HomeMy WebLinkAboutBuilding Permit 04-1008
CITY OF PRIOR LAKE
INSPECnON NOTICE
SCHEDULED
DATE TillE
.5; 23 ,oy
ADDRESS
/4-S-34'- Gc..e-NO#L.b /h15
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH R1"
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
COMMENTS:
4.ldo~
o EXIGRADIFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
~ASUNE AIR TST
('_ ..!:'72/n;l ",
(!." '- OS fS
DIl FJ I ( )
7716 PI 06'
//VAeT/VITV
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 INSPEcnON 24 HOURS IN ADVANCE.
lNSIiOTI
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH &: SAFETYI
~~
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
DIRECTIONS 1/. ODAT_E_~_"''''''lf-'
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN U
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bot,tom)
2. SITE ADDRESS / 4 53'1- 6/"2 nclrt k U 5 F
pATE RECEIVED
1. White
2. Pink
3. Yellow
File
City
Applicant
It). 5""',0'4'-
Permit No.
04-./006
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
3, LEGAL DESC71 TION
LOT
12. NO. OF STORIES
5. ARCHITECT
(Name)
<-: (Address)
~ hi 11>0/\
I Add ress)
PID a;-. 115-. 0 () I. 0
(,'tj~ LNo I~
4 '53Y- G-Ien~ r~ Atf 5 E
(Tel. NO.)/.:(.L805-5So/'
13. TYPE OF CONSTRUCTION
ADDITION
4. OWNER
BLOCK
(j 11 ~rr,A/ 0 $(:;'/1 c.W
12-.~a;s
14. FLOOR AREA APPORTIONMENT USE
6, BUILDER
(Name)
(Address)
(Tel. No.)
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
7. TYPE OF WORK Fireplace 0 Septic 0 Deck 0 Re.roofing 0 Porch 0
New Construction 0 Alterations 0 Addition 0 Finish Attic 0 Re.siding 0 Finish Basement 0
Chimney 0 Mise, ~7\ fX:.t nJJCAL-\ 0" b 1';;vUL.. \'~r (.j tic. kl\'I'{l (C,1 f-yl..{-( .
8. PROPERTY AREA OR ACRES 9. PROPERTY DiMENSIONS 10. CULVERT SIZE
SEATS
16, PROJECT COSTNALUE
17. COMPLETION DATE
Sq. Ft.
Width
Depth
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 loca/laws and wil/ proceed in accordance with submitted plans. I am aware that the
building official can revo~e this perm~t for :Z:' Furthermore, I hereby agree that the city official or a designee may enter upon the property to perfor~ needed inspections.
X ~ r-::~ A---.- /(..')-Y-r~'I--
Signature License No. 6ate
Front
FOR ADMINISTRATIVE USE
MATERIAL FILED WITH APPLICATION
Back Side Side SOIL TESTS 0 ENERGY DATA 0
OFF STREET PARKING PILING LOGS 0 PERCOLATION TESTS 0
SPACES REQ, PLANS & SPECS 0 SETS
SPACES ON PLAN SURVEY 0 COPIES
PERMIT VALUATION 2.J5DO.OO PLOT PLAN 0
SETBACKS: Required
Actual
BUILDING DEPARTMENT 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 ....................... $
SewerTap ................................... $
$
Plan Check Fee ............................. $
State Surcharge ............................. $
Penalty....................................... $
Plumbing Permit Fee ....................... $
Sewer & Water Permit ...... ........ ........ $
Pressure Reducer .......................... $
Meter Horn ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
WaterTowerFee ........................... $
Water Tap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
Total Due .............................. $
Paid '7 (i . () 0 Receipt No,
Date / (). {,. -() 4-
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proce as requested. 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.
'7CtJ.oO
.flfJSb
Mechanical Permit Fee ..................... $
Gas Fireplace Permit ....................... $
This Application Becomes Your Building Permit When Approved,
By Date
Certificate of Occupancy
Issued
City Planner
Date
Special Conditions ~ any
24 hour notice for all inspections 447.9850