HomeMy WebLinkAboutBUILDING 01-0364
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
5.7,0%
ADDRESS
/537 / E..Olrll3o~UGH ~vC
OWNER
CONTR.
PHONE NO.
PERMIT NO.
01. () 3ro4--
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
o EXIGRADIFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o t6& SID6
COMMENTS:
u~OS6
Dt/ 6 7ZJ
7l-I15 R vb
IN~c:TJ VI TV
I
o WORK SATISFACTORY. PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: .
Owner/Contr:
.CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH cl SAFETY!
lNSItOTl
QATE R~
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)
2. SIJE ADDRESS ~/
/537/ /tZlYJ#}.OIM /j7U.)Jf
3. LEGAL DESCRIPTION J
. ,~/T~.~
:ixI;tN
LOT
BLOCK
PID/~5- 3:55- 001-0
ADDITION
4J9"!.NJR/i. . ;/. (Name). ..." c;;1 / (Address) /J ;; /'
~./(!LJ1 Jt":3?L2.L'.kMH /tu);J /f//) ~
, 5. ARCHITECT (Name) /-"Z'&;rofi:. ~v U (Addr~SS) '\_
( #JJ~ (}U' tf:1.rf.,1 ~ I 17:W-e 4JJi) . ~ iG <7-
6. BUILDER (Name) t (Address)
IJ l/lJ
~/t~Y/'or5
7. TYPE OF WORK
New Construction 0
(Tel. No.)
.q---,) -(If I? ~vC;to
(Tel. No.) .
/f,:3~191 -if/V
(Tel. No.)
8' ~1~V
(1 L<-9/1J)C!lV f(-v<./ II CqY00 55 3b C;
';7I--Je~t~ ~ Deck 0 IRe-roofing 0 Porch 0
Addition 0 Finish Attic 0 Re-sidin~ Finish Basement 0
Fireplace 0
Alterations 0
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES
Sq.Ft.
9. PROPERTY DIMENSIONS
Width Depth
10. CULVERT SIZE
Yes No
L(- J L,-O I
L White
2. Pink
3. Yellow
File
City
Applicant
Permit NO~,~ / .- (5 3(glJ
_DING INFORMATION
11. Slz~l~ 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. i!;,;n~:u~
17. COMPLETION DATE
I hereby certify that I have fumished. formation 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 a. n . t a~1 co. . n tr:tJctiO. n will conform to all existing state and local laws a. n. d will proceed in accordance with SUbmitte~Plan I am aware that the
building official can rev e this rmit jus. use. Furthermore, I hereby agree that the city ~ial or a d~si~nee may enter upon the property to pe 0 eedl!p y(spec,'ons.
X . vle'AO /)(i.d(J 77 'd<'//r)
/- Sign!.ture License No. /bate
FOR ADMINISTRATIVE USE
MATERIAL FILED WITH APPLICATION
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
SETBACKS: Required
Actual
Back
Side
Side
Front
BUILDING DEPARTMENT VALUATION
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
USE OF BUILDING
TYPE OF CONSTRUCTION: I II III IV V
Occupancy Group A B E F HIM
Division 1 2 :3 4
Permit Fee ................................... $
City:
R S U
/'-/, "1S
Plan Check Fee ............................. $
J ;)cJ
State Surcharge ............................. $
Penalty ....................................... $
Plumbing Permit Fee ....................... $
SOIL TESTS
o ENERGY DATA
o
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS 0 SETS
SURVEY
PLOT PLAN
o COPIES
o
Pressure Reducer .......................... $
Meter Horn................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Mechanical Permit Fee ..................... $
Sewer & Water Permit ....................... $
WaterTowerFee ........................... $
Gas Fireplace Permit ....................... $ Water Tap ................................... $
This Application Becomes Your Building Permit When Approved. Builder's Deposit ............. ......... ...... $
::"..,. of"'",,,, 0... :';;~~~::;;:::::::~~;~;.w~ : ;~;::~
Issued
Date {j -:JiLl-OJ By /
This is to certify that the request in the above application and accompanying documents is in accordance with the City zonin;brdinance and may proceed as !a4uested. ThiS document when
signed by the City Planner consl~utes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy. a Certificate of Occupancy must be issued.
24 hour notice for all inspections 447-9850
Special Conditions ~ any
City Planner
Date