HomeMy WebLinkAboutBuilding Permit 99-0652
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS I (. (. ZD
~~~
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDAT
DFRA
o ULA TION
INAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
COMMENTS:
~
~
TIME
k-
'tq. ySz.
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
~ J
f.-1t
/
~ SATI:F"~Y. PROCEED
o CORRECyf' ~~PROCEED
o CORR1T WO~ ,/FOR REINSPECTION BEFORE COVERING
I nspector I Owner/Contr:
CAL.L 447.9850kR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
COD~MENTSARE FOR YOUR PERSONAL HEALTH & SAFETY/
INSNOTl
- I
14. OWNER (Name) (Address) (Tel. No.)
se-rloOL.- O/SI. 47/'1. 5!!O0 WESTWooO Ot2.., P. L....
15. ARCHITECT (Name) (Address) (Tel. No.)
6. BUILDER (Name) ~ I (Address) (Tel. No.)
CJ\se.n ..3iA.l! pro t. tton /..01:1-33/- 3/1)
30 I \ Y Sc.,^ :')-\.. .I\J[ roo/<-. "S~L/ 1-3
7. TYPE OF WORK Fireplace LJ Septic LI Deck Q . Re-roofing 0 Porch 0
New Construction 0 ~ Alterations 0 Addition 0 FdJ;~ A~.:o Re-s~ding 0 Finish Basement a
Chimneyo Misc. .=:J\,., 'Soc-l"~~ y<:"._ ~~~ In...~ Q.ODI,u-;
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 me ioned property and that all construction will conform to aU existing state and local laws and will proceed in accordance with submitted plans. I am aware that the
buil . . can revoke this permi!ibr just J4ytJe. Furthermore, I hereby agree that the city .Pficial.o~ ~Sign.ee may enter upon the property to p~.:z:e~ inspections.
X , _~~ (~~S M
I SiQilature - LICense No. Date
..-;
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ............................,...... $
$
QATF RFr.FIV<;!l CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
. II IN - I !999 ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
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 1 \
/(OIDd.t'l r:;1i~ Hfltlll', fu~
3. LEGAL DESCRIPTION
LOT ~ /N (!;CuNni:> BLOCK
ADOITION
'SF.,
;J;~ JCf1
((O::J:::;Q..O
PIO .z5~q{)z.' 105-0
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
Front
Be'"
Side
Side
BUILDING DEPARTMENT VALUATION
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
-:itI 5XJ.Q:::)
USE OF BUILDING
1/ (!.. -o/~
TYPE OF CONSTRUCTION: I II III 1vLl.?'_
Occupancy Group A B E F HIM -G S U
Division 1 20)4
Permit Fee ................................... ~ 21.fXJ
/,>,UC
,;lS-
City,
Plan Check Fee ..................,.......,.. $
\~ C~\
'\)~
~
State Surcharge ............................. ~
Penalty ....................................... $
l. White
2. Pink
3. Yellow
File
City
Applicant
Permit No.
qq -(P52..
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Heignt) (Width) (Depth)
12. NO. OF STORIES
13. TYPE OF CONSTRUCTION
B>i~~~O 00~d' l\ tU! 0",ler;.
14. FLOOR AREA APPORTIONMENT USE
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANT~
SEATS
16. PROJECT COSTNA~_
5~;ATE
MATERIAL FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA 0
PILING LOGS Ll PERCOLATiON TESTS Ll
PLANS & SPECS 0
SURVEY 0
SETS
COPIES
PLOT PLAN
Ll
Plumbing Permit Fee ....................... :or
Mechanical Permit Fee .............,.,..... $
Pressure Reducer .......................... $
Meter Hom ....... .... ........................ $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
WaterTowerFee ........................... $
Water Tap ................................... $
Builders Deposit ............................ $
Other ......................................... $
Total Due .............................. $
Paid 3t.E: if 0 Receipt No.
Date V / /rJ./4 q BY.lJ;t-
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinlmce 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.
Sewer & Water Permit ...................... $
Gas Areplace Permit ....................... !t
;iSt!.iPt6CO;P- Buiiding ~:t:,ii Z~~ Ylfed
. /
Certificate of Occupancy
Issued
City Planner
Date
~Lf ~'1l)
~:5+.:~
I
24 hour notice for all inspections 447.9850
Special Conditions W any
PRIOR LAKE
INSPECTION
RECORD
DEPARTMENT OF
BUILDING AND INSPECTION
SITE ADDRESS J..lo.kd0 F.w> I+"",kc.. A\I.-e
TYPE OF WORK _~I2\O""--<'- S?~''u1..c.L.o.>- \-ko..db I',.^- Qool-tt-
USE OF BUILDING E.
PERMIT NO. ~":J C DATE ISSUED (,-1-1(
BUILDER (jt~ \~N<. Yto~e.,.J'1"1\-1 .
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR
DATE