HomeMy WebLinkAboutBuilding Permit 99-0420
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULrl?
DATE TIME
j6-1'f-'19 A ~
ADDRESS / S 2 00 FA rfZ.- L--fhu AJ Sffl t2-ES
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING 0 PLUMBING RI
o FOUNDATION 0 MECH RI
o FRAMING 0 WATER HOOKUP
o INSULATION /,") 0 SEWER HOOKUP
JL FINAL (LI:/ 0 PLUMBING FINAL
o SITE INSPECTION 0 MECH FINAL
COMMENTS: ~
KIHY/ ~
/ -
~ -
~~b<U
,
~
-::--
~~V
Q9-12-0
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
~
~K SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT W~..:..CALL FOR REINSPECTION BEFORE COVERING
Inspector: fJ 1- ' Owner/Contr:
I
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
lNSNOTJ
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
~\
~"F","n CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUeD (Please Print or Type and sign al bottom)
12SITEADDis.;)M r~"'1
I
/ S..
3. LEGAL DESCRIPTION
2-
C...LA-yTDll..) S
LOT
BLOCK
ADDITION
140 OWNER
'" 0 VI
15. ARCHITECT
(Name)
fJ../a/YVYlI/l )
(Name)
6'B~~)
~lA)
7. TYPE OF WORK Fireplace 0
New Construction D Alterations 0
1. White
2. Pink
3. Yellow
File
City
Applicant
Permit No.
QQ-42.0
1. DATE
SiLtld~
Lj. ;J7-q<f
I2.ISD
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
-
~.
12. NO. OF STORIES
PID 2.!5-?S4--()O?""-O
ADDr0
13. TYPE OF CONSTRUCTION
(Address)
SAm>
(Address)
(Tel. No.)
'-/4i-f:3'1<
(Tel. No.)
14. FLOOR AREA APPORTIONMENT USE
(Address)
(Tel. No.)
15. NUMBER OF OCCUPANTS OR SEATS
3bSb
("J ~ S1- '
" q,;)..... 3cf~ ~ OCCUPANTP
SEATS
Septic 0
Addition 0
Deck 0
Finish Attic 0
Re.roofing"'" Porch 0
Re-siding 0 Finish Basement 0
16. PROJECT COSTNALUE
Chimney CI Misc.
8. PROPERTY AREA OR ACRES 19. PROPERTY DIMENSIONS 110. CULVERT SIZE
Sq. Ft. Width Depth Yes No
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 official can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to pertorm needed inspections.
X ~JL ~~~,L)M_./
Signature License No. Date
17. COMPLETION DATE
SETBACKS: Required
Actual
Front
BUILDING DEPARTMENT VALUATION
USE OF BUILDING _
I
\("e3 p< / jt!:..-.
FOR ADMINISTRATIVE USE
MATERIAL FILED WITH APPLICATION
Back
Side
Side
SOIL TESTS
o ENERGY DATA
o
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS [')
SURVEY 0
SETS
COPIES
2~- c/L.
PLOT PLAN
o
TYPE OF CONSTRUCTION: I II 111 IV V
OccupancyGroup A B E F HIM R S U
Permit Fee ..........~i~~~~~...1...~...~..~... $ 14- ./~
Plan Check Fee ............................. $
State Surcharge ............................. $
Penalty ....................................... <f:
Plumbing Permit Fee ....................... <I:
Mechanical Permit Fee ..................... It.
Sewer & Water PermIt ...................... 4:
Gas Fireplace Permit ....................... $
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee . ........ .... .... ...... It.
Sewer Tap ................................... $
City:
I . 2- <;""
$
Pressure Reducer .......................... $
Meter Horn ... .... .... ................. ....... $
Water MeIer ................................. $
Sewer & Water Connection Fee ........... $
WaterTowerFee ........................... $
Water Tap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
This Application Becomes Your Building Permit When Approved.
By _ Date
Total Due .............................. . 7(.,. Ub
Peid I c.. 0 0 Receipt No. 3 -S-o 7S"""
Issued
Date -f-/u,/ q"'l By M--
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning 6rdina~ce and 'may proceed~~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.
Certificate of Occupancy
City Planner
Date
SpecialConditiOl1s~any
24 hour notice for an inspections 447-9850