HomeMy WebLinkAboutBuilding Permit 99-0207
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS ~ 1405
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
~ FINAL
o SITE INSPECTION
COMMENTS:
DATE TIME
SCHEDULEQ
ICrZ-Z-7'
A.,Tr
aJ'~f-J.~ ~ T/C., I
CONTR.
PERMIT NO. 9 9 -2. CJ 7
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 ;& ~
K-f fA ~ ,r
,~
/'
~K SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspecloe ~ . _ Qwne,/ConbC
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYl
INSNOTI
.~._..._..--_._~._.._~.--
QATERECEIV~ CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
. ZONING COMPLIANCE
. Z 5 ~ND UTILITY CONNECTION PERMIT
1. White
2. Pink
3. Yellow
File
City
Applicant
Permit No. ~ -:dD7
. 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
3<16< u...J,'//o l.t.J 1?r..4-()), 721
3. LEGAL DESCRIPTION
1. DATE
d-o?$ -7'9
(( {5~
PIf./~ R...
BUILDING INFORMATION
11. SIZE OF STRUCTURE
L I (Height) (Width)
4./o.e
(Depth)
<. OJ
LOT
ADDITION 7fu.c f {::'
BLOCK
/'CLS#-Sf{
PIDcY)-I(JI-oO~-lJ
12. NO. OF STORIES
13. TYPE OF CONSTRUCTION
(!j(l. ~ Ai 411-
(Address)
JJr; iJ L
(Address)
(Tel. No.)
L /IL-c . f11 )I
(Tel. No.)
14. FLOOR AREA APPORTIONMENT USE
6. BUILDER (Name)
'TY!a:di f~
New Construction 0 Alterations 0
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES
Sq. Ft.
(Address)
(Tel. No.)
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
SePtic~~:
Addition 0 Finish Attic 0
tip .I/?~1&1
Re-roofing}!l' Porch 0
Re-siding 0 Finish Basement 0
SEATS
16. PROJECT COSTNALUE
9. PROPERTY DIMENSIONS
Width Depth
10. CULVERT SIZE
17. COMPLETION DATE
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
buildingjlliC!al. can lJJv,o)l9this 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~~rat..JJ -r:'D~ cJ1,/)/SS<./KC, B -~ $"- ~7
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
USE OF BUILDING ~ t4-{ t'l
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
PILING LOGS 0
PLANS & SPECS 0
SURVEY 0
PERCOLATION TESTS 0
SETS
COPIES
PLOT PLAN
o
TYPE OF CONSTRUCTION: I II III IV V
Occupancy Group A B E F HIM R S U
Division 1 2 3 4 /4.lS
Permit Fee ................................... $
'.)6
City:
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
Plan Check Fee ............................. $
State Surcharge ............................. $
Penalty ....................................... $
Pressure Reducer .......................... $
Meter Horn................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
Plumbing Permit Fee ....................... :I:
Mechanical Permit Fee ..................... $
Sewer & Water Permit ...................... $
Gas Fireplace Permit ....................... $
This Application Becomes Your Building Permit When Approved.
By Date
Water Tap ................................... $
Builder's Deposit ............................ $
Other ......................................... $_ _
Total Due .............................. $ )(0.0()
Paid jfo.c(j Receipt No. C1--I ~ (Ei
Date 3';;S-c[~ By OlM
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 reque~d. 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
Issued
City Planner
Date
Special Conditions ff any
24 hour notice for all inspections 447-9850