HomeMy WebLinkAboutBldg Permit 01-0466
DATE RECEIVED CITY OF PRIOR LAKE
BUILDING PERMIT,
TLI)IIPORARY 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)
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I ! RJ5lJ
2. SITE ~DDJ~S . -" A I! ~ ~ _ 1 II r:
I Lt-o ! (' '---//J #LIa. r U!U-I' ~).r..-
;
3. LEGAL DESCRIPTION
.~
BLOCK, f)'
~JW(JJ
PID -;2c;/ 1~:~/-O
&lU'~ -
(Tel. No.)
9'S-.,) -C/.-f/) -6e}..j /
(Tel. No.)
LOT
ADDITION
4. OWNER (Name) (Address)
GbJ ?tst./LJ IrflK J /?J1lfb ~~\~
1ARCHITECT (Name) (Address)
~JL~
~
f/p<;~PJ X:Mf (Address)
fJ{)fj/PI.R"? f)JifA '7nA,) 5~ ~ bq
7. TYPE OF WORK
(Tel. No.)
7b3-"99/ -S1 / <I
Fireplace LJ
Alterations LJ
Septic LJ
Addition LJ
Deck LJ
Finish Attic LJ
Re-rooflng LJ Porch LJ
Re-sidin~ Finish Basement LJ
New Construction LJ
Chimney CJ Misc.
8. PROPERTY AREA OR ACRES
Sq.Ft.
9. PROPERTY DIMENSIONS
Width Depth
1 O. CULVERT SIZE
Yes No
1. White
2. Pink
3. Yellow
File
City
Applicant
Permit No. C2J - OLf b fe..-
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
12. NO. OF STORIES
7....
13. TYPE OF CONSTRUCTION
14. FLOOR AREA APPORTIONMENT USE
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
SEATS
16. PROJECT COSTN ALUE _-" '\
/.J( b 7l-V'u
17. COMPL€TION DATE
I hereby certify that I have fumished 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 t all construction will confonn to all existing state and local laws and will proceed in accordance with SUbmitledf~~ am awa. re that the
:uilding official can revoke is ~e j 0 ju use. Furthennore, I hereby agree that the city 0~~2 d~:J1a17r upon the property to perf~l~.erions.
/' 'Signature License No. ( Date
Amount Brought Forward .................. ~
Park Support Fee ........................... ~,
SAC ......................................... $
Collective Street Fee ....................... ~
Sewer Tap ................................... $
$
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
Front
8ack
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 S U
City:
Division 1 2 3 4
Pennit Fee ................................... $
-v!, jt;'
Plan Check Fee ............................. $
State Surcharge............................. $
Penalty ....................................... $
II~~
MATERIAL FILED WITH APPLICATION
SOIL TESTS LJ ENERGY DATA LJ
PILING LOGS LJ PERCOLATION TESTS LJ
PLANS & SPECS LJ SETS
SURVEY
PLOT PLAN
CJ COPIES
LJ
Plumbing Pennit Fee ....................... $
Mechanical Pennit Fee ..................... $
Pressure Reducer .......................... $
Meter Hom ................................... ~,
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
Sewer & Water Pennit ...................... $
Gas Fireplace Pennit ....................... ~, Water Tap ................................... $
This Application Becomes Your Building Pennit When Approved. Builder's Deposit ............................ $
By Date Other ......................................... ~ . W
Certificate of Occupancy Paid Tota:!JU~..gg;.""'" "~~~~i~: ~o~-#i D~
Issued
This is to certify that the request in the above application and accompanying documents is in accordance with the c~:;or:(n~e:~ lay pr~ .(~. This document when
signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certifica:~::~cy must be issued.
City Planner
Date
24 hour notice for all inspections 447-9850
Special Conditions H any
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
. ,
ADDRESS
1~f7P's ~
I
CONTR.
OWNER
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION /!)\
~FINAL ~
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
COMMENTS: tt~
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rt>- ~ t-:R q') ')
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DATE TIME
'lit/a I
;{.(-,
I ft!-,
o ( ,... Lf' ~
o EXIGRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
~WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector:
Owner/Contr:
~i
...... I
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE..
INSNOTI
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYl