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CITY OF P LAKE
Prpartntruf of !uithin Jnspttfion
❑ Final Permitted ❑ Conditional C.O. Expires
,, T his Certificate issued pursuant to the requirements of Section 110 of the El Residential l ❑ International K� 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:
��' h^ Bld Permit No. �� ' l��
�I NGI F FA:11 g 1')_
Use Class ifi ca tion ti ��
V ' Zon District
R Type Construction r,
� : Oc cupancy Type ��
�. 1 .31, PJ , JFFFFRS WATFPFRONT
Le Description 1 2 P A !� S I F COUR NICE
S ite Address `Y
Owner of Building
z MATTA HOM
Contractor's Name &Address
1 pOP,PRT �, H!ITCHI S City Planner
" Date Building Official
/- — '� Date:
P OST IN CONSPICUOUS PLACE
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6 ,r. ''''?e• CITY OF PRIOR LAKE BUILDING PERMIIT, 1JdtG l�A, i. u
TEMPORARY CERTIFICATE OF ZONLNG COMIPLIAtiCE
AND UTILITY CONNECTION PERMIT ,, , ; , �' g ' 'Y `.
" r 6S
N <�j E S 2. white File P ERM T N O 14y 2. Pink City •
3. Yellow Applicant
(Please , e or . tint and si at bottom)
ZONL�i G (office use)
ADDRESS 1 t-1 . 3 v ca � � rp � LT
LEGAL DESCRIPTION (office use only) 1 ^ / 2-G41 O 3 1 n
l J E � r �/ " R- , rL- u-0 t-J--t PID
LOT BLOCK ADDITION
OWNER M (Phone)
(Name) i'l P T T A. M `�
(Address) - 12c51 W R S1-1- t 14 6; u t-.1 0./ E S STE_ 20 l
e.0l1-..14k r-1N sSU-39
BUILDER j .. 1 �, r - t Amt —ti' -1-4-0 1 "t ES (Phone)
(Company Name) (Phone)
(Contact Name) S U E 7"" - t� I-1 1 SST 39
(Address) 1' t 1."-ilk S 44 1t--.1 (, N
v1= S S-r� 2-U t t=o t NJ A
TYPE OF WORK % New Construction
Deck ❑Porch ['Re- Roofing ['Re- Siding ['Lower Level Finish [' Fireplace
['Addition []Alteration ['Utility Connection
❑ Misc:
CODE: I.R.C. 6 [JI•B•C• v U b0
I II III IV V A B
Type of Co. • coon: PROJECT COST /VALUE $
Occupancy Group: A B E F HI MR S U (excluding land)
p 1 2 3 4 5
Division:
that I am the owner or authorized agent for the
application which is to the best of my knowledge true and re t. I asoce� that I am plans. I am aware that the building
I hereby n property have and that furnished information on this app ' stare and local laws and will proceed on the property to perform needed inspections.
a
above-mentioned cial can revoke per and that all cause. e will conform to all existing
permit for just cause. Furthermore, I hereby agree that the city official or a designee may enter up P oP�y p \ \\1‘.., \12_
official can revoke this p �� fj? c J3a b
�� �, Date
X4111111‘
�� Contractor's License No.
Signature
Park Support Fee # $
Permit Valuation 1 (e 60 � � '
MSIIIINIIIIIIIIII $ 12 • to . So $ go,
IlgaSinaIIIIIIIIIII "; 1 ";
1 $
$ ' S , p, Pressure Reducer $
Sewer /Water Connection Fee # $ 00,
liiiiiiNIIIMINIIMUIIIIIIIIIIIIIII Water Tower Fee # $ p -
Plumbing Permit Fee $ 1 S 4• S O 1 S Bp, -
$ Builder's Deposit
Mechanical Permit Fee S , 50 $ 4 .Co
$ (0 O Other l ast t 5, , , .► • ,
• TOTAL DUE $ Z `i • . l S
Gas Fireplace Permit Fee $ 5 4 , Sfl
owed Pai B
This App '., tion . omes Your Buildin Permit Wh Ap' Date > >
/ i � • l Z IZ rL
. /x.411111 Date
Buil. , a f cut
4
This is certify t i. ,
.Cu is is in accordance with the City Zoning ordinance and may proceed as requested. This document
when signed ned � accompanying
an
, e Ci � I. � • cons qu: in the amabove tes a temporary application Certificate r ertificcate ats of Zo . ! co. dunce and allows construction to commence. Before occupancy, a Certificate of coup cY must be
/ il�
issued. I 4
"ghl■-. 12- /Z. 1i Special Conditions, if any
Date
NonniDirector
24 hour notice for all inspections (952) 447-9850, fax (952) 447-
4646 Dakota Street S.E., Prior Lake, Minnesota 55372 .
1 7 0c., 11, to , t„,
•ZIP A •
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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
understood the owner's representative's signature in no way prejudices any claim against contractor for faulty material, poor workmanship, or failure to
comply with approving authority's requirements or local ordinances.
DATE 60! — 2-) -- I.5
PROPERTY NAME:. JEFFERS POND
PROPERTY ADDRESS: 14388 PARKSIDE COURT
ACCEPTED BY APPROVING AUTHORITIES: CITY OF WOODBURY
ADDRESS:
PLANS INSTALLATION CONFORMS TO ACCEPTED PLANS ISIYES ONO
®YES ONO
EQUIPMENT USED IS APPROVED
IF NO, EXPLAIN DEVIATIONS
HAS PERSON TO LOCATION CONTROL VALVES AND CARE AND MAINTENANCE AS
YES ONO
OF THIS NEW EQUIPMENT?
IF NO, EXPLAIN
INSTRUCTIONS HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES: OYES ONO
®YES ONO
1. SYSTEM COMPONENTS INSTRUCTIONS BYES ONO
2. CARE AND MAINTENANCE INSTRUCTIONS EYES ONO
3. NFPA 25
LOCATION ENTIRE BULDING TEMPERATURE
YEAR OF
MAKE MODEL MANUFACTURE SIZE QTY. RATING
RELIABLE RES 49
2012 1/2 11 155
SPRINKLERS RELIABLE RES 44HSW 2012
1/2 16 155
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 MAKE MODEL MIN SEC
FLOW INDICATOR TYPE LFl
FLOW INDICATOR POTTER VSR - F CP
DRY VALVE Q.O.D.
SERIAL NO. MAKE I MODEL SERIAL NO.
MAKE MODEL I
TIME WATER ALARM
O PIPE TIME G H TT IP EST WATER TRIP POINT REACHED OPERATED
OERATING TEST THROUGH TEST AIR
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
PRESSURE
REDUCING INLET (PSI) OUTLET (PSI) INLET (PSI) OUTLET (PSI) FLOW (GPM)
R
VALVE TEST
N/A
OPERATION: ❑PNEUMATIC ❑ELECTRIC ❑HYDRAULIC
PIPING SUPERVISED OYES ONO DETACHING MEDIA SUPERVISED DYES ONO
DOES VALVE OPERATE FROM THE MANUAL TRIP AND /OR REMOTE
CONTROL STATIONS OYES ONO
DELUGE & IS THERE AN ACCESSIBLE FACILITY IN EACH CIRCUIT IF NO, EXPLAIN
PREACTION FOR TESTING
VALVES
N/A DYES ONO
MAKE MOflFL DOES EACH
RVISION CIRCUIT n S O Al ARM OPFRATF VA CIRCUIT MAXIMUM TIME TO
ARF OPFRATF FFI FARE
YES NO YES NO MIN
SEC
HYDROSTATIC: Hydrostatic test shall be made at not less than 200 psi (13.6 bars) for two hours of 50 psi (3.4 bars) above static pressure
Aboveground 1 pipi g leakage shall be stopped. Differential dry-pipe valve clappers shall be left open during test to prevent damage. All
TEST
DESCRIPTION PNEUMATIC Establish 40 psi (2.7 bars) air pressure and measure drop, which shall not exceed 1 -1/2 psi pressure tanks at normal water level and air pressure and measure air pressure drop, which shall not exceed 1-1/ p s) in hour 24 ht
psi (0.1 1 bars) in s 24 hours.
ALL PIPING HYDROSTATICALLY TESTED AT 200 PSI FOR _ HRS IF NO, STATE REASON
DRY PIPING PNEUMATICALLY TESTED OYES ®NO
EQUIPMENT OPERATES PROPERLY YES ONO
N/A
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?
, EMS NO
DRAIN READING OF GAGE LOCATED R WATER RESIDUAL PRESSURE WITH VALVE IN TEST CONNECTION
TESTS TEST SUPPLY TEST CONNECTION PSI CONNECTION OPEN WIDE WI 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. 858 (RYES ONO OTHER
FLUSHED BY INSTALLER OF UNDERGROUND I EXPLAIN
SPRINKLER PIPING ISMS ONO
IF POWDER DRIVEN FASTENERS ARE USED IN !EYES ONO
CONCRETE, HAS REPRESENTATIVE SAMPLE IF NO, EXPLAIN
TESTING BEEN SATISFACTORILY COMPLETED?
BLANK TESTING NUMBER USED I LOCATIONS I
GASKETS 0 NUMBER REMOVED
WELDED PIPING DYES ONO
IF YFS
DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING PROCEDURES
COMPLY WITH THE REQUIREMENTS OF AT LEAST AWS 010.9, LEVEL AR -3?
OYES 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 YES 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?
YES ONO
CUTOUTS DO YOU CERTIFY THAT YOU HAVE A CONTROL FEATURE TO ENSURE THAT ALL
CUTOUTS (DISCS) ARE RETRIEVED? YES ONO
HYDRAULIC NAMEPLATE PROVIDED IF NO, EXPLAIN
DATA
EWES ONO
NAMEPLATE
REMARKS DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN: G Z) -2
NAME OF SPRINKLER CONTRACTOR: FIRE SUPPRESSION SERVICES. LLC.
TEST WITNESSED BY
FOgPFjOP TY OWNER (SIGNED) 1 TITLE DATE
SIGNATURES
— (4/7.166:" A4 1 — 44,e 67ii /3
• e PRI /I ONT' : •R (SIGNED)
WO " ' TITLE DATE
ADDITIONAL EXPLANATION AND NOTES
•
ItHill lff, 1 ,tp, H 11, \y 11= \
. ?kir. L. ,.._ 1 ■
CITY OF PRIOR LAKE 131:ILD1\ G PERMIT. l' u 1 - — Date Res- d 1
i--- e'
TENIPORARY CERTIFICATE OF ZONING COMPLIANCE 1\ APR 1. 1 2013 i l 1 1 1
AD UITLITN CONNECTION PERMIT
PERAK'!" O.
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ZOrs;G 0,.,..,5=t
r—AbDRESS ,,r. , il ,
_ .--------._-------------_,..-------- ---------
, __._..._._-------_------------__ _. _ _—__—.--__--,_------------
, LEGAL DESCRIPTION (unict USC OnlY' ,
, LC)-Al2DIT.......----_-___—_—_,,N; ----- —______________--.-----PID --------
-----------_--_--_ ---_,
OWNER
(Name) MATT-01/4IJ1/4. -\,01-kc.6. _ .1
ite
(Addtess) •
.._____ ____-% ( 1------_----- -----
'414014,14ER cx w-reru.. Tog. ..
(Company Namel_SZC. ifr 1 4 v. , 4
(Contact Name) IA I:L. . ._ • ..6, tPhone)
,^) ,
(rTE OF WORK 4w Corstrucum Crack 721Fc.:.,+ CiRe*RooF.r4 CRe :St -.17r...; 'D.1..'N'et Le l FlrItSh
Arldmort DA.Iterar:or. C... ta Loartcrlors
CODE: XI.R.C, 01.B.C. 0 M:,:.
Type of Construction: 1 11 111 15" V A B
Occupancy Group: A B E F II 1 M tt 5 U 22.3 oC)
PROJECT
Division: 1 2 9 4
i hirtri, CCIT that i FIA‘ ?,stsitshed 4nfotrustion t-----r----"hs spc4,!...soor th; --------7-7 's , , of co .,, st.o,e., , s- .. „ 4 .:7,- t.,:ri,,-------------- am
r ss , ,,, i r,,b,,n ,' ate.:},,,i; v: ,-,, s , 4,,,,wti.,tt
31,0,t rner.somed properto stld that all constriction wil cont strs 1: s ta c.ag .,' • , C. a ,.... c J, .. i, c c , c ; r, , ,
or .:111 rerictr ;as perrit Of )4}it CALtit FUrtherr,cre 1 ',e'en, acct t 1-c or, ccf or A arrtgirt ..,-. , - ..r*, rc,r ; rtn nc-ec,r2
...., Ce''
Sagnature
----
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7Permalla7.1017.-----1 1,—Pa:k Sunort Fee # 5
"---"--
Perrmt Fee , 5 AC # S ,
1
------------ ' ____-----,-, >...—
Plan Check Fcc -11--- Watcr Nteret _Size 5 '' . . 5
State S asure urcharge 5 !,...._.--_
i Ptsr Reth:zer 5
—.---- r--
Perak!, 5 , srAcT W ater G-74-ine... :yr. PT. 5 ...*:(
.,--_--_—.
Plurnbing Permit 'Fee t $ Waterr Ica rr Fee 5
___-----------,,,
Mechantca: Pelt Fee $ ' L,..,_'_,------L-------------
----------- --------1
Sewer 14 Water Pernut Fee $ Other $
' Gas Ftrep:ace Permit Fee t S 1 TOTtkl. DLL .
, 1,1 ve
Ofr,,e$ Your Building Permit 'ben Aptir---ored --; 1 raid 1.0,, - 'a
1 Alk
- 15 . ,,, . tt. _—__ ____,_,c2o.
ie •
4/7(
f • .110
' Du ! n Official
Ms a t.0 cestlfs the the requast In the above applitstpois and accf.ircpatyttag 4xiantnts Is ■.41 acartax‘ce NI'll ■ : ,i+. C, ntr,g ,"■ta..sartce seal may proceed at ttowaested r-,,a 4,ocurtsen•
whez .igried t the C.tv Planner alnStItUrCS A tt-st-porars :: c-rf' zee. , sf 7or.4-1. cssiwasttce c --,,Tcnct ictt,) o cculsanc , a Cestfcee of Occsscats..-s ,"1:',1V be
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PlAWItni, t,),MCW,t -------- ' - ----""m—'--T-m
24 hour noose Mr all mipermons (4 44 -WO. flx 19.5..$ 44 -424;
4646 Datiot* Street Sf..,. Prior 1, stke. stiorimots 441-.2
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• ' ° 1 i •
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Date Rec'd
0,.,7 R CITY OF PRIOR LAKE PLUMBING PERMIT
}.M f < ft ill etre F,le PERMIT NO. l 2 , i4 z/
4 . 2 GoW City
INNBS O 3. Yellow Applicant
'lease or , ',t andst: • at bottom
ZONING (office use)
ADDR U s D
LEGAL DESCRIPTION (office use only) �► PIDv3 , .D l_
LOT 1 BLOCK 1 ADDITION
OWNER 1 (Phone)
(Name) -
(Address)
(Phone) • .. 111 q
(Name) - A ! ,l. ui. ■ "11) t (P 3
(Name) �
�-a r I(� - 1� 1 (Zip Code)
(Contact Person)
(Address) l� (City)
(Address) nn ''II 1 ' ^ , 1 •'-
V (<� ' • Al ai 1 (Phone)
. 1,i ! ' 1 l 1 , DATE o
J_ I
APPLICANT SIGNATURE I
APPLICANT PLEASE COMPLETE BELOW T �, a of Fixture
4
T lie of Fixture Rou -ins
_ Bath Tub with or without shower
Dishwasher Water Softener
IIINIIIIIII Floor Drain Stand a ashin: Machine
�� Lavato : athroom Sink Sawa :e E' ector
IIIIIIIIIIINIIII Laund Tra 1 or 2 corn • artment sink Back flow Assembl
Shower Stall Back l ow Assembl Test
�, Sinks
—11111111111111111 .
Bar Sink
�� Water Closet Toilet IIIIIIIIIIIIM
FEE SCHEDULE
Industrial, Commercial & Multi - family 1% of job cost with a $49.50 minimum Residential, New One &Two- 1:anilY 5149.50
Residential, Additions & Alterations 549.50
+st $ Building Permit #
The Minnesota Statutes § 3268.148 �� /' X7'1
"SURCHARGE" has been extended
PL
BING PERMIT FEE $ `I ,
until June 30, 2013, STATE�SURCHARGE S
The minimum surchar for TOTAL PERMIT FEE $ --
"Fixed fee" permit is $5.00
This Application Becomes Your Building Permit When Approved Paid Receipt No.
Date liall.11111
Sandlot Official Date pe �� ��
24 ho 4646 Dakota S E., Prior Lake, fax (952)
55372 447-4245
BUILDING PERMIT
CITY OF PRIOR LAKE Date Recd
of R � HEATING /AIR CONDITIONING/FIREPLACE PERMIT
u , g
1 pink File PERMIT NO. 417/All
'fit) ,� 3 Pink Cl / w
NNESa P 3. Yellow Applic nt
(Please type or print and sign at bottom) ZONING (office we)
ADDRESS � ,t , f (` 1 71).5b 1 LI 313 Pak -td�. ca,'
LEGAL DESCRIPTION (office use only) a3�'�
�//yy'' IV/44 ._ ID03J �'1f-
LOT�f BLOCK � ADDTTION�J•e`E't.�+` ,J, 4 ► • P
OWNER „.p � } . M' AA (Phone)
(Name) J�. 'lJ
(Address)
APPLTC�`� �� �/� (Phone) 9) — 0)9
ame) AN G,c vet V W t �� /L 4 I
CO .,. ) 3
(Address) 1 / ( City) (Zip Code (Addy s) c
,. ' . ' <SA f (Phone) - 1 ( •
(Contact Person) ,� ! / 3
APPLICANT SIGNATURE � 1 e1`/ DATE (o 1 1
APPLICANT PLEASE COMPLETE BELOW
°t.t W CON RUCTION L
r' REPLACEME T ❑ C ALTERATIO�(S /-/
iV�I �lJ 7 ' r 'J FUEL / ��V
FURNACE MAKE AND MODELS �� r, ' � -�
�
PENINGS 3 INPUT ,„) 6) t
FLUE SIZE OUTPUT 3, 3t e)6
TYPE OF SYSTEM HEATING OR. POWER PLANT PLEASE NOTE: Air Conditioner
d el Air Plants 0 Steam Units and Fireplaces Cannot Encroach
❑Gravtry ❑ Hot Water into Required Side Yard Setbacks.
■ anicai 0 Radiation Fireplaces with Box Additions or
' ►. Sys tem ing ❑ OtheDevices Special Devices Cantilevers to the Outside of Buildings
Oven t. Syst [] Other Require a Building Permit.
FIREPLACE MAKE AND MODEL _, _ ,
FEE SCHEDULE $49.50
1% of job post Residential, Gas Fireplace
Industrial, Commercial & Multi - Family ofjob
minimum $49.50
Residential, Additions & Alterations $49.50
Residential, Heating & A/C (New Construction) $149.50 Residential, AC Only
Residential, Heating Only (New Construction) (( $64.50
;os $ l0 `•t `�V Building Permit #
'he Minnesota Statutes § 3268.148
"SURCHARGE” has been extended ,
until June 30, 2013,
HEATINCrPEXtMIT FEE $ / ct,sz)
The minimum surcharge for a STATE SURCHARGE $ r _
"fixed fee" permit is $5.00 TOTAL PERMIT FEE s . • in
•
This Application Becomes Your Building Permit When Approved Paid Receipt No.
Date By
Buildine Official Date PAM WITH
r lTH
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 BUILDING PERMIT
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
07 -03-' 13 15:18 FROM -
T-003 P0003 /0004 F -003 paU
CITY OF PRIOR LAKE Date Reed •
o 4 PRto� HEATING /Alit CONDITIONING/PLACE PERMIT
u
k * >, PERMIT NO. j l- _ i y. Z
1. Wier Asibuss .
ADDRESS— ,,, ZONING somm 64
'4'5t) . 4 ide. Pr , id
LEGAL DESCERITION ssaim WS s
Lim RLOC ADDITION Pu>
I b AA.
*tress) .
APPLICANT tr� . I I ,, • . 1
IL (Addy* tom» We Coda)
L. 4 -
t Psi Jr ar ' 0 . 411... p t ,• - rr.�► _ ._ _.._
APPLICANT SIGNATURE i yr ..0 _ .
y
APPLI PLEASE COMPLE'T'E B -,! W
jig`` [ XiSTRUCCiO i ■ REPLACEMENT % ALTBRATiONS •
FUEL
FURNACE MAKE AND MODEL OUTPUT SIZE OPENINGS . •
TYPE OP SYSTEM HEAT NG OR POWER PLANT P : Alr Cow
MT /lose P1mss MOM Units soul Fireplaces aces Cannot Encroach
Net Water lute Side Yard Setbacks.
CI Mectomicai k gireplacea with Box Addition* or
°Air Conditioning
Meat. System 4.14/ ma CalltheV tt to the Outside of Bail
Oilusr Dsvfvsa Rare a Bundles Permit.
FiR>I'LACE MA1(.6 AND MODEL
FRt SCRSDULE I` °1 $493
tasattstrixi. mad k b+ioili 1% d job cost
$49.50 taiamasm so
Residantial, Besting k AFC (Now � R, ) S149.50 de+ti Addniotd' � 849.So
Itssidendol, Hating Only Mew Cotes) S64.50 Residential, AC Only
Estimated Cost $ . Builder Permit #_____
Tito Minnesota Simms >) 32613.148
I S URCWARGEV has been shroard liu sae
HEATING PERMIT PEE $ year etietl'n+t
STATE SURCHARGE. $ X1 July 1. 2010. sari! Jam 30. 10 11.
Tae mipimeui sarek�lr�e tnr � "sisal tee" *eraeit
MOW TOTAL PUMITfB k$' ►etdauiaitonly t.zeta
Ike Receipt No.
TI Application Bscotwm Your Beres Permit When Approved s d
.
24 hour natiao fray all impeedem f 441-905% iat 44
4644 De kola Strut 82., ?Ass Lake. M4uczaht 531171
«w...� ..••w.r..*..• - ... s.�wrw r.....r vn• —�� ■..f..M./... M a. M.naw`. �...1•.,...w..w.. w...,................... .y. ... . M w+
07 -03-' 13 15:18 FROM.-
T-003 P0004/0004 F -003 0.10
o� par CITE O1 PRIOR LAKE j
ATINC /AIR CONDITIONING/FIREPLACE PERMIT Date Reed
kaitudo
. x „ 24 �.,, PERMIT NO.
ADD _ .
/O . •
r
LEGAL DESCBYPTIONt arvsr aatf) .
LOT BLOCK Abb1TION
arm
•
OW i
•
(N .414 • A ! o ti.
(Phase) .
•
APPLICANT .
mA / F Mame / _ -.
MIIMIr' ! l [f t 9 l
t L e ch � Me 0 3410
AP7PLZ r �!� �.r.• (Phone) der /.-- t , N — Jr •
CANT'SIGNATU E 4. �r.I .;i� , A' or
DATE
•
PLEAS COMPLETE BRLO • —
•
•
FURNACE 1dAKS AL.TB)ZATfOrNS
A N D MO
PUSH S Eyf'l1i+iQS FURL •
TYPE OF SYSTEM INPUT O$l'Y'P()a•
HEATING OR POWER - -.�.
1 to awn Air Pleats Mena U PLEASE NOTE: '
Fireplaces Cannot
l i .p vity
� % Hot Reproach
II [yam ;,� Itad�ra Mk Ode Yard Satba ks;.
eai. System B Odter Fireplaces with Box Addition or Special Devices
Gang to the Outside of Ba
PnntBPrAC,�
MAKE Alm MODEL Rogabre a Banding Peter
J
lr+dutlsisl. t b ! % at FEE SCHEDULE ood Rte, Gar Fireplace
Residential, R AIC S� Caartrue� �'� • $49.30 dal, flag Mew •
� + : Residential, Moat A Ahsa on. •
aal. AC Only 3499.30
31.30
Mooted Cost = recruit S
HEATING PERMIT FEE
the Mi nn� yar a Rtotutas f 326B.149 s 'SURCN%�IZ( «bee �d !br vas
t th. TOTAL ?EMIT rigs $ Y4 s �r 3010 o moil .art 3., se lN.
mite awe axai Re remit
This AppSo Beowr,oe Year M �saat �•� I. Me
Permit When Appre'red
Rees* T1®.
s�
24 hoar Nodes he di 4eons 4 kx M44414245
446441 Dakota lbnt 6.Y. Pier Inks, Miasmas 56372
•
... srr� ...- .r... +.�.��w.rrw...vv�vr 1.w✓.. �..r �..w�.w.uwr.�rl w+�.... ........ .. w..r.... YW�. W .i .� I.. .. w.. ........
o� p ° �{ Builders Deposit
. 7 x
U rn
City of Prior Lake
to
ilders De osit is included in the Building Permit fee. The Builders De osit for issued
s s c url
insure $1,500.00 nsurre e compliance but
om Bu P pliance for a Final Occupancy Permit. (It is not an escrow account.)
of limited to grading, sodding, landscaping, tree planting, driveways, siding and painting shall be completed 180
n If the work is not complete within the 180 day time period, the
days after the date the building p ermit is issued.
City shall notify the applicant of the violation and the applicant 0
' licant shall have 10 days s corrective work to r$ to comply or the X11,,5500 0. .0
builders deposit will be forfeited and the applicant will be billed for clean up or
situation.
riod of
A $500.00 Tree Deposit may also be required and will be eacknowledgecthat 1 am preserved
of the erosion
one year. By signing this I, the undersigned contractor,
requirements of the City of Prior Lake as outlined in the Erosion Control Measures for Building Contractors
q
handout. / Z , /,�'
DATE:
SITE ADDRESS: 1 1 4:2 ) � �3 Re - s i o G C3 N) N)1. PERMIT #
REFUND TO BE MAILED TO: M -a r i -C ° M E_S
N a. S .k.) I'VE Zdl
'12 o f W Ns t-� t �l 6 D t.../ {�
— ry SS 43 9-1-1 AUTHORIZATION TO RELEASE
PLEASE REMEMBER
_
_, S. A en, �r
Build Servic Acct. 801.20204
/0 7 !
Date
1. KEEP EROSION CONTROLRNNPLAOE STRUCTION
2. KEEP
3. TEMPORARY OCCUPANCY PERMIT MUST NOT EXPIRE OR $500.00 WILL BE FORFEITED
SIGNATURE "
- 1
THE FACE OF THIS DOCUMENT HAS A COLORED BACKGROUND ON WHITE PAPER AND ORIGINAL DOCUMENT SECURITY SCREEN ON BACK WITH PADLOCK SECURITY ICON.
1876
Mattamy Minneapolis Partnership
7201 Washington Ave S., Ste 201
Edina, MN 55439 �� L 2O Z
DATE
PAY TO THE 6 Sfj � ulpZ -Za
, _� pg �rzt o>z— u `=
ORDER OF Security features 1 ' t i 1) e-1 6t -4T - US- A.�1"� Fo U 9--- U r`l D TD `04,0
1 D 0 DOLL ARS n t°Idisunb..k.
Wells Fargo Illb
J nR
MEMO 114y60.-
000 LE 760 1:0 S 3000 2 191:20000 2 3 L 10 2 7"'
C:\Doc
uments and Settings \sbare \Local Settings \Temporary Internet Files\ Content .Outlook\BD80X19A\BUILDERS DEPOSIT
FORM.DOC
PRI LAKE DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTI
RECORD
ADDRESS '4' irO �•
SITE ADD
NATURE OF WORK • �..
USE OF BUILDING � � -�
PERMIT NO. BATE ISSUED �,�,�
� ; it ,'L PHONE
CONTRACTOR �✓ % � �� ANY OF THE INSPECTI • NS BELOW
THE PERM
NOTE: THIS IS NOT I S BYRSEPARATE DOCUMENT
Install erosion control & maintain clean streetsm4/TOal l times. DATE
FOOTING
FOUNDATION (Prior to Backfill)
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
Radon system under concrete slab ROUGH - INS
SEWER/WATER/SEPTIC
FRAMING rall I
INSULATION
ELECTRICAL �� A ' >
PLUMBING � I 's (
HEATING (if required)
FIREPLACE
GAS LINE AIR TEST Iiiiiiiiiiiiiiiiiii
tadon piping COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
system,
Housewrap IIIIIIIIIIIIIIIIIII
fire Sprinkler L ea
FINALS , f-,</
GRADING (Prior to Sodding) IIIIIIIIIIIIIIIIIII
BUILDING 11111111111115°1 - /.1
ELECTRICAL 11111111111111311111111111/111111111
PLUMBING
HEATING
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 145 21 447 -4R511