HomeMy WebLinkAboutBuilding Permit 99-0137
SCHEDULED I D -/ '1- / c:; -AJ;
I~O'f1.- J{t ),0,
o FOOTING 0 PLUMBING RI
o FOUNDATION 0 MECH RI
o FRAMING @ 0 WATER HOOKUP
o INSULATION 0 SEWER HOOKUP
If FINAL 0 PLUMBING FINAL
10' SITE INSPECT.ON 0 MECH FINAL
COMMENTS~ ~.
~(~~
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CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
(~( L/ {
OWNER
CONTR.
PHONE NO.
PERMIT NO.
DATE TIME
19-/3'7
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
~
/
~RK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WOR~ALL FOR REINSPECTION BEFORE COVERING
Inspector: PI } (. Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.,
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTI
DATE RECEIVED CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
1. White
2. Pink
3. Yellow
File
City
Applicant
n{{'_^ 13(
Permit No. v ~ { L' ...
DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
1, DATE
2, SITE ADDRESS 3/" f
/70 fl1 Sf
~L.
3-/- 9r
f( ts(J
/}c:::- -{&g- 60?rO
PID ot..j
BUILDING INFORMATION
11, SIZE OF STRUCTURE
(Height) (Width) (Depth)
3. LEGAL DESCRIPTI.8N
LOT J. BLOCK / A
ADDITION ~Arr s, +1 L5 /c:r /idclJ~\
(Nam~
K,QeoS ~ R
12, NO, OF STORIES
13, TYPE OF CONSTRUCTION
(Name)
(Address)
~fI'" t..
(Address)
(Tel. No,)
14, FLOOR AREA APPORTIONMENT USE
4, OWNER
CJ-'L~
5. ARCHITECT
(Tel, No,)
6, BUILDER
(Name)
(Address)
(Tel, No,)
15, NUMBER OF OCCUPANTS OR SEATS
1?1th ~/LI
36gJ U/~ Sf '
W~-3J~~
OCCUPANTS
7. TYPE OF WORK
New Construction 0
Fireplace 0
Alterations 0
Septic 0
Addition 0
Deck 0
Finish Attic 0
Re-roofi!jI:CJ Porch 0
Re-siding 0 Finish Basement 0
SEATS
16, PROJECT COSTNALUE
Chimney 0 Mise,
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 official can revoke this pe it for just cause, Furthermore, I hereby agree that the city official or a designee may enter upon the property to pertorm needed inspections,
X" 'Yl .J 3-/--qlj
Signature - License No. Date -
FOR ADMINISTRATIVE USE
,
SETBACKS: Required
Actual
MATERIAL FILED WITH APPLICATION
Front
Back
Side
Side
SOIL TESTS
o ENERGY DATA
o
BUILDING DEPARTMENT VALUATION
OFF STREET PARKING
SPACES REO,
SPACES ON PLAN
PERMIT VALUATION
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS 0 SETS
USE OF BUILDING
SURVEY
PLOT PLAN
o COPIES
o
TYPE OF CONSTRUCTION: I II III IV V
Occupancy Group A B E F HIM R S U
. ---
-Ie.;. 7~
City:
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
Division 1 2 3 4
Permit Fee ................................... $
Plan Check Fee ............................. $
State Surcharge ............................. $
Penalty ....................................... $
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
/.;}6
Sewer & Water Permit ...................... $
Pressure Reducer .......................... $
Meter Horn ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
Issued
Water Tap .... ....... ........................ $
Builder's Deposit ............................ $
Other ......................................... $
7(- rOo
Paid T07Z~ o11-..............~~~~i~~~O~ 3V73&;
Date 3-I-q7 By CjKtU
y
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 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,
Certificate of Occupancy
City Planner
Date
Special Conditions W any
24 hour notice for all inspections 447-9850