HomeMy WebLinkAboutRe-roof 04-0992
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
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ADDRESS
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OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
~AL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
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TIME
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o EXIGRADIFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
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. ORK SATi~:v.,.pRnGEED
o . CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR INSPECTION BEFORE COVERING
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Inspector:
...owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
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CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH &: SAFETY!
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
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White
Pink
Yellow
File
City
Applicant
(Please type or print and sign at bottom)
ADDRESS
113 ~o HaLI).t2/J O'~ {' ~
LEGAL DESCRIPTION (office use only)
LOTtj BLOCK6" ADDITION
OWNER
(N ame)
Date Rec' d
f/. 30" of-
PERMIT NO. 0 ~r 0'192-
ZONING (office use)
(Phone) q ~~.C-(4~S~
(Address)
BUILDER / rO /
(Company Namet~ V-v~
(Contact Name) &t.LL/
(AddreSS)c.lIo:::;~_(t~ Nv:J ~L~ 1\
(PhOne~Q .<?<_~~O~
(Phone)~~ :::<.q 0 Z~
TYPE OF WORK 0 New Construction ODeck o Porch bd'Re-Roofing ORe-Siding OLower Level Finish 0 Fireplace
OAddition OAlteration OUtility Conne~n 0 Misc.
CODE: DI.R.C. DI.B.C.
Type of Construction:
Occupancy Group: A B
Division:
B
S U
PROJECT COST /V ALUE $
(excluding land)
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E
ITI IV V A
HIM R
2 3 4 5
IT
F
1
I hereby certifY that I have htmished 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
abovc-mentloned 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 revo e this permit for JUS use Furthermore, I hereby agree that the City official or a designee may enter upon the property to perform need cd Inspcctions.
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V Signature Contractor's License No. Date \..
Permit Valuation
Permit Fee $
Plan Check Fee $
State Surcharge $
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace Permit Fee $
Park Support Fee
SAC
Water Meter Size 5/8"; 1 ";
Pressure Reducer
Sewer/Water Connection Fee
Water Tower Fee
Builder's Deposit
Other
TOTAL DUE
This Application Becomes Your Building Pennit When Approved
Paid /Y.Ofi f
Date . f. )fI. d
Buildll1g Otlicial
Date
# $
# $
$
$
# $
# $
$
$
$ ~. cP
Rec1 afY~-
By .
ThiS IS to certifY that thc 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 constltutcs a temporary Certificate of Zoning compliance and allows construction to commence, Before occupancy, a Certificate of Occupancy must be
issued
Planning Director
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
Special Conditions, if any