HomeMy WebLinkAboutBldg Permit 01-1281
DATE RECEIVED
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
i 70' C ,)
.u, 114ur
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1. White
2. Pink
3. Yellow
File
Oty
Applicant
//- If
Permit No.
t)/-I Ze/
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 " I J I '''7 "-'1 ' I --I O'
j '-f <o&~) '(5. Ul b lIre r(l.L.l /liE
3. LEGAL DESC~ON U
LOT BLOCK k//{){) ,_
ADDITION Q [)
1. DATE
11- cY-O/
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
12. NO. OF STORIES
4. OWNER .\ (Name) '(
l\ I (1 I'YtR D CL
5. ARCHITECT (Name)
, (Address)
S t YU rYj I'Yj e...-
(Address)
tfJ~.:: '.: ! /
(Tel. No.)
';/ln1l /Jj) aft:w )UJ -//1:.,-lS-7&
(Tel. No.)
'. _I
<~ ~ C~:;
13. TYPE OF CONSTRUCTION
14. FLOOR AREA APPORTIONMENT USE
6. BUILDER
(Name)
(Address)
, , !\
~VJ~l {)(t{J 1\V-t
SEATS
16. PROJECT COSTNALUE
k.lJU0~/\r/J;,'~\ reA Ce.--l I) . qc; ()~
7. TYPE OF WORK Fireplace 0 Septic 0
New Construction 0 Alterations 0 Addition 0
''1{j ~) 6)
Deck 0
Finish Attic 0
(Tel. No.) (.1)J -V,j
("11.,' ;)/,-' Y v
tv' J
; !' C(C;f.lrYlnCith-r:",
Re-roofingJl( Porch 0 .J
Re-siding 0 r Finish Basement 0
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES 19. PROPERTY DIMENSIONS 110. CULVERT SIZE
Sq. Fl. Width Depth 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 locai laws and will proceed in accordance with submitted plans. I am aware that the
building officiaJ ca,n~!1.lv9,ke1hi\yp~rmit f~~ just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed insp';Ctions.
X ';~~..J,r f::'Jrt/()1:) .L,./'J :fI ;; () /4/ (,1 / 0 / 1- 7 - c I
Signkture License No. Date
17. COMPLETION DATE
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
Front
8ack
Side
Side
MATERIAL FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA 0
PILING LOGS 0 PERCOLATION TESTS 0
BUILDING DEPARTMENT VALUATION
USE OF BUILDING
." ~I-'" l._"'
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT V ALUA TION
PLANS & SPECS 0
SURVEY 0
SETS
COPIES
_:.j.
,~ ."
, ,
" ,:_J
PLOT PLAN
o
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 ................................... $
$
,
. ,if. /
.,
l .
Plan Check Fee ............................. $
State Surcharge ............................. $
Penalty ....................................... $
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
,
,
'-
"
Pressure Reducer .......................... $
Meter Hom ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
Water Tap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
Sewer & Water Permit ...................... $
Gas Fireplace Permit ....................... $
This Application Beromes~~ur Building Permit Whel) Approved.
I t -,i"'" I! -'
By ,'~ I... " .--.. Date , I I"
Certificate of Occupancy
Total Due .............................. $
Paid ' ,/ 1/ {) Receipt No.
" ,/- /' ! /
Date - I -. io/: By, l
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~' 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.
",~ ~~. .(, <j
Issued
:~:/</).~/,,-
City Planner
Date
Special Conditions ij any
24 hour notice for all inspections 447-9850
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
/~ G (p 3
SCHEDUioED 111/6(01
~~
A.r,
OWNER
CONTR.
PHONE NO.
PERMIT NO.
(j( - / ;;).f'(
o FOOTING
o FOUNDATION(@
o FRAMING
o INSULATION
~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: ~
~ WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
K, CALL FOR REINSPECTION BEFORE COVERING
Inspector:
Owner/Contr:
OR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYl
INSNOTl