HomeMy WebLinkAboutBuilding Permit 12.103 J
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OF PRic CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
4. TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
x AND UTILITY CONNECTION PERMIT 2 - 10. (Z—
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Ar1HNESOlt* I white File PERMIT NO. -
3 pink City / Z - / O3
3 Yellow Applicant `
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
11/1 7 Pre- /.-zip Ui ct /2 0
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) £ .D Z Y Z t _.. (Phone)
(Address) / `'f/ 7 t G km.1 e, 7212) T ,,' cA e " L c; 1 e...--(...._
BUILDER
(Company Name) 04 4. J L & ( CIS1 -8 U + l dC (Phone) 6o-- '1 S 4, S
(Contact Name) 7) h.') K-1 (Phone)
(Address) //d_.0 3 ,.,-, t k r— 1--rJ
TYPE OF WORK ❑ New Construction ❑Deck Porch ❑Re- Roofing ❑Re- Siding ower Level Finish El Fireplace
['Addition ❑Alteration ❑Utility Connection 3 ft/11f
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc. t// 61)-
Type of Construction: I II RI IV V AB PROJECT COST /VALUE $
Occupancy Group: A B E F HI MR S U (excluding land)
Division: 1 2 3 4 5
1 hereby certify that I have furnished information on this application which is to the best of my knowledge true and correct. 1 also certify that I am the owner or authorized agent for the
above- menttone roperty 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 o this permit for Just cause Furthermore, 1 hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X r'''r ,,VM / H' U � �'` ( YD-.0 ' v1. /� o /mil.,
/ Sig ature Contractor's License No. at e
Permit Valuation 3 060 Park Support Fee # $
Permit Fee $ I 7L/ 7 S SAC # $
Plan Check Fee $ Water Meter Size 5/8 "; 1 "; $
State Surcharge $ , ``C--4-) Pressure Reducer $
Penalty $ Sewer /Water Connection Fee # $
Plumbing Permit Fee $ 54 5 ) Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee I $ 4 t �'.-.-0 TOTAL DUE $ / S5 2.
G Z 7'
This Application Becomes Your Building Permit When Approved Paid / e5+ .t r eipt No. 6 5 0
Date a., i , .IA_ j 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 ay 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 Alteratioirto Single Family
BY: Date: '
Building Permit # t - , 03 PID: Zoning:
Site Address �/ 1(9 /7 &i7 //1.
Legal: L B Subdivision:
Existing Structure: YES or NO
CONFORMS TO ZONING 17 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?
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:ITEMPLATE\A.LTCHCK.DOC
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ttt0 CITY OF PRIOR LAKE ]Date Recd
' i" 4 u HEATING /AIR . CONDITION JNG /I'IREFLACE PER ' ' WIT
�IIT
��yD,�ti e. P1�I: =is I ...„:0„.„ [ c� .:�� coif PE It11�MYT 1'�10.�� •
lease t . or rime ind si.ra ac bottum
ADDRESS 14 I ZONING (office u se)
f
LEGAL DESCRIPTION (office u only)
LOT BLOCK ADDITION 1 ID
OWNER 1 -
(Na.ne) I . 4, : k it. , _ . A IAA . ... . ...1, r (Phone) -- 75 — & d r •
(Address) 4 L 1� , . , ' , c � � 1 / + `V t5s .3_
APPLICANT - _
(Name) _' . 0 t 1 1 c(.r t (Phone) �
(Address) 1 _ _ u o a 1 ir {. m `' )53_,, --
(Add ,,ss) (City) (Zip Cede)
(Cor►tac Person) r_ + .. (?hone ) D- ( � 7
APPLICANT SIGNATURE E' /`� . DATE _ : I • / /,�.
EICANT PLEASE COMPLETE BELOW 1 _
ENEW CON TRCCT ION Ej REPLACEMENT ❑ ALTERA' IONS
FURNACE MAKE AND MODEL U 1
FLUE SIZE RE 1 U'RN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR. POWER PLANT
PLEASE NO `E: Air Conditioner
DWarm Air Plants 0 Steam 'Units and Fir places Carin4t Encroach
❑Gravity �.
Q Me-ba.'tical 0 Radiation Hot Water into Required fade lard Setbacks,
❑Ai: Conditioning ❑ Special llwices _.• I ireplat wi? fox Additions or .
(went. Sys:cm ❑ Other Devices Cantilevers tt. the Outside of Buildings
Require a ]3ubi ding Permit.
FIREPLACE MAKE AND MODEL 1` 20 `t, <'>* - 50 -`.� i , G ..
FEE SCII -^ ■
. Industrial, COalinerciai & Multi- Family 1% of job cost residential, Gas Fireplace h $49,50
$49.50 miniritum
Residential, Heating & A/C (New Construction) $149.50 Rcsideutial, Additions & Aiceratiors 1 $49.50
Residential, Heating Only (Naw Construction) $64,50 Residential, AC Only I $49.50
1
Estimated Cost S Building ,Permit #
rl : m in.zc«lu Statutes C 3268.145
HEATING PI;ItMIT FEE $ [ t ��J " 5u :?, ;11AR OW tau be;,n clanged fur one
STATE SURCHARGE $ -1. year ct'leetive
TOTAL PERMIT FEE $ ; :. :; . ,sum -, e .a .,:. '.:.:.
(Office Use Only) .� •-� f'hc alit mum surcharl;c I'ar,: ' lixcd foe" pu•mit
_.. —, is', i, beginning July 1, 2010
This Application Becomes Your Building Permit When Approved Pa )` ueeipt No. I
Dale 1,. 1D WITH 1
i3ulldin_Ufficia! Da to _
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24 hour notice for all inspections (952) 447 -9S5O, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
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PRI0R DEP ARTMENT OF
TI
LA KE BUILDING AND INSPE INSPECTION
INSPECTION RECORD
SITE ADDRESS /1*17(4 ele -ENA q AD.
NATURE OF WORK 4 0W �� ,,;v ,
USE OF BUILDIN3 $ /'
PERMIT NO. Z /03 A TE ISSUED 2. 10
i , !L
CONTRACTOR , 4IICW®G�O WSTVM RDA( PHONE toil. 751. 621
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
I I
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING l
INSULATION
ELECTRICAL
PLUMBING
HEATING (if required)
FIREPLACE
GAS LINE AIR TEST
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I �
FINALS
BUILDING
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