HomeMy WebLinkAboutBuilding Permit #99-0402
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULE!?
/a-/s-Cf1 A:T:
ADDRESS ILl :S;)... 'S
RumElLS 'Sf:
OWNER
CONTR.
PHONE NO.
PERMIT NO.
q'1-~02.-
o FOOTING
o FOUNDATION
o FRAMING y(0
o INSULATION
Iii FINAL
b' SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
COMMENTS:
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0.1~
~_...
~A~
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~/':A _.......................
(~ ~~ "
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LK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT W071' CALL FOR REINSPECTION BEFORE COVERING
Inspector: t1} I Owner/Contr:
J
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE,
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY/
INSNOTl
._-_._..__._._...._-,--_.,-,.-~----~---'_._-_._-,.._~-'.'.
~~
DA Tt! RECEIIJFD
4l~jct1.
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
I. White
2. Pink
3. Yellow
File
City
Applicant
Permit No. qq - 4fJ 7.-
DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign al bottom)
12. SITE ADDRESS
L=! ~] <
3. LEGAL DESCRIPTION
1. DATE
4 -.Jo r' 99
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
12.4F2~
12. NO. OF STORIES
LOT
PID 3'3-( 1'1 - M3 - 6
BLOCK
"BOUO/I\J<;: M~
13. TYPE OF CONSTRUCTION
te..E:: - /f-O 0 F='
14. FLOOR AREA APPORTIONMENT USE
ADDITION
140WNE1~1\)?me) I UV1rI~...
15. ARCHIT-ECT (Name) .
6. BUILDER (Name)
~~
7. TYPE OF WORK
New Construction 0
Fireplace 0
Alterations 0
Septic 0
Addition 0
(Address)
0i3.d.. S
(Address)
~ (T")):h - 7;n.c
(TeL No.)
(Address) *' 2,0'2-311 <:; (Tel. NO.). L 15 NUMBER OF OCCUPANTS OR SEATS
?:kSV ~~~. Lt9.;), 3JSI~ OCCUPANTS
Re.roofin~ Porch 0 SEATS
Re-siding 0 Finish Basement 0 16. PROJECT COSTNALUE
Deck 0
Finish Attic 0
Chimney 0 Mis"
la. PROPERTY AREA OR ACRES 19. PROPERTY DIMENSIONS 110. 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 official can revoke th~3P~t for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform.J1~ed jps..R,ec:!iq.~",
X "-7J1Ajd.. ~(LbL) y-,.,LC/ ""'-f,
. Signature License No.
17. COMPLETION DATE
Date
SETBACKS: Required
Actual
Front
BUILDING DEPARTMENT VALUATION
USE OF BUILDING
f<'E':;.
k /12.-
I
TYPE OF CONSTRUCllON: I II III IV V
Occupancy Group A B E F HIM R
Division 1 2 3 4
FOR ADMINISTRATIVE USE
MATERIAL FILED WITH APPLICATION
Back
SOIL TESTS
o
o ENERGY DATA
Side
Side
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS 0
SURVEY 0
SETS
COPIES
z..m.O'LJ
PLOT PLAN
o
Permit Fee ............................... .... $
J4..7S-
s U
City:
Amount Brought Forward .................. $
Park Support Fee ............. .............. $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
.
Plan Check Fee ............................. $
State Surcharge ........ ......... ............ $
Penalty ....................................... $
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
Sewer & Water Permit ...................... $
Gas Fireplace Permit ....................... $
1."2...S"""'
Pressure Reducer .......................... $
Meter Horn ... .... .... ........................ ~
Water Meter ................................. ,It
Sewer & Water Connection Fee ........... ~
Water Tower Fee ........................... ~
Water Tap ................................... ~
This Application Becomes Your Building Pennit When Approved.
By Date
Builder's Deposit ............................ $
Other ......................................... $
Total Due .............................. $
7(". 0lJ
Paid 7 fD .09 Receipt No. <3 5l)(" 0
Date 4/20/ qq By ~
This is to certify that the request in the above application and accompanying documents is in accordance with the City ZoninglOrdina11ce an~ may proceed as4eqUested. 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
Issued
City Planner
Date
Special Conditions ~ any
24 hour notice for all inspections 447-9850