HomeMy WebLinkAboutBuilding Permit 99-0028
r
1. While
2. Pink
3. Yellow
File
City
Applicant
CITY OF PRIOR LAKE
. ~ BUILDING PERMIT,
0'" CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Permit No. 9f-02!J
1. DATE
/-/d ~f
-fJ J:r:1r
. DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
2. SITE ADDRESS
J 103~1J
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height)J~ (Widlh~ (Depl~~
12. NO. OF STOR~.
?4c-:lOKP1#-?vKCJ~
3. LEGAL DESCRIPTION
LOT r BLOCK. '3
ADDITION C~~'.:('."d _H:";;~ ~~
4. OWNER II / (Name) u::;? ? (Add~s)
7?J?m A''::. /:"7 Y 1"';-./A;2C= P
5. ARCHITECT (Name) ~ (A"essy 1- " /
/~f ~r~(r1-7 A"A
'(Name) _ ,I // (Address) . (Tel. No.) 15. NUMBER OF OCCUPANTS OR SEATS
..L5 PJ//..e- :JJi/l _ ~~~7 OCCUPANTS
7. TYPE OF WORK Fireplace 0 Septic 0 Heating 0 Plumbing 0 Reroofing 0 Porch 0 SEATS
New Construct~ Alterations 0 Addition 0 Finish Attic 0 Residing 0 Finish Basement 0 16. ESTIMATED VALUE
Chimney 0 Misc. ., , / J ~ # (.)
8. PROPERryREA OR ACRES. 9. PROPERTY DIMENSIONS 10. CULVERT SIZE 17. COMPLETION DATE
Sq.Ft.~/~,I- Width Depth Yes No X ,$#~
I hereby certify t t I have ~shed information on this application which is to the best of my knowledge true and 'Cbrrect. I also certify that I am the owner or authorized agent for
the above menti ed property and that all constru 'on will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the
building ffici, n rev~~ermit ~st . Furthermore, I hereby agree that the city official or a desig"e may enter upon the property to perform needed i~P~;--
X W~~- /AAt'~ /~/9' /-/t) ?,
. J ~ure ~ . Lieense,Xo. . Date
JX -ti3S -()Z-'1~O
PID
13. TYPE O~NSTRUCTION
I-~
14. FLOOR AREA APPORTIONMENT USE
~o.)
~??-~ "5 ~7
(Tel. No.) ,
6. BUILDER
FOR ADMINISTRATIVE USE
MATERIAL FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA 0
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS O. SETS
SURVEY 0 COPIES
SETBACKS: Required
Actual
Side
Side
Back
Front
PROPOSED GRADE FOUNDATION
IN RELATION TO CURB OR CROWN
OF STREET
USE OF BUILD~ _
':::::>r-.()
TYPE OF CONSTRUCTION: I II 1II1~'
Occupancy Group A BEl ~ M
Division 1 () 4
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
PLOT PLAN
J51,000 ,00
o
Amount Brought Forward .................. $
Park Support Fee ........................... $ eso. 00
SAC ......................................... $ /000 .00
Collective Street Fee ....................... $
Sewer Tap ................................... $
License Check Fee ......................... $
Pressure Reducer .......................... $
City:
1.142.2S'
l)Ll '2 . l{ ( "
'1').50
lof). "tJ
kS.11)
JSslJ
1/.().00
CAJ) ~J+ k\
Permit Fee ................................... $
Plan Checking Fee ......................... $
q5, 06
State Surcharge ............................. $
Penalty H...9.f.::.ur................. $
Septic System }!I!.l.l~~!:f............. $
OtheJ-t.J!../!/JllrJ..'f'........ $
Subtotal............................... $
Meter Hom ................................... $
/;}~,OO
Water Meter ................................. $
o Sewer & Water Connection Fee ........... $4?: ('J 0 .n9--
o Water Tower Fee ........................... $ '1 t)C) .0 f':>
Water Tap ................................... $
Builder's Deposit ............................ $~(9 . AO-
Other ......................................... $
Total Due .............................. $ 110 107/
Paid Receipt No. . 3: LJ ~ , ( -
Date 2-9 -<i ~ By /;A. -
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 ieq;rested. This document when
signed ~ .S1ity Plan'l6r fOO~itutes a temporary Certificate of Zoning compliance and allows constructiJ,:;/me. nee. Be.'fpre occ.::cu~ncYI a Certificate of Occupancy must be issued.
~~.PAAN\ __,1-- L1~ ~~~ \. f ~/VA.JtU.AAr Ik.L.~"- ~
City P1ann'&r Date- - sPecial Conditions ~ any fJV - . - '"
24 Hour notice for all inspections 447.42309:00 a.m. . 10:00 a.m.
Check if
Deferred
T Dfp({.c fon B6J1m~our Building Permit When Approved.
f~ 'Jt;. ~ Date I - lS-'l,}
Certificat~ of ~upa~CY .
Issued
flf-!Lf
GREEN - FILE
YELLOW - APPLICANT
GOLD. CIT'f
CITY OF PRIOR LAKE NO. crt -OO){-I.
SEWER AND WATER PERMIT
NOTE: Sewer and Water
contractors must
be registered
with the city.
\ ^' \ It-l ~ ) ~ ) (& --. Lj tn-- J I )-
APPLICANT: 1 _ PHONE:
f{ Ltu I " {/ f),.t \ ., 1<; (
ADDRESS: Qv~"L - \v<':(" DATE: d
(' A/'J I #
SIGNATURE: BLDG. PERMIT
SITE ADDRESS: \ ()~SD \J :rL,...;I' r vI - , PID# dl5 - 3-35- oJCf-O
-
FILL IN THE BLANKS
1. Estimated length of water service
feet.
2. size of water service
inch(es) .
3. Location of any couplings from structure
feet.
4. Type of sewer pipe. ABS
PVC
Cast Iron
5. Estimated length of sewer line
feet.
6. Clean out (if required), located at
structure.
feet
from
------------------------------------------------------------------
------------------------------------------------------------------
This application becomes your permit when approved.
BY
DATE:
------------------------------------------------------------------
------------------------------------------------------------------
FEES:
$
$
$
35.00
.50
35.50
Sewer and water line connection permit.
Surcharge
TOTAL
* Fee for either sewer or water individually is $20.00 plus
$ .50 surcharge.
* Sewer and water permits issued for new construction must be
recorded on the building permit card at the time of issuance
to insure that no duplicate sewer and water permits are
issued.
DATE PAID
AMOUNT PAID
RECEIPT #
REC'D BY
,-- PAID WITH
BUILDING PEH\'ilT
16200 Eagle Creek Av. S.E., Prior Lake, Minnesota 55372 / Ph. (612) 447-4230/ FAX (612) 447-4245
An Equal Opportunity Employer
1. Blue
2. Gold
3. Yellow
File
City
Applicant
CITY OF PRIOR LAKE
PLUMBING PERMIT
\)1\\\\.'/ pI) ru J'. Phone: '-j4;J-J,f'
<:(.LcJ rJ,-"U Ad - 1"r(I__, r-- ~
(1 .J /'V- I'
Lot q Block '3 sub(G~d, l1f:t/ /.(;dq t' 'J~\.
\ I/~ 50 lJ ,c ~<:-^. i'- Lv./- t
PP No. q{j - CXJ d- <z
Applicant:
Address:
Signature:
Legal Description:
Site Address:
Building Permit #
NOTE: This permit will not be processed without complete information.
Th. C.n.., of lh. Lok. Country
Quantity
\
\
\
\--\
\
\
\
)
PID # c15 - y/)"- 0,)/( -0
FIXTURE UNITS
Type of Fixture
Quantity
Type of Fixture
Bath Tub with or without shower
~
1
Rough-ins
Water Heater
Water Softner
Stand Pipe (washing machine)
Sewage Ejector
Backflow Assembly (RPZ, Double Check, PVB)
Backflow Assembly Test
Lawn Sprinkler
Other
Dishwasher
Floor Drain
Lavatory (bathroom sink)
Laundry Tray (1 or 2 compartment sink)
Shower Stall
Sinks
Bar Sink
Water Closet (toilet)
FEE SCHEDULE
Industrial, Commercial & Multi-Family
(1 % of job cost, $39.50 minimum)
Residential, New One & Two Family
Residential, Additions & Alterations
State Surcharge
$99.50
$39.50
$
$
$
$
.50
GRAND TOTAL $
This permit is granted upon the express condition that said
contractor, shall comply in all respects with the ordinances
of the State Plumbing Code and the amendments thereof.
RECEIPT NO. DATE
ATIEST
Call for all inspections 24 hours in advance.
( PAID WITH
BUILDING PERMIT
16200 Eagle Creek Av. S.E. Prior Lake, MN 55372/ Ph (612) 447-9850/ FAX (612) 447-4245
An Equal Opportunity Employer
Lt;Ss. / LoAi /CAU!S'
CITY OF PRIOR LAKE .' FEE
16200 Eagle Creek Av. S.E. Perm" No. qq -Zi f - en aU (;t:!Vy
Prior Lake, MN 55372 ~ '-'1
Single Family .
HEATING APPLICATION I PERMIT .
Commercial
Date 3)\ I ~ q PID # d.5' - 3"3.5' - U 2/1-{)
Site Address I ~ 35"0 \/[ ~~VtW ~IfLVe- PLfsf)
lot q BIoC~ . c 3 Addition fa tdo e.d Kb0e 6 +t~~/7 -
Owner's Name 8\2. ~ u -r! ~ u ~ (. H e1Wt~ B: CH ~ )
Address. I t~ 35"0 V I G-to~ l~ ~ \'LVe,
Heating Contractor Co~~t 1 pJ A. \ it., Jl,vc
Address. :1/ d... / () I3'p. 1-0 A.J A lie....
Telephone # 0~1 #0 (;,O;J...;)
Furnace Make & Model "II~N E:"
Model Size /00" f.)6(;> TfJ D 100 ~1('
Conn. load. 7;;.. 000
TYPE OF WORK '\. /'
Replacement New Construction ../
Est. Comp. Date fI1/1A\J/::10 Rqq
Building per~it'4 tjt(- j6"
Q'1. S(;) JIU ~A. C;
..,.. c PAID WITH
..50 , BUILDING PERMIT
/O() . 00 Receipt #
~
Fuel NA.T
srP
Flue Size
/4-
Return Openings 'l
Input 1txJ. JCd) . Output ~ 0 cr:O f3+lJf{
Supply Openings
Edr.
efm.
/~Cf) c.~
Alterations
Repair
Est. Cost $
HEATING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEES $
TYPE OF SYSTE"t ./"\
Warm Air Plants 1<- '
Gravity
Mechanical
Air Conditioning
Vent. System
HEATING OR POWER PLANT
Steam
Hot Water
Radiation
Special Devices
Other Devices
TYPE OF STRUCTURE
I. Piat
2. Green
3. Yellow
- File
City
Contractor
Two-Family
Industrial
Multi-Family
Other
Public.
Fee Schedule
Industrial, Commercial & Multi-Family
Residential, Heating & AC
Residential, Heating Only
Residential, Gas Fireplace
Residential, Additions & Alterations
Residential, AC Only
1 ~ cost ($39.50 minimum)
199.5Q.)
$64.50
$39.50
$39.50
$39.50
Remember to add the State Surcharge on the bottom of this application.
The price of your heating permit includes one rough-in and one final inspection.
Additional inspections will be billed at $35.00 each.
.HQUse Heatinq Test Record must be submitted with buildina oermit number before build-
ing certificate of occupancy will be issued. t)~S.~"'"
l::I.EAI CALCULATIONS REOUIREQ with number of supply and return openings listed per
rODm with CFM's per opening. New structures or additions send floor plan with supply
and return locations shown. HEAT LOSS CALCULATIONS, PAYMENT AND
APPLICATIONS MAY BE MAILED TO THE CITY OF PRIOR LAKE, 16200 EAGLE
CREEK AVE. S.E. PRIOR LAKE, MN 55372.
City Hall business hours are 8 a.m. - 4:30 p.m.
ALL WORK MUST BE INSPECTED (ROUGH-IN AND FINAL) - CALL CITY HALL
447-4230
I hereby apply for a mechanical systems permit and I acknowledge that the
information above is complete and accurate; that the work will be in conformance
with the ordinances and codes of the city and with the state building/mechanical
codes; that this form does not become a permit until signed by the BUILDING
OFFICIAL; that the work will be in accordance with the approved plan in the
case of all work which requires review and approval of plans.
9f1l~~~e- 3/lt 111.
Date
3-/9 -17'
Date
71- Dt. 3
Thr (-..nln of th.. L.kt' Counlry
White - Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT 11.." .A_J Ar" (Id.~ I --'
APPLICATION RECEIVED 1//1./V,
The Building, Engineering, and Planning Departments have reviewed the building permit
application fronstruc~ion activity which is proposed at:
--1/0 j-tJ 1b ~;;-YJ../' !n/l.N~
Accepted
..,/
Accepted With Corrections
Denied
Reviewed' By: tJ,qt.17E"!f. EJ.ME..:5Yt'fA/IIN
Date: /Izo I"~
Comments: 5"1bttil1 J.l~'1"E~ 'RuNoFF fI1v..r 31; (!.o,JlI€'1qj To A,v/j AL'o.v6
rnf\II'JA6E: AtJJ\ tJr'll..I 1\1 EA<:..~ r'oIE.JTS A:-
~lIc.J.I A'\ fflAC./lcA c... .
SE"F IN Fo~r\t ~Tj()N 0..1 R~J~e: S'/rE.
u.sE:
C 4VTIO^"
tJl-ICAJ /j}.d5.:r./itJf"-nOl1I Ac..,luIIY OCt:.u~" oN oR ~R. 7t,~
eO;<)c.RerE: "VALK. DAM~ rAtJELS
1j)ILL
BF.:
f<EPU\c.El'\ RY 7HE:
3.J 1l.J:)E.R.. .
x~ 8:rrA('.j.J~ : I. h.AJAI a~. IN_"Pt!c:fitlN INFOlltll,qruJAJ
Z. ttMlAA..I CII..Jl-ItoL ~e;,
'? ~RAlll.J' ,R,.qAJ 1-. ERos/ow (ONT1tDL ?~,J
"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
Tho Confor of lho Lake Counlry
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT ~ fL ^ I"
APPLICATION RECEIVED I /;JJ~
The Building, Engineering, and Planning Departments have reviewed the building permit
application f~?~n:truction activity which is proposed at:
JjJSlJ 1~' ~~
Accepted
Accepted With Corrections
~-'
"
Denied
Reviewed By(-h2..J ~/ r\, Date: ) ~ 1'2 -?i
Comments:
I. &-0 ~ ~ ~j'r\lP\~~~\~
2. MCl;~k\~ ~(CJlA ~t-~
3. ~~aJJL oL~c~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."
"".<.
White - Building
Canary - Engineering
Pink - Planning
The ('enter of the Lake Country
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
!
/ < ,
of J
APPLICATION RECEIVED ,'!. 'j1f
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
( ;
"r'
j t', ... J
,', '
Accepted
.~
Accepted With Corrections
Denied
Reviewed By:
Comments:
\ ') 1- L-{ ~r \MLtlG,~ JLv~ ~~ ut-
~V~ rL-t.-\m p
~.._- 7" ^ <;P AA..A.A.
U~
Date:
l ~ t..{_ LfC1
2-) p,~~~ <\1~ V~~ ~~ ~1/~\~~
<i7CJe--' Q~ lL{ ud~~ I~~'~ 6_tL~d.
IAJh~\f~~~ rq~ ol94f~'\'
D~ <~ n,~~< K. lJ_ ar 2, 5 (~~ .
- ,. ,
fV8\J.tr1~ / L{ ~,~ .J-- ~ u ~ 4 ~ ~e..e,~
we- \WC-hevv<-ec-f)~ A.~ VVL~~Q ~ ~lY1~iL
"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,"
._~ .__ _"=~"~.~'."",__.;::'-='.:.=:_~,"",'_..,,-=__._~'~'_"__M._"_""- ;'.--;~
."...--.------.- -_._---~_._.._..,-_.~;..,._-.,............_.,.-...".,.._----' ~~.
"
CITY OF PRIOR LAKE
.~ BUILDING PERMIT,
0'" CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT 911 IJ 71!1l
Permit No. 7 - "-0
3. LEGAL DESCRIPTION
q
,
ADDITION c~,.i ,(' d
4. OWNER / / (Name) Id ? (Addyss)
/~ m A'~ /:'7", ("";-/ #c= p
5. ARCHITECT (Name) ,I (AdJ'essy;- " /
,,/h6R' e ~'~/r1-7 .~A
(Name) ^ ,I // (Address) (Tel. No.) 15. NUMBER OF OCCUPANTS OR SEATS
..L5 tll//..e- :JJi/l _ ~~~7 OCCUPANTS
7. TYPE OF WORK Fireplace 0 Septic 0 Heating 0 Plumbing 0 Reroofing 0 Porch 0 SEATS
New Construct~ Alterations 0 Addition 0 Finish Attic 0 Residing 0 Finish Basement 0 16. ESTIMATED VALUE
Chimney 0 Misc. /.} ~ kI (.)
8. PROPERryREA OR ACRES, 9. PROPERTY DIMENSIONS 10. CULVERT SIZE 17. COM~LETION DATE
Sq.FI..A'~_._ Width Depth Yes No X ,$#~
I hereby certify t t I have ~shed information on this application which is to the best of my knowledge true and 'Cbrrect. I also certify that I am the owner or authorized agent for
the above menti ed property and that all constru 'on will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the
building ffi, ci fun rev~~ermit fyst c . Furthermore, I hereby agree that the city official or a desig"e may enter upon the property to perform needed insp~;--
X ~~_ /A"'/~~ /~/9 /-/t) -?'jv
- . - SftrnIll'ure. - - . Lieense"HO. . Date
DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
2. SITE ADDRESS
J 103~1J
LOT
?4c-:70K~?vKCJ~
BLOCK '3
KL/.,.~ ~~
1. While
2. Pink
3. Yellow
File
City
Applicant
1. DATE
./-/d ~f
-fJ lJ:1)r
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height)J~ (Widlh~ (Depl~+,
12. NO. OF STO~_
PID
JX ~1)S - () 1--'1 ~ 0
6. BUILDER
~o.)
~P?-~ :5 37
)
13. TYPE O~NSTRUCTION
I-~
14. FLOOR AREA APPORTIONMENT USE
(Tel. No.)
SETBACKS: Required
Actual
FOR ADMINISTRATIVE USE
Front
Side
Back
PROPOSED GRADE FOUNDATION
IN RELATION TO CURB OR CROWN
OF STREET
USE OF BUILD~ .
';::)r- J )
TYPE OF CONSTRUCTION: I II 1I11~1
Occupancy Group A BEl rrQ M
DMslon 1 ~ 4
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
Side
MATERIAL FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA 0
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS O. SETS
SURVEY 0 COPIES
City:
J511000 ,00
o
Meter Hom .............. ............ ......... $
Water Meter ................................. $
o Sewer & Water Connection Fee ........... $ 4~ c> 0 . n9-
o Water Tower Fee ........................... $ r') ()C) .C) (')
Water Tap ................................... $
Builder's Deposit ............................ $_~ C:::;-0f9 . Arl
Other ......................................... $
Total Due .............................. $ 1<0 1 el71
Paid Receipt No. . 3: LJ ~ , ( .
Date 2~7 -CZ -; By ~!5- -
This is to certify that the request in the above application and accompanying documents is in accordance w~h the City Zoning Ordinance and may proceed as requested. This document when
signed ~S;ity P~an r st~utes a temporary Certificate of Zoning compliance and allows constructi~o commence. Befpre occuPjncy\ a Certificate of Occupancy must be issued.
-.......-y A _ 1'.AA.-v\ 1_ - L-l~~. L:.,..,,~ v.J,.?<,'J f -Yv~~ ~~.ft.. ~
"<.J City P1ann r . Date v' - Sj58cial Conditions n any ''1'\ - -
24 Hour notice for all inspectiOns 447-42309:00 a.m. .10:00 a.m.
Permit Fee ................................... $
l. I 42 . 2~
TlLl "2 . 4 ( 0
'1').50
IO~.b()
tS.41J
JS.SlJ
I/.(). Of)
Deferred
Plan Checking Fee ......................... $
W ~Jf k'\
State Surcharge ............................. $
Penalty II. ..9. f.:: .~. Y:. ... .. ..... .. .... $
Septic System JJ.I!. If. ~ ~ y....... ...... $
OtheJt.Jl..f!/JlfrLy........ $
Subtotal............................... $
Check if
mas Your Building Permit When Approved.
Date _, - t'S-'lc}
Issued
PLOT PLAN
Amount Brought Forward .................. $
Park Support Fee ........................... $ eso. 00
SAC ......................................... $ /000 . {) 0
Collective Street Fee ....................... $
Sewer Tap ................................... $
License Check Fee ......................... $
Pressure Reducer .......................... $
'15, 06
/:;2~IOO
f/f-~Lf
GREEN - FILE
YELLOW . APPLICANT
GOLD - CITY
CITY OF PRIOR LAKE NO. ~(-oo)/'
SEWER AND WATER PERMIT
NOTE: Sewer and Water
contractors must
be registered
with the city.
SIGNATURE:
\)~ IIL1 ~} ~ ) ( v
I" r/
7uu QV'\.L I),.t-
(' A^^---
\L~SD \J j~~;"
--.
1 _
)0./ <.:( ,-
SITE ADDRESS:
(vI' ,
PHONE: Lj,l11-) 1\-
DATE: d. 1'1 / ~ (
I I
BLDG. PERMIT #
PID#0?5 -3-35- O].q-O
APPLICANT:
ADDRESS:
FILL IN THE BLANKS
1. Estimated length of water service
feet.
2. Size of water service
inch(es) .
3. Location of any couplings from structure
feet.
4. Type of sewer pipe. ABS
PVC
Cast Iron
5. Estimated length of sewer line
feet.
6. Clean out (if required), located at
structure.
feet
from
------------------------------------------------------------------
------------------------------------------------------------------
This application becomes your permit when approved.
BY
DATE:
------------------------------------------------------------------
------------------------------------------------------------------
FEES:
$
$
$
35.00
.50
35.50
Sewer and water line connection permit.
Surcharge
TOTAL
* Fee for either sewer or water individually is $20.00 plus
$ .50 surcharge.
* Sewer and water permits issued for new construction must be
recorded on the building permit card at the time of issuance
to insure that no duplicate sewer and water permits are
issued.
DATE PAID
AMOUNT PAID
RECEIPT #
REC'O BY
~ PAID WITH
BUILDING PEl'::;;\;JlT
16200 Eagle Creek Av. S.E., Prior Lake, Minnesota 55372 / Ph. (612) 447-4230/ FAX (612) 447-4245
An Equal Opportunity Employer
Tht Ctnltr or Iht L.kt Counlry
Quantity
\
\
\
\..-\
\
\
\
)
CITY OF PRIOR LAKE
PLUMBING PERMIT
\) 1\ \ \ l ~,' P I ~ ru J'-
C(Lu (')",,,U A~( - l....rc(~_,
(l A /v,_
Lot q
\ 1/~51J
1. Blue
2. Gold
3. Yellow
File
City
Applicant
PPNo. ql7 -00 d-.<t
Phone: l.,j 4:J- J I Y1
Applicant:
Address:
Signature:
Legal Description:
Site Address:
Building Permit #
NOTE: This permit will not be processed without complete information.
,...--. -
/
Block "3
tJ ,c.L,^.1'-
sUbrord'lV-d /,(;dq t' ()Ii\.
Lv./- t
PID #.&S- 3:)t)'- 0,)0-0
FIXTURE UNITS
Type of Fixture
Quantity
Type of Fixture
Bath Tub with or without shower
Dishwasher
Floor Drain
Lavatory (bathroom sink)
Laundry Tray (1 or 2 compartment sink)
Shower Stall
~
1
Rough-ins
Water Heater
Water Softner
Stand Pipe (washing machine)
Sewage Ejector
Backflow Assembly (RPZ, Double Check, PVB)
Backflow Assembly Test
Lawn Sprinkler
Other
Sinks
Bar Sink
Water Closet (toilet)
FEE SCHEDULE
Industrial, Commercial & Multi-Family
(1 % of job cost, $39.50 minimum)
Residential, New One & Two Family
Residential, Additions & Alterations
State Surcharge
$99.50
$39.50
$
$
$
$
.50
GRAND TOTAL $
This permit is granted upon the express condition that said
contractor, shall comply in all respects with the ordinances
of the State Plumbing Code and the amendments thereof.
RECEIPT NO. DATE
ATTEST
Call for all inspections 24 hours in advance.
( PAID WITH
BUILDING PERMIT
16200 Eagle Creek Av. S.E. Prior Lake, MN 55372/ Ph (612) 447-9850/ FAX (612) 447-4245
An Equal Opportunity Employer
Lt;s> / ~J / CAU!..f'
CITY OF PRIOR LAKE ,FEE'
16200 Eagle Creek Av. S.E. Ponni! No. qq.~ _. n an (;t:iN"y'
Prior Lake, MN 55372 ().J..Aj(. '-'1
Single Family
HEATING APPLICATION I PERMIT
Commercial
Date "3' \ 11 ~i PID # ~l5'-3"3.~ - {):LC?-Q
Site Address . I c:, 35'0 VI g1vv'lltu ~VLVe- fLisIJ
Lot q Block c3 Addition (!at(b~d A?~e 6>ft~d/7,
Owner'sName (3\2.~U-r!~ U~ ( H~~ B~ CH~ ")
Address _ I t.a 35"0 V I c 10 /( I A C.u \'LVe..
Heating Contractor, Co,J~t t,..,J A. \ ~ JJ,vc
Address, ;;< 1;).../0 t=F 10 A.J A II e,
Telephone # c:'~1 #0 ~oJ..d.
Furnace Make & Model "~N e;
Model Size . /00, ()6(JTf:JD/oO?1'
Conn. Load ty~ 000
Fuel NA-r
s-I;
Flue Size
Supply Openings
Return Openings
Input /oo,,d1)
Edr.
/4-
~
Output ~ 0 ern 8+WH
Cfm.
/QCD ~~
TYPE OF SYSTE..... ..".,
Warm Air Plants ?<-- '
Gravity
Mechanical
Air Conditioning
Vent. System
HEATING OR POWER PLANT
Steam
Hot Water
Radiation
Special Devices
Other Devices .
TYPE OF WORK
Replacement New Construction X
Est. Comp. Date '1JII-A'Y 30 fl~~ r
Building Permit iJ, ! ( d~
Q'1. SO Ilk fA. C;
+ r PAID WITH
1.50 . BUILDING PERMIT
lOt) . 00 Receipt #
~
Alterations
Repair
Est. Cost $
HEATING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEES $
TYPE OF STRUCTURE
I. Pillk
2. Green
3. Yellow
- File
. City
Contractor
Two-Family
Industrial
Public
Multi-Family .
Other
Fee Schedule
Industrial, Commercial & Multi-Family
Residential, Heating & AC
Residential, Heating Only
Residential, Gas Fireplace
Residential, Additions & Alterations
Residential, AC Only
~,1% ~ cost ($39.50 minimum)
99.50
$64.50
$39.50
$39.50
$39.50
Remember to add the State Surcharge on the bottom of this application.
The price of your heating permit includes one rough-in and one final inspection.
Additional inspections will be billed at $35.00 each.
,HolJse Heatina Test Record must be submitted with building oermit number before build-
ing certificate of occupancy will be issued. a /!.> 7fJ.~
liEAI CALCULATIONS REQUIRED. with number of supply and return openings listed per
room with CFM's per opening. New structures or additions send floor plan with supply
and return locations shown. HEAT LOSS CALCULATIONS, PAYMENT AND
APPLICATIONS MAY BE MAILED TO THE CITY OF PRIOR LAKE, 16200 EAGLE
CREEK AVE. S.E. PRIOR LAKE, MN 55372.
City Hall business hours are 8 a.m. . 4:30 p.m.
ALL WORK MUST BE INSPECTED (ROUGH-IN AND FINAL) - CALL CITY HALL
447-4230
I hereby apply for a mechanical systems permit and I acknowledge that the
information above is complete and accurate; that the work will be in conformance
with the ordinances and codes of the city and with the state building/mechanical
codes; that this form does not become a permit until signed by the BUILDING
OFFICIAL; that the work will be in accordance with the approved plan in the
case of all work which requires review and approval of plans.
9f!lduuJ~~e- 3/ult1.
Date
3-/Y-'17'
Date
71- D2. 8
Tht' ('..nlu of 'ht' LalLI' Coun.ry
White - Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLlSl
NAME OF APPLICANT lJ" __j '&J-- rld...\ I -'
1//2/{, -
APPLICATION RECEIVED
The Building, Engineering, and Planning Departments have reviewed the building permit
apPI:c~tion fronstruc~ion activity which is proposed at:
-LbJJ TJ lljhY..L/ ~A~.-.e/
Accepted
Denied
./"
Accepted With Corrections
Reviewed' By: JJ4L.iE'J( EJ.-/fiEStt1t4I\JN
Date: Ilzo;"
Comments: 5'1btt.+l J..,I~rEl2 KUNoFF rttvsr'" Be. (!,0I\Jl/&'1'C/) To AAltJ AL'o1l16
lJn.f\lI'JA6E: AN]\ tl-rJLIT\J F~E...JTS As
fY/v<.w ~'i Fk~:nc,q L.. .
sn' INFot't"1~TI()1\J 0-.1 Rf'tJERSE: S:ICE.
use:
(! 41.1T, 0 '-.I
1..11.,/(;'; /''1Al~-r//u('.n(J".1 AC.TIWrY OCl':.tJR<: ON oR. IdEAIt -n,e-
(1o~C-Re::TE: "'-lAw<. DAj\<4~ ?i-\rJEL-s
I.) ILL
Be:
R.EPL.AC~ R.., 7HE:
3" I LI:lE.R.. .
x~ 8:r'rAr.I-/J1,f6Jr..") : I. hAJt4L a~r. /,JSf'6c:fiMJ lAlF"rt.I!.1!J.,q. T/(JAl
2. E' ~ CII..0TIl.()(_ MeA'" I ~€S
:! Ck46,^.I, ,R,qAJ 1: Ello:HOAJ CONT1J..DL fi-t4AJ
"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
Thr ('eon.eor of thr Lake Country
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT 1k~ t fl./> I ~
APPLICATION RECEIVED I hJJ.,
The Building, Engineering, and Planning Departments have reviewed the building permit
application fo~onstruction activity which is proposed at:
/t0SlJ 1j~uJ L~
Accepted
~.
Accepted With Corrections "
Denied
Reviewed sl2J ~~ A,
Comments:
I.~ ~~ps~sAk~~~~
2. MCl;,^-~~J~ ~('otA ~,t~
3. ~~~ ai,{kc~l ~
Date:
) -/'2 -(I
.
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.1I
"
. .
. .
White - Building
Canary - Engineering
Pink - Planning
The- ('rnter of Ihe' Lake Counery
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
/
,: J
APPLICATION RECEIVED
i J.1f
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
,
.'; \
;,
f,
~.r/
. .
Accepted
.~
Accepted With Corrections
Denied
Reviewed By:
~~
Date:
2 ~ l-{_ ct0
Comments:
\ ') ,2- t-{ ~r \M(~~ JLv~4 ~&k\ ""- ut-
~\/~ I"LMm p
z-i Pr~~ <\.t=e- Ve-u<-Dv.--,Q ~ ~\L~
0oe-, ~~ IL{ r'M\lb.P-v ,~~<.., ~ blL~~
voh ~ \f8f\~~ (et~ "/~ }~\
8'~ <~ n,~_< K YJ_ {A.r- 2~ (5 I~~ .
- , ,
fJt6hJ.e-tM I L/ ~~ J- ~ u lfV\(~ 4 ~ ~ .(~,~
we- \CV-c-~evvte.d)., t^-'~ v'VL~~Q CW" ~~tL
"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."
-,,,....,.-.-.-,;.=.-.-----....-~...,.-.- -.---,.'-...-.---.-,------- .-.-,"-- ~-.--_.-"...,..._~,..... ~~-c._"-----""'" ...,.......,-
~ .. -.- --" ..---_._~..._._....._---------
.
/b3~
Job Address VJ~x,:>>- ~L~.iC:..
Heating Contractor Controlled Air
Name of Tester v/e5
Date -?I-~.z.-"l<
Percent O2 sr.~-
Percent CO2 7'0
Percent CO ~
Stack Temp. p-
~~r
i'
..
/
A
<;..
'"
....:",7 t -.';~
J,
1., 1",'_ ~,~.-> '~,',-:..- ~,"~:4 '<~..i<~: .,"","""
"~.;\ '. .~; ,
\"><j"A:,:;,.<
')~'~'i~~ I i~!1\J;~.r:i~~,;t ~
..
~'~~~~~~~~~..~;~~,'r'.*'fItt;C':.~.'".:f*,';,'~~'
: ,.~J ~~ I A.~ ;'~~ p':.;l!~'+~,l-'A~ ~',L,,~.;~,.~,.,~.j/~..)~~-.'~~..~~+"_~--'.:~~.:~~ .'~" ,~....
" _',~' 't ...... 101 b. ..." .dil'L. 1 l:. l:. loll 1. .!.!.. 1. 1. 1 ~ ~ ~1iI1.
I..
~.:.:' r QLertifirQU of (JDrCUpat
1'-
.~:, ,: CITY OF PRIOR LAIili ~-
. ,~~ I, I\tpartmtnt of ~uilbing 3Jnspettion
1'3 ~Final Permitted 0 Conditional C.O. Expires
-I This Certificate issued pursuant to the requirements of Section 307 of the Uniform Building Code
~;~ cenifying that at the time of issuance this structure was in compliance with the various ordinances of the
City of Prior Lake regulating building construction or use. For the following:
n ~ Q~
Use Classificati('lJ' \ I Ng If f--A/\^.\ L-~) Bldg. Permit No -{ v 0'). f
Occupancy Type R - 3 Type Construction -1 Fire Zone tJ ~. Zoning District e...
Legal Description LOf q is (k: 3 C M2 0' t-Jp. L- e \ O~ c ? 'tb ~& l1-~
Owner of Building I-btv\.f'S ~ cJU>.se.....c;iteAddress jlP 350' Ult.TVVZ-IA e.wwe-
cont{G'" N_ .. """'" %0),,",,-<; is u ~ 5" ---=is' tl JJ.e rV\ ; tJ.., S 057
" I I
~ 0 bert\ '\\'^"\ Ctl \ ~ S /!;:::;, CityPI~~ Ul~ ~....."- et I
a Building Official I J () . -::> /I _ q h
I - ~o - Cf <J Date: -I ..?U . 7
Date:
~~
.
\.
POST IN A CONSPICUOUS PLACE
, I
DATE TIME
CITY OF PRIOR LAKE 9-'3D-99
INSPECTION NOTICE SCHEDULED ItJ :00
ADDRESS I t, 3 So J cC3n fl.-{ A:. eUA.UE
OWNER CONTR.
PHONE NO. PERMIT NO. q q -6~?
o FOOTING o PLUMBING RI o EX/GRAD/FILLING
o FOUNDATION o MECH RI o COMPLAINT
o FRAMING o WATER HOOKUP o FIREPLACE RI
o INSULATION @ o SEWER HOOKUP o FIREPLACE FINAL
,PC FINAL o PLUMBING FINAL o GASLlNE AIR TST
o SITE INSPECTION o MECH FINAL 0
COMMENTS: S1 0 ~ / /U=.C-~
~ ~ ~ ~-Pyf-
~ - Uq.fJ_:,- ,..,....,_~ ~ f'~ ~
~ ~~~ -HL-
~;rJ A- 1J,.ih~<'(
...- ~
(~ ~tl _ p~,"""",
~.~.~
./
L SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WfjRK. CALL FOR REINSPECTION BEFORE COVERING
Inspector: n. Owner/Contr:
,;
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE..
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTI
DA TE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
5P9/99 ~; 0 ()
/~35?J V/CroJC..IA C.UICVC
SCHEDULED
ADDRESS
OWNER
CONTR.
PHONE NO.
PERMIT NO.
Q9-ZB
o FOOTING
o FRAMING ,I'L
~.JNSULATION i'~
"..,FINAL ~P'i"
o FOUNDATION
o DEMOLITION
o FIRE PREV.
I\~LUMBING RI ~ L-
V' ECHANICAL
o WATER HOOKUP
o SEWER HOOKUP
~EPTIC INSTALL
PLUMBING FINAL
A 0 SITE INSPECTION
o EXC/GRAD/FILLING
o LKSHORElWETLAND
o COMPLAINT
o SEPTIC FINAL
o FIREPLACE
o
COMMENTS:
CJ FiN..Q (,ylllk G..v-& M-~f!c:h1Yl ~ ~.h~t~
~ &J ~d- 1vl.~ ~ ~f~
~"e. ~tv-(~ dveJJv'~
W ~v.- "5 ~ o.~ I $+vL<:...:r
~ ~n+U y -trG...t? I kC(S{
,
o WORK SATISFACTORY, PROCEED
~ORRECT ACT~
?- CORRECT WOF ALL F R REINSPECTION BEFORE COVERING
Inspector: (' Owner/Contr:
CALL j7-4 30 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
(M ~ <.yl~ Jy~
---- ~ ~
r ~ ~
flr~ [ \~:L~f~
~ ~ ~
~~~
CODE RE lREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
7 -Z~ ~f 4":6'V
ADDRESS
1('~50 V,c.1o.....~ ~~'G-
OWNER
PHONE NO.
CONTR.
PERMIT NO. ~~ - z- f
o FOOTING
o FRAMING
o INSULATION
o FINAL
o FOUNDATION
o DEMOLITION
o FIRE PREVo
o PLUMBING RI
~CHANICAL
WATER HOOKUP
EWER HOOKUP
o SEPTIC INSTALL
o PLUMBING FINAL
o SITE INSPECTION
o EXC/GRAD/FILLING
o LKSHOREIWETLAND
o COMPLAINT
o SEPTIC FINAL
o FIREPLACE
o
COMMENTS: t ~
5L- t 4{J/rLi) l.~
. . -
\ '( 7V{lA ~ t;r
I
ltJ
rvc,
NO Lcc-k<;.
SP-
A.L--
c::V---
(gr~
6'^--
~ * rkuk(
w
AV
I A
i2J G/U dJ .--
N BEFORE COVERING
Owner/Contr:
'NTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI