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F PR / CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT '
/ 7 /0
4f11'NEs01P 1. White File
2 Pink City PERMIT NO. /0 003
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
3056 (_a�e �vQv� C' I vv/ e-r Lake- ..53 ?-
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
(Name) S — t v T to 1 GO TA 1/1 (Phone) I 2 _ I q t2 - (72—i
(Address)
BUILDER .
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction ❑Deck OPorch DRe-Roofing ❑Re- Siding Lower Level Finish I=1 Fireplace
❑Addition ❑Alteration ❑Utility Connection `
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III IV V AB PROJECT COST /VALUE $
Occupancy Group: A B E F HI MR S U (excluding land)
Division: 1 2 3 4 5 1
1 hereby certify that I have , furnished information on this application which is to the best of my knowledge taste and correct. 1 also tify that I am 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 accordan a with submitted plans. I am aware that the building
official can re ke this permit for iu caus Furtherpore, I hereby agree that the city official or a designee may enter upon the property to perform needed ins4ections. i
X 1 1 1 Ip
Signature Contractor's License No. Date
Permit Valuation 4000, - Park Support Fee # $
Permit Fee $ $, ZS SAC # $
Plan Check Fee $ - ' Water Meter Size 5/8 "; 1 "; $
State Surcharge $ Pressure Reducer $
Penalty $ Sewer /Water Connection Fee # $ \
Plumbing Permit Fee $ 5 0 . . Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $5 0 -. TOTAL DUE $ t 89 .Z5
This • . , 'ca ■i :ecomes Yo '' . • ding Permit When Approved Paid " cei.t No. S �-
j 1, 1I Date /. 1./0 I
I V, I . i( • 1 10
But ding Of '‘114111114 Date IF
This is to certify that c request in the above application and accompanyi documen , is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when sig• /. the 1 Planner co I temporary Certificate of Zon g compli. ce and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued
fi 10
Planning Director l ate Special Conditions, if any
hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street Prior Lake, MN 55372
Residential Building Permit Checklist
asement Finish or Interior Alteration to Single Family Homes
BY: Date: /9 id
Buildin Permit # /0, 0 03 Z PID: Zoning:
Site Address
3O5 LA /6 - mv6AI a—
Legal: L B Subdivision:
Existing Structu : YES r NO
CONFORMS TO ZONING YES NO
ORDINANCE
YES NO
Ls this an expansion of the existing footprint or Refer to Planning
building height?
Is the property located within the flood plain? Refer to Planning
Does the alteration include any additional kitchens? Refer to Planning
Does the proposed alteration include any outside Refer to Planning
entrances other than patio doors?
Is the proposed use of the finished space or Refer to Planning
alteration for anything other than a normal single ✓
family home (office, group home, day care, etc.)?
THIS CHECKLIST MUST BE COMPLETED AND INCLUDED IN THE BUILDING PERMIT FILE TO
MAINTAIN A RECORD OF THE REVIEW.
L : \TEMPLATE\ALTCHCK.DOC
PRIOR LAKE BUILDING AND INSPECTION
RECQRD
INSPECTION
SITE ADDRESS 3 SO L,- w� C�
NATURE OF WORK FiNIis Lo Ld - c_
USE OF BUILDING Res A. •
PERMIT NO. /a - 3Z DATE ISSUED I ict/a
CONTRACTOR SrevG �«� "i"J • P ONE 44D -/
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
1 e. 1 1
f1 (Prior to Backfill) 1 1
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
" ER:/ EPTIC
FRAMING lo(
INSULATION
ELECTRICAL
PLUMBING
HEATING (if required)
FIREPLACE
GAS LINE AIR TEST
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
1 1
FINALS
fjior to Sodding)
BUILDING I /2
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