HomeMy WebLinkAboutBuilding Permit 00-0823
CITf O~ PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
c:-::I.
ADDRESS
1~i
CONTR.
OWNER
PERMIT NO.
PHONE NO.
-
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
LJ.."':l!l. FINAL ~
11 /OSITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
COMMENTS:
-
I DATE I
~
c::. \ f2-C-t..b
TIME
A-:r:
DC> - 62-3
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
-
--f:.:!!ORK SATISFACTORY. PROCEED
10 CORREW;T N AND PROCEED
o CORRE WO , LL FOR REINSPECTION BEFORE COVERING
)
\nspector:" . . owner/contr: -
CAj~8se16'R TIiE NEXT INSPECTION 24 HOURS IN ADVANCE.
CO~IREMEN;S ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTl
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,--- ..-".-- -.....-.--....--
_.~-_.._"--
DATE RECEIVED
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
1. White
2. Pink
], Yellow
File
City
Applicant
q'l.$ .(/1)
Permit No.
00- oroZ3
DIRECTIONS 1. DATE
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN C" 12/ /'7r /<V>
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom) ~ ("':>I v""'"
2. SITE ADDRESS
4///y-' I ~//?- C'J C'/K' .5e_
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
3. LEGAL DESCRI~ON
LOT ..:5
ADDITION
12. NO. OF STORIES
BLOCK
'2-
PID :z5-?_Oe- Oa7-t)
,
13. TYPE OF CONSTRUCTION
4. OWNER
&;~~
<(7 (Address)
~N~J'Q
(Address)
(Tel. No.)
14. FLOOR AREA APPORTIONMENT USE
5. ARCHITECT
(Name)
(Tel. No.)
6. BUILDER
(Name)
(Address)
(Tel. No.)
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
7. TYPE OF WORK
Fireplace 0
Alterations 0
Septic 0
Addition 0
Deck 0
Finish Attic 0
Re-roofin~ Porch 0
Re-siding 0 Finish Basement 0
SEATS
New Construction 0
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES 19. PROPERTY DIMENSIONS 110. 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 mentio rope nd that a.1I co~ction will conform to all existing state and Jocallaws and will proceed in accordance with submitted plans. I am aware that the
building 0 . . p~r ~ause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to p~. r ne~d i~ons.
X ~J ~~ t:r.,O-O
SignalUre. License No. Dale
16. PROJECT COSTNALUE
17. COMPLETION DATE
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
Front
Back
Side
MATERIAL FILED WITH APPLICATION
Side SOIL TESTS 0 ENERGY DATA 0
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS 0 SETS
SURVEY 0 COPIES
PLOT PLAN 0
BUILDING DEPARTMENT VALUATION
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
USE OF BUILDING
TYPE OF CONSTRUCTION: I II III IV V
Occupancy Group A B E F HIM R S U
City:
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
Division 1 2 3 4
Permit Fee ................................... $_
'74-. 7r
q
1.2-<
Plan Check Fee ........ ..................... $
State Surcharge ............................. $
Penalty .................. ..................... $
Plumbing Permit Fee ....................... $
Pressure Reducer .......................... $
MeIer Hom ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
Water Tap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
Mechanical Permit Fee ..................... $
Sewer & Water Permit ...................... $
Gas Rreplace Permit ....................... $
This Application Becomes Your Building Permit When Approved.
By Date
Certificate of Occupancy
Paid
l' .q7
City Planner
Date
Special Conditions n any
24 hour notice for all inspections (952) 447.9850