HomeMy WebLinkAboutBldg Permti 01-1228
DATE RECEIVED CITY OF PRIOR LAKE
/o...29...tJ / BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
..
1. White
2. Pink
3. Yellow
Permit No. ()/-I
DIRECTIONS 1. DAZ
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN I I tI.
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom) I 0 ~ l' 0 BUILDING I . .. ./~TION
2.SITEAD~ESS ~ /I.. - J L' I.' ,() ... V L A I 11.SIZEOFST.R.U.0" E
~ q~ -W A ~ . ~ -..:), UJ' r'Mb't ~ I m IV (Height) ~) (Depth)
3. LEGAL DESCRIPTION '$5"3 '7:J... _ 12. NO. OF STORIES
LOT I - U ~ tv BLOCK 0 PID 2.5-/33 - tJOPJ-tJ 02...
ADDITION A jlA~9 (~t:eh-e ietUJ1../ -
/1WLdlel.p;5a-wIJ-t$~
(Tel. No.)
-
5. ARCHITECT
(Name)
(Address)
6. BUILDER (~ame) . (Address) _ (Tel. No.) 9'5"Dl.-
-(tdiJL~ 9155" ~UrrdPJ~II//IJ$3'1j'7'1ItA59tJ
7. TYPE OF WORK Fireplace a Septic a Deck a Re-roofing 0' Porch a
New Construction a Alterations a Addition a Finish Attic a Re-siding a Finish Basement a 16. PROJECJ. CjOST N ~I\
Chimney a Misc. :IJ .S' 91.6: av
8. PROPERTY AREA OR ACRES.. 9. PROPERTY DIMENSIONS 10. CULVERT SIZE 17. COMPLETI9N DAJE
Sq. oR. d-q~.~ Width Depth Yes No ~, II/;:L/O J
I hereby certify that I Wave fumished4nformation 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 property a 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' ial can rev ke is it or ju t cause. Furthermore. I hereby agree that the city ~~/ 2;?5e~1 e:d)er upon the property to perlo;; 7JJ..~7ois.
Signature License No. ~ Date
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
SEATS
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
Front
Back
Side
Side
MATERIAL FILED WITH APPLICATION
SOIL TESTS a ENERGY DATA a
PILING LOGS a PERCOLATION TESTS a
BUILDING DEPARTMENT VALUATION
USE OF BUILDING
.
tce.J ~;?
I
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
2,500. 00
PLANS & SPECS a
SURVEY a
PLOT PLAN a
SETS
COPIES
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:
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC .........................................$
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
7'~. 7~
Plan Check Fee ............................. $
State Surcharge ............................. $
Penalty ....................................... $
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
--
/. L-J
Sewer & Water Permit ...................... $
Pressure Reducer .......................... $
Meter Hom ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
Water Tap ................................... $
Builder's Deposit ............................ $
Other......................................... $
Gas Fireplace Permit ....................... $
This APPIi~~/.JYour R.JilAing Permit 111 ;'-Pr:vO'iJd.:()
By ::J'(T I~ Date t./! I
Certificate of Occupancy
Issued
Total Due .............................. $
Paid 7 b . oV Receipt
Date lo.d-'f.o J By /j
-
"7h.rJV
. 7ft2 "1
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordina~ and may proceed requested. 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.
City Planner
Date
Special Conditions ff any
24 hour notice for all inspections 447-9850
cm:-OF PRIOR LAKE
INSPECTION NOTICE
DATE TIME
SCHEDULED
I;;'J~).cJz.. P .-1.
ADDRESS
2 950 / C~ eG (!,./ e....- ,
OWNER
CONTR.
PHONE NO.
PERMIT NO.
01-/2-2.8
o FOOTING
o FOUNDATION
o FRAMING
~NSULA TION
~~INAL !e.,ooF=
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:
R.rmj ~ ~
~~
"fJ WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector:
~,
~
Owner/CDntr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTl