HomeMy WebLinkAboutPermit 4233B11
Apr ICATlON FOR BUILDING PF-'IIIIT
SCOTT COUNTY, MINNESOTA
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Project Address
Post Office City
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Permit number Lj;). 3 ?.;~ /1
Receipt number '-"nJ
Zip
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L I ftPPLlCANT FILL OUT INFORMATION BELOW:
Applicant -!\ r'J; r-;~ 0 adl1 , __~. Phone (Home) rfh{~wOrk) y30 -/351
Address LvI/ AI!...0/r /JlY'lf toad". cityfl?d,/...4Ke State MAl' Zip SJ..3 72
Owner (if other than Applicant) Phone (Home) (Work)
Address City State Zip
Contractor Name _
Address
State Contractor's License Number
Project Legal Desc.
City
Phone (Home)
State
(Work)
Zip
Parcel No.
No. Acres
Sec
Lot
Block
Subdivision Name
The above applicant applies for a permit to:
(erect. construct, enlarge, aller, repair. move, improve, remove or convert as case may be)
USf"
(house, garage. deck, reroof,etc_)
Type of construction: Wood Masonry _Other _ Type of heating system
Dimensions of structure
Estimated cost or value 3,) ::St:;(.,(Qrt'::,5 NumberofBedrooml ,-::::
I
NOTE: A survey Is required by a registered surveyor for all new home applications on les8 than 10 acres.
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 materiats used shall be In
compliance with any applicable township, cit nJl county ordin ces. The applicant agrees to abide by all zoning
regulations, and utilize this structure for ~ted use. d- k
v /APPlicant's"Signature' D~ =--""~" ,
~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
~COUNTYORCITYPLANNINGUSEONLY~
Minimum setbacks: Road
Approved Denied
fOllowing conditions:
Signature Planning)
Signature (Environmental Health)
Side. Rear Lake/CreeklWetlMd 70nlng district
_By Planning/Environmental Health, subject to existing regulations and the
Date
Date
~~COUNTYBUILDINGUSEONLY~~
APpr:;p ~ D~~ _BY Building Off~.i _ s~~~ to exis' g regulatio nd the fOllowi~nd~ns: /7
-t'.I' ~ ~ -...d/... rr/I /1';,<.M.. ~/~./"~
Slg~atu~" ~t;r,:0:A ~ -' . () Dat~ f-:';;~99 ~
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Additional Comments:
FEES: Land Use Permit
Sewer Installation Permit
Plumbing Permit
Plbg./Mech. State Surcharge
Bldg. State Surcharge
Building Permit
Plan Check
.9/
-r 3, 0 'l>
a7,95
Erosion Control
TOTAL FEE
'7 /I&~
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06600-2805 (10-96 1M)
White.County Yellow. Township Pink.Applicant Gold. Township
COUNTY OF SCOTT
INSPECTION NOTICE
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'S. L COMPLETE~!Z-~! ..,'(
t"10l{1 WlJ"h-fau::>^ R-O
n l'Xr'\I">
o FOOTING
o FOUNDATION
o FRAMING
:;. 0 INSULATION
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L.l. NAL ruu--y-
'0::( PROGRESS
CI) 0 DEMOL
~ [) FIRE PAEV
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8 .L' PROJECT COMPLETION DATE'
~ORK SATISFACTORY: PROCEED [) PHOTO TAKEN
[) CORRECT WORK & PROCEED
o CORRECT WORK CALL FOR REINSPECT ION BEFORE CovERING
o CORRECT UNSAfE CONDITION WITHIN HOURS INSPECTOR Will RETURN
o STOP WORK ORDER POSTED CALL INSPECTOR
o INSPECTION REQUIRED CALL TO ARRANGE ACCESS
PERMIT NO.
TOWNSHIP/CITY
ADDRESS
OWNER
CONTRACTOR.
COMMENTS:
J>~ oc-"
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o PLUMBING AI
[) MECHANICAL
[) WATER HOOKUP
[) SEWER HOOKUP
[) SEPTIC INSTALL
o SEPTIC MAINT
o SEPTIC FINAL
[) PLUMBING FINAL
~
L~olr-<'
PHONE: 496-8334 Or 496-8475
DATE TIME
SCHEDULEDX'-~:l,-9. '1
\1'3(:)
7/ : ~O-
[) SITE INSPECTION
o EXCAVATING/GRADING/FILLING
o LAKESHORE/WETLANDS
o COMPLAINT
o FOLLOW-UP
o FIREPLACE/CHIMNEY THROAT
o FIREPLACE/CHIMNEY FINAL
o GAS LINE PRESSURE
o
/_0""'" 1'/
BUILDING INSPECTION OFFICE
Courthouse A102. 428 S'~Olmes. akopee. MN 55379,
Call for the next Insp n hours In a~d
Owner/Contr. on site ~ff~ (~
Inspecto~:-r~ #h-.,L ~ _ .
~. .,. - l/ r - / --- Y'V'"
06600-2807 (6-97 5M)
White Copy/lnspeclor"s File Canary Copy/Records Pink Copy/Site