HomeMy WebLinkAboutBuilding Permit 99-0794
City of Prior Lake
Inspection Notice
DATE
,
1 O/25/9~
SCIfEDULED
ADDRESS 16423 DULUTH AVENUE SE
OWNER CONTR
PHONE NO. PERMIT # 99-794
TYPE OF INSPECTION RE-ROOF
COMMENTS:
~
o
o
Inspector:
Work Satisfactory, Proceed
Correct Action and Proceed
Correct Work, Call for Reinspection Before Covering
&/
Owner/Contr.
TIME
A.T.
5~~
DATE RECEIVED
0~:?1-q9
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
I 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
/1/;1.);;" ~ Ou flA.-fA AUfP 5 E
1. White
2. Pink
3. Yellow
File
City
Applicant
Permit No. l'q "("l_ 4=--
1. DATE
3. LEGAL DESCRIPTION
{?IW t-k ,e.1....
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
12. NO. OF STORIES
LOT
BLOCK
PID 2S -40Z"03,z-0
13. TYPE OF CONSTRUCTION
ADDITION
4. OWNER /'l (Name)
nlMJ {_h:/I
5. ARCHITECT (Name)
(Address)
/~~3.&I...jL.. ~.sE
(Address)
f)L
6. BUILDER
(Name)
(Address)
(Tel. No.)
~~2S'
(Tel. No.)
14. FLOOR AREA APPORTIONMENT USE
(Tel. No.)
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
SEATS
16. PROJECT COSTNALUE
Fireplace LJ
Alterations 0
/
Re-roofing rJ Porch 0
Ae-siding 0 Finish Basement 0
7. TYPE OF WORK
New Construction 0
Septic 0
Addition 0
Deck 0
Finish Attic 0
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES 19. PROPERTY DIMENSIONS /10. CULVERT SIZE
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. J also certify that I am the owner or authorized agent for
the above mentioned property and that all construction will form to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the
~u~~;;;:ermit for just cause ore, I hereby ag'ee that the city official or a designee may enter upon the property to (;: .:l~; i~
/ Signature license No. Dale ,
17. COMPLETiON DATE
- SETBACKS: Required
Actual
FOR ADMINISTRATIVE USE
Pressure Reducer .......................... $
MeIer Horn ................................... $
Water Meter ................................. $
Sewer & WalerConnection Fee ........... $
Water Tower Fee ........................... $
Water Tap ................................... $
Builder's Deposit ............................ $
Other ......... ........ ............. .... ....... $
Total Due .............................. $--1('0. C1[)
....
Paid '1 b.. ReceiptNo.'~S"c.. b
Date t.. (~ 1"7 By \e..fllA
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 as requested. This document when
signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction 10 commence. Before occupancy, a Certificate of Occupancy must be issued.
Front
Back
Side
BUILDING DEPARTMENT VALUATION
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
USE OF BUILDING
~s II lL-
TYPE OF CONS11lUcnON: i II III IV V
Occupancy Group A B E F HIM R S U
City:
Division 1 2 3 4
Permit Fee ................................... $
14.1~
Plan Check Fee ........ ..................... $
State Surcharge ............................. $
Penalty ....................................... $
t.'l.{'
Plumbing Permit Fee ........... .... ........ $
Sower&W e'Pe 1;1:::t~.:::.::..::..:
GasRre ceRrrmt ...1.........
on Be ,,-1:11 I perm)....hen AP~~ed
\'lA)lJ' __._"",\ ~
1
Certificate of Occupancy
-------
Issued
CRy Planner
Date
24 hour notice for all inspections 447-9850
Special Conditions W any
Side
MATERIAL FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA 0
PILING LOGS 0 PERCOLATION TESTS 0
..
PLANS & SPECS 0
SURVEY 0
SETS
COPIES
'Z-s 00.
-.
PLOT PLAN
o
Amount Brought Forward .................. ~
Pal1<: Support Fee .... ....................... $
SAC ......................................... $
Collective Street Fee ................. ...... $
Sewer Tap ................................... $
$