HomeMy WebLinkAboutBuilding Permit 99-0816
,-
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
DATE TIME
/4 -If3-91
A.V:
ADDRESS
I~;)~(j ~ ~,
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
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~~,
47
4 -)d.v'~
~ /.-, r ----;z'
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
Dl: FINAL
/0' SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
COMMENTS:
~
99- ~/(p
~K SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
Inspector:
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
9,
Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
INSNOTl
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
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I. White
2. Pink
3. Yellow
~
DATE RECEIVED
'"1/ / /1q
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
File
City
Applicant
Permit No.
qq-8/G
DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
1. DATE
2. SITE ADDRESS /'-I;).lJ (j
h0l.o 1!lJ..Q.
7-/-tj
12.150
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
3. LEGAL DESCRIPTION
3
BouolrJS
12. NO. OF STORIES
LOT
BLOCK
t1/1NO,e.
PID 25 -/22-(5{)3-0
13. TYPE OF CONSTRUCTION
ADDITION
3120
(Name)
(Address)
.J r~1. Nol
7'11- j71/
14. FLOOR AREA APPORTIONMENT USE
4. OWNER
(Name)
5. ARCHITECT
(Tel. No.)
6. BUILDER
(Name)
(Address)
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
/nJa. ~
7. TYPE OF WORK
New Construction 0
Fireplace 0
Alterations 0
Septic 0
Addition 0
Deck 0
Finish Attic 0
Porch 0
Finish Basement 0
SEATS
16. PROJECT COSTNALUE
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES
Sq.Ft.
9. PROPERTY DIMENSIONS
Width Depth
1 O. CULVERT SIZE
Yes No
17. COMPLETION DATE
I hereby certify that I have fumished 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
building ~ this .;;r;or just cause. Furthermore, I hereby agree thai the city official or a designee may enter upon the property to pertorm needed inspections.
X . 'UtJk/ 7-1-91
Signature License No. Date
FOR ADMINISTRATIVE USE
Fron'
Back
Side
Side
MATERIAL FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA 0
PILING LOGS tl PERCOLATION TESTS tl
SETBACKS: Required
Actual
BUILDING DEPARTMENT VALUATION
USE OF BUILDING
ReS A/~
,
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
PLANS & SPECS 0
SURVEY 0
SETS
COPIES
z5l5() . CJ1..)
PLOT PLAN
tl
TYPE OF CONSTRUCTION: I II III IV V
OccupancyGroup A B E F HIM R S U
Permit Fee ..........~i~~~~~...1...~...~..~... $ 7'-/.-'~
City:
Amount Brought Forward .................. $
Par1< Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
Plan Check Fee ............................. $
State Surcharge ............................. $
Penalty....................................... $
Plumbing Permit Fee ....................... $
j.2.)
Mechanical Permit Fee ..................... $
Pressure Reducer .......................... $
Meter Hom... .... ............................ $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
Water Tap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
Total Due .............................. $ 7 in. dO
Paid -{f..de) R.ceiptN . 35512-
Date q
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zonin 0 ance and may proceed 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.
................ $
i1din9 ~:t';lt '77 ~rtf'l!j
Sewer & Water Permit ...................... $
Issued
City Planner
Date
Special Conditions d any
24 hour notice for all inspections 447-9850
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