HomeMy WebLinkAboutBuilding Permit 99-0322
DATE TIME
CITY OF PRIOR LAKE /a-2l-??
INSPECTION NOTICE SCHEDllJ,.ED A.7i
ADDRESS --Y'0/? U~ .:c# ~
OWNER CONTR.
PHONE NO. PERMIT NO. 99-.322-
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
lzl1 FINAL
/0 SITE INSPECTION
o PLUMBING RI 0 EX/GRAD/FILLING
o MECH RI 0 COMPLAINT
o WATER HOOKUP 0 FIREPLACE RI
o SEWER HOOKUP 0 FIREPLACE FINAL
o PLUMBING FINAL 0 GASLINE AIR TST
o MECH FINAL 'f'!-~
COMMENTS: &-? ~ ~
_ ~L P_o<;-:; ~
C A'j/~ ~ ~
J
-
L-" . _ II --- ,,~.
/
~ORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
:,::.ECT;; ~LL FOR REINS:::::,:EFORE COVE~NG
f
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.,
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
/NSNOT/
OAIE' RECFIVFQ
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
1. White
2. Pink
3. Yellow
File
City
Applicant
.'t.
Permit No.
qq- 32.2-
DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
f :2. SITE ADDRESS
L/ b II Co \.or-o..M ~ b \
3. LEGAL DESCRIPTION
10
P C\ 0(' la.1<. e.
1. DATE
4-!,Z-/q 1
1<.'2-
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
rf\tJ
BLOCK
15""
12. NO. OF STORIES
LOT
PID Z5 - 00 I - {ll- 0
13. TYPE OF CONSTRUCTION
ADDITION
> ~. OWNER
10 ''-l
5, ARCHITECT'
(Name)
(),o.C-t \ '"'
(Name)
(Address)
4~11 LolOfQ~O ~~.
(Address)
(;:B)o~ 4/-6db6
(Tel. No.)
14. FLOOR AREA APPORTIONMENT USE
'1 :6. BUILDER
se\f
(Name)
(Address)
(Tel. No,)
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
? J, TYPE OF WORK
New Construction 0
Fireplace 0
Alterations 0
Septic 0
Addition 0
Deck 0
Finish Attic 0
Re-roofin~ 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
17. COMPLETION DATE
Yes No
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
~Uild~cial ca~r-h~e~ for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perfk nt?:._eJJs~9t'2fs,
( ~ Signature License No. 'Date
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
Front
Back
Side
Side
MATERIAL FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA 0
PILING LOGS 0 PERCOLATION TESTS 0
BUILDING DEPARTMENT VALUATION
USE OF BUILDING
,
~S A/R-
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
PLANS & SPECS 0
SETS
COPIES
SURVEY 0
'Z Sl.ro . cJl)
PLOT PLAN
o
TYPE OF CONSTRUCTION: I II III IV V
Occupancy Group A B E F HIM R S U
Division 1 2 3 4
City:
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
SewerTap ................................... $
$
Permit Fee ................................... $
-'4-./5
Plan Check Fee ............................. $
State Surcharge ............................. $
Penalty ....................................... $
Plumbing Permit Fee ....................... $
I.-;>C;-
Mechanical Permit Fee ..................... $
Pressure Reducer .......................... $
Meter Hom ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... ~
Sewer & Water Permit ...................... $
Certificate of Occupancy
Water Tower Fee ........................... $
WaterTap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
Total Due .............................. $
Paid '7 " .0 0 Receipt No. '3 4-s q ~
I$ued ~
Th' , 'fy th th 'th bo I' t' d 'd t ' , d "th th c~atze ,4;~d'''Z-/ q d~ BYed ~d Th' .
IS IS to certi at e request In eave app lca Ion an accompanYing ocumen s IS In accor ance WI e IIy onlng ur Inance an may proce as requeste. IS 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.
"7(,.00
Gas Fireplace Permit ....................... $
This Application Becomes Your Building Permit When Approved.
By Date
City Planner
Date
Special Conditions ~ any
24 hour notice for all inspections 447.9850