HomeMy WebLinkAboutBuilding 05-1156
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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
(Please type or print and sign at bottom)
I ADDRESS
L /4r1D
LEGAL DESCRIPTION (office use only)
LOT 1
ADDITION
OWNER
(Name)
(,
(Address)
Date Rec' d
White
Pink
Yellow
I PERMIT NO. 05" ~ 11~4
File
City
Applicant
LLJt1Jcl(jl~u~~iL 'r ~.
ZONING (office use)
PID
(Phone) 1~) yo;; 1c J I
BUILDER
(Company Name)
(Contact Name)
(Address)
(Phone)
(Phone)
TYPE OF WORK 0 New Construction ODeck OPorch ORe-Roofing ORe-Siding rn'Lower Level FinIsh 0 Fireplace
OAddition OAlteration OUtility Connection i\'
CODE: DI.R.C. DI.B.C.
Type of Constmction:
Occupancy Group: A B
Division:
I
E
o Mise.
II
F
I
III
H
2
IV V
I M
3 4
A
R
5
B
S U
PROJECT COST IV ALUE $
(excluding land)
I hereby eertify that I have hlrmshed mformatlun on this application which IS to the best of my knowledge lrue and correct. I also certIfY that I am the owner or aulhonzed agent for the
,Ib<,ve-menuoned property and that all construction will conform to all eXlStmg stale and loeallaws and will proceed in accordance with submllled plans I am aware lhat the buildmg
I ntlicial can revoke thiS p~)r J.ust c.a.use. F. urthermore,) hereby agree that the CIty official or a desIgnee may enter upon the propeny to perform needed mspect.lons . _
, X I / ~;t[5?f-C //- Ij-(;( ~
L - Signature Contractor's License No - Date
Permit Valuation
Permit Fee
Plan Check Fee
State Surcharge
i Penalty
r- Plumbing Permit Fee e.
IMechal1lcal Permit Fee
r Sewer & Water Permit Fee
L Gas Fireplace Permit Fee
$
$
$
$
$
$
$
$
<lc/OZ? -
1-OJ-S-
Park Support Fee # $
SAC # $
Water Meter Size 5/8"; I"; $
Pressure Reducer $
Sewer/Water Connection Fee # $
Water Tower Fee # $
Builder's Deposit $
Other $
./
TOTAL DUE $ /lft"J ~
,;).<.7D
-
~d
Date
../
~~ q 'f?
/1- /()
This Application Becomes Your Building Pennit When Approved
L
BuildllH! Orticial
Date
I ~;CfP:: CfJ /:3
nus 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
\vheTI signed by the City Planner constltutcs a temporalY Certificate of Zoning compliance and allows constructIOn to commence Before occupancy, a Certificate of Occupancy must be
lssued
Planning Director
Special Conditions, if any
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
Residential Building Permit Checklist
, Basemen! Finish or InTerior .-VTGr3.DOn to Single Family Homes
BV / hi. a- Date /!fir-v;
Building Permit ;:;
Site Address
PID: Zoning:
/I/!/() (u{)Ld C:;; j lAC (~_
Subdivision:
Legal: L B
E.Jisting scruc:ure:@or NO
CON~OR1.ylS TO ZONlliG ('lIS \ NO
ORD~-AJ.~CE -~
NO
YES
Is ::ru.s an expansion aI' dle ex:s-c.ng fooLpru:.: or Rc:fe-: :0 P laIL-::"""J.g
building height? L--------
Is dle property loc3.:d ;0.rh." che flood p13.in? I Re:'e: ::0 Plar...."ling I I
I ----"
I Does b.'le alteration include any addirional :c-::cie:::s? I
Refe:- ::0 Plam:ing
..,/-',........
Does me oro"Cose:i alte:ar:on include an'! outside R~fe: :0 plaT'!71.; ~g
. . .
e:l tra."'1C ~s othe:- than patio doors? -----
Is the proposed. l.l.Se of :he 5:::ishe:i s-pace or R.efe: ~o PlarrT"'l"!i"g ~--i
alteration for anyrbng o:b.e:' :blll a aOG:al s1ngle
Ia.--nil y h orr. e (0F-~"'~ g:-8U'9 Gcce. 6.y cz~~ ~,- .....i, I
..-...--...., ..'-.J'
'--
THIS CHECK1.1ST:'iIUST BE: COMl'LETID A.:.'fD INCUrDED IN nIT Bl;lLDING ?~R['dIT mE TO
LYL-ill'iTAlN A RECORD OF THI REVIEW.
PRIOR LAKE
INSPECTION RECORD
'P'I
DEPARTMENT OF
BUILDiNG AND INSPECTION
SITE ADDRESS ~ ~'-"~~
NATURE OF WORK ~tJ..,-r.-. I.~ ,
USE OF BUILDING ~. F". ."
PERMIT NO. --V$"- l/.ST. DATE ISSUED
CONTRACTOR ()~~ PHONE
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR
DATE
I r.ee1>ItJ&i I
I rgYrU'ATlel~ (,.."UI 10 Dac!kfill) r I
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
~U"A ,. WArtn I ~L..Ill'le
FRAMING
INSULATION
ELECTRICAL
PLUMBING
HEATING (if required)
&lAEPLACf!
c ^ ~ I I~J~ !l.IA "FE8T
1.\
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I I
FINALS
~AJl.I5If~~ \,.., ~UI lU ~uuuing)
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.
FOR ALL INSPECTIONS (952) 447-9850