HomeMy WebLinkAboutBuilding Permit 99-0404
""'-
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
S 6 c;Lj
SCHEDULED /.:J..~ J. ''i'~
~Sr. /'Ie
OWNER
CONTR.
PHONE NO.
PERMIT NO.
'17- '10</
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION Al
;B FINAL :;~ flJ/
o SITE INSPECTI6N
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EXlGRADfFlLLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
COMMENTS:
~-4d~
~p
'!f WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector:
fT'..t^- Owner/Contr:
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY/
INSNOTl
~~
DATE RECEIVED
4--1z,l/q~
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
I. White
2. Pink
3 Yellow
File
City
Applicant
permitNO.~
DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
2. SITE ADDRjSS
S"" 4,,\ C d~.....,ooo s+
3. LEGAL DESCRIPTION
It
LOT
BLOCK
PT
ADDITION
4. OWNER
PI;,
5. ARCHITECT
~.......vo
(Name) ,
A~ S~\'\Mr
1. DATE
4-20-9li
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
I
S~
12. NO. OF STORIES
PID
2..'5 - 2.'39 - 0 q -0
13. TYPE OF CONSTRUCTION
(Address)
tr IVOOD
(Address)
(Tel. No.)
14. FLOOR AREA APPORTIONMENT USE
(Name)
6. BUILDER
(Name)
fc,oF'-,.x.,.-
Fireplace 0
Alterations 0
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES
Sq. Ft.
"
Septic
Addition 0
<>'I
(Tel. No.)
(Tel. No.)
15. NUMBER OF OCCUPANTS OR SEATS
"
'tS'~-co4"1
OCCUPANTS
Deck 0
Finish Attic 0
Re-roofing,A. Porch 0
Rs-siding 0 Finish Basement 0
SEATS
16. PROJECT COSTNALUE
s-COOr -
17. COMPI.ETION DATE
9. PROPERTY DIMENSIONS
Depth
Yes No
10. CULVERT SIZE
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
at all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the
it just cause. Furthermore, r hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
ooo3'il/"/ 4-Zo--qq
License No. Date
SETBACKS: Required
Actual
Front
BUILDING DEPARTMENT VALUATION
USE OF BUILDING
e..e>
4tc-
TYPE OF CONSTRUCTION: I II III IV V
Occupancy Group A B E F HIM R S U
Division 1 2 3 4
Permit Fee .................. ......... ........ $
Plan Check Fee ................. ............ $
State Surcharge ............................. $
Penalty ....................................... $
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
Sewer & Water Permit ...................... $
FOR ADMINISTRATIVE USE
Back
MATERIAL FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA 0
PILING LOGS 0 PERCOLATION TESTS 0
Side
Side
OFF STREET PARKING
SPACES REQ.
SPACES ON PI.AN
PERMIT VALUATION
PLANS & SPECS 0
SURVEY 0
SETS
COPIES
? n-v ~c/t.)
PLOT PLAN
o
City:
Amount Brought Forward .................. $
Park Support Fee .... .... ................... $
SAC .........................................$
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
/4 "1C;-
L -z. ...-
Pressure Reducer .......................... $
Meter Horn .................... .... .... ....... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
WaterTowerFee ........................... $
Water Tap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
Total Due .............................. $
Paid Receipt No.
Gas Fireplace Permit ....................... $
This Application Becomes Your Building Permit When Approved.
By Date
Certificate of Occupancy
Issued
Date
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning rdina and may proceed as 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.
City Planner
Date
Special Conditions if any
24 hour notice lor all inspections 447-9850