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ADDRESS
/ ~1 g9
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
~+k.~~LL
Date Rec' d
1. White File
2_ Pink City
3. Yellow Applicant
LEGAL DESCRIPTION (office use only)
LOT b BLOCK ADDITION A C? d CJ t4/' vl'r> 1/1./
1, o70-D
PID J5'"
OWNER //_
(Name) C-fP1!ex -rrvi'YJti'
(Address)
(Phone)
BUILDER
(Name)
(Contact Name)
(Address)
:; c:?~
F::: ;:; ivdl7/,j-.,
.qn-,~
(Phone)
(Phone)
S~nJf>
9'.s) -~02-6;) YO
TYPE OF WORK
ORe-Siding
~New Construction
OLower Level Finish
o Misc.
~eck
o Fireplace
DPorch
ORe-Roofing
DUtility Connection
000
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 plan 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 e operty to d inspections.
x
Signature
Permit Valuation
Permit Fee
Plan Check Fee
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
Sewer & Water Permit Fee
Gas Fireplace Permit Fee
DAddition
o Alteration
PROJECT COST IV ALUE (excluding land) $
?-oa76717
Contractor's License No.
$
$
$
$
$
$
$
$
#
#
Park Support Fee
SAC
#
#
Water Meter Size 5/8"; I";
Pressure Reducer
City SAC and WAC
Water Tower Fee
IbO .c>O
I () 0 .~ l>
Builder's Deposit
Other
TOTAL DUE
our Building Permit When Approved
1-1/-07 __
-
Date
g-;;2o~o';)
Date
$
$
$
$
$ f ~oo .C;i?
$ O.ao
$
$
.OD
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.~ :t~
Planning Director
ItJl'f Ii2./'
k ~ 1&J
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
Tht' C'rnlt'r or .ht' tikI' ('ounlry
White - Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
, ,
NAME OF APPLICANT
APPLICATION RECEIVED
(~/Y! -JeA/ ~
y-/O-oZ
The Building, Engineering, and Planning Departme'nts have revfewed the building permit
application for co. nstruction activity which is proposed at: . ;2' )
. 'lL/3!9~k~ Jd/LC!-
Accepted
^-
Accepted With Corrections
Denied
Reviewed By:
fY)trs
5-ce P1C1,'1 h'le.
Date:
9-;<3-0L
Comments:
Driveway Must Have Concrete Apron
'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
The Cf'nlt>r or .hl" Lak.. ('ounu1:
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
~M1~ i/nlA-
C;-/()-~
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at/J ' )
ILj319 ~~D/L.C!/
Accepted
~
Accepted With Corrections
Denied zd1
Reviewed By:
Date:
r--r7
Comments: k ~
-
~a
"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,"
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10/07/2002 12:00 5
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PAGE 07
1..1
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:'. A.P'PtJCANI' K&. R Contractingl Inc.
I <N...\, .324J5 Lake Avenue ...)
i CA~) - N~ Praiue, MN 56071
: (CeralAa ~ ~~~~~/2_ ~ J ' ::.)
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AP.LICAA"T PLIASE COMPUTE BELOW
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CITY OF PRIOR LAKE
[(lj 001
CITY OF PRIOR LAKE
HEATING! AIR CO!\"DITIONING1FmEPLACE PERMIT
Date Ree'd
6/JJ()
, "/)
/...R// /;;; (.Y' ()
~: ~ ~~j~ ~Rl'dIT NO. d - 1::J-5 sf
I: ZONING ,__l \
LEGAL DESCRIPTION (o~ ~ only)
Lor
BLOCK
AD:OITION
Pro
Ovn'lER
(Name) C f:'1'J f~~ V
(Addre6S)
;-J 0 m...lf"';"
(Phone)
APPLICAN'r
(Name) lIeCl fr' ":"7
(Atldzci3)-L...~ S-5'"o
J (. OD /,' V\1 '/t"L/()
(Q<:"".......d~'Y f2J ~
(.A.d.c:l.rll~s)
(Phone:) 763 - Lf). <1 ~ 3 & 77
/7"'" l'>"/~ G ,..~ .....t
(CIty)
SJ-'?~ 'I
(Zip Cede)
APPLICANT SIGNATURE
(phone) ~ 1)..._ "3 c... 3 - S-.s-..:" "7
(Contact Pe!Son)
DATE
/ _ I?~ 0 ;;
EW CONSTRUCTION REPLACEMENT 0 AL TEM nONS
F'URNACE MAKE AND MODEL 13(' '1Q/\ t 3"t 3" '3~o 70 FUEL G ~ .s
{I
FLUE SiZE 11 RETURN OPENINGS ~ INPUT ':;j' n I <0 0/:/ OUTPUT /; 5: (J.:) 0
TYPE OF SYSTEM HEATING OR POWER. PLANI'
, ~arm Air Plants 0 StllItn
Orlwlt>' 0 Hot W'jjj.cr
MllchUllcal , 8 lUdlatl.on
[9~lr Conditioning Sp~~iAl Deyic~'
g\'ont. Sy~u:m 0 Other D,vl\;~3
1 FIREPLACE MAKE AND MODEL
APPLICANT PLEASE COMPLETE BELOW
Pl.,LASZ j"l(/tE:
Air Conditioner Unit:!
Camlot Enc;roagn into
Required Sid!: Ylard
Setbacks
Ru~ldential. Heatina ~ Ale (New Consu\lctlon)
Resld~ntllll. Heating Only (NI:W COlnU'\lctlon)
FEESCBltDULE
1 % of Job CO:lt ROJidcntlw, Ou Flnlpl"'
539,'0 minimum '., ,.
S99.'O Residential, Additions &: Alt~atlon~
$64,50 Residential. AC Only
$39.50
Industrial, Commercial & Ml.Iltl.F~Il)'
$39.'0
$39,50
Estimated COlt S
BulldlnS Pc:rmit #
HEA11NGPE~TFEE
STATE SURCHARGE
TOTAL pERMIT FEE
$
$
S
.50
_.d J
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UlllldillB om..I.1
Dille
(orne, lllle OnlJ)
This Application Becomes Your Building Plrmlt When Appr
14 hour noth:e for alllnlpeedo>>1 ) 447.jISO. fax (952) 447..4 .as
Sd W~[O:01 [OO~ L1 'uer
~89[8~t'[9L: 'Ot~ >~~.:J
or'l1-'Jt'~ I IOOJ-'JI~ I 1~3H: l..JOd.:J
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Date R(!c'd
CITY OF PRIOR LAKE PLUfvlBING PER1\1IT
l. ijlUl:
:!. Guld
J YcHc..w
rile
City
^f'~il'I:I."l
, PERMIT NO. J. -Jst-2iJ
I
r'leo1:'~ tYpe or pnot ,ll\d ~\>'JI at hG1tom)
ADDRESS /} /-
"-Ill] ~f ,,-Olj(}f---/'t1J?/f._
tlv!
ii,EGP.L DESCRlPTION '(~rtic~ Ll>C: only)
I
ll:.OT___BLOCK ADDITION
[ OWiIER "-71'''-'-';;-:
(1'4 am e) ",.l ~:~f2..1.l!..'!M._.--
Pill
-- ..-...".-.--1
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(Phone)
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L.,..._.." nO" "'''_ .,_...'-.._.._._.__.,."..,,,....
-'-'''''''-''''---'7fliil'-'''-~----'
APPLICANT / / / '
(}Ji1nlel_Cfi2.L! .bi.-
. (Addre$s) .Sp(J . I 'lr "'M_i!::.~,..__._...._._
! (Addrf:s:;)
(phone) t/5"J .1/;02 -,,J / rJ~ 7'-~~='-
~rj!lA.- ~:f':J{~::._.
(City) (Zip Cod~)
(COn1:::\ct Person) ., ...__~ ..
I APPLICANT SlC~:~-~~E. 7 ?t/V'~:!. I( \ AJ(~
(Phone)
1
,
I
}v/m~" r( ~---I
DATE
APPLlCANT PLEASE COMPLETE BELO'VV
L___~.llU~ty 0'__ Typ~of Fi~:~
! J Bath Tub with or withQut :,
I'''''' ....7-.....--' 'I)D;hwasher
1::3=~;~:~~~~a~~athroom S;nlT
..._.._L____ i Laundry Tray (1 Qr ::. cO~.E
~_l__ I Shower Stall
t I \ Sinks
i-..........- Bar Sink
CJ_....._.".J,.~y<lter Clo~et (TQikt)
---- Quantity Type of ~ixture
'ure
h o-i~:er-----'-'- --...,., ...-----1
{ Rough-ins
/ Water Heater "_,._. .",0.--... ..~'" ,.
Water Softner '-""'~."._-'-"'" .,.......,
. I Stand Pipe (Washing Machine)
'U!:l11ent sink Sewage Ejector
----- Backflow Assembly -.----.-.,-
Backflow Assembly Test -
- Lawn Sprinkler
Other .-
-----
FEE SCHEDULE
jlldu~lrial. Commercial & Multl.famlly 1% cd'.lllh CIl$l with a '539.50 minimum
Residential. N~w One & Two-Family $99.50
Residenrial, Additions & Alteratilms ';39.50
Estimated Cust $
Building Permit #
.50
8UIL~t~ ~
PI:RA,f,.,.
PLC'MI3fNG PERlvfIT FEE $
STATE SURCHARGE $
TOT A-L PERMIT FEE $
IOrfLcc l).<c :)nly)
IT"" Appll,.",," '''~o,"e' y",,, B,;;jd;ng-~~~m;~ Wh: App,oved
nll\t..lin1,! om~I:11 O'lte
......~,,-,-.,,~~..~_...~-.....,"'----,--_.._-_._----
r'n ~
, [I
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W ~~R 2 5 2003
Receipt No.
l~ hour nOri,(t lur .111 ilJ~pccrilln~ (952)" B.~~,~:.:,,~1t_~9,5,,/2.,) 14'14Ii~24S
l6:?OIJ T(~gh: Cr,"ck Alic., S.E., Prior ....."" ::!::>n_ ._...
,
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10dO'd
JNIOJ~NI8Wnld^3ll~~
Bc:91 (00c-lc-~~W
PRIOR LAKE
INSPECTION RECORD
~~ ~ '^- t'\lL
DEPARTMENT OF
BUILDING AND INSPECTION
SITEADDRESS fJs8S ~b\A.L.Cl~ ~uhQ
NATURE OF WORK jj..Dc.J
USE OF BUILDING ~FA
PERMIT NO. 02 - /ZSr DATE ISSUED 9 -I ,-oz...
CONTRACTOR C'~:ljo" PHONE~- 'W~ -ta1. \.{O
""--...
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR
DATE
I FOOTING I
I FOUNDATION (Prior to Backfill) I I
PLACE NO CONCRETE UNTil ABOVE HAS BEEN SIGNED
ROUGH - INS
SEWER I WATER I SEPTIC
FRAMING ~~ 2-/ 1-/; Ia3
INSULATION ~ ,
ELECTRICAL
PLUMBING ~ '01 L{ /fYJ
HEATING (if required) 5^A< 1-/ 4, fer!>
FIREPLACE
GAS LINE AIR TEST
COVER NO WORK UNTil ABOVE HAS BEEN SIGNED
I I
FIN A L S 1J.;f, {) (A-
GRADING (Prior to Sodd. g)
BUilDING V
ELECTRICAL
PLUMBING
HEATING
DO NOT OCCUpy UNTil ABOVE HAS
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