HomeMy WebLinkAboutBUILDING 08-0410
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
DATE TIME
7.~b~
, J
ADDRESS (. g(p~ (\~e5~V'\\,)\-
OWNER
CONTR.
PHONE NO.
PERMIT NO.
R - ~'D
o FOOTING
o FOUNDATION
o FRAMING
o INSULAiiON r
)?FINAL oc.e ~\r
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EXIGRAD/FILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
COMMENTS:
. "'- I
(llose.~.\:~ \ /7
J!!1'WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORREMRK. CALL FOR REINSPECTION BEFORE COVERING
InSpectO) / ~\ Owner/Contr:
CAL~-~ THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH de SAFETY!
INSNOTl
CITY OF PRIOR LAKE \l.-t-lOt)
BUILDING PERMIT.
TEMPORARV CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT Permit No.
(Tel. No.) 14. FLOOR AREA APPORTIONMENT USE
q5~-WS'-6'&/ ;
(Tel. NO.)
1 hereby cerllfy \hell have Ivmlshed Information on Ihis application whle" Is to the t>9st 01 my knOWledge trUe and correct I al(;o certily Ihall ~m the owner ()( IIvlhorized a~llor
the ~oove men\loned property and \hilI all conlllrue\lOl\ will conlOflTl 10 all axiSllng 5",te and IOc&Ilaw5 Olnd will proceed in accordance wttI1 submillOO pl!lns. lllm awerp' IMl !he
:Ulldi~ dL'hl.s~re. I herotlyegree Ihlll Ihe c~or;;'/10 9~A 3Y enter U[)O!l the property 10 pertZ$;f?M'
/ )---.- Slgr>oture .:~._:.._\'---'''NO. / 10
FQ.R ADMINISTRATIVE USE
Q"TE RECEIVED
1. DATI<
I b/;J-~JO (
tie.
DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST Bf 'FIllED IN
BEFO~f f"ERMIT IS ISSUED (Plesu p.;nl or Ty~ and !<ign :11 OCllIom)
2. SrTEADORESS 11_ /J ~- ~ ~ _ /...j" .
. J. /' 430r ~rvt.V ~
3. LEGAL OES~ON
\.OT _ BLOCK - PIO -
"ODITION
4. OWNER (Name)' (A~ress)
~';-U5rL O~ 4%4 {!hd~ ~
S. AJ:l~CT (Name) (.Address)
6. BUILOER . lNamel (MorO$s) . ('ret. No.). .
~1<-.t:>~ ~rdt114./ ;l9~ ;:Jt4da.d/JR. .su2Ubo
q~-;"'-lo7- h~69 13u47tXUJd<< j ~5931
7. TYPE OF WORK F1repiac!! n SeptiC C1 Dee\<" ~Re.rcolln\l ?orch:::)
New ConslruCllon 0 AIIerallons 0 Add/non 0 Fintsn AHIe CI R; I
Chlmney:J Misc. ~
8. PROPERTY AREA OR ACRES
Sa. Ft
9. PROPERTY DIMENSIONS
W,<l\l'I Deplh
10. CULVERT SIZE:
Yes NO
SETBACKS: Requlr9d
Aclual
5aCl<
~.
S;d.
Fronl
BUILDING OEP~TMENT VA1..UATION
OFF STf~eET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
USE OF BUILDING _
I. While
I.. Pink
1 YeU,,'"
F,k
City
"prlicMl
D8.000
BUilDING INFORMATION
11. SIZE OF STRUCTURE
(~) lW.cl\h\ (O"P"')
12. NO. OF STORIES
13. TYPE OF CONSTRUCTION
1S. NUMBER OF OCCUP"NTS OR SEA T$
OCCU~ANTS
SEATS
16. PROJECT COSTNALUE
8'~/9. hO
17. COMPLETION DATE
?-/-o(
MATERIAL ALEDWlTH APPUCATION
SOIL TESTS [) ENERGY OAr" 0
PIUNG LOGS 0 PERCOLATION TESTS 0
PlANS & SPECS 0
SURVEY 0
P\.OT PLAN n
sers
COPIES
'n'PE Of coNSTRUCTION: I n 111 IV V
OcoupQncy GroUP A B E F ti I M FI S U
~ , ,3.
Permit Fee ................................... $-
CI!y:
Amoutll Brovght FofW;lrd .................. S
Pel1c S~or\ Fllll .....................,..... $
SAC ......................................... S
Collective Slroet Fee .......................5_.
Sewer Tap ................................... S
S
Preswral=\educet .......................... s.
MeterHem ................................... $
WeltrMeler ................................. S
Sel/ler & Waler COr'lnection Fee ........... S
WlllorToWtlr ~ee ........................... S
Plen Checll Fee ..................... ........ S
$ra\e Surcharge ............................. S
Penally ....................................... S
Plumbing Permft ~ee ....................... $_
Mechanical Permll Foe ..................... S
Sewer & warer Permll ...................... S
GaS ri .......J Permit ....................... $ walorTap ................................... S
This A./~,Jon B,.. "YOIX BuIlding PB,,"II When A.. . _.. 9IJllder'B o..poslt ............................ S
By _ Dale Other ......................................... S ~
c.rtJlIcale 01 Oceupancy Toral Due .............................. S &:/ ?:!r,
I eel Paid -' RecelPl No. ~ 0 ( ~
ssu . Del8 (, 1:27 /~ By ~.
thIS IS 10 cerllIy \llel lhel8queslln \he ~ applica(lOll end BCC()IIll)&I1VIno oocumenls Is In accorclallCe with !he city ~rce and ""'y pr~ccd liS requeSlllO Thl& documenr when
$ignlll5 \lIy thll CIty P18N* c;on$lllUleS. ,.' .' ,. ! ee"mca18 01 Zoning compIiatICe and alowS cons\luc:lIon to commBllCll. Belore oot<fDency. a Cer1lfI<;a\e 01 OCC\lPftl'lCY t'i'lUS1 be l""ued.
Cl)- PIornet
0818
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