HomeMy WebLinkAboutBuilding Permit #00-0445
W TIME
CITY OF PRIOR LAKE '1~
INSPECTION NOTICE SCHEDULED
ADDRESS I (,b45 ,JOy'+Rv.:JtlO~ 12.d
OWNER CONTR.
PHONE NO. PERMIT NO. O.f./SS
o FOOTING o PLUMBING RI o EX/GRAD/FILLING
o FOUNDATION o MECH RI o COMPLAINT
o FRAMING o WATER HOOKUP o FIREPLACE RI
~NSULATION @ o SEWER HOOKUP o FIREPLACE FINAL
FINAL o PLUMBING FINAL o GASLINE AIR TST
o SITE INSPECTION o MECH FINAL 0
COMMENTS: Rrr.! t:J
1M! Wo.o ~ d~
~
C!!~-:;~~
,I,( WORK SATISFACTORY, PROCEED
/6 CORRECT ACTION AND PROCEED
o CORRECT W04 CALL FOR REINSPECTION BEFORE COVERING
Inspector: ' rJ;r, Owner/Contr:
I
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
INSNOTl
----"._'_.__._._.~'----_._.__.,~..._.._-_.."----_.__.--_._---------,--.--
D4TF RI=r.EelE(l
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
':/7/ao
/,
f? '" (} <7LN fAY
6/7/cm
- DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
2. SITE ADDRESS or!
/ c.., rJ 4C:: ^ JT~'AJ7")
3 LEGAL DESCRIPTIO~ 0 t. La} \ 1 0.
LOT \ \, ~ "'-/ BLOCK
N ai--Y'hI.U rrnd
4. OWNER f (Name)
jfl.f.~ecK .-J,..(; /.Q1l pj0./A.,J
5. ARCHITECT (Name)
ADDITION
PID d:r- \41- 07S"-O
I
(Address) Jr _ I (Tel. No.) I'
/60 L{~ AfarTIII..X:J~ M ('(IV 441::....1..73 ~
(Address) (Tel. No.) ,I
6. BUILDER
(Name)
(Address)
(Tel. No.)
f r ,~d floeS
7. TYPE OF WORK
New Construction LI
Chimney 0 Misc.
Co>>.d
~
Ae-roofing Porch 0
Ae-siding LJ ish Basement 0
Fireplace 0
Alterations 0
Septic 0
Addition [j
Deck 0
Finish Attic 0
1. White
2. Pink
3. Yellow
File
City
Applicant
Permit No.O-O - 04 S3;"
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
12. NO. OF STORIES
13. TYPE OF CONSTRUCTION
14. FLOOR AREA APPORTIONMENT USE
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
SEATS
16. PROJECT COSTNALUE
8. PROPERTY AREA OR ACRES /9. PROPERTY DIMENSIONS 1'0. CULVERT SIZE
Sq. Ft. Width Depth Yes No
t hereby certify that I have furnished information on this application which is 10 the besl of my knowledge true and correct. I also certify thai 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.ge CJf9cial Co/} revoje thi~er1J1t for jutJCauseAurthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed InsReclions.
X ~-h (~o..-..!/ _ t,- '7- ()O
I Signature License No. Date
17. COMPLETION DATE
FOR ADMINISTRATIVE USE
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
Pressure Reducer .......................... $
Meter Horn .................... .... .... ....... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
Water Tap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
Total Due .............................. $
PaidW ~7t-.. CJ7J Receipt No. '5'1 c.. 4Y
Issued / ~ .
Date t,/7 rnJ By I
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning 6rdina/ce 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 ccupancy must be issued.
SETBACKS: Required
Actual
Front
Back
Side
Side
BUILDING DEPARTMENT VALUATION
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
USE OF BUILDING
,k Ml(
. . I
TYPE OF CONSTRUCTION: I II III IV V
OccupancyGroup A B E F HIM R S U
Division 1 2 3 4
Permit Fee ............................... .... $
City:
Plan Check Fee ............................. $
State Surcharge ............................. $
Penalty ....................................... $
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
Sewer & Water Permit ...................... $
Gas Fireplace Permit ....................... $
Certificate of Occupancy
~"C. uilding ~:t';it 7J71m
City Planner
Date
Special Conditions if any
24 hour notice for all inspections (952) 447-9850
MATERIAL FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA 0
PILING LOGS CJ PERCOLATION TESTS CJ
PLANS & SPECS CJ
SURVEY CJ
PLOT PLAN CJ
SETS
COPIES