HomeMy WebLinkAboutBuilding Permit 99-1149
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CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
,)!( FINAL ,lU)G'::::
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
COMMENTS:
DATE TIME
14.7.
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o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
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LK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WO!,,"::. CALL FOR REINSPECTION BEFORE COVERING
Inspector: _ fJ ~ I Owner/Contr:
I
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE..
INSNOTl
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
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CITY OF PRIOR LAKE
BUILDING PERMIT,
lEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
I. White
2. Pink
3. Yellow
File
City
Applicant
Permit No.
qq-//~
. DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
2. Sl"n, ADDRESS
1. DATE
BLOCK
'iJ7) A- tV 11/ .4
C(-:11J-19
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PID 2S-,007- OO~..() I
, I
I
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BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
/" t.. ?o
3. LEGAL DESCRIPTION
e>
12. NO. OF STORIES
LOT
ADDITION
2I\JlJ
13. TYPE OF CONSTRUCTION
4. OWNER (Naib" -+-
...2lJ.~ /~.
5. ARCH'ITECT (Name) ~
(Ad~ d -I?
IM/Jo ~
(Address)
11-7~ ..2.2 S- ~
14. FLOOR AREA APPORTIONMENT USE
(Tel. No.)
6. BUILDER
(Name)
(Address)
(Tel. No.)
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANT~
7. TYPE OF WORK
New Construction 0
Chimney CJ MIsc.
8. PROPERTY AREA OR ACRES 190 PROPERTY DIMENSIONS 110. CULVERT SIZE
Sq. FI. 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 co~st ction will confonn to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the
building official can rev~~ permit for just ca " Fu~re. I hereby agree that the city official or a designee may enter upon the property to ~ ~ M1epections.
X H(..ut.uJ_~. 1-;2p-',
- Signature Cl license No. Date
Fireplace LJ
Alterations LJ
SepticLJ
Addition LI
Deck 0
Finish Attic LI
Re-rooflng. Porch LI
Re-siding 0 FInish Basement LI
SEATS
16. PROJECT COST N ALUE
17. COMPLETION DATE
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
MATERIAL FILED WITH APPLICATION
Front
Back
Side
Side
SOIL TESTS
o ENERGY DATA
o
BUILDING DEPARTMENT VALUATION
R.t;..s /1t IL..
,
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
PILING LOGS 0 PERCOLATION TESTS LJ
USE OF BUILDING
PLANS & SPECS 0
SURVEY LJ
SETS
COPIES
"2.. nnJ ...cfl../
PLOT PLAN
o
TYPE OF CONSTRUCTION: I II III IV V
OccupancyGroup A B E F HIM R S U
. Division 1234 7t.{.7r
PerrmtFee ................................... $
City:
Amount Brought FOlWard .................. $
Park Support Fee ........................... <t
SAC ......................................... $
Collective Street Fee ........................'t:
Sewer Tap ................................... ct
$
Plan Check Fee ............................. $
State Surcharge ............................. $
Penalty ....................................... $
Plumbing Permit Fee ....................... $
/. 2-r--
Mechanical Permit Fee ..................... $
Pressure Reducer .......................... $
Meter Horn ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
WaterTowerFee ........................... $
Water Tap ....................................It
Builder's Deposit ............................ 4:
Sewer & Water Permit ...................... $
~:~~~i~~;:.;itW"ftt~
Certificate of Occupancy /
Other ......................................... $--" cJ-
Total Due .............................. $ (, .cJ
Paid . 06 ReceiP\l~9. -3(. 7..3 /
Date ~"1 By ~
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zonin Ord' ance ,{nd may procee~s requested. This document when
signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certifica"of Occupancy must be issued.
Issued
City Planner
Dale
Special Conditions if any
24 hour notice for all inspections 447-9850
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