HomeMy WebLinkAboutBldg Permit 01-1176
DATE RECEIVED
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
1. DATE
! 0 - 15-<> l
2'~qrQESS c.ROSSAtJMA
3. LEGAL DESCRIPTION
ST
SL
LOT
ADDITION
4. OWNER (Name)
WlLL.1 A"" ":f
5. ARCHITECT (Name)
BLOCK
PID
b~lJtJ[lddre~ Iii c.ROS5ANIfA (qsjj~47-J308
(Address) $'r" (Tel. No.)
6. BUILDER
(Address)
(Name)
(Tel. No.)
WtLL\A.k T ~AtfJN~~ Y"~
7. TYPE OF WORK Fireplace LJ Septic LJ Deck LJ Re-roofing LJ ~h LJ
New Construction LJ Alterations LJ Addition LJ Finish Attic LJ Re-siding LJ Finish Basemenprl..
Chimney LJ Misc.
8. PROPERTY AREA OR ACRES
Sq.Ft.
9. PROPERTY DIMENSIONS
10. CULVERT SIZE
Width Depth
Yes No
1 White File
/1) t::... J i: Pi~ City
I\..OCe~(...v 0-3. Yellow Applicant
10- 1 f- ()/
Permit No. 0/- //71:>
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
12. NO. OF STORIES
13. TYPE OF CONSTRUCTION
14. FLOOR AREA APPORTIONMENT USE
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
SEATS
16. PROJECT COSTNALUE
17. COMPLETION DATE
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
bulldinll ~fflllltil rfrtrrvoke this pe~or j~se. Fuf!l19rmore, I hereby agree that the city official or a designee may enter upon the property to perform need~lnspections.
X V\.l:..v~ II \..!.)~~ 10-1 -01
S~ License No. Date .
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
Pressure Reducer .......................... $
Meter Hom ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
Front
Back
Side
Side
BUILDING DEPARTMENT VALUATION
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
/,t'XJiJ .Or?
USE OF BUILDING
TYPE OF CONSTRUCTION: I II III IV V
Occupancy Group A B E F HIM R S U
City:
Division 1 2 3 4
3q.7~
Permit Fee ................................... $
Plan Check Fee ............................. $
State Surcharge............................. $
Penalty ....................................... $
.S-o
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
Sewer & Water Permit ...................... $
:z:J;:tl21;~;~;:,:.;':.~~
BY~ Date-!t/- y
Certificate of Occupancy
MATERIAL FILED WITH APPLICATION
SOIL TESTS LJ ENERGY DATA LJ
PILING LOGS LJ PERCOLATION TESTS LJ
PLANS & SPECS LJ SETS
SURVEY
PLOT PLAN
LJ COPIES
LJ
Water Tap ........... ........................ $
Builder's Deposit .~........ "&'Ar~ $
Other ............... ... ..~........ $
Total Due.... ..:~J.......... $ .~~ ,;::).~
Paid ;17.~ I;;!C:; Receipt No. LJO'7a.- S
Issued - J .
Date It!> --/9-0 By c;yy
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 a~u~ed. 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
24 hour notice for all inspections 447-9850
Special Conditions ~ any
White - Building
Canary - Engineering
Pink - Planning
The ('f'nlf'r of Ihl' take ('ounlry
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
,
,
NAME OF APPLICANT ~/~ ~
APPLICATION RECEIVED J 0- I~-O~.
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is propa ed at:
1M-
Accepted With Corrections ^
v
,!) 9 ILI-
Accepted
Denied /)/712 (l
Reviewed s..,(ftr/ -j~.
Comments:
Date: J /) -I ~.. 200 (
,
~ ~ ~ ~ -:,?~~~_ ~
"The issuance or granting of a permit or approval of plans, specifications and
computations shall not be construed to be a permit for, or an approval of, any violation of
any of the provisions of this code or of any other ordinance of the jurisdiction. Permits
presuming to give authority to violate or cancel the provisions of this code or other
ordinances of the jurisdiction shall not be valid."
PRIOR LAKE
INSPECTION RECORD
DEPARTMENT OF
BUILD1NG AND INSPECTION
. .
SITE ADDRESS 6~'t
NATURE OF WORK HIAI~~ n) ~
USE OF BUILDIN~D....-L
PERMIT NO. _ ~DATE ISSUED IO-lB-'2co(
CONTRACTOR - ..... PHONE <f!i!)- 1!3..08
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR
DATE
I
I I
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING
INSULATION
ELECTRICAL
{PI;
. HEATING (if required)
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
I I
FINALS
BUILDING
ELECTRICAL
Wi
J - / }; --fP:,
HEATING
DO NOT
Vl.I0' /,.. 2 f /{)'>
OCCUpy UNTIL ABOVE HAS BEEN SIGNED
NOTICE
This card must be posted near an electrical service cabinet prior to rough-in inspections
and maintained until all inspections have been approved. On buildings and additions
where no service cabinet is available, card shall be placed near main entrance.
Call between 8:00 and 9:00 A.M. for all inspections
FOR ALL INSPECTIONS (952) 447-9850
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
~- /! I
. .', IL-,
- : I ~
( /t2S~ C( v/(J,,, '1
CONTR.
OWNER
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION I-
,P"FINAL l--'
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
COMMENTS:
/' /
( _I ()St-
DATE TIME
"') ... I /
- Lj.
Ol-~
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
Ih~
? WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
':1''t-/ '! I D Ci 7
Inspector: ii, I /-.- i.l' ..)Owner/CDntr:
t..." '
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE..
INSNOTJ
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!