HomeMy WebLinkAboutBuilding Permit 00-0411
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
\SSCcr
~
hSH
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING 0 PLUMBING RI
o FOUNDATION 0 MECH RI
o FRAMING @ 0 WATER HOOKUP
o INSULATION f'" 0 SEWER HOOKUP
~FINAL fZE 1'2-= 0 PLUMBING FINAL
o SITE INSPECTION 0 MECH FINAL
COMMENTS:
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TIME
A.T.
~ 1,,-,"- +20
CD-A; r \
o EXIGRAD/FILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
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~ {o"
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i. WORK SATISFACTORY. PROCEED
I~'CORRECT ACTION AND PROCEED
o CORRECT W~~L(FOR REINSPECTION BEFORE COVERING
Inspector: ~ /1 Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
INSNOTl
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
.~~
DATE RECEIVED CITY OF PRIOR LAKE
BUILDING PERMIT,
auv 25- 'lnnn-TEMPORARY CERTIFICATE OF
I'IrV QAAJ ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
1. White
2. Pink
3. Yellow
File
City
Applicant
Permit NO.r1'J- 04/ I
DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
2. llITE ADDRESS
, ,,<\.t:;h"
I ~;s1cv
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
1=: "" Pnlnt- ~l
-:--'F
3. LEGAL DESCRIPTION
LOT
RLQCK
{Y\; Il~ I >r At\()I\./
(Name)
<:::'GAFIf,k.: ,"-e"
PID
d.. r;-07{' -66'I-Q
12. NO. OF STORIES
5. ARCHITECT
(Name)
(Address) (Tel. No.)
/-rs-b7 r:-S-.4 r'DlJ-1<J o/'SI'7-7",~ I
(Address) (Tel. No.)
1~PE OF CONSTRUC~ON
JfSL. - \7-1 JJYt'""
14. FLOOR AREA APPORTIONMENT USE
ADDITION
4. OWNER
6. BUILDER
(Name)
(Address)
(Tel. No.)
15. NUMBER OF OCCUPANTS OR SEATS
s"...........
OCCUPANT~
7. TYPE OF WOR~
New Construction 0
Fireplace 0
Alterations 0
Septic 0
Addition 0
Deck 0
Finish Attic 0
,
Re-roofingX Porch 0
Ae-siding rJ / ~nish Basement 0
SEATS
16. PROJECT COSTNALUE
Chimney 0 Misc.
B. PROPERTY AREA OR ACRES 19. PROPERTY DIMENSIONS 110. CULVERT SIZE
Sq. Ft. Width Depth Yas 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 Offici~~jj.l'ermit for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform need~ ins.!:..~ns.
x~ ~C--' <\/2.5700
- SIgnature License No. I Date
17. COMPLEflON DATE
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
MATERIAL FILED WITH APPLICATION
Front
Back
Side
Side
SOIL TESTS
o ENERGY DATA
o
Jili
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
PILING LOGS 0 PERCOLATION TESTS 0
BUILDING DEPARTMENT VALUATION
USE OF BUILDINGI1
VOy..,
PLANS & SPECS 0
SURVEY 0
PLOT PLAN 0
SETS
COPIES
TYPE OF CONSTRUCTION: I II III IV V
Occupancy Group A B E F HIM R S U
Division 1 2 3 4 '7L{ I 7S-
Permit Fee ...................... ......... .... $
City:
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
Plan Check Fee ............................. $
State Surcharge ............................. $
Penalty. ...................................... <t
Plumbing Permit Fee ....................... ~
I.::J.<
Mechanical Permit Fee ..................... $
Pressure Reducer .......................... $
Meier Horn ................ .... .... .... ....... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... ~
Water Tower Fee ........................... $
Sewer & Water Permit ...................... $
Gas Fireplace Permit ....................... t Water Tap ................................... $
~1!9f!ion~~~+>t~~r_BUilding perm~.tW UtJed. Builder's Deposit ............................ $
By ~ Date Other......................................... $
:::cate of Occupancy :::~u~................:;~f;j ;;~: y
This Is to certify that the request in the above application and accompanying OOcuments is in acco'dance. wifh the City Zoning 6;:";1. ~ may pnx:eedLs r~uested. This doc~ment when
signed by the City Planner constitUtes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certiflca~pancy must be ISSUed.
City Planner
Date
Special Conditions ~ any
24 hour notice for all inspections (952) 447-9850