HomeMy WebLinkAboutBuilding Permit 99-1139
DATE TIME
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ADDRESS /71 () 8" ~ Av-e
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
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CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
OWNER CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATIO:@
fIC FINAL
o SITE INSPE N
COMMENTS:
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tf1-l!31
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
~
/
~ORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WOR~~L FOR REINSPECTION BEFORE COVERING
Inspector: l?J --+---1 Owner/Contr:
/
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE,
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTl
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DATE RECEIVED
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
1. White
2. Pink
3. Yellow
File
Qty
Applicant
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Permit No.
99-//39
OIRECTlONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
2. SITE ADDRESS
\"1 \ 0 <;(
3. LEGAL DESCRIPTION
LOT (0 BLOCK
.5UN.J'c-t !-IIL.W
1. DATE
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BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Heiltlt) (Width) (Depth)
12. NO. OF STORIES
4-
PID
ZS-j/2-05G.-O
'-I '-{O.- 31 'X~
13. TYPE OF CONSTRUCTION
ADDITION
4. OWNER (Name^
:J'f> .f-.f- V...fA I'Y( n 11
5. ARCHITECT (Name)
(Address)
l'iIO'?
(Address)
(Tel. No.)
)u,.,,...,'s('"T,r. )(,.<1
(Tel. No.)
14. FLOOR AREA APPORTIONMENT USE
6. BUILDER
(Name)
(Address)
(Tel. No.)
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
!/,YCU5er
t100n nq
J Septic 0
Addition 0
'fCI}t- 3r'id-
SEAT"
16. PROJECT COSTNALUE
7. 'TYPE OF WORK
New Construction 0
Fireplace 0
Alterations 0
Deck 0
Finish Attic 0
Re-roofing~ Porch 0
Re-siding 0 Finish Basement 0
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES \9. PROPERTY DIMENSIONS 110. CULVERT SIZE
Sq. Ft. Width Depth Ves 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 win proceed in accordance with submitted plans. I am aware that the
building 9~1a1 can revoke this permit for jUlf 9'us~. Furthermore, I hereby agree that the city official or a designee may enter upon the property to pertormJeded j' pections.
X tYa;;;tL/.f~ 1'Y7..l.-G.:-,~ _ d.O/d 3/7" Of /5_ q.,
Signature License No. Date
17. COMPLETION DATE
FOR ADMINISTRATIVE USE
'ront
Bed<
Side
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MATERIAL FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA 0
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS 0 SETS
SURVEY 0 COPIES
PLOT PLAN 0
SETBACKS: Required
Actual
BUILDING DEPARTMENT VALUATION
USE OF BUILDING
A2~S ,q1i'C
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
'2 r?J7) _ cJ?J
TYPE OF CONSTRUCTION: I II 111 IV
Occupancy Group A B E F H 1 M
Division 1 2 3 4
Permit Fee ................................... $
Plan Check Fee ............................. $
State Surcharge ............................. $
Penalty ....................................... $
Plurrt>ing Permit Fee ....................... $
V
R S U
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City:
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
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Mechanical Permit Fee ..................... $
Pressure Reducer .......................... $
Meter Horn ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Sewer & Water Permit ...................... $
Issued
Water Tower Fee ........................... $
Water Tap ...................................!I:
Builder's Deposit ............................ $
Other ......................................... $
Total Due .............................. $ 7{,. 0 0
Paid "7 r-, 0 U Receiptl'~. :5 & 2- /3
Date '" /rr1~ C; By rfiJt/'--
This is to certify that the request in the above application and accompanying documents Is in accordance with the City Zoning Ordinance and may proceedJs requested. This document when
signed by the City Planner constitutes a temporary Certificate of Zoning cor11>liance and allows construction to commence. Before occupancy. a Certificate of Occupancy must be issued.
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Certificate of OcCupanf!y
City Planner
Dale
Special Conditions W any
24 hour notice for all inspections 447-4230
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