Correspondence - 2478 Black Lake Road - 6/5/2025 (9)CITY OF SPRING PARK
PAGE 1
BUILDING PERMIT
4349 Warren Avenue
Spring Park, MN 55384
11 Handout Given
Phone: 952-471-9051 Fax: 952-471-9160
❑ Lead Handout Given
Routed to MNSPECT
:SITE ADDRESS: � q� B , G� 1 �j�2 � CL PID:_ H- // % of 3 - Q - o aO /
1) Was the home ceir tRt,tcci bt-fore., 1978? yyES u, continue with line 2, NO ❑ continue without completing EPA Section)
2) Will the work disturb -1 sq ft cf interior p tinted surfaces or >_20 sq
ft of exterior painted surfaces? (YES ❑ go to line 4, NO ❑ line 3)
:1) are there any windows being replaced? (YES ❑, go to line 4, NO ❑ continue without completing EPA Section)
41) H35 this home been Certified Lead Free? (YES ❑, you MUST Attach Certification Information, NO o complete line 5)
5) EPA Contractor Certification Number NAT -
(appttes to contractor only)
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PROPERTY OWNER: e rnC18 4, Lau'rr r I I Q yr, '
Address:6Z90 Ai4a r'
-
City: -den f e r r . a� State: %P1 /1rZi p' �S� "iCo
Email: P-M %J c.vn 5) i
•
Contact Name.
Phone
CONTRACTOR: .s-}• t,, }� y i��;,,Q
Address: 4 IS ,� , RJ 110
'
CitYM I , StateM/li Zip: ig-S [a Ll
Phone: 7 G°S - -` e-91 Fax:
Contractor License No: c�lo-3 7%O
Contact Name: Phone:. - .
Email:
ARCHITECT: +1Ik 1z+0swl
Address:
City: State: Zip:
Phone: Fax:
•
Email:
Contact Name ''` Phone:
TYPE OF WORK: X New Construction
❑ Deck ❑ Re -Roof
❑ Commercial kResidential ❑ Change of Use
❑ Pool ❑ Re -Side
EST. VALUATION OF WORK ❑ Finish Basement
r- Retaining Wall ❑ Fence
$ E, Remodel
❑ Porch Shed
Squam f0et ❑Addition
❑ Demolition _ Window/Door Replacement
3 loo ❑ Garage-Attached/Detach
Io
❑'Plumbing -provide detail on Page 2 tl being replaced
Detailed Description of Work: Accesso Structure
❑ Mechanical -provide owa,i on� ?agc ? = Misc Other
Y
Signature of this application by the legal property owner or a kensed.cgybbctor, as the owflees representative. Is requiad and authorizes the Zoning Administrator or designee and the Building official
or designee to enter upon the property to perform needed IneWlions. Entry may be At�0A prior notice. I hereby acknowledge that I have read this applkaGon and state that all information Is true and
correct to the best of my knowledge. I further agree that al work performed. wr.' be m'Midance with approved plans, specifications and conditions and to abide by all ordinances of the Municipality
and the laws of the State of Minnesota regarding actions talwn prtieuand to %a p•mfi.1 agree to pay all plan review fees even If 1 choose not to proceed with the work. Permit expires when work
�r
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Is not commenced w:tht,180 days from dr86 of peaoil o IF work Is "ended. abandoned, or not
all be subject to a penalty. .:' , _
inspected for 180 days. Work beyond the scope of this permit, or work without a permit or inspection,
Noise Ordinance In, Effect, MONDAY - FRIDAY Before 7 a.m. and after 10 p.m. Weekends/Holidays before 7 a.m. and after 8 p.m.
:SIGNATURE OF APPLICANT:
DATE:
PRINTED NAME: 0.111 r htn _ :,
This is the signature of: ❑ Owner or-V Owner's Representative
OCCUP. TYPE: CONST. TYPE: CODE:
BLDG SPRINKLED Yes / No
VALUATION: S ,
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: $
SAC Escrow: $2 485
Copy Charge ($.25 per 8.5 x11 page) $
Other. $
z0
License Check ($5) / Lead Check ($5) $
TOTAL DUE: $
w
SUB -TOTAL $
rA
Plumbing Fee (from Page 2) $
'NOTE: Commercial plans will be submitted to the Met Council Environmental Svcs
W
0
Mechanical Fee from Page 2 $
for SAC determination. Escrow payment will be required when permit is issued. If
after Met Council review no SAC is determined, escrow will be refunded In full.
LL
U.
Special Conditions/Required Setbacks:
Building Approval By:
DATE:
Punted Building Approval By:
❑ License Verification ❑ Lead Verification - Checked By:
City Approval By.
DATE:
Paid: Date: Receipt No.
By.