HomeMy WebLinkAboutBuilding Permit 01-0668
q'lease ~ or 'Orint and si2ll at bottom)
ADDRESS
4-0/4-
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
'-/1-01
c~
lie-.. to hh
J
LOT
BLOCK
LEGAL DESCRIPTION (ollice use only)
~. ~;':: ~:~ r PERMIT NO. Of-(Jf' /J.
3. Yellow Applicant l..tJ{JI.l/'
~'j
)E
ZONING (o_use)
1<150
ADDITION/r.ccfc Il~LJ,..,.....J ~ )~7J:.(,,/ PID 25...32,9. 0l>.3-0
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OWNER n
(Name 1, D a...,.' b ___"
(Address)
fI. ~ I..r.
BUILDER /7 L f
(Name)--1okfg,t.. C/If/ c,." ~
(Contact Name) <J h
(Address) / 't 906 In~,rh, 't, Ed
TYPE OF WORK
[]f'New Construction
o Misc.
DLower Level Finish
PROJECT COST IV ALUE (excluding land) S
(Phone)
J:.... r
(phone)
(phone)
?.9-V'l'J-6'990
($/~ ?~1-.56.7}1
oRe.Siding
oUti1ity Connection
I hereby certify that I have furnished information on this application which is to the best of my knowledge true and comet. 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. Furthermore, I hereby agree that the city official or a designee may
;~7;?X"2 /JfiJ C/l9~/
Signature Contra.ct6t's License No. Date
1000J)c)
1M .I")D
J?I\.SO
ILII ,(')()
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comes Your Building Permit When Approved
I Pennit Valuation
I Pennit Fee
I Plan Check Fee
I State Surcharge
I Penalty
I Plumbing Pennit Fee
I Mechanical Pennit Fee
I Sewer & Water Permit Fee
I Gas Fireplace Pennit Fee
$
$
$
$
$
$
$
$
I I.Q.,000. Q?
l-)?8.'iC}"
''7~ .~"'L
71 . r'JO I
I
I
I
/1/ 'C
oDeck
o Fireplace
oPorch
oRe.Roofing
#
#
#
#
$ ~.AAI
$ /. / fJ:) ..(!18 I
$ I z..t::;.no
$ .4s;co
$ I,QOO.~
$ . rzno.('!YJ
$1,nM~
$ ..
$ '7Q i/L/,:). 1
I ~~cepgJ 3/lU(,
r
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
~hen signed by the City Planner constitutes a V.IU}'UI<IJ.] Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
..
Planning Director
\I
(, -:1(,,- 7ft, (
Date
oAddition
oAlteration
~ G..P A~ 'M(h5\~<'A
Date Special Conditions, i any
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
I Park Support Fee
I SAC
I WaterMeter S~; I";
1 Pressure Reducer
I Sewer/Water Connection Fee
I Water Tower Fee
I Builder's Deposit
lather
I TOTALDUE
I Paid
l Date
7 q.,..,.. z.' /
. '7.4.0/
/
. FEDERAL EMERGENCY MANAGEMENT. AGENCY
.NA TIONAVFLOOJ) INSURANCE PROGRAM
ELEVATION CERTIFICATE .
AND
'",
INSTRUCTIONS
~Re"\bk\.oI"7.Da\ LSf3~ Lo~~",4- $~~N..~~\}-
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NATIONAL FLOOD INSURANCE PROGRAM
ELEVATION CERTIFICATE
PAPERWORK REDUCTION ACT NOTICE
Pllblic reporting bllrden for the Elevation Certificate is estimated to average 2.25 hOllrs per response. Burden 'means the
time, effort, orfil)ancialresources expended by persons to generate, maint;tin, retain, disclose, or provide infonrtation to
the Federal Emergency Management Agency (FEMA). YOll are not required to respond to the collection of inform'3tion
unless a valid OMB control number is displayed in the upper right corner of each form. You may send comments
regarding the accuracy ofthe burden estimate and anysuggestions for reducing the burden to: Infonnation collections
Management, Federal Emergency Management Agency, 500 C Street, SW, Washington, DC 20472, Paperwork Reduction
Project (3067.0077). Do not send completed fonn(s) to the above address. To obtain or retain benefits under the National
Flood Insurance Program (NFIP), YOll mllstrespond to this collection ofinfonnation.
PURPOSE OF THE ELEVATION CERTIFICATE
,The Elevati6nCertificate is an important administrative tool of the National Flood Insurance Program (NFIP). It is to be
used to provide elevation infonnation necessary to ensure compliance with community floodplain management
ordinances, to detennine the properinsllrangepremium rate, and to .support a request for a Letter of Map Amendment or
Revision (LOMAorLOMR-F).
The Elevation Certificate is required in order to properly rate post-FIRM buildings, which are buildings constructed after
publication of the Flood Insurance Rate Map (FIRM), for flood insllrance Zones Al-A30, AE, AH, A (with BFE), VE,
VI-V30, V (with BFE), AR, ARlA,ARlAE, ARlAI-A30, ARlAH, and ARlAO. The Elevation Certificate is not required
for pre-FIRM buildings unless the building is being rated under the optional post-FIRM flood insurance rules.
As part ofthe agreement for making flood insllrance available in a community, the NFIP reqllires the commllnity to allopt
a floodplain management ordinance that SPecifieS milJimum requiremelJts for reducing flood losses. One such requirement
is that the community obtain the elevation of the lowest floor (including basement) of all new and substantially improved
. buildings,andmajntain a record of such information. The Elevation Certificate provides a way for a community to
comply with this reqllirement. ' '
Use qfthis certificate dOes not provide a waiver of the flood insurance purchase requirement. Only a LOMA or LOMR-F
from the .Federal Emergency Management Agency (FEMA) call amend the FIRM and remove the Federal mandate for a
lending instiMion to reqllire thepllrchase of flood insurance. However, the lending i.nstitution has the option ofreqlliring
flood insurance even if a LOMNLOMR-F has been issued by FEMA. The Elevation Certificate may be used to support a
LOMA or LOMR-P request. Lowest floor and lowest adjacent ground elevations certified by a surveyor or engineer will
be required if the certificate is used to support a LOMA or LOMR-F request.
This certificate is used only to certify building elevations. A separate certificate is required for floodproofing. Under the
NFIP, non-residential buildings can be floodproofeQ up to or above the Base Flood Elevation (BFE). A floodproofed
building is a building that has been designed and constructed to be watertight (substantially impermeable to floodwaters)
. below the BFILFloodproofingofresidentlal buildings is notpermilted under the NFIP unless FEMA has granted ,the
cOmmunityan.exceptionforresidelltial floodproofed baseillents. The comlllunity must adopt standards for design and'
'constructionof floodproofedbasements before FEMA will grant a basement exception. For both floodproofed non-,
residential buildings and residential floodproofed basements in .collllllunities that have been granted an . exception by
FEMA, atloddproofing certificate is required. '
jI",
"':". .
FEDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLO<:>D INSURANCE PROGRAM
ELEVATION CERTIFICATE
Important: Read the Instructions on pa\l-!'s 1 - 7.
SECTION A- PROPERTY OWNER INFORMATION
BUILDINP OWNER'S NM1.E 'l2 ". \. ,I .,
. .p,..,.,o.,.... ~_)I\
B... UIL.D..I.N P.ST.R...E.E..nr..A. ..0 D.'R,E SS (In. C~Q.A.P. I., U.nit,~S.I.te,. a.ndlo. . .B.1d g,~R P\O. ,ROUTE A. NO B. OX NO. .
. . ..~B.I.. _ -.... . . . ~~\
CITY.~. ".\ ,Ire:' ". . .. . STATE .
.r'" \r,,9.M' . ~
PROPE .DESCRI.PTION (Lot~~n . I~ber$, Tax P1cel Number, Le.l!~ Oescriptlon, etc.) ~
'. . '. l:..\ .'S. ~.... \l.'2.. 4~
BUILDINPUSE (e.g.~"sldentla, on-resldentiel, Ad~ltlon, ccassory, ate. Use comments sactlbn It nacessary.)
LA TITUDE/LONGITUDE (OPTIONAL)
##' . ##' -##.##' or ##.##;11#II')
HORIZONTAL DATUM:
L.J NAD 1927 U NAD 1963
SOURCE: I_I GPS (Type)'
U USGS auad Mep LI Other'
O.M.B. No, .3067.0077
Expires July 31, 2002
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l.J.~.,.".;I.".,,,'.II't "'."!;~Ii'iF.~'i;I1IliII~~'~'~a!n~" ;I"r,;f.~. "lIm",". IDifi.i I' '. .,I."I'~':i- f..
.',"";!;,!,,,,c",,;.,.f";"'-_"':"""lli~:i~i;~,""!~.-t,- -,p1"- " l'~%' 'I;,,,. ,,,~. ',:oP .
, ZIP CODE .
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SECTION B. FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
I B1, NFIPCR-lMUN.ITYfAME & COMMUNITY NUMBER I B2. COUNTY NAM,!\ .1 B3.STATE
. nlta.... .1 .. 'y, S~ t\\.....
B.4, MAP. AN.D PAN.E. L.I B5. S. UFF. IX I B6. F..IRM IN. DE. XI B7. F.IR.M PANEL. . I B6. FLOOD I B9. BASE FLOOD ELEVATIDN(S)
NUMBER..... f" . . . DATE EFFECTIVE/REVISED DATE ZO"lE(S) (Zon. AO, us. dep h otfloodlng)
000:::r . "'" \I~ \~.C\., \\-I~_C\" "f.-
B1.. D..,r.ndlcate the. source.of th)l. Ba.se FIC)od Elevetlon (B. FE) data or base flO.Od dapthenterad In B. 9. f= lChllcl f\-.\'-
. U FIS PrC)file IJ1FIRM LICommunlty Determlnad I_I Other (Describe):
B11, Indicat~ the alayatlon datum used for the BF.E In 89: IJlI NGVD 1929 I_I NAVD 1988 U Other (Describe):
B12.ls the building localed In a Coastal Barrier Resources System (CBRS) srea or Otherwise Protected Area (OPA)? I_I Yea l..!1No
.' Designation Date: . . . . .
SECTION.C . BUILDING ELEVATION INFQ.RMATION (SURVEY REQUIRED)
C1 Building elevations are based on:' UConstructlon Drawings' . I~Bulldlng Under Construction' UFinlshed Construction
'A new Elevation Certificate will be required when conatructlC)nofthe building is complete. . .
C2. Building Dlagrall) Number -L. (Select the building diagram mo~t similar to the building for which this certificate Is being completed - sea
pages 6 and 7. 'If no diagram a9Curatelyrepresenls the building, provide a sketch or pholograph.)
C3.Eievations.., Zones A1-A3D.., AE,AH, A (with BFE), VE, V1-V3D., V (with BFE), AR, ARIA, ARlAE, ARIA1-A3D., ARIAH, ARIAO
. Complete Items C3a-j below accordlng.lo the building diagram specified In Item C2. State the datum used. If the datum Is different from
the datum use.d for the BFE in SectionB, convert the datum to that used forthe BFE. Show field measurements and datumconveralon
calculation. Use the spe<;s provided or the Comments area of Section D or Section G, as appropriate, to document the datum conversion.
Datum. ConverslonlComments
. Elevation referenca mark used Does the elevation reference mark used appear on the FIRM? I_I Yes I..!1"No
o a) Top of bottom fioC)r (Including baaement or enclosure) ~lO-..!:l,. ft.(m) ~
o b) Top C)f next higher floor . _ ft.(m) I
o c) Bottom of lC)w~st horizontalstructura.1 member N zones only) . _ ft.(m) ~
o d) Attached gara~~ (top of slab) . "', '!"> . Q.. ft.(m) ~
o e) Lowest elevation of machinery andlor equlpmeni 'i ~
servicing the building . _ ft.(m) ~!
Of) Lowest adjacent grade (LAG) . _ ft.(m) z ~
o g) Highest adjacent grade (HAG) ._ft.(m) a
of permanent openings (flood vants) within 1 ft, above adjacent grade ~
o I) Tolal area of all permanent openings (flC)od vents) in C3h sq. In. (sq. em)
SECTION D. SURVEYOR, ENGINEER, OR ARCHiTECT CERTIFICATION
This certlflcatlon Is to be signed and sealed by a land surveyor, engineer, or architect authorized by law 10 csrtlfyelevatlon Information.
. .1 certlfyfhet the InfOrmation In SecUons A, a,end C on this certificate represents my best efforts to interpret the date avalleble.
., understend that eny fe/se stetement may be ounlshable by fine or imortsonment under 18 U. S. Code. SecUon 100.1.
. CERTIFIER.SNAMc.o...... .\ f\J ^ ..... ~.' '.' ..' .... . LICENSE NUMBER Go.
. __ ,"ntl~~ ."', ;;du..-"'.... \Olw~
.,,~. ~>". '-AA'_"l..\\_ ~..oJ:.., Rio,
.ADtlRESS~!.l\LII"l/ .... .~~~(JW'~CITY . 1~1.". I st~oEks'@..,2.._
llIPNATUR7" ...... '.' ~~. D TE7 /c::>/ TE~NEQ"'2._I.\"'f,V;10'
FEMA Form 81-31, AUG 99 SEE REVERSE SIDE FOR ONTI~UATION REPLACES ALL PREVIOUS EDITIONS
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1"P::Ql10""'Ntlmh'ern!~WI,..,I""m"',!'I;'!""';;';!~i"";'H,--,Il'''!'''';;';''i"'':;.:.
)~:I~i~ifi'i~~I~~i~M1~1W~ii~~~I~l1~~~iri:i!i:~\iiirii~i~~~i;~~l:iit:li:iij~:i~!:i:~
ZIP CODE :!i~~::"i:,',':;';I.:,.'~~~~~i,;~r~ii '~'li:~l!~~'~~ii:;'~lii~
l'IlIn.'I"'I~.~b~~'",li~.ilil'il!llii!~!ilf~!il~illi~~'~!,1~~li"!!
.. ...,. ...
SECTIOND. SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED)
, ' ,
Copy both ~ldQs of this ElevQtlon CQrtificat. for (1) community official, (2) in~urarica aganVcompany, and (3) bulldlngownQr. '
COM~~NTS~.... .'~. 1'1V\.A......~.d. ..."
\~P.~~~~.q~6tc:~P'~,~ ~~[2~:~ ~E::f 9kAJIe
It; fu~a(M\- 4h~,,:!,-e:. WJ., bc'l'l,\ r~~&. ~.}IO, ~L~,qt\-'f-..-LCheckhereifalllll:hments
SE ON E. BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) .
.For Zona.AO Md ZonQ A (wltho~t BFE), complete ltamsE1through E4. If thQ E/evetlon Certificate Is intended for use es supporting
information for eLOMA or LOMR-F.' Section C must becompletad.
E1. Building Qiagram NumbQr-,-- (Select the building diagram most ~imllar to the building for which this cartlficata Is being completed -
sea pagQs 6 and 7. If no diagram accurately repre~Qnts the building, provide a ~katch or photograph.)
E2: The top ofthe bOllOmfloor (Including basement or enclosure) of the building is LU It.(m) LI_lln,(cm) LI above or LI balol'!
i(check one) the hlghe~t adjacent grade. . . . . . . .."
, ".E3..For Building'Olag/ams 6-8 with. ~panlngs (~aa PQge 7), tha next hlghar floor or elevatad floor (alavatlon b) of the building 18'
. LLLft.(m) U....Iln.(cm) aPoVethe hlghe~tadjQcant gradQ.
E4.For ZonQAO qnly: .Ifno flood dQpth numbQr Is evallablll, I~thetop .ofthe bollOm floor elavated In accordanca with tha community's
floodplain mana~ementordtnence? 1.;.1 Ye~ l I No' '1 . J Unknown. Tha loCal officlel must cartlfy this Information in Section G,
'I SECTION F . PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION '
The proper!yowner or own",-'s authorizQd repre~entativa who completes SQctlon~ A, B, and Efor Zone A (without a FEMA-is~ued or
. community-Issu~d BfE). or Zona AO mu~t sign hare. .
IMPORTANT: In the~e epaces, copy the cOrresponding Information from Section A.
BUILDING STR~~T ADDR~SS (Incll.ldingi\pl., Unit, Sulto, and/or Bldg. No.) DR P.O. ROUT~ AND BOX NO.
CITY. .
STATE
PROPERTY OWN~R'S OR OWNER'S,AOTHORIZ~D R~PRES~NTATIV~'S NAM~
ADD~~SS
SIGNI\TUR~
COMM~NTS
CITY
STATE
tiP CODE
DAT~
T~L~PHONE
I_I Check here if attachments
SECTION G . COMMUNITY INFORMATION (OPTIONAL)
Thaloca' officiQI who Is authorizQd by law or ordlnanca to Qdminl~tar tM communlty'~ flOOdplain managemant ordlnanca can complata
Sactlons A,B,C (or E), and G of thl~ Elevation .Cartlficate. Complatalha appilcabla Item(s) and sign balow.
Gr. L...I The Information In Section C wa~.taken irom other dOCumentation that has baen signed and embos~Qd by a Hcan~ed ~urvayor,
englnaer, or archltacl who Is authorizad by slate o.i local law to cartlfy alevatlon Information. (Indicate the sourca and date of the
elevation dala In tha Comment~ area below.J
G2. I_I A community official complQted Section E for a building locatad In Zone A (Without a FEMA-issued or community.ls~uadBFE) or
Zona AO.
G.3. I_I ThQ foilowlng In(ormatlon.(ltem~ G4-G9) Is provldad for community floodplain management purposes.
1.04. PE.RMIT NUMBER I G5. DAT~ P~RMIT ISSU~D I G6. DAT~ CERTIFICAT~ OF COMPLIA"'C~/OCCUPANCY
'.. '. ISSUED.
G7. Thi~ parmlt ha~ baen I~sued for: LI New Construction. LI Sub~IQntlallmproVQmQnt
G8. Elavatlon of as-bulltlowa~t floor (Including basament) of the building Is:
G9;BFE or (in Z9nQ AO) dapth of flooding aUhe building slta I.S:
LOCAL OFFICIAL'S NAME
. _ It.(m) Datum:
. _ It.(m) Datum:
TITLE
.:'~:'
COMIVIUNITY. NAM~
T~L~PHONE
SIGNATURE
DAT~
, COMM~NTS
I'.
FEMA FOrm 81,31, AUG. 99
I~ Check here If attachments
REPLACES ALL PREVIOUS EDITIONS
(Jt)..~ { ~ 2-
.
Thf ("nlff of Ih, Like Counlr)'
White - Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
RCb'EJ::::.:'! UrJt:t::.. ('-L fJ 5'T)L.
(,.-::- /q-O/
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
4-{/4- 6~&6/1/ JlE:./ €jf-lT~ 7L'lJIL-
Accepted
v-
Accepted With Corrections
~
~-',
Denied :~ / A ~
Reviewed BY:~~.-/~ Date: & /~tlz ,Ie I
Comments:
fo ~fe~Y- ~ ~ ~Ar~~ q/f).S-'Fr-
7 C-vttWL .s.~/P - ~1Vt (iV/l~ 14v~ ) ill
_4\fD ~ ~ ~ ?/, -
~cit9~/~l ~ .!?cv ~N~ '
-/1I;;;:M 1&f-\ ~. (Y~ ~ ~ LV<2-.,
J-L~~ A-~~J F~ ~~ _I'~~
~ ~ 5t 1~VII1itrd ~ t/,P...v~~i1
~ ~~ Ut(At'€-d>l.. -~J~
~~Lo~~ )=.
"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."
2", ~-S2.B:JIJQ.-''iY~ ~
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Tht ("lIltr of thl' .1Ikt COUIIII'J
White . Building
Canary . Engineering
Pink . Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
.
NAME OF APPLICANT K!OI3t-:.e...l - ~e.K- (' 1) tJS772-.
APPLICATION RECEIVED (,..., - / q - () /
\
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
4-0/4- G /2.&F;. J\/ /-IE / €lHT:S /ZV-7/ L.---
Accepted
)(
Accepted With Corrections
Denied
Reviewed By:
AlI1R
Date:
c;-,J S--O I
Comments: ~F!F! RAverse Side for Additional I nformation I
See Attachments: 1) Grading Plan, 2) Erosion Control Measures
~.~ I=rnc:;ion r.ontrnl PI~n
\
"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. .
White - Building
Canary - Engineering
Pink - Planning
Th~ ("t'nll'f of lhl' L.kr ('ounll'}'
8UlI.DING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT RtJB~ c,ugeK- (!.1) NS772...
APPLICATION RECEIVED ~ - / q - 0 /
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
40/4- G.eeB AI JIG/ €4h- I.:J -T}f;rJ! L-
Accepted Accepted With Corrections ~
Denied
Reviewed By
Date: fa-?7r~
Comments:
"- s.,,~ t:t (l Icnl'-G... SI"J i l anD.D..S::
~a..I( Q/ftacW ~kuls
'3, Mo...""b;,^- 1~t~'-Dv\. ~
"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."
Date Rec'd
CITY OF PRIOR LAKE
SEWER AND WATER PERMIT
;~;;. ~ii~ I PERMITNO./_ / ~;
3. Gold Applicant ~
(Please !VP~ or orint and sim. at bottom)
ADDRESS
Lfn /tJ 6('rvN He!..tJs 1~ f L---
.
I Z;~; (offine) I
LEGAL DESCRIPTION (office use only)
LOT~LOCK ADDITION /(L5 / t, J
PII12S'- 3 d- if - 003- {)
OWNER
(Name)
(Address)
(Phone)
(Address)
(City)
(Zip Code)
~;;~~~c.l<k,..~! l)oeAL ~'U < :/..t1r_
(Address) l'to)o t' OhtY"'c/l'( e A-v'l"-
(Address) / (City)
(Contact Person) Jrrr;- IJ. 1)()~I1..L. I .In (Phone)
APPLICANT SIGNATURE ~JVh.4-- n.n~ DATE
U U '--
APPLICANT PLEASE COMPLETE BELOW
(Phone)
95'J- r't7~S().t7.
"
(Zip Code)
7/fl/O I
Size of water service inches.
Location of any couplings from structure
Type of sewer pipe. 0 ABC 0 PVC
Estimated length of sewer line feet.
Clean out (if required) located at feet from structure.
feet.
o Cast Iron
Residential sewer and water line connection
Sewer connection only
FEE SCHEDULE
$35.50 Industrial, Com'l & Multi-family 1% of job cost with a $39.50 minimum
$17.50 Water connection only $17.50
Estimated Cost $
Building Pennit #
SEWER AND WATER PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
50
. PAID WITH
WILDING PER;';,IT
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Date
I Paid ,
I Dat7_/7_()j
R,~o.
Building Offici.1
By Q..C/
V
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
CITY OF PRIOR LAKE
SEWER AND WATER PERMIT
Date Rec'd
7./3-0 J
; ~w ~\~. I PERMIT NO. O/-OfRfe;y'1
3. Gold Applicant
(Please ~ or mint and sil!Jl at bottom)
ADDRESS
+ () J 4- ~ f!.. ~G N
rl~-r, WrS
10-
ZONING (office....)
#?2S 0
. LEGAL DESCRIPTION (office use only)
LOT BLOCK
ADDITION
32&'/ <()o1-0
PID <5-(.,.,~ sf'! c
OWNER
(Name) (, LA';;, f:'. r All~ ~
(Phone)
4~1 W6
(Address)
(Address)
(City)
(Zip Code)
~;;~~A0 J ~ b-J r LB ~
(Address) _C;....y-'f\) ) ~ ) 5:J~.,... 61
"""'f,i\ddress)
(Contact Person) G-r....jf, IJ k-- ~ v-rI
APPLICANT SIGNA;URE,,~ (J ,
0~
vrD"
(Phone) OJ '5 ..l 43 j ;
r2l.f.f..Ll, V flU,f, \ l . fS )J..~_
(City) ~ (ZiR Code)
(Phone) b J dv I b ) f 1 st
DATE 'I ~ I ~ ~ 6 )
APPLICANT PLEASE COMPLETE BELOW
Size of water service ~ inches.
Location of any couplings from struc~. feet.
Type of sewer pipe. 0 ABC J1I PVC 0 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 $35.50 Industria!, Com'! & Multi-family
Sewer connection only $17.50 Water connection only
Estimated Cost $
Building Permit #
1% of job cost with a $39.50 minimum
$17.50
O(-O,,~y
r PAID \IV'
.so,BUILDING PL.
SEWER AND WATER PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
(Office Use Only) f A 11 I
This APPlitrJi. .'. ~mes. Your Building Permit When Approved
. . l
. )\/\/-
BuPdl~g Offidal Date
V
IPai~
I Dat7./? 01
I
24 hour notice ror all inspections (952) 447-9850, rax (952) 447-4245
::~
-r
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONING/FIREPLACE PERMIT
Date Rec'd
: =. ~:~ I PERMIT NO. ,~ / / 0.-
3. Yellow Apphant f/'JI/70
(Please'!vpe or orint and sim at bottom)
ADDRESS !ff}/'-! f}/lUA1~ t/1fs d/l/
LEGAL DESCRIPTION (oflice~use oaly)
ZONING (0_ use)
LOT
BLOCK
ADDITION
PID~- ~ d--G-D,,~40
OWNER
(Name)
(Phone)
(Address)
APPLIC~ h :j- /A /L .. /) _. . ..J--
(Name) ') ~A . (~~ --"
(Phone)
(Address)
(Address)
(Contact Person) ~1t6- ~~ _
APPLICANT SIGNATURE . :},6.#~
APPLICANT PLEASE COMPLETE BELOW
ONEW CONSTRUCTION 0 REPLACEMENT 0 AL TERA TIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
(City) (Zip Code)
(Phone) h 101-- 7d-~-C:; bJ-4
DATE 4/;lt6 /0/
OWarm Air Plants
OGravity
o Mechanical
DAir Conditioning
OVent. System
o Steam
o Hot Water
o Radiation
o Special Devices
c/JtJ d-A/ ~;:rDevib emf)
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
FIREPLACE MAKE AND MODEL
Industrial, Commercial & Multi-Family
FEE SCHEDULE
1 % of job cost Residential, Gas Fireplace
$39.50 minimum
$99.50
$64.50
$39.50
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
Residential, Add;f~'-.:::II~I'u .Ins
Residential, AC ~ry'H::iJM QIVd
.... '
BuildingPennit # '~!~/,I~"'IO
'-Uf[j)' D ''''-'1.-. Is.-~,
/)u. A //\'(;, '~q ~;.:..",
.50 l'~o,~O ~ '11-
G ~;,. '1f
"/:> .
lJ~/'"
Receipt No.
$39.50
$39.50
Residential, Heating & NC (New Construction)
Residential, Heating Only (New Construction)
Estimated Cost $
$
$
$
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
I Paid
I Dat:q...;).. tt-ol
BYf/
24 hour notiee for all inspections (952) 447-9850, fax (952) 447-4245
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
: ~~ ~::, I PERMIT NO. -'1/_ rV f rJ I
3. Yellow Applicant r/I (..,/ft:'~
(Please t.voc:.. or mint and sien at bottom)
ADDRESS
4--D } 1.). ~ ~ (6 w
Nr..J:L m< If!...
. ZONING (office use) .
RISO
BLOCK
PID.;l5""" "j.;tJ -O(J ~
LOT
LEGAL DESCRIPTION (office us. only)
ADDITION
(j~'r
(phone) ft;, (~Jf-t
OWNER A
(Name) C L- \2, k'
(Address)
APPLICANT , If
(Name) C9 I :5 ~J ~l~ YYl BJv~
(Address) b 4- ()V \ '< ) 1>-'I~ \:11'
. (Addiess)
(Contact Person) C, r: ^/.( b L < 0
APPLICANT SIGNATURE ,~. 10,
(Phone) ~S.l. LJ,:~ j, tt VI ~
vv 'P(J U IJ ilW \) ,~ s"),,) Ll
(City) .. '/ (Zip Code) .
(Phone) r; )J. J~) 'I.) 5 (
DATE '7 -' J-:<,., () )
Quantity
L
I
I
. )
I
I
I
~
APPLICANT PLEASE COMPLETE BELOW
Type of Fixture Quantity
Bath Tub with or without shower --...
Dishwasher
Floor Drain
Lavatory (Bathroom Sink)
Laundry Tray (lor 2 compartment sink
Shower Stall
Sinks
Bar Sink
Water Closet (Toilet)
Type of Fixture
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
Backflow Assembly Test
Lawn Sprinkler
Other
FEE SCHEDULE
Industrial, Commercial & Multi-family 1 % of job cost with a $39.50 minimum Residential, New One & Two-Family $99.50
Residenlial, Additions & Alterations $39.50
Estimated Cost $
Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
.50 eUIL:~WG ~i~Mlr
(om.. Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
I Paid
I Date
"/- /3-01
,BY g0
. Receipt No.
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
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CITY OF PRIOR LAKE lie
18200 EagllCI'HkAv.S.E. PMllIltNo. 01- 0&"8
Prior Lan. UN 55372 .
HEAllNG APPUCAllON I PERMIT
Dal. IfIJ-A'1'"' ~I PIO, 25- 32.Q- d03-0
SUAdclnIl ~IJ/# ~"'Cr..v Hc.,~i,'. "',./.
F
1aI _ Block Add.1an
OWnefa Name A ../._f C I.,."J,. 1"':___ f-
1u>>__I'...'~, LL~
HH1ing ConIIdlf FM""~J '- ,^, FJ"..f.I
Adct_ 'J./tI.N ~A,~_..J.I"'L L~ Id FIUN' ~ I'1N
r. ...,.
Telephone' 41'"' - ~"7- 7"1-40/ ~aa{
F...._ Milke & Model L.LJVh,.t:. /,1L TYPE OF SYSTEM
W.m Air PIanIa
Gravl1y
Mech8niclll \i
Air CondlllDninli \l
Fkle Siz. j...'. AI L Vent. Syllem
HEAYlNG OR POWER PLAHl'
Slam
Hal Wiler
AadilllDn
, SpecIal De...
Model Size
'7tf"'.,p,1J
Conn. loacf
Fuel ...AL'" -#-
Supply Openings
RIIum apenqa
Inpul.J5: g" /J
Edr.
0uIpu1~
r_JI ~
0lIIII Devicel
am.
TYPE OF WORK
Mllalions
J(
RsplKemSnl
, New Conslruclion
AlplliI
Est. Comp. Dal.
8uIdInll Perm.. ,D' - b~ '
rA~
.50 !-
Ell. Cost .
HEATING PERMfTFEEI
STATE SURCHARGE .
lOT AL PEIIMIT FEES .
R8celpt II
TYPE OF STRUCTURE
L _ ""
1_ at,
1 _ eo...a
Single FemlIy
CoIllll18R:1a1
It Two-f'vnilV
1nti1e1ri8/
FIB Schedule
Induntal, C " ..,.. II I MuII-FemIy
Reaidenllll, Helling & At;
Relldtnlil\, Helling Ontv
Relldtnlll. au F1..~
ReIIdtnIIIl. AddiIona I AIllllllloN
ReIldenlil\, ~ Only
M"r.mIy
. PlGiic. . Oller
......
. "
1% aI jab -' 1138.50 rNnl_l
S9&..50 PLEASE NOTE:
$14..50 Air Conditioner Units Cann
13UO Encroach Into Required Sid
139.50 Yard Sefbacks.
139.50
AI .1" 10 Idd \he Stale Sun:harge on Ihe bollom aI thII " ,. ,~.
The price III)'IIlIl' huIing pemjI JnclIdee _lDug/I-In Md _ fi\IIrllllcllln.
AdIIIorwl'.." .." I wi! be billlch' $35.00 ..m.
Houle ~ TIIIt RIrooId mual be SIlblntIecI wilh IIIiIdiJg IIIIIIIIIIIIIIIIIIIl befonI buid-
ing ClflllGalII 01 0CCIlpInl:y wlI be IIIUId.
UEaI elf r.J ILATI00S RF':lJUIRED witlllUIIIber of ... IIld RIIum . ., :. I' IlII8d pili"
- wIlh CRA per opening. New -.ucuw or eddIllane IIIJId __ plan wWIl1U111l1v
8fId ilium loc:allonllhown. HEAT LOSS CAlCULAflONS. Pll\YMENT IN)
APPUCATlONS MAY BEMAlLEDlOTHECITYOFPRIORLAKE.112Cll1 EAGLE
CREEk AVE, S.E. PRIOR LAKE. MN 65372-
CIIy HIII___ '- ... I LIB. . 4:30 p.m.
AU WORK MUST IE INSPECTED {ROUQ~ AND ANA4' CALL CIlY HALL
,
..7.... .
I herllly Ipply fa; a m.chanlcal'lyllllfJil permit Ind' ~ "It the
Inlonnllion lbove I, completl 'Iind_lIIIl1; that the wiIIll iIlII be In conformlllCll
wilh thl ordlnlnc.. and cDdN 01 the cllY'lI\d with the ..... bUlld1nglmechlll\lcal
cod..; that 11111 lorm doN not become a pennil unlIt elgned by lhe 8UILDING
OFFICIAL: I~I the walk .llll"lnlCc.ordlncll With the epproved plln in Ihl
ca.. of "I work whlcb .."'*....vJn end .pprOOla' of plan..
j,~..
Bu.~ 0fIica1'l Slgnelln
,'-~r'~'
lltIIe
IO-ZS-()j
DII.
PRIOR LAKE DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION RECORD
I
Q".,.a", .< ~">., " ....
..~~ So,l A"-S .~r~.\',^cJ.
, GRADING (Prior to Sodding)
BUILDINGT,~O. ~ gll/o't. ~,
ELECTRICAL I
PLUMBING
HEATING
DO NOT
SITEADDRESS ~N!!JlnA ~...~ J;.
NATURE OF WORK l)-e.-u
USE OF BUILDING S~D
, PERMIT NO. (J!- O(p~g DATE ISSUED (P-2C..Z-
CONTRACTOR ~ L. a~ PHONE t./2- ~-Sr..;?'f
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
;1: ;<., '.' . .., ,+~:~~~=E D9-CUME.~~n., ..."'""'.. ......~ ~f1~,..
~ _.~..w ,\ :~- " ,i. '. -''''': -_,'::_~_t'""~V'Y\.J-~~A~W I
, FOOTING ~ ~ It/~Dl I fttJ.. 7J1!../ol I~/P~ ~/D{
FOUNDATION (Prior to Backfill) I ~t)1 I ,
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH. INS
SEWER I WATER I SEPTIC b::r. 7/1'1,'a (
FRAMING . ~. . . 'Ij;-'/II
INSULATION IJt. , / S/4/
ELECTRICAL /.1_
PLUMBING 1!!T1' . 'rJ/ >>Ilf I
HEATING (ifrequired) ~ 3Jd-'JhJ
FIREPLACE W~. 9//-;'H' ~ 1'/,;)-'/0
GAS LINE AIR TEST (;p, '~', (1<"';'" 4 . jf:;.,/4, .
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I I l
FINALS F=:~\v,Ae\~ ~~~-~~
71/5 IZ../I 4f ) ~ } -
fof ;).~'j1Jl tJ:r . ~!t ~/o z.-
'. (l..~ \Oll~i4J\.
. ftq-I 1(J/~\'5;D)
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.
Call between 8:00 and 9:00 A.M. for all inspections
FOR ALL INSPECTIONS (952) 447-9850
~
Itrtiftcau at Ql)cmpancy
Clli OF PRIOR LAKE
J)tpartmtnt of lBuilbinlt. Jn~ptdion
~ina1 Permitted 0 Conditional C.O. Expil'l'.
This Certificate isswd pursuanl to ,he requiremelllS of Section 307 of ,he Uniform Building Code
certifying that IJl the time of isSUlJllCe tltis structure wa.r in compliance with the WlriOIlS ordillQ1lCes of the
City of Prior Loke replaling building construction or IISe. For the following:
SINGLE FAMILY
Use C1usi_
BIdg_ Permit HI"
01-0668
Lepl [_,.,', :...
R3 Type Construction
TRACT C RLS #161
VN
_ Fire Zone
N/A
ZoDina Distric:l R 1 sn
(.."".. Type
OwnerofBuildinS SitcAddress 4014 GREEN HEIGHTS TRAIL SE
ROBERT CLARK CONSTR. INC., 14906 MANITOU RD., PRIOR LAKE
ConIroc"".s Name A Address
ROBERT D. HUTCHIN{' ~,. ,~ity_
l~~h~
., f
DON RYE
Dale:
Dale: ,
POST IN A CONSPICUOUS PLACE
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
OWNER
PHONE NO.
o FOOTING
o FOUNDATION (p)
o FRAMING
o INSULATION
,..d" FINAL
o SITE INSPECTION
COMMENTS:
DATE TIME
SCHEDULED ~-=/" --;2--,;3/'36
1(014 ~~OJAA. rJ:r~/L'
CONTR.
PERMIT NO.
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING F AL
o MECH FINA
It/~
&....~~
/-~ {;??'
o EXIGRADIFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
1
~'
- 4-!
-jJtll- ~ ~
d..o. {},d tq ~ ~.I
('}3 ~ORK SATI~FACTOR~. P;WCEED )
~:t.. :_"I~\""u.'Ia~I".Ji"i\.Vv'L..~
o CORRECT WO K, CALL FOR REINSPECTION BEFORE COVERING
Inspector:
Owner/Contr:
I~fwl,,",
CALL .&47-98 0 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUiREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
lNVWn
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
iZ.'/ivl fl>')
ADDRESS 46/'1 (;ru~ rhs~ t~ Ir~' '/
OWNER CONTR. f'."~~rl (/c,tJt'L;IIsl
PHONE NO. PERMIT NO. 0/-1:.,;.1
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
rm FINAL
""'0 "SrrE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
(jiIluJGRADIFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
COMMENTS:
r".u/o l?a."..~ oK
6rc,rlt '" s - '" t:.
~RK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
InSpector~_ -owner/Conlr:
~
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTJ
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
/d-lf.tJ/ /:/5'
7}c
ADDRESS
4-01 ~ riltiaV ffII
OWNER
CONTR.
PHONE NO.
PERMIT NO.
/- 0& I
o FOOTING 0 PLUMBING RI
o FOUNDATIO~ 0 MECH RI
o FRAMING i.. \ 0 WATER HOOKUP
~NSULATIO \" 0 SEWER HOOKUP
FINAL 0 PLUMBING FINAL
o .SITE INSPECTION @XMECH FINAL
COMMENTS:lD "Muk . '_~ ~ ~
~ -h> l;e ~,..J} ~ f
(~ }40..,.,~..:2 ""'- ~ AuLO.? 0/-,., ~~ (~
::tr, ~. ~J
(~~ ~ I ~.~ .P~~ f!--m" ~Sl.-<..J
~:.~-j~ o.,-fL ~ +w &-<- QO'?,'1
fl ~, ~ /5/ /~ t:;~ ~.
(41 ~O P,.",t.- b"., /~JLQ 10 I~
~~ ~ Q.".".J ,'... / ctuL ;-<1 ~.
~)~..:v..~l-..~~~~
(fJPO~ ~-' ~ot1 o-r-. -",;/'vJ:& ,
o EXIGRAD/FlLLlNG
o COMPLAINT
~IREPLACE RI
IREPLACE FINAL
o GASLINE AIR TST
o
~~
o ~ATISFACTORY. PROCEED
o CORRECT ACTION AND PROCEED
~ CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector:~, OWner/Conlr:
'/
CALL <147-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH'" SAFETY!
INSJ<<JTl
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
COMMENTS:
DATE TIME
l./o I '-I
SCHEDULED tt1-( R-( ~: 3D
r;,A~t1/l1) ~~~~
CONTR.
,
PERMIT NO.
f- G(;;,,~
o PLUMBING RI 0 EXIGRAD/FILLING
o MECH RI 0 COMPLAINT
o WATER HOOKUP j) 0 FIREPLACE RI
o SEWER HOOKUP 0 FIREPLACE FINAL
~LUMBING FINAL. 0 GASLINE AIR TST
o MECH FINAL 0
pf\i'SG.,~
./
qWORK SATISFACTORY, PROCEED
d-CORRECTVi ATI N ND PROCEED
o CORRECT . L~ FOR REINSPECTION BEFORE COVERING
Inspector. / OwnerlConlr:
CALL 447.9850 FOR THE NEXT INSPECTlON:U HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
IN'N01'1
:,:?r~/~;~~~--
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