HomeMy WebLinkAboutBuilding Permit 99-0199
CITY OF PRIOR LAKE
INSPECTION NOTICE
DATE TIME
SCHEDULED
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ADDRESS ~~h. '5r
OWNER
PHONE NO.
o FOOTING
o FRAMING
.'1- INSULATION ^
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o FOUNDATION
o DEMOLITION
o FIRE PREVo
COMMENTS:
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ri WORK SA TISF
CONTR.
PERMIT NO.
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o PLUMBING RI
o MECHANICAL
o WATER HOOKUP
o SEWER HOOKUP
o SEPTIC INSTALL
o PLUMBING FINAL
o SITE INSPECTION
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o EXC/GRAD/FILLING
o LKSHORE/WETLAND
o COMPLAINT
o SEPTIC FINAL
o FIREPLACE
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, Owner/Contr:
R THE NEXT INSPECTION 24 HOURS IN ADVANCE.,
ENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
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.
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DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
1. DATE
3. LEGAL DESCRIPTION
LOT ?)
~St
BLOCK z.
~C h (\lie) r'-c:l c:::> AeVL1
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R2
BUILDING INFORMATION
11 . SIZE OF STRUCTURE
(Height) (Width) (Depth)
2. SIT~ ADDRESS
Lf1 Li L{ VVtiyt I1iStW^- s-l
_ PID -':)~ -oc::) - 00 ~ {)
12. NO. OF STORIES
13. TYPE OF CONSTRUCTION
ADDITION
4. OWNER
Brit.' '(\
5. ARCHITECT
(Na ne)
~"~:r~,I)'"
(Name)
(Address)
.l-fCP--t 4 m; ^"L~'
(Address)
(Tel. No.)
Y!lO -3571
(Tel. No.)
14. FLOOR AREA APPORTIONMENT USE
6. BUILDER (Name) (Address) (Tel. No.) 15. NUMBER OF OCCUPANTS OR SEATS
(X\(U/\ (7.p)eJ(~~ ~JA,vl OCCUPANTS
7. TYPE OF WORK Fireplace CJ Septic CJ Deck CJ Re-roofi~ Porch CJ SEATS
New Construction CJ Alterations CJ Addition CJ Finish Attic CJ Re-siding CJ Finish Basement CJ 16. PROJECT COSTNALUE
Chimney CJ Misc.
8. PROPERTY AREA OR ACRES 9. PROPERTY DIMENSIONS \10, CULVERT SIZE
Sq. Ft. Width Depth Yes No
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
buil official can revo"d~il for iust cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X ~ ~ ' . <_.-<.y.-99
Signature License No. ... Date .
17. COMPLETION DATE
FOR ADMINISTRATIVE USE
Front
Back
Side
Side
MATERIAL FILED WITH APPLICATION
SOIL TESTS CJ ENERGY DATA CJ
SETBACKS: Required
Actual
BUILDING DEPARTMENT VALUATION
USE OF BUILDING tl.>..~ A I K.
- .
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
PILING LOGS CJ
PLANS & SPECS CJ
SURVEY CJ
PERCOLATION TESTS CJ
SETS
COPIES
PLOT PLAN
CJ
TYPE OF CONSTRUCTION: I II III IV V
Occupancy Group A B E F HIM R S U
Division 1 2 3 4 -1 L( - -lS
Permit Fee ................................... $
( .;)s
City:
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
Plan Check Fee ............................. $
State Su rcharge ............................. $
Penalty ....................................... $
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
Pressure Reducer .......................... $
Meter Hom .................... ........ ....... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
This Application Becomes Your Building Permit When Approved.
By _ Date
Water Tower Fee ........................... $
Water Tap ............. ...................... $
Builder's Deposit ............................ $
Other ......................................... $
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Total Due .............................. $ ,"" - , )
Certificate of Occupancy I '2 // A (
Paid . lo _ (() Receipt No. a -L{<.:I.- i
Issued - Date :;-2 U -1 C{ By Q (luJ .
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 request!,ft. 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 Permit ...................... $
Gas Fireplace Permit ....................... $
City Planner
Date
Special Conditions ~ any
24 hour notice for all inspections 447-9850
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