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of PRI CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
, TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
. tia AND UTILITY CONNECTION PERMIT 6 13 s l
;tHtvespte' 1. White File
Pink City PERMIT NO . /3 s
3
3 Yellow Applicant
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(Please type or print and sign at bottom)
ADDRESS j+ ZO office use}
1 7 7 r LDsr). ik41_,-.. ' LEGAL DESCRIPTION (offi ' use only)
LOT 9 BLOCK ADDITION - the 4 !/G e OL 4 14 k e—TID 5---
-.4.s'4- 0/4- 0
OWNER -� ' - }� /�
(Name) J ><U 1 ' l R tTh (Phone) (U IQ- 9 1 O 0340.'1
(Address) I -72 S9 l ( 9 - i r�AST
BUILDER � �} (� `"]
(Company Name 1-$ ►�d bs4 Ifr\0 :. r-7 \ i G t'\ Li (Phone e 3 615 1 d 5 7
(Contact Name) ACC1 l ,gy m ■rn A r (Phone)0 ) a. ') Li Lf 3 3 7 G
(Address) I 1 (DID (.9 - �fck. % ;,ek C bf k v.-Q vt �9 �fCl�Q _ y v- 55346
TYPE OF WORK 0 New Construction ❑Deck DPorch DRe- Roofing ORe-Sidi;NaLower Level Finish 0 Fireplace
❑Addition DAlteration DUtility Connection
COt F$JI.R.C. DI.B.C. 0 Misc.
Type of Construction: I II III IV V AB PROJECT COST /VALUE $ diV ,U
Occupancy Group: A B E F HI MR S U (excluding land)
Division: 1 2 3 4 5
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
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 evo i rmit for just cause- Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X (9 (v 07 I 5/31 t.
Signature Contractor's License No. Date
Permit Valuation 3, D Park Support Fee # $
OD
Permit Fee $ 77 d Or SAC # $
Plan Check Fee $ --. Water Meter Size 5/8 "; 1 "; $
State Surcharge $ / 6-v Pressure Reducer $
Penalty $ ! Sewer /Water Connection Fee # $
Plumbing Permit Fee $ 4. S0 Water Tower Fee # $
Mechanical Permit Fee $ / • Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ 6-150 TOTAL DUECAL61) 57 Z44, /3 $
� J� Q
This Application Becomes Your Building Permit When Approved 1 , ► 1 a / / e /- / Receipt No. / t7 % l/ g
Date — ? cp .( (3 SN� By �'
Building Official Date t .J
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
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Residential Building Permit Checklist
Basement Finish or Interior Alteration to Single Family Homes
BY: // Date: s 2'i'd a
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Building Permit # /3 1-61 PID: Zoning:
Site Address 17 acme /
Legal: L B Subdivision:
Existing Structure: YES or 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.
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4 -PRIO C ITY OF PRIOR LAKE D ate R 'd
° : ' e HEATING /AIR CON DITIONING/F IR EPLACE PERMIT r kiiI3
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4,t o,,, 2t. Plink Piie PERMIT NO /3, /g.1
4 7
3. Yellow Applicant '
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
/1 • . :,....- ,....i j ie ,. /
LEGAL DESCRIPTION (office use only) ,,+
LOT r / BLOCK f" ADDITION e C - jam (V £ 2& 7 t pm „?5 7 .Sy D/� -
OWNER /
(Name) 'Othe..Q.:. (Phone)
t
(Address) -- 1 Jr / /"—
APPLICANT HEARTH & HOMt t tCHNOLOGICS
(Name) dba FIRESIDE HEARTH & HOME ( Phone) •
Lic 66L656
(Address) 2700 FAIRVIEW AVENUE N •
(Addre4OSEVILLt, MN 55113 (City) (Zip Code)
1 / 651.633.256
(Contact Person) % a (Phone) •
APPLICANT SIGNATURE &E DATE 5 -7°-
2- 13 •
APPLICANT PLEASE COMPLETE BELOW
414 :CONSTRUCTION ❑ REPLACEMENT ❑ ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT .
TYPE OF SYSTEM HEATING OR POWER PLANT PLEASE NOTE: Air Conditioner
❑Warm Air Plants ❑ Steam Units and Fireplaces Cannot Encroach
❑Gravity ❑ Hot Water
❑ Mechanical ❑ Radiation into Required Side Yard Setbacks.
❑Air Conditioning ❑ Special Devices Fireplaces with Bog Additions or
❑Vent. System ❑ Other Devices Cantilevers to the Outside of Buildings
f Require a Building Permit.
FIREPLACE MAKE AND MODEL H.,, JUov3'/ 3 3 2 Z7419e7-
FEE SCHEDULE
Industrial, Commercial & Multi - Family l% of job cost Residential, Gas Fireplace $49.50 •
$49.50 minimum
Residential, Heating & A/C (New Construction) $14930 Residential, Additions & Alterations $49.50
Residential, Heating Only (New Construction) $64.50 A Residential, AC Only $49.50
Estimated Cost $ / ,7� C U Building Permit #
The Minnesota Statutes § 326B.148
HEATING PERMIT FEE $ "SURCI- IARGE" has been changed for one in i liar effective
STATE SURCHARGE $ .50 P A a rc' . u nc 30, 2011.
TOTAL PERMIT FEE $ B ust: tiw'gtnimutrf n �i a "lined fee" permit
(Office Use Only) is S_:+, beginning July 1.2010
This Application Becomes Your Building Permit When Approved Paid Receipt No.
Date a : . l — '
Building Official Date •
s 0 a. n.
24 hour notice for ail inspections (952) 447 -9850, fax (952) 447 -42455
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
PRIOR LAKE DEPARTM
BUILDING AND ENT OF INSPECTION
INSPECTION RECORD
SITE ADDRESS /7709 7 -� /L
NATURE OF WORK /...414/ E
USE OF BUILDING /C�
PERMIT NO. 0. DATE ISSUED l# 3
CONTRACTOR f c/ /Sf' ) /1 7; die . PHONE 763. 575. /057
INSTALL EROSION CONRTOL AND MAINTAIN CLEAN STREETS AT ALL TIMES
INSPECTOR DATE
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PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
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FRAMING 1
INSULATION
ELECTRICAL
PLUMBING \1. �� - <
HEATING
FIREPLACE
GAS LINE AIR TEST 1
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COVER NO WORK UNTIL THE ABOVE HAS BEEN SIGNED
LATH I I
Ji-t l- FINALS , ��
BUILDING ki... Q'-- ra. - -i3
ELECTRICAL
PLUMBING
HEATING
A DO NOT OCCUPY UNTIL ABOVE HAS BEE 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