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CITY OF PRIOR LAKE
~rparfntrnf of ~uil~ing Jl nsprrfion
[J Final Permitted
D Conditional C.O. Expires
This Certificate issued pursuant to the requirements of Section IIO of the D Residential / D 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 ,~ ;.:::. A Bldg. Permit No.00.... 5';,) 3
n ~ // J. / . .../;.) / / C /'
Occupancy Type 1-<., '--' Type <;;onstruction Y !..V ZonuW Dlstncf !.---L..... ..-' U
Legal Description I}(~~I I>L / /: J~.~(~4.-0 />JJ;d / Sf'
t. Site~ddress /1-1) J/7 1'('//1):' VAJ2...uJ Lrv
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Contractor's ~e & Address {l/PrL.:]/niet..,,, y.- r". (-';10~""'-<:l
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I l../ r "L I I' ./lA/LC>/'.^/Y', City Planner -r"'" I.' ~ ./'c. 'i" 'I J
,Building Official
Owner of Building
Date:
Date:
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8
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
5....;)~-O'"
ii"""; "~\V1.. It -if ;1" -1"
,"' '-;,' ~ i't"""i 11 Vhitc File
" ,'i e, .e ,t. ,a, !1'i~ " '!.' P'mk C"y
"'"-'.' ;#' ~ ..-. __-,".. ...t JtJl. ...w- J._ ~
B b _i . 3 Yellow Applicant
("" err ......, cvt
(Please
ADDRESS
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LEGAL DESCRIPTION (office use only)
I PERMIT NO. () b -- L) d- ~
~
ZONING (office use)
PUSD
LOT ~O BLOCK I
ADDITION :Sf!
;. 4-.- 0'-"
PID d.S~ I( ~")- 0 ~ '.
OWNER
(Name)
g~; \Jer
(Address)
(Phone)
BUILDER
(Company Name) Vvot-'S AA",I"\" I-l e,......t'~
(Contact Name) jJ..^^;' oS fl.. S.d,J't. ;,l{,.......
(Address) R.... S
(Phone) (.,S-1-4 D6..i.{'{o 0
(Phone) b I) - :3 (, '\ - ") q ~ L(
SSI ~
TYPE OF WORK Ii! New Construction Da'Deck OPorch ORe.Roofmg ORe.Siding !XI Lower Level FinIsh 2 Fireplace
DAddition o Alteration DUtility ConnectIOn
CODE: D{jI.R.C. DI.B.c.
Type of Construction:
Occupancy Group: A B
Division:
I
E
II
F
1
III IV
H 1
2 3
V
M
4
A
R
5
PROJECT COST /V ALUE
(excluding land)
o Mise.
B
S U
$ ,3q CC'b. 00
I hereby certify that I have fllrnished mformatlon on this application which IS to the best of my knowledge true and correct. I also certify thai I am the owner or authorized agent for the
above.mentlOned property and thaI' all construction Will conform to all eXlstmg statc and local laws and will proceed in accordance wilh submrtted plans I am aware thai the buildmg
:''''" ~=nm;Z:' '~:a..::t:' ,"",", 'u" '"" .of no """ill '; ~';; ill" eW' Of"" ,", ''''fer" m "','c= "";_m~~~'b
Signature Contractor's License No, Date
Permit Valuation
Permit Fee
Plan Check Fee
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
Sewer & Water Permit Fee
Gas Fireplace Permit Fee
This Application Becomes Your Building Permit When Approved
~~
Buildl11g Uflicial
(o/11/0{,
I Date
Park Support Fee # $ ----
SAC # $ 155'0. --
Water Meter Size 5/8"; I"; $ ~
Pressure Reducer $ -
Sewer/Water Connection Fec # $ 10-~'-"
Water Tower Fee # $ I C) 00 . --'
Builder's Deposit $ ~a:~
.
Other $
TOTAL DUE $ h69d ~/ ~
Paid
Date
/
Ii r~J;:f,
t.X,
irrtNo
J,-IJ- ij J
r
ThiS IS to certify that lhe requcst rn the above application and accompanyrng documents is m accordance wrth the City Zonmg Ordinance and may proceed as requcsted, TIllS document
when signed by the Crty Planner constrtutes a temporary Certificate of Zonrng compliance and allows construction t~mmence: Betlf.'e occupancy, a Certificate of Occupancy must be
'~ ~;PLJ ~/I<{(O" ~ee tVlain }R]le
Planning Director I Date Special Conditions. if any --
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
08/04/2006 FRI 7:48 FAX 952 767 1900 GENZ-RYAN
I4J 033/033
CITY OF PRIOR LAKE
IlEA TING/AIR CONDITIONINGfFIREPLACE PERMIT
Date Rec\d
~.~.::.^ ~I~: fJ>ERMITNO. '- 6( 7.
~ YcH()w API"UC.Wlt fI..... t;jJ ~
\ ZONING (ofrie.
use)
1~) O\/tk V Ie lA) l. jf)
\ LEGAL DESCRIPTION (ofJice use oniy)
,. LOT BLOCK ADDITION
PID
fN:~~~- U.tr"S(Y\CJJ~\n
(Address) \ gqs' P( (JZO I)( # 2{J)
APPLICANT G ')
(NameL 1-CV'(t.- r~~LJ{1J\.
(Address)t?")CO UJ ' rJ(UJl/l I'~J ij ilynsvi lie .___~=f5.}~'n
t/' (Address) (City) (Zip Code)
(Con",' P,",on) r,/(1~ . .' \ .' +;hone) - CV5'd,- -__J(t?l J I OlD --
APPLlCANTSIGNATURE. ~ r\-. ~ DATE -X/-3-LoJ~- .
APPLlCANTP n ..E'COMPLETEBELOW
\!&t.JEW CONSTRUCTION ' ,tJ REPLACEMENT 0 ALTERATJONS ~
FURNACE MAKE AND MODEL lCnnux. (P-10Dfl- 3I;IY~XiO~_- FUEL nC(J~~ll('. 11
FLUE SIZE ._____ RETURN OPENINGS _ ,-~ .._ INPUT .)SJi( lAJ OUTPUT 7QSjLU_
TYPE OF SYSTEM HEATING OR rmVER PLANT
~Warm Air Plants 0 Steam PLEASE NOTE: .
i' ral'it)' 0 Hot Watcr AIr Conditioner Ulllts I
'. Mechanical 0 Radiation _____. Cannot Encroach into
>oil' Conditioning 0 Special Devices ---- Side Yard
.. _ ent. System 0 Other Dcvice, .__ Setbacks
(Phone) qr)()}':'7 (IF? ~ 1000
,~ Lo' 6i-QaS-3701i\
(Phone)'1
MN '35/2J-d \
I
\
~g[lf\
~
FIREPLACE MAKE AND MODEL
.~-=. -_.~~_.:.
Re,idential. Heating & AIC (New Construction)
Residential, Heating Only (New Construction)
FEE 3CBEDULE
1 % cf job co,t Residenlial, Gas Fireplace
$39.50 nlir.imum
$99.50 Residential, Additions & Alterations
$64.50 Residential, AC Ollly
$3950
Ind\ISlrial, ComnH~rcial &. Multi-Family
$39.50
$39.50
13l1ildin!! Oflidat
Date
~
I Date
I Receipt No.
\ By
\
---I
---I
Estimated Cost $
HEATING PERMlT FEE
STATE SURCHARGE
TOT AL PERMIT FEE
Building Permit f,.__
$
$
$---
:::PAID WITH
BmOING PERMIT
(Omce Use Only)
This Application Becomes Yonl" Building Permit When Approved
.----
24 hour nntice for all inspedinlls (952) 447.9850, fa~ (952) 447-4245
08/04/2006 FRI 7:47 FAX 952 767 1900 GENZ-RYAN
tm U;jUJ UJJ
Date Rcc'd
CITY OF PRIOR LAKE PLUMBING PERMIT
~: ~~:~ ~:~y I PERMIT NO./_. 5 Z -:t
), Yenow ^9plicanl . II..--~
ZONING (offieeUIC)
ADDRESS
\. ! ~' ;'_-1
Iii (I
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L4~ f L-' \(\ P i'v!
\ vl'-/ll\ "1 ! '-V
\ ,I""
vv\
t' LEGAL DESCIUPTION (office use only)
LOT BLOCK ADDITION
PID
OWNER
(Name)
; t I
it IOtflr'n(jQ I
vV( I ~\ \' ' y,\ (']
12GJ5 {~)lQZ;. Dy-,
#~ ,200
(Phone)u5J - q Cc::).- ':5ICCJ
flA( CU!) tv1 N fJ:.--' " ~
(Address)
APPLlCANT (\_ "}11 .~ ,. i /.}. n 01lr::: -1(';-'
(Name) a,t., \l.. -.....vlud' I (Phone) j - .J1-- I fi r r
I <'"70 -. '1\)/' [~ I '2 r2 (
(Address) _'- U \/'. \-1 \/\J L-\ .~') o(A.rt/1qr ( Ie.. \vi 1\1
(Address) _ (City)
, /. · {)f-"
(Contact Person) -A"" \YY\ (Phone) 'f )J-~707~ {OW
'1:~ i.~_ U}JJX/;
1000
S5337
(Zip Code)
APPLICANT SIGNATURE
DATE
Quantity Type of Fixture Quantity Type of Fixture
Z Bath Tub with or without shower .~ Rough-ins
I Dishwasher I Water Heater
I I Floor Drain -- --.I I VI ater Softner
'~ Lavatory (Bathroom Sink) ~ , :;tand Pipe (Washing Machine)
\ Laundry Tray (lor 2 compartnlent sink I _~ Sewage ~iector
I t;wer Stall -c. Backflow Assembly
I Backflow Assembly Test
Sinks
Bar Sink Lawn Sprinkler
'~ Water Closet (Toilet) Other
...
APPLICANT PLEASE COMPLETE BELOW
FEE SCHEDULE
Industrial, Commercial & Multi-family 1% of job cost with a $39.50 minimum Residential, New One & Two-Family $99.50
Residential, Additions & Alterations $39.50
Estimated Cost $
Building Permit #
PLUMBING PSRMlf FEE $
8T A TE SURCHARGE $
TOTAL PERMIT :FEE $
PAID WITH
DtftLDING PERMIT
(Orric~ Usc Only)
This Application Becomes Your Building Permit When Approved
Paid
Receipt No.
l
I
Date
. By
Date
Building Official
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
See Main File
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
iL J '
~Y;1/J/r1/Y2..)lJ IJ
::)~dG-~
cfl-tru~
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
/1./;;' 1(7
/;;'t:~ch~~t.MU L A.J
Accepted
x
Accepted With Corrections
Denied
Reviewed By:
114M
.5~e #h,:... h'!(
Date:
b-IS'''~
Comments:
" n--FiW
See Mai ,. .
"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."
See Maint File
c1Vhit,. - Rlliltli"~
Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT tt~~tJ ~
APPLICATION RECEIVED ~... d 0 - G:
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
~
1'-/~'I7 "?{jAJi;~ L0
/
Accepted
Accepted With Corrections
Denied
~~
Date:
~!It(;;t;,
Reviewed By:
Comments:
See Main File
"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."
See :rVIain F'ile
White - Building
Canary - Engineering
~lnK - Plannln~IJ
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
I'
-'~
"-",;'-'
The Building, Engineering, and Planning Departments have reviewed the building permit
~ application for construction activity which is proposed at:
/
/
'"./'
I J )
l. i',..."
Accepted
Denied
v
Accepted With Corrections
~~
Date:
~ /Ilf/o (,
,
Revieyved By:
Comments:
Se .
"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."
PRIOR LAKE
INSPECTION RECORD
DEPARTMENT OFSee Main File
BUILulNG AND INSPECTION
SITE ADDRESS /~z.r? t?A/2./l:.II'{iJ '-~ JJ't,J.
NATURE OF WORK NEW CLJ,.JS'r. (I,.J I..,. FiJJ, ~ D€cJ<)~Ile.H
USE OF BUILDING - 3 f:; I!,.
PERMIT NO. ~~ 5-;). . DATE ISSUED G{,,/LJ(.
CONTRACTOR S'~ f1d1l\&,s PHONE 012 - ~"q - " 2.'(
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR
DATE
I FOOTING I
'1 FOUNDATION (Prior to Backfill) I I
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
SEWER I WATER I SEPTIC
FRAMING
INSULATION
ELECTRICAL
PLUMBING U U - (frI~'UCt
HEATING (if required)
FIREPLACE
GAS LINE AIR TEST
COVER NO WORK UNTIL ABOVE HA
I~ i tfdlAS~ IL'I'If,o I
FINALS
I ~.{?
N SIGNED
I
GRADING (Prior to Sodding)
BUILDING
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 (952) 447-9850