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2. Pink city I PERMIT NO. /4.- 4.--7
3.Yellow Applicant
1Mease type or print and sign at bottom)
ADDRESS 1ZONING(office use)
14070 Rutgers St. N.E. P(JJ12
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID -2-6—, /(o l• 0 04'-0
OWNER
(Name) Mike&Jill Follingstad (Phone)952-917-9238
(Address) 14070 Rutgers St. N.E. , Prior Lake
BUILDER
(Company Name) Van Heel Dream Builders (Phone) 763-438-9920
(Contact Name) Jim Van Heel (Phone)763-438-9920
(Address)2375 Orkla Dr., Golden Valley, MN 55427
TYPE OF WORK El New Cons.+ ;on ['Deck ['Porch ❑Re-Roofing ❑Re-Siding ❑Lower Level Finish El Fireplace
['Addition ►1 Alteration ['Utility Connection
CODE: ❑I.R.C. ❑I.B.C. Single family residence l Misc: Create_la-undry room in lower level
Type of Construction: I II III IV V AB
Occupancy Group: ABE F HI M R S U PROJECT COST/VALUE $ 8,400
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 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.
x James P.Van Heel BC001592 3-31-16
Signature Contractor's License No. Date
Permit Valuation ! 000
OG W00 Park Support Fee # $
Permit Fee $ 3 4 `75 SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ e 5U Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ ..5", L,,77 Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer&Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE60-4,6_69260-4,6_692 Gr.4 ,f $ e97.5-
7 .r
This Application Becomes Your Building Permit When Approved Paid ,j 9 r i� Rec t No. /7r ?
Date C., " 5 , R-14 By _
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
4 pyo Date Reed
' CITY OF PRIOR LAKE PLUMBING PERMIT •. /( 0 )
1.alp Fik
Z� Ary PERMIT NO. /L/. 4L'7/3.Yellow Apican
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
/y'07° gill tr./ , fYeeel ,see PU5-4
LEGAL DESCRIPTION(office use only)
LOT BLOCK / ADDITION A/41--e PID?5-4,1_G1-D
OWNER
(Name) nib - x,II /43/411s1740, (Phone) FA".,t,..0 ...grid/
(Address) „ARM
APPLICANT
(Name) lt Of 4.job ",,,erL• S c (Phone) y6? - 716 • 3 9..C/
(Address) V ' O e4�....✓ — # Coen /i 4 //4°' _ f X 3
(Address) (ty) (Zip Code)
(Contact Person) 3.4% Al �s r.!ew (Phone) Lig/• S/I• 7'90•EA)0 t
APPLICANT SIGNATURE � 4.' �i�-- DATE 6� o
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
Shower StallBackflow Assembly
_ Sinks T Backflow Assembly Test
Bar Sink Lawn Sprinkler
Water Closet(Toilet) Other
The Minnesota Statutes FEE SCHEDULE
§326B.1'48 f jo>i 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
"fixed fee"permit is$5.00 $ � S Building Permit#
-PLUMBING PERMIT FEE $
STATE SURCHARGE $ . r2 5.00
TOTAL PERMIT FEE $
(Office Use Only) PAID Ig .
This Application Becomes Your Building Permit When Approved 'aid i. r.:
,M--
E""7 "�,i '`� i�
D: aIM By
Buntline Official Date A'� wigi '
24 hour notice for all inspections(952)447-9850,fax(952) 47-42 5 y
4646 Dakota Street S.E. ailq A!(lSraesota 55372BUILDING PERMIT C,WAN''' %
i , } U I 10 S
�P1�tJ 91 � �i'1 If
.
Y DEPARTMENT OF
_ PRI R 0 BUILDING AND INSPECTION
INSPECTION RECORD
SITE ADDRESS /4t070 g `�
S'T. /v. Fi
NATURE OF WORK LQW _ 4140Y62.. /!
L 't/Nd/ R. O#'f
USE OF BUILDIN ..
PERMIT NO. Alff[ DATE ISSUED
CONTRACTOR j'17 ,71-1 ir7 ' 'HONE 2,40
INSTALL EROSION CONRTOL AND MAIN AIN CLEAN STREETS AT ALL TIMES
INSPECTOR DATE
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
iniiiiiiiilla
FRAMING IDA-c., (. V104
L.I.
INSULATION R`,c LI )1 L.
ELECTRICAL ,
PLUMBING jL 6.I 1-7 //z1
HEATING -czlL,�, L l Ii iLt
C ORK UNTIL THE ABOVE HAS BEEN SIGNED
011011111111 LATH
FINALS
BUILDING 04 270/0
ELECTRICAL1
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