HomeMy WebLinkAboutBuilding Permit 99-0360
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE SCHEDULED I 0 -( ~ - '} '1 A. . r.
ADDRESS /51055 !( ~ 4Pe '
U
OWNER CONTR.
PHONE NO.
PERMIT NO.
cJ9-SbO
o FOOTING [] PLUMBING RI 0 EX/GRAD/FILLING
o FOUNDATION 0 MECH RI 0 COMPLAINT
o FRAMING 0 WATER HOOKUP 0 FIREPLACE RI
[] INSULATION 0 SEWER HOOKUP [] FIREPLACE FINAL
.!rFINAL [] PLUMBING FINAL [] GASLlNE AIR TST
/ D SITE INSPECTION 0 MECH FINAL Y ~
COMMENTS: ~~ ~ ~ ~
(
/
~ORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WOR)7CALL FOR REINSPECTION BEFORE COVERING
Inspector: Ihr Owner/Contr:
./
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE..
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYl
INSNOfl
DATE RECEIVED
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
1. White
2. Pink
3. Yellow
File
City
Applicant
APR "!999
Permit No.
W-36()
"DIRECTIONS 1. DATE
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN /" / le...c;/i
BEFORE PERMIT IS ISSUED. (Please Print or Type and sign at bottom) --r -,. ( /"'. (;pl.,
2. SITE ADDRESS ...-. / ,/' _ (), I ", / K (,).
/, ~ /r") I'>> \ ') X J 01 C/e/YI~ q(k: S..
3. LEGAL DESCRIPTION' L" . - 'J -
PID 0;() ~ 0 7~ --Q:? I -0
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
5. ARCHITECT
(Name.h-<
\ JIM
(Name)
BLOCK. A /
,:JtJ{/ /IddI~
/) (Address)
11 rnc..-k A e:Ul.!"
(Address)
12. NO. OF STORIES
LOT
ADDITION
4. OWNER
,w. /1 't f/-f
13. TYPE OF CONSTRUCTION
(Tel. No.)
14. FLOOR AREA APPORTIONMENT USE
(Tel. No.)
6. BUILDER
(Name)
(Address) '6"0//- /1 ;'NO.)
q4iLJJfN () r '-0 Ie vv-. At/ !jSI (;l '-f
Fireplace 0 Septic 0 Deck 0 Re-roofing 0 Porch 0
Alterations 0 Addition 0 Finish Attic 0 Re-siding 0 Finish Basement 0
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
1lt1/JV
~WORK
New Construction 0
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES
Sq. Ft.
SEATS
16. PROJECT COSTNALUE
9. PROPERTY DIMENSIONS
Width Depth
10. CULVERT SIZE
Yes No
17. COMPLETION DATE
I hereby certify that I have furnished 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
building offi~e"f>ke 'is permit for just~. F~rther~~ hereby agree that the city official or a des'.\ln,~ mal.. enter ygqp the property to perform n~~<I ins,R.ecti9~. .
X '~,~.o/,~ ~OO'7B...""g'/. -Y//7/7Y
-- Signature ~ License No. Date or r
SETBACKS: Required
Actual
FOR ADMINISTRATIVE USE
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
EP c, flJl<.'
t -
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PLANS & SPECS 0
SURVEY 0
SETS
COPIES
PERMIT VALUATION
c2StYJ ~[~
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 ....................... $
Sewer Tap ................................... $
$
Permit Fee ................................... $
7'-1. 7LJ
j. ).s
Plan Check Fee ............................. $
State Surcharge ............................. $
Penalty....................................... $
Plumbing Permit Fee ....................... $
Mechanical Permit Fee..................... $
Pressure Reducer .......................... $
Meter Horn ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Sewer & Water Permit ...................... $
Water Tower Fee ........................... $
Water Tap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
Total Due .............................. $~7t, _ ~() J
--:;1, 'I ~ _2 .
Paid /6.6t.! Receipt No. (../\
~ . . Q-
Date C!-ty 49' By i<./.U:
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 sted. 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.
Gas Fireplace Permit ....................... $
This Application Becomes Your Building Permit When Approved.
By Date
Certificate of Occupancy
City Planner
Date
Special Conditions ff any
24 hour notice for all inspections 447-9850