HomeMy WebLinkAboutBldg Permit 01-1214
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
. DIRECTIONS 1. DATE
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN n j I
~EFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom) 7 /11/0 J BUILDING INFORMATION
2. SITE ADDRESS Ii J ~ -~ J -'. /i. A. . -../I n. L/ L _ It.. J ~ 11. SIZE OF STRUCTURE
. .., J6:"o ~ ~ / /. e... rJuc1~/tJ/JVv:::xJ Po _ (Height) (Width) (Depth)
PID 25-9.30 - fJM-O
! ......
10-25-0/
DATE RECEIVED
3. LEGAL DESCRIPTION
LOT
BLOl(lY' i __
_~t717
~
ADDITION
4.0~e)
5. ARCHITECT (Name)
/1 (Address)
1rl'd~
(Address)
9&;t~t/O-7Y18
(Tel. No.)
6. BUILDER (Name) (Address) (Tel. No.)
-f titJtl1w7J1Ihff- tt7!5~1?tJ,E.~J/fJnS53W W~s9o
7. TYPE OF WORK
New Construction 0
Fireplace 0
Alterations 0
Deck 0
Finish Attic 0
Re-roofing)f Porch 0
Re-siding 0 Finish Basement 0
Septic 0
Addition 0
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES
Sq.Ft.
9. PROPERTY DIMENSIONS
10. CULVERT SIZE
Width
Depth
Yes
No
1. White
2. Pink
3. YelIow
File
City
Applicant
Permit No. ~/ zL4:;-.
12. NO. OF STORIES I
13. TYPE5CONST UCTION
'1U--
14. FLOOR AREA Ii. PORTIONMENT USE
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
SEATS
16. P~O~CT CO~~VE
t$ , /} tJ35 · (TV
17. COMPLETION ~'TE / )
9k5/lJ/ ( ~
I hereby certify that I have furnished 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 entioned prop~~~~~at all construction will conform to all existing state and local laws and w.i11 proceed in accordance with submitted plans. I am aware that the
:u~ cial can r voke ~~Furthermore, I hereby agree that the Ci~~1 / ~s-~ 1 ~er upon the property to performlje;~r;ojtions.
V Signature License No. Date
FOR ADMINISTRATIVE USE
MATERIAL FILED WITH APPLICATION
Side SOIL TESTS 0 ENERGY DATA 0
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS 0 SETS
SURVEY 0 COPIES
PLOT PLAN 0
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
Pressure Reducer .......................... $
Meter Horn ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
Water Tap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
Total Due .............................. $
Paid Receipt No.
SETBACKS: Required
Actual
Front
Back
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:
?q7~
Plan Check Fee ............................. $
State Surcharge ............................. $
---
1.2--,)
Penalty ....................................... $
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... ~
Sewer & Water Permit ...................... !I'
Gas Fireplace Permit ....................... !I'
This APPIi4-~M v....-.ilding Permit V'tJ!!' -App~.9dJ
By 7<J1~uu Date II .~)-
Certificate of Occupancy
Issued
Date
7&.(/U
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 requested. This document when
signed by the City Planner constttutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy. a Certificate of Occupancy must be issued.
By
City Planner
Date
Special Conditions ~ any
24 hour notice for all inspections 447-9850
OA TE TIME
CITY OF. PRIQ,ft LAKE
INSPECTION NOTICE
ADDRESS
/LJ3S--S
SCHEDULED '!3Iaz,
~~,
A. T:.
OWNER
CONTR.
PHONE NO.
PERMIT NO.
~ I - 1."./1.{
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
/II FINAL
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:
~.
o
-""
K#fhf,.o~~
_A
(/~ ~-
1?L'- 7'fro -499 fIJ
~WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: ~ ~l Owner/Contr:
CALL 447~8;;JOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
.i
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYl
INSNOTl