HomeMy WebLinkAboutBuilding 06-0580
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
4100 BROUGHAM BLVD NE
ADDRESS _ ELDER JONES
OWNER Re-Roof
06-0580
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
COMMENTS:
DATE TIME
'-(- J.- 06
o EXIGRAD/FILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
~RK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT ~~ FOR REINSPECTION BEFORE COVERING
Inspector: W- Owner/Contr:
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
IIiSNOTl
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH cl SAFETY!
lrM/i/'~4a '1H
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
1. D~E7-71() G
DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (PleasE! Print or Type and sign at bottom)
2. SITE ADDR SS
/1)0
tl> rl;) k
h.~
3. LEGAL DESCRIPTION
LOT
,rC. j 5:..D
BLOCK
PID
z5. -z.U, OO&' . ()
ADDITION
6. BUILDER
(Name)
(Address)
ttb~E ~r ~(' I~m~ )\SYl.I(IUCS
7. TYPE OF WORK
New Construction 0
Fireplace 0
Alterations 0
SeptiC 0
Addition 0
Deck 0
Finish Attic 0
Re-roofing
Re-siding 0
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES
Sq. Ft.
(Tel. No.)
Porch 0
Finish Basement 0
Width
Depth
Yes
10. CULVERT SIZE
No
9. PROPERTY DIMENSIONS
~.-lrtrh~P
1. White
2. Pink
3. Yellow
File
City
Applicant
Permit No.
o ro .058 0
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
12. NO. OF STORIES
13. TYPE OF CONSTRUCTION
14. FLOOR AREA APPORTIONMENT USE
o
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
SEATS
16. PROJECT COSTNALUE
17. COMPLETION DATE
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 at II construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the
building 0 . .~ thO e it f just cause. Furthermore, I hereby agree thpl the city official or a designee may enter upon the property to perform ne ed insp tions.
X - t:2~ - "t--OZ- ~ e '1-57 2-
Signa.ture 'iJcense No. Date
SETBACKS: Required
Actual
FOR ADMINISTRATIVE USE
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
Pressure Reducer .......................... $
Meter Horn. ................... ............... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
Water Tap ................................... $
Builder's Deposit ............................ $
Other......................................... $
Total Due.............................. $
Paid . 0 0 Receipt
Date {... . ()ft;
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proc d a requested. This document when
signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certifi ate f Occupancy must be issued.
Frelnt
Back
Side
BUILDING DEPARTMENT VALUATION
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
USE OF BUILDING
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:
Plan Check Fee ............................. $
State Surcharge ............................. $
Penalty....................................... $
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
City Planner
Date
24 hour notice for all inspections 447-9850
Special Conditions ~ any
Side
MATERIAL FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA 0
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS 0 SETS
SURVEY
PLOT PLAN
o COPIES
o
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