HomeMy WebLinkAboutBldg Permit 04-1204
DATE RECEIVED CITY OF PRIOR LAKE
/1 . 2,., 0 .,........ BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
. 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 ~ I n () 7 'I
~ , t?- SuNI~IS~
3. LEGAL DESCRIPTION
1. DATE
A-.J(;
,,- dX'3-oL/-
Sw
LOT
4-
4-
S t//VJ f-:} /flU-/'
PID
zS: I? z.. .054-. 0
BLOCK
ADDITION
4. OWNER (Name)
EDOlf: Jl.€"~D~l-L.
5. ARCHITECT (Name)
(Address)
\ ")07,}. 5\)N\tAS€ 'fJ1/'C S \oJ
(Address)
(Tel. No.) q S;,t. -
tt4ts - (p 3,.3
(Tel. No.)
6. BUILDER (Name)
JA,)I\I1 ~\ t.~ B~ I\.. Q r N c.-
UJi-J-pt.t)- c... ~ I ::pJe.-
7. TYPE OF WORK Fireplace 0
New Construction 0 Alterations 0
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES
Sq.Ft.
(Address) (Tel. No.)
1;lJ.4-1 flIUlL.l.GT 95"< - 7(J7-
~ 0 6 '$0\ Bv- (t....I S v · L-Ll: b '1 51
Septic 0 Deck 0 Re-rooting 0 Porch 0
Addition 0 Finish Attic 0 Re-Sldl~ finish Basement 0
10. CULVERT SIZE
9. PROPERTY DIMENSIONS
Width Depth
Yes
No
\0(0 ~)
I. While
2. Pink
3. Yeliow
File
City
Applicent
Permit No.
()t:f, IZ,04--
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Hliclhll (Width) (Depth)
12. NO. OF STORIES
13. TYPE OF CONSTRUCTION
14. FLOOR AREA APPORTIONMENT USE
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
SEATS
16. PROJECT COSTNALUE
1> f 3) ()06
17. COMPLETION DATE
I heraby certlfy that I have fumished Information on this application which is to the bast of my knowledge true and correct. I also certify that I am the owner or authollzed agent for
the above mentioned property and thet all construction will conform to all existing state and local laws and will proceed In aww.';"nce with submmed plans. I am aware that the
building offIcial can revoke this permit for just cause. Furthermore. I hereby agree that the city offICial or a designee may enter upon the property to perform needed Inspections.
X
Signature
License No.
Date
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
Pressure Reducer .. ........................ $
Meter Hom ................................... $:.
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
Gas Fireplace PermR ....................... $ Water Tap ................................... ~
This Application Becomes Your Building PermR When Approved. Builder's Deposit ............................ $
By Date Other ......................................... $ r /t (/'v
Certificate of Occupancy Total Due .............................. $ ,
Paid '/ (,. vz) Receipt No. 1/ ;U =>bO
Issued ~ j
Datel? ~~o f- By f4
This is to carlify lhatlhe request in the above application and accompanying documents is in accordance with the CRy Zoning Ordinance and may proceed as uested. This document wr~ -
signed by the CRy Planner constRutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certiflcete pancy must be issued.
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
Side
Side
Front
Back
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
Division 1 2 3 4
PermR Fee ................................... $
City:
Plan Check Fee ............................. $
State Surcharge ............................. $
PenaRy ......... .............................. $
Plumbing Permit Fee ....................... $
Mechanical PermR Fee ..................... $
Sewer & Water Permit ...................... $
MATERIAL FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA 0
PIUNG LOGS 0 PERCOLATION TESTS 0
PlANS & SPECS a SETS
SURVEY
PLOT PLAN
o COPIES
o
24 hour notice for all inspections 447-9850
Special Condrtions K any
City Planner
Dale
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
/7CJ72
Sv"",/ /" S .e.
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
[] INSULATION
~L
[] SITE INSPECTION
[] PLUMBING RI
o MECH RI
o WATER HOOKUP
[] SEWER HOOKUP
[] PLUMBING FINAL
[] MECH FINAL
COMMENTS:
u(l/
/-e~)Je-
tZ/as--
t
TIME
(!X/- /2dt./
o EXIGRADlFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
/7 / /
G~ dJ/t:! -re
/
------- --...... -
/__/ ~J
( C (OS-e- h /~ /
~ORKS~ORy.PROCE~
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
~ Owner/Contr:
v
Inspector:
~
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
/N6NOTl
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SA.FETYI