HomeMy WebLinkAboutBuilding Permit 12. 1370 ' ,4* A A \
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`; CITY OF PRIOR LAKE .
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, Z Final Permitted [1 Conditional C.O. Expires ><
s l This Certificate issued pursuant to the requirements of Section 110 of the El 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
Use Classification S INGLE FAMILY Bldg. Peat No._ 12 —13 70
Occupancy Type R Type Construction Vi i Zoning District PU�
Legal Description L17, B1, JEFFERS POND 2ND APDN,
Owner of Building Site Address 14991 JEFFERS PASS
Contractor's Name & Address R Y L A N HOMES
ROBERT D. HUTCHINS J'
� City Planner
- Building Official
Date: / K t i Date:
POST IN CONSPICUOUS PLACE
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( PR CITY OF PRIOR LAKE BUILDING PERMIT, Date Recd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE 1 ` (?J . `�
PERMIT NOl[�
.. x AND UTILITY CONNECTION PERMIT
'rjNNESol� I. White File . ,
2.
Pink City
/3 �0
3
Yellow Applicant fff"'
Please .e or print and sign at bottom)
ADDRESS ZONING (office use)
1 'tql - leAtc ha s pu 0
LEGAL DESCRIPTION (office use only) 'n , � 1 �� �/
LOT 1 l BLOCK 'L ADDITION (� � C � ► U- Ad( 45 , U a
OWNER
(Name) _ (Phone)
(Address)
BUILDER I. eRN Vri4 S aQ- V b 0 O
(Company Name) ( Phone)
(Contact Name) _ :s AmPODJ � AL... (Phone
(Address) /]5i = Lo. , . . �r •' A ' � ' ' "_..4114'.../ ` A & al J ) 1 _Alt
1
TYPE OF WORK■ew Construction ['Deck ❑Porch ❑Re- Roofing ❑Re- Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration DUtility Connection
. CODE:[.R.C. ❑I.B.C. ❑ Misc. /3t) Type of Construction: I II III IV V AB PROJECT COST /VALUE $ ' 3 b 0 0
Occupancy Group: A B E F HI MR S U (excluding land)
Division: I 2 3 4 5
I hereby certify that I have furnished information on this application which is to the best of my knowledge true and comet. I also certify that 1 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 ca evoke this permit for just c use Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
.. i 4. - je Signature Contractor's License No. Date
Permit l
\(aluation Z t5 O p O, ----- Park Support Fee # $ —. 0 Permit lkee $ I 1 4-2 Cp SAC # $ 2 3( _ (70 Plan Check Ft 1 $ 122 Water Meter Size 5/8 "; 1 "; $ G ° 0
State Surcharge $ 1 � ( o � t 5° Pressure Reducer $ / &,� 6 6
Penalty $ Sewer /Water Connection Fee # $ /5-67) - Jfj)
Plumbing Permit Fee $ /5 371 Water Tower Fee # $ /060. 60
Mechanical Permit Fee $ is-4 fv Builder's Deposit $ / $ 67)
Sewer & Water Permit Fee $ J r S� Other $
Gas Fireplace Permit Fee $ Lf , S TOTAL DUE $ /6 / 20
This Appl' , tion Bec i • • s Your Building Permit When • . pr i ed Paid 0 (/ Recei lot NO. C,./ ti ; —� Date Z B �;.
/ 1
Buildine Oftict i 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 consntut •s a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must he
issued. /t
� %a - 7- /02 fv per✓'..µf ....C.,-4„ /644mq
/GL Planning 'rector 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
Residential Building Permit Checklist
New Construc ion for Single or Two - family Dwellings in R- or R- istricts
Reviewed by: Date: , i O ( Z
Building Permit # PID: Zoning: l >" c,
Address: t ll q( � ?f"7 —S 3
Legal: L , B Subdivision:
Existing Structure? YES/ Existing Nonconforming Structure? YES 1 NO •
CONFORMS TO ZONING IA NO
ORDINANCE
Yard Setbacks: NA I FAILS/ C0.1S I Standard Proposed
• Front Yard (can be 20' if av . wlin 150'_ 25' a 5. V
• Side Yards A -ra - L 4 S5 -' '
ri kit lam* ,, 4.4 , P , VI' , 1 abutting street R
• Sidewali exceeding 60' requires additional side 2" 10' setback +
setback for every 1' over 60' in length. Not required 2"/1' over 60'
if building wall is 10' -0" or greater of being parallel to
a side lot line. _
ine. ,,r, _
• Rear Yardn — $ 5• C
• 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 wetland /NURP 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 / CO PIES 1 .30 Maximum 1 I
I Yard Encroachments: /47 FAILS /COMPLIES Standard Proposed I
Eaves and Gutters no • - than 2 feet in width and no
closer than 5 feet to a lot line (Easements).
A/C and other equipment cannot encroach on interior
side yards.
Tree Preservation: 1 FAILS 1 COMPLIES ' Standard Proposed
• Total caliper in hes
• Permit 35% Removal - — -
• Caliper Inches Rerp'oved
• • Cali,per'lgches P,rherved
• Replacementf %:1
L: \T1MEth.TE\BLD GLIST.D O C
/
Driveway: NA / FAILS / , ' S PLIES • Standard Proposed
• Maximum width a t ' ke line 24'
• Required setback • 5' from side lot line or •
30' from r -o -w on corner lots
• Maximum sloe 10%
• All parking areas to be paved including R -V or
s' aces ad'acenttothe ' am e
• Location to match subdivision 'radin. plan •
Building Height: NA/ FAILS / CO IES
35' Maximum Z S
Shoreland District: NA l FAILS / LIES Standard Proposed
Minimum lot area so uare feet 7,500 Rio, 7,999 Non-do
Minimum lot width 50' Rip, 57.3' Non -rip
Shoreland alterations
Impervious surface 30% Maximum Pw
Bluff in Shoreland a/ FAILS / COMPLIES Standard Proposed
• Setback from tiff bluff
By planning dept.
• Bluff im . act zone 20' From Top of Bluff
• Engineering certification submitted /approved By City Engineer
• Gradin in bluff or bluff im •act zone No im I orting/exporting •
Floodplair, / FAILS /COMPLIES Standard Proposed I
• 100 ye flood elevation 908.9' Prior Lake
914.4' Spring Lake
• Lowest floor elevation 909.9' Prior Lake /
915.4' S . rin . 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
• 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\BLDGLIST.DOC
o� Ri0
Builders Deposit
V I,
s a A 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 th'e erosion control
requirements of the City of Prior Lake as outlined in the Erosion Control Measures for Building Contractors
handout. r�
DATE: 1 L - 43 - -- SITE ADDRESS: ` L C -1 M ( `TZ C-S19 - 8 PERMIT # tZ • (370
REFUND TO BE MAILED TO: t 6)44 -46----y\Ay24---
' - 1 a A !, �' _ 1v
_ a.' /A , ' ' ,t I c�j
PLEASE REMEMBER _ ! ,' i ` i. ` # ,
1. KEEP STREETS CLEAN DURING CONSTRUCTION / Sr70 _ Uv
�ynda .Allen, Building Services Amount
2. KEEP EROSION CONTROL IN PLACE iz,z43 Acct. 801.20204
3. TEMPORARY OCCUPANCY PERMIT MUST NOT EXPIRE OR $5C Date
SIGNATURE: . eb -
Y OPPler, City Engineer
___ . ____.. _. -- 16 4 2 y
THE RYLAND GROUP, INC.
RYLAND HOMES TWIN CITIES CD JPMORGAN CHASE BANK, N.A.
7599 ANAGRAM DRIVE COLUMBUS, OHIO
EDEN PRAIRIE, MN 55344 56- 1544 -441
12/17/2012 1
PAY TO THE
ORDER OF City Of Prior Lake
$ * * 10,519,28
Ten Thousand Five Hundred Nineteen and 28/100 a
I
4646 Dakota St SE OLLARS
Prior Lake, MN 55372 CHECKS NOT VALID OVER $5 ww
B
MEMO �= 1 1
Bldg Permit for 14991 Jeffers Pass, Courtland Spec i AUTHO SIGNATURE
11° 000011642v .0441 154434 936 194554x■ _ ____ ----
J :IFORMSIBUILDERS DEPOSIT FORM.DOC
O PRIp�
H
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White - Building
�P Canary - Engineering
NNES� Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
Accepted Accepted With Corrections
Denied
Reviewed By:
0 1 1
Date: O _ 7X02
Comments: e /i *t as eicrvtakive
O v'� Cr re T+zrr-ar, 8„,A go-01 f" A Aktle S . LYI GfieiA4es
/i . 2rVWx3 su Gri /S /h awpG A 4Ly me a €4:0 ��
"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."
PR io�
0
ti �
White - Building
yr �� Canary - Engineering
NNESO Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT A. ' , 4 . ...
APPLICATION RECEIVED '
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
A
i
Accepted Accepted With Corrections
Denied
Reviewed By: Date: `O — 7 /2
.4 471,(‘- z Comments: 1'�. oe.rdeus r i,� -c__ i s eva.histei as tccnAuLeile
p 7' eNti re - T t- ervo l a f C /ga /Alf 1 2t cfiee es IA
A et-4Jx s Su.4'T t e, Is I MCI QAa ma 4/r" OG itigw. [ lA d -(1 41P.
"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."
Z
U rr1
White - Building
yI �� Canary - Engineering
Nrvss° Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
// .
APPLICATION RECEIVED `l' 43 . / Z_____.
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction acti • which is proposed a
/.q9/ — .
Accepted Accepted With Corrections
Denied
Reviewed By: 40 A Date: 1 z/7/
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."
CITY OF PRIOR LAKE
Impervious Surface Calculations
(To be Submitted with Building Permit Application)
For All Properties Located in the Shoreland District (SD).
The Maximum Impervious Surface Coverage Permitted in 30 Percent.
[ rr id /7 etoc k
Property Address Pigq/ rT-Pflri4 A53 L. E - S Pa v6 ,5r.oitrO ADM 7t0it/7
Lot yy ,y J. J. ( yy m `1 ,y ,yy yy J.4. JJ.. JJ.. y ,,yy yy yy ,,yy ,,yy ,,yy yy yy yy q. .yy F yy e et ..yy ,,yy ,�yy _
,,yy ..!!.. yy,,yy ,,yy yy y .y ,�yy yy � / y 4.. ...LL $ 'P ..yy t� h.
T
Ly..II,,.. yy ,y
* *** `T* T TT T T * ***TTT TT T *TTT TT T*** *T TT *TT **** ******TT******** 1•'1`**** TT TT
LENGTH WIDTH SQ. FEET
HOUSE X
x =
ATTACHED GARAGE x =
TOTAL PRINCIPLE STRUCTURE Zlv Sr
DETACHED BLDGS x
(Garage /Shed) X
TOTAL DETACHED BUILDINGS
DRIVEWAY/PAVED AREAS x =
(Driveway -paved or not) X elf;ve = h -
(Sidewalk/Parking Areas) x .;,ti wee = X 3 sr
TOTAL PAVED AREAS `7 / 7 5r
PATIOS/PORCHES/DECKS x =
(Open Decks '/" min. opening between X =
boards, with a pervious surface below,
are not considered to be impervious)
X =
TOTAL DECKS Jr , x
OTHER X =
X =
TOTAL OTHER „—
TOTAL IMPERVIOUS SURFACE 2gg7 5
UNDER/OVER /U.A. $ee Able
Prepared By 44 Date / /- - /z
Company /iodeff 6- n y i4C7°44y /4' Phone # 065/) 6 8/-i9/J
Froa:Genz -Ryan 952 767 1900 01/08/2013 10:38 #921 P.001/O7
_
4 P Rib Date Ree'd
Cr:
. t CITY OF PRIOR LAKE PLUMBING PERMIT
4 41
+iNxssciv- i. a,K ru,
:. oad ay I PERMIT NO. /1- -_/3 7.61
ease or prat and alp at bottom) 3. Yaw Applieou
ADDRESS on t \leFFras �, ZONING torso use)
���Zi� -rte J
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) (Phone)
(Address)
AIPPLICANT / ��
(Name) r� '.� (Phone) (991)1 0 j �-7
" k cOO ---
(Address) Z 2-OO �1 Y v W 1 AS l Ike SG I
(Addres (City) (Zip Code)
(Contact Person) CIA +1 1 n ti S U r� (Phone) (9g - 1 �1
G
r
APPLICANT SIGNATURE � � �L� i DATE _ ' �113
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
. L. Bath Tub with or without shower h - ins
— Dishwasher Water Heater
A Floor Drain 41 Water Softener
Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
Laundry Tray (1 or 2 compartment sink Sewage Ejector
1 Shower Stall _ I3acktlow Assembly
Sinks Backflow Assembly Test
Bar Sink 2 Lawn Sprinkler
'2.. Water Closet (Toilet) Other
FEE SCHEDULE
industrial, Commercial & Multi - family 1% of job cost with a 549.50 minimum Residential, New One & Two - Family 5149.50
Residential, Additions & Alterations 549.50
The Minnesota Statutes f 32611.148 'st $ Building Permit # _ PAID WITH
a p 1 .p.
"SURCHARGE" has been changed for one
year effective PLUMBING PERMIT FEE $
BUILDING PERMIT
Jat 1, 2010. untll June .30, 2011. STATE SURCHARGE $ .50
The minimum surcharge fora "fixed fee" permit TOTAL PERMIT FEE 5
is,si, beginning duly 1, 2010
This Application Becomes Your Building Permit When Approved Paid Receipt No.
Date By
Bnitdiaa OftIctat Date
24 hour notice for all inspections (952)447-9850, fax (952) 447 -4245
4646 Dakota Street B.E., Prior Lake, Minnesota 55372
From:Genz -Ryan 952 767 1900 01/08/2013 10:38 #921 P.002IODf
1
0 r ro, CITY OF PRIOR LAKE Date Recd
, , HEATING /AIR CONDITIONING/FIREPLACE PERMIT
h
° NNEscrd is o «,, c x I PERMIT NO. f
ud o
3. Yellow Apoacra
c —1
gn at bottom)
AD e and aj S 149 I I < \e C ZONING (*Ike ox)
LEGAL DESCRIPTION (orrice use only)
LOT BLOCK ADDITION PID
OWNER
(Name) q1✓ • (Phone)
(Address) •
APPLI •
(Name) Z —n (Phone) 0 52) 7 0 - t Oo 0
(Address) =0 V W t v I t te... 33
(A re) (City) (Zip Code)
•
(Contact Pelson) ` i LO S U{ e.- (Phone) C tcl) 7(61 G •
APPLICANT SIGNATURE i1, � � 4 ' DATE t 4 7 j
APPLICANT PLEASE COMPLETE BELOW
X EW CONSTRUCTION ❑ REPLACEMENT ❑ ALTERATIONS P -
FURNACE MAKE AND MODEL cr1 A" G . 1 0 a( FUEL K.)04 E
FLUE SIZE RETURN OPENINGS to INPUT �T 00..__. OUTPUT EFi,2 0
TYPE OF SYSTEM HEATING OR POWER PLANT
PLEASE NOTE: Air Conditioner
,]Warm Air Plants ❑ Steam Units and Fireplaces Cannot Encroach
;germ
avvi ❑ Hot Water into Required Side Yard Setbacks.
"Ell � ❑ Radiation
Fireplaces with Box Additions or
Conditioning 0 Special Devices p
[)Vent. Syatem 0 Other Devices - Cantilevers to the Outside of Buildings
Require a Building Permit.
FIREPLACE MAKE AND MODEL
FEE SCHEDULE
Industrial, Commercial & Multi- Family l% of jab cost Residential, Gas Fireplace 649.50 •
$49.50 minimum
Residential, Heating & A/C (New Construction) 214930 Residential, Additions & Alterations 249.50
Residential, Heating Only (New Construction) 564.50 Residential, AC Only $49.50
Estimated Cost $ Building Permit #
The Minnesota Statutes ti 32613.148
HEATING PERMIT FEE $ • "St IRCiIAR(i� " has been chanced rot one
year etTeeti■r
STATE SURCHARGE $ .50` July 1.201u. until .tune 31). 21111.
TOTAL PERMIT FEE $ 1 h minimum aurrharge for a "find fee" permit
(Office Use Only) is a5, brgiaaing July 1.2011f
This Application Becomes Your Building Permit When Approved Paid Receipt No.
Date By
Building Official Data
24 hour notice for all inspections (952) 447 -9850, fax (952) 447.4245
4646 Dakota Street 51., Prior Lake, Minnesota 55372
21i 20 '13
4 P LIO CITY OF PRIOR LAKE Date Rec'd
. BEATING /AIR CONDITIONING/FIREPLACE PERMIT
M ' i `: i
PERMIT NO.
`tl�� t nk die
3 ri Y eeo Ci 12. .13
3 Yellow Applicant
Please ty a or print and sign at bottom)
ADDRESS ZONING (office use)
1 yqq 11 912rnv2 ,PctOP
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER c�
(Name) 1 hL (Phone) < C2--y 224-GOCC'
(Address) 7 5 qq O
APPLICANT
-- _ _ _ _ •
(Name) dba FIRESIDE HEARTH & HOME (phone)
L1C. 13CUbJ2Ob°
(Address) 2700 FAIRVIEW AVENUE N
ROSEVA4IN 55113 (City) (Zip Code)
651.633.2561
(Contact Person) (Phone) •
APPLICANT SIGNATURE /"' </ Q1'20.4 DATE L -- 0 —13
APPLICANT PLEASE COMPLETE BELOW
DNEW 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 into Required Side Yard Setbacks.
❑ Radiation Fireplaces with Box Additions or
❑Air Conditioning ❑ Special Devices
❑Vent. System [] Other Devices Cantilevers to the Outside of Buildings
,jj �/ ��� ���� Require a Building Permit.
FIREPLACE MAKE AND MODEL /T 214 - 4 1(73 3 3 d(rJ.:`. • rel--
FEE SCHEDULE
Industrial, Commercial & Multi- Family 1% of job cost Residential, Gas Fireplace $49.50 •
$49.50 minimum
Residential, .Keating & 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 $ 166.. 0a Building Permit #
The Minnesota Statutes * 32613.148
HEATING PERMIT FEE $ "Sl RC1IARGI:" has been changed for one
)' ear ef fective
STATE SURCHARGE $ .50 J11ly 1, 20tt1, until June 30, 2011.
TOTAL PERMIT FEE $ The minimum surcharge fora "lined fee" permit
(Office Use Only) is ys, beginning July 1.2010
This App lication Becomes Your Building Permit When Approved Paid Rece ±Qt�� WITH
Date umDfl(Z PERMIT
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
; co?
1 ,
t 1 • .....-• ,
0 rR_O$' Date Rec'd
a,•
E. „ ` 9
" SEWER AND WATER PERMIT P--)-0-0
aiI,'NESD
1. Green Fite PERMIT NO . I�
2. G ol d A p p ��
3. Gold Applicant
ease or print and sign at bottom)
ADDRESS ZONING (office use)
I LI a,1 1 T-44-Fun Pco0
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) �c° (Phone)
(Address) _.
(Address) (City) (Zip Code)
APPLICANT t, / ��
(Name) II.) - q S . ' " • I CJ � Co • (Phone) 5 l'LeW Q /•3.5.5
(Address) _. 6 Z G i' tji. 1/4 S C.) 33
(Address) (City) (Zip Code)
(Contact Person) evi. lc, A-r At— (Phone) 6 1 -"cl 1 9 q
APPLICANT SIGNATURE 4 44 A 1/4 C DATE / ) - 1 1 O -12
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 $25.50
Estimated Cost $ Building Permit #
SEWER AND WATER PERMIT FEE $
STATE SURCHARGE $ �(�` - A .�
TOTAL PERMIT FEE $ i 1-71 ro�' r)
U1
(Office Use Only) ')-
This Application Becomes Your Building Permit When Approved Paid Receipt No.
4,e' ' 4 - —16)— .._ Dale J 11 By .. /
Buildine Official Date l I- '
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
P R' DEP ARTMENT OF
L A KE
BUIL DIN G AND
INSPECTION
1NSPE
RE
SITE ADDRESS /4 iAS MST
NATURE OF WORK SINGLE N FAMILY DETACHED 1 ,JC. fig. L , 1-. ,Ja ae.G,� ,,,, /34, OF BUILDING
PERMIT NO. / 2. 1370 DATE ISSUED
CONTRACTOR #41.44/1) hOfl PIA
HONE 22 Q
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIO S BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSTALL EROSION CONTROL & MAINTAIN CLEAN STREEZ ALL TIMES DATE
I FOOTING I ,PS I (2/41z- 1
1 FOUNDATION (Prior to Backfill) I i 1 ) 2 27 ice_ I
6,p,/, f , §., PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
GNED
RADON SYSTEM UNDER CONCRETE SLAB R O U G H - I N S
MEMBRANE
EWER /WATER / SEPTIC 12f i L
FRAMING 9ff )/.,
gt 1
INSULATION /# 6/
ELECTRICAL
PLUMBING Vic 0C ?L 2 1/ fir, % �j-'p
HEATING (if required) p
FIREPLACE
GAS LINE AIR TEST /tiAakde, d',i
RADON PIPING COVER NO' VORI UNT IL ABOVE HAS BEEN SIGNED
SYSTE ik 1 HOUSEWRAP i LATH I
FINALS
GRADING (Prior to Sod g) 1 i h /ZZ
BUILDING - ; CZ- 1 z - ! j
E
7 ZO
LECTRICAL " "'
PLUMBING 4 V pl
HEATING / Rf -- Le, (3
Air Can . Or d 4'cht t ABOVE HAS BEEN SIGNED
Units Cannot Encroach into ;quire . NOTICE
T ?Ngrd a 3iear 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.
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� a FOR ALL � (952) 447 -9850 � J
P L am ? 6 sui,NAaO k c, Sd r !; , it A[,h 2 See k A dle*€ !'
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