HomeMy WebLinkAboutBuilding Permit 00-0169
CI~ OF PRIOR LAKE
INSPECTION NOTICE SCHEDULED
H:;;(g 76
ADDRESS I .' - A-A V\&L- '"IV"
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
~NSULATION
FINAL
SITE INSPEttON
COMMENTS:
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o CORREC
Inspector:
CODE
CONTR.
PERMIT NO.
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
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DATE TIME
4-c;-9d
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Owner/Contr:
INSNOTl
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(J-l&q
o EX/GRAD/FilLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASllNE AIR TST
o
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7. TYPE OF WORK Fireplace 0 Septic 0
New Construction 0 Alterations 0 Addition 0
Chimney 0 Misc. ....'i.J\.1'L-- OFF-
8. PROPERTY AREA OR ACRES I~' ....HOPERTY DIMENSIONS --110. 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 above mentioned property and that all construction will confonn to all existing state and local laws and win proceed in accordance with submitted plans. I am aware that the
building official can revoke this pennit for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perfonn needed inspections.
X ~ z.. ~'J._ ~.~O- DO
l)si9nature Ucense No. o.tt
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CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
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
1~c../~ A-,..H/A--ntl\lL SE.-
3. LEGAL DESCRIPTION
;7~1 (/l)
f-I
PID?S-()/Z--{J08 -()
LOT
~ BLOCK
~/I1V/II /I
110\<11'" (Addr.ss)
1\ U\J l\- 1"'''"(,,'-
(Address)
-::-.f_
PI
(T.I No.)
4'-1, - u., 'I S-
(Tel No.)
ADDITION
4. OWNER
~06t:.1I.. .,.
(Name)
MtAi.L""-'J
(Name)
5. ARCHITECT
6. BUILDER
(Name)
(Address)
(Tel No.)
Deck 0
Finish Attic 0
Re.rooting ~ Porch 0
Re-siding 0 Finish Basement 0
1. White
2. Pink
3. Yellow
File
City
Applicant
Permit No.fJ]J -(}&1-
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
OCCUPANT~
SEATS
16. PROJECT COSTNALUE
17. COMPLETION DATE
I
FOR ADMINISTRATIVE USE
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ...................................~.
$
Pressure Reducer .......................... $
MeterHom ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... ~
WaterTowerFee ........................... It
SETBACKS: Required
Actual
Back
Side
Side
Front
BUILDING DEPARTMENT VALUATION
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
"2 ~ - "-"
USE OF BUILDING
JZFS ~L
TYPE OF CONSTRUCTION: I II III IV V
Occupancy Group A B E F HIM R
Division 1 2 3 4
Pennit Fee ................................... $
S U
74-.7r
City:
Plan Check Fee ............................. <l:
/.z-r
State Surcharge ............................. <t.
Penalty ....................................... $
Plumbing Pennit Fee ....................... $
Mechanical Pennit Fee ..................... $
Sewer & Water Pennit ...................... $
MATERIAL FILED WITH APPLICATION
SOIL TESTS Cl ENERGY DATA Cl
PILING LOGS Cl PERCOLATION TESTS Cl
PLANS & SPECS Cl SETS
SURVEY Cl COPIES
PLOT PLAN Cl
Water Tap ...................................4'.
Builder's Deposit ............................ $
Other ......................................... $j;
Total Du. .............................. . (p < a.J
Pa,d .JtV' (t5l R.ce'~tN'" 1/ z.-I
Issued Date 5/3 d / OU By .' ~
This IS to certify that the request In the above apphcatlon and accompanYing documents IS In accordance with the City Zomng OrdinanCe and may proceed a uested ThiS document when
signed by the City Planner constitutes a temporary Certificate of Zomng compliance and allows construction to commence Before occupancy, a Certificate f Occupancy must be ISSUed.
Gas Fireplace Pennit ..... ................. $
ing ~:;:it~"/'!tf(ft-
. ,
24 hour notice for all inspections 447-9850
Special Conditions d any
City Planner
Date