HomeMy WebLinkAboutBuilding Permit 99-0455
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
6-3-1'1 /:30
DATE TIME
ADDRESS
551:;<!- (tJid/l@JYY!
;ermu.. N6
CONTR.
OWNER
PERMIT NO.
Qt( - r.( c;5'
PHONE NO.
o FOOTING
o FRAMING
~~SULATI~
r 1HAL
UNOATION
o DEMOLITION
o FIRE PREVo
o pL.UMBING RI
o MECHANICAL
o WAfER HOOKUP
o SEWER HOOKUP
o SEPTIC INSTALL.
o PLUMBING FINAL
o SITE INSPECTION
o EXC/GRAD/FILLING
o LKSHORENVETLANO
o COMPLAINT
o SEPTIC FINAL
o FIREPLACE
o
!<9MMENTS'_
~ CD~~ ~
1)':1
\
--.
/
XWORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CAL\ \OR REINSPECTION BEFORE COVERING
Inspector: "\ \' W . Owner/contr:
~.l. 447-4230 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
~1
QAJ'F: Ri=r.I=IVl=n
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
1. While
2. Pink
3. Yellow
File
Cily
Applicant
4-/ z..€;/ ~~
Permit No.
QCf-4-t5b
I DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign al bottom)
12SS~St\ ~WtiD \1L
1. DATE
lJ'L
l\-~t- ~ '\
pvO
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
3. LEGAL DESCRIPTION
:3
12. NO. OF STORIES
LOT
PID ~' 2-14-- 003-0
ADDITION
'3~O
13. TYPE OF CONSTRUCTION
15. ARCHITECT
6. BUILDER
(Name)
p, \JL
(Na~)
t::" ,..lA~5) . (Tel. NO.~ ~S _
w "S'i,L\'--t>\,)N'\.UJO(j) \R.. ~~ \S....,
(Address) (Tel. No.)
14. FLOOR AREA APPORTIONMENT USE
(Name)
(Address)
(Tel. No.)
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
'3;:t:~~ ~:a:~ll
\ clOD E. '1'\ J:h '::.\
q 0, ~ ---()()'{ c,
SEATS
New Construction 0
Alterations LJ
Septic 0
Addition 0
Deck 0
Finish Attic 0
Re-roofin~ Porch 0
As-siding 0 Finish Basement 0
16. ~.~ JECT COSTNALUE
~~SOl) ~
17. COMPLETION DATE
Chimney 0 Misc.
18. 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. 1 also certify that I am the owner or authorized agent for
e 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
~~ing offici can revoke t~rmitf'(l" j~~cws~rthermore, I hereby agree that the Ci~f~1 or a designee may enter upon the property to file[form needed inspections.
~ Ov~ \.J..j~~ LU~('\C\~ U(._~,,_-<',o,
Signature License No. Date -
Front
FOR ADMINISTRATIVE USE
MATERIAL FILED WITH APPLICATION
Back Side Side SOIL TESTS 0 ENERGY DATA 0
OFF STREET PARKING PILING LOGS 0 PERCOLATION TESTS 0
SPACES REO. PLANS & SPECS 0 SETS
SPACES ON PLAN SURVEY 0 COPIES
PERMIT V ALUA TION "2.~ 0 V,OU PLOT PLAN 0
SETBACKS: Required
Actual
BUILDING DEPARTMENT VALUATION
USE OF BUILDING
PJG~ p( / e-
,
TYPE OF CONSTRUCTION: I II III IV V
Occupancy Group A B E F HIM R
Division 1 2 3 4
Permit Fee .............. ..................... ,'I:
S U
City,
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
74-.,':;-
Plan Check Fee ............................. $
State Surcharge ............................. $
Penalty ....................................... $
Plumbing Permit Fee ....................... $
I,L~
Mechanical Permit Fee ..................... :t
Pressure Reducer .......................... $
Meter Horn ... .... .... ................. ....... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
WaterTowerFee ........................... $
Water Tap ................................... $
Sewer & Water Permit ...................... :t
Gas Fireplace Pennh ....................... $
This Application Becomes Your Building Permit When Approved.
By Date
Builder's Deposit ............................ $
Other .......................... .... .... ....... $
Total Due .............................. $
Paid -Z f(). 6CJ Receipt No. ~~'lIlf <j
Issued /- / ~
Dale iJ... 'ZAl' Q.4 By
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning brdinante and may proceed a 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.
7(, ,em
Certificate of Occupancy
CityPJanner
Date
Special Conditions ~ any
24 hour notice for aU inspections 447-9850