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CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT ~/I Z /o?
3&t7t1
For -~,' / Ira / I
tJ.fJ/
1 White
Pink
3 Yellow
File
City
Applicant
I PERMIT NO'Og_O/OO
M.'or
'-<< k (11... :'>-J3)~
ZONING (office use)
~-~
LEGAL DESCRIPTION (office use only)
LOT J5BLOCK I
ADDITION
/;J~;.c2 t:/l 4L.i2--,
Pro 20 3?S" tJ25"'.()
OWNER
(Name)
-J;; h 0\
3(0
(Phone) 'iS~- YY)-j8'3o
S53 )r)..
(Address)
BUILDER
(Company Name)
(Contact Name)
(Address)
a.s
odoov~
,<;"tA. ~.e
(Phone)
(Phone)
TYPE OF WORK 0 New Construction ODeck OPorch ORe-Roofing
OAddition OAlteration o Utility Connection
CODE: bQiT.R.C. DI.B.c.
Type of ~strnction: I II III IV V A B
Occupancy Group: A B E F H ~ M R S U
Division: I 2 ~ 4 5
ORe-Siding
o Fireplace
ower Level Finish
o Mise.
PROJECT COST IV ALUE $
(excluding land)
I hereby certify that I have furnished mformation on this applicatlon which is to the best nf my knowledge true and correct. I also certIfy that I am the owner O!" authorized agent for the
Jbove- e lOncd property and that all Clmstruction will conform to all existmg state and local laws and will proceed in accordance with submitted plans_ 1 am aware that the ouildmg
omCla can 'v e tlm pel It tIll JUS auslt Furt ermore,] hereby agree that the CIty official or a deSIgnee may enter upon the propelty to pert(lrm needed lI1Spectlons
..
Permit Valuation .'j ,"2., 000. Ov
Permit Fee $ 7<'{, 75"
Plan Check Fee $ -
State Surcharge $ (.~o
I Penalty $
I Plumbing Permit Fee $ 50.00
I
Mechanical Permit Fee I $
Sewer & Water Permit Fee I $
I Gas Fireplace PermIt Fee $
I This Application Becomes Your Building Permit When Approved
I ~ ~7-?-J S r:!" Z/aY' I
I Huildmg Uftlcial .
Contractor's License No.
o3.~V
Date
Park Support Fee
SAC
#
#
$
$
$
$
Water Meter Size 5/8"; I",
Pressure Reducer
Sewer/Water Connection Fee
#
$
Water Tower Fee
#
Builder's Deposit
Other
TOTAL DUE
~/2S
.5SS 0
ThiS IS to certify that the requestll1 the a cove applicatllln and accompanYll1g documents is 1I1 accordance WIth the City ZOnIng Ordinance and may proceed as requested Tim document
when signed by the CIty Planner CIlnstItutcs a temporalY Certiticate of Zonll1g compliancc and allows construction to commence Before occupaocy, a Cl'ltlticate of Occupancy must be
issucd
Planning Director
Special Conditions, if any
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372
Residential Building Permit Checklist
Basement Finish or Interior Alteration to Single Family Homes
/? ~'
BY: 1!u~~'-~Ld2r Date: ,-ill Z /~ 6'-
Building Permit #
Site Address ,:) (; 9 I
Legal: L B
Existing Structure~r NO
PID: Zoning:
.~t~ ~ /Jc/J/
Subdivision:
7JCUf1- k~-/
I YES
I CONFORMS TO ZONING
ORDINANCE
NO
YES NO
Is this an expansion of the existing footprint or Refer to Planning ;JZJ
building height?
Is the property located within the flood plain? Refer to Planning /,,){)
Does the alteration include any additional kitchens? Refer to Planning /00
Does the proposed alteration include any outside Refer to Planning
entrances other than patio doors? Il/O
Is the proposed use of the finished space or Refer to Planning
alteration for anything other than a normal single Iv0
family home (office, group home, day care, etc.)?
THIS CHECKLIST MUST BE COMPLETED AND INCLUDED IN THE BUILDING PERMIT FILE TO
MAINTAIN A RECORD OF THE REVIEW.
L:\TEMPLA TE\AL TCHCK.DOC
r;EPARTMENT OF
BUILDING AND INSPECTION
PRIOR LAKE
INSPECTION RECORD
SITE ADDRESS ~"9 I F~Ai L 71J,.At't.. IJ. W.
NATURE OF WORK /ApJ I-~n Fi,J;rH (Nt, F: p.L
USE OF BUILDING ~1:{tJ.
PERMIT NO. IlJO DAT~ISSUED 31'2,/~
CONTRACTOR ~ 1tA.. MI c..c.AtJ ,~ PHONE · t( ..-s
NOTE: THIS IS NOT A PERMIT FOR P~NY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
H - INS
- - : .
-~- - --_.
INSPECTOR
DATE
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I I
ALS
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