HomeMy WebLinkAboutBuilding Permit 99-0353
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
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ADDRESS
5~09
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PERMIT NO. ,~5-3
fl\ )If PLU."NG R' 1-1..0"' . ~ <=..DlFlLu:J
o MECHANICAL 0 LKSHOREIWETLAND
o WATER HOOKUP 0 COMPLAINT
o SEWER HOOKUP 0 SEPTIC FINAL
o SEPTIC INSTALL 0 FIREPLACE
o PLUMBING FINAL 0
o SITE INSPECTION
CONTR.
OWNER
PHONE NO.
o FOOTiNG
o FRAMING
o INSULATION
o FINAL
o FOUNDATION
o DEMOLITION
o FIRE PREVo
COMMENTS: . - ~~
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Inspector:
Owner/Contr:
CALL .l47 -4230 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE RVUlREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
I
QATE RECEI'lEQ
CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
L White
2. Pink
3. Yellow
File
City
Applicant
Mll.till
Permit No. o/l - 353
DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
1. DATE
4-/14-/~4
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
ADDITION
2. SITE ADDRES~? I o/'tJ ~ $Ir~<:--r /VL"
3. LEGAL DESCRIPTION
LOT -# g BLOCK
~rtJhJdf.s Mdlh);)4
.- t, <::d/reS~) tn14
.:J ~U 7 7(,/ _)IY. N f--
12. NO. OF STORIES
PID 25-0(P~" 008-0
13. TYPE OF CONSTRUCTION
4. ~WfER_ / (Namf) . _
..LYU/fUUJ/dl/t/ISJ Ie
5. ARCHIT,etT (Nam~) .
(Address)
(Tel. No.)
0/7 ~ ,-tJ 7tJ~
(Tel. No.)
14. FLOOR AREA APPORTIONMENT USE
6. BUILDER
(Name)
(Address)
(Tel. No.)
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
7. TYPE OF WORK Fireplace 0 Septic 0 Deck 0
New Construction 0 Alterations 0 Addition 0 Finish Attic 0
Chimney 0 Misc. t!, 4 St!'w~, a-z:I p/i"" k<
8. PROPERTY AREA OR A~ES 9. PROPERTY DIMENSIONS
Sq. Ft. Width Depth
Re-roofing 0 Porch 0
Re-siding 0 Finish Basement 0
SEATS
16. PROJECT COSTNALUE
10. CULVERT SIZE
Yes No
17. COMPLETION DATE
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 official can revoke this 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
Signature
License No.
Date
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
MATERIAL FILED WITH APPLICATION
Front
Back
Side
Side
SOIL TESTS
o ENERGY DATA
o
BUILDING DEPARTMENT VALUATION
USE OF BUILDING ~
OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
PILING LOGS 0
PLANS & SPECS 0
SURVEY 0
PERCOLATION TESTS 0
SETS
COPIES
PLOT PLAN
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:
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
i D5{). 00
Plan Check Fee ............................. $
State Surcharge ............................. $
" em
Penalty ....................................... $
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
o.vO\
~ 0./
~~
Pressure Reducer .......................... $
Meter Hom ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
45".00
Sewer & Water Permit ...................... $
j.).S-c 00
I ~OO -00
',D().oO
Water Tap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
Total Due .............................. $-312..0 . ~
Paid 3, 12..0. 5V Receipt No. 35044
Issued ~
Date A-/I~m By
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinan~e and 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 Certificate of Occupancy must be issued.
ermit WI)~n AP~ro~ct::v
Date C/ -(4- T r
City Planner
Date
Special Conditions if any
24 hour notice for all inspections 447-9850
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