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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec'd
rf-/8 ~OL
White File I PERMIT NO J
Pink City . Ol.-I Z I-i
Yellow Applicant , ,
4-q58 ~(/ t::-/Voe-
~f)
5~
ZONING (officeu
~L
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID z.5 ~CjOZ - oSZ-(
~~e~R J~u\d ~U'?~~
(Phone) q~~ '4 4 7J- S- '''i'-f
(Address)
~~~~R'1>\A-v l~U .~'-~:; L . t'~;/\(~f'J)
.~/ /j] , I
(Contact Name) . ';:''7 /7'1"1/1/ 1> t.'.; 7
(Address) ./
(Phone)
(Phone)
&/.2- "?...2 ;::"7. (.:~ :'" .
?:/~ :? 2P' , 0- :) iI-
TYPE OF WORK
o New Construction
ODeck
o Porch
ORe-Roofing
ORe-Siding
OLower Level Finish
o Fireplace
OAddition
o Alteration
OUtility Connection
Misc. rtJtJl'iO/fTION ~/J/Je-
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 01
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 the property to perform needed inspections.
X ~' ~~~.. C</,j~/_7
/ Signature ~ Contractor's License No. Date
Permit Valuation
Permit Fee $ , LF,j
Plan Check Fee $ ; $1
State Surcharge $ lQO
Penalty $
Plumbing Permit Fee $ U-D,.&D
/"
Mechanical Permit Fee $ U-DiilX)
f.
Sewer & Water Permit Fee $
Gas Fireplace Permit Fee $
Park Support Fee
SAC
~~~~b-r7
, BUildirl{ 0 IClal
C1 /2-/:)1 CL
Date
I ~~~ ~~-,":;.~t
# $
# $
$
$
# $
# $
$
$
- Z-~ *0 $
I r:::J/IlC-3ti'77
Water Meter Size 5/8"; 1";
Pressure Reducer
City SAC and WAC
Water Tower Fee
Builder's Deposit
Other
TOTAL DUE
This Application Becomes Your Building Permit When Approved
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
q /z~/[)2- 5c~ 4~~r~l4C~{~~dn
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
White - Building
Canary - Engineering
Pink - Planning
-
Tht' ("("nter of rht Lab Count.,.
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
DAV I 0 BUSC;S
-
q-/8---0Z-
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
4-q56 ~vlT R-\ VE-R- RO . s-:e-
Accepted
Accepted With Corrections l./
Denied
Reviewed By: ~~~~
Com ents:
Date:
q!7-'-i!02-
.,.
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NO ~rt8n'5 e-r '21Z~k~vt~
1e-\!v\~1"V0f
"~~ ~ ,2Cf-L
"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."
Residential Building Permit Checklist
Basement Finish or Interior Alteration to Single Family Homes
BY:
Date:
Building Permit # Pill:
Site Address
Zoning:
Legal: L B
Subdivision:
Existing Structure: YES or NO
I CONFORMS TO ZONING
ORDINA1'{CE
"YES
NO
YES NO
Is this an expansion of the existing footprint or Refer to Planning
building height?
Is the property located within the flood plain? Refer to Planning
Does the alteration include any additional kitchens? Refer to Planning
Does the proposed alteration include any outside Refer to Planning
entrances other than patio doors?
Is the proposed use of the finished space or Refer to Planning
alteration for anything other than a nonnal single
family home (office, group horne, day care, etc.)?
Tms CHECKLIST MUST BE COMPLETED A.ND INCLUDED IN THE BUTLDING PERi"IIT FILE TO
MAINTA1N A RECORD OF THE REVIEW.
L:\TE:VfPLA TE"AL TCHeZ.DOC
PRIOR LAKE
INSPECTION RECORD
DEPARTMENT OF
BUILDING AND INSPECTION
~~~~~~FE~~RK ~1{M~'5 ~~~ ~V0
USE OF BUILDING ~1~,.L7 FAMlL<{ ~I..JLLUAt&
PERMIT NO. 07- - /1-/7 DATE ISSUED
CONTRACTOR ()Avl~ ~S$'-L. PHONE tk//L. 32....~. ~J~2
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
! FOOTING ! 6 -( 0
. FOUNDATION (Prior to Backfill) f:) ~ IS
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
DATE
SEWER I WATER I SEPTIC
FRAMING
INSULATION
ELECTRICAL
PLUMBING
HEATING (if required)
L1- >0 ~
j-r;- -0- L
4-30V".J
GAS LINE AIR TEST
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I I
FINALS
GRADING (Prior to Sodding)
BUILDING
ELECTRICAL
PLUMBING
HEATING
DO NOT 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 shall be placed near main entrance,
FOR ALL INSPECTIONS (952) 447-9850