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Building Permit 14. 0989
AA, UX U 4 k iSp'.p��'�,¢' f 4 F KA:A f{a .Y ,_Ir. .. ;_ _, .ii,_. . _ i _. i. i r.. 7 _I IM _,,,:iiv I It __,YYyV y„ i .fh i_ 7 ii:,,fii,eiii .\��„ rl 1, 11,. f C trfiffrafr III Ox jaattr r CITY OF PRIOR LAKE K- :• prparfittettf of (Aluilliing (:-.1ittsyrrfititt JZ-Final Permitted ❑ Conditional C.O. Expires , ,'� This Certificate issued pursuant to the requirements'of Section 110 of the El Residential 1❑International 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: Use Classification G1 1 Bldg.Permit No. i�/ cite? Occupancy Type Type Construction Zoning District PV�� Legal Description L- Z / 0 f// '`.J Cf`F / P O t\JL) / S M L)L/moi k 3 I¢& W'L s /JL GF Al'Owner of Building Site Address �, Contractor's Name&Address C,,(./L).t)I Ci f9"/ V'..1. 5 , �()'��i &7-64,.--y L ity Planner 4 '-‘i , Building Official Date: ( ,t) 1 1', Dater ;: POST IN CONSPICUOUS PLACE >. 11, '' '' ' ivy N' ' ' " " nl''' i tiia; �� ' X� � / -V ,.<','V.''- rX %4;x '(1 } ‘• ' '/g � � � � 4 � v ,��� � } t 4 c � 4 �X i n O&0000 1 0 a E o 0 0 O ■� ■mm1 O $ 0 �� z ■ ° m o 2 g % % Bk �Pk ¢� co \-0 % r 0 0@ • rn -I 0 § k % .4 -1 § . Z § ro0 S \ 14v�� ° \ % 0z ■■ m m n > 0 _ 7 0 F § 3 El k 0 0 000000 m m ■ � ■ ■ s "0 o \ VI cn § x�% �\k m 0 co u C � zx = z ■ z ■, m 7 2 C G m r- ii §§ % § C % d 0 m ik� o ma § / R m / 1 73 2 0 000000 �_ i zh1n § § \ 7 KmmE© � . v ® . , t, f. (:)\ 41 z 00 hi � mm 53 ii E k § cog -Ir Q 1 'lt% T . 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N_ a o z > cc zo r b� 0 m 1- 'D � ., • 0 O z -n m 0 I" y <m I 000 0 ❑ ❑ 1 v ti _ xi � c1I1nm ^ > z ^ M3m ymm i >< 41 Z m c tti Xrx _, E m ,� > - z m i -t r 6) ƒ 0 0 C) 000000 0 0 > E O ■ -nsm �� § & § SG4 k r \ 0 0 0 s _Iz ■pco z m m mo m° k 0 0 m ■� � §§ - z �� 111 r � � z m §o0Q P Z- f 0 @ • - z ._..1 0 ■ Di 0 - ' 00 Z fa 0m Po 0 § z k 111 -n -o "o m 2 0 0 000000 E Z xi ■ -0 ® * ® - _ CJ c § c c,i .1 co? m � k � ,373za3 m 0 o m ! C) c 0 § -kk �� 0 q / Z > cc z g § 0 K w r 13 -0 P _ '� o 2 = q § 0 $ 0 0 D ❑ OD | 0 E > 22 § § § 2 0 § C -o -o -0 ® \ z . m0o2a § xi � , � E @ - z m Q OPRIPCITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd f: ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE e zo 4- U AND UTILITY CONNECTION PERMIT 4Tt . Pink City White File 2. /-•NEPERMIT NO. pee._ OP8? 3 Yellow Applicant (Please type or print and sign at bottom) ADDRESS ZONINGCC �(office use) 3798 1N14 444 N� J LEGAL DESCRIPTION(office use only) / f� LOT oZ BLOCK /I ADDITION TeF- T5' a , / Ik��[r• PIDZS, `fiA'3'7 . i'210 U OWNER I (Name) (Phone) (Address) I BUILDER (Company Name) C-1-41150,,, a h (..41(41,)-5 /./..c- (Phone) / (Contact Name) 0c e a b 4 // (Phone) 6/L'2 4I(2' (Address) Ze /`e 2!3? Carol L.I i// huh. STbW TYPE OF WORK $.New Construction ❑Deck ❑Porch ORe-Roofing ORe-Siding ['Lower Level Finish 0 Fireplace OAddition ❑Alteration OUtility Connection CODE: ( I.R.C. ❑LB.C. 0 Misc. j Type of Construction: I II HI IV V A B PROJECT COST/VALUE $ L/20 DOO Occupancy Group: ABE F HI MR SU Division: 1 2 3 4 5 (excluding land) I hereby certify that I have furnished i - ation 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 . co s uction 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,t - -t. rmit for .st car Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections. X ECOCag, 5e/W/Y • ignature Contractor's License No, Date Permit Valuation Od OW Park Support Fee # $.------- Permit Fee $ 1 .V 0/R) SAC # sRai eo Plan Check Fee $ Igr Water Meter Size 5/8" $ ,e,U /I. State Surcharge $ 030 00 Pressure Reducer $ /53 00 Penalty $ ---- Sewer/Water Connection Fee # $ /99 ,. ®0 / Plumbing Permit Fee $ ,[1 7 Water Tower Fee # $ `600.040 Mechanical Permit Fee $ !/�5—11,,S � Builder's Deposit $ _ 0®_ C Sewer&Water Permit Fee $ ( -6,sQ Other $ Gas Fireplace Permit Fee $ ‘72/ S-0 TOTAL DUE WW2 a✓'(14,. $ /3/� / Z e This App ' do Q-7tipt,.come.Your Building Permit en A.'roved Paid Z-. Receipt No. �a0av 44. Date . l/ . / By tri— ui ding Utiicial'••••■•••..- 11111:7te This is to certify hat the r quest i the above�application and accompanying docum is is in cm-dance with the City Zoning Ordinance and may proceed as requested. This document when signed b/ e Ci . a�.onsntutes a temporary Certificate of Zon9allows construction to commence_ Before occupancy,a Certificate of Occupancy must be issued. 1 _Plannin '� Special Conditions,if any 24 hour notice for all inspections(952)447-9850,fax(952)447-4245 4646 Dakota Street Prior Lake,MN 55372 Residential Building Permit Checklist New nstruc ion for Single or Two-family Dwellings in R. or R•2 Di ricts Reviewed by: / Y Date: (0 I .. Building Permit# .------°"7"71111.1111, Zoning: Address: . C., v 5 \ � Legal: L , B Subdivision: Existing Structure? YE 0 10 Existing Nonconforming Structure? YES/NO CONFORMS TO ZONING NO ORDINANCE Yard Setbacks: NA/FAILS/COMPLI Standard Proposed. • Front Yard(can be 20'if avg.w/i • 25' 2 __ • Side Yards 10'/ 25'if abutting a street i 5 • Sidewall exceeding 60'requires additional side 2" 10'setback+ setback for every 1'over 60'in length. Not required 2"/1'over 60' if building wall is 10'-0"or greater of being parallel to a side lot line. • Rear Yard 25' S A-_ 3 • Patio Door: provide for minimum 10'deck or sign 10'side/ statement indicating no deck will be built in the future 25'rear • From 100 year flood elevation of wetland/NURP 30' pond. • Refer in-ground pools to the Planning Department • From OHW(Prior or Spring Lake) 75'or setback average of adjacent structures,but no less than 50' I Floor Area Ratio: NA/FAILS/ ►• p'LIES I .30 Maximum I 'C'i 0 I Yard Encroachmentsk J FAILS ►IPLIES Standard I Proposed Eaves and Gutters no a than 2 feet in width and no closer than 5 feet to a lot line(Easements). A/C and other equipment cannot encroach on interior side yards. I Tree Preservation: FAILS/COMPLIES Standard Proposed • Total caliper incfi • Permit 35%Removal • Caliper Inches Removed • Caliper Inches Preserved • Replacement %:1 L:\TEMPLATE\BLDGLIST.DOC 04 PRlp* N� White -Building Canary -Engineering 'hwNtscit' Pink -Planning BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST • NAME OF APPLICANT_ / irjaAL (714kbei)// L--/ . — LGlif .� ' . APPLICATION RECEIVED l/ - The Building, Engineering, and Planning Departments have reviewed the building permit application for consttr_uction activit which is proposed at: • AI 1. . Accepted Accepted With Corrections Denied Reviewed By: /� Date: 7 Comments: See Reverse Side for Additional Information! See Attachments: 1) Grading Plan, 2) Erosion Control Standards "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." c7 Lte White -Building •hw,vaeo�� Canary -Engineering Pink -Planning '' BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST • NAME OF APPLICANT L.OL( ' : ,1' t 1 �/ `�1--- � ` t APPLICATION RECEIVED L Vi - _ f', ( The Building, Engineering, and Planning Departments have reviewed the buildingt permit application for construction activity which is proposed at: -7 7 <al,")1 Accepted Accepted With Corrections Denied / Reviewed By: / ` ----Qte: C Comments: "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." OFRIC% White - Building Canary -Engineering Ms°'it' Pink - Planning BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANTe(kA1641 retA44//'t i/e64--- APPLICATION RECEIVED '• LoA4 The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activit which is proposed at: 3 _/ _.,_! 4. .4./11 . Accepted Accepted With Corrections Denied i to 1 Reviewed By: /0t1i:.; •ate: r C I ' Comments: r. C0 -L. (--Yz-, 2' / ,'ice' Z-c,s----r) -----737-a--- --r-S 4C--- 4t-L- ir014-C-5, "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." SEP-16-2014 05:36 FRIXI:BADGER EXCAVATING 5077445565 TO:9524474245 P. Date Reel ot CITY OF PRIOR LAICE e SEWER AND WATER PERMIT f(/'. / Voikoppe.i.v. f a*. I Fill PERMIT NO, NI. MOW L add APPrumo, „..0., _,,,tE.,9imoeftf boding) ADDRESS ZONING*gripe 31 1-1-4" IA) RLv4 ARA) tat LEGAL DESCRIPTION(cmcg may) LOT.2 MOCK I ADDMON jf '49 Pvhd irs7 P1D - - f) OIVNER (Name) Ct--t-Ct.,cArr Cu,Stll, (Addrs) (Addiess) (CV PG)* • APPLICANT-, &IZ41. 0"e=ber (phone) (Adds) __g3—?5 70111 ire41. CA") C 41,S Cr/40 SZ-.1-•40%, (Addrail) PAY) (Contact Person) Vrierr1/4 (Phone) APPLICANT SIGNATURE_ 11;.00.11, IL" DATE 5 r^ .71 5" APPLICANT PLEASE COMPLETE BELOW . . Size of water service Location of any couplings from structure ----feet. Type of sewer pipe. Ei ABS,, INTINC 0 Cast iron Estimated length of sewer line 3,5 feet Clean out(ifrerittired)located at feet from stracp, FEE SaligintE Ratideatial ScWor nod muter Ertl ccoacedon $.35,50 liniustrial,Coen it Mai-family 1%ofjob cost with a S39.50 minimum &MCI COnneclion oeJy $17i0 Wars tienection only 7,50 Estimated Cost $ Building Permit# SEWER AND WAXER.PERMIT FEE $ STATE SURCHARGE $ .50 TOTAL PERMIT FEE mite Bre oN kato 0 This,Application Becomes Your Building Permit Whin Approved Paid c #.414 • noon BMW Date D614 • 24 hour notice for all inspections(952)4474850,fax(952)447-4245 10/20/2014 09:09 9524926006 GLOWING HEARTH PAGE 01/04 tov TRig CITY OF PRIOR LAKE Date Reed troDlit HEATING/AIR CONDIONING/FIREPLACE PERMIT (0. Zo b• - Irma l r car PERMIT NO. N zie F . 3.Yellow Applicant (Please type or print and sign at bottom) ' • ADDRESS ZON NG(office use) 3rig% 181 ?..ti., , . N LEGAL DESCRIPTION(office use only) LOT `2 -BLOCK i t ADDmON. •TeIcvs inen d / rm 65 3 7/Z?!O OWNER . _ ) (Name) .5._-_:_wascl._. 4 I_ ' MilliMinlti! 'hone Er *"' �-y li APPLIC(NamANT .A . _ eat" !,. ri It it . tit►`_*1 • (Phone)`� ' c_. s (Address) •,) is. el 1 _le # .l r`. ► ik (Contact Person) - . a (Phone) - APPLICANT SIGNATURE _ .41" DATE /0/.3.0,41 • APPLI 441/ PLEASE COMPLETE BELOW NEW CONSTRUCTION C�REPLA�'T 0 ALTERATIONS FUEL FtRN MAKE AND MODEL FLUE IZE RETURN OPENINGS - MUT OUTPUT TYPE OF SYSTEM HEATING OR-POWER PLAINT PLEASE NOTE:Air Conditioner OW=Air Plants 0 Stamm Units and Fireplaces Cannot Encroach 1 Gravity Besot Water into Required Side Yard Setbacks. �; chanical Iladaation Fireplaces with Box Additkata or 8(J�Conditioning. ppoig ther Devi -• Require a_BuiW1ng Permit. • FIREPLA.CE MAKE AND MODEL.. !►y,e;. a i!%s •A' SCfEDJLE $49.50 Commercial&Multi Family 1%of job cost Residential,Gas Fireplace Industrial, $49.50 minimum &AJC Construction) $14950 Residential,Additions&Alterations $4930 Residential,Big (New Construction) $64.50 Residential,AC Only $49.50 Resit Heating ' Cost$ Building Peanit# HEATING PERMIT FEE S a' \ ,N STATE SURCHARGE $ 100 _ \ r TOTAL PERMIT ME $--511`+SQ Cti\ This Application Becomes Your Building Permit When Approved. Paid I • -.' a .o. _ .�-- BUIL 1 ' PE la l,4 `l" . I . Offxd Date 24 hair nodes faraft i, > > Lake,ons( )44T-9 AL At 71a4a►iA 10~1'r ' i Nfinnestita 55372 • 01?R•ro.. Date Rec'd CITY OF PRIOR LAKE PLUMBING PERMIT /0. z o, / 13 PERMIT NO. /4,q8( 4 &Yaw, Applicant (17'eateit moist and dee at bottom) ADDRESS ZONING Wee we ,37.36'Wiids Ridge NW I LEGAL DESCRIPTION(office use only) P �a Tom+ / �[2 �} •. LOT LOCK ADDITION J 5 r • C I �� PID `5- T J `1-7 r OWNER Cuddigan Custom Builders (phone) 952-469-1611 (Address) 22133 Logan Ave.,Lakeville MN 55044 APPLICANT (Name)Alta Htg&Pig,dba Clearwater Pig&Htg (Phone) 952-440-3779 (Address) 19260 Mushtown Road, Prior Lake 55372 (Address) (City) (Zip Code) (Contact Person) Susan Schlink (phone) 952-440-3779 APPLICANT SIGNATURE __ iii C!/f�C),.G:�-�C�G DATE 10/20/14 APPLICANT PLEASE COMPLETE BELOW Quantity Type of Fixture Quantity Type of Fixture 1 Bath Tub with or without shower 4 Rough-ins 1 , Dishwasher 1 Water Heater 2 _Floor Drain Garage Water Softener 5 Lavatory(Bathroom Sink) 1 Stand Pipe(Washing Machine) 1 _Laundry Tray(1 or 2 compartment sink Sewage Ejector 9 Shower Stall Backflow Assembly 1 Sinks Backflow Assembly Test Bar Sink Lawn Sprinkler 3 Water Closet(Toilet) Other FEE SCHEDULE The Minnesota Statuses§3265.1gg' .E cod vrith a$49 50 minimum Residential,New One&Two-Pamily $149.50 "SURCHARGE"has been extended' ' Residential.Add`tions&Alterations $4930 • The minimum surcharge for a "fixed fee"permit is$5.00 • .$ Building Permit N •PLUMBING PERMIT FEB $ LI, 5-® STATE SURCHARGE $ X1 5.00 TOTAL PERMIT FEE $ n S® mince use only) "I This Application Becomes Your Building Permit When Approved Paid Receipt No. Date By i. Milne Official Date 24 hour notice for all inspections(952)4479850.tax(952)447-4245 A646 Dakota Street S.E.,Prior Lake.Minnesota 55372 BUILPA ID WI °i Scanned by CamScanner rleilna scnwartzoauer t.xtbyl till ) 1U/ 14/GU14 1U: 1D:Gu HM g,4puu e Rip CITY OF PRIOR LAKE Date Reed0g i� � HEATING/AIR CONDITIONING/FIREPLACE PERMIT j0, /S /9 • #r °'cF is Pink a y PERMIT NO. /474 ,,9 3.Yellow App5mt (Please type er print and sign at bottom) ADDRESS ZONING(ores.w.) • 3748 WILDS RIDGE NW past/ • LEGAL DESCRIPTION(Mice use only) / . LOT BLOCK,/ ADDITION \Tf�1''5 PCIMCI f -! PID g5- lig 4N- d OWNER (Name) CUDDIGAN CUSTOM HOMES (Phone) (Address) - : APPLICANT • • (Name)AIR MECHANICAL, INC. (Phone) 763-746-3756 • • (Address) 1641.1 ABERDEEN ST NE HAM LAKE 55304 (Address) (City) (Zp Co&) (Contact person) MEL INA S/CHHWARTZBAUER (Phone) 763-746-3756 APPLICANT SIGNA " 1-eJ4 ACK 0 f , DATE 10/14/2014 APPLICANT PLEASE CO 'LETE BELOW .•• JIBW CONSTRUCTION 0 REPLACEMENT 0 ALTERATIONS FURNACE MAKE AND MODEL BRYANT 912 SB4 8 0 8 0 S17 FUEL NATURAL GAS FLUE SIZE RETURN OPENINGS 10 INPUT 8 0,0 0 0 OUTPUT 7 5,0 0 0 • TYPE OF SYSTEM HEATING OR POWER PLANT C]Watm Air Plants Steam PLEASE NOTE: Air Conditioner Units and Fireplaces Cannot Encroach Gravity Hot Water into Required Side Yard Setbacks. itMechanicalConditioning 9 RadiationrigAFireplaces with Boz Additions or OveConditioning ❑Speed DevicesviesCantilevers to the Outside of Buildings Qvatt,System ❑Other Devices Require a Building Permit FIREPLACE MAKE AND MODEL FEE SCHEDULE Industrial.Commercial&Multi-Family 1%of job cost Residential,Gas Fireplace $4930 • $49.50 minimum Residential,Heating&A/C(New Construction) $149.50 Residential,Additions&Alterations 249.50 Residential,Heating Only(New Construction) 864.50 Residential,AC Only $49.50 Estimated cost$ 7,8 0 0 Building Permit # The Minnesota Statutes$32613.148 HEATING PERMIT FEE S 149.50 "SURCHARGE"has been changed fotone year effective STATE SURCHARGE $ 5.0 0,50- July 1,2010.until June 30.2011. TOTAL PERMIT FEE S 154 .5 0" The minimum maim*for a"fixed fee"permit (Oaks use Only) Is,S,S beginning July t.2010 This Application Becomes Your Building Permit When Approved Paid Receipt No. Date By tsasdtas omeai Date . 24 hour notice for all inspections(952)447-9850,fax(952)447-4245 4646 Dakota Street S.E.,Prior Lake,Minnesota 55372 • PRIOR LAKE DEPARTMENT OF BUILDING AND INSPECTION INSPECTION RECORD SITE ADDRESS eih S NATUREOFWOR 4/ .� �/ �t , rp:4"4 ! , • .. ' USE OF BUILDING / f ,i � ,�/ ,f, - 6/ p /" -NJ PERMIT NO. -, DATE ISSUED / ' t� CONTRACTOR /AM''1W f,. ,, i iihz ONE 9S �1 INSTALL EROSION CON ' OL AND M A A N LEAN TREETS AT ALL TI ES INSPECTOR DATE FOOTING P 2/(4// FOUNDATION (Prior To Backfill) Q06 y' t 11 RADON RETARDER "" ,/ PLACE NO CONCRETE UNTIL ABOVE HAS BE N SIGNED ROUGH - INS SEWER/WATER/SEPTIC ® `V z( iy FRAMING • = P 0 /3„/ ' INSULATION `"6 " /Vacs/ ELECTRICAL PLUMBING d/o8/e/ HEATING -$ FIREPLACE W /19/7O/ / GAS LINE AIR TE T j4 7 /211( (1/1 RADON AMINEMMIR ri POg 1 /2 /AG COVER NO WORK UNTIL THE ABOVE HAS BEEN SIGNED HOUSEWRAP 15 ,b(pl►,, LATH ► f` I / FINALS GRADING ( PRIOR TO /ODDING) 5 BUILDING r. c. 7,30 64' { ELECTRICAL PLUMBING (i' l HEATING e4 t 2 2I l 4- 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 Builders Deposit • u ,,, „:,,, re/ \------,o0.7.1,--;". ''''''.':: :`.'' '11.411 ESOlt' City af Prior Lake A$1,500.00 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 afte the date the ettloino permit is issued. if the work is not complete within the 180 day time period,the City shall notify the applicant of Mt violation and the applicant shall have 10 days to comply or the $1,500.00 builders deposit will be forfeited and the applicant will be billed icr clean up or corrective work to rectify the situation. A$500.00 Tree Deposit may also be required and will be refunded if speci'ed trees era preserved for a period of one year. DATE: /2-°1141/ 0 4,4-.1 1 i- 14--, 9 t Ci SITE ADDRESS: 7790 lias g..., ,e/Fit.) PERMIT# REFUND TO BE MAILED TO: auttcl5Actrt as li,"„ Ruc,Icifri CIL-- 2)il,/ tocie,,,, Ave, 4,4144th fle) Atli. c5-DV9 PLEASE ItE BE i AUTHORIZATION TO RELEASE t . /(A— --ta 5co_co i 1. KEEP STREETS CLEAN DURING CONSTRUCTION Lynda S Allen,BuildiritOervices Amount 7,-30-/- Acct.801.20204 2. KEEP EROSION CONTROL IN PLACE 3. TEMPORARY ot s - .NCY 9PERMI ..T NOT EX?iRE OR $500.00 WILL BE FORFEITED SIGNATURE: ..... '; - - 75-905 150 35 =.1 CUDDIGAN CUSTOM BUILDERS,LLC —0 : WILLIAM J..CUDDIGAN • ,, iy DAVID CU ,,,,, DDIGAN • DATE ii i 22133,p_LOGAN AVE ' PAY TO THE ' LKE• r' 'N1Of 1 $: /1 V 2r: 1- t +A. At, - .6" ..., ,..... c n ,n-gl r-cleed% ,,,rovici.P6.01 i,ht 041- DOLLARS Da.... i I r. fPnor0LakeStatellank / , - 359-PRIOR LAKE.MN 55372 - - -i°09111:100551: lin0 3 1 3 6 gu8u J:\FORMS\BUILDERS DEPOSIT FORM.DOC