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CITY OF PRIOR LAKE
1. While
2. Pink
3. Yellow
File
City
Applicant
q:s;:- 1t 3.~
DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
2. SITE ADDRESS I J ~ 0
Iilt..~ 1().s/1 '1 B(7)'f-O; L
3. LEGAL DESCRIPTION W. 180.- Fr
(}l=- 6-OV. W, JJ 56c ;3D" 70WMSltlfP //S-N;
LOT BLOCK
ADDITION
4. OWNER (Name)
AAK. 'It" ...lO~'
5. ARCHITECT
-
(Name)
7. TYPE OF WORK Fireplace 0
New constructio!J!!f:" Alterations 0
Chimney 0 Misc. X \i O\,{S~
8. PROPERTY AREA"'''' ~"'RIii~
Sq. Ft. l; ~ 500
1. DATE
..sePT
- ~y
.AS len
J
)~
12. NO. OF STORIES
I
BaCU/v
(Address)
(p ).0 I!t..iTO U.
(Address)
13. TYPE OF CONSTRUCTION
Wcx>b FrL~
(Tel. No.) Q'..;;t~- ).'10'3 14. FLOOR AREA APPORTIONMENT USE
(ljJ1'rb
(Tel. No.)
S St{.3 g
(Address)
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
SEATS
~ ESTIMATED VALUE
.i7 I JlO, OOC
17. COMPLETION DATE
(Tel. No.)
Septic 0 Heating 0 Plumbing 0
Addition 0 Finish Attic 0 Residing 0
MDV(~
Reroofing 0 Porch 0
Finish Basement 0
9. PROPERTY DIMENSIONS
WidthllS' Depth jfro I
10. CULVERT SIZE
Yes V No
/::1. J'
I hereby certify tha
the above me .
building offi .
X
ve 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
property an hat all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the
oke i rmit for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perf~ needed inspect~
,- -.)S- ~~
Signature Ucense No. Date
~A:::!s J:=A:-('(~
SETBACKS: Required
Actual
PROPOSED GRADE FOUNDATION
IN RELATION TO CURB OR CROWN
OF STREET
USE OF BUILDING
FOR ADMINISTRATIVE USE
MATERIAL FILED WITH APPLICATION
Front
Back
Side
501 L TESTS 0 ENERGY DATA :P
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS4 SETS
SURVEY ?f COPIES 2-
Side
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
PLOT PLAN
o
F1U_
, '/ ,....
::::..~..~
;..s;:D<< ~~
~. ~~
TYPE OF CONSTRUCTION: I II 1II1vCY::)
Occupancy Group A BEl f@
DIvision 1 0
Permit Fee ................................... $
Plan Checking Fee ......................... $
State Surcharge ............................. $
Penalty ....................................... $
Septic System ............................... $
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
License Check Fee .... ..................... $
Pressure Reducer .......................... $
Meter Horn ................................... $
Water Meter ................................. $
b
City:
1"b87 - Z'So
"/Db,''71
"70, ~
.lI.s:' _ c;;::Jo::..
q s;: _~b.
, :>~(.~" ~,~
'/~."",,~
Check if
Deferred
o Sewer & Water Connection Fee ........... $
o
Other ......................................... $ . q
Subtotal.............................. $ /) 7& ~ .... 6
ecom Your Building Permit W2jAPprOVed.
Date -27-9~
Certificate of Occupancy
Issued
WaterTowerFee ........................... $
Water Tap ................................... $
Builder's Deposit ............................ $ l:l ~~. ~~
Other ......................................... $
Paid TO~~;.'?);""""""'~:C~i";~O~'
./
Date 0 IJ \
in the above application and accompanying documents is in accordance w~h the City Zoning Ordinance and may proceed a uested. This document when
stit es a temporary ~2!,,7:~~nce and allows construction to commence. Before occupancy, a Certificate . Occupancy must be issued.
Date Special Conditions ~ any
24 Hour notice for all inspections 447-42309:00 a.m. . 10:00 a.m.
qJJ~~
TIlt. Ctnltf or Iht J..kt Counlry
White . Building
Canary . Engineering
Pink . Planning
Co
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
.--4 ... .~
/1' L5.
NAME OF APPLICANT !lid fL. "/ (/, . v
I
APPLICATION RECEIVED '1l ~ J.?r~
9/2e19r
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activ~ which is proposed at:
/412.0 .' .- ') "
}.i.fHrf) -..../i II i ~/ 1\ <. ,: / ..---1/ ,~( L_' (PIP 25-930-036 -I)
~ / .,.../-, z ~
~,.ea:d~~~~~~ "
Accepted V"" . Accepted With Corrections
Denied
Reviewed By: ~. Mlt: HAE..L I j: ~
Comments: I) ~~/~~LL ;.J ~I;?D
- "
~~ -#AH1
Date: 9/2.8/1990-
/A~ ,?>~/'" ~/.; 14V">('l
/
...
J
"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."
CITY OF PRIOR LAKE
PLUMBING PERMIT
1. Blue
2. Gold
3. Yellow
File
City
Applicant
Applicant: A's /1J c c h ,q;v t t At..
Address: :u.W;g NaZ~J
Signature: __ /
Legal Description: Lot 1dL-:Y if.- c -- Sub:
Site Address: / Jj J!'). 0 S'1,Ad'l A CO ,qch +If 191' ~
Building Permit # 9S -~iI3J PIDIt,33- 'l3{) -b.J!-/
NOTE: This permit will not be processed without complete information.
# f/b*3i
Phone: ~tjJ - ??t:!Jtt,
/1/1 tv.
FIXTURE UNITS
Unit Tot~
Quantity Type of Fixture Amount
Bath Tub with or without shower $ 6.00 /'
Dishwasher $ 6.00 V
Floor Drain $ 6.00 /'
Lavatory (bathroom sink) $ 6;xJ
Laundry Tray (1 or 2 compartment sink) ".4'6.00
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 (w~ng machine) $ 6.00
Sewage ~or $ 6.00
Ba9k'fOw Assembly (RPZ, Double Check, PVB) $25.00
l,Afackflow Assembly Test $10.00
/' Lawn Sprinkler $25.00
/' Other $ 6.00
/' Minimum Fee $25.00
SURCHARGE .50
GRAND TOTAL $ ,/O.Of)
This permit is granted upon the express condition that said
contractor, shall comply in all resl?ects with the ordinances
of the State Plumbing Code and t~e am~ments thereof.
J. 77 (P)... ECEIPT N6. I Jill, DATE
. .
ATTEST
all for all inspecho
16200 Eagle Creek Av. S.E., Prior Lake, Minnesota 55372 / Ph. (612) 447-4230 / FAX (612) 447-4245
An Equal Opportunity Employer
White - Building
Canary - Engineering
Pink - Planning
The Cen'e. or 'he Like Coun'ry
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT t"L.!tw.hL
APPLICATION RECEIVED tJi2s/fJ
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction acti~ which is proposed at:
I'/LQOdJ.t ~J~
Accepted Accepted With Corrections+-
Denied
Reviewed By:
Comments: .-!L
Date: 9- zl7-q ~
~~~~ ~\ ~ A~ ~~~~
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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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GReeN - ....e
YellOW - AftltLlCANT
GOLD - CtTY
CITY OF PRIOR LAKE
SEWER AND WATER PERMIT
No.9S-/'IJ
NOTE: Sewer and Water
contractors must
be registered
with the city.
APPLICANT~)~il..J~:i~ oJ-. J1tr~ PHONE: lJ'IT - w'l'l
ADDRESS:LIJ _.3 --'-- ~,/, 1~1~ATE: /ljr,!?S-
SIGNATURE: BLDG. PERMIT # rs-~s-
SITE ADDRESS: /'I!LIJ~~~,'tu. PID#)f -9Jb - b0!-/
ILL IN THE BLANKS
1. Estimated length of water service
feet.
2. Size of water service
inch(es) .
3. Location of any couplings from structure
feet.
4. Type of sewer pipe. ABS
PVC
Cast Iron
5. Estimated length of sewer line
feet.
6. Clean out (if required), located at
structure.
feet
from
------------------------------------------------------------------
------------------------------------------------------------------
This application becomes your permit when approved.
BJr!'...k.J. 'Ji/ DATE: Il./t/~
=====i =========~================================================
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~ il/~/fs
RECEIPT # J. 7/ 7?
*
AMOUNT PAI~ Jf;-:v
REC'D BY c}'liJ/
4629 Dakota 51. 5.E., Prior Lake, Minnesota 55372 / Ph. (612) 447-4230 / Fax (612) 447-4245
AN EQUAL OPPORTUNITY EMPIDYER
----
- -""
1. Blue
2 Gold
3. Yellow
File
City
Applicant
CITY OF PRIOR LAKE
PLUMBING PERMIT #~ 4
Applicantb'1lAl~~~~ ~ili:t:hone:
A~dress: fr{41;~' - -- - -- It/~ .sS37,f
Signature: _ _ _ .
Legal Description: Lot Block Sub:
Site Address: I'I/:if) -;:j,d;- 801Cr'J. '1',z .
Building Permit # 9~ - ~ '3 PID #
NOTE: This permit will not be processed without complete information.
FIXTURE UNITS
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 ~Gc.JlJt wk.a- $ 6.00 3S-~
Minimum Fee $25.00
SURCHARGE
.50
3)"?
GRAND TOTAL $
Call for al inspections 24 urs in advance.
4629 Dakota St. S.E., Prior Lake, Minnesota 55372 / Ph. (612) 447-4230 / FAX (612) 447-4245
AN EQUAL OPPORTUNITY EMPLOYER