HomeMy WebLinkAboutBuilding Permit #99-0273
CITY OF PRIOR LAKE
INSPECTION NOTICE
iJ il.i
SCHEDULeD
ADDRESS
/6'</6'0 :r~
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION . .-I1if)
~FINAL All""""'" 'CI
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
COMMENTS:
Olr
~/~
DATE
TIME
iJ-6-crq
? ?- d. '13
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
~RK SATISFACTORY, PROCEED
~~RRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
~Apwner/contr:
Inspector:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE~
/NSNOT/
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYl
---------,----_.._~.....,..."_.._._-_..~-
Q.ATF R~
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
1ft f-
DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
1. DATE
~-s. P9
2. SI~ ADDRESS
(~lj~/') LA/Oo/14-1//1.-
3. LEGAL DESC~l}ON I -
LOT ~ Lf BL09< _ ~ I .
ADDITION ~UI1 dc5V't^- ~
4~W ER - ,('~ A . (Address)
'jr(j /(d~/ 10.~f' j-l7l;j//tf/10/Jd
5. CHITeCT (Name) (Ad ess)
-0/;/2 ~IJ~~
~c; 1YI~ - () t.J3 -/
PID 0(
(Tel. No.)
t/V7- 325/
(Tel. No.)
6. BUILDER
(Name)
(Address)
(Tel. No.)
7)t>Jy Pllft.i~;;t-i;/ -0~ef~/a~0~ &~ fL3/- 5>/P(7
7. TYPE OF wORK Fir;&lace 0 Septic 0 Deck Re-roofing t;/ Porch 0
New Construction 0 Alterations 0 Addition 0 Finish Attic 0 Re-siding 0 "I=inish Basement 0
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES
Sq.Ft.
9. PROPERTY DIMENSIONS
Width Depth
10. CULVERT SIZE
Yes No
1. White
2. Pink
3. Yellow
File
City
Applicant
Permit No. crc;- 2 {'5
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
41 :1/ ~ 11, eJ 0
1 ~OMPL~TIONDATE
I hereby certify th 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 me one 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 offi . I can evoke this permit fo~justJ8Jse. F~hermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X PA~, A /-::~~ :)tJd ?''i t./9~ 9'- s~ C/9
II ~gnature License No. Date
FOR ADMINISTRATIVE USE
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
COllective Street Fee ....................... $
Sewer Tap ................................... $
$
Pressure Reducer .......................... $
Meter Horn................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
WaterTap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
Paid tl/fue ................... ~~~~i~~ ~o~
Date v1_ y-c; tJ By
SETBACKS: Required
Actual
Side
Front
Back
Side
BUILDING DEPARTMENT VALUATION
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION 21)0 ('J . C:7C1
USE OF '";t':CS f rt/2
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 ................................... $
/4. {S-
Plan Check Fee ............................. $
~
l . "Z. c;
State Surcharge ............................. $
Penalty ....................................... $
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
Sewer & Water Permit ...................... $
Gaa1ePla P ~'t ...... ............... $
Th' I com ur Building Permit Whe1!.!~d.
By Date If-t.,
10- '" I - -
Certificate of Occup ncy
Issued
MATERIAL FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA 0
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS 0
SURVEY 0
PLOT PLAN 0
SETS
COPIES
&I~
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 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.
24 hour notice for all inspections 447-9850
Special Conditions ~ any
City Planner
Date