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CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS ~ 0
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
~NAL L.L. F;/fIi~
o SITE INSPECTION
COMMENTS:
DATE nME
SCHEDULED I (J ,t5-oS
5':~
~
CONTR.
PERMIT NO. .J - / S""(j I
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EXlGRAD/FlllING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
./ .
ARK SATISFACTORY, PROCEED
o CORRECT A~CON AND PROCEED
o COR~~lR ,CAll FOR REINSPECTlON BEFORE COVERING
Inspector' V Owner/Contr:
CA~1..7J.J FOR TH.....;; INSPECnON ;. HOURS IN ADVANCE.
-, . .
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH .t SAFETY!
INSNon
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
Oz.-C)(J(P-l-
(Please type or print and sign at bottom)
White File
Pink City
Yellow Applicant
PERMIT NOOol_ I ~ Lj I J
. I
ADDRESS
:3&/7
P"ox
-pq/L
/ /C.-~ / L-
ZONING (office use)
.e2-
LEGAL DESCRIPTION (office use only)
LOT q BLOCK
I
ADDITION
/11 e;/V-f /7/'1 tV!\/ ;? /\/0
PID 25- Z<?)5 - 009 - ()
OWNER
(N ame)
L3tJL3 "e/~.oFo/2'/
(Phone) 95'-- 441..- :;;J{S t,
(Address)
Sfi n 6
BUILDER
(Name)
(Contact Name)
(Address)
(Phone)
(Phone)
I TYPE OF WORK
o New Consttuction
~ower Level Finish
ODeck
OPorch
ORe-Roofing
ORe-Siding
o Fireplace
OAddition
OAlteration
OUtility Connection
o Misc.
PROJECT COST IV ALUE (excluding land) $
I hereby certify that I have furnished information on this application which is to the best of my knowledge ttue and correct. I also certify that I am the owner or
authorized agent for the above-mentioned property and that all consttuction 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
:ter upon th~/&;:f#ons. / ;)- / -; !;}Db?--
. Signature 'V Contractor's License No. Date
I Permit Valuation ....3f)tJ & , tJO I I Park Support Fee # $
I Permit Fee $ 79-;25 I I SAC # $
I Plan Check Fee $ I I Water Meter Size 5/8"; I"; $
I State Surcharge $ /.5D I I Pressure Reducer $
I Penalty $ I I City SAC and WAC # $
I Plumbing Permit Fee $ J/b,()() I I Water Tower Fee # $
I Mechanical Permit Fee $ I I Builder's Deposit $
I Sewer & Water Permit Fee $ I I Other e ~ec'/TK.-I t.!/t ~ $ I. (.10
-
I Gas Fireplace Permit Fee $ I I TOTAL DUE $ 1/5,15
--- ReceF/MXh
This Application Becomes Your Building Permit When Approved Paid ) /&:), f 1'::J
,. Date i d- - -=5- C9--
~ ~ /d/~ 2- By
Building Official 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
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
is~ ,. =7~~
Planning Director
ImA2-- -t?~
, 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
~-~
CITY OF PRIOR LAKE PLUMBING PERMIT
Date Rec'd
(Please type or print and sign at bottom)
ADDRESS
-.--- /
ja./
~]0/7
,
'-;7/,
1(/
{.
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
..,
OWNER
(Name)
/.J l/)
,I fll .J-
A'/C.C/L/r/ .
(Address)
APPLICANT
(N ame)
(Address)
(Address)
(Contact Person)
I
l~41I/f::tJii
APPLICANT SIGNATURE
,
I. Blue File PERMIT NO I
2, Gold City O//.)"...l _ /~__ zj
3 Yellow Applicant L v' .-~ W'.
'-J
--=-. ~/
ZONING (office use)
o.~ ~, ,(-'
PID ,>.7.5" -.:-1-6 ~ -C/C; " -C)
(Phone)
(It/ /7 - l~).' rs~;
(Phone)
(City)
(Zip Code)
(Phone)
DATE
1). / '3 /~(fCj "
APPLICANT PLEASE COMPLETE BELOW
Type of Fixture Quantity I Type of Fixture
Bath Tub with or without shower I Rough-ins
I Dishwasher I Water Heater
I Floor Drain I Water Softner
I Lavatory (Bathroom Sink) I Stand Pipe (Washing Machine)
I Laundry Tray (] or 2 compartment sink I Sewage Ejector
I Shower Stall I Backflow Assembly
I Sinks I Backflow Assembly Test
I Bar Sink I Lawn Sprinkler
I Water Closet (Toilet) I Other
I Quantity
I ,[ V \
I, !dl' -).
I' .\'; - . ,....
v. \..
I ~\:
FEE SCHEDULE
Industrial, Commercial & Multi-family 1% of job cost with a $39.50 minimum
Estimated Cost $
PLUMBING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
Residential, New One & Two-Family $99.50 J
Residential, Additions & Alterations $39',51' /
I ,
/
Building Permit # ,''''l " '"
'<<, '- / ,/'
< ) 1./, l . ,;
I t .~1"'\;
.50 /~ ;... t;l'~' I
-1 'if'
l)Jv J
$
$
$
nJ
I Paid /i;y
Date ."? /y
1]'/) "
I Receipt No.
/' .
By" 11-- /"
(.If~
'j
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714
PRIOR LAKE
INSPECTION RECORD
h, !a/I Tv
DEPARTMENT OF
BUILDING AND INSPECTION
SITE ADDRESS 3 &/7
NATURE OF WORK /- L-
USE OF BUILDING .'"'1 r= /
PERMIT NO. 0;) - 15'if! ~ DATE ISSUED Id - 7- CJ 0-
CONTRACTOR ,/tot /?, 'erI +0 ri" PHONE VL/j- ~jI~~
. l/
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR
DATE
I. I
, I I
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING n/f/ '~.. ~O '-0)
n,SULATION n# :3.-- )/l) -U]
ELECTRICAL
PLUMBING rvr/ ).- ""0 -03-
HEATING (if required) rvy/ ~ ~ ~()- cr:>
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I I
FINALS
BUILDING
ELECTRICAL
PLUMBING
HEATING
DO NOT
./f1S /
(
l
,?
OCCUpy UNTIL ABOVE HAS BEEN SIGNED
NOTICE
/0 -IS-
This card must be posted near an electrical service ca~inet 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