HomeMy WebLinkAboutBuilding Permit 00-0122
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CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
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!~e;mit N~. () 0 -() / 2 Z-
1. White
2. Pink
3. Yellow
File
City
Applicant
DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
12SITEADi4//3 ASP6N rive;.
3. LEGAL DESCRIPTION
1. DATE
/116
BUILDING INFORMATION
11. SIZE OF STRUCTURE
P l/~D (Height) (Width) (Depth)
12. NO. OF STORIES
q
. <:AND POI NT
14. OWNER (Name)
'l3K:(/e.,e; /'?1'-'-61<-
15. ARCHITECT
6. BUILDER
LOT
5
BLOCK
PID
2ND
?oC) - 7..()5 - ()P>A- Q
AnnAl.
13. TYPE OF CONSTRUCTION
ADDITION
(Address)
(Tel. No.)
14. FLOOR AREA APPORTIONMENT USE
(Name)
(Address)
(Tel. No.)
(Name)
(Address)
(Tel. No.)
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
'~/.?1~
7. TYPE OF WORK
New Construction CI
Chimney 0 Misc.
6wAJr...L
Fireplace 0
Alterations 0
Septic 0
Addition 0
Deck 0
Finish Attic 0
Rll-roofing 0 Porch 0
Re-siding)( Finish Basement 0
SEATS
16. PROJECT COSTNALUE
8. PROPERTY AREA OR ACRES 19. PROPERTY DIMENSIONS 110. CULVE"T SIZE
Sq. Ft. Width Depth Yes No
I hereby certify that I have furnished 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 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
buildin~cial can revoke this pe~st ~u~J'Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X..............:u.- _ tC../rt:.~ 3-/~~CX>
Signature License No. Date
17. COMPLETION DATE
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
MATERIAL FILED WITH APPLICATION
Front
Back:
Side
Side
SOIL TESTS
r:l ENERGY DATA
r:l
FF-;S /7/ Ai:;
,
OFF STREET PARKING
SPACES REQ.
SPACES ON PLAN
PERMIT VALUATION
PILING LOGS 0 PERCOLATION TESTS 0
BUILDING DEPARTMENT VALUATION
USE OF BUILDING
PLANS & SPECS 0
SURVEY 0
SETS
COPIES
:?so-n. 07)
PLOT PLAN
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TYPE OF CONSTRUCTION: I II III IV V
Occupancy Group A B E F HIM R
Division 1 2 3 4
S U
City:
Amount Brought Forward .................. $
Park Support Fee ........................... It
SAC ......................................... ,It
Collective Street Fee ....................... It
Sewer Tap ................................... It
$
Permit Fee ................................... $
7-+. 75
Plan Check Fee ............................. $
State Surcharge ............................. $
Penalty ....................................... $
1.25"
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
Pressure Reducer .......................... $
Meter Horn ................................... It
Water Meter ................................. It
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
Sewer & Water Permit ...................... $
Gas Rreplace Permit ....................... $ Water Tap ................................... $
:~i~~:t:"~J3,7Jv ~:~::~~:::i~::.:::.::..:::.::::::::::::::: 7 (P. 0 0
Paid ~ &> .07) Receipt No.. 3C> f(; '1
Issued .-
Data ~4/1'1() By ~14-
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed a~equested. 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.
City Planner
Date
Special Conditions n any
24 hoor notice for all inspections 447-9850
DATE TIME
CITY OF PRIOR LAKE ~ /:~ L. /
INSPECTION NOTICE SCHEDULED ~/?'.r
ADDRESS ~ lkpt!!./-J
Oa- IJ.~
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
&INAL
~TE INSPECTiON
COMMENTS:
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
~':CsiJe-
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
./"'? /-7 I. /
/' ~~./J/,., h:-. j
- ,
~ORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT W~"'J~/~INSPECTION BEFORE COVERING
Inspector: t/~ r Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH .l SAFETY/
INSNOTl
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