HomeMy WebLinkAboutBuilding Permit 00-0344
6~~
DATF R~r.~
5/rz./OO
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
I 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 '/
/5SII Sice{tul.. [A.,{-
3. LEGAL DESCRIPTION
LOT 7 BLOCK
G~AY
4. OWNER I fName; .
lir/A k'rUr' t.j (f '
5. ARCHITECT (Name)
1. DATE
5-/2-0D
Ie/SO
ADDITION
4-
::sHo.ees
PID Z5-0Q{- 077-0
(I'
J J
(Tef. No.)
,~ 4" I"
Ii: '17-L k'.
(Tel. No.)
,
(Address)
,~ . I
r,"..J
(Address)
'S f:{ lit /
6. BUIl.DER
(Name)
(Tel. No.)
(Address)
7. TYPE OF WORK
New Construction 0
Chimney 0 Misc.
Septic 0
Addition 0
Re-rOOfin~ Porch 0
Re.sidln!JX' Finish Basement LJ
Fireplace 0
Alterations 0
Deck 0
Finish Attic 0
fll16
t. White
2. Pink
3. Yellow
File
City
Applicant
Permit No. nO-6311-
BUILDING INFORMATION
1,. 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
OCCUPANTF
SEATF
16. PROJECT COSTNALUE
17. COMPLETION DATE
8. PROPERTY AREA OR ACRES 19. PROPERTY DIMENSIONS 110. CULVERT SIZE
Sq. Ft. Width Depth YEiS 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 mentioned property and tha~all nstruction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the
bUildlllQPff~ia~ can ~evoke thilPP'TIit f . st cayse. ~prthermore, I hereby agree that the city official or a designee may enter upon the property to perfo"!'Jleeded ,inspectiOQ~. .
X XI--ItiLU/ LA, U: #1/)_ '), / 'I -l\I'
SIgnature ~I License No. Date
Amount Brought Forward .................. $
Park Support Fee ........................". It
SAC ......................................... It
Collective Street Fee ............. .......... $
Sewer Tap ................................... It
$
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
Front
Back
Side
Side
BUILDING DEPARTMENT VALUATION
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
2, SO(). 00
,
USE OF BUILDING
K6 S AU<..
/
TYPE OF CONSTRUCTION: I II III IV V
Occupancy Group A B E F HIM R S U
Permit Fee ..........~~~~~~~...1...~...~..~... $ 74. 75
Ci~r
Plan Check Fee ................. ............ $
State Surcharge ............................. $
/.2.6
Penalty ................................... .... ~
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
MATERIAL FILED WITH APPLICATION
SOIL TESTS LJ ENERGY DATA a
PILING LOGS a PERCOLATION TESTS Ll
PLANS & SPECS 0
SURVEY 0
SETS
COPIES
PLOT PLAN
o
Pressure Reducer .......................... It
Meter Ham .,. .... ............................ $
Water Meter ................................. .'t.
Sewer & Water Connection Fee ........... $
WaterTowerFee ........................... ~
Water Tap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
e~ '~l~o;;;;~I;.f~7
Date S z/n() By 11^--.
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning' Ordinance and may proceeds requested. This document when
signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a CertificSl-~f Occupancy must be issued.
Sewer & Water Permit ...................... $
This
By
Certificate of Occupa/cy
Issued
.................. $
ing ~:.:,it ~jt~:rlJ()
I
Cijy Planner
Special Conditions ~ any
Date
24 hour notice for aU inspections 447-9850
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
PHONE NO,
IS~ /1- Sfv!!'~""
PERMIT NO. ~
CONTR.
ADDRESS
OWNER
o FOOTING 0 PLUMBING RI
o FOUNDATION 0 MECH RI
o FRAMING 0 WATER HOOKUP
~NSULATION 0 SEWER HOOKUP
FINAL 0 PLUMBING FINAL
SITE INSPECTION ~;;;;:;::L
COMMENTS: 'l? e.
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
Q.
//
( G~/)
,
~'k
hORK SATISFACTORY, PROCEED
/0' CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR INSPECTION BEFORE COVERING
Inspector:
Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
INSNOTJ