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CITY OF PRIOR LAKE E '
PrparfnIttlf of f uilMng jin rsprxfinn I )
Final Permitted ❑ Conditional C.O. Expires 1_ '
O �': This Certificate issued pursuant to the requirements of Section 110 of the ❑ Residential / ❑ International E-. „)
>00ares Building Code certifying that at the time of issuance this structure was in compliance with the various <
(0:::::;.- .1 ordinances of the City of Prior Lake regulating building construction or use For the following: = ?!
Use Classification Bldg. P ermit No.
(`' S FAMILY 12 -1100
> _ Occupancy Type R3 Type Construction Zoning District � VN PUSD vo
Legal Description L7, B2, JEFFERS POND THIRD ADDITION
fir r _ , 3905 S TAT T ON PLACE N , W . ')
1 Owner of Building Site Address
41:1
City Contractor's Name & Address I : ► ! . 1 � _ k _
ROBERT TCN I NS - �)
C i Planner
((1, . ]
N. Building Official
Date: I ' \ Date: ;Ii;;;
(i 1 E- ))
!
POST IN CONSPICUOUS
PLACE
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�/ v CITY OF PRIOR LAKE BUILDING PERMIT, Date Recd
,.
TEM PORARY CERTIFICATE OF ZONING COMPLIANCE G
z..--; ANt ` � AND UTILITY CONNECTION PERMIT ( - r. 12..
't trNN ESOS � Fi1e S ee Main File PERMIT NO b
2. Pink Cp / � • / /c
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
3 s CA7i oN J' tAc-E NIA/
LEGAL DESCRIPTION (office use only)
LOT 1 BLOCK ADDITION A p _ J - PID
OWNER
(Name) - — (Phone) • - -
(Address) _ _
1
(Co DER P Oa-, S INC . 952 - 9$S— S9S9
(Company Name) (
(Contact Name) Joni lPiUT - (Phone) Si q" `?'6S-4 /7 1 q
(Address) 2 14 % 3 G 1 2 F _ N A D A r - a n / E _ 5.- -re..,- 12 v 1 LA E v1 (4-� S SO A 9
TYPE OF WORK New Construction ID Deck ❑Porch ❑Re- Roofing ❑Re- Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ['Alteration ❑Utility Connection
CODE: I.R.C. ❑I.B.C. l:] Misc:
Type of onstruction: I II III IV V A B 75 O ob
Occupancy Group: A B E F H I MR S U PROJECT COST /VALUE $
Division: 1 2 0 4 5 (excluding land)
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- ntioned pro. -rty 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
ffi
ocial • o e ermit f or just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed spect ns.
X P &C < 6o307 c i It 1
Signature Contractor's License No. Date
Permit Valuation 1 2. 4., aoo _ Park Support Fee # $
Permit Fee $ c SAC # $ 'Z,3 6S
( Z-- °(. So
Plan Check Fee $ 1 $G.. Is Water Meter Size "; 1 "; $ 4 30 - -
State Surcharge $ Gc 3 — Pressure Reducer $ k _&
Penalty $ Sewer /Water Connection Fee # $ 1 S-00 .. .
Plumbing Permit Fee $ 1 5 5.0 Water Tower Fee # $ 1
k ono, -
Mechanical Permit Fee $ ` 4 S 0 Builder's Dep $ (5 co.
Sewer & Water Permit Fee $ -(=> } Other $
• Gas Fireplace Permit Fee $ 5 TOTAL DUE $994110:
This Ap i ication Bet es our Building Permit When Approved Paid V 84/3- G 6 Recei No. JV 4
/ / , ` o Date /6 - e j? .� By
......... .d. - 44.1 ■..... ( g / 2—
Building Of tcial ate
This is to certi' at the reques/ the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signe.. t e Ci Plann S •nst tes a temporary Certificate of Zoning co pli ce and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
. A/60W I fir.....—_\ -..._ kD i
issued. / /
Planning Di r ector 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
II 6
'6 )
4*'*. • k 401,
hi
4 I,
oq PRr
Builders Deposit
! NESO1 City of Prior Lake
A $1,500.00 Builders Deposit is included in the Building Permit fee. The Builders Deposit is issued as security to
insure compliance for a Final Occupancy Permit. (It is not an escrow account.) All exterior items including but
not limited to grading, sodding, landscaping, tree planting, driveways, siding and painting shall be completed 180
days after the date the building permit is issued. If the work is not complete within the 180 day time period, the
City shall notify the applicant of the violation and the applicant shall have 10 days to comply or the $1,500.00
builders deposit will be forfeited and the applicant will be billed for clean up or corrective work to rectify the
situation.
A $500.00 Tree Deposit may also be required and will be refunded if specified trees are preserved for a period of
one year. By signing this I, the undersigned contractor, acknowledge that I am aware of the erosion control
requirements of the City of Prior Lake as outlined in the Erosion Control Measures for Building Contractors
handout. /3 , /h170N' r ,
DATE: /•0• I3 SITE ADDRESS: 3945' • PERMIT # /• / 160
REFUND TO BE MAILED TO: gfiregvAine 'Mal
2 /443 *VC sdiTE /20
1.490.5s#61., Hy 5
PLEASE REMEMBER
1. KEEP STREETS CLEAN DURING CONSTRUCTION
2. KEEP EROSION CONTROL IN PLACE
3. TEMPORARY OCCUPANCY PERMIT MUST NOT EXPIRE OR $500.00 WILL BE FORFEITED
AUTHORIZATION TO RELEASE
SIGNATURE:
/9
ynda S. All i, Building Services Amount
Acct. 801.20204
Date
J:IFORMSIBUILDERS DEPOSIT FORM.DOC
2 /1 /3
•
. .
0 a m 02-13-2013 .... •• ... •,....•• •:...it:......::.
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1112013 01:42 6514637835 FARMIINTON PLUMING l@H PAGE 0
T'i 1 111q 13
Date Reed
, A
' ° ' CITY OF PRIOR LA PLUMB/N._ � PERMIT
, 43
.. r. °"' r, ' PERMIT NO. 12. . i
xsCs :. 001i1 ;' r
1 Ycllrm ..-qt''
7 lcasc tppe nr prlat ,yst n at batter .. _ „ . --" — .. .'_ —" z o TG (0 nx:
1,PDRESS
3 c 76-A -- toln- 91cm„-s,-_______ 1 . _._____
EGAL DESCRIPTION Klee we only)
_
LOT BLOC: ADT]I:t7:OL , �. —.. _ PT_D _. F
OWl ER l/ .y ____� (Phone)
�,Narne) - .
A - , iL 1 ,________
_.. — ... _ 5, 56a°
APPLICANT ,
(Narriorar rn4.32_4—___112)____. 0 0.S —J Ttione) (6 i — ":“._113_=_T 4 _
(Address) ,t 1 ;:221. 4 � ' — ' ' O 's-' {tap Code}
{ _... (none, _
(Contact Person) � yn. '�
APPLICANT SIGNATURE � .. ‘.,�. �" n —.. .— ' )A .
APPLICANT PLEASE COMPLETE 1;1 OW _..
~
Quantity T j e of Fixture .. Quantity .. a o
f Fixture
Bath `I h with. or without shower. _. tough - ius __
Dishwasher 1 er (Cat ,__,_.
_ 1 Vat �Iafiet Softener
Floor. Drain __ ;` �lSlllft* lV1aClatn�
Lavatd Rathrooaaa Sid() stand Pipe (
--- T ---T— Laun Try (1 or 2 compartment sink . ; >ewago �iector ..
Shower Stall ' 3ackflow Assembly ,�. _
____I �� , 3ackflow Assembl _ Test
Sulks
Isa1 Sink —. ,� — . :.awsa Sarin cx _
2..- Water Closet (Toilet) — '3ther
FEE SCHEDULE
lndultrHai, Commercial & Muiti- fatnily 1% of job asst with a $49.50 minimum Resi F /Alai, New On & Two- Fanntiy S i49.5O
Res t antial, Additicros & Al talons $49.50
The Mint/emu' Slattstrs § 32613.14 tist _ �ixilding Perini . x` •
•
SURCHARGE" runs been nang i fbr one
year elective PLUMBING $ PAID WITH
i, 2010• anti! :rune ,0, 200 i. STATE SURCHARGE S „ .50 ', Q e ryp y �� n A+
e Atiairaurtt %nrcharp! for "axed fee" permit �IOT PERMIT FEE BUILDING PERMIT'
iS M. Waning ;lily 1, 2010 •-- -
This Application Becomes Your Building Permit When Approved Paid .. _... — Receipt No. Date .. By - -
tSuildinr( Metal Date
24 hour Mike for Al inspections (952) 40- 9850, fox 4 )52) 447424$
4646 Dakota Street S.F..,,Prior Lake, l4flnnesat-t 5$,372
k t CITY OF PRIOR LAKE 1
; BEATING /AIR CONDITIONING/FIREPLACE PERMIT
E6a�� t, MX Fat 1
2, ar„, cu PERMIT NO. /L_ /Ql
3. Ytlinw Applicant ...
Oc or p pi n t a n d at bottom) v . ..
t ZONING (oft.0
3 is -
Z DESCRIPTION (office use only)
BLOCK ADDITION PID
ER 1 PLY IIMAL (Phone) 'xl ! ' 1120
•s ! 1 : AIL .0 4.. - ,.1 li a, ' 522 ANT r ' 2 .�' '' . �+'
=) .. �[ if �' bane) .._.. ,_____
,so • -� r }. MIA& _ 1 it 1 .l S3S
(Ad&tess) (City) (hip Code)
.at Person) # .- ...4_-4:— (P — hi a '^ 1 ,e
)1
[CT SIGNATURE f : —
[CAN DATE _.� / 1
A LYCANT PLEASE COMPLETE BELOW
L NBW CONSTRUCTION 0 REPLACEMENT 0 ALTERATIONS
q.CE MADE AND MODEL FUEL
SIZE RETURN OPENINGS INPUT OUTPUT
OF SYSTEM HEATING OR POWERPLANT
PLEASE NOTE: Air Conditioner
farm Air Plants D Steam Units and Fireplaces Cannot Encroae
Welty D Rot Water into Required Side Yard Setbacks.
vicchaniral D Radiation
Conditioning D Spocial Aeviocs Fireplaces with Box Additions or
rent. System D Other o: 'cos M-- Cantilevers to the Outside of Building
�� � � e- o j Require a Building Pct•�
LACE MAC AND IvIUDEL. 1 ..
IT. ,•i .
al, Commercial & Multi- Family 1% a . eost Residential, Gas Fireplace $4950
.5o m
.tial, ;onti & A/C (Now Construction) $149.54 . ` es! , at 1. , • i I eons & Alterations $49.50
fiat, Heating Only (Nqw Construction) 564,50 Residential, AC Only $4950
l ost $ Building Permit #
�sofa Statutes § 326)3.148 g �
t &G>~" his beep e;�tet�cle ,�,
:E.`i1 Iluzis 9.0, 2(ila a, iEATING PERMIT FEE $ Ail, t
rti ,um surcharge for a STATE SURCHARGE . $ 7 :!.::
I fee' perthit is ti:.: f OTAL PERMIT FEE $ IA
Application Becomes Your Building Permit When Approved. Paid Receipt No. .
Date By ��C® ��
Buildbls Official Date 81,IILD , ..7 PERMIT
24 hour notice for all inspections (Y52) 447-9550, fax (952) 447 -4745
4646 Dakota Street S.F., Prior Lake, Minnesota 5S372 .
f 3EVd Hier' 3H ENIMC19 9009Z617Z56 95:0T 6T0Z /L
P RI R LAKE BUILDING AN O P E
PE TI
IN C O
S N RECORD
SITE ADDRESS 310 . ."-p.arc N• �.
NATURE OF WORK ? N aec.w otie �� N
USE OF BUILDING Jr.v FAr-t,LT Ac - �ALbk- �G,,
PERMIT NO. 12 IIOO DATE ISSUED 1 6/3 Ile
CONTRACTOR Imo. --• z I- o iE s (NG. PHONE qsz - `\SS.411dt
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
_
THE PERMIT IS BY SEPARATE DOCUUM VT ! .,,
e‘ G8^iTR4l. 3 Sitactns ra 66.-6141.4 �INSPECfOR DATE
FOOTING 1 1
1 FOUNDATION (Prior to Backfill) 1
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
[ Zj2 h ROUGH - INS
SEWER / WATER / SEPTIC
FRAMING
INSULATION
ELECTRICAL
PLUMBING " "�v�'
Vt U G Qe e l - .
HEATING (if required)
FIREPLACE
GAS LINE AIR TEST Fe) 0
C P- 1() "`' Th)1 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
FINALS
GRADING (Prior to Sodding) /�
BUILDING Ih
g f`e[ -7
ELECTRICAL
PLUMBING :}2/5
HEATING 2 ` l
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
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