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CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
8Di~~C7q1
1. White
2. Pink
3. Yellow
File
City
Applicant
Permit No.
Cjq-/077
DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
1. DATE
g/30!QQ
P,i'o~ Lo.ke.. ~/SO
2. SITE ADDRESS
3~5~ Pex-shl n
5i. C;;w
3. LEGAL DESCRIPTION
35
ADDITION G fee
(Tel. No.)
4-t!-,- tol S::L
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(H . ~ I ~W~th~ (~t~ I
12. NO. OF STORIES ;;L
13. TYPE OF CONSTRUCTION
ado i +-;'0 n
14. FLOOR AREA APPORTIONMENT USE
PID ~ 6 Oq t..J.o d.. 01
,{-{on
Pen:~h ff)
LOT
4. OWNER (Name) "\
Bro.ci ~ M.~Chete..- Le.in
5. ARCHITECT (Name)
~ddress)
3'6S~
(Address)
6. BUILDER (Name)
(Address)
4-4-7 -(p I g;L
(Tel. No.)
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
Bn?4 ~ Mi'che\e...
Le1 V\
7. TYPE OF WORK
New Construction 0
Fireplace )l
Alterations 0
Deck)l:(
Finish Attic 0
Re-roofing 0 Porch 0
Re-siding 0 Finish Basement 0
Septic 0
Addition)\,
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES
Sq. Ft. <iJ 31 t
9. PROPERTY DIMENSIONS
Width s5' Depth /55 J
10. CULVERT SIZE
Yes No
(Tel. No.)
SEATS
16. PROJECT COSTNALUE
't qo OOO.OD
17. COMPLETION DATE
q - f - ~OOO
I hereby certify that I have fumished 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 . perl(l~r j~st cause. urthermore, I rebyag e that the city official or a designee may enter upon the property to perform needed inspections.
xcnv.-au& .~ ~-3o-9q
Signature License No. Date
FOR ADMINISTRATIVE USE
MATERIAL FILED WITH APPLICATION
Back Side Side SOIL TESTS 0 ENERGY DATA 0
OFF STREET PARKING PILING LOGS 0 PERCOLATION TESTS 0
SPACES REO. PLANS & SPECS 0 SETS
SPACES ON PLAN SURVEY 0 COPIES
PERMIT VALUATION 90 ,lX.r:). 00 PLOT PLAN 0
SETBACKS: Required
Actual
Front
BUILDING DEPARTMENT VALUATION
USE OF BUILDING
..eE5 A / Ie.
I
TYPE OF CONSTRUCTION: I II III IV V
Occupancy Group A B E F HIM R S U
Division 1 2 3 4
City:
Permit Fee ................................... $
8Q~ .l70
5~~ ~C)1
4€ .() 0
Plan Check Fee ............................. $
State Surcharge ............................. $
Penalty ....................................... $
Plumbing Permit Fee ...t:p~I.t2n.. $
Mechanical Permit Fee .1t~t.t?.1J... $
4C~C)D
4,0 . CO
~
Sewer & Water Permit ...................... $
Gas Fireplace Permit ....1~L?tI'.... $ tlO. () 0
~is1!f~~r Building ~:tr;i1W~~~~red.
Certificate of Occupancy
Issued
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
Pressure Reducer .......................... $
Meter Horn ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
WaterTap ................................... $
24 hour notice for all inspections 447-9850
The eenler of Ihe L.ke Counlry
White - Building
Canary - Engineering
Pink - Planning
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 V
Accepted With Corrections
Denied
Reviewed By: ~~~~
comm~.t A .
~#I~
'ot9- ( /L y'J ~ {yt
Date:
q-~-00
~t/~~~ (~~L~~
lef A'9d) ca- ~ {J T L.()z~
IThe 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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CITY OF PRIOR LAKE
PLUMBING PERMIT
,
Applicant: 231€/JD ~ /'-1/c:!r;St,E LEI N
Address: --:!!!S?~. 7>l5eS~. 51
Signature: ~. ~.J ~''-Y7
Legal Description: Lot 35 Block Sub 6.eEbA./ Iis/c:jHT!5
Site Address: 3652- '?6e.S'/7 / A/q .s-r- Sw
Building Permit # qq - 1077 PID # 25 -0 9<1-- - OZ&'- /
NOTE: This permit will not be processed without complete information.
I. Blue
2. Gold
3. Yellow
File
City
Applicant
Thr Ctnter of the Lake Counlr}'
PPNo, q9~/077
Phone: L/-t./7 -fp I 8 z...,
Sw
FIXTURE UNITS
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher Water Heater
Floor Drain Water Softner
Lavatory (bathroom sink) Stand Pipe (washing machine)
Laundry Tray (1 or 2 compartment sink) Sewage Ejector
Shower Stall Backflow Assembly (RPZ, Double Check, PVB)
Sinks Backflow Assembly Test
Bar Sink Lawn Sprinkler
Water Closet (toilet) Other
FEE SCHEDULE
Industrial, Commercial & Multi-Family
(1"10 of job cost, $39.50 minimum)
Residential, New One & Two Family
Residential, Additions & Alterations
State Surcharge
$99.50
$39.50
$
$
$
$
.50
D \j'\j{\". ".~
GRAND TOTAL p~ ps,\,::,.\;;\
,e\J\\..O \ G
This permit is granted upon the express condition that said
contractor, shall comply in all respects with the ordinances
of the State Plumbing Code and the amendments thereof,
RECEIPT NO,
DATE
A ITEST
Call for all inspections 24 hours in advance,
16200 Eagle Creek Av. S.E. Prior Lake, MN 55372/ Ph (612) 447-9850/ FAX (612) 447-4245
An Equal Opportunity Employer
:":'.:;':..~"',':-.:'T''''l'..,"t-,-.-":,,,.'''::\~'---:"
Thf' Cf'nlf'r of thf' I..kt ('ounrry
/-/ 'I' / -j -7
. / - / I I
White - Building
Canary . Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
(.;. ;.j ,1-) 0 (E / /'
APPLICATION RECEIVED
, ,
! r;~-
2 / ~( /-1/
/ I
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
~;> /. r--/
'---' 0 --../ L-
!-<~ ,~-~I'-// // ~
- /
I
-' /
- ; ,I
-.----.J ~,',
Accepted
./
Accepted With Corrections
Denied
Reviewed By:
. I
;.., J ,t/I.TEt2
Eri1r:s "",,q /'J'\J
Date:
J ,
'1Ild 71
.
Comments: R\J/'o.Y)F'F Mu~-r BE" CO}o.)IJE'(~
10 1/ AJl:l
ALON~ ?t<~PfRr'r' CINES
AS
f'(.I!'-'IN~ SEvJf:t."
sefl..v,(t..
SHOV'-D
L" Nt; A~
T'~ E.
P"'ttP"sEO
LO"";('sT
r~...~
I::.
HfGHEa.
IrlA1>\
JHe E:1-,S,/.-...)c"
Lo-.-l ('Sl
rLOO a... .
$E:6
ItJFo~M"",'O-J
0,0
To.tc
f<Evt.a.Sf':. oS lOt..
:>t:c ArrAC/"IMe::'/VT3.: I. hv.q.L C~"'OE.
/..vSF~cno"; /-v~on..I"<"1norJ
,J CONTtt..oL- HlSq ...n..r::
3.
o (o,J C,.vra.D(.. (...IfN
"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."
q9~ /077
The Crnlf'r of the take- Country
White - Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
Bk!A-O L~/N
g/30/QQ
I I
APPLICATION RECEIVED
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
svl
3652- peJesr-!/N9 ST
AccePte~
Accepted With Corrections
Denied r::;v~Jk-
Reviewed By:
Date: r - /eJ--- 9;37
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."
PRIOR LAKE
INSPECTION RECORD
DEPARTMENT OF
BUILDING AND INSPECTION
3852. PERSHINe, ST
NATURE OF WORK I\DDN.
USE OF BUILDING ~ AIR-
PERMIT NO. ~ct' - I 077 I DATE ISSUED
CONTRACTOR --13J2A D l ~5 ( ~ J
NOTE: THIS IS NOT PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE P MI I BY SEB ATE DOCUMENT
II I t:t1 /~/;~ ~tj R
SITE ADDRESS
qlIO/qCj
I I
FOOTING (/.
FOUNDATION (Prior to Backfill) f; 2-~ ?
PLACE NO CONCRETE UNTIL A VE HAS BEEN SIGNED
ROUGH - INS
DATE
SEWER I WATER I SEPTIC
FRAMING
INSULATION
ELECTRICAL
PLUMBING U6; Vl_>
HEATING (if required)
FIREPLACE
GAS LINE AIR TEST
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I WALLBOARD I I
FINALS
GRADING (Prior to Sodding)
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.
Call between 8:00 and 9:00 A.M. for all inspections
FOR ALL INSPECTIONS (612) 447-9850