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HomeMy WebLinkAboutUtility Connectio 14. 0172 z _0 �22 o v ��kO p $z ■ ok§ § $m A mokk7 m � � � 0 P �52 o rn > m Z ■ ® o Zb mm 1/ § - kz0r ■ ..4 -4 $ -,\B 2 mq zq§t n a o 0 7 q r 0 7 X ° ° �� co z § 0 m m2i $ � � 't 2 -1 z 0 0 _§_§ 7373_0 m o n ) -- n C zz - 20 k G § . r - 0O a k 43 -0 -0 . m q / $ � � o r■ , z R m ® o g X m CI i'0 0 00000$ g -n o 2■ $ - - § m az � mmE0 13 X a A gq 4\ msm � MI RI» F ■Z m117cn § K §§ ri 1O n❑ io n 000000 17 0 2 n g o 0 o 0 ■ m - II-n-n 0 $ o Kq P I R gi 0 ° 3 rig 0 8 8 ri m 2 f PI t -4 \ § IL m zr- 2222 z " 2 q� ■ » p z S K -9@ ( 2 0 �0 � �■ r, » , . - - z §§ # m n z 2 ; m 2 > > 2 n r o 3 } k m m M o 73 m % , �' P § o o mm IT ! 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Fill City 3 Yellow Applicant (Please pe or .tint and si: 17061 Sunset Ave SW ZONING(office use) ADDRESS 25-488-005-0 Minh &Southsakhone Nguyen LEGAL DESCRIPTI LOT q BLOCK ADDITION PID OWNER (Name) 1"6/► it/4v + Io y K &let V� (Phone) is-a, q311-2-89 �y'l�// (Address) L 70 b( 5 u� 5et A J-� S/tG Lpt e— BUILDER (Company Name) K-. VI I t (On 64-'1 14.41 Y1-' (Phone) 952 731 .214g (Contact Name) (Phone) (Address) j5-36 2go t& ,Pee# MAAJ Pia' 'e— I"4) J7( TYPE OF WORK 0 New Construction ❑Deck ['Porch ❑Re-Roofing ORe-Siding ❑Lower Level Finish 0 Fireplace DAddition DAlteration ❑Utility Connection CODE: ❑I.R.C. ❑I.B.C. 0 Misc. Type of Construction: I II III IV V A B PROJECT COST/VALUE $ Occupancy Group: A B E F H I M R S U (excluding land) Division: 1 2 3 4 5 I hereby certify that I have furnished information on this application which is to the best of my knowledge true and correct. I also certify that I am the owner or authorized agent for the above-mention. property and that all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building official c. revo• this p rmit for just cause. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed map ' X 1' I .���� !i ' Contractor's License No. -Da - afore Permit Valuation Park Support Fee # $ Permit Fee $ SAC # $2.47-3S-, 00 Plan Check Fee $ Water Meter Size 5/8";1"; $ ...5-(70, 00 State Surcharge $ Pressure Reducer $ /50,00 Penalty $ Sewer/Water Connection Fee # $ X500. 0 0 Plumbing Permit Fee $ ..5.".V ,j Water Tower Fee # $ /0 0 ©. 0 0 Mechanical Permit Fee $ Builder's Deposit $ Sewer&Water Permit Fee $ 3-6, 3-6Other $ p /� Gas Fireplace Permit Fee $ TOTAL DUE $5 7 V co . 0 0 This Application Becomes Your Building Permit When Approved Paid .5 7 Y/co.,- -1-1 R eipt No. G 096-3 I Date 3_ z-?_ /4/ Building Official 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 proceed as requested. This document when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy,a Certificate of Occupancy must be issued. Planning Director Date Special Conditions,if any 24 hour notice for all inspections(952)447-9850,fax(952)447-4245 4646 Dakota Street Prior Lake,MN 55372 • o 4 PRI04) Date Rec'd CITY OF PRIOR LAKE PLUMBING PERMIT F U + ESOzti I.Blue File PERMIT NO. 2,Gold City 3.Yellow Applicant lease a or that and sign at bottom) ADDRESS 17061 Sunset Ave SW ZONING(officeuse) 25-488-005-0 Minh &Southsakhone Nguyen LEGAL DESC] LOT q BLOCK ADDITION PID OWNER 4 l.y / .162 ql�� �"l 0 (Name) ,t nii 4- �7 OLL Sakh cone,� AJ7ttye ii_. (Phone) (Address) 1706 t S UNs d A-Ve, _51tAk&peg_ fyt Ai 5T3 7 9 APPLICANT (Name) _ . (Phone) (AddreL, _-2- t \ -t" A-1^-t. -71,t t,V M - kt Ai ✓✓ (Address) ' (City) (Zip Code) (Contact Person) (Phone) 9 a 2-- 29 Z'— 0 C APPLICANT SIGNATURE L ._/A_L_.a.. .1 DATE 3 26-- l R(fiqii&iii\) / APPLI'ANT PLEASE COMPLETE BELOW Quantity Type of Fixture Quantity Type of Fixture Bath Tub with or without shower Rough-ins Dishwasher Water Heater Floor Drain Water Softener Lavatory(Bathroom Sink) Stand Pipe(Washing Machine) Laundry Tray(1 or 2 compartment sink Sewage Ejector Shower Stall Backflow Assembly Sinks Backflow Assembly Test Bar Sink Lawn Sprinkler Water Closet(Toilet) Other YLUIVILSIrvo rtt ul• 4.51./NAILS Isr The Minnesota Statutes§.326B.148. FEE SCHEDULE HOMEOWNER—Plumbing Permit must "SURCHARGE"has been extended .. >f job cost with a$49.50 minimum Residentia be signed by Plumbing Contractor . The minimum surcharge for a . ResidentiE "fixed fee"permit is.$5.00'- , $ Building Permit# .,,, „__,_ _„ /PLUMBING PERMIT FEE Permit Fee $49.50 STATE SURCHARGE State Surcharge 5.00 TOTAL PERMIT FEE TOTAL $54.50 _ (Office Use Only) I This Application Becomes Your Building Permit When Approved _._._ Receipt No. Date By Building Official Date 24 hour notice for all inspections(952)447-9850,fax(952)447-4245 4646 Dakota Street S.E.,Prior Lake,Minnesota 55372 4 VRIO Date Rec'd � CITY OF PRIOR LAKE _ ,-- ASEWER AND WATER PERMIT 4fiNNESOo* I. Greenite PERMIT NO. 2. Yellow City 3. Gold Applicant 'lease •e or 'tint and si:• at' ADDRESS 17061 Sunset Ave SW ZONING(office use) 25-488-005-0 Minh &Southsakhone Nguyen LEGAL DESCRIPTION LOT 9 BLOCK ADDITION PID OWNER �A / / / 1 9 q Q (Name) I"t 1 Fl.A ¢ J�OG11h so-(�I j O✓1 e. M (Phone) q-CA 3 .2g 1 U (Address) 1712( 1 Sii-S1G- Atli 6k4Zeo?ee /4d 5.5.37 (Address) (City) (Zip Code) APPLICANT /�A M r (Name) /V 6 YZ 7U Cj�,I.��/17/ (Phone) '��oZ 9�J Y 2 (Address) 17 06 I l tlti.s�4( Ave_- 6'A � �c3 1 (Address) (City) (Zip Code) (Contact Person) (Phone) APPLICANT SIGNATURE / !/moi t'L---------- DATE 3 2 S- I 1 APPLICANT PLEASE COMPLETE BELOW Size of water service 1 inches. Location of any couplings from structure feet. Type of sewer pipe. ❑ ABC ❑ PVC ❑ Cast Iron Estimated length of sewer line feet. Clean out(if required) located at feet from structure. JtVVtK tic VVA I I_K VtKIVII I I-tt LA- FEE SCHEDULE $56.50 PAID BY HOMEOWNER. Residential sewer and water line connection $51.50 Industrial,Com'l&Multi-family Sewer&Water Contractor MUST sign Sewer connection only $25.50 Water connection only Sewer&Water Permit Form Estimated Cost $ Building Permit# __,,,_,_ „ ,.,.___'.. „T ^_^ SEWER AND WATER PERMIT FEE STATE SURCHARGE Permit Fee $51.50 State Surcharge 5.00 TOTAL PERMIT FEE TOTAL $56.50 (Office Use Only) This Application Becomes Your Building Permit When Approved Paid , Receipt No. Date By Building Official Date 24 hour notice for all inspections(952)447-9850,fax(952)447-4245 4646 Dakota Street S.E.,Prior Lake,Minnesota 55372 W SANITARYTON SEWER & COUNTRY SERVICE I N2730 40th Street West VO 'C E WEBSTER, MINNESOTA 55088 952 /652-2923 ❖ 1-800/ 417-2718 13231 TO DATE /67-0'15\--I Justin Klepperich �� 77.01,9VN,�+ 'ver ,:e d OPERATOR QUANTITY DESCRIPTION � Pump SepticPRICE �. AMOUNT 0 Holding Tank 0 Grease Trap *71 Lift Station • Excavate Manway r Backflush/Tank Agitation ❑100+ Foot Hose Extension 0 Install Riser - ❑ Float Switch Replacement 0 Pump Repacement _ ❑ Scott Coun Permit - Dakota County Log - Rice County Log ❑ Monthl Portable Restroom/s _ • 06-oft - ❑ Fuel Surchar.e ❑ Clean Owner's Portable Restroom/s ❑ Re.ular Portable Restroom/s _ ❑ Handica. Portable Restroom/s _ ❑ Handwash Stations TERMS: DUE UPON RECEIPT. 1 1,2°o Finance Charge after 30 days. TOTAL REVISED 12H1 75c minimum gha�� you! �,� °O u N % AS-BUILT TIES PROJECT ADDRESS: � O5.D ". DATE: NOTES: f I\ A W Q �+ 4.:;)(we- ® 0 Show following items: . Dimension to property lines . Lengths of pipe,offsets in pipe,depth of pipe,size of pipe,type of pipe,offsets from house corners . Show all termination points of draintile with ties to pipe(from two house corners) . Septic tanks:length of pipe,height of risers,pump type and model,size of tanks,offsets to house/well/property lines/mound,float setting . Sewer and water:length of pipe,depth of pipe,offsets in pipe,drop sections,offset between sewer and water,pvc and copper size and type ties to curb box . Drain tile:length of pipe,depth of pipe,slope of pipe,any interesections with other utilities,size of pipe,connections at house/garage/etc. . Mount:size of rockbed/sandbed/downslope/unslope,lateral spacing,hole size and spacing,depth of sand,length of force main.