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4-°______ PRI �
CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE 4. l
y
tri AND UTILITY CONNECTION PERMIT ' `/rrNNES
1. White File
2. Pink City t PERMIT NO. ii . z78
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS , (office use)
li3 WILDERPJtS.$ i RL SE I R1vR LAKE
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER MAC "JRM G%1 °t £ 't L`( 95a` a r d
(Name) 1 (Phone) l/ rn r �✓
(Address) () ,1:73 l) l L-D ER N E5 5 - L se 1° R 1° R L A k E
BUELDER S" S as a. '9R6 (o53
(Company Name)
3€.1-€ ( L I C E +� D (Phone) 9S
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction ❑Deck ['Porch ❑Re- Roofing DRe-Siding Lower Level Finish ❑ Fireplace
❑Addition DAlteration ❑Utility Connection
CODE: .R.C. ❑I.B.C. ❑ Misc:
Type of Construction: I II III IV V A B (` 1 �J (� S o. o /�
Occupancy Group: A B E F H I M R. S U PROJECT COST/VALUE $
Division: 1 2 3 4 5 (excluding land)
I hereby certify . . ave 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 - mentio :. . � d .. at 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 r site .' •F"1, y� ns 1∎ just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspectio
X
Signature Contractor's License No. Date
Permit Valuation 4-000 -- Park Support Fee # $
Permit Fee $ e . Zy SAC # $
Plan Check Fee $ Water Meter Size 5/8 "; 1 "; $
State Surcharge $ Z — Pressure Reducer $
Penalty $ Sewer /Water Connection Fee # $
Plumbing Permit Fee $ 4 5° Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other �s/���. �,/ $ / �^'
Gas Fireplace Permit Fee $ TOTAL DUE CAr(.tea" ZZ • ii ! $ /4-3. 7
This Ap . ,•. 'o• t mes Yo . : I ding Permit n Appr J ved Paid /4,3 7,5
Date 4-, t4 � j/ ReC pt No. GL=��/
A / 4 B J
di ! • •.l Date
This is to certify that the request in .. e 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 Lion 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 S.E., Prior Lake, Minnesota 55372
Residential Building Permit Checklist
Baseme Fin' i : - • Alteration to Sing Fa ily Homes
BY: 4 14 Date: f
Building Permit # ID: Zoning:
Site Address 11 (`d
3 eSs T
Legal: L B Subdivision:
Existing Structure: YES or NO
CONFORMS TO ZONING YES NO
ORDINANCE
YES NO
Is 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? i
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.D OC
p Rt0 Date Rec'd
4, CITY OF PRIOR LAKE PLUMBING PERMIT
., . 4 i f. , :5; it:c.
2.
i. BGoW Cdy ,7 Pile PERMIT NO. l ( . 2W1
3. Yellow Applicant
(Please type or print and sign at bottom) _
ADDRESS ` ZONING (office use)
f1 al3 \-,)'‘ Uc -cAFSS T.- 1 . S i, Pry Lake
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
( O Na WNER C r 0. • . k r , ` t o MQ; W v r N. (Phone) 9 5 4 2. 22 6 C s 3 0
(Address) fl'-3 W l de.-r'`Css I r k S C. pr--.r L i /'` ``l .5537A
APPLICANT ()_) p (Name) �c -dor -� P L L (Phone) lSa q aa'•tia
p I
(Address) 1 L G Q• t'c t, L. ( s,$ oy 9
3-0k, (Address) (City) (Zip Code)
(Contact Person) ) C ` ^ d'° r (Phone) 9 5 a q9 9 a a o a
APPLICANT SIGNATURE \ \ - s V. \ `.
, �\ DATE LQ - 1 - 1
I li
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 OT 2 compartment sink Sewage Ejector
I Shower Stall Backflow Assembly
Sinks Backflow Assembly Test
I Bar Sink Lawn Sprinkler
i 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
I Residential, Additions & Alterations $49.50
The Minnesota Statutes $ 32613.148
" Est $ 1 as 0 , e o Building Permit # i I • X 6
"SURCHARGE" has been changed for one D � � j � '
year effective PLUMBING PERMIT FEE $ 'vl
July 3, 2010, until June 30. 2011. STATE SURCHARGE $ .50
The minimum surcharge fora "fixed fee" permit TOTAL PERMIT FEE $
is IS, beginning July 1, 2010
This Appli on ∎ .. nr BniI Z ing Permit WheiyA roved Paid Receipt No.
li'
_ 4.. It �� 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 BUIILDRNG AND INSPECTION
INSPECTION RECORD
SITE ADDRESS x - 72 73 -F)( A SS l 1
NATURE OF WORK F"I ti s 1t �--��
USE OF B U I L D I N G
PERMIT NO. I L Z1 DATE ISSUED 1 Z % / I
CONTRACTOR C-g�+v I1t.Qi � U2ov1 PHONE 151 -
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
1
- FOtJNBAT ON (.Prior to Backfill) 1
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
SEWER i WATER i SEPTIC
FRAMING 71-0
INSULATION
ELECTRICAL
PLUMBING
HEATING (if required)
Uc7 K, P.
GAS LINE AIR TEST F
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
1 1
FINALS
—GRADING-(Prior to Sodding)
BALDING '/ j I I
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