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CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
:T, AND UTILITY CONNECTION PERMIT 3 - r (o • 1
rk'N E S OS
/` �i ?� - L white Poe
2. Pink City PERMIT NO 12 - 1 7 5
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
- 7795 C 1ery Tr. u. SE
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) Toe co- T6k11Q 0.1'1 in S-i-r, , k (Phone) (is) 601 ' 71
(Address) 177 `1S C-1 ec�ryMr se
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction ['Deck ❑Porch ❑Re- Roofing ['Re-Siding fkower Level Finish ❑ Fireplace
['Addition ['Alteration ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc:
Type of Construction: I 11 III IV V A B 500°---- Occupancy Group: A B E F HI MR S U PROJECT COST /VALUE $
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 can revoke this permit f• =. cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
_ .. 3/ I I ' ( Signature Contractor's License No. a te
Permit Valuation , U G 0_ c t) Park Support Fee # $ /
Permit Fee $ . L v SAC # $ _
Plan Check Fee $ Water Meter Size 5/8 "; 1 "; $
State Surcharge $ / 6 (J Pressure Reducer $
Penalty $ Sewer /Water Connection Fee # $
Plumbing Permit Fee $ .5-4. 57) Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE i / $ r / 7 75 This Application Becomes Your Building Permit When Approved Paid /17. 7.S Re pt No. 47 i 1 -i
/
Z
Date 3_ /4,. /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 pro ed 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 'ficate 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
Mar. 30. 2012 9: 37AM No. 2522 P. 2 0r13
...I-PP-to, bate Ret'd
:.'S• ` ii... .. CITY PRIOR LAKE L U11�1 .1.NG PEL7 -lii11
40 2Yentso`''
r e
. Zed Ell
�. 4afd Cita y PET lY0
I. Mow Awlinni 0
(Please type ox print and sign at bottom) ZQivII�t (ogta� we)
ADDRESS
— 1 - 71 . 5 CI AC- Tra411 S
LEGAL DESCRIPTION (af0oe use only)
LOT BLOCK ADDITION PLO
N
OWNER {
(?dame) tads.. cr 04-ne.Ct h W.. vIt 1c.. (phone) 0* GO 7 — K11 I
Address) Mv-t, y
.F 3'RLICANT
(Name) e ' P -47 6 '� (Phone) 9‘z - e/c/ - - 3 7 `3
`E-
(Address) ' 7- t L---. 2 r i Ir - ' 7 --.--
(Add,) J( (City) / (Zip Code)
(Contact Pelson) y (Phone) 6 ._.___
,
APPLICANT SIGNATURE `" DATE 3 /' fl /1 L .
APPLICANT PLEASE COMPLETE BELOW
Onattc* — T; a of Fi -f re t uarttity — __ Type of l?i ctnre
Bath Tab with Or without shower �Raugh -ins
' Dishwasher Water Heater
Floor Drain. Water Softener
J Lavatory (Bathroom Sink) . Stand Pipe ( \'U'ashitlg Machine)
Lan Txay (1 ter 2 canipartment sink Sewage Ejector
1 Shower Stall .. Backflow Assembly
Sinks Baokflow Assembly Test '
Bar Sink Lawn Sprinkler
1 Water Closet (Toilet) ,__ Other
FEE SCHEDULE
Industrial, Commercial & Mul1i- faot11y 1% of job cost with a $49.50 mbirii n kesidentioI, New Ono & Two-Family $140.50
Residential, Additiow & Alterations $49.50 .1
The il'tinnegcta Swifts 326!3.148 yet buiidh).g?eriult # +� D. ��
"SURCHARGE' in been changed for one
yeareffeetivo PLUMBING PERMIT FEE $ -A td
.114 t, 2014, until June 30, 2011. STATE S fACRA.> .GP $ .50
If' nFtnrnlurri " l
ra'rge tor he's pe,'mft TOTAL PERMIT FEE $
is b�• twinn jiay 1, a4I0
Tuts Application D ecanter Your Building Pernik When Approved Paid - -- - Receipt No.
Date By
nulydtiu ()Vidal Data
24 hour notice for all Inspection& (952) 447 -9850, fax (952)447 -4245 .i iWING PERMIT
4646 Dakota Street B.R., Prior Lake, Minnesota 55372
mk 6i • g
Residential Building Permit Checklist
Basement Finish or Interior Alteration to Single Family Homes
BY: / / Date: 2 /4 ! 2.
Building Permit # / / 7S"' PID: Zoning:
Site Address
Legal: L B Subdivision:
Existing Structure: ES o NO
CONFORMS TO ZONING 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: \TEMPLATE\ALTCHCK.DOC
PRIOR LAKE
DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION RECORD
SITE ADDRESS / 71 q5 c'Z'e19 y 7 ? /
NATURE OF WORK L- di,Vt /2- EVEL-
USE OF BUILDING
PERMIT NO. / - / 7 DATE ISSUED 3 - R-8 ' Z—
CONTRACTOR /iE 3 7I /K-- PHONE 9 Z , c 7 . 677/
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
EAMMENS 1 1
INOWMMIMMINFiriarga I
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING
INSULATION
ELECTRICAL
PLUMBING 6'r
HEATING (if required) WC
E
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
1 1 ) I
FINALS
BUILDING f/3//5
[ELE PLUMBING
CTRICAL
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