HomeMy WebLinkAboutBuilding Permit 99-1179
CITY OF PRIOR LAKE
INSPECTION NOTICE
DATE TIME
S
.~D
/ J..-J/lq
ADDRESS
{ 1-6'0
/S04 St.
OWNER
CONTR.
PHONE NO.
PERMIT NO.
?7- //79
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION ,a)
!3 FINAL ~ '(1/
o SITE INSPECTIl'lN
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
COMMENTS:
_'S!&L.:.~ ~'/ ~::' ,~A/J.J!
alP /7,11
~o.f$
~ WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector:
l'lt-&... . Owner/Contr:
CALL ....7-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE,
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY/
INSNOTI
&~~
DATE RECEI\lED CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
I. White
2. Pink
3. Yellow
File
City
Applicanl
1. DATE
Permit No.~!"/4
~ROJECT COSTNALUE
/~ [(F' :,~"
. 17. COMPLETION DATE
I
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
buildi~ ~al ~is pel1Tlit for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perfwn needed iw>~tlons.
-V--/T~/V7.P----. drYJft lth ,r;t::' r.2 7- 17
. Signature License No. Date
DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
2 SITE ADDRESS6'/ h rJ /(IO 'dl 0/f
3. LEGAL DESCRIPTION
1--/7- 9~
1C;-~ln ~O'Q-O I
I
I
.1
LOT
I':; . BLOCK
IGA<... u..IO<? 0
PID
ADDITION
4. OWNER (Name)
C I.l f'<-T
15. ARCHITECT
6. BUILDER
(Address)
(Tel. No.)
R6 I $ON
(Name)
(Address)
(Tel. No.)
(Name)
(Address)
/.IZ (Tel. No.1 3
... - U c;l-r!! 0<{
w65 /'U/lflJ,Ch..'I2lQ l?P'1 /371'1,d elF, ItJ Pi.. 'tmP.-r1l
7. TYPE OF WORK Fi~place CI Septic CI Deck 0 Re-roofing" Porch'O
New Construction 0 Alterations 0 Addition CI Finish Attic 0 Re-siding 0 Finish Basement CI
Chimney CI Misc.
la. PROPERTY AREA OR ACRES
Sq. Ft.
19. PROPERTY DIMENSIONS
Width Depth
/10. CULVERT SIZE
Yes No
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
12. NO. OF STORIES
13. TYPE OF CONSTRUCTION
I? t. I1IJ/Jj:
14. FLOOR AREA APPORTIONMENT USE
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
SEATS
SETBACKS: Required
Actual
FOR ADMINISTRATIVE USE
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
Pressure Reducer .......................... $
Meter Horn .................... .... .... ....... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
WaterTowerFee ........................... $
Water Tap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
Front
Back
Side
Side
BUILDING DEPARTMENT VALUATION
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
USE OF BUILDING
~
I
1t-/(2-
PERMIT VALUATION
z S-C:::O.-
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:
1~.1S
Plan Check Fee ............................. $
State Surcharge ............................. $
Penalty ....................................... q:
Plumbing Pennit Fee ....................... $
I. '2-~
nnit Fee ..................... $
MATERIAL FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA 0
PILING LOGS 0 PERCOLATION TESTS LJ
PLANS & SPECS LI
SURVEY 0
SETS
COPIES
PLOT PLAN
o
Total Due .............................. <I:
::~: ; r~~ l'ri
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 constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be issued.
1'=>' -
Receipt No. ,'" Z-G. 't
rWH-
Issued
City Planner
Date
Special Conditions if any
24 hour notice for aU inspections 447-9850
By