HomeMy WebLinkAboutBuilding Permit 09-0458
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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
at bottom)
~
~.s~ A\}...L N. E
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
. JoJE.
BUILDER
(Company Name)
(Contact Name)
(Address)
Date Rec' d
1 LO~
~~~~: ~i;lic.nt I PERMIT NO. tct ~4$B I
ZONING (office use)
(Phone) <:f5""2..-~o3 -~8oS-
(Phone)
(Phone)
TYPE OF WORK 0 New Cons~2, DDeck DPorch ORe-Roofing
DAddition ~ration DUtiIity Connection
CODE: ,\f..R.C. DI.B.c. 0 Misc.
Type of ~struction: I II III IV V A B
Occupancy Group: A B E F HIM R S U
Division: I 2 3 4 5
ORe-Siding OLower Level Finish
o Fireplace
PROJECT COST IV ALUE $
(excluding land)
x
I hereby certifY that I have t\Jrmshed mformation on this application which is to the best of my knowledge true and correct. I also cenify that I am the owner or authof!zed agent for the
above-mentIOned property, nd 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 buildmg
o clal voke this p t for Just cause FUlthermore. I hereby agree that the CIty official or a designee may enter upon the property to perform needed mspeCl1ons.
7-1- O~
Signature
Permit Valuation
Permit Fee $
Plan Check Fee $
State Surcharge $
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace Permit Fee $
54
..-
Contractor's License No.
Date
Park Support Fee # $
SAC # $
Water Meter Size 5/8"; 1 "; $
Pressure Reducer $
Sewer/Water Connection Fee # $
Water Tower Fee # $
Builder's Deposit $
Other $
TOTAL DUE $ 4\ 'l"
~~'l4
I Receipt No. ~ 3G)3
By (t,l) .
Paid
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
issued
Planning Director
Date Special Conditions, if any
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONINGIFIREPLACE PERMIT
Date Rec'd
1. Pink
2. GI'eeo
3. Yellow
File
City
Applicant
~-rE-~.:
li~~ . .slw vc
I ZONING ("""~) I
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDmON
PID
I &':: U!l<- Meo.nso'1
. (Address)
(phone)
APPLICANTL IJ J' ^ '
(Name) e.w;~ f,ev11'lj ..f1'1rr
(Address) J~ 71 1L.f4i~ Sf
(Address)
(Contact Person) ~erel( Leu; s
APPLICANT SIGNATURE
(phone) C. JJ -q LJ(j -lIst 5
New l1 (JrnonrJ 51..10 II
(City) (Zip Code)
C. J)- ql.f(J , 1..15 t-s-
I J l)
(phone)
DATE
DNEW CONSTRUCTION D REPLACEMENT III AL TERA TIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR. POWER. PLANT
DWarm Air Plants PLEASE NOTE: Air Conditioner
o Steam Units and Fireplaces Cannot Encroach
DGravity D Hot Water into Required Side Yarel Setbacks.
D Mechanical o Radiation
DAir Conditioning o Special Devices Fireplaces with Box Additions or
Y1vent. System D Other Devices Cantilevers to the Outside of Buildings
Require a Building Permit.
FIREPLACE MAKE AND MODEL
APPLICANT PLEASE COMPLETE BELOW
Industrial, Commercial & Multi-Family
FEE SCHEDULE
1 % of job cost Residential, Gas Fireplace
$49.50 minimum
$149.50 Residential, Additions & Alterations
$64.50 Residential, AC Only
$49.50
$49.50
$49.50
Residential, Heating & NC (New Construction)
Residential, Heating Only (New Construction)
Estimated Cost $
Building Permit #
HEATINGPERNnTFEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
q i:l, SO
.50
SO,oO
(Office Use OoIy)
This Application Becomes Your Building Permit When Approved
Buildill2 Official
Date
Paid SO _ UO
Datee.3.0