HomeMy WebLinkAboutBUILDING 01-1093
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
DATE TIME
j, Z/, Of'
ADDRESS
/538/ IUlJ (),4K,S K-LJ
OWNER
CONTR.
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
COMMENTS:
(j1,1093
I
o EXIGRADIFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o ;&c -K-~O~
. &'-OS 6
DtJB' Ie)
7716 PI vb .
J /V ,?) eTl V I 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.
INSNOTl
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH cl SAFETYI
~~ if DATE RECE'~D
~ 131q
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
L White
2. Pink
3. Yellow
File
City
Applicant
Permit No. <:V)- to 93
DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
2. SITE ADDRESS 153 g I l? ed 0 oXIJ Rc1.
1. DATE
BUILDI;FORMATION
11. SIZE OF ST CTURE
(Height) idth) (Depth)
3. LEGAL DESCRIPTION
12. NO. OF STORIES
LOT
!
j
BLOCK
Co
-,
I 53 ~ ( K ~dAdOats Rd
I
PID;;;?)"- OQj- 001-0
4.o!Cefl .+{ J;;})
5. ARCHITECT (Name)
(Address)
(Tel. No.)
9SJ - (j1./7-}{f,).,J.
(Tel. No.)
A. TYPE 9f CONSTRUCTION
lAetwr1J sq .
14. FLOOR AREA APPORnONMENT USE
ADDITION
7. TYPE OF WORK
New Construction 0
Fireplace 0
Alterations 0
(~dfess) L__ .
IS l oom I () 0 rv>v
qsog UmdaJ~ S#v
V Deck 0
Finish Attic 0
(Tel. No.)
6. BUILDER
(Name)
&YOO~ ~l (Q Corf'
~ 9 -e6 fx we
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES
Sq. Ft.
9. PROPERTY DIMENSIONS
Width Depth
10. CULVERT SIZE
Yes No
SEATS
16;O~C&19OTNALUE
17. COMPLETION DATE
! 0/31)
Septic 0
Addition 0
Re-roofing ~ Porch 0
Re-siding 0 Finish Basement 0
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 above mentione roperty 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
~Uilding'a v k rVk~se. Furthermore, I hereby agree that the city o"ic~oil2i Dj Oer upon the property to perform ?Jl7I"~cins.
~ignature License ~No. Date
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
Front
Back
Side
MATERIAL FILED WITH APPLICATION
Side SOIL TESTS 0 ENERGY DATA 0
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS 0 SETS
SURVEY 0 COPIES
PLOT PLAN 0
BUILDING DEPARTMENT VALUATION
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
USE OF BUILDING
TYPE OF CONSTRUCTION: I II III IV
Occupancy Group A B E F HIM
Division 1 2 3 4
Permit Fee................................... $
V
R S U
City:
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
P.l<>i.. .,. ,,'>Fee ............................. $
/i./,-7~
{,-;J- ~
State Surcharge ............................. $
Penalty....................................... $
Plumbing Permit Fee ....................... $
Pressure Reducer .......................... $
Meter Horn................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Mechanical Permit Fee ..................... $
Sewer & Water Permit ...................... $
Water Tower Fee ........................... $
WaterTap ................................... $
Builder's Deposit............................ $
Other......................................... $
Total Due .............................. $ ~
/0,00 Receipt No. 40(ot/(:'
Date la -;oJ -01 By au
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and ~ay proceed as rUested. 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.
Paid
Gas Fireplace Permit ....................... $
This Application Becomes Your Building Permit When Approved.
By Date
Certificate of Occupancy
Issued
City Planner
Date
Special Conditions tl any
24 hour notice for all inspections 447-9850