HomeMy WebLinkAboutBldg Permit 01-0206
DATE RECEIVED
0ob4:\: B3B0
~ llo '00
File
City
Applicant
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
3- 2-3-DI
DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
1. DATE
3~dd.-QI
2. SITE ADDRESS 6W \ '3 & \sam .s-\it ee.A- s w
3. LEGAL DESCRIPTION
LOT ./ BLOCK
ADDITION /'
4. OWNER (Name)
jor R'le rY\c.,c.,OLLr-t;P.J
5. ARCHITECT (Name)
PID
(Address)3413 etll..saIYl. ~1t\g~. NO..)
Prior L.l1.JLL. - '1'..rJ.-~-3gldJ
(Address) (Tel. No.)
HUILDER (Name) . J.?6A 111 fff (Address) (Tel. No.)
Ke.\'O-f\+ Cneyglf d~ Sr~J~i(\":1 Av~.s. loIQ-7d\-;;}OOO
7.~~~rl~CD FireplaceO (Y\1I1~:gDII.s.De~~L/D1 Re-roofing~ Porch 0
New Construction 0 Alterations 0 Addition 0 Finish Attic 0 Re-siding 0 Finish Basement 0
Chimney 0 Misc.
1. White
2. Pink
3. Yellow
Permit No.
Ol-Dz.o(p
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) ..-/ (Width) (Depth)
12. N70RIES
13. TY7NSTRUCTION
14. F,/REA APPORTIONMENT USE
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
/
./
SEATS
16. PROJECT COSTNALUI;,....
(0 lRW . (l:/.
8. PROPERTY AREA OR ACRES 9. PROPERTY DIMENSIONS 10. CULVERT SIZE 17. COMPLETION DATE
Sq. Ft.",- Width ...-- Depth Yes ~o mQ LA I I d(XJI
I hereby certify that have fumished information on this application which is to the best of my knowledge true and correct. I also certify that I am th~ owner or authorized agent for
the above mention 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
building official can evoke 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 ., I', ~ ~0/0qK50 :=3~d;)~()'
^' I . A~~ License No. Date
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
Pressure Reducer .......................... $
Meter Horn ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
Water Tap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
Total Due .............................. $ 7t,.. (JO
Paid 1~ .00 Receipt.. 3~/3
Date 3. ZI,p.O! By
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
signed by the City Planner constttutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
Front
Back
Side
Side
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
Division 1 2 3 4
Permit Fee ................................... $
S U
City:
'74-.15
Plan Check Fee ............................. $
State Surcharge............................. $
I. z.5'"
Penalty ....................................... $
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
Sewer & Water Permit ...................... $
Gas Fireplace Permit ....................... $
This Application Becomes Your Building Permit When Approved.
By Date
Certificate of Occupancy
Issued
City Planner
Date
MATERIAL FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA 0
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS 0 SETS
SURVEY
PLOT PLAN
o COPIES
o
24 hour notice for all inspections 447-9850
Special Conditions d any
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDUlED
ADDRESS ~i113
b~ ~-I-
OWNER
CONTR.
PHONE NO. PERMIT NO.
D FOOTING ~ PLUMBING RI
D FOUNDATION MECH RI
D FRAMING WATER HO P
D INSULA TI~ .,/1 D SEWER H UP
~FINAL -(C-{lv D PL.I L
D SITE INSPECTION D MECH F
COMMENTS: &~
DATE TIME
10 ..q-I 1lJ~
1-- J.fJ~
D EX/GRAD/FILLING
D COMPLAINT
D FIREPLACE RI
D FIREPLACE FINAL
D GASLlNE AIR TST
D
fI WORK SATISFACTORY, PROCEED
D CORRECT ACTION AND PROCEED
D CORRECT WORK'~L FOR REINSPECTION BEFORE COVERING
Inspector: Owner/Contr:
, I
\
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE..
INSNOTl
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYl
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