HomeMy WebLinkAboutBuilding Permit 99-1160
CITY OF PRIOR LAKE
INSPECTION NOTICE
CIS
DATE
SCHI:DUbED "'I.J - (.. 7q_
TIME
ADDRESS
/15/0/ /!/~ RdJ
OWNI:R
CONTR.
PHONE NO.
PERMIT NO.
'1'7 -//('0
o FOOTING 0 PLUMBING RI
o FOUNDATION 0 MECH RI
o FRAMING 0 WATER HOOKUP
o INSULATION ,1f) 0 SEWER HOOKUP
tCf FINAL /U ~ '(j/ 0 PLUMBING FINAL
o SITE INSPECTION 0 MECH FINAL
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACI: RI
o FIREPLACI: FINAL
o GASLINE AIR TST
o
COMMENTS:
r)A
("~
~
~RK SATISFACTORY, PROCEED
o CORRI:CT ACTION AND PROCI:ED
o CORRECT WORK, CALL FOR RI:INSPI:CTION BEFORE COVERING
Inspector:
~ Owner/Contr:
CALL 447-9850 FOR THE NEXT INllPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
INSlVOTl
_..._"--"'.~...-_._._-----
$~~
DA TI= RI=r.I=IVE.Q
9/ :z.z/9.'t
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
I. White
2. Pink
3. Yellow
File
City
Applicant
Permit No.
qq-//"o
. DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST eE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
2. SITE ADDRESS
/&/0/
3. LEGAL DESCRIPTION
6 e BLOCK
j./tJ/2.7JfW t:IO.o
1. DATE
/'lOr-{./MLWN~ 12,1.
Q/U!9'J
.e /.J' 0
BUILDING INFORMA nON
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
12. NO. OF STORIES
LOT
PID ZS -ltll- 057-0
ADDITION
13. TYPE OF CONSTRUCTION
4. OWNER (Name)
TItNC t!.rOlC'N
5. ARCHITECT (Name)
(Address)
/Ip/O/ jI/,rft,..,ucd /l).
(Address)
(Tel. No.)
110/1- <?'11ft{
(Tel. No.)
14. FLOOR AREA APPORTIONMENT USE
6. eUILDER
(Name)
(Address)
(Tel. No.)
15. NUMBER OF OCCUPANTS OR SEATS
Sa."""'<r>w-
7. TYPE OF wo'Rr<
New Construction 0
Chimney 0 Mis'"
8. PROPERTY AREA OR ACRES /9. PROPERTY DIMENSIONS 110. CULVERT SIZE
Sq. Ft. 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 mentionedrjrty and that 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 v t~is pe or just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to pertorTl1 njeded inspections.
X A_. /elr/ e:J/zzl9?
Signature license No. . I bate
L ,,,,l.Q,!W
1;.< .
SepticLl
Addition LI
72.. 2_?
DeckLl
Finish Attic LI
t;'A,.f :?('i0H
Ae-roofing~ Porch LI
Ae-siding LI Finish Basement LI
?)..1-~'I6
OCCUPANTS
Fireplace LI
Alterations LI
SEATS
16. PROJECT COSTNALUE
17. COMPLETION DATE
SETBACKS: Required
Actual
FOR ADMINISTRATIVE USE
MATERIAL FILED WITH APPLlCAnON
Front
Back
Side
Side
SOIL TESTS
o ENERGY DATA
o
BUILDING DEPARTMENT VALUATION
~.s ...vA:..-
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
PILING LOGS 0 PERCOLATION TESTS 0
USE OF BUILDING
PLANS & SPECS LI
SURVEY LI
SETS
COPIES
'2- Mf'V ;</'"'
PLOT PLAN
o
TYPE OF CONSTRUcnON: I II III IV V
OccupancyGroup 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 ................................... $
1~1s
Plan Check Fee ............................. $
State Surcharge ............................. $
I. z..,r'""
Penalty .................. ..................... $
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... It
Pressure Reducer .......................... $
Meter Horn ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
Sewer & Water Permit ...................... $
Water Tap ................................... $
This Builder's Deposit ............................ $
By Other ......................................... $
Total Due .............................. $
Paid 76. tJ V Receipt
Issued
Date '1/z. 2--/"" By
This is to certify that the request in tile above application and accompanying documents is in accordance with the City Zoning Ordin{~ and may proceed 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.
CilyPlanner
Date
Special Conditions ff any
24 hour notice for all inspections 447-9850