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of pRio� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
,�
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
NNBSOSh I. White File
2. Pink city PERMIT NO. (3,2z
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
- .' Z I c0 Sej, MO 1(1 4- Qvz_, low r-P,0,---- 1-0,.14-,_ ik-A a ,
LEGAL DESCRIPTION(office use only) \\\
LOT BLOCK ADDITION PID
--\- (ONaam ER Pe--kQ-v--- ( 1 0 iti.. (Phone) l C-J S-13 87 O S---
(Address)(Address)
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK 0 New Construction ❑Deck ❑Porch ❑Re-Roofing ❑Re-Siding ..ower Level Finish 0 Fireplace j
❑Addition ❑Alteration ❑Utility Connection r ,
CODE: 146LR.C. ❑I.B.C. 0 Misc. (7-
Type of Construction: I II III IV V A B PROJECT COST/VALUE $
Occupancy Group: A B E F H I M R SU (excluding land)
Division: 1 2 3 4 5 i
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-m 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 buildin
oMg
c can rev this ermit for just cause Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
Signature Contractor's License No. Date
Permit Valuation Ansr2.• Park Support Fee # $
Permit Fee $ ,2 j SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ 2,. r Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ 'r�0 Water Tower Fee # $
'rt `7tJ
Mechanical Permit Fee $ Builder's Deposit $
Sewer&Water Permit Fee $ Other $
Gas Firepl.ce Permit Fee $ d S� TOTAL DUE $ �( 2?
This Ap 'cati t e o • our:uilding Permit en pproved Paid -7 3-Z- Receipt No. ‘018C)
,t�ai�r" 7i 1� (� Date Date By
Building 43 A-
0 ', Date
This is to cet/t that the requ•st in thegve application and accompanying document is in accordance with the CityZoning Ordinance and may proceed as requested. This document
when signe y the icy mer constitutes a temporary Certificate of Zoning mplia ce and allows construction to commence. Before occupancy,a Certificate of Occupancy must be
issued. e
Tanning ' ctor D to Special Conditions,if any
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street Prior Lake,MN 55372
Date Rec'd
��r �'� CITY OF PRIOR LAKE PLUMBING PERMIT
s'zivNrnso44 2.t.Bc: rlienr PERMIT NO.
"ta c� (3.
3.Yellow Appticna
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
I 5-0 13e1/otov i A(IC, N (,)
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER ?j l 5). 573 )/OSf
(Name) 1- `e`1 I..- C- O t (Phone)
(Address) IS-Cs R.-LIamu•,rY ei--U e-, &(AJ
APPLICANT Ctfo -I' LiI%41,x,;7 „-hJ L (Phone) 6-0-7 260 3 87/ /
(Address) 3)
111 3s t4-Ut- wi tom, Scoi 8
(Address) (City) (Zip Code)
;��l�
(Contact Person) t l�. e (Phone) 6/2.. -10/ <5'0 7
APPLICANT SIGNATURE r__. ._._.A. ) v - _•- DATE y/ 3 h ›
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher Water Heater
Floor Drain Water Softener
V Lavatory(Bathroom Sink) Stand Pipe(Washing Machine)
Laundry Tray(1 or 2 compartment sink Sewage Ejector
I Shower Stall Backflow Assembly
Sinks Backflow Assembly Test
1 Bar Sink Lawn Sprinkler
1 Water Closet(Toilet) Other
FEE SCHEDULE
Industrial,Commercial&Multi-family I%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 $ Building Permit#
"SURCHARGE"
year
e has been changed for one PLUMBING PERMIT FEE $ 149'S O PAID wiTH
yea until ve fIL
July i,2fli0,until June 30,2011. STATE SURCHARGE $ 'tJ N� PERMIT
minimum surcharge for a"Fixed fee"permit TOTAL PERMIT FEE $ `i 0. d B `�RM T
is it.,,beginning July.i,2010
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
( PR'o�P CITY OF PRIOR LAKE Date Rec'd
HEATING/AIR CONDI
TIONING/FIREPLACE PERMIT
4e so��
2.C Fi
Pink t, 3
PERMIT NO.
3.Yellow Applicant
(Please type or print and at bottom) av
ADDRESS r O Ar_e.
Nik..) ZONING(office use)
t jirykrayd--
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER pUer ) -- /L)
mame, �� - - (Phone) �,�2 S13 �/ S
(Address) Pt 56 ,� ! V'LL ,, L/( / i Vsic37D____
APPLICANT /� j�/ l
(Name) t"''h r 011 /t-- , tl)iL! (Phone) Ci `-`7r-/d- — 90)-7
(Address) 1 I I 0 0 /j _I Ci 1'7 MV v c5.3, -_
(Address (City) ` (Zi Code)
(Contact Person) --/ ' 'Le _I � ` (Phone) ' :: c.1.2-' :: c.1.2- `7�9d'-'707-76
APPLICANT SIGNATURE _.... 1111111111rill DATE 3 i
APP //ANT PLEASE COMPLETE BELOW
❑NEW CONSTRUCTION 0 REPLACEMENT -*t:1 RATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM BEATING OR POWER PLANT
OWarm Air Plants d.Steam PLEASE NOTE: Air Conditioner
Units and Fireplaces Cannot Encroach
❑Gravity 0 Hot Water into Required Side Yard Setbacks.
.chanical 0 Radiation
❑Air Conditioning ❑Special Devices Fireplaces with Box Additions or
❑Vent.System 0 Other Devi. s Cantilevers to the Outside of Buildings
Require a Building Permit.
FIREPLACE MAKE AND MODEL ink 2 O_u toDUDL'-/r t
FEE SCHE i !
Industrial,Commercial&Multi-Family 1%of job cost •esidential,Gas Fire•1. $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 $49.50
The Minnesota Statutes§3268.148 dost$ Building Permit #
"SURCHARGE"has been extended
L 0 Q
until lune 30,2013, HATING PERMIT FEE $ �CI -J ‘ 0 (2*--
The minimum surcharge for a ;TATE SURCHARGE $ -S . -‘ cliV
"fixed fee"permit is$5.00 COTAL PERMIT FEE $ \
This Application Becomes Your Building Permit When Approved Paid 3-2/3- Receipt No. 4 y Li/
Building Official Date Date atile By F...t
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372
DEPARTMENT OF
PRIOR
LAKE BUILDING AND INSPECTION
INSPECTION R
SITE ADDRESS
cr." 4-6--
NATURERE OF WORK 1-.0.-4-4,4"-- ASjtAsc.
USE OF BUILDING �'t"!tz"
PERMIT NO. l 5- Z24 DATE ISSUED '43
CONTRACTOR P 97 61- PHONE 93z' /3 -,1(4 'S^
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
I FØUNDATION (Prior fo`Backfill)
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING 0 2 3 1/
INSULATION
ELECTRICAL
PLUMBING V `S 8,),,41
HEATING (if required)
FIREPLACE
GAS LINE AIR TEST
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
FINALS
BUILDING Z/ 1 p
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