HomeMy WebLinkAboutBuilding Permit 00-0124
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEOULEQ
_ I~~TEI TIME
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OWNER
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CONTR.
AOORESS
PHONE NO.
PERMIT NO.
(30- \ '2-4-
o FOOTING 0 PLUMBING RI 0 EXlGRAO/FILLlNG
o FOUNOATION 0 MECH RI 0 COMPLAINT
o FRAMING ~ 0 WATER HOOKUP 0 FIREPLACE RI
o INSULATION 0 SEWER HOOKUP 0 FIREPLACE FINAL
~INA~OO\P' 0 PLUMBING FINAL 0 GASLlNE AIR TST
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60RK SATISFl1ATO FCEEO
o CORRECT ACTIO A OCEEO
o CORRECT WOR . ~ REINSPECTION BEFORE COVERING
Inspector: Owner/Contr:
v
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN AOVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH '* SAFETY/
INSNOTJ
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CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
1. While
2. Pink
3. Yellow
File
City
Applicant
Permit No. _1'],1. / Z l(
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 II ?Gt< 1\[6 /..
tl ~ 1./ t-\ !lv-.j f\viL.
3. LEGAL DESCRIPTION I
I 1.DATE
Jr /b "0:\
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
12. NO. OF STORIES
LOT
BLOCK
PID
13. TYPE OF CONSTRUCTION
ADDITION
14. OWNER (N~e) I, (Adq'1SS)
~"f'Y"\1 kA..V-f- Ib ~qS A.{b~''.'./ ~V('
15. ARCHITECT I (Name) (Address) I (fel. No.)
6. BUILDER (N~e) L \ (Address) I ~ (Tel. No.)
.l..~l ~~Q ~~- 't.C 'l.I~~ VJ. J,(3-". <;; \ <;4VlI"l?_ 'flfS-!fQ(j9
7. TYPE OF woRt Fireplace 0 Septic 0 Heating 0 Plumbing CJ V Reroofi~ Porch CJ
New Construction 0 Alterations 0 Add\!j,o~ 0 Finish Attic CJ Residing 0 Fimsh Basement 0
Chimneyo Misc. W/~eAY .-ott
18. 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 tioned prope an 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
~Uifding offi a ~e t ~ for Just cause. Furthermore, I hereby agree that the city official or a de~~ ~~~ent8f upon the property to Perfor~ :j6_i(j;ions.
SI nature Wcense No. Date
(fel. No.)
if/f(\- "Z1...H(:,
14. FLOOR AREA APPORTIONMENT USE
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
SEATS
16. ESTIMATED VALUE")l b S~~
17. COMPLETION DATE
"3 -2 iH>CJ
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
Front
""'''
Sid&
Side
I MATERIAL FILED WITH APPUCATION
SOIL TESTS 0 ENERGY DATA 0
PILING LOGS LJ PERCOLATION TESTS LJ
PLANS & SPECS 0 SETS
PROPOSED GRADE FOUNDATION
IN RELATION TO CURB OR CROWN
OF STREET
USE OF BUIL~ <:,. ~ /p
TYPE OF CONSTRU~ IV V
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
SURVEY
o COPIES
. c:.rrJ
PLOT PLAN LJ
:~;=;.;:;::";"-~::)
Certificate of Occupancy
Check ~
Deferred
o
o
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
LicenseCheckFee ......................... $
Pressure Reducer .......................... $
Meter Horn ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Wm.erTowerFee ........................... $
Water Tap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
Total Due .............................. $
7t..{!)d
City:
Occupancy Group A BEl H R M
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Permit Fee ................................... $
74.7c::.
Plan Checking Fee ......................... $
State Surcharge ............................. $
Penalty ....................................... $
Septic System ............................... $
Other ......................................... $
1."2<
Issued Paid RBVecei~~ I
Date "3'/<;"- 20CllT 1k1/::>
This is to certify that the request in the above application and accompanying documents is in accordarce 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 ........, ",.,,, ,..". Before occupancy, a Certificate of Occupancy must be issued.
CltyPlanner
Date
Special Conditions if any
24 Hour ootice for all inspections 447....ee&9:oo a.m. .10:00 a.m.
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