HomeMy WebLinkAboutBuilding Permit 99-0114
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDUL~D
ADDRESS
SS~.5 F~ cr
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING 0 PLUMBING RI
o FOUNDATION 0 MECH RI
o FRAMING 0 WATER HOOKUP
o INSULATION ~A 0 SEWER HOOKUP
)r FINAL v<I - 0 PLUMBING FINAL
o SITE INSPECTION 0 MECH FINAL
COMMENTS:
n//
(U/'\
c-f~
tu
DATE TIME
JJ -~-fi
?9-0J/L/
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
~ORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector:
/1LfA
,/
Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.,
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY/
INSNOTI
01
DATE RECEIVED
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. 91 -() 11t./
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 /
rL);~q- '-rr7/4r ( ~
3. LEGAL DESCRIPTION
LOT (~ BLOCK
kusf tJal::5 I~ ~L
4,0W~MdJe~~/6 a69?~/#/
5. ARCHITECT (Name) (Address)
~I
q/? /99
I jIjs 0
I
PID
:<.s-~ ~Y7-(y)h-o
ADDITION
~ ~39to
(Tel. No.)
~~
7?JP~~
(Name)
~/!) ~~ 4uJ( . (Tel. No.)
;::b~/}rd~0 eSS:-4J -mAJ 39/-S-S/Y
7. TYPE OF WORK Fireplace 0
New Construction 0 ~Aons 0
Chimney 0 Misc. U ~ 'l
.
8. PROPERTY AREA OR ACRES
Sq.Ft.
Septic 0 Deck 0 Re-roofing 0 Porch 0
d ition ~;Attic~~~_ FinishBasementO
DIMENSIONS v 10. CULVERT SIZE
Depth Yes No
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
12. NO. OF STO~
13. TYPE OF CONSTRUCTION
14. FLOOR AREA APPORTIONMENT USE
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
SEATS
16. PRO?YJ~A~
17. COMP~TION DATE
I hereby certify that I have fumished infonnation 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 an that all construction will conform to all existing state and local laws. and will proceed in accordance with submitted plans. I al~ i:i;are that the
:uilding official can~vok~ ~ . for ju ~rthermore, I hereby agree that the~~~77 enter upon the property to pe~)e/9qns.
Y / --;ignature License No. '-1' / ,,;f>ate
FOR ADMINISTRATIVE USE
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
SETBACKS: Required
Actual
Front
Back
Side
Side
BUILDING DEPARTMENT VALUATION
OFF STREET PARKING
SPACES REO.
USE OF BUILDING
SPACES ON PLAN
PERMIT VALUATION
TYPE OF CONSTRUCTION: I II III IV V
Occupancy Group A B E F HIM R S U
Penni! Fee ..........~~~~~~...1...~...~..~... $ -ILl .15"
City:
Plan Check Fee ............................. $
State Surcharge ............................. $
Penalty ....................................... $
Plumbing Pennit Fee ....................... $
Mechanical Penni! Fee ..................... $
I,J.:)"
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
Pressure Reducer .......................... ~
Meter Horn ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
WaterTap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
Total Due .............................. $ I & ~CX)
Paid! (, ~tX) Receipt No. 3 <-/7 q
~ . ~- )
Dateo? -It:( -'(t( By .' A
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as quested. 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.
Sewer & Water Pennlt ...................... $
Gas Fireplace Pennit ....................... $
This Application Becomes Your Building Pennit When Approved.
By Date
Certificate of Occupancy
City Planner
Date
Special Conditions ff any
24 hour notice for all inspections 447-9850