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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE QF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
,-)~ ....-
1./ __ _ )
.' 1I~~. ..'''
Date Rec" d
9-5--02-
I. White File
2. Pink City
3. Yellow Applicant
I PERMIT NO.D 2 -eo I
,
'-"<::.:>u.'\../j ,A , ".J
/~f;l "
/~.
(_/
LEGAL DESCRIPTION (office use only)
LOT'7 BLOC~
ADDITION ~;;:...; IV 1'/"\ : '\J
! I
l,tr
2-f\" ~\
PID 2- )--'-]<7 t:) ,- 0 (l t/- ()
OWNER
W',,'. .-
(Name) . '.-../,.-" ,1-1.,r", """,,1
(Address)
"f'
'(...,
/",
rltl7-..A
ZONING (office use)
tf!-4-
/-Iu~'-1f(_'5
(Phone) ./ \-/'.., '/./"/ 'I/IL) ()
~,1. . .J...:' _/'
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~ '17__
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BUILDER
II
(Name)
(Contact Name)
(Address)
Ii
I;:
I i
~"
L)(/f ;1_
-~
l L.,"'" -.-' ,"'- ......I:?;'
; )'.' .
(Phone)
(Phone) 7<';;" ';:"~::; .~~-~.iJI'
TYPE OF WORK
ORe-Siding
New Construction
ODeck
ORe-Roofing
OPorch
o Fireplace
o Alteration
o Misc.
OLower Level Finish
PROJECT COST IV ALUE (excluding land) $
OAddition
OUtility Connection
,-~
--
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 official can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may
enter upo~e pro~~d inspections. (' / ,-- \ , (./02_ '" ' ._ _;"_
X ?~ / r . ) ~ ~~
, ...../ 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
$
$
$
$
$
$
$
$
City SAC and WAC
Water Tower Fee
#
#
Park Support Fee
SAC
#
#
Water Meter Siz 51 " I";
Pressure Reducer
too -00
\00. ot)
3S.SO
D. va
Builder's Deposit
Other
TOTAL DUE
mes Your Building Permit When Approved
1-IS- 02
Date
$
$
$
$
$
$
$
$
$
. ,
This is to certify that the i'ell\!.est 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 Plani)er constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued.
JO .(. Of;-
Date Special Conditionso 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
SITE ADDRESS l:laS'7 fOOt1alV\ Mt((5 01-
NATURE OF WORK -1Jev"J
USE OF BUILDING -EFt)
PERMIT NO. ~~_ DATE ISSUED q- ~-(J2-
CONTRACTOR ~l)P ~ PHONE C(6).-;)3~?-eBt4
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
~~-~/
DEPARTMENT OF
BUILDING AND INSPECTION
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 ~
INSULATION
ELECTRICAL
PLUMBING W t.r
HEATING (if required)
FIREPLACE
GAS LINE AIR TEST
{,t~~
GRADING (Prior to Sodding)
BUILDING
ELECTRICAL
PLUMBING LV ( t- ~ .Je- LL/va ~
<- fl'
HEATING
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I I
FINALS
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.
Call between 8:00 and 9:00 A.M. for all inspections
FOR ALL INSPECTIONS (952) 447-9850
C:'~
White - Building
Canary - Engineering
Pink - Planning
The Cenler of .he l..ke ('ounlry
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
VV E (\1 S rl f\W tJ
Cj-S-02-
APPLICATION RECEIVED
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
I 4257 Fou f\)1t\ I f'J HIL--GS ~1.
Accepted X
Accepted With Corrections
Denied \ ~ t
Reviewed By: ~
Comments: S~ k( "'B-u:
. .. See Reverse Side for Addition'allnformation!
Date: ,jJl~ 10L
See Attachments: 1) Graqing Plan, 2) Erosion Control Measures
3) Erosion Control Plan
"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.."
k Jt{~~;Le
Th(" CE'nlt"r or Ihl' t.kt Counll1"
White - Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
\ "
! ,! )
r \ I,' i
/
" (,...-.-
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
/...-
.. . 1
i
I
{ I!! :
, f \. '...."
r'
1_.'_,'.__
i
Accepted
J
Accepted With Corrections
n
Denied
Reviewed By: ~
Date: Q.q @
.. '.
Comments:
"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
Th... Ct'nff'r of the I.akt Counlf)"
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
ow E ,\1 S 1"'1 A IJ tv'
~ -5- 02-
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
i 4-ZS7 Fou l\JiA I N' Ii/LoGS C;r-.
Accepted X_
Accepted With Corrections
Denied
V2J
Date:
f-()-Cf?
Reviewed By:
Comments:
~ ~ ~. /)(
:-.." /.' +,~~
"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."
'03 10: 58 I D : PLYf'10UTH PLUnB I ~,jG
FA><:7635331121
PAGE 44/ 47
aR~e. - filE
YELLOW. ...PPLIC.....T
GOLD. ell.,
CITY OF PRIOR LAKE
SEWER AND WATER PERMIT
NOTE:
s.w No. d --- /3() /
Sewer and Water
contractors must
be registered
with the City.
APPLI CANT, {.) ~;O L\-tVl P \ LA iIV\ ~~ PHONE t7ll>"'j)S.:o L1 oS 7
~;h.DDRESS: 1L\____ fOL")'I\"L~\v'\__\\"J Q.'\-. DATE: ~-\L\-O~
SIGNATU~Q.v&;,~wmW~Q~\ BLDG. PERMIT I
SITE ADORES : PID#
FILL IN THE BLANKS
1. Estimated length of water service
I
AD
feet.
\ "
inch(es) .
2. Size of water service
3. Location of any couplings from structure
feet.
4. Type of sewer pipe. ABS
PVC 'i
Cast Iron
5. Estimated length of sewer 1 ine )...10
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
TOT.ll.L
* 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 in ure that no duplicate sewer and water pe~wits are
DATE ;::;e U [E @ [E 0 [J7 U! AMOUNT PAID -..;.~'"
RECEIPT FEe 1 8 2003 REC I D BY
li:
By__
----.:::-~~~=:::.:..._=:~~i
16200 Eagle Creek Av. S.E., Prior Lake, Minnesota 55372 / Ph. (612) 447-4230 I FAX (612) 447-4245
An Equal Opponunity Employer
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
#707.:7?
~: ~:n ~:~. I PERMIT NO. , ., - I 3 /) /1
3. Yellow Apphcanl .'X _ L .
.----
../--cY~~ /u ,,;L
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
(Address)
(Phone)
OWNER
(Name)
APPLICANT A . /. ./ /'H_
(Name) /7'//~~, /'~~A4~-r~(Phone) "/-
(Address) l -?&.:>"?) /~.A:.I 61!!* ~ ~. /:=- ~~
(Address) (CitYV'
(Contact Person) A~L:)~ 6~c./( (Phone) 5/-
APPLICANT SIGNATURE DATE
.
r71!l..TPW CONSTRUCTION o REPLACEMENT o AL TERA TIONS
v==r
FURNACE MAKE AND MODEL ~'4\,sr- -=:Slo~O~46}D FUEL NP>.. G A... 'S
if INPUT 66, ("')(') <:)
FLUE SIZE tj RETURN OPENINGS OUTPUT 5~ nn(l
TYPE OF SYSTEM HEATING OR POWER PLANT
[j\vann Air Plants o Steam PLEASE NOTE:
o Gravity o Hot Water Air Conditioner Units
i Mechanical o Radiation Cannot Encroach into
Air Conditioning o Special Devices Required Side Yard
Vent. System o Other Devices Setbacks
FIREPLACE MAKE AND MODEL .
APPLICANT PLEASE COMPLETE BELOW
Residential, Heating & AIC (New Construction)
Residential, Heating Only (New Construction)
FEE SCHEDULE
I % of job cost Residential, Gas Fireplace
$39.50 minimum
$99.50 Residential, Additions & Alterations
$64.50 Residential, AC Only
$39.50
Industrial, Commercial & Multi-Family
$39.50
$39.50
Estimated Cost $ Building Permit #
PAID ~
. ~~'LDING ~~~MIT
.50
HEATING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
i.:~ !I'~ Receipt No.
I : ~~! \
L'=:1 1
24 hour notice for all inspections (952) 4 7-9850, fax (952) 447-4245
By
FILE No.502 04/11 '03 06:52
ID:PLYMOUTH PLUMBING
FA><: 7635331121
PA(;E 3/ 11
Date Ret'd
CrTY OF PRlOR LAKE PLUMBING PERMIT
; ~~~ ~;:} I PERMIT NO. 1-/30 ('
~ \'~ao...... l,ppllEl1nl d--
20ND.JG Illll\c"lI~CI
-- ou V\~~
ltt\
LEGAL DESCRlPTJON (Ofr;CL' ~sc only\
LOT
BLOCK
ADDITiON
Pro
I' OVlNEK \ J ~
i (t-Jame) ". ~M ~ b'V\ I\I^ VI, ~~
I (Address) \ ~q ~ p (C\ 1N~ 0 \ '\ \~
-
A.PPllCflJ\fT ()'
IN,,,,) ~I 'jV\^.IK'tl:J' ILl,\',~ I "'j
(Addn:s~) ( 0 '1 (1 q \1\ \ ,", \. "0: l ~
(Addrts$'j
QU:J.ntit.")' Type of Fixtu rc Ouan titv T~J I)l~ of Fixtu/"C
.... .
\ Bath Tub with or without shower Rough-ins ..
, Dishwilsho:r \ Water Heater
iJ... Floor Drain \ Water Sofmer
~ LavalOry (Bathroom Sink) \ Stand Pipe (W:ishll'~ MOlc1111ie)
Laundry Tr2l> 11 or 2 cOl11p<:l.rtmell1 slIlk Sewagt E:jeclor
Sl1owel'Stal1 Backflow Assem b Iy
i \ Sinks Bacldlow Assembly Test
- . . . .
L.J'-Ll -'>1,,,,,
\)\'atl:l" Clo~el IT(H!e1)
FEE SCHEDULE
Irlduwi.ll, C0n1rnercl;l1 & h~ultl-(;lli1il\ 10i.. of 1')\' ':"SI Wllh " l;3'ljO nllnlmum
R.c~idcnL1UI, New One &:. I'wl,.j=..mil.l' $q9 sn
Rcs\cknllal. A"adllILll1~, & Allt:r~li,)n~' l:39.50
E~\im:Jl::d COSt $ ~ \?JO ,m
Building Permit #
,.
.[>
,50
~~
P~Fi4t,.,.
PLUMBING PERM;1' FEE
STA TE. SURC:.lARCE
TOTAL PERMIT FEE
$
$
illfr1~I' Ul~ (lUll'!
Pjj((;
Rl:ct:lpl No,
This Applic~tJ()n Bccomc.~ YlIur Building P~rml1 Wh~n Apprll\'cd
U"iIJlII:; 1.)(,/",,.,,,1
B"
,! ~
2~ \lioU' \H'li.:<: I'!o!' ~Il ill'.ptClilln' (I!S~J':; i-~~311, 1';1), (~:5:\ ~4i-J~:j:\
11.,~IH F.:, '.!1 I (.'l.l'I.'I~~\'i.I,. 1....[. "I'lId' B~i~_';'~;;''''''' l""i, I
j
,
.... .
-'
Date Rec'd
CITY OF PRIOR LAKE
SEWER AND WATER PERMIT
(Please type or print and sign at bottom)
I ADDRESS
1'-( ;}J:; /
~. ~w ~\~ I PERMIT NO. I
3. Gold Applicant. . 0 1- - I? 0 ,
ZONING (office use)
~(hJ'1^IIo..."'" IJ./ If ( e.,--
LEGAL DESCRIPTION (office use only)
LOT 7 BLOCK 3 ADDITION
PID cJ.f:- 3~trO'lL-(-()
OWNER
(Name) WGNS MA,.)N H 11J'V/0
(Address) 181C:- PI.A~A DIL
(A dress)
(Phone) t,~l...t/tJ6 -'flr/'t)
S-S 180:;2.
(Zip Code)
APPLICANT c-_
(Name) ~cr
M
At1J07A3-
(Phone)
(Address)
(City)
(Zip Code)
(Contact Person)
(Phone) ~/~-).Z./"""1J.2'9
DATE
APPLICANT PLEASE COMPLETE BELOW
Size of water service ---L inches.
Location of any couplings from structure 2.1T" feet.
Type of sewer pipe. ~ ABC D PVC D Cast Iron
Estimated length of sewer line 62 5teet.
Clean out (if required) located at feet from structure.
FEE SCHEDULE
Residential sewer and water line connection $35.50 Industrial, Com'l & Multi-family 1% of job cost with a $39.50 minimum
Sewer connection only $17.50 Water connection only $17.50
Estimated Cost $
Building Permit #
SEWER AND WATER PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
.50
!)U1l. j:)AlID lA.
DI""G 7/1'"1j
, ~f::/~ A
'viI.,.
(Office Use Only)
This Application Becomes Your Building Permit When Approved
- =_...-""-~_.~ ~ - ~
Receipt No.
Building Official
I" ~.
Date \
I' I
i : i lJ
24 boo, noti<< 'O' ,II '"p",,'o.. (952) ..to"'X(952):7-42~5 L, \
',.,...~-_.~-=~.:..~.,._~."- ---...,'--~-.