HomeMy WebLinkAboutBuilding Permit #99-0251
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DATE
TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
LjLjO/
SCHEDULED la-~~'L
,
fJ~ Sr
OWNER
CONTR.
PHONE NO.
PERMIT NO.
79-~sl
o FOOTING 0 PLUMBING RI
o FOUNDATION 0 MECH RI
o FRAMING 0 WATER HOOKUP
,..P...JNSULATION _.. /J JAlD SEWER HOOKUP
~FINAL Aa -~\!Y 0 PLUMBING FINAL
o SITE INSPECTION 0 MECH FINAL
o EXIGRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
COMMENTS:
_ 1
t~f\
c&p{df
~RK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
./fLll\ Owner/Contr:
Inspector:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYl
INSNOTI
k'3
DATE RECEIVED CITY OF PRIOR LAKE
BUILDING PERMIT,
.. a ..- TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
- 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
liVe I
1_ DATE
3/s( If1
K2
~ ielf.$A' ~'1 r _~T:
3. LEGAL DESCRIPTION
LOT
PID ,:}s--CftjJ -057-()
ADDITION
BLOCK
!l111..15 111 ~AIAd5
4. OWNER (Name) (Address) (Tel. No.)
.;JOI,.... Lv A. r/'(' V"1 Y'1t9/ f')t'd#_r 7r '1'17-5'010
5. ARCHITECT (Name) (Address) (Tel. No.)
6. BUILDER (Name) (Address) (Tel. No.)
~l,....
7. TYPE OF WORK
New Construction 0
'1'1 (J J
Septic 0
Addition 0
Jd k" f( .,r
Deck 0
Finish Attic 0
w Cc ,"of" ...,
Fireplace 0
Alterations 0
5, LILt 7 - S-.:J 10
Re-roofing 0 Porch 0
Re-siding)( Finish Basement 0
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES
Sq.Ft.
9_ PROPERTY DIMENSIONS
Width Depth
1 O. CULVERT SIZE
Yes No
I. White
2_ Pink
3_ Yellow
File
City
Applicant
Permit No.
t]Y-dC; J
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
16. PROJECT COSTNALUE
17. COMPLETION DATE
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 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
bU~ilding offi . I n revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections_
X 'Z/~
Signature License No. Date
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
Front
Back
Side
Side
BUILDING DEPARTMENT VALUATION
OFF STREET PARKING
SPACES REO_
SPACES ON PLAN
PERMIT VALUATION
;>,5OO.OoJ
USE OF BUILDING
r~~ ~! K,
TYPE OF CONSTRUCTION: I II III IV V
Occupancy Group A B E F HIM R S U
Division 1 2 3 4
City:
Permit Fee ................................... $
74. ,e;-
Plan Check Fee ............................. $
State Surcharge............................. $
Penalty ....................................... $
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
1.2.~
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 Hom ............................ ....... $
Water Meter................................. $
Sewer & Water Connection Fee ........... $
WaterTowerFee ........................... $
Sewer & Water Permit ...................... $
Water Tap ................................... $
Builder's Deposit ............................ $
Other ......................................... $ -/-r_.. ~)O
Total Due .............................. $ _ 10 L-
Paid k- ro Receipt No. ~Lt~l.j2)
~~ {.
This is to certify that the request in the above application and accompanying documents is in accordance with the c~:;on~ ~~Ln; :~ may pr:~d as requeS ~ent when
signed by the City Planner constttutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be issued_
uilding perm~~prr. Ejd.
Date-)-S (- 1
City Planner
Date
24 hour notice for all inspections 447-9850
Special Conditions ~ any