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CIO
fPg.,ARto* CITY OF PRIOR LAKE BUILDING PERMIT, Date Recd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT 2-1_ !J
U K7
kft'NES01e' I. White File �
2. Pink city PERMIT NO./�`- o97
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
17 2__Za0 piwAtnk AL>_�
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER ROGER A & DONNA L KNOX
(Name) 17260 PANAMA AVE SE (Phone)
(Address) PRIOR LAKE MN 55372
BUILDER
(Company Name) (Phone)
(Contact Name) (Phone)
(Address)
TYPE OF WORK ❑New Construction ['Deck ❑Porch ❑Re-Roofing ❑Re-Siding ['Lower Level Finish ❑Fireplace
❑Addition ❑Alteration ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. El Misc.
Type of Construction: I II III IV V A B
Occupancy Group: A B E F H I M R 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-menno d 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 oke this per t for Just cause. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
1x k" it 4 -2/"/
Signature Contractor's License No. bate i
Permit Valuation Park Support Fee # $
Permit Fee $ SAC # $ z,4-6e5., CO
Plan Check Fee $ Water Meter Siz / ; 1"; $
5'D U_00
State Surcharge $ Pressure Reducer $ /5?)
Penalty $ Sewer/Water Connection Fee # $
l300_00
Plumbing Permit Fee $ 372 Water Tower Fee # $ /COo a 0
Mechanical Permit Fee $ Builder's Deposit $
Sewer&Water Permit Fee $ fZ_52j Other $
Gas Fireplace Permit Fee $ TOTAL DUE ? $ 5'73 0i . O/-t
This Application Becomes Your Building Permit When Approved Paid .3-739_Cl C.) Re ipt No. A8-77%
%
Date Q_ Z,(_ /r
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
4646 Dakota Street Prior Lake,MN 55372
4 MO Date Rec'd
4e CITY OF PRIOR LAKE PLUMBING PERMIT
ESoie'
I. Blue File 7
3. GoldCity /p PERMIT NO. JI._ 0a
3. Yellow Applicant ! `
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
i-7zLo ( Jpr , Rye—
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION ^ HD
V'
OWNER ROGER A & DONNA L KNOX ` /0 �✓0 - 3
(Name) 17260 PANAMA AVE SE �QC - one) //y7 /
(Address)
PRIOR LAKE MN 55372Al
e��
APPLICAN
(Name) eiVi�l` CJJ'' f /i7 /� 1Q1�J 1LhrkS (Phone) 9c--z-' / 6t 33
(Address) /O VPr/I7c i i t. AVe, 3Z1, '\v . --.c,-.1 .---z_
(Address) (City) (Zip Code)
A
(Contact Person) 'DA i.4d (A)a-74- (Phone) W2—j '?33
f
APPLICANT SIGNATURE 1, DATE 9--,73/-
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 Stall Backflow Assembly
Sinks Backflow Assembly Test
Bar Sink Lawn Sprinkler
Water Closet(Toilet) Other
FEE SCHEDULE
Industrial,Commercial&Multi-family I%of job cost with a$49.50 minimum Residential,New One&Two-Family $149.50
Residential,Additions&Alterations $49.50
Estimated Cost $ Building Permit#
PLUMBING PERMIT FEE $
STATE SURCHARGE $ .50 PAID WITH
TOTAL PERMIT FEE $ h _ )iP , rag—ri:A c!(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid Receipt No.
Date By
Building Official Date
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372
�PRIo� Date Rec'd
Off; �
CITY OF PRIOR LAKE
M SEWER AND WATER PERMIT 9- 2- ( , I S
1NNEso-
21
. Green
Yellow FileCity PERMIT NO./ 3' / Li/1 7
.
3, Gold Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office se)
(7 2-11 0 IP /1-01k k
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER ROGER A & DONNA L KNOX
(Name) 17260 PANAMA AVE SE (Phone)
(Address) PRIOR LAKE MN 55372
(City) (Zip Code)
APPLICANT
(Name) J' . L.5 Se. _ e_/ � (Phone) 9$c2 "W6 -/�O)
(Address) / (.0 c,(, / ,77"5 g`le-criAi �,ll Rio+--Lcz.. & (5-6-'872—
(Address)
5�`3 7 2
(Address)� k (City) (Zip Code)
�t&f'f"
(Contact Person) ( t
, c,iU (Phone) 40 f2--- 2-2- (-21, 7
APPLICANT SIGNATURE t--��� DATE 9- 2'7' IS-
APPLICANT PLEASE COMPLETE BELOW
Size of water service inches.
Location of any couplings from structure feet.
Type of sewer pipe. n ABC 'PVC ❑ Cast Iron
Estimated length of sewer line 1 Z feet.
Clean out (if required) located at ,. `feet from structure.
FEE SCHEDULE
Residential sewer and water line connection $51.50 Industrial,Com'l&Multi-family 1%of job cost with a$51.50 minimum
Sewer connection only $25.50 Water connection only $25.50
Estimated Cost $ Building Permit#
SEWER AND WATER PERMIT FEE $ I ne iviinnesota statutes g.5z0115.1LFb
STATE SURCHARGE $ "SURCHARGE" has been extended
TOTAL PERMIT FEE $ The minimum surcharge for a
"fixed fee" permit is$5.00
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid Rgcei t No.
WITH
Date -i 'p"i?i'ylr- pt:-1:1!4-00
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
G/60 P/6-711 5alt4" e-62 • ") t ) S
SCOTT COUNTY, MINNESOTA Permit#
* SSTS ANNUAL PUMPING PERMIT Permit cost= $85
Owner v Address t'"�
nn( c
Pumper VEL P S L For Period: January 1, 2015 to December 31, 2015
Scott County must be notified of any pumping by the end of the following month in accordance with the SSTS
Ordinance. If an annual permit is not purchased prior to the end of that month, an individual pump permit must
be submitted by that date in lieu of this permit. To comply with submittal requirements, you can fax, mail or e-
mail us a copy of this sheet every month or as required.
DATE PUMPED DRIVERS GALLONS PUMPED DISPOSAL LOCATION SURFACE
INITIALS DISCHARGE EVIDENT
1.
2.
2 _/3 ��d,— �2 r� t<
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Scott County/teamSC00P/Sewer/Forms/Pumping Permit/Annual Pump Pmt Log Sheets
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MAPLE LANE, MUSHTOWN RD, PANAMA AVE
WATER & SEWER CONNECTIONS
PROPERTY
Property Address: 17260 PANAMA AVE SE PID: 259110520
Property Owner Name: KNOX ROGER A& DONNA L Phone 1: (952)447-2831
Property Owner Address: 17260 PANAMA AVE SE PRIOR LAKE MN 55372
Owner Email: Phone 2: :
PERMIT/CONTRACTORS
Building Utility/Connection Permit#: 15-1097 Date Issued: 12:00:00 AM
Sewer Contractor Name: Mikes Septic Date Issued: 12:00:00 AM Phone: (952)440-1800
Plumber Contractor Name: David Wolf Date Issued:12:00:00 AM Phone: (952)492-6933
INSPECTIONS
DATE OF CONNECTION DEADLINE: 9/26/2016
Sewer/Water Install Completed: Yes Date: 12:00:00 AM
Plumbing Rough-In Completed: Yes Date: 10-1-15
Water Meter Install Completed: Yes Date: 12:00:00 AM
Plumbing Final Completed: Yes Date: 11-4-15
Septic Pump Ticket Received: Yes Date: 10-1-15
Septic Removed/Crushed Completed: Yes Date: 10-1-15
Well Capped Completed: Not Required Date: NOT REQUIRED
Asbuilt/Ties Completed: Yes Date: 12:00:00 AM
Grading Completed: Yes Date: 11-4-15
Final Inspection Completed: No Date:
PLEASE DO THE FOLLOWING OUTSTANDING ITEMS NEEDED FOR COMPLETION:
1.Bed Sewer 2.Insulate Lines 3.Curb Box @ Grade 4.Repair Tracer Wire
5.Box Cover Missing 6.Erosion Control 7.Clean Street 8.Grade
9.Water Hookup 10.Sewer Hookup 11.MXU Hookup 12.Seal Meter
13.Pump Ticket 14.Crush/Fill Septic 15.Remove Sewer Mound 16.Seal Well
17.Seed/Sod X 18.Asbuilt/Ties 19.Repair Cut Line 20.Repair Driveway
21.Repair Floor 22.Install Flr Drain
COMMENTS: SEED/SOD,INSULATE CEILING IN WELL ROOM
DEFAULT STATUS
Property in Default: NO 1-Year Letter Sent: NO
Default Date: 9/26/2016 Date Default Letter Sent: N/A
Additional Default Action Taken:
UTILITY CONNECTION FOR THIS PROPERTY IS: OPEN
H:\MUSHTOWN SEWER&WATER CONNECTIONS RECORD.docx November 12.2015
Mary Lein
From: Mary Lein
Sent: Monday, November 09, 2015 9:22 AM
To: Mary Lein
Subject: RE: 17280 Panama Ave
This is actually 17260 Panama : Knox
Mary Lein
Engineering/Community Development
CITY OF PRIOR LAKE
4646 Dakota Street SE I Prior Lake I MN 155372 Direct (952) 447-9830 I Fax: (952) 447-4245
mlein@cityofpriorlake.com www.cityofpriorlake.com
Original Message
From: Dale Chard
Sent: Wednesday, November 04, 2015 10:16 AM
To: Mary Lein<mlein@cityofpriorlake.com>
Subject: 17280 Panama Ave
Meter reader hooked up.
Plant grass or install sod
Insulate ceiling in well room
Call for final
Sent from my iPhone
STATUS OF ALL UTILITY CONNECTIONS
November 9, 2015
Mushtown Utility Connections:
Open:
17101 Maple Lane
17260 Panama
17048 Maple
17075 Maple
Closed:
17280 Panama
17056 Maple
Shoreline Utility Connections: 8
Open:
1711 Shoreline—paid fees
1735 Shoreline-default
1751 Shoreline—Pump record needed
1765 Shoreline—Tracer wire, asbuilt, plbg final, clean street
1771 Shoreline—paid fees
1781 Shoreline—paid fees
1795 Shoreline—replace driveway&sod
1799 Shoreline—Pump ticket, install driveway, clean street, sod
Sunset Utility Connections: 7
Open:
17081 sunset—Demo permit issued. Hookup fees paid.
17131 Sunset—Pump ticket
17141 Sunset—Seal well, curb stop, plbg final
17261 Sunset—Seal well