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II CITY OF PRIOR LAKE
I.. ,'.' " BUILDING PERMIT,
TEMPORARY~~TIFICATE OF ZONING COMPLIANCE
l((l1lL1TY CONNECTION PERMIT q. -:25'~
.J Permit No. 5.
1. White
2. Pink
3. Yellow
File
City
Applicant
DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
2.SITEADD5~<PO Co tV/) OJ} 'S .:J TI2"'S~ /
1. DATE
~/50Iqj
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
3. LEGAL DESCRIPTION
LOT 7
12. NO. OF STORIES
ADDITION
PID '-0'" 01 q... b DJ- -0
tAlOO/J.4t'-G-
New Construction 0
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES
Sq.Ft.
Reroofing 0 Porch 0
Finish Basement 0
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS ~
SEATS
16. ESTIMATED VALUE
/1/ aJ
17. COMPL TI. NATE
0' I 15'
10. CULVERT SIZE
Yes No
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
Front
Back
Side
Side
MATERIAL FILED WITH APPUCATlON
SOIL TESTS 0 ENERGY DATA
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS tf!J"" SETS
SURVEY ~ COPIES
PROPOSED GRADE FOUNDATION
IN RELATION TO CURB OR CROWN
OF STREET
USE OF B LING
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
City:
""f), DOC . C!) C)
Amount Brought Forward .................. $ _t~
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
License Check Fee ......................... $
PLOT PLAN
o
TYPE OF CONSTRUCTION: I II III IV 0
Occupancy Group A BEl H<ilM
Division 1 2 (j
Permit Fee ................................... $ ~ J \ . 00 _,
Plan Checking Fee ......................... $~ 0..?-S .'5./
State Surcharge ............................. $ 3'1. SO
Pressure Reducer .......................... $
Penalty ....................................... $
Septic System ............................... $
Other ......................................... $
Subtotal ............................... $~
ecomes You uildlng Permit When Approved.
Date ~ -I?-~
Meter Hom ................................... $
Water Meter ................................. $
o Sewer & Water Connection Fee ........... $
o
Water Tower Fee ........................... $
Check if
Deferred
Issued
Water Tap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
Paid Total Due ..b;('...........~:~I..~~O~ J.};.3
r1 - /"
Date fJ~ S B
above application and accompanying documents Is In accordance with the City Zoning Ordinance and may proceed as
temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate
~. 19-~
Date Special Conditions ~ any
24 Hour notice for all inspections 447-4230 9:00 a.m. . 10:00 a.m.
tlr -).~ft,
'~
CITY OF PRIOR LAKE
PLUMBING PERMIT
I~
1. Blue
2. Gold
3. Yellow
File
City
Applicant
Applicant:
Address:
Signature:
Legal Description: Lot
Site Address: 0 tJ
Building Permit # liS -02.;51 PID #lS -01 f/ - 0 or - ()
NOTE: This permit will not be processed without complete information.
Sub:
FIXTURE UNITS
Unit
Quantity Type of Fixture Amount Total
I Bath Tub with or without shower $ 6.00
Dishwasher $ 6.00
I Floor Drain $ 6.00
3 Lavatory (bathroom sink) $ 6.00
Laundry Tray (1 or 2 compartment sink) $ 6.00
f Shower Stall $ 6.00
Sinks: $ 6.00
Bar Sink $ 6.00
3 Water Closet (toilet) $ 6.00
Rough-ins $ 6.00
Water Heater $ 6.00
Water Softner $ 6.00
i 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
GRAND TOTAL $
.50
t.~.nJ
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 am~?dmtnts thereof.
RECEIYf NO. q urnS DATE
,
ATIEST
all for all inspec 0 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
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White - Building
Canary - Engineering
Pink - Planning
Thr Crnler of the Lake Country
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
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The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
.... !~" i ,,,\
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;~
(''i'I!.- ., ~.^ . ...1'+'
Accepted /
Accepted With Corrections
Denied
Reviewed By: ~. tv11/ ~~
I rE.~
Date: ~/'u>/(99S-
21 I .? FY:) j -"'-\.-.,. % \::>c:. I 5 I E .<~..
, , -..) ";;.1
Comments:
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31 I ,
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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. II
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Th~ C~nt~r of the Lake Country
White - Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT ~le ~ ~.
APPLICATION RECEIVED S I 3 j I tf S
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
SO~O (~,~~ ,~+.
Accepted /'
Accepted With Corrections
Denied
Reviewed By:
'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 01 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."
/
',;
"
Th. C.nl., 0' lh. Llk. Counlry
White - Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT ~~ ~ ~.
APPLICATION RECEIVED S / 3 II 'f S
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
GaG, 0 C,(J,^~ ~+.
Accepted
Accepted With Corrections ~
Denied ~
Reviewed By: /2I~r
Comments:
I,~~ d!f~kr-~
Date:
b-I9'~
~~
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."
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PRIOR LAKE
INSPECTION RECORD
SITE ADDRESS SlJb() ~.Jb.
NATURE OF WORK ~
USE OF BUILDING
PERMIT NO. 'S"- h
CONTRACTOR
NOTE: THIS IS N T A PERM FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
DEPARTMENT OF
BUILDING AND INSPECTION
DATE ISSUED 7k/ff
INSPECTOR
DATE
FOOTING
FOUNDATION (Prior to Backfill) 1hllfS'
PLACE NO CONCRETE UNT L ABOVE HAS BEEN SIGNED
ROUGH - INS
SEWER I WATER I SEPTIC
FRAMING
INSULATION
ELECTRICAL
PLUMBING
HEATING (if required)
FIREPLACE 'S"
GAS LINE AIR TEST (
COVER NO WORK UNTIL BOVE HAS BEEN SIGNED
I WALLBOARD ~ Ilfhsllt"
F I N[A~[-S
GRADING (Prior to Sodding) 7~" I.. -/ 1I1s;'''
BUILDING I
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.
Call between 8:00 and 9:00 A.M. for all inspections
FOR ALL INSPECTIONS 447-4230