HomeMy WebLinkAboutBuilding Permit #93-0358 (2)
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICAN~'''~1. f4. ~-iG"
APPLICATION RECEIVED -~J~ ~
The City of Prior Lake PLANNING Department has reviewed the
building permit application for construction activity located at
Comments:
.
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Accepted with Corrections 1
Date /0' dro~ 93
Accepted
Reviewed
"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."
CITY OF PRIOR LAKE
PLUMBING PERMIT
t ~~+er V \ U'fn b l)~ \ ~~<;:'
I c\ U.l\L.
1. Blue
2. Gold
3. Yellow
File
City
Applicant
Applicant:
Address:
Signature:
Legal DescriptiOn:
Site Address: 'S ':::> .J
Building Permit # ,/0.">> ~S ~' I PID # J 5 - 0 "\0 ---0\6 ~O
NOTE: This permit w~OQ! b~E!~~~,~~~~wit11'out complete information.
FIXTURE UNITS
-/ < C fcSf-
Unit
Quantity Type of Fixture Amount Total
L\ Bath Tub with or without shower $ 6.00 .) t/ Oil
I Dishwasher $ 6.00 /;/ 00
.1 Floor Drain $ 6.00 I,l. 0 ()
y Lavatory (bathroom sink) $ 6.00 ,< Lj tJ ()
, Laundry Tray (1 or 2 compartment sink) $ 6.00 ~ . VC
i Shower Stall $ 6.00 ~(}O
i Sinks: $ 6.00 t . cO
~. Bar Sink $ 6.00 { DC
L.-l Water Closet (toilet) $ 6.00 J.tf tJO
Rough-ins $ 6.00
\ Water Heater $ 6.00 b.Ot)
Water Softner $ 6.00
1 Stand Pipe (washing machine) $ 6.00 6 IJD
Sewage Ejector $ 6.00
Backflow Assembly (RPZ, Double Check, PVB) $25.00
Backflow Assembly Test $10.00
Lawn Sprinkler $25.00
Other $ 6.00
Minimum Fee $25.00
SURCHARGE
.50
GRAND TOTAL $ / It Ju
This permit is granted upon the express condition that said
contractor, shall comply in all respects with the ordinances
of the State Plumbing Code and the amendments thereof.
If 7ll~ ,RECEIPT NO. flu/fl/ DATE
ATIEST
I Call for all inspe io s 24 hours in advance.
4629 Dakota St. S.E., Prior Lake, Minnesota 55372 / Ph. (612) 447-4230 / FAX (612) 447-4245
AN EQUAL OPPORTUNITY EMPLOYER
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GREEN - FILE
YELLOW - APPLICANT
GOLD. CITY
CITY OF PRIOR LAKE
SEWER AND WATER PERMIT
No.9'1-/l-7
NOTE: Sewer and Water
contractors must
be registered
with the City.
A I co 1) .'
APPLI CANT: ri J h As. I C /L I '/)J f1 ~ N b PHONE: '-11 ;)_ 0 ~O'S""
ADDRESS: '0 -:- f eel. 'al.. DATE: ff?( ;?'O(~C{'f _ _.~
SIGNATURE: ~,-,- . BLDG. - PE~IT ''t.3-1.!,1'
SITE ADDRESS: 910 t~l,erL I f#r4.1 PID# 2r:-iJlla- _ - 0 ~
1.
FILL IN THE BLANKS
Estimated length of water service~feet.
Size of water service~inCh(es).
2 .
3. Location of any cOuplings from structure
~ feet.
4. Type of sewer pipe. ABS~ PVC Cast Iron
5. Estimated length of sewer line~ ~~ feet.
6. Clean out (if required), located at ~~ feet
structure.
from
------------------------------------------------------------------
------------------------------------------------------------------
This application becomes your permit when approved.
BY jk',!Ji,J",/ 11J' DATE: ?!2.IJ/ftj
~~~~~~-~~~~~~~~~~~!~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
FEES:
$
$
$
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 building permit card at the time of issuance
to insure that no duplicate sewer and water permits are
issued.
DATE PAID 9 JLC)Pt)
RECEIPT # -:/Ylt1fj
AMOUNT PAID ..J,-~, ..)L:'
REC'D By/}-jJ~
,j
4629 Dakota 51. 5.E., Prior Lake, Minnesota 55372 / Ph. (612) 447-4230 / Fax (612) 447-4245
AN EQUAL OPPORTUNITY EMPWYER
CITY OF PRIOR LAKE
DEMOLITION PERMIT
1. White - File
2. Blue - City
3. Yellow - Applicant
Permit No.
.~,.~-.
DIRECTIONS '
1, DATE
LOT
,....~
BLOCK
0.,
PID
J"~ <"-"_' /.. .r'jl/
',-'( ,) r'> <;,~, - LJ. (i~1
,/\
-(_.J
BUILDING INFORMATION
7. SIZE OF STRUCTURE
I
8. NO. OF STORIES
I
9. TYPE OF CONSTRUCTION
F 1.;2/)/ e....
10. COMPLETION DATE
") /,~ ,
., (~1 ./
SPACES NUMBERED 1 THRU 10 MUST BE FILLED IN
BEFORE PERMIT ISSUED
(Please print or type and sign at bottom).
'.? .J. I' J!L:> ')
'<;;'/;/ ~ -';)
2. SITE ADDRESS ,- J .1 U' .r-
.:? "., I .;:,
3. LEGAL DESCRIPTION
~
,'''' , -~" I
\'::>ho/';? /r~l
J '''''-
;7..,./ t:;.
ADDITION
,N~) / Ii .51:01 tC_ Cre.;!
4. OWNER (NSlme)
/j'//'Ylr I
/ '," \,,- / .~> ':r.../
5. ARCHITECT (Name) /' ,;/,/
6. CONTRACTOR (Name) ~_:..- t... 5/ '
/
I hereby certify I have futlhished information which is to the best of my knowledge true and correct. I also c~rtify that I am the
ow.ner or. author. iZ. e~ ag e~, t for. t,h above mentioned property and that all construction will conform to all existing state and local laws
and w}tf proceeglinl acG6rdan with submitted plans. I am aware that the building official can revoke this permit for just cause.
Furt.Wermore, I ne!feby agr 'that the city official or a designee may enter upon the property to perform needed inspections.
... {'j '/~ / ,,! ''"'\
X ' ( '/ /'/ '< / J ,/
/1' (,/V Lsignature I / Date
(Address)
II ,J I d;J-;i a,J ) )
(Address)
(reI. No.)
(Tel. No.) 7,,) 0 - 7';; 50
'J..] .::;. S q ? '..;
.'
(Address)
(Tel. No,)
,/
FOR ADMINISTRATIVE USE
r
METRO SAC UNIT DETERMINATION i
.- '\; ~
MA TERIAL FILl;t) WITH APPLlCA nON
\
o Site Restoration Plan
" \
o Utility Abandonment Plan
USE OF BUILDING
o Sewer Abandonment
SITE RESTORATION PLAN
.'
o Water Abandonment
Accepted by
'.-i:-
Rejected by
It
/~-
o Electrical Abandonment
o Other
Division
2
3
4
CREDITS
Park Oed. Credit ................................................ $
SAC Credit ......................................................... $
Sewer & Water Connec. Fee Credit .................. $
Water Tower Fee Credit .....................................$
Other .................................................................. $
'TOTAL CREDITS ........................ $
TYPE OF CONSTRUCTION:
Occupancy Group A
B
I
E
II
III
H
IV . V
R M
This applicatiQI') becomes your
demolitiOQ,.peFt.when approved
By. ~.
Date
Issued by
--~-:t.~,.."
Date
This is to certify that the request in the above and accompanying documents is in accordance with the City Zoning Ordinance and
may proceed as reque~ted.
~.
".
-: ~'..""'k
City Planner
-,-
Date
Special Conditions if any
PRIOR LAKE
INSPECTION RECORD
DEPARTMENT OF
BUILDING AND INSPECTION
SITE ADDRESS
NATURE OF WORK
USE OF BUILDING Sf 1>
PERMIT NO. ~ ~. 35~ DATE ISSUED /l' 1"3
CONTRACTOR 41'1 d. r is V" I J 'YlCl" ).5 )..,0 ~ (1'VoJ~
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
5'/ldo If''r\!'-u 11.'2,.';)3'NJ"fcToR
p(3
~Lj05
ShiN..( t(~
DATE
FOUNDATION (Prior to Backfill)) \1..\' "ff-. 6
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
S" v'J . 'VI' 6)
SEWER WATE V SEPTIC
FRAMING 1.'l)Rt\'f
INSULATION
ELECTRICAL
PLUMBING ~.? 6)\(1 <1.fI> <')
HEATING (if required)
FIREPLACE
GAS LINE AIR TEST
q.10 n
'1-Q-99
<6 -Ji- ~ ,-
q'l~q(p
3. J ~., i
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I WALLBOARD I I
FINALS
GRADING (Prior to Sodding)
BUILDING
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.
Call between 8:00 and 9:00 A.M. for all inspections
FOR ALL INSPECTIONS 447-4230