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'.(2 c::v...:;:. (Address) 5C)(9.4 C "- \/\..9 St C;~ (Phone) .--:;, r Y \ DV' \...a.: '"::)5- ;1.--417 - ~419 NtV BUILDER (Name) (Contact Name) , (Address) (Phone) (Phone) TYPE OF WORK o New Construction ORe-Roofing Re-Siding OLower Level Finish o Fireplace OAddition OAlteration PROJECTCOST/VALUE (exc1udingland) s1i ~~ OUtility Connection ~ Misc. W ~ 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 p. . rm needed inspections. I ~ t-l X ~ - ~_~ , Signature Contractor's License No. Date Permit Valuation Permit Fee $ Plan Check Fee $ State Surcharge $ Penalty $ Plumbing Permit Fee $ Mechanical Permit Fee $ .00 Sewer & Water Permit Fee $ Gas Fireplace Permit Fee $ Park Support Fee SAC ~ r- t{ - (j ( Paid Date ~~{r # $ # $ $ $ # $ # $ $ /) . $ --30-01 $ I :;ceF !jpS-. dr Water Meter Size 5/8"; I"; Pressure Reducer Sewer/Water Connection Fee Water Tower Fee Builder's Deposit Other omes Your Building Permit When Approved Date 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 ~::;/g./!~e~ by the ,City Planner constitutes a temporary Certifi:~ O{f. ~:g ~~~liance and allows construction t~A=ce. Before occupancy, a Certificate of Occupancy must be / ./ ~([) p~ /6r\ ~ ~~1- ~~\~~ Plann g ~~ ~ Date Special Conditions, if any 24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245 II'P!ltM 8q lOU lIe4s UO!P!pspnf 84llo S80UeU!pJO J84l0 JO 8pOO S!4l lO SUO!s!^oJd 84l 18oueo JO 8leIO!^ Ol Al!Jo4lne 8^!6 Ol 6U!WnS8Jd Sl!WJ8d 'uO!P!pspnf 84llo 80UeU!pJo J84l0 Aue lO JO 8pOO S!4ll0 SUO!s!^oJd 84llo Aue lO UO!lBIO!A AUB 'lO IBAOJddB UB JO 'JOll!WJ8d B sq Ol pSnJlSUOo sq lOU IIB4s SUO!lBlndwoo pue SUO!leO!lP8ds 'sueld lO le^oJdde JO l!WJ8d e lO 6u!lueJ6 JO 80UenSS! 84l... '~~c:l 9 :SlBO ~~7 .Jj ~ :118 paMa!Aal::l PS!USO SUO!PSJJOO 4l!M PSldsoo'v' /1 pSldaoo'v' (\i )1 -.-.-"-' 1 \',' . :le p8sodOJd S! 40!4M Al!^!pe UO!pnJlSUOO JOl UO!leO!ldde l!WJsd 6u!pl!nq s4l PSMS!ASJ SAB4 SlUswJ,JedsO 6u!UUeld pue '6upsSU!6U3 '6u!PI!ns S41. .......-\ -",,-...- ---f7 ) ,.':; ---''', -... ~ \ / - -' !. "-) 03A1303t1 NOI1'v'Olldd'v' IN'v'Olldd'v' .:10 3V\1'v'N <~f " ,-.../ . r"-':I -I,! i ,-:) .1 " I J.SIl)l:>3H:> J.N3WJ.t:lYd30 NOIJ.Y:>llddY J.IWt:l3d 9NI011na 6Uluueld - >jUld 6UlJaaUl6u3 - A1eueo 6Ulpll"a - al!4M ,\.lIuno.) ;>>"1'] .llll JO J.JIU,}.) ,JI~.l --~---_.~- '.._.n___~..,.,_.__._._ _ . _ ,_._.._..__.._R_~__"-.'~_.__._~_.._... --.-____,.__....___.__._.._._.. _-,_______. ....-....._.......__ ____._ ....____.__"-__..._ _ _..__._ ~,_.. ~_...._,_.. ._.... _'h'_ White - Building Canary - Engineering Pink - Planning Tht' Ct'n't'r of .1It' L..;t' Country BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT 6tuc..e... ~ APPLICATION RECEIVED 8 - I - 2~( The 8uildin~, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: SCX::II Cc:t)l1~ S'~. Accepted x Accepted With Corrections Denied Reviewed By: ill 111~ Date: 51-I~-O I Comments: See Reverse Side for Additional Information! See Attachments: 1) Grading Plan, 2) Erosion Control Measures 3) Erosion Control Plan 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. II White - Building Canary - Engineering Pink - Planning Th~ Crnlrr of Ihr Lake Counlry BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLlCANT6)-{ Jc...f' ~-e.J:S APPLICATION RECEIVED 8 -9 - ~ / The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: 5COf( C1nttO~ ~+-, Accepted Accepted With Corrections X- Denied ~ Reviewed B(' Date~- Icf- ~ ( Comments: I. New ~~\-r.v<:.~nll\ Sl""'l~d- t-~ 2000 ~~ 2. t?ou~ <kM ~~I'~ Att- te t"tH1Aad 3' 4J1,L. S\MQkL A~ ~u~_ tho ~ -ld C('J~ C<,d2~ "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 HEATING/AIR CONDITIONING/FIREPLACE PERMIT Date Rec'd 1. Pink 2. Green 3. Yellow ~!~ I PERMIT NO. C)./' -- 954- Applicant dOll -S ZONING (office use) LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION ~ PID~ 5-077- tX7/- OWNER ~ p., (Name) r t1 tv e.-' (:)1-fJ f~ S (Phone) l/ 1./ 7 '- LI tI"7 C( (Address) APPLICAl'fT \ LI _ I (Name) b, -e I n I~ ~t:l"t- (' J'7.J (Address) 3~52 ,tJ-ef-5hi n cP 5r- J1 (Addre$ (Contact Person) QrO J A. -e } I (Phone) q~2.. - L/L/7- (9!<;:; '/ ~ 4/0)-' .L.ct kQ (City) (Zip Code) (Phone) GJd.~ -=? &.{,- :3 /../34 DATE L//~/02- APPLICANT SIGNATURE DNEW CONSTRUCTION ~ REPLACEMENT o AI.. TERA TIONS FURNACE MAKE AND MODE(~ Ii e: ( t{me.- 7::; ) V /Uc.-. $"0 FUEL /Va -t- GOa- .s FLUE SIZE Q IIp !/C2- RETURN OPENINGS INPUT OUTPUT TYPE OF SYSTEM HEATING OR POWER PLANT ~Warm Air Plants o Steam PLEASE NOTE: o Gravity o Hot Water Air Conditioner Units 8Mechanical 'T o Radiation Cannot Encroach into ~ir Conditioning 3 o Special Devices Required Side Yard OVent. System o Other Devices Setbacks FIREPLACE MAKE AND MODEL APPLICANT PLEASE COMPLETE BELOW Industrial. Commercial & Multi-Family FEE SCHEDULE 1% 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 Pennit # .50 byp1#L/ (Office Use Only) This Application Becomes Your Building Permit When Approved HEATING PERMIT FEE STATE SURCHARGE TOTAL PERMIT FEE $ $ $ fd Paid Receipt No. Building Official Date Dat~ _ :2. -0 24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245 PRIOR LAKE DEFARTMENTOF BUILDING AND INSPECTION INSPECTION RECORD SITE ADDRESS 5004 OCJYJ~{)V) ~ St. NATURE OF WORK Add ,..J..,"rrv1 USE OF BUILDING ~ PERMIT NO. ~ tJl-OfSZ DATE ISSUED 8-!t{-~1 CONTRACTOR · e..f:e,.",. PHONE q</7- ~fl/"z,.'t NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW THE PERMIT IS BY SEPARATE DOCUMENT - INSPECTOR DATE (; I t;J ~ S/tL/a- 0. q 01 PLACE NO CONCRETE UNTIL AB VE HAS BEEN SIGNED ROUGH - INS FRAMING INSULATION ELECTRICAL wv COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED I I FINALS GRADING (Prior to Sodding) ? 2.. r-:qJ BUILDING ELECTRICAL \ HEATING DO NOT OCCUpy UNTIL ABOVE HAS 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 CITY OFPRlOR LAKE Impervious Surface Calculations (To be Submitted with Building Penn it Application) For All Properties Located in the Shoreland District (SD). 'The Maximum Impervious Stpi'ace Coverage Permitted in 30 Percent. Property Address 60 () yQ.o.., it.)'? ~,,-i- Lot Area '2.?> I -, '-\ 'Z.. ",\x,"""'tL "'\<::!:l Sq. Feet x 30% = ............. .-'1 \ z. 3 ..........*.~,..***....****.******........................~.....*....... LENGTH ~DTH ~,t> x~ tlX1. 1-2 'x -z.~ SQ. FEET :: \l,11-- 1..f? ::~ :: HOUSE An ACHED GARAGE DETACHED BLDGS (Garage/Shed) TOTAL PRINCIPLE STRUCTURE...................... 1-\~i x. x. . . DRlVEW A YIP A VEDAREAS (Driveway-paved or not) (SidewalkIParking Areas) . TOT ALDETACHED BUILDINGS....................... x = X -= X - ~..Ne~ P A TIOSIPORCHESIDECKS ~ TOTAL PA YEn AREAS......................................... (Open DeckS ~ man. bpening between boards. with a pervious surface below, are not considered to be impervious) &x l~ :: "L"? "2.- x. = x :: Z. 9., (, OTHER TOT AL DECKS...... .................................................. 1- ?2. x x = = - TOTAL IMPERVIOUS SURFACE L 1S'i3"2. I ~VER ... .. 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