HomeMy WebLinkAboutBUILDING 05-1084
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
JY2S
,-<:::~"l,./c.~
/
CONTR.
OWNER
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
,.....iFflNAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
O. PLUMBING~IN
~ECH FINAL
/L e <oS / e
COMMENTS:
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DATE TIME
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o EXIGRADIFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
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/1iO'RK SATiSFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WOR~~~R REINSPECTION BEFORE COVERING
Inspector: ~ '/ /' Owner/Contr:
V'
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
INSNOTI
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH &: SAFETY!
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
I White
Pink
Yellow
File
City
Applicant
PERMIT NO. O~ (OM--
(Please type or print and sign at bottom)
ADDRESS .
3lf~ :3~ WAJI,. I1uv 1m
(f)N 6637~
LEGAL DESCRIPTION (office use only)
Date Rec' d
ZONING (office use)
LOT
BLOCK
ADDITION
PID L5. j72 .073. 0
OWNER
(Name)
Dd1L&i
~
~ ~ laf
(Phone) ~.~. &5/f5
(Address)
BUILDER ha I 0 fl.. ~
(Company Name) '"fV "',,11U)(!..O I l.>W\.e..
(Contact Name) ~ ~~atr;/
(Address) 5558 ~+~ &..MJe f
l.
(Phone) tjS~. Cj35" .q 0fR q
(Phone)
m/1::tk. fY} t{ b~3'-13
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TYPE OF WORK 0 New Construction ODeck OPorch ORe-Roofing ~e-Siding OLower Level Finish 0 Fireplace
OAddition OAlteration OUtility ConnectIOn
CODE: DI.R.C. DI.B.c.
Type of Construction:
Occupancy Group: A II
Division:
o Mise.
A
R
5
B
S U
III IV
H I
2 3
V
M
4
II
F
I
I
E
PROJECT COST IV ALUE
(excluding land)
$
IlS5/'
OD
I hereby certify that I have hlrnlshed mformation 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 fln the
above-mentIOned pro crty 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 buildmg
:ficiaI can revoke t IS pelr'It ~ ust.ca,lSe Furthermore, I hereby agree that the City official or a d;J{/7,Jer upon the propel1y to perform neededJo~/ /OS
Signature Contractor's License No. Date .
Rece!2No.
o
Permit Valuation
Park Support Fee
SAC
#
#
Permit Fee $
Plan Check Fee $
State Surcharge $
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace Permit Fee $
Water Meter Size 5/8"; I",
Pressure Reducer
Sewer/Water Connection Fee
#
#
Water Tower Fee
Builder's Deposit
Other
TOTAL DUE
This Application Becomes Your Building Permit When Approved
Paid
Date
7(P --
rO, ~l. err--
l3uildll1g Ol1'lclal
Date
$
$
$
$
$
$
$
$
$
'l~' M./
S~
ThiS IS to certify that the request in the above application and accompanymg documents is in accordance with the City Zoning Ordinance and may proceed as requested TillS document
when signed by the City Planner constitutes a temporary Certificate of Zomng compliance and allows constructIOn to commence. Before occupancy, a CertIficate of Occupancy must be
issucd
Planning Director
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
Special Conditions, if any