HomeMy WebLinkAboutBldg Permit 04-0028
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
(Please"!ype or print and sign at bottom)
I ADDRESS
/hlrL/cr A-1I//1;'?-~r~{L
_ere
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
OWNER
(Name)
E/~"'4rd
/l-1,d--4UJ ~
J
(Address)
BUILDER
(Name)
(Contact Name)
(Address)
TYPE OF WORK
o New Construction
~ower Level Finish
o Misc.
I,White
2. Pink
3. Yellow
File
City
Applicant
I PERMIT NO. 04-, 60Z-fl I
-t:-,'I} r !4L~ . ft1 AJ
/ r<.",,")
"
Date Rec'd
/. /(,.O-!-
ZONING (office use)
PIDzS. 007,013 . l'>
K -L- L t'Vl
(Phone)
/95..;l-L~'/D- Z!Lo/ 7
"-. ../
(Phone)
(Phone)
DDeck
DPorch
ORe-Roofing
o Fireplace
DAddition
DAlteration
PROJECT COST IV ALUE (excluding land) $
ORe-Siding
DUtility Connection
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 y.vy...aJ and that all construction will conform to all existing state and local laws and will proceed in accorq.ance with
submitted plans I am aware that the buildmg offiCIal can revoke thiS permIt for Just cause Furthermore, I hereby agree that the City OffiCIal or a deSl;ye may
enter u? pr'pperty to perform needed mspectlOns. /J
X '7' r-FL/ >-r J 1'1_ J::;,jf,_ / ~ / fP ---()
- ......... Signature Contractor's Llcense No Date
,
Permit Valuation '1-,000.0 0
Permit Fee $ PJ1.Z-S
Plan Check Fee $ -
I State Surcharge $ 2-.00
I Penalty $
I Plumbing Permit Fee $ 4--0.00
Mechanical Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace Permit Fee $
This Application Becomes Your Building Permit When Approved
~~ ~ -4//~loi
Building Official Da[{,
Park Support Fee
SAC
#
#
$
$
$
$
$
$
$
$
$/Zt1. Zs
Receipt,Wo. ~2-ZrO
BV~
This is to certify that the request in the above application and accompanying documents is in accordance with he 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 constru . on to commence. Before occupancy, a Certificate of Occupancy must be
issued.
I Water Meter Size 5/8"; I";
I Pressure Reducer
I City SAC and WAC
I Water Tower Fee
I Builder's Deposit
I Other
I TOTAL DUE
#
#
Planning Director
Date Special Conditions, if any
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake. MN 372
Paid
Date
/7JI. ?~
/./~. (/~
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
/
;~~: ~::y I PERMIT NO. /71t/:-'J...CI
3. Yellow Applicant l/ f 07 t>
(Please ~e or Drint and sistO. at bottom)
ADDRESS ZONING (office",,)
U., (" L./ cr
CI/I'U\<' 1:;;--
S~
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER .
(Name) ED -+
(Address) / ({; 6 <I C(
NAN c Y KELM
/lNl\lff 7f(. 5E.
(Phone) 1" Q - l.f 7" () ~ iq 97
t;-~- ') 7 ~
APPLICAN1-, /'
(Namp\ /( L
(Address)t;1/IJ
P L.t. 1'131 lYe.
C tlE<:',ER
(Address)
(Contact Person) 'R/ cH N YR c>
APPLICANT SIGNATURE RJ'd.~fJ
AVE
(Phone) 1EiJ-(P(;;)' -;;173?
X/oI('T h Ffl,; en
(City)
(Phone)
c:;- c;- 1', C/
(Zip Code)
'7':,--;:1- ~t,-;;J-:) 9;; 3'
DATE :J-9-C'~
C)kv€~
7
~
APPLICANT PLEASE COMPLETE BELOW
Type of Fixture Quantity I Type of Fixture
Bath Tub with or without shower I Rough-ins
Dishwasher I Water Heater
I Floor Drain I Water Softner
I Lavatory (Bathroom Sink) I Stand Pipe (Washing Machine)
I Laundry Tray (1 or 2 compartment sink I Sewage Ejector
I Shower Stall I Backflow Assembly
I Sinks I Backflow Assembly Test
I Bar Sink I Lawn Sprinkler
I Water Closet (Toilet) Other
Quantity
/
FEE SCHEDULE
Industrial. Commercial & Multi-family 1% of job cost with a $39.50 minimum Residential, New One & Two-Family $99.50
Residential, Additions & Alterations $39.50
Estimated Cost $
Building Permit #
PLUMBING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
"wY
I Paid iJtt ~. I Receipt No.
I Date ~ -q -0 t1 I Br Jr---
J
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714
1V~VV L<1~I~ ,:~_c_~_~~:~~.~__~~-~:_~:~~~_,~:m ~I~ f 4
PRIOR LAKE
INSPECTION RECORD
DEPARTMENT OF
BUILDING AND INSPECTION
SITE ADDRESS /rR(~ /t/VN,4 I/GA/ L-
NATURE OF WORK /../J;A/e:7L /.....bL/eL...---'
USE OF BUILDING ~.I /7) /L-
PERMIT NO. n4-. I?D?" 6 I DATE ISSUED /.- 1(, . 0 ~
CONTRACTOR /LF:LJVJ PHONE_44-0 74-4 -Z
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR
DATE
I
I I
CE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING vy(/ S-l.j-Olf
INSULATION ~ t; -(/-0' I
ELECTRICAL
PLUMBING J) ./ /- y1;(7 'JI11f'- J--IO-{;L \
HEATING (if re uired) t~ S-f.../-OLr
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I I
FINALS
BUILDING
ELECTRICAL
PLUMBING
HEATING
DO NOT
/1
M/
f1- ].,L(1 /lJl
j/~r/
iLl"'"
OCCUPY UNTIL ABOVE HAS
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.
, /. ),1.-1-(/1/
; i- ( :/UV]
BEEN SIGNED
'..-- 'l',.' I"'r:"'~".' ~-'~,.
...,~<:\t;n
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
-i/-Jq-o.!
ADDRESS
1~(,t{C{
~/I&l 1'" (
OWNER
CONTR.
PHONE NO.
PERMIT NO.
4-)..$-"
o FOOTING
o FOUNDATION
o FRAMING
o INSULA TIO't l--
B1'INAL I'
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EXIGRAD/FILLING
o COMPLAINT
o FIREPLACE Rl
o FIREPLACE FINAL
o GAS LINE AIR TST
o
COMMENTS:
/
1/1
~~! ! h<---
-----
r~ ')
r--' l/l /
----
o WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT jJ>~~ FOR REINSPECTION BEFORE COVERING
lnspecto~ -fJJ.! - OWner/Cont~
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH" SAFETYI
/J4NO"