HomeMy WebLinkAboutBuilding Permit 99-0468
City of Prior Lake
Inspection Notice
DATE
TIME
10/25/99 A.T.
SCHEDULED
ADDRESS 16073 MALLARD WAY SE
OWNER CONTR
PHONE NO. PERMIT # 99-468
TYPE OF INSPECTION RE-ROOF
COMMENTS:
~ Work Satisfactory, Proceed
o Correct Action and Proceed
o Correct Wor~Reinspection Before Covering
Inspector: ~ Owner/Contr.
~~
;'/~~7;9
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
1. White
2. Pink
3 Yellow
File
City
Applicant
Permit No.
qq-468
DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign al bottom)
2. SITE ADDRESS
fJ, t) 7 3 H~R72D WI
1. [1.lATE
4- lofer e;
PUp
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
3. LEGAL DESCRIPTION
10
ADDITION CA-/Ul/IoJA1... ~DG;E
12. NO. OF STORiES
LOT
BLOCK
2.
PID
;>~-soz...-O\t.{ - 0
13. TYPE OF CONSTRUCTION
'2.-1'0 M)D/J.
4. OWNER
J~'
5. ARCHITECT
Name)
(Address)
14. FLOOR AREA APPORTIONMENT USE
r
(Name)
(Tel. No.)
6. BUILDER
(Name)
(Address)
(Tel. No.)
15. NUMBER OF OCCUPANTS OR SEATS
A' OJ.
/'"2-2'f7 ,N/u /lef-Il.x-~".f1.
7. TYPE OF WORK
New Construction CI
Deck 0
Finish AWc 0
OCCUPANTS
Fireplace 0
Alterations 0
Septic 0
Addition 0
SEATS
16. PROJECT COSTNALUE
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES
Sq. Ft.
9. PROPERTY DIMENSIONS
Width Depth
10. CULVERT SIZE
17. COMPLETION DATE
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
the above mentioned property and ,lhat 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 c 0 th.s P it for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perfo~edec:t inspections.
X . , ~ 'I/tIP!
Signature License No. . / Date
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
Front
Back
Side
Side
MATERIAL FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA 0
PILING LOGS 0 PERCOLATION TESTS 0
BUILDING DEPARTMENT VALUATION
USE OF BUILDING
.I
/ee:J/9'/L.
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
PLANS & SPECS 0
SETS
SURVEY 0
COPIES
2- C--rv. ~
PLOT PLAN
o
TYPE OF CONSTRUCTION: 1 II III IV V
Occupancy Group A B E F HIM R
Division 1 2 3 4
S U
City:
Amount Brought Forward .................. $
Park Support Fee .... .... ................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
Pressure Reducer .......................... $
MeterHom ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
Water Tap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
Total Due .............................. $
Permit Fee ................................... $
J 4-?J, $I)
Plan Check Fee ............................. $
State Surcharge ............................. $
z.. S1>
Penalty ....................................... $
Plumbing Permit Fee ....................... $
Mechanical Pennit Fee ..................... $
Sewer & Water Permit ...................... $
Gas Fireplace Permit ....................... $
~iS~~~ng~:t:'it~1~O ~.
Certificate of Occupancy
Issued
Paid
/52...00
~114-
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning rdin nee 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.
CRy Planner
Date
Spec~1 Condrtions ~ any
24 hour notice for all inspections 447-9850