HomeMy WebLinkAboutBuilding Permit 99-1383
CITY OF PRIOR LAKE
INSPECTION NOTICE
'.
Sc;HEDULED
ADDRESS
533!::::;
14077+
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
,Cl)NSULATI9,N_ @)
~ FINAL ,K.(JDP
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
COMMENTS:
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DATE TIME
1~(P/1c;
ST.
,CI.T.
Qc;-13f33
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
~ORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK. CALL FOR REINSPECTION BEFORE COVERING
Inspector:
/!YA
. Owner/Conlr:
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE,
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
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~~~CCE~ONNUSMBEAbHRU 17 MUSTBEFILiED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
CITY OF PRIOR LAKE
BUILDING PERMIT,
,EMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
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,
1. White
2. Pink
3. Yellow
File
City
ApplicaDl
Permit No. ~I ~.i
53 s r;-
lilt> 'Th.
7-T
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
2. SITE ADI)RESS
3. LEGAL DESCRIPTION
LOT 4-
ADDITION
4. OWNER
12. NO. OF STORIES
-eLOCK
Nt>/brlk-"::>~ v~
Pin
( ll-~J)
13. TYPE OF CONSTRUCTION
15. ARCHITECT
6. BUILDER
(Name)
7rVJf <7h,.,.../\
(Name) ,
(Address)
"S'-'3'SS-
(Address)
IV/J'1'( >1
(Tel. No.)
f~,)-; S'9 .3 7
(Tel. No.)
14. FLOOR AREA APPORTIONMENT USE
(Name)
(Address)
(Tel. No,)
15, NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
7, TYPE OF WORK
New Construction 0
Fireplace 0
Alterations 0
Septic 0
Addition 0
Deck 0
Finish Attic 0
~/
Re-roofin~ Porch 0
Re-siding 0 I ~ish Basement 0
SEATf:
16. PROJECT COSTNALUE
Chimney 0 Misc.
18. PROPERTY AREA OR ACRES 19. PROPERTY DIMENSIONS 110. CULVERT SIZE
Sq. Ft. Width Depth Yes No
I hereby certify that] have furnished information on this application which is to the best of my knowledge true and correct. I also certify that 1 am the owner or authorized agent for
th~ a,be . ,entioned property Ed t~at a.1I construction will conform to all existing state an~ ]0~1 !aws and ~i]] proceed in accordance with submitted plans. I am .aware that the
bUild. lal can revoke ~s .. ..... .tor Just cause. Furthermore,] hereby agree that the CIty offiCial ora deSlgn.ee may enter upon the property to perform n~.~ ed Insp~Jils.
Xf_ ~ IJ-~-7,
Signature License No. - Date r
17. COMPLETION DATE
FOR ADMINISTRATIVE USE
Front
Back
Side
Side
MATERIAL FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA 0
SETBACKS: Required
Actual
BUILDING DEPARTMENT VALUATION
I
rzesN (L
OFF STREET PARKING
SPACES REQ.
SPACES ON PLAN
PERMIT VALUATION
PILING LOGS 0
PLANS & SPECS 0
SURVEY 0
PERCOLATION TESTS 0
SETS
COPIES
USE OF BUILDING
z..~CX). ~
PLOT PLAN
o
TYPE OF CONSTRUCOON: I II III IV V
Occupancy Group A B E F HIM R
Division 1 2 3 4
Permit Fee ................................... $
Plan Check Fee ............................. $
S U
City:
Amount Brought Forward .................. $
Park Support Fee ............. .... .... ...... $
SAC .........................................$
Collective Street Fee ......... .... .... ...... $
Sewer Tap ................................... $
$
14-_ 1<"
State Surcharge ............................. ~
\, '2.-)
Penalty............................... .... .... $
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
This
By
Builder's Deposit ............................ $
Other ......................................... $
Total Due .............................. $
Paid ,L, .-{ Receipt No. ~~-=\ \
Date \\1"11 'i' By ~
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordina~ce 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.
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-"enn. When Ap7tp4pr
Pressure Reducer .......................... $
Meter Horn ... .... .... ........................ $
Water Meter ...............,.,............... $
Sewer & Water Connection Fee ........... $
WaterTowerFee ........................... $
Water Tap ................................... $
Certificate of Occupancy
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Issued
City Planner
Date
Special Conditions if any
24 hour notice for all inspections 447-9850