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o f PRi CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
y TEMPORARY CERTIFICATE OF ZONING COMPLIANCE 5 & ` `/
AND UTILITY CONNECTION PERMIT /
M N'NESD� P I. White File PERMIT NO LJ�//��
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`
3 Pink City / /
3 Yellow Applicant �" ` JJ
(Please type or print and sign at bottom)
ADDRESS ' r i + ZONING (office use)
1 \‘w.k8(lwok-F c'ia_ kiQ' Pr" %0 r- lake. 1'\n.t:1
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER .
(Name) U ov ■ A \Aktir.+sav (Phone) \S Z —S 13 —8/80
(Address) - 3 ■12 q..vtarn..wotc C ►ti ti0■JJ 06`;c: r LC Le ¥tk" -)
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑ New Construction ['Deck ❑Porch DRe-Roofing ❑Re- Siding [Lower Level Finish ❑ Fireplace -
['Addition ❑Alteration DUtility Connection [y Lower
3 e-00
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III IV V A B
Occupancy Group: A B E F HI MR S U PROJECT COST /VALUE $ S i 000
Division: 1 2 3 4 5 (excluding land)
1
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 -men : • 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 ca revo , this •ermit for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
x t. --.) 4 -4 —t1
Signature Contractor's License No. Date
Permit Valuation 3 000. 00 Park Support Fee # $
Permit Fee $ /4-. 1 75. SAC # $
Plan Check Fee $ Water Meter Size 5/8 "; 1 "; $
State Surcharge $
! ` SD Pressure Reducer $
Penalty $ Sewer /Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee I $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ /3( 7_5
This Application Becomes Your Building Permit When Approved Paid iJ , ,� Re t No. 6 Z2/ f(/
Date r <
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
. pR7
o Date Rec'd
, CITY OF PRIOR LAKE PLUMBING PERMIT J, 7/
,,-.3.,4, : x
4INNE, 1. Blue File
- z. Gold City PERMIT NO /7 34,4
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
` 1 n 3, ( r LOc5 1 6vxle )\j °
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
(Name) WNER X w Q M (4. % 6 1v' (Phone) C 75 - a-- Q `) • 2. ra L
(Address)
APPLICAN / r1
(Name) CWS 01J \ ' WW h I v' J J i Ztv L + (Phone) � La.: ,
(Address) J l.J C / lea. ill h 1,-- hj.1(,�) t' WA er, PA NI 6 c o
' a (Address) (City) (Zip Code)
(Contact Person) vim' - I (Phone)
APPLICANT SIGNATU -CrA DATE L ° - 3' - - / 1
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough -ins
Dishwasher Water Heater
Floor Drain Water Softener
I Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
Laundry Tray (1 or 2 compartment sink Sewage Ejector
1 Shower Stall Backflow Assembly
Sinks Backflow Assembly Test
1 Bar Sink Lawn Sprinkler
1 Water Closet (Toilet) Other
FEE SCHEDULE
Industrial, Commercial & Multi - family 1% of job cost with a $49.50 minimum Residential, New One & Two - Family $149.50
Residential, Additions & Alterations $49.50
Estimated Cost $ Building Permit # PLUMBING PERMIT FEE $ PA ( D By
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $ TO, i./Q
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid Receipt No.
Date By
Building Official Date
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
Residential Building Permit Checklist
- Basement Finish or Interior Alteration to Single Family WIome —
_
BY: / Date: r . 6 . `l
Building Permit # /1,34- f PI;D: Zoning:
Site Address 3/72 77M8E4 W ocE fie.
Legal: L B Subdivision:
Existing Structur YES NO
� r
CONFORMS T 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 .i
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
PRIORLAKE
DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION RECORD
SITE ADDRESS 3112 fliiaew
NATURE OF WORK 44914/.a
USE OF BUILDING
PERMIT NO. if MATE ISSUED
CONTRACTOR ..T1 PHONE
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
011111111111111
1
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING &) ti
INSULATION G
ELECTRICAL
PLUMBING (15000 (o ///
HEATING (if required)
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I � 1
FINALS
BUILDING 3Mi
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