HomeMy WebLinkAboutBuilding Permit 99-0172
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
OWNER
/~/9~
SCHEDULED ItJ -Ir-99 A..,~
rJI~ JJLw ~,
CONTR.
PHONE NO.
PERMIT NO.
99 -/7:J-
o FOOTING 0 PLUMBING RI
o FOUNDATION 0 MECH RI
o FRAMING 0 WATER HOOKUP
o INSULATION 0 SEWER HOOKUP
~FINAL 0 PLUMBING FINAL
o SITE INSPECTION 0 MECH FINAL
COMMENTS: ~ ~
. I
o EXIGRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
p:~
~~
'~
7L~~
I _
-/
~ORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WOR~ALL FOR REINSPECTION BEFORE COVERING
Inspector: ~l Owner/Contr:
/
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
INSl'IOTI
DATE RECEIVED
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
-...
.
L White
2. Pink
l Yellow
File
City
Applicant
1. DATE
Permit No.
qc;-/P-
, 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
ILl 10 L/ /J; cl clt:.n V'~I A.') W 7<d.
3. LEGAL DESCR/'PTION b
LOT BLOCK
d;ddr~ VIeW
?!:.}.}Lhe-v
~/I<( Jq q
I I
d5-~11- tJO/~O
PIO
ADDITION
~NER
~....IM ) ~ d
5. ARCHITECT
(Address)
(Tel. No.)
l-J q ~ - (),<:"" ~
(Tel. No.)
(Name)
(Address)
6. BUILDER (Name) (Address) (Tel. No.)
/ IOIln, LQfLWclu~fyt'c ( fbl uC I
4KJ1Q1Y\ U; (~ Kp A+ -r ^- l I/O" - 0/ DC>
7. TYPE OF WORK Fireplace CJ Septic CJ Deck CJ Re-roofin~ Porch CJ
New Construction CJ i Alterations CJ Addition CJ Finish Attic CJ Re-siding CJ . F. inish Basement CJ
Chimney CJ Misc. I} '-^--<..- ~ ,<)+0,.. (Y'\ ('lc/V'\~ _
8. PROPERTY AREA OR ACRES 9. PROPERTY DIMENSIONS 1 O. CULVERT SIZE
Sq. Ft. Width Depth Yes No
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
12. NO. OF STORIES
13. TYPE OF CONSTRUCTION
14. FLOOR AREA APPORTIONMENT USE
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
SEATS
1~ROJECT COSTNALUE
:p Q'1nLJ-
17. COMPLETION DATE
t-J/ IS/o, 0,
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 thai I am th~ owner or authorized agent for
the above me~~~~~~rop~~and that all construction will conform to all existing slate and local laws and will proceed in accordance with submitted plans. I am aware that the
:uilding ~a~oki/ ~ Furthermore, I hereby agree thaJ2:6' \"i~q ~e6ne~ay enter upon the property to perform/~e~iqc;ions.
I Signature License No. ~ !!late
SETBACKS: Required
Actual
FOR ADMINISTRATIVE USE
MATERIAL FILED WITH APPLICATION
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
Front
Back
Side
Side
BUILDING DEPARTMENT VALUATION
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
/l ....
USE OF BUILDING ~ 5 1ft K
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
City:
74. r:;-
I . .JC;-
Plan Check Fee ............................. $
State Surcharge............................. $
Penalty ....................................... $
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
SOIL TESTS
CJ ENERGY DATA
CJ
PILING LOGS CJ PERCOLATION TESTS 0
PLANS & SPECS CJ
SURVEY 0
SETS
COPIES
PLOT PLAN
CJ
Pressure Reducer .......................... $
Meter Horn ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Sewer & Water Permit ...................... $
Water Tower Fee ........................... $
Water Tap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
Total Due "0' ......................... $ /~,oct
"7/ ~ - ,
Paid /0 ~ - Receipt N?fl' '{f77J"
Issued I/. i
Date i" -/s:--1i By /'<-<A
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 sled. This document when
signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be issued.
Certificate of Occupancy
City Planner
Date
Special Conditions ff any
24 hour notice for all inspections 447-9850