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rip Rjop CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
ti , TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
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tire...,,. AND UTILITY CONNECTION PERMIT " �'
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City /
. pick i PERMIT NO . C- + / 3
3
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
/('& 1 H/qwkr(1ij . C it-r
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION ND
(Name) C(1.W kW V /V'(l / C"l 0 /Ut J (Phone)
(Address)
BUILDER
(Company Name) al ktic/r;(if Ito" t f (Phone) 6 .57 ( 1 6 3 1 c L `l O
(Contact Name) 3 /1 .4` rn ft- (Phone) l TL Zq L. 0 9 (p /
(Address) 3 (0 3s- 3'r {- /Gt., ( A ) ID 0 51.5 .
TYPE OF WORK 0 New Construction ❑Deck [Porch DRe- Roofing DRe- Siding Xikower Level Finish 0 Fireplace
DAddition DAlteration DUtility Connection
CODE: DLR.C. DLB.C. 0 Misc:
Type of Construction: I II III IV V A B f Z! s ---- 0 0
Occupancy Group: A B E F H I M R S U PROJECT COST /VALUE $
Division: 1 2 3 4 5 (excluding land)
1 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 1 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
official can revoke this permit for just cause. Furthermore, I hereby a{itee that the city official or a designee may enter upon the ptopcxty to perform needed inspections.
x Dc_ 67t 3 Z s 11— (..... 0,..... Si tor Contractor's License No. Date
Permit Valuation • 3 , 00C, Lj 0 Park Support Fee # $
Permit Fee $ -74. 7,"' SAC # $
Plan Check Fee $ - Water Meter Size 5/8 "; 1"; $
State Surcharge $ / SO Pressure Reducer $
Penalty $ Sewer /Water Connection Fee # $
Plumbing Permit Fee $ 5 5-0 Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE (� I/ j /5 $ / 3 0 „ .7....
This Application Becomes Your Building Permit When Approved Paid /30 77
, eipt Nt 10
Date /1. "7 ; t! Z—
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 S.E., Prior Lake, Minnesota 55372
BUILDING PERMIT #
P.LD.#
CITY OF PRIOR LAKE
SINGLE FAMILY WORKSHEET
NAME OF GENERAL CONTRACTOR: C 6-4 14'/V/
ADDRESS OF PROPOSED PROJECT: ( �p `f 6 7 /4 4W lc r? d d S
SQUARE FOOT FLOOR AREA
FIRST FLOOR (INCLUDE 4- SEASON PORCH AREA)
SECOND FLOOR
BASEMENT FINISHED P
BASEMENT UNFINISHED 2 Q 7
GARAGE
DECK
3- SEASON PORCH
SCREEN PORCH QQ,
NUMBER OF FULL BATHROOMS 3/14 W�CJ� � 1 0 i-
NUMBER OF HALF BATHROOMS
SEWER AND WATER CONTRACTOR: /(f A
NAME PHONE #
NUMBER OF GAS FIREPLACES:
INSTALLER:
NAME PHONE #
NUMBER OF WOOD BURNING FIREPLACES:
INSTALLER:
NAME ` PHONE #
MECHANICAL CONTRACTOR: kt ' c- C ` C ,'A'�'` + c' ( 2 " 7 Z' 0 G 6 0 k
NAME PHONE#
FURNACE: CHECK ONE: n YES ❑ NO
AIR CONDITIONER: CHECK ONE: ❑ YES ❑ NO
AIR To AIR EXCHANGER: CHECK ONE: ❑ YES n / NO
PLUMBING CONTRACTOR: Pld ci rG t ?Go °`� r J V f CP I Z- cif 3 , L (rs
NAME PHONE #
WATER METER SIZE: CHECK ONE: hi- 5/8" (STANDARD)
1"
9 1 72
❑ 2"
'"THE CONTRACTOR HAS VISUALLY INSPECTED THE SIDEWALK AND CURB AND THERE ARE NO CRACKS.
❑ THE CONTRACTOR HAS VISUALLY INSPECTED THE SIDEWALK AND CURB AND THERE ARE CRACKS IN THE
SIDEWALK n CURB
ATTENTION APPLICANT: YOUR BUILDING PERMIT APPLICATION WILL NOT BE ACCEPTED UNTIL ALL REQUIRED INFORMATION IS
COMPLETE.
C:\Documents and Settings\HP_Administrator\Local Settings \Temporary Internet Files \OLK2DO \Single Family Worksheet.doc
A
PRIOR LAKE BUILDING EPARTME AND INSPECTION
INSPECTION RECORD
SITE ADDRESS /4447 Mt of
NATURE OF WORK L OWEF L•i` L•
USE OF BUILDING RBI ,/..
PERMIT NO. /2 023 DATE ISSUED it Sp 12.
CONTRACTOR etingi PHONE &57. ' Lr3
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
I OEM
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING
/ J�
INSULATION /� J
ELECTRICAL
PLUMBING
HEATING (if required)
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
1 1
FINALS
BUILDING iz �2 0
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