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f PRioCITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
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A, e TEMPORARY CERTIFICATE OF ZONING COMPLIANCEI S�
F. z AND UTILITY CONNECTION PERMIT 7.
4.v to
4.� NE$oK� t.white me
2 pi is City `1.PERMIT NO../ 71113 N �
t Yellow Apphcwit
(Please type or print and sign at bottom)
ADDRESS ZONING(office use}
„5-5/4 it:-.1,,,A4,1 err „ f , 'r- ,'s , f fiA1 $c37 `J/C
[�
LEGALq DESCRIPTION(office use only) J
LOT BLOCK 3 ADDITION /_' FA/ i - 0`a' / PID 075; 7 5-% t 03/ 0
OWNERr 'f '- `�
(Name) $.40 ,f-fe u�` r 4..4u t/cm (Phone) , "
IV
(Address) , ? f it _
BUILDER
Vat
.rk 1;(06/01
a // L'4
(Company Name) (Phone) rs'yJ '
(Contact Name) VRr~K T/tt441 L.4C (Phone) /5"2- f?6, 'SOf
(Address) JD 7i 6 -tc 194kx MO, iD!"/oI"" �' �, AM/
TYPE OF WORK D New Construction ❑Lteck ❑Porch ❑Re.Roofing ❑Re-Siding Xower Level Finish 0 Fireplace
❑Addition °Alteration ❑Utility Connection
CODE: DI.R.C. :ILEX. ❑Misc.__
Type of Construction: I II 171 IV V A B PROJECT COST/VALUE $ 50t*Mt .. t►oj oop
Occupancy Group: ABE T HI M R S U (excluding land)
Division: 1 2 3 4 S
1 hereby certify that I have furnished information on this application which is to the best of my knowledge hue and confectI also crucify that t 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 yoke foriust cause Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X 7/OAC/�
aturc _ Contractor's License No. Date
— Park Support Fee # S
Permit Valuation ,0�� Pp E
_ $
SAC #
Permit Fee $ EV. -' r
Plan Check Fee $ �u Water Meter Size 5/8"; 1"; 1
J
State Surcharge $ Z •0 O Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
.�— -
Plumbing Permit Fee $ 50'5.0— Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer&Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ So 00 TOTAL DUE 7i • f5 $ifroszei ,
This Application Becomes Your Budding Permit When A aved Paid y�Q/�/'^�J 2_5-- 1 Rc ,
PP� � g PPr R SC.) eCC1 t No.
Date 7. lc-- 1 By 6,x4A )
Buildine Otiictat Date
_
i
This is to certify that the ii quest in the aborve application and accompanying dice me its is in accia dance with the Cay Zoning Oirlin toe anti may proceed is Riposted Tins document
when signed by the City Planet constitutes a temporary Certificate of Zoning camphance and allows czonsttuchtit,to commence Befit e occupancy. Certificate,if Occupancy most be
issued
_-- - Piann _
Planning Director Date Special Conditions,if any i
24 hour notice for all inspections(952)447-9850
4646 Dakota Street Prior Lake.MN 55372
,
[
i Pltro4 Date Rcc'd
4,9(1)1 CITY OF PRIOR LAKE PLUMBING PERMIT -
,.. 1 7
0
44%,,Esdo
PERMIT NO./5 Igo
3.Yellow Applicant
(Please type or print and sten at bottom)
ADDRESS ZONING(office use)
55/G 7 A eaal Z.n ..ci; 6-11,91- j..,:je 41A) 517,2 S/ -
/ '
LEGAL DESCRIPTION(office use only)
LoTcr BLOCK-3 ADDITION >he admo-e elb-mal Leptem 251. V3y,-,031-0 ,
!
OWNER ,_ I Ws /4
(Name) N Coil- 'le enn i e". uri (42D (Phone) 642 'Ya —ZIY
A r- if
(Address) —% a eil e --
APPLICANT Cain 1-4 c, ' r 19 eledzi lie/
(Name) (Phone)
(Address)
(Address) (City) (Zip Code)
(Contact Person) _ (Phone)
i • i
APPLICANT SIGNATURE ....., , / rAr- _ DATE
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 _
1 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
i Bar Sink Lawn Sprinkler
1 Water Closet(Toiiel4fouj h- I A Al rt ear e xi J.is , Other
FEE SCHEDULE
Ts
r, .yrte ---------------------i § 611.148 ' riot;cost with a$4%50 minimum
" Residential,Nm One&Two-Farnily $149.50
cHARGEhas been extended
The mininmin surcharge for a
Residential,Additions&Alterations $49.50
"fixed fee permit is$5.00 $ Building Permit 11
PLUMBING PERMIT FEE $ Y 9 .5-0
STATE SURCHARGE $ _AM 5.00
TOTAL PERMIT FEE $ sy. SO
(Office Use Only) 41
A S f' IN/171#
This Application Becomes Your Building Permit When Approved Paid <.:6 1440440n._
"A PA,Pim
-
Date By
Ir.init6 Official Date
24 hour notice for all Inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372
rniU CITY OF PRIOR LAKE Date Recd
°� `k` HEATING/AIR CONDITIONING/FIREPLACE PERMIT .` 1 , i 'T-
6" v' ; tri
1.Pink Fits 2,Green City PF,t MIT NO. /S'
703
���NNES���
1 Yellow Applicant
(Please type or print and sign al bottom)
ADDRESS ZONING(office use)
SS/G 7 i iA ee Ln SE Pr�`,o r L A, M Al sS37 I [ S F
LEGAL DESCRIPTION(office use only) ,1 l
�y�i�
LOT C( BLOCK 3 ADDITION ,� �IM
& e e a /4.4.1_D 5-- 1745-V-.0 /—c:0
OWNER ,.. r
(Name) G .oleiin/ e r Lq.vie/e Z� (Phone) 6/.2 9I r 7£'Y
(Address) ti a m e fi
APPLICANT /C. #r4 c#r not se/s 7LeI ye 1L
(Name)_ __(Phone) ..,
(Address)__
(Contact Person) (Phone)__� .
APPLICANT SIGNATURE r / ; / DATE 716
APPLICANT PLEASE COMPLETE BELOW
)61LW CONSTRUCTION ❑REPLACEMENT ['ALTERATIONS
FURNACE MAKE AND MODEL - Not se/et~led yef FUEL
FLUE SIZE RETURN OPENINGS INPUTOUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT PLEASE NOTE;Air Conditioner
❑Warm Air Plants ❑Steam Units and Fireplaces Cannot Encroach
❑Gravity ❑Hot Water into Required Side Yard Setbacks,
❑Mechanical ❑Radiation Fireplaces with Box Additions or
ID Air Conditioning ❑Special Devices Cantilevers to the Outside of Buildings
❑Vent. S stem ❑Other Devices Require a Building Permit.
1'PLACE MAKE AND AODBL
FEE SCHEDULE
•, ', a Multi Family 1%of job cost Residential,Gas Fireplace $49,50
$49.50 minimum
Residential,Heating&A/C(New Construction) $149.50 Residential,Additions&Alterations $49.50
Residential,I leafing Only(New Construction) $64.50 Residential,AC Only $49.50
Cost$ Building Permit/{
HEALING PERMIT FEE $ j Co
STATE SURCHARGE $ 5._()0� � �a,,
TOTAL,PERMIT FEE $ 1 /o /r� 0
14777)
This Application Becomes Your Building Permit When Approved Paid ReceicAP.thA
Date By
Building Official Date
24 hour notice for all inspections(952)447-9850
4646 Dakota Street S.I .,Prior Lake,Minnesota 55372
o �ff; L ,. +
gE
4 '� CITY,c • OF PRIOR LAKE PLUMBING PERMIT 'I .
$1 't: JUL 16 2015
dr cP - 1.sine me PERM Tiih' : , ! . 1
2.Gala City
3.Y to toa� AApp13aM * I•,
(Please type or print and sign at bottom)ADDRESS ( ` ZONING orrice used
551 6 .T i Y f'�e&I (-N 5-1
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION FID
OWNEIi. S GO A"----‘' Lou( C r\ Z-0 (Phone) to!2 -9gi`7g -
(Name) G
(Address) 5 J 1 Cc K Ai 1 L 1""/J S
APPLICANT kb 1r\Gk A.l i cr"-\ Co _T-Pc (Phone) 9-5-2---75g --- ()(35--
(Name)...
a �.4-v, rte-I-- N 0 Nu,J rruc 5(06-7)
(Address)(Address) 2 (City) U (Zip Code)
(Contact Person) 'ha e 4 0 S4-e ffG� (Phone) °152-'158 -809S
APPLICANT SIGNATURE — P6,--(;144-a_ic,-&-- DATE 7/
ik Ii S
APPLICANT PLEASE COMPLETE BELOW
_
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
/ Dishwasher Water Heater
/ _Floor DrainWater Softener
Lavatory(Bathroom Sink) Stand Pipe(Washing Machine)
Laundry Tray(1 or 2 compartment sink Sewage Ejector
/ Shower Stall Backflow Assembly
/ Sinks Backflow Assembly Test
Bar Sink Lawn Sprinkler
/ Water Closet(Toilet) _ Other
FEE SCHEDULE 0The Minnesota Statutes§32613.148 , ,lob cost with a$49.50 minimum Residential,New One&Two-Family $149.50
"SURCHARGE"has been extended' . . Residential,Additions&Alterations $49.50 .
- The minimum surcharge for a • Building Permit# / O
"fixed fee"permit Is$5.00 $ ,i
,Off
PLUMBING PERMIT FEE $ -,i96,0.)�,�
STATE SURCHARGE $ knit . .�1 5.00 ' ti
E $
TOTAL PERMIT FEE
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid Receipt No.
Date BY �0 �¢�� I.
Buttdine Ometat Date
24 hour notice for all inspections(952)447-9850,fax(952)441-4245 n 4 ,
.s l iro
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372 .y"-
DROF
PRIOR BUILEPADING TMENT AND INSPECTION
INSPECTION RECORD
SITE ADDRESS 55/ � /,,
NATURE OF WORK APO 1— - fide w/FP.
USE OF BUILDING if
PERMIT NO. DATE ISSUED 1. �•
CONTRACTOR Seim LAOIQ6W O PHONE &&It. ?8( . 76�
INSTALL EROSION CONRTOL AND MAINTAIN CLEAN STREETS AT ALL TIMES
INSPECTOR DATE
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING ! 1 aT? \IC
INSULATION
ELECTRICAL
PLUMBING
HEATING
FIREPLACE
GAS LINE AIR TEST
COVER NO WORK UNTIL THE ABOVE HAS BEEN SIGNED
011111111111111111111111
FINALS
BUILDING - ' i ( 2 , 1 /3-
ELECTRICAL
'I /'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