HomeMy WebLinkAboutBldg Permit 03-0749
DATE RECEIVED CITY OF PRIOR LAKE
C, - I ~, ()J BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
1. White
2. Pink
3. Yellow
File
City
Applicant
Permit No. 0]>- () "74-1
DIRECTIONS
SPACES NUMBERED 1 THRU 17 MUST BE FILLED IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
1. DATE
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Height) (Width) (Depth)
12. NO. OF STORIES
lOT
ADDITION
4. OWNER
BLOCK
PID
13. TYPE OF CONSTRUCTION
14. FLOOR AREA APPORTIONMENT USE
5. ARCHITECT
7. TYPE OF WORK
New Construction 0
(Tel. No.)
9sZ-10b~/lOD
15. NUMBER OF OCCUPANTS OR SEATS
OCCUPANTS
6. BUILDER (Name)
t00/f/J~th
Firep ace 0
Alterations 0
Septic 0
Addition 0
Porch 0
inish Basement 0
SEATS
Chimney 0 Misc.
8. PROPERTY AREA OR ACRES
Sq. Ft.
9. PROPERTY DIMENSIONS
Width Depth
10. CULVERT SIZE
Yes No
x
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
Front
Back
Side
Side
MATERIAL FILED WITH APPLICATION
SOil TESTS 0 ENERGY DATA 0
BUILDING DEPARTMENT VALUATION ?,5l/lJ ~
USE OF BUILDING ,k'4;J' /1/ It,
FF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
PILING LOGS 0
PERCOLATION TESTS 0
PLANS & SPECS 0
SETS
COPIES
SURVEY 0
PLOT PLAN
o
TYPE OF CONSTRUCTION: I II III IV
Occupancy Group A B E F HIM
Division 1 2 3 4
Permit Fee ................................... $
V
R S U
7<{. (/
City:
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC ......................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
$
Plan Check Fee ............................. $
State Surcharge ............................. $
Penalty ....................................... $
,,~/
Plumbing Permit Fee ....................... $
Mechanical Permit Fee ..................... $
Pressure Reducer .......................... $
Meter Hom ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
Sewer & Water Permit ...................... $
Gas Fireplace Permit ....................... $
This Application Becomes Your Building Permit When Approved.
By Date
Date
Paid
1-t vV
~4- b Z--J
Certificate of Occupancy
Issued
Date
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may pr eed s requested. This document when
signed by the City Planner constnutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a C 'ficat of Occupancy must be issued.
City Planner
Special Conditions ff any
24 hour notice for all inspections 447-9850
CITY OF PRIOR LAKE dOZ /
INSpeCnON NOTICE SCHEDULED~-
ADDRESS s-#I tt/o~j k4-;1--
OWNER
TIUE
CONTR.
PHONE NO.
PERMIT NO.
t13 - 7-/,9
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
,..Jiit'fiNAL
o SITE INSPECTION
COMMENTS:
d:roo /
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EXIGRADIFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
~ / /
~p:J/e7e
/
.-
___-.--.~~...'H" <_.
,./-
-""
VWORKSATISFAC . ED
,/ & CORRECT ACTION AND PROCEED
o CORRECT WORK, CAL FOR REINSPECTION BEFORE COVERING
Inspector:
Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
INSliOTl