HomeMy WebLinkAboutBuilding 99-1262
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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
J lP 2..CU ?4~VI GvJ Dl2... Se.
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
OCT 1 81m ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
)~ 11/11
I. White
2. Pink
3. Yellow
File
City
Applicant
DATE RECEIVED
Permit No. 99 - / 2~ 2-
?'P-\~ LA'J-IC'
PUD
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
3. LEGAL DESCRIPTION
q
C--R 12. 0/1\/ At.-
12. NO. OF STORIES
LOT
BLOCK
/
~I otq6
PID z5-.3/~- O()q- 0
3.eo
13. TYPE OF CONSTRUCTION
ADDITION
(Address)
(Tel. No.)
0l12. 2-z-l4.C;o'1
(Tel. No.)
14. FLOOR AREA APPORTIONMENT USE
4.9,WNER (Name)
UA1Z-12.I~ i\> J~FF -e,~\..n.)e:.f2-
5. ARCHITECT (Name)
(Address)
II
6. BUILDER
(Name)
(Address)
(Tel. No.)
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
7. TYPE OF WORK
New Construction 0
Fireplace 0
Alterations 0
Septic 0
Addition 0
Deck)l(
Finish Attic 0
Re.roofing 0 Porch 0
Re.siding 0 Finish Basement 0
SEATS
16. PROJECT COSTNALUE
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES
Sq. Ft.
9. PROPERTY DIMENSIONS
Width Depth
10. CULVERT SIZE
Yes No
17. COMPLETION DATE
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 mentioned 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 o~ can r~voke this permit f~t cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform eded' s~ons.
X ~~h '-'-- 0 1'1 'fC'f
Signature License No. Date
FOR ADMINISTRATIVE USE
Front
Back
Side
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
SETBACKS: Required
Actual
BUILDING DEPARTMENT VALUATION
USE OF BUILDING
/265 Ale
.
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION I, ~c:o .0 0
TYPE OF CONSTRUCTION: I II III IV V
Occupancy Group A B E F HIM R S U
Division 1 2 3 4
City:
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
Permit Fee ................................... $
51.25
3}. 31
.ao
Plan Check Fee ............................. $
State Surcharge ............................. $
This
By
widing Permit When Approved. tj
Date (tJ-7..0-'i
~ff'1
101"11 /qq
r~1- 0
Pressure Reducer .......................... $
Meter Horn................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
Water Tap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
Total Due .............................. $ 85.30
::ceiPt7$: S9~
Paid
Penalty ....................................... $
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
Sewer & Water Permit ...................... $
Gas Fireplace Permit ....................... $
Certificate of Occupancy
Issued
Special Conditions if any
24 hour notice for all inspections 447.9850
White - Building
Canary - Engineering
Pink - Planning
The Ctnltr of the Lake Country
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
Reviewed By:
/
~~j~
~0:l ~ OIL,
Accepted With Corrections
Accepted
Denied
Date:
ftJ/J-,f7/
.
Comments:
t '
"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."
_~~...._~~~__,_~__.c,_,._,____._~.....-.- _~ _._ ..H.____..__,~~_.~.__._ u__. ..~_.,,-'--'.- .--..--.. .------.-
qc;- /2 tPZ-
White - Building
Canary - Engineering
Pink - Planning
The Crnler of Ihe Like eOURI.,
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
c:-~,e.e/G/ ..:T~FF
/
/O/lq/Cf't:J
Be c.J 0 (5 Ie-
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
/ ~ 2-- '9 I P/J,eK (/ I 6 w Ole S 6'
Accepted
Accepted With Corrections /('
Denied
Reviewed By: r21 f{../
I. ~~ +l.t ~~ ~
Date:
J () --/1'.- 2"
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."
PRIOR LAKE
INSPECTION
RECORD
DEPARTMENT OF
BUILDING AND INSPECTION
SITE ADDRESS Ito-z.9. l ~\<.uJoo~ '\)r-
TYPE OF WORK D?c l<:
USE OF BUILDING S.rp
PERMIT NO. 9''1- 1'2 b-Z DATE ISSUED 10- 2L;-'1c-
BUILDER Dr ()&.a.r-
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
I FOOTING ~(I ~/t!Jb
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
I~~ ~H; I I
I FINAL I r
Call between 8:00 and 9:00 A.M. for all inspections
FOR ALL INSPECTIONS 447-9850