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OF P11-10 CITY OF PRIOR LAKE BUILDING PERMIT, Date Recd
F TEMPORARY CERTIFICATE OF ZONING COMPLIANCE �? S f 4-
AND UTILITY CONNECTION PERMIT U
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4/NNESDtr I. White File PERMIT NO. /// /yy'tI
2. Pink City / �, L
541,
3 Yellow Applicant {' Li
(Please type or print and sign at bottom)
ADDRESS / / ZONING(office use)0....i
/ 44?? W. / ' - 1/ i 0 '''?r
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER ---.
iee/�1 3 g 7733
(Name) //— /"/}1 A.-) ' -�'� (Phone)
(Address)
BUILDER e
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑New Construction ['Deck ❑Porch [IRe-Roofing ['Re-Siding ['Lower Level Finish ❑Fireplace
['Addition ❑Alteration ❑Utility Connection _
CODE: I': . .C. ❑LB.C.
XMisc. i/117E)U6!“L �(i/ .
Type of onstruction: I II III IV V A B PROJECT COST/VALUE $
Occupancy Group: ABE F HI MR SU (excluding land)
Division: 1 2 3 4 5
I hereby certify that I F,{ia'rrntI.t • info- anon 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
4
above-mentioned pr.., truction 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 r ijh . ,sc Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed insp• tions.
_
Signature \ Contractor's License No. ( Date
Permit Valuation h 000 (JO Park Support Fee # $
Permit Fee $ ” lc SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ 50 Pressure Reducer $
Penalty $ / Sewer/Water Connection Fee # $
Plumbing Permit Fee $ - , Sr) Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
7
Sewer&Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE $ e3.9. 7.
�� �¢
This Applic ion : om Your Building Permit Whe Appro d Paid eipt No. /72--/O(...) \
/.� 0 Date _ ,,(�
Build,tg 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 Prior Lake,MN 55372
G
1 PR/0Date Rec'd
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CITY OF PRIOR LAKE PLUMBING PERMIT g ✓ //9c. (�
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*Mie
I. Blue File PERMIT NO. /C/• 5�
2. Gold City .
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
J6 y 9'9 Kofi it>cc / 2)r. S
.� D
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID &S^' /- (- 077~
OWNER /
(Name) /.//�02 v lel 0, /4" 5' 7 (Phone)6/Z .3g2 7 2_3 3
(Address)
APPLICANT L g C `/
(Name) .► .SO / /J� _♦ . ��✓ (Phone) a/Z - <�� ?7/ 9
(Address) l • V6 (1)6/6P-(404 r/— tE, ,fes!tx . r."--sZV W
(Address) (City) (Zip Code)
(Contact Person) 40e9 .- -e —S-2/ (Phone)
APPLICANT SIGNATURE I 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
Lavatory(Bathroom Sink) Stand Pipe(Washing Machine)
Laundry Tray(1 or 2 compartment sink Sewage Ejector
fShower Stall Backflow Assembly
Sinks Backflow Assembly Test
Bar Sink Lawn Sprinkler
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#
The Minnesota Statutes§326B.148
PLUMBING PERMIT FEE $ "SURCHARGE"has been extended
The minimum surcharge for a
STATE SURCHARGE $
TOTAL PERMIT FEE $ "fixed fee" permit is$5.00
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid Rec ipt No.
Date -
is v�
Buildine Official Date
24 hour notice for all inspections(952)447-9850,fax(952)447-4245 ,
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372 • (� `(
V
DEPARTMENT OF
PRIOR LAKE BUILDING AND INSPECTION
INSPECTION pEC9RD
SITE ADDRESS (o4`V
NATURE OF WORK IOboN
USE OF BUILDING Pre-
PERMIT
r (�-
PERMIT NO. t4-$5-4 DATE ISSUED 137t4
CONTRACTOR Di Q t-140 56-11PHONE �f 2-32, - 1133
INSTALL EROSION CONRTOL AND MAINTAIN CLEAN STREETS AT ALL TIMES
INSPECTOR DATE
FOOTING
iG (Prior To Backfill)
R
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
R/SEPTIC
FRAMING P-04 IV/y
INSULATION 9 e)
ELECTRICAL
PLUMBING -c_ "`VZ,L 1 i.
E
IR TEST
ARDER
COVER NO WORK UNTIL THE ABOVE HAS BEEN SIGNED
FINALS
ITSSERMIR PRIOR TO SODDING)
BUILDING Er
rep 2/5/p1
ELECTRICAL
PLUMBING Lif��
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