HomeMy WebLinkAboutBuilding Permit 12.0053 J
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c:s' Il \ \ CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
�� `� TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
u—'''' Jl - _ ` .,- AND UTILITY CONNECTION P ERMIT
r`t'N E S OS e,lGf ,,,, /T/Y
i ; . 1. White File
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2. pink city PERMIT NO. /Z , 0053
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
CA 1Z,- o ` (,'u k. M) 3-73-7--- ID
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID $ 03o . 46¢ _ 0
OWNER , �j / > / 6 " �J
(Name) ✓C , ll) M Ci �i�L'l�; Q , t� l� 1 ( Phone ) cU f Z - 4'l ��-,3
(Address) c 1---194...„ 61. Pv lG' Y L„ ke -, IV ti cc371,
BUILDER t // / /
•
(Company Name) ■ IA . 1 - ' 4 / 4 i _ _ .) (Phon • 6 [y-" 4lt3 -2,2-77
I
(Contact Name) • (> �.j) J `' ft J (Pho 11 .
C/
(Address) 61 (�"t'4YKtkeod bp., (9,,v6,4,1-e.,, » /t.) 5 7. -
TYPE OF WORK ❑ New Construction ['Deck ['Porch [Re-Roofing ['Re-Siding ['Lower Level Finish ❑ Fireplace
❑Addition Alteration ['Utility Connection
CODE: ❑I.R.C. OLB.C. ❑ Misc:
Type of Construction: I II III IV V A B /' �{� ett /�
Occupancy Group: A B E F HI MR S U PROJECT COST /VALUE $ Jt2 j r 647
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have furnished information 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 that all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee � may enter upon the property to perform needed inspections.
X 6 to gl al s t; Azi he e) 7-+
Signature Contractor's License No. D. to
Permit Valuation ( 0 O— — Park Support Fee # $
Permit Fee $
11-1•2-` � SAC # $
Plan Check Fee $ Z(p o 1 Water Meter Size 5/8"; 1"; $
State Surcharge $ p Pressure Reducer $
Penalty . $ Sewer/ Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DUE C t79 J- /7 /Z So
This Ap ,, k , do : co . s Your Buildhtg Permit en A proved Paid 4 Recei r t No. , 1bl/jj��
�f Date ! /j, B WI
Buildi Official --...m... - i
This is to ce ' x th. 1 e request in the above application and accompanying doc ments i in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signe ' , , th , t ity Planner constitutes a temporary Certificate of Zoning c mplian and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued.
Oren . • D . D to Special Conditions, if any
24 hour notice for al inspect ons (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
Date Recd
04 PRIO1'
-
;R y CITY OF PRIOR LAKE PLUMBING PERMIT Z . G - / Z
: . �� iz .- oUS3
M�NNESO�P I. a '"` pig
2. PERMIT NO. /� .y___
Gold A p p / / A
3. Gold Applicant / a
Please type or print and sign at bottom)
ADDRESS - - - --
ZONING (office use)
'5dra
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER (L1 c e (.e4-1 1 '1 ') (Phone)
(Name) + l
(Address)
APPLIC T Y j �
(Name) ' , - c4- .. t` t- � .G',:a �' _ l e f.34' t.A '� (Ph e) JJJ 9c -4 +-t'O- - 5 7 j
/�� 1 - d . � 0 - v - �� .1-c -t `- 3
(Address) �'1 Z-1-�� F'Y'I U ___�.�"1.._._ _ ___..
(Address) (City) (Zip Code)
(Contact Person) .1 'r" J1(i ✓t I (Phone) q cd_ 4 lr 3 --) ?
APPLICANT SIGNAT 1: - _,. .r I '` _ / -.J I DATE _____/AU/I2 -
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity T ype of Fixture
Bath Tub with or without shower _ Rough -ins
_Dishwasher _ _Water Heater
Floor Drain Water Softener _
1 Laundry Tray (1 or 2 compartment sink
--t Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
Q` Sewage Ejector
g J
) Shower Stall - Backflow Assembly
Sinks Backflow Assembly Test
Bar Sink Lawn Sprinkler
j Water Closet (Toilet) Other --
f c 4., p c.. (.3 r>1 ..- :-
s .--* -- . ; -r v� i--t G�' s ,;- .t.- w cal-. - J e .✓
1 ,44 -, Nt-e A-- FEE SCHEDULE (3.s L c.. lam. ,
Industrial, Commercial & Multi- family 1% of job cost with a $49.50 minimum Residential, New One & Two - Family $149.50
Residential, Additions & Alterations $49.50
• — )st $ Building Permit #
The Minnesota Statutes § 3268.148 —
"SURCHARGE- "" has been changed for one PLUMBING PERMIT FEE $
year effective SO
July 1, 2010, until June 30, 2011. STATE SURCHARGE $
The minimum surcharge fora "fixed fee" permit TOTAL PERMIT FEE $` S
is 55, beginning July I, 2010
This Application Becomes Your Building Permit When Approved Paid 0, Rece No. 6 5736 U
Date / B
Date Z . l0 . /1.-- _.___
Building Official —
24 hour notice for all inspections (9.52) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
PRIOR LAKE BUILDING AND IN SPECTION
INSPECTION RECORD
SITE ADDRESS Sz. (Z. k"--L,`
NATURE OF WORK A c.-->tgi.,.41 5
USE OF BUILDING
PERMIT NO. ATE ISSUED ' /1 ) Z
CONTRACTOR t} c� +..� t` (Nc• PHONE* Iz• 2--1
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
G ' 1 1
ITOUNDATIOMMTOTWEratiffitir 1
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
A TER / SEP
FRAMING
INSULATION d,,
ELECTRICAL
PLUMBING (/Svc.[ f / /o /
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
FINALS
.o BUILDING 1.0 (9/ 7.—
[ ELECTRICAL
PLUMBING
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