HomeMy WebLinkAboutBuilding Permit #00-0052
CITY OF PRIOR LAKE
INSPECTION NOTICE
1;j1UL-
S~HEDUl,ED
DATE TIME
~ A-.T,
ADDRESS
5500 co~ IOI\lWOOO
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
COMMENTS:
CONTR.
PERMIT NO.
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
0052-
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
Ll.. ~ GASLINE AIR TST
" ~-E/;e..6
SP~/A/t<:..(.,~
./
~#
~ORK SATISFACTORY, PROCEED
o CORRECT AC AND PROCEED
o CORR T ~. CALL FOR REINSPECTION BEFORE COVERING
') I /
InspectrJ' r: ) i / . Owner/Contr:
....V
CA 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTI
DATE RECEIVED
2-/ 3 / (>0
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
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
==tY/;
I~^n
Sl. -b---
5500 CAJlnJNNOOD LN.
3. LEGAL DESCRIPTION
1. DATE
1-3/-cx)
BLOCK PID ZS' Z9h - 001- z..
ADDITION ~J <./ AprvtJct/~/J -N.a~
4. OWNER _ \ \ (Name) ,(Address) (Tel. No.) tJcrnie
{Y\w-\ C>~ \SLh ld..:tt5 . Sa.ff\. ~ z,fo-'J- 155+1
5.~RCIII~T (Name) (!'Pdress) (Tel. No.)
..surnr..it ~ 9~o.,- ~(!jeuek:lNlAIl'~ ?ast'vlll~ t.tJ39-rrta
6. BUILDER (Name) (Address) (Tel. No.)
LOT
1. White
2. Pink
3. Yellow
File
City
Applicant
Permit No. ()() -O[)::JL
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (WIdth) (Depth)
12. NO. OF STORIES
13. TYPE OF CONSTRUCTION
14. FLOOR AREA APPORTIONMENT USE
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
SEATS
16. PROJECT COSTNALUE
10rf'. -
17. COMPLEflON DATE
Z-(fO-OO
I hereby certify that I have fumished infonnation 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 confonn to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the
bUildingGI can revok'Whisf~Wit for~ust cause. Furthennore. I hereby agree that the city official or a designee may enter upon the property to perfonn need, ed inspections.
X ~'-l ~ t!-rY15 j-7/YJeY
Signature License No. Date
7. TYPE OF WORK Fireplace Cl Septic Cl Deck Cl
New Construction Cl ,Alterations., Addition Cl Finish Attic Cl
Chimney Cl Misc. JL h.n .... S~1I\ t:J t?r- S~
8. PROPERTY AREA OR ACRES 9. PROPERTY DIMENSIONS
Sq. Ft. Width Depth
Re-roofing Cl Porch Cl
Re-siding Cl Finish Basement Cl
10. CULVERT SIZE
Yes
No
SETBACKS: Required
Actual
FOR ADMINISTRATIVE USE
Front
Back
Side
BUILDING DEPARTMENT VALUATION
Side
USE OF BUILDING ~ A,/,t;!!.
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION I. I ()(") .C):7
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
License Check Fee ......................... $
Pressure Reducer .......................... $
Meter Horn ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ..................... ...... $
Water Tap ................................... $
Builder's Deposit ............................ $
Other ......................................... !to
Total Due .............................. $~ OS
Paid .3B _ 05' Receipt " 10 4-
Date zJ ~ In () By
dance with the City Zoni~ and may proc s requested. This document when
:-t~com~~.o~~o:~~ ~rtificate of Occupancy must be issued.
- ~conditions ~ any
TYPE OF CONSTRUCTION: I II III IV V
Occupancy Group A B E F H IRS U
Division 1 2 3 4
Penni! Fee ................................... $
Plan Checking Fee ......................... $
State Surcharge ............................. $
Penalty ....................................... $
Septic System ............................... $
Other ......................................... $
-
-
Subtotal ............................... $
This '):?Io~mes YO~lniR!l PeFmit Whe~ Ap~oved.
By {ftwL ~ .. s;J Date 2 5 2.Lv
CertWicate of Occupancl
Issued
This is to certify that the request in the above application and accompanying documents is in a
signed by the City Planner constitutes a temporary Certificate of Zoning comPIi~11 a~~
City Planner Date
City:
24 hour notice for all inspections 447-4230
MATERIAL FILED WITH APPLICATION
SOIL TESTS Cl ENERGY DATA Cl
PILING LOGS Cl PERCOLATION TESTS Cl
PLANS & SPECS Cl
SURVEY Cl
SETS
COPIES
PLOT PLAN
Cl