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ri CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
_. TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT / - / , I I
R1
Mi A'NE SO I. White File PERMIT NO. ^
2. Pink City // O tJ '�
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
1 ' t 76 thDpfld FOND TR_
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER > /
\� (Name) V /T /3j LL (Phone) G /SL -2 2C - 3 ? (o
T (Address) q/76 I /iDDew Po niy 7 ?.
BUILDER
mpany ) P / / 1 /AJ (Phone) 6/Z - `l 01
(Company Name) (P hone
\. Q
(Contact Name) t3O L (Phone)
(Address)
TYPE OF WORK ❑ New Construction ['Deck [Porch ❑Re- Roofing DRe-Siding sower Level Finish El• Fireplace
\ ['Addition DAlteration ['Utility Connection
1 - CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II MN V A B PROJECT COST /VALUE $ r D/ 0 0
Occupancy Group: A B E F HI MR S U
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have furnished information on this application which is to the best of my knowledge true and correct. I also certify that 1 am the owner or a thorized 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 a re that the building
official can revoke t . permit for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspection
' x i( ( fi t
Signature Contractor's License No. Date
Permit Valuation 2i 0 0 0 ., co Park Support Fee # $
Permit Fee $ & 2-, ZC SAC # $
Plan Check Fee $ Water Meter Size 5/8 "; 1 "; $
State Surcharge $ l U 0 Pressure Reducer $
Penalty $ Sewer /Water Connection Fee # $
Plumbing Permit Fee $ ,51 5-0 Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $ ;,
Gas Fireplace Permit Fee $ ,..5-i- sD TOTAL DUE $ /72 7 : , 5 -
This Application Becomes Your Building Permit When Approved Paid /72._ , 2 S"
ceipt No. 6 �3e
Date /, 3 /. (I
Building Official Date
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
Residential Building Permit Checklist
Basement Finish or Interior Alteration to Single Family Homes
BY: Date: ///
Building Permit # //, d 6 4. PID: Zoning:
Site Address 47 7? , P J
Legal: L B Subdivision:
Existing Structure: YES or 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
INSPECTION RECORD
SITE ADDRESS 4-1 2 ep 117 Od LAI P °AJD
NATURE OF WORK L4tn/bk (,61/CZ --
USE OF BUILDING 9//z --
PERMIT NO. 1 / _ 00(o DATE ISSUED /. (/
CONTRACTOR Yf PHONE
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
1.50
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
c ,
FRAMING C F Z v /
INSULATION
ELECTRICAL
PLUMBING
HEATING (if required)
FIREPLACE •
GAS LINE AIR TEST
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
( � I
FINALS
g)
BUILDING Z .
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