HomeMy WebLinkAboutBuilding Permit 99-0450
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
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DATE TIME
A.r-
CONTR. C CJa I'-=-----
. PERMIT~~O )
o PLUMBING RI 0 EXC/GRAD/FILLING
o MECHANICAL 0 lKSHOREIWETLAND
o WATER HOOKUP 0 COMPLAINT
o SEWER HOOKUP 0 SEPTIC FINAL
o SEPTIC INSTALL 0 FIREPLACE
o PLUMBING FINAL 0
o SITE INSPECTION
ADDRESS / ~ /21
OWNER
Sr ff...J ~
PHONE NO.
o FOOTING
o FRAMING
E.)NSULA TIONA
~ ~I_NAL n-
O FQUNDA TlON
o DEMOLITION
o FIRE PREVo
COMMENTS: ~F
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ECTION BEFORE COVERING
Inspector:
Owner/Contr:
CALL 4<17
THE NEXT INSPECTION 24 HOURS IN ADVANCE.,
TS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
~~
DATE RECEIVEn
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
1. White
2. Pink
3 Yellow
File
Cily
Applicant
Permit No.
_qq-45D
I DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
2. SITE ADDRESS
ICI:21 st. 9nu I A-0<," SE
1. DATE
4-2~ -99
~2-
BUILDING INFORMATION
11, SIZE OF STRUCTURE
(Height) (Width) (Depth)
3. LEGAL DESCRIPTION
12. NO. OF STORIES
LOT
ADDITION
4. OWNER
SU<::CJ IA
15, ARCHITECT
6. BUILDER
BLOCK
e-OGn:;u.o'S
PID
25- (}(J/J(- (')"2:7 - 0
13, TYPE OF CONSTRUCTION
AnON.
I
(Address) (Tel No) I
t,,\~~ G[")..~<r1~93(
I
14. FLOOR AREA APPORTIONMENT USE
(Name)
Sc.I-,,,,,...II''''~
(Name)
(Address)
(Tel No)
(Name)
(Address)
(Tel. No.)
I 15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
7. TY'E OF WORK
New Construction 0
Fireplace 0
Alterations 0
Septic 0
Addition 0
Deck a
Finish Anic 0
Re-roofinK Porch a
Re-siding 0 Finish Basement 0
SEATS
16. PROJECT COSTNALUE
Chimney 0 Misc.
18. PROPERTY AREA OR ACRES /9, 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 prope and that all construction will conform 10 all existing state and Jocallaws and will proceed in accordance with submitted plans. I am aware Ihal the
builOing o.t'iciJI can revoke t perm^for just c~s~ Furthermore, I hereby agree that the city official or a designee may enter upon the property 10 perform n~ed inspections.
X '1<, 1.1 mn\.l..,. 'I ~-<;9
. Signature \ - J License No. Date
..>.
17. COMPLETION DATE
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
MATERIAL FILED WITH APPLICATION
Front
..ok
Side
Side
SOIL TESTS
o ENERGY DATA
CJ
BUILDING DEPARTMENT VALUATION
f2e'S K/ tZ-
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION '"2..~. cfU
PILING LOGS 0 PERCOLATION TESTS 0
USE OF BUILDING
PLANS & SPECS 0
SURVEY 0
SETS
COPIES
PLOT PLAN
D
TYPE OF CONSTRUCTION: r II III IV V
Occupancy Group A B E F HIM R S U
Division 1 2 3 4
Perml' Fee .""""........"",,,........... $ J4. '1 S--
City:
Amount Brought Forward .................. or
Park Support Fee ........................... ~
SAC ........................................, $
Collective Street Fee ....................... or
Sewer Tap ...................................0;:
$
Plan Check Fee ............................. $
state Surcharge ............................. $
l.?_r
Penalty ....................................... $
Pressure Reducer .......................... $
Meier Horn ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
WaterTowerFee ........................... ~
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
Sewer & Water Permit ...................... $
Gas Fireplace Permit ....................... $
Water Tap ................................... t
Builder's Deposit ............................ ct'
Other ......................................... $
Total Due ......"...................... $ 1(.. Of)
Paid "'7(. . Of.) Rece;p' No, 'i IV 'I J
Issued I
Oate .4-lze/tiPt By (jf~
#, "
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceedrllS requested. 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.
This Application Becomes Your Building Permit When Approved.
By Date
Certificate of Occupancy
CilyPlanner
Date
Special Conditions if any
24 hour notice for all inspections 447.9850