HomeMy WebLinkAboutBuilding 01-0717
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CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
1. White File
i. ~;~oW~licant -
Permit No.
.:1'
OtrtJ7/7
DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
2. SITE ADDRESS
\L\
3. LEGAL DESCRIPTION
/
1. DATE
'."j..
l' 0-0\
BUILDINCi.ORMATlON
11. SIZE OF ST RE
(Height) (Depth)
W'\\d~
Qo.c
12. NO. OF STORIES
ADDiTiON
P/G
BLOCK 7
NIL.-DS
PID 25, z- en - 074-...CJ
. 13. TYPE OF CONSTRUCTION
LOT
4. OWNE;R (Name\
-rk \.J..L \ ds
(Address)
(Tel. No.)
<=\5
(Tel. No.)
14. FLOOR AREA APPORTIONMENT USE
5. ARCHITECT
(Name)
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 property and that all construction will conform to all existing state and Ioca1laws and will proceed in accordance with submitted plans. I am aware that the
building officiaJ-ran rovoke this permit for lust cause. Furthermore~ agree that the city official or a de(3nee may enter upon the property to perform needed inspections.
X //k-----' 0/5" 7- 10. .01
SlQ1atih. Ucense No. Dale
9. PROPERTY DIMENSIONS
Width Depth
10. CULVERT SIZE
Yes No
15. NUMBER OF OCCUPANTS OR SEATS
~\I OCCUPANTS
SEATS
16. ESTIMATED VALUE
a-
17. COMPLETION DATE
,- \2-0\
6. BUILDER
C'J.
0\ 0 f
7. TYP OFWORK
New Construction 0
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES
Sq.Ft.
Residing 0
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
Front
Back
Side
Side
MATERIAL FILED WITH APPUCATION
SOIL TESTS 0 ENERGY DATA 0
PROPOSED GRADE FOUNDATION
IN RELATION TO CURB OR CROWN
OF STREET
USE OF BUILDING
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
Sa::) . 60
PILING LOGS 0
PlANS & SPECS 0
SURVEY 0
PLOT PLAN 0
PERCOLATION TESTS 0
SETS
COPIES
TYPE OF CONSTRUCTION: I II III N V
City:
Amount Brought Forward ...... ......... ... $
Paril Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
license Check Fee ......................... $
Pressure Reducer ........ ,. ........ .... .... $
Meter Horn ................................... $
Water Meter ..:.............................. $
o Sewer & Water Connection Fee ........... $
o WaterTowerFee ........................... $
Occupancy Group A BEl H R M
Civlslon1234
State Surcharge............................. $
Penalty ....................................... $
Septic System ............................... $
Other ......................................... $
~~.~
{~. 2-
, ')(.)
Permit Fee ................................... $
Plan Checking Fee ......................... $
Check if
Deferred
. ing Permit ~n Approved.
Dato - ( L, .. 7Ac(
~Ol
Water Tap ................................... $
Builder's Deposit ............................ $
Other ...............................;......... $
Total Due .............................. $
Paid
~
Igsued
Date
Thlg is to certify that \he request in \he above application and accompanytng documents Is In accordance with the City Zoning Ofdinance and may proceed requested. This document when
signed By the City Planner coost~utes a temporary Certiflcato of Zoning compliance and allom construction to commence. Before occupancy. a CertiflC3 of Occupancy must be Issued.
City PlolIInor
Oate
Spedal Conditions If erry
24 Hour notice for all Inspections 447.42309:00 a.m. . to:oo a.m.
1:qeD
SimplexGrinnell
2730 Nevada Avenue
Minneapolis, MN 5542 7
Tel: 763-4 17-0011
Fax: 763-477-0066
Fire &
Security
SimplexGrinnell
TO: CITY OF PRIOR LAKE
16200 EAGLE CREEK AVE. SE
PRIOR LAKE, MN 55372
DATE: I JOB
July 26, 2001 NO:
ATTENTiON:
PERMITS
RE:
WE ARE SENDING YOU
ATTACHED
UNDER SEPARATE COVER VIA
THE FOLLOWING ITEMS:
Ud_.. Shop Drawings
Copy of Letter
Other
tj'-~
Prints
Change Order
I-I Equipment Submittal
Specifications
1---1 Samples
COPIES DATE NO. DESCRIPTION
1 7-10-01 PERMIT APPLICATION FOR 14998 WILDS PARKWAY
1 7-26-01 CHECK #4926 IN THE AMOUNT OF $39.27
THESE ARE TRANSMITTED as checked below:
H For Approval B Approved as submitted
For your use Approved as noted
As requested Returned for corrections
U For review and comment LJ
H Resubmit - copies for approval
Submit _ copies for distribution
Return _ corrected prints
D FOR BIDS DUE
D RETURN OF PRINTS THAT WERE ON LOAN TO US
REMARKS
COpy TO:
If enclosures arc not as noted, kindly notify us at once.
SIGNED:
:Nancy 9vlcqraw
White - Building
Canary - Engineering
Pink - Planning
The Centt'f of Ihe Like Coun111'
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
5/MPL,6X q/c);VN6GG
1-/2--0/
APPLICATION RECEIVED
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
J4qq8 ItJI '--OS P~I2J:::WAY
Denied
Date:
7-(~-~/
Accepte
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."
SimplexGrinnell
2730 Nevada Avenue
Minneapolis, MN 5542 7
Tel.- 763-417-0011
Fax: 763-417-0066
DATE: JOB
July 10, 2001 NO:
ATTENTION:
PERMITS
1:LfCD
Fire &
Security
RE:
SimplexGrinnel1
TO: CITY OF PRIOR LAKE
16200 EAGLE CREEK AVE. SE
PRIOR LAKE, MN 55372
WE ARE SENDING YOU
ATTACHED
UNDER SEPARATE COVER VIA
THE FOLLOWING ITEMS:
~ Shop Drawings
Copy of Letter
Other
B
Prints
Change Order
r 1 Equipment Submittal
Specifications
B Samples
COPIES DATE NO. DESCRIPTION
1 7-10-01 PERMIT APPLICATION FOR 14998 WILDS PARKWAY
THESE ARE TRANSMITTED as checked below:
H For Approval ~ Approved as submitted
For your use Approved as noted
As requested . Returned for corrections
LJ For review and comment LJ
B Resubmit - copies for approval
Submit _ copies for distribution
Return _ corrected prints
D FOR BIDS DUE
D RETURN OF PRINTS THAT WERE ON LOAN TO US
REMARKS
PLEASE CALL ME WITH THE PERMIT AMOUNT @ 763-765-2416.
COpy TO:
SIGNED:
:Nancy 9r1cC}raw
If enclosures are not as noted, kindly notifY us at once.
..t
PRIOR LAKE
INSPECTION
RECORD
SITE ADDRESS title W"18~"':ep~ilJ.S Q1d., I:tou~)
TYPE OF WORK ~'_kl.(). r- S_ _ ___
USE OF BUILDING Ccn-.. .
PERMIT NO. (J/- 07/7 DATE ISSUED 7-/~-kJ(
BUILDER Sl\AA.ytq~_~rlV\~ PHONE # 7(,~ -'II,,,OO( I
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
DEPARTMENT OF
BUILDING AND INSPECTION
~ I I
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
~ I I
I FINAL I I
Call between 8:00 and 9:00 A.M. for all inspections
FOR ALL INSPECTIONS (952) 447-9850
INSPECTOR
DATE