HomeMy WebLinkAboutBuilding Permit 99-1021
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CITY OF PRIOR LAKE
INSPECTION NOTICE
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SCHEDULED
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ADDRESS
3'1G;3 .s./.)t"'~
11
CONTR.
OWNER
PHONE NO.
79- JOd l
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
\f!,1NSULATION ~
,.Il{ FINAL
o SITE INSPECTI
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
COMMENTS: W~
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r ~ .-fJ6
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~RK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
~ Owner/Contr:
Inspector:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE,
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTl
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CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
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1. White
2. Pink
3. Yellow
File
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Applicallt
Permit No. 9Cf-/tJz/
I DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
~SUEO (Please Print or Type and sign at bottom)
3 I.{ S'3 S 1/ c., '" vr~ tr..; I
3. LEGAL DESCRIPTION
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(H.~ht) (Wodlh) (Oeplh)
12. NO. OF STORIES
LOT
'LOCK
l'1eTFS /!NO !50UA/OS
PIO 25-0113 -0//-0
13. TYPE OF CONSTRUCTION
ADDITION
.- (Name)
,..--"" fY1,. I< f 5 /l c, /l ,
'r
(Address)
7'1%1
(Address)
(Tel. No.)
J v~",.,~r( rrl
14. FLOOR AREA APPORTIONMENT USE
5. ARCHITECT
(Name) r'
(Tet. No.)
(Name)
(Address)
(Tel. No.)
15. NUMBER OF OCCUPANTS OR SEATS
(30/3 Oltr"'~'" I tJ-VL' sT Fr,nc..;, (..;v YYh~,,~ 7
.~.fI:-;':>~~~~' Fireplace LJ Septic a Deck 0 Re-roofing LJ Porch 0
New Construction 0 Alterations 0 Addition CI Finish Attic CI Ae-siding 0 Finish Basement 0
ChJmneyD Misc. /3 ~;'lJv-... J- C/l/,r,e 5; Z,(
8. PROPERTY AREA OR ACRES 19. PROPERTY DIMENSIONS /10, CULVERT SIZE
Sq. Ft. Width Depth Yes No
I hereby certify that I have furnished infonnation 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 contonn to aU existing state and local laws and will proceed in accordance with submitted plans. I am aware that the
.. off A :t:evo;e (J~to~t cause. Furthennore, I hereby agree th~ 2e ~i~ 0~116r ;designee may enter upon the property to,
Signature License No.
OCCUPANTS
SEATS
16. PROJECT COSTNAlUE
17. COMPLETION DATE
Dale
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
BUILDING DEPARTMENT VALUATION
. . /
USEOFBUILOING ~ ~~
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
l-')U) . -
MATERIAL FILED WITH APPLICATION
Side SOIL TESTS 0 ENERGY DATA 0
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS 0 SETS
SURVEY 0 COPIES
PLOT PLAN 0
Front
Back
Side
TYPE OF CONSTRUCTION: I II III IV V
Occupancy Group A B E F HIM R
Division 1 2 3 4
Permit Fee ............................... .... $
S U
City:
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
74. 7r-
Plan Check Fee ............................. $
State Surcharge ..................... ........ $
Penalty .............. ......................... $
Plumbing Permit Fee ....................... $
/.~~
Mechanical Permit Fee ..................... $
Pressure Reducer .......................... $
Meter Horn ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
Sewer & Water Permit ...................... ,f
it ....................... $
ing ;;r;it W~ ilo/tt? Cj
, /
Water Tap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
Total Due .............................. $
This
By
'7{P.oo
Paid 7 (P . CJ1J Receip' No, ..3:') 8 B '3
Issued t:::.
Da'e pJ, q By A...---
Th~ is '0 certify lha' the request in ,he above epplication and accompanying documen's is in accordance wi'h lhe Cify zonin6 :rdi?i.. :'d may proceed a uesled. This document"
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 n any
24 hour notice for all inspections 447-9850