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HomeMy WebLinkAboutDriveway Permit 16-D-28 i *S•ingle Family, Multi Family, Commercial , Industrial , Agricultural Ir DRIVEWAY PERMIT FOR CITY USE ONLY 0{ C'..t "Exhibit B" PERMIT# /b - - �` i. Email completed form to NBriese@CityofPriorLake.com DATE f d/g�/� c� r �n Mail$30.00 check payable to City of Prior Lake to Nate Briese CHECK# b F a 4646 Dakota St,Prior Lake MN 55372 RECEIPT# L (3 9 iANtsoc LLL /1 APPLICANT NAME: jl n S 0#40 / MAO ( 7, 5 �_ &��G._ OWNER NAME: 0l '�'7 J PROPERTY ADDRESS:// ni ;�6 ea-4 j4)0,61. c PHONE NUMBER:64.17-a?",?".S7EMAIL ADDRESS: WCC >ce7e.pot i ,.c-p PROPERTY CLASSIFICATION Single Family Home * . .-----'- r . * `Yoncrete, Paver, Other Proposed width of temporary or permanent driveway /4, (Please provide sketch on reverse side or on separate sheet)(Yes Is property located within the Shoreland District? _____)2 If yes,applicant must submit impervious surface calculation A4 4111"-) , G/3-kte2..//��_ The driveway is proposed off what roadway? ,14,-/(it v...o ci Pc.N-ch Cif -)7- Is driveway shared by another property owner? (If yes,signature of all parties is required) Yes // Estimated Start Date: Estimated Completion Date: /O-/9 Wil' //- t9 —7?-47 SKETCH REQUIREMENTS 1. A driveway sketch is required as part of this permit. The sketch can be drawn on page two of the permit or on a separate sheet. The sketch does not need to be drawn to scale, however dimensions must be provided on the sketch. 2. Driveway sketch should include the proposed driveway,existing driveway(dashed line), driveway dimensions, property lines,dimensions of driveway from property lines, building locations near driveway, arrow indicating north,surface features near proposed driveway location (trees, hydrants, utilities, etc.) 3. If on a corner lot,the sketch should include dimensions to intersecting roadways. CONDITIONS OF APPROVAL 1. No work under this application is to be started until application is approved and the permit is issued. 2. Where work on traveled roadway is necessary,traffic must be protected and flags,signs,safety cones and proper barricades must be placed in accordance with safety procedures. 3. No foreign material such as dirt,gravel,or bituminous material shall be left or deposited on the road during the construction of driveway. 4. Road must be swept clean after work is completed. 5. Prior to placement of concrete or bituminous surfacing,the applicant shall notify the Engineering Department at 952-447-9830 that the work has been completed and is ready for final inspection. 6. Permit expires 90 days after approval date. 7. Additional Conditions i rah) DRIVEWAY PERMIT f1, ,7! "Exhibit B" PI IMPORTANT--- BEFORE STARTING WORK EXCAVATOR AND •PEAT•R'S NOTICE This notice is to inform excavators and operators they must comply with Sections 2160.03 to 2160.07 of MINNESOTA STATUTES Call Gopher State One Call (800)252-1166 or 651-454-0002 Or go to www.gopherstateonecall.org Smart Phone: http://mnticketentrv.korterraweb.com As provided in Ordinance Numbers 1107.205& 1107.206, I/We the undersigned, herewith make application for permission to construct the driveway at the above location,said driveway to be constructed to conform with the standards of the City of Prior Lake and to any special provisions included in the permit. It is agreed that all work will be done to the satisfaction of the Engineering Department. It is further agreed that no work in connection with this application shall start until the application is approved and the permit issued. /s/ /s/ w4/ /moor's Signatur � Applicant's Signature FOR CITY USE ONLY AUTHORIZATION OF PERMIT Permit Fee$ 3o. 00 In consideration of agreement to comply in all respects with the regulations of the City of Prior Lake covering such operations,and pursuant to authorization duly given by said City of Prior Lake, permission is hereby granted for the work to be done as described in the above application and submitted drawings,said work to be done in accordance ith this application and submitted drawings. ENGINEER4ATIO : E( oaysfmwovaIdate) /,� j ,L ' Date /� //f7/6 --- #."&alis ali. ' •�necj_by City Official ! L 7 4' 4a '7/ aeU ct _a 1 . /4, filw. "A PROVEN NAME SINCE 1947" i www.bestblacktop.com F �_ __ LICENSED• BONDED• INSURED Milk = l� !�` lkiir BLOOMINGTON BURNSVILLE (952) 881-3514 (952) 890-4664 (952) 361-0653 FAX (952) 361-0653 FAX '> ,, , Name /4yvi y 04 c9-7/7"./62c9-7/7"./62 50 Date c9-7/ � Address ,f i' jaaL'io3,/ A/te Zip S a `aR Phone(h)4:57E5 3-/S//_ (w) Sales Rep.__/ )l1._ _Phone:l -2$l Approximately pi 7 70�- Square Feet Square Yards Tons Footing Blocks if footing blocks need repair there will be an extra cost. _ 3; — .... L_ ❑ Remove Apron Imove Driveway /> $'1 I ----> ( Z�ade&Gravel 1g / ` ° Er<cktop&Warranty r ill f 7 ?-itjN' I � ve Sod&dirt • a� - 1 �9'f<emotori(4) s,z - ❑Widen • f 7- f 1 , do ZIT New Driveway cost ` 0� 7 s-) lirf'ermit if Required /p©-- l Total Cost I ( — ILP — 10% I,,wn Payment _ , - Balance -P� ( ()00- f f o o' Asphalt •94� f compacted ! / � / V TTl."i' l Base established when digging out and using our Lime Rock/Class#5 base. R -a/ - /� O established when using your base and adding our Lime Rock/Class#5 as needed. r Ft'' viere / Property Owner ,..rDate -� eV, �} TERMS:10%down.Balance due up n completion.Fi ance Charge of 18%annually. Check to be made out to Jellisons Best Blacktop an.-given to Foremen on completion of job.Lien waiver and instructions will be given to you on how to care for your new asphalt at this time. NOTICE OF LIEN:Material meets Minn.Standards;labor will be in workmanlike manor.Persons or companies furnishing labor or materials for the improvement of real property may enforce a lien upon the improved land if they are not paid for their contributions,even if such parties have no contractual relationship with the owner.Minnesota law permits the owner to withhold from his contractors so much of the contract price,or withhold amounts from his contractor until the expiration of one hundred twenty(120)days from the completion of such improvement unless the contractor furnishes to the owner of claims for mechanics lien signed by persons who furnished any labor or materials for the improvement and who provided the owner with timely notice.The owner hereby waives all further requirements of notice under Minnesota Statue 514.011. Price Good for 30 Days due to asphalt pricing. Back of this sheet constitutes part of the contract Sign and return Top copy r rRi6 City of Prior Lake 0 \ 4646 Dakota Street SE RECEIPT n' ?A Prior Lake MN 55372 171 952-447-9840 i ReceivedReceipt: 7138 Of: Date: 10/18/16 Jellisons Best Blacktop Customer: Jellisons Best Blacktop 7625 Co Rd 50 Carver MN 55315 , e iptitiW""} Red&fpt°bescriptidn . GLNunbe thJ��� . * Driveway Permit 16-D-28/16565 Northwood Rd Zoning&Subdivision Fees 30.00 Receipt Total 30.00 TENDERED: Checks 6852 30.00 Total:30.00