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f \ CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
l / 1�sy� TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
"•, [)rn AND UTILITY CONNECTION PERMIT Z . Z 2. . (Z
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1.White File /Z
2. Pink City PERMIT NO. ^�
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3.Yellow Applicant L�GG����
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
i 4 S P, z POS► '�-Jp-17' t ()(2-- IL
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER 1 V . A` 9 .'2-7.�'A-31
(Name) � �C T 1� �vl`�fv (Phone)
b
(Address �a p-j Pfig.
BUILDER i
(Company Name)_1P )V°ihcit`4 c, (Phone) (109-- 3-- 7' .4- 1
(Contact Name)1)qne a2 32f "pp'i``c1, ..\-570‘..-1 (Phone) 1 1 ' `427(I
(Address) �
/ ,t ,> belw.701/4s )
TYPE OF WORK El New Construction ['Deck ['Porch ❑Re-Roofing ['Re-Siding Xower Level Finish ❑Fireplace
['Addition ['Alteration ['Utility Connection G, 1/4/5
CODE: ❑I.R.C. ❑I.B.C. ❑Misc:
Type of Construction: I II III IV V AB /� Xi' -----'
Occupancy Group: ABE F HI MR SU PROJECT COST/VALUE $ I'
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 _
Signature Contractor's License No. Date
Permit Valuation Z o U a _U 0 Park Support Fee # $
Permit Fee $ 6'1,15 SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ / d O Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ 2)-4". 5 0 Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer&Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ 54- 50 TOTAL DUE $ / 77 _ 7-5-
This
.5This Application Becomes Your Building Permit When Approved Paid Receipt No.
Date 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
p RZp CITY OF PRIOR LAKE Date Rec'd
a. r A e HEATING/AIR CONDITIONING/FIREPLACE PERMIT 3 6 /�
°r'tvnrssoVP z.1.',' Fae, PERMIT NO./2, —��—/22.....� c��
' 3.Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS G ZONING(office use)
)
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
(Name)R . c 51 Vy V I•N E IDA1•1 1 `- (Pilon 6152)22 4-3
(Address) 1975 I B E-z'/ -p( ' -1b SE.
APPLICt / / y
(Name) EEfY SI ft ,,L (Phoneel52) 4 -3LO v
(Address)/ 10 151 AMI1‘1 AVE 31 _ R2 lag.. LAV- . 53 2-
(Address)
(Address) (City) (Zip Code)
(Contact Person) 'A �,' LI/o r -d.,'_ (Phone) (0,Z� I -7
APPLICANT SIGNATU' :Fr ,/ DATE M I M }- 7, ZO I Z
APP ICANT PLEASE COMPLETE BELOW /25 bp -
❑NEW CONSTRUCTION ❑REPLACEMENT 0 ALTERATIONSRae,i
FURNACE MAKE AND MODEL FUEL a}> 2U( CraS
FLUE SIZE lyNt 4-4)1' RETURN OPENINGS —. INPUT Zf,CU0 OUTPUT ,bOO
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 D Radiation Fireplaces with Box Additions or
DAir Conditioning ❑Special Devices
DVent.System ❑Other Devices Cantilevers to the Outside of Buildings
/� Require a Building Permit.
FIREPLACE MAKE AND MODEL( iaci-Vei/ti-�ietana ti- cls- 7 i1c IV L- 3(90
FEE SCHEDULE
Industrial,Commercial&Multi-Family I%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 $49.50
Estimated Cost$ "`0C) Building Permit #
The Minnesota Statutes§32611.148
HEATING PERMIT FEE $ 4q' 56 "SURCHARGE"has been changed 1'or one
year effective
STATE SURCHARGE $ .50 .July I,2011), n1til June 30.2011.
TOTAL PERMIT FEE $ ,6j"p, 00 -file minimum surcharge for a"fixed fee"permit
(Office Use Only is Ste,beginning July 1.2011)
•
This Applic._', Becomes Your Building Permit When Approved Paid `� t 10.
1 •
1 1
3. �' Date 44t ®�� ����
Bu ding Official Date BU 14
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372
DEPA
TMENT OF
PRIOR LAKE BUILDING AND INSPECTION
INSPECTION RECORD
SITE ADDRESS 545 f o t& T ,eu11-..,'
NATURE OF WORK L-EV
USE OF BUILDING Iecr n//z
PERMIT NO. IZ._ Q 17-2- DATE ISSUED Z. 12... I
CONTRACTOR DPl-/JIELSON PHONE ZZLo I f
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING , j5--//
INSULATION
ELECTRICAL
PLUMBING
HEATING (if required)
FIREPLACE
GAS LINE AIR TEST
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
FINALS
BUILDING %ij
'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