HomeMy WebLinkAboutBUILDING 05-1071
CITY OF PRIOR LAKE
INSPECTION NOTICE
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TIME
ADDRESS
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OWNER
CONTR.
PHONE NO.
PERMIT NO.
5'-/0 :?/
o FOOTING
o FOUNDATION
o FRAMING
g.~LATION
~I~~L
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EXIGRADIFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
COMMENTS:
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~ WORK SA TISFAt:Ten,v gg"rCcn
/ So. CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REI~ECTION BEFORE COVERING
Inspector: /' ~ / Owner/Contr:
CALL 447-;850FO~HE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INS/iOTl
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
(Please type or print and sil!:n at bottom)
ADDRESS
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c(q (~
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White
Pink
Yellow
File
City
Applicant
LEGAL DESCRIPTION (office use only) (
LOT t)BLOCK ~ADDITION WliVIJSGJNG c:f)/V 7i~lJtt(b-
OWNER L1 j
(Name) 110 fk.Kf- 'f~/lJ~
(Address) <IoU) ~C<<A. C~,~ C'v-
(Address)
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/dJ0t-7V'l{'" ~ M-
3797 w(ll'~oJ s-t-
BUILDER
(Company Name)
(Contact Name) ,.
Date Rec' d
PERMIT NO. ()~J (011
ZONING (office use)
1>u~/J
PID 1-~--2.3~ -oLj--o
(Phone) VC!7 ll-V 2...
(Phone) c; (1..- re C 7 - J 797
(Phone) ~ '/2.- 9' 7* ] 7't7
lJtl'ft1 ':2.S j 7 '-
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TYPE OF WORK 0 New Construction ODeck OPorch ~ROOfing
/ OAddil1on OAlteration OUtility ConnectIOn
CODE: ~.R.C. OLB.C. 0 Mise.
Type of Construction: I II III IV V A B
Occupancy Group: A B E F HIM R S U
Division: I 2 3 4 5
ORe-Siding OLower Level Finish
o Fireplace
PROJECT COST IV ALUE $
(excluding land)
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I hereby certify that I have fUfmshed Information on this application which is to the best of my knowledge true and correct. I also certity that I am the owner or <luthonzed agent for the
dh')Vl'.mcntlllned property and that all constructIOn will conform to all eXlsung state and local laws and Will proceed in accordance with submllled plans I am aware that the buildmg
,)If1C1al can revoke t11lS permll for Just cause Furthermore, I hereby agree that the City official or a deSIgnee may enter upon the prope11y to perform needed mspectlOns
x~n
Signature
Permit Valuation
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Permit Fee
$
$
$
(. '7-S
Plan Check Fee
State Surcharge
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace Permit Fee $
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BlItldl1l~ "Ufficlal ____~I Date i -
I
c-OdIJ) ~c) 9'
Contractor's License No.
r Park Support Fee
I SAC
I Water Meter Size 5/8"; I";
I Pressure Reducer
I Sewer/Water Connection Fee
I Water Tower Fee
I Builder's Deposit
I Other
I TOTAL DUE
Paid
Date
/f:)- W--OJ
Date
# $
# $
$
$
# $
# $
$
$
$ 1",-
Receipt No.
By
Tim IS to cerufy that the request 10 the ahove applicalHm and accompanymg documents is 10 accordance with the City Zoning Ordinance and may proceed as requested Tim document
wht'll Signed hy the City Planner constllutes a temporary Certificate of Zonmg compliance and allows construction to commence Before occupancy, a Certificate of Occupancy must be
issllcd
Planning Director
Date
24 hOllr notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
Special Conditions, if any