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o4 Pli:i CITY OF PRIOR LAKE BUILDING PERMIT, Dat Rec'd
,, TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT 1 1 1 e) I
44,lyEget. I. White File
City PERMIT NO.IJ //362. Pink
3 Yellow Applicant r
(Please type or print and sign at bottom)
ADDRESSZONING(office use)
C);7 �.� O11bt� S0'....... ....(,4-1.9., re—•
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER c�
A.-- (Name) n(24.s i K Lsa (Phone) (o ig-7 70''y 441
(Address)
BUILDER p
X (Company Name) t �Q C� $Av t.,. �a>C.. (Phone) (o i a " 7 7 O " ( '
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑New Construction ❑Deck ❑Porch ❑Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑Fireplace
❑Addition ❑Alteration ❑Utility Connection
CODE: 1 ' .C. ❑I.B.C. ❑Misc.
Type of onstruction: I II III IV V A B
Occupancy Group: ABE F HI MR SU PROJECT COST/VALUE $
(excluding land)
Division: 1 2 3 4 5
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
�t\lam official c revoke this permit for just cause. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections. )
Sig iii re Contractor's License No. Date
Permit Valuation t 1 000'-- Park Support Fee # $
Permit Fee $ 3 2c— SAC # $
Plan Check Fee $ . i 76, Water Meter Size 5/8"; 1"; $
State Surcharge $ Ct (9) Pressure Reducer $
Penalty $ `` Sewer/Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer&Water Permit Fee $ Other ����QQ�� //JJ $
Gas Fireplace Permit Fee $ TOTAL DUE`�� — q ZZ_a— $ 57
This Ap i(cation : .t s Your Building Permit en Appr ved Paid 3 7 S/ Recei tt N 3 --
.ZZ
Date 9 .�1 By (� °
Building ""1°r‘... Date
This is to certify t. t the re'ucst in the above application and accompanying documents in acco-.ance with the City Zoning Ordinance and may proceed as requested. This document
when signed by,,/e City P.nn r constitiires a temporary Certificate of Zoning complia,cc and ows construction to commence. Before occupancy,a Certificate of Occupancy must be
issued.
/ i, .r_/p �''_ n�4cm� Abp lifl irk J>�,,.
`�� •: Date / ecial Conditions,if any LI/MA-
24 hour notice for all inspections(952)447-9850 �
4646 Dakota Street Prior Lake,MN 55372 Y y l,,�^
v +6' Ac( "5�^r v)j
--5k7.--
o. PRJ( CITY OF PRIOR LAKE C Date Rec'd
e HEATING/AIR CONDITIONING/FIREPLACE PERMIT
yz l(, /3r /i''
1.Pink File PERMIT NO. 4
'1INNE90CP 2.Green City /� //$1
3.Yellow Applicant /
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
C . CZ 11O1b /MM50n (`i-, El
LEGAL DESCRIPTION (office use only) /moi
LOT ?BLOCK / ADDITION 7jr� '"
e v;G4 4 5 � •f PID •25(3 7404'0
OWNERt
(Name) f QV 01 4/ a IA (Phone)
(Address) <3 d Z AcIP big-S'/fi) e i t I/'
(Name) AN '/ �a 366 , y3'f
(Name) � Q� � f'�Qty��l� (Phone)
(Address) 315'&a
2. ,e1-7 g A /`h5 97<. S Gr/ 1!1( • hr kkt ) 4114
(Contact Person) ,D`ha , 5A'ef - (Phone) '/ -36'6- 31-139
APPLICANT SIGNATURE ( I'!, 4J2'7� DATE it ///51/3"--
APPLICANT
/APPLICANT PLEASE COMPLETE BELOW
i.NEW CONSTRUCTION REPLACEMENT 0 ALTERATIONS
FURNACE MA ND MODEL O)10�/jZ till )./4 Pea L FUEL �p r iritig
FLUE SIZE k 4 RETURN OPENINGS /- INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT PLEASE NOTE:Air Conditioner
❑Warm Air Plants 0 Steam Units and Fireplaces Cannot Encroach
❑Gravity 0 Hot Water into Required Side Yard Setbacks.
❑Mechanical 0 Radiation Fireplaces with Box Additions or
❑Air Conditioning ❑Special Devices Cantilevers to the Outside of Buildings
0 Vent. System ❑Other Devices Require a Building Permit.
FIREPLACE MAKE AND MODEL
FEE SCHEDULE
Industrial,Commercial&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,Heating Only(New Construction) $64.50 Residential,AC Only $49.50
Cost$ Building Permit#
HEATING PERMIT FEE $ .- 0
STATE SURCHARGE $ 1.00
TOTAL PERMIT FEE $ Am, non
This Application Becomes Your Building Permit When Approved Paid rt) Receipt No. 3 3 q'
Building Official Date Date r /' (- '. 'S- By
c3...........
24 hour notice for all inspections(952)447-9850
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372
PRIOR LAKE DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION RECORD
SITE ADDRESS
NATURE OF c�Z-' 3 ii0SON/ ekgCL.5-
USE OF BUILDING 11.4-A • '�" lc,�`'
AA
PERMIT NO. "DATE SUED r
CONTRACTOR (2ex' i.J F, -A-,,J PHONE (,)(7,-.1-7e) -`146t1
INSTALL EROSION CONRTOL AND MAINTAIN CLEAN STREETS AT ALL TIMES
INSPECTOR DATE
FOOTING Com \ 0-
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
1111111111111111111111110
FRAMING l
( z-INSULATION
ELECTRICAL
MEW
COVER NO WO K UNTIL THE ABOVE HAS BEEN SIGNED
I HOUSEWRAP a-An I I I
1 \ FINALS
GRADING ( PRIOR TO SODDING)
BUILDINGS t zAl 5K
ELECTRICAL
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
NT4 ‘<''''''''''''''''.'"-NH 'IX--
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