HomeMy WebLinkAboutBuilding Permit 94-0225
CODE REOUIREMENTS ARE FOR YOUR PERSONAL HEALTH AND SAFETYI
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"" TV OF PRIOR LAKE
, , BUILDING PERMIT,
TEMPQIiJA~V ',ERTIFICATE OF ZONING COMPLIANCE
"Ir"ml T I~J:ND ~LlTV CONNECTION PERMIT
permitNo.~q1-~b
DIRECTIONS
SPACES NUMBERED 1
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
2. SITE ADDRESS t:; ~ s f
3. LEGAL DESCRIPTION
1. DATE
~- '\ -q
LOT
ADDITION
4. OWNER
~>
5. ARCHITECT
M.
BLOCK
PID~ ?-~~oo6'o
6. BUILDER
~I"".
-ssto
(Name)
7. TYPE OF WORK
New Construction 0
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES
Sq.Ft.
Septic 0
Additio.
Heating 0 Plumbing 0
Finish Attic 0 Residing 0
Reroofing 0 Porch 0
Finish Basement 0
9. ROPERTY DIMENSIONS
Width Depth
10. CULVERT SIZE
Yes No
1. White
2. Pink
3. Yellow
File
City
Applicant
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
SEATS
16. ESTI~.ATED VALUE "
, \~ ()(., (1
17. COMPLETION DATE
SURVEY
PLOT PLAN
7S
12. NO. OF STORIES
I hereby certify that I have furnished 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 cial can revoke . permit for just cause. Furthermore. I hereby agree that the city official or a designee may enter upon the property to perfS need~sP~
X . -Ol.: -
Signature Ueense No. Date
FOR ADMINiSTRATIVE USE
SETBACKS: Required
Actual
Side
Side
Front
Back
PROPOSED GRADE FOUNDATION
IN RELATION TO CURB OR CROWN
OF STREET
USE OF BUILDING
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION -'7.., oe>o
TYPE OF CONSTRUCTION: I II III IV
Occupancy Group A BEl H R (6)
OMsl~ 3 4
Permit Fee ................................... $~
Plan Checking Fee ......................... $ q'5 . W)
State Surcharge ............................. $ (/I . (!)n
-
City:
Penalty ....................................... $
Septic System ............................... $
Other ......................................... $
Check if
Deferred
~~gA too
Permjt When Approved. ~'
Date {;-/3--/7
Pald
Issued
MATERIAL FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA LI
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS~ETS
Date
ion and acco" mpanyi~nts is in accordance with the City Zoning Ordinance and may proceed
rt~!'2:!5'- ff ~and allows construction to commence. Before occupancy, a Certificate
Date Special Conditions n any
24 Hour notice for all inspections 447-42309:00 a.m. '10:00 a.m.
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ........... ............ $
Sewer Tap ................................... $
Ucense Check Fee ......................... $
Pressure Reducer .......................... $
Meter Horn.... ............. .................. $
Water Meter ................................. $
o Sewer & Water Connection Fee ........... $
o Water Tower Fee ........................... $
91/-~1.s-
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF ~PLICANTd1fJA~
APPLICATION RECEIVED 0'/'<7 If tJ
The City of Prior Lake BUILDING Department has reviewed the
building permit application for construction activity located at
1/;3 'I /'-/~.U JfihL 1/. u .
Accepted
.-()rt1-ed _~ed
Reviewed bY.~~_/~
Comments:
with Corrections :><-...
Date G-I?-?Cf
S~..12 '" trO~ Q (' ~ ft~ ~.V ,\..eA. ,
J.Ikt~
"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."
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT d~~
APPLICATION RECEIYED ~/L71?Y
The City of Prior Lake ENGINEERING Department has reviewed the
building permit application for construction activity located at
L/10 if I va ;iL \)hI1L/ ~. L.
AccePted~ Denied
Reviewed by: V RttaM'I
Comments: 17 tfJlR .I'
Accepted with Corrections
Date 5 ~7 /'14'
I ,
"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."
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT ~}jrL- )~
APPLICATION RECEIVED J/Z7/~Y
The City of Prior Lake PLANNING Department has reviewed the
for construction activity located at
building permit application
L/ld tj /'ftJ JI...; dL. ~. t .
./' Den.i7~
Reviewed by: ~
Accepted
Accepted with Corrections
Date ~~/-p'V
Comments:
liThe 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."
CITY OF PRIOR LAKE
PLUMBING ..PERMIT
1. Blue
2. Gold
3. Yellow
File
City
Applicant
# q '/~JJj'-
4J./ 7-5'S~ ~
Applicant:
Address:
Signature:
Legal Descrip n: Lot ...3 Block f
Site Address: i.JjIJ 1.- ClJ-~)ffL..L../ 1 [ .
Building Penn it 1# fit.! -IJ J 1/1 PID 1# JS -J. t 6 - d, lJ/- ()
.
NOTE: This pennit will not be processed without complete infonnation.
FIXTURE UNITS
Sub:
- J-
&l
Unit
Quantity Type of Fixture Amount Total
Bath Tub with or without shower $ 6.00
Dishwasher $ 6.00
Floor Drain $ 6.00
Lavatory (bathroom sink) $ 6.00
Laundry Tray (1 or 2 compartment sink) $ 6.00
Shower Stall $ 6.00
Sinks: $ 6.00
Bar Sink $ 6.00
Water Closet (toilet) $ 6.00
Rough-ins $ 6.00
Water Heater $ 6.00
Water Softner $ 6.00
Stand Pipe (washing machine) $ 6.00
Sewage Ejector $ 6.00
Backflow Assembly (RPZ, Double Check, PVB) $25.00
Backflow Assembly Test $10.00
/ Lawn Sprinkler $25.00
Other $ 6.00
Minimum Fee $25.00
SURCHARGE
.50
GRAND TOTAL $ ;lS.S-o
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. 9111/'1 DATE
,
AITEST
Call for all ins ti s 24 hours in advance.
4629 Dakota St. S.E., Prior Lake, Minnesota 55372 / Ph. (612) 447-4230 / FAX (612) 447-4245
AN EQUAL OPPORTUNITY EMPLOYER