HomeMy WebLinkAboutBuilding Permit 00-0357
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CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
I. White
2. Pink
3. Yellow
File
City
Applicant
G/ I ((50
Permit No. (J{"\ -O~S;7
DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FillED IN
BEFORE PERMIT IS ISSUED {Please Print or Type and sign al bottom}
2. SITE ADDRESS
:2,'k5J'C\ bNQn W-uQ\\'\h "lr7"t".! ~\0
3. LEGAL DESCRIPTION (j
;;< BLOCK PID a $'- IOcr ell?, - (')
ADDITION ('~ bJ"\ ~ ~n k \ ~r A\lj ~\N
4.0WNeRDA^,r~t.l.._ Sf.lUCV ('3&ROGtIV I4srL iv (T~'{)t!Db(o
5. ARCHITECT (Name)
1. DATE
CoII/OV
BUilDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (DePth)
12. NO. OF STORIES
LOT
13. TYPE OF CONSTRUCTION
14. FLOOR AREA APPORTIONMENT USE
(Address)
(Tel. No.)
6. BUilDER
(Name)
(Address)
(Tel. No.)
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
~
7. TYPE OF WORK
New Construction LJ
Fireplace 0
Alterations LJ
SepticLl
Addition 0
Deck 0
Finish Attic 0
/'
Ae-roofing ~ Porch 0
Rs-siding 0 Finish Basement LJ
SEAT~
16. PROJECT COSTNALUE
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES 19. PROPERTY DIMENSIONS 110. CULVERT SIZE
Sq. Ft. Width Depth Y4~S 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 tile owner or authorized agent for
the abo enlioned pro~nd*onstruction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the
building ffi 'al can revok t s I J t clo<lfJ;;rmore, I hereby agree that the city official or a designee may enter upon the property to perform needed insPli:lions.
X A (;'1,00
SIgnature ~ license No. . Date
17. COMPLETION DATE
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
Front
Back
Side
Side
MATERIAL FilED WITH APPLICATION
SOIL TESTS a ENERGY DATA a
PILING LOGS 0 PERCOLATION TESTS D
BUILDING DEPARTMENT VALUATION
USE OF BUILDING ~l:(
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMlT VALUATION
PLANS & SPECS 0
SURVEY 0
PLOT PLAN 0
SETS
COPIES
TYPE OF CONSTRUCTION: I II III IV V
OccupancyGroup A B E F HIM R S U
City:
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
Diviskm 1 2 3 4
Permit Fee ............................... .... (:
'<74,.7 'S"
Plan Check Fee ............................. (:
State Surcharge ............................. .(:
I . .::l.Ci
Penalty......... ............. ................. ~
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
Pressure Reducer .......................... $
Meier Horn ................................... $
WalerMeler ................................. $
Sewer & Water Connection Fee ........... $
WalerTowerFee ........................... $
Sewer & Water Permit ...................... It
Gas Fireplace Permit ....................... It'
~is$J:riJ/Ia:~g ~:t':i1(':f7;;ed
Certificate of Occupancy
WalerTap ................................... $
Builder's Deposit ............................ $
Other ..... .... .... ............................ $
Total Due .............................. $ "7 f, .,<eO
Paid '7 L vC Receipt No 3 7 ? C'l Q
Issued I ~ I
Date Q 11m) By {
ThIS IS to certify that the request In the above application and accompanYing documents IS In accordance With the City Zomng'Ordl~ance and may proceed as eq ested ThiS document when
stgned by the City Planner constitutes a temporary Cerbficate of Zoning compliance and allows construction 10 commence Before occupancy, a Certificate of upancy must be ISSUed
City Planner
Dale
Special Conditions if any
~
24 hour notice for aU inspections (952) 447.9850
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
y~~
r "
OWNER
3lHW
GREEN HEIGHTS
00-0357
Re-Roof
ADDRESS
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
~AL
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:
-
~f) Grz/#i-k
~K SATISFACTORY. PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WOJ))i1jf FOR REINSPECTION BEFORE COVERING
Inspector: ~r r Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH .l SAFETY/
INSNon