HomeMy WebLinkAboutBuilding 99-0501
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DATE RECEIVED
5/ ro/91
CITY OF PRIOR LAKE
BUilDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
I. White
2. Pink
3. Yellow
File
City
Applicant
Permit No.
qq- 50/
DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
1. DATE
5:'- S-Cj
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
su)
12. NO. OF STORIES
LOT
BLOCK '3
S ~ v. I- /f
PID :2-5-z+8-oICf-O
A-l) DL+lQ^I~
ADDITION
Re-roofing D Porch D
Re-siding D Finish Basement D
~
15. NUMBER OF OCCUPANTS OR SEATS
(Address)
UJMt 17 '11lJ1!c
Deck If
AllicD
Sf
OCCUPANTS
SEATS
Sq.Ft.
Yes
No
10. CULVERT SIZE
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 local laws and will proceed in accordance with submitted plans. I am aware that the
building offici r oke thO ermit for just cause. Furthermore, I hereby agree that the city offjcia~ a designee may enter upon the property to perform needed i~ections.
X -- "2005.)00"1 ,S--3-1f
Signature License No. Date
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
MATERIAL FILED WITH APPLICATION
Front
Back
Side
Side
SOIL TESTS
D ENERGY DATA
D
(p,c>~ . ~
r I 1- ~~
PILING LOGS D
PLANS & SPECS .,.
SURVEY V
PLOT PLAN D
PERCOLATION TESTS D
BUILDING DEPARTMENT VALUATION
USE OF BUILDING
,e6S r1 /;::..
I
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
SETS
COPIES
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 ............................. $
\ l ?:ZC;-
72. t1
s.oa
State Surcharge ............................. $
Penalty....................................... $
Plumbing Permit Fee ....................... $
Pressure Reducer .......................... $
Meter Horn ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
WaterTap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
Total Due .............................. $ da. f. ~
Paid Z Z ':2,?- Receipt No. '3<"1."
Issued ~
. Date "5/1 g /tJ 1 By (Yl ..
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordi~ance and may proceed as requested. This document when
signed I ity PI r constitutes a temporary Certificate of Zoning compliance and al s constructio 0 commence. B fo occupa cy, _Ce . icate of Occupancy must be issued.
S-,I"2~~ \.
City Planner Date
Mechanical Permit Fee ..................... $
40 . 0 C)
Sewer & Water Permit ...................... $
24 hour notice for all inspections 447-9850
Tht' Ct'nlt'r of Ihe Lake Counlry
White - Building
Canary - Engineering
Pink - Planning
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:
Accepted
(/
Accepted With Corrections
Denied
Cj~~
Date:
5- l 'L- 4~
Reviewed By:
Comments:
t~~ ti},vvtt~ ~CR~ v~J{vedJ"
"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
SITEADDRESSJ~'('1~ f,1~\ ~
NATURE OF WORK ~_ -_y<2Ss, W,~c...J .J-- ~~ g;)~
USE OF BUILDING
PERMIT NO. 99 -,,'"501 DATE ISSUED
CONTRACTOR =rt~J""\'-'~ (~~ .
NOTE: THIS IS NOT A PERMIT FbR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR DATE
~ ~F-~
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING
INSULATION
ELECTRICAL
PLUMBING ,\, e-,~ ie' I--C)~
HEATING (if required) ~.\ \2.. ~ - . -I ~r;1
- -91
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
~D I I
FINALS
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.
Call between 8:00 and 9:00 A.M. for all inspections
FOR ALL INSPECTIONS (612) 447-9850