HomeMy WebLinkAboutBuilding Permit 99-1278
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
3410 ~
OWNER
CONTR.
DATE TIME
I H-'1<1
Ar
PHONE NO.
PERMIT NO.
o FOOTING 0 PLUMBING RI
o FOUNDATION 0 MECH RI
o FRAMING 0 WATER HOOKUP
~I SULATION A- 0 SEWER HOOKUP
INAL 0 PLUMBING FINAL
SITE INSPECTION 0 MECH FINAL
COMMENTS: 'K....ll'
.,,,- 1l..'lY
o EXfGRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
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Inspector:
Owner/Contr:
NEXT INSPECTION 24 HOURS IN ADVANCE.
INSNOTl
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CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
. ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
1. White
2. Pink
3. Yellow
File
City
Applicant
Permit No.
q9-/2-78
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
:s
1. DATE
/0/1-1../91
,€!/
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
3. LEGAL DESCRIPTION
12. NO. OF STORIES
LOT
BLOCK /
SUIJS U- NIU...S
(Name)
eD JA
N
(Address) \
"3L.-l'lO &A S'\iN\
(Tel. No.)
:;Jd.(., '-::1'.JJc
(Tel. No.)
14. FLOOR AREA APPORTIONMENT USE
/
PID 25-/72-- ()Of-O
13. TYPE OF CONSTRUCTION
ADDITION
4. OWNER
5. ARCHITECT
(Name)
(Address)
6. BUILDER (Name)
,4-metc:.. .
d-onSf(11~hot1
(Address)
/LIo w 'tg'Hil/il3
(Tel. No.)
qLjf 1'll{1.f
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
7. TYPE OF WORK
New Construction i""J
Fireplace Cl
Alterations CI
Septic 0
Addition 0
DeckCl
Finish Attic 0
Rs-roofi
Re-siding 0
Porch 0
Finish Basement 0
SEATS
16. PROJECT COSTNALUE
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES
Sq.Ft.
9. PROPERTY DIMENSIONS
Width Depth
10. CULVERT SIZE
Yes No
17. COMPLETION DATE
I hereby certify that 1 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 submitted plans. I am aware that the
building official c ok is permit for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed InsetJ9~ons.
X e /tJ-~:;"-77
19nature license No. Date
FOR ADMINISTRATIVE USE
Front
Back
Side
Side
MATERIAL FILED WITH APPLlCA nON
SOIL TESTS Ll ENERGY DATA Ll
PILING LOGS Ll PERCOLATION TESTS Ll
SETBACKS: Required
Actual
BUILDING DEPARTMENT VALUATION
USE OF BUILDING
fU3 ~L.
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
PLANS & SPECS 0
SURVEY 0
SETS
COPIES
2. m . en...)
PLOT PLAN
Ll
TYPE OF CONSTRUCTION: I II 111 IV V
Occupancy Group A B E F HIM R
Division 1 2 3 4
Permit Fee ................................... $
S U
7<(. IF
City:
Amount Brought Forward .................. $
Par1<: Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
Plan Check Fee ............................. $
I """l t-
. <-
State Surcharge ............................. $
Penalty....................................... $
Plumbing Permit Fee ....................... $
Sewer & Water Permit ...................... $
Pressure Reducer .......................... $
Meter Hom ................ .... .... ........... $
Water Meier ................................. $
Sewer & Water Connection Fee ........... $
WaterTowerFee ........................... $
Water Tap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
Total Due .............................. $
Paid 1 (, ,<f?)
Mechanical Permit Fee ..................... $
Issued
Date By
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zonin Ordina and may proceed 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 Certificate of Occupancy must be issued.
City Planner
Date
Special Conditions it any
24 hour notice lor all inspections 447.9850