HomeMy WebLinkAboutBuilding Permit 99-0261
City of Prior Lake
Inspection Notice
DATE
TIME
,
10/25/99 A. T.
SCHEDULED
ADDRESS 16211 BIRCH AVENUE SE
OWNER CONTR
PHONE NO. PERMIT # 99-261
TYPE OF INSPECTION RE-ROOF
COMMENTS:
~w ork Satisfactory, Proceed
D Correct Action and Proceed
D Correct Work, Call for Reinspection Before Covering
Inspector: ~ Owner/Conte.
DATE RECEIVED
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CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
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1. White
2. Pink
3. Yellow
File
City
Applicant
.
-
Permit No.
9C)~c./
DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
2. SI/lzi I
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BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width)
(Depth)
.
3. LEGAL DESCRIPTION
LOT
12. NO. OF STORIES
ADDITION
4. OWNER
111-e e I::;,
/1';;t
BLOCK ~
/'-j/l ~~
r 'I. _ (Addr~S)
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13. TYPE OF CONSTRUCTION
5. ARCHITECT
(Name)
(Address)
(Tel. No.) 14. FLOOR AREA APPORTIONMENT USE
VY'"Z-7S:-~S- -
(Tel. No.)
'.BUILDER Me1 (~,
(Address)
(Tel. No.)
15. NUMBER OF OCCUPANTS OR SEATS
~
. .
w
OCCUPANTS
7. TYPE OF WORK
New Construction CJ
Fireplace CJ
Alterations CJ
Septic CJ
Addition CJ
Deck CJ
Finish Attic CJ
Re-roofi~ Porch 0
Re-siding CJ Finish Basement CJ
SEATS
Chimney 0 Misc.
8. PROPERTY AREA OR ACRE.S / YROPERTY DIMENSIONS 10. CULVERT SIZE
Sq. Ft. / / ,$ Width Depth Yes No
I herebY. certify tha~1 h IS 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 mentione Q 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
bUild~ca v. e permit~se. 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
16. PROJECT ~~E
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17. COMPLETION DATE
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
MATERIAL FILED WITH APPLICATION
Front
Back
Side
Side
SOIL TESTS
o ENERGY DATA
CJ
BUILDING DEPARTMENT VALUATION
k5ff1K
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
PILING LOGS 0
PLANS & SPECS CJ
SURVEY 0
PERCOLATION TESTS 0
SETS
COPIES
USE OF BUILDING
PLOT PLAN
CJ
TYPE OF CONSTRUCTION: I II III IV V
Occupancy Group A B E F HIM R
Division 1 2 3 4
Permit Fee ................................... $
S U
City:
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
Plan Check Fee ............................. !I'.
iL( 7S-
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State Su rcharge ............................. $
Penalty ....................................... $
Plumbing Permit Fee ....................... $
Pressure Reducer .......................... $
Meter Hom ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Mechanical Permit Fee ..................... $
Sewer & Water Permit ...................... $
This Application Becomes Your Building Permit When Approved.
By Date
Water Tower Fee ........................... $
Water Tap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
Total Due .............................. $
Paid -; t:, ~ () 6 Receipt No. /) \
Issued Date /j() --qCj By (l/M
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 requ:!ed. 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.
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Gas Fireplace Permit ....................... $
Certificate of Occupancy
City Planner
Date
Special Conditions ~ any
24 hour notice for all inspections 447-9850