HomeMy WebLinkAboutBuilding Permit 99-1027
CITY OF Pfl.IOfl. LAKE
INSPECTION NOTICE
SCHEDULED
DATE TIME
ID/~v/o' p.."
ADDfl.ESS
15~;).'7
~ JJ,W
OWNEfl.
CONTfl..
PHONE NO.
PEfl.MIT NO.
C}'7-IO~'7
o FOOTING
o FOUNDATION
o FRAMING
AD INSULA nON
f.: FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o sEWEfl. 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: ~_ oK
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"e(WOfl.KSATISFACTORV, PROCEED
o CORRECT ACTI~ AND PROCEED
o CORRE~OR CALL FOR REINSPECTION BEFORE COVERING
Inspector: -;f)~ (JAA~ _ Owner/Conlr:
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY/
CALL 447,9850 FOR HE NEXT INSPECTION 24 HOURS IN ADVANCE.
INSNOTl
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DATE RECEIVFD
a/ler/Q'1
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
. DIREcnONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
li-1qE-qq
/2/50
2. SITE ADDRESS
I ~'"i 7 ,q 'J1:/ Alub Vff>>v
3. LEGAL DESCRIPTION
S
/ ttiLANO
ed AW
LOT
J
VI F:.-W
(Address)
Ic.:T/7.~ T,/a...o(Mc..w ncA
(Tel. No.)
'l<f7-6iLQ :)
PID 25- OI?F, - fJn5-(')
BLOCK
ADDITION
4. OWNER
_K1"V\J
5. ARCHITECT
f,~k
(Name)
(Address)
(Tel. No.)
6. BUILDER
(Name)
(Address)
(Tel. No.)
~(\-S ~1.0l'Vf50T\J C~Mf
17n w1lvl/uw'fkt!f Sf 4tlo-3717
1. White
2. Pink
3. Yellow
-
File
City
Ap,plicanl
lOr dD
~-/()21
.1(",-1
I'~-
Permit No.
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
12. NO. OF S7R'ES
13. TYPE OF CONSTRUCTION
<;/dJ1v-
14. FLOOR AtlA APPORTIONMENT USE
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANT~
SEAT~
7. TYPE OF WORK Fireplace 0 Septic 0 Deck 0 Ae-roofing 0 Porch 0
New Construction LJ Alterations LJ Addition LJ Finish Attic LJ Re'sidin~ Finish Basement LJ 16. PROJECT COSTNALUE
Chimney 0 Misc. JSO (j
8. PROPERTY AREA OR ACRES 19. PROPERTY DIMENSIONS 110. CULVERT SIZE 17. caMP 1.1::; liON DATE
Sq. Ft. Width Depth Ves No ~ - "lO~ q
I hereby certify that J 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 prope 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 official can re thi~st cause. Furthermore, I hereby a.1ree th>lllh,,: ...ity_official or a designee IJl2Y enter upon the property to perform needed inspections.
X _ _ /;,J _ 'IIOIJ 1hM-t: r_....J ~'f-q9
--- / - Signature r--" .. License No. Date
FOR ADMINISTRATIVE USE
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
Pressure Reducer .......................... $
Meter Ham ... .... .... ................. ....... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
WaterTowerFee ........................... $
Water Tap ................................... $
Builder's Deposit ............................ $
Other ......................................... ct
SETBACKS: Required
Actual
Front
Back
Side
Side
BUILDING DEPARTMENT VALUATION
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
260t.J. (PJ
USE OF BUILDING
J2 F- S.
A/Ie.
TYPE OF CONSTRUCTION: J II III IV V
Occupancy Group A B E F HIM R
Division 1 2 3 4
S U
City:
Permit Fee ................................... $
74. "7 S-
Plan Check Fee ............................. $
State Surcharge ............................. $
Penalty ....................................... $
Plumbing Permit Fee ....................... $
1.2.,...-
Mechanical Permit Fee ..................... $
Sewer & Water Permit ...................... $
;w;JJfi.:~;;'~
Certificate of Occupanl
MATERIAL FILED WITH APPLICATION
SOIL TESTS Ll ENERGV DATA Ll
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS Ll
SETS
COPIES
SURVEY LJ
PLOT PLAN
Ll
7{g.()O
Paid 7(, 0 U Receipt No. ,35'896
Issued r / ~
Date 8/lq q1 By /1/'.6...
. ,
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 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.
Total Due .............................. $
City Planner
Dale
Special Conditions if any
24 hour notfce for all inspections 447-9850
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