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CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
N 9 TEMPORARY CERTIFICATE OF ZONING COMPLIANCE / 2 s, 13
AND UTILITY CONNECTION PERMIT '
A'N E S��
1. white File
2. Pink City PERMIT NO. 3 _ 83
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
17 Iii Su,►se 4 Au Pr tar 1 ke MA(
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER 1: /
(Name) C- N I L r A. t 1 y L C L A, L Pk ( Phone ) 61 - 3 ? -- / 55- 2
(Address) (77 111 Su N 5 i' .4 /4 c) C (T rf o Z.-c, C.
BUILDER `
(Company Name) ` - f y brook �� (U y�S 'I'r'�cJt c 4 , �., 4- 'Cis u cc.P l'r- C' /2 (Phone) 2 7 ) 0 — • , c o 2
(Contact Name) ctr-t I [�( t,r / (Phone) 612 - 7 .-0 - %GCS a
(Address) 6,6 3 1 3 c a 5 '1 r' c f /As # i3 G f rSut' (1 C till( ' C5 3 7-
TYPE OF WORK ❑ New Construction ['Deck ❑Porch ❑Re- Roofing ❑Re- Siding ['Lower Level Finish ❑ Fireplace
['Addition ['Alteration ['Utility Connection
CODE: ❑I.R.C. ❑I.B.C. gmisc: P ' Flout lot E l 0C 1 e
Type of Construction: I II III 1V V A B
Occupancy Group: A B E F H I M R S U PROJECT COST /VALUE $ S s 00 v
Division: 1 2 3 4 5 (excluding land)
I hereby certify : t 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- mentio.. /property d 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 'eke this . v 't for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X V; QcS2.5i3 1—z -2o
/ Signature Contractor's License No. Date
Permit Valuation
D I 0 o0 ' ' Park Support Fee # $
Permit Fee $ III .5 7 SAC # $
Plan Check Fee $ (24 • /1O Water Meter Size 5/8 "; 1 "; $
State Surcharge $ S Pressure Reducer $
Penalty $ Sewer /Water Connection Fee # $
Plumbing Permit Fee $ 5- 4. Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ 370.4
This A . lication Belo es ur Building Permit en Ap l oved Paid ����i�� Recei t NO. , �G� r
' Z 3 Date j ,3 //A3 By , Wr
Building Official 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.
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
O
4 e. HEATING /AIR CONDITIONING /FIREPLACE PERMIT
1,3
M4 'NESd cP 1 Fi iF/ (r61 /$)
le
o
2 Green Cep PERMIT NO. i3 q4..
3 Yellow Applicant
(Please type or Qrint and sign at bottom)
ADDRESS ZONING (office use)
i '._] 1 1 1 u( --2'f rice...
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) (Phone)
(Address)
APPLICANT
i� __ _.11_ °�
(Name) 1i f i C`. 44-i_Q T I n , �. K. �.,. (Phone) 95 r� 0,, ° 3--1 ] 5 - 0071D-
(Address) 8v,,Ocl 44 Lo (3 CO B u r n t I k .c S 3 3
(Addressl (CA (Zip Cod
(Contact Person) `C" v---- Le-D- (Phone) c L k ` c
APPLICANT SIGNATURE CXd 9 \ l k DATE I
APPLICANT PLEASE COMPLETE BELOW
ANEW CONSTRUCTION ® REPLACEMENT ❑ ALTERATIONS 1
FURNACE MAKE D MODEL ! k \ ft c I (C-i FUEL ��`~ d'' \
FLUE SIZE 3` , v u t € v 0 - RETURN OPENINGS INPUT 10 .O� OUTPUT L S , O ° i
TYPE OF SYSTEM HEATING OR POWER PLANT
❑Warm Air Plants ❑Ste PLEASE NOTE: Air Conditioner
Units and Fireplaces Cannot Encroach
['Gravity of Water into Required Side Yard Setbacks.
El Mechanical Radiation q
r nt. Conditioning ❑ Special Devices Fireplaces with Box Additions or
System ❑ Other Devices Cantilevers to the Outside of Buildings
Require a Building Permit.
FIREPLACE MAKE AND MODEL
FEE SCHEDULE
Industrial, Commercial & Multi - Family 1% of job cost Residential, Gas Fireplace $49.50
$49.50 minimum
Residential, Heating & A/C (New Construction) $149.50 Residential, Additions & Alterations $49.50
Residential, Heating Only (New Construction) $64.50 Residential, AC Only $49.50
r_.:_ Cost $ Building Permit #
The Minnesota Statutes $ 326B.148
"SURCHARGE" has been changed for one HEATING PERMIT FEE $ 9 ! 3V
year effective STATE SURCHARGE $ 5.619750 -
July 1, 2010, until June 30, 2011. TOTAL PERMIT FEE $ ,5
The minimum surcharge for a "fixed fee" permit rj V
is 55,, beginning July 1, 2010
This Application Becomes Your Building Permit When Approved Paid t No.
Building Official Date Dat 7 7 i L / .,
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
P R I Q R LAKE BUILDING AND INSPECTION
INSPECTION RECORD
SITE ADDRESS /7/11 S / AVE
NATURE OF WORK //iff:
USE OF BUILDING
• PERMIT NO. iG D • E ISSUED
CONTRACTOR i/ .1 ' _ i . 1 PHONE 5b
NOTE: THIS IS NO A PERMIT FOR ANY OF THE INSPECTIONS BEL
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
ME I Cgit \ W7
I
1
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
EIHNONMENNIONI
fr2IS FRAMING
ELECTRICAL
PLUMBING Ui� U C 1 <1 rt,„ e /fC(113
HEATING (if required)
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
( I
FINALS
BUILDING
ELECTRICAL
PLUMBING V i S Ud
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