HomeMy WebLinkAboutBuilding Permit 99-0275
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
'il,
DATE TIME
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It.T
ADDRESS J~S-'<;3 ~ ~~ eQ..
P/
OWNER CONTR.
PHONE NO.
PERMIT NO. 99 - C).. /~
o FOOTING 0 PLUMBING RI
o FOUNDATION 0 MECH RI
o FRAMING @) 0 WATER HOOKUP
o INSULATION 0 SEWER HOOKUP
)( FINAL 0 PLUMBING FINAL
o SITE INSPECTION 0 MECH FINAL
COMMENTS: 4 '
/J
I(~ ~ I~
o EXIGRADIFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
~
~
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/
~ORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WO~ CALL FOR REINSPECTION BEFORE COVERING
Inspector: e; -r ( Owner/Contr:
I
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE..
INSNOTI
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
DATE RECEIVED
CITY OF PRIOR LAKE
<< BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
1. White
2. Pink
3. Yel10w
File
City
Applicant
NlRSIII
Permit No.
99 - :lIS-
. 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
I ct5.3?>
3. LEGAL DESCRIPTION
l
ft1~V1
1. DATE
4 J 5 J qq
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
LOT
P>ref"j R+
BLOCK f
31:9 MdVl
Rcl
/'}~- /5~-OO I-a
PIDO(V
12. NO. OF STORIES
13. TYPE OF CONSTRUCTION
ADDITION
4. OW~ER _ 11 (Name)
L\ n L\ ~
5. ARCHITECT (Name)
(Address)
1< (/\ S'IO C1 y f (c....-
-, (Address)
Li41~1j~{,
(Tel. No.)
14. FLOOR AREA APPORTIONMENT USE
6. BUILDER (Name)
KfeuS{'y ~~n~
(Address)
(Tel. No.)
15. NUMBER OF OCCUPANTS OR SEATS
Lj4~-3<6'1)
OCCUPANTS
7. TYPE OF WORK
New Construction 0
Fireplace 0
Alterations 0
'""Septic 0
Addition 0
Deck 0
Finish Attic 0
Re-roofing ~ Porch 0
Re-siding 0 Finish Basement 0
SEATS
16. PROJECT COSTNALUE
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES
Sq.Ft.
9. PROPERTY DIMENSIONS
Width Depth
10. CULVERT SIZE
Yes No
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
:uilding official can re~m.;!::-t ~ebY agree that the city Offici~;;etgg:e.;:y r~ Sn the property to pe;,sje,ns:,ections.
, Signature License No. Date
FOR ADMINISTRATIVE USE
Front
Back
Side
Side
MATERIAL FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA 0
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS 0 SETS
SETBACKS: Required
Actual
BUILDING DEPARTMENT VALUATION
TYPE OF CONSTRUCTION: I II III
Occupancy Group A B E F):l 1 M
Division 1 2(3.,/
Permit Fee ................................... $
/1_
IVG.Y
~S U
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION ~
SURVEY
o COPIES
USE OF B~ING /i J A
PCpS' H//(
.-;
PLOT PLAN 0
City:
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
7 (p!JZ---
7 c.f.""D
Plan Check Fee ............................. $_
State Surcharge ............................. $
,.2~
Penalty ....................................... $
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
Pressure Reducer .......................... $
Meter Hom .................... .... ........... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
Water Tap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
Paid TOplJ..................~~~~i~;~O~ 3Cf8CJfj
Date f{ - ')- Jj f By
Sewer & Water Permit ...................... $
:: M" . .....I:;;,~,~;.;.:.~ '-. ~~
By ~~ * Date 'i "} - "'-+-
Certificate of Occupan
Issued
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 constnutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy. a Certificate of Occupancy must be issued.
City Planner
Date
Special Conditions ~ any
24 hour notice for all inspections 447-9850