HomeMy WebLinkAboutBuilding Permit 15. 1360 0. .0'RID :
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In
MEMORANDUM
DATE: Friday, December 4, 2015
TO: Janet Ringberg
FROM: Lynda Allen
RE: Building Permit#15-1360
4993 Martindale Street NE
The contractor at the above referenced address will not be performing the work and has
requested a refund of their permit fee.
$74.75 /2 =Refund of$37.38
Return to:
Elder-Jones Building Permit Service, Inc.
1120 East 80th Street
Bloomington, Minnesota 55420-1498
Thank you `'
c e
Lynda S.
Building :.ervices Assistant C ks
AIlit5,� 4/j‘
;vim
of PRfO� CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE Date Recd
m AND UTILITY CONNECTION PERMIT ii, 7 (S--
I. venae File
2. Pink City /5-,-
V I PENT NO. l� )3( 2 I
type or print and sign at bottom) 3 Yellow Applicant V
ADDRESS �
Li 9 9 3 iY1 Q r I-i n d o /t, {_.ye 'VE ZONING(office use)
LEGAL DESCRIPTION(office use only)
LOT q BLOCK 2-- ADDITION JJlae 4-76 513 Tiros/4 Cl¢
e PID zs 07„q —007 4_10
WNE(OName) U@ O r 1 1(, h l S i -C rf 3
p /y� (Phone) 1 3 1 . 9 a y ?
q p
(Address) L 1 3 J ) j.?r-A n a' ' 4 54. NE
E
BUILDER
(Company Name) THD At- Home Service, Inc, (Phone) ?5 2/34/S. C 0 Y7
(Contact Name) 2690 Cumberland Pkwy, Ste 300
(Address)
Atlanta, GA 30339-3913 (Phone)
Lic#CR268257 Ph. 763/542-8826
TYPE OF WORK 0 New Construction [Deck OPorch
DAdditionORe-Roofing ORe-Siding ['Lower Level Finish ❑Fireplace
DAlteration ❑Utility Connection
ODE: I.R.C. ❑I.B.C. �tQa1o% des/' tit/4 �)'A / in Ax»/i4,
'[�f4isc. 010/n I !1
e of Construction: I II III IV V A B
pancy Group: A B E F H I M R S U PROJECT COST/VALUE $ 3 3 7
vision: 1 2 3 4 5 (excluding land)
II hereby certify that I have fitmished 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-mentioned 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 can revoke this permit for list eau . Furthermore,I hereby agree that the city official ora designee may enter upon the property to perform needed inspe hors.
�� _ CRa �vaS7 ° a 1, ��
Signature
Contractor's License No. Date
Permit Valuation
Park Support Fee
Permit Fee $ SAC
, telD
Plan Check Fee $
$ Water Meter e 5 $ 1' 5$
State Surcharge $ 1Pressure R cer
Penalty $
$ t Sewer/ ter Connec
n Fee , $
Plumbing Permit Fee $� 00
Water ower Fee #
Mechanical Permit Fee $ \siiii.
Build 's Deposit $
Sewer&Water Permit Fee $ Other
Gas Fireplace Permit Fee $
$ TOTAL DUE $-7}5 4,5/
This Application Becomes Your Building Permit When Approved Paid ,1 !'
Receipt No.
Date l ( , 4 i I s- By r'— )
Building Official Date 40
lipsto cerequest in above application and accompanying documents accordance e Zoning Ooas u
signed byrtify thethat Citythy Planner constitutes a temporary Certificate of Zoning complianceis andin allows construction toCity commencerdinance Before occupancy,andmaypra ceed Certs icatereqof Occupancyested. This mustdocument be
issued.
Planning Director Date
24 hour notice for all inspections(952)447-9850 Special Conditions,if any
4646 Dakota Street Prior Lake.MN 55372