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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
COU R:r
LEGAL DESCRIPTION (office use only)
'3
LOT BLOCK / ADDITION
Date Rec' d
I White
Pink
Yellow
File
City
Applicant
q.- ;)-ft,-Io
0& .092.Z+
I PERMIT NO.
6E~E~ lJQO
OWNER
(N ame)
(Phone)
(Address)
BUILDER
(Company Name)
(Contact Name)
(Address)
~II "3JiUJ rflE"12 S ::C'tJc.
-k~ 13vRr~l\A
(Phone)
(Phone)
9S":l- ""'IS-- 3~~~
'Sf - ~Cj, - &';ls-<f
Ee
,j
TYPE OF WORK [ltf New Construction ODeck OPorch ORe-Roofing ORe-Siding OLower Level Fimsh 12f Fireplace (I)
OAdditIon OAlteration o Utility Connectlon r
CODE: [}l'I.R.C. r.
Type of &nstmction':
Occupancy Group:
Division:
.B.C.
A B
I
E
II
F
1
III
H
2
IV
I
3
V
M
4
o Mise.
A
R
5
B
S U
$~ ZSo VOlt" C!)O
I
PROJECT COST IV ALUE
(excluding land)
I hereby certify that I have hlrmshcd mformation 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
al1ovc-mcntlOI1ed property and that (ill structio!1 will conform to all existing state and local laws and will proceed in accordance with submItted plans_ I am aware that the buildmg
official can rc lk 11 per (Just lL' Furthermore, I hereby agree that the City official or a deSignee may enter upon the propel1y to perform needed IOspectl<lns
x
Permit Valuation
Permit Fee
Plan Check Fee
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
/ lJ 0, D-O
00 DO
"3~, .>0
f),Ot:)
Sewer & Water Permit Fee
Gas Fireplace Permit Fee
I $
$
This Application Becomes Your Building Permit When Approved
I~~
I Huildllll! Uniclal
lo/-s /d ~
I Dlie
JOLl s:~c. b~
Contractor's License No.
Cf/{J.7-/"
Date
Park Support Fee
SAC
#
#
,- C),dO
.3Z.S-, tJO
---
Water Meter Size 5/8"
Pressure Reducer
Sewer/Water Connection Fec
#
Water Tower Fee
Builder's Deposit
Other
#
TOTAL DUE eAViE'O
TIllS IS 10 cerllly that the requcst m the above applIcatllln and accompanymg documents IS 10 accordance with the City loning Ordinance and may proceed as requested TIllS document
when signed by the CIty Pl.mner constItutes a temporary Certlticate of lOnIng compliance and allows construction to commence. Bcfme occupancy, it Certllieate of Uccupancy must be
I i~.. __~ ~ /O/5/fJ~ .
Planning Director Date Special Conditions, if any
24 hour notice for all inspections (952) 447-9850. fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372
Residential Building Permit Checklist
New Construction for Single or Two-family Dwellings in R-1 or R-2 Districts
Reviewed by: ~ ~
Building Permit # PID:
Address: / (p 30 z. ~ (!.;I..
Legal: L .:3 , B / Subdivision:
Date: / {)1S-;0~
Zoning:
~~.
Existing Structure? YE~
Existing Nonconforming Structure? YES@
I CONFORMS TO ZONING
ORDINANCE
. Sidewall exceeding 50' requires additional side 2"
setback for eve l' over 50' in len th
. Rear Yard
. Patio Door: provide for minimum 10' deck or sign
statement indicatin no deck will be built in the future
. From 100 year flood elevation of wetland/NURP
ond
. From OHW (Prior or Spring Lake)
I
c~
I
Standard
25'
10'1
25' if abutting a street
10' setback +
2"/1' over 50'
25'
1 0' sidel
25' rear
30'
75' or setback average of
adjacent structures, but no
less than 50'
,30 Maximum
Standard
Pro osed
V{),J6
,,';15'
-
Tree Preservation:{NA'1 FAILS I COMPLIES Standard Proposed
. Total caliper inches
. Permit 25% Removal
. Caliper Inches Removed
. Caliper Inches Preserved
. Replacement %:1
L:\TEMPLA TE\BLDGLIST,DOC
BUILDING PERMIT APPLICATION DEPf.RTMENT C-HECKLlST
NAME OF APPLICANT
APPLICATION RECEIVED
-;;// 6rtJ5
I
9,-- d Y-- b
The Building, Engip8ering, and Planning Departments have reviewed the building permit
application for cons~ruction activity which is prop,osed at:
I~ ~O~ (!l>lY~~VJ (~-r
Accepted --.X-.--
Accepted With Corrections
Denied
Reviewed By: (V ff 8
Date: _-'-0- 10.i.0'C
Comments: See Reverse Side for Addliion81 Informationl
See Attach;rnents: 1) Grading Plan, 2) Erosi<m Contro:Measures
"The issuance or granting of a permit or approval of plans, ;:pecifications and
compute'ions shall not be construed to be a permit for, or an approval of, 2ilY violation of
any of the provisioi's of this code or of any other ordinance of the jlJ'isdi~;tion. Permits
presuming t'J give authority to violate or cancel the provisions of 'his code or other
ordinances of the jurisdiction shall not be valid."
~"'ite - Buildine>
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
-;;/1 gms
, (j-.:JY--6
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is pro osed at:
Accepted
Accepted With Corrections
Denied
Reviewed By: ~ ~ Date: /0/5/0"
Comments: ~ CJL( ~ _ ~ ~ ~
~ ~ au ~.
"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 - Plann,"~
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
,.'. ~...
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
Accepted
/
Accepted With Corrections
Denied
Reviewed By:
~~
~
Date:
/o;4-~~
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."
.
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N0V. 30. 200~ 9:58AM
PIYlrlOUU Plumbing & Hedin;
..461:~
Date Rec' d
CITY OF PR10R IJ~ :?LUMBING PERMIT
~: ~I~ ~!~, I PERJ.\11T NO.~. ....., ,~'
3, 'hllMI A;ph""" , ~
I ~ 'SO L
1o\..V" +-
ZONING [office v,le)
LEGAL DESCRIPTION (office u.\e only)
I APPLICA1"IT
I (Name) ~I."\yoy...~ P\~.m~ '0.."0 ~
I, (Address) It.. "L "I I;) I.-\. ~ vel 9'lr-re.Lr
(Address)
(Contact Person) ~~
~-h"'~
'S,+-- YY\\ ~~
(City)
(phone)
1\0 ~ - Y'j Lo - lc 10C;:>
'5 5 '> 1 L..,
(Zip Code)
APPLICANT SIGNATURE
~~i'~_.___ (Phone) ~- LJ'1lo-lol~&
=d#~7
APPLICAl~T PLEASE COMPLETE BELO\V
DATE
I ( ('3 0 I OLe>
,
I Quantity I Type of Fixture Ouantity Type of Fixture
3 I Bath Tub with or v{itbout shower Rough-ins
I Dishwasher I Water Beater
-
\ Floor Drain Water Softner
~ Lavatory (Bathroom Sink) Stand Pipe (Washing ~i1achine)
Laundry Trav (lor 2 compartment sink Sewage Ejector
I I Shower Stall Backflow Assembly i
\ Sinks Backflow Assemblv Test
Bar Sink I ! Lawn S~rinkler I
I.-{ Water Closet (Toilet) I l 'bo..'I-
I I Other 'I...l"-. ~~..v-
I
FEE SCHEDULE
Industrial, Commercial & Multi-fumj]y 1 % of job cost with a $39.50 mfuimwn Residential, ~c:w One & Two-Family $99.50
Rcsidrntia1, Additions &. Al;er-alions $39.50
Estimated Cost $
Building Pennjt #:
PAID Vifl TH
50 B' - 'LD I"~ .,...... ~".,.f. ~. r
. ',J,." 'jC\;... ,j..i ,n,;;;"1
h ~<l 'of ''''.' I '-__ '-' L
PLUMBING PERMIT FEE $
STATE SlJRCHARGE $
TOTAL PERMIT FEE S
(Office Use OnJ)')
This Application Becomes Your Building Permit When Approved
Paid
Receipt No.
Buildlne: Official
Dllle
I IQ!t 0 8 2006
I By
24 bour notice for all inspections (952) 447-9850, fax (952)~t7-i21:S
16200 Eagle Creek Ayc., S.E., Prior Lake, IvIN 55372-17H
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONINGlFlREPLACE PERMIT
Date Rec'd
1. Pink
Z, Green
3. Yellow
~~~, I PERMIT NO. '--..!lZZ-
Apphcant .
ZONING (office
use)
ADDRESS
\~'3Od.. ~ c+
LEGAL DESCRIYfION (office use only)
LOT
BLOCK
ADDITION
PID
(Phone) toS-I-3c.oS- DSS- /
WCf
APPLICANT
(Name~~~ \X-rA J J- ~. R
(AddreS~
9co /09,u, aue~ )J #/000
(Address) I
(Contact Person) ~c\:::' ~Y"le~a~
(Phone) ~ lD 3 - S r'j 1- dS"dS
~lJ~(..Jl:tyrn) 1'/ 5S3/(p
L (Zip Code)
(phone) ~ltl~ - Sf/CJ;-/;) llo
APPLICANT SIGNATURE DATE
APPLICANT PLEASE COMPLETE BELOW
qRmW CONSTRUCTION 0 REPLACEMENT 0 AL TERA nONS
FURNACE MAKE A~ MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
OWarm Air Plants
o Gravity
o Mechanical
DAir Conditioning
DVent. System
o Steam
o Hot Wllter
o Radiation
o Special Devices
o Other Devices
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
FIREPLACE MAKE AND MODEL
FEE SCHEDULE
1 % of job cost Residential, Gas Fireplace
$39,50 minimum
$99_50
$64,50
$39,50
Industrial, Commercial & Multi-Family
Residential, Heating & NC (New Construction)
Residential, Heating Only (New Construction)
Residential, Additions & Alterations
Residential, AC Only
$39,50
$39.50
Estimated Cost $
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
Building Permit #
$
$
S
,50
PAiD VVITH
AU/LDIN;,:;! PEFtMI r
(Office Use Only)
Dale
Paid Receipt No.
15~" DB 2005 By
l...v
This Application Becomes Your Building Permit When Approved
Buildinc Official
24 hour nolice fnr all inspections (952) 447-9850, fax (952) 447.4245
ZOO~
llooa 3~VllV~ JI~VWO~rrv
66ZL 9L9 C9L XVd 90:L1 90/90/Z1
l~r)V, 30, 2006 9: 58AM
PI ymout~ PI umb I ng & HE2! I ng
i']), 4 r: 1 :~
r, L
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONU~GlFlREPLACE PERMlT
Date Rec'd
(P1e.a<€ t}~ err print ;md sign at bottom)
I ADDRESS
, ll.,301.. ~~~
~f-
~.~" ;U'-'"' I PERMIT NO~
ZONlNG (ofbce
me)
I LEGAL DESCRIPTION (oiflce ~ only)
I LOT BLOCK ADDmON
PID
I OWNER
(Name) 10\\ ~ro~~
I (Address) \ "-\ 00 t...oI'"IOOV"'(o.J,(....
(phone)
L<..n~~v{..
~~o
~~\
\'v) N
J:5~I1..l
P\.~~~
., IJeA.j-) \"\ '2'
(phone) L \,p ~ ~ l.{ q [0 - I.e.! 00
~eLt- NS
(Addres..q)
~\.-. mi c...h~
(CIty)
S531L.,
(Zip Code)
I (Contact Person) ~ ~ ~'" 'S..~ (Phone) 11.&>>- L.;C) ~ - L,.., I 5 B
!APPLIC.ANTSIGNATURE 4A~ L~ DATE 11/30JO<.
. APP CAN PLEASE COMPLETE BELOW
J2'NEW CONSTRUCTION o REPLACEMENT o ALTERATiONS
F\JR;.'\iACE MAKE AND MODEL B~+ 3'""0 ~c..v D3\o D~o FUEL ~Q..,{-. ~c.s
FLUE SIZE RETURN OPB-.'INGS lNPUT OUTPUT
TYPE OF SYSTEM HEATING OR POVlER PLANT
DW(J!1ll Air Plant~ o Steam PLEASE NOTE:
DGmvity o Hul Water Air Conditioner Units
r:;g Mechnllical o R.1di:ltju)] Ca.nnot Encroach into
at\ir Conditioning o Special Devices Required Side Yard
Vent. System D Other Device~ Setbacks
FIREPLACE J-v1AKE Ai\iD MODEL
Ind~trial, COll1D'lercial & Multi-f'amily
FEE SCHEDULE
I % of job CO~l Re5idL'ntiul, Gas Fireplace
.$39,50 :minimum
$99,50 Residential, AddJtioo.s & AllL'rlllions
S6<UO Residential, AC Only
$39,50
Residential, Heating & AJC (New Constructil)D)
Residential, Heating Only (New Construction)
$39,50
$39,50
Estimated Cost $
HEA TING PERMJT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
Building Permit if.
$
$
S
,50
PAiD VVfTH
p) j.! f",;, ~ ~ ~ I J"' 4\.t.: r
~'I'L..,c"., ;:;::,i~i."!!!
(OtI'ic~ U~r Only)
BuiJdi.o!! OITlcl31
Datr
Paid Receipt No,
~c: 08 ....r*'i")...... By
lUUO
Thi.q AppliClttiOD Becomes Your Building Permit ''''hen Approved
24 hour notice for aU inspedioD~ (952) 4-t7-98~O, rllX (952) 4174245
PRIO LAKE
INSPECTION RECORD
DEPARTMENT Of
BUILDING AND INSPECTION
SITE ADDRESS J~ SO, Uta-E NS U!>CJ..Ii.T
NATURE OF WORK tJE&Ll ~6rJ'T'. (~/cu.." ~4CH, ~ ".t.. _~.:a;"\
USE OF BUILDING S.F:"Q. ~_~P. I~(.....~
PERMIT NO. 0(,. 0 rZ2- DATE ISSUED J o/'i 10 f.Ij __,_
CONTRACTOr-l 1l:>1.L ~R.lr. ,~. PHONE-fDS 1- "" ,. ,~~
NOTE: THIS ~s NOT A PERMIT FOR ANY OF THE n~SPECTIONS BELOir"
THE PERMIT IS BY SEPARATE DOCUMENT
DATE
] ((y )/O'lL1
fFOOTING
'~
[ FOUNDATION (Prior to Backfill) ] t/1/]/:? J (O,),7'V<.,
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
J
--J
-- ..--,.--
SEWER I Wi\TER I SEPTIC ,
FRAMING ~ ' Dt/ r) j V { ~ - C~
INSULATION
ELECTRICAL " /J
PLUMBING if ~V /'1 I r'I(~
HEATING (if rEquired) "~L/ F~: J L- I vl--1,1o
FIREPLACE -=,
GAS LINE fl;,IR TEST
c_
CO-\fE1 NO WORK UNTIL ABOVE HAS BEEN SIGN[-:D
ILAThe _~jj~IJS'. ~IlA' I C
FINALS
GRADING (Prior to Sodding) ~. '2. Y.CJ {
t?UILDING <t IV'(? u'" /-t I I/f-of
ELECTRICAL
PLUMBING
HEATING
DO NOT OCCUPY UNTIL ABOVE HAS BEEN
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-S850
CITY OF PRlOR LAKE
Impervious Surface Calculations
(To be Submitted with Building Pennit Application)
For All Properties Located in the Shoreland District (SD).
The Maximum Impervious Surface Coverage Permitted is 30 Percent.
Property Address
/0 ~o~ f3E02E-N5 COUT2-T N.W.
Lot Area ZCJ zzz sq. ft. x 30% = .............. 87G6, 0
************************************************************************
LENGTH
WIDTH
SQ, FEET
HOUSE
x
=
x
A TT ACHED GARAGE
x
TOTAL PRINCIPAL STRUCTURE...................... 3 I q '-3
INCLVVES pof<.cH
DET ACHED BUILDINGS
( Garage/Shed)
x
x
TOTAL DETACHED BUILDINGS....................... N A
~RlVEW9:r A VED AREAS
(lJnveway-paved or not)
<@idew~arking Areas)
x
X
=
/87
4-- X 30
=
]1.-0
TOTAL PAVED AREAS...................................~..... q 0 7
.PATIO~RCHES>nECKS
(Open Decks Y." min, opening between
boards, with a pervious surface below,
are not considered to be impervious)
X
x
X
TOTAL DECKS ........ .................... ..... .................. .....
INCLW8) A'bov6
OTHER
X
X
=
=
TOTAL OTHER....................................................... N A
TOTAL IMPERVIOUS SURFACE
~VER
Prepared By ~ -L
Company f(lp~5 bGIPt:erUJ./t Co. ~c,
14-100 I
~~0.0~
Date q-27 ~Ob
Phone # &>2) 4,2 - ~tJ()6
I'\HA Nn()IIT"\THD"'O";~m rl~~