HomeMy WebLinkAboutBuilding Permit 99-0212
CITY OF PRIOR LAKE
INSPECTION NOTICE
SC~E~ULEI)
DATE TIME
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ADDRESS
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OWNER
CONTR.
PHONE NO.
PERMIT NO.
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o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
~FINAL
/ 0 SITE INSPECTION
COMMENTS:
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
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~RK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT W7' CALL FOR REINSPECTION BEFORE COVERING
Inspector: ~, Owner/Contr:
/
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.,
INSNOTI
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYl
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DATE RECEIVED
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
,.ZSS99
, lilRECTIONS
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,-~~
3. LEGAL DESCR.J.Eq"ION
LOT L1
ADDITION }J - 5 h61ff
1'"
L White
2. Pink
3. Yellow
File
City
Applicant
1. DATE
Permit No.
qq -2/2
6. BUILDER (Name) (Address) (Tel. No.)
i fq 11laV"L~dv-~+r'ia.\ 6\ud
4M(Y\.(x~ c.fl-.' ~ic ~'- . '100 - 0 (CO
7. TYPE OF WORK Fireplace 0 Septic 0 Deck 0 Re-roofinV'(.. Porch 0
New Construction 0 rJ Alterations 0 Addition 0 FinishlAttic 0 Re-siding 0 Finish Basement 0
ChimneyO Misc. U~-v -h:::- _~~V-~ 1']f).~Q.L<e-
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 me1;tion pro~e 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
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X ~ ---c..-. :;U6 ( "J...q tJ 0 '.~ .:J/;JLf Cj
t Signature . -License No. ate
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Ilo{Yt p+a 0) S- - I
BLOCK
OctrS
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4. OWNER
. .'-)~h
5. ARCHITECT
(Name)
,"\I',,\..,~ S(~\iA.
(Name)
(Address)
(Tel. No.)
"~
(Tel. No.)
(Address)
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
FOR ADMINISTRATIVE USE
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... !l'
Sewer Tap ...................................lI:
!l'
Pressure Reducer .......................... $
Meter Hom ................................... $
Water Meter ......._......................... $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
Water Tap ................................... lI:
Builder's Deposit ............................ $
Other ......................................... $
Total Due .............................. $~'OO
Paid /b .CC) Receipt No. 3 L{g;{ b
Issued . ~ .
Date 3- LS--4~ By
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 . 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.
SETBACKS: Required
Actual
Front
Back
Side
Side
BUILDING DEPARTMENT VALUATION
USE OF BUILDING ~O Stt/ R-.
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
TYPE OF CONSTRUCTION: I II III IV V
Occupancy Group A B E F HIM R
Division 1 2 3 4
Permit Fee ................................... $
S U
City:
Plan Check Fee ............................. $
State Surcharge............................. $
Penalty ....................................... $
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
14 - 7'5
( - d-S-
Sewer & Water Permit ...................... $
Gas Fireplace Permit ....................... $
This Application Becomes Your Building Permit When Approved.
By Date
Certificate of Occupancy
City Planner
Date
Special Conditions ij any
24 hour notice for all inspections 447-9850
MATERIAL FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA 0
PILING LOGS 0
PLANS & SPECS 0
SURVEY 0
PERCOLATION TESTS 0
SETS
COPIES
PLOT PLAN
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