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nATI; R~C~IV~D
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CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
1. White
2.PinIr.
3. Yellow
Fde
City
Applicaot
pe"'l" No.
1'1 tJe; t.,J
DIREC110NS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Pleas. Print or Typ. and sign at bottom)
2. SITE ADDRESS
/.s~3 / E2>6'EbVA7G ~
3. LEGAL DESCRIPTION
LOT "5"
BLOCK
/<;~
ADDITION
A't~r^,~dN
4. OWNER (Nam.)
.?/J/.?~Y 8-eNVil r
5. ARCHITECT (Nam.)
6. BUILDER
(Nam.)
12./0<&-A/'-'0 c..
eM o..-{~
(?" -
1. DATE
, 1'5 1'1'1
1</ Ao
B~ILDING INFORMAnON
11. SIZE qlF STRUCTURE
IH.",.) i (Widlh) (DopIh)
12. NO. 0' STORIES
PID '2...;"-OS-7-a=o:::-c:>
13. TYPE JF CONSTRUCTION
(Address)
/.:5d~/
(Address)
(T.I.~.)
R.!Jbff"CN4rc<.C-r .
(T.l. No.)
41J..cs ~~4. FLOO!l AREA APPORTIONMENT USE
!
/
I
15. NUM~ER OF OCCUPANTS OR SEATS
aCCL/PANTS
SEAT?
16. P~To2r6LUE
~ t.
17. COM,! L~TION DATE
(Addr.ss), ."" /<
~,,/ e=-. r'-' '.57.
jJ~O'H~--vG.r..,....J
(T.l. No.) <-iJ
.M'".. ....
&>a8-,,);;Jd'--;
Fireplace C] septic C] Deck C]
A1terations~ Addition C] Finish Attic C]
Ae-roofing C] Porch C]
Re-sldlng LJ Finish Basement C]
7. TYPE OF WORK
New Constructlon C]
Chimney C] Misc.
a. PROPERTY AREA OR ACRES 19. PROPERTY DIMENSIONS 110. CULVERT SIZE
Sq. Ft. Width Depth Yes No
I heraby~ have fu~sh ormation on t application which is to the best of my knowledge true and correct. I also certify that I; the owner or authorized agent for
the above i'led property that all oonst will conform to all existing state and local laws and will proceed in accordance with '. bmltted plans. I am aware that the
building can revoke th P$TTl r just Furthermore, I hereby agree that the city official or a ~ee may enter upon the prope to perform needed !~.
X G/f .' /77': /- r-"j"?
.1 ( Si(p'lature license No. ; Oem
Meter Hom .........................;......... <<
Water Meter .......................~......... $
,
Sewer & Water Connection Fee .,......... $
Water Tower Fee .................J......... $:
WaterTap .........................;......... $
Builder's Deposit ..................;......... $
Other ......................................... $
TotalDu. .............................. $--1. 2'},.,.. "5''t
Paid f ~tVI-5'1 l10celpt No. .. VI- "?4...,
Date 11 kJlI{q , ~ f f!>.
the In the oboV9 appllca1lon and a......,.... ". doaJments Is In accon1ance with the City ZontndDrdln8ncJ and may proajed aSfeQ_. This document when
ner aterJ1>Ol'8l'Y..,~- ..'-..;,. of- ~ianceandallowscons1ructionto_w................. Before occupancy, a Certlflltate of Occupancy musI be Issued.
~ . 'tf
City Planner Special Conditions if any
24 hour notice for all inspections 447-9850
SETBACKS: Required
Actual
Front
BUILDING DEPARTMENT VALUATION
USE OF BUILOIL, o/L.
TYPEOFw..~.~.JC11ON: I II III IV%
Occupancy Group A B E F ~ I M Uf
0IvIs1on 1 2# 4
Permit Fee ................................... $
Plan Chock Fee ............................. $
State Surcharge ............................. $
Penalty ....................................... $
-8'
Plumbing Permit Fee ....................... $
~
Mechanical Permit Fee ..................... $
sewer&WaterP.rmll...................... $-/7
FOR ADMINISTRATIVE USE
Bock
Side
MATER~L FILED WITH APPLlCAnON
SOIL TESTS 'LI ENERGY DATA t:J
PILING LOGS . t:J PERCOLATION TESTS t:J
PlANS & SPEC$ t:J SETS
S~.
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
SURVEY
PLOT PLAN
t:J COPIES
t:J
PERMIT VALUATION
76.0OCJ. 0 d
S U
CIIy:
Amount Brought Forward ........,......... $_1: "')?~ . <::J(
Park Support Fee .................~.........!t
SAC ...............................J......... f:
Collective Street Fee .............~......... <to
Sewer Tap .........................~......... $
$
Pressure Reducer ................~......... lit
[.''1."7<)
L164 .8<f
35.0::>
'10.00
Gas Fireplace Permll ....................... $
~UlidlngpermIlWhenAppro'f7.
~ Dat. / . 1'2..-
v
Certificate of OcCupancy
Issued
J
C/?S7{
EDG,{; WA TC-/e ~tlZ...CL6
Address
,
Healing Contractor
Address
-..SliCK F1Fl1PLACf SALES INC
.1St UAI~. AVe:
PRIOR LAKE. UN 5H72
.. 4<<11111
-~~0ifl- --..
W\A TYPE OF SYSTEM
Warm Air Plants
Gravity
Mechanical
Air Conditioning
Vent System
.
I
Telephone # ,
Furnace Make & Model
Model Size
1
Conn. Load
Fuel -O.tl- J Flue Size
Supply &'ningS .
HEATING OR POWER PlANT
Steam
Hot Water
Radiation
Special Devices
Return Openings
Input
Edr. ,
Clm.,
. Output
OI.herDefj! Z_C1 7/N
l;)Yr ~~
TYPE OF WORK
___ Alterations _
Repair
Raopbat'!AmAnt
----New Conlin 'cticn
Est. Comp. Dale
Est. Cost $ BuDding Permit #
HEATING PERMIT FEE $-39 .. S'"'O
STATE SURCHARGE $
TOTAL PERMIT FEES $
.50
1Il 11
~(),.
Receipt #
TYPE OF STRUCTURE,
I. PiDk
2. """"
3. Yellow
Fole
City
:;:roor
Single Family
Commercial
b(
Multi.Family
Other
Two-Family
Industrial
Public
Fee Schedule
Industrial, Commercial & Multi-Family
Residential, Heating & AC
Residential, Heating Only
Residential, Gas Fireplace
Residential, Additions & Alterations
Residential, AC Only
1% of job cost ($39.50 minimum)
$99.50
$64.50
$39.50
$39.50
$39.50
Remember to add the State Surcharge on the bollom of this application.
The price of your heating permit includes one rough-in and one final inspection.
Additional inspections will be billed at $35.00 each.
House Heating Test Record must be submilled with building IlmII1ilIllllllllm before build-
ing certificate of occupancy will be issued.
l:IEAI CALCULATIONS REQUIRED with number of supply and return openings listed per
room with CFM's per opening. New structures or additions send floor plan with supply
and retum locations shown. HEAT LOSS CALCULATIONS, PAYMENT AND
APPLICATIONS MAY BE MAILED TO THE CITY OF PRIOR LAKE, 16200 EAGLE
CREEK AVE. S.E. PRIOR LAKE, MN 55372.
City Hall business hours are 8 a.m. - 4:30 p.m.
ALL WORK MUST BE INSPECTED (ROUGH-IN AND FINAL) -- CALL CITY HALL
447-4230
I hereby apply for a mechanical systems permit and I acknowledge that the
information above is complete and accurate; that the work will be in conformance
willi me urCllnanC65 ana codes 01 lin:, ~lty ana Wit" me state Dullaingtmecnanieal
codes; that this form does not become a permit until signed by the BUILDING
OFFICIAL; that the work wjll be in accordance with the approved plan in the
ca.d\Df all work J,hich re4uires review and approval of plans.
Date
5//9hq
Ollte
Building Offical's Signature
7'1- OOZ(
Tht ('''"ltr of Iht l.kt COllnt!')'
;hite - Building
nary - Engineering
ink - PIBnnlng
i
BUILDING peRMIT APPLICATION DEPARTMENT CHEI;:K4"'SI
NAME OF APPLICANT
APPLICATION RECEIVED
~t ~
IL 1:: F r-1 f>Oc.-
1("') (qq
I
D,-on.- <)
The Building, Engineering, and Planning Departments have reviewed thy building permit
application for construction activity which is proposed at: ,
1523/ Eu6E rJ,q/Ftf ~I?OF I
Accepted ./
Accepted With Corrections
Denied
Reviewed By: trll1L'Tge E'HRi'"JfI4NIL.J Date: ;1;09
Comments: XtJAJ"FF i. JJI?/I/lvJ'16E: S--Icv(...6 AJoT F.E: A{)VC,t9_ Y
AO::~ECTEfl f3 'I "Tr/r$
PRofh<E:tJ
RuILDIA.It:' 1400/77"'AI
Set=: ItJFor</VIA-rt",^-J aN R.-E"11/E."t?'f€ ~ICl~.
-~
I
/. h,.,,"',- (;ItA{)/Al"- /A_J"~C'..r/tJA J IllJrOlV"<!!T'"/"AJ
. , ... ,> 3. &fl.<IIJA) CIJAh7l('JL 14f~
i
St=:t:
~rHWI~A1= .'
_.~ .. .~4I'J,
"The issuance or granting of a permit or approval of plans, spe~ifications and
computations shall not be construed to be a permit for, or an approval of, ~lnY violation of
any of the provisions of this code or of any other ordinance of the jurisdiption. Permits
presuming to give authority to violate or cancel the provisions of this !code or other
ordinances of the jurisdiction shall not be valid."
,
~~
White - Building
C~nary - Engineering
Pillk - Planning
T"~ Crnlrr of Ihl! ukr Counlry
BUILDING PERMIT APPLICATION DEPARTMENT CHECKL IS!
~
NAME OF APPLICANT ,\..)/ ",.'
APPLICATION RECEIVED
'L V f" r.J f>u<.....
I (.=; (Cfct
r
\S,- Or< S
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
I '5;;;23/ ~~ fArvI-e-
v
Accepted \/
Denied j.
Reviewed By: 9 /1)', ~
O!~ !I~. /J1P~
j~JA/7AfW? &~CL ~oIc..J "Sisl1nJL
(J ~00t ~O( &n fUrt!yC~ /tYYJ1A)M .
Accepted With Corrections
Date:
1.1i::JJtL9
Comments:
,
uh -cJ/<-
q()L/ I/J
I ~ "The issuance or granting of a permit or approval of plans, spe :ifications 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."
~\
W~te - Building
C ary - Engineering
PI k - Planning
Thf Ctnll'r 0' lIlt L.k.. Counlry
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
i
~{
F. lL V ~ 1>0<.-
/1"1 (qq
, I
\S'--DCt.- S
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
x
Denied ---: 17.10 I
Reviewed By: ( t/ ~ r-
Comments:
I. \)", I-lC'lt- r'"lc;:<"' JLJf~ +-1.Ac"'" lA(")( I s".p cPom} U OIi2}S.-+/Y Jrj~
2.. S...~ <it {l ho.r---e..- SI'\ ..I At'lQ ~
? (2....,L- *- ~~'J'U.'.... ~/~ ~~
Date:
/ - / ~- 9'7
"The issuance or granting of a permit or approval of plans, spe,':ifications and
computations shall not be construed to be a permit for, or an approval of, my violation of
any of the provisions of this code or of any other ordinance of the jurisd ction. Permits
presuming to give authority to violate or cancel the provisions of this i code or other
ordinances of the jurisdiction shall not be valid."
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS J.S.:l. '"< \
OWNER
PHONE NO.
[] FOOTING
[] FOUNDATION
[] FRAMING
[] INSULATION
[] FINAL
[] SITE INSPECTION
COMMENTS:
DATE TIlle
SCHEDULED 7 - H Q.
>€-'1() L~~
CONTR.
PERMIT NO.
-.iJ - 06-7 j
[] PLUMBING RI
[] MECH RI
[] WATER HOOKUP
[] SEWER HOOKUP
[] PLUMBING FINAL
[] MECH FINAL
[] EXlGRADlFILUNG
[] COMPLAINT
[] FIREPLACE RI
[] FIREPLACE FINAL
[] GASLINE AIR TST
[]
r\ ~ /"1
1\-'l<L \'-:I~
..,/
/'
/WORK SATISFACTORY. PROCEED
[] CORRECT ACTION AND PROCEED
[] CORi{'A. CALL FOR REINSPECTION BEFORE COVERING
Inspect . ) '} Owner/Contr.
CA~ fu ~o FOR mE NEXT INSPECTION :u HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
IN_'"
DAtE 11IIE
CITY OF PRIOR LAKE
INSPECnON NOTICE
SCHEDULED
IJ- 3D--cIf
PHONE NO.
/52 ~I Ek vv",/er r/,
CONTR. ~o(&J.J~\
PERMIT NO. tJ r7 -OOzJ
o PLUMBING RI Jt. EXlGRADlFIUING .
o MECH RI 0 COMPLAINT :
o WATER HOOKUP 0 FIREPLACE RI i
o SEWER HOOKUP 0 FIREPLACE FINAL:
o PLUMBING FINAL 0 GASUNE AIR TST ,
o MECH FINAL 0
v
ADDRESS
OWNER
o FOOTING
o FOUNDATION
o FRAMING
q INSULATION
~NAL
o SITE INSPECTION
COMMENTS:
f-r..kJ- c91(,
A(WoRK SATISFACTORY, PROCEED
,. O"eoRRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
InspeclO~.oe;~
Owner/Contr:
-
CALL 447.9850 FOR THE NEXT INSPECTlON:U HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY/
uaNOn
P R[GR; lAK E ~~itD~~~N,JD ~~SPECTl9N,:
:rPlsft~"erl()NRECOFfiS~~~':~~'
. SI,.~t~bD~ESS?~,c;d3 t.' . ~'. ~cn' \~ tn ~ . . Cr. ' '.:;;::~~~f~~~f,:~t.;,:.i,'.,
..... '''-.'.'....-." ..
"u NA.S.~E9ofl$iB.bU,fl..[yvD:OI.N.c.~G' ~;;i~_\~-;<;";"" "",- ('....... ~ ~.~d0.:'~' '~~:~i:;"'~-n*'~$t#f;Ri
'-.... .., .' _;'..;.', "r::-/ .._. ,:.__ _'_'> ;'-1..:'.'- '~t=""rJ --",'~.. J. . "'::;;i;;~.->:tf~~l~~~~~":~~~J,~f7,.
. PJ::RMJTNO.'Y"'7''7-'~'7 ( . DATE ISSUED
. .cPNJ.et.C:rq~J('~~\.:\c~'~^\ ~~ . ,,~~,.~~:~.:
. NOTE:::THISIS NOTA PERMIT FOR ANYOF THEINSPECnON'S~BELO
. o;i{'2!i;':'/ij"HE PERMIT IS BY SEPARATE DOCUMENT " ' ,."''';i,............
"j.;:;~~'t~~}:;::,f;::;-'6L,;}': .. .....'.... .... "'~E';~R ,'. ::';:~;f':JA'
i.. IF-O()TING,"'j,L:i'1!J,;1'"T>i'.' I ';;;')"'\11.
'. " FOUNOATION'(priortoBackfill) "d' .i'V' .......,'.. ';';;:;~~l~~~~i!~"
""f!.'~P1L'''ACE''Nbfco N CRETE' U NTI LA B OV E'HAS.'B C EW~STGiNE'D.~"
",;;,-,:~'~"";-4"i\;?~.::,.:~::~..:~.,;,,~.,.,c::;)':~.',,:," .('t'_.:..,. ""'" '.,..i:., ,., n,_, , "p, ",'" :.':f.'.-.";~:'_;'. ""." '. ,"',~;'"" ',,:.,:,,?~ ., ',:1,;'"'7..'
;;;,~i~r;Li;;,<;" .... '.. ,.' . ROUGH - INS':, . ",;..
. .
, I
"FR"'A"'M".'I"rG'K)..,l.i,;,;'~;..',?':-. ....,'>!,';;;::;..... '. , . ,"'..."'.."""".
"'1~w>~", ,.v 7 I :irt.Y-jO'~~ ,"' :~'~!;i1~tJ'!;;j~,
I INSULATION \~ \-\\, ",-",.
ELECTRICAL .~. I I, .
PtUMBING'.;, "".;,~,5!" I 'I~;-<"#:}f::'~~'f:..~,.;;;;\;~
,I ~EATING (if;~~ti;~e'd) . .>". . . I I~ ""':;:;{;;~1fJ:,~~
I FIREPt;ACE ,':5- J'1~qq 1/3::1-1 <." '1' ':~:;~.;~t~~t",.~~; ,0~
I'G"A"'S""I'IN"E;ii.'IR".,T E'S T',.''':: "'''" I ".. '. .'.L".....,.,iI'i~-'"
.... "". ' :~: " '- '::.!'j;.~'~'?"~~~~~:t!:::':~1~;i~"~~-~
.' ,.,."~""~.;<'1t,';'Q:~'~~"',-'~~;-"-"'':'"''-~:',~:,J>t:,;..:,i.''~:.'i,""," --: "', " . - . .' . ", .' ;'~ ""; . .-; >. :~"''''.:.',::r'''''':."';:;:,-..
. ',. :ff;:ii:;~COVERNOWORK UNTIL ABOVE HAS.BEENSIGNE
.. ......' ". .... . .
, ,.' ,",;,',. '.. '.;. CO" I I
;. :-"--"7.::' '~!,;...~, ,.. .",J. ,,' .... .'
},~~i:~~~t~~~71~~~:;<:"'~~~:';i,\ ":,' . FIN A L S~. ::~""\\'%mlJ~;:':\~
,,;,1 GRADING (Prior.to Sodding)" ".j; ,,;i,~;'f7!J1i.:":':>..K~,,~.'~":rc;!-".';;;:':-:;~:~~f~J::"j
'.' I BU.lr'OluG';"'",".,"'"'-_..,,,....,."'.,,-j,,,....P,'...: "".. ':?''''fJ~'' ,,''',r;;.. >'... "";~ff,,,,",,~.v-2';":-
..' I:.. ...' ."t,;;-,'i'E.' ..l-":""_-',,'L~""'" ,,1""1<'. , ..,. , -.- ;"1....,;' ~''jI: {S~:1';.'''rWr€l~::6:~~!
I EL'ECTRICAL' . " ' , . ~'...:::"-;;'!!.; .."r;:."'if.tJi
. '. ' ~ ttJi..!:~f"'~,:, :;:::"Ji~.:o~:::~ ,;::~
. PI:.UMBING:c.I'c>;;.~'~',.~: ,','~,;i:":ii:;.c',';;~ 1..;:~:'i;~~~iI.;:::!$:~
. BE~]_I',~Q~~~~~~fr~~:,~~;fi~~~~~~i~:~~~~:~'i,~;~~ li,,::\f;;~~f~-;:F~~~~4i:~rJJ*~:~I;~~~~~1It~Ji
, " ----"----
-"."..."..~".,""~;~"..~.',~',.,-'''" :'-'-~" ."..' " ,.. "'';;' , :'." ',;""" '., ".' ',,' ,", '.... ;,' ~'-"'. ...~....~..,..,:" .,~"~'-;:.~~...~,,.,,;:':.
i:r.~::;!;OO:.?NOT::OC.CUpy..u NTIL 'AB9VE .HAS, BEEN:'''srqNEQ'';.;f '.
. .'" ,., " , : .,;, '~' .. " . NOT ICE" .. " ',..' - . ',~""C ';,,":.....,.,~~~~,!o
'. .'~ This,,;ard 'must be. posted near an electrical service, cabinet prior to ~ough.in' i';~pe~i~~t ,~;-,.;,.:.:~:.~.~.[....~,','..:,.,i~
"'O':' and' maintained, until' all, inspections have been ap"proved. . On.- buildings 'and additions': . .._~~.,'
. ',~ wher" no service' cabinet is available, card shall be placed nearmai" entrance.; -:~':~:\'.i,'7.1!.;i.:.'
, ~.": _' ., . >. - - r- :- ".-".' ._':. . ' ~'" ';'- . ~c ..' ;;'~':':;.:""-' ~<',:,>\,:~;',::, :>:., ~",,:~~~:t;?;:;!R;-~.
Call between 8:00 and 9:00 A.M. for all inspections' .' '..
FOR ALL INSPECTIONS 447-4230