HomeMy WebLinkAboutBUILDING 08-0407
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CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
4~,l
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OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING 0 PLUMBING RI
o FOUNDATION 0 MECH RI
o FRAMING 0 WATER HOOKUP
~NSU~ ~ 0 SEWER HOOKUP
~ ~INA ,:>,y..{ 0 PLUMBING FINAL
o SITE IN ION v:?; 0 MECH FINAL
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o FIREPLACE FINAL
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~o '(.001 ~ - I
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~WORK SATISFACTORY, PROCEED
/ 0 CORREafACv"lON AND PROCEED
. CALL FOR REINSPECTION BEFORE COVERING
K110 t-05
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Inspect4>r: -1 { I " Owner/Contr:
J44~850 F1R THE NEXT INSPECTION 24 HOURS IN ADVANCE.
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INSNOTJ
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
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C,..\.: ' MENTS A 11"5/'1011
CODE REQUIRE
1 'Z-~-;
DATE RECEIVED CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
1. White
2. Pink
3. Yellow
File
City
Applicant
Permit No. 08 - O!/.O 7
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 __
L(3b I ,-oX
3. LEGAL DESCRIPTION
)J-u,u-; eOC(R, N. E:.
1. DATE
b/~3.-/() (
I I
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
12. NO. OF STORIES
LOT
BLOCK
PID
13. TYPE OF CONSTRUCTION
ADDITION
4. OWNER (Name)
l<eITH.fLVJ.fjJ 5~
5. ARCHITECT (Name)
(Address)
'f~ 1 FOx J./UIJ-r (!:1: JJf-
(Address)
(Tel. No.) 14. FLOOR AREA APPORTIONMENT USE
q~:J.-i./9~-3"~~
(Tel. No.)
6. BUILDER, (Name) (Address) ~. (Tel. N<?) . 15. NUMBER OF OCCUPANTS OR SEATS
~~~;./~'*~~~ V1GO Ud,Gut.fKW.su.ddoo OCCUPANTS
--'~ ~ 'ifH5 13UA4t<J,()M I /l~ 5"5337 q5'""Z--=rdl~t:l/~~
7. TYPE OF WORK Fireplace 0 Septic 0 Deck 0 Re-roolinq)( Porch 0 ATS
New Construction 0 Alterations 0 Addition 0 Finish Allic 0 Re-sidinlj)( Finish Basement 0 16. PROJECT COSTNALUE
/~t 500 .~o
17. COMPLETION DATE
~ --;)-3 -og
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES
Sq. Ft.
9. PROPERTY DIMENSIONS
Width Depth
10. CULVERT SIZE
Yes
No
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
building 0 . can revoke this p~~ just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform ')'leded jnspections.
X . ~1. /...v<.~ :J-I:>1~~3 B""3 ~/.;1310v"
Signature License No. I 6ate-
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
MATERIAL FILED WITH APPLICATION
Front
Back
Side
Side
SOIL TESTS
o ENERGY DATA
o
BUILDING DEPARTMENT VALUATION
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS 0 SETS
USE OF BUILDING
PERMIT VALUATION
2, -)OO.od
SURVEY
PLOT PLAN
o COPIES
o
TYPE OF CONSTRUCTION: I II III IV V
Occupancy Group A B E F HIM R S U
Division 1 2 3 4
Permit Fee ................................... $
City:
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
Plan Check Fee ............................. $
State Surcharge ............................. $
Penalty....................................... $
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
Pressure Reducer .......................... $
Meter Hom ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
Sewer & Water Permit ...................... $
Issued
WaterTap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
Total Due .............................. $ 7t.()d
Paid Receipt No. ~~ 6 {, ,
Date fJb~/{)PJ By ftIJ - ~
This is to certify that the request in the above application and accompanying documents is in accordance with the City zonirfg Orc4nanc~ and may proceed as requested. 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.
..................... $
Your Building Permit vlJ,eJr,p ro 'd.,
Date rr.?1
!
Ctty Planner
Date
Special Conditions n any
24 hour notice for all inspections 447-9850