HomeMy WebLinkAboutBldg Permit 01-0829
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)
2. SITE ADDRESS
1(0361
1. DATE
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,.SJ-OCK 3 . _ PID ;)!; - ~:}-.). CJdf-{)
(tr-U~ !/:jjfr(// Llt;A
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4. OWNER (Na"\e) (Address) U (Tel. No.) ,\52-
Bnan JD\r\nSOIl 1~3b7 \/\C!.tO'\\2i tl}.~\J.e 441.11'\1
5. ARCHITECT (Name) (Address) (Tel. No.)
3. LEGAL DESCRIPTlj
LOT
ADDITION
(Name)
Re'(" DOt- A-m er I La
CD,<,pD'\atI6n
7. TYPE OF WORK
(Address) (Tel. No.) 9"52..-
<150'8 L'lnda.l~ ~e.5 cg't>S'"
81Domlnq+onkN S5L.f2D <844 D
SeptiC 0 Deck 0 Re-roofing 0 Porch 0
Addition 0 Finish Attic 0 Re-siding 0 Finish Basement 0
6. BUILDER
Fireplace 0
Alterations 0
New Construction 0
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES
Sq.Ft.
9. PROPERTY DIMENSIONS
10. CULVERT SIZE
Yes
No
Width
Depth
1. White
2. Pink
3. Yellow
BUILDING
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
12. NO. OF STORIES
13. TYPE OF CONSTRUCTION
\e 50 l c. \ f\q.....
14. FLOOR AREA APPORTIOffMENT USE
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
SEATS
16. PROJECT COSTNALUE
q \q~,5\
17. COMPLETION DATE
<=6-1-01
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 menti ed 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
:uildin . ia revo this p~urthermore. I hereby agree that the city Off~O i qi/4 to enter upon the property to P::5 r::..ie;:;oitions.
Signature License No. Date
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
Division 1 2 3 4
Permit Fee ................................... $
R S U
7'-(1)'
City:
Plan Check Fee ............................. $
State Surcharge ............................. $
Penalty ....................................... $
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
L / d-b
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 Hom ............................ ....... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
Water Tap ................................... $
Builder's Deposit ............................ $
Other ......................................... $ ,
Paid;p1~etiid.............~~~~i~;~O~ -?~,or.;
Date 1t-~1 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 aUequested. 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.
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
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDUI,.ED
DATE TIME
8'10-0/ ;;;: 3.e)
ADDRESS
)(P30~7 1/~~ ~,
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING 0 PLUMBING RI
o FOUNDATION 0 MECH RI
o FRAMING (lJ 0 WATER HO KUP
9rINSULATION 0 SEWER H KUP
~FINAL ;etm 0 PLUMBI FINAL
o SITE INSPECTIO 0 MECH I\L
COMMENTS:
"'~
'9-~ ")
c-,.c....,.4
-~....,.."'"'
o ( . D82--9
I
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
d WORK SATISFACTORY, PROCEED
/0- CORRECT ACTION AND PROCEED
o CORRECT WORK, C~ FOR REINSPECTION BEFORE COVERING
Inspector: ~ Owner/Contr:
CALL 447-9850 ~O~ iHE NEXT INSPECTION 24 HOURS IN ADVANCE..
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYl
INSNOTl