HomeMy WebLinkAboutBuilding Permit 00-0823
CITY or; PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
1'~~
c::I.
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
~INAL ~
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
COMMENTS:
~j;:E/~ AE~
c: I (Z.C.Lb
()C) - 62-3
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
--;J2(WORK SATISFACTORY, PROCEED
10 CORRECT N AND PROCEED
o CORRE WO LL FOR REINSPECTION BEFORE COVERING
'>
Inspector: Owner/Contr:
cALi/ -98~ THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CO~REMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY/
ll'iSNOTl
_.------~-"._._---------_. ,",_.,,_._,,__,_,_,~,_--'---_.~~"^'._- -- ,-,..........
DATE RECEIVED
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
1. White
2. Pink
3. Yellow
File
City
Applicant
q.(,} .(fi>
Permit No.
00. Oez3
DIRECTIONS 1. DATE
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN C' /1/
BEFORE PERMIT 15 ISSUED (Please Print or Type and sign at bottom) ...;;;vry.- I3r CO
12. SITE ADDRESS./ / // / ./
"7'1'1''7' r ~//~ C'J (',K' Se_
BUILDING INFORMATION
". SIZE OF STRUCTURE
(Height) (Width) (Depth)
3. LEGAL DESCRIPTION
3
12. NO. OF STORIES
LOT
BLOCK
2-
PID ZS,~e- O()~
.
13. TYPE OF CONSTRUCTION
ADDITION
14 OWNER &J~~
5. ARCHITECT (Name)
'<:7 (Address)
Ocr-cN~
(Address)
(Tel. No.)
14. FLOOR AREA APPORTIONMENT USE
(Tel. No.)
6. BUILDER
(Name)
(Address)
(Tel. No.)
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
New Construction 0
Chimney 0 Misc.
B. PROPERTY AREA OR ACRES \9. PROPERTY DIMENSIONS \10. CULVERT SIZE
SQ. Ft. 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~entio rope nd that all con ction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the
building 0 . . rpe~r j ause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to p~ ne~d ins~ions.
X ..-7 ~>-) dY~ t~1 0-0
<----J ~ S~nalure. License No. . - Dale
Fireplace 0
Alterations 0
Septic 0
Addition 0
Deck 0
Finish Attic 0
Re-roofinllCC-. Porch 0
Re-siding 0 Finish Basement 0
SEATS
7. TYPE OF WORK
16. PROJECT COSTNALUE
17. COMPLETION DATE
FOR ADMINISTRATIVE USE
Front
Back
Side
Side
MATERIAL FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA 0
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS 0 SETS
- SETBACKS: Required
Actual
USE OF BUILDING
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
SURVEY
PLOT PLAN
o COPIES
o
BUILDING DEPARTMENT VALUATION
TYPE OF CONSTRUCTION: I II 111 IV V
Occupancy Group A B E F HIM R S U
Division 1 2 3 4 4'- 1 S--
Permit Fee ................................... $~ .
City:
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
Plan Check Fee ........ ..................... $
q-
I. 2.-<
$
State Surcharge ............................. $
Penalty ....................................... $
Gas Fireplace Permit ....................... $
Pressure Reducer .......................... $
Meter Hom ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
Water Tap ................................... $
Builder's Deposit ............................ $
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $-
Sewer & Water Permit ...................... $
This Application Becomes Your Building Permit When Approved.
By Date
Issued
Other ......................................... $
Total Due .............................. $ ..". qz,
Paid 1'. ~ RecelPt~J tf-( I
Date tl. /:1. ViI By ~
This is to certify that the request in the above application and accompanying documents is in accordance with the City zonin'g Ordinance 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.
Certificate of Occupancy
C~yPlanner
Dale
Special Conditions if any
24 hour notice for all inspections (952) 447.9850
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