HomeMy WebLinkAboutBldg Permit 01-0986
r' r" '; DI\J:t;:REC~'H;> CITY OF PRIOR LAKE
kill) ft ~ti'TEMP~~~~~N;E~~R~~~TE 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 \ S" ~ 15 t-.r-e~V^CN\\- f\ve ~)W
1. DATE
~ {~\ /6 \
3. LEGAL DESCRIPTION ( i
LOT 1 , B~OCK.
ADDITION ~ \~ ()
I
>>M.J
4. OWNER (Nam~ , (Address)
S~\I\~\t..1/\ ~~c:,\V'-\( S~\M.,~
5. ARCHITECT (Name)
PID
Lf1ft..-
'1..\- 2~ -{jOrj-D
(Tel. No.)
(\~ ~~D-~l\?17
(Tel. No.)
(Address)
6. BUILDER
(Name)
(Address)
(Tel. No.)
C.~~1107 -G{\~
tlH'Y\C,V\\\p Mt-J
Re-rOOfing~ Porch 0
Re-siding 0 Finish Basement 0
~i"\~r,CM^- ~v~tv\,", r9""~(,~t;
7. TYPE OF WORK )Fireplace 0
New Construction 0 Alterations 0
\1.~,""l 'IJ.w\\et~!I
Deck 0
Finish Attic 0
Septic 0
Addition 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
Qty
Applicant
Permit No.
o/-Oqg(p
,
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. PROJECT COSTNALUE
nr. ~O(7 - cO
fl. COMPLETION 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 meJeon,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
~Uilding officia~~ ~v::s permit for just cause. Furthermore, I hereby agree that t~ cc) \ff~q ~ ~~nee may enter upon the property to pertoi r~~i~ns1ections.
'- Signature Licanse No, Date
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee .. .. .. .. .. .. . . .. .. .. ... $
Sewer Tap ................................... $
$
Pressure Reducer .......................... $
Meter Hom ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
Water Tap ................................... $
Builder's Deposit ............................ $
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
Division 1 2 3 4
Permit Fee ................................... $
S U
City:
7'-1.7>
Plan Check Fee ............................. $
State Surcharge ............................. $
Penalty ....................................... $
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
(.2 r--
Sewer & Water Permit ...................... $
Gas FirePlac~permi . ...... ... ........ $ _
This Applicati IIdlng Permit When Approved.
By. Date
MATERIAL FILED WITH APPLICATION
SOIL TESTS
o ENERGY DATA
o
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS 0 SETS
SURVEY
o COPIES
o
PLOT PLAN
Other ......................................... $ r 7.
Total Due .............................. $ /'f 1!7' crv
Certificate of Occupancy -'1/ _ A ) LJ.., J
Paid / \Q . U' v Rece/L,pt 0 M 7 v'5 ti3
Issued
Date ~-O 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 proceed asl~uested. This document when
signed by the City Planner const~utes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate 6t Occupancy must be issued.
24 hour notice for all inspections 447-9850
Special Conditions ff any
City Planner
Date
DATE TIME
.Jb~A,5 -
./)"yZ] //eftf&~/~e
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
~INAL
o SITE INSPECTION
COMMENTS:
('
&'/"0 r
SCHEDULED
CONTR.
PERMIT NO.
-.tJ/- 9R6
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
./"" ./ /
&~#/e- T~
/
~-----'---_. ~
/~ ..,., .I "",,),.
( ~ ~ --5' -e /::",' /::?
~OR~TORy.PROCEED~
o CORRECT ACTION AND PROCEED
o CORRECT WORK, C~~~REINSPECTION BEFORE COVERING
Inspector: H,~ Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTl