HomeMy WebLinkAboutBuilding Permit 99-0210
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS / <( / Zf)
OWNER
DATE TIME
SCHEDULED I' -;e-9'J A, 1:
p(~ J~ h.
CONTR.
PERMIT NO.
~ 'J - Z/ (J
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATI
FINAL
,{- SITE INSP CTION
o PLUMBING RI 0 EXIGRAD/FILLING
o MECH RI 0 COMPLAINT
o WATER HOOKUP 0 FIREPLACE RI
o SEWER HOOKUP 0 FIREPLACE FINAL
o PLUMBING FINAL 0 ~L1~E AIR TST
o MECH FINAL 0 ~
~~
COMMENTS:
/
~ORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
K, CALL FOR REINSPECTION BEFORE COVERING
Inspector:
,
Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYl
INSNOTI
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
teM 25 S'
Permit No. qq ~C I 0
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
1. DATE
:3 -~ 5 ~ 9 ')
{(ISD
PID c2~ -d4/. {){J~ -()
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
3. LEGAL DESCRIPTION
5', /. BLOCK /
ADDITION HI dtLL t-t U~.
12. NO. OF STORIES
LOT
13. TYPE OF CONSTRUCTION
4. OWNER
(Name)
(Address)
t
I
(Address)
(Tel. No.)
6~
14. FLOOR AREA APPORTIONMENT USE
(Tel. No.)
(Address)
(Tel. No.)
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
7. TYPE OF WORK
New Construction 0
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES
Sq. Ft.
ro~" A-
Septic 0
Addition 0
Ilj-J 7J7
Re-roofing'J( Porch 0
Re-siding 0 Finish Basement 0
SEATS
16. PROJECT COSTNALUE
9. PROPERTY DIMENSIONS
Width Depth
10. CULVERT SIZE
17. COMPLETION DATE
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 0 . ial can re k his permit for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
X J:~~O/.E5t/f'k .;3-c2S-9'J
License No. Date -
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
Front
8ack
Side
Side
MATERIAL FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA 0
PILING LOGS 0 PERCOLATION TESTS 0
BUILDING DEPARTMENT VALUATION
USE OF BUILDING
~~ ftIr(
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
PLANS & SPECS 0
SURVEY 0
SETS
COPIES
PLOT PLAN
o
TYPE OF CONSTRUCTION: I II III IV V
Occupancy Group A B E F HIM R S U
Division 1 2 3 4
City:
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
Permit Fee ................................... $
iW.7'5'
1.25
Plan Check Fee ............................. $
State Surcharge............................. $
Penalty ....................................... $
Pressure Reducer .......................... $
Meter Horn ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
Water Tap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
Paid T7 t-dS...........~~~~i~;~O~
Date d ~ ')S' -'1 q By
7~:ue:o
3C{~{5
<L,J
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
Sewer & Water Permit ...................... $
Gas Fireplace Permit ....................... $
This Application Becomes Your Building Permit When Approved.
By Date
Certificate of Occupancy
Issued
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 requeste . 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.
Crty Planner
Date
Special Conditions rt any
24 hour notice for all inspections 447-9850