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CITY OF PRIOR LAKE
pepartntruf of euiI Mng 4nsptrfiun
:Q Final Permitted El Conditional C.O. Expires }a
This Certificate issued pursuant to the requirements of Section 110 of the ❑Residential l❑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:
CK �f���(�C/ t �L�/ l Bldg.Permit No. �z
Use Classification /
-> e Construction 17/'� Zoning District
Occupancy Type �P
_ Legal Description G.2 J 8/, & X ' - e
r
. �/� 0....40y511-41.... 0a�4
Owner of Building Site Address
Contractor's Name&Address
le-vet-J.-Cr P. f/v-i(,/ff/ S , City Planner
it Building fi
i ;. Date:
.';
iC Date:
' POST IN CONSPICUOUS PLACE
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,-( PR/ CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE ✓J /Z
. AND UTILITY CONNECTION PERMIT `
U en
�1ANE90�� MainFile IWhite File
2 pink Cit PERMIT NO.
Y /1 � 72
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
3585 Cry M.e.ti Say e N 0
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
(Name)OWNEP�WX.1 V S )peE k`1'e-S (Phone) (_95/- "Z10Z '15 10l
(Address) O?3S2 CA 1 p perelet (e Ale ►- 411 t i lt) /14/113... D2 V
DER
(Company Name) e-4( ''Sl fx 1e--001-.S (Phone) 6j/- /1 " 10/g/
� � q,
(Contact Name) .. -411 /i�� ` (Phone) (-t�'J 1— Z2� I— &) $
(Address) ;2-3' 2 Ck- -en _lam Y\Ue. rairwll n ✓k f'ul/U ., -�.3U27"
PP �
TYPE OF WORK,ga WORK, New Construction ['Deck EPorch ORe-Roofing ❑Re-Siding ['Lower Level Finish 0 Fireplace
['Addition ❑Alteration ['Utility Connection
CODE: [I.R.C. ❑I.B.C. 0 Misc.
Type of Construction: I II III IV V A B PROJECT COST/VALUE $ 35oi bD b
Occupancy Group: ABE F HI MR SU (excluding land)
Division: 1 2 3 4 5
I hereby certify that I have furnished information on this application which is to the best of my knowledge nue and correct I also certify that lam the owner of 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
officia n rev pet for Just cause Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform neede inspect ons
X (o39" t05 7 6 &/a—
Signature Contractor's License No Date
Permit Valuation ' ' Park Support Fee # $
Permit Fee $ 7-54,--& cp SAC # $ �?c
Plan Check Fee $ _
P
1 1 SG� '1e Water Meter Size 5/8"; ? $ SG(C.,.,(C.,.,State Surcharge $ 1�V—t S-.. , Pressure Reducer $ i. tat).-
Penalty $ Sewer/Water Connection Fee # $ ( C—c —
r
Plumbing Permit Fee $ t SA-,co Water Tower Fee # $ k 060.
Mechanical Permit Fee $ t c 'CS-0 Builder's Deposit $ t cam)
Sewer&Water Permit Fee $ c , c1;) Other ,�, $
Lf
Gas Fireplace Permit Fee $ 5 _ SJ (it/Ma- TOTAL DUE •7�1'�Tl t i.•-- $ 1, 1 qZ [�3. Z
1
This p lic io 1 Permit pp oved
/comes Your Building Pit n APaid 1� I Z3. i 0 R rpt No.6 L ri r
a Date '7 2 S , i-t
4011611 7 r 3 tz--
Burldut_. 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 7'lq'12_
ening Director 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
„;.:,:%.,!- t ., „A-",i F'ii...r.,4,, ^ •,!, ;M`..'.j4, `% -y*$) - .14-r,. - m,,,. .;p %41,-z - '-r%.,w-.:;'Ywa%-,-, ,,,.r r
of PRIp4,
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White -Building
�., �P Canary -Engineering
NNEso Pink -Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT } ' , i i. Y i - , i ( i'.
APPLICATION RECEIVED i/ • - - , 4--
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
f.• f, t r r' C. of, s •`__, / '1
f
Accepted Y Accepted With Corrections
Denied
Reviewed By: Date: 7-/7--7.2
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.”
4 PR/Ob
1 ;7
.( Z
White - Building
MINNESO�P Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT 0l .>.. t �:. ( //... l 11..!6Ac >
APPLICATION RECEIVED t7 `1.:: —
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
--::)::11% ,/:- _5)-`- & Cl('.t,/�; /m'ml_ 1'�. d jl/ ,� }
f i
Accepted k Accepted With Corrections
Denied
Reviewed By: A - Date: -7-ie--17--
Comments:
-/e--/ZComments: 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."
O. PRIG!
ti x
White -Building
Canary - Engineering
"�`^NEs° P Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT L1l,.5I eC i (c'iC/c.'_..S
APPLICATION RECEIVED 17 - =� Z-'
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction ctivity which is proposed at:
•-357--e- 5- —3-5—g (1 0671.7n1, C7)1/ /--Al
Accepted ' Accepted With Corrections
Denied
Reviewed By: /01/ Date: 17(--,4
, _.,
CoA-v toc� �d 4' ��r 41y7ievv �!'-ci,/
Comments: yam' ,
cc14dA-f- A--c-.- --U,K(`5
"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."
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Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT q, 2-4
A `�
r4
I. Blue File PERMIT NO./ --72_02 GoldCity
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
-) 5:E:?5 c4-K5?-79-e_ /7-7' 0it rt
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PH)
OWNER
(Name) C ll_. 5T moi- ,K?G`.g: -S (Phone)
(Address)
APPLICANT
(Name) L t/ /&-fr1 6,,� A/c-- (Phone) �V2__W 2 -o--,
(Address) / f `-5 /41)�S ' L-77 A0/2- /Vc, 'I` 6J 5-5---e)7
(Address) (City) (Zip Code)
(Contact Person) O,/ Z __,A...ig//r ' (Phone)
APPLICANT SIGNATURE i�I � C--/ DATE % '/z
AP 'LICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
( Bath Tub with or without shower Rough-ins
I Dishwasher / Water Heater
f Floor Drain I Water Softener
5 Lavatory(Bathroom Sink) / Stand Pipe(Washing Machine)
f Laundry Tray(1 or 2 compartment sink Sewage Ejector
'3 Shower Stall ( Backflow Assembly
Z. Sinks Backflow Assembly Test
/ Bar Sink I Lawn Sprinkler
f Water Closet(Toilet) 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 ost $ Building Permit#
"SURCHARGE"has been extended PLUMBING PERMIT FEE $
until June 30,2013, STATE SURCHARGE $ .50
The minimum surcharge for a TOTAL PERMIT FEE $
"fixed fee"permit is$5.00
This Application Becomes Your Building Permit When Approved PaidRece 10••100A
Date By p VCg a�
Building Official Date . L
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372
..V
RIO Date Rec'd
C
ev
CITY OF PRIOR LAKE �? Z 7.
SEWER AND WATER PERMIT
NEso�� /2 . 72&
Green
ellow FCdrtey PERMIT NO. iz 72
Y
3 Gold Applicant
(Please type or print and sign at bo om)
ADDRESS /��/� ZONING(orrice use)
35 85 09 f� L SAY AY t VV
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER �I t1�/ -�--;�a
(Name) ��/�� `�I� t C-i (Phone)
(Address)
(Address) (City) (Zip Code)
APPLICAZITE
(Name) .5__J ?cC 11�, ` � (Phone) 6-�,�/�6 'Z o
(Address) 7 1 Z !2fi L V-N` . �Q� Al
t.1 a) S'SOS
(Address) (City) (Zip Code)
(Contact Person) Q� 1 , _-1,51 /4 ' ''L— (Phone)
II2 l 2-
APPLICANT
APPLICANT SIGNATURE .i%:.J`r '` DATE
4.1 17 Z? 20 )2-
NW �
C '
AP 'LICANT 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'!&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#
The Minnesota Statutes§326B.148 ER AND WATER PERMIT FEE $ �g PAID '•,'t'1
"SURCHARGE"has been extended 'E SURCHARGE $ .50 ®�rr��r� 71
until June 30,2013, AL PERMIT FEE $ P�RN}IT
The minimum surcharge for a
"fixed fee"permit is$5.00
This 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.E.,Prior Lake,Minnesota 55372
1PRI0 CITY OF PRIOR LAKE Date Reed
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
‘-'1' 1.L5'e �.31 .1Z
III
\\`�.... `.''`"'` Pae PERMIT NO.
`._,�� 2.r=„ City
42)
3.Yellow Applicant 12.•"120
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
' - S Cr'-js+rgI C KI,./ LAnC /I/1--v'
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
(Name)OER L_/to SI C-i f f,C( 3 (Phone) 6s--I `7 66 ,i O
(Address) #9 a (A. 2 f ?it C11,9 1 .e H,7 -- Fig(w, ..i‘c Jo t'1
APPLIC(Name)A tC r ✓ eviA. e 1- seri 4-- t`2. ' (Phone) l 2 . ;41° a g`7 J
(Address) S) 01 L44 0 r vq (--.0 u /-- C_A4 Sli 4 5— c / d
C�h tA�SC. 14 .e d (Phone)(City) Cpl. (V q O Zip�g LJ
(Contact Person) ✓1 `��'J
APPLICANT SIGNATURE (---,11-7---- ' ' /-�- DATE 3 1 r 1 'Z.
APPLICANT PLEASE COMPLETE BELOW
1(EW CONSTRUCTION ❑REPLACEMENT 0 ALTERATIONS
FURNACE MAKE AND MODEL —7----e 4r`2 ( / v N Z C a g a A C()41 VA FUEL 7)/4 kar4 1
FLUE SIZE `rp c- RETURN OPENINGS /0 INPUT gd. seO OUTPUT 7G ere
e
TYPE OF SYSTEM HEATING OR POWER PLANT
VPLEASE NOTE: Air Conditioner
�] 0 Steam Units and Fireplaces Cannot Encroach
GravamitypAir Plants ❑Hot Water
❑Mechanical 0 Radiation into Required Side Yard Setbacks.
DAir Conditioning ❑Special Devices Fireplaces with Boz Additions or
OVent.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 $49.50
` CC
Estimated Cost$ /`'� Building Permit #
The Minnesota Statutes§32613.148
HEATING PERMIT FEE $ "SURCHARGE"has been changed for one
year effective
STATE SURCHARGE $ .50 July 1,2010,until June 30,2011.
TOTAL PERMIT FEE $ The minimum surcharge for a"fixed fee"permit
(Office Use Only)
• July 1.2010
This Application Becomes Your Building Permit When Approved aid PAID Vteriel No.
Date BUILDiNc EIFRAi!?
Building Official Date
i
t rxx° CITY OF PRIOR LAKE Date Rec'd •
° t`i ` HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Z?Is
�'m tnsc 2.1.r axn Fag . i
CEtp L-� �PERMIT NO ' ,7
:to
• 3.Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
59 s C' r3 sA-A l ZP,� tP,I.�
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER , (( '
(Name) 1 t S'!t- F`T'C.) : Q J 5 (Phone)
(Address) -
APPLI
(Name) OC `\-G F c Elk -(Nc c (Phone) 6( -y (LI— Fa 4 a
(Address) (9 kln C) ' iJ r'AO st\ LS� i---4,Leo t`l LI:- S'504(4
S'504(4
(Address) (City) (Zip Code)
(Contact Person) 5c.i 4" A ""\-ki✓A.--% (Phone) ( (D-Li i - t-r" ,t-(D •
APPLICANT SIGNATURE , ./....--*- --- :47 DATE -1'S- 13
APPLICANT PLEASE COMPLETE BELOW •
IEW CONSTRUCTION ❑REPLACEMENT ❑ALTERATIONS •
a-F.( . Vacs kr,115A,P:.g P ,.anrc.kPS4g
-?�E��fN eEMAKEANDIMODEL idd30Gix. H-NC� S�.--15C.) TR FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
PLEASE NOTE: Mr Conditioner
DWann Air Plants ❑Steam Units and Fireplaces Cannot Encroach
DGravity ❑Hot Water into Required Side Yard Setbacks.
❑Mechanical ❑Radiation Fireplaces with Box Additions or
❑Air Conditioning 0 Special Devices
Went System 0 Other Devices Cantilevers to the Outside of Buildings
Op 'Nb.,-n Require a Building Permit.
FIREPLACE MAKE AND MODEL .-a No `8 p D o C. S t- 7 SO 7p..._
FEE SCHEDULE
Industrial,Commercial&Multi-Family 1%of job cost Residential,Gas Fireplace �A F t A yE 49.50 •
$49.50 minimum AI WITH
Residential,Heating&A/C(New Construction) $149.50 Residential,Additions&Al ltilt�Ds r-' ti p,_
Residential,Heating Only(New Construction) $64.50 Residential,AC Only l�t�.
Estimated Cost$ Building Permit #
The Minnesota Statutes§32613.148
"SURCHARGE"has been changed for one
HEATING PERMIT FEE $ year effective
STATE SURCHARGE $ .50 July 1,2010,until June 30,2011.
TOTAL PERMIT FEE $ The minimum surcharge for a"fined fee"permit
(Office Use Only) is,$:f,beginning July 1.2010
This Application Becomes Your Building Permit When Approved Paid Receipt No.
Date By
Buildinr Official Date
'M ham..,..r.na far.en,..o.,o..H.,,.e 104/1.4.41-0S1411 fay(0491&d"1-AMS
PRIOR LAKE DEPARTMENT OF
BUILDING AND INSPECTION
1. 0 °n File
INSPECTION RECO - i Em.r
SITE ADDRESS �� �'IgiC`SrAL- L—
NATURE 'OF WORK 5 i\ Ir l C . peck.- + p-itJ. L i L.
p,,, USE OF BUILDING -t1A(.. ( .Ir5- F,a vu, k -f
PERMIT NO. 12- - 12 DATE ISSUED 1 1t�//2—
E__0(—/..iL )wCONTRACTOR 1'l --sr t % tz-t o z S PHONE asi - Sz-i - . ) S
I2/u/NOTE: THIS IS NOTA PERMIT FOR ANY OF THE INSPECTIONS BELOW
,` �q�THf,E�,,'P MIT IS Ba(AtAtAIT-41
EPARATE � 'T �rn"5'�
(� u-- 6--/sil�� �! A) INSPECTOR �� DTE
I FOOTING
I FOUNDATION (Prior to Backfill) r,5- ,7,-,),c2PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
eitc(„ , ,�.I) } ROUGH - INS
SEWER /WATER /SEPTIC ir-i __ ' ��Z
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FRAMING vu ,q. (AJA , I,SpCZ'R n
INSULATION
ELECTRICAL
PLUMBING 6a ° �,9 P1 /r, �'' tz.LA. Ilc,!!Z
HEATING (if required) Q,��, ,\(li(1.--
FIREPLACE slo FLue ik-og,
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/'�ICOVER NO‘VIATN NTIL ABOVE HAS SEEN SIGNED
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FINALS
GRADING (Prior to Sodding) is -711/91'BUILDING%- 9 ' 7/ y e
ELECTRICAL
PLUMBING i, Vet5HEATING �'� ` 1<�
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
Builders Deposit
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sO 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 the erosion control
requirements of the City of Prior Lake as outlined in the Erosion Control Measures for Building Contractors
handout. Bicy I
DATE: -7l5�101 ?- SITE ADDRESS: 3S3 Cry 3 J. �.T,e PERMIT# 12. :7 Z-S
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REFUND TO BE MAILED TO: Q2cf extzd-.S
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PLEASE REMEMBER I, , _ k � t ,,, r
III`! e1IL500 ,00
1. KEEP STREETS CLEAN DURING CONSTRUCTION Lynda:.Allen,Building Services Amount
2. KEEP EROSION CONTROL IN PLACE 1 /f i Acct.801.20204
3. TEMPORARY OCCUPAN Y •ERMIT MUST NOT EXPIRE OR$5C Date
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SIGNATURE: ---.01 oJt w
AR' ' PIPP 9 , IT' E G ER
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J:IFORMSIBUILDERS DEPOSIT FORM.DOC