HomeMy WebLinkAboutBldg Permit 02-0314
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. 3701 S-/l>~
2. SITE ~~E}S / 11 . I ()
tX7l./D -l~ ,U).,UL ~.iI).
3. LEGAL DESCRIPTION
LOT
ADDITION
BLOCK
Q::>f...t~<D ~ to......-J S (n;...
PIQ "2<;--\ $ 3:. . COB -\
4. OWNI)R). ..~Na e) _ / Jr (Addre~ . _ . _ J/. PI 9;el. No.)
~ . Uf{t J,9?{) ~i~J.l. y~-I/y()-/(/j()
5. ARCHITECT (Name (Address) (Tel. No.)
7. TYPE OF WORK
New Construction LI
(Address) m, (Tel. No.)
91SS-#~/UJllb<. 9s;?-7t~-~59D
&4M..fJA.bJ~ /IJ1V5."11Y'I
Septic LI Deck LI Re-roofing LI Porch LI
Addition LI Finish Attic LI Re-sidin~ Finish Basement LI
6. BUILDER (Name)
-rtdi&~
Fireplace LI
Alterations LI
Chimney LI Misc.
8. PROPERTY AREA OR ACRES
Sq. Ft.
9. PROPERTY DIMENSIONS
Width Depth
10. CULVERT SIZE
Yes No
1. White
2. Pink
3. Yellow
File
City
Applicant
"
Permit No.
02..<314:-'
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
12. NO. OF STORIE~
13JAi~UCTION
14. FLOOR AREA APPORTIONMENT USE
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
SEATS
16. ftlOJECT COSTNALUE
~ 9. 1 ()S':, 1ft)
;;MPf/;J~~
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 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
bulldi . al can rev ke this rmit or jU.J1 caus," Furthermore, I hereby agree that the c~ offiCi~ 7r a designel!:j"ay enter upon the property to perform ne~~ons.
X 'Y.A.-r- iifO/'t..5b 9 -, (:;/;l~/I)~
Signature License No. ' Date
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 .............................. $ 1l,. rf)
Paid "1 (p. ~ Receipt No.4' ~
Date ~/#f I C"]- By rz.J) ~
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordi~ance and may proceed as requested. This document when
signed by the City Planner constRutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be issued.
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
Front
Back
Side
Side
BUILDING DEPARTMENT VALUATION
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
USE OF BUILDING
PERMIT VALUATION
Z-Son
TYPE OF CONSTRUCTION: I II III IV V
Occupancy Group A B E F HIM R S U
Division 1 2 3 4 ~4 r
Permit Fee ................................... $ '- r . { ~
City:
, ./
Plan Check Fee ............................. $
State Surcharge............................. $
Penalty ....................................... $
Plumbing PermR Fee ....................... $
Mechanical Permit Fee ..................... $
1. "2..S
This
By _
............. $
I
........i~~.~e:R ~~n NJ~e 2-
Date <<> ~ (7
"/
Certificate of Occupancy
Issued
City Planner
Special Conditions K any
Date
24 hour notice for all inspections 447-9850
MATERIAL FILED WITH APPLICATION
SOIL TESTS LI ENERGY DATA LI
PILING LOGS LI PERCOLATION TESTS LI
PLANS & SPECS LI SETS
SURVEY
PLOT PLAN
LI COPIES
LI
_ CITY OF PRIOR LAKE
INSPECTIOH>NOTICE
DATE TIME
".
5' 300'2.. A- .,..
Z l' fa 0 .../ t:- ~ C!E (!../ te:.- ~
SCHEDULED
ADDRESS
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION ~ J
1stFINAL Sf 0/ fVU
O'SITE INSPECTIONl
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
COMMENTS:
~~
02---03/4-
o EX/GRADfFILLlNG
o COMPLAINT
o FIREPLACE Rl
o FIREPLACE FINAL
o GASLINE AIR TST
o
~<1WORK SATISFACTORY, PROCEED
J CORRECT ACTION AND PROCEED
:,::ECT ~ CA~L FOR REINS::::FORE COVERING
J
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE..
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH &: SAFETYI
INSNOTl