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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
I White File
2. Pink City
3 . Yellow Applicant
5/ JL/~
I PERMIT NO.(J.~ -S9fc;? I
ADDRESS
ZONING (office use)
Ii 10 '3 ~
LOT
d.. lVd
PIDd.S"" -
s--()
=R D tz./ Pr.N C 1000 v'\/ /,0
(PJt.Otl~ q .;).. - J.- ~ ~ .. 0 ~ J... ~
(Address) 14-0'~"(
~L vat?:;,iZI:.J -TI<... /V C
/Y'j.-V
BUILDER
(Name)
(Contact Name)
(Address)
~(' ,"'"
()'-v IV e r-z
(Phone)
(Phone)
TYPE OF WORK
o New Construction
~Lower Level Finish
ODeck
o Porch
ORe-Roofing
ORe-Siding
o Fireplace
OAddition
OAlteration
OUtility Connection
o Mise.
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 upon t roperty to perform needed in ections.
Permit Valuation
Contractor's License No.
~'-^/-o}
t'. ....
~~:>i~~ a.
x
40.0
TOTAL DUE
#
#
Permit Fee
$
$
$
$
$
$
$
$
Park Support Fee
SAC
Plan Check Fee
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
Sewer & Water Permit Fee
Gas Fireplace Permit Fee
?.oo
Water Meter Size 5/8"; I";
Pressure Reducer
Sewer/Water Connection Fee
#
#
(fO. DO
Water Tower Fee
Builder's Deposit
Other
S -Z{--c5C-
I Paid
Date
/l_Oj!;2--
I ~;1't-
~~I e)~
r Building Permit When Approved
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
'hen 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
led.
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 Date Rec'd
HEATING/AIR CONDITIONING/FIREPLACE PERMIT &_ /.s-02-
. 5f~
~. S:w E~ieanl I PERMIT N(, 0 l- - P 5f! I
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNE~ - _
(Name) ~Y'\ Gncx:ltArc /y,
\
(Address) \'-\03~ ';vd 'TJlCUJ JUf.
(Ph~~) .9S) - X-S<1-8L/L/L/
dress)
(Contact Person) ~(\~l/\- ~VW\~c..~
APPLICANT SIGNATURE ~) ~
(Phone) ~llP3-3IS-7S00
m SSLJ<..JS
(Zip Code)
(Phone) "LP3 -31 S-7<SJlp
DATE &//.:J/O;)
APPLICANT PLEASE COMPLETE BELOW
ONEW CONSTRUCTION 0 REPLACEMENT AL TERA nONS
FURNACE MAKE AND MODEL J1UEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM REA TING OR POWER PLANT I
'. OWann Air Plants
OGravity
o Mechanical
OAir Conditioning
OVent. System
o Steam
o Hot Water
o Radiation
o Special Devices
o Other Devices
PLEASE NOTE:
Air Conditionet Units
Cannot Encroach into
Required Side Yard
Setbacks
FIREPLACE MAKE AND MODEL
Industrial, Commercial & Multi-Family
FEE SCHEDULE
I % of job cost Residential, Gas Fireplace
$39,50 minimum
$99.50
$64.50
$39.50
Residential, Heating & NC (New Construction)
Residential, Heating Only (New Construction)
Residential, Additions & Alterations
Residential, AC Only
Estimated Cost $
\~.oo
Building Permit #
$39.50
$39.50
fRIO ~~p
t5 ~JI V
(Office Use Only)
HEA TING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
3Q.so
.50
Yr'\.OO
This Application Becomes Your Building Permit When Approved
eI7kt- 19 ~ 1]-02-
Duilding Official
Date
-IJ -0 z,
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
PRIOR LAKE
INSPECTION RECORD
&~6cd~
F~~~
DEPARTMENT OF
BUILDING AND INSPECTION
SITE ADDRESS /l/tJ3/5
NATURE OF WORK L- L
USE OF BUILDING ,5 F
PERMIT NO. /)~q& DATE ISSUED s- ~W/~D.;A..
CONTRACTOR A~ e~ PHONE d 33- CJ2};;z.-3
NOTE: THIS IS NOT A PE MIT FOR ANY OF THE INSPECTIONS BELOW.
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR
DATE
~ I
I I
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING
INSULATION
ELECTRICAL
PLUMBING
HEATING if required)
FIREPLACE
GAS LINE AIR TEST
. P.
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I I
FINALS
BUILDING
ELECTRICAL
PLUMBING
HEATING
DO NOT
/2,.
l
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 shali be placed near main entrance.
Call between 8:00 and 9:00 A.M. for all inspections
FOR ALL INSPECTIONS (952) 447-9850