HomeMy WebLinkAboutBUILDING PERMIT #99-0157
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
~CJ ;< L-j
K~~
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o G~AIR TST
~ I
~
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
liir FINAL
'0 SITE INSPECTION
COMMENTS:
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
If' ~ ,,;,
r~
~"'.,
DATE TIME
/tJ-Zz-'7? A.l(
11 ~ /57
~
....-
~WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WO~ALL FOR REINSPECTION BEFORE COVERING
Inspector: t;?.; ~ Owner/Contr:
f
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
INSNOTI
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYl
----"-"^,._..,_..._.._, . ~._...._- ,.__.._,,_.'^~ ~'~_"'__'.~_'_"__'._._..~__,.______w.._____.._,~_.,~_____~,~~."___.___,_____.,._
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
.'01999
- DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
Permit No. gq -/57
~2DESS ~Q(l V\~
3. LEGAL DESCRIPTION
3
ADDITION S~
4. OWNER~ (Name)
~" N..~ \~C'r'\
(Name)
t*
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width)
(Depth)
LOT
-
B~CK
. f)n.:o 1<. t?n r (~
q
~/sb
t9~ -oqq-()OJ. -0
12. NO. OF STORIES
PID
13. TYPE OF CONSTRUCTION
(Address)
(Tel. No.)
14. FLOOR AREA APPORTIONMENT USE
5. ARCHITECT
(Address)
(Tel. No.)
L/ L) l) -~~S- ..2
6. BUILDER (Name) (Address) (Tel. No.)
4f411fY\eYl'LC~ ~-\- ~~ 1D""l-otc::(:)
f(q ('I {OVI w.d" Q....,\- (' (C'-L\ '0' II C \.
7. TYPE OF WORK Fireplace LJ Septic LJ Deck LJ Re-roofing~ Porch LJ
New Construction LJ Alterations LJ Addition 0 Finish Attic 0 Re-siding 0 Finish Basement 0 16. PROJECT COSTNALUE
ChimneyO Misc. l'? ~- ~ S.vr.,..-y.,. 0.nrv-...../? I}-L- Lf?;~Q.::.
8. PROPERTY AREA OR ACRES 9. PROPERTY DIMENSIONS . 10. CULVERT SIZE 17. (C~MI qPLE7;rql\JIO~1L.iA I to
Sq. Ft. Width Depth Yes No "-I
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 amI the owner or authorized agent for
the above mention 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 o~ial ca evo~eJhis permit for just cause. Furthermore, I hereby agree that t~ city official or a designee m~ enter upon the property to perform ee ed in;t?ections.
X U V"' V ~ ;.,J[")\ ~q I/() ") '1
I Signature - - License-No. . Date
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
SEATS
SETBACKS: Required
Actual
FOR ADMINISTRATIVE USE
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
OccupancyGroup A B E F HIM R S U
Division 1 2 3 4
City:
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
Permit Fee ................................... $
Plan Check Fee ............................. $
State Surcharge ............................. $
Penalty ....................................... $
Plumbing Permit Fee ....................... $
74. 75"
I . JC:;
Mechanical Permit Fee ..................... $
Pressure Reducer .......................... $
Meter Horn ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
Sewer & Water Permit ...................... $
WaterTap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
Total DU~....................... $
Paid -;I' ~ Receipt No. ~ l/76 3
Issued .
Date :5-i6 #~ By a f6.-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 aslequested. 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.
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By' ~ ~l~f ,1, )"/U Y"/
,..,.J ~ ~_ _ \/ ~
70~CY)
Certificate of Occupancy
City Planner
Date
Special Conditions ff any
24 hour notice for all inspections 447-9850