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, CITY OF PRIOR LAKE BUILDING � ec'd ttyv4A-:"e e -61-3
a.. TEMPORARY CERTIFICATE OF ZONING COMPLIANCE C at "�""
" '
AND UTILITY CONNECTION PERMIT t - (1
b. 1C
rl N Gr !C` � . Cam.
1 whi,e i
2 Pink Ci n PERMIT NO. /3 /43
.
3 Yellow Applicant
(Please type or ptint an s ign at bottom
ADDRESS ZONING (office use)
ISM LP Celt, ,it - »0..k e.- x- ""C"„'
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) (QP try ft y. (Phone) C i5a . 4 1 1 -1 1 - 3(o C.) C3
(Andress) . t *0 & , . e._ .. t_ : \ fit ;t~§ , e a♦ ik ` X * 1
D U M B E R c rv\Acac-Nur Name) r_Xet (Phone) (at, ` gne iCe 74
(Contact Name) On nel x - t a. A a a- (Phone) LO 1 -7(p .. !(P7
(Address) _ . t $* a ' r , ,to s 4 ...' tit a a e I, 'S ♦ R 5 L> (.>d
TYPE OF WORK 0 New Construction DDeck ['Porch DRe- Roofing DRe- Siding ['Lower Level Finish 0 Fireplace
DAddition [(]Alteration DUtility Connection
CODE: DI.R.C. DLB.C. ❑ Misc:
Type of Construction: I 11 III IV V A B
Occupancy Group: A 13 E F H I M R S U PROJECT COST /VALUE SW
f (
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 I am the owner or authorized agent for the
rib. . • Toned property and that all co client will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
trial can revoke this permit for just tati tlrenno c I hereby a , . • that the city official or a designee may enter upon the property to perform needed inspections.
. 13t V)(o) \: 3 l -- 1 3 _.
Signature Contractor's License No Date
Permit Valuation Park Support Fee # $
Permit Fee $ 00 G. GO 31--, 7.5— SAC # $
Plan Check Fee $ Water Meter Size 5 /8"; 1 "; $
State Surcharge $ • Pressure Reducer $
Penalty $ Sewer /Water Connection Fee # $
Plumbing Permit Fee $ Jam " . Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other n $
Gas Fireplace Permit Fee $ ~
TOTAL DUE 12 Z, 7-0,13 $
89Zs
Y
This Appl I tion Becomes Your Building Permit When Approved Pal Receipt No. T
Date , � � � ` { ��,,.,•e.... B p
.1'7 , me :af 'ehli Date _ f /
l
This is to c airy that he 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,
Blannatia 1, eclot Dale
sr. 'al C onditions 'Fans
24 hour notice for all inspections (952) 447-9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
4 ? Rlp� Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT 4r /!
I . Blue d Filty e PERMI . NO. /
J I
. tied C i
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS (office use)
-- act rd .1�.c c.2°`4 c re,l,
,
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) � e b (el (Phone) `i'c L / '7 36.01
(Address)
APPLICANT
(Name) b 'Wockl 1 f vzcr Pk, wh . J �Q (Phone) 0:53 4-
(Address) j0 13C7K ! Ze CP l 1 412 -mac /1
(Address) (City) (Zip Code)
(Contact Person) 062 /'� (Phone) 763 e6 4
APPLICANT SIGNATURE -- (�/ �.- �--- -- DATE l 'Y 30 -
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
Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
Laundry Tray (1 or 2 compartment sink Sewage Ejector
I Shower Stall Backflow Assembly
Sinks _ Backflow Assembly Test
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
C
Estimated Cost $ i'' Building Permit #
PLUMBING PERMIT FEE $ '..1 .1) (0 4441/
STATE SURCHARGE $ .50 QV
TOTAL PERMIT FEE $
(Office Use; , ly)
This , t is : 1Becomes Your Building Permit hen Approve Paid Receipt No.
�r T � - -- I • Date By
Bu i . ,„, Date
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
DEPARTMENT OF
P RIOR LAKE BUILDING AND INSPECTION
INSPECTION RECORD
SITE ADDRESS 5694 ' . iti. aware. 7...
NATURE OF WORK • L. . - Orrif
USE OF BUILDING i _ -' .
PERMIT NO. DATE ISSUED
CONTRACTOR ..� PHONE ile 74°
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
01.1111111 1 1 1
1 1 1
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
c
FRAMING (-5
INSULATION
PLUMBING Plc- 6' - r3 -13
- 'HEA
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
1 1 1 J
FINALS
BUILDING 7 S zi��c,3
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 14521 447 -4Rcn