HomeMy WebLinkAboutBuilding Permit 00-0658
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
?~4C;
Le.-w-.. l "'j
CONTR.
OWNER
PHONE NO.
PERMIT NO.
o FOOTING 0 PLUMBING RI
o FOUNDATION 0 MECH RI
o FRAMING @ 0 WATER HOOKUP
o INSULATION '^ 0 SEWER HOOKUP
l'lI'FINAL r 0 PLUMBING FINAL
ofJ SITE INSPECTION 0 MECH FINAL
COMMENTS: ~ Roo!
I)
j:i" '0 l.'r.:2
( ~ ~~)
............... .."."."
DATE TIME
~ 't"eO
c.. VC k..
0- ~ S8
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
~ WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: ~ I Owner/Contr:
I
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
lNSNOTl
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY/
-_.,'---_._-------,-,_._.~_.._.._._-~------"
~~
DIRECTIONS
SPACES NUMBERED 1 THRU l' N1lJST Be r-IL.Lr:.LJ I....
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
2. SITE ADDRESS
S~,<;;;
3. LEGAL DESCRIPTION
1\ _,WiflIf'flWl " ~-~ CITY OF PRIOR LAKE
), ..... U \:I - If: BUILDING PERMIT,
la.. .. t ~PORARY CERTIFICATE OF
ZONING COMPLIANCE
_' AI TILITY CONNECTION PERMIT
1. DATE
1/a~ Ian
1. White
2. Pink
3. Yellow
File
City
Applicanl
Permit No. on-() {..~
LOT
L E> ..m~)
I
01N I P.
~~
BUILDING INPORMA TION
11. SIZE OF STRUCTU, RE
(Height) (WWlhl (Depth)
12. NO. OF STORIES
~
ADDITION I r, 1.... A I ,.., . _
4. OWNER -r:- (Name)....._..
, ho I'\'l'l S <..J.il71A.bllY
5. ARCHITECT (Name)
=tLOCK
PID
::>ls- D~- () (\;;ro
~". ""y
(Address) (Tel. No.)
.!7.345 LaIJ.w ~iytL ~ 'fJ.#O~~
(Address) ., (Tel. No.)
13. TYPE OF CONSTRUCTION
14. FLOOR AREA APPORTIONMENT USE
6. BUILDER
(Name)
(Address)
(Tel. No.)
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
7. TYPE OF WORK
New Construction 0
Chimney 0 Misc.
&l'rePlace 0
Alterations 0
Septic 0
Addition 0
Deck 0
Finish Attic 0
~'
Rs-roofing Porch 0
Rs-siding 0 lnlsh Basement 0
SEATS
16. PROJECT COSTNALUE
8. 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 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
building icial ca evok . pe "t for jus sa. Furthermore,~)y agree that the city official or a design,ee may enter upon the property to perform needed inspections.
X (,.~ 7-,:Jg-1J1J
Signature.s- license No. Date
17. COMPLETION DATE
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
Front
Back
Side
Side
MATERIAL FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA 0
PILING LOGS LJ PERCOLATION TESTS LJ
BUILDING DEPARTMENT VALUATION
USE OF BUILDING ~
MR
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
PLANS & SPECS 0
SURVEY 0
SETS
COPIES
PLOT PLAN
o
TYPE OF CONSTRUCTION: I II III IV V
Occupancy Group A B E F HIM
Division 1 2 3 4
Permit Fee ................................... $
R S U
City:
Amount Brought Forward .................. $
Park Support Fee .... .... ................... $
SAC ......................................... $
Collective Street Fee .... ................... $
Sewer Tap ................................... ~
$
'14.'S-
Plan Check Fee ..................... ........ $
State Surcharge ............................. $
Penalty ............................... ........ $
Plumbing Permit Fee ....................... $
\. OlS
Mechanical Permit Fee ..................... $
Pressure Reducer .......................... ~
Meter Horn ... .... ......... .... ........ ....... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
WaterTowerFee ........................... $
Sewer & Water Permit ...................... $
Gas Fireplace Permit ....................... ~
Th~'ca' n B mtFoU~B 'Idin perm~'t Ap lO'fBd.
By . Date fCrn
,
Certificate of Occupancy
Water Tap ................................... $
Builder's Deposit ............................ lI:
Other ......................................... ~
Total Due .............................. $~ 00
Pa,d '1 7' t1() Receipt No. :) 'i({')L/4
Issued
Da1. l-J :;;l.C6 ~ By ~
ThiS IS to certify that the request In the above application and accompanYing documents IS 10 accordance With the City ZOOlng drdlnance and may proceed - r uested. ThiS document when
signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence Before occupancy, a Certificate 0 cupancy must be ISSUed
City Planner
Date
Special Conditions ~ any
24 hour notice for all inspections (952) 447.9850