HomeMy WebLinkAboutBuilding Permit 99-0250
~ PRIOR LAKE
-..:CTION. NOTICE
ADDRESS
5~\
OWNER
PHONE NO.
o FOOTING
o FRAMING
~ .0 )NSULA TIO'j, r
XFINAL r-~ ~
o FOUNDATION
o DEMOLITION
o FIRE PREVo
COMMENTS:
~J
SCHEDULED
DATE
.
'-f ;cn
TIME
~k.s C\l'i'".
CONTR.
PERMIT NO.
q q - ~SO
o PLUMBING RI
o MECHANICAL
o WATER HOOKUP
o SEWER HOOKUP
o SEPTIC INSTALL
o PLUMBING FINAL
o SITE INSPECTION
o EXC/GRAD/FILLING
o LKSHORElWETLAND
o COMPLAINT
o SEPTIC FINAL
o FIREPLACE
o
//
O~
~ORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: . J! R. ~ Owner/Contr:
CALL 447~230 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE..
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
(
-~-~'_.~-"-' ~"'-'-- -,- '-'-'., <~_._~--_...,-_. - ._._.....~_..._.- .............
DATE RECEIVED
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
WI 3 I 1900
1.~A7) 1 Jq~
2. SITE ADDRESS {r (" ~ I
--5~~\ B"OD'K-S iy:Jl.- ?L. 5~~1?- I'--
3. LEGAL DESCRIPTION { r
LOT 3 BLOCK '1 . A J A PID dS- --0 (~ - b3 <{ -0
ADDITION ~ Ym \(s\' I \ {e... H7 r I ~ L Vlg f1Ot^ t 1
4. OWNER (Na~~ J (Addre~)h
rVt4:lk IVR./). /'y).W~ ( S~e JJ OW
5. ARCHITECT (Name) (Address)
DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
(Tel. No.)
(Tel. No.)
6. BUILDER (Name) A ((AddreSS) ("?;. No~
-1OfJ,1\(. Consl. ff/lOO Ol~ Lb/})
7. ~~ ~~VlA.~'tre~ . Aft!ceo~ II~g 55~?!Ofin9~,-:-c{3:0;!1J~
New Construction 0 Alterations 0 Addition 0 Finish Attic 0 Re-siding 0 I~nish Basement 0
1. White
2. Pink
3. Yellow
File
City
Applicant
Permit No. Cfi c)sO
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
12. NO. OF STORIES
13. TYPE OF CONSTRUCTION
14. FLOOR AREA APPORTtONMENT USE
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
SEATS
16. PROJ~T COSTNALUE
cr-J OrJ ~
Chimney 0 Misc. .,J ,
8. PROPERTY AREA OR ACRES 9. PROPERTY DIMENSIONS 10. CULVERT SIZE 17. ~ETION DATE
Sq. Ft. Width Depth Yes No ~
I hereby certi t I haven f' ed 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 ntioneYfpe d 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 offic I n r ke is armit for just cause. Furthermore, I hereby agree that the c~ official or a dSiqee may enter upon the property to perfOIgl f;edtLcrections.
X . I ~O'Od-f..)) ~
Signature License No. D te
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
Front
Side
Side
Back
BUILDING DEPARTMENT VALUATION
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
USE OF BUILDING
~~ A-i 11.
TYPE OF CONSTRUCTION: I " III IV V
Occupancy Group A B E F HIM R S U
Division 1 2 3 4 /4 ~ ,e;
Permit Fee ................................... $
!.J.-c;
City:
Plan Check Fee ............................. $
State Surcharge ............................. $
Penalty ....................................... $
Plumbing Permit Fee ....................... $
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 ........................... $
WaterTap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
Total Due .............................. $ 16 -00
Paid {ro. ()() Receipt No. ""6Ll'642-
~ ~/._l
Date '3/3" ClC, By C.~
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'.ed. ThiS document when
signed by the City Planner const~utes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Cert~icate of Occupancy must be issued.
Mechanical Permit Fee ..................... $
Sewer & Water Permit...................... $
Gas Fireplace Perm~ ....................... $
This Application Becomes Your Building Permit When Approved.
By Date
Certificate of Occupancy
City Planner
Dale
Special Conditions ~ any
24 hour notice for all inspections 447-9850