Permits - 4177 Shoreline Drive - 4/24/2001 CITY OF SPRING PARK
P. O. BOX 452
4349 WARREN AVENUE
SPRING PARK, MN 55384
952-471-9051 FAX 952-471-9160
BUILDING PERMIT APPLICATION
Building Permit Application Requirements: Date Received
1. Application to be filled out&signed Date Approved
2. Mechanical Permit Application &Calculation filled out Permit No.
3. Energy Calculations filled out
4. Furnish a Certificate of Survey -See Attached
5. Furnish 3 sets of Construction Plans Fees To Be Charged: _
a) 1 set for City files Permit 91•Z5
b) 1 set for builder to use on site State Surcharge Z.0 O
c) 1 set for City Building Inspector Plan Review N/►4
Construction Plans should include: SAC Charge
1. First floor plan Availability Chrg
2. Footing Moundation plan
3. Elevations of all sides TOTAL �I`1 • LS
4. Wall sections &cross sections
5. Details -stairs &any special connections
ALL INFORMATION MUST BE SUBMITTED IN FULL BEFORE PLAN REVIEW WILL BE STARTED
THE APPLICANT IS (CIRCLE ONE) OWNER OR CONTRACTOR
JOB SITE ADDRESS 4 17 7 S mono-wc Dki uc
NAME OF OWNER MI-VIV&TM)(<A I�L-���I e ��TS W�.CiM PHONE �yL� WORK PHONE`ri�Z"4�� lC •
MAILING ADDRESS -T 7 7 ! RCXCUA.t Pr, CITY S7P' �iAJ�- Pfl<< ZIP _1,-S 3&4
CONTRACTOR 13%'J QLf-'r t, Lu<16NT' PHONE 763`4 n,16'7 7 MOBILE PHONE
MAILING ADDRESS 18 2 6( NNbv SFKc=r J_ CITY /"PC PL- 11 c 0/t) ZIP �'9,53-57-7
STATE LICENSE NO.
ARCHITECT/ENGINEER PHONE
MAILING ADDRESS CITY ZIP
NAME REGISTRATION NO.
TYPE OF WORK: NEW ADDITION ACCESSORY STRUCTURE MOVE DEMO
REMODELIALTERATION RENOVATE LAND ALTERATION
PROPOSED WORK(Describe in Detail) et PL^4CF
wilt( MjC<(3L 4,IJ q5 St IFIEr� t; JJ SU���I�tZ
ZONING DISTRICT
STORIES Sa FEET OR EACH FLOOR NO.OF BEDROOMS GARAGE STALLS
ATTACHED OR DETACHED BLDG.SIZE: LENGTH WIDTH HEIGHT
ESTIMATED CONSTRUCTION VALUATION (excluding land) $
BUILDING PERMIT APPLICATION
PAGE 2
HARDCOVER CALCULATION WORKSHEET
A. House X = S.F.
Length Width
X = S.F.
B. Garage X = S.F.
C. Driveway X = S.F.
X = S.F.
D. Sidewalk X = S.F.
/ X = S.F.
E. Patio/Deck ! X = S.F.
F. Other X = S.F.
1. TOTAL HARDCOVER S.F.
2. TOTAL PROPERTY AREA S.F.
/ 1 DIVIDED BY 2 X 100 = %
I hereby apply for a building permit and 1 acknowledge that the information above is complete and accurate;that the work will be in conformance
with the ordinances and codes of the City and with 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 ap roved plan. /
X APPLICANT'S SIGNATUREC✓ DATE i Z3 �Za Cl
INSPECTION REQUIRED: WORK REQUIRING SEPARATE PERMITS:
Footing before a pour Plumbing
Framing rough-in Mechanical
Insulation Well
Wallboard before taping Grading &filling
FINAL before occupancy Sewer
Water
WORK BEYOND OR WITHOUT A REQUIRED
INSPECTION WILL BE SUBJECT TO PENALTY Electrical from State
24 HOUR NOTICE REQUIRED CALL 249-4600
ZONING CERTIFICATE
I do hereby certify to the Orono Building Official that the following described work has been reviewed for
compliance with the Zoning Requirements of the City of Spring Park and will be approved for construction upon
approval of the construction plans by the Building Official.
Name Date
BUILDING C D EVIEW
Name Date
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