HomeMy WebLinkAboutBldg Permit 05-0930
QATE RECfIYEQ CITY OF PRIOR LAKE
Cl ZI.. oS- 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)
1. DATE
9v?/-,(}5
2}4Jq4Ji; ,C;J;/hI/ /'l///);'71v/ /J. E
3. LEGAL DESCRIPTION /. .
LOT BLOCK PID zs: 2-~ I. () 6 z,. 0
1. White
2. Pink
3. Yellow
File
City
Applicant
Permit No.
O=>. 0 t:t30
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
12. NO. OF STORIES
ADDITION
4. OWNER M (Name)
7LffJ tvp
5. ARCHITECT (Name)
)1. TYPE OF CONWRUCTION
Hfl/ - r /7/)";;
,; / ~"}ddressl ~~ --r'. )Tel. No.) Id/t?i- - 14. FLOOR AREA APPORTIONMENT USE
/~?4eJ. 7~~ l(1/~ /)g ~R-J%~/
(Addr s) (Tel. No.)
6. BUILDER (Name) (Address) (Tel. No.) tlfc?l"
fJvd~ (!n?~Aa2J/Jt!. JtPl-1~6MV//~IJ/ 8f1I-/jc1tJc(
7. TYPE OF WORK Fireplace 0 Septic 0 Deck 0 Re-roofin~ Porch 0
New Construction 0 Alterations 0 Addition 0 Finish Attic 0 Re-siding 0 Finish Basement 0
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES
Sq. Ft.
9. PROPERTY DIMENSIONS
Width Depth
10. CULVERT SIZE
Yes No
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
SEATS
>>. PROJECT COSTNALUE
if t/7tt/%J
'17. COMPLETION DATE
I hereby certify that I have fumished 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 entioned property and that all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the
:uilding '~~it fo j c,aus.. Furthermore. I hereby ag~~M~4i;?Signee may enter upon the property to pe~~/:~ns.
Signature f 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 ........................... ~
Water Tap ................................... ,.
Builder's Deposit ............................ ,.
Other ......................................... $~, _ ~
Total Due .............................. $~'
Paid 7~. ~ Receip}'t)lo. 4"f '17?
Date f. 'Z-r'lv r
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
Front
Side
Side
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
Occupancy Group A B E F HIM R S U
Division 1 2 3 4
Permit Fee ................................... $
City:
Plan Check Fee ............................. $
State Surcharge ............................. $
Penalty ....................................... $
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
Sewer & Water Permn ...................... $
Gas Fireplace Permit ....................... $
This Application Becomes Your Building Permit When Approved.
By Date
Certificate of Occupancy
Issued
MATERIAL FILED WITH APPLICATION
SOIL TESTS
o ENERGY DATA
o
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS 0 SETS
SURVEY
PLOT PLAN
o COPIES
o
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may pr eed s requested. This document when
signed by the cny Planner const~utes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy. a C rtilic of Occupancy must be issued.
24 hour notice for all inspections 447-9850
Speciai Conditions ij any
City Planner
Date
( OF PRIOR LAKE
,,~SPECTION NOTICE
DATE TIME
SCHEDULED ~~~~
0~L&~d 'Z/
/
CONTR.
ADDRESS
/~7/0
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL ./1
DIHFINAL I /
/Cer~d /
/;J / r- 7 __
,?: e-Tl/YeS ~.Ao'-../ /1YY""'--L
~~~ ~~ 4h.cho~
./
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
~L
o SITE INSPECTION
COMMENTS:
PERMIT NO.
.s--73 0
o EXIGRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
,// // . /
~~ r a /-P.e"""" ad
+..rP~ ~ <7J~I./~.
/ '~
~K SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT wy~?~ REINSPECTION BEFORE COVERING
Inspector: .~ ~contr:
v ~
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
/NSNOTl