HomeMy WebLinkAboutBuilding Permit 99-0255
City of Prior Lake
Inspection Notice
DATE
TIME
10/25/99 A. T.
SCHEDULED
ADDRESS 16980 BLIND LAKE TRAIL SW
OWNER CONTR
PHONE NO. PERMIT # 99-255
TYPE OF INSPECTION RE-ROOF
COMMENTS:
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Inspector:
Work Satisfactory, Proceed
Correct Action and Proceed
Correct Work, Call for Reinspection Before Covering
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Owner/Contr.
11Ift
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CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CI;RTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
1. White
2. Pink
3. Yellow
File
City
Applicant
QATE RECEIVED
Permit No.
crt - :;}55'"
. DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
1. DATE
2. SITE ADDRESS / t:, 9'~D
13(,~
'1-/- 99
~~ rvct,-{ (2rsb
Plod') -n/7- (/1r-o
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
3. LEGAL DESCRIPTION
/7 BLOCK
PrIor sl'JuJ!/\..-
4. OWNER lCo..:J~) I
12. NO. OF STORIES
-
LOT
5. ARCHITECT
(Name)
j' / (Address)
TJ21\ y-e- if y
(Address) .
~;;o No:. ~ 5 <ir/
(Tel. No.)
1~~~TRUCTION
14. FLOOR AREA APPORTIONMENT USE
ADDITION
(~TtHT-WA V Rdfr~)ING
1200 E. 79th Street
7. TYPE OF WORK BI~mP!'i9ton I SPQfiNJ 554~O
New Construction 0 Altel}l~n~ q) \ ..f.cjl1itIQ,n 0 Fjn~ AttiC' 0
Chimney 0 Misc. \ \ ,. .. } H :J 0 - 0 0 q ~
8. PROPERTY AREA OR ACRES - .- . -'fCPROPi::H I V LJIIVII::I~'::>IU"'::> 1
Sq. Ft. Width Depth
(Tel. No.)
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
6. BUILDER
Re-roofing 0 Porch 0
Re-siding 0 Finish Basement 0
SEATS
16. PROJECT COSTNALUE
10. CULVERT SIZE
Yes No
17. COMPLETION DATE
I hereby certify that ve 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
roperty 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
evoke this permit fo~ ~"e, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
......., :::::? ~ oCt:? *5 999 if - / - er'9
- ./ ......- ~ - License No. Date
x
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
MATERIAL FILED WITH APPLICATION
Front
Back
Side
Side
SOIL TESTS
o ENERGY DATA
o
BUILDING DEPARTMENT VALUATION
USEOFBUILDING ~l().s A-! K~
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
PILING LOGS 0
PLANS & SPECS 0
SURVEY 0
PERCOLATION TESTS 0
SETS
COPIES
PLOT PLAN
o
TYPE OF CONSTRUCTION: I " III IV V
Occupancy Group A B E F HIM R
Division 1 2 3 4
Permit Fee ................................... $
Plan Check Fee ............................. $
State Surcharge ............................. $
Penalty....................................... $
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
S U
lLl./S
(.~'5""
City:
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
Sewer & Water Permit ...................... $
Pressure Reducer .......................... $
Meter Hom ................................... $
Water Meter................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
Gas Rreplace Permit ....................... $ Water Tap ................................... $
This Application Becomes Your Building Permit When Approved. Builder's Deposit ............................ $
By Date Other ......................................... $ -
Certificate of Occupancy Total Due .............................. $ ;frJ caJ
Paid I~ .c() Receipt No. ~L(~Lf~
Issued .,
This is to certify that the request in the a~ application and accompanying documents is in accordance with the c~:;on~t!)a~~nd may pr::ed as r~~s document when
signed by the City Planner constitutes a tem~ Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be issued.
cny Planner
Date
Special Conditions ~ any
24 hour notice for all inspections 447-9850