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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
~-Pl-OJ-
~
I. White File
2. Pink City
3. Y cllow Applicant
I PERMIT NO. aZ-o'OIO
<, I
rcu.
LOT
LEGAL DESCRIPTION (office use only)
BLOCK 3 ADDITION ~ II../ C( f'I j 0o.d-.. if fA.
OWNER ~
(Name) ,-J I VV"..
(Address)
33
BUILDER -1./ '
(Name) tS::... I h lj
.---:--. .
(Contact Name) / J "."
(Address)o?o g
TYPE OF WORK
o Misc.
G r c..Y'\6j e r
.-.....
fV1 c.. )-<-- J r 0..1(
~-es>
KJr-,~
'1() ~ ~I
ZONING (office use)
rS_O
-()
(Phone)
q$~- '/'/7- 57 3cl
$
$
$
$
$
$
$
$
Water Meter Size 5/8"; I";
Pressure Reducer
(Phone) 6/.2- ?s/- ~;2 S ,}
(Phone)~ C;~"'.)- 'I'I~-hOf3
.~. Co' /J1 Ai_
o New Construction
ORe-Siding
OUtility Connection
000. 00
ODeck o Porch
o Fireplace ~
ORe-Roofing
OLower Level Finish
OAlteration
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 upo~ prope~ to p;rf~ nee~ed inspections.
X /I(~~ ~~:::l ='''9-2 f/;;)/~2.,
Signatu e Contractor's License No. . ~te
Permit Valuation
Permit Fee
Plan Check Fee
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
Sewer & Water Permit Fee
Gas Fireplace Permit Fee
PROJECT COST /V AL UE (excluding land) $
Park Support Fee
SAC
Sewer/Water Connection Fee #
Water Tower Fee #
Builder's Deposit
Other
TOTAL DU
-' 3-0'V
s Your Building Permit When Approved
t., - 2t;; -OZ
!paid 3~~
Date _ - 0 ~
I ~?38~
Date
#
#
$
$
$
$
$
$
$
$
$39~. 4-~
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 sign by the City anner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy. a Certificate of Occupancy must be
issue
___:_ _.c-
7/J-/O;?-- ~ j~-t- O-/'"L~~eQ C~L~;\~1~,-
Date ~e(~1 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
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
I. Pink File
2. Green City
3. Yellow Applicant
['(-.,33
LEGAL DESCRIPTION (office use only)
LOT
BLOCK:5 ADDITION (j)<<tla
t:f::..
OWNER
(Name)
- -.J"--l W\
6 RA~4E/C
o
PIDckS~/.3~ O;2~ 0
0',
/u .
(Phone) 9Sd. - s/Y 7 - .5 7 39
(Address)
APPLICANT
(Name)
'1
2, ';;- 0'"'
, ,r5 (AJ)
(\ ~v
(Contact Person) ',~ , Q
APPLICANT SIGNATUk" .
I
\\/
{I
(Phone)
(Address)
(City)
(Phone)
DATE
APPLICANT PLEASE COMPLETE BELOW
(Zip Code)
ONEW CONSTRUCTION o REPLACEMENT o AL TERA TIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM REA TING 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
Industrial, Commercial & Multi-Family
FEE SCHEDULE
I % of job cost Residential, Gas Fireplace
$39.50 minimum
$99.50 Residential, Additions & Alterations
$64.50 Residential, AC Only
Residential, Heating & AIC (New Construction)
Residential, Heating Only (New Construction)
Estimated Cost $
Building Permit #
HEA TING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$ 3 q:;c
$ .50
$ liD
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Paid
d--
Date
Building Official
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
$39.50
$39.50
$39.50
Th(" ('("nIN or Ihe t.ke Counlry
White - Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
.~ ."" .,.-
.-'
l'
/,,~- ~_._....,/"
. -,~"'~,.,
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
,,/
.:' ..-........
Accepted L /'
Accepted With Corrections
Denied J /l
Reviewed BYC~4-y~~~
co~mrt1en=-_ n
-'Vq~ ~ ~M(.()
f/ ~
Date: 7/7-- /0 J-
~~'v~ {~t1~1,
"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
Thr Ctnlf'r of Ih(" I..kt Coun'r}"
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT cp~ 4- -1~~
APPLICATION RECEIVED ~- c9-1 ~ ;)
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at: \
Ill? 3',~ mUfJ-fl' tJjLJ
Accepted
Accepted With Corrections--X
Denied ~ 12 9.
Reviewed ~ v+---
Comments:
----Llpr:OQ}~ Q SV\tVok j::kk~j~
Date:
& ~2~--CJ( /
~cJ~Jn..1 ~ tk~
"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 PRlORLAKE
Impervious'Surface Calculations
. . .' (To be Submitted w'ith Building Permit Application)
For All Properties Located in the Shoreland District (SD). .
The Maximum Impervious Surface Coverage Pennitted in 30 Percent.
-----.=-- ~ -' '----~3'Q
r;,uJ:-_.I.) nw.GJ.C;;:-.) .
~~ \e ~o..'~
Lot Area --1.z:W.::IlP ... .. .. .. . Sq. Feet x 300/0 = ..............~~~ .
........................................................................
- ..
- :~
. LENGTH
WIDTH
SQ. FEET
HOUSE .
.~
ATTACHEDGARA.GE
. ~
'l
x
==
x
::::
x
::::
DEI ACHED BLDGS
(Garag€he~
TOTAL PRINCIPLE STR UCTURE...................... -D \ 0
eX\\o
x
l~~
D~EWAY~AVEDAREAS
(Driveway-paved or not)
(SidewalkIParking Areas)
TOT AL D ETA CHE D B UlLD IN GS.. ............ ......... I '2. ~
\ ~ X S1P5
x
.= -990
=
X
=
PATIOS~ORCHESIDECKS . ~~
TOT AL P A YEn AREAS......................................... q'lO
(Open Decks y." min. opening between
boards. with a pervious surface below,
are not considered to bt: impervious)
, 11.... X \ 'ft
X
.-C.or.t.fc.k _
=
:::::
\ q "2.
X
'2. -'lD
:::::
OrnER N~ &~~e'
'. ~c ~"T"i c.~
TOT.'-\L DECKS........................................................
1.l. i . X 'Z.'-{
X
L\StO
=
'S\~
TOTAL IlYIPERVIOUS SURFACE
TOTAL OTHER...................................................... ~ 1.1
[3~ ]
[ 1$3 ]
\ (:) - 0"2.
PRIOR LAKE
INSPECTION RECORD
DEPARTMENT OF
BUILDING AND INSPECTION
SITE ADDRESS I'/(.~~~ \[h,..: _(
NATUREOFWORK ~;h ~A0
USE OF BUILDING >1 Jt
PERMIT NO. :j':/fIO DATE ISSUED ~_ 2r.,-dL
CONTRACTOR f<; ~ PHONEMl:' . ~ ,) }!jl
NOTE: THIS IS NOT A-PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT G.IZ-'X"! -(,:2 '5J
DATE
FOOTING
FOUNDATION (Prior to Backfill) 7, 1'7. 0 Z-
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING
INSULATION
ELECTRICAL
'vvr
ctr- ~
1-k- OL
~~ '02
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
1 I
FINALS
~
lL
DO NOT OCCUpy UNTIL ABOVE HAS BEEN SIGNED
NOTICE
This card must be posted near an electrical servIce cabinet prIor to rough-In Inspeellons
and maintained until all Inspections have be4jtn approved. On buildings and additions
where no service cabinet Is available, ca;-d'shall be placed near main entrance.
FOR ALL INSPECTIONS (952) 447-9850