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CITY OF PRIOR LAKE
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Final Permitted ❑ Conditional C.O. Expires
This Certificate issued pursuant to the requirements of Section 110 of the ❑Residential l❑International
K Building Code certifying that at the time of issuance this structure was in compliance with the various
ordinances of the City of Prior Lake regulating building construction or use. For the following:
�i �t' u u,� t I�( Cr A Bldg.PermitN
Use Classification 4o.)
Occupancy Type V - Type Construction Zoning District
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Legal Description b ?('O / Llt I/.)Q 1 r 1 a tilt,� I f I1} {- �j
Site Address )(,,:2 I) )0 l 't
Owner of Building y
Contractor's Name&Address
K �C\ Ht)1(. (o G City Planner
Building Official
Date: i/ 0 (Li Date:
POST IN CONSPICUOUS PLACE
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FK/614
CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE 4:_. z7 is-
AND UTILITY CONNECTION PERMIT
Ar E 5 0��
See FJ'
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2.
1. whitePnk PileCity PERMIT NO.
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3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
2622 Waterfall Way NW Prior Lake. MN 55372 e3
LEGAL DESCRIPTION(office use only)
LOT 36 BLOCK 4 ADDITION Wensmann 4th PID 254181120
OWNER
(Name) Centra Homes (Phone) 763-772-1000
(Address) 11460 Robinson Dr NW Minneapolis, MN 55433
BUILDER Centra Homes 763-772-1000
(Company Name) (Phone)
(Contact Name) Jon Solomonson (Phone) 612-242-5046
(Address) 11460 Robinson Dr NW Minneapolis, MN 55433
TYPE OF WORK El New Construction ['Deck ['Porch ❑Re-Roofing ❑Re-Siding ['Lower Level Finish ❑Fireplace
['Addition ❑Alteration ❑Utility Connection
CODE: ❑I.R.C. ❑LB.C• ❑Misc:
Type of Construction: I II III IV V A B
Occupancy Group: A B E F H I MR SU PROJECT COST/VALUE $ 146,496.72
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 prop- and that all cons on 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 revo -t,., it for just K.
rthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
Signature Contractor's License No. Date
Permit Valuation ! Z/ , Park Support Fee # $
Permit Fee t
I 342, S $
SAC #
465-.60
Plan Check Fee $ e J_ tie e t Water Meter Siz 5/8'; 1"; $ � 3O 0
State Surcharge tP �` g
g $ /73, 00 Pressure Reducer $ /50 00
Penalty $ Sewer/Water Connection Fee # $ / L/}0 . 00
Plumbing Permit Fee $ /5¢ 5-0. � Water Tower Fee (000. 00
Mechanical Permit Fee $ /6--1_,
5l Builder's Deposit l ,p $ �DO. 00
Sewer&Water Permit Fee $ ��.50 Jv Other /1 --)/v ink 1 e f $ 4534S-0
Gas Fireplace Permit Fee $ 5-4. , TOTAL DUE
This Appy• Become§Your Building Permit en:.pproved Paid Re i No. `fq/
A
/ Date� i e r` - rC 6 ( 4S-' By
111
`lding111R111.11 --- Da e
This is to certify t th eque tin the above application and accompanying docum: is is in ccordance with the City Zoning Ordinance and may proceed as requested. This document
when signed byit'- i •Ian. r constitutes a temporary Certificate of Zoning co .liance d allows construction to commence. Before occupancy,a Certificate of Occupancy must be
issued.
Planning Director 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,Minnesota 55372
4 PR/Oh CITY OF PRIOR LAKE •
r Date Reed
° t~ HEATING/AIR CONDITIONING/FIREPLACE PERMIT 1� ,i U,vj z •,;
.� . aj
V . M
4stMVESds� 1 Prnk File
Green ca, PERMIT NO. ��- �-z-6---------
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
LEGAL DESCRIPTION(office use only)
-k 1
LOT \BLOCK ADDITION PID
OWNER
(Name) (Phone)
(Address)
APPLICANT/1 -�
(Name) -i-e9J,r'c_ . 6/ C:,7,,i----- (Phone)
•=R f / 1, &./(7.1/(.2.7P//1/1(''
(Address) e' /'9 i -
) i ' I G' `" '�- j
,,,-r — , (Addrt�ss) / (City) (Zip Code)
(Contact Person) ,.,1 f,:i r 1l /Ui= (fti1 /C' fi � f
(Phone) s:',-)
APPLICANT SIGNATURE �' #� ( .��Ay(. c kk, DATE 6- 2< 1 .
APPLICANT PLEASE COMPLETE BELOW
OftsIEW CONSTRUCTION 0 REPLACEMENT
I ❑ALTERATIONS
FURNACE MAKE AND MODEL v f. y ' (i ' ` � ��' Ci �
tX � `� )` �-� � �5 ) )� FUEL //
�I" r� tiAfft/0 1
FLUE SIZE ����� RETURN OPENINGS INPUT 4��� '���' l.7 ( �
f OUTPUT �.
TYPE OF SYSTEM HEATING OR POWER PLANT
['Warm Air Plants ❑Steam PLEASE NOTE: Air Conditioner
LiWar tyUnits and Fireplaces Cannot Encroach
0 Hot Water
►.Mechanical into Required Side Yard Setbacks.
❑Radiation
it Conditioning Q Special Devices Fireplaces with Box Additions or
R. eat.System 0 Other Devices Cantilevers to the Outside of Buildings
Require a Building Permit.
FIREPLACE MAKE AND MODEL
FEE SCHEDULE
Industrial,Commercial&Multi-Family 1%of job cost Residential,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) $64.50Residential,AC Only $49.50
'-'--•-'Cost$ t tib ;\y Building Permit #
The Minnesota Statutes§326B.148
"SURCHARGE"has been changed for one HEATING PERMIT FEE $
year effective STATE SURCHARGE $ .50 6i`stt, Al
July 1,2010,until June 30,"fixed
fe 1. TOTAL PERMIT FEE
he minimum surcharge fora"fixed fee"permit $ ,
is ss beginning July I,20104i
This Application Becomes Your Building Permit When Approved Paid Receipto. Pi
Building Official Date Date By ,0,
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
A4A4 rs.h.so 04....,.e e le n.S.._i_a__ •R!_.._-..4.- er.s7A
' Ui , n
04 r 81-64 Date Rec'd
. eN CITY OF PRIOR LAKE PLUMBING PERMIT i'
v g ,U
`t'livnaso't`
1.>3,d F,Qe PERMI HiQ:.,/
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS
ZONING ogrwc
1 c
\j\-1 ,-\,,A,
i
LEGAL DESCRIPTION(office use only)
iBLOC �
LOt)R \ ADDITION Pm
OWNER
(Name) _ (Phone)
(Address)
APPLICANT ,j
(Name) (t' °.v ry .' cZ-y-=-- (Phone)
(Address) is !-' 1 c. / (__ t f`,/..: / /- U' ,-') S_`)„j '
(Address) (City) (Zip Code)
(Contact Person) _,,L4/1-77.,� t , v f ' G;'; .h.... (Phone) J� 1_�/ 1 -
APPLICANT SIGNATURE •'_" : _'2,., b v4' (1" DATE + C
7
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher \ Water Heater
---- Floor Drain — Water Softener a
Lavatory(Bathroom Sink) --• Stand Pipe(Washing Machine)
Laundry Tray(1 or 2 compartment sink Sewage Ejector
I Shower Stall w . Backflow Assembly .
Sinks _ T Backflow Assembly Test
Bar Sink Lawn Sprinkler
Water Closet(Toilet) _ Other
FEE SCHEDULE
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
The Minnesota Statutes§3268.148 �'j''\/-,i`^.j Building Permit#
st $ ~t,
"SURCHARGE"has been changed for one
year effective PLUMBING PERMIT FEE $
July 1,2010,until June 30,2011. STATE SURCHARGE $ .50
The minimum surcharge fora"fixed fee"permit
is SI beginning July 1,2010 e TOTAL PERMIT FEE $
This Application Becomes Your Building Permit When Approved Paid Receipt No.s`
Date By �� ""'!
Building Official Date
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372
r� L P n
f•-, ,,,.. ,,,)
(x ; _ ,NE
yrn
•• a '4
1, Grcen Fite {,E is,MIT Nab—.. D
z, venoW caY !r tl:rn�le+ll A 1 y`1V S
3. cow Applicant
(Please type or print and sign at bottom)
ADDRESS f ZONING(office use)
Gf'
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
O E 6ame)
(N �% (Phone) /4di '° / "/e1k(Address) // o, a, yy ,,v,A,, IN > ( 4) t. ..1441:?
Address (City) (Zip Code)
APPLICANT p �-3 1r .r
(Name) .,,.* **1 ,� <0_,V. i/ 't.44 01 • (Phone) ` 4: `:49A—o.J�
(Address) kgz,1 I ,/j e,.aa ) a! /e,,,,y, ie+o.
(Addres CI' (City) (zip code) ,
(Contact Person) i►_J1t al _ - (Phone) óJ1°?" 7"Ad 79
APPLICANT SIGNATURE DATE
APPLICANT PLEASE COMPLETE BELOW
Size of water service inches.
Location of any couplings from stricture ,/%A feet.
Type of sewer pipe. ❑ ABC KIPVC ❑ Cast Iron
Estimated length of sewer line 42 feet.
Clean out(if required)located at /40 feet from structure.
FEE SCHEIiULE
Residential sewer and water line connection $51.50 Industrial,Com'l&Multi-family 1%of job cost with a$51.50 minimum
Sewer connection only $25.50 Water connection only $25.50
Estimated Cost $ Building Permit#
SEWER AND WATER PERMIT FEE $ 7�
STATE SURCHARGE $ I .50 (�, r
LA2.44:44.04.4
TOTAL PERMIT FEE $
(3/4/771-4±'
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid Receipt No.
Date
Solidity Official Date a ,0 „114y0 191
7�jr
24 hour notice for all inspections(952)447-9850,fax(952)447-4245 ( I,�
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372 ....,AlitvT.
CONTRACTORS MATERIAL &TEST CERTIFICATE FOR ABOVEGROUND PIPING
PROCEDURE:
Upon completion or work,inspection and tests shall be made by the contractor's representative and witnessed by an owner's representative. All defects shall
be left in service before contractor's personnel finally leave the job.
A certificate shall be filled out and signed by both representatives. Copies shall be prepared for approving authorities,owners,and contractor. It is understood
the owner's representative's signature in no way prejudices any claim for faulty material,poor workmanship,or failure to comply with approving authority's
requirements or local ordinances.
PROPERTY NAME: Approach at the Wilds DATE: 9/23/2015
PROPERTY ADDRESS: 26Waterfall Way
ACCEPTED BY APPROVING AUTHORITIES(NAMES)
City of Prior Lake
PLANS ADDRESS:
INSTALLATION CONFORMS TO ACCEPTED PLANS • YES ❑ NO
EQUIPMENT USED IS APPROVED El YES ❑ NO
IF NO,EXPLAIN DEVIATIONS
HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS TO LOCATION
OF CONTROL VALVES AND CARE AND MAINTENANCE OF THIS NEW EQUIPMENT El YES ❑ NO
IF NO,EXPLAIN
INSTRUCTIONS
HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES: • YES ❑ NO
1.SYSTEM COMPONENTS INSTRUCTIONS • YES ❑ NO
2.CARE AND MAINTENANCE INSTRUCTIONS El YES ❑ NO
3.NFPA 25 • YES D NO
LOCATION OF SUPPLIES BUILDINGS
SYSTEM ENTIRE BUILDING
DESCRIPTION MODEL YEAR ORIFICE SIZE TEMPERATURE QUANTITY
Reliable Residential F1 49 2015 1/2" 155° 16
Reliable Residental F1 44 2015 1/2" 155° 32
Reliable Dry 18" F3QR 2015 1/2" 155° 1
SPRINKLERS
CPVC w/CPVC Slip Fittings3
PIPE&FITTINGS
ALARM DEVICE MAXIMUM TIME TO OPERATE THROUGH TEST
ALARM VALVE CONNECTION
OR FLOW TYPE MAKE MODEL MINUTES SECONDS
INDICATOR Vane Potter VFS-R
DRY VALVE Q.O.D.
MAKE MODEL SERIAL NO. MAKE MODEL SERIAL NO.
TIME TO TRIP* WATER AIR TRIP POINT TIME WATER REACHED ALARM OPERATED
THROUGH TEST CONNECTION PRESSURE PRESSURE AIR PRESSURE TEST OUTLET" PROPERLY
MINUTES SECONDS PSI PSI PSI MINUTES SECONDS YES NO
DRY PIPE WITHOUT
OPERATING Q.O.D.
TEST WITH
Q.O.D.
IF NO,EXPLAIN
*MEASURED FROM THE TIME THE INSPECTOR'S TEST CONNECTION IS OPENED.
OPERATION
I::1 PNEUMATIC 1:::1 ELECTRIC I=1 HYDRAULIC
_
. Builders Deposit
` ' .� City of Prior Lake
F t ,
A$2,500.00 Builders Deposit is included in the Building Permit fee. The Builders Deposit is issued as security to
insure compliance for a Final Occupancy Permit. (It is not an escrow account:) All exterior items including but
not limited to grading, sodding, landscaping,tree planting , driveways, siding and painting shall be completed 180
days after the date the building permit is issued. If the work is not complete within the 180 day time period, the
City shall notify the applicant of the violation and the applicant shall have 10 days to comply or the $2,500.00
builders deposit will be forfeited and the applicant will be billed for clean up or corrective work to rectify.the
situation.
A $500.00 Tree Deposit may also be required and will be refunded if specified trees are preserved fora period of
one year. By signing this I, the undersigned contractor, acknowledge that I am aware of the erosion control
requirements of the City of Prior Lake as outlined in the Erosion Control Measures for Building Contractors
handout.
DATE: 4-26-2015 SITE ADDRESS: 2616, 2618, 2620, 2622 Waterfall Way NW PERMIT - r
REFUND TO BE MAILED TO: Centra Homes ir'5—G'-2,
11460 Robinson Dr NW
Minneapolis, MN 55433
PLEASE REMEMBER
1. KEEP STREETS CLEAN DURING CONSTRUCTION
2. KEEP EROSION CONTROL IN PLACE
3. TEMPORARY OCCUPANCY PERMIT MU NOT EXPIRE OR$500.00 WILL BE FORFEITED
SIGNATURE. / AUTHORIZATION TO RELEASE
21500. 0 V
LyndaS. en,Buildin Services Amount/0_ Gr _/5- Acct.801.20204
0__
nRfP
..�,,-�, FOR SECURITY PURPOSES THE FACE OF THIS DOCUMENT CONTAINS A COLORED BACKGROUND AND MICROPRINTING IN THE BORDER
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DEPARTMENT OF
1
RIOR LAKE BUILDI A SJ E
11 1
sie
I N S P E CTI 0 N RECORD
SITE ADDRESS ZZ � A�h
NATURE OF WORK
USE OF BUILDING , z
' ' `> 4'/ DCS LCA
PERMIT NO. " ,Y� T D A J' ISSUED
CONTRACTOR IOW ! ,- - PHONE ?73 77:72 /, te,e?
INSTALL EROSION CONRTOL AND MAINTAIN CLEAN STREETS AT ALL TIMES
INSPECTOR DATE
FOOTING
FOUNDATION (Prior To Backfill)
RADON RETARDER
P.
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
FAee-fyi;nklbia__ ROUGH - INS
SEWETER/SEPTIC
FRAMING rY; 8 6—
INSULATION 4cj
ELECTRICAL
PLUMBING (,vc, d 81137/16
HEATING
FIREPLACE
GAS LINE AIR TEST .
RADON MM. 4,464
COVER NO VVORTIL THE ABOVE HAS BEEN SIGNED
I HOUSEWRAP LATH I I I
FINALS
GRADING ( PRIOR TO SODDING)
BUILDING - �,3 it l ki 01
ELECTRICAL I l
PLUMBINGc./tib/
HEATING 122,h7
DO NOT OCCUPY UNTIL ABOVE HAS BEEN SID
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