HomeMy WebLinkAboutBuilding Permit 99-1296
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CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULE:D
ADDRESS
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
o PLUMBING RI
11- ~-"'I~ _
11 . ..iTER HOO~
SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
COMMENTS:
, .
DATE TIME
~""IL 1(P
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
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~ORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORr1JT ~ALL FOR REINSPECTION BEFORE COVERING
Inspectl,r: {/ Owner/Contr:
CA 44~~ FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
J
INSNOTI
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
.
~. .
CITY OF PRIOR LAKE
BUILDING PERMIT,
A TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
/ ~~R~Ci;r
, 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
'3:)7'1 \Lto ~ S~ .
3. LEGAL DESCRIPTION
LOT l BLOCK
ADDITION No('~ ~\...e,..,. "o..ks
4. ~R (Name)
I -e..'r- u :r:-~ ~
5. ARCH ITEM (Name)
1. White
2. Pink
3. Yellow
File
City
Applicant
Permit No.
q9- /2..9("
,
1. DATE
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
12. NO. OF STORIES
PID ;2S - OtDl. .00\ - t:>
(Address)
So.-..- -.a.
(Address)
(Tel. No.)
&/. tf.- ':l" I S-
(Tel. No.)
6. BUILDER
(Name)
(Address)
7. TYPE OF WORK Fireplace 0 Septic 0 Deck 0
New Construction 0 (\Alterations 0 Addition 0 ^ Finish e~ 0
ChimneyO Misc. ,~~ W~ ~
8. PROPERTY AREA OR ACRES 9. PROPERTY DIMENSIONS
Sq. Ft. Width Depth
13. TYPE OF CONSTRUCTION
14. FLOOR AREA APPORTIONMENT USE
(Tel. No.)
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
Re-roofing 0 Porch 0
Re-siding 0 Finish Basement 0
SEATS
16. PROJECT COSTNALUE
10. CULVERT SIZE
Yes No
17. COMPLETION DATE
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 abo~entioned property an tha all con truction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the
bUilding_/~ial can revoke thi it f r ju . Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
y . ~ ~1 Signature License No. It> -2. ~a: '7 q
FOR ADMINISTRATIVE USE
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
Water Tap ................................... $
Builder's Deposit ............................ $ _
n....__ ...~'I,-e
- ................................:..'/;-4 ..
Total Due ........3./20~U$~_ _,_ Q..
Paid31-htJ~ ReceiptN 71~t./7~
Date /() 'zt; 't!jt:j By
This is to certify that the request in the above application and accompanying documents is in accordance with the City zonin6 Ordin6'nce arli may proceed 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.
SETBACKS: Required
Actual
Front
Back
Side
BUILDING DEPARTMENT VALUATION
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
USE OF BUILDING
TYPE OF CONSTRUCTION: I II III IV V
Occupancy Group A B E F HIM R S U
Division 1 2 3 4
Permit Fee ................................... $
City:
Plan Check Fee ............................. $
State Surcharge ............................. ~
. ~Zl
Penalty ....................................... $
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
~-:-t;~
f ^
-
Sewer & Water Permit .. .................... $
"2 r; l:)O
.. ..
GaS~i lace P rmit ...~.... .............. $
This Ap' I . Become uilding Permit When ~~oved~
By 4.o-d' Date 10 - .J. -, ~L-
Certificate of occupa!cy
Issued
City Planner
Date
24 hour notice for all inspections 447-9850
n
II
MATERIAL FILED WITH APPLICATION
Side
SOIL TESTS
o
o ENERGY DATA
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS 0 SETS
SURVEY
PLOT PLAN
o COPIES
o
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $ II Q sa .tJ 0
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
Pressure Reducer .......................... $
Meter Hom ................................... $
t.(s,OC>
L 25'.~O
/2()O. tJ1)
~'T .uQ
7(JO .00.
Special Conditions n any
I
u
~~
~NE5~
GIlt!!. - 'Ro!!
YELLOW - A~~ICA"T
GOLD. CITY
...
CITY OF PRIOR LAKE
SEWER AND WATER PERMIT
NOTE:
NO.
tt1?~/Z9r;,
. -:JiJ.A it!. r 7A~ p~.PWI~
cdli<J: 4r-rrv'7:(,;C. .:7,r . -~" rlif& 4- 'f~-.."/t/(1
APPLICANT:~J~'Y"'r-\1 ~. r:-c.~ ke1-+ PHONE: t..{ q ~- 2 t.{ I ~
I .
ADDRESS: 5' 2. 7-!J !-!if) ~ ~+- ~
SIGNATURE: ~ _ ~J
SITE ADDRESS;' ~A mE:.
Sewer and Water
contractors must
be registered
with the city.
DATE: _' 0........ '") If ... 't1
BLDG. PERMIT # ff-f2f~
PID#
1.
Estimated length of water service
FILL IN THE BLANKS
~?
feet.
~uJifJ
2.
Size of water service / inch(es) .
Location of any couplings from structure~~eet.
3.
4. Type of sewer pipe. ABS
PVC
cast Iron
5. Estimated length of sewer line
feet.
6. Clean out (if required), located at
structure.
feet
from
BY
s your permit when approved. I (1
~ DATE: III /Zq ~ 7
. I
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This
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FEES:
$
$
$
35.00
.50
35.50
Sewer and water line connection permit.
Surcharge
TOTAL
* Fee for either sewer or water individually is $l1.~0 plus
$ .50 surcharge.
* Sewer and water permits issued for new construction must be
recorded on the building permit card at the time of issuance
to insure that no duplicate sewer and water permits are
issued.
DATE PAID
AMOUNT PAID. /-eo ,N\~
/ ~~'v ._
REC I D BY . "., .....'
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RECEIPT #
4629 Dakota St. S.E., Prior Lake, Minnesota 55372 / Ph. (612) 447-4230 / Fax (612) 447-4245
AN EQUAL OPPORTUNITY EMPIDYER
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