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Home My WebLink AboutLA109398 y PERMIT (;ity of Lakeville Permit Type: Building ' Zd195 Holyoke Ave Permit Number: LA109398 Lakeville, MN 55044 (952)985-4440 *LR 1>~9398* www.ci.lakeville.mn.us Date Issued: 01/21/2009 Site Address: 16358 Elm Creek La Lot: 003 Block: 001 Addition: Fieldstone Creek 3rd Addition PID: 22-26702-063-18 Use: ~KZZ-267QJ2-Q163- 18* Description: Sub Type: Res Addn/Repair/Rmdl Construction Type: Work Type: Repair Description: Water Damage Census Code: 434 - Addition/Bsmt fin/Decks/Porch Occupancy: Zoning: Square Feet: 0 Comments: WATER REPAIRS Fee Summary: Descri tp jOp Amount Revenue Code 1997 UBC Permit Fee $111.25 1000-4151 i Valuation: 5,000.00 plan Review $0.00 1000-4170 Surcharge -Based on Valuation $2.50 1000-2127 Total: $113.75 Contractor: -Applicant - Owner: GIERTSEN COMPANY Syed Hassan 8385 10TH AVE NO 16358 Elm Creek La GOLDEN VALLEY MN 55427 Lakeville MN 55044 {763) 546-1300 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. Applica ermitee: Signature Issued By: Signature Office Use Only RESIDENTIAL BUILDING ~ ,N: PERMIT APPLICATION permit Number i CITY OF LAKEVILLE ~ ~ ~ BUILDING INSPECTIONS DEPARTMENT Received By s ' 20195 HOLYOKE AVENUE _ ! LAKEVILLE, MN 55044 952-985-444D Date Received ~.:.~~~1 www.ci.lakeville.rnn.us ? jam. ~j r~ Fee Total SITE ADDRESS: ~ ~ ~ J C) ~ /~f ~/C/C ~~J/L~~'~ MAILING ADDRESS: CITY: STATE: ZIP: JOB DESCRIPTION: ESTIMATED VALUATION: PROPOSED START DATE: END DATE: (New Residential Only): LEGAL DESCRIPTION: LOT: BLOCK:- SUBDIVISION: APPLICANT IS: ? RESIDENT OWNER ~ CONTRACTOR NEW MODEL HOME: ? YES ? NO IF YES -ADMINISTRATIVE PERMIT REQUIRED ISD # PLEASE FILL OUT THE FOLLOWING COMFLETELY NAME; RESIDENT OWNER HOME PHONE CELL PHONE: GENERAL CONTRACTOR CONTRACTOR: 1. - LICENSE BC ~ 7~6 ? Homeowner OFFICE PHONE --a ~ 49-I'-~f?Cj ~ LL PHONE: `7Fs`3 -~3~5- l~U ~ Contractor ADDRESS: IU's' /ai/L 11f CITY: ~ ~ ST: ?Y1N ZIP:SStiZ~ ELECTRICAL WORK CONTRACTOR: LICENSE CA ? Homeowner * OFFICE PHONE CELL PHONE: D 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: D 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) ~ ~ DATE ~ t7~/ APPLICANT'S SIGNATURE: r RESIDENTIAL BUILDING PERMIT APPLICATION PAGE 2 OFFICE USE ONLY BUILDING PERMIT TYPE REQUIRED INSPECTIONS SINGLE FAMILY DWELLING BUILDING DUPLEX EOOT~IG TOWNHOUSE UNITS POURED WALL DETACHED TOWNHOUSE UNIT GARAGES CONDO FOUNDATION ACCESSORY BUILDING FRAMING. REROOF LATH RESIDE FIREPLACE RES ADDN/REAIR/BMOC INSULATION DECK DECK FOOTING PORCH PORCH FOOTING LOWER LEVEL FINISHBUILDING FINAL ADDITION LOWER LEVEL FRAME FOUNDATION ONLY SITE MISCELLANEOUS OTHER UNDEFINED WELL SEAL DEMO SEPTIC TANK REMOVAL MOVED c~ $ ~ ' ELECTRICAL CITY BUILDING VALUATION ROUGH-IN TRENCH BUIIDING PERMIT FEES FINAL $ 2 ~ PERMIT FEE MECHANICAL $ PLAN CHECK ROUGH-IN $ 2 ~ ~ O SURCHARGE AIR TEST $ METRO SAC FINAL $ CITY WATER HOOKUP UNIT PLUMBING $ CITY SEWER HOOKUP UNIT ROUGH-IN $ LANDSCAPE ESCROW FINAL $ TREE ESCROW METER SIZE $ MISC ESCROW PRESSURE REDUCING VALVE $ ELECTRICAL SEWER AND WATER $ PLUMBING FINAL $ MECHANICAL STREET DRAINTILE $ SEWER & WATER $ OTHER BUILDING INFORMATION TYPE OF CONSTRUCTION ~ 17J ~ ~J~ TOTAL ZONING CODE EDITION APPROVED BY: FIRE SUPPRESSION SYSTEM OCCUPANCY GROUP BUILDING INSPECTOR: ~ DATE: I'Z ~ PLUMBING/MECIifANICAL INSPECTOR: DATE: COMMENTS: ~ ~l~- ~-e rs (Revised 03/26/2007)