HomeMy WebLinkAboutBuilding Permit #99-0295
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
4 ~ v-1't
Nr
ADDRESS
~8S !;
Cw-~
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OWNER
CONTR.
PHONE NO.
PERMIT NO.
G19-l~<
o FOOTING
o FRAMING
o INSULATION
"~L
W-- 0 FOUNDATION
o DEMOLITION
o FIRE PREVo 1'..,_ L.
COMMENTS: -"1)
o PLUMBING RI
o MECHANICAL
o WATER HOOKUP
o SEWER HOOKUP
o SEPTIC INSTALL
o PLUMBING FINAL
o SITE INSPECTION
o EXC/GRAD/FILLlNG
o LKSHORENYETLAND
o COMPLAINT
o SEPTIC FINAL
o FIREPLACE
o
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~ WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector:
-~ .\~
_ Owner/Contr:
CALL 447-4230 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.,
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYl
DATE RECEIVED
CITY OF PRIOR LAKE
BUILDING PERMIT,
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
5 if S' C\ Ca..c.A ~ (\ 'lJ 12 ~dci-,
3, LEGAL DESCRIPTI01 ')
LOT ~ _ j. BLOC~ 11(7-
ADDITION ~ K,'dat.
J
1, DATE
4-~-qq
fltlJ
lr).. ~ \
PID ~ -d '17-()J.f, -D
1~7ddn t
4. OWNER (Name)
~\--.. ~~"Ir-u-
5. ARCHITECT (Name)
(Address)
.l\.K5.S Cd,{t';d\ R..~~.. Ir
(Address)
(Tel. No,)
Lt'D-7~
(Tel. No,)
6, BUILDER (Name)
~L.O\ 'i3~2S
A/pptJ h~m R I'r~t\4
7. TYPE OF WORK Firepla~
(Address) d (Tel. No,)
ttltJlletJ)(J::) !Y:>~t /7
I3E3 S 1t::L1. ~=.11 .$' Ie S (,QJ - 17ltJ-SSO{)
Septic 0 Deck 0 Re-roofing)l Porch 0
Addition 0 Finish Attic 0 Re.siding 0 Finish Basement 0
New Construction 0
Alterations 0
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES
Sq.Ft.
Width
9. PROPERTY DIMENSIONS
No
10. CULVERT SIZE
Depth
Yes
1. White
2, Pink
3, Yellow
File
City
Applicant
Permit No.
qt;- ~9r;-
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
12, NO. OF STORIES
13. TYPE OF CONSTRUCTION
~~r^-Cl
14. FLOOR A~APPORTIONMENT USE
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
SEATS
16. PROJECT COSTNALUE
LoL500. ~
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 ntioned property 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
buil' 0 cial can revo thi pe . for just cause, Furthermore. I hereby ag~ tJelf342~eSignee may enter upon the property to perform ~eK ;:;:;;ns,
Signature License No, ~ ~ate
SETBACKS: Required
Actual
Front
BUILDING DEPARTMENT VALUATION
~viJt~
USE OF BUILDING
FOR ADMINISTRATIVE USE
MATERIAL FILED WITH APPLICATION
Back Side Side SOIL TESTS 0 ENERGY DATA 0
OFF STREET PARKING PILING LOGS 0 PERCOLATION TESTS 0
SPACES REO. PLANS & SPECS 0 SETS
SPACES ON PLAN SURVEY 0 COPIES
PERMIT VALUATION dSZ'tl. tV PLOT PLAN 0
TYPE OF CONSTRUCTION: I " III IV V
Occupancy Group A B E F HIM R S U
Division 1 2 3 4 -1 '-1_ ~'
Permit Fee ................................... $
Plan Check Fee ............................. $
State Surcharge ............................. $
Penalty ....................................... $
Plumbing Permit Fee ....................... $
MeChanical Permit Fee ..................... $
Sewer & Water Permit ...................... $
Gas Fireplace Permit ....................... $
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
City:
J.).c:J
Pressure Reducer .......................... $
Meter Hom ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
This Application Becomes Your Building Permit When Approved,
By Date
Water Tower Fee ........................... $
Water Tap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
Total Due .............................. $--2f,L!O
Paid 7ft,.~ Receipt No. 'ZDl{~ 78
~ JI 2
Date~'-f -1 ~ By
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 req ested. 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.
Certificate of Occupancy
city Planner
Date
Special Conditions ff any
24 hour notice for all inspections 447-9850