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di' OF PRIOR LAKE BUILDING PERMIT, Date Recd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE 5 a- /2-- ,. x AND UTILITY CONNECTION PERMIT
U Itj
��A'NESO�� I. while File PERMIT NO `�
2. Pink City /� �/ l
Applicant VVV
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
Z / . 9 0 36c,/'1C/r/ 4'v'- . ,2..,S. '
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID 2.5 44e. 0 z .0
OWNER
(Name) Si i P/ -16.6. (Phone) (,i! Z - 052-- 8 7 Z
(Address)
BUILDER q
(Company Name) D /2-5 ex)".1S% /Ul e.:7 7 04 (Phone) 7/ � • 33 b . 72-70
(Contact Name) :— /3'/'1 3 /11 LL O/l (Phone)
(Address) X330 2. "° <5i• , /fUl)S .5 0 Ai kir_e- .59-6/62
TYPE OF WORK ❑ New Construction ['Deck [Porch ❑Re- Roofing ❑Re- Siding Lower Level Finish ❑ Fireplace
['Addition ❑Alteration ❑Utility Connection / 3 / -M7-5.
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III IV V A B PROJECT COST /VALUE $
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
1 1 hereby certify that I have furnished information on this application which is to the best of my knowledge true and correct. 1 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 for just cause Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
1 X 62 a 14-30¢6
Signature Contractor's License No. Date ■
Permit Valuation 3 , U C) 0 , 0 0 Park Support Fee # $
Permit Fee $ I .. 75 SAC # $
Plan Check Fee $ — Water Meter Size 5/8 "; 1 "; $
State Surcharge $ / 50 Pressure Reducer $
Penalty $ V Sewer /Water Connection Fee # $
Plumbing Permit Fee $ 5 6-6 Water Tower Fee # $
Mechanical Permit F V p P $ Builder's Deposit $
7. SO
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE 8 ~19 5', 1 / /Z, $ /65. Z5
This Application Becomes Your Building Permit When Approved Paid / C5� . a.c. R ec pt No. 76 0
Date /1 /2_ B�' . J
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
12/r. — Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
Z.") rn
4 fINNrsds'* 761
1. Blue File PERMIT NO .
2. Yel City
Applicant
/2
3 Yel . 1pplicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
8 Ike tk L
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER -� r C i
(Name) �e- \, c l.. d L)6 (Phone) ' 715— 33Y— 707 2
(Address)
(Nam ICA '
(Name) 1 4 2J Cr..) (..012_v C rv‘zz.v Pt urylito tqvcyl (Phone) 6 / 2-1 '- yo y�
(Address) 0.sa O cm (Vc9l.-r< '. , cv
(Ad s) (City) (Zip Code)
. .r (Phone) GS Z., oZl L S 9-5
(Contact Person) u • �J.:u.� ►�� ( )
APPLICANT SIGNATURE __ DATE / 7— / Z.
•
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
Shower Stall Backflow Assembly
Sinks Backflow Assembly Test
Bar Sink Lawn Sprinkler
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
ost $ Building Permit #
The Minnesota Statutes § 326B.148
"SURCHARGE" has been extended PLUMBING PERMIT FEE $ PAID WITH
until June 30, 2013, STATE SURCHARGE $ BUILDING PERMIT
The minimum surcharge for a TOTAL PERMIT FEE $
"fixed fee" permit is $5.00
This Application Becomes Your Building Permit When Approved Paid Receipt No.
Date By
Buildine 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 Homes
BY:
' 12/ Date:
Building Permit # �U� PID: Zoning:
Site Address 2- ( ' 70 cum0/-f / fh/e ,
Legal: L B Subdivision:
Existing Structur : YES M 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 j
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
DEPARTMENT OF
P RIOR LA KE BUILDING AND INSPECTION
INSPECTION RECORD
SITE ADDRESS 2/q0 s ELr 1O,V l /t V E.
NATURE OF WORK i.-a/1/6g, L -6 /6Z-
USE OF BUILDING /26.r A /A
PERMIT NO. /2.. 4 DATE ISSUED 5 // /2-- -_
CONTRACTOR tE7A3 /LS e..49.441-77€.. PHONE 115. 338
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
Ina 1 1
101111111111111111110 I 1
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING y4
INSULATION
ELECTRICAL 0,j19
PLUMBING 1
HEATING (if required) # ,; R
GAS LINE AIR TEST Z nit ie t--
�c
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
1
FINALS
BUILDING Ji 4/,
ELECTRICAL
PLUMBING _
HEATING
DO NOT OCCUPY UNTIL ABOV 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