HomeMy WebLinkAboutBuilding Permit 99-0165
".
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
:~CHEDUlED
lo-I&{~cyj
A,/r
ADDRESS /~'77/ vJ~ 4ve ,2~.
OWNER
CONTR.
PHONE NO.
PERMIT NO.
CfCf-ICo5
o FOOTING
g ~~:~:~ION ~
o INSULATION 0 SEWER HOOKUP
FINAL 0 PLUMBING FINAL
~ SITE INSPECT N 0 MECH FINAL
COMMENTS: ~ '
~
((MY! ,~
I
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
(~
~~
- 1-J7(L
--.,
/
~ORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WO",. .:ALL FOR REINSPECTION BEFORE COVERING
Inspector: _ rr--" 1 . Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.,
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTl
DATE RECEIVED
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
1. White
2. Pink
3. Yellow
File
City
Applicant
.. II_
Permit No.
qlj -/~"')
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
/571 ,
1. DATE
LOT
t.U ~ VJl;{.
BLOCK / ()
f!lffJI..11J.4J
,
s (; 11LlJ.;:- f<
(Address)
(1L.
3 - I;;),.. Cfq
KtSD
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
3. LEGAL DESCRIPTION
q
ADDITION fJ my.:!
12. NO. OF STORIES
PID ;lC:; -04/- (JO 7-0
13. TYPE OF CONSTRUCTION
4. OWNER (Name)
r.h AJ(L~ 5
5. ARCHITECT (Name)
(Address)
(Tel. No.)
4'11-(,330
(Tel. No.)
14. FLOOR AREA APPORTIONMENT USE
"rnJ<.J2
'-If..2- 3i'l d.,.
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
~:S6~
(Address) J~J.1n.J
3~ W d(Jjjf,
(Tel. No.)
6. BUILDER
(Name)
7. TYPE OF WORK
New Construction 0
Fireplace 0
Alterations 0
Septic 0
Addition 0
Deck 0
Finish Attic 0
Re-roofin9""- Porch 0
Re-siding 0 Finish Basement 0
SEATS
16. PROJECT COSTNALUE
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES
Sq.Ft.
9. PROPERTY DIMENSIONS
Width Depth
1 O. CULVERT SIZE
Yes No
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
build~c;!tic~al Cilry~v~ke thi~ust cause. Flfhermore, I hereby agree that the city official or a designee may enter upon the property to perform. needed inspections.
X r ~ '4AM_/ _ 3--/~- 9'f
ignature License No. Date
FOR ADMINISTRATIVE USE
Front
Back
Side
Side
MATERIAL FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA 0
PILING LOGS 0 PERCOLATION TESTS 0
PLANS & SPECS 0 SETS
SETBACKS: Required
Actual
BUILDING DEPARTMENT VALUATION
USE OF BUILDING
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
SURVEY
PLOT PLAN
o COPIES
o
Plan Check Fee ............................. $
S U
74. 7~
II .)~
City:
Amount Brought Forward .................. $
Park Support Fee ........................... ~.
SAC .........................................~.
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
TYPE OF CONSTRUCTION: I II III IV V
Occupancy Group A B E F HIM R
Division 1 2 3 4
Permit Fee ................................... $
State Surcharge ............................. $
Penalty ....................................... $
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
Pressure Reducer .......................... $
Meter Hom ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... 'l:
Sewer & Water Permit ...................... $
Issued
WaterTowerFee ........................... $
Water Tap ................................... $
Builder's Deposit ............................ $
Other......................................... $
Total Du~ ...ifV...................... $ -10 .00
Paid 70 . ~ Receipt No. 54-n J-
Date ~':";).49 By aM
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance ~nd may proceed as r~uested. This document when
signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certijicate of Occupancy must be issued.
Gas Fireplace Permit ....................... $
This APrrctYJer:mry. Your Building permit~r~d.
By ~ _ / Date":>l.. I
Certificate of Occupancy
City Planner
Date
Special Conditions ~ any
24 hour notice for all inspections 447-9850