HomeMy WebLinkAboutBuilding Permit 99-1273
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CITY OF PRIOR LAKE
INSPECTION NOTICE
.
S::-.HEDULECI
ADDRESS
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATIO~
%- FINAL
o SITE INSPECTI N
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
COMMENTS:
1.,-
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,
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DATE
TIME
'n~/;F73
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
~ORK SATISFACTORY, PROCEED
./;;; ~RRECT ACTION AND PROCEEO
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: ~ Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
INS/'iOTl
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
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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. 99 - 12- 7-3
DIRECTIONS 1. DATE
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
2. SITE ADDRESS
/.,.:; L/.-J Ed.ia.../;/JfO'-!..), A",,- /?;",.- LqJ... fr1N
3. LEGAL DESCRIPTION "
BUILDING INFORMATION
". SIZE OF STRUCTURE
(Height) (Width) (Depth)
12. NO. OF STORIES
LOT
ADDITION
4. OWNER
hff.."''''''"
5. ARCH' Eel
BLOCK
-"'7r~/~ ~ ~rJi//Vf:)S
PID
ZS-Il':i?A - t103-Q
13. TYPE OF CONSTRUCTION
(Name)
~. fi.u e
(Name)
(Address)
i.'5~ '/:1. t;'J",Iw,"Yh'7.
(Address)
6. BUILDER
(Name)
(Address)
(TeI.No.)~f~ I
I,. ,.lr Ia k.:. . 4'l.7 7'i'fY
{lei. No.) I
,I
14. FLOOR AREA APPORTIONMENT USE
(Tel. No.)
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
SEATS
16. PROJECT COSTNALUE
7. TYPE OF WORK
New Construction 0
Fireplace 0
Alterations 0
Septic 0
Addition 0
Deck 0
Finish Attic 0
Re-roofing)q Porch 0
Re-siding 0 Finish Basement 0
Chimney 0 Misc.
18. PROPERTY AREA OR ACRES 19. 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 mentioned property and that all construction will conform to all existing state and local laws and will proceed in accordance with submined plans. I am aware that the
bUil~~1 can 'evoke this pennlt fOl just cause. Furth.,mOle. I heleby aglee that the city omclal DC a designee may entel upon the pcoperty to pertonn needed .. ~.._.._.~.
X . /?.7~ ItJ-ri.I--ry
Signature License No. Date
17. COMPLETION DATE
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
Front
Baok
Side
Side
MATERIAL FILED WITH APPLICATION
SOIL TESTS LJ ENERGY DATA LJ
PILING LOGS LJ PERCOLATION TESTS LJ
PLANS & SPECS LJ SETS
SURVEY LJ COPIES
PLOT PLAN LJ
BUILDING DEPARTMENT VALUATION
USE OF BUILDING
K. es. '7 K-
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
Z >lfV _VC..J
TYPE OF CONSTRUCTION: I II III IV V
Occupancy Group A B E F HIM R
Division 1 2 3 4
S U
City:
Amount Brought Forward .................. $
Park Support Fee ..................... ...... $
SAC .........................................4'
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
Permit Fee ................................... $
7{.~(
Plan Check Fee ............................. $
State Surcharge ............................. $
I. l, r-
Penalty....................................... $
Plumbing Permit Fee ....................... $
Pressure Reducer .......................... $
Meter Horn ... .... .... ........................ $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $-
Water Tower Fee ........................... ~
Water Tap ................................... $
Builder's Deposit ............................ ~
Other ......................................... !t
Mechanical Permit Fee ..................... $
Sewer & Water Permit ...................... $
~;~~~;z..fif~i:.;IIW;~h~+-
Certificate of Occu~cy
Total Due .............................. $ ? 6 _0 CI
Paid 7fo. 00 Rece,ptNjl .3'" -1St/-
Issued Date I a Iz-( Ie q By ~
ThIS IS to certify that the request In the above alllhcatlon and accompanying documents IS in accordance With the City zomn{Ordlna~e and' may proceed ~:ested. T~ 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.
City Planner
Dale
Special Coodilions ~ any
24 hour notice for all inspections 447-9850