HomeMy WebLinkAboutBldg Permit 01-1021
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BUILDING PERMIT, L
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
1. DAT~
t// 7/~ /
DATE RECEIVED
CITY OF PRIOR LAKE
. 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
!55.BL/ C'J11f6A '7;'uJJ)...
3. LEGAL DESCRIPTION
II
'5Z"
I PID Z5-2-(P7- 01/'" 0
d~
LOT
B~
~/.J _
ADDITION
4. OWNER (Name)
.?" D /'11" IJ 12,4 A 5" C J-/
5. ARCHITECT (Name)
(Address)
/55 3 ~
(Address)
(Tel. No.) y'S';;> - 14. FLOOR AREA APPORTIONMENT USE
c/;41C'o/l '7/}. 5[, -r"l/) -7E.J5
(Tel. No.)
6. BUILDER
(Address)
(Tel. No.) 95;; -
707' t.,C;~,
1;;')'1'7 NI to LiEf /lv'f",5
Re-roofinS<l!( Porch 0
Re-siding 0 Finish Basement 0
(Name)
/!/J1[!f/[Il,'lI 8tJ/,Lj)1 Nt:? rotl/r~Il{1bR~
7. TYPE OF WORK
New Construction 0
Fireplace 0
Alterations 0
Septic 0
Addition 0
Deck 0
Finish Attic 0
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES
Sq. Ft.
9. PROPERTY DIMENSIONS
Width Depth
10. CULVERT SIZE
Yes No
~
I. White
2. Pink
3. Yellow
File
L'IY
Applicant
Permit No. 0/- / oz.-I
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
12. NO. OF STORIES
13. TYPE OF CONSTRUCTION
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
SEATS
16. PROJECT COSTNALUE
'$ 13, 9fis. ~
17. 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 m~nti ed property a at all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the
bUildinw' n rev~ll thi rmi r just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform{leedpd inspections.
X J' ~ \M -;)",0 (fJ Cf3 rg~ '1/fS/ty
v / . Signature License No. . Date
FOR ADMINISTRATIVE USE
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 Depos~ ............................ $
Other ......................................... $
-7/_, (.IZ)
Total Due .............................. $ / U"
Paid ~b. (f7) Rec~iPt~Cf) 4rJ585'
Issued I '
Date q,/ 1 ,() J By
This IS to certify that the request in the above application and accompanymg documents IS In accordance With the City Zoning Ordinance and may proceed requested. ThiS document when
Signed by the City Planner const~utes a temporary Certificate 01 Zoning compliance and allows construction to commence. Before occupancy, a Certnieat of Occupancy must be issued.
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
Division1234
Permit Fee................................... $
Plan Check Fee ............................. $
State Surcharge............................. $
Penalty ....................................... $
Plumbing Perm~ Fee ....................... $
S U
City:
'14. 7~
/. -z,~-
Mechanical Permit Fee ..................... $
Sewer & Water Perm~ ...................... $
This Appli i
By
Certificate 01 Occupancy
Cny Planner
Dale
Special Conditions H any
24 hour notice lor all inspections 447-9850
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
CITY OF PRIOR LAKE
INSPE;TION NOTICE
SCHEDULED
DATE TIME
/,tJ/;,ICJJ A ,7'-,
/
ADDRESS
/5~3~ ~ ~,
t/
CONTR.
OWNER
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION ~
o FRAMING
o INSULATION
'jZ[. FINAL .
o SITE INSPECTI N
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
COMMENTS: ~
Ilf~ ~
~
ol-/oz..r
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
t WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK'lj'LL FOR REINSPECTION BEFORE COVERING
Inspector: ~ Owner/Contr:
I
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
INSNOTl
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!