HomeMy WebLinkAboutBuilding Permit 87-0098
QLertificate of ~crnpanry
CITY OF PRIOR LAKE
nltpartmtnt of Jjuilbtng 3Jn~ptttton
E1F-inal Permitted D Conditional C. O. Expires
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This Certificate issued pursuant to the requirements of Section 307 of the Uniform Building Code
certifying that at the time of issuance this structure was in compliance with the various ordinances of the
City of Prior Lake regulating building construction or use. For the following:
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Use Classification ,-----> t, -\ '- . " A, l\'~,. \ LIB, ldg, . ferrnit No.j "
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Occupancy Type ~- -' ~'> Type Construction \/ Fire Zone /\/ / Zoning District
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CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
1. White, City
2. Yellow, Assessor
3. Pink, Building Official
4, Gold. Applicant
Permit No.
DIRECTIONS 11, DAT~,
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN ,....
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom BUILDING INFORMATION
2. SITE ADDRESS 11. SIZE OF STRUCTURE
~,. \;." " , .- .. ." ) ,;: .' " (Height) (Wi,dth) (Depth) ,
-, .i>'"
\' ,,- -.. . ," " .'
3, LEGAL DESCRIPTION 12. NO. OF STORIES
PROPERTY 1.0.# .-:"..t
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SECTION LOT " . ."( ~ "1\'.. BLOCK
~ .. ';/.' .. ..~-' , ,~ , ~i .c'''- ~....." .; /" t. 13, TYPE OF CONSTRUCTION
. ~. " .~'. - , .: t.,
..
ADDITION "" ," PLAT NUMBER PARCEL NUMBER
. 'y' . ,i,~,..
" .. '.
4. OWNER (Name) (Address) (Tel. No.) 14. FLOOR AREA APPORTIONMENT
.. " .. " , "', " .( .. /,', <, ,,~.,~,>- ,.' '. ').>..(;,~ .. "'-:;",r""'" USE
., ."
5. ARCH ITECT (Name) (Address) (Tel. No,) /~~, , ~
,
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6, BUILDER (Name) (Address) (Tel. No.) 15. NUMBER OF OCCUPANTS OR
~, /.~; , ,",' ,/ "/ ":(:. , ,"'>', I,: ...., . ,.- ~ w~ , ,-" SEATS ,I".
.' / .'" . ',. OCCUPANTS
7. TYPE OF WORK FireplaceD SepticD Heating D Plumbing D Reroofing D "...-
SEATS
New Construction r;;J Alterations D Addition D Finish AtticD Residing D 16. ESTIMATED VALUE
Finish BasementD Porch D Garage D Chimney D Misc. , , '
8. PROPERTY AREA OR ACRES 19. PROPERTY DIMENSIONS 110, CULVERT SIZE 17, COMPLETION DATE
Sq. Ft. ,Width . .,.,. Depth ' Yes No :' .;'
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 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 building official can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed Inspec,
tlons.
X t..:;:' , ,J' ... .. , ,', N ,
Signature Date
FOR ADMINISTRATIVE USE
SETBACKS: Required MATERIAL FILED WITH APPLICATION
Actual SOIL TESTS D ENERGY DATA D
Front Back Side Side
PROPOSED GRADE FOUNDATION PILING LOGS D PERCOLATION
IN RELATION TO CURB OR CROWN OFF STREET PARKING TEST D
PLANS & SPECS D SETS
OF STREET SPACES REO,
USE OF BUILDING SPACES ON PLAN SURVEY D COPIES
PERMIT VALUATION PLOT PLAN D
TYPE OF CONSTRUCTION; I II III IV V Amount Brought Forward, , . . . . . . . . , . , $
Occupancy Group A BEl H R M City: Park Ded . . . . . . . . . . . . . . . . . . . . . , . . . . . ., $
Division 1 2 3 4 Sac..............,.,....,.,....,..., . $
Permit Fee. . . . . . , . . . . . , . , , . , , . . . , . . , . $ Plumbing. . , . , . , . , , . , , , . , , , , , , , , . . . , , $
Plan Checking Fee, . , , , , . . , . . . . , . . . , .. $ Sewer Tap,...........,..,......,.,., $
State Surcharge, , . . . , , , , , , , , . . , . . . , .. $ Sewer Hook-up, . . . . . , . . . . , . . . . . . . . . .. $
Penalty . . . . . . . . , . . . . . . , . . . . . . . . . . . . . . $ Water Hook-up, . . . , , . , , . . , . , . . . . . . . . . $
Septic System. . . . . . . , , . , . , , . , . . , . , . .. $ Meter Horn. . . , . , . . . . , . , . . . . , . . , . , , . ,. $
Other. , , , . , , . . , , , , , , , . , . . . . , . , . . . . . . . $ Water Meter. , , . , , , , . , . . . , . . . . . . . . . . . . $
Subtotal, . , . , , , , . . . . , . , . . . . , . .. $ Check if DSewer & Water Connection Fee""." $
Deferred DWater Tower Fee..... .. ... .... .,. .. .. $
This Application Becomes Your Building Permit When
Approved Water Tap. . . . , . , . , , , , , . , . . , . , . . , . . . .. $
City Fee. . . , . . . . . . . . . . . , . . , . , . , . . , . , . . $
By Date Other. , , . , . , . , . . , . . . . . . . . . . . . , . , . . . . . $
Certificate of Occupancy Total Due.,......"."".".... $ .J
Issued Paid Rece~.
Date
y
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 requested, This dOcu,
ment when signed By the City Planner constltues a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy. a Cerltlflcate of Occupancy
must be Issued. ? -
City Planner Date Special Conditions If any
24 Hour notice for all inspections
447,42309:00 S.m. ' 10:00 a.m.