HomeMy WebLinkAboutBuilding Permit 99-1078
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CONTR.
PERMIT NO. QQ-lOlf
CITY OF PRIOR LAKE
INSPECT/ON NOTICE
SCHEDUl,ED
ADDRESS 5410
OWNER
PHONE NO.
o FOOTING D PLUMBING RI
D FOUNDATION D MECH RI
D FRAMING 0 WATER HOOKUP
~NSULATION ~ D SEWER HOOKUP
p{. FINAL "'" D PLUMBING FINAL
D SITE INSPECTION D MECH FINAL
COMMENTS: ~j(l~
oJ
j....\, (.fl"'fLthA.
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'ocr,."
l~
Ave.
TIME
~
D EX/GRAD/FILLING
D COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
D GASLINE AIR TST
D
/
/
I
~ORK SATISFACTORY, PROCEED
o CORRECT A TI AND PROCEED
EINSPECTION BEFORE COVERING
Owner/Contr:
THE NEXT INSPECTION 24 HOURS IN ADVANC~
INSNOTl
TS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
DATF RFCFIVFD
~p6/9,r
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
1. White
2. Pink
3. Yellow
File
City
Applicant
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
Permit No.
9.:;- -/o7L
1. DATE
8-30-~9
5Ylc l-(o._p 1.,.-,
Sr.
/!:./
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
LOT
3. LEGAL DESCRIPTION
(p
N. Sh'o#!e-
12, NO, OF STORIES
BLOCK
ADDITION
OArs
2~
,PID .2./',-OrA_ ()Ot;,-O,
13. TYPE OF CONSTRUCTION
4. OWNER
(Name)
(Address)
(Tel. No.)
14. FLOOR AREA APPORTIONMENT USE
5, ARCHITECT
(Name)
(Address)
(Tel. No,)
6. BUILDER
(Name)
(Address)
(Tel. No.)
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
S-""'6o..V
c "'-'<;~rv,h'.,......
Fireplace 0
Alterations CJ
Septic 0
Addition 0
t..:ffas ~_,~ <; +
'P.L.
Deck 0
Finish Attic 0
N~
('-lY"'-~Oo()
Re-roofing 0'"' Porch 0 ~
Re-siding)( Finish Basement 0
SEATS
16, PROJECT COSTNALUE
I
J
7, TYPE OF WORK
/9. PROPERTY DIMENSIONS /10. CULVERT SIZE
Width Depth Yes No
l3T1Ch....;:tn this application which is to the best of my knowledge true and correct. I also certify that I am lt1e owner or authorized agent for
t all ~slruclion will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the
for just cause. Furthermore, I hereby agree lt1at the city official or a designee may enter upon the property to perform needed inspections.
- . 7Z5/~_1C'\. ~
License No. Date
17, COMPLETION DATE
x
- SETBACKS: Required
Actual
Signature
FOR ADMINISTRATIVE USE
BUILDING DEPARTMENT VALUATION
F"",r
Back
Side
Side
MATeRIAL FILED WITH APPLICATION
SOIL TESTS D ENERGY DATA D
PILING LOGS 0 PERCOLATION TESTS 0
USE OF BUILDING
/?,c.oS A / /.e.
,
OFF STREET PARKING
SPACES REQ.
SPACES ON PLAN
PERMIT VALUATION
PLANS & SPECS 0
SURVEY 0
SETS
COPIES
2- Sl51J ~ (/U
PLOT PLAN
o
TYPE OF CONSTRUCTION: I II III IV V
Occupancy Group A B E F HIM R S U
City:
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ..,...................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
Division 1 2 3 4
Permit Fee ................................... $
74 7)
Plan Check Fee ............................. $
State Surcharge ............................. $
Penalty ....................................... $
.--
I /_S
Pressure Reducer .......................... $
Meter Hom ............................ ....... $
WalerMeler ................................. $
Sewer & Water Connection Fee ........... $
WaterTowerFee ........................... $
Water Tap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
Total Due .............................. $
Paid 7(;. dO Receipt N.. '
Date e&
This is to certify that the request in the above application and accompanying documents is in accordance wilt1 the City Zoni Ordinance and may proceed as quested. This document when
''gnad 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.
Plumbing Permit Fee ....................... ,01:
Mechanical Permit Fee ..... ............. ... $
Sewer & Water Permit ...................... $
~~:.~{.;.;~~~i:.;itWfJJ11ottf1
Certificate of Occup/ncy I } /
7(p.(JV
~ "'Oc./~
Issued
City Planner
Date
Special Conditions if any
24 hour notice tor all inspections 447-9850