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I
PERMIT
Clty Of LakeVllle Permit Type: Building
20195 Holyoke Ave Permit Number: LA108004
Lakeville, MN 55044
(952) 985-4440 * L R 1 (d 8 fl7 0 4
www.ci.lakeville.mn.us Date Issued: 09/15/2008
Site Address: 16726 Asterbilt La
Lot: 001 Block: 001 Addition: Spirit of Brandtjen Farm LakePointe Addition
PID: 22-71315-010-01
Use: NEC 2008
*2z-7 13 15-~ 1>?J-f~ 1
Description:
Sub Type: Addition -Residential Construction Type: V-B
Work Type: Addition
Description: Adding room in lower level--add screen porch
Census Code: 434 - Addition/Bsmt fin/Decks/Porch Occupancy: IRC-2
Zoning: PUD
Square Feet: 0
Comments' ADDING ONE ROOM IN LOWER LEVEL AND INSTALLING SCREEN PANELS
AT EXISTING COVERED DECK.
Fee Summary: Description Amount Revenue Code
Valuation: 3,000.00 1997 UBC Permit Fee $83.25 1000-4151
Electrical Addition/Remodel Fees $40.00 1000-4167
Plan Review $0.00 1000-4 ] 70
Surcharge -Based on Valuation $1.50 1000-2127
Total: $124.75
Contractor: -Applicant - Owner:
Charles Cudd CO Charles Cudd LLC
DBA: Signature Homes 275 Market St Ste 445
275 Market St Suite445 Minneapolis MN 55405
Minneapolis MN 55405
(612) 333-8020
I HEREBY AGREE THAT THIS WORK WILL BE PERFORMED ACCORDING TO: (1) THE APPROVED PLANS &
SPECIFICATIONS; (2) THE APPLICABLE CITY ORDINANCES & CODES; AND (3) THE MN STATE BUILDING CODE.
Applicant/Permitee: Signature Issued By: Signature
RESIDENTIAL BUILDING OfOffice Use only
PERMIT APPLICATION fP~~
CITY OF LAKEVILLE _ r ~
~ $UILDING INSPECTIONS DEPARTMENT ~ ~ eceived By
~~~r"° ~ 20145 HOLYOKE AVENUE ~i1
...j L
09 1 1 0 8 P12
AKEVILLE MN 044.
55
952-985-4440 ~ " Date Received
www.ci.lakeville.mn.us
Fee Total
SITE ADDRESS:_I 2 ~ /1 ~"i~qq~-81 L
~ L.,{~I ,
M?~ILING ADDRESS: CITY: ~ ~ Z(, 1+ STf I1. LT' L N~ STATE: 1 (~I ZIP: SS d Z~
JOB DESCRIPTION:_ I1DD STU~`9 ~v bPScd~r ~ AND r~Nyl~r-Z` ~DtiIC~-~,9 ~~Lk i
~ Sc SL~L~~~~
ESTIMATED VALUATION: ~ ~7 PROPOSED START DATE: 01 1 tom/ D~ END DATE: °I '~4-~~~
(New Residential Only): LEGAL DESCRIPTION: LOT: ~ BLOCK:. SUBDIVISION:
APPLICANT IS: ? RESIDENT OW/NER L~CONTRACTOR
NEW MODEL HOME: ? YES L9~N0 IF YES -ADMINISTRATIVE PERMIT REQUIRED ISD #
PLEASE FILL OUT THE FOLLOWING COMPLETELY
RESIDENT OWNER NAME. ~ }-k A 21.aFS Gv~ ~D ~ L L C
HOME PHONE#:(9l2 3~ ~~~{D`ZD CELL PHONE: I"~--~ 1~ 2320
'GENERAL CONTRACTOR CONTRACTORa _~aJLI,~S w~ D ~ ~1~. LICENSE BC2,b135¢'14-
~omeowner OFFICE PHONE i 2-3 3'3-- ~ Z d CELL PHONE:~o l 2-"~ \ °l ' ~L3"'trt~ ~?Vlt t~
~Y C:ontractor ADDRESS: ~ ~tl~ p Z.~R~ Ind ~ ~ ~ CITY: ~ ~-'1' Y~'~ UU~ ST: 'i ~ ZIP:~~
ELECTRICAL WORK CONTRACTOR: ~ ~ ~ c,_ LICENSE CA
? Homeowner * OFFICE PHONE CELL PHONE:
Contractor ADDRESS: CITY: ST: ZIP:
Single Meter on individual unit Meter Bank at end of building (Requires licensed electrician.)
PLUMBING WORK CONTRACTOR: LICENSE PM
? Homeowner OFFICE PHONE CELL PHONE:
? Contractor ADDRESS: CITY: ST: ZIP:
MECHANICAL WORK CONTRACTOR:
? Homeowner OFFICE PHONE CELL PHONE:
? Contractor ADDRESS: CITY: ST: ZIP:
~ SEWER/WATER CONTRACTOR NAME:
New Construction Only HOME PHONE CELL PHONE:
INTEREST EARNINGS ON THE ESCROW ACCOUNTS, IF ANY, ARE RETAINED BY THE CITY TO OFFSET THE
ADMINISTRATIVE COSTS ASSOCIATED WITH PROCESSING THE ESCROW APPLICATION AND REFUND. I HEREBY
APPLY FOR A BUILDING PERMIT AND I ACKNOWLEDGE THAT THE INFORMATION ABOVE IS COMPLETE AND
ACCURATE; THAT THE WORK WILL B IN CONFORMANCE WITH THE ORDINANCES AND CODES OF THE CITY AND
~ WITHT THE STATE BUILDING CODE, THAT I UNDERSTAND THIS IS NOT A PERMIT AND WORK IS NOT TO START
WITHOUT A PERMIT AND THAT THE WORK WILL BE IN ACCORDANCE WITH THE APPROVED PLAN
NAME OF APPLICANT (Please Print) CN~~:~S Gvd}(j~ ~M1?LE" ~1`1Sto~'P'~ DATE 1 I ~ ~ b~_
APPLICANT'S SIGNATURE:
i
t -
RESIDENTIAL BUILDING PERMIT APPLICATION PAGE 2
OFFICE USE ONLY "
BUILDING PERMIT TYPE REQUIRED INSPECTIONS -
SINGLE FAMILY DWELLING BUILDING
......DUPLEX FOOTING.
TOWNHOUSE UNITS POURED WALL
DETACHED TOWNHOUSE UNIT GARAGES
CONDO FOUNDATION
ACCESSORY BUILDING FRAMING
REROOF LATH
RESIDE FIREPLACE
~RES ADDNlREAIR/RMDL _Zl INSULATION
DECK DECK FOOTING
PORCH PORCH FOOTING
LOWER LEVEL FINISH -}BUILDING FINAL
ADDITION _~LOWER LEVEL FRAME
FOUNDATION ONLY SITE
MISCELLANEOUS OTHER
UNDEFINED WELL SEAL
DEMO SEPTIC TANK REMOVAL
MOVED
$ ~ ~ ~ ELECTRICAL
CITY UILDING VALUATION ROUGH-IN
TRENCH
BUILDING PERMIT FEES }C" FINAL
$ PERMIT FEE MECHANICAL
$ PLAN CHECK l ROUGH-IN
$ . SURCHARGE AIR TEST
$ METRO SAC FINS,
$ CITY WATER HOOKUP UNIT UMBING
$ CITY SEWER HOOKUP UNIT ROUGH-IN
$ LANDSCAPE ESCROW p~AL,
$ TREE ESCROW METER SIZE
$ MISC ESCROW RESSURE REDUCING VALVE
$ ELECTRICAL WER AND WATER
$ PLUMBING FINAL
$ MECHANICAL STREET DRAINTILE
$ SEWER & WATER
$ OTHER BUILDING INFORMATION
$ ~ Z ~ ~ TOTAL TYPE OF CONSTRUCTION
~!1.~~_ZONING
~A.~r ~ ~ CODE EDITION
APPROVED BY: ~ FIlZE SUPPRESSION SYSTEM
'~~t~OCCUPANCY GROUP
BUILDING INSPECTOR: DATE:rJ'~ /l -Carr'
PLUMBING/MEACHANICAL INSPECTOR: DATE:
COMMENTS: IW~~ rw~ ~ ° ~ ~ ~-~8/ eve r Lr. ~si~~rwy .fttw
m (Revised 03/26/2007)
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