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CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
'6.'',C.; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
" AND UTILITY CONNECTION PERMIT �) ' ,
' kAr E SD
I.White File
2. Pink City PERMIT NO.' 4yct
3.Yellow Applicant •
(Please type or print and sign at bottom) ,
ADDRESS ZONING(of Ice use)
52 6, 1 Fox 1j/ C--- N w'/ Pv-ib r LA-14e.) MA( 5- 7� 0J3
LEGALDESCRIPTION(office use only)
LOT 7 BLOCK a ADDITION We.nSrrLa." / $-4 PID (95 '• 370;110
O(Name) S CO-N-- '- S h.ea-y/ J-1--a L.4.5.c_.--N (Pho ) 4 S; - (bii• Lis s 3
(Address) / 5a („,9 F x 7 & j Gf-- NEA) P ri y r / a c,. .
BUILDER r
(Company Name) tJ A (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK 0 New Construction ❑Deck ❑Porch ORe-Roofing ORe-Siding Lower Level Finish 0 Fireplace
❑Addition ❑Alteration ❑Utility Connection Ly /Z '7S
CODE: ❑I.R.C. DLB.C. 0 Misc:
Type of Construction: I II III IV V A B m
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE $ 5o/ O n o
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 this permit for just cause. urthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
Xl3�/V-20 l<L
Signature Contractor's License No. D
Permit ValuationPk Support Fee # $
��() �0 0 pp°
Permit Fee $ U-7 Z,5 SAC # $
Plan Check Fee $ Water Meter Size 5/8";1"; $
State Surcharge $ U 0 Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ 5 4. 57 Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer&Water Permit Fee $ Other ,{� $
Gas Fireplace Permit Fee $ ..� TOTAL DUE Nit 3.. 1 1 . 1`T $//43, /y
This Applicatio.Becomes Your Building Permit When Approved Paid 413.176— Receipt No. 76g 1 7
�i Date �/////,i By Sit4G(.�
Buil. '75v'1 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.
Planning Director Date Special Conditions,if any
pi)
05/28/2014 07:12 FAX
kti 001
. •
•
Dad Reed
M*mg.
49CD.1
CITY OF PRIOR LAKE PLUMBING PERMIT
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"11" MI6 PERrinTri--- fra--1/0 —
a ado qr. /7
3.Yawl Ward
Rime tYllo OtiOttritgate)ti
ADDRESS
ZONING okalco usefl
IE-A69 FoxmiL
TETALDEsaurnoriVi;„....40
LOT BLOCK ADDITION
P31)-
•
OWNER. Lo Ls
(Phone)
(Address) "* ' fttm-e pi4 44a dE
APPLIC
(Name rilt_Pki, alhone04-44 aiat
(Address) °LI 18 — 1...ovevaLF" u. 83-044
(Address)
(ow (Zip Code)
(Contact Pelson) P ' "- ‘) 1,'-31°I
(Phone)
APPLICANT SIGNATURE -411 A41141,441044 DATE 5
APPLICANT PLEASE COMPLETE BELOW
e Fixture
Bath Tab with or without ahower Rough-ins
Dishwaaher %ter Heater
-
PlOOr Drain
Water Softener
ri intro° Pi e ashing Maine)
0.1•11.1.•
Tr 1 artniellt Sink Ejector
Shower Stan Ilackftow As
Sinks
sem*Trot
Tittekflow
0,1P.AAAMI.
Bar Sink Lawn Spriekkr
Watr Clerollet) I Other
FEE SCHEDULE
u has b-deaee ikex326-B.144* job cost with $4940 minimum Reideitlial,14aw Ma*Isato-Fansily $149.51)
'SURCHARGE°
d" • Residential,Addant&Meadow $49.50
Tiie mlninnun sun:holt%for •
PAID'WITH
mfixed fee permit is$5.00 " $ Building Pennit
UILD!NG PERMIT
PLUMBING nuturr FEE $
STATE SURCHARGE $ XII 5.00
TOTAL PERMIT PEE $
(Mee Use thdy) •
•
Tide Appileatiou!lemmas Your Building Permit When Approved Paid Receipt No,
Date Ay
ldiatteritetal pats
24 lout mese lktr ail ktspeetians(952)4474660, 447-4245
4646 Dakota Street 8.1,,Prior Latiepramesets
•
4 rnl!a� CITY OF PRIOR LAKE Date Reed�° °, HEATING/AIR CONDITIONING/FIREPLACE PERMIT
-5- 1 ' (q
'yiNrttisciit' 2.G
t.Pinkreen PileCity �PERMIT NO. 4 ,
r-,.,1
l l
3_Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID (RS-. 3%. O I.0
OWNER S Ott
� rr- yL
//iAtuE-7‘) {Phone} _
(Address) / s - 7 F9( Ti}"f.- GT P�
(Name)ACANT E/V t 5 ter e-47-7/1 "le— (Phone) Jam ) 447-- 57e ____7--
(Address)
7e7(Address) /1519'-‘4 & "Ari /-U /9 Lac aiaimi.
(Contact Person) L/ = _—' P. !?i /D /5 7
APPLICANT _ s ' .TURE �j1 - _ DATE S(6`(�
APPLICANT PLEAS : t 4 ' ki ELOW 'DU CT7Av p
El NEW CONSTRUCTION 0 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 DHot Water into Required Side Yard Setbacks.
DMechanical ❑Radiation Fireplaces with Box Additions or
DAir Conditioning ❑Special Devices Cantilevers to the Outside of Buildings
Vent. System DOther Devices 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 t'esi t ential,Additions&Alterations .50 k)
Residential,Heating Only(New Construction) $64.50 Rest ten a, ' • , $49.50
Cost$ Building Permitll
HEATING PERMIT FEE $
STATE SURCHARGE
$_____57
TOTAL PERMIT FEE $
6:
This Application Becomes Your Building Permit When Approved Paid (V Receipt No_ —
Date By
Building Official Date —
24 hour notice for all inspections(952)447-9850
�II
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II
.
DEPARTMENT OF FPRI RLAKE BUILDING AND IN
SPECTION
INSPECTION RECORD
SITE ADDRESS Al - ' X fC
NATURE OF WORK 1.4 A -4 ' -�
USE OF BUILD!► _ 1
PERMIT NO. l`: DATE ISSUED
CONTRACTOR s/ &71' T- 11 PHONE A , r lir T513
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
ORM
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING L; ��S"X
INSULATION kX• 3/2r/f'
ELECTRICAL
PLUMBING
HEATING (if required) �J
011111111
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
FINALS
BUILDING h 9)2.5j/
ELECTRICAL /
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 (952) 447-9850
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