HomeMy WebLinkAboutBuilding Permit 01-0421
DATE RFCEIVFD CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
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
Permit No.
~G INFORMATION
11..~ OF STRUCTURE
("7" (WKfth) (De"h)
4-/0/
fV/f.,vO IV NOOO
st.
1<./
3. LEGAL DESCRIPTION
PJ
12. NO. OF STORIES
4. OWNER
(Name)
,I/(.,"e6~
5. ARCHITECT (Nama)
z
NG::::'f bCJJe.tj pl)/lIOS
..:me~dy)
(Addrass)
(Tel. No.)
(,1'2-' 1/3, 3~
14. FLOOR AREA APPORTIONMENT USE
LOT
BLOCK
PID ~ -3:ZID~OI"- 0
3 /2.0
13. lYPE OF CONSTRUCTION
ADDITION
(Tal. No.)
6. BUILDER
(Name)
(Address)
(Tel. No.)
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
7. lYPE OF WORK
New Construction CI
Chimney CJ Misc.
8. PROPERlY AREA OR ACRES 19. PROPERlY DIMENSIONS /' O. CULVERT SIZE
Sq. Ft. Width Depth Yes No
I hereby certify that I have fumi~nforma on th~' appl" tion which is to the best of my knowledge true and correct. I also certify that I am the owner or authorized agent for
the ~men:o:r~ a at all 'on wi form to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the
buildin trlclar can is it for . F re, I hereby agree that the city official or a designee may anter upon the property to perform needed Inspections.
X. .
~ \ -_ ,"",,,,,No._
Areplace CI
Alterations c:J
SeptiCc:J
Addition c:J
DeclO1t
Finish Atti! CI -
Ae-roofing Cl Porch Cl
Re-slding Cl Finish Basement Cl
SEATS
16. PROJECT COSTNALUE
17. COMPLEtiON DATE
I I I
~ReqUlred -
Actual
FOR ADMINISTRATIVE USE
F"""
"ok
Side
Side
MATERIAL FILED WITH APPLICATION
SOIL TESTS 0 ENERGY DATA 0
PILING LOGS 0 PERCOLATION TESTS 0
BUILDING DEPARTMENT VALUATION
USE OF BUILDING
ee.s filL
.
OFF STREET PARKING
SPACES REO.
I SPACES ON PLAN
PERMIT VALUATION ~.. -
PLANS & SPECS 0
SURVEY 0
PLOT PLAN 0
SETS
COPIES
lYPE OF CONSTRUCTION: I " III IV V
OccupancyGroup 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 ................................... $
$
Plan Check Fee ............................. $
State Surcharge ............................. $
Penalty....................................... II:
~3.2';-
5'4,11
1.5:)
Pressure Reducer .......................... $
Mechanical Permit Fee ..................... $
Meter Hom ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
Water Tap ................................... $
Builders Deposit ............................ $
Other ......................................... $
TotarDue ...........................i1~~
Paid, Reoalpt No. 5'
Dele C;; I By ,
This is to certify that the request In the above application and accompanying documents is in accordance with the City zoning- I ark! may proceed as requested. This doCument when
signed by the CIty Planner constitutes a temporary Certificate of Zoning compliance and aNows construction to commence. Before occupancy, a Certificate of Occupancy must be issued.
Plumbing Permit Fee ....................... $
Issued
City Planner
De..
Special Conditions R any
24 hour notice for all Inspections (952) 447-9850
, FINAL
~.
~ .
Call between 8:00 and 9:00 A.M. for all Inspections
FOR ALL INSPECTIONS 447-9850
,
,
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
DATE TIME
78C1( /-l-:t
ADDRESS
4/0 I !,t!IL{/UL\'! Lvt:OD s (
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o {-c42-/
o FOOTING 0 PLUMBING RI
o FOUNDATION ~ 0 MECH RI
o FRAMING 0 WATER HOOKUP
o NSULATION 0 SEWER HOOKUP
-.eiFINAL Da...c- 0 PLUMBING FINAL
It} ~ITE INSPECTION 0 MECH F AL
o EXIGRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
COMMENTS:
.)
_.~-~
~WORK sATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK~LL FOR REINSPECTION BEFORE COVERING
Inspector: ~ Owner/Contr:
CALL U7.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY/
lN$NOTI