HomeMy WebLinkAboutBuilding Permit 99-0377
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULEU
DATE TIME
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h/ N/l/Es01 rt SI.
ADDRESS
.:502-0
-
OWNER
CONTR.
PHONE NO.
PERMIT NO.
~9-377
o FOOTING
o FRAMING
o INSULATION It'fl
,Ji{FINAL tE6ieEs,S f!:5/
o FOUNDATION
o DEMOLITION
o FIRE PREVo
r
COMMENTS: ~~?/' -' f)~ ~Q'-.c>--'-"_
crL- ~ {/ ~ --p
o PLUMBING RI
o MECHANICAL
o WATER HOOKUP
o SEWER HOOKUP
o SEPTIC INSTALL
o PLUMBING FINAL
o SITE INSPECTION
o EXC/GRAD/FILLING
o LKSHORElWETLAND
o COMPLAINT
o SEPTIC FINAL
o FIREPLACE
o
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=(~~7<~)
/
~ORK SATISFACTORY, PROCEED
o CORRECT ACT/ON AND PROCEED
o CORRECT WORY"'L~OR REINSPECT/ON BEFORE COVERING
Inspector: Y:A -f I Owner/Contr:
QALL::.Jr.; FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
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
I. White
2. Pink
3. Yellow
File
City
Applicant
1. DATE
Permit No.
qq... 377
. DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
2. SIT7;,ADDAESS 5 0 ~O ml nnlSofa. 5+.sE'.
J..j-/t; -CJ9
,eZ-
3. LEGAL DESCRIPTION
LOT
/7 BLOCK
e!l5r6 LU>S
Z.
A-QOAJ.
PID
25-00~-()ZS" 0
ADDITION
4. OWNER
5. ARCHITECT
(Name) (Address) (Tel. No.)
marK~J()anYI.L EYI~on 5 OJ.O m'f)n~5of4.5f.
(Name) (Address) (Tel. No.)
4f'f7-/tdq
6. BUILDER
(Name)
(Address)
(Tel. No.)
BUILDING INFORMA nON
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
7. TYPE OF WORK Fireplace a Septic a Deck a Re-roofing a Porch a
New Construction a Alterations a Addition a Finish Attic a Re-siding a Finish Basement a
Chimneya Misc. 81J.st.~ent EEhSC LJIi-v:lDf.i)
8. PROPERTY AREA OR ACRES 9. PROPERTY DIMENSIONS 10. CULVERT SIZE
Sq. Ft. Width Depth 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
building offici ca.n revoke this P2JJ;~t ca~se. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X .. V1V. ./"YIJ .I,/-/t:99
C !lignature License No. . Date
SEATS
16. PROJECT COSTNALUE
17. COMPLETION DATE
FOR ADMINISTRATIVE USE
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
SewerTap ................................... $
$
Pressure Reducer .......................... $
Meter Hom ................ .... ............... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
WaterTap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
Total Due .............................. $
SETBACKS: Required
Actual
Front
Back
Side
Side
BUILDING DEPARTMENT VALUATION
USE OF BUILDING e ~<; A r cZ-
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
TYPE OF CONSTRUCTION: I II III IV V
Occupancy Group A B E F HIM R
Division 1 2 3 4
Permit Fee ................................... $
S U
City:
'74. 'l~
Plan Check Fee ............................. $
State Surcharge............................. $
j.Z$"""
Penalty ....................................... $
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
Sewer & Water Permit ...................... $
Gas Fireplace Permit ....................... $
This Application Becomes Your Building Permit When Approved.
By Date
Certificate of Occupancy
MATERIAL FILED WITH APPLICATION
SOIL TESTS
o ENERGY DATA
o
PILING LOGS a
PLANS & SPECS a
SURVEY 0
PERCOLATION TESTS a
SETS
COPIES
PLOT PLAN
o
Receipt No.
'1(0.00
3S0s<G,
P,;d l!t~()
Date ~ /qq 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 r uested. 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.
Issued
cny Planner
Date
Special Conditions ~ any
24 hour notice for all inspections 447-9850