv1IT FEE
ST,L.TE SURCH.ARGE
TOTAL PERWT FEE
s
.50
.,.
-:,
s
[O~c~ tJ;t Or.ly::
\ I
. I
I
I
i PLEASE NOTE:
I l~jr Conditione:- Unhs
j Cannot EncToach iiit"
i
i Regui.~d Side Ya,ci
I Setbacks
L--
; I
--,..---!
5:30',50
::-.;::i ,')J
c; ,,/" '", !.
--, ,
r3.2~
~e::el?t, No.
I This Application Becomes Your Building Permit \Vhe:l Appro....d
j
L
:au~lding omciR:
D!le
2~ hour notice for ~II inspedihns (9::2) 44"7-9850, ra~ (~52) ~7~::45
3y
17
100~
HIV mrTlOH.LNO:::>
9LZ909tlS9 XV~ SZ:91 ilH.L ZOOZI60/S0
From JECHEEXC
PHONE No.
612 8926396
Rpr.292002 6:07RM P01
"
','
CITY OF PJUOR LAKE
SEWER AND WATER PERMIT
Date ReCl'd
i,
:: =w ~~: fI'ERMlT NO. ~--<3KJi
J, 00" 4,pll..... .
I I~O(_~!
LRGAL DESCItU'TION (olftr.r. lUr ullly)
LO ) nLOc.0 ADDITlo.d1.:rl /~, S' () I . PlD
~~~R . ~..__.. .... ...... _ (;~o..) q;:-~;;{'J("Q-I;]
(Add..,,) ~T~~ .----.!1~ '/Lllff:J<.JfW;~~lit'rl~- ..... ~
'k:, 0,... (Acldrcu) "_~'_~ ~eilY) .:',.,'~ ,"'l:'~"~""..'~:""".' (ZiP-Code) "
~,._...._-,~...-
~ - . I .
-
APPIJCANT-r- I E
(Name)' ", . .J,~ I\e... ~ ~ _'._
(Address) ~JQ ~~:_..
(Address)
--------.....---...... ...-
"
(Contact Person)
APPLICANT SIGNATURE
(PIlODe) "(01 va 7 '1 ~
glf)()m;~+6h MAl Iili-4 I
( it)') (Zip Code)
fJ I~ ?~ 0 7'/~~
(Phone)
DATE
APPLICANT PLEASE COMPLETE BELOW
Size of water service .~ inches.
Loclltion of any eoupJings from Slructw'e feet.
o Type of sewer pipe. 0 ABC. 0'Pvc 0 Cast Iron
Estimated length of Sewer line Z- feet.
Clean out (ifrequired) located at __ feet from structure.
Residential sewer Gnd ~ater line connection $35.50
SeWer connection only $17.50
E$tilllLJtl,ld Cost $ .7 Z] ()
11'EE SCHEDULlJ:
Industrial, Com'l & Multi-family
Water conne~tion only
1% of job Clost with a $39.50 minimum
$17.50
Building Permit #
SEWER AND W A'rER PERMJT FEE
S')'A TE SURCHARGE
TOTAL ~ER.MIT FEE
$-..,
$-
$
,5Q
lomce tJall Only)
:'. AP:",::~::::::O==i1::::h,n AP~'."d II:::~ dJ ~ =f~:~ ~
24 hour nQ.i~., f';>r' 1111 inSrl/lc(lon, (952) 447.9850, rllx (95:2) 447-414!11
.J
..
White - Building
Canary - Engineering
Pink - Planning
Tht> Crntrr of Ihe Like Country
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
" . - "~.
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
<- ./
'--
Accepted
Accepted With Corrections ~
Denied
~
. "e'/~
Date:
'-/ (1$;./02--
Reviewed By:
"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."
White - Building
Canary - Engineering
Pink - Planning
Thf' ("enter of rhf Lakf ('ounlry
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT ~/J1 tL&n~4! ~
APPLICATION RECEIVED 1./- ~ -CJ~
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
~RL/S- W~ L~
Accepted
y
Denied
Reviewed By: Q.f) tJ1~ '/ ~
Comments:
_62~ ~ aifCLG-kece ~ ~-f-s
Accepted With Corrections
Date:
t/- 8- RcxQ
"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."
....~'I
White - Building
Canary - Engineering
Pink - Planning
lh. ('.nl., or lh. I..k. ('ounlry
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT (7;1cP.JSb.ncV?L!? ~o:;;b=--
APPLICATION IiECEIVED' Lj- d. -O~
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
SRL/~ W~ l~
Accepted
Denied
x
Accepted With Corrections
Reviewed By:
/---1
(t!!!~
Date:
L/-/o-O,.{
Comments: See Reverse Side for Additional Information!
Driveway Mllst Have Concrete Apron
~ee 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
ordinances of the jurisdiction shall not be valid."
\,
OAEU . flU
'fIlU,OW . APPlICA.T
GOl.D . en.,
CITY OF PRIOR LAKE S.W. No.
SEWER AND WATER PERMIT
NOTE: Sewer and Water
contractors must
be registered
with ,the City.
APPLI 'ANT:f11efJfI')"J;) a~/
ADORE S: ?~ I / L.I-.rJ - ~ T (.,(.,,,p. s ~ .
SIGNA' IURE:,,-1dJ (l~
SITE , DDRE~ ~tcr f..u:IJ~ he-- fit V
FILL 'IN THE BLANKS
-\
',1
PHONE-t;.Jj. 43;' - ?GO I
DATE: tt -'- - 0'1....
BLDG. PERMIT #
PID#
1. E: timated length of water service
feet.
2. S ze of water service
inch(es) .
3. L cation of any couplings from structure
feet.
4. I pe of sewer pipe. ABS PVC Cast Iron____
5. E timated length of sewer line
feet.
6. C' ean out (if required), located at
5 ructure.
feet
from
===== ==========~~~=============~=================================
This. pplication b~comes your permit when approved.
BY DATE:
=====: ========~============~=~~=~=================================
FEES:
$
$
$
35.00
.50
35.50
Sewer and water line connection permit.
Surcharge
TOTAL
* f e for either sewer or water individually is $)1.4D plus
$ .50 surcharge.
* S wer and water permits issued for new construction must be
r corded on the buildin9 permit card at the time of ~ssuance
t I insure that no dupllcate sewer and water permits are
i sued. _
DATE 'AID
RECEI IT #
AMOUNT PAID
REC'D BY
16200 Bagl : Creek Av. S.E., Prior Lake, Minnesota 55372/ Ph. (612) 447-4230 / FAX (612) 447-4245
. An Equal Opportunity Employee
T1" - ?F,- ?nnV1 1 C;: ;xl
F,1?4474:>4C;
97%
p n1
O)-3Cd7
White - Building
Canary - Engineering
Pink - Planning
The ('("nfer of the Lab COURIf)"
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
, I
NAME OF APPLICANT \'7:;?-1 rL! /\'(771cJ!/{:
APPLICATION RECEIVED Lj- ,;< - ();L---
/~ .
}:L!r/ ,--/--
/ " '<11 -'1, 'I/'---'
,_ /( lot'
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
. ,
c) ~:; L'/S-- ,i V .-L~t~/~Z::.} / r-:;!/r-Y--
j -'~
Accepted
x
Accepted With Corrections
Denied
Reviewed By:
fl#fB
Date:
L/ -/0 -a,.(
Comments: See Reverse Side for Additional Information!
Driveway Must Have Concrete Apron
~ee Attachments: 1) Grading Plan, 2) Erosion Control Mea"sures
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
ordinances of the jurisdiction shall not be valid."
PRIOR LAKE
INSPECTION RECORD
L.)l\&s ~.
DEPARTMENT OF
BUILDING AND INSPECTION
SITE ADDRESS ~c.JI~
NATURE OF WORK (1~t.l1
USE OF BUILDING SFD
PERMIT NO. ~~ DATE ISSUED c/- 8 - .;(co';;(
CONTRACTOR' PHONE ~.l/'c~0{-7~o/
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
FOOTING
FOUNDATION (Prior to Backfill) ~ {)J... 4: ~(" "'\ ~
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
SEWER I WATER I SEPTIC
FRAMING
INSULATION
ELECTRICAL
PLUMBING
HEATING (if required)
FIREPLACE
GAS LINE AIR TEST ( ei 10-;
COVER NO WORK UNTIL ABOVE HAS B
I
FINALS
b ~;L Va
EN SIGNED
I
GRADING (Prior to Sodding)
BUILDING
ELECTRICAL
PLUMBING
HEATING
DO NOT OCCUpy UNTIL ABOVE HAS BEEN SIGNED
NOTICE
This card must be posted near an electrical ser~Jice -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