HomeMy WebLinkAboutBuilding Permit 00-0142
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U'RK SA TI ~A TORY, PROCEED
~ C~RRECT AND PROCEED
o CORRECT WO, L FOR REINSPECTION BEFORE COVERING
CITY OF PRIOR LAKE
It/SPECTJON NOTICE
ADDRESS
/4QltJ
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING ^
o INSULATION r
XFINAL RG-'2,\DE
o SITE INSPECTION
COMM.an-~:
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LJ J.~17 Tm,
SCHEDULED . ~
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TIME
/: IS-
CONTR.
PERMIT NO.
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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 GASLlNE AIR TST
o
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Owner/Contr:
NEXT INSPECTION 24 HOURS IN ADVANCE.,
TS ARE FOR YOUR PERSONAL HEALTH & SAFETY/
lNSNorl
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DATE RECEIVED CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
I. White
2. Pink
3. Yellow
File
City
Applicant
Permit No.
00_ \4'2--
DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
2 SITE AD'j':/ilO {-- JfldM I~. 't), E ,
13rh-/(}o
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BUILDING INFORMATION
". SIZE OF STRUCTURE
(Height) (Width) (Depth)
3. LEGAL DESCRIPTION
12. NO. OF STORIES
S" BLOCK 2-
.. i:~
_ - A.."b J'-lx..""t~
~. OWNER -( ,f'w\ (Nj~
5. ARCHITECT (Name)
ADDITION
s~
NJ.;!tr~ ~.}J.I:.(T11~-1M.e)
PID 1.;-0.5+-01:;....0
c:A-\O';
13. TYPE OF CONSTRUCTION
LOT
14. FLOOR AREA APPORTIONMENT USE
(Address)
(Tel. No.)
6. BUILDER
(Name)
(Address)
(Tel. No.)
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTC;:;
'5~tnJ,
WiJ ~ r;; J.l t. 'Ii? -~tJ61
7. TYPE OF WORK
New Construction 0
Fireplace 0
Alterations 0
Septic 0
Addition 0
Deck 0
Finish Attic 0
Re-roofing 0 Porch 0
Re-siding" Finish Basement 0
SEATS
16. PROJECT COSTNALUE
Chimney D Misc.
8. PROPERTY AREA OR ACRES 19. PROPERTY DIMENSIONS 110. CULVERT SIZE
Sq. Ft. Width Deplh Yes No
I hereby certify that I have furnished information on this application which is 10 the best of my knowledge true and correct. I also certify that I am the owner or authorized agent for
the above men' ned property and that all construction will conform to all existing stale and local laws and will proceed in accordance with submitted plans. I am aware that the
:uildlng 0 i . revok (is Y};it~. Furthermore, I hereby agree that thell~~l or a designee may enter upon the property to perf 0'3 n!7~lons.
Signature License No. I Date
17. COMPLETION DATE
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
MATERIAL FILED WITH APPLICATION
Front
Back
Side
Side
SOIL TESTS
o ENERGY DATA
o
PERMIT VALUATION
"'Z-~
PILING LOGS D
PLANS & SPECS 0
SURVEY 0
PLOT PLAN 0
PERCOLATION TESTS 0
SETS
COPIES
BUILDING DEPARTMENT VALUATION
USE OF BUILDING
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pd 12-
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OFF STREET PARKING
SPACES REa.
SPACES ON PLAN
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 Slreet Fee ....................... <I:
Sewer Tap ................................... <I:
$
Division 1 2 3 4
Permit Fee ................................... $.
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Plan Check Fee ............................. .<1:
State Surcharge ............................. .<1:'
I. '- ..;
Penalty .......................................9:
Plumbing Permit Fee ....................... <I:
Water Tap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
"1l-, -
Total Due .............................. $
Paid 1(,:,' . Receipt No. 3'- <fq3
Date ~h..:l.-foo By (tj)fIr
, .
This is to certify that the request in the above application and accompanying documents is In accordance with the City Zoning Ordinance and may proceed as requested. 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.
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. . ...... $ J-{
o e""it When "V!tvrt.-/OO
/ I
Pressure Reducer .......................... $
Meter Horn ... .... .... ........................ $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $.
Water Tower Fee ........................... $
Mechanical Permit Fee ..................... <I:
This Ap
By
Certificate of Occupancy
Issued
City-Planner
Date
Special Conditions if any
24 hour notice for all inspections 447-9850