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HomeMy WebLinkAboutBuilding Permit 12. 1282 + 13. 0423 r s �� � [: � � C:lf l ., Ill.��� r � � n�iil � r � � I .. � � f,.il _. r..Y 11 _. � _.l .5t _. t _: � � .. � �.0 nVi .. r i i� II� f.4fh _. Y _. ii.. �-_. � it ._ i � _ _..� _ J f.. _., � _., ii. CITY OF PRIOR LAKE Prparfittruf of Puilbing 4 ❑ Final Permitted ❑ Conditional C.O. Expires This Certificate issued pursuant to the requirements of Section 110 of the ❑ Residential / ❑ International Building Code certifying that at the time of issuance this structure was in compliance with the various - ' ordinances of the City of Prior Lake regulating building construction or use. For the following: 1 N C F A M 1 Y Bld Per mit No. 1? — 1 2 82 Use Classification . f p �, , ! 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White File PERMIT NO . Pink City /Z /0 �/Z 3. Yellow Applicant !/�'' (Please type or print and sign at bottom) ADDRESS 143 3 Z 1 0 E C --r— ZONDiG (office use) PvD LEGAL DESCRIPTION (office use only) LOT BLOCK ' ADDITION F S L.1 -r lz- tzo t - PID OWNER (Name) ' A T 1 A. M'' 44 O 1"1 ES (Phone) 9 5 2- 5 % - Z l b° (Address) - 12-4:211 V A S 1 - 1- t t-.16 a +,l Q t/E S s a 20 ( t .O t t..1 -k H N SS 43 9 BUILDER (Company Name) MS IN i v t ES (Phone) 9c2Z i3 9 8 - 6126 (Contact Name) S t) E B (Phone) (Address) 12O t 1...l4 S L-} (J �'rut....j vs S 5TH w t -O t u Ac t--t t....1 SSLI' TYPE OF WORK % New Construction gDeck ['Porch ❑Re- Roofing ❑Re- Siding ['Lower Level Finish ❑ Fireplace ['Addition ['Alteration ❑Utility Connection CODE: [t.R.C. ❑I.B.C. ❑ Misc: Type of Construction: I 11 III IV V A B Occupancy Group: A B E F H I M R S U PROJECT COST /VALUE $ (40 GOO - OC) Division: 1 2 3 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. 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 pennit for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections. g c..Rae, 2231 S38b 1 n ` V9 I l Signature Contractor's License No. Date Permit Valuation ( S, DD© - Park Support Fee # $ Permit Fee $ 13 s 3.5® SAC # $ - 3 6 S, - Plan Check Fee $ 4 c . 223 Water Meter Size to "; 1' ; $ 4 8 ®, - State Surcharge $ 1-1 . So Pressure Reducer $ ( Penalty $ Sewer /Water Connection Fee # '.`-,.,C5f).,` Plumbing Permit Fee $ ( S 4. cc) Water Tower Fee # $ / o co, Mechanical Permit Fee $ (541' . cc' Builder's Deposit $ ( 00 . Sewer & Water Permit Fee $ b (c • 50 Other F(tz6 v PP R eSSl • 1-/ $ (S 5 Gas Fireplace Permit Fee $ s 4. 5 - 0 TOTAL DUE a 9 q . 7e This Ap Ica . in/ e om . / our Building Permit When Approved /2. Paid £j'' 9 4 t LA / ,TA Date R ipt No. 7 2_ - s l - d"f! /1 Building Official Date This is to c.. ' that the request '1. e above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document when signed the Ci • e r /-n titutes a temporary Certificate of Zoning corn fiance d allows construction to commence. Before occupancy, a Certificate of Occupancy must be issued. r- ,, f1 2 -6 0 Planning Dire 7!. 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 er.AP sP o r � 4 CITY OF PRIOR LAKE BtiILDING PERMIT, V Date Rec'd TEMPORARY CERTIFICATE OF ZONING COMPLIANCE AND UTILITY CONNECTION PERMIT e- ��. rMNESO� / Z / Cf33 1. White File 2. Pink city PERK T NO. /3 42.E 3. Yellow Applicant (Please type or print and sin at bottom) ADDRESS l 4 , 4 P h j24S 1 0 - LCU?-_`r IV rNI ZONING (office use) LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION v 1 -c--F--r---(2-S A--'r� -u-r--= ^' T PID Z. C- l i 1 S • o 0 OWNER (Name) 11 A "T A- M `t' -E 0 t%• F.--.S (Phone) (Address) 12a 1 W A S E-I- t tJ 6 1',1-1 A v E S S TE- 2-0 t t -0 t t..1 4t H • S S 4 3 9 BUILDER ViI1Ok 4 Yi . 2: G1 z , 3g 0 (Company Name) MAr'r t i\-"Y 4+0 t--t ES (Phone) (Contact Name) S U F.-- BtIQR- (Phone) c ' - . 2- fro . (14-4 - (Address) 120 t ti• k S 14 ti--.l (, .1 p ./ S sT - 7 ___ e , t t= 0 t .b t--t 14 S64-I39 TYPE OF WORK Jg New Construction 'Deck ❑Porch ❑Re- Roofing ❑Re- Siding ower Level Finish ❑ Fireplace ❑Addition ['Alteration ❑Utility Connection A 2_ /2.4/-1 CODE: I.R.C. I.B.C. ❑ Misc: ,jQ P, P. Type of Construction: I II III IV V A B 1 S OOU - Occupancy Group: A B E F H I M R S U PROJECT COST /VALUE $ Division: 1 2 3 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 - 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. x� �,.•—� 1 ::: — BL 2 3'1 5323 b s 1 9 k Signature Contractor's License No. Date Permit Valuation z, 6 6 p_ 01) Park Support Fee # $ Permit Fee $ ( L 1,S- SAC # $ Plan Check Fee $ Water Meter Size 5/8 "; 1 "; $ State Surcharge $ / • U Pressure Reducer $ Penalty $ Sewer /Water Connection Fee # $ Plumbing Permit Fee $ 5y, S7) Water Tower Fee # $ Mechanical Permit Fee $ Builder's Deposit $ Sewer & Water Permit Fee $ Other $ Gas Fireplace Permit Fee $ TOTAL DUE $ ( 1 1, 1 r This Application Becomes Your Building Permit When Approved Paid j 7 . g, Recei N jD 9 7.2_ Date 7°-�„Z,, BY ' ,...,1'✓ 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 S.E., Prior Lake, Minnesota 55372 o 'r'�¢ O� PRIO_ ti U ni White - Building y� �P Canary - Engineering NNESO Pink - Planning BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT "If) 7Th/vi fr/"tip APPLICATION RECEIVED /6 - /9, /2 The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: / - 2 / .3 ,og 0 E. i . �'�`'`s Accepted x Accepted With Corrections Denied Reviewed By: /4 Date: /0'3/ Comments: See Reverse Side for Additional Information! • See Attachments: 1) Grading Plan. 2) Erosion Control Standards "The issuance or granting of a permit or approval of plans, specifications and computations shall not be construed to be a permit for, or an approval of, any violation of any of the provisions of this code or of any other ordinance of the jurisdiction. Permits presuming to give authority to violate or cancel the provisions of this code or other ordinances of the jurisdiction shall not be valid." • ADDITIONAL COMMENTS FOR BUILDING PERMIT APPLICATIONS • Surface storm water drainage flowing to the perimeter of this lot to and from adjoining properties must be conveyed to the roadway and/or to the rear of the lot in drainage swales within' the drainage • easement. • All- bare soil areas must be protected from eroding into neighboring properties through the properly installed and maintained silt fence or bales. . . • The'silt fence required by the erosion control plan must be installed prior to any earthwork being started. • The builder is responsible for maintaining the erosion control measures until the turf is established. .. The rock construction entrance must be installed at the time of 4iCackfilling of the foundation. • • • • 6:\Admin \dept info\ADDITIONAL COMMENTS FOR BUILDING PERMIT APPLTCATIONS.doc O� PRIp 7 �' U to White - Building Canary - Engineering 4-4 INNESOc P Pink - Planning BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT nfrr � y MOH 7 APPLICATION RECEIVED /6 l 9 ' ` The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: ��t /372- / / 12R - 12-is (06 _ (� Accepted ' Accepted With Corrections Denied • , Reviewed By: M� Date: / - i Comments: i . G 0 ^ 311 `v c- 6n-...s c^' 14( - A-(' Cc-�-11" "The issuance or granting of a permit or approval of plans, specifications and computations shall not be construed to be a permit for, or an approval of, any violation of any of the provisions of this code or of any other ordinance of the jurisdiction. Permits presuming to give authority to violate or cancel the provisions of this code or other ordinances of the jurisdiction shall not be valid." ( 64 9 White - Building Canary - Engineering N Pink - Planning BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT ; r 1 ' „ f APPLICATION RECEIVED r r f' / The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: A .� - I,1+ f. ! Accepted ' Accepted With Corrections Denied , j Reviewed By: '` _ Date: //, Comments: "The issuance or granting of a permit or approval of plans, specifications and computations shall not be construed to be a permit for, or an approval of, any violation of any of the provisions of this code or of any other ordinance of the jurisdiction. Permits presuming to give authority to violate or cancel the provisions of this code or other ordinances of the jurisdiction shall not be valid." Residential Building Permit Checklist New nstr 1 tion for Single or Two - family Dwellings in R -1 or R -2 Districts Reviewed by: 1 I' Date I Z Building Permit # PI ►� Zoning: \..) Address: ‘11(3. Z - \ i- 3 } - 4-k4 5 k,3t5G C r - Legal: L , B Subdivision: • Existing Structure? YES 1 . Existing Nonconforming Structure? YES I NO CONFORMS TO ZONING YO NO ORDINANCE _ Yard Setbacks: NA! FAILS/ CO l ES Standard I Pro osed ' ( • Front Yard (can be 20' if avg. w in 150') 25' Pf 25.31 • Side Yards 107 25' if abutting a strAet 21. 5 To t4eCi ewt, A-vo W N I- • Sidewall exceeding 60' requires additional side 2" 10' setback + setback for every 1' over 60' in length. Not required 2 " 11' over 60' if building wall is 10' -0" or greater of being parallel to a side lot line. • Rear Yard ,25' PcYp 4 47i 11,61 • Patio Door: provide for minimum 10' deck or sign 10' side/ statement indicating no deck will be built in the future 25' rear • From 100 year flood elevation of wetlandINURP 30' - pond. • Refer in- ground pools to the Planning Department • From OHW (Prior or Spring Lake) 75' or setback average of adjacent structures, but no less than 50' I Floor Area Ratio: NA 1 FAILS / C I .30 Maximum mot, Z 3 t *{- Yard Encroachments:( 1 FAILS /COMPLIES I Standard I Proposed Eaves and Gutters no more than 2 feet in width and no closer than 5 feet to a lot line (Easements). NC and other equipment cannot encroach on interior side yards. I Tree Preservation: / FAILS /COMPLIES I Standard I Proposed • Total caliper inches • Permit 35% Removal • Caliper Inches Rena'oved • • Caycr'Igches P served • ROlaceme�i tf Y2:1 L : \TI MEL • Driveway: NA/ FAILS / CO ! • • Standard Proposed I • Maximum width at propgty e 24' Required setback `` Pw • 5' from side lot line or 30' from r -o -w on corner lots • Maximum slope • 10 % • All parking areas to be paved including R -V or spaces adjacent to the garage • Location to match subdivision grading plan 6--N <=3. Building Height: NA / FAILS / CO r • S 35' Maximum Pt-A, 1 Shoreland District: NA / FAILS / C �� MFjLIES ,Standard Proposed I • Minimum lot area (square feet) 7,500 Rip, 7,999 Non -rip Minimum lot width • 50' Rip, 57.3' Non -rip Shoreland alterations Impervious surface 30% Maximum Bluff In Shoreland / FAILS / COMPLIES Standard Proposed • Setback from t of bluff By planning dept. • Bluff impact zone 20' From Top of Bluff • Engineering certification submitted /approved By City Engineer • Grading in bluff or bluff impact zone No importing /exporting • Floodplain: FAILS / COMPLIES Standard Proposed • 100 yea ood elevation 908.9' Prior Lake 914.4' Spring Lake • Lowest floor elevation 909.9' Prior Lake / 915.4' Spring Lake • Proposed lowest floor elevation Must be 1' above flood elevation for new and existing structures. If existing structure was constructed 9/19/90 - 11/22/97 then additional foot is not required. • Elevations 15 feet from structure Must be flood elevation or 1 higher • Road access must be no more than 2 feet below 907.9' for Prior Lake Regulatory Flood Protection Elevation 913.4' for Spring Lake Accessory Structure: / FAILS / COMPLIES Standard Proposed ' • Size 1000 sq.ft. or 30% rear yard • Not located in front yard (Materials) • Side yard and rear yard setbacks 10' • Maximum height 15' • Materials compatible with principle structure L: \TEMPLATE\BLD GLIST.D O C i r Ri CITY OF PRIOR LAKE Date Recd o , �, �,{ HEATING /AIR CONDITIONING/FIREPLACE PERMIT v 4 "" g 4 '4 IVl:so't S. t. r�„t Fik CHP I PERMIT NO. i i . � ' tiRfl! ]. Ytnw Applieat - _ (Please type or print and sign at bottom) . , ADDRESS (Ace usel .. 392 'Pc:0(Kt olZONING ( e C21 _. LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID OWNER (Name) (Phone) (Address) APPLICANT( (619) 7 �? _ (O L Fl (Phone) �n \'\ 11� `�3�7 (Address) ��J V T� Y`�1� l � '11\.) � JrnS ddress) (City) (Zip Code) � (Contact Person) C ei n a` �� (Phone) 4 y? C P1 APPLICANT SIGNATURE / I� ' r DATE 2/ 1 / 13 . APPLICANT PLEASE COMPLETE BELOW � EW CONSTRUCTION ❑ REPLACEMENT ,^ 0 ALTERATIONS FURNACE MAKE AND MODEL Pj) -V)� (l Z', �Go ( / 00 S 1'7 FUEL N ak. l�&S FLUE SIZE RETURN ( OPENINGS E3 INPUT 6 9 ) i COO - OUTPUT 63 , 3(7 0 TYPE OF SYSTEM HEATING OR POWER PLANT PLEASE NOTE: Mr Conditioner Warm Air Plants ❑ Steam Units and Fireplaces Cannot Encroach ravity ❑ Hot Water into Required Side Yard Setbacks. echanical ❑ Radiation Fireplaces with Box Additions or Air Conditioning ❑ Special Devices []vent. System 0 Other Devices Cantilevers to the Outside of Buildings Require a Building Permit. FIREPLACE MAKE AND MODEL • FEE SCHEDULE Industrial, Commercial & Multi - Family I% 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 V WM Estimated Cost $ Building Permit # BUIL .ING, 'lERMI`� The Minnesota . tatuicc + "st:RCIIARGls" has been chanced I'nr one HEATING PERMIT FEE S year effective STATE SURCHARGE S .50 tidy 1.20111. until .tune 30.2011. TOTAL PERMIT FEE $ t he minimum currhnrge fnr n "fixed fee" permit (Office Use Only) Is 53, beginning July 1.2010 This Application Becomes Your Building Permit When Approved Paid Receipt No. Date By Buntline Date 24 hour notice for all inspections (952) 447 -9850, fax (952) 447-4245 4646 Dakota Street S.E., Prior Lake, Minnesota 55372 p Rr Date Rec'd CITY OF PRIOR LAKE PLUMBING PERMIT Mfi'NtSDKp _ ;Lill F* PERMIT NO. : aoia car .. I A . / f) 1 Ydba Apphose (Please type or print and sign at bottom) ADDRESS ZONING (orrice use) ' tl . 2 Cu S i dC CA N .v.1 LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITXON PID OWNER (Name) (Phone) (Address) APPLICANT (Name) C enz- Cl._,y (Phone) ( -(000 (Address) - O 6 -1/%4 % ) 1 N U i Y\ j \ 55337 (Address) (City) (Zip Code) (Contact Person) Gti.i tli.n WSu (Phone) (C162) 701 - «`3 1 APPLICANT SIGNATURE , • e r ' 41 , DATE -2 15 APPLICANT PLEASE COMPLETE BELOW Quantity Type of Fixture Quantity Type of Fixture Bath Tub with or without shower 3 Rough -ins Dishwasher 1 Water Heater Al Floor Drain ?j t Water Softener Lavatory (Bathroom Sink) 1 Stand Pipe (Washing Machine) Laundry Tray (1 or 2 compartment sink Sewage Ejector Shower Stall Backflow Assembly 1 _ Sinks Backflow Assembly Test Bar Sink I Lawn Sprinkler 3 Water Closet (Toilet) Other FEE SCHEDULE industrial, Commercial & Multi- family 1% of job cost with a $49.50 minimum Residential, New One & Two - Family S149.50 Residential, Additions VAEIM1' p 0 A The Minnesota Statutes 3268.145 _ 1st $ Building Permit # BUILDING PERMIT 1 "SURCIIARfE" has been changed for one year effective PLUMBING PERMIT FEE $ July 1, 2010. until ,June 30, 2011. STATE SURCHARGE $ .50 The minimum surcharge fora "Mixed fee" permit TOTAL PERMIT FEE $ is SS beginning duly 1, 2010 ThLs Application Becomes Your Building Permit When Approved Paid Receipt No. Date By Building Official Date 24 hour notice for all inspections (952) 447 - 9850, Fax (952) 447 - 4245 4646 Dakota Street S.F., Prior Lake, Minnesota 55372 • • ,--..,.. .... dp CITY OF PRIOR LAKE BUILDING PERMIT. Date Recd (..6. .r . 7) TEMPORARY CERTIFICATE OF ZONING CONIPLIANCE — AND UTILITY CONNECTION PERMIT A:Es PERMIT NO. (2. i z e t z Please type or print and sign at bottom) ADDRESS ' . ZONENG , AT.ce :Iv' s 1 4 '2 --.'7 ) -1" . pt 1Z, Kt"(:) C C--1 . LEGAL DESCRIPTION (office use LOT BLOCK ADDITION PID OWNER 1 ,i ......, (Name) r I Pk 1 iirkM` / -<; (Phone) q 5Z - 277 (Address) - 7 z 0 t t,,,Y050 i 1,1 usec tkos C - t .- ) 1 t-J A , 1 Pki , 4 3 .- . . 1 --lailki3€41. C:„.1.7 tv,STRACi DR. . .-1 -a -v -1 (Company Name) lac r" ` 1 riN1 * ) te..E25 ) 1 ...1-1-„, . (Phone) t (,),,,., - 217 I i - , (01:3 (Contact Name) HAZY KO...A t.-4.6,14. (Phone) (Address) 1 iii 0 TIP-Ck. ili— CA e(...t.i.. '-' t'IL):S e"..):: a c- k , TYPE OF WORK )11,vew Construction ODe OPorch C3Re-Roofng DRe-Siding ElLower Level Finish 0 Fireplace OAdditiort OAlteration OCtilitv Connection CODE: pl.R.C. OLB.C. 0 Mtsc Type of nstruction: 1 11 111 IV V A B - 2, I Occupancy Group: A B E F II I M (I) S U PROJECT COST/VALUE S , ---9 40 - 00 Division: 1 2 0) 4 (excluding land) ; reicbs ..r.-dfs that 1 have furnished information on thus am:hearten svh...M ts ed tt ben of my loniwtedo true ini memo: la:so :tent that 1 am the ovate- or aurhornted agent for the shovemeranned powers and that all constructs= Ann contamn to ar extstut4 sate and Inca; !EWS. 1,7:',1 w poreeed r: serordance wnh submitted plans 1 an aware tat the hufairng , Tota! can !Twice mat pentut fir rust cause Furtherrnote i 4, crehs /Vet thA 'he Clii." OtFC131 a dCA'griett "'A) er mr.r Mt. rmt7en to perform needed ,nspertasns :,""s. -■if . C. — /45 2 -2.2..- is Signature Ct74C1, 4 L ove tit., Date Permit Valuation I Park Support Fee « $ Permit Fee S SAC # S Plan Check Fee 1 S Water 1.1eter Size 5/S I 5 s State Surcharge 5 Pressure Reducer 5 Penalty 5 Sewer/Water Connecnon Fee # $ 1 Plumbing Permit 5 Water Tower Fee # S s Mechanical Permit Fee $ Builder's Deposit ! $ Sewer & Water Pertnit Fee 5 Other PAO) WITH Gas Fireplace Permit Fee 5 TOTAL DUE BUILDWG PERMIT ) - 'on Becomes Your Building Permit Approved Paid 1 Receipt No. 1 1 i 4 , Date I By 1 \33/47 Thiii Offisni Date Th.s is to certify the the request us the above application and si.,- donsments ss in arcordamre * the Cr, Zoning Ordinance and may pureed as respelled Thts ducurresr when iqzned tw thg Cu l! FIVITICI COttEltUtC1 a tempstran Ctetlioate of 7. onmg ownplumx and aL'itsys .,1!15•MA..X.I! tL` , Before occupancy. A Crndicate of Occupancs rITAV he issued Mons% Director Doc Special Conditions, It an) 1 24 hour notice for all inspections (952) 447-91150. Dis )952) 44 4646 Dakota Street S.E., Prior Lake, Minnesota 55372 • t 4 PRI i Date Rec'd H CITY OF PRIOR LAKE /1,./Li /2_ rn SEWER AND WATER PERMIT p� jNNESO�� /2 . /LO 2 - 1. Green File PERMIT N d Z . / Z ri 2. Yellow / 7 o *— 3. Gold d Applicant ! . pplicant p� (Please type or print and sign at bottom) / 2� ` / ?4Q 5 ADDRESS Z ON IN G (office use) 1' 9 '1 9 P a .o G LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID OWNER (Name) (Phone) (Address) (City) zi Code) (Address) ( ty) ( p APPLICANT (Name) t• S, AA' (Phone) A S /-lad - 1 3 SS (Address) 911 /1-we . • 1� vw►. .5Sel 3 3 Address (Address) (City) (Zip Code) IAA ` (Contact Person) r I` _ Q A (Phone) APPLICANT SIGNATURE " t / ' `^ DATE I I - I I I - I L APPLICANT PLEASE COMPLETE BELOW Size of water service inches. Location of any couplings from structure feet. Type of sewer pipe. ❑ ABC ❑ PVC ❑ Cast Iron Estimated length of sewer line feet. Clean out (if required) located at feet from structure. FEE SCHEDULE Residential sewer and water line connection $51.50 Industrial, Com'l & Multi- family 1% of job cost with a $51.50 minimum Sewer connection only $25.50 Water connection only $25 Estimated Cost $ Building Permit # �,. -D__Ns' ' SEWER AND WATER PERMIT FEE $ 1 STATE SURCHARGE $ .50 TOTAL PERMIT FEE $ DrL. (Office Use Only) This Application Be es Your Building Permit When A roved Paid Receipt No. I Date By Building Offic !', Date 24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 4646 Dakota Street S.E., Prior Lake, Minnesota 55372 From:Genz -Ryan 952 767 1900 02/15/2013 11:57 #061 P.002 /0 ,7. Q O1 p R>r�'� Date Rec'd ��' CITY OF PRIOR LAKE PLUMBING PERMIT v d'hv»aso�r` I Z7, 2 ''e [PERMIT NO. ^Z _/Z L. Z App 6 3. Yellow Applicant ease a or and sign at bottomnj ADDRESS � Cil— N \i _....___ — ZONING? (owe two de LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID OWNER �. (Name) (Phone) (Address) API'I.ICANT � nx (Phone) ( - 7( 1 1 —' ©00 (Name) �1 f (Address) 220 RYA 1 \/\\ Burn&ii \,k-e_- _._._.. 6533 7 (Add) (City) (Zip Code) (Contact Person) 4 ill n Liu r (Phone) (1'SY7(o1 ` (2 i \` APPLICANT SIGNATURE dr , 4 " r ' fi t DATE APPLICANT PLEASE COMPLETE BELOW 1 uanti 9, e of Fixture 1 uanti T . e of Fixture 1111111/111111 Bath Tub with or without shower Ewa= Row_ -ins ME Dishwasher 111111111111111 Water Heater IIIIII Floor Drain apf= W ater Softener `, r Lavato : athroom Sin Stand Pi .e ashin: Machine Laund Tra 1 or 2 corn, ailment sink 1111111.11. Sewa:e E'ector mu Shower Stall Backflow Assembly 111111i Sinks Backflow Assembl Test Mill Bar Sink Lawn Sprinkler Water Closet oilet 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 The Minnesota Statutes 326B.148 • " 1st $ --_ Building Permit # "SURCHARGE' has been changed for one PAID WITH year effective PLUMBING PERMIT FEE $ BUILDING PERMIT duly t, 2010, until .tune 30, 2011. STATE SURCHARGE $ .50 The minimum surcharge fora "fixed fee" permit TOTAL PERMIT FEE $ is LS heginninx 311/y 1, 2010 This Application Becomes Your Building Permit When Approved Paid Receipt No. Date By Ba3tdtna UfMdat Date ( _.. 24 hour notice for all inspections (952) 447-9850, fax (952) 447 -4245 4646 Dakota Street S.E., Prior Lake, Minnesota 55312 From:Genz -Ryan 952 767 1900 02/15/2013 11:57 #061 P.001 /0.7. i Q ztt� o + Sy il CITY OF PRIOR LAKE Date Rec'd = '' � BEATING /AIR CONDITIONING/FIREPLACE PERMIT • 41 4vi rEsol Z Z,`„ rZ PERMIT NO. /2._ J 212.....1 3. Yellow Aoollesnt , (Please type or print and sign at bottom) ADORES _ ZONING (umcc use) 9 e 2—. VtaXV ae CI \t LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID OWNER - (Name) (Phone) (Address) • APPLICANT ) 052 7 (1 ( 000 � (Name) t�l hone (Address) _..... 6 R1 ?Or n I"OL ( ddress) (City) (Zip ,, �(.( de)) (Contact Person) l t f ��`� (P ( 4l ) (L I �r � . APPLICANT SIGNATURE _ 2/ DATE APPLICANT PLEASE COMPLETE BELOW • )SKEW CONSTRUCTION G ❑ REPLACEMENT " El ALTERATIONS FURNACE MAKE AND MODEL B)r l k t 1Z SP42 O(UO S 17 FUEL \N . Ct—S FLUE SIZE RETURN (OPENINGS S INPUT GP) i COO OUTPUT 63 I N 0 TYPE OF SYSTEM HEATING OR POWER PLANT • PLEASE NOTE: Mr Conditioner Wa Air Plants ❑ Steam Units and Fireplaces Cannot Encroach cavity ❑ Hot Water into Required Side Yard Setbacks. echanica) ❑ Radiation Air Conditioning El Special Devices Fireplaces with Box Additions or []Vent. Systetn Q Other Devices Cantilevers to the Outside of Buildings Require a Building Permit. FIREPLACE MAKE AND MODEL FEE SCHEDULE Industrial, Commercial & Multi- Family I% of job cost Residential, Gas Fireplace S49.50 S49.50 minimum ' D WITH Residential, Heating & A/C (New Construction) $149.54 Residential, Additions & Alterations S A Residential. Heating Only (New Construction) $64.50 Residential, AC Only M U I a ` , (3 PERMIT Estimated Cost $ Building Permit # The Minnesota Statutes * 32613.1411 HEATING PERMIT FEE $ "St :RCF1AR(fl "has heen changed for one yearelTectivc STATE SURCHARGE $ .5Q Judy I.2011), ant nr ti1, 2011. TOTAL PERMIT FEE $ The minimum surcharge fora "fired fee" permit (Oince Use Only) b Ef beginning duty 1.2010 This Application Becomes Your Building Permit When Approved Paid Receipt No. Date By Buildtna Official Date • 24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 4646 Dakota Street S.E., Prior Lake, Minor-seta 5537E Contractor's Material & Test Certificate for Aboveground Piping PROCEDURE Upon completion of work, inspection and tests shall be made by the contractor's representative and witnessed by an owner's representative. All defects shall be corrected and system left in service before contractor's personnel finally leave the job. A certificate shall be filled out and signed by both representatives. Copies shall be prepared for approving authorities, owners, and contractor. It Is A ' understood the owners representative's signature in no way prejudices any claim against contractor for faulty material, poor workmanship, or failure to ' X comply with approving authority's requirements or local ordinances. PROPERTY NAME: . JEFFERS POND , DATE #2. '11 (3 1 c PROPERTY ADDRESS: 14392 PARKSIDE COURT i...... ACC TED BY APPROVING AUTHORITIES: CITY OF PRIOR LAKE ADDRESS PLANS INSTALLATION CONFORMS TO ACCEPTED PLANS EVES ❑NO •------ EQUIPMENT USED IS APPROVED EMS ONO IF NO, EXPLAIN DEVIATIONS HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS BYES ❑NO TO LOCATION OF CONTROL VALVES AND CARE AND MAINTENANCE OF THIS NEW EQUIPMENT? IF NO, EXPLAIN INSTRUCTIONS HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES: OYES ❑NO 1. SYSTEM COMPONENTS INSTRUCTIONS OYES ONO 2. CARE AND MAINTENANCE INSTRUCTIONS OYES ONO 3. NFPA25 EVES ONO LOCATION ENTIRE BULDING YEAR OF TEMPERATURE MAKE MODEL MANUFACTURE SIZE QTY. RATING RELIABLE RES 49 2012 1/2 11 155 SPRINKLERS RELIABLE RES 44HSW 2012 1/2 15 155 RELIABLE F3QR 2012 1/2 1 155 PIPE AND Type of Pipe BLAZEMASTER FITTINGS Type of Fitting CPVC MAXIMUM TIME TO OPERATE ALARM DEVICE THROUGH TEST CONNECTION ALARM VALVE OR FLOW INDICATOR TYPE MAKE MODEL MIN SEC FLOW INDICATOR POTTER VSR - F 0 L t 9 DRY VALVE Q.O.D. MAKE MODEL SERIAL NO. MAKE MODEL SERIAL NO. DRY PIPE TIME TO TRIP TIME WATER ALARM OPERATING TEST THROUGH TEST WATER AIR TRIP POINT REACHED OPERATED CONNNECTION' PRESSURE PRESSURE AIR PRESSURE TEST OUTLET' PROPERLY MIN SEC PSI PSI PSI MIN SEC YES NO W/O Q.O.D. WITH Q.O.D. IF NO, EXPLAIN LOCATION MAKE & SETTING STATIC PRESSURE RESIDUAL PRESSURE FLOW RATE & FLOOR MODEL (FLOWING) PRESSURE REDUCING INLET (PSI) OUTLET (PSI) INLET (PSI) OUTLET (PSI) FLOW (GPM) VALVE TEST N/A OPERATION: ❑PNEUMATIC ❑ELECTRIC ❑HYDRAULIC PIPING SUPERVISED OYES ONO DETACHING MEDIA SUPERVISED OYES CI NO DOES VALVE OPERATE FROM THE MANUAL TRIP AND /OR REMOTE OYES ONO CONTROL STATIONS DELUGE & IS THERE AN ACCESSIBLE FACILITY IN EACH CIRCUIT IF NO EXPLAIN PREACTION FOR TESTING VALVES OYES O NO N/A DOES EACH CIRCUIT OPERATE DOES EACH CIRCUIT MAXIMUM TIME TO MAKF MfDFL RI IPFRVIRIC) I ORS Al ARM CIPFRATF VAI VF RFI FASF CIPFRATF FI EASE YES NO YES NO MIN SEC HYDROSTATIC: Hydrostatic test shall be made at not less than 200 psi (13.8 bars) for two hours of 50 psi (3.4 bars) above static pressure In excess of 150 psi (10.2 bars) for two hours. Differential dry-pipe valve clappers shall be left open during test to prevent damage. All Aboveground piping leakage shall be stopped. TEST DESCRIPTION PNEUMATIC: Establish 40 psi (2.7 bars) air pressure and measure drop, which shall not exceed 1 -1/2 psi (0.1 bars) in 24 hours. Test pressure tanks at normal water level and air pressure and measure air pressure drop, which shall not exceed 1 -1/2 psi (0.1 bars) in 24 hours. ALL PIPING HYDROSTATICALLY TESTED AT 200 PSI FOR _g_HRS IF NO, STATE REASON DRY PIPING PNEUMATICALLY TESTED OYES ONO EQUIPMENT OPERATES PROPERLY YES CI NO WA DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT ADDITIVES AND CORROSIVE CHEMICALS, SODIUM SILICATE OR DERIVATIVES OF SODIUM SILICATE, BRINE, OR OTHER CORROSIVE CHEMICALS WERE NOT USED FOR TESTING SYSTEMS OR STOPPING LEAKS? EVES NO _ DRAIN READING OF GAGE LOCATED R WATER RESIDUAL PRESSURE WITH VALVE IN TEST CONNECTION TESTS TEST SUPPLY TEST CONNECTION /0U PSI CONNECTION OPEN WIDE70 PSI UNDERGROUND MAINS AND LEAD IN CONNECTIONS TO SYSTEM RISERS FLUSHED BEFORE CONNECTION MADE TO SPRINKLER PIPING. VERIFIED BY COPY OF THE U FORM NO. 85B YES ONO OTHER EXPLAIN FLUSHED BY INSTALLER OF UNDERGROUND SPRINKLER PIPING BYES ONO IF POWDER DRIVEN FASTENERS ARE USED IN OYES ONO IF NO, EXPLAIN CONCRETE, HAS REPRESENTATIVE SAMPLE TESTING BEEN SATISFACTORILY COMPLETED? BLANK TESTING NUMBER USED LOCATIONS NUMBER REMOVED GASKETS 0 WELDED PIPING OYES ®NO IF YFR DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING PROCEDURES COMPLY WITH THE REQUIREMENTS OF AT LEAST AWS 010.9, LEVEL AR-3? YES ONO WELDING DO YOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS QUALIFIED IN COMPLIANCE WITH THE REQUIREMENTS OF AT LEAST AWS D10.9, LEVEL AR-3 EMS ONO DO YOU CERTIFY THAT WELDING WAS CARRIED OUT IN COMPLIANCE WITH A DOCUMENTED QUALITY CONTROL PROCEDURE TO INSURE THAT ALL DISC ARE RETRIEVED, THAT OPENINGS IN PIPING ARE SMOOTH, THAT SLAG AND OTHER WELDING RESIDUE ARE REMOVED, AND THAT THE INTERNAL DIAMETERS OF PIPING ARE NOT PENETRATED? OYES ONO CUTOUTS DO YOU CERTIFY THAT YOU HAVE A CONTROL FEATURE TO ENSURE THAT ALL CUTOUTS (DISCS) ARE RETRIEVED? IF.YES ONO HYDRAULIC NAMEPLATE PROVIDED IF NO, EXPLAIN DATA YES ONO NAMEPLATE REMARKS DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN: 4//Z4/) 5 NAME OF SPRINKLER CONTRACTOR: FIRE SUPPRESSION SERVICES, LLC. TEST ESSED BY ! e •�� • '� IGNED) TITLE DATE SIGNATURES ^ �pC(�' y y //3 s r- r 'T"� " � 6 RIN / C ' (SIGNED) TITLE DATE '111 ' ate, ,.t.il 0-1- 0 i IZStir 3 �JJ ADDITIONAL EXPLANATION AND NOTES) 9 Builders Deposit rn 4INNEso"0" 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 dean 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. '}, DATE: 10� \ \� SITE ADDRESS: L1 Z-- Pi`-" VStDE G PERMIT# �� REFUND TO BE MAILED TO: N (,"rb N �v � S SU rf E Zo 1 SS 43 9 AUTHORIZATION TO RELEASE PLEASE REMEMBER X1 S Y Services Amount 1. KEEP STREETS CLEAN DURING CONSTRUCTION Date Acct. 801.20204 2. KEEP EROSION CONTROL IN PLACE MI Iat'i I: e 4"�_ ��eZKK�I g y�J a: ►fil k Y i kgkt, MAWA:4IN Z** ! IDIVA'Il4 141.0 724 Il#1! SI G NATURE:�`'� -- � -- C:lDocuments and Settings\sbare\Local SettingslTemporary Internet Files\ Content .Outfook1BD80X19A1BUILDERS DEPOSIT FORM.DOC PRIOR LAKE DEPARTMENT OF BUILDING AND INSPECTION 0 INSPECTION RECO SITE ADDRESS I"t3c 2 P/At2446 IDE C- T. NATURE OF WORK DEcic too R,(2z4A ors. . USE OF BUILDING Sulep Fl -" A- r-c,4Ge# PERMIT NO. 12- 128 Z I DATE ISSUED «/z ► CONTRACTOR MATTA rt-c' k o A k e - s - PHONE 952. • 8°t -C71 NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW THE PERMIT IS BY SEPARATEDOCUM (NI STA u— e I o +� Cc ; (2-0 t.. I +aT�411J G� '`ta TR I a bR r 1..[.. 1 I M s DATE I FOOTING (Y 1► � S 1 ?,6 1 / /hb / l I 1 FOUNDATION (Prior to Backfill) air: f s / Z J PLACE NO C o CRETE UNTIL ABOVE HAS BEEN SIGNED 0 0 ,0 ^ 1 �;r,��uz. !''-,' TROUGH - INS SEWER / WATER /SEPTIC '/ x" FRAMING PA, XI ,,�,,, �,, INSULATION t ..- , ELECTRICAL PLUMBING 047, vi s a / g ° / - „J� HEATING (if required) / ' t/ FIREPLACE GAS LINE AIR TEST > � , - 4, x;' - 0 1 f 13 � ‘" `� COVER O WORK UNTILABOVE HAS BEEN SIGNED 1 FINALS P13 lz.91,1 GRADING (Prior to Sodding) BUILDING S i3 ELECTRICAL PLUMBING pp ci f HEATING 5=1570 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