Permits - Permit# 23SP-00007 - 2486 Black Lake Road - 1/20/2023 City of Spring Park Re-Window/Exterior Door
(Residential
4349 Warren Ave, Spring Park, MN 55384
PRING PARK 23SP-00007
)n Lake�Vinneton°a (952)471-9051 (952)471-9160
For Inspections: (952) 442-7520
Date Issued: 01/20/2023 Property Owner: Josh Clemons
Expiration Date: 07/19/2023 Mailing Address: 2486 Black Lake Road
Job Site Address: 2486 Black Lake Road, Spring Park,
MN 55384 Spring Park, MN 55384
Category: Residential Miscellaneous Phone:
Permit Type: Re-Window/Exterior Door(Residential) Email:
Valuation:
Description of Work:
Replace 7 existing windows
Subdivision: Required Setbacks:
Parcel ID:
Filing:
Lot: Actual Setbacks:
Block:
Total Sq Ft:
Contractors: Fee Items Amount
State Surcharge(Fixed) $ 1.00
Lead Certification Look-up $ 5.00
Residential Building Maintenance Permit $50.00
Total Fees: $56.00
NOTICE
Signature of Applicant/Date Building Department Signature/Date
01/20/2023
MUST BE POSTED ON JOB SITE
INSPECTION CARD
*4::4 City of Spring Park
SPRING PARK
On Lakf 94inneton4a 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
AUiHORRY AND THE BUILDING IS APPROVED FOR OCCUPANCY.STAMPED APPROVED PLANS MUST BE AVAILABLE ON THE JOBSITE.
Re-Window/Exterior
PERMIT NO.: 23SP-00007 PERMIT TYPE: Door(Residential) ISSUED DATE: 01/20/2023 EXPIRATION DATE: 07/19/2023
PROJECT ADDRESS: 2486 Black Lake Road,Spring Park,MN 55384 PARCEL NO.:
OWNER: Josh Clemons CONTRACTOR: CONTRACTOR PHONE:
DESCRIPTION OF WORK: Replace 7 existing windows
CONSTRUCTION TYPE: OCCUPANT LOAD:
DATE DATE
INSPECTION INSP PASSED COMMENTS INSPECTION INSP PASSED COMMENTS
Final/In-Progress
Fire Approval: Date: Engineering Date:
Approval:
PW Approval: Date: Other( ): Date:
To request an inspection:(952)442-7520
Paae 1 of 1
CITY OF SPRING PARK PAGE 1 BUILDING PERMIT
4349 Warren Avenue o��"' 6U�a 7
Spring Park, MN 55384 Handout Given
Routed to MNSPECT
Phone: 952-471-9051 Fax: 952-471-9160 ❑ Lead Handout Given
SITE ADDRESS: 2486 Black Lake Rd Spring Park,MN 55384 PID:
1)Was the home constructed before 1978?(YES 9,continue with line 2,NO❑continue without completing EPA Section)
2)Will the work disturb 26 sq It of interior painted surfaces or 220 sq ft of exterior painted surfaces?(YES X go to line 4,NO❑line 3)
3)Are there any windows being replaced?(YES 9,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 X complete line 5)
5)EPA Contractor Certification Number: NAT- 21315-3 (applies to contractor only)
• PROPERTY OWNER: Josh Clemons Address: 2486 Black Lake Rd
• City:Spring Park State: MN Zip: 55384 Email: clemons.oshualero mail.com
rr Contact Name: Phone: 612-817-4647
CONTRACTOR: MN Rusco Address: 5010 Hwy 169 N
City: New Hoe State: MN Zip: 55428 Phone: 952-935-9669 Fax:
Contractor License No: CR002173 Contact Name: Kelli Gugisberg Phone: 952-935-9669
Email, kelli@minnesotarusco.com
ARCHITECT: Address:
City: State: Zip: Phone: Fax:
• Email: Contact Name. Phone:
TYPE OF WORK: New Construction ❑Deck ❑Pool ❑Re-Roof
❑Commercial XResidential ❑Change of Use ❑ Retaining Wall =Porch ❑Re-Side
EST.VALUATION OF WORK ❑Finish Basement ❑Demolition Li Fence
$ 14 850.00 ❑Remodel ❑Fire Sprinkler Li Shed
Square feet: ❑Addition ❑Fire AlarmIVindow/Door Replacement
Garage-Attached/Detach ❑Plumbing-provide detail on Page 2 #being replaced 7
rr Detailed Description of Work: Accessory Structure ❑Mechanical-provide detail on Page 2 ❑Misc Other
•
Replacing seven windows in existing openings.
signature of this application by the legal property owner or a licensed contractor,as the owners 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 will be In accordance with approved plans,specMcatlons and conditions and to abide by all ordinances of the Municipality
and the laws of the State of Minnesota regarding actions taken pursuant to this 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 within 180 days from date of permit,or Ifwork 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.
Noise Ordinance In Effect:�MiONDAAY-FRIDAY Before 7 a.m.and after 10 p.m.Weekends/Holidays before 7 a.m.and after 8 p.m.
SIGNATURE OF APPLICANT: /12 .G DATE: 1/10/23
PRINTED NAME: Kelli Gugisberg This is the signature of: ❑ Owner or Owner's Representative
OCCUR TYPE: CONST.TYPE: CODE: BLDG SPRINKLED Yes/No
VALUATION:$
Permit Fee: $ 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: $2.485
>_ Copy Charge($25 per 8.5 x11 page) $ _ Other. $
Z License Check($5)/ ad Ch ($5) $ TOTAL DUE: $ G G
O SUB-TOTAL $ C510
(n '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
LL Special Conditions/Required Setbacks:
LL
O
Building Approval By: DATE:
Printed Building Approval By: ❑ License Verification O Lead Verification-Checked By:
City Approval By: DATE:
Paid: J%.M Date: a Receipt No. l0 S gr7 By: r--
RECEIPT
City of Spring Park �^
4349 Warren Ave, Spring Park, MN 55384
(952)471-9051
SPRING PARK
23SP-00007 I Re-Window/Exterior Door(Residential) On Gaff Minnetonka
Receipt Number: 121
Payment Amount: $56.00 January 20,2023
Transaction Method Payer Cashier Reference Number
Check Minnesota Rusco Jamie Hoffman 116887
Comments
Assessed Fee Items
Fee items being paid by this payment
Date Fee Item Account Code Assessed Amount Paid Balance Due
01/10/23 State Surcharge(Fixed) $1.00 $1.00 $0.00
01/10/23 Lead Certification Look-up $5.00 $5.00 $0.00
01/10/23 Residential Building Maintenance Permit $50.00 $50.00 $0.00
Tots/s• $56.00 $56.00
Previous Payments $0.00
Remaining Balance Due $0.00
Permit Info
Property Address Property Owner Property Owner Address Valuation
2486 Black Lake Road Josh Clemons 2486 Black Lake Road
Spring Park, MN 55384 Spring Park, MN 55384
Description of Work
Replace 7 existing windows