HomeMy WebLinkAboutBuilding Permit 00-0424
ADDRESS
J 4/20
DATE TIME
SCHEDULED ~ A .{,
d~ (5//2 A./&
CITY OF PRIOR LAKE
INSPECTION NOTICE
OWNER
CONTR.
PHONE NO.
PERMIT NO.
00-04-24-
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
)j(FINAL f2.,(n)p
/OSITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
COMMENTS:
a.e-....... ~
~ WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WOR~CALL FOR REINSPECTION BEFORE COVERING
Inspector: ~ Owner/Contr:
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE,
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
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~CU::r.I:=I\fI:'r)
CITY OF PRIOR LAKE
. BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
~30 era
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
I L..\ I Q () ('V, C.hA rei
3. LEGAL DESCRIPTION
LOT ~ BLOCK
luOn'....
1. DATE
'5("5010-0
Urr\o.
Nt:
ADDITION
I
1"* AtJ..ti.n
PID J).', -;::)(\7 -- oo3-n
V(Nama)
TOu f) ~
15. ARCHITECT (Name)
6. BUILDER (Name)
~~'f L.u"'9 ~Of';>~
(Address)
14 \;)0
(Address)
(Tel. No.)
C. ( ( 40 J, - o4a<6
(Tel. No.)
4. OWNER
OR\--;d
\:":'il'Vl
(Address)
434~ ~k:O+~ S-i.
(Tel. No.)
440- J~ 3'1
7. TYPE OF WORK
New Construction 0
Septic 0
Addition 0
Deck 0
Finish Attic 0
~
Re-roofin l Porch 0
Re-siding 0 I ish Basement 0
Fireplace 0
Alterations 0
1. White
2. Pink
3. Yellow
File
City
Applicant
Permit No. rm- OLJ(9.t.J
BUILDING INFORMATION
1,. SIZE OF STRUCTURE
(Height) (WklIh) (Depth)
12. NO. OF STORIES
13. TYPE OF CONSTRUCTtON
14. FLOOR AREA APPORTIONMENT USE
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANT~
SEAT::::
16. PROJECT COSTNALUE
Chimney LJ Misc.
lB. PROPERTY AREA OR ACRES 19. PROPERTY DIMENSIONS 1'0. CULVERT SIZE
Sq. Ft. Width Depth Yes No
I hereby certify that I have fumish 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 mention 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
building offici n r voke this permit for jUs, ~~it Firthe~e, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X N'1 Y r \V/~- ~
(J Y Signature - License No. Date
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
Side
Front
Back
Side
BUILDING DEPARTMENT VALUATION
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
USE OF BUILDING
~AtK
I
TYPE OF CONSTRUCTION: I II III IV V
Occupancy Group A B E F HIM R S U
17. COMPLETION DATE
MATERIAL FILED WITH APPLICATION
SOIL TESTS
o ENERGY DATA
o
PILING LOGS LJ PERCOLATION TESTS 0
PLANS & SPECS 0
SURVEY LJ
PLOT PLAN 0
SETS
COPIES
Division 1 2 3 4
Permit Fee ................................... <t.
Amount Brought Forward .................. $
Park Support Fee .... .... ................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
Pressure Reducer .......................... $_
Meter Hom ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
WaterTowerFee ........................... $
Water Tap ................................... $
~i e Yo r ulldlng ~:tr:lt~!3mlb :~:~~~.~~~~~.i~.:::::::::::::::::::::::::::: :
cenlf'cateofoccup~ncy I Pa,d T~'b':'O'O''''~~~,~;~o$ ~; b~
Issued Date ~SLs61aJ BY~' )
ThIS IS to certify that the request In the above application and accompanYing documents IS In accordance With the City Zomng Ordln&nce aid may proceed as ~u ted ThiS document when
signed by the City Planner constitUtes a temporary Certificate of Zomng compliance and allows construction to commence Before occupancy, a Certificate of ccu ancy must be ISSUed.
City:
~LJ.1S-
Plan Check Fee ............................. It
State Surcharge ......................... .... $
I.a~
Penalty ....................................... $
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
Sewer & Water Permit ...................... $
City Planner
Dale
Special Conditions n any
24 hour notice for all inspections (952) 447.9850
$