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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
ADDRESS
1(//(.</ (/
(~.:;...; tV) ,,~. ',j
f:.f-> 1/ s
LEGAL DESCRIPTION (office use only)
-) r"7J r-
LOT.5 BLO!=~ ADDITION ;-.C,,;,/ jV -:/-... I \,;
OWNER
(Name) (~/z'.-.;'/v -) 11.< /"IJ.j
(Address)
,/}I
, (/I ]"",,;
7
BUILDER
(N ame)
(Contact Name)
. ,
"
I *;//l.~./('-' S
,
r;" {. <-"-~ "r[~,~-
Date Rec' d
{jr 5 -()2-
I. White File
2 Pink City
3. Yellnw Applicant
[ PERMIT NO.O ? -/367
ZONING (office use)
,c4--
.,... ~-
'.....-/
I' J /II -
-<("7 (I ~~
21';>
PID.;lS: Jt}U-04'{J--C
(Phone) (, -> - /- '/ t:X~ II '/~U>
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(Phone)
(Phone) i." -;.,# .';?:: -3
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(Address)
.--;,.---- ..: -
,', l' /.:'.' .f,
(. /1 '
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/.
ORe-Siding
TYPE OF WORK
New Construction
ODeck
OPorch
ORe-Roofing
o Misc,
OLower Level Finish
o Fireplace OAddition o Alteration OUtility Connection
PROJECTCOST/VALUE (excluding land) $ ;- Z, 1~1'} ~/
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 upon the property to perform needed inspections,
X -;:? ~:~---,.- /1/\):' 1-;/ "L--
C ,jl /Is'ignature 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 $
Your Building Permit When Approved
q- l5-0-
Date
Park Support Fee
SAC
Water Meter Size 18" I";
Pressure Reducer
City SAC and WAC
Water Tower Fee
Builder's Deposit
Other
#
#
#
#
$
$
$
$
$
$
$
$
$
L/s.cO
Qoo~ (..;6'
)tJCJ . c.tJ~
--
1 0 ,7 -0:;)-
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
TOTAL DUE
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,
~
White - Building
Canary - Engineering
Pink - Planning
Thr Crnlrr or Ihr tab ('ounlry
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
WbN5~1 A WtJ
q-s - 02-
APPLICATION RECEIVED
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
J4/&4- FOUNTAIN I-I(L~S (!;'J
Accepted '><
Accepted With Corrections
Denied
Reviewed ky: ~ if-
Comments:
Date: ~ II~ lOl.-
I
~ rt1MiJ fc.LE
See Reverse Side for Additional Information!
'.
See Attachments: 1) Grading 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."
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pUB SUO!lBO!!peds 'SUBld !O IB^OJddB JO l!WJ8d B !O 6UnUBJ6 JO 8::>UBnSS! 84..L"
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'...----
White - Building
Canary - Engineering
Pink - Planning
The (-t'nlf'r of the Lllkt ('ounll1'
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
\N GrJ5M A N tJ
q-5 - 02-
APPLICATION RECEIVED
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
/4/G,4- POVN"JAIN {-I(Lc/~> C./I
Accepted V
Denied -f}j}
Reviewed By: t; b
Accepted With Corrections
Date:
1-1 f-6L
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 : PLVr10UTH PLUr18 I ~,j[;
FAi<: 7635331121
PAGE 40/ 47
GAEE. . I"U'
YELLOW - APPLICANT
GOl.D . CIT 1
CITY OF PRIOR LAKE
SEWER AND WATER PERMIT
NOTE:
s.w. No.;;) - /30 'i
Sewer and Water
contractors must
be registered
with the City.
A PPLI CANT: 2J ~~1YI4) (,i-\r\ P \ LA Vy\ I", , ~ PHONE :(7 0J)Sx:> - L1 ':>57
~DDRESS: l.~--' __ VOL)V\t:~\^ J_,\~ C'-\-., DATE: d--\~-O~ _
SIGNATU:JQ.Ji6'~~')~21{ BLDG, PERMIT #
ITE ADDRES : PID#
FILL IN THE BLANKS
I
AD
feet.
1. Estimated length or water service
2. size of water service
\ "
inch(es) .
3. Location of any couplings from structure
fee~.
4. Type of sewer pipe. ABS
PVC '{.
Cast Iron
5. Estimated length of sewer line /-10
feet.
6. Clean out (if required) I 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.~L
* Fee for either sewer or water individually is $20.00 plus
S .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, permit. s are
issued. PAID V,/I":'
(JJY6LDING t;,~, '
DATE PAID
AMOUNT PAID
f(J
RECEIPT #
RECIO BY
innesota 55372 / Ph. (612) 447-4~30 / FAX (612) 447-4245
ual Opportunity Employer
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
#' 7o:z:<
~. ;:'~n ~:~, I PERMIT NO. ':1 _(/7 d'fl
3, Yellow Applicant , ( z u ~ '
ZONING (office use)
/Z;;-~/~
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name)
(Phone)
r-:=-~~
'-' ~
APPLICANT A .. ". -/~
(Name) /-7//~A."d.' /"Gt!!'~",~~ (Phone) ;/-
(Address) l -?~~7) /~~~ 6~ ~ ~. /~ ~~
(Address) (CityV'
(Contact Person) .AA../L)~ ~c.~ (Phone) 5/-
APPLICANT SIGNATURE DATE
(Address)
'?9.5 ~~ ..?~
a
.
~1'JPW CONSTRUCTION o REPLACEMENT o AL TERA TIONS
FURNACE MAKE AND MODEL ~~Y-A..t-..\I ~kJ~044o/0 FUEL .N ~ G~.3
FLUE SIZE 4 l~ RETURN OPENINGS INPUT 66. C"tC90 OUTPUT 53, c-rX/
t /
TYPE OF SYSTEM HEATING OR POWER PLANT
t Ai, PI",. o Steam PLEASE NOTE:
ravity o Hot Water Air Conditioner Units
echanical o Radiation Cannot Encroach into
ir Conditioni~g o Special Devices Required Side Yard
ent. System o Other Devices Setbacks
FIREPLACE MAKE AND MODEL .
APPLICANT PLEASE COMPLETE BELOW
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 & AIC (New Construction)
Residential, Heating Only (New Construction)
$39,50
$39,50
Estimated Cost $ Building Permit #
PAID WITH
. ~~BUILD'NG PERM'T
.50
HEATING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
Receipt No.
By
24 hour notice for all inspections (952) 4
B2"=--------:~~--~---
FILE ~,jo. 502 04/11 . 03 06: 52 I D : PL\'f'10UTH PLUf'1B H,j(;
FAX:7635331121
PAGE 4/ 11
/~
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',- ~ ~... .'
',~-
CrTY OF PRJOR LAKE PLU1\1BING PERMIT
D3te Rec'd
loi bot'\Clml
I Bhn:. r:i~,
~ GnwJ Cil)'
) \'dIO\,o.o Ar~JjGl;""~
I PERMIT NOd - I 30/71
(Pl~~sc
ADDRESS
lL\I(QL{
ZONmG lor.k" u.\CI
- Ou. VI ~o<
~tl
LEGAL DESCRlPTION (offic. Us" only)
LOT
BLOCK
A[1DJTJON
PID
(Phone) LI ()( 0 - ~ L( E()
I~ ~~/ '(JeU ~,'ll{)'~
;..PPLlC.Al'lT n t /J I ' I
(Name) +'~VVV)l.''-\\'1 y LI';~'VI"^') (Phon,) l'Ju-~:j,,>')-Ljb5(
IAddrm) (oq (,\ C{ \^ I, (\ vLl + ~ N A (, ~ ' l; hrC'[lk \ ~r/\ Pc'j\( GSL(d-7':;,
(Address) (CJt)1}..; , (Zm Coder
IComa" Person) Si (( ,00~ vJJW Yl'llJ -I I.1R (Phone! t!! 0 ~~ ~ S 7
, APPLICANT SIGNATlTf,9ll &JW~1A DATE - , _ - ;2~
-\PPLICANT PLEASE COMPLETE BELOW
(Adams)
r- Quan tit)' Typt' of Fi;,.:tu rc Quantity Typt: of Fi:<:tun
B4!h TLlb with or with0L11 shower Rough-ins ......
Dishw"sh~r I Water Heater --
~ Flour Drain i W:iter Sonner
--; ~ LavalOry (Bathroom Sink) i Stand Pipt (WushlOg MachIne)
Laundry Tra~' [lor 2 COl11p01l"lmem sink Sewage E;jector
i Shower Stall Back-flow Assel11 bly
l Sinks Backflow Assembl), TC:Sl I
- - , .. , ,
"""".., --'111I\
L.,..
Water Ckl>iel I TuileO
FEE SCHEDULE
InclllmlilL Coml11ercl~1 ~ l\llulll-L1I111Iy I"..;, ()l.1l1h l:lISllVllh ~ ~3l)5(1 minimum
kC:::ildcnulll. New Olle &. Two-Full11ly $4950
Resil:it::nll~1. Addllion,; &. A!tcT:lli"n:' S::l9,:'iO
E$l1nl:.lll::d Cost ,\: 51 ?:/D.m
BuildIng Penllil f:i
8lJll.~AIo &tn..... .
'1NG ;""11
't!IIMrr
PLUMBfNG PERMrT FEE $
STA TE SVRCl-l..ARGC j;
TOTAL PERMIT FIm, $
5C
hlldYI":: oni,',""
II;d..
IOlrIC(' U~t OIlJ\.,
This Appllc:Jtlon BCCl)mC~ \llllr Budding P~nnll Wh~n Apprtl\'ed
:~ IIIIUI Ill'(ic~ i'll' JII jf"f'~C\lIlIl' 1~5_
lll~flfl L~..lllll ('r"i'" .~\'I' "';',17 Y'rLlIf I ;d;; I'V"~I ,.;:~..,
PRIOR LAKE
INSPECTION RECORD
i;{ I"{(~
l~~ r.'~
DEPARTMENT
BUILDING AND INSPECTION
SITE ADDRESS JL{ I (gl( ~~~
NATURE OF WORK to-..
,
USE OF BUILDING ~~0
PERMIT NO. 02-/307 DATE ISSUED 1-/5 - OL
CONTRACTOR LJ~_ PHONE q52-~33-~toY
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
d~
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
HEATING (if required)
FIREPLACE
GAS LINE AIR TEST
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I I
FINALS <::\i.Mt. C-
It 0/rE
GRADING (Prior to Sodding)
BUILDING lAJ
ELECTRICAL
PLUMBING
HEATING
DO NOT OCCUPY UNTIL ABOVE HAS
NOTICE
I
..l103
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