HomeMy WebLinkAboutBuilding Permit 99-0709
CITY OF PRIOR LAKE
INSPECTION NOTICE
DATE TIME
SCHEDULED
/0-,9-'9
A,I;
ADDRESS
ILjP~ ,
~~~k,
OWNER
CONTR.
PHONE NO.
PERMIT NO.
CJe; - '/ tJ ,
o FOOTING 0 PLUMBING RI
o FOUNDATION 0 MECH RI
o FRAMING 0 WATER HOOKUP
o INSULATION 0 SEWER HOOKUP
)a- FINAL 0 PLUMBING FINAL
/6 SITE INSPECTION 0 MECH FINAL
COMMENTS: ~~ ~
~
( (I~
'-
----
o EXIGRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
)(""-~..... ~
~ /
.~~
~~~)
-"
Inspector:
~RK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
6;.
/
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
Owner/Contr:
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYl
INSNOTI
, --.._._~..___u__._._._._."
S~1
DATE RECEIVED
G#O/91
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
1. White
2. Pink
3, Yellow
File
City
Applicant
DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
1. DATE
Permit No.
QC;-709
2. SITr AD?~SS jJ /' 'j) . /J
1i.{J:){) fYI/l// IJ.Jli,} ntlAtl/'.It///_ (./;.
3. LEGAL DESCRIPTION
LOT Z BLOCK /
77-I~f...,6NS IS{ fiOON
4~NER J l, SNa;ne) (Address)
.L/J lJO !u1..:#1 /t/Pal/ t));J,/:'/d-l/dAlut,{ Iv('.J
5. ARCHITECT (Name) (Address)
ADDITION
6. BUILDER (Name)
. ~/!j (Jltal
7. TYPE OF WORK
0J f'1J-99
,e/SD
PID 25.lq~, ot')2.: 0
I
Cb '7~ I
I
.1
BUILDING INFORMA nON
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
12. NO. OF STORIES
13. TYPE OF CONSTRUCTION
14. FLOOR AREA APPORTIONMENT USE
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTo
SEATS
New Construction 0
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES /9. PROPERTY DIMENSIONS 110. CULVERT SIZE
Sq. Ft. Width Depth Yes No
I hereby .certlfy~all have fuffii.shed info lTllation on this application which is to the besl 01 my knowledg e true and correct. I also certify thai I am the owner or authorized agen, t lor
the abov~mentio ed 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
buildi')O"official c revoke this permit.~ust cause. ~~urthermore, I hereby agree that th,",City offici!!! or a de~ne~ay enter upon the property to perform needed insp~ions.
X \... :. i,..I" ..L}:.1' iu~. :.t /}/'J.?/? L/<;('j & -Af 7/
~'-_. ;{~. LJCenseNo. Date
V
SETBACKS: Required
Actual
(Tel. No.)
~?0
(Tel. No.)
w~/);
FirePlac'S;
(Address) (Tel. No.) ~
@.S/F(P
.f/-? ~//J;u.-j~(/ ~~r.#,t'
Septic 0 Deck 0 ,R'e-roofing d----Porch 0
Addition 0 Finish Attic 0 Re-siding 0 Finish Basement LJ
Alterations 0
.
FOR ADMINISTRATIVE USE
Front
Back
Side
Side
USE OF BUILDING
BUILDING DEPARTMENT VALUATION
.e&s ,4/ ~
,
OFF STREET PARKING
SPACES REQ.
SPACES ON PLAN
PERMIT VALUATION
~.cIV
TYPE OF CONSTRUCTION: I II III IV V
Occupancy Group A B E F HIM R
Division 1 2 3 4
Amount Brought Forward .................. $
Park Support Fee ........................... <I'
SAC ......................................... $
Collective Street Fee ....................... <I'
Sewer Tap ................................... <I:
$
S U
City:
Permit Fee ................................... $
7c.1.1~
Plan Check Fee ............................. $
State Surcharge ............................. $
Penalty ....................................... $
Plumbing Permit Fee ....................... $
/.z..r
16. PROJECT COSTNALUE
17. COMPLETION DATE
MATERIAL FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA 0
PILING LOGS 0 PERCOLATION TESTS D
PLANS & SPECS 0
SURVEY 0
SETS
COPIES
PLOT PLAN
o
Pressure Reducer .......................... $
Meter Horn .................... ............... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... <I'
Water Tower Fee ........................... $
Mechanical Permit Fee ..................... $
Sewer & Water Permit ...................... $
Thi
By
ilding Permit Wh1,ApPtve~
Date 1.1 10. q
/
Water Tap ................................... $
Builder's Deposit ............................ $
Other ..... .... ..................... .... ....... $
Total Due .............................. $ 7". () 0
Pa;d I (g. dV Receipt No S S cf2b
Issued
Dale tp/t ~/ f( 'f By 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 proceed a~uested. 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.
City Planner
Dale
24 hour notice for all inspections 447-9850
Special Conditions if any