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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Re~
/7 .. /
'7 - (O,.....d.-
grook:
White File
Pink City
Yellow Applicant
~~ R~!/D
LEGAL DESCRIPTION (office use only)
LOT 5:l BLOCK
ADDITION /l/J~?cJ6t..-(/Vt't? t.L.-
PIDdS--.
OWNER C ~
(Name) f>r; 'Y
-#O~S
(Address)
BUILDER
(Name)
<;~-e
-
~ c--e
;;;; t::?" ~ ~
.s-h./d-h/ej-q
(Contact Name)
(Address)
(Phone) 9'S') --9']d-76?~
(Phone)
(Phone)
s: Q'~--(
l"S':J- Y03--6~ yo
03 -~ Lo/O
~
TYPE OF WORK
~New Construction
OLower Level Finish
ORe-Siding
~eck
o Fireplace
o Misc.
o Porch
ORe-Roofing
OAddition
o Alteration
OUtility Connection
/;;2 S/ 000
PROJECT COST IV AL UE (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 or
authorized agent for the above-mentioned property and that alI construction will conform to alI 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 roperty to per nee inspections.
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
Building Permit When Approved
1-/ 7-~,-
Date
;l00 76?J7
Contractor's License No.
g-;)6~o;).
Date
Park Support Fee # $
MC $
Water Meter Size 5/8"; 1"; $
Pressure Reducer $
City SAC and WAC # $
Water Tower Fee # $
Builder's Deposit $
Oilicr $
TOTAL DUE $. 35 ~
I ~~~ $1?51~~f~J ~cei~INct::OO
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
iS~~~p
Planning Director
Jt)h~2- x:Ie~ ~ ~
f ' Date Special Conditions, ifany
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
''''.':' _....~',.:.~:1\. ':~.,.~"" .T.;' ~~'\!'".......~_.c;..t.:''''''''''}-'1.'''lJi''\.....~~lv,)~'';''''
'-~';"';"'''\..o~'''::~:ll'''''''' .~; .i...;."",~ ~-<''-''''~- ~.; ~- ~ '~~ ,
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White - Building
Canary - Engineering
Pink - Planning
. ,
Thf C'fntfr of Iht takt ("ounlrl
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
rl//J ];// -J~
. .
Cf-/O- ~
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
/ 'II/of:; 8ACJL~ n/~(J 6/ vel
Accepted
x
.....
Accepted With Corrections
Denied
Reviewed By: /179-13 Date: 9-20-0<:......
Commer;lts: See Reverse Side for Additional Information!
IY/a,/n hi ~
See Attachments: 1 ) Gradiog Plan,. 2) Erosion Control Measures
3) Erosion Control Plan
liThe 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." 0"
..,
White - Building
Canary - Engineering
Pink - Planning
--
The ('f"nlrr of the Lakt Count,.,.,
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT f'lt/Jl7U.L 7j~
APPLICATION RECEIVED 41-;0 / ~
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
/ Lj/(O/:; &CJtJfe n1-MJ2 61 vel
~
Accepted
Accepted With Corrections
Denied ~;Q --L
Reviewed By: 0i.t. V~ Date: q - C 7 - CJ 1 ~
Comments:
()~p~ all ~~ ~ ~
"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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PAGE 13
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CITY or PIUOK LAKE
SEWER AND WA.TER PaDDT
,..sr-...~-"*'.. \ t ~ E.~ (r~\"01_/~70 I
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-
, ""'PLICANt'
I (Naaw) K &. R Contracting, Inc. CPh=.)
I (A 3245 Lake Avenue
i d4m1) - New Prague, MN 56071 (air)
. C a- 952.758.62%
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APPLICANT PLEASE COMPLETE BELOW
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T~ ohewer plpe. 0 ABC ~C 0 CUE !ron
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fEE SC'lIEDutZ
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Sewer ~~",n.adan em l) II ''"'0 W... ~.&tab nl) I I ?SO
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Siwn AND WA1'U P!JM1T FEE S
5t A T1t SlJ1lCHAIlOB S
TOTAL PUMJT IU S
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STATESURCK~GE S
TOTALPE~'OTFEE S
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CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
~ ~~~~nw J~~icant I PERMIT NO. Oz- - (L 701
ADDRESS
ZONING (office use)
14406 BROOKMERE BLVD
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name)
CENTEX HOMES
(Phone)
(Address)
APPLICANT
(Name) ALLIED FIRESIDE DBA FIRESIDE HEARTH & HOME
(Phone)
651-633-2561
(Address)
2700 NORTH FAIRVIEW A VENUE
(Address)
ROSEVILLE
(City)
55113_
(Zip Code)
(Contact Person)
BRENDA HUSTON
(Phone) _651-633-2561
APPLICANT SIGNATURE
BRENDA HUSTON
DATE
2/6/03
xD NEW CONSTRUCTION o REPLACEMENT o ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
DWarm Air Plants D Steam PLEASE NOTE:
DGravity D Hot Water Air Conditioner Units
D Mechanical D Radiation Cannot Encroach into
DAir Conditioning D Special Devices Required Side Yard
DVent. System D Other Devices Setbacks
FIREPLACE MAKE AND MODEL HEAT N GLO SL-550TR
APPLICANT PLEASE COMPLETE BELOW
Industrial, Commercial & Multi-Family
FEE SCHEDULE
1% of job cost Residential, Gas Fireplace
$39.50 minimum
$99.50 Residential, Additions & Alterations
$64.50 Res
$39.50
Residential, Heating & AlC (New Construction)
Residential, Heating Only (New Construction)
$39.50
Estimated Cost $ Build
HEATING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
idential, AC ani <l'~" ~"
ing Permit # PAID WITH
.soBUliDING
PERMIT
(Office lIse Only)
This Application Becomes Your Building Permit When Approved
Paid
Receipt No.
Building Official
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONINGlFlREPLACE PERMIT
Date Rec'd
~. $~~:w ~~100l" I PERMIT NO. ,J. ~ / ~ I h l
ZONING (otnce U&c)
LEGAL DESCRIPTION (office u~e only)
LOT
BLOCK
ADDITION
PID
I
1
I OWNER
(Name)
(Address)
<2. ( 11 r--<.. '{
t+ c;J ;b-i) S
(Phone)
APPLICANT
(Name) /9!'C4 .(-,' "'?
(Address) ) ?J-$"C)
i- (loo(I^J r-JJ~
(?() \,.f l\4r-~ Lc:/ g (
(Addrc:sf;
(Phone) 7C, 3. f.J ~)> - -::j fo 71
(Contact Person)
~"t
rn~pl4 G.,q~ <"",--:;.I~<?
(City) (Zip Code)
(Phon!::) 1~::,,1? - "3~:;, ~S-~ 7 '
DATE -:;2.,-1 "j'''tiPJ ~
APPLICANT PLEASE COMPLETE BELOW
COot:.
APPLICANT SIGNATURE
~:,-
EW CONSTRUCTION
FUR...~ACE MAKE AND MODEL L!3./.y -"9,.,.f
FLUE SIZE 4" RETURN OPENfNGS
TYPE OF SYSTEM
[3Warm Air Pla.nts
, OOrayity
o Mechanical
~r Conditioning
OVent. System
o REPLACEMENT 0 ALTERATIONS
~ 5130 ~ ~<:') 7'0 FUEL (Q 0\ S
G, INPUT 70,0<)0 OUTPUT 5"S: O<JO
HEATINGORPO~RPLANT
o STeam
o Hot Water
o Radiation
o Special Devices
o .other Devices
PLEASE NOTE:
Air Conditioner Unit!.
Cannot Encroach Into
Required Side Yard
Setbacks
FIREPLACE MA.KE AND MODEL
lndu:;trial, 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
$39.50
Residential, Heating & NC (New Construction)
Residential, Heating Only (New Construction)
$39.50
$39,50
Estimated Cost $
Building Permit #
.50
~'')
~ i...L;! to fe. ~17'1
. PCh
<.;; i ',1 A,/,?-
"'7, I
(Office U~e Only)
This Application Becomes Your J3uildln~ Permit When Approv U; a
I W F Bat!
HEATING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
Dalt
,.........
ecelpt No.
BulIdlnt: Official
2003
By .
24 hour notice for Illllnspectlon' (9 147-9850, fax (?52) 447-424
9d l,JtH 0 : 60 [o0c n . qa.:l
c89[8ct'[9L. : 'Ot~ ><Ij.:l
-
OM1-~NIlOOJ-~NIlIj3H: WOd.:l
PRIOR LAKE
INSPECTION RECORD
I Ma..,^- t,.~
DEPARTMENT OF
BUILDING AND INSPECTION
SITE ADDRESS ~1 r;'~~ ~
NATURE OF WORK ~
USE OF BUILDING -gFt
PERMIT NO. _.2-10;2- ~ DATE ISSUED 7'- L?~
CONTRACTOR ('J)' PHONE tffz-f(oJ-~{q'O
NOTE: THIS IS NOT A PERMI FORt'ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
I FOOTING
L1 v'" i ~
INSPECTOR
V1/
SEWER I WATER I SEPTIC
FRAMING
INSULATION
ELECTRICAL
PLUMBING
HEATING (if required)
FIREPLACE
GAS LINE AIR TEST
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I I
FINALS
.~ !1-t, ~
3
D::)
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.
,
~l(e3
FOR ALL INSPECTIONS (952) 447-9850