HomeMy WebLinkAboutBuilding Permit 99-1000
ADDRESS
/522-9
DATE
SCHEDULED ~~
8t--i60CJ;2./L/
TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
/~
OWNER
CONTR.
PHONE NO.
PERMIT NO.
99~/OOO
o PLUMBING RI 0 EX/GRAD/FILLING
o MECH RI 0 COMPLAINT
o WATER HOOKUP 0 FIREPLACE RI
o SEWER HOOKUP 0 FIREPLACE FINAL
o PLUMBING FINAL 0 p~GASLlNEAIRTST
o MECH FINAL ~ I'{ .sL.ruAl ~
f
COMMENTS: ~~ f...., ~~)(_ob,
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
r(lf~
l
~
-Jpp ~
~
~
~ORK SATISFACTORY. PROCEED
o CORRECT ACTION AND PROCEED
:S::~O:ECT W~ ~ALL FOR REINS~::::::n::FORE COVERING
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY/
INSNOTl
~~
Q4l,TF 1::1I=r.f::WI=D.
B/;z./QCJ
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
I. White
2. Pink
3. Yellow
File
City
Applicant
Permit No. c?9- lOG 0
DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
12. SIT, ~;a11:\
~\ ~"'-~r-" (1\('(' \.-.&L
I ::~~ ~ '=\
C:;.I;.. Je/Q)
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
3. LEGAL DESCRIPTION
7
12. NO. OF STORIES
LOT
I
. C:;/-dl/l/6RJ LA
BLOCK
PID 25- /t..5 - () 0 7-0
13. TYPE OF CONSTRUCTION
ADDITION
14. OWNER (Name)
\-\o...~("-'.~
15. ARCHITECT (Name)
6. BUILDER (Name)
(Address) (Tel. No.)
\ '5 ~.:a... q "\?-,\ ,,~. ~ Cl.:.r. -.:>. €'
(Address) (Tel. No.)
14. FLOOR AREA APPORTIONMENT USE
qlfa--"lCt'/
~~\l..\\..u-
(Address)
't'\2.1.\ \".!>'\. \.,....J<:..,.. .
~'il..-\. ~,~"\.c-<\. ~~
Septic 0 Deck 0 -- Rs-roofing (J Porch LI
Addition 0 Finish Attic 0 Re'Sidin~ Finish Basement 0
(Tel. No.)
<...0\-0 ee<\:~
/Q~'o.3
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
7. TYPE OF WORK
New Construction 0
Fireplace 0
Alterations 0
SEATS
16. PROJECT COSTNALUE
Chimney 0 Misc.
18. PROPERTY AREA OR ACRES 19. PROPERTY DIMENSIONS 110. CUI.VERT 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. 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
bui~ial can revoke this pe~ :~~ Furthermore, I hereby agree that the city official or a designee may enter upon the property to pertorm needed Inspections.
x~,~~ _ , . 'Z...0Cll..I.."&"1"L ~~qC\
- '-.l -="'" Signa'tlJfe Ucensa No. Date~ ...
17. COMPLETION DATE
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
Front
Baok
Side
MATERIAL FILED WITH APPLICA nON
Side SOIL TESTS 0 ENERGY DATA 0
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS 0 SETS
SURVEY 0 COPIES
Z. 5752). VV PLOT PLAN 0
I
BUILDING DEPARTMENT VALUATION
USE OF BUILDING
/2.&.5: A-/L
OFF STREET PARKING
SPACES REQ.
SPACES ON PLAN
PERMIT VALUATION
TYPE OF CONSTRUCTION: I II III IV V
OccupancyGroup A B E F HIM R
Division 1 2 3 4
Permit Fee ................................... $
S U
741s
City,
Amount Brought Forward .................. ~
ParkSuppOI1Fee ........................... $
SAC ......................................... t
Collective Street Fee ....................... It
Sewer Tap ................................... It
Plan Check Fee ............................. $
State Surcharge ............................. $
I. Z-~
$
Penalty ....................................... $
Plumbing Permit Fee ....................... $
Pressure Reducer .......................... c;:
Meter Horn ............................ ....... c;:
Water Meter ................................. <l:
Sewer & Water Connection Fee ........... It
Water Tower Fee ........................... ~
Mechanical Permit Fee ..................... $
Sewer & Water Permit ...................... $
Water Tap ................................... cr
Builder's Deposit ............................ <l:
Other ......................................... It
Total Due .............................. L..2c. . r7 0
Paid J~ .00 ReceIPt'.~ ~5P3?:' 3
Issued Date BI/7jqq By ~
ThIS IS to certify that the request In the above application and accompanying documents IS In accordance WIth the City ZOning b~ay proceed at4'equested. 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
Special Conditions if any
24 hour notice for all inspections 447.9850