City of Maple Grove

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Obstruction Permit Obstruction Permit Permit No. 2021-OP004, UID # 4271
App. Status: Returned for ChangesCity of Maple Grove
Engineering Department
12800 Arbor Lakes Parkway
Maple Grove, MN 55369

Kelly Matzke (612-968-3615)
 

APPLICANT

Applicant:
Name:
Kelly Edward Matzke
Company:
City of Maple Grove
Company Phone:Local Phone:
(763) 494 - 6365
(612) 968 - 3615
Email Address:
kmatzke@maplegrovemn.gov
Mailing Address:
12800 Arbor Lakes Parkway
Maple Grove MN 55369
Additional email address to notify:

CONTRACTOR

Contractor:
Name:
Kelly Edward Matzke
Company:
City of Maple Grove
Company Phone:Local Phone:
(763) 494 - 6365
(612) 968 - 3615
Email Address:
kmatzke@maplegrovemn.gov
Mailing Address:
12800 Arbor Lakes Parkway
Maple Grove MN 55369

OBSTRUCTION

Reason for obstruction: 
TEST
Right-of-Way being obstructed:
Street
If other is selected, please provide additional information: 




Attach detailed plan sheet:




Obstruction to start on or after:
01/01/2021



Obstruction to be completed on or before:
12/31/2021



Applicant Project No.:
TEST



Attach letter/door hanger used to notify property owners affected by construction:

    		

    

    

    
	
    

    

    
	
    LOCATION
    
	
    

    Location/Address:
10622 Lancaster Lane N.

    

    Mark the location of the obstruction:

    

    

    

    


    


    		

    

    

    
	
    

    

    
	
    TRAFFIC CONTROL
    
	
    

    Proposed work that impacts vehicle and/or pedestrian traffic will require a traffic control plan.  Will traffic control be necessary?
Yes

    

    

    
	
    

    

    
	
    TRAFFIC CONTROL PLAN
    
	
    

    Attach Traffic Control Plan:

      		

      

      

      
	
      

      

      
	
      Invoice #3753 (01/21/2021)
      
	
      

      


      
	
	Charge
	Cost
	Quantity
	Total
	

      

      
	Non-Taxable

      
	
	 added 01/21/2021 2:13 PM
      Obstruction Permit fee per occurance
      		
	$75.00
	 x 1
	$75.00
	

      
	Grand Total

      
	Total
	$75.00

      Due$75.00
      This Application has not been submitted, so you may not pay for this Invoice.
      Action: Print  
      


      
	
      

      

      

      


      

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