1518 Lakeview Curve? • CASH RECEIPT ,
CITY OF EAGAN
3830 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122
DATE r ?
19
NECEFvEO
FROM ?
AMDUM $
8 DOLLARS
iro
? CASH Q CHECK
wn y Q?
., _
FUND OBJECT AMOUNT
' ..
Thank You BY
Whne-Payers Copy
Yellovv?-Poatf^9 CoPY
Pink-Flle Copy
i CASH RECEIPT
CITY OF EAGAN
1 3830 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122
i
DATE 19
' I
IECENED . - ?
FROI/ r 1
?
tMOUNT $ ?
? CASH C] CHECK
eY
DOLLARS
ioo
W,ne--Peyars Copy
Ye1low-Postin9 CoPY
Pink-File Copy
Thank You
CITY OF EAGAN
3830 Pflot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHON E: 454-8100
BUILDING PERMIT
To be used for S'' i??I? Est Value ?'6y,?
Receipt *
Date Sin i
19 Es
SiteAddress 151$ LAXYVIBV CURWH
Lot 3 Block 4 SeclSub. MNSY POIPdT
Parcel No,
m Name CUI.LtGIK CIZY CQ11SZ'RUCTiOl1
3 Address .= (yr) # - IST S? W
0 CityA1'Pt-.e Phone 43 _? -• 1211
, a fvame SAM
0 ¢ AcWress
? Citv Phone
Name._
Address
City _
I hereby acknowledge that I have read this application and state that the
infarmation is correct and agree to comply with all applicable State of
Minnesota Statutes and City of Eagan Ordinances.
Signature of Permittee
A Building Permit is issued to: ?UI.L.[.(',.E C I'."`[ _ Cvh"ST
on the express cond ition that all work shall be done +n accordance with all
applicable State of Minnesota 5tatutes and City of Eagan Ordinances.
Building OHicial '
OFFICE USE ONLY
On Ske Sewage Occupancy
MWCC System X 2oning ?-?
On Slte Well (Actual) Const v-?
City Water X
(Aliowable)
PRV Required x * of Stories
Booster Pump Length 42'
Depth 421
S.F. Total
Footprint S.F.
APPROVALS FEES
4?2'?
Engr./Assess. _ Permit
Planner Surcharge ?
Council Plan Review
?
Bldg. ON. SAC, City
?'
Variance SAC, MWCC
?
Water Conn.
67 • 00
water Meter
RoadUnit 3145•oo
204•W
Treatment P1
Parks
TOTAL 2 ??
- CITY OF EAGAN ,
? -? 3830 Pilot Knob Road, P.O. Box 21-1 99, Eagan, MN 55121
PH ON E: 454-8100 ?
BUILDING PERMIT Receipt ?
SF DWG1GAIL
$62*OOC
T
d f
b
l 'EPT i
D 96
1
e use
or
o
Est. Va
ue ate ,
9
1
Site Address 1518 LAlGEYI?W ::'UF.1lK OFFICE USE ONLY
4
sTMY POINT
3 On Site Sewage Occupancy ft` 3 j''"' 1
Lot
Block
Sec/Sub. X
MWCCSystem Zoning
ParCel No. l v'N
On Site Well (Actua
) Const
GULt
EGE CZn CONSTSVMCfi Cirywater Y (Aliowable) V"N
a
.
Name
z Address 6970 1515'? ST V PRV Required x # of Stories
42/
;
a ? ?tr
City?r !'LE vALLEY Phone 431-1211 Booster Pump Length
Depth ?? ;
°?
O Name S A M F S.F. Total
.
? Q Address Footprint S.F.
r°C- City Phone APPROVALS FEES
d ^
?
z
Engr./Assess. _
Permit
? ?
µ
'
Planner _ Surcharge
=Z ress
Add
?
L) v Council Plan Review
Q W City Phone Bldg. Off. SAG City
I hereby acknowledge that I have read this applicatfon and state that the Variance SAC, MWCC ?'
intormation is correct and agree to comply with all applicable 5tate of Water Conn. ?
Minnesota Statutes and City ol Eagan Ordinances. Water Meter
Signature of Permittee Road Unit
'LZI.'1'L?'i" C1'??k "(??'+iT ? }
A Building Permit is issued to: Treatment P1 ?
on the express condition that all work shall be done in accordance with all Parks
applicable State of Minnesota Statutes and City of Eagan Ordinances. ??
TOTAL ?
Building Official---
Permit No. Permit Holder Date Talephone it
Plumbing C/C/ C?•?, cir/ F`?/(^:,'° /C ??,;??'
H.V.AC.
Electric
SJ
Softener
Inspsction Dnta Insp. Comments
Footings I ?
Footings II
Foundation
Framing ?.2
Roofing
Rough Pibg. O-/
ROUgh Htg.
Isul.
Fireplace
Final Htg. ?= r ?--
'
Final Pibg. r --?
Bldg. Final
Cert. Occ.
Temp. LP
Deck Ftg.
Deck Final
Well
Pr. Disp.
CONTRACT PRICE:
r
Site Address
Lot Black
? Name '
Address
c Ciry- ? -? a-
c Name
Address
O CitY'
MECHANlCAL PERMIT
3830 PILOT
RECEIPT #
MN 55122 DATE: -
/
I
TYPE OF WORK
Forced Air =5 ~ M BTU
Boiler M BTU
Unit Heater M BTU
Air Gond. M BTU
Vent. CFM
Gas Piping Oudet s # i
Other
I
01
FEE:
S/C:
TOTAL• ? } .' . ?. :.
BLDG. TYPE WORK DESCRIPTION
Res. f New ?--'
Mult. Add-on
Gomm. Repair
Other
FEES
RES. HVAC 0-100 M BTU - $24.00
ADDITIONAL 50 M BTU - 6.00
(RES. HVAC INCLUDES A/C ON NEW
CONSTRUCTION)
GAS OUTLETS (MINIMUM - 1 PER PEkMln - 1.50 EA.
COMMIIND FEE - 1% OF COiVTRACT FEE
APT. BLDGS. - COMM. RATE APPLIES
TOWNHOUSE & CONDOS - RES. RATE APP4IES
MINIMUM RESIDENTIAL FEE - ALL ADD-ON &
REMODELS - 12.00
MINIMUM COMMERCIAL FEE - 20.00
STATE SURCHARGE PER PERMIT - .50
(ADD $.50 S/C IF PERMIT PRICE GOES
BEYOND $1,000)
SIGNATURE OF PERM1TfEE i
, .?.....+V?•?. 'r-.? ... ....-.-.... i. ..-. . .. .... ?.... ?..q , ....e..y_ :,» rya...+.e .?.. ? .. . .. ._
PERMIT #
' PLUM8ING PERMIT RECEIPT #
CITY OF EAGAN
3830 PILOT KNQB ROAD, EAGAN, MN 55122 DATE:
CONTRACT PRICE: PHONE: 454-8100 ?
Site Address '
Lot Block Sec/Sub
.i.?'-
Name
m
? ,
Address
c Ciry Phone
Name
c Address
p City PhOne
FEES
COMM/IND FEE - 1% OF CONTRACT FEE
APT. BLDGS - COMM RATE APPLIES
TOWNHOUSE 8 CONDO - RES. RATE APPLIES
MINIMUM - RESIDENTIAL FEE - $12.00
MINIMUM - COMM/IND FEE - $20.00
STATE SURCHARGE PER PERMIT - .50
(ADD $.50 S/C IF PERMIT PRICE GOES
BEYOND $1,000.00)
SIGNATURE OF PERMITTEE
BLDG. TYPE WORK DESCRIPTION
Res. New
Mult. Add-on
Comm. Repair
Other
RES. PLBG. ONLY - COMPLETE THE FOLLOWING:
NO. FIXTURES TOTAL
Water Closet - $3.00 R
? Bath Tubs - $3A0
1 Lavatory - $3.00
Shower - $3.00 .
Kitchen Sink - $3.00
Urinal/Bidet - $3.00
i Laundry Tray - $3.00
? Floor Drains - $1.50
' Water Heater - $1.50
Whirlpool - $3.00
Gas Piping Outlets - $1.50
(MINIMUM - 1 PER PERMIT)
Softener - $5.00
Well - $10.00
Private Disp. - $10.00
Rough Openings - $1.50
FEE: '
STATE S/C:
GRAND TOTAL:
IF EAGAN
(gertifir??it of (Orrupttnry
Citp of (Eagan
arprbunt uf Naming Jnprctin»
This Certificate issued pursuant w the requirei?ients of Section 306 of 1he Uni, f'orm Buildtng
Code certifying tlrat at the time of issuance thrs suucture was in compliance widt the various
ordinances of the City regulaling building carstruction or use. For the fo!lowing.uW cinnfic.am `7r TWGAR swe. rtnWt rro. 15554
occw.-r Tym Zonins nLa;c+ rya 9N
.
ownu oc euWam !??F? ?•;??i `.Z?';.'? ? Addnass A.rr ,"
HuildingAddress t5l? ?•r?.a'?? - ?i'?''.i', larlity i•:, Wi1 '.'..+
Dslt:
Building Oiricial
POST IN A CONSPICUOUS PLACE
'OFEAGAN
i pibt knoD A
Box 21199
3n, MN 55121
Permit IVo:
B/P No: -
Date: -2
-?-?4
Date: 9
:.C: `50. nOP;i Zoning•
? '?`? • `??' No. of Units:
Chg:
. Dep: I . ?
.. ?,; I agree to comply wffh the City of Eagan
?it Fee: Ordinances. ,
;harge:
,.. ;:•• p r *'Z #4' i BY
SEWER SERVICE PERMIT
j CITY OF EAGAN ` Permit Na `'?C3 Date:
3830 PUof Knoti Fioad Meter No: Size:
? P.O: Box 21199 Reader No: Oate:
` Eaaan, MN 55121
Conn. Chg: Zaning: Fs
Acct Dep: No. of Units: 1
Permit Fea 1;1„s'Ylpd
Surcharge: I agree to comply with the City ol
Tr. Plant Ordinances.
- - -
' OF EAGAN Permit No: 0 7 Date: 9-8-88 ?
i Pilo1 Knob R'oad Meter No: W!V 7.3 '79' Size: oc
Box 21199 Reader No: l0 Oate: 1o1-6 -kft
m, MN 55121
Con
Address: 1518 Lakeview Curve' L3 B4 5
. Chg: _449.Q8,pd Zoning: _
Dep: _ No. ot Units:
t Fee: _tP..(aQ,Pd
1 agree to comply with the City ot Eagan
CITY OF EAGAN
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 N? 15559
' '
BUILDING PERMIT PHONE: 454•8100 Receipt #S --? I I ?
To be used for SF DWG I GAR Est. Value $62, 000 Date SEPT 1 1988
Site Address 1518 LAKEVIEW CURVE
Lot 3 Block 4 Sec/Sub. STONEY POINT
Parcel No,
x Name COLLEGE CITY CONSTRUCTION
,z, Address 6970 151ST ST W
° CityAPPLE VALLEY phone 431-1211
a Name_
0
?a Address
? City_
.
Ww Name_
FW
i z' Address
aw GitY_
I hereby acknowledge that I have read this appiication and state that the
information is corred a re o comply with all applicable Stale of
Minnesota Stetutes d City f an ances.
Si9nature ot Permittee • ?
A Building Permit' ed to: COLLEGE CITY__QONST-
ontheexpressc n ionthatallworkshallbedoneinaccordancewilhall
apphcable State oi Minnesota StaNtes and City of Eagan OrOmances.
Bwlding Ofhcial
OFFICE USE ONLY
On SRe Sewage _ OccuDancy
MWCC System X Zoning
On Site Well _ (ACtual) Const
Ciry Water X_ (Allowable)
PRV Required X # of Stories
Booster Pump _ Length
Depth
S.F. Total
Footprint S.F.
APPROVALS
Engr./ASSess.
Planner
CouncJ
Bldg Off
Variance
FEES
Permit
Sumharge
Plan Review
SAC, City
SAC, MWCC
Waler Conn.
Water Meter
Road Unit
Treatment P 1
Parks
70TAL
R-3 M-1
R-1
V-N
V-N
42'
42'
422.00
31.00
211.00
100.00
550.00
550.00
67.00
325.00
204.00
2,460.00
BLDG. PERMIT NO_ t5
L,o-l- 3 61 c-,t S S'4
?e"V-Au
-?
01-3210 Bldg. Permit
01-3422 Plan Check C
q
, ,
013445
Surch./Adm.
L0C
.
? 01-3446 SAC/Adm.
? 01-2155 Surcharge 3 x
75-3860 Road Unit -D?S 0 c
J 20-2275 SAC q ?
.?
?
20-3865
WaterConn
J50
oO
? 20-3868 .
WaterTrmt
?
20-3716 .
Water Meter
Lo
OC
? 20-2252 Acct. Dep.
w 20-3713 Water Permit
to 20-3743 SewerPermit
79-3866 Sewer Conn.
28-3855 Park Ded.
TOTAL o.? ? ? O O
REQUEST FOH ELECTRICAL INSPECTION 0 ea-ooooi-os
1 See inshuc?ons lor complebng Ihis torm oo back ot Yellow copy. Fgi al/
-rJ. O "X" Below Work Covered by 7hia Request
ana aeo. Tvoa oi auimine Aonliuncee WireA Enuiument wi
Home Rmige Tempurary Service
Duplex Water Heater Lir{htiny Fixture5
ApL Bmldlng Dryer Electnc HeTtin
Commercial Bldy. Pumace Silo Unloader
InAustnal Bldy. Air Conditioner Bulk Milk Tank
Parm O1nvr oaci v Oihcr ISUCi.,tyl
t er SyeuW 01her Other
Compute lnspection Fee 8elow -
# Fee ServiceEnhenceSize M Fee Feetlers/SUbieeJers N Frze Circwls
0 ro 200 qm s 0 to 30 Am s .2 0 tn 30 Am s
Above 200 qmps 31 to 100 qmps / y- 31 to 100 Am s
Swimming Pool Above 100_Am s Above 7(10_AmPs
Transiormers Irrigation 8oorris SO Partial-
'Othe
r Fee
Signs Spectal Inspection ?D /
?
TOTA FEE^IC
Nertmrks ? ?
? y r,..?
BouBh-in Da?e ? ? tpe Ela
Inspectoq ?eroby
eridy ??a? ihe above
Flnal nspection has bee.
• ? ?T matle.
Thln reauesl voiE 18 monitre Irom
?1
Th,s reauest vmd /C^?/^/„/ ? 0
16 nwmhs fmm ?7 ?j"
E 132 50 ?.-q. PW?-??
Ra?uesl Date Fire N RmHh-m InsVection
RequireA?
DReatly Nnw?W,ll Nuufy Inspec-
/? `a? );a1'es ?NO 101 When fleadY
WLi ce.sed Elecvical Convacmr I hereby reGUest inspaction of above
? Owner elactncal work instellad af:
Street AAaress, Boa or Noute No. City
Sr Lm - e, -4 €a)
ecuon o. Townshi0 Name or No. qange No. Cwnty
pbKoT?
OcwUent IPPINTI Phone No.
C • Gr , ir? ? ?'
Power Sup0lier Atldress
Tw Lee..T?i.?G F'642uhiAiG-' N /
Electncal Contractor (CompanY Nomel Cnprractor"s License No.
lYl/.c9ST?? ' -<l
Mailing Address IConVactor or Owner Makiny Instailatmnl
a snr
Authonzed nature 1 nvactar Own Mak g InstallaLOnl Phonc Number
? ? 36i- Fr
MINNESOTA STATE BOAPD OF ELECTRIC THIS INSPECTION REQUEST WILL NOT
CrigBS•Midwey Bitlg. - floom N•191 BE ACCEPTED BY THE STATE BOAND
1821 Universitv Ave.. St. Paul, MN O6 UNLESS PNOPEN INSPECTION FEE IS
......... i aezrwnn ENCLOSED.
198$ BUILDING PERMIT 9PPLICATION - CITY OF EAGAN
SINGLE FAMILY DWELLINGS
INCL E 2 S TS OF PLANS, 3 CERTIFICATES OF SURVEY 1 OF ENERGY CALCULATIONS
NOTE: ADDRESSES FOR CORNER LOTS - CONTR9CTOR/HO ER MIIST DESIGNATE WHICH 9DDRESS
IS DESIAED. NO CHANGES WILL HE ALLOWED ONCE HOILDING PERMIT IS ISSUED.
MULTIPLE DWELLINGS RENTAL IINITS FOR SALE UNITS 8 OF UNITS
INCLUDE 2 SETS OF PLANS, CERTIFICATE OF SURVEY - CHECK WITH BLDG. DEPT.,
1 SET OF ENERGY CALC[1LATIONS
CO[•MERCIAL
INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS,
1 SET OF SPECIFICATIONS AND 1 SET OF ENERGY CALCULATIONS
To Be Used For: al m) f Valuation: Date: (3 '? U-
Site Address }h 1 ? za J(tve ?r ?urV`
Lot -3 Block A-1
Parcel/Sub S70 n cry_ C j v, ?
?
Owner
Address
City/Zip Code
e;.Z Ob0
On site sewage Occupancy R M-I
MWCC system ? Zoning R-I
On site well Actual Const V- N
City water _47Allowable V-N
PRV required ? N of stories
Booster Pump ` Length [U '
Depth S.F. Total
Footprint S.F.
Phone
Contractor
Address 697a -Is) r? S
City/Zip Code(f(w(e.. !/?11fe" ?S)?Y
Phone -/_Z 2 - f..Z))
Arch./Engr. S"? "I r qJ C Orl
Address
City/Zip Code
APPROVALS
Engr/Assess
Planner
Couneil
Bldg. Off.?i
Variance
FEES
Permit 2?'00
Surcharge 31 D o
Plan Review D-O
SAC, City Ino,Oo
SAC, MWCC SSn'Ofl
Water Conn .SSD, o0
Water Meter brJ, o,
Road Unit 392s.00
Treatment Pl o .OD
Parks
Copies
TOTAL
Phane #
.UAt..uAMOO
GrAIPA-P?-?
•.----
Zc;lX2rp, 'fC? a XiN'- s?oa
?Sna7
Lfo 0
20
x ?a = zon
r?9oy
?y ouSE
ZZ?t34= `7ye
i 7
10%)( l4 = lyo
?%z?
?6Y7 z 5??
? ?y X 49 = ?!'? `? 2 ?
?/230
t, y, , •?, ?:
-, •?.?{
??i i •u,
. ,
* ** *
* pIon
* engir
*,? **
2422 Enterprise Drive
Mendota Heights, MN 55120
:ering..
11 (612) 681-1914
Certificate of Survey for: COLLC GE CI { Y CONST ?
NoRtN
?J 00? /?99
L o T Z
?pKE D'?1• ?i ? ?' 9,
/ o0 0 \ 8f(3?hi
' `? ?/ ?? ? va 2 °n \ 3
\ k",;" ' •, b. ? tiy,' ?
?.a} '• tA° ?F€rorbs?D? \>
\' HeusE ? /
t?o
Z tiA ?'
ryN ?
L. o T
\ i
v
?
R C V E- D N
J.,AC?.r.t±T
paRMo REQMORIE a
• 900.0 Denotes exislino Flevafion ?
. 900.o Deno{es propaMd Elevolion
---- -- Denofes Orarna?e ? Ufrlr IJ' Easement
benotes DrUma eFlow Arrows
o Denoies monumenf
8 e4rint shownnre assumed
PROPOS£D NOUS£ ELEVA710N5
LowesP Floor flevalion = gkg,b
Top or 8/ock Elevafion = 8?2.0
G'arpfz 5lab Elevafion = 611, 7
LOT 3, BLOCk 4)$rONEy I?OIN7"
DQKOTA COeINTY, M/NNESaT<1 SUBJEfJ TD EASfMENTS OF/jfcORD
1 here6y cerNTy that this survey, plan or reporl wae pre red by ''``?? or under/ my direct supe?rvfis?ion and that I em Auly Registered Land Survayor
i under the laws of tha Stete oi Minnesote, Oated thlsday of AL'i ycet A.D. 19
Scale: 1?n?h= 40gell ,? ?
?? ?I I, I ROBERT B. SIKICH L.S. REG. NO, 14 91
/
/
/
v .titi
2n
E'Y'.R10R El' -LUPE AYERAGE "U" GUIr 'IAIIUN
? oVrNER
e_-_ • C-. ?
v
SITE AOURESS ? q iC1 •e Y, e u/ ?? r? e
LONTMGTOR eocLCGF G!T'Y ?nM%r-DATE o"???b'S( PfIONE
l ? - ?/ ??onQy o; n?
Uetermine working square footage of each.
1. 7otal exposed Yiall area ...... Z,,?os4- sq. ft. x_,11? a-
2. Total roof/ceiling arca ...... 1$'10 sq. ft. x 104110
Totai exposed wall area above flour =
a. Total wall window area ........................... 'Z 7- 3
b. Total door area ................................. c. Total sliding glass door area ................... p
d. Total fireplace wall area ........................ ? o
e. Total wall framing area (average 10%)...:........ _ lT O .
f. Total net wall area a6ove floor ................. ?2 00 ?u•=•
g. Total rim joist area ............................ 19 2.
p` .
Total-ekposed foundatton area ? (o 4- ,
h. Total foundation window-area ......... ............ o
i. Toal net foundatlon area above grade ......... ... lo h-
Detennine "U" value of each wall seyment.
?
a. ' '2'Z •n X ;,U??
• a.
b; G75 z nun
C: ? X "U"
?iZa ° 7•a4-
O n C
d. O X "U" O = ?
e. ?'70 X"U" , 092. ° ?5• e4-
f. (Zk.,O X "U°
y, lq 2 x ilu°
h. 0 ' X aun
i . 10 A- X "U"
?h3 ? • 5?.??
.O/1-1 = 7. 91
'p t O
3 ......................6 ..............Total
Tf j?nm #I is khn Same a5. )r 1r55 tfidn itrm P1 von r hwe mPt' }h- 1??t-0
}, t
Y.: . .. ?p
Total..exposed rnof/ceiling area = 17 S.G?
J. Total skyliqlst area .....:....................... O
k. 7ota1 roof/ceiling framing area (average lOX)... 179,
l. Total net.lnsulated rooF/ceiling area............ ?,,,r,-<f-
Oetetmine "U" value for each roof/ceiling Segment.
l1 Y 11u11 O 6 O
k. (18 x'Hu,.?,_____
xioull
4 ............... ........ ............ 7ota1 =• Z.•Fc:T,
If tatal of 14 is the same as, or less than 12, you have met the intent of
S[1C _GOOi+(c)1. •
Alternate Bullding Envelope Design
To utilize the total envelope system metliod, the values established by the'
sum of ltems 13 and 04 shal,l rtot be qreater ttian the sum of items al and 12.
1. + 2. _
3. + 4.
F?
_. ; ---?- -
: K MD LC VA L l1E A NA !. Y 5 i 5 Of L Q_ y' D ; L AZ EO A Rr-A5
VYINDGW AIMA :
TYpE OF W 1 N1JOW i
Tue N.v,,.c+o.u uuirs 14AVL gii../ Tisre'G /04 "R=VA&-µi, TM{Y A:c nM L.,sIio
aBoJc qV0 iyay 41 I55i441EO A OCJi4,V Cs.rc) Vw"..Lc. oF z'&<T
14CLuDING AIR IrILMS,
4'??RSi =? _
fDOtwqLZZ3 '4'foeTA4¦ ? - ZZ j
FOUNI7AT ION yVlNOOW /'1R.FA : TyPE oF ?ti???DOW :
TjIE VViNODW U+?jr+/a4 if&. aG" r'ESrCP FoR *lZ: VAA"C? THLY ARL AS l. .7LG AGey? ALLO
M9y' 8? ASIIC, NLOA L?l.S1yP4 V/.Rt-D VAI.uC (Mr- `[t"r ?uC4.?+0IA/Cr
Ai.4 PILrns ,
Uqz: I/r?.. • Foorn44 + FaornqC m Q
SLIbINi; <?LASS Dba1Z ARfsA: TyPc oa Doort:
St. iD+4<4 Gj l. 0?59 l700R S?II•V L O iR -{ 76}T 4C Fo R"R= v4"Kr-, THCY &BL '.a L-IAr+c F'
ADOt'L AtJO MA.y 6? ?SS?yHtiQ A VASJ4ZrNG3Af[) yw".4G oK•k"• i
.410 FILt'LS
i-ly; . IJ"4i = 1/ _ T====:l Foori+4r-
DooR ARa A : TYPG oF DovR :
paaQ UNiYS HAYG LrcN Tr-srtp ANO Kouyp ro HAVC AM
'R'-VALi.IA Of '1.HI JNCL+NO/NCf AIII P14.M3.
I/rtdi = I /! ' v J? = •i.? FOOTACt IL=
5PEcIqLs :
TYPE. '
y ?I
tbRM L_/ !s?lh4? I?rE',73U 1?1.^ SYrq E
?
r
AND • yVALUy
q?JAVYZIS oP•??t ?F? -?"ic. .??..?,...?.?
J
JaiST/FRAMI ro G AREv,
•R•. YA LU. E
- 'b 1 1N7?RiaR AIR FILM
3 Z- Soprwooo
?? ?GYPS?.M N/?LLbcn4D
t NTER iOa, AIR F?t-M
Z?Z?- ? TOTAL "Ft?..i VALU.E.
. ?--?--??--?
u.?? . ? / ?? ¦ 1 / ._ - _ •1.?`'?--?
,. 'L7:73S
, 7'oTAl. poor?.Gi - ?7?
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APFLICATION FOR PERMIT INOTEO pAYMFNP OF FEE AT TIME OF ?
; rsrLtcrMoN ooES rOr car ;
szz?cme nergc?nv, oF PMuur. ;
. .
SEWER AND/OR WATER CONNECTIO : Ir?'rM°r' oF s?+ ^rm/ox c,mT°t *
; xtzsruuTTazs w¢.t Nar eE scEYJtm :
. . t I37CIL PIItt4T HAS HEESd APPROVID. ?
dtV f#k'1?lR!*Y41ftf1r?4! 4'ifefMfllfi#ltifll
OF CC'iCjC8n
(PLEASE PRINT
1) PROPERTY ADDRFSS:
T.FY;AT, DESCRIPTION:
IF EXISTING STRL'CT[JRE, DATE OF ORIGINAI, BLILDING P°,.E2MZT ISSIIANCE:
PRFSENT ZONING/PROPOSID LSE:
Q CODM'IERCIAL/RETAIL/OFFICE
Q INDL?STRIAL
a INSTI'IVTIONAL/G0VERPIIMENT
2) ? NAME:
ADDRFSS:
CZTY, STATE, ZIP:
PHONE:
Nbnt Yeaz
IZ R-1 SINGLE FAMILY
? R-2 DL?PLEX (3+.vv C'nits)
Q R-3 TOWDIIIOL'SE (Three + Units) ( Units)
Q R-4 APARTMENT/CONIDOMINIUM ( Units)
,Ltmioers iacense:
I? Active
Expired
Not recordec
St Initial
3) NAME: ???^n 4
ADDRESS: !b l B
CITY, STATE, ZIP: -RI60/4,
PxorE:
4) C_w •,?a •.u?•
ADDRFSS:
CITY, STATE, ZIP:
PHONE:
?
? u. _ o?, • ?: u &?':SaTii?'..e? : o,n. ?i ??
5)
g?fCONNE)CTION TO CITY SE44ER Ej CONNECTION TO CITY WATER O 0'IHER
6)
-7`W
:r*****************?***'?,r?*?**??*******?*+*******?*?*+?**,r*,?*?**?*?*******?++?**?+*x?********?**?
*
TI3E GOLD COPY OF THE PII2MIT WILL BE SIINr DII2FX.TLY TO PUBLIC WORKS TO FACILITATE MEl'ER PICK-OP.
* PLEASE ALIiOW 'iW0 WORKING DAYS FOR PROCFSSING. SONIDONE FROM TM CITY WILL ODN1'ACT YOD IF 7Y]ERRE 'f
* ARE ANY PROBT,EMS. +
???* x?****r e**** r*,r,r,e ****,rt*+*+?+,r**,tr+r,r**?t**?**+??***?*****?**,+r*,tt****,t*+**t**** ?+****,t**?***?**;
FOR CITY USE 4NLY PERMIT # ISSOED
G 7 ' .
Pd w/Bldg. Permit FEES:
$ $ /G' 5--2:) SEWER PERMIT (INCLUDE SURCHARGE)
$ $ WATER PERMIT (INCLUDE SC'RCHARGE)
$ (n 7'U Z) $ WATER METER
/COPPERHORN/OUTSIDE READER
$ $ WATER TAP (INCLDDE CORPORATION STOP)
$ $ SEWER TAP
$ $ I??•p? ACCOUNT DEPOSIT - SEWER
$ $ ACCOUNT DEPOSIT - WATER
$ SS 0 g--6 $ WAC
$ $ SAC
$ $ TRLNK WATER ASSESSMENT
$ $ TRONK SEWER ASSESSMENT
$ $ LATERAL BENEFIT/TRUNK SEWER
$ $ LATERAL BENEFIT/TRUNK WATER
$ $ WATER TREAT
MENT PLANT SURCHARGE
$ $ OTHER:
7 $ S?- U J
$
- TOTAL
(5; 711
l f 72
z3
RECEIPT RECEIPT
DOES DTILITY CONNECTION REQUIRE EXCAVATION IN PUBLIC RIGHT OF WAY?
F--j YES IF YES, THEN A"PERMIT FOR WORK WITHIN PUBLIC
Q ROADWAY" MUST BE ISSUED BY THE ENGI[VEERING
NO DIVISIO
[V. LIST AS A CONDITION.
SOBJECT TO THE FOLLOWING CONDITIONS:
APPROVED BY:
TITLE:
DATE: