HomeMy WebLinkAboutBuilding Permit 99-0145
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
A' FINAL
o SITE INSPECTION
COMMENTS:
DATE TIME
SCHEDULED
/CJ '=':l - " A ~ '\J,
."
%0/
~~,
CONTR.
PERMIT NO. 99-/~S
o PLUMBING RI 0 EX/GRAD/FILLING
o MECH RI 0 COMPLAINT
o WATER HOOKUP 0 FIREPLACE RI
o SEWER HOOKUP 0 FIREPLACE FINAL
o PLUMBING FINAL 0 GASLINE AIR TST
o MECH FINAL )( _..e,--r1
~t~~ ;-
(J
~..7~~
/
~RK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
:.::.ECT WO"f;U FOR REIN:::,:n:EFORE COVERING
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE..
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTl
'_C""_""h',__",_,__,__,_~,,_~,__,,_,~___,_~~_,,___'__~'~__."__"___"._
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
-..
Permit No.
qq-(~-
- 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 f) ~ ...J-. ~ J 0
i.)b 0 I -tL~t-.J./..J f /. d V.
3. LEGAL D;.sCRIPTION
LOT LJ ~ 0 f IJ.. all /5 BLOCK -3
ADDITION 1/'/2- ~/2- "- tLIi..._ ~~ il-"']
4. OWNER ~ame) 1iJ. (Address) ,
5.ARCHITE~Tq~~a:e) 7,.11 A.. ,,-- -'" (Address)
6. BUILDER (Name) (Address)
1. DATE
S/I/?9
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
12. NO. OF STORIES
PID J.. s- tJ IJ 1. - ^iIJ - 0
~ ~Lt. .~--' _
13. TYPE OF CONSTRUCTION
) (Tel. No.)
(~Il_ 1/-1/7-J/.I/
(Tel. No.)
14. FLOOR AREA APPORTIONMENT USE
(Tel. No.)
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
<rJ~ ( . /I/l/
7. TYPE OF WORK
New Construction 0
d/t'1>-v--l ./
Fireplace 0
Alterations 0
Septic 0
Addition 0
Deck 0
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 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 and that all construction will confonn to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the
build' g fficial can revok~~enni for just cause. Furthennore, I hereby agree that the city official or a designee may enter upon the property to perfonn needed inspections.
X a/.4I..fl.. /' t"_ ~ ~ ... 4- _ y-o/
/ r - ature License No. Dete'
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
MATERIAL FILED WITH APPLICATION
Front
Back
Side
Side
SOIL TESTS
o ENERGY DATA
o
BUILDING DEPARTMENT VALUATION
USE OF BUILDING '~<.Y JJL
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
PILING LOGS 0
PLANS & SPECS 0
SURVEY 0
PERCOLATION TESTS 0
SETS
COPIES
TYPE OF CONSTRUCTION: I II III IV V
Occupancy Group A B E F HIM R S U
Division 1 2 3 4
~.sl)l) . 0 j)
PLOT PLAN
o
City:
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
7l ()/)
Pennit Fee ................................... $
11. 7S-
Plan Check Fee ............................. $
State Surcharge............................. $
Penalty ....................................... $
Plumbing Pennit Fee ....................... $
Mechanical Pennit Fee ..................... $
/.L.5
Sewer & Water Pennit ...................... $
Pressure Reducer .......................... $
Meter Hom ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
Gas Fireplace Pennn ....................... $ Water Tap ................................... $
This Application Becomes Your Building Pennit When Approved. Builder's Deposit ............................ $
By Date Other ......................................... $
76.0C
Certificate of Occupancy Total Due 6'J0........... ............... $ Y'
Paid '-:1&<" ~ Receipt No. 34-7'10
Issued . r J. _ I
Date 2; -(j -4 7 By (;) I<..L<.J
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 r~sted. This document when
signed by the City Planner constnutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be issued.
City Planner
Date
Special Conditions ff any
24 hour notice for all inspections 447-9850