HomeMy WebLinkAboutBldg Permit 01-0559
DATE RECEIVED CITY OF PRIOR LAKE
(, . (, . 0 J 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 Ai5~e(3
3. LEGAL DESCRIPTION
LOT
ADDITION
4. ~NER
. -:J-er't-{
5. ARCHIn:CT
6. BUILDER
}(q5Tk
7. TYPE OF WORK
New Construction 0
(Name)
/11/ /I~
(Name)
(Name)
iA/oI
f
(!c:; l/Jl (//'
#v~
,uc
BLOCK
PID Z5-03S-0ro-O
(Address) (Tel. No.) 1S'Z- j
1<; S 6'.3 &/!mp r .fh- 1\l~ t/t/7- tj7l/t
(Address) (Tel. No.)
(Address)
(Tel. No.)
15/ Z - <j" 0.,-- '30 20
~r r 21q1'17r mfJ/<.
Fireplace 0 Septic 0 Deck 0
Alterations 0 Addition 0 Finish Attic 0
Re-roofingjD Porch 0
Re-siding 0 Finish Basement 0
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES
Sq.Ft.
9. PROPERTY DIMENSIONS
Width Depth
1 O. CULVERT SIZE
Yes No
12. NO. OF STORIES
13. TYPE OF CONSTRUCTION
14. FLOOR AREA APPORTIONMENT USE
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
SEATS
16. PROJECT COSTNALUE
//0':3 0
17. COMPLETION DATE
I hereby certify that I have furnished 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
building official can revoke ~it for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform ~eejed in)pections.
X /7 -?'~ '--:/ ~ -.T' .:;)~~ "5~r) 6' /<)/~
~~/ Signature - - ~icense No. . -!fate '
SETBACKS: Required
Actual
FOR ADMINISTRATIVE USE
MATERIAL FILED WITH APPLICATION
Back Side Side SOIL TESTS 0 ENERGY DATA 0
OFF STREET PARKING PILING LOGS 0 PERCOLATION TESTS 0
SPACES REO. PLANS & SPECS 0 SETS
SPACES ON PLAN SURVEY 0 COPIES
PERMIT VALUATION ~~ SIJlJ fU PLOT PLAN 0
USE OF BUILDING
BUILDING DEPARTMENT VALUATION
Front
~mlL
I
TYPE OF CONSTRUCTION: I II III IV V
Occupancy Group A B E F HIM R S U
7~' 7";-
Division 1 2 3 4
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
SewerTap ................................... <t_
$
City:
Permit Fee ................................... ~,
Plan Check Fee ............................. $
I.z-~
State Surcharge ............................. $
Penalty ....................................... $
Plumbing Permit Fee ....................... $
Pressure Reducer .......................... $
Meter Hom ....... ......... ............ ....... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
WaterTap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
Mechanical Permit Fee ..................... il:
Sewer & Water Permit ...................... $
OM ~.................... .
This A I' n;lvour Building Permit When Approved.
By Date
Certificate of Occupancy
Total Due .............................. $ '7 ~ . () c)
/ -
Paid ':1 ~ . cn./ ReceiPt~fI.3RfL e /
Date · t . {,. e> I 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 proceJa~ requested. This document when
signed by the City Planner constnutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certifi~e of Occupancy must be issued.
Issued
City Planner
Date
Special Conditions ff any
24 hour notice for all inspections 447-9850
T' ,
ADDRESS
I ~ sk 3
DATE TIME
,..--
SCHEDULED 7-/,,)-0/ lEI,
(kd~
CITY OF PRIOR LAKE
INSPECTION NOTICE
OWNER
CONTR.
PHONE NO.
PERMIT NO.
/- 551
o FOOTING 0 PLUMBING RI
o FOUNDATION 0 MECH RI
o FRAMING M WATER HOOKUP
o INSULATION a AI 0 SEWER HOOKUP
~AL OV 0 PLUMBING FINAL
. 0 SITE INSPEC ION @ 0 MECH FINAL
COMMENTS:
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
~'.'A-;;';-:~-".:.-;::' .....f.. --'-,~
/. !!)~_ ~f,~~
/..~""-~ .'
)4 WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WOR'lfALL FOR REINSPECTION BEFORE COVERING
Inspector: ~ I Owner/Contr:
,
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTI
"-T'" .