HomeMy WebLinkAboutBuilding Permit 00-0767
D PLUMBING RI
D MECH RI
D WATER HOOKUP
D SEWER HOOKUP
D PLUMBING FINAL
'71ECH FINAL t /
/0:r 12%-_.
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CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
/552-0 ~(//
OWNER
CONTR.
PHONE NO.
PERMIT NO.
D FOOTING
D FOUNDATION
D FRAMING
~NSULATION @
FINAL AZ4Q~;ta-
D SITE INSPECTION
COMMENTS:
DATE TIME
9./~'P() A.T.
{1/)-o7r, -;
D EXIGRAD/FILLING
D COMPLAINT
D FIREPLACE RI
D FIREPLACE FINAL
D GASLINE AIR TST
D
,.
,/
/'
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L,~,=.y~~
D CORRECT ACTION AN9 PROCEED
D CORRECT WO~tLt ~OR REINSPECTION BEFORE COVERING
Inspector: ! Owner/Contr:
I
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE,
INSJVOTJ
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
6~~
DATE RECEIVED
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
1. While
2. Pink
3. Yellow
File
City
Applicanl
Permit No.
0001(",7
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
/5.S 20 Ca.LI11I,F G'N. ;J e
3. LEGAL DESCRIPTION
1. DATE
7> . 2Z. - CJCJ
I
BUILDING INFORMATION
". SIZE OF STRUCTURE
(Height) (Width) (Depth)
12. NO. OF STORIES
LOT
'1---
10 lNJ :"0 t-.lr....
BLOCK 4- PIO
n~ Ttte CA-vA-
'2.';-' 23l:, ~O'fa -'0
4. OWNER
t..Qrry
5. ARCHIT~CT
(Name)
0,11...... <-
(Nama)
(Address)
/'5"52-> c~/n..';r JJv..
(Address)
(Tel. No.)
tJ~ '1'17-616<;(
(Tel. No.)
13. TYPE OF CONSTRUCTION
/0 ~R. /-} ~ (C#
14. FLOOR AREA APPORTIONMENT USE
ADDITION
6. BUILDER
(Name)
(Address)
(Tel. No.)
<::{t""1- 3o~o
15. NUMBER OF OCCUPANTS OR SEATS
J(Qsll-e.. ~#-'''f
<gor E t{'3'~ sf
PI/Ie:
OCCUPANTS
7. TYPE OF WORK
New Construction 0
Fireplace 0
Alterations 0
Septic 0
Addition 0
Deck 0
Finish Attic 0
Re-roofing}i1 Porch 0
Re.siding 0 Finish Basement 0
SEATS
Chimney 0 Misc.
18. PROPERTY AREA OR ACRES 19. 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 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
bUildi~~lal can . is permit for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X (//'.-- ;:;;? ,.,.,:::M7 "5~o '1)- ;}'2~
~ / Signature License No. Date
Front
FOR ADMINISTRATIVE USE
MATERIAL FILED WITH APPLICATION
Back Side Side SOIL TESTS 0 ENERGY DATA 0
OFF STREET PARKING PILING LOGS 0 PERCOLATION TESTS 0
SPACES REO. PLANS & SPECS 0 SETS
SPACES ON PLAN SURVEY 0 COPIES
'"Z.-~. - PLOT PLAN 0
PERMIT VALUATION _
SETBACKS: Required
Actual
USE OF BUILDING
BUILDING DEPARTMENT VALUATION
,.J /Z--
)
M:S
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 ................................... $
'\.'\."1-)
Plan Check Fee ......................... .... $
State Surcharge ............................. $
l. -z...;-
Penalty. ......................... ............. $
This Appl'
By
Pressure Reducer .......................... $
Meter Horn ................................... $
Water Meier ................................. $
Sewer & Water Connection Fee ........... ~
WaterTowerFee ........................... $
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
Certificate of Occupancy
Water Tap ................................... $
Builder's Deposit ............................ ~
Other ......................................... ~
Total Due .............................. $
Issued
City Planner
Date
Special Conditions if any
24 hour notice for all inspections 447-9850