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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
(;, -~-{)2-
~. ~i~i~e ~:~y I PERMIT NO. ()? -0/83 I
J. Yellow Applicant t,..... lO ,
C!--tJve: 7JZA /L-
{!49 NO
ZONING (office use)
elS 0
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID2f';>-v2-7- 12/5-0
OWNER
(Name)~f2-AH ~ DA01G;L BA)lTh R-
(Address)
BUILDER
(N ame) (Phone)
(Contact Name) (Phone) ~
(Address) I --------
,
TYPE OF WORK o New Construction ODeck OPorch ORe-Rootl lug ORe-Siding
OLower Level Finish o Fireplace OAddition ~Iteration OUtility Connection
o Misc. 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
auth ed 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
submitte lans. 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 up pro rty to perform need nsp tions.
X
Permit Valuation 5
Permit Fee $ II .2....
Plan Check Fee $ 72.
State Surcharge $ 2.515
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace Permit Fee $
Contractor's License No.
Park Support Fee
SAC
#
#
Water Meter Size 5/8"; 1";
Pressure Reducer
Sewer/Water Connection Fee
Water Tower Fee
Builder's Deposit
Other
#
#
b-G-~()d--
Date
$
$
$
$
$
$
$
$
$
s Your Building Permit When Approved
TOTAL DUE
(;. 7-07--
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
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.
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
Planning Director
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
1"' 'b 'f..-p z.....-
I. Blue File I PERMIT NO I
2. Gold City . 0 z,., (J / ~
3. Yellow Applicant "ClJ .
ZONING (office use)
ADDRESS ,
5 1) 9(P
CapJ
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name)
D4N' ,~
$ ~ y(,
o~~
~}l~
(Address)
APPLICANT
(Name)
Llt.
fr~
"Q.r PI""", b~
(, ~'11 I 'I ) \tk. ~}- I-J
(Address)
(Address)
(Contact Person)
APPLICANT SIGNATURE
(Phone) 'f S J. C( t/ 7 - 'JOa
~(. ~. S~j)
(Phone)
LJ.
(City)
1~;)-
f"1-'
'ILl) 86p-,
5S'/~~
(Zip Code)
(Phone) t) P- :7, C
DATE
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
-S Bath Tub with or without shower Rough-ins
I Dishwasher Water Heater
J Floor Drain Water Softner
J Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
I Laundry Tray (lor 2 compartment sink Sewage Ejector
J Shower Stall Backflow Assembly
, Sinks Backflow Assembly Test
Bar Sink Lawn Sprinkler
I Water Closet (Toilet) Other
FEE SCHEDULE
Industrial, Commercial & Multi-family 1% of job cost with a $39.50 minimum
Estimated Cost $
PLUMBING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
(Office Use Only)
This Application Becomes Your Building Permit When Approved
B.k!~ ~'~,.~
Residential, New One & Two-Family $99.50
Residential, Additions & Alterations $39.50
Building Permit # 02.. ,0(,87 JI
o is I
~ ~~ f(Xt ()~.
V lltl
By
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
White - Building
Canary - Engineering
Pink - Planning
The ("t'nler of .hr t..kf Counlry
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
L5Ayn;;e~
,
0-(c--OZ-
,
DANieL- " LJ &:7;o.efir/
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
549& GP7/Vot( e-oV6 '7JZA/L- .5~
>(
Accepted
Accepted With Corrections
Denied ~
Reviewed ~)djk
Comments:
I, Ptou ('ClCL ~l.+-~ "~l .(:','Co.t\....c.M.. -tor 5' aM"~ ~ + 164 e k -h:::> AL. UtA. " /-
4-0 P~(Ur7 (,~
Z~ kk 3~C)~ M.QJo~ -fl.N~ dJ ~ ~~
Date:
6 .-- 7-0;:>
"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
DEPARTMENT OF
BUILDING AND INSPECTION
SITE ADDRESS S~(1UJ C~ ~ 7)
NATURE OF WORK Iin.+e.1'"oor A\~'c.Jv...
USE OF BUILDING ~FD
PERMIT NO. {)Z ~ 0& tl.3 DATE ISSUED G,.(P -OL.-
CONTRACTOR _'D.e\c~~ ~-\-Qr PHONE4J. tI,/O-1a!30-H. t.1C/7~fD70~
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR
DATE
.....
I I
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING
INSULATION
ELECTRICAL
PLUMBING
~'t al,
.1.
62---
v
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I I
FINALS
5 · 1M: "" S..~ bc.Le....
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 ~hall be placed near main entrance.
Call between 8:00 and 9:00 A.M. for all inspections
FOR ALL INSPECTIONS (952) 447-9850