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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
1 White
Pink
Yellow
File
City
Applicant
I PERMIT NO. CC) ...g~
KCU-SH...(; h,~ .AvE Nf
. .Z...t)-'l L.u./il nil-'- 55572
ZONING (office use)
05-8'
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER L~~ (.< L~Hi9L t~l P '15'1 - '1'15- 2s"YD
(Name) (Phone)
(Address) rS~5.o lL6-~( "'-~ it f.... E- ;\J'c hUh<-lrll!i; iVi II '- ~s ~ 72-
BUILDER
(Company Name)
(Contact Name)
(Address)
f!: I Di.l' "" 1.~ 1 '1);' ~"""'~~v
I E1> \U..WJA~
~USL ,tji:- (Phone)
(Phone) '1 S Z.'- c.fS c.j '- (;'1.) 2'>
TYPE OF WORK 0 New Construction
OAddition OAlteration
CODE: btII.R,C. DI.B.C.
Type of &nstmction: I II III
Occupancy Group: A B E F H
Division: I 2
eck OPorch ORe-Roofing
OUtiIity ConnectIOn
ORe-Siding OLower Level Finish
o Fireplace
o Misc.
IV V A
I M R
3 4 5
B
S U
PROJECT COST /V ALUE $
(excluding land)
I hereby certify that I have hlrnlshed mformation on this application which is to the best of my knowledge true and correct. I also certify that I am the owner or authl>r1zed agent Illr the
abovc-menl1oned property an that all co . truction will conform to all eXIstmg state and local laws and will proceed in accordance with submil1ed plans am aware that the buildmg
oftkial can revoke tl1l5 per It or jus.t e F .thermo '''J I hereby agree that the CIty official or a designee may enter upon the propelty to perform needed In CCtl ns
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
Contractor's License No.
I ate
Park Support Fee # $
SAC # $
Water Meter Size 5/8"; I"; $
Pressure Reducer $
Sewer/Water Connection Fee # $
Water Tower Fee # $
Builder's Deposit $
Other $
TOTAL DUE $ I Z? /i_a
.
r.~
~n "'ro~d..gp~ Whm App~,d
Buddin!! OffiCial ~f 5
Paid
Date
("t.:Z..~ I ~~ceiPt No. 4-4G{ l~
~~r~ . _ ~
~ 81z,t1(O~ ~ '.~ 1lt,
ThiS IS to certIfy that the requcst 10 the above applical10n and accompany 109 documents is In accordance with the City Zoning Ordinance and may proceed as requested. Tim document
when sIgned by the City Planner conSl1tutes a temporalY Certificatc of Zonmg compliance and alluws construction to commence. Beforc occupancy, a Cerl1ticate of Occupancy must be
issucd
Planning Director
Date
24 hour notice for all inspections (952) 447.9850. fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
Special Conditions, if any
Residential Building Permit Checklist
Deck Additions to Single Family Homes
BY:~
r
~
Date: J1~(l, (o.s-
Pill: Zoning:
~ '~4v-e , IV,C'
~Sbd'"
u IVlslon:
Building Permit #
Site Address / 3?~ ~
Legal: L
B
Existing Structure@r NO
I. CONFORMS TO ZONING
. ORDINA1~CE
YES
NO
Yard Setbacks: NOT APPLICABLE Requirement Proposed
MEETS CODE
. Side Yard 10'
(25' if abutting a street, 30' if abutting a street in ,
Cardinal Ri~e) 2-')
. Side Yard 10' . ,
" @>f3,"2- ~
. Rear Yard 25'
~ GSJ
. Townhouses Must be consistent ",ith
approved plan for ~~.
development
Blc90 '
AL'IY PROPOSED DECK NOT MEETING THE ABOVE CRITERIA MUST BE REFERRED TO THE
PLANNING DEPARTl\iIENT. ALSO, ANY DECK ON A LOT WITH A SUSPECTED BLUFF, OR Ai.'lY
OTHER UNUSUAL CIRCUMSTANCE MUST BE REFERRED TO THE PLAl'o/NING DEPARTMENT.
Tills CHECKLIST MUST BE COMPLETED AND INCLUDED IN THE BUILDING PERMIT FILE TO
l\1AINT AIN A RECORD OF THE REVIEW.
L:\TENIPLA TE\DECKCHCK.DOC
PRIOR LAKE DEPARTMENT OF
. ' BUILDING AND INSPECTION
INSPECTION
RECORD
SITE ADDRESS /3eso Ke:NSI lUG ~N ~C I
TYPE OF WORK ~e;1..J 'bET:.#-
USE OF BUILDING s,F. j).
PERMIT NO. , O~- ~,,~ DATE ISSUED S/'u.{O $""
BUILDER C1lAt6. ~,EIi:J PHONE IJsv~l{Yr-23l(tJ
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
FOOTING
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN
I I
I FINAL I I
Call between 8:00 and 9:00 A.M. for all inspections
FOR ALL INSPECTIONS (952) 44!-9850
KENSINGTON AVENUE
CERTIFICATE OF SURVEY
For: CUDDIGAN CUSTOM BUILDERS
CITY OF FJRIOR LAKE
J
I
A.PRotED
'I :ERlrfG OEPT
I\)
Siqner! 11&_ ____ Date ~i.l- ori
-b..
James R. Hill, Inc. I
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APPROVED
PLANNING DEPT
Signed 1!rr
\I^'....^/\II
Vf\'-Jf\I'J1
II
Date 3(28r5
Scale: 1"=30'
Page 2 of 2
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