HomeMy WebLinkAboutBuilding Permit 00-0172
CIT'f OF PRIOR LAKE
INSPECTION NOTICE
DATE TIME
SCHEDULED
S~3:~
ADDRESS .s- F; G () l'J\,,;.{ e ~ T ('('1 \ I
OWNER
PHONE NO.
CONTR.
PERMIT NO. (")(j - all a
o EXlGRAD/FILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
o FOOTING 0 PLUMBING RI
o FOUNDATION 0 MECH RI
o FRAMING 0 WATER HOOKUP
~NSULATION @D SEWER HOOKUP
. FINAL <;>\\:)\1'\(; f' 0 PLUMBING FINAL
o SITE INSPECTION 0 MECH FINAL
COMMENTS: (M~'C.\. C:l\N(\lt.r ')
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~ WORK SATISFACTORY, PROCEED
! ~ CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: ~ ( Owner/Contr:
~ J
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE,
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNon
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~A/13F ~FOr.F~OO CITY OF PRIOR LAKE
..:/ ~ V BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
1. White
2. Pink
3. Yellow
File
City
Applicant
Permit No.
()()- 0/72-
DIRECTIONS
SPACES NUMBE~ED 1 TH~U 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
12SITEADD~ESSS5WO (\11~ fr. <S;S
:~~GAL DESCRIPinN BLOCK 5
<:::;rI7J/l/t7e-/ LA
4. OWNER fVldr-"k. ~ (j era {L (Address~()YJfu(abo.,e) tfiJ"O".::19 zf??
15. ARCHITECT (Name) 7J;::.SSI J (Tel No.1
~e), &<a5~ud.ln8f.IJGTelijL/7-
_ T-p-n5~ t7Y\Pr-(or 19l:~ %001
7. TYPE OF WORK FireplaceLJ Septic 0 DackLJ Re-roofingO Porch 0
New Construction 0 Alterations 0 Addition 0 Finish Attic 0 Re-sidi~ Finish Basement 0
Chimney 0 Misc.
la. PROPERTY AREA OR ACRES 19. PROPERTY DIMENSIONS 110. CULVERT SIZE
Sq. Ft. Width Depth Yes No
I hereby certify that I have fumished 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
~Uildin9 Cf/::.an, revo I penn. r just cause. Furthenn~erebY agree thaI Ihe city OffiCi76/5g)"e may enler upon the property to perto::g7.;t ~?DnC
License No. Date
1. DATE
3/&3/00
,et SO
BUILDING INFORMATION
1,. SIZE OF STRUCTURE
(Height) (Width)
(Depth)
12. NO. OF STORIES
PID 2-5 -/(g5 -D75-()
13'pE OF CONS"'!"RUCTION
_ e'-'.-~ 0.
14. FLOOR AREA APPORTIONMENT USE
ADDITION
15. NUMBE~ OF OCCUPANTS OR SEATS
OCCUPANTS
SEA TF.
16. PROJECT COSTNALUE
$ 9'-1Q9. 00
17. COMPLETION DAlE
I
SETBACKS: Required
Actual
FOR ADMINISTRATIVE USE
Front
Back
Side
MATERIAL FILED WITH APPLICATION
Side SOIL TESTS 0 ENERGY DATA 0
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS 0 SETS
SURVEY 0 COPIES
PLOT PLAN 0
BUILDING DEPARTMENT VALUATION
USE OF BUILDING
/Zb::. /If /2-
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
TYPE OF CONSTRUCTION: I II III IV V
Occupancy Group A B E F HIM R S U
City,
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ,........................................ $
Collective Street Fee .......................!l:
Sewer Tap ................................... It,
$
Division 1 2 3 4
Permit Fee ................................... $
'1ll1~
Plan Check Fee ............................. C!:
/. Z-~
State Surcharge ............................. C!:
$ewer& Water Permit ...................... $
Pressure Reducer .......................... $
Meter Hom ........................ .... ....... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
WaterTowerFee ........................... $
Penalty ....................................... ,It
Plumbing Permit Fee ....................... C!:
Mechanical Permit Fee ..................... $
Gas Fireplace Pennit ....................... ct. Water Tap ................................... $
ThIS~~t~s r Ulldlngpennl''J!;f~^';,;t/df) Builders Deposit ............................ $
By Dale n[ Other ......................................... $
CertitlcaleofOccupa~cy PaId T~ ~~ dQ.............~~~~,~;~o: ;~;;
l$uOO T~
ThIS IS to certify "'at "'e request In the above application and accompanYing documents" In accordance WI'" the c~:;on-:lo~;j,I:!.~ may pr~ ,ff.".~est;;; ThIS document when
signoo by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be issued.
City Planner
Dale
Special Conditions if any
24 hour ootice for all inspections 447~9850
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