HomeMy WebLinkAboutBuilding Permit 99-0177
eriY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS Il()~ loln Mf'lV\t1d.,-^ Au,,"
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FRAMING
o INSULAJ!ON r ^
;aFINAL 'f(o<'~ ("\
o FOUNDATION
o DEMOLITION
o FIRE PREVo
o PLUMBING RI
o MECHANICAL
o WATER HOOKUP
o SEWER HOOKUP
o SEPTIC INSTALL
o PLUMBING FINAL
o SITE INSPECTION
COMMENTS:
J~7 c~ 1'~):-;J
DATE TIME
~-\~.<1~ A+-
'11-/,7
o EXC/GRAD/FILLING
o LKSHOREIWETLAND
o COMPLAINT
o SEPTIC FINAL
o FIREPLACE
o
~
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I WORKSATI FA
o CORRECT A I
Inspector:
Owner/Contr:
THE NEXT INSPECTION 24 HOURS IN ADVANCE..
TS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
, ~
DATE R~ 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
lip 3to~ 7n It rtJ (J Ani
3. LEGAL DESCRIPTION
,
LOT
1. DATE
3-/3-9q
~.E. ~ I
PID 'Ls-O(~-O I ~ -0
A~ () ,..J
Atlr.
"L
BLOCK
f, t'-o Olt:.-S V l '--L..&
H, ........ s
-z~
ADDITION
4. OWNER (Name)
-m.r K ~
5. ARCHITECT (Name)
(Address)
J:;rEl..fTAA
(Address)
(Tel. No.)
41../0 -71'17
(Tel. No.)
6. BUILDER (Name) 111. .~~ (Address)
~fI KI 3{P~'O W .:')00
7. TYPE OF WOR-:n:x:: ~;ce 0 Ii' c ~~i:O I( Deck 0 .sf' Re-~~ Nporch 0
New Construction 0 Alterations 0 Addition 0 Finish Attic 0 Re.siding 0 / F1?Iish Basement 0
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES
Sq. Ft.
(Tel. No.)
9. PROPERTY DIMENSIONS
Width Depth
10. CULVERT SIZE
Yes No
1. White
2. Pink
3. Yellow
File
City
Applicant
Permit No.
1q -/1/
. ,
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
12. NO. OF STORIES
13. TYPE OF CONSTRUCTION
14. FLOOR AREA APPORTIONMENT USE
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
SEATS
16. PROJECT COSTNALUE
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 permit for just cause. Furthermore. I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X ~ ~a~ License No. 3-1?;"t?9
SETBACKS: Required
Actual
BUILDING DEPARTMENT VALUATION
FOR ADMINISTRATIVE USE
Front
Back
Side
Side
USE OF BUILDING
I
fl-es IA(L
I
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
L.-SQ? -
TYPE OF CONSTRUCTION: I II III IV V
Occupancy Group A B E F HIM R
Division 1 2 3 4
Permit Fee ................................... $
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
S U
City:
\ 4~1')
Plan Check Fee ............................. $
State Surcharge............................. $
Penalty ....................................... $
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
(. '--S-
MATERIAL FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA 0
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS 0
SURVEY 0
SETS
COPIES
PLOT PLAN
o
Pressure Reducer .......................... $
Meter Horn ............................ ....... $
Water Meter................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
Water Tap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
Sewer & Water Permit ...................... $
:::'?"T .MJK;~.;,~.w~~" 6,
By ~ Y'~ate ~~
Certificate of Occupancy
Total Due .............................. $ --r h. -
Paid ., <0 - Receipt No. 3471 i
Date ~/'0 r"7 q By ~O 11
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 const~utes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be issued.
Issued
City Planne,
Date
Special Conditions n any
24 hour notice for all inspections 447.9850