HomeMy WebLinkAboutBuilding Permit 00-0822
~1
DATE RECEIVED CITY OF PRIOR LAKE
q. /:3. 0 (J BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
1. White
2. Pink
3. Yellow
File
City
Applicant
Permit No.
o "d ..() 82:2__--
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
WIt! ,l/I/;L CS. e.1<. S S'.
1. DATE
~i /3. trO
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
3. LEGAL DESCRIPTION
I
12. NO. OF STORIES
LOT
BLOCK
Z-
PID
:?e;-z.o~-()D5 -0
13. TYPE OF CONSTRUCTION
ADDITION
4. OWNER
8,e/';;J.; tI()~::;r.ssl.
(Tel. No.)
14. FLOOR AREA APPORTIONMENT USE
5. ARCHITECT
(Name)
(Address)
(Tel. No.)
6. BUILDER
(Name)
(Address)
(Tel. No.)
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
7. TYPE OF WORK
New Construction 0
Fireplace 0
Alterations 0
Septic 0
Addition 0
DeckLJ
Finish Attic 0
Re-roof~ Porch 0
Re-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 Yas No
I hereby certify that I have furnished infonnation 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 clion will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the
buildin~~"- ~ pe for just use. Furthermore, I hereby agree that the city official or a designee may enter upon the property to peri~reeded inspections.
X ~C .-?c. "...., C v?-d.. /<?;_ QZ')
c::::::.-' ~ ignBttJret' License No. ,,~, . "'o..te
17. COMPLETION DATE
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
Front
Back
Side
Side
MATERIAL FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA 0
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS 0 SETS
BUILDING DEPARTMENT VALUATION
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
SURVEY
PLOT PLAN
o COPIES
USE OF BUILDING
D
TYPE OF CON$TRUCT10N: I II III IV V
Occupancy Group A B E F HIM R S U
City:
Amount Brought Forward .................. It
Park Support Fee .... .... ................... $
SAC ......................................... $
Collective Street Fee .... ................... ct:
Sewer Tap ................................... $
$
Division 1 2 3 4
Permit Fee ................................... $'
71.7}
Plan Check Fee ............................. $'
State Surcharge ............................. $
Penalty ....................................... $
Plumbing Pennit Fee ....................... $
/."2..)
Mechanical Permit Fee ..................... $'
Pressure Reducer .......................... $
Meter Horn ................ .... .... .... ....... ct:
Water Meter ................................. $
Sewer & Water Connection Fee ........... ct:
WaterTowerFee ........................... <t
Sewer & WaterPennlt ...................... $'
Gas Fireplace Permit ....................... $
Water Tap ................................... $
Certificate of Occupancy
Builder's Deposit ............................ <I'
Other ......... .... .... ........................ $
TotalDu. ............................... 7(,.00
7" . fYr/ R.ceiPI\I~.3 8 4-1/
Dat. 4. /? 0 0 By,f/l,.--
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/s requested. 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.
Paid
This Application Becomes Your Building Pennit When Approved.
By r)ate
Issued
City Planner
Dale
Special Conditions if any
24 hour notice for all inspections (952) 447.9850
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
DATE TIME
o/I~
OWNER
4110
CJ
00-0822
Re-Roof
ADDRESS
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o I!!IlULA nON
~INAL
o SITE INSPECTION
U rL............._.
iRAD/FILLlNG
o COMPLAINT
o FIREPLAcE RI
o FIREPLAcE FINAL
o GASLINE AIR TST
o
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
COMMENTS:
K:o./ (:~/J ~/e
"
~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 <l SAFETYI
INSNOTI