HomeMy WebLinkAboutBuilding Permit 99-0456
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
IO-2.Z-~~ A.V-;
ADDRESS
~3qCj ~ ..Jr/'.
OWNER
CONTR.
PHONE NO.
PERMIT NO.
1';' - .y5?
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
~FINAL
o SITE INSPECTION
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 GA~R TST
~ .-
COMMENTS:
~,u:.
-
~ (Jf~
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-
~
~...........
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/
~ORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: 6, 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-/z-e/QQ
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 at bottom)
12~~~E~ \:r~LcflA~
3. LEGAL DESCRIPTION
LOT l f BLOCK
W ~S;T
1. DATE
4-~'1-~ ~
,('"2/1
PID z.C;-~OO';--OIO- 0 I
I
1
"S\.
ce.
ADDITION
I
SCOr:::
~\Rck
5. ARCHITECT
~ame) I \: (Addres~ . ...JTe!. No.) Ll'-i"
'K.f"-\Ji:)() ~ r-- '""\~ I..\:<i \:.Ol()M\)b <:;I. t 'l \ \ ~ -
(Tel. No.)
(Name)
(Address)
6. BUILDER
(Name)
(Address) ~\..oO{{\\I,r\S~
\~€ '1q-"" $I ~ar?>-OlJl.t~
'3~:;KL~"\~a~/lV~ SepticO
Addition LJ
Deck 0
Finish Attic 0
Re-roofin~ Porch CJ
Re-siding CJ Finish Basement 0
New Construction 0
Chimney LI Misc.
lB. PROPERTY AREA OR ACRES
Sq. Ft.
Alterations 0
19. PROPERTY DIMENSIONS
Width Depth
f'o. CULVERT SIZE
Yes No
I. White
2 Pink
3. Yellow
File
City
Applicant
Permit No.
qq-46b
BUILDING INFORMATION
11. 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. P'EHNEfT COSTNALUE
"l\>1-\(X)O 00
17. COMPLETION DATE
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 abovem. entia ned prope~n that all ~nstruction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the
~g offic\!\can revoke hi e I or ju ~se~ermore, I hereby agree thai the city ojf~i~~ <;>r a des~nee may enter upon the property to perform needed inSP%!iO,ns.
~ h ,\1'1\>--/\;:-\ , '.'llM.)(,..,_, U-J~ IC1 '---\--~'\-,ll
Signature \ LlCense No. Date
FOR ADMINISTRATIVE USE
Amount Brought Forward .................. $
ParkSupponFee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... <I:
.
Pressure Reducer .......................... $
Meter Horn ................................... 'to
Water Meter ................................. <I'
Sewer & Water Connection Fee ........... <I'
WaterTowerFee ........................... $
Water Tap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
Total Due .............................. $
Paid '1 f4. 00 Receipt No. 3<;DQ'l
Issued ~
This is to cerofy that the request In the above application and accompanying documents is in accordance with the c~:;ontlc:~!~~a1 may pr~ :~:e;ed. 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.
SETBACKS: Required
Actual
Front
Back
Side
Side
BUILDING DEPARTMENT VALUATION
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
USE OF BUILDING
teE5 p(/te--
PERMIT VALUATION
z. rru ....c:1l.)
TYPE OF CONSTRUCTION: t II III IV V
Occupancy Group A B E F HIM R
Division 1 2 3 4
Permit Fee ................................... $
S U
City:
74-:7)'"
Plan Check Fee ............................. $
State Surcharge ............................. $
Penally. ...................................... $
Plumbing Permit Fee ....................... $
I. '1-('
Mechanical Permit Fee ..................... $
Sewer & Water PermIt ...................... $
Gas Fireplace Permit ....................... $
This Application Becomes Your Building Permit When Approved.
By Date
Certificate of Occupancy
CijyPlanner
Date
Special Conditions if any
24 hour notice for all inspections 447-9850
MATERIAL FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA 0
PILING LOGS LI PERCOLATION TESTS LI
PLANS & SPECS 0
SURVEY a
SETS
COPIES
PLOT PLAN
o
7(.,,00