HomeMy WebLinkAboutBuilding Permit 04-0838
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
_574ft;
tEOI7 /U'VO() 0 7Jt.-G
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:
DATE TIME
SI 23. CJ"
4-. Y3Y
o EXIGAADIFILLING
o COMPLAINT-
o FIREPLACE RI
o FIREPLACE FINAL
J GASLlNE AIR TST
t ..~/olN'6
/
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DIJ H 77J
7716 PI 06
/ /V ;?f eT/ V / TV
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. [J WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
[J CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector:
Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADV""I~r::
IIUiion
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH III SAFETYI
DATE RECEIVED.
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
1 ~~~ ~ tJ t.{-
1. White
2, Pink
3. Yellow
File
City
Applicant
g ,,2.-. 04--
Permit No.
O+-.063&;
DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
2. SITkA14Eb ~M-rri <1_~ 11~
3. LEGAL DESCRIPTION
5
SmJD PT 3~
'lip~NE_R 1 "",, (~,lim~ . ft_ fI (Add~)~\.... .. \rb (Tel.~ '1~J.;o I
..WttQ~~>ul'~ f)1Y~ ~Ql1~ Ll^:{-93tf~
5. ARCt-OECT (Name) (Address) (Tel. .1
12. NO, OF STORIES
LOT
BLOCK
2-
PID
z.5. 2.1+. 015.0
13, TYPE OF CONSTRUCTION
ADDITION
14. FLOOR AREA APPORTIONMENT USE
6, BUILDER (Name)
u4~)~.
(Address) (Tel. No.) b ~ I
Y7Y ~J;~1 ~L.("d.laLf ~
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
7. TYPE OF WORK
New Construction 0
Fireplace 0
Alterations 0
Septic 0
Addition 0
Deck 0
Finish Attic 0
Re-r~ng 0 Porch 0
Re-Sidingr Finish Basement 0
SEATS
16. PROJECT COSTNALUE
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES
Sq. Ft
9, PROPERTY DIMENSIONS
Width Depth
10. CULVERT SIZE
17. COMPLETION DATE
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 above mentioned property 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 Off~,:r~ this p rmit forju cause. Furthermore, I hereby agree that the city officia~esln7 ~ ~upon the property to perform ~~d ins~eOoLt..
0" t\ Li\:ense No. D:l .
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
MATERIAL FILED WITH APPLICATION
Front
Back
Side
Side
SOIL TESTS
o ENERGY DATA
o
BUILDING DEPARTMENT VALUATION
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS 0 SETS
USE OF BUILDING
SURVEY
PLOT PLAN
o COPIES
o
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 ................................... $
$
..., 1,,00
Plan Check Fee ............................. $
State Surcharge ............................. $
Penalty....................................... $
Sewer & Water Permit ...................... $
Pressure Reducer .......................... $
Meter Horn ................................... $
Water Meter................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
Water Tap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
Total Due .............................. $--2fp. 00
Paid '7~. 0 0 +7751
Date 8,/3.04-" By
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed s requested. This document when
signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certifica of Occupancy must be issued,
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
Gas Fireplace Permit ....................... $
This Application Becomes Your Building Permit When Approved.
By Date
Certificate of Occupancy
Issued
Crty Planner
Date
Special Conditions ~ any
24 hour notice for all inspections 447-9850