HomeMy WebLinkAboutBuilding Permit #00-0141
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crN OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS 5~ /2.
Rr:l)'h fil Yl f_ 1--
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o FOOTING
o FOUNDATION
o FRAMING
D.)NSULATION (!J
'&-FINAL
o SITE INSPECTI
COMMENTS: ~f
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TIME
-AL
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o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
"b( WORK SATISFACTORY, PROCEED
10' CORRECT ACTION AND PROCEED
o CORRECT WORKrJALL FOR REINSPECTION BEFORE COVERING
Inspector: m I Owner/Contr: .PO 0 rw
I
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
lNSNOTJ
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
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CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
1. White
2. Pink
3. Yellow
File
City
Applicant
Permit No.
c:>o -
14/
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 '---;#/ I. // r /J 1/ r?
53/.2 R'Y~. ~.At L ,
37~~/oo
BUILDING INFORMATION
". SIZE OF STRUCTURE
(Height) (WIdth) (Depth)
3. LEGAL DESCRIPTION
LOT" BLOCK ,
E>1Zo0fLS V ll-l-~ H--, W-c... C:. r~
~lP~ ~3;2K~~ Q.;:.JJ';;Oi~7~,
(Tel. No.)
12. NO. OF STORIES
PID
'2.5-1 81- DD~ - 0
13. TYPE OF CONSTRUCTION
ADDITION
14. FLOOR AREA APPORTIONMENT USE
5. ARCHITECT
(Name)
(Address)
~ &x.J- ~;t~;;C;./ ;;~7P~/
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
7. TYPE OF WORK
New Construction Ll
Fireplace LJ
Alterations 0
Septic 0
Addition 0
DeckLl
Finish Attic 0
Re-rOOfin~ Porch 0
Re-siding 0 Finish Basement 0
SEATS
16. PROJECT COSTNALUE
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES 19. PROPERTY DIMENSIONS 110. CULVERT SIZE
Sq. Ft. Width Depth Yes No
I hereby certify that' 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 fOf
the above mentioned property an hat all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the
~u~e this i r justcau . F~e; hereby agree t~~bO'??993e may enter upon the property 10 3'p~~~'
Signature License No. Date
17. COMPLETION DATE
FOR ADMINISTRATIVE USE
Front
Back
Side
Side
MATERIAL FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA 0
SETBACKS: Required
Actual
USE OF BUILDING
~
OFF STREET PARKING PILING LOGS ("J PERCOLATION TESTS ("J
f
A-f~ SPACES REO. PLANS & SPECS 0 SETS
I. SPACES ON PLAN SURVEY ("J COPIES
PERMIT VALUATION ILq,o. PLOT PLAN ("J
BUILDING DEPARTMENT VALUATION
TYPE OF CONSlRUCTlON: I II III IV V
Occupancy Group A B E F HIM R
Division 1 2 3 4
Permit Fee ................................... $
P'GNAl-lY
..., ..--,----::....-{--...................$
State Surcharge ............................. $
Penalty .................. ..................... $
Plumbing Permit Fee ....................... $
S U
City:
Amount Brought Forward .................. $
Park: Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
14.15
"14.1<\
I _ "2-6
Certificate of Occupancy
Issued
. ......~....... $
'n9 ~:t~itwJ];fmbO
, I
Pressure Reducer .......................... $
Meter Hom ................ ................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
Water Tap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
Total Due .............................. $ l~c:J , ., c::;:-
Paid ,. J '5:0. 7 S- Receipt No.
Date "3/-zz.J~ By f2t}/(J"
Mechanical Permit Fee ..................... $
This A
By
, .
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 tempora'Y Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be issued.
City Planner
Date
Special Cond~ions if any
24 hour notice for aU inspections 447-9850
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