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o PRio R CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
: ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE "7. 6. / 3
. x AND UTILITY CONNECTION PERMIT
u ell -.IA'NESp�r I White File
2 Pink City PERMIT NO. /3 7Z,..6
3 Yellow Applicant
' l : . rint and si , at bottom)
ADDRESS ZONING (office use)
. Z— 3 7 11 Die- .
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER i, ,�,.�
am e ' A745� L c v-N/1i/ J d / ')Q/ 2&2 (Phone)
/ ) 3� 3 � 7`i✓, / ,mil s � C
(Address) , 'S�� - � 1 .�
( /k. ` ,
BUILDER_ - _ T /
om.an Na . - �C2S -rte �_�tivv,4w/`2 / , �� C= hon C.—s57 XY� 57
((Contact Na �f /r �S ,a ec hone)
�
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re- Roofing DRe-Siding wer Level Finish ❑ Fireplace
DAddition ❑Alteration ❑Utility Connection 2 / /tf
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Construction: I II III IV V A B
Occupancy Group: A B E F HI MR S U PROJECT COST /VALUE $
(excluding land)
Division: 1 2 3 4 5 i
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 - mention . r Illy and that all co.. ucti will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official c- evoke t. 's permit for Just c 5, ermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
.Sign a lum Contractor's License o., c c D ate
Permit Valuation 1 ' U c ei _ 0 0 Park Support Fee # $
Permit Fee $ G Z Z- S' SAC # $
Plan Check Fee $ — Water Meter Size 5/8 "; 1 "; $
State Surcharge $ / _ U p Pressure Reducer $
Penalty $ Sewer /Water Connection Fee # $
Plumbing Permit Fee $ 6 z C° Water Tower Fee # $
Mechanical Permit Fee $ / Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ - ---- -- . TOTAL DUE $ // 7 73
_
This Application Becomes Your Building Permit When Approved Paid // S e eipt j No. � 1th
Date ._ _ (3
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
C :4i 4 F-94P CITY OF PRIOR LAKE Date Rec'd
HEATING /AIR CONDITIONING /FIREPLACE PERMIT
'NNEsdd I. Pink Pile 1 PERMIT NO. I -, /",
I„
2. Green p V l
;. Yellow Applicant
"'
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
`3 tir c lr-1- 1 CV- - 5S,,.) ..
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER ll^
(Name) . l- _ - -__'. 3 1 .1.>aA1 \AAA -\ 6t (Phone) 1 --'L 5 - r j 3100 •
(Address) 31._?.. �C rSX( ►4\ .___i:C .. 1
APPLICANT
(Name) C-, ,at Virs CT Ct- ' J,, AIL. (Phone) ( S\ - Z.ZA.R -- O56 •
(Address) t .wt � � U,'- �'" Q-`w` xi-0 NV of 5 s4L' .
(Addres•t (City) (Zip Code)
(Contact Person) La: Aft, Li∎ .Mt (Phone) S� AS
APPLICANT SIGNA'T'URE V DATE 1 ,, l;
i W w
A ' ' .ICANT PLEASE COMPLETE BELOW
•
ANEW CONSTRUCTION ❑ REPLACEMENT r: ALTERATIONS e'S ,,,,,, ! • _
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RE"T"URN 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 into Required Side Yard Setbacks.
❑ Mechanical ❑ Radiation
❑Air Conditioning El Special Devices Fireplaces with Box Additions or
❑Vent. 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
Estimated Cost $ '11 Building Permit #
/
The Minnesota Statutes .32613.148
"SURCI IARGF" has been changed R!r one
HEATING PERMIT FEE $ _ year effective
STATE SURCHARGE $ A — inly 1.2010. until June 30, 2011.
TOTAL PERMIT FEE $ S S a The minimum surcharge for a "lined fee" permit
(Office Use Only) is SS beginning July 1.2910
This Ap ' ation Becomes Your Building permit When Approved Paid Receipt No.
G�C���;�/ 7 Date 7_3 _/.. By U
Building Official Date
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 O R LAKE DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION RECORD
SITE ADDRESS 313 17 'a / „ .
NATURE OF WORK Woe
USE OF BUILDING /1
PERMIT NO. /.5 • 7&(. DATE ISSUED 7 e. / 3
CONTRACTOR �icJ� e6AI PHONE 4 . 2,4t • 3 /%G%
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
1
1 I
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING
INSULATION
ELECTRICAL
PLUMBING 4,-.40, '5) -I -3,
HEATING (if required)
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
� � I
FINALS
BUILDING �- i 2
ELECTRICAL
C L
PLUMBING r.ej'nl-t, l - C? 1 lG ( 7/
HEATING � //:
DO NOT OCCUPY UNTIL BOVE HAS BEEN SIGNED
G ED
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