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(Please type or print and sign at bottom) I. ADDRESS ~ Us J/3 . L+ ~ U01J& a+ /l/c- LEGAL DESCRIPTION (office use only) LOT ADDITION k:-. srr PI I OWNER (Name) (Address) /V1 t7/~ / (Phone) BUILDER rr (N ame) I aft-'! , (Contact Name) (Address) !Ic- /~'1 e ~~ COM~ (Phone) (Phone) TYPE OF WORK IiiaNew Construction ODeck o Porch ORe-Roofing ORe-Siding OLower Level Finish o Fireplace OAddition OAlteration OUtility Connection o Misc. PROJECT COST IV ALUE (excluding land) $ I CJC2;/ 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-lIlaY_ r- enter upon the property to perform needed inspections. 7zv ~ 11 Cf6 7~ /t/-/IJ-O/ Signature Contractor s License No. Date x Permit Valuation Permit Fee $ Plan Check Fee $ State Surcharge $ Penalty $ Plumbing Permit Fee $ /OO~ 00 Mechanical Permit Fee $ /(;)0 .00 Sewer & Water Permit Fee $ .35". 50 Gas Fireplace Permit Fee $ l{O.OO Park Support Fee SAC # # Water Meter Siz 5/8 ;1"; Pressure Reducer Sewer/Water Connection Fee # Water Tower Fee # Builder's Deposit Other TOTAL DUE ames Your Building Permit When Approved (0-1,- 7.001 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 si ned 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 _tL0(:2'~/<!"/\ <<k ~~.J''4.1 r~i~,1.-~ Date Special Conditions, if any 24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245 01- cxn (0 The Crnlt'f of Ihe tab Country BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST , NAME OF APPLICANT u'-rZ'l/l /\/'('(~1.U f~!-:~2f!/l,;)tC APPLICATION RECEIVED /0 - /0-- () ) , The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: I {f :3 11~3' ,. I ;,,,,/'\ '\ Accepted )( Accepted With Correctiohs Denied Reviewed By: NAP:> Date: II-/~t)' Comments: See Reverse Side for Addition~1 Inform~tionl \' See Attachments: 1) Grading Plan, 2) Erosion Control Measures ~) Frosion Conlrol Plan 'The issuance or granting of a permit or approval of plans, specifications and computations shall not be construed to be a permit for, or an approval of, any violation of any of the provisions of this code or of any other ordinance of the jurisdiction. Permits presuming to give authority to violate or cancel the provisions of this code or other ordinances of the jurisdiction shall not be valid." Ih(' ('('n'('r of 'he takt Country White - Building Canary - Engineering Pink - Planning BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT '/{}7JJ I/~ ~ APPLICATION RECEIVED (0- /0- 0 J The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: IIJ 3 '1!3 /J() uc:- Q"\ Accepted Accepted With Corrections ~ Denied ~ Reviewed By: [ ._ . Comments: ~O(QQ a-(/ClcW Date: 10-{7-01 ~~ "The issuance or granting of a permit or approval of plans, specifications and computations shall not be construed to be a permit for, or an approval of, any violation of any of the provisions of this code or of any other ordinance of the jurisdiction. Permits presuming to give authority to violate or cancel the provisions of this code or other ordinances of the jurisdiction shall not be valid." '-" ...1'-... Tht Ctnf.. nf Iht I..kt ('ounfry White - Building Canary - Engineering Pink - Planning BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT --/1''/}7 //fJ(:J 1CR . APPLICATION RECEIVED ( () - /0- 0 J .' ) ,'<.'/ ,.,J... ., ." I!- (f 1.<:' 'J; .\.j 1'L- ..-~.' /c The Building, Engineering, and Planning Departments have reviewed the building p~r~t/ I~- !r' application for construction activity which is proposed at:- Il/) 1/3 i'" ('""\ Accepted ~ ./ I I Denied Accepted With Correctiorlp, \ I \J" // CJiu~, ~?~-:.., Date: to/t~~ Reviewed By: A C-- ~JN~F.&Q .~~.&Ll'l; ~~ :f~1~W&t9V= ~~~rct k< "The issuance or granting of a permit or approval of plans, specifications and computations shall not be construed to be a permit for, or an approval of, any~.violation of any of the provisions of this code or of any other ordinance of the jurisdiction. Permits presuming to give authority to violate or cancel the provisions of this code or other ordinances of the jurisdiction shall not be valid." 3:45PM METRO RIR NO.5SS . CITY OF PRIOR LAKE HEATING/AIR CONDITIONING/FIREPLACE PERMIT P.l Dale RCI:'d 2, Ilnr WI, ~:~:.. ~:,~. I PERMIT NO. ~;z -GoO ~) ]. V.\low Appl'..nl . 1 ZONING ((,lm~~use) '- -\- - LaGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID 5-;}108'-6/0 OWNER eN ~m(;) Tp........ \-\-~\~ \ \.\ "" -, ~.\ ~ \... (.)~.~ . s \ ~ \\.,0' ~'- (Phone) '\ ~ :1- d (, ~- \ '-\ ~~ (A\ldress) Y"' APPLICANT '^ \ -r-- (~i1mc) ~~ ~('\::) t'I;,,.... -'- Y1 ~ (A~dress) \ ~ ~ ~ CJ \j" \ \ U,,",- t'. \I \..... N <Addn:u) (Cl(nmcc Person) L\ V\ L. \) S L-~ ~ '- \ \.. A~,PLICANT SIGNATURE '-./'{\~:1 ~\~ (Phone) ~ S ;),., \.\ \.\ l- ~~~ ~C'()- l~\~ \'\\\) SS'~'''''d (City) (Zip Code) (Phone) q ~'A~ \:~ ~ ,. ~ ~ Q>\ DATB \.\- ~ - ~ APPLICANT PLEASE COMI)LETE BELOW , ~EW CONSTRUCTION 0 REPLACEMENT 0 ^L'rEl'lATIO~SJ FU~NACE MAKE AND MODEL .~)c f\ h \~~. \ \, FUEL .uL l\ T FL\JE SIZE' 'I C RETURN OPENINGS "& INPlJ'r' ~~ J \\ ~ OUTPUT C1 ).. a 'i.\ ~ TYPE OF SYSTEM BEA TINO OR POWER PLANT . . ~Warln Air Plants 0 Stearn Oaravity 0 Hot Walcr -fid Mechanical 0 Radiation ~Aif COll(lilioning 0 Special Devices OVenl. Syst.eln 0 Other Deviccs PLEASE NOTE: Air Conditioner Units Cannot Encroach into Retluircd Side Yard Setbacks Flf\EPLACE MAKE AND MODEL Indllslrinl. \..:ommcrclal & Mulli-11arnily JiEESCHEDULE 1% orjob cost Residential, aas Fircplace $39.50 minimunI $99.S0 ReslcJclltial. AcJditiolls &. AllCl'aliullli $64.50 Residentiol, AC Only $J 9.S0 R.e~ldenlial. HCaling & NC (New Constructiun) RCll!dc:ntiaJ, Heating Only (New Conslruc;lioll) SJ9.S0 $39.~O Estimated Cost $ Building Pennit f/ ,.. . .50 r' Ifll r. / . c.) " i'o:'J~D'\t. 1.\", HEATING IJERMIT FEE STATE SURCHARGE TOTAL PERMIT FEE $ $ S (Ol~cc l/u Only) Thill AIJplicatioJl Becollles YOQr BuildIng Permit When Approved Paid Receipt No.--' Dulldlnl{ OfOci.1 Date R _ 2 2002 By I).It 24 hour nDlice for.1I inslJedlo", (952) 447.9850, fll.l (952) 447-4245 Date Rec~ CITY OF PRIOR LAKE PLUMBING PERMIT l' - 4 -() L I. Blue File I PERMIT NO 2. Gold City .0' '2 _/1/"/) /, 3. Yellow Applicant . VVL Jc LJovE: &1 .- ZONING (office use) LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID I OWNER (Name) (Address) (Phone) (Address) (Contact Person) ICANT SIGNATURE Quantity - Type of Fixture Quantity Type of Fixture ( .8:iIDlTub wi!hor without shower ? Rough-ins / DIshwasher I Water Heater / Floor Drain Water Softner L/ Lavatory (Batly:oom Sink) / Stand Pipe (Washing Machine) 'J Laundry Traf(!)or 2 compartment sink Sewage Ejector I Shower Stal1 Backflow Assembly I Sinks Backflow Assembly Test Bar Sink Lawn Sprinkler .) Water Closet (Toilet) Other ....... 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 6Z-00~0H .50 Y?~1J)r . Estimated Cost $ Building Permit # PLUMBING PERMIT FEE $ STATE SURCHARGE $ TOTAL PERMIT FEE $ (Office Use Only) Th;, Appli'aY7~'1'" Yoar Bailding Porm;t When Approved t!!!~ 4-/~~-~ Building Official Date --c Z- By 24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245 RPR-22-02 MON 11:02 RM KLINGBERG CO. 4473982 P.01 GIIEU - Fft..1 ,eLLOW - .""UQjllCT GOLD - elT' CITY OF PRIOR LAKE SEWER AND WATER PERMIT NO. ()2- 0600 NOTE: Sewer and Water contractors must be reqistered with the City_ APPI,ICANT: ADDREss;~_13 SI'GNATURE: SITE ADDRESS: /4343 ~tv\. ~~. ~2.i:f;~,_.Lj:.~ PHONE: l/ Y7 -:A ~~-Z,._ ,.-\ ~~:-btJ__D~TE: J61/p;;z. ~:T PERMIT # FILL IN THE BLANKS 1. Estimated length of water service 5tJ' feet. 2. Size of water service II' inch(es) . 3. Location of any couplings from structure feet. 4_ Type of sewer pipe. ABS PVC~ Cast Iron 5 _ Estimated length of sewer 1 ine ..stJ' feet. 6. Clean out (if required) I located at structure- feet from =~~~~~~=~=========~=====~=~=~===~~=~~=~==~=================~=;==== This application becomes your permit when approved. BY DATE: 'c'" 2 3 ?nm ..'. K . ! ' ===============~===============:=~=~~~~~=-~~~~~=========~=======~~ FEES: $ S $ 35.00 .50 35.50 Sewer and water line connection permit. surcharge TOTAL * Fee for either sewer or water individually is $20.00 plus $ .50 surcharge. * sewer and water permits issued for new construction must be recorded on the buildin~ permit card at the time of issuance to insure that no dupllcate sewer and water permits are issued. DATE PAID RECEIPT # ~ (!t~ ~ O,#rn-\ AMOUNT PAJ.t'_ ~NG pE gU\ --- R~C;U ~y ~--- 4629 Dakota St. S.E., Prior Lake, Minnesota 55372 / Ph. (6121 447-4230 AN EQUAL OPPORTUNITY EJ..\P\,.O.....ER Fax (612) 447.424-5 \" \- 651 633 BBB4 FIRESIDE CORNER #4571 P.DD1/DD2 Date Ree'd CITY OF PRIOR LAKE REA TING/AIR CONDITIONING/FJREPJ...ACE PERMIT ~: ~CJW ~~jGOM I PERMIT NO.OZ - 00 00 j I ~~li~:;;~;: ZONING Coffice use) eI- I LEGAL DESCRIPTION (offi,cc: Use only) LOT BLOCK ADDmON prD I oWNER (Name) (Address) -j/Jh ~ ~ (phone) - I APPLICANT ~a,m~) AIJLIEO FIRESIDE DBA FIRESIDE CORNER (Phon.e) 65J..633-2 515), (Ad.dress) ;4700 N. FAIRVIEW AVENUE (Ad,dn:~~) BRENDA HUS'l'ON (Contact Person) RDSEVTJ..LE MN . (City) 65J.-633-2561 (Phone) S<;;1 , 3 (Zip Code) APPLICANT SIGNATURE . DATE APPJ..ICANT PI..EASE COMPLETE BELOW EW CONSTllUCTION 0 REPLACEMENT 0 ALTERATlONS FURNACE MAKE AND MODEL FUEL FLUE SIZE RETURN OPENJNGS ~NPUT OUTPUT TYPE OF SYSTEM HEATING OR POWER PLANT ~wnnn Air Planrs Orll.viry Mcchaolc81 Air Cond.itioning Vent. System FIREPLACE MAKE AND MODEfJ -1J.€GI-&!. Cf.R OSt.l:sm o HOI W Jl!;er o Radilltlr.m o Spechd Devicc=s o Other Devicc=s ~1jl) PLEASE NOTE; Air Ccndidoner Units Cann(Jr. Encroach int.o Required Side Yard Setbacks E.stimat.ed Cost $ FEE SCHE;DU'..E J % of job cost Re.sldemlal, GIIS Firephl.cc: 539.50 minimum $99.50 Residenriijl, Addit,ion,s & AlteratIons $154.50 RcstdeodoJ. AC Only Building Permit # 0 Z -- 000 & $39.50 industrjpJ. CQmmcrcial &. Multi.PIUTl.ily Residential. J-fellting & Ale (New CmlstnJctlon) ResidenciaL HC/ilting Only (New Construction.) $39.50 $39.50 "'l:"1.J f!! \I'J' \, " t'p.~O ~~ gU\\P~N~ ~--- HEATING PERMIT FEE STATESTJRCHARGE TOTAL PERMIT FEE $ $ $ (OMcc Use Qn'y) This Appl.icati"n Becomc5 Your BuildIng Permit When Approved Paid Recetpt No. Dille Date APR 2 B'lihll"g omcln' 14, hlJur notice for nil ill~pcc:~lon8 (951) 447-9850, fu (9~1) 447....,:zc5 ... , ,;. ... '" ~ . ~ ~ -J_ " -~ n. ~-N '" Q: ~ I': I- 0 /'t) "~QIOO o :J~IO" O~U ~ ~lUo::{l -~Ol-" "".... -O~ .S 0 It CI) ~ ~" O~- Q)tO ~~ ::. ~ -J -,. to ... ~~- :::J .. Q: .. <I) 01- IU IU 6~~~ """"-<\1-:)0 ii' - -J :x: - ~~Q:fb - t::~~-J ~:::>Q:Q:1U ~ CI) lL. a. I- ~ ? o U ~~ .-? '" 0 ~~ '" '\ ~) \ -y- ~\ ... '" ~ ... ... 0- o ,.. \oJ~ r- 'al$lo. ~~o;;. l.!l"'''' ,,~ l$lN '" ":>< on '" :-"J " ,....1 "" . M ~.'O: -'0._ W. ~~ \ ~$ \ Z"'..: ::E....., ."'", Z::E> <r-Z 1IlG::_ o , cD.,. :I.,;~ ::Eon.., o . ~ '" ..::.... .,,0 I- (J) >- Z m ILl 8 '" > l'i) 0:: ILl I[) :::> >10 Cl)o::Uj - ~o~ ~. OZ -lL. ~ :E ...J D::oO CI) ... WwJ: -w Ww a..~ J:a.. c>~~ 1-0 "'~ OILlO ....<r -10:: mal- ~~ PRIOR LAKE INSPECTION RECORD DEPARTMENT OF BUILDING AND INSPECTION SITE ADDRESS ..l!13!:13 D-w.JL C--\- . NATURE OF WORK jJe.t.0 USE OF BUILDING SFO PERMIT NO. Ot--0o6fo DATE ISSUED fO" 17-ot CONTRACTOR TaM ltd."", e... C~. PHONE ttSJ. - 2' 2~ I 'f~f!j NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW THE PERMIT IS BY SEPARATE DOCUMENT INSPECTOR I FOOTING ft B, FOUNDATION (Prior to Backfill) PLACE NO CONCRETE UNTIL ABOVE HAS BE ROUGH - INS DATE OZ--6()(J(, ~gJ OV N SIGNED SEWER I WATER I SEPTIC FRAMING INSULATION ELECTRICAL PLUMBING HEATING (if required) FIREPLACE GAS LINE AIR TEST ~ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED I I FINALS fl GRADING (Prior to Sodding) BUILDING ELECTRICAL PLUMBING HEATING DO NOT OCCUPY UNTIL ABOVE HAS NOTICE '61_ l5ICT.~ 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 se placed near main entrance. Call between 8:00 and 9:00 A.M. for all inspections FOR ALL INSPECTIONS (952) 447-9850