HomeMy WebLinkAboutBuilding Permit 93-0347
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORABY CERTIFICATE OF ZONING COMPLIANCE
..... -.--AND. UTILITY CONNECTION PERMIT .9 '3 ?A-
- Permit No. ,- 7
".)
1. White
2 Pink
3. Yellow
File
City
Applicant
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
&l.
1. DATE
lolr;; 13
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Helg.t) (WIdth) (Depth)
~oCL<<t:e
~
3. LEGAL DESCRIPTION
LOT BLOCK
ADDITION ~ (,....,} ~I- J
12. NO. OF STORIES
PID 2~~qo( - 02~ ....1
13. TYPE OF CONSTRUCTION
(Name)
C>~
(Address)
O~ Ow e<
(Address)
ov.-t.€ O~. e-r-.
Fireplace 0 Septic 0 Heating 0 Plumbing 0
Alterations 0 Addition 0 Finish Attic 0 Residing 0
vv.c:
(Tel. No.)
J.f 7 -- <i(oS
(Tel No.)
14. FLOOR AREA APPORTIONMENT USE
4. OWNER \ (Name)
J..)'D :
5. ARCHITECT (Name)
(Address)
Yes
No
~3
6. BUILDER
(Tel. No.)
7. TYPE OF WORK
New Construction 0
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES
Sq.Ft.
Reroofing 0 Porch 0
Finish Basement.D(
9. PROPERTY DIMENSIONS
Width Depth
10. CULVERT SIZE
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
buildi fficial r,!lVoke this perm' r just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform nTled iip89ti~s.
X . r'rt4 /0.-1;}- f_~
Signature LIcense No. Date
FOR ADMINISTRATIVE USE
Front
Back
Side
Side
MATERIAL FILED WITH APPUCATION
SOIL TESTS 0 ENERGY DATA 0
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS av--SETS 2-
SURVEY 0 COPIES
SETBACKS: Required
Actual
PROPOSED GRADE FOUNDATION
IN RELATION TO CURB OR CROWN
OF STREET ~
USE OF BUI~G .
hi'\.:i<h
TYPE OF CONSTRUCTION: I II 1111
Occupancy Group A BEl H {;; M
Division 1 2~
OFF STREET PARKING
SPACES REa.
SPACES ON PLAN
PERMIT VALUATION
'{ 2.,000. 00
PLOT PLAN
o
City:
Amount Brought Forward .... .. .. ..... ..... $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
SewerTap ................................... $
Ucense Check Fee ......................... $
Pressure Reducer .......................... $
7S. '2.~
Plan Checking Fee ......................... $
State Surcharge ............................. $
45.00
zq. z>
I. ~o
Permit Fee ................................... $
Subtotal............................... $
., s- . ~ S""
Meter Hom ................................... $
Water Meter ................................. $
o Sewer & Water Connection Fee ........... $
o
Water Tower Fee ........................... $
Penalty ....................................... $
Septic System ............................... $
Other ......................................... $
Check if
Deferred
Issued
Water Tap ................................... $
Other ......................................... $
Other ......................................... $
Total Due .............................. $ .., S-. "2..~
... ~~ ~r=
Date .- / '- :s By .
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 document when
signed By the City Planner constftutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be issued.
. ing Permit When Approved.
Date lOr 16 -qj
City Planner
Dele
Special Conditions ff any
24 Hour notice for all inspections 447-42309:00 a.m. . 10:00 a.m.
1. Blue File
2 Gold City
# 93w_ ;;;;
Phone: r/f7~ ~o5q
?.i.... 1A..L.v, S
.:t
Applicant:
Address:
Signature:
Legal Descri Ion: Lot
Site Address: StX--v\-o\..C
Building Permit # q.S ~ :3 4- 7 PID # :1. 5-- 9'0 ( - 0(1 t/ -/
NOTE: This permit will not be processed without complete information.
Sub:
FIXTURE UNITS
Unit
Quantity Type of Fixture Amount Total
Bath Tub with or without shower $ 6.00
Dishwasher $ 6.00
Floor Drain $ 6.00
Lavatory (bathroom sink) $ 6.00
\ Laundry Tray (1 or 2 compartment sink) $ 6.00 &, . Do
Shower Stall $ 6.00
I Sinks: )( ,- 1 "S.~ "'- ~ $ 6.00 4: ~
Bar Sink $ 6.00
Water Closet (toilet) $ 6.00
Rough-ins $ 6.00
Water Heater $ 6.00
Water Softner $ 6.00
Stand Pipe (washing machine) $ 6.00
Sewage Ejector $ 6.00
Backflow Assembly (RPZ, Double Check, PVB) $25.00
Backflow Assembly Test $10.00
Lawn Sprinkler $25.00
Other $ 6.00
Minimum Fee $25.00
SURCHARGE
.50
GRANDTOTAL$,.~S-, SV
This permit is granted upon the express condition that said
contractor, shall comply in all respects with the ordinances
of I ,Stare Plumb;n. Co<I< .nd th, .:;....7;7 th,reof.
- R CEIPT NO. ~ DATE
AITEST
Call for all inspections 24 hours in advance.
4629 Dakota St. S.E., Prior Lake, Minnesota 55372 / Ph. (612) 447-4230 / FAX (612) 447-4245
AN EQUAL OPPORTUNITY EMPLOYER
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT f/J~. (]~p J. -1,-< ~
APPLICATION RECEIVE //) -- / :-;; -- C).3
The City of Prior Lake BUILDING Department has reviewed the
building permit application
S ') ~~t-
activity located at
Accepted vi Denied~ Accepted
Reviewed bY:-Pou, fhr ~
Comments: (i)lJ1J Pk~ ~)
jJ~ ;;;;~A</
with Corrections
Date 1/)-/ r-tiJ
~ Oh
"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."