HomeMy WebLinkAboutBuilding Permit 07-0089 \ ' - -
C�������x��� �� (����x��x���r
CITY OF PRIOR LAKE
����r����� �� �.ix����z�� �z����x���x�
�' Final Permitted ❑ Conditional C.O. Expires
This Certificate issued pursuant to the requirements of Section 110 of the � Residential / � International
Building Code certifying that at the time of issuance this structure was in compliance with the various
ordinances of the City of Prior Lake regulating building construction or use. For the following:
Use Classification �/ N�C7 L� �H j`� ��-Y Bldg. Pernut No. a� U U�i �
� �N Zonin District P U1�
Occupancy Type ���--- Type Construction g
Legal Descrip6on L�� L' �� TE �f'�E /C S /� �'/�/1� 2 Nl�
Owner of Building Site Address W I�/ �/�� �L �G /� C/•
Contractor's Name & Address 1� � /'"' f-'/ /V ✓ /''�!//"/ E.� / � L H Z /� L� l`� /`� � /1 �� ` Z
/� UG'-!L` U. f ,�� - CityPlanner J�,NE �N.r�E�.
Building Official
Date: � ^ Date:
POST IN CONSPICUOUS PLACE
DATE TIME
CITY OF PRlOR LAKE s �, ,�
INSPECTION NOTICE SCHEDULED �
3 2 C�� �--
AODRESS `
OWNER CONTR.
PHONE NO. PERMIT NO. �7 '— ���
❑ FOOTING O PLUMBING RI ��EX/GRAD/FILLING
❑ FOUNDATION ❑ MECH RI ❑ COMPLAINT
❑ FRAMING ❑ WATER HOOKUP � FIREPLACE RI
❑ INSULATION ❑ SEWER HOOKUP ❑ FIREPLACE FINAL
�FINAL ❑ PLUMBING FINAL � GASLINE AIR TST
❑ SITE INSPECTION O MECH FINAL ❑
COMMENTS:
�WORK SA7ISFACTORY, PROCEED
❑ CORREC TION AND PROCEED
❑ CORR T , CALL FOR REINSPECTION BEFORE COVERING
Inspector. OwneNContr.
CALL 7 850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTSARE FOR YOUR PERSONAL HEALTH & SAFETY!
wskon
DATE TIME
CITY OF PRIOR LAKE CkT —
INSPECTION NOTICE SCHEDULED
ADDRESS 3 GO� c��'�
OWNER CONTR.
PHONE NO. PERMIT NO. ��"' Oa ��
O FOOTING O PLUMBING RI ❑ EX/GRAD/FILtlNG
❑ FOUNDATION ❑ MECH RI ❑ COMPLAINT
❑ FRAMING O WATER HOOKUP ❑ FIREPLACE RI
❑ INSULATION ❑ SEWER HOOKUP ❑ FIREPLACE FINAL
0'FINAL O PLUMBING FINAL �G�1$L1NE IR TST
O SITE INSPECTION ❑ MECH FINAI ❑/��
COMMENTS:
� WORK SATISFACTORY, PROCEED
❑ CORRE AND PROCEED
❑ CORR CT W R, CALL FOR REINSPEC710N BEFORE COVERING
Inspecto Owner/Contr.
CAIL 447-9850 FOR THE NEXT INSPECTION 24 HOURS !N ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
uvs,ror,
DATE 71ME
CITY OF PRIOR LAKE
INSPECTION NOTICE SCHEDULED � 2 (
ADDRESS � b � ��(� ��"' � � �
OWNER CONTR.
PHONE NO. PERMIT NO. � - � �
❑ FOOTING � PLUMBlNG RI ❑ EX/GRAD/FILLING
❑ FOUNDATION O MECH RI ❑ COMPLAINT
O FRAMING D WATER HOOKUP � FIREPLACE RI
❑ INSULATION O SEWER HOOKUP ❑ FIREPLACE FINAL
❑ FINAL ❑ PLUMBING FINAL ❑ GASLINE AIR TST
0 SITE INSPECTION � MECH FINAL ❑
COMMENTS: �� � �` � CF'S �
�• ,
.
t
�a �, c`( � `. lK•: S.Q � rr
L� c
❑ WORK SATISFACTORY, PROCEED
❑ CORRECT ACTION AND PROCEED
� CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector. OwnedContr:
CALL 447-9850 FOR THE NEXT IIVSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTSARE FOR YOUR PERSONAL HEALTH dc SAFETY!
nvs�ron
DATE TIME
CITY OF PRIOR LAKE �/�
INSPECTION NOTICE SCHEDULED ( L
ADDRESS ,39 O � �p�,� �`� �,r
OWNER CONTR.
PHONE NO. PERMIT NO. (""' C��
O FOOTING � PLUMBING RI ❑ EX/GRAD/FILLING
❑ FOUNDATIOM 0 MECH RI ❑ COMPLAINT
❑ FRAMING ❑ WATER HOOKUP ❑ FIREPLACE RI
❑ INSUUITiON ❑ SEWER HOOKUP O FIREPLACE FINAL
0 FINA[. � PLUMBING FINAL O GASLINE AIR TST
❑ SITE INSPECTIOH ❑ MECH FtNAt ❑
COMMENTS:
06
� WORK SATISFACTORY, PROCEED
❑ CORRECT ACTION AND PROCEED
❑ CORRE K, CALL FOR REINSPECTION BEFORE COVERING
Inspecto Owner/Contr.
CALL 447- 0 FOR THE NEXT INSPECTION 24 HOURS tN ADVANCE.
CODE REQUlREMENTSARE FOR YOUR PERSONAL HEALTH & SAFETYI
�r,
oF PRlp� CITY OF PRII�R LAKE BUILDING PERMIT, Date Rec'd
� ,?� � TEMPORARY CERTIFICATE OF ZONING COMPLIANCE //, Z¢, �0
AND UTILITY CONNECTION PERMIT
U �
' C�7
���'NESD�P I Whrte Fde
2 Pmk �,� PERMIT NO. 07 Q Ob'
3 Yellow App6cant
Please e or rint and si at bottom)
ADDRESS ZONING (otTice use)
3 9 n� �+�r.. �o�T � � 2T
LEGAL DESCRIPTION (office use only)
LOT $LOCK / ADDITION f F �bnlD /4-�,f�.�?'�b�! PID Z� � U O , v
OWNER 1 ^
(Name) [..�V i �� / CLrt� /� . J O G! � (Phone) ��a' .� C2 �'' 7 f 'Ia
(Address) fj /�v2,u,,+c.IS�,�J y2�K E I
BUII..DER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK New Construction ❑Deck ❑Porch ❑Re-Roofing ❑Re-Siding ❑Lower Level Fimsh ❑ Fireplace
ddit�on ❑Alteration ❑Utility Connection �_.� ,/ r ��, �
CODE: ❑T.R.C. ❑I.B.C. ❑ Misc. � ���� � ��� ���
T�pe of Constiuction: I II III N V A B pROJECT COST/VALLTE $
Occupancy Group: A B E F H I M R S U
Division: 1 2 3 4 5 (excluding land)
[ hcreby certify that I have fi�mished mformanoq on this appLcanon which is to the best of my knowledge true and correct I also cernfy that I am the owner or authonud agent for the
above-mennon d property and that� constru ion will conform to all ex�snng state and local laws and will proceed m accordance w�th submrtted plans. I am aware that the bmldmg'
offic�al ca rev this perm�t for�tu6t c�use urthermore, I hereby agree that the c�ty official or a designee may enrer upon the property to perform needed inspechons
X S�� �/��r�`� �t�
re Contractor's License No. ate
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DiTE
This Applicarion Becomes Yoar Building Pernrit When Approved Paid Recei '
Date O , Q B
Buildm � Utlicial Date
Th�s is to cert�fy that the request m the above applicanon and accompanymg documents is m accordance w�th the City Zonmg Ordmance and m y proceed as requcsted Thts document
when s�gned by the Gry Planner consumtcs a temporary Cert�ficate of Zonmg comphance and allows construcuon to commence Before occupancy, a Ccitificate of Occupancy must be
issued
Planning Director Date Special Conditions, if any
24 hour notice for all inspections (9S2) 447-9850, f'ax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372
Residential Building Permit Checklist
New Construction for Single or Two-family Dwellings in R-1 or R-2 Districts
.
Reviewed by: � �� �, Date: a. �a �� 7
Building Permit # PID: � Zoning:
Address: ,� 9 a 7 � /�d.- �j.ti,,� �-, 1�1, (,�.) ,
Legal: L_�, B_�_ Subdivision: �CQ�t,o �lH�Q. 4�= D+��..
�/
Existing Structure? YES Existing Nonconforming Structure? YE NO
�
CONFORMS TO ZONING � YES NO
ORDINANCE
Yard Setbacks: NA 1 FAIL Standard Pro osed
• Front Yard can be 20' if av . wfin 150' 25' 30� ��
• Side Yards 10'/ r
25' if abutting a street � S b'�"- I� �
7S'
• Sidewall exceeding 50' requires additional side 2" 10' setback + � �
setback for eve 1' over 50' in len th 2"/1' over 50' ��� � g�`' '� S
• Rear Yard 25� �
• Patio Door: provide for minimum 10' deck or sign 10' sidel
statement indicatin no deck will be built in the future 25' rear .
• From 100 year flood elevation of wetland/NURP 30'
pond. 3 I � ' �
• Refer in- round ools to the Plannin De artment
• From OHW (Prior or Spring Lake) 75' or setback average of
adjacent structures, but no _ /'�
less than 50' N
Floor Area Ratio: NA 1 FAILS LI .30 Maximum o Z . Go ° 70
Yard Encroachments: NA 1 FAIL PLI Standard Pro osed
Eaves and Gutters no more than 2 feet in width and no
closer than 5 feet to a lot line Easements , d'v�
AIC and other equipment cannot encroach on interior �
side ards. d�`'' ��
Tree Preservatio . AILS 1 COMPLIES Standard Pro osed
• Total cali er inches
• Permit 25% Removal
• Cali er Inches Removed
• Cali er Inches Preserved
• Re lacement �z��
L:\TEMPLATE�BLDGLIST.DOC
Drivewa : NA / FAI PLIES Standard Proposed
• Maximum width at ro ert line 24' F
• Required setback 5' from side lot line or �
30' from r-o-w on corner lots �
• Maximum slo e 10% o 0
• All parking areas to be paved including R-V or
s aces ad'acent to the a�a e �0"�i--
• Location to match subdivision radin lan
Building Hei ht: NA 1 FAILS I COMPLIES 35' Maximum
Shoreland District: NA 1 FAILS / COMPLIES Standard Pro osed
Minimum lot area s uare feet 7,500 Ri , 7,999 Non-ri —~'
Minimum lot width 50' Ri , 57.3' Non-ri '"—
Shoreland alterations —
Im ervious surface �,f'`D —'—' 30% Maximum 3 Y . 7%.
S.¢� e,F,a-�..�' • ov� �4u.ow-�t •
Bluff in Shoretan NA' FAILS I COMPLtES Standard Pro osed
• Setback from top of bluff By planning dept.
. Bluff im act zone 20' From Top of Biuff
• En ineerin certification submitted/a roved B City Engineer
• Gradin in bluff or bluff im act zone No importin /exportin
Flood lai . N FAILS I COMPLIES Standard Pro osed
• 100 year flood elevation 908.9' Prior Lake
914.4' S rin Lake
• Lowest floor elevation 909.9' Prior Lake /
915.4' S rin Lake
• Proposed lowest floor elevation Must be 1' above flood
elevation for new and existing
structures. If existing
structure was constructed
9119190-11/22/97 then
additional foot is not re uired.
• Elevations 15 feet from structure Must be flood elevation or
hi her
• Road access must be no more than 2 feet below 907.9' for Prior Lake
Re ulato Flood Protection Elevation 913.4' for Sprin Lake
Accesso Structur . N AILS 1 COMPLIES Standard Pro osed
• Size 832 sq.ft. or 25% rear yard
• Not located in front ard Materials
• Side ard and rear ard setbacks 10'
• Maximum hei ht 15'
• Materials com atible with rinci le structure
L:\TEMPLATE�BLDGLIST.DOC
O � PRIp�
l
�' �x
U trl
- UI� 1
� ,� Canary - Engineering
^'NESO Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT VV Elvs� l��N �OM�S
APPLICATION RECEIVED Z.� T. D�
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
.39p7 7�i�. Po�� �i.
Accepted Accepted With Corrections ✓
Denied ..
� a/� l �o 7
Reviewed By: ���-�-� Date:
Comments: � Q� � . �y��� t
.
.
G�`ir ! -�-e_ � � L.�e?yc� .��('
~ �'+�-�`� �-� � . '
"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."
� -�------:��
. :,
�_-- --- n O� Pltlo�'
� l
� � �
U �
White - Buiiding
��NN�S�� a neer n�
nlc ann ng
BUILDING PERMIT ApPLICATION DEPARTMENT CHECKLIS7'
NAME OF APPLICANT � "� f r /'�' ti �' % � � /�� f � f "�I �- �l`�1( �. � �
APPUCATION RECEIVED _ � , / •-,� !� ` l �
! -
The Building, Engineering, and Pianning Departments have reviewed the bui(ding permit
application for construction activity which is proposed at:
.�.��' f'� �.� � TIC�'�-i t.�' � - � c / ��.- j - �'.._� .
Accep#ed _�_ Accepted With Gorrections
Denied
Reviewed By: Date: � � �7- O � ,
�-
Comments: S��everse Si�.ae fdr Additional Infvrmat
�
r �
�
� �
�
< �
' c�.� �d_+�Qr�,,,�,A„+ • ' � Plan, 2) �rosion Control Meast�re� �
... . . . �
t
"The issu�nce or r�ntin of a �
g g permit or appro�ral of plans, specifications and ,'
computations shall nat be construed to be a permit for, or an approvai of, any violation of
any of the pr�visions of this code or of any other ordinance of the jurisdiction. i�ermits �
. presuming to give authority to violate or cancel the provisions of this code or other ,
� ordinances �f. the jurisdictibn sh�ll not be valid."
. _ �
a
.
�
� , - _ O 4 PRIp�
�
ti �
U tr�
White - Building
P Cana - En ineering
'�`NNES°'� in - Plannin
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIS'[
NAME OF APPLICANT � -
APPLICATION RECEIVED `
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
Accepted Accepted With Corrections �/
"��"`"� "` Denied ..
� Reviewed By: ^ �ze—�-��'' Date: c�a--/ �a 7
Comments: ��� G�-Q ^ . N�
.�
. � ' . Q-t2ac..a. � _ o
.�t..y�� C:OT i
�ir COIIditiOIIer �d Other MecJf�unical
Side Yard Setba�cks
"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."
LIMITED WARRANTY DEED �'orm No. 21-1vT � � � �Nlinnesota Unuorm
Corporation, Partnership or Conveyancing Blanks (1/15/97)
Limited Liabitity Company to Individual(s) (Top 3 Inches Reserved for Recording Data)
DEED TAX DUE: $
Date: 11/24/2010
FOR VALUABLB CONSIDBRATTON, Central Bank
>
a Corporation under the laws of Minnesota
Grantor, hereby conveys and quitclaims to William D. John
,
Grantee, real property in Scott County, Minnesota, described as follows:
Lot 8, Block 1, Jeffers Pond Second Addition, Scott County, Minnesota.
� Abstract Property
together with all hereditaments and appurtenances.
This Deed conveys after-acquired title. Grantor warrants that Grantor has not done or suffered anything to encumber the
property, EXCEPT:
Covenants, Cvnditions, Restrictions and Easements of record, if any
Check box if applicable:
� The Seller certifies that the Seller does not lrnow of any wells on the described real property.
❑ A well disclosure certificate accompanies this document.
❑ I am familiar with the property described in this instrument and I certify that the status and number of wells on
the described real property have not changed since the last previously filed well disclosure certif'icate.
Central Bank
Affix Decd Tax Stamp Here By �2r/k i�sr�—
Zach McBroom
Its Asst Vice President
STATE OF MINNESOTA � ss By
COUNTY OF WASHINGTON
Its
This instrument was acknowledged before me on ��� Z 3 20 l � �
by Zach McBroom �an �
the Asst Vice President and �
of Central Bank
,
a Cor»oration under the laws of Minnesota �,
on behalf of the Coraoration --
NOTARIAL STAMP OR SEAL (OR OTHER TITLE R RANK)
HEATHER L. WHEBBE �
y Notary Public SIGNA � O NO ARY PUBLIC OR OTHER OFFICIAL
Minnesota�3' 2015
. �y�pmrrissio�ExPxes
Check he.re if all or paM of the land is Registered (Torrens) ❑
TFIIS INSTRUMENT WAS DRAFTED BY (NAME & ADDRESS): Tax statsments f� the reai p�uperty descn'bed in this inskument shovid
be sent W(include name and address of Grantec):
Custom Home Builders Title, LLC
10850 Old County Road 15 William D. John �
Plymouth, MN 55441
(763)489-3240
3907 Trail Point Court NW
File No: HB-20186 Prior Lake, MN 55372 �
o � QR � o � Date Rec'd
CITY OF PRIOR LAKE
� D x SEWER AND WATER PERMIT 'L l(� ��
I �
~ �Hnesa'��
� � File pERMIT NO.
2 Yellow City
3. Gold Applicant
Please or rint and si at bottom
ADDRESS ZOI�TING (o�'ice use)
r—
U� ��' � ' W
LEGAL DESCRIPTION (oflFice use only)
�
LOT BLOCK ADDITION -('��' o N N G��/ PID S- S�- ��� 'v
OWNER
(Name) (Phone)
(Address)
(Address) (City) (Zip Code)
APPLICANT > �
(Name) P/Y.J'/I'► y'/V/v ;��0/1�► t1' (Phone) <(!� �/ - ` /� ' y�a D
(Address) � /-� ��' Z � � /'' aN � .� 2
(Address) ( ' ) (Zip Code)
(Contact Person) /' (Phone) (0 /•2 � � �- 7l/ / �
APPLICANT SIGNATURE DATE r� �l`�� Ud
APPLICANT PLEASE COMPLETE BELOW
Size of water service inches.
Location of any couplings from structure feet.
Type of sewer pipe. � ABC � PVC � Cast Iron
Estimated length of sewer line feet.
Clean out (if required) located at feet from structure.
FEESCHEDULE
Residentiai sewer and water line connection $35.50 Industrial, Com'1 & Multi-family 1% of job cost with a$39.50 minimum
Sewer connection only $17.50 Water connection only $17.50
Estimated Cost $ Building Permit #
SEWER AND WATER PERMIT FEE $ � w
STATE SURCHARGE $ .50 /
TOTAL PERMIT FEE $ �'� •
�/
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid Receipt No.
� ^ �-�"' _—
2- Z. p 7 Date By
Building Official D te
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
FA��i��� ��1'F�1LEL PL11Iv�EIN�� � HEtiTING (51-452 ITUE? �. 13� 0? 15:42, �T, 15: �6 �'c?, 4060053���4 P 1
>
. O � YBIp .... �AtE �C'�
� ; CT ['Y OF PRIOR LAKE PL�MBIl�IG PERMTt
x _ -
. c�7 nr .
~ ��eo�`
,. �` �° �1 NO.
i c�e cxr
S. YNvr Abp�aat
a ' aadm atboaa� '
' ADDRF•SS � � / � .`` � i'Y`` �� • 1 � , �1 ZONING �� �)
� N .
�,�ec� z��sc�rtox c� � aL �r� . _
�,oT ar,oc� . .�nnzTto v �
o�vx� ��'�.m�r �n�e..s crn�a� �51 - 4�OC��`�1� t� �
(x • .�'�, o� �n �,'�1.,
,��� � ..� _ -
• APPI.YC.ANT�� Q' (Phonc) c�J���'�� � 5�7
��) � P�-)
� , ��Q, 1 � ` �� .
(Addrexs) �
� . � ) �'} � �� �)
�� �� � '�a�~ ��J�
(Cauiaa Petson) .
�� ���.� �A� °� 13 D
��r�c�v'.r r�co�r�B�.ow
Q��t9 '- 1y*pe r�f Fiartare ' , of I�atnre
• ga�r �tb wiih or wi 3�out owcr Ro ias
. ��� . _.. " .. . . w� H�
g! � � . ' st� s°'t�:`
. La.'�rai�nr5+ (Bathroam Sink) ' S`tgn Pipe (Washtan� Machsne) J ,..
ZYay (1 oP : comparlmeitt . Sowage Ejedtu
aa►ec S Bacl�lawAssembly .
Sinks . A.sseanbl Test _ �
Bar Siait - .. �p'�
W'ai�or Closet o ef � � • �� .
FFsE SG`gEDUL�
]adustrinl, Commcr�its! � Mu1Q-fami]y 1°� of job oost vuitii a S39.St! m�imaa� Resida►day, tscw Onc E� ltivo-Pamd7 599.50
� r.�, naa� � �u�� s�vso
E�no�l Cn: t S ' Bn7diug F<xmit# • ,
PLUMBItNG PF.RMI'T FEE � �''D WITFI :
� sra� svRCr�c;� $ � sa BUILDlNG P�RMIT
TOTAY, PERNaIT FEE � .
�otsm [r� 004) � � � .......�..-.�. -�— _ .. _--m----_ . .
'19�is iication Becomes Yonr BaiL limg peia�it'.W6ea A�proVed q.. No.
APP ', , d'' I, I 1''!� r ��
A ,
� ',_ tri
� ` AR 2 6 2007
�ua� o�ma� ' � � �
Za houuu � natire for Pu to�ead+niis t9sZ? aa7- so, Gs (952) 4a7-d24s . . .
16 t00 �agje G�eek'Ave, S.E, PrSar ` �-'�-- _
� r R j CITY OF PRIOR LAKE Date Rec'd
F �� HEATING/AIR CONDITIONING/FIREPLACE PERMIT 2, -�, /�
.. x
v �
�INNES��P '. P"''` F"e pERMIT NO. � /,�
z. c�n c�ty
3. Yellow Applicant � ��
lease or ' t and si at bottom
ADDRESS ZONING (ot&ce use)
.�� o � .��. / �, �, �- c �
LEGAL DESCR]I'TION (oflE'ice use only)
LOT BLOCK ADDITION PID
� �/' �/ J� �"� (Phone)
/
(Address)
APPLICAN /
(Name) �-E'�� �tt l ��� � � ` " (Phone)
�ACIt�I'eSS� � ✓ � [ �! R r . �CP1 ��c . �4'� `UYl S �i�.�� S�-6
( ddress) (City) (Zip Code)
(Contact Person) k/ �t G �, t �� �— (Phone) �f 2— eZ�'Td - Y�y�
APPLICANT SIGNA - �-- DATE � �
APPLICANT PLEASE COMPLETE BELOW
�NEW CONSTRUCTION ❑ REPLACEMENT ❑ ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
PLEASE NOTE: Air Conditioner
❑Warm Air Plants ❑ Steam Units and Fireplaces Cannot Encroach
❑Gravity ❑ Hot Water into Required Side Yard Setbacks.
❑ Mechanical ❑ Radiation
�Air Conditioning ❑ Special Devices Fireplaces with Box Additions or
❑Vent. System ❑ Other Devices Cantilevers to the Outside of Buildings
Require a Building Permit.
FIREPLACE MAKE AND MODEL
FEESCHEDULE
Industrial, Commercial & Mulri-Family 1% of job cost Residential, Gas Fireplace $49.50
$49.50 minimum
Residential, Heating & A/C (New Construction) $149.50 Residential, Additions & Alterations $49.50
Residential, Heating Only (New Construction) $64.50 Residential, AC Only $49.50
Estimated Cost $ Building Permit # � � �
HEATING PERMIT FEE $ � � � �, _
STATE SURCHARGE $ .50 � »�� �
TOTAL PERMIT FEE $ '��� v
(Oftice Use Only)
This Application Becomes Your Building Permit When Approved Paid Rece'
Date By
Buildin¢ Ofticial Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
lmpervious Surface Calcula�ions
'' � � (To be 5ubmitted•wit�h Bu�ding Permit Application}
For All Properties Located in the Shoreland District (SD).
The Maximum Impervious.Surface Coverage Permitted in 30 Percent:
Prc�p�rty Add�'ess _ �i�a � �l , foi�t� (�o�� �
Lot Asea ( N.A. – SEE TABLE fl ( N.A. – SEE "
) � Sq. Feet x 30% _ ..............
��*�������**���*�:�*�����:�:�����*��***��:�����**����*��•���*��****�������
. . .. LENGTH WIDTH SQ. FFET
� HO�J�`E X =
� x =
� ATTAC�D GARAGE X =
. TOTAL PRIlVCIFLE STRUC"I'[JItE ...................... J �$' �S
T�ETACHED BLDGS X �
{Garag�/Shed) X �
" `� TOTAL DETACSED BTJILDINGS .................s,�,.. ..
DRNEWAY/PAVED AREAS x Dn:►�w�l = S S•/� .
(Drivevva'y-paved or not) x /k d; = 6 S F
(s�dewa.ttc/Parlcing .�reas) x = �
TOTAL PAVED AREAS ......................................�.. �+� 5. f..
FATTOS/PORCHES�DECKS x �D�„� �, _
topc�n Dxks �° ►nin. o. _ 1.�0 S. F:
��g � X —
. bo�rids� witb a parvious � bclow, .
ar� �oc �as;de�d m tx imp�vto+ts) � p 2� ,� F•
� � X = '
TOTAI, DECKS ............:........................................... /��ISF
OTHER X = � .
. � _ _
� T V ii J�Y O�a iiiliY�1�H�N�NM�N�NN�NN�wNN�MN�N���N�Mr ---_
�'(}�C'AL I'MPERVI+4US S7JR�'ACE . ..--,, � j �,a�
tFNDER/OVER { N.A.. – SEE TABLE } _. —
,�
Prepared By ,�� � 4 wk�'nsan Date ?,l/t l�� .
� , .
, � Pioneer Engin.eering , phone # 6 S1-68i_Igj4
Lot S, Block �, JEFFERS POTJlS �-T �DTTTQ�t
� � LA DEPA.�TMENT OF
BIli�.DANG AND INSPE(�TION
� I� P TI
C N RE
ORD
SITE ADDRESS O7 �t�. OI lM ���
NATURE OF WORK � � 1�"it�11 � . .�
USE OF BUILDING •
PERMIT NO. o, oo DATE ISSUED o
CONTRACTOR N • PHON �,�.4 • �Z
NOTE: THIS IS NOT A PERMIT F4R AN OF THE INSPECTlONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
FOOTING f� C � "
FOUNDATION (Prior to Backfill) 3, u�.o'1
PLACE NO CONCRETE UNTIL ABOV HAS BEEN SIGNED
ROUGH - I S
SEVI��R / WATER / SEPTIC J�
FRAMING
INSULATION �
ELECTRICAL
PLUMBING ��� 6 ��3 �0 6
HEATING (if required)
FIREPLACE '
GAS LINE AIR TEST f j ii
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
t.,�.T �E" 0
FINALS
GRADING (Prior to Soddin )
8��11L.DING y
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.
FOR ALL INSPECTIONS (952) 447-9850 '