HomeMy WebLinkAboutBuilding Permit 99-0235
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CITY OF PRIOR LAKE
INSPECTION NOTICE
DATE TIME
SCHEDULED.
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A.t;
ADDRESS
/~7tJ3 4~Aoe.
OWNER
CONTR.
PHONE NO.
99 -;;"35
PERMIT NO.
o FOOTING
o FOUNDATION
D FRAMING
o INSULATION
FFINAL
D SITE INSPECTION
o PLUMBING RI
o MECH RI
D WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
D MECH FINAL
o EX/GRAD/FILLING
D COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
D GASj.INE AIR TST
14 R!.; ~
,
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COMMENTS:
p~
(~
"- .
~
~RK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
D CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
61;
I
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE..
Inspector:
Owner/Contr:
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTI
DATE RECEIVED
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
1lP- 3 0 I!Sl
. DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bollom)
2. SITE ADDRESS
..1!:tW3
1. DATE
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RlSb
l:k-olO -()
~ ~l'E
3. LEGAL DESCRIPTION
"6 tLOCK Z M. PID l~5 -
ADDITION ()Q/(lCUllO t\Ocu::.V1 '2 M.d.v1.
("d~rrSS)
111Q2 EJ/CYr1QlE AY~;F
(Address)
LOT
4. OWNER () (Name)
:Tom Ke.mf:S
5, ARCHITECT
(Tel. No.)
'I.!fJ- z.~
(Tel. No.)
(Name)
6. BUILDER
(Name)
(Address)
(Tel. No.)
, . ~~-
HbrTZOI1 [J+CflffS 1~3 Larc j rrI U~ tfln J ~'vd. 3~ro
7. TYPE OF WORK Fireplace 0 Septic 0 D~ Porch 0
New Construction 0 Alterations 0 Addition 0 Finish Allie 0 Re-siding 0 Finish Basement 0
Chimney 0 Misc.
B. PROPERTY AREA OR ACRES
Sq.Ft.
9. PROPERTY DIMENSIONS
Width Depth
10. CULVERT SIZE
Yes
No
., ~.C:l:)
1. White
2. Pink
3. Yellow
File
City
Applicant
Permit No. Cf{1-l65'
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
12. NO, OF STORIES
13. TYPE OF C.~N~T,64CTION
(c- rear
14. FLOOR AREA APPORTIONMENT USE
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
SEATS
16. PROJECT COSTNALUE
~~1'0..~
17, COMPLETION DATE
I hereby certify that I have furnished 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
ilding official can revoke this perm' for just cause. Furthermore, ~ hereby agree that the city official or a designee may enter upon the property to perform needed inspe tions.
X \ !-r- ..... LDOI OJ"? 9....Cj -.l z. 2.
Signature I License No. Date
FOR ADMINISTRATIVE USE
MATERIAL FILED WITH APPLICATION
SETBACKS: Required
Actual
Front
Back
Side
Side
BUILDING DEPARTMENT VALUATION
~(i~ M~
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
USE OF BUILDING
TYPE OF CONSTRUCTION: I II III IV V
Occupancy Group A B E F HIM R
Division 1 2 3 4
Permit Fee ................................... $
SOIL TESTS
o ENERGY DATA
o
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS 0
SURVEY 0
SETS
COPIES
PLOT PLAN
o
Plan Check Fee ............................. $
-1 C{, ,5
I.~~
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
S U
City:
State Surcharge............................. $
Penalty ....................................... $
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
Pressure Reducer .......................... $
Meter Horn ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
WaterTap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
T..Q!.al Due ................W........ $ ,fv, .-GO _
Paid f/, U't\ L I 7~- Receipt No. 3q~~/
Issued
Date ~ ,-~{q By ( \ \(t
This is to certify thatlhe request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requesteS. 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 ....................... $
This Application Becomes Your Building Permit When Approved,
By Date
Certificate of Occupancy
City Planner
Date
Special Conditions ~ any
24 hour notice for all inspections 447-9B50