HomeMy WebLinkAboutBuilding Permit 99-0081
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
/~~ %'~1
/'1703 G~ ~ 5"
SCHEDULED
OWNER
CONTR.
PHONE NO.
PERMIT NO.
99-ooRJ
o FOOTING 0 PLUMBING RI
D FOUNDATION D MECH RI
o FRAMING 0 WATER HOOKUP
D INSULATION .' .A hlD SEWER HOOKUP
~FINAL /LIl -~D PLUMBING FINAL
o SITE INSPECTION D MECH FINAL
o EX/GRAD/FILLING
D COMPLAINT
D FIREPLACE RI
D FIREPLACE FINAL
D GASLINE AIR TST
o
COMMENTS:
'[)I{
dfIIi!Y; ~ ~
~ORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
D CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector:
/AlA
. Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.,
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTI
.5~
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
ildin official can revoke this pe it for' st use. Furthe l~erebY agree that the city official or a designee may enter upon the property to perform ne ed inspections.
~I ;::JfCl:=; .
License No.
DATE RECEIVED
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
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
\4W~
1. DATE
\ 2/31/Q ~
R \ 'SD
33-13"~OIO-o
(1 \ etrloJ e..
Ave... S.
3. LEGAL DESCRIPTION
-:z...
LOT ,
L-- PID
& r"\~-\~ L-~
I' ~ddreSSj _ \.....
\Ltlo.~ Ol~ Ave- $;.
(Address)
(Tel. No.)
41.17.2.4 lob
(Tel. No.)
ADDITION
. BLOCK
t'>At::-, L/~y"..v0
~ER f) _ (Name)
\om ~me5
5. ARCHITECT
(Name)
(Address) r:<, : f) ^ i,' " ,(T,el. No.)
~('A-6\i \l.<-tr ~e;z,'37
\-hrllOo t'ttte.r~O'S r3~6 \a.cc.'l"du.~-tflQ.I ~vd. g9D- ~qOO
Fireplace LI Septic LI Deck 0 Re-roofing 0 Porch 0
Alterations 0 Addition 0 Finish Allie 0 Re-siding)( Finish Basement 0
6. BUILDER
(Name)
7. TYPE OF WORK
New Construction LI
Chimney 0 Misc.
10. CULVERT SIZE
Yes No
B. PROPERTY AREA OR ACRES
Sq.Ft.
9. PROPERTY DIMENSIONS
Width Depth
7~. 00
1. White
2. Pink
3. Yellow
File
City
Applicant
Permit No.
9~-OO~ I
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
12. NO. OF STORIES
13. ~E OF CONS;'d,9T, ION
K.e. - ~\ \\"Q
14. FLOOR AREA APPORTIONAlENT USE
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
SEATS
16. PROJECT COSTNALUE
\5 SCOI 00
17. COMPl~TION DATE
FOR ADMINISTRATIVE USE
Amount Brought Forward .................. $,
ParkSupportFee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
SETBACKS: Required
Actual
Back
Side
Side
Front
BUILDING DEPARTMENT VALUATION
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
'2Sco .-
USE OF BUILDING
l2. E= S
A/K
I
TYPE OF CONSTRUCTION: I II III IV V
Occupancy Group A B E F HIM R
Division 1 2 3 4
Permit Fee ................................... $
S U
City:
! 1. (~
Plan Check Fee ........ ..................... ~
t. L\
State Surcharge ............................. $-
Penalty ....................................... $
Plumbing Permit Fee ....................... $
Mechanical Perm~ Fee ..................... $
MATERIAL FILED WITH APPLICATION
SOIL TESTS LI ENERGY DATA 0
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS 0
SURVEY 0
SETS
COPIES
PLOT PLAN
o
Pressure Reducer .......................... $.
Meter Hom ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
Sewer & Water Perm~ ...................... $
:::1lJI ..JJ-7.:;;;.:.~~"Wh'" .,
By ~ ~"'~ ~T<; 1
Cert~icate of Occupancy
Water Tap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
Total Due .............................. $
Paid ..., ~ .- Receipt No. ~" 7.:1 e
Issued 'Ore,." . ~ ,.J I
Date 1-/ ~ /1'1 By (2.Olrf
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and'r/ay proceed as requested. This document when
signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy. a Certificate of Occupancy must be issued.
-, ".-
24 hour notice for all inspections 447-9850
Special Conditions ~ any
Date
City Planner