HomeMy WebLinkAboutBuilding Permit 00-0483
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS t..I 8("(,,
MWi/1Mh J-t
CONTR.
OWNER
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
~SULATION ~
J1!. ~~NAL j>o..
o SITE INSPECTIO
COMMENTS: \(/'.,):
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
, CAT t
TIME
~ 2,.1 --'V
~
K
o - 4B3
o E)(/GRADIFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
)!il. WORK SATISFACTORY. PROCEED
( 0 CORRECT ACTION AND PROCEED
~=--e;~'ro'-:="""""
I
CALL 447-9850 FOR THE NEXT I...SPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY/
rNSNOTl
..--..-----
~1
DAT~ Rl=r.i=1YEQ.
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
1. While
2. Pink
3. Yellow
File
City
Applicant
b//qo-o
Permit No. f'Tl ) -() Qf(.,3
DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
12. SITE A~bSLS I
I 0 !-, f'f\&.Y''\-' (\o"olJl_ '::-" ~... -*
1. DATE
ro/istoiJ
BUILDING INFORMATION
11. SIZE OF STRUCnJRE
(Height) (WIdth) (Depth)
t\ll=
3. LEGAL DESCRIPTION
12. NO. OF STORIES
LOT
ADDITION
1('\
'T, ,h"
BLOCK
\;..j.
I
A-l\t:-,N
PID
;;)" -Ol~- 0 10-0
13. TYPE OF CONSTRUCTION
4. Or"NfR
lJ-k.... L-r
5. ARCHITECT
~ame)
t,j,-
(Name)
't'~
A (Addr~s)
ITS fiA-Jk.--
(Address)
(Tel. No.) ~ ~ . .
LlLJJ 6.0;..,;,
(Tel. No.)
14. FLOOR AREA APPORTIONMENT USE
rD:R t9 /:ve)~~~"4 ~
7. lYPaOF WORK
(Address)
7o~ .~
1~7t"A(/~ ~Rrib.;...J
btL.
"""4.-
,,~ "
}' .L't"
Re-roofin~ Porch 0
Re-siding 0 Finish Basement 0
(Tel. No.)
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTR
New Construction 0
Chimney 0 Misc.
Fireplace [j / Septic 0 Deck 0
Alterations 0 Addition 0 Finish Attic 0
SEATR
16. PROJECT COSTNALUE
8. PROPERlY AREA OR ACRES 19. PROPERlY DIMENSIONS 1'0. 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 a e entiOnerPfO rty 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 9 0 cia an e this ~~ just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to pertorm n~e~ions.
X ~/. lV~- - I../"U /o~
t I SignatlJre License No. Dlte
17. COMPLETION DATE
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
MATERIAL FILED WITH APPLICATION
Front
Back
Side
Side
SOIL TESTS
o ENERGY DATA
o
BUILDING DEPARTMENT VALUATION
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS 0 SETS
USE OF BUILDING 17..(..) iI/ll
SURVEY
PLOT PLAN
o COPIES
o
TYPE OF CONSTRUCTION: I II III IV V
OccupancyGroup A B E F HIM R S U
Division 1 2 3 4 11)
Permit Fee ................................... $~-
Plan Check Fee ................. ............ 't
City:
Amount Brought Forward .................. $
Park Support Fee ........................... ,If
SAC ......................................... $
Collective Street Fee .... ................... ,'"
Sewer Tap ................................... $
$
State Surcharge ............................. 'l:
I. d~-
Penalty ....................................... 'l:
Plumbing Permit Fee ....................... <t.
Pressure Reducer .......................... $
Meter Horn ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
WaterTowerFee ........................... $
Mechanical Permit Fee ......... ......... ... $
Sewer & Water Permit ...................... $
Gas Fireplace Pem}i1 ....................... 'l:
IS' Ii tio Be, ~i1ding permit'1'~d'
By : Date 1m
\
Certificate of Occupancy
Water Tap ................................... $
Builder's Deposit ............................ $
Other ..... .... ............. ............ ....... $
Total Due .............................. $ "r] t... C'I/
Paid'lL c.<i Receipt No. '.~ 7 (, 7 S-
Issued -
Date I~ /I~.m By ~)
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning O'jn~ncl;nd may proceed rested. This document when
signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate cupancy must be issued.
C~yPlanner
Date
Special Conditions n any
24 hour notice for all inspections (952) 447.9850