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�/^\, � CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORA ND UTI ITY CONNECT ON ERM T PLIANCE � /
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'. "''"`e F''e pERMIT NO. (�8. O�
2. r;a� c�tY
3. Yellow Applicant
Please e or rint and si at bottom
ADDRESS ZONING (ott'ice use)
� l�t30 VJovc� �e.�c. � N �V �rc'or (�.�c.e I�t N 553�L.
LEGAL DESCRIPTION (oflice use only)
LOT BLOCK ADDITION PID � L'.�Z - � ��
owrrE (Q r Z . $� . Z5(�8
(Name)�e.�1.1/� � �O�Z �r �� (Phone)
(Address) c�� �� w� 1�.� �� W ��l'i vl l� M IJ G �'j 3� Z.
BUII,DER � t 1
(Company Name) O���Y C��`��ti� ' � ' (Phone) � . 'l� � . ( U��
(Contact Name) �- �-��-�/` ` (Phone) �! � 2 • � SO . ( Ov0
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(Address) ' 2 � x2.V�w6i�' PC�-- cS. �a � �� � �J� 31 g � �L � 2 � � a
TYPE OF WORK ❑ New Construction ODeck �Porch QRe-Roofing �Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition �Alteration �Utility Connection
CODE: .R.C. �I.B.C. �Misc: �{ ba-(�U�UU�1�(� __
Type of �nstruction: I II III IV V A B � �
0 �C�,
Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE S ��
Division: 1 2 3 4 5 (excluding land)
T hereby certify have fumished information on this application which is to the best of my knowledge hue and conect. I also certify that I am the owner or authorized agent for the
above-mentio prop d that all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am awaze that the building
official o it for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspe tions.
X ��
Signature Contractor's License No. Date
Permit Valuation �� p Qp , Park Support Fee # $
Permit Fee $ Z ` . Z ,� SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ � Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ � r - Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE �`� �,�; � f� $ 'Z � 2'�
.
This Applic c � Permit Whe App oved Paid Z1'1 � Z� Recei t NO. s S�
Date � � B p-�D
� Z �
Bwldin O � te
This is to certify that the equest in theabove applicaaon and accompanying do en is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed C' Planner const�'�a temporary Certificate oF Zoning mpli ce and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued.
� C �
ning Director Date Special Conditions, if any
24 hour notice for all inspections (952) 447-9550, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
Residential Building Permit Checklist
Swimming Pool Additions to Single Family Homes
BY: ��� I 1 Date: G�� ��N
tt u
Building Permit #� t vv �,� Q J PID:_� Zoning:
Site Address �
Legal: L B Subdivision:
Existing Structure YES r NO
CONFORMS TO ZONING YES NO
ORDINANCE
IN-GROUND $WIMMING POOL Requirement Proposed
Yard Setbacks: NOT APPLICABLE
MEETS CODE
• Side Yard 5', 25' or 30'
(25' if abutting a street, 30' if abutting a street in �
Cardinal Rid e) '�
5'
• Side Yard �� �
• Rear Yard g'
.� � I
• Not to be located within 6' of any principal
structure or frost footings, including deck � �
footin s.
ABOVE GROUND SWIMMING POOL Requirement Proposed
Yard Setbackss NOT APPLICA LE
MEETS CODE ��, �''�
• Side Yard ����- ��� -�` 5', 25' or 30'
(25' if abutting a street, 30' if abutting ,,st�eet in
Cardinal Rid e)
• Side Yard y� 5'
• Rear Yard g'
• Not to be located within of any principal
structure.
ANY PROPOSED SWIMMING POOL NOT MEETING THE ABOVE CRITERIA MUST BE REFERRED TO
THE PLANNING DEPARTMENT. ALSO, ANY POOL ON A LOT WITH A SUSPECTED BLUFF, OR ANY
OTHER UNUSUAL CIRCUMSTANCE MUST BE REFERRED TO THE PLANNING DEPARTMENT.
THIS CHECKLIST MUST BE COMPLETED AND INCLUDED IN THE BUILDING PERMIT FILE TO
MAINTAIN A RECORD OF THE REVIEW.
J:�FORMS�Pool planning checklist 2007.DOC
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Wfiite - Building
,y� ,�� Canary - Engineering
'"'v$sO Pink - Planning
BUI DIN� PERMIt APPLICATION D�PARTMENT CJ�.�;KLIST
f_ , .�
NAME OF APPLICANT DL(-TG�d01 �11V I�''Or1 rYIe�T_tL .
APPLICATION RECEIVED �" "" ��''�g SvB�''� �'r� . S'��' w / ��'
_ o hs $ +to oa
The Building, Engineering, and Planning Departt�enfs have reviewed the building permit
application for construction activity which is proposed at:
�,-� , J� � �� �,(� � �iuC�... �'�. � UJ
Accepted ''�'L Accepted V1�i#h Correct�ons
a�nied
Reviewad By: Date: �i �
Cvrnm�nts:
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;� �i��� �ide f�r �c�it��r��1 lr�fc�m^�� �
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"The issuance or granting of s p�errr�i# or �aprav�l a# plans, s���i#ic�#ic�rls and
compu#ations sh�N nfl# b� construed to b� a perm+t for, or an approv�t af, a�y�.viol�#ion of
any cr� fhe provis{�ns af �is �de vr c�f ar�y +�ther esrdlnartce o# tl�e' jurisdi�ti�n: Perrnits
presuming ta give authority to vi�tt� �r +canc�l #M�e pnavision� c�f this cc�de or o#her
ordinan�+�s of the jurisdia#�on sMall not be valid."
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White - Building
, ,� Canary - Engineering
NNES° Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT C�(.�- �h�'l YD/1rnC'VI,T� ..-�►u�. .
APPLICATION RECEIVED � � ZS�O�
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
v l�'3o I,c) o ��� 1� �2 ��
Accepted ✓ Accepted With Corrections
Denied �
Reviewed By: Date: � a7 D�
Comments: S ��iv� '� ��r� m �s� P�4ss /.tiSPE�-7'c� �lcv2
rd cv,9 �. �, c.L ,.ti � r��L . �u.� � c.9-� /La�ef�-- /�
�.�YI �(ri�A-�. 11� � +� 1��'tSs '�'t'SP�`�'�r""�' � �� �/�l'�tU C-. l��r �E'C�/� '
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C G-a � <.�.�z� /� � 1v�`� ' l�`t�GL� /�ts � /� -� --� /5�l aGf .
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"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."
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White - Building
P Canary - Engineering
`�'NNES°`� Pink - Ptanning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST �
NAME OF APPLICANT (�C� �G�C.�?�P'� �Ol iIl ��1.���� � r��{��"�. �� � -.�IiC. .
APPLICATION RECEIVED �" `" Z �' ��
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at: .
� l �3a �� �� � c �e.... �.-=-� �.. �� t�.1
Accepted �� Accepted With Corrections .
'� � �.� ���
z�� - w. t�t
Denied `
;;
Reviewed By: � Y Date: � � °$
,; . .
i. Comments: -��� �4�rP�rr6r'�' �x.�r l� �- �1'l�.u��n� rx� ZS
.�► NE Ba�..�r� 5in �� ,� �:,
.�-
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;
"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."
o � p RIO� CITY OF PRIOR LAKE Date Rec'd
F � HEATING/AIR CONDITIONING/FIREPLACE PERMIT � Zp�tl f�
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� �4� 1. Pink File �
j NNESO PERMIT NO.�
2. Green City �
3. Yellow Applicant
lease or 'nt and si at bottom
E�IDD�s$ � �� S /q/O � ' J L J !`%i`" // � , ZONING (o�ce use)
v� �� � v
LEGAL DESCRTPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) (Phone)
(Address)
ameCANT � � � � Cc S � �l S �4 lC �i'" hone ? �
� � m � � [� 3 � Y 7�� �
ddress) J c7 ?� � / ! ( S � "' � ' V � � r� G� GV `Rf"
(Address) (City) (Zip Code)
ontact Person) � �� / ! � (Phone)
PLICANT SIGNATURE � � � ` ATE � � � U f - � �
APPLICANT PLEASE COMPLETE BELOW
�NEW CONSTRUCTION ❑ REPLACEMENT ❑ ALTERATIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
PLEASE NOTE: Air Conditioner
❑ Warm Air Plants ❑ Steam Units and Fireplaces Cannot Encroach
❑Gravity ❑ Hot Water into Required Side Yard Setbacks.
❑ Mechanical ❑ Radiation
❑Air Conditioning ❑ Special Devices Fireplaces with Boz Additions or
❑Vent. System ❑ Other Devic s Cantilevers to the Outside of Buildings
� � � Require a Building Permit.
FIRE E MAKE AND MODEL .
. l
FEE SC EDUL
Industrial, Commercial & Multi-Family 1% of job cost Resi ential, Gas Fireplace $49.50
$49.50 minimum
Residential, Heating & A/C (New Construction) $149.50 Residential, Additions & Alterations $49.50
Residential, Heating Only (New Construction) $64.50 Residential, AC Only $49.50
Estimated Cost $ Building Permit # � �
HEATING PERMIT FEE $ � V
STATE SURCHARGE $ .50 � � V �
TOTAL PERMIT FEE $
6�
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid Re ' o.
Date By
BuildinL Official Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street 5.E., Prior Lake, Minnesota 55372
' DEPARTMENT OF
BUILDING AND INSPECTION
SITE ADDRESS ��� �� ��n C��� On�. �•`
TYPE �'JF WORK ��r G� ��
USE OF BUILDING (� �+
PERMIT NO. b S-�-�� DATE ISSUED � 7
BUILDER DvTnr�2 �NVt��►t�f PHONE # �(Z• _�o�ao
NOTE: THIS !S NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PER IT I BY SEPARATE DOCUMENT
C� LJ/f� 2� D� OR DAT@
FoonNG �' � �
PLACE NO C�NCRETE UNTIL AB�VE AS BEEN SIGNED
�� 5 � F�Nt.E inv5� p.rss /iVSP ati �
8� cs porx.. c.4ti .r � c.�.
FINAL � , �
�LC-�Gj1 G/� �. �21' f F
FOR ALL INSPECTIONS` (952) 447-9850
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