HomeMy WebLinkAboutBuilding Permit 99-0390
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
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ADDRESS lto I Bfa
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OWNER
CONTR.
PHONE NO.
PERMIT NO.
'fq~ 3'W
o FOOTING
o FRAMING
..0 jPjSULATIO~
'FI~AL
o FOUNDA TI N
o DEMOLITION
o FIRE PREVo () l'
COMMENTS: Leo+-
o PLUMBING RI
o MECHANICAL
o WATER HOOKUP
o SewER HOOKUP
o SEPTIC INSTALL
o PLUMBING FINAL
o SITE INSPECTION
o EXC/GRAD/F1LLlNG
o LKSHORElWETLAND
o COMPLAINT
o SEPTIC FINAL
o FIREPLACE
o
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Inspector: Owner/Contr:
CALL 447~23D FbR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REVENTSARE FOR YOUR PERSONAL HEALTH & SAFETY/
~1
IlAI" c.".,"~ CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
DIRECTIONS 4,.DATlq m'
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please P!int or Type and sign at bottom)
I. White
2.Pmk
3. Yellow
File
City
Applicant
Penn It No. ~q.39()
2SITEADDRESjt, I~ ~~~ G.,\~ s,~ Il.ISj)
BUILDING INFORMA11ON
11. SIZE OF STRUCTURE
(_I) (W\dIh) (lJeolh)
3. lEGAl DESCRIPTION
LOT f".O. {~T ~ 7.. ,BLOCK
ADDITION LA'''1''''51C'l6'' ~I~
4 OWN;; ItW~am~-i~
5. ARCHITECT #I (Name)
12. NO. OF STORIES
P'D
tZS.l>"".l>I1-~ L.n
..."J-.S- a
~~-30t:J.
13.TYPEOliROI'STRUC;PON i~,(:,.
~~ ~~, (.;P'f,vJl.p.,11"I.
14. Fi.OOR~REAAPPOR'noNMENTUSE ~
(Address)
~~
(Address)
(Tal. No.)
6. BUILDER S~i:A
(Addrass) (Tal. No.) 15. NUMBER OF OCCUPANTS OR SEATS
41 ()IO t::)C c. ~... 51 i)(l.. B<-JD ~ OCCUPANTS
7. TYPE OF WORK Fireplace LI Septic LI Deck LI Re-rooflng Porch 0 SEATS
New Construction (] Alterations 0 Addition LJ Finish AUk: LI Re-sidlng 0 Inlsh Basement 0 16. P~SI COO~lUE
Chlmneyo Misc. '""t~
8. PROPERTY AREA OR ACRES 19. PROPERTY DIMENSIONS 110. CULVERT SIZE 17. GOM~ON DATE
Sq. Ft. Width Depth Yes No ~t.(J C; 1
I ha~. t I ~~.n~olTT\lltlon this appficatlon which Is to the best of my knowledge true and coned. I also certify that I am the owner or authorized agent for
the . P and . will conform to all existing state and local laws and will proceed in accordance with submitled plans. I amawal8 thai the
~I I .~ pe ~ r . Furthermore. I hereby agree that the city .:m'~~nee may enter upon the property to pe~ ~.-. .IS.
t- Signat~ license No. Date
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
Front
..'"
Side
Side
MATERIAL FILED WITH APPLICATION
SOIL TESTS D ENERGY DATA (1
PILING LOGS D PERCOLATION TESTS (J
BUILDING DEPARTMENT VAlUATION
USEOFB~
/
,",,-I r<:-
I .
OFF STREET PARKING
SPACES REa.
SPACES ON PLAN
PERMIT VALUATION
COPIES
"2..'U() . .-0
PLANS & SPECS a
SURVEY LI
PLOT PLAN D
SETS
TYPE OF CONSTRUCTION: I II III IV V
City:
Amount Brought Forward .................. $
Pari< Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
License Check Fee ......................... $
Pressure Reducer .......................... $
MeterHom................................... $
Water Meter ................................. $
Sewer & Water Connection Fee . .... ...... $
Occupancy Group A B E F H IRS U
Division 1 2 3 4
Permil Fee ................................... $:
P1anCheckingFee ......................... $
"74.1-)"
State Su"","rge ............................. $
Penalty ....................................... $
1.2..-')
Sept~ System ............................... $
By
Water Tower Fee ........................... $
Water Tap ................................... $
Builder's Deposit ............................ It
Other ......................................... $
Total aua .............................. $ ...., c::,. -
pald/c...'. Race'DtNo3.S0S7_
Issuad Date .,.1,,, I <Irf Bv ~,tI-
This IS to certify that the request In the above application and .............. '...-:u .,iog documents is In 8CCOIdance wiIt1 the City Zorung Ordlnahce ~ may proceed as requested This OOcument when
sigled by the City Planner constitutes a temporary Cartificate of Zoning compliance and allows construction to commence. Before occupancy. a CertIfIcate of Occupancy must be issued.
............ $
,lding Pann~ When ,.J,~ved'
Date k I
I
This Appll
Certilicate of Occupancy
CilyPlanner
Da'e
Special Condtions If any
24 hour notice for alllnspectloos 4474230