HomeMy WebLinkAboutBldg Permit 01-0964
DATE RECEIVEQ
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
1. White
2. Pink
3. Yellow
File
City'
Applicant
9-5-01
Permit No.
0/ -09to4-
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. DATE
q- S - (5 (
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
3. LEGAL DESCRIPTION
LOT /li+ /6
153f{ ~(~Z'Y QlV\~
Y {)f, p+ 00 Ii
BLOCK
~C)/)~iA
eo
12. NO. OF STORIES
ADDITION
PID Z,!"5 'OU-
?/?~
r? ' (Addres!if /
\'-l \(VY}QIi'\V\ ~
(Address)
/169-0
4. OWNER I J J _ (Name)
l,AP-{{ I\.fL
5. ARCHITECT (Name)
(Tel. No.)
tl5Z- ZZv;; - L.(e,70
13. TYPE OF CONST~TION
P" 101"l~
14. FLOOR AREA APPORTIONMENT USE
f I
(Tel. No.)
~Jf'JN&i' ;;-:F"~E:Ul~':;' "...
(Name) 4100 EXC~t~~OR BLVD.
ST. LOUIS PARK, MN 55416
10 #OOO105{, . ~ ~ 8~.tc..J ~
7. TYPE OF WORK Fireplace 0 Septic 0 Deck 0 Re-roofin~ Porch 0 -
New Construction 0 Alterations 0 Addition 0 Finish Attic 0 Re-siding 0 Finish Basement 0
ChimneyO Misc. :r;,s~a.d ~..IA) -if ( ~llWPAA a.~ hc......d "'Pr:~ &til.d';NYI sh...ks
8. PROPERTY AREA OR ACRES 9. PROPERTY DIMENSIONS 10. CULVERT SIZE 5' 0
Sq. Ft. Width Depth Yes No <-<:'9 (hvr-e...
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
:uilding Offi? flAe thir'::a:aLus/~erm.::: I hereby agree that the city official or a ;e;::n~aoter upon the property to perfoq:~ insPc;:oi'
./ . ~nature - l..--"'"" / - LiCense No. -Date ,
6. BUILDER
(Tel. No.)
cf$z.-~3 - 'gc;<f(o
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
SEATS
16. PROJECT COSTNALUE at:>
.($ ZZ( rooo,
17. COMPLETION DATE
9-- or
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
Front
Back
Side
Side
MATERIAL FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA 0
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS 0 SETS
BUILDING DEPARTMENT VALUATiON
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
SURVEY
PLOT PLAN
o COPIES
o
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
City:
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Permit Fee ................................... $
74.7r
State Surcharge ............................. $
/. z. J"-
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
Plan Check Fee ............................. $
Penalty ....................................... $
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
Pressure Reducer .......................... $
Meter Horn ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
Sewer & Water Permit ...................... $
Gas Fireplace Permit ....................... $
This APPlicJt~r/vour Buildin2!erm~ When .AEP-~O,d'l
By ~I' Date" >
Water Tap ................................... $
Builder's Deposit ............................ $
Other......................................... $ r, , )
Total Due .............................. $ 7ft,. ()~
Paid 7t .Ot) Recei~~r/,4 ~:rY
Date q-_~. d / By/!ft<-/
This is to certify that the request in the above application and accompanying documents is in accordance with the City zonfng Ordinance and may proc~s requested. This document when
signed by the City Planner const~utes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a CertificLe of Occupancy must be issued.
Certificate of Occupancy
Issued
City Planner
Date
Special Conditions ~ any
24 hour notice for all inspections 447-9850
..ITY CF PRIOR LAKE
:NSPEC-nON NOTICE
SCHEDULED
ADDRESS
/5311
fStle c..L 1
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION ~
o FRAMING
o INSULA TWN
FINAL ~
~ITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
COMMENTS:
.?
(~~/~~
1......,/<
';".
I'
DATE /
17-~~L
4-'
TIME
A.T
el-9~'f
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
tI WORK SATISFACTORY, PROCEED
fu CORRECT ACTION AND PROCEED
:'::O:ECT ~: FOR REINS:::,:::FORE COVERING
,
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
INSNOTl
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYl