HomeMy WebLinkAboutBldg Permit 01-0379
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
DATE RECEIVED
1. White
2. Pink
3. Yellow
APR 3 0 2001
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
6S-??J ~ll\..[\au).f\ ~(5L~.1C V\A~
3. LEGAL DESCRIPTION
{)d--. BLOCK I PIDf)5 .. J.;;.1 - 0 C}d-O
~+tJl/Y'nA- /.s.f- ftdo/-N
1. DATE
~ 11lot
ZONING
. (eS-lde~ \
(Depth)
12. NO. OF STORIES I
LOT
13. TYPE OF C9NSTRUCTION
-t:~i~t'i.(' I (t/{fY)f
14. FLOOR AREA APPORTIONMENT USE
ADDITION
4. OWNER (Name) (Address) (Tel. No.)QS1-
tl~ ~C\Lt.~ SS3~ f'Oo-\f\a.wf\~~. Qfla\.UL u.r-~-;)L\"
5. ARCHITECT (Name) (Address) (Tel. No.)
6. BUILDER (Name) (Address)
~\~ ~ ~\(\G\ \"\OSO '2-;(c\~ .t\..Q\"'M,')",,-""'. f'I\~
(Tel. NO.),,~_
':I':fVib'1<'6
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
SEATS
16. PROJECT COSTNALUE
1> ~~ri)
17. COMPLETION DATE
Fireplace CI
Alterations CI
Deck CI
Finish Attic CI
7. TYPE OF WORK
New Construction CI
Septic CI
Addition CI
Re-roofin~ Porch CI
Re-siding CI Finish Basement CI
Chimney CI Misc.
8. PROPERTY AREA OR ACRES
Sq.Ft.
9. PROPERTY DIMENSIONS
Width Depth
10. CULVERT SIZE
Yes No
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 mentioned 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
bUild~~ 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 AILt1t:v~_~~~q~ ~/nIOI
Signature License No. Date
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
MATERIAL ALED WITH APPLICATION
SOIL TESTS CI ENERGY DATA CI
PILING LOGS CI PERCOLATION TESTS CI
PLANS & SPECS CI SETS
Front
Back
Side
Side
BUILDING DEPARTMENT VALUATION
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
USE OF BUILDING
SURVEY
PLOT PLAN
CI COPIES
CI
TYPE OF CONSTRUCTION: I II III IV V
OccupancyGroup A B E F HIM R S U
Division 1 2 3 4
Amount Brought Forward . . .. .. .. .... ...... $
Park Support Fee ........................... $
SAC ......................................... $
Collector Street Fee ....................... $
Sewer Tap ................................... $
License Check Fee ......................... $
Pressure Reducer .......................... $
Meter Hom ................................... $
Water Meter ................................. $
City:
-;J ii' 95'
I ' ;)S'
Permit Fee ................................... $
Plan Checking Fee ......................... $
State Surcharge............................. $
Penalty ....................................... $
Septic System.. ............ ................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
Water Tap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
Paid Tota~t;.:..o6......~~~~i~~~0$3 9If f' 00
Date ~/-ol By ?K/
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 aUequested. This document when
signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy. a Certilicate of Occupancy must be issued.
Other ......................................... $
IJh,OO
Subtotal ............................... $
This Application Becomes Your Building Permit When Approved.
Date
By
Certnicate of Occupancy
Issued
Special Conditions n any
City Planner
Date
24 hour notice for all inspections 447-4230
DATE TIME
CITY OF PRIOR LAKE L'1:;r
INSPECTION NOTICE SCHEDULED ~ 5'jCt./ ,/1/
ADDRESS -5533 ~~Sh~
OWNER
CONTR.
PHONE NO.
PERMIT NO.
/-,3 79
o FOOTING
o FOUNDATION
o FRAMING
o I~LATIO~ J-
~NAL Otfl/-'"'"
o SITE INSPE TION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
COMMENTS:
J(}.vORK SATISFACTORY, PROCEED
(0- CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
~/l
(.../ -
Inspector:
Owner/Contr:
CALL 447-9850 F lR THE NEXT INSPECTION 24 HOURS IN ADVANCE.,
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYl
lNSNOTl