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i of PRIO CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
i. TEMPORARY CERTIFICATE OF ZONING COMPLIANCE 4 Z Z 1/
AND UTILITY CONNECTION PERMIT
M l ' y' NESO °P i. White File PERMIT NO . / / z7e
3 Pink City ` <
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS l D"r� J 04 QJ ZONING (office use)
I L- 1 O I AV - " oC • k W \ efao
LEGAL DESCRIPTION (office use only)
LO'T/ /JBLOCK ADDITION /1(0/27701/000 PID ?�, /4 0 77, 0
OWNER ( 1
(Name) >eo qtr. Cam- Sc. "
(Phone)
(Address)
BUILDER
(Company Name) OAo... a . u„.) u„.) ,1 \; ..,.,,s ..,.,,s c s1-0 v (-o W rr `¢ S (Phone) �0 1 - dls 1- 9 ) SAO
(Contact Name) (Phone)
(Address) /'• 0. 3 0 X 5-S-- I ! Z KL..` YVW s s`3 c )
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re- Roofing ❑Re- Siding ['Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connection KMIsc. CODE: ❑I.R.C. ❑I.B.C. •a , 0 NU' '�'odri
Type of Construction: I II III IV V A B PROJECT COST /VALUE S Pi "" • ud
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 informati 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 -- stuction will c • . to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official can revoke this per Just cause. Fur . , ore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
x 00 3 //OW I)
Signature Contractor's License No. Date
Permit Valuation 1 900 Park Support Fee # $
Permit Fee
$ It. 15- SAC # $
Plan Check Fee $ Water Meter Size 5/8 "; 1 "; $
State Surcharge $ . SO 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 DUE E/frlA/e 4-,2,7 /1 $ 3 3
This Ap icati • • co s Your Building Permit en • pproved Paid 3 J • Z S Re ipt No. (g2,..1 2.----
2
K �41- 11 Date 6 2-, I ( B
Building • Dat
This is to certify that the request in the above application and accompanying docume is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by • • City •la , eonsut es a temporary Certificate of Zoning comp , ancc a , allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued
� �. A ..elI '' 27 It
anning Director Dat Special Conditions, if any
24 hour notice for all inspections (952) 447 - 9850, fax (952) 447 -4245
4646 Dakota Street Prior Lake, MN 55372
( 0 , , RI CITY OF PRIOR LAKE Date Rec'd
� Vo 4 . HEATING /AIR CONDITIONING /FIREPLACE PERMIT ,S , i/ „,tr,
.3,,,,,,, .1, NNFSO
2. G reen Cit 1 . Pink File PERMIT NO / / ��� ///
/ / �'�/
3. Yellow Applicant III ` (((///
(Please type or print and sign at bottom)
ADDRESS R ZONING (office use)
/b 0 � /� / tt f 11 r a oe -OC I R Ci ) /V k
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) (Phone)
(Address)
APPLICANT ,�
(Name) .. ,/ . _ c.. (Phone) 1 4 1/ 7 -,A,&
(Address) C� C�''/ -9�Sr7r1; .41v.3. ,� /,bg l~4VI`i4 M , s- i
(Address) (City) (Zip Code)
�---' a CC
(Contact Person) o _ • one) , 3. e ” :7 / 9
APPLICANT SIGNATURE W # ..— ft DATE .5 • d t
APPLICANT PLEASE COMPLETE BELOW
['NEW CONSTRUCTION ❑ REPLACEMENT .2 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
OVent. System ❑ Other Devices Cantilevers to the Outside of Buildings
Require a Building Permit.
FIREPLACE MAKE AND MODEL
FEE SCHEDULE
Industrial, Commercial & Multi- 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 # p (3
---
HEATING PERMIT FEE $ 1-)D 3J(__
STATE SURCHARGE $ .50 )�
TOTAL PERMIT FEE $ V
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid pHl I
Date / By iff
Buildinu Official Date I \ � L ;
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 f
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
P R I R LA K E BUILDING AND IN SPECTION
INSPECTION RECORD
SITE ADDRESS /( O4'-/ A(01Q7itAIO00 /ez.
NATURE OF WORK t /Sf/ BOA/US RO011
USE OF BUILDING /s / //--
PERMIT NO. 1/. Z- 98 DATE ISSUED ` -. z I 1
CONTRACTOR lingell GW ICU A S HO MES PHONE 64Z.. 25/_ 47. b
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
imear 1
1 1 1 1
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
go /WM NW
FRAMING
INSULATION S`4 /t/
ELECTRICAL
11011111111111111P
HEATING (if required)
eiNIENIME
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
1 � 1
FINALS
BUILDING 0/5 (( 4
ELECTRICAL l
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