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CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT c --- ), 'I
Permit No. - { .:::::.. - ~ d-
1. While
2. Pink
3. Yellow
File
City
Applicant
DIRECTIONS
SPACES NUMBERED 1THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
2. SITE ADDRESS
1. DATE
2... /6 ~ c:;;S
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (WIdth) (Depth)
12. NO. OF S IES
LOT
(Address)
(Tel. No.)
13. TYPE OF CON~TRUCTION
WOLV"'-
14. FLOOR AREA APPORTIONMENT USE
2
ADDITION
e
5. ARCHITECT
(Name)
(Address)
(Tel. No.)
6. BUILDER
(Address)
(Tel. No.)
,,/:1 Z ~
~
7. TYPE OF WORK
New construction)(
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES
Sq. Ft.
Septic 0
Addition 0
Heating 0 Plumbing 0
Finish Attic 0 Residing 0
Reroofing 0 Porch 0
Finish Basement 0
9. PROPERTY DIMENSIONS
Width Depth
10. CULVERT SIZE
Yes No
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 a 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 offi i ~ ~n re~ke this it for ust cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X PA/<' /~~ ~Ae~ Z-{~#75'
Signature . Uc:ense No. Date
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
MATERIAL FILED WITH APPLICATION
Front
Back
Side
Side
SOl L TESTS
o ENERGY DATA
-;t-.
PROPOSED GRADE FOUNDATION
IN RELATION TO CURB OR CROWN
OF STREET
USE OF BUILDING S, 'r-.~ '~ \ '-
(~
TYPE OF CONSTRUCTION: I II 1I11\(i::>
Occupancy Group A BEl H(!tM
DMsion 1 @
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION I Z'
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS~ SETS
SURVEY jD- COPIES d-
2""7.::::s..0
PLOT PLAN
o
City:
Amount Brought Forward .. .. . ..... .. .. . '" $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
License Check Fee ......................... $
Pressure Reducer .......................... $
Meter Horn ................................... $
Water Meter ................................. $
o Sewer & Water Connection Fee ........... $
o WaterTowerFee ........................... $
Permit Fee ................................... $
'741. o~
)-ti \ - Cc:.::;::
(--,,l.L 2-- ~
J..;~.~~
Plan Checking Fee ......................... $
State Surcharge ............................. $
Penalty ....................................... $
Septic System ............................... $
Other ......................................... $
............................... $
I ,2-Yb- ({ ~
-
Check if
Deferred
c.; '"i. . t>~
I . (x')c> , 0<::::::",.
. '7 CJ:::") ( ~~
in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed a
stit a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate
3--- ~---c:; ~
Date Special Conditions ~ any
24 Hour notice for all inspections 447-42309:00 a.m. '10:00 a.m.
Byn
mes Your Building Permit When Approved.
Date -.:3,- ~-~---s::-
Certificate of Occupancy
Issued
qs -'11--
White - Building
Canary - Engineering
Pink - Planning
Th. C.nt., of rh. Lib Counlry
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
f'l'W ~~.
)-17-"'Qs-
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
~ 4 9'&'2? 0\~~/nA"~ 0 ~ ~
Accepted
Accepted With Corrections
i--
Denied
Date: ~- ~ c:r s;:-
Reviewed By:
Comments: J ..
4.
~
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3.
"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."
The Center of the Lake Country
White - Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
[."/'1 n 0 .~.'
1l..()J'~ r o-:.~ ).J.i/\
).-1.7-C1S-
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
I Ltb'S)('
..'7' ;~' , ;r" \ ~,
. :'. " \\
I ; .'" V,I(. / -'1V"l A".'! i.'
f' l\
~ A,/\( ~
Accepted
Accepted With Corrections
~
Denied
Date:
Comments:
J/leU1.$e/) -1lJ
.
"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."
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GREE. - ....
YELLOW - AP\
GOlD - CITf
CITY OF PRIOR LAKE NO. ?~- 2-7
SEWER AND WATER PERMIT
ADDRESS:
NOTE: Sewer and Water
contractors must
be registered
with the city.
tt/l.
PHONE: Yt 3- 7Y.1 Y
DATE: V'- 2 o~fr
.
BLDG. PERMIT # tis- -yv
PID#o(S -~;-f - 011-0
SITE ADD
FILL IN THE BLANKS
1. Estimated length of water service .s--O
;11
2. Size of water service _ inch(es).
3. Location of any couplings from structure
feet.
feet.
4. Type of sewer pipe. ABS PVC~ Cast Iron
5. Estimated length of sewer line :r-o feet.
6. Clean out (if required), located at
structure.
feet
from
------------------------------------------------------------------
------------------------------------------------------------------
This application becomes your permit when approved.
ByJj,~Jt~j 'IV. DATE: 1!M11f
====== =========~~=========================~===================
FEES:
$
$
$
35.00
.50
35.50
Sewer and water line connection permit.
Surcharge
TOTAL
* Fee for either sewer or water individually is $20.00 plus
$ .50 surcharge.
*
Sewer and water permits issued for new construction must be
recorded on the building permit card at the time of issuance
to insure that no duplicate sewer and water permits are
issued.
DATE PAID #k/f(
RECEIPT # J.. 7.jIJ (
AMOUNT PAID (36-/;-V
REC'D BY 1:fJ.....iL
4629 Dakota 51. 5,E" Prior Lake, Minnesota 55372 / Ph, (612) 447-4230 / Fax (612) 447-4245
AN EQUAL OPPORTUNITY EMPLDYER
Applicant:
Address:
Signature:
Legal Description:
Site Address:
Building Perm' 1#
NOTE: This pe .
CITY OF PRIOR LAKE
PLUMBING PERMIT
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1. Blue
2 Gold
3. Yellow
File
City
Applicant
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Phone:
FIXTURE UNITS
Unit
Quantity Type of Fixture Amount Total
::L Bath Tub with or without shower $ 6.00
I Dishwasher $ 6.00
I Floor Drain $ 6.00
~ Lavatory (bathroom sink) $ 6.00
j Laundry Tray (1 or 2 compartment sink) $ 6.00
1 Shower Stall $ 6.00
I Sinks: $ 6.00
Bar Sink $ 6.00
::L Water Closet (toilet) $ 6.00
.3 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 Cheek, PVB) $25.00
Backflow Assembly Test $10.00
Lawn Sprinkler $25.00
Other $ 6.00
Minimum Fee $25.00
SURCHARGE
GRAND TOTAL $
.50
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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 am5?dments thereof.
RECEIPT NO. ~u,L,{' DATE
AITEST
all for all inspectio 2 hours in advance.
4629 Dakota St. S.E., Prior Lake, Minnesota 55372 / Ph. (612) 447-4230 / FAX (612) 447-4245
AN EQUAL OPPORTUNITY EMPLOYER
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PRIOR LAKE
INSPECTION RECORD
DEPARTMENT OF
BUILDING AND INSPECTION
SITE ADDRESS
NATURE OF WORK
USE OF BUILDING
PERMIT NO. ~ -5. 01.1 J.- DATE ISSUED a .IB' 'IS
CONTRACTOR MMArv r os t-A.L(t., -lJW~
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
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INSPECTOR
DATE
I FOOTING
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I FOUNDATION (Prior to Backfill) 17 i)" 1~'3 '~~..tq~
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
SEWER I WATER I SEPTIC .')0- s\l.~p
FRAMING v T"IS "I.~~ 1,q~ ,{) IJ
'}.,') A (A l' /j' 1\. l'
INSULATION v oV., v 1,,'2,.Q S
ELECTRICAL (/
PLUMBING ?r '''l> .
. lP.<t
HEATING (if required) }- .1'lq~
FIREPLACE v
GAS LINE AIR TEST
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I WALLBOARD If,...Q.M 11-lf.'1 S
FINALS
GRADING (Prior to Sodding) _
BUILDING \,'1 ,,; \V~~
ELECTRICAL .
PLUMBING jOvltg -'7'5'
HEATING " tv.III"!>
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.
Call between 8:00 and 9:00 A.M. for all inspections
FOR ALL INSPECTIONS 447-4230