HomeMy WebLinkAboutBldg Permit 01-1142
QA]]; RF~~ 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. {) /-- J / Lf rr-
DIRECTIONS 1. DATE
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN ) /'11- I
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom) 0 ~~ . tJ BUILDING INFORMATION
2. SITE AD~SS _ 0, L' ) I 11. SIZE OF STRUCTURE
J.5'/~J (YJrtJJi lOti Rd13J..tJ I ~'I 9RIOK It/C~ /l1~~- )7H~9ht) (Width) (Depth)
3. LEGAL DESCRIPTION I / ...:::>-...J..... 12. NO. OF STORIES
/J f..p BLOCK (~ . PID ,...~5/~r;-5-00fo-O
(~~~.- kYtlq'-fJ
I ~.me) U. (f~ss) (Tel. No.)
/<.1 e.I'JT'7l, 16/$;2 fJ1AtJiinlA J-l1C (}S-2-
(Name) d (Address) (Tel. No.)
LOT
13. TYPE OF CO~RU TION
,ell/?" . R.e~F
14. FLOOR AREA' ORTIONMENT USE
~.~- 3~ '91:
ADDITION
4. OWNER
tvllR tot..
5. ARCHITECT
6. BUILDER (Namel. . (Address) I ^...., t . JI4 (Tel. No.) q 6:;2 -%-~5. NUMBER OF OCCUPANTS OR SEATS
fb~eJ( S1V( f1rJ~ ~ Afljf'.ll es 111/9 J-41II'C- V1;t lW'L q 8-S-- OCCUPANTS
~ c.. P. J 1~.~'''Slit.U!.. 1I!~7'?-'..2.. SEATS
7. TYPE OF WORK Fireplace 0 Septic"!J Deck 0 / - of II , 1So'rch 0
New Construction 0 Alterations 0 Addition 0 Finish Attic 0 Re- !nish Basement 0 16. PROJECT COSTNALUE
.$ J 0_ j.j 7 / . <97
17. COMj;LE"1 iol'. DATE .
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES
Sq.Ft.
9. PROPERTY DIMENSIONS
Width Depth
10. CULVERT SIZE
Yes
No
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
building offici I c rev ke this p.e. rmit for just caus . Furthermore, I hereby agree that the Cit1.jlficial or a designee may enter upon the property to perf~rm needed inspections.
X ~l\ - O'/-.,~- ~-PI-
Signature - -- Q L~nsINo~ DBte
FOR ADMINISTRATIVE USE
Front
Back
Side
Side
MATERIAL FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA 0
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS 0 SETS
SETBACKS: Required
Actual
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
Permit Fee ..........~~~~~~...1...~...~..~... $ -:J J/. 7<
City:
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
Plan Check Fee ............................. $
State Surcharge............................. $
Penalty ....................................... $
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
Jr a-S'
Gas Fireplace Permit ....................... $
Pressure Reducer .......................... $
Meter Horn ................................... $
WaterMeter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
Water Tap ................................... $
Sewer & Water Permit ...................... $
This Application Becomes Your Building Permit When Approved.
By Date
Builder's Deposit ............................ $
Other......................................... $ ,
Total Due .............................. $~ ..00
Certificate of Occupancy /7/ Pr1\ q I
Paid 10 r vl..I Receipt No. lIoltJ
Issued .
This is to certify that the request in the above application and accompanying documents is in accordance with the c~:;on~~ ~~:: ~!may pr::ed as r~his 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.
City Planner
Date
Special Conditions ~ any
24 hour notice for all inspections 447-9850
CITY OF PRIOR LAKE
INSPECTION NOTICE
OA TE TIME
SCHEDULED /1- ol ) -j If./
/ !) (3.?- maJrYU- 'K ct
ADDRESS
. , I
OWNER
CONTR.
PHONE NO.
PERMIT NO.
I-i /td;}--/
o FOOTING 0 PLUMBING RI
o FOUNDATION 0 MECH RI
o FRAMING (B) 0 WATER HOOKUP
o INSULATION 0 SEWER HOOKUP
P"FINAL 0 PLUMBING FINAL
o SITE INSPECTION 0 MECH FINAL
COMMENTSf(OOP
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
(J j 1J.4..e
)a'WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
'",pedoc ~! Ow...c/Co,"'
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSl'IOTI