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eSiA5'1OCITY OF PRIOR LAKE BUILDING PERMIT, Date RecdTEMPORARY CERTIFICATE OF ZONING COMPLIANCE
I
AND UTILITY CONNECTION PERMIT . IV/9a 6
rkNESO�
1.White File
2. Pink City PERMIT NO. /5-: /9-7
3.Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
llf 3S'7 e,r,de' C (4 i ) LAJ 10 US r1)
LEGAL DESCRIPTION(office use only)
LOT4g9BLOCK 00/ ADDITION JAI-Fie/es On T&e-Ff DL)T PID cacit 7C0 S/9a
OWNER v p
(Name) Ne LIC;C �- (v , (Phone)(gf2) Z.3 3 — `l )/2
(Address) ,43-7 f?,Ks:A /yL N(it)
BUILDER
(Company Name) 0w^-€i (Phone) 9ô2. 35.(af 3
(Contact Name) ,dtru kr4 LY ,J • Ku 6 rig- (Phone) 9'' 2.W9*‘1.54 6'
(Address)
TYPE OF WORK 0 New Construction ['Deck ['Porch ❑Re-Roo
[]Addition DAlteration � Erne-Siding wer Levei Finish ❑Fireplace
❑Utility Connection 2S
CODE: I.R.C. DI.B.C. 0 Misc:
Type of Construction: I II III 1V V A B /
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE S /6, ro o. 00
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 rev�e[t�hiss permit for just cause. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
L
x L4 --- ` -fl� 1
tr
_..Signa t- Contractor's License No. Date
Permit Valuation zado .0 0 Park Support Fee # $
Permit Fee $ SAC # $
la2,. 25
Plan Check Fee $ ..._.—. Water Meter Size 5/8"; 1"; $
State Surcharge $ /, 0 O Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ 54Z 50 Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer&Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ /1 7, 7
This Application Becomes Your Building Permit When Approved Paid /1 /-7,l- R c ' t 1
Date 3 4,.,/ r B
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
of ltlo� Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
'''rNN E sots'
1. Blue File PERMIT NO.
2. Gold City '
11
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
`A3 5'7 Por /(-51' e_ (-
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) '-tvi K.s s 14-t`c._ (Phone) '1 SZ- 23 ? — c9 13
(Address) k q3 S7 f CE k- ; (-14e C r
APPLIC
(Name) 1/'D {M-c.Ls 1 - P t 1, (Phone) 6.tl- 3.3 7- /7 3 e?
(Address) I O g/ 11 ec-,-7'!
c,/- p✓ l,„)Uv d b,)7',-7 6 5 7 2 7
(Address) (City) (Zip Code)
(Contact Person) -3—"frsov (Phone) 54-A-—
APPLICANT SIGNATUREr — DATE A1197/C
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 I Water Softener
Lavatory(Bathroom Sink) Stand Pipe(Washing Machine)
Laundry Tray(1 or 2 compartment sink _ Sewage Ejector
Shower Stall Backflow Assembly
1 Sinks Backflow Assembly Test
1 Bar Sink Lawn Sprinkler
1 Water Closet(Toilet) Other
FEE SCHEDULE
Industrial,Commercial&Multi-family 1%of job cost with a$49.50 minimum Residential,New One&Two-Family $149.50
Residential,Additions&Alterations $49.50
Estimated Cost $ Building Permit#
PLUMBING PERMIT FEE $
STATE SURCHARGE $ $5.W1
t
TOTAL PERMIT FEE $ 'Q<--
(Office Use Only) �tg��� 3
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
RNT O
PRIOR LAKE BUILDEPADINGTMEAND INF
SPECTION
INSPECTION RECORD
SITE ADDRESS /4-357 P/'�-=-5''o6 6c(i1CT
NATURE OF WORK LC) 11/W72
USE OF BUILDING /?aS's1`/�
PERMIT NO. LAS: /77 DATE ISSUED 3_ 6 . /.5"
CONTRACTOR et1,5/C/E PHONE 2,33 . 4-013
INSTALL EROSION CONRTOL AND MAINTAIN CLEAN STREETS AT ALL TIMES
INSPECTOR DATE
rililliall 1111LIIIIMI
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
aimmumnimme ROUGH - INS
FRAMING 0 V/b 9_6
INSULATION
ELECTRICAL
PLUMBING
HEATING
4.1011111111111.111111.
Wiliiiiiiiela
COVER NO WORK UNTIL THE ABOVE HAS BEEN SIGNED
FINALS
alikiliiiaiiiiiiiiiiiiiiiiiiiiii
BUILDING $ )/),g/4_(..
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
pt is available, card shall be placed near main entrance.
Minnesota DOLI
Online Eieetrioa1P.emit System DR ALL INSPECTIONS (952) 447-9850
for Hon'ieewiers.
www.doli.state.mn.us/CCLD/