Permits - Permit# 22SP-00015 - 3852 Northern Avenue - 7/11/2022 City of Spring Park
Re-Roof (Residential)
4349 Warren Ave, Spring Park, MN 55384
PRING PARK 22SP-00015
La e�finneton a (952)471-9051 Fax(952)471-9160
For Inspections: (952)442-7520
Date Issued: 07/11/2022 Property Owner: Keith Emery
Expiration Date: 01/07/2023 Mailing Address: 3852 Northern Avenue
Job Site Address: 3852 Northern Avenue, Spring Park, Spring Park, MN 55384
MN 55384 Phone: (612)425-9107
Category: Residential Miscellaneous Email:
Permit Type: Re-Roof(Residential)
Valuation:
Description of Work:
Re-roof with asphalt
Subdivision: Required Setbacks:
Parcel ID:
Filing:
Lot: Actual Setbacks:
Block:
Total Sq Ft:
Contractors: Fee Items Amount
State Surcharge (Fixed) $ 1.00
Contractor License Look-up $ 5.00
Residential Building Maintenance Permit $ 50.00
Total Fees: $ 56.00
NOTICE
Signature of Applicant/Date Building Department Signature/Date
07/11/2022
INSPECTION CARD
City of Spring Park
SPRING PARK
On Lake 91,finnetonKq 4349 Warren Ave, Spring Park, MN 55384
POST THIS CARD IN A SAFE CONSPICUOUS LOCATION.PLEASE DO NOT REMOVE THIS NOTICE UNTIL ALL REQUIRED INSPECTIONS ARE MADE AND SIGNED OFF BY THE APPROPRIATE
AUTHORITY AND THE BUILDING IS APPROVED FOR OCCUPANCY.STAMPED APPROVED PLANS MUST BE AVAILABLE ON THE JOBSITE.
Re-Roof
PERMIT NO.: 22SP-00015 PERMIT TYPE: (Residential) ISSUED DATE: 07/11/2022 EXPIRATION DATE: 01/07/2023
PROJECT ADDRESS: 3852 Northern Avenue,Spring Park,MN 55384 PARCEL NO.:
OWNER: Keith Emery CONTRACTOR: CONTRACTOR PHONE:
DESCRIPTION OF WORK: Re-roof with asphalt
CONSTRUCTION TYPE: OCCUPANT LOAD:
DATE DATE
INSPECTION INSP PASSED COMMENTS INSPECTION INSP PASSED COMMENTS
Final/In-Progress
Fire Approval: Date: Fire Approval: Date:
PW Approval: Date: Other( ): Date:
To request an inspection:(952)442-7520
Page 1 of 1
CITY OF SPRING PARK PAGE 1 BUILDING PERMIT
4349 Warren Avenue '06fl — 000/
Spring Park, MN 55384 ❑ Handout Given
Routed to MNSPECT
Phone: 952-471-9051 Fax: 952-471-9160 ❑ Lead Handout Given
SITE ADDRESS: « r,, 9 9 f- PID:
1)Was the home constructed before 1978?(YES❑,continue with line 2,NO❑continue without Completing EPA Section)
2)Will the work disturb>_ti sq ft of interior painted surfaces or>_20 sq ft of exterior painted surfaces?(YES❑go to line 4,NO❑line 3)
_ 3)Are there any windows being replaced?(YES❑,go to line 4,NO❑continue without completing EPA Section)
4)Has this home been Certified Lead Free?(YES❑,you MUST Attach Certification Information,NO❑complete line 5)
5)EPA Contractor Certification Number. NAT- (applies to contractor only)
• PROPERTY OWNER: .F.,�a.1'=6 Address: P - ��: ��� lf ..
' City: (a•�17J/_State: /B✓1AV Zi �, � -� A, Email:
Contact Name: Phone: tom/ L?
• CONTRACTOR: b e `r a ? r��s '° �' �. Address: m qs_ Iv tz'4n_f` ;4442 w�
City: Fr:�`a _i'=r� ° <°at = fate: "L?AfZip: 11 ?,7 Phone: !! Z Fax:",
Contractor License No: tl C: 1 Contact Name: L PM ites
Email: b`'i0--0 o,-44" 2 12 07- 40 -// owf'-V 6-L',
ARCHITECT: Address: :r
City: State: Zip: Phone: Fix:
Email: Contact Name Phone:
TYPE OF WORK: ❑New Construction ❑Deck ❑Pool ig.Re-Roof
❑Commercial rkResidential ❑Change of Use ❑Retailill Wall%' Porch ❑Re-Side
EST.VALUATION OF WORK ❑Finish Basement r of o Fence
$ w f'y�t ' ❑Remodel ❑Fir' pnn4�r; t ❑Shed
Square feet ❑Addition ❑ 1slAlarm '} ❑Window/Door Replacement
❑Garage-Attach ITT. lumbing-Provide detail on Page 2 #being replaced
Detailed Description of Work: ❑Accesso oture ❑Mechanical-provide detail on Page 2 ❑Misc Other
"Ov✓',R;'t ,.fir' F�{ pr. y E``r'� a',`i. .44C...
Signature of this application by the legal property owner or a licensed contractor,as the.owner's representative,Is required and authorizes the Zoning Administrator or designee and the Building Official
or designee to enter upon the property to perform needed Inspections.Entry may be without prior notice.I hereby acknowledge that I have read this application and state that all information is true and
correct to the best of my knowledge.I further agree that all work performed wil be In accordance with approved plans,specifications and conditions and to abide by al ordinances of the Municipality
and the laws of the state of Minnesota regaMng.pctigre taken pursuant to tMs permit-I agree to pay all plan review fees even If i choose not to proceed with the work.Permit expires when work
u Is not commenced wither 180 days from d* pip iRlir,oh*wark Is suspended,abandoned,or not Inspected for 180 days.Work beyond the scope of this permit,or work without a permit or Inspection,
• will be subject to a penalty. 3 `
Noise OrdinanCe<th Effec1MONDAY-FRIDAY Before 7 a.m.and after 10 p.m.Weekends/Holidays before 7 a.m.and after 8 p.m.
DATE
SIGNATURE OF APPICAIT: ; ---
PRINTEDiME This is the signature of: ❑Owner or ❑Owner's Representative
OCCUP.TYPE: CONST.TYPE: CODE: BLDG SPRINKLED Yes/No
VALUATION.
Permit Fee: $ ��•D� WAC Charge: $
Plan Review Fee: $ Sewer&Water Hook-Up: $
State Surcharge: $ Sewer&Water Disconnect: $
Site Inspection Fee_ $ Water Meter. $
S.E.C.Fee: $ Muni SE/WA Fee: $
Investigation Fee/Other Fee: $ *2016 SAC Escrow. $2485
r Copy Charge($.25 per 8.5 x11 page)$ Other. $
OLioonso Chock($5)/Lead Chock($5) $_ TOTAL DUE: $
W SUB-TOTAL $ CJ rD V *NOTE:Commercial plans will be submitted to the Met Council Environmental Svcs
Plumbing Fee(from Page 2) $ for SAC determination. Escrow payment will be required when permit is Issued. If
w Mechanical Fee from Page 2 $ after Met Council review no SAC is determined,escrow will be refunded in full.
U
a Special Conditions/Required Setbacks:
IL
O
Building Approval By: DATE:
Printed Building Approval By: ❑ License Verification❑ Lead Verification-Checked By:
City Approval By: DATE:
Paid: Date: Receipt No. By:
Payment Confirmation
Payer Information:
Payment Made By: Luke Conzet
Payment Made For: Luke Conzet
Email: Productiondept@fiemn.com
Permit Address: 3852 northern avenue
Address: 2525 Nevada Ave Ste 212
Golden valley, MN 55446
Payment Description: Permits
Payment Date: 7/11/2022 10:43:42 AM
Business Name Payment Payment Confirmation Amount Convenience Total
Method Account Number Fee
City of Spring Park VISA ****7462 12603378 $56.00 $2.40 $58.40
(Permits)
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RECEIPT
City of Spring Park
4349 Warren Ave, Spring Park, MN 55384
(952)471-9051
SPRING PARK
22SP-00015 I Re-Roof(Residential) On Gale Xinnetottla
Receipt Number:27
Payment Amount: $56.00 July 11,2022
Transaction Method Payer Cashier Reference Number
Credit Card Contractor Jamie Hoffman 12603378
Comments
Assessed Fee Items
Fee items being paid by this payment
Date Fee Item Account Code Assessed Amount Paid Balance Due
07/11/22 State Surcharge(Fixed) $1.00 $1.00 $0.00
07/11/22 Contractor License Look-up $5.00 $5.00 $0.00
07/11/22 Residential Building Maintenance Permit $50.00 $50.00 $0.00
Totals. $56.00 $56.00
Previous Payments $0.00
Remaining Balance Due $0.00
Permit Info
Property Address Property Owner Property Owner Address Valuation
3852 Northern Avenue Keith Emery 3852 Northern Avenue
Spring Park, MN 55384 Spring Park, MN 55384
Description of Work
Re-roof with asphalt