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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
02-0137
ADDRESS
/#ZtJ
Date Rec' d
/0-1-07-
White File
Pink City
] Yellow Applicant
PERMIT NO. 0
(JI1STt-6 q/t"/C WIi V
Nw
LEGAL DESCRIPTION (office use only)
LOT Z IBLOCK / ADDITION
#e7I 00 W VI t:;, W
PID;;z5-384-- oz,/- b
OWNE~. ~8~.~
(Name) . <::k::: . _ I " - I~ oY
(Address)
(Phone)qQ-d3~-SCk::G-
BUILDER
(Name)
(Contact Name)
(Address)
(Phone)
(Phone)
TYPE OF WORK
ORe-Siding
o Misc.
o New Construction
'f,.Lower Level Finish
3 eotJI'15
ODeck
OPorch
ORe-Roofing
o Fireplace
OAddition
o Alteration
OUtility Connection
PROJECT COST IV ALUE (excluding land) $
I hereby certiIY that I have furnished information on this application which is to the best of my knowledge true and correct. I also certiIY that I am the owner or
authorized agent for the ab entioned property and that all construction will conform to all existing state and local laws and will proceed in accordance with
su itted pIa s. I am a at the building official can e oke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may
ent r pr erty t needed in . ons.
Permit Valuation
Permit Fee
.3 () 00 .00
$ ",'1.( ~-
$ ~
$ I .50
$
$ 40.00
$
$
$
Plan Check Fee
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
Sewer & Water Permit Fee
Contractor's License No.
q ~ t/ /oZ
Date
Park Support Fee # $
SAC # $
Water Meter Size 5/8"; 1"; $
Pressure Reducer $
City SAC and WAC # $
Water Tower Fee # $
Builder's Deposit $
Other &:t..Ce-71<. ( M & $ /. 00
TOTAL DUE $ //'7. z5'
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.
Planning Director
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
PRIOR LAKE
INSPECTION RECORD
DEPARTMENT OF
BUILDING AND INSPECTION
SITE ADDRESS / ?/2 g C!#JfJ"Z..-6 ~TE- Wm(
NATURE OF WORK L CJWOL- L-6VE:L-
USE OF BUILDING /C'.6S /4/ /Z-
PERMIT NO. O?_ -- /2 Z 7 ' DATE ISSUED /0 . /- 02-
CONTRACTOR S/A/6t.670A/ - 774VUJ~ PHONE
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
---
I_ill) I I
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
INSPECTOR
DATE
FRAMING
INSULATION
ELECTRICAL
PLUMBING
HEATING (if required)
FIREPLACE
GAS LINE AIR TEST
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I I
FINALS
nf?
l}. - 30--0 'd"
"~ JOL
BUILDING
ELECTRICAL
PLUMBING
HEATING
DO NOT OCCUpy UNTIL ABOVE HAS BEEN
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
Residential Building Permit Checklist
ent Finish or Interior Alteration to Single Family Homes
BY:
Date:
/0';' tJ 2--
BuildingPermit# oz. -/2-1-1 Pill: 2-5'- 3J"4-ozl-cJ Zoning: ,e::.. L
SiteAddress /44Z-8 tJrlJTL-6&R7C- ~VAf
Legal: L '2- I B / Subdivision: /-?~7'tt:JOLUV(~J
CONFORlVIS T
ORDlliAJ.'{CE
NO
YES NO
Is this an expansion of the existing footprint or Refer to Planning
building height? X-
Is the property located within the flood plain? Refer to Planning I .,L
Does the alteration include any additional kitchens? Refer to Planning I 'I
Does the proposed alteration include any outside Refer to Planning
entrances other than patio doors? K
Is the proposed use of the finished space or Refer to Planning
alteration for anything other than a normal single r
family home (office, group home, day care, etc.)?
THIS CHECKLIST MUST BE COM'PLETED A.I.'fD INCUJDED IN THE BUlLDING PERlvIlT FILE TO
l'tL-\ll'lTA1N A RECORD OF THE REVIEW.
L\TEv1PLA TE\Al TCHCZ.DOC