HomeMy WebLinkAboutBuilding Permit 04-1251
~~
I'a '16'5'
DAn: RECEIVED
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.
04- ./ZS I
DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at Eottom)
2. SITE ADDRESS ...H
1C?1~'5-C::; r::~I-^ 'P"M+ }>It- 5. €.
3. LEGAL DESCRIPTION \
1. DATE
W.Ue'-'.. o...e. ()11c:ld.(
r;:;'/';'?J/6.<l
BUILDING INFORMATIDN
11. SIZE OF STRUCTURE
(Hoi~t) (Widttl) (Doplh)
LOT
ADDITION
4. OWNER
f1",I.nV' U.
5. ARCHtTECT
BLOCK
PID 2.5. 93(p. 074-.0
12. NO. OF STORIES
13. TYPE OF CONSTRUCTION
(Name)
~d.A""""''':;'
(Nam.)
(Address)
5'116l:::,l.'\.....-J-u'1^^d 0"-~.~1
(Address)
(Tel. No.)
14. FLOOR AREA APPORTIONMENT USE
(T.1. No.)
6 _ ...1-._ (Nam.) (Addr~
:"''\A.""tV".u-\ or '2)';z1 LQ. I ~ st-, Vl,~ ,
C;!~ H.~ "PY'o~;OV\. ~,p_'6. VlIl..\.56'1rZJ "1'd-?8?~
7. TYPE OF WORK Rreplace LJ Sepll~ i:J ). Deck LJ Re-roofing CI Porch 0
New Construction 0 Alterations .. Addition LI Finish Attic (""J Re-sldlng 0 FInish B~~
ChlmnoyO Misc. fidd 111 t...J.. .rl-~,<< (';tv; t .., ...:t- 16!<,) ce-.lIVlA~ '::;;- ~
8. PROPERTY AREA OR ACRES 19. PROPERTY DIMENSIONS I 10. CULVERT SIZE - ..
Sq. Ft. Width Depth Yes 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 construction will confonn to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the
building of(lc@lcan revoke this penn.!!Jor just ~se. Furthennore, I hereby agree that the city official or a designee may enter upon the property to perionn needed insP.8dions.
X '" '\ ~n. c::~-, C-Qq~ 1'A/;;{21!D'f
Signature license No. Date
(T.1. No.)
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTI'
SEATS
16. PROJECT COSTNALUE
/lJ,60.Q,OO
17. COMPLETION OATE
FOR ADMINISTRATIVE USE
SElBACKS: Required
Actual
F.""
60ck
Sklo
Sklo
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
· I >00. -
SURVEY
PLOT PLAN
o COPIES
USE OF BUILDING _
~
TYPE OF CONSTRUCTION: iliV III IV V 15
Occupancy Group A B (!:> F HIM R S U
DivIsion 6)2 3 4 __
p.nnn F.. uuu........u...............uu $ <-1. '""0
Plan Check F.. u.........uuuuuuuuu $_ <"..3~
.7"\
City:
AmountBroughtForward ..................'$.
ParkSupportFee ........................... $
SAC .uuUUmuum.......u......u...u $_
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
Ponalty uuuu...uuuuuuuuuuuuuu $
Pressure Reducer .......................... $
State Surcharge ............................. '"
Mechanical Perrnit Fee ..................... !to
Meter Horn ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
Water Tap ................................... $
Builder's Deposit ............................ $
other ......................................... $
Total Due .............................. $
Paid tJS, I.;) Receipt tjo.
Issued . -
Date fl. Vf.-; .,:-~y ~
This Is to certify that the request In the above application and .:............p""'.jing documents is In accordance with the City Zoning Ordinance and may requested. This document when
signed by the Qty Planner constitutes a ter'rlXlrary Certificate of Zoning compliance and allows construction to commence. BefOre occupancy, a of Occupancy must be issued.
,
,
Plumbing Pennn Fee ....................... $:
Sewer & Water Pennlt ...................... It
this
By
. ,
u..u.u~.~.nnnWhen~
Dal. IZ.- ie'
/
Cf~-~2J
91(, tj'"
Certlfic:ate of Occupancy
Cilyptanner
o.te
Special Conditions If any
24 hour notice for all inspections 447-9850
-.,
..
PRIOR LAKE
INSPECTION
RECORD
DEPARTMENT OF
BUILDING AND INSPECTION
SITE ADDRESS I sass FI&~ ~DI__ ~b - f'\.'l>Po!oJ D.t...$
TYPE OF WORK "'M \"\ ~\>.. e to\@1A C~T6A..
USE OF BUILDING \ (e- AI'? .
PERMIT NO. C>~- /zo5/ DATE ISSUED 12-/L."l lo,\-
BUILDER DI..'5EN F-,,1,t l'llo\E-~..,.J . PHONE #J.h..2,..~\.~,,\
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
~,,,,,,"NA l I !
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
1-'::IH,llfl9 I I I
I FINAL 4lA III~Y/~ I
I V
FOR ALL INSPECTIONS (952) 447-9850
INSPECTOR
DATE
"
/
/'
/
/
~IOR LAKe
~CTlON NOTICE
/
ADDRESS J.5!. ~II;'
OWNER
PHONE NO.
lJ FOOTING
lJ FOUNDATION
o FRAMING
o INSULATION
d FINAL
-C SITE INSPECTION
COMMENTS:
SCHEDULED
l/27'>'1
TIllE
~.
CONTR.
PERMIT NO.
q -/?c,/
lJ PLUMBING RI
lJ MECH Rl
o WATER HOOKUP
lJ SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EXlGRADlFILLING
o COMPLAINT
o FIREPLACE Rl
o FIREPLACE FINAL
lJ GASUNE AIR TST
lJ
Joc.;:b,,,^,
~ - 1'1d;f ~ ~
XWORK SATISFACTORY, PROCEED
o CORREC C ON AND PROCEED
o COR CALL FOR REINSPECTION BEFORE COVERING
OwnerlContr.
C ~ FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
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CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
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