HomeMy WebLinkAboutBuilding Permit 03-0238
CITY OF PRIOR LAKE
INSPECTION NOTICE'"
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SCHEDULED
ADDRESS
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CONTR,
OWNER
PHONE NO,
PERMIT NO,
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
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COMMENTS:
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DATE
TIME
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o EXIGRADIFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
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Ii""WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTlON BEFORE COVERING
Inspector: rvr? ] - /4-0 6:.ner/Contr.
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE,
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CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
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QAIEFF=r:FI\'F=D.
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
13~;. Q j
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rOJ-~l50 .'
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DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
2, SITE ADD}lESS P I /l V
J {.-, OeJO (_c<ql(~ I _ .J..aJ-
3, LEGAL DESCRIPTION I
LOT \ ~ BLOCK
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ADDITION
02. ,
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5. ARCHITECT
(Address) A
/(,MJ /! /3f:: .
(Address)
(Te' No.)
9Sl.#l/1-9ossl'
(Te' No.)
(Name) I
J-/u h"t ~hr ~
(Name)' /
(Name)
'flet~7P/ -Sc,/~!r.f
(Address)
(Tel. No.)
6. BUILDER
';0; C. 7~
9.52- S'&-&-}.JJ.S
7. TYPE OF WORK
New Construction 0
Chimney LJ Misc.
Fireplace 0
Alterations 0
Septic 0
Addition 0
Re-roofinq}t Porch 0
Re-siding 0 Finish Basement 0
Deck 0
Finish Attic 0
1. White
2. Pink
3. Yellow
File
City
Applicant
Permit No, o:~ --;;3 g
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
12. Nj OF STORIES
13. TYPE 'IF CO)"STR"lCTlON -t"? (J
'P-:<,'_;/a, <<. ',< . .1?I'l-'Od'f"
14. FLOOR AREA AP~ORTlONMENT USE
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
SEATS
16, PROJECT COSTNALUE
~h-AAI
17, ~'&rYoN DATE
B. 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. I also certify that I am the owner or authorized agent for
the abov~me oned property and that all construction will conform to all existing state and local Jaws and will proceed in accordance with submitted plans. I am aware that the
building 0 can rev~e~t for just cause. Furthermore, I hereby agree that the city offici~rh~gnee may enter upon the property to perform needed ins~,~lons.
X ti-%/.//h / /7'J '3-7"6.>
- / - Signature - , License No. Date
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ........................................,$
Collective Street Fee ....................... ,II':
Sewer Tap ................................... $
$
Pressure Reducer .......................... $
Meter Hom ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
WaterTowerFee ........................... $
Water Tap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
To~a ....00.................... $
Paid ~ / h ~ Receipt No.
Date ~3 -5- 3 By at::../
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proce'Us 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.
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
Front
Back
Side
Side
BUILDING DEPARTMENT VALUATION
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
USE OF BUILDING
PERMIT VALUATION
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TYPE OF CONSTRUCTION: I II III IV V
OccupancyGroup A B E F HIM R S U
Division , 2 3 4 1'/ ~
Permit Fee ................................... $ -
City:
Plan Check Fee ............................. $
State Surcharge ............................. $
Penalty ....................................... $
I'a.~
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
Sewer & Water Permit ...................... $
Gas Fireplace Permit ....................... $
This Application Becomes Your Building Permit When Approved.
By Date
Certificate of Occupancy
Issued
CityPlanllElf
Dale
Special Conditions if any
24 hour notice for all Inspections 447-9B50
MATERIAL FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA 0
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS 0 SETS
SURVEY
PLOT PLAN
o COPIES
o
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