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Microsoft W - CITY OF PRIOR LAKE BUILDING PERMIT.doc... http://www.cityofpriorlake.com/pdf/bIdg_pennit.pdf
r - CITY OF PRIOR LAKE BUILD G PERMIT, Date Rec' d
r\ � 9 TEMPORARY CERTIFICATE OF ZONING COMPLIANCE 3_ /q e
\i r"' AND UTILITY CONNECTION PERMIT
a lrN :r
1 L1'hite bile
,_ r� cm _ PERMIT NO. /3 _ Z-/ (o
i. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
/ v I Ld Ve k )
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNE f t _ ?
(N ame } �/ O N ta 1 e a McC�' 11'1 m`{' (Phone) f" ?5� - J07/z--
(Address) 1 L I - 1 ■3 W it CLS V I
BUILDER I /
(Company Name) J K� ,/ LL � � (Phone) (Q ( 27730-3 2-9
1
(Contact Name) � L � was (Phone)
(Address) 3 (s 1a I .LS Pl, otw__ N v)) Q r A p r LC .`-C. , flAj s ac n 2.—
r
TYPE OF WORK ❑ New Construction ['Deck ['Porch ❑Re- Roofing ❑Re- Siding gower Level Finish ❑ Fireplace
['Addition ❑AIteration ❑Utility Connection ¢ -e)iS
CODE: DL.R.C. DL.B.C. ❑ Misc:
Type of Construction: I II III IV V A B
Occupancy Group: A B E F HI MR S U PROJECT COST /VALUE $ 620, CO 0
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have futuuhed information on this application which u to the best of my knowledge true and correct. I also certify that I am the owner or authonzed agent for the
above - mentioned property and tha co 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 f i au . ennore, I hereby agree that the city official or a des may enter upon the property to perform needed inspec
X BG ( 0 4 2 1S5 3f ‘//3
Signature Contractor's License No. ate
Permit Valuation !j pQ (0 - Park Support Fee # $
Permit Fee $ / C 7.2,5 SAC # $
Plan Check Fee $ „— Water Meter Size 5/8 "; 1 "; $
State Surcharge $ 2-6 6 Pressure Reducer $
Penalty $ Sewer /Water Connection Fee # $
Plumbing Permit Fee $ 5 CD Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ _ .- TOTAL DUE $ / 43
hh
—.- ✓
this Application Becomes Your Building Permit When Approved Paid /7 b .f 1 `i Rec t No. Cy $4p e
Date 3„ / q, 7(3 By
Building Official Date
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and ivay proceed as irquested. This document
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued
Platmme Duector Date Special Conditions. if any
24 hour notice for all inspections (952) 447-9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Mia.esota 55372
4 PRJ Date Recd
,, - .. ^ ti, � CITY OF PRIOR LAKE PLUMBING PERMIT
73 ,�
A /1,0 /3. ZI (o
1. al"` File
2. Gold City PERMIT NO.
Cil
3. Yellow Applicant _
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
I G3 ■)L 0 oa k)
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) (Phone) '
(Address)
ALI � 1 �� � _ --/(4i- IS
R PPANT Phone) Q `,� / _..._
(Address) If 1 a . . 1 1 ?)(Jfk I 55 33
(Address) (City) (Zip � C " od .)
(Contact Person) .r (tX ( l y l)es ( V �1' - 6t Phone) -C SD ) / ? I ,S 5V
APPLICANT SIGNATURE L t- a DATE 1/41// /1
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough -ins I ,,f/
Dishwasher _ Water Heater a
„ili,,t
_ Floor Drain Water Softener , r
Lavatory (Bathroom Sink) Stand Pi ae ashin: Machine r
Laundry Tray (1 or 2 compartment sink Sewage Ejector 1
Shower Stall ______ Backflow Assembly
Sinks _ Backflow Assembly Test •
1 I Bar Sink Lawn Sprinkler
Water Closet (Toilet) Other
FEE SCHEDULE
Industrial, Commercial & Multi -family l% of job cost with a $49.50 minimum Residential, New One & Two - Family $149.50
C Residential, Additions & Alterations $49.50
The Minnesota Statutes § 326i3.148 .Est $ J� �O Building Permit #
"SURCHARGE" has been changed for one ��i ��
year effective PLUMBING PERMIT FEE $
July I, 2010, until June 30, 2011. STATE SURCHARGE $ 5'•d 0 3
The minimum surcharge fora "fixed fee" permit TOTAL PERMIT FEE $ ` j q .'j O
is , beginning Judy 1, 2010
This Application Becomes Your Building Permit When Approved Paid 1'�/ /
Receipt No. / Kb
BnildinaOfficial Date Date W9 By
/� /
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
PRIOR LA K E DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION RECORD
SITE ADDRESS /41 2.3 W/(iia$ Wert
NATURE OF WORK 40W
USE OF BUILDIN _ - A,
PERMIT NO. la 7 1 BATE ISSUED
CONTRACTOR 11.' CO PHONE
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
0111110.11
l 111111011111110111111.1111.11110
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING
INSULATION
ELECTRICAL
PLUMBING
HEATING (if required)
MEM
MININIMMEIN
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I I �
FINALS
BUILDING C)/ , /o T
ELECTRICAL
/
LECTRICAL
PLUMBING
HEATING
312-6 3
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