HomeMy WebLinkAboutBuilding Permit 99-0453
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
.5 773
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATI,!N_jA'l
'l!f FINAL /~ \LJ/
o SITE INSPECTION
COMMENTS:
/l\ MH
SCHEDtlLED
~S1.
CONTR.
PERMIT NO.
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
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~
DATE TIME
;,;~-7+
9'1-~53
o EXIGRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
';JifWORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector:
d~ {Uf
ilLIii! Owner/Contr:
. ...
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.,
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY/
INSNOTI
~~
DATE RECEIVED
4-/W/qcr
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
I. White
2. Pink
3. Yellow
File
City
Applicant
1. DATE
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 ADDRESS (\
. '3-.'\'\~ ,-E~UJo~
L\-- d.~- ~ ~
PUp
s"
3. LEGAL DESCRIPTION
~
SA N I) PO /1\1-,-
4S'bt~~\:) \\Elt)
LOT
"2-
~
C'" ~ddrei\S) _ _ _
:::, 'l I~ \....C~\..UJtot) 'S'f
RLOCK
PID 2P~'2.3q-oW-C>
ADDITION
(Tel. No.)
'-\\-ltc::.- '")..~ l~
5, ARCHITECT
(Name)
(Address)
(Tel. No.)
6. BUILDER (Name) (Address)
<\\\CjN=uJI\l\ ~cllt0~ \doD L 'l'\~sr
(Tel. No.)
(is>~-o()tt q
7. TYPE OF WORK
New Construction Cl
. Fireplace 0
Alterations 0
Septic 0
Addition 0
Deck 0
Finish Attic 0
Re-roofin~ Porch 0
Ae-siding 0 Finish Basement D
BUILDING INFORMATION
1" SIZE OF STRUCTURE
(Height) (Width) (Depth)
12. NO. OF STORIES
13. TYPE OF CONSTRUCTION
14. FLOOR AREA APPORTIONMENT USE
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
SEATS
16, PROJECT COS~ALUE
u.~
17. CO~PLETION UATE
Chimney 0 Misc.
8. PROPERlY 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
above mentioned property and that aU construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the
\(>~ officia"""n revo~is ~~it 1\I.'l'ius!!rn'se. Furthermore. I hereby agree that the city omcial or a ~signee may enter upon the property to pertorm needed inspections,
X'-......'t\0-...\. \ ~~ ()r\""'i~o., l..\-~l~ '1 q
- , Signature \ - . license No. Date
FOR ADMINISTRATIVE USE
Amount Brought Forward .................. $
Park Support Fee ........ ................... $
SAC ......................................... ,t
Collective Street Fee ....................... 'I'
Sewer Tap ................................... $
$
Pressure Reducer .......................... $
Meter Horn ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
WaterTowerFee ...........................!t
WalerTap ................................... $
SETBACKS: Required
Actual
Front
Back
Side
Side
BUILDING DEPARTMENT VALUATION
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
'Z..~~ov
USE OF BUILDING
12..~tt1l:.-
.
TYPE OF CONSTRUCTION: I II JII IV V
Occupancy Group A B E F HIM R
Division 1 2 3 4
S U
City:
Permit Fee ................................... $
r4->""1CS
Plan Check Fee ............................. $
State Surcharge ............................. $
Penalty ....................................... $
Plumbing Permit Fee ....................... $
l. '2.-"-
Mechanical Permit Fee ..................... $
Sewer & Water Permit ...................... $
Gas Fireplace Permit ....................... $
This Application Becomes Your Building Permit When Approved.
By Date
MATERIAL FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA 0
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS 0 SETS
SURVEY 0 COPIES
PLOT PLAN 0
Builder's Deposit ............................ $
Other ......................................... $
Total Due .............................. $ -J(, .60
Paid ,'.V7) Receipt No, 3SVQQ
l~uoo lA4,
Date A--/~/f{4 By-~
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning brdinance and may proceed" requested. This document when
signoo 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
CityPtanner
Date
Special Conditions it any
24 hour notice for all inspections 447-9850