HomeMy WebLinkAboutBldg Permit 05-0991
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CITY OF PRIOR LAKE
BUILDING PERMIT,
TEMPORARY CERTIFICATE OF
ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
1. White
2. Pink
3. Yellow
File
City
Applicant
10. S. OS
Permit No.
05.()CJ9/
OIRECTlONS
SPACES NUMBEREO 1 THRU 17 MUST BE FILLEO IN
BEFORE PERMIT IS ISSUED (Please Print or Type and sign at bottom)
2l/!;i;7{ /L//)-Ij <:-f. NE
3. LEGAL DESCRIPTION ~F.lS
1. DATE
/O~ tf-o <I
BUILDING INFORMATION
11. SIZE OF STRUCTURE
(Hei!;.t1t) (WIdth) (Depth)
LOT
BLOCK
PID
Z5 QZ3. ()(J1-./
12. NO. OF STORIES
ADDITION
13. lYPE OF CONSTRUCTION
(Address) '( I~ (Tel. No.) 114. FLOOR AREA APPORTIONMENT USE
/ L/ (J-/'f1/<..+.~: C(5";l. -;;)?~ ~ 5 .:L
(Address) (Tel. No.)
I
6. BUILDER (.N, ame) (Address) (Tel. No.) qS~ 15. NUMBER OF OCCUPANTS OR SEATS
MA.1I21AS(!flI^,c.<;~~ SrrJ,f-tl.rtd by, M-fi/q.. <?.3f1- OCCUPANTS
7. TYPE OF WORK' Fireplace ~ Septic ~ Deck 0" Re-roofing ~ Porch 0 SEATS
New Construction ~ Alterations 0 Addition 0 Finish Attic 0 Re-siding ~Finish Basement 0 '16. PROJECT COSTNALUE /
Chimney LI Misc. ~ /2 i -i~ r /lQ.LL::U'O.....aS ~ SqfQ3 c:aJiDcloors
8. PROPERTY AREA OR ACRES 19. PROPEHTv DIMENSIOtli- . /10, CULVERT SIZE 17. COMPLETION DATE I ~ . .
Sq.F!. Width Depth Ves No ,(~~/z..{rk8 ~8.J/f(J{)s'aUfJ
I hereby certify that I have furnished infonnation on this application which is to the best of my knowledge true and correct. I also certify that I dm the owner or authorized agent for
the above ntloned ~erty and that all construction will confonn to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the
buildi al,ean rev tpis yenni(for Just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perfonn needed inspections.
X I.L(lh'AJ ;:)173 jlJ-4-1lt:;
Signature - License No. Date
4. OWNER Gr (Name)
12 flU e..a. #:J.{/J!l
~CT fIla';'e)
FOR ADMINISTRATIVE USE
SETBACKS: Required
Actual
MATERIAL FILED WITH APPLICATION
Front
e."
Side
Side
SOIL TESTS
LJ ENERGY DATA
LI
BUILDING DEPARTMENT VALUATION 2500
USE OF BUILDING ~S .I'f- / "-
_ OFF STREET PARKING
SPACES REO.
SPACES ON PLAN
PERMIT VALUATION
PILING LOGS 0
PLANS & SPECS LI
SURVEY 0
PERCOLATION TESTS 0
SETS
COPIES
PLOT PLAN
LI
TYPE OF CONSTRUCTION: I II III IV V
City:
Amount Brought Forward .................. $
Park Support Fee ........................... $
SAC _....................................... $
Collective Street Fee ....................... $
Sewer Tap ................................... $
License Check Fee ......................... $
Pressure Reducer .......................... $
Meter Hom ................................... $
Water Meter ................................. $
Sewer & Water Connection Fee ........... $
Water Tower Fee ........................... $
Occupancy Group A B E F H IRS U
Division 1 2 3 4
Permit Fee ................................... $
Plan Checking Fee ......................... $
State Surcharge ............................. $
Penalty ....................................... $
Septic System ............................... $
Other ......................................... $
Subtotal............................... $
ThiS~~ ~e~mes VOLg Building Penni! When Approved.
By ~ ~ Date lo/"",/as-
Certificate of Occupancy
Water Tap ................................... $
Builder's Deposit ............................ $
Other ......................................... $
Total Due .............................. $7 ft,. 00
Paid 'Jr;,.Od ReceiDtNo. 5lJ30!
Date /0.5.05" Bv $//'
This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as reqi'e'Sted. This document when
signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to ",,,,,,,,,",,,,,"...,3. Before occupancy, a Certificate of Occupancy must be issued.
Issued
City Planner
0."
Special Conditions if any
24 hour notice for all inspections 447-4230
'"
PRIOR LAKE DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION
RECORD
SITE ADDRESS 42hO /40 TH 51 N6
TYPE OF WORK ;,:36. S fOE
USE OF BUILDING ;26s /(/12-
PERMIT NO. 06. oc;q I DATE ISSUED /0. S. o..s-
BUILDER /1/'/ RU560 PHONE # C/.52, 93S.c1C;>0f
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
~~q. /"O.e O(}OrG!tNft{OOW W/f1lipEr:TOR, pm /
W R/1 P tIIIIll/t;ltt--' ~ I /.:z/27/DT
PLACE NO CONCRETE UNtiL ABOVE HAS BEEN SIGNED
I I I
I FINAL ~ I /Z~7A/~ 1
"'"
FOR ALL INSPECTIONS (952) 447-9850
jc,!1r AI-t~ /JoZ)/J <<~ 6Zc-J.~
DATE TIME
SCHEDULED 1.y.J.? ~<:"'
Jc/~~4 SJ}
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
!/~6tJ
,-
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
,......efFRAMING
o j.ll5lllATION
~ ~I~~L.
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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.
~JJ
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o EXIGRADIFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
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f6r fQi~":- ~C /
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o WORK SATI
~T ACTION AND PROCEED
o CORRECT WORK. CALL 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 & SAFETY!
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