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Z ~ em 0 00000000 m m 0 0 JJO " ."oo."O>~~ 000 < J: -moo -l ~ -m 0 ~",....~"'(")m zJJ ~ ~,.... m>- 00- 0 "oO"en<z 0 "z ~"'~~5C5~ ~G) ~ )> mZczJJ~m ~ ~ '" >"-l~ (") m i 0 m ,.... o:j JJ Z !!li~ i ~ t ;= ) >- ~ ,.... Z"'" ::0 ~ ...., JJ oC ~ .?:- m ~ ooz a f ~ ~ ~ G) m I\) e ,. W :II ." ~ i' 0 DATE RECEIVED CITY OF PRIOR LAKE BUILDING PERMIT, TEMPORARY CERTIFICATE OF ZONING COMPLIANCE AND UTILITY CONNECTION PERMIT 1. White 2. Pink 3. Yellow File City Applicant Permit No. Cff-3S-S- 1. DATE DIRECTIONS SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom) W I I c:f)" 3. LEGAL DESCRIPTION LOT () (~D) BLOCK , ADDITION 13. TYPE OF CONSTRUCTION BUILDING INFORMATION 11. SIZE OF STRUCTURE (Height) (Width) (Depth) 12. NO. OF STORIES PID dS--.j'o3-0Q0 - 0 5t+m€:- 7. TYPE OF WORK New Construction 0 Chimney 0 Misc. 8. PROPERTY AREA OR ACRES Sq.Ft. 5. ARCHITECT 6. BUILDER 1'(Tel. No.) 'I%'- ()l) (TeI.NO~Xr =>~[{ 14. FLOOR AREA APPORTIONMENT USE (Name) (Address) (Name) (Address) (Tel. No.) 15. NUMBER OF OCCUPANTS OR SEATS OCCUPANTS Fireplac Alterations 0 Septic 0 Addition 0 Deck 0 Finish Attic 0 Re-roofing 0 Porch 0 Re-siding 0 Finish Basement 0 SEATS 16. PROJECT COSTNALUE 10. CULVERT SIZE Yes No 17. COMPLETION DATE 9. PROPERTY DIMENSIONS Width<..5'D Depth I hereby certify that I have fumished 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 tioned 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 icia can revoke this permit for j re, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections. - x SETBACKS: Required Actual USE OF BUILDING BUILDING DEPARTMENT VALUATION Front Back Side Date MATERIAL FILED WITH APPLICATION Side SOIL TESTS 0 ENERGY DATA 0 PILING LOGS 0 PERCOLATION TESTS 0 PLANS & SPECS 0 SETS SURVEY 0 COPIES PLOT PLAN 0 OFF STREET PARKING SPACES REO. SPACES ON PLAN PERMIT VALUATION TYPE OF CONSTRUCTION: I II III IV Occupancy Group A B E F HIM Division 1 2 3 4 Permit Fee ,.................................. $ V R S U City: Amount Brought Forward .................. $ Park Support Fee ........................... $ SAC ......................................... $ Collective Street Fee ....................... $ Sewer Tap .........,......................... $ $ Plan Check Fee ............................. $ State Surcharge ............................. $ Penalty....................................... $ Pressure Reducer .......................... $ Meter Horn ................................... $ Water Meter .....,........................... $ Sewer & Water Connection Fee ........... $ Water Tower Fee ........................... $ Water Tap ................................... $ Builder's Deposit ............................ $ Other ......................................... $ Total Due.............................. $ Plumbing Permit Fee ....................... $ Mechanical Permit Fee ..................... $ Sewer & Water Permit ...................... $ Gas Fireplace Permit ....................... $ This Application Becomes Your Building Permit When Approved. By Date Certificate of Occupancy Issued Paid Receipt No. Date By 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. City Planner Date Special Conditions ~ any 24 hour notice for all inspections 447.4230 PRIOR LAKE INSPECTION RECORD DEPARTMENT OF BUILDING AND INSPECTION' ~~TEU~~D~FE~;RS; IJ. !1{~~1:r-likt; _ USE OF BUILDING PERMIT NO. f/II-Jj-r- t DATE ISSUED f/.lrl?'1 CONTRACTOR )t"'"f~6 I~I\L~ :. NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW THE PERMIT IS BY SEPARATE DOCUMENT INSPECTOR DATE FOOTING FOUNDATION (Prior to Backfill) '111 PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ROUGH - INS n. SEWER I WATER I SEPTIC FRAMING INSULATION ELECTRICAL PLUMBING HEATING (if required) FIREPLACE GAS LINE AIR TEST COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED I WALLBOARD rfi ~/2Vk7 :J FIND S .. GRADING (Prior to Sodding) BUILDING / Jr..._ ' J '1%1'11 ELECTRICAL ./1 PLUMBING HEATING , - DO NOT OCCUpy UNTIL fN80VE 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 additio;1s where no service cabinet is available, card shall be placed near main entrance. Call between 8:00 and 9:00 A,M. for all inspections FOR ALL INSPECTIONS 447-4230 D rn @ rn 0 WI [g r~ ITV OF PRIOR LAKE _II 2 fl... BUILDING PERMIT, 1'!MP~ TIFICATE OF ZONING COMPLIANCE ITY CONNECTION PERMIT jy '3 S c- Permit No. -, - .J 1. White 2. Pink 3. Yellow File City Applicant ~ECTlONS ,PACES NUMBERED 1 THRU 17 MUST BE FIlleD IN BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom) 2. SITE ADDRESS ~l4 WIWS lU~ 3. LEGAL DESCRIPTION 2. trwo ) LOT -=1::::( ()fJt, \ BLOCK 11tf..- W I v() S Iq1~r~ 1'\j;~_pt7I:""'7 ~l {Tel. No.) Nt.- <bH?1"~WOPI I ~;.~~ \ ~), - . 4- I e~? Ii ~c.J Irf~ AVf:; (Tel. NO:) ... ~ -2. ..- (Address) (Tel. No.) ?o '~ ~ !W?ove- Septic 0 Heating Plumbing Reroofing 0 Porch)t Addition 0 Finish Attic 0 Residing 0 Finish Basement rI ~ 1. DATE BUILDING INFORMATION 11. SIZE OF STRUCTURE (Hel~)'2 ~" (Width4 t5 I (Depth) 12. NO. OF STORIES B Me..""'/ A-j...~~i" 13. TYPE OF CONSTRUCTION ~ ~ ;:-p.-p. Me.-- 14. FLOOR AREA APPORTIONMENT USE A NW (OtJ~ ) PID 6lo - 3tJ "5 - 00 <... - 0 1 ADDITION 4. OWNER (Name) !5~b t--JOv 7. TYPE OF WORK New Construction ~ Chimney 0 Misc. 8. PROPERTY AREA OR ACRES Sq. Ft. 1;5' OOt' 9. PROPERTY DIMENSIONS Width So Depth lPtl 10. CULVERT SIZE Yes No 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 construction will conform to all existing slate and local laws and will proceed In accordance with submitted plans. I am aware that the cause. Furthermore, I hereby agree that lI)t city official or a designee may enter upon the property to pelform needed inspections. ~ 000 ~b4~ 7-- .zO-<14-- f'I\ F- j". ~ ~ LIcense No. Date FOR ADMINISTRATIVE USE Front Back Side Side MATERIAL FILED WITH APPUCATlON SOIL TESTS 0 ENERGY DATA PIUNG LOGS 0 PERCOLATION TESTS 0 PlANS & SPECS ~ETS SURVEY 6" COPIES SETBACKS: Required Actual PROPOSED GRADE FOUNDATION IN RELATION TO CURB OR CROWN OF STREET USE OF BUILDING OFF STREET PARKING SPACES REO. SPACES ON PLAN PERMIT VALUATION PLOT PLAN o CIty: Amount Brought Forward .................. $ ~ ;~ 3' . <c cJ Pari< Support Fee ........................... $ Co':'-o .00 SAC ......................................... $ 8 ex::>. f'1f"\ Collective Street Fee ...........,........... $ '& 6"0 I ~ Sewer Tap ................................... $ Ucense Check Fee ......................... $ Occupancy Group A BEl ~ M Division 1 0 4 Permit Fee ................................... $ ~ 77 I So Plan Checking Fee ......................... $ 5 '70. ~8 State Surcharge ............................. $ A 3 . T] a Penalty ....................................... $ Septic System ............................... $ Other ......................................... $ Subtotal............................... $ \ S;; \ .lD D 46.~ Water Meter ................................. $ <1 5' .00 o Sewer & Water Connection Fee ........... $--J oC) .W o Water Tower Fee ........................... $ (p W .~ Meter Horn ................................... $ Pressure Reducer .......................... $ Check if Deferred mes~j!YiIding Permit When Approved. ~ Date e-:s -?tJ Water Tap ................................... $ Other ......................................... $ Other1?)I...\.91~..~L....... $ Issued the above application and accompanying documents Is In accordance with the City Zoning Ordinance and may proceed as ,r nstit es a temporary Certificate of Z~COmpllance and a1IOY1s construction to commence. Before occupancy, a Certificate 0 ~-3-~ snner Date Special Conditions ~ any 24 Hour notice for all inspections 447-42309:00 a.m. . 10:00 a.m. q J/,-c,JSS- GREEN - FILE YELLOW - APPLICANT GOLD - CITY CITY OF PRIOR LAKE SEWER AND WATER PERMIT NO. tj(j-I ~/ APPLICANT: C. oQQ\ N o ~ \. \. \ \,' \ ('L SITE ADDRESS:b\l~ W, :,s. ~ $)<..~C -\ FILL IN THE BLANKS NOTE: Sewer and Water contractors must be registered with the City. Q\ ~\(})~\($G- PHONE: 4l~'~,\ b alJl ~ ~ S~iT1; ~ -d-.,C, cj --" BLDG. PERMIT # c;ij- 35-.3 PID# ';:<5 -- 36 ~ '00 J- -0 SIGNATURE: 1. Estimated length of water service 51J feet. 2. Size of water service \ inch(es) . 3. Location of any couplings from structure feet. 4. Type of sewer pipe. ABS PVC C-/ Cast Iron 5. Estimated length of sewer line \~ feet. 6. Clean out (if required), located at structure. feet from ------------------------------------------------------------------ ------------------------------------------------------------------ ------------------------------------------------------------------ ------------------------------------------------------------------ FEES: $ $ $ 35.00 .50 35.50 Sewer and water line connection permit. Surcharge TOTAL * Fee for either sewer or water individually is $20.00 plus $ .50 surcharge. * Sewer and water permits issued for new construction must be recorded on the building permit card at the time of issuance to insure that no duplicate sewer and water permits are issued. DATE PAID 1-d-, --- ? Y RECEIPT # c;Jl.j 0r:J....!)- --0 AMOUNT PAID c3,t): S ____ REC'D BY q 1J1S!:,. 4629 Dakota St. S.E., Prior Lake, Minnesota 55372 / Ph. (612) 447-4230 / Fax (612) 447-4245 AN EQUAL OPPORTUNITY EMPLDYER