Permits - Permit# 25SP-00032 - 4333 Channel Road - 5/12/2025I-'" I City of Spring Park I Re -Roof (Residential -
PARK
4349 Warren Ave, Spring Park, MN 55384
Phone:(952) 471-9051 Fax: (952) 471-9160
For Inspections: (952) 442-7520
25SP-00032
Daie Issued:
05/12/2025
Property Owner: STEPHEN L VERTNIK
Expiration Date:
11/08/2025
Mailing Address: 5217 WINDSOR RD
Job Site Address:
4333 CHANNEL RD, SPRING PARK,
MN 55384
MOUND, MN 55364
Category:
Residential Miscellaneous
Phone:
Permit Type:
Re -Roof (Residential)
Email:
Valuation:
Description of Work:
Tear off and re -roof
Subdivision:
Required Setbacks:
Parcel ID:
19-117-23-12-0035
Filing:
Lot:
Actual Setbacks:
Block:
Total Sq Ft:
Contractors:
Fee Items
Amount
State Surcharge (Fixed)
$ i.00
Residential Building Maintenance Permit
$ 50.00
Total Fees:
$ 51.00
NOTICE
Signature of Applicant/Date
Building Department Signature/Date
05/12/2025
MUST BE POSTED ON JOB SITE
INSPECTION CARD
City of Spring Paris
SPRING PARK
on Lakf winnetonb 4349 Warren Ave, Spring Park, MN 55384
POST THIS CARD IN A SAFE CONSMCUOUS LOCATION. PLEASE DO NOT REMOVE THIS NOTICE UNTIL ALL REQUIRED MSPECTIONS ARE MADE AND SIGNED OFF BY THE APPROPRIATE
AUTHORITYAND THE BUILDING IS APPROVED FOR OCCUPANCY. STAMPED APPROVED PLANS MUST BE AVAILABLE ON THE JOesrm
PERMIT NO.: 25SP-00032 PERMIT TYPE: R
(Reesideside
ntial) ISSUED DATE: 05/12/2025 EXPIRATION DATE: 11/08/2025
19-117-23-
PROJECT ADDRESS: 4333 CHANNEL RD, SPRING PARK, MN 55384 PARCEL NO.: 12-0035
OWNER: STEPHEN L VERTNIK OWNER PHONE:
CONTRACTOR: CONTRACTOR PHONE:
APPLICANT: Deb Vertnik APPLICANT PHONE: (612) 220-8747
DESCRIPTION OF WORK: Tear off and re -roof
CONSTRUCTION TYPE: OCCUPANT LOAD:
DATE DATE
INSPECTION INSP PASSED COMMENTS INSPECTION INSP PASSED COMMENTS
Finavin-Progress
Fire Approval:
PW Approval:
To request an Inspedfon: (952) 442-7520
Date:
Date:
Engineering
Approval:
Other (
Date:
): Date:
Page 1 of 1
CITY OF SPRING PARK
PAGE 1
BUILDING PERMIT
4349 Warren Avenue
C � QSg' PbI V
Spring Park, MN 55384
❑ Handout Given
Phone: 952-41711-990512 Fax:
❑ Lead Handout Given
Routed to SAFEbuilt
�9,5�2-471-9160
SITE ADDRESS:�Jir Y`T i 1% /[�
L ,j� P1D:
1) Was the home constructed before 1978? (YESXcontinue with line 2, NO ❑ coli without completing EPA Section)
2) Will the work disturb z6 sq ft of interior painted`surfaces or ?20 sq ft o xterior painted surfaces? (YES C7 go to line 4, NOXine 3)
3) Are there any windows being replaced? (YES ❑, go to line 4, NQWpontinue without completing EPA Section)
4) Has this home been Certified Lead Free? (YES C1, you MUST
Attach Certification Information, NO ❑ complete line 5)
5) EPA Contractor Certification Number: NAT -
PROPERTY OWNER: T_A- ,`— to
Address:�5v
Ci State: MN Zi E.
Email: , �$ h ` j
Contact Name:
Phone: �p%Z� 12
CONTRACTOR:
Address:
City: State: M N zip.Phone:
�� Fax:
Contractor License No:
Contact Name: hone:
Email:
ARCHITECT:
Address:
'it : State: M N zip:
Pho-- / Fax:
=mail:
nt a Phone:
TYPE OF WORK: New Construction ❑ ck` , �� [}Re Roof
�
❑Commercial Wesidential ❑Change of Use
oal �Re-Side
EST.VALUATION OF WORK []Finish Base
- Retairii�Wall ❑Fence
6 i ❑Ren
❑Porch ❑Shed sgft
Square feet: `�, ❑Ad trio ) �`¢'�
*Demolition ❑Window/Door Replacement
I ❑ e M� ed/D
ch ❑Plumbing -provide detail on Page 2 # being replaced
0etalled Description of Work: ,. ❑Ac 'ory
❑Mechanical -provide detail or. Page 2 ❑Misc Other
signature of this applicationMIA al pro rty cP r or censed contractor, as the owners representative, is required and authorizes the Zoning Administrator or designee and the Building
Jffcial or designee to enter up per- fo perffi needed inspections. Entry maybe
without prior notice. I hereby acknowledge that I have read his application and state that ail info mat on
3 true and corned to the best of r I further agree that all wok performed will be in accordance with approved plans, specifications and canditions and to abide by all ordinances of the
inn a regarding actions taken pursuant to this
rAuniapeliry and the laws of the S+tDenattv_
permit. I agree to pay ell plan review fees even If I choose riot to proceed with the work. Permit
. )pires when work is not commencein 180 days from date of permit, or If rs suspended, abandoned, or not inspected for 180 days. Work beyond the scope of this permit, or work without
armit or ins action will be su c
_31GNATURE OF APPLICANT:
DATE: �`1 +-% 2 ,- 2S
-PRINTED NAME:
This Is the signature of: er or ❑Owner's Representative
OCCUR TYPE: CONST. TYPE: CODE:
BLDG SPRINKLED Yes / No
VALUATION: $
Permit Fee: $
Park Dedication: $
Plan Review Fee: $
SAC Charge: $
State Surcharge: $ 1.00
WAC Charge: $
Site Inspection Fee: $
Sewer Hook -Up: $
S.E.C. Fee: $
Water Hook -Up: $
Investigation Fee / Other Fee: $
Sewer Trunk: $
zCopy
Charge ($.25 per 8.5x11 page) $
Water Trunk: $
O
UJI
License Check ($5) / Lead Check ($5) $
SUIB-TOTA $
Water Meter $
N
City Fee: $
D
Plumbing Fee (from Page 2) $
Other: $
Mechanical Fee (from Page 2) $
TOTAL DUE: $
,
Special Conditions/Required Setbacks:
O
Building Approval By:
DATE:
Printed Building Approval
El License Verification ❑ Lead Verification - Checked By:
ABy:
City Approval By: ,+
DATE: 5 a
Paid. rJl . M Date: CJ 1a Receipt No.
�, By:
RECEIPT
City of Spring Park
4349 Warren Ave, Spring Park, MN 55384
(952) 471-9051 =
25SP-00032 I Re -Roof (PesidentiaD
Payment Amount: $51.00
Transaction Method Payer
Check Deb Vertnik
Comments
Assessed Fee Items
Fee items being paid by this payment
l
19 Pik" -Z " �4-
SPRING PARK
On Lang Yinnetonkq
Receipt Number: 440
Cashier Reference Number
Jamie Hoffman 3812
May 12, 2025
Assessed Fee Item Account Code Assessed Amount Paid Balance Due
On
05/12/25 State Surcharge (Fixed) $1.00 $1.00 $0.00
05/12/25 Residential Building Maintenance Permit $50.00 $50.00 $0.00
Totals.- $51.00 $51.00
Application Info
Property Address Property Owner
4333 Channel Road Deb Vertnik
Spring Park, MN 55384
Description of Work
Tear off and re -roof
Previous Payments
Remaining Balance Due
Property Owner Address
4333 Channel Road
Spring Park, MN 55384
Valuation
$0.00
$0.00