HomeMy WebLinkAboutBuilding Permit 00-0017
_CITY Of; PRIOR LAKE
INSPECTION NOTICE
ADDRESS ( S' ;) 3{:'
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING ~
o INSULATION
~FINAL PO()
o SITE INSPECTION
iJ/I~"cm ATlMrE
SCHEDULED 7
>: rI 'V_I .0(1\ 4-f A (~of
CbhTR.
PERMIT NO.
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
0-0 - Ml"l
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
COMMENTS:
\~IA ~~
(\ ~~
~ (7J'''Yft\fl
~
~\
'j
/
/
~
Inspector:
--. '--r'h"-
INSNQTl
FOR YOUR PERSONAL HEALTH & SAFETY!
__ -0 ._______ __~~. _..._.__._.
-'<~~x PR~O-?<:
~ ~
U f'1
Q4TC ClC(".EJ.Y:E..O.
;j/.3 / tJt)
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
l. White
2. Pink
3. Yellow
File
City
Applicant
Permit No.
1)1) -(JQ/1
,
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. DATE
I
J C:::J-.3 6
3. LEGAL DESCRIPTlON~
e
c~watffZ
i -/]-@
N&
BUILDING If!!IlQIIMATlON
11. SIZE OF STRuaYURE
(Height) (W\dIM (Depth)
CI f1..-.
12. NO. OF STORIES
LOT
BLOCK
PID f-,!:-OS"7- fJ08-()
/..rL-~ .
13. TYPE OF CONSTRUCTION
ADDITION
4. OWNER...:::;
L,n r/PI- I-
5. ARCHITECT
M~77 A/SOA/
...JJ-..- (Address)
(6,ck'-ef! 5t-<Mt!-
(Address)
(Name)
T"'"
(Name)
(Tel. No.)
14. FLOOR AREA APPORTIONMENT USE
(Tel. No.)
o~dT0.JrIl(c .:;, REM9~i' 11>'"
4100 EXCELSIOR B .
ST. LOUIS PARK, MN 55416
~l:t. #OQn1 ~fi'\
7. TYPE OF WORK FireplaceO SepticLJ DeckQ Ae.roofin~ Porch 0
New Construction LJ A1terat~s 0 Addition 0 Fitus~ Attic 0 Ae-siding (] /. Finish Bas.ementp
ChimneyLl Misc. tV<YI>"'I1T I'~I"'^"'Y /pt>OI"II",C (,I' J.'f~1/ !;3'aF~
8. PROPERTY AREA OR ACRES 19. PROPERTY DIMENSIONS 110. CULVERT SIZE
Sq. Ft. Width Depth Yes No
I hereby certify that I have furnished in,-v'" "".....' , 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
building Offi~j~ke thi~e'!!!!lJOr just cause. Furthermore, I hereby agree that the city qff2~ designee may enter upon the property to pertol}'" needed inspections.
X (h"'PO-- ~ ((/:>0 /-13-a::J
C/ -- Signature License No. Date
6. BUILDER
r (Tel. No.)
CJrr
f;?-3 -~
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTR
SEATS
16. PROJECT COSTNALUE
"IVL-<.:-/
17. COMPLETION DATE
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
Front
Back
Side
Side
MATERIAL FILED WITH APPLICATION
SOIL TESTS Ll ENERGY DATA Ll
PILING LOGS Ll PERCOLATION TESTS Ll
BUILDING DEPARTMENT VALUATION
USE OF BUILDING
~ ;y /L.
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALVA TION
PLANS & SPECS CJ
SURVEY 0
SETS
COPIES
PLOT PLAN
Ll
TYPE OF CONSTRUCTION: I II III IV V
Occupancy-Group A B E F HIM R
Division 1 2 3 4
Permit Fee ............................... .... ~
S U
City:
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
CoUectiveStreetFee ....................... $
Sewer Tap ................................... $
$
7c.f.7r
Plan Check Fee ............................. ~
State Surcharge ............................. $
1-7...-J
Penalty ....................................... ~
Plumbing Pennit Fee ....................... ~
Builder's Deposit ............................ If:
Other ......................................... <t
Tot.1 Due .............................. $ 7 (A. (/()
Issued P.,d l" If) Receip~~~.. ?;.h"'1r4'
Dete I /3/ {1J By AflA..--
ThIS IS to certify that the request In the above application and accompanYing documents IS In accordance with the CIty Zom Ordln/nee and may proceed Is 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.
rmit .. .................... $
:'n9 ;:,7:'t Wi;! f'ft"IV
Pressure Reducer .......................... $
MeterHom ................................... $
Water Meter ................................. q:,
Sewer & Water Connection Fee ........... <t
Water Tower Fee ........................... $
Water Tap ................................... $
Mechanical Permit Fee ..................... ~
Sewer & Water Permit ...................... $
City Planner
o.to
Special Conditions if any
24 hour notice for all inspections 447-9850