HomeMy WebLinkAboutBldg Permit 01-0998
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QAIf 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
Permit No.OI-Ot1q~"
DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
1. DATE
9 -/.p - () I
Prto r LC1--K~
PIDd5"- [Jftp- ()Og-()
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
2.S;&:;iE90 p~ Ave I
3. LEGAL DESCRIPTION
LOT I~ ^ ~/IB~O~~/_
ADDITION IJ)UJ~
4. O~NER ~me)
~6'hn ~~a....u-f' ~
5. ARCHITECT (Name)
s.
"
12. NO. OF STORIES
PIU-/l../
13. TYPE OF CONSTRUCTJRN
f2~ ro-o r
14. FLOOR AREA APPORTIONMENT USE
(Address)
~
(Address)
L/47e~N/03 3
(Tel. No.)
(Tel. No.) c?SZ-L '
rr3'-1ij n-/-K~3#l-
6. BUILDER (Name) (Addriss)
S-u..hl...~.-r I:.o-c-. ~~ ~ "o-T"SJ Yl c.. ·
"1 ""' (, t,c;bs JU'^;j '/ ~ d A-tr -t'. ~ 'J 'C, P.
7. TYPE OF WORK Fireplace 0 Septic 0 Deck 0
New Construction 0 Alterations 0 Addition 0 Finish Attic 0
Chimney 0 Misc.
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
SEATS
Re-roofing ~orch 0
Re-siding 0 Finish Basement 0
16~OiEfT COSTNA.LUY
y- ~ 91./ l...f I CJ ()
17. COMPCETION DATE
8. PROPERTY AREA OR ACRES 9. PROPERTY DIMENSIONS 10. CULVERT SIZE
Sq. Ft. ;2." S Q.. Width Depth Yes No
I hereby certify that I have furnished information on this application which is to the best of rny knowledge true and correct. I also certify that I am the owner or authorized agent for
the above ntioned 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
:Uild' al ~an reV:ke p~r;;~,;::;urthermore, I hereby agree tha,c;;.?;aIJt!!/inee may enter UPo~i o;;lrty to P:9 n":ed(; irv::(~/L
Signa ure ./ Lice~ / Date
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
MATERIAL FILED WITH APPLICATION
SOIL TESTS
o ENERGY DATA
o
Front
Back
Side
Side
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS 0 SETS
BUILDING DEPARTMENT VALUATION
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
USE OF BUILDING
SURVEY
PLOT PLAN
o COPIES
o
TYPE OF CONSTRUCTION: I II III IV V
Occupancy Group A B E F HIM R S U
Division 1 2 3 4
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... :I;
Sewer Tap ................................... $
$
City:
7] U~ ~~
J' ~:s-
Permit Fee ................................... $
Plan Check Fee ............................. $
State Surcharge ............................. $
Penalty ....................................... <1:.
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 ....................... $
Water Tap ................................... $
Builder's Deposit ............................ <I:
Other ......................................... $ '"
r;& .(7U
Total Due .............................. $
paidif ? t, ,00 Receipt No.
Issued Date q-II-o' By r~
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 as rItu~sted. This document when
signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy. a Certificate of Occupancy must be issued.
This Application Becomes Your Building Permit When Approved.
By Date
Certificate of Occupancy
City Planner
Date
Special Conditions ff any
24 hour notice for all inspections 447-9850
ADDRESS
Ib;;"Q{)
DATE TIME
SCHEDULED /6 r36-l J4.-r
cfJ 0AJu ~
CITY OF PRIOR LAKE
INSPECTION NOTICE
OWNER
CONTR.
PHONE NO.
PERMIT NO.
J-qq<g'
o FOOTING
o FOUNDATION
o FRAMING
o INSULA TIO~ .f'V') F
~INAL r'\.V'-'
o SITE INSPECTION
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 GASLlNE AIR TST
o
COMMENTS:
(' .f~* J'L
'Iji WORK SATISFACTORY, PROCEED
10 CORRECT ACTION AND PROCEED
o CORRECT WOi: CALL FOR REINSPECTION BEFORE COVERING
Inspector: ~ Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.,
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTI