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4 PRIOR
CITY OF PRIOR LAKE BUILDING PERMIT, Date Recd
�
N1 TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT 6./4----. I Z---
4 "1' 47
1. White File
2. Pink City / ! PERMIT NO . �y
z y (�' ( vvv j 0
3. Yellow Applicant �!/
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
I (o S 0 PMT (. se, pr\ o T l,fA.Ke ILEA/ 5c3 0-
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID r
OWNER �CIl q,j -a o -ac7Q
(Name) Mo.r is 1:1./t/ P n (Phone)
(Address) /k, 57 / AM & 1 ✓' . S c r Tr 1 D / L e
U , / V �S 37 U`
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re- Roofing ❑Re- Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connection • .P1
4'r
E } y /4 fd R 14 l !s •
CODE: DI.R.C. �LB.C. XMisc: A54 -c .11 .,
Type of Construction: I II III IV V A B /
Occupancy Group: A B E F H I MR S U PROJECT COST /VALUE $ // D 0 O --
Division: 1 2 3 4 5 (excluding land)
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
official cfrF
tht fo • st caus rth e, hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X can 6 a 19-
Signature Contractor's License No. D
Permit Valuation , , Park Support Fee # $
Permit Fee $ 4 I . Z .- SAC # $
Plan Check Fee $ 2 ,�� Water Meter Size 5/8 "; 1 "; $
State Surcharge $ - S p 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 $ (ogj 5c,
This Ap anon : i ' es Your Building Permit R'he Appr ved P aid Recei t No. � j]J)/
/ Date /�jy / Z� By � (4_
.. , ( (z-
Buildin. ! :m I _ — ate
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. Separ• ten
A %'" ,9 .5 - d f r►n!t refu'rel 'fir �xL'terdor M.
PI: ' :,- 'rector 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
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CITY OF PRIOR LAKE
BULOfl13 - 1 r � PLAN REVIEW
INSPECTOR -- .,...,,..
Separate permits are required NOE ; t y- f z ‘c29
for CJ °�. t .
. _ _ . _ 0 Ac EPIC' M� r� `TIoNs AS NOTF'
• $ e - *7 ;•• ' ! t ry
4 ' l..! NOT ACCIPTEINCOOlea t RES!)tNHT
Electrical, ete. Theowansaisielbluribuillm At wne 41.44 be do
Fr(2c ,?,a��SSl�N tc� ilulea ra NON haft az coder,
A/660 61D �111���,M�s NM 10111021114/ Wed hi this mule
Niiraiiilial WON SItEAT L TIMES
f2le
SERVICE FIRE PROTECTION, INC.
THIS AREA EQUIPPED WITH:
WET SYS. DELUGE VALVE
DRY SYS. [J RATE OF RISE VALVE
ANTI - FREEZE
THERMAL CONTROL
VALVE El
PRE - ACTION El OTHER TYPE
VALVE.
; VALVE
C c �_ " 1st 2nd 3rd 4th
VALVE SERIAL NO.
STATIC WATER P.S.1. �x
RESIDUAL WATER P.S.I. 620
DID ALARMS OPERATE?
AIR PRESSURE
AIR PRESSURE
TRIP POINT
TRIP TIME (SEC.)
WATER FLOW TIME (SEC.) (
LOW POINTS DRAINED , -
WATER SUPPLY &
VALVE LEFT OPEN i&
LOW AIR ALARM
NO. LOW POINTS
TO BE DRAINED:
INSPECTION MADE AND WITNESSED BY
DATE& INSP. # MADE BY WITNESSED BY
/-/40--/3
DEPARTMENT OF
P RIOR LAKE BUILDING AND INSPECTION
TI
INSPE N RECORD C O
SITE ADDRESS /(5 // ANNA ••
NATURE OF WORK r11411 /S#t
USE OF BUILDIN
PERMIT NO. s D L E ISSUED fr •
CONTRACTOR r /77.-1 PHONE 2 2.0 � 0
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BEL W
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
1 1
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING pa' ‘9/7/4
ELECTRICAL
MOM
HEATING (if required) (,,) � (24 (P(7
COVER NO WORK UNTIL ABOVE HAS BUN I NED
10 1 1 i4 1 (4
FINALS
BUILDING
ELECTRICAL
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