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of PRIo. CITY OF PRIOR LAKE BUILDING PERMIT, Date Recd
,�
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
....� AND UTILITY CONNECTION PERMIT �� Z . /41
U trj
2.
�FNNESOt I. White File Pink City PERMIT NO.
y et 3
3
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
5379 Brook Circle Prior Lake il\ 1
LEGAL DESCRIPTION(office use only) I
LOT BLOCK ADDITION 73 Keei's�/6. . 7 S'AVPID r7,. Qp./' 'CJf l
--0
OWNER
(Name) Linda Byers (Phone) 952-334-6434
(Address) 5379 Brook Circle
BUILDER
(Company Name) Doug Carlson,INc. (Phone) 952-431-4488
(Contact Name) Doug Carlson (Phone) cell; 612-720-4045
(Address) 7185 — 132nd St. West Apple Valley, MN 55124
/ I ,/
TYPE OF WORK ❑New Construction ❑Deck ❑Porch ❑Re-Roofing ❑Re-Siding XLower Level Finish ❑Fireplace
DAddition ❑Alteration DUtility Connection
CODE: ❑I.R.C. ❑I.B.C. ❑Misc.
Type of Construction: I II III IV V A B PROJECT COST/VALUE $
Occupancy Group: ABE F HI MR SU (excluding land)
Division: 1 2 3 4 5 l
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 caus urthermor ,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X ey�,L.d.t�.o �y� Ade,' PC005552 09-02-14
/! Signature Contractor's License No. Date
Permit Valuation l600. 60 Park Support Fee # $
Permit Fee $ e4 / . 2-5 SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ S''-6 Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer&Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $
•
This Application Becomes Your Building Permit When Approved Paid et% %SS/ Z Receipt iJ / , •
Date 1'2(1(-( By �i f ��
t�y �'�
l
Building Official ate
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
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street Prior Lake,MN 55372
rite. CITY OF PRIOR LAKE Data Rec'd
c 1 HEATING/AIR CONDITIONING/FIREPLACE PERMIT
1.Pint File PERMIT NO.
vNEso 2.Green City• /4 /. /
lease type or print and sign at bottom) 3.Yellow Applicant /��/�
&DRESS ZONING(office use)
5 39 C &mss Gals c,1,e. SF . Cwt
JEGAL DESCRIPTION(office use only) /
LOT ZBLOCK ADDITION ,j Y®a�i S 0L ,'/I/ V-1'2-,'1,1'Ly, 5---61�J'D/!/`O
)WNER
Name) L-� �0. .S (Phone)
S319 �3ra -S C�1 - s5�—
Address) � ,._.. _..,.... -r��:�.;�,::< ..�.
k.PPLICANT
Name) Ce\ 4-ki 4- 1- - (Phone) t5� Lig). 1)_171
�
Address) « EA. em:11p f• det-r\. .
Contact Person) Rej(\2 e ,‘mk.Y._.— (Phone) ci a 41 - cl>9i
APPLICANT SIGNATURE (1DATE 5/1,9)41(1
APPLICANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION ['REPLACEMENT 0 ALTERATIONS
FURNACE MAKE AND MODEL FUEL GL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT PLEASE NOTE:Air Conditioner
❑Warm Air Plants 0 Steam Units and Fireplaces CannotEncrOclach
❑Gravity 0 Hot Water into Required Side Yard Setbacks.
0 Mechanical ❑Radiation Fireplaces with Box Additions or
❑Air Conditioning , . e ;., A _ '. . -,,. 7 ' 4y ,,; b
0 Vent. System Other Devices Require a Building Permit.
'FIREPLACE MAKE AND MODEL +43G-10 C ce'-nA. -35--C, -...,;v .3,er . iv to „m m,
FEE SCHEDULE
ndustrial,Commercial&Multi Family 1%of job cost Residential,Gas Fireplace $49.50
$49.50 minimum
Lesidential,Heating&A/C(New Construction) $149.50 Residential,Additions&Alterations $49.50
tesidential,Heating Only(New Construction) $64.50 Residential,AC Only $49'.50
Cost$ Building Permit#
HEATING PERMIT FEE $
STATE SURCHARGE $ 5.00
n TOTAL PERMIT FEE $ S1-1..Sti
II
0
This Application Becomes Your Building Permit When Approved 117�.
Receipt No. ..,
illiMi
l�alri, MI By
Building Official Date
24 hour notice for all inspections(952)447-9850
DRNT OF
PRIOR LAKE BUILEPADINGTMEAND INSPECTION
INSPECTION RECORD
SITE ADDRESS . 379 7E d O, -J etr6
NATURE OF WORK Gew k- r.6VZ-- Cic%"Lez0/4/
USE OF BUILDING /1��J "Viz-
PERMIT NO. / f_ q3/ DATE ISSUED q. z.o¢
CONTRACTOR AOuc lnle„ PHONE QSZ - itz t . X9'88
INSTALL EROSION CONRTOL AND MAINTAIN CLEAN STREETS AT ALL TIMES
INSPECTOR DATE
G
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING qh t /7(
INSULATION
ELECTRICAL
411111111111111111111
HEATING
FIREPLACE D C /6)(7
GAS LINE AIR TEST
11111111111111CIM WORK UNTIL THE ABOVE HAS BEEN SIGNED
11101111111111111. =Eft
FINALS.
BUILDING
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