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PR 10* CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE ` Z , 3
— g AND UTILITY CONNECTION PERMIT
1. White File
2. Pink City PERMIT NO. / // •
7 vy
3. Yellow Applicant
(Please a or print and sign at bottom)
ADDRESS ZONING (office use)
1 loZA PrIA <V 161 1 (IX
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER.,,
(Name) 15 R (4 1 <i/�1'h(d \A16 i> >M4r! (Phone) q5Z- 447 -
y � _
(Address) J( '2 f vKtJirv'/ �1z1dt . tai f11K. Lf j -MN 553IZ
BUILDER J �y
(Company Name) Q9-()P ` / M-(1 <(�f /11 (3U /(�.S I'IC..,, (Phone) (p[ 7- T 1 r- 7418
(Contact Name) IMF lc (Phone) 61 Z-' 9 53-
(Address) 1 S4,;"1 6 4STwlb IeL1.4t. > dtit'tS 0E01 Opi GS7 I a.
TYPE OF WORK ❑ New Construction ['Deck ['Porch ❑Re- Roofing ❑Re- Siding .Lower Level Finish Fireplace
['Addition ❑Alteration ['Utility Connection J 4401./
CODE: Li ' .C. I.B.C. ❑ Misc: _
Type of 1 • nstruction: I II III IV V A B
Occupancy Group: A B E F III MR S U PROJECT COST /VALUE $ 5 no 0
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 "t f just ca urthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X (,1 � �� ) ` BC., 1031512- a ( 2-z I Z01,3
Signature Contractor's License No. Date
Permit Valuation 3 , Goo . (,) 0 Park Support Fee # $
Permit Fee $ 7 7.5 SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1 "; $
State Surcharge $ .-1.3-0 Pressure Reducer $
Penalty $ Sewer /Water Connection Fee # $
Plumbing Permit Fee pA / p $ ,y y pc.,, „/ 6, c-2i Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ . < �L s 2-) TOTAL DUE $ /30 r /
' f_C”
ee
This Appl' 'o ecome�� s`Your Building Permit When Approved Paid a , Z ') Recei .t N. . 70
Date b M B 411
-if IA
•u ..`�1SEt1• Date
__
This is to certify that the equ in the above applcation and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by the Ci 'Ian A constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued. / ,
' l... mg Dtrecc5 � 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
PRIOR LAKE DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION RECORD
SITE ADDRESS th2,- / //J < �1 D/� -
NATURE OF WORK )
USE OF BUILDING S" //--
PERMIT NO. ELL, DATE ISSUED /0 . Z Z, i3
CONTRACTOR "41714c "`'1 £ (-0 PHONE 6 /Z., q ef
INSTALL EROSION CONRTOL AND MAINTAIN CLEAN STREETS AT ALL TIMES
INSPECTOR DATE
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING i /1 //-
INSULATION �
ELECTRICAL
PLUMBING vysw ,O/903
HEATING / l// 7 / j
FIREPLACE / /�
GAS LINE AIR TEST$ y� d ez 3 %Lh'' 1`7
COVER NO WORK UNTIL THE ABOVE HAS BEEN SIGNED
LATH I 1
FINALS
Ph l lze( i
ELECTRICAL
l
PLUMBING
HEATING
DO NOT OCCUPY UNTIL ABOVE HAS EEN 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
Date Recd
CITY OF PRIOR LAKE PLUMBING PERMIT
Blue File
PERMIT NO.
`
2. cold city
Please 3. Yellow Applicant /3 1/(3
( type or print and sign at bottom)
ADDRESS /� ZONING (office use)
fv - 8 4 _ "�`I,'
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) (Phone)
(Address)
APPLIC
(Name)_ _ _ I _ . (Phone) 7t 3 -0- 9S - -J-7 0 9
(Address) /OS/ U l4 n f )a- -c, 1J-ti • ie._e ,r 5 $ 55 7 (Address) (Ci ) (Zip Code) ci
(Contact Person) ii > ' - (Phone) 12 5 - < 95 c 1 9
APPLICANT SIGNATURE DATE / 0/LZ -l&3
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough -ins
Dishwasher Water Heater
Floor Drain Water Softener
j Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
Laundry Tray (1 or 2 compartment sink Sewage Ejector
J' Shower Stall Backflow Assembly
Sinks Backflow Assembly Test
% Bar Sink Lawn Sprinkler
/ Water Closet (Toilet) Other
FEE SCHEDULE
Industrial, Commercial & Multi - family I% of job cost with a $49.50 minimum Residential, New One & Two - Family $149.50
Residential, Additions & Alterations $49.50
The Minnesota Statutes § 326B.]48 Est $ Building Permit #
"SURCHARGE" has been changed for one
year effective PLUMBING PERMIT FEE $ tf 9,S'C7
July 1, 2010. until June 30, 2011. STATE SURCHARGE $ - r OO ..'
The minimum surcharge fora "fixed fee" permit TOTAL PERMIT FEE $
is, beginning July i, 2010
This Application Becomes Your Building Permit When Approved Paid / i ,—A
Receipt No. r4 .2/ j
Building Official Date Date /0123//3 By t �
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372