HomeMy WebLinkAboutBldg Permit 02-0734
16.!O.p;.cT COSTNALUE
t::J" 000
9. PROPERTY DIMENSIONS 10. CULVERT SIZE 17.' OMPLETION DATE
Depth Yes No ~/30 /0,2.
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 men:,~ ~ ld 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
:uilding official \..~~ ~Furthermore, I hereby agree that the ci;;'cMiu/m(;/D upon the property to perfo(;~d~~~
Signatur \.icense No. , Date
~ 320lf1.l
~ DAlE RECEWFO
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
6 !rr;!fJ^
2.SITEADDRESS351& 15 ass-wood Ltick--
3. LEGAL DESCRIPTION
ILl
.
BLOCK 3 . PIDdS-- 'I b- ~-o
ADDITION 1/ / /~ "3 t"d-
... ~
4. OWNER &f1A ~~~~I) / Il V r ?Fi(f; (mrw6orf f}/Jdt 9E: Y?7 -l;97J
5. ARCHITECT ~ (Address) (Tel. No.)
LOT
6. BUILDER
(Name)
(Address) ?f,!I}ra - fCfC{1>
q~~a:fr~R~~~~
Addition c:J Finish Attic c:J Re-siding c:J / ~inish Basement c:J
1{ erOot I'rrrtJAl(f)..&>t.
7. TYPE OF WORK
New Construction c:J
Fireplace c:J
Alterations c:J
Chimney c:J Misc.
8. PROPERTY AREA OR ACRES
Sq.Ft.
Width
t 7~ -oof(af~ ,.
1. White File
2. Pink City
3. Yellow A~pliC8Dt
Permit No. O~-/32f
&
BUILDING INFORMATION
11. SIZE OF STRUCTUR~
(Heigh~6.s~h) t:'(,_~~)
12. NO. OF STORIES
13AYPE OF C NSTRUCTION
1(1 '
14. FLOOR AREA RTIONMENT USE
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
SEATS
FOR ADMINISTRATIVE USE
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 ........................... $
Water Tap ................................... $
Builder's Deposit ............................ $
Other......................................... $
Total Due ...00.................... $
Paid '1 f.c, ( Receipt No. _
Date b- ICj-O~ ~
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 req~ed. This document when
signed by the City Planner constitutes a .......v...ty Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be issued.
SETBACKS: Required
Actual
Front
Back
Side
Side
BUILDING DEPARTMENT VALUATION
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN ~ /T1 )
PERMITVALUATIQMi"' ol..S CXJr
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
7#7S-
City:
Plan Check Fee ............................. $
-
I .., CJ,S
State Surcharge............................. $
Penalty ....................................... $
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
Sewer & Water Permit ...................... $
Gas Fireplace Permit ....................... $
This Application Becomes Your Building Permit When Approved.
~ Dme
Certificate of Occupancy
Issued
City Planner
Date
Special Conditions ff any
24 hour notice for all inspections 447-9850
MATERIAL FILED WITH APPLICATION
SOIL TESTS c:J ENERGY DATA c:J
PILING LOGS c:J PERCOLATION TESTS c:J
PLANS & SPECS c:J SETS
SURVEY
PLOT PLAN
c:J COPIES
c:J
7ro ,0('
'."~'.
II"~~
7 11-'"""\ 717-...."'..
- - -P OIl.. ,,--',,"
~~~
CITY OF PRIOR LAKE
'NSPEe'rION NOTICE
SCHEDULED
ADDRESS
3s/Co
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING 0 PLUMBING RI
o FOUNDATION 0 MECH RI
o FRAMING {EJ 0 WATER HOOKUP
o INSULATION 0 SEWER HOOKUP
)ill FINAL 0 PLUMBING FINAL
o SITE INSPECTI 0 MECH FINAL
<t:~~i~
,~
COMMENTS:
-";
DATE
d -7 3'1
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
~ORK SATISFACTORY. PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
'",pedo" ~, OwoedCoo,"
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE..
INSNOTI
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!