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CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT,p! .~. 010 I fJ-OIo
I \~i~i~e ~:~v I PERMIT NO. /- -/- /}/ / I
Yellow Applicant (p.. 'L...."1 L '
(Please
ADDRESS
5"'3
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
~~~~~
t>" \ \Je.. S E
ZONING (officc usc)
PI
36 -OCI ()
OWNER,
(Name) ?C'\Ot'""
Lo.-~
(Address)
~\
.
\)~:S~~~~
(Phone)
waD~ ~
(Company Name) 5t-"~ \'€....C_J" 'S
(Contact Name) 'PC) b (1r-.'l " .~
(Address) ..-26" c-~d-",~+- ,~z.
--.--
"- L ~e.. .
(Phone)
(Phone)
.~
t'h~
TYPE OF WORK J:JJilew Construction ODeck OPorch ORe-Roofing
~dditlOn ~teration OUtility ConnectIOn
CODE: OI.R.C. OI.B.C. ~Misc
Type of Construction: I II III IV V A B
Occupancy Group: A B E F HIM R S U
Division: 1 2 3 4 5
ORe-Siding OLower Level Finish
o Fireplace
_~~ NL ~ ""'('\~
~~W"'\.
PROJECT COST IV ALUE $
(exduding land)
ation 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
tructlon w1l1 conform to all eXISting state and local laws and will proceed In accordance with submllled plans I am aware that the building
Furthermore, I hereby agree that the city oftlcial or a deslgnce may enter upon the propel1y to perform needed inS ccllons
TS 53! 3/
Contractor's License No.
Permit Valuation
Permit Fee
Plan Check Fee
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
Sewer & Water Permit Fee
$
$
$
Park Support Fee
SAC
# $
# $
$
$
# $
# $
$
$
- d --tp $
Water Meter Size 5/8"; I";
Pressure Reducer
Sewer/Water Connection Fee
Water Tower Fee
Builder's Deposit
Other
TOTAL DUE
Receipt No.
By
Paid
Date
ThIS IS to certify that the request II ve applicatIOn and accompanYing documents IS In accordance WIth the City loning Ordinance and may proceed as requested ThIS document
when signed by the City Planner Cllnstltlltcs a temporaty Certificate of Zonmg compliance and allows construction W commence. Before occupancy, a Ceruficate of Occupancy must be
i.<.;sucd
Planning Director
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
Special Conditions, if any
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
~. ~~w Jliicant I PERMIT NO. 0& . O~ 74
ZONING (office
use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name) Indepedent School District 719
(Phone) 952-226-000
(Address)
PO BOX 539
Prior Lake MN
55372
APPLICANT
(Name)
Northwest Sheetmetal Co of St Paul
(Phone)
651-310-0102
(Address)
110 Sycamore St. W.
(Address)
St. Paul
(City)
MN
55117-5451
(Zip Code)
(Contact Person)
(Phone)
651-310-0102
APPLICANT SIGNATURE ~ DATE 6-6-06
APPL ANT PLEASE COMPLETE BELOW
DNEW CONSTRUCTION fJ REPLACEMENT 0 AL TERA TIONS
FURNACE MAKE AND MODEL Make up air Greenheck lGX-118-H32 FUEL nat gas
FLUE SIZE on roof RETURN OPENINGS INPUT 535.5 MBH OUTPUT
TYPE OF SYSTEM
DWann Air Plants
DGravity
o Mechanical
DAir Conditioning. h
~Vent. System Kl tc en
HEATING OR POWER PLANT
o Steam
o Hot Water
o Radiation
o Special Devices
o Other Devices
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
FIREPLACE MAKE AND MODEL
Industrial, 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 & AlC (New Construction)
Residential, Heating Only (New Construction)
$39.50
$39.50
Estimated Cost $ 24 500 00
HEA TING'PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
Building Permit #
$ 245.00
$
$ 24~. 50
.50
(Office Use Only)
This Application Becomes Your Building Permit When Approved
~~~~ ~~~~
Buddin!! Official Date
Paid.,,2~. 57)
Date 7 "d-/. () (p
Receipt No. 5/98 tj
By
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
U3/23/2008 12:44 FAX
III 007/007
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
l1ate Rec1d
MAR 2 3 2006
I. Pink
1 Croon
J. y.u"",
f~icon' I PERMIT NO. O~. 0/891
E fe~^4ry :5c. hocl
; vt:" ~
ZONING (office
us.)
LEGAL DESCRIPTION (office u~e on[y)
LOT
BLOCK
ADDITION
PID
OWNER
(Name)
~ #7JC1
(Phone)
(Address) 757 S J50..J..h S+-- ~
S -.,.-0, MAl :;;-5378
-...;
APPLICANT
(Name) 00 ~)I /V1ee-~",-i ~ t=I. I
(Phone) bS-J- q8 7-106 /
(Address) c-~........ r A
~ 04---' '/-Y"o"J.. rh.~,,-..ce S.1.. ~...), M N 55: 117
(Address) (Ctly) (Zip Code)
B'II Roskas (Phone) 6<;:'J-cm7-;),7S-8
A PPLl CANT SIGNATURE ~R~ DATE ~
APPLICANT PLEASE COMPLETE BELOW
(Contact Person)
DNEW CONSTRUCTION o REPLACEMENT 1,&:.AL TERA TIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM REA TING OR PO'WER PLANT
DWann Air Plants ~team .,Jt ~ PLEASE NOTE:
OGravity ot Water l~ \I rv6 Air Conditioner Unirs
re;feehaniC31 Radiation Cannot Encroach into
Air Conditioning o Special Devices Required Side Yard
OVenl. System o Other Devices Setbacks
FIREPLACE MAKE AND MODEL
Industrial, Commercial & Multi-Family
FEE SCHEDULE
I % of job COSI Residential, Gas Fireplace
S39.S0 minimum
$99.50 Residential, Additions & Alterations
$64.50 Residential, AC Only
$39.50
$39.50
$39.50
Residential, Healing & Ale (New ConStruction)
Residential, Healing Only (New Construction)
(omet U~e Only)
Estimated Cost S I, ceo. C(:)
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
Building Permit #
$ 39 Sb
$ .50
$ J70,CO
This Application Becomes Your Building PermIt When Approved
S-~//&C
Oalo
I ::"iP' No
#/ 4~,"-
Bulldlnli! Official
I Paid
Datc
24 hour notice for all jnspection~ (952) 447-9850, fax (952) 447-4245
OJ/23/2008 12:43 FAX
~ 004/007
CITY OF PRIOR LAKE PLUMBING PERMIT
Date Rec'd
MAR 2 3 2006
~. ~~~~ ~~~ I PERMIT NO.O~. 0 led)
J. Yelle.w ^~IJ.u1l1 . V .
~I-co I ZONING (o/flce
ute)
,..,'Or ~~
IV 5537.;;
LEGAL DESCIUPTION (offlce use only)
LOT
BLOCK
ADDITION
PID
OlVNER
(Name)
-T.$D # 7/ q
(Phone)
(Address) 75 75 J~ Sf- ~
~c..y~qe ,/"v-)N 55"378
...
APPLICANT n ,
(Name) ~>-' ~/....a,"'ira/
(Address) ~D ;:::;(7;o.J. AV6>"H.-t@
(Address)
(Contact Person) B; (I 1<0 SKo s
/;/ /.
APPLICANT SIGNATURE ~4 ~-:at- DATE 3/d~/06
APPLICANT PLEASE COMPLETE BELOW
Tv e of Fixture uantit
Bath Tub with or without shower
Dishwasher
Floor Drain
Lavato Bathroom Sink
Laund Tra 1 or 2 com artment sink
Shower Stall
Sinks
Bar Sink
Water Closet
~.
(Phone) 6$"/- 487-/06/
P~J , jV1 f....-/ ~/ /7
(City)
(Zip Code)
(Phone) 657-;28 7 - d75""8
I
J
e of Fixture
, FEE SCHEDULE
Industrial. Commercial & Multi.family 1% of job COSt with a $39.50 minimum Residential. New One & Two-Family $99.50
Residential, Additions &, Altemions $39.50
(Omc:e Use Only)
This Application Becomes Your Building Permit When Approved
/I(~~ Sft;~6
Estimated Cost $ )61 1-f.;(5 Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE S
)6~.:J~
.50
/61-/, 7S-
Paid
Receipt No,
Dat~
By
24 hour notice for alllnspecllons (952) 447-9850, flU: (952) 4.7-4245
16200 Eagle Creek Ave,. S.E., Prior La.ke. MN 55372-1714
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
I. Whil. Fil.
2. Pink City
3 Yellow Applic:am
ZONING (office use)
WESTWO()
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
~=\:-~~t ~O\ h',&\-ti<:"'-t 4i 119 (Phone)
(Address) 5300 \J.JQS-u.)oo&., h~. S.E. ~.zjOL lat.a.. NlJ 5"53,2..
BUILDER \ \ , ~ .
(Company Name) M~'ne.. s\-~k"", ~.
(Contact Name) 't\C\. ~ ~f2..a...~
(Address) ILlOD se:lb Ave.. S+e. ;;J~D ~. pQ.lJ
(Phone) iPS l-lb4~- ;;935'
(Phone) iDS / - 33ic- 490s
tv1~ ss/o
TYPE OF WORK 0 New Cons~n DDeck o Porch o Re.Roofing ORe.Siding
OAddition ~lteration o Utility Connection 0 Misc.
OLower Level Fimsh
o Fireplace
'0
50. ~oo-
/
CODE: OX.R.C. OX.B.C.
Type of Construction:
Occupancy Group:
Division:
PROJECT COST IV ALUE $
(excluding land)
Cr:; L ,'JJCt, klUo
X
E
II
F
I
ill IV
H X
Z 3
V
M
4
A
R
5
B
S U
A
B
Hoc/) t!J,JLY-
I hereby cenify chat I have furnished mformation on this application which is to the best of my knowledge true and correct. I also cenify that I am the owner or authorized agent for the
above-mentIoned property and that all constnlction 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 ju use. Furthermore. I hereby agree that the city official or a designee may enter upon the property to perform needed mspections.
::,--.;1.6 - 0 ~
Date
x
Contractor's License No.
Permit Valuation
Permit Fee
Plan Check Fee
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
Sewer & Water Permit Fee
Gas Fireplace Permit Fee
Park Support Fee
SAC
#
#
$
$
$
$
$
$
$
$
$
$
$
Water Meter Size 5/8"; I";
Pressure Reducer
SewerlWater Connection Fee
Water Tower Fee
Builder's Deposit
Other
$
$
$
$
$
$
#
#
TOTAL DUE
This Application Becomes Your Building Pennit When Approved
f/~
- Building Ollicinl
6fl"fl6
r Dnle'
ThIS IS to cenify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as rcqul'Stcd. This document
when signcd by the City Planner constitutes a temporary Cenificate of Zoning compliance and allows construction to commence. Before occupancy, a ClTlificate 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
1.,.-./
6/
MINNESOTA DEPARTMENT OF LABOR AND INDUSTRY
Division of Construction Codes and Licensing
REPORT ON PLANS
Plans and specifications on plumbing: Westwood Elementary School, Kindergarten Additions/Renovations,
5370 Westwood Drive SE, Prior Lake, Scott County, Minnesota, Plan No. 062442
OWNERSHIP:
Independent School District No. 719, c/o Mr. Tom Westerhaus, Superintendent,
P.O. Box 539, Prior Lake, Minnesota 55372-0539
SUBMITTER(S): Wold Architects and Engineers, 305 St. Peter Street, St. Paul, Minnesota 55102
Plans Dated: January 12,2006; Addenda Nos. 1-2
Date Received: February 8, 2006
Date Reviewed: March 9,2006
SCOPE: This review is limited to the design of this particular project only insofar as the provisions of the
Minnesota Plumbing Code, as amended, apply, and does not cover the water supply or sewerage system to which
this plumbing system is connected. The review is based upon the supposition that the data on which the design is
based are correct, and that necessary legal authority has been obtained to construct the project. The
responsibility for the design of structural features and the efficiency of equipment must be taken by the project
designer. Approval is contingent upon satisfactory disposition of any requirements included in this report.
Special care should be taken to insure that the material and installation of the plumbing system are in accordance
with the provisions of the Minnesota Plumbing Code. A copy of the approved plans and specifications should
be retained at the project location for future reference.
INSPECTIONS: All plumbing installations must be tested and inspected in accordance with the requirements of
the Minnesota Plumbing Code. As specified in Minnesota Rules, part 4715.2830, no plumbing work may be
covered prior to completing the required tests and inspections. Provisions must be made for applying an air test
at the time of the roughing-in inspection as outlined in Minnesota Rules, part 4715.2820, subpart 2, of the code.
A manometer test, as specified in Minnesota Rules, part 4715.2820, subpart 3, is required at the time of the
finished plumbing inspection. It is the responsibility of the contractorlinstaller to notify the Minnesota
Department of Labor and Industry when an installation for a state contract job, licensed facility, or project in an
area where there is no local administrative authority is ready for an inspection and test. To schedule inspections,
contact the state plumbing standards representative for your region, or call Jim Peterson at 651/284-5889.
REQUIREMENT(S):
I. Verify that the existing water supply and waste systems are sized to accommodate the added fixtures (see
Minnesota Rules, part 4715.3800 and part 4715.2310).
2. Solvent weld joints in PVC and CPVC pipe must include use of a primer which is of contrasting color to the
pipe and cement (see Minnesota Rules, part 4715.0810, subpart 2).
3. It is recommended that a cleanout be provided where new waste and vent piping connects with existing
plumbing to facilitate required testing of the new installation.
4. The plumbing system shall be tested in accordance with Minnesota Rules, part 4715.2820. Only
thermoplastic pipe materials may be tested hydrostatically (see Minnesota Rules, part 4715.2820, subpart 2).
5. The submitted plan review fee was $40. However, the plans appear to indicate 16 drainage fixture units, for
which the required fee is $150. Therefore, please submit an additional $110 for the plan review.
~)
10/21/05 14:57 FAX 6512235646
WOLD
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DEPARTMENT OF ADMINISTRATION
Initial Application for Plan Review
Please complete this application and return it to the Building Codes and Standards Division prior to
your expected plan review submittal date. This will help us expedite your project while we determine
where you will make application for plan review.
12104
000
E-mail:
o Public (state-owned) building paid for by the state or other state agency for:
o National Guard a Historical Society a MN Zoo 0 D.O.T. a D.N.R.
o MNSCU State Call e or Universi a Stc;lte Has ital 0 State Home
Public school district building of $100,000 or more in construction cost
[J State Licensed Facility licensed as a: 0 Hospital 0 Nursing Home 0 Cor.rectional Facility
a Supervised livin Facili 0 Free-standing Outpatient Surgical Center
o New Building Construction 0 Addition IX Remodeling 0 Other; specify
LL
o ~ IBC Occupancy Classification(s): E A IBC Type of Construction: II !.
enD:
~ ~ Pp:j~~:;ti04 (K,,~ Sf~U.J 40 c.v~'G '2- ~U"60W\' A~ ,~ Ct)
",~.... "'b,,, J-!J"""Mo\. ~ ~\ vU\WoeW $I c.a I' t'Q)cI~ 4,~o r.~.
0, ~. ."'" 'If '" '" (~ "oJ( u ~ JJ ........ .
Upon receiving thi~ completed initial application, we will confirm proper juris ictlon for the project,
assign a project number, and determine who will do plan review and inspections. Within a few days
we will notify you in writing of the project number, where to submit your documents for review, and
how inspections will be handled. If delegated to the municipality, you will need to follow their
procedures and fee schedule. Otherwise our standard application process will need to be followed.
I-
Uw
wa..
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I completed the information on this application and un
_~ 'R"pl,~"
Applicant Name nnt)
10/"2.1 ~~----
Date
tand that it does not authorize the start of construction.
Bui/ding Codes and Standards Division, 408 Metro Square Building, 121 it. Place East, St. Paul, MN 55101-')1R1
Voice: 651.296.4639; Fax: 651.297.1973; TTY: 1.800.627.3529 and ask for 296.9929
Web Site: www.buildingcodes.admin.state.mn.us
PR586
BUILDING CODES &
STANDARDS DIVISION
408 Metro Square Building
121 7th Place East
St. Paul, MN 55101-2181
www.buildingcodes.stat9?mNWT J
651-296-4639
Fax: 651-297-1973
TTY: 651-627-3529
TTY Toll Free: 800-627-3529
Minnesota Department
~Laborandlndustry
I'.' I '. ..".',
COpy TO BUILDING OFFICIAL:
Hutchins. Robert Dana
City of Prior Lake
16200 Eagle Creek Ave.
Prior Lake MN 55372
Date:
10/21/2005
Project Title: Westwood Elementary - Kindergarten Ren
I.Q~ation: City ofPlior Lake
Description: renov 4 existing spaces to create 2 class filS & ki
Date Received: 10/21/2005
Assigned Project Number: 20050421
Dear Building Official:
Attached is a copy of the notice to the Architect / Designer of the project described above
as to the agreement reached between the Minnesota Building Codes and Standards
Division and City of Prior Lake delegating building code
administration to your office as per our agreement on this project.
Yours truly,
~CODES STANDARDS
Scott D. MCL~ c~
Supervisor, Plan Review
SDM:w
Attachment
PaFormRl
This information can be provided to you in alternative formats (Braille, large print or audio tape).
An Equal Opportunity Employer
CITY OF PRIOR LAKE BillLDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Rc-/IlO//H;7cl/JS
5
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
(Address) I
Date Rec' d
/, Z3. CJrv
~: E: ~:licanl I PERMIT NO. 0&, ()! 0/ I
<3,.~
ZONING (office use)
CI
P.O.
2..
B~DER n Cd
(Company Name) ~$J:.\\<h, ~~t:\l\O~
fdtit> lueR&1t.:)
\.Je ~
(Contact Name)
(Address) es
(Phone) '15'-- ~\. S40~
(phone)9SZ. ~~.,. ~~4 2.
~ s
"',
TYPE OF WORK 0 New Construction ODeck OPorch ORe-Roofing ORe-Siding OLower Level Finish 0 Fireplace
OAddition OAlteration OUtility Connection
CODE: OI.R.C. ~I.B.C.
Type of Construction: I <if)
Occupancy Group: @ B (E) F
Division: I
ill IV
H I
2 3
V
M
4
iii Mise: U{t,.~.
A
R
5
B
S U
PROJECT COST IV ALUE $
(excluding land)
L/as1XXJ .~
,
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 plans. I am aware that the building
:ffioW ,m ok... ~ F_, I -by..... ""'.. ,""0,,,,", oc. ""_ =y m", 'P<m fu, ,",,""00""""'" ""'; go~
Signature Contractor's License No. Date
Permit Valuation
Permit Fee $
Plan Check Fee $
State Surcharge $
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace Permit Fee $
Park Support Fee # $
SAC # $
Water Meter Size 5/8"; I"; $
Pressure Reducer $
Sewer/Water Connection Fee # $
Water Tower Fee # $
Builder's Deposit $
Other $
TOTAL DUE $ 5Bz~..+~
I paid~~{3 . Va
Date -:> '3 . C)~,
I ~i~')GJ 5"'-, '1
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
Dale Special Conditions, if any
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
Pink
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
L3 OSJ A- /L.O T (!"o ~ .
I. 2..3 , () ~
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
5370 W6~ooO .Dt2-.
Accepted
\.,,'/
Accepted With Corrections
Denied .. / k
011 /J---r.- 2./ 1.'3 /")/
Reviewed By: N)~ Date: _ ~
Comments: /". ~ IT> 4/d-...Z? f~ PL(-.41t3II\J~, ;1 f/11-c.."
, .
S Pf2-(.uI~ M E:L~t::_::rf2-(C- .~
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~ ('is/'/ GI2AI.v-~J/) /2;u~ {.r
I>~I
/
"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."
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTmCATE OF ZONING COMPLIANCE
AND UTILITY CONNECI10N PERMIT
8 .7. () b
Date Rec' d
f:iL-6 w! OG.OIO/
~. E.. ~.. I I PERMIT NO. ()(,. 0 7S J
Dr. - E.
ZONING (ollltt usc:)
..s, (!Ij 0 (J t-
55'
LEGAL DESCRIPTION (omce use only)
LOT
BLOCK
ADDmON
OWNER/! 1 J - .L
(Name) l.I\...Ie..~l- ~)~:d !;./e'!1(,iIO("(
(Add."eSS) 5370 Lu est'-'Uood Dr
pm 25.. Sc:,. 001. 0
~chc)c>l
Se..
(phone)
Pr:o ( Lt" ke..
/?-7n
5-5-3-.7 ;;l
~~~R;t/orjh )C\flJ i- j'r(... ~ ~ec~Jr/+"
(Contact Name) G reo.. . r-
(Address) Y'I'Is ~v-77t~ sf
(phone) j~a..-9~~ - C7o~-
(phone)
--5.S- '9'3
TYPE OF WORK ~ew Construction
;t!N tV~6 ttiJcV OLower LegelFinisb
Sv
ODcct [JPorc:b ORe-RoofiDg ORe-Siding
o Fireplace []Addition OAJteration OUtility Connection
PROJECTOOST/VALUE(exdudiDglaod) S I' 0-0. (:ro
[ hereby cenifY that I have fumisbed inlormaboo on this appticatioa whicb is to dae best or my IaIowIedF true aDd oonect. I also cmiJY that I am the owner or
authorized qeDt lOr Ibe ~ property aDd dial .. ............... wiD caabm to all e:xbdaa ICaIIe md local laws lIIId wiD proceed in accordance with
~ pIaDs. I am awue Cbat Ibe baiIdiIIi ofIidII caalnob: dais permit b just CUR. Pb.1hmnore, I baeby ~ Ibat die city ofticiaI or a designee may
enter upon property to perf'onn needed impeaioos.
X (l CK.,~ 8 ,,- 9'-0 b
s' CoabKtor's Lia:ase No. Date
Permit Valuation
Permit Fee
Plan Check Fee
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
Sewer & Water Permit Fee
Gas Fireplace Permit Fee
s
s.
s
s
s
s
s
s
.
.
Park Support Fee # S
SAC # S
Water Meter Size 5/8':; 1"; S
Pressure Reducer S
City SAC and WAC # S
Water Tower fee # S
Builder's Deposit S
"
Other S
TOTALDUE ~ 8 _/fLO<O $ /~,,~~S
..
~o
oz,.~.s
.
I Paid
Date
/0(;,. ~S
8. 2--1. q(,
This is to ccnify'Wt die ~est ill die above appIicalIoo and ~ cIocuJIKats is in ~ willi die 0Iy Zonina Ordiaanc:e and may proceed u ~estcd This documenl
when silned by the City PIanncr ~ a trmponry Ca1ificaIe 01 Zoainc ~ and aDows alIISIrUCtioa to COIIIIIIaICe. Ildin occupancy, a Ccrtificalr of Occupancy must Ix'
issued,
Planninl! Director
Date
Special Conditions. if any
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"'VM LAK~_
INSPECTION RECORD
....r1fMENY OF
BUILDING AND INSPECTION
SITEADDRESS . b;S~ow.s-,~~n De. <;', ~.
NATURE OF WORK R~NOV A-T1uN '>
USE OF BUILDING ~ \ Ie.. A.. rz..
PERMIT NO, ~/O( DATE ISSUED 2 I." 00
CONTRACTOR FY-""''''''''2.Or: ~/l ~ PHONE '15'>- -t? 0, I _ 5 l' 4e
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
GAS LINE AIR TEST A
COVER NO WORK UNTIL ABOVE HAS BEE~ SIGNED
1_~-"iLI/'J~~~_ FIlAlS I
- (Prior to s~, Jding)
. - --
BUIL:DING
ELECTRICAL
PLUMBING
HEATING
DO NOT OCCUpy UNTIL ABOVE HAS
NOTICE
SEWER I WATER I SEPTIC
FRAMING
INSULATION
ELECTRICAL
PLUMBING , . A
HEATING (if required)
~
INSPECTOR
DATE
I
]
J
This card musI be posted near an eleclrical service cabinel prior to rcugh-in inspecticns
and maintained unlil all inspections have been approved, On buildings and addillons
where no service cabinel is availabie, card shall be placed near main enlrance,
FOR ALL INSPECTIONS (952) 447-9850