HomeMy WebLinkAboutBldg Permit 01-0772
DATE RECEIVED CITY OF PRIOR LAKE
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)
f!A~T
7/1 M
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12.1S0
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3. LEGAL DESC11PTION I
LOT BLOCK
ADDITION ~. ~ J$d-
~. .
4.9WfJ":ER AI / }'la",). ~ (Address) /2 -I A .i_
:J/Ja&J~ 554c ~2fJJf;j ~ ML/J \~
(Address)
2.SI~69{)
(Tel. No.)
f/</7- (jf~ ~
5. ARCHITECT
(Name)
(Tel. No.)
6. BUILDER (Name) ~O /:;Y;I:c:h$j-:> (Address) 01~ (Tel. No.)
~f.~ a:,~~: DOC~"R1_"'~"Jo3'J~::/c/
New Construction 0 Alterations 0 Addition 0 Finish Attic 0 Re-sidin~ Finish Basement 0
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES
Sq. Ft.
9. PROPERTY DIMENSIONS
Width Depth
10. CULVERT SIZE
Yes
No
1. White
2. Pink
3. Yellow
File
City
Applicant
Permit No. 0/-77;)-
BUILDING INFORMATION
,
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
12. NO. OF STORIES
13. TYPE OF CONSTRUCTION
14. FLOOR AREA APPORTIONMENT USE
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
SEATS
16. PRO~95,TNALU~
- 1 7" /
17. COI?'LETION 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 mentioned property an at all construction will conform to all existing state and local laws and will proceed in accordance with submitted Pla,"~;lam i~:Z: that the
:Uildin9 ollicial can revoke is . ~~urthermore. I hereby agree that the city ollA ;;~igdrrY/JPon the property to pe~ 1i9"7~'
r Signature license No. I Ollfe
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee .... .. .. .. ... .... ...... $
Sewer Tap ................................... $
$
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 S U
Division 1 2 3 4 -.../f , / 1~
Permit Fee ................................... $ / .,....
City:
Plan Check Fee ............................. $
State Surcharge............................. $
Penalty ....................................... $
Plumbing Permit Fee ....................... $
/ - ().t:)
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
Pressure Reducer .......................... $
Meter Horn ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
Water Tap ........................ ..... ...... $
Builder's Deposit ............................ $
Other ......................................... $ (/ to rut:)
Paid Tot1~ ..:O.D.........~~~~i~;~O~ tlo I (p I1
Date 1'-Y3-0 I By r~
This is to certify that the request in the above application and accoinpanying documents is in accordance with the City Zoning Ordinance and may proceed as r~sted. This document when
signed by the City Planner constnutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy. a Certificate of Occupancy must be issued.
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
Special Conditions ~ any
24 hour notice for all inspections 447-9850
//.1;;~<;-
s-sro ~~S I c/
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
~ ....~AL
o SITE INSPECTION
COMMENTS:
.Il \ I
fL-e.5 j r!~ _
SCHEDULED
CONTR.
PERMIT NO.
CJI-77/
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EXIGRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
/! / /
Lo~//~ Ie...
/J/? //
I' (O,re- /'l(~
~ORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT W~R} .7VR REINSPECTION BEFORE COVERING
Inspector: j/t/[,// ~ Owner/Contr:
r
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
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