HomeMy WebLinkAboutBldg Permit 05-0902
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
I. White File I PERMIT NO t:j ~ I
i ~:~I~w ~:;Iicant . 06'- -/ (Jo-r
IS- Y .J)
~t'lllSt~~ C, ',...
LOT
BLOCK
LEGAL DESCRIPTION (office use only)
OWNER
(Name)
Lu.-..
{S-Y:J 7
(Address)
BUILDER
(Company Name)
(Contact Name) _
(Address) .1 / ~ 0
ADDITION
1<~+JaN
t!L Q ,(<.'
C/lJI- LoA
6~rL
PID
(Phone)
<is-.l. "~96 .. 1., /.5
fl~~/,;I
.
I' v
- -
C INJ t-
(Phone)
(Phone)
~ fS-.2 -.J/J--4Yo
9r-.J "./I'..J-l'tP/O
.u< .J /If..J A'"
[I. If J ,:7
ORe-Siding ~ower Level Finish
''-1 Rooms
TYPE OF WORK 0 New Construction ODeck OPorch ORe-Roofing
OAddition o Alteration OUtility Connection
CODE: OI.R.C. OI.B.C.
Type of Construction:
Occupancy Group: A B
Division:
I
E
n
F
1
ill IV V
HIM
234
o Fireplace
o Misc.
A
R
5
PROJECT COST IV ALUE $ _ ""~...... t/'i!lJ
(excluding land) (;/&'0<' . ~
B
S U
ormation 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
construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
use. F e, I hereby agree that the city official or a designee may enter upon the property to perform needed Inspections.
"JoO V'tJ-,l? 9-H-()J-
x
I Permit Valuation
I Permit Fee
I Plan Check Fee
I State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
I Sewer & Water Permit Fee
I Gas Fireplace Permit Fee
Signature
$
$
$
$
$
$
$
$
L./ t>?I'J r- ,,---
R'?,~S-
d'~
yo. -
Your Building Pennit Whm Approved
cug-a\
Date
Contractor's License No.
Date
I Park Support Fee
SAC
Pressure Reducer
$
$
$
$
$
$
$
$
111M fI:'l (). O!!r $ /2- 9. 2 ~
I Receipt No. 5tfO?Y
By ~/
#
#
Water Meter
SizeS/8"; 1";
Sewer/Water Connection Fee
#
I Water Tower Fee
I Builder's Deposit
Other
TOTAL DUE
#
Paid
Date
- ./
J:J-~.c,
- 1(1- ~- '"'
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
Jk,r1 ~ lru I ~dN-r
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 55372
/IT/ N.'
05.0,tJZ-
I PERMIT NO. .
L,i/C//~~E:
('152) ItfOI.'~~5L
(PI"" ,ype or Otiot ud 11M II bonom.
ADDRESS
IS437 BLACK BEAR CIRCLE NW
ZONING
LEGAL DESCRIPTION (office use only)
LOT BLOCK
ADDITION
PID
OWNER
(Name) TIM & RACHEL KNUTSON
(Phone)
(Address) 15437 BLACK BEAR CIRCLE NW
APPLICANT
(Name)MIKELARSON MASTER PLUMBER INC (Phone) 612-363-2588
(Address) 5120 HOOPER LAKE ROAD
(Address)
(City) DEEPHA YEN MN
(Zip Code)55331
(Contact Person) LUCILLE HAZELWOOD
(Phone) 612.363.2588
APPLICANT SIGNA TORE' .'
',.
DATE _10/4/05
I Quantity
APPLICANT PLEASE COMPLETE BELOW
Type of Fixture Quantity
Bath Tub with or without shower
Dishwasher
Floor Drain
Lavatory (Bathroom Sink)
Laundry Tray (lor 2 oom9artment sink
Shower Stall
Sinks
Bar Sink
Water Closet (Toilet)
Type of Fixture
RouAh-ins
Water Heater
Water Softner
Stand Pipe (WasbinJ!; Machine)
SewaJ5e Eiector
Backflow Assembly
Backflow Assemblv Test
Lawn Sprinkler
, Other
FEE SCHEDULE
Industrial. Commercial & Multi-family 1% of job cost with a $39.50 minimum
Two-Family $99.50
ltesil1ential, New <me &
Rcaidcnaal. Adclitiollll &
Alterations $39.50
Estimated Cost S
Building Pencit # _ ()5:,()9tJZ-
PLUMBING PERMIT FEE
$
1MJWITH
BUILDING PERMIT
/
/
-4.
Residential Building Permit Checklist
Basement Finish or Interior A.lt~ration to Single Family Homes .
f/1J- (2 Ln ~
9"'( q-~S-
&~g:f&ttA-/
BY:
Date:
Building Permit #'
Site Address
PID:
If;)ij51
L~al: L
B
Subdivision:
E.risting structure@r NO
CONFORLVIS TO ZONThG
ORDlliAl\fCE
.... ........
(y~S~
-
YES
Is this an expansion of me e:cisting fOO~:,1;""t or
building height?
Refe: to Plaming
Is the t''''I.,I~ert'f located within the flood plain?
Refe: to Flaming
Does the alt~tion include any additional kitchens?
Refe: to Planning
Does the proposed alteration include any outside'
entranc:s othe: than patio doors?
Refe: to Flaming
Is the proposed use of me finished. space or
alte:-ation for anything othe: than a nonnal single
family home (office, group home, day c:lI"e.:~c.)?
Rder to Planning
NO
NO I
no
J1D
/10
110
00
THIS cmCXl.1ST MUST BE COMPLETED .-\.J.'fD INCLUDED IN TEE BUlLDING PERl'YIlT FILE TO
MAINTA1N A RECORD OF' THE REVIEW.
PRIOR LAKE
INSPECTION RECORD
IS If S ? BJ..eK ,8{:A,V
NATURE OF WORK I I-
USE OF BUILDIfi.G-&-. - ..,-
PERMIT NO. ~- Dr3. DATE ISSUED ~ rf-~
CONTRACTOR tt &d~ PHONE---aJS- ~
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
DEPARTMENT OF
BUILDING AND INSPECTION
I-
SITE ADDRESS
INSPECTOR
DATE
I
I I
NTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
J-
FRAMING
INSULATION
ELECTRICAL
PLUMBING
HEATING (if required)
%
rl'/ff.~
y'W./
I () -I J....{)'(
(O~/L,.of
IO//O/O~
( o..-{ J,- ~
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I I
FINALS
/J
'VVr/
1
/
1-:/
J~JVt.({
I
)
c:;/
BUIL~~G
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
DATE nilE
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
/.2-Il- ,oS
ADDRESS
It"/3 7 adt (ku-
OWNER
CONTR.
PHONE NO.
PERMIT NO.
os- t(o'L.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION / . /
pINAL c.,....-, V(
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EXIGRADlFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
COMMENTS:
----
/' .
/ //
( LY(k
"---
--
------
"'
" -.......
ftZ )
. /
--------
~ORK SATISFACTORY, PROCEED
o CORRECT ACTION AND CEED
o CORRECT WO OR REINSPECTION BEFORE COVERING
Inspector:
Owner/Contr:
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH cl SAFETYI
INS1fOrl