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4.(3's/ t.� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
j ti;` TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
v1 rn (.57 /3
AND UTILITY CONNECTION PERMIT
rNN E SOS
1.White City
ale
2. Pink PERMIT NO. /3 --fii7
3.Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
I "l ®23 W1\AernQ,SS Tr_ Se ?loYL &_
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER • Ol.C
(Name) M( `` W r 0V1 Y1CO` kfara S (Phone) q5 a -4 4 0-7 LI 7 2-
(Address) 110 Z 'S (.3 t. I A-e-t ,s r Tr SC PYi by e--,z
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑New Construction ❑Deck ❑Porch ORe-Roofing ❑Re-Siding -Wer Level Finish 0 Fireplace
DAddition ❑Alteration ❑Utility Connection
CODE: I.R.C. I.B.C. 0 Misc.
Type of Construction: I II III IV V A B
Occupancy Group: ABE F HI MR SU PROJECT COST/VALUE $
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 permit forjust cause. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X 061/067/.:;
Signature Contractor's License No. Date
Permit Valuation 3/000. 00 Park Support Fee # $
Permit Fee $ 74 7S- SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ /, S-0 Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ S I S---0 Water Tower Fee # $
Mechanical Permit Fee $ ,._ -- Builder's Deposit $
Sewer&Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ cb TOTAL DUE $ /05 75
This Application Becomes Your Building Permit When Approved Paid / r -2 S Recei. N .• 9 t ,,
Date A/3 By t�-.�L
Building Official 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
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372
Residential Building Permit Checklist
Basement Finish or Interior Alteration to Single Family Homes
BY: Date: �-/2
Building Permit# /3„ c(o 7 PID: Zoning:
Site Address /7023viz,0(�� A - '
Legal: L B Y� Subdivision:
Existing Structure: YES or NO •
CONFORMS TO ZONING YES NO
ORDINANCE
YES NO
Is this an expansion of the existing footprint or Refer to Planning
building height?
Is the property located within the flood plain? Refer to Planning
Does the alteration include any additional kitchens? Refer to Planning
Does the proposed alteration include any outside Refer to Planning
entrances other than patio doors? ✓
Is the proposed use of the finished space or Refer to Planning
alteration for anything other than a normal single ✓
family home(office, group home,day care,etc.)?
THIS CHECKLIST MUST BE COMPLETED AND INCLUDED IN THE BUILDING PERMIT FILE TO
MAINTAIN A RECORD OF THE REVIEW.
L:\TEMPLATE\ALTCHCK.DOC
PRIOR LAKE DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION RECORD
SITE ADDRESS /10L3 / b assgrovi..
NATURE OF WORK _ _1 -1
USE OF BUILDI
PERMIT NO. . 'LI DA E ISSUED ,Atcor
CONTRACTOR L- _ S PHON 111.4116j Lune's
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
111111115 '
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING /� �?
INSULATION �I ,�/�-L /�w„.„2„ /4T fV�/�/ .00" .,/,;/ / 2
ELECTRICAL
PLUMBING O 1. . JO 7
HEATING (if required) / �%
FIREPLACE %
GAS LINE AIR TEST 3
COVER NO WORK UNTIL ABOV HAS BEEN SIGNED
11
FINALS
BUILDING 2 I7 (
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