HomeMy WebLinkAboutBuilding Permit 99-0686
DATE TIME
SCHEDULED cf ' ~-I /II
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CONTR.
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
/S79/
OWNER
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
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COMMENTS:
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o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
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~ORK SATISFACTORY, PROCEED
o jl'lRRECT ACTION AND PROCEED
~RRECT WORK, CALL FOR REINSPECTlON BEFORE COVERING
Inspecto~VCe Owner/Contr:
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE..
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY/
INSNOTl
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DAT~ RFr:~IYFQ
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CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
1. White
2. Pink
3. Yellow
FiI'V
City
Applicant
Permit No. <:;'Cj-(,B6
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
_l'i" taj 5k"'1h,.., Y. /). ,J,,, ,~....
3. LEGAL DESCRIPTION / "
4
1. DATE
~
J5,. ;~.....
&--1./. -/CJvr
L /210$0
Ill<<'t'" 11A1 5$372
)
BUILDING INFORMA nON
". SIZE OF STRUCTURE
(Height) (Width) (Depth)
12. NO. OF STORIES
LOT
BLOCK
s-
V/~ 1ST"
PID .25-143-1"1(.7-0
/<:;LANO
14. OWNER (Nam.) II
~V_4H,j --g.A.,r
15. ARCHITEcT (Name)
6. BUILDER (Name)
13. TYPE OF CONSTRUCTION
ADDITION
(Address)
(T.1. No.)
14. FLOOR AREA APPORTIONMENT USE
(Address)
(Tel. No.)
(Address)
(T.1. No.)
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
7. TYPE OF WORK Fireplace CJ Septic CJ Deck CJ
New Construction CJ Alterations a Addition CJ Finish Attic CJ
ChimneyO Misc. 1~}"V1JAlh -.1"'''' o~__.)...
IS. PROPERTY AREA OR ACRES 19. PROPERTY DIMENSIONS 110. CULVERT SIZE
Sq. Fl. 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 local laws and will proceed in accordance with submitted plans. I am aware that the
buil . ial can revo,e this perm~u~hermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X ""'..J / ( -ir~ h.-L/-19~t}
Signature - license No. Date -
Re-roofing a Porch a
Re-siding)( Finish Basement CJ
SEATS
16. PROJECT COSTNALUE
17. COMPLETION DATE
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
Front
Back
Side
Side
MATERIAL FILED WITH APPLlCA nON
SOIL TESTS a ENERGY DATA a
PILING LOGS c:J PERCOLATION TESTS c:J
BUILDING DEPARTMENT VALUATION
USE DF BUILDING
/2eJ A/II?-
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
PLANS & SPECS 0
SURVEY 0
SETS
COPIES
2. c;cm en )
PLOT PLAN
c:J
TYPE OF CONSTRUCTION: I II III IV V
Occupancy Group A B E F HIM R
Division 1 2 3 4
S U
City:
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
Permit Fee ................................... $
,4. ,f,
Plan Check Fee ............................. $
State Surcharge ............................. $
penany ....................................... $
I. v)
Plumbing Permit Fee ....................... $
Pressure Reducer .......................... $
Meter Hom ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Mechanical Permit Fee ..................... $
Sewer & Water Permit ...................... $
WaterTowerFee ........................... $
Water Tap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
Tolal Du. .............................. $ t (". ell)
Paid 1 ~ . 0 U Receipt No. ..3 s-r-Ior
Issued
Dal.(,/1 fen By fM-
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoni~g OrdinJ,ce and may proceed'as requested. This document when
signed by the City Planner const~utes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be issued.
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Certificate of Occupancy
City Planner
Date
Special Condrtions if any
24 hour notice for all inspections 447-9850