HomeMy WebLinkAboutBldg Permit 01-1094
QATE R~
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
1. White
2. Pink
3. Yellow
File
City
Applicant
/o-z-{) l
Permit No.
01- (~tl~
. DIRECTIONS 1. DATE --1.
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN ./'
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom) / /) . () j- tJ / BUILDI~FO~MA TION
2. SITE ADDRESS . J A J '"' 1/ \ 11. SIZE OF STRUCTURE
.Jb~ ,/ $ V; Cf 7>R.,'fA Cf..1 rQ (/L...s. E I;; j((f<.~J(. fl\d':-"<t;,~~r;ght) (Width) (Depth)
3. LEGAL DESCRIPTION /' I /--:J 3:::; _ C:/3 I "12. NO. OF STORIES
LOT ~ lBLOCK 1 Lf PID J ~
I'} /J ~ r /')// ,) -t} J i. t.P. -' z-TJ--.-, 13. TYPE OF CONSTRUCTION
ADDITION .- ,itA <t-</HY~,- ~L.:.:::::....=:)
4. OWNER (Name)" - 1(,37s:..1I,'~sJ,i1J CtJ~tlc..S, It.. (T. eI.No.) '1S~~ 14. FLOOR AREA APPORTIONMENT USE
Jo ~ tJJfr& ,7 t# . 'P tl.-t ..\ 8^ f...1t k t:J 1-11 "-I,~""7"" '\.2.;liJ
5. ARCHITECT (~me) (Address).1 ~ (Tel:No.)
6. BUILDER,/ (Name~ . (Address) A..,....,.. 0 . leI. No.) 'j.s~ r.:15. NUMBER OF OCCUPANTS OR SEATS
Bj,IJ/1t.",':;TCRi\tJ. to..;.r~<Po. /19/9 L~~lI5r~. 9~~ ' .... OCCUPANTS
RlJ.J~..~ roJ,C't" ?]'''/ SEATS
~ptic 0 Deck 0 I :r~1i~0.tnW Porch 0
Addition 0 Finish Attic 0 Re-siding i:f~ Finish Basement 0 16. PROJECT COSTNALUE
~.~. 7_~.7. '1;)....
17. COMPLETION DATE
/0 - (i) ,/~O/
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~bo e 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
bull 'nit 2!,fi<j}l1 c~voke this permit for i\Jst cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to pe~r~eded i7pections.
X ...;J\.. ~ ~/\ ..r 26 7 ~ -LLI A.' () .;;)..(J 0/
... Signature - License No. Date..... ,
7. TYPE OF WORK
New Construction 0
Fireplace 0
Alterations 0
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES
Sq.Ft.
9. PROPERTY DIMENSIONS
10. CULVERT SIZE
Width
Depth
Yes
No
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
MATERIAL FILED WITH APPLICATION
Front
Back
Side
Side
SOIL TESTS
o ENERGY DATA
o
BUILDING DEPARTMENT VALUATION
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS 0 SETS
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
City:
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
Division 1 2 3 4
74-. 7~
Permit Fee ................................... $
Plan Check Fee ............................. $
State Surcharge ............................. $
Penalty....................................... $
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
(. 7./,$-
Sewer & Water Permit ...................... $
Pressure Reducer .......................... $
Meter Hom ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
Water Tap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
Paid T~~~ .(jV...........~~~~i~;.. $
Date 10. 2,..() t By!J
1') (, . oV
~4-7
{
Gas FirePlac~e Permit .... .................. ~
This APPIJ.cz Ullding Permit When Approved.
By !{) Date 10 . ~()'
Certificate of Occupancy
Issued
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 equested. This document when
signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate Occupancy must be issued.
City Planner
Date
Special Conditions ff any
24 hour notice for all inspections 447-9850
DATE TIME
CITY OF PRIOR LAKE
IN:5P!:CTION NOTIC!:
:5C..rEDULED
to.S -0 I Ih T.
ADDRESS
OWNER
/~375 VIf!.AoJUA Ouell6
CONTR.
PHONE NO.
PERMIT NO.
) - /094-
o FOOTING
o FOUNDATION
o FRAMING @)
o INSULATION
FINAL
~ SITE INSPECTI0r..
COMMENTS: ~
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FI AL
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
- "
f!,{
~ WORK SATISFACTORY, PROCEED
/0 CORRECT ACTION AND PROCEED
o CORRECT W!iALL FOR REINSPECTION BEFORE COVERING
Inspector: I Owner/Contr:
CALL 447_9~~OrF R THE NEXT INSPECTION 24 HOURS IN ADVANCE..
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYl
INSNOTI