HomeMy WebLinkAboutPermit 4635B11
APP' 'CATlON FOR BUILDING PE~"AlIT
T~shlp/~ ~COTT COI,JNTY, MINNESOTA
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Project Address
Post Office City
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7ip ~S37 .:2.
Permit number '-It $-15 -II
Receipt number :1...tJ 70 'I
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Applicant fie.... f>erf
Address 11 0 4 ~
Owner (if other than Applicant)
Address
Contractor Name 5~< 1I
Address
APPLICANT FILL OUT INFORMATION BELOW: IJ
S('\~ II Phore (Home) '{'/I)-51b T (Work)
(ht:{p/~ Lu,l' City PI'J.~L-.ff.. State m,/}/) Zip
Phone (Home) (Work)
State Zip
s,~ 3 ,?-
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City
City
Phone (Home)
State
(Work)
Zip
State Contractor's License Number
Project Legal Desc,
Parcel No,
No, Acres
Se~ Lot Block _ Subdivision Name
The above applicant applies for a permit to: R.p Q "ff
(erecl, construct. enlarge. alter, repair, move. Improve. remove or convert as case may be)
use:
t\-nu '\ e.,
(house, garage, deck, rerool,elc.)
Type 01 construction: Wood Masonry_Other _ Type of heating system
Dimensions 01 structure
Esllmated cost or value J-;)., -'l"'-""'<< Number 0' Bedroom.
NOTE: A survey Is required by a registered surveyor for all new home applications on less th.n 10 .cres.
If a survey is not required, a Plot Plan must be submitted. Please contact the Building Department for a complete list
of items required for permit approval.
Applicant hereby agrees that, upon issuance of this permit, all work shall be done and all materials used shall be in
compliance with any applicable township, city and county ordinances. The applicant agrees to abide by all zoning
regulations, and utilize this structure for i~\rmi\leld u~ \ . ^ (\
'i\~ ../~X 7-J~-OO
Applicant's Signature Date
~~TOWNSHIPORCITYUSEONLY~~~
Recommend Approval
Recommend Disapproval
Permit complies with the Wetland Conservation Act
Subject to following Conditions
Signature of Township or City Clerk (or representative)
Date
~~~ COUNTY OR CITY PLANNING USE ONLY .......""'.....-........"...."..,:~:~
Minimum setbacks: Road
Approved Denied
following condition"
Signature Planning)
Signature (Environmental Health)
Side Rear Lake/CreeklWetlartd 7"nlng district
By Planning/Environmental Health, subject to existing regulations and the
Date
Date
--~COUNTYBUILDINGUSEONLY~~
Approved
Denied
By Building Official subject to existing regulations and the following conditions:
Signature
. Date
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Additional Comments:
FEES: Land Use Permit
Sewer Installation Permit
Plumbing Permit
PlbgjMech. State Surcharge
Bldg. State Surcharge
Building Permit
Plan Check
Erosion Control
.(P/
'-17.'10
3/, /3
TOTAL FEE
7 '1,t,4
06600-2805 (10-961M)
White.County Yellow- Township Pink-Appiicant Gold. Township
COUNTY OF SCOTT
INSPECTION NO~5 B 11
PERMIT NO ~L
TOWNSHIP/CITY
17048 MAPLE LN
PHONE: 612-496-8334 OR 612-496-8475
2000/08$DII._/_/13:00 TIME:
SCHEDULED
COMPLETED <](-1-(7(;) I' ,DC)
~
ADDRES~
OWNER
~i;bLL
:X::"::' ;;Hr.ILY
CONTRACTOR
roof final
TYPE OF INSPECTION
COMMENTS:
tcl >lP,
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(l V!:lQ,,'1,
~ 1M__ (j
)
/1
;1iork Satisfactory: Proceed
1:1 Correct Work Call for Reinspection before Covering
1:1 Correct Unsafe Condition within _ Hours Inspector will Return
1:1 Correct Work & Proceed
1:1 Stop Work Order Posted Call Inspector
1:1 Inspection Required Call to Arrange Access
BUILDING INSPECTION OFFICE: 200 Fourth Avenue West, Shakopee, MN 55379.1220
Call for the next inspection 24 hours in advance I I
Owner/Contr. on site p~ ~l!P InspectOlc:::At'_ 't:f'1/.L -
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