HomeMy WebLinkAboutBuilding Permit 12.0041 •
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OF PRlp� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
F. U em
AND UTILITY CONNECTION PERMIT /- � O. 12— em
4',xxesol° I. White File
2. Pink City PERMIT NO. /z 4/
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
/63 / C) — / A i i C 4 . C At IV .
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER / �/
(Name) D// +� / U� 5 g C �7X (Phone) 7 3Z . <I5 733
(Address)
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ['New Construction ['Deck ❑Porch DRe-Roofing DRe-Siding (Lower Level Finish ❑ Fireplace
DAddition ❑Alteration ['Utility Connection / `
CODE: I.R.C. I.B.C. ❑ Misc. WI t * .
Type of Construction: I II III 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 1 have 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 - mentioned property and that all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. 1 am aware that the building
officialiap revoke this permit jus taus F hermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
x�.1/l/�� err /— )d-'
S ignature Contractor's License No. Date
Permit Valuation (( UU o 00 Park Support Fee # $
Permit Fee $ 3 4 , , is. SAC # $
Plan Check Fee $ Water Meter Size 5/8 "; 1 "; $
State Surcharge $ ,S� 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 $ 4 S7) TOTAL DUE $ 8' 7
This Application Becomes Your Building Permit When Approved Paid fl el -
7 c eipt No. 6, tf`��
Date /'> ec).- (2
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
Baseiilent - Finis 11 • • I '1 • • ' • • ` : i r$omes
BY: -- Date: /. / L r Z
Building Permit # /Z 4 PID: Zoning:
Site Address / 63/ 0 T N
Legal: L B Subdivision:
Existing Structure. S r NO
CONFORMS TO ZONING / YE NO
ORDINANCE
YES NO
Is this an expansion of the existing footprint or Refer to Planning
building height? l/
Ls 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?
- - U
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:ITEMPLATEIALTCHCK.DOC • - •
o rRro� � CITY OF PRIOR LAKE Date Rec'd
, C 9 HEATING /AIR CONDITIONING/FIREPLACE PERMIT ! + /o r`
j�'NESD�P 1
2. Pink reen Fi i t ty e PERMIT NO. /Z
. G
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
16310 ti./ 4 Cr ,vi
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
(Name) . /la tli?.t d' �'' S4P�Px (Phone) f5 7 IS / 3
(Address) (6 3/o "Tai /2 Cr AA
(Name) � l �..Y� 2 (Phone) (Name) � p i - f4 6 ) Q / "So / 71S /331 /
(Address) 4g/0 u'4 i k Kr /V 4) P " (:k ' K2 , 372
(Address) (City) (Zip Code)
(Contact Person) f r' Ca i / (Phone) 1S 7 /1/33/
APPLICANT SIGNATURE ._ / i, , i i DATE / — f --- 0204.2
APPLICANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION ❑ REPLACEMENT ❑ 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 Fireplaces with Box Additions or
['Air Conditioning ❑ Special Devices
['Vent. System 0 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 #
HEATING PERMIT FEE $ FAID 13's(
STATE SURCHARGE $ .50 � � k ,
TOTAL PERMIT FEE $ N
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid �.
Date By
Buildine Official Date
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
�►EPARTMENT OF
P RIOR LAKE BUILDING AND INSPECTION
INSPECTION
RECORD
SITE ADDRESS /6,310
NATURE OF WORK / 0 6 -
USE OF BUILDING
PERMIT NO. 12 _ 4-1 DATE ISSUED / / • /2__.
CONTRACTOR PHONE 95z ; /-
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
1 1
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
--FRAMING 4 IA/a.
•--- INSULATION
1 ELECTRICAL
PLUMBING
HEATING (if required)
--FIREPLACE 9I) .0.0-?
GAS LINE AIR TEST 4 k
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
1 1 1
FINALS
UILDING
LECTRICAL)
LUMBING
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
i