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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
/54-34- jJL-17 t!-K- LJ e::rre.
Date Rec' d
/~ s-. 44-
While
Pink
Yellow
File
City
Applicant
I PERMIT NO. a4--.I/4.:3
e-/~
ZONING (office use)
~l
LEGAL DESCRIPTION (office use only)
LOT '1 BLOCK
/ ADDITION
WIt-lJ.S soUTH
PID Z5"..382. 009.0
OWNER
(N ame)
h /1
i er.N/)f\.I '/)JL,..)(-
(Address)
(Phone) (<15'2) Z 31 -) \82-
BUILDER
(Company Name)
(Contact Name)
(Address)
(Phone)
(Phone)
~ower Level Finish
.3 bitS.
TYPE OF WORK 0 New Construction ODeck OPorch ORe-Roofing ORe-Siding
DAddition DAlteration DUtility Connection 0 Misc.
CODE: OI.R.C. OI.B.C.
Type of Construction:
Occupancy Group: A B
Division:
I
E
II
F
I
III IV V A
HIM R
2 3 4 5
o Fireplace
B
S U
PROJECT COST IV ALUE $
(excluding land)
I hereby certity that I have turnished mformatIon on this application which IS to the best of my knowledge true and correct. I also certll'y that I am the owner or authOrIzed agent for the
above-menlloned prop'.ty and that construction will conform to all existmg state and local laws and will proceed in accordance with submitted plans. I am aware that the buildmg
st causc Furthermorc, I hereby agree that the CIty official or a deSIgnee may enter upon the propelty to perform needed mspectlOns
X IljrlfX/-
Contractor's License No. Date
Permit Valuation 3, 000. () tJ
Permit Fee $ 71-. 75"
Plan Check Fee $ --
State Surcharge $ I. SO
Penalty $
Plumbing Permit Fee $ ~O. 00
Mechanical Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace Permit Fee $
This Application Becomes Your Building Permit When Approved
~,~ I~~i
Park Support Fee # $
SAC # $
Water Meter Size 5/8"; I"; $
Pressure Reducer $
Sewer/Water Connection Fee # $
Water Tower Fee # $
Builder's Deposit $
Other e;t-ec.::nu eR '-- $ I. aO
TOTAL DUE $ //7. z,S
Paid
Date
1/7.2.5*
/L s,~?-
I ~~ ~eP
ThIS IS to certify that the request 10 the above applicatIon and aecompanymg 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 Zonmg compliance and allows constrUCl1on to commence. Before occupancy, a CertIficate of Occupancy must be
I issued
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
;952 894 0925
# 2/ 2
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
;. ~;;.:n ~~~. I PERMIT NOAL . 'L ~ I I~.
J. Yellow Applicant . ~
Date Rec'd
ZONING (officc mc)
fu-
.~
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
I
OWNER
(Name)
{JJJu76Y7
/. .- L)
(Phone) '1.:):J - ::133 - ,;;J5P d.
(Address)
APPLICANT
(Name)
Bumsville Heating 8. Ale LlC
12481 Rhode Island Ave', So.
Savage, MN 55378 1122
(Address)
(Phone) 95 d - t'9t/ - Oa:;s-
:::;f~
~\~
:'1
'~,;::~
(Address)
(City)
(Zip Code)
i~~~
(Contact Person)
(phone)
APPLICANT SIGNATURE
APPLICANT PLEASE COMPLETE BELOW
DNEW CONSTRUCTION XPLACEMENT ALTERATIONS
FY:mIACClob'.l..J;;.l1,,,..r.lIl1-r ~U/7T '/4/1 (p ijtL /~
FLUE SIZE RETURN OPENINGS tI INPUT '
TYPE OF SYSTEM
OWannAir Plants
OGravity
o Mechanical
OAir Conditioning
o Vent, System
HEATINGORPO~RPLANT
o Steam
o Hot Water
ORadi~tion
o SpecialDeviccs
o Other Devices
PLEASE NOTE:
AirCoIlditionerUnits
CannotEJlCrOil<;h into
Required Side Yard
Setbacks
FIREPLACE MAKE AND MODEL
Industrial, Commercial & Multi-Family
FEE SCHEDULE
1 % of job cost Residential, Gas Fireplace
$39.50 minimum
$99.50
$64.50
$39.50
$
$
$
~50
$39.50
$39.50
PAID WITH
BUILDING PERMIT
~fH~xI
,~,i/i~~'i .
Residential, Heating & AIC (New Construction)
Residential, Heating Only (New Construction)
Residential, Additions & Alterations
Residential, AC Only
Estimated Cost $
Building Pennit #
This Applica tiorlBec(JlDes)'ourB.l1ildillg ~ermit iWI1~I1.A.P}lI'~yed ..........
",-'.',":-""'-":'--"""',-:-.-:-'
::......::::.-:-':.:-...-...:....:-...,.,
".- ...-:'.<.-".,-."....
;.:,-~'-~-;~';;",:"-:;"~'--:'" . - .. ,--.
;:.
Building Official
Date
24 hour notice for allinspections(952J~'7-p~~tf~(~~#44'7-424S
16200 Eagle Creek Av~nue,Prlor.Ht~~,<l\1NS~~7~
PRIOR LAKE
INSPECTION RECORD
DEPARTMENT OF
'BUILDING AND INSPECTION
SITE ADDRESS / 5 ~.3 4- BLA(y::" Petie. al eu.e:
NATURE OF WORK LOWc!2- U5i/cL-
USE OF BUILDING /2es ,q/,e..
PERMIT NO. ~+. //~ ' DATE ISSUED 11.5".04-
CONTRACTOR !et;W6 PHONE 2.33.2.582-
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR
DATE
- -----
CRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING
INSULATION
ELECTRICAL
PLUMBING
HEAT i required)
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I I
FINALS
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.
FOR ALL INSPECTIONS (952) 447-9850