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of PR/0 CITY OF PRIOR LAKE BUILDING PERMIT, Date Recd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE 2
v
PC
AND UTILITY CONNECTION PERMIT r� . ,�
;�HNBS��� I. White File PERMIT NO. /
3 pelf Cpl /4L3 Yellnw Applicant I
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
167/ 7 AkIII 644 ,ijf, i rasp
LEGAL DESCRIPTION(office use only)
LOT 7 BLOCK ADDITION e -rf P 4 / S
[ �6Alin PID Z5, 4-37 /S?j. U
OWNER
(Name) (Phone)
(Address)
BUILDER J r
(Company Name) C"..)
cftd—Oevt g4let /IC- (Phone)
(Contact Name) � � �/,,,�,a�t G4"1 /
7 /' � /� /�,� �(Pyh�—one) �1 Z'3L�' !8�
(Address) 7 C.�S et,� t (j't��Ji l , 5 )
TYPE OF WORK 0 New Construction ❑Deck ❑Porch ❑Re-Roofing ORe-Siding Lower Level Finish 0 Fireplace
❑Addition DAlteration 0 Utility Connection
CODE: DLR.C. DI.B.C. 0 Misc.
Type of Construction: I II III IV V A B PROJECT COST/VALUE $ /4:4 16)
Occupancy Group: ABE F HI MR SU (excluding land) /
Division: 1 2 3 4 5
I hereby certify that I have furnished in ,.tion 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. struction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official c s permit for) ise. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed ins echoX Signature 0®l��'9 /9
gn Contractor'sLicense No. ate
Permit Valuation 'Z/ 6 O G . L 0 Park Support Fee # $
Permit Fee $ 6 Z 2-5- SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ /_ Ci ci Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ -5I./.5-0 Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer&Water Permit Fee $ Other $
Gas Fireplace Permit Fee I $ TOTAL DUE4m 6.19 3 / - 4 $ //7 7,5—
...--
This
c;This Application Becomes Your Building Permit When Approved Paid /1 Li(' Re tpt No. 14)72.5
Date j . 7-2_ / B ,.
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 may proceed as requested. 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.
Planning Director Date Special Conditions,if any
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street Prior Lake,MN 55372
o� rnto?
64,,,,
,A HEATING/AIR CONDITIONING/FIRCITYOFPRIORLAEKEPLACE PERMIT Date Reed
t.Piek +1� PERMIT NO I ���
anNcs�t' z.crn�, city
3.Yellow Appficam
(Please type or print and sign at bottom) ZONING(office use)
ADDRESS
3617 Wilds Ridge NW
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION MD
OWNER (Phone)
(Name) Dallas Holm
Address 3617 Wilds Ride NW
APPLICANT (Phone) 952-440-3779
(Name) Clearwater PI & Ht
(Address) 19260 Mushtown Road Prior Lake MN 55372 (Phone) 952-440-3779
(Contact Person) Susan Schlink i / la A DATE 4 9/14
APPLICANT SIGNATURE -�`
APPLICANT PLEASE COMPLETE BELOW
REPLACEMENT QALTj;RATtONS
ONEW CONSTRUCTION � FUEL
FURNACE MAKE AND MODEL INPUT________9_U__ _r_----
FLUE SIZE RETURN OPENINGS
OI SYSTEM HEATING OR POWER PLANT PLEASE
is l Fireplaces s Cannot on Encroach
TYPE 0Steam
❑Gia vi Air Plants ❑Hot Water into Required Side Yard Setbacks.
❑Gravity. ❑Radiation Fireplaces with tiox Additions or
❑McchantCal [ISpcctal Devices Cantilevers to the Outside of Buildings
°Air Conditioning 0 Other Devices„--__ Require a Building Permit.
[�Vcnt.System I stall 2 s 1 r' •, : - t i
FIREPLACE MAKE AND MODEL Residential,AC Only
FEE SCHEDULEbasement finish
Industrial,Comineroiat&Multi Family $49.50
I%of job cost Residential,Gas Fireplace
$49.50 minimum Residential,Additions&Alterations $49.50
Residential,Heating&AIC(New Constntction) $149.50 4PerrnitN
Cost$ Building
Residential,Heating Only(Mery Construction) �^^
HEATING PERMIT FEE S �
S_�
STATE SURCHARGES
TOTAL PERMIT FEE
Application Becomes Your Building Permit When Approved
Paid Receipt No.
This pP Date P 1 a
Date ��� ii���ll�
Buitdiug plhcial 44'1-985t
24 hotota Street SE.Prior inspections 55372 j
4646 Dalt
PRILA
DEPARTMENT OF
R
E BUILDING AND INSPECTION
INSPECTION
RECORD
SITE ADDRESS 11 1 DS Ito 4.
NATURE OF WORK ry• air
USE OF BUILDING '
PERMIT NO. DA E ISSUED
CONTRACTOR CU 1 I ,t/J PHONE GI2 , 3284' p
NOTE: THIS IS NOT A PERM FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
111.111111
I \\ I I
1110.0.111111.111.0
PLACE NO CONCRETE UNTIL ABOVE
HAS BEEN SIGNED
ROUGH - INS
FRAMING
INSULATION 4,
ELECTRICAL
PLUMBING
HEATING (if required)
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
FINALS
BUILDING 7 c4(
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 (9521447-9850