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CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
ADDRESS
JcfJ"J.
LEGAL DESCRIPTION (office use only)
LOT
ADDITION
OWNER
(Name)
/Vb)
f:(''!)
I. White File
2. Pink City
J. Y cllow Applicant
~-- / '--I--c>d--
I PERMIT NO. OZ - 0 fR P1J
ZONING (office use)
f<1
C' r e.r ,~
PID..25-- 3.it ""06 ., 0
(Phone)
(Address)
BUILDER
(Name) tJe /\If Jn~l'/'V/v
G(7.~y
/
'F 7 S' ~ ~ 2 6~.
(Contact Name)
(Address)
TYPE OF WORK
JJ" rn ~.J'
j) " - ~I-I
o Misc.
o Lower Level Finish
ew Construction
ODeck
o Fireplace
(~
(Phone)~/- Y'6' .yYuv
(Phone)" I,,). - :J " 7- 7// / :J-
/IJ
q/v
o Porch
OAddition
ORe-Roofing
ORe,Siding
OAlteration
OUtility Connection
PROJECT COST /V 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 i~cordance 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(tesignee may
enter upon e property to perf! m need inspections.
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
0--
$
$
$
$
$
$
$
$
our Building Permit When Approved
5' ..- 23-02--
Date
J Y' .>- ,:J-
Contractor's License No.
r-/~02-
Date
Park Support Fee
SAC
#
#
Water Meter Size /8 ; 1";
Pressure Reducer
Sewer/Water Connection Fee
#
#
Water Tower Fee
Builder's Deposit
Other
TOTAL DUE
~:~ -f3tJi/6Y
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, L J ., -'" ~ , - , U (
~~- S/~~/~2- ~ ~onditions'ifanY~tw\.,
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
1DIZ~/Ol WEO 11:Z2 FAX 6124474245
CITY OF PRIOR LAKE
~OOl
D.te Rec'd
CITY OF PRlOR LAKE PLUMBING PERMIT
l~~DUs5P;~';~~ ~~ %~
;, ~~ ~:~ I.I'ERMITNO. I... /'011
',1.1'- .''''<'''1, ~ /' (j;;/ .
I I ZONING ,-.-> I
LEGAL OeSCRIP'I10N (gffia: ilK anb)
LOT t BLOCK \ ADDITION
~~T
PlD
O'WNER
(Name)
(AddrI:SS)
(phone) b.5)-LfO' -WOO
Y'\ \t\ f\, ~J 2'::L
(Phgnt) g/ -fs2-/Si.
lVW\ ~ S5l ;;2 J
CZip C~)
(l'hc~) t.sl-1s;2. -15/:;S
DATB 5L e;L.
(Address)
(Canraa PelSOn)
Type Df btarll
JiEE SCHD)ULE
'"dUSlriBI. Cl:lmme.rcllll /I; MuJtj-fmlll~ J % ot jab ,g5t with a lJ9,~D minimum
Residmtial, New One: & Two-Family ~99,50
iUsidl:J1Lilll, Aclditiana a AltUllLions 139,SO
Estimm:d Cgst S
Building pmnit 1J
PLUMBING PED1fiT fEE S
STATE5URCHA~GE S
TOTAL PDlMII'RE $
.50
f
'. P.'"
...r~uffui;\,:. " ;
...............-. '~"" J
lomcw 1.).( aBly)
Thill Applic:IIlion Bcetllmc:s Your BlIiJdins Permit When -'JIIprQud
Julldlne ODlci.1
a~
5 ~ Receipt No,
By
PaId
Dale
%4 beloll" uQtiClilfar 1111 io.ptc:tlUG. (":j "7-~~, till. (952) .w,...u4S
l \ d vg2l g8l9g8 'ON/08: 60 '18/88: 60 20 ,22 'gO (a3M)
WOHd
--
t
aR<<b . P1l..I!
Tl!.UD1I/ " _l't.Jc:......,.
~D ' CZT'1
C!TY OF P~IOR LAKE
SEWER AND WATER ?SRl'!IT
'} - G 01
NO.O<
NOTE: S~~e~ and Wa~er
contractors :must
be !:e'~i.$tered
yith the City.
APPLICANT: ~ ~~ FHONE:tJSn9-rJ~
::::~.:~~~:~~~_.~;===::::~~~~=
4.
F!LL IN THE B~~~S
Es~i:r!le.tec lengt!'1 of 'Jater service <) 0 feet',
Size 0= water se=vice / inc~(es). UM\^
Lo~atio~ of any co~plin~s from s~=~c~ure~feet.
~~pe of $~we~ pipe, ABS PVC~ C2S~ Iron____
Es~i~a~ed l~ngtn of $ewer line ~C)
1 .
2,
J .
6.
Clec.n O\.1t
s"::='..1cc:u:-e.
(if
re01irec::.) ,
locat.ec.
fee~~Ja '
at. ~feet
from
5 .
~~~=~~~~~~~~=~~==~~===~=~==~~~~:=~==~~~~~~~~~~~========~~===~=====
Th~s a?~licetion becomes ~o~r pe~~t ~hen a?provec::.,
BY
OAT:=::
;~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~=~~~~~-~~=~~~-~~~~=~~*=~~~~~=
F"::"':"<:-
-~- .
S
5
S
35,00
.50
35.50
Se'Jer and ~ater line connection pe~mit,
Sur~harge
TOTAL
~ Fee fo= eit~er se~er or ~ater individually is 520.00 plus
5..50 s".J:::'charge.
* Se~er and wate= pe~its iS$ued for new cons~ruction must be
reco=ded on the buildins permit ca=d at the time of issu2nce
to i~sure that no ~u?licate se~er and ~2ter pe~its are
iss~ec.. .
D)..'!'~ ~.:;:lJ
P.!10UN'!' P,'\ID i ,':1 .....r!:,~~_~
llEC'O BY C:::>d"""'f:o_ J
R;=---=-i'':l'''' ~
-\...,,--- - ~
. ,:""''-r ~,~'.. -......__- .=."! 5."S.. "0--:,...... T ,~x': '-'r:.........~~."'~r: :::-: ''''1.., I'::' ~\ .~-r-!."2::f) I F,~,Y. f~'-:\ ~'*:_~~~..l~
Gl d tgGlg8l9g8 'ON/08:60 '18/88:60 GO ,GG 'gO (QjM)
WOHd
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
~. ~e~n ~::y I PERMIT NO. d.. - (PO?
3. Yellow Applicant .
ZONING (office use)
3852 REGAL PASS
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name)
WENSMANN HOMES
(Phone)
(Address)
APPLICANT
(Name) ALLIED FIRESIDE DBA FIRESIDE CORNER
(Phone)
651-633-2561
(Address)
2700 NORTH FAIRVIEW AVENUE
(Address)
ROSEVILLE
(City)
(Phone) _651-633-2561
55113
(Zip Code)
(Contact Person)
BRENDA HUSTON
APPLICANT SIGNATURE
BRENDA HUSTON
DATE
8/5/2
xD NEW CONSTRUCTION o REPLACEMENT o AL TERA TIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
OWarm Air Plants o Steam PLEASE NOTE:
OGravity o Hot Water Air Conditioner Units
o Mechanical o Radiation Cannot Encroach into
OAir Conditioning o Special Devices Required Side Yard
OVent. System o Other Devices Setbacks
FIREPLACE MAKE AND MODEL HEAT N GLO 6000TR-OAK X 2
APPLICANT PLEASE COMPLETE BELOW
Industrial, Commercial & Multi-Family
FEE SCHEDULE
1 % of job cost Residential, Gas Fireplace
$39.50 minimum
$99,50 Residential, Additions & Alterations
$64,50 Residential, AC Only
$39,50
Residential, Heating & AlC (New Construction)
Residential, Heating Only (New Construction)
$39.50
$39,50
Estimated Cost $
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
Building Permit #
$
$
$
.50
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid
J."I",.,.
1.J, .'!3c::J t'\ ..
LI. "", ~'- ""
· -,.,.,l ~':- {. 1 J
Receipt No. . , '....
Buildine Official
Date
- 5 2002 By
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
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Thr \rntrr of Ihr Lake Counlry
White - Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT !4-J P1t.C011tVY~ ;J~~
APPLICATION RECEIVED ..iJ - J 1-/-;;2.....
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
,3 9');;(_ 7::e<r~1 fJ~
Accepted
Accepted With Corrections Y
Denied ~ II (f< . J
Reviewed By: i.JL--t; ~~ Dale: )- 23 -(jL
Comments:
~(i& c&Q ~ ~ckw{, ~ ~~
"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
The Cf'nler or the L.ke Country
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
"t.;.:"
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
Accepted
~
Accepted With Corrections
Denied
~;, ~-<",d'~
Date:
-5/23 /0:L
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
Th~ (-~n.tr o~.'lhe Lake Counlry
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT Ii) JV}1/JA0~ 1f~ Ji9-J-1U ~
APPLICATION RECEIVED ..5- ) 1/-;;2..
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
- . ,-......') '/j
,:.:s 9,5 ~~ -A~c;a..l /~{4J4/'
/
Accepted
~
Accepted With Corrections
Denied
Reviewed By:
I)?JE
Date: 9.:?7-t:J2..
Comments: See Reverse'Side for Additional Information!
1Ylc,"n ,=,.{ c
See Attachments: 1) Grading Plan, . 2) Erosion Control Mea~.ures
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."
CITY OF PRIOR LAKE PLUMBING PERMIT
/) II/Ph .7 l# 61
1YfY~O
~o
D1e r'd
r!r /0'-
I. Blue File
2 Gold City
:1 Yellow Applicant
I PERMIT NO. () z-II/ ~
(Please
ADDRESS
ZONING (office use)
~) yo ;2
GI (';'I L/ /1fCr?
/ lL4/ /
,,(j ()
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
I OWNER
(Name)
(Address)
~E .r- 5/YJI}~'/
(Phone)
APPLICANT A/I /!
(Name) / j/ I /)C Il {' -6 /t1i! DI?C
b' '?'2,r .} (.. 11) /1/ C
(Address) I{ j -; ./10 ..",L. '19 . I-f VC/
(Address)
4/.lYJe-Y(
7{;/
(Phone) I '? ,-
f'li 'toIe('nll'
(City)
(Contact Person)
(Phone)
J z,q ~;2~"".;2 J
>--')57/
(Zip Code)
76 '5 .- ;21'6 "c5/VJ-
<f - 9- c ;2
APPLICANT SIGNATURE
DATE
/'
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher Water Heater
Floor Drain ./l Water Softner
Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
Laundry Tray (lor 2 compartment sink Sewage Ejector
Shower Stall Backtlow 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 Penn it #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL E IT FEE $
.') ,-
'~1. "\ 0
.50
4-0 -
Paid
. 40.
Receipt NoA-, ._
, X)'z. '"'
By
(Ll) It
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714
PRIOR LAKE
INSPECTION RECORD
DEPARTMENT OF
BUILDING AND INSPECTION
l KC(.\,,^- {.1p
SITE ADDRESS 3852 Re.~ ~~':>~
NATURE OF WORK JJ ~
USE OF BUILDING S ~A
PERMIT NO. 02 ....0&07 DATE ISSUED 5-2s....0L
CONTRACTOR IA)~~\A-- ~~ PHONE{qrz.-~7-7~()__
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
FOOTING K.
FOUNDATION (Prior to Backfill) (0 - (8... 0(.
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
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I I
FINALS
7 - 3/
~~
"t J 'z '3 ~6 '-::/
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 inspe9tions have been approved. On buildings and additions
where no service cabinet is available, C~lrc:i shellJI be placed near main entrance.
Call between 8:00 and 9:00 A.M. for all inspections
FOR ALL INSPECTIONS (952) 447-9850