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rmshed 1l).l"I'matlOn on thi application which is to the bcst of my knowledge true and corrcct. I also ccrtlfY that I am the owner or authonzed agcnt Il)r thc
nd tl1a~j1i construction w conform to all cXlstmg state and local laws and will proceed in accordance with submItted plans I am aware that the buildmg
It j>JlIst ca~se FUlt~1 Ole, I heleby agree that the City offiCIal or a destgnce may enter upon the propelty to pel form ~d 10;;'3';)9 /oPl
Stgq~ -.-- Contractor's Ltcense No r\ li6ate / "
Permit Fee $
Plan Check Fee $
State Surcharge $
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace Permit Fee $
,
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/Q -z. :z. 5"
59.-
50.-
II r
;s . .ti~Y=BUilWngP': T,;ut~ro...
, Ul dlllg OHicial ~ .[)atc~
~
Park Support Fee
SAC
Water Meter Size 5/8"; I";
Pressure Reducer
SewerlWater Connection Fee
Water Tower Fee
Builder's Deposit
Other
TOTAL DUE
Paid
Date
(~"5. ~ ":'\
\~
#
#
#
#
$
$
$
$
$
$
$
$
$
''''3. 2.5
Receipt ~~ ~!!'
By flj)t+-"
.
~anmng Dny(;(or
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372
Special ConditIOns, if any
@
Residential Building Permit Checklist
Basement Finish or Interior Alteration to Single Family Homes
PO~ Date: (2!( "t (0(3
BY:
Building Permit # PID:
Site Address
Zoning:
Legal: L B
Subdivision:
Existing Structure~ NO
CONFORMS TO ZONING
ORDINANCE
~ ""'-
( YE~
NO
t
Is this an expansion of the existing footprint or
building height?
Is the proposed use of the finished space or
alteration for anything other than a normal single
family home (office, group home, day care, etc.)?
YES NO
Refer to Planning
/'
Refer to Planning /
Refer to Planning ~
Refer to Planning
",---
Refer to Planning
/'
Is the property located within the flood plain?
Does the alteration include any additional kitchens?
Does the proposed alteration include any outside
entrances other than patio doors?
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
PRIOR LAKE
INSPECTION RECORD
DEPARTMENT OF
BUILDING AND INSPECTION
SITE ADDRESS tS~Z.l CS~.ca.. ~~c...~
NATURE OF WORK 2. (lOOM~ F,~ IS ~60 IN L6. ...6-. L6v~'-
USE OF BUILDING ~s A (tL , I
PERMIT NO. ~Q ./c:>2,..O . DATE ISSUED 1Z. /'9. (o~
CONTRACTOR ~~1-f.~~v.e I;~p PHONE'
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
I j
Prior to Backfill) I I 1
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
INSPECTOR
DATE
FRAMI
INSULATION
ELECTRICAL
PLUMBING
HEATING (if required)
FIREPLACE
GAS LINE AIR TEST
,v>R,1
l
, I
,/1'/4/ f
, v
FP
...
'flJ I
1
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I I
FINALS
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.
FOR ALL INSPECTIONS (952) 447-9850
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
I White
Pink
Yellow
File
City
Applicanl
PERMIT NO. C9-[ 0'V5J
(Please type or print and siJ!:n at bottom)
ADDRESS
152@li ~\1f(tcJ,Q/ C Ifl- \e, ~J G I "PC(V L..(',_ VO_. ; \\A ~ \
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
-f
OWNER
(N ame)
t1f\[ /\
J~ -I- S"~vtf
...
(Phone)
4324L/Crldd- I
(Address)
':fl.~
BUILDER
(Company Name)
(Contact Name)
(Address)
(Phone)
(Phone)
TYPE OF WORK 0 New Construction ODeck OPorch ORe-Roofing ORe-Siding ~ower Level Finish ~ireplace
OAdditlon OAlteration DUtility Connection
CODE:~.R,C. DI.B.C. o Mise
Type of onstroction: I II III IV V A B
Occupancy Group: A B E F H I M R S U
Division: I 2 3 4 5
PROJECT COST IV ALUE $
(excluding land)
I hereby certify that I have
f abovc-m,ntlOned property
otliciaJ-tan rcvokc this per
xL..~
0'
Permit V~uation
Permit Fee $
Plan Check Fee $
State Surcharge $
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Perrnit Fee ! $
Gas Fireplace Perrnit Fee , I $
Contractor's License No
5<9.-
SewerlWater Connection Fee
Water Tower Fee
#
#
$
$
$
$
$
$
$
$
$
I ~3. 2.5
2~.-
to -z. . 1. -5"
Park Support Fee
SAC
#
#
Water Meter Size 5/8"; I";
Pressure Reducer
Builder's Deposit
Other
5(9. -
t( ~lonBe Yom Bulldin, P': lJ;''''
, 1I1~ Date
TOTAL DUE
Paid
Date
- --
(~-j. 2- ~
\~
Receipt N Cl.571 ry t!!J
By f2jJfA-..
,
th t the rcquest m the above applicatIOn and accompanymg documents IS in accordance with the City Zoning Ordinance and may proceed as requested ThIS document
City Plannel"constltutcs a temporary Certificate of Zonmg compliancc a allows constructlOn to commence Before occupancy, a CertIficate of Occupancy must bc
...
Special Conditions, if any
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372