HomeMy WebLinkAboutBuilding Permit 99-1350
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
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ADDRESS
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OWNER
CONTR.
PHONE NO.
PERMIT NO.
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o FOOTING
o FOUNDATION
o FRAMING
~NSULATION
FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o G~LINE AIR TST
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COMMENTS:
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XWORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector:
~
OWner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.,
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTJ
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1/ /1E3/'19
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
I DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
12. SITE ADDRESS
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3, LEGAL DESCRIPTION
1. DATE
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LOT
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PID 25 -22. 7--N)1 - 'I
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I
BLOCK
ADDITION
4. OWNER
(Name) (Address) (Tel. No,)
/),'..-<,,~ / /(/5(/1} H/J ,,4c' ~j97- 7'75
(Name) (Address) (Tel. No.)
(Name) (Address) (Tel. No,)
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5. ARCHITECT
6, BUILDER
~ / / /
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7. TYPE OF WORK Fireplace 0
New Construction 0 Alterations 0
,&'./ ~ '0'/ / Y,/"7' ,f,:;'
Deck 0 Re-roofin~' Porch 0
Finish Attic 0 Re-sidingJr" I Finish Basement a
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Septic 0
Addition 0
t. White
2. Pink
3. Yellow
File
City
Applicant
Permit No.
99- /3::;;u
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
12, NO, OF STORIES
13. TYPE OF CONSTRUCTION
14, FLOOR AREA APPORTIONMENT USE
15, NUMBER OF OCCUPANTS OR SEATS
OCCUPANTF:
SEATS
16, PROJECT COSTNALUE
Chimney 0 Misc.
18. PROPERTY AREA OR ACRES 19. PROPERTY DIMENSIONS 10. CULVERT SIZE
Sq. FI. Width Depth Yes No
I hereby certify that I have fumished 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 mention 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
~Uilding offle~a~~ 'ev~!JTlit fo' just cause, FurthemlDCe, I he,eby ag,ee that the city official DC a designee may enter upon the property to perl~~ ;:;I;~ections,
- /' /' ~Ignature license No. bate
17. COMPLETION DATE
FOR ADMINISTRATIVE USE
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
Pressure Reducer .......................... $
Meter Horn ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
WaterTowerFee ........................... If:
Water Tap ...................................0;::
Builder's Deposit ............................ $
Other ......................................... $
SETBACKS: Required
Actual
Front
Back
Side
Side
BUILDING DEPARTMENT VALUATION
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
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USE OF BUILDING _/2&::I /ti'"
TYPE OF CONSTRUCTtDN: I II III IV V
Occupancy Group A B E F HIM R S U
City:
Division 1 2 3 4
Permit Fee ................................... $
7t:/. ,r
Plan Check Fee ............................. $
State Surcharge ............................. $
/. '2- S--
Penalty ....................................... $
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
Sewer & Water Permit ...................... $
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I I ' f
Certificate of Oc~pancy
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
Total Due ,.......,....."."""....... $ 7 h. () tJ
Paid 710.0 () ReeeiPn{)/}3to52 L-
Date II/I d t{ t'j By J!t{ ~
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordina~ce and 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 Certilie& of Occupancy must be issued.
Issued
City Planner
Date
24 hour notice for all inspections 447-9850
Spec;al Conditions ~ any