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o f re�o CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd A TEMPORARY CERTIFICATE OF ZONING COMPLIANCE // Z (1
AND UTILITY CONNECTION PERMIT /'
4iA'NESO :P I. White File PERMIT NO
2. Pink City 0 Uv Z-'-'
3 Yellow Applicant ,
(Please type or print and sign at bottom)
ADDRESS /� ZONING (office use)
(7 - � .? N i, ( 1, F-)c / -
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER - U
(Name) I) r`^ 'j (-1-,,, AIL C `111" (Phone) ( 7 S 4 l 1 17 -- CS''
(Address) / 7 ? S:7 J'Is r S L e i# 1&/L P (N/' I e k l_
BUILDER -
(Company Name) pit i tsL. {1,,hl, (Phone) (tic r a PI "/ 22 3
(Contact Name) AND (Phone)
(Address) 1 I v if 1f t S S P Am L Al n/ S
5 S
TYPE OF WORK ❑ New Construction ❑Deck ['Porch ❑Re- Roofing DRe-Siding ❑Lower Level Finish ❑ Fireplace
DAddition er ation ['Utility Connection
CODE: I.R.C. ❑I.B.C. ❑ Misc.
Type of onstruction: I II III IV V AB PROJECT COST /VALUE $ 9/ O JU
Occupancy Group: A B E F III MR S U
(excluding land)
Division: 1 2 3 4 5 1
I hereby certify that 1 have 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 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
official can revo this permit for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X / Z04 LG 51 S / / -2f /o
Signature Contractor's License No. Date
Permit Valuation J _ Park Support Fee # $
Permit Fee $ 1 3 - •, SAC # $
Plan Check Fee $ 41 111 Water Meter Size 5/8 "; 1 "; $
State Surcharge $ ( ( _ Pressure Reducer $
Penalty $ Sewer /Water Connection Fee # $
Plumbing Permit Fee $ 5 4 , S v Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee I $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE ak p� `113 $ /71-
_ c- - VUt,U 0 V ! 9
This A do ecomes Your Building Permit W n Appr ved Paid 1 ' Receipt No.
Date ( y.
t ! t 1 '70 ( o
' Buildin_ ate
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued.
Planning Director Date Special Conditions, if any
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street Prior Lake, MN 55372
°/ Y RIp Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
j NNESD � ¢
1. Gol Blue File
2 PERMIT NO
. Gold City / �-
3. Yellow Applicant
( Please type nr print and sign at bottom)
ADDRES ZONING (office use)
/7 Z . 'Z- / / L// .
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) (Phone)
(Address)
ame d Ii f ,/ 1 -L (Phone) 7623 - ,0 C- 679W
/
4 1 Address) / 4 / 9 bg 297` // i e6e /( (/f NA) ,C.? -7e'
(Address) (City) (Zip Code)
e t ontact Person) / c? N fW.0 r fP /c9 (Phone)
`
• • LICANT SIGNATURE DI f — -)
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough -ins
Dishwasher Water Heater
Floor Drain Water Softener
Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
Laundry Tray (1 or 2 compartment sink Sewage Ejector
Shower Stall Backflow Assembly
Sinks Backflow Assembly Test
Bar Sink Lawn Sprinkler
Water Closet (Toilet) Other
FEE SCHEDULE
Industrial, Commercial & Multi- family 1% of job cost with a $49.50 minimum Residential, New One & Two - Family $149.50
Residential, Additions & Alterations $49.50
Estimated Cost $ Building Permit # 1 0 EV
PLUMBING PERMIT FEE $
STATE SURCHARGE $ .50 - ,
U
TOTAL PERMIT FEE $ 1 (..... 0 c ?k____ /
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid Receipt No.
Date By
Building Official Date
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
PRIOR LAKE BUILDING AND INSPECTION
INSPECTION RECORD
SITE ADDRESS .12 L 2- MA,' 14 r- i 6 LA-
NATURE OF WORK ;.
USE OF BUILDING 1 2 -e . c A
PERMIT NO. (ADDL. { DATE ISSUED L L 13c
CONTRACTOR — 551 `t z6> PHONE 425/-2- 3
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
MOOTING 1 1
I 41011NDAFIGN (Prior to Backfill) 1 1
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
Spa A TER -LSEE T4C
FRAMING f 14/1(1
1
ELECTRICAL
PLUMBING /)()))0
I4 G (if required)
SUIERIOCE
fillitatint AIR TEST
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
1 1
FINALS
OPEEADSIG (Prior to Sodding) _
BU LDING li 121)10
ELECTRICAL
PLUMBING
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
/ ° \ 0
Closet
Bedroom
Augustana Therapy Services Title: Lori Albright
Existing bathroom plan
h j For Concept Only
i
ACCESSS LLkT1 NS Sheet #�
° r Scale: 1/4" = 1'0"
' 1007 E. 14 Street Minneapolis, MN 55404 Ph 612.238.5429 Fax 612.339.3085
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Roll -in
p; +d, ci,.,c k Shower Full fi
S1a. - 4t,c'R.rLin height > ,
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�,� .1 .14 ' cbt � � 1Z
�`/ r` �'""^ 6- ''''' Open Below N�°
Closet
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_ ■ / 3068 �y
1
Bedroom
CflYOFPR PRIOR
BUILDING P:" ; T PLAN REVIEW
t
INSPECTOR s ��-
DATE ' . 0 (:) PE 'fkilli .
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❑ ACCEPTED AS SUBMITTED separat permits are required
O ACCEPTED WITH CORRFC;TICTN, AS NOTEi f ®r • Pia
❑ NOT ACCEPTED-CORREC 1 8 Ki St li3MlT I .
These comments are for your informati n ; Ain shall be dor a . , - • • ,
in full compliance with all applicable b; llIdp ig zoning code r a
iuirements including items not specifically noted in this revi� Electric c� � e
KEEP THIS PLAN SET ON SITE AT Ai L TIMES
0 Augustana Therapy Services Title: Lori Albright
Modified bathroom plan
AC N cS For Concept Only
Sheet #: 2
Scale: 1 /4" = 1
1007 E. 14 Street Minneapolis, MN 55404 Ph 612.238.5429 Fax 612.339.3085
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