HomeMy WebLinkAboutBuilding Permit 00-0156
CITY OF PRIOR LAKE
. INSPE\i:TION NOTICE
SCHEDULED
ADDRESS @q;:) Fr7l..... +- P \-
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION A-
"'l1( FINAL geo F n.
/D"! E INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
(I I) +----;
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DATE
r!f~
TIME
AT
-,
t)O-OIS~
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
TION BEFORE COVERING
Inspector:
CALL J7-98S0 FOR THE
Owner/Contr:
:XT INSPECTION 24 HOURS IN ADVANCE.
CODE
INSNOTI
FOR YOUR PERSONAL HEALTH & SAFETY!
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
-.l.~({~' PR/Oli',
t: ~
U en
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I DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED {Please Print or Type and sign at bottom}
12. SITE ADDRESS
J)~t{2 F1?t7cr .Pr; u},
3. LEGAL DESCRIPTION
LOT
ADDITION
BLOCK
.l!t-5 # 2f/
PID
14.0~~
V oHv
15. ARCf-llTECT
6. BUILDER
(Name)
1//6
(Address)
~:;l L(2 FJ'ltKr Prh -f/T
(Address)
(Name)
(Name)
(Address)
/f; /38 6OO01/,e;z.J d-t,c,
.!-r~/t.~.e-/ s-T<I4+-
A Ad ( (~fL No.) q
~. r;,1Z;- 791- 71bl
OCCUPANTS
81/ZTZ(
7. TYPE OF WORK Fireplace [j Septic 0 Deck 0 Re-roofin~ Porch 0
New Construction 0 Alterations 0 Addition 0 Finish Attic 0 Re-siding 0 Finish Basement 0 16. PROJECT COSTNALUE
Chimney 0 Misc. / (I t? 0 0
lB. PROPERTY AREA OR ACRES 19. PROPERTY DIMENSIONS 110. CULVERT SIZE 17. COMPLETION DATE
Sq. F1. Width Depth Yes No )A-Jf'1? CI t7
1 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
bUildin~OftiC'i11 can ~k~this itJj(or' st cause. Furthermore, I hereby agree that the city official or a des~.e ay enter upon the property to perform needed inspections.
X ~" A ?/J2. l/nt/I'i J.7m~nl'}l1
Signa re License No. Date
I. While
2. Pink
3 Yellow
File
City
Applicanl
1. DATE
Permit No. {)() - 0 15 ~
@
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) '(Width) (DSlPI~
':2A ....,.,.- ,-/"
12. NO. OF STORIES
t'Jne
113. TYPE OF CONSTRUCTION ./ I
f...,J 00 /)- fJ.. e~; lr:.f.1:!r'1l ~
14. FLOOR AREA APPORTIONMENT USE
-:J.7J11Af10d
KIS1/
25-()C,O ,IJ(J&-O
(Tel. No.)
u/2 QIP.;7tJ7'7
(Tel. No.)
15. NUMBER OF OCCUPANTS OR SEATS
SEATS
SETBACKS: Required
Actual
FOR ADMINISTRATIVE USE
Front
.",,,
Side
BUILDING DEPARTMENT VALUATION
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
USE OF BUILDING
.er;s -"'1/2...
TYPE OF CONSTRUCTION, I II III IV V
Occ:upancyGroup A B E F H t M R S U
71./. 1 ~
Division 1 2 3 4
Permit Fee ................................... $
Plan Check Fee ............................. $
State Surcharge ............................. $
Penalty....................................... $
Plumbing Permit Fee ....................... $
I. 2-~
Mechanical Permit Fee ..................... $
Sewer & Water Permit ...................... $
Side
MATERIAL FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA 0
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS 0
SURVEY 0
SETS
COPIES
?' ~ITJ . cIV
PLOT PLAN
o
City:
Amount Brought Forward .................. $
Par1\: Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
Pressure Reducer .......................... $
Meter Horn ... .... ............................ II'
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
WaterTowerFee ........................... cr
Water Tap ................................... $
Builder's Deposit ............................ 4:
Other .........................................4:
Total Due .............................. $ .7('0.0 ()
Paid
ThIS document when
signed 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.
Date
City Planner
Date
24 hour notice for all inspections 447.9850
Special Conditions if any
T.