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)! I her.ebY certify that 1. have hlrntshed Information on this applicatllln which IS to the best of my knowledge true and correct. I also certify that. I a the owner or authOrized agent tor the
I above-mentlllned property and that all cllostructlOn Will conform to all eXisting state an Llcallaws and will proceed In accordance with submttte Ian,. I am aware that the bUilding
,,~liClal can revnke tlus permit for JU~urthcrmore, I hereby agree that the CIty offici, or a ;~;;a;;;;;propeI1Y to pertnrm nee nsp~ ~D 7
',- · dlrgnature ontractor's License No. Date r
Permit Fee
Permit Valuation
Plan Check Fee
$
$
$
'3, otJO. -
1,4-"'''-
I . 4:)""0
Penalty
State Surcharge
$
$
$
Sewer & Water Permit Fee $
Gas Fireplace Permit Fee $
J .
I I I
~~d1n,p~tf;~7d
gO Icial _____ , Date !
--- ---
Plumbing Permit Fee
40. -
Mechanical Permit Fee
/
Park Support Fee
SAC
Water Meter Size 5/8"; 1";
Pressure Reducer
Sewer/Water Connection Fee
Water Tower Fee
Builder's Deposit
Other
TOTAL DUE
I Paid f{ ~~. ,-
I Date ...., /- Q 7
,
#
#
#
#
$
$
$
I $
I $
$
$
$
$
1I~_Z5'
Receipt No. ~~cF(/
~.1!+
By
ThIS lS to certify that the requl'st In the above applIcatiOn and accompanymg documents is m accordance with the City Zoning Ordinance and may proceed as requested Tll1S document
when signed by the City Planner constItutes a temporary CertIficate of Zonmg compliance and allows construction to commence Before llCcupancy, a Certificate of Occupancy must be
isslled
Planning Director
Date
24 hour Jloticc for all inspeetioJls (952) 447-91150, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372
Special Conditions, if any
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
/ 2-.5.ob
~. ~~ ~:~ I PERMIT NO. r7 r-c:2j
3 , Yellow Applicant / ~.:::::JO
(Please type or print and siltll at bottom)
ADDRESS
/'147 &
J)6bIC//CW
LJ/L-,
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name)
(Phone)
(Address)
APPLICANT
(Name)
(Address)
/4 L/}I/ S
G II? t1 /../ .5
(Phone)
CJ,')) - )6'1 - .R96 7
(Address)
(City)
(Zip Code)
(Contact Person)
~
(Phone)
APPLICANT SIGNATURE
DATE
0'" . 'j -:7 /7(/'
f -. O<~ - 1../('\
G/'
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher Water Heater
I Floor Drain Water Softner
I Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
I Laundry Tray (lor 2 compartment sink Sewage Ejector
I Shower Stall I Backflow Assembly
I Sinks I Backflow Assembly Test
I Bar Sink I Lawn Sprinkler
I Water Closet (Toilet) I Other
FEE SCHEDULE
Industrial. Commercial & Multi-family 1% of job cost with a $39.50 minimum
Building Official
Residential, New One & Two-Family $99.50
Residential, Additions & Alterations $39.50 it
"'timoted Co" $ Buildiog Pennit # I D ~
PLUMBING PERMIT FEE $$ / () fY 'vO {;;
STATE SURCHARGE ~O ~ ' II
TOTAL PERMIT FEE $ ~ ~V
~
p~
Date (j I
/. '7.,3. () V
----
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Date
By
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714
PRIOR LAKE
INSPECTION RECORD
SITE ADDRESS j,4-7Ca ~~(l9-0 D. S~6.
NATURE OF WORK i=/NI51-} L~~
USE OF BUILDING fZe. ~ A Itz. I J
PERMIT NO. '~-Z- ~€>, DATE ISSUED '1/f3/o-,
CONTRACTOR ,fl-ot'l (J~7'4...)cr /c>^J. PHONE hlz-803 -1109
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTOR
DATE
I
_r to Backfill) I I
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING
INSULATION
ELECTRICAL
PLUMBING
HEATING (if required)
VO//
1)'-()~
Y117"
WV/
?5- v 157IJ
~/,)--vJ
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I I
FINALS
r to Sodding)
/)J
fP
l 2-W()8
v
BUIl..DING
ELECTRICAL
PLUMBING
HEATING
DO NOT
l
V
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
Residential Building Permit Checklist
Basemi\ Finish or Interior Alteration to siIfle FlilY Homes
BY: (<() ;s- Date: {( S ( 0 (
Building Permit # PID: \ Zoning:
Site Address
Legal: L B
Existing StrucG2 NO
CONFORMS TO ZONING
ORDINANCE
Subdivision:
~'})
(YEV
I
Is this an expansion of the existing footprint or
building height?
YES
Refer to Planning
Is the property located within the flood plain?
Refer to Planning
Does the alteration include any additional kitchens?
Refer to Planning
Does the proposed alteration include any outside
entrances other than patio doors?
Refer to Planning
Is the proposed use of the finished space or
alteration for anything other than a normal single
family home (office, group home, day care, etc.)?
Refer to Planning
NO
NO
~o
~o
No
A/o
THIS CHECKLIST MUST BE COMPLETED AND INCLUDED IN THE BUILDING PERMIT FILE TO
MAINTAIN A RECORD OF THE REVIEW.
L:\TEMPLA TE\AL TCHCK.DOC
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
(Please type or print and si~n at bottom)
(fDRESS ( -, 4 1 &
LEGAL DESCRIPTION (office use only)
LOT Z~LOCK Z ADDITION
Date Rec' d
I White
Pink
Yellow
File
City
Applicant
PERMIT NO. (!) 7 - 5~ /
De-6 ,"2. F f ~~~ Prz-. 5. e .
ZONING (office use)
(Z'Z-
1/114-
V<%(L\q~()
At>c>
pm 25"-4-01 -o4b -'(:)
OWNER // / / /'l I.-
\--(Name) rUdQ5 ~er~C--#~
(Address) /747~ 0~h~e:/ ~r:- S-e-
~
(Phone) 9~"Z r6~ ;P6.2
9rz. ~~~ 3967
#/f/ ~~372
./
/:-'orLak'~ /
BUILDER 7'L!> ~~/..../ I
(Company Name) /,c~/V t1,hp;e,doH _ /-'X'. (Phone) //2.,g0 3 //03
(Contact Name) <;l), ~, 1!~~ ~HK,-cz6v (Phone)
(Address) ~.r~.fI .&.~L'I!:JC~ A/7' /AVe.1 ~r0/;"~ ~~
TYPE OF WORK 0 New Construction ODeck OPorch ORe-Roofing ORe-Siding 'j(lLower Level Finish 0 Fircplacc
OAdditIon OAlteration OUtility ConnectIon
CODE: DI.R.C. DI.B.c.
Type of Construction:
Occupancy Group: A B
Division:
o Misc.
I
E
II
F
I
III IV V
HIM
2 3 4
A
R
5
B
S U
PROJECT COST IV ALUE $
(excluding land)
)1 I h. er.ebY certity that I have filrnlshed rnt(lrmatwn on this applicatIOn whtch IS to the best O.f my knowledge true and correct. I also certifY that I a the owner or auth. onzed agent tor the
I Jbove,mentlllned property and that all construction WIll conform to all eXlStrng state an ocallaws and will proceed rn accordance with submilte lans I am Jware that the bUlldrng
i,ntfinal can revoke thiS permit for JlI aus' urthcrmorc, I hereby agree that the City offiCI< or a desIgnee may enter upon the prope11y to perform nee ' nspcctHms
x- 206 27.RP/ ~~D7
',- ~ gnature ~ontractor's License No. Date r
Permit Fee $
Plan Check Fee $
State Surcharge $
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace Permit Fee $
I .
A I I
~~dfu' P'~" "Rti'
~ > (Date!
Permit Valuation
~O()C). -
(,4.1"-
I.~O
Park Support Fee
SAC
#
#
$
$
$
$
$
$
$
$
$
1I~.Z5'
Water Meter Size 5/8"; I",
Pressure Reducer
SewerlWater Connection Fee
#
#
40. -
Water Tower Fee
Builder's Deposit
Other
I
TOTAL DUE
Paid If ftq.Z, S-
Date ,/\1CJ 7
i Receipt No. 5"""4cFt /
I By ~~/-L
ThiS IS to certity 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 tcmporaIY Certificate of ZOning complIance and allows construction to commence. Befnre occupancy, a Certificate l)f Occupancy must be
isslIed
Planning Dircctor
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372
Spceial Conditions. if any