HomeMy WebLinkAboutBuilding Permit 00-0822
QATF RFr.FIVFn CITY OF PRIOR LAKE
q. /:3. 0 (J BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
L White
2. Pink
3. Yellow
File
City
Applicant
Permit No.
6 ~ -lJ 82-7---.
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
0/tI . t/I/;L C..T ~..Ie
3. LEGAL DESCRIPTION
/
1. DATE
~113,{y()
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
S&-o
12. NO. OF STORIES
LOT
BLOCK
Z-
PID
/~-Z08-/)05' -0
13. TYPE OF CONSTRUCTION
ADDITION
14. OWNER 11 ,e'/;'ii./
ISo ARCHITECT (Name)
6. BUILDER (Name)
(Address'
tJ(I~V/
(Tel. No.)
14. FLOOR AREA APPORTIONMENT USE
(Address)
(Tel. No.)
(Address)
(Tel. No.)
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
7. TYPE OF WORK
New Construction 0
Fireplace LI
Alterations 0
SepticCl
Addition 0
DeckL!
Finish Attic 0
Re.rOOf~ Porch LJ
Ae-siding 0 Finish Basement 0
SEATS
16. PROJECT COSTNAlUE
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES 19. PROPERTY DIMENSIONS 110. CULVERT 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 con ction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the
bUil~in .. a.w' -~ pe for just' use. Furthermore, I hereby agree that the city official or a designee may enter upon the property to pe~f1eeded inspections.
X / 7'--- '- 4 /?-orJ
- ~ 1ignatu License No. ,.---/- Data
17. COMPLETION DATE
r
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
Front
Ba'"
Side
MATERIAL FILED WITH APPLICATION
Side SOil TESTS 0 ENERGY DATA 0
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS 0 SETS
SURVEY 0 COPIES
PLOT PLAN 0
BUILDING DEPARTMENT VALUATION
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
USE OF BUILDING
TYPE OF CONSTRUCTION: I II III IV V
OccupancyGroup A B E F HIM R S U
Ci'Y:
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
~
Division 1 2 3 4
Permit Fee ................................... $
71.7}
Plan Check Fee .........."................. $
State Surcharge ............................. $
Penalty ....................................... g:
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
1.2r
Sewer & Water Permit ...................... $
Pressure Reducer .......................... $
Meter Horn ... .... ............................ ~
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
WaterTowerFee ........................... $
Gas Fireplace Permit ....................... $
Water Tap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
Total Due .............................. $ 7(,.00
7(, . VV ReceiPt~::.:3 8 4-11
Date 4. /~. 00 By,//l.--
This is 10 certify that the request in the above application and accompanying documents is in accordance with the City Zonj~g Ordinance and may proceed;&" ;equested. This document when
signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction 10 commence. Before occupancy, a Certificate of Occupancy must be issued.
Paid
This Application Becomes Your Building Permit When Approved.
By Ilate
Certificate of Occupancy
Issued
City Planner
Dale
Special Conditions i1any
24 hour notice for all inspections (952) 447-9850
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
~
ADDRESS
4110
CJ
00.0822
Re-Roof
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o ''!J'ULATION
Ai"1'INAL
o SITE INSPECTION
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
3RADfFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
L.J r................_.
COMMENTS:
go -F
~ .. /
(O,/<."" /.....~
;'
~RK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING.
~ Owner/Contr:
Inspector:
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTI