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DATE8ECEIVED
.!t 51998
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
2. SITE ADDRESS
7
~y'~/II H<u It{ $" 7('fA', I
?t4a.\ of t(lf:1. I -SEvrIDU "3
3. LEGAL DESCRIPTION
LOT
BLOCK
cJEIIt U 1M 1t.)..ff t-t>-
ADDITION
4. OWNER (Name)
E. t'vt~Uu ~L.
5. ARCHITECT (Name)
(Address)
'397'f (, (au" H<2-'
(Address)
1. White
2. Pink
3. Yellow
File
City
Applicant
Permit No. BP q f' :2tJf
1. DATE
(Depth)
(Tel. No.)
'-/'17- 3S8~
(Tel. No.)
13. TYPE OF CONSTRUCTION
lJJ COD ~(l 1\ '1M tt...
14. FLOO AREA APPORTIONMENT USE
1.fZ-
Chimney 0 Misc.
B. PROPERTY/AREA OR ACRES
~.R ~ ~
I hereby certify that I have fumished infonnation 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 hat all construction will confonn to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the
~uildin .. I can revo this it for just caus urthennore, I hereby agree that the ~ o~e;iie~ enter upon the property to perfo~eedH~ons.
License No. 1 ~ Dale
6. BUILDER
(Name)
cO~ OD)Jc; T
Fireplace ~
Alterations '"
o
New Construction 0
SETBACKS: Required
Actual
Front
BUILDING DEPARTMENT VALUATION
USE OF BUILDING
f2e.;. . It J R.
I
(Address) 1J't1P VIA
/ Olf ~'Z~~ ik ~ l' /J.J
Septic 0 Deck 0
Addition 0 Finish Attic 0
c::tf
15. NUMBER OF OCCUPAN S OR SEATS
OCCUPANTS
SEATS
16. PfjROJECT COSTNALUE
9o~
17. COMPL ION DATE
Porch 0
FOR ADMINISTRATIVE USE
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION I ~,ooo. 00
Back
Side
TYPE OF CONSTRUCTION: I II III IV
Occupancy Group A B E F HIM <Af's U
Division 1 2(jl 4
Penni! Fee ................................... $
Plan Checking Fee ......................... $
State Surcharge ............................. $
Penalty. Jjf..9 i:~ J.. o.f............. .... $
Septic systed;j;.9.!..-:.J...~).f........ $
Other ......................................... $
Subtotal............................... $
City:
2.~'l. '2.. S
l 5tf . "2."2
8.~o
tltl. C ()
ifll 0 D
47C/.t/7
By
our Building Pennit When Approved.
Date "-17~
Certificate of Occupancy
Issued
Side
MATERIAL FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA 0
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS fiF SETS
SURVEY
PLOT PLAN
-r:t COPIES
o
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collector Street Fee ....................... $
Sewer Tap ................................... $
License Check Fee ......................... $
Pressure Reducer .......................... $
MeIer Hom ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
WaterTap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
Total Due .............................. $
7
Paid
24 hour notice for all inspections 447-4230
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The Cenler of Ihe like Counlry
Applicant:
Address:
,,---h
1. Blue
2. Gold
3. Yellow
CITY OF PRIOR LAKE
Signature:
Legal Descript
Site Address:
~
Block Su~kv ~
3 &" /' ~ \~~ t>~p I//S"' ILs:..
Building Permit # q cr - D2 q 'i' PID # c{f -f/d3 .-~~ r-~
NOTE: This permit will not be processed without complete information.
FIXTURE UNITS
Quantity Type of Fixture Quantity Type of Fixture
:L Bath Tub with or without shower Rough-ins
, Dishwasher Water Heater
Floor Drain Water Softner
/).. Lavatory (bathroom sink) Stand Pipe (washing machine)
Laundry Tray (1 or 2 compartment sink) Sewage Ejector
/ Shower Stall Backflow Assembly (RPZ, Double Check, PVB)
Sinks Backflow Assembly Test
Bar Sink Lawn Sprinkler
~ Water Closet (toilet) Other
FEE SCHEDULE
Industrial, Commercial & Multi-Family
(1 % of job cost, $39.50 minimum)
Residential, New One & Two Family
Residential, Additions & Alterations
State Surcharge
$99,50
$39,50
$
$
$ d?JP
$ .50
$ :.!d .6 ()
GRAND TOTAL
This permit is granted upon the express condition that said
contractor, shall comply in all respects with the ordinances
oPAl Qa'JWilifd,ing Code and ~e a ndments thereof.
BUILDIN Pr:=RMflEIPTJI~C DATE
/~ ','. I ...... ATIEST
Call for all inspections 24 hours in advance.
16200 Eagle Creek Av. S.E., Prior Lake, Minnesota 55372 / Ph. (612) 447-4230 / FAX (612) 447-4245
An Equal Opportunity Employer
The Center of Ihe take Counlry
White - Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
,
i r't; ./ / < '~ .
C.,
APPLICATION RECEIVED 1'//' // ...
. }
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
/., .
,/11
. /u.
, .i .'
/V;:I_f ~i, i
,
,.' ~.../,
Accepted
/
Accepted With Corrections
Denied
()fl1. J~
Date:
4//0/*
Reviewed By:
Comments:
"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."
Thr Crn.rr of Ihe Lake- Counlry
White - Building
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT JA~!.~t~ j'ltU,^v:)~ t~
APPLICATION RECEIVED i-/J 11 f
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
41" y( .
3fJl/ )jll'..J FJJUJ./
Accepted
Accepted With Corrections ~
Denied
Reviewed By(;2tJ ~ / k-
Comments:
Date: q-/7-'i~
I. U~~ ~VV\ok dAe~~ ~ ~Ll UCSC
"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."
PRIOR LAKE
.' , . .
INSPECTION RECORD
DEPARTMENT OF
BUILDING AND INSPECTION
SITE ADDRESS 38'1'1 GI'~ Hl.i~ 1'~{
NATURE OF WORK J:",,~,.. ,...W\.-l_\
USE OF BUILDING ~F'D
. PERMIT NO. CiS - 20e, DATE ISSUED 4-/ '7-~
CONTRACTqR ~.(.)t-~lJ. ~.
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
j,J
"...,:_:;F<.....:......,' ,I'
, '~, ..~.,,', , ' ., .
"\~I I
\;PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
INSPECTOR
DATE
"~.
. "-'
'li\t;Y"!
," '_'_:":,If:~' - - _
.', '.(',' ',~~:;:: ;~..!:~,;;~/~,::',.\A
FRAMING
INSULATION
ELECTRICAL
PLUMBING
HEATING (if required)
FIREPLACE>
GAS LINE AIR TEST
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
__ I I I.
.; FINALS
- -~---
l
BUILDING
ELECTRICAL
PLUMBING
HEATING
~>L:>ft>P. 0 NOT
(,
OCCUPY UNTIL ABOVE HAS
NOTICE
;..:TJ"lis cartr-'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.
Call between 8:00 and 9:00 A.M. for all inspections
FOR ALL INSPECTIONS 447-4230