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e $ PRj04, CITY OF PRIOR LAKE BUILDING PERMIT, , Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE • 1
< AND UTILITY CONNECTION PERMIT ��
1. White File
2. link City PERMIT NO. / / ` Q
3. Yellow Applicant /
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
/6 y` ? f t Ave S e " ft.ten. Lel r r v i d 5 3 — /2 iso
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION • PID Z5. 3Z9. 00 1 . 0
,y, /� 1
(Na me VAN 7 /'r /L',, e-ri CAse.4 - p (Phone) ! 5Z • �
��0' TJ7r/
� 1
(Address) /6 2/Lig /" QQ 'Li. ,4-v 5 4/a72- Lf "ke. mit 6'5%5 / . �J Z
(Comps BUILDER . C/ divl2. l C O �/ ?6 z • 965' 35gz-
(Company Name) � � /t'/�p' Lss (Phone /
(Contact Name) 4 5Gf/2�4 //9400if 521 /E7 (Phone) �ofz 31o. (�oi3
(Address) 9 eX GlrLSI a2.. &-t)b lft 300 ST Z is /'��R-IZ/l j MA/ 5
TYPE OF WORK ❑ New Construction ['Deck ❑Porch ❑Re- Roofing ❑Re- Siding ❑Lower Level Finish ❑ Fireplace
DAddition %Alteration ['Utility Connection '/
CODE: 0.12.C. DLB.C. j J Mist:: XI To4.01%' gent/ L
Type of Construction: I II III IV V A B
Occupancy Group: A B E F HI MR S U PROJECT COST /VALUE $ „- Q 0 0. 0 0
Division: 1 2 3 4 3 (excluding land)
I hereby certify that I have flunished 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 an existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official can evoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed ons.
inspe
X � el 2os9v/7� 1//‘ I/
Signature Contractor's License No. Date
Permit Valuation 5 0 Q 0 , .0 0 Park Support Fee # $
Permit Fee $ 1/ 7, 75 SAC # $
Plan Check Fee $ 7 to . 5¢. Water Meter Size 5/8"; 1 "; $
State Surcharge $ z 50 Pressure Reducer $
Penalty $ Sewer/Water Connection Fee ' # $
Plumbing Permit Fee $ 54- , s - 0 Water Tower Fee # $
Mechanical Permit Fee $ S l�_ SO
Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE ,i4/ , $
� 4�.,1 _ � vs 79
This Ap c. on : comes�tourBttildingPermit ' en proved Paid 305 Receipt yo. &4- Zf
1 I Date l/ H A By �,
! VIT, _ ` G
Building Official tr ate
This is to certify, . t . e request in the above application and accompanying documents is i n ord a with the City Zoning Ordinance and may proceed as requested. This document
"
when signed by e (' , P . er constitutes a temporary Certificate of Zoning compliance an alto construction to commence. Before occupancy, a Certificate of Occupancy must be
issued.
64. l I(
daman •
4 r Rjo CITY OF PRIOR LAKE Date Rec'd
H 1 9 HEATNG /AIR CONDITIONING /FIREPLACE PERMIT /0 , UM 3
4
aij N 1VEse. 1. Pink File
. Green City Date
NO /
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONIN (office use)
16LILIL1 Park AU
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER i-
(Name) 1 (Phone)
(Address)
(N P m ICAN S e.L ' i c tn d (1?'h ` ) C1a- g L1a — L /.SC
ame �J �r�K �C l (L i S ti � nq one
(Address) 13 -2 1 1 N �f 4 ' S J /I) e w R c h n( Wf .y 5L
(Address) (City) (Zip Code)
(Contact Person) f Je/c 1� 9 (Phone) C - q40 I - 5G ‘5— APPLICANT SIGNATURE _ r J D/�. 99../ DATE /6/a (� i
APPLICANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION ❑ REPLACEMENT El 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
❑Vent. System 0 Other Devices Cantilevers to the Outside of Buildings
Require a Building Permit.
L 6 *J Li J svPP "�iuti
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 ', ' ' 0
The Minnesota Statutes § 326B.148 Cost $ Building Permit #
"SURCHARGE" has been extended Ai D I3 y
until June 30, 2013, HEATING PERMIT FEE $
The minimum surcharge for a STATE SURCHARGE $ .50 t(� K
"fixed fee" permit is $5.00 TOTAL PERMIT FEE $ �..//
This Application Becomes Your Building Permit When Approved Paid Re j 1 1..
Date By i ,
Building Official Date i
I
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 All "
lr �r .
NATURE OF WORK . /I�.'1 TI��/L M Ik
USE OF BUILDING Air I D PERMIT NO. 4 " r ATE ISSUED f. i fa Lisz..e
CONTRACTOR ?.JTP P_ J. , .. PHON
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
011111.1.
1
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING Lf) ( P // / / //(
INSULATION
ELECTRICAL
PLUMBING
HEATING (if required)
MINIM ev ,-vim /�/4- ((//, /(
GAS LINE AIR TEST #.&& /2 ( t( /(/4'
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
1 1
FINALS
BU ILDING 4 2 lam,
ELECTRIC
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