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PRtp CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE Q
> AND UTILITY CONNECTION PERMIT S . 3 * f Z
dj NNE so le* t. White File
2. Pink City / / PERMIT NO . '�'
2 _ 8 0
3 Yellow Applicant ffff VV
(Please type or print and sign at bottom)
ADDRESS C ZONING (office use)
I6 —� PQr>� •� - v12 �
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
(Name) i 4. C e • ed O (Phone) (3 $`Z,' S — Z 666
(Address) /G 3 s" i JC ,4 S a
BUILDER (� J�
(Company Name) ���Z�� I t �c S''{T�. (Phone) 9'S" ?. 2 �yA
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(Contact Name) ✓� Ge . f) (Phone) 9 S. - 2 -.Q) - 3 4d.
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(Address) / �/D Q E _ Mc., ^.S- /JJ T" e.c. v -� A-_ Ss
c> v e - , e>R s -R a -e-GK. - e... Pee40.435 wew42- s i z-ei .r-c Pare - k., c sumo% V`
TYPE OF WORK jrNew Construction ( 9eck xorch ❑Re- Roofing ❑Re- Siding ['Lower Level Finish ❑ Fireplace
['Addition ['Alteration ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III IV V AB PROJECT COST /VALUE $ 2 -8 ch:=)•n,
Occupancy Group: A B E F HI MR S U (excluding land)
Division: 1 2 3 4 5
I hereby certify that I 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. I am aware that the building
officia woke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspc Lions.
X *S - ._ _ (7°0 1I I S 3 1 3 ) 1 Z
L S ignature Contractor's License No. Date
Permit Valuation 1000- -- Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ M Water Meter Size 5/8"; 1 "; $
State Surcharge $ _ 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 edz4,0 b. 13,.12____ $ '? -' ,
This A ..cat B mes Your : uilding Permit When Apprt , e , Paid • aC / Receipt No G.aG.a 6 c7 IV
II C.
Date , f )- -- By " P : z r -----
� L
1 _ . 7
Bui im_ Tictal • irate
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 co stitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must he
issued i' G! - 7 -42
P lanning !Vector 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
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White - Building
yl �� Canary - Engineering
^'NESO Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
RECEIVED / '
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is pro osed at:
'4-.,, _ V
Accepted Accepted With Corrections
Denied
Reviewed By: Date: g "! >—
Comments:
"The issuance or granting of a permit or approval of plans, specifications and
computations shall not be construed to be a permit for, or an approval of, any. violation of
any of the provisions of this code or of any other ordinance of the jurisdiction. Permits
presuming to give authority to violate or cancel the provisions of this code or other
ordinances of the jurisdiction shall not be valid."
2012
PROJECT VALUATION WORKSHEET
ADDRESS: (�3SJi�(1 -,� A
SINGLE FAMILY ATTACHED:
1 Floor Wood Frame $84.85 X =
2 Floor $42.43 X =
SINGLE FAMILY DETACHED:
1 Floor Wood Frame $92.94 X
2 Floor $46.47 X =
GARAGE:
Wood Frame $39.23 X
Slab On Grade Garage $20.00
BASEMENT:
Completely Finished (New) $25.00 X =
Unfinished $16.50 X =
Crawl Space $16.00 X =
3 Season Porch (unheated) $45.00 -- 3 3. r. 2 ,=‘ -?=. (s
Screen or covered Porch or stoop $30.00 X =
Deck 12.00 X 5 )c ; 4-o = 4o
FIREPLACE:
Masonry Single $7,000.00 X =
Stacked Masonry $5,000.00 X =
Gas or "0" Clearance E.A. $3,000.00 X =
Other X =
TOTAL VALUATION c'„
CONTRACTOR'S VALUATION
UPDATED 6 / 22 / 2012
J:\FORMS\PROJECT VALUATION WORKSHEET 2012.doc
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DEPARTMENT OF
P BUILDING AND ' ECTION - II
INSPECT 07,
REC.. _
SITE ADDRESS / ' "t A I'•E.
TYPE OF WORK . Pa ,' j t) e —
USE OF BUILDING
PERMIT NO. vice -r '; D' E ISSUED 9,, 2 12..
BUILDER 9 :7 / ,, ' : /Los. PHONE # 7R. Z$4.Z.
NOTE: THIS IS NOT A 3a F RMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT BY SEPARATE DOCUMENT
INSPECTOR DATE
FOOTING
PLACE 0 CONCRETE UNTIL ABOVE HAS BEEN IG ED
FRAMING ; . 6 t' �, f P411 c 7. / i_
I
FINAL _ i'/. /e E
FOR ALL INSPECTIONS (952) 447 -9850
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