HomeMy WebLinkAboutBuilding Permit 00-0095
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3/2./00
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
1. White
2. Pink
3. Yellow
File
City
Applicant
Permit No.
oo,q IS""
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
:?-2.-.J.t1"'P1
1&/'25 MAIN
A..Je
c-3
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
3. LEGAL DESCRIPTION
12. NO. OF STORIES
LOT
1\
BLOCK
to
PID
fl.~ -o::J\ -01<1-0
13. TYPE OF CONSTRUCTION
ADDITION
4. OWNER
(Name)
F~NK.
5. ARCHITECT
(Name)
(Address)
M U~ l-l"-eN
(Address)
(Tel. No.)
'-/'17-11/77
(Tel. No.)
14. FLOOR AREA APPORTIONMENT USE
6. BUILDER
(Name)
(Address)
(Tel. No.)
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
7. TYPE OF WORK
New Construction LI
Fireplace 0
Alterations 0
Septic 0
Addition 0
Deck 0
Finish Attic 0
~
Re-roofin Porch 0
Ae-siding 0 F ish Basement 0
SEATS
16. PROJECT COSTNALUE
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES 19. PROPERTY DIMENSIONS 110. CULVERT SIZE
Sq. Ft. Width Depth Y HS 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 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 offic~ ~~rmit for just cause. Furtherm~~.:~~!:?y.agree that the city official or a designee may enter upon the property to perform needed inspections.
X ~.-O l. _ ... '3. :t - 2."'"
~ ~;nature UcenseNo. 0818
17. COMPLETION DATE
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
USE OF BUILDING
~~
J
A-/12.
('
TYPE OF CONSTRUCTION: I II III IV
Occupancy Group A B E F HIM
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
'2 Soo.
MATERIAL FILED WITH APPLICATION
Side SOIL TESTS a ENERGY DATA a
PILING LOGS a PERCOLATION TESTS a
PLANS & SPECS a SETS
SURVEY a COPIES
PLOT PLAN a
Front
Back
Side
BUILDING DEPARTMENT VALUATION
V
R S U
CUy:
Amount Brought Forward .................. <t
Park Support Fee ........................... $
SAC ......................................... <l:
Collective Street Fee ....................... <!;
Sewer Tap ................................... $
<
Pressure Reducer .......................... $
Meter Horn .......... ...... .... ............... <!;
Water Meter ................................. ~
Sewer & Water Connection Fee ........... <t
WaterTowerFee ........................... $
Water Tap ................................... $
Builder's Deposit ............................ $
Other ......................................... It
Division 1 2 3 4
Permit Fee ................................... $
"14.,,,
Plan Check Fee ............................. $
State Surcharge ............................. $
Penalty.................. ..................... $
\ .25
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
Certificate of Occupancy
Total Due .............................. $ ,1..-. ~
Paid 7 ~ . r Receipt No. 3~
Date >/~/GO By f.-DA
This is 10 certify that the request in the above application and accompanying documents is in accordance with the City Zoning 6rdinJnce and may proceed as requ~ted. 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.
rm".. ................... $
....................~ J I
o :;twhjhr&O
/ I
Sewer &
Issued
CijyPlanner
Date
SpecialCondilions ~any
24 hour notice lor aU inspections 447.9850
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
;;/~ TIME
OWNER
16125
_ MAIN
00-0095
Re-Roof
ADDRESS
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
.p FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
COMMENTS:
.Lt ~ftJile
,
pORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
-#tf~
Inspector:
Owner/Contr:
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY/
INSNOTl